Association between cognitive declines and disability in activities of daily living in older adults with COPD: evidence from the China health and retirement longitudinal study

Subjective Cognitive Decline in COPD - A Cross-Sectional Analysis of the Behavioral Risk Factor Surveillance System

BACKGROUND

Subjective cognitive decline (SCD), an early indicator of cognitive impairment, may affect COPD care and outcomes, yet its sociodemographic associations in Chronic Obstructive Pulmonary Disease (COPD) remain poorly understood.

OBJECTIVE

To investigate the prevalence of SCD among people with COPD across different age groups and identify associations between demographics, risk behaviors, comorbidities, and self-reported SCD.

DESIGN

Pooled 2019 BRFSS data from 24 states using the Cognitive Decline module were analyzed. Logistic regression assessed relationships between demographics, behaviors, comorbidities, and SCD, adjusting for confounders.

PARTICIPANTS

A total of 12,003 adults with COPD aged ≥ 45 were included in the study (weighted population = 617,792).

MAIN MEASURES

Prevalence of SCD, associations with demographics, behaviors, health status, income, employment, and smoking.

KEY RESULTS

Among adults with COPD, 24.1% reported SCD. The prevalence among those with SCD was highest in those aged 55-64 (30.2%), followed by 65-74 (24.5%) and 45-54 (23.1%). Older age (55 to 64: AOR = 0.63, 95% CI: 0.49 - 0.80; 65 to 74: AOR = 0.54, 95% CI: 0.40 - 0.72; 75 to 79: AOR = 0.41, 95% CI: 0.29 - 0.60; 80 + : AOR = 0.47, 95% CI: 0.32 - 0.69) and higher annual income (e.g., $25,000 to $49,999: AOR = 0.80, 95% CI: 0.65 - 0.99; $50,000 to $74,999: AOR = 0.68, 95% CI: 0.51 - 0.91) were associated with lower odds of reporting SCD, while unemployment (AOR = 1.73, 95% CI: 1.33 - 2.27), history of stroke (AOR = 1.35, 95% CI: 1.05 - 1.74), and fair or poor health (AOR = 0.47, 95% CI: 0.39 - 0.57) were linked to higher odds of reporting SCD.

CONCLUSIONS

Among adults with COPD, the prevalence of SCD varied by age, with the highest rates in those aged 55-64, and was independently associated with socioeconomic factors and health risks, emphasizing the complex interplay of demographic and health-related factors in SCD.

Impact and Heterogeneity of Self-reported Hearing on Trajectories of Cognitive Function in Middle-Aged and Older Couples

OBJECTIVES

Hearing status is identified as a significant predictor of cognitive function. The life course principle of linked lives posits that the lives of couples often become increasingly interconnected or embedded over time, thereby cumulatively intensifying their influence on spouse's health and well-being. We aim to examine the impact of self-reported hearing on cognitive function among married couples across adulthood and whether there is heterogeneity in the associations.

METHODS

Utilizing data from the 2011, 2013, 2015, to 2018 waves of the China Health and Retirement Longitudinal Study (n = 2,847 middle-aged and older couples, totaling 5,694 observations across all waves), we employ the growth curve model to examine the impact of self-reported hearing, both individually and from spouses, on the age-related trajectories of cognitive function.

RESULTS

This study demonstrates that poor self-reported hearing is significantly associated with worse cognitive function compared with those with good hearing. Additionally, there is a significant temporal association between poor spousal hearing and cognitive decline, compared with individuals whose spouses have good hearing. Heterogeneity analysis shows that the association between poor spousal hearing and increasing cognitive disadvantage across time is particularly significant among men and rural residents.

DISCUSSION

This research provides new evidence of the longitudinal association between hearing and cognitive function among married couples, thus contributing to a growing body of literature documenting the importance of understanding how spousal health conditions affect health trajectories.

Impact of disabilities in activities of daily living on opioid use for chronic pain in older adults: an exploratory secondary analysis from ELSI-Brazil

OBJECTIVES

Problematic use of opioids by older adults is associated with adverse effects and has become a public health crisis worldwide. Ageing-related disabilities in activities of daily living (ADL) could promote unnecessary use of opioids in this population. This study evaluates the association between ADL disability and opioid consumption in Brazilian older adults.

STUDY DESIGN

Study design- cross-sectional secondary data analysis of the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil).

METHODS

Data from the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil) were used. Older adults with chronic pain were included. ADL disability was measured using the Katz Index. The primary outcome was opioid consumption for chronic pain. The primary association was explored using logistic regression models adjusting for predetermined confounders. Sensitivity analyses evaluating model performance were done by calibrating and validating the model using randomly split equal sets.

RESULTS

In those who reported presence of chronic pain (n = 2865), the prevalence of opioid use was 29% (95% CI:23.1%-35.6%). In adjusted models, participants with moderate and severe ADL disability had 1.6 (95% CI:1.13-2.32; P = 0.009) and 3.8 (95% CI: 1.80-7.90; P < 0.001) times higher odds of opioid consumption compared to no disability, respectively. Being female, alcohol consumption, higher pain intensity, history of dementia, fractures, and presence of ≥2 comorbidities were significantly associated with increased opioid use (P < 0.05).

CONCLUSION

Nearly one-third of the Brazilian elderly population experiencing chronic pain reported using opioids. The functional decline during the process of ageing appears to be a risk factor for pain intolerance and opioid use. Multidisciplinary approaches to detect early ADL disabilities and improve mobility and access to assistive technologies need to be established to prevent opioid overuse and addiction in elderly populations.

Interactions between Cognitive, Affective, and Respiratory Profiles in Chronic Respiratory Disorders: A Cluster Analysis Approach

This study conducted at Leamna Pulmonology Hospital investigated the interrelations among cognitive, affective, and respiratory variables within a cohort of 100 patients diagnosed with chronic respiratory conditions, utilizing sophisticated machine learning-based clustering techniques. Spanning from October 2022 to February 2023, hospitalized individuals confirmed to have asthma or COPD underwent extensive evaluations using standardized instruments such as the mMRC scale, the CAT test, and spirometry. Complementary cognitive and affective assessments were performed employing the MMSE, MoCA, and the Hamilton Anxiety and Depression Scale, furnishing a holistic view of patient health statuses. The analysis delineated three distinct clusters: Moderate Cognitive Respiratory, Severe Cognitive Respiratory, and Stable Cognitive Respiratory, each characterized by unique profiles that underscore the necessity for tailored therapeutic strategies. These clusters exhibited significant correlations between the severity of respiratory symptoms and their effects on cognitive and affective conditions. The results highlight the benefits of an integrated treatment approach for COPD and asthma, which is personalized based on the intricate patterns identified through clustering. Such a strategy promises to enhance the management of these diseases, potentially elevating the quality of life and everyday functionality of the patients. These findings advocate for treatment customization according to the specific interplays among cognitive, affective, and respiratory dimensions, presenting substantial prospects for clinical advancement and pioneering new avenues for research in the domain of chronic respiratory disease management.

The bidirectional relationship between activities of daily living and frailty during short-and long-term follow-up period among the middle-aged and older population: findings from the Chinese nationwide cohort study

Objective

Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.

Methods

The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.

Results

In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)].

Conclusion

In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.

Effects of accelerated biological age on depressive symptoms in a causal reasoning framework

BACKGROUND

Depression in middle-aged and elderly individuals is multifaceted and heterogeneous, linked to biological age (BA) based on aging-related biomarkers. However, due to confounding with chronological age and the absence of subgroup analysis and causal reasoning, the association between BA and depressive symptoms (DS) might be unstable and requires further investigation.

METHODS

We utilized data from the China Health and Retirement Longitudinal Study (N = 9478) to perform association analysis, causal inference, and subgroup analysis. BA acceleration (BAA) was derived using machine learning and adjusted for chronological age. A generalized linear mixed-effects model (GLMM) tree algorithm was employed to identify subgroups. The causal reasoning frame included propensity score matching and fast large-scale almost matching exactly.

RESULTS

In the longitudinal analysis, BAA exhibited a consistent and significant positive association with DS, even after controlling for demographic characteristics, lifestyle factors, health status, and physical functions. This association remained unchanged within the causal framework. GLMM tree analysis identified three partitioning variables (sex, satisfaction, and BMI) and five subgroups. Further subgroup analysis revealed that BAA exerted the strongest effect on DS among women with less satisfying lives.

LIMITATIONS

Depressive symptoms were evaluated through scale measurements rather than clinical diagnosis. The sample was derived from the general population, not the clinically depressed population.

CONCLUSIONS

This study provided the first longitudinal evidence that biological age acceleration increases depressive symptoms under causal reasoning and subgroup analysis, particularly among less satisfied women. And the association between BAA and DS was independent of known risk factors.

Association between cognitive decline and activities of daily living decline in patients undergoing long-term oxygen therapy: a prospective observational pilot study

PURPOSE

Patients undergoing long-term oxygen therapy (LTOT) are predisposed to progressive cognitive decline; however, the association between cognitive decline progression and activities of daily living (ADL) decline has not been described. We aimed to describe the association between cognitive decline progression and ADL decline in patients undergoing LTOT.

MATERIALS AND METHODS

In this prospective observational pilot study, data were collected at baseline and 1-year following the ambulatory recruitment of patients in the Department of Respiratory Medicine at the National Hospital Organization Nishiniigata Chuo Hospital. We recruited 96 patients with chronic respiratory disease undergoing LTOT, and 55 patients who completed a 1-year follow-up were finally included.

RESULTS

Multivariate logistic regression analysis revealed that Montreal Cognitive Assessment score reduction (a measure of cognitive decline) was associated with Barthel index score reduction (a measure of ADL) at 1-year follow-up (odds ratio: 3.98; 95% confidence interval: 1.16 - 13.69; p = 0.02).

CONCLUSION

A progression of cognitive decline in patients undergoing LTOT may affect ADL decline. An early detection of cognitive decline in patients undergoing LTOT is essential for ADL maintenance in rehabilitation practice.IMPLICATIONS FOR REHABILITATIONPatients undergoing long-term oxygen therapy (LTOT) present with progressive cognitive decline.Cognitive decline progression is associated with a decline in activities of daily living in patients undergoing LTOT.A periodic cognitive assessment is important in rehabilitation practice for the early detection of progressive cognitive decline in patients undergoing LTOT.

Association of pre-stroke frailty and health-related factors with post-stroke functional independence among community-dwelling Chinese older adults

OBJECTIVES

Frailty is associated with a range of poor post-stroke outcomes. There is still a lack of comprehensive understanding of the temporal relationship between pre-stroke frailty status and other related factors with functional recovery after stroke. This study aims to evaluate pre-stroke frailty status and health-related factors associated with functional independence among community-dwelling Chinese older adults.

MATERIALS AND METHODS

The dataset based on the China Health and Retirement Longitudinal Study (CHARLS) conducted in 28 provinces across China was used. The pre-stroke frailty status was assessed using the Physical Frailty Phenotype (PFP) scale with the 2015 wave data. The PFP scale consisted of five criteria with a total score of 5, and categorized into non-frail (0 point), prefrail (1 and 2 points), and frail (3 or more points). Covariates included demographic factors (age, sex, marital status, residence, and education level) and health-related variables (comorbidities, self-reported health status and cognition). Activities of daily living (ADL) and instrumental activities of daily living (IADL) were assessed as the functional outcomes, with difficulties in at least one of the 6 ADL items and 5 IADL items defined as ADL/IADL limitation respectively. A logistic regression model was used to estimate the associations.

RESULTS

A total of 666 participants who were newly diagnosed with stroke during the 2018 wave were included. 234 (35.1%) participants were classified as non-frail, 380 (57.1%) participants were classified as prefrail, and 52 (7.8%) participants were classified as frail. Pre-stroke frailty was significantly associated with ADL and IADL limitations post stroke. Additional significant variables with ADL limitation were age, female and more comorbidities. Additional significant variables with IADL limitation were age, female, married or cohabitating, more comorbidities and pre-stroke lower global cognitive score.

CONCLUSION

Frailty status was associated with ADL and IADL limitations after stroke. A more comprehensive assessment of frailty in older people may help to identify those with most significant risk for declining functional capacities after stroke and to develop appropriate intervention strategies.

Cognitive Function and Depressive Symptoms among Chinese Adults Aged 40 Years and Above: The Mediating Roles of IADL Disability and Life Satisfaction

The purpose of this study was to investigate the relationship between cognitive function and depressive symptoms among Chinese adults aged 40 years and above, as well as the series of multiple mediating effects of Instrument Activities of Daily Living disability and life satisfaction on this relationship. The data was obtained from the China Health and Retirement Longitudinal Study (CHARLS, 2013-2018), including 6466 adults aged 40 years and above. The mean age of the adults was 57.7 ± 8.5. The SPSS PROCESS macro program was conducted to examine the mediating effects. The results indicated that there was a significant association between cognitive function and depressive symptoms five years later (B = -0.1500, 95%CI: -0.1839, -0.1161), which could also be demonstrated through three mediation pathways: (1) the mediating pathway through IADL disability (B = -0.0247, 95%CI: -0.0332, -0.0171); (2) the mediating pathway through life satisfaction (B = 0.0046, 95%CI: 0.0000, 0.0094); and (3) the chain mediation pathway through IADL disability and life satisfaction (B = -0.0012, 95%CI: -0.0020, -0.0003). Both IADL disability and life satisfaction have been proven to be crucial mediators for the relationship between cognitive function and depressive symptoms five years later. It is necessary to improve individuals' cognitive function and reduce the negative impact of disability on them, which is important to enhance their life satisfaction and prevent depressive symptoms.

Identification of biomarkers in COPD by metabolomics of exhaled breath condensate and serum/plasma

Chronic obstructive pulmonary disease (COPD) is the third cause of death worldwide, presenting poor long-term outcomes and chronic disability. COPD is a condition with a wide spectrum of clinical presentations because its pathophysiological determinants relate to tobacco smoke, genetic factors, alteration of several metabolic pathways, and oxidative stress. As a consequence, patients present different phenotypes even with comparable degrees of airflow limitation. Because of the increasing social and economic costs of COPD, a growing attention is currently payed to "omics" techniques for more personalized treatments and patient-tailored rehabilitation programs. In this regard, the systematic investigation of the metabolome (i.e., the whole set of endogenous molecules) in biomatrices, namely metabolomics, has become indispensable for phenotyping respiratory diseases. The metabolomic profiling of biological samples contains the small molecules produced during biological processes and their identification and quantification help in the diagnosis, comprehension of disease outcome and treatment response. Exhaled breath condensate (EBC), plasma and serum are biofluids readily available, with negligible invasiveness, and, therefore, suitable for metabolomics investigations. In this paper, we describe the latest advances on metabolomic profiling of EBC, plasma and serum in COPD patients.

Metabolomic profiling of exhaled breath condensate and plasma/serum in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is an increasing cause of global morbidity and mortality, with poor long-term outcomes and chronic disability. COPD is a condition with a wide spectrum of clinical presentations, with different phenotypes being identified even among patients with comparable degrees of airflow limitation. Considering the burden of COPD in terms of social and economic costs, in recent years a growing attention has been given to the need of more personalized approaches and patient-tailored rehabilitation programs. In this regard, the systematic analysis of metabolites in biological matrices, namely metabolomics, may become an essential tool in phenotyping diseases. Through the identification and quantification of the small molecules produced during biological processes, metabolomic profiling of biological samples has thus been proposed as an opportunity to identify novel biomarkers of disease outcome and treatment response. Exhaled breath condensate (EBC) and plasma/serum are fluid pools, which can be easily extracted and analyzed. In this review, we discuss the potential clinical applications of the metabolomic profiling of EBC and plasma/serum in COPD.

The mediating and moderating effects of depressive symptoms on the prospective association between cognitive function and activities of daily living disability in older adults

OBJECTIVES

This study aimed to examine to what extent depressive symptoms mediated and moderated the association between cognitive function and activities of daily living (ADL) disability in older adults.

METHODS

In older participants from the China Health and Longitudinal Retirement Survey (CHARLS), structural equation modeling and multiple regression were performed to examine the mediating and moderating role of depressive symptoms (measured by the 10-item Center for Epidemiologic Studies Depression Scale) in the association between baseline cognitive function (episodic memory, attention, orientation to time, and visuospatial ability) and endpoint disability in basic ADL (BADL) or instrumental ADL (IADL).

RESULTS

Over a 2-year follow-up, among 1677 participants (67.5 ± 6.0 years old) free of BADL disability and 1194 participants (66.9 ± 5.6 years old) free of IADL disability, 8.3% and 22.9% developed BADL disability and IADL disability, respectively. Good baseline cognitive performance was significantly associated with the reduced incidence of BADL/IADL disability. The indirect effects of baseline depressive symptoms explained 16.9% and 14.5% of the total effect between cognition and BADL and IADL dependency, respectively. The Johnson-Neyman technique identified a threshold of 7.88 for endpoint depressive symptoms, beyond which the protective effect of baseline cognitive function on BADL emerged.

CONCLUSIONS

In older adults, good cognitive function reduces the risk of BADL/IADL disability. Depressive symptoms downregulate the protective effect of cognitive function on BADL/IADL over time. Intervention techniques focusing on the simultaneous improvement of cognitive dimensions and depression help improve ADL difficulty and prevent disability in older adults.

The mediating and moderating effects of depression on the relationship between cognitive function and difficulty in activities of daily living among postmenopausal women

OBJECTIVE

Cognitive function and depression impact critically the daily functioning of menopausal women. This study aimed to explore the mediating and moderating effects of depressive symptoms on the association between cognitive function and activities of daily living (ADL) difficulty in postmenopausal women.

METHODS

A total of 2,596 postmenopausal women from the China Health and Retirement Longitudinal Study completed the Chinese version of the Mini-Mental State Examination, basic ADL (BADL) and instrumental ADL (IADL) scales, and 10-item Short-Form Center for Epidemiological Studies Depression. We constructed structural equation modeling to examine the association between cognitive function, depressive symptoms, and BADL/IADL difficulty.

RESULTS

The prevalence of BADL/IADL difficulty in postmenopausal women was 22.5% and 31.5%, respectively. After adjustments for demographic and health-related covariates, cognitive decline (contributed by four cognitive dimensions with different weights) was significantly associated with BADL/IADL difficulty (contributed by six-item daily activities with different weights). Depressive symptoms mediated and explained 28.8% and 23.2% of cognitive function associations with BADL and IADL difficulty, respectively. The Johnson-Neyman technique identified a threshold of eight and four for depressive symptoms, beyond which the protective effect of cognitive function on BADL and IADL emerged.

CONCLUSIONS

Depressive symptoms mediated and moderated the association between cognition and BADL/IADL difficulty in postmenopausal women. Compared with BADL, IADL may be more sensitive to changes in cognitive function. More strength should be put on developing comprehensive intervention techniques focusing on simultaneous intervention of multidimensional cognitive function and depression to maintain and improve the quality of life of postmenopausal women.