Functional autonomy in dementia of the Alzheimer’s type, mild cognitive impairment, and healthy aging: a meta-analysis

Cumulative blood pressure burden and the risk of functional dependence in elderly cohorts: An exploration of the influencing factors

BACKGROUND

To investigate the correlation between cumulative blood pressure levels and functional dependence in individuals aged 60 and older.

METHODS

Data were sourced from two distinct elderly databases: CHARLS and ELSA. Various statistical techniques, including logistic regression analysis, restricted cubic spline analysis, forest plot visualization, and interaction analyses, were employed to delve into the associations between cumulative blood pressure and difficulties in performing activities of daily living.

RESULTS

Across both cohorts, there was a discernible trend towards an increased risk of ADL difficulties with escalating cumulative blood pressure levels. Logistic regression analysis confirmed a statistically significant relationship between cumulative blood pressure and ADL difficulties (P < 0.001). The results derived from restricted cubic spline plots further underscored this relationship, demonstrating that, after adjusting for a multitude of confounding factors, the risk of ADL difficulties augmented with rising cumulative blood pressure. Additionally, the forest plot and interaction plot findings revealed that the association between heightened cumulative blood pressure and the risk of ADL difficulties was contingent upon factors such as body mass index, gender, and memory-related disorders.

CONCLUSIONS

Our findings indicate a positive correlation between cumulative blood pressure and the risk of experiencing difficulties with ADLs. Furthermore, this association appears to be modulated by BMI, gender, and the presence of memory-related diseases.

IADL for identifying cognitive impairment in Chinese older adults: insights from cross-lagged panel network analysis

BACKGROUND

As China has entered an aging society, the prevention of cognitive impairment is of great importance. The progression of cognitive impairment is usually a slow and continuous process, with Instrumental Activities of Daily Living (IADL) serving as a sensitive indicator for early prediction of cognitive decline. The objective of this study was to utilize longitudinal network analysis to pinpoint the most sensitive indicators of IADLs to identify cognitive impairment in different populations, and to offer practical recommendations for preventing cognitive impairment among older adults in China.

METHODS

A total of 2,781 participants were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2014-2018). Cognitive function and IADLs were assessed by Mini-mental State Examination (MMSE) and Chinese modified Lawton scale, respectively. In this study, the cross-lagged panel network (CLPN) model was employed to construct three separate networks for all Chinese older adults, male Chinese older adults, and female Chinese older adults, respectively. Two centrality indices were used to quantify symptom centrality in directed CLPN: In-Expected-Influence (IEI) and Out-Expected-Influence (OEI).

RESULTS

In the IADLs and cognitive function networks, "Use public transit," "Make food" and "Walk 1 km" emerged as the most influential and important indicators. The edge "Use public transit → Attention and Calculation" was the strongest edge connection in all three networks. Among older adult males, "General ability" exhibited the most influence on other cognitive domains, followed by "Language," while "Attention and Calculation" had a weaker influence. Conversely, among older adult females, "Attention and Calculation" was the most influential factor, followed by "General ability" and "Language."

CONCLUSIONS

This study provides new insights into the associations between specific IADL activities and cognitive function domains among Chinese older adults. Concentrate on monitoring limitations related to "Use public transit," "Make food" and "Walk 1 km," and promoting broader life-space mobility may be beneficial to preventing the decline of cognitive function. The findings underscore the importance of targeting interventions not only by specific cognitive domains, but also potentially by gender.

CLINICAL TRIAL NUMBER

Not applicable.

Current status and future directions for the diagnosis and management of mild cognitive impairment in Southeast Asia: A SEACURE consensus paper

Global aging populations are facing increased prevalence of mild cognitive impairment (MCI) - the preclinical stage of dementia characterized by single/multi-domain neurocognitive decline that does not impair an individual's normal daily functioning. Asian populations are at increased risk of developing MCI and dementia, and many cases go undetected in Southeast Asia (SEA), resulting in increased burden on patients, caregivers and national healthcare systems. There is an urgent need for efficient and scalable diagnostic and management strategies across SEA. Our findings illustrate that current strategies are limited by insufficient resources and a lack of awareness, particularly in developing SEA nations. Strategies for improving the MCI landscape in SEA include increasing widespread community awareness and cognitive health screenings for individuals with a history of vascular risk factors, validation of traditional cognitive screening tests in the respective countries, greater access to blood-biomarker testing, and the development and validation of novel digitized diagnostics.

Concurrent Validity of Performance-Based Measures of Daily Functioning with Cognitive Measures and Informant Reported Everyday Functioning

OBJECTIVE

Despite the substantial need for reliable and valid assessment of functional ability in older adults, there is currently limited research on the emergence of early functional declines during prodromal dementia stages, such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This study uses novel performance-based assessments to characterize subtle, yet clinically meaningful, changes in functional ability.

METHOD

A sample of 93 older adults classified as cognitively unimpaired (CU; n = 30, Mage = 73.57 ± 6.66), SCD (n = 34, Mage = 72.56 ± 6.43), or MCI (n = 29, Mage = 78.28 ± 7.55) underwent neuropsychological testing along with an informant-rated daily functional skills measure (Assessment of Functional Capacity Interview). Participants also completed the Night Out Task (NOT), an open-ended performance-based measure of functional assessment, and the Financial Capacity Instrument-Short Form (FCI-SF) that assesses financial skills.

RESULTS

The MCI group performed worse on the NOT and FCI-SF relative to SCD and CU. NOT and FCI scores were associated with measures of global cognitive function, executive function, processing speed, language and memory, and FCI-SF overall score was correlated with informant-rated functional ability. The NOT and FCI-SF were also predictive of informant-reported daily functioning over and above traditional cognitive data and demographics.

CONCLUSIONS

Performance-based measures of IADL may allow for earlier detection of subtle functional changes that might not be adequately captured by traditional measures. The measurement of early functional changes is an important global outcome to evaluate the efficacy of interventions in dementia research.

Associations of baseline and longitudinal changes in basic activity of daily living with risk of cardiovascular disease among older adults in China

BACKGROUND AND AIMS

The purpose of this study was to examine the associations of basic activities of daily living (BADL) and its longitudinal changes with cardiovascular disease (CVD) risk among older population.

METHODS AND RESULTS

We conducted a prospective analysis of the Chinese Longitudinal Healthy Longevity Survey between 2008 and 2018 in 7051 participants aged 65 years or over. Cox proportional hazards models were performed to evaluate the associations of baseline and longitudinal changes in BADL with the incidence of CVD. A total of 1510 incident CVD cases were identified. The participants with BADL limitation at baseline had a 67 % increased risk of CVD compared with those without BADL limitation (multivariable-adjusted hazards ratio (HR): 1.67, 95 % confidence interval (CI): 1.35-2.07). Moreover, participants with persistent BADL limitation (HR: 2.25, 95 % CI: 1.73-2.93), BADL from limitation to non-limitation (HR: 1.80, 95 % CI: 1.27-2.54), and BADL from non-limitation to limitation (HR: 1.86, 95 % CI: 1.62-2.14) were each experienced a higher risk of CVD compared with those with persistent BADL non-limitation. Of all the items of BADL, limitation of bathing or multiple BADL limitations (≥2) was positively associated with the risk of stroke.

CONCLUSION

Longitudinally persistent BADL limitation was associated with a more than twofold risk of CVD in later life among the Chinese older adults. Similar but slightly weak association was also observed for temporary BADL limitation. Older adults with BADL limitation, especially those with bathing limitation or with multiple functional limitations, should be the target population for CVD prevention.

Cognitive performance classification of older patients using machine learning and electronic medical records

Dementia rates are projected to increase significantly by 2050, posing considerable challenges for healthcare systems worldwide. Developing efficient diagnostic tools is critical, and machine learning (ML) algorithms have shown potential for improving the accuracy of cognitive impairment classification. This study aims to address challenges in current systems by leveraging readily available electronic medical record (EMR) data to simplify and enhance the classification of cognitive impairment. The analysis includes 283 older adults, categorized into three groups: 144 individuals with mild cognitive impairment (MCI), 38 with dementia, and 101 healthy controls. Various ML techniques are evaluated to classify cognitive performance levels based on input features such as sociodemographic variables, lab results, comorbidities, Body Mass Index (BMI), and functional scales. Key predictors for distinguishing healthy controls from individuals with MCI are identified. These are history of myocardial infarction, vitamin D3 levels, the Instrumental Activities of Daily Living (IADL) scale, age, and sodium levels. The nonlinear Support Vector Machine (SVM) with a Radial Basis Function (RBF) kernel achieve the best performance for MCI classification, with an accuracy of 69%, an AUC of 0.75, and a Matthews Correlation Coefficient (MCC) of 0.43. For distinguishing healthy controls from those with dementia, the most influential factors include the IADL scale, the Activities of Daily Living (ADL) scale, education, vitamin D3 levels, and age. Here, the Random Forest algorithm demonstrates superior performance, achieving 84% accuracy, an AUC of 0.96, and an MCC of 0.71. These two models consistently outperform other ML techniques, such as K-Nearest Neighbors, Multi-Layer Perceptron, linear SVM, Naive Bayes, Quadratic Discriminant Analysis, Linear Discriminant Analysis, AdaBoost, and Gaussian Process Classifiers. The findings suggest that EMR data can be an effective resource for the initial classification of cognitive impairments. Integrating these ML-driven approaches into primary care settings may facilitate the early identification of older patients who could benefit from further cognitive assessments.

Cognitive impairment in CKD patients: a guidance document by the CONNECT network

Cognitive impairment is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). This position paper, developed by the Cognitive Decline in Nephro-Neurology: European Cooperative Target network, provides guidance on the epidemiology, risk factors, pathophysiology, diagnosis and clinical management of CKD-related cognitive impairment. Cognitive impairment is significantly more common in CKD patients compared with the general population, particularly those undergoing haemodialysis. The development of cognitive impairment is influenced by a complex interplay of factors, including uraemic neurotoxins, electrolytes and acid-base disorders, anaemia, vascular damage, metabolic disturbances and comorbidities like diabetes and hypertension. Effective screening and diagnostic strategies are essential for early identification of cognitive impairment utilizing cognitive assessment tools, neuroimaging and circulating biomarkers. The impact of various drug classes, including antiplatelet therapy, oral anticoagulants, lipid-lowering treatments and antihypertensive drugs, on cognitive function is evaluated. Management strategies encompass pharmacological and non-pharmacological interventions, with recommendations for optimizing cognitive function while managing CKD-related complications. This guidance highlights the importance of addressing cognitive impairment in CKD patients through early detection, careful medication management and tailored therapeutic strategies to improve patient outcomes.

The Impact of Prior Incarceration on Cognitive Trajectories Among Older Adults: Evidence From the Health and Retirement Study

OBJECTIVES

This study examines the association between prior incarceration and cognition trajectories among older adults in the United States.

METHODS

Data are from the Health and Retirement Study (HRS), a nationally representative longitudinal survey of older adults in the United States. The analysis included respondents aged 55 and older who participated in the 2012-2020 HRS surveys and had valid responses on Langa-Weir cognition scores, incarceration history, and covariates (n = 5,663). Cognition trajectories were estimated using group-based trajectory modeling, and multinomial logistic regression was used to assess the relationship between prior incarceration and cognition trajectory group membership.

RESULTS

The study identified four distinct cognition trajectories. Formerly incarcerated individuals were significantly more likely to be in cognition trajectory groups defined by lower cognition scores and steeper declines in cognitive functioning over time. However, these associations were attenuated after accounting for sociodemographic and health-related characteristics, and all associations were rendered statistically nonsignificant after accounting for educational attainment.

DISCUSSION

These findings highlight poorer cognition among older formerly incarcerated individuals compared with their never incarcerated counterparts, as well as underscore the role of educational attainment in this relationship. Future research and data collection efforts are needed to further understand the nexus between incarceration and cognitive functioning and the mechanisms underpinning this association.

Social support and aging: psychometric analysis of the ENRICHD Social Support Instrument in a Chilean population over 50

BACKGROUND

Social support is relevant to studying well-being, quality of life, and health during aging, particularly in people over 50. Therefore, brief instruments that allow its measurement within the clinical evaluation and research processes are necessary. The ENRICH Social Support Scale (ESSI) is a brief and easy-to-use instrument that measures the perception of social support; however, its psychometric properties in people over 50 in the Chilean context have yet to be tested.

METHOD

This study had a non-experimental, longitudinal panel design in which a sample of 303 people over 50 years of age (M = 55.14 years, SD = 5.19; 52% women) were administered a survey incorporating sociodemographic variables, the ESSI and the Newsom Social Negativity Scale. 277 participants completed the follow-up survey (M = 56.75 years, SD = 5.15; 54% women). Confirmatory factor analysis (CFA), structural equation modeling (SEM), invariance analysis, and internal consistency tests were performed to determine the psychometric properties.

RESULTS

The six items from the scale load in a single-factor model obtained an excellent fit to the data and reliability coefficients (α = 0.902; ω = 0.904). The SEM analysis evidenced an inverse correlation between the ESSI and Newsom's social negativity scale, demonstrating evidence of construct validity. Furthermore, in the sex invariance analyses, the scalar level was reached, implying that the items' meanings are the same for men and women. Finally, the residual level was reached in the temporal invariance analyses, which means that the scale items are consistent in time.

CONCLUSIONS

The ESSI is a reliable and valid tool to be used in the Chilean context both in the clinical setting and in research on people over 50. The evidence obtained supports its usability to appropriately measure the perception of social support, which is relevant considering that it has been associated with reports of higher quality of life and lower mortality and morbidity during aging.

Comparison of robustness, resilience and intrinsic capacity including prediction of long-term adverse health outcomes: The KORA-Age study

BACKGROUND

Frailty, resilience and intrinsic capacity (IC) are concepts to evaluate older person`s health status, but no comparison of their associations with adverse health outcomes exists. We therefore aimed to assess which concept is most useful for determining long-term health of older adults.

METHODS

Analyses were based on the KORA (Cooperative Health Research in the Region of Augsburg)-Age study (n = 940, 65-93 years). Frailty was evaluated using the physical frailty-phenotype by Fried et al. For comparability to resilience and IC, we chose the protective concept of robustness instead of frailty in the present analysis. Resilience was measured by the 11-item resilience-scale. The IC-score was based on 4 domains (locomotion, cognition, vitality and psychiatric capacities). Associations with falls, disability, and hospitalization at 3-year and 7-year follow-up and with mortality were evaluated by multivariable adjusted logistic and Cox regression. Concept overlaps were illustrated by a Venn-diagram.

RESULTS

In the fully adjusted models, robustness showed significant inverse associations with most outcomes (3-year follow-up: OR (95%CI): disability 0.448 (0.300-0.668), 7-year follow-up: falls 0.477 (0.298-0.764), hospitalization 0.547 (0.349-0.856), and all-cause mortality 0.649 (0.460-0.915)) while resilience and IC showed significant inverse associations with disability only (e.g., 7-year-follow-up: resilience: 0.467 (0.304-0.716), IC: 0.510 (0.329-0.793)). 23% of the participants met the criteria for both robustness and IC while 22% met those for robustness and resilience.

CONCLUSION

Robustness was the most useful concept, showing the strongest protective associations for most adverse health outcomes. IC and resilience showed their main strengths in capturing protective associations for disabilities. Robustness overlapped with resilience and IC, supporting the concept of mind-body-interaction.

Factors associated with the occupational balance in caregivers of people with dementia: A cross-sectional study from the ATENEA project

BACKGROUND

Occupational balance (OB) has been associated with health indicators in informal caregivers (CGs) such as well-being and subjective health. Consequently, maintaining an adequate OB could be crucial to providing adequate care without becoming overwhelmed, converting the condition of caregivers into an important aspect of public health as the ageing population increases. However, little is known about the factors influencing OB in CGs. Thus, this study aimed to explore the associated factors with the OB in CGs of persons with dementia.

METHODS

We cross-sectionally analysed data from 134 CGs and the individuals with dementia. We assessed CGs' OB using the Occupational Balance Questionnaire (OBQ). Simultaneously, several sociodemographic, clinical, and caregiving-related variables including CGs' burden and psychological distress were assessed. The association between the CGs' OB and those factors was explored through robust multiple linear regression.

RESULTS

Firstly, CGs that presented secondary education exhibited a decrement of 5.41 (CI95% = -10.62, -0.41; p-value = 0.03) OB points. Moreover, CGs with higher education experienced a more pronounced OB reduction (β = -7.74; 95%CI = -12.19, -3.29; p-value = < 0.001). Secondly, those CGs that were retired showed an OB increment of 5.52 (CI95% = 1.14, 9.38; p-value = 0.01). Thirdly, receiving assistance with household chores was associated with an OB increase of 5.80 (CI95% = 2.21, 9.38; p-value = 0.001). Fourthly, and regarding clinical measures, CGs experiencing overload or psychological distress were associated with an OB points decrement of 7.87 (CI95% = -12.51, -3.23; p-value = 0.001) and 9.17 (CI95% =-13.51, -4.84; p-value < 0.001), respectively. Finally, 1% increment in the Disability Assessment for Dementia obtained from the individuals with dementia was associated with an increment of 0.11 (CI95% = 0.04, 0.18; p-value = 0.002) OB points.

CONCLUSIONS

This study identified several associated factors with the OB of CGs of persons with dementia. Specifically, we remarked that the CGs' education, employment status, household chores assistance, overload presence, psychological distress symptoms and the functional level of the person with dementia who cared for were important variables that should be considered when evaluating OB or creating OB-related interventions in CGs.

Associations between physical activity, sedentary behaviour and cognitive domain performance of people living with mild cognitive impairment in the community

INTRODUCTION

Physical activity is known to positively influence cognitive performance. For adults with mild cognitive impairment (MCI), the relationship between physical activity levels and cognitive performance is unknown. This cross-sectional study aimed to determine if cognitive performance [as measured by the Montreal Cognitive Assessment (MoCA)] of people living in the community with MCI is associated with their physical activity levels or sedentary behaviour.

METHODS

ActivPAL™ accelerometers were used to objectively measure physical activity and sedentary behaviour for seven full days. Cognitive performance was measured using the MoCA.

CONSUMER AND COMMUNITY INVOLVEMENT

No involvement other than as research participants RESULTS: Eighty-two participants from the Balance on the Brain randomised controlled trial were included. Most participants were retired (88%), with 33 (40%) reporting a fall in the last year. The median MoCA score was 24 (IQR 22-26). Participants achieved a mean of 6296 (±2420) steps per day and were sedentary for 10.6 (±2) hours per day. The only physical activity outcomes that had a fair, positive correlation were moderate- to vigorous-intensity physical activity measures of total stepping time and total number of steps (with a cadence of ≥100 steps/min) with the orientation MoCA domain score (r(82) = 0.36, p ≤ 0.001 and r(82) = 0.37, p ≤ 0.001, respectively). Higher total sedentary time had a weak, positive correlation with better visuospatial/executive performance (r(82) = 0.23, p = 0.041). The orientation outcomes remained significant when analysed in an adjusted logistic regression model.

CONCLUSION

This study found that performance in the MoCA orientation domain had a fair-positive correlation with moderate-intensity physical activity (i.e., stepping time and step count with a cadence of ≥100 steps/min) as measured by a thigh-worn accelerometer for community-dwelling older adults with MCI. When considering the relationship between cognitive domains and sedentary behaviour, consideration may be needed regarding whether cognitive enhancing activities (such as crosswords and other brain games) are being performed, which may confound this relationship. Further investigation is required to confirm these results.

Does Mild Functional Impairment Predict Dementia in Older Adults With Normal Cognition?

OBJECTIVES

Functional impairment can be an early indicator of cognitive decline. However, its predictive utility in cognitively normal (CN) older adults remains unclear. This study aimed to determine whether mild functional impairment (MFI) in CN older adults could predict incident dementia over 6 years, in addition to assessing its association with cognitive performance.

DESIGN

A longitudinal study with a 6-year follow-up.

PARTICIPANTS

A cohort of 296 community-dwelling CN older adults.

MEASUREMENTS

MFI was defined by cutoffs for impairment on an objective performance-based and/or subjective questionnaire-based functional assessment. Cox regression analysis was conducted to assess the relationship between MFI and risk of incident dementia and cognitive performances over 6 years. Linear regression analysis examined the association between MFI and baseline cognitive performance.

RESULTS

There were no significant longitudinal associations between MFI and incident dementia or changes in cognitive performance over 6 years. Defining MFI using both performance-based and informant-reported assessments was predictive of dementia. Cross-sectional analyses demonstrated significant associations between MFI and poorer baseline global cognition and performance in attention, visuospatial ability, and executive functioning.

CONCLUSIONS

CN older adults with MFI were not at an increased risk of developing dementia over 6 years. A definition of functional impairment requiring both performance-based and informant-based assessments may be useful in predicting dementia.

The relation between cognitive functioning and activities of daily living in normal aging, mild cognitive impairment, and dementia: a meta-analysis

Literature suggests that dementia and, more generally, cognitive impairment affect the capacity to carry out activities of daily living (ADL) in aging. However, it is important to decipher the weight of specific cognitive domains and neurodegenerative profiles mainly related to ADL difficulties. A meta-analysis was conducted to investigate the nature and strength of the association between cognitive functioning and ADL in healthy older adults, mild cognitive impairment (MCI), and dementia. A comprehensive search of the PubMed, PsycINFO (PROQUEST), and Scopus databases for cross-sectional or longitudinal studies up until December 2022. Our meta-analytic results revealed that: overall, instrumental ADL (IADL) showed a significant association with executive functioning, in particular, abstraction ability/concept formation, set-shifting, and processing speed/complex attention/working memory, regardless of type of participants (i.e., healthy older adults, MCI, and dementia); whereas ADL (both basic ADL, BADL, and IADL) significantly correlated with global cognitive functioning and long-term verbal memory, with a moderator effect of clinical condition (e.g., increasing ES based on the level of cognitive impairment). Moreover, visuospatial and language abilities significantly correlated with ADL, mainly when performance-based tasks were used for ADL assessment. These findings emphasize the importance of neuropsychological assessment in aging to early identify people most at risk of functional decline and shed light on the need to consider specific cognitive abilities in rehabilitation programs.

Land/Water Aerobic Activities: Two Sides of the Same Coin. A Comparative Analysis on the Effects in Cognition of Alzheimer's Disease

Evidence in the literature indicates that aerobic physical activity may have a protective role in aging pathologies. However, it has not been clarified whether different types of aerobic exercise produce different effects. In particular, these potential differences have not been explored in patients with Alzheimer's disease (AD). The present narrative review has the specific aim of evaluating whether land (walking/running) and water (swimming) aerobic activities exert different effects on cognitive functions and neural correlates in AD patients. In particular, the investigation is carried out by comparing the evidence provided from studies on AD animal models and on patients. On the whole, we ascertained that both human and animal studies documented beneficial effects of land and water aerobic exercise on cognition in AD. Also, the modulation of numerous biological processes is documented in association with structural modifications. Remarkably, we found that aerobic activity appears to improve cognition per se, independently from the specific kind of exercise performed. Aerobic exercise promotes brain functioning through the secretion of molecular factors from skeletal muscles and liver. These molecular factors stimulate neuroplasticity, reduce neuroinflammation, and inhibit neurodegenerative processes leading to amyloid-β accumulation. Additionally, aerobic exercise improves mitochondrial activity, reducing oxidative stress and enhancing ATP production. Aerobic activities protect against AD, but implementing exercise protocols for patients is challenging. We suggest that health policies and specialized institutions should direct increasing attention on aerobic activity as lifestyle modifiable factor for successful aging and age-related conditions.

Social Isolation and Loneliness in a Population Study of Cognitive Impairment: The MYHAT Study

In this study, we examined associations of social isolation and loneliness with cognitive impairment among older adults from a Rust Belt region in Southwest Pennsylvania. We used data from the population-based Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. We found that (a) 11 items combined into two reliable composites of social isolation and loneliness; (b) unique to this study, providing unpaid help to others was an indicator of reduced social isolation; (c) social isolation and loneliness were positively associated with cognitive impairment; and (d) these associations were appreciably attenuated by general health and physical functional status and depressive symptoms, respectively. We concluded that social isolation and loneliness are differentially associated with older adults' cognitive health, and that their effects might operate through separate pathways. Approaches to address social isolation and loneliness should consider the community context and its implications for older adults' cognitive health.

Mesoporous Silica Nanoparticles: Types, Synthesis, Role in the Treatment of Alzheimer's Disease, and Other Applications

Globally, many individuals struggle with Alzheimer's disease (AD), an unrelenting and incapacitating neurodegenerative condition. Despite notable research endeavors, effective remedies for AD remain constrained, prompting the exploration of innovative therapeutic avenues. Within this context, silica-based nanoplatforms have emerged with pronounced potential due to their unique attributes like expansive surface area, customizable pore dimensions, and compatibility with living systems. These nanoplatforms hold promise as prospective interventions for AD. This assessment provides a comprehensive overview encompassing various forms of mesoporous silica nanoparticles (MSNs), techniques for formulation, and their applications in biomedicine. A significant feature lies in their ability to precisely guide and control the transport of therapeutic agents to the brain, facilitated by the adaptability of these nanoplatforms as drug carriers. Their utility as tools for early detection and monitoring of AD is investigated. Challenges and prospects associated with harnessing MSNs are studied, underscoring the imperative of stringent safety evaluations and optimization of how they interact with the body. Additionally, the incorporation of multifunctional attributes like imaging and targeting components is emphasized to enhance their efficacy within the intricate milieu of AD. As the battle against the profound repercussions of AD persists, MSNs emerge as a promising avenue with the potential to propel the development of viable therapeutic interventions.

Brief instrument for direct complex functionality assessment: a new ecological tool

Background

The Direct Assessment of Functional Status (DAFS) is the only instrument validated in Brazil that assesses functionality directly with the patient. However, this clinical tool takes a long time to be administered. This limits its use in hospitals and outpatient clinics that require brief assessment instruments. Additionally, we need to count with a direct assessment because the number of older adults living alone is increasing and we thus lack reliable informants.

Objective

This study aimed to present the development and content validity evidence of a direct complex functionality test for older adults, the Brief Instrument for Direct Functionality Assessment (BIDFA).

Method

A total sample of 30 older adults and eight expert judges took part in the study stages. The BIDFA construction stages were: (1) literature review of functionality instruments; (2) development of seven ecological tasks to evaluate the performance of daily complex activities with the older adults; (3) content analysis by eight expert judges; (4) pilot study with 30 older adults; (5) the ecological analysis of items; (6) focus group analysis; and (7) final version of the BIDFA.

Results

The BIDFA had evidence of content validity with an agreement index of 96.5%. The final version of BIDFA was left with six domains of complex functionality divided into semantic memory and time orientation; shopping skills; executive attention, math and finance skills; organization; planning and procedural memory; and problem-solving. The complex functionality score by BIDFA ranges from 0 to 100 points.

Conclusion

The BIDFA was found to have good content validity by the expert judges and by the ecological analysis of the items by the older adults. The new instrument is expected to help assess the functional status of older adults, in an abbreviated context including complex functionality demands, with a wider range of total and subdomain scores.

Effectiveness of an Individualized Exergame-Based Motor-Cognitive Training Concept Targeted to Improve Cognitive Functioning in Older Adults With Mild Neurocognitive Disorder: Study Protocol for a Randomized Controlled Trial

BACKGROUND

Simultaneous motor-cognitive training is considered promising for preventing the decline in cognitive functioning in older adults with mild neurocognitive disorder (mNCD) and can be highly motivating when applied in the form of exergaming. The literature points to opportunities for improvement in the application of exergames in individuals with mNCD by developing novel exergames and exergame-based training concepts that are specifically tailored to patients with mNCD and ensuring the implementation of effective training components.

OBJECTIVE

This study systematically explores the effectiveness of a newly developed exergame-based motor-cognitive training concept (called "Brain-IT") targeted to improve cognitive functioning in older adults with mNCD.

METHODS

A 2-arm, parallel-group, single-blinded randomized controlled trial with a 1:1 allocation ratio (ie, intervention: control), including 34 to 40 older adults with mNCD will be conducted between May 2022 and December 2023. The control group will proceed with the usual care provided by the (memory) clinics where the patients are recruited. The intervention group will perform a 12-week training intervention according to the "Brain-IT" training concept, in addition to usual care. Global cognitive functioning will be assessed as the primary outcome. As secondary outcomes, domain-specific cognitive functioning, brain structure and function, spatiotemporal parameters of gait, instrumental activities of daily living, psychosocial factors, and resting cardiac vagal modulation will be assessed. Pre- and postintervention measurements will take place within 2 weeks before starting and after completing the intervention. A 2-way analysis of covariance or the Quade nonparametric analysis of covariance will be computed for all primary and secondary outcomes, with the premeasurement value as a covariate for the predicting group factor and the postmeasurement value as the outcome variable. To determine whether the effects are substantive, partial eta-squared (η²_p) effect sizes will be calculated for all primary and secondary outcomes.

RESULTS

Upon the initial submission of this study protocol, 13 patients were contacted by the study team. Four patients were included in the study, 2 were excluded because they were not eligible, and 7 were being informed about the study in detail. Of the 4 included patients, 2 already completed all premeasurements and were in week 2 of the intervention period. Data collection is expected to be completed by December 2023. A manuscript of the results will be submitted for publication in a peer-reviewed open-access journal in 2024.

CONCLUSIONS

This study contributes to the evidence base in the highly relevant area of preventing disability because of cognitive impairment, which has been declared a public health priority by the World Health Organization.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05387057; https://clinicaltrials.gov/ct2/show/NCT05387057.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41173.

Everyday function profiles in prodromal stages of MCI: Prospective cohort study

INTRODUCTION

The nature and course of limitations in everyday function in the early clinical stages of cognitive decline is not well known.

METHODS

We compared complex everyday functional profiles at baseline in 59 community-dwelling older individuals with normal cognitive performance who went on to develop incident mild cognitive impairment (MCI) ("pre-MCI") with 284 older individuals who remained cognitively normal over follow-up.

RESULTS

The mean number of limitations on complex everyday function at baseline was 3.1 ± 3.0 in the 59 pre-MCI cases and 2.0 ± 2.4 in the 284 normal controls (P = .003). Pre-MCI cases had limitations in traveling, entertaining, remembering appointments, and hobbies compared to normal controls. A progressive increase in mild limitations on complex everyday function preceded the incidence of MCI (mean change: pre-MCI 1.9 ± 3.6 vs normal controls 0.5 ± 2.7, P < .001).

DISCUSSION

Prodromal stages of MCI are associated with progressive mild limitations in complex activities of daily living.

Prodromal Motoric Cognitive Risk Syndrome and Everyday Function

BACKGROUND

Motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by subjective cognitive complaints and slow gait, is associated with disability in instrumental activities of daily living. It is unknown whether these functional limitations occur even before this pre-dementia syndrome is diagnosed.

OBJECTIVE

To assess profiles of complex and instrumental activities of daily living in the prodromal stages of MCR.

METHODS

We examined functional profiles in 46 older adults (mean age 79 years, 59% women) living in the community with normal cognition at baseline who developed MCR over follow-up ('pre-MCR') with 264 older adults (mean age 75 years, 57% women) who remained cognitively intact over the follow-up period.

RESULTS

Pre-MCR individuals had more limitations on complex everyday function at baseline compared to normal controls in multivariable logistic regression models (odds ratio 1.21). Pre-MCR cases at baseline had limitations in handling finances (odds ratio 3.0) and performing hobbies (odds ratio 5.5) as compared to normal controls. Pre-MCR cases had a greater difference in the number of complex functional limitations from baseline to MCR compared to the difference from baseline to final visit for the controls (1.2±3.0 versus 0.5±2.2, p < 0.001).

CONCLUSIONS

Limitations in complex everyday tasks arise in the prodromal stages of MCR and can assist in risk prognostication.

Relationship Between Non-Cognitive Intrinsic Capacity and Activities of Daily Living According to Alzheimer's Disease Stage

BACKGROUND

Few studies have examined the relationship between non-cognitive factors and activities of daily living (ADL) according to Alzheimer's disease (AD) stage.

OBJECTIVE

We aimed to identify the differences in non-cognitive factors according to AD stages and their involvement in basic and instrumental ADL performance by using intrinsic capacity (IC) in groups with cognition ranging from normal to moderate or severe AD.

METHODS

We enrolled 6397 patients aged≥65 years who visited our memory clinic. Non-cognitive IC was assessed using the locomotion, sensory, vitality, and psychological domains. Multiple logistic regression was performed to identify how non-cognitive IC declines over the AD course and examine the correlation between non-cognitive IC and basic and instrumental ADL performance.

RESULTS

Non-cognitive IC declined from the initial AD stage and was significantly correlated with both basic and instrumental ADL performance from the aMCI stage through all AD stages. In particular, the relationship between IC and basic ADL was stronger in mild and moderate to severe AD than in the aMCI stage. On the other hand, the relationship between IC and instrumental ADL was stronger in aMCI than in later AD stages.

CONCLUSIONS

The results show non-cognitive factors, which decline from the aMCI stage, are correlated with ADL performance from the aMCI stage to almost all AD stages. Considering that the relationship strength varied by ADL type and AD stage, an approach tailored to ADL type and AD stage targeting multiple risk factors is likely needed for effectively preventing ADL performance declines.

Gaps between Activities of Daily Living Performance and Capacity in People with Mild Dementia

Persons with mild dementia can effectively maintain and improve their quality of life (QOL) by regularly performing their daily activities. However, research on activities of daily living (ADL) in this population often fails to distinguish between ADL performance and ADL capability, that is, actual independence in daily lives and potential independence in an ideal setting. This study aimed to identify the potential gaps between ADL performance and capability in individuals with mild dementia. A total of 137 community-dwelling older adults (aged ≥ 65 years) who had been diagnosed with dementia and assessed as 0.5 and 1 on a global clinical dementia rating (CDR). Participants were evaluated for basic ADL (BADL) and instrumental ADL (IADL) using the Hyogo Activities of Daily Living Scale (HADLS). Around 35 individuals who met the inclusion criteria were enrolled in the study. BADL performance and BADL capacity were not significantly different (p = 0.128); however, participants rated IADL capacity significantly higher than IADL performance (p < 0.01). Gaps between performance and capability were observed for IADL but not for BADL. This study distinguishes between ADL performance and capability in individuals with mild dementia and is the first to identify the IADL-specific gap between these two components; pertinent targeted interventions are vital in closing this gap. Environmental adjustments are important to improve QOL of persons with mild dementia.

Influencing factors on instrumental activities of daily living functioning in people with mild cognitive disorder - a secondary investigation of cross-sectional data

BACKGROUND

Finding a strategy to reduce the impact of cognitive decline on everyday functioning in persons suffering from cognitive impairment is a public health priority. Instrumental activities of daily living (IADL) are key to everyday functioning. Hence, it is essential to understand the influencing factors on IADL to develop specific interventions to improve everyday functioning in persons with mild cognitive disorder. Therefore, this study aimed to 1) explore different influencing factors on IADL functioning considering all domains of the International Classification of Functioning, disability, and health and 2) rank these factors.

METHODS

We performed a secondary analysis of a cohort including participants with amnestic mild cognitive impairment (a-MCI) or mild Alzheimer's Dementia (mild AD). The IADL functioning model was used as a starting point to estimate the effects of cognitive and physical function factors and personal and environmental factors on IADL functioning using multiple linear regression analysis, including subgroup analysis in persons with a-MCI. We used standardized coefficient estimates to relate the size of the predictor effects in the final model.

RESULTS

We included 105 participants (64 a-MCI, 41 mild AD); the mean age was 81.9 years (SD 4.9), with 70% females. Based on a multi-step approach and model fit, the final model included IADL functioning as the response variable and memory, attention, executive function, vision and hearing, mobility, balance, education, and social support as predictors. The final model explained 75% of the variability. The significant predictors in the model were mobility, balance, attention, and education, and were the predictors with the most considerable effects based on standardized coefficient estimates. The subgroup analysis, including only a-MCI participants, revealed a similar pattern.

CONCLUSION

Our results confirm that IADL functioning in people with mild cognitive disorder is influenced by cognitive and physical function and personal factors. The study provides further insight into understanding IADL functioning impairments in persons with mild impaired cognition and may be used to develop specific non-pharmacological interventions.

Changes in Measures of Vestibular and Balance Function and Hippocampus Volume in Alzheimer's Disease and Mild Cognitive Impairment

OBJECTIVE

To test the hypotheses that people with Alzheimer's disease and mild cognitive impairment have increased frequency of vestibular impairments and decreased hippocampal volume compared with healthy age-matched controls.

STUDY DESIGN

Retrospective, with some historical controls.

SETTING

Out-patient, tertiary care center.

SUBJECTS

People with mild to moderate dementia diagnosed with Alzheimer's disease and with mild cognitive impairment. Main Outcome Measures: A standard clinical battery of objective tests of the vestibular system, and screening for balance; available clinical diagnostic magnetic resonance imaging (MRIs) were reviewed and postprocessed to quantify the left and right hippocampal volumes utilizing both manual segmentation and computer automated segmentation.

RESULTS

Study subjects (N = 26) had significantly more vestibular impairments, especially on Dix-Hallpike maneuvers and cervical vestibular evoked myogenic potentials (cVEMP), than historical controls. No differences were found between mild and moderate dementia subjects. Independence on instrumental activities of daily living in subjects with age-normal balance approached statistical differences from subjects with age-abnormal balance. MRI data were available for 11 subjects. Subjects with abnormal cVEMP had significantly reduced left hippocampal MRIs using manual segmentation compared with subjects with normal cVEMP.

CONCLUSION

The data from this small sample support and extend previous evidence for vestibular impairments in this population. The small MRI sample set should be considered preliminary evidence, and suggests the need for further research, with a more robust sample and high-resolution MRIs performed for the purpose of hippocampal analysis.

The Instrumental Activities of Daily Living in Parkinson’s Disease Patients Treated by Subthalamic Deep Brain Stimulation

Background

Everyday functioning and instrumental activities of daily living (IADL) play a vital role in preserving the quality of life in patients with Parkinson’s disease (PD) after deep brain stimulation of the subthalamic nucleus (STN-DBS).

Objective

The main goal of the current study was to examine IADL change in pre-and post-surgery of the STN-DBS. We also analyzed the influence of the levodopa equivalent daily dose (LEDD) and global cognitive performance (Dementia Rating Scale; DRS-2) as covariates in relation to IADL.

Methods

Thirty-two non-demented PD patients were administered before and after STN-DBS neurosurgery the Penn Parkinson’s Daily Activities Questionnaire (PDAQ; self-report), the DRS-2 and Beck Depression Inventory (BDI-II) to assess IADL change, global cognition, and depression.

Results

We found a positive effect of STN-DBS on IADL in the post-surgery phase. Moreover, lower global cognition and lower LEDD are predictive of lower IADL in both pre-surgery and post-surgery examinations.

Summary/Conclusion

STN-DBS in PD is a safe method for improvement of everyday functioning and IADL. In the post-surgery phase, we show a relation of IADL to the severity of cognitive impairment in PD and to LEDD.

Relationships Among Cognitive Function, Frailty, and Health Outcome in Community-Dwelling Older Adults

Background

Frailty and cognitive impairment are significant problems faced by older adults, which have a significant impact on their activities of daily living, social activities, and quality of life.

Design

Cross-sectional study.

Methods

A total of 252 older adults in two communities in Yangzhou were randomly selected. The cognitive function of the elderly was assessed using the Memory and Executive Screening (MES). The frailty phenotype was used to evaluate the frail situation of older adults. The activity of daily living (ADL), functional activities questionnaire (FAQ), and European quality of 5-dimensions (EQ-5D) were used to evaluate health outcomes in the elderly. SEM was used to explore the direct and indirect relationship among cognitive function, frailty and health outcomes.

Results

There was a significant direct correlation between cognitive function and frailty; the direct effect was −0.521. The influence path of cognitive function on health outcomes included direct and indirect effects; the total effect was −0.759. The effect of frailty on health outcomes included direct and indirect effects; the total effect was 0.440.

Conclusion

According to SEM, cognitive function interacts with frailty and may reduce the quality of life, the ADL, and social activities among older adults directly and indirectly, so future assessments of older adults should consider both cognitive function and frailty, so as to further improve the health outcome of the elderly. When formulating relevant intervention measures in the future, we need to consider that it cannot only improve the cognitive function, but also improve the frail situation, so as to jointly improve the health outcomes of older adults.

Quantifying activities of daily living impairment in Parkinson's disease using the Functional Activities Questionnaire

OBJECTIVE

Cognitive-driven activity of daily living (ADL) impairment in Parkinson's disease (PD) is increasingly discussed as prodromal marker for dementia. Diagnostic properties of assessments for this specific ADL impairment are sparsely investigated in PD. The ability of the Functional Activities Questionnaire (FAQ) for differentiating between PD patients with normal cognition and with mild cognitive impairment (PD-MCI), according to informant and self-reports, was examined. Global cognitive function in groups with and without mild ADL impairment was compared according to different cut-offs.

METHODS

Multicenter data of 589 patients of an international cohort (CENTRE-PD) were analyzed. Analyses were run separately for informant-rated and self-rated FAQ. Receiver operating characteristic (ROC) analysis was conducted to define the optimal FAQ cut-off for PD-MCI (≥ 1), and groups were additionally split according to reported FAQ cut-offs for PD-MCI in the literature (≥ 3, ≥ 5). Binary logistic regressions examined the effect of the Montreal Cognitive Assessment (MoCA) score in PD patients with and without mild ADL impairment.

RESULTS

Two hundred and twenty-five (38.2%) patients were classified as PD-MCI. For all three cut-off values, sensitivity was moderate to low (< 0.55), but specificity was moderately high (> 0.54) with a tendency of higher values for self-reported deficits. For the self-report, the cut-off ≥ 3 showed a significant effect of the MoCA (B =  - 0.31, p = 0.003), where FAQ ≥ 3 patients had worse cognition. No effect for group differences based on informant ratings was detected.

CONCLUSION

Our data argue that self-reported ADL impairments assessed by the FAQ show a relation to the severity of cognitive impairment in PD.