Advertisement

Cognitive Decline in Women: The ZARADEMP Study

  • Patricia Gracia-GarcíaEmail author
  • Elena Lobo
  • Javier Santabárbara
  • Concepción de la Cámara
  • Raúl López-Antón
Chapter

Abstract

The burden of cognitive impairment and dementia is rapidly expanding with the aging of the population worldwide. Globally, the number of people living with dementia all over the world in 2015 was 46.8 million and is predicted to triple by 2050. In this chapter, we first describe the cognitive aging profile in women: they perform better than men in tasks related to memory. We then summarize epidemiological cognitive impairment and dementia data, specifically in women: despite controversial data for mild cognitive impairment (MCI), several data in literature support that the prevalence of dementia is higher among women, specifically Alzheimer’s disease (AD). We finally discuss the potential risk and protective factors for cognitive impairment and dementia, specifically in women when there is evidence in the available literature. Women have a higher life expectancy than men, and men who survive to older ages might be healthier and have fewer risk factors for dementia than women. Aside from this survival bias, other biological, societal, and cultural factors may affect women and men differently: estrogen depletion in menopause, depression, obesity, diabetes, hypertension, smoking, alcohol, educational and occupational attainment, and physical exercise. In conclusion, there is a need to prioritize dementia as a global women’s health issue, and future studies on cognitive impairment and dementia should stratify their analysis by sex: understanding factors related to cognitive impairment and dementia specifically in women is crucial for developing interventions for their prevention which target specifically to these factors.

Keywords

Alzheimer’s disease Cognitive impairment Dementia Gender differences Risk factors Sex differences 

Notes

Conflict of Interest

P. Gracia-García has received honorarium and support for attendance to scientific meetings from Servier and Pfizer; C. de la Cámara has received funding to attend scientific meetings from Janssen, Lundbeck, and Otsuka. None of these companies have influenced the content of this work. The other authors declare that they have no conflict of interest.

Funding: The ZARADEMP study was supported by the Fondo de Investigación Sanitaria (FIS), Instituto de Salud Carlos III, Gobierno de España (PI 94-1562, 97-1321E, 99-0608, 01-0255, 10-01132, 12-02254 and 16-00896); by the Gobierno de Aragón (B35-Grupo Consolidado Biomedicina); and by the Fondo Europeo de Desarrollo Regional (FEDER) de la Unión Europea: “Una manera de hacer Europa”. The funding sources had no involvement in the study or chapter preparation.

References

  1. 1.
    United Nations (UN), Department of Economic and Social Affairs, World population prospects: the 2017 revision, United Nations (UN); 2017.Google Scholar
  2. 2.
    Lipnicki DM, Crawford J, Kochan NA, Trollor JN, Draper B, Reppermund S, Maston K, Mather KA, Brodaty H, Sachdev PS, S.M.a.A.S. Team. Risk factors for mild cognitive impairment, dementia and mortality: The Sydney Memory and Ageing Study. J Am Med Dir Assoc. 2017;18(5):388–95.PubMedGoogle Scholar
  3. 3.
    Prince M, Wimo A, Guerchet M, Ali G, Wu Y, Prina M, Alzheimer’s Disease International, World Alzheimer Report. The global impact of dementia. An analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International (ADI); 2015.Google Scholar
  4. 4.
    American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Washington, DC: American Psychiatric Association Publishing; 2013.Google Scholar
  5. 5.
    Alzheimer’s Association. 2017 Alzheimer’s disease facts and figures. Alzheimers Dement. 2017;13:325–73.Google Scholar
  6. 6.
    Fratiglioni L, Launer LJ, Andersen K, Breteler MM, Copeland JR, Dartigues JF, Lobo A, Martinez-Lage J, Soininen H, Hofman A. Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54(11 Suppl 5):S10–5.PubMedGoogle Scholar
  7. 7.
    Petersen RC, Caracciolo B, Brayne C, Gauthier S, Jelic V, Fratiglioni L. Mild cognitive impairment: a concept in evolution. J Intern Med. 2014;275(3):214–28.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56(3):303–8.PubMedGoogle Scholar
  9. 9.
    Erol R, Brooker D, Peel E. Women and dementia: a global research review, the global voice on dementia. London: Alzheimer’s Disease International (ADI); 2015.Google Scholar
  10. 10.
    Launer LJ, Andersen K, Dewey ME, Letenneur L, Ott A, Amaducci LA, Brayne C, Copeland JR, Dartigues JF, Kragh-Sorensen P, Lobo A, Martinez-Lage JM, Stijnen T, Hofman A. Rates and risk factors for dementia and Alzheimer’s disease: results from EURODEM pooled analyses. EURODEM Incidence Research Group and Work Groups. European Studies of Dementia. Neurology. 1999;52(1):78–84.PubMedGoogle Scholar
  11. 11.
    Compère L, Piolino P. [Does the brain have a gender? A literature review in younger and older adults]. Geriatr Psychol Neuropsychiatr Vieil. 2014;12(4):404–12.Google Scholar
  12. 12.
    van Hooren SA, Valentijn AM, Bosma H, Ponds RW, van Boxtel MP, Jolles J. Cognitive functioning in healthy older adults aged 64-81: a cohort study into the effects of age, sex, and education. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2007;14(1):40–54.PubMedGoogle Scholar
  13. 13.
    Navarro-Pardo E, Holland CA, Cano A. Sex hormones and healthy psychological aging in women. Front Aging Neurosci. 2017;9:439.PubMedGoogle Scholar
  14. 14.
    Munro CA, Winicki JM, Schretlen DJ, Gower EW, Turano KA, Muñoz B, Keay L, Bandeen-Roche K, West SK. Sex differences in cognition in healthy elderly individuals. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2012;19(6):759–68.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Lobo A, Launer LJ, Fratiglioni L, Andersen K, Di Carlo A, Breteler MM, Copeland JR, Dartigues JF, Jagger C, Martinez-Lage J, Soininen H, Hofman A. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54(11 Suppl 5):S4–9.PubMedGoogle Scholar
  16. 16.
    Sachdev PS, Lipnicki DM, Kochan NA, Crawford JD, Rockwood K, Xiao S, Li J, Li X, Brayne C, Matthews FE, Stephan BC, Lipton RB, Katz MJ, Ritchie K, Carrière I, Ancelin ML, Seshadri S, Au R, Beiser AS, Lam LC, Wong CH, Fung AW, Kim KW, Han JW, Kim TH, Petersen RC, Roberts RO, Mielke MM, Ganguli M, Dodge HH, Hughes T, Anstey KJ, Cherbuin N, Butterworth P, Ng TP, Gao Q, Reppermund S, Brodaty H, Meguro K, Schupf N, Manly J, Stern Y, Lobo A, Lopez-Anton R, Santabárbara J. COSMIC (Cohort Studies of Memory in an International Consortium): an international consortium to identify risk and protective factors and biomarkers of cognitive ageing and dementia in diverse ethnic and sociocultural groups. BMC Neurol. 2013;13:165.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Lobo A, Saz P, Marcos G, Dia JL, De-la-Camara C, Ventura T, Montañes JA, Lobo-Escolar A, Aznar S, Workgroup Z. Prevalence of dementia in a Southern European population in two different time periods: the ZARADEMP Project. Acta Psychiatr Scand. 2007;116(4):299–307.PubMedGoogle Scholar
  18. 18.
    Lobo A, Lopez-Anton R, Santabárbara J, de-la-Cámara C, Ventura T, Quintanilla MA, Roy JF, Campayo AJ, Lobo E, Palomo T, Rodriguez-Jimenez R, Saz P, Marcos G. Incidence and lifetime risk of dementia and Alzheimer’s disease in a Southern European population. Acta Psychiatr Scand. 2011;124(5):372–83.PubMedGoogle Scholar
  19. 19.
    Ganguli M, Chang CC, Snitz BE, Saxton JA, Vanderbilt J, Lee CW. Prevalence of mild cognitive impairment by multiple classifications: the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) project. Am J Geriatr Psychiatry. 2010;18(8):674–83.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Lopez-Anton R, Santabárbara J, De-la-Cámara C, Gracia-García P, Lobo E, Marcos G, Pirez G, Saz P, Haro JM, Rodríguez-Mañas L, Modrego PJ, Dewey ME, Lobo A. Mild cognitive impairment diagnosed with the new DSM-5 criteria: prevalence and associations with non-cognitive psychopathology. Acta Psychiatr Scand. 2015;131(1):29–39.PubMedGoogle Scholar
  21. 21.
    Sachdev PS, Lipnicki DM, Kochan NA, Crawford JD, Thalamuthu A, Andrews G, Brayne C, Matthews FE, Stephan BC, Lipton RB, Katz MJ, Ritchie K, Carrière I, Ancelin ML, Lam LC, Wong CH, Fung AW, Guaita A, Vaccaro R, Davin A, Ganguli M, Dodge H, Hughes T, Anstey KJ, Cherbuin N, Butterworth P, Ng TP, Gao Q, Reppermund S, Brodaty H, Schupf N, Manly J, Stern Y, Lobo A, Lopez-Anton R, Santabárbara J, CSoMiaIC (COSMIC). The prevalence of mild cognitive impairment in diverse geographical and ethnocultural regions: the COSMIC Collaboration. PLoS One. 2015;10(11):e0142388.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Lipnicki DM, Crawford JD, Dutta R, Thalamuthu A, Kochan NA, Andrews G, Lima-Costa MF, Castro-Costa E, Brayne C, Matthews FE, Stephan BC, Lipton RB, Katz MJ, Ritchie K, Scali J, Ancelin ML, Scarmeas N, Yannakoulia M, Dardiotis E, Lam LC, Wong CH, Fung AW, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Kim TH, Anstey KJ, Cherbuin N, Butterworth P, Scazufca M, Kumagai S, Chen S, Narazaki K, Ng TP, Gao Q, Reppermund S, Brodaty H, Lobo A, Lopez-Anton R, Santabárbara J, Sachdev PS, C.S.o.M.i.a.I.C. (COSMIC). Age-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: a collaborative cohort study. PLoS Med. 2017;14(3):e1002261.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Au B, Dale-McGrath S, Tierney MC. Sex differences in the prevalence and incidence of mild cognitive impairment: a meta-analysis. Ageing Res Rev. 2017;35:176–99.PubMedGoogle Scholar
  24. 24.
    Ward A, Tardiff S, Dye C, Arrighi HM. Rate of conversion from prodromal Alzheimer’s disease to Alzheimer’s dementia: a systematic review of the literature. Dement Geriatr Cogn Dis Extra. 2013;3(1):320–32.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Marcos G, Santabárbara J, Lopez-Anton R, De-la-Cámara C, Gracia-García P, Lobo E, Pírez G, Menchón JM, Palomo T, Stephan BC, Brayne C, Lobo A, Workgroup Z. Conversion to dementia in mild cognitive impairment diagnosed with DSM-5 criteria and with Petersen’s criteria. Acta Psychiatr Scand. 2016;133(5):378–85.PubMedGoogle Scholar
  26. 26.
    Artero S, Ancelin ML, Portet F, Dupuy A, Berr C, Dartigues JF, Tzourio C, Rouaud O, Poncet M, Pasquier F, Auriacombe S, Touchon J, Ritchie K. Risk profiles for mild cognitive impairment and progression to dementia are gender specific. J Neurol Neurosurg Psychiatry. 2008;79(9):979–84.PubMedGoogle Scholar
  27. 27.
    Hunderfund AL, Roberts RO, Slusser TC, Leibson CL, Geda YE, Ivnik RJ, Tangalos EG, Petersen RC. Mortality in amnestic mild cognitive impairment: a prospective community study. Neurology. 2006;67(10):1764–8.PubMedGoogle Scholar
  28. 28.
    Wilson RS, Aggarwal NT, Barnes LL, Bienias JL, Mendes de Leon CF, Evans DA. Biracial population study of mortality in mild cognitive impairment and Alzheimer disease. Arch Neurol. 2009;66(6):767–72.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Santabárbara J, Gracia-García P, Pírez G, López-Antón R, De La Cámara C, Ventura T, Pérez-Sastre M, Lobo E, Saz P, Marcos G, Lobo A. Mortality in mild cognitive impairment diagnosed with DSM-5 criteria and with Petersen’s criteria: a 17-year follow-up in a community study. Am J Geriatr Psychiatry. 2016;24(11):977–86.PubMedGoogle Scholar
  30. 30.
    Vassilaki M, Cha RH, Aakre JA, Therneau TM, Geda YE, Mielke MM, Knopman DS, Petersen RC, Roberts RO. Mortality in mild cognitive impairment varies by subtype, sex, and lifestyle factors: the Mayo Clinic Study of Aging. J Alzheimers Dis. 2015;45(4):1237–45.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Jorm AF, Korten AE, Henderson AS. The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatr Scand. 1987;76(5):465–79.PubMedGoogle Scholar
  32. 32.
    Schmidt R, Kienbacher E, Benke T, Dal-Bianco P, Delazer M, Ladurner G, Jellinger K, Marksteiner J, Ransmayr G, Schmidt H, Stögmann E, Friedrich J, Wehringer C. [Sex differences in Alzheimer’s disease]. Neuropsychiatr. 2008;22(1):1–15.Google Scholar
  33. 33.
    Andersen K, Launer LJ, Dewey ME, Letenneur L, Ott A, Copeland JR, Dartigues JF, Kragh-Sorensen P, Baldereschi M, Brayne C, Lobo A, Martinez-Lage JM, Stijnen T, Hofman A. Gender differences in the incidence of AD and vascular dementia: the EURODEM studies. EURODEM Incidence Research Group. Neurology. 1999;53(9):1992–7.PubMedGoogle Scholar
  34. 34.
    Chêne G, Beiser A, Au R, Preis SR, Wolf PA, Dufouil C, Seshadri S. Gender and incidence of dementia in the Framingham Heart Study from mid-adult life. Alzheimers Dement. 2015;11(3):310–20.PubMedGoogle Scholar
  35. 35.
    Wu YT, Beiser AS, Breteler MMB, Fratiglioni L, Helmer C, Hendrie HC, Honda H, Ikram MA, Langa KM, Lobo A, Matthews FE, Ohara T, Pérès K, Qiu C, Seshadri S, Sjölund BM, Skoog I, Brayne C. The changing prevalence and incidence of dementia over time - current evidence. Nat Rev Neurol. 2017;13(6):327–39.PubMedGoogle Scholar
  36. 36.
    Wimo A, Sjölund BM, Sköldunger A, Qiu C, Klarin I, Nordberg G, von Strauss E. Cohort effects in the prevalence and survival of people with dementia in a rural area in northern Sweden. J Alzheimers Dis. 2016;50(2):387–96.PubMedGoogle Scholar
  37. 37.
    Matthews FE, Stephan BC, Robinson L, Jagger C, Barnes LE, Arthur A, Brayne C, CFaASC Collaboration. A two decade dementia incidence comparison from the cognitive function and ageing studies I and II. Nat Commun. 2016;7:11398.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Satizabal C, Beiser AS, Seshadri S. Incidence of dementia over three decades in the Framingham Heart Study. N Engl J Med. 2016;375(1):93–4.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Grasset L, Brayne C, Joly P, Jacqmin-Gadda H, Peres K, Foubert-Samier A, Dartigues JF, Helmer C. Trends in dementia incidence: evolution over a 10-year period in France. Alzheimers Dement. 2016;12(3):272–80.PubMedGoogle Scholar
  40. 40.
    Laws KR, Irvine K, Gale TM. Sex differences in cognitive impairment in Alzheimer’s disease. World J Psychiatry. 2016;6(1):54–65.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Lobo A, Saz P, Marcos G, Día JL, De-la-Cámara C. The prevalence of dementia and depression in the elderly community in a southern European population. The Zaragoza study. Arch Gen Psychiatry. 1995;52(6):497–506.PubMedGoogle Scholar
  42. 42.
    Steinberg M, Corcoran C, Tschanz JT, Huber C, Welsh-Bohmer K, Norton MC, Zandi P, Breitner JC, Steffens DC, Lyketsos CG. Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry. 2006;21(9):824–30.PubMedGoogle Scholar
  43. 43.
    Saz P, Launer LJ, Día JL, De-La-Cámara C, Marcos G, Lobo A. Mortality and mental disorders in a Spanish elderly population. Int J Geriatr Psychiatry. 1999;14(12):1031–8.PubMedGoogle Scholar
  44. 44.
    Santabárbara J, Lopez-Anton R, Marcos G, De-la-Cámara C, Lobo E, Saz P, Gracia-García P, Ventura T, Campayo A, Rodríguez-Mañas L, Olaya B, Haro JM, Salvador-Carulla L, Sartorius N, Lobo A. Degree of cognitive impairment and mortality: a 17-year follow-up in a community study. Epidemiol Psychiatr Sci. 2015;24(6):503–11.PubMedGoogle Scholar
  45. 45.
    Jagger C, Andersen K, Breteler MM, Copeland JR, Helmer C, Baldereschi M, Fratiglioni L, Lobo A, Soininen H, Hofman A, Launer LJ. Prognosis with dementia in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54(11 Suppl 5):S16–20.PubMedGoogle Scholar
  46. 46.
    Mielke MM, Vemuri P, Rocca WA. Clinical epidemiology of Alzheimer’s disease: assessing sex and gender differences. Clin Epidemiol. 2014;6:37–48.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Georgakis MK, Kalogirou EI, Diamantaras AA, Daskalopoulou SS, Munro CA, Lyketsos CG, Skalkidou A, Petridou ET. Age at menopause and duration of reproductive period in association with dementia and cognitive function: a systematic review and meta-analysis. Psychoneuroendocrinology. 2016;73:224–43.PubMedGoogle Scholar
  48. 48.
    Hansson L, Lithell H, Skoog I, Baro F, Bánki CM, Breteler M, Castaigne A, Correia M, Degaute JP, Elmfeldt D, Engedal K, Farsang C, Ferro J, Hachinski V, Hofman A, James OF, Krisin E, Leeman M, de Leeuw PW, Leys D, Lobo A, Nordby G, Olofsson B, Opolski G, Prince M, Reischies FM. Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics. Blood Press. 2000;9(2–3):146–51.PubMedGoogle Scholar
  49. 49.
    Cherbuin N, Kim S, Anstey KJ. Dementia risk estimates associated with measures of depression: a systematic review and meta-analysis. BMJ Open. 2015;5(12):e008853.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Gracia-García P, de-la-Cámara C, Santabárbara J, Lopez-Anton R, Quintanilla MA, Ventura T, Marcos G, Campayo A, Saz P, Lyketsos C, Lobo A. Depression and incident Alzheimer disease: the impact of disease severity. Am J Geriatr Psychiatry. 2015;23(2):119–29.PubMedGoogle Scholar
  51. 51.
    Umegaki H. Type 2 diabetes as a risk factor for cognitive impairment: current insights. Clin Interv Aging. 2014;9:1011–9.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Lobo-Escolar A, Saz P, Marcos G, Quintanilla MA, Campayo A, Lobo A, Workgroup Z. Somatic and psychiatric comorbidity in the general elderly population: results from the ZARADEMP Project. J Psychosom Res. 2008;65(4):347–55.PubMedGoogle Scholar
  53. 53.
    Kautzky-Willer A, Baggio G, Rossi MC, Lapolla A, Russo GT. Type 2 diabetes and cardiovascular risk in women 2016. Int J Endocrinol. 2017;2017:6905697.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective. Alzheimers Dement. 2015;11(6):718–26.PubMedGoogle Scholar
  55. 55.
    Dufouil C, Seshadri S, Chêne G. Cardiovascular risk profile in women and dementia. J Alzheimers Dis. 2014;42(Suppl 4):S353–63.PubMedGoogle Scholar
  56. 56.
    Letenneur L, Launer LJ, Andersen K, Dewey ME, Ott A, Copeland JR, Dartigues JF, Kragh-Sorensen P, Baldereschi M, Brayne C, Lobo A, Martinez-Lage JM, Stijnen T, Hofman A. Education and the risk for Alzheimer’s disease: sex makes a difference. EURODEM pooled analyses. EURODEM Incidence Research Group. Am J Epidemiol. 2000;151(11):1064–71.PubMedGoogle Scholar
  57. 57.
    Gracia Rebled AC, Santabárbara Serrano J, López Antón RL, Tomás Aznar C, Marcos Aragüés G. [Occupation and risk of cognitive impairment and dementia in people in over 55 years: a systematic review, Spain]. Rev Esp Salud Publica. 2016;90:e1–15.Google Scholar
  58. 58.
    Gracia-Rebled AC, Santabárbara J, Lopez-Anton R, Tomas C, Lobo E, Marcos G, Lobo A. [Influence of occupation on cognitive impairment with no dementia in a sample population over 55 years from Zaragoza]. Rev Esp Geriatr Gerontol. 2017;53(3):134–40.Google Scholar
  59. 59.
    Lobo E, Marcos G, Santabárbara J, Salvador-Rosés H, Lobo-Escolar L, De la Cámara C, Aso A, Lobo-Escolar A, Workgroup Z. Gender differences in the incidence of and risk factors for hip fracture: a 16-year longitudinal study in a southern European population. Maturitas. 2017;97:38–43.PubMedGoogle Scholar
  60. 60.
    Barha CK, Davis JC, Falck RS, Nagamatsu LS, Liu-Ambrose T. Sex differences in exercise efficacy to improve cognition: a systematic review and meta-analysis of randomized controlled trials in older humans. Front Neuroendocrinol. 2017;46:71–85.PubMedGoogle Scholar
  61. 61.
    Pines A. Mid-life smoking and cognition. Climacteric. 2011;14(4):426–7.PubMedGoogle Scholar
  62. 62.
    Dufouil C, Ducimetière P, Alpérovitch A. Sex differences in the association between alcohol consumption and cognitive performance. EVA Study Group Epidemiology of Vascular Aging. Am J Epidemiol. 1997;146(5):405–12.PubMedGoogle Scholar
  63. 63.
    Mukamal KJ, Kuller LH, Fitzpatrick AL, Longstreth WT, Mittleman MA, Siscovick DS. Prospective study of alcohol consumption and risk of dementia in older adults. JAMA. 2003;289(11):1405–13.PubMedGoogle Scholar
  64. 64.
    Peters R, Peters J, Warner J, Beckett N, Bulpitt C. Alcohol, dementia and cognitive decline in the elderly: a systematic review. Age Ageing. 2008;37(5):505–12.PubMedGoogle Scholar
  65. 65.
    Lobo E, Dufouil C, Marcos G, Quetglas B, Saz P, Guallar E, Lobo A, Workgroup Z. Is there an association between low-to-moderate alcohol consumption and risk of cognitive decline? Am J Epidemiol. 2010;172(6):708–16.PubMedGoogle Scholar
  66. 66.
    World Health Organization (WHO). Gender, women and the tobacco epidemic. Geneva: Wold Health Organization (WHO); 2010.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Patricia Gracia-García
    • 1
    • 2
    • 3
    • 4
    Email author
  • Elena Lobo
    • 3
    • 4
    • 5
  • Javier Santabárbara
    • 3
    • 4
    • 5
  • Concepción de la Cámara
    • 2
    • 3
    • 4
    • 6
  • Raúl López-Antón
    • 3
    • 4
    • 7
  1. 1.Psychiatry Service, Hospital Universitario Miguel ServetZaragozaSpain
  2. 2.Medicine DepartmentUniversity of ZaragozaZaragozaSpain
  3. 3.Instituto de Investigación Sanitaria de Aragón (ISS Aragón)ZaragozaSpain
  4. 4.Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and InnovationMadridSpain
  5. 5.Preventive Medicine and Public Health DepartmentUniversity of ZaragozaZaragozaSpain
  6. 6.Psychiatry Service, Hospital Universitario Lozano BlesaZaragozaSpain
  7. 7.Psychology and Sociology DepartmentUniversity of ZaragozaZaragozaSpain

Personalised recommendations