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Social networks, social participation and cognition: effects across the life-course

Social networks, social participation and cognition: effects across the life-course. MacArthur Foundation Aging Society Network. NYC Meeting. Laura Fratiglioni. Bengt Winblad HuiXin Wang, Stephanie Paillard-Borg Marti Parker, Anita Karp

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Social networks, social participation and cognition: effects across the life-course

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  1. Social networks, social participation and cognition: effects across the life-course MacArthur Foundation Aging Society Network NYC Meeting Laura Fratiglioni

  2. Bengt Winblad • HuiXin Wang, Stephanie Paillard-Borg • Marti Parker, Anita Karp • Lars Bäckman, Agneta Herlitz, Ross Andel, Stuart MacDonald USA - Alzheimer’s Association Swedish Research Councils FAS and VR Swedish Brain Power Initiative http://www.KI-SU-ARC.se

  3. Social networks, social participation and cognition: Effects across the life-course The topic Psychosocial factors Dementia risk in late life Personality

  4. MacArthur Foundation Aging Society Network NYC Meeting Psychosocial factors in dementia:effects across the life-course OUTLINE 1. Life course approach to dementia risk 2. Current aetiological hypotheses 3. Studied psychosocial factors 4. New studies from the Kungsholmen Project

  5. Exposure assessment Detection of the incident cases

  6. Risk Factors Birth Childhood- Adult life- Old 2nd decade Middle age Transition age 0 20 60 75 Protective Factors

  7. Risk Factors Psych. stress Drugs, cortisol levels. life events, work-related stress Inflammatory hypoth.: HRT, NSAID Toxic hypothesis: Occupat. exposures Genes Vascular Midlife hypertension, Diabetes, hypothesis Obesity, Smoking, HD, Stroke Birth Childhood- Adult life- Old 2nd decade Middle age Transition age 0 20 60 75 Oxidative stress Diet, Folate & B12, hypothesis Antioxidant Reserve Education, Occupation, Active hypothesis life, Social network Protective Factors

  8. Risk Factors Psych. stress Drugs, cortisol levels. life events, work-related stress Inflammatory hypoth.: HRT, NSAID Toxic hypothesis: Occupat. exposures Genes Vascular Midlife hypertension, Diabetes, hypothesis Obesity, Smoking, HD, Stroke Birth Childhood- Adult life- Old 2nd decade Middle age Transition age 0 20 60 75 Oxidative stress Diet, Folate & B12, hypothesis Antioxidant Reserve Education, Occupation, Active hypothesis life, Social network Protective Factors

  9. Several biological mechanisms contributes to dementia Psychosocial factors may act through common pathways related to at least 3 hypotheses: Reserve hypothesis Vascular hypothesis Stress hypothesis

  10. Psychosocial factors in dementia • Education • SES • Work stress • Work complexity • Social network • Leisure activity: mental, physical and social activities

  11. The Faenza Project De Ronchi et al 2005

  12. Biological evidence Bennett, Wilson et al, Neurology 2003 Religious Order Study, 130 subjects Years of schooling 90th percentile 50th percentile 10th percentile Global cognitive function Summary meausure of AD pathology

  13. Results from the KP Karp et al, Am J Epidemiol 2004 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)

  14. Karp et al, Am J Epidemiol 2004 SES at age Adjusted 20 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) Moceri et al. 2001 Father’s occup. (manual/labour): RR for dementia=4.0 (2.5-6.4)

  15. Risk Factors Low Education Low SES Childhood- 2nd decade Adult life - Middle age 0 20 60 75 Protective Factors

  16. Psychosocial factors in dementia • Education • SES • Work stress • Work complexity • Social network • Leisure activity: mental, physical and social activities

  17. Karp et al, J Am Ger Psychiatry, in press aRR (95%CI) Work complexity With data0.9 (0.8-1.0) With people0.9 (0.8-1.0) With things1.1 (1.0-1.1)

  18. Karp et al, J Am Ger Psychiatry, in press Education Work complexity Low Low Ref High Low Decreased dementia risk High High Samedecrease indementia risk Low High Samedecrease indementia risk

  19. Risk Factors Low Education Low SES Childhood- 2nd decade Adult life - Middle age 0 20 60 75 Workcomplexity Protective Factors

  20. Karasek’s job strain model

  21. Wang et al, unpublished data aRR (95%CI) Work stress Job control Low-moderate vs. high1.9 (1.2-3.0) Job demands Low-moderate vs. high1.3 (0.9-1.8)

  22. 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

  23. Risk Factors Low Education Workstress Low SES Childhood- 2nd decade Adult life - Middle age 0 20 60 75 Workcomplexity Protective Factors

  24. Psychosocial factors in dementia • Education • SES • Work stress • Work complexity • Social network • Leisure activity: mental, physical and social activities

  25. 25 20 1.Extensive social network Relative risk and 95% CI 15 2. Moderate social network 10 3. Limited social network 4. Poor social network 5 0 1 2 3 4 Social network and dementia incidence (Fratiglioni et al, Lancet 2000

  26. Karp et al, Dement Geriatr Cogn Disord 2005 RR (95%CI) High mentalscore0.71 (49-1.03) High physicalscore0.61 (0.42-0.87) High socialscore0.68 (0.47-0.99)

  27. Risk Factors Low Education Poor social network Workstress Low SES Childhood- 2nd decade Adult life - Middle age 0 20 60 75 Workcomplexity • Leisure activity: • Mental activity • Social activity • Physical activity Protective Factors

  28. SEM- confirmatory analysis Preliminary Results

  29. Adjusted Hazard ratios for dementia Preliminary Results Separate models

  30. Adjusted Hazard ratios for dementia Preliminary Results Same model

  31. Adjusted Hazard ratios for dementia Preliminary Results

  32. Social networks, social participation and cognition: Effects across the life-course The topic Psychosocial factors Dementia risk in late life Personality

  33. Wang et et al, Neurology, in press Eysenck Personality Inventory Adjusted HR Neuroticism One unit decrease 0.98 (0.93-1.03) Low vs. high 0.70 (0.48-1.03)(median) Extraversion One 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.

  34. Wang et et al, Neurology, in press Only inactive or socially isolated subjects Adjusted HR and 95% C Neuroticism One 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.

  35. Conclusions Psychosocial factors acting at different life periods are equally relevant to decrease dementia risk They may have a cumulative beneficial effect Adulthood and late lifestyle variables seem to emerge as the strongest protective factors Among socially isolated and inactive individuals, even high neuroticism alone may increase dementia risk

  36. SNAC-Kungsholmen

  37. Thank you for your attention

  38. Distribution of dementia subtypes: incident cases The outcome Longitudinal studies on dementia in Europe (Fratiglioni et al, Neurology 2000) MIXED CASES Aguero-Torres, 2001

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