Lifestyle changes and outcomes of older adults with mild cognitive impairment: A 4-year longitudinal study

The prevalence and influencing factors of reversion from mild cognitive impairment to normal cognition: A systemic review and meta-analysis

OBJECTIVE

The aim was to investigate the pooled prevalence of reversion from mild cognitive impairment (MCI) to normal cognition people, and the influencing factors for reversion.

METHODS

PubMed, Embase, Web of Science, The Cochrane Library, Wanfang Database, China Knowledge Resource Integrated Database (CNKI), Weipu Database, SinoMed were systematically searched from the inception to June 1, 2023. Participants were diagnosis as MCI adults.

RESULTS

In total, 4075 studies were screened and data from 48 studies involving 31876 subjects were used in meta-analysis. The pooled prevalence of reversion from MCI to normal cognition was 31%. The following risk factors were associated with the reversion from MCI to normal cognition: education (low to high), age, Mini-Mental State Examination (MMSE), Functional Activities Questionnaire (FAQ), Auditory Verbal Learning Test (AVLT) delay recall test, Apolipoprotein E (APOE) positive, multiple domain impaired, live along, depression, doing house work daily/exercise once a week.

CONCLUSIONS

The study shows the pooled prevalence of reversion from MCI to normal cognition was high, and there are controllable factors. Understanding the controllable factors of reversion from MCI to normal cognition can provide the clinicians with the theoretical basis for the management and treatment of the patients.

Repetitive transcranial magnetic stimulation may promote the reversion of mild cognitive impairment to normal cognition

Purpose

This study aimed to investigate the potential effects of repetitive transcranial magnetic stimulation (rTMS) on the reversion of mild cognitive impairment (MCI) to normal cognitive function and to elucidate the underlying mechanisms.

Methods

The study enrolled 25 MCI participants, who underwent a 10-day of rTMS treatment and an 18-month follow-up, along with 15 healthy subjects. Participants with MCI were categorized into MCI reverters (MCI-R) and MCI maintainers (MCI-M). We assessed differences in baseline cognitive performance, functional connectivity, and changes of cognitive functions after rTMS between MCI-R and MCI-M to identify possible predictors of reversion of MCI and explore the neural modulation mechanisms.

Results

MCI-M exhibited more severe cognitive impairments across more domains, particularly in language function (p < 0.05). Functional connectivity was more severely damaged in MCI-M participants, notably within the default mode network (DMN), executive control network (ECN), and frontoparietal network (FPN). After rTMS therapy, MCI-R participants demonstrated more significantly improved immediate and delayed recall memory scores (p < 0.05). These memory function changes and baseline functional connectivity of DMN, ECN, and FPN were predictive of the reversion of MCI.

Conclusions

The efficacy of rTMS in memory function may promote the reversion of MCI to normal cognition, with the functional connectivity of DMN, ECN, and FPN playing a crucial important role. The severity of cognitive impairment and functional connectivity damage correlated with the likelihood of the reversion of MCI to normal cognition, underscoring the importance of early rTMS intervention for dementia prevention.

Effects of digital technology-based serious games interventions for older adults with mild cognitive impairment: a meta-analysis of randomised controlled trials

OBJECTIVE

To evaluate the effectiveness of digital technology-based serious games (DTBSGs) interventions in older adults with mild cognitive impairment (MCI).

METHODS

A librarian-designed search of eight databases was conducted to identify randomised controlled trials published in English or Chinese up to 10 August 2024. The primary and secondary outcomes were compared between the intervention and control groups. A fixed- or random-effects meta-analysis model was used to determine the mean difference, based on the results of the heterogeneity test. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

RESULTS

A meta-analysis of 28 trials, including 1698 participants, showed greater improvements in favour of interventions using DTBSGs compared to the control group in global cognitive function, executive function, attention function, depression, and activities of daily living (ADL). However, there was no significant improvement in memory function, anxiety, apathy or quality of life (QOL) compared to the control group. Subgroup analysis showed that computer games, exergames and iPad tablet games were superior to immersive virtual reality (VR) games in terms of global cognitive and executive function. VR games were superior to computer games in terms of attention and ADL. The GRADE evidence quality assessment results showed that global cognitive function and ADL were of moderate quality; executive function, attention, depression and anxiety were of low quality; and memory, apathy and QOL were of very low quality.

CONCLUSION

Patients with MCI benefited from DTBSGs. With the rapid development of information and communication technology, DTBSGs have great potential and may be used as adjuncts or substitutes in MCI rehabilitation.

Knowledge, Attitudes, and Practices of General Physicians towards Mild Cognitive Impairment amidst an evolving era of Interprofessional Collaboration: Insights from a small-scale survey in India

BACKGROUND

Early identification and intervention of Mild Cognitive Impairment (MCI), led by General Physicians (GPs), can delay dementia onset and enhance patient outcomes. GPs recognize MCI risk factors, conduct assessments, and manage associated conditions, playing a crucial role in cognitive pathology intervention, especially in the era of Interprofessional Collaboration (IPC). In India, where cognitive impairment rates are projected to rise sharply, understanding GPs' knowledge, attitudes, and practices (KAP) is vital. This study aimed to investigate the KAP of GPs regarding the diagnosis and treatment of MCI using a customized, predesigned questionnaire.

METHOD

The study employed a cross-sectional design using a convenience sample of 180 invited participants between July and October 2023. A customized questionnaire, based on Lu et al., 2022, evaluated GPs' KAP regarding MCI and IPC in the Indian context towards its assessment and management. The tool including 9 knowledge items, 15 attitude items, and 12 practice items, was made available through Google Forms and disseminated via WhatsApp. Responses were scored to indicate KAP levels, with maximum scores being 50 for knowledge, 75 for attitudes, and 60 for practices.

RESULTS

103 GPs completed the survey, showing varied practice experience. The average knowledge score was 28.1 ± 7.98, indicating uncertainty about MCI-related factors and diagnostic criteria. Attitude scores averaged 53.5 ± 4.73, with most GPs endorsing early detection and non-pharmacological interventions. Practice scores averaged 41.8 ± 8.32, showing mixed adherence to screening and referral practices. Most participants found IPC highly effective for MCI diagnosis and management, with many referring patients to specialists for confirmation, while over half used an IPC approach for both. Education level and previous experience significantly influenced knowledge and practice scores.

CONCLUSION

This study sheds light on the evolving landscape of Indian GPs' KAP related to MCI assessment and management. It identifies areas where understanding could be strengthened and highlight opportunities for growth through education and training. Notably, there is a need for increased involvement in IPC. These findings emphasize the importance of holistic approaches, advocating for enhanced education and the fostering of collaborative relationships across disciplines to tackle the rising prevalence of MCI in India effectively.

Machine learning algorithms to predict mild cognitive impairment in older adults in China: A cross-sectional study

OBJECTIVE

This study aimed to explore the predictive value of machine learning (ML) in mild cognitive impairment (MCI) among older adults in China and to identify important factors causing MCI.

METHODS

In this study, 6434 older adults were selected based on the data of the China Health and Elderly Care Longitudinal Survey (CHARLS) in 2020, and the dataset was subsequently divided into the training set and the test set, with a ratio of 6:4. To construct a prediction model for MCI in older adults, six ML algorithms were used, including logistic regression, KNN, SVM, decision tree (DT), LightGBM, and random forest (RF). The Delong test was used to compare the differences of ROC curves of different models, while decision curve analysis (DCA) was used to evaluate the model performance. The important contributions of the prediction results were then used to explain the model by the SHAP value.The Matthews correlation coefficient (MCC) was calculated to evaluate the performance of the models on imbalanced datasets. Additionally, causal analysis and counterfactual analysis were conducted to understand the feature importance and variable effects.

RESULTS

The area under the ROC curve of each model range from 0.71 to 0.77, indicating significant difference (P < 0.01). The DCA results show that the net benefits of LightGBM is the largest within various probability thresholds. Among all the models, the LightGBM model demonstrated the highest performance and stability. The five most important characteristics for predicting MCI were educational level, social events, gender, relationship with children, and age. Causal analysis revealed that these variables had a significant impact on MCI, with an average treatment effect of -0.144. Counterfactual analysis further validated these findings by simulating different scenarios, such as improving educational level, increasing age, and increasing social events.

CONCLUSION

The ML algorithm can effectively predict the MCI of older adults in China and identify the important factors causing MCI.

Subjective cognitive complaints and future risk of dementia and cognitive impairment, which matters most

Many older adults report subjective cognitive decline (SCD); however, the specific types of complaints most strongly associated with early disease detection remain unclear. This study examines which complaints from the Everyday Cognition Scales (ECog) are associated with progression from normal cognition to mild cognitive impairment (MCI)/dementia. 415 older adults were monitored annually for 5 years, on average. Cox proportional hazards models assessed associations between ECog complaints and progression to MCI/dementia. Follow-up models included depression as a covariate. Numerous Memory (5 items), Language (3 items), Visuospatial (1 item), Planning (2 items), and Organization (1 item) complaints were associated with diagnostic progression. After covarying for depression, remembering appointments and understanding spoken instructions remained significant predictors of diagnostic progression. While previous work has focused largely on memory-based SCD complaints, the current findings support a wider assessment of complaints may be useful in identifying those at risk for a neurodegenerative disease.

Gender-specification lifestyle factors associated with mild cognitive impairment among young-old adults in Taiwan

BACKGROUND

The prevalence of mild cognitive impairment (MCI) exhibits a positive correlation with age, particularly evident in the old-old female population. Lifestyle factors have been identified as crucial risk determinants for MCI. However, there is a scarcity of research focusing on lifestyle factors among young-old population.

OBJECTIVE

This study aimed to explore the lifestyle factors associated with MCI in young-old male and female.

METHODS

This study employed a cross-sectional design and utilized demographic and lifestyle data obtained from participants enrolled in the Taiwan Biobank (TWB) between 2008 and 2021, with 32,897 individuals aged 60 to 70 years old. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), with a total score ranging from 0 to 30 points. The cut-off of MCI scores was ≤18, ≤21, and ≤25 according to the education level, respectively. Logistic regression analysis was employed to assess the association between lifestyles and cognitive function.

RESULTS

3,878 individuals (11.78%) suffered from MCI. Upon gender stratification, high exercise metabolic equivalents in male (OR = 0.8, 95% CI: 0.70 - 0.92) and moderate exercise in female serve as protective factors for MCI (OR = 0.78, 95% CI: 0.70 - 0.87). Additionally, diversified dietary preferences among female (OR = 0.80, 95% CI: 0.66 - 0.97) also emerge as protective factors for cognitive function.

CONCLUSIONS

It is worth noting that male is advised to target a higher exercise metabolic equivalent, while female can attain cognitive benefits with moderate exercise and diversified dietary.

The Association between cognitive impairment and anthropometric indices among the elderly: birjand longitudinal aging study

Background

The population of older adults has been consistently on the rise. We aimed to assess the possible relationship between cognitive decline and anthropometric indices in older adults, using data from the Birjand longitudinal aging study (BLAS).

Methods

In this cross-sectional research, the association between cognitive impairment as determined by two tests (Six Item Cognitive Impairment Test (6-CIT)) and (Mini-Mental State Examination (MMSE)) and anthropometric indices including waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), waist to hip ratio (WHR), body roundness index (BRI), and a body shape index (ABSI) were assessed among 1353 elderly ≥ 60 years old, participating in the BLAS cohort study (September 2018 to April 2019). Ordinal and binary logistic regression were used for analysis.

Results

According to the MMSE test, 58.3% of participants had cognitive impairment, while this frequency was 64.2% based on the 6-CIT test. A significant reverse association was observed between cognitive decline according to the 6-CIT test and BMI, WHR, and WC (P < 0.05). Cognitive impairment, according to MMSE, was inversely associated with WC and directly associated with WHtR and ABSI in the crude model, which disappeared after adjustment for confounders. BRI was not significantly related to any of the cognitive tests. According to BMI and WC, overweight and obesity could reduce the risk of cognitive impairment.

Conclusions

Overall, the result of this study showed that the risk of cognitive decline decreased among the elderly as BMI, WC, and WHR increased.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01404-8.

The Effect of Levels of Leisure-Time Physical Activity on Cognitive Functions Among Older Adults with Mild Cognitive Impairment: A Longitudinal Analysis

One dementia prevention strategy that is effective for older adults is frequent participation in leisure time physical activity. However, research gaps exist in our understanding of the longitudinal relationship between different levels of leisure time physical activity participation and the cognitive function of older adults with mild cognitive impairment. Thus, we investigated this relationship using Health and Retirement Study data from 2012 to 2020. Results from Repeated Measures Multivariate Analysis of Covariance indicated that both the mid (Mean Difference = -0.45) and high level (Mean Difference = -0.82) leisure time physical activity groups showed higher levels of memory function compared to the low-level leisure time physical activity group. Additionally, the mid (Mean Difference = -0.21) and high level (Mean Difference = -0.37) leisure time physical activity groups reported better working memory function, and the mid (Mean Difference = -0.02) and high level (Mean Difference = -0.02) leisure time physical activity groups showed higher levels of attention and processing speed than the low-level leisure time physical activity group. These findings suggest that older adults with mild cognitive impairment who engage either vigorously or moderately in leisure time physical activity (more than three times a week) experience improvements in cognitive function compared to those who do not. This study provides valuable insights for clinicians on the optimal level of leisure time physical activity required to mitigate cognitive decline in older adults with mild cognitive impairment.

Chanwuyi Lifestyle Medicine Program Improves Memory and Executive Functions of Older Adults With Mild Cognitive Impairment

The Chanwuyi Lifestyle Medicine Program (CLMP) was found to enhance the memory and executive functions of older adults with or without subjective memory complaints. The present study investigated whether similar beneficial effects can be extended to mild cognitive impairment (MCI). Twenty-four older adults with MCI were randomly assigned to receive the CLMP (the experimental group) or strategic memory training (SMT; the active control group) for 10 weeks. They were assessed by neuropsychological tests at baseline and post-intervention. Older adults showed similar visual and verbal memory improvements after receiving the CLMP and SMT. Yet, only those who received the CLMP showed distinct improvements in planning/organization, working memory, and attention in terms of accuracy, with greater cognitive gains associated with older age and lower levels of education and baseline cognitive functions. This study provides preliminary evidence for the effects of the CLMP on improving memory, attention, and executive functions in MCI.

The Association Between Mild Cognitive Impairment and Medication Non-adherence Among Elderly Patients With Chronic Diseases

BACKGROUND

Medication adherence is essential for optimizing treatment outcomes in elderly patients who frequently contend with multiple chronic diseases requiring pharmacological interventions. Mild cognitive impairment (MCI) is a prevalent cognitive disorder among the elderly population, but its impact on medication adherence among elderly patients is still uncertain. This cross-sectional study aimed to investigate the impact of MCI on medication adherence among elderly patients.

METHODS

A cross-sectional study of 436 elderly patients with common chronic diseases aged 60 years and above was conducted. Medication adherence was measured using the Morisky Medication Adherence Scale-8 (MMAS-8). MCI was screened, and cognitive status was assessed using the Mini-Mental State Examination (MMSE) questionnaire. Multivariate logistic regression analysis was performed to identify independent risk factors of medication non-adherence.

RESULTS

Among these elderly patients, 212 (48.6%) had poor medication compliance, and 181 (41.5%) had MCI. Preliminary analyses showed a significant association between MCI and medication non-adherence among elderly patients (odds ratio (OR)=3.95, 95% confidence interval (95%CI)=2.63-5.92, P<0.001). Multivariate logistic regression analysis showed that MCI was independently associated with the risk of medication non-adherence among elderly patients (adjusted OR=2.64, 95%CI=1.64-4.24, P<0.001). Additionally, adverse drug reaction and poor evaluation of medication effects were also independently associated with medication non-adherence in elderly patients (P<0.05).

CONCLUSION

Findings from this cross-sectional study proved the substantial adverse impact of MCI on medication adherence among elderly patients, and MCI was an independently influential factor of medication non-adherence. Identifying the MCI status early and providing interventions to enhance medication adherence are undoubtedly essential for optimizing healthcare outcomes in elderly patients.

Association of Unhealthy Lifestyle and Genetic Risk Factors With Mild Cognitive Impairment in Chinese Older Adults

Importance

Apolipoprotein E polymorphism ε4 (APOE ε4) and methylenetetrahydrofolate reductase (MTHFR) TT genotype are genetic risk factors of mild cognitive impairment (MCI), but whether this risk can be changed by modifiable lifestyle factors is unknown.

Objective

To explore whether unhealthy lifestyle (unhealthy dietary intake, current smoking, nonlimited alcohol consumption, and irregular physical activities) is associated with a higher risk of age-related MCI considering genetic risk.

Design, Setting, and Participants

This population-based cohort study used data from Tianjin Elderly Nutrition and Cognition (TENC) study participants, recruited from March 1, 2018, through June 30, 2021, and followed up until November 30, 2022. Participants were Chinese adults aged 60 years or older who completed the neuropsychological assessments, general physical examinations, and a personal interview.

Exposures

Healthy lifestyle was defined according to the Chinese Dietary Guidelines 2022, including healthy diet, regular physical activity, limited alcohol consumption, and no current smoking, categorized into healthy and unhealthy lifestyles according to weighted standardized lifestyle score. Genetic risk was defined by MTHFR TT genotype and APOE ε4, categorized into low and high genetic risk according to weighted standardized genetic risk score.

Main Outcomes and Measures

The main outcome was newly diagnosed MCI as identified using a modified version of Petersen criteria. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazard regression models.

Results

A total of 4665 participants were included (mean [SD] age, 67.9 [4.9] years; 2546 female [54.6%] and 2119 male [45.4%]); 653 participants with new-onset MCI (mean [SD] age, 68.4 [5.4] years; 267 female [40.9%] and 386 male [59.1%]) were identified after a median follow-up of 3.11 years (range, 0.82-4.61 years). Individuals with a low genetic risk and an unhealthy lifestyle (HR, 3.01; 95% CI, 2.38-3.79), a high genetic risk and a healthy lifestyle (HR, 2.65; 95% CI, 2.03-3.44), and a high genetic risk and an unhealthy lifestyle (HR, 3.58; 95% CI, 2.73-4.69) had a higher risk of MCI compared with participants with a low genetic risk and a healthy lifestyle. There was a synergistic interaction between lifestyle categories and genetic risk (β = 3.58; 95% CI, 2.73-4.69).

Conclusions and Relevance

In this cohort study of TENC participants, the findings show that unhealthy lifestyle and high genetic risk were significantly associated with a higher risk of MCI among Chinese older adults. Unhealthy lifestyle factors were associated with a higher risk of MCI regardless of genetic risk, and lifestyle and genetic risk had synergistic interactions. These findings could contribute to the development of dietary guidelines and the prevention of early-stage dementia.

The Relationship between Handgrip Strength, Timed Up-and-Go, and Mild Cognitive Impairment in Older People during COVID-19 Pandemic Restrictions

The COVID-19 lockdown restrictions affected physical performance and cognitive function in older people as they were confined to their homes. There is an association between physical and cognitive functions. Mild Cognitive Impairment (MCI) is a condition that risks progressing to dementia. This study aimed to identify the relationship between handgrip strength (HGS), Timed Up-and-Go (TUG), and MCI in older people during the COVID-19 pandemic restrictions. The cross-sectional study recruited 464 eligible participants for an interview and anthropometric measurement. The Montreal Cognitive Assessment-Basic (MoCA-B), HGS, and TUG were measured in addition to demographic and health characteristics. A total of 398 participants (85.8%) were found to have MCI when screened with the MoCA-B. Their mean age was 71.09 ± 5.81 years. Forward multiple regression analysis demonstrated that HGS (β = 0.032, p < 0.001), education level (β = 2.801, p < 0.001), TUG (β = -0.022, p = 0.013), Thai Geriatric Depression Score, TGDS (β = -0.248, p = 0.011), and age (β = -1.677, p = 0.019) were associated with MCI. A decrease in HGS and an increased TUG might allow for the early detection of MCI and promote physical training in order to reduce the risk of MCI. Further studies can investigate multidomain indicators for MCI, for example, fine motor skills and pinch strength as components of the motor abilities.

Statistical Approaches for the Analysis of Combined Health-Related Factors in Association with Adult Cognitive Outcomes: A Scoping Review

BACKGROUND

Dementia prevention is a global health priority, and there is emerging evidence to support associations between individual modifiable health behaviors and cognitive function and dementia risk. However, a key property of these behaviors is they often co-occur or cluster, highlighting the importance of examining them in combination.

OBJECTIVE

To identify and characterize the statistical approaches used to aggregate multiple health-related behaviors/modifiable risk factors and assess associations with cognitive outcomes in adults.

METHODS

Eight electronic databases were searched to identify observational studies exploring the association between two or more aggregated health-related behaviors and cognitive outcomes in adults.

RESULTS

Sixty-two articles were included in this review. Fifty articles employed co-occurrence approaches alone to aggregate health behaviors/other modifiable risk factors, eight studies used solely clustering-based approaches, and four studies used a combination of both. Co-occurrence methods include additive index-based approaches and presenting specific health combinations, and whilst simple to construct and interpret, do not consider the underlying associations between co-occurring behaviors/risk factors. Clustering-based approaches do focus on underlying associations, and further work in this area may aid in identifying at-risk subgroups and understanding specific combinations of health-related behaviors/risk factors of particular importance in the scope of cognitive function and neurocognitive decline.

CONCLUSION

A co-occurrence approach to aggregating health-related behaviors/risk factors and exploring associations with adult cognitive outcomes has been the predominant statistical approach used to date, with a lack of research employing more advanced statistical methods to explore clustering-based approaches.

Validation of a novel computerized cognitive function test for the rapid detection of mild cognitive impairment

BACKGROUND

In the present study, we examined the distinguishing ability of a mild cognitive impairment (MCI) assessment tool for rapid screening using a computer (MARC) for Alzheimer's disease dementia (ADD), MCI, and non-demented controls (NDC) with no cognitive impairment, as well as its validity and reliability, as part of a preliminary trial for the development of the tool.

METHODS

A total of 64 participants (23 in the ADD group, 17 in the MCI group, and 24 in the NDC group) were analyzed. The participants were administered MARC and a pre-existing computerized Alzheimer's dementia screening test (MSP), and 31 participants (14 in the MCI group, 17 in the NDC group) were readministered MARC within 4 months from the first test.

RESULTS

The median (interquartile range) test time for MARC was 401 (350-453) s. Total MARC scores were significantly worse in the MCI and ADD groups than in the NDC group (p < 0.05 and p < 0.01, respectively). In the receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) when comparing the NDC and MCI groups was 0.866 (95% CI, 0.759-0.974), when comparing the NDC and AD groups was 0.989 (95% CI, 0.970-1.000), and when comparing the MCI and AD groups was 0.889 (95% CI, 0.790-0.988). Furthermore, there was a significant correlation with the results of the existing test, MSP (r = 0.839, p < 0.001). In addition, the intraclass correlation coefficient (ICC) (1,1) when the first and second MARC scores were compared was 0.740 (95% CI, 0.529-0.865; p < 0.001).

CONCLUSIONS

MARC is considered capable of distinguishing MCI with high accuracy. The tool has good validity and reliability, and it can be administered in a short period of time without the need for a specialist.

Association of leisure activity changes and reversion from mild cognitive impairment to normal cognitive function among older adults: A prospective cohort study

Background

Older adults with mild cognitive impairment (MCI) have the possibility of reverting to normal cognitive function. Leisure activity engagement (LAE) plays a critical role in the progress of the cognitive function. A better understanding of the dynamic relationship between LAE and MCI reversion would inform the implementation of preclinical dementia interventions. This study aimed to investigate the association between change patterns of LAE and MCI reversion among older adults using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database.

Study design

Longitudinal population-based study.

Methods

Older adults with MCI at the baseline were enrolled in this study. Information about cognitive function, overall, cognitively stimulating, physically active/demanding, and socially engaged LAE was collected at baseline and follow-up. Adjusted hazard ratios (HRs) for reversion and 95% confidence intervals (CIs) were calculated by Cox hazard models with time as the underlying time metric. We also assessed potential effect modifications by creating a cross-product of the stratifying variable with LAE change patterns in the fully adjusted model.

Results

The restricted cubic spline showed that the association between LAE change scores and MCI reversion rate was statistically significant and nonlinear (p<0.01). Taking participants in the low-low group as a reference, participants in the low-medium, low-high, medium-medium, medium-high, high-medium, and high-high groups had increased possibilities of MCI reversion with HRs (95% CI) of 2.19 (1.57-3.06), 2.97 (2.13-4.13), 0.87 (0.64-1.19), 2.28 (1.71-3.03), 2.78 (2.10-3.69), 1.93 (1.43-2.59), and 2.74 (2.09-3.60), respectively. Further stratified models showed that the impact of LAE change patterns on MCI reversion varied in different ages (nonagenarian, octogenarian, and younger elderly) and gender.

Conclusions

Participants who maintained the highest LAE had the greatest possibility of MCI reversion. Meanwhile, a higher level of LAE maintenance was associated with the increased possibility of MCI reversion. These results provide a practical message to older adults about how dynamic changes in LAE are associated with improved cognitive function.

Addressing Mild Cognitive Impairment and Boosting Wellness for the Elderly through Personalized Remote Monitoring

Mild cognitive impairment (MCI) may occur with old age and is associated with increased cognitive deterioration compared to what is normal. This may affect the person’s quality of life, health, and independence. In this ageing worldwide context, early diagnosis and personalized assistance for MCI therefore become crucial. This paper makes two important contributions: (1) a system (RO-SmartAgeing) to address MCI, which was developed for Romania; and (2) a set of criteria for evaluating its impact on remote health monitoring. The system aims to provide customized non-invasive remote monitoring, health assessment, and assistance for the elderly within a smart environment set up in their homes. Moreover, it includes multivariate AI-based predictive models that can detect the onset of MCI and its development towards dementia. It was built iteratively, following literature reviews and consultations with health specialists, and it is currently being tested in a simulated home environment. While its main strength is the potential to detect MCI early and follow its evolution, RO-SmartAgeing also supports elderly people in living independently, and it is safe, comfortable, low cost, and privacy protected. Moreover, it can be used by healthcare institutions to continuously monitor a patient’s vital signs, position, and activities, and to deliver reminders and alarms.

Comparison of the Greek Version of the Quick Mild Cognitive Impairment Screen and Montreal Cognitive Assessment in Older Adults

Objective: Cognitive screening instruments (CSIs) are essential for everyday practice. The Quick Mild Cognitive Impairment (Qmci) screen, a short instrument designed to identify mild cognitive impairment, was recently translated into Greek (Qmci-Gr). The present study compared its diagnostic value against the Montreal Cognitive Assessment (MoCA) screen and examined its optimal cutoffs. Method: We recruited consecutive patients aged ≥55 years that presented with cognitive complaints from two outpatient clinics in Greece. The Qmci-Gr and MoCA were completed by all patients. Furthermore, they were assessed independently with a comprehensive flexible neuropsychological battery to establish a diagnostic classification. Results: In the current study, we assessed a total of 145 patients, with a median age of 70 years; 44 were classified as having Subjective Memory Complaints (SMC) but normal cognition, 32 with MCI and 69 with dementia. The Qmci-Gr had a higher accuracy compared to the MoCA in discriminating MCI from dementia, area under the curve (AUC) of 0.81 versus 0.75, respectively; however, this finding was marginally significant (p = 0.08). Its accuracy was marginally higher for distinguishing SMC from dementia, AUC of 0.94 versus 0.89 (p = 0.03). However, Qmci-Gr presented a lower accuracy than MoCa in differentiating SMC from MCI, AUC of 0.76 versus 0.94 (p = 0.006). Conclusions: The Qmci-Gr has comparable diagnostic accuracy to the MoCA regarding MCI and dementia groups. Further research, with larger and more diverse samples, may be necessary to ensure generalizability.

Cognitive Function and Olfactory Impairment in Community-Dwelling Older Adults Attending a Salon

Background:

Early detection, treatment, and care are important for the prevention of dementia. Though olfactory impairment has been reported to be associated with mild cognitive impairment (MCI), there are few reports involving community-dwelling older adults with no difficulty in daily life in Japan.

Objective:

This study aimed to identify the frequency of MCI in community-dwelling elderly people attending community salons in a city with a high aging population, and to determine the usefulness of a pocket olfactory discrimination test.

Methods:

We recruited 268 independent older adults attending community salons. The Japanese version of the MCI Screen was used to evaluate cognitive function, defining MCI as <49.8 out of 100 scores of the memory performance index (MPI). The Japanese version of the University of Pennsylvania Smell Identification Test (UPSIT-J) was used for olfactory discrimination and the number of correct answers out of 4 questions was noted.

Results:

Of the salon participants, 138 (51.5%) were classified as having MCI. As the number of correct answers on the olfactory test decreased, the percentage of participants with MCI increased. The MPI score of the low UPSIT score group was significantly lower than that of the high UPSIT score group.

Conclusions:

This study revealed that approximately half of the elderly local residents living without daily problems were suspected of having MCI. The UPSIT-J-4 is a simple olfactory identification test, and can be used at any time and any place. It is useful for screening cognitive function via olfactory identification in a salon-like setting.