Social networks, social participation and cognition: effects across the life-course
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Transcript of Social networks, social participation and cognition: effects across the life-course
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Laura Fratiglioni— New York—September 2008
NYC Meeting
Social networks, social participation and cognition: effects across the life-course
MacArthur Foundation Aging Society Network
Laura Fratiglioni
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Laura Fratiglioni— New York—September 2008
http://www.KI-SU-ARC.se
Bengt Winblad
HuiXin Wang, Stephanie Paillard-Borg
Marti Parker, Anita Karp
Lars Bäckman, Agneta Herlitz, Ross Andel, Stuart MacDonald
USA - Alzheimer’s AssociationSwedish Research Councils FAS and VRSwedish Brain Power Initiative
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Laura Fratiglioni— New York—September 2008
Social networks, social
participation
and cognition:
Effects across the life-course
The topic
Psychosocial factors
Dementia risk in late life
Personality
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Laura Fratiglioni— New York—September 2008
OUTLINE
1. Life course approach to dementia risk
2. Current aetiological hypotheses
3. Studied psychosocial factors
4. New studies from the Kungsholmen
Project
NYC Meeting
Psychosocial factors in dementia:
effects across the life-course
MacArthur Foundation Aging Society Network
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The Kungsholmen ProjectStockholm, Sweden
1987-89 1994-96 1997-98
1st follow-up
Baseline
1991-93
2nd follow-up
3rd follow-up
1999-2000
4thfollow-up
1810 participants, 75+ old at baselineLiving in a central area of Stockholm
Exposureassessment
Detection of the incident cases
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Laura Fratiglioni— New York—September 2008
Birth Childhood- Adult life- Old2nd decade Middle age Transition age
Risk Factors
Protective Factors
0 20 60 750
10
20
30
40
50
60
30- 65- 75- 85- 95+
Fratiglioni et al,1999; All continents
Lobo et al, 2000;Europe
Dementia Prevalence per 100
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Laura Fratiglioni— New York—September 2008
Birth Childhood- Adult life- Old2nd decade Middle age Transition age
Risk Factors
Protective Factors
0 20 60 75
Genes
Reserve Education, Occupation, Active hypothesis life, Social network
Vascular Midlife hypertension, Diabetes, hypothesis Obesity, Smoking, HD, Stroke
Inflammatory hypoth.: HRT, NSAID
Oxidative stress Diet, Folate & B12, hypothesis Antioxidant
Toxic hypothesis: Occupat. exposures
Psych. stress Drugs, cortisol levels. life events, work-related stress
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Laura Fratiglioni— New York—September 2008
Birth Childhood- Adult life- Old2nd decade Middle age Transition age
Risk Factors
Protective Factors
0 20 60 75
Genes
Reserve Education, Occupation, Active hypothesis life, Social network
Vascular Midlife hypertension, Diabetes, hypothesis Obesity, Smoking, HD, Stroke
Inflammatory hypoth.: HRT, NSAID
Oxidative stress Diet, Folate & B12, hypothesis Antioxidant
Toxic hypothesis: Occupat. exposures
Psych. stress Drugs, cortisol levels. life events, work-related stress
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Laura Fratiglioni— New York—September 2008
Several biological mechanisms contributes to dementia
Psychosocial factors may act through common pathways related to at least 3 hypotheses:
1.Reserve hypothesis
2.Vascular hypothesis
3.Stress hypothesis
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Laura Fratiglioni— New York—September 2008
Psychosocial factors in dementia
1. Education2. SES
3. Work stress4. Work complexity
5. Social network6. Leisure activity:
mental, physical and social activities
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The Faenza Project
De Ronchi et al2005
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Laura Fratiglioni— New York—September 2008
Biological evidence
Bennett, Wilson et al, Neurology 2003 Religious Order Study, 130 subjects
Global cognitivefunction
Summary meausure of AD pathology
Years of schooling90th percentile
50th percentile
10th percentile
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Results from the KP
Adjusted RR for Dementia
Education SES
High High 1
High Low 0.9 (0.2-3.6)
Low High 2.2 (1.3-3.8)
Low Low 2.8 (1.8-4.6)
Karp et al, Am J Epidemiol 2004
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SES at age Adjusted20 40 60 RR for AD
High/ High/ High 1
Low/ High/ High 1.5 (0.8-2.9)
Low/ Low/ High 2.4 (1.1-5.4)
Low/ Low/ Low 1.7 (1.0-3.1)
Karp et al, Am J Epidemiol 2004
Father’s occup. (manual/labour):
RR for dementia=4.0 (2.5-6.4)
Moceri et al. 2001
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laura fratiglioni, 080125
Risk Factors
Protective Factors
0 20 60 75
Adult life - Middle age
Low Education
Childhood-2nd decade
Low SES
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Laura Fratiglioni— New York—September 2008
Psychosocial factors in dementia
1. Education2. SES
3. Work stress4. Work complexity
5. Social network6. Leisure activity:
mental, physical and social activities
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aRR (95%CI)Work complexity
With data 0.9 (0.8-1.0)
With people 0.9 (0.8-1.0)
With things 1.1 (1.0-1.1)
Karp et al, J Am Ger Psychiatry,
in press
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Education Work complexity Low Low Ref
High Low Decreased dementia risk
High High Same decrease in dementia risk
Low High Same decrease in dementia risk
Karp et al, J Am Ger Psychiatry,
in press
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Risk Factors
Protective Factors
0 20 60 75
Adult life - Middle age
Low Education
Childhood-2nd decade
Low SES
Workcomplexity
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Karasek’s job strain model
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aRR (95%CI)Work stress
Job controlLow-moderate vs. high 1.9 (1.2-3.0)
Job demands Low-moderate vs. high 1.3 (0.9-1.8)
Wang et al, unpublished data
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Wang et al, unpublished data
aRR (95%CI)Job strain
Active Ref
Low strain 0.8 (0.2-3.2)
Passive 1.8 (1.1-3.0)
High strain 1.8 (1.1-2.9)
RR adjusted for age, gender, and education, depressive symptoms and cardiovascular diseases
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Risk Factors
Protective Factors
0 20 60 75
Adult life - Middle age
Low Education
Childhood-2nd decade
Low SES
Workcomplexity
Workstress
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Laura Fratiglioni— New York—September 2008
Psychosocial factors in dementia
1. Education2. SES
3. Work stress4. Work complexity
5. Social network6. Leisure activity:
mental, physical and social activities
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Laura Fratiglioni— New York—September 2008
Social network and dementia incidence
0
5
10
15
20
25
Rel
ativ
e ris
k an
d 95
% C
I
1 2 3 4
1. Extensive social network
2. Moderate social network
3. Limited social network
4. Poor social network
(Fratiglioni et al, Lancet 2000
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RR (95%CI)
High mental score 0.71(49-1.03)
High physical score 0.61 (0.42-0.87)
High social score 0.68 (0.47-0.99)
Karp et al, Dement Geriatr Cogn Disord
2005
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Risk Factors
Protective Factors
0 20 60 75
Adult life - Middle age
Low Education
Childhood-2nd decade
Low SES
Workcomplexity
Workstress
Poorsocial network
Leisure activity:
-Mental activity-Social activity-Physical activity
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SEM- confirmatory analysis
Early Life
Adulthood
Late Life
Education
SES at 20yrs
Psychological demands
Control at work
Complexity with data
Complexity with people
Physical activities
Mental activities
Social activities
e1
e2
e3
e4
e5
e6
e7
e8
e9
Prelim
inar
y
Resul
ts
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Adjusted Hazard ratios for dementia
Early LifeAdulthood
Late Life
Continous 0.61 (0.41-0.90)
0.53(0.31-0.91)
0.70(0.53-0.92)
Dichotomised(Median)
0.66 (0.46-0.95)
0.60 (0.42-0.87)
0.52 (0.37-0.73)
Prelim
inar
y
Resul
ts
Separate models
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Adjusted Hazard ratios for dementia
Early LifeAdulthood
Late Life
Continous 0.61 (0.41-0.90)
0.53(0.31-0.91)
0.70(0.53-0.92)
Dichotomised(Median)
0.66 (0.46-0.95)
0.60 (0.42-0.87)
0.52 (0.37-0.73)
Prelim
inar
y
Resul
ts
Same model
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Adjusted Hazard ratios for dementia
Low score in all 3 periods 1
High scores in one or two time periods
0.52(0.30-0.90)
High scores in all three time periods
0.30(0.17-0.52)
Prelim
inar
y
Resul
ts
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Social networks, social
participation
and cognition:
Effects across the life-course
The topic
Psychosocial factors
Dementia risk in late life
Personality
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Wang et et al, Neurology, in press
Eysenck Personality Inventory
Adjusted HR NeuroticismOne unit decrease 0.98 (0.93-1.03)Low vs. high 0.70 (0.48-1.03) (median)
ExtraversionOne unit decrease 1.07 (0.95-1.09)Low vs. high 1.25 (0.86-1.81) (median)
HRs adjusted for age, sex, education, cognitive functioning, vascular diseases, and depressive symptoms.
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Wang et et al, Neurology,in press
Only inactive or socially isolated subjects
Adjusted HR and 95% C
NeuroticismOne unit decrease 0.93 (0.87-0.99)
Low vs. high 0.51 (0.27-0.96) (median)
HRs adjusted for age, sex, education, cognitive functioning, vascular diseases, and depressive symptoms.
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Conclusions
1. Psychosocial factors acting at different life periods are equally relevant to decrease dementia risk
2. They may have a cumulative beneficial effect
3. Adulthood and late lifestyle variables seem to emerge as the strongest protective factors
4. Among socially isolated and inactive individuals, even high neuroticism alone may increase dementia risk
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SNAC-Kungsholmen
2007 20132010
Ag e g roup 60
Ag e g roup 66
Ag e g roup 72
Ag e g roup 78
Older ag e g roups81+
B
2016
New ag e g roup 81
New ag e g roup 60
2001 2004
B
B
B
B
F 1
F 1
F 1
F 1
F 1
F 2
F 2
F 2
F 3
F 3
B
B
F 2
F 2
F 3
F 4
F 4
F 2F 1
B =bas eline. F 1=firs t, F 2=s econd, F 3=third, F 4=fourth follow-up
C alendarY ears
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Thank you for your
attention
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AD
VaD
OD
Longitudinal studies on dementia in Europe
MIXED CASES
Aguero-Torres, 2001
The outcome
Distribution of dementia subtypes: incident cases
(Fratiglioni et al, Neurology 2000)