Fernando Massa

Cognitive reserve reflects the brain’s capacity to maintain function despite ageing or pathology, potentially delaying cognitive decline. Its timing and dynamic effects on memory remain unclear. We analyzed longitudinal data from 10,203 participants in the English Longitudinal Study of Ageing, assessed across nine waves over a follow-up period up to 18 years. Verbal episodic memory was assessed using immediate and delayed recall from a ten-word task (Total Recall, range 0–20). Cognitive reserve was indexed by educational attainment, physical activity, and social engagement. A Bayesian nonlinear mixed-effects change-point model estimated effects on pre-decline memory performance, onset of decline, and deterioration rate. Compared with less than upper secondary education, tertiary education was associated with higher pre-decline memory performance (posterior median [PM] = 2.85 words; 95% credible interval [CrI]: 2.70–3.01) and a later estimated onset of decline (PM = 3.11 years; 95% CrI: 1.12–5.19), but a steeper subsequent rate of deterioration. Higher physical activity at wave 4, compared with sedentary activity, and social engagement were associated with a later estimated onset of memory decline (2.64 and 2.04 years, respectively). Women showed higher pre-decline memory performance and a later estimated onset of accelerated decline (PM = 3.82 years; 95% CrI: 2.43–5.25), but a steeper subsequent rate of deterioration. These findings are consistent with the cognitive reserve hypothesis, although the observational design and the timing of exposure assessments limit causal interpretation.

La gingivitis es más frecuente en niños y adolescentes, influenciada por factores compartidos con enfermedades no transmisibles (ENTs). Objetivo Estudiar la inflamación gingival y su relación con indicadores de riesgo en escolares montevideanos de 12 años. Método. Fueron utilizados datos secundarios de un estudio transversal poblacional realizado entre 2011-2012. Se emplearon cuestionarios, mediciones antropométricas y examen bucal. Resultados. Fueron examinados 1.154 escolares con un 66,6% de respuesta. El 70,2% (IC 95%: 64,9-75,5) presentó gingivitis, siendo el 33,0% (IC 95%: 27,7-38,2) severa. Los escolares que declararon cepillarse ≥3 veces al día y tenían sobrepeso/obesidad presentaron OR: 0,66 (IC 95%: 0,46-0,95) y OR: 1,57 (IC 95%: 1,12-2,20) respectivamente, ajustado por tipo de escuela y atención odontológica. Conclusiones. Se halló una alta prevalencia de gingivitis, estando asociada al hábito de cepillado dental y a la condición de sobrepeso/obesidad, confirmando la importancia de incorporar la odontología en la estrategia de factores de riesgo común de las ENTs.

Change-point models are frequently considered when modeling phenomena where a regime shift occurs at an unknown time. In aging research, these models are commonly adopted to estimate of the onset of cognitive decline. Yet these models present several limitations. Here, we present a Bayesian non-linear mixed-effects model based on a differential equation designed for longitudinal studies to overcome some limitations of classical change point models used in aging research. We demonstrate the ability of the proposed model to avoid biases in estimates of the onset of cognitive impairment in a simulated study. Finally, the methodology presented in this work is illustrated by analyzing results from memory tests from older adults who participated in the English Longitudinal Study of Aging.

Change-point models are frequently considered when modeling phenomena where a regime shift occurs at an unknown time. In ageing research, these models are commonly adopted to estimate of the onset of cognitive decline. Yet commonly used models present several limitations. Here, we present a Bayesian non-linear mixed-effects model based on a differential equation designed for longitudinal studies to overcome some limitations of classical change point models used in ageing research. We demonstrate the ability of the proposed model to avoid biases in estimates of the onset of cognitive impairment in a simulated study. Finally, the methodology presented in this work is illustrated by analysing results from memory tests from older adults who participated in the English Longitudinal Study of Ageing.

Cross-sectional studies have shown improvements in cognition in later-born cohorts. However, it remains unclear whether these cohort effects extend beyond cognitive levels and are also detectable in the rate of age-related cognitive decline. Additionally, evidence is scarce on the presence and consistency of cohort effects throughout different segments of the distribution of cognitive trajectories. This study evaluates the existence and variability of cohort effects across the entire distribution of aging-related trajectories of verbal fluency. With this purpose, we develop sex and education-adjusted longitudinal norms of verbal fluency using data from 9 waves of the English Longitudinal Study of Aging (ELSA) by fitting quantile mixed models. The effect of age was modeled using splines to assess birth cohort effects, after grouping individuals in 5-year groups from 1920 to 1950 according to their age at study entry. To test for possible cohort effects across the 10th, 50th, and 90th quantiles, the coefficients associated with the splines were allowed to vary among cohorts. Our results suggest that, consistently across longitudinal quantiles, decline in verbal fluency across age is less pronounced for later-born individuals (p < .001), supporting the hypothesis of cohort effects. Additionally, we also found that quantiles of verbal fluency at any age are shifted upwards in later-born cohorts compared to those in earlier-born cohorts. These results enhance our understanding of cognitive decline in older adults by demonstrating that cohort effects on cognition are observable both cross-sectionally and longitudinally, affecting the entire range of verbal fluency trajectories.

Background : The global phenomenon of increasing older adult populations is evident across diverse societies, including historically youthful middle- and low-income countries. Conducting population-specific research in low- and middle-income countries becomes imperative to gather pertinent evidence for crafting interventions tailored to the unique needs of each group. In this context, the present study centers on aging and frailty within rural communities situated in the Province of Loja, Ecuador, with the primary objective to analyze the aging process and assess the level of frailty, contributing valuable insights to scientific knowledge in this domain and establishing a robust foundation for future targeted health interventions. Methods : The study, conducted in rural communities of Calvas and Gonzanamá counties in the Province of Loja, Ecuador, in individuals aged 55 and older, utilized mobile stations set up for health evaluations over a two-week period in June-July 2023. A total of 269 participants underwent extensive measurements, including anthropometrics, blood samples, and assessments of physical and cognitive function. The study covered sociodemographic, lifestyle, and health-related measures, along with mental health evaluations, quality of life, functional status, and global cognition, utilizing validated scales. Results : A total of 269 individuals, mostly women (56.1%), aged 70.1 on average, participated in the study. Predominantly mestizo (93.7%), participants maintained healthy lifestyles, with minimal smoking (4.1%) and alcohol consumption (7.4%). While physical performance results indicated overall well-being, anxiety and depression levels were concerning, affecting approximately 75% of participants. No significant gender differences were observed in physical performance, independence, cognition, anxiety, depression, or well-being. Conclusion : The ECUAging study will provide detailed clinical data and will substantially contribute to new information on the predictors of aging, senescence, and senility, particularly in frail and pre-frail outpatients from rural areas of Ecuador.

The fact that there are different epidemiological definitions of periodontitis and different evaluation protocols affects the estimate of periodontitis prevalence and of the influence of associated factors. The gold standard for periodontal examination is full-mouth record assessing CAL and PD. However, there are not always sufficient human and financial resources available to apply such assessment for epidemiological surveillance systems. Aim: This study was conducted to compare different protocols and definitions of periodontitis for assessing prevalence and the impact of related factors in adult patients who requested care at the School of Dentistry, UdelaR. Materials and Method: This was a cross-sectional study of 410 subjects with a high burden of disease in terms of NCDs and periodontitis. Clinical examination evaluated PD in all teeth and CAL in the CPI sextants (WHO 2013). Four periodontitis criteria were defined based on two examination protocols (WHO 2013 and WHO 1997) and two definitions of epidemiological case. Comparisons were made taking the 2013 WHO protocol as a reference. Results: Comparison of the two examination protocols showed that prevalence was underestimated when the WHO 1997 protocol was used to define moderate-severe and severe periodontitis, by 20% and 60%, respectively. Conclusions: When the severity of periodontitis was not considered, the WHO 2013 protocol did not provide more information on what factors increase the chance of periodontitis. However, when severity was considered, the associated factors were different. Consequently, in a small population, it would be worth using the WHO 2013 protocol, which is the closest to the full-mouth gold standard criterion. Keywords: cross-sectional studies - periodontal index - periodontitis - risk factors - non-communicable diseases