Decomposition of gender differences in cognitive functioning: National Survey of the Japanese elderly

Automated vehicles for older adults with cognitive impairment: a survey study

As the population is ageing, the number of older adults with cognitive impairment (CI) is increasing. Automated vehicles (AVs) can improve independence and enhance the mobility of these individuals. This study aimed to: (1) understand the perception of older adults (with and without CI) and stakeholders providing services and supports regarding care and transportation about AVs, and (2) suggest potential solutions to improve the perception of AVs for older adults with mild or moderate CI. A survey was conducted with 435 older adults with and without CI and 188 stakeholders (e.g. caregivers). The results were analysed using partial least square - structural equation modelling and multiple correspondence analysis. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided recommendations to improve older adults' perception of AVs including education and adaptive driving simulation-based training.Practitioner summary: This study investigated the perception of older adults and other stakeholders regarding AVs. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided guidelines to improve older adults' perception of AVs.

The Beneficial, Formative Role of Lifetime Exposures across Cognitive Domains in Barbados Using Data from the SABE Study

This study tested the hypothesis that within older Barbadian adults, sex, education, and occupation type lessen age-related cognitive decline. The analyses used a cross-sectional data set from 1325 people collected in the 2006 SABE Study (Health, Well-being, and Aging). Cognition was assessed as scores in each subdomain of the Mini-Mental State Exam. The loss of a single point in each subdomain was predicted by sex, years of education, job type, and their interactions with age. Results demonstrated that age and protective factors affect each cognitive domain differently. High education combined with mentally complex employment helped maintain cognitive performance in later life. Beneficial lifetime exposures are additive, providing combined benefits. Findings provide insight into public policy aiming to minimize the number of adults with cognitive decline and dementia in Barbados and the Caribbean.

Cognitive trajectories in older adults and the role of depressive symptoms: A 7-year follow-up study

OBJECTIVES

To examine different trajectories of cognitive changes in elderly adults and explore the mediating role of depressive symptoms.

DESIGN

A 7-year, community-based, prospective cohort study.

SETTING

The downtown neighborhood of Shanghai, China.

PARTICIPANTS

A cohort of 394 older adults, with an average age of 71.8 years, was recruited in 2015 and has been reassessed every two years until 2021.

METHODS

Latent Class Growth Analysis was used to model aging trajectories and Linear Mixed-Effect Models for Repeated Measures were used to estimate the least squares mean changes of cognition between subjects with depression (DEP+) and without (DEP-) across all visits.

RESULTS

Three cognitive trajectories were identified: the "successful aging" (SA) trajectory had the best and most consistent performance (n=229, 55.9%); the "normal aging" (NA) trajectory showed lower but stable cognition (n=141, 37.3%); while the "cognitive decline" (CD) trajectory displayed poor and declining cognition (n=24, 6.8%). Depressive symptoms were found to be influential across all trajectories. In the CD trajectory, the MoCA scores of the DEP+ group increased in within-group comparisons and were significantly higher than those of the DEP- group at visits 1 and 3 in between-group comparisons. A similar trend was observed in the NA trajectory, though it did not reach statistical significance.

CONCLUSIONS

Our research suggests that mild and decreasing depressive symptoms can be a reversible factor that might slow down the irreversible cognitive decline in the elderly. Therefore, we suggest that even mild depressive symptoms in the elderly should be monitored and detected.

Work and self-rated memory among native Hawaiian and other Pacific Islander older adults

OBJECTIVES

Engagement in work has an important association with cognitive health in later life, yet little is known about this association among Native Hawaiian and other Pacific Islander (NHPI) older adults. This study assesses the associations between various work characteristics and memory problems among this population.

DESIGN

Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS), the research question was explored among those who were aged 50+.

RESULTS

Engagement in work, certain occupation types (e.g., clerical or professional occupations compared to blue-collar jobs), and the current/most recent job that is also the longest job held were associated with lower odds of having memory problems.

CONCLUSION

The study's results suggest that work characteristics and opportunities to engage in work are important considerations in preventing memory problems in later life. As the NHPI population experiences cognitive health disparities earlier than other groups, timely interventions that focus on work engagement and a culturally relevant environment require further investigation.

Investigating Sex Differences in Risk and Protective Factors in the Progression of Mild Cognitive Impairment to Dementia: A Systematic Review

BACKGROUND

Developing effective strategies for reducing dementia risk requires a detailed understanding of the risk and protective factors associated with the progression of mild cognitive impairment (MCI) to dementia.

OBJECTIVE

We aimed to systematically review the evidence for sex differences in these factors.

METHODS

Five online databases (PubMed/CINAHL/EMBASE/PsycINFO/Cochrane) were searched from inception until 17 October 2022 for cohort studies that focused on sex differences in risk and protective factors in the progression of MCI to dementia.

RESULTS

A total of 2,972 studies were identified, of which 12 studies from five countries were included in the systematic review. There was substantial variability in study designs, study populations and outcome measures. Sex differences were present in the associations of sociodemographic, health, psychological factors, genetic and other biomarkers with the progression of MCI to dementia. APOE ɛ4 status and depression appeared to increase the risk of progression for females, whereas history of stroke, MRI markers and cerebrospinal fluid biomarkers appeared to increase the risk of progression for males. APOE ɛ2 status and marital status (unmarried) were observed to reduce risk of progression in males and females, respectively.

CONCLUSIONS

The ability of studies to accurately detail risk factors for dementia are likely limited when solely controlling for the effects of sex. Although the heterogeneity and underpowered nature of the studies made it difficult to synthesize the findings for each risk factor, this study highlights the apparent need for further research examining risk factors for dementia in males and females with MCI separately.

Decomposing the change in the cognitive function gap between older men and women over time in China: The Chinese Longitudinal Healthy Longevity Survey

Background

This study explored how modifiable social determinants of cognitive function can influence these gender gaps.

Methods

We utilized six waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 56,127 individuals aged 65+. The Kitagawa-Oaxaca-Blinder decomposition approach was used for the analysis.

Results

Older women consistently had lower average levels of cognitive function than men in each period, but the gap is narrowing. From 2002 to 2018, the gender gap in cognitive function decreased by 1.45 (95% confidence interval (CI) = -1.843, -1.097) points. The coefficients for the endowment effects decreased from 0.387 (95% CI = -0.563, -0.211) to 1.789 (95% CI = -2.471, -1.107) from 2005 to 2018. Lifestyle changes, social participation, and physical health factors significantly contributed to explaining the changes in gender gaps in cognitive function.

Conclusions

Among these contributing factors, lifestyle, social participation, and physical health have emerged as pivotal elements in reducing the gender gap in cognitive function. Targeted interventions for these variables are essential among older women to narrow the cognitive gender gaps effectively.

Effect of Combined Exercise Training on Physical and Cognitive Function in Women With Type 2 Diabetes

OBJECTIVES

One of the consequences of old age is cognitive and physical decline, which can cause a wide range of problems. These complications are more pronounced in those with type 2 diabetes (T2D). The aim of this pilot study was to investigate the effect of combined exercise training on blood biomarkers, physical fitness, and cognitive function in elderly women with T2D.

METHODS

Twenty-one elderly women with T2D were randomly allocated to training (n=12) and control (n=9) groups. The exercise training program was a combination of aerobic, resistance, and balance exercises performed 3 times per week over 12 weeks. In the same period, the control group received no training intervention. Blood markers, including brain-derived neurotrophic factor (BDNF), irisin, glycated hemoglobin (A1C), fasting blood sugar (FBS), cardiorespiratory fitness (CRF), lower and upper body strength, and cognitive function, were measured in all participants at baseline and after 12 weeks.

RESULTS

Serum BDNF levels were not significantly different between the exercise and control groups at 12 weeks (p>0.05). FBS and A1C levels in the exercise group decreased significantly compared with the control group (p<0.05). CRF, dynamic balance, and both upper and lower body strength in the exercise group improved significantly compared with the control group (p<0.05). Irisin levels decreased significantly in the control group, but levels did not change significantly in the exercise group. Greater improvements from exercise were observed on the Montreal Cognitive Assessment index compared with the control group (p=0.05), but no other group differences in cognitive function were noted.

CONCLUSIONS

Combined exercise improved some physical fitness and diabetes-related surrogate factors, as well as select cognitive functions, but had no significant effect on cognition-related biochemical factors (i.e. BDNF) in women with T2D.

Mortality and morbidity in ageing men: Biology, Lifestyle and Environment

Males live shorter lives than women in all countries. The universality of shorter male life expectancy is a 21st Century phenomena. It occurs with the decline in infectious diseases and the rise in cardiovascular diseases accounting for mortality. Male/female differences in morbidity are not as succinctly characterized. Men have a higher prevalence of lethal diseases, which is linked to their lower life expectancy. Women have more non-lethal conditions such as depression and arthritis; which may also be linked in part to longer survival. Men have better physical functioning and less disability which is partly explained by gender differences in diseases and also by their greater strength, size, and stamina. Gender differences in risk factors for disease have changed over time with the prevalence and treatment of risk as well as differential behavior by gender. Examination of what are seen as basic molecular and cellular measures related to aging indicates men age faster than women; however, even these basic biological measures result from a combination of biology, behavior, and social factors.

Perception of dignity in older men and women in the early stages of dementia: a cross-sectional study

BACKGROUND

Dementia is a serious problem in old age, that impacts an individual's ability to function and may threaten personal dignity. Given the variable features of the illness and the diversity of life experiences, many factors may contribute to the perception of dignity by men and women with dementia. The purpose of the study was to explore the factors that contribute to dignity and its domains in men and women with dementia.

METHODS

This cross-sectional study involved 316 community-dwelling patients with early-stage dementia (aged ≥ 60) (PwD). We assessed the participants' sociodemographic and social involvement characteristics, health-related variables (pain, depression, physical performance, visual and hearing impairments), attitude to aging, and self-sufficiency in the activities of daily living (ADL). These factors were investigated as independent variables for the perception of dignity and of its domains in men and women.

RESULTS

Multivariate regression analysis showed that PwD experienced minor dignity problems in the early stages of dementia. In both men and women higher rates of depression, negative attitudes to aging, and pain were associated with reductions in the perception of dignity. In men, but not in women visual impairment had a negative effect on overall dignity, and on the associated domains of 'Loss of Autonomy' and 'Loss of Confidence'. In women, lowered self-sufficiency in ADL contributed to reduced self-perception of dignity and in the associated domains of 'Loss of Purpose of Life', 'Loss of Autonomy', and 'Loss of Confidence'. Sociodemographic and social involvement characteristics, hearing impairment, and physical performance did not influence the participants' self-perception of dignity.

CONCLUSION

The results suggested that several common factors (depression, attitudes to aging, and pain) contribute to the perception of dignity in both men and women. Other factors, visual impairments in men, and self-sufficiency in ADL in women, appear to be more gender specific. These differences might relate to their specific gender roles and experiences. The self-perception of dignity in PwD can be helped by supporting the individual, to the extent that their illness allows, in maintaining activities that are important to their gender roles, and that preserve their gender identity.

TRIAL REGISTRATION

NCT04443621.

Association between childhood friendship and cognitive ageing trajectory in later life: evidence from the China Health and Retirement Longitudinal Study (CHARLS)

Background

Childhood experience has been suggested to affect cognitive function in later life. However, the association between childhood friendship status and cognitive ageing trajectory in middle-aged and older adults has not been fully assessed. This study examined the association between childhood friendship status and cognitive ageing trajectory and identified factors modifying this association.

Methods

We used four waves of data from the China Health and Retirement Longitudinal Study (CHARLS), a national representative longitudinal study of adults aged 45 years or older, 2011–2018. The CHARLS included surveys on childhood friendship and cognitive assessments. Childhood friendship status was categorised as poor, fair, and good. To examine the association between childhood friendship and cognitive ageing trajectory in later life, we applied multilevel linear regression models, and explored potential influences of sociodemographic factors, health status and behaviours, and childhood conditions on this association.

Results

Of the 4,350 participants, 1,919 (44.1%) were women. The mean age was 56.29 ± 7.80 years. We found childhood friendship was significantly associated with cognitive ageing trajectory in later life, with a dose–response relationship. After adjusting for covariates, comparing to participants with poor childhood friendships, those with better childhood friendships had lower rates of cognitive decline (β = 0.12, 95% confidence interval [CI]: 0.03 to 0.22 [interaction term of fair friendship and time]; β = 0.19, 95% CI: 0.10 to 0.28 [interaction term of good friendship and time]) and higher level of cognitive functions (β = 0.40, 95% CI: 0.22 to 0.58 [fair friendships]; β = 0.61, 95% CI: 0.43 to 0.79 [good friendships]). These associations were stronger for those who were female, less educated, and had experienced more adverse childhood experiences.

Conclusions

Childhood friendship is associated with cognitive ageing in later life. Enhancing childhood friendships can play an important role to promote healthy ageing in the future.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03181-6.

The association between body mass index, demographic and clinical characteristics with cognitive performance in patients with neuromyelitis optica spectrum disorder

Background: Cognitive dysfunction is one of the problems that patients with neuromyelitis optica spectrum disorder (NMOSD) suffer from. We aimed to assess the association between demographic and clinical features as well as body mass index (BMI) and cognitive function in patients with NMOSD. Methods: A cross-sectional study was performed on 41 patients with definite diagnosis of NMOSD. Serum status of neuromyelitis optica immunoglobulin G (NMO-IgG) was determined using enzyme-linked immunosorbent assay (ELISA) method. Cognitive function was assessed by Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery which is validated for Persian people before and North American Adult Reading Test (NAART). Results: The mean score of NAART test was higher in participants with normal weight compared with overweight patients (40.47 ± 3.51 vs. 36.00 ± 5.74, P = 0.02). Current age was negatively correlated with Delis-Kaplan Executive Function System (D-KEFS)-Sorting (P = 0.05, r = -0.30). The correlation of duration of disease and cognitive performance was not significant (P > 0.05). Higher physical disability based on Expanded Disability Status Scale (EDSS) was correlated with lower results in Brief Visuospatial Memory Test-Revised (BVMT-R) (P < 0.01, r = -0.50), California Verbal Learning Test-second edition (CVLT-II)-Delayed Recall (P = 0.02, r = -0.35), and Symbol Digit Modalities Test (SDMT) (P = 0.03, r = -0.33) subtests of MACFIMS. Annual relapse rate was indirectly correlated with CVLT-II (P = 0.03, r = -0.34) and CVLT-II-Delayed Recall (P = 0.01, r = -0.38). Male participants obtained better scores in Paced Auditory Serial Addition Test (PASAT) subtest (P = 0.05). NMO-IgG seropositive patients had poorer performance in terms of CVLT-II-Delayed Recall, Controlled Oral Word Association Test (COWAT), and D-KEFS-Descriptive (P < 0.05). Participants with bachelor and master education degrees showed significantly better results compared to those with high school degree (P < 0.05). Conclusion: Investigating the clinical and demographic factors affecting cognitive impairment can increase the awareness of health care providers for early diagnosis of cognitive impairment in patients with NMOSD and increase the quality of health services.

Changes in Health Expectancy for Older Adults in Japan: Results from Two Longitudinal Surveys

BACKGROUND

Although there is evidence of improvements in health expectancy among the Japanese population, existing estimates are based on the prevalence of morbidity taken from cross-sectional survey data.

OBJECTIVES

This study employed a multistate life table approach to compute incidence-based health expectancy measures, namely active and inactive life expectancy (LE), for two longitudinal survey cohorts from 1990 to 2009.

METHODS

This study used data from two longitudinal surveys of older adults in Japan: the National Survey of the Japanese Elderly (1990-1999) and the Nihon University Japanese Longitudinal Study of Aging (1999-2009). We employed the Interpolation of Markov Chains technique to compute the number of years at age 65 years to be spent with and without difficulty in performing activities of daily living (ADLs) or instrumental ADLs.

RESULTS

We documented significant increases in active LE for men and women at age 65 years over the 10-year study period. There were significant changes in total LE for men and in the percentage of active life for women. Inactive LE did not significantly change across the two survey cohorts during the study period.

CONCLUSIONS

Our results show that the health status of older adults in Japan has largely improved over the 10-year study period, with increases in both the duration of life and time spent in an active state. This finding offers evidence of compression of morbidity among older men and women in Japan.

Relationship between physical activity and cognitive functioning among older Indian adults

In a culturally different and low-resource setting, where lifestyle habits, including dietary pattern and physical activities differ from those in high-income countries, the association between physical activity and cognition is expected to differ. We aimed to investigate the association between physical activity and cognitive functioning after controlling for potential confounders among older adults in India. Furthermore, gender differences in this relationship were analyzed. Using a national-level data from the Longitudinal Ageing Study in India (2017-2018), this paper employed propensity score matching (PSM) approach to examine the association between physical activities and cognitive functioning among Indian older adults. Cognitive impairment was measured through five broad domains (memory, orientation, arithmetic function, executive function, and object naming). We limit our sample to older adults aged 60 + years, and our final dataset contains 31,464 participants (men = 16,366, and women = 15,098). The results indicated that older adults who engaged in frequent physical activity have greater cognitive functioning than older adults without physical activity after adjusting for various individual, health, lifestyle, and household factors. This association holds true for both older men and older women. The results from the PSM revealed that the cognitive function score was increased by 0.98 and 1.32 points for the frequently physically active older men and women population, respectively. The results demonstrate the possible beneficial effects of frequent physical activity on cognitive functioning among older adults. Thus, regular physical activity can be considered as an effective lifestyle factor to promote healthy cognitive aging.

Association between Handgrip Strength and Cognitive Function in Older Adults: Korean Longitudinal Study of Aging (2006-2018)

Accumulating research indicates that handgrip strength is associated with cognitive function. Studies have also shown the difference in cognitive decline between males and females. We investigated the association between baseline handgrip strength and later cognitive function in older adults according to sex using the dataset from Korean Longitudinal Study of Aging (2006–2018). Overall, 9707 observations of 1750 participants (989 males and 761 females) over 65 years of age were sampled from the first wave, followed by six consecutive waves. The Korean version of the Mini-Mental State Examination and baseline handgrip strength scores were assessed. Sociodemographic and health-related variables were also included as covariates in the multivariable linear mixed models. Males in the lowest quartile of the baseline handgrip strength decreased in cognitive function (β = −0.54, standard error (SE) = 0.16, p < 0.001), compared to males in the highest quartile. For females, those in the second lowest quartile (β = −0.65, SE = 0.19, p < 0.001) and the lowest quartile (β = −0.53, SE = 0.19, p< 0.01) decreased in cognitive function. Handgrip strength may be positively associated with later cognitive function, but the association may be non-linear and differ between sexes. Sex-specific preventive assessment of handgrip strength may help identify older adults at risk for cognitive impairment.

Prevalence of preoperative cognitive impairment in older surgical patients.: A systematic review and meta-analysis

STUDY OBJECTIVE

Older surgical patients with cognitive impairment are at an increased risk for adverse perioperative outcomes, however the prevalence of preoperative cognitive impairment is not well-established within this population. The purpose of this review is to determine the pooled prevalence of preoperative cognitive impairment in older surgical patients.

DESIGN

Systematic review and meta-analysis.

SETTING

MEDLINE (Ovid), PubMed (non-MEDLINE records only), Embase, Cochrane Central, Cochrane Database of Systematic Reviews, PsycINFO, and EMCare Nursing for relevant articles from 1946 to April 2021.

PATIENTS

Patients aged ≥60 years old undergoing surgery, and preoperative cognitive impairment assessed by validated cognitive assessment tools.

INTERVENTIONS

Preoperative assessment.

MEASUREMENTS

Primary outcomes were the pooled prevalence of preoperative cognitive impairment in older patients undergoing either elective (cardiac or non-cardiac) or emergency surgery.

MAIN RESULTS

Forty-eight studies (n = 42,498) were included. In elective non-cardiac surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% confidence interval [CI]: 30.0%, 45.0%) among 27,845 patients and diagnosed cognitive impairment was 18.0% (95% CI: 9.0%, 33.0%) among 11,676 patients. Within the elective non-cardiac surgery category, elective orthopedic surgery was analyzed. In this subcategory, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% CI: 26.0%, 49.0%) among 1117 patients, and diagnosed cognitive impairment was 17.0% (95% CI: 3.0%, 60.0%) among 6871 patients. In cardiac surgeries, the unrecognized cognitive impairment prevalence across 588 patients was 26.0% (95% CI: 15.0%, 42.0%). In emergency surgeries, the unrecognized cognitive impairment prevalence was 50.0% (95% CI: 35.0%, 65.0%) among 2389 patients.

CONCLUSIONS

A substantial number of surgical patients had unrecognized cognitive impairment. In elective non-cardiac and emergency surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% and 50.0%. Preoperative cognitive screening warrants more attention for risk assessment and stratification.