Browsing by Author "De-la-Cámara, Concepción"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic
    (Elsevier, 2024-09-12) Zhao, Xuhao; Xu, Xiaolin; Yan, Yifan; Lipnicki, Darren M.; Pang, Ting; Crawford, John D.; Chen, Christopher; Cheng, Ching-Yu; Venketasubramanian, Narayanaswamy; Chong, Eddie; Blay, Sergio Luis; Lima-Costa, Maria Fernanda; Castro-Costa, Erico; Lipton, Richard B.; Katz, Mindy J.; Ritchie, Karen; Scarmeas, Nikolaos; Yannakoulia, Mary; Kosmidis, Mary H.; Gureje, Oye; Ojagbemi, Akin; Bello, Toyin; Hendrie, Hugh C.; Gao, Sujuan; Guerra, Ricardo Oliveira; Auais, Mohammad; Gomez, José Fernando; Rolandi, Elena; Davin, Annalisa; Rossi, Michele; Riedel-Heller, Steffi G.; Löbner, Margit; Roehr, Susanne; Ganguli, Mary; Jacobsen, Erin P.; Chang, Chung-Chou H.; Aiello, Allison E.; Ho, Roger; Sanchez-Juan, Pascual; Valentí-Soler, Meritxell; Del Ser, Teodoro; Lobo, Antonio; De-la-Cámara, Concepción; Lobo, Elena; Sachdev, Perminder S.; Xu, Xin; Cohort Studies of Memory in an International Consortium (COSMIC); Psychiatry, School of Medicine
    Background: Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical. Methods: Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies. Findings: Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = -0.207, 95% CI = (-0.255, -0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = -0.040, 95% CI = (-0.047, -0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies. Interpretation: Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness.
  • Thumbnail Image
    Item
    Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis
    (American Medical Association, 2023-09-05) Lennon, Matthew J.; Lam, Ben Chun Pan; Lipnicki, Darren M.; Crawford, John D.; Peters, Ruth; Schutte, Aletta E.; Brodaty, Henry; Thalamuthu, Anbupalam; Rydberg-Sterner, Therese; Najar, Jenna; Skoog, Ingmar; Riedel-Heller, Steffi G.; Röhr, Susanne; Pabst, Alexander; Lobo, Antonio; De-la-Cámara, Concepción; Lobo, Elena; Bello, Toyin; Gureje, Oye; Ojagbemi, Akin; Lipton, Richard B.; Katz, Mindy J.; Derby, Carol A.; Kim, Ki Woong; Han, Ji Won; Oh, Dae Jong; Rolandi, Elena; Davin, Annalisa; Rossi, Michele; Scarmeas, Nikolaos; Yannakoulia, Mary; Dardiotis, Themis; Hendrie, Hugh C.; Gao, Sujuan; Carrière, Isabelle; Ritchie, Karen; Anstey, Kaarin J.; Cherbuin, Nicolas; Xiao, Shifu; Yue, Ling; Li, Wei; Guerchet, Maëlenn M.; Preux, Pierre-Marie; Aboyans, Victor; Haan, Mary N.; Aiello, Allison E.; Ng, Tze Pin; Nyunt, Ma Shwe Zin; Gao, Qi; Scazufca, Marcia; Sachdev, Perminder S. S.; Psychiatry, School of Medicine
    Importance: The utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested. Objectives: To assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group. Data source and study selection: Longitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium (COSMIC) group were included. Participants were individuals without dementia at baseline aged 60 to 110 years and were based in 15 different countries (US, Brazil, Australia, China, Korea, Singapore, Central African Republic, Republic of Congo, Nigeria, Germany, Spain, Italy, France, Sweden, and Greece). Data extraction and synthesis: Participants were grouped in 3 categories based on previous diagnosis of hypertension and baseline antihypertensive use: healthy controls, treated hypertension, and untreated hypertension. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data reporting guidelines. Main outcomes and measures: The key outcome was all-cause dementia. Mixed-effects Cox proportional hazards models were used to assess the associations between the exposures and the key outcome variable. The association between dementia and baseline BP was modeled using nonlinear natural splines. The main analysis was a partially adjusted Cox proportional hazards model controlling for age, age squared, sex, education, racial group, and a random effect for study. Sensitivity analyses included a fully adjusted analysis, a restricted analysis of those individuals with more than 5 years of follow-up data, and models examining the moderating factors of age, sex, and racial group. Results: The analysis included 17 studies with 34 519 community dwelling older adults (20 160 [58.4%] female) with a mean (SD) age of 72.5 (7.5) years and a mean (SD) follow-up of 4.3 (4.3) years. In the main, partially adjusted analysis including 14 studies, individuals with untreated hypertension had a 42% increased risk of dementia compared with healthy controls (hazard ratio [HR], 1.42; 95% CI 1.15-1.76; P = .001) and 26% increased risk compared with individuals with treated hypertension (HR, 1.26; 95% CI, 1.03-1.53; P = .02). Individuals with treated hypertension had no significant increased dementia risk compared with healthy controls (HR, 1.13; 95% CI, 0.99-1.28; P = .07). The association of antihypertensive use or hypertension status with dementia did not vary with baseline BP. There was no significant association of baseline SBP or DBP with dementia risk in any of the analyses. There were no significant interactions with age, sex, or racial group for any of the analyses. Conclusions and relevance: This individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive use was associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.