Cognitive Status In Older Adults Research Articles

Allostatic load measures in older adults with subjective cognitive decline and mild cognitive impairment: A cross-sectional analysis from the Brazilian Memory and Aging Study

IntroductionAn increasing body of research suggests that stress and allostatic load are related to cognitive dysfunction and neurodegeneration. Objectivesto determine the relationship between allostatic load (AL) and cognitive status in older adults classified with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). MethodologyUsing the Brazilian Memory and Aging Study (BRAMS) database, we analyzed data from 57 older adults with SCD and MCI. Blood neuroendocrine (cortisol, DHEA-s), inflammatory (C-reactive protein, fibrinogen), metabolic (HbA1c, HDL-cholesterol, total cholesterol, creatinine), and cardiovascular (blood pressure, waist/hip ratio) were transformed into an AL index. ResultsDespite a significant difference in the univariate analysis between waist/hip ratio (0.94 in the MCI group vs. 0, 88 in the SCD group, p = 0.03), total cholesterol levels (194 vs. 160, p = 0.02), and AL index (36.9 % in the MCI group vs. 27.2 % in the SCD group, p = 0.04), AL was not associated with SCD or MCI in the multivariate analysis. ConclusionOur data suggest that different profiles of AL in MCI compared to individuals with SCD could be due to cofounding factors. These findings need to be confirmed in longitudinal studies investigating profiles of AL changes at preclinical and prodromal stages of Alzheimer’s disease.

Pressure injury education for older adults and carers living in community settings: A scoping review.

Older adults are at increased risk of pressure injuries (PIs) due to age-related changes. Traditionally, PI knowledge and education have been delivered in hospitals and residential aged care facilities, however, there remains a critical gap in understanding how PI knowledge on prevention and management is shared with older adults and their carers living in the community. We aimed to describe the nature and characteristics of structured and unstructured PI education programs available to community-dwelling older adults and their carers. As coping review was undertaken. We searched five databases: CINAHL, Medline, Scopus, Cochrane Library and ProQuest from 2009 to August 2023. The review was guided by Arksey and O'Malley's six-step framework and adhered to the PRISMA-ScR guidelines. It included primary peer-reviewed papers published in English, which focus on PI education for older adults and/or their carers living in community settings. Data extraction was organised in a table, and findings presented as a narrative summary. One-hundred and thirty-six papers were screened and four included in the review. Results indicate that consideration was placed on literacy levels and cognitive status of older adults and their carers when designing PI education materials. Educational materials such as leaflets/brochures, in-person training sessions or a combination of both were used. However, duration of these interventions varied, lasting for 1-4 weeks while others were completed over 12 months. Some improvements in PI knowledge such as how to treat PI, dietary requirements and importance of mobility were noted. However, information retention and its translation into effective long-term behaviour change remained unclear. In conclusion, adopting a multifaceted educational approach increases the effectiveness of PI knowledge translation. Continuous education, support and reinforcement on PIs over time are necessary when interacting with older adults and caregivers to ensure long-term management and prevention success. Conversations on PIs should start at the primary care levels when older adults and carers are visiting their GP clinics and accessing support services for other healthcare needs. Understanding older adults' and carers' literacy levels, cognitive status and cultural background can assist clinicians in designing and delivering fit-for-purpose PI educational interventions that are accessible, relatable and effective in promoting knowledge transfer and behaviour change. Carers are vital conduits in the care continuum. These factors will lead to a more informed, collaborative and person-centred approaches to PI management and prevention.

Long Objective Sleep Duration is a Marker of Cognitive Impairment in Older Adults: Findings from the Cretan Aging Cohort.

We examined associations between objective sleep duration and cognitive status in older adults initially categorized as cognitively non-impaired (CNI, n = 57) or diagnosed with mild cognitive impairment (MCI, n = 53). On follow-up, 8 years later, all participants underwent neuropsychiatric/neuropsychological evaluation and 7-day 24-h actigraphy. On re-assessment 62.7% of participants were cognitively declined. Patients who developed dementia had significantly longer night total sleep time (TST) than persons with MCI who, in turn, had longer night TST than CNI participants. Objective long sleep duration is a marker of worse cognitive status in elderly with MCI/dementia and this association is very strong in older adults.

A prospective association between social isolation and cognitive performance among older adults in Europe: the role of loneliness and poor oral health

Objectives The relationship between social isolation, loneliness, and tooth loss and cognition in older people is poorly understood. We examine how social isolation and cognitive performance are associated prospectively among older adults, as well as how tooth loss and loneliness are related to this association. Methods Using data from 26,168 participants aged ≥50 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we explored the association between social isolation, loneliness, tooth loss and cognition. We used bootstrapping with resampling strategies for testing a moderated mediating model. Results Higher social isolation was associated with poorer cognitive performance (B = −0.20, 95% CI = −0.03, −0.01; R 2 =0.60), an association mediated by the respondent’s number of missing teeth (B = −0.001, 95% CI = −0.002, −0.001). Higher levels of social isolation were associated with a greater number of missing teeth, and a higher number of missing teeth was linked with poorer cognition. We also found that loneliness moderated the relationship between social isolation and both the number of missing teeth (B = −0.11, p = 0.047) and cognitive performance. Conclusion In later life, social isolation and loneliness are associated with shoddy oral health and poor cognitive status. Clinicians and policymakers should be aware of both the association between social isolation and feelings of loneliness on dentition and oral health and their relationship to the cognitive status of older adults.

SELF-PERCEIVED COGNITIVE CHANGES IN OLDER BLACK ADULTS DURING COVID-19

Abstract The COVID-19 pandemic has had myriad effects on health and well-being. Contracting the COVID-19 virus and concerns of social and physical consequences during pandemic-related restrictions have been proven to negatively impact health. To better understand possible effects of COVID-19 on Black community-dwelling older adults’ perceived cognitive changes, we conducted a pilot study with 48 community-dwelling African Americans with measures obtained over 24 months from 10/2020 to 10/2022. Participants were recruited from the Wayne State University Institute of Gerontology Healthier Black Elders Center, and Michigan Alzheimer’s Disease Research Center, and the general Detroit Area (Mage=73.07, Range=65-87 years). The Cognitive Change Index (CCI) was used as a self-report measure of perceived change over the last five years. The COVID Impact Survey (CIS) was used to assess the burden of COVID-19 on daily living. To evaluate emotional-being, the Perceived Stress Scale (PSS responses referred to the last month) and the Geriatric Depression Scale (GDS, within the last week) were administered. Stepwise regression models showed CIS outcome measures did not predict CCI. GDS outcome measures predicted CCI to some degree (R2adj = .15, p = .008), whereas PSS was the strongest predictor (R2adj = .50, p < .001). Results suggest that for older community-dwelling African Americans, past COVID-19 pandemic experiences did not affect their self-evaluated cognitive changes. Higher levels of self-perceived stress within the last month best predicted their subjective cognitive decline. Future research should involve interventions focused on stress reduction, and clinicians should consider stress level when diagnosing cognitive status in older adults.

Brain Function Entropy Analysis during Dual‐Tasking: Application of Functional Near Infrared Spectroscopy to Screen Alzheimer’s Disease

AbstractBackgroundDespite a high prevalence, over half of patients with dementia never receive an evaluation, indicating a need for a quick and objective routine test for screening cognitive decline in older adults. Due to neural death and disconnections, Alzheimer’s disease (AD) is associated with a low value of nonlinear complexity of brain function, which can be quantified using multiscale entropy analysis.MethodOur proposed solution is an upper extremity function dual‐task screening method, during which, brain function is measured by functional near infrared spectroscopy (fNIRS). The aim of this study was to investigate association between fNIRS entropy during upper‐extremity dual‐tasking and cognitive status in older adults. The sample population for this data includes 40 older adults with ages ranging from 65‐96 years. Participants were categorized into cognitive normal (CN), mild cognitively impaired (MCI), and AD based on MoCA test results. The fNIRS device took measurements over the frontal (right and left) and parietal (right and left) brain regions. Participants were first instructed to rest for three minutes, during which they were asked to relax and not think about any specific topic. Participants were then asked to flex and extend their right arm consistently for three minutes, while counting backwards by intervals of three.ResultWe used multivariable repeated measures analysis using mixed effects modeling to assess the effect of cognitive status on multiscale entropy, with task condition (rest and dual‐task) as within‐subject parameter and sex as covariate. We observed a significant effect of cognitive status on multiscale entropy of left frontal (p = 0.0196) and right frontal brain regions (p = 0.0448), with 0.198, 0.267, and 0.301 entropy values on average across AD, MCI, and CN, respectively. There was also a significant effect of task on multiscale entropy of right frontal (p = 0.0165), left frontal (p = 0.0209) and left parietal regions (p = 0.0011), with 39.79% higher entropy during dual‐task compared to rest trials.ConclusionThe results of this study indicate potential for the use of fNIRS multiscale entropy analysis as a screening tool for cognitive impairment. More research is necessary to better understand other potential confounding factors as well as validate this approach in a larger sample size.

The Effect of Superbrain Yoga Exercises on Cognitive Functions of Older Adults: A Randomized Controlled Clinical Trial

Background: The prevalence of cognitive disorders among older individuals is considered to be one of the most significant and controversial health problems. This study was conducted to determine the effect of Superbrain yoga exercises on older adults’ cognitive status. Methods: This is a randomized controlled clinical trial conducted on 60 older adults who were referred to centers of comprehensive health services in Khaf City in 2020. The participants were selected by random allocation and randomly divided into two groups (30 people equally in both groups). The mini-mental status examination was used to assess cognitive status, which was completed at the beginning and end of the intervention. Subjects, after obtaining a score of 21 to 23 from the above questionnaire, were placed in two intervention and control groups. The intervention group performed superbrain yoga exercises three days a week for one month. Data analysis was done by SPSS software, version 20 software using independent t-test, and Kolmogorov-Smirnov, chi-square, and Mann-Whitney U tests. Results: The mean score of the mini-mental status examination in the intervention group was higher than in the control group before the intervention (P=0.009). A comparison of the score of the mini-mental status examination after the intervention showed that the score of the intervention group was higher than the control group (P<0.001). Also, the comparison of the mean score of the groups after the intervention showed that the scores of the intervention group increased compared to before the intervention (P<0.001). Conclusion: Superbrain yoga exercises have a positive effect on the cognitive status of older adults with mild cognitive impairment; thus, it is recommended to prevent cognitive disorders and improve the cognitive status of these people.

Health‐related lifestyle behaviors predict changes in cognitive status in older adults: A latent transition analysis of data from the Mexican Healthy Aging Study 2012‐2018

AbstractBackgroundHealth behaviors, such as exercise, smoking, and alcohol consumption, are potentially modifiable risk factors for cognitive impairment and dementia. The effect of these behaviors on cognitive function is important to examine in Mexico, which faces a rapidly aging population.MethodData came from the 2012, 2015, and 2018 waves of the Mexican Health and Aging Study. The final sample included 8,112 participants aged 60 and older. We used latent transition analysis (LTA) to identify latent statuses of cognitive functioning using standardized scores for five cognitive tasks (orientation, visual scanning, verbal learning, delayed verbal recall, and verbal fluency). We evaluated associations between baseline lifestyle behaviors and transition probabilities for latent statuses of cognitive functioning across observation waves.ResultWe identified a three‐status model across the three waves with support for measurement and stationary invariance. Latent statuses were characterized by low (24% at baseline), average (55%), and high cognitive abilities (21%). With probabilities of .66, .78, and .90, respectively, individuals’ statuses tended to stay the same between time periods. The probabilities of an individual with these statuses transitioning to death were .15, .07, and .02, respectively. For individuals with a low cognition status, reporting exercising or doing hard physical work three or more times a week on average during the two years preceding baseline was associated with lower odds of transitioning to either death (OR = 0.551, p<.001) or a high cognition status (OR = 0.006, p<.001), in relation to staying in the same status. Similarly, alcohol use for this group was associated with decreased odds of transitioning to either death (OR = 0.74, p = .040) or a high cognition status (OR = 0.005, p<.001). Finally, for individuals with a low cognition status, reporting reading regularly was associated with increased odds of transitioning to average cognition status (OR = 1.44, p<.046), in relation to staying in the same status.ConclusionFindings suggest that individuals tended to stay in the same cognitive status over time and that reading regularly predicted favorable changes in cognition. LTA may be useful for identifying discreet statuses and subsequent transitions in older adults’ cognitive functioning as determined by performance on cognitive tasks.

Minding your steps: a cross-sectional pilot study using foot-worn inertial sensors and dual-task gait analysis to assess the cognitive status of older adults with mobility limitations

BackgroundCognitive impairment is a critical aspect of our aging society. Yet, it receives inadequate intervention due to delayed or missed detection. Dual-task gait analysis is currently considered a solution to improve the early detection of cognitive impairment in clinical settings. Recently, our group proposed a new approach for the gait analysis resorting to inertial sensors placed on the shoes. This pilot study aimed to investigate the potential of this system to capture and differentiate gait performance in the presence of cognitive impairment based on single- and dual-task gait assessments.MethodsWe analyzed demographic and medical data, cognitive tests scores, physical tests scores, and gait metrics acquired from 29 older adults with mobility limitations. Gait metrics were extracted using the newly developed gait analysis approach and recorded in single- and dual-task conditions. Participants were stratified into two groups based on their Montreal Cognitive Assessment (MoCA) global cognitive scores. Statistical analysis was performed to assess differences between groups, discrimination ability, and association of gait metrics with cognitive performance.ResultsThe addition of the cognitive task influenced gait performance of both groups, but the effect was higher in the group with cognitive impairment. Multiple dual-task costs, dual-task variability, and dual-task asymmetry metrics presented significant differences between groups. Also, several of these metrics provided acceptable discrimination ability and had a significant association with MoCA scores. The dual-task effect on gait speed explained the highest percentage of the variance in MoCA scores. None of the single-task gait metrics presented significant differences between groups.ConclusionsOur preliminary results show that the newly developed gait analysis solution based on foot-worn inertial sensors is a pertinent tool to evaluate gait metrics affected by the cognitive status of older adults relying on single- and dual-task gait assessments. Further evaluation with a larger and more diverse group is required to establish system feasibility and reliability in clinical practice.Trial registrationClinicalTrials.gov (identifier: NCT04587895)

Gait speed according to cognitive status in older adults: a cross-sectional study in a resource-limited country

Objective We aimed to investigate the association between gait speed and cognitive status in outpatient older adults from a resource-limited setting in Peru. Methods We performed a cross-sectional study including older adults aged ≥60 years attending a geriatrics outpatient clinic between July 2017 and February 2020. Gait speed was measured over a 10-meters distance without considering the first and last meter traveled. Cognitive status was assessed through the Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE). We used a multivariate binomial logistic regression to conduct both an epidemiological and fully adjusted models. Results We included 519 older adults (mean age: 75 years; IQR = 10), of whom 95 (18.3%) and 151 (31.5%) were cognitively impaired according to the SPMSQ and MMSE, respectively. Gait speed was slower among patients with poorer cognitive status as assessed by both tools (p < 0.001). Malnutrition (PR: 1.74; CI: 1.45–2.08) and functional dependency (PR: 4.35; CI: 2.68–7.08) were associated with a greater prevalence of cognitive impairment according to the SPMSQ, whereas a faster gait speed (PR: 0.27, CI: 0.14–0.52) and longer years of education (PR: 0.83, CI: 0.77–0.88) were associated with a less prevalence. Conclusions Slower gait speed was associated with poorer cognitive status in outpatient older adults. Gait speed may be a complementary tool in the cognitive assessment of older adults from resource-limited settings.

Association between alcoholic (poly)phenol-rich beverage consumption and cognitive status in older adults living in a Mediterranean area

The prevalence of cognitive disorders is growing and evidence suggests the putative role of plant-based foods and beverages containing (poly)phenols. The aim of this study was to explore the association between the consumption of (poly)phenol-rich beverages, including wine and beer, resveratrol intake, and cognitive status in a cohort of older adults. The dietary intakes were assessed using a validated food frequency questionnaire, and cognitive status using the Short Portable Mental Status Questionnaire. Multivariate logistic regression analyses showed that individuals in the second and third tertile of red wine consumption were less likely to have cognitive impairment than those in the first tertile. In contrast, only individuals in the highest tertile of white wine intake were having lower odds of cognitive impairment. No significant results were found for beer intake. Individuals with higher resveratrol intake were less likely to have cognitive impairment. In conclusion, consumption of (poly)phenol-rich beverages may potentially affect cognition among older adults.

Visual and cognitive functioning among older adults with low vision before vision rehabilitation: A pilot study.

The occurrence of age-related vision changes is inevitable. However, some of these changes can become pathological. Research indicates that vision and hearing loss is correlated with age-related cognitive decline, and with a higher risk of developing dementia due to Alzheimer's disease. Low vision rehabilitation could possibly be a protective factor against cognitive decline, as it provides the clients with compensatory strategies to overcome their visual deficits. The aim of this pilot study was to assess correlations between visual and cognitive functions in older adults referred for low vision rehabilitation. We hypothesized that more severe impairment of visual acuity and contrast sensitivity would be correlated with more advanced levels of cognitive impairment. The second objective was to examine which of these correlations would remain significant once established variables that influence cognition are statistically removed (e.g., age, education). Thirty-eight older adults (age range: 66-97 years old) with a visual impairment (acuity <20/70) were recruited before the onset of their low vision rehabilitation. They underwent vision (reading acuity, reading speed, contrast sensitivity), hearing (audiogram, speech-in-noise perception) and cognitive (global cognition, memory, executive functions) testing, and demographic information was obtained. Correlations among global cognition and visual aid use, memory and reading speed, memory and contrast sensitivity, memory, and visual aid use, and between executive functions and contrast sensitivity were significant. Correlations between contrast sensitivity and memory, as well as between global cognition and visual aid use remained significant after controlling for age and education. The present study is relevant to clinicians who are assessing the cognitive status of older adults, such as neuropsychologists, because it highlights the importance of considering low vision when administering neuropsychological tests, especially to persons who have not yet received rehabilitation for their visual impairment.

R1ρ dispersion in white matter correlates with quantitative metrics of cognitive impairment

Much previous neuroimaging research in Alzheimer’s disease has focused on the roles of amyloid and tau proteins, but recent studies have implicated microvascular changes in white matter as early indicators of damage related to later dementia. We used MRI to derive novel, non-invasive measurements of R1ρ dispersion using different locking fields to characterize variations of microvascular structure and integrity in brain tissues. We developed a non-invasive 3D R1ρ dispersion imaging technique using different locking fields at 3T. We acquired MR images and cognitive assessments of participants with mild cognitive impairment (MCI) and compared them to age-matched healthy controls in a cross-sectional study. After providing informed consent, 40 adults aged 62 to 82 years (n = 17 MCI) were included in this study. White matter ΔR1ρ-fraction measured by R1ρ dispersion imaging showed a strong correlation with the cognitive status of older adults (βstd = −0.4, p-value < 0.01) independent of age, in contrast to other conventional MRI markers such as T2, R1ρ, and white matter hyperintense lesion volume (WMHs) measured with T2-FLAIR. The correlation of WMHs with cognitive status was no longer significant after adjusting for age and sex in linear regression analysis, and the size of the regression coefficient was substantially decreased (53% lower). This work establishes a new non-invasive method that potentially characterizes impairment of the microvascular structure of white matter in MCI patients compared to healthy controls. The application of this method in longitudinal studies would improve our fundamental understanding of the pathophysiologic changes that accompany abnormal cognitive decline with aging and help identify potential targets for treatment of Alzheimer's disease.

Preventing and treating delirium in clinical settings for older adults.

Delirium is a serious consequence of many acute or worsening chronic medical conditions, a side effect of medications, and a precipitant of worsening functional and cognitive status in older adults. It is a syndrome characterized by fluctuations in cognition and impaired attention that develops over a short period of time in response to an underlying medical condition, a substance (prescribed, over the counter, or recreational), or substance withdrawal and can be multi-factorial. We present a narrative review of the literature on nonpharmacologic and pharmacologic approaches to prevention and treatment of delirium with a focus on older adults as a vulnerable population. Older adult patients are most at risk due to decreasing physiologic reserves, with delirium rates of up to 80% in critical care settings. Presentation of delirium can be hyperactive, hypoactive, or mixed, making identification and study challenging as patients with hypoactive delirium are less likely to come to attention in an inpatient or long-term care setting. Studies of delirium focus on prevention and treatment with nonpharmacological or medication interventions, with the preponderance of evidence favoring multi-component nonpharmacological approaches to prevention as the most effective. Though use of antipsychotic medication in delirium is common, existing evidence does not support routine use, showing no clear benefit in clinically significant outcome measures and with evidence of harm in some studies. We therefore suggest that antipsychotics be used to treat agitation, psychosis, and distress associated with delirium at the lowest effective doses and shortest possible duration and not be considered a treatment of delirium itself. Future studies may clarify the use of other agents, such as melatonin and melatonin receptor agonists, alpha-2 receptor agonists, and anti-epileptics.

Are the spatiotemporal gait parameters at different walking speeds capable of predicting variations in cognitive status by the mini-mental state examination?

Background Several studies have reported the association between cognition and gait; however, most are limited to investigating gait in just one speed, usually the self-selected one, and commonly, only the general score of cognitive tests is used. Aims Investigate the relationship between the spatiotemporal gait parameters at different speeds (self-selected and fast walking speeds) and cognitive status in older adults. Methods Cross-sectional study. Two hundred and ninety-five older adults (70.9 ± 7.2 years; 82.3% women) were evaluated according to cognitive status (Mini-Mental State Examination, MMSE) and spatiotemporal gait parameters. Results Data analysis indicates that the spatiotemporal gait parameters (stride length, step time, and single support time) were able to predict cognitive status, assessed by the MMSE general score and its subdomain (temporal and spatial orientation) at both walking speeds. Conclusions The spatiotemporal gait parameters were associated with cognitive status, assessed by the MMSE (general score and temporal and spatial orientation), regardless of the walking conditions. The model’s variance was significant and with a large effect size. Stride length and step time were identified as the variables with the best explanatory factors. Therefore, it is concluded that greater cognitive performance is associated with longer stride lengths and faster step times.

Osteoporosis and cognitive impairment in older adults: what is the link?

Osteoporosis and various cognitive disorders occupy a special place among a number of specific pathological conditions associated with age. Epidemiologically these two conditions are closely related thus the presence of cognitive impairment increases the risk of osteoporosis; and, visa versa, dementia, in particular, caused by Alzheimer's disease, and is more often detected among patients with osteoporosis. Osteoporosis in patients with dementia is an extremely serious problem, since the development of osteoporotic fractures is fraught with a sharp deterioration in cognitive status and a significant increase in disability and mortality. The connection between changes in bone mineral density and cognitive status in older adults is not well understood. The review presents data from non-clinical and clinical studies that describe common genetic and metabolic factors underlying the pathogenesis of the pathological conditions under discussion, which should be taken into account when planning future dementia and osteoporosis clinical trials.

Cognitive status is associated with performance of manual wheelchair skills in hospitalized older adults

Purpose To examine the relationship between manual wheelchair skills and cognitive function in hospitalized older adults. Methods The observational study included older adults who used a manual wheelchair following hip/knee surgery. Participants underwent a series of tests to evaluate manual wheelchair skills and cognitive performance. Four items appearing on the Wheelchair Skills Test: brake handling (locking/unlocking), a 10-metre forward roll, a 2-metre backward roll and rotating in place, were used to evaluate manual wheelchair skills. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), the Clock Drawing Test, and the Loewenstein Occupational Therapy Cognitive Assessment. The relationship between wheelchair skills and cognitive scores was assessed by a series of univariate linear regression analyses. Results Fifty older adults, aged 65–85, participated in the study. The MoCA-7 (orientation) explained 19.3% of the variance related to the turn in place wheelchair skill, 18.8% of the variance related to the two-metre backwards roll and 31.9% of the variance related to the 10-metre forward roll. The addition of gender (to the MoCA-7) increased the explained variance related to the 10-metre forward roll and turn in place skills to 38.5% and 28.5%, respectively. As for the brakes handling skill test, gender explained 18.3% of the variance. The addition of the CDT (to gender) increased the explained variance for the brakes handling skill to 31.4%. Conclusions Because cognitive impairments negatively affect the performance of wheelchair skills, rehabilitation therapists may need to adjust wheelchair mobility training methods for cognitively impaired older adults. Implication for rehabilitation Given the prevalence of older adults with cognitive impairments who use manual wheelchairs, it is critical to better understand the relationship between cognition and wheelchair skills. Poor results reported on the cognitive tests, specifically, visual attention and orientation, were found to be associated with poor performance of four manual wheelchair skills. Rehabilitation therapists should consider the cognitive status of older adults when teaching manual wheelchair skills, specifically in new users. Future studies should examine whether a customized preparation program, enhancing visuospatial orientation, can benefit manual wheelchair control in older adults.

Dietary patterns and cognitive function in older New Zealand adults: the REACH study.

The global population is ageing. Evidence show dietary patterns may be associated with cognitive status in older adults. This cross-sectional study investigated associations between dietary patterns and cognitive function in older adults in New Zealand. The REACH study (Researching Eating, Activity, and Cognitive Health) included 371 participants (65-74years, 36% male) living independently in Auckland, New Zealand. Valid and reproducible dietary patterns were derived, using principal component analysis, from dietary data collected by a 109-item validated food frequency questionnaire. Six cognitive domains (global cognition, attention and vigilance, executive function, episodic memory, working memory, and spatial memory) were tested using COMPASS (Computerised Mental Performance Assessment System). Associations between dietary patterns and cognitive scores, adjusted for age, sex, education, physical activity, energy, and Apolipoprotein E-ε4 status were analysed using multiple linear regression analysis. Three dietary patterns explained 18% of dietary intake variation-'Mediterranean style' (comprising: salad vegetables, leafy cruciferous vegetables, other vegetables, avocados and olives, alliums, nuts and seeds, white fish and shellfish, oily fish, and berries); 'Western' (comprising: processed meats, sauces and condiments, cakes, biscuits and puddings, meat pies and chips, and processed fish); and 'Prudent' (comprising: dried legumes, soy-based foods, fresh and frozen legumes, whole grains, and carrots). No associations between any cognitive domain and dietary pattern scores were observed. Global cognitive function was associated with being younger and having a university education. In this cohort of community-dwelling, older adults in New Zealand, current dietary patterns were not associated with cognitive function.

Knowledge About COVID-19 Symptoms, Transmission, and Prevention: The Relationship With Cognitive Status in Older Adults.

Objective: Advanced age poses an increased risk for cognitive impairment, and therefore, poor knowledge regarding the risks associated with COVID-19 may confer vulnerability. We administered a COVID-19 Knowledge Questionnaire to older persons to evaluate the association between knowledge regarding public health recommendations, and cognitive status as measured by the Montreal Cognitive Assessment (MoCA). Method: Ninety-nine participants completed a 22-item questionnaire about COVID-19 symptoms, risks, and protective strategies, and they also completed the MoCA. Associations between knowledge and cognitive status were examined via Spearman correlations. Results: The mean (SD) age of participants was 72.6 (7.6) years, and MoCA scores averaged 23.4 (4.5) points. Higher MoCA total scores were significantly (p < .001) correlated with a greater number of correct questionnaire responses. Higher Orientation and Memory Index scores were moderately associated with an increased number of correct responses (p < .001), with the Executive Index exhibiting a significant albeit weaker association. MoCA Index scores assessing attention, language, and visuospatial functioning were not significantly associated with COVID-19 knowledge. Conclusions: Given the rapid transmission rate of the SARS CoV-2 infections, COVID knowledge lapses will likely have deleterious repercussions. Public health messages should ensure effective acquisition and retention of COVID specific information, especially in cognitively compromised older adults.

Does Cognitive Status Moderate the Relationship between Environmental Factors and Self-Reported Health?

Using data from NHATS Round 9, the present study examines the relationships between environmental factors and self-reported health among older adults with dementia, mild cognitive impairment (MCI), and normal cognition. Based on neighborhood stress process theory, we investigate the following questions: 1) Are there associations between dwelling safety hazards and neighborhood environments and self-reported health? 2) Is cognitive status a moderator between the relationship? 3) How do these associations differ between older adults with varying cognitive status (i.e., dementia, MCI, and normal cognition)? A hierarchical linear regression analyses are conducted. Results indicate that better quality of sidewalk surface and neighborhood social cohesion are associated with better self-reported health, after taking into account sociodemographic, health, and social factors. Interaction terms are then used to examine the moderating effects of cognitive status on the associations; four interactions terms are found to be statistically significant. Lastly, separate linear regression analyses are implemented for the dementia, MCI, and normal cognition groups. Findings show that the predicting power of environmental factors vary by cognitive status of older adults. For individuals with dementia, tripping hazards, cluttered home, and community disconnectedness are associated with poor self-reported health. However, no significant relationship was found for older adults with MCI. For older adults with normal cognition, better quality of sidewalk surface and neighborhood social cohesion predict better self-rated health scores. Findings of this study illuminate the important role of a hazard-free home, community walkability, and socially cohesive neighborhood environments in predicting better health status of older adults.