Unveiling the role of work characteristics before retirement in cognitive functions among retirees: evidence from Taiwan’s Health and Retirement Study

Background: Cognitive impairment should be accurately assessed in the elderly. The presence of a valid Arabic version of the SLUMS Examination would allow better diagnosis of cognitive impairment as it considers different educational levels prevalent in the Egyptian community. Aim: To assess the reliability and validity of the Arabic version of Saint-Louis-University-Mental-Status (SLUMS) Examination for cognitive impairment and to estimate the prevalence of cognitive impairment among community dwelling Egyptian older adults. Materials and methods: This study was conducted in two phases: phase I, during which reliability and validity of the Arabic version of SLUMS Examination was assessed; then phase II, where the prevalence of cognitive impairment among community dwelling Egyptian elders was estimated using the Arabic version of SLUMS Examination . Results: The phase I of the study was conducted on 90 elderly group for testing validity and reliability of the SLUMS tool. A statistically significant agreement was evident between SLUMS Examination and Mini Mental State Examina tion MMSE (Kappa 0. 826, P 0.05, Kappa 0.806 P<0.001). The internal consistency of the Arabic version of SLUMS Examination on the main items of cognitive function showed a Cronbach’s alpha of 0.723 with a significant item-to-item and item-to-total correlation. The phase II of the study was conducted on 284 elderly. 51.4% of them demonstrated mild neuro-cognitive disorder and 5.6% were demented. Age showed a significant relationship with cognitive function level (P<0.001). Education level, employment and depression showed significant differences between elders with normal cognitive function and the demented (P<0.001, P=0.003 and P <0.001 respectively). Conclusion: The Arabic version of SLUMS-Examination was found to be a valid and reliable screening tool for cognitive impairment in elderly. Almost half of the community dwelling Egyptian elderly showed mild neurocognitive disorder and a minority were demented. Older age, less education, unemployment and evidence of depression were found to be significantly associated with cognitive impairment. The Arabic version of SLUMSExamination should be included in the routine assessment of cognitive impairment in Egyptian elders.

Comparison of the Saint Louis University Mental Status Examination, the Mini-Mental State Examination, and the Montreal Cognitive Assessment in Detection of Cognitive Impairment in Chinese Elderly from the Geriatric Department

Background: One of the fundamental challenges for gerontological research is how to maintain and promote intact cognitive functioning in old age. Previous research revealed that high educational level, good health status, and an active lifestyle during adulthood seem to be protective against cognitive impairment in old age. However, up to now, a detailed examination of the interaction of these relations based on a broader variety of activities and considering past and current activities is missing. Objective: The present study set out to extend the literature by investigating in more detail the interactions of educational level and health status with a broad variety of past and current leisure activities in their association with cognitive functioning in a large sample of older adults with a wide age range. Methods: A total of 2,812 older adults (aged 65-101 years) served as the sample for the present study. A test on verbal abilities and one on processing speed were applied. In addition, individuals were retrospectively interviewed regarding their educational level, current general health status, and 18 leisure activities (in terms of currently performed activities and those that had been carried out at the age of 45 years). Results: Regressions indicated that engaging in more current activities and in more activities at the age of 45 years (both analyzed as an overall activity measure) was related to better cognitive performance in old age (r values up to 0.39, p values <0.001). These associations were more pronounced in individuals with a low (compared to a high) educational level. Conclusion: Present results suggest that an active lifestyle during middle adulthood may be related to better cognitive functioning in old age, particularly in individuals with a low educational level. These findings are discussed with respect to models of cognitive aging.

Objectives: We investigated modulating effect of education levels on the association between Cardiac index (CI) and cognitive function among older adults. Methods: A total of 725 elders (≥60 years) with normal ejection-fraction (50%) were identified from the Cardiovascular Diseases Risk Factor Two-Township Study.CI was calculated as the product of Doppler-derived stroke volume and heart rate divided by body surface area. The global cognitive function was assessed by the Mini-Mental Short Examination (MMSE). General linear and logistic regressions were used to evaluate the association of CI with MMSE and cognitive function impairment (MMSE< = 26. Results: CI was positively associated with MMSE (age, sex and education years adjusted-beta[a-Beta] = 0.16, p-value[p] = 0.0167) in those elders with low levels of education (≤ 9 years of education), but not in those elders with high levels of education (>9 years of education) (a-Beta = 0.031, p = 0.5039). In the multivariable linear regression with further adjustments for history of stroke and heart disease, low-density lipoprotein, glucose levels, left ventricular mass index, and ventricular-arterial coupling, CI persisted to associate significantly with MMSE in elders with low levels of education (beta = 0.73, p = 0.044). Furthermore, a low CI (less than 3.1 L/min/m2) was significantly associated with cognitive function impairment in those elders with low levels of education (odds ratio[OR] = 2.36, 95% confidence intervals = 1.08–5.15), but not in those with high levels of education (OR = 1.15, p = 0.7664) in the multivariable models. Conclusion: Low CI was associated with low MMSE and cognitive function impairment in elders with low education levels but not in those with high education levels. Higher education levels may obscure the impact of low CI on cognitive function.

BackgroundThe Saint Louis University Mental Status (SLUMS) Exam is a commonly used tool for screening cognitive function, particularly for detecting mild cognitive impairment (MCI) and early dementia. It was developed to overcome limitations in existing cognitive assessments by evaluating a broad range of domains, including language comprehension, executive function, memory, and attention. While effective in English-speaking populations, its use in non-English-speaking settings is limited by language and cultural differences. In Thailand, the lack of linguistically and culturally adapted cognitive screening tools can lead to inaccurate assessments. To ensure reliable and valid evaluations in older Thai adults, the SLUMS must be appropriately translated and culturally adapted.ObjectiveThis study aimed to translate the SLUMS into Thai (SLUMS-Thai) and validate its use among older adults in Thailand.MethodsThe translation process consisted of seven steps: establishing the expert team, synthesizing the translated version, forward translation, pilot testing to ensure clarity, cultural appropriateness testing, blind back-translation, and translation equivalence testing. The study involved 100 older adults. Validation was performed using descriptive statistics, Pearson’s correlations, the Index of Item-Objective Congruence (IOC), and Cronbach’s alpha coefficients.ResultsThe findings showed that cultural appropriateness was assessed using expert evaluations on the relevance and sensitivity of the tool to Thai cultural norms and practices, with the rate of appropriateness at the highest level (Mean = 4.97, SD = 0.71), and translation equivalence was also rated highly (Mean = 4.76, SD = 0.27). The correlation between the original SLUMS and the SLUMS-Thai was strong (r = 0.84 - 0.91). The IOC values for the 11 questions ranged from 0.80 to 1.00, and the Cronbach’s alpha coefficient was 0.83, indicating high internal consistency. The tool’s ability to differentiate between different cognitive states was proven by the Discriminant Index, which ranged from 0.23 to 0.62.ConclusionThe SLUMS-Thai demonstrated acceptable content validity and strong psychometric properties that were linguistically and culturally appropriate. As a consequence, the SLUMS-Thai can be used to screen older persons for dementia and mild cognitive impairment in Thailand and may be helpful for modifying interventions for accurate diagnosis and cognitive function assessment.

Background Dutch legislation stimulates active participation of employees in their return-to-work (RTW) process. Earlier research showed that employees, particularly with low levels of education, are not always able to self-direct RTW. Empowering leadership may support this process. This study answers two research questions: (1) What differences and similarities do employers of employees with low versus high levels of education show in their management of RTW? (2) To what degree do the roles of employers in both types of organizations resemble empowering leadership? Methods We performed semi-structured, in-depth interviews with 10 HR professionals and supervisors working at a Dutch university. We also analysed transcripts from a study in which 13 HR professionals and supervisors from multiple Dutch industries (employing workers with low levels of education) were interviewed. We used purposive sampling to recruit participants. For question 1, the transcripts were analysed thematically. For question 2, pattern matching was applied. Results Preliminary results indicate that supervisors of both types of employees, show several similarities in managing RTW, such as the focus on possibilities instead of impossibilities, asking the advice of the occupational physician, and seeking support to increase employability. We also found that supervisors of employees with low levels of education have a stronger tendency to control and steer RTW and feel that possibilities for RTW are limited, while supervisors of high-educated employees tend to engage in dialogue more often and search for possibilities for work adjustments. Empowering leadership seems to be less common among supervisors of employees with low levels of education. Conclusions This study will benefit employers (of workers with both low and high levels of education) who aim to enable employees' self-direction in RTW, and help supervisors to develop more empowering leadership styles. This may lead to more sustainable RTW. Key messages Supervisors of employees with lower levels of education have a strong tendency to control and steer their employees’ return-to-work. Enabling employees’ self-direction in return-to-work requires empowering leadership.

Objective To probe into the cognitive function among elders in Xinzhongjie community and provide the evidence for corresponding nursing interventions. Methods Convenient sampling was used to recruit 193 elders who were equal to or older than 60 for the investigation by Montreal cognitive assessment (MoCA). Results There were 37 elders (19.17%) who were abnormal on cognitive function. Cognitive function was related to age, educational level, and whether had brain disease. Elders, who were in older, with lower educational level, and had brain disease, were more frequently to have abnormal cognitive function (χ2=9.54, 20.58, 21.92; P<0.01). By Logistic regression analysis, older age and brain disease were risk factors for cognitive function declines, while high educational level was a protective factor for the cognitive function. Conclusions Community nurses should pay increasing attention on the changes of cognitive function among elders who are in older age, with lower educational level, and have brain disease. Non-pharmacological nursing intervention can be provided to elders according to their specific cognitive function decline. Key words: Community; Elders; Cognitive Function

Early impairments in spoken discourse abilities have been identified in Alzheimer's disease (AD). However, the impact of AD on spoken discourse and the associated neuroanatomical correlates have mainly been studied in populations with higher levels of education, although preliminary evidence seems to indicate that socioeconomic status (SES) and level of education have an impact on spoken discourse. The purpose of this study was to analyze microstructural variables in spoken discourse in people with AD with low-to-middle SES and low level of education and to study their association with gray matter (GM) density. Nine women with AD and 10 matched (age, SES, and education) women without brain injury (WWBI) underwent a neuropsychological assessment, which included two spoken discourse tasks, and structural magnetic resonance imaging. Microstructural variables were extracted from the discourse samples using NILC-Metrix software. Brain density, measured by voxel-based morphometry, was compared between groups and then correlated with the differentiating microstructural variables. The AD group produced a lower diversity of verbal time moods and fewer words and sentences than WWBI but a greater diversity of pronouns, prepositions, and lexical richness. At the neural level, the AD group presented a lower GM density bilaterally in the hippocampus, the inferior temporal gyrus, and the anterior cingulate gyrus. Number of words and sentences produced were associated with GM density in the left parahippocampal gyrus, whereas the diversity of verbal moods was associated with the basal ganglia and the anterior cingulate gyrus bilaterally. The present findings are mainly consistent with previous studies conducted in groups with higher levels of SES and education, but they suggest that atrophy in the left inferior temporal gyrus could be critical in AD in populations with lower levels of SES and education. This research provides evidence on the importance of pursuing further studies including people with various SES and education levels. Spoken discourse has been shown to be affected in Alzheimer disease, but most studies have been conducted on individuals with middle-to-high SES and high educational levels. The study reports on microstructural measures of spoken discourse in groups of women in the early stage of AD and healthy women, with low-to-middle SES and lower levels of education. This study highlights the importance of taking into consideration the SES and education level in spoken discourse analysis and in investigating the neural correlates of AD. https://doi.org/10.23641/asha.24905046.

Objectives Compared to its alternatives (e.g., Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), little is known about the psychometric properties and factor structure of the Saint Louis University Mental Status (SLUMS) Examination. The purpose of the current study is to describe the internal consistency, factor structure, and temporal stability of the SLUMS, a widely used cognitive screening measure. Methods We examined the SLUMS of 108 mostly White male Veterans seen for home-based primary care services, 101 of whom had complete data and 28 who completed retesting approximately one year later. Results At time one, Veterans averaged 76.44 (SD = 9.88) years of age and 13.07 (SD = 2.26) years of formal education. Results indicated that the SLUMS had acceptable internal consistency (α = .709) and temporal stability (ρ =.723), with strongest evidence for a one-factor structure. Conclusions The SLUMS appears to have adequate reliability and clear one-factor structure in this sample. Additional research with diverse samples is needed to characterize the psychometrics of the SLUMS more comprehensively. Clinical Implications The SLUMS appears to be an efficient method for approximating global cognitive functioning among medically complex older adults.

Comparison of the Saint Louis University Mental Status Examination and the Mini-Mental State Examination for Detecting Dementia and Mild Neurocognitive Disorder—A Pilot Study

Purpose: To evaluate the association of county level characteristics with the incidence of invasive squamous cell carcinoma of the cervix among Hispanic women. Methods: The Surveillance, Epidemiology, and End Results (SEER) Program's 18 registries from 2000-2009 were queried and average annual age-adjusted incidence rates per 100,000 Hispanic women for invasive squamous cell carcinoma of the cervix (SCC) were calculated. Patients were stratified by residence in a county with high versus low percent language isolation, percent of Hispanics with less than a high school education and percent of Hispanic families below the poverty level. Results: Between 2000-2009, 5,534 Hispanic women were diagnosed with SCC in SEER. Incidence rates were highest among those living in counties with high levels of LI (8.9 v 10.7), or low levels of education (8.9 v 10.8) or income (8.7 v 11.0). The incidence of SCC was significantly less in women living in counties with higher levels of education and income and lower levels of LI than among those living in counties with lower levels of education and income and higher levels of LI (8.6 v. 11.3). Counties that have higher levels of income and education are less likely to be LI whereas counties with lower levels of income and education are more likely to be LI. Conclusions: Among Hispanic women, county level characteristics such as LI, education, and income have a complex interaction that appears to be associated with the incidence of SCC. Community level interventions need to be evaluated to decrease the high incidence of SCC in this population. Citation Format: Kristy K. Ward, Angelica M. Roncancio, Steven C. Plaxe. The association of county level characteristics with the incidence of squamous cell carcinoma of the cervix in Hispanic women. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A54.

Background: Early identification of cognitive weakening in previously undetected cases could help deal by starting programs for rehabilitation. Aim: The aim of this survey was to evaluate the prevalence and degree of cognitive impairment among adults of rural area in Nineveh, Iraq. Method: A cross-sectional study with convenient sampling technique was conducted to enroll subjects from a rural area in Nineveh. Cognitive function was examined in all the patients by the Saint Louis University Mental Status (SLUMS) is a screening tool for the cognitive state. A total of 213 agreed to participate in the survey with a mean age of 52.1 ± 11.8 years and higher percentage of participants were with primary level of education 125 (58.7%). Results: The mean score for the cognitive function examination was 18.85 ± 4.55 with significant differences were found between cognitive function and educational level, employment, and monthly income. Cognitive score was negatively correlated with age of participants (r= - 0.128, p value = 0.031). Although it was not significantly associated with level of education but around 43% of the study population suffered from mild cognitive impairment to dementia. Conclusion: The study concludes that there have been strong calls for program from the Ministry of Health to improve dementia care and support for societies with dementia and their occupations that will stay a life of that means and dignity. Efforts to make societies greater cognitively functioned, as well as, actively attractive patients will improve cost, the sustainable, treatment and care methods for diseases and quality of life.

AimA disadvantaged socioeconomic status (SES) was previously associated with higher incidence and poor outcomes both of non-communicable diseases (NCDs) and infectious diseases. Inequalities in health services also have a negative effect on the coronavirus disease 2019 (COVID-19) morbidity and mortality.Subject and methodsThe study analysed the role of SES measured by the educational level (EL) in hospitalised patients with COVID-19 between 9 March 2020 and 20 September 2021 at our centre of infectious diseases. Clinical outcomes were: length of hospitalisation, in-hospital mortality and the need of intensive-care-unit (ICU) support.ResultsThere were 566 patients included in this retrospective analysis. Baseline EL was: illiterate (5, 0.9%), primary school (99, 17.5%), secondary school (228, 40.3%), high school (211, 37.3%), degree (23, 4.1%); median age was higher in low EL (72.5 years vs 61 years, p = 0.003), comorbidity (56% in low EL, 34.6% in high EL, p < 0.001), time from the symptoms and PCR diagnosis (8.5 days in low EL, 6.5 days in high EL, p < 0.001), hospitalisation length (11.5 days in low EL, 9.5 days in high EL, p = 0.011), mortality rate (24.7% in low EL, 13.2% in high EL, p < 0.001). In the multivariate analysis there were predictors of mortality: age (OR = 4.981; 95%CI 2.172–11.427; p < 0.001), comorbidities (OR = 3.227; 95%CI 2.515–11.919; p = 0.007), ICU admission (OR = 6.997; 95%CI 2.334–31.404; p = 0.011), high vs low EL (OR = 0.761; 95%CI 0.213–0.990; p = 0.021). In survival analysis, higher EL was associated with a decreased risk of mortality up to 23.9%.ConclusionEven though the EL is mainly related to the age of patients, in our analysis, it resulted as an independent predictor of in-hospital mortality and hospitalisation time. Unfortunately, this is a study focused only on hospitalised patients, and we did not examine the possible effect of EL in outpatients. Further analyses are required to confirm this suggestion and provide novel information.

The aims of this study were to examine the relationships between overall cognitive function and the quality of life (QOL) domains, and to compare the differences in these by age, gender, and educational level in community-dwelling seniors in Taiwan. A cross-sectional study was conducted, with the participants screened and recruited from Southern Tainan. The Saint Louis University Mental Status Examination was used to screen the cognitive status of the participants. A total of 144 seniors participated in this study were assessed using the Taiwanese version of WHOQOL-BREF. The results showed that the participants performed better in the cognitive domains of "figure identification" and "orientation" while they performed poor in "delayed recall" and "immediate paragraph recall". No significant relationship between cognitive function and overall QOL, but a positive relationship between cognitive function and the physical health domain of QOL was found. The findings of this study provide valuable information for community healthcare providers.

Screening for Obstructive Sleep Apnea in the Long-Term Care Setting