Cognitive Impairment No Dementia Research Articles

Long-term exposure to transportation noise in relation to global cognitive decline and cognitive impairment: Results from a Swedish longitudinal cohort

Background and aimsTransportation noise is an environmental exposure with mounting evidence of adverse health effects. Besides the increased risk of cardiovascular and metabolic diseases, recent studies suggest that long-term noise exposure might accelerate cognitive decline in older age. We examined the association between transportation noise and cognitive function in a cohort of older adults. MethodsThe present study is based on 2594 dementia-free participants aged 60 + years from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Global cognition score and CIND (cognitive impairment, no dementia) were assessed with a comprehensive neuropsychological battery at baseline and up to 16 years. Residential transportation noise resulting from road traffic, railway, and aircraft were estimated at the most exposed façade and the time-weighted average exposure was assessed. Linear mixed-effect models were used to assess the effect of long-term traffic noise exposure on the rate of change in global cognition score. Hazard ratios (HRs) and 95 % confidence intervals (CIs) of CIND by transportation noise exposure were obtained with Cox proportional hazard models. ResultsGlobal cognition score decreased at an average rate of −0.041 (95 %CI −0.043, −0.039) per year. Aircraft noise was associated with a 0.007 (per 10 dB Lden; 95 %CI −0.012, −0.001) faster annual rate of decline. Global cognition score seems to be not affected by road traffic and railway noise. During the follow-up, 422 (21 %) participants developed CIND. A 10-dB Lden difference in exposure to aircraft and railway noise was associated with a 16 % (HR 1.16, 95 %CI 0.91, 1.49) and 26 % (HR 1.26, 95 %CI 1.01, 1.56) increased hazard of CIND in the multi-pollutant model, respectively. No association was found for road traffic (HR 1.00, 95 %CI 0.83, 1.21). ConclusionsTransportation noise was linked to cognitive impairment and faster cognitive decline among older adults. Future studies are warranted to confirm our results.

Study of electronic biofeedback combined with nursing intervention in the treatment of vascular cognitive impairment-no dementia.

To investigate the effects of electronic biofeedback combined with nursing intervention and conventional drug treatment on cognitive function in patients with vascular cognitive impairment-no dementia (VCIND). A total of 102 patients with VCIND treated in the Department of Neurology from January 2021 to May 2022 were enrolled and divided into the routine treatment group and biofeedback group according to different treatment methods. The routine treatment group was given conventional drug therapy and nursing intervention; for the biofeedback group, electronic biofeedback therapy was added, based on the routine treatment group. The Montreal Cognitive Assessment, (MoCA), Alzheimer's Disease Assessment Scale-Cognitive Subscale, (ADAS-cog), and Hamilton Depression Scale (HAMD) were checked before treatment, 2weeks after treatment, and 3months after treatment. At 3months of treatment, the scores of the MoCA and ADAS-cog scales in the biofeedback group were better than those in the routine treatment group, while no difference was detected in the HAMD scores before and after treatment and between the two groups. Electronic biofeedback therapy for VCIND can significantly improve the MoCA score, reduce the ADAS-cog score and improve the cognitive level of patients and can be used as a complementary treatment for VCIND.

Mini-ACE: Validation Study Among Older People in Long-Term Care.

The Mini-Addenbrooke's Cognitive Examination (M-ACE) is a valid and reliable tool that accurately differentiates various types of cognitive impairment from Normal-cognition assessed in multiple settings. However, its validity among older individuals in long-term care (LTC) was not yet established. Therefore, we sought to assess the Portuguese M-ACE's validity, reliability, and accuracy in detecting cognitive impairment no-dementia (CIND) in LTC users. A comprehensive assessment was performed on 196 LTC Portuguese users aged ≥ 60 years, among whom 71 had Normal-cognition, and 125 had CIND. The M-ACE was found to be reliable (McDonald's ω = .86, Cronbach's α = .85) and consistent over time (r = .72; ICC = .83) and between raters (k = .92). Strong correlations with related measures supported construct validity (both r = .67). The M-ACE accurately distinguished CIND from Normal-cognition with a cut-off of 17 points (AUC = 0.81, Sensitivity = 81.7%, Specificity = 74.4%). Our findings suggest that the Portuguese M-ACE is a valid and reliable cognitive assessment tool for LTC users, allowing for accurate differentiation between CIND and Normal-cognition. Thus, the M-ACE's use could contribute to the early detection and intervention of cognitive disorders, especially among older adults in LTC.

Prevalence of cognitive impairment in home health physical therapy.

The prevalence of cognitive impairment in home health physical therapy (HHPT) is unknown. We sought to identify the prevalence of cognitive impairment, including cognitive impairment no dementia (CIND) and dementia, among older adults who used HHPT, and if cognitive impairment prevalence was higher among those with HHPT-relevant characteristics. For our cross-sectional analysis, we identified 963 fee-for-service Medicare beneficiaries with HHPT claims (>85 years old: 28.8%, women: 63.7%, non-Hispanic White: 82.1%) in the 2014 and 2016 waves of the Health and Retirement Study (HRS) and used a validated algorithm to categorize cognitive status as normal, CIND, or dementia. We estimated the population prevalence and calculated age, gender, race/ethnicity adjusted odds ratio (aOR) of CIND and dementia for characteristics relevant to HHPT service delivery including depression, walking difficulty, fall history, incontinence, moderate-vigorous physical activity (MVPA) ≤1x/week, and community-initiated HHPT using multinomial logistic regression. The population prevalence of cognitive impairment was 46.4% (CIND: 27.3%, dementia: 19.1%). The prevalence of cognitive impairment was greater among those with depression (46.7% vs. 39.5%), difficulty walking across the room (58.9% vs. 41.8%), fall history (49.1% vs. 42.9%), MVPA ≤1x/week (50.0% vs. 38.0%), and community-initiated HHPT (55.2% vs. 40.2%). Compared to normal cognitive status, the odds of cognitive impairment were greater for those with MVPA≤1x/week (CIND: aOR = 1.57 [95% CI: 1.05-2.33], dementia: aOR = 2.55 [95% CI: 1.54-4.22]), depression (dementia: aOR = 1.99 [95% CI: 1.19-3.30]), difficulty walking across the room (dementia: aOR = 2.54 [95% CI: 1.40-4.60]), fall history (dementia: aOR = 1.85 [95% CI: 1.20-2.83]), and community-initiated HHPT (dementia: aOR = 1.72 (95% CI: 1.13-2.61]). There is a high prevalence of CIND and dementia in HHPT, and no characteristics had a low prevalence of cognitive impairment. Physical therapists should be ready to identify cognitive impairment and adapt home health service delivery for this vulnerable population of older adults.

Transition in the cognitive continuum from normal cognition to dementia: the interplay of lifelong cognitive reserve with brain aging and genetic predisposition

AbstractBackgroundHigher cognitive reserve (CR) has been associated with lower risks of cognitive decline and dementia. In this study, we sought to investigate associations of lifelong CR capacity with transitions of cognitive phenotypes in older adults, while accounting for age, sex, APOE genotype, and pathological load of brain aging.MethodThis population‐based Swedish National study on Aging and Care‐Kungsholmen included 2631 participants (age≥60 years, 61.4% female) free of dementia at baseline (2001‐2004); among them 517 had brain MRI. At baseline, lifelong CR capacity was assessed by integrating early‐life education, midlife occupational complexity, later‐life social network and leisure activity. The load of pathological brain aging was assessed using volumes of grey matter (GM), white matter, hippocampus, and white matter hyperintensity, and count of perivascular space and lacunes. Cognitive impairment no dementia (CIND) and dementia were defined at baseline and across up to 15 years until 2016‐2019. Data were analyzed using the Markov multi‐state model.ResultDuring the mean 10.7 years of follow‐up, 9.0% had incident dementia (95%CI: 7.8%–10.3%). Among people free of CIND at baseline (n = 2023), 27.4% had incident CIND during follow‐up (25.3%–29.6%). Higher lifelong CR capacity (mean value of composite CR score = 0.2; range: ‐4.2‐3.6) was associated with a lower risk of direct transitions from non‐dementia (normal or CIND) to dementia (multivariable‐adjusted HR = 0.84; 95% CI 0.73–0.95) and from normal cognition to CIND (0.79; 0.73–0.85), but not with the direct transitions from normal cognition to dementia (0.86; 0.72–1.03), from CIND to dementia (0.93; 0.76–1.14), or from CIND to normal cognition (1.15; 0.98–1.35). Higher lifelong CR capacity was associated with a lower risk of direct transition from normal cognition to dementia in people with APOE‐ε4 and those with high GM volume (2nd‐4th quartiles), but not in those without APOE‐ε4 or with low GM volume (1st quartile) (P‐for‐interaction<0.05). There was no statistical interaction of CR with age, sex, or other brain MRI markers on cognitive transitions.ConclusionHigher lifelong CR capacity may benefit late‐life cognitive status by reducing the risk of cognitive deterioration to dementia, especially in people with genetic predisposition or with low neurodegenerative load.

Late, but not too late, is better than never: late‐life literacy is not associated with lower prevalence of dementia and cognitive impairment no dementia

AbstractBackgroundEducation is a major modifiable risk factor for dementia and is usually considered an early‐life intervention. However, low‐ and middle‐income countries usually have high rates of illiteracy among older adults, and some became literate after childhood. Therefore, we aimed to investigate whether there were any associations between the age of literacy with the prevalence of cognitive impairment no dementia (CIND) and dementia, compared to illiteracy, regardless of the educational attainment.MethodWe used baseline data from the Brazilian Longitudinal Study of Aging (ELSI‐Brazil), a population‐based nationally representative cohort of people aged 50 years or older, and the first Health and Retirement Studies (HRS) partner study in South America. For this study, we restricted our analysis to those aged 60 years or older, who had been classified as cognitively normal, CIND, or dementia. Participants were stratified into five groups: four according to their age when started schooling (early‐life literacy (EL) (<11 years), adolescent literacy (AdL) (11‐19 years), adulthood literacy (AhL) (20‐59 years) and late‐life literacy (LL) (≥60 years)) and illiteracy (IL). CIND and dementia classification prevalence ratios (PR) according to literacy status were assessed using Poisson regression, and adjusted for sociodemographic (age, sex/gender, educational attainment, race/ethnicity) and clinical confounders (memory complain, depressive symptoms, heavy drinking, smoking status, hypertension, and diabetes).ResultOur final sample comprised 5,244 older adults (mean age 70.1±7.8 years, mean education 4.6±4.4 years, 60% female, 55% Black/Brown, 6% with dementia and 8% with CIND) (Table 1). Fifteen percent of the sample started their literacy after childhood, and 21% remained illiterate. EL and (PR = 0.22, 95%CI = 0.09;0.53) and AdL (PR = 0.42, 95%CI = 0.18;0.98) groups had lower dementia prevalence compared to IL group (Table 2). However, there was no prevalence difference between IL and those who started literacy after adolescence.ConclusionWe found a lower prevalence of dementia among participants with early‐life and adolescent literacy compared to illiteracy. Adulthood and late‐life literacy were not associated with lower dementia prevalence. Literacy after childhood might have same beneficial impact if it is not started too later in life. Further studies should be conducted to better understand the impact of late‐life literacy interventions on reducing dementia risk.

Prevalence of subjective memory complaints at age 90+ and their cross‐sectional association with cognition: The 90+ Study

AbstractBackgroundSubjective memory complaints (SMC) present in 8‐33% of older adults younger than 90, and associated with worse cognition in cross‐sectional studies. However, the prevalence of SMC and its cross‐sectional association with objectively measured cognition at age 90+ are unknown. The aims are to: (1) determine the prevalence of SMC and (2) examine the cross‐sectional association of SMC with cognitive diagnosis and cognitive test scores in individuals aged 90 and older.MethodWe analyzed data from 1,112 participants of The 90+ Study , a longitudinal study of aging and cognition in people age 90 and older. SMC was assessed at baseline using an item from the Geriatric Depression Scale (GDS): “Do you think you have more problems with memory than most?” Cognitive diagnosis was determined from a neurological exam without knowledge GDS scores and catergorized as normal, cognitive impairment no dementia (CIND), and dementia. Cognitive tests measured verbal memory, verbal fluency, and executive function. We assessed the association between SMC and cognitive diagnosis using multinomial logistic regression and estimated the odds ratios of having CIND or dementia in those with SMC vs. No SMC. We used linear regression models stratified by congitive diagnosis to analyze the relationship between SMC and test scores. All analyses were adjusted for age, sex, education, and total GDS.ResultMean age was 93 years, 68% were women, 46% had college education or higher, and 16% had SMC. Participants reporting SMC had 1.69 times higher odds of a CIND diagnosis and 4.07 times higher odds of a dementia diagnosis compared to No SMC (Figure). SMC was associated with worse performance on memory and animal fluency in normal, and on memory only in CIND. SMC was not associated with performance on cognitive tests in participants with dementia (Table 2).ConclusionIn this cohort of adults aged 90+, SMC prevalence was comparable to reports in older adults <90. Cross‐sectionally, SMC was associated with higher odds of cognitive impairment, and with poorer performance on memory in participants without dementia, potentially reflecting insight into their cognition. Our findings suggest that SMC is a useful indicator of memory impairment after age 90.

Neuro‐immune markers, socioeconomic inequalities, and neurodegenerative disorders in older age

AbstractBackgroundAccumulating evidence suggests that the neuro‐immune markers of inflammation may be involved in the onset of neurodegenerative disorders (Bostancıklıoğlu, 2019; Park et al., 2020). However, immune mechanisms linking socioeconomic adversities in later life and neurodegenerative disorders have yet to be fully explored. This study has used a large longitudinal study to investigate the mediating effects of neuro‐immune markers in the socioeconomic disparities of neurocognitive disorders in older adults.MethodData of 4815 participants aged 50 and above from the English Longitudinal Study of Ageing (ELSA) across three waves of data collection. Socioeconomic position was assessed in 2008/9 and neuro‐immune markers in 2012/2013. Neurocognitive disorders were ascertained using cognitive variables available in 2018/2019 using a well‐accepted consensus criterion (Richardson et al., 2019). It was categorised into no cognitive impairment, cognitive impairment, no dementia (CIND) and dementia. Mediation analysis was carried out to investigate the mediation effect of c‐reactive protein (CRP), fibrinogen and white blood cell (WBC) count in the association between socioeconomic position and different subtypes of neurocognitive disorders. All models were adjusted for age, sex, marital status and baseline cognitive status.ResultAfter accounting for potential confounders, CRP, fibrinogen, and WBC partly mediated the association of education, occupation, and wealth with cognitive impairment. Results on dementia were all non‐significant.ConclusionAdverse socioeconomic environment were related to early stages of neurocognitive disorders partly via elevated biomarker levels in later life. Neuroinflammation might be one of the immunobiological mechanisms underlying socioeconomic disparities in cognitive impairment. Further research should explore other plausible biological mechanisms to develop interventions to delay the onset of neurodegeneration.

Discriminant Validity and Time‐effectiveness of A Stepwise Dementia Case‐finding Approach in an Asian Elderly Community

AbstractBackgroundTo investigate the discriminant validity and time‐effectiveness of a stepwise dementia case‐finding approach in a community‐based Singaporean older adult population.MethodParticipants who completed the Progressive Forgetfulness Question (PFQ) and the Abbreviated Mental Test (AMT) were invited to phase II and administered the Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a formal neuropsychological battery. Participants were diagnosed by cognitive performance and DSM‐IV criteria into No Cognitive Impairment (NCI), Cognitive Impairment‐No Dementia (CIND) mild (≤2 cognitive domains impaired), CIND moderate (>2 domains impaired) and dementia. Receiver Operating Characteristic were conducted for different cognitive instruments (AMT, MoCA, MMSE) between PFQ = Yes and PFQ = No groups. All discriminant indices including sensitivity, specificity, positive (PPV), negative predictive values (NPV) and accuracy were calculated. Bayesian correction methods were used to adjust the verification bias. Screening time saving and number of subjects further evaluated was estimated in two scenarios with or without the PFQ.ResultThe PFQ showed an NPV of 94.2% for excluding dementia‐free cases after adjustment. After excluding PFQ = No participants, all cognitive tools achieved optimal NPV (>99%). Furthermore, the number of people requiring further evaluation decreased by 129 (42.7%), 58 (36.5%), 25 (14.3%) subjects, corresponding to 48.2%, 48.2%, and 47.8% of screening time being saved, when the PFQ was conducted prior to the MoCA, MMSE, and AMT, respectively.ConclusionUsing a single‐question assessment as the first step of a case‐finding approach, followed up a cognitive test such as the MoCA, could minimize time and resources for further investigation in the community.

Cost-benefit and discriminant validity of a stepwise dementia case-finding approach in an Asian older adult community

BackgroundCase-finding is a recommended approach for dementia early detection in the community.AimsTo investigate the discriminant validity and cost-effectiveness of a stepwise dementia case-finding approach in a Singaporean older adult community.MethodsThe...

Role of inflammation in the socioeconomic inequalities of neurocognitive disorders

BackgroundSocioeconomic position has been shown to be associated with inflammation. However, little is known about the role of inflammation in socioeconomic inequalities in relation to neurocognitive disorders in later life and the potential underlying inflammatory mechanisms. This study has used longitudinal data to investigate the mediation effects of inflammation in the relationship between socioeconomic position and neurocognitive disorders in older adults. MethodsUsing data from the English Longitudinal Study of Ageing (ELSA, n = 4,815), we ascertained neurocognitive disorders using a recognised consensus criterion and included the following categories: (1) No Cognitive Impairment (NOCI) (2) Cognitive Impairment No Dementia (CIND) and (3) Dementia. We examined whether socioeconomic position (education, occupation, and wealth) measured in 2008/09 was associated with neurocognitive disorders measured in 2018/19. Mediation analyses were carried out to investigate the role of inflammatory markers [C-Reactive Protein (CRP), plasma fibrinogen and white blood cells (WBC)] in the association between socioeconomic inequalities and subsequent neurocognitive disorders. Sensitivity analyses were conducted to assess the mediating role of lifestyle behaviours and body mass index (BMI). ResultsHigher education, occupation and wealth were longitudinally associated with a lower likelihood of cognitive impairment and dementia. WBC mediated the association between latent socioeconomic position and CIND [β = -0.037 (CI: −0.06 to −0.01)], but not the association with dementia. Indirect effects were attenuated but remained significant when other mediators, such as lifestyle behaviours and BMI were considered. In a separate analysis accounting for main confounders, CRP and fibrinogen mediated the association between education and CIND, all three inflammatory biomarkers mediated the association of occupation and CIND, while WBC mediated the association between wealth and CIND. ConclusionThese findings emphasise that socioeconomic inequalities in mid and later life could contribute to the prevalence of neurocognitive disorders in later life. Our results provide some evidence for the biological embedding of WBC in the association between socioeconomic inequalities and cognitive impairment via elevated inflammation. Future studies should explore other plausible biological mechanisms.

Advanced brain age in community-dwelling population with combined physical and cognitive impairments

We investigated whether advanced brain biological age is associated with accelerated age-related physical and/or cognitive functional decline: mobility impairment no disability (MIND), cognitive impairment no dementia (CIND), and physio-cognitive decline syndrome (PCDS). We constructed a brain age prediction model using gray matter features from the magnetic resonance imaging of 1482 healthy individuals (aged 18–92 years). Predicted and chronological age differences were obtained (brain age gap [BAG]) and analyzed in another 1193 community-dwelling population aged ≥50 years. Among the 1193 participants, there were 501, 346, 148, and 198 in the robust, CIND, MIND, and PCDS groups, respectively. Participants with PCDS had significantly larger BAG (BAG = 2.99 ± 8.97) than the robust (BAG = −0.49 ± 9.27, p = 0.002; η2 = 0.014), CIND (BAG = 0.47 ± 9.16, p = 0.02; η2 = 0.01), and MIND (BAG = 0.36 ± 9.69, p = 0.036; η2 = 0.013) groups. Advanced brain aging is involved in the pathophysiology of the co-occurrence of physical and cognitive decline in the older people. The PCDS may be a clinical phenotype reflective of accelerated biological age in community-dwelling older individuals.

Prevalence and Progression of Subjective Cognitive Decline Among Rural Chinese Older Adults: A Population-Based Study.

Few community-based studies have examined occurrence and progression of subjective cognitive decline (SCD). To investigate prevalence and progression of SCD among rural-dwelling Chinese elderly people. This cohort study included 2,488 cognitively unimpaired adults (age≥65 years) who were examined at baseline (2014-2015) and followed in 2018. Demographic, epidemiological, clinical, and neuropsychological data were collected via in-person interviews and clinical examinations following a structured questionnaire. At baseline, SCD was assessed using the self-rated Ascertain Dementia 8-item Questionnaire. At follow-up, Alzheimer's disease (AD) and vascular dementia (VaD) were clinically diagnosed following the international criteria. Data were analyzed using logistic regression models. The prevalence of SCD was 40.07%. SCD at baseline was associated with the multivariable-adjusted odds ratio (OR) of 1.51 (95% confidence interval 1.10-2.07) for incident cognitive impairment, no dementia (CIND) and 3.11 (1.64-5.93) for incident AD. Among people with SCD at baseline, the multivariable-adjusted OR of incident CIND was 0.55(0.32-0.96) for hyperlipidemia; the multivariable-adjusted OR of incident AD was 1.21 (1.14-1.30) for older age, 0.32 (0.12-0.88) for high education, 2.60 (1.11-6.08) for carrying APOEɛ4 allele, and 0.34 (0.13-0.86) for high social support, whereas the multivariable-adjusted OR of incident VaD was 6.30 (1.71-23.18) for obesity. SCD affects over 40% of rural-dwelling cognitively unimpaired older adults in China. SCD is associated with accelerated progression to CIND and AD. Older age, lack of school education, APOEɛ4 allele, and low social support are associated with an increased risk of progression from SCD to AD, whereas obesity is related to accelerated progression to VaD.

Association of Proton Pump Inhibitor Use With Incident Dementia and Cognitive Decline in Older Adults: A Prospective Cohort Study

Prior studies have suggested that proton pump inhibitor (PPI) use is associated with increased risk of dementia; however, these have been limited by incomplete assessment of medication use and failure to account for confounders. Furthermore, prior studies have relied on claims-based diagnoses for dementia, which can lead to misclassification. We investigated the associations of PPI and histamine-2 receptor antagonist (H2RA) use with dementia and cognitive decline. We conducted a post hoc analysis of ASPirin in Reducing Events in the Elderly (ASPREE), a randomized trial of aspirin in the United States and Australia, including 18,934 community-based adults ≥65 years of all races/ethnicities. Baseline and recent PPI and H2RA use were determined according to review of medications during annual in-person study visits. Incident dementia was defined according to Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria. Secondary endpoints include cognitive impairment, no dementia (CIND) and changes in cognition. Associations of medication use with dementia and CIND outcomes were examined using Cox proportional hazards models. Changes in cognitive test scores were examined using linear mixed-effects models. Baseline PPI use vs nonuse was not associated with incident dementia (multivariable hazard ratio, 0.88; 95% confidence interval, 0.72-1.08), CIND (multivariable hazard ratio, 1.00; 95% confidence interval, 0.92-1.09), or with changes in overall cognitive test scores over time (multivariable B,-0.002; standard error, 0.01; P= .85). Similarly, no associations were observed between H2RA use and all cognitive endpoints. In adults ≥65 years of age, PPI and H2RA use were not associated with incident dementia, CIND, or decline in cognition over time. These data provide reassurance about the safety of long-term use of PPIs among older adults.

Prevalence and progression of subjective cognitive decline among rural Chinese older adults: A Population‐based follow‐up study

AbstractBackgroundFew studies have examined occurrence and progression of subjective cognitive decline (SCD) in rural China. We aimed to investigate the prevalence of SCD and explore factors associated with progression from SCD to cognitive impairment, no dementia (CIND) and Alzheimer’s disease (AD).MethodThis community‐based study included 2488 cognitively unimpaired participants (age ≥65 years; 55.18% women; and 39.87% illiterate) in the Shandong Yanggu Study of Aging and Dementia who were examined at baseline (2014‐2015), of these, 1843 were followed in 2018. Demographic, epidemiological, clinical, and neuropsychological data were collected following a structured questionnaire. SCD was defined based on the Chinese version of the self‐rated Ascertain Dementia 8‐item Questionnaire (AD8) score. CIND and AD were diagnosed following the international criteria. Data were analyzed with the multivariate logistic regression models.ResultAt baseline, 997 of the 2488 participants were defined to have SCD. The prevalence of SCD was 40.07%, and the prevalence was increased with age. Of the 1843 participants in the follow‐up examination in 2018, 189 were diagnosed with CIND and 58 with AD. Having SCD at baseline was significantly associated with the multi‐adjusted odds ratio (OR) of 1.55 (95% confidence interval = 1.14‐2.12) for incident CIND and 2.91 (1.56‐5.42) for incident AD. Of 745 participants with SCD at baseline, 97 progressed to CIND and 43 to AD during the average 3.79 years of follow‐up. Multivariable logistic regressions showed that the multi‐adjusted OR of incident CIND was 0.51 (0.26‐0.98) for high social support, whereas the multi‐adjusted OR of incident AD was 1.22 (1.14‐1.31) for older age (per 1‐year increment), 0.31 (0.11‐0.85) for high education, 2.77 (1.17‐6.57) for carrying the apolipoprotein E (APOE) ε4 allele, 0.29 (0.11‐0.75) for high social support, and 3.98 (1.37‐11.52) for mild depressive symptoms.ConclusionSCD affects over 40% of rural‐dwelling older adults in China who are free of cognitive impairment. Older people with SCD are more likely to develop CIND and AD. Older age, illiteracy, APOE ε4 allele, low social support, and depressive symptoms are associated with accelerated progression from SCD to CIND or AD.

Prevalence of dementia and cognitive impairment no dementia in a large nationally representative sample: The ELSI‐Brazil study

AbstractBackgroundApproximately 77% of older adults in Brazil with dementia have not been diagnosed, indicating a major public health issue. Previous dementia epidemiologic studies from Brazil were based on data from one geopolitical region. We aimed to estimate the general and subgroup‐specific (age, education, and sex) prevalence of dementia diagnosis and cognitive impairment no dementia (CIND) using data from 5,249 participants aged 60 years and older from the Brazilian Longitudinal Study of Aging (ELSI‐Brazil), a large nationally representative sample of older adults.MethodParticipants were classified as either: having normal cognitive function, CIND, or dementia based on a combination of the individuals’ cognitive and functional status. A normative subsample provided adjusted regression‐based norms for the cognitive assessment, and a z‐score of ‐1.5 or lower for global cognition was considered to indicate cognitive impairment. We considered functional impairment if the participant reported one or more difficulties in four gender‐independent daily living activities. Participants were classified as having normal cognitive function if there was no cognitive and functional impairment, as CIND if there was only cognitive impairment, and as dementia if there were both cognitive and functional deficits or if the informant scored above 3.4 points in the Informant Questionnaire on Cognitive Decline in the Elderly.ResultWe found a general prevalence of 6.1% (95% CI = 5.1‐7.3) for dementia and 8.6% (95% CI = 7.1‐10.3) for CIND (Table 1). Dementia prevalence ranged from 3.3% (60‐64 years) to 43.0% (≥ 90 years) by age, and from 2.0% (College level or higher) to 17.5% (illiterates) by educational level. Females had a higher prevalence (7.4%) than males (4.4%). CIND prevalence was similar across the age, sex, and education groups.ConclusionThe estimated dementia prevalence is in line with previous epidemiologic studies. Only 0.8% of the ELSI participants self‐reported having a previous diagnosis of dementia, revealing that underdiagnosis is rampant and a common reality. Based on our results, we expect that nearly 1.7 million of the 2015 population, and 2 million of the 2019 population, might have dementia in Brazil.

The age-dependent association of Life's Simple 7 with transitions across cognitive states after age 60.

Life's Simple 7 (LS7) aims to promote ideal cardiovascular health (CVH). Its association with different cognitive states in the older old is unclear. To assess the associations of LS7 with transitions across normal cognition, cognitive impairment, no dementia (CIND), and dementia and evaluate cognitive impairment-free years of life by LS7-defined CVH levels in older adults. This cohort study included 2746 participants from the Swedish National Study on Aging and Care in Kungsholmen, regularly examined over 15 years. Total LS7 scores were created and dichotomized into worse and better CVH categories. The associations of LS7 total scores and CVH categories with cognitive states were assessed with multistate models in the whole sample and in younger old (<78 years) and older old adults (≥78 years) separately. Cognitive impairment-free life years by CVH categories were then predicted. A 1-point increment in the LS7 total score was associated with lower dementia risk in younger old adults (hazard ratio: 0.87 [0.78-0.97]) but not in older old adults (1.04 [0.97-1.13]). Better CVH was also associated with a lower risk of transition from normal cognition to CIND (0.76 [0.61-0.95]) and from normal cognition to dementia (0.42 [0.21-0.82]) in younger old adults. In younger old adults, those with better CVH were predicted to have two-to-three more cognitive impairment-free life years than those with worse CVH. Maintaining LS7-defined ideal CVH seems relevant in younger old adults but not in older old adults when considering the potential protective effects against cognitive impairment.

Gender differences in the association between sensory function and CIND among Chinese elderly: Based on CLHLS

ObjectiveTo explore the gender differences of the association between sensory impairment (SI) and the risk of cognitive decline and possible cognitive impairment, no dementia (CIND). MethodData were drawn from three waves of the nationally representative survey of China Longitudinal Healthy Longevity Survey (CLHLS) between 2011/12-2018 surveys, involving 6138 participants aged 65 or older who had no CIND at the baseline. Multivariate linear or logistic regression models were employed to examine the effect of SI on cognitive decline and CIND risk by gender stratification, respectively. ResultsHearing impairment and visual impairment were associated with lower MMSE scores, and the strength of the association was stronger in men than in women. Hearing impairment was related to an elevated risk of CIND both in men and women (Men: OR=2.46; 95% CI=1.81, 3.35; Women: OR=1.43; 95% CI=1.09, 1.88). However, the effect of visual impairment on CIND was statistically significant only in men (OR=1.43; 95% CI=1.09, 1.88). The risk of cognitive decline and CIND were significantly higher with single and dual SI than those without SI, except for women with single visual impairment. ConclusionSI is independently associated with cognitive decline and CIND risk, and the association differed by gender. Further researches should clarify the mechanism between SI and cognitive function among older adults, especially for gender differences.

Prediabetes, diabetes and loss of disability-free survival in a community-based older cohort: a post-hoc analysis of the ASPirin in Reducing Events in the Elderly trial

Evidence for the prognostic implications of hyperglycaemia in older adults is inconsistent. To evaluate disability-free survival (DFS) in older individuals by glycaemic status. This analysis used data from a randomised trial recruiting 19,114 community-based participants aged ≥70years, who had no prior cardiovascular events, dementia and physical disability. Participants with sufficient information to ascertain their baseline diabetes status were categorised as having normoglycaemia (fasting plasma glucose [FPG] < 5.6mmol/l, 64%), prediabetes (FPG 5.6 to <7.0mmol/l, 26%) and diabetes (self-report or FPG ≥ 7.0mmol/l or use of glucose-lowering agents, 11%). The primary outcome was loss of disability-free survival (DFS), a composite of all-cause mortality, persistent physical disability or dementia. Other outcomes included the three individual components of the DFS loss, as well as cognitive impairment-no dementia (CIND), major adverse cardiovascular events (MACE) and any cardiovascular event. Cox models were used for outcome analyses, with covariate adjustment using inverse-probability weighting. We included 18,816 participants (median follow-up: 6.9 years). Compared to normoglycaemia, participants with diabetes had greater risks of DFS loss (weighted HR: 1.39, 95% CI 1.21-1.60), all-cause mortality (1.45, 1.23-1.72), persistent physical disability (1.73, 1.35-2.22), CIND (1.22, 1.08-1.38), MACE (1.30, 1.04-1.63) and cardiovascular events (1.25, 1.02-1.54) but not dementia (1.13, 0.87-1.47). The prediabetes group did not have an excess risk for DFS loss (1.02, 0.93-1.12) or other outcomes. Among older people, diabetes was associated with reduced DFS, and higher risk of CIND and cardiovascular outcomes, whereas prediabetes was not. The impact of preventing or treating diabetes in this age group deserves closer attention.

Using Item Response Times in Online Questionnaires to Detect Mild Cognitive Impairment.

With the increase in web-based data collection, response times (RTs) for survey items have become a readily available byproduct in most online studies. We examined whether RTs in online questionnaires can prospectively discriminate between cognitively normal respondents and those with cognitive impairment, no dementia (CIND). Participants were 943 members of a nationally representative internet panel, aged 50 and older. We analyzed RTs that were passively recorded as paradata for 37 surveys (1,053 items) administered online over 6.5 years. A multilevel location-scale model derived 3 RT parameters for each survey: (1) a respondent's average RT and 2 components of intraindividual RT variability addressing (2) systematic RT adjustments and (3) unsystematic RT fluctuations. CIND status was determined at the end of the 6.5-year period. All 3 RT parameters were significantly associated with CIND, with a combined predictive accuracy of area under the receiver-operating characteristic curve = 0.74. Slower average RTs, smaller systematic RT adjustments, and greater unsystematic RT fluctuations prospectively predicted a greater likelihood of CIND over periods of up to 6.5, 4.5, and 1.5 years, respectively. RTs for survey items are a potential early indicator of CIND, which may enhance analyses of predictors, correlates, and consequences of cognitive impairment in online survey research.