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1. Cognition, function, and prevalent dementia in centenarians and near‐centenarians: An individual participant data (IPD) meta‐analysis of 18 studies

Author

Leung, Yvonne, Barzilai, Nir, Batko‐Szwaczka, Agnieszka, Beker, Nina, Boerner, Kathrin, Brayne, Carol, Brodaty, Henry, Cheung, Karen Siu‐Lan, Corrada, María M, Crawford, John D, Galbussera, Alessia A, Gondo, Yasuyuki, Holstege, Henne, Hulsman, Marc, Ishioka, Yoshiko Lily, Jopp, Daniela, Kawas, Claudia H, Kaye, Jeff, Kochan, Nicole A, Lau, Bobo Hi‐Po, Lipnicki, Darren M, Lo, Jessica W, Lucca, Ugo, Makkar, Steve R, Marcon, Gabriella, Martin, Peter, Meguro, Kenichi, Milman, Sofiya, Poon, Leonard W, Recchia, Angela, Ribeiro, Oscar, Riva, Emma, Rott, Christoph, Sikkes, Sietske AM, Skoog, Ingmar, Stephan, Blossom, Szewieczek, Jan, Teixeira, Laetitia, Tettamanti, Mauro, Wilczyński, Krzysztof, and Sachdev, Perminder

Subjects
Biomedical and Clinical Sciences, Neurosciences, Clinical Sciences, Clinical Research, Behavioral and Social Science, Dementia, Prevention, Brain Disorders, Acquired Cognitive Impairment, Neurodegenerative, Aging, Neurological, Quality Education, Male, Aged, 80 and over, Humans, Female, Centenarians, Cognition, Body Mass Index, Educational Status, centenarians, dementia, education, exceptional longevity, prevalence, risk factors, Geriatrics, Clinical sciences, Biological psychology
Abstract

IntroductionThere are limited data on prevalence of dementia in centenarians and near-centenarians (C/NC), its determinants, and whether the risk of dementia continues to rise beyond 100.MethodsParticipant-level data were obtained from 18 community-based studies (N = 4427) in 11 countries that included individuals ≥95 years. A harmonization protocol was applied to cognitive and functional impairments, and a meta-analysis was performed.ResultsThe mean age was 98.3 years (SD = 2.67); 79% were women. After adjusting for age, sex, and education, dementia prevalence was 53.2% in women and 45.5% in men, with risk continuing to increase with age. Education (OR 0.95;0.92-0.98) was protective, as was hypertension (odds ratio [OR] 0.51;0.35-0.74) in five studies. Dementia was not associated with diabetes, vision and hearing impairments, smoking, and body mass index (BMI).DiscussionAmong the exceptional old, dementia prevalence remains higher in the older participants. Education was protective against dementia, but other factors for dementia-free survival in C/NC remain to be understood.

Published
2023

3. Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment

Author

Makkar, Steve R, Lipnicki, Darren M, Crawford, John D, Kochan, Nicole A, Castro-Costa, Erico, Lima-Costa, Maria Fernanda, Diniz, Breno Satler, Brayne, Carol, Stephan, Blossom, Matthews, Fiona, Llibre-Rodriguez, Juan J, Llibre-Guerra, Jorge J, Valhuerdi-Cepero, Adolfo J, Lipton, Richard B, Katz, Mindy J, Zammit, Andrea, Ritchie, Karen, Carles, Sophie, Carriere, Isabelle, Scarmeas, Nikolaos, Yannakoulia, Mary, Kosmidis, Mary, Lam, Linda, Fung, Ada, Chan, Wai Chi, Guaita, Antonio, Vaccaro, Roberta, Davin, Annalisa, Kim, Ki Woong, Han, Ji Won, Suh, Seung Wan, Riedel-Heller, Steffi G, Roehr, Susanne, Pabst, Alexander, Ganguli, Mary, Hughes, Tiffany F, Jacobsen, Erin P, Anstey, Kaarin J, Cherbuin, Nicolas, Haan, Mary N, Aiello, Allison E, Dang, Kristina, Kumagai, Shuzo, Narazaki, Kenji, Chen, Sanmei, Ng, Tze Pin, Gao, Qi, Nyunt, Ma Shwe Zin, Meguro, Kenichi, Yamaguchi, Satoshi, Ishii, Hiroshi, Lobo, Antonio, Escolar, Elena Lobo, De la Cámara, Concepción, Brodaty, Henry, Trollor, Julian N, Leung, Yvonne, Lo, Jessica W, Sachdev, Perminder, and Consortium, for Cohort Studies of Memory in an International

Subjects
Public Health, Health Sciences, Women's Health, Aging, Neurosciences, Neurodegenerative, Acquired Cognitive Impairment, Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD), Behavioral and Social Science, Alzheimer's Disease, Brain Disorders, Dementia, Quality Education, Aged, Aged, 80 and over, Apolipoprotein E4, Cognitive Dysfunction, Educational Status, Ethnicity, Female, Humans, Longitudinal Studies, Male, Risk Factors, Cognitive decline, Education, Ageing, Sex, Age, for Cohort Studies of Memory in an International Consortium, Clinical Sciences, Geriatrics, Clinical sciences, Public health
Abstract

BackgroundWe examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4).MethodsParticipants were 30,785 dementia-free individuals aged 55-103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School.ResultsCompared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P

Published
2020

4. APOE ε4 and the Influence of Sex, Age, Vascular Risk Factors, and Ethnicity on Cognitive Decline

Author

Makkar, Steve R, Lipnicki, Darren M, Crawford, John D, Kochan, Nicole A, Castro-Costa, Erico, Lima-Costa, Maria Fernanda, Diniz, Breno Satler, Brayne, Carol, Stephan, Blossom, Matthews, Fiona, Llibre-Rodriguez, Juan J, Llibre-Guerra, Jorge J, Valhuerdi-Cepero, Adolfo J, Lipton, Richard B, Katz, Mindy J, Wang, Cuiling, Ritchie, Karen, Carles, Sophie, Carriere, Isabelle, Scarmeas, Nikolaos, Yannakoulia, Mary, Kosmidis, Mary, Lam, Linda, Chan, Wai Chi, Fung, Ada, Guaita, Antonio, Vaccaro, Roberta, Davin, Annalisa, Kim, Ki Woong, Han, Ji Won, Suh, Seung Wan, Riedel-Heller, Steffi G, Roehr, Susanne, Pabst, Alexander, Ganguli, Mary, Hughes, Tiffany F, Snitz, Beth, Anstey, Kaarin J, Cherbuin, Nicolas, Easteal, Simon, Haan, Mary N, Aiello, Allison E, Dang, Kristina, Ng, Tze Pin, Gao, Qi, Nyunt, Ma Shwe Zin, Brodaty, Henry, Trollor, Julian N, Leung, Yvonne, Lo, Jessica W, and Sachdev, Perminder

Subjects
Health Sciences, Alzheimer's Disease, Acquired Cognitive Impairment, Genetics, Brain Disorders, Mental Health, Clinical Research, Cerebrovascular, Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD), Vascular Cognitive Impairment/Dementia, Dementia, Aging, Neurosciences, Prevention, Alzheimer's Disease Related Dementias (ADRD), Women's Health, Neurodegenerative, Behavioral and Social Science, 2.4 Surveillance and distribution, Age Factors, Aged, Aged, 80 and over, Alleles, Apolipoprotein E4, Cognitive Dysfunction, Female, Genotype, Humans, Longitudinal Studies, Male, Middle Aged, Risk Factors, Sex Factors, Cognitive decline, APOE genotype, Epidemiology, Sex, Ethnicity, Clinical Sciences, Gerontology, Biomedical and clinical sciences, Health sciences
Abstract

We aimed to examine the relationship between Apolipoprotein E ε4 (APOE*4) carriage on cognitive decline, and whether these associations were moderated by sex, baseline age, ethnicity, and vascular risk factors. Participants were 19,225 individuals aged 54-103 years from 15 longitudinal cohort studies with a mean follow-up duration ranging between 1.2 and 10.7 years. Two-step individual participant data meta-analysis was used to pool results of study-wise analyses predicting memory and general cognitive decline from carriage of one or two APOE*4 alleles, and moderation of these associations by age, sex, vascular risk factors, and ethnicity. Separate pooled estimates were calculated in both men and women who were younger (ie, 62 years) and older (ie, 80 years) at baseline. Results showed that APOE*4 carriage was related to faster general cognitive decline in women, and faster memory decline in men. A stronger dose-dependent effect was observed in older men, with faster general cognitive and memory decline in those carrying two versus one APOE*4 allele. Vascular risk factors were related to an increased effect of APOE*4 on memory decline in younger women, but a weaker effect of APOE*4 on general cognitive decline in older men. The relationship between APOE*4 carriage and memory decline was larger in older-aged Asians than Whites. In sum, APOE*4 is related to cognitive decline in men and women, although these effects are enhanced by age and carriage of two APOE*4 alleles in men, a higher numbers of vascular risk factors during the early stages of late adulthood in women, and Asian ethnicity.

Published
2020

6. Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study.

Author

Lipnicki, Darren M, Makkar, Steve R, Crawford, John D, Thalamuthu, Anbupalam, Kochan, Nicole A, Lima-Costa, Maria Fernanda, Castro-Costa, Erico, Ferri, Cleusa Pinheiro, Brayne, Carol, Stephan, Blossom, Llibre-Rodriguez, Juan J, Llibre-Guerra, Jorge J, Valhuerdi-Cepero, Adolfo J, Lipton, Richard B, Katz, Mindy J, Derby, Carol A, Ritchie, Karen, Ancelin, Marie-Laure, Carrière, Isabelle, Scarmeas, Nikolaos, Yannakoulia, Mary, Hadjigeorgiou, Georgios M, Lam, Linda, Chan, Wai-Chi, Fung, Ada, Guaita, Antonio, Vaccaro, Roberta, Davin, Annalisa, Kim, Ki Woong, Han, Ji Won, Suh, Seung Wan, Riedel-Heller, Steffi G, Roehr, Susanne, Pabst, Alexander, van Boxtel, Martin, Köhler, Sebastian, Deckers, Kay, Ganguli, Mary, Jacobsen, Erin P, Hughes, Tiffany F, Anstey, Kaarin J, Cherbuin, Nicolas, Haan, Mary N, Aiello, Allison E, Dang, Kristina, Kumagai, Shuzo, Chen, Tao, Narazaki, Kenji, Ng, Tze Pin, Gao, Qi, Nyunt, Ma Shwe Zin, Scazufca, Marcia, Brodaty, Henry, Numbers, Katya, Trollor, Julian N, Meguro, Kenichi, Yamaguchi, Satoshi, Ishii, Hiroshi, Lobo, Antonio, Lopez-Anton, Raul, Santabárbara, Javier, Leung, Yvonne, Lo, Jessica W, Popovic, Gordana, Sachdev, Perminder S, and for Cohort Studies of Memory in an International Consortium (COSMIC)

Subjects
for Cohort Studies of Memory in an International Consortium, Humans, Diabetes Mellitus, Exercise, Risk Assessment, Risk Factors, Smoking, Cognition, Age Factors, Comorbidity, Health Education, Aged, Aged, 80 and over, Middle Aged, Ethnic Groups, Female, Male, Stroke, Cognitive Dysfunction, and over, General & Internal Medicine, Medical and Health Sciences
Abstract

BackgroundWith no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups.Methods and findingsWe harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife.ConclusionsThese results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.

Published
2019

8. Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment

Author

Makkar, Steve R., Lipnicki, Darren M., Crawford, John D., Kochan, Nicole A., Castro-Costa, Erico, Lima-Costa, Maria Fernanda, Diniz, Breno Satler, Brayne, Carol, Stephan, Blossom, Matthews, Fiona, Llibre-Rodriguez, Juan J., Llibre-Guerra, Jorge J., Valhuerdi-Cepero, Adolfo J., Lipton, Richard B., Katz, Mindy J., Zammit, Andrea, Ritchie, Karen, Carles, Sophie, Carriere, Isabelle, Scarmeas, Nikolaos, Yannakoulia, Mary, Kosmidis, Mary, Lam, Linda, Fung, Ada, Chan, Wai Chi, Guaita, Antonio, Vaccaro, Roberta, Davin, Annalisa, Kim, Ki Woong, Han, Ji Won, Suh, Seung Wan, Riedel-Heller, Steffi G., Roehr, Susanne, Pabst, Alexander, Ganguli, Mary, Hughes, Tiffany F., Jacobsen, Erin P., Anstey, Kaarin J., Cherbuin, Nicolas, Haan, Mary N., Aiello, Allison E., Dang, Kristina, Kumagai, Shuzo, Narazaki, Kenji, Chen, Sanmei, Ng, Tze Pin, Gao, Qi, Nyunt, Ma Shwe Zin, Meguro, Kenichi, Yamaguchi, Satoshi, Ishii, Hiroshi, Lobo, Antonio, Lobo Escolar, Elena, De la Cámara, Concepción, Brodaty, Henry, Trollor, Julian N., Leung, Yvonne, Lo, Jessica W., and Sachdev, Perminder

Published
2020
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9. Long-Term Cognitive Decline After Stroke: An Individual Participant Data Meta-Analysis

Author

Lo, Jessica W., Crawford, John D., Desmond, David W., Bae, Hee-Joon, Lim, Jae-Sung, Godefroy, Olivier, Roussel, Martine, Kang, Yeonwook, Jahng, Seungmin, Köhler, Sebastian, Staals, Julie, Verhey, Frans, Chen, Christopher, Xu, Xin, Chong, Eddie J., Kandiah, Nagaendran, Yatawara, Chathuri, Bordet, Régis, Dondaine, Thibaut, Mendyk, Anne-Marie, Brodaty, Henry, Traykov, Latchezar, Mehrabian, Shima, Petrova, Neli, Kim, Ki Woong, Bae, Jong Bin, Han, Ji Won, Lipnicki, Darren M., Lam, Ben, and Sachdev, Perminder S.

Published
2021
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11. Association of Prediabetes and Type 2 Diabetes With Cognitive Function After Stroke: A STROKOG Collaboration Study

Author

Lo, Jessica W., Crawford, John D., Samaras, Katherine, Desmond, David W., Köhler, Sebastian, Staals, Julie, Verhey, Frans R.J., Bae, Hee-Joon, Lee, Keon-Joo, Kim, Beom Joon, Bordet, Régis, Cordonnier, Charlotte, Dondaine, Thibaut, Mendyk, Anne-Marie, Lee, Byung-Chul, Yu, Kyung-Ho, Lim, Jae-Sung, Kandiah, Nagaendran, Chander, Russell J., Yatawara, Chathuri, Lipnicki, Darren M., and Sachdev, Perminder S.

Published
2020
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12. Network analysis of neuropsychiatric, cognitive, and functional complications of stroke: implications for novel treatment targets.

Author

Oestreich, Lena K.L., Lo, Jessica W., Di Biase, Maria A., Sachdev, Perminder S., Mok, Alice H., Wright, Paul, Crawford, John D., Lam, Ben, Traykov, Latchezar, Köhler, Sebastian, Staals, Julie E.A., van Oostenbrugge, Robert, Chen, Christopher, Desmond, David W., Yu, Kyung‐Ho, Lee, Minwoo, Klimkowicz‐Mrowiec, Aleksandra, Bordet, Régis, O'Sullivan, Michael J., and Zalesky, Andrew

Subjects
*APATHY, *STROKE, *ACTIVITIES of daily living
Abstract

Aim: Recovery from stroke is adversely affected by neuropsychiatric complications, cognitive impairment, and functional disability. Better knowledge of their mutual relationships is required to inform effective interventions. Network theory enables the conceptualization of symptoms and impairments as dynamic and mutually interacting systems. We aimed to identify interactions of poststroke complications using network analysis in diverse stroke samples. Methods: Data from 2185 patients were sourced from member studies of STROKOG (Stroke and Cognition Consortium), an international collaboration of stroke studies. Networks were generated for each cohort, whereby nodes represented neuropsychiatric symptoms, cognitive deficits, and disabilities on activities of daily living. Edges characterized associations between them. Centrality measures were used to identify hub items. Results: Across cohorts, a single network of interrelated poststroke complications emerged. Networks exhibited dissociable depression, apathy, fatigue, cognitive impairment, and functional disability modules. Worry was the most central symptom across cohorts, irrespective of the depression scale used. Items relating to activities of daily living were also highly central nodes. Follow‐up analysis in two studies revealed that individuals who worried had more densely connected networks than those free of worry (CASPER [Cognition and Affect after Stroke: Prospective Evaluation of Risks] study: S = 9.72, P = 0.038; SSS [Sydney Stroke Study]: S = 13.56, P = 0.069). Conclusion: Neuropsychiatric symptoms are highly interconnected with cognitive deficits and functional disabilities resulting from stroke. Given their central position and high level of connectedness, worry and activities of daily living have the potential to drive multimorbidity and mutual reinforcement between domains of poststroke complications. Targeting these factors early after stroke may have benefits that extend to other complications, leading to better stroke outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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13. STROKOG (stroke and cognition consortium): An international consortium to examine the epidemiology, diagnosis, and treatment of neurocognitive disorders in relation to cerebrovascular disease

Author

Sachdev, Perminder S., Lo, Jessica W., Crawford, John D., Mellon, Lisa, Hickey, Anne, Williams, David, Bordet, Régis, Mendyk, Anne-Marie, Gelé, Patrick, Deplanque, Dominique, Bae, Hee-Joon, Lim, Jae-Sung, Brodtmann, Amy, Werden, Emilio, Cumming, Toby, Köhler, Sebastian, Verhey, Frans R.J., Dong, Yan-Hong, Tan, Hui Hui, Chen, Christopher, Xin, Xu, Kalaria, Raj N., Allan, Louise M., Akinyemi, Rufus O., Ogunniyi, Adesola, Klimkowicz-Mrowiec, Aleksandra, Dichgans, Martin, Wollenweber, Frank A., Zietemann, Vera, Hoffmann, Michael, Desmond, David W., Linden, Thomas, Blomstrand, Christian, Fagerberg, Björn, Skoog, Ingmar, Godefroy, Olivier, Barbay, Mélanie, Roussel, Martine, Lee, Byung-Chul, Yu, Kyung-Ho, Wardlaw, Joanna, Makin, Stephen J., Doubal, Fergus N., Chappell, Francesca M., Srikanth, Velandai K., Thrift, Amanda G., Donnan, Geoffrey A., Kandiah, Nagaendran, Chander, Russell J., Lin, Xuling, Cordonnier, Charlotte, Moulin, Solene, Rossi, Costanza, Sabayan, Behnam, Stott, David J., Jukema, J. Wouter, Melkas, Susanna, Jokinen, Hanna, Erkinjuntti, Timo, Mok, Vincent C.T., Wong, Adrian, Lam, Bonnie Y.K., Leys, Didier, Hénon, Hilde, Bombois, Stéphanie, Lipnicki, Darren M., and Kochan, Nicole A.

Published
2017
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15. Long-Term Cognitive Decline After Stroke: An Individual Participant Data Meta-Analysis

Author

Lo, Jessica W, Lo, Jessica W, Crawford, John D, Desmond, David W, Bae, Hee-Joon, Lim, Jae-Sung, Godefroy, Olivier, Roussel, Martine, Kang, Yeonwook, Jahng, Seungmin, Köhler, Sebastian, Staals, Julie, Verhey, Frans, Chen, Christopher, Xu, Xin, Chong, Eddie J, Kandiah, Nagaendran, Yatawara, Chathuri, Bordet, Régis, Dondaine, Thibaut, Mendyk, Anne-Marie, Brodaty, Henry, Traykov, Latchezar, Mehrabian, Shima, Petrova, Neli, Kim, Ki Woong, Bae, Jong Bin, Han, Ji Won, Lipnicki, Darren M, Lam, Ben, Sachdev, Perminder S, Stroke Cognition STROKOG Collabora, Lo, Jessica W, Lo, Jessica W, Crawford, John D, Desmond, David W, Bae, Hee-Joon, Lim, Jae-Sung, Godefroy, Olivier, Roussel, Martine, Kang, Yeonwook, Jahng, Seungmin, Köhler, Sebastian, Staals, Julie, Verhey, Frans, Chen, Christopher, Xu, Xin, Chong, Eddie J, Kandiah, Nagaendran, Yatawara, Chathuri, Bordet, Régis, Dondaine, Thibaut, Mendyk, Anne-Marie, Brodaty, Henry, Traykov, Latchezar, Mehrabian, Shima, Petrova, Neli, Kim, Ki Woong, Bae, Jong Bin, Han, Ji Won, Lipnicki, Darren M, Lam, Ben, Sachdev, Perminder S, and Stroke Cognition STROKOG Collabora

Abstract

BACKGROUND AND PURPOSE: Poststroke cognitive impairment is common, but the trajectory and magnitude of cognitive decline after stroke is unclear. We examined the course and determinants of cognitive change after stroke using individual participant data from the Stroke and Cognition Consortium.METHODS: Nine longitudinal hospital-based cohorts from 7 countries were included. Neuropsychological test scores and normative data were used to calculate standardized scores for global cognition and 5 cognitive domains. One-step individual participant data meta-analysis was used to examine the rate of change in cognitive function and risk factors for cognitive decline after stroke. Stroke-free controls were included to examine rate differences. Based on the literature and our own data that showed short-term improvement in cognitive function after stroke, key analyses were restricted to the period beginning 1-year poststroke to focus on its long-term effects.RESULTS: A total of 1488 patients (mean age, 66.3 years; SD, 11.1; 98% ischemic stroke) were followed for a median of 2.68 years (25th-75th percentile: 1.21-4.14 years). After an initial period of improvement through up to 1-year poststroke, decline was seen in global cognition and all domains except executive function after adjusting for age, sex, education, vascular risk factors, and stroke characteristics (-0.053 SD/year [95% CI, -0.073 to -0.033]; P<0.001 for global cognition). Recurrent stroke and older age were associated with faster decline. Decline was significantly faster in patients with stroke compared with controls (difference=-0.078 SD/year [95% CI, -0.11 to -0.045]; P<0.001 for global cognition in a subgroup analysis).CONCLUSIONS: Patients with stroke experience cognitive decline that is faster than that of stroke-free controls from 1 to 3 years after onset. An increased rate of decline is associated with older age and recurrent stroke.

Published
2022

16. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups

Author

Lo, Jessica W., Crawford, John D., Desmond, David W., Godefroy, Olivier, Jokinen, Hanna, Mahinrad, Simin, Bae, Hee-Joon, Lim, Jae-Sung, Köhler, Sebastian, Douven, Elles, Staals, Julie, Chen, Christopher, Xu, Xin, Chong, Eddie J., Akinyemi, Rufus O., Kalaria, Rajesh N., Ogunniyi, Adesola, Barbay, Mélanie, Roussel, Martine, Lee, Byung-Chul, Srikanth, Velandai K., Moran, Christopher, Kandiah, Nagaendran, Chander, Russell J., Sabayan, Behnam, Jukema, J. Wouter, Melkas, Susanna, Erkinjuntti, Timo, Brodaty, Henry, Bordet, Régis, Bombois, Stéphanie, Hénon, Hilde, Lipnicki, Darren M., Kochan, Nicole A., and Sachdev, Perminder S.

Published
2019
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17. Short-term Trajectories of Poststroke Cognitive Function: A STROKOG Collaboration Study

Author

Lo, Jessica W., Crawford, John D., Desmond, David W., Bae, Hee Joon, Lim, Jae Sung, Godefroy, Olivier, Roussel, Martine, Köhler, Sebastian, Staals, Julie, Verhey, Frans, Chen, Christopher, Xu, Xin, Chong, Eddie J., Kandiah, Nagaendran, Bordet, Régis, Dondaine, Thibaut, Mendyk, Anne Marie, Brodaty, Henry, Traykov, Latchezar, Mehrabian, Shima, Petrova, Neli, Lipnicki, Darren M., Lam, Ben Chun Pan, Sachdev, Perminder S., Lo, Jessica W., Crawford, John D., Desmond, David W., Bae, Hee Joon, Lim, Jae Sung, Godefroy, Olivier, Roussel, Martine, Köhler, Sebastian, Staals, Julie, Verhey, Frans, Chen, Christopher, Xu, Xin, Chong, Eddie J., Kandiah, Nagaendran, Bordet, Régis, Dondaine, Thibaut, Mendyk, Anne Marie, Brodaty, Henry, Traykov, Latchezar, Mehrabian, Shima, Petrova, Neli, Lipnicki, Darren M., Lam, Ben Chun Pan, and Sachdev, Perminder S.

Abstract

Background and ObjectivesPast studies on poststroke cognitive function have focused on the average performance or change over time, but few have investigated patterns of cognitive trajectories after stroke. This project used latent class growth analysis (LCGA) to identify clusters of patients with similar patterns of cognition scores over the first-year poststroke and the extent to which long-term cognitive outcome is predicted by the clusters ("trajectory groups").MethodsData were sought from the Stroke and Cognition consortium. LCGA was used to identify clusters of trajectories based on standardized global cognition scores at baseline (T1) and at the 1-year follow-up (T2). One-step individual participant data meta-analysis was used to examine risk factors for trajectory groups and association of trajectory groups with cognition at the long-term follow-up (T3).ResultsNine hospital-based stroke cohorts with 1,149 patients (63% male; mean age 66.4 years [SD 11.0]) were included. The median time assessed at T1 was 3.6 months poststroke, 1.0 year at T2, and 3.2 years at T3. LCGA identified 3 trajectory groups, which were characterized by different mean levels of cognition scores at T1 (low-performance, -3.27 SD [0.94], 17%; medium-performance, -1.23 SD [0.68], 48%; and high-performance, 0.71 SD [0.77], 35%). There was significant improvement in cognition for the high-performance group (0.22 SD per year, 95% CI 0.07-0.36), but changes for the low-performance and medium-performance groups were not significant (-0.10 SD per year, 95% CI -0.33 to 0.13; 0.11 SD per year, 95% CI -0.08 to 0.24, respectively). Factors associated with the low- (vs high-) performance group include age (relative risk ratio [RRR] 1.18, 95% CI 1.14-1.23), years of education (RRR 0.61, 95% CI 0.56-0.67), diabetes (RRR 3.78, 95% CI 2.08-6.88), large artery vs small vessel strokes (RRR 2.77, 95% CI 1.32-5.83), and moderate/severe strokes (RRR 3.17, 95% CI 1.42-7.08). Trajectory groups were predictive

Published
2023

18. Predicting Incident Dementia in Cerebral Small Vessel Disease: Comparison of Machine Learning and Traditional Statistical Models

Author

Li, Rui, primary, Harshfield, Eric L., additional, Bell, Steven, additional, Burkhart, Michael Craig, additional, Tuladhar, Anil, additional, Hilal, Saima, additional, Tozer, Daniel J., additional, Chappell, Francesca M., additional, Makin, Stephen D.J., additional, Lo, Jessica W., additional, Wardlaw, Joanna, additional, de Leeuw, Frank-Erik, additional, Chen, Christopher, additional, Kourtzi, Zoe, additional, and Markus, Hugh Stephen, additional

Published
2023
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19. Cognition, function, and prevalent dementia in centenarians and near‐centenarians: An individual participant data (IPD) meta‐analysis of 18 studies

Author

Leung, Yvonne, primary, Barzilai, Nir, additional, Batko‐Szwaczka, Agnieszka, additional, Beker, Nina, additional, Boerner, Kathrin, additional, Brayne, Carol, additional, Brodaty, Henry, additional, Cheung, Karen Siu‐Lan, additional, Corrada, María M., additional, Crawford, John D., additional, Galbussera, Alessia A., additional, Gondo, Yasuyuki, additional, Holstege, Henne, additional, Hulsman, Marc, additional, Ishioka, Yoshiko Lily, additional, Jopp, Daniela, additional, Kawas, Claudia H., additional, Kaye, Jeff, additional, Kochan, Nicole A., additional, Lau, Bobo Hi‐Po, additional, Lipnicki, Darren M., additional, Lo, Jessica W., additional, Lucca, Ugo, additional, Makkar, Steve R., additional, Marcon, Gabriella, additional, Martin, Peter, additional, Meguro, Kenichi, additional, Milman, Sofiya, additional, Poon, Leonard W., additional, Recchia, Angela, additional, Ribeiro, Oscar, additional, Riva, Emma, additional, Rott, Christoph, additional, Sikkes, Sietske AM, additional, Skoog, Ingmar, additional, Stephan, Blossom, additional, Szewieczek, Jan, additional, Teixeira, Laetitia, additional, Tettamanti, Mauro, additional, Wilczyński, Krzysztof, additional, and Sachdev, Perminder, additional

Published
2022
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20. Short-term Trajectories of Poststroke Cognitive Function.

Author

Lo, Jessica W., Crawford, John D., Desmond, David W., Hee-Joon Bae, Jae-Sung Lim, Godefroy, Olivier, Roussel, Martine, Kohler, Sebastian, Staals, Julie, Verhey, Frans, Chen, Christopher, Xin Xu, Chong, Eddie J., Kandiah, Nagaendran, Bordet, R´egis, Dondaine, Thibaut, Mendyk, Anne-Marie, Brodaty, Henry, Traykov, Latchezar, and Mehrabian, Shima

Published
2023
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21. Cognition, function, and prevalent dementia in centenarians and near-centenarians: An individual participant data (IPD) meta-analysis of 18 studies.

Author

Leung, Yvonne, Leung, Yvonne, Barzilai, Nir, Batko-Szwaczka, Agnieszka, Beker, Nina, Boerner, Kathrin, Brayne, Carol, Brodaty, Henry, Cheung, Karen Siu-Lan, Corrada, María M, Crawford, John D, Galbussera, Alessia A, Gondo, Yasuyuki, Holstege, Henne, Hulsman, Marc, Ishioka, Yoshiko Lily, Jopp, Daniela, Kawas, Claudia H, Kaye, Jeff, Kochan, Nicole A, Lau, Bobo Hi-Po, Lipnicki, Darren M, Lo, Jessica W, Lucca, Ugo, Makkar, Steve R, Marcon, Gabriella, Martin, Peter, Meguro, Kenichi, Milman, Sofiya, Poon, Leonard W, Recchia, Angela, Ribeiro, Oscar, Riva, Emma, Rott, Christoph, Sikkes, Sietske Am, Skoog, Ingmar, Stephan, Blossom, Szewieczek, Jan, Teixeira, Laetitia, Tettamanti, Mauro, Wilczyński, Krzysztof, Sachdev, Perminder, Leung, Yvonne, Leung, Yvonne, Barzilai, Nir, Batko-Szwaczka, Agnieszka, Beker, Nina, Boerner, Kathrin, Brayne, Carol, Brodaty, Henry, Cheung, Karen Siu-Lan, Corrada, María M, Crawford, John D, Galbussera, Alessia A, Gondo, Yasuyuki, Holstege, Henne, Hulsman, Marc, Ishioka, Yoshiko Lily, Jopp, Daniela, Kawas, Claudia H, Kaye, Jeff, Kochan, Nicole A, Lau, Bobo Hi-Po, Lipnicki, Darren M, Lo, Jessica W, Lucca, Ugo, Makkar, Steve R, Marcon, Gabriella, Martin, Peter, Meguro, Kenichi, Milman, Sofiya, Poon, Leonard W, Recchia, Angela, Ribeiro, Oscar, Riva, Emma, Rott, Christoph, Sikkes, Sietske Am, Skoog, Ingmar, Stephan, Blossom, Szewieczek, Jan, Teixeira, Laetitia, Tettamanti, Mauro, Wilczyński, Krzysztof, and Sachdev, Perminder

Abstract

IntroductionThere are limited data on prevalence of dementia in centenarians and near-centenarians (C/NC), its determinants, and whether the risk of dementia continues to rise beyond 100.MethodsParticipant-level data were obtained from 18 community-based studies (N = 4427) in 11 countries that included individuals ≥95 years. A harmonization protocol was applied to cognitive and functional impairments, and a meta-analysis was performed.ResultsThe mean age was 98.3 years (SD = 2.67); 79% were women. After adjusting for age, sex, and education, dementia prevalence was 53.2% in women and 45.5% in men, with risk continuing to increase with age. Education (OR 0.95;0.92-0.98) was protective, as was hypertension (odds ratio [OR] 0.51;0.35-0.74) in five studies. Dementia was not associated with diabetes, vision and hearing impairments, smoking, and body mass index (BMI).DiscussionAmong the exceptional old, dementia prevalence remains higher in the older participants. Education was protective against dementia, but other factors for dementia-free survival in C/NC remain to be understood.

Published
2022

26. Is hospitalization a risk factor for cognitive decline in older age adults?

Author

Chinnappa-Quinn, Lucia, Makkar, Steve Robert, Bennett, Michael, Lam, Ben C. P., Lo, Jessica W., Kochan, Nicole A., Crawford, John D., and Sachdev, Perminder S.

Abstract

Objectives: Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD).Methods: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle-Ottawa Scale.Results: The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen's d = -0.25, 95% CI [-0.02, -0.49] I2 35%).Conclusions: There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization. [ABSTRACT FROM AUTHOR]

Published
2022
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27. Trajectory of Cognitive Decline Before and After Stroke in 14 Population Cohorts.

Author

Lo, Jessica W., Crawford, John D., Lipnicki, Darren M., Lipton, Richard B., Katz, Mindy J., Preux, Pierre-Marie, Guerchet, Maëlenn, d'Orsi, Eleonora, Quialheiro, Anna, Rech, Cassiano Ricardo, Ritchie, Karen, Skoog, Ingmar, Najar, Jenna, Sterner, Therese Rydberg, Rolandi, Elena, Davin, Annalisa, Rossi, Michele, Riedel-Heller, Steffi G., Pabst, Alexander, and Röhr, Susanne

Published
2024
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31. O4-03-04: PROFILE OF AND RISK FACTORS FOR POST-STROKE COGNITIVE IMPAIRMENT IN DIVERSE ETHNO-REGIONAL GROUPS

Author

Lo, Jessica W., primary, Crawford, John D., additional, Desmond, David W., additional, Godefroy, Olivier, additional, Jokinen, Hanna, additional, Mahinrad, Simin, additional, Bae, Hee-Joon, additional, Lim, Jae-Sung, additional, Koehler, Sebastian, additional, Douven, Elles, additional, Staals, Julie, additional, Chen, Christopher, additional, Xu, Xin, additional, Chong, Eddie, additional, Akinyemi, Rufus O., additional, Kalaria, Raj N., additional, Ogunniyi, Adesola, additional, Barbay, Mélanie, additional, Roussel, Martine, additional, Lee, Byung-Chul, additional, Srikanth, Velandai K., additional, Moran, Christopher, additional, Kandiah, Nagaendran, additional, Chander, Russell J., additional, Sabayan, Behnam, additional, Jukema, Wouter, additional, Melkas, Susanna, additional, Erkinjuntti, Timo, additional, Brodaty, Henry, additional, Bordet, Régis, additional, Bombois, Stephanie, additional, Hénon, Hilde, additional, Lipnicki, Darren M., additional, Kochan, Nicole A., additional, and Sachdev, Perminder S., additional

Published
2019
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33. [P2-551]: THE RELATIONSHIP OF HYPERTENSION, DIABETES AND OTHER VASCULAR RISK FACTORS WITH POSTSTROKE COGNITIVE FUNCTION: THE STROKOG (STROKE AND COGNITION) CONSORTIUM

Author

Lo, Jessica W., primary, Crawford, John D., additional, Desmond, David W., additional, Akinyemi, Rufus O., additional, Bae, Hee-Joon, additional, Bordet, Régis, additional, Chen, Christopher, additional, Godefroy, Olivier, additional, Kandiah, Nagaendran, additional, Koehler, Sebastian, additional, Lee, Byung-Chul, additional, Srikanth, Velandai, additional, and Sachdev, Perminder S., additional

Published
2017
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34. PROFILE OF AND RISK FACTORS FOR POST-STROKE COGNITIVE IMPAIRMENT IN DIVERSE ETHNO-REGIONAL GROUPS

Author

Lo, Jessica W., Crawford, John D., Desmond, David W., Godefroy, Olivier, Jokinen, Hanna, Mahinrad, Simin, Bae, Hee-Joon, Lim, Jae-Sung, Koehler, Sebastian, Douven, Elles, Staals, Julie, Chen, Christopher, Xu, Xin, Chong, Eddie, Akinyemi, Rufus O., Kalaria, Raj N., Ogunniyi, Adesola, Barbay, Mélanie, Roussel, Martine, Lee, Byung-Chul, Srikanth, Velandai K., Moran, Christopher, Kandiah, Nagaendran, Chander, Russell J., Sabayan, Behnam, Jukema, Wouter, Melkas, Susanna, Erkinjuntti, Timo, Brodaty, Henry, Bordet, Régis, Bombois, Stephanie, Hénon, Hilde, Lipnicki, Darren M., Kochan, Nicole A., and Sachdev, Perminder S.

Published
2019
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35. STROKOG (stroke and cognition consortium): An international consortium to examine the epidemiology, diagnosis, and treatment of neurocognitive disorders in relation to cerebrovascular disease

Author

Sachdev, Perminder S., primary, Lo, Jessica W., additional, Crawford, John D., additional, Mellon, Lisa, additional, Hickey, Anne, additional, Williams, David, additional, Bordet, Régis, additional, Mendyk, Anne‐Marie, additional, Gelé, Patrick, additional, Deplanque, Dominique, additional, Bae, Hee‐Joon, additional, Lim, Jae‐Sung, additional, Brodtmann, Amy, additional, Werden, Emilio, additional, Cumming, Toby, additional, Köhler, Sebastian, additional, Verhey, Frans R.J., additional, Dong, Yan‐Hong, additional, Tan, Hui Hui, additional, Chen, Christopher, additional, Xin, Xu, additional, Kalaria, Raj N., additional, Allan, Louise M., additional, Akinyemi, Rufus O., additional, Ogunniyi, Adesola, additional, Klimkowicz‐Mrowiec, Aleksandra, additional, Dichgans, Martin, additional, Wollenweber, Frank A., additional, Zietemann, Vera, additional, Hoffmann, Michael, additional, Desmond, David W., additional, Linden, Thomas, additional, Blomstrand, Christian, additional, Fagerberg, Björn, additional, Skoog, Ingmar, additional, Godefroy, Olivier, additional, Barbay, Mélanie, additional, Roussel, Martine, additional, Lee, Byung‐Chul, additional, Yu, Kyung‐Ho, additional, Wardlaw, Joanna, additional, Makin, Stephen J., additional, Doubal, Fergus N., additional, Chappell, Francesca M., additional, Srikanth, Velandai K., additional, Thrift, Amanda G., additional, Donnan, Geoffrey A., additional, Kandiah, Nagaendran, additional, Chander, Russell J., additional, Lin, Xuling, additional, Cordonnier, Charlotte, additional, Moulin, Solene, additional, Rossi, Costanza, additional, Sabayan, Behnam, additional, Stott, David J., additional, Jukema, J. Wouter, additional, Melkas, Susanna, additional, Jokinen, Hanna, additional, Erkinjuntti, Timo, additional, Mok, Vincent C.T., additional, Wong, Adrian, additional, Lam, Bonnie Y.K., additional, Leys, Didier, additional, Hénon, Hilde, additional, Bombois, Stéphanie, additional, Lipnicki, Darren M., additional, and Kochan, Nicole A., additional

Published
2016
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36. A phase III, multi-centre, double-masked randomised controlled trial of adjunctive intraocular and peri-ocular steroid (triamcinolone acetonide) versus standard treatment in eyes undergoing vitreoretinal surgery for open globe trauma (ASCOT): statistical analysis plan

Author

Lo, Jessica W., primary, Bunce, Catey, additional, Charteris, David, additional, Banerjee, Philip, additional, Phillips, Rachel, additional, and Cornelius, Victoria R., additional

Published
2016
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37. Adjunctive intraocular and peri-ocular steroid (triamcinolone acetonide) versus standard treatment in eyes undergoing vitreoretinal surgery for open globe trauma (ASCOT): study protocol for a phase III, multi-centre, double-masked randomised controlled trial

Author

Banerjee, Philip J., primary, Cornelius, Victoria R., additional, Phillips, Rachel, additional, Lo, Jessica W., additional, Bunce, Catey, additional, Kelly, Joanna, additional, Murphy, Caroline, additional, Edwards, Rhiannon Tudor, additional, Robertson, Elizabeth L., additional, and Charteris, David G., additional

Published
2016
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40. Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely

Author

Peacock, Janet L., Lo, Jessica W., D’Costa, Walton, Calvert, Sandra, Marlow, Neil, and Greenough, Anne

Abstract

Background:The aim of this study was to determine whether small-for-gestational-age (SGA) infants born very prematurely had increased respiratory morbidity in the neonatal period and at follow-up.Methods:Data were examined from infants recruited into the United Kingdom Oscillation Study (UKOS). Of the 797 infants who were born at <29?wk of gestational age, 174 infants were SGA. Overall, 92% were exposed to antenatal corticosteroids and 97% received surfactant; follow-up data at 22–28 mo were available for 367 infants.Results:After adjustment for gestational age and sex, SGA infants had higher rates of supplementary oxygen dependency at 36?wk postmenstrual age (odds ratio (OR): 3.23; 95% confidence interval: 2.03, 5.13), pulmonary hemorrhage (OR: 3.07; 95% CI: 1.82, 5.18), death (OR: 3.32; 95% CI: 2.13, 5.17), and postnatal corticosteroid requirement (OR: 2.09; 95% CI: 1.35, 3.23). After adjustment for infant and respiratory morbidity risk factors, a lower mean birth weight z-score was associated with a higher prevalence of respiratory admissions (OR: 1.40; 95% CI: 1.03, 1.88 for 1 SD change in z-score), cough (OR: 1.28; 95% CI: 1.00, 1.65), and use of chest medicines (OR: 1.32; 95% CI: 1.01, 1.73).Conclusion:SGA infants who were born very prematurely, despite routine use of antenatal corticosteroids and postnatal surfactant, had increased respiratory morbidity at follow-up, which was not due to poor neonatal outcome.

Published
2013
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41. Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study

Author

Lipnicki, Darren M, Makkar, Steve R, Crawford, John D, Thalamuthu, Anbupalam, Kochan, Nicole A, Lima-Costa, Maria Fernanda, Castro-Costa, Erico, Ferri, Cleusa Pinheiro, Brayne, Carol, Stephan, Blossom, Llibre-Rodriguez, Juan J, Llibre-Guerra, Jorge J, Valhuerdi-Cepero, Adolfo J, Lipton, Richard B, Katz, Mindy J, Derby, Carol A, Ritchie, Karen, Ancelin, Marie-Laure, Carrière, Isabelle, Scarmeas, Nikolaos, Yannakoulia, Mary, Hadjigeorgiou, Georgios M, Lam, Linda, Chan, Wai-Chi, Fung, Ada, Guaita, Antonio, Vaccaro, Roberta, Davin, Annalisa, Kim, Ki Woong, Han, Ji Won, Suh, Seung Wan, Riedel-Heller, Steffi G, Roehr, Susanne, Pabst, Alexander, Van Boxtel, Martin, Köhler, Sebastian, Deckers, Kay, Ganguli, Mary, Jacobsen, Erin P, Hughes, Tiffany F, Anstey, Kaarin J, Cherbuin, Nicolas, Haan, Mary N, Aiello, Allison E, Dang, Kristina, Kumagai, Shuzo, Chen, Tao, Narazaki, Kenji, Ng, Tze Pin, Gao, Qi, Nyunt, Ma Shwe Zin, Scazufca, Marcia, Brodaty, Henry, Numbers, Katya, Trollor, Julian N, Meguro, Kenichi, Yamaguchi, Satoshi, Ishii, Hiroshi, Lobo, Antonio, Lopez-Anton, Raul, Santabárbara, Javier, Leung, Yvonne, Lo, Jessica W, Popovic, Gordana, Sachdev, Perminder S, and For Cohort Studies Of Memory In An International Consortium (COSMIC)

Subjects
2. Zero hunger, Aged, 80 and over, Male, Smoking, Age Factors, Comorbidity, Middle Aged, Risk Assessment, 3. Good health, Stroke, Cognition, Risk Factors, Diabetes Mellitus, Ethnicity, Humans, Cognitive Dysfunction, Female, Exercise, Health Education, Aged
Abstract

BACKGROUND: With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. METHODS AND FINDINGS: We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. CONCLUSIONS: These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.

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