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45'
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6 January 2012 Last updated at 01:08 GMT
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Top StoriesTurkey's ex-army chief arrested
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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Features & AnalysisLiving it upIndividuals were tested for
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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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Most PopularSharedBrain function declines from 45 Worm 'steals
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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
ReadBrain function declines from 45 Men 'unhappy with beer
bellies' The day Kim Jong-il gave me a Rolex Probe into film on Bin
Laden raid Turkey's ex-army chief arrested Third sex charge for
footballer Tymoshenko husband 'seeks asylum'
http://www.bbc.co.uk/news/health-16425522[06/01/2012
11:12:30]
BBC News - Brain function can start declining 'as early as age
45'
in an individual's 50s but we only start looking at risk in
their 60s, then how do you start separating cause and effect?"
Worm 'steals Facebook passwords' French crack down on Roma gangs
Hague: 'More Burma change needed'
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."
Video/Audio If the disease has started in an individual's 50s
but we only start looking at risk in their 60s, then how do you
start separating cause and effect?Professor Archana Singh-Manoux
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Programmes
More on This StoryRelated Stories'We want to prevent people
getting dementia' 19 DECEMBER 2011 , HEALTH Smoking 'linked to
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Related Internet linksBritish Medical Journal Alzheimer's
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BBC News - Brain function can start declining 'as early as age
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http://www.bbc.co.uk/news/health-16425522[06/01/2012
11:12:30]
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).
Articles by Aline Dugravot No Citing articles via Web of Science
No Citing articles via Scopus
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RAPID RESPONSES Latest responses Most responses
Latest responsesRe:rectal examn.Published Thu, 2012-01-05
17:32
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]
Why does BMJ support donations of pulse oximeters when they have
no effect?Published Thu, 2012-01-05 14:24
The Test of time: a key diagnostic strategy in primary
carePublished Thu, 2012-01-05 12:32
Re: Publication of NIH funded trials
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.
Should governments be allowed to censor research because of
biosecurity fears?Yes No
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