Chinese Mini-Mental State Examination Research Articles

Dynamic relations between longitudinal morphological, behavioral, and emotional indicators and cognitive impairment: evidence from the Chinese Longitudinal Healthy Longevity Survey

BackgroundWe aimed to assess the effects of body mass index (BMI), activities of daily living (ADL), and subjective well-being (SWB) on cognitive impairment and propose dynamic risk prediction models for aging cognitive decline.MethodsWe leveraged the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2018. Cognitive status was measured using the Chinese Mini-Mental State Examination. We employed repeated measures correlation to assess associations, linear mixed-effect models to characterize the longitudinal changes, and Cox proportional hazard regression to model survival time. Dynamic predictive models were established based on the Bayesian joint model and deep learning approach named dynamic-DeepHit. Marginal structural Cox models were adopted to control for time-varying confounding factors and assess effect sizes.ResultsADL, SWB, and BMI showed protective effects on cognitive impairment after controlling observed confounding factors, with respective direct hazard ratios of 0.756 (0.741, 0.771), 0.912 (0.902, 0.921), and 0.919 (0.909, 0.929). Dynamic risk predictive models manifested high accuracy (best AUC = 0.89). ADL was endowed with the best predictive capability, although the combination of BMI, ADL, and SWB showed the most remarkable performance.ConclusionsBMI, ADL, and SWB are protective factors for cognitive impairment. A dynamic prediction model using these indicators can efficiently identify vulnerable individuals with high accuracy.

Contribution of social activity participation to the relationship between sensory impairment, physical performance and cognitive decline: a longitudinal study in China

ObjectivesThis study examined the impact of sensory impairment (hearing and/or vision) combined with poor physical performance on cognitive decline and assessed whether social activity participation mediated this relationship.MethodsMultilevel models were used to explore the relationships between sensory impairment, physical performance, their combination, and cognitive decline. A multilevel mediation model analyzed the mediating effect of social activity participation. The study included 10,149 adults aged 45 and older (mean age 53.84) from five waves (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS). The exposure variable, body function (BF), was categorized into six groups based on sensory impairment and physical performance. Cognitive function was measured using an adapted Chinese Mini-Mental State Examination (MMSE).ResultsCompared to BF group 1 (normal physical performance without sensory impairment), individuals in BF group 4 (low physical performance without sensory impairment) (β = −0.670, P < 0.001), BF group 5 (low physical performance with single sensory impairment) (β = −1.029, P < 0.001), and BF group 6 (low physical performance with dual sensory impairment) (β = −1.630, P < 0.001) showed worse cognitive function. Only BF group 4 (β = −0.670, P < 0.001) had a faster cognitive decline. Mediation analysis revealed a significant indirect effect of social activity participation on cognitive function in BF group 4 (β = −0.03, P < 0.01, mediation proportion: 4.32%).ConclusionThe combined effect of sensory impairment and low physical performance on cognitive decline may be accumulative, and social activity participation could mitigate this effect. Prioritizing social activity participation is crucial for health professionals and policymakers.

A Comparative Study of Three Dementia Screening Instruments (CSI-D, CMMSE, and ECAQ) in a Multi-Ethnic Asian Population

Background—There is no validated dementia screening tool for multi-ethnic Asian populations comprising Chinese, Malays, and Indians. This study aimed to establish the psychometric properties of the Community Screening Instrument for Dementia (CSI-D), Chinese Mini Mental State Examination (CMMSE), and Elderly Cognitive Assessment Questionnaire (ECAQ) in multi-ethnic Singapore. Methods—Participants were randomly drawn from a community-based neurological diseases study of older adults conducted in Singapore, with oversampling to allow similar subject numbers from the three major ethnicities: Chinese, Malay, and Indian. The CSI-D, CMMSE, and ECAQ were administered by trained research nurses using a standardised translated questionnaire in a language the participant was most conversant in. Participants were independently diagnosed as a case/non-case of dementia using the DSM-IV. Results—There were 259 participants (85 Chinese, 85 Malays, and 89 Indians, mean age 70.15 years, 65.4% female, 58.8% had no/minimal formal education); 22.8% (n = 59) had dementia. Correlations between the measures were substantial. All the measures had acceptable overall discriminative abilities. Diagnostic accuracies of the instruments did not differ across the ethnic groups. Effects of education were present in the cognitive screening measures. Conclusions—The CSI-D, CMMSE, and ECAQ are valid dementia instruments in this multi-ethnic Asian setting.

Validating the Centre of Excellence on Longevity Self-AdMinistered (CESAM) Questionnaire: An Online Self-Reported Tool for Frailty Assessment of Older Adults.

Subjective health measures are often used to assess frailty, but the validity of self-reported online tools to identify frailty remains to be established. We aimed to assess concurrent, known-groups, convergent and predictive validity of the Centre of Excellence on Longevity Self-AdMinistered (CESAM) questionnaire for frailty assessment of older adults in an outpatient setting. Cross-sectional analysis of 120 participants. Participants of age ≥65 were recruited from an outpatient geriatric clinic. Individuals who had severe neurological, cognitive, or motor deficits were excluded. We assessed concurrent validity with area under receiver operating characteristic curve (AUC) against the Frailty Index (FI) and Clinical Frailty Scale (CFS). We analyzed known-groups validity between CESAM scores with frailty status (CFS and FI), Modified Barthel Index (MBI), and modified Chinese Mini-Mental State Examination (mCMMSE) using 1-way analysis of variance. We evaluated convergent validity using correlations with MBI, the Lawton index, mCMMSE, and Geriatric Depression Scale (GDS). Associations between CESAM-identified frailty for clinician-diagnosed geriatric syndromes, and health-related quality of life (HRQoL) was analyzed using regression analysis. The CESAM questionnaire demonstrated excellent diagnostic performance for frailty using FI ≥0.25 (AUC= 0.88; 95% CI: 0.82-0.94; P < .001) and CFS ≥4 (AUC= 0.78; 95% CI: 0.68-0.88; P < .001). CESAM scores increased significantly with increasing frailty (both CFS and FI), lower MBI, and lower mCMMSE scores (all P < .001), indicating concurrent validity. The moderate-good correlation of CESAM scores with MBI (r=-0.61; P < 0.001), Lawton Index (r=-0.54; P < .001), mCMMSE (r=-0.53; P < .001) and GDS (r= 0.58; P < .001) supports convergent validity. Using a cutoff of ≥8 for frailty identification, CESAM-identified frailty was associated with cognitive impairment (OR= 3.7; 95% CI: 1.7-8.2; P= .001) depression (OR= 4.0; 95% CI: 1.7-9.6; P= .002), falls (OR= 3.1; 95% CI: 1.2-8.2; P= .021) and poorer HRQoL (β=-0.1; 95% CI:-0.2 to-0.02; P= .017). Our results support the validity of an online self-reported tool to identify frailty and geriatric syndromes in an outpatient setting, an approach that is potentially applicable for remote screening of frailty.

Turning Point of Cognitive Decline for Chinese Older Adults from a Longitudinal Analysis: Protective Factors and Risk Factors.

To explore the turning point of cognitive decline in Chinese older adults and to explore the influencing factors including covariates. Aged 65 and older whose cognitive function was normal at their first test. a secondary analysis that identified participants from the database of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cohort-sequential design was used to categorize the data by age (rather than study wave), including the follow-up data of Chinese older adults aged 65-79 years and spanning 14 years. Cognitive function in 1278 participants was assessed using the Chinese Mini-Mental State Examination (CMMSE) in five waves over 14 years. Piecewise latent growth curve modeling was used to analyze the data. (1) The turning point of cognitive decline in Chinese older adults occurs between the ages of 68 and 70. (2) There are statistically significant individual differences in the initial level of cognitive function and the growth rate of cognitive function before and after the transition stage. (3) Factors influencing cognitive function include residence, education level, smoking, drinking, exercise, leisure activities, social activities, Activities of Daily Living (ADL), and Instrumental Activities for Daily Living (IADL). (4) Exercise and ADL are the main protective factors, while smoking and drinking are the main risk factors. There is a transition stage (68-70) in the decline of cognitive function in Chinese older adults and four main factors (such as smoking, drinking, exercise and ADL) have impacts on the cognitive decline. We should strengthen these protective factors (exercise and ADL) for the cognitive decline of older adults and avoid these risk factors (smoking, drinking). To prevent the decline of the cognitive function of older adults, the government should build more places conducive to activities for older adults and actively encourage older adults to improve their physical activity level. Given our findings, public health interventions centered on alcohol and tobacco cessation in older adults should be governmentally endorsed.

Urban-Rural Disparity in Cognitive Performance Among Older Chinese Adults: Explaining the Changes From 2008 to 2018.

ObjectivesThis study aims to identify the dynamic changes in cognitive performance differentials between urban and rural older adults in China from 2008 to 2018 and decomposes determinants affecting such changes.MethodsTwo waves (2008 and 2018) of data were extracted from the Chinese Longitudinal Healthy Longevity Survey. The cognitive function was tested using the Chinese Mini-Mental State Examination (MMSE). The effects of the explanatory variables (demographic, economic, neighborhood, environmental events and social and cultural domains) on the changes in the urban-rural inequality of cognitive performance were divided into two components using the Juhn–Murphy–Pierce (JMP) decomposition: quantity effect and price effect.ResultsA total of 14,628 (urban respondents: 5,675, rural respondents: 8,953) and 10,311 older adults (urban respondents: 5,879, rural respondents: 4,432) for 2008 and 2018, respectively, were included in our study. A narrowing of 0.071 in the urban-rural disparity in cognitive function score of the older adults from 2008 to 2018 was identified. Quantity and price effects of explanatory variables contributed 65.21 and 46.84%, respectively, to the observed components in explaining the narrowed disparity. Quantity effects of age (35.71%), exercise (56.72%), self-rated economic status (33.19%) and price effect of homeownership (54.97%) contributed significantly to the reduced urban-rural gap. Contrastingly, inequality in pension (−27.31%) and social security (−23.11%) between urban and rural widened cognitive performance differentials. Furthermore, effects of hunger in childhood (−10.53%) and less years of schooling (−77.20%) on the increase in urban-rural inequality seemed to be stronger over time.ConclusionEconomic development and reform of the rural health system are responsible for the decline in the urban-rural disparity in the cognitive performance of older adults. Equalizing the distribution of social security and welfare between urban and rural must be highlighted for eliminating cognitive ability disparity. Additionally, rural older adults who endured hunger and poor education in childhood also deserve further policy interventions.

Cognitive Assessment by Telemedicine: Reliability and Agreement between Face-to-Face and Remote Videoconference-Based Cognitive Tests in Older Adults Attending a Memory Clinic.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has spurred the rapid adoption of telemedicine. However, the reproducibility of face-to-face (F2F) versus remote videoconference-based cognitive testing remains to be established. We assessed the reliability and agreement between F2F and remote administrations of the Abbreviated Mental Test (AMT), modified version of the Chinese Mini-Mental State Examination (mCMMSE), and Chinese Frontal Assessment Battery (CFAB) in older adults attending a memory clinic.MethodsThe participants underwent F2F followed by remote videoconference-based assessment by the same assessor within 3 weeks. Reliability was evaluated using intraclass correlation coefficients (ICC; two-way mixed, absolute agreement), the mean difference between remote and F2F-based assessments using paired-sample t-tests, and agreement using Bland-Altman plots.ResultsFifty-six subjects (mean age, 76±5.4 years; 74% mild; 19% moderate dementia) completed the AMT and mCMMSE, of which 30 completed the CFAB. Good reliability was noted based on the ICC values—AMT: ICC=0.80, 95% confidence interval [CI] 0.68–0.88; mCMMSE: ICC=0.80, 95% CI 0.63–0.88; CFAB: ICC=0.82, 95% CI 0.66–0.91. However, remote AMT and mCMMSE scores were higher compared to F2F—mean difference (i.e., remote minus F2F): AMT 0.3±1.1, p=0.03; mCMMSE 1.3±2.9, p=0.001. Significant differences were observed in the orientation and recall items of the mCMMSE and the similarities and conflicting instructions of CFAB. Bland–Altman plots indicated wide 95% limits of agreement (AMT -1.9 to 2.6; mCMMSE -4.3 to 6.9; CFAB -3.0 to 3.8), exceeding the a priori-defined levels of error.ConclusionWhile the remote and F2F cognitive assessments demonstrated good overall reliability, the test scores were higher when performed remotely compared to F2F. The discrepancies in agreement warrant attention to patient selection and environment optimization for the successful adaptation of telemedicine for cognitive assessment.

Associations of Sarcopenia, Handgrip Strength and Calf Circumference with Cognitive Impairment among Chinese Older Adults

ObjectiveTo evaluate the associations of sarcopenia, handgrip strength and calf circumference with cognitive impairment among Chinese older adults. MethodsTotally 2,525 older adults were recruited from the Healthy Aging and Biomarkers Cohort Study. Cognitive impairment was assessed by the Chinese Mini-Mental State Examination. Handgrip strength was calculated from the means of the right and left hand values. Calf circumference was measured at the site of maximum circumference of the non-dominant leg. The formula developed by Ishii was used to define sarcopenia. Multiple logistic regression was performed to evaluate the associations of sarcopenia, handgrip strength, and calf circumference with cognitive impairment. ResultsThe prevalence of cognitive impairment was 34.36%. The adjusted odds ratio (OR) for cognitive impairment in individuals with sarcopenia was 2.55 [95% confidence interval (95% CI): 1.86–3.50]. Compared with individuals in the first quartile (Q1) of calf circumference, the adjusted ORs in the second, third, and fourth quartiles (Q2, Q3, and Q4) were 0.75 (95% CI: 0.58–0.96), 0.59 (95% CI: 0.44–0.79), and 0.62 (95% CI: 0.45–0.8), respectively. Compared with individuals in Q1 of handgrip strength, the adjusted ORs for Q2, Q3, and Q4 were 0.49 (95% CI: 0.38–0.62), 0.31 (95% CI: 0.23–0.41), and 0.30 (95% CI: 0.21–0.44), respectively. ConclusionSarcopenia, identified by low handgrip strength and low calf circumference, was positively associated with cognitive impairment.

Combined Impact of Positive Screen for Sarcopenia and Frailty on Physical Function, Cognition and Nutrition in the Community Dwelling Older Adult.

BackgroundWhile sarcopenia and frailty independently contribute to functional impairment and disability, the combined impact resulting from their interplay is unclear. We investigated if functional, physical, cognitive, and nutritional measures were more adversely affected in community-dwelling older adults who were screened positive for both frailty and sarcopenia.MethodsUsing the FRAIL (≥1) and SARC-F (Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls) (≥1) scales for screening, we categorized 200 participants (age, 67.9±7.9 years) as combined (both positive, 12.5%), intermediate (either positive, 25.5%), or robust (both negative, 62%). ResultsComparisons of the three groups showed that the combined group had significantly worse functional ability (Frenchay Activities Index and Modified Barthel Index), physical performance (knee extension, gait speed, and Short Physical Performance Battery score), cognition/mood (Chinese Mini-Mental State Examination [CMMSE] score and Geriatric Depression Scale), and nutrition (Mini Nutritional Assessment [MNA] score) (p<0.05, one-way analysis of variance). Post-hoc comparisons revealed similar findings between the combined and robust groups, except for knee extension and CMMSE scores. Only MNA scores were significantly lower between the intermediate and robust groups. ConclusionFunctional ability, physical performance, and nutrition were more adversely affected in our study population of community-dwelling older adults who screened positive for both frailty and sarcopenia than in those who screened positive for either or neither, supporting the use of community screening for early detection and intervention for both frailty and sarcopenia as opposed to either alone.

The Impact of the COVID-19 Pandemic on Alzheimer's Disease and Other Dementias.

Introduction: Numerous countries went into lockdown to contain the COVID-19 outbreak, which has impeded follow-up of chronic diseases, such as cognitive impairment (CI). Cognitive and neuropsychiatric changes during the COVID-19 pandemic are neglected in China, which is the world's whistleblower. To investigate the cognitive and neuropsychologic changes in CI, as well as the proportions of rapid cognitive decline (RCD) before and during the COVID-19 pandemic to provide clinical evidence for CI intervention during a public health emergency.Methods: We performed a descriptive and retrospective study based on medical records from the memory clinic of Tianjin Dementia Institute collected through face-to-face evaluations. Information of 205 patients with CI, including patients with mild cognitive impairment and dementia, of whom 131 with Alzheimer's disease (AD) were analyzed and compared to a control group before the COVID-19 pandemic.Results: Among the 205 CI patients, the scores on the Chinese Mini Mental State Examination (C-MMSE), the Montreal Cognitive Assessment (MoCA), activities of daily living (ADLs), and the global Neuropsychiatric Inventory (NPI) were significantly different at the baseline and follow-up evaluations (p < 0.05) after 14.07 (±2.87) months. The same findings were recorded among AD patients, and they exhibited more sleep disturbances at the follow-up than at baseline (32.8 vs. 20.6%, p = 0.035). When compared to the control group, slightly worse performance of cognitive, −1.00 (−4.00, 1.00) from the C-MMSE, −1.00 (−2.00, 0.00) on the MoCA, 1.00 (0.00, 9.00) on ADLs and neuropsychological 0.00 (−1.00, 3.50) on the global NPI profile, at the follow-up were presented, particularly for delusion, agitation, irritability, and appetite disturbances (p < 0.05). Twenty-five (19.1%) AD patients and 48 (36.6%) controls suffered RCD during the COVID-19 pandemic. Moreover, AD patients during the COVID-19 pandemic were 0.408 times (95% confidence interval: 0.232–0.716) less likely to suffer RCD than the control.Conclusion: Confinement might ease the cognitive and neuropsychiatric deterioration of AD patients compared to those not in crisis and help prevent RCD in AD patients.

Duration of Poverty and Subsequent Cognitive Function and Decline Among Older Adults in China, 2005-2018.

To investigate the relationship between late-life duration of poverty exposure and cognitive function and decline among older adults in China. Data were from 3,209 participants ≥64 years of age in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Duration of poverty, defined according to urban and rural regional standards from the China Statistical Yearbook, was assessed according to annual household income from 2005 to 2011 (never in poverty; one-third of the period in poverty; two-thirds or more of the period in poverty). Cognitive function was measured by the Chinese Mini-Mental State Examination (CMMSE) from 2011 to 2018. We used attrition-weighted, multivariable mixed-effects Tobit regression to examine the association of duration of poverty with cognitive function and rate of decline. A total of 1,162 individuals (36.21%) were never in poverty over the period from 2005 to 2011; 1,172 (36.52%) were in poverty one-third of the period; and 875 (27.27%) were in poverty two-thirds or more of the period. A longer poverty duration was associated with lower subsequent CMMSE scores with a dose-response relationship (one-third vs never in poverty: β = -0.98; 95% confidence interval -1.61 to -0.35; two-thirds or more vs never in poverty: β = -1.55; 95% confidence interval -2.29 to -0.81). However, a longer duration of poverty was associated with a slower rate of CMMSE score decline over time from 2011 to 2018. These findings provide valuable evidence for the role of cumulative late-life poverty in relation to cognitive health among older adults in a rapidly urbanizing and aging middle-income country. Our findings may support a compensation hypothesis for cognitive reserve in this setting.

Association of blood uric acid and cognitive impairment in oldest-old aged 80 years and older in 9 longevity areas of China

Objective: To examine the association of blood uric acid (UA) and cognitive impairment (CI) among oldest-old adults in China. Methods: Data was collected in 9 longevity areas of China from Healthy Aging and Biomarkers Cohort Study (HABCS) conducted during 2017-2018. Finally,1, 622 elderly aged 80 years and older with complete information on blood UA and cognitive function score were included in this study. Information on demographic characteristics, lifestyle, and health status were collected through questionnaire and physical examination. Venous blood samples of the participants were collected to test blood UA level. Cognitive impairment (CI) was assessed using the Chinese Mini-Mental State Examination (MMSE) according to personal educational level. Generalized Estimating Equations (GEE) model for binary data was used to analyze the association of blood UA and CI, and further compared the associations among different age and body mass index (BMI) groups. Results: Of the 1 622 oldest-old, the mean age was (92.2±8.1) years, 656 (40.4%) were male, the mean level of blood UA was (343.3±86.2) μmol/L, and 482 (29.7%) oldest-old had CI. Compared with the lowest quartile of UA, the risks of CI in the second, third and highest quartiles were gradually reduced, the corresponding ORs and 95%CI were 0.99 (0.71-1.33), 0.87 (0.68-0.94) and 0.69 (0.48-0.85), respectively; and the linear trend test was statistically significant (P<0.001). Subgroup analysis showed that the effects of higher UA associated with lower risk of CI were stronger in younger oldest-old (aged 80-89 years) and thinner group (BMI<24) (Pinteraction<0.05). Conclusions: Blood UA was negatively associated with the risk of having CI in the oldest-old among the nine longevity areas of China.

Social Frailty and Executive Function: Association with Geriatric Syndromes, Life Space and Quality of Life in Healthy Community-Dwelling Older Adults.

BackgroundDespite emerging evidence about the association between social frailty and cognitive impairment, little is known about the role of executive function in this interplay, and whether the coexistence of social frailty and cognitive impairment predisposes to adverse health outcomes in healthy community-dwelling older adults.ObjectivesWe aim to examine independent associations between social frailty with the MMSE and FAB, and to determine if having both social frailty and cognitive impairment is associated with worse health outcomes than either or neither condition.MethodsWe studied 229 cognitively intact and functionally independent community-dwelling older adults (mean age= 67.2±7.43). Outcome measures comprise physical activity; physical performance and frailty; geriatric syndromes; life space and quality of life. We compared Chinese Mini Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (FAB) scores across the socially non-frail, socially pre-frail and socially frail. Participants were further recategorized into three subgroups (neither, either or both) based on presence of social frailty and cognitive impairment. Cognitive impairment was defined as a score below the educational adjusted cut-offs in either CMMSE or FAB. We performed logistic regression adjusted for significant covariates and mood to examine association with outcomes across the three subgroups.ResultsCompared with CMMSE, Chinese FAB scores significantly decreased across the social frailty spectrum (p<0.001), suggesting strong association between executive function with social frailty. We derived three subgroups relative to relationship with socially frailty and executive dysfunction: (i) Neither, N=140(61.1%), (ii) Either, N=79(34.5%), and (iii) Both, N=10(4.4%). Compared with neither or either subgroups, having both social frailty and executive dysfunction was associated with anorexia (OR=4.79, 95% CI= 1.04–22.02), near falls and falls (OR= 5.23, 95% CI= 1.10–24.90), lower life-space mobility (odds ratio, OR=9.80, 95% CI=2.07–46.31) and poorer quality of life (OR= 13.2, 95% CI= 2.38–73.4).ConclusionOur results explicated the association of executive dysfunction with social frailty, and their synergistic relationship independent of mood with geriatric syndromes, decreased life space and poorer quality of life. In light of the current COVID-19 pandemic, the association between social frailty and executive dysfunction merits further study as a possible target for early intervention in relatively healthy older adults.

322 - Heterogeneity in dynamic change of cognitive function among Chinese elderly: A growth mixture model

Objectives:Our aim is to use the growth mixture model (GMM) to distinguish different trajectories of cognitive change in Chinese geriatric population and identify risk factors for cognitive decline in each subpopulation.Methods:We obtained data from the Chinese Longitudinal Health Longevity Survey, using the Chinese Mini-Mental State Examination (C-MMSE) as a proxy for cognitive function. We applied the GMM to identify heterogeneous subpopulations and potential risk factors.Results:Our sample included 2850 older adults, 1387 (48.7%) male and 1463 (51.3%) female with age range of 62 to 108 (average of 72.3). Using GMM and best fit statistics, we identified two distinct subgroups in respect to their longitudinal cognitive function: cognitively stable (91.4%) group with 0.42 C-MMSE points decline per 3 years, and cognitively declining (8.6%) group with 4.76 C-MMSE points decline per 3 years. Of note, vision impairment and hearing impairment had the highest associations with cognitive decline, with stronger association found in the cognitively declining group than the cognitively stable group. Cognitive activities were protective in both groups. Diabetes was associated with cognitive decline in cognitive declining group. Physical activities, social activities and intake of fresh vegetables, fruits, and fish products were protective in cognitive stable group.Conclusions:Using GMM, we identified heterogeneity in trajectories of cognitive change in Chinese elders. Moreover, we found risk factors specific to each subgroup, which should be considered in future studies.

Lower-caloric intake but different nutrient profiles in cognition impaired and in frail elderlies

Abstract Background Frailty and dementia are two common geriatric syndromes associated with poor nutritional status. The nutritional role in the pathogenesis of frailty and dementia remains unclear. We examined the associations between energy intake and frailty/cognition impairment and also compared the nutrient intake between frail and cognition impaired elderlies by sex. Methods Data of 1,920 elderly adults (≧65y) from the 2014-2017 Nutrition and Health Survey in Taiwan was used. Frailty was defined using modified L. Fried criteria. The Chinese Mini-Mental State Examination score was grouped into tertiles: cognitive impairment (score ≦ 23), mild cognitive impairment (score = 24-27), and the normal (score ≧28). Total energy intake was grouped into tertiles. Logistic regression adjusted for age, sex, and sampling strata was used for association test. The trend test was performed using generalized linear model with age adjustment to examine whether various nutrient intake indicators had an ordered relationship with the severity of frailty and cognitive impairment. Results Lower energy intake (men &amp;lt;1540 Kcal or women&amp;lt;1182 Kcal) was significantly associated with frailty (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.45-2.66) and cognition impairment (OR: 1.88; 95%CI: 1.43-2.47), respectively. Larger number of micronutrients and food substances per Kg body weight exhibited decreasing trends with MCI (protein, fat, carbohydrate, vitamins B1, B2, B3, B6, B12, C, E, Ca, P, Fe, Mg, K, Zn, dietary fiber, and cholesterol) than with frailty (protein, vitamin B1, B3, B6, C, P, Mg, K, Zn, polyunsaturated fatty acids, and dietary fiber). Conclusions The lower the energy intake, the higher the odds ratio for frailty and for dementia. Dietary quality expressed by nutrient intake per Kg body weight was poorer in elderlies with cognition impairment than those with frailty. Key messages Lower energy intake is associated with MCI and with frailty, respectively. The MCI elderlies involve more micronutrient deficiencies than the frail counterpart.

Relationship Between Fear of Falling, Fear-Related Activity Restriction, Frailty, and Sarcopenia.

To determine the prevalence of fear of falling (FOF) and fear-related activity restriction (FAR) and their association with frailty, sarcopenia, gait speed and grip strength, cognitive impairment, depression, social isolation, self-perceived health, and vision. Observational cross-sectional study. Community. A total of 493 community-dwelling older adults, 60 years and older. FOF and FAR were assessed using validated single closed-ended questions. Questionnaire was administered to evaluate frailty (FRAIL scale - Fatigue, Resistance, Aerobic, Illness, and Loss of Weight), sarcopenia (SARC-F - lifting and carrying 10 pounds, walking across a room, transferring from bed/chair, climbing a flight of 10 stairs, and frequency of falls in the past 1 year), social isolation (six-item Lubben Social Network Scale), depression (Even Briefer Assessment Scale), cognition (Chinese Mini-Mental State Examination), and perceived general health and pain (The EuroQol-5 Dimension (EQ-5D)and EQ visual analogue scale (EQ VAS)) . Binary logistic regression was performed to determine the influence of sociodemographic, medical, functional, and cognitive variables on FOF with/without FAR. Prevalence of FOF was 69.2%, and among them, 38.4% had FAR. Prevalence of FOF with or without FAR in those with sarcopenia was 93.3% and in prefrail/frail was 76.6%. FOF was significantly associated with prefrail/frail (odds ratio (OR) = 2.17; 95% confidence interval (CI) = 1.26-3.73), depression (OR = 4.90; 95% CI = 1.06-22.67), number of medications (OR = 1.28; 95% CI = 1.03-1.59), and female sex (OR = 3.54; 95% CI = 1.82-6.90). FOF + FAR was associated with depression (OR = 5.17; 95% CI = 1.84-14.54) and sarcopenia (OR = 8.13; 95% CI = 1.52-43.41). FOF with/without FAR is highly prevalent among community-dwelling older adults, especially in those with sarcopenia, prefrailty, and frailty, with significant negative impact on function, quality of life, social network, and mental health. Further research is needed to investigate the value of population-level screening, causal relationship, and efficacy of comprehensive intervention strategies.

Heterogeneity in the dynamic change of cognitive function among older Chinese people: A growth mixture model.

Our aim is to distinguish different trajectories of cognitive change in Chinese geriatric population and identify risk factors for cognitive decline in each subpopulation. We obtained data from five waves (2002, 2005, 2008, 2011, 2014) of the Chinese Longitudinal Health Longevity Survey, using the Chinese Mini-Mental State Examination (C-MMSE) as a proxy for cognitive function. We applied growth mixture modeling (GMM) to identify heterogeneous subpopulations and potential risk factors. Our sample included 3859 older adults, 1387 (48.7%) male and 1974 (51.2%) female with age range of 62 to 108 (average of 74.5) at initial survey. Using GMM and best fit statistics, we identified two distinct subgroups in respect to their longitudinal cognitive function: (a) cognitively stable (87.8%) group with 0.49 C-MMSE points decline per 3 years, and (b) cognitively declining (12.2%) group with 6.03 C-MMSE points decline per 3 years. Of note, cognitive activities were protective, and hearing and visual impairments were risk factors in both groups. Diabetes, hypertension, stroke and cardiovascular disease were associated with cognitive decline in the cognitively declining group. Physical activities, and intake of fresh vegetables, fruits, and fish products were protective in the cognitively stable group. Using GMM, we identified heterogeneity in trajectories of cognitive change in older Chinese people. Moreover, we found risk factors specific to each subgroup, which should be considered in future studies.

Factors associated with social isolation in community-dwelling older adults: a cross-sectional study.

Social isolation in older adults is a major public health problem and associated with increased morbidity and mortality. There are limited data on the association between social isolation and physical function including gait speed. Hence, this study is to determine the prevalence of social isolation and its association with gait speed, frailty, cognition, depression and comorbidities amongst community-dwelling older adults. Social isolation, depression, frailty and perceived general health were assessed using 6-item Lubben Social Network Scale (LSNS-6), Geriatric Depression Scale (GDS), FRAIL scale and EuroQol EQ-5D-5L questionnaire which includes EQ Visual Analogue Scale (EQ-VAS), respectively. Cognition was assessed using the Chinese Mini Mental State Examination (cMMSE), while physical performance test included gait speed and short physical performance battery test. Binary logistic regression was performed to determine the influence of socio-demographic, medical, functional and cognitive variables on social isolation. Out of 202 participants, 27.7% were robust, 66.8% of participants were pre-frail, and 5.4% of participants were frail. Almost half (45.5%, n = 92) of the participants were found to be at risk of social isolation. A poor social network was negatively associated with mean gait speed (OR = 0.674, CI 0.464-0.979, p = 0.039), EQ-VAS (OR = 0.561, CI 0.390-0.806, p < 0.01) and cMMSE (OR = 0.630, 95% CI 0.413-0.960, p = 0.032). Almost half of older adults in the community are at risk of social isolation with a very significant association with gait speed, cMMSE and EQ-VAS scores.

GENDER DIFFERENCES IN THE PREVALENCE AND INCIDENCE OF COGNITIVE IMPAIRMENT: DOES IMMIGRATION MATTER?

Using two waves of the PINE data, this study examined gender difference in the associations between immigration-related factors and cognitive impairment (CI). CI was assessed by the Chinese Mini-Mental State Examination (C-MMSE). CI prevalence was determined by C-MMSE < 18 at baseline; incidence was the percentage of the respondents whose C-MMSE > 18 at baseline but dropped below 18 at Wave 2. We found 7.62% CI prevalence and 5.12% incidence rate. Women were more likely than men to have CI, consisting of 77.06% and 75.20% among persons with CI at two time points. Older Chinese women were generally disadvantaged in cognition and overall health compared with older men. Yet immigration experience does not link to CI for both men and women after controlling the well-established effects of age and education. Future research needs to investigate what biological and contextual factors earlier in life are predictive of late-life CI risk.

THE ASSOCIATION BETWEEN COGNITIVE FUNCTION AND TAI-CHI: FINDINGS FROM THE PINE STUDY

The study examined the association between cognitive function and Tai Chi practice among older Chinese Americans. Data from the Population Study of Chinese Elderly in Chicago (N=3,157) was analyzed by multivariate logistic regression. Cognitive function was assessed by global cognition, episodic memory, executive function, working memory, and Chinese Mini-Mental State Examination (C-MMSE). The results showed that cognitive function was significantly associated with Tai Chi practice. Participants with higher scores of global cognition (OR = 1.44, 95% CI: 1.20–1.73, p = 0.00), episodic memory (OR =1.27, 95% CI: 1.10–1.47, p = 0.00), executive function (OR = 1.017, 95% CI:1.00–1.03, p = 0.01), working memory (OR = 1.07, 95% CI: 1.02–1.12, p = 0.01), and C-MMSE (OR = 1.06, 95% CI: 1.03–1.09, p = 0.00) were more likely to practice Tai Chi. This study demonstrated that Tai Chi may benefit cognitive function in Chinese older adults.