Cognitive Abilities Screening Instrument Score Research Articles

Non-linear relationship between serum cholesterol levels and cognitive change among older people in the preclinical and prodromal stages of dementia: a retrospective longitudinal study in Taiwan

BackgroundAdverse effects of rigorously lowering low-density lipoprotein cholesterol on cognition have been reported; therefore, we aimed to study the contribution of serum cholesterol in cognitive decline in older people with or without dementia.MethodsCognitive function was assessed by the Cognitive Abilities Screening Instrument (CASI). We investigated associations between serum cholesterol with cognitive decline using multiple regressions controlling for the effects of demographics, vascular risk factors, and treatments.ResultsMost associations between cholesterol and CASI scores could be explained by non-linear and inverted U-shaped relationships (R2 = 0.003–0.006, p < 0.016, Šidákcorrection). The relationships were most evident between changes in cholesterol and CASI scores in older people at the preclinical or prodromal stages of dementia (R2 = 0.02–0.064, p values < 0.016). There were no differences in level of changes in CASI scores between individuals in 1st decile and 10th decile groups of changes in cholesterol (p = 0.266–0.972). However, individuals in the 1st decile of triglyceride changes and with stable and normal cognitive functions showed significant improvement in CASI scores compared to those in the 10th decile (t(202) = 2.275, p values < 0.05).ConclusionThese findings could implicate that rigorously lowering cholesterol may not be suitable for the prevention of cognitive decline among older people, especially among individuals in preclinical or prodromal stages of dementia.

Neuropsychiatric Symptoms Predict Faster Cognitive Decline in Dementia Collaborative Care Than Antipsychotic Use.

To compare short-term cognitive outcomes among groups with and without neuropsychiatric symptoms (NPSs) or antipsychotic prescription and to determine which disease status or treatment modality is associated with relatively faster cognitive decline. We retrospectively analyzed a prospective cohort of patients diagnosed with dementia and mild cognitive impairment. All participants were evaluated using the Cognitive Abilities Screening Instrument (CASI) during their initial clinical assessments and at the annual follow-up. The dependent variable was annual delta CASI. Multivariate linear regression analysis was used to assess the degree of association between NPS, antipsychotic use, and cognitive decline after adjusting for confounding factors. Neuropsychiatric symptoms were examined individually to determine their predictive value for cognitive decline. A total of 407 (N = 407) patients were included in the study. NPSs, rather than antipsychotic use, led to faster cognitive decline. A higher baseline NPI total score predicted a significantly faster decline in CASI scores (1-year delta CASI = -0.22, 95% CI = -0.38~ -0.05, p = 0.010). Specific items (delusions, agitation, depression, anxiety, euphoria, and apathy) in the NPS significantly increased cognitive decline. Certain neuropsychiatric symptoms, rather than antipsychotic use, lead to faster cognitive decline in a dementia collaborative care model. Checking for and providing appropriate interventions for NPS in people with dementia and their caregivers are highlighted.

The association of upper airway anatomy with cognitive test performance: the Multi-Ethnic Study of Atherosclerosis

BackgroundNumerous upper airway anatomy characteristics are risk factors for sleep apnea, which affects 26% of older Americans, and more severe sleep apnea is associated with cognitive impairment. This study explores the pathophysiology and links between upper airway anatomy, sleep, and cognition.MethodsParticipants in the Multi-Ethnic Study of Atherosclerosis underwent an upper airway MRI, polysomnography to assess sleep measures including the apnea-hypopnea index (AHI) and completed the Cognitive Abilities Screening Instrument (CASI). Two model selection techniques selected from among 67 upper airway measures those that are most strongly associated with CASI score. The associations of selected upper airway measures with AHI, AHI with CASI score, and selected upper airway anatomy measures with CASI score, both alone and after adjustment for AHI, were assessed using linear regression.ResultsSoft palate volume, maxillary divergence, and upper facial height were significantly positively associated with higher CASI score, indicating better cognition. The coefficients were small, with a 1 standard deviation (SD) increase in these variables being associated with a 0.83, 0.75, and 0.70 point higher CASI score, respectively. Additional adjustment for AHI very slightly attenuated these associations. Larger soft palate volume was significantly associated with higher AHI (15% higher AHI (95% CI 2%,28%) per SD). Higher AHI was marginally associated with higher CASI score (0.43 (95% CI 0.01,0.85) per AHI doubling).ConclusionsThree upper airway measures were weakly but significantly associated with higher global cognitive test performance. Sleep apnea did not appear to be the mechanism through which these upper airway and cognition associations were acting. Further research on the selected upper airway measures is recommended.

Automated Video Analysis of Audio-Visual Approaches to Predict and Detect Mild Cognitive Impairment and Dementia in Older Adults.

Early identification of different stages of cognitive impairment is important to provide available intervention and timely care for the elderly. This study aimed to examine the ability of the artificial intelligence (AI) technology to distinguish participants with mild cognitive impairment (MCI) from those with mild to moderate dementia based on automated video analysis. A total of 95 participants were recruited (MCI, 41; mild to moderate dementia, 54). The videos were captured during the Short Portable Mental Status Questionnaire process; the visual and aural features were extracted using these videos. Deep learning models were subsequently constructed for the binary differentiation of MCI and mild to moderate dementia. Correlation analysis of the predicted Mini-Mental State Examination, Cognitive Abilities Screening Instrument scores, and ground truth was also performed. Deep learning models combining both the visual and aural features discriminated MCI from mild to moderate dementia with an area under the curve (AUC) of 77.0% and accuracy of 76.0%. The AUC and accuracy increased to 93.0% and 88.0%, respectively, when depression and anxiety were excluded. Significant moderate correlations were observed between the predicted cognitive function and ground truth, and the correlation was strong excluding depression and anxiety. Interestingly, female, but not male, exhibited a correlation. The study showed that video-based deep learning models can differentiate participants with MCI from those with mild to moderate dementia and can predict cognitive function. This approach may offer a cost-effective and easily applicable method for early detection of cognitive impairment.

Long-term exposure to ambient air pollution and cognitive function in older US adults: The Multi-Ethnic Study of Atherosclerosis.

Cognitive assessment, including the Cognitive Abilities Screening Instrument (CASI), Digit Symbol Coding (DSC), and Digit Span (DS), was completed in 4392 older participants in the United States during 2010-2012. Residence-specific air pollution exposures (i.e., oxides of nitrogen [NO2/NOx], PM2.5 and its components: elemental carbon [EC], organic carbon [OC], sulfur [S], and silicon [Si]) were estimated by geo-statistical models. Linear and logistic regression models were used to estimate the associations between each air pollutants metric and cognitive function. An interquartile range (IQR) increase in EC (0.8 μg/m3) and Si (23.1 ng/m3) was associated with -1.27 (95% confidence interval [CI]: -0.09, -2.45) and -0.88 (95% CI: -0.21, -1.54) lower CASI scores in global cognitive function. For each IQR increase in Si, the odds of low cognitive function (LCF) across domains was 1.29 times higher (95% CI: 1.04, 1.60). For other tests, NO X was associated with slower processing speed (DSC: -2.01, 95% CI: -3.50, -0.52) and worse working memory (total DS: -0.4, 95% CI: -0.78, -0.01). No associations were found for PM2.5 and two PM2.5 components (OC and S) with any cognitive function outcomes. Higher exposure to traffic-related air pollutants including both tailpipe (EC and NO x ) and non-tailpipe (Si) species were associated with lower cognitive function in older adults.

The Association between Electronegative Low-Density Lipoprotein Cholesterol L5 and Cognitive Functions in Patients with Mild Cognitive Impairment

L5, the most electronegative subfraction of low-density lipoprotein cholesterol (LDL-C), may play a role in the pathogenesis of cerebrovascular dysfunction and neurodegeneration. We hypothesized that serum L5 is associated with cognitive impairment and investigated the association between serum L5 levels and cognitive performance in patients with mild cognitive impairment (MCI). This cross-sectional study conducted in Taiwan included 22 patients with MCI and 40 older people with normal cognition (healthy controls). All participants were assessed with the Cognitive Abilities Screening Instrument (CASI) and a CASI-estimated Mini-Mental State Examination (MMSE-CE). We compared the serum total cholesterol (TC), LDL-C, and L5 levels between the MCI and control groups and examined the association between lipid profiles and cognitive performance in these groups. The serum L5 concentration and total CASI scores were significantly negatively correlated in the MCI group. Serum L5% was negatively correlated with MMSE-CE and total CASI scores, particularly in the orientation and language subdomains. No significant correlation between the serum L5 level and cognitive performance was noted in the control group. Conclusions: Serum L5, instead of TC or total LDL-C, could be associated with cognitive impairment through a disease stage-dependent mode that occurs during neurodegeneration.

Implications of Response Patterns in Questions of Early Life Adverse Events as a Risk Factor for Lower Cognitive Function in the Multi‐Ethnic Study of Atherosclerosis

AbstractBackgroundEarly‐life disadvantage may increase the risk for later cognitive decline. Recently, other aspects of early‐life adversity (ELA) have received attention but their associations with cognitive decline in later life has not been widely studied. Due to the sensitivity of such questions and the potential for systematic bias, we examined (1) predictors of response patterns to ELA questions, and (2) among those who completed ELA questions, we examined whether responses were associated with cognitive decline in the Multi‐Ethnic Study of Atherosclerosis (MESA).MethodELA was self‐reported via a 7‐item telephone assessment of socioemotional and physical threat or deprivation at MESA annual follow‐up call in 2019. Descriptive statistics were grouped by completion status: not completed, partially completed, and fully completed. Continuous variables were compared across groups with t‐tests; categorical variables were compared with chi‐square tests. Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI) at MESA Exams 5 (2010‐2012) and 6 (2016‐2018). Multinomial logistic regression was used to determine predictors of completion group membership. Cognitive decline from Exam 5 to 6 by completion group was assessed using multivariable linear regression.ResultOf the 3,990 participants interviewed, the mean age was 59.2y (SD = 8.8), 55% were female, and 40% were White (n = 1,604), 13% Chinese (n = 508), 26% Black (n = 1,036), and 21% Hispanic/Latino (n = 842). The odds of partial response was higher for those born outside of the U.S. (2.17, CI 95%: 1.53‐3.09), and among participants who spoke Spanish (2.82, CI 95%: 1.74‐4.58) or Chinese (2.04, CI 95%: 1.08‐3.88) at baseline. Among participants with completed ELA (n = 3,173), one component of childhood adversity: how often was your household well‐organized/managed, was associated with better Exam 6 CASI score (β = 0.80, SE = 0.33; p = 0.015) adjusting for age, race, education, gender, language, years in the U.S., socio‐economic status (SES), and parental birthplace. There was no significant association between cognitive change from Exam 5 to Exam 6 and ELA completion.ConclusionFactors associated with acculturation including country of participant’s birth and language preference predicted completion status on questions of ELA. Future studies should be mindful of the potentially differential response patterns and the implications for interpretation when analyzing ELA data.

Social Networks and Incident Alzheimer’s Disease: the Kuakini Honolulu‐Asia Aging Study

AbstractBackgroundWe assessed the longitudinal association between social networks in late life and the incidence of all‐cause dementia (DEM), Alzheimer’s disease (AD) and vascular dementia (VaD) over a 10‐year follow‐up period in a community‐based cohort of older Japanese‐American men.MethodThis prospective study analyzed data from cognitively intact participants of the Kuakini Honolulu‐Asia Aging Study (K‐HAAS). The K‐HAAS began with the Kuakini Honolulu Heart Program’s fourth examination in 1991‐1993, which served as our baseline timepoint. We followed 2,636 Japanese‐American men through the seventh exam (1999‐2000). Participants were dementia‐free at baseline and during the first 3 years of follow‐up. Social network strength was assessed by the Lubben Social Network Scale (LSNS). Weak and strong social network groups were defined by a median split of LSNS scores. Global cognitive functioning was evaluated by the Cognitive Abilities Screening Instrument (CASI), and depressive symptoms by the Center for Epidemiologic Studies Depression (CES‐D) 11‐item Scale. Dementia was diagnosed and classified by consensus of neurologists and geriatricians using standard criteria. Associations between baseline LSNS scores and the risks of DEM, AD and VaD were evaluated by multivariable Cox regression and Kaplan‐Meier estimators using age as the time scale.ResultStudy participants had a median (range) baseline age of 77 (71‐93) years. The age‐adjusted incidence of DEM was significantly higher among men who had weak (LSNS score ≤29) vs. strong (&gt;29) social networks (12.6 vs. 8.7 per 1,000 person‐years of follow‐up; p = 0.014). Kaplan‐Meier survival curves showed that the men with strong social networks were less likely to develop DEM (p&lt;0.0001) and AD (p = 0.0006); the probability of DEM‐free survival at almost 10 years was 93.8% for participants with strong social networks and 89.0% (11% incidence) for those with weak networks. In Cox regression models adjusting for baseline age, education, presence of at least one ApoE ɛ4 allele, prevalent stroke, depressive symptoms (CES‐D score ≥9), and CASI score, weak social networks were significantly associated with increased risk of DEM (HR = 1.52, 95%CI = 1.11‐2.08, p = 0.009) and AD (HR = 1.67, 95%CI = 1.11‐2.51, p = 0.014).ConclusionStrong social networks may protect against incident dementia and Alzheimer’s disease. Effective strategies should be devised to prevent the social isolation of older adults.

Association between Subclinical Epileptiform Discharge and the Severity of Cognitive Decline in Alzheimer's Disease: A Longitudinal Cohort Study.

Alzheimer's disease (AD) is the most common type of dementia. Aging is a risk factor for both AD and seizures. Subclinical epileptiform discharge (SED) has no evident clinical manifestation in patients with AD. Therefore, SED is liable to be overlooked in these patients since electroencephalography is not routinely performed in clinical settings. Previous studies about the association between SED and AD have yielded inconsistent results. The current study aimed to evaluate the prevalence of SED and its effect on AD severity and clinical outcomes. Patients with AD from Kaohsiung Municipal Ta-tung Hospital were included in this study. International 10-20 system scalp electroencephalography for 13 minutes was performed to detect SED. Clinical outcomes of patients with and without SED were assessed by neuropsychological tests [Cognitive Abilities Screening Instrument (CASI), Mini-Mental State Examination (MMSE), and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB)]. 288 patients (mean age 80.5 years, 60.4% female) were enrolled in this study. Fifty-seven (19.8%) out of 288 patients with AD had SED. The prevalence of SED increased with the severity of cognitive impairment. Compared with patients without SED, those with SED showed significantly greater decline in CASI (-9.32 versus -3.52 points, p = 0.0001) and MMSE (-2.52 versus -1.12 points, p = 0.0042) scores in one year. SED may play a significant role in AD progression and is a potential therapeutic target.

Weak Social Networks in Late Life Predict Incident Alzheimer's Disease: The Kuakini Honolulu-Asia Aging Study.

We assessed 10-year longitudinal associations between late-life social networks and incidence of all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VaD) in Japanese-American men. We prospectively analyzed, from baseline (1991-1993) through 1999-2000, 2636 initially nondemented Kuakini Honolulu-Asia Aging Study participants who remained dementia-free during the first 3 years of follow-up. Global cognition was evaluated by the Cognitive Abilities Screening Instrument (CASI); depressive symptoms by the 11-item Center for Epidemiologic Studies Depression (CES-D) Scale; and social networks by the Lubben Social Network Scale (LSNS). Median split of LSNS scores defined weak/strong social network groups. A panel of neurologists and geriatricians diagnosed and classified dementia; AD and VaD diagnoses comprised cases in which AD or VaD, respectively, were considered the primary cause of dementia. Median (range) baseline age was 77 (71-93) years. Participants with weak (LSNS score ≤29) versus strong (>29) social networks had higher age-adjusted incidence (in person-years) of ACD (12.6 vs. 8.7; p = .014) and AD (6.7 vs. 4.0; p = .007) but not VaD (2.4 vs. 1.4; p = .15). Kaplan-Meier curves showed a lower likelihood of survival free of ACD (log-rank p < .0001) and AD (p = .0006) for men with weak networks. In Cox proportional hazards models adjusting for age, education, APOE ɛ4, prevalent stroke, depressive symptoms, and CASI score (all at baseline), weak networks predicted increased incidence of ACD (hazard ratio [HR] = 1.52, p = .009) and AD (HR = 1.67, p = .014) but not VaD (p > .2). Weak social networks may heighten the risk of dementia and AD, underscoring the need to promote social connectedness in older adults.

Relation of Progression of Coronary Artery Calcium to Dementia (from the Multi-Ethnic Study of Atherosclerosis)

Baseline coronary artery calcification has been shown to be associated with dementia. However, the value of coronary artery calcium (CAC) progression in the prediction of dementia remains unclear. In this study, we examined the association between CAC progression and dementia in the Multi-Ethnic Study of Atherosclerosis. The Multi-Ethnic Study of Atherosclerosis is a prospective study consisting of 6,814 participants 45 to 84years of age, free of overt cardiovascular disease at baseline. A total of 5,570 subjects had baseline and follow-up CAC scans approximately 2.5years apart and were included this analysis. A total of 4,173 of these participants completed cognitive testing with the Cognitive Abilities Screening Instrument (CASI) approximately 10years after the baseline CAC scan. Dementia diagnoses were identified using International Classification of Diseases codes from hospitalizations, death certificates, and medications used to treat dementia. The absolute change between baseline and follow-up CAC was used to assess CAC progression. Cox proportional hazards and multivariable linear regression models were used to examine the association of CAC progression with incident dementia and with CASI score. Over a median follow-up of 13.2 (interquartile range: 11.2 to 15.3) years, 350 participants developed incident dementia. CAC progression showed no association with dementia risk after adjustment for age, gender, race/ethnicity, vascular risk factors, and baseline CAC score. There was no association of CAC progression with CASI score in any adjusted model. In conclusion, progression of CAC over approximately 2.5years was not associated with increased risk of dementia after adjustment for demographic variables, vascular risk factors, and baseline CAC.

Twelve Weeks of Additional Fish Intake Improves the Cognition of Cognitively Intact, Resource-Limited Elderly People: A Randomized Control Trial.

Dietary omega 3 polyunsaturated fatty acids (PUFA) may reduce the risk of dementia. Many studies have investigated PUFA supplementation in high-income countries, yet food-based randomized control trials using omega 3 PUFA rich fish in lower to middle income countries, are lacking. To determine the effect on cognition of adding either fish or non-fish foods for twelve weeks to an enhanced diet of cognitively intact, independently living, resource-limited elderly people. Randomized control trial (National Health Trial register: DOH-27-061-6026). Retirement center in urban South Africa. Fifty-seven (74% female, mean age: 72±7 years) elderly participants with cognitive function exceeding 22 on the Mini Mental State Examination were randomized into an intervention (n=31) and control (n=26) group. The usual diets of both groups were enhanced with context-appropriate foods to mimic elements of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. The intervention group additionally received canned pilchards and fish spread every week amounting to an additional (theoretical) intake of 2.2g omega 3 PUFA daily. The control group received canned meatballs and texturized soya every week. Cognition was measured twice before and once after the intervention phase using the Cognitive Abilities Screening Instrument (CASI). Adherence was assessed by a study-specific food frequency questionnaire and red blood cell (RBC) PUFA biomarkers. Data were analyzed using a non-parametric analysis of covariance (ANCOVA) with, and without, bootstrap imputation. Participants in the intervention group had a significantly higher post intervention (P=0.036) CASI score than the control group, when the model was fitted with imputation and controlled for baseline scores. Participants in the intervention group also had a significantly higher intake of calculated dietary omega 3 PUFA and higher levels of RBC eicosapentaenoic acid and docosapentaenoic acid content than the control group (P < 0.05). Twelve weeks of fish intake in the context of a modified MIND diet may improve the cognition of cognitively intact, resource-limited elderly people.

Associations among sleep-disordered breathing, arousal response, and risk of mild cognitive impairment in a northern Taiwan population.

Dementia is associated with sleep disorders. However, the relationship between dementia and sleep arousal remains unclear. This study explored the associations among sleep parameters, arousal responses, and risk of mild cognitive impairment (MCI). Participants with the chief complaints of memory problems and sleep disorders, from the sleep center database of Taipei Medical University Shuang-Ho Hospital, were screened, and the parameters related to the Cognitive Abilities Screening Instrument, Clinical Dementia Rating, and polysomnography were determined. All examinations were conducted within 6 months and without a particular order. The participants were divided into those without cognitive impairment (Clinical Dementia Rating = 0) and those with MCI (Clinical Dementia Rating = 0.5). Mean comparison, linear regression models, and logistic regression models were employed to investigate the associations among obtained variables. This study included 31 participants without MCI and 37 with MCI (17 with amnestic MCI, 20 with multidomain MCI). Patients with MCI had significantly higher mean values of the spontaneous arousal index and spontaneous arousal index in the non-rapid eye movement stage than those without MCI. An increased risk of MCI was significantly associated with increased spontaneous arousal index and spontaneous arousal index in the non-rapid eye movement stage with various adjustments. Significant associations between the Cognitive Abilities Screening Instrument scores and the oximetry parameters and sleep disorder indexes were observed. Repetitive respiratory events with hypoxia were associated with cognitive dysfunction. Spontaneous arousal, especially in non-rapid eye movement sleep, was related to the risk of MCI. However, additional longitudinal studies are required to confirm their causality. Tsai C-Y, Hsu W-H, Lin Y-T, etal. Associations among sleep-disordered breathing, arousal response, and risk of mild cognitive impairment in a northern Taiwan population. J Clin Sleep Med. 2022;18(4): 1003-1012.

Abstract 9298: Associations of Demographic, Socioeconomic, and Cognitive Characteristics With Mobile Health Access Indicate a Digital Divide: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Mobile health (mHealth) has an emerging role in prevention of cardiovascular disease (CVD), but there is rising concern about inequities in access. This study aimed to evaluate possible divides in mHealth access by demographic, socioeconomic, and cognitive characteristics. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) is a population-based observational cohort study of adults free of CVD at baseline in 2000-02. Multivariable logistic regression modeling assessed associations of age, sex, race/ethnicity, education level, annual family income, health insurance status, and Cognitive Abilities Screening Instrument (CASI) with three mHealth outcomes in 2019-20. Results: Among 2796 participants (mean [SD] age 75 [9], 55% women, 40% White, 25% Black, 21% Hispanic, 14% Chinese), 63% (n=1756) had internet access (IA), 65% (n=1828) owned a computing device (CD), and 9% (n=248) owned a fitness tracker (FT). There were lower odds of all mHealth outcomes for older age (per 10 years odds ratios (OR) from 0.35 to 0.55), Hispanic ethnicity (vs. White 0.49-0.59), and lower income (&lt;$35,000 vs. ≥$75,000 0.32-0.47) (Figure). For IA and CD, lower odds were seen with Black race (vs. White OR [95% CI] 0.54 [0.41-0.73], 0.66 [0.41-0.73]) and higher odds with higher education (≥Bachelor’s degree vs. &lt;high school 4.75 [3.19-7.12], 3.08 [2.09-4.56]), HMO/private health insurance (vs. other 1.66 [1.31-2.11], 3.08 [2.09-4.56]), and higher CASI score (per 10 points 1.14 [1.02-1.27], 1.15 [1.04-1.28]). There was an inconsistent pattern for Chinese race and sex. Chinese race (vs. White) had lower odds of IA and FT but higher odds of CD, and men (vs. women) had higher odds of CD but lower odds of FT. All results were from a multivariable model. Discussion: All mHealth outcomes varied by major demographic, socioeconomic, and cognitive characteristics, indicating the presence of a digital divide. mHealth interventions should consider individual barriers to access.

Measurement Equivalence between the Original and Estimated Mini-Mental State Examination in People with Dementia.

Background: The Cognitive Abilities Screening Instrument (CASI) is increasingly used to assess general cognitive function in people with dementia. The Mini-Mental State Examination (MMSE) score can be converted from the CASI (i.e., the estimated MMSE). Recognizing that measurement equivalence is critical to meaningfully representing one with the other, we aimed to determine whether the estimated MMSE score obtained from the CASI was equivalent to the original MMSE in people with dementia. Methods: We obtained 110 data points for the MMSE and CASI scores in people with dementia. The intraclass correlation coefficient (ICC), Pearson’s r, percent of standard error of measurement (SEM%), paired t-test, and effect size (Cohen’s d) were used to investigate the equivalence. Results: To examine the equivalence between the original and estimated MMSE score, the ICC and Pearson’s r of the total score and six domains were 0.62–0.95 and 0.62–0.96, respectively. The SEM% of the total score and six domains were 0.6–8.9%. The paired t-test results showed a significant difference (p < 0.05) between the total score and the three domains. The Cohen’s d of the total score and six domains were 0.06–0.27. Conclusions: The estimated MMSE score was found to have moderate to excellent equivalence to the original MMSE score. The three domains (i.e., registration, attention and calculation, and visual-constructional ability) with moderate equivalence should be used cautiously to interchange with the original MMSE in people with dementia.

Factors Associated with Lower Cognitive Performance Scores Among Older Japanese Men in Hawaii and Japan.

Few studies have compared factors related to cognitive function among people with similar genetic backgrounds but different lifestyles. We aimed to identify factors related to lower cognitive scores among older Japanese men in two genetically similar cohorts exposed to different lifestyle factors. This cross-sectional study of community-dwelling Japanese men aged 71-81 years included 2,628 men enrolled in the Kuakini Honolulu-Asia Aging Study based in Hawaii and 349 men in the Shiga Epidemiological Study of Subclinical Atherosclerosis based in Japan. We compared participant performance through Cognitive Abilities Screening Instrument (CASI) assessment in Hawaii (1991-1993) and Japan (2009-2014). Factors related to low cognitive scores (history of cardiovascular disease, cardiometabolic factors, and lifestyle factors) were identified with questionnaires and measurements. Multivariable logistic regression analysis was used to calculate the adjusted odds ratios (ORs) of a low (< 82) CASI score based on different factors. CASI scores were lower in Hawaii than in Japan [21.2%(n = 556) versus 12.3%(n = 43), p < 0.001], though this was not significant when adjusted for age and educational attainment (Hawaii 20.3%versus Japan 17.9%, p = 0.328). History of stroke (OR = 1.65, 95%confidence interval = 1.19-2.29) was positively associated with low cognitive scores in Hawaii. Body mass index ≥25 kg/m2 tended to be associated with low cognitive scores in Japan; there was a significant interaction between the cohorts. Cognitive scores differences between cohorts were mostly explained by differences in educational attainment. Conversely, cardiovascular diseases and cardiometabolic factors differentially impacted cognitive scores among genetically similar older men exposed to different lifestyle factors.

Subjective cognitive impairment differs by racial/ethnic groups and sociodemographic factors: The Multi‐Ethnic Study of Atherosclerosis and Alzheimer’s Disease (MESA‐MIND)

AbstractBackgroundSubjective cognitive decline (SCD) is associated with objective cognitive decline, incident cognitive impairment, and AD pathology in mostly white populations. Little data are available to describe SCD and objective cognitive impairment in diverse populations.MethodThe Multi‐Ethnic Study of Atherosclerosis (MESA) began cognitive testing, including the Cognitive Abilities Screening Instrument (CASI), in 2010‐12 among four racial/ethnic groups: 38% white, 28% African‐American, 22% Hispanic, and 12% Chinese Americans across six field centers. MESA‐MIND and ancillary studies added repeated CASI by in‐person exam (2016‐2018) and the 12‐item Cognitive Change Index (CCI‐12) during the 2018 annual follow‐up call. Statistical analyses using the CCI‐12 item sum and two published thresholds (CCI‐12≥16 and CCI‐12≥23) established the point prevalence for SCD across racial/ethnic groups. Socio‐demographic factors were examined using multivariable logistic regression. Spearman correlations and general linear models related 5‐year subjective change (CCI‐12) and objective change in cognitive performance (change in CASI) over the same time period.ResultCCI‐12 data were available on 3,676 MESA participants (aged 60‐95) across all racial/ethnic groups and sites. Table 1 presents demographics, CCI‐12 scores, and CASI scores. The prevalence of SCD (CCI‐12≥16) across racial/ethnic groups ranged between 52% to 72%. There was a lower prevalence in African‐American and white and a higher prevalence in Chinese and Hispanic participants. In adjusted models, various socio‐demographic factors were significantly associated with a higher odds of reporting SCD (CCI‐12≥16), including: older age, female gender, Chinese language preference, diabetes, smoking, birth in the Western US or Mexico, and lacking health insurance coverage. African‐American ethnicity, higher education, and income greater than $75,000 were each associated with a lower reporting of SCD. CCI‐12 was weakly and inversely correlated with antecedent cognitive performance (2010‐12, n=3,200, Rho=‐0.16, p&lt;0.01) and cognitive decline (n=1,800, Rho=‐0.06, p=0.01) over 6 years of follow‐up. In stratified analyses, associations between CCI‐12 and objective cognitive decline were observed in white participants only.ConclusionIn a large regionally and ethnically diverse cohort of older adults, SCD defined by subjective memory concerns on the CCI‐12 significantly differed by race/ethnicity and indicators of socioeconomic status, suggesting that cultural and institutional biases may influence reporting SCD in diverse populations.

Obstructive sleep apnea is associated with depressive symptoms among patients with mild cognitive impairment

AbstractBackgroundObstructive sleep apnea (OSA) is increasingly recognized as a modifiable risk factor of cognitive decline and dementia. However, the impacts of OSA on mood among patients with mild cognitive impairment (MCI) have remained rarely explored. The aim of this study was to investigate whether OSA is associated with depressive symptoms among patients with MCI.MethodThe diagnosis of MCI was based on the criteria proposed by Peterson in 2004 after a series of comprehensive work‐up. The over‐night polysomnography (PSG) was performed in hospital for the diagnosis of OSA and the patients with AHI of 10/hour or higher were eligible for enrollment in the OSA group. The group for comparison was composed of the patients without OSA (AHI &lt; 5/hour) by over‐night PSG and the patients with low risk of OSA defined by Berlin Questionnaire. The Center for Epidemiologic Studies Depression Scale (CESD) was administered for assessing depressive symptoms and the Cognitive Abilities Screening Instrument (CASI) with derived Mini‐Mental State Examination (MMSE) score was used for assessing cognitive function. Apolipoprotein E (APOE) genotyping was done in each subject.ResultThe study sample was composed of 68 MCI patients (age: 67.5 ± 8.83 years; female: 46.8%). As compared to the MCI patients without OSA or with low risk of OSA (n=14), the MCI patients with OSA (AHI ≥ 10/ hour; n=54) had higher CESD score ( 15.8 ± 10.6 versus 7.1 ± 1.9 ; P = 0.011). In the multivariate analysis, the association remained significant after adjusting the confounding factors including age, gender, education years, baseline CASI score, BMI and APOE epsilon 4 genotyping status. (β = 5.54; 95 % CI: 0.63– 10.45, p = 0.028).ConclusionThe results of this cross‐sectional study suggest that obstructive sleep apnea is independently associated with depressive symptoms among patients with MCI. The long‐term effects of OSA on the mood among MCI patients warrant longitudinal studies. Our results probably set the horizon for the basic researches for the delineation of pathological mechanisms underlying the association between OSA and depression among MCI patients.

Proteinuria and Reduced Estimated Glomerular Filtration Rate are Independently Associated With Lower Cognitive Abilities in Apparently Healthy Community-Dwelling Elderly Men in Japan: A Cross-sectional Study.

BackgroundThe association of proteinuria and reduced estimated glomerular filtration rate (eGFR) with cognition needs more clarification. We cross-sectionally examined whether proteinuria and reduced eGFR, even in moderate stages, were independently associated with lower cognition in a community-based sample of elderly men.MethodsOur cohort initially comprised 1,094 men aged 40–79 years from a random sample from Shiga, Japan in 2006–2008. Of 853 men who returned for the follow-up examination (2009–2014), we analyzed 561 who were ≥65 years, free of stroke, and completed the Cognitive Abilities Screening Instrument (CASI) at follow-up (higher CASI scores [range 0 to 100] indicate better cognition). Proteinuria was assessed via dipstick. eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration Equation. Participants were divided into three groups either by eGFR (≥60, 59–40, and <40 mL/min/1.73 m2) or by proteinuria (no, trace, and positive), considered normal, moderate, and advanced, respectively. Using linear regression, we computed mean CASI score, with simultaneous adjustment for proteinuria and eGFR in addition to other potential confounders.ResultsSignificant trends of lower cognition were observed across the groups of worse proteinuria and lower eGFR independently: multivariable-adjusted mean CASI scores were 90.1, 89.3, and 88.4 for proteinuria (Ptrend = 0.029), and 90.0, 88.5, and 88.5 for eGFR (Ptrend = 0.015) in mutual-adjustment model.ConclusionsProteinuria and reduced eGFR, even in their moderate stages, were independently associated with lower cognition in a community-based sample of elderly men. The results suggest the importance of proteinuria and low eGFR for early detection and prevention of cognitive decline.

Prevention of Early Alzheimer's Disease by Erinacine A-Enriched Hericium erinaceus Mycelia Pilot Double-Blind Placebo-Controlled Study.

ObjectiveTo investigate the efficacy and safety of three H. erinaceus mycelia (EAHE) capsules (350 mg/capsule; containing 5 mg/g erinacine A active ingredient) per day for the treatment of patients with mild Alzheimer’s Disease (AD).MethodsThis study comprised a 3-week no-drug screening period, followed by a 49-week double-blind treatment period with 2-parallel groups in which eligible patients were randomized to either three 5 mg/g EAHE mycelia capsules per day or identical appearing placebo capsules. Cognitive assessments, ophthalmic examinations, biomarker collection, and neuroimaging were followed throughout the study period.ResultsAfter 49 weeks of EAHE intervention, a significant decrease in Cognitive Abilities Screening Instrument score was noted in the placebo group, a significant improvement in Mini-Mental State Examination score was observed in the EAHE group and a significant Instrumental Activities of Daily Living score difference were found between the two groups. In addition, EAHE group achieved a significantly better contrast sensitivity when compared to the placebo group. Moreover, only the placebo group observed significantly lowered biomarkers such as calcium, albumin, apolipoprotein E4, hemoglobin, and brain-derived neurotrophic factor and significantly elevated alpha1-antichymotrypsin and amyloid-beta peptide 1–40 over the study period. Using diffusion tensor imaging, the mean apparent diffusion coefficient (ADC) values from the arcuate fasciculus region in the dominant hemisphere significantly increased in the placebo group while no significant difference was found in the EAHE group in comparison to their baselines. Moreover, ADC values from the parahippocampal cingulum region in the dominant hemisphere significantly decreased in the EAHE group whereas no significant difference was found in the placebo group when compared to their baselines. Lastly, except for four subjects who dropped out of the study due to abdominal discomfort, nausea, and skin rash, no other adverse events were reported.ConclusionThree 350 mg/g EAHE capsules intervention for 49 weeks demonstrated higher CASI, MMSE, and IADL scores and achieved a better contrast sensitivity in patients with mild AD when compared to the placebo group, suggesting that EAHE is safe, well-tolerated, and may be important in achieving neurocognitive benefits.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT04065061.