Talk:Vascular dementia

Pollution is not defined as a cause of vascular dementia

This revert was justified because there is no cause and effect relationship established by a WP:MEDRS source between pollution and (specifically) 'vascular' dementia. Zefr (talk) 04:29, 3 April 2024 (UTC)

Removed content

For the record, this is the content removed, which was written by GOV.UK and COMEAP (not by me):

... risk factors

An updated study on dementia published in the Lancet found that around 40% of dementia cases worldwide might be attributable to 12 potentially modifiable risk factors. The study found that there was evidence for 3 new risk factors for dementia – excessive alcohol consumption, head injury and air pollution – to be added to the 9 risk factors which were highlighted in the 2017 Lancet Commission on dementia prevention, intervention and care.

The Committee on the Medical Effects of Air Pollutants (COMEAP) in UK have reviewed nearly 70 studies in human populations (epidemiological studies) and think it is likely that air pollution can contribute to a decline in mental ability and dementia in older people. It is known that air pollution, particularly small particle pollution, can affect the heart and the circulatory system, including circulation to the brain. These effects are linked to vascular dementia, which is caused by damage to the blood vessels in the brain. In 2022, COMEAP has concluded that the evidence is suggestive of an association between ambient air pollutants and with the risk of developing dementia. The epidemiological literature is inconsistent as to which pollutant is most associated with these effects.

FYI, pollution *is* a risk factor of vascular dementia.

• [1] Quote: “The results showed that there was a significant positive association between long-term PM2.5 exposure and all-cause dementia, Alzheimer's disease as well as Parkinson's disease, with pooled OR of 1.30 (95%CI: 1.14, 1.47, I2 = 99.3%), 1.65 (95%CI: 1.37, 1.94, I2 = 98.2%), and 1.17 (95%CI: 1.00, 1.33, I2 = 91.8%). A positive association between PM10 and vascular dementia was observed (OR = 1.12, 95%CI: 1.04, 1.21, I2 = 0.0%). Association between PM exposure and decreased cognitive function score was found. Our results highlight the important role of PM pollution ...”

BTW, I only see this post after my last edit to the article. Thanks. --Dustfreeworld (talk) 05:51, 3 April 2024‎ (UTC); --Dustfreeworld (talk) 08:17, 3 April 2024 (UTC)

References

"Might be", "think it is likely", "potentially modifiable", "suggestive of an association" - these are all loose associations of possible risk, with only odds ratios and correlations used as measures. These are speculations based on non-rigorous assessments, and are not evidence of causality - see correlation does not imply causation.

The content and sources offered introduce only potential risk under preliminary research, and are too vague and undeveloped to include in an encyclopedic article on a specific kind of cerebrovascular injury causing dementia. Zefr (talk) 15:29, 3 April 2024 (UTC)

Yes, of course it's possible to have non-causative correlations. However, in this case, that's unlikely. We don't just have a random coincidence like https://xkcd.com/882/; we have strong evidence of a correlation plus a scientifically plausible mechanism for pollution to cause (specifically) vascular dementia, described in one source as "the well-recognized link between PM2.5 and vascular injury and the role of vascular injury in dementia". In other words, air pollution causes strokes, and strokes result in vascular dementia.

This is the subject of a number of review articles saying things like "pooled HRs were...2.00 (95% CI 1.30, 3.08) for VaD per 10.0 μg/m³ PM_2.5 increase" and "positive association between PM₁₀ and vascular dementia" and "Exposure to particulate matter (PM) pollution damages the human brain" and so forth.

Some editors might prefer the simplicity of a source that says says "air pollution in the cerebrovascular system causes stroke, vascular dementia, or other types of dementia" on page 242. WhatamIdoing (talk) 00:19, 4 April 2024 (UTC)

@Zefr. You have been edit warring, and tendentiously reverted my different/modified edits 4 times in 24 hours from 2 April to 3 April, with untrue claims such as WP:SYNTH / “promoting a POV”:

• [2]
  • revert of hatnote: {{Further|Brain health and pollution#Neurodegenerative disorders}}
• [3]
  • revert of open source text (lay summary and executive summary from their 200+ pages report), all written by COMEAP (*not* me)
• [4]
  • revert of section heading “and risk factors==“ together with open source text written by UK GOV (summarising review from the Lancet) and COMEAP
• [5]
  • revert of update template: {{Update section|reason=http://pubmed.ncbi.nlm.nih.gov/36763275/ <small>Global ambient particulate matter pollution and neurodegenerative disorders: a systematic review of literature and meta-analysis.</small> <!--Quote: “A positive association between PM10 and vascular dementia was observed (OR = 1.12, 95%CI: 1.04, 1.21, I2 = 0.0%). Association between PM exposure and decreased cognitive function score was found.” -->|date=April 2024}}

As to your repeated claims that “Correlation does not imply causation”, please note that "A risk factor ... is a variable associated with an increased risk of disease or infection."

I'd never said / stressed the causality or “implied causation” as you mentioned when I was editing this article. I repeat: Air pollution is a risk factor of vascular dementia. But of course, as another user already said above, more accurately, it *is* actually a cause of VaD, a much more important one than the other “correlations” now mentioned in the article.

The article now says: “Risk factors for vascular dementia include age, hypertension, smoking, hypercholesterolemia, diabetes mellitus, cardiovascular disease, and cerebrovascular disease. Other risk factors include geographic origin, genetic predisposition, and prior strokes.” And what’s written in the 20122000 source that support that content?

“Increasing age is the only well established risk factor for vascular dementia ... Other risk factors, such as diabetes mellitus, smoking, cardiac arrhythmia, hyperlipidemia, and ApoE status remain controversial.”

Your preference of keeping the “Correlation does not imply causation“ content unchanged as it was 10+ years ago and refused to have the content updated / new information added really surprised me, and I don’t think it is how the encyclopaedia should be written. It maybe ok that you don’t do the work yourself, but it’s not ok to persistently preventing others to do so, without showing any possibilities to discuss/ compromise/ gain consensus/ edit collaboratively. That’s not how science can advance (or how Wikipedia should be edited). And if a disease is potentially preventable, what you are doing is depriving people the right to know what they should have known and depriving them the chance to prevent the disease. That’s really not for the good of the project or it’s readers …

IMO, knowledges that labelled themselves as “further research needed” are very different from “misinformation”. Also, no one knows everything in the world. Somethings that we don’t know don’t mean they’re wrong. I really hope you (and/or others) can be more open-minded to new knowledge, and have your editing style adjusted in the future. Yours truly, --Dustfreeworld (talk) 18:52, 8 April 2024 (UTC); 03:34, 9 April 2024 (UTC); 07:04, 12 April 2024 (UTC)

You are a novice user persistently using talk pages as a forum for your long-winded opinions and attacks on editors who disagree with you - knock it off, WP:NPA. 

No MEDRS review establishes pollution as a cause of cerebrovascular pathology and dementia, and a 2019 expert review doesn't mention pollution as a risk factor. 122 people watch this article - if new content or revisions are warranted and supported by a review, they are welcome to make changes.  Zefr (talk) 21:33, 8 April 2024 (UTC)

What I said is true as shown by the diffs above. You have been edit warring and WP:ABF, making untrue claims/ potential WP:PA about me. You may want to read [6] as well. Yes, 122 people watch this article, I’m one of them. Have I been “welcome to make changes?” Or have I been welcome by WP:4RR? BTW, only you, out of the 122 people, had reverted my edits. Further, we are now in 2024, not “2019” anymore.

I do hope people can stop the untrue claims. Thanks and regards, --Dustfreeworld (talk) 21:54, 8 April 2024 (UTC)

@Zefr, the "Number of page watchers who visited recent edits" for this page is 5 (five, as in a single-digit number). The number you mention is nearly all inactive editors (from many years ago).

While you're here, could anyone explain a 24-year-old (MEDDATE violation) article from a what's basically a local newsletter (the Jacksonville Medicine by the non-notable Duval County Medical Society) with no evidence of peer-review (though a later incarnation invited to all members to become a "Guest Editor or an author for an NEFM journal issue or advertise...AND...Advertise in the print journal and its virtual edition online - all for one reasonable price.  Buy an ad to announce a special event, Introduce new staff, Advertise your practice, Honor a longtime colleague and more!") is something that should be cited in this article? We have much bigger problems here than citing review articles in the ==Causes and risk factors== section that talk about risk factors. Removing a risk factor from the "and risk factors" section on the grounds that a risk factor is not a causative agent would probably count as Wikipedia:Tendentious editing, but if it would help, we could have separate sections for ==Causes== and ==Risk factors==. WhatamIdoing (talk) 02:51, 9 April 2024 (UTC)

“Removing a risk factor from the "and risk factors" section on the grounds that a risk factor is not a causative agent would probably count as Wikipedia:Tendentious editing”

Agree. --Dustfreeworld (talk) 22:46, 11 April 2024 (UTC)

I don't understand what's going on. Some content was added at 3 April, which was reverted and then repeatedly reinstated and reverted, while it was being discussed. As far as I can tell 2 editors where having an argument over whether the information is in fact due. Why are we not applying standard BRD here? Why the talk about 4RR(?) and TE? Draken Bowser (talk) 23:36, 11 April 2024 (UTC)

@Draken Bowser, Wikipedia:BOLD, revert, discuss cycle is optional, but for it to resolve a dispute, it requires everyone to think about what to do, instead of just reverting and asserting that you are correct to revert it. This is probably an oversimplification, but what I see here is:

• One editor adding content about air pollution being a risk factor vascular dementia.
• Another editor removing it because air pollution not a proven cause that is specific for vascular dementia.
• A source in the discussion above that literally contains the exact words "air pollution...causes...vascular dementia".

As for why TE has been mentioned, its sections on #Disputing the reliability of apparently good sources, #Repeating the same argument without convincing people, and #Deleting the pertinent cited additions of others sound pretty relevant to me. What do you think? WhatamIdoing (talk) 01:23, 12 April 2024 (UTC)

I don't exactly get why anyone would downplay BRD as it's "optional" or "just an essay", both of which frequently occur. The reason being that it's a smart way to avoid edit wars (over non-BLP content) while the discussion is ongoing, widely adopted across the two language version I frequent (i occasionally refer to en:WP:BRD over on sv-wiki, since the approach was never eloquently codified over there).

I don't think there is anything tendentious about it. The phrasing of the report is very careful, including: This would require linking the quantification of the cardiovascular effects of particulate pollution with quantitative evidence linking these cardiovascular endpoints to neurological outcomes. Also of note, is that the four conclusions listed on p. vii-viii do not make an explicit link between AP and VD. Number 1 links AP to dementia (in general). Number 2 links AP to cardiovascular decline, and again dementia. There's an inference to be made that the implicit suggestion is that this is caused by the physiological changes causing VD, but unless they make the case more clearly I think there's an argument that we shouldn't conclude on our own that there is a link.

I'm not firmly on either side of the content dispute, because I think the issue of interpreting the source is very complex in this case. But I'm willing to hear more arguments. Draken Bowser (talk) 06:35, 12 April 2024 (UTC)

Hi there, yes you are right, the COMEAP source that I used is not tendentious, and the phrasing is very careful. Only the reverts are tendentious. I didn’t / hadn’t concluded on my own that there is a link. All the edits that were reverted were direct copy of “their words”, not “my words”. I’ve edited my post above to show the content that were reverted. Thanks. --Dustfreeworld (talk) 07:27, 12 April 2024 (UTC)

BTW, the more important issues here probably aren’t content disputes. It’s more about edit warring, potential WP:ABF, WP:PA, WP:TE, untrue claims (e.g., in edit summaries), etc. --Dustfreeworld (talk) 07:33, 12 April 2024 (UTC)

These effects are linked to vascular dementia.. ← Making the link. Draken Bowser (talk) 08:34, 12 April 2024 (UTC)

That sentence you quoted is an exact quote from the COMEAP pdf [7]. If you think it is making the link, then yes, COMEAP is making the link. --Dustfreeworld (talk) 08:49, 12 April 2024 (UTC)

I can't find it by ctrl+f, page? Draken Bowser (talk) 08:53, 12 April 2024 (UTC)

My apologies, there maybe some misunderstanding/ language barrier here. The original wording of the PDF is in pp. V:

“These effects are linked to a form of dementia (vascular dementia) caused by damage to the blood vessels in the brain.”

I copied it to the article Brain health and pollution, and I copyedited the addition to make it easier to understand: [8], and the sentence changed to “These effects are linked to vascular dementia (a form of dementia), which is caused by damage to the blood vessels in the brain.” It was later copied to this article (Vascular dementia). The meaning should be the same IMO, though it seems that my ce hasn’t made things better ... (Aside, editors who revert should be careful in checking the source and AGF before reverting, especially when the page numbers have already been given in the citation; as long as an edit is representing the source correctly, it shouldn’t be reverted *even if* the editor adding the content is using their own words. And as I said, four different edits of mine had been reverted in 24 hrs, not just that one, together with problematic edit summaries / talk page comments. So there are behavioural issues.) That said, I’m glad that you’ve pointed out a potential reason of misunderstanding :-) Regards, --Dustfreeworld (talk) 09:33, 12 April 2024 (UTC)

Respectfully, if you tell me that the sentence is an "exact quote" only to later inform me that you have refactored it, that's on you. Draken Bowser (talk) 12:42, 12 April 2024 (UTC)

Yes that’s my fault that I forgot I’ve slightly copyedited the sentence before adding it to this article, and have told you that it’s “exact copy”, and that’s why I’ve apologised at the very beginning of my last post. No hard feelings at all, really; and again, please accept my apologies. The problem we are discussing here is another user tendentiously reverted my edits repeatedly no matter whether anyone had told them it’s “exact copy” or not, and repeatedly making untrue potentially ABF claims (speculation, POV editing, etc.) about me (even across other articles) and violating Wikipedia’s edit warring rule at the same time. I hope you can understand that. Respectfully, --Dustfreeworld (talk) 17:06, 12 April 2024 (UTC)

Ok, no worries then. Back to the issue at hand: as long as an edit is representing the source correctly, which I think you're correct about. The problem is that the edit didn't represent the source correctly. The section quoted is from the "Lay summary". Here the authors explain to the uninitiated what anyone with medical expertise would automatically assume, that the patophysiological connection between air pollution and dementia is cardiovascular, i.e. atherosclerosis.

The problem is that, as they explain on page vii, they have yet to substantiate the connection. This is why the four bullet-points summarizing their conclusions make no mention of "vascular dementia", only "dementia" and the unspecific "cerebrovascular disease". A natural consequence of this is that the content is only DUE in the article on dementia (where it is already mentioned), but not here.

I won't opine on your interactions in other articles, but I don't think you have a case against Zefr here. Since you (inadvertently) misrepresented the source he has the right to reverse your edits. Draken Bowser (talk) 20:34, 12 April 2024 (UTC)

In your post above you said “These effects are linked to vascular dementia” is making the link. Now you said that sentence, which originated (and almost identical) to the COMEAP PDF’s lay summary, “didn't represent the source correctly”...

Further, I don’t think we have “back to the issue at hand”. There are issues of blatant violation of the WP:3RR policy (4 reverts within 24 hours), and failed AGF with untrue claims / potential WP:PA such as “Editor is promoting a POV” [9], etc, not to mention the WP:Tendentious editing that others had said above; and it would really surprise me if anyone thinks all these policy violations are ok. Anyway, I’m already burnt out with all those edit warring, untrue accusations and long discussions. Regards, --Dustfreeworld (talk) 22:43, 12 April 2024 (UTC)

Yes, the source is misrepresented. We don't get to pick and choose single sentences and ignore the rest of rhe text, the subject matter of medicine requires a more careful approach than that. The source enumerates 4 conclusions, without making a direct link to vascular dementia. Draken Bowser (talk) 05:11, 13 April 2024 (UTC)

The source has 200+ pages, I don’t know what would be your approach of *not* misrepresenting the text, if an almost direct quote from it’s summary is still not ok. I still don’t think we’ve “back to the issue at hand”. BTW, there were 4 reverts, not all were about the source you mentioned. Further, there are many other sources in the above discussion that support VaD as a risk factor or even cause of air pollution. FYI, the article has been improved a lot by others since the start of this discussion. You may want to have a deeper look at it too. I may not be able to reply soon as I’m occupied in RL. Anyway, I’m not fond of long discussions, and you can have your own opinion on the source. Best regards, --Dustfreeworld (talk) 05:24, 13 April 2024 (UTC)

@Draken Bowser, here is a source that says "air pollution in the cerebrovascular system causes stroke, vascular dementia, or other types of dementia". What kind of statement do you think would accurately represent that source? I assume that since it uses the exact word "causes", there could be no question about whether it's "just" a risk factor, and since it specifically names "vascular dementia", then none of the excuses about it being some unspecified form of dementia would be relevant. What do you think?

I think, by the way, that there's a reason that WP:MEDASSESS warns that editors should determine the appropriate type of source and quality of publication. Respect the levels of evidence: Do not reject a higher-level source (e.g., a meta-analysis) in favor of a lower one (e.g., any primary source) because of personal objections to the inclusion criteria, references, funding sources, or conclusions in the higher-level source. Editors should not perform detailed academic peer review. We really don't want editors to reject review articles because Wikipedians have decided that they know more than the academic literature. It'd be one thing if there were any decent sources saying that air pollution probably doesn't have any effect on vascular dementia, but there aren't. The mainstream medical opinion appears to be at the point of saying that we're certain this is related, and is causative, and all that remains is to finish quantifying and testing the mechanisms by which air pollution causes vascular dementia. Nobody out there is trying to say that pollution is healthy for brains. WhatamIdoing (talk) 05:24, 17 April 2024 (UTC)

Yeah, with that source we probably can. I'm ignorant as to whether Frontiers is considered a respected publisher of books, I know some of their journals have been naughty. I won't opine on the exact phrasing because (a) I can't see the preceding and following page on google books and (b) I'm unsure what they're communicating by using "or" instead of "and", but provided there are no concerns with respect to the publisher I'd say go ahead.

If your second paragraph is directed at me I'm not sure what point you're trying to make. Draken Bowser (talk) 12:48, 17 April 2024 (UTC)

I was answering my own question, since it seems aggressive to demand that you share your view without being willing to disclose my own. It's not directed at you.

Frontiers Media is neither the best nor the worst academic publisher. WhatamIdoing (talk) 00:06, 18 April 2024 (UTC)