According to new research from the Lawson Health Research Institute and ICES, dementia among homeless people was 1.9 times greater than in the general population, with a higher prevalence in age groups under 85.
The study was published in The Lancet Public Health.
Homeless at risk of juvenile dementia
In one of the first population-based studies of its kind, researchers compared the prevalence of dementia in homeless people with the general population and people living in low-income neighborhoods in Ontario, Canada.
“Not only did we find that dementia was more common among homeless individuals, but the difference was greatest between ages 55 and 64,” says lead author Dr. Richard Booth, a scientist at ICES and the Lawson Health Research Institute and associate professor and Arthur Labatt Family Research Chair in Nursing at Western University.
“There is a strong link between homelessness and accelerated aging, which may be one reason why people experience earlier onset of the disease,” says Dr. Booth.
Using a prevalence ratio, the researchers found that in the 55- to 74-year-old age group, rates of dementia were 4 to 5 times higher than in the general population and 3 to 3.5 times higher than in the age group. low income. A higher prevalence of dementia was found in all age groups under 85 among homeless people, both in males and females.
Homeless people were younger on average, less likely to be female, and less likely to live in rural areas than the other two groups. They also had higher rates of health conditions associated with dementia, such as head trauma, neurological conditions, HIV, and mental health and substance use disorders.
After adjusting for factors such as age, sex, residential area and health conditions, the prevalence rate for homeless people was 1.7 times higher than for the low-income group and 1.9 times higher than for the general population .
“Other research has highlighted that rates of homelessness among older adults are expected to double by 2030, meaning the number of people living with dementia could increase substantially,” says Dr. Booth. “Our findings suggest that homeless individuals should be screened for dementia at a younger age, rather than waiting until age 65, as many guidelines suggest.”
The researchers also note the complexity of diagnosing dementia in an individual experiencing multiple chronic health conditions, as cognitive symptoms can overlap. Because of the difficulty in obtaining a history and diagnosis in this population, the study may have underestimated the true prevalence of dementia.
“We hope this work will serve to raise awareness among policymakers and professionals of the growing prevalence of dementia among people experiencing homelessness,” says study author Salimah Shariff, a scientist in the Population and Public Health Research Program at ICES, associate director of research. operations and strategic partnerships at ICES Western and associate scientist at Lawson.
“Because housing is a key determinant of health and essential to supporting the health and well-being of individuals, access to permanent and supportive housing facilities for people experiencing homelessness is also critical to preventing and slowing the progression of dementia in this population.”
People with essential tremor may have a higher risk of dementia
Dementia may be three times more common among people with essential tremor, a movement disorder that causes involuntary tremors, than the general population, according to research.
Essential tremor is the most common tremor disorder, more common than Parkinson's disease. In addition to arm and hand tremors, people may also develop involuntary tremors of the head, jaw, and voice.
“While many people living with essential tremor experience mild tremor, in some individuals the tremor can be quite severe,” said study author Elan D. Louis, MD, MSc, from the University of Texas Southwestern Medical Center of Dallas and a member of the American Academy of Neurology. “Not only do tremors affect a person's ability to complete daily tasks such as writing and eating, our study suggests that people with essential tremor also have a greater risk of developing dementia.”
The study involved 222 people with essential tremor who had an average age of 79 years at the start of the study. They took thinking and memory tests to determine whether they had normal cognitive abilities, mild cognitive impairment or dementia at the start of the study.
Participants then had follow-up exams every 1.5 years for an average of five years. Of this group, 168 people had normal cognitive abilities, 35 had mild cognitive impairment and 19 had dementia at the start of the study.
During the study, 59 developed mild cognitive impairment and 41 developed dementia.
The researchers then compared the rate at which people developed mild cognitive impairment and dementia, as well as the prevalence of these conditions, with the rates and prevalence in the general population. They also compared participants with rates and prevalence for people with Parkinson's disease.
The researchers found that 19% of participants had or developed dementia during the study, and each year an average of 12% of people diagnosed with mild cognitive impairment went on to develop dementia. These rates were three times higher than rates in the general population. However, the rates were lower than those seen in people with Parkinson's disease, a population for which dementia is more prevalent.
The researchers also found that 27% of participants had or developed mild cognitive impairment during the study, a rate nearly double that of 14.5% of the general population, but lower than the 40% rate for people with Parkinson's disease.
“Although most people with essential tremor will not develop dementia, our findings provide the basis for doctors to educate people with essential tremor and their families about the increased risk and any potential life changes that may accompany this diagnosis,” Louis said.
A limitation of the study was that comparison data for the general population were published before the study began.
Do your gums say anything about your risk of dementia?
Gum disease, especially irreversible gum disease that causes tooth loss, may be associated with mild cognitive impairment and dementia 20 years later, according to a study published online in Neurology.
“We looked at people's dental health over a 20-year period and found that people with the most severe gum disease at the start of our study had about double the risk of mild cognitive impairment or dementia at the end,” he said study author Ryan T. Demmer, Ph.D., MPH, of the University of Minnesota School of Public Health in Minneapolis. “However, the good news is that people with minimal tooth loss and mild gum disease were no more likely to develop thinking problems or dementia than people without dental problems.”
The study involved 8,275 people with an average age of 63 who did not have dementia at the start of the study. Participants were assessed for mild cognitive impairment and dementia. Participants received a complete periodontal examination that included measurement of gingival probing depth, amount of bleeding, and recession.
Then participants were divided into groups based on the severity and extent of gum disease and the number of teeth lost, with implants counted as lost teeth. At the start of the study, 22% had no gum disease, 12% had mild gum disease, 12% had severe gum inflammation, 8% had some tooth loss, 12% had molar disease , 11% had severe tooth loss, 6% suffered from severe gum disease, and 20% were completely toothless.
At the end of the study, a total of 4,559 people were evaluated and followed for an average of 18 years.
Overall, 1,569 people developed d. during the study, equal to 19%. This equated to 11.8 cases per 1,000 person-years. The study found that of people who had healthy gums and all teeth at the start of the study, 264 of 1,826, or 14 percent, developed d. by the end of the study. Among those with mild gum disease, 623 of 3,470, or 18%, developed d.
Among participants with severe gum disease, 306 of 1,368, or 22 percent, developed d. And 376 of 1,611, or 23 percent, developed dementia in the group that had no teeth. This equated to a rate of 16.9 cases per 1,000 person-years.
Considering both mild cognitive impairment and dementia, the toothless group had about double the risk compared to participants with healthy gums and all teeth.
People with intermediate or severe gum disease, but who still had some teeth, had a 20 percent greater risk of developing mild cognitive impairment or dementia compared to the healthy group.
These risks were taken into account after researchers took into account other factors that could influence dementia risk, such as diabetes, high cholesterol and smoking.
“Good dental hygiene is a proven way to keep your teeth and gums healthy for life. Our study does not prove that an unhealthy mouth causes dementia and only shows an association. Further studies are needed to demonstrate the link between microbes in the mouth and dementia, and to understand whether treatment for gum disease can prevent dementia,” Demmer said.
One limitation of the study is that the initial gum exams were performed when the participants had an average age of 63, and it is possible that cognitive decline may have begun before the onset of gum disease and tooth loss.
Some personality traits can influence the risk of “pre-dementia”
A study published in the Journal of the American Geriatrics Society examined five personality traits – neuroticism, extraversion, conscientiousness, agreeableness and openness – and their links to pre-dementia conditions called motor cognitive risk (MCR) syndromes and mild cognitive impairment (MCI ). .
Among 524 adults aged 65 years and older followed for an average of 3 years, 38 participants developed MCR and 69 developed MCI (some with memory loss or amnestic MCI).
Openness was associated with a 6% reduced risk of developing MCR, while neuroticism was associated with a 6% increased risk of non-amnestic MCI. In non-amnestic MCI, memory remains intact, but one or more other cognitive abilities, such as language, visuospatial skills, or executive functioning, are impaired.
None of the personality traits were associated with overall MCI or amnestic MCI.
“Although further studies are needed, our findings provide evidence that personality traits play an independent role in risk or protection against specific pre-dementia syndromes,” said lead author Emmeline Ayers, MPH, of Albert Einstein College of Medicine.
“From a clinical point of view, these findings highlight the importance of taking personality aspects into account when assessing dementia risk.”
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