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MacArthur Foundation Aging Society Network
NYC Meeting
Social networks, social participation and
cognition: effects across the life-course
Laura Fratiglioni
Laura Fratiglioni— New York—September 2008
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Bengt Winblad
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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
Laura Fratiglioni— New York—September 2008
The topic
Social networks, social participation
and cognition:
Effects across the life-course
Psychosocial factors
Dementia risk
in late life
Personality
Laura Fratiglioni— New York—September 2008
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
Laura Fratiglioni— New York—September 2008
The Kungsholmen Project
Stockholm, Sweden
Exposure
assessment
Baseline
1810
participants,
75+incident
old at baseline
Detection
of the
cases
Living in a central area of Stockholm
1st
follow-up
3rd
follow-up
2nd
follow-up
1987-89
1991-93
1994-96
4th
follow-up
1997-98
1999-2000
Risk Factors
60
Dementia Prevalence per 100
50
Fratiglioni et al,
1999; All continents
40
30
Lobo et al, 2000;
Europe
20
Birth
Childhood2nd decade
0
10
Adult lifeMiddle 0age
20
30-
Transition
65- 6075-
85-
Old
age
7595+
Protective Factors
Laura Fratiglioni— New York—September 2008
Risk Factors
Psych. stress Drugs, cortisol levels. life
events, work-related stress
Toxic hypothesis:
Occupat. exposures
Genes
Birth
Vascular
hypothesis
Childhood2nd decade
0
Inflammatory
hypoth.: HRT, NSAID
Midlife hypertension, Diabetes,
Obesity, Smoking, HD, Stroke
Adult lifeMiddle age
20
Oxidative stress
hypothesis
Old
age
Transition
60
75
Diet, Folate & B12,
Antioxidant
Reserve Education, Occupation, Active hypothesis
life, Social network
Protective Factors
Laura Fratiglioni— New York—September 2008
Risk Factors
Psych. stress Drugs, cortisol levels. life
events, work-related stress
Toxic hypothesis:
Occupat. exposures
Genes
Birth
Vascular
hypothesis
Childhood2nd decade
0
Inflammatory
hypoth.: HRT, NSAID
Midlife hypertension, Diabetes,
Obesity, Smoking, HD, Stroke
Adult lifeMiddle age
20
Oxidative stress
hypothesis
Old
age
Transition
60
75
Diet, Folate & B12,
Antioxidant
Reserve Education, Occupation, Active hypothesis
life, Social network
Protective Factors
Laura Fratiglioni— New York—September 2008
Several biological mechanisms contributes
to dementia
Psychosocial factors may act
through common pathways
related to at least 3 hypotheses:
1.Reserve hypothesis
2.Vascular hypothesis
3.Stress hypothesis
Laura Fratiglioni— New York—September 2008
Psychosocial factors in dementia
1. Education
2. SES
3. Work stress
4. Work complexity
5. Social network
6. Leisure activity:
mental, physical
and social activities
Laura Fratiglioni— New York—September 2008
The Faenza
Project
De Ronchi et al
2005
Biological evidence
Bennett, Wilson et al, Neurology 2003
Religious Order Study, 130 subjects
Global
cognitive
function
Years of
schooling
90th percentile
50th percentile
10th percentile
Summary meausure of AD pathology
Laura Fratiglioni— New York—September 2008
Results from the KP
Karp et al, Am J Epidemiol 2004
Education
SES
Adjusted
RR for Dementia
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)
Karp et al, Am J Epidemiol 2004
SES at age
20
40 60
Adjusted
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)
Risk Factors
Low
Education
Low SES
Childhood2nd decade
0
Adult life - Middle age
20
60
75
Protective Factors
laura fratiglioni, 080125
Psychosocial factors in dementia
1. Education
2. SES
3. Work stress
4. Work complexity
5. Social network
6. Leisure activity:
mental, physical
and social activities
Laura Fratiglioni— New York—September 2008
Karp et al,
J Am Ger Psychiatry,
in press
Work complexity
aRR (95%CI)
With data
0.9
(0.8-1.0)
With people
0.9
(0.8-1.0)
With things
1.1
(1.0-1.1)
Karp et al,
J Am Ger Psychiatry,
in press
Education
Low
Work
complexity
Low
Ref
High
Low
Decreased
dementia risk
High
High
Same decrease in
dementia risk
High
Same decrease in
dementia risk
Low
Risk Factors
Low
Education
Low SES
Childhood2nd decade
0
Adult life - Middle age
20
60
Work
complexity
Protective Factors
75
Karasek’s job strain model
Wang et al,
unpublished data
Work stress
aRR (95%CI)
Job control
Low-moderate vs. high 1.9 (1.2-3.0)
Job demands
Low-moderate vs. high
1.3 (0.9-1.8)
Wang et al,
unpublished data
Job strain
Active
aRR (95%CI)
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
Risk Factors
Low
Education
Work
stress
Low SES
Childhood2nd decade
0
Adult life - Middle age
20
60
Work
complexity
Protective Factors
75
Psychosocial factors in dementia
1. Education
2. SES
3. Work stress
4. Work complexity
5. Social network
6. Leisure activity:
mental, physical
and social activities
Laura Fratiglioni— New York—September 2008
Social network and dementia incidence
Relative risk and 95% CI
(Fratiglioni et al, Lancet 2000
25
20
1. Extensive social network
15
2. Moderate social network
10
3. Limited social network
4. Poor social network
5
0
1
2
3
4
Laura Fratiglioni— New York—September 2008
Leisure activities decrease the risk
of dementia
Wang et al, Am J Epidemiol 2002
NO
< Weekly
Daily
RR (95% CI)
Mental
Activity
1
0.8 (0.5-1.3)
0.6 (0.4-0.9)
Social
Activity
1
0.9 (0.5-1.4)
0.6 (0.4-0.9)
Productive
Activity
1
0.8 (0.3-2.6)
0.6 (0.4-0.9)
Laura Fratiglioni—Montreal—October 2004
Karp et al,
Dement Geriatr Cogn Disord
2005
RR (95%CI)
High mental score
0.71
(49-1.03)
High physical score
0.61
(0.42-0.87)
High social score
0.68
(0.47-0.99)
Risk Factors
Low
Education
Work
stress
Low SES
Childhood2nd decade
0
Poor
social
network
Adult life - Middle age
20
60
Work
complexity
Protective Factors
75
Leisure
activity:
-Mental activity
-Social activity
-Physical activity
SEM- confirmatory analysis
Early Life
Adulthood
Education
e1
SES at 20yrs
e2
Psychological
demands
e3
Control at work
e4
Complexity with data
e5
Complexity with people
Late Life
e6
Physical activities
e7
Mental activities
e8
Social activities
e9
Adjusted
Hazard ratios for dementia
Early Life
Adulthood Late Life
Continous
0.61
0.53
0.70
(0.41-0.90) (0.31-0.91) (0.53-0.92)
Dichotomised
(Median)
0.66
0.60
0.52
(0.46-0.95) (0.42-0.87) (0.37-0.73)
Separate models
Adjusted
Hazard ratios for dementia
Early Life
Adulthood Late Life
Continous
0.61
0.53
0.70
(0.41-0.90) (0.31-0.91) (0.53-0.92)
Dichotomised
(Median)
0.66
0.60
0.52
(0.46-0.95) (0.42-0.87) (0.37-0.73)
Same model
Adjusted
Hazard ratios for dementia
Low score in all 3 periods
1
High scores in one or two time
periods
0.52
(0.30-0.90)
High scores in all three time
periods
0.30
(0.17-0.52)
The topic
Social networks, social participation
and cognition:
Effects across the life-course
Psychosocial factors
Dementia risk
in late life
Personality
Wang et et al, Neurology, in press
Eysenck Personality Inventory
Adjusted
Neuroticism
One unit decrease
Low vs. high
(median)
Extraversion
One unit decrease
Low vs. high
(median)
HR
0.98 (0.93-1.03)
0.70 (0.48-1.03)
1.07 (0.95-1.09)
1.25 (0.86-1.81)
HRs adjusted for age, sex, education, cognitive functioning, vascular diseases,
and depressive symptoms.
Wang et et al, Neurology,
in press
Only inactive or socially isolated
subjects
Adjusted
Neuroticism
HR and 95% C
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.
Conclusions
1.
Psychosocial factors acting at different life
periods are equally relevant to decrease
dementia risk
2. They may have a cumulative beneficial
effect
3. Adulthood and late lifestyle variables seem
to emerge as the strongest protective
factors
4. Among socially isolated and inactive
individuals, even high neuroticism alone
may increase dementia risk
SNAC-Kungsholmen
Ag e g roup 60
B
F1
F2
Ag e g roup 66
B
F1
F2
Ag e g roup 72
B
F1
F2
F3
Ag e g roup 78
B
F1
F2
F3
F4
O lder ag e g roups
81+
B
F1
F2
F3
F4
B
F1
F2
New ag e g roup 81
B
New ag e g roup 60
C alendar
Y ears 2001
2004
2007
2010
2013
B =bas eline. F 1=firs t, F 2=s econd, F 3=third, F 4=fourth follow-up
2016
Thank you
for your
attention
The outcome
Longitudinal studies on dementia in Europe
(Fratiglioni et al, Neurology 2000)
AD
Distribution of
dementia
subtypes:
incident cases
VaD
OD