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Yu M, Jiang Y, Gong X, Gao X. Relationship Between Sleep Duration and Cognitive Function in Older Adults: Analysis of NHANES and UK Biobank GWAS Data. Biol Res Nurs 2024; 26:399-409. [PMID: 38302190 DOI: 10.1177/10998004241230325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To explore the relationship between sleep duration and cognitive functions in older adults using NHANES, a national US population study dataset, and to explore the causal association with Mendelian randomization (MR) using the UK Biobank. METHODS First, an observational study was conducted with the NHANES database with participants ≥60 years. Sleep duration was measured with accelerometers for 7 consecutive days. Participants were divided into habitual short sleep (<7 h) and long sleep (>9 h) groups. Cognitive functions were measured with the CERAD Word Learning sub-set, Animal Fluency, and Digit Symbol Substitution test (DSST). Multivariate regression models were used to explore relationships between sleep duration and cognitive functions. Second, bidirectional MR was conducted with data for self-reported sleep duration, which came from a genome-wide association study (GWAS) comprising 446,118 adults from the UK Biobank, and general cognitive performance, which was obtained from a recent GWAS study (N = 257,841). Inverse-variance weighted (IVW) was used as the primary estimation of the outcome. RESULTS In the observational study, 2687 participants were included. Sleep duration was associated with cognitive functions in a non-linear way. Habitual long sleep (>9°h) was associated with lower scores on DSST (OR = 0.01, p = .003) in the fully-adjusted model. The association between habitual short sleep and cognitive functions was insignificant. For the MR, genetically predicted lower general cognitive performance was causally associated with a higher prevalence of habitual short sleep (OR = 0.97, p = 5.1 × 10-7) and long sleep (OR = 0.97, p = 8.87 × 10-16). DISCUSSION Short and long sleep duration might be both causally associated with worse outcomes of cognitive functions in older adults, highlighting the importance of maintaining sleep health.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, China
- National Center for Stomatology, Beijing, China
| | - Yang Jiang
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, China
- National Center for Stomatology, Beijing, China
| | - Xu Gong
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, China
- National Center for Stomatology, Beijing, China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, China
- National Center for Stomatology, Beijing, China
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Fang Z, Zhang Q. Association between cognitive impairment and cardiovascular mortality in mature and older adults: A meta-analysis. Exp Gerontol 2024; 192:112440. [PMID: 38679351 DOI: 10.1016/j.exger.2024.112440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Cognitive impairment contributes significantly to negative health outcomes. This meta-analysis aimed to investigate the association between cognitive impairment and cardiovascular mortality in mature and older adults. METHODS PubMed, Web of Science, and Embase databases were searched until February 10, 2024, to identify the association between cognitive impairment and cardiovascular mortality in mature and older adults (aged 50 years and older) from the general population. The adjusted risk estimates from the included studies were extracted and pooled using a random effects model. RESULTS Ten studies were included in the meta-analysis, involving 16,765 participants. The pooled hazard ratio (HR) of cardiovascular mortality was 1.75 (95 % confidence interval [CI] 1.44-2.14; I2 = 48.2 %) for individuals with cognitive impairment compared to those without, even after adjusting for common confounding factors. Subgroup analysis revealed that the prognostic value of cognitive impairment may be influenced by the assessment tools used for measuring cognition. Additionally, cognitive impairment significantly predicted cardiovascular mortality in women (HR 2.40; 95 % CI 1.54-3.74; I2 = 45.4 %) but not in men (HR 1.49; 95 % CI 0.99-2.24; I2 = 44.8 %). CONCLUSIONS Cognitive impairment is a significant predictor of cardiovascular mortality in mature and older adults from the general population. However, future studies are needed to evaluate the specific impact of cognitive impairment on different genders.
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Affiliation(s)
- Ze Fang
- Department of Geriatrics, Zhongjiang County People's Hospital, Zhongjiang County, Deyang City, Sichuan Province 618100, China.
| | - Qiongfang Zhang
- Department of Infection Management, Zhongjiang County People's Hospital, Zhongjiang County, Deyang City, Sichuan Province 618100, China
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Di Passa AM, Prokop-Millar S, Yaya H, Dabir M, McIntyre-Wood C, Fein A, MacKillop E, MacKillop J, Duarte D. Clinical efficacy of deep transcranial magnetic stimulation (dTMS) in psychiatric and cognitive disorders: A systematic review. J Psychiatr Res 2024; 175:287-315. [PMID: 38759496 DOI: 10.1016/j.jpsychires.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
Deep transcranial magnetic stimulation (dTMS) has gained attention as an enhanced form of traditional TMS, targeting broader and deeper regions of the brain. However, a fulsome synthesis of dTMS efficacy across psychiatric and cognitive disorders using sham-controlled trials is lacking. We systematically reviewed 28 clinical trials comparing active dTMS to a sham/controlled condition to characterize dTMS efficacy across diverse psychiatric and cognitive disorders. A comprehensive search of APA PsycINFO, Cochrane, Embase, Medline, and PubMed databases was conducted. Predominant evidence supports dTMS efficacy in patients with obsessive-compulsive disorder (OCD; n = 2), substance use disorders (SUDs; n = 8), and in those experiencing depressive episodes with major depressive disorder (MDD) or bipolar disorder (BD; n = 6). However, the clinical efficacy of dTMS in psychiatric disorders characterized by hyperactivity or hyperarousal (i.e., attention-deficit/hyperactivity disorder, posttraumatic stress disorder, and schizophrenia) was heterogeneous. Common side effects included headaches and pain/discomfort, with rare but serious adverse events such as seizures and suicidal ideation/attempts. Risk of bias ratings indicated a collectively low risk according to the Grading of Recommendations, Assessment, Development, and Evaluations checklist (Meader et al., 2014). Literature suggests promise for dTMS as a beneficial alternative or add-on treatment for patients who do not respond well to traditional treatment, particularly for depressive episodes, OCD, and SUDs. Mixed evidence and limited clinical trials for other psychiatric and cognitive disorders suggest more extensive research is warranted. Future research should examine the durability of dTMS interventions and identify moderators of clinical efficacy.
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Affiliation(s)
- Anne-Marie Di Passa
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Shelby Prokop-Millar
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Horodjei Yaya
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Melissa Dabir
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Carly McIntyre-Wood
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada
| | - Allan Fein
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada
| | - Emily MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - James MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Michael G DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada
| | - Dante Duarte
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Seniors Mental Health Program, Department of Psychiatry and Neurosciences, McMaster University, Hamilton, ON, Canada.
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Li JX, Zhong QQ, Zhu T, Jin YL, Pan J, Yuan SX, Zhu F. Associations of cognitive impairment and longitudinal change in cognitive function with the risk of fatal stroke in middle-aged to older Chinese. Heliyon 2024; 10:e29353. [PMID: 38655351 PMCID: PMC11035061 DOI: 10.1016/j.heliyon.2024.e29353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
It is unclear whether cognitive impairment and the longitudinal change in cognition are associated with the risk of fatal stroke in aging populations. Based on the Guangzhou Biobank Cohort Study data a sum of 26,064 participants at baseline and all deaths caused by stroke in a mean follow-up of 14.3 years (standard deviation = 3.2) were included, and the Cox proportional hazard regression was used in this prospective cohort study. Cognitive impairment was respectively associated with an increased risk of fatal strokes (the adjusted hazard ratio (aHR) = 1.38, 95% CI1.16-1.64, P < 0.001) and fatal ischaemic stroke (aHR = 1.39, 95% CI1.10-1.77, P = 0.007), compared to median cognition; the Delayed Word Recall Test (DWRT) score was associated with a decreasing trend for the risk of fatal strokes in a restricted cubic spline analysis; the longitudinal DWRT score decline was associated with the increased risks of fatal strokes (aHR = 1.42, 95% CI 1.11-1.82, P = 0.006) and fatal haemorrhagic stroke (aHR = 1.75, 95% CI 1.10-2.78, P = 0.02), compared to the longitudinal DWRT score rise. In summary, cognitive impairment and the longitudinal decline in DWRT scores were associated with the increased risk of fatal strokes; early screening of cognitive function should be conducive to predictive intervention in fatal stroke among relatively healthy middle-aged to older populations.
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Affiliation(s)
- Jun-xiao Li
- Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China
- Departments of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Qiong-qiong Zhong
- Departments of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Tong Zhu
- Department of Science and Education, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Ya-li Jin
- Department of Science and Education, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jing Pan
- Department of Science and Education, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Shi-xiang Yuan
- Department of Neurosurgery, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Feng Zhu
- Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China
- Departments of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
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Zhang C, Liu Y, Zeng L, Luo X, Fan G, Shi H, Shen J. Combined associations of cognitive impairment and psychological resilience with all-cause mortality in community-dwelling older adults. J Affect Disord 2024; 351:962-970. [PMID: 38346647 DOI: 10.1016/j.jad.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Cognitive impairment and psychological resilience are closely related in older adults, but their combined effect on mortality has not been reported. Using a nationally representative sample from the Chinese Longitudinal Healthy Longevity Study, this study examined the interactions between cognitive impairment and psychological resilience and their associations with overall survival. METHODS A total of 32,349 community-dwelling older adults (86.85 ± 11.16 years, 56.06 % female) were enrolled in 1998, 2000, 2002, 2005, 2008, 2011, and 2014; all participants were followed until 2018. Cognitive function and psychological resilience were assessed using the Mini-Mental State Examination (MMSE) and the 7-item psychological resilience questionnaire (PRQ), respectively. Illiterate subjects with an MMSE score <18, or literate subjects with an MMSE score <24 were defined as having cognitive impairment. Cox proportional risk regressions were used to analyze the association of cognitive impairment and psychological resilience with all-cause mortality. RESULTS After 146,993.52 person-years of follow-up, 23,349 older adults died. Both MMSE and PRQ scores (as continuous variables) were negatively associated with mortality risk after adjusting for all covariates. The hazard ratio (HR) of all-cause mortality for cognitive impairment was not significantly moderated by levels of psychological resilience (P-interaction = 0.094). In joint analyses, participants with combined cognitive impairment and low resilience (by the median of PRQ: < 25 points) had the highest risk of mortality (adjusted-HR: 1.56, 95%CI: 1.48-1.61), which was higher than that of patients with either condition alone. There was a significant additive interaction effect of cognitive impairment and low resilience on all-cause mortality (relative excess risk due to interaction: 0.11, 95 % CI: 0.09-0.13), and 7 % of the overall mortality risk was attributable to their synergistic effect. CONCLUSIONS Cognitive impairment and low resilience are synergistically associated with increased risk of all-cause mortality in community-dwelling older adults. The potential mechanisms underlying this combined effect warrant further exploration.
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Affiliation(s)
- Chi Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - Ye Liu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - Lvtao Zeng
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - Xuanmei Luo
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China
| | - Guoqing Fan
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Shi
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
| | - Ji Shen
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
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Park S, Kim J, Ha Y, Kim KN, Yi S, Koo BN. Preoperative mild cognitive impairment as a risk factor of postoperative cognitive dysfunction in elderly patients undergoing spine surgery. Front Aging Neurosci 2024; 16:1292942. [PMID: 38282693 PMCID: PMC10811182 DOI: 10.3389/fnagi.2024.1292942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction Any persistent degree of cognitive impairment in older adults is a concern as it can progress to dementia. This study aimed to determine the incidence and risk factors for early postoperative cognitive dysfunction (POCD) in elderly patients undergoing spine surgery. Methods Patients were enrolled from a previous prospective observational study after screening for normal cognitive function using the Mini Mental State Examination (MMSE). Cognitive function was evaluated before surgery and at 1 week, month, and year post-surgery using MMSE and Montreal Cognitive Assessment scores (MoCA). Mild cognitive impairment (MCI) was determined using the MoCA scores adjusted for age. POCD was defined as a drop of three or more points on the MMSE 1 week post-surgery. Multivariate logistic analysis was performed to identify POCD risk factors. Results A total of 427 patients were included. Eighty-five (20%) had pre-existing MCI. The MCI group showed lower MoCA scores at each time point (baseline, 1 week after surgery, 1 month after surgery, 1 year after surgery) compared to the non-MCI group. Those in the MCI group had a higher rate of admission to intensive care unit after surgery, postoperative delirium, and POCD 1 week post-surgery, than those in the non-MCI group (16.5% vs. 6.7%, p = 0.008; 27.1% vs. 15.8%, p = 0.024; and 18.8% vs. 8.2%, p < 0.001, respectively). Among them, 10.3% were assessed for POCD on postoperative day 7 and self-reported poor social roles and physical functioning 1 week postoperatively. Conclusion Preoperative MCI was seen in ~20% of surgical patients aged >70 years. POCD was seen in ~20% of patients with pre-existing MCI, and ~ 10% of those without. Benzodiazepine use, significant comorbidities, pre-existing MCI, and depressive tendencies were risk factors for POCD.
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Affiliation(s)
- Sujung Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Ha
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- POSTECH Biotech Center, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Keung N. Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Yi
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Souza-Lima J, Matsudo SM, Valdivia-Moral P, Pérez W, Drenowatz C, Zenteno JS, Ferrari G. Association between cardiovascular risk factors and cognitive impairment in adults aged 60 years or older from Chile: a cross-sectional study. BMC Geriatr 2023; 23:806. [PMID: 38053094 PMCID: PMC10696861 DOI: 10.1186/s12877-023-04410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/16/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Few studies in Latin America have examined the association between cardiovascular risk factors and cognitive impairment (CI) in a nationally representative sample. Therefore, this study aimed to estimate the prevalence of CI in a nationally representative sample of adults aged 60 years or older from Chile and to investigate the association between cardiovascular risk factors and CI. METHODS Data from the cross-sectional 2016-2017 National Health Survey of Chile, which included 2031 adults (63.7% women) was used. Body mass index, metabolic syndrome (blood pressure, triglycerides, fasting glucose or treatment for diabetics, waist circumference, and HDL cholesterol), risk of cardiovascular disease (history and measured variables, using the Framingham risk score), tobacco use, and physical activity were measured. CI was assessed using the Mini-Mental Status Examination (MMSE). RESULTS Overall, the prevalence of CI was 12.2% at the national level. Significant differences in CI were observed by age, education level, risk of cardiovascular disease, and smoking. High risk of cardiovascular disease was associated with higher odds of CI (OR: 2.04; 95%CI: 1.20-3.45) compared to low risk. Smoking was significantly associated with a lower likelihood of CI (OR: 0.56; 95%CI: 0.36-0.87) compared to never smoking. Body mass index, metabolic syndrome, and physical activity were not associated with CI. CONCLUSIONS This study provided additional support for previous findings on the relationship between cognitive decline and an elevated risk of cardiovascular disease. Worse CI was associated with the group with the highest risk of cardiovascular disease, and the presence of lifestyle factors, such as obesity and physical inactivity, exacerbate this relationship, but not being a current smoker.
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Affiliation(s)
| | | | | | - Waldo Pérez
- Hémera Centro de Observación de la tierra, Facultad de Ciencias Universidad Mayor, Santiago, Chile
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University of Education Upper Austria, Linz, Austria
| | - Jorge Sapunar Zenteno
- Centro de Excelencia de Medicina Translacional, Facultad de Medicina, Universidad de La Frontera, Chile
| | - Gerson Ferrari
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Providencia, Chile.
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Kalra K, Moumneh MB, Nanna MG, Damluji AA. Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease. Front Cardiovasc Med 2023; 10:1276370. [PMID: 38045910 PMCID: PMC10690830 DOI: 10.3389/fcvm.2023.1276370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.
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Affiliation(s)
- Kriti Kalra
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Mohamad B. Moumneh
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Abdulla A. Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular, Fairfax, VA, United States
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Li F, Harmer P, Eckstrom E, Fitzgerald K, Winters-Stone K. Clinical Effectiveness of Cognitively Enhanced Tai Ji Quan Training on Global Cognition and Dual-Task Performance During Walking in Older Adults With Mild Cognitive Impairment or Self-Reported Memory Concerns : A Randomized Controlled Trial. Ann Intern Med 2023; 176:1498-1507. [PMID: 37903365 DOI: 10.7326/m23-1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) negatively impacts cognition and dual-task abilities. A physical-cognitive integrated treatment approach could mitigate this risk for dementia. OBJECTIVE To compare the effectiveness of cognitively enhanced tai ji quan versus standard tai ji quan or stretching exercise in improving global cognition and reducing dual-task walking costs in older adults with MCI or self-reported memory concerns. DESIGN 3-group, randomized (1:1:1), superiority trial. (ClinicalTrials.gov: NCT04070703). SETTING Community residential homes. PARTICIPANTS 318 older adults with self-reported memory decline or concern and a Clinical Dementia Rating (CDR) global score of 0.5 or lower at baseline. INTERVENTION Cognitively enhanced tai ji quan (n = 105), standard tai ji quan (n = 107), or stretching (n = 106). All groups exercised at home via real-time videoconferencing, 1 hour semiweekly for 24 weeks. MEASUREMENTS The co-primary endpoints were change in Montreal Cognitive Assessment (MoCA; range, 0 to 30) and dual-task walking costs (difference between single- and dual-task gait speed, expressed in percentage) from baseline to 24 weeks. Secondary outcomes included CDR-Sum of Boxes (CDR-SB), Trail Making Test B, Digit Span Backward (DSB), and physical performance tests. Outcomes were assessed at 16, 24 (primary endpoint), and 48 weeks (6 months after intervention). RESULTS A total of 304 participants (96%) completed the 24-week assessment. Cognitively enhanced tai ji quan outperformed standard tai ji quan and stretching with a greater improvement in MoCA score (mean difference, 1.5 points [98.75% CI, 0.7 to 2.2 points] and 2.8 points [CI, 2.1 to 3.6 points], respectively) and in dual-task walking (mean difference, 9.9% [CI, 2.8% to 16.6%] and 22% [CI, 13% to 31%], respectively). The intervention effects persisted at 48-week follow-up. LIMITATION There was no nonexercise control group; participants had subjective or mild cognitive impairment. CONCLUSION Among community-dwelling older adults with MCI, cognitively enriched tai ji quan therapy was superior to standard tai ji quan and stretching exercise in improving global cognition and reducing dual-task gait interference, with outcomes sustained at 48 weeks. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Fuzhong Li
- Oregon Research Institute, Springfield, Oregon (F.L., P.H.)
| | - Peter Harmer
- Oregon Research Institute, Springfield, Oregon (F.L., P.H.)
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, Oregon (E.E.)
| | | | - Kerri Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon (K.W.)
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Crowell V, Reyes A, Zhou SQ, Vassilaki M, Gsteiger S, Gustavsson A. Disease severity and mortality in Alzheimer's disease: an analysis using the U.S. National Alzheimer's Coordinating Center Uniform Data Set. BMC Neurol 2023; 23:302. [PMID: 37580727 PMCID: PMC10424331 DOI: 10.1186/s12883-023-03353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Evidence on the relative risk of death across all stages of Alzheimer's disease (AD) is lacking but greatly needed for the evaluation of new interventions. We used data from the Uniform Data Set (UDS) of the National Alzheimer's Coordinating Center (NACC) to assess the expected survival of a person progressing to a particular stage of AD and the relative risk of death for a person in a particular stage of AD compared with cognitively normal (CN) people. METHODS This was a retrospective observational cohort study of mortality and its determinants in participants with incident mild cognitive impairment (MCI) due to AD or AD dementia compared with CN participants. Overall survival and hazard ratios of all-cause mortality in participants ≥ 50 years of age with clinically assessed or diagnosed MCI due to AD, or mild, moderate, or severe AD dementia, confirmed by Clinical Dementia Rating scores, versus CN participants were estimated, using NACC UDS data. Participants were followed until death, censoring, or until information to determine disease stage was missing. RESULTS Aged between 50 and 104 years, 12,414 participants met the eligibility criteria for the study. Participants progressing to MCI due to AD or AD dementia survived a median of 3-12 years, with higher mortality observed in more severe stages. Risk of death increased with the severity of AD dementia, with the increase significantly higher at younger ages. Participants with MCI due to AD and CN participants had a similar risk of death after controlling for confounding factors. CONCLUSIONS Relative all-cause mortality risk increases with AD severity, more so at younger ages. Mortality does not seem to be higher for those remaining in MCI due to AD. Findings might imply potential benefit of lower mortality if preventing or delaying the progression of AD is successful, and importantly, this potential benefit might be greater in relatively younger people. Future research should replicate our study in other samples more representative of the general US population as well as other populations around the world.
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Affiliation(s)
| | | | | | - Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Anders Gustavsson
- Quantify Research, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Knight J, Yoneda T, Lewis N, Muniz-Terrera G, Bennett D, Piccinin A. Transitions Between Mild Cognitive Impairment, Dementia, and Mortality: The Importance of Olfaction. J Gerontol A Biol Sci Med Sci 2023; 78:1284-1291. [PMID: 36611276 PMCID: PMC10329218 DOI: 10.1093/gerona/glad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The existing literature suggests that impaired olfaction may be an early marker for cognitive decline. Tracking the earliest stages of the progression to dementia is paramount, and yet the importance of olfactory ability throughout cognitive states and death remains unclear. METHODS Drawing data from the Rush Memory and Aging Project (N = 1 501; 74% female), olfactory ability was assessed using the Brief Smell Identification Test (range = 0-16), while cognitive states (unimpaired, mild cognitive impairment [MCI], and dementia) were determined using a 3-step neuropsychological diagnostic protocol at up to 15 annual occasions. Multistate survival models simultaneously estimated the association of olfactory ability on transitions through cognitive states and death, while multinomial regression models estimated cognitively unimpaired and total life expectancies. RESULTS Higher olfactory scores were associated with a reduced risk of transitioning from unimpaired cognition to MCI (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.82-0.88) and from MCI to dementia (HR = 0.89, 95% CI = 0.86-0.93), indicating that 1-unit increase in olfactory scores was associated with an approximate 14% and 11% reduction in risk, respectively. Additionally, higher olfactory scores were associated with a greater likelihood of transitioning backward from MCI to unimpaired cognition (HR = 1.07, 95% CI = 1.02-1.12). Furthermore, higher baseline olfactory scores were associated with more years of longevity without cognitive impairment. However, olfaction was not associated with the transition to death when accounting for transitions through cognitive states. CONCLUSIONS Findings suggest that higher olfactory identification scores are associated with a decreased risk of transitioning to impaired cognitive states and that associations between olfaction and mortality may occur primarily through the pathway of neurodegeneration.
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Affiliation(s)
- Jamie E Knight
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Tomiko Yoneda
- Department of Medical Sciences, Northwestern University, Evanston, Illinois, USA
| | - Nathan A Lewis
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Graciela Muniz-Terrera
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
- Centre for Dementia Prevention, The University of Edinburgh, Edinburgh, UK
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrea M Piccinin
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
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12
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Rogers CJ, Ayuso J, Hackney ME, Penza C. Alzheimer Disease and Related Cognitive Impairment in Older Adults: A Narrative Review of Screening, Prevention, and Management for Manual Therapy Providers. J Chiropr Med 2023; 22:148-156. [PMID: 37346234 PMCID: PMC10280085 DOI: 10.1016/j.jcm.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/16/2022] [Accepted: 03/08/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The aim of this narrative review was to review literature relevant to manual therapists about cognitive impairment, together with screening, potential treatment, and prevention modalities. Methods A literature search of AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index of Nursing and Allied Health Literature), PubMed, and MEDLINE was conducted with the search terms "cognitive decline," "cognitive impairment," "screening," and "prevention." We reviewed current screening practices, including functional exams, imaging, and laboratory testing. We reviewed current potential preventive measures and treatments being implemented in practice. Results We selected 49 resources for this narrative summary. The Montreal Cognitive Assessment and Mini-Mental State Exam are recommended screening tools. Imaging and laboratory testing are not recommended in screening for cognitive decline. Promotion of healthy, active living through physical and mental activities may assist with prevention of cognitive decline. Conclusion Cognitive decline affects a large proportion of the US population. Recognizing signs and symptoms of this condition starts with individuals, caretakers, family members, and health care providers. Health care providers should utilize the most appropriate screening tools to assess the presence of cognitive conditions.
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Affiliation(s)
- Casey J. Rogers
- Veteran's Health Administration Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Birmingham, Alabama
| | - Jaime Ayuso
- Northwestern Health Sciences University, Bloomington, Minnesota
| | - Madeleine E. Hackney
- Veteran's Health Administration Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Birmingham, Alabama
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Lor YCM, Tsou MT, Tsai LW, Tsai SY. The factors associated with cognitive function among community-dwelling older adults in Taiwan. BMC Geriatr 2023; 23:116. [PMID: 36864383 PMCID: PMC9983251 DOI: 10.1186/s12877-023-03806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND This research aimed to investigate the associations of anthropometric measurements, physiological parameters, chronic disease comorbidities, and social and lifestyle factors with cognitive function amongst community-dwelling older adults in Taiwan. METHODS This was an observational, cross-sectional study involving 4,578 participants at least 65 years old, recruited between January 2008 and December 2018 from the Annual Geriatric Health Examinations Program. Cognitive function was assessed using the short portable mental state questionnaire (SPMSQ). Multivariable logistic regression was done to analyze the factors associated with cognitive impairment. RESULTS Among the 4,578 participants, 103 people (2.3%) with cognitive impairment were identified. Associated factors were age (odds ratio (OR) = 1.16, 95% confidence interval (CI) = 1.13,1.20), male gender (OR = 0.39, 95% CI = 0.21,0.72), diabetes mellitus (DM) (OR = 1.70, 95% CI = 1.03, 2.82), hyperlipidemia (OR = 0.47, 95% CI = 0.25, 0.89), exercise (OR = 0.44, 95% CI = 0.34, 0.56), albumin (OR = 0.37, 95% CI = 0.15, 0.88), and high-density lipoprotein (HDL) (OR = 0.98, 95% CI = 0.97, 1.00). Whereas waistline, alcohol intake in recent six months, and hemoglobin was not significantly associated with cognitive impairment (all p > 0.05). CONCLUSIONS Our findings suggested that people with older age and a history of DM had a higher risk of cognitive impairment. Male gender, a history of hyperlipidemia, exercise, a high albumin level, and a high HDL level seemed to be associated with a lower risk of cognitive impairment amongst older adults.
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Affiliation(s)
- You-Chen Mary Lor
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu, 300, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Nursing and Management, MacKay Junior College of Medicine, New Taipei City, Taiwan
| | - Li-Wei Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Ying Tsai
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu, 300, Taiwan.
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Association Between Motoric Cognitive Risk Syndrome and Risk of Mortality in Older Adults: Results of a 5-year Retrospective Cohort. AGEING INTERNATIONAL 2022. [DOI: 10.1007/s12126-022-09508-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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A Systematic Review of the Current Evidence from Randomised Controlled Trials on the Impact of Medication Optimisation or Pharmacological Interventions on Quantitative Measures of Cognitive Function in Geriatric Patients. Drugs Aging 2022; 39:863-874. [PMID: 36284081 PMCID: PMC9626423 DOI: 10.1007/s40266-022-00980-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
Background Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. Methods A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. Results Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). Conclusion This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00980-9.
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The impact of self-reported sensory impairment on cognitive function using the Korean longitudinal study of aging survey data. Sci Rep 2022; 12:17907. [PMID: 36284163 PMCID: PMC9596449 DOI: 10.1038/s41598-022-22840-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/19/2022] [Indexed: 01/20/2023] Open
Abstract
Recent studies suggest that sensory impairment is related to cognitive function at older ages. Therefore, we aimed to investigate the impact of sensory impairment on cognitive function in the Korean population. We used the Korean Longitudinal Study of Aging data from 2006 to 2018. Cognitive function was measured by the Korean version of the Mini-Mental State Examination scale. A score < 24 at the time of assessment was defined as cognitive impairment. Sensory impairment was assessed according to the self-reported levels of hearing or vision, and the development of sensory impairment was investigated using records of prior survey. We used the generalized estimating equation model to determine association between cognitive function and sensory impairment. A total of 4844 participants (age range: 47-95 years; mean age: 58) were included in the study. Compared to people without sensory impairment, people with a single sensory impairment of hearing or vision had a higher risk of cognitive impairment (odds ratio (OR) = 1.65 [95% confidence interval (CI), 1.49-1.82]). People with dual sensory impairment had the greatest risk of cognitive impairment (OR = 3.23 [95% CI, 2.52-4.12]). The findings suggested the need for timely assessment of sensory function in older persons, which may be useful in identifying individuals at risk for cognitive impairment.
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Wong RMY, Ng RWK, Chau WW, Liu WH, Chow SKH, Tso CY, Tang N, Cheung WH. Montreal cognitive assessment (MoCA) is highly correlated with 1-year mortality in hip fracture patients. Osteoporos Int 2022; 33:2185-2192. [PMID: 35763077 DOI: 10.1007/s00198-022-06426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/04/2022] [Indexed: 10/17/2022]
Abstract
UNLABELLED Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates. INTRODUCTION Hip fractures rank amongst the top 10 causes of disability and current mortality of hip fractures is high. Objectives were to determine 1) prevalence of cognitive impairment, 2) whether Montreal Cognitive Assessment (MoCA) score was an independent risk factor associated with mortality, 3) MoCA cut-off that result in high risk of mortality. METHODS This was a cohort study between July 2019 to June 2020. Inclusion criteria were 1) hip fracture, 2) > = 65 years old, and 3) low-energy trauma. Patients undergo assessment for cognitive impairment with MoCA. Prevalence was assessed, MoCA cut-off point, and accuracy of statistical model was evaluated. Logistic regression modelling was used to assess association between mortality and MoCA. RESULTS There were 260 patients recruited. Two hundred twenty-five patients had MoCA score < 22 signifying cognitive impairment, and 202 patients had MoCA score of < 19. 46 hip fracture patients died at 1-year follow-up. 45 of these patients had MoCA score < 19, and 1 patient had a MoCA > 22. Results showed statistical significance and good model effect (at least 0.8) with MoCA cut-off points between < 15 and < 19 (p < 0.05). After controlling confounding factors, statistical significance still existed in MoCA cut-off point at < 15 (odds ratio (95% CI) = 11.71 (1.14, 120.71); p = 0.04). CONCLUSION Prevalence of cognitive impairment in hip fractures was 86.5%. MoCA is an independent risk factor of mortality in hip fracture patients. MoCA score of < 15 is correlated with 11.71 times increased risk of mortality at 1-year after a hip fracture. AUC with MoCA score < 15 was 0.948. Early attention and caution should be given to these patients for appropriate intervention to decrease mortality rates.
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Affiliation(s)
- R M Y Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - R W K Ng
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - W W Chau
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W H Liu
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - S K H Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - C Y Tso
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - N Tang
- Department of Orthopaedics & Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - W-H Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Yan J, Luan F, Wang M, Dong W, Zhang X, Li M, Cao Y. Prospective association between standing balance and cognitive function in middle-aged and older Chinese adults. Front Psychol 2022; 13:931216. [PMID: 36225682 PMCID: PMC9549916 DOI: 10.3389/fpsyg.2022.931216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the association of standing balance with cognitive functions and the rate of cognitive decline among middle-aged and older Chinese adults. Methods Participants were selected from China’s Health and Retirement Longitudinal Study. A total of 8,499 subjects aged ≥45 years who participated in wave 1 to wave 3 surveys were included in the final analysis. Standing balance was measured using the tandem test, and participants were categorized into two groups according to their ability to maintain standing balance. Cognitive functions were assessed in three domains: episodic memory, mental status, and global cognition. The associations between standing balance scores, cognitive scores, and the rate of cognitive decline were evaluated using linear regression and linear mixed models. Results Compared with participants who successfully completed the standing balance test, those who were unable to complete the test had lower scores on episodic memory [β = −0.18; 95% confidence interval (CI): −0.24, −0.11], mental status (β = −0.28; 95% CI: −0.37, −0.19), and global cognition (β = −0.51; 95% CI: −0.65, −0.38) after 4 years of follow-up. In addition, the rate of decline in mental status and global cognition increased by 0.10 (β = 0.10; 95% CI: 0.07, 0.13) and 0.08 (β = 0.08; 95% CI: 0.04, 0.12) units, respectively, in participants who were unable to complete the test compared with their counterparts. Conclusion Good standing balance was significantly associated with higher cognitive function and a lower decline in mental status and global cognition in middle-aged and older Chinese adults.
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Affiliation(s)
- Jingzheng Yan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fangyun Luan
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
| | - Meijuan Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenshuo Dong
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xinyue Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mengli Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Nursing, Qilu Hospital, Shandong University, Jinan, China
- *Correspondence: Yingjuan Cao,
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Martinez M, Dawson AZ, Lu K, Walker RJ, Egede LE. Effect of cognitive impairment on risk of death in Hispanic/Latino adults over the age of 50 residing in the United States with and without diabetes: Data from the Health and Retirement Study 1995-2014. Alzheimers Dement 2022; 18:1616-1624. [PMID: 34873809 PMCID: PMC9170835 DOI: 10.1002/alz.12521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To understand the relationship between mortality and cognitive function among older US Hispanic adults with and without diabetes. METHODS Data from the Health and Retirement Study (1995-2014) were analyzed. Cox proportional hazard models were used to estimate the association between mortality and cognitive function. Models were stratified by diabetes. RESULTS Four thousand thirteen older US Hispanic adults were included. Fully adjusted models for individuals with diabetes showed those with mild cognitive impairment (MCI; hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.06, 2.45; P = .025) and dementia (HR: 2.14; 95% CI: 1.25, 3.67; P = .006) had increased mortality compared to normal cognition. Fully adjusted models for individuals without diabetes showed those with MCI (HR: 1.87; 95% CI: 1.28, 2.74; P = .001) and dementia (HR: 3.25; 95% CI: 1.91, 5.55; P < .001) had increased mortality compared to normal cognition. CONCLUSIONS Cognitive impairment is associated with increased mortality in older US Hispanic adults with and without diabetes. Clinicians should regularly assess cognitive function in this group to quickly identify declines and make appropriate referrals for support to optimize health and reduce mortality.
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Affiliation(s)
- Martin Martinez
- Department of MedicineMedical College of WisconsinMedical SchoolMilwaukeeWisconsinUSA
| | - Aprill Z. Dawson
- Department of MedicineDivision of General Internal MedicineMedical College of WisconsinMilwaukeeWisconsinUSA,Center for Advancing Population ScienceMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Kevin Lu
- Department of MedicineDivision of General Internal MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Rebekah J. Walker
- Department of MedicineDivision of General Internal MedicineMedical College of WisconsinMilwaukeeWisconsinUSA,Center for Advancing Population ScienceMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Leonard E. Egede
- Department of MedicineDivision of General Internal MedicineMedical College of WisconsinMilwaukeeWisconsinUSA,Center for Advancing Population ScienceMedical College of WisconsinMilwaukeeWisconsinUSA
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Zhang XM, Jiao J, Guo N, Zhu C, Li Z, Lv D, Wang H, Jin J, Wen X, Zhao S, Wu X, Xu T. The association between cognitive impairment and 30-day mortality among older Chinese inpatients. Front Med (Lausanne) 2022; 9:896481. [PMID: 36091678 PMCID: PMC9449351 DOI: 10.3389/fmed.2022.896481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Although the association between cognitive impairment and mortality has been widely described among community-dwelling older adults, this association in hospitalized patients was limited. Objectives This study's purpose was to explore the association between cognitive impairment and 30-day mortality after adjustment of factors among Chinese in-patients. Methods This was a large-scale prospective study based on a cohort of patients aged 65 years and older, whose cognitive function was assessed using the Mini-Cog instrument, followed up at 30-days for mortality. Multivariate logistic regression models were used to assess the association between cognitive impairment and 30-day mortality. Results There were 9,194 inpatients in our study, with an average age of 72.41 ± 5.72. The prevalence of cognitive impairment using the Mini-Cog instrument was 20.5%. Multivariable analyses showed that patients with cognitive impairment have an increased risk of 30-day mortality, compared to those with normal cognitive function (OR = 2.83,95%CI:1.89–4.24) in an unadjusted model. In the fully adjusted model, Patients with cognitive impairment had an increased risk of 30-day mortality compared to those with normal cognitive function in the completely adjusted model (OR = 1.76,95% CI: 1.14–2.73). Additionally, this association still existed and was robust after performing a stratified analysis of age, gender, frailty and depression, with no significant interaction (P > 0.05). Conclusions Our study found that older Chinese in-patients with cognitive impairment have a 1.76-fold risk of 30-day mortality compared to patients with normal cognitive function, suggesting that clinicians and nurses need to early implement cognitive function screening and corresponding interventions to improve clinical outcomes for older in-patients.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
- *Correspondence: Jing Jiao
| | - Na Guo
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Zhen Li
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Wang
- Department of Nursing, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
- Xinjuan Wu
| | - Tao Xu
- Department of Epidemiology and Statistics, Peking Union Medical College, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Beijing, China
- Tao Xu
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Lin S, Chen M. Gender-specific impact of cognitive impairment on all-cause mortality in older persons: A meta-analysis. Exp Gerontol 2022; 165:111860. [DOI: 10.1016/j.exger.2022.111860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/23/2022] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
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22
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The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients. PLoS One 2022; 17:e0263024. [PMID: 35239678 PMCID: PMC8893618 DOI: 10.1371/journal.pone.0263024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background Older patients are often users of prolonged Central Nervous System Depressants (CNSD) (Z-hypnotics, benzodiazepines and opioids), which may be associated with reduced cognition. The long-term effects of CNSD use and reduced cognitive function in older patients are unclear. The aim of this study was to examine whether cognitive function and CNSD use at baseline hospitalisation were associated with all-cause mortality two years after discharge. Methods We conducted a prospective observational study, including baseline data (2017–2018) from previously hospitalised older patients (65–90 years), assessing all-cause mortality two years after discharge. We used logistic regression to assess the primary outcome, all-cause mortality two years after baseline hospitalisation. The primary predictors were cognitive function measured by The Mini Mental State Examination (MMSE) and prolonged CNSD use (continuous use ≥ 4 weeks). Adjustment variables: age, gender, education, the Hospital Anxiety and Depression Scale (HADS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), using receiver operating characteristics (ROC) to compare the predictive power of the models. In a sub-analysis we used, the Neurobehavioural Cognitive State Examination (Cognistat) and the Clock Drawing Test. Results Two years after discharge, out of 246 baseline patients, 43 were deceased at follow-up, among these 27 (63%) were CNSD users, and 16 (36%) were non-users at baseline, (p = 0.002). In the multivariable models cognitive function (MMSE score) was a predictor of mortality (OR 0.81 (95% CI 0.69; 0.96), p = 0.014). CNSD use was associated with mortality (OR 2.71 (95% CI 1.06; 6.95), p = 0.038), with ROC AUC: 0.74–0.77 for these models. Results using Cognistat supported the findings. The Clock Drawing Test was not significant predictor of mortality. Conclusion Two years after discharge from the hospital, older patients with reduced cognitive function and CNSD use during hospital stay had higher mortality. This underlines that inappropriate (prolonged and concurrent) use of CNSDs should be avoided by older patients, particularly in patients with reduced cognitive function. Trial registration NCT03162081, 22 May 2017.
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Zhang XM, Wu XJ, Cao J, Jiao J, Chen W. Association between Cognitive Frailty and Adverse Outcomes among Older Adults: A Meta-Analysis. J Nutr Health Aging 2022; 26:817-825. [PMID: 36156673 DOI: 10.1007/s12603-022-1833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to pool the effect size of the association between cognitive frailty and adverse outcomes (e.g., falls, disability, and hospitalization) among older adults. DESIGN Systematic review and meta-analysis. METHODS PubMed, ScienceDirect, and Embase were searched from their respective inceptions to June 1, 2022. We extracted prospective cohort studies that reported the association between cognitive frailty and adverse outcomes. Random or fixed-effects models based on heterogeneity were used to pool the effect sizes of independent associations of cognitive frailty, frailty only, and cognitive impairment only with each adverse outcome. RESULTS Fifteen studies involving 49,122 older adults were included in the meta-analysis. Older adults with cognitive frailty had higher odds ratios (OR) for falls (1.82, 95% confidence interval [CI]: 1.29-2.58), disability (3.17, 95%CI: 2.24-4.48), and hospitalization (1.78, 95%CI: 1.48-2.14) compared with those without frailty and cognitive impairment. Older adults with frailty only demonstrated a high risk for falls (pooled OR 1.76, 95%CI: 1.25-2.48), disability (pooled OR 1.82, 95%CI: 1.43-2.33), and hospitalization (pooled OR 1.64, 95% CI: 1.45-1.85). The influence of cognitive impairment only on adverse outcomes was lower compared with cognitive frailty or frailty. Subgroup analyses showed that those with cognitive frailty (defined by the frailty phenotype plus Mini-Mental State Examination) were at greater risk for developing adverse outcomes. CONCLUSION Our findings indicate that cognitive frailty is an independent risk factor for adverse outcomes (e.g., falls, disability, and hospitalization). Early screening and comprehensive intervention may improve cognitive frailty and reduce the risk for adverse outcomes among older adults.
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Affiliation(s)
- X M Zhang
- Xiao-Ming Zhang, Xin-Juan Wu, Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, China, ,
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Zhang XM, Wu X, Chen W. The Association between Number of Teeth and Cognitive Frailty in Older Adults: A Cross-Sectional Study. J Nutr Health Aging 2022; 26:430-438. [PMID: 35587754 DOI: 10.1007/s12603-022-1783-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to explore the association between number of teeth and cognitive frailty in American older adults. DESIGN Cross-sectional study. SETTING Community. PARTICIPANTS The participants were 1,531 community-dwelling older adults aged 60 or older from the NHANES database. METHODS Frailty was assessed using a 49-item frailty index, with a cut-off value for frailty of more than 0.21. Cognitive dysfunction was evaluated by the Digit-Symbol Coding Test (DSCT), with the cut-off being below the lowest interquartile range (scores ≤37). Cognitive frailty was defined as participants who suffered from both frailty and cognitive dysfunction. Oral health indicators included number of teeth and other factors, such as the presence of gum disease, daily use of dental floss, daily use of mouthwash and self-rated oral health. Multivariable logistic regression models were used to explore the relationship between number of teeth and cognitive frailty. RESULTS The mean age of the total sample was 69.67 (SD=6.60) years, and 52.71% (n=807) were female. Our study suggests there was a negative association between number of teeth and cognitive frailty (OR =0.98,95%CI:0.96-0.99, P=0.044) after controlling for potential confounding factors. In addition, older adults with 20 or more teeth had lower odds of being cognitively frail (OR=0.66,95%CI:0.44-0.99, P=0.046) than individuals who had less than 20 teeth. CONCLUSION This study suggests that older adults who have more teeth are associated with a lower risk of cognitive frailty. This finding highlights the importance of maintaining as many teeth as possible throughout life and into old age. Cohort studies will be required in the future to determine this relationship.
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Affiliation(s)
- X-M Zhang
- Xinjuan Wu and Wei Chen, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, 100730, China, Xinjuan Wu: ; Wei Chen:
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Yuan L, Zhang X, Guo N, Li Z, Lv D, Wang H, Jin J, Wen X, Zhao S, Xu T, Jiao J, Wu X. Prevalence of cognitive impairment in Chinese older inpatients and its relationship with 1-year adverse health outcomes: a multi-center cohort study. BMC Geriatr 2021; 21:595. [PMID: 34696723 PMCID: PMC8543818 DOI: 10.1186/s12877-021-02556-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/12/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Previous studies on the relationship between cognitive impairment and adverse outcomes among geriatric inpatients are not representative of older inpatients in China because of insufficient sample sizes or single-center study designs. The purpose of our study was to examine the prevalence of cognitive impairment and the relationship between cognitive impairment and 1-year adverse health outcomes in older inpatients. METHODS This study was a large-scale multi-center cohort study conducted from October 2018 to February 2020. Six tertiary hospitals across China were selected using a two-stage cluster sampling method, and eligible older inpatients were selected for the baseline survey and follow-up. The Mini Cognitive Scale and the FRAIL scale were used to screen for cognitive impairment and frailty, respectively. The EuroQol-5 Dimension-5 Level questionnaire was used to assess health-related quality of life (HRQoL). We used a generalized estimating model to evaluate the relationship between cognitive impairment and adverse outcomes. RESULTS The study included 5008 men (58.02%) and 3623 women (41.98%), and 70.64% were aged 65-75 years, and 26.27% were aged 75-85 years. Cognitive impairment was observed in 1756 patients (20.35%). There were significant differences between participants with cognitive impairment and those with normal cognitive function for age, gender, surgery status, frailty, depression, handgrip strength and so on. After adjusting for multiple covariates, compared with patients with normal cognitive function, the odds ratio for 1-year mortality was 1.216 (95% confidence interval [CI]: 1.076-1.375) and for 1-year incidence of frailty was 1.195 (95% CI: 1.037-1.376) in patients with cognitive impairment. Similarly, the regression coefficient of 1-year HRQoL was - 0.013 (95% CI: - 0.024-- 0.002). In the stratified analysis, risk of adverse outcome within 1 year was higher in older patients with cognitive impairment aged over 75 years than those aged 65-74 years. CONCLUSIONS We revealed that cognitive impairment was highly correlated with occurrence of 1-year adverse health outcomes (death, frailty, and decreased HRQoL) in older inpatients, which provides a basis for formulating effective intervention measures. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1800017682 , registered 09 August 2018.
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Affiliation(s)
- Li Yuan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, 5 Dongdan Santiao, Beijing, 100005, China
| | - Xiaoming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Na Guo
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zhen Li
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, 5 Dongdan Santiao, Beijing, 100005, China.
| | - Jing Jiao
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Xinjuan Wu
- Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, China.
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Su Y, Dong J, Sun J, Zhang Y, Ma S, Li M, Zhang A, Cheng B, Cai S, Bao Q, Wang S, Zhu P. Cognitive function assessed by Mini-mental state examination and risk of all-cause mortality: a community-based prospective cohort study. BMC Geriatr 2021; 21:524. [PMID: 34600472 PMCID: PMC8487495 DOI: 10.1186/s12877-021-02471-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background The Mini-Mental State Examination (MMSE) is the most widely used instrument to test cognitive functioning. The present study prospectively investigated the association between MMSE scores, MMSE domains, and all-cause mortality. Methods A total of 2134 participants aged 60 years or over, selected from one urban community-dwelling population in China, were enrolled in the study. The cognitive test was performed by use of the MMSE at baseline, and covariates were recorded simultaneously. Cox regression models were used for examining the cognitive function, expressed by different MMSE transformations, and all-cause mortality. After followed up for a median of 10.8 years (ranging from 1.0 to 11.3 years), loss to follow-up was 13.1% and 1854 individuals were finally included in the analyses. Results The subjects had the mean (SD) age of 71.01 (7.00) years, and 754 (40.67%) of them were women. Per point increase on MMSE scores was associated a 4% decreased risk of all-cause mortality [hazard ratio (HR): 0.96; 95%confidence interval (CI): 0.93–0.98]; compared to MMSE scores of ≥24, MMSE scores of < 24 was associated with a 43% increased risk of all-cause mortality (HR: 1.43; 95% CI: 1.05–1.95); compared to MMSE scores of 30, MMSE scores of 27–29 (HR: 1.27; 95% CI: 0.89–1.82), 24–26 (HR: 1.30; 95% CI: 0.86–1.99), and < 24 (HR: 1.79; 95% CI: 1.15–2.77) had a graded increase in risk of all-cause mortality (p for trend =0.003). Of MMSE domains, orientation to time (HR: 2.00; 95% CI: 1.29–3.11), attention and calculation (HR: 1.49; 95% CI: 1.16–1.92), recall (HR: 2.59; 95% CI: 1.22–5.47), and language (HR: 1.68; 95% CI: 1.25–2.26) were significantly associated with all-cause mortality in the unadjusted model; for one increase in the number of impaired MMSE domains, the unadjusted HR (95% CI) of mortality is 1.51 (1.38, 1.65), and the HR (95% CI) of mortality is 1.12 (1.01, 1.25) with full adjustment; compared to 0 and 1 impaired MMSE domains, the HRs of all-cause mortality associated with 2, 3, 4, and ≥ 5 impaired MMSE domains were 1.14 (95% CI: 0.84–1.54), 1.50 (95% CI: 0.98–2.28), 2.14 (95% CI: 1.12–4.09) and 2.29 (95% CI: 1.24–5.04), respectively, and a dose-dependent relationship was significant (p for trend =0.003). Conclusion Cognitive impairment is associated with the increased risk of all-cause mortality in the Chinese elderly. Similarly, reduced MMSE scores, as well as impaired MMSE domains, are also associated with the increasing risk of all-cause mortality.
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Affiliation(s)
- Yongkang Su
- Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Geriatrics, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jing Dong
- Department of Geriatrics, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jin Sun
- Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Geriatrics, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yan Zhang
- Department of Cadre Clinic, the First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Shouyuan Ma
- Department of Cardiology, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Man Li
- Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Anhang Zhang
- Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Geriatrics, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bokai Cheng
- Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Geriatrics, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Shuang Cai
- Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Geriatrics, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Qiligeer Bao
- Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853, China.,Department of Geriatrics, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Shuxia Wang
- Department of Geriatrics, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Ping Zhu
- Department of Geriatrics, the Second Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Abstract
There is a strong association between obstructive sleep apnea (OSA) and cognitive dysfunction. Executive function, attention, verbal/visual long-term memory, visuospatial/constructional ability, and information processing are more likely to be affected, whereas language, psychomotor function, and short-term memory are less likely to be affected. Increased accumulation of Aß2-amyloid in the brain, episodic hypoxemia, oxidative stress, vascular inflammation, and systemic comorbidities may contribute to the pathogenesis. Patients with OSA should have cognitive screening or formal testing, and patients with cognitive decline should have testing for OSA. Treatment with continuous positive airway pressure may improve cognitive symptoms in the patient with OSA.
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Affiliation(s)
- Arpan Patel
- Department of Neurology, Donald and Barbara Zucker School of Medicine, Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA
| | - Derek J Chong
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell Health, Lenox Hill Hospital, 130 East 77th Street, 8 Black Hall, New York, NY 10075, USA.
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Mild cognitive impairment, dementia and risk of mortality in essential tremor: A longitudinal prospective study of elders. J Neurol Sci 2021; 428:117563. [PMID: 34274879 DOI: 10.1016/j.jns.2021.117563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is evidence that the risk of mortality is increased in patients with essential tremor (ET), however, there are few longitudinal, prospective data on the predictors of mortality in ET. There is also evidence that ET is associated with cognitive impairment; yet, it is unknown whether this is associated with elevated risk of mortality. METHODS In a longitudinal, prospective study of 194 elders with ET, an extensive neuropsychological test battery was performed at three time points: baseline, 18 months, and 36 months, and cognitive diagnoses (normal, mild cognitive impairment [MCI], and dementia) were assigned during consensus conferences. We used Cox proportional hazards models to estimate hazard ratios (HR) for death. RESULTS The mean baseline age was 79.1 ± 9.7 years. During follow-up, 52 (26.8%) died. In initial univariate models, a variety of baseline factors were associated with increased risk of mortality, including demographic variables (i.e., older age), cognitive variables and gait and balance variables. In the final multivariate Cox model, baseline dementia (HR = 2.66, p = 0.006), older baseline age (HR = 1.18, p < 0.001), and more reported falls at baseline (HR = 1.10, p < 0.001) were independently associated with increased risk of mortality. Amnestic MCI was marginally associated with increased risk of mortality (HR = 1.93, p = 0.08) in primary analyses and significantly (p < 0.05) in several sensitivity analyses. CONCLUSIONS In this longitudinal, prospective study, baseline dementia resulted in a 2- to 3-times increase in risk of mortality in ET, further highlighting the clinical significance of cognitive impairment, specifically dementia, in this population.
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The impact of cognitive impairment in patients with acute coronary syndrome undergoing percutaneous revascularization: a systematic review and meta-analysis. Coron Artery Dis 2021; 31:e59-e66. [PMID: 34010188 DOI: 10.1097/mca.0000000000001049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment has been known to be associated with negative health impacts. Several studies recently demonstrated inconsistent outcomes among cognitive impaired patients with acute coronary syndrome (ACS). Our study aimed to determine the impact of cognitive impairment for patients with ACS. METHODS Databases were searched through October 2020. Studies reporting revascularization rates, short- and long-term mortality among ACS patients with cognitive impairment were included. Effect estimates from the individual studies were extracted and combined using random effect and generic inverse variance method of DerSimonian and Laird. RESULTS In total, 11 observational studies were included in the analysis consisting of 810 122 ACS patients, with 3.5% cognitive impairment patients. Our analysis suggested that cognitive impairment was associated with a lower rate of percutaneous coronary intervention (PCI) [odds ratio (OR), 0.63; 95% confidence interval (CI), 0.42-0.96; I2 = 98.5%; P = 0.033]. Among patients undergoing PCI, cognitive impairment was statistically associated with increased 30-day mortality (OR, 1.34; 95% CI, 1.14-1.57; I2 = 83.1%; P < 0.001) and long-term mortality (OR, 1.80; 95% CI, 1.04-3.11; I2 = 36.3%; P = 0.034). CONCLUSION Our study demonstrated that cognitive impairment was not only associated with lower rates of percutaneous revascularization but also with increased 30-day and long-term mortality.
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Kotwal AA, Lee SJ, Dale W, Boscardin WJ, Waite LJ, Smith AK. Integration of an Objective Cognitive Assessment Into a Prognostic Index for 5-Year Mortality Prediction. J Am Geriatr Soc 2020; 68:1796-1802. [PMID: 32356919 PMCID: PMC8189656 DOI: 10.1111/jgs.16451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Prognostic indices rarely include cognition. We determined if a comprehensive cognitive screen or brief individual items were associated with improved mortality predictions of a widely used prognostic index. DESIGN, SETTING, AND PARTICIPANTS The National Social Life Health and Aging Project Wave 2, a nationally representative, cross-sectional, in-home survey conducted in 2010 to 2011 on 3,199 community-dwelling adults aged 60 to 99 years. MEASUREMENTS Cognition was measured using a Survey-Adapted Montreal Cognitive Assessment (MoCA-SA) grouped into three screened categories: screen normal (≥24 points), screen positive for mild cognitive impairment (18-23 points), and screen positive for dementia (<18 points). Single-item cognitive measures included clock-draw and five-word delayed recall. We constructed a modified Lee Prognostic Index (range = 0-18 points) based on age, behavior, function, and comorbidities shown to predict long-term mortality. We used logistic regression and the fraction of new information provided to determine if each cognitive measure improved the Lee index's 5-year mortality prediction. RESULTS The sample was 54% female and had a mean age of 72 years, MoCA-SA score of 22 (SD = 4.5), and Lee index of 7 (SD = 3). Regression analysis indicated the MoCA-SA modestly improved the Lee index's mortality prediction (P < .001; fraction of new information provided = 0.06); for low Lee index scores (<4 points), the absolute mortality rate difference was 7% by cognitive status; and for higher Lee index scores (4-7 points or 8-12 points), the absolute mortality rate difference was 15% by cognitive status. The clock-draw and delayed-recall items added similar value to mortality predictions as the longer MoCA-SA. Cognition had the third highest fraction of new information of all 13 Lee index items. CONCLUSION Incorporating a brief measure of cognition into a modified Lee index, even with single items, resulted in more accurate 5-year mortality risk predictions. Cognition should be included in prognostic calculators in older adults given its independent association with mortality risk. J Am Geriatr Soc 68:1796-1802, 2020.
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Affiliation(s)
- Ashwin A. Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
| | - Sei J. Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
| | - William Dale
- Department of Supportive Care Medicine, City of Hope National Medical Center
| | - W. John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical
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Power R, Nolan JM, Prado-Cabrero A, Coen R, Roche W, Power T, Howard AN, Mulcahy R. Targeted Nutritional Intervention for Patients with Mild Cognitive Impairment: The Cognitive impAiRmEnt Study (CARES) Trial 1. J Pers Med 2020; 10:jpm10020043. [PMID: 32466168 PMCID: PMC7354621 DOI: 10.3390/jpm10020043] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022] Open
Abstract
Omega-3 fatty acids (ω-3FAs), carotenoids, and vitamin E are important constituents of a healthy diet. While they are present in brain tissue, studies have shown that these key nutrients are depleted in individuals with mild cognitive impairment (MCI) in comparison to cognitively healthy individuals. Therefore, it is likely that these individuals will benefit from targeted nutritional intervention, given that poor nutrition is one of the many modifiable risk factors for MCI. Evidence to date suggests that these nutritional compounds can work independently to optimize the neurocognitive environment, primarily due to their antioxidant and anti-inflammatory properties. To date, however, no interventional studies have examined the potential synergistic effects of a combination of ω-3FAs, carotenoids and vitamin E on the cognitive function of patients with MCI. Individuals with clinically confirmed MCI consumed an ω-3FA plus carotenoid plus vitamin E formulation or placebo for 12 months. Cognitive performance was determined from tasks that assessed global cognition and episodic memory. Ω-3FAs, carotenoids, and vitamin E were measured in blood. Carotenoid concentrations were also measured in tissue (skin and retina). Individuals consuming the active intervention (n = 6; median [IQR] age 73.5 [69.5–80.5] years; 50% female) exhibited statistically significant improvements (p < 0.05, for all) in tissue carotenoid concentrations, and carotenoid and ω-3FA concentrations in blood. Trends in improvements in episodic memory and global cognition were also observed in this group. In contrast, the placebo group (n = 7; median [IQR] 72 (69.5–75.5) years; 89% female) remained unchanged or worsened for all measurements (p > 0.05). Despite a small sample size, this exploratory study is the first of its kind to identify trends in improved cognitive performance in individuals with MCI following supplementation with ω-3FAs, carotenoids, and vitamin E.
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Affiliation(s)
- Rebecca Power
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 K0EK Waterford, Ireland; (J.M.N.); (A.P.-C.); (W.R.); (T.P.)
- Correspondence: (R.P.); (R.M.); Tel.: +353-01-845-505 (R.P.); +353-51-842-509 (R.M.)
| | - John M. Nolan
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 K0EK Waterford, Ireland; (J.M.N.); (A.P.-C.); (W.R.); (T.P.)
| | - Alfonso Prado-Cabrero
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 K0EK Waterford, Ireland; (J.M.N.); (A.P.-C.); (W.R.); (T.P.)
| | - Robert Coen
- Mercer’s Institute for Research on Ageing, St. James’s Hospital, D08 NHY1 Dublin, Ireland;
| | - Warren Roche
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 K0EK Waterford, Ireland; (J.M.N.); (A.P.-C.); (W.R.); (T.P.)
| | - Tommy Power
- Nutrition Research Centre Ireland, School of Health Sciences, Carriganore House, Waterford Institute of Technology West Campus, X91 K0EK Waterford, Ireland; (J.M.N.); (A.P.-C.); (W.R.); (T.P.)
| | - Alan N. Howard
- Howard Foundation, 7 Marfleet Close, Great Shelford, Cambridge CB22 5LA, UK;
| | - Ríona Mulcahy
- Age-Related Care Unit, Health Service Executive, University Hospital Waterford, Dunmore Road, X91 ER8E Waterford, Ireland
- Royal College of Surgeons Ireland, 123 Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland
- Correspondence: (R.P.); (R.M.); Tel.: +353-01-845-505 (R.P.); +353-51-842-509 (R.M.)
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Wang MC, Li TC, Li CI, Liu CS, Lin CH, Lin WY, Yang CW, Yang SY, Lin CC. Cognitive function and its transitions in predicting all-cause mortality among urban community-dwelling older adults. BMC Psychiatry 2020; 20:203. [PMID: 32375731 PMCID: PMC7201694 DOI: 10.1186/s12888-020-02618-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cognitive impairment is accompanied with high rates of comorbid conditions, leading ultimately to death. Few studies examine the relation between cognitive transition and mortality, especially in Asian population. This study evaluated baseline cognition and cognitive transition in relation to all-cause mortality among community-dwelling older adults. METHODS We conducted a community-based prospective cohort study among 921 participants of Taichung Community Health Study for Elders in 2009. Cognitive function was evaluated by the Mini-Mental State Examination. Cognitive impairment was considered if the total score is less than 27, 24, and 21 for a participant's educational level of more than 6 years, equal or less than 6 years, and illiteracy, respectively. One-year transition in cognitive function was obtained among 517 individuals who were assessed in both 2009 and 2010. Mortality was followed up until 2016. Cox proportional hazards models were applied to estimate the adjusted hazard ratios of mortality for baseline cognitive impairment and one-year transition in cognitive status. RESULTS After a follow-up of 6.62 years, 160 deaths were recorded. The multivariate adjusted hazard ratio (95% confidence interval) for baseline cognitive impairment was 2.08 (1.43, 3.01). Significantly increased mortality risk was observed for cognitively impaired-normal and impaired-impaired subgroups over 1 year as compared with those who remained normal [2.87 (1.25, 6.56) and 3.79 (1.64, 8.73), respectively]. The area under the receiver operating characteristic curves demonstrated that baseline cognition and one-year cognitive transition had no differential predictive ability for mortality. Besides, there was an interaction of cognitive impairment and frailty, with an additive mortality risk [5.41 (3.14, 9.35)] for the elders who presented with both. CONCLUSION Baseline cognitive impairment rather than one-year progression is associated with mortality in a six-year follow-up on older adults.
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Affiliation(s)
- Mu-Cyun Wang
- grid.411508.90000 0004 0572 9415Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan ,grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- grid.254145.30000 0001 0083 6092Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Ing Li
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ,grid.411508.90000 0004 0572 9415Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- grid.411508.90000 0004 0572 9415Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan ,grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ,grid.411508.90000 0004 0572 9415Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- grid.411508.90000 0004 0572 9415Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan ,grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Yuan Lin
- grid.411508.90000 0004 0572 9415Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan ,grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chuan-Wei Yang
- grid.411508.90000 0004 0572 9415Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- grid.254145.30000 0001 0083 6092Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. .,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. .,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Fan R, Zhao L, Ding BJ, Xiao R, Ma WW. The association of blood non-esterified fatty acid, saturated fatty acids, and polyunsaturated fatty acids levels with mild cognitive impairment in Chinese population aged 35-64 years: a cross-sectional study. Nutr Neurosci 2019; 24:148-160. [PMID: 31079572 DOI: 10.1080/1028415x.2019.1610606] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to explore the correlation between blood profiles and cognitive functions or mild cognitive impairment (MCI) in the Chinese population aged 35-64 years old. METHODS A cross-sectional study was performed, which recruited 675 Chinese adults aged 35-64 years old from Beijing, China. Their cognitive performance was assessed with Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), the serum lipids levels were measured by hexokinase method and colorimetric assay, and the plasma fatty acids profiles were analyzed by fast gas chromatography. RESULTS Among the 675 participants, 84 (12.4%) had MCI. Age, years of education, saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs) were associated with MMSE scores (all P < 0.05). Age, years of education, smoking, drinking, non-esterified fatty acids (NEFAs), SFAs, MUFAs, n-3 polyunsaturated fatty acids (n-3 PUFAs) and n-6/n-3 PUFAs were associated with MoCA scores (all P < 0.05). Increased age (P = 0.002) and smoking (P = 0.028) were positively associated with the prevalence of MCI, while educational level (P = 0.005) and alcohol drinking (P = 0.003) both were negatively correlated to the prevalence of MCI. Elevated serum NEFAs (P = 0.032), high plasma SFAs (P = 0.023), and excessive polyunsaturated fatty acids (PUFAs) levels (P = 0.033) were significantly associated with increased frequency of MCI. CONCLUSION In the Chinese population aged 35-64 years, advanced age and cigarette smoking were risk factors of MCI, whereas higher educational level and alcohol drinking were protective factors for MCI. Excessive serum or plasma levels of NEFAs, SFAs and PUFAs were associated with an increased risk of MCI.
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Affiliation(s)
- Rong Fan
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, People's Republic of China
| | - Lei Zhao
- Department of Molecular Physiology and Biophysics, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bing-Jie Ding
- Department of Clinical Nutrition, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Rong Xiao
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, People's Republic of China
| | - Wei-Wei Ma
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, People's Republic of China
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