bbc news - brain function can start declining 'as early as age 45

BBC News - Brain function can start declining 'as early as age 45'

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6 January 2012 Last updated at 01:08 GMT

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Brain function can start declining 'as early as age 45'The brain's ability to function can start to deteriorate as early as 45, suggests a study in the British Medical Journal. University College London researchers found a 3.6% decline in mental reasoning in women and men aged 45-49. They assessed the memory, vocabulary and comprehension skills of 7,000 men and women aged 45 to 70 over 10 years.

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The Alzheimer's Society said research was needed into how changes in the brain could help dementia diagnoses. Previous research had suggested that cognitive decline does not begin much before the age of 60. But the results of this study show that it could in fact begin in middle age. This is important, the researchers say, because dementia treatments are more likely to work at the time when individuals start to experience mental impairment. The UCL researchers tested the cognitive functions of 5,198 men and 2,192 women aged 45 to 70, who were all UK civil servants, from 1997 to 2007. Individuals were tested for memory, vocabulary and aural and visual comprehension skills. Differences in education level were taken into account.

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Mid-life crisisThe results of the tests show that cognitive scores declined in all categories except vocabulary - and there was a faster decline in older people. The study found a 9.6% decline in mental reasoning in men aged 65-70 and a 7.4% decline for women of the same age. For men and women aged 45-49, there was a 3.6% decline. Professor Archana Singh-Manoux from the Centre for Research in Epidemiology and Population Health in France, who led the research team at University College London, said the evidence from the study showed that dementia involved cognitive decline over two to three decades. "We now need to look at who experiences cognitive decline more than the average and how we stop the decline. Some level of prevention is definitely possible. "Rates of dementia are going to soar and health behaviours like smoking and physical activity are linked to levels of cognitive function. "It's important to identify the risk factors early. If the disease has started

Although we don't yet have a surefire way to prevent dementia, we do know that simple lifestyle changes can all reduce the risk of dementiaDr Simon Ridley Alzheimer's Research UK

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http://www.bbc.co.uk/news/health-16425522[06/01/2012 11:12:30]


in an individual's 50s but we only start looking at risk in their 60s, then how do you start separating cause and effect?"

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Lifestyle choicesDr Anne Corbett, research manager at the Alzheimer's Society, said the study added to the debate on when cognitive decline began, but it left some questions unanswered. "The study does not tell us whether any of these people went on to develop dementia, nor how feasible it would be for GPs to detect these early changes. "More research is now needed to help us fully understand how measurable changes in the brain can help us improve diagnosis of dementia." Dr Simon Ridley, head of research at Alzheimer's Research UK, said he wanted to see similar studies carried out in a wider population sample. He added: "Previous research suggests that our health in mid-life affects our risk of dementia as we age, and these findings give us all an extra reason to stick to our New Year's resolutions. "Although we don't yet have a sure-fire way to prevent dementia, we do know that simple lifestyle changes - such as eating a healthy diet, not smoking, and keeping blood pressure and cholesterol in check - can all reduce the risk of dementia." Professor Lindsey Davies, president of the Faculty of Public Health, said that people should not wait until their bodies and minds broke down before taking action. "We need only look at the problems that childhood obesity rates will cause if they are not addressed to see how important it is that we take 'cradle to grave' approach to public health."

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Timing of onset of cognitive decline: results from Whitehall II prospective cohort study | BMJ

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Timing of onset of cognitive decline: results from Whitehall II prospective cohort studyBMJ 2012; 344 doi: 10.1136/bmj.d7622 (Published 5 January 2012) Cite this as: BMJ 2012;344:d7622

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Archana Singh-Manoux, research director 1 2 3 , Mika Kivimaki, professor of social epidemiology2 , M Maria Glymour, assistant professor 4 , Alexis Elbaz, research director 5 6 , Claudine Berr, research director 7 8 , Klaus P Ebmeier, professor of old age psychiatry 9 , Jane E Ferrie, senior research fellow10 , Aline Dugravot, statistician 1 Author Affiliations Correspondence to: A Singh-Manoux, INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hpital Paul Brousse, Bt 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France [email protected] Accepted 26 October 2011 http://www.bmj.com/content/344/bmj.d7622[06/01/2012 11:13:50]

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CitationsArticles by Archana Singh-Manoux Articles by Mika Kivimaki Articles by M Maria Glymour Articles by Alexis Elbaz Articles by Claudine Berr

Timing of onset of cognitive decline: results from Whitehall II prospective cohort study | BMJ

Articles by Klaus P Ebmeier Articles by Jane E Ferrie

AbstractObjectives To estimate 10 year decline in cognitive function from longitudinal data in a middle aged cohort and to examine whether age cohorts can be compared with cross sectional data to infer the effect of age on cognitive decline. Design Prospective cohort study. At study inception in 1985-8, there were 10 308 participants, representing a recruitment rate of 73%. Setting Civil service departments in London, United Kingdom. Participants 5198 men and 2192 women, aged 45-70 at the beginning of cognitive testing in 1997-9. Main outcome measure Tests of memory, reasoning, vocabulary, and phonemic and semantic fluency, assessed three times over 10 years. Results All cognitive scores, except vocabulary, declined in all five age categories (age 45-49, 50-54, 55-59, 60-64, and 65-70 at baseline), with evidence of faster decline in older people. In men, the 10 year decline, shown as change/range of test100, in reasoning was 3.6% (95% confidence interval 4.1% to 3.0%) in those aged 45-49 at baseline and 9.6% (10.6% to 8.6%) in those aged 65-70. In women, the corresponding decline was 3.6% (4.6% to 2.7%) and 7.4% (9.1% to 5.7%). Comparisons of longitudinal and cross sectional effects of age suggest that the latter overestimate decline in women because of cohort differences in education. For example, in women aged 45-49 the longitudinal analysis showed reasoning to have declined by 3.6% (4.5% to 2.8%) but the cross sectional effects suggested a decline of 11.4% (14.0% to 8.9%). Conclusions Cognitive decline is already evident in middle age (age 45-49).

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IntroductionContinuing increases in life expectancy imply fundamental changes to the population structure and an exponential increase in the number of elderly people. 1 2 These changes are likely to have a profound influence on individuals lives and society at large. Poor cognitive status is perhaps the single most disabling condition in old age. There is a finely graded inverse association between age and cognitive performance,3 4 5 but the age at which cognitive decline becomes evident at the http://www.bmj.com/content/344/bmj.d7622[06/01/2012 11:13:50]

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Timing of onset of cognitive decline: results from Whitehall II prospective cohort study | BMJ population level remains the subject of debate. 5 6 7 A recent review of the literature concluded that there was little evidence of cognitive decline before the age of 60.8 This point of view, however, is not universally accepted. 5 6 Clinicopathological studies show good correlation between neuropathology and the severity of cognitive decline, 9 10 11 and neurofibrillary tangles and amyloid plaques, the hallmarks of pathology, are known to be present in the brains of young adults. 12 13 Emerging consensus on the long gestation period of dementia 14 15 also suggests that adults aged under 60 are likely to experience age related cognitive decline. The assessment of the effect of age on cognitive decline is not straightforward as longitudinal data that span many decades are rare. Cross sectional data might not accurately distinguish longitudinal changethat is, the effect of chronological age from secular change, also called cohort effects. The age at which cognitive decline begins is important because behavioural or pharmacological interventions designed to alter cognitive ageing trajectories are more likely to work if they are applied when individuals first begin to experience decline. We examined whether cognitive decline begins before the age of 60 using a large sample of middle aged adults from the longitudinal Whitehall II cohort study. We also evaluated the bias in estimates of cognitive decline drawn from cross sectional data.

registered in ClinicalTrials.gov: cross sectional analysisPublished Thu, 2012-01-05 09:59

Re: Compliance with mandatory reporting of clinical trial results on ClinicalTrials.gov: cross sectional studyPublished Thu, 2012-01-05 09:48 more

MethodsStudy populationThe Whitehall II cohort was established in 1985 among 10 308 (67% men) British civil servants.16 All civil servants aged 35-55 in 20 London based departments were invited to participate by letter, and 73% agreed. Although all participants in the study are white collar workers, a wide range of occupations is represented with a salary difference of over 10-fold between the top and bottom of the hierarchy. Study inception (phase 1) was over the years 1985-8 and involved a clinical examination and a self administered questionnaire. Subsequent phases of data collection have alternated between inclusion of a questionnaire alone and a questionnaire accompanied by a clinical examination. The focus of the clinical examination is anthropometry, cardiovascular and metabolic risk factors, and disease. Cognitive testing was introduced to the full cohort during the clinical examination at phase 5 (1997-9) and repeated at phases 7 (2002-4) and 9 (2007-9), alongside the standard Whitehall II clinical screening measures.

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AgeAt baseline for this study (phase 5 of Whitehall II) participants were aged 45-70. To allow comparison of cognitive decline as a function of age we categorised this in five year age groups: 45-49, 50-54, 55-59, 60-64, and 65-70.

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Cognitive functionThe cognitive test battery, administered at three clinical examinations over 10 years (phases 5, 7, and 9), was chosen to provide a comprehensive assessment of http://www.bmj.com/content/344/bmj.d7622[06/01/2012 11:13:50]

Timing of onset of cognitive decline: results from Whitehall II prospective cohort study | BMJ cognitive function and be appropriate for this population composed of individuals younger than in most studies on cognitive ageing. The mini-mental state examination, 17 although included in the test battery, was not used in the current analysis because of ceiling effects (that is, simple tests leading to little variability in scores). The tests included in the analysis, described below, had good test-retest reliability (range 0.60-0.89) in 556 participants who were invited back to the clinic within three months of having taken the test at baseline. The Alice Heim 4-I (AH4-I) is composed of a series of 65 verbal and mathematical reasoning items of increasing difficulty.18 It tests inductive reasoning, measuring the ability to identify patterns and infer principles and rules. Participants had 10 minutes to do this section. Short term verbal memory was assessed with a 20 word free recall test. Participants were presented a list of 20 one or two syllable words at two second intervals and were then asked to recall in writing as many of the words in any order within two minutes. We used two measures of verbal fluency: phonemic and semantic. 19 Participants were asked to recall in writing as many words beginning with S (phonemic fluency) and as many animal names (semantic fluency) as they could. One minute was allowed for each test; the observed range on these tests was 0-35. Vocabulary was assessed with the Mill Hill vocabulary test,20 used in its multiple choice format, consisting of a list of 33 stimulus words ordered by increasing difficulty and six response choices.

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EducationEducation was assessed with a three level variable: did not complete secondary school, obtained higher qualification at secondary school (at about age 18), and obtained university degree or higher. Results with continuous years of education were similar and are not presented.

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Statistical analysisWe first examined the cross sectional associations between age (in five categories) and the cognitive tests at baseline using linear regression. A linear test for trend was used to assess whether cognitive scores were progressively lower in older age cohorts. The age cohortsex interactions (all tests P

bbc news - brain function can start declining 'as early as age 45

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