Modifiable risk factors for stroke, dementia and late-life depression: a systematic review and DALY-weighted risk factors for a composite outcome

Mary Pat Campbell

Link: https://jnnp.bmj.com/content/early/2025/03/21/jnnp-2024-334925.long

Excerpt:

Abstract

Background At least 60% of stroke, 40% of dementia and 35% of late-life depression (LLD) are attributable to modifiable risk factors, with great overlap due to shared pathophysiology. This study aims to systematically identify overlapping risk factors for these diseases and calculate their relative impact on a composite outcome.

Methods A systematic literature review was performed in PubMed, Embase and PsycInfo, between January 2000 and September 2023. We included meta-analyses reporting effect sizes of modifiable risk factors on the incidence of stroke, dementia and/or LLD. The most relevant meta-analyses were selected, and disability-adjusted life year (DALY) weighted beta (β)-coefficients were calculated for a composite outcome. The β-coefficients were normalised to assess relative impact.

Results Our search yielded 182 meta-analyses meeting the inclusion criteria, of which 59 were selected to calculate DALY-weighted risk factors for a composite outcome. Identified risk factors included alcohol (normalised β-coefficient highest category: −34), blood pressure (130), body mass index (70), fasting plasma glucose (94), total cholesterol (22), leisure time cognitive activity (−91), depressive symptoms (57), diet (51), hearing loss (60), kidney function (101), pain (42), physical activity (−56), purpose in life (−50), sleep (76), smoking (91), social engagement (53) and stress (55).

Conclusions This study identified overlapping modifiable risk factors and calculated the relative impact of these factors on the risk of a composite outcome of stroke, dementia and LLD. These findings could guide preventative strategies and serve as an empirical foundation for future development of tools that can empower people to reduce their risk of these diseases.

Author(s): http://orcid.org/0009-0002-6540-480XJasper Senff1,2,3,4,5, http://orcid.org/0000-0003-3204-0309Reinier Willem Pieter Tack1,2,3,4,5, Akashleena Mallick1,2,3,4, Leidys Gutierrez-Martinez1,2,3,4, Jonathan Duskin1,2,3,4, Tamara N Kimball1,2,3,4,6, Benjamin Y Q Tan1,2,3,4,7, Zeina N Chemali1,2,8, Amy Newhouse1,9, Christina Kourkoulis1,2,3,4, Cyprien Rivier10,11, Guido J Falcone10,11, Kevin N Sheth10,11, Ronald M Lazar12, Sarah Ibrahim13,14,15,16,17, Aleksandra Pikula14,15,16,17, Rudolph E Tanzi1, Gregory L Fricchione8, Hens Bart Brouwers5, Gabriel J E Rinkel5, Nirupama Yechoor1,2,3,4, Jonathan Rosand1,2,3,4, Christopher D Anderson1,2,3,4,6, Sanjula D Singh1,2,3,4

https://doi.org/10.1136/jnnp-2024-334925

Publication Date: April 2025

Publication Site: Journal of Neurology, Neurosurgery, & Psychiatry

17 Ways to Cut Your Risk of Stroke, Dementia and Depression All at Once

Mary Pat Campbell

Link: https://www.nytimes.com/2025/04/23/well/dementia-stroke-depression-prevention.html?smid=url-share

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Excerpt:

New research has identified 17 overlapping factors that affect your risk of stroke, dementia and late-life depression, suggesting that a number of lifestyle changes could simultaneously lower the risk of all three.

Though they may appear unrelated, people who have dementia or depression or who experience a stroke also often end up having one or both of the other conditions, said Dr. Sanjula Singh, a principal investigator at the Brain Care Labs at Massachusetts General Hospital and the lead author of the study. That’s because they may share underlying damage to small blood vessels in the brain, experts said.

….

The study, which looked at data from 59 meta-analyses, identified six factors that lower your risk of brain diseases:

  • Low to moderate alcohol intake (Consuming one to three drinks a day had a smaller benefit than consuming less than one drink a day.)
  • Cognitive activity, meaning regular engagement in mentally stimulating tasks like reading or doing puzzles
  • A diet high in vegetables, fruit, dairy, fish and nuts
  • Moderate or high levels of physical activity
  • A sense of purpose in life
  • A large social network

The study also identified 13 health characteristics and habits that make you more likely to develop dementia, a stroke or late-life depression. (Altogether, the protective and harmful factors add up to 19 factors because two of them, diet and social connections, can increase or decrease risk, depending on their type and quality.)

  • High blood pressure
  • High body mass index
  • High blood sugar
  • High total cholesterol
  • Depressive symptoms
  • A diet high in red meat, sugar-sweetened beverages, sweets and sodium
  • Hearing loss
  • Kidney disease
  • Pain, particularly forms that interfere with activity
  • Sleep disturbances (for example, insomnia or poor sleep quality) or sleep periods longer than eight hours
  • Smoking history
  • Loneliness or isolation
  • General stress or stressful life events (as reported by study subjects)

Author(s): Nina Agrawal

Publication Date: 23 Apr 2025

Publication Site: NYT

A Subsidy for Motherhood: Why I Now Support Social Security

Mary Pat Campbell

Link: https://eppc.org/publication/a-subsidy-for-motherhood-why-i-now-support-social-security/

Excerpt:

But a major source of Social Security’s popularity, I believe, is that it is the last major institution in America to embody what used to be called the “family wage”—an adjustment of the pre-tax market wage to accommodate the responsibilities of raising a family. This is what now most embarrasses liberals about Social Security, no less than it offends yuppies. Social Security stands almost alone in accepting the traditional family (in which the father works to support the family and the mother raises the children) as normal. In addition to the basic retirement benefit based on each worker’s lifetime of contributions, there is an extra 50 percent spouse’s benefit. For most married women who work part-time, intermittently, or not at all outside the home, this spousal benefit is greater than the one to which they are entitled based on their own lifetime cash earnings. There is also a widow’s benefit equal to 100 percent of the husband’s basic benefit, and coverage of surviving dependents. To qualify, in general, the couple must remain married, the husband must be steadily employed, and the wife must give up a lifetime of earnings equal to at least one-half of her husband’s. Thus the structure of Social Security—in sharp contrast to welfare—upholds intact marriage, a father’s responsibilities, a mother’s sacrifice.

….

Yet every major Social Security reform proposal would pare down or phase out the “family wage.” Liberal proposals to tax or to means-test benefits would disproportionately hit the family benefits. Proposals by conservatives to privatize Social Security would hit the family twice. Social Security’s benefits for the traditional family, in effect, would effectively be phased out. In addition, the whole baby boom would be forced to “pay twice for retirement,” making it even harder to raise a family.

….

The birth rate in industrial countries has been falling steadily since the 19th century (in fact, one of the few interruptions of this decline in the United States, the baby boom, started after Social Security). The Myrdals were among the first to argue that this “demographic transition” has three causes: urbanization (which ends the economic value of children as unpaid farmhands and geographically scatters the extended family); industrialization (which makes widespread saving and social insurance against old age both possible and necessary); and secularization (which changes attitudes about birth control and abortion).

….

No one can argue that keeping Social Security will trigger a resurgence of traditional values; Great Awakenings are not kicked off by the retention of federal programs. But no one can doubt that officially upholding the family as the norm is important—or deny that undermining the “family wage” aspect of Social Security would be a serious blow to the family.

Author(s): John D. Mueller

Publication Date: October 15, 1987

Publication Site: Policy Review

BRCA1, BRCA2, and Associated Cancer Risks and Management for Male Patients

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jamaoncology/article-abstract/2821594

Excerpt:

Importance  Half of all carriers of inherited cancer-predisposing variants in BRCA1 and BRCA2 are male, but the implications for their health are underrecognized compared to female individuals. Germline variants in BRCA1 and BRCA2 (also known as pathogenic or likely pathogenic variants, referred to here as BRCA1/2 PVs) are well known to significantly increase the risk of breast and ovarian cancers in female carriers, and knowledge of BRCA1/2 PVs informs established cancer screening and options for risk reduction. While risks to male carriers of BRCA1/2 PVs are less characterized, there is convincing evidence of increased risk for prostate cancer, pancreatic cancer, and breast cancer in males. There has also been a rapid expansion of US Food and Drug Administration–approved targeted cancer therapies, including poly ADP ribose polymerase (PARP) inhibitors, for breast, pancreatic, and prostate cancers associated with BRCA1/2 PVs.

Observations  This narrative review summarized the data that inform cancer risks, targeted cancer therapy options, and guidelines for early cancer detection. It also highlighted areas of emerging research and clinical trial opportunities for male BRCA1/2 PV carriers. These developments, along with the continued relevance to family cancer risk and reproductive options, have informed changes to guideline recommendations for genetic testing and strengthened the case for increased genetic testing for males.

Conclusions and Relevance  Despite increasing clinical actionability for male carriers of BRCA1/2 PVs, far fewer males than female individuals undergo cancer genetic testing. Oncologists, internists, and primary care clinicians should be vigilant about offering appropriate genetic testing to males. Identifying more male carriers of BRCA1/2 PVs will maximize opportunities for cancer early detection, targeted risk management, and cancer treatment for males, along with facilitating opportunities for risk reduction and prevention in their family members, thereby decreasing the burden of hereditary cancer.

Author(s): Heather H. Cheng, MD, PhD1,2; Jeffrey W. Shevach, MD3; Elena Castro, MD, PhD4; et al

JAMA Oncol. 2024;10(9):1272-1281.

doi:10.1001/jamaoncol.2024.2185

Publication Date: July 25, 2024

Publication Site: JAMA Oncology

AI Tools for Actuaries (work in progress)

Mary Pat Campbell

Link: https://aitools4actuaries.com/

SSRN link: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5162304

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Excerpt:

About This Project

This project aims to empower the actuarial profession with modern machine learning and AI tools. We provide comprehensive teaching materials that consist of lecture notes (technical document) building the theoretical foundation of this initiative. Each chapter of these lecture notes is supported by notebooks and slides which give teaching material, practical guidance and applied examples. Moreover, hands-on exercises in both R and Python are provided in additional notebooks.

Author(s): Mario V. Wüthrich, Ronald Richman, Benjamin Avanzi, Mathias Lindholm, Michael Mayer, Jürg Schelldorfer, Salvatore Scognamiglio

Accessed: 24 Apr 2025

Publication Site: AI Tools for Actuaries 

Fecal Immunochemical Test Screening and Risk of Colorectal Cancer Death

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821348

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Excerpt:

Key Points

Question  What is the colorectal cancer mortality benefit of screening with fecal immunochemical tests (FITs)?

Findings  In this nested case control study of 10 711 individuals, completing a FIT to screen for colorectal cancer was associated with a reduction in risk of dying from colorectal cancer of approximately 33% overall, and there was a 42% lower risk for left colon and rectum cancers. FIT screening was also associated with lower risk of colorectal cancer death among non-Hispanic Asian, non-Hispanic Black, and non-Hispanic White people.

Meaning  This study provides US community-based evidence that suggests FIT screening lowers the risk of dying from colorectal cancer and supports the strategy of population-based screening using FIT.

Author(s): Chyke A. Doubeni, MD, MPH1,2; Douglas A. Corley, MD, PhD3; Christopher D. Jensen, PhD3; et al

Publication Date: July 19, 2024

Publication Site: JAMA Netw Open. 

2024;7(7):e2423671.

doi:10.1001/jamanetworkopen.2024.23671