Cognitive Impairment Without Dementia Research Articles

Air pollution and traffic noise interact to affect cognitive health in older Mexican Americans

BackgroundBoth air pollution and noise exposures have separately been shown to affect cognitive impairment. Here, we examine how air pollution and noise exposures interact to influence the development of incident dementia or cognitive impairment without dementia (CIND). MethodsWe used 1,612 Mexican American participants from the Sacramento Area Latino Study on Aging conducted from 1998 to 2007. Air pollution (nitrogen dioxides, particulate matter, ozone) and noise exposure levels were modeled with a land-use regression and via the SoundPLAN software package implemented with the Traffic Noise Model applied to the greater Sacramento area, respectively. Using Cox proportional hazard models, we estimated the hazard of incident dementia or CIND from air pollution exposure at the residence up to 5-years prior to diagnosis for the members of each risk set at event time. Further, we investigated whether noise exposure modified the association between air pollution exposure and dementia or CIND. ResultsIn total, 104 incident dementia and 159 incident dementia/CIND cases were identified during the 10 years of follow-up. For each ∼2 µg/m3 increase in time-varying 1- and 5-year average PM2.5 exposure, the hazard of dementia increased 33% (HR = 1.33, 95%CI: 1.00, 1.76). The hazard ratios for NO2-related dementia/CIND and PM2.5-related dementia were stronger in high-noise (≥65 dB) exposed than low-noise (<65 dB) exposed participants. ConclusionOur study indicates that PM2.5 and NO2 air pollution adversely affect cognition in elderly Mexican Americans. Our findings also suggest that air pollutants may interact with traffic-related noise exposure to affect cognitive function in vulnerable populations.

Health Disparities in Cognitive Impairment and Dementia: Role of Social Strain, Depression, and C-Reactive Protein.

We investigated the association of social strain from friends, depression, and systemic inflammation (C-Reactive Protein [CRP]) with cognitive impairment without dementia (CIND) and dementia among 9,262 participants (age ≥ 65). We analyzed data from the Health Retirement Study (HRS), performing Chi-squared and logistic regression analyses. Measures included the 27-point HRS cognition scale, social strain scale, Center for Epidemiological Studies Depression scale, and dried-blood CRP levels. Black and Hispanic participants had a significantly increased dementia risk (OR = 2.69 and OR = 2.54). Black participants also had a high risk of CIND (OR = 2.80), but no association of Hispanic participants with CIND. Increased social strain from friends and depression were significantly associated with CIND (OR = 1.50 and OR = 1.44) and dementia (OR = 1.57 and OR = 1.78). Elevated CRP levels were only linked to CIND risk (OR = 1.03), not dementia. Early detection and interventions targeting social strain, depression, and CRP levels may help promote cognitive functioning in older adults.

Links between inflammation and immune functioning with cognitive status among older Americans in the Health and Retirement Study

Elevated inflammation and poor immune functioning are tied to worse cognitive health. Both processes are fundamental to aging and are strongly implicated in the development of age-related health outcomes, including cognitive status. However, results from prior studies evaluating links between indicators of inflammation and immune function and cognitive impairment have been inconsistent due to biomarker selection, sample selection, and cognitive outcome. Using the Health and Retirement Study (HRS), a nationally representative study of older adults in the United States, we assessed how indicators of inflammation (neutrophil-lymphocyte ratio (NLR), albumin, CRP, IL6, IL10, IL-1Ra, sTNFR1, and TGFβ1) and immune functioning (CMV, CD4+ TN/TM, and CD8+ TN/TM) are associated with cognitive status. First, to examine the association between each biomarker and cognitive status, we tested whether markers of inflammation and immune functioning varied across cognitive status categories. We found that dementia and cognitive impairment without dementia (CIND) were associated with elevated inflammation and poorer immune functioning across biomarkers except for CD4+ TN/TM. Next, we estimated multinomial logistic regression models to assess which biomarkers would continue to be associated with dementia and CIND, net of each other. In these models, albumin, cytokines, CMV, CD4+ TN/TM, and CD8+ TN/TM are associated with cognitive status. Because poor immune functioning and increased inflammation are associated with cognitive impairment, improving immune functioning and reducing inflammation may provide a mechanism for reducing ADRD risk in the population.

Depression as a Mediator of the Association Between Wealth Status and Risk of Cognitive Impairment and Dementia: A Longitudinal Population-Based Cohort Study.

Wealth and income are potential modifiable risk factors for dementia, but whether wealth status, which is composed of a combination of debt and poverty, and assessed by wealth and income, is associated with cognitive impairment among elderly adults remains unknown. To examine the associations of different combinations of debt and poverty with the incidence of dementia and cognitive impairment without dementia (CIND) and to evaluate the mediating role of depression in these relationships. We included 15,565 participants aged 51 years or older from the Health and Retirement Study (1992-2012) who were free of CIND and dementia at baseline. Dementia and CIND were assessed using either the modified Telephone Interview for Cognitive Status (mTICS) or a proxy assessment. Cox models with time-dependent covariates and mediation analysis were used. During a median of 14.4 years of follow-up, 4,484 participants experienced CIND and 1,774 were diagnosed with dementia. Both debt and poverty were independently associated with increased dementia and CIND risks, and the risks were augmented when both debt and poverty were present together (the hazard ratios [95% confidence intervals] were 1.35 [1.08-1.70] and 1.96 [1.48-2.60] for CIND and dementia, respectively). The associations between different wealth statuses and cognition were partially (mediation ratio range: 11.8-29.7%) mediated by depression. Debt and poverty were associated with an increased risk of dementia and CIND, and these associations were partially mediated by depression. Alleviating poverty and debt may be effective for improving mental health and therefore curbing the risk of cognitive impairment and dementia.

Association of Leisure Activities With Cognitive Impairment and Dementia in Older Adults in Colombia: A SABE-Based Study.

Observational and interventional studies suggest that participation in leisure activities may help protect against cognitive decline in older people. This study aimed to examine the association between participation in leisure activities and cognitive impairment in older adults in Colombia. Data for this study were derived from the Colombian National Survey of Aging (SABE 2015), a cross-sectional survey with a sample size of 23,694 older adults representing the total population (mean age, 70.8 years; 57.3% females). Cognitive impairment was classified as cognitive impairment without dementia (CIWD) and dementia, according to the revised version of the Folstein Mini-Mental State Examination and the Lawton and Brody functional scale. Leisure activities were evaluated using six items of a questionnaire. Sex-stratified multinomial regression models were used to analyze the association of leisure activities with CIWD and dementia after adjusting for educational attainment, literacy, and other potential confounders. In adjusted models for men, leisure activities in later life were associated with a decreased risk of CIWD (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.68–0.78) and dementia (OR, 0,52; 95% CI, 0.48–0.58). For women, leisure activities in later life were associated with a decreased risk of CIWD (OR, 0.72; 95% CI, 0.66–0.78) and dementia (OR, 0.48; 95% CI, 0.43–0.53). The findings suggest that greater participation in leisure activities in later life may act as a protective factor against CIWD and dementia among older adults in Colombia, independent of educational attainment and literacy.

Metabolic dysfunction modifies the influence of traffic-related air pollution and noise exposure on late-life dementia and cognitive impairment: A cohort study of older Mexican-Americans.

For 1,612 elderly Mexican-American participants of the Sacramento Area Latino Study on Aging (SALSA) followed for up to 10 years, we estimated residential-based local traffic-related exposures relying on the California Line Source Dispersion Model version 4 (CALINE4) for nitrogen oxides (NOx) and the SoundPLAN software package (Version 8.0; NAVCON, Fullerton, CA) that implements the Federal Highway Administration Traffic Noise Model (TNM) for noise, respectively. We used Cox proportional hazard models to estimate the joint effects of NOx or noise exposures and obesity, hyperglycemia, or low high-density lipoprotein (HDL) cholesterol. The risk of developing dementia/CIND among participants with hyperglycemia who also were exposed to high levels of NOx (≥3.44 parts per billion [ppb] [75th percentile]) or noise (≥65 dB) was 2.4 (1.4, 4.0) and 2.2 (1.7, 3.9), respectively. For participants with low HDL-cholesterol, the estimated hazard ratios for dementia/CIND were 2.5 (1.4, 4.3) and 1.8 (1.0, 3.0) for those also exposed to high levels of NOx (≥3.44 ppb) or noise (≥65 dB), respectively, compared with those without metabolic dysfunction exposed to low traffic-related air pollution or noise levels. Exposure to traffic-related air pollution or noise most strongly increases the risk of dementia/CIND among older Mexican-Americans living in California who also exhibit hyperglycemia or low HDL-cholesterol.

Estimates of the Association of Dementia With US Mortality Levels Using Linked Survey and Mortality Records

Vital statistics are the primary source of data used to understand the mortality burden of dementia in the US, despite evidence that dementia is underreported on death certificates. Alternative estimates, drawing on population-based samples, are needed. To estimate the percentage of deaths attributable to dementia in the US. A prospective cohort study of the Health and Retirement Study of noninstitutionalized US individuals with baseline exposure assessment in 2000 and follow-up through 2009 was conducted. Data were analyzed from November 2018 to May 2020. The sample was drawn from 7489 adults aged 70 to 99 years interviewed directly or by proxy. Ninety participants with missing covariates or sample weights and 57 participants lost to follow-up were excluded. The final analytic sample included 7342 adults. Dementia and cognitive impairment without dementia (CIND) were identified at baseline using Health and Retirement Study self- or proxy-reported cognitive measures and the validated Langa-Weir score cutoff. Hazard ratios relating dementia and CIND status to all-cause mortality were estimated using Cox proportional hazards regression models, accounting for covariates, and were used to calculate population-attributable fractions. Results were compared with information on cause of death from death certificates. Of the 7342 total sample, 4348 participants (60.3%) were women. At baseline, 4533 individuals (64.0%) were between ages 70 and 79 years, 2393 individuals (31.0%) were between 80 and 89 years, and 416 individuals (5.0%) were between 90 and 99 years; percentages were weighted. The percentage of deaths attributable to dementia was 13.6% (95% CI, 12.2%-15.0%) between 2000 and 2009. The mortality burden of dementia was significantly higher among non-Hispanic Black participants (24.7%; 95% CI, 17.3-31.4) than non-Hispanic White participants (12.2%; 95% CI, 10.7-13.6) and among adults with less than a high school education (16.2%; 95% CI, 13.2%-19.0%) compared with those with a college education (9.8%; 95% CI, 7.0%-12.5%). Underlying cause of death recorded on death certificates (5.0%; 95% CI, 4.3%-5.8%) underestimated the contribution of dementia to US mortality by a factor of 2.7. Incorporating deaths attributable to CIND revealed an even greater underestimation. The findings of this study suggest that the mortality burden associated with dementia is underestimated using vital statistics, especially when considering CIND in addition to dementia.

Traffic-related Noise Exposure and Late-life Dementia and Cognitive Impairment in Mexican-Americans.

Recently, it has been suggested that environmental exposures from traffic sources including noise may play a role in cognitive impairment in the elderly. The objective of the study was to investigate the association between local traffic-related noise pollution and incident dementia or cognitive impairment without dementia (CIND) during a 10-year follow-up period. 1612 Mexican-American participants from the Sacramento Area Latino Study on Aging (SALSA) were followed every 12-15 months via home visits from 1998 to 2007. We used the SoundPLAN software package to estimate noise originating from local traffic with the input of Annual Average Daily Traffic (AADT) data from Metropolitan Planning Organizations (MPO) based on geocoded residential addresses at baseline (1998-1999). We estimated the risks of incident dementia or CIND from 24-hour and nighttime noise exposure using Cox proportional hazard models. During the follow-up, we identified 159 incident dementia or CIND cases in total. Per 11.6 dB (interquartile range width) increase in 24-hour noise, the hazard of developing dementia or CIND increased (hazard ratio = 1.3 [1.0, 1.6]) during follow-up; estimates were slightly lower (hazard ratio = 1.2 [0.97, 1.6]) when adjusting for modeled local air pollution exposure from traffic sources. Overall, the risk of dementia/CIND was elevated when 24-hour and nighttime noise were higher than 75 and 65 dB respectively. See video Abstract: http://links.lww.com/EDE/B728. In our study, traffic-related noise exposure was associated with increased risk of dementia or CIND in elderly Mexican-Americans. Future studies taking into account other noise sources and occupational noise exposure before retirement are needed.

Nodal Global Efficiency in Front-Parietal Lobe Mediated Periventricular White Matter Hyperintensity (PWMH)-Related Cognitive Impairment.

White matter hyperintensity (WMH) is widely observed in the elderly population and serves as a key indicator of cognitive impairment (CI). However, the underlying mechanism remains to be elucidated. Herein, we investigated the topological patterns of resting state functional networks in WMH subjects and the relationship between the topological measures and CI. A graph theory-based analysis was employed in the resting-state functional magnetic resonance scans of 112 subjects (38 WMH subjects with cognitive impairment without dementia (CIND), 36 WMH subjects with normal cognition and 38 healthy controls (HCs), and we found that WMH-CIND subjects displayed decreased global efficiency at the levels of the whole brain, specific subnetworks [fronto-parietal network (FPN) and cingulo-opercular network (CON)] and certain nodes located in the FPN and CON, as well as decreased local efficiency in subnetworks. Our results demonstrated that nodal global efficiency in frontal and parietal regions mediated the impairment of information processing speed related to periventricular WMH (PWMH). Additionally, we performed support vector machine (SVM) analysis and found that altered functional efficiency can identify WMH-CIND subjects with high accuracy, sensitivity and specificity. These findings suggest impaired functional networks in WMH-CIND individuals and that decreased functional efficiency may be a feature of CI in WMH subjects.

Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition

Physical frailty is a powerful tool for identifying nondisabled individuals at high risk of adverse outcomes. The extent to which cognitive impairment in those without dementia adds value to physical frailty in detecting high-risk individuals remains unclear. To estimate the effects of combining physical frailty and cognitive impairment without dementia (CIND) on the risk of basic activities of daily living (ADL) dependence and death over 8 years. Prospective cohort study. The Health and Retirement Study (HRS). A total of 7338 community-dwelling people, 65 years or older, without dementia and ADL dependence at baseline (2006-2008). Follow-up assessments occurred every 2 years until 2014. The five components of the Cardiovascular Health Study defined physical frailty. A well-validated HRS method, including verbal recall, series of subtractions, and backward count task, assessed cognition. Primary outcomes were time to ADL dependence and death. Hazard models, considering death as a competing risk, associated physical frailty and CIND with outcomes after adjusting for sociodemographics, comorbidities, depression, and smoking status. The prevalence of physical frailty was 15%; CIND, 19%; and both deficits, 5%. In unadjusted and adjusted analyses, combining these factors identified older adults at an escalating risk for ADL dependence (no deficit = 14% [reference group]; only CIND = 26%, sub-hazard ratio [sHR] = 1.5, 95% confidence interval [CI] = 1.3-1.8; only frail = 33%, sHR = 1.7, 95% CI = 1.4-2.0; both deficits = 46%, sHR = 2.0, 95%CI = 1.6-2.6) and death (no deficit = 21%; only CIND = 41%, HR = 1.6, 95% CI = 1.4-1.9; only frail = 56%, HR = 2.2, 95% CI = 1.7-2.7; both deficits = 66%, HR = 2.6, 95% CI = 2.0-3.3) over 8-year follow-up. Adding the cognitive measure to models that already included physical frailty alone increased accuracy in identifying those at higher risk of ADL dependence (Harrell's concordance [C], 0.74 vs 0.71; P < .001) and death (Harrell's C, 0.70 vs 0.67; P < .001). Physical frailty and CIND are independent predictors of incident disability and death. Because together physical frailty and CIND identify vulnerable older adults better, optimal risk assessment should supplement measures of physical frailty with measures of cognitive function. J Am Geriatr Soc 67:477-483, 2019.

Non-Alzheimer's contributions to dementia and cognitive resilience in The 90+ Study.

The diagnosis of Alzheimer's disease (AD) in the oldest-old is complicated by the increasing prevalence of age-related neurofibrillary tangles, plaques and non-AD pathologies such as cerebrovascular disease (CVD), hippocampal sclerosis (HS), aging-related tau astrogliopathy (ARTAG), as well as TDP-43 and Lewy pathology. The contribution of these non-AD pathologies to dementia and cognitive resilience is unclear. We assessed the level of AD neuropathologic change (ADNPC) and non-AD pathology in 185 participants enrolled in The 90+ Study with available cognitive assessments and brain tissue. Logistic regression models-adjusting for age, sex and education-determined the association between each pathology and dementia or between subgroups. 53% had dementia, primarily AD or mixed AD; 23% had cognitive impairment without dementia (CIND); 23% were not impaired. Both AD and non-AD pathology was prevalent. 100% had tangles, 81% had plaques, and both tangles and plaques associated with dementia. ARTAG distributed across limbic (70%), brainstem (39%) and cortical regions (24%). 49% had possible CVD and 26% had definite CVD, while HS was noted in 15%. Cortical ARTAG, CVD and HS were each associated with dementia, but limbic and brainstem ARTAGs were not. TDP-43 and Lewy pathologies were found in 36 and 17% and both associated with dementia. No pathology distinguished CIND and the not impaired. By NIA-AA criteria and dementia status, the cohort was subdivided into four groups: those with minimal ADNPC included the not dementia (ND) and Not AD dementia groups; and those with significant ADNPC included the Resilient without dementia and AD dementia groups. Compared to the ND group, the Not AD dementia group had more HS, cortical ARTAG, TDP-43, and Lewy pathology. Compared to the AD dementia group, the Resilient group had less CVD, no HS and less cortical ARTAG, TDP-43 and Lewy pathology. Our findings imply that reductions in non-AD pathologies including CVD contribute to cognitive resilience in the oldest-old.

Educational Differences in the Prevalence of Dementia and Life Expectancy with Dementia: Changes from 2000 to 2010.

This article provides the first estimates of educational differences in age-specific prevalence, and changes in prevalence over time, of dementia by education levels in the United States. It also provides information on life expectancy, and changes in life expectancy, with dementia and cognitively healthy life for educational groups. Data on cognition from the 2000 and 2010 Health and Retirement Study are used to classify respondents as having dementia, cognitive impairment without dementia (CIND), or being cognitively intact. Vital statistics data are used to estimate life tables for education groups and the Sullivan method is used to estimate life expectancy by cognitive state. People with more education have lower prevalence of dementia, more years of cognitively healthy life, and fewer years with dementia. Years spent in good cognition increased for most sex-education groups and, conversely, years spent with dementia decreased for some. Mortality reduction was the most important factor in increasing cognitively healthy life. Change in the distribution of educational attainment has played a major role in the reduction of life with dementia in the overall population. Differences in the burden of cognitive loss by education point to the significant cost of low social status both to individuals and to society.

Secular Trends in Dementia and Cognitive Impairment of U.S. Rural and Urban Older Adults

This is a nationally representative study of rural-urban disparities in the prevalence of probable dementia and cognitive impairment without dementia (CIND). Data on non-institutionalized U.S. adults from the 2000 (n=16,386) and 2010 (n=16,311) cross-sections of the Health and Retirement Study were linked to respective Census assessments of the urban composition of residential census tracts. Relative risk ratios (RRR) for rural-urban differentials in dementia and CIND respective to normal cognitive status were assessed using multinomial logistic regression. Analyses were conducted in 2016. Unadjusted prevalence of dementia and CIND in rural and urban tracts converged so that rural disadvantages in the relative risk of dementia (RRR=1.42, 95% CI=1.10, 1.83) and CIND (RRR=1.35, 95% CI=1.13, 1.61) in 2000 no longer reached statistical significance in 2010. Adjustment for the strong protective role of educational attainment reduced rural disadvantages in 2000 to statistical nonsignificance, whereas adjustment for race/ethnicity resulted in a statistically significant increase in RRRs in 2010. Full adjustment for sociodemographic and health factors revealed persisting rural disadvantages for dementia and CIND in both periods with RRR in 2010 for dementia of 1.79 (95% CI=1.31, 2.43) and for CIND of 1.38 (95% CI=1.14, 1.68). Larger gains in rural adults' cognitive functioning between 2000 and 2010 that are linked with increased educational attainment demonstrate long-term public health benefits of investment in secondary education. Persistent disadvantages in cognitive functioning among rural adults compared with sociodemographically similar urban peers highlight the importance of public health planning for more rapidly aging rural communities.

Physical activity modifies the influence of apolipoprotein E ε4 allele and type 2 diabetes on dementia and cognitive impairment among older Mexican Americans

IntroductionThe etiologies of dementia are complex and influenced by genetic and environmental factors including medical conditions. MethodsWe used Cox regression model to estimate the individual and joint effects of physical activity (PA), apolipoprotein E (APOE) ε4, and diabetes status on risk of dementia and cognitive impairment without dementia (CIND) among 1438 cognitively intact Mexican American elderly who were followed up to 10 years. ResultsThe risk of developing dementia/CIND was increased more than threefold in APOE ε4 carriers or diabetics with low levels of PA compared with ε4 noncarriers or nondiabetics who engaged in high PA (ε4: hazard ratio [HR] = 3.44, 95% confidence interval [CI] = 1.85–6.39; diabetes: HR = 3.11, 95% CI = 1.87–5.18); the presence of all three risk factors increased risk by nearly 10-fold (HR = 9.49, 95% CI = 3.57–25.3). DiscussionPA in elderly Hispanics protects strongly against the onset of dementia/CIND, especially in APOE ε4 carriers and those who have diabetes.

Change in cognitively healthy and cognitively impaired life expectancy in the United States: 2000–2010

ObjectiveTo determine how cognitively healthy and cognitively impaired life expectancy have changed from 2000 to 2010 among American men and women 65 years of age and over. MethodsThe prevalence of dementia, cognitive impairment without dementia (CIND), and normal cognition is determined from nationally representative data from the U.S. Health and Retirement Study (HRS). Mortality rates are from U.S. Decennial Life Table for 2000 and the U.S. annual life table for 2010. Life expectancy by cognitive status is estimated using the Sullivan method. ResultsMost of the increase in life expectancy has been concentrated in cognitively healthy years in this 10 year period. The increase in expected years cognitively intact at age 65, which exceeded that in total life expectancy, was 1.8 for men and 1.6 for women. ConclusionThis study provides evidence suggesting that there has been a compression of cognitive morbidity.

Feeling Older and the Development of Cognitive Impairment and Dementia.

Subjective age is a biopsychosocial marker of aging associated with a range of outcomes in old age. In the domain of cognition, feeling older than one's chronological age is related to lower cognitive performance and steeper cognitive decline among older adults. The present study examines whether an older subjective age is associated with the risk of incident cognitive impairment and dementia. Participants were 5,748 individuals aged 65 years and older drawn from the Health and Retirement Study. Measures of subjective age, cognition, and covariates were obtained at baseline, and follow-up cognition was assessed over a 2- to 4-year period. Only participants without cognitive impairment were included at baseline. At follow-up, participants were classified into one of the three categories: normal functioning, cognitive impairment without dementia (CIND), and dementia. An older subjective age at baseline was associated with higher likelihood of CIND (odds ratio [OR] = 1.18; 1.09-1.28) and dementia (OR = 1.29; 1.02-1.63) at follow-up, controlling for chronological age, other demographic factors, and baseline cognition. Physical inactivity and depressive symptoms partly accounted for these associations. An older subjective age is a marker of individuals' risk of subsequent cognitive impairment and dementia.

Multidisciplinary rehabilitation program: effects of a multimodal intervention for patients with Alzheimer&amp;#8217;s disease and cognitive impairment without dementia

Background Non-pharmalogical interventions represent an important complement to standard pharmalogical treatment in dementia. Objective This study aims to evaluate the effects of a multidisciplinary rehabilitation program on cognitive ability, quality of life and depression symptoms in patients with Alzheimer’s disease (AD) and cognitive impairment without dementia (CIND). Methods Ninety-seven older adults were recruited to the present study. Of these, 70 patients had mild AD and were allocated into experimental (n = 54) or control (n = 16) groups. Two additional active comparison groups were constituted with patients with moderate AD (n = 13) or with CIND (n = 14) who also received the intervention. The multidisciplinary rehabilitation program lasted for 12 weeks and was composed by sessions of memory training, recreational activities, verbal expression and writing, physical therapy and physical training, delivered in two weekly 6-hour sessions. Results As compared to controls, mild AD patients who received the intervention had improvements in cognition (p = 0.021) and quality of life (p = 0.003), along with a reduction in depressive symptoms (p < 0.001). As compared to baseline, CIND patients displayed at the end of the intervention improvements in cognition (p = 0.005) and depressive symptoms (p = 0.011). No such benefits were found among patients with moderate AD.Discussion: This multidisciplinary rehabilitation program was beneficial for patients with mild AD and CIND. However, patients with moderate dementia did not benefit from the intervention.

The association of depression, cognitive impairment without dementia, and dementia with risk of ischemic stroke: a cohort study.

To determine if depression, cognitive impairment without dementia (CIND), and/or dementia are each independently associated with risk of ischemic stroke and to identify characteristics that could modify these associations. This retrospective-cohort study examined a population-based sample of 7031 Americans older than 50 years participating in the Health and Retirement Study (1998-2008) who consented to have their interviews linked to their Medicare claims. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Hospitalizations for ischemic stroke were identified via ICD-9-CM diagnoses. After adjusting for demographics, medical comorbidities, and health-risk behaviors, CIND alone (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.11-1.69) and co-occurring depression and CIND (OR = 1.65, 95% CI = 1.24-2.18) were independently associated with increased odds of ischemic stroke. Depression alone was not associated with odds of ischemic stroke (OR = 1.11, 95% CI = 0.88-1.40) in unadjusted analyses. Neither dementia alone (OR = 1.09, 95% CI = 0.82-1.45) nor co-occurring depression and dementia (OR = 1.25, 95% CI = 0.89-1.76) were associated with odds of ischemic stroke after adjusting for demographics. CIND and co-occurring depression and CIND are independently associated with increased risk of ischemic stroke. Individuals with co-occurring depression and CIND represent a high-risk group that may benefit from targeted interventions to prevent stroke.

Neuropsychiatric Disorders and Potentially Preventable Hospitalizations in a Prospective Cohort Study of Older Americans

The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood. To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI). Prospective cohort study. Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008). The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI. All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95% Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI. Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.

Cognitive Function and Oral Health–Related Quality of Life in Older Adults

To examine the relationship between cognitive function and self-reported oral health-related quality of life (HRQoL) in community-dwelling older adults. Cross-sectional. Community in West Virginia. Two hundred twenty-six community-dwelling older adults. Oral HRQoL was measured using the Geriatric Oral Health Assessment Index (GOHAI) (range 12-60), and cognitive function was assessed using a comprehensive neuropsychological test battery. Dental professionals performed oral health examinations. Participants with normal cognitive function had higher GOHAI total scores (mean 55.1), indicating better oral HRQoL, than participants with cognitive impairment without dementia (CIND) (mean 52.3) and mild dementia (mean 51.0). The difference remained significant after controlling for sociodemographic, health status, comorbidity, and clinical dental status covariates. Oral HRQoL, as measured using the GOHAI, was better in participants with normal cognitive function than in those with CIND of mild dementia in the population studied.