Linguistic biomarkers for the detection of Mild Cognitive Impairment

Dementia is associated with sleep disorders. However, the relationship between dementia and sleep arousal remains unclear. This study explored the associations among sleep parameters, arousal responses, and risk of mild cognitive impairment (MCI). Participants with the chief complaints of memory problems and sleep disorders, from the sleep center database of Taipei Medical University Shuang-Ho Hospital, were screened, and the parameters related to the Cognitive Abilities Screening Instrument, Clinical Dementia Rating, and polysomnography were determined. All examinations were conducted within 6 months and without a particular order. The participants were divided into those without cognitive impairment (Clinical Dementia Rating = 0) and those with MCI (Clinical Dementia Rating = 0.5). Mean comparison, linear regression models, and logistic regression models were employed to investigate the associations among obtained variables. This study included 31 participants without MCI and 37 with MCI (17 with amnestic MCI, 20 with multidomain MCI). Patients with MCI had significantly higher mean values of the spontaneous arousal index and spontaneous arousal index in the non-rapid eye movement stage than those without MCI. An increased risk of MCI was significantly associated with increased spontaneous arousal index and spontaneous arousal index in the non-rapid eye movement stage with various adjustments. Significant associations between the Cognitive Abilities Screening Instrument scores and the oximetry parameters and sleep disorder indexes were observed. Repetitive respiratory events with hypoxia were associated with cognitive dysfunction. Spontaneous arousal, especially in non-rapid eye movement sleep, was related to the risk of MCI. However, additional longitudinal studies are required to confirm their causality. Tsai C-Y, Hsu W-H, Lin Y-T, etal. Associations among sleep-disordered breathing, arousal response, and risk of mild cognitive impairment in a northern Taiwan population. J Clin Sleep Med. 2022;18(4): 1003-1012.

A Clinical Approach to Mild Cognitive Impairment

Small but continuous progress in the research of preoperative and postoperative cognitive dysfunction

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.

Mild cognitive impairment and subjective cognitive impairment

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.

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify the effectiveness of combined cognitive and physical interventions on the risk of falls in cognitively impaired older adults. INCLUSION CRITERIA Types of participants Older persons who are 65 years or older will be included. Studies where the majority of participants have been indicated through mean ages and standard deviations will also be eligible for inclusion. Participants who have been diagnosed or identified as having a cognitive impairment will be included in this review. The participants will be characterized as having a cognitive impairment through: 1. Diagnosis of a dementia or cognitive impairment or other condition which directly results in reduced cognition. 2. Reduced Mini Mental State Examination or other such global assessment of cognition, e.g. through the Montreal Cognitive Assessment. Participants will not be limited by dementia diagnosis (i.e. Alzheimer's disease, vascular, mild cognitive impairment), but their cognitive impairment must be acquired and progressive in nature. Studies with a population of older adults with an increased risk of falls will be considered but will only be included if more than 75% of the total sample has reduced cognition identified in the criteria above. Types of intervention(s)/phenomena of interest This review will consider publications that describe multifactorial or multiple interventions where a physical and cognitive element has been noted by the authors or reviewers. It is the aim of this review to capture studies which have a combined physical and cognitive element in the intervention; however studies which TRUNCATED AT 250 WORDS

Objective To investigate the risk factors and clinical features of mild cognitive impairment （MCI） in patients with ischemic cerebral small vessel disease （SVD） for early diagnosis and prevention. Methods Montreal Cognitive Assessment Scale （MoCA） was used to screen MCI. The related risk factors and other clinical data were collected, and other neuropsychological tests were conducted. SVD was divided into leukoaralosis （LA）, lacunar infarction （LI）, and LA ＋ LI. Results A total of 143 patients with SVD were enrolled （68 in an MCI group, 75 in a non-MCI group）. Univariate analysis showed that there was no significant difference in the constituent ratio of age and gender between the MCI group and the non-MCI group, but the years of education in the MCI group was shorter than that in the non-MCI group, while the composition ratios of hypertension （69. 11% vs. 45. 33 % ;X2 = 8. 215, P = 0. 004）, diabetes （57. 35% vs. 40. 00% ; X2 = 4. 301, P = 0. 038 ）, hyperlipidemia （48. 53% vs. 24. 00% ; X2 = 9. 352, P = 0. 002 ）, carotid atherosclerosis （41.18% vs. 21.33% ;X2 =6. 592, P =0. 010）, and smoking （32. 35% vs. 14. 67% ;X2 =6. 285, P =0. 012）, as well as the levels of uric acid （351.81± 83.21 mmol/L vs. 323.03 ±80. 43 mmol/L; t = 2. 102, P = 0. 037） and total cholesterol （5.26± 1.26 mmol/L vs. 4. 56 ± 1.23 mmol/L; t = 3. 326, P = 0. 001） were significantly higher than those in the non-MCI group. Multivariate logistic regression analysis showed that hypertension （odds ratio OR] 2. 227, 95% confidence interval [ CI], 1. 001 -4. 954; P =0. 026）, diabetes （OR 2. 056, 95% CI 1. 862 -4. 937; P =0. 046）, hyperlipidemia （OR 2. 528, 95% CI 1. 361 - 5. 770; P =0. 028）, carotid atherosclerosis （OR 2. 658, 95% CI 1. 110 -6. 367; P =0. 029）, smoking （OR 2. 566, 95% CI 1. 017 - 6. 474; P = 0. 046）, and years of education （OR 0. 825, 95% CI 0. 745 - 0. 914; P = 0. 000） were the independent risk factors for the occurrence of MCI in patients with SVD. The subscores in the MCI group, includingMoCA total score （18.44 ± 5.60 vs. 27. 09 ±1.37; t= -12.422; P=0.000）, as well as visuoconstructional skills （2. 65 ± 1.39 vs. 4.49 ±0 . 74; t = - 9. 762; P = 0. 000）, attention （4.48 ± 1.70vs. 5. 89 ± 0. 31; t = 6. 706, P=0.000）,language （1.69 ± 0.80vs. 2. 41 ± 0. 95;t=4.893, P= 0.018）, abstraction （0.85 ± 0.69vs. 1.71 ± 0.53; t= -7.081, P=0.000）, delayed recall （1.29± 1.01 vs. 4. 04± 0. 99; t = 13. 824, P =0. 000） were significantly lower than those in the non-MCI group, and there were no significant differences in naming and orientation scores. In the MCI group, the subscores such as the MoCA total score in the LA＋ LI group （17.04 ±6. 15 vs. 21.04 ± 3.98; P〈 0.05）, as well as visuoconstructional skills （1.68 ± 1. 16 vs. 3.24 ± 1.13; P〈0. 05）, attention （3.92 ± 2. 03 vs. 5.19 ± 0. 87; P 〈0. 05）, delayed recall （1.35 ± 1.01 vs. 1.86 ±1.58; P 〈0. 05） were significantly lower than those in the LI group; the subscores such as the MoCA total score in the LA group （18. 18 ± 5.31 vs. 21.04 ± 3.98; 〈 =0.05）, as well as visuoconstructional skills （2.56 ±1.78 vs. 3.24 ±1.13; P〈0.05）, language （0.64 ± 0.23 vs. 1.24 ±0.83;P〈0.05）,delayedrecallO. 69 ± 0.58vs. 1.86 ±1.58;P〈0.01）were significantly lower than those in the LI group; the visuoconstmctional skills in the LA ＋ LI group was significantly lower than that in the LA group （1.68 ±1.16 vs. 2. 56 ± 1.78; P〈0. 05） and the LI group （1.68 ± 1.16 vs. 3.24± 1.13; P〈 0. 05）. Conclusions Hypertension, diabetes, hyperlipidemia, carotid atherosclerosis, smoking and the low level of education were the independent risk factors for MCI in patients with SVD. After SVD, the cognitive impairment in MCI presented as multiple cognitive domains impairments, including visuoconstructional skills and delayed recall. Cognitive impairment differed among the different types of SVD. Key words: Stroke; Brain Infarction; Cerebrovascular Disorders; Leukoaraiosis; Cognition Disorders; Neuropsychological Tests; Risk Factors

Age and asymmetry of corticospinal excitability, but not cardiorespiratory fitness, predict cognitive impairments in multiple sclerosis

Mild cognitive impairment (MCI) is a mild memory or cognitive impairment. To explore the relationship between serum klotho (K1) protein and insulin-like growth factor-1 and mild cognitive impairment in the elderly in order to provide accurate and appropriate indicators for clinical diagnosis and treatment of MCI. This randomized stratified study adopted a multistage cluster sampling method. 161 elderly patients with mild cognitive impairment were included as the MCI group, and 161 healthy people matched with the MCI group in gender, age and education were selected as the control group. The levels of serum K1 protein and insulin-like growth factor-1 in the MCI group were lower than those in the control group (P< 0.05). Both IGF-1 and K1 had predictive value for MCI (P< 0.05). The area under the curve (AUC) of IGF-1 for predicting MCI was 0.859 (95% CI: 0.790∼0.929), and the AUC of K1 for predicting MCI was 0.793 (95% CI: 0.694∼0.892). The value of joint prediction of the two indicators was the highest, with an AUC of 0.939 (95% CI: 0.896-0.993). High serum K1 and insulin-like growth factor-1 are the protective factors of cognitive impairment in MCI patients. Both IGF-1 and serum K1 proteins have predictive value for MCI, and the combination of the two indicators has the highest predictive value.

Neurocognitive Impairment and Dementia in Mood Disorders

Alzheimer's disease (AD) is the most common cause of dementias. Mild cognitive impairment (MCI) indicates the situation that a person has memory complaints and mild objective cognitive impairment but no evidence of dementia. Sleep disturbance, one of the behavioral and psychological symptoms of dementia (BPSD), frequently occurs in patients with AD or MCI. The alteration of sleep architectures in AD patients remains inconclusive. In this study, we conducted the polysomnography. (PSG) examination among patients with mild AD with cholinesterase inhibitors (N=10) or MCI (N=12) and age-matched nondemented controls (N=13). The results showed sleep efficiency, which was one of the important parameters for sleep quality was significantly lower in patients with MCI and AD (N=22), 79.14 +/- 11.06 % vs. 67.07 +/- 19.10 %, p=0.046. There were no statistic differences of sleep architecture but a trend of REM insufficiency in patients with MCI or AD. The mean scores of geriatric depression score (GDS) and Epworth sleepiness scale (ESS) did not differ among the three groups. Our study implicated maintenance of sleep was impaired in patients with cognitive impairment and it was independent with depressive symptoms.

Prevalent Depressive Symptoms as a Risk Factor for Conversion to Mild Cognitive Impairment in an Elderly Italian Cohort

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.

(Reprinted with permission from American Psychiatric Association, http://psychiatryonline.org/guidelines).