Cognitive Impairment In Older People Research Articles

Cognitive impairment in older people living in the community.

To investigate the prevalence and severity of cognitive impairment among older people living in the community in Cebu City, the Philippines. The cognitive function of 120 older people living in the community was assessed using the mini-mental state examination translated into the Cebuano language. Details of age, gender, education level and number of health problems were noted for all participants. On average, participants had mild cognitive impairment. Cognitive status differed significantly when participants were grouped according to age, education level and number of concurrent health problems. The male participants were less likely (odds ratio (OR) =0.34, P=0.02; 95% confidence interval (CI) 0.134, 0.840) to have mild cognitive impairment than no cognitive impairment. Participants aged 75 and older were more likely (OR=1.42, P=0.003; 95% CI 1.131, 1.789) to have moderate or severe cognitive impairment than no cognitive impairment. Cognitive decline was more prevalent in older participants. Implementation of cost-effective, early detection and interventions in primary care is needed to prevent the potential debilitating effects of cognitive impairment.

Predictors of cognitive impairment in population over 64 years institutionalized and non-institutionalized

Describe the factors which can be associated with cognitive impairment in institutionalized and non-institutionalized elderly. Cross-sectional study of 200 people aged over 64 in Huelva (Spain) in 2014. Of these, 100 people were institutionalized in a residential facility and 100 were not. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE-35), basic activities of daily living by Barthel index, general health through the Goldberg GHQ-28 and social, clinical and behavioural variables were contemplated in the study. The association of cognitive impairment with all the variables was analysed using Chi-square test. Finally, a multivariate analysis was performed using logistic regression to identify possible joint influence of variables to study on the cognitive impairment. The prevalence of cognitive impairment in those institutionalized was 47%, higher than that of non-institutionalized group which was only 8% (p<.001). The dependence for basic activities for daily living and learning activities were the only variables in both groups which were associated with the cognitive impairment. Institutionalization (OR=5.368), age (OR=1.066) and dependence for basic activities (OR=5.036) were negatively associated with CI, while learning activities (OR=.227) were associated in a positive way. Conducting learning activities and the promotion of personal autonomy can delay cognitive impairment in older people. It is important to include cognitive stimulation programs aimed at the old population, especially in residential institutions.

Living Unnoticed: Cognitive Impairment in Older People with Multimorbidity.

To investigate the correlation between MMSE ≤ 23 and the presence of a diagnosis of dementia in the medical record in a population with multimorbidity. This cross-sectional study was part of the Ambulatory Geriatric Assessment - a Frailty Intervention Trial (AGe-FIT; N = 382). Participants were community dwelling, aged ≥ 75 years, had received inpatient hospital care at least three times during the past 12 months, and had three or more concomitant diagnoses according to the International Classification of Diseases, 10th revision. The Mini Mental State Examination (MMSE) was administered at baseline. Medical records of participants with MMSE scores < 24 were examined for the presence of dementia diagnoses and two years ahead. Fifty-three (16%) of 337 participants with a measure of MMSE had a MMSE scores < 24. Six of these 53 (11%) participants had diagnoses of dementia (vascular dementia, n = 4; unspecified dementia, n = 1; Alzheimers disease, n = 1) according to medical records; 89% did not. A MMSE-score < 24 is not well correlated to a diagnosis of dementia in the medical record in a population of elderly with multimorbidity. This could imply that cognitive decline and the diagnosis of dementia remain undetected in older people with multimorbidity. Proactive care of older people with multimorbidity should focus on cognitive decline to detect cognitive impairment and to provide necessary help and support to this very vulnerable group.

Cognitive Impairment in Diabetes: Rationale and Design Protocol of the Cog-ID Study.

BackgroundCognitive impairment frequently co-occurs with type 2 diabetes but is often undiagnosed. Cognitive impairment affects self-management leading to treatment-related complications.ObjectiveThe aim of this study is to develop a stepped diagnostic procedure, consisting of a screening test complemented by an evaluation by a general practitioner (GP), to detect undiagnosed cognitive impairment in older people with type 2 diabetes.MethodsThe accuracy of two self-administered cognitive tests, the “Test Your Memory” (TYM) and “Self-Administered Gerocognitive Examination” (SAGE) alone, and in combination with an evaluation by a GP will be assessed. A diagnosis of mild cognitive impairment (MCI) or dementia at a memory clinic will serve as reference standard. This cognitive impairment in diabetes (Cog-ID) study will include 513 people from primary care facilities aged ≥70 with type 2 diabetes. The participants will first fill out the TYM and SAGE tests, followed by a standardized GP evaluation for cognitive impairment, including a mini mental state examination (MMSE). Subsequently, participants suspected of cognitive impairment (on either test or the GP assessment) and a random sample of 15% (65/435) of participants without suspected cognitive impairment will be referred to the memory clinic. At the memory clinic, a medical examination, neuropsychological examination, and magnetic resonance imaging (MRI) of the brain will be performed. Participants will also fill out questionnaires assessing health status and depressive symptoms at baseline and after 6 and 24 months.ResultsThis research obtained funding and ethical approval. Enrolment started in August, 2012, and all study-related activities will be completed in September, 2016.ConclusionsWith the results from this study, physicians will be able to detect cognitive impairment affecting type 2 diabetes patients through case-finding, and can use tailored care to reduce associated complications. Additionally, the results may stimulate discussions about cognitive impairment and whether early recognition is desirable.

Older people experiencing homelessness show marked impairment on tests of frontal lobe function.

Reported rates of mild and moderate cognitive impairment in older people experiencing homelessness range from 5-80%. The objective of this study was to determine the prevalence and characteristics of cognitive impairment in older people experiencing homelessness in the inner city of Sydney, Australia. Men and women experiencing homelessness aged 45 years and over in the inner city were screened for cognitive impairment. Participants who scored 26 or below on the mini-mental state examination and/or were impaired on any one of the clock-drawing test, the verbal fluency test and the trail-making test, part B were then assessed with a semi-structured interview, including the 21-item Depression Anxiety Stress Scale and the 12-item General Health Questionnaire. Screening of 144 men and 27 women aged between 45 years and 93 years identified cognitive impairment in 78%. Subsequently, high rates of mental and physical illness were identified, and 75% of subjects who were cognitively impaired performed poorly on frontal lobe tests. The trail-making test, part B was the most sensitive measure of frontal function. This study demonstrated that a large majority of older people experiencing homelessness, in the inner city of a high-income country, showed impairment on tests of frontal lobe function, a finding that could have significant implications for any medical or psychosocial intervention.

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.

Single screening questions for cognitive impairment in older people: a systematic review

Single-item screening questions may be a practical first step in screening for cognitive problems in older people. A form of single-item cognitive assessment is proposed in the NHS England and Wales dementia strategy. We aimed to provide a review and synthesis of the evidence regarding the performance of single-item tests for detection of cognitive impairment. This review used Cochrane diagnostic test accuracy procedures. Two independent researchers searched for relevant papers across multiple, cross-disciplinary electronic databases using previously validated search strings. Our index test was any single screening question for cognitive impairment, including factor analysis of multi-item tools. Our reference standards included clinical diagnosis and multi-domain cognitive assessments. From 884 titles, 11 studies were identified as eligible for inclusion. Four studies were graded low risk of bias and recruited a representative patient sample. Five papers described a single screening question for cognitive impairment with each using a different question. Sensitivity ranged from 26 to 96% and specificity from 45 to 100%. Six papers described the component analysis of multiple item tools with broadly worded single questions ('decline in memory function', 'changes in ability to think and reason' or 'learning new things') performing best. Informant-based, single-item screening questions show promise for detecting cognitive impairment. However, there was substantial heterogeneity in format and application of single-item screens, and several studies were of poor methodological quality. Currently, there is insufficient evidence to support routine screening using a single-item approach.

Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis.

To investigate whether people with subjective memory complaints (SMC) but no objective deficits are at increased risk of developing mild cognitive impairment (MCI) and dementia. Major electronic databases were searched till 03/2014, and a meta-analysis was conducted using inception cohort studies. Across 28 studies, there were 29,723 unique individuals (14,714 with SMC and 15,009 without SMC) (mean 71.6 years) followed on average for 4.8 years through to dementia. The annual conversion rate (ACR) of SMC to dementia was 2.33% (95% CI = 1.93%-2.78%) a relative risk (RR) of 2.07 (95% CI = 1.76-2.44) compared with those without SMC (n = 15,009). From 11 studies the ACR of developing MCI was 6.67% (95% CI = 4.70-8.95%). In long-term studies over 4 years, 14.1% (9.67-19.1%) of people with SMC developed dementia and 26.6% (95% CI = 5.3-39.7) went on to develop MCI. The ACR from SMC to dementia and MCI were comparable in community and non-community settings. Older people with SMC but no objective complaints are twice as likely to develop dementia as individuals without SMC. Approximately 2.3% and 6.6% of older people with SMC will progress to dementia and MCI per year.

P067: Cognitive impairment in older people with arterial hypertension

significant difference on MMSE, etiology and drug number. The correlation between total DBI and MMSE was r = −0.118 (p =0.003), between sedative DBI and MMSE was r = −0.118 (p =0.003) and between anticholinergic DBI and MMSE was r = −0.044 (p =0.267). Conclusions: This study allows a better understanding of demographics and clinical patterns of outpatients with cognitive impairment in France. Those preliminary results shown that increased DBI is correlated with diminution of MMSE. Furthermore, it would be interesting to assess the impact of decreased DBI on cognitive function and other clinical outcomes (falls, physical and functional performance).

The pros and cons of early diagnosis of dementia

We read the paper ‘The pros and cons of early diagnosis of dementia’ published by Fox et al 1 with great interest, which raised the question of how Brazilian doctors’ knowledge on the detection of cognitive impairment in older people could be improved. Such papers can help us discuss the paths we should take regarding early detection of dementia. Questions concerning the ‘pros and cons’ in an aged, developed nation with a model healthcare system as the UK may serve …

Relationship between asthma and cognition: the Cooper Center Longitudinal Study

Minimal data are available on the relationship between asthma and cognitive performance. In this report, we examine the relationship between asthma and cognitive performance in older adults, a subpopulation with elevated risk of cognitive impairment. We conducted a cross-sectional, retrospective analysis of 1380 participants age ≥55 who completed preventive health examinations at the Cooper Clinic in Dallas, TX. Cognition was assessed using the Montreal Cognitive Assessment (MoCA), a brief test for mild cognitive impairment. Data were analyzed in a multiple logistic regression using MoCA scores suggestive of cognitive impairment as the dependent variable. When controlling for demographic characteristics, self-rated health status, inhaled corticosteroid use, and FEV1 /FVC, asthma were associated with 78% increased risk of cognitive impairment (P=0.02) as defined by MoCA score. In the largest sample examined to date, we have identified a significant relationship between asthma and cognitive impairment in older people.

The older patient with heart failure: high risk for frailty and cognitive impairment

Managing older heart failure (HF) patients can be complicated by both cardiac and noncardiac conditions. Over the past 20 years, care for HF patients has become more complex, with a rising proportion of older people living with HF. In particular, cognitive impairment (CI) and frailty often coexist with HF in the elderly. With the prevalence of HF, frailty and cognitive impairment rising with age, the simultaneous occurrence of at least two of these conditions in the same individual will become more frequent. The presence of frailty and/or cognitive impairment in older people with HF is independently associated with worse clinical outcomes. The purpose of this review is to provide an overview of frailty and cognitive impairment in older HF patients. Specifically, this article describes the epidemiology of these conditions in HF patients, outlines potential underlying mechanisms, highlights relevant screening tools and reviews relevant clinical implications.

Effects of Drug Burden Index on Cognitive Function in Older Men

We aimed to assess the relationship between Drug Burden Index (DBI), a risk assessment tool that measures anticholinergic and sedative medication exposure and cognitive performance, and cognitive impairment in older people. The study population consisted of community-dwelling older men, 70 years or older, living in Sydney, Australia. The Addenbrooke's Cognitive Examination (ACE) and the Trail Making Task (TMT) cognitive tests were performed, and participants were categorized as having intact cognition, mild cognitive impairment, or dementia using clinical diagnostic criteria. The analyses were restricted to participants with English-speaking background (n = 987) and to the subgroup whose cognition was intact (n = 887). In the study group, DBI exposure was not associated with poorer performance on the ACE (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.66-1.47) or the TMT (OR, 0.71; 95% CI, 0.40-1.24) tests, after controlling for covariates. Similarly, DBI exposure was not associated with cognitive impairment (OR, 1.34; 95% CI, 0.83-2.16). There was no association between increasing DBI scores and poorer performance on any of the outcomes. On subgroup analysis of cognitively intact subgroup, DBI exposure or increasing DBI scores were not associated with poorer performance on the ACE or the TMT tests. In this study of community-dwelling older men, DBI was not associated with limitations on objective cognitive performance measures or with a clinical diagnosis of mild cognitive impairment or dementia.

Associations between n−3 PUFA concentrations and cognitive function after recovery from late-life depression

Lower concentrations of n-3 PUFAs have been reported to be associated with cognitive impairment and dementia, but also with depression-itself a potential risk factor for cognitive decline. The aims of this study were to investigate associations between n-3 PUFA concentrations in erythrocyte membrane or plasma and cognitive function in an at-risk sample of older people with previous major depression and to explore specificity with respect to cognitive domains. A cross-sectional sample of 132 eligible participants who had recovered from major depression (mean ± SD age: 67.8 ± 6.6 y) were enrolled from outpatient psychiatric services. A series of cognitive tests and a structured questionnaire were administered. Fasting blood samples were collected for n-3 PUFA measurements. Higher EPA and total n-3 PUFA concentrations and a lower ratio of arachidonic acid to EPA in erythrocyte membranes were associated with a higher cognitive composite score: independent of age and sex, but no longer significant after adjustment for education. No associations were found with plasma concentrations of any fatty acid. Considering individual cognitive tests, the strongest and most consistent correlations were found between immediate recall and concentrations of total n-3 PUFAs and α-linolenic acid (ALA) in erythrocytes, which were observed only in participants with recurrent depression. Total erythrocyte n-3 PUFA concentrations are positively associated with cognitive function, particularly immediate recall, in older people with previous depression. Lower concentrations of n-3 PUFAs or ALA in erythrocyte membranes may be good predictors for cognitive impairment in older people with previous recurrent depression.

Dementia: a growing problem for older people with diabetes?

Stephen Phillips and Anne Phillips explain why there is a raised risk of cognitive impairment in older people with diabetes. They discuss its impact on diabetes management and ways to support the older people affected

Short or Long Sleep Duration Is Associated with Memory Impairment in Older Chinese: the Guangzhou Biobank Cohort Study

To examine the association between sleep-related factors and memory impairment. Cross-sectional study Community-based study in Guangzhou, China. 28,670 older Chinese (20,776 women and 7,894 men) aged 50 to 85 years. Demographic and socioeconomic data, sleep-related factors, and cognitive function were collected by face-to-face interview. Potential confounders, such as employment and occupational status, smoking, alcohol and tea use, physical activity, self-rated health, anthropometry, blood pressure, and fasting plasma glucose and lipids were measured. After adjusting for multiple potential confounders, an inverted U-shaped association between sleep duration and delayed word recall test (DWRT) score, a validated measure of memory impairment, was found, with 7 to 8 h of habitual sleep duration showing the highest score (P-values for trend from 3 to 7 h and from 7 to ≥ 10 h were all ≤ 0.001). Compared to sleep duration of 7 h, the adjusted odds ratio for memory impairment from the sleep duration of 3 to 4 or ≥ 10 h was 1.29 (95% confidence interval 1.07-1.56) and 1.52 (1.25-1.86), respectively. Subjects with daily napping, morning tiredness, or insomnia had significantly lower DWRT scores than those without (P ranged from < 0.001 to 0.01). Short or long sleep duration was an important sleep-related factor independently associated with memory impairment and may be a useful marker for increased risk of cognitive impairment in older people.

Case Report: an unusual case of post‐stroke psychosis in a 71‐year‐old lady with a learning disability

Accessible summary People with a learning disability are at special risk of developing certain problems with their health. A stroke can also happen to people with a learning disability. It can sometimes be difficult to tell whether someone has had a stroke, especially if they seem well. Sometimes, people can develop mental health problems after a stroke. It can be difficult for professionals to understand what has happened to the person, and certain tests, such as a brain scan, need to be carried out to work out what is wrong with the person. We talk about the importance of getting to know the person well to help understand what their problems are and how to treat the problems. This is to make sure that they get the right diagnosis and treatment. SummaryPeople with a learning disability are just as likely as people in the general population to be at risk of cerebrovascular disease, due to the presence of undetected/undertreated vascular risk factors. When people with a learning disability are presenting with additional cognitive impairment, it is important to consider a range of conditions that may account for this. Stroke is a major cause of cognitive impairment in older people, affecting at least one‐third of stroke survivors (Leeds et al. 2001). However, post‐stroke psychosis is rare following stroke, and, as can be seen from the case of ‘May’, individuals can make a good recovery with appropriate assessment and intervention. It is important that a diagnosis of dementia is given only after all other potentially treatable conditions have been excluded, and there is a stepwise global deterioration without any other explanation.

Screening for cognitive impairment in older people attending accident and emergency using the 4-item Abbreviated Mental Test

To determine the utility of the 4-item Abbreviated Mental Test (AMT4) for detecting cognitive impairment in accident and emergency patients aged 65 years or older. Cognitive function was assessed using the Mini Mental State Examination (MMSE), 4 and 10-point AMT and subjective judgment. Cognitive impairment was defined as an MMSE score 23/30 or less. Of 601 patients, 226 (37.6%) scored 23 or less on MMSE. Cutoffs of 3 or less for AMT4 and 7 or less for AMT had sensitivities of 80% [95% confidence interval (CI): 0.75-0.85] and 76% (95% CI: 0.69-0.81), and specificities of 88% (95% CI: 0.84-0.91) and 93% (95% CI: 0.90-0.96), respectively, for detection of cognitive impairment; subjective judgement of admitting nurse had 50.5% (95% CI: 44-57%) sensitivity and 98.6% (95% CI: 0 96-1.00%) specificity. In conclusion, the AMT4 performs as well as the 10-point AMT in screening for cognitive impairment, and will assist in the early detection of cognitive problems.

Ventral striatal volume is associated with cognitive decline in older people: a population based MR-study.

Striatal degeneration may contribute to cognitive impairment in older people. Here, we examine the relation of degeneration of the striatum and substructures to cognitive decline and dementia in subjects with a wide range of cognitive function. Data are from the prospective community-based Honolulu Asia Aging Study of Japanese American men born 1900-1919. Brain magnetic resonance imaging (MRI) (1.5 T) was acquired on a stratified subsample (n = 477) that included four groups defined by cognitive status relative to the scan date: subjects without dementia (n = 347), subjects identified as demented 2-3 years before brain scanning (n = 30), at the time of scanning (n = 58), and 3-5 years after scanning (n = 42). Volumes of the striatum, including the accumbens, putamen, and caudate nucleus were automatically estimated from T1 MR images. Global cognitive function was measured with the cognitive ability screening instrument (CASI), at four examinations spanning an 8-year interval. Trajectories of cognitive decline were estimated for each quartile of striatal volume using mixed models, controlling for demographic variables, measures of cerebro-vascular damage, global brain atrophy, and hippocampal volume. Diagnosis of dementia before, during, and after brain scanning was associated with smaller volumes of n. accumbens and putamen, but not with caudate nucleus volume. Subjects in the lowest quartile of n. accumbens volume, both in the total sample and in the subjects not diagnosed with dementia during the study, had a significantly (p < 0.0001) steeper decline in cognitive performance compared with those in the highest quartile. In conclusion, volumes of the n. accumbens and putamen are closely associated with the occurrence of dementia and n. accumbens volume predicts cognitive decline in older people. These associations were found independent of the magnitude of other pivotal markers of cognitive decline, i.e. cerebro-vascular damage and hippocampal volume. The present study suggests a role for the ventral striatum in the development of clinical dementia.

Review of cognitive impairment with antimuscarinic agents in elderly patients with overactive bladder

Overactive bladder (OAB) will become an increasingly prevalent problem as the proportion of older people in the population increases over the next 20 years. In addition to the urological symptoms (urinary urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia), OAB is associated with other problems in older patients, especially an increased risk of falls and fractures. The bother caused by OAB needs not be an inevitable consequence of ageing, because the symptoms can usually be alleviated, even in frail older people. Pharmacological treatment for OAB involves the use of antimuscarinic agents, whose efficacy and safety profiles depend on their interactions with muscarinic receptors that are widely distributed throughout the body. Interactions between antimuscarinics and M(1) receptors in the central nervous system may have the potential to cause cognitive impairment in older people, depending on muscarinic receptor binding profiles, lipophilicity and the ability to cross the blood brain barrier. Concerns over the possibility of cognitive impairment have contributed to an under-utilisation of antimuscarinics in the geriatric population, despite the high prevalence and severity of OAB in older subjects. Antimuscarinic agents should be actively considered for elderly patients with OAB, but it is desirable to establish the cognitive risk for every type of antimuscarinic, using robust cognition assessment methods.