Prevalence of mild cognitive impairment in community-dwelling Chinese populations aged over 55 years: a meta-analysis and systematic review

Prevalence and Risk Factors of Cognitive Impairment in COPD: A Systematic Review and Meta-Analysis

AIM

The aim of this systematic review is to present the pooled estimated prevalence and risk factors for cognitive impairment (CI) in patients with chronic obstructive pulmonary disease (COPD).

BACKGROUND

Patients with COPD suffer from progressive and irreversible airflow limitation, resulting in continuous impairment of lung function, which in addition to causing lesions in the lungs, often accrues to other organs as well. In recent years, a growing number of cross-sectional and longitudinal studies have shown that hypoxia is an important factor in causing CI and that there is an important link between them, but the assessment of co-morbid neurocognitive impairment and dysfunction is often overlooked. Some studies suggest that the diagnosis of mild cognitive impairment (MCI) is considered a precursor to dementia symptoms, with an annual conversion rate of 5%-10%, and it has been suggested that MCI is a potentially reversible state that can be used as a window for intervention. There is a lack of evidence on the prevalence and influencing factors of CI and its MCI.

DESIGN

A systematic review and meta-analysis.

METHODS

PubMed, Web of Science, the Cochrane Library, Ovid, Wiley, and Scopus were searched for cohort, case-control, and cross-sectional studies investigating the prevalence and risk factors of CI and MCI in COPD to June 2023 from building. Meta-analyses were performed to identify CI and MCI prevalence and risk factors using a random-effects model. The methodological quality assessment was conducted by the modified Newcastle-Ottawa Scale (NOS) and Agency for Healthcare Research and Quality (AHRQ). This study was registered on PROSPERO (CRD42021254124).

RESULTS

In total, 41 studies (21 cohort studies, 7 case-control studies, and 13 cross-sectional studies) involving 138,030 participants were eligible for inclusion. Current evidence suggests that the average prevalence of CI and MCI in COPD was 20%-30% (95% CI, 0.17-0.28) and 24% (95% CI, 0.17-0.32), respectively. Significant heterogeneity existed both in CI and MCI (I2 = 99.76%, 91.40%, p < 0.001). Mata-regression analysis showed that different region could be the source of heterogeneity in the pooled results. Cough, FEV1, PaO2, age, education, depression, and BODE index are influential factors in the development of CI in COPD.

CONCLUSION

Integrated epidemiological evidence supports the hypothesis that the prevalence of CI in the COPD population has shown an increasing trend, with differences by region and by instrument. Cough, FEV1, PaO2, age, education, depression, and BODE index are influential factors in the development of cognitive impairment in COPD patients. We should promote early screening and management of COPD patients and take targeted measures to prevent and reduce the incidence of CI.

IMPLICATIONS FOR PRACTICE

This systematic evaluation and meta-analysis identifies seven important risk factors for the development of CI among COPD patients and exposes their current epidemiological findings to provide a theoretical basis for public health administrators and healthcare professionals to effectively increase the screening rate of cognitive impairment in patients with COPD as well as to carry out early intervention.

TRIAL REGISTRATION

PROSPERO).crd. york.ac.uk.

Social frailty and its association with cognitive trajectories in older adults: a prospective cohort study

BACKGROUND

Social frailty, a multidimensional construct encompassing various social behaviors, resources, and needs, significantly impacts cognitive health in older adults. Despite existing studies linking specific social factors to cognitive function, the association between social frailty and long-term cognitive trajectories remains underexplored. This study aims to evaluate the longitudinal association between social frailty and trajectory of cognitive function in dementia-free older adults.

METHODS

This prospective cohort study used data from the National Health and Aging Trends Study (NHATS). Social frailty was assessed using the Makizako Social Frailty Index. According to the presence of social components, individuals were categorized into social frailty (≥ 2), pre-social frailty (1), and robust (0), respectively. Cognitive function was annually evaluated through memory, orientation, and executive function tests from 2011 to 2018. Mixed-effects linear models were employed to assess the associations between social frailty and changes in global and domain-specific cognitive function, adjusting for relevant covariates.

RESULTS

In this study, 4956 dementia-free older adults (mean age 76.57 [7.41]) with complete at least 2 times of cognitive tests were included. Compared with the robust, social frailty was associated with significantly faster decline in global cognitive function (β = -0.041, 95% CI [-0.047, -0.036] z score per year) and domain-specific cognitive function (βmemory = -0.045, 95% CI [-0.055, -0.036] z score per year; βorientation = -0.027, 95% CI [-0.034, -0.020] z score per year; βexecutive = -0.042, 95% CI [-0.053, -0.032] z score per year) over the follow-up. Additionally, pre social frailty was associated with significantly faster decline in global cognitive function (β = -0.016, 95% CI [-0.021, -0.012] z score per year), memory function (β= -0.045, 95% CI [-0.055, -0.036] z score per year), and orientation function (β= -0.027, 95% CI [-0.034, -0.020] z score per year) over the follow-up.

CONCLUSIONS

Social frailty is associated with faster decline in cognition in older adults, underscoring the necessity for enhanced social support and engagement to mitigate cognitive deterioration in vulnerable populations.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Profile of non-invasive physical health indicators associated with cognitive performance in Chinese older adults: evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

Existing studies have indicated the potential role of non-invasive physical health indicators as an early detector of mild cognitive impairment (MCI) in older adults. However, evidence is lacking in determining the appropriate physical health indicators for early screening of cognitive decline in each domain. Therefore, the current study aimed to establish a comprehensive physical health indicators profile in association with cognitive performance.

METHODS

The present study utilized a three-year longitudinal cohort design, with data from the China Health and Retirement Longitudinal Study (CHARLS). 4,869 participants aged 60-97 years from CHARLS wave 2015 and 2018 who were cognitively and physically healthy were included in analysis. Physical functions (BMI, grip strength, blood pressure, balance tests, course walking time, repeated chair stands, and pulmonary function) were objectively measured by physical tasks. Cognitive performance domains (general cognition, episodic memory, executive function, verbal fluency, orientation, and language-and-praxis) were measured through standardised interviews and cognitive tasks. Multiple linear regression models were conducted to explore the association between physical health indicators and cognitive performance. Subgroup analysis was conducted to identify sex-specific factors.

RESULTS

Pulmonary function was identified as associated with all domains of cognitive performance in older adults (β ranged between 0.05 and 0.08). Right grip strength was also identified as an important factor associated with all cognitive domains except general cognition (β ranged between 0.04 and 0.12). Subgroup analysis revealed that the association between physical health indicators and cognitive performance is more pronounced in males than in females.

CONCLUSIONS

A profile of non-invasive physical health indicators associated with cognitive performance was established, which warrants future incorporation of non-invasive physical health indicators in early risk screening systems for MCI, enabling timely intervention and prevention in older adults. Future studies can delve deeper into the mechanisms underlying this full-dimensional relationship between physical and cognitive domains.

Identification of circulating risk biomarkers for cognitive decline in a large community-based population in Chongqing China

INTRODUCTION

This study aims to investigate the relationship between blood-based pathologies and established risk factors for cognitive decline in the community-based population of Chongqing, a region with significant aging.

METHODS

A total of 26,554 residents aged 50 years and older were recruited. Multinomial logistic regression models were applied to assess the risk factors of cognition levels. Propensity score matching and linear mixed effects models were used to evaluate the relationship between key risk factors and the circulating biomarkers.

RESULTS

Shared and distinct risk factors for MCI and dementia were identified. Age, lower education, medical history of stroke, hypertension, and epilepsy influenced mild cognitive impairment (MCI) progression to dementia. Correlations between key risk factors and circulating neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), amyloid β protein (Aβ)40, and Aβ42/Aβ40 ratio suggest underlying mechanisms contributing to cognitive impairment.

DISCUSSION

The common and distinct risk factors across cognitive decline stages emphasize the need for tailored interventions. The correlations with blood biomarkers provide insights into potential management targets.

HIGHLIGHTS

From a large community-based cohort study on the residents in Chongqing, we have identified that mild cognitive impairment (MCI) and dementia share several common risk factors, including age, female gender, rural living, lower education levels, and a medical history of stroke. However, each condition also has its own unique risk factors. Several factors contribute to the progression of MCI into dementia including age, education levels, occupation, and a medical history of hypertension and epilepsy. We discover the correlations between the risk factors for dementia and blood biomarkers that indicate the presence of axonal damage, glial activation, and Aβ pathology.

Coping with cognitive decline in older adults with mild cognitive impairment or mild dementia: a scoping review

OBJECTIVES

This scoping review aims to map out the coping strategies among Persons with Mild Cognitive Impairment (PwMCI) and Persons with Mild Dementia (PwMD), identifying the facilitators and the barriers to the use of the strategies.

METHOD

We conducted a systematic search of peer-reviewed studies in PubMed, CINAHL, EMBASE, and PsycINFO. Under the guidance of the Coping Circumflex Model, we identified coping strategies and then conducted thematic synthesis.

RESULTS

Our review of 17 studies revealed 13 themes for coping strategies among PwMCI and PwMD, categorized into problem-solving, positive emotional, problem avoidance, and negative emotional strategies. The strategies included utilization of reminders, active engagement in daily tasks, acceptance, and concealing memory problems. The themes for facilitators and barriers encompassed social interactions, assistance from informal care partners, support from professionals, and the influence of emotion.

CONCLUSION

The review revealed the practical types of coping strategies and the influence of context on their use and development, highlighting the need for personalized coping strategies. These insights are crucial for developing tailored interventions to improve quality of life in PwMCI and PwMD. Future research should focus on how PwMCI and PwMD develop their effective coping strategies, considering their trajectory of cognitive decline.

Effects of Protein Intake on Cognitive Function in Chinese Older Adults: A 10-Year Follow-Up Study

BACKGROUND

As the global population ages, there is an increasing prevalence of mild cognitive impairment and dementia. Protecting and preserving cognitive function in older adults has become a critical public health concern.

METHODS

This study utilized data from four phases of the Chinese Longitudinal Healthy Longevity Survey conducted from 2008 to 2018, encompassing a total of 2454 participants. Latent growth curve modeling was employed to analyze the trajectory and role of protein intake frequency and cognitive function.

RESULTS

The frequency of protein intake among older adults tends to rise, with individuals exhibiting higher initial levels experiencing smaller subsequent increases. Conversely, cognitive function generally declines, with those starting at higher levels experiencing more pronounced decreases. Notably, the initial frequency of protein intake is positively correlated with the initial level of cognitive function (β = 0.227, 95% CI: 0.156 to 0.299, p < 0.001), but does not significantly influence the rate of change in cognitive function (β = -0.030, 95% CI: -0.068 to 0.009, p = 0.128). The rate of change in protein intake frequency is positively associated with the rate of change in cognitive function (β = 0.152, 95% CI: 0.023 to 0.280, p = 0.020).

CONCLUSIONS

The alterations in protein intake frequency are linked to alterations in cognitive function among older adults. Maintaining a stable high frequency of protein intake or increasing the frequency of protein intake may contribute to stabilizing cognitive function as well as reducing the risk of cognitive impairment and dementia in older adults.

Sleep disturbances and their correlation with memory impairment in patients with Alzheimer's disease and amnestic mild cognitive impairment

Background

Episodic memory impairment is the core clinical feature of patients with typical Alzheimer's disease (AD) at an early stage. Since sleep plays a very important role in memory consolidation, the relationship between memory impairment and sleep disorders in AD patients is worthy of investigation.

Objective

To investigate sleep disturbances and their correlations with memory impairment in patients with AD and amnestic mild cognitive impairment (aMCI).

Methods

Forty-three patients with AD, 43 patients with aMCI, and 43 cognitively unimpaired controls (CUCs) were recruited and subjected to memory assessment via the Hopkins Verbal Learning Test-Revised and objective sleep evaluation via polysomnography (PSG).

Results

The total sleep time and the percentages of nonrapid eye movement (NREM) sleep stage 3 (N3) and the rapid eye movement (REM) were lower, while the percentages of NREM sleep stage 2 (N2) were greater in the AD and aMCI groups than in the CUC group (all p < 0.01). Compared with the CUC group, the AD group also presented a longer sleep latency and higher NREM sleep stage 1 (N1) percentage, apnea-hypopnea index (AHI), periodic limb movements during sleep index (PLMSI), and arousal index (AI). Both total learning scores and delayed recall scores were positively correlated with the N3 sleep percentage and negatively correlated with the AHI and PLMSI (all p < 0.01). Recognition scores were positively correlated with the N3 sleep percentage and negatively correlated with the AI (all p < 0.01).

Conclusions

Our results suggest that sleep disturbance is correlated with learning and memory disability in AD and aMCI patients. PSG is useful for screening and monitoring AD.

A study of the correlation between sarcopenia and cognitive impairment in older individuals over 60 years: cross-sectional and longitudinal validation

Objective

To validate the correlation between sarcopenia and cognition, and explore cognitive subdomains affected by sarcopenia.

Methods

A case-control study was designed to recruit 90 individuals aged 60 and above from June to October 2023 in the same community, all individuals meeting the inclusion criteria were categorized according to the 2019 Asian criteria for sarcopenia and divided into the sarcopenia group and non-sarcopenia group at baseline. After a 12-week follow-up recording, individuals were classified into the aggravation group and alleviation group based on the change of sarcopenia severity. Sarcopenia tests including muscle mass, calf circumference, grip strength and physical function assessment, using Montreal Cognitive Assessment (MoCA) of nine dimensions for cognitive assessment.

Results

(1) There was a significant positive correlation between cognitive function and grip strength in males (r = 0.42, p < 0.05). (2) There was a moderate correlation between sarcopenia grading and MoCA score (r = -0.4, p < 0.001). (3) Individuals with sarcopenia had significantly lower MoCA total scores and sub-scores in executive function, fluency, calculation and delayed recall compared to non-sarcopenia group (p < 0.05). (4) After 12 weeks, the mean value of the change in fluency in the alleviation group increased by 0.33 points, while the aggravation group decreased by 0.2 points (W = 128, p < 0.05).

Conclusion

There is a correlation between sarcopenia and cognitive function, individuals with sarcopenia performing poorly in overall cognition as well as refined dimensions. The degree of cognition like fluency degenerates over time with increasing severity of sarcopenia.

Socio-economic inequalities in health-related quality of life and the contribution of cognitive impairment in Australia: A decomposition analysis

BACKGROUND

The distributional effects of cognitive impairment on inequalities in health-related quality of life (HRQoL) are not well studied. This relationship has not been studied in any Australian health inequality literature. Therefore, this study aims to examine how cognitive impairment affects the distribution of HRQoL across various socio-economic classes amongst older Australians.

METHODS

Data for this study was collected from the Household, Income and Labour Dynamics in Australia (HILDA) survey. The final analysis consisted of 5,247 and 5,614 unique individuals from wave 2012 and wave 2016, respectively. An ordinary least squares (OLS) regression model was used to investigate the relationship between cognitive impairment and HRQoL. Additionally, the Wagstaff-Doorslaer-Watanabe standard concentration index was used to examine socioeconomic inequality in HRQoL.

RESULTS

The findings revealed pro-rich inequalities in HRQoL, as indicated by the concentration indices of 0.029 and 0.025 for wave 12 and wave 16, respectively. Additionally, the results showed that mild cognitive impairment accounted for 7.60% and 9.03%, respectively, of pro-rich socioeconomic inequality in HRQoL in 2012 and 2016.

CONCLUSION

People from lower socioeconomic status (SES) groups tend to have lower HRQoL compared to those from higher SES. This leads to a greater disparity in HRQoL based on SES. Cognitive impairment positively contributed to this inequality in HRQoL. Therefore, it is critical to incorporate cognitive impairment into the design of interventions to reduce socioeconomic inequality in HRQoL.

Dual group-based trajectories of physical activity and cognitive function in aged over 55: a nationally representative cohort study

Background

As individuals age, they commonly experience reduced physical activity and cognitive decline. While evidence, there is limited trajectory research on their concurrent progression and interrelation in individuals over 55 years old.

Methods

The data was collected from 5,765 individuals aged over 55 years who participated in the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020. Physical activity was measured by IPAQ, cognitive function by episodic memory, and mental intactness score. Separate sets of group-based trajectory models were fitted to identify physical activity trajectories and cognitive function trajectories. Multivariate logistic regression was used to estimate the association between baseline characteristics and each set of trajectories. Group-based dual trajectory modeling (GBDTM) was applied to quantify these associations.

Results

GBDTM identified three distinct trajectory groups for physical activity and cognitive outcomes. The physical activity trajectories were classified as "Persistently low physical activity" (74.2%), "Decreasing physical activity" (13.7%), and "Rising physical activity" (12.1%). Similarly, cognitive function trajectories were categorized as "Persistently low cognitive function" (22.2%), "Persistently moderate cognitive function" (37.9%), and "Persistently high cognitive function" (39.9%). Notably, 15.6% of participants followed the trajectories of "Persistently low physical activity" and "Persistently low cognitive function." The presence of a severe decline in physical activity was associated with an increased likelihood of poor cognitive function and vice versa. Age, sex, education, residential status, BMI, and visual impairment were identified as significant predictors for physical activity and cognitive decline.

Conclusion

This study found that the GBDTM can determine the consistent trajectories of physical activity and cognitive function trajectories that persistently decline in individuals over 55 years. Analyses of predictive factors can be instrumental in promoting physical activity and delaying cognitive decline.

Gender differentials in cognitive frailty among older adults in India: a multivariate decomposition approach

There has been an increasing focus on the interplay between physical frailty and cognitive impairment, as both conditions pose significant risks for life-threatening health complications and are receiving considerable attention in global geriatric health initiatives. A recent consensus introduces "cognitive frailty," denoting the co-existence of physical frailty and cognitive impairment without dementia. This study aims to ascertain the prevalence of cognitive frailty and investigate the factors contributing to gender differentials of cognitive frailty among older adults in India. This study has used the data from the nationally representative survey Longitudinal Ageing Study in India 2017-18. This study included a sample of 13,946 males and 14,989 females aged 60 and above. Descriptive and bivariate analyses were conducted. A proportion test was employed to assess gender disparities and determine the statistical significance of risk factors. Furthermore, multivariate decomposition analysis was performed to identify the extent to which various covariates contribute to explaining the gender differences observed in cognitive frailty. The overall prevalence of cognitive frailty was 4.4%. There was a significant gender difference in cognitive frailty among older adults in India (Difference: 4.3%; p-value < 0.001] with 2.1% (95% CI: 1.8-2.3) older males and 6.4% (95% CI: 6.0-6.8) older females suffering from cognitive frailty. The considerable gender gap in cognitive frailty would be reduced if women had similar levels of education (37% reduction) than men. Results highlight that increasing age, being a woman (AOR: 1.61; 95% CI: 1.33-1.95), out-of-wedlock, less education and non-working status (AOR:2.19; 95% CI: 1.71-2.80) were significantly associated with cognitive frailty. Poor nutritional status, and depression are also prone among the cognitively frail participants. Gender sensitive interventions improving education access for women are crucial. Developing countries like India urgently require a multidimensional approach to ensure appropriate and comprehensive healthcare for the elderly population.

Efficacy of wooden toy training in alleviating cognitive decline in elderly individuals with cognitive impairment: A cluster randomized controlled study

BACKGROUND

With the increasing global aging population, the health and welfare of elderly individuals, especially individuals with prevalent mild cognitive impairment (MCI) living in nursing homes, have become critical concerns. These concerns highlight the urgency of developing effective interventions to address the cognitive and psychological needs of elderly individuals, ensuring their well-being and alleviating the burden on their caregivers.

OBJECTIVE

This study investigates the impact of wooden toy training on mitigating cognitive decline in elderly individuals with cognitive impairment. It evaluates how this training influences cognitive functions and psychological well-being, exploring whether it can slow or reverse the progression of cognitive decline. This outcome will be assessed in a randomized controlled trial, in which changes in cognitive ability and psychological health indicators among the participants will be measured.

DESIGN

A two-arm, open-label, cluster-randomized controlled trial.

SETTING(S)

The study was conducted in two nursing homes, which served as both the recruitment sites for participants and the intervention locations. These nursing homes were selected for their ability to facilitate the intervention and for their representative demographic characteristics of the elderly population. The settings provided a controlled environment that was conducive to implementing the wooden toy training program and observing its effects on the participants.

PARTICIPANTS

A total of 76 elderly participants with mild cognitive impairment but functional independence were recruited.

METHODS

Participants were randomized into an intervention group and a control group. The intervention group engaged in an 8-week wooden toy training program, whereas those in the control cohort received customary nursing care. Standardized cognitive and psychological well-being measures were used to assess improvements in cognitive performance and mental health.

RESULTS

Significant improvements were observed in the cognitive functions of the intervention group from a baseline score of M = 13.11 to M = 16.29 postintervention (95% CI [-4.44, -1.93]), along with reductions in depressive symptoms from a baseline score of M = 8.63 to M = 7.18 (95% CI [0.38, 2.51]). Additionally, engagement in activities with wooden toys significantly satisfied their need for competence, increasing from a baseline of M = 16.29 to M = 20 postintervention (95% CI [-5.92, -1.51]), and relatedness, which improved from a baseline of M = 20.32 to M = 22.95 (95% CI [-4.73, -0.53]).

CONCLUSIONS

This study underscores the potential of a wooden toy intervention in nursing homes that combines cognitive challenges with traditional cultural elements to improve cognitive functions in elderly individuals with mild cognitive impairment. Our findings suggest a novel method of promoting the cognitive and psychological health of nursing home residents through emotional comfort and social interaction.

Comorbidities, medications, depression, and physical performance measures associated with severe cognitive impairments in community-dwelling adults

Cognitive impairment negatively impacts health, psychological, social, and economic domains. Cognitive impairment commonly affects physical functions in older adults, whereas these are deteriorated. However, the prevalence and associated factors of cognitive impairment among community-dwelling adults in Saudi Arabia have not been investigated yet. This study aimed to examine the prevalence of severe cognitive impairment and its associated factors in community-dwelling older adults in Saudi Arabia. This cross-sectional study involved adults aged ≥50 years. Demographic data and clinical data, including number of medications and body mass index (BMI), were collected. Cognitive impairment and depressive symptoms were measured using Arabic versions of the Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9), respectively. The participants were divided into severe cognitive impairment and mild cognitive impairment or normal cognitive function groups based on a score of <20 or ≥20, respectively, using the MoCA. Physical measures included dynamic gait index (DGI) scores, timed up-and-go (TUG), 5 times sit-to-stand (5XSST), functional reach test, and 6-minute walk test. A total of 206 participants (female: n = 96) were included. The prevalence of severe cognitive impairment in the community-dwelling older adults was 12.6%. The number of chronic conditions (odds ratio [OR]: 2.31, p<0.001), number of medications (OR: 1.36, p = 0.003), and depressive symptoms using PHQ-9 (OR: 1.11, p = 0.009) were significantly associated with severe cognitive impairment after adjustment for other covariates, including age, sex, and BMI. Based on the physical function measures, only the scores for DGI (OR: 0.86, p = 0.003), TUG (OR: 1.16, p = 0.035) and 5XSST (OR: 1.25, p <0.001) were significantly associated with severe cognitive impairment. This study revealed a high prevalence of severe cognitive impairment among community-dwelling adults in Saudi Arabia. Its major risk factors include depressive symptoms, number of chronic conditions and medications, and physical measures, including DGI, TUG, and 5XSST.

Identifying exercise and cognitive intervention parameters to optimize executive function in older adults with mild cognitive impairment and dementia: a systematic review and meta-analyses of randomized controlled trials

Physical exercise is recognized for its beneficial effects on brain health and executive function, particularly through the careful manipulation of key exercise parameters, including type, intensity, and duration. The aim of this systematic review and meta-analysis was to delineate the optimal types, intensities, and durations of exercise that improve cognitive functions in older adults with mild cognitive impairment (MCI) or dementia. A comprehensive search was conducted in Scopus, Web of Science, and PubMed from their inception until December 2023. The methodological quality and publication bias of the included studies were assessed using the PEDro scale and Egger's regression test, respectively. Separate meta-analyses were performed to assess the overall impact of exercise on cognitive assessments and to explore the effects of different exercise types (i.e., aerobic, resistance, dual-task, mind-body, and multi-component exercises) and intensities (i.e., low, moderate, and high) on executive function. Results were presented as standardized mean differences (SMD) and 95% confidence intervals (95% CI). A meta-regression analysis was conducted to examine the correlation between exercise duration and mean effects. In total, 15,087 articles were retrieved from three databases, of which 35 studies were included in our final analyses. The results indicated high overall methodological quality (PEDro score = 8) but a potential for publication bias (t = 2.08, p = 0.045). Meta-analyses revealed that all types of exercise (SMD = 0.691, CI [0.498 to 0.885], p < 0.001) and intensities (SMD = 0.694, CI [0.485 to 0.903], p < 0.001) show significant effects favoring exercise. Notably, dual-task exercises (SMD = 1.136, CI [0.236 to 2.035], p < 0.001) and moderate-intensity exercises (SMD = 0.876, CI [0.533 to 1.219], p < 0.001) exhibited the greatest effect. No significant correlation was observed between exercise duration and SMD (R² = 0.038, p = 0.313). Overall, our meta-analyses support the role of physical exercise in enhancing executive function in older adults with MCI or dementia. It is essential to carefully tailor exercise parameters, particularly type and intensity, to meet the specific needs of older adults with MCI or dementia. Such customization is crucial for optimizing executive function outcomes and improving overall brain health.

A randomized, double-blind, placebo-controlled study of Cistanche tubulosa and Ginkgo biloba extracts for the improvement of cognitive function in middle-aged and elderly people

Mild cognitive impairment poses an increasing challenge to middle-aged and elderly populations. Traditional Chinese medicinal herbs like Cistanche tubulosa and Ginkgo biloba (CG) have been proposed as potential agents to improve cognitive and memory functions. A randomized controlled trial involving 100 Chinese middle-aged and elderly participants was conducted to investigate the potential synergistic effects of CG on cognitive function in individuals at risk of neurodegenerative diseases. Over 90 days, both CG group and placebo group received two tablets daily, with each pair of CG tablets containing 72 mg echinacoside and 27 mg flavonol glycosides. Cognitive functions were assessed using multiple scales and blood biomarkers were determined at baseline, Day 45, and Day 90. The CG group exhibited significant improvements in the scores of Mini-Mental State Examination (26.5 at baseline vs. 27.1 at Day 90, p < 0.001), Montreal Cognitive Assessment (23.4 at baseline vs. 25.3 at Day 90, p < 0.001), and World Health Organization Quality of Life (81.6 at baseline vs. 84.2 at Day 90, p < 0.001), all surpassing scores in placebo group. Notably, both the Cognitrax matrix test and the Wechsler Memory Scale-Revised demonstrated enhanced memory functions, including long-term and delayed memory, after CG intervention. Moreover, cognitive-related blood biomarkers, including total tau, pT181, pS199, pT231, pS396, and thyroid-stimulating hormone, significantly decreased, whereas triiodothyronine and free triiodothyronine significantly increased. No treatment-related adverse events were reported, and routine blood and urine tests remained stable. These findings indicated that CG supplementation could potentially serve as an effective supplementary solution for enhancing cognitive and memory functions.

A nomogram for individualized prediction of mild cognitive impairment in patients with subjective cognitive decline during physical examinations: a cross-sectional study

Background and objectives

To develop a nomogram for mild cognitive impairment (MCI) in patients with subjective cognitive decline (SCD) undergoing physical examinations in China.

Methods

We enrolled 370 patients undergoing physical examinations at the Medical Center of the First Hospital of Jilin University, Jilin Province, China, from October 2022 to March 2023. Of the participants, 256 were placed in the SCD group, and 74 were placed in the MCI group. The population was randomly divided into a training set and a validation set at a 7:3 ratio. A least absolute shrinkage and selection operator (LASSO) regression model was applied to optimize feature selection for the model. Multivariable logistic regression analysis was applied to construct a predictive model. The performance and clinical utility of the nomogram were determined using Harrell's concordance index, calibration curves, and decision curve analysis (DCA).

Results

Cognitive reserve (CR), age, and a family history of hypertension were associated with the occurrence of MCI. The predictive nomogram showed satisfactory performance, with a concordance index of 0.755 (95% CI: 0.681-0.830) in internal verification. The Hosmer-Lemeshow test results suggested that the model exhibited good fit (p = 0.824). In addition, DCA demonstrated that the predictive nomogram had a good clinical net benefit.

Discussion

We developed a simple nomogram that could help secondary preventive health care workers to identify elderly individuals with SCD at high risk of MCI during physical examinations to enable early intervention.

The Role of Depression and Anxiety in the Relationship Between Arthritis and Cognitive Impairment in Chinese Older Adults

BACKGROUND

Mental disorders and cognitive impairment are common in older patients with arthritis. While it is recognized that mental conditions may play a role in the connection between arthritis and cognitive impairment, the precise underlying relationship remains uncertain.

METHODS

The data was derived from the baseline survey of the Guangdong Mental Health Survey in South China, involving a sample of 3,764 citizens aged 65 and older. An array of aspects were explored, including socio-demographics, lifestyle behaviors, self-reported chronic conditions, depression, anxiety, and cognitive impairment. Logistic regression analyses examined the association between arthritis and cognitive impairment after adjustment for potential confounders. Serial mediation models were used to examine whether depression or anxiety played a mediating role in the arthritis-cognitive impairment linkage.

RESULTS

The prevalence rates of cognitive impairment and arthritis of the older adults were 28.9% and 12.1%, respectively. Compared to those without arthritis, participants with arthritis were at a higher risk of cognitive impairment (OR = 1.322, 95%CI: 1.022-1.709) after adjustment for socio-demographics, lifestyle behaviors, and mental health conditions. Serial mediation analyses indicated that depressive and anxiety symptoms co-played a serial mediating role in the association between arthritis and cognitive impairment (B1 = 0.025, 95%CI: 0.005-0.052; B2 = 0.050, 95%CI: 0.021-0.086).

CONCLUSIONS

Arthritis may heighten cognitive impairment risk in Chinese older adults, and the relationship was potentially mediated by depressive and anxiety symptoms. Future interventions should be considered, integrating mental health assessments into arthritis care frameworks and being alert to possible cognitive impairment.

Prevalence of cognitive impairment and associated factors in older people

BACKGROUND

Older people are the fastest-growing age group, with the highest risk of cognitive impairment. This study assessed the prevalence and associated factors with cognitive impairment in community-dwelling older people.

METHODS

Older people were interviewed and accomplished through sociodemographic and health questionnaires. The quantitative variables were described by mean and standard deviation or median and interquartile range. The significance level adopted was 5 % (p < 0.05). The association between the quantitative variables was evaluated using the Pearson or Spearman correlation coefficients.

RESULTS

The research population comprised 165 long-lived adults aged ≥80. The youngest one was 80, and the oldest one was 94 years old. The participants were 84.8 ± 3.6 years old, female (63 %) with a mean of education of 2.9 ± 1.8 years. A poor performance in the Mini-Mental State Examination (MMSE) was found in 58 (35.2 %) individuals when adjusted for educational level. After adjustment for confounding factors, body mass index (BMI) (p = 0.09), total older adults' income (up to 1 minimum wage [mw], p = 0.023; over 1 to 2 mw, p = 0.023), functional disability (Moderate dependence 75 %, p = 0.038; Moderate dependence 50 %, p = 0.081; Moderate dependence 25 %, p = 0.054), and the anxiety scale (p = 0.032), remained associated with cognitive impairment.

CONCLUSIONS

This study showed that BMI, total older adults' income, functional disability, and anxiety are related to cognitive impairment in long-lived adults. This study has some limitations, such as the fact that it is a cross-sectional study, the reduced number of individuals, and the fact that there were no comparisons among different ages and populations.

The Prevalence of Mild Cognitive Impairment in China: Evidence from a Meta-Analysis and Systematic Review of 393,525 Adults

OBJECTIVE

This study aims to precisely determine the prevalence of mild cognitive impairment (MCI) in China, acknowledging its significance as a preclinical stage of dementia and a potential "intervention window." The acceleration of the aging process in China underscores the urgency of this research.

METHODS

A comprehensive search was conducted across PubMed, Embase, Web of Science, CNKI, WFD, VIP, and CBM databases from their inception until March 1, 2023. The Agency for Healthcare Research and Quality (AHRQ) methodology checklist guided our quality assessment. A random-effects model meta-analysis was employed to synthesize the pooled prevalence data of MCI in China.

RESULTS

Our analysis encompassed 139 studies, incorporating data from 393,525 individuals aged 40 years and above. The studies were predominantly rated as moderate-to-high quality. The overall prevalence of MCI was determined to be 19.6% (95% CI: 17.7-21.6%). Subgroup analyses indicated variations in prevalence: 20.8% (95% CI: 18.9-22.7%) for P-MCI compared to 16.2% (95% CI: 11.7-20.7%) for DSM criteria. Geographically, prevalence in Southern China (21.0%, 95% CI: 18.1-23.9%) exceeded that in Northern China (17.6%, 95% CI: 15.9-19.4%). Notably, prevalence in hospitals (61.7%, 95% CI: 27.8-95.7%) was significantly higher than in nursing homes (16.1%, 95% CI: 14.3-17.9%) and communities (25.3%, 95% CI: 17.4-33.2%), especially after the COVID-19 outbreak.

CONCLUSION

The study confirms a 19.6% prevalence rate of MCI in China, influenced by factors such as sample sources, beginning year of survey, and regional differences. It highlights the need for targeted screening and resource allocation to subpopulations at risk, aiming to prevent the progression to dementia.

Associations between frailty and mild cognitive impairment in older adults: Evidence from rural Chiang Mai Province

Thailand entered an aged society phase in 2000, with mild cognitive impairment (MCI) and frailty becoming prevalent among the older adult population. However, no studies have yet examined these issues specifically within rural communities. This study aims to explore the relationship between frailty and MCI among older adults in rural Thailand. It was a cross-sectional study conducted between December 2022 and June 2023. A questionnaire was administered by trained village health volunteers. The survey targeted older adults aged 60 years and above, residing in rural Chiang Mai, Thailand, with those having a history of dementia, depression, and brain injury being excluded from participation. Nine hundred eighty-four participants among the older adults were available for analysis. The mean age was 69.8 (SD 7.9) with 62.2% females (n = 612). The median frequency of exercise was three days (0-7). The prevalence of MCI and frailty among rural older adults in the community was 35.6% (n = 350) and 8% (n = 79), respectively. There were four factors associated with an increased risk of MCI, including age (aOR = 1.07, 95% CI 1.04-1.09, p < 0.001), smoking cigarettes (aOR 1.95, 95% CI 1.27-2.98, p = 0.002), feelings of loneliness (aOR 1.43, 95% CI 1.01-2.03, p = 0.043), and the presence of frailty (aOR 1.92, 95% CI 1.10-3.35, p = 0.022). There were two factors associated with a lower risk of MCI: a higher education level (aOR 0.90, 95% CI 0.86-0.94, p <0.001) and engaging in frequent exercise (aOR 0.9, 95% CI 0.86-0.95, p < 0.001). Frailty exhibited an association with an elevated risk of MCI among older adults in rural communities. Enhancing screening through health volunteers and primary healthcare professionals, coupled with bolstering community-driven health promotion initiatives, becomes imperative.

Associations between regular physical exercise and physical, emotional, and cognitive health of older adults in China: an 8-year longitudinal study with propensity score matching

Background

The importance of healthy aging is growing in China as it has the largest number of older adults in the world and is one of the fastest-aging countries. This study aimed to examine the predictive value of regular physical exercise in relation to the physical, emotional, and cognitive health among samples of adults aged ≥60 years in China during an 8-year period.

Methods

A total of 10,691 older adults were extracted from two waves of national data from the China Family Panel Studies in 2010 and 2018. To minimize the impact of selection bias on the findings, a longitudinal propensity score matching (LPSM) method was used to examine the relationships between regular physical exercise and emotional health (depression), between regular physical exercise and physical health (instrumental activities of daily living), and between regular physical exercise and cognitive health (cognitive ability) of older adults. After LPSM, 856 older adults were included in the study. In the regular physical exercise group, the average age of participants at baseline year was 65.67 years, with an average age of 65.90 years for 238 men and 65.45 years for 190 women, and in the non-physical exercise group, their average age at baseline year was 65.70 years, with an average age of 65.45 years for 253 men and 65.98 years for 175 women.

Results

LPSM indicated that regular physical exercise has been found to be effective in improving physical function and reducing depressive symptoms in old adults, even after controlling for background differences. However, the sensitivity analysis suggests that the positive association between regular physical exercise and cognitive function may not be sufficiently valid.

Conclusion

The findings of this study indicate that engaging in long-term structured and repetitive physical exercise can have a significant positive effect on reducing depressive symptoms and improving the physical function of older adults. As a result, incorporating regular physical exercise into the lifestyle of older adults is recognized as an effective strategy for promoting healthy aging and reducing the strain on public health resources.

A household survey of the prevalence of subjective cognitive decline and mild cognitive impairment among urban community-dwelling adults aged 30 to 65

While it is possible to detect cognitive decline before the age of 60, and there is a report indicating that certain cognitive abilities peak in one's 30s, the evidence regarding cognitive problems in populations younger than 65 years is scarce. This study aims to (1) determine the proportion of community-dwelling adults with different cognitive status, and (2) determine the prevalence of neuropsychiatric behaviors. A population-based survey was conducted in Chiang Mai, Thailand. Individuals aged 30 to 65 were recruited and assessed for demographic data, memory complaints, cognitive performance, and neuropsychiatric symptoms using self-reported questionnaires. In a total of 539 participants, 33.95% had mild cognitive impairment (MCI), 7.05% had subjective cognitive decline (SCD), and 52.50% had neuropsychiatric symptoms. The risk of MCI increased with age, and neuropsychiatric symptoms were significantly higher in those with MCI or SCD than in those without (p < 0.001). The most common complaints were sleep problems, anxiety, and irritability. Screening for MCI in adults aged < 65 years might be useful. However, further investigation on the appropriate age to screen and the program's cost-effectiveness is suggested.

Spectral analysis and Bi-LSTM deep network-based approach in detection of mild cognitive impairment from electroencephalography signals

Mild cognitive impairment (MCI) is a neuropsychological syndrome that is characterized by cognitive impairments. It typically affects adults 60 years of age and older. It is a noticeable decline in the cognitive function of the patient, and if left untreated it gets converted to Alzheimer's disease (AD). For that reason, early diagnosis of MCI is important as it slows down the conversion of the disease to AD. Early and accurate diagnosis of MCI requires recognition of the clinical characteristics of the disease, extensive testing, and long-term observations. These observations and tests can be subjective, expensive, incomplete, or inaccurate. Electroencephalography (EEG) is a powerful choice for the diagnosis of diseases with its advantages such as being non-invasive, based on findings, less costly, and getting results in a short time. In this study, a new EEG-based model is developed which can effectively detect MCI patients with higher accuracy. For this purpose, a dataset consisting of EEG signals recorded from a total of 34 subjects, 18 of whom were MCI and 16 control groups was used, and their ages ranged from 40 to 77. To conduct the experiment, the EEG signals were denoised using Multiscale Principal Component Analysis (MSPCA), and to increase the size of the dataset Data Augmentation (DA) method was performed. The tenfold cross-validation method was used to validate the model, moreover, the power spectral density (PSD) of the EEG signals was extracted from the EEG signals using three spectral analysis methods, the periodogram, welch, and multitaper. The PSD graphs of the EEG signals showed signal differences between the subjects of control and the MCI group, indicating that the signal power of MCI patients is lower compared to control groups. To classify the subjects, one of the best classifiers of deep learning algorithms called the Bi-directional long-short-term-memory (Bi-LSTM) was used, and several machine learning algorithms, such as decision tree (DT), support vector machine (SVM), and k-nearest neighbor (KNN). These algorithms were trained and tested using the extracted feature vectors from the control and the MCI groups. Additionally, the values of the coefficient matrix of those algorithms were compared and evaluated with the performance evaluation matrix to determine which one performed the best overall. According to the experimental results, the proposed deep learning model of multitaper spectral analysis approach with Bi-LSTM deep learning algorithm attained the highest number of correctly classified samples for diagnosing MCI patients and achieved a remarkable accuracy compared to the other proposed models. The achieved classification results of the deep learning model are reported to be 98.97% accuracy, 98.34% sensitivity, 99.67% specificity, 99.70% precision, 99.02% f1 score, and 97.94% Matthews correlation coefficient (MCC).

Cognitive and physical declines and falls in older people with and without mild cognitive impairment: a 7-year longitudinal study

OBJECTIVES

We examined longitudinal changes in cognitive and physical function and associations between change in function and falls in people with and without mild cognitive impairment (MCI).

DESIGN

Prospective cohort study with assessments every 2 years (for up to 6 years).

SETTING

Community, Sydney, Australia.

PARTICIPANTS

Four hundred and eighty one people were classified into three groups: those with MCI at baseline and MCI or dementia at follow-up assessments (n = 92); those who fluctuated between cognitively normal and MCI throughout follow-up (cognitively fluctuating) (n = 157), and those who were cognitively normal at baseline and all reassessments (n = 232).

MEASUREMENTS

Cognitive and physical function measured over 2-6 years follow-up. Falls in the year following participants' final assessment.

RESULTS

In summary, 27.4%, 38.5%, and 34.1% of participants completed 2, 4, and 6 years follow-up of cognitive and physical performance, respectively. The MCI and cognitive fluctuating groups demonstrated cognitive decline, whereas the cognitively normal group did not. The MCI group had worse physical function than the cognitively normal group at baseline but decline over time in physical performance was similar across all groups. Decline in global cognitive function and sensorimotor performance were associated with multiple falls in the cognitively normal group and decline in mobility (timed-up-and-go test) was associated with multiple falls across the whole sample.

CONCLUSIONS

Cognitive declines were not associated with falls in people with MCI and fluctuating cognition. Declines in physical function were similar between groups and decline in mobility was associated with falls in the whole sample. As exercise has multiple health benefits including maintaining physical function, it should be recommended for all older people. Programs aimed at mitigating cognitive decline should be encouraged in people with MCI.

Comparison of Cognitive Impairment Diagnosis Criteria in Clinical Settings: Conventional vs. Neuropsychological

Background

Theories on Alzheimer disease pathogenesis propose a gap between pathological changes and the onset of clinical symptoms. The early detection of cognitive decline is crucial for the implementation of preventive strategies. Mild cognitive impairment is a transitional stage and an accurate diagnosis is vital. However, the diagnosis of mild cognitive impairment varies due to inconsistent diagnostic criteria. This study aims to explore the effectiveness of comprehensive neuropsychological criteria, including all cognitive domains, for diagnosing cognitive impairment in clinical settings.

Methods

The study included 509 subjects with subjective cognitive complaints between 2017 and 2021. They were diagnosed using the conventional and neuropsychological criteria, and the results were named the complex criteria (conventional criteria-neuropsychological criteria).

Results

Concordance between the conventional and neuropsychological diagnostic criteria diagnoses was 87.82%. Some participants diagnosed with mild cognitive impairment or dementia using the conventional criteria were classified as normal according to the neuropsychological criteria. Notably, the mild cognitive impairment - normal cognition (MCI-NC) and dementia (DEM)-NC (normal cognition) groups exhibited distinct characteristics. The MCI-NC group had higher depression scores (P = .008) and better memory performance (P = .026) and executive function (P = .020) than the MCI-MCI group. The DEM-NC group had better instrumental activities of daily living (P < .001) than the DEM-DEM group.

Conclusion

This study highlights the complexity of diagnosing cognitive impairment and the importance of comprehensive criteria. Relying solely on conventional criteria may lead to overdiagnosis. The neuropsychological criteria consider various cognitive domains and better discriminate between individuals with MCIs or other factors that contribute to cognitive difficulties.

Alterations in hippocampus-centered morphological features and function of the progression from normal cognition to mild cognitive impairment

Mild cognitive impairment (MCI) is a significant precursor to dementia, highlighting the critical need for early identification of individuals at high risk of MCI to prevent cognitive decline. The study aimed to investigate the changes in brain structure and function before the onset of MCI. This study enrolled 19 older adults with progressive normal cognition (pNC) to MCI and 19 older adults with stable normal cognition (sNC). The gray matter (GM) volume and functional connectivity (FC) were estimated via magnetic resonance imaging during their normal cognition state 3 years prior. Additionally, spatial associations between FC maps and neurochemical profiles were examined using JuSpace. Compared to the sNC group, the pNC group showed decreased volume in the left hippocampus and left amygdala. The significantly positive correlation was observed between the GM volume of the left hippocampus and the MMSE scores after 3 years in pNC group. Besides, it showed that the pNC group had increased FC between the left hippocampus and the anterior-posterior cingulate gyrus, which was significantly correlated with the spatial distribution of dopamine D2 and noradrenaline transporter. Taken together, the study identified the abnormal brain characteristics before the onset of MCI, which might provide insight into clinical research.

Prevalence, cognitive characteristics, and influencing factors of amnestic mild cognitive impairment among older adults residing in an urban community in Chengdu, China

Objective

Dementia is a significant public health concern, and mild cognitive impairment (MCI) serves as a transitional stage between normal aging and dementia. Among the various types of MCI, amnestic MCI (aMCI) has been identified as having a higher likelihood of progressing to Alzheimer's dimension. However, limited research has been conducted on the prevalence of aMCI in China. Therefore, the objective of this study is to investigate the prevalence of aMCI, examine its cognitive characteristics, and identify associated risk factors.

Methods

In this cross-sectional study, we investigated a sample of 368 older adults aged 60 years and above in the urban communities of Chengdu, China. The participants underwent a battery of neuropsychological assessments, including the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), Auditory Verbal Learning Test (AVLT), Wechsler's Logical Memory Task (LMT), Boston Naming Test (BNT) and Trail Making Test Part A (TMT-A). Social information was collected by standard questionnaire. Multiple logistic regression analysis was utilized to screen for the risk and protective factors of aMCI.

Results

The data analysis included 309 subjects with normal cognitive function and 59 with aMCI, resulting in a prevalence of 16.0% for aMCI. The average age of participants was 69.06 ± 7.30 years, with 56.0% being females. After controlling for age, gender and education, the Spearman partial correlation coefficient between various cognitive assessments and aMCI ranged from -0.52 for the long-term delayed recall scores in AVLT to 0.19 for the time-usage scores in TMT-A. The results indicated that all cognitive domains, except for naming scores (after semantic cue of BNT) and error quantity (in TMT-A), showed statistically significant associations with aMCI. Furthermore, the multiple logistic regression analysis revealed that older age (OR = 1.044, 95%CI: 1.002~1.087), lower educational level, and diabetes (OR = 2.450, 95%CI: 1.246~4.818) were risk factors of aMCI.

Conclusion

This study found a high prevalence of aMCI among older adults in Chengdu, China. Individuals with aMCI exhibited lower cognitive function in memory, language, and executive domains, with long-term delayed recall showing the strongest association. Clinicians should prioritize individuals with verbal learning and memory difficulties, especially long-term delayed recall, in clinical practice.

The prevalence of mild cognitive impairment in Gulf War veterans: a follow-up study

Introduction

Gulf War Illness (GWI), also called Chronic Multisymptom Illness (CMI), is a multi-faceted condition that plagues an estimated 250,000 Gulf War (GW) veterans. Symptoms of GWI/CMI include fatigue, pain, and cognitive dysfunction. We previously reported that 12% of a convenience sample of middle aged (median age 52 years) GW veterans met criteria for mild cognitive impairment (MCI), a clinical syndrome most prevalent in older adults (e.g., ≥70 years). The current study sought to replicate and extend this finding.

Methods

We used the actuarial neuropsychological criteria and the Montreal Cognitive Assessment (MoCA) to assess the cognitive status of 952 GW veterans. We also examined regional brain volumes in a subset of GW veterans (n = 368) who had three Tesla magnetic resonance images (MRIs).

Results

We replicated our previous finding of a greater than 10% rate of MCI in four additional cohorts of GW veterans. In the combined sample of 952 GW veterans (median age 51 years at time of cognitive testing), 17% met criteria for MCI. Veterans classified as MCI were more likely to have CMI, history of depression, and prolonged (≥31 days) deployment-related exposures to smoke from oil well fires and chemical nerve agents compared to veterans with unimpaired and intermediate cognitive status. We also replicated our previous finding of hippocampal atrophy in veterans with MCI, and found significant group differences in lateral ventricle volumes.

Discussion

Because MCI increases the risk for late-life dementia and impacts quality of life, it may be prudent to counsel GW veterans with cognitive dysfunction, CMI, history of depression, and high levels of exposures to deployment-related toxicants to adopt lifestyle habits that have been associated with lowering dementia risk. With the Food and Drug Administration's recent approval of and the VA's decision to cover the cost for anti-amyloid β (Aβ) therapies, a logical next step for this research is to determine if GW veterans with MCI have elevated Aβ in their brains.

Effects of Virtual Reality Physical and Cognitive Training Intervention On Cognitive Abilities of Elders with Mild Cognitive Impairment

Background

Virtual reality (VR) technology has become increasingly used for assessment and intervention in the neuroscience field.

Objective

We aimed to investigate the effects of a VR Training System, named VRADA (VR Exercise App for Dementia and Alzheimer's Patients), on the cognitive functioning of older people with mild cognitive impairment (MCI).

Methods

In this intervention study, 122 older adults with MCI were randomly assigned to five groups (the VRADA group (n = 28), a bike group (n = 11), a physical exercise group (n = 24), a mixed group (physical and cognitive exercise) (n = 31), and a non-contact control group (n = 28). The VRADA group underwent 32 physical and cognitive training sessions, performed 2 or 3 times weekly for 12 weeks in the VR environment. All participants had detailed neuropsychological assessments before and after intervention.

Results

A series of linear regression models revealed that the VRADA group showed improvement or no deterioration in cognitive decline in global cognitive function (MMSE), verbal memory (Rey Auditory Verbal Learning Test and WAIS forward test), and executive functions, mental flexibility (Trail Making Test B).

Conclusions

This interventionstudy indicates that the VRADA system improves the cognitive function of elders with MCI.

Physical activity, sleep disorders, and type of work in the prevention of cognitive function decline in patients with hypertension

BACKGROUND

Hypertensive patients are likelier to have cognitive function decline (CFD). This study aimed to explore physical activity level, sleep disorders, and type of work that influenced intervention effects on cognitive function decline in hypertensive patients and to establish a decision tree model to analyze their predictive significance on the incidence of CFD in hypertensive patients.

METHODS

This cross-sectional study recruited patients with essential hypertension from several hospitals in Shandong Province from May 2022 to December 2022. Subject exclusion criteria included individuals diagnosed with congestive heart failure, valvular heart disease, cardiac surgery, hepatic and renal dysfunction, and malignancy. Recruitment is through multiple channels such as hospital medical and surgical outpatient clinics, wards, and health examination centers. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Moreover, we obtained information on the patients' type of work through a questionnaire and their level of physical activity through the International Physical Activity Questionnaire (IPAQ).

RESULTS

The logistic regression analysis results indicate that sleep disorder is a significant risk factor for CFD in hypertension patients(OR:1.85, 95%CI:[1.16,2.94]), mental workers(OR:0.12, 95%CI: [0.04,0.37]) and those who perform both manual and mental workers(OR: 0.5, 95%CI: [0.29,0.86]) exhibit protective effects against CFD. Compared to low-intensity, moderate physical activity(OR: 0.53, 95%CI: [0.32,0.87]) and high-intensity physical activity(OR: 0.26, 95%CI: [0.12,0.58]) protects against CFD in hypertension patients. The importance of predictors in the decision tree model was ranked as follows: physical activity level (54%), type of work (27%), and sleep disorders (19%). The area under the ROC curves the decision tree model predicted was 0.72 [95% CI: 0.68 to 0.76].

CONCLUSION

Moderate and high-intensity physical activity may reduce the risk of developing CFD in hypertensive patients. Sleep disorders is a risk factor for CFD in hypertensive patients. Hypertensive patients who engage in mental work and high-intensity physical activity effectively mitigate the onset of CFD in hypertensive patients.

Peptidomimetics based on ammonium decasubstituted pillar[5]arenes: Influence of the alpha-amino acid residue nature on cholinesterase inhibition

Cholinesterase inhibitors are a group of medicines that are widely used for the treatment of cognitive impairments accompanying Alzheimer's disease as well as for the treatment of pathological muscle weaknesses syndromes such as myasthenia gravis. The search for novel non-toxic and effective cholinesterase inhibitors for creating neuroprotective and neurotransmitter agents is an urgent interdisciplinary problem. For the first time, the application of water-soluble pillar[5]arenes containing amino acid residues as effective cholinesterase inhibitors was shown. The influence of the nature of aliphatic and aromatic alpha-amino acid residues (glycine, l-alanine, l-phenylalanine and l-tryptophan) on self-assembly, aggregate's stability, cytotoxicity on A549 and LEK cells and cholinesterase inhibition was studied. It was found that the studied compounds with aliphatic amino acid residues showed a low inhibitory ability against cholinesterases. It was established that the pillar[5]arene containing fragments of l-phenylalanine is the most promising inhibitor of butyrylcholinesterase (IC50 = 0.32 ± 0.01 μM), the pillar[5]arene with l-tryptophan residues is the most promising inhibitor of acetylcholinesterase (IC50 = 0.32 ± 0.01 μM). This study has shown a possible application of peptidomimetics based on pillar[5]arenes to inhibit cholinesterase, as well as control the binding affinity to a particular enzyme in a structure-dependent manner.

Association between the neutrophil-to-lymphocyte ratio and cognitive impairment: a meta-analysis of observational studies

Background

Systemic inflammation is one of the underlying mechanisms of cognitive impairment. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a systemic inflammation indicator. This meta-analysis aimed to evaluate the association between high NLR and cognitive impairment (CI) risk.

Method

A comprehensive systematic search was conducted to identify eligible studies published until May 30, 2023. The reference group comprised patients with the lowest NLR level, whereas the exposure group comprised those with the highest NLR level. The main outcome was to examine the relationship between NLR and CI risk. The secondary outcome included the association between patient characteristics or comorbidities and CI risk.

Results

This meta-analysis included 11 studies published between 2018 and 2023, involving 10,357 patients. Patients with CI had a higher NLR than those without (mean difference=0.35, 95% confidence interval [CI]: 0.26-0.44, p < 00001, I2 = 86%). Consistently, pooled results revealed an association between high NLR and CI risk (odds ratio [OR]=2.53, 95% CI:1.67-3.82, p<0.0001, I2 = 84%). Furthermore, aging (mean difference =4.31 years, 95% CI:2.83-5.8, p < 0.00001, I2 = 92%), diabetes (OR=1.59, 95% CI:1.35-1.88, p < 0.00001, I2 = 66%), and hypertension (OR=1.36, 95% CI:1.19-1.57, p < 0.00001, I2 = 0%) were significant risk factors for CI. However, no significant associations were observed between CI and male gender (OR = 0.84, 95% CI:0.64-1.11, p = 0.22, I2 = 81%), body mass index (mean = -0.32 kg/m2, 95% CI: -0.82, 0.18, p = 0.2, I2 = 82%), alcohol consumption (OR = 1.11, 95% CI:0.95-1.3, p = 1.35, I2 = 0%), and smoking (OR = 0.99, 95% CI:0.87-1.13, p = 0.86, I2 = 0%). Meta-regression found that diabetes and hypertension, but not age, significantly moderated the association between NLR and CI.

Conclusion

This meta-analysis showed a significant association between high NLR and increased CI risk. Moreover, meta-regression identified diabetes and hypertension, but not age, as significant moderating factors in the relationship between NLR and CI. To validate and strengthen these findings, further large-scale studies are required.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023430384, identifier CRD42023430384.

Physical Activity Mediates the Relationship Between Sarcopenia and Cognitive Function Among Older Adults in Nursing Homes

Purpose

Sarcopenia and physical activity are significant factors influencing cognitive function. However, few studies have examined their underlying mechanisms between the three conditions. The aim of the study is to examine the mediating role of physical activity in the relationship between sarcopenia and cognitive function in elderly nursing home residents.

Materials and Methods

A total of 420 older adults aged 60 years and above in nursing homes participated in this study. Sarcopenia was defined following the Asian Sarcopenia Working Group (AWGS) 2019 criteria. Cognitive function was assessed by the Mini-Mental State Examination (MMSE). Multiple linear regression analysis was employed to explore the relationships between sarcopenia, cognitive function and physical activity. Mediation analyses were performed to examine whether physical activity moderates the relationship between sarcopenia and cognitive function, with the use of PROCESS macro version 4.0.

Results

A total of 386 older adults were included in the analysis (mean age 80.30 years), 175 (45.3%) were assessed as cognitive impairment, and sarcopenia was more common in those with cognitive impairment (p < 0.01). The linear regression analysis indicated that there were significant associations between sarcopenia and physical activity (β = -0.285, p = 0.012), physical activity and cognitive function (β = 0.218, p < 0.001), and sarcopenia and cognitive function (β = -0.245, p = 0.021). Mediating effects of physical activity on the association between sarcopenia and cognitive function were observed in participants, with 20.2% of partial mediating effect.

Conclusion

The results of the study suggest physical activity may partially buffer the adverse effects of sarcopenia on cognitive impairment among the older adults in nursing homes. Accordingly, engagement in physical activity can help to preserve cognitive function among those with sarcopenia.

Circadian Rhythm Changes in Healthy Aging and Mild Cognitive Impairment

Disruptions in circadian rhythms can occur in healthy aging; however, these changes are more severe and pervasive in individuals with age-related and neurodegenerative diseases, such as dementia. Circadian rhythm alterations are also present in preclinical stages of dementia, for example, in patients with mild cognitive impairments (MCI); thus, providing a unique window of opportunity for early intervention in neurodegenerative disorders. Nonetheless, there is a lack of studies examining the association between relevant changes in circadian rhythms and their relationship with cognitive dysfunctions in MCI individuals. In this review, circadian system alterations occurring in MCI patients are examined compared to healthy aging individuals while also considering their association with MCI neurocognitive alterations. The main findings are that abnormal circadian changes in rest-activity, core body temperature, melatonin, and cortisol rhythms appear in the MCI stage and that these circadian rhythm disruptions are associated with some of the neurocognitive deficits observed in MCI patients. In addition, preliminary evidence indicates that interventions aimed at restoring regular circadian rhythms may prevent or halt the progress of neurodegenerative diseases and mitigate their related cognitive impairments. Future longitudinal studies with repeated follow-up assessments are needed to establish the translational potential of these findings in clinical practice.

Bayesian estimation for the accuracy of three neuropsychological tests in detecting Alzheimer's disease and mild cognitive impairment: a retrospective analysis of the ADNI database

BACKGROUND

The neuropathological confirmation serves as the gold standard for diagnosing Alzheimer's disease (AD), but it is usually not available to the living individuals. In addition, the gold standard for diagnosing Mild Cognitive Impairment (MCI) remains unclear yet. Neuropsychological testing, such as the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), is commonly used tests in identifying AD and MCI, offering convenience, affordability, non-invasiveness, and accessibility in clinical settings. We aimed to accurately evaluate the discriminative ability of the three tests administrated at the same visit simultaneously in detecting AD and MCI due to AD in the absence of a gold standard.

METHODS

A total of 1289 participants aged over 65 were included from the baseline visits of Alzheimer's disease Neuroimaging Initiative. Bayesian latent class models, accounting for conditional dependence between MoCA and MMSE, were conducted to assess the diagnostic accuracy of the three tests for detecting AD and MCI.

RESULTS

In detecting AD, the ADAS-cog had the highest Youden's Index (0.829), followed by the MoCA(0.813) and MMSE(0.796). The ADAS-cog and MoCA showed similar sensitivity (0.922 vs 0.912) and specificity (0.907 vs 0.901), while the MMSE had lower sensitivity (0.874) and higher specificity (0.922). For MCI detection, the ADAS-cog had the highest Youden's Index (0.704) compared to the MoCA (0.614) and MMSE (0.478). The ADAS-cog exhibited the highest sensitivity, closely followed by the MoCA and MMSE (0.869 vs 0.845 vs 0.757), and the ADAS-cog also had good specificity (0.835 vs 0.769 vs 0.721). The estimated true prevalence of AD among individuals aged over 65 was 20.0%, and the estimated true prevalence of MCI due to AD was 24.8%.

CONCLUSIONS

The findings suggest that the ADAS-cog and MoCA are reliable tools for detecting AD and MCI, while the MMSE may be less sensitive in detecting these conditions. A large underdiagnosis of the MCI and Alzheimer's population still remains in clinical screening.

Predictors of Adherence to Continuous Positive Airway Pressure in Older Adults With Apnea and Amnestic Mild Cognitive Impairment

BACKGROUND

Almost 60% of adults with amnestic mild cognitive impairment (aMCI) have obstructive sleep apnea (OSA). Treatment with continuous positive airway pressure (CPAP) may delay cognitive decline, but CPAP adherence is often suboptimal. In this study, we report predictors of CPAP adherence in older adults with aMCI who have increased odds of progressing to dementia, particularly due to Alzheimer's disease.

METHODS

The data are from Memories 2, "Changing the Trajectory of Mild Cognitive Impairment with CPAP Treatment of Obstructive Sleep Apnea." Participants had moderate to severe OSA, were CPAP naïve, and received a telehealth CPAP adherence intervention. Linear and logistic regression models examined predictors.

RESULTS

The 174 participants (mean age 67.08 years, 80 female, 38 Black persons) had a mean apnea-hypopnea index of 34.78, and 73.6% were adherent, defined as an average of ≥4 hours of CPAP use per night. Only 18 (47.4%) Black persons were CPAP adherent. In linear models, White race, moderate OSA, and participation in the tailored CPAP adherence intervention were significantly associated with higher CPAP use at 3 months. In logistic models, White persons had 9.94 times the odds of adhering to CPAP compared to Black persons. Age, sex, ethnicity, education, body mass index, nighttime sleep duration, daytime sleepiness, and cognitive status were not significant predictors.

CONCLUSIONS

Older patients with aMCI have high CPAP adherence, suggesting that age and cognitive impairment should not be a barrier to prescribing CPAP. Research is needed to improve adherence in Black patients, perhaps through culturally tailored interventions.

Association between whole blood essential trace elements and cognitive function in older adults

BACKGROUND

Essential trace elements (ETEs) are essential nutrients for keeping the nervous system functioning. Associations between ETEs and cognitive function are still inconclusive and limited.

OBJECTIVES

We aimed to investigate the individual and joint associations between ETEs and cognitive function among older adults.

METHODS

A population (N = 2181) at an average age≥ 65 from Yiwu cohort in China was available for this study. Whole blood chromium (Cr), selenium (Se), manganese (Mn), and copper (Cu) concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), consisting of five specific cognitive domains: orientation, registry, attention and calculation, recall, and language and praxis. Linear regression, restricted cubic spline (RCS) analysis, and Bayesian kernel machine regression (BKMR) were used to analyze the individual and joint associations between ETEs and cognitive function.

RESULTS

The association between Cr and MMSE score presented an inverted-U shape (Q3 versus Q1: β = 0.774, 95 % CI: 0.297, 1.250; Q4 versus Q1: β = 0.481, 95 % CI: 0.006, 0.956); and Cr was especially associated with the registry, recall, and language and praxis. Per IQR (36.32 μg/L) increase of Se was positively associated with the MMSE score (β = 0.497, 95 % CI: 0.277, 0.717) and all five cognitive domains. The BKMR showed that the dose-response association between Se and cognitive function increased initially and then decreased with increasing Se concentration when fixed the other ETEs in median. ETEs mixture was positively associated with cognitive function, and Se (posterior inclusion probabilities, PIPs = 0.915) was the most important contributor within the ETEs mixture.

CONCLUSIONS

The nonlinear association between Cr and cognitive function suggested further exploration of an appropriate concentration range for ETEs. A positive association between mixed ETEs and cognitive function is a reminder that their joint association should be considered. Further prospective studies or intervention studies are warranted to validate our findings in the future.

Effect of acupuncture on episodic memory for amnesia-type mild cognitive impairment: study protocol of a multicenter, randomized, controlled trial

BACKGROUND

Amnesic mild cognitive impairment (aMCI) is the main subtype of mild cognitive impairment (MCI) and has the highest risk of conversion to Alzheimer's disease (AD) among all MCI subtypes. Episodic memory impairment is the early cognitive impairment of aMCI, which has become an important target for AD prevention. Previous clinical evidence has shown that acupuncture can improve the cognitive ability of MCI patients. This experiment aimed to observe the efficacy and neural mechanism of TiaoshenYizhi acupuncture on the episodic memory of patients with aMCI.

METHODS

In this multicenter, parallel-group, double-blind, randomized controlled trial, 360 aMCI participants will be recruited from six subcenters and randomly assigned to the acupuncture group, sham acupuncture group, and control group. The acupuncture group will receive TiaoshenYizhi (TSYZ) acupuncture, the sham acupuncture group will use streitberger sham acupuncture, and the control group will only receive free health education. Participants in the two acupuncture groups will receive real acupuncture treatment or placebo acupuncture three times per week, 24 sessions over 8 consecutive weeks. The primary outcome will be global cognitive ability. Secondary outcomes will be a specific cognitive domain, including episodic memory and execution ability, electroencephalogram, and functional magnetic resonance imaging data. Outcomes will be measured at baseline and the fourth and eighth weeks after randomization. Repeated measurement analysis of variance and a mixed linear model will be used to observe the intervention effect.

DISCUSSION

The protocol will give a detailed procedure to the multicenter clinical trial to further evaluate the efficacy and neural mechanism of TiaoshenYizhi acupuncture on episodic memory in patients with aMCI. From this research, we expect to provide clinical evidence for early aMCI management.

TRIAL REGISTRATION

http://www.chictr.org.cn/edit.aspx?pid=142612&htm=4 , identifier: ChiCTR2100054009.

Advances in diagnosing mild cognitive impairment and Alzheimer's disease using 11C-PIB- PET/CT and common neuropsychological tests

Alzheimer's disease (AD) is a critical health issue worldwide that has a negative impact on patients' quality of life, as well as on caregivers, society, and the environment. Positron emission tomography (PET)/computed tomography (CT) and neuropsychological scales can be used to identify AD and mild cognitive impairment (MCI) early, provide a differential diagnosis, and offer early therapies to impede the course of the illness. However, there are few reports of large-scale ¹¹C-PIB-PET/CT investigations that focus on the pathology of AD and MCI. Therefore, further research is needed to determine how neuropsychological test scales and PET/CT measurements of disease progression interact.

Usefulness of the Visual Cognitive Assessment Test in Detecting Mild Cognitive Impairment in the Community

BACKGROUND

A delay in the detection of mild cognitive impairment (MCI) in the community delays the opportunity for early intervention. Accurate tools to detect MCI in the community are lacking. The Visual Cognitive Assessment Test (VCAT) is a visual based cognitive test useful for multilingual populations without the need for translation.

OBJECTIVE

Here, we evaluate the usefulness of VCAT in detecting MCI in a community population in Singapore.

METHODS

We recruited 301 participants from the community who completed a detailed neuropsychological assessment and 170 of them completed a 3T magnetic resonance imaging (MRI) brain scan. We performed a receiver operating characteristics analysis to test the diagnostic performance of VCAT compared to Montreal Cognitive Assessment (MoCA) in distinguishing MCI from cognitively normal (CN) by measuring area under the curve (AUC). To test for the association of VCAT with structural MRI, we performed a Pearson's correlation analysis for VCAT and MRI variables.

RESULTS

We recruited 39 CN and 262 MCI participants from Dementia Research Centre (Singapore). Mean age of the cohort was 63.64, SD = 9.38, mean education years was 13.59, SD = 3.70 and majority were women (55.8%). VCAT was effective in detecting MCI from CN with an AUC of 0.794 (95% CI 0.723-0.865) which was slightly higher than MoCA 0.699 (95% CI 0.621-0.777). Among subjects with MCI, VCAT was associated with medial temporal lobe atrophy (ρ = -0.265, p = 0.001).

CONCLUSIONS

The VCAT is useful in detecting MCI in the community in Singapore and may be an effective measure of neurodegeneration.

Psychosocial profiles within community-dwelling older adults with Mild Cognitive Impairment: A prevalence and latent profile analysis study

OBJECTIVES

Mild Cognitive Impairment (MCI) is an at-risk stage for dementia and accurate prevalence studies are lacking in Singapore. From the literature, it is evident that psychosocial factors increase the risk of conversion to dementia. In this study, we sought to establish the prevalence of MCI in Singapore and study the associated psychosocial factors using latent profile analysis.

METHOD

902 community-dwelling older adults, aged between 60 and 99 years old (Mage = 70.48 years), were recruited as part of the Community Health and Intergenerational Study (CHI). They completed neurocognitive assessments and questionnaires on depression and anxiety symptoms, quality of life, social support, satisfaction with life, and social connectivity. Petersen's criteria was used to diagnose MCI. Within the MCI sample, 166 subjects' psychosocial scores were entered into a latent profile analysis to identify profiles of psychosocial functioning.

RESULTS

The prevalence of MCI in our sample was 21.5%. They had significantly lower years of education and perceived social support and higher depressive symptoms than the normal ageing group. Three distinct profiles emerged within the MCI group corresponding to a positive (45.2%), neutral (38.5%), and negative (16.3%) pattern of psychosocial scores. These profiles did not differ significantly in terms of demographic or cognitive variables.

DISCUSSION

The three psychosocial profiles might reflect the differing implications of MCI on a person's well-being and the negative psychosocial profile might likely be most at risk of conversion to dementia. Future longitudinal studies are required to confirm these implications.

Global prevalence of mild cognitive impairment among older adults living in nursing homes: a meta-analysis and systematic review of epidemiological surveys

Mild cognitive impairment (MCI) is the early stage of cognitive impairment between the expected cognitive decline of normal aging and the more serious decline of dementia. This meta-analysis and systematic review explored the pooled global prevalence of MCI among older adults living in nursing homes and its relevant factors. The review protocol was registered in INPLASY (INPLASY202250098). PubMed, Web of Science, Embase, PsycINFO, and CINAHL databases were systematically searched from their respective inception dates to 8 January 2022. The inclusion criteria were made based on the PICOS acronym, as follows: Participants (P): Older adults living in nursing homes; Intervention (I): not applicable; Comparison (C): not applicable; Outcome (O): prevalence of MCI or the data can generate the prevalence of MCI according to study-defined criteria; Study design (S): cohort studies (only baseline data were extracted) and cross-sectional studies with accessible data published in a peer-reviewed journal. Studies involving mixed resources, reviews, systematic reviews, meta-analyses, case studies, and commentaries were excluded. Data analyses were performed using Stata Version 15.0. Random effects model was used to synthesize the overall prevalence of MCI. An 8-item instrument for epidemiological studies was used to assess the quality of included studies. A total of 53 articles were included involving 376,039 participants with a mean age ranging from 64.42 to 86.90 years from 17 countries. The pooled prevalence of MCI in older adults in nursing homes was 21.2% (95% CI: 18.7-23.6%). Subgroup and meta-regression analyses revealed that the screening tools used were significantly associated with MCI prevalence. Studies using the Montreal Cognitive Assessment (49.8%) had a higher prevalence of MCI than those using other instruments. No significant publication bias was found. Several limitations warrant attention in this study; for example, significant heterogeneity between studies remained and some factors associated with the prevalence of MCI were not examined due to insufficient data. Adequate screening measures and allocation of resources are needed to address the high global prevalence of MCI among older adults living in nursing homes.

Socioeconomic and Contextual Differentials in Memory Decline: A Cross-Country Investigation Between England and China

OBJECTIVES

Although cognitive functioning is strongly associated with biological changes in the brain during the aging process, very little is known about the role of sociocultural differentials between the western and eastern parts of the world. We examined the associations between individual socioeconomic markers (e.g., education, household wealth) and contextual levels characteristics (e.g., urbanicity) with memory performance and memory decline over up to 8 years of follow-up in England and China.

METHODS

The analytical samples included participants aged 50+ from the English Longitudinal Study of Aging (n = 6,687) and the China Health and Retirement Longitudinal Study (n = 10,252). Mixed linear models were employed to examine the association between baseline individual socioeconomic markers (education, wealth) and contextual-level characteristics (urbanicity) on the change in memory over time.

RESULTS

Our analyses showed that higher education and wealth were associated with better baseline memory in both England and China. Still, the impact of contextual-level characteristics such as urbanicity differed between the 2 countries. For English individuals, living in a rural area showed an advantage in memory, while the opposite pattern was observed in China. Memory decline appeared to be socioeconomically patterned by higher education, wealth, and urbanicity in China but not in England.

DISCUSSION

Our findings highlight substantial socioeconomic and contextual inequity in memory performance in both England and China, as well as in the rate of memory decline primarily in China. Public health strategies for preventing memory decline should target the socioeconomic gaps at the individual and contextual levels to protect those particularly disadvantaged.

Cognitive impairment does not impact sacral neuromodulation implant rates for overactive bladder

OBJECTIVE

To evaluate the impact of cognitive impairment (CI) diagnoses on sacral neuromodulation (SNM) outcomes in older patients.

MATERIALS AND METHODS

We completed a retrospective review of all patients aged ≥55 years who underwent test-phase SNM (peripheral nerve evaluation (PNE) or stage 1) for overactive bladder (OAB) between 2014 and 2021 within a large multi-regional health system. Patient demographics, relevant comorbidities, CI diagnoses (dementia or mild CI), and SNM procedures were recorded. Logistic regression modeling was performed to evaluate the impact of CI on SNM implantation rates.

RESULTS

Five-hundred and ten patients underwent SNM test phase (161 PNE, 349 Stage 1) during the study period. The mean age was 71.0(8.5) years, and most (80.6%) were female. Overall, 52(10.1%) patients had a CI diagnosis at the time of SNM, and 30 (5.8%) were diagnosed at a median of 18.5 [9.25, 39.5] months after SNM. Patients with CI diagnoses were older, with more comorbidities, and were more likely to undergo PNE. Univariable comparison found no difference in implantation rate based on pre-SNM CI (85.4% vs. 76.9%, p = 0.16). Multivariable analysis identified PNE (OR 0.43, 95% CI 0.26-0.71), age (OR 0.96, 95%CI 0.93-0.98), and prior beta-3 agonist use (OR 0.60, 95% CI 0.37-0.99) but not CI or dementia as independent negative predictors of implantation. Implanted patients had a median follow-up of 25 [12.0, 55.0] months. Explant and revision rates did not differ according to CI.

CONCLUSION

Patients with OAB and CI diagnoses proceed to SNM implant at rates similar to patients without CI diagnoses. A diagnosis of CI should not necessarily exclude patients from SNM therapy for refractory OAB.

Cretan Aging Cohort-Phase III: Methodology and Descriptive Characteristics of a Long-Term Longitudinal Study on Predictors of Cognitive Decline in Non-Demented Elderly from Crete, Greece

Identifying modifiable factors that may predict long-term cognitive decline in the elderly with adequate daily functionality is critical. Such factors may include poor sleep quality and quantity, sleep-related breathing disorders, inflammatory cytokines and stress hormones, as well as mental health problems. This work reports the methodology and descriptive characteristics of a long-term, multidisciplinary study on modifiable risk factors for cognitive status progression, focusing on the 7-year follow-up. Participants were recruited from a large community-dwelling cohort residing in Crete, Greece (CAC; Cretan Aging Cohort). Baseline assessments were conducted in 2013-2014 (Phase I and II, circa 6-month time interval) and follow-up in 2020-2022 (Phase III). In total, 151 individuals completed the Phase III evaluation. Of those, 71 were cognitively non-impaired (CNI group) in Phase II and 80 had been diagnosed with mild cognitive impairment (MCI). In addition to sociodemographic, lifestyle, medical, neuropsychological, and neuropsychiatric data, objective sleep was assessed based on actigraphy (Phase II and III) and home polysomnography (Phase III), while inflammation markers and stress hormones were measured in both phases. Despite the homogeneity of the sample in most sociodemographic indices, MCI persons were significantly older (mean age = 75.03 years, SD = 6.34) and genetically predisposed for cognitive deterioration (APOE ε4 allele carriership). Also, at follow-up, we detected a significant increase in self-reported anxiety symptoms along with a substantial rise in psychotropic medication use and incidence of major medical morbidities. The longitudinal design of the CAC study may provide significant data on possible modifiable factors in the course of cognitive progression in the community-dwelling elderly.