Cognitive Risk Factors Research Articles

Development and validation of a risk prediction model for cognitive impairment in breast cancer patients

BackgroundBreast cancer patients often experience cognitive impairment as a complication during treatment, which seriously affects their quality of life. This study aimed to assess the risk factors associated with cognitive impairment in breast cancer patients and to construct and validate a nomogram model to predict cognitive impairment in this population.MethodsIn this study, we used a convenience sampling method to select 423 breast cancer patients who attended the Department of Breast Surgery at the First Hospital of Jinzhou Medical University from September 2023 to March 2024. We analyzed these patients’ cognitive impairment risk factors through LASSO regression and logistic regression analysis to develop a predictive model. The model was evaluated using the area under the curve (AUC) from the receiver operating characteristic (ROC) curve and the calibration curve and decision curve analysis.ResultsThis study found a prevalence of cognitive impairment of 19.62% among breast cancer patients. A nomogram model was developed based on six influencing factors: age, educational level, pathological type, treatment program, emotional state, and fatigue. The area under the curve (AUC) for the model’s training and validation groups was 0.944 and 0.931, respectively. The model calibration curves showed a high degree of consistency, and the decision curve analysis (DCA) indicated good clinical applicability of the model.ConclusionsThis nomogram demonstrates good discrimination, calibration, and clinical applicability, making it a more intuitive predictor of the risk of cognitive impairment in breast cancer patients.

A viewpoint on stress generation methodology.

This article provides an overview of Stress Generation Methodology. Stress generation is a phenomenon in which individuals with depression or vulnerability to depression experience greater dependent stressful life events (SLEs), defined as stressors in which individuals at least partially contributed to occurrence. The stress generation process demonstrates how depressed individuals shape their environments, contributing to depression maintenance and exacerbation. Subsequent extensions have shown that other forms of psychopathology and a variety of cognitive and personality risk factors also predict stress generation. The focus on stress generation in women is accompanied by an emphasis on interpersonal stress. In addition to emphasizing communal SLEs, stress generation studies have also focused on communal vulnerability factors. However, men do not typically exhibit communal vulnerabilities to the degree that women do. Thus, it is also important to broaden the scope of vulnerability factors examined to include vulnerabilities associated with stress generation in men. These could include impulsivity, anger and aggression, and the need for autonomy and self-definition, all of which tend to be more common in males. Lastly, studies often employ self-report measures of SLEs which could artificially accentuate gender differences in stress generation findings. As existing studies may be more sensitive to detecting stress generation in women, future research should examine this phenomenon with the following methodological refinements: (a) use male-only or adequately sized samples with equal gender representation to test gender moderation effects, (b) expand the range of SLEs to include agentic and achievement-oriented stressors and use wider assessment windows, and (c) examine vulnerability factors that may be relevant to men such as impulsivity, anger, aggression, and the need for autonomy and self-definition. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Increased dementia risk in patients with Parkinson's disease attributed to metabolic syndrome.

Metabolic syndrome (MetS) manifests resembling pathophysiological mechanisms with Parkinson's disease (PD). Current research on the overall population has emphasized MetS as a freestanding risk factor for cognition. This research aims to explore the impact of MetS on cognition in Parkinson's patients. We involved subjects identified as having early-stage PD patients. The MetS was diagnosed dependent on parameters overviewed in the National Cholesterol Education Program's Adult Treatment Panel III. The clinical severity and stages in patients with PD were dependent on the disease rating scales. The cognition was evaluated by the Turkısh version of the Montreal Cognitive Assessment Scale (MoCA-TR). The cases were categorized according to cognitive failure: mild cognitive impairment in PD (PD-MCI), and PD dementia (PDD). Metabolic syndrome was present in 39.6% of the participants. 22.0% of patients were in the normal cognition, 29.1% in the PD-MCI group, and 48.9% in the PD-D group. The cognitive scores in patients with MetS is considerably lower than MetS negative group. A statistically notable inverse association was detected between fasting blood glucose levels and the visual-spatial/executive functions, naming, language, and orientation scores. The multivariate logistic regression analysis showed individuals with MetS were found to have an 11.308 times higher risk of PD-D (odds ratio [OR]: 11,3, 95% confidence interval [CI]: 1.61-79.2 ). We discerned the occurrence of MetS in PD raises the possibility of advancing dementia. This suggests that considering MetS in this patient group could contribute to the effective management of dementia.

Research hot topics and frontiers in social anxiety over the past decade: a CiteSpace bibliometric analysis based on Web of Science database from 2013 to 2023.

To understand the current study of social anxiety (SA) over the past decade, and to analyze the research hot topics and frontiers in this field. CiteSpace 6.2.R3 was used to analyze the literature on SA collected in the Web of Science Core Collection database from 2013 to 2023. A total of 9940 literature were included after the screening, and the annual publication volume showed a steady increase. The results emphasize that Zvolensky MJ, Pine DS, and Heimberg RG are important authors in the field of SA. The United States has the highest number of publications, with the University of California System contributing the most. Research hotspots include cognitive impairment, risk factors, complications, neuroimaging, and intervention strategies. SA related to the "theory of mind", "bullying victimization", "mobile phone", "network analysis", "technology", and "satisfaction" are emerging research foci. This study identifies the current situation and trends of SA research, and provides a reference for future research topics and directions.

Deconstructing Cognitive Impairment in Psychosis With a Machine Learning Approach

Cognitive functioning is associated with various factors, such as age, sex, education, and childhood adversity, and is impaired in people with psychosis. In addition to specific effects of the disorder, cognitive impairments may reflect a greater exposure to general risk factors for poor cognition. To determine the extent that impairments in cognition in psychosis reflect risk factor exposures. This cross-sectional study examined the relationship between exposures and cognitive function using data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes studies 1 and 2 across 6 sites. Participants included healthy controls; patients with schizophrenia, schizoaffective disorder, or bipolar I disorder with psychosis; and relatives of patients. Predictive modeling was performed using extreme gradient boosting regression to train a composite cognitive score prediction model with nested cross-validation. Shapley additive explanations values were used to examine the relationship between exposures and cognitive function. Exposures were chosen based on associations with cognition previously identified: age, sex, race and ethnicity, childhood adversity, education, parental education, parental socioeconomic status, parental age at birth, substance use, antipsychotic dose, and diagnosis. Cognition was assessed using the Brief Assessment of Cognition in Schizophrenia. A total of 3370 participants were included: 840 healthy controls, 709 patients with schizophrenia, 541 with schizoaffective disorder, 457 with bipolar I disorder with psychosis, and 823 relatives of patients. The mean (SD) age was 37.9 (13.3) years; 1887 were female (56%) and 1483 male (44%). The model predicted cognitive scores with high accuracy: out-of-sample Pearson correlation between predicted and observed cognitive composite score was r = 0.72 (SD = 0.03). Individuals with schizophrenia (z = -1.4), schizoaffective disorder (z = -1.2), and bipolar I disorder with psychosis (z = -0.5) all had significantly worse cognitive composite scores than controls. Factors other than diagnosis and medication accounted for much of this impairment (schizophrenia z = -0.73, schizoaffective disorder z = -0.64, bipolar I disorder with psychosis z = -0.13). Diagnosis accounted for a lesser proportion of this deficit (schizophrenia z = -0.29, schizoaffective disorder z = -0.15, bipolar I disorder with psychosis z = -0.13), and antipsychotic use accounted for a similar deficit across diagnostic groups (schizophrenia z = -0.37, schizoaffective disorder z = -0.33, bipolar I disorder with psychosis z = -0.26). This study found that transdiagnostic factors accounted for a meaningful share of the variance in cognitive functioning in psychosis. A significant proportion of the cognitive impairment in psychosis may reflect factors relevant to cognitive functioning in the general population. When considering interventions, a diagnosis-agnostic, symptom-targeted approach may therefore be appropriate.

Comparison of Memory, Balance and Fear of Falling in Older Women After Performing Yoga and Square-stepping Exercises

Objectives Most falls in the elderly occur due to physical and cognitive risk factors. This study aims to compare the effect of two types of mind-body exercises, yoga and square-stepping exercise (SSE), on memory, balance, and fear of falling in older women. Methods & Materials A quasi-experimental study was conducted on 20 elderly women with an age range of 60 to 70 years. Participants were selected through purposive sampling and were randomly assigned to yoga and Square-Stepping groups. Both groups did exercise for 12 weeks and participated in a pre-test and post-test. The Wechsler memory test, stork test, berg balance test, and international falls efficacy scale were used to measure memory quotient, static balance, dynamic balance, and fear of falling, respectively. Analysis of variance with repeated measures was conducted to analyze the data Results The mean scores of memory quotient in the two groups after exercises were significantly higher than before exercises (F(1, 18)=32.692, P<0.001, η2=0.645). The mean static balance time in the yoga group was significantly higher than in the SSE group (F(1, 18)=60.755, P<0.001, η2=0.771). Furthermore, the mean dynamic balance score in the SSE group was significantly higher than in the yoga group (F(1, 18)=7.714, P=0.012, η2=0.300). In addition, the mean square of fear of falling in the SSE group was significantly lower than in the yoga group (F(1, 18)=11.777, P=0.003, η2=0.396). Conclusion It seems that square stepping exercises can also be used as a simple exercise program to improve physical and cognitive functions in older women.

Behavioral, Cognitive, and Functional Risk Factors for Repeat Hospital Episodes Among Medicare-Medicaid Dually Eligible Adults Receiving Long-Term Services and Supports.

Repeat hospitalizations adversely impact the well-being of adults dually eligible for Medicare and Medicaid in the United States. This study aimed to identify behavioral, cognitive, and functional characteristics associated with the risk of a repeat hospital episode (HE) among the statewide population of dually eligible adults in Maryland receiving long-term services and supports prior to an HE between July 2018 and May 2020. The odds of experiencing a repeat HE within 30 days after an initial HE were positively associated with reporting difficulty with hearing (adjusted odds ratio, AOR: 1.10 [95% confidence interval: 1.02-1.19]), being easily distractible (AOR: 1.09 [1.00-1.18]), being self-injurious (AOR: 1.33 [1.09-1.63]), and exhibiting verbal abuse (AOR: 1.15 [1.02-1.30]). Conversely, displaying inappropriate public behavior (AOR: 0.62 [0.42-0.92]) and being dependent for eating (AOR: 0.91 [0.83-0.99]) or bathing (AOR: 0.79 [0.67-0.92]) were associated with reduced odds of a repeat HE. We also observed differences in the magnitude and direction of these associations among adults 65 years of age or older relative to younger counterparts.

'Flashforward' mental imagery in adolescents: exploring developmental differences and associations with mental health.

Future events can spring to mind unbidden in the form of involuntary mental images also known as 'flashforwards', which are deemed important for understanding and treating emotional distress. However, there has been little exploration of this form of imagery in youth, and even less so in those with high psychopathology vulnerabilities (e.g. due to developmental differences associated with neurodiversity or maltreatment). We aimed to test whether flashforwards are heightened (e.g. more frequent and emotional) in autistic and maltreatment-exposed adolescents relative to typically developing adolescents. We also explored their associations with anxiety/depression symptoms. A survey including measures of flashforward imagery and mental health was completed by a group of adolescents (n=87) aged 10-16 (and one of their caregivers) who met one of the following criteria: (i) had a diagnosis of autism spectrum disorder; (ii) a history of maltreatment; or (ii) no autism/maltreatment. Flashforwards (i) were often of positive events and related to career, education and/or learning; with phenomenological properties (e.g. frequency and emotionality) that were (ii) not significantly different between groups; but nevertheless (iii) associated with symptoms of anxiety across groups (particularly for imagery emotionality), even after accounting for general trait (non-future) imagery vividness. As a modifiable cognitive risk factor, flashforward imagery warrants further consideration for understanding and improving mental health in young people. This implication may extend to range of developmental backgrounds, including autism and maltreatment.

Comparative Study of Risk Factors Associated with Normal Cognition and Cognitive Impairment in Rural West Elderly Texans.

Alzheimer's disease (AD) is related to one or more chronic illnesses, which may develop cognitive decline and dementia. Cognitive impairment is increasing, and public health officials must address risk factors for AD to improve the health of rural West Texas communities. The purpose of this study was to explore the sociodemographic and chronic disease risk factors related to cognitive impairment among elderly adults living in Cochran, Parmer, and Bailey counties in rural West Texas. Statistical methods such as Pearson's chi-squared, proportion tests, univariate binary logistic regression, and a multivariable logistic regression were utilized to analyze data. SPSS software was used to detect the significant relationship between cognitive impairment and risk factors. Summary statistics were obtained for sociodemographic and chronic diseases by using cross-tabulation analysis and comparing the county respondents with proportion tests. A univariate binary logistic regression method was utilized and found that age group 60-69, anxiety, depression, diabetes, hypertension, and cardiovascular disease were significantly associated with cognitive impairment. Using a multivariable logistic regression approach, it was found that Bailey County (age group 60-69) had a higher likelihood (p = 0.002) of cognitive impairment than Parmer (p = 0.067) and Cochran counties (p = 0.064). The risk of females (p = 0.033) in Parmer County was 78.3% lower compared to males in developing AD. Identifying significant risk factors for cognitive impairment are important in addressing issues of geographic variations and integrating such factors may guide relevant policy interventions to reduce cognitive impairment incidence in rural communities within West Texas.

The Impact of Misaligned Perceived and Objective Fall Risk in Cognitively Impaired Older People.

Cognitive impairment (CI) may impair the ability to accurately perceive physical capacity and fall risk. We investigated perceived (measured as concern about falls) and physiological fall risk in community-dwelling older people with CI, the characteristics of the aligned and misaligned groups and the impact of misaligned perceptions on falls. Participants (n= 293) with mild-moderate CI were classified into four groups based on validated physiological and perceived fall risk assessments: 1) vigorous: low perceived and physiological fall risk; 2) anxious: high perceived and low physiological fall risk; 3) unaware: low perceived and high physiological fall risk; and 4) aware: high perceived and physiological fall risk. Groups were compared with respect to neuropsychological and physical function, activity and quality of life measures, and prospective falls (12-months). The anxious (IRR = 1.70, 95% CI = 1.02-2.84), unaware (IRR = 2.00, 95% CI = 1.22-3.26), and aware (IRR = 2.53, 95% CI = 1.67-3.84) groups had significantly higher fall rates than the vigorous group but fall rates did not significantly differ among these groups. Compared with the vigorous group: the anxious group had higher depression scores and reduced mobility and quality of life; the unaware group had poorer global cognition, executive function and mobility and lower physical activity levels; and the aware group had an increased prevalence of multiple physical and cognitive fall risk factors. Fall rates were increased in participants who had increased perceived and/or physiological fall risk. Contrasting fall risk patterns were evident in those who under- and over-estimated their fall risk. Understanding these characteristics will help guide fall risk assessment and prevention strategies in community-dwelling older people with CI.

Research on cognitive impairment and potential risk factors in peritoneal dialysis patients: An observational study.

The objective of this study is to investigate the associated risk factors and their effects on cognitive impairment (CI) in patients undergoing peritoneal dialysis. A retrospective analysis was conducted on the basic information of 268 patients who underwent continuous ambulatory peritoneal dialysis (CAPD) at our hospital from January 2020 to September 2023. Cognitive function was assessed using the Montreal Cognitive Assessment Scale during their subsequent dialysis visits. Participants were categorized into a CI group and a cognitively normal group. Blood and other biological samples were collected for relevant biomarker analysis. Subsequently, we analyzed and compared the factors influencing CI between the 2 groups. The prevalence of CI among CAPD patients was 58.2%. Compared to the cognitively normal group, the CI group had a higher prevalence of alcohol consumption, lower levels of education, and reduced serum uric acid levels (P < .05). There was also a higher incidence of autoimmune diseases such as systemic lupus erythematosus in the CI group (P < .05). In terms of dialysis efficacy, the residual kidney Kt/V and residual kidney Ccr were significantly lower in the CI group compared to the cognitively normal group. In blood parameters, the CI group showed elevated total cholesterol levels and lower serum calcium concentrations (P < .05). Logistic regression analysis identified male gender, older age, lower educational attainment, hypercholesterolemia, and elevated high-sensitivity C-reactive protein levels as independent risk factors for CI in CAPD patients (P < .05). Additionally, in this patient cohort, dialysis duration and residual renal function were protective factors against CI (P < .05). CI is prevalent among PD patients. Elevated high-sensitivity C-reactive protein levels, male gender, older age, lower educational attainment, and hypercholesterolemia constitute an independent risk factor for CI in CAPD patients, whereas residual renal function acts as a protective element.

Intolerance of uncertainty and psychological flexibility as predictors of mental health from adolescence to old age

PurposeThe COVID-19 pandemic brought with it significant social, economic and health uncertainties. These were proposed to impact young people more compared to adults, leading adolescents to report more mental health problems during the pandemic. The current study examined whether differences in cognitive risk (tolerance of uncertainty) and protective (psychological flexibility) factors accounted for age-related differences in depression and anxiety.MethodsThese associations were investigated in the COVID-19 Risks Across the Lifespan (CORAL) cohort (N = 2280, 11–89 years).ResultsThe results showed that adolescents experienced greater intolerance of uncertainty and lower psychological flexibility compared to adults and older adults. Tolerance of uncertainty did not account for age-related differences in depression or anxiety. However, psychological flexibility conferred more protective advantage for anxiety in adults compared to adolescents.ConclusionThe observed age-related differences in risk and protective factors advance our understanding of developmental vulnerabilities to depression and anxiety. Implications for mental health interventions in the context of future pandemics are discussed.

Cognitive and interpersonal moderators of two evidence-based depression prevention programs.

To test potential cognitive and interpersonal moderators of two evidence-based youth depression prevention programs. Two hundred four adolescents (Mage = 14.62 years, SD = 1.65; 56% female; 71% White, 11% Black, 11% multiracial, 5% Asian, 2% other races, 18% Hispanic/Latinx) were randomized to either a cognitive-behavioral (Coping With Stress [CWS]) or interpersonal (Interpersonal Psychotherapy-Adolescent Skills Training [IPT-AST]) prevention program. Potential moderators, selected based on theory and research, included rumination, negative cognitive style, dysfunctional attitudes, hopelessness, parent-adolescent conflict, negative interactions with parents and friends, and social support from parents and friends. Depression symptoms were assessed repeatedly through 18 months postintervention. After adjusting for multiple comparisons, rumination (B = -2.02, SE = .61, p = .001, d = .47), hopelessness (B = -2.03, SE = .72, p = .005, d = .41), and conflict with father (B = 1.68, SE = .74, p = .02, d = .32) moderated intervention effects on change in depression symptoms from postintervention through 18-month follow-up. For example, at high levels of conflict with father, youth in IPT-AST reported a significant decrease in symptoms during follow-up, whereas youth in CWS reported a nonsignificant change in symptoms. At low levels of conflict with father, youth in IPT-AST reported a significant increase in symptoms during follow-up, whereas youth in CWS reported a nonsignificant change in symptoms. These exploratory secondary analyses of Personalized Depression Prevention study data highlight specific cognitive and interpersonal risk factors that could be considered when determining which prevention program may be most effective for a given adolescent. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pathways between parental depressed mood and child cognition in economically marginalized populations

Research supports parental depressed mood, negative parenting, and family conflict as risk factors for poorer cognition in early childhood. The current study is the first to examine bidirectional associations between maternal and paternal depressed mood, negative maternal and paternal parenting, family conflict, and child cognition. Data was drawn from the Early Head Start Research and Evaluation study using interviews, self-report, and performance-based measures completed by parents when children were age 14 months, age 2 years, and age 3 years. Results showed bidirectional pathways between maternal depressed mood and child cognition, but a unidirectional pathway from child cognition to paternal depressed mood. Family conflict mediated links between greater maternal depressed mood and poorer child cognition, but negative maternal parenting mediated links between poorer child cognition and negative maternal depressed mood. Results highlight transactional relations among parents and children as well as the salience of family conflict and negative parenting in exacerbating this transaction.

A feature-aware multimodal framework with auto-fusion for Alzheimer’s disease diagnosis

Alzheimer’s disease (AD), one of the most common dementias, has about 4.6 million new cases yearly worldwide. Due to the significant amount of suspected AD patients, early screening for the disease has become particularly important. There are diversified types of AD diagnosis data, such as cognitive tests, images, and risk factors, many prior investigations have primarily concentrated on integrating only high-dimensional features and simple fusion concatenation, resulting in less-than-optimal outcomes for AD diagnosis. Therefore, We propose an enhanced multimodal AD diagnostic framework comprising a feature-aware module and an automatic model fusion strategy (AMFS). To preserve the correlation and significance features within a low-dimensional space, the feature-aware module employs a low-dimensional SHapley Additive exPlanation (SHAP) boosting feature selection as the initial step, following this analysis, diverse tiers of low-dimensional features are extracted from patients’ biological data. Besides, in the high-dimensional stage, the feature-aware module integrates cross-modal attention mechanisms to capture subtle relationships among different cognitive domains, neuroimaging modalities, and risk factors. Subsequently, we integrate the aforementioned feature-aware module with graph convolutional networks (GCN) to address heterogeneous data in multimodal AD, while also possessing the capability to perceive relationships between different modalities. Lastly, our proposed AMFS autonomously learns optimal parameters for aligning two sub-models. The validation tests using two ADNI datasets show the high accuracies of 95.9% and 91.9% respectively, in AD diagnosis. The methods efficiently select features from multimodal AD data, optimizing model fusion for potential clinical assistance in diagnostics.

Linking the 1940 US Census to the NSHAP: Novel Opportunity to Understand the Effects of Childhood Residential Environment on Cognitive Aging.

The 1940 Census is a valuable resource for understanding various aspects of historical populations in the United States. Recently, the National Social Life, Health and Aging Project (NSHAP) integrated 1940 Census data into its extensive dataset, providing researchers with an opportunity to explore new avenues of life course investigation. We leverage the newly-introduced measures of childhood residential environment and evaluate their potential predictive utility in older adult cognitive functioning net of childhood and adulthood characteristics known to be key risk factors for poor cognition. We analyzed 777 respondents who were children in 1940 (age<17) that have been linked to the 1940 U.S. Census. We used childhood geographic location, homeownership status, household composition, and parental nativity as predictors. Cognitive function was measured using the Montreal Cognitive Assessment. Regression analysis showed that growing up in an urban area was associated with better cognitive function, while being born in the South was linked to poorer cognitive function, even after controlling for childhood health, parental education, educational attainment, stroke, and smoking status. Additionally, childhood multigenerational household was associated with better cognitive function, and childhood family size was associated with poorer cognitive function. However, these associations became statistically insignificant with the inclusion of educational attainment. We did not find homeownership and parental nativity to be associated with cognitive function. The findings may shed light on the potential long-term effects of childhood circumstances on cognitive aging processes. Implications for current literature and directions for future research are discussed.

Pilot Perceptions of Wire Strikes in Agricultural Aviation Operations.

INTRODUCTION: Agricultural aircraft operations are associated with unique challenges. In particular, these include maintaining awareness of obstacles associated with flight at very low altitudes. Wire strikes are a common cause of accidents in these operations.METHODS: Focus groups were completed during the 2022 Ag Aviation Expo hosted by the National Agricultural Aviation Association with pilots who had experienced wire-strike events (N = 22). The researchers coded the transcripts using a human factors framework.RESULTS: Notably, unplanned "trim passes" were a key stage of flight during wire-strike events. Cognitive risk factors that may have affected their performance included situation awareness, decision-making choices, and pressure to perform. Over half of subjects reported being aware of the wire before collision. Possible prevention strategies include not spraying the field due to safety risks, paying better attention to where they were in the field, and avoiding deviation from the planned route.DISCUSSION: Wire-strike events often occur due to momentary lapses in attention, even when the pilot is already aware of the wire. This study shows that targeted approaches to prevent wire strikes in agricultural aviation operations require addressing a number of cognitive risks and human factors, rather than implementing increased preflight surveillance. These results have implications for preventing future wire-strike accidents based directly on pilot perceptions, both within agricultural operations and general aviation more broadly.Baumgartner HM, DiDomenica R, Hu PT, Thomas S. Pilot perceptions of wire strikes in agricultural aviation operations. Aerosp Med Hum Perform. 2024; 95(6):305-312.

#3042 Prevalence and associations of impaired cognitive function for people with chronic kidney disease: baseline findings from the NURTuRE-CKD cohort study

Abstract Background and Aims Chronic kidney disease (CKD) is known to be associated with impaired cognitive function, with lower estimated glomerular filtration rate (eGFR) associated with poorer cognitive performance [1]. Though CKD prevalence increases with age, the association with cognitive disorders is not entirely explained by age distribution. Cognitive impairment in CKD is multifactorial with potential biochemical, cardiovascular, medication and socio-economic mediators. As with other long-term conditions, self-management of kidney disease becomes more difficult in the context of cognitive impairment. The prevalence and associations of cognitive impairment in people referred to secondary care with CKD is not well described. This study therefore aimed to identify the prevalence and associations of impaired cognitive function among a referred population of people with CKD. Method The NURTuRE-CKD cohort recruited 2996 people with an estimated Glomerular Filtration Rate (eGFR) of 15-59 ml/min/1.73 m2 (CKD-EPI equation) or ≥60 ml/min/1.73 m2 with a urine albumin to creatinine ratio (uACR) of more than 30 mg/mmol referred to one of 16 secondary care nephrology clinics. Baseline data were collected between 2017-2019 including sociodemographic, anthropometric, biochemical, and clinical information and included the 6-item cognitive impairment test (6-CIT), a commonly used cognitive screening instrument. Other scores collected included the Hospital Anxiety and Depression score (HADS), EQ-5D-5L as a health-related quality of life (HRQoL) measure and Single Item Literacy Screener (SILS). Prevalence of impaired cognitive function (defined as 6-CIT score of 8 or more out of 28) was calculated and multivariable mixed effects logistic regression models used to identify associations with impaired cognitive function. The multivariable model was adjusted for known factors impacting cognitive impairment and recruitment region as a random effect. Results A total of 2743/2996 (91.6%) participants had complete 6-CIT data. Median age was 66 years and 41% were female. Median eGFR was 34 ml/min/1.73 m2. Prevalence of cognitive impairment was 8.7% (240/2743), rising from 5.3% in those &amp;lt;65 to 10.6% in those ≥65 years. eGFR was not associated with cognitive impairment on univariate analysis. After adjustment, greater likelihood of cognitive impairment was independently associated with older age, Asian and Black ethnicity (compared to white), and limited health literacy. Lower likelihood of cognitive impairment was associated with better HRQoL and higher education attainment (Figs 1 and 2). Conclusion Cognitive impairment was relatively common in this cohort of people with CKD. Similar associations for cognitive impairment with age and education in a CKD population had also been identified in CKD-REIN—a prospective cohort of CKD patients recruited from secondary care in France, though using a different cognitive function measure. Associations of limited health literacy, ethnicity, and HRQoL with cognitive impairment were identified risk factors that could aid clinicians in recognising high risk patients to prompt screening and improve management. Follow-up data will allow longitudinal analyses to explore associations between impaired cognitive function and health-related outcomes, between kidney function and change in cognitive function and risk factors for change in cognitive function, including the role of inflammatory markers. Limitations: this analysis only used baseline data so causality cannot be established, 6-CIT is a screening rather than diagnostic tool for cognitive impairment.

Exploring the differential impacts of social isolation, loneliness, and their combination on the memory of an aging population: A 6-year longitudinal study of the CLSA

Memory plays a crucial role in cognitive health. Social isolation (SI) and loneliness (LON) are recognized risk factors for global cognition, although their combined effects on memory have been understudied in the literature. This study used three waves of data over six years from the Canadian Longitudinal Study on Aging to examine whether SI and LON are individually and jointly associated with memory in community-dwelling middle-aged and older adults (n = 14,208). LON was assessed with the question: "In the last week, how often did you feel lonely?". SI was measured using an index based on marital/cohabiting status, retirement status, social activity participation, and social network contacts. Memory was evaluated with combined z-scores from two administrations of the Rey Auditory Verbal Learning Test (immediate-recall, delayed-recall). We conducted our analyses using all available data across the three timepoints and retained participants with missing covariate data. Linear mixed models were used to regress combined memory scores onto SI and LON, adjusting for sociodemographic, health, functional ability, and lifestyle variables. Experiencing both SI and LON had the greatest inverse effect on memory (least-squares mean: -0.80 [95 % confidence-interval: -1.22, -0.39]), followed by LON alone (-0.73 [-1.13, -0.34]), then SI alone (-0.69 [-1.09, -0.29]), and lastly by being neither lonely nor isolated (-0.65 [-1.05, -0.25]). Sensitivity analyses confirmed this hierarchy of effects. Policies developed to enhance memory in middle-aged and older adults might achieve greater benefits when targeting the alleviation of both SI and LON rather than one or the other individually.

Prevalence of Cognitive Impairment and Risk Factors among Elderly in Rawalpindi, Pakistan: A cross-Sectional study

Objective: The study aimed to find out the prevalence of cognitive impairment and risk factors among elderly. Study Design and setting: Descriptive cross-sectional study was conducted in elderly population of Rawalpindi. Methodology: The study was conducted from October 2020 to February 2021. After getting approval from the ethical committee, data was collected using a semi structured questionnaire. The sample of 446 participants, raised through nonprobability convenient sampling technique. Participants aged above 60 years, both genders were included however individuals who had severe head injury, depression, severe hearing and visual impairment, delirium and not willing to participate were excluded from study. Informed consent was obtained from all participants. Data was analyzed by using SPSS v24. Results: Overall mean age of sample was 69±4.6 years. Overall prevalence of cognitive impairment was 35.4 %. Among them 134 (30%) had mild cognitive impairment and 24 (5.4%) had dementia. The prevalence of cognitive impairment increases with age being higher (64.2%) at 70 years and above than at 60-69 years of age. Females 82 (61%) had high prevalence of MCI than males 52 (39%). Age, gender, hypertension, diabetes, and physical activity were significantly associated with cognitive impairment. Data was analyzed using SPSS version 24. Descriptive statistics were applied. Pearson chi square of independence was used to find the association of various factors. The p value less than 0.05 was considered significant. Conclusion: Cognitive impairment increases with the increasing age and was more prevalent among females. Hypertension, Diabetes, physical activity were modifiable risk factors for cognitive impairment