Cognitive Function Status Research Articles

Sleep Quality and Cognitive Function after Stroke: The Mediating Roles of Depression and Anxiety Symptoms.

This study examined the association between post-stroke cognitive function and sleep status at 30 days post-stroke and evaluated the role of anxiety and depression as potential mediators of that association. The participants in this study were 530 acute ischemic stroke (IS) patients. Sleep disturbance at 30 days post-stroke was assessed by the Pittsburgh Sleep Quality Index. Basic patient information, cognitive function, depression, and anxiety status were assessed before discharge from the hospital. Stratified linear regression analysis models were fit to examine the associations between post-stroke sleep quality and the influencing factors. A structural equation model was developed to evaluate the role of anxiety and depression as potential mediators of sleep quality and cognitive function. At 30 days post-stroke, 58.7% of IS patients had sleep disturbance. Women and older IS patients were more likely to suffer poorer sleep quality (p < 0.05). A stratified linear regression analysis showed that the inclusion of cognitive function variables and indicators of depression and anxiety were statistically significant in predicting improvement in the sleep disturbance of AIS patients. Cognitive function, depression, anxiety, and sleep status were selected to construct a structural equation model. The total effect of cognitive function on sleep status was -0.274, with a direct effect of -0.097 and an indirect effect (through depression) of -0.177. The total effect of anxiety on sleep status was 0.235, with a direct effect of 0.186 and an indirect effect (through depression) of 0.049. IS patients often experience poor sleep quality. Depression in IS patients mediates two pathways: the pathway through which cognitive function affects sleep quality and the pathway through which anxiety affects sleep quality.

Leisure-Related Social Work Interventions for Patients with Cognitive Impairment: A Systematic Review and Meta-Analysis.

The social work profession has been exploring nonpharmacological interventions for patients with cognitive impairment, but there are few evidence-based research outputs. Systematically evaluating the effectiveness of social work interventions for people with cognitive impairment can shed light on the matter to further improve similar interventions. Randomized controlled trials of nonpharmacological interventions for patients with cognitive impairment were selected from key literature databases in both English and Chinese from 2010 to 2021. A systematic review and meta-analysis with Revman 5.4 were performed. Seven trials were included, involving 851 patients with cognitive impairment. The meta-analysis showed that, in terms of overall cognitive function, the Montreal Cognitive Assessment score (MD = 1.64, 95% CI [0.97, 2.30], p < 0.001) of the intervention group was superior to the control group, but there was no significant difference in the Mini-Mental State Examination score between the two groups (MD = 0.33, 95% CI [-0.16, 0.82], p = 0.18). Compared with the control group, nonpharmacological intervention can effectively improve the neuropsychiatric condition of patients (SMD = -0.42, 95% CI [-0.64, -0.20], p = 0.0002). In summary, the current evidence shows that nonpharmacological social work interventions had a positive effect on the cognitive function and neuropsychiatric status of patients with cognitive impairment. Suggestions for future nonpharmacological intervention practice are discussed.

Association between walking and square dancing-oriented leisure-time physical activity and cognitive function among middle-aged and elderly people in Southwest China

BackgroundSouthwest China is facing a serious aging problem across the country, but the status of cognitive function in middle-aged and elderly people in this region is superior to the national average. This study intends to reveal the leisure-time physical activity (LTPA) pattern in this region and explore whether this pattern is beneficial for cognitive function.MethodsThe data came from the 2019–2021 baseline survey on cognitive function of a natural population cohort conducted by West China Hospital of Sichuan University. A structured questionnaire was used to investigate the LTPA status of the participants, and the Mini-Mental State Examination was used to evaluate their cognitive function. Then, we used multiple linear regression to analyze the association between LTPA and cognitive level, and further subgroup analysis was carried out according to sex, age and waist-to-hip ratio.ResultsA total of 2697 participants were enrolled, with an average age of 66.19 ± 6.68 years. The average cognitive function score was 27.23 ± 2.72, of which 8.60% indicated mild cognitive impairment. Their median LTPA level was 24.50 MET-hours per week, of which 70.37% reached the activity level recommended by WHO, with the main types being walking (1340 cases, 49.68%), square dancing (270 cases, 10.01%), or walking + square dancing (172 cases, 6.38%). Multiple linear regression showed that cognitive function increased with the amount of LTPA from 11.25 MET-hours/week to 36.40 MET-hours/week (β 0.09 for 11.25 ~ 24.50 MET-hours/week, β 0.38 for 24.50 ~ 36.40 MET-hours/week) but stabilized at more (β 0.39 for ≥36.40 MET-hours/week). The positive association persisted even for those who only walked (β 0.37 for 24.50 ~ 36.40 MET-hours/week, P = 0.008).ConclusionsMiddle-aged and elderly people in Southwest China hold a relatively high level of LTPA status, and walking and square dancing-oriented LTPA are positively correlated with cognitive function.

Association between cognitive frailty and falls among older community dwellers in China: A Chinese longitudinal healthy longevity survey-based study.

The combined effect of cognitive impairment (CoI) and frailty on falls is controversial. This study aimed to explore whether older adults with cognitive frailty (CF) were at a higher risk of falls than those with only CoI or frailty and to present a fall prediction model based on CF. A total of 4,067 adults aged ≥ 60 years were included from the Chinese Longitudinal Healthy Longevity Survey through face-to-face interviews. Cognitive function and frailty were assessed using the mini-mental state examination scale and frailty index, respectively. Logistic regression was used to determine fall-associated risk factors and develop a fall prediction model. A nomogram was then plotted. The model performance was evaluated using the area under the curve (AUC), concordance index (C-index), and calibration curve. All analyses were performed using SPSS and R statistical packages. The prevalence of CF and falls were 1.4 and 19.4%, respectively. After adjusting for covariates, the odds ratio of CF, frailty only, and CoI only for falls were 2.27 (95% CI: 1.29-3.97), 1.41 (95% CI: 1.16-1.73), and 0.99 (95% CI: 0.43-2.29), respectively. CF, sex, age, hearing difficulty, depression, anxiety, disability in instrumental activities of daily living, and serious illness in the past 2 years were independently associated with falls. A prediction model based on these factors yielded an AUC of 0.646 and a C-index of 0.641. Cognitive frailty (CF) exerted a cumulative effect on falls than did CoI or frailty alone. Joint assessments of cognitive function and frailty status may be beneficial for fall risk screening in community. A prediction model using CF as a factor could be helpful for this process.

The Feasibility and Safety of Endoscopic Submucosal Dissection for Circumferential Superficial Esophageal Squamous Cell Neoplasms.

Background It remains controversial whether endoscopic submucosal dissection (ESD) is still appropriate for circumferential superficial esophageal squamous cell neoplasms (SESCN), and few studies compared the short-term and long-term outcomes of ESD with radical surgery. Methods A total of 140 patients with SESCN who underwent ESD or surgery between February 2014 and October 2021 were retrospectively reviewed. The characteristics of patients, operative time, postoperative complications, overall survival (OS), recurrence-free survival (RFS), and quality of life (QOL) were compared between the ESD and surgery groups. The effect of different methods to prevent esophageal stenosis after ESD were analysed. Results Drinking, family history of cancer, macroscopic type, and intrapapillary capillary loop (IPCL) type were independent risk factors for deep submucosal invasion (SM ≥ 200 μm). Smoking and IPCL type were independent predictive factors for angiolymphatic invasion. The average operative time of ESD was significantly shorter than that of surgery (174.5 ± 51.16 min vs. 255.9 ± 88.18 min, p < 0.001). The incidence of perioperative complications in ESD group was significantly lower than that in surgery group (5.5% vs. 19.4%, p = 0.015). The ESD group had significantly better functional scale scores for emotional functioning, cognitive functioning, and global health status, and lower rates of pain, dyspnoea, insomnia, appetite loss, diarrhoea, reflux, and trouble with taste than the surgery group. No significant difference in OS and RFS between ESD and surgery group. Conclusions ESD can significantly shorten the operative time and reduce perioperative complications. Additionally, on the premise of using appropriate measures to prevent postoperative stenosis, ESD can be the first choice for the treatment of SESCN, which could provide better QOL, and the long-term prognosis of ESD is no less than that of surgery.

Anemia in Elderly Patients-The Impact of Hemoglobin Cut-Off Levels on Geriatric Domains.

Background: The primary aim of this study was to evaluate the impact of anemia—according to the WHO criteria—on cognitive performances, mood, functional and nutritional status, and comorbidities in a population of subjects aged 65 years or older. The secondary aim of this study was to understand if different hemoglobin cut-off levels are associated with a variation of the mentioned domains’ impairment. Methods: We designed a cross-sectional study, including subjects aged 65 or more consecutively evaluated in an outpatient setting from July 2013 to December 2019. A sum of 1698 subjects met the inclusion criteria. They were evaluated with: MMSE and CDT (cognitive assessment), GDS (mood), BADL, IADL, PPT, and POMA (autonomies), MNA (nutritional status), and CIRS (comorbidities). Results: According to the WHO criteria, non-anemic patients reported significantly better performances than the anemics in BADL (p < 0.0001), IADL (p = 0.0007), PPT (p = 0.0278), POMA (p = 0.0235), MNA, CIRS TOT, CIRS ICC, and CIRS ISC (p < 0.0001). The same tendency has been found by considering the 12 g/dL- and the 13 g/dL-cut-off level in the whole population. The multivariate analysis showed that, considering the 12 g/dL-cut-off level, age (OR: 1.03, p = 0.0072), CIRS (OR: 1.08, p < 0.0001), and gender (OR: 0.57, p = 0.0007) were significant regressors of anemia, while considering the 13 g/dL-cut-off level, age (OR: 1.04, p = 0.0001), POMA (OR: 1.03, p = 0.0172), MNA (OR = 0.95, p = 0.0036), CIRS (OR: 1.17, p < 0.0001), ICC (OR = 0.83, p = 0.018), and gender (OR = 0.48, p < 0.0001) were significant regressors of anemia, while the other CGA variables were excluded by the model (p > 0.01). Conclusions: Our study showed that anemia negatively impact on geriatric people’s general status, regardless of which hemoglobin cut-off level is considered. It also highlighted that hemoglobin concentrations < 13 g/dL, regardless of gender, have an association with the impairment of the affective-functional-nutritional state as well as an increase in comorbidities; therefore, it should be pursuable to consider the elderly person “anemic” if Hb < 13 g/dL regardless of gender.

Global iterative optimization framework for predicting cognitive function statuses of patients with end‐stage renal disease

AbstractThe existing methods to determine the cognitive function level of end‐stage renal disease (ESRD) are not only inaccurate but also susceptible to the influence of the patient's education level, emotional state, and examination environment. We proposed a global iterative optimization framework (GIO) to accurately predict cognitive function statuses of ESRD patients without being affected by the above factors. First, the functional magnetic resonance imaging (fMRI) data preprocessed and the time series were extracted to construct brain functional networks. Secondly, the areas under curve (AUC) of topological attribute parameters in the brain functional networks were extracted as features. After statistical analysis, the global efficiency, the characteristic path length, and the shortest path length in the small‐world network were selected as features for linear fusion. Finally, the support vector regression (SVR) was used as the basis of GIO framework, and the global iterative search strategy was introduced to find out the most appropriate penalty factor and radial basis function parameters. Achieving the objective of accurately predicting the cognitive function status of patients with end‐stage renal disease. Since this framework uses SVR which has special advantages in processing small sample data, and introduces appropriate parameter selection method, the prediction ability of GIO framework has been significantly improved. Experimental results demonstrate that the final prediction accuracy of the proposed framework is significantly better than those of SVR, LSSVR, GMO‐SVR, GMO‐LSSVR, and PSO‐SVR. The mean absolute error (MAE) and the mean absolute percentage error (MAPE) of the proposed framework are 0.55% and 2.58%, respectively. It is suggested that this framework is more convenient to determine the current level of cognitive function in ESRD patients and is conducive to the early prevention of cognitive dysfunction in ESRD patients.

Undernutrition and associated factors among older adults in Ethiopia: systematic review and meta-analysis

ObjectiveUndernutrition contributes to decreased physical and cognitive functional status, higher healthcare consumption, premature institutionalisation and increased mortality. So, the objective of this study was to determine the pooled prevalence and...

JS-HR-6: CONSIDERING FRAILTY AND EXERCISE FOR MANAGEMENT OF HYPERTENSION AND HYPERTENSIVE ORGAN DAMAGE

Frailty is defined as physiological decline and a state of vulnerability to stress and results in adverse health outcomes. It consists of multiple domains such as physical, social, and psychological factors. Cognitive decline is one of the factors concerning frailty, and blood pressure (BP) control reduced dementia or cognitive decline significantly in meta-analysis. However, in elderly population above 80 years, positive effect of antihypertensive therapy for preventing dementia was not proved. In the latest study in hypertension research, meta-analysis of prevalence of mild cognitive impairment (MCI) among hypertensive patients were conducted. Overall prevalence of MCI was 30% in a sample of 47179 patients. Another study which prospectively followed elderly hypertensive patients for 41 months, mortality rates were lowest in those with systolic blood pressure &lt; 140mmhg with no frailty, and highest in those with systolic blood pressure &lt; 140mmHg with frailty. Since frailty and cognitive decline is common in hypertensive patients, adequate blood pressure management in frailty patients are required. Further research accumulating scientific evidence with longitudinal data is needed for the guidance of blood pressure control in such patients. On the other hand, treatment of elderly hypertensive patients is complicated because their comorbidity, frailty, cognitive function, and social status should be taken into consideration. Individual assessment and constant follow up is imperative for the treatment of these patients. In the era of technically advanced, people are spending less active which leads to cardiovascular risks including hypertension. However, guidelines emphasize the importance of non-pharmacological strategies such as life style modification and exercise to prevent diseases. In the latest study in hypertension research, a study compared different types of exercise which is beneficial for health. As for the result, combination exercise of aerobic and resistance training was most effective at improving cardiorespiratory fitness, muscle strength BMI, fat mass, glucose, cholesterol and triglyceride. Several studies showed isometric exercise training reduced systolic blood pressure. Other study showed vascular function improved with daily exercise habits such as stair climbing.

Evaluation of cognitive functions in adult individuals with COVID-19.

Cognitive deficits that are associated with coronavirus disease 2019 (COVID-19) and occur in the acute period are gaining importance. While most studies have focused on the elderly severely affected during acute infection, it remains unclear whether mild to moderate COVID-19 results in cognitive deficits in young patients. This study aims to evaluate the post-infection cognitive functions of young adults with mild to moderate symptoms of COVID-19. A total of 100 adults with similar age and educational background were included in the study. Half of those had been infected with COVID-19 in the last 60days (N = 50), and the other half had not (N = 50). Global cognitive skills of the participants were evaluated through Montreal Cognitive Assessment Scale (MoCA) and Clock-Drawing Test; memory functions with Öktem Verbal Memory Processes Test (Ö-VMPT); attention span with Digit Span Test; executive functions with Fluency Tests, Stroop Test, and Trail Making Test; visual perceptual skills with Rey Osterrieth Complex Figure Test (ROCF); and neuropsychiatric status with Neuropsychiatric Inventory (NPI). Evaluations were performed in the experimental group for 21 to 60days from the onset of the disease, and throughout the study, in the control group. It was found that global cognitive skills, verbal memory, visual memory, executive function, and neuropsychiatric status were affected during COVID-19 (p < 0.05). When the cases were analyzed according to disease severity, no relationship was found between cognitive deficits and disease severity.

To Study the efficacy of Plumbum Metallicum Homoeopathic Medicine in improving the Cognitive function in Elderly

Background: Cognitive function may deteriorate with age owing to numerous reasons such as hypertension, Type-II Diabetes Mellitus, Hypothyroidism. This in turn has a negative impact on the physical activity as well as quality of life in elderly. Mini-mental state examination is a technique used to assess the status of cognitive function of any individual. This study aims to assess the efficacy of homoeopathy in improving the cognitive function in elderly. Methods: It was a non-randomized study, wherein 50 patients satisfying the inclusion and exclusion criteria were selected for the study. All the patients were administered PlumbumMetallicum homoeopathic medicine. The cognitive function of the elderly was evaluated using Mini-mental state examination every1 month of treatment till the end of the study period. All the data was measured and analysed at entry and every 1 month till the completion of the study period. Results: At the end of the study, significant improvement in the Mini mental State Examination response score was recorded. Conclusion: Homoeopathic Medicine Plumbum Metallicum is efficient in improving the cognitive function of elderly.

Early identification of subjective cognitive functional decline among patients with Parkinson’s disease: a longitudinal pilot study

Practical methods for early identification of Parkinson’s disease (PD) mild cognitive impairment (PD-MCI) through changes in real-life daily functioning are scarce. The aim of the study was to examine whether the cognitive functional (CF) feature, comprising of seven self-reported Movement Disorder Society’s (MDS) Unified Parkinson’s Disease Rating Scale (UPDRS) items, predicts PD patients’ cognitive functional status after a year. We conducted a 1-year follow-up of 34 PD patients (50–78 year; 70.6% men) suspected of MCI using the following measures: the MDS-UPDRS, UPDRS-CF feature, Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Parkinson’s Disease Cognitive Functional Rating Scale (PD-CFRS), and Daily Living Questionnaire (DLQ). The first and second UPDRS-CF feature scores, and additional measures at the 1-year follow-up significantly correlated. Hierarchical regression revealed that the initial MoCA, TMT, and BDI scores predicted the second UPDRS-CF, and the first UPDRS-CF predicted 31% of the second PD-CFRS score variance. Depression moderated the relationship between the first UPDRS-CF score and the DLQ Part A. These results suggest practical, self-reported, daily functional markers for identifying gradual decline in PD patients. They consider the patients’ heterogeneity, underlying cognitive pathology, and implications on daily functioning, health, and well-being.

FACTORS ASSOCIATED WITH COGNITIVE FUNCTION AMONG OLDER ADULTS IN VIETNAM

Abstract While Viet Nam is aging rapidly, there are few studies on cognitive function of older adults. We aimed to study status of cognitive function among older adults in Viet Nam and examine factors associated with cognitive function. The baseline data of the Longitudinal study of Ageing and Health in Viet Nam conducted in 2018/2019 was used for the study. LSAHV was a nationally representative survey of those aged 60 and above and computer-assisted personal interview (CAPI) using a tablet was conducted for data collection. The number of older person included in the study was 5,530. Cognitive function was measured by Short Portable Mental Status Questionnaire (SPMSQ). Factors such as demographic, socioeconomic, health behavior and daily activities such as reading newspaper were examined for their association with cognitive function by linear regression analyses. We found that better cognitive function was associated with engaging in physical activity in both male and female, listening to radio and receiving material support from children in male, and reading in female. Poorer cognitive function was associated with IADL limitation and financial support in both male and female, obesity in male, and hypertension and hearing loss in female. Our study provides an understanding of the associated factors with cognitive function of older people in Viet Nam. Some of the factors examined are modifiable and can be improved to prevent cognitive decline. It is also important to consider sex differences in planning and implementation of interventions and programs to prevent cognitive decline in Viet Nam.

Effectiveness of interventions in older adults with cognitive frailty: a systematic review and meta-analysis of randomised controlled trials.

interventions targeting older adults with cognitive frailty have grown rapidly in recent years with inconsistent findings. However, there is no meta-analysis that has synthesised pooled estimates. to synthesise the pooled effect of current targeted interventions in older people with cognitive frailty. we conducted a systematic search in PubMed, Embase, Web of Science, the Cochrane Library, the JBI database and three Chinese databases (CNKI, Wan-Fang and VIP) for literature from the inception of the database until 8 March 2022. The mean difference or standardised mean difference with 95% CIs was calculated. The methodological quality was assessed by the Cochrane RoB 2.0. The certainty of evidence was assessed using the GRADE criteria. thirteen randomised controlled trials with a total of 1,089 participants were included. The results of the meta-analysis showed that older adults with cognitive frailty in the intervention groups had significant improvement in frailty score [MD = -1.67, 95% CI (-2.39, -0.95), P < 0.00001, I2= 97%], global cognitive function [MD = 3.38, 95% CI (1.90, 4.85), P < 0.00001, I2= 93%], mobility [MD = -0.96, 95% CI (-1.27, -1.66), P < 0.00001, I2= 0%], muscle strength [SMD = 0.75, 95% CI (0.09, 1.41), P = 0.03, I2= 85%] and nutritional status [MNA:MD = 5.64, 95% CI (3.99, 7.29), P < 0.00001, I2= 89%; ALB: MD = 3.23, 95% CI (0.76, 5.71), P = 0.01, I2= 93%; PALB: MD = 54.52, 95% CI (25.26, 83.77), P = 0.0003, I2= 96%; TRF: MD = 0.64, 95% CI (0.22, 1.06), P = 0.003, I2= 97%]. The overall certainty of the evidence ranged from low to moderate. interventions targeting older adults with cognitive frailty are effective in improving physical frailty, global cognitive function, physical function and nutritional status with low to moderate certainty. More research is still needed in the future to further enrich the evidence in these fields. CRD42022318758.

Associations between dual‐decline in cognition and gait speed with risk of dementia – results from the ASPREE trial cohort

AbstractBackgroundDual decline in gait speed and cognition is associated with an increased risk of dementia. However, it is unclear if risks are conferred by decline in domain‐specific cognition and gait. We aimed to examine associations between dual decline in gait speed and cognition (global cognition, memory, processing speed and verbal fluency) with risk of dementia.MethodsProspective cohort study. Participants were from the ASPREE (ASPirin in Reducing Events in the Elderly) study, a double‐blind, randomized, placebo‐controlled trial of low dose aspirin in older adults (≥70 years; ≥65 if US minority). Of 19,114 randomized participants, 16,855 (88%) had longitudinal gait and cognitive data. Gait speed was measured at 0, 2, 4, 6 years and close‐out. Cognitive measures included Modified Mini‐Mental State examination (3MS, global cognition), Hopkins Verbal Learning Test‐Revised (HVLT‐R, memory), Symbol Digit Modalities (SDMT, processing speed) and Controlled Oral Word Association Test (COWAT‐F, verbal fluency), assessed at years 0, 1, 3, 5, and close‐out. Participants were classified into four groups: 1) dual decline in gait and cognition; 2) gait decline only; 3) cognitive decline only and 4) non‐decliners. Cognitive decline was defined as membership of the lowest tertile of annual change. Gait decline was defined as decline in gait speed ≥0.05 m/s per year across the study. Dementia (DSM‐IV criteria) was adjudicated by an expert panel using cognitive tests, functional status and clinical records. Cox proportional hazard models were used to estimate risk of dementia adjusting for covariates with death as competing risk.ResultsThe mean age of participants was 75.0 (SD4.4) years. Compared with non‐decliners, risk of dementia was highest in the gait+HVLT‐R decliners (HR 24.7; 95% CI 16.3‐37.3), followed by the gait+3MS (HR 22.2; 95% CI 15.0‐32.9), gait+COWAT‐F (HR 4.66 95%; CI 3.5‐6.3) and gait+SDMT (HR 4.3 95% CI 3.2‐5.8) groups. Dual decliners also had higher risk of dementia than those with either gait or cognitive decline alone for 3MS and HVLT‐R.ConclusionThe combination of decline in gait speed and memory may be the best suited to predict future dementia risk.

The Relationship of the Risk of Falls with the Features of Cognitive Function and Emotional Status (Fear of Falls) in Older People

Objective. To assess the frequency of falls, the relationship between fear of falling and the risk of falls in people aged 60 years and older. Material and methods. The open cross-sectional study included 51 outpatients (49 women, 2 men) aged 61 to 90 [70 (67; 75)] years. A conventional physical examination, clinical and biochemical blood tests, screening for fragility (the “Age is not a hindrance” questionnaire), the risk of falls (history, the “Get up and go” test), fear of falls (“Short scale for assessing the fear of falls”, “Scale of effectiveness falls”), assessment of cognitive function (CF) — Montreal scale of cognitive assessment — MoCa-test). Results. A high risk of senile asthenia was found in 38 %, preasthenia — in 31 %, a history of falls — in 75 %, fear of falls — in 78 %, impaired CF — in 49 % (MOCA 24.3±2.9 points) of patients. An association was found between fear of falls and history of falls (odds ratio [OR] 9.92, p=0.003, 95 % confidence interval [CI] 2.20-44.63), 2 or more comorbidities (OR 10.86, p=0.013, 95 % CI 1,66- 71,09); between the “Get up and go” test for more than 10 seconds and MOCA less than 25 points (OR 8.57, p=0.001, CI 2.4-30.3); scores less than 25 on the Fall Effectiveness Scale and MOCA (OR 5.6, p=0.018, CI 1.34-23.36). The optimal value of the “Get up and walk” test for predicting falls was 10.5 seconds or more (area under the curve 0.753±0.083, p=0.019), the MOCA test was 24.5 points or less (area under the curve 0.792±0.065, p &lt;0.001); the fall effectiveness scale for predicting fear of falls — 72.5 points or more (area under the curve 0.743±0.092, p=0.014); test “Get up and go” — 9.5 seconds or more (area under the curve 0.708±0.098, p=0.036). Conclusion. Fear of falls was associated with a history of falls, соmorbidity, low functional activity, and a decrease in CF, which confirms the multifactorial origin of the fear of falls in older age and requires consideration in the development of comprehensive treatment and prevention programs.

Associations between cognitive function and marital status in the United States, South Africa, Mexico, and China

We investigate the associations between marital status and cognitive well-being among adults aged 50 and older across four settings: the United States, rural South Africa, Mexico, and China. Using a standardized measure of immediate word recall, we assess whether people in each non-married status have worse cognitive function than their married counterparts, and the extent to which these associations vary across settings. We theorize that the practices around marriage in each setting, as well as the social stigma attached to marital dissolution, will reveal differing associations between marital status and cognition. Results suggest that, among women, being in a widowed marital status is associated with lower cognitive function in each setting except Mexico (after accounting for education and employment), while being separated/divorced or never married is associated with lower cognitive function only among women in the U.S. and Mexico. Among men, being widowed is associated with lower cognitive function relative to being married in each setting except South Africa (after accounting for education and employment), and being never married is associated with lower cognitive function in the U.S. and China (but not in South Africa or Mexico, after accounting for education and employment). Men also face relatively lower cognitive function if separated/divorced in the U.S. and South Africa. We discuss possible reasons for these associations across settings.

Moderated-mediation analysis of multimorbidity and health-related quality of life among the Chinese elderly: The role of functional status and cognitive function

To investigate the relationship between multimorbidity and health-related quality of life (HRQoL), and explore the effects of functional status and cognitive function on Chinses elderly behind this relationship. The Multivariate logistic regression and Tobit regression models were used to determine the influence of multimorbidity on HRQoL. Bootstrap analysis was used to probe the mediating effects of functional status and the moderating role of cognition on multimorbidity and HRQoL. Results of the 2,887 participants age ≥ 60 years included in the analysis, 51.69% had chronic diseases. Stroke (β = -0.190; 95% confidence interval [CI], -0.232, -0.149; p < 0.001) and the combination of hypertension and stroke (β = -0.210; 95% CI, -0.259, -0.160; p < 0.001) had the greatest influence on HRQoL. Functional status partially mediated the relationship between the number of non-communicable diseases (No. of NCDs) and HRQoL, while cognitive function had a moderating effect not only in the A-path (No. of NCDs to functional status, β = 0.143; t = 7.18; p < 0.001) and but also in the C-path (No. of NCDs to HRQoL, β = 0.007; t = 6.08; p < 0.001). Functional status partially mediated the relationship between multimorbidity and HRQoL in older adults. And cognitive function, if declined, may strengthen this relationship. These findings suggested that improving cognitive function and functional status in those who developed multimorbidity could be a viable prevention or treatment strategy to improve HRQoL in elderly patients.

Prevalence of pre-operative undiagnosed cognitive impairment and its association with handgrip strength, oral hygiene, and nutritional status in older elective surgical patients in Japan.

Preoperative cognitive impairment is a significant factor influencing post-operative delirium. We have been performing routine pre-operative comprehensive assessments, including evaluation of cognitive function, handgrip strength, oral hygiene, and nutritional status, in patients aged ≥ 65years since April 2021. This study aimed to examine the completion rate of pre-operative comprehensive assessment and assess the prevalence of pre-operative undiagnosed cognitive impairment. In this prospective observational study including patients aged ≥ 65years scheduled for elective surgery with general or regional anesthesia, cognitive impairment was defined as a Mini-Cog score ≤ 2, and its associations with handgrip strength, oral hygiene, and nutritional status were evaluated. Oral hygiene and nutritional status were assessed using an oral frailty self-checklist and the Mini Nutritional Assessment-Short Form, respectively. The incidence of pre-operative undiagnosed cognitive impairment was estimated, and its associated factors were explored with multiple logistic regression. Among 331 eligible patients, the completion rate was 97.7% (305/312). The mean age was 74.8years, and 13.1% (40/305) (95% confidence interval [CI], 9.7-17.3%) of the patients had pre-operative undiagnosed cognitive impairment. Multiple logistic regression revealed that handgrip strength (odds ratio [OR] = 0.94, 95%CI = 0.89-0.99) and oral frailty self-checklist score (OR = 1.19, 95%CI = 1.02-1.40) were associated with pre-operative undiagnosed cognitive impairment, while the Mini Nutritional Assessment-Short Form score was not significantly associated (OR = 0.97, 95%CI = 0.82-1.14). Preoperative comprehensive assessment was feasible. The prevalence of pre-operative undiagnosed cognitive impairment was 13%, and poor handgrip strength and worse oral hygiene were significantly associated factors.

Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial fibrillation.

In older patients with atrial fibrillation (AF), cognitive impairment and frailty are prevalent. It is unknown whether the risk and benefit of anticoagulation differ by cognitive function and frailty. A total of 1244 individuals with AF with age ≥65 years and a CHADSVASC score ≥2 were recruited from clinics in Massachusetts and Georgia between 2016 and 18 and followed until 2020. At baseline, frailty status and cognitive function were assessed. Hazard ratios of anticoagulation on physician adjudicated outcomes were adjusted by the propensity for receiving anticoagulation and stratified by cognitive function and frailty status. The average age was 75.5 (± 7.1) years, 49% were women, and 86% were prescribed oral anticoagulants. At baseline, 528 (42.4%) participants were cognitively impaired and 172 (13.8%) were frail. The adjusted hazard ratios of anticoagulation for the composite of major bleeding or death were 2.23 (95% confidence interval: 1.08-4.61) among cognitively impaired individuals and 0.94 (95% confidence interval: 0.49-1.79) among cognitively intact individuals (P for interaction=0.08). Adjusted hazard ratios for anticoagulation were 1.84 (95% confidence interval: 0.66-5.13) among frail individuals and 1.39 (95% confidence interval: 0.84-2.40) among not frail individuals (P for interaction=0.67). Compared with no anticoagulation, anticoagulation is associated with more major bleeding episodes and death in older patients with AF who are cognitively impaired.