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Vascular burden, brain beta-amyloid, and soy isoflavones: informing dementia prevention programs

Cui, Chendi (2019) Vascular burden, brain beta-amyloid, and soy isoflavones: informing dementia prevention programs. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Dementia is now challenging the U.S. health system with its increasing prevalence and huge disease burden. Unfortunately, no cure for dementia is currently available. Therefore, the prevention of dementia is of high public health relevance. This dissertation takes a combination of epidemiological approaches to inform dementia prevention.

The first paper examined the association between arterial stiffness and dementia. With a 15-year follow-up, arterial stiffness was associated with increased risk of all-cause dementia among older adults. This finding emphasizes the vascular burden in the development of dementia. The second paper compared three biomarkers of beta-amyloid deposition, brain vascular burden, and neurodegeneration, which are important dementia pathologies, between Japanese and Americans. Japanese are known to have elevated vascular burden which is related to their high-salt intake. Yet, the Japanese diet also contains high intake of marine omega-3 fatty acids and soy isoflavones which are thought to be protective against brain damage. A comparison of these biomarkers between cognitively normal elderly men and women in Japan and the U.S., showed that Japanese had significantly higher amount of white matter lesions, but lower brain beta-amyloid than U.S. Caucasian older adults. This finding lent support to this concept of multiple pathologies in the expression of dementia. Considering the uniqueness of Japanese diet, this difference could be due to dietary factors. The third paper, a systematic review and meta-analysis of randomized controlled trials, showed that intervention group of soy isoflavones had greater improvement in cognitive function than control group, especially in the domain of memory.

The implications of these findings for dementia prevention strategies have substantial public health significance. First, these results point to the fact that dementia involves a combination of multiple pathologies: brain beta-amyloid deposition, brain vascular burden, and neurodegeneration. Second, strategies that can improve arterial stiffness, such as reducing blood pressure and increasing physical activity, may reduce or delay the onset of dementia. The finding of lower beta-amyloid burden in Japanese suggests that the Japanese lifestyle, especially diet, may be protective against amyloid deposition. Additionally, soy isoflavones might be beneficial to cognitive function. This information should be considered in future dementia prevention programs.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Cui, Chendichc217@pitt.eduCHC2170000-0002-7022-4486
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSekikawa,
Committee MemberChang,
Committee MemberAizenstein,
Committee MemberLopez,
Committee MemberMackey,
Date: 26 September 2019
Date Type: Publication
Defense Date: 2 August 2019
Approval Date: 26 September 2019
Submission Date: 12 July 2019
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 217
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: arterial stiffness; beta-amyloid; cognition; dementia; soy isoflavones; vascular burden
Date Deposited: 26 Sep 2019 16:48
Last Modified: 26 Sep 2019 16:48


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