Baseline Cognitive Impairment Research Articles

Introduction of enhanced weekend physiotherapy for patients with hip fracture is associated with improved early mobility outcomes.

To assess whether enhanced daily weekend physiotherapy (EWP) for patients with hip fracture was associated with improved clinical outcomes. We retrospectively analysed all previously ambulatory adults admitted with hip fracture to our tertiary hospital, comparing 'usual' ('control') care (09/19-03/20) to EWP (09/20-03/21). Outcomes included Day-7 mobility ≥20 m (primary), additional mobility measures, specified postoperative complications, new residential facility placement, acute length-of-stay (LOS) and 30-day death. Amongst 235 eligible patients (128 control, 107 EWP), 66% were female, mean age was 80.4 years (SD 10.5), 20% from residential care and 49% (114/235) were mobilising without aid at baseline (no between-group differences; all p ≥ .20). Median acute LOS was 10 days (IQR 6-15), total hospital LOS was 21 days (IQR 12-37) and 3% (n = 6) died by Day 30. Median Day-7 distance mobilised was 25 m (IQR 7-50) with EWP versus 10 m (3-40) (p = .06). No EWP patients developed pressure injury (0 vs. 6, p = .02); other outcomes were similar between groups. Adjusting for age, residence, baseline cognitive impairment, American Society of Anesthesiologist score and preadmission mobilisation without aids, EWP was independently associated with increased likelihood of mobilising ≥20 m at Day 7 (aOR 1.83, 95% CI 1.04-3.23, p = .03). Enhanced daily weekend physiotherapy was associated with improvement in early mobility, but not other outcomes assessed. These data would be strengthened by randomised controlled trial data exploring more intense physiotherapy, cost-benefit analysis and patient experience measures.

Cognitive impairment and treatment strategy for atrial fibrillation in older adults: The SAGE-AF study.

Cognitive impairment is strongly associated with atrial fibrillation (AF). Rate and rhythm control are the two treatment strategies for AF and the effect of treatment strategy on risk of cognitive decline and frailty is not well established. We sought to determine how treatment strategy affects geriatric-centered outcomes. The Systematic Assessment of Geriatric Elements-AF (SAGE-AF) was a prospective, observational, cohort study. Older adults with AF were prospectively enrolled between 2016 and 2018 and followed longitudinally for 2 years. In a non-randomized fashion, participants were grouped by rate or rhythm control treatment strategy based on clinical treatment at enrollment. Baseline characteristics were compared. Longitudinal binary mixed models were used to compare treatment strategy with respect to change in cognitive function and frailty status. Cognitive function and frailty status were assessed with the Montreal Cognitive Assessment Battery and Fried frailty phenotype tools. 972 participants (mean age = 75, SD = 6.8; 49% female, 87% non-Hispanic white) completed baseline examination and 2-year follow-up. 408 (42%) were treated with rate control and 564 (58%) with rhythm control. The patient characteristics of the two groups were different at baseline. Participants in the rate control group were older, more likely to have persistent AF, prior stroke, be treated with warfarin and have baseline cognitive impairment. After adjusting for baseline differences, participants treated with rate control were 1.5 times more likely to be cognitively impaired over 2 years (adjusted OR: 1.47, 95% CI:1.12, 1.98) and had a greater decline in cognitive function (adjusted estimate: -0.59 (0.23), p < 0.01) in comparison to rhythm control. Frailty did not vary between the treatment strategies. Among those who had 2-year follow-up in non-randomized observational cohort, the decision to rate control AF in older adults was associated with increased odds of decline in cognitive function but not frailty.

Plasma oxysterols are associated with serum lipids and dementia risk in older women.

Apolipoprotein E4 (APOE4) carriers' tendency toward hypercholesterolemia may contribute to Alzheimer's disease (AD) risk through oxysterols, which traverse the blood-brain barrier. Relationships between baseline plasma oxysterols, APOE status, serum lipids, and cognitive impairment risk were examined in 328 postmenopausal women from the Women's Health Initiative Memory Study. Women were followed for 25 years or until incident dementia or cognitive impairment. Levels of 24(S)-hydroxycholesterol (24-OHC), 27-hydroxycholesterol (27-OHC), and 24-OHC/27-OHC ratio did not differ by APOE status (p's>0.05). Higher 24-OHC and 27-OHC were associated with higher total, low density lipoprotein (LDL), non-high density lipoprotein (HDL), remnant, LDL/HDL, and total/HDL cholesterol and triglycerides (p's<0.05). Higher 24-OHC/27-OHC was associated with greater dementia risk (hazard ratio=1.51, 95% confidence interval:1.02-2.22), which interaction analyses revealed as significant for APOE3 and APOE4+, but not APOE2+ carriers. Less favorable lipid profiles were associated with higher oxysterol levels. A higher ratio of 24-OHC/27-OHC may contribute to dementia risk in APOE3 and APOE4+ carriers.

Abstract P328: Hepatocyte Growth Factor and Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke (REGARDS)

Background: Cognitive impairment is a major public health burden in the U.S., and Black adults experience a disproportionate burden of cognitive impairment, including dementia. Hepatocyte growth factor (HGF) is a tyrosine kinase receptor MET agonist with neuroprotective properties, including peptide synthesis, neuronal regeneration, and inflammation reduction. Recombinant HGF aids endothelial repair and combats tissue fibrosis in mice. A positive HGF/MET pathway modulator (fosgonimeton) is in Phase 2 clinical trials for mild to moderate Alzheimer’s disease. We investigated the link between circulating HGF and incident cognitive impairment (ICI) in a national cohort study. Methods: REGARDS enrolled a cohort of 30,239 Black and White adults aged ≥45 in 2003-2007. ICI was identified using a 3-test battery administered every 2 years. Excluding participants with baseline cognitive impairment or stroke, with a mean follow-up of 3.5 years, 432 ICI cases and 520 controls were identified and HGF was measured in their baseline blood samples. Logistic regression estimated odds ratios (OR) of ICI by continuous HGF and also per quartile of HGF, controlling for known confounders. We assessed sex*HGF and race*HGF interactions on ICI. Restricted Cubic (RC) splines illustrated potential non-linear relationships. Results: Higher HGF was not associated with greater ICI risk in any model ( Figure ). There was no observed significant sex*HGF (P=0.58) or race*HGF interactions (P=0.19). RC splines visualized a possible non-linear relationship between lower HGF and higher risk of ICI relative to the median HGF level. Conclusions: In a prospective study of HGF in adults free from stroke or cognitive impairment, there was no clear association between higher HGF and ICI, though possible nonlinear associations might exist at low levels. This suggests that pharmaceuticals augmenting HGF pathways may benefit in primary prevention of ICI. Confirmatory studies are needed.

The impact of frailty on short-term prognosis in discharged adult stroke patients: A multicenter prospective cohort study

BackgroundFrailty is commonly observed in stroke patients and it is associated with adverse outcomes. However, there remains a gap in longitudinal studies investigating the causal relationship between baseline frailty and short-term prognosis in discharged adult stroke patients. ObjectiveTo examine the causal impact of frailty on non-elective readmission and major adverse cardiac and cerebral events, and investigate its associations with cognitive impairment and post-stroke disability. DesignA multicenter prospective cohort study. SettingTwo tertiary hospitals in Central and Northwest China. Participants667 adult stroke patients in stroke units were included from January 2022 to June 2022. MethodsBaseline frailty was assessed by the Frailty Scale. Custom-designed questions were utilized to assess non-elective readmission and major adverse cardiac and cerebral events as primary outcomes. Cognitive impairment, assessed using the Mini-Mental State Examination Scale (MMSE), and post-stroke disability, measured with the Modified Rankin Scale (mRS), were considered secondary outcomes at a 3-month follow-up. The impact of baseline frailty on non-elective readmission and major adverse cardiac and cerebral events was examined using bivariate and multiple Cox regression analyses. Furthermore, associations between baseline frailty and cognitive impairment, or post-stroke disability, were investigated through generalized linear models. ResultsA total of 5 participants died, 12 had major adverse cardiac and cerebral events, and 57 had non-selective readmission among 667 adult stroke patients. Frailty was an independent risk factor for non-selective readmission (hazard ratio [HR]: 2.71, 95 % confidence interval [CI]: 1.59, 4.62) and major adverse cardiac and cerebral events (HR: 3.77, 95 % CI: 1.07, 13.22) for stroke patients. Baseline frailty was correlated with cognitive impairment (regression coefficient [β]: −2.68, 95 % CI: −3.78, −1.58) adjusting for socio-demographic and clinical factors and follow-up interval. However, the relationship between frailty and cognitive impairment did not reach statistical significance when further adjusting for baseline MMSE (β: −0.39, 95 % CI: −1.43, 0.64). Moreover, baseline frailty was associated with post-stroke disability (β: 0.36, 95 % CI: 0.08, 0.65) adjusting for socio-demographic and clinical variables, follow-up interval, and baseline mRS. ConclusionsThe finding highlights the importance of assessing baseline frailty in discharged adult stroke patients, as it is significantly associated with non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability at 3 months. These results highlight the crucial role of screening and evaluating frailty status in improving short-term prognosis for adult stroke patients. Interventions should be developed to address baseline frailty and mitigate the short-term prognosis of stroke. Tweetable abstractBaseline frailty predicts non-elective readmission, major adverse cardiac and cerebral events, and post-stroke disability in adult stroke patients. @haiyanhexyyy

Gaps in cognitive care among older patients undergoing spine surgery.

Among older adults undergoing surgery, postoperative delirium is the most common complication. Cognitive impairment and dementia are major risk factors for postoperative delirium, yet they are frequently under-recognized. It is well established that applying delirium preventive interventions to at-risk individuals can reduce the likelihood of delirium by up to 40%. The aim of this study was to evaluate how often delirium preventive interventions are missing in patients at risk for delirium due to baseline cognitive impairment. We conducted a retrospective study using data from the observational study Perioperative Anesthesia Neurocognitive Disorder Assessment-Geriatric (PANDA-G) and clinical data from the University of California San Francisco delirium prevention bundle. Patients age 65+ received preoperative multidomain cognitive assessment as part of a research protocol prior to undergoing inpatient spine surgery at a single major academic institution. Results of the cognitive testing were not available to clinical teams. Using electronic medical records, we evaluated if patients who were cognitively impaired at baseline received delirium prevention orders, sleep orders, and avoidance of AGS Beers Criteria® potentially inappropriate medications. Of the 245 patients included in the study, 42% were women. The mean [SD] age was 72 [5.2] years. Preoperative cognitive impairment was identified in 40% of participants (N = 98), and of these, 34% had postoperative delirium. Of patients with preoperative cognitive impairment, 45% did not receive delirium preventive orders, 43% received PIMs, and 49% were missing sleep orders. At least one of the three delirium preventive interventions was missing in 70% of the patients. Undiagnosed preoperative cognitive impairment among older adults undergoing spine surgery is common. When cognitive test results were not available to clinicians, patients with baseline cognitive impairment frequently did not receive evidence-based delirium preventive interventions. These findings highlight an opportunity to improve perioperative brain health care via preoperative cognitive assessment and clinical communication.

Polygenic burden and its association with baseline cognitive function and postoperative cognitive outcome in temporal lobe epilepsy

ObjectiveDemographic and disease factors are associated with cognitive deficits and postoperative cognitive declines in adults with pharmacoresistant temporal lobe epilepsy (TLE), but the role of genetic factors in cognition in TLE is not well understood. Polygenic scores (PGS) for neurological and neuropsychiatric disorders and IQ have been associated with cognition in patient and healthy populations. In this exploratory study, we examined the relationship between PGS for Alzheimer’s disease (AD), depression, and IQ and cognitive outcomes in adults with TLE. Methods202 adults with pharmacoresistant TLE had genotyping and completed neuropsychological evaluations as part of a presurgical work-up. A subset (n = 116) underwent temporal lobe resection and returned for postoperative cognitive testing. Logistic regression was used to determine if PGS for AD, depression, and IQ predicted baseline domain-specific cognitive function and cognitive phenotypes as well as postoperative language and memory decline. ResultsNo significant findings survived correction for multiple comparisons. Prior to correction, higher PGS for AD and depression (i.e., increased genetic risk for the disorder), but lower PGS for IQ (i.e., decreased genetic likelihood of high IQ) appeared possibly associated with baseline cognitive impairment in TLE. In comparison, higher PGS for AD and IQ appeared as possible risk factors for cognitive decline following temporal lobectomy, while the possible relationship between PGS for depression and post-operative cognitive outcome was mixed. SignificanceWe did not observe any relationships of large effect between PGS and cognitive function or postsurgical outcome; however, results highlight several promising trends in the data that warrant future investigation in larger samples better powered to detect small genetic effects.

PLANNING AHEAD FOR POSTHOSPITALIZATION DISCHARGE NEEDS AMONG OLDER ADULTS

Abstract Frequently hospitalized older adults require assistance at discharge – either with transfer to a skilled nursing facility (SNF) or additional support at home. Our research has demonstrated that older adults can effectively plan ahead for their discharge needs (e.g., selecting SNFs) prior to hospitalization but some chose not to. Very little is known about what motivates older adults to plan. We sought to identify what variables impact older adults’ post-hospitalization planning. We surveyed a cohort of non-hospitalized adults age 65+ who received PlanYourLifespan.org (PYL), a tool to help older adults plan for their post-hospitalization needs, and then completed follow-up surveys at one month and every 6 months thereafter. Surveys inquire about their post-discharge plans if they were to be hospitalized, specifically rehabilitation/caregiver preferences. Multivariate logistic regression models adjusted for baseline hospitalization decision-making, sex, race, self-efficacy, living status, cognitive impairment, and PYL use. 293 subjects were enrolled (mean 73.5 yrs,40.4% non-White;12 mo. retention rate 94.5%). Subjects were more likely to have plans if they had increased chronic conditions (OR 1.23;p&amp;gt;0.05,1.02-1.47), increased medications (OR 1.15;p&amp;lt; 0.01,1.07-1.25), power of attorney (OR 1.84;p&amp;lt; 0.05,1.01-3.38), and used PYL (OR 2.61;p&amp;lt; 0.01,1.45-4.72). Subjects were more likely to have plans if they had higher medical complexity (OR 1.13 [p&amp;lt; 0.05, 1.03-1.24]), limited health literacy (OR 3.13 [p&amp;lt; 0.05, 1.25-7.81]), and used the PYL website (OR 1.72 [P&amp;lt; 0.05,1.00-2.93]) when asked about planning for future post-hospitalization requiring help in the home. Higher medical complexity, limited health literacy, and use of the planning website were associated with increased hospitalization discharge planning.

Risk factors for cognitive impairment and dementia after stroke: a systematic review and meta-analysis

Cognitive impairment and dementia are highly prevalent among stroke survivors and represent a major burden for patients, carers, and health-care systems. We studied the risk factors for post-stroke cognitive impairment (PSCI) and dementia (PSD) beyond the well established risk factors of age and stroke severity. In this systematic review and meta-analysis we conducted a systematic literature search from database inception until Sept 15, 2023. We selected prospective and retrospective cohort studies, post-hoc analyses from randomised controlled trials, and nested case-control studies of patients with acute stroke (ischaemic, haemorrhagic, and transient ischaemic attack), exploring associations between risk factors at baseline and PSCI or PSD over a follow-up period of at least 3 months. Study quality was assessed using the Newcastle-Ottawa quality assessment scale. We calculated pooled relative risks (RRs) with random-effects meta-analyses and performed subgroup, meta-regression, and sensitivity analyses. This study was preregistered with PROSPERO, CRD42020164959. We identified 162 eligible articles for our systematic review, of which 113 articles (89 studies, 160 783 patients) were eligible for meta-analysis. Baseline cognitive impairment was the strongest risk factor for PSCI (RR 2·00, 95% CI 1·66-2·40) and PSD (3·10, 2·77-3·47). We identified diabetes (1·29, 1·14-1·45), presence or history of atrial fibrillation (1·29, 1·04-1·60), presence of moderate or severe white matter hyperintensities (WMH; 1·51, 1·20-1·91), and WMH severity (1·30, 1·10-1·55, per SD increase) as treatable risk factors for PSCI, independent of age and stroke severity. For PSD, we identified diabetes (1·38, 1·10-1·72), presence of moderate or severe WMH (1·55, 1·01-2·38), and WMH severity (1·61, 1·20-2·14, per SD increase) as treatable risk factors. Additional risk factors included lower educational attainment, previous stroke, left hemisphere stroke, presence of three or more lacunes, brain atrophy, and low baseline functional status. Associations of risk factors with PSD were weaker in studies conducted and published more recently. We found substantial interstudy heterogeneity and evidence of reporting bias. Our results highlight the importance of cognitive impairment in the acute phase after stroke for long-term prediction of PSCI and PSD. Treatable risk factors include diabetes, atrial fibrillation, and markers of cerebral small vessel disease (ie, white matter hyperintensities and lacunes). Future trials should explore these risk factors as potential targets for prevention of PSCI and PSD. German Research Foundation.

Accordance to a MIND–Style Diet is Associated with Decreased Risk of Dementia Mortality in the REasons for Geographic and Racial Disparities in Stroke (REGARDS) Cohort

AbstractBackgroundThe Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) diet (high in nuts, seeds, vegetables, berries and low in meat, dairy, and butter) has been associated with reduced risk of dementia. However, no studies have examined the role of the MIND diet in a racially diverse population nor have there been studies that have examined the association of the MIND diet with dementia mortality.MethodWe examined data from Black and White adults (age 45‐98) in the US‐based REGARDS cohort. Dietary and covariate data were collected at baseline (2002‐2007). MIND diet score was created as described by other cohort studies (Table footnote). The primary outcome was dementia‐related mortality through December 31, 2020 from the National Death Index using ICD‐10 codes F00‐F03, G30, G31.0‐G31.1, and R54. Cox proportional hazards regression was used to model MIND diet score (in tertiles and as a continuous variable) and time to dementia death. To ensure robust association across sub‐groups, we tested for interactions of MIND diet with sex, race, age, obesity, history of stroke, and baseline cognitive impairment and adjusted for competing risks.ResultA total of 18,277 participants (mean age 64.9) had dietary data available to calculate the MIND diet score. MIND diet score was higher among females compared with males, White compared with Black participants, and college graduates. There were no differences in accordance by age. After a median of 12 years, participants with the highest MIND diet scores had the lowest risk of dementia death HR = 0.78 {95% CI; (0.66, 0.94)} comparing the 3rd tertile with the 1st tertile and after adjustment for age, race, sex, income, education, total energy, and other medical conditions (Table). This association was attenuated slightly when a competing risk analysis was considered HR = 0.84 {95%CI; (0.70, 1.00)}. There were no significant interactions observed.ConclusionThe MIND diet score is associated with dementia death in a large bi‐racial cohort in the US. This association is robust across race, age, and sex groups. Dietary interventions using the MIND diet may further clarify whether this association is causal and whether MIND diet may be an important tool in reducing rates of dementia.

Neurofilament Light and mean Free Water as prognostic enrichment biomarkers for cognitive worsening and small vessel disease progression

AbstractBackgroundPlasma neurofilament light (NfL) and free water (FW), a DTI‐derived measure, are considered, individually, sensitive markers of axonal damage that relate to cognition. A significant remaining challenge for clinical trials resides in identifying biomarkers able to detect, simultaneously, early SVD abnormalities and baseline cognitive impairment, particularly in non‐demented participants, who are also at risk of cognitive worsening and SVD progression during the trial.MethodThis study includes 200 non‐demented individuals from the MarkVCID‐UH3 cohort who had baseline NfL and baseline and follow‐up (1.3±0.5 years) cognitive assessment and MRI (Table 1). We used a composite measure of global cognitive function (GCF) using scores from the NACC‐UDS. WMH volumes were log‐transformed and corrected for intracranial volume. Annual change (Δ) in GCF and WMH was computed using baseline and follow‐up measures. A threshold, determined from 3 independent cohorts, was applied to FW measures to group individuals (low: &lt;0.22 and high &gt; = 0.22). Low and high NfL levels were defined using age‐based NfL z‐scores (low←0.5SD and high&gt; = ‐0.5SD). We finally grouped individuals with both high NfL and FW levels (MULTIBIO+) vs. individuals with at least one biomarker with low level (MULTIBIO‐). We used linear regressions with either baseline GCF, baseline WMH, ΔGCF or ΔWMH as the dependent variable and, separately, baseline FW, NfL and MULTIBIO as the independent variable. Analyses were adjusted for relevant confounding variables.ResultsWe found that, as compared with MULTIBIO‐, MULTIBIO+ group had significantly lower baseline GCF and higher baseline WMH (p = 0.033 and p&lt;0.001), as well as accelerated ΔGCF and larger ΔWMH (pvalues&lt;0.01, Table 2, Figure 1). Individually, although FW was associated with baseline WMH and accelerated ΔGCF, neither FW nor NfL levels simultaneously explained baseline cognition and SVD burden, or simultaneous ΔGCF and ΔWMH (Table 2).ConclusionThese findings emphasize the potential of combining NfL and FW measures as a prognostic enrichment biomarker panel for identifying individuals with both early SVD abnormalities and cognitive impairment and who are also at risk of cognitive worsening and substantial SVD burden progression during clinical trials.Data collection and sharing for this project was funded by NINDS/NIA as part of the MarkVCID Consortium (U24NS100591, UH2NS100599, UH2NS100605, UH2NS100588, UH2NS100608, UH2NS100606, UH2NS100598, UH2NS100614)

COGNITIVE IMPAIRMENT AFTER THE DIAGNOSIS OF LATE‐ONSET EPILEPSY ‐ A SYSTEMATIC REVIEW

AbstractBackgroundThe management of late‐onset epilepsy in older people (LOE) is often suboptimal despites its high incidence. The impact of LOE is not only epileptic, it also leads to multiple consequences, such as cognitive decline, and other geriatric syndromes. Cognitive decline, as one of the major consequences of LOE, causes in turn deterioration in quality of life and loss of autonomy. However, the effect of de novo LOE on cognitive decline without dementia in older people remains poorly understood. Similarly, very few studies have analysed the risk factors associated with cognitive decline. Therefore, we conducted a systematic review to describe the long‐term effect on cognition of LOE on older people, including the incidence of cognitive decline after the diagnosis of LOE and the associated risk factors.MethodAccording to PRISMA 2020 guidelines, we searched 5 electronic databases (“EMBASE”, “Medline”, “CINAHL”, “PsycINFO”, “Web of Science”) for articles published until 27th Oct 2022. The criteria selected were patients “60 years old and older” with “late onset epilepsy” diagnosis and “cognitive decline” or “cognitive impairment”, whom do not have known brain tumor or a posttraumatic etiology. Four researchers independently screened studies based on the title and abstract, then by full text. Data extraction was done through “Covidence” platform with each study being processed by two reviewers and conflicts were solved by a third reviewer.ResultWe selected 26 out of 326 initially retrieved publications based on full text review. Most of the studies conducted so far however did not take into consideration or did not control for the baseline cognitive status of their patients before or at the onset of epilepsy and therefore could not objectively determine the real burden of late onset epilepsy on cognitive impairment in this population.ConclusionData in favour of a causal relationship between late onset epilepsy and cognitive decline in elderly with no known baseline cognitive impairment is still precarious. More studies should be conducted with more specific assessment tools that could permit us to have a better estimate of the burden of LOE on cognition such for example imaging and neuropsychological assessment before and after the incidence of epilepsy.

Abstract 17744: Intracranial Atherosclerosis Disease (ICAD) and Risk of Cognitive Impairment and Dementia: Systematic Review and Meta-Analysis

Introduction: Intracranial atherosclerosis disease (ICAD) alters cerebrovascular hemodynamics and is linked with brain structural changes and atrophy. Various studies evaluated the relationship between ICAD and risk of cognitive impairment with mixed results. This study aims to systematically review the current evidence and compile data on the association between ICAD and cognitive impairment and dementia. Methods: PubMed, EMBASE, PsycInfo and Web of Science were searched from January 1-2000, to March 1-2023, without language restriction. Cross-sectional and prospective cohort studies as well as post-mortem studies were included. Studies containing data on the link between ICAD and cognitive impairment and dementia were screened by two independent reviewers for inclusion in a systematic review and meta-analysis. From each study, data on the association between ICAD (at least 50% stenosis in one intracranial vessel) and cognitive impairment and dementia were extracted. Results: A total of 22 (17 observational and 5 post-mortem) unique studies comprising 11,184 individuals (average age range: 59.8 to 87.6 years, 45.7% female, 36.5% Asian) were included in the systematic review. Seven out of 10 cross-sectional studies and 5 out of 7 prospective studies showed a significantly higher risk of cognitive impairment and dementia in association with ICAD.Population-based studies and studies with patients with baseline cognitive impairment or dementia (consist of study participants from Asian, Europe and North America) consistently showed a significant association between ICAD and risk of cognitive decline. In the pooled analysis, ICAD was associated with 1.87-fold (95% confidence interval 1.49-2.35) increased risk of cognitive impairment. Meta-regression analysis did not show a significant impact of age, sex and ethnicity on the findings. All post mortem studies have shown that patients with Alzheimer’s disease and vascular dementia had a higher burden of ICAD as compared to cognitively normal controls. Conclusions: ICAD is associated with a higher risk of cognitive impairment and dementia in various age, sex and ethnic groups. Our findings underscore the importance of intracranial vascular health in brain health and prevention of dementia.

Associations of baseline obstructive sleep apnea and sleep macroarchitecture with cognitive function after 8 years in middle-aged and older men from a community-based cohort study.

Previous prospective studies examining associations of obstructive sleep apnea and sleep macroarchitecture with future cognitive function recruited older participants, many demonstrating baseline cognitive impairment. This study examined obstructive sleep apnea and sleep macroarchitecture predictors of visual attention, processing speed, and executive function after 8 years among younger community-dwelling men. Florey Adelaide Male Ageing Study participants (n = 477) underwent home-based polysomnography, with 157 completing Trail-Making Tests A and B and the Mini-Mental State Examination. Associations of obstructive sleep apnea (apnea-hypopnea index, oxygen desaturation index, and hypoxic burden index) and sleep macroarchitecture (sleep stage percentages and total sleep time) parameters with future cognitive function were examined using regression models adjusted for baseline demographic, biomedical, and behavioural factors, and cognitive task performance. The mean (standard deviation) age of the men at baseline was 58.9 (8.9) years, with severe obstructive sleep apnea (apnea-hypopnea index ≥30 events/h) in 9.6%. The median (interquartile range) follow-up was 8.3 (7.9-8.6) years. A minority of men (14.6%) were cognitively impaired at baseline (Mini-Mental State Examination score <28/30). A higher percentage of light sleep was associated with better Trail-Making Test A performance (B = -0.04, 95% confidence interval [CI] -0.06, -0.01; p = 0.003), whereas higher mean oxygen saturation was associated with worse performance (B = 0.11, 95% CI 0.02, 0.19; p = 0.012). While obstructive sleep apnea and sleep macroarchitecture might predict cognitive decline, future studies should consider arousal events and non-routine hypoxaemia measures, which may show associations with cognitive decline.

Association between body mass index and cognitive impairment in Chinese older adults

BackgroundThe association between body mass index (BMI) and the risk of cognitive impairment remains uncertain. Relatively few studies have analyzed the dose–response relationship between BMI and cognitive impairment. This article utilized nationally representative longitudinal data to assess the association between BMI and cognitive impairment in Chinese older adults.ObjectiveThe present study aimed to analyze the association between BMI and cognitive impairment in Chinese older people, including an investigation of gender differences and the dose–response relationship.MethodsData were obtained from the China Health and Retirement Longitudinal Study database in 2015 and 2018. The present study used logistic regression to analyze the relationship between baseline BMI and cognitive impairment, and adopted a restricted cubic spline model to plot dose–response curves for baseline BMI and prevalence of risk of cognitive impairment.ResultsThe mean BMI of the survey population was 23.48 ± 3.66 kg/m2, and the detection rate of cognitive impairment was 34.2%. Compared to the normal weight group (18.5 ≤ BMI &amp;lt; 23.9 kg/m2), the odds ratio (OR) for cognitive impairment was 1.473 (95% CI: 1.189–1.823) in the underweight group (BMI &amp;lt; 18.5 kg/m2), whereas the corresponding OR was 0.874 (95% CI: 0.776–0.985) for the overweight or obese group (BMI ≥ 24.0 kg/m2) after adjusting for confounders. Gender subgroup analysis showed that overweight or obese older women were less likely to develop cognitive impairment (OR = 0.843; 95% CI: 0.720–0.987). The results of the restricted cubic spline analysis revealed a curvilinear L-shaped relationship between BMI and the risk of cognitive impairment (P non-linearity &amp;lt;0.05). In particular, the risk of cognitive impairment was higher at a lower baseline BMI. In contrast, BMI in the range of 23.2–27.8 kg/m2 was associated with a decreased risk of cognitive impairment.ConclusionBMI is a dose-dependent related factor for cognitive impairment in Chinese older adults. Being underweight is a risk factor for the development of cognitive impairment, while being overweight or obese is less likely to have cognitive impairment, particularly in female older people. Keeping BMI ranging from 23.2–27.8 kg/m2 in older adults can help maintain cognitive function.

Temporal course of cognitive and behavioural changes in motor neuron diseases

BackgroundCognitive and behavioural dysfunction may occur in people with motor neuron disease (MND), with some studies suggesting an association with the C9ORF72 repeat expansion. Their onset and progression, however, is...

42 Resolution of delirium upon discharge &amp; mortality rates among frail older persons attending an Emergency Department frailty service

Abstract Background Delirium is an acute confusional state, frequently associated with older hospitalised patients and has been found to be related to several adverse outcomes including longer length of stay and mortality. Better baseline cognition has been linked with a lower risk of delirium however those with high baseline cognition may experience greater cognitive decline post delirium. Methods We undertook a retrospective study of 92 patients who attended the Frailty service in the Emergency Department between 01/01/2023 and 31/01/2023. We screened for delirium using the 4AT within 12 hours of presentation to the ED and collected additional data collected to define baseline cognitive status, delirium resolution, and length of stay and discharge disposition. Results Delirium prevalence in this cohort was estimated at 22%. Overall delirium had resolved for our patients at discharge in 56% of cases. In the cognitively intact at baseline group (29%) delirium had resolved at discharge in 33% of cases only. For patients with baseline cognitive impairment (71%) delirium had resolved in 50% of cases. The mortality rate for patients with delirium was 14% with average CFS of 6. All patients who died had cognitive impairment at baseline. The mortality rate for patients without delirium was 1.4%. Length of stay ranged from 0 to 80 days. Length of stay for patients with delirium &amp; baseline cognitively intact was 39 days. Length of stay for patients with delirium and baseline cognitively impaired was 8 days. Conclusion Two thirds of patients who were cognitively intact at baseline experienced longer length of stays &amp; non resolution of delirium at discharge. There may be a need for dedicated follow up of these patients post-acute discharge. There was a higher mortality rate for patients with delirium and baseline cognitive impairment. Future studies may address illness acuity, delirium severity and duration &amp; emergency department length of stay as influencers on mortality rate.

41 Prevalence of delirium among older patients attending a Frailty service in an Emergency Department

Abstract Background Delirium is a common clinical syndrome in older patients attending the emergency department and its incidence increases with patient age, disease severity and baseline cognitive impairment. However delirium is frequently unrecognised in emergency departments. The 4AT is a simple and short delirium detection tool designed for easy and effective clinical use. Early proactive recognition of delirium in the ED may improve outcomes such as length of stay and discharge to patients own home. Methods We undertook a retrospective study of 92 patients who attended the Frailty service in the ED between 01/01/2023 and 31/01/2023. We screened for delirium using the 4AT within 12 hours of presentation to the ED and screened for frailty using the CFS with additional data collected to define age, sex, presenting complaint, length of stay and readmission rates. Results The 4AT was completed for 92/94 patients. 21/94 scored positive for delirium indicating a delirium prevalence rate of 22% among our Frailty service cohort. The average age of the patients was 84 years and 57% were female. Clinical Frailty Scale ranged from CFS 4–7 reflective of service parameters. The primary presenting reasons were fall (38% of patients) and infection (LRTI or UTI) for (38% of patients). The average length of stay was 8 days and the readmission rate was 12%. Baseline cognitive impairment was present in 71% of cases. 53% of patients were discharged to their own homes. Conclusion Delirium prevalence in the ED among frail older persons is 22%. The 4AT is a useful tool to quickly detect delirium in the ED. Delirium prevalence is greater in patients with baseline cognitive impairment.

Epidemiology & management of complex ankle fractures in the United Kingdom: A multicentre cohort study

BackgroundPatient factors are known to contribute to decision making and treatment of ankle fractures. The presence of poor baseline mobility, diabetes, neuropathy, alcoholism, cognitive impairment, inflammatory arthritis or polytrauma can result in a higher risk of failure or complications. Limited evidence is available on the optimum management for this challenging cohort of patients herein described as complex ankle fractures. This UK multicentre study assessed and evaluated the epidemiology of ankle fractures complicated by significant comorbidity and patient factors and use of specialist surgical techniques such as hindfoot nails (HFN) / tibiotalarcalcaneal (TCC) nails and enhanced open reduction and internal fixation (ORIF). Patients and MethodsA UK-wide collaborative study was performed of adult distal AO43/AO44 fractures, associated with 1 or more of the patient factors listed above. Primary outcomes included patient demographics, comorbidities, surgical technique and implants. Secondary outcomes included surgical complications and early post-operative weight bearing instructions. Statistical analysis was performed to assess patient and fracture characteristics on outcome, including propensity matching. ResultsOne-thousand three hundred and sixty patients, with at least one of the above complex factors, from 56 centres were included with a mean age of 53.1 years. 90.2% (1227) patients underwent primary fixation which included 78.9% (1073) standard open reduction internal fixations (ORIF), 3.25% (43) extended ORIF and 8.1% (111) primary HFN / TCC. Overall wound complications and thromboembolic events were similar in the hindfoot nail group and the ORIF group (11.7% vs 10.7%). Wound complications were greater in diabetic patients versus non-diabetic patients independent of fixation method (15.8% vs 9.0%). After propensity matching for comorbidities and fracture type, overall complications were lower in the hindfoot nail (11.8%) and extended ORIF groups (16.7%), than the standard ORIF group (18.6%). ConclusionOnly a minority of complex ankle fractures are treated with specialised techniques (HFN/TCC or extended ORIF). Though more commonly used in older and frail patients their perceived advantages are often negated by a reluctance to bear weight early. These techniques demonstrated a better complication profile to standard ORIF but hindfoot nail with joint preparation for fusion was associated with more complications than hindfoot nail for fixation. Level of Evidence: III

Incident sarcopenia in hospitalized older people: A systematic review.

Hospitalization has been associated with the development of sarcopenia. This study aimed to examine the new incidences of hospital sarcopenia, associated risk factors and health outcomes, as defined by internationally recognized diagnostic criteria in hospitalized older people. Pre-defined search terms were run through five databases. Six studies that assessed sarcopenia on two separate time points during hospitalization on older inpatients were included. Prevalence of sarcopenia varied from 14.1% to 55% depending on diagnostic criteria and cut-off points used. New sarcopenia occurred between 12% to 38.7% patients following hospitalization. Risk factors were older age, longer duration of bed rest, lower baseline body mass index, cognitive impairment and activities of daily living disability. None of the studies reported health outcomes associated with newly developed sarcopenia in hospital.