Nutrition Effects on Brain Outcomes and Recovery in Stroke after Hospitalization (NOURISH): Randomized controlled trial protocol and rationale.

Introduction Early detection of cognitive impairment in older adults is important for the prevention of dementia. Intra-individual variability in reaction time (IIV-RT) during go/no-go tasks can be used for the early detection of cognitive impairment in older adults living in the community. This study aimed to determine the relationship between IIV-RT and cognitive function during go/no-go tasks and the cutoff values for determining the risk of cognitive impairment in community-dwelling older adults. Methods This study included 31 older adults without cognitive impairment, 15 community-dwelling older adults with cognitive impairment, and 34 healthy young adults. All participants performed a go/no-go task to assess the IIV-RT. Additionally, older adults underwent neuropsychological testing. Based on the results of the Japanese version of the Montreal Test of Cognitive Abilities (MoCA-J), older adults were divided into those with normal cognition and those with cognitive impairment. Results There were significant differences in the IIV-RT among groups, including a higher IIV in the cognitively impaired group than in young adults and cognitively normal older adults. Moreover, the IIV-RT was correlated with the MoCA-J (r = −0.531, p < 0.001), Trail Making Test Part A (r = 0.571, p < 0.001), and Verbal Fluency Test scores (r = −0.442, p = 0.002). Receiver operating curve analysis showed that the area under the curve for IIV-RT was 0.935, and the cutoff value at which the IIV-RT identified cognitive impairment was 25.37%. Conclusions These findings indicate that the IIV-RT during go/no-go tasks is a useful early indicator of cognitive impairment in community-dwelling older adults.

Association of the combination of social isolation and living alone with cognitive impairment in community-dwelling older adults: The IRIDE Cohort Study

Background: Previous studies have confirmed that both healthy diets and physical exercise have preventive effects with respect to cognitive decline with aging. The aim of this study was to investigate whether the associations of physical exercise with cognitive impairment differ in community-dwelling older adults with different dietary habits. Methods: In the 2008/2009 wave of the Chinese Longitudinal Healthy Longevity Survey, 14,966 community-dwelling older adults (≥65 years) were included for analyses. Dietary habits (including daily intake of fruits, vegetables, tea, meat, fish, eggs, food made from beans, salt-preserved vegetables, sugar, garlic, milk products, nut products, mushroom or algae, vitamins and medicinal plants) and physical exercise were assessed. Cognitive impairment was evaluated using the Chinese version of the MMSE in the 2008/2009 and 2011/2012 waves. The effect modifications of physical exercise on cognitive impairment by dietary habits were estimated using logistic regression models. Results: Older adults who practiced physical exercise exhibited a trend of decreased probability of cognitive impairment at baseline and follow-up (OR = 0.92, 95% CI = 0.80–1.06, p = 0.273; OR = 0.83, 95% CI = 0.65–1.05, p = 0.123, respectively) compared with those who did not practice physical exercise. When stratified by dietary habits, physical exercise had a protective effect with respect to prevalent cognitive impairment in older adults who ate fruits (OR = 0.74, 95% CI = 0.58–0.94, p = 0.016), ate food made from beans (OR = 0.76, 95% CI = 0.62–0.93, p = 0.007), did not eat sugar (OR = 0.81, 95% CI = 0.68–0.98, p = 0.028) and ate milk products (OR = 0.75, 95% CI = 0.57–0.97, p = 0.030); in the longitudinal analyses, physical exercise had a protective effect with respect to incident cognitive impairment in older adults who ate fruits (OR = 0.63, 95% CI = 0.41–0.98, p = 0.040) and milk products (OR = 0.57, 95% CI = 0.35–0.94, p = 0.027). Fruits, food made from beans and milk products modified the associations of physical exercise with prevalent cognitive impairment (p values for interaction = 0.008, 0.005 and 0.082, respectively). Conclusions: The associations of physical exercise with cognitive impairment could be modified by certain dietary habits. Physical exercise was not found to be significantly protective with respect to cognitive impairment in older adults unless they had specific dietary habits. Thus, dietary habits should be emphasized when investigating the beneficial effects of physical exercise on cognitive function in community-dwelling older adults.

Background Cognitive impairment and dementia are estimated to affect 1 in 5 adults over 80 years (TILDA 2023) which impacts on participation in complex activities eg. Drving, managing finances, complex decision making. The importance of addressing these issues is to the fore with the enactment of the Assisted Decision Making Act. This review aims to provide local context to design and implementation of assessment and intervention processes for Subjective Cognitive Impairment (SCI), Mild Cognitive Impairment (MCI) and dementia in older adults attending the Integrated Day Hospital (IDH). Methods A retrospective analysis of health care records was undertaken on patients attending the IDH from January to May 2023. Inclusion criteria were adults over 70 years, recent history of falls or deterioration in functional or cognitive status. Evidence regarding SCI was gathered via patients’ response to specific question on comprehensive geriatric assessment. Evidence of MCI and dementia was gathered via cognitive screening scores. Results Preliminary results indicate a cohort of 150 patients. Preliminary analysis of cognitive screening scores reflect prevalence of MCI at 16% and dementia at 36% of older adults attending the IDH. Family-carer reported impairment is more likely to correlate to an impaired range score on testing, in comparison with self-reported impairment. 50% of older adults report SCI, with 70% of family carers reporting SCI in the same cohort. There is a prevalence of cognitive impairment in older adults presenting for falls and frailty. Final findings will be available for the purpose of this poster presentation. Conclusion Cognitive impairment in older adults is evidenced across a range of presentations including falls and frailty. This review highlights the need to explore the holistic needs of older adults to identify presence of SCI, MCI and dementia. Subsequently there is a need to provide person centred, co-ordinated and integrated interventions tailored to the needs of the older adults.

To explore cancer-related cognitive impairment (CRCI) in older adults with acute myeloid leukemia (AML) receiving venetoclax in combination with hypomethylating agents or low-dose cytarabine chemotherapy. This study is a longitudinal, qualitative descriptive study. Participants were recruited using purposive sampling. Semi-structured interviews were conducted among 11 older adults with AML at cycle 2, cycle 4, and cycle 7 of chemotherapy. An early end-of-study interview was conducted for those who changed treatment plans during the study follow-up. A total of 22 transcripts were included for thematic analysis. Four themes emerged: (1) CRCI experiences, (2) impact of CRCI, (3) CRCI coping strategies, and (4) perceived CRCI-related factors. Older adults with AML experienced challenges in memory, language, and attention both intermittently and daily. These cognitive changes impacted their emotion, daily activities, social connection, and their caregivers' responsibilities. Hence, these older adults with AML developed problem-solving and emotional coping strategies to cope with CRCI. Older adults with AML also identified demographic, physiology/clinical, psychological, and other factors that might contribute to CRCI. This study offers important insight for clinicians to understand how older adults with AML experience CRCI and how it impacts their daily routines. It indicates that clinicians should ask patients about their experience with cognitive changes at each encounter to provide support or coping strategies as needed to prevent CRCI from further hindering their quality of life.

Characteristic of process analysis on instrumental activities of daily living according to the severity of cognitive impairment in community-dwelling older adults with Alzheimer's disease.

The independent effect of physical work on the risk of cognitive impairment in older Chinese older adults living in rural areas remains to be elucidated. We aimed to determine whether physical work and physical exercise can reduce the risk of cognitive impairment. We collected data from 7,000 permanent residents without cognitive impairment (age ≥60 years) over a follow-up period of 2 years. We used the Chinese version of the Mini-Mental State Examination (MMSE) to assess cognitive function. We performed multivariate Cox regression analyses to calculate adjusted Hazard Ratios (HRs) and 95% Confidence Intervals (%95 CIs) as measures of the association between physical work/exercise and cognitive impairment while controlling for potential confounders. Over a median follow-up period of 1.93 years, 1,224 (17.5%) of 7,000 participants developed cognitive impairment, with a total incidence of 97.69 per 1,000 person-years. After adjustment for potential confounders, participating in physical work (HR: 0.51; 95% CI: 0.43-0.60) or physical exercise (HR: 0.53; 95% CI: 0.44-0.65) was associated with a reduced risk of cognitive impairment. Stratified analyses suggested additive and multiplicative interactions between physical work and exercise. Agricultural work (HR: 0.46; 95% CI: 0.38-0.55), walking/tai chi (HR: 0.54; 95% CI: 0.44-0.67), and brisk walking/yangko (HR: 0.57; 95% CI: 0.33-0.97) exerted significant protective effects against cognitive impairment. Both physical work and exercise can reduce the risk of cognitive impairment in older adults. Reasonable types and appropriate intensities of physical activity are recommended to prevent or delay the progression of cognitive impairment.

Few studies have examined the variety in fruit and vegetable (FV) intake with cognitive impairment in older adults. This study examined the associations of variety in fruit, vegetable and combined FV with 4-year incident cognitive impairment in Chinese community-dwelling older adults. Data was derived from a cohort study among Chinese community-dwelling older adults aged ≥ 65years in Hong Kong. At baseline, a validated food frequency questionnaire was used to assess variety in fruit, vegetable and combined FV. Cognitive impairment was defined as a Community Screening Instrument of Dementia score of < 29.5 points and/or Mini-Mental State Examination score of < 27 points. Adjusted multiple logistic regression was performed to examine the associations. Results are presented as odds ratio (OR) and 95% confidence interval (CI). Of the 1518 participants [median age: 70years (IQR 68-74), 32.7% women] included at baseline, 300 men and 111 women were newly identified as cognitively impaired at the 4-year follow-up. In men, higher variety in vegetable (adjusted OR: 0.97, 95% CI 0.95-0.99, p = 0.029) and combined FV (adjusted OR: 0.98, 95% CI 0.96-0.98, p = 0.039) were significantly associated with a lower risk of cognitive impairment. Fruit variety was not associated with cognitive impairment. In women, there were no associations between variety in fruit, vegetable and combined FV with cognitive impairment in the adjusted model. Independent of FV quantity, higher variety in vegetable and combined FV were associated with lower risk of cognitive impairment in Chinese community-dwelling older adults, and these associations were only observed in men.

Studies have shown that both inter-arm blood pressure difference (IABPD) and cognitive impairment are associated with vascular events. However, the relationship between IABPD and cognitive impairment among elderly individuals in rural China remains unclear. This study aims to investigate the association between IABPD and cognitive impairment in rural older adults in Guizhou, southwestern China. The study data were obtained from the Cohort Study of the Health Status of Guizhou Rural Older Adults in China (SHGROC). A multi-stage cluster sampling method was employed to select 1,088 rural elderly individuals aged ≥ 60 years from Guizhou Province for questionnaire surveys, physical examinations, and biological sample collection. Cognitive function of participants was assessed using the Mini-Mental State Examination (MMSE). Bilateral blood pressure was measured simultaneously using an automated device, and the IABPD was calculated. Multivariable linear and logistic regression models were used to examine the relationship between IABPD and cognitive impairment. The overall prevalence of cognitive impairment in the study sample was 27.85%, and it was more common among participants with an IABPD ≥ 10 mmHg (P < 0.05). Multivariable regression analysis revealed that an inter-arm systolic blood pressure difference (IASBPD) ≥ 10 mmHg was independently associated with lower MMSE scores (β = -1.113; 95% CI: -2.120, -0.106; P = 0.030) and a higher risk of cognitive impairment (OR = 1.902; 95% CI: 1.189, 3.040; P = 0.007). Additionally, a dose-response relationship was observed between IASBPD and the risk of cognitive impairment, with a linear positive correlation. Further subgroup analysis indicated that the relationship between IASBPD and cognitive impairment was modified by sex, smoking, and regular exercise (P for interaction < 0.05). IASBPD ≥ 10 mmHg is associated with an increased risk of cognitive impairment in rural Chinese older adults. This suggested that IASBPD may provide a reference for early identification of individuals at risk of cognitive impairment.

Association of passive smoking with cognitive impairment in older adults is unclear. We carried out a systematic literature review and a new study to determine the association. There were 3 cross-sectional studies published, showing a significant association of passive smoking with cognitive impairment (a relative risk (RR) of about 1.30-1.90). In the new cohort study, we interviewed 1081 never-smoking participants aged ≥ 65 years in China using a standard method of the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy and found a significant association with dose response; multivariate adjusted RR was 1.02 (95% confidence interval 0.67-1.55) in > 0 to 49 exposure level years of passive smoking, 1.57 (1.00-2.47) in 50 to 99, and 2.12 (1.24-3.63) in ≥ 100, trend P = .008. The relationship seems not to be a reverse causality of the effect. Passive smoking could be considered an important risk factor for cognitive impairment in older adults. Avoiding exposure to passive smoking would help to preserve cognitive decline in later life.

Introduction: Cognitive impairment among older adults is a significant public health concern worldwide. This study aimed to investigate the prevalence of cognitive impairment, its correlates, and the mediating role of depressive symptoms between frailty and cognitive impairment among older adults in northeast region of China. Methods: This was a cross-sectional study which used the intercept interview method to recruit participants. Social demographic characteristic, health-related behaviours, physical health, and functional status of the participants were collected. Univariate and multivariate analyses were conducted to correlates of cognitive impairment. Additionally, mediating effect analysis was performed using the Bootstrap tool. Results: Among the 2,859 older adults included in the study, 32.4% of participants screened positive for cognitive impairment. Higher educational attainment had negative association with cognitive impairment in older adults (p < 0.05). Living in rural areas, fair/poor self-rated health, pre-frailty, frailty, having depressive symptoms, impaired activities of daily living, poor sleep quality, and inactive physical activity had positive association with cognitive impairment in older adults (p < 0.05). Furthermore, depressive symptoms exhibited a partial mediating role between frailty and cognitive impairment, with a mediating effect of 58.0%. Conclusions: Preventive measures should be implemented to address the associated factors with cognitive impairment. Promoting higher education levels, advocating for a positive and healthy lifestyle, and ensuring their physical and mental well-being among older adults are essential. Early diagnosis and proactive prevention of frailty and depressive symptoms in older adults may effectively decelerate cognitive decline.

Age is the most important risk factor for develop dementia, and the recommendation is that older adults are cognitively tested to detect impairment in the initial stage for adequate treatment. The demand for the care of these older adults is great, drawing attention to the need for rapid tests, with good accuracy and simple application to identify cognitive impairment. To develop and validate the Brazilian Mini-Addenbrooke Cognitive Examination (M-ACE BR) as a short screening test for cognitive impairment in older adults. The M-ACE BR was developed using the Mokken scaling analysis in 352 participants (cognitively unimpaired [CU] = 232, cognitive impairment no dementia [CIND] = 82; and dementia = 38) and validated in an independent sample of 117 participants (CU = 25; CIND = 88; and dementia = 4). The Mokken scaling analysis derived 9 items (spatial orientation, anterograde memory, retrograde memory, delayed recall, recognition [name and address], letter verbal fluency, repetition of 4 words, naming of 10 items, and comprehension) with a maximum score of 51 points and an average duration time of 7 minutes. The cut-off score ≤ 43/51 for CIND had a sensitivity of 59.09% and a specificity of 80%. For a screening test in which sensitivity is prioritized for further investigation, we suggest using a cutoff of ≤ 47 (sensitivity 85.23% and specificity 24%), maintaining a good positive predictive value (79.8%). The M-ACE BR is a brief and adequate instrument to detect cognitive impairment in older Brazilian adults. However, screening for CIND and for different educational levels should be further explored.

Introduction: As the prevalence of age-related sensory impairment increases, more evidence emerges on the association between uni-sensory and cognitive impairment (CI) in older adults. However, the link between CI and concurrent hearing and vision impairment (referred to as dual sensory impairment/DSI) is not well-understood, and this combined effect may be additive or multiplicative. Moreover, the existing evidence on CI in older adults with DSI is scattered and limited. Through this systematic scoping review, we aim to map existing evidence on CI in older adults with DSI, and to summarize what is known about the prevalence, incidence and risk factors of CI, and tools used to screen or assess CI in older adults with DSI.Methods and Analysis: We will use the Joanna Briggs Institute framework to perform the review. Eleven databases [MEDLINE, CINAHL/EBSCO, EMBASE, Mednar, WorldWideScience, PsycEXTRA, OAIster, OpenGrey (SIGLE), Global Health, PsycINFO, and Web of Science] and clinical trial registries (ISRCTN Registry, WHO ICTRP, and ClinicalTrials.gov) will be searched. Study selection will be completed using Covidence, and data will be extracted using an a priori data extraction tool. To be included, studies had to be peer-reviewed, had older adults with DSI as the focal population, and are related to CI. Data will be presented using a narrative summary with emphasis on implications for future research and practice.Discussion: Reliable cognitive screening is of the utmost importance for prevention and treatment of CI within DSI population. The study findings will have significant implications for health services delivery and policy research. The summarized findings on the prevalence, incidence, associated risk factors, and CI screening and assessment tools will inform geriatric care. The review will also document knowledge gaps on CI in the DSI population and identify areas of interest for future studies.Ethics and Dissemination: The scoping study, being a review of existing documents, does not require ethics approval. The findings will be disseminated with relevant stakeholders using knowledge translation activities such as scientific presentations and publications. We intend to use the findings to conduct a Delphi study to evaluate which CI tools are suitable for older population with DSI.

Treatment of blood pressure in acute stroke is controversial, whether attempts are made to reduce or to increase blood pressure. Few clinical studies are available to guide clinicians. A Cochrane review1 on deliberately altering blood pressure within 2 weeks of stroke onset found 5 small trials, involving 218 patients randomized to nimodipine, nicardipine, captopril, clonidine, glyceryl trinitrate, or perindopril versus placebo or control treatment. The limited number of data made it impossible to assess the relationship between blood pressure and clinical outcome. Ahmed et al2 made a post hoc analysis on the effect of intravenous nimodipine in acute ischemic stroke within 24 hours. They found that a reduction of diastolic blood pressure of about 15 mm Hg was associated with poor outcome, whereas a spontaneous fall in the placebo group of about 8 …

Role of Abciximab in the Management of Acute Ischemic Stroke