Relationship between intracranial pressure and neurocognitive function among older adults after radical resection of rectal cancer.

Hip joint fractures are the most common fractures in elderly patients and a major cause of neurological disorders. The purpose of this non-interventional, observational, prospective study is to evaluate the effects of physiotherapeutic interventions on the neuropsychophysiological profile of patients during the rehabilitation period after hip fracture surgery, starting from discharge from the hospital. This study involved 64 mainly elderly patients who underwent surgery for various hip fractures and followed a standardized physical therapy protocol in the rehabilitation center. The Mini-Mental State Examination (MMSE) and Confusion Assessment Method (CAM) scores which are part of the neurological assessment in the rehabilitation center, were recorded on the 1st, 5th, 15th, and 30th days of hospitalization. Statistical analysis followed and the results aimed to evaluate the role of physical therapy in enhancing recovery and preventing cognitive complications in the postoperative period. The first 64 patients with hip fractures admitted in the rehabilitation center after the initiation of the study protocol were enrolled in the study. Always the same two observers recorded MMSE and CAM scores for each patient during the four aforementioned time points. A statistical analysis included descriptive statistics for each of the four studied time points proved that both MMSE and CAM scores showed statistically significant positive outcomes in the neuropsychophysiological profile of patients following the same physical therapy protocol. Suggesting and supporting physical therapy through well standardized protocols after hip fracture surgery is crucial for improving and maintaining neurological status, particularly for patients at high risk of neurological disorders and delirium during the immediate postoperative period.

Positive end-expiratory pressure (PEEP) is widely used during surgery, but its effects on lung and brain protection remain debated. This study aimed to evaluate the impact of individualized PEEP on lung ultrasound score (LUS) and optic nerve sheath diameter (ONSD) in elderly patients undergoing laparoscopic rectal cancer surgery. Forty-six patients aged 60-79 years undergoing laparoscopic rectal tumour resection between June 2022 and December 2022 were randomized into two groups: Group E (individualized PEEP guided by driving pressure) and Group C (control group, PEEP = 5 cm H2O). LUS was assessed 30 minutes postoperatively. ONSD was measured at 5 minutes before anesthesia induction (T0), 5 minutes after tracheal tube insertion (T1), 5 and 60 minutes after Trendelenburg positioning (T2, T3), and 30 minutes postoperatively (T4). Arterial oxygen index (OI) and arterial partial pressure of carbon dioxide (PaCO2) were recorded post-intubation and pre-extubation. Postoperative pulmonary and neurological complications were followed up. Postoperative LUS was significantly lower in Group E than in Group C (P < 0.05). OI was significantly higher in Group E before extubation (P < 0.05). There were no significant differences in ONSD between groups. Within each group, ONSD values at T2 and T3 were significantly higher than those at T0 (P < 0.01). No significant differences were observed in the incidence of postoperative complications between the two groups. During laparoscopic radical resection for rectal cancer, individualized PEEP reduces LUS scores, improves oxygenation, and does not increase ONSD values compared to fixed PEEP. Chinese Clinical Trial Registry: ChiCTR2200060434.

To the Editor: There is controversy about whether high blood pressure is associated with impaired cognitive function or dementia.1, 2 Recently Skoog and colleagues3 revealed an association between high blood pressure at age 70 and the development of dementia 10 to 15 years later. We show the J-curve relation between blood pressure and decline in cognitive function in older Japanese people in a 3-year follow-up study. We assessed blood pressure (BP) and Mini-Mental State Examination (MMSE) scores in older people living in Kahoku,4 a rural Japanese town, in 1992 and 1995. We studied 155 older subjects (58 men and 97 women, mean age in 1992: 78 years; range: 70 to 91 years). In 1992, the subjects were divided into four groups according to their systolic blood pressure (SBP): SBP < 125 (Group I, n = 38); SBP 125 to <150 (Group II, n = 63,); SBP 150 to <175 (Group III, n = 40); SBP > 175 (Group IV, n = 14). There were no significant differences in age and MMSE scores among the four groups in 1992. The rates of antihypertensive medications prescribed in each group were 13.5%, 47.5%, 40.0%, and 71.4%, respectively, and those did not change significantly 3 years later. Figure 1 shows MMSE scores in 1992 and 1995 and the decline in the scores during the 3 years by each blood pressure group. Groups I, II, and IV showed significant deterioration in MMSE scores during the 3-year period (Group I from 27.2 ± 3.7 to 26.3 ± 4.2; Group II 28.2 ± 2.2 to 27.6 ± 2.4; Group IV 27.9 ± 2.2 to 26.1 ± 3.8; each P < .05 by paired t test), whereas Group III showed no significant change in MMSE scores (from 27.5 ± 3.2 to 27.9 ± 2.4). The difference in MMSE scores in each group between 1992 and 1995 showed significant decline in the scores in Groups I and IV (P < .05, Fisher PLSD, ANOVA: P < .05) compared with that in Group III, revealing the J-curve relation between SBP and the decline in MMSE scores. The relationship between the decline in MMSE scores and diastolic BP also showed a tendency of J-curve relation but failed to be significant (P < .09). . MMSE scores in 1992 and 1995 and decline in the scores during 3 years by each blood pressure group. °P < .05, MMSE scores in 1995 vs in 1992 (paired t test). *P < .05, decline in MMSE compared with that in Group III (Fisher PLSD) (ANOVA: P < .05). Although the duration of follow-up was only 3 years, we revealed an association of high BP with deterioration in cognitive function, adding the J-curve relation between blood pressure and decline in cognitive function in a longitudinal study. Our results also support the findings of Meyer and colleagues,5 which showed improvement of cognition after control of SBP from 135 to 150 mm Hg but decline in cognition after lowering SBP below the level of 135 mm Hg in hypertensive patients with multi-infarct dementia. In conclusion, it is worth remembering that not only high blood pressure, but also lower blood pressure, may be associated with later decline in the cognitive function of older people.

The aim of the study was to explore the effect of acupuncture combined with rehabilitation on cognitive and motor functions in poststroke patients. All patients were divided into Group A and Group B based on different interventions (Group A: acupuncture + conventional rehabilitation, Group B: conventional rehabilitation alone). Acupuncture was conducted once a day, five times a week for 8 weeks, and rehabilitation (including physical therapy and occupational therapy) was conducted for 2 hr per session, once a day, five times a week for 8 weeks. Mini-mental State Examination (MMSE) and Fugl-Meyer Assessment (FMA) were used to assess the motor and cognitive functions at baseline and the end of 8 weeks. After the intervention, FMA and MMSE scores were improved significantly in the two groups (p <.05), compared with the scores prior to intervention. After 8 weeks of intervention, a statistically significant difference in the FMA and MMSE scores was observed between the Group A and the Group B. The results suggested that the combined intervention is more effective than the conventional rehabilitation alone in improving cognitive and motor functions in poststroke patients.

Background/Aims: Delirium and the apolipoprotein E ε4 allele are risk factors for late-onset Alzheimer disease (LOAD), but the connection is unclear. We looked for an association. Methods: Inpatients with delirium (n = 18) were compared with LOAD outpatients (n = 19), assaying blood and cerebrospinal fluid (CSF) using multiplex ELISA. Results: The patients with delirium had a higher Confusion Assessment Method (CAM) score (5.6 ± 1.2 vs. 0.0 ± 0.0; p < 0.001) and Delirium Index (13.1 ± 4.0 vs. 2.9 ± 1.2; p = 0.001) but a lower Mini-Mental State Examination (MMSE) score (14.3 ± 6.8 vs. 20.8 ± 4.6; p = 0.003). There was a reduction in absolute CSF apolipoprotein E level during delirium (median [interquartile range]: 9.55 μg/mL [5.65–15.05] vs. 16.86 μg/mL [14.82–20.88]; p = 0.016) but no differences in apolipoprotein A1, B, C3, H, and J. There were no differences in blood apolipoprotein levels, and no correlations between blood and CSF apolipoprotein levels. CSF apolipoprotein E correlated negatively with the CAM score (r = –0.354; p = 0.034) and Delirium Index (r = –0.341; p = 0.042) but not with the Acute Physiology and Chronic Health Evaluation (APACHE) index, or the MMSE or Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Conclusion: Reduced CSF apolipoprotein E levels during delirium may be a mechanistic link between two important risk factors for LOAD.

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

Background:We evaluated the relationship between ultrasonographical acquired parameters and short-term postoperative cognitive function in patients undergoing robotic-assisted radical prostatectomy (RALP).Methods:Ninety elderly patients scheduled for RALP had their optic nerve sheath diameter (ONSD), the cross-sectional area (CSA) of the internal jugular vein (IJV) and the IJV valve (IJVV) competency assessed by ultrasound. The patients were analyzed in 2 groups based on whether displayed IJVV incompetency (IJVVI). The 3 parameters were measured before anesthesia (T0), immediately after induction of general anesthesia (T1), 5 minutes after establishing pneumoperitoneum (T2), 5 minutes after placing the patient in the Trendelenburg position (T3), and 5 minutes after the release of the pneumoperitoneum in the supine position (T4). Regional cerebral tissue oxygen saturation (rSO2) was also measured by near-infrared spectroscopy intraoperatively. The Mini-Mental State Examination (MMSE) and Confusion Assessment Method (CAM) were performed the day before surgery and on postoperative days 1, 3, and 7.Results:We found that 52% of patients had evidence of IJVVI after being placed in the Trendelenburg position after pneumoperitoneum was established (T4). Patient with IJVVI showed a significant increase of ONSD and CSA at T1, T2, T3, T4 but there was no associated decrease in rSO2. MMSE scores were reduced at postoperative day 1 and the 7 patients that developed postoperative delirium came from Group IJVVI.Conclusions:Our observations suggest that elderly patients that show IJVVI after adequate positioning for RALP may develop elevated intracranial pressure as well as mildly compromised postoperative cognitive function in the short term.

Relatively little is known about late-life patterns of cognitive function among Hispanics of Mexican heritage who reside in the United States. The authors designed a study to assess the association between Mexican-American ethnicity (defined in terms of childhood and adolescent developmental history) and cognitive function among elderly Mexican-American and non-Hispanic white residents of El Paso County, Texas. Our findings indicate significant associations between the degree of Mexican-American ethnicity and cognitive impairment on all three measures of cognitive function. These statistically significant findings remain after effects of education, age, and gender have been removed from the multiple regression equation. The authors conclude that a dependable and clinically meaningful negative association exists between Mexican-American ethnicity and late-life cognitive function in this region that is mediated by as yet unmeasured variables.

The relationship between blood pressure and cognitive function

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

Impact of Induced Cardiac Arrest on Cognitive Function after Implantation of a Cardioverter-Defibrillator

BackgroundWhether cognitive decline is related to a higher risk of death independent of the initial cognitive function is inconclusive. Evidence of the association between cognitive decline and mortality among Chinese older people is limited. We aimed to examine whether cognitive decline, assessed by the rate of decrease in the Mini-Mental State Examination (MMSE) score, was associated with mortality independent of initial cognitive function (baseline MMSE score) among Chinese older people.MethodsWe established two successive and non-overlapping cohorts of older adults nested within the Chinese Longitudinal Healthy Longevity Survey (CLHLS), an ongoing, open, community-based cohort survey conducted every 2–3 years. Cognitive function was measured using the Chinese version of the MMSE. A total of 11,732 older adults who completed two consecutive cognitive function examinations were included and followed for 3 years. A Cox proportional hazards model was used to examine the association of cognitive decline with mortality after adjusting for sociodemographic characteristics, health behaviours, comorbidities and initial cognitive function.ResultsThe mean age was 82.5 years old, and 44.9% (5264/11732) of participants were men. After adjusting for baseline MMSE scores and other covariates, the rate of change in MMSE scores over 3 years was monotonically and positively associated with subsequent 3-year mortality. Compared to those with stable cognitive function, participants with rapid cognitive decline (decline faster than average, a reduction of MMSE scores > 1.62 points/year) had a 75% higher risk of death (hazard ratio = 1.75, 95% confidence interval 1.57–1.95). The association between cognitive decline and mortality was stronger among relatively younger Chinese older people (aged 65–79 years versus 80 years and over) and those with normal cognitive function at baseline (MMSE scores ≥ 24 versus < 24 points), respectively, but did not differ by cohort and sex.ConclusionFaster cognitive decline was associated with higher mortality independent of initial cognitive function, especially among those aged 65–79 years and those with normal cognitive function at baseline. The association was consistent across two successive cohorts. Our findings indicate the practical significance of monitoring cognitive change in older adults.

Although many studies have shown no significant change in global cognitive function after subthalamic brain stimulation (STN DBS) in patients with Parkinson disease (PD) and have concluded that STN DBS is generally safe from a cognitive standpoint, some studies have reported a decline in global cognitive function after STN DBS. Interestingly, in some studies, the decline in cognitive function appears to be greater during the initial short period after surgery (within 6 or 12 months after surgery) than the decline thereafter. To this end, we examined whether the rate of change in global cognitive function during the initial 6 months after STN DBS was different from the mean 6-month change that occurred between 6 and 36 months after surgery. Thirty-six PD patients who underwent bilateral STN DBS and were followed for more than 3 years were included. Change in Mini-Mental Status Examination (MMSE) score during the first 6 months after surgery was compared with the 6-month MMSE score change between 6 and 36 months after surgery. Mean MMSE change during the first 6 months after surgery was significantly greater than the mean 6-month MMSE change between 6 to 36 months after surgery. The levodopa equivalent daily dose at baseline and the score for Stroop Color-word test at baseline were significantly associated with the decline in MMSE score during the first 6 months after surgery. Our result showed that decline in global cognitive function was faster in the first 6 months after surgery, compared with that after 6 months.

Decline in cognitive function and elder mistreatment: findings from the Chicago Health and Aging Project.

Background: Obesity and cognitive function decline are independent risk factors for chronic kidney disease (CKD). However, few studies have examined the combined effects of obesity status and cognitive function on change in CKD risk. We aimed to evaluate the association between obesity status, cognitive function and CKD risk change in patients with type 2 diabetes mellitus (T2DM).Methods: Data on 3399 T2DM patients were extracted from a diabetes disease management program between 2006 and 2018. Univariate and multivariate analyses were used to assess the association between obesity, cognitive decline, and CKD risk change. Three indexes, including the relative excess risk of interaction (RERI), attributable proportion of interaction (API), and synergy index (SI), were used to analyze interactions. CKD risk was classified according to the KDIGO 2012 CKD definition.Results: In multivariate analysis, the hazard ratio (HR, 95%Cis) for CKD risk progression was 1.34 (1.12-1.61) times higher in the moderate and severely obese patients compared with the normal weight patients, and 1.34 (1.06-1.67) times higher in the patients with a Mini-Mental State Examination (MMSE) score ≤18 compared to those with an MMSE score ≥24. There was a synergistic interaction between moderate and severe obesity and MMSE score ≤18 on CKD risk progression (SI=4.461; 95% CI: 1.998-9.962), and the proportion of CKD risk progression caused by this interaction was 52.7% (API=0.527; 95% CI: 0.295-0.759). However, normal weight and MMSE score ≥24 were not beneficial on CKD risk improvement in the patients with a moderate risk and very high-risk stage of CKD.Conclusion: There may be a synergistic interaction between obesity and cognitive function decline, and the synergistic interaction may increase the risk of CKD progression.