Good social connections are proposed to positively influence the course of cognitive decline by stimulating cognitive reserve and buffering harmful stress-related health effects. Prior meta-analytic research has uncovered links between social connections and the risk of poor health outcomes such as mild cognitive impairment, dementia, and mortality. These studies have primarily used aggregate data from North America and Europe with limited markers of social connections. Further research is required to explore these associations longitudinally across a wider range of social connection markers in a global setting.

We examined the associations between social connection structure, function, and quality and the risk of our primary outcomes (mild cognitive impairment, dementia, and mortality).

Individual participant-level data were obtained from 13 longitudinal studies of ageing from across the globe. We conducted survival analysis using Cox regression models and combined estimates from each study using two-stage meta-analysis. We examined three social constructs: connection structure (living situation, relationship status, interactions with friends/family, community group engagement), function (social support, having a confidante) and quality (relationship satisfaction, loneliness) in relation to the risks of three primary outcomes (mild cognitive impairment, dementia, and mortality). In our partially adjusted models, we included age, sex, and education and in fully adjusted models used these variables as well as diabetes, hypertension, smoking, cardiovascular risk, and depression.

In our fully adjusted models we observed: a lower risk of mild cognitive impairment was associated with being married/in a relationship (vs. being single), weekly community group engagement (vs. no engagement), weekly family/friend interactions (vs. not interacting), and never feeling lonely (vs. often feeling lonely); a lower risk of dementia was associated with monthly/weekly family/friend interactions and having a confidante (vs. no confidante); a lower risk of mortality was associated with living with others (vs. living alone), yearly/monthly/weekly community group engagement, and having a confidante.

Good social connection structure, function, and quality are associated with reduced risk of incident MCI, dementia, and mortality. Our results provide actionable evidence that social connections are required for healthy ageing.

Normative data for older adults may be tainted by inadvertent inclusion of undiagnosed individuals at the very early stage of a neurodegenerative process. To avoid this pitfall, we developed norms for a cohort of older adults without MCI/dementia at 3-year follow-up.

A randomly selected sample of 1041 community-dwelling individuals (age ≥ 65) received a full neurological and neuropsychological examination on two occasions [mean interval = 3.1 (SD = 0.9) years].

Of these, 492 participants (Group 1; 65–87 years old) were without dementia on both evaluations (CDR=0 and MMSE ≥ 26); their baseline data were used for norms development. Group 2 (n = 202) met the aforementioned criteria only at baseline, but not at follow-up. Multiple linear regressions included demographic predictors for regression-based normative formulae and raw test scores as dependent variables for each test variable separately. Standardized scaled scores and stratified discrete norms were also calculated. Group 2 performed worse than Group 1 on most tests (p-values < .001–.021). Education was associated with all test scores, age with most, and sex effects were consistent with the literature.

We provide a model for developing sound normative data for widely used neuropsychological tests among older adults, untainted by potential early, undiagnosed cognitive impairment, reporting regression-based, scaled, and discrete norms for use in clinical settings to identify cognitive decline in older adults. Additionally, our co-norming of a variety of tests may enable intra-individual comparisons for diagnostic purposes. The present work addresses the challenge of developing robust normative data for neuropsychological tests in older adults.

There is limited research on the prognostic value of language tasks regarding mild cognitive impairment (MCI) and Alzheimer’s clinical syndrome (ACS) development in the cognitively normal (CN) elderly, as well as MCI to ACS conversion.

Participants were drawn from the population-based Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) cohort. Language performance was evaluated via verbal fluency [semantic (SVF) and phonemic (PVF)], confrontation naming [Boston Naming Test short form (BNTsf)], verbal comprehension, and repetition tasks. An additional language index was estimated using both verbal fluency tasks: SVF-PVF discrepancy. Cox proportional hazards analyses adjusted for important sociodemographic parameters (age, sex, education, main occupation, and socioeconomic status) and global cognitive status [Mini Mental State Examination score (MMSE)] were performed.

A total of 959 CN and 118 MCI older (>64 years) individuals had follow-up investigations after a mean of ∼3 years. Regarding the CN group, each standard deviation increase in the composite language score reduced the risk of ACS and MCI by 49% (8–72%) and 32% (8–50%), respectively; better SVF and BNTsf performance were also independently associated with reduced risk of ACS and MCI. On the other hand, using the smaller MCI participant set, no language measurement was related to the risk of MCI to ACS conversion.

Impaired language performance is associated with elevated risk of ACS and MCI development. Better SVF and BNTsf performance are associated with reduced risk of ACS and MCI in CN individuals, independent of age, sex, education, main occupation, socioeconomic status, and MMSE scores at baseline.

We investigated the utility of traditional neuropsychological tests in older uneducated/illiterate individuals without dementia to determine the possibility that they are likely not appropriate for this group.

We assessed the neuropsychological performance of 1122 older adults [≥65 years old; mean age: 74.03 (SD = 5.46); mean education: 4.76 (SD = 2.5) years; women: n = 714], in the context of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population-based study conducted in Greece.

We based our analyses on three groups: high-functioning/cognitively healthy (i.e., without dementia) uneducated/illiterate individuals (n = 80), high-functioning/cognitively healthy educated/literate individuals (n = 932), and low-functioning/cognitively impaired educated/literate individuals (presumably with dementia; n = 110). We used binary regression analyses with Bonferroni correction to investigate whether test performance differentiated uneducated/illiterate from educated/literate individuals. Models were adjusted for age and sex; raw test scores were the predictor variables. The uneducated/illiterate cohort was at a disadvantage relative to the healthy educated/literate group on all variables but verbal memory recognition and consolidation, congruent motor responses, and phonological fluency clustering (p > .002). Moreover, only word list learning immediate and delayed free recall and delayed cued recall differentiated the high-functioning/cognitively healthy uneducated/illiterate from the low-functioning/cognitively impaired educated/literate group, favoring the former (p’s < .002).

Our findings suggest that only particular verbal memory test variables are fair in determining whether older uneducated/illiterate individuals have functional/cognitive impairment suggestive of a neurodegenerative process. On all other neuropsychological variables, this cohort was at a disadvantage. Therefore, we highlight the need for identifying appropriate methods of assessment for older uneducated/illiterate individuals.

The prevalence and associated factors related to psychotic symptoms in older adults are understudied. The objectives were to assess the prevalence, incidence and factors associated with psychotic symptoms in a representative Greek sample of community living older adults.

This study includes older adults aged ≥ 65 years participating in the Hellenic Longitudinal Investigation of Aging and Diet. The analysis is based on n=1,904 participants with available data at baseline and n=947 participants at the 3-year follow-up. The presence of delusions and hallucinations in the past month was assessed on the grounds of the 17 symptoms of the Columbia University Scale for Psychopathology in Alzheimer's Disease and of the 14 symptoms of the Neuropsychiatric Inventory Questionnaire. An affirmative answer to any of these 31 symptoms defined the presence of psychotic symptoms. A comprehensive neuropsychological assessment for probable diagnosis of dementia and physical comorbidity was carried out by neurologists. Study factors included age, education, marital status, widowed in the past year, occupation, hearing impairment and number of chronic comorbidities. Penalized logistic regression analyses were carried out to assess the socio-demographic and clinical factors associated with the prevalence and incidence of psychotic symptoms.

The past-month prevalence of any psychotic symptom was 1.9% and 1.0% when excluding cases of dementia. The prevalence of any delusion and hallucination was 1.5% and 0.7%, and 0.8% and 0.3% when excluding cases with dementia. Paranoid delusions were the most prevalent. The incidence at the follow-up of any psychotic symptom was 2.1% and 1.3% when excluding dementia. Individuals not married had twice the odds and, farmers/breeders had three times the odds than public servants/teachers/executives of experiencing psychotic symptoms. Hearing impairment and the number of comorbidities increased the odds of the presence of psychotic symptoms. In addition to age and recent widowhood, these factors remained significantly associated with the presence of psychotic symptoms in cases without dementia.

Dementia was not related to over half of the cases observed with psychotic symptoms. Paranoid delusions were the most prevalent. Socio-economic and health status factors are significant predictors of psychotic symptoms.

Life expectancy has increased leading to a concomitant increase in the population of older people. Malnutrition, a major problem in this age group, deteriorates their health and quality of life. The association between risk of malnutrition and dietary intake has not been investigated sufficiently. The aim of this study was to examine potential associations between risk of malnutrition and dietary intake in a representative cohort of adults ≥ 65 years old.

1,831 older people (mean age 73.1 ± 5.9 years old) from the HELIAD study were included in the analyses. Risk of malnutrition was assessed with the “Determine your Nutritional Health” checklist. Total score of the questionnaire ranges from 1–21, with 0–2 indicating good nutritional status, 3–5 moderate nutritional risk and ≥ 6 high nutritional risk. Dietary intake was evaluated with a semi-quantitative food frequency questionnaire, validated for the Greek population, from which consumption of specific food groups (non-refined cereals, fruits, vegetables, legumes, fish, red meat, poultry, fish, dairy products, alcohol and sweets in servings/day) was estimated, as well as adherence to the Mediterranean diet, using a relevant a priori score.

35.8% of the participants were well-nourished, 34.8% were at moderate nutritional risk and 29.4% were at high nutritional risk. Total energy intake did not differ between the groups (1,984 ± 500 kcal/day for those well-nourished, 1,995 ± 537 kcal/day for those at moderate nutritional risk and 1,934 ± 566 kcal/day for those at high nutritional risk, p = 0.140). Well-nourished older people consumed per day more portions of vegetables, fruits, legumes, poultry, sweets and fewer portions of alcohol compared to those at moderate and high risk (all p < 0.05). Furthermore, adherence to the Mediterranean diet differed significantly between the groups, i.e. those well-nourished had greater adherence to the Mediterranean Diet compared to the other groups (p < 0.001).

Although energy intake did not differ between the groups, there were significant differences in quality of their diet, as this was depicted in specific food group intake and adherence to a healthy dietary pattern. Thus, health experts should also consider diet quality when screening malnutrition in this vulnerable age group.

Adherence to the Mediterranean dietary pattern has been associated with numerous health benefits in non-communicable diseases, including obesity management. However, the associations of the Mediterranean Diet with weight loss maintenance remain to be evaluated.

We analyzed data from 500 participants (61% women) of the MedWeight study. Eligible volunteers were men and women 18–65 years old, reporting an intentional weight loss of at least 10%, starting from a BMI ≥ 25 kg/m2. Based on their current weight, participants were characterized as maintainers (current weight ≤ 90% of maximum weight), or regainers (current weight > 95% of maximum weight). Socio-demographics, lifestyle measurements and weight history were recorded. Dietary intake was assessed by 2 telephone 24-hour recalls. Adherence to the Mediterranean Diet was assessed with the MedDietScore (range 0–55, greater scores showing higher adherence). Physical activity levels were assessed with the International Physical Activity Questionnaire-short form. Results are expressed as means ± SD, frequencies (%) or Odds Ratio [OR; 95%Confidence Interval].

Compared to regainers (31%), maintainers were younger (31.4 ± 10.0 vs. 36.6 ± 10.8 years, p < 0.001), had lower BMI (25.7 ± 4.3 vs. 31.4 ± 5.1 kg/m2, p < 0.001), and had greater initial body weight loss (25.5 ± 8.6% vs. 18.4 ± 6.9%, p < 0.001). Sex and years of formal education were not significantly different between maintainers and regainers (p > 0.05). Being in the highest MedDietScore quintile (vs. the lowest) was associated with 91% higher odds of being a maintainer [crude OR = 1.91; 1.05–3.45]. This association remained significant after adjusting for sex, age, physical activity level (METŸminutes/week) and energy intake (kcal/day) [adjusted OR = 2.01; 1.05–3.83].

Higher adherence to the Mediterranean Diet was independently associated with 2-fold increased likelihood of weight loss maintenance. Our results highlight the favorable effects of a prudent dietary pattern in long-term obesity management, as well as novel targets for diet planning during weight loss maintenance.

The present study aimed to explore the associations between social life and adherence to a healthy dietary pattern, the Mediterranean diet (MD), in a population-representative cohort of older people.

Cross-sectional study. Adherence to the MD was evaluated by an a priori score; tertiles of the score, indicating low, medium and high adherence, were used in the analyses. Social life was assessed by a questionnaire evaluating participation in leisure-time activities and the number of social contacts; primary occupation was also recorded and job characteristics were further explored.

Community-dwelling older adults.

Adults from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study (n 1933; age range 65–99 years).

Each unit increase in the number of social contacts/month and in the frequency score of intellectual, social and physical activities was associated with a 1·6, 6·8, 4·8 and 13·7 % increase in the likelihood of a participant being in the high MD adherence group, respectively. The analysis by age group revealed that younger elderly participants had a 1·4, 8·4 and 11·3 % higher likelihood to be in the high adherence group for each unit increase in the number of social contacts/month and in the frequency score of engagement in intellectual and physical activities, respectively. Similar associations were found for older elderly participants with high compared with low MD adherence, except for the intellectual activities.

The present results suggest that high MD adherence is associated with good social life, suggesting a clustering of health-promoting lifestyle factors in older adults.

To explore factors affecting children’s and adolescents’ diet quality, in the framework of a food aid and promotion of healthy nutrition programme implemented in areas of low socio-economic status of Greece, during the current financial crisis.

From a total of 162 schools participating in the programme during 2012–2013, we gathered 15 897 questionnaires recording sociodemographic characteristics, lifestyle parameters and dietary habits of children and their families. As a measure of socio-economic status, the Family Affluence Scale (FAS) was used; whereas for the assessment of diet quality, the KIDMED score was computed. Associations between KIDMED and FAS, physical activity and socio-economic parameters were examined using regression and classification–regression tree analysis (CART).

The higher the FAS score, the greater the percentage of children and adolescents who reported to consume, on a daily basis, fruits and vegetables, dairy products and breakfast (P<0·001). Results from CART showed that children and adolescents in the medium or high FAS groups had higher KIDMED score, compared with those in the low FAS group. For those in the low FAS group, KIDMED score is expected to increase by 12·4 % when they spend more than 0·25 h/week in sports activities. The respective threshold for the medium and high FAS groups is 1·75 h/week, while education of the mother and father affected KIDMED score significantly as well.

Diet quality is strongly influenced by socio-economic parameters in children and adolescents living in economically disadvantaged areas of Greece, so that lower family affluence is associated with worse diet quality.

To evaluate the 5-year incidence of obesity in a sample of CVD-free adults and investigate the potential effect of several sociodemographic and lifestyle habits on weight change and obesity incidence in these individuals.

Men (n 1514) and women (n 1528) (>18 years) without any clinical evidence of CVD, living in the Attica area of Greece, were enrolled in the ATTICA study from May 2001 to December 2002. The sampling was random, multistage and included information about various sociodemographic, lifestyle (diet, exercise and smoking), biochemical and clinical characteristics. In 2006, the 5-year follow-up was performed through telephone calls or personal visits. Data from the 1364 participants are analysed in the present work.

The 5-year incidence of obesity was 21·8 % in men and 11·9 % in women. The ratio of men to women revealed that more men than women developed obesity, while more women than men became overweight during the follow-up period. It was found that men were 1·6 times more likely to develop obesity compared with women; abnormal waist circumference, smoking habits and the presence of hypercholesterolaemia increased the risk for developing obesity, irrespective of age and baseline lifestyle characteristics of the participants. In the multivariate analysis, no association was detected between adherence to a Mediterranean diet and incidence of obesity in initially normal-weight individuals.

Obesity remains a serious health problem for the Greek population; the alarming rates of excess body weight continue to increase. Preventive measures should be urgently addressed, targeting particularly those with metabolic risk factors.