Cognitive Impairment In Old Age Research Articles

Association Between Dietary Intakes of B Vitamins in Midlife and Cognitive Impairment in Late-Life: The Singapore Chinese Health Study.

Dietary intakes of B vitamins (eg, folate) are related to cognitive function according to epidemiological studies in western countries. But prospective studies in Asian populations are scarce. This study evaluated the relationships of dietary intakes of six B vitamins in midlife with cognitive impairment in old age in a Chinese population living in Singapore. This study included 16,948 participants from the Singapore Chinese Health Study, a population-based prospective cohort. Baseline dietary intakes of B vitamins were assessed using a validated 165-item food frequency questionnaire when the participants were aged 45-74 years (1993-1998). After an average follow-up of 20 years, cognitive function was examined using a Singapore-modified version of Mini-Mental State Examination scale in 2014-2016, and cognitive impairment was defined using education-specific cutoffs. Logistic regression models were applied to estimate the association between B vitamins and cognitive impairment. All the six B vitamins were mutually adjusted in the final model. In the 2014-2016 interview, 2,443 participants were defined as cognitive impairment. Riboflavin and folate were significantly and independently associated with cognitive impairment in a dose-dependent manner: the odds ratio (95% confidence interval) comparing the highest with the lowest quartile was 0.82 (0.69, 0.97) for riboflavin and 0.83 (0.70, 0.98) for folate (both p-trend <.05). Dietary intakes of thiamine, niacin, vitamin B-6, and B-12 were not significantly associated with risk of cognitive impairment. Higher dietary intakes of riboflavin and folate in midlife were associated with a lower risk of cognitive impairment in late-life in the Chinese population.

Associations of the metabolic syndrome and its components with cognitive impairment in older adults

BackgroundThe metabolic syndrome (MetS) is an established cardiovascular risk factor. Here, we investigated its role in cognitive impairment.MethodsBaseline data from 202 participants (aged 65 to 87 years) of the BioCog study were used. All were free of clinical dementia (MMSE≥24/30). Cognitive impairment was defined as the lowest tertile of a cognitive summary score. Multiple logistic regression analyses examined associations of body mass index (BMI), triglycerides (TG), high-density lipoprotein (HDL-C), glucose and glycated hemoglobin A1c (HbA1c) levels with the odds of cognitive impairment. MetS was defined as ≥3 of its 5 components obesity (BMI ≥ 30 kg/m2), elevated TG (TG ≥1.7 mmol/L), reduced HDL-C (males: < 1.0 mmol/L; females: < 1.3 mmol/L), elevated glucose (glucose ≥5.5 mmol/L and/or diagnosed diabetes) and elevated blood pressure (history of hypertension). Analyses controlled for age, sex and smoking history.ResultsLower HDL-C was significantly associated with a higher odds of cognitive impairment (OR 2.70 per 1 mmol/L reduction; 95% CI 1.25, 5.56; p = 0.011), whereas BMI, TG, glucose and HbA1c were not (all p > 0.05). Results for HDL-C were similar when HDL-C, glucose, BMI and TG were entered into a single model (OR 2.56 per 1 mmol/L reduction, 95% CI 1.09, 5.88, p = 0.031) and when cerebrovascular disease and coronary heart disease were additionally controlled for (OR 2.56 per 1 mmol/L reduction, 95% CI 1.06, 6.25, p = 0.036). Among the 5 MetS components, participants with elevated TG were at 2-fold increased odds of impairment (OR 2.09, 95% CI 1.08, 4.05, p = 0.028) including when the remaining 4 MetS components were entered (OR 2.23, 95% CI 1.07, 4.65, p = 0.033), but the finding was no longer statistically significant when cerebrovascular disease and coronary heart disease were additionally controlled for (p = 0.11). Presence of MetS and of obesity, reduced HDL-C, elevated glucose or elevated blood pressure were not significantly associated with impairment (all p > 0.05).ConclusionOur findings support low HDL-C as an independent risk marker of cognitive impairment in older age. The need for research into mediatory and confounding factors, and re-evaluation of traditional cut-off points is highlighted.Trial registrationThe study was registered on 15th October 2014 at clinicaltrials.gov (NCT02265263).

Age-Normative MMSE Data for Older Persons Aged 85 to 93 in a Longitudinal Swedish Cohort.

Background/ObjectivesNormative Mini‐mental state examination (MMSE) reference values in elderly are scarce. Therefore, the aim is to present normative MMSE values for 85–93 year olds.DesignA longitudinal age cohort study.SettingA population study of the residents in the municipality of Linköping, Sweden.ParticipantsResidents (n = 650) born in 1922 during the course of 2007. In total, 374 individuals participated and were tested with MMSE at age 85, 280 of these were willing and able to also participate at age 86, 107 at age 90 and 51 at age 93.MeasurementsMMSE, from 0–30, with lower scores denoting more impaired cognition.ResultsMedian MMSE values for the total population over the ages 85, 86, 90 and 93 years was 28 for all ages investigated. The 25th percentile values were 26, 26, 26 and 27, respectively. For a “brain healthy” sub‐group median values were 28, 29, 28, and 28. The 25th percentile values were 27, 28, 26 and 27, respectively. Comparisons for age‐effects showed no differences when all individuals for each age group were compared. When only the individuals reaching 93 years of age (n = 50) were analyzed, there was a significant lowering of MMSE in that age group.ConclusionThe literature is variable and in clinical practice a low (24) MMSE cut off is often used for possible cognitive impairment in old age. The present data indicate that MMSE 26 is a reasonable cut off for possible cognitive decline in older persons up to the age of 93. J Am Geriatr Soc 67:534–538, 2019.

Sensorial frailty: age-related hearing loss and the risk of cognitive impairment and dementia in later life.

The peripheral hearing alterations and central auditory processing disorder (CAPD) associated with age-related hearing loss (ARHL), may impact cognitive disorders in older age. In older age, ARHL is also a significant marker for frailty, another age-related multidimensional clinical condition with a nonspecific state of vulnerability, reduced multisystem physiological reserve, and decreased resistance to different stressors (i.e. sensorial impairments, psychosocial stress, diseases, injuries). The multidimensional nature of frailty required an approach based on different pathogeneses because this clinical condition may include sensorial, physical, social, nutritional, cognitive, and psychological phenotypes. In the present narrative review, the cumulative epidemiological evidence coming from several longitudinal population-based studies, suggested convincing links between peripheral ARHL and incident cognitive decline and dementia. Moreover, a few longitudinal case-control and population-based studies also suggested that age-related CAPD in ARHL, may be central in determining an increased risk of incident cognitive decline, dementia, and Alzheimer’s disease (AD). Cumulative meta-analytic evidence confirmed cross-sectional and longitudinal association of both peripheral ARHL and age-related CAPD with different domains of cognitive functions, mild cognitive impairment, and dementia, while the association with dementia subtypes such as AD and vascular dementia remained unclear. However, ARHL may represent a modifiable condition and a possible target for secondary prevention of cognitive impairment in older age, social isolation, late-life depression, and frailty. Further research is required to determine whether broader hearing rehabilitative interventions including coordinated counseling and environmental accommodations could delay or halt cognitive and global decline in the oldest old with both ARHL and dementia.

Visceral fat-related systemic inflammation and the adolescent brain: a mediating role of circulating glycerophosphocholines.

Life-long maintenance of brain health is important for the prevention of cognitive impairment in older age. Low-grade peripheral inflammation associated with excess visceral fat (VF) may influence brain structure and function. Here we examined (i) if this type of inflammation is associated with altered white-matter (WM) microstructure and lower cognitive functioning in adolescents, and (ii) if recently identified circulating glycerophosphocholines (GPCs) can index this type of inflammation and associated variations in WM microstructure and cognitive functioning. We studied a community-based sample of 872 adolescents (12-18 years, 48% males) in whom we assessed VF and WM microstructure with magnetic resonance imaging, processing speed with cognitive testing, serum C-reactive protein (CRP, a common marker of peripheral inflammation) with a high-sensitivity assay, and serum levels of a panel of 64 GPCs with advanced mass spectrometry. VF was associated with CRP, and CRP in turn was associated with "altered" WM microstructure and lower processing speed (all p < 0.003). Further, "altered" WM microstructure was associated with lower processing speed (p < 0.0001). Of all 64 tested GPCs, 4 were associated with both VF and CRP (at Bonferroni corrected p < 0.0004). One of them, PC16:0/2:0, was also associated with WM microstructure (p < 0.0001) and processing speed (p = 0.0003), and mediated the directed associations between VF and both WM microstructure (p < 0.0001) and processing speed (p = 0.02). As a mediator, PC16:0/2:0 explained 21% of shared variance between VF and WM microstructure, and 22% of shared variance between VF and processing speed. Similar associations were observed in an auxiliary study of 80 middle-aged adults. Our results show that VF-related peripheral inflammation is associated with "altered" WM microstructure and lower cognitive functioning already in adolescents, and a specific circulating GPC may be a new molecule indexing this VF-related peripheral inflammation and its influences on brain structure and function.

Association of obesity, diabetes and hypertension with cognitive impairment in older age.

BackgroundAge-related cognitive impairment is rising in prevalence but is not yet fully characterized in terms of its epidemiology. Here, we aimed to elucidate the role of obesity, diabetes and hypertension as candidate risk factors.MethodsOriginal baseline data from 3 studies (OCTOPUS, DECS, SuDoCo) were obtained for secondary analysis of cross-sectional associations of diabetes, hypertension, blood pressure, obesity (body mass index [BMI] ≥30 kg/m2) and BMI with presence of cognitive impairment in log-binomial regression analyses. Cognitive impairment was defined as scoring more than 2 standard deviations below controls on at least one of 5–11 cognitive tests. Underweight participants (BMI<18.5 kg/m2) were excluded. Results were pooled across studies in fixed-effects inverse variance models.ResultsAnalyses totaled 1545 participants with a mean age of 61 years (OCTOPUS) to 70 years (SuDoCo). Cognitive impairment was found in 29.0% of participants in DECS, 8.2% in SuDoCo and 45.6% in OCTOPUS. In pooled analyses, after adjustment for age, sex, diabetes and hypertension, obesity was associated with a 1.29-fold increased prevalence of cognitive impairment (risk ratio [RR] 1.29; 95% CI 0.98, 1.72). Each 1 kg/m2 increment in BMI was associated with 3% increased prevalence (RR 1.03; 95% CI 1.00, 1.06). None of the remaining risk factors were associated with impairment.ConclusionOur results show that older people who are obese have higher prevalence of cognitive impairment compared with normal weight and overweight individuals, and independently of co-morbid hypertension or diabetes. Prospective studies are needed to investigate the temporal relationship of the association.

Association of Obesity, Diabetes, and Hypertension with Cognitive Impairment in Older age

Association of Obesity, Diabetes, and Hypertension with Cognitive Impairment in Older age

The Integrity of the Corpus Callosum Mitigates the Impact of Blood Pressure on the Ventral Attention Network and Information Processing Speed in Healthy Adults.

Hypertension is a risk factor for cognitive impairment in older age. However, evidence of the neural basis of the relationship between the deterioration of cognitive function and elevated blood pressure is sparse. Based on previous research, we speculate that variations in brain connectivity are closely related to elevated blood pressure even before the onset of clinical conditions and apparent cognitive decline in individuals over 60 years of age. Forty cognitively healthy adults were recruited. Each received a blood pressure test before and after the cognitive assessment in various domains. Diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rsfMRI) data were collected. Our findings confirm that elevated blood pressure is associated with brain connectivity variations in cognitively healthy individuals. The integrity of the splenium of the corpus callosum is closely related to individual differences in systolic blood pressure. In particular, elevated systolic blood pressure is related to resting-state ventral attention network (VAN) and information processing speed. Serial mediation analyses have further revealed that lower integrity of the splenium statistically predicts elevated systolic blood pressure, which in turn predicts weakened functional connectivity (FC) within the VAN and eventually poorer processing speed. The current study sheds light on how neural correlates are involved in the impact of elevated blood pressure on cognitive functioning.

Prevalence of thyroid dysfunction and its impact on cognition in older mexican adults: (SADEM study).

Subclinical thyroid dysfunction is a possible risk factor for cognitive impairment in old age, but results are inconsistent. Aim of the present study was to evaluate the prevalence of thyroid dysfunction among older community-dwelling adults and to see whether thyroid function impacts the cognitive status of the elderly. We included 1750 participants from the Study on Aging and Dementia in Mexico (SADEM). All subjects were evaluated clinically via specific interviews. TSH levels were analyzed by chemiluminescent immunometry assay. We classified participants into five thyroid state groups: (1) normal TSH levels (0.40-4.0IU/L) were considered euthyroid; (2) Overt hyperthyroidism: TSH <0.3IU/l and FT4 >23pmol/l; (3) Overt hypothyroidism: TSH >4.8IU/l, FT4 <13pmol/l; (4) Subclinical hyperthyroidism: TSH <0.3IU/l, FT4: 13-23 pmol/l; (5) Subclinical hypothyroidism: TSH >4.8IU/l, FT4: 13-23 pmol/l. The overall estimated prevalence of thyroid dysfunction in Mexican population was 23.7% (95% CI, 22.66-26.77). Of these, 15.4% older adults were classified as subclinical hypothyroidism, 7.2% overt hypothyroidism, 0.5% subclinical hyperthyroidism, and 0.6% overt hyperthyroidism. The association of thyroid dysfunction with cognitive impairment was most evident in overt hypothyroidism OR = 1.261 (1.185-1.343). The present study demonstrated a high prevalence of thyroid dysfunction in Mexican elderly people living in the community. A relationship between cognitive impairment and the presence of hypothyroidism was also shown, and to a lesser degree in hyperthyroidism.

LA ACTIVIDAD FÍSICA Y DEPORTIVA COMO MEDIO PARA LA REDUCCIÓN DE LOS NIVELES DE DETERIORO COGNITIVO EN LAS PERSONAS MAYORES

Abstract.SPORT AND PHYSICAL ACTIVITY AS A MEANS FOR REDUCING LEVELS OF COGNITIVE DECLINE IN THE ELDERLY.Thanks to scientific knowledge, developed societies begin to assume that the population is growing significantly, which makes copper paramount importance in order to guarantee high levels of quality of life, articulation and implementation of a wide range of activities and programs that enable them to reduce their levels of cognitive impairment. It is in this context that the programs and activities of sport and physical activity are presented as outstanding instruments to ensure that older acquire and adopt efficient sports routines and healthy habits that will enable them to reduce their levels of cognitive decline and improve the quality of lifetime. From this situation, with this empirical study, we try to ascertain whether there is empirical evidence to affirm categorically that the combination of exercise and healthy lifestyle helps reduce levels of cognitive impairment in old age and therefore, to increase their quality of life. For this we used a descriptive methodology characterized by the use of qualitative instruments, such as the analysis of the main scientific studies on the subject, preceded the present. Although the data collected are not entirely decisive, it does shows that those elderly who manage to maintain significant levels of physical activity and sport and, moreover, are able to adopt healthy lifestyles will be able to maintain adequate health balance and, Consequently, a higher quality of life. interesting results are presented for future studies and research in this area continue to deepen. the desirability of the biggest sporting routines and adopt healthy lifestyles as a great strategy to ensure adequate health balance that enables them to increase their levels of perceived quality of life.Keywords: Health balance, cognitive impairment, elderly, programs and physical activities and sports, healthy lifestyle, quality of life.Resumen.Merced al conocimiento científico, las sociedades desarrolladas comienzan a asumir que la población mayor está creciendo de manera significativa, lo que hace que cobre una importancia capital, a fin de garantizarles altos niveles de calidad de vida, la articulación e implementación de una amplio abanico de actividades y programas que les posibiliten reducir sus niveles de deterioro cognitivo. Es precisamente en este contexto donde los programas y actividades de actividad física y deportiva se presentan como destacados instrumentos para garantizar que los mayores adquieran y adopten eficientes rutinas deportivas y hábitos de vida saludable que les posibiliten reducir sus niveles de deterioro cognitivo e incrementar su calidad de vida. A partir de esta situación, con el presente estudio empírico, se intenta comprobar si existen evidencias empíricas que permitan afirmar, con rotundidad, que la combinación de ejercicio físico y de hábitos de vida saludable contribuye a reducir los niveles de deterioro cognitivo durante la vejez y, por tanto, a incrementar su calidad de vida. Para ello se ha utilizado una metodología descriptiva caracterizada por el empleo de instrumentos de corte cualitativo, como son el análisis de los principales estudios científicos que, sobre la temática, han precedido al presente. Aunque los datos recopilados no son totalmente determinantes, sí que se aprecia que aquellos mayores que logran mantener importantes niveles de actividad física y deportiva y que, además, son capaces de adoptar hábitos de vida saludable van a conseguir mantener un adecuado equilibrio sanitario y, en consecuencia, una mayor calidad de vida. Se presentan resultados interesantes para futuros estudios e investigaciones que continúen profundizando en este ámbito. Se percibe la conveniencia de que los mayores adopten rutinas deportivas y hábitos de vida saludable como una gran estrategia para garantizarles un adecuado equilibrio sanitario que les posibilite incrementar sus niveles de calidad de vida.Palabras clave: Equilibrio sanitario, deterioro cognitivo, personas mayores, programas y actividades físicas y deportivas, hábitos de vida saludable, calidad de vida.

Childhood physical neglect promotes development of mild cognitive impairment in old age – A case-control study

This study aimed to investigate the role of early traumatic experiences in development of mild cognitive impairment (MCI) in Chinese elderly people. Seventy six patients and 61 controls were selected and assigned into two study groups, MCI and control, respectively. Childhood Trauma Questionnaire-Short Form (CTQ-SF) was used for assessment of early trauma, episodic memory and association learning scales for memory evaluation. In addition, event-related potentials (ERPs) were measured using electroencephalography (EEG) to indicate brain electrical activity of subjects during memory/cognitive tests. MCI patients showed higher scores of physical neglect and lower scores of emotional abuse in childhood than control group. Physical neglect score was negatively correlated with scores of MMSE, MoCA, episodic memory, calculation, and the amplitude of CzP300, FzP300 and PzP300, while a positive correlation was seen between the score of physical neglect and the latency of PzN200, FzN200, CzN200, CzP300, FzP300 and PzP300. The score of emotional abuse was weakly correlated with FzP300 amplitude, but not with any other ERP components. Our results suggested that early childhood exposure to physical neglect may lead to impairment in learning and memory, particularly in the associative learning and episodic memory, in old age.

The Economics of Cognitive Impairment: Volunteering and Cognitive Function in the HILDA Survey

Background: The economic impact of older-age cognitive impairment has been estimated primarily by the direct and indirect costs associated with dementia care. Other potential costs associated with milder cognitive impairment in the community have received little attention. Objective: To quantify the cost of nonclinical cognitive impairment in a large population-based sample in order to more fully inform cost-effectiveness evaluations of interventions to maintain cognitive health. Methods: Volunteering by seniors has economic value but those with lower cognitive function may contribute fewer hours. Relations between hours volunteering and cognitive impairment were assessed using the Household, Income and Labour Dynamics in Australia (HILDA) survey data. These findings were extrapolated to the Australian population to estimate one potential cost attributable to nonclinical cognitive impairment. Results: In those aged ≥60 years in HILDA (n = 3,127), conservatively defined cognitive impairment was present in 3.8% of the sample. Impairment was defined by performance ≥1 standard deviation below the age- and education-adjusted mean on both the Symbol Digit Modalities Test and Backwards Digit Span test. In fully adjusted binomial regression models, impairment was associated with the probability of undertaking 1 h 9 min less volunteering a week compared to being nonimpaired (β = -1.15, 95% confidence interval -1.82 to -0.47, p = 0.001). In the population, 3.8% impairment equated to probable loss of AUD 302,307,969 per annum estimated by hours of volunteering valued by replacement cost. Conclusion: Nonclinical cognitive impairment in older age impacts upon on the nonmonetary economy via probable loss of volunteering contribution. Valuing loss of contribution provides additional information for cost-effectiveness evaluations of research and action directed toward maintaining older-age cognitive functioning.

The Effect of Prenatal and Childhood Development on Hearing, Vision and Cognition in Adulthood.

It is unclear what the contribution of prenatal versus childhood development is for adult cognitive and sensory function and age-related decline in function. We examined hearing, vision and cognitive function in adulthood according to self-reported birth weight (an index of prenatal development) and adult height (an index of early childhood development). Subsets (N = 37,505 to 433,390) of the UK Biobank resource were analysed according to visual and hearing acuity, reaction time and fluid IQ. Sensory and cognitive performance was reassessed after ~4 years (N = 2,438 to 17,659). In statistical modelling including age, sex, socioeconomic status, educational level, smoking, maternal smoking and comorbid disease, adult height was positively associated with sensory and cognitive function (partial correlations; pr 0.05 to 0.12, p < 0.001). Within the normal range of birth weight (10th to 90th percentile), there was a positive association between birth weight and sensory and cognitive function (pr 0.06 to 0.14, p < 0.001). Neither adult height nor birth weight was associated with change in sensory or cognitive function. These results suggest that adverse prenatal and childhood experiences are a risk for poorer sensory and cognitive function and earlier development of sensory and cognitive impairment in adulthood. This finding could have significant implications for preventing sensory and cognitive impairment in older age.

Negative social interactions and risk of mild cognitive impairment in old age.

To test the hypothesis that negative social interaction is associated with increased risk of mild cognitive impairment and rate of cognitive decline. Participants were 529 older people without cognitive impairment at study onset. They completed annual evaluations that included assessment of negative social interactions (e.g., unsympathetic behavior, rejection), cognitive testing, and clinical classification of mild cognitive impairment. During a mean of 4.8 years of follow-up (SD = 2.5), 198 individuals (37.4%) developed mild cognitive impairment. In a proportional hazards model, higher baseline frequency of negative social interactions (M = 1.51, SD = 0.43, skewness = 1.60) was associated with higher risk of developing mild cognitive impairment (hazard ratio = 1.53, 95% confidence interval: 1.13, 2.07). Results were similar after adjustment for depressive symptoms, social network size, social activity, and loneliness. This association was mainly due to neglect and rejection. There was no change in negative social interaction rate over time (estimate = -0.003, SE = 0.004, p = .508). Higher baseline level of negative social interaction was associated with lower initial level of global cognition (estimate = -0.096, SE = 0.034, p = .005) but not with cognitive decline (estimate = -0.018, SE = 0.011, p = .098). A higher mean level of negative interactions across the study period was robustly related to faster cognitive decline (estimate = -0.036, SE = 0.012, p = .002). Frequent negative social interactions may be a risk factor for mild cognitive impairment and cognitive decline in old age.

The Association of Leisure Activities in Middle Adulthood with Cognitive Performance in Old Age: The Moderating Role of Educational Level

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

GA to HbA1C ratio, but not HbA1C is associated with cognition in Chinese nondiabetic old adults

Objectives: To investigate the relationship between glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and cognitive impairment in old age. Diabetes is associated with cognitive impairment in older people. However, the link between elevated GA/HbA1c levels and the risk of cognitive impairment in nondiabetic individuals is unclear.Methods: A cross-sectional study of 474 old, nondiabetic adults (192 women, mean age 73.8 years ± 6.9 SD) who had been admitted to our hospital was conducted. Glycemic measures included fasting plasma glucose (FPG), 2-hour post-prandial plasmic glucose (2hPPG), GA and HbA1c. Cognitive function was assessed using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at the same examination visit in which the glycemic measures were determined.Results: When the individuals were divided into two groups according to the median of GA/HbA1c ratio, old adults with GA/HbA1c ratio ≥ 2.53 showed lower MMSE and MoCA scores compared to those with GA/HbA1c ratio < 2.53. Univariate regression analysis showed that MMSE and MoCA scores were not correlated with HbA1c, but were inversely correlated with GA and GA/HbA1c ratio. Linear regression analysis revealed that there was a significant negative correlation between GA/HbA1c and cognitive function (β = −0.77, P < 0.01 for MoCA and β = −0.69, P < 0.05 for MMSE) even after adjustment for age, body mass index, systolic blood pressure, lipoprotein(a) and sex.Conclusion: Our results indicate that even in the absence of manifest type 2 diabetes mellitus, GA/HbA1c ratio levels exert a negative influence on cognition and it may be a better predictor for cognitive impairment in the older population.

Pain reporting in older adults: the influence of cognitive impairment - results from the Cambridge City >75 Cohort study.

Evidence suggests that while disabling back pain (BP), and rheumatic diseases associated with pain, continues to increase with age, the prevalence of non-disabling BP reaches a plateau, or even decreases, in the oldest old. This study aimed to determine whether this age-related pattern of non-disabling BP is a function of increasing cognitive impairment. Cross-sectional study of adults aged >77 years. Participants answered interviewer-administered questions on BP and cognitive function, assessed using the Mini-Mental State Examination, categorised into normal versus mild, moderate or severe impairment. The relationship between cognitive function and BP was examined using multinomial logistic regression, adjusted for age, sex and residence. Of 1174 participants with BP data, 1126 (96%) completed cognitive assessments. The relationship between cognitive function and BP differed for disabling and non-disabling BP. Across categories of cognitive impairment, increasingly higher prevalence of disabling BP was reported, compared to those with normal cognition, although this was not statistically significant (odds ratio (OR) = 1.7; 95% confidence interval (CI) = 0.7-4.6). No association was found between cognitive function and non-disabling BP (OR = 0.8; 95% CI = 0.4-1.6). This study found no association between the reporting of BP and level of cognitive impairment, suggesting that increasing cognitive impairment is an inadequate explanation for age-related decline in self-reported non-disabling BP. Future research should determine the reasons for the decline in non-disabling pain in older adults, although, meanwhile, it is important to ensure that this group receive appropriate pain assessment and pain management. Prevalence of non-disabling back pain decreases in the oldest old.Some have proposed that this may be a function of cognitive impairment in older age, and an increasing inability to adequately report pain.Our findings do not support this hypothesis.

Helping Older People with Cognitive Decline Communicate: Hearing Aids as Part of a Broader Rehabilitation Approach

There is a strong connection between hearing loss and cognitive impairment in old age. Dementia affects ∼10% of persons over the age of 65 years and increases in prevalence to 25 to 30% for persons older than 85 years. Hearing loss is even more prevalent, affecting roughly half of those over the age of 65 years and an increasing majority as age increases. Given these high prevalences, it is reasonable to assume that many older adults will have dual hearing and cognitive loss and that these losses will combine to affect individuals' everyday functioning, communication, social participation, and quality of life. Older adults with cognitive impairment may not receive adequate hearing care. Audiologic rehabilitation may help to optimize communication, which in turn may improve the individual's well-being directly as they engage more fully in activities of daily living. Maintaining communication also may confer indirect benefits to other aspects of the person's health and/or the health of their significant others. In the present article, we examine the continuum from healthy cognitive aging to dementia and review the literature concerning rehabilitation, the commonly overlooked brain connection, and the use of hearing aids by older adults with dementia. Directions for research and new practices are suggested.

Abstract 363: Better Control of Blood Pressure in Midlife was Associated with Cognitive Function in Old Age: The Minabe Study in Japan

Several studies show that hypertension in midlife is also related to cognitive impairment in old age. However, the associations between blood pressure and cognitive functions have been inconclusive. In this study, we examined this association in the sexagenarian and the septuagenarian separately to test our hypothesis that different risk factors were related to cognitive decline in each generation respectively. Participants were 1476 community-dwelling persons without dementia (708 men and 768 women). Resting systolic and diastolic blood pressures were measured in the seated position using an automated sphygmomanometer (HEM-907; Omron). The cognitive functions were measured by means of logical memory test, D-CAT (digit cancellation test; neuropsychological test for attention) and verbal fluency test. We asked participants about their use of antihypertensive drug and collected their data about blood pressure measured at a health examination conducted ten years ago. We constructed a series of multiple linear regression models to examine the association of blood pressure with each cognitive function. Separate analyses were conducted for each combination of predictor (SBP, DBP, past SBP, past DBP, and use of antihypertensive drug) and dependent value (logical memory test, D-CAT, and verbal fluency test). Regression models included the following covariates: age, education, gender, and body mass index. Results indicated the following two points: (1) Higher levels of past DBP (β = -.121, p &lt; .05) was associated with decline in logical memory test and higher level of past SBP (β = -.127, p &lt; .05) was associated with decline in verbal fluency test in the sexagenarian, (2) The use of antihypertensive drug was associated with decline in D-CAT (β = -.194, p &lt; .001) and verbal fluency test (β = -.196, p &lt; .05) in the septuagenarian. Our findings suggest that high blood pressure in the past decade is risk factor for cognitive decline in the sexagenarian but is not risk factor in the septuagenarian. The treatment of high blood pressure in midlife is important for the maintenance of cognitive functions. Early control of high blood pressure might reduce the risk of cognitive impairment in old age.

History of lifetime smoking, smoking cessation and cognitive function in the elderly population

To examine potential associations of the history of lifetime smoking and smoking cessation with cognitive function in the elderly. In a population-based cohort study of older adults in Saarland, Germany, a detailed lifetime history of smoking was obtained using standardised questionnaires. Cognitive function was assessed with a validated telephone-based instrument (COGTEL) at the five-year follow-up in a subsample of n=1,697 participants with a baseline age >65years. Multiple linear regression models were employed to predict cognitive performance, adjusting for potential confounding factors. Ever-smokers with a higher cumulative dose of smoking in pack-years scored lower in the cognitive assessment than never-smokers, with the association being more pronounced in current smokers than in former smokers. In fully adjusted models, current smokers with 21-40 pack-years scored 4.06 points lower (95% CI -7.18 to -0.94) than never-smokers. In former smokers, a longer time since smoking cessation was associated with higher scores in the cognitive test with reference to current smokers, even after adjustment for pack-years. Former smokers who had quit for more than 30years scored 4.23 points higher (95% CI 1.75 to 6.71) than current smokers. Dose-response-relationships of cognitive function with cumulative dose of smoking as well as with time since smoking cessation were substantiated by restricted cubic splines regression. Our results support suggestions that smokers are at an increased risk for cognitive impairment in older age; that the risk increases with duration and intensity of smoking, and subsides with time after smoking cessation.