Marriage can, milkshake cannot?…

Can marriage protect us against dementia?

Researchers at Loughborough University wanted to see whether marriage offers a protective role in dementia.  The study was part of the English Longitudinal Study of Ageing. This is a population-based longitudinal  study of a representative sample of adults aged 50 and older. It began in 2000.  Repeat assessments take place every two years.  2004 assessment was taken as the baseline  for this analysis as this was the first time a measure of loneliness was first introduced in to the data collection.  The primary data was collected by a face-to-face interview.  Additional assessments in subsequent waves are done using  postal questionnaires . Dementia was defined as physician diagnosis of dementia, when participants were not able to provide information,  carers completed the short form IQCODE. On this scale, a score of 3.5 was used to diagnose dementia.  During the face-to-face assessment,   memory  tests (immediate and delayed recall using a word list and   MMSE elements of time orientation)  were carried out. Loneliness was measured using the revised UCLA  scale . Social network was assessed by looking at their actual contacts   with children, family and friends.  Participants also received a score for social networks.

Results

During the follow up period,   220 were diagnosed with dementia that is 3.3 percentage.  Regression analysis showed that marital status was associated with dementia with  HR of 1.77 . Social isolation did not come out as an independent predictor of dementia, However, loneliness was associated with future dementia risk with an HR of 1.44 . i.e. There was 44 percentage increase in the risk of future dementia for every unit change in loneliness.

 Conclusion

this study looked at the risk of dementia in relation to social relationships. Loneliness is positively and independently related to increased risk of future dementia.  Being married / having close relationships are protective factors.

How does this happen?

Studies have often found that married men on average have healthier lifestyles than single men, such as better diets, less alcohol, less smoking and more and earlier health services visits.

Socially isolated and lonely may experience heightened exposure to stress may  lack the social resources to buffer biological changes. isolation and loneliness are both associated with higher cortisol levels and more inflammatory markers.

Social isolation by itself is not a risk factor.   Previous research  ( Wilson et al. 2007, Holwerda et al 2014) ) have shown that loneliness is a predictive factor for dementia onset .  Social isolation , as shown in some previous studies , was not shown to be a risk factor in this study.  It is possible that the differences in social network assessment and scoring may explain this. Present study appears to have a better definition and differentiation of network assessment and loneliness.

Summary of study: 

Loneliness, Social Integration, and Incident Dementia Over 6 Years: Prospective Findings From the English Longitudinal Study of Ageing.Snorri Bjorn Rafnsson,Martin Orrell, Eleonora d’Orsi, Eef Hogervorst,and Andrew Steptoe. J Gerontol B Psychol Sci Soc Sci, 2017, Vol. 00, No. 00, 1–11 doi:10.1093/geronb/gbx08

 

 Milkshakes for dementia?

Diet is considered to be an important modifiable risk factor for dementia and some nutrient interventions has shown some early benefits previously. A multi-nutrient combination which contains DHA, EPA, uridine monophosphate, vitamins (B12, B6, C, E)  , folic acid, phospholipids and selenium has recently been marketed as a medicinal drink.  It is considered that this can provide neuro protection by supplying the rate-limiting compounds  for brain phospholipid synthesis.

LipiDiDiet study group reports the results of an RCT attempting to see whether this milkshake is effective. This was a 24 month randomised controlled, double-blind, parallel group study conducted  across 11 sites in Finland, Germany, Netherlands and Sweden. Patients aged 55 to 85 with an MMSE score of 24 points or higher who met criteria for prodromal Alzheimer’s disease and  had evidence for underlying Alzheimer’s   pathology (CSF/MRI/  FDG PET)  were recruited. Those with   depressive disorders , substance use   disorders, as well as those on  memory  medications or multivitamin components were excluded . Active group were given the nutritional supplement (125 mL once a day  drink ). Control group received 125 ml  of similar flavoured drink ( same calories).The primary efficacy endpoint was the change over 24 months in a composite score of cognitive performance.

 

 Results

311 participants were randomly assigned.   drop out was similar (21-22%) in both groups.   Groups were similar at baseline except for the MMSE score.

There was no statistically significant difference between groups on the primary or secondary outcome criteria  at any time. There was a significantly less reduction in hippocampal volume and less increase in ventricular volume  during the 24 months in the active  group.  There was no statistically significant difference between groups for the whole brain  volumes.

During the 24 month trial period , 37% of control group and 41% of active group were diagnosed with dementia .

Conclusion

The nutrient intervention had no significant effect on the primary endpoints over a two-year period in prodromal Alzheimer’s disease however there are some benefits on brain atrophy measures . The brain effect seen in this study warrants  further research.

Summary of the article :

24-month intervention with a speci c multinutrient in people with prodromal Alzheimer’s disease (LipiDiDiet):a randomised, double-blind, controlled trialHilkka Soininen, Alina Solomon, Pieter Jelle Visser, Suzanne B Hendrix, Kaj Blennow, Miia Kivipelto, Tobias Hartmann, on behalf of the LipiDiDiet clinical study group. Lancet neurology 2017.Published Online. October 30, 2017 http://dx.doi.org/10.1016/ S1474-4422(17)30332-0

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