Sertraline Improves Executive Function in Patients With Vascular Cognitive Impairment

To examine the relative contributions of Executive Control Function (ECF), general cognition, mood, problem behavior, physical disability, demographic variables, and the number of prescribed medications to the level of care received by older retirees. Multivariate regression and discriminant modeling. A single Continuing Care Retirement Community (CCRC) in San Antonio, Texas. A total of 107 older retirees (mean age = 83.7+/-7.2 years), including 17 community-dwelling, well, older controls and 90 CCRC residents. CCRC subjects represented a convenience sample of consecutive referrals for geropsychiatric assessment. Sixty-one subjects resided at a noninstitutionalized level of care, and 46 were institutionalized. Tests of ECF (the Executive Interview (EXIT25)), general cognition (the Mini-Mental State Examination (MMSE)), mood (the Geriatric Depression Scale short-form (sGDS)), problem behavior (the Nursing Home Behavior Problem Scale (NHBPS)), physical disability (the Cumulative Illness Rating Scale (CIRS)), age, gender, years of education, and the number of prescribed medications were studied. All variables except gender and education varied significantly across level of care. Four variables made significant independent contributions; EXIT25 score (r2 = .48, P< .001), medication usage (partial r2 = .11, P<.001), sGDS score (partial r2 = .06, P = .001), and problem behavior (partial NHBPS r2 = .04, P<.04). These variables accounted for 69% of the total variance in level of care (R2 = .69; F (df 7,99) = 32.1, P<.001). A discriminant model based on the number of prescribed medications, EXIT25, sGDS, and NHBPS scores classified 83.2% of cases correctly (Wilke's lambda = .50, F(5,101) = 20.1; P<.001). The MMSE enters but fails to contribute significantly, independent of the other variables. Age and CIRS scores fail to enter. Cognitive (particularly ECF) impairment contributes most to the observed variance in level of care received by older retirees in this CCRC. In contrast, markers of general cognition, depression, and physical illness contributed relatively little additional variance. ECF is not detected well by traditional cognitive measures and must be sought by specific tests. Further study is needed to replicate these findings in other populations.

Prospective Evaluation of Pretreatment Executive Cognitive Impairment and Depression in Patients Referred for Radiotherapy

"Senility" redefined as age-associated frontal system impairment?

Little is known about the prevalence of impaired executive control function (ECF) in community dwelling elderly or minority populations. We have determined the prevalence of cognitive impairment and impaired ECF in a community dwelling Mexican American elderly population, and their associations with functional status. Subjects were 1165 Mexican Americans age 65 and over who were administered CLOX as part of the third wave of the Hispanic Established Population for Epidemiological Study (HEPESE) conducted from 1998 to 1999. ECF was measured by an executive clock-drawing task (CDT) (i.e. CLOX1). Non-executive cognitive function was assessed by the Mini-Mental State Examination (MMSE) and a non-executive CDT (CLOX2). CLOX scores were combined to estimate the prevalence of global CLOX failure (i.e. 'Type 1' cognitive impairment) vs isolated CLOX1 failure (i.e. Type 2 cognitive impairment). 59.3% of subjects failed CLOX1. 31.1% failed both CLOX1 and CLOX2 (Type 1 cognitive impairment). 33.3% failed CLOX1 only (Type 2 cognitive impairment). 35.6% passed both measures [no cognitive impairment (NCI)]. Many subjects with CLOX1 impairment at Wave 3 had normal MMSE scores. This was more likely to occur in the context of Type 2 cognitive impairment. Both CLOX defined cognitive impairment groups were associated with functional impairment. A large percentage of community dwelling Mexican American elderly suffer cognitive impairment that can be demonstrated through a CDT. Isolated executive impairments appear to be most common. The ability of a CDT to demonstrate ECF impairments potentially offers a rapid, culturally unbiased and cost-effective means of assessing this domain. In contrast, the MMSE is relatively insensitive to ECF assessed by CLOX1.

Background: Cerebrovascular disease is a common cause of vascular cognitive impairment (VCI) and may progress to vascular dementia at a relatively fast rate. Strengthening intervention in patients with mild VCI can delay cognitive decline and prevent vascular dementia. Purpose: To investigate the effect of an immersive motor-cognitive training program on executive function in patients with mild VCI. Methods: A total of 60 patients with mild VCI were divided into two groups: the intervention group (n=30) and control group (n=30). The participants were recruited from an outpatient Neurology clinic between May 2021 and January 2022. The intervention group was received immersive motor-cognitive training for 2 months, while the control group was received traditional motor-cognitive training during the same duration. Before the intervention and at the end of the first and second months of the intervention, executive function was assessed as the primary outcome using the Trail-Making Test (TMT)-A/B. General cognitive, speech function and balance function were evaluated as secondary outcomes using the Mini-Mental State Examination (MMSE)/Montreal Cognitive Assessment (MoCA), Boston Naming Test, and Berg Balance Scale, respectively. Data analysis was performed using independent sample t-test, Chi-Square test, nonparametric test, and generalized estimation equation model. Results: Among 60 patients, 54 were completed the 2 month-follow-up. Our results showed that there is a significant time effect ( F =14.36, P =0.001) regarding the TMT-A score. In addition, significant time (F=7.28, P =0.001) and interaction effects (F=7.43, P =0.001) on the TMT-B score were noted. The MMSE score showed significant time (F=64.66, P =0.001) and interaction effects (F=12.01, P =0.002), and similar results were observed for the MoCA score with significant time (F=38.29, P=0.001) and interaction effects (F=22.89, P =0.001). The time effect of the Boston Naming Test score was also found to be statistically significant ( F =2.92, P =0.003). However, no significant differences were observed in the Berg Balance Scale score. Conclusion: Immersive motor-cognitive training may improve the executive function and general cognitive function in patients with mild VCI.

Comments on the executive control of clock-drawing.

Measurement of meaningful treatment effects in CADASIL

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.

Tackling the Toll of Hearing Loss on Executive Function

Impact of Frontal Systems Behavioral Functioning in Dementia on Caregiver Burden

Introduction Cardiovascular disease is an independent contributor to cognitive impairment. With an imminent rise in chronic cardiovascular disease, a better understanding of its effects on brain health is warranted. Impaired blood flow to the brain is one of the main hypothesized mechanisms linking cardiovascular disease with abnormal brain aging. Purpose To investigate relations between (subclinical) cardiac dysfunction and vascular brain injury, cognitive impairment and depressive symptoms, with a side-by-side comparison of cardiac biomarkers and imaging parameters. Methods Multicenter, cross-sectional, observational cohort study among 559 participants: 431 with manifest cardiovascular disease (heart failure [HF], carotid occlusive disease or vascular cognitive impairment) and 128 control participants, all without dementia. Participants underwent 3T heart-brain MRI and cognitive testing. Determinants were cardiac biomarkers (NT-proBNP and high-sensitive Troponin-I) and left ventricular (LV) functional parameters by MRI (LV ejection fraction, cardiac output, LV global function index). Outcome measures were cerebral small vessel disease (CSVD) by MRI (presence of white matter hyperintensities, microbleeds, lacunar infarcts or perivascular spaces), CSVD score (0–4), cognitive impairment in ≥1 domain (memory, language, attention-psychomotor speed and executive functioning) and depressive symptoms (Geriatric Depression Scale-15 score &amp;gt;5). Interaction analyses were used to investigate effect modification by patient group; results are reported pooled or stratified accordingly. Results In patients with cardiovascular disease and controls, but not in those with manifest HF, LV functional parameters were associated with CSVD and cognitive impairment, with the following associations: LVEF &amp;lt;50% with CSVD (OR 4.67 [1.37–15.95]) and CSVD score (RR 1.38 [1.06–1.81]); LV global function index with CSVD (OR 0.71 [0.58–0.86]), CSVD score (RR 0.90 [0.84–0.96]) and cognitive impairment (OR 0.84 [0.72–0.97]). LV global function index (OR 0.82 [0.71–0.95]) and cardiac output (OR 0.81 [0.71–0.93]) were also associated with depressive symptoms in all. These relations were independent from age, sex, hypertension, diabetes, waist-hipratio, history of ischemic heart disease, transient ischemic attack or stroke. Cardiac biomarkers were univariably associated with brain outcome measures, but not in multivariable analysis. Conclusion This study indicates that subclinical cardiac dysfunction, as assessed by cardiovascular MRI, is independently associated with vascular brain injury, cognitive impairment and depressive symptoms. Of all parameters, LV global function index showed the most robust relations, indicating that global cardiac performance is more closely related to poorer brain outcome than merely LV systolic function. In those with clinically manifest HF, the severity of cardiac dysfunction was related to depressive symptoms but not to other brain outcome measures. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Netherlands CardioVascular Research Initiative; The Dutch Heart Foundation

To assess the contribution of executive control function (ECF) to functional status. Three-year longitudinal cohort study. A comprehensive-care retirement community. Five hundred forty-seven noninstitutionalized septuagenarians. The Mini-Mental State Examination (MMSE) and Executive Interview (EXIT25). Functional status was assessed using instrumental activities of daily living (IADLs). Latent growth curves of MMSE, EXIT25, and IADL were modeled. The rate of change in IADLs (DeltaIADL), adjusted for baseline IADLs and cognition, was regressed on the rate of change in each cognitive measure (adjusted for baseline cognition). Models were also adjusted for baseline age, level of care, and comorbid illnesses. Baseline test scores were within normal ranges, but mean EXIT25 scores reached the impaired range by the second follow-up. There was significant variability around the baseline means and slopes for all variables. The rate of change in EXIT25 was strongly correlated with DeltaIADL (r=-0.57, P<.001). This remained significant after adjusting for baseline EXIT25 scores, IADLs, age, comorbid disease, and level of care. The effect of the EXIT25 on DeltaIADL was stronger than those of age, baseline IADLs, comorbid disease, or level of care. The rate of change in MMSE scores was not significantly associated with DeltaIADL. ECF is a significant and independent correlate of functional status in normal aging. Traditional dementia case finding is likely to underestimate cognition-related disability. Neither a normal baseline MMSE score nor stable MMSE scores over time preclude functionally significant changes in ECF.

EPA-1751 – Cognitive function correlates of apathy in late-life depression

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

To explore the characteristics of cognitive impairment in depressive elders in Shanghai. A total of 1 068 participants randomly selected from 4 communities in Shanghai underwent neuropsychiatric and psychiatrists clinical assessment. Among them, 102 depressive ones with a score of geriatric depression scale (GDS) > 10 and 102 non-depressive ones with a score of GDS ≤ 10 were selected as depression and non-depression groups respectively. The SPSS statistic software V17.0 was used. Significant differences existed between the depressive and non-depressive patients in the total score of Montreal Cognitive Assessment (MoCA) (t = 2.353), trail making B task (t = 2.236), attention (t = 2.621), sustained attention (t = 2.381), calculation (t = 2.612) and fixed orientation (t = 2.259) (P < 0.05). The negative correlation had significant inter-group differences in the total score of MoCA (r = -0.142), attention (r = -0.161), sustained attention (r = -0.160), calculation (r = -0.150), fluency (r = -0.156), delayed recall (r = -0.175) and orientation to place (r = -0.172) (P < 0.05). Cognitive impairment in depression group had lower scores than non-depression group in the total score MoCA (14.9 ± 7.3 vs 17.5 ± 6.7), attention (1.1 ± 0.8 vs 1.4 ± 0.8), calculation (1.9 ± 1.2 vs 2.3 ± 1.1) and fixed orientation (1.7 ± 0.7 vs 1.8 ± 0.5) (P < 0.05). In depressive elders, cognitive impairment occurs in multiple cognitive domains of attention, executive function and orientation to place. There is a negative correlation between GDS score and MoCA. The higher GDS score, the worse cognitive function.