Authors: Zhao, Qianhua | Xiong, Yunyun | Ding, Ding | Guo, Qihao | Hong, Zhen
Article Type: Research Article
Abstract: Diabetes is thought to contribute to cognitive impairment in the elderly. The risk may be modified by genetic factors such as apolipoprotein E (APOE). We aim to determine the prevalence of dementia in Chinese diabetics and non-diabetic individuals, and assess the effect of the APOE genotype. A cross-sectional study was conducted among participants aged 50 and over in an urban community. Subjects were 1 : 1 matched for age and gender (diabetes group (n = 497) versus non-diabetes group (n = 497)). Each subject was interviewed for dementia and related risk factors. Fasting blood samples were drawn for glucose and …APOE. Subjects were screened using the Mini Mental State Examination (MMSE) and were examined by a series of neuropsychological tests if screened positive (indicated by an MMSE score below 19, 21, and 24, respectively according to different educational attainment). A diagnosis of dementia was defined according to DSM-IV criteria. The prevalence of all-cause dementia, Alzheimer's disease, and vascular dementia in diabetics (4.8%, 2.7%, 1.4%) was higher than that of non-diabetics (2.2%, 1.2%, 0.4%) (all-cause dementia, diabetics versus non-diabetics, p < 0.05). APOE ε4 carriers had higher prevalence of dementia and AD (diabetics: 9.2%, 7.55%, non-diabetics: 3.3%, 3.3%) than APOE ε4 non-carriers (diabetics: 6.3%, 2.3%, non-diabetics: 2.35%, 0.7%) (p < 0.05). Diabetics carrying the APOE ε4 allele had a 3.982-fold [95%CI, 1.418–11.184] likelihood of having dementia compared with those without these two factors. This study showed that the prevalence of dementia was significantly higher in diabetics than non-diabetics. APOE ε4 further enhanced the risk. Show more
Keywords: Alzheimer's disease, apolipoprotein E, dementia, diabetes
DOI: 10.3233/JAD-2012-120442
Citation: Journal of Alzheimer's Disease, vol. 32, no. 4, pp. 1019-1027, 2012
Authors: Zhou, Bin | Zhao, Qianhua | Teramukai, Satoshi | Ding, Ding | Guo, Qihao | Fukushima, Masanori | Hong, Zhen
Article Type: Research Article
Abstract: We aimed to investigate the natural history of Alzheimer's disease (AD) and the risk factors associated with survival. We performed a 5-year retrospective cohort study on 467 consecutive outpatients clinically diagnosed with AD and treated between January 1, 2003, and December 31, 2006, at Huashan Hospital, Shanghai, China. The primary endpoint in this study was survival. At baseline, we evaluated the patients' demographic characteristics and neuropsychological characteristics, comorbid conditions, neuroimaging findings, complications, and neurological signs. Among the 467 patients, 398 survived. Male gender, age, and disease severity were associated with mortality. Survival analysis using the proportional hazard model with adjustments …for gender, age, and disease stage revealed that the cognition factors that predicted longer survival included high total score [hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.76–0.96] and sub-scores in the verbal fluency test (animals, vegetables, and fruits). The presence of at least 1 complication was an independent factor predictive of a decreased lifespan (HR, 5.55; 95% CI, 1.91–16.13). In AD patients, presence of complications was an indicator of poor survival, while good performance in assessments of executive function, such as the verbal fluency test and Stroop test, at baseline was associated with longer survival. Show more
Keywords: Alzheimer's disease, complications, executive function, prognosis, retrospective longitudinal
DOI: 10.3233/JAD-2010-100318
Citation: Journal of Alzheimer's Disease, vol. 22, no. 2, pp. 673-682, 2010
Authors: Xiao, Zhenxu | Wu, Wanqing | Zhao, Qianhua | Liang, Xiaoniu | Luo, Jianfeng | Ding, Ding
Article Type: Research Article
Abstract: Background: Growing evidence has shown the association between ophthalmic disorders and the risk of cognitive decline, but the conclusions were inconsistent. Objective: This study aimed to verify the hypothesis that glaucoma or cataract or their combination is associated with incident dementia in Chinese older adults. Methods: We followed up 1,659 non-demented community residents aged ≥60 years for an average of 5.2 years in the Shanghai Aging Study. Histories of glaucoma and cataract were collected based on self-report and medical record confirmation. Consensus diagnoses of incident dementia and Alzheimer’s disease (AD) were made based on neurological and neuropsychological assessments. Results: During …the follow-up, 168 cases (10.1%) of incident dementia and 124 cases (7.5%) of incident AD were identified. Participants with glaucoma at baseline had a significant risk of incident dementia (hazard ratio [HR] = 2.38, 95% confidence interval [CI] 1.08–5.23) and incident AD (HR = 2.77, 95% CI 1.17–6.56) after adjusting for confounders. There was no association between cataract and incident dementia (HR = 1.23, 95% CI 0.85–1.79) or AD (HR = 1.14, 95% CI 0.73–1.77). Those who had both glaucoma and cataract were more likely to develop dementia (HR = 3.08, 95% CI 1.29–7.37) and AD (HR = 3.72, 95% CI 1.52–9.14), compared to those without ophthalmic conditions. Conclusion: Glaucoma is an independent risk factor of incident dementia and AD. The comorbidity of glaucoma and cataract may significantly increase the risk of dementia and AD. Show more
Keywords: Alzheimer’s disease, cohort studies, cataract, dementia, glaucoma, ophthalmology
DOI: 10.3233/JAD-200295
Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 529-537, 2020
Authors: Lei, Qiqi | Tian, Hongdou | Xiao, Zhenxu | Wu, Wanqing | Liang, Xiaoniu | Zhao, Qianhua | Ding, Ding | Deng, Wei
Article Type: Research Article
Abstract: Background: The relationship between body mass index (BMI) and dementia is inconclusive. Undesirable loss of fat-free mass is a risk factor for cognitive decline while obesity is also a risk factor for cardio-metabolic disorders among the older adults. Objective: This study aimed to examine the association between BMI and incident all-cause dementia among Chinese older adults using a prospective study. Methods: Participants were 1,627 community residents aged 60 or older without dementia from the Shanghai Aging Study. Cox regression models, incorporated with restricted cubic splines, were used to explore a nonlinear association between baseline BMI and risk of all-cause dementia …as measured by hazard ratio (HR) using both frequentist and Bayesian approach. Results: We diagnosed 136 incident dementia cases during the mean follow-up of 5.3 years. Compared with moderate BMI (18.5–24.0 kg/m2 ), low BMI (< 18.5 kg/m2 ) were related to an increased risk of dementia with the HR as 3.38 (95% CI 1.50–7.63), while high BMI (≥24.0 kg/m2 ) showed a decreased risk of dementia without statistical significance (HR = 0.91, 95% CI 0.60 to 1.39). Sensitivity analysis in participants without central obesity indicated that the association was still significant with even higher HR. Bayesian approach presented the similar results. Conclusion: Our result indicates that low BMI may contribute to high risk of incident dementia, even in individuals without central obesity. Show more
Keywords: Body mass index, cognitive dysfunction, dementia, proportional hazards models, prospective studies
DOI: 10.3233/JAD-215517
Citation: Journal of Alzheimer's Disease, vol. 86, no. 2, pp. 919-929, 2022
Authors: Cui, Xiaoyan | Wang, Junqiao | Wu, Bei | Zhao, Qianhua | Tang, Xueting | Wang, Jing
Article Type: Review Article
Abstract: Background: Dementia occurring before age 65 is known as young-onset dementia (YOD), with Alzheimer’s disease being the most common type. YOD poses unique challenges for persons and families, impacting their working-age years and family responsibilities. Person-centered interventions and services are essential to improve their quality of life and social engagement. Objective: This study aims to synthesize non-pharmacological interventions for persons with YOD and their families to inform future targeted interventions. Methods: We conducted a systematic literature search across four databases: PubMed, PsycINFO, Scopus, and CINAHL. The included articles were carefully screened, categorized, and synthesized by following Arksey and O’Malley’s five …stages framework. Results: We included 20 studies reported in 24 papers, with 11 studies (14 papers) on persons with YOD and nine studies (10 papers) on families. Quantitative intervention results vary, but qualitative interviews show positive feedback. Stakeholders provided positive evaluations, stating these interventions provided a sense of normalcy, facilitated communication among families, enhanced the independence of persons with YOD, and improved the families’ caregiving self-efficacy, thereby reducing care burden and psychological distress. The heterogeneity among the studies posed integration challenges. Conclusions: Interventions for YOD can improve the quality of life for both persons with YOD and their families. More extensive intervention studies are urgently needed, especially in developing countries, with a focus on family-centered and life course perspectives. In future intervention research design, a more extensive incorporation of stakeholder involvement is essential for successful implementation. Moreover, the integration of new technologies shows promise as a potential avenue for intervention advancement. Show more
Keywords: Alzheimer’s disease, early-onset dementia, non-pharmacological interventions, review, young-onset dementia
DOI: 10.3233/JAD-231006
Citation: Journal of Alzheimer's Disease, vol. 97, no. 4, pp. 1519-1531, 2024
Authors: Wang, Fei | Luo, Jianfeng | Ding, Ding | Zhao, Qianhua | Guo, Qihao | Liang, Xiaoniu | Zhou, Fen | Deng, Wei | Hong, Zhen
Article Type: Research Article
Abstract: Background: Several studies have demonstrated that the elevated fasting blood glucose (FBG) may increase the risk of incident dementia in older adults with or without diabetes mellitus (DM). However, similar results are rarely reported in Chinese population. Objective: This study aimed to demonstrate the association between FBG and risk of incident cognitive decline in older Chinese adults. Methods: We prospectively followed up 1,555 dementia-free participants with baseline FBG measurement in the Shanghai Aging Study. Results: We identified 126 incident dementia cases across a mean of 5.2 years. Cumulative dementia incidence in type II DM participants with higher FBG (>6.1 mmol/L) increased …most dramatically, second with that of non-DM participants with higher FBG, than that of participants with lower FBG (≤6.1 mmol/L). DM participants had a significant higher risk of incident dementia (adjusted HR 1.51, 95% CI 1.25–1.82) by every 1 mmol/L increment of FBG. Among DM participants, baseline FBG was positively related to the rate of annual decline of MMSE (β= 0.10, p = 0.0018). Conclusions: Our results suggest that especially in people with type II DM, effective blood glucose control may help to prevent cognitive impairment in later life. Show more
Keywords: Cognitive function, cohort study, dementia, diabetes mellitus, fasting glucose, incidence
DOI: 10.3233/JAD-180662
Citation: Journal of Alzheimer's Disease, vol. 67, no. 4, pp. 1255-1265, 2019
Authors: Wu, Wanqing | Ding, Ding | Zhao, Qianhua | Wang, Ruru | Liang, Xiaoniu | Xiao, Zhenxu | Luo, Jianfeng | Guo, Qihao | Hong, Zhen
Article Type: Research Article
Abstract: Background: There is significant evidence that physical activity has profound effects on the neurochemistry and plasticity of the brain and may prevent cognitive decline. Objective: This study aimed to determine the association between physical activity and incident dementia among older Chinese adults. Methods: In the prospective phase of the Shanghai Aging Study, 1,648 community-dwellers aged 60 years or older were followed for an average of 5 years. Their physical activity was assessed based on questionnaires. The physical activities were further transformed into metabolic equivalent values. A consensus diagnosis of incident dementia was ascertained based on medical, neurological, and neuropsychological data …and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Results: We identified 166 incident dementia cases; the incidence rate was 19.4 per 1000 person-years. A multivariate Cox regression model indicated that compared to low levels of physical activity, medium-to-high levels of physical activity were associated with a reduced risk of dementia (hazard ratio, 95% confidence interval = 0.62, 0.44–0.89) after adjusting for age, sex, years of education, apolipoprotein E ɛ 4, and other confounders. Conclusion: Our findings demonstrate that medium-to-high level of physical activity is protective against dementia in older adults. Show more
Keywords: Chinese, cognition, cohort studies, dementia, incidence, physical activity
DOI: 10.3233/JAD-190937
Citation: Journal of Alzheimer's Disease, vol. 73, no. 2, pp. 751-758, 2020
Authors: Su, Ya | Fu, Jiayu | Yu, Jintai | Zhao, Qianhua | Guan, Yihui | Zuo, Chuantao | Li, Ming | Tan, Haibo | Cheng, Xin
Article Type: Research Article
Abstract: Background: Flortaucipir (AV-1451) and pyridinyl-butadienyl-benzothiazole 3 (PBB3) are newly developed and commonly used positron emission tomography (PET) tracers to detect tau deposition in tauopathies, including frontotemporal dementia (FTD). [18 F]PM-PBB3, as a second-generation compound, has not been described in FTD so far. Objective: We aim to explore the in vivo performance of [18 F]PM-PBB3 tau PET in an FTD case caused by microtubule-associated protein tau (MAPT) mutation and compare the binding to different tau strains between AV-1451 and PBB3. Methods: We reported the clinical and FDG, [18 F]AV45 amyloid and [18 F]PM-PBB3 tau PET findings in a patient with FTD …of P301L MAPT mutation. Based on our results and published data, we summarized and compared the different utilities of tau PET tracers of AV-1451 and PBB3 in FTD with MAPT mutation. Results: The patient demonstrated slightly diffuse [18 F]PM-PBB3 tau deposition in cerebral lobes especially in the left frontal lobe overlapping with the hypometabolic region detected by FDG PET. From our analysis of 35 FTD patients with MAPT mutation who underwent tau PET, AV-1451 was positive in all (n = 11) patients with mutations known to cause three and four repeat (3R/4R) tau deposition and in 14.3% (n = 2/14) of 4R tauopathies, while positive PBB3 retention was found in all patients with both 3R/4R (n = 2) and 4R (n = 8) tau. Conclusions: [18 F]PM-PBB3 tau PET assisted the diagnosis of FTD with P301L MAPT mutation, and might be useful in the in vivo detection of both 3R/4R and 4R tau domains in the brain of FTD with MAPT mutation. Show more
Keywords: [18F]PM-PBB3, AV-1451, frontotemporal dementia, MAPT mutation, positron emission tomography
DOI: 10.3233/JAD-200287
Citation: Journal of Alzheimer's Disease, vol. 76, no. 1, pp. 149-157, 2020
Authors: Mortimer, James A. | Ding, Ding | Borenstein, Amy R. | DeCarli, Charles | Guo, Qihao | Wu, Yougui | Zhao, Qianhua | Chu, Shugang
Article Type: Research Article
Abstract: Physical exercise has been shown to increase brain volume and improve cognition in randomized trials of non-demented elderly. Although greater social engagement was found to reduce dementia risk in observational studies, randomized trials of social interventions have not been reported. A representative sample of 120 elderly from Shanghai, China was randomized to four groups (Tai Chi, Walking, Social Interaction, No Intervention) for 40 weeks. Two MRIs were obtained, one before the intervention period, the other after. A neuropsychological battery was administered at baseline, 20 weeks, and 40 weeks. Comparison of changes in brain volumes in intervention groups with the No …Intervention group were assessed by t-tests. Time-intervention group interactions for neuropsychological measures were evaluated with repeated-measures mixed models. Compared to the No Intervention group, significant increases in brain volume were seen in the Tai Chi and Social Intervention groups (p < 0.05). Improvements also were observed in several neuropsychological measures in the Tai Chi group, including the Mattis Dementia Rating Scale score (p = 0.004), the Trailmaking Test A (p = 0.002) and B (p = 0.0002), the Auditory Verbal Learning Test (p = 0.009), and verbal fluency for animals (p = 0.01). The Social Interaction group showed improvement on some, but fewer neuropsychological indices. No differences were observed between the Walking and No Intervention groups. The findings differ from previous clinical trials in showing increases in brain volume and improvements in cognition with a largely non-aerobic exercise (Tai Chi). In addition, intellectual stimulation through social interaction was associated with increases in brain volume as well as with some cognitive improvements. Show more
Keywords: Cognition, exercise, intervention studies, magnetic resonance imaging, pilot study, Tai Chi
DOI: 10.3233/JAD-2012-120079
Citation: Journal of Alzheimer's Disease, vol. 30, no. 4, pp. 757-766, 2012
Authors: Ding, Ding | Xiong, Yunyun | Zhao, Qianhua | Guo, Qihao | Chu, Shuguang | Chu, Winnie W.C. | Luo, Jianfeng | Liang, Xiaoniu | Zheng, Li | Hong, Zhen | Wong, Lawrence K.S. | Mok, Vincent C.T.
Article Type: Research Article
Abstract: Background: Unlike western countries, data on white matter hyperintensity (WMH) in community dwelling elderly in Asian population is very limited. Objective: To examine the relation between baseline WMH burden and the risk of incident cognitive decline in a community-based cohort with Chinese-dwelling elderly. Methods: We prospectively evaluated the incident cognitive decline for 226 participants in the Shanghai Aging Study. Baseline WMH severity was visually rated by the age-related white matter changes (ARWMC) scale based on MRI. Cox proportional hazards regression model was used to estimate the relative risk (RR) of total ARWMC scale, global ARWMC score, presence of lacune and …microbleed, for incident cognitive decline by adjusting potential confounders. Results: Forty subjects were identified with incident cognitive decline (new onset 34 mild cognitive impairment and 6 dementia) during a median duration of 6 years follow–up. The incidence of cognitive decline was 3.0 (95% confidence interval [CI] 2.2–4.1) per 100 person-years. Increasing total ARWMC scale [RR1.21 (95% CI 1.06–1.39), p = 0.004)], confluent WMH [RR3.16 (95% CI 1.50–6.64), p = 0.002), and presence of lacunes [RR 2.73 (95% CI 1.21–6.15)] at baseline were independent predictors of incident cognitive decline. Conclusion: Our study demonstrated that confluent WMH may increase the risk of incident cognitive decline by 3 folds in community dwelling subjects. Small vessel disease may cause heavy burden of cognitive impairment in the elderly in China. Show more
Keywords: Cognitive decline, dementia, mild cognitive impairment, small vessel disease, white matter hyperintensity
DOI: 10.3233/JAD-170876
Citation: Journal of Alzheimer's Disease, vol. 61, no. 4, pp. 1333-1341, 2018