Defining Cognitive Reserve and Implications for Cognitive Aging

Mental Health of Older Adults in the Emergency Department

Older adults with acute mental health concerns represent a large and growing population presenting to emergency departments (EDs). An organized approach to seniors experiencing a mental health crisis, grounded in a life course perspective, is essential. A structured approach to suicide risk assessment is a key part of ED practice. Mania, psychosis, anxiety, trauma, substance use, and the neuropsychiatric complications of Parkinson's disease are described in this article.

Investigation of risk of Alzheimer's disease diagnosis and survival based on variation to life experiences used to operationalize cognitive reserve

BackgroundAlzheimer's disease dementia (AD) is a debilitating progressive neurodegenerative disease. Life experiences are hypothesized to build cognitive reserve (CR), a theoretical construct associated with delayed onset of AD symptoms. While CR is a key moderator of cognitive decline, operationalization of CR is varied resulting in inconsistencies within the literature.ObjectiveThis study explored the relationship between life experiences used as proxies of CR and risk of AD diagnosis and death following diagnosis.MethodsWe explored results based on 30 different published CR operationalizations, including two standardized questionnaires and an investigator-developed lifecourse indicator. Using data from the Memory and Aging Project, we applied Cox proportional hazard models to evaluate the impact of operationalization on time to outcomes.ResultsHazard ratios, indicating instantaneous risk of AD or death for a standard deviation increase in the CR proxy utilized as a predictor, ranged from 0.80-1.40 for AD diagnosis and 0.80-1.29 for death following diagnosis. Among nine predictors that showed a significant reduction in risk of AD, there was a decrease of between 12% and 20%. Two predictors were associated with reduced risk of death, with 13%-20% reduction, while three predictors were associated with 18%-22% heightened risk of death following diagnosis.ConclusionsModel results were highly sensitive to CR operationalization. Based on the variation in results, composite measures that incorporate multiple lifecourse variables may still be the most comprehensive and faithful representation of CR. Attention to methodology and refining of measurement are needed to make use of CR and promote healthy aging.

Cross-Cultural Adaptation and Spanish Validation of the Computerized Information Processing Assessment Battery (COGNITO)

INTRODUCTION

Mild cognitive impairment (CI) has an exponential increase in its prevalence and causes functional deficits and dependence. Its early detection allows for timely treatment and greater therapeutic efficacy. However, mild cognitive impairment (MCI) is currently underdiagnosed. Although recent decades have seen a rise in computerized instruments for the detection and early diagnosis of MCI, showing numerous advantages over the classic paper-and-pencil methods, such as standardized stimulus presentation. However, their limitations include the use of self-administered application without professional supervision. Few of these instruments have Spanish-adapted versions.

OBJECTIVE

To translate, adapt, and validate the computerized Information Processing Assessment Battery (COGNITO) battery in the Spanish population and to develop a portable administration system that facilitates its application in different settings. COGNITO was then administered to 232 Spanish participants (18-89 years) without cognitive impairment, after which preliminary normative data were obtained.

RESULTS

Strong positive correlations were found between the main cognitive domains assessed by COGNITO and the variables of age, educational level, and MEC score. The gender variable only correlated with visuospatial skills, with men outperforming women. The test-retest correlations conducted after 4 weeks with 89 participants revealed adequate reliability coefficients ranging between.63 and.66 (visuospatial skills = 0.35). Internal consistency coefficients were satisfactory in Attention-Executive Functions and Memory domains.

CONCLUSIONS

The Spanish adaptation of COGNITO shows adequate psychometric characteristics of validity and reliability. The preliminary normative data provided may contribute to the early detection of cognitive impairments associated with both normal aging and various types of neurological pathology. This tool has great utility and versatility for neuropsychological practice.

Cortical activation and functional connectivity in visual-cognitive-motor networks during motor-cognitive exercise

PURPOSE

When compared to computer-based brain training, motor-cognitive exercises and exergaming claim to provide stronger brain activation and better transfer due to the integration of a more complex motor task. To evaluate if this is supported by neural dynamics, this study compared event-related potentials and connectivity between a cognitive and motor-cognitive training task.

METHODS

21 participants performed a choice-reaction task with either an upper extremity button press (cognitive condition) or lower extremity stepping movement (motor-cognitive condition) input using the SKILLCOURT technology. The visual stimulation and cognitive task were identical. In addition to reaction time, neural activity was recorded using a 64-channel EEG system. Time course of neural activation and event-related potential data in visual premotor, primary motor and sensory regions of interest were compared between conditions. In addition, connectivity was calculated to identify differences in functional communication.

RESULTS

Neural engagement was stronger in the motor-cognitive condition as reflected by a higher amplitude (p < 0.001) and longer latency (p = 0.02) of the BA6 negativity potential as well as higher activity in electrodes representing the foot region of the primary motor cortex (p < 0.001). This was accompanied by enhanced connectivity between electrodes covering the premotor cortex and frontal, primary motor and visual areas p < 0.05).

CONCLUSION

The findings suggest that the premotor cortex plays a key role in motor-cognitive training. This supports the assumption of stronger engagement of motor areas in motor-cognitive when compared to cognitive training and shed light on the neural processes that may underly superior training effects when compared to computer-based cognitive training.

The protective role of education in white matter lesions and cognitive decline

Cognitive reserve, often reflected by education, may protect against cognitive decline linked to brain pathology. White matter lesions (WMLs), common in aging, are associated with the progression from healthy cognitive status (HC) to mild cognitive impairment (MCI). This study explores education's role, as a proxy for cognitive reserve, in moderating the relationship between WML burden and the HC to MCI transition. Data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were analyzed for 153 cognitively healthy adults. Participants were divided into two groups: one (n = 85) remained cognitively healthy for at least seven years, while the other (n = 68) progressed to MCI. WML volumes were assessed using MRI scans and analyzed with linear regression models including age, sex, and an intraction term between group status and education to examine moderation effects. Both WM-hyper and WM-hypo showed a similar pattern across analyses. A significant interaction between group and education for both WML types (WM-hyper: β = -0.097, p = 0.047; WM-hypo: β = -0.070, p = 0.037) was found, suggesting that among individuals who progressed to MCI, higher education was associated with lower WML burden.This suggest that education plays a protective role against white matter pathology among individuals at risk for cognitive impairment.

One-Year Changes in Depressive Symptoms and Cognitive Function Among Brazilian Older Adults Attending Primary Care

Background: Aging is a global phenomenon closely associated with changes in cognitive function and mental health. These conditions substantially burden public health systems and adversely affect the quality of life of older adults. This study aimed to examine changes in depressive symptoms and cognitive function over a 12-month follow-up period in a cohort of Brazilian older adults attending primary care. Methods: This observational longitudinal study included a randomized sample of individuals aged ≥60 years residing in São Paulo, Brazil, and registered at a Primary Healthcare Unit (PHU). Data collection involved administering a sociodemographic and health questionnaire along with two validated instruments: the Geriatric Depression Scale-15 (GDS-15) and the Mini-Mental State Examination (MMSE). Linear regression models were used for the analyses. Results: A total of 368 older adults were included, with 63% being men and a mean age of 74.65 years. After one year, depressive symptoms showed a notable increase, with the mean GDS-15 score rising from 5.97 to 7.48 (Cohen-d = 0.542). Likewise, there was a decrease in the mean MMSE score ranging from 19.11 to 18.88 (Cohen-d = 0.216). Adjusted regression analyses revealed that depressive symptoms at baseline (B = 0.696; p = 0.048; R2 = 0.19) and cognitive function at baseline (B = 0.444; p < 0.001; R2 = 0.26) were predictive of their respective deteriorations over the follow-up period. Conclusions: Depressive symptoms and cognitive decline place a significant burden on public health systems in aging societies. These findings underscore the importance of continuous monitoring and early intervention strategies to mitigate their impact and enhance the quality of life for older adults.

Marital Status-Specific Associations Between Multidomain Leisure Activities and Cognitive Reserve in Clinically Unimpaired Older Adults: Based on a National Chinese Cohort

Background: It is unclear how marital status moderates the association between multidomain leisure activities and the progression of cognitive decline in community-dwelling older adults. Methods: Data from the Chinese Longitudinal Healthy Longevity Survey with up to 10 years of follow-up were used. The study included participants aged ≥65 years without cognitive impairment at baseline. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Linear mixed-effect models were used to evaluate the modifying effect of marriage on leisure activities (multiple types, frequency, and single type) and cognitive decline. Results: A total of 5286 participants (aged 79.01 ± 9.54 years, 50.0% women, and 61.4% rural residents) were enrolled. The results indicated that marital status moderates the relationship between leisure activities and cognitive decline. In the unmarried group, multi-type and high-frequency leisure activities were more strongly associated with slower cognitive decline. Specific activities such as gardening, reading, performing household chores, and playing cards were found to significantly contribute to cognitive protection exclusively within the unmarried group, with no such effect observed in the married group. Conclusions: Marital status affects the relationship between participation in multiple leisure activities and cognitive decline in cognitively intact elderly people. For unmarried older adults, regular participation in leisure activities may be an effective intervention.

Association of Alzheimer's disease biomarkers with low premorbid intellectual functioning in a multi-ethnic community-dwelling cohort: A cross-sectional study of HABS-HD

Background: Individuals with intellectual disability (ID) may have a five-fold increased risk for developing Alzheimer's disease (AD). However, studies investigating brain aging among individuals with ID without Down syndrome (DS) are lacking. To begin addressing this gap, our study utilized word reading, a widely recognized indicator of an individual's premorbid intellectual ability (pIQ), to examine the effects of ID without DS on plasma AD biomarker outcomes. Objective: To investigate the relationship between premorbid intellectual ability (pIQ) and plasma AD biomarkers in individuals with ID without DS, while considering ethnic differences in these associations. Methods: Participants from the Health & Aging Brain Study - Health Disparities (HABS-HD) were categorized into low (z ≤ -2.00) or average (z = 0.00 ± 1.00) pIQ groups based on word reading scores. Plasma biomarkers including Aβ40, Aβ42, Aβ42/40, phosphorylated tau 181 (p-Tau181), neurofilament light chain (NfL), and total tau (t-tau) were assayed using Simoa technology. Results: Individuals with low pIQ exhibited significantly higher levels of p-Tau181 (p < 0.05), NfL (p < 0.05), and t-tau (p < 0.05) compared to those with average pIQ. Stratified analysis by ethnicity revealed differential associations, with Hispanic and non-Hispanic White (NHW) participants showing distinct biomarker profiles relative to non-Hispanic Black (NHB) individuals. Conclusions: The findings demonstrate that low pIQ is a reliable factor associated with plasma AD biomarker outcomes. Ethnicity appears to modulate these associations, suggesting complex interactions between factors driving AD susceptibility across diverse populations. This study highlights the importance of considering both pIQ and ethnicity in neurodegenerative processes, particularly in individuals with non-DS intellectual developmental disability.

Neuroprotective mechanisms of exercise and the importance of fitness for healthy brain ageing

Ageing is a scientifically fascinating and complex biological occurrence characterised by morphological and functional changes due to accumulated molecular and cellular damage impairing tissue and organ function. Ageing is often accompanied by cognitive decline but is also the biggest known risk factor for Alzheimer's disease, the most common form of dementia. Emerging evidence suggests that sedentary and unhealthy lifestyles accelerate brain ageing, while regular physical activity, high cardiorespiratory fitness (CRF), or a combination of both, can mitigate cognitive impairment and reduce dementia risk. The purpose of this Review is to explore the neuroprotective mechanisms of endurance exercise and highlight the importance of CRF in promoting healthy brain ageing. Key findings show how CRF mediates the neuroprotective effects of exercise via mechanisms such as improved cerebral blood flow, reduced inflammation, and enhanced neuroplasticity. We summarise evidence supporting the integration of endurance exercise that enhances CRF into public health initiatives as a preventive measure against age-related cognitive decline. Additionally, we address important challenges such as lack of long-term studies with harmonised study designs across preclinical and clinical settings, employing carefully controlled and repeatable exercise protocols, and outline directions for future research.

Mutation spectrum and clinical features of MYORG in Iranian patients with Primary Familial Brain Calcification (PFBC)

INTRODUCTION

Mutations in myogenesis regulating glycosidase (MYORG), result in autosomal recessive (AR) form of Primary Familial Brain Calcification (PFBC) which is a rare neurodegenerative disease. PFBC is characterized by symmetric brain calcifications, particularly in the thalami, cerebellum, basal ganglia, and subcortical white matter. To date, eight genes have been linked with PFBC, however, currently about half of people with PFBC remain without a genetic diagnosis. Among these genes, MYORG, JAM2, CMPK2, and NAA60 are associated with an AR-PFBC. Within AR-PFBCs, the frequency of mutations in MYORG and JAM2 is 13% and 2%, respectively. In this study, we present a comprehensive clinical and genetic analysis of a group of Iranian PFBC patients.

METHODS

Clinical and paraclinical assessments of all patients were done. Whole-exome sequencing was performed for all probands. Candidate variants were confirmed and checked in their family members.

RESULTS

Four homozygous variants in MYORG across four families were identified: two novel variants, c.1727G > A;p.Arg576His and c.1687del;p.The563Glnfs*191, in two families and two known mutations, c.176G > A;p.Gly59Asp and c.1092_1097del;p.Phe365_Asp366del in the remaining two families. A potential SNV/CNV in the PFBC-related genes that causes disease was not detected in one proband.

CONCLUSION

Our study expanded the clinical features and mutation spectrum of MYORG and emphasizes to genetic heterogeneity in different populations. While SLC20A2 mutations are the common cause of PFBC in other populations, MYORG and JAM2 mutations seem to be the main cause of this disease in Iran. This issue could prove to be advantageous in the process of gene prioritization for screening within this specific population.

Bridging two communities: impact of a university reading and writing workshop on older adults

In this study, the impact that a reading and writing workshop had on older adults was examined. Providing opportunities for later-life learning has become increasingly important in Chile as the population continues to age and analyzing their experiences from their own viewpoint is also relevant for their developing opportunities. In this case study, semi-structured interviews were conducted with 10 older female adults who embarked on their first university experience while participating in a workshop focused on improving reading and writing skills. Through reflective thematic analysis, the study identified five main categories and looked into them from a legitimate peripheral participation perspective. The findings showed various personal and social beneficial gains, demonstrating the accountability of the older adults and the general positive impact of the experience.

Examining the effects of extremely low-frequency magnetic fields on cognitive functions and functional brain markers in aged mice

Extremely low-frequency magnetic fields (ELF-MFs) are ubiquitously present in various environments of everyday life. While surveys from the World Health Organization (WHO) have not demonstrated the existence of ELF-MF-induced harmful consequences in healthy subjects, whether older adults are more vulnerable to the effects of residential and occupational ELF-MF exposure, and therefore may be at risk, remains unsettled. Here, we explored this potential health issue by investigating, in aged mice, the effects of chronic exposure to ELF-MFs (50 Hz ELF-MF at 1 mT for 8 h/day, 5 days/week for 12 consecutive weeks) on cognitive functions and expression profile of brain markers typically associated with aggravated aging or the development of Alzheimer`s disease (AD). Sham-exposed mice showed a significant age-related decline in spatial memory functions compared to young adult mice. However, this expected pattern was neither exacerbated nor counteracted by chronic exposure to ELF-MFs. No difference in hippocampal expression of APP-695, Aβ(1-42), S100b and GFAP proteins or in the pTau/Tau ratio was observed between sham- and ELF-MF-exposed aged mice, suggesting that chronic exposure to ELF-MFs does not aggravate aging and associated neuroinflammation, or promote pathological pathways involved in the initiation of AD. Because care should be taken in extrapolating these results to older adults with various comorbidities, applying current exposure limits to existing or new sensitive ELF-MF locations is recommended.

Exosomes derived from human placental mesenchymal stem cells in combination with hyperbaric oxygen therapy enhance neuroregeneration in a rat model of sciatic nerve crush injury

Peripheral nerve damage continues to be a significant challenge in the field of medicine, with no currently available effective treatment. Currently, we investigated the beneficial effects of human placenta mesenchymal stem cells (PMSCs)- derived exosomes along with hyperbaric oxygen therapy (HBOT) in a sciatic nerve injury model. Seventy-five male mature Sprague-Dawley rats were allocated into five equal groups. In addition to the control group that received no intervention, damaged animals were allocated into four groups as follows: crush group, exosome group, HBOT group, and Exo+HBOT group. After the last neurological evaluations, tissue samples (sciatic nerve and dorsal root ganglion (DRG)) at the injury side, as well as spinal cord segments related to the sciatic nerve were collected to investigate histological, immunohistochemical, biochemical, and molecular characteristics. We found that the volume of the sciatic nerve, the thickness of the myelin sheath, the densities of nerve fibers and Schwann cells, the numerical densities of sensory neurons and glial cells in the DRG, as well as the numerical density of motor neurons in the anterior horn of the spinal cord, the levels of antioxidative factors (GSH, SOD, and CAT) in the sciatic nerve, as well as the neurological functions (EMG latency and SFI) in the treatment groups, especially the Exo+HBOT group, were significantly improved compared to the crush group. This is while the numerical density of glial cells in the spinal cord, the levels of an oxidative factor (MDA), and pro-inflammatory cytokines (IL-1β, TNF-α, and IFN- γ) considerably decreased in the treatment groups, particularly the Exo+HBOT group, compared to the crush group. We conclude that co-administration of PMSCs-derived exosomes and HBOT has synergistic neuroprotective effects in animals undergoing sciatic nerve injury.

Performance of older adults in a digital change detection task: The role of heterogeneous education

The influence of education on traditional paper-and-pen cognitive assessments is widely reported. However, a minimal amount of evidence is available regarding the role of education in digital tasks. This study aimed to compare the performance of older adults with different educational attainment in a digital change detection task, as well as to relate their performance on the digital task and traditional paper-based tests. Participants (n = 180) were recruited in primary health care settings from a countryside city in the state of Sao Paulo-Brazil and were assigned to three different groups according to their educational background. Traditional paper-based neuropsychological instruments (i.e., ACE-R, Digit Span, Bells test) were used in addition to a digital change detection task. There was no difference in reaction time on the change detection task between the groups; however, participants with higher educational levels performed better than illiterates or lower education groups. The digital test was correlated to ACE-R total score as well as to its language domain. Our results suggested that the performance in the digital task was different for older adults with heterogeneous educational attainment. Technology is a promising pathway in cognitive assessment, and education should be considered in the interpretation of the results.

Age-invariant approaches to cognitive reserve

Cognitive reserve (CR) and its measurement by proxies have gained interest in cognitive aging research. While CR proxies seem valuable for predicting cognitive function, their measures are often conflated with age effects. The current study aims to address this by introducing an age-invariant approach of CR. We included 380 participants (age = 18-79) from the Advanced Brain Imaging on aging and Memory (ABRIM) study who completed the Cognitive Reserve Index questionnaire (CRIq), a measure to estimate verbal IQ, and several neuropsychological tasks in the domains of memory, executive function and attention/speed. With various regression models and structural equation modeling, we assessed age effects on the CRIq subscales and their predictive value on cognitive function. Results showed a significant non-linear age effect on the Education and Occupation subscale of the CRIq and a linear age effect on the Leisure subscale. New age-corrections derived from these effects were more accurate than age-corrections from the original norm scores. Moreover, the three cognitive domains were significantly predicted in the expected direction by the new age-corrected CRIq scores, and not by the raw scores or original age-corrected scores. However, compared to verbal IQ, the predictive value of these CRIq scores was still low. Associations between the CRIq and cognitive function seemed to vary across the lifespan, but were not consistently stronger for older adults. These findings illustrate the importance of age adjustments in CR research. Most importantly, appropriate age-adjustments may be sample specific and non-linear effects to properly correct for age must be considered.

Smart Digital Solutions for EARLY Treatment of COGNitive Disability (EARLY-COGN^3): A Study Protocol

Background: Healthy cognitive functioning is a primary component of well-being, independence, and successful aging. Cognitive deficits can arise from various conditions, such as brain injury, mental illness, and neurological disorders. Rehabilitation is a highly specialized service limited to patients who have access to institutional settings. In response to this unmet need, telehealth solutions are ideal for triggering the migration of care from clinics to patients' homes. Objectives: The aim of EARLY-COGN^3 will be threefold: (1) to test the efficacy of a digital health at-home intervention (tele@cognitive protocol) as compared to an unstructured cognitive at-home rehabilitation in a cohort of patients with Chronic Neurological Diseases (CNDs); (2) to investigate its effects on the biomolecular and neurophysiological marker hypothesizing that people with CNDs enrolled in this telerehabilitation program will develop changes in biological markers and cortical and subcortical patterns of connectivity; (3) to analyze potential cognitive, neurobiological, and neurophysiological predictors of response to the tele@cognitive treatment. Method: In this single-blind, randomized, and controlled pilot study, we will assess the short- and long-term efficacy of cognitive telerehabilitation protocol (tele@cognitive) as compared to an unstructured cognitive at-home rehabilitation (Active Control Group-ACG) in a cohort of 60 people with Mild Cognitive Impairment (MCI), Subjective Cognitive Complaints (SCCs), or Parkinson's Disease (PD). All participants will undergo a clinical, functional, neurocognitive, and quality of life assessment at the baseline (T0), post-treatment (5 weeks, T1), and at the 3-month (T2) follow-up. Neurophysiological markers and biomolecular data will be collected at T0 and T1. Conclusions: EARLY-COGN^3 project could lead to a complete paradigm shift from the traditional therapeutic approach, forcing a reassessment on how CNDs could take advantage of a digital solution. (clinicaltrials.gov database, ID: NCT06657274).

Investigating Modifiable Factors Associated with Cognitive Decline: Insights from the UK Biobank

Objectives: Given the escalating global prevalence of age-related cognitive impairments, identifying modifiable factors is crucial for developing targeted interventions. Methods: After excluding participants with dementia and substantial missing data, 453,950 individuals from UK Biobank (UKB) were included. Cognitive decline was assessed across four cognitive domains. The top 10% exhibiting the greatest decline were categorized as the "Cognitively At-Risk Population". Eighty-three potential factors from three categories were analyzed. Univariate and multivariate Cox proportional hazards models were employed to assess the independent and joint effects of these factors on cognitive decline. Population Attributable Fractions (PAFs) were calculated to estimate the potential impact of eliminating each risk category. Results: Our findings revealed a significant impact of unfavorable medical and psychiatric histories on processing speed and visual episodic memory decline (Hazard Ratio (HR) = 1.34, 95% CI: 1.20-1.51, p = 6.06 × 10⁻7; HR = 1.50, 95% CI: 1.22-1.86, p = 1.62 × 10⁻4, respectively). Furthermore, PAF analysis indicated that physiological and biochemical markers were the most critical risk category for preventing processing speed decline (PAF = 7.03%), while social and behavioral factors exerted the greatest influence on preventing visual episodic memory decline (PAF = 9.68%). Higher education, socioeconomic status, and handgrip strength emerged as protective factors, whereas high body mass index (BMI), hypertension, and depression were detrimental. Conclusions: By identifying this high-risk group and quantifying the impact of modifiable factors, this study provides valuable insights for developing targeted interventions to delay cognitive decline and improve public health outcomes in middle-aged and older adults.

Cortical excitability and the aging brain: toward a biomarker of cognitive resilience

This perspective article addresses the potential use of cortical excitability (CE) as an indicator of cognitive health in aging people. Changes in CE may be considered a sign of resilience to cognitive decline in old age. The authors describe research on CE and its link to cognitive function in older adults and emphasize that it is a promising, non-invasive measure of healthy aging. They also address the current challenges in its implementation, the need for standardized measurement protocols and possible future avenues of research. If properly considered, CE could pave the way for early detection of cognitive decline and facilitate targeted interventions to promote cognitive resilience.

Carotid revascularization improves cognition in patients with carotid stenosis

Patients with atherosclerosis in the carotid arteries are at risk of ischemic stroke and cognitive decline due to emboli and chronic hypoperfusion of brain tissue. Revascularization procedures improve cerebral hemodynamics, which has some effect on cognitive function. Some authors suggest that the presence of stenosis in the carotid arteries is an independent factor influencing cognitive decline. The aim of this study was to investigate the relationship between the degree of stenosis of a stented carotid artery and attentional performance in individuals with carotid atherosclerosis. A prospective longitudinal study was conducted at a single center involving patients during cardiology hospitalization (T-1) and 1 year after hospital admission (T-2) for invasive treatment of carotid stenosis. The attention D2 test by R. Brickenkamp was used. The study showed that a critical degree of internal carotid artery stenosis is associated with poorer attentional performance in individuals undergoing carotid artery stenting. However, the ability to concentrate improved one year after the procedure in all groups of patients who underwent carotid artery stenting, regardless of the degree of internal carotid artery stenosis. It was also found that the side of the vasoconstriction (right/left) in patients with atherosclerosis in the carotid arteries has no influence on cognitive functions in relation to attention.

Investigating dynamic brain functional redundancy as a mechanism of cognitive reserve

Introduction

Individuals with higher cognitive reserve (CR) are thought to be more resilient to the effects of age-related brain changes on cognitive performance. A potential mechanism of CR is redundancy in brain network functional connectivity (BFR), which refers to the amount of time the brain spends in a redundant state, indicating the presence of multiple independent pathways between brain regions. These can serve as back-up information processing routes, providing resiliency in the presence of stress or disease. In this study we aimed to investigate whether BFR modulates the association between age-related brain changes and cognitive performance across a broad range of cognitive domains.

Methods

An open-access neuroimaging and behavioral dataset (n = 301 healthy participants, 18-89 years) was analyzed. Cortical gray matter (GM) volume, cortical thickness and brain age, extracted from structural T1 images, served as our measures of life-course related brain changes (BC). Cognitive scores were extracted from principal component analysis performed on 13 cognitive tests across multiple cognitive domains. Multivariate linear regression tested the modulating effect of BFR on the relationship between age-related brain changes and cognitive performance.

Results

PCA revealed three cognitive test components related to episodic, semantic and executive functioning. Increased BFR predicted reduced performance in episodic functioning when considering cortical thickness and GM volume as measures of BC. BFR significantly modulated the relationship between cortical thickness and episodic functioning. We found neither a predictive nor modulating effect of BFR on semantic or executive performance, nor a significant effect when defining BC via brain age.

Discussion

Our results suggest that BFR could serve as a metric of CR when considering certain cognitive domains, specifically episodic functioning, and defined dimensions of BC. These findings potentially indicate the presence of multiple underlying mechanisms of CR.

Moderation of midlife cognitive activity on tau-related cognitive impairment

INTRODUCTION

We investigated the moderating effects of midlife and late-life cognitive activity (CA) on the relationship between tau pathology and both cognition and cognitive decline.

METHODS

Eighty-nine non-demented older adults from a Korean cohort underwent comprehensive evaluations, including CA assessments and tau neuroimaging at baseline, and Mini-Mental State Examination (MMSE) at baseline and the 2-year follow-up.

RESULTS

Greater midlife CA was associated with higher MMSE scores in a given amount of tau pathology, whereas higher levels of midlife CA were associated with faster tau-related decline in MMSE scores, particularly in individuals with mild cognitive impairment. Late-life CA did not exhibit any interaction with tau on either MMSE scores or their 2-year change.

DISCUSSION

Greater midlife CA is generally associated with better cognitive performance despite the presence of tau pathology. However, paradoxically, increased midlife CA appears to be linked to a more rapid tau-related cognitive decline in already cognitively impaired individuals.

HIGHLIGHTS

Greater midlife cognitive activity (CA) was generally associated with better cognitive performance in a given amount of tau pathology. Paradoxically, higher levels of midlife CA were related to a more rapid tau-related cognitive decline in already cognitively impaired individuals. Late-life CA did not exhibit any moderation effect on the association between tau and cognitive performance or decline.

The impact of cognitive reserve relative to risk of Alzheimer's disease and rate of progression: an up-to-date review of the literature

INTRODUCTION

Cognitive reserve (CR) is a crucial factor in explaining individual differences in the risk of Alzheimer's disease (AD) and cognitive decline. CR refers to the brain's ability to cope with pathology through compensatory mechanisms. This review examines the various methods used to measure, predict, and influence CR.

AREAS COVERED

Based on a search of PubMed, PubMed Central, EMBASE, Scopus, and the Cochrane Library (up to 1 June 2024), this review addresses key CR proxies, highlighting their strengths and limitations. The review also explores established and emerging interventions. We critically evaluate the statistical methods used to measure CR and assess its practical application.

EXPERT OPINION

CR plays a crucial role in delaying the onset and progression of AD. Lifestyle choices and experiences build CR and impact cognitive aging. However, practical challenges remain in applying CR in clinical settings, particularly in individuals with advanced cognitive decline. Education, while commonly used as a proxy for CR, may not fully capture its complexity. Alternatives like occupational complexity could offer more practical measures, but their application is still evolving. Addressing these limitations is key to advancing dementia prevention strategies.

Determinants of cognitive health in the elderly: a comprehensive analysis of demographics, health status, and lifestyle factors from NHANES

This study analyzes data from the National Health and Nutrition Examination Survey (NHANES) to identify factors influencing cognitive performance among the elderly, as measured by the Digit Symbol Substitution Test (DSST). Employing multivariable linear regression, we evaluated the impact of demographic, lifestyle, and health-related factors on cognitive function in U.S. adults aged 60 and older. Our findings indicate that advanced age, particularly in those aged 70-79 and 80 + years, is associated with lower DSST scores. Male gender is linked with reduced cognitive performance, while higher educational attainment appears protective. Lifestyle factors, including current smoking and higher alcohol consumption, negatively impact cognitive outcomes, and excessive sleep duration (over 9 h) is also detrimental. Among health conditions, diabetes, chronic heart failure, and a history of stroke were associated with cognitive declines. Furthermore, increasing severity of depression correlates with lower cognitive function. These results underline the need for comprehensive public health strategies that integrate lifestyle modifications and chronic disease management to maintain cognitive health in older adults.

Life Course Patterns of Work History and Cognitive Trajectories Among Community-Dwelling Older Adults

OBJECTIVES

Prior research indicated that diverse work experiences in early and middle life stages are associated with cognitive function in later life. However, whether life course patterns of work history are associated with later life cognitive function in China remains unknown.

METHODS

Data were derived from the China Health and Retirement Longitudinal Study, and 5,800 participants aged 60 years or older were included. We used sequence analysis to identify the work history patterns between ages 18 and 60. Growth curve modeling was performed to evaluate how the work-history patterns are associated with global and domain-specific (i.e., mental intactness and episodic memory) cognitive function.

RESULTS

We identified 8 work patterns, distinguished by duration, transitions, timing, and sequence of work history. Compared with individuals exposed to lifelong agricultural work, those engaged in lifelong nonagricultural employed work had better cognitive function in later life and experienced slower rates of cognitive decline in both global cognitive function and the mental intactness domain. In addition, individuals who shifted from agricultural to nonagricultural employed work early (around age 30) had better global cognitive function in later life, whereas the association was not significant for such a transition later (around age 50).

DISCUSSION

Our study highlights the importance of the duration, sequence, and timing of transitions in work history for cognitive health among older Chinese. Future interventions and policies aimed at improving cognitive function should fully consider the cumulative and dynamic nature of work from a life course perspective.

Adaptation, construct validity, and test-retest reliability of the Cognitive Reserve Index Questionnaire for the Israeli multiple sclerosis population

INTRODUCTION

A common tool used to measure cognitive reserve is the Cognitive Reserve Index questionnaire (CRIq). In the present study, we aimed to adapt and determine the psychometric properties (validity and intra-rater test-retest reliability) of the Hebrew version of the CRIq in a cohort of people with multiple sclerosis (pwMS).

METHODS

Fifty pwMS (30 women aged 48.3 (SD=10.2)) completed the CRIq and the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), which were used for validation. Secondary outcome measures included the evaluation of depression, anxiety, and perceived fatigue. Twenty-five (of the 50) pwMS were randomly selected and participated in the CRIq intra-rater test-retest reproducibility study based on a 7-12-day interval between tests.

RESULTS

The mean CRIq total was 101.8 (S.D.=13.04), which is considered at the medium level. The CRIq section scores were at a similar medium level. According to Pearson's Rho correlation analysis, the CRIq total score and sections of education, work, and leisure were significantly correlated at a medium level (Rho ranging between 0.282 to 0.415) with the SDMT score, a measurement of cognitive information processing speed. The intraclass correlation coefficient (ICC) values of the CRIq total and CRIq sections ranged between 0.942 to 0.998, indicating a strong correlation.

CONCLUSIONS

The Hebrew version of the CRIq is a reliable and valid tool for assessing cognitive reserve in pwMS, hence enabling clinicians and researchers to effectively monitor cognitive reserve in this population.

The Role of Education and English Proficiency in Cognitive Health Among Older Refugee Populations in the United States

Cognitive impairment is pronounced in forcibly displaced populations. This study examined how education and English proficiency are associated with cognitive difficulties between refugee and non-refugee older immigrants. Analyses assessed the moderating effect of refugee status on the association of education and English proficiency with cognitive difficulty. Results revealed that higher educational attainment and English proficiency were significantly associated with decreased odds of reporting cognitive difficulty. Further, refugees who had completed high school and were English proficient exhibited greater cognitive resilience. The implications emphasize the need for policies and focused interventions related to education and English language programs for resettled refugees.

Long term effects of severe acquired brain injury: A follow-up investigation on the role of cognitive reserve on cognitive outcomes

In a recent study we showed that Cognitive Reserve (CR) did not significantly predict the neuropsychological outcomes of patients with severe Acquired Brain Injury (sABI), after a rehabilitation program. The present study aims to extend the previous results by assessing the role of CR on long-term neuropsychological outcomes of a subgroup (N = 27) of that same population. Patients took part in a telephone interview, where Tele-Global Examination Mental State (Tele-GEMS) and Glasgow Outcome Scale Extended (GOS-E) were administered. A linear regression model was conducted considering Tele-GEMS and GOS-E as dependent variables, while the scores on Cognitive Reserve Index questionnaire (CRIq), Disability Rating Scale (DRS), and Level of Cognitive Functioning (LCF), administered at discharge, were considered as predictors. Results show that higher levels of CR and LCF, significantly predicted cognitive performance 4 years later. However, in the same follow-up, CR did not predict functional outcome, which was only predicted by lower disability scores at discharge. Thus, even if CR seems not showing an effect on cognitive efficiency when tested after the first rehabilitation intervention, current results show that CR has significant effects on long-term cognitive outcomes.

The importance of non-pharmacological interventions to improve cognitive reserve prior to the administration of a drug against the causative agent of Alzheimer's disease

Lecanemab, an antibody drug targeting amyloid-β, has been approved to treat Alzheimer's disease (AD) in the United States and Japan recently. However, there are several concerns about Lecanemab, such as its minimum biological effects, possible side effects, and its economic burden. On the other hand, non-pharmacological approach without major side effects has a potential to alleviate the symptoms of AD by improving cognitive reserve, which is individual's resilience to AD pathology. It is important to compare the benefits and risks of pharmacological and non-pharmacological approaches, especially in the oldest old with AD, to give priority to the safe and cost-effective approach.

Lifestyle and Environment Influence the Psychological Well-Being of Elderly Subjects in Italy

BACKGROUND/OBJECTIVE

Aging is associated with both cognitive and physical decline. Some factors, such as lifestyle and environment, can significantly contribute to accelerating or slowing down the decline processes. Our study aimed to evaluate the impact of lifestyle (active vs. non-active) and environmental context (institutionalized vs. non-institutionalized) on the cognitive functioning, psychological well-being, sleep quality, and daily living skills of elderly people.

METHODS

Our sample consisted of 182 subjects divided into active and non-active groups (subjects who engage or not in physical and social activities, respectively; mean age in years: 67.19 vs. 68.75) and 245 subjects divided into institutionalized and non-institutionalized groups (i.e., living in a nursing home or not, respectively; mean age in years: 79.49 vs. 71.72). Participants were enrolled voluntarily and randomly in the city of L'Aquila. A battery of psychological instruments was administered to evaluate general cognitive decline, depressive symptoms, self-assessed sleep quality, and daily living skills.

RESULTS

Regarding lifestyle, the active group exhibited significantly lower levels of depression, better sleep quality, and daily living skills with respect to the non-active group. Regarding environmental context, institutionalized subjects showed higher levels of depression and reduced cognitive functioning, which were linked to reduced sleep quality and worsened daily living skills. When comparing the non-active with the institutionalized group, the latter showed higher levels of depression and reduced cognitive functioning, more sleep complaints, and reduced daily living skills.

CONCLUSIONS

Our study highlights that an active lifestyle and a non-institutionalized environment, both allowing greater mobility and autonomy, are two factors that positively contribute to the mental and physical well-being of elderly individuals. Furthermore, the healthcare institution context appears to have a greater negative impact on the psycho-physical well-being of the subjects involved compared to a non-active lifestyle.

Childhood maltreatment, cognitive performance, and cognitive decline in middle-aged and older adults with chronic disease: A prospective study

OBJECTIVES

Childhood maltreatment (CM) may increase the risk for cognitive deficits and dementia later in life. However, most research has been cross-sectional in nature, has typically focused on specific types of CM, and rarely examined individual differences. The objectives are to evaluate 1) if CM predicts poorer cognitive performance and greater cognitive decline over a 5-year follow-up in older men and women with coronary artery disease (CAD) or other non-cardiovascular (non-CVD) chronic disease, and whether 2) sex and CAD status influence these relations.

METHODS

Men and women (N = 1254; 39.6 % women; 65.6 ± 7.0 years old) with CAD or other non-CVD chronic diseases completed the Childhood Trauma Questionnaire Short Form (CTQ-SF). The Montreal Cognitive Assessment (MoCA) was administered twice at 5-year intervals. Main analyses included bivariate correlations, hierarchical analyses and moderation analyses controlling for sociodemographic and health parameters.

RESULTS

CM was experienced by 32 % of the sample, while scores suggestive of cognitive deficits were obtained by 32.7 % and 40.2 % at study onset and follow-up, respectively. CM was associated with significantly lower MoCA scores at study onset (b = -0.013, p = 0.020), but not with change in MoCA over time (b = -0.002, p = 0.796). While MoCA scores did differ as a function of sex and CAD status, the latter did not influence the relations between maltreatment and MoCA.

CONCLUSIONS

CM predicted poorer cognitive functioning among older individuals with chronic diseases but did not play a role in any further cognitive decline over the follow-up period. Further research is needed to help understand the mechanisms implicated.

The Role of Cognitive Reserve in Post-Stroke Rehabilitation Outcomes: A Systematic Review

Background/Objectives: Stroke remains a major cause of disability and death, with survivors facing significant physical, cognitive, and emotional challenges. Rehabilitation is crucial for recovery, but outcomes can vary widely. Cognitive reserve (CR) has emerged as a factor influencing these outcomes. This systematic review evaluates the role of CR in post-stroke rehabilitation, examining whether higher CR is associated with better outcomes. Methods: A systematic search of PubMed, Google Scholar, Scopus, and Cochrane Library databases was conducted for studies published between 2004 and 2024. Studies examining social-behavior CR proxies (e.g., education, bilingualism) and their impact on post-stroke outcomes were included. Data were analyzed using descriptive statistics. The study quality was assessed using the Methodological Index for NOn-Randomized Studies (MINORS) scale. Results: Among 3851 articles screened, 27 met the inclusion criteria. Higher education levels, bilingualism, and engagement in cognitively stimulating activities were associated with better cognitive outcomes and functional recovery. Lower socioeconomic status (SES) correlated with poorer outcomes. Early rehabilitation and dynamic CR proxies showed stronger associations with cognitive recovery than static ones. Conclusions: CR may predict post-stroke rehabilitation outcomes, with education, bilingualism, and active engagement in cognitive activities showing potential benefits. Future research should explore CR's role alongside factors like lesion location and severity in enhancing recovery.

Effects of self-rated mental and physical work demands on cognition are dependent in a cross-sectional sample of the Health and Retirement Study

Objective

This study assessed whether self-rated physical and mental work demands were associated with cognition among older working adults and whether their effects were dependent.

Methods

Our cross-sectional sample consisted of 6,377 working older adults uisng the Health and Retirement Study in 2004. Self-rated work demands were summarized from four questions about frequency of mental or physical demands in the respondent's current job. Cognition was assessed using a subset of the Telephone Interview for Cognitive Status. We used multivariable linear regression to test for associations and additive interaction between physical and mental work demands and cognition, adjusted for age, sex, race, education, and practice effect.

Results

Independently, higher physical work demands were associated (P<0.001) with poorer cognition and higher mental work demands were associated (P<0.001) with better cognition. The effect of one work demand measure became more negative as level of the other increased (B for interaction = -0.23, 95% CI: -0.43, -0.03). A one-point increase in mental work demands was associated with 0.79 (95% CI: 0.51, 1.08) points higher cognition score when physical work demands were lowest, but was not associated with cognition when physical work demands were highest (0.11, 95% CI: -0.26, 0.48). The highest predicted cognition score was for the highest mental and lowest physical work demands. Results were robust to additional adjustment for health and behavior covariates.

Conclusions

The associations of self-rated mental and physical work demands on cognition are dependent. Future studies should strongly consider examining interactions to capture the range of work demand effects.

Impact of social wellbeing on tooth loss and cognition: A scoping review

OBJECTIVE

The proposed explanations for the association between tooth loss and cognitive function have largely focused on systemic inflammation, mechanoreceptor feedback, and nutritive deficiencies. However, the role of social wellbeing in this relationship remains unknown. The aim of this scoping review is to explore the pathways linking different aspects of social function, collectively grouped under the umbrella of social wellbeing, to tooth loss and cognitive impairment.

DATA AND SOURCES

An electronic database search was performed in PubMed, Scopus, and Embase. Reference lists of relevant articles were also searched. Data on the associations between social wellbeing, cognitive function and tooth loss was charted in an extraction form and summarised qualitatively.

STUDY SELECTION

From the initial search of 3293 records, 71 studies were included in the present review. Forty-seven studies investigated the relationship between social wellbeing and cognition, 21 studies investigated the relationship between social wellbeing and tooth loss, and only 3 studies investigated all three variables.

CONCLUSION

This review demonstrates the need for further research on tooth loss, cognition and social wellbeing in tandem and describes potential psychological, biological, cognitive, and behavioural mechanisms interlinking these factors. While substantial evidence was found for the association between social relationships and cognition, fewer studies explored the potentially bidirectional relationship of social wellbeing and tooth loss.

CLINICAL SIGNIFICANCE

The implications of this review may guide clinicians to focus on the social consequences of tooth loss, which may have broader repercussions on cognitive health. The role of social support in helping older people cope with oral disease and the benefits of fostering positive lifestyle habits should not be underestimated.

Socio-cognitive mindfulness predicts memory complaint and cognitive performance of older adults with different years of education

BACKGROUND

Even though the effect of education on cognitive performance has been widely reported, the relationship between socio-cognitive mindfulness, cognitive performance, and memory complaint among the elderly with heterogeneous educational levels has not yet been investigated.

AIM

This study aimed to analyze the potential relationship between cognitive performance, memory complaint, and socio-cognitive mindfulness in a sample of healthy older adults with different years of education.

METHODS

In this quantitative, cross-sectional, observational, and analytical study, participants (n = 68) were assessed with a sociodemographic questionnaire, cognitive performance test (ACE-III), levels of socio-cognitive mindfulness (LSM-21), and memory complaint (Memory Complaint Scale). Descriptive statistics, as well as Pearson's correlation, and linear regression analysis were performed, and significance was assumed if p < .05.

RESULTS

Years of education correlated with cognitive performance and socio-cognitive mindfulness, but not with memory complaint. Socio-cognitive mindfulness had a positive correlation with cognitive performance and a negative correlation with memory complaint. Also, socio-cognitive mindfulness predicted cognitive performance and memory complaint both in bivariate analysis and when controlling for years of education.

CONCLUSION

Our findings suggested that older adults with higher levels of socio-cognitive mindfulness showed better cognitive performance and less memory complaint.

Performance Under Fire: Older Adult Cognitive Risks and Protections Under Heat Strain

BACKGROUND AND OBJECTIVES

Although extreme heat events disproportionately affect older adults and the importance of cognition is known, research examining older adult cognition under heat stress is limited. This study examines the relationship between risk/protective factors and heat strain on older adult cognition, employing a social-ecological model.

RESEARCH DESIGN AND METHODS

Retrieved from the 1996-2016 waves of the Health and Retirement Study, our study used older adults aged 50 and older and their spouses residing in the United States. Individual-fixed effects models estimated changes in cognition as measured by fluid and crystallized intelligence scores in response to extreme heat days. This study further estimated interactions of extreme heat with protective/risk factors for cognition (i.e., education, physical activity, social engagement, and genetic risk for Alzheimer's disease).

RESULTS

Our results demonstrated that extreme heat days were associated with fluid but not crystallized intelligence scores. Educational attainment, mild physical activity, and social contacts with children moderated this relationship. Furthermore, Alzheimer's disease polygenic scores moderated the correlation between extreme heat days and crystallized intelligence scores.

DISCUSSION AND IMPLICATIONS

An increasing frequency of extreme heat events and an aging population globally highlight the need for policies and interventions building resiliency in older adults. Actions promoting the protective modifiable behaviors to older adult cognition identified by our study can lead to healthier individuals and communities.

Effects of (pre)frailty and cognitive reserve on mild cognitive impairment among community-dwelling older adults

OBJECTIVE

We aimed to identify the effect of lifespan cognitive reserve and (pre)frailty on mild cognitive impairment (MCI) among older adults.

MATERIALS AND METHODS

A total of 4420 older adults aged above 60 with intact cognition recruited in 2011/2012 were followed up in 2015 from the China Health and Retirement Longitudinal Study (CHARLS). The assessment of MCI was based on executive function, episodic memory, and visual-spatial ability. (Pre)frailty was assessed by the validated version of the Fried physical frailty phenotype scale. The lifespan cognitive reserve consisted of the highest educational level, occupational complexity, and participation in leisure activities. Modified Poisson regression models were used to identify the risk of MCI in relation to (pre)frailty and lifespan cognitive reserve index. We examined the interactions of (pre)frailty and lifespan cognitive reserve index on both additive and multiplicative scales.

RESULTS

Baseline (pre)frailty significantly increased the risk of MCI after 3-4 years of follow-up, and high cognitive reserve protected individuals from the risk of MCI. There was an additive interaction between (pre)frailty and the low lifespan cognitive reserve (the relative excess interaction risk=1.08, 95 % CI= 0.25-1,91), but no multiplicative interaction (RR=0.95, 95 % CI= 0.67-1.37). The risk of MCI was larger among older adults with comorbid (pre)frailty and low cognitive reserve than those with each condition alone.

CONCLUSION

Cognitive reserve attenuates the risk of MCI associated with (pre)frailty. This finding implicates the urgency for identifying and managing MCI among frail older adults who accumulate low cognitive reserve in the life course.

Analysis of the effectiveness of a computerized cognitive stimulation program designed from Occupational Therapy according to the level of cognitive reserve in older adults in Primary Care: Stratified randomized clinical trial protocol

Normal aging presents subtle cognitive changes that can be detected before meeting the criteria for Mild cognitive impairment (MCI). Older people with low cognitive reserve and who receive limited cognitive stimulation are at greater risk of deterioration. In this regard, cognitive stimulation (CS) has been identified as an intervention that reduces this risk, provided that its design takes into account the differences in the level of cognitive reserve (CR) acquired throughout life and the baseline level of cognitive functioning. The general objective of this study is to evaluate, through a randomized clinical trial, the effectiveness of a computerized cognitive stimulation program, designed and adapted from Occupational Therapy based on the level of cognitive reserve in older adults in Primary Care. 100 participants will be randomized in a stratified manner according to the level of cognitive reserve (low/moderate/high), assigning 50 participants to the control group and 50 participants to the intervention group. The intervention group will carry out a computerized cognitive stimulation intervention designed and adapted from occupational therapy according to the level of cognitive reserve, through the "stimulus" platform. The main result expected to be achieved is the improvement of higher brain functions. As secondary results, we expect that those cognitive aspects most vulnerable to aging will decrease more slowly (in areas such as memory, executive function, attention and processing speed), and that the cognitive reserve of the participants will increase, in addition to being able to balance gender differences in these aspects. We think that these results can have a positive impact on the creation of adapted, meaningful and stimulating CS programs in older adults to prevent MCI and experience healthier aging.

Sedentary Lifestyle Is a Modifiable Risk Factor for Cognitive Impairment in Patients on Dialysis and after Kidney Transplantation

Background: Chronic kidney disease (CKD) is a risk factor for cognitive impairment (CI), and this risk is the highest in patients with end-stage kidney disease (ESKD). As a multifactorial disease, CI may be influenced by several potentially modifiable lifestyle and behavioral factors that may reduce or increase the risk of dementia. The aim of this study was to evaluate the associations between the known modifiable risk factors for dementia and the risk of CI in patients with ESKD treated with renal replacement therapy. The Charlson Comorbidity Index and the risk of CI in patients with ESKD were also assessed. Methods: In this cross-sectional study, 225 consecutive patients with ESKD treated with different modalities of renal replacement therapy were assessed for cognitive decline using the Addenbrooke's Cognitive Examination (ACE III) test. Information was also collected on modifiable risk factors for dementia, medical history and demographics. Results: This study included 117 patients after kidney transplantation (KT) and 108 patients with ESKD undergoing peritoneal dialysis and hemodialysis. The prevalence of modifiable risk factors for dementia differed between the groups; KT patients were more likely to be physically active, residing in cities with populations of less than 500,000 inhabitants, and were less likely to suffer from depression. Furthermore, the KT group had a lower Charlson Comorbidity Index score, indicating less severe comorbidities, and a lower risk of CI (3.6 ± 1.67 vs. 5.43 ± 2.37; p = 0.001). In both the KT and dialysis groups, patients with CI were more likely to have a sedentary lifestyle (45% vs. 9%, p = 0.001 and 88% vs. 48%, p = 0.001, respectively), whereas lower educational attainment and depression had a significant negative impact on ACE III test results, but only in KT patients. Finally, cognitive function in dialysis patients was negatively affected by social isolation and living in urban areas. Conclusions: Modifiable risk factors for dementia, particularly a sedentary lifestyle, are associated with a higher risk of CI in patients treated with different renal replacement therapy modalities. As CI is an irreversible condition, it is important to identify lifestyle-related factors that may lead to dementia in order to improve or maintain cognitive function in patients with ESKD.

Ketone body metabolism and cardiometabolic implications for cognitive health

Cardiometabolic complications of obesity present a growing public health concern and are associated with poor outcomes, mediated in part by an increased risk for cardiovascular disease, metabolic dysfunction-associated fatty liver disease, and systemic insulin resistance. Recent studies support that both insulin resistance and obesity are also associated with aberrant brain metabolism and cognitive impairment similar to what is observed in neurodegenerative diseases. Central to these pathological outcomes are adverse changes in tissue glucose and ketone body metabolism, suggesting that regulation of substrate utilization could be a mechanistic link between the cardiometabolic outcomes of obesity and the progression of cognitive decline. Here, we review ketone body metabolism in physiological and pathological conditions with an emphasis on the therapeutic potential of ketone bodies in treating cardiometabolic diseases and neurodegenerative diseases that lead to cognitive decline. We highlight recent findings in the associations among cardiometabolic disease, ketone body metabolism, and cognitive health while providing a theoretical framework by which ketone bodies may promote positive health outcomes and preserve cognitive function.

Cognitive impairment in young and middle-aged patients with acute heart failure

AIMS

This study aimed to investigate the prevalence, risk factors and prognostic implications of cognitive impairment in young and middle-aged patients with acute heart failure (HF).

METHODS

In a prospective cohort of patients with acute HF, we assessed cognitive function by the Mini-Cog, predictors of the cognitive impairment and its associations with 30 day and 1 year cardiovascular death or HF rehospitalization among young and middle-aged patients (<65 years old).

RESULTS

Among 1958 young and middle-aged patients, the prevalence of cognitive impairment was 19.6%. Predictors of cognitive impairment included older age, females, lower education levels and prior strokes. Compared with patients having normal cognitive function, cognitive impairment was associated with a higher risk of 30 day cardiovascular death or HF rehospitalization [hazard ratio (HR), 1.52, 95% confidence interval (CI), 1.07-2.17, P = 0.02], but not for 1 year cardiovascular death or HF rehospitalization (HR, 1.06, 95% CI, 0.87-1.30, P = 0.55).

CONCLUSIONS

Cognitive impairment is present in a notable proportion of young and middle-aged patients with acute HF and is associated with an increased risk of short-term adverse outcomes. Strategies for screening and intervention for cognitive impairment at a younger age are necessary, particularly for those at high risk.

Aging and cognitive resilience: Molecular mechanisms as new potential therapeutic targets

As the global population ages, the need to prolong lifespan and healthspan becomes increasingly imperative. Understanding the molecular determinants underlying cognitive resilience, together with changes during aging and the (epi)genetic factors that predispose an individual to decreased cognitive resilience, open avenues for researching novel therapies. This review provides a critical and timely appraisal of the molecular mechanisms underlying cognitive resilience, framed within a critical analysis of emerging therapeutic strategies to mitigate age-related cognitive decline. Significant insights from both animals and human subjects are discussed herein, directed either toward active pharmaceutical ingredients (drug repositioning or macromolecules), or, alternatively, advanced cellular therapies.

Pomegranate polyphenol punicalagin as a nutraceutical for mitigating mild cognitive impairment: An overview of beneficial properties

Dementia treatment has become a global research priority, driven by the increase in the aging population. Punicalagin, the primary polyphenol found in pomegranate fruit, exhibits a variety of benefits. Today, a growing body of research is showing that punicalagin is a nutraceutical for the prevention of mild cognitive impairment (MCI). However, a comprehensive review is still lacking. The aim of this paper is to provide a comprehensive review of the physicochemical properties, origin and pharmacokinetics of punicalagin, while emphasizing the significance and mechanisms of its potential role in the prevention and treatment of MCI. Preclinical and clinical studies have demonstrated that Punicalagin possesses the potential to effectively target and enhance the treatment of MCI. Potential mechanisms by which punicalagin alleviates MCI include antioxidative damage, anti-neuroinflammation, promotion of neurogenesis, and modulation of neurotransmitter interactions. Overall, punicalagin is safer and shows potential as a therapeutic compound for the prevention and treatment of MCI, although more rigorous randomized controlled trials involving large populations are required.

Examining the alignment between subjective effort and objective force production

Ratings of Perceived Exertion (RPE) are frequently used to prescribe exercise intensity. A central assumption of using RPE scales is that the subjective perception of effort maps onto objective performance in a consistent way. However, the degree and shape of how RPE aligns with objective performance is not fully understood. Here, we investigate the degree and shape of alignment, as well as how time (i.e., how frequently an effort needs to be performed) and mental effort (i.e., if one has to invest mental effort and physical effort) correspond with the alignment. In a randomized within-subjects experiment, we used a grip-to-scale method that asked participants (N = 43) to repeatedly squeeze a handgrip dynamometer with four to-be-produced RPE target levels relative to their subjective maximum strength (representing 20%, 40%, 60%, or 80%). We found that the RPE-force alignment was not the same across RPE-levels: Whereas subjective differences from 20-40% and 40-60% were met by comparable differences in produced force, a substantially larger difference was observed for the 60-80% interval. Interestingly, exploratory post-hoc analyses revealed that this was mirrored by an increase in variance at the higher effort levels. In addition, at constant RPE-levels, participants produced less force over time, and this effect was more pronounced at lower RPE target levels. Lastly, anticipating mental effort after the physical effort slightly altered the alignment as a function of the to-be-produced RPE-level and experimental duration. Taken together, our results indicate that the mapping of perceived effort on objective performance is intricate, and several factors affect the degree and shape of how RPE and performance align. Understanding the dynamic adjustment of RPE-performance alignment across different RPE levels is particularly relevant for contexts that use RPE as a tool for training load prescription.

Association of birthweight and risk of incident dementia: a prospective cohort study

Given the epidemiological studies investigating the relationship between birthweight and dementia are limited. Our study aimed to explore the association between birthweight and the risk of dementia, cognitive function, and brain structure. We included 275,648 participants from the UK Biobank, categorizing birthweight into quartiles (Q1 ≤ 2.95 kg; Q2 > 2.95 kg, ≤ 3.32 kg; Q3 > 3.32 kg, ≤ 3.66 kg; Q4 > 3.66 kg), with Q3 as the reference. Cox regression models and restricted cubic splines estimated the relationship between birthweight and the risk of all causes of dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VD). Multivariable linear regression models assessed the relationship between birthweight, cognitive function, and MRI biomarkers. Over a median follow-up of 13.0 years, 3103 incident dementia cases were recorded. In the fully adjusted model, compared to Q3 (> 3.32 kg, ≤ 3.66 kg), lower birthweight in Q1 (≤ 2.95 kg) was significantly associated with increased risk of ACD (HR = 1.18, 95%CI 1.06-1.30, P = 0.001) and VD (HR = 1.32, 95%CI 1.07-1.62, P = 0.010), but no significant association with AD was found. Continuous birthweight showed a U-shaped nonlinear association with dementia. Lower birthweight was associated with worse performance in cognitive tasks, including reaction time, fluid intelligence, numeric, and prospective memory. Additionally, certain brain structure indices were identified, including brain atrophy and reductions in area, thickness, and volume of regional subcortical areas. Our study emphasizes the association between lower birthweight and increased dementia risk, correlating cognitive function and MRI biomarkers of brain structure, suggesting that in utero or early-life exposures might impact cognitive health in adulthood.

Can neurodevelopmental disorders influence the course of neurodegenerative diseases? A scoping review

This scoping review aims at giving an overview of the possible influence of neurodevelopmental disorders (NDDs) on cognitive-behavioral neurodegenerative diseases (CBNDs). Based on the PRISMA-ScR checklist, it details the methods of NDDs screening, the identified NDDs-CBNDs associations, as well as the criteria and types of association. The last literature search was performed in June 2023. In the final study, 32 articles were included. Analysis first showed that NDDs were mainly detected through medical records screening. Second, the association of specific learning disorders and major or mild neurocognitive disorder due to Alzheimer's disease was the most investigated. Third, associations were mostly based on prevalence comparisons. Finally, 66 % of studies reported a positive association between NDDs and CBNDs. Notably, up to 67 % of positive associations were observed with atypical forms of certain CBNDs. Authors' interpretations suggest that NDDs could constitute a risk factor for CBNDs. However, the influence of NDDs on CBNDs still lacks evidence and biological support, possibly due to the heterogeneity of methods and criteria employed. Developing validated assessment tools for all NDDs and conducting cohort studies could be beneficial for research, and clinical practice. Indeed, this review also underlines the importance of adopting a life-span approach regarding CBNDs.

A 32-Month Follow-Up Study of the Effect of APOE ε4 on the Whole Brain Connection in Young Healthy Individuals

APOE ε4 is risk for cognitive decline even in normal aging, but its effect on the whole-brain functional connectivity (FC) among time in young adults remain elusive. This study aimed to validate the time-by-APOE ε4 interaction on brain FC of this specific population. Longitudinal changes in neuropsychological assessments and resting-state functional magnetic resonance imaging in 26 ε4 carriers and 26 matched non-ε4 carriers were measured for about 3 years. Whole-brain FC was calculated, and a full factorial design was used to compare the difference among groups. Two-sample t test was used for post-hoc analysis. Pearson's correlation analysis was conducted to investigate the relationships between FC and cognitive tests. Of 26 specially appointed ROIs, left superior temporal gyrus (TG) was most sensitive to the effect of time-by-gene interaction. Specifically, the alteration of FC was distributed between the left TG and right TG with GRF correction (voxel-P < 0.001, cluster-P < 0.05), and decreased in ε4 carriers while increased in non-ε4. The main effect of gene showed ε4 carriers has lower FC between left TG and right middle frontal gyrus as compared with non-ε4 both at baseline and follow-up study; ε4 carriers has lower FC between left TG and right supramarginal as compared with non-ε4 at baseline, but no difference in follow-up study. The time-by-APOE ε4 interaction on brain FC was demonstrated at a young age, and left TG was the earliest affected brain regions. The young adult ε4 carriers experience decreased FC among time in the absence overt clinical symptoms.

A Framework for an Effective Healthy Longevity Clinic

In the context of an aging global population and the imperative for innovative healthcare solutions, the concept of longevity clinics emerges as a timely and vital area of exploration. Unlike traditional medical facilities, longevity clinics offer a unique approach to preclinical prevention, focusing on "prevention of prevention" through the utilization of aging clocks and biomarkers from healthy individuals. This article presents a comprehensive overview of longevity clinics, encompassing descriptions of existing models, the development of a proposed framework, and insights into biomarkers, wearable devices, and therapeutic interventions. Additionally, economic justifications for investing in longevity clinics are examined, highlighting the significant growth potential of the global biotechnology market and its alignment with the goals of achieving active longevity. Anchored by an Analytical Center, the proposed framework underscores the importance of data-driven decision-making and innovation in promoting prolonged and enhanced human life. At present, there is no universally accepted standard model for longevity clinics. This absence highlights the need for additional research and ongoing improvements in this field. Through a synthesis of scientific research and practical considerations, this article aims to stimulate further discussion and innovation in the field of longevity clinics, ultimately contributing to the advancement of healthcare practices aimed at extending and enhancing human life.

Development of a machine learning algorithm to predict the residual cognitive reserve index

Elucidating the mechanisms by which late-life neurodegeneration causes cognitive decline requires understanding why some individuals are more resilient than others to the effects of brain change on cognition (cognitive reserve). Currently, there is no way of measuring cognitive reserve that is valid (e.g. capable of moderating brain-cognition associations), widely accessible (e.g. does not require neuroimaging and large sample sizes), and able to provide insight into resilience-promoting mechanisms. To address these limitations, this study sought to determine whether a machine learning approach to combining standard clinical variables could (i) predict a residual-based cognitive reserve criterion standard and (ii) prospectively moderate brain-cognition associations. In a training sample combining data from the University of California (UC) Davis and the Alzheimer's Disease Neuroimaging Initiative-2 (ADNI-2) cohort (N = 1665), we operationalized cognitive reserve using an MRI-based residual approach. An eXtreme Gradient Boosting machine learning algorithm was trained to predict this residual reserve index (RRI) using three models: Minimal (basic clinical data, such as age, education, anthropometrics, and blood pressure), Extended (Minimal model plus cognitive screening, word reading, and depression measures), and Full [Extended model plus Clinical Dementia Rating (CDR) and Everyday Cognition (ECog) scale]. External validation was performed in an independent sample of ADNI 1/3/GO participants (N = 1640), which examined whether the effects of brain change on cognitive change were moderated by the machine learning models' cognitive reserve estimates. The three machine learning models differed in their accuracy and validity. The Minimal model did not correlate strongly with the criterion standard (r = 0.23) and did not moderate the effects of brain change on cognitive change. In contrast, the Extended and Full models were modestly correlated with the criterion standard (r = 0.49 and 0.54, respectively) and prospectively moderated longitudinal brain-cognition associations, outperforming other cognitive reserve proxies (education, word reading). The primary difference between the Minimal model-which did not perform well as a measure of cognitive reserve-and the Extended and Full models-which demonstrated good accuracy and validity-is the lack of cognitive performance and informant-report data in the Minimal model. This suggests that basic clinical variables like anthropometrics, vital signs, and demographics are not sufficient for estimating cognitive reserve. Rather, the most accurate and valid estimates of cognitive reserve were obtained when cognitive performance data-ideally augmented by informant-reported functioning-was used. These results indicate that a dynamic and accessible proxy for cognitive reserve can be generated for individuals without neuroimaging data and gives some insight into factors that may promote resilience.

A Controlled Clinical Trial on the Effects of Aquatic Exercise on Cognitive Functions in Community-Dwelling Older Adults

Several therapies have been developed to reduce cognitive decline associated with aging. Aquatic exercises, which are widely used to enhance functional capacity, may play a role in stimulating cognitive functions. This study investigated the effects of a 3-month aquatic exercise program on cognitive functions in community-dwelling older adults. In this prospective, single-blinded, controlled clinical trial, 31 participants were allocated to either the experimental (aquatic exercises) or control (no-exercise) group. The intervention program consisted of exercises conducted twice a week in a 1.2 m deep indoor pool. The main outcome measures were cognitive functions, assessed using Raven's Progressive Matrices test and the Wisconsin Card Sorting Test. A repeated-measures analysis of variance was used to assess the impact of the exercise program. The effect sizes (η2p) were reported when a level of significance was achieved (p < 0.05). Compared with the control group, the participants who underwent aquatic exercises showed positive outcomes in Raven's Progressive Matrices test (p = 0.046; η2p = 0.131) and the Wisconsin Card Sorting Test (p = 0.001, η2p = 0.589). Complementary analyses of the Wisconsin Card Sorting Test indicated that the benefits of the aquatic exercise were observed in terms of the number of trials (p = 0.001, η2p = 0.478), number of errors (p = 0.001, η2p = 0.458), and number of non-perseverative errors (p = 0.001, η2p = 0.302). The results indicate that a period of three months of aquatic exercise was beneficial for stimulating specific aspects of the cognitive function of community-dwelling older individuals. Aquatic exercise should be prescribed to this population.

Longevity as a Responsibility: Constructing Healthy Aging by Enacting within Contexts over the Entire Lifespan

Studying aging now requires going beyond the bio-psycho-social model and incorporating a broader multidisciplinary view capable of capturing the ultimate complexity of being human that is expressed as individuals age. Current demographic trends and the lengthening of life expectancies allow the observation of long-lived individuals in full health. These super-agers are no longer an exception. Indeed, individuals can have a good quality of life even over age 70 and living with chronic or neurodegenerative diseases. This change is driven in part by the cohort effect observed in people who are about to age today (e.g., better schooling, more advanced health conditions, and technologization) but more so by the gradual overcoming of ageist views. An aged person is no longer seen as a quitter but rather as one empowered to direct their own trajectory of potentially healthy longevity. According to this vision, this article proposes a situated lifespan perspective for the study of aging that integrates pedagogical models of developmental ecology with psychological theories of optimal experience to understand the individual motivational perspective on aging. At the same time, it does not disregard analyzing the daily and cultural contexts in which everyone situates and that guide aging trajectories. Nor does it forget that aging people are body-mind (embodied) organisms that, with contexts and through motivations, seize opportunities for action (affordances) to evolve in an optimal way during their lifespan. This theoretical reflection sheds new light on the aging process and on future trends in healthy longevity research.