Cognitive-Communicative Aspects of Language Functioning in Older Adults: Bulgarian Application of the SCCAN

Background: Cognitive function in older adults is a crucial aspect of overall health and well-being, particularly as the global population continues to age. Rural areas often face unique challenges that can impact cognitive health, including limited access to health-care services, lower educational opportunities, and lifestyle factors that may differ significantly from urban counterparts. By identifying the predictors of cognitive function and understanding the geographical disparities, the study seeks to inform targeted public health strategies and interventions to support cognitive health in rural populations. Aim: This study aims to investigate the level of cognitive function among older adults in four different rural areas, examining how demographic, socioeconomic, and lifestyle factors contribute to cognitive health. Methodology: A cross-sectional study was conducted with 800 participants (200 from each rural area). Cognitive function was assessed using the mini–mental state examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Demographic, socioeconomic, and lifestyle variables were recorded. Correlation analyses, analysis of variance, analysis of covariance, and multivariable regression analyses were performed to identify significant relationships and differences. Results: The study’s participants had a mean age of 72.4 years, with females comprising 55% of the sample. A quarter of participants reported education beyond primary school, and 42.5% had low socioeconomic status. Smoking was reported by 28.75% of participants, while 46.25% engaged in regular physical activity. Significant differences were observed in MMSE and MoCA scores between rural areas (P < 0.001), with rural area D scoring the highest (MMSE: 27.5, MoCA: 24.2) and rural area C scoring the lowest (MMSE: 24.1, MoCA: 20.7). Positive correlations were found between cognitive scores and education level (MMSE: r = 0.35, MoCA: r = 0.40) and physical activity (MMSE: r = 0.21, MoCA: r = 0.22), while negative correlations were observed with age (MMSE: r = −0.15, MoCA: r = −0.12), smoking status (MMSE: r = −0.28, MoCA: r = −0.27), and alcohol use (MMSE: r = −0.25, MoCA: r = −0.23). ANOVA indicated significant differences in MMSE scores between areas (F[3, 796] =12.34, P < 0.001). ANCOVA, adjusting for confounders, confirmed these differences (F[3, 792] =10.47, P < 0.001). Post hoc Tukey tests revealed that rural area D had significantly higher MMSE scores than Areas B and C (P < 0.01), and Area A had higher scores than Area C (P < 0.05). Significant factors associated with MMSE scores included age (β = −0.12, P = 0.01), education level (β =0.35, P < 0.001), physical activity (β =0.21, P < 0.05), smoking status (β = −0.28, P < 0.01), and alcohol use (β = −0.25, P < 0.01). Conclusion: Cognitive function among older adults varies significantly across different rural areas. Higher education levels and regular physical activity are associated with better cognitive performance, while older age, smoking, and alcohol use are negatively associated. These findings underscore the importance of targeted interventions to improve cognitive health in rural aging populations.

Association between serum vitamin D metabolite levels and cognitive function in community-dwelling older adults: A cross-sectional study.

The clinical utility of the Mini-Mental State Examination (MMSE) and its shorter version (SMMSE) is still debated. There is a need to better understand the neuroanatomical correlates of these cognitive tests. The objective of this cross-sectional study was to determine whether lower MMSE and SMMSE scores correlated with focal brain volume reduction in older adults. Participants from the GAIT study (n = 207; mean, 70.9±5.9 years; 57% female; mean MMSE 26.2±3.9; mean SMMSE 5.1±1.1) were evaluated using the MMSE and SMMSE and received a 1.5-Tesla MRI scan of the brain. Cortical gray and white matter subvolumes were automatically segmented using Statistical Parametric Mapping. Age, gender, education level, and total intracranial volume were included as potential confounders. We found correlations between the MMSE score and specific cortical regions of the limbic system including the hippocampus, amygdala, cingulate gyrus, and parahippocampal gyrus, independently of the diagnostic category (i.e., mild cognitive impairment or Alzheimer disease or controls). Regarding correlations with the SMMSE score, only one cluster in the left hippocampus was identified, which overlapped with the cluster that was positively correlated with the MMSE score. There were no correlations with the volume of white matter. In conclusion, worse MMSE and SMMSE scores were associated with gray matter atrophy mainly in the limbic system. This finding highlights that atrophy of specific brain regions are related to performance on the MMSE and the SMMSE tests, and provides new insights into the cognitive function probed by these tests.

It is well known that low educational attainment is associated with cognitive function decline in older age. Childhood book availability may help to preserve cognitive function in older adults with low education. The study objective was to examine the association between childhood book availability and cognitive function among older adults with low educational attainment, and to investigate the mediating effect of the volume of reading-related brain regions (e.g., superior temporal cortex). A cross-sectional study of community-dwelling older Japanese adults aged 65-84 years was conducted (n = 474). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Childhood book availability was assessed using a retrospective questionnaire. Brain region volume was measured using magnetic resonance imaging. Multivariate regression modeling and structural equation modeling were used for analysis. Both high educational attainment and childhood book availability were independently associated with high MMSE score. Stratification of educational level showed that childhood book availability was positively associated with MMSE score among participants with low educational attainment (coefficient = 1.48, 95% confidence interval [CI]: 0.31 to 2.66), but not among those with moderate or high educational attainment (coefficient = -0.01, 95% CI: -1.44 to 1.42 and -1.21, 95% CI: -3.85 to 1.42, respectively). Among participants with low educational attainment, left superior temporal cortex volume mediated the association between childhood book availability and MMSE score. The availability of books in childhood helps to preserve cognitive function in older adults with low education via left superior temporal cortex volume. Further research is needed to replicate these findings.

High Activities of BACE1 in Brains with Mild Cognitive Impairment

Background: A large number of individuals with Alzheimer’s disease (AD) live alone and receive little or no help from family members, which implies an additional pressure on the increasing societal costs of dementia care. Their adult children, if any, might have very limited ability to assist by providing informal help because of social structural changes, such as full-time work for most women and sometimes a place of residence located far away from the parents’ home. About half of the informal help received has been reported to consist of surveillance, diversion from repetitive or dangerous activities, and management of behavioral disturbances. Lack of help in monitoring these expressions of AD might lead to safety issues for individuals who live alone. Moreover, difficulties in detecting increasing impairments in their cognitive and functional abilities could affect negatively the opportunities of solitary-living individuals to receive necessary formal help. Living alone with dementia is also a strong factor for nursing home placement. This study aimed to describe the cognitive and functional abilities of solitary-living AD patients, as well as the potential predictors of usage of community-based home help services (HHS). Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, open, nonrandomized, multicenter study that was undertaken the investigation of the long-term effectiveness of cholinesterase inhibitor (ChEI) treatment from various perspectives, such as cognition, activities of daily living (ADL), and usage of community-based services. Among the 1,258 outpatients with a clinical diagnosis of probable or possible AD in the SATS, 1,021 had mild-to-moderate AD (Mini-Mental State Examination (MMSE) score, 10–26) at the start of ChEI therapy (baseline). Three hundred fifty-five (35%) of these individuals were living alone at the baseline, with or without HHS, and were included in the current study. Patients were assessed regarding cognitive ability (MMSE), functional capacity (Instrumental Activities of Daily Living (IADL) scale and Physical Self-Maintenance Scale (PSMS)), and the amount of HHS (hours/week), at baseline and every 6 months for a total period of 3 years. Binary logistic regression was used to determine the individuals’ characteristics that affected the use of HHS at baseline. The following potential predictors were investigated: gender, APOE 4 carrier status, years of education, illness duration, age, number of medications, and cognitive and functional abilities at baseline. Results: At the start of ChEI therapy, 267 (75%) of the solitary-living patients were in the mild stage of AD (MMSE score, 20–26). HHS was used by 85 (32%) of the mild and 48 (55%) of the moderate (MMSE, 10–19) AD patients (P < 0.001). The mean hours of HHS used per week was 5.7 (95% confidence interval (CI), 5.0–6.5); no difference in this parameter was detected among the disease stages. The IADL capacity was already markedly impaired at baseline: 50–65% of the individuals were dependent on assistance to perform these activities (IADL score, 2–5). Regarding basic ADL, most patients were able to manage themselves independently, with the exception of physical ambulation (almost 60% of individuals needed some assistance; PSMS score, 2–5). A significant difference in mean IADL score at the start of ChEI treatment was observed between the mild and moderate AD patients: 14.6 points (95% CI, 13.9–15.2) vs 19.2 points (95% CI, 18.1–20.3; P < 0.001). The corresponding PSMS scores were 7.5 points (95% CI, 7.2–7.7) vs 8.9 points (95% CI, 8.2–9.6; P < 0.001). No difference in age or number of medications at baseline was found among the disease stages. In a logistic regression model, the variables IADL score (OR, 1.27; 95% CI, 1.17–1.38; P < 0.001) and number of medications at baseline (OR, 1.19; 95% CI, 1.07–1.33; P = 0.002) correctly classified 80.2% of the patients with AD regarding whether they used HHS at the start of ChEI therapy. After 3 years of ChEI treatment, 89 AD patients (25%) were still living alone in their own home. Of those, 65 individuals used a mean of 9.5 hours (95% CI, 7.8–11.3) of HHS per week. The cognitive ability of the solitary-living patients varied appreciably, but 80–90% could not carry out IADL tasks independently. In addition, more than 50% of the individuals needed assistance in performing the basic ADL items of grooming and physical ambulation. Conclusions: A substantial number of AD patients, predominantly females, with severe cognitive and functional impairments live alone, which might lead to safety risks for these vulnerable individuals. The amount of HHS used did not reflect disease severity. Functional, but not cognitive, ability predicted the need for home help, suggesting that HHS meets the needs related to cognitive deterioration to a lesser extent. Increased knowledge about how community-based services can better accommodate the care needs of recipients with cognitive impairment is essential. (Less)

The association between essential trace element mixture and cognitive function in Chinese community-dwelling older adults

The aim of the COGNIDAGE study was to examine the association between 25(OH)D and cognitive status in a group of elderly patients with vitamin D deficiency and high burden of comorbidities attending Geriatric Outpatient Clinics. We studied the relationship between 25(OH)D and cognitive functions taking into account comorbidities and cognitive functions assessed by MMSE (Mini Mental State Examination), CDT (Clock Drawing Test) and CIRS (Cumulative Illness Rating Scale), in 132 consecutive elderly patients with low levels of 25(OH)D (<10 ng/ml) compatible with the condition of vitamin deficiency. The association among 25(OH)D levels, MMSE score, CDT score and CIRS scores were analyzed using Pearson correlation. All the elderly patients received an adequate vitamin D supplementation and were reassessed after 6 months. At baseline, mean MMSE and CIRS scores were: 21.8+5.56 and 2.96 +1.63 respectively. Mean CDT score was 3,66+-2.05. No associations were found between 25(OH)D levels and global cognitive function. A significant relationship was observed between the total CIRS score and 25(OH)D levels (r=0.305; p=0.000) as well as between total CIRS score and MMSE (r=-0.375; p=0.000). After 6 months, 83.9 % had 25(OH)D levels >20 ng/ml. Mean MMSE and CDT scores were 22.20+-5.76 and 3.90+-2.06 respectively. There was no significant correlation among 25(OH)D, MMSE and CDT scores while a significant correlation was found between 25(OH)D and CIRS- severity score (r=0.275; p=0.001) and between MMSE and total CIRS scores (r=-0.247; p=0.005 for CIRS-comorbidities; r=-0.184; p=0.04 for CIRS-severity). A post hoc evaluation on two subgroups of elderly patients (the first with vitamin D deficiency without cognitive impairment, the second with vitamin D deficiency and dementia) showed a statistically significant difference (p=0.00001) regarding the CIRS-comorbidities scores. In our cohort of elderly patients with a high burden of comorbidities, 25(OH)D low levels (<10 ng/ml) are not associated with MMSE and CDT scores. There is no statistically difference among the levels of 25(OH)D and MMSE and CDT scores after 6 months. The strong correlation we found regarding CIRS-comorbidities in the two sub-groups suggests that vitamin D deficiency may play a role in promoting cognitive impairment only with comorbidities.

Task-oriented circuit training (TOCT) is a structured intervention to enhance older adults' cognitive and motor functions. However, the feasibility and effectiveness of TOCT delivered through face-to-face, telerehabilitation, and home-based methods remain unclear. To evaluate the feasibility and preliminary efficacy of TOCT delivered through different modalities on cognitive and motor functions in older adults. A randomized feasibility study. A state-operated skilled nursing facility in Turkey that provides daily-living assistance with on-site medical coverage for emergencies. Fifty-four older adults (ages ≥65 yr). Inclusion criteria included Mini-Mental State Examination (MMSE) scores >18. Adults with moderate or severe impairment (MMSE scores ≤18) were excluded. Participants were randomly assigned to face-to-face, telerehabilitation, or home-based TOCT. They engaged in structured TOCT activities to improve joint protection, memory, attention, and fine motor skills. Sessions were delivered for 60 min daily for 2 wk. Pre- and postintervention assessments were conducted. Assessments included the MMSE, the Montreal Cognitive Assessment, the Nine-Hole Peg Test, and subscales of the 36-Item Short Form Health Survey. Face-to-face TOCT showed the greatest cognitive improvements (MMSE: d = 1.52), whereas telerehabilitation improved energy and vitality levels (d = 0.91) and social functioning (d = 1.41). Home-based training showed the smallest improvements overall. TOCT through face-to-face and telerehabilitation methods effectively improved cognitive and motor functions. Face-to-face training yielded the greatest cognitive benefits, whereas telerehabilitation enhanced quality of life. Home-based interventions had limited impact. Future research should explore long-term outcomes and refine home-based programs. Plain-Language Summary: As people age, cognitive and motor skills decline, making daily activities harder. This study examined task-oriented circuit training, a structured program delivered through face-to-face, telerehabilitation, and home-based methods. Face-to-face training showed the greatest cognitive improvements, whereas telerehabilitation enhanced energy and vitality levels and social participation. Home-based programs had minimal benefits. These findings support remote task-oriented circuit training as a viable option, although further research is needed to improve home-based interventions.

Objective To detect the diffusional kurtosis imaging (DKI) parameters of patients with Alzheimer's disease (AD), and evaluate the inner link of DKI parameters with cognitive function and serum nerve injury index. Methods 78 patients who were first diagnosed with AD in our hospital between December 2015 and January 2018 were enrolled in AD group, and 50 healthy volunteers who had physical examination in our hospital during the same period were enrolled in normal control group. The corpus callosum DKI parameters [mean kurtosis (MK), axial kurtosis (AK) and radial kurtosis (RK)] values, Mini-Mental State Examination (MMSE) score as well as serum nerve damage indexes [β amyloid 1-42 (Aβ1-422), S100B protein (S100B) and brain-derived neurotrophic factor (BDNF)] were compared between the two groups of subjects. Pearson test was used to evaluate the correlation of DKI parameters with MMSE score as well as serum nerve injury index in patients with AD. Results MK, AK and RK levels in AD group were lower than those in normal control group; MMSE score was lower than that of normal control group; serum Aβ1-42 and S100B contents were higher than those of normal control group while BDNF content was lower than that of normal control group (P<0.05). Correlation analysis revealed that the MK, AK and RK values in AD patients were directly correlated with the MMSE score as well as Aβ1-42, S100B and BDNF levels (P<0.05). Conclusions The corpus callosum DKI parameter levels decrease in AD patients, and the specific levels are closely related to the severity of cognitive function and nerve injury, which may be one of the effective methods for early assessment of AD condition. Key words: Alzheimer disease; Corpus callosum; Diffusion magnetic resonance imaging; Cognition; Cytokines

To prevent the adverse effects, deprescribing is a structured approach aimed at reducing anticholinergic burden and improving clinical outcomes, particularly in those with cognitive impairment. The objective of this study was to ascertain the impact of alterations in the total number of medications and the Drug Burden Index (DBI) score on cognitive tests and Activity of Daily Living (ADL) scores during a 6-month follow-up period in older patients with major neurocognitive impairment. A total of 232 older patients with major neurocognitive impairment were enrolled in this study, which was retrospectively designed and followed up. The alterations in the total number of medications and the DBI scores were evaluated at baseline and at the end of the sixth month, which were compared with the changes in cognitive tests and ADL scores. Comparing baseline and end-of-six-month Mini-Mental State Examination (MMSE) scores revealed a significant decrease in MMSE scores in patients with elevated DBI scores and those with increased medication intake (P=0.001 and P=0.034, respectively). A subsequent comparison of the change in MMSE score across the groups revealed a significant decrease only among the group with decreased DBI score (Δ=0.45±3.29 and P<0.001). In the linear regression analysis, a 1-unit increase in DBI score and drug number was associated with a decrease in MMSE scores (B: -0.245 vs. -0.197). The 6-month follow-up study demonstrated that deprescribing should prioritize the comprehensive evaluation of medication quantity and anticholinergic burden to enhance the efficacy of dementia care in older adults.

Diagnostic performance of the cingulate island sign ratio for differentiating dementia with Lewy bodies from Alzheimer's disease changes depending on the mini-mental state examination score

Impaired Awareness of Deficits and Neuropsychiatric Symptoms in Early Alzheimer's Disease: The Danish Alzheimer Intervention Study (DAISY)

BackgroundDespite the rapidly rising incidence of cognitive impairment, no current medications have proven effective for mild cognitive impairment (MCI). The Integrated dementia clinic at Dongguk University Ilsan Hospital is a nationally recognized Korean‐Western (KW) clinic that provides the integrated medical service via co‐consultation by both neurologists and Korean medicine neuropsychologists.ObjectiveThe purpose of this study is to examine whether the integrated KW treatment prevents cognitive decline in patients with MCI as measured by changes in the Mini Mental State Examination (MMSE) scores over time.MethodWe retrospectively examined the medical records of patients from May 2015 to June 2020. Of 19 patients who were diagnosed as MCI, twelve MCI patients underwent MMSE at their initial visit to the clinic and at least once more over a period of up to 5 years. These twelve MCI patients divided into two groups: MMSE improvement group vs. MMSE worsening group. We performed the Wilcoxon rank sum test to compare the group achieving improvement in MMSE to decrease in MMSE. We also used the same test to assess the difference in the median length of follow‐up between the two groups.ResultThe prevalence of MCI seen during the review period was 23% (19/82). The baseline characteristics of patients with MCI were shown in Table 1. Among those twelve MCI patients who received integrated KW treatment, 67 % (8/12) of them achieved improvement in MMSE score, which was statistically significant (p‐value = 0.008) compared to those showing a decrease in MMSE score while the length of follow‐up was not significantly different between the two groups. The detailed treatment and changes in MMSE presented in Table 2. For treatment from Western medicine, anticonvulsants were most commonly prescribed, and donepezil was given to 63%. Acupuncture (100%), Moxibustion (100%), and herbal medicine (Gagam‐sohabhwangwon: 6/8,62.5 %) were most prescribed Korean medicine.ConclusionsThis study demonstrates, for the first time, that integrated KW treatment positively affects cognitive function in MCI patients with increases in MMSE scores over time. Further research with a larger data set, needs to be conducted to validate the effectiveness of integrative approach.

The purpose of this study is to develop a software for the extraction of the hippocampus and surrounding medial temporal lobe (MTL) regions from T1-weighted magnetic resonance (MR) images with no interactive input from the user, to introduce a novel statistical indicator, computed on the intensities in the automatically extracted MTL regions, which measures atrophy, and to evaluate the accuracy of the newly developed intensity-based measure of MTL atrophy to (a) distinguish between patients with Alzheimer disease (AD), patients with amnestic mild cognitive impairment (aMCI), and elderly controls by using established criteria for patients with AD and aMCI as the reference standard and (b) infer about the clinical outcome of aMCI patients. For the development of the software, the study included 61 patients with mild AD (17 men, 44 women; mean age +/- standard deviation (SD), 75.8 years +/- 7.8; Mini Mental State Examination (MMSE) score, 24.1 +/- 3.1), 42 patients with aMCI (11 men, 31 women; mean age +/- SD, 75.2 years +/- 4.9; MMSE score, 27.9 +/- 1.9), and 30 elderly healthy controls (10 men, 20 women; mean age +/- SD, 74.7 years +/- 5.2; MMSE score, 29.1 +/- 0.8). For the evaluation of the statistical indicator, 150 patients with mild AD (62 men, 88 women; mean age +/- SD, 76.3 years +/- 5.8; MMSE score, 23.2 +/- 4.1), 247 patients with aMCI (143 men, 104 women; mean age +/- SD, 75.3 years +/- 6.7; MMSE score, 27.0 +/- 1.8), and 135 elderly healthy controls (61 men, 74 women; mean age +/- SD, 76.4 years +/- 6.1). Fifty aMCI patients were evaluated every 6 months over a 3 year period to assess conversion to AD. For each participant, two subimages of the MTL regions were automatically extracted from T1-weighted MR images with high spatial resolution. An intensity-based MTL atrophy measure was found to separate control, MCI, and AD cohorts. Group differences were assessed by using two-sample t test. Individual classification was analyzed by using receiver operating characteristic (ROC) curves. Compared to controls, significant differences in the intensity-based MTL atrophy measure were detected in both groups of patients (AD vs controls, 0.28 +/- 0.03 vs 0.34 +/- 0.03, P < 0.001; aMCI vs controls, 0.31 +/- 0.03 vs 0.34 +/- 0.03, P < 0.001). Moreover, the subgroup of aMCI converters was significantly different from controls (0.27 +/- 0.034 vs 0.34 +/- 0.03, P < 0.001). Regarding the ROC curve for intergroup discrimination, the area under the curve was 0.863 for AD patients vs controls, 0.746 for all aMCI patients vs controls, and 0.880 for aMCI converters vs controls. With specificity set at 85%, the sensitivity was 74% for AD vs controls, 45% for aMCI vs controls, and 83% for aMCI converters vs controls. The automated analysis of MTL atrophy in the segmented volume is applied to the early assessment of AD, leading to the discrimination of aMCI converters with an average 3 year follow-up. This procedure can provide additional useful information in the early diagnosis of AD.