Evaluation of the cognitive-motor training effectiveness in combination with drug therapy among patients with moderate cognitive disorders: the own research results

Systemic immunological disorders are associated with various geriatric conditions, including cognitive dysfunction. However, in patients with diabetic retinopathy, the changes of blood interleukin profile were studied without considering the severity of cognitive impairment. The aim of this study was to analyze blood plasma levels and intercorrelations of interleukins in the patients with diabetic retinopathy accompanied by mild and moderate cognitive impairment. Fifty-four elderly patients with diabetic retinopathy and mild cognitive impairment, and 62 patients with diabetic retinopathy and moderate cognitive disorders underwent inpatient examination and treatment at the Tambov branch of the S. Fedorov Center of Eye Microsurgery over 2021-2022. The interleukins contents in blood plasma were studied by enzyme immunoassay using the Protein Contour kit, including IL-1α, IL-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-17, IL-18. The diagnostics of diabetic retinopathy was based on comprehensive ophthalmological examination, according to the Clinical recommendations of the Society of the Russian Association of Ophthalmologists «Diabetes mellitus: diabetic retinopathy, diabetic macular edema». Cognitive functions were assessed according to a valid Mini- Mental-State-Examination scale. It has been shown that the patients with diabetic retinopathy and moderate cognitive impairment have a significantly increased level of all the studied proinflammatory interleukins, as compared to similar cohort with diabetic retinopathy accompanied by a mild cognitive impairment. In mild cognitive disorders, the content of IL-6 in blood plasma was higher (24.4±2.1 pg/mL versus 5.1±0.8 pg/mL, p < 0.001). Development of moderate cognitive impairment in the patients with diabetic retinopathy was also accompanied by a statistically significant increase of plasma IL-8 to 36.7±3.5 pg/mL versus 10.5±2.3 pg/mL with mild cognitive impairment; IL-17, to 21.9±1.8 pg/mL versus 8.5±1.1 pg/mL, respectively. Concentrations of anti-inflammatory interleukins in blood plasma of the patients with diabetic retinopathy and moderate cognitive dysfunction were significantly decreased, i.e., IL-4 to 2.1±0.3 pg/mL versus 3.4±0.5 pg/mL in cases of mild mental deterioration; IL-10, to 8.7±0.5 pg/mL versus 15.4±1.3 pg/mL, respectively. A sufficient correlation was shown between the levels of systemic interleukins and moderate cognitive disorders in the patients with diabetic retinopathy. For the proinflammatory interleukins in cases of moderate cognitive impairment, an inverse correlations with IL-1β (r = -0.336; p = 0.021), IL-6 (r = -0.584; p = 0.019), IL-8 (r = -0.469; p = 0.006), and with IL-17 (r = -0.348; p = 0.018) were shown. The content of IL-4 and IL-10 in blood plasma of the patients with diabetic retinopathy correlated with moderate cognitive impairment at a significant level of r = +0,407 (p = 0.016) and r = +0.359 (p = 0.008), respectively. In mild cognitive impairment, the correlations with fewer numbers of interleukins were revealed, i.e., IL-1β, IL-6, IL-8 and IL-10, and exhibit weaker connections, except of IL-6 (a moderate connection level). Development of moderate cognitive impairment among the patients with diabetic retinopathy may be caused by increase in IL-1β, IL-6, IL-8, IL-17, and a decrease in IL-10.

Introduction Cognitive impairment is a common and serious comorbidity in patients with heart failure (HF) and its prevalence follows the severity of the condition. Preventing deterioration in patients with heart failure is key to improve outcomes. Cognitive impairment might be correlated to physical function. Purpose To assess cognitive impairment in patients with HF and exploring its potential association with physical function. Methods Data was collected in 246 patients with HF (mean age 68±10, 28% female). Cognition was measured with the Montreal Cognitive Assessment (MoCA). Physical function was measured with an activity monitor – Actigraph (minutes/day spent in sedentary time, light physical activity and moderate to vigorous physical activity (MVPA) as well as steps daily), exercise capacity (6-minute walk test), self-selected walking speed (gait speed for 10 meters in seconds) and the dynamic balance/mobility (Sit-to-stand test: number in 30 seconds). Difference in physical function between patients who have mild to moderate cognitive impairment (MoCA cut off value 26) were compared to patients who had no to light cognitive impairment (MoCA Cut off value ³27) with Mann-Whitney U tests. Results A total of 246 patients with HF were evaluated, 171 patients (70%) had mild cognitive impairment and 3 patients (1%) had moderate cognitive impairment. Patients with mild or moderate cognitive impairment, were older (mean 69 vs. 63 years old, p-value<.001) and with diverse comorbidities, as they suffered more often from COPD (18% vs 7%, p-value=0.015) and stroke (15% vs. 6%, p-value 0.028) compared to patients with no to light cognitive impairment. Patients with mild or moderate cognitive impairment spent more time sedentary (median 562 vs. 530 min/day, p-value=0.029), less time in MVPA (median 10 vs. 21 min/day, p-value=0.003) compared to patients with no to light cognitive impairment and walked less steps a day (median 3884 vs. 5206, p-value=0.002). No differences were found in spent time in light physical activity (206 vs 226 min/day p-value=0.65). Patients with mild or moderate cognitive impairment walked a lower number of meters on the 6MWT (median 438 vs. 528 meters, p-value=<.001), were slower on gait speed (median 6 vs. 5 seconds, p-value<.001) and on the sit-to-stand test (median 11 vs. 9 times, p-value<.001) compared to patients with no to light cognitive impairment. Conclusion 71% of patients with heart failure had mild or moderate cognitive impairment, which was negative associated with physical function. Screening for cognitive impairment together with physical function may decrease adverse events by identifying those who need tailored care.

Background A correlation between social isolation and poorer cognitive function in later life has been increasingly implied in literature. Research indicates that maintaining a socially active lifestyle can enhance cognitive reserve and benefit cognitive function. Whereas social exclusion has been significantly associated with higher risks of cognitive impairment (Evans, et al., 2019). Recent studies reviewed the consequences of restrictive living conditions during COVID-19, finding poorer cognitive performance (Ingram, et al., 2021). However, few services have investigated this. This study intended to explore the impact of social isolation on cognitive function of hospitalised older adults. Methods Quantitative measures were used. A retrospective review of cognitive results of individuals open to occupational therapy in an acute Care of the Older Person’s service in May 2018 (n = 23) were compared to cognitive results of individuals open to occupational therapy in the same acute Care of the Older Person’s service in May 2021 (n = 62). Results For the purpose of this study, cognitive results were compared by means of assessment results which indicated a mild, moderate or significant cognitive impairment. Of the patients seen in May 2021 (n = 62), 9.68% (n = 6) had a mild cognitive impairment, 25.81% (n = 16) had a moderate cognitive impairment and 32.26% (n = 20) presented with a significant cognitive impairment. Comparatively in May 2018 (n = 23), 30.43% (n = 7) had a mild cognitive impairment, 43.38% (n = 10) had a moderate cognitive impairment and just 4.35% (n = 1) presented with a significant cognitive impairment. Conclusion A substantial increase in the number of inpatients presenting with a significant cognitive impairment in an acute Care of the Older Person’s service was found between May 2018 (4.35%) and May 2021 (32.26%). This suggests that COVID-19 had a severe impact on cognitive functioning of older adults and implies that this cohort are at a high risk of cognitive decline caused by social isolation. These findings are preliminary and further research is recommended.

Introduction and Aim: Changes in nutritional status play an important role in progress of cognitive decline among the elderly. This study aimed to assess the nutritional status and cognitive function among the elderly population and factors associated with them. Materials and Methods: This cross-sectional study was conducted in a rural community among 270 elderly individuals. Data was collected using the Mini Nutritional Assessment Tool (MNA) and Mini Mental State Examination (MMSE) Tool to assess the nutritional, status and cognitive functioning. Data was analysed using Chi square test and Pearson correlation coefficient test. Results: As per MNA scale, 63.3% of the participants are at risk of malnutrition and 8.9% are malnourished. Assessment by MMSE scale reported 25.6% having mild cognitive impairment and 11.1% having moderate cognitive impairment. Statistically significant difference was seen between age groups, presence of co-morbidity and categories of MNA tool. Almost two thirds of the participants belonging to mild cognitive impairment category were in the age group of 60-69 years and this difference was statistically significant. Moderate positive co-relation between mini nutritional assessment scores and mini mental state examination scores was reported and this was found to be statistically significant. Conclusion: The study results report more than two thirds of the participants were at risk of malnutrition and were malnourished. Almost 40% of them had mild and moderate cognitive function impairment. The study has implications at policy level highlighting the need for comprehensive assessment and care and its integration into primary health care. Keywords: Nutritional status; cognition; aged.

Caregiver (CG)'s depression is common and its prevalence is rising. The relationship of CG depression with care recipients (CR)'s subsequent cognitive impairment remains unclear. This study examines the association of CG depressive symptoms trajectories with 6-year cognitive impairment risk among care recipients (CR) who are older adults with functional limitations. Retrospective analysis of prospectively collected data cohorts from 2010 to 2016. The sample included 810 community-dwelling older adults aged ≥75years, dementia free at baseline, with their primary caregiver dyads. CG's depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. The main outcomes were incident mild, moderate, and severe cognitive impairment of CRs measured using Short Portable Mental Status Questionnaire. Group-based trajectory modeling identified three CG depressive symptom trajectory groups. Competing risks regression analysis modeled the hazards as a function of CG depressive symptom trajectories. Of 810 CRs, 3% developed severe cognitive impairment, 21% had moderate cognitive impairment, and 37% had mild cognitive impairment. Only CG's "Increasing" trajectory group predicted increased risk of CR's mild and moderate cognitive impairment relative to "persistently low" group (subhazard ratio [SHR]=1.52, 95% confidence interval [CI], p<0.05; SHR=1.87, 95% CI, p<0.05, respectively). Finding highlight the intricate and non-linear association between CG depressive trajectory and CR cognitive impairment. This evidence can be used to enlighten policymakers and health providers about the need for risk stratification screening for CG mental health and early treatment for CG depression to prevent or delay CR's cognitive impairment.

Comparison of the Brief Interview for Mental Status (BIMS) and Montreal Cognitive Assessment (MoCA) for identifying cognitive impairments and predicting rehabilitation outcomes in an inpatient rehabilitation facility.

As the growth of the population aged 65 and older is projected to be one of the most substantial demographic trends in history, geriatricians and other professionals working with older adults will be regularly consulted for opinion regarding an individual’s testamentary capacity (Brenkel et al., 2018). For individuals with severe cognitive and psychiatric impairment, the reduced capacity to make decision is evident. However, testamentary capacity among individuals with mild or moderate cognitive impairment has been mixed: some patients with mild cognitive impairment may be incapable of will making, while other patients with moderate cognitive impairment may have testamentary capacity (Spar & Garb, 1992). While several measures of testamentary capacity have been developed, these instruments are either not available for clinicians or lacks the sophistication of a comprehensive assessment (Marson, Huthwaite, & Herbert, 2004; Papageorgiou et al., 2018). With increasingly complex modern family structures (e.g., multiple marriages and stepchildren from these relationships), together with a projected largest transfer of wealth in human history about to occur in the next 30 years (Havens and Schervish, 2003), more standardized assessment procedures for testamentary capacity will be valuable for clinicians working with geriatric populations. In this study, healthy community-dwelling older adults and patients with Major Neurocognitive Disorder due to Alzheimer’s disease were recruited to participate in a validation study of a proposed testamentary capacity measure. Preliminary findings and implications are discussed.

Objective: Dementia and cognitive impairment (CI) are common in Parkinson's disease (PD) and have important clinical consequences. We explored the prognostic factors for CI in patients with PD. Methods: A total of 102 patients with PD in Xuan wu hospital and Qian dongnan People's Hospital from 2005 to 2010 were included in this study. All patients underwent clinical and neurological assessments. Relevant demographic and performance parameters were analysed to determine variables that may be independently associated with the progression of CI. Results: In the 6-month follow-up group, CI progressed in three out of 58 cases (5%): two cases progressed from mild CI (MiCI) to moderate CI (MoCI), and one case from MoCI to dementia. In the six-month-to-two-year follow-up group, seven out of 46 cases (15%) worsened: one case developed MiCI, three cases progressed from MiCI to MoCI and three other cases from MoCI to dementia. In the two-to-five-year group, 20 out of 44 cases (45%) worsened with one case developing MiCI, 14 cases progressing from MiCi to MoCI and five cases from MoCI to dementia. Compared with other patients, those with worsening of CI symptoms were significantly older in the two-to-five-year group. Progression of CI was also associated with age at onset and initial staging of PD. Conclusions: Advanced age, late onset of disease and severity of PD are the predictive factors for the progression of CI in PD. The highest probability of progression of CI is in patients with initial severe impairments of visuospatial function.

Introduction: Recently, the concept of vascular cognitive impairment, combining all variants of cognitive decline due to cerebrovascular insufficiency, is actively being developed. This concept goes far beyond traditionally existing ideas about the problem of vascular cognitive disturbances. The aim of the study is to demonstrate the correlation between the indices of structural and functional rearrangement of the cardiovascular system and the state of intellectualmnemonic functions in patients with hypertension. Materials and methods: A comprehensive survey of 146 patients with hypertension of the II and III stage according to ESH / ESC 2013, 2017, 2018 has been performed. The study included patients with mild and moderate cognitive impairment (CI). Depending on the state of the cognitive sphere and on the basis of the results of the neuronpsychological testing, The patients were divided into 3 groups depending on the state of the cognitive sphere and on the basis of the results of the neuron-psychological testing with further comparisons of their clinical and instrumental data. Results: According to the results of our study, it has been found that an increase of the signs of cardiovascular remodeling was observed in patients with more pronounced changes in cognitive activity. The analysis of intracardiac hemodynamic parameters in patients of the studied groups revealed more significant pathological changes in patients with cognitive impairments than in patients without them. Patients with mild and moderate CI had significantly higher heart rates, left ventricular wall thickness (LV) which led to impairment of the diastolic function of LV and had already been registered in patients without cognitive dysfunction. Moreover, it increased with the appearance (mild) and growth of the degree (moderate) cognitive impairment. The average daily values of BP (SBP, DBP) in patients of all studied groups significantly exceeded the recommended norms, while in patients with moderate CI these rates were significantly higher than those in the group with mild CI (p = 0.028). In addition, the variability of systolic blood pressure was increasing simultaneously with the deterioration of cognitive function of our patients. Also, signs of remodeling were being observed during the study of the state of peripheral vessels (increase of peripheral resistance, pulsation index, linear velocity and thickening of the intima-media complex), which is the main cause of cognitive impairment and causes their appearance and reflects their degree. Conclusions: The presented study revealed a clear correlation between the degree of cognitive impairment and the degree of changes in the daily blood pressure profile, the most important of which were the average daily systolic blood pressure and systolic blood pressure variability. On the basis of the conducted research, in the future it will be possible to predict the level of the cognitive sphere involvement, depending on the state of the daily blood pressure profile, changes of the ventricle and vessels geometry, which will enable timely diagnosis of cognitive impairment and the prescription an adequate therapy.

Study Shows Association Between Pain and Depression in Dementia

The aim of this study was to evaluate the recovery of functional status and effectiveness of the second-stage rehabilitation depending on the degree of cognitive impairment in stroke patients. The study sample comprised 226 stroke patients at the Viršužiglis Hospital of rehabilitation, Hospital of Lithuanian University of Health Sciences. Functional status was evaluated with the Functional Independence Measure, cognitive function with the Mini-Mental Status Examination scale, and severity of neurologic condition with the National Institutes of Health Stroke Scale. The patients were divided into 4 study groups based on cognitive impairment: severe, moderate, mild, or no impairment. More than half (53%) of all cases were found to have cognitive impairment, while patients with different degree of cognitive impairment were equally distributed: mild impairment (18%), moderate impairment (17%), and severe impairment (18%). Improvement of functional status was observed in all study groups (P<0.001). In the patients with moderate and severe cognitive impairment, cognitive recovery was significantly more expressed than in other study groups (P<0.001). Insufficient recovery of functional status was significantly associated with hemiplegia (OR, 11.15; P=0.015), urinary incontinence (OR, 14.91; P<0.001), joint diseases (OR, 5.52; P=0.022), heart diseases (OR, 4.10; P=0.041), and severe cognitive impairment (OR, 15.18; P<0.001), while moderate and mild cognitive impairment was not associated with the recovery of functional status. During the second-stage rehabilitation of stroke patients, functional status as well as cognitive and motor skills were improved both in patients with and without cognitive impairment; however, the patients who were diagnosed with severe or moderate cognitive impairment at the beginning of second-stage rehabilitation showed worse neurological and functional status during the whole second-stage rehabilitation than the patients with mild or no cognitive impairment.

In the field of modern medicine, there is a significant focus on addressing cognitive impairments due to their widespread prevalence and substantial impact on patients' quality of life. The human brain's cognitive functions are closely tied to a wide range of structural and functional characteristics of individual brain regions, as well as the specific interactions between these regions. When individuals engage in cognitive activities, such as solving complex tasks, the efficiency of processing and transmitting information between different brain areas becomes a key consideration. Each of these brain regions is meticulously designed to assess various neuropsychological functions, including memory, language, executive function, abstract thinking, attention, and visuospatial abilities. Recently, healthcare professionals and researchers have been increasingly focusing on pre-dementia (mild and moderate) cognitive impairments. The spectrum of cognitive impairments in the elderly is broad, encompassing not only dementia and Alzheimer's disease but also less severe, moderate cognitive impairments. Assessment tools vary, ranging from those designed to evaluate a single neuropsychological domain to comprehensive neuropsychological testing, which evaluates all neuropsychological domains. This review provides an analysis of the most common modern methods, including classical neuropsychological tests and the use of eye-tracking technology, which offers quantitative assessment and sensitive detection of cognitive impairments in conditions such as dementia, concussion, traumatic brain injuries, autism spectrum disorders, and attention deficit hyperactivity disorder, among others. The review also discusses the advantages and limitations of these methodologies, highlighting the necessity of a comprehensive approach to assessing cognitive functions. This comprehensive approach is crucial for diagnosing both severe and mild cognitive impairments, evaluating brain damage, determining decision-making capacity, and testing for intellectual disabilities. Keywords: psychophysiological tests, brain, cognitive disorders, screening test, dementia.

a non-randomized controlled trial study was conducted. We included 40 patients with cognitive impairment from a nursing home who were categorized into mild and moderate cognitive impairment and divided separately into a control and experimental group. Experimental group performed a 4-week group work, in which each patient with mild cognitive impairment was paired with a patient with moderate cognitive impairment. Thus, patients with mild cognitive impairment observed a series of functional exercises performed by their peers and replicated them. Simultaneously, the patients with moderate cognitive impairment replicated the movement after observing it performed by a patient with mild cognitive impairment. The control group continued to receive their usual care at the center. The upper limb function, cognitive level and function in basic activities of human daily life were measured before and after the intervention and compared with the control group. statistically significant differences were found in the functionality of basic activities of daily living, in the functionality of the upper limb and in the cognitive level in all patients in the experimental group regardless of the initial cognitive level. No statistically significant differences were found in the control group. the implementation of a group, peer-based, action-observation learning therapeutic program is effective in improving the basic activities of human daily life, cognitive level and upper limb functionality in patients with mild and moderate dementia.

In recent years, there has been an increased number of cases of obesity, type 2 diabetes mellitus, and cardiovascular diseases, which are components of the metabolic syndrome (MS), worldwide. Mortality rates from cardiovascular complications in people with MS remain high. The objective: to determine the degree of cognitive impairment in military personnel with obstructive sleep apnea syndrome (OSAS) during combat operations. Materials and methods. To achieve the set goal, 32 military personnel with signs of MS and OSAS, who were undergoing treatment at the National Military Medical Center “Main Military Clinical Hospital”, were examined and formed the main group. The comparison group included 43 patients with signs of MS, but without OSAS. All examined patients were male, and the average age was 45.2 ± 2.1 years. All patients signed an informed consent to participate in the study. The office blood pressure level was determined, daily blood pressure monitoring, echocardiography, and lipid and carbohydrate metabolism indices were studied. Polysomnography was recorded using a dual-channel portable monitor (SOMNOcheck micro, Weinmann, Germany). Obstructive apnea was defined as cessation of airflow with preservation of thoraco-abdominal movements. The degree of cognitive impairment was assessed using the Mini Mental State Examination. The sum of the test scores (orientation in time, place, state of short-term, long-term memory, language function, gnosis, praxis) was the total MMSE score, in which the maximum score 29–30 points – is the absence of cognitive impairment, 27–28 points – mild, 24–26 points – moderate cognitive impairment, 20–23 points – the initial stage of dementia, &lt; 20 – more pronounced stages of dementia. The 10-word memorization technique was also used, which allowed to assess the memory (memorization, preservation and reproduction of information). Schulte tables were used to assess the rate of sensorimotor reactions, mental performance, and the volume of active attention of patients. Results. The clinical characteristics of both groups of patients revealed a high percentage of patients with obesity and overweight. However, in the main group, the percentage of patients with obesity of grade 3 was significantly higher, and in the comparison group – with obesity of grade 1 and overweight. Also, in the main group, significantly more patients with type 2 diabetes were found. It is noteworthy that the rapid weight gain in the servicemen of the main group occurred after injury, due to changes in service conditions and decreased physical activity. In the comparison group, 39.5% of patients did not have cognitive impairments, 53.5% of persons had mild impairments, and 6.9% – moderate impairments. At the same time, in the main group of patients, mild cognitive impairments were detected in 43.8% (p &lt; 0.05), moderate ones – in 53.1% (p &lt; 0.05), and mild dementia in 3.1%. Patients in the main group needed significantly more time to complete tasks according to the Schulte tables. The average testing time in the main group was 55.8 ± 6.7 s, and in the comparison group – 39.6 ± 4.7 s. Patients in the main group complained of inability to concentrate, focus, and rapid fatigue. Conclusions. OSAS is a common comorbid pathology in military personnel with MS and a potentially dangerous factor for life and effective performance of official duties. OSAS in military personnel is manifested by mild and moderate cognitive impairment, which require correction to restore the quality of life of patients.

Objective: to analyze electroencephalographic parameters in patients with hypertension and cognitive complaints receiving standard antihypertensive therapy, without concomitant cardiovas-cular disease, for the purpose of early diagnosis of brain damage as the main target organ in hy-pertension. Materials and methods: 135 people were examined (95 people with arterial hyperten-sion and 43 potentially healthy). The average age of patients is 63±8.2 years. As a result of the diagnosis, patients were distributed as follows: no cognitive impairment-82 people (60.7 %), mild cognitive impairment – 32 people (23.7 %), moderate cognitive impairment – 21 people (15.6 %). The studies were carried out on the apparatus "Encephalan-EEGR-19/26". Results: after the treatment, the majority of patients had a reduction of pre-reported complaints, an increase on the "Montreal scale" from 1 to 2 points, a decrease in anxiety and depression on the "Hospital scale", an increase in indices on SF-36. According to EEG data, there was an increase in the frequency of the main alpha rhythm and the total bioelectric power of the rhythm, the appearance of a pro-nounced spectral peak in the alpha range, a decrease in the power of the slow-wave rhythm in the anterior parts, which also indicates a positive dynamics that correlates with clinical data and test data. Conclusions: the study established the diagnostic value of quantitative processing of elec-troencephalogram (the frequency of the main rhythm, the power of the theta and Delta rhythms in the anterior parts, the total power of the b. e. a.), which suggest the need for additional therapy to standard antihypertensive treatment.