Cognitive Function Scores Research Articles

Requiring an Interpreter Influences Stroke Care and Outcomes for People With Aphasia During Inpatient Rehabilitation.

Communicative ability after stroke influences patient outcomes. Limited research has explored the impact of aphasia when it intersects with cultural or linguistic differences on receiving stroke care and patient outcomes. We investigated associations between requiring an interpreter and the provision of evidence-based stroke care and outcomes for people with aphasia in the inpatient rehabilitation setting. Retrospective patient-level data from people with aphasia were aggregated from the Australian Stroke Foundation National Stroke Audit-Rehabilitation Services (2016-2020). Multivariable regression models compared adherence to processes of care (eg, home assessment complete, type of aphasia management) and in-hospital outcomes (eg, length of stay, discharge destination) by the requirement of an interpreter. Outcome models were adjusted for sex, stroke type, hospital size, year, and stroke severity factors. Among 3160 people with aphasia (median age, 76 years; 56% male), 208 (7%) required an interpreter (median age, 77 years; 52% male). The interpreter group had a more severe disability on admission, reflected by reduced cognitive (6% versus 12%, P=0.009) and motor Functional Independence Measure scores (6% versus 12%, P=0.010). The interpreter group were less likely to have phonological and semantic interventions for their aphasia (odds ratio, 0.57 [95% CI, 0.40-0.80]) compared with people not requiring an interpreter. They more often had a carer (68% versus 48%, P<0.001) and were more likely to be discharged home with supports (odds ratio, 1.48 [95% CI, 1.08-2.04]). The interpreter group had longer lengths of stay (median 31 versus 26 days, P=0.005). Some processes of care and outcomes differed in inpatient rehabilitation for people with poststroke aphasia who required an interpreter compared with those who did not. Equitable access to therapy is imperative and greater support for cultural/linguistic minorities during rehabilitation is indicated.

Cerebral perfusion correlates with amyloid deposition in patients with mild cognitive impairment due to Alzheimer's disease.

Changes in cerebral blood flow (CBF) may contribute to the initial stages of the pathophysiological process in patients with Alzheimer's disease (AD). Hypoperfusion has been observed in several brain regions in patients with mild cognitive impairment (MCI). However, the clinical significance of CBF changes in the early stages of AD is currently unclear. The aim of this study was to investigate the characteristics, diagnostic value and cognitive correlation of cerebral perfusion measured with arterial spin labeling (ASL) magnetic resonance imaging (MRI) in patients with MCI due to AD. A total of fifty-nine MCI patients and 49 cognitively unimpaired controls (CUCs) were recruited and underwent multimodal MRI scans, including pseudocontinuous ASL, and neurocognitive testing. MCI patients were dichotomously classified according to the presence of amyloid deposition on 11C-labelled Pittsburgh compound B (PiB) positron emission tomography (PET). The differences in CBF and expression of the AD-related perfusion pattern (ADRP), established by spatial covariance analysis in our previous study, were compared between the PiB+ MCI group and the CUC group and between the PiB+ and PiB- MCI groups. The diagnostic accuracy and correlations with cognitive function scores for CBF and ADRP expression were further analyzed. Hypoperfusion in the precuneus and posterior cingulate cortex (PCC) was more characteristic of patients with MCI due to AD than of those with non-AD-related MCI. The relative regional CBF value of the left precuneus best distinguished patients with MCI due to AD from CUCs and patients with MCI due to non-AD conditions. Cerebral perfusion, as indicated by either the relative regional CBF or the expression score of the ADRP, was strongly correlated with certain cognitive function scores. Here, we show that changes in CBF in the precuneus/PCC are promising MRI biomarkers for the identification of an AD etiology in patients with MCI. ASL, a noninvasive and cost-effective tool, has broad application prospects in the screening and early diagnosis of AD.

Prehabilitation of Patients With Oesophageal Malignancy Undergoing Peri-Operative Treatment (Pre-EMPT): Outcomes From a Prospective Controlled Trial.

The Pre-EMPT study aimed to determine if structured exercise could reduce length of stay, post-operative complications and improve fitness and health-related quality of life (HQRL) in patients undergoing neoadjuvant chemotherapy (NAC) and oesophagectomy. A prospective non-randomised trial compared a standard care pathway (control) to a structured prehabilitation exercise programme (intervention) commenced before NAC and surgery for oesophageal adenocarcinoma. Length of hospital stay and post-operative complications were recorded. Cardiopulmonary exercise testing (CPEX), body composition analyses, lymphocyte levels and HRQL questionnaires were performed at multiple time points. Median length of stay was similar in both groups. There were 6 versus 11 complications observed (intervention vs control p = 0.086). Cardio-pulmonary fitness (VO2peak) declined after NAC, but less in the intervention group (intervention -13.54% vs control -21.40%, p = 0.02). Body composition improved in the intervention group (FMi/FFMi -5.5% intervention, 10.7% control p = 0.043). Performance, cognitive, sleep and emotional function scores improved following NAC in the intervention group. Lymphocyte subsets increased in the intervention group compared to the control group after chemotherapy (p = 0.034). Chemotherapy response was improved in the intervention group (p = 0.022). A structured exercise programme may mitigate cardiopulmonary deconditioning, reduce sarcopenia and offset lymphopenia, during chemotherapy, in patients undergoing NAC and oesophagectomy.

Sleep spindles and slow oscillations predict cognition and biomarkers of neurodegeneration in mild to moderate Alzheimer's disease.

Changes in sleep physiology can predate cognitive symptoms by decades in persons with Alzheimer's disease (AD), but it remains unclear which sleep characteristics predict cognitive and neurodegenerative changes after AD onset. Using data from a prospective cohort of mild to moderate AD (n=60), we analyzed non-rapid eye movement sleep spindles and slow oscillations (SOs) at baseline and their associations with baseline amyloid beta (Aβ) and tau and with cognition from baseline to 3-year follow-up. Higher spindle and SO activity predicted significant changes in Aβ and tau at baseline, lower Alzheimer's Disease Assessment Scale Cognitive Subscale (better cognitive performance) score, and higher Mini-Mental State Examination score from baseline to 36 months. Spindles and SOs mediated the effect of phosphorylated tau 181 (pTau181)/Aβ42 on cognition, while pTau181/aβ42 moderated the effect of spindles and SOs on cognition. Our findings demonstrate that spindle and SO activity during sleep constitute predictive and non-invasive biomarkers of neurodegeneration and cognition in AD patients. Sleep spindles predict long-term cognitive performance in AD. Sleep spindle and SOs can be predictive, non-invasive biomarkers for AD. Sleep may be one of the most important modifiable risk factors for AD progression. Sleep microarchitecture is a novel therapeutic target for preserving brain heath. Sleep physiology can provide novel therapeutic targets to slow AD progression.

Clinical validation of an individualized auto-adaptative serious game for combined cognitive and upper limb motor robotic rehabilitation after stroke

BackgroundIntensive rehabilitation through challenging and individualized tasks are recommended to enhance upper limb recovery after stroke. Robot-assisted therapy (RAT) and serious games could be used to enhance functional recovery by providing simultaneous motor and cognitive rehabilitation.ObjectiveThe aim of this study is to clinically validate the dynamic difficulty adjustment (DDA) mechanism of ROBiGAME, a robot serious game designed for simultaneous rehabilitation of motor impairments and hemispatial neglect.MethodsA proof of concept, with 24 participants in subacute and chronic stroke, was conducted using a 5-day protocol (two days were dedicated to assessment and three days to consecutive training sessions). Participants performed three consecutive ROBiGAME sessions during which overall task difficulty was determined through simultaneous DDA of motor and attentional parameters. Relationships between clinical and robotic assessment scores with respective task-difficulty parameters were analyzed using a multivariate regression model and a principal component analysis.ResultsGame difficulty rapidly (within approximately thirty minutes) auto-adapted to match individual impairment levels. The relationship between task-difficulty parameters with motor (Fugl Meyer Assessment: r = 0.84 p < 0.05) and with attentional impairments (Bells test total omissions: r = 0.617 p < 0.05) showed that task-difficulty during RAT adapted to each participant’s degree of impairment. Principal component analysis identified two data subsets determining overall task-difficulty, one subset for motor and the other for cognitive functional evaluation scores with respective task-difficulty parameters.ConclusionsThis proof of concept clinically validated a DDA mechanism and showed how task-difficulty adequately adapted to match individual degrees of impairment during RAT after stroke. ROBiGAME provided simultaneous motor and attentional exercises with parameters determining task-difficulty strongly related with respective clinical and robotic evaluation scores. Individualized levels of game difficulty and rapid adjustment of the system suggest implementation in clinical practice.Registry number This study was registered at ClinicalTrials.gov (NCT02543424).

Living in Historically Redlined Neighborhoods and the Cognitive Function of Black and White Adults.

We determined if living in historically redlined neighborhoods was associated with level and change in cognitive functioning and if this association differed for Black and White older adults. We linked the Health and Retirement Study 1998-2018 data to redlining scores from the Historic Redlining Indicator data. Our sample included adults aged 50 years and older (24,230 respondents, 129,618 person-period observations). Using three-level linear mixed models, we estimated the relationship between living in historically redlined neighborhoods on level and change in cognitive functioning for pooled and race-stratified samples. Residents of historically redlined "Declining" and "Hazardous" neighborhoods had lower cognitive functioning scores compared to residents of "Best/Desirable" neighborhoods. Among Black adults, living in "Hazardous" neighborhoods was associated with slower declines in cognitive functioning compared to living in "Best/Desirable" neighborhoods. Historical redlining is associated with older adults' cognitive functioning, underscoring the importance of sociohistorical context for the neighborhood-cognition relationship.

TRANSIENT ALTERATIONS IN THALAMO-CEREBELLAR FUNCTIONAL CONNECTIVITY IN PREMANIFEST HUNTINGTON'S DISEASE.

There are no disease modifying therapies for Huntington's disease (HD), a rare but fatal genetic neurodegenerative condition. To develop and test new management strategies, a better understanding of the mechanisms underlying HD progression is needed. Aberrant changes in thalamo-cortical and striato-cerebellar circuitry have been observed in asymptomatic HD, along with transient enlargement of the dentate nucleus. To evaluate the relationship between thalamo-cerebellar connectivity and HD progression. Prospective and retrospective. Patients with HD and healthy controls from a single-center dataset (n=34), and patients from the public TRACK-HD dataset (n=91). 3T and 7T. Thalamo-cerebellar connectivity was compared across patients and controls and related to motor scores and predicted years to symptom onset. Cross-sectional findings were validated within-patient by mapping changes in individual connectivity over time. HD effects on cognitive performance were also explored and related to connectivity. Kruskal-Wallis with post hoc Dunn's tests and Pearson correlations (p significant <0.05). In the 7T cohort, significant premanifest and control group differences in thalamo-dentate connectivity were observed (p Dunn <0.05, η 2 =.19-.22), with manifest HD connectivity approaching normative values. Thalamic connectivity with the dentate nucleus and anterior cerebellum also correlated with years to onset (p Den =0.06, r=0.42, p Ant <0.05, r=-0.45), together indicating potential transient functional alterations in premanifest HD. Similar patterns were observed between connectivity (thalamus to dentate nucleus and anterior lobe) and cognitive performance scores across all subjects (p<0.05, r Den =-0.17, r Ant =-0.18). In the premanifest TRACK-HD cohort, connectivity of multiple thalamo-cerebellar connections correlated with years to onset, revealing distinct patterns for patients with low versus high motor scores, again indicative of potential transient alterations. Exploratory non-parametric regression of serial imaging data further supported these findings. Transient changes in thalamo-cerebellar connectivity are seen in premanifest HD with increasing progression. More studies are needed to validate this potentially useful biomarker.

Exploring the triglyceride-glucose index's role in depression and cognitive dysfunction: Evidence from NHANES with machine learning support.

Depression and cognitive impairments are prevalent among older adults, with evidence suggesting potential links to obesity and lipid metabolism disturbances. This study investigates the relationships between the triglyceride-glucose (TyG) index, body mass index (BMI), depression, and cognitive dysfunction in older adults, leveraging data from the NHANES survey and employing machine learning techniques. We analysed 1352 participants aged 60-79 from the 2011-2014 NHANES dataset, who underwent cognitive function testing, depression assessments, and TyG index measurements. Multivariate linear regression and subgroup analyses were conducted to examine associations between the TyG index and depression/cognitive impairment. Machine learning models evaluated the importance of predictive factors for depression, while Mendelian randomization (MR) was employed to explore the causal relationship between BMI and depression/cognitive function. The TyG index was negatively associated with cognitive function scores and positively associated with depression scores in adjusted models (p < 0.001). In fully adjusted subgroup analyses, among obese individuals (BMI ≥ 28), a 100-unit increase in the TyG index was linked to a 3.79-point decrease in depression scores. Machine learning models (Xgboost, AUC = 0.960) identified BMI, TyG-BMI, gender, and comorbidities (e.g., asthma, stroke, emphysema) as key determinants of depression. MR analyses revealed a negative association between BMI and depression risk [OR: 0.9934; 95 % CI (0.9901-0.9968), p = 0.0001] and cognitive dysfunction risk [OR: 0.8514; 95 % CI (0.7929-0.9143), p < 0.05]. No evidence of heterogeneity or pleiotropy was detected. Depression and cognitive impairments were self-reported, potentially introducing bias. The observed associations may be influenced by unmeasured confounders, necessitating further research into the underlying mechanisms. Our findings reveal associations between the TyG index and psychocognitive health in older adults. While these results highlight lipid metabolism as a potential factor in depression and cognitive dysfunction, further studies are needed to validate these findings and explore underlying mechanisms.

The Association Between Metabolic Score for Visceral Fat and Cognitive Function Among Older Adults in the United States.

Although several studies have demonstrated a link between obesity and cognitive function, the majority have primarily utilized body mass index (BMI) and waist circumference, ignoring the distribution of body fat. Evidence regarding the association of metabolic score for visceral fat (METS-VF), a proposed measurement for visceral adipose tissue (VAT), with cognitive function remains limited. We mainly aimed to investigate this association in older adults in the United States. Data were from the National Health and Nutrition Examination Survey (NHANES) 2011 to 2014. Weighted linear regression models were adopted to examine the association of METS-VF and cognitive function scores, with further exploration of these associations across different obesity subgroups. Smoothing curve analysis, along with threshold and saturation effect analysis, were conducted to explore potential non-linear relationships. In the multivariable-adjusted model, participants in the highest quartile (Quartile 4) of METS-VF exhibited a β coefficient of -1.52 [95% CI (-2.43, -0.62)] for the CERAD score compared with those in the lowest quartile (Quartile 1). Threshold and saturation effect analysis revealed non-linear associations of METS-VF with DSST score and Z-score. The findings of this study indicate that elevated METS-VF scores are inversely related to cognitive function, highlighting the importance of considering visceral fat distribution in cognitive health assessments.

Effects of interactive boxing-cycling on dual-task walking and prefrontal cortex activation in older adults with cognitive frailty: A randomized controlled trial.

Older adults with cognitive frailty often have impaired dual-task walking and prefrontal cortex (PFC) activation. Combining cycling with interactive boxing offers an innovative and interesting dual-task training to challenge both physical and cognitive skills. This study investigated the effects of interactive boxing-cycling on this population. Thirty-nine participants were assigned to the interactive boxing-cycling group (n = 20) or the stationary cycling group (n = 19) for 36 sessions over 12 weeks. The outcomes included dual-task walking performance, PFC activation, cognitive function, and frailty scores. Results showed the interactive boxing-cycling group had greater improvements in dual-task walking speed and cost and beneficially reduced oxygenated hemoglobin levels compared to the stationary group. Furthermore, both groups improved in frailty and cognition, but the interactive boxing-cycling group had better effects on general and specific cognitive function. Interactive boxing-cycling is an efficient intervention to enhance dual-task walking and PFC activation in older adults with cognitive frailty.

Plasma S100β is a predictor for pathology and cognitive decline in Alzheimer’s disease

BackgroundBlood–brain barrier dysfunction is one characteristic of Alzheimer’s disease (AD) and is recognized as both a cause and consequence of the pathological cascade leading to cognitive decline. The goal of this study was to assess markers for barrier dysfunction in postmortem tissue samples from research participants who were either cognitively normal individuals (CNI) or diagnosed with AD at the time of autopsy and determine to what extent these markers are associated with AD neuropathologic changes (ADNC) and cognitive impairment.MethodsWe used postmortem brain tissue and plasma samples from 19 participants: 9 CNI and 10 AD dementia patients who had come to autopsy from the University of Kentucky AD Research Center (UK-ADRC) community-based cohort; all cases with dementia had confirmed severe ADNC. Plasma samples were obtained within 2 years of autopsy. Aβ40, Aβ42, and tau levels in brain tissue samples were quantified by ELISA. Cortical brain sections were cleared using the X-CLARITY™ system and immunostained for neurovascular unit-related proteins. Brain slices were then imaged using confocal microscopy and analyzed for microvascular diameters and immunoreactivity coverage using Fiji/ImageJ. Isolated human brain microvessels were assayed for tight-junction protein expression using the JESS™ automated Western blot system. S100 calcium-binding protein B (S100β), matrix metalloproteinase (MMP)-2, MMP-9, and neuron-specific enolase (NSE) levels in plasma were quantified by ELISA. All outcomes were assessed for linear associations with global cognitive function (MMSE, CDR) and cerebral atrophy scores by Pearson, polyserial, or polychoric correlation, as appropriate, along with generalized linear modeling or generalized linear mixed-level modeling.ResultsAs expected, we detected elevated Aβ and tau pathology in brain tissue sections from AD patients compared to CNI. However, we found no differences in microvascular diameters in cleared AD and CNI brain tissue sections. We also observed no differences in claudin-5 protein levels in capillaries isolated from AD and CNI tissue samples. Plasma biomarker analysis showed that AD patients had 12.4-fold higher S100β plasma levels, twofold lower NSE plasma levels, 2.4-fold higher MMP-9 plasma levels, and 1.2-fold lower MMP-2 plasma levels than CNI. Data analysis revealed that elevated S100β plasma levels were predictive of AD pathology and cognitive impairment.ConclusionOur data suggest that among different markers relevant to barrier dysfunction, plasma S100β is the most promising diagnostic biomarker for ADNC. Further investigation is necessary to assess how plasma S100β levels relate to these changes and whether they may predict clinical outcomes, particularly in the prodromal and early stages of AD.

Dynamic retinal vessel analysis: flickering a light into the brain.

Growing aging populations pose new challenges to public health as the number of people living with dementia grows in tandem. To alleviate the burden of dementia, prodromal signs of cognitive impairment must be recognized and risk factors reduced. In this context, non-invasive techniques may be used to identify early changes and monitor disease progression. Dynamic retinal vessel analysis (DVA) provides an opportunity to measure retinal vasoreactivity in a way that may be comparable to cerebral vasoreactivity, thus providing a window to the brain. We conducted a literature search on PubMed and Scopus to identify studies utilizing DVA to describe retinal vasoreactivity in central nervous system diseases and compare it with brain function and structure. We included original papers with full text in English. We identified 11 studies, of which most employed a cross-sectional design (91%). Studies on cerebrovascular diseases reported that retinal vasoreactivity decreased in patient populations compared with that of healthy controls. Studies on cognitive impairment and dementia yielded mixed results, at least in part due to high population heterogeneity. There is also evidence for the association between DVA and brain and cognition parameters such as cerebral blood flow velocity, cerebral microvascular diffusivity, and cognitive function score. The reviewed papers on DVA and brain function, despite the mixed results, have demonstrated the relationship between retinal vasoreactivity and cerebrovascular function and cognition. Heterogeneity in study populations, procedures, and analyses make comparisons difficult. Studies with larger sample size, clear description of the population and methods, and standardized DVA analysis are needed to elucidate the eye-brain connection and to enhance the translational and clinical applications of DVA.

Quality of Life in Pediatric Oncology Patients in Lebanon (2014-2019): A Multi-center Study.

Aim Cancer is one of the leading causes of death in pediatrics worldwide. The present study aimed to assess the quality of life (QOL) of pediatric oncology patients diagnosed within the last five years at Lebanese hospitals, and who are residing in Lebanon. Methods Pediatric oncology patients were asked to fill out a questionnaire collecting data on personal information, disease status, and QOL using the EORTC-QLQ-C30 (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-Core 30-item version) after receiving their guardian's consent. IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, NY, USA)was used for statistical analysis. Results The study enrolled 146 patients; 82 (56.2%) were boys. The mean age was 11.39 ± 3.90 years. Significant statistical correlations were found between the mother's educational level and physical functioning (p-value = 0.006), the number of siblings and each cognitive functioning (p-value = 0.025), and financial difficulties (p-value < 0.0001). The father's salary was statistically correlated with the patient's emotional and social functioning and financial difficulties (p-value < 0.05). The type of treatment had a significant effect on cognitive functioning and financial difficulties (p-value < 0.05), with chemotherapy patients having lower scores for financial burden than combination therapy patients. A total of 77.4% (113 patients) had leukemia, 16 (11%) had lymphoma, and 17 (11.6%) had solid tumors. Solid tumor patients had higher cognitive functioning scores than leukemia patients (difference = 12.65 ± 4.74, p-value = 0.023). Conclusion Palliative care is needed to relieve the symptom burden and enhance the psycho-social functioning of pediatric oncology patients.

Shadow puppetry therapy enhances dementia-related cognitive function and interpersonal relationship.

With the growing demand for dementia care, non-pharmacological interventions, such as creative arts therapies, have been proven effective in stabilizing cognitive function. Shadow Puppetry Therapy (SPT), which integrates visual, auditory, and kinesthetic elements, offers a promising care option for individuals with dementia. This study evaluated the effectiveness of SPT on cognitive function, self-esteem, and interpersonal relationships among older adults with mild dementia. We adopted a quasi-experimental design and recruited 33 older adults with mild dementia from two dementia care centers. Older adults with mild dementia were randomly assigned to an experimental group (n=15) and a control group (n=18). The experimental group participated in a 16-week SPT program, and the control group engaged in regular activities, such as physical exercises, painting, cooking, music, and handicraft projects. Assessments included the short portable mental status questionnaire (SPMSQ), the Rosenberg self-esteem scale (RSES), and the interpersonal relationship scale, with evaluations conducted before and after the intervention. The intervention significantly improved cognitive function, self-esteem, and interpersonal relationships in the experimental group. SPMSQ scores decreased, indicating enhanced cognitive function (p=.001), while self-esteem and interpersonal relationship scores showed significant improvements (p=.001). No significant changes were observed in the control group. SPT is an effective non-pharmacological intervention for enhancing cognitive function, self-esteem, and interpersonal relationships in older adults with mild dementia. The findings support the integration of creative arts therapies into dementia care.

Effectiveness of Distant/Remote Blessing Treatment on Cognitive-motor Function: A Randomized Double-blind Placebo-controlled Trial.

Biofield therapies can be administered in person (hands-on treatment) or remotely, and this study focuses on the latter. A literature review did not find any reports on the effectiveness of remote biofield energy /blessing therapy in enhancing cognition and motor function performance in adults. The aim of this study was to examine the effect of distant/remote blessing (biofield energy) therapy on the cognitive and motor functions in adults with self-reported neuropsychological impairments using NIH Toolbox®. The present study was a randomized, double-blind clinical trial involving 117 participants with self-reported neuropsychological impairments. These participants were stratified into three distinct groups: control, sham control, and blessing/biofield treatment as the intervention. At baseline (day 0), day 90, and day 180, NIH Toolbox® was employed to evaluate all participants' cognitive and motor function scores. In the blessing treatment group, language function score (p <0.01), working memory (p <0.0001), and episodic memory (p <0.0001) scores exhibited statistically significant differences compared to both the naïve control and sham control groups. Moreover, in the blessing intervention group, a substantial improvement was observed in locomotion (p <0.0001), standing balance (p <0.01), dexterity (p <0.01), grip strength (p <0.05), and muscle endurance (p <0.05) compared to the naïve control and sham control groups. Importantly, no adverse effects were reported during the study period. The study outcomes revealed that distant/remote blessing/biofield energy therapy is safe, non-invasive, and less expensive. It enhances cognitive-motor functions in adults with perceived neuropsychological impairments. CTRI/2022/07/043736.

The Role of Inflammation, Oxidative Stress, Neuronal Damage, and Endothelial Dysfunction in the Neuropathology of Cognitive Complications in Diabetes: A Moderation and Mediation Analysis.

Cognitive impairment is increasingly recognized as a complication of diabetes, yet the underlying pathology remains unclear. This study aims to investigate the roles of inflammation, oxidative stress, endothelial dysfunction, and neuronal damage in the neuropathology underlying diabetes related cognitive impairment. This study assessed 183 participants (54 prediabetes, 71 Type 2 diabetes mellitus [T2DM], and 58 controls) for cognitive performance using the Montreal Cognitive Assessment (MoCA). Blood samples were analyzed for interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), VCAM-1/CD106, and neuron-specific enolase (NSE) using ELISA. Mediation and moderator analysis methods were used to examine the roles of these biomarkers in diabetes-related cognitive impairment. After adjusting for age, education, and gender, group comparisons revealed significant cognitive impairment in patients with T2DM, particularly in visuospatial functions, naming, language, and memory performance, compared to the control group. The patients with T2DM and prediabetes exhibited similar performance in cognitive functions, except for language. Significant differences in VCAM-1 and TNF-α levels were observed; however, these biomarkers did not mediate the effect of T2DM and prediabetes on cognitive functions. Nevertheless, VCAM-1 was found to moderate abstraction abilities in T2DM. Prediabetes represents a transitional stage not only for the pathology of diabetes but also for cognitive complications. Although there were correlations between cognitive performance and various cognitive scores, IL-6, MDA, NSE, VCAM-1, and TNF-α did not play a mediator role in the neuropathology of diabetes-related cognitive impairment.

Impact of Behavioral and Environmental Health Impact of Behavioral and Environmental Health Impact of Behavioral and Environmental Health

Aim: This study intends to control aggressive health behaviors in children with craniocerebral damage and assess the impact of behavioral and environmental health therapies on neuroplasticity. Methodology: Two groups were formed out of 68 children with traumatic brain injuries (TBI), one with conventional medical treatment and another with an intervention incorporating specific environmental and behavioral change. The intervention aimed to promote neuroplasticity and control aggressive behavior after damage. Results: Evaluations of outcomes included cognitive and motor function scores (GCS), quality of life (SF-36), and neuroimaging (NIHSS, Fugl-Meyer). Moreover, under close observation were hostile actions and surgical errors. The intervention group exhibited clearly higher neuroplasticity, less aggressive behaviors, and improved cognitive and motor performance than the general care group with a p-value less than 0.05. Along with a lower incidence of rebleeds and infection, the intervention group scored better in quality of life and controlled aggression. Interventions in behavioral and environmental health help children with TBI have better neuroplasticity, control of aggressiveness, and results of rehabilitation. Conclusion: It is recommended that these operations should be used widely in clinical practice since they surpass standard therapy.

LONELINESS AND COGNITIVE FUNCTION IN OLDER ADULTS: A LONGITUDINAL ANALYSIS

Abstract Only a few studies have confirmed cognition as a predictor of loneliness. This study investigated the dynamic relationship between loneliness and cognitive performance in older adults through a random intercept cross-lagged panel model. Data from 8,443 individuals aged 65 years and older, drawn from Waves 9–14 of the Health and Retirement Study (HRS), were analyzed. Loneliness was assessed using the UCLA Loneliness Scale, and cognitive function was measured using delayed memory recall. Age, gender, and education were included as covariates. We combined waves 9-10, waves 11-12, and waves 13-14 to include all participants. Bivariate correlations revealed that older age was negatively correlated with cognitive function, loneliness was positively correlated with older age, and male gender and higher education were positively correlated with cognitive function, and negatively correlated with loneliness. Cognition and loneliness were negatively associated. Using Mplus, we computed an unconditional random intercept cross-lagged panel model (RI-CLPM) with no exogenous predictors (X2=.186, df=1, p=0.67, RMSEA=0.000 [.000,.018], CFI=1.0, TLI=1.0) and a conditional model (X2=13.431, df=7, p&amp;lt;.06, RMSEA=0.009 [.000,.015], CFI=.999, TLI=.997) including age, gender, and education as predictors. Results indicated individuals reporting higher loneliness exhibited lower cognitive functioning scores and older age. Male gender and higher education were negatively associated with loneliness and positively with cognitive function. This study underscores the link between loneliness and cognitive decline in older adults, emphasizing the need to address loneliness to potentially reduce cognitive decline. Insights into demographic predictors of loneliness and cognitive function could inform targeted interventions for promoting successful aging.

EDUCATIONAL ATTAINMENT AND LATER-LIFE COGNITIVE FUNCTION IN HIGH- AND MIDDLE-INCOME COUNTRIES

Abstract The rising number of dementia cases worldwide, especially in low- and middle-income countries (LMICs), underscores the need to identify social policies that promote cognitive health of older adults in LMICs and reduce global dementia burden. Many studies have found that educational attainment is associated with better cognitive function. However, these findings are mostly from Western high-income countries where the social and historical contexts of education differ from LMICs. In this research, we aim to evaluate the importance of educational attainment for later-life cognitive function in various social and geographic settings. Using data from the US Health and Retirement Study (HRS) and its sister studies in England, Mexico, China, and India and each study’s respective Harmonized Cognitive Assessment Protocol (HCAP) (n = 14,978, 2016–2019), we compared later-life global cognitive function across countries, examined educational differences in cognitive function within each country, and evaluated the potential impact of improving educational attainment in LMICs on reducing differences in later-life cognitive function between LMICs and high-income countries. In Mexico, China, and India, the general cognitive function score was approximately one standard deviation of HRS-HCAP scores lower compared to the US and England, paralleling patterns of educational attainment across countries. Higher educational attainment was consistently associated with better cognitive function across countries. Differences in educational attainment explained ~50%–90% of observed differences in cognitive function across countries. Our results underscore the importance of education to promote cognitive health. Continual improvement of educational attainment in LMICs may yield significant payoffs in later-life cognitive health.

Cognitive function status and its correlation with blood pressure control in patients with hypertension in China

Objective: To investigate the global cognitive function and the function of specific cognitive domains in hypertensive patients at high risk of cardiovascular disease in China, and to explore the impact of cognition function on blood pressure control. Methods: This is a cross-sectional survey. Data were obtained from the ESPRIT study. Patients with a history of hypertension who participated in the ESPRIT study from September 2019 to July 2020 were selected. Mini-mental state examination (MMSE) was used to evaluate patients' overall cognition and the function of each cognitive domain. According to the total MMSE score, patients were divided into the cognitive-intact group (MMSE total score=30 points), cognitive-declined group (MMSE total score<30 points, but did not reach the dementia screening threshold) and cognitive-impaired group (MMSE total score reached the dementia screening threshold). A multivariable logistic regression model was used to explore the effects of cognitive function and MMSE score on blood pressure control. The years of education were removed from the adjustment variables for sensitivity analysis. The interaction effect modeling of stratified variables and exposed variables was used for hierarchical analysis. Results: A total of 10 834 patients with hypertension at high risk of cardiovascular disease were enrolled, aged 65 (60, 69) years and 4 476 (41.3%) patients were female. There were 989 patients in cognitive-intact group, 8 676 patients in cognitive-declined group and 1 169 patients in cognitive-impaired group. The MMSE score of all included patients was (25.6±3.8) points. In the overall study population, 10.8% (1 169/10 834) of hypertensive patients had cognitive impairment, with an MMSE total score of (18.6±4.1) points. The cognitive domains with obvious impairment were recall memory (-80%), visuospatial function (-64%), attention and computation (-60%); 80.1% (8 676/10 834) of hypertensive patients did not meet the criteria for cognitive dysfunction, but had cognitive decline, and the cognitive domains with significant impairment were recall memory (-51%) and visuospatial structure (-23%). Multivariate logistic regression analysis showed that cognitive dysfunction (OR=0.88, 95%CI: 0.72-1.08, P=0.212) and cognitive decline (OR=0.96, 95%CI: 0.83-1.12,P=0.629) was not correlated with blood pressure control. MMSE total score and scores in each cognitive domain were not correlated with blood pressure control (P>0.05). Sensitivity analysis showed that cognitive function was not related to blood pressure control (all P>0.05). Stratified analysis according to different frequency of medication showed that cognitive function and MMSE score were not correlated with blood pressure control (P>0.05). Conclusion: One in ten hypertensive patients who were at high risk of cardiovascular disease have comorbid cognitive impairment. In patients with high risk of cardiovascular disease, the most affected cognitive domains were recall memory, visuospatial function, attention and calculation. Part of hypertensive patients have not reached the level of cognitive dysfunction, but have begun to show cognitive decline. Cognitive function is not an independent influencing factor on blood pressure control.