Insulin resistance, age and depression’s impact on cognition in middle-aged adults from the PREVENT cohort

International audienceBackground Alzheimer’s disease (AD), type 2 diabetes mellitus (characterised by insulin resistance) and depression are significant challenges facing public health. Research has demonstrated common comorbidities among these three conditions, typically focusing on two of them at a time. Objective The goal of this study, however, was to assess the inter-relationships between the three conditions, focusing on mid-life (defined as age 40–59) risk before the emergence of dementia caused by AD. Methods In the current study, we used cross-sectional data from 665 participants from the cohort study, PREVENT. Findings Using structural equation modelling, we showed that (1) insulin resistance predicts executive dysfunction in older but not younger adults in mid-life, that (2) insulin resistance predicts self-reported depression in both older and younger middle-aged adults and that (3) depression predicts deficits in visuospatial memory in older but not younger adults in mid-life. Conclusions Together, we demonstrate the inter-relations between three common non-communicable diseases in middle-aged adults. Clinical implications We emphasise the need for combined interventions and the use of resources to help adults in mid-life to modify risk factors for cognitive impairment, such as depression and diabetes

The rules for online clinical engagement in the COVID era

COVID-19 has generated a need to rapidly increase online consulting in secondary care, an area in which it has previously been underutilised. We sought to review the guidance around conducting remote consultations and found that while there is a large amount of information about the implementation of remote consultations at an organisation level, there is a paucity of high-quality papers considering the guidelines for online consultations alongside practical advice for their implementation at the individual level. We reviewed guidelines from reputable medical sources and generated practical advice to assist practitioners in performing safe and effective video consultation. Additionally, we noted reports in the literature of a lack of transparency and resulting confusion regarding the choice of telemedicine platforms. We therefore sought to summarise key characteristics of a number of major telemedicine platforms. We recognised a lack of clarity regarding the legal status of performing remote consultations, and reviewed advice from medicolegal sources. Finally, we address the sources of these individual uncertainties, and give recommendations on how these might be addressed systematically, so the practitioners are well trained and competent in the use of online consultations, which will inevitably play an increasingly large role in both primary and secondary care settings in the future

Insulin Resistance’s Impact on Cognition in Middle Aged Adults from the PREVENT cohort: Interactive Effects with Depression

AbstractBackgroundAlzheimer’s disease, type 2 diabetes mellitus, and depression are significant challenges facing public health. Research has demonstrated common comorbidities amongst these three conditions, typically focusing on two of them at a time.ObjectivesThe goal of this study, however, was to assess the interrelationships between the three conditions, focusing on mid-life risk before the emergence of dementia caused by Alzheimer’s Disease.MethodsIn the current study, we used data from 665 participants from the prospective cohort study, PREVENT.FindingsUsing structural equation modelling, we showed that (i) insulin resistance predicts executive dysfunction in older but not younger adults in midlife, that (ii) insulin resistance predicts self-reported depression in both older and younger middle-aged adults, and that (iii) depression predicts deficits in visuospatial memory in older but not younger adults in midlife.ConclusionsTogether, we demonstrate the interrelations between three common non-communicable diseases in middle-aged adults.Clinical ImplicationsWe emphasise the need for combined interventions and the utilisation of resources to help adults in midlife to modify risk factors for cognitive impairment, such as depression and diabetes.FundingThe PREVENT study was funded by the Alzheimer’s Society (grant numbers 178 and 264), the Alzheimer’s Association (grant number TriBEKa-17-519007) and philanthropic donations. GR acknowledges funding for this work for his research programme funded by the Medical Research council (Dementias Platform UK) and Five Lives Ltd. IK declares funding for this project through Medical Research Council (Dementias Platform UK), NIHR Oxford Health Biomedical Research Centre and NIHR personal awards. SG acknowledges funding for salary from the Medical Research Council Nutrition Research Partnership Collaboration Award (MR/T001852/1).Key MessagesWhat is already known on this topicMood disorders and metabolic diseases are known to be frequently comorbid. Furthermore, both conditions are known to be associated with cognitive impairment and cognitive decline. There has been some evidence that the risk of cognitive impairment associated with diabetes and depression is most notable in midlife. However, studies focusing on this period of life have been sparse and most research has modelled bivariate correlations amongst cognitive impairment, depression, and diabetes. As such, this study was conducted in order to model the interrelations between the three conditions in a large cohort, whilst focusing on midlife as depression and diabetes in this period are thought to carry higher risk for cognitive impairment.What this study addsWhilst insulin resistance, as a core feature of diabetes, was related to depression across all stages of midlife, the relationship with cognitive functioning was more complex. In the current study, we found that the stage of midlife in which middle-aged adults find themselves moderates the relationship between insulin resistance and cognition and depression and cognition. That is, only in older middle aged adults does insulin resistance predict impaired cognition (i.e., executive function) and does depression predict impaired cognition (i.e., visuospatial memory).How this study might affect research, practice or policyClinicians should be mindful of the impact of comorbidities between cognitive impairment, metabolic diseases, such as diabetes, and mood disorders, such as depression in midlife. Given the risk of intractable dementia in individuals with cognitive impairment, available resources for intervening in modifiable risk factors, such as depression and diabetes, should be considered for adults in the middle period of life.</jats:sec

The Duration, Dynamics, and Determinants of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibody Responses in Individual Healthcare Workers

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) antibody measurements can be used to estimate the proportion of a population exposed or infected and may be informative about the risk of future infection. Previous estimates of the duration of antibody responses vary. Methods We present 6 months of data from a longitudinal seroprevalence study of 3276 UK healthcare workers (HCWs). Serial measurements of SARS-CoV-2 anti-nucleocapsid and anti-spike IgG were obtained. Interval censored survival analysis was used to investigate the duration of detectable responses. Additionally, Bayesian mixed linear models were used to investigate anti-nucleocapsid waning. Results Anti-spike IgG levels remained stably detected after a positive result, for example, in 94% (95% credibility interval [CrI] 91–96%) of HCWs at 180 days. Anti-nucleocapsid IgG levels rose to a peak at 24 (95% CrI 19–31) days post first polymerase chain reaction (PCR)-positive test, before beginning to fall. Considering 452 anti-nucleocapsid seropositive HCWs over a median of 121 days from their maximum positive IgG titer, the mean estimated antibody half-life was 85 (95% CrI 81–90) days. Higher maximum observed anti-nucleocapsid titers were associated with longer estimated antibody half-lives. Increasing age, Asian ethnicity, and prior self-reported symptoms were independently associated with higher maximum anti-nucleocapsid levels and increasing age and a positive PCR test undertaken for symptoms with longer anti-nucleocapsid half-lives. Conclusions SARS-CoV-2 anti-nucleocapsid antibodies wane within months and fall faster in younger adults and those without symptoms. However, anti-spike IgG remains stably detected. Ongoing longitudinal studies are required to track the long-term duration of antibody levels and their association with immunity to SARS-CoV-2 reinfection. </jats:sec