Strength together: examining risk and protective factors associated with dementia and cognitive impairment in Aboriginal and Torres Strait Islander peoples through harmonisation of landmark studies.
Humans
Dementia
/ epidemiology
Native Hawaiian or Other Pacific Islander
/ psychology
Cognitive Dysfunction
/ ethnology
Risk Factors
Australia
/ epidemiology
Male
Female
Cohort Studies
Protective Factors
Middle Aged
Aged
Adult
Cross-Sectional Studies
Australian Aboriginal and Torres Strait Islander Peoples
Ageing
Cohort studies
Epidemiology
Indigenous health
Preventative health
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
01 Jun 2024
01 Jun 2024
Historique:
received:
28
09
2023
accepted:
23
05
2024
medline:
2
6
2024
pubmed:
2
6
2024
entrez:
2
6
2024
Statut:
epublish
Résumé
Rates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia. Three cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI). Greater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.
Sections du résumé
BACKGROUND
BACKGROUND
Rates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia.
METHODS/DESIGN
METHODS
Three cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI).
DISCUSSION
CONCLUSIONS
Greater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.
Identifiants
pubmed: 38824519
doi: 10.1186/s12883-024-03688-y
pii: 10.1186/s12883-024-03688-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
185Subventions
Organisme : National Health and Medical Research Council
ID : 1137425
Organisme : National Health and Medical Research Council
ID : 1150337
Organisme : National Health and Medical Research Council
ID : 1137425
Organisme : National Health and Medical Research Council
ID : 1150337
Organisme : National Health and Medical Research Council
ID : 1137425
Organisme : National Health and Medical Research Council
ID : 1150337
Organisme : National Health and Medical Research Council
ID : 1150337
Organisme : National Health and Medical Research Council
ID : 1150337
Organisme : National Health and Medical Research Council
ID : 2006797
Organisme : National Health and Medical Research Council
ID : 1150337
Organisme : National Health and Medical Research Council
ID : 1137425
Informations de copyright
© 2024. The Author(s).
Références
Smith K, Flicker L, Lautenschlager NT, Almeida OP, Atkinson D, Dwyer A, et al. High prevalence of dementia and cognitive impairment in indigenous australians. Neurology. 2008;71(19):1470–3.
doi: 10.1212/01.wnl.0000320508.11013.4f
pubmed: 18799785
Radford K, Lavrencic LM, Delbaere K, Draper B, Cumming R, Daylight G, et al. Factors Associated with the high prevalence of dementia in older Aboriginal australians. J Alzheimers Dis. 2019;70(s1):S75–85.
doi: 10.3233/JAD-180573
pubmed: 30507573
pmcid: 6700619
Russell SG, Quigley R, Thompson F, Sagigi B, LoGiudice D, Smith K, et al. Prevalence of dementia in the Torres Strait. Australas J Ageing. 2021;40(2):e125–32.
doi: 10.1111/ajag.12878
pubmed: 33169520
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013;9(1):63–e752.
doi: 10.1016/j.jalz.2012.11.007
pubmed: 23305823
Health, AIo. Welfare. Aboriginal and Torres Strait Islander Stolen generations aged 50 and over. Australian Institute of Health and Welfare; 2018.
Aboriginal. and Torres Strait Islander life expectancy 2020–2022 [press release]. Canberra, 2020–2022.
Collins HP, AM Q, Kalisch D. Life expectancy and mortality of Aboriginal and Torres Strait Islander people.
Smith K, Flicker L, Dwyer A, Atkinson D, Almeida OP, Lautenschlager NT, et al. Factors associated with dementia in Aboriginal australians. Australian New Z J Psychiatry. 2010;44(10):888–93.
doi: 10.3109/00048674.2010.491816
Lo Giudice D, Smith K, Fenner S, Hyde Z, Atkinson D, Skeaf L, et al. Incidence and predictors of cognitive impairment and dementia in Aboriginal australians: a follow-up study of 5 years. Alzheimer’s Dement J Alzheimer’s Assoc. 2016;12(3):252–61.
doi: 10.1016/j.jalz.2015.01.009
Radford K, Delbaere K, Draper B, Mack HA, Daylight G, Cumming R, et al. Childhood Stress and Adversity is Associated with late-life dementia in Aboriginal australians. Am J Geriatr Psychiatry. 2017;25(10):1097–106.
doi: 10.1016/j.jagp.2017.05.008
pubmed: 28689644
Lavrencic LM, Delbaere K, Broe GA, Daylight G, Draper B, Cumming RG, et al. Dementia incidence, APOE genotype, and risk factors for Cognitive decline in Aboriginal australians: a longitudinal cohort study. Neurology. 2022;98(11):e1124–36.
doi: 10.1212/WNL.0000000000013295
pubmed: 35140131
Russell SG, Quigley R, Thompson F, Sagigi B, Miller G, LoGiudice D, et al. Factors associated with the increased risk of dementia found in the Torres Strait. Australas J Ageing. 2022;41(1):88–96.
doi: 10.1111/ajag.12980
pubmed: 34351674
Anstey KJ, Ee N, Eramudugolla R, Jagger C, Peters R. A systematic review of Meta-analyses that evaluate risk factors for dementia to evaluate the quantity, Quality, and global representativeness of evidence. J Alzheimers Dis. 2019;70:S165–86.
doi: 10.3233/JAD-190181
pubmed: 31306123
pmcid: 6700718
Radford K, Mack HA, Robertson H, Draper B, Chalkley S, Daylight G, et al. The Koori growing Old Well Study: investigating aging and dementia in urban Aboriginal australians. Int Psychogeriatr. 2014;26(6):1033–43.
doi: 10.1017/S1041610213002561
pubmed: 24507414
LoGiudice D, Smith K, Thomas J, Lautenschlager NT, Almeida OP, Atkinson D, et al. Kimberley Indigenous Cognitive Assessment tool (KICA): development of a cognitive assessment tool for older indigenous australians. Int Psychogeriatr. 2006;18(2):269–80.
doi: 10.1017/S1041610205002681
pubmed: 16403247
Jackson Pulver L, Broe A, Grayson D, Chalkley S, Flicker L, Daylight G et al. Dementia screening for urban Aboriginal Australians: The modified kimberly indigenous cognitive assessment (mKICA). 2012.
LoGiudice D, Strivens E, Smith K, Stevenson M, Atkinson D, Dwyer A, et al. The KICA screen: the psychometric properties of a shortened version of the KICA (Kimberley Indigenous Cognitive Assessment). Australas J Ageing. 2011;30(4):215–9.
doi: 10.1111/j.1741-6612.2010.00486.x
pubmed: 22176567
Russell S, Quigley R, Strivens E, Miller G, Norrie J, Craig D, et al. Validation of the Kimberley Indigenous Cognitive Assessment short form (KICA-screen) for telehealth. J Telemed Telecare. 2021;27(1):54–8.
doi: 10.1177/1357633X19860309
pubmed: 31284810
Radford K, Mack HA, Draper B, Chalkley S, Daylight G, Cumming R, et al. Prevalence of dementia in urban and regional Aboriginal australians. Alzheimer’s Dement J Alzheimer’s Assoc. 2015;11(3):271–9.
doi: 10.1016/j.jalz.2014.03.007
Lavrencic LM, Delbaere K, Broe GA, Daylight G, Draper B, Cumming RG, et al. Dementia incidence, APOE genotype, and risk factors for Cognitive decline in Aboriginal australians: a longitudinal cohort study. Neurology. 2022;98(11):1124–36.
doi: 10.1212/WNL.0000000000013295
Bradley K, Smith R, Hughson J-A, Atkinson D, Bessarab D, Flicker L et al. Let’s CHAT (community health approaches to) dementia in Aboriginal and Torres Strait Islander communities: protocol for a stepped wedge cluster randomised controlled trial. BMC Health Serv Res. 2020;20(1).
Council AHaMR. AH&MRC Ethical Guidelines Key Principles (2020) V2.0. 2020.
Council NHaMR. Keeping research on track II: a companion document to ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: guidelines for researchers and stakeholders. Canberra National Health and Medical Research Council; 2018.
Association AP. Diagnostic and statistical manual of mental disorders. Washington: American Psychiatric Association; 1997. p. 317.
Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–734.
doi: 10.1016/S0140-6736(17)31363-6
pubmed: 28735855
Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–46.
doi: 10.1016/S0140-6736(20)30367-6
pubmed: 32738937
pmcid: 7392084
Peters R, Booth A, Rockwood K, Peters J, D’Este C, Anstey KJ. Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis. BMJ open. 2019;9(1):e022846.
doi: 10.1136/bmjopen-2018-022846
pubmed: 30782689
pmcid: 6352772
Alagiakrishnan K, Hsueh J, Zhang E, Khan K, Senthilselvan A. White matter disease severity of the brain and its association with geriatric syndromes. Postgrad Med. 2013;125(6):17–23.
doi: 10.3810/pgm.2013.11.2708
pubmed: 24200757
Sakakibara R, Panicker J, Fowler CJ, Tateno F, Kishi M, Tsuyuzaki Y, et al. Vascular incontinence: incontinence in the elderly due to ischemic white matter changes. Neurol Int. 2012;4(2):52–9.
doi: 10.4081/ni.2012.e13
World Health Organisation. Risk reduction of cognitive decline and dementia: WHO guidelines. 2019.
Kivipelto M, Ngandu T, Laatikainen T, Winblad B, Soininen H, Tuomilehto J. Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Lancet Neurol. 2006;5(9):735–41.
doi: 10.1016/S1474-4422(06)70537-3
pubmed: 16914401
Anstey KJ, Cherbuin N, Herath PM, Qiu C, Kuller LH, Lopez OL, et al. A self-report risk index to predict occurrence of dementia in three independent cohorts of older adults: the ANU-ADRI. PLoS ONE. 2014;9(1):e86141.
doi: 10.1371/journal.pone.0086141
pubmed: 24465922
pmcid: 3900468
Organization WH. Guidelines for ATC classification and DDD assignment. 1996.
MacDonald JP, Barnes DE, Middleton LE. Implications of risk factors for Alzheimer’s disease in Canada’s indigenous population. Can Geriatr J. 2015;18(3):152–8.
doi: 10.5770/cgj.18.159
pubmed: 26495049
pmcid: 4597815
Ma’u E, Cullum S, Cheung G, Livingston G, Mukadam N. Differences in the potential for dementia prevention between major ethnic groups within one country: a cross sectional analysis of population attributable fraction of potentially modifiable risk factors in New Zealand. Lancet Reg Health - Western Pac. 2021;13:100191.
doi: 10.1016/j.lanwpc.2021.100191
Thompson F, Russell S, Quigley R, Sagigi B, Taylor S, McDonald M, et al. Potentially preventable dementia in a First Nations population in the Torres Strait and Northern Peninsula Area of North Queensland, Australia: a cross sectional analysis using population attributable fractions. Lancet Reg Health West Pac. 2022;26:100532.
pubmed: 35833207
pmcid: 9272378
Ashby-Mitchell K, Burns R, Shaw J, Anstey K. Proportion of Dementia in Australia explained by common modifiable risk factors. Alzheimer’s Res Therapy. 2017;9:11.
doi: 10.1186/s13195-017-0238-x
Zhang J, Lenarczyk R, Marin F, Malaczynska-Rajpold K, Kosiuk J, Doehner W, et al. The interpretation of CHA2DS2-VASc score components in clinical practice: a joint survey by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, the EHRA Young Electrophysiologists, the association of cardiovascular nursing and allied professionals, and the European Society of Cardiology Council on Stroke. EP Europace. 2021;23(2):314–22.
doi: 10.1093/europace/euaa358
Schnabel RB, Sullivan LM, Levy D, Pencina MJ, Massaro JM, D’Agostino RB, et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet. 2009;373(9665):739–45.
doi: 10.1016/S0140-6736(09)60443-8
pubmed: 19249635
pmcid: 2764235
Kanis J, McCloskey E, Johansson H, Oden A, Ström O, Borgström F. Development and use of FRAX® in osteoporosis. Osteoporos Int. 2010;21:407–13.
doi: 10.1007/s00198-010-1253-y
Nguyen ND, Frost SA, Center J, Eisman JA, Nguyen TV. Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int. 2008;19:1431–44.
doi: 10.1007/s00198-008-0588-0
pubmed: 18324342