Effects of intermittent hypoxic–hyperoxic training on exercise tolerance, cognitive function, and arterial stiffness in older patients with myocardial infarction and chronic heart failure

Cognitive impairment has a negative impact on older patients with cancer. The aim of this study was to evaluate for interindividual differences in 2 subjective measures of cognitive function in older patients (n = 112), as well as determine which demographic, clinical, and symptom characteristics, and levels of physical function, were associated with initial levels and with the trajectory of each of these 2 measures. Cognitive function was assessed using the cognitive function scale from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Attentional Function Index at the initiation of chemotherapy and at 1, 3, 6, 9, and 12 months after its initiation. Hierarchical linear modeling was used to assess for interindividual differences in and characteristics associated with initial levels and changes in cognitive function. Characteristics associated with decreases in Quality of Life Questionnaire Core 30 scores at the initiation of chemotherapy were longer time since the cancer diagnosis and higher depression scores. Characteristics associated with poorer Attentional Function Index scores at enrollment were lower levels of education and higher depression scores. No characteristics were associated with worse trajectories of either cognitive function measure. Some older patients undergoing chemotherapy experience decrements in cognitive function. Our findings suggest that clinicians need to assess for depressive symptoms in older patients before the initiation of chemotherapy. Evidence-based interventions (eg, cognitive stimulation, increased physical activity) can be recommended to maintain and increase cognitive function in older oncology patients.

Objective: There are many cases of potentially impaired cognitive function in older patients with hypertension. Therefore, we investigated factors associated with one-year changes in cognitive function in older hypertensive patients during outpatient visits. Design and method: We included 223 hypertensive patients (age 76.3 ± 6.3 years, 106 males) aged 65 years or older who attended outpatient hypertension clinics at six specialized institutions nationwide and had no prior diagnosis of dementia. We obtained the mini-mental state examination (MMSE) from all participants. We defined the impaired cognitive function as an MMSE score of 27 or less. At baseline and one year later, the participants were evaluated for comprehensive geriatric assessment, including MMSE, and muscle strength, with the converted group defined as having new cognitive decline at one year and the reverted group as having cognitive improvement one year after the cognitive decline. All participants gave informed consent, and our institutional review board approved the study protocol. Results: At baseline, 81 of 223 elderly hypertensive patients had impaired cognitive function. At one-year follow-up, 40 of 142 patients in the maintained cognitive function group were classified as converted, and 33 of 81 patients in the impaired cognitive function group were classified as converted. The converted group was older than the cognitively intact group (76.8 vs. 73.9 years, p < 0.05), had higher home blood pressure, and had more significant grip strength loss over the year. Multivariate analysis identified age (odds ratio 1.1, 95% CI 1.0–1.2) and change in grip strength (odds ratio 0.84, 95% CI 0.72–0.99) as factors associated with the converted group. The reverted group was younger, had a higher percentage of males, and had weaker grip strength than the group with persistent cognitive decline. In multivariate analysis, grip strength (odds ratio 0.80, 95%CI 0.68–0.94) was extracted as a factor associated with the revert group. Conclusions: Potential cognitive decline was observed in 36% of older patients with hypertension. Furthermore, we examined a high rate of cases of cognitive function change over one year. Age and grip strength decline was considered responsible for cognitive conversion and baseline grip strength for revert, respectively.

Purpose: The present study aimed to examine the effect of a physical-strengthening exercise program on physical fitness, depression, and cognitive function in older patients with Parkinson's disease (PD).Methods: Forty-one PD patients who were recruited from D University hospital in B Metropolitan City were allocated to the experimental group (n=21) and control group (n=20). Participants completed the physical-strengthening exercise program 2 times a week for 12 weeks. Before and after the intervention, we administered a senior fitness test (SFT), the depression scale (the Korean version of the Montgomery-Asberg depression rating scale, MADRS-K), and cognitive function scale (the Korean version of the Alzheimer’s disease assessment scale, ADAS-K). The data were analyzed by repeated measures ANOVA.Results: The physical-strengthening exercise program was effective as indicated by significant improvement in physical fitness, cognitive function, but not depression in participants.Conclusion: Our results suggest the physical-strengthening exercise program will be a valuable non-pharmacological intervention to promote physical fitness and cognitive function in older patients with PD. In addition, this intervention may be used to alleviate the risk of gait disturbance and falls due to PD.

To investigate the effects of an exercise training program on physical and cognitive function in older patients with dementia. Thirty-eight patients with early-middle dementia (31 females and seven males), aged 80.6±6.9 years, residents in an Elderly Care Unit, either completed a 36-week structured exercise program (Intervention Group, IG; n=19), or received the usual medical care (Control Group, CG; n=19). Before and after the 36-week intervention, cognitive function was evaluated in both groups by Mini-Mental State Examination (MMSE) and depression by Geriatric Depression Scale (GDS); physical function was assessed using handgrip test, Timed Up to Go (TUG), Berg Balance Scale (BBS) and Chair-Stand Test (CST), and daily living functionality by Functional Rating Scale for Symptoms of Dementia (FRSSD). As a result of exercise intervention, participants scored better in all functional and cognitive test assessments compared to the control group, as reflected by absolute and relative (%) differences in all metrics after the 36-week exercise program (p<0.001). A 36-week supervised exercise training program was found to result in significant improvements in physical and cognitive function of elderly patients in early to middle stages of dementia at an Elderly Care Unit. The promising results of this study shed more light on the adaptability of elderly patients with early and mild dementia to long-term exercise training and verified the feasibility of applying such programs in this clinical population.

Our study aims to assess the effectiveness of horticultural therapy in improving outcomes in older patients with dementia. A systematic review and meta-analysis. The included studies comprised randomised controlled trials (RCTs) that aimed to assess the effectiveness of horticultural therapy on cognitive function in older patients with dementia. The study design and data extraction were independently conducted by two investigators, who also evaluated the risk of bias using RoB 2.0. The meta-analysis was carried out using Stata 15.1 software. On November 2023, we searched relevant English and Chinese publications in PubMed, Web of Science, Cochrane Library, Embase, CNKI and Wanfang databases. The meta-analysis included a total of 9 RCTs, involving 655 older patients diagnosed with dementia. The findings from these studies demonstrated that horticultural therapy had a significant positive impact on various aspects of the patients' well-being when compared to conventional care. Specifically, it was found to improve cognitive function scores, alleviate symptoms of depression, enhance daily activities and enhance overall quality of life. When conducting a subgroup analysis, it was observed that horticultural therapy had a statistically significant effect on cognitive function in older patients with dementia when the intervention frequency was at least two times per week. Furthermore, interventions with a duration of less than 6 months were found to be more effective than those lasting 6 months or longer. Additionally, outdoor horticultural therapy was found to be superior to indoor interventions. Moreover, structured interventions were observed to yield better outcomes compared to non-structured interventions. More high-quality studies are needed to further corroborate these findings due to the low quality of the included studies. Horticultural therapy has been found to have a significantly positive impact on the cognitive function, depression status, ADL, and quality of life of older patients with dementia. We provide references for non-pharmacologic treatment of older patients with dementia. WHAT PROBLEM DID THE STUDY ADDRESS?: This study aimed to measure the efficacy of horticultural therapy in older patients with dementia across four dimensions: cognitive function, depression levels, daily living activities and overall quality of life. WHAT WERE THE MAIN FINDINGS?: In older patients with dementia, horticultural therapy has been proven to have a significant positive impact on cognitive function, depressive status, activities of daily living and quality of life. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This study will inform non-pharmacological interventions for older patients with dementia worldwide. No Patient or Public Contribution.

Pulse wave velocity, a common metric of arterial stiffness, is an established predictor for cardiovascular events and mortality. However, its intrinsic pressure-dependency complicates the discrimination of acute and chronic impacts of increased blood pressure on arterial stiffness. Cardio-ankle vascular index (CAVI) represented a significant step towards the development of a pressure-independent arterial stiffness metric. However, some potential limitations of CAVI might render this arterial stiffness metric less pressure-independent than originally thought. For this reason, we later introduced CAVI0. Nevertheless, advantages of one approach over the other are left debated. This review aims to shed light on the pressure (in)dependency of both CAVI and CAVI0. By critically reviewing results from studies reporting both CAVI and CAVI0 and using simple analytical methods, we show that CAVI0 may enhance the pressure-independent assessment of arterial stiffness, especially in the presence of large inter-individual differences in blood pressure.

To explore the association between stress hyperglycemia ratio (SHR) levels and cognitive function in older patients with diabetes or prediabetes. Cognitive function was assessed through a composite Z-score, the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) subtest, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). SHR was calculated as the fasting blood glucose divided by the estimated average glucose from glycated hemoglobin. In subsequent analyses, SHR was divided into quartiles (quartiles 1 to 4), with the second quartile serving as the reference group. A weighted linear regression model was used to assess the association between SHR and cognitive function. After adjusting the corresponding covariates, the analysis revealed that compared to the second quartile, the first [β: –0.26; 95% confidence interval (CI): –0.39– –0.12], third (β: –0.13, 95% CI: –0.25– –0.02), and fourth (β: –0.21, 95% CI: –0.36– –0.06) quartiles were all associated with a decrease in Z-score. The first quartile was associated with a decline in AFT (β: –1.46, 95% CI: –2.57– –0.36). The first (β: –3.72, 95% CI: –6.06– –1.38) and fourth (β: –2.58, 95% CI: –4.98– –0.17) quartiles were associated with a decline in DSST. No statistically significant associations were observed between any of the quartile groups and CERAD (all p > 0.05). Both higher and lower SHR were associated with poorer overall cognitive function, with higher and lower SHR being related to worse memory dimensions, while lower SHR was associated with impaired executive function.

ObjectiveThis study evaluated the effects of the Bushen Yinao pill, combined with standard therapy, on gut flora, inflammatory markers, and cognitive function in older patients with Alzheimer's disease (AD).MethodsA total of 136 AD patients treated at the department of neurology at a hospital in China from August 2022 to September 2023 were randomly assigned to two groups: 68 patients received standard treatment (control group, CTG), and 68 patients received the Bushen Yinao pill plus standard treatment (intervention group, ITG). Outcomes included Traditional Chinese Medicine (TCM) syndrome scores, gut microbiota composition, inflammatory markers, cognitive function, overall efficacy, and safety.ResultsAfter treatment, the intervention group (ITG) showed significant reductions in TCM syndrome scores compared to the control group (CTG) (P < 0.05). The ITG also showed significant increases in beneficial bacterial flora in the gut and decreases in harmful bacteria compared to the CTG (P < 0.05). Inflammatory markers (Aβ, IL-6, TNF-α) were reduced, and cognitive function improved significantly more in the ITG (P < 0.05). There were no significant differences in adverse reactions between the groups (P > 0.05).ConclusionThe Bushen Yinao pill, when combined with standard therapy, may help to regulate gut microbiota, reduce inflammatory markers, and enhance cognitive function in AD patients, while also showing a favorable safety profile. Further research is recommended to validate these findings in other populations.

AimTo investigate the associations of sleep duration and physical frailty with cognitive function in older patients with both atrial fibrillation and heart failure.DesignThis study used a cross‐sectional, secondary data analysis design.MethodWe included outpatients aged ≥ 65 years with coexisting atrial fibrillation and heart failure in South Korea. We used a sample of 176 patients (men = 100) with HF among 277 data from the parent study. The data were collected through a self‐report, structured questionnaire and electronic medical record.ResultsOur main finding showed that long sleep duration and physically frail status were significant predictors of cognitive impairment in older adults with both atrial fibrillation and heart failure. Healthcare providers should be aware of the importance of assessing sleep duration and physical activity in older adults with both atrial fibrillation and heart failure to prevent or delay cognitive impairment.

BackgroundThe prevalence of impaired cognitive functioning in older patients with end stage kidney disease (ESKD) is high. We aim to describe patterns of memory, executive function or psychomotor speed and to identify nephrologic, geriatric and neuroradiologic characteristics associated with cognitive impairment in older patients approaching ESKD who have not yet started with renal replacement therapy (RRT).MethodsThe COPE-study (Cognitive Decline in Older Patients with ESRD) is a prospective cohort study including 157 participants aged 65 years and older approaching ESKD (eGFR ≤20 ml/min/1.73 m2) prior to starting with RRT. In addition to routinely collected clinical parameters related to ESKD, such as vascular disease burden and parameters of metabolic disturbance, patients received a full geriatric assessment, including extensive neuropsychological testing. In a subgroup of patients (n = 93) a brain MRI was performed.ResultsThe median age was 75.3 years. Compared to the normative data of neuropsychological testing participants memory performance was in the 24th percentile, executive function in the 18th percentile and psychomotor speed in the 20th percentile. Independent associated characteristics of impairment in memory, executive and psychomotor speed were high age, low educational level and low functional status (all p-values < 0.003). A history of vascular disease (p = 0.007) and more white matter hyperintensities on brain MRI (p = 0.013) were associated with a lower psychomotor speed.ConclusionOlder patients approaching ESKD have a high prevalence of impaired memory, executive function and psychomotor speed. The patterns of cognitive impairment and brain changes on MRI are suggestive of vascular cognitive impairment. These findings could be of potentially added value in the decision-making process concerning patients with ESKD.

To explore the potential classes of social isolation in older patients with chronic obstructive pulmonary disease (COPD), analyze the influencing factors of these classes, and investigate the relationship between different classes and cognitive function. From April to December 2024, a convenience sampling method was used to survey older COPD patients at a tertiary hospital in Shanxi Province. The general information questionnaire, Social Network Scale Brief, Hamilton Depression Scale, Social Support Rating Scale, and Montreal Cognitive Assessment Scale were employed. Latent profile analysis was conducted to categorize social isolation in older COPD patients. Uni-variate and multivariate analyses were used to explore the influencing factors of different social isolation classes, and a mixed-effects regression model was applied to analyze the relationship between these classes and cognitive function. A total of 245 older COPD patients were included, with 33.5% experiencing social isolation. Social isolation in older COPD patients could be divided into three classes, named "High Social Isolation-Interaction Deficiency Group", "Moderate Social Isolation-Moderate Interaction Group", and "Low Social Isolation-Coordinated Relationship Development Group", accounting for 27.4%, 43.9%, and 28.7% of the sample, respectively. The unordered multinomial results indicated that older age, living alone, annual household income per capital below 7000-Yuan, acute exacerbation history within the last month, and high levels of depression were more likely to be associated with the "High Social Isolation-Interaction Deficiency Group". Patients with low education levels and annual household income per capital between 7000 and 15,000 Yuan were more likely to belong to the "Moderate Social Isolation-Moderate Interaction Group". Patients with moderate airflow limitation, long disease duration, and high levels of social support were more likely to belong to the "Low Social Isolation-Coordinated Relationship Development Group". The mixed-effects regression model analysis showed that patients in the "High Social Isolation-Interaction Deficiency Group" were at a higher risk of cognitive impairment compared to the other two groups. The findings reveal a significant association between social isolation patterns and cognitive dysfunction risk in older COPD patients. Nurses and healthcare providers should prioritize screening for cognitive impairment in the "High Social Isolation-Interaction Deficiency Group", as this subgroup exhibits the highest prevalence of cognitive deficits. Future interventions may consider tailoring strategies to address distinct social isolation profiles, pending validation through longitudinal or experimental studies to establish causal pathways.

To the Editor: Impaired cognition is observed frequently in older patients admitted to a hospital. Cavanaugh and Wettstein found that 28% of a random sample of hospital patients evidenced cognitive dysfunction on the Mini-Mental Status Examination (MMSE).1 Older patients with fractures of the extremities are especially at risk of developing neuropsychological problems.2,3 It is unclear whether cognitive impairment in older hospital patients with injury to the extremities will disappear over time. On the one hand, neuropsychological dysfunction may be the result of factors associated with hospitalization (e.g., psychological stress, sleep disturbances, or the use of medication acting on the Central Nervous System). This would mean that impaired cognition will disappear after discharge from the hospital. On the other hand, neuropsychological problems may also be attributable to brain damage caused by surgery and anesthesia. In this case, cognitive impairment could be more permanent. To gain more insight into the duration of cognitive dysfunction in older patients with fractures of the extremities, we decided to compare the cognitive function of older patients, measured 2 months after injury to the extremities (i.e., after discharge from hospital), with their prefracture function. This investigation is part of the Groningen Longitudinal Aging Study (GLAS).4 In 1993, more than 5000 older people from the patient panels of 12 family physicians were interviewed and administered the short version of the MMSE.5 GLAS participants who sustained injury to the extremities after the baseline, were invited for a second interview 2 months postinjury. The shortened MMSE was also administered during this interview. By the end of 1996, 166 patients had entered the study. Fifty four of them had been hospitalized because of a fracture. Baseline and postfracture cognitive function was available for 46 of these patients. Mean (SD) age of the patients was 72.9 (8.1) years. There were 32 women and 14 men. Twenty-two patients had sustained a broken hip, and the others had mainly wrist and ankle fractures. Mean (SD) baseline score on the short MMSE was 11.0 (1.1), mean (SD) postfracture score was 10.9 (1.3). A paired t test shows that this difference is not statistically significant (t = .5, df = 45, P = .622). We were unable to find a decline in cognitive function 2 months after a fracture of the extremities. This suggests that impaired cognition in older patients admitted to a hospital for injury to the extremities is often caused by factors related to hospitalization. Stress and anxiety, sleep disturbances and/or psychotropic drugs (e.g., benzodiazepines, corticosteroids, anticholinergics etc.) seem to be responsible for the high prevalence of cognitive dysfunction in this patient group. Note that our study does have one limitation. The MMSE is a somewhat crude measure for assessing cognitive function. Using more sensitive neuropsychological tests may yield evidence for lower cognitive function 2 months after a fracture of the extremities.

ABSTRACTAimsTo investigate the efficacy and safety of transcutaneous auricular vagus nerve stimulation (taVNS) in improving cognitive function in older inpatients with schizophrenia.DesignRandomised controlled trial.SettingCognitive improvement in hospitalised older patients with schizophrenia in Shanghai.ParticipantsFifty‐one older inpatients with schizophrenia in Shanghai Mental Health Center.InterventionThe taVNS electrodes were placed on the skin with vagus nerve distribution in the taVNS group, whereas the electrodes were placed on the skin without vagus nerve distribution in the sham taVNS group. taVNS parameters included 25 Hz, the maximum tolerated current intensity (apparatus maximum load current ≤ 6 mA) and one 30‐min session per day for 2 weeks, for a total of 10 interventions.MeasurementsThe primary outcome was a neurocognitive assessment. Safety was the secondary outcome measure. After each treatment session, adverse reactions were assessed using the self‐administered Adverse Reaction Assessment Scale. Four subtests of the Cambridge Neuropsychological Test Automated Battery were further considered: reaction time (RTI), paired associate learning (PAL), multitasking test (MTT) and spatial working memory (SWM).ResultsThe time and interaction effects of between‐group search errors were statistically significant (F = 9.51, p < 0.001). Compared to the sham taVNS, taVNS improved SWM performance in older patients with schizophrenia. Furthermore, the SWM performance after a single session of taVNS showed fewer errors in the taVNS group, whereas no such improvement was observed in the sham taVNS group. Unlike in SWM, there were no significant between‐group differences in RTI, PAL or MTT after either a single stimulation or a session of 10 stimulations.ConclusionstaVNS may have the potential to improve SWM in older patients with schizophrenia.

Effect of transcutaneous electrical acupoint stimulation on postoperative cognitive function in older patients with lung cancer: A randomized, double-blind, placebo-controlled trial

Myocardial Infarction (MI) is an obstruction in the coronary arteries, resulting in restricted blood flow and oxygen supply to the heart, leading to damage to the heart's tissues. Beyond the cardiovascular system, the impact of MI extends to potentially affecting cognitive abilities, especially in elderly populations. To optimize patient recovery and long-term outcomes, timely cardiac interventions and subsequent rehabilitation programs are essential. This systematic review aims to assess the potential benefits of cardiac rehabilitation (CR) in enhancing cognitive function among elderly individuals who have experienced an MI. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and utilizes PubMed, PubMed Central, Cochrane, Google Scholar, and ScienceDirect databases. Studies included in the review encompass meta-analyses, controlled trials, systematic/narrative reviews, randomized/nonrandomized trials, observational studies, and research articles published within the past five years. Only accessible, full-text English-language studies meeting the inclusion criteria are selected, while books, documents over five years old, animal studies, and individuals under 65 are excluded. Following a predefined template, the initial search identifies 4,915 studies. From this pool, 27 free full-text articles are then selected for quality appraisal based on relevance. After performing a quality assessment on each survey, 12 high-quality studies are included in this systematic review. The research studies demonstrate notable cognitive improvements among elderly patients who have experienced an MI and participated in CR programs. Additional clinical trial studies are recommended to substantiate these findings further and advance our understanding.