Impairment in instrumental activities of daily living with high cognitive demand is an early marker of mild cognitive impairment: the Sydney memory and ageing study

Instrumental activities of daily living function and cognitive status among Chinese older adults: a serial multiple mediation model

Objective

This study aimed to develop and validate a serial multiple mediation model to investigate the association between instrumental activities of daily living (IADL) function and cognitive status among older adults while exploring the underlying mechanisms.

Methods

This cross-sectional study involved 3,665 individuals aged 60 years and older who participated in the China Health and Retirement Longitudinal Survey (CHARLS). A serial multiple mediation model was utilized to explore the direct and indirect relationship between IADL function and cognitive status and whether sleep duration, social engagement, and depressive symptoms mediated this relationship.

Results

Decreased IADL function was associated with worse cognitive status [effect = -0.620, 95% CI: (-0.692, -0.540)]. Sleep duration, social participation (SP), and depressive symptoms all acted as mediators in the relationship between IADL function and cognitive status.

Conclusion

This study found both direct and indirect associations between IADL function and cognitive status, providing new insights into the effective prevention and intervention of cognitive decline among older adults.

Sex differences in cognitive function trajectories and their determinants in older adults: Evidence from the Chinese longitudinal healthy longevity survey

OBJECTIVES

To examine sex differences in the cognitive trajectories of a nationally representative sample of older people living in China and to explore potential determinants of these trajectories.

METHODS

The study included 2230 women and 2171 men who were cognitively healthy and aged over 60 at the first observation from the Chinese Longitudinal Healthy Longevity Survey based on the 2008-2018 cohort. Cognitive function was measured using the Chinese version of the Mini-Mental State Examination (MMSE). Group-based trajectory modeling was used to identify potential heterogeneity of longitudinal changes over the 10 years in each gender. Logistic regression was used to investigate associations between baseline characteristics (age, education, fertility history, sleep length, physical activity, and health status and behaviors) and trajectory classes.

RESULTS

Three trajectories (labeled stable, slow decline, and rapid decline) were identified according to the changes in MMSE scores for both women and men. For the women, both the slow and rapid decline groups accounted for a larger proportion (14.7% and 11.0%, respectively) than the male decline groups (8.1% and 6.6%, respectively), and the women had a lower baseline MMSE score with a faster decline. In the multivariable logistic regression analyses, older age, less education, older age at first birth, poorer functional abilities, hearing impairment, and lower baseline MMSE scores were significantly associated with cognitive decline in both the female and male groups compared to the stable group. For the women, sleeping over 9 h was also associated with a rapid cognitive decline trajectory, while current exercise and being overweight/obese were protective factors against cognitive decline.

CONCLUSIONS

The women had an overall more serious cognitive decline than men. The potential determinants of cognitive decline identified in this study could be considered for developing specific intervention strategies aimed at promoting a healthy brain and preventing cognitive decline in different sexes, especially in low-income and developing countries.

Enhancing cognitive flexibility and working memory in individuals with mild cognitive impairment: Exploring the impact of virtual reality on daily life activities

Mild Cognitive Impairment (MCI) serving as a transitional stage between normal aging and dementia. This study aimed to explore the impact of virtual reality (VR) on enhancing cognitive flexibility, working memory, and daily life activities. Forty participants diagnosed with MCI were randomly assigned to either an intervention group (N = 20) or a control group (N = 20). Evaluations were at baseline, post-training, and three months post-training using various cognitive assessment tools. Results showed that the VR-based cognitive rehabilitation significantly improved instrumental activities of daily living performance, visual and verbal working memory, and reduced anxiety and depression symptoms. While cognitive flexibility did not exhibit significant improvement, these findings highlight VR interventions as a potential avenue for improving cognitive and functional aspects, and alleviating psychological symptoms in individuals with MCI. Further research with larger sample sizes and extended follow-up periods is recommended to establish the long-term effectiveness of such interventions.

Validity and Reliability Study of Online Cognitive Tracking Software (BEYNEX)

Background

Detecting cognitive impairment such as Alzheimer's disease early and tracking it over time is essential for individuals at risk of cognitive decline.

Objective

This research aimed to validate the Beynex app's gamified assessment tests and the Beynex Performance Index (BPI) score, which monitor cognitive performance across seven categories, considering age and education data.

Methods

Beynex test cut-off scores of participants (n = 91) were derived from the optimization function and compared to the Montreal Cognitive Assessment (MoCA) test. Validation and reliability analyses were carried out with data collected from an additional 214 participants.

Results

Beynex categorization scores showed a moderate agreement with MoCA ratings (weighted Cohen's Kappa = 0.48; 95% CI: 0.38-0.60). Calculated Cronbach's Alpha indicates good internal consistency. Test-retest reliability analysis using a linear regression line fitted to results yielded R∧2 of 0.65 with a 95% CI: 0.58, 0.71.

Discussion

Beynex's ability to reliably detect and track cognitive impairment could significantly impact public health, early intervention strategies and improve patient outcomes.

Subjective Functional Difficulties Were Associated With Subjective Cognitive Decline Among U.S. Older Adults: Mentally Unhealthy Days Mediation and Income Level Moderation Effects

Introduction

Subjective cognitive decline (SCD) is a self-perceived decline in cognition that may progress to mild cognitive impairment or Alzheimer's disease. SCD may be associated with difficulties in daily functioning and psychological distress. Previous research has shown the association between functional difficulties and SCD via mentally unhealthy days (MUDs). However, whether income levels influence the mediation effect of MUDs is less understood.

Objectives

This study examined the association between subjective functional difficulties and the odds of SCD through MUDs, and whether the mediation effect was moderated by income levels.

Methods

Cross-sectional data were obtained from the 2019 Behavioral Risk Factor Surveillance System (N = 13,160 older adults aged 65+; 7,370 women). SCD was assessed by more frequent or worse memory loss and confusion in the past 12 months. Subjective functional difficulties represented difficulties with daily activities. MUDs denoted the days that a person felt mentally unwell within the past 30 days. We used path analysis with 5,000 bootstrapped confidence intervals and logistic regression to classify the risks of SCD based on subjective functional difficulties and MUDs.

Results

Subjective functional difficulties were positively associated with SCD through mediation by MUDs (b = 0.119, 95% CI 0.102, 0.137). After accounting for covariates, we found that greater subjective functional difficulties were associated with 2.50 times the odds of SCD (AOR = 2.50; 95% CI: 2.14, 2.91); MUDs were related to 1.06 times the odds of SCD reporting (AOR = 1.06; 95% CI: 1.05, 1.07). Income levels moderated the indirect effect of MUDs in the subjective functional difficulties-SCD relationship, with an income of <$15,000 showing the most prominent effect. Those earning ≥$50,000 self-reported a lower SCD than those earning <$15,000.

Conclusions

Our study extends previous findings by demonstrating that greater subjective functional difficulties are associated with higher odds of SCD through more frequent MUDs, with higher income levels being associated with more SCD reporting.

Psychometric Evaluation of the A-NKS: A Diagnostic Instrument to Assess Impairment of Activities of Daily Living in Mild and Major Neurocognitive Disorder According to DSM-5

BACKGROUND

Activities of daily living (ADL) functioning are important in the diagnosis of neurocognitive disorders (NCD), yet no standardized and validated instrument exist based on international classification systems.

OBJECTIVE

We aimed to psychometrically evaluate the differentiated assessment of ADL and instrumental ADL (IADL) impairments due to NCD according to DSM-5 criteria (Instrument für die Erfassung von Alltagsbeeinträchtigungen bei Neurokognitiven Störungen; A-NKS).

METHODS

We conducted a pilot study involving 92 participant-informant dyads of participants with mild or major NCDs, cognitively healthy individuals, and an informant, to test acceptability, internal consistency, and convergent validity with similar measures.

RESULTS

Both A-NKS versions demonstrated excellent internal consistency (α= 0.95 -0.99) and correlate with other instrumental ADL instruments (participant [informant]: Barthel Index: rs = -0.26, p≤0.05 [rs = -0.30, p≤0.01]; Amsterdam IADL: rs = 0.59, p≤0.01 [rs = 0.48, p≤0.01]; SIDAM ADL: rs = 0.46, p≤0.001 [rs = 0.47, p≤0.001]). Additionally, there are correlations with the scale autonomy of the WHOQOL-OLD (rs = -0.50, p≤0.001 [rs = -0.37, p≤0.001]) and physical, as well as cognitive activities (rs = -0.39, p≤0.001 [rs = -0.50, p≤0.001]). They were well-accepted by participants and informants.

CONCLUSIONS

The A-NKS is an instrument with acceptable psychometric properties to assess ADL due to neurodegenerative decline in healthy individuals, and those with mild or major NCD. Further research is needed to confirm reliability and validity and investigate the factor structure.

Analysis of Convergent Validity of Performance-Based Activities of Daily Living Assessed by PA-IADL Test in Relation to Traditional (Standard) Cognitive Assessment to Identify Older Adults with Mild Cognitive Impairment

Difficulty in performing instrumental activities of daily living (IADLs) is currently considered an important indicator of cognitive impairment in the elderly. A non-experimental case-control investigation was conducted to assess the convergent validity of the PA-IADL with traditional (standard) cognitive assessment tests in its ability to identify adults with mild cognitive impairment. The analysis of the data was carried out by means of various multivariate statistical tests, and the sequence in its execution led to the conclusion that 8 of the 12 Tasks that make up the PA-IADL allow for the identification of people with mild cognitive impairment (MCI) to the same extent as traditional cognitive assessment tests and regardless of age. Age was found to be a moderating variable in the performance of the eight tasks; however, the results allow us to hypothesize that people with MCI experience a significant decline when it happens but thereafter, the deterioration that occurs does so at the same rate as the deterioration experienced by healthy people. They also allow us to hypothesize that the difference in the cognitive skills required by the eight functional tasks, and therefore also in the cognitive skills required by the traditional (standard) tests of a person with MCI compared to a person of the same age without MCI (Healthy), is approximately 10 years. These hypotheses have remarkable relevance and should be tested via longitudinal research. In the meantime, the results highlight the importance of the IADL assessment for the diagnosis of MCI as a complement to the standard cognitive assessment.

Association Between Neuropsychological Functions and Activities of Daily Living in People with Mild Cognitive Impairment

OBJECTIVE

The aim of this study was to explore the relationship between performance in neurocognitive variables and daily functioning (basic or b- and instrumental or i-ADL) in people with mild cognitive impairment (MCI).

METHODS

A sample of 157 participants with MCI (73.65 ± 7.58 years) completed a battery of tests for assessing ADL and cognitive functions. t-test, Pearson's correlation and multiple linear regression (backward stepwise selection) were used for data analyses.

RESULTS

Significant correlations were found between b- and i-ADL, and several neuropsychological tests (p < .01). Multivariate analysis showed that difficulties in Blessed Rating Scales (BLS) explained 33.2% of the variation in b-ADL and that this variation rises to 42.9% when BLS is associated with Frontal Assessment Battery Flexibility, Trail Making Test A (TMT-A) and BLS Personality. For i-ADL, BLS and Dementia Rating Scale Total (DRS-T) explained 47.7% of the variation and the inclusion in the model of BLS, DRS-IP (Initiation/Perseveration), TMT-A and BLS Personality explained 53.5% of this variation. Executive functions explained 24.8% of the variation in i-ADL.

CONCLUSIONS

Cognitive functions are related to i- and b-ADL in people with MCI. The general indicators and those that assess executive functions and verbal- or visual-spatial memory should be considered to predict i-ADL.

Are Protective Activities and Limitations in Practical Skills of Daily Living Associated with the Cognitive Performance of People with Mild Cognitive Impairment? Baseline Results from the BrainFit-Nutrition Study

Limitations in daily living have not yet been described adequately for mild cognitive impairment (MCI). In this study, we investigated first, time spent on protective activities (social, mental, and physical) and second, limitations in practical skills of daily living, both for people with MCI. We used baseline data from 270 individuals who participated in the randomized controlled trial BrainFit-Nutrition. The Montreal Cognitive Assessment (MoCA) was used to identify people with MCI. Participants were asked how much time they spent engaged in social, mental, and physical activities each week. Furthermore, the Bayer-ADL scale was used to quantify deficits in activities of daily living (ADLs). Regarding protection, the number of hours spent engaged in the three activity areas was significantly correlated with the cognitive performance in people with MCI. Social activities were positively associated with current cognitive performance. Concerning the limitations in practical skills of daily living, older and more cognitively impaired individuals were affected. Memory and orientation appear to be among the first practical skills of daily living that become impaired in people with MCI. Treatment recommendations for people with MCI include an increase in social, mental, and physical activities as well as the promotion of a healthy lifestyle.

Assessing functional ability of healthy adults with the Night Out Task

Objective: Given the negative health outcomes associated with functional loss, there is need to better understand the trajectory of functional change and compensation use with age. Many older adults successfully age in place, and there is not a one-to-one relationship between cognitive changes and ability to live independently. This study compared healthy age cohorts' performance and approach on a functional measure, particularly examining compensatory strategy use to support task performance. Methods: 57 young adults (YAs; ages 18-39), 42 young-old adults (YOAs; ages 60-69) and 47 old-old (OOAs; ages 70+) completed the Night Out Task (NOT); an open-ended functional assessment in which participants complete eight subtasks in preparation for a night out with a friend (e.g. prepare tea and gather items for a recipe). The NOT measures both primary outcome variables (e.g. time and accuracy), error types and 'compensation variables', which are process-approach variables intended to map on to the types of compensatory strategies individuals use in their everyday lives (e.g. planning and checking). Results: Results revealed that YAs performed better than the oldest group on the NOT in accuracy, execution time and number of both inefficient and inaccurate/incomplete errors. YAs additionally used fewer compensatory strategies than both older groups. Only one compensation variable had a positive relationship to outcome; double-checking was related to improved accuracy and fewer inaccurate/incomplete errors within the oldest cohort. Conclusion: Together these findings support a spectrum of functional change with age. While compensation use increased with age, the relationship between compensation use and outcome was unclear. Future work is needed to understand under what conditions older adults' self-initiate compensation use and to understand the relationship between compensation use and outcome.

The Role of Body Mass Index, Advanced Age, and Low Educational Attainment in Mild Cognitive Impairment among the Older Adult Population: A Study in a Rural Area in Indonesia

This study evaluated the prevalence of mild cognitive impairment (MCI) and factors associated with MCI among older adults in a rural area of Indonesia. This cross-sectional study was conducted in a rural area of East Java, Indonesia. Four hundred and twenty-seven older adults aged ≥60 years were included in the study. MCI was assessed using the Brain Health Test Cognitive Tool. Data related to possible risk factors were obtained using semi-structured questionnaires. The indirect body mass index was determined based on ulnar length. The prevalence of MCI was 12.9%. Being underweight (<18.5 kg/m2) (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.17-4.97; p = 0.016), requiring assistance to manage money or medications (OR, 2.72; 95% CI, 1.02-7.23; p = 0.045), age ≥70 years (OR, 2.50; 95% CI, 1.11-5.60; p = 0.026), and having an educational attainment of ≤6 years (OR, 4.92; 95% CI, 1.92-12.60; p = 0.001) were significantly associated with MCI. In this Indonesian older adult population, underweight people who had an educational attainment of <6 years, those aged ≥70 years, and those who needed assistance to manage money or medications were more likely to have MCI.

Preoperative Quality of Life and Mental Health Can Predict Postoperative Outcomes and Quality of Life after Colorectal Cancer Surgery

Background and Objectives: It remains unclear which domains of preoperative health-related quality of life (HRQOL) and mental health are predictive of postoperative clinical and patient-reported outcomes in colorectal cancer (CRC) patients. Materials and Methods: A prospective cohort of 78 CRC patients undergoing elective curative surgery was recruited. The EORTC QLQ-C30 and HADS questionnaires were administered preoperatively and one month after surgery. Results: Preoperative cognitive functioning scores (95% CI 0.131-1.158, p = 0.015) and low anterior resection (95% CI 14.861-63.260, p = 0.002) independently predicted poorer 1-month postoperative global QOL. When postoperative complications were represented using the comprehensive complication index (CCI), poorer preoperative physical function scores were associated with higher CCI scores (B = -0.277, p = 0.014). Preoperative social function score (OR = 0.925, 95% CI 0.87 to 0.99; p = 0.019) was an independent predictor for 30-day readmission, while physical functioning score (OR = -0.620, 95% CI -1.073--0.167, p = 0.008) was inversely related to the length of hospitalization. The overall regressions for 1-month postoperative global QOL (R²: 0.546, F: 1.961, p = 0.023) and 30-day readmission (R²: 0.322, χ2: 13.129, p < 0.001) were statistically significant. Conclusions: Various QLQ-C30 domains were found to be predictive of postoperative outcomes, including complications, readmission, and length of hospitalization. Preoperative cognitive dysfunction and low AR were independent predictors of poorer postoperative global QOL. Future research should seek to examine the efficacy of targeting specific baseline QOL domains in improving clinical as well as patient-reported outcomes after CRC surgery.

Subjective Aging Difficulties among Older Adults with Subjective Cognitive Decline

In older adults, subjective cognitive decline (SCD) may progress to an early stage of dementia. Yet, its association with subjective daily functional difficulties in aging is less well studied by experiences of mentally unhealthy days (MUDs). Employing a cross-sectional design approach, we analyzed the Behavioral Risk Factor Surveillance System dataset on 7429 older adults with SCD (aged 65 to >80, 45% males, 55% females) to explore SCD in instrumental daily activities of living (SCD-IADLs) and healthcare access mediation by MUDs and moderated mediation by age cohort, controlling gender and education. The bias-corrected percentile bootstrap with 5000 samplings revealed that MUDs partially mediate the relationship between SCD-IADLs and healthcare access, with a 28.2% mediating effect. Age cohort moderated the relationship between healthcare access and MUDs, MUDs and SCD-IADLs. Specifically, the predictive effects from healthcare access to MUDs and MUDs to SCD-IADLs were more profound in the 70-74 age cohort.

Subjective Functional Difficulties and Subjective Cognitive Decline in Older-Age Adults: Moderation by Age Cohorts and Mediation by Mentally Unhealthy Days

Background and Objectives: Despite the expected positive association between subjective functional difficulties (SFD) and subjective cognitive decline (SCD), their mediation by mentally unhealthy days (MUDs) is under-studied. Moreover, few SCD studies have examined affective reactivity to functional difficulties by age cohort. This study examined the mediation effect of MUDs on the association between SFD and SCD by age cohorts' moderation among older adults. Methods: Using a cross-sectional design approach, we used the 2019 BRFSS dataset on 13,377 older adults aged 65 to ≥80 (44% males and 56% females). Results: The bias-corrected percentile bootstrap with 5000 samplings revealed that MUDs partially mediate the relationship between SFD and SCD (14.12% mediation effect), controlling depressive symptoms, education, income levels, and race. Age cohorts moderated the relationship between SFD and SCD and between SFD and SCD but not between MUDs and SCD. The predictive effects of the path from SFD to MUDs and from MUDs to SCD were stronger in the younger-old (65-69) than the middle-old (70-79) and oldest-old (≥80) age cohorts. Worse SCD was associated with being Asian, in female older adults, and in those with lower education and income levels. Conclusions: These findings extend the chronic stress theory predictions that accentuated emotional vulnerability to subjective functional difficulties may magnify SCD, particularly in the younger-old age group. By implication, preventive SCD interventions should seek to support younger-old adults in their activities of daily life for successful aging transitioning into older-age cohorts.

Cognitive impairment in daily life (CID): A double-faced instrument to detect changes and impairments in activities of daily living for people with suspected cognitive impairment

BACKGROUND

Assessment of cognitive function and its consequences for activities of daily living is an important part of a dementia evaluation. To describe patients' functional impairment accurately, a feasible instrument is needed. The Cognitive Impairment in Daily Life (CID) is an instrument developed with that purpose.

AIM

To describe and compare self- and proxy-reported difficulties in everyday life in patients undergoing a dementia investigation, measured by CID. A secondary aim was to compare the results between those who were diagnosed with dementia versus those without dementia.

METHOD

Self- and proxy-reported data using CID in 77 cases in dementia investigations. Of those, 32 were diagnosed with dementia and were compared to those without dementia (n = 45). Descriptive statistics.

RESULTS

When comparing self-reported and proxy-reported activity problems, most activities differed significantly. Proxies reported more difficulties than patients did. When comparing no dementia and dementia groups, significant differences were shown regarding initiative, planning and performance but not for memory and attention estimated by the patient themselves. Proxies differed significantly from patients in all tasks.

CONCLUSION

Overall, proxies reported that patients had more difficulties than patients reported themselves. The CID seems to be usable in dementia investigations and the results highlight the importance of involving both patients and relatives.

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

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

Association of retinal thickness and microvasculature with cognitive performance and brain volumes in elderly adults

BACKGROUND

Retinal structural and microvascular changes can be visualized and have been linked with cognitive decline and brain changes in cerebral age-related disorders. We investigated the association between retinal structural and microvascular changes with cognitive performance and brain volumes in elderly adults.

MATERIALS AND METHODS

All participants underwent magnetic resonance imaging (MRI), and a battery of neuropsychological examinations. Macula retinal thicknesses (retinal nerve fiber layer, mRNFL, and ganglion cell-inner plexiform layer, GCIPL) were imaged and measured with swept-source optical coherence tomography (SS-OCT) while Optical Coherence Tomography Angiography (OCTA) imaged and measured the superficial vascular complex (SVC) and deep vascular complex (DVC) of the retina.

RESULTS

Out of the 135 participants, 91 (67.41%) were females and none had dementia. After adjusting for risk factors, Shape Trail Test (STT)-A correlated with SVC (P < 0.001), DVC (P = 0.015) and mRNFL (P = 0.013) while STT-B correlated with SVC (P = 0.020) and GCIPL (P = 0.015). mRNFL thickness correlated with Montreal Cognitive Assessment (MoCA) (P = 0.007) and Stroop A (P = 0.030). After adjusting for risk factors and total intracranial volume, SVC correlated with hippocampal volume (P < 0.001). Hippocampal volume correlated (P < 0.05) with most cognitive measures. Stroop B (P < 0.001) and Stroop C (P = 0.020) correlated with white matter volume while Stroop measures and STT-A correlated with gray matter volume (P < 0.05).

CONCLUSION

Our findings suggest that the retinal structure and microvasculature can be useful pointers for cognitive performance, giving a choice for early discovery of decline in cognition and potential early treatment.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Bidirectional relationship between cognitive function and loss hierarchy of activities of daily living among older adults with disabilities in urban China: a cross-lagged analysis

OBJECTIVES

The present study aimed to determine the bidirectional relationship between cognitive function and the loss hierarchy of activities of daily living (ADL) among older adults in China.

DESIGN

Data were derived from the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai (2010-2013).

SETTING

Community-dwelling older adults and their primary caregivers were invited to participate in this research.

PARTICIPANTS

The inclusion criteria for the older adults were as follows: (a) have a Shanghai urban household registration status, (b) be 75 years old or older, (c) have no fewer than two limitations in ADLs or equivalent, and (d) have one primary caregiver aged 18 years or older. 469 older adults cared by their spouses or children were included in the final analytical sample of this research.

PRIMARY AND SECONDARY OUTCOME MEASURES

Cognitive function was assessed using the Chinese version of the Short Portable Mental Status Questionnaire and ADLs were measured by self-reports of having difficulty or needing help with basic daily activities.

RESULTS

Cognitive function in 2010 was a significant predictor of intermediate loss of ADLs in 2013 (β=-0.13, p<0.05) and late loss of ADLs in 2013 (β=-0.17, p<0.01). The loss hierarchy of ADLs among older adults was not shown to be significant as a risk factor of cognitive function in 2013.

CONCLUSIONS

Practitioners are encouraged to adopt the ADL loss hierarchy as a supplementary needs assessment tool to make the social service delivery process more effective, economical and tailored. Cognitive function change monitoring programmes and services providing education on nutrition and encouraging social participation of older individuals were also helpful in promoting the quality of life of the older adults.

T2DM patients with depression have higher levels of hyperglycemia and cognitive decline than T2DM patients

The cognitive impairment, depression, a decrease in the ability to perform activities of daily living (ADLs), and salivary gland dysfunction, as indicated by the reduction of alpha-amylase activity, have been reported in patients with type 2 diabetes (T2DM). However, the effects of depression on cognitive function, salivary alpha-amylase activity, and ADLs in T2DM patients have never been investigated. In this study, 115 participants were divided into three groups, including 30 healthy people, 50 T2DM patients without depression, and 35 T2DM patients with depression. Then, the cognitive function, the level of depression, salivary-alpha amylase activity, ADLs, and metabolic parameters were determined. Results showed that T2DM patients had hyperglycemia and cognitive impairment. A decrease in the salivary alpha-amylase activity was observed in T2DM patients. Interestingly, T2DM patients with depression had higher level of hyperglycemia and cognitive impairment than T2DM patients. Additionally, cognitive function was associated with the salivary-alpha amylase activity in T2DM without depression, while the severity of depression was associated with the salivary-alpha amylase activity in T2DM patients with depression. Therefore, we concluded that T2DM caused the impairment of metabolism, decreased salivary alpha-amylase activity, and cognitive impairment. Furthermore, T2DM patients with depression had higher level of hyperglycemia and cognitive decline than T2DM patients.

Methodological Issues in Advancing the Status of Functional Cognitive Assessment

Many individuals in acute hospital and post-acute care settings experience changes in their capacity to perform complex activities of daily living associated with deficits in functional cognition. Occupational therapists regularly assess and treat these occupational performance deficits. The construct of functional cognition offers oportunities for occupational therapists to define an approach to cognition that is both distinct from that of other disciplines and that supports evidence-based interventions. This article provides a rationale for performance-based assessment of functional cognition and an overview of the methodological issues associated with the development and implementation of reliable and valid screening and comprehensive asseements of functional.

Daily Living Subjective Cognitive Decline Indicators in Older Adults with Depressive Symptoms: A Scoping Review and Categorization Using Classification of Functioning, Disability, and Health (ICF)

(1) Background: This scoping review identifies subjective cognitive decline (SCD) indicators in ADLs and instrumental activities of daily living (IADLs) in older adults with depressive symptoms using the WHO International Classification of Functioning, Disability, and Health (ICF). (2) Methods: We searched Medline via Ebscohost, Pubmed, and PsycINFO for articles published on activities of daily living (ADL) indicators of SCD in older adults with depressive symptoms, published in English language journals from January 2011 to November 2021. Following the flow diagram, 2032 titles and abstracts were screened for relevance based on the Population, Concept, and Context inclusion and exclusion criteria. (3) Results: Eight articles provided evidence about the ADL indicators of SCD in older adults with depressive symptoms. The analysis yielded indicators based on low and high cognitively demanding tasks assessed on five different scales. Framed on the ICF categorization and coding system, the SCD-ADL indicators are personal care, mobility, and general tasks and demands; SCD-IADL indicators are mobility, general tasks and demands, learning and applying knowledge, domestic life, communication, major life areas, and community, social, and civic life. (4) Conclusion: Highly cognitively demanding activities present more difficulties for individuals with SCD, making IADLs a stronger predictor of SCD than ADLs.

Enhancing Brain Connectivity With Infra-Low Frequency Neurofeedback During Aging: A Pilot Study

Aging is associated with decreased functional connectivity in the main brain networks, which can underlie changes in cognitive and emotional processing. Neurofeedback is a promising non-pharmacological approach for the enhancement of brain connectivity. Previously, we showed that a single session of infra-low frequency neurofeedback results in increased connectivity between sensory processing networks in healthy young adults. In the current pilot study, we aimed to evaluate the possibility of enhancing brain connectivity during aging with the use of infra-low frequency neurofeedback. Nine females aged 52 ± 7 years with subclinical signs of emotional dysregulation, including anxiety, mild depression, and somatoform symptoms, underwent 15 sessions of training. A resting-state functional MRI scan was acquired before and after the training. A hypothesis-free intrinsic connectivity analysis showed increased connectivity in regions in the bilateral temporal fusiform cortex, right supplementary motor area, left amygdala, left temporal pole, and cerebellum. Next, a seed-to-voxel analysis for the revealed regions was performed using the post- vs. pre-neurofeedback contrast. Finally, to explore the whole network of neurofeedback-related connectivity changes, the regions revealed by the intrinsic connectivity and seed-to-voxel analyses were entered into a network-based statistical analysis. An extended network was revealed, including the temporal and occipital fusiform cortex, multiple areas from the visual cortex, the right posterior superior temporal sulcus, the amygdala, the temporal poles, the superior parietal lobule, and the supplementary motor cortex. Clinically, decreases in alexithymia, depression, and anxiety levels were observed. Thus, infra-low frequency neurofeedback appears to be a promising method for enhancing brain connectivity during aging, and subsequent sham-controlled studies utilizing larger samples are feasible.

Mixed Reality Prototype of Multimodal Screening for Early Detection of Cognitive Impairments in Elderly Individuals: Protocol Development and Usability Study (Preprint)

Background

The early diagnosis of cognitive impairments is an important step in the adequate management of dementia. The project “Smart Cognition & Behaviour Screening powered by Augmented Reality” (SCOBES-AR) aims to develop a multimodal screening tool (MST) for the early detection of cognitive impairments using augmented and virtual reality. The first project phase selected validated assessments for combination with the MST and tested it in 300 healthy older adults.

Objective

This study established a protocol for the implementation and usability of a mixed reality (MR)–enhanced multidisciplinary screening tool for the early detection of cognitive impairments in older adults. The developed MST will be partially enhanced by MR, which is a combination of augmented reality (AR) and virtual reality (VR). This MR-enhanced prototype of the screening tool (MR-MST) will be tested and compared to the previously developed MST. The usability of the prototype will also be examined.

Methods

This single-center observational crossover design study screens 100 healthy participants (aged 60-75 years) for cognitive decline using a specially developed MST (assessment of cognitive functions, olfactory sensitivity, nutritional preferences, gait parameters, reaction times, and activities of daily living) and an MR-enhanced MST in which the assessments of cognitive functions, reaction time, activities of daily living, and gait will be performed using tailor-made software and AR and VR hardware. The results of the MR-enhanced MST will be compared to those without MR. The usability of the developed MR-enhanced MST will be tested on 10 investigators and 10 test participants using observed summative evaluation and the codiscovery method, and on 2 usability experts using the codiscovery and cognitive walkthrough methods.

Results

This study was funded by the Austrian Research Promotion Agency (grant 866873) and received approval from the ethics committee of the Medical University of Graz. The MR-MST and the experimental protocol for this study were developed. All participants gave written informed consent. As of July 15, 2022, a total of 70 participants have been screened. Data analysis and dissemination are scheduled for completion by September 2023.

Conclusions

The development and testing of the MR-MST is an important step toward the establishment of the best practice procedure for the implementation of AR and VR in the screening of cognitive declines in older adults. It will help improve our knowledge of the usability and applicability of the developed prototype and promote further advancement in AR and VR technologies to be used in therapeutic settings.

International Registered Report Identifier (IRRID)

DERR1-10.2196/39513

Social Interaction, Lifestyle, and Depressive Status: Mediators in the Longitudinal Relationship between Cognitive Function and Instrumental Activities of Daily Living Disability among Older Adults

(1) Background: Cognitive decline is associated with instrumental activities of daily living (IADL) disability. Intervention targeting the mediators of this association will provide a path to avoid cognition-related IADL disability. (2) Methods: This study used data of wave 2008 (baseline) and wave 2014 of Chinese Longitudinal Healthy Longevity Surveys. Structural equation modeling was conducted to examine the mediating effect of social interaction, lifestyle (fruit and vegetable intake; exercise habits), and depressive status on the association between four baseline cognitive function dimensions (measured by the Chinese version of the Mini-Mental State Examination) and five (2014) IADL dimensions (visiting neighbors, shopping, preparing meals, washing clothes, and taking public transportation). (3) Results: Among 1976 older adults, 29.1% developed IADL disability 6 years later. The cognition−disability association was completely mediated by social interaction (estimate = −0.095, p < 0.001), lifestyle (estimate = −0.086, p < 0.001), and depressive status (estimate = −0.017, p = 0.003). The mediating effects of social interaction (46.3% variances explained) and lifestyle (42.0% variances explained) were both larger than that of depressive status (8.3% variances explained). (4) Conclusions: The development of interventions aimed at improving social interaction, depression, and lifestyle could be of value to prevent cognition-related IADL disability.

Cognitive reserve, cognition, and real-world functioning in MCI: A systematic review and meta-analysis

OBJECTIVE

To synthesize quantitatively the mild cognitive impairment (MCI) literature with respect to the relationship between cognitive reserve and neuropsychological and functional outcomes.

METHOD

Participants with a diagnosis of MCI (total n = 7,871; 53% female) were included in this random-effects meta-analysis. Neuropsychological measures were combined into composite scores (e.g., overall cognitive functioning, screening measures, memory, language, visuospatial, attention/processing speed/working memory, executive functioning, and motor functioning). Measures assessing real-world abilities were combined into an activities of daily living (ADL) composite.

RESULTS

Nearly all neuropsychological composite values were significantly correlated with education, with effect sizes ranging from small to moderate. The effect between overall neuropsychological functioning and occupation was weak and varied by cognitive domain. For cognitively stimulating leisure activity, only overall neuropsychological functioning demonstrated a significant relationship, with a weak effect size (r = .16). In contrast, ADLs were most strongly associated with leisure experience (r = .27), with a negligible relationship with education (r = 0.08) and occupation (r = 0.09).

CONCLUSIONS

Of the cognitive reserve proxies examined in this study, participation in leisure activity had the largest magnitude of effect size with ADL functioning. This was in stark contrast to the negligible relationship found for education and occupation. Although education has been widely considered the most important cognitive reserve proxy with respect to cognition, this work questions whether other lifestyle factors may play a more important role in preserving real world functioning.

Trends in Research on Traditional Chinese Health Exercises for Improving Cognitive Function: A Bibliometric Analysis of the Literature From 2001 to 2020

Although previous studies have investigated the ability of traditional Chinese health exercises (TCHEs) to improve cognitive function, few have utilized bibliometric analyses to address this topic. We aimed to investigate the current status of and developmental trends in this field from 2001 to 2020. We searched the Web of Science Core Collection (WoSCC) for all research publications on cognitive function in relation to TCHEs. CiteSpace V was used to analyze the number of papers, countries, institutions, journals, authors, and citations. We identified hotspots and trends in the field by drawing co-citation reference and co-occurrence keyword maps. From 2001 to 2020, 406 relevant articles were published in the WoSCC, with a gradual increase in the annual number of publications. The three countries/regions with the most publications were the Chinese mainland, the United States, and Canada. Six universities from China and four from the United States were identified as the top 10 institutions. Most research was conducted at universities. Evidence-based Complementary and Alternative Medicine was identified as the most productive journal. Together, these findings indicate that TCHEs have received increasing attention as a method for improving cognition.

Association between depressive symptoms, metabolic risk factors, and cognitive function: cross-sectional results from a community study in Quebec, Canada

OBJECTIVE

To investigate the cross-sectional association between depressive symptoms and metabolic risk factors with cognitive function in a middle-aged population.

METHODS

A stratified subsample of the CARTaGENE (CaG) cohort (n = 1991) was used to compare cognitive function outcomes between groups. The stratification was based on the presence of depressive symptoms and metabolic dysregulation (MetD): the presence of a) neither condition (reference group); b) MetD only; c) depressive symptoms only; and d) both depressive symptoms and MetD. Individuals with type 2 diabetes were excluded. Three cognitive domains were assessed: processing speed, episodic memory, and executive function. An overall cognitive function score, standardized for age and education, was computed. Poor cognitive function was defined as the lower quartile of the overall cognitive function distribution. Linear and logistic regression analyses were conducted.

RESULTS

The poorest cognitive performance was observed in the group with both depressive symptoms and MetD, followed by the group with depressive symptoms only, then the group with MetD only and the reference group. Mean (SD) overall cognition scores for the four groups were -0.25 (1.13), -0.13 (1.05), 0.11 (0.90), and 0.15 (0.93), respectively. Linear regression analyses suggested a linear increase in cognitive function across groups.In the logistic regression analyses, the highest risk of poor cognitive function was observed in the comorbid (depressive symptoms and MetD) group (adjusted OR = 1.99, 95% CI 1.46, 2.71).

CONCLUSION

Comorbidity of depressive symptoms and MetD was associated with reduced cognitive performance in middle-aged adults without diabetes.KEY POINTSPoor cognitive function is a major public health concern and can be potentially prevented by targeting its modifiable risk factors.Metabolic dysregulation and depression have both been independently associated with poor cognitive function.Comorbidity of metabolic dysregulation and depressive symptoms is associated with an increased risk of poor cognitive function in middle-aged individuals.Future health interventions might benefit by screening for comorbidity in patients with poor cognitive function and by targeting depression and metabolic dysregulation together.

Adaptation and Validation of the Memory Alteration Test (M@T) in Greek Middle-Aged, Older, and Older-Old Population with Subjective Cognitive Decline and Mild Cognitive Impairment

BACKGROUND

The Memory Alteration Test (M@T) is a verbal episodic and semantic memory screening test able to detect subjective cognitive decline (SCD) and Mild Cognitive Impairment (MCI).

OBJECTIVE

To adapt M@T, creating a Greek version of the Memory Alteration Test (M@T-GR), and to validate M@T-GR compared to the Mini-Mental State Examination (MMSE), and Subjective Cognitive Decline- Questionnaire (SCD-Q) MyCog and TheirCog.

METHODS

232 people over 55 years old participated in the study and they were classified as healthy controls (HC, n = 65), SCD (n = 78), or MCI (n = 89).

RESULTS

The ANCOVA showed that the M@T-GR's total score was significantly different in HC and SCD (I-J = 2.26, p = 0.032), HC and MCI (I-J = 6.16, p < 0.0001), and SCD compared to MCI (I-J = 3.90, p < 0.0001). In particular, a cut-off score of 46.50 points had an 81%sensitivity and 61%specificity for discriminating HC from SCD (AUC = 0.76, p < 0.0001), while a cut-off score of 45.50 had a sensitivity of 92%and a specificity of 73%for discriminating MCI (AUC = 0.88, p < 0.0001), and a cut-off score of 45.50 points had a sensitivity of 63%and a specificity of 73%for discriminating SCD from those with MCI (AUC = 0.69, p < 0.0021). Exploratory factor analysis indicated that there was one factor explaining 38.46%of the total variance. Internal consistency was adequate (α= 0.75), while convergent validity was found between M@T-GR and MMSE (r = 0.37, p < 0.0001) and SCD-Q TheirCog (r = -0.32, p < 0.0001).

CONCLUSION

The M@T-GR is a good to fair screening tool with adequate discriminant validity for administration in people with SCD and MCI in Greece.

Dynamic reciprocal relationships between cognitive and functional declines along the Alzheimer's disease continuum in the prospective COGICARE study

BACKGROUND

Thoroughly understanding the temporal associations between cognitive and functional dimensions along the dementia process is fundamental to define preventive measures likely to delay the disease's onset. This work aimed to finely describe the trajectories of cognitive and functional declines, and assess their dynamic bidirectional relationships among subjects at different stages of the dementia process.

METHODS

We leveraged extensive repeated data of cognition and functional dependency from the French prospective COGICARE study, designed to better characterize the natural history of cognitive and functional declines around dementia diagnosis. Cognition was measured by the Mini-Mental State Examination, the Isaacs Set Test for verbal fluency, the Benton Visual Retention Test for visuo-spatial memory, and Trail Making Test Part B for executive functioning. Functional dependency was measured by basic and instrumental activities of daily living. The study included 102 cognitively normal, 123 mildly cognitively impaired, and 72 dementia cases with a median of 5 repeated visits over up to 57 months. We used a dynamic causal model which addresses the two essential issues in temporal associations assessment: focusing on intra-individual change and accounting for time.

RESULTS

Better cognitive abilities were associated with lower subsequent decline of the functional level among the three clinical stages with an intensification over time but no reciprocity of the association whatever the clinical status.

CONCLUSION

This work confirms that the progressive functional dependency could be induced by cognitive impairment. Subjects identified as early as possible with clinically significant cognitive impairments could benefit from preventive measures before the deterioration of activities of daily living and the appearance of dementia clinical signs.

Association of self-perceived income sufficiency with cognitive impairment among older adults: a population-based study in India

BACKGROUND

Greater cognitive performance has been shown to be associated with better mental and physical health and lower mortality. The present study contributes to the existing literature on the linkages of self-perceived income sufficiency and cognitive impairment. Study also provides additional insights on other socioeconomic and health-related variables that are associated with cognitive impairment in older ages.

METHODS

Data for this study is derived from the 'Building Knowledge Base on Population Ageing in India'. The final sample size for the analysis after removing missing cases was 9176 older adults. Descriptive along with bivariate analyses were presented to show the plausible associations of cognitive impairment with potential risk factors using the chi-square test. Also, binary logistic regression analysis was performed to provide the relationship between cognitive impairment and risk factors. The software used was STATA 14.

RESULTS

About 43% of older adults reported that they had no source of income and 7.2% had income but not sufficient to fulfil their basic needs. Older adults with income but partially sufficient to fulfil their basic needs had 39% significantly higher likelihood to suffer from cognitive impairment than older adults who had sufficient income [OR: 1.39; OR: 1.21-1.59]. Likelihood of cognitive impairment was low among older adults with asset ownership than older adults with no asset ownership [OR: 0.83; CI: 0.72-0.95]. Again, older adults who work by compulsion (73.3%) or felt mental or physical stress due to work (57.6%) had highest percentage of cognitive impairment. Moreover, older adults with poor self-rated health, low instrumental activities of daily living, low activities of daily living, low subjective well-being and low psychological health were at increased risk for cognitive impairment.

CONCLUSION

The study highlights the pressing need for care and support and especially financial incentives in the old age to preserve cognitive health. Further, while planning geriatric health care for older adults in India, priority must be given to financially backward, with no asset ownership, with poor health status, older-older, widowed, and illiterate older individuals, as they are more vulnerable to cognitive impairment.

Cognitive impairment in sporadic cerebral small vessel disease: A systematic review and meta-analysis

This paper is a proposal for an update on the characterization of cognitive impairments associated with sporadic cerebral small vessel disease (SVD). We pose a series of questions about the nature of SVD-related cognitive impairments and provide answers based on a comprehensive review and meta-analysis of published data from 69 studies. Although SVD is thought primarily to affect executive function and processing speed, we hypothesize that SVD affects all major domains of cognitive ability. We also identify low levels of education as a potentially modifiable risk factor for SVD-related cognitive impairment. Therefore, we propose the use of comprehensive cognitive assessments and the measurement of educational level both in clinics and research settings, and suggest several recommendations for future research.

Differences between episodic and semantic memory in predicting observation-based activities of daily living in mild cognitive impairment and Alzheimer's disease

Individuals with mild cognitive impairment (MCI) can often progress into Alzheimer's Disease (AD). Research suggests that decline in episodic memory and semantic memory, as well as functional abilities, can be sensitive in predicting disease progression. This study aimed to (a) investigate episodic and semantic memory performance differences between AD and MCI, (b) determine if memory performance predicts observation-based activities of daily living (ADLs), and (c) explore whether semantic memory mediates the relationship between episodic memory and ADLs. Fifty-eight AD, 53 MCI, and 72 healthy control participants were administered the Rey-O, California Verbal Learning Test, Animal Fluency Test, Boston Naming Test, and Direct Assessment of Functional Status (DAFS). The results revealed, first, that AD participants performed significantly lower than the MCI participants across semantic memory and episodic memory tasks, with the exception of the Boston Naming Test. Second, hierarchical-stepwise regression analyses found that semantic memory significantly predicted DAFS orientation, communication, and financial skills in AD, but episodic memory predicted shopping skills. Furthermore, semantic memory significantly predicted DAFS transportation skills in AD and MCI. Third, within the overall sample, semantic memory mediated the relationship between episodic memory and ADLs. Taken together, the findings suggest decline in semantic memory (as measured by confrontational naming and category fluency) and episodic memory (as measured by list and complex visual design learning and recall) may lead to decline in different and specific aspects of functional abilities in AD and MCI.

Activities of Daily Living and Categorization Skills of Elderly with Cognitive Deficit: A Preliminary Study

Cognitive dysfunction affects the performance of Activities of Daily Living (ADL) and the quality of life of people with these deficits and their caregivers. To the knowledge of the authors, to date, there are few studies that focus on knowing the relationship between personal autonomy and deductive reasoning and/or categorization skills, which are necessary for the performance of the ADL. The aim of this study was to explore the relationships between ADL and categorization skills in older people. The study included 51 participants: 31 patients with cognitive impairment and 20 without cognitive impairment. Two tests were administered to assess cognitive functions: (1) the Montreal Cognitive Assessment (MoCA); and (2) the digital version of Riska Object Classification test (ROC-d). In addition, the Routine Tasks Inventory-2 (RTI-2) was applied to determine the level of independence in activities of daily living. People with cognitive impairment performed poorly in categorization tasks with unstructured information (p = 0.006). Also, the results found a high correlation between cognitive functioning and the performance of ADLs (Physical ADL: r = 0.798; p < 0.001; Instrumental ADL: r = 0.740; p < 0.001), a moderate correlation between Physical ADLs and categorization skills (unstructured ROC-d: r = 0.547; p < 0.001; structured ROC-d: r = 0.586; p < 0.001) and Instrumental ADLs and categorization skills in older people (unstructured ROC-d: r = 0.510; p < 0.001; structured ROC-d: r = 0.463; p < 0.001). The ROC-d allows the assessment of categorization skills to be quick and easy, facilitating the assessment process by OT, as well as the accuracy of the data obtained.

Trajectories of decline on instrumental activities of daily living prior to dementia in persons with mild cognitive impairment

OBJECTIVES

The main objective was to determine the trajectory of instrumental activities of daily living (iADL) decline in persons with mild cognitive impairment (MCI) who progressed towards dementia relative to persons with MCI who remained stable.

METHODS/DESIGN

At study entry, 121 participants met criteria for MCI. Based on the follow-up, 47 participants later converted to dementia and were identified as progressors. Sixteen participants, identified as decliners, presented a significant cognitive decline but did not reach the criteria for dementia within the study timeframe. Stable MCI remained cognitively stable during the 5-year follow-up; n = 58. Participants completed a yearly assessment using clinical tests/questionnaires, neuropsychological measures, and functional autonomy assessment until they met criteria for dementia. The average number of months for the follow-up was 34.

RESULTS

Many years of stable performance followed by an accelerated decline just prior to diagnosis, was observed for complex activities for progressors. No change was found for stable MCI and a gradual linear decline characterized decliners. The housekeeping-related activities component showed a linear decline in progressors and did not change in stable and decliner MCI. We found a predictive model that includes significant predictors of dementia conversion with a high diagnostic accuracy the following year (area under the curve = 0.94 [95% confidence level; lower bound: 0.87, upper bound: 1]).

CONCLUSIONS

It is critical to assess iADL that reflect complex activities in the evaluation of MCI individuals as their impairment, combined with change on cognitive markers, indicates a higher risk of dementia progression 1 or 2 years later.

Predementia constructs: Mild cognitive impairment or mild neurocognitive disorder? A narrative review

BACKGROUND

Predementia is a heuristic umbrella concept to classify older adults with cognitive impairment who do not suffer dementia. Many diagnostic entities have been proposed to address this concept, but most of them have not had widespread acceptance.

AIMS

To review clinical definitions, epidemiologic data (prevalence, incidence) and rate of conversion to dementia of the main predementia constructs, with special interest in the two most frequently used: mild cognitive impairment (MCI) and minor neurocognitive disorder (miNCD).

METHODS

We have selected in three databases (MEDLINE, Web of Science and Google scholar) the references from inception to 31 December 2019 of relevant reviews, population and community-based surveys, and clinical series with >500 participants and >3 years follow-up as the best source of evidence.

MAIN RESULTS

The history of predementia constructs shows that MCI is the most referred entity. It is widely recognized as a clinical syndrome harbinger of dementia of several etiologies, mainly MCI due to Alzheimer's disease. The operational definition of MCI has shortcomings: vagueness of its requirement of "preserved independence in functional abilities" and others. The recent miNCD construct presents analogous difficulties. Current data indicate that it is a stricter predementia condition, with lower prevalence than MCI, less sensitivity to cognitive decline and, possibly, higher conversion rate to dementia.

CONCLUSIONS

MCI is a widely employed research and clinical entity. Preliminary data indicate that the clinical use of miNCD instead of MCI requires more scientific evidence. Both approaches have common limitations that need to be addressed.

Assessing functional status using the IADL-extended scale: results from the HELIAD study

OBJECTIVES

Instrumental activities of daily living (IADL) have been operationalized as exhibiting a greater level of complexity than basic ADL. In the same way, incorporating more advanced ADLs may increase the sensitivity of functional measures to identify cognitive changes that may precede IADL impairment. Towards this direction, the IADL-extended scale (IADL-x) consists of four IADL tasks and five advanced ADLs (leisure time activities).

DESIGN

Retrospective, cross-sectional study.

SETTING

Athens and Larissa, Greece.

PARTICIPANTS

1,864 community-dwelling men and women aged over 64.

MEASUREMENTS

We employed both the IADL-x and IADL scales to assess functional status among all the participants. Diagnoses were assigned dividing the population of our study into three groups: cognitively normal (CN), mild cognitive impairment (MCI) and dementia patients. Neuropsychological evaluation was stratified in five cognitive domains: memory, language, attention-speed, executive functioning and visuospatial perception. Z scores for each cognitive domain as well as a composite z score were constructed. Models were controlled for age, sex, education and depression.

RESULTS

In both IADL-x and IADL scales dementia patients reported the most functional difficulties and CN participants the fewest, with MCI placed in between. When we restricted the analyses to the CN population, lower IADL-x score was associated with worse cognitive performance. This association was not observed when using the original IADL scale.

CONCLUSION

There is strong evidence that the endorsement of more advanced IADLs in functional scales may be useful in detecting cognitive differences within the normal spectrum.

A French-Greek Cross-Site Comparison Study of the Use of Automatic Video Analyses for the Assessment of Autonomy in Dementia Patients

Background: At present, the assessment of autonomy in daily living activities, one of the key symptoms in Alzheimer’s disease (AD), involves clinical rating scales. Methods: In total, 109 participants were included. In particular, 11 participants during a pre-test in Nice, France, and 98 participants (27 AD, 38 mild cognitive impairment—MCI—and 33 healthy controls—HC) in Thessaloniki, Greece, carried out a standardized scenario consisting of several instrumental activities of daily living (IADLs), such as making a phone call or preparing a pillbox while being recorded. Data were processed by a platform of video signal analysis in order to extract kinematic parameters, detecting activities undertaken by the participant. Results: The video analysis data can be used to assess IADL task quality and provide clinicians with objective measurements of the patients’ performance. Furthermore, it reveals that the HC statistically significantly outperformed the MCI, which had better performance compared to the AD participants. Conclusions: Accurate activity recognition data for the analyses of the performance on IADL activities were obtained.

Identification of a Cascade of Changes in Activities of Daily Living Preceding Short-Term Clinical Deterioration in Mild Alzheimer's Disease Dementia via Lead-Lag Analysis

BACKGROUND

Cognitive functions and activities of daily living (ADL) become increasingly impaired with progressing Alzheimer's disease. However, the temporal dynamics of this decline are inconsistent.

OBJECTIVE

To gain insight into the classical temporal cascade of specific cognitive and ADL changes, which may aid in improving detection of an impending clinical deterioration in patients, and to select ADL items and tests most sensitive to change in a specific disease stage.

METHODS

Patients with mild Alzheimer's dementia (AD; MMSE = 23.9±2.88) were followed at 12 and 24 months. Lead-lag analysis of changes in cognitive and functional outcome measures (CDR-SOB, 12 neuropsychological subtest scores from the CERAD + test battery, 25 Bayer-ADL items) was applied to rank the temporal sequence of changes on an ordinal scale.

RESULTS

Of 164 patients with mild AD, moderate disease progression was identified in 84 patients over 24 months (ΔMMSE 5.8±8.64; ΔCDR-SOB 4.32±4.03). Ten Bayer-ADL item measures were altered early in moderate progressors and included in a new ADL composite score. Accordingly, the new ADL score surpassed all neuropsychological measures in repeated lead-lag analysis. The Bayer-ADL total score, TMT-A, and MMSE were lagging variables in all lead-lag analyses.

CONCLUSION

Short-term clinical deterioration in mild AD is initially preceded by changes (i.e., decline) in a well-defined set of ADL and not in classical cognitive measures.

Memory and Executive Dysfunction Predict Complex Activities of Daily Living Impairment in Amnestic Multi-Domain Mild Cognitive Impairment

BACKGROUND

Specific cognitive alterations could be one of the predictors that lead to the complex activities of daily living (CADL) impairment in mild cognitive impairment (MCI) and, hence, help to explain the continuum between MCI and dementia.

OBJECTIVE

We aimed to reevaluate the existing uncertainty regarding the impact of memory and executive functions on CADL in patients with MCI.

METHODS

Caregivers of 161 patients with amnestic multi-domain MCI and of 150 patients with incipient Alzheimer's disease as well as 100 age-, sex-, and education-matched controls, completed the Interview for Deterioration in Daily Living Activities in Dementia, a suitable instrument for the description and discrimination of CADL. In addition, all patients and controls were assessed with a neuropsychological battery to measure explicit memory and executive functions performance.

RESULTS

Multiple regression analyses showed that in the group of patients with amnestic multi-domain MCI, 67.4% of the variability of the CADL impairment was explained by worse performance on executive functions tests (p < 0.0001) and 41.8% by different explicit memory components impairment (p < 0.0001). Further, in patients with incipient AD, 44.0% of the variability of CADL impairment was explained by worse performance on executive functions tests (p < 0.0001) and 39.9% by different explicit memory components worsening (p < 0.0001).

CONCLUSIONS

Memory and executive functions alterations impact similarly on the CADL in both amnestic multi-domain MCI and incipient Alzheimer's disease. Given the continuum that exists between both conditions, we conclude that CADL impairment may be an important early step in the evolution towards Alzheimer's disease from amnestic multi-domain MCI.

Aerobic Exercise Sustains Performance of Instrumental Activities of Daily Living in Early-Stage Alzheimer Disease

BACKGROUND AND PURPOSE

Individuals with Alzheimer disease (AD) experience progressive loss of independence-performing activities of daily living. Identifying interventions to support independence and reduce the economic and psychosocial burden of caregiving for individuals with AD is imperative. The purpose of this analysis was to examine functional disability and caregiver time in individuals with early-stage AD.

METHODS

This was a secondary analysis of a randomized controlled trial of 26 weeks of aerobic exercise (AEx) versus stretching and toning (ST). We measured functional dependence using the Disability Assessment for Dementia, informal caregiver time required using the Resources Utilization in Dementia Lite, and cognition using a standard cognitive battery.

RESULTS

We saw a stable function in the AEx group compared with a significant decline in the ST group (4%; F = 4.2, P = .04). This was especially evident in more complex, instrumental activities of daily living, with individuals in the AEx group increasing 1% compared with an 8% loss in the ST group over 26 weeks (F = 8.3, P = .006). Change in memory was a significant predictor of declining instrumental activities of daily living performance (r = 0.28, 95% confidence interval = 0.08 ∞, P = .01). Informal caregiver time was not different between the AEx and ST groups.

CONCLUSIONS

Our analysis extends recent work by revealing specific benefits for instrumental activities of daily living for individuals in the early stages of AD and supports the value of exercise for individuals with cognitive impairment.

Relationship between instrumental activities of daily living performance and incidence of mild cognitive impairment among older adults: A 48-month follow-up study

Early prevention of mild cognitive impairment MCI is crucial because individuals with MCI are at high risk for progression to dementia. The purpose of the present study was to examine the relationship between the performance of instrumental activities of daily living IADL and future incidence of MCI among community-dwelling older adults in Japan. A total of 1595 individuals without cognitive impairment at baseline participated in this prospective cohort study with a 48-month follow-up period. Performance on the following IADL was assessed at baseline: handling cash and banking, shopping for necessities, going out using buses/trains, using maps to travel to unfamiliar places, and operating video/DVD players. Objective cognitive screening using the National Center for Geriatrics and Gerontology-Functional Assessment Tool and Mini-Mental State Examination was conducted at baseline and follow-up; new MCI incidence over the 48 months was determined. Of all participants, 922 (57.8 %) had a limitation in at least one IADL at baseline. During the follow-up period, 179 (11.2 %) participants experienced a transition from normal cognition to MCI. Participants who had not engaged in "going out using buses/trains" or "using maps to travel to unfamiliar places" at baseline showed a significantly higher risk of MCI incidence than those who had engaged in such activities. Limitations in outdoor IADL were associated with MCI onset. Individuals with such limitations need to be monitored, as these limitations are strong indicators of cognitive decline and MCI.

Characterizing functional alterations in instrumental activities of daily living using latent class analysis: a population-based study (NEDICES)

Background and Objectives: The existence of different patterns of functional impairment in older adults has scarcely been addressed. This research investigates major patterns of functional impairment based on Pfeffer's Functional Activity Questionnaire (FAQ).Research Design and Methods: The participants come from NEDICES (Neurological Disorders in Central Spain), a prospective population-based cohort study. A total of 3837 individuals without dementia who completed the Spanish version of the FAQ was selected. Latent Class Analysis (LCA) was carried out to examine potential cluster subgroups based on FAQ responses.Results: The FAQ showed good internal consistency (Cronbach's alpha: 0.86) and moderate correlation (r = -.40) with cognitive performance on the Mini-Mental State Examination (MMSE-37). The response patterns revealed the presence of three latent classes: absence of functional alteration (Class 1), established functional alteration (Class 2), and minimal functional alteration (Class 3). Moreover, the probability of resolving Items 2 ('shopping alone for…'), 3 ('heating water…'), 4 ('preparing a balanced meal'), and 9 ('travelling out of neighbourhood…') was close to 0% for Class 2 membership, while those with the lowest probability of resolution for Class 3 were Items 2 and 9. Items 3 and 4 were the best to discriminate between different grades of functional alterations (Class 2 vs. Class 3).Discussion and Implications: Our findings indicate that the combination of overall FAQ score and item response pattern may help to classify individuals with different subtypes of functional impairment. The Spanish version of the FAQ is a useful tool for detection of functional impairment in older adults.

Temporal precedence of cognitive function and functional abilities: A latent difference score model of the Chinese community-dwelling elders

OBJECTIVES

Little research has explored how cognitive function and activities of daily living (ADL) affect each other over time. In addition, no current finding provides a clear hint to the temporal precedence between them. The present study tries to address these limitations of prior studies by utilizing a longitudinal data and advanced statistical modeling.

METHODS

This study analyzed the data from the China Health and Retirement Longitudinal Study (CHARLS), a prospective observational study performed every 2 years for a total of three waves between 2011 and 2015 using a multistage probability sampling. Cognitive function was measured on the basis of three aspects of cognitive performance. Functional abilities were assessed using six types of activities of ADL and five types of instrumental ADL (IADL). Latent difference score modeling was employed to investigate the temporal precedence between cognitive function and ADL.

RESULTS

The best fitting model indicates poor cognitive function precede worsening in ADL function, whereas the current findings did not support that poor ADL predate the cognition decline or reciprocal influence hypotheses.

CONCLUSIONS

The elderly with poor cognitive function may be more vulnerable to deterioration in ADL. Findings underscore the importance of early screening for cognitive function among the elderly as the key strategy to prevent further ADL impairment and keep independence.

The Historical Progression From ADL Scrutiny to IADL to Advanced ADL: Assessing Functional Status in the Earliest Stages of Dementia

Background

Decrements in instrumental activities (IADL) have been observed in the prodromal phase of dementia. Given the long predementia stage in neurodegenerative diseases, it has been proposed that subtle functional changes may precede clinical IADL impairment. Incorporating more challenging advanced ADLs (eg, volunteer work) into the assessment process may increase the sensitivity of functional measures, thus expanding the window for monitoring or interventions.

Methods

Longitudinal cohort study was used (follow-ups, 18-24 month), with subjects aged 60 and older (n = 3,635). To elucidate the relationship between cognitive ability and functional status we employed an IADL scale with an extended range (ADL-extended; includes IADL but also more challenging advanced ADLs) that meets item response theory properties of dimensionality, monotonicity, and item hierarchy. Procedures involved (a) a dynamic change model employed to inspect the temporal relationship between ADL-extended and cognitive status and (b) Cox proportional hazards to assess the risk of incident dementia based on ADL-extended scores.

Results

Growth curve modeling: baseline ADL-extended was significantly associated with all four cognitive domains investigated. Worse baseline ADL-extended was associated with more rapid declines in speed/executive function, and worse baseline memory was associated with more rapid declines in ADL-extended; a concurrent association was found for language and ADL-extended. Cox model: the risk of dementia was decreased for each additional ADL-extended item endorsed (hazard ratio [HR], 0.85; 95% confidence interval = 0.81-0.90).

Conclusions

An increased risk of dementia could be observed in the ADL-extended items, which reflects an area of the functional continuum beyond IADL competencies.

Effectiveness of using assistive technology for time orientation and memory, in older adults with or without dementia

AIMS

The purposes of this study were to reveal the effectiveness of an electric calendar, showing the date and schedule automatically for older people, and to prove the characteristics of appropriate users.

MATERIAL AND METHODS

The participants were 27 older adults with or without dementia (9 men and 18 women, mean age: 81.5 ± 6.9 years, range: 72-94 years). The study design was a cross-over randomized controlled trial, with 15 participants (55.6%) allocated to the first group to use the electric calendar, and 12 participants (44.4%) to the second intervention group. The outcome measures are daily behaviors and cognitive function assessed by the Mini-Mental State Examination and Neurobehavioral Cognitive Status Examination.

RESULTS

Participants showed significant increase in total Mini-Mental State Examination score (p = 0.020, a paired t-test) after intervention period, whereas there was no significant difference after no intervention. Daily activities related healthcare were improved. The participants with positive outcomes showed higher motivations, and around 18 points in Mini-Mental State Examination. Most healthy older adults mentioned that electric calendars were useful, but unnecessary.

CONCLUSION AND SIGNIFICANCE

Using the electric calendar was effective in improving global cognitive function and daily activities. The target users are older people, who (1) might have mild dementia, (2) have difficulties in daily activities, (3) can be supported by caregivers, and (4) have positive motivation to new technologies.IMPLICATIONS FOR REHABILITATIONAn electric calendar is effective on grovel cognitive function, and activities of daily living related to healthcare in older adults, as well as reality orientation therapy.The electric calendar can be useful for older people with mild dementia or mild cognitive impairment, having difficulties activities of daily living, supported by caregivers at regular intervals.

Instrumental Activities of Daily Living: The Processes Involved in and Performance of These Activities by Japanese Community-Dwelling Older Adults with Subjective Memory Complaints

Subjective memory complaints (SMCs) may predict the onset of dementia. The purpose of this study was to clarify characteristics of performance of activities of daily living (ADL) for older adults with SMCs and to offer support options that enable them to maintain their community-based lifestyle. A self-administered questionnaire was sent to 2000 randomly selected members of CO-OP Kagoshima, and 621 responded. 270 responders answered all questions were categorized into SMC (+) group and SMC (−) group (n = 133). Participants were evaluated the Process Analysis of Daily Activity for Dementia. A 2-sample t-test or the Chi-square test were used to compare the averages of continuous variables or the proportions of categorical variables. The results showed the SMC (+) group ranked significantly lower in ability to use the telephone, shop, cook, do housekeeping, manage finances, and manage medications compared with the SMC (−) group. In addition, the SMC (+) group was significantly less independent than the SMC (−) group in many processes requiring the use of tools, operation of machines, management of goods, selection of tools, and monitoring. To enable continued independence of older adults’ experiencing SMCs, it may be important to analyze their performance of ADL and to develop plans for supporting their strengths.