Cognitive Impairment In Older Adults Research Articles

Correlation between blood pressure control status and cognitive impairment in older adults: A national cross-sectional study.

Hypertension is closely related to cognitive impairment; however, the correlation between blood pressure control and cognitive impairment in the hypertensive population is unclear. We aimed to explore the relationship between blood pressure control and cognitive impairment in older adults with hypertension. Using the cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, 5,860 people with self-reported history of hypertension were divided into the hypotension, intermediate blood pressure, and hypertension groups. Cognitive impairment was defined as a score of < 18 on the Chinese version of the Mini-Mental State Examination. Demographics of the population were also collected. Bivariate Logistic regression analysis and restricted cubic spline (RCS) model were used to analyze the relationship between blood pressure control and cognitive impairment. After adjusting for confounding factors, binary logistic regression analysis showed that the intermediate group was significantly associated with an increased risk of cognitive impairment than the hypotension group, whereas the hypertension group was significantly correlated with a reduced risk of cognitive impairment. No significant correlation was found between blood pressure control and cognitive impairment in patients aged <80 years, with hearing impairment, or with cerebrovascular diseases, whether in the hypotension or hypertension groups. There was a significant correlation between hypotension and cognitive impairment, and no correlation between hypertension and cognitive impairment in people aged ≥ 80 years, Han ethnicity and those who used antihypertensive drugs. Furthermore, RCS model analysis showed that there was a non-linear relationship between systolic blood pressure and cognitive impairment in individuals aged ≥ 80 years and those using antihypertensive drugs. There was a linear relationship between diastolic blood pressure and cognitive impairment. Blood pressure control in the hypertensive group was significantly associated with a lower risk of cognitive impairment.

The mediating effect of depressive symptoms between frailty and cognitive impairment in the Northeast Chinese older adults.

Cognitive impairment among older adults is a significant public health concern worldwide. This study aims to investigate the prevalence of cognitive impairment, its correlates, and the mediating role of depressive symptoms between frailty and cognitive impairment among older adults in northeast region of China. This was a cross-sectional study which used the intercept interview method to recruit participants. Social demographic characteristic, health-related behaviours, physical health, and functional status of the participants were collected. Univariate and multivariate analyses were conducted to correlates of cognitive impairment. Additionally, mediating effect analysis was performed using the Bootstrap tool. Among the 2,859 older adults included in the study, 32.4% of participants screened positive for cognitive impairment. Higher educational attainment had negative association with cognitive impairment in older adults (P<0.05). Living in rural areas, fair/poor self-rated health, pre-frailty, frailty, having depressive symptoms, impaired activities of daily living, poor sleep quality, and inactive physical activity had positive association with cognitive impairment in older adults(P<0.05). Furthermore, depressive symptoms exhibited a partial mediating role between frailty and cognitive impairment, with a mediating effect of 58.0%. Preventive measures should be implemented to address the associated factors with cognitive impairment. Promoting higher education levels, advocating for a positive and healthy lifestyle, and ensuring their physical and mental well-being among older adults are essential. Early diagnosis and proactive prevention of frailty and depressive symptoms in older adults may effectively decelerate cognitive decline.

Persistent depressive symptom trajectory is associated with cognitive impairment: a population-based longitudinal study of aging in Taiwan

BackgroundTo investigate the associations between five depressive symptom trajectories and cognitive impairment in Taiwan’s older population. In addition, we investigated the moderating factors influencing these associations.MethodsThis population-based, longitudinal, cohort study was conducted on the basis of the Taiwan Longitudinal Study on Aging. Data corresponding to the fifth (2003), sixth (2007), and seventh (2011) survey waves were analyzed, focusing on individuals aged ≥ 65 years. Depressive symptom trajectories were analyzed using the 10-item Centre for Epidemiological Studies Depression scale, and cognitive function was assessed using the Short Portable Mental State Questionnaire. Logistic regression models were adjusted for various covariates such as sociodemographic, lifestyle, and health-related variables. We also investigated moderating effects of sex, age, type 2 diabetes mellitus, hypertension, and coronary heart disease.ResultsFive trajectories of depressive symptoms included 1,549 older individuals were identified. Approximately 36.09%, 47.13%, 5.68%, 6.20%, and 4.91% exhibited no, mild, decreasing, increasing, and persistent depressive symptom trajectories, respectively. The odds ratios for cognitive impairment were 3.17 (95% confidence interval [CI]: 1.41–7.15) in Model 1; 3.24 (95% CI: 1.42–7.41) in Model 2; and 2.95 (95% CI: 1.24–7.00) in Model 3 in individuals with persistent depressive symptom trajectory. Only persistent depressive symptom trajectory reached statistical significance in all three models. Cognitive decline was evident across all trajectories. The rate of cognitive decline was more rapidly in the persistent depressive symptom trajectory, nearly twofold to no depressive symptom trajectory, which the corresponding β values (score/year) were − 0.0862, − 0.1020, − 0.1192, − 0.1206, and − 0.1683 for the no, mild, decreasing, increasing, and persistent depressive symptom trajectories, respectively. Female sex, older age, type 2 diabetes mellitus, and coronary heart disease were significant moderators on the risk of cognitive impairment.DiscussionPersistent depressive symptoms is associated with cognitive impairment in older adults. Identifying high-risk subgroups is crucial for targeted assistance. Policymakers and health-care professionals should be informed accordingly.

Integrated digit in noise test (iDIN) for rapid hearing and cognitive screening: a preliminary exploration.

Hearing and cognitive impairments are common amongst older adults, both affecting communication and are not easy to distinguish from each other. To preliminarily evaluate the efficacy of the integrated Digit in Noise Test (iDIN) for rapid screening of hearing and cognitive functions in older adults. This cross-sectional cohort study was conducted at multiple clinical sites. Data collection occurred in sound-treated booths and quiet rooms at several outpatient clinics and elderly community centres. The study included 107 older adults, aged 58-96, who were long-term residents of Hong Kong and native Cantonese speakers. Participants were selected through convenience sampling. Primary outcomes were the speech reception thresholds (SRTs) for 2-, 3- and 5-digit sequences with forward and 3-digit sequences with backward recall measured on iDIN. Hearing level was assessed using pure-tone audiometry. Cognitive function was assessed using the Hong Kong version of the Montreal Cognitive Assessment (HK-MoCA). The 2-digit and 3-digit SRTs effectively distinguished participants with hearing loss, demonstrating high sensitivity (0.815 and 0.908, respectively) and specificity (0.905 and 0.853, respectively). The SRT3b-3f index effectively discriminated between participants who passed or failed the MoCA, with sensitivities of 0.727 and 0.781, and specificities of 0.885 and 0.787 using the two MoCA scoring methods. No significant correlation was found between SRT3b-3f and hearing levels after adjustment for educational background. iDIN demonstrates significant promise for rapid and effective screening of both hearing and cognitive impairments in older adults.

Sleep structure of short-term insomnia disorder with mild cognitive impairment in older adults and their correlation with cognitive function: a case-control study.

This study seeks to delineate the sleep architecture characteristics in older adults with short-term insomnia and mild cognitive impairment (MCI) and to explore their association with cognitive performance. Ninety elderly individuals with short-term insomnia were enrolled and stratified into two cohorts based on their Montreal Cognitive Assessment (MoCA) scores: the Short-Term Insomnia Group (STID) comprising 35 participants and the Short-Term Insomnia with Cognitive Impairment Group (STID-MCI) with 55 participants. Demographic data, Pittsburgh Sleep Quality Index (PSQI), MoCA, Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), and polysomnography (PSG) parameters were compared between groups. Correlations between MoCA scores and PSG metrics were also analyzed. No significant disparities were noted between groups in terms of HAMD-17, HAMA, and PSQI scores (p > 0.05). However, marked differences were identified in MoCA scores and its subdomains (p < 0.05). Significant variations were also observed in the duration and proportion of slow-wave sleep (N3) between groups (p < 0.05). In STID-MCI patients, memory scores correlated positively with N3 duration and percentage (p < 0.05), while verbal functions and attention were positively associated with rapid eye movement (REM) sleep duration. This study highlights the potential of PSG in the clinical assessment of cognitive function and underscores the need for targeted interventions to improve sleep quality in this vulnerable population.

Emergency Nurses' Perspectives on Adopting Geriatric Screenings for Cognitive Impairment: A Qualitative Study.

Cognitive impairment in older adults is underrecognized in emergency departments. Despite emergency nurses' central role in facilitating ED screening for clinical and social needs, little is known about their perspectives on implementing delirium and dementia screenings. Nurses can provide insights to promote the uptake of these screenings. Using a case study approach, we conducted qualitative interviews with emergency nurses at a public safety net hospital about their perspectives on implementing screening for delirium and dementia. Interview topics were derived from an implementation science framework (Consolidated Framework for Implementation Research). We performed a combined deductive-inductive analysis. Eleven nurses participated in interviews. Four overarching themes were identified. Emergency nurses viewed safety as the core function of screening. Emergency nurses identified adequate staffing, private care spaces, and electronic medical record support as important resources required to support screening implementation. Nurses perceived benefits of screening ED patients for cognitive impairment specifically related to hazards of ED boarding. However, they simultaneously found screenings complex and incompatible with their workflows and available health system resources. Emergency nurses conceptualize screenings in terms of patient safety, which may be the best way to frame initiatives to implement screenings for cognitive impairment. In light of ED crowding and boarding's impacts on patient safety, nurses highlighted screening for cognitive impairment as increasingly relevant. However, they found current working conditions of delivering patient care in waiting rooms and hallways not conducive to implementing screenings. Using the Consolidated Framework for Implementation Research framework helped identify workflow limitations that are barriers to ED screening.

Beneficial Effects of the Herbal Medicine Zuo Gui Wan in a Mice Model of Alzheimer's Disease via Drp1-Mediated Inhibition of Mitochondrial Fission and Activation of AMPK/PGC-1α-regulated Mitochondrial Bioenergetics.

Zuo Gui Wan (ZGW) is a well-known traditional Chinese medicine decoction used for approximately 400 years to treat age-related degenerative conditions, including cognitive impairment in older adults, osteoporosis, and general aging. However, the mechanism of action for ZGW remains unclear. This study aims to investigate the efficacy of ZGW in improving cognitive function in Alzheimer's disease (AD) animal models and to explore the underlying mechanisms, presenting a novel perspective in the field. Six-month-old male APP/PS1 mice were divided into three groups that received either metformin (200 mg/kg daily) or ZGW (6 and 12 g/kg daily). High-performance liquid chromatography was conducted for ZGW's quality control. Cognitive function was assessed using the Morris water maze test. Neuronal loss, synaptic plasticity, and β-amyloid (Aβ) deposition were evaluated through Western blot or immunofluorescence staining. The underlying molecular mechanisms were investigated using ELISA, Western blot, qRT-PCR, co-immunoprecipitation assay, ATP assay, and cytochrome c oxidase assay. ZGW, administered in both low and high doses, significantly enhanced cognitive performance, notably decreased neuronal loss and Aβ deposition, and reduced levels of Aβ1-40/42. It also inhibited excessive mitochondrial division primarily by suppressing phosphorylated Drp1, especially at high doses of ZGW. Co-immunoprecipitation experiments further confirmed that ZGW inhibited the interaction between Aβ and p-Drp1. Furthermore, similar to the effects of the AMPK activator metformin, ZGW led to a marked increase in the mitochondrial DNA copy number and upregulated the AMPK/PGC-1α/NRF1/TFAM pathway. Improvements in mitochondrial function were evident from the increased ATP production, elevated expression of SOD2, and upregulated cytochrome c oxidase activity. Additionally, the excess byproduct of reactive oxygen species, 4-HNE, decreased in the group treated with ZGW. This study provides compelling evidence that ZGW improves cognitive impairment in APP/PS1 mice by activating AMPK/PGC-1α-regulated mitochondrial bioenergetics and inhibiting Aβ-induced mitochondrial fragmentation, highlighting its potential as an effective therapeutic strategy for AD.

Impact of physical fitness and lifelong education on mild cognitive impairment in older adults

Impact of physical fitness and lifelong education on mild cognitive impairment in older adults

Hypertension may lead to cognitive dysfunction in older adults via methylmalonic acid: evidence from NHANES 2011–2014 population

BackgroundAn enriched understanding is necessary concerning the association between hypertension and cognitive impairment in older adults, particularly regarding the potential underlying mechanisms at a biological level. This study aimed to explore the mediating role of methylmalonic acid (MMA) in the hypertension-cognition link in the older population.MethodsA total of 2762 adults (age > = 60 years) from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 participated. Cognitive function was assessed using a combination of the Animal Fluency Test (AFT), the Digit Symbol Substitution Test (DSST), and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test. Self-reported hypertension diagnosis, antihypertensive medications use, and blood pressure examinations were used to identify hypertension. Serum MMA (sMMA) levels were collected. Weighted multiple linear regressions and mediation analysis were applied. A subgroup analysis by sex and age was performed.ResultsAfter adjusting for potential confounding factors, we observed a significant mediating effect of the sMMA level in the hypertension-cognition link, accounting for 11.14% (95% CI 4.09%-14.00%, p < 0.001) of the relationship in older adults. The proportion mediated by the sMMA level in the relationship between hypertension and cognitive function was higher in males (15.23%, 95%CI 1.32%-27.00%, p < 0.001) than in females (6.61%, 95%CI 2.12%-10.00%, p < 0.001). This mediating effect of sMMA was observed only in individuals aged 68 years and older (11.31%, 95%CI 3.80%-16.00%, p < 0.001), with no significant mediation detected in those younger than 68 years.ConclusionHypertension may lead to cognitive dysfunction in older adults through MMA. Apart from its role as a biomarker reflecting vitamin B12, MMA may act as an independent neurotoxin capable of inducing brain injury and cognitive impairment. Addressing MMA accumulation, such as through Vitamin B12 supplementation, may have a potential to mitigate hypertension-induced cognitive decline in older adults. Special attention could be paid to hypertensive males with an advanced age (> = 68) to address MMA-related cognitive decline.

Abnormalities in gut virome signatures linked with cognitive impairment in older adults.

Multiple emerging lines of evidence indicate that the microbiome contributes to aging and cognitive health. However, the roles of distinct microbial components, such as viruses (virome) and their interactions with bacteria (bacteriome), as well as their metabolic pathways (metabolome) in relation to aging and cognitive function, remain poorly understood. Here, we present proof-of-concept results from a pilot study using datasets (n = 176) from the Microbiome in Aging Gut and Brain (MiaGB) consortium, demonstrating that the human virome signature significantly differs across the aging continuum (60s vs. 70s vs. 80+ years of age) in older adults. We observed that the predominant virome signature was enriched with bacteriophages, which change considerably with aging continuum. Analyses of interactions between phages and the host bacteriome suggest that lytic or temperate relationships change distinctly across the aging continuum, as well as cognitive impairment. Interestingly, the phage-bacteriome-metabolome interactions develop unique patterns that are distinctly linked to aging and cognitive dysfunction in older adults. The phage-bacteriome interactions affect bacterial metabolic pathways, potentially impacting older adults' health, including the risk of cognitive decline and dementia. Further comprehension of these studies could provide opportunities to target the microbiome by developing phage therapies to improve aging and brain health in older adults.

Perfetti-based exercise program for mild cognitive impairment in older adults

Background: Mild cognitive impairment in older adults is gaining more strength as a social problem in recent years, since there has been no timely treatment, which gives way to older adults suffer significant changes in their normal development of activities of daily living. Objective: To implement an exercise program using the Perfetti Method that allows us to improve cognitive processes and therefore help the recovery of the development of activities of daily living of older adults with mild cognitive impairment. Methods: For this project, the Mini Mental teas were used to evaluate cognitive impairment, in addition to the Barthel index, to show the degree of affection in activities of daily living, which were carried out pre and post application of an exercise program based on the Perfetti Method for mild cognitive impairment in older adults. Results: After having analyzed the results, it was evidenced that, with cognitive stimulation, cognitive processes are improved in older adults, which, if a significant improvement is seen in the execution of activities of daily. Conclusions: The application of the exercise program based on the Perfetti method, if it has a positive effect, in the cognitive and physical processes of the elderly.living.

Main factors of cognitive decline in older adults: a review of scientific literature

Cognitive impairment in older adults is a multifactorial problem that significantly affects their quality of life and poses challenges to public health systems. Vascular, metabolic, inflammatory, and lifestyle factors play a central role in its development and progression. The objective of this study was to identify the main factors associated with cognitive impairment in older adults through a bibliographic review. A systematic review of the literature was conducted in PubMed using a search algorithm that included terms related to cognitive impairment, risk factors, and the older adult population. Studies published between 2018 and 2024 that met pre-established criteria were selected. The results showed that arterial hypertension is one of the most important risk factors, associated with alterations in cerebral microcirculation, blood-brain barrier dysfunction, and neuroinflammation. Other relevant factors include unhealthy lifestyle patterns, such as physical inactivity, unbalanced diets, and poor sleep quality, which exacerbate systemic inflammation and cognitive impairment. Additionally, mixed pathologies, such as the coexistence of Alzheimer’s disease and small vessel disease, underscore the need for comprehensive diagnostic and therapeutic approaches. Multidomain strategies based on lifestyle changes and vascular risk factor control have shown promising results in preserving cognition. This study concludes that identifying and addressing modifiable factors through an integrated preventive approach is essential to reduce the incidence of cognitive impairment and improve the quality of life of older adults

Efficacy of vocal biomarkers in detecting cognitive impairment: interim findings from US and Indian populations

AbstractBackgroundVocal biomarkers are emerging as potentially meaningful health indicators in multiple domains, including cognition. Because voice‐enabled devices are widespread, automated vocal analysis could become a useful modality for early detection and monitoring of cognitive impairment. To assess the efficacy of vocal biomarkers in identifying cognitive impairment we evaluated prosodic speech features on vocal tasks in a research cohort from Kerala, India, and a referral cohort from the Montefiore‐Einstein Center for the Aging Brain in the Bronx, NY.Methods157 participants (38% female, mean age 67 (4.9)) in India, and 57 participants (65% female, mean age 76 (6.3)) in NY completed voice protocols and cognitive screening (Addenbrooke's Cognitive Examination‐III in India, mean 81 (13); Blessed Information Memory Concentration Test in NY, mean 6.0 (3.7)). Prosodic speech features on vocal tasks with low and high mental effort were compared to performance on cognitive screening. Speech feature values were characterized using means and standard deviations, and subgroup distributions were compared using ratio of means, Cohen’s d for effect size, and significance testing using independent sample t‐tests.ResultsMean speech rate across conditions in syllables/minute was 100 (37) for the India and 107 (34) for the US cohort; pause duration in seconds was 0.68 (0.40) and 0.56 (0.33), respectively. Participants with worse performance on cognitive screening exhibited reduced speech rates and increased pause durations—23% variation in the Indian and 4% in the US cohort. Tasks with higher mental effort mirrored these effects, with about 25% variation in both cohorts. Mental effort had medium to large effect size (0.6‐0.9) and was statistically significant (p&lt;0.01), while cognitive impairment achieved similar effect size and statistical significance for the India cohort only.ConclusionThese preliminary findings reinforce the potential of vocal biomarkers, especially speech rate and pause duration, as potential indicators of cognitive impairment in older adults. The results align with our goals to develop accessible vocal biomarker technology and support continued investigation into their utility in clinical and everyday settings, development of predictive analytics, and incorporating these into existing vocal biomarker platforms.

Lewy Body Dementia.

Lewy body dementia (LBD) is an umbrella term describing two closely related conditions: Parkinson disease dementia (PDD) and dementia with Lewy bodies (DLB). LBD is the second most common cause of neurodegenerative dementia but is often underrecognized in clinical practice. This review covers the key epidemiologic, clinical, cognitive, behavioral, and biomarker features of LBD and discusses current treatment options. Indicative biomarkers of LBD improve the ability to make a diagnosis and include single-photon emission computed tomography (SPECT) of the dopamine system (brain) and the noradrenergic system (cardiac), and polysomnography. α-Synuclein-specific biomarkers in spinal fluid, skin, plasma, and brain imaging are in active development with some available for clinical use. Prodromal stages of PDD and DLB have been contextualized, and diagnostic criteria have been published. An emerging theme is whether an integrated staging system focusing on protein aggregation, rather than clinical symptoms, may advance research efforts. LBD is a common cause of cognitive impairment in older adults but is often subject to significant delays in diagnosis and treatment, increasing the burden on patients and family care partners. Understanding key features of disease and the use of biomarkers will improve recognition. Earlier detection may also facilitate the development of new therapeutics and enrollment in clinical trials.

Contribution of White matter Hyperintensities Lesion Burden to Cognitive Impairment in Older Adults with Epilepsy

AbstractBackgroundOlder adults with epilepsy represent the largest and fastest‐growing segment of individuals with epilepsy and harbor risk factors for pathological aging, including cerebrovascular risk factors (CVRFs) and Alzheimer’s disease (AD)‐related pathology. In fact, several community‐based studies have reported up to a 3‐fold increased risk for dementia including AD among individuals with epilepsy. Despite this, identification of risk factors for AD and related dementias (ADRD) remains largely unexplored in epilepsy, which has critical implications for patient care and dementia risk stratification. Here, we examine the relationship between white matter hyperintensities (WMH) as a marker for vascular brain injury, a common contributor to the ADRD spectrum (i.e., biomarker of non‐AD co‐pathology), and sociodemographic, clinical, and cognitive profiles in older adults with epilepsy.MethodForty‐nine older adults with epilepsy without dementia (average age=66.6, average education=15.1, 52.8% female, 86.8% non‐Hispanic white) completed cognitive testing, a comprehensive lipid panel, and MRI that included 3D FLAIR. The 3D FLAIR was analyzed to quantify WMH lesion burden (LB) using the LesionQuant software. Stepwise regressions were used to examine the contribution of sociodemographic, clinical, and vascular risk factors to WMH‐LB. The association between cognitive scores and WMH‐LB was analyzed with Spearman rho.ResultOlder age, male sex, non‐White race, hypertension, and diabetes were associated with increased periventricular (adjusted R2= .518, p=.016) and whole brain WMH‐LB (adjusted R2= .456, p=.025). Smoking was associated with increased juxtacortical WMH‐LB (β= .684, p=.025). Higher juxtacortical WMH‐LB was associated with poorer performance on measures of visual immediate (rho=‐.374, p=.010) and delayed memory (rho=‐.408, p=.004), delayed list recall (rho=‐.363, p=.011), processing speed (rho=‐.364, p=.010), confrontation naming (rho=‐.314, p=.010), and lower scores on the MoCA (rho=‐.350, p=.014) and more errors on the ADAS‐Cog (rho=.372, p=.008).ConclusionIn a group of older adults with epilepsy, greater WMH burden was associated with a worse cognitive profile and with the presence of CVRFs. The etiology of dementia in epilepsy remains understudied, and here, we provide evidence for WMH burden as a potential contributing factor to cognitive decline in this population. Older adults with epilepsy with evidence of vascular pathology would benefit from targeted interventions focused on the management of modifiable vascular risk factors.

Current epidemiological and experimental evidence relating the chemical exposome to Alzheimer’s disease

AbstractThis critical overview aims to provide one of the most comprehensive synthesis of epidemiological and experimental evidence relating the chemical exposome to Alzheimer’s Disease (AD). We have focused on chemical pollutants that mostly result from anthropic activities and involved in toxicology pathways, including pesticides, organic solvents, metals, combustion air pollutants, dioxins, flame retardants, fluorosurfactants, plastic components and food/cosmetic additives. In total, we have reviewed over 120 epidemiological studies examining the link between chemical exposures and the risk of AD or cognitive impairment in older adults, along with more than 250 experimental studies assessing the impact of chemical exposures on neurodegeneration‐related pathways.The predominant emphasis in epidemiological research has been on pesticides, metals, solvents and combustion air pollutants. The most consistently observed associations with AD/cognitive impairment involve occupational exposure to pesticides and exposure to fine particulate matter. Less is known about the impact of lower levels of pesticide exposure in the general population, with emerging evidence supported by a few studies. Conversely, in the general population, there is growing evidence of the role of air pollution, especially increased exposure to fine particulate matters, in AD. Regarding metals and solvents, associations with AD have been suggested in several case‐control or cross‐sectional studies but the overall weight of evidence remains low. In experimental studies, pesticides and metals have also been the most extensively investigated and predominantly implicated in the disruption of neurotransmission, oxidative stress and mitochondrial dysfunction; some pesticides might also specifically target amyloid‐β aggregation.Finally, our comprehensive literature review highlights a gap in knowledge concerning the influence of many chemical exposures on AD, especially the most recent pesticide families as well as synthetic additive chemicals considered as ubiquitous. Yet, some of these chemicals have been incriminated in neurodevelopmental defects, and there exists suggestive, albeit still limited, evidence of their involvement in neurodegeneration‐related pathways, such as neurotransmission disruption, supporting the need for further research efforts.

Developing a prediction model for cognitive impairment in older adults following critical illness

BackgroundNew or worsening cognitive impairment or dementia is common in older adults following an episode of critical illness, and screening post-discharge is recommended for those at increased risk. There is a need for prediction models of post-ICU cognitive impairment to guide delivery of screening and support resources to those in greatest need. We sought to develop and internally validate a machine learning model for new cognitive impairment or dementia in older adults after critical illness using electronic health record (EHR) data.MethodsOur cohort included patients > 60 years of age admitted to a large academic health system ICU in North Carolina between 2015 and 2021. Patients were included in the cohort if they were admitted to the ICU for ≥ 48 h with ≥ 2 ambulatory visits prior to hospitalization and at least one visit in the post-discharge year. We used a machine learning model, oblique random survival forests (ORSF), to examine the multivariable association of 54 structured data elements available by 3 months after discharge with incident diagnoses of cognitive impairment or dementia over 1-year.ResultsIn this cohort of 8,299 adults, 22% died and 4.9% were diagnosed with dementia or cognitive impairment within one year. The ORSF model showed reasonable discrimination (c-statistic = 0.83) and stability with little difference in the model’s c-statistic across time.ConclusionMachine learning using readily available EHR data can predict new cognitive impairment or dementia at 1-year post-ICU discharge in older adults with acceptable accuracy. Further studies are needed to understand how this tool may impact screening for cognitive impairment in the post-discharge period.

Denture Use Mitigates the Cognitive Impact of Tooth Loss in Older Adults.

Denture use may contribute to maintaining cognitive function by addressing the masticatory difficulties caused by tooth loss. However, reports on the association between tooth loss and cognitive impairment have been inconsistent. The impact of changes in tooth number and denture use on the development of cognitive impairment in older adults remains unclear. This study aimed to evaluate these impacts among community-dwelling older adults. This 7-year longitudinal prospective cohort study included 64 520 community-dwelling Taiwanese older adults aged ≥65 years without cognitive impairment at baseline. The primary outcome was cognitive impairment assessed using the Short Portable Mental Status Questionnaire. Older adults with 10-19, 1-9, and 0 teeth, including natural teeth and dentures, had higher risks of developing cognitive impairment than those with ≥20 teeth, with adjusted odds ratios (ORs) of 1.40 (95% confidence intervals [CIs], 1.14-1.71), 1.85 (95% CI, 1.40-2.43), and 2.56 (95% CI, 1.74-3.76), respectively. Furthermore, among those with 10-19 teeth (OR, 0.71; 95% CI, 0.52-0.98) or 1-9 teeth (OR, 0.43, 95% CI, 0.27-0.68) at baseline, an increase of more than 1 level in tooth number during follow-up (eg, from 10-19 to ≥ 20 teeth and dentures through the acquisition of dental prosthetics such as dentures, bridges, or implants) was associated with a lower risk of developing cognitive impairment compared with those with a stable tooth number. Our findings suggest that prompt denture use and maintaining >20 teeth (including natural teeth and dentures) mitigate the risk of cognitive impairment associated with tooth loss among community-dwelling older adults.

Mediation effect of neuropsychological factors on the relationship between social networks and mild cognitive impairment in older adults.

Although links between social networks and mild cognitive impairment (MCI) have been suggested. The pathway between social networks and MCI from the Person-Environment-Occupation (PEO) model perspective among older adults remains inconclusive. To examine the relationship between social networks and MCI, and further identify whether neuropsychological factors mediate the relationship. 1036 participants aged 55 to 75 years were recruited from two districts of Fuzhou, China, from December 2020 to December 2022. Data were obtained via a face-to-face neuropsychological scale assessment. Social networks and cognitive function were assessed by the Lubben Social Network Scale and the Montreal Cognitive Assessment, respectively. The mediation model and structural equation model (SEM) pathway analysis were used to examine the direct and indirect effects of social networks on MCI via neuropsychological factors. Data from 580 participants were analyzed (year: 65.16 ± 5.38). Regression analysis indicated that higher levels of social networks and psychological resilience were positively correlated with improved cognitive function, even after adjusting for demographic data. Increased depressive symptoms and poor sleep quality were linked to cognitive decline. Support from family members had a greater impact than support from friends in reducing the risk of developing MCI. The SEM model supported the hypothesis that significant indirect effects of social networks on MCI via psychological resilience, depressive tendencies, and sleep quality. The effects of social networks on MCI are mediated by psychological resilience, depressive tendencies, and sleep quality.

Recognition of mild cognitive impairment in older adults using a polynomial regression model based on prefrontal cortex hemoglobin oxygenation

AimThis study employed a three-minute game-based intelligence test (GBIT) to create a hemoglobin polynomial regression model for early identification of mild cognitive impairment (MCI) in older adults. Methods210 older adult participants were recruited from community centers in the central region of Taichung City. Working memory (WM) performance in older adults was assessed during GBIT, while hemoglobin responses were measured by near-infrared spectroscopy (NIRS). Variables included oxyhemoglobin (O2Hb) and deoxyhemoglobin (HHb). Data sequences underwent a fitting procedure using a transformed cubic polynomial function. The transformed coefficients were used as predictors of a logistic regression model to recognize MCI in older adults. ResultsThis study confirmed the relationship between age and cognitive performance. The findings demonstrate that the NIRS cubic polynomial function trends during the GBIT test showed significant changes in older adults, increasing with age. Logistic regression analysis identified age and the orientation (coefficient a) of HHb as the main factors for recognizing MCI. The model achieved an overall precision of 83.33 % (sensitivity = 75.00 %; specificity = 84.68 %) with the formula: ln (Odds [MCI]) = −1.64 + 0.57 × HHb_a + 1.40 × age. ConclusionsNIRS hemoglobin response characteristics during GBIT may serve as an efficient indicator of MCI in older adults. These findings may advance the field of cognitive health evaluation, resulting in earlier detection of cognitive deterioration in older adults.