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INTRODUCTION: The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS: We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort‐specific Cox proportional hazard regression analyses in a two‐step individual participant data meta‐analysis. RESULTS: A one‐standard‐deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow‐up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION: Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. Highlights: A two‐step individual participant data meta‐analysis was conducted.This was done at a global scale using data from 21 ethno‐regionally diverse cohorts.The association between a modifiable dementia risk score and dementia was examined.The association was modified by geographical region and age at baseline.Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Hearing loss (HL) has been associated with cognitive decline and dementia. We examined the temporal association between prevalent and incident HL and cognitive change. METHODS: A total of 1823 participants (24‐82 years) from the Maastricht Aging Study (MAAS) were assessed at baseline, 6 and 12 years, including pure‐tone audiometry. Linear‐mixed models were used to test the association between HL and cognition, adjusted for demographics and other dementia risk factors. RESULTS: Participants with prevalent and incident HL showed a faster decline in verbal memory, information processing speed, and executive function than participants without HL. Decline was steady from baseline to 6 and 12 years for prevalent HL, but time‐delayed from 6 to 12 years for incident HL. Having a hearing aid did not change associations. DISCUSSION: Findings support the notion that HL is a risk factor for cognitive decline independent of other dementia risk factors. Onset of HL preceded onset of cognitive decline. Highlights: We examined cognitive change in prevalent and incident hearing loss.Prevalent and incident hearing loss were associated with faster cognitive decline.For prevalent hearing loss, decline was steady from baseline to 6 and 12 years.Onset of hearing loss preceded the onset of cognitive decline.Having a hearing aid did not change the observed associations. [ABSTRACT FROM AUTHOR]

A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the "LIfestyle for BRAin health" (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta‐analyses with a two‐round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts. Highlights: An umbrella review was combined with opinions of 18 dementia experts.Various candidate targets for dementia risk reduction were identified.Experts prioritized hearing impairment, social contact, and sleep.Re‐assessment of dementia risk scores is encouraged.Future work should evaluate the predictive validity of updated risk scores. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The retina may provide non‐invasive, scalable biomarkers for monitoring cerebral neurodegeneration. METHODS: We used cross‐sectional data from The Maastricht study (n = 3436; mean age 59.3 years; 48% men; and 21% with type 2 diabetes [the latter oversampled by design]). We evaluated associations of retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer thicknesses with cognitive performance and magnetic resonance imaging indices (global grey and white matter volume, hippocampal volume, whole brain node degree, global efficiency, clustering coefficient, and local efficiency). RESULTS: After adjustment, lower thicknesses of most inner retinal layers were significantly associated with worse cognitive performance, lower grey and white matter volume, lower hippocampal volume, and worse brain white matter network structure assessed from lower whole brain node degree, lower global efficiency, higher clustering coefficient, and higher local efficiency. DISCUSSION: The retina may provide biomarkers that are informative of cerebral neurodegenerative changes in the pathobiology of dementia. [ABSTRACT FROM AUTHOR]

Aims: There are sex differences in the excess risk of diabetes‐associated cardiovascular disease. However, it is not clear whether these sex differences exist with regard to other complications like mental health aspects. Therefore, we investigated sex differences in the association of prediabetes and type 2 diabetes (T2D) with cognitive function, depression, and quality of life (QoL). Materials and Methods: In a population‐based cross‐sectional cohort study (n = 7639; age 40–75 years, 50% women, 25% T2D), we estimated sex‐specific associations, and differences therein, of prediabetes and T2D (reference: normal glucose metabolism) with measures of cognitive function, depression, and physical and mental QoL. Sex differences were analysed using multiple regression models with interaction terms. Results: In general, T2D, but not prediabetes, was associated with higher odds of cognitive impairment, major depressive disorder, and poorer QoL. The odds ratio (OR) of cognitive impairment associated with T2D was 1.29 (95% CI: 0.96–1.72) for women and 1.39 (1.10–1.75) for men. The OR of major depressive disorder associated with T2D was 1.19 (0.69–2.04) for women and 1.68 (1.02–2.75) for men. The mean difference of the physical QoL score (ranging from 0 to 100, with 100 indicating the best possible QoL) associated with T2D was −2.09 (−2.92 to −1.25) for women and −1.81 (−2.48 to −1.13) for men. The mean difference of the mental QoL score associated with T2D was −0.90 (−1.79 to −0.02) for women and −0.52 (−1.23 to 0.20) for men. There was no clear pattern of sex differences in the associations of either prediabetes or T2D with measures of cognitive function, depression, or QoL. Conclusions: In general, T2D was associated with worse cognitive function, depression, and poorer QoL. The strength of these associations was similar among women and men. [ABSTRACT FROM AUTHOR]

Introduction: There is an urgent need for biomarkers identifying individuals at risk of early‐stage cognitive impairment. Using cross‐sectional data from The Maastricht Study, this study included 197 individuals with mild cognitive impairment (MCI) and 200 cognitively unimpaired individuals aged 40 to 75, matched by age, sex, and educational level. Methods: We assessed the association of plasma sphingolipid and ceramide transfer protein (CERT) levels with MCI and adjusted for potentially confounding risk factors. Furthermore, the relationship of plasma sphingolipids and CERTs with magnetic resonance imaging brain volumes was assessed and age‐ and sex‐stratified analyses were performed. Results: Associations of plasma ceramide species C18:0 and C24:1 and combined plasma ceramide chain lengths (ceramide risk score) with MCI were moderated by sex, but not by age, and higher levels were associated with MCI in men. No associations were found among women. In addition, higher levels of ceramide C20:0, C22:0, and C24:1, but not the ceramide risk score, were associated with larger volume of the hippocampus after controlling for covariates, independent of MCI. Although higher plasma ceramide C18:0 was related to higher plasma CERT levels, no association of CERT levels was found with MCI or brain volumes. Discussion: Our results warrant further analysis of plasma ceramides as potential markers for MCI in middle‐aged men. In contrast to previous studies, no associations of plasma sphingolipids with MCI or brain volumes were found in women, independent of age. These results highlight the importance of accounting for sex‐ and age‐related factors when examining sphingolipid and CERT metabolism related to cognitive function. [ABSTRACT FROM AUTHOR]

Introduction: Differences in brain network connectivity may reflect the capability of the neurological substrate to compensate for brain damage and preserve cognitive function (cognitive reserve). We examined the associations between white matter connectivity, brain damage markers, and cognition in a population sample of middle‐aged individuals. Methods: A total of 4759 participants from The Maastricht Study (mean age = 59.2, SD = 8.7, 50.2% male) underwent cognitive testing and diffusion magnetic resonance imaging (dMRI), from which brain volume, structural connectivity, and vascular damage were quantified. Multivariable linear regression was used to investigate whether connectivity modified the association between brain damage and cognition, adjusted for demographic and cardiometabolic risk factors. Results: More atrophic and vascular brain damage was associated with worse cognition scores. Increasing connectivity moderated the negative association between damage and cognition (χ2 = 8.64, df = 3, p ≤ 0.001); individuals with high damage but strong connectivity showed normal cognition. Discussion: Findings support the reserve hypothesis by showing that brain connectivity is associated with cognitive resilience. [ABSTRACT FROM AUTHOR]

Background: Evidence of modifiable risk factors for cognitive decline and dementia is accumulating, showing the potential of dementia risk reduction via lifestyle modification and cardiovascular risk management. People with low socioeconomic status (SES) have increased dementia risk and on average worse health. This study investigated whether the association between a modifiable dementia risk score and rate of cognitive decline differs across SES strata. Method: Data were used from Maastricht Aging Study (MAAS), a prospective cohort study with a 12‐year follow‐up. Participants aged ≥40 years with complete dementia risk profiles were included (n = 1223). The validated 'LIfestyle for BRAin health' (LIBRA) index was used to assess the modifiable dementia risk fraction. Cognitive performance was serially assessed at baseline, 6 and 12 years and measured in the domains of information processing speed, executive functioning and verbal memory function. A SES compound score was calculated from equivalent income and educational level and divided into tertiles (low, middle, high). Linear mixed models were used to study the association between LIBRA, SES and their interaction on the rate of cognitive decline. Result: Participants in the lowest SES tertile displayed more decline in information processing speed (vs. middle SES: X2 = 7.08, p = 0.029; vs. high SES: X2 = 9.49, p = 0.009) and verbal memory (vs. middle SES: X2 = 9.28, p<0.001; vs. high SES: X2 = 16.68, p<0.001) compared to their middle‐ and high‐SES counterparts. Higher (unhealthier) LIBRA scores were also associated with more decline in information processing speed (X2 = 12.66, p = 0.002) and verbal memory (X2 = 4.63, p = 0.032). No consistent effect modification by SES on the association between LIBRA and cognition was found. Conclusion: This study shows that lower SES and higher modifiable dementia risk predict faster decline in information processing speed and verbal memory function over 12 years. Results suggest that lifestyle is an important determinant of cognitive decline across SES groups. Yet, people with low SES had a more unfavourable modifiable risk score suggesting more potential for lifestyle‐based interventions. LIBRA could be useful as a participant selection tool or as a surrogate outcome measure in lifestyle intervention trials, and can inform people about individual risk behaviours as part of public health initiatives. [ABSTRACT FROM AUTHOR]

Background: Life‐course exposure to risk and protective factors impacts brain macro‐ and micro‐structure, which in turn affects cognition. Brain Age Gap (BAG) directly measures brain reserve by comparing an individual's neuroimaging‐based predicted age with their calendar age. Higher BAG implies accelerated brain aging and lower brain reserve. In this study, we comprehensively modeled mutual associations between brain risk and protective factors, reserve, and cognition in a large, middle‐aged population using structural equation modelling (SEM). Method: Cognitive test scores, lifestyle, and 3T MRI data for n = 4881 participants (mean age(±SD) = 59.2(±8.6), 50.1% male) were available from The Maastricht Study, a population‐based cohort study with extensive phenotyping. Whole brain volumes (gray matter (GM), cerebrospinal fluid (CSF), white matter hyperintensity (WMH)), cerebral microbleeds (CMB), and structural white matter connectivity were calculated. Lifestyle factors were combined into the Lifestyle for BRAin health (LIBRA) weighted sum score, with higher score indicating greater dementia risk (Figure 1). Cognition was calculated by averaging z‐scores across three cognitive domains (executive function and attention, memory, information processing speed). BAG was calculated by comparing calendar age to predictions from a neuroimaging‐based multivariable regression model. Paths between LIBRA, BAG and cognitive function were tested using linear regression and SEM, adjusting for confounders. LIBRA was split into tertiles for SEM analysis. Result: CSF, GM, WMH and CMB best predicted BAG (R2 = 0.455, RMSE = 6.44). In regression analysis higher LIBRA scores (greater dementia risk) were associated with higher BAG (standardized regression coefficient ß = 0.127, p<0.001), lower connectivity (ß = ‐0.071, p = 0.002) and worse cognition (ßlinear = ‐0.044, p = 0.017, ßquadratic = ‐0.047, p = 0.018). Higher BAG was associated with lower connectivity (ß = ‐0.418, p<0.001) and worse cognition (ß = ‐0.165, p<0.001). Lower connectivity was associated with worse cognition (ß = 0.086, p<0.001). In mediation analysis (Figure 2), 21% of the total differences between the highest and lowest LIBRA tertile on cognition was mediated by BAG (ßindirect = ‐0.019, p<0.001; ßtotal = ‐0.092, p<0.001), and an additional 4.1% was mediated via connectivity (ßindirect = ‐0.003, p<0.001; ßtotal = ‐0.073, p<0.001). Conclusion: Associations between health‐ and lifestyle‐based risk/protective factors (LIBRA) and cognition is partially explained by maintenance of brain reserve (BAG) and neural reserve (connectivity). Lifestyle interventions promoting brain and neural reserve may help maintain cognitive function into older age. [ABSTRACT FROM AUTHOR]

Aim: To synthesize international findings on the alcohol–dementia relationship, including representation from low‐ and middle‐income countries. Methods: Individual participant data meta‐analysis of 15 prospective epidemiological cohort studies from countries situated in six continents. Cox regression investigated the dementia risk associated with alcohol use in older adults aged over 60 years. Additional analyses assessed the alcohol–dementia relationship in the sample stratified by sex and by continent. Participants included 24 478 community dwelling individuals without a history of dementia at baseline and at least one follow‐up dementia assessment. The main outcome measure was all‐cause dementia as determined by clinical interview. Results: At baseline, the mean age across studies was 71.8 (standard deviation = 7.5, range = 60–102 years), 14 260 (58.3%) were female and 13 269 (54.2%) were current drinkers. During 151 636 person‐years of follow‐up, there were 2124 incident cases of dementia (14.0 per 1000 person‐years). When compared with abstainers, the risk for dementia was lower in occasional [hazard ratio (HR) = 0.78; 95% confidence interval (CI) = 0.68–0.89], light–moderate (HR = 0.78; 95% CI = 0.70–0.87) and moderate–heavy drinkers (HR = 0.62; 95% CI = 0.51–0.77). There was no evidence of differences between life‐time abstainers and former drinkers in terms of dementia risk (HR = 0.98; 95% CI = 0.81–1.18). In dose–response analyses, moderate drinking up to 40 g/day was associated with a lower risk of dementia when compared with lif‐time abstaining. Among current drinkers, there was no consistent evidence for differences in terms of dementia risk. Results were similar when the sample was stratified by sex. When analysed at the continent level, there was considerable heterogeneity in the alcohol–dementia relationship. Conclusions: Abstinence from alcohol appears to be associated with an increased risk for all‐cause dementia. Among current drinkers, there appears to be no consistent evidence to suggest that the amount of alcohol consumed in later life is associated with dementia risk. [ABSTRACT FROM AUTHOR]

Background: During the last decades, evidence supporting the relevance of brain health promotion and dementia risk reduction has considerably expanded (1). Currently, this evidence is sufficient to take public health action (2, 3). However, implemented interventions are still scarce, especially at a large scale. In the Netherlands, evidence‐based cardiovascular risk management is already implemented in primary care. Since there is a large overlap between modifiable risk factors for dementia and those for cardiovascular disease, discussing dementia risk reduction next to cardiovascular health in the general practice seems a feasible, first step towards future large‐scale implementation of dementia risk reduction strategies. Method: A proof‐of‐concept study is currently being conducted in ten general practices in the Netherlands in which 180 participants between 40 and 60 years old, with room for improvement on at least one modifiable risk factor, will have a consultation with their general practitioner or practice nurse. During this consultation, they will learn about brain health promotion and how they could personally improve their risk profile. Practices have been randomly allocated (1:1) to either provide the consultation only, or to additionally provide the participants with a brain health promotion smartphone app (i.e. MijnBreincoach). Result: Feasibility will be evaluated using validated questionnaires assessing knowledge on dementia risk reduction, health behavior, motivation, usability, satisfaction, and user experience with the smartphone app. Surveys will be administered before the consultation at the general practice and three months thereafter. Further, ten participants and four healthcare professionals will be invited for a qualitative interview to get a more in‐depth view of the intervention's feasibility. Conclusion: Discussing dementia risk reduction in the general practice may constitute a feasible and effective, scalable approach towards dementia risk reduction. Results of the study are expected by July 2023. References 1. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413‐46. 2. World Health Organization. Risk reduction of cognitive decline and dementia: WHO guidelines. Geneva; 2019. 3. Steyaert J, Deckers K, Smits C, et al. Putting primary prevention of dementia on everybody's agenda. Aging Ment Health. 2020:1‐5. [ABSTRACT FROM AUTHOR]

Background: Hearing impairment (HI) is a common and often treatable condition that is associated with increased risk of cognitive impairment and dementia. However, little is known about the cognitive course of individuals with incident HI. The objective of this study was to investigate the temporal association between prevalent and incident HI and change in cognition over 12 years. Method: Data was used from the Maastricht Ageing Study (MAAS), a Dutch cohort of 1823 cognitively healthy individuals aged 24‐82 years. Individuals were repeatedly assessed at baseline, 6 and 12 years. Hearing acuity was assessed using pure‐tone audiometry thresholds in decibel (dB). Prevalent (baseline) HI was categorized into no HI (average acuity <20 dB), mild HI (≥ 20 and <35 dB) and moderate to profound HI (≥35 dB). The presence of incident HI was defined by an average threshold of 20 dB at 6‐ or 12‐years in those without HI at baseline and follow‐up data (n = 1071). Verbal memory, information processing speed, and executive function were assessed. Linear mixed models were used to test the association between HI and change in cognitive function over time, adjusted for age, sex, education, and a composite score of 11 modifiable dementia risk factors. Result: Participants with mild prevalent HI (n = 322; 17.8%) and moderate to profound prevalent HI (n = 198; 10.9%) showed more decline over time in verbal memory, information processing speed, and executive function than participants without prevalent HI, independently of the other demographical and risk factors in the model. Likewise, participants with incident HI (n = 360; 33.6%) showed more decline over time in all cognitive domains than those with normal hearing at follow‐up. Comparing slopes across time showed a steady cognitive decline across all time points for prevalent HI, while for incident HI, a more time‐delayed pattern of increasing decline from 6 to 12 years was observed. Conclusion: Prevalent and incident HI predict cognitive decline in adults aged between 24‐82 years. This association is already present in individuals with mild HI. Findings for incident HI suggest that cognitive decline evolves gradually over time and after the onset of HI, possibly opening a window for risk management. [ABSTRACT FROM AUTHOR]

Background: Evidence on the effectiveness of multidomain lifestyle interventions to prevent cognitive decline in non‐demented older individuals is mixed. The multidomain FINGER study1 found small positive effects on cognition among older people at risk for dementia. As part of the World‐Wide FINGERS initiative to replicate and build on these results, FINGER‐NL aims to investigate the effectiveness of a 2‐year high versus low intensive multidomain lifestyle intervention on cognitive functioning in Dutch older at‐risk individuals. Method: FINGER‐NL is a Dutch multi‐center, randomized, controlled, multidomain lifestyle intervention trial aiming to include 1,206 adults at risk for cognitive decline. Adults aged 60‐80 years with at least 3 modifiable dementia risk factors (based on 'LIfestyle for BRAin Health' (LIBRA))2 and either a family history of dementia or self‐reported cognitive decline are eligible for inclusion. Participants are randomized (1:1 ratio) to either a high (HI‐group) or low‐intensity (LI‐group) intervention group. The multi‐domain intervention comprises a combination of 7 lifestyle components (physical exercise, cognitive training, cardiovascular risk management, nutritional counseling (with a specific focus on the MIND diet), sleep counseling, stress management, social activities) and 1 nutritional product (Souvenaid, 125ml). The HI‐group receives a personalized, supervised and hybrid intervention consisting of group meetings and individual sessions guided by a lifestyle coach. The LI‐group receives online lifestyle‐related health education. Primary outcome is 2‐year change from baseline on the cognitive composite score covering processing speed, executive function and memory. Secondary outcomes including changes in specific cognitive domains, instrumental activities of daily living, LIBRA score, and lifestyle component specific outcomes. For recruitment, we use the Dutch Brain Research Registry.3 Result: Participant recruitment started in January 2022. So far, 2405 people were interested, 1711 individuals have been screened for eligibility, 949 underwent baseline testing and 880 participants (73% of target sample) have been randomized and started with the intervention. The intervention is well‐accepted based on drop‐out rate (0.5%) and use of the online intervention portal. We expect to finalize randomization in Q2 of 2023 and complete the two‐year trial in 2025. Conclusion: Results so far show that FINGER‐NL is well on track, the intervention is well‐accepted and the trial will reach its inclusion target. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic inequalities in the risk for cognitive impairment have been reported, which might partly act through structural brain damage or differential numbers of brain connections (structural connectivity). This study investigated the extent to which the association of early‐life socioeconomic status (SES) with later‐life cognitive performance is mediated by later‐life SES, and whether the association of SES with later‐life cognitive performance can be explained by structural brain damage and connectivity. Method: We used cross‐sectional data from the population‐based Maastricht study (n = 4,839; mean age 59.2±8.7 years, 49.8% women). Early‐life SES was assessed retrospectively by self‐reported poverty and parental education. Later‐life SES included education, occupation, and household income. Participants underwent cognitive testing and 3 T magnetic resonance imaging to measure volumes of white matter hyperintensities, gray matter, white matter, cerebrospinal fluid, and structural connectivity. Multiple linear regression analyses tested the associations between SES, brain markers and cognition. Analyses were adjusted for age, sex, and type 2 diabetes (because of oversampling). Structural equation modeling tested mediation. Result: Higher SES was associated with higher grey matter volume, lower white matter volume, and higher structural connectivity. Structural brain damage and lower structural connectivity were associated with lower overall cognitive performance. Both higher early‐life and later‐life SES were associated with overall higher cognitive performance (B [95% CI] medium versus low early‐life SES = 0.17[0.12;0.23]; B high versus low early‐life SES = 0.26[0.20;0.32]; B medium versus low later‐life SES = 0.46[0.41;0.52]; B high versus low later‐life SES = 0.72[0.67;0.78]). The association of early‐life SES with later‐life cognitive performance was partly mediated by later‐life SES (73.8%). The extent to which the association of SES with cognitive performance could be explained by structural brain damage or connectivity was marginal (up to 5.9%). Conclusion: Though there was an association between early‐life SES and later‐life cognitive performance independent of later‐life SES, a large part of this association could be explained by later‐life SES. Structural brain damage and connectivity marginally explained socioeconomic inequalities in cognitive performance. More research is needed to investigate alternative pathways that explain associations of life‐course SES with later‐life cognition. [ABSTRACT FROM AUTHOR]

Objective: As no causal treatment for dementia is available yet, the focus of dementia research is slowly shifting towards prevention strategies. Therefore, this study aimed to examine the predictive accuracy of the "LIfestyle for BRAin Health" (LIBRA) score, a weighted compound score of 12 modifiable risk and protective factors, for dementia and mild cognitive impairment (MCI) in midlife and late-life, and in individuals with high or low genetic risk based on presence of the apolipoprotein (APOE) ε4 allele.Methods: The LIBRA score was calculated for participants from the Finnish Cardiovascular Risk Factors, Aging and Dementia (CAIDE) population-based study examined in midlife (n = 1024) and twice in late-life (n = 604) up to 30 years later. Diagnoses of MCI and dementia were made according to established criteria. Cox proportional hazards models were used to assess the association between LIBRA and risk of dementia and MCI in models adjusted for sex and education (age as timescale).Results: Higher midlife LIBRA scores were related to higher risk of dementia (hazard ratio [HR] = 1.27; 95% confidence interval [CI], 1.13-1.43) and MCI (unadjusted model: HR = 1.12; 95% CI, 1.03-1.22) up to 30 years later. Higher late-life LIBRA scores were related to higher risk of MCI (HR = 1.11; 95% CI, 1.00-1.25), but not dementia (HR = 1.02; 95% CI, 0.84-1.24). Higher late-life LIBRA scores were related to higher dementia risk among apolipoprotein E (APOE) ε4 non-carriers.Conclusions: Findings emphasize the importance of modifiable risk and protective factors for dementia prevention. [ABSTRACT FROM AUTHOR]

Background: Dementia is a global health challenge. Currently, there is no curative treatment for dementia and therefore risk reduction through lifestyle modifications has become more prominent with high cognitive activity as a promising target. This study explored the association between an individual's need to engage in cognitively stimulating activities, brain damage and cognitive functioning in the Dutch general population. Method: This study used cross‐sectional data from the population‐based cohort The Maastricht Study (N = 4,209; mean age 59.06 ± 8.58 years, 50.11% women). Need For Cogntion (NFC) was measured with the Need For Cognition Scale. Cognitive functioning was tested in three domains: verbal memory, information processing speed and executive functioning and attention. Standardized volumes of white matter hyperintensities (WMH) and cerebrospinal fluid (CSF) and presence of cerebral small vessel disease (CSVD) were derived from 3 Tesla MRI. Multiple linear regression analysis was used to explore the association between NFC and cognitive functioning, NFC and WMH and NFC and CSF. Binary logistic regression analysis was used to assess the association between NFC and CSVD. Interaction between brain damage or cognitive impairment (a score of <1.5 standard deviation below the mean on any of the three cognitive domains) and NFC on cognitive functioning was tested by including interaction terms in the regression analyses. Result: High NFC was positively associated with cognitive functioning (β: 0.21, p = <0.001) and negatively associated with CSVD (OR: 0.74, p = 0.005). These associations were independent of demographic and somatic factors. A dose‐response relationship between NFC and cognitive functioning was observed. There was no statistically significant association between NFC and WMH or CSF. No interaction between CSVD, WMH or CSF and NFC on cognitive functioning was found. Cognitive impairment did not moderate the association between NFC and cognitive functioning. Conclusion: A high need for engaging in cognitively stimulating activities is associated with better cognitive functioning and less brain damage. This is in line with previous research. These results indicate that, in middle‐aged populations, stimulating cognitive activity may be an opportunity for risk reduction of cognitive decline and dementia. [ABSTRACT FROM AUTHOR]

Background: Dementia prevention poses one of the biggest challenges to our ageing society (1,2). Next to individual modifiable risk factors, shared environmental risk factors have been linked to dementia risk. Exposure to air pollution has been identified as a new candidate risk factor which on a population level carries more risk than well‐established risk factors such as hypertension and type‐2 diabetes (1). This study aimed to investigate the association between exposure to air pollutants with cognitive functioning and markers of structural brain damage next to and above individual risk factors. Method: Cross‐sectional data from the population‐based cohort (N = 4,154; mean age 59.27±8.54 years, 50.12% women) of The Maastricht Study (3) was used and matched to address‐based data from the Geoscience andHealth Cohort Consortium of average exposure to particulate matter (<2.5mg and <10mg), NO2 and soot over the years 2013‐2018. Cognitive functioning was assessed through a neuropsychological test battery. Standardized volumes of grey matter, white matter, cerebrospinal fluid, and presence of cerebral small vessel disease were derived from 3‐Tesla MRI. Individual risk factors were added as one covariate, using the validated Lifestyle for Brain Health score (4). Binary logistic and multiple linear regression analyses tested the associations between air pollutants and the outcome measures. Likelihood‐ratio tests were performed to compare the extensive models. Result: We found a curvilinear association relating particulate matter exposure in the mid to higher range to lower grey matter and higher cerebrospinal fluid volume, independent of age, sex, education, and LIBRA score. There was no association between air pollutant exposure and cognitive functioning or markers of cerebral small vessel disease. Conclusion: In this population‐based cohort, average to high exposure to particulate matter was related to an increase in markers of brain atrophy, showing important implications for environmental and public health policymaking. [ABSTRACT FROM AUTHOR]

Background: Given the projected increase in the number of people with dementia and the lack of curative treatment, there is increasing attention to the contribution of modifiable risk and protective factors to dementia risk. In 2015, the "LIfestyle for BRAin health" (LIBRA) index was developed based on the results of a systematic literature review and Delphi expert study (Deckers et al., 2015). LIBRA consists of twelve modifiable risk factors for cognitive decline and dementia. Although this risk index has been well‐validated for cognitive decline and dementia risk in numerous population‐based cohorts and intervention studies, newly emerged risk factors might ask for an update (Deckers et al., 2019; Deckers et al., 2020). Method: To update LIBRA, we conducted an umbrella review to assess all systematic reviews (SR) and meta‐analyses (MA) on modifiable dementia risk factors published between January 2015 and June 2021 in four databases (Pubmed, Embase, Web of Science, and PsychINFO). In parallel, a two‐round Delphi expert study was conducted. In the first round (May‐June 2022), eighteen dementia experts were asked to evaluate the factors currently included in LIBRA. Additionally, we asked to list new modifiable factors not previously included in LIBRA. In the second round (December 2022‐January 2023), the experts ranked the most important risk factors identified in the umbrella review and first Delphi round. Result: The search returned 6,540 hits, of which 147 SR/MA were included in our umbrella review. Next to the existing LIBRA factors, new candidate risk factors that were consistently associated with increased risk for cognitive decline and dementia included: low social engagement, hearing impairment, vision impairment, atrial fibrillation, and anxiety. After triangulation of the results of the umbrella review and the first Delphi round, the experts identified hearing impairment, lifecourse inequalities, social contact, atrial fibrillation, and sleep as the most important new modifiable risk factors in the second Delphi round. Conclusion: Several new modifiable risk factors for cognitive decline and dementia have been identified in this umbrella review and Delphi consensus study. These factors will be used for updating the existing LIBRA index, which will subsequently be externally validated in population‐based cohort studies. [ABSTRACT FROM AUTHOR]

Background: Many people are unaware of the potential for dementia risk reduction, but state they would appreciate more information on this topic (1). Raising awareness is important as a first step towards behavior change (2). The knowledge that a set of lifestyle behaviors is beneficial for your cognitive health may also provide additional motivation (2). Method: An online, free e‐learning on the topic of dementia risk reduction for the Dutch adult population will be developed (in co‐creation with Alzheimer Netherlands). It will cover the following topics: physical activity, healthy diet and alcohol consumption, cognitive activity, mental wellbeing including social wellbeing and sleep, cardiovascular health, and tips from lifestyle coaches and end‐users on how to make sustainable lifestyle changes. The content of the e‐learning will be delivered in stages, so that completion of the full course takes approximately seven weeks. Result: The e‐learning's effectiveness in terms of knowledge acquisition, evolution in motivation for health behavior and actual health behavior improvements will be assessed with validated questionnaires in a pre‐post study. Participants (minimum N = 300) will complete an online survey before starting the course, immediately thereafter and again three months later. User experiences and engagement with the e‐learning materials will also be evaluated. Conclusion: Awareness of the potential for dementia risk reduction is currently lacking in the general population. An e‐learning is a low‐level means that can be used to increase knowledge and awareness, and could further easily be implemented as a stand‐alone tool or as part of current or future dementia risk reduction initiatives. References 1. Heger I, Kohler S, van Boxtel M, de Vugt M, Hajema K, Verhey F, et al. Raising awareness for dementia risk reduction through a public health campaign: a pre‐post study. BMJ Open. 2020;10(11):e041211. 2. Rosenberg A, Coley N, Soulier A, Kulmala J, Soininen H, Andrieu S, et al. Experiences of dementia and attitude towards prevention: a qualitative study among older adults participating in a prevention trial. BMC Geriatr. 2020;20(1):99. [ABSTRACT FROM AUTHOR]

Background: Social relationship factors and cognitive activity engagement have been suggested as protective for cognitive decline and dementia. However, relatively few studies have addressed the risk for reverse causation with extended follow‐up periods. This study therefore aimed at examining associations between those factors and cognitive decline across up to 25 years. Method: We used data of 1,823 participants of the Maastricht Ageing study, who received baseline measurements of social relationship factors (social network size, social activity engagement and loneliness) and cognitive activity engagement (e.g. hours per week spent with reading books) from 1993 to 1995. Associations with baseline levels and change in memory, processing speed and executive functioning until the fifth Wave of follow‐up (2019 to 2022) were assessed using linear‐mixed models, controlling for age, sex, education, and a summary score of ten risk and protective factors for cognitive decline and dementia (the LIfestyle for BRAinhealth/LIBRA score). Result: Mean age at baseline was 51.1 years (SD = 16.4) and 49.9% of participants were female. Participants were followed up for 17.3 years on average (SD = 9.1). At baseline, more frequent social activity engagement was positively associated with processing speed (p<.001). Moreover, larger social network size (p =.023), and more frequent cognitive activity engagement (p =.037) were associated with better executive functioning. Longitudinal analyses showed that people with smaller social network size (p<.001) and higher levels of loneliness had a steeper decline in processing speed from baseline to the 25‐year follow‐up (p =.020). People with higher levels of loneliness additionally showed a steeper decline in memory (p =.006). Conclusion: Social relationship factors were associated with cognitive function and decline across 25 years in a sample representative of the general Dutch adult population. Our findings support their role as potential targets for the maintenance of optimal cognitive functioning. [ABSTRACT FROM AUTHOR]

Objective: Modifiable risk factors for dementia were recently identified and compiled in a systematic review. The 'Lifestyle for Brain Health' (LIBRA) score, reflecting someone's potential for dementia prevention, was studied in a large longitudinal population-based sample with respect to predicting cognitive change over an observation period of up to 16 years.Methods: Lifestyle for Brain Health was calculated at baseline for 949 participants aged 50-81 years from the Maastricht Ageing Study. The predictive value of LIBRA for incident dementia and cognitive impairment was examined by using Cox proportional hazard models and by testing its relation with cognitive decline.Results: Lifestyle for Brain Health predicted future risk of dementia, as well as risk of cognitive impairment. A one-point increase in LIBRA score related to 19% higher risk for dementia and 9% higher risk for cognitive impairment. LIBRA predicted rate of decline in processing speed, but not memory or executive functioning.Conclusions: Lifestyle for Brain Health (LIBRA) may help in identifying and monitoring risk status in dementia-prevention programmes, by targeting modifiable, lifestyle-related risk factors. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background. Cognitive interventions for older persons that may diminish the burden of cognitive problems and could delay conversion to dementia are of great importance. The underlying mechanisms of such interventions might be psychological compensation and neuronal plasticity. This review provides an overview of the literature concerning the evidence that cognitive interventions cause brain activation changes, even in damaged neural systems. Method. A systematic search of the literature was conducted in several international databases, Medline, Embase, Cinahl, Cochrane, and Psychinfo. The methodological quality was assessed according to the guidelines of the Dutch Institute for Health Care Improvement (CBO). Results. Nineteen relevant articles were included with varied methodological quality. All studies were conducted in diverse populations from healthy elderly to patients with dementia and show changes in brain activation after intervention. Conclusions. The results thus far show that cognitive interventions cause changes in brain activation patterns.The exact interpretation of these neurobiological changes remains unclear. More study is needed to understand the extent to which cognitive interventions are effective to delay conversion to dementia. Future studies should more explicitly try to relate clinically significant improvement to changes in brain activation. Long-term follow-up data are necessary to evaluate the stability of the effects. [ABSTRACT FROM AUTHOR]

Background: Previous multidomain lifestyle intervention trials to prevent cognitive decline in non‐demented elderly have found conflicting effects, with positive findings including the multidomain FINnish GERiatric intervention (FINGER) study (Ngandu T, Lehtisalo J, Solomon A, et al. Lancet 2015), and in specific at‐risk subgroups in other trials (Moll van Charante EP, Richard E, Eurelings LS, et al. Lancet 2016; Andrieu S, Guyonnet S, Coley N, et al. Lancet Neurol. 2017). As part of a world‐wide effort to replicate and build on these results, FINGER‐NL aims to investigate the effectivity of a 2‐year multidomain lifestyle intervention in Dutch older adults to prevent cognitive decline. Method: FINGER‐NL is a Dutch multi‐center, randomized, controlled, multidomain lifestyle intervention trial among 1,206 adults at risk for cognitive decline with a duration of 24 months. Inclusion criteria are 60‐80 years of age and presence of both modifiable (based on LIfestyle for BRAin health (LIBRA) score) and non‐modifiable (family history, worries about subjective cognitive decline) dementia risk factors. Participants will be randomized in a 1:1 ratio to the structured intervention group or the self‐guided control group. The multidomain lifestyle intervention comprises 8 modules, namely physical exercise, cognitive training, management of metabolic and vascular risk factors, nutritional counseling, Souvenaid®, sleep counseling, stress management, and social activities. The structured intervention group receives a personalized, supervised and hybrid (both online and at study site) intervention consisting of group meetings and individual sessions. The self‐guided control group receives online lifestyle‐related health education. Primary outcome is 2‐year change from baseline on a cognitive composite score covering processing speed, executive function and memory. Secondary outcomes including changes in specific cognitive domains, Amsterdam Instrumental Activity of Daily Living Questionnaire (A‐IADL‐Q), LIBRA score, EQ‐5D‐5L, lifestyle component specific outcomes. Participant recruitment will start in June 2021 and FINGER‐NL is expected to be completed in 2024. Result: Results of FINGER‐NL will provide further insight in the effectivity and feasibility of a multidomain lifestyle intervention to prevent cognitive decline in older adults. Conclusion: Given the current lack of curative treatment options and the growing prevalence of cognitive impairment and dementia, lifestyle interventions may play an important role in preventing or delaying disease onset. [ABSTRACT FROM AUTHOR]

Method: The Maastricht Study is a population‐based cohort study with extensive phenotyping, enriched for type‐2 diabetes. Cognitive test scores, structural connectivity data, and 3T MRI were available for n=4798 participants (mean age(±SD)=59.2(±8.7), 50.0% male). Images were assessed by Fazekas score (£1 or ≥2), presence of microbleeds and lacunar infarcts in terms of dichotomous measures, and combined into a cSVD score (range 0‐3). Node degree (ND), a measure of the mean interconnectedness of nodes in the structural connectome, was used as connectivity score. A composite cognition score (CS) was taken as the mean score across three cognitive domains (Memory, Information Processing Speed and Executive Function). Multivariable linear regression analyses were used to investigate the interaction effect between ND and cSVD score on CS, adjusted for age, sex, education, and diabetes status. Result: Higher cSVD score was associated with lower CS. ND modified the association between cSVD score and CS in the adjusted model (p for interaction p<0.004). While there were clear cognitive differences across cSVD levels if ND was low, the association between cSVD and cognition was attenuated in a dose‐response fashion with increasing ND (Figure 1). Conclusion: Structural ND provides evidence of an individual’s CR based on white matter organization in the presence of damage from cSVD. Even in participants with the highest cSVD burden, sufficiently high ND score was associated with normal CS. [ABSTRACT FROM AUTHOR]

There is increasing evidence that subjective cognitive decline (SCD) in individuals with unimpaired performance on cognitive tests may represent the first symptomatic manifestation of Alzheimer's disease (AD). The research on SCD in early AD, however, is limited by the absence of common standards. The working group of the Subjective Cognitive Decline Initiative (SCD-I) addressed this deficiency by reaching consensus on terminology and on a conceptual framework for research on SCD in AD. In this publication, research criteria for SCD in pre-mild cognitive impairment (MCI) are presented. In addition, a list of core features proposed for reporting in SCD studies is provided, which will enable comparability of research across different settings. Finally, a set of features is presented, which in accordance with current knowledge, increases the likelihood of the presence of preclinical AD in individuals with SCD. This list is referred to as SCD plus . [ABSTRACT FROM AUTHOR]

Abstract: Background: Gray matter atrophy, an important biomarker for early Alzheimer’s disease, might be due to white matter changes within gray matter. Methods: Twenty older participants with significant memory decline over a 12-year period (T12) were matched to 20 nondeclining participants. All participants were magnetic resonance imaging scanned at T12. Cortical thickness and diffusion tensor imaging analyses were performed. Results: Lower cortical thickness values were associated with lower diffusion values in frontal and parietal gray matter areas. This association was only present in the memory decline group. The cortical thickness–diffusion tensor imaging correlations showed significant group differences in the posterior cingulate gyrus, precuneus, and superior frontal gyrus. Conclusions: Decreased gray matter diffusivity in the posterior cingulate/precuneus area might be a disease-specific process and a potential new biomarker for early Alzheimer’s disease. Future studies should validate its potential as a biomarker and focus on cellular changes underlying diffusivity changes in gray matter. [Copyright &y& Elsevier]

Cerebral white matter damage is not only a commonly reported consequence of healthy aging, but is also associated with cognitive decline and dementia. The aetiology of this damage is unclear; however, individuals with hypertension have a greater burden of white matter signal abnormalities (WMSA) on MR imaging than those without hypertension. It is therefore possible that elevated blood pressure (BP) impacts white matter tissue structure which in turn has a negative impact on cognition. However, little information exists about whether vascular health indexed by BP mediates the relationship between cognition and white matter tissue structure. We used diffusion tensor imaging to examine the impact of vascular health on regional associations between white matter integrity and cognition in healthy older adults spanning the normotensive to moderate-severe hypertensive BP range (43-87 years; N = 128). We examined how white matter structure was associated with performance on tests of two cognitive domains, executive functioning (EF) and processing speed (PS), and how patterns of regional associations were modified by BP and WMSA. Multiple linear regression and structural equation models demonstrated associations between tissue structure, EF and PS in frontal, temporal, parietal, and occipital white matter regions. Radial diffusivity was more prominently associated with performance than axial diffusivity. BP only minimally influenced the relationship between white matter integrity, EF and PS. However, WMSA volume had a major impact on neurocognitive associations. This suggests that, although BP and WMSA are causally related, these differential metrics of vascular health may act via independent pathways to influence brain structure, EF and PS. Hum Brain Mapp, 2013. © 2011 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the temporal association between depressive symptoms and cognitive functioning and estimate the effect measure modification of the apolipoprotein E (APOE) ℇ4 allele on this relationship. DESIGN: Prospective cohort study. SETTING: General community. PARTICIPANTS: Population-based sample of 598 cognitively intact older adults aged 60 and older, with re-assessments after 3 (N=479) and 6 years (N=412). MEASUREMENTS: Depressive symptoms (Symptom Checklist) and neurocognitive functioning (memory, Visual Verbal Learning Test; attention, Stroop Color–Word Test; processing speed, Letter Digit Substitution Test; general cognition, Mini-Mental State Examination). Longitudinal associations were assessed using linear mixed models. The risk for cognitive impairment, no dementia (CIND) was examined using logistic regression. RESULTS: Adjusting for age, sex, education, and baseline cognition, the rate of change in memory z-scores was 0.00, −0.11, −0.20, and −0.37 for those in the lowest (reference group), second, third, and highest depressive symptom quartiles at baseline, respectively ( P<.001 for highest vs lowest quartile). The odds ratios for developing CIND with amnestic features were 1.00, 0.87, 0.69, and 2.98 for the four severity groups ( P=.05 for highest vs lowest quartile). Associations were strongest for those with persistent depressive symptoms, defined as high depressive symptoms at baseline and at least one follow-up visit. Results were similar for processing speed and global cognitive function but were not as strong for attention. No APOE interaction was observed. CONCLUSION: Depression and APOE act independently to increase the risk for cognitive decline and may provide targets for prevention and early treatment. [ABSTRACT FROM AUTHOR]

( Headache 2010;50:176-184) Objective.— To investigate the effects of migraine and related pharmacotherapy on cognitive performance and cognitive change over time in a longitudinal population-based study. Methods.— Migraineurs (n = 99) and healthy controls (n = 1724) participating in the Maastricht Aging Study were cognitively tested at baseline and after 6 years. Scores on Mini Mental State Examination, immediate and delayed recall tests, and tests for simple and complex speed were compared for both groups. Generalized Estimating Equations analyses were performed to test the longitudinal effects of migraines on cognition. Effects of migraine medication use were also tested. Results.— Migraine headaches were found to have no effect on any of the cognitive measures. Medication use also had no effect on all cognitive measures. Conclusions.— No evidence was found that migraine headaches or migraine-related medication use are risk or protective factors for cognitive dysfunction or cognitive deterioration over time. [ABSTRACT FROM AUTHOR]

Objective Memory complaints in the absence of objective test impairments are common. Only a subset of these subjects seeks medical attention for these complaints. The aim of the present study was to investigate which factors determine why people with subjective memory complaints (SMC) seek medical attention. Methods Thirty-three cases with SMC from a memory clinic were compared to 85 control subjects with SMC from a population-based study who did not seek help for their complaints. We investigated whether cases differed from controls with respect to the following: depressive and anxiety symptoms (SCL-90), extraversion and neuroticism (EPQ), meta-memory (MIA), quality of life (SF-36), changes in memory and daily functioning according to a relative (DECO), life-changing events, and a family history of dementia. Results Cases with SMC who seek medical attention, scored lower on memory self-efficacy and quality of life. They were more often worried due to a positive family history of dementia by comparison to the control subjects. Relatives of cases reported more deterioration in daily functioning than relatives of controls. Both the cases and control subjects had similar levels of depressive and anxiety symptoms, as well as levels of extraversion and neuroticism. Conclusion Lower memory self-efficacy and quality of life, deterioration in daily functioning, and worries due to a positive family history for dementia are factors that determine why subjects with SMC seek medical attention. This information may be useful for the development of interventions for these subjects. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Middle-aged and older people often worry that their perceived diminishing memory function may indicate incipient dementia. Objectives The present study addresses questions regarding subjective memory complaints as a predictor of lower performance on cognitive tasks. Also, in participants with subjective memory complaints it was investigated, whether trying to keep mentally active improved memory function. Characteristics of the participants who were and were not interested in an intervention to decrease worries and to improve memory in daily life were determined. Methods Data were obtained from a large longitudinal study: the Maastricht Aging Study, involving 557 participants aged 55 to 85 years. Follow-up measurement was performed after 6 years. Outcome variables were simple, complex and general information processing speed and immediate and delayed recall. Results At baseline, forgetfulness was associated with a slower general information processing and delayed recall. At the six-year follow-up, being forgetful was not associated with a significant change in cognitive performance. Taking steps to remain cognitively active was not a predictor of better performance on cognitive tasks at baseline or at the six-year follow-up. Conclusion Being forgetful might be an indicator of slower general information processing speed and delayed recall at baseline but does not predict cognitive change over 6 years in older adults. However, the effects are rather small and cannot directly be generalized to applications in clinical settings. Other factors, such as depression and anxiety might also underlie the cause of the forgetfulness. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background To date, it remains unclear to what extent cognitive competence is related to a change in general functional status in older adults. Objectives To evaluate both the cross-sectional and the longitudinal relation between cognitive functioning and functional status. Methods Sensorimotor speed, memory, and executive functioning were assessed in a large population of healthy adults aged 60 years and older (n = 485) who participated in the Maastricht Aging Study. Data from the baseline (1993–1995), three-year follow-up, and six-year follow-up were used. Functional status was measured using the SF-36, which was coded into a physical and a mental component summary measure. Results After adjustment for age, sex, and educational level, a high level of cognitive functioning appeared to be associated with better functional status in the cross-sectional analysis. Longitudinal analyses demonstrated, that cognitive functioning was not a predictor of functional status three or six years later. Conclusions Thus while cognitive functioning is useful clinically for predicting the short-term functional status of an older person, it is not useful for predicting that person's long-term (>3 years) functional status and thus the period of validity of the results of these tests in answering such questions is limited. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

To examine the longitudinal relationship between sensory functioning and a broad range of cognitive functions after 6 years follow-up and whether cataract surgery or first-time hearing aid use affected cognition.Hierarchical regression procedures were employed to determine whether sensory functioning was predictive of cognitive performance.Maastricht University and the University Hospital Maastricht, the Netherlands.Older Dutch adults (≥55) enrolled in the Maastricht Aging Study (N=418).Visual and auditory acuity, the Visual Verbal Learning Test (VVLT), the Stroop Color Word Test (SCWT), the Concept Shifting Task (CST), the Verbal Fluency Test, and the Letter-Digit Substitution Test (LDST).A change in visual acuity was associated with change in most cognitive measures, including the total and recall scores of the VVLT, the mean score of the first two SCWT cards, the mean score of the first two CST cards and the LDST. In addition, a change in auditory acuity predicted change in memory performance (VVLT total and recall scores), and auditory acuity measured at baseline predicted change in the mean score of the first two SCWT cards and the LDST.The findings support the notion of a strong connection between sensory acuity in auditory and visual domains and cognitive performance measures, both from a cross-sectional and a longitudinal perspective. They also suggest that it is essential to screen older individuals in a clinical context for sensory functioning so that changes in visual or auditory acuity are not interpreted as changes in cognitive performance. [ABSTRACT FROM AUTHOR]

Background Although biological sleep criteria seem to be associated with cognitive changes in older people, it is not clear if subjective sleep parameters are related to cognitive decline in later life. Objectives The aim of this study was to determine whether subjective sleep complaints in a population-based sample of 838 middle aged and older adults (≥ 50 years) predicted cognitive decline over a period of 3 years. Methods Sleep complaints at baseline, assessed with the subscale Sleep Problems of the Symptoms Checklist-90, were used as a predictor variable. Cognitive performance at follow-up, measured with the Mini Mental Status Examination, was employed as a dependent variable. Results Controlling for the effects of age, gender, length of follow-up interval, systemic diseases, and cognitive function at baseline, subjective sleep complaints were negatively associated with cognitive performance at follow-up. Conclusion Subjective sleep complaints predict cognitive decline in middle aged and older adults. Mechanisms behind the effect of subjective sleep complaints on cognitive performance are discussed. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine two aspects of cognitive functioning—information processing speed and memory—in both young/middle-aged and older subjects with and without migraine, using data from a large population-based sample. We found that, although age had a large effect on processing speed and memory, migraine did not influence cognitive performance. In addition, there was no significant interaction between age and migraine on processing speed and memory. Our results suggest that, in the general population, migraine does not seriously affect cognitive functioning in young/middle-aged or older adults. [ABSTRACT FROM AUTHOR]