Gilsanz, Paola
Lifecourse health, cerebral pathology and ethnic disparities in dementia (KHANDLE Study)
The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study, a collaborative study between DOR and UC Davis, follows a diverse cohort of Kaiser Permanente Northern California members who participated in at least one optional check-up (Multiphasic Health Checkups) during…
Electronic Health Record-Based Dementia Prediction for HIV Primary Care
The goal of this K01 Career Development Award is to receive mentored training on the development of risk prediction models for dementia in people with HIV using electronic health records data. The project will quantify the contribution of HIV- and…
Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-life Cognition: Study of Healthy Aging in African Americans (STAR)
Midlife cardiovascular risk factors (CVRF) increase risk of dementia. Black Americans experience an elevated prevalence of CVRF and dementia. However, little is known of how CVRF prior to midlife affect late-life cognition. We examined CVRF in adolescence, young adulthood, and…
Racial/Ethnic Disparities in Young Adulthood and Midlife Cardiovascular Risk Factors and Late-life Cognitive Domains: The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
Midlife cardiovascular risk factors (CVRF) increase dementia risk. Less is known about whether CVRF identified before midlife impact late-life cognition in diverse populations. Linear regression models examined hypertension, hyperlipidemia, and overweight/obesity at ages 30 to 59 with late-life executive function,…
Do the Benefits of Educational Attainment for Late-life Cognition Differ by Racial/Ethnic Group?: Evidence for Heterogenous Treatment Effects in the Kaiser Healthy Aging and Diverse Life Experience (KHANDLE) Study
Educational attainment is associated with late-life cognitive performance and dementia; few studies have examined diverse racial/ethnic groups to assess whether the association differs by race/ethnicity. We investigated whether the association between educational attainment and cognition differed between White, Black, Asian,…
Sex Differences in Cognitive Decline Among US Adults
Sex differences in dementia risk are unclear, but some studies have found greater risk for women. To determine associations between sex and cognitive decline in order to better understand sex differences in dementia risk. This cohort study used pooled analysis…
Association of Major Dietary Protein Sources With All-Cause and Cause-Specific Mortality: Prospective Cohort Study
Background Dietary recommendations regarding protein intake have been focused on the amount of protein. However, such recommendations without considering specific protein sources may be simplistic and insufficient. Methods and Results We included 102 521 postmenopausal women enrolled in the Women's Health…
Fitting a shared frailty illness-death model to left-truncated semi-competing risks data to examine the impact of education level on incident dementia
Semi-competing risks arise when interest lies in the time-to-event for some non-terminal event, the observation of which is subject to some terminal event. One approach to assessing the impact of covariates on semi-competing risks data is through the illness-death model…
Statin Treatment and Incident Alzheimer’s Disease and Related Dementias in a Large, Multi-ethnic Health Plan
The study will assess the effects of statin treatment on risk of Alzheimer's disease and related dementias, controlling for potential confounding and examining potential mediating factors among Kaiser Permanente Northern California members during the years 1996 to 2020. A second…
Association of genetic risk for Alzheimer disease and hearing impairment
To test the hypothesis that incipient AD may adversely affect hearing and that hearing loss may adversely affect cognition we evaluated whether (1) genetic variants that increase AD risk also increase problem hearing and (2) genetic variants that increase hearing…
Cardiovascular Risk Factors and Accelerated Cognitive Decline in Midlife: the CARDIA Study
Increasing evidence supports an association between midlife cardiovascular risk factors (CVRFs) and risk of dementia, but less is known about whether CVRFs influence cognition in midlife. We examined the relationship between CVRFs and midlife cognitive decline. In 2,675 black and…
Glycemic Control and Dementia: The Role of Pharmacotherapy and Vascular Complications
About 25% of people over the age of 65 are living with diabetes, with 90% of them managing type 2 diabetes. Studies have shown that older individuals with type 2 diabetes have a 51-62% higher risk of dementia than those…
Smoking mediates the relationship between SES and brain volume: The CARDIA study
Investigate whether socioeconomic status (SES) was related to brain volume in aging related regions, and if so, determine whether this relationship was mediated by lifestyle factors that are known to associate with risk of dementia in a population-based sample of…
Differences in association of leisure time activities and cognition in a racially/ethnically diverse cohort of older adults: Findings from the KHANDLE study
Leisure time activity is associated with better cognitive function but has not been well studied in racially/ethnically diverse cohorts, who may have different access to activities. Frequency of participation in 10 leisure time activities (eg, reading, attending cultural events) and…
Neurocognitive Impairment and Dementia in People With and Without HIV
People with HIV infection are at increased risk for dementia, possibly due to the combined effects of HIV-associated inflammation and traditional dementia risk factors such as chronic drug use and cerebrovascular disease. With the widespread use of antiretroviral therapy for…
Contributions of Educational Quality and Occupational Complexity on Racial and Ethnic Inequities in Brain Health and Alzheimer’s Disease and Related Dementia
This study utilizes a lifecourse approach to evaluate the roles of education quality and occupational complexity on dementia risk and cognitive decline and to examine if patterns of educational quality and occupational complexity across the lifecourse drive racial and ethnic…
Alzheimer’s Disease and Related Dementias in a Diverse Cohort of Asian Americans
This study considers the extent to which immigration history, social factors, cardiometabolic health, and genetic factors contribute to heterogeneity in dementia incidence between Asian American subgroups and between Asian Americans and whites.
Stressors in Midlife and Risk of Dementia: The Role of Race and Education
Posttraumatic stress disorder is associated with increased dementia risk but less is known about stress because of everyday problems in diverse populations. A total of 9605 health care plan members who provided information regarding midlife stressors in 1972 to 1973…
Reproductive period and risk of dementia in a diverse cohort of health care members
Women have >50% greater lifetime risk of dementia than men but the role of female-specific endocrine milieu is not well-understood. This study evaluates associations between indicators of estrogen exposure from women's reproductive period and dementia risk in a large diverse…
Incidence of dementia after age 90 in a multiracial cohort
Little is known about dementia incidence in diverse populations of oldest-old, the age group with highest dementia incidence. Incident dementia diagnoses from 1/1/2010 to 9/30/2015 were abstracted from medical records for 2350 members of an integrated health care system in…
Study of Healthy Aging in African Americans (STAR)
Rates of dementia and Alzheimer’s disease are 40% to 100% higher among African Americans compared to non-Hispanic whites. STAR is a longitudinal cohort study of lifecourse vascular risk and brain aging in 700 African Americans ages 50 and older. The goals…
Kaiser Healthy Aging and Diverse Life Experiences Study (KHANDLE)
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early-life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups. We…
Life After 90
Alzheimer’s disease and other dementias affect 15 percent of those aged 65 and older, by age 90 and older this number increases to a startling 40 to 50 percent. The oldest-old, people aged 90 and older, are the fastest growing…
Lifecourse Health, Cerebral Pathology, and Ethnic Disparities in Dementia
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early-life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups. This…
Closing the Gap Between Observational Research and Randomized Trials for Prevention of Alzheimer‘s Disease and Dementia
Observational studies should have a core role in justifying and guiding the development of randomized controlled trials, but to date observational research and trials on Alzheimer’s disease prevention are not closely aligned. Observational and randomized studies nearly always answer different…
Birth in High Infant Mortality States and Dementia Risk in a Cohort of Elderly African American and White Health Care Members
Birth in areas with high infant mortality rates (IMRs) has been linked to worse long-term health outcomes, yet it is completely unknown if it impacts dementia risk. In total 6268 health care members were followed for dementia diagnosis from 1996…
Early Midlife Pulmonary Function and Dementia Risk
Poor pulmonary function (PPF) is associated with increased risk of dementia, yet it is unclear if PPF in early adulthood to midlife increases risk, independent of smoking and subsequent vascular disease. This study evaluated the association between multiple markers of…
Traumatic brain injury associated with dementia risk among people with type 1 diabetes
To examine the association between traumatic brain injury (TBI) and dementia risk among a cohort of middle-aged and elderly individuals with type 1 diabetes (T1D). We evaluated 4,049 members of an integrated health care system with T1D ≥50 years old…
Long-term Glycemic Control and Dementia Risk in Type 1 Diabetes
Individuals with type 1 diabetes have experienced an increase in life expectancy; yet, it is unknown what level of glycemic control is ideal for maintaining late-life brain health. We investigated the association of long-term glycemic control with dementia in older…
Early Identification and Prognosis in Neurodegenerative Parkinsonism
The goals of this study are to develop an efficient method for identification of people destined to develop a neurodegenerative synucleinopathy, develop an efficient method for early stratification of persons with neurodegenerative parkinsonism to identify expected final diagnosis (e.g., Parkinson’s…
Depression in type 1 diabetes and risk of dementia
Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk.…
Associations of plasma clusterin and Alzheimer’s disease-related MRI markers in adults at mid-life: The CARDIA Brain MRI sub-study
Clinical and epidemiological studies of older persons have implicated clusterin in Alzheimer's disease (AD) pathogenesis. In the context of identifying early biomarkers of risk, we examined associations of plasma clusterin and characteristics of AD in middle-aged individuals from the community.…
Post-traumatic stress disorder and risk of dementia among members of a health care delivery system
Post-traumatic stress disorder (PTSD) is associated with an increased risk of dementia in male veterans, but little is known in females and civilians. PTSD and comorbidities were abstracted from medical records from 1/1/1996 to 12/31/2001. Dementia incidence from 1/1/2002 to…
Epidemiology of Age-related Dementia, Mild Cognitive Impairment, and Brain Pathology in a Multiethnic Cohort of Oldest-Old
Alzheimer's disease and other dementias affect 15 percent of those aged 65 and up; by age 90 and up, this number increases to a startling 40 to 50 percent. The oldest-old, people aged 90 and -older, are the fastest-growing segment…
Female sex, early-onset hypertension, and risk of dementia
To evaluate the association of early-adulthood and mid-adulthood hypertension with dementia in men and women. We evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean…
Alzheimer’s disease genetic risk variants beyondAPOEε4 predict mortality
INTRODUCTION: We hypothesized that, like apolipoprotein E (APOE), other late-onset Alzheimer's disease (LOAD) genetic susceptibility loci predict mortality.METHODS: We used a weighted genetic risk score (GRS) from 21 non-APOELOAD risk variants to predict survival in the Adult Changes in Thought…
Heterogeneity in 14-year Dementia Incidence Between Asian American Subgroups
Asian Americans are a rapidly growing and diverse population. Prior research on dementia among Asian Americans focused on Japanese Americans or Asian Americans overall, although marked differences in cardiometabolic conditions between subgroups have been documented. We compared dementia incidence among…
Early Vascular Contributions to Dementia Risk in African-Americans
This is a lifecourse study of vascular risk and brain aging in a well-characterized population of 1,200 elderly African-Americans that will close the gap in knowledge regarding midlife risk and protective factors for cognitive decline. The data collected, in conjunction…
Lifecourse Health, Cerebral Pathology and Ethnic Disparities in Dementia
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups.…
Early Vascular Contributions to Dementia Risk in African-Americans – DUPLICATED DO NOT ACTIVATE
This is a life-course study of vascular risk and brain aging in a well-characterized population of 1,200 elderly African-Americans that will close the gap in knowledge regarding midlife risk and protective factors for cognitive decline. We will conduct cognitive testing…
Predictors of Late-Life Cognitive Health in Type 1 Diabetes
There is evidence that middle aged-adults with Type 1 diabetes have deficits in cognitive function and are more likely to be diagnosed with depression . Although it is well established that elderly individuals with type 2 diabetes are at double…
Changes in Medication Use After Dementia Diagnosis in an Observational Cohort of Individuals with Diabetes Mellitus
To assess changes in medication use after a diagnosis of dementia in individuals with type 2 diabetes mellitus. Difference-in-differences analysis of changes in the number of dispensed chronic medications between individuals with and without newly diagnosed dementia. Integrated healthcare delivery…
A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline
Common diseases like diabetes, hypertension, and atrial fibrillation are probable risk factors for dementia, suggesting that their treatments may influence the risk and rate of cognitive and functional decline. Moreover, specific therapies and medications may affect long-term brain health through…
Inequalities in dementia incidence between six racial and ethnic groups over 14years
Reducing racial/ethnic disparities is a primary objective of the National Alzheimer's Plan (NAPA), yet direct comparisons within large samples representing diversity of the United States are lacking. Dementia incidence from January 1, 2000 to December 31, 2013 and a 25-year…
First translational ‘Think Tank’ on cerebrovascular disease, cognitive impairment and dementia
As the human population continues to age, an increasing number of people will exhibit significant deficits in cognitive function and dementia. It is now recognized that cerebrovascular, metabolic and neurodegenerative diseases all play major roles in the evolution of cognitive…
Anemia and risk for cognitive decline in chronic kidney disease
Anemia is common among patients with chronic kidney disease (CKD) but its health consequences are poorly defined. The aim of this study was to determine the relationship between anemia and cognitive decline in older adults with CKD. We studied a…
Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults With Diabetes: The Diabetes and Aging Study
The aim of this study was to evaluate ethnic differences in burden of prevalent geriatric conditions and diabetic complications among older, insured adults with diabetes. An observational study was conducted among 115,538 diabetes patients, aged ³60, in an integrated health…
Cardiorespiratory fitness and brain volume and white matter integrity: The CARDIA Study
We hypothesized that greater cardiorespiratory fitness is associated with lower odds of having unfavorable brain MRI findings. We studied 565 healthy, middle-aged, black and white men and women in the CARDIA (Coronary Artery Risk Development in Young Adults) Study. The…
Diabetes and Cognition
Dementia is a major cause of disability and death among older adults. Those with type 2 diabetes (T2D) are 50-100% more likely to develop dementia than those without T2D, but it is unknown whether this association reflects a causal relationship.…
Midlife risk score for the prediction of dementia four decades later
The objective of this study was to obtain external validation of the only available midlife dementia risk score cardiovascular risk factors , aging and dementia study (CAIDE) constituting age, education, hypertension, obesity, and hyperlipidemia in a larger, more diverse population.…
Racial/ethnic differences in dementia risk among older type 2 diabetes patients: The Diabetes and Aging Study
OBJECTIVE Although patients with type 2 diabetes have double the risk of dementia, potential racial/ethnic differences in dementia risk have not been explored in this population. We evaluated racial/ethnic differences in dementia and potential explanatory factors among older diabetic patients.…
Dementia and cognitive decline in type 2 diabetes and prediabetic stages: towards targeted interventions
Type 2 diabetes is associated with dementia, and also with more slight cognitive decrements. In this Review we discuss trajectories from normal cognition to dementia in people with type 2 diabetes, and explore opportunities for treatment. Slight diabetes-associated cognitive decrements…
Severe Diabetic Retinal Disease and Dementia Risk in Type 2 Diabetes
Persons with type 2 diabetes are at an increased risk of dementia compared to those without, but the etiology of this increased risk is unclear. Cerebral microvascular disease may mediate the link between diabetes and dementia. Given the anatomical and…
Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study
Although patients with type 2 diabetes are twice as likely to develop dementia as those without this disease, prediction of who has the highest future risk is difficult. We therefore created and validated a practical summary risk score that can…
Subclinical atherosclerotic calcification and cognitive functioning in middle-aged adults: The CARDIA study
Cardiovascular risk factors in middle-age are associated with cognitive impairment and dementia in older age. Less is known about the burden of calcified subclinical atherosclerosis and cognition, especially in midlife. We examined the association of coronary artery and abdominal aortic…
An update on type 2 diabetes, vascular dementia and Alzheimer’s disease
The risk of dementia is increased in people with type 2 diabetes mellitus (T2DM). This review gives an update on the relation between T2DM and specific dementia subtypes - i.e. Alzheimer's disease and vascular dementia - and underlying pathologies. We…
Hormone therapy and Alzheimer disease dementia: New findings from the Cache County Study
OBJECTIVES: Observational studies suggest reduced risk of Alzheimer disease (AD) in users of hormone therapy (HT), but trials show higher risk. We examined whether the association of HT with AD varies with timing or type of HT use. METHODS: Between…
Midlife vs Late-Life Depressive Symptoms and Risk of Dementia: Differential Effects for Alzheimer Disease and Vascular Dementia
CONTEXT: Depression and dementia are common in older adults and often co-occur, but it is unclear whether depression is an etiologic risk factor for dementia. OBJECTIVE: To clarify the timing and nature of the association between depression and dementia. DESIGN:…
Association of Depression With Increased Risk of Dementia in Patients With Type 2 Diabetes: The Diabetes and Aging Study
CONTEXT: Although depression is a risk factor for dementia in the general population, its association with dementia among patients with diabetes mellitus has not been well studied. OBJECTIVE: To determine whether comorbid depression in patients with type 2 diabetes increases…
Central Obesity, Leptin and Cognitive Decline: The Sacramento Area Latino Study on Aging
BACKGROUND/AIMS: Central obesity is a risk factor for cognitive decline. Leptin is secreted by adipose tissue and has been associated with better cognitive function. Aging Mexican Americans have higher levels of obesity than non-Hispanic Whites, but no investigations examined the…
Heavy smoking in midlife and long-term risk of Alzheimer disease and vascular dementia
BACKGROUND: Smoking is a risk factor for several life-threatening diseases, but its long-term association with dementia is controversial and somewhat understudied. Our objective was to investigate the long-term association of amount of smoking in middle age on the risk of…
Timing of hormone therapy and dementia: the critical window theory revisited
OBJECTIVE: Although previous research has shown that initiation of postmenopausal estrogen hormone therapy (HT) in late life increases risk of dementia, animal studies and some observational studies have suggested that midlife use of HT may be beneficial; however, this has…
Use of angiotensin receptor blockers and risk of dementia in a predominantly male population: prospective cohort analysis
OBJECTIVE: To investigate whether angiotensin receptor blockers protect against Alzheimer's disease and dementia or reduce the progression of both diseases. DESIGN: Prospective cohort analysis. SETTING: Administrative database of the US Veteran Affairs, 2002-6. Population 819 491 predominantly male participants (98%)…
Predicting risk of dementia in older adults: The late-life dementia risk index
OBJECTIVE: To develop a late-life dementia risk index that can accurately stratify older adults into those with a low, moderate, or high risk of developing dementia within 6 years. METHODS: Subjects were 3,375 participants in the Cardiovascular Health Cognition Study…
Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus
CONTEXT: Although acute hypoglycemia may be associated with cognitive impairment in children with type 1 diabetes, no studies to date have evaluated whether hypoglycemia is a risk factor for dementia in older patients with type 2 diabetes. OBJECTIVE: To determine…
Midlife serum cholesterol and increased risk of Alzheimer’s and vascular dementia three decades later
AIMS: To investigate midlife cholesterol in relation to Alzheimer's disease (AD) and vascular dementia (VaD) in a large multiethnic cohort of women and men. METHODS: The Kaiser Permanente Northern California Medical Group (healthcare delivery organization) formed the database for this…
Central obesity and increased risk of dementia more than three decades later
BACKGROUND: Numerous reports show that a centralized distribution of adiposity is a more dangerous risk factor for cardiovascular disease and diabetes than total body obesity. No studies have evaluated whether the same pattern exists with dementia. The objective was to…
Type 2 diabetes and risk of cognitive impairment and dementia
Diabetes is a major public health burden. Even a modest effect of diabetes on cognitive function has significant public health implications. Several lines of mechanistic evidence implicate a role of insulin and glucose metabolism on risk of developing dementia, including…
Metabolic syndrome and cognitive decline in elderly Latinos: findings from the Sacramento Area Latino Study of Aging study
OBJECTIVES: To investigate the effect of metabolic syndrome on cognitive function in an elderly Latino population and to determine whether inflammation modifies this association. DESIGN: A longitudinal cohort study. SETTING: Sacramento area and the surrounding California counties from 1998 to…
Body mass index in midlife and risk of Alzheimer disease and vascular dementia
Prior work has suggested that obesity and overweight as measured by body mass index (BMI) increases risk of dementia. It is unknown if there is a difference in the risk of developing Alzheimer disease (AD) versus vascular dementia (VaD) associated…
The epidemiology of adiposity and dementia
Adipose tissue is the largest endocrine gland in the body, yet only recently has its role in neurodegenerative disease been considered. Prospective population level evidence has emerged to show that both obesity and overweight, is associated with an increased risk…
Homocysteine, B vitamins, and the incidence of dementia and cognitive impairment: results from the Sacramento Area Latino Study on Aging
BACKGROUND: High concentrations of homocysteine have been linked to a greater risk of Alzheimer disease, dementia, and cognitive decline. OBJECTIVE: We evaluated the association between homocysteine and 4.5-y combined incidences of dementia and cognitive impairment without dementia (CIND) in a…
Physical activity and dementia: The need for prevention trials
Dementia is a common and debilitating disease that will increase dramatically for the next 50 years unless a prevention or treatment is identified. This review summarizes the evidence that physical activity is associated with a reduced risk of dementia in…
Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study
OBJECTIVE: To evaluate any association between obesity in middle age, measured by body mass index and skinfold thickness, and risk of dementia later in life. DESIGN: Analysis of prospective data from a multiethnic population based cohort. SETTING: Kaiser Permanente Northern…
Midlife cardiovascular risk factors and risk of dementia in late life
OBJECTIVE: To evaluate if midlife cardiovascular risk factors are associated with risk of late-life dementia in a large, diverse cohort. METHOD: The authors conducted a retrospective cohort study of 8,845 participants of a health maintenance organization who underwent health evaluations…
Hormone replacement therapy and cognitive performance: the role of homocysteine
BACKGROUND: Clinical trials have shown that estrogen reduces levels of homocysteine, and recent work has shown that elevated homocysteine increases the risk of incident dementia. However, no studies have investigated whether reduction of homocysteine is a mechanism by which estrogen…
