Sex and gender differences in risk scores for dementia and Alzheimer's disease among cisgender, transgender, and non-binary adults.

INTRODUCTION: Few studies have explored dementia risk according to sex and gender including for transgender and non-binary adults. This study evaluated dementia risk factors and risk scores among cisgender, transgender, and non-binary adults. METHODS: Observational data were drawn from the 2019 Behavioral Risk Factor Surveillance System. A matched-cohort approach was used to develop sex (male, female) and gender identity cohorts (cisgender men, cisgender women, transgender men, transgender women, and non-binary adults) for comparison. Dementia risk scores were calculated using established mid-life and late-life risk score algorithms. RESULTS: Males had higher overall mid-life dementia risk, and lower late-life Alzheimer's disease risk compared to females. Transgender men, transgender women, and non-binary adults had higher overall late-life risk compared to both cisgender men and women. DISCUSSION: Future research is needed to build the evidence base for specific risk factors that may be contributing to higher overall risk among understudied and underserved gender groups. HIGHLIGHTS: Using data from the 2019 Behavioral Risk Factor Surveillance System, this matched-cohort study found that those assigned female at birth had lower overall mid-life dementia risk and higher overall late-life Alzheimer's disease (AD) risk compared to those assigned male at birth. Transgender men, transgender women, and non-binary adults all showed higher overall late-life AD risk compared to cisgender men and cisgender women. Between-group differences were found in the incidence of specific risk and protective factors for dementia and AD.

A Technology-Enriched Approach to Studying Microlongitudinal Aging Among Adults Aged 18 to 85 Years: Protocol for the Labs Without Walls Study.

BACKGROUND: Traditional longitudinal aging research involves studying the same individuals over a long period, with measurement intervals typically several years apart. App-based studies have the potential to provide new insights into life-course aging by improving the accessibility, temporal specificity, and real-world integration of data collection. We developed a new research app for iOS named Labs Without Walls to facilitate the study of life-course aging. Combined with data collected using paired smartwatches, the app collects complex data including data from one-time surveys, daily diary surveys, repeated game-like cognitive and sensory tasks, and passive health and environmental data. OBJECTIVE: The aim of this protocol is to describe the research design and methods of the Labs Without Walls study conducted between 2021 and 2023 in Australia. METHODS: Overall, 240 Australian adults will be recruited, stratified by age group (18-25, 26-35, 36-45, 46-55, 56-65, 66-75, and 76-85 years) and sex at birth (male and female). Recruitment procedures include emails to university and community networks, as well as paid and unpaid social media advertisements. Participants will be invited to complete the study onboarding either in person or remotely. Participants who select face-to-face onboarding (n=approximately 40) will be invited to complete traditional in-person cognitive and sensory assessments to be cross-validated against their app-based counterparts. Participants will be sent an Apple Watch and headphones for use during the study period. Participants will provide informed consent within the app and then begin an 8-week study protocol, which includes scheduled surveys, cognitive and sensory tasks, and passive data collection using the app and a paired watch. At the conclusion of the study period, participants will be invited to rate the acceptability and usability of the study app and watch. We hypothesize that participants will be able to successfully provide e-consent, input survey data through the Labs Without Walls app, and have passive data collected over 8 weeks; participants will rate the app and watch as user-friendly and acceptable; the app will allow for the study of daily variability in self-perceptions of age and gender; and data will allow for the cross-validation of app- and laboratory-based cognitive and sensory tasks. RESULTS: Recruitment began in May 2021, and data collection was completed in February 2023. The publication of preliminary results is anticipated in 2023. CONCLUSIONS: This study will provide evidence regarding the acceptability and usability of the research app and paired watch for studying life-course aging processes on multiple timescales. The feedback obtained will be used to improve future iterations of the app, explore preliminary evidence for intraindividual variability in self-perceptions of aging and gender expression across the life span, and explore the associations between performance on app-based cognitive and sensory tests and that on similar traditional cognitive and sensory tests. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47053.

Role of apolipoprotein E epsilon 4 (APOE*ε4) as an independent risk factor for incident depression over a 12-year period in cognitively intact adults across the lifespan.

BACKGROUND: The apolipoprotein E ε4 allele (APOE*ε4) is indicated as a risk for Alzheimer's disease and other age-related diseases. The risk attributable to APOE*ε4 for depression is less clear and may be because of confounding of the relationship between dementia and depression. AIMS: We examined the risk of APOE* ε4 for incident depression and depressive symptomology over a 12-year period across the adult lifespan. METHOD: Participants were from the Personality and Total Health Through Life study, aged 20 to 24 (n = 1420), 40 to 44 (n = 1592) or 60-64 (n = 1768) at baseline, and interviewed every 4 years since 1999. Ethnicities other than White, those without genotyping and those with depression at baseline, or who reported strokes and scores on the Mini-Mental State Examination <27 at any observation, were excluded. RESULTS: Over the study period, there was no evidence that APOE*ε4+ was a risk factor for depression, including any depression (odds ratio (OR) = 0.94, 95% CI 0.77-1.16, P = 0.573), major depression (OR = 0.96, 95% CI 0.60-1.53, P = 0.860), minor depression (OR = 0.94, 95% CI 0.67-1.30, P = 0.695) or depressive symptomology (incidence rate ratio (IRR) = 1.02, 95% CI 0.97-1.08, P = 0.451). APOE*ε4 was unrelated to incident depression. Findings were consistent for all age cohorts. CONCLUSIONS: Among cognitively intact Australian adults who were free of depression at baseline, there was little evidence that APOE*ε4+ carriers are at increased risk for depression over a 12-year period among those who are cognitively intact.

The influence of smoking, sedentary lifestyle and obesity on cognitive impairment-free life expectancy.

BACKGROUND: Smoking, sedentary lifestyle and obesity are risk factors for mortality and dementia. However, their impact on cognitive impairment-free life expectancy (CIFLE)has not previously been estimated. METHODS: Data were drawn from the DYNOPTA dataset which was derived by harmonizing and pooling common measures from five longitudinal ageing studies. Participants for whom the Mini-Mental State Examination was available were included (N»8111,48.6% men). Data on education, sex, body mass index, smoking and sedentary lifestyle were collected and mortality data were obtained from Government Records via data linkage.Total life expectancy (LE), CIFLE and years spent with cognitive impairment (CILE)were estimated for each risk factor and total burden of risk factors. RESULTS: CILE was approximately 2 years for men and 3 years for women, regardless of age. For men and women respectively, reduced LE associated with smoking was 3.82and 5.88 years, associated with obesity was 0.62 and 1.72 years and associated with being sedentary was 2.50 and 2.89 years. Absence of each risk factor was associated with longer LE and CIFLE, but also longer CILE for smoking in women and being sedentary in both sexes. Compared with participants with no risk factors, those with 2þ had shorter CIFLE of up to 3.5 years depending on gender and education level. CONCLUSIONS: Population level reductions in smoking, sedentary lifestyle and obesity increase longevity and number of years lived without cognitive impairment. Years lived with cognitive impairment may also increase.

Recognition, attitudes and causal beliefs regarding dementia in Italian, Greek and Chinese Australians.

BACKGROUND/AIM: To investigate recognition, attitudes and causal beliefs regarding dementia in Italian, Greek and Chinese Australians in comparison with 3rd generation Australians. Little is known about dementia literacy in these racial and ethnic minority groups. METHODS: A cross-sectional telephone survey was conducted of 350 Italian, 414 Greek, 437 Chinese and 500 3rd generation Australians randomly selected from the telephone directory. RESULTS: Third generation participants (85%) were more likely to recognize dementia symptoms in a vignette in comparison to Italian (61%), Greek (58%) and Chinese (72%) participants. Overall, the racial and ethnic minority groups had more negative attitudes about persons with dementia. The racial and ethnic minority groups were more likely to suggest old age and psychosocial risk factors caused dementia, whereas 3rd generation Australians were more likely to suggest brain disease. Differences between ethnic minority and 3rd generation groups remained after controlling for sociodemographic variables. There were differences between Italian, Greek and Chinese participants on markers of acculturation associated with knowledge and beliefs within each group. CONCLUSIONS: Racial and ethnic minority groups have poor dementia literacy in comparison to 3rd generation Australians. There is a need for dementia education targeted to and tailored for these groups.

Dementia literacy: recognition and beliefs on dementia of the Australian public.

BACKGROUND: Dementia is a growing health problem worldwide and in Australia. Little research has been conducted on dementia literacy in the community. METHODS: The aim of this study was to investigate the recognition of dementia and beliefs regarding prognosis, cause, and risk reduction in the Australian public. A cross-sectional telephone survey of 2,000 randomly selected community-dwelling adults (23.4% response rate) was conducted. RESULTS: Eighty-two percent of the sample correctly identified "dementia" or "Alzheimer's" from a vignette. There were no differences in recognition rates between vignettes describing mild or moderate dementia symptoms. Almost half thought that at least partial recovery would occur, given appropriate treatment. More than 80% of the sample thought that genetics, old age, brain disease, and stroke or mini-stroke contributed to a person getting dementia. Seventy-two percent thought that the risk of dementia could be reduced. The most frequently suggested methods for risk reduction were mental exercise (38.8%), eating healthily (31.0%), physical exercise (30.2%), and socializing more (13.9%). Sociodemographic characteristics were associated with dementia knowledge and beliefs. CONCLUSIONS: The majority of the Australian public recognize the symptoms of dementia and think dementia risk can be reduced. However, most do not know of the association between dementia and cardiovascular factors. Public awareness campaigns need to increase accurate knowledge of factors consistently found to be associated with dementia.

The public's perception of the plausibility of dementia risk factors is not influenced by scientific evidence.

BACKGROUND/AIM: The public know little about risk factors for dementia. The aim of this study was to explore belief structures underlying how plausible risk factors for dementia appear to the general public. METHODS: Two thousand members of the Australian public were surveyed by telephone on their beliefs regarding dementia risk factors. Factor analysis was performed on 17 modifiable behaviours that were rated by participants as increasing, not changing or decreasing the risk of dementia. RESULTS: Three factors were obtained - Health and Lifestyle, Activity, and Nutrition. Items loading on the Health and Lifestyle factor were management of cardiovascular risk factors, drinking more water, reducing stress, coffee and tea, and alcohol intake. Items loading on the Activity factor were mental, physical and social activity and getting out and about more. Items loading on the Nutrition factor were eating foods high in omega-3 fatty acids, antioxidants and estrogen, using non-aluminium cookware and taking vitamin and nutritional supplements. Factors were characterised by similarity of items, rather than level of scientific evidence of an association with dementia. Factor scale scores differed according to sociodemographic characteristics. CONCLUSIONS: The public do not process dementia risk factor information based on level of scientific evidence.