Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults:a competing risk analysis

Background Depressive symptoms and cognitive impairment often interact,rendering their associations controversial.To date,their joint trajectories and associations with dementia and death remain underexplored.Aims To explore the interactions between depressive symptoms and cognitive function,their developmental trajectories and the associations with all-cause dementia,Alzheimer’s disease(AD)and all-cause death in older adults.Methods Data were from the Health and Retirement Study.Depressive symptoms and cognitive function were measured using the 8-item Centre for Epidemiologic Studies Depression Scale and the Telephone Interview of Cognitive Status,respectively.All-cause dementia and AD were defined by self-reported or proxy-reported physician diagnoses.All-cause death was determined by interviews.The restricted cubic spline,group-based trajectory modelling and subdistribution hazard regression were used.Results Significant interactions between depressive symptoms and cognitive function in 2010 in their association with new-onset all-cause dementia and AD from 2010 to 2020 were found,especially in women(p for interaction<0.05).Independent trajectory analysis showed that emerging or high(vs no)depressive trajectories and poor or rapidly decreased cognitive trajectories(vs very good)from 1996 to 2010 were at significantly higher risk of subsequent all-cause dementia,AD and all-cause death.15 joint trajectories of depressive symptoms and cognitive function from 1996 to 2010 were determined,where rapidly decreased cognitive function was more common in those with no depressive symptoms.Compared with older adults with the trajectory of no depressive symptoms and very good cognitive function,those with the trajectory of no depressive symptoms but rapidly decreased cognitive function were much more likely to develop new-onset all-cause dementia and death,with subdistribution hazard ratios(95%confidence intervals)of 4.47(2.99 to 6.67)and 1.84(1.43 to 2.36),especially in women.Conclusions To effectively mitigate the risk of dementia and death,it is crucial to acknowledge the importance of preventing cognitive decline in older adults without depressive symptoms,particularly in women.

Adverse childhood experiences from family and society contribute to increased risk of depressive symptoms and cognitive impairment:a cross-sectional study

Background Family environments can shape children’s personalities and social networks,rendering distinguishing adverse childhood experiences(ACEs)from family and society essential,but related evidence remains limited.Aims This cross-sectional study aimed to investigate the correlations between intrafamilial and social ACEs,their associations with depressive symptoms and cognitive impairment and the(education-moderated)mediating role of social ACEs.Methods Data for this cross-sectional study were from the China Health and Retirement Longitudinal Study.Nine intrafamilial(0,1,2,3,and 4 or more)and three social(0,1,and 2 or more)ACEs were identified.Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale.Global cognition,including episodic memory and mental intactness,was calculated as z scores.Binary and ordered logistic regressions,generalised linear models with Gaussian family and identity link,and mediation analysis were used.Results 13435 participants aged 59.0(51.0–66.0)were included.Compared with participants with no intrafamilial ACEs,those with 1,2,3,and 4 or more intrafamilial ACEs tended to develop more social ACEs,with odds ratios(ORs)of 1.55(95%confidence interval(CI):1.36 to 1.76),2.36(95%CI:2.08 to 2.68),3.46(95%CI:3.02 to 3.96)and 6.10(95%CI:5.30 to 7.02),respectively.Both intrafamilial and social ACEs were associated with depressive symptoms(OR>3 for four or more intrafamilial ACEs and two or more social ACEs)and global cognition(β=−0.26 for four or more intrafamilial ACEs andβ=−0.29 for two or more social ACEs).Social ACEs mediated the associations of intrafamilial ACEs with depressive symptoms and global cognition by 12.3%and 13.1%,respectively.Furthermore,as education levels increased,the impact of intrafamilial ACEs on depressive symptoms was increasingly mediated through social ACEs,while the mediating role of social ACEs between intrafamilial ACEs and cognitive impairment gradually diminished.Conclusions Improving children’s social environments and elevating general education can prevent later-life depressive symptoms and cognitive impairment attributed to ACEs in China.

Effect modifications of BMI transition and trajectory in the associations of adverse childhood experiences with new-onset dementia and its subtypes in older US adults

Background Adverse childhood experiences(ACEs)and dementia are associated and comorbid with obesity.However,according to emerging research,the role of obesity in the association between ACEs and dementia seems controversial.Aims This analysis aimed to explore the associations between ACEs and different dementia subtypes and the effect modification of long-term body mass index(BMI).Methods Data were obtained from the US Health and Retirement Study.Six ACEs were categorised as 0,1 and 2 or more.All-cause dementia,Alzheimer’s disease(AD)and other dementias were defined by self-reported or proxy-reported physician diagnosis.Cox proportional hazards regression was used to explore the associations of ACEs with new-onset all-cause dementia,AD and other dementias from 2010 to 2020.Effect modification of BMI in 2010 and BMI transition and trajectory(fitted by group-based trajectory modelling)from 2004 to 2010 were assessed.Results 15282 participants with a mean age of 67.0 years(58.0–75.0)were included in the 2010 data analysis.Significant interactions of ACEs with baseline BMI,BMI transition and BMI trajectory in their associations with new-onset all-cause dementia and AD were observed(all p<0.05).For instance,positive associations of two or more ACEs(vs none)with all-cause dementia and AD were found in those with a BMI trajectory of maintaining≥30 kg/m2(maintain obesity)rather than a decline to or maintaining<25 kg/m2(decline to or maintain normal weight),with hazard ratios(HRs)of 1.87(95%confidence interval(CI):1.45 to 2.42)and 1.85(95%CI:1.22 to 2.80),respectively.Conclusions ACEs were associated with dementia and AD in US adults with long-term abnormally elevated BMI but not with long-term normal or decreasing BMI.Integrated weight management throughout life could prevent dementia among those with childhood adversity.

Healthy Lifestyles and Chronic Pain with New-Onset Metabolic-Related Multimorbidity among Older Adults—China,2011–2018

Summary What is already known about this topic?Chronic pain has been identified as a risk factor for cardiovascular diseases.Evidence shows that adopting a healthy lifestyle can help reduce the cardiometabolic risks associated with chronic pain.What is added by this report?Results from this cohort study suggest a positive association between chronic pain and the development of new-onset metabolic-related multimorbidity,specifically metabolic multimorbidity and cardiometabolic comorbidity,within middle-aged and older Chinese adults.Furthermore,adopting healthy lifestyles can potentially mitigate or even reverse these associations.What are the implications for public health practice?The results of our study emphasize the importance of promoting healthy lifestyles among older Chinese adults as a preventative measure against the medical burdens and cardiometabolic risks associated with chronic pain.

Periconceptional Folic Acid Only Versus Multiple Micronutrients Containing Folic Acid and Association with Gestational Diabetes Mellitus-Beijing Municipality,China,2017-2021

Summary What is already known about this topic?Inconsistent results have been reported on the association between periconceptional folic acid only(FAO)or multiple micronutrients containing folic acid(MMFA)supplementation and the risk of gestational diabetes mellitus(GDM)in previous research.What is added by this report?In a prospective cohort study conducted among pregnant women in Haidian District,Beijing Municipality,it was observed that those who took MMFA demonstrated a higher likelihood of developing GDM in comparison to those who consumed FAO periconceptionally.Interestingly,the increased risk for GDM in pregnant women supplemented with MMFA compared to FAO was primarily due to changes in fasting plasma glucose.What are the implications for public health practice?It is highly recommended that women prioritize the use of FAO in order to yield potential benefits in the prevention of GDM.