The prevalence of mild cognitive impairment in Latin America and the Caribbean: a systematic review and meta-analysis

in Aging and Mental Health (in press)

The Role of Country-Level Availability and Generosity of Healthcare Services, and Old-Age Ageism for Missed Healthcare during the COVID-19 Pandemic Control Measures in Europe

in Journal of Aging and Health (2022)

Objectives: The effects of the COVID-19 outbreak on non-COVID-19-related healthcare need further investigation. Methods: Using the Survey of Health, Ageing and Retirement in Europe’s COVID-19 module (2020 ... [more ▼]

Objectives: The effects of the COVID-19 outbreak on non-COVID-19-related healthcare need further investigation. Methods: Using the Survey of Health, Ageing and Retirement in Europe’s COVID-19 module (2020) (N = 57,025), country-level data from the European Social Survey (2008) and OECD (2020), and logistic regressions, this study examines predictors of older Europeans’ forgone, postponed, and denied healthcare during the pandemic. Results: Country-level availability of physicians, healthcare systems’ generosity, and beliefs that older persons burden healthcare systems all increased forgone healthcare. Healthcare system generosity increased postponed and denied healthcare. Greater medical resources decreased denied healthcare. Furthermore, missed healthcare varied by individual-level gender (higher rates among women), age, education, and health. Discussion: This study reveals predictors of missed healthcare during the pandemic. To decrease unintended health consequences of a pandemic, both individual-level determinants, such as gender and health, and contextual-level determinants, such as healthcare systems’ characteristics, should be considered in research and practice. [less ▲]

Determinants of Self-Stigma in People with Parkinson's Disease: A Mixed Methods Scoping Review

in Journal of Parkinson's Disease (2021)

Background: Self-stigma in people with Parkinson's disease (PD) can substantially impact quality of life and possibilities for social participation. An integrative analysis of determinants of self-stigma ... [more ▼]

Background: Self-stigma in people with Parkinson's disease (PD) can substantially impact quality of life and possibilities for social participation. An integrative analysis of determinants of self-stigma has been lacking. Objective: We sought to explore which complementary insights from qualitative and quantitative studies, as well as from expert consultation, could be gained. Methods: An established mixed methods study design was employed to first conduct a mixed methods scoping review of published qualitative and quantitative literature, and then consult with experts to arrive at an exhaustive list of determinants of self-stigma after a thematic synthesis. Results: A total of 87 unique determinants of self-stigma were identified. Quantitative studies and expert consultations mainly identified personal determinants of people with self-stigma (e.g., age, anxiety, or apathy). In contrast, qualitative studies identified social situations associated with self-stigma (e.g., joint meals of people with typical PD with others). Notably, self-stigma of people with PD was found to be particularly salient in unfamiliar places, at the working place or in contact with people without PD. Across methods, cognitive impairment, tremor, and abnormal walk and unsteady gait, respectively, were associated with self-stigma. Conclusion: The mixed method study design yielded complementary insights, but also factors commonly associated with self-stigma across methods. Future prioritization exercises may gain further insights into self-stigma of people with PD. Facilitating social encounters by both addressing needs of affected people and raising knowledge and public awareness may improve quality of life in people with PD [less ▲]

Machine learning and health inequalities

Presentation (2021, November 08)

The retrograde procedural memory in people with Parkinson’s disease with or without freezing of gait – a cross-sectional study

Poster (2021, September 17)

Objective: To investigate the retrograde procedural memory in people with typical Parkinson’s disease (PwP) with or without freezing of gait (FOG). We hypothesized that the retrograde procedural memory is ... [more ▼]

Objective: To investigate the retrograde procedural memory in people with typical Parkinson’s disease (PwP) with or without freezing of gait (FOG). We hypothesized that the retrograde procedural memory is more strongly impaired in patients with FOG (FOG+) than in patients without FOG (FOG-). Background: Given that cognitive functions, like executive control and automaticity, are crucial for mobility, it is of great importance to get a deeper knowledge of the cognitive impairment that may interfere with walking and causing gait disturbances in PwP, i.e. FOG. The integrity of retrograde procedural memory, the ability to execute skills that have been learned in earlier life stages, is essential for a person’s ability to complete routine, procedural activities like walking. As FOG is characterized as a de-automatization disorder, we hypothesized an impairment of the retrograde procedural memory in patients with FOG. Methods: A total of 194 patients from the Luxembourg Parkinson’s study were included into the cross-sectional study. All patients were assigned to the FOG+ / FOG- groups based on a semi-structured interview conducted by a study physician. The extended evaluation system of the cube copying test was applied to evaluate both the cube-drawing procedure, representing the retrograde procedural memory, and the final result, representing the visuo-constructive abilities (Pauly et al., 2020, MDS abstract). We compared the cube copying performance of n=97 FOG+ with n=97 age-, gender- and education-matched FOG-. Results: FOG+ scored lower on the cube copying procedure compared to the FOG- (p=0.027), which is suggestive of an impaired retrograde procedural memory in FOG+. No significant differences in the visuo-constructional abilities were detected (p=0.945). Conclusion: In line with FOG being considered a de-automatization of walking, a skill acquired in earlier life stages, the present results suggest that PwP with FOG have an impaired retrograde procedural memory in comparison to PwP without FOG. The results lend support to the ability of the extended evaluation system of the cube copying test to assess impaired retrograde procedural memory and help improve our understanding of behavioral symptoms in PwP. [less ▲]

Investigating the associations of trajectories of depressive symptoms and self-perceived health and incident dementia : an unsupervised machine learning approach.

Poster (2021, July)

Background: Risk factors for dementia show inter-individually varying trajectories over the lifespan. However, risk factors have been mainly investigated with one time-point assessments. New research ... [more ▼]

Background: Risk factors for dementia show inter-individually varying trajectories over the lifespan. However, risk factors have been mainly investigated with one time-point assessments. New research suggests that certain risk factor trajectories are associated with increased risk of adverse cognitive outcomes (Demnitz et al., 2020 [https://doi.org/10.1101/2020.05.20.20106963]; Singh-Manoux et al., 2018 [https://doi.org/10.1016/j.jalz.2017.06.2637]). However, it remains unclear how sequential and simultaneous changes of risk factors alter the individual risk for developing dementia. Testing the joint contribution of trajectories of depressive symptoms and self-perceived health on incidence of dementia, we hypothesized that consistently poor as well as deteriorating trajectories increase the risk for incident dementia, and explored possible interactions of the trajectories. Method: A total of 5,326 respondents to the SHARE survey, mean age 73.9 years, and 6 complete follow-ups spanning ~13 years, answered the EURO-D depression scale, self-perceived health (SPH) (t1-t5), and self-reported dementia diagnosis at last follow-up (t6). To investigate the predictive ability of distinct longitudinal trajectories, we applied unsupervised statistical learning methods (K-means cluster modelling). Clusters indicated distinct risk factor trajectories, which were used as exposures in stepwise logistic regressions to predict incident dementia, controlling for age, gender, education, and country. Result: Cluster analysis revealed five distinct trajectories each for SPH and EURO-D, with varying dementia incidence. In stepwise logistic regressions, respondents with trajectories “consistently poor health” and “consistently high depression” showed elevated risk of dementia (OR = 4.02 [1.39, 14.75] and OR = 2.26 [1.03, 4.95], respectively) compared to the combined baseline risk for “consistently low depression” and “consistently good health”. Interactions were not significant. However, respondents with the combination of “consistently high depression” and “consistently poor health” showed increased risk (N = 246; 6.1% dementia). Conclusion: Applying unsupervised machine learning is helpful to incorporate longitudinal information on depressive symptoms and self-perceived health and model these risk factors longitudinally to test their contribution to explain incidence of dementia. The predictive ability of the trajectories of depressive symptoms and self-perceived health for dementia indicates the potential for improving the identification of people at risk for developing dementia in late life by exploiting trajectory information readily accessible through regular medical check-ups in old age. [less ▲]

Luxembourg

in Immergut, E.; Anderson, K.; Devitt, C. (Eds.) et al Health politics in Europe: A handbook (2021)

Symposium: Contextual and life-course determinants of later-life cognitive functioning and dementia

Scientific Conference (2021, June)

Exploring the frequency of anxiety and depression symptoms in a Brazilian sample during the COVID-19 outbreak

in International Journal of Environmental Research and Public Health (2021), 18(9),

Returns to Educational and Occupational Attainment in Cognitive Performance for Middle-Aged South Korean Men and Women

in Gerontology and Geriatric Medicine (2021), 7

Background: Gender differences in late middle-age cognitive performance may be explained by differences in educational or occupational attainment rates, or gender-patterned returns of similar education ... [more ▼]

Background: Gender differences in late middle-age cognitive performance may be explained by differences in educational or occupational attainment rates, or gender-patterned returns of similar education and occupation to cognitive reserve. We tested these competing hypotheses in the historically highly gender unequal context of South Korea. Methods: Data came from the 2006 wave of the Korean Longitudinal Study of Aging. We included adults aged 45–65 years. Using quantile regression decompositions, we decomposed cognitive performance differences across quantiles into differences due to rates of educational and occupational attainment and differences due to divergent returns to those characteristics. Results: Gender-based cognitive performance differences across deciles were driven by differences in rates of educational and occupational attainment, while the returns to these characteristics were similar for both genders. Conclusions: Findings suggest that educational and occupational characteristics contribute to cognitive performance similarly in men and women, but discordant rates of these characteristics contribute to performance gaps. [less ▲]