Authors: Dhana, Klodian | Aggarwal, Neelum T. | Beck, Todd | Holland, Thomas M. | Dhana, Anisa | Cherian, Laurel J. | Desai, Pankaja | Evans, Denis A. | Rajan, Kumar B.
Article Type: Research Article
Abstract: Background: Patients with stroke are at a higher risk of cognitive impairment and Alzheimer’s disease dementia. Objective: To quantify the role of lifestyle pre-stroke, post-stroke, and changes in lifestyle before and after stroke with cognitive decline in community-dwelling stroke survivors. Methods: Utilizing data from the Chicago Health and Aging Project, a population-based cohort study, we studied 1,078 individuals with stroke (662 incident and 416 prevalent) who underwent cognitive testing during the study period. A healthy lifestyle score was defined by scoring four behaviors: non-smoking, exercising, being cognitively active, and having a high-quality diet. The global cognitive score was derived from …a comprehensive battery of 4 standardized tests. Results: The mean age at incident stroke was 78.2 years, and 60.1% were women. A healthy lifestyle pre-incident stroke was associated with a slower rate of cognitive decline after stroke. Participants with 3–4 healthy lifestyle factors pre-incident stroke had a slower cognitive decline after stroke by 0.046 units/year (95% CI 0.010, 0.083), or 47.7% slower, than participants with 0–1 healthy lifestyle factor. Lifestyle score post-prevalent stroke was not associated with cognitive decline. Changes in lifestyle behaviors from pre- to post-incident stroke were related to cognitive decline after stroke. Individuals who deteriorated their lifestyle quality after stroke had a faster cognitive decline by 0.051 units/year (β –0.051, 95% CI –0.090, –0.012) than participants with no change in lifestyle score. Conclusion: A healthy lifestyle pre-stroke was associated with a slower rate of cognitive decline in stroke survivors, highlighting the importance of primary prevention. After the stroke, changes in lifestyle behaviors may influence the cognitive abilities of older adults as they age. Show more
Keywords: Cognition, cognitive decline, cohort study, healthy lifestyle, stroke patients
DOI: 10.3233/JAD-220305
Citation: Journal of Alzheimer's Disease, vol. 89, no. 2, pp. 745-754, 2022
Authors: Liu, Xiaoran | Finno, Carrie J. | Beck, Todd | Dhana, Klodian | Tangney, Christy | Desai, Pankaja | Krueger, Kristin | Evans, Denis A. | Rajan, Kumar B.
Article Type: Research Article
Abstract: Background: The association of different types of tocopherols (vitamin E) with cognition might vary by the APOE ɛ 4 allele status. Objective: We examined the association of dietary tocopherols with cognitive decline among participants with and without the APOE ɛ 4 allele over a median of 12 years. Methods: 2,193 participants from the Chicago Health and Aging Project were included in the analyses. Global cognition was assessed in three-year cycles. We used a 144-item FFQ to assess dietary intakes of tocopherols and hME Sequenom mass-array platform to assess APOE genotype. We used linear mixed effects models to examine the relationship …between tocopherol from food sources and global cognitive decline. Results: The mean baseline age was 74.1 (SD = 5.9) years. Among APOE ɛ 4 carriers, participants in the highest quintile of intakes of dietary vitamin E had a slower cognitive decline of 0.022 SDU (95% CI: 0.000, 0.043) compared to those in the lowest quintile. A higher intake of dietary α -tocopherol from food sources only was associated with slower cognitive decline in APOE ɛ 4 carriers (p for trend 0.002) but not among the non-carriers (p for trend 0.937). Among APOE ɛ 4 carriers, those in the highest quintile of intake of α -tocopherol had a 16.4% slower rate of decline of global cognition compared to those in the lowest quintile (β= 0.034, 95% CI: 0.013, 0.054). Conclusions: Individuals consuming high α -tocopherol from food sources had slower cognitive decline among APOE ɛ 4 carriers. In older adults, different forms of vitamin E might moderate the relationship of APOE ɛ 4 with global cognition. Show more
Keywords: Alpha-tocopherol, Alzheimer’s disease, antioxidant, APOE, bi-racial, cognitive decline, dietary, longitudinal cohort, nutrients, vitamin E
DOI: 10.3233/JAD-230797
Citation: Journal of Alzheimer's Disease, vol. 96, no. 3, pp. 1129-1138, 2023
Authors: Agarwal, Puja | Ford, Christopher N. | Leurgans, Sue E. | Beck, Todd | Desai, Pankaja | Dhana, Klodian | Evans, Denis A. | Halloway, Shannon | Holland, Thomas M. | Krueger, Kristin R. | Liu, Xiaoran | Rajan, Kumar Bharat | Bennett, David A.
Article Type: Research Article
Abstract: Background: We have limited evidence for the relationship of high sugar intake with dementia risk. Objective: To determine whether high sugar intake is associated with an increased risk of dementia in community-dwelling older adults Methods: This study included 789 participants of the Rush Memory and Aging Project (community-based longitudinal cohort study of older adults free of known dementia at enrollment), with annual clinical assessments and complete nutrient data (obtained by validated food frequency questionnaire). Clinical diagnosis of dementia is based on the criteria of the joint working group of the National Institute of Neurological and Communicative Disorders and Stroke and …the Alzheimer’s Disease and Related Disorders Association. We used Cox proportional hazard models. Results: 118 participants developed dementia during 7.3±3.8 years of follow-up. Those in the highest quintile of total sugar intake were twice as likely to develop dementia than those in the lowest quintile (Q5 versus Q1:HR=2.10 (95% CI: 1.05, 4.19) when adjusted for age, sex, education, APOE ɛ 4 allele, calories from sources other than sugar, physical activity, and diet score. Higher percent calories from sugar were positively associated with dementia risk (β=0.042, p = 0.0009). In exploratory analyses, the highest versus lowest quintile of fructose and sucrose in the diet had higher dementia risk by 2.8 (95% CI: 1.38, 5.67) and 1.93 (95% CI: 1.05, 3.54) times, respectively. Conclusions: A higher intake of total sugar or total calories from sugar is associated with increased dementia risk in older adults. Among simple sugars, fructose (e.g., sweetened beverages, snacks, packaged desserts) and sucrose (table sugar in juices, desserts, candies, and commercial cereals) are associated with higher dementia risk. Show more
Keywords: Alzheimer’s disease, dementia, longitudinal, total sugar intake
DOI: 10.3233/JAD-230013
Citation: Journal of Alzheimer's Disease, vol. 95, no. 4, pp. 1417-1425, 2023
