Development Of Dementia In Patients Research Articles

EEG Frequency Correlates with α2-Receptor Density in Parkinson's Disease.

Increased theta and delta power and decreased alpha and beta power, measured with quantitative electroencephalography (EEG), have been demonstrated to have utility for predicting the development of dementia in patients with Parkinson's disease (PD). Noradrenaline modulates cortical activity and optimizes cognitive processes. We claim that the loss of noradrenaline may explain cognitive impairment and the pathological slowing of EEG waves. Here, we test the relationship between the number of noradrenergic α2 adrenoceptors and changes in the spectral EEG ratio in patients with PD. We included nineteen patients with PD and thirteen healthy control (HC) subjects in the study. We used positron emission tomography (PET) with [11C]yohimbine to quantify α2 adrenoceptor density. We used EEG power in the delta (δ, 1.5-3.9 Hz), theta (θ, 4-7.9 Hz), alpha (α, 8-12.9 Hz) and beta (β, 13-30 Hz) bands in regression analyses to test the relationships between α2 adrenoceptor density and EEG band power. PD patients had higher power in the theta and delta bands compared to the HC volunteers. Patients' theta band power was inversely correlated with α2 adrenoceptor density in the frontal cortex. In the HC subjects, age was correlated with, and occipital background rhythm frequency (BRF) was inversely correlated with, α2 adrenoceptor density in the frontal cortex, while occipital BRF was inversely correlated with α2 adrenoceptor density in the thalamus. The findings support the claim that the loss or dysfunction of noradrenergic neurotransmission may relate to the parallel processes of cognitive decline and EEG slowing.

Impact of prescribed opioid use on development of dementia among patients with chronic non-cancer pain

We aimed to examine the association between opioid use and the development of dementia in patients with chronic non-cancer pain in South Korea. Data were extracted from the National Health Insurance Service database in South Korea. Adult patients diagnosed with musculoskeletal diseases with chronic non-cancer pain between 2010 and 2015 were included in the analysis. Patients who were prescribed opioids regularly and continuously for ≥ 90 days were classified as opioid users. In total, 1,261,682 patients with chronic non-cancer pain were included in the final analysis, of whom 21,800 (1.7%) were opioid users. From January 1, 2016 to December 31, 2020, 35,239 (2.8%) patients with chronic non-cancer pain were newly diagnosed with dementia. In the multivariable model, opioid users showed a 15% higher risk of developing dementia than the control group. Additionally, opioid users showed a 15% and 16% higher risk of developing Alzheimer’s disease and unspecified dementia, respectively, than the control group, but did not show any significant differences for vascular dementia. Among adult patients with chronic non-cancer pain, opioid users were at a higher risk of developing dementia than the control group; the risk was significantly higher for Alzheimer’s disease but not for vascular dementia in this study. Our results suggest that in patients with CNCP, public health strategies should target opioid users for early dementia detection and intervention.

Post-stroke dysphagia and ambient air pollution are associated with dementia.

This cohort study aimed to explore the potential association between ambient air pollution and dementia incidence in adults who have experienced a stroke. Additionally, the study aimed to determine dysphagia as a predictive factor for the subsequent development of dementia in patients with stroke. This retrospective nested case-control study used data from the Kaohsiung Medical University Hospital Database in Taiwan. Data collected include average ambient air pollution concentrations within 3 months and 1 year after the index dysphagia date. The primary outcome includes incident dementia in patients with or without dysphagia. Logistic regression analysis was performed to examine the association between significant air pollution exposure and the risk of dementia while controlling for baseline demographic characteristics (age and sex), and comorbidities. The univariable regression models revealed a higher likelihood of dementia diagnosis in patients with dysphagia (odds ratio = 1.493, 95% confidence interval = 1.000-2.228). The raw odds ratios indicated a potential link between air pollution exposure and elevated dementia risks in the overall study population and patients with stroke without dysphagia, except for O3. Particulate matter (PM)2.5 and nitrogen oxides (NOx) exhibited significant effects on the risk of dementia in the stepwise logistic regression models. The presence of dysphagia following a stroke may pose a risk of developing dementia. Additionally, PM2.5 and NOx exposure appears to elevate the risk of dementia in patients with stroke.

Acute Pancreatitis and the Risk of Dementia in Diabetes: A Nationwide Cohort Study Using Korean Healthcare Claims Database.

Diabetes is a major risk factor for the development of dementia, which has been proven to be associated with systemic inflammation. Acute pancreatitis, also a local and systemic inflammatory disease, is the most common gastrointestinal disease requiring acute hospitalization. The effect of acute pancreatitis on dementia was investigated in type 2 diabetic patients. Data was collected from the Korean National Health Insurance Service. The study sample included type 2 diabetes patients who received general health examination from 2009 to 2012. Cox proportional hazard regression analysis was used to evaluate the association between acute pancreatitis and dementia with adjustment of confounders. Stratified subgroup analysis by age, sex, smoking, alcohol consumption, hypertension, dyslipidemia, and body mass index was conducted. Among the 2,328,671 participants in total, 4,463 patients had a history of acute pancreatitis before the health examination. During a median follow-up of 8.1 (IQR, 6.7-9.0) years, 194,023 participants (8.3%) developed all-cause dementia. Previous history of acute pancreatitis was a significant risk factor for dementia after adjustment of confounding variables (HR 1.39 [95% CI 1.26-1.53]). In the subgroup analysis, patient characteristics such as age under 65 years, male, current smoker, and alcohol consumption were significant risk factors for dementia in patients with a history of acute pancreatitis. The history of acute pancreatitis was associated with the development of dementia in patients with diabetes. Because the risk of dementia increases with alcohol consumption and smoking in diabetic patients with history of acute pancreatitis, abstinence from alcohol and smoking should be recommended.

Acupuncture is associated with reduced dementia risk in patients with insomnia: A propensity-score-matched cohort study of real-world data.

Insomnia is a subjective illness that has been identified as a risk factor for dementia. In this study, we investigated the association of acupuncture treatment for insomnia with the risk of dementia. We collected data from the National Health Insurance Research Database (NHIRD) of Taiwan to analyze the incidence of dementia in patients with insomnia who received acupuncture treatment. This retrospective matched-cohort study included 152,585 patients, selected from the NHIRD, who were newly diagnosed with insomnia between 2000 and 2010. The follow-up period ranged from the index date to the date of dementia diagnosis, date of withdrawal from the insurance program, or December 31, 2013. A 1:1 propensity score method was used to match an equal number of patients (N=18,782) in the acupuncture and non-acupuncture cohorts. We employed Cox proportional hazards models to evaluate the risk of dementia. The cumulative incidence of dementia in both cohorts was estimated using the Kaplan-Meier method, and the difference between them was assessed through a log-rank test. Patients with insomnia who received acupuncture treatment were observed to have a lower risk of dementia (adjusted hazard ratio=0.54, 95% confidence interval=0.50-0.60) than those who did not undergo acupuncture treatment. The cumulative incidence of dementia was significantly lower in the acupuncture cohort than in the non-acupuncture cohort (log-rank test, p<0.001). The results suggest that acupuncture treatment significantly reduced or slowed the development of dementia in patients with insomnia.

Development of dementia in patients who underwent bariatric surgery.

Dementia, including Alzheimer's disease, interfere with daily function and are one of the major causes of disability, institutionalization, and death. Obesity is associated with an increased risk of dementia. However, the effect of significant and sustained weight loss following bariatric surgery on dementia is not known. The purpose of this study was to assess the long-term risk of dementia following bariatric surgery. A surgical cohort was identified from the Utah Bariatric Surgery Registry and was linked to the Utah Population Database that includes electronic medical records, death records, and State Facility data. Adult subjects (≥ 18years old) at time of surgery (1996-2016) were matched with non-surgical subjects. The final sample included 51,078 subjects (1:2 matching); surgery group n = 17,026; non-surgery subjects n = 34,052). Dementia were identified by ICD-9/10 diagnosis codes following surgery year or matched baseline year. Cox proportional hazard model was used to calculate the hazard ratio in the outcome between the groups. Average (SD) age of the subjects was 42 (12) years old at surgery or matched baseline year, 78% were female and mean follow-up time was 10.5years. 1.4% of the surgery group and 0.5% of the control group had an incidence of dementia. Controlling the covariates in the Cox regression, the surgery group had a higher risk for dementia incidence than the matched non-surgery subjects (HR = 1.33, p = 0.02). The study showed an increased hazard for dementia in individuals who underwent bariatric surgery compared to matched non-surgical subjects. Additional long-term data is needed to verify this association.

Predicting cognitive decline in Parkinson’s disease using FDG-PET–based supervised learning

BackgroundCognitive impairment is a common symptom of Parkinson’s disease (PD) that increases in risk and severity as the disease progresses. An accurate prediction of the risk of progression from the mild cognitive impairment (MCI) stage to the dementia (PDD) stage is an unmet clinical need.MethodsWe investigated the use of a supervised learning algorithm called the support vector machine (SVM) to retrospectively stratify patients on the basis of brain fluorodeoxyglucose-PET (FDG-PET) scans. Of 43 patients with PD-MCI according to the baseline scan, 23 progressed to PDD within a 5-year period, whereas 20 maintained stable MCI. The baseline scans were used to train a model, which separated patients identified as PDD converters versus those with stable MCI with 95% sensitivity and 91% specificity.ResultsIn an independent validation data set of 19 patients, the AUC was 0.73, with 67% sensitivity and 80% specificity. The SVM model was topographically characterized by hypometabolism in the temporal and parietal lobes and hypermetabolism in the anterior cingulum and putamen and the insular, mesiotemporal, and postcentral gyri. The performance of the SVM model was further tested on 2 additional data sets, which confirmed that the model was also sensitive to later-stage PDD (17 of 19 patients; 89% sensitivity) and dementia with Lewy bodies (DLB) (16 of 17 patients; 94% sensitivity), but not to normal cognition PD (2 of 17 patients). Finally, anti-PD medication status did not change the SVM classification of the other set of 10 patients with PD who were scanned twice, ON and OFF medication.ConclusionsThese results potentially indicate that the proposed FDG-PET–based SVM classifier has utility for providing an accurate prognosis of dementia development in patients with PD-MCI.

Spatial Navigation and Its Association With Biomarkers and Future Dementia in Memory Clinic Patients Without Dementia.

Impaired spatial navigation is considered an early sign in many neurodegenerative diseases. We aimed to determine whether spatial navigation was associated with future dementia in patients with subjective cognitive decline (SCD) or mild cognitive impairment (MCI) and to explore associations between spatial navigation and biomarkers of Alzheimer disease (AD) and neurodegeneration. This study included memory clinic patients without dementia in the longitudinal BioFINDER cohort. The Floor Maze Test (FMT) was used to assess spatial navigation at baseline. Conversion to dementia was evaluated at 2-year and 4-year follow-ups. At baseline, amyloid-β 42/40 ratio, phosphorylated-tau (P-tau), and neurofilament light (NfL) were analyzed in CSF. Cortical thickness and volume of regions relevant for navigation and white matter lesion volume were quantified from MRI. The predictive role of the FMT for conversion to all-cause dementia was analyzed using logistic regression analyses in 2 models: (1) controlled for age, sex, and education and (2) adding baseline cognitive status and MMSE. Associations between FMT and biomarkers were adjusted for age, sex, and cognitive status (SCD or MCI). One hundred fifty-six patients with SCD and 176 patients with MCI were included. FMT total time was associated with progression to all-cause dementia in model 2 at 2-year (OR 1.10, 95% CI 1.04-1.16) and at 4-year follow-up (OR 1.10, 95% CI 1.04-1.16), i.e., a 10% increase in odds of developing dementia per every 10 seconds increase in FMT. In the adjusted analyses, P-tau and NfL were associated with FMT total time, as well as hippocampal volume, parahippocampal, and inferior parietal cortical thickness. Amyloid-β 42/40 ratio was not associated with FMT total time. Impaired spatial navigation was associated with conversion to dementia within 2 and 4 years and with key CSF and MRI biomarkers for AD and neurodegeneration in patients with SCD and MCI. This supports its use in early cognitive assessments, but the predictive accuracy should be validated in other cohorts. This is a Class I prospective cohort study demonstrating association of baseline markers of spatial recognition with development of dementia in patients with SCD or MCI at baseline.

Acupuncture Treatment is Associated with Reduced Dementia Risk in Patients with Migraine: A Propensity-Score-Matched Cohort Study of Real-World Data.

BackgroundMigraine is a recurrent headache disease that has been identified as a risk factor for subsequent dementia. The present study collected data from Taiwan’s National Health Insurance Research Database (NHIRD) to investigate the incidence of dementia in patients with migraine who did or did not concurrently receive acupuncture treatment.MethodsA 1:1 propensity score method was used to match an equal number of patients (N = 4813) in the acupuncture and nonacupuncture cohorts based on sex, age, migraine diagnosis year, index year, insurance amount, urbanization level, baseline comorbidities, and medication usage. We employed Cox proportional hazards models to evaluate the risk of dementia.ResultsPatients with migraine who received acupuncture treatment were found to have a lower risk of dementia (adjusted hazard ratio [aHR] = 0.51, 95% CI = 0.40–0.65) than those who did not undergo acupuncture treatment. The cumulative incidence of dementia was significantly lower in the acupuncture cohort than in the nonacupuncture cohort (Log rank test, p < 0.001). This propensity score–matched cohort study demonstrated an association between acupuncture treatment and dementia development in patients with migraine in Taiwan.ConclusionThe results suggest that acupuncture treatment significantly reduced the development of dementia in patients with migraine.

Predictors of Parkinson’s disease Dementia in a Sample of Bangladeshi Patients

Background: Parkinson’s disease dementia (PDD) is a common consequence during the course of the disease. It deeply influences patients’ prognosis, quality of life, caregiver burden and economic strain. However, effective treatment for PDD is currently unclear. Clinical and demographic predictors for this comorbidity are not well studied. Objectives: To investigate putative risk factors for the development of dementia in patients with Parkinson’s disease (PD) attending a tertiary care and teaching hospital in Bangladesh. Methods: One hundred thirty-one consecutive PD cases were enrolled in this cross-sectional study; whose disease duration was more than a year. Comparison was done between demented and non-demented PD cases. Structural CNS diseases including secondary parkinsonism were excluded by clinically and MRI of brain for all cases. Dementia was evaluated based by DSM-IV and assessed using mini-mental state examination (MMSE) score and Parkinson’s disease dementia short screen (PDD-SS) score. Severity of disease was evaluated by Hoehn and Yahr stage (H-Y I to V). Depression was assessed using DSM-IV. Data were analysed on a logistic regression model using SPSS v 23. Results: The overall frequency of dementia was 38%. The mean (SD) age of the demented and non-demented PD cases was 73.32(8.86) and 63.98 (6.19) years respectively. On multivariate logistic regression model, age ³70 years [OR=4.25, p=0.031], diabetes [OR=5.37, p=0.019], hypertension [OR=7.63, p=0.011], disease duration ³5 years [OR=10.01, p&lt;0.001], H-Y stage e” 3 [OR= 9.52, p&lt;0.001] and depression [OR=8.79, p&lt;0.001] were significantly associated with PDD. Conclusion: In this study of PD cases, overall risks of dementia were advancing age, diabetes, hypertension, longer disease duration, higher disease stage and presence of depressive illness. Bangladesh Med Res Counc Bull 2021; 47(2): 192-198

Microarray Genotyping Identifies New Loci Associated with Dementia in Parkinson's Disease.

Dementia is one of the most disabling nonmotor symptoms of Parkinson’s disease (PD). However, the risk factors contributing to its development remain unclear. To investigate genetic variants associated with dementia in PD, we performed microarray genotyping based on a customized platform utilizing variants identified in previous genetic studies. Microarray genotyping was performed in 313 PD patients with dementia, 321 PD patients without dementia, and 635 healthy controls. The primary analysis was performed using a multiple logistic regression model adjusted for age and sex. SNCA single nucleotide polymorphism (SNP) rs11931074 was determined to be most significantly associated with PD (odds ratio = 0.66, 95% confidence interval = 0.56–0.78, p = 7.75 × 10−7). In the analysis performed for patients with PD only, MUL1 SNP rs3738128 (odds ratio = 2.52, 95% confidence interval = 1.68–3.79, p = 8.75 × 10−6) was found to be most significantly associated with dementia in PD. SNPs in ZHX2 and ERP29 were also associated with dementia in PD. This microarray genomic study identified new loci of MUL1 associated with dementia in PD, suggesting an essential role of mitochondrial dysfunction in the development of dementia in patients with PD.

Cellular and Molecular Mechanisms of Dementia: Decoding the Causal link of Diabetes Mellitus in Alzheimer's Disease.

Dementia and diabetes are the two major disorders that are linked at both biochemical and molecular levels, which is due to the existing similarities between pancreatic beta-cells and neuronal cells at the transcriptional and translational levels. Both diseases have similar causative genes or factors, and dementia is one of the advanced complications in about 50-52% of patients with Type 2 Diabetes Mellitus (T2DM). Further, patients with T2DM are at a higher risk of neuronal degeneration and Alzheimer's Disease (AD). Dementia, which is most common in AD, is associated with diminished insulin receptors by nearly 80%. The impairment in insulin signaling thus leads to the development of dementia and AD. Biochemical changes in 'tau' protein and amyloid-- beta proteins make them critical players in the formation of plaques in patients with dementia and AD. Here, we decode various cellular and molecular mechanisms associated with the development of dementia in patients with diabetes and AD.

Association Between Inflammatory Bowel Disease and Dementia: A Retrospective Cohort Study.

The critical role of inflammatory processes in the pathogenesis of dementia has recently been established. The aim of this study was to investigate the association between inflammatory bowel disease (IBD) and dementia risk in patients followed in general practices in Germany. This study included patients aged over 60 with an initial diagnosis of IBD (Crohn's Disease (CD), ulcerative colitis (UC)) who were followed in 1,159 German general practices between January 1995 and December 2014. IBD patients were matched to healthy patients using propensity scores based on age, gender, index year, insurance type and comorbidities. Kaplan-Meier curves were used to study the development of dementia in patients with or without IBD within up to 15 years of the index date. Cox proportional hazard regression models were used to estimate the relationship between IBD and dementia. The study included 3,850 patients with and 3,850 patients without IBD and revealed a higher cumulative incidence of dementia in IBD patients than in non-IBD patients after the follow-up period. The cumulative incidence of dementia differed within IBD subtypes; it was significantly higher in UC patients than in CD patients. Cox proportional hazard models showed that IBD is associated with a 1.22-fold increase in the risk (95% CI: 1,07-1,39) of developing dementia. UC patients had a 1.25-fold higher risk of developing dementia (95% CI: 1.07-1.46). CD is not significantly associated with an increased risk of dementia (HR: 1.17, 95% CI: 0.93-1.47). A positive association between IBD and dementia was found in patients followed in general practices in Germany.

Skala CHA2DS2-VASc jako predyktor demencji wśród chorych w podeszłym wieku z migotaniem przedsionków

Introduction. Many studies suggest that atrial fibrillation (AF) is associated with an increased risk of functional decline and may contribute to the development of dementia. It is not known whether the CHA 2 DS 2 -VASc scale allows the development of dementia in patients with AF to be predicted. To assess whether CHA 2 DS 2 -VASc score can be a predictor of dementia evaluated with Mini-Mental State Examination (MMSE) questionnaire in the elderly patients with atrial fibrillation. Material and methods. The study included 157 patients (mean age 73.4) with non-valvular atrial fibrillation and no history of stroke. The presence of dementia was defined as the MMSE score of ≤ 23 points. Results. The univariate analysis revealed that age (b = 0.132, p 2 DS 2 -VASc score were significant determinants of dementia. In multivariate analysis, the CHA 2 DS 2 -VASc score was proved to be an independent determinant of dementia (β = 0.385, p = 0.003). Prevalence of dementia was one and a half times higher in the group of patients with a CHA 2 DS 2 -VASc score > 4 points (odds ratio = 0.47) that in the group of patients with CHA 2 DS 2 -VASc score ≤ 4 points. Conclusion. The CHA 2 DS 2 -VASc score is a useful predictor of dementia in the ageing population with atrial fibrillation without clinical stroke.

Atrial Fibrillation and Dementia.

Atrial fibrillation is associated with multiple adverse comorbidities, including the development of dementia in patients with and without a history of stroke. Mechanistic models have been proposed to explain the association of AF and dementia. Alterations of brain perfusion from embolic events, bleeding, and rhythm-related hypoperfusion underlie many of these models. Multiple mediators such as oxidative injury, inflammatory and autoimmune mechanisms, and genetic predisposition also interplay in the disease association. There are potential therapeutic opportunities to reduce dementia risk, including early and effective use of anticoagulation and strategies to improve brain perfusion through rhythm and rate control approaches. Prospective trials are needed to evaluate these therapeutic opportunities that carefully measure cognitive function and dementia incidence.

ОЦЕНКА КОГНИТИВНОГО СТАТУСА У ПАЦИЕНТОВ С АКИНЕТИКО-РИГИДНОЙ И ДРОЖАТЕЛЬНОЙ ФОРМАМИ БОЛЕЗНИ ПАРКИНСОНА

Objective: To study cognitive changes in patients with akinetic-rigid and tremor-dominant Parkinson’s disease (PD). Methods: From January to May 2019 were examined and responded 32 patients with akinetic-rigid (n=15; 46.9%) and tremor-dominant (n=17; 53.1%) PD. The average age of the patients was 66.5±3.7 years. All patients of PD before and after receiving appropriate therapy were responded using the MMSE (Mini-Mental State Examination) scale to detect the possible cognitive dysfunctions. The study of cognitive functions in patients was conducted before the start of therapy, as well as 3 months after treatment. Results: At the admission, cognitive disorders were more significant in akinetic-rigid PD than in a tremor-dominant PD. After 3 months of appropriate therapy, cognitive dysfunction rates in patients with akinetic-rigid PD improved significantly (p&lt;0.001) in compare to tremor-dominant PD (p&lt;0.05). Conclusions: Using the MMSE scale helps to detect and determine the severity of cognitive changes in a timely manner and the risk of further development of dementia in patients with PD, that allows to start corrective activities in time. Timely detection and appropriate approach to the treatment of the underlying disease and the correction of cognitive impairment significantly improves the quality of life of patients themselves, contributes reducing economic costs. Keywords: Parkinson’s disease, cognitive disorders, akinetic-rigid and tremor-dominant Parkinson’s disease, MMSE scale.

Four-Week, Home-Based, Robot Cognitive Intervention for Patients with Mild Cognitive Impairment: a Pilot Randomized Controlled Trial.

Background and PurposePrevious studies suggest that cognitive intervention can mitigate the development of dementia in patients with mild cognitive impairment (MCI). However, the previous cognitive intervention was mostly provided as a group session, in which MCI patients sometimes had difficulty in regularly attending sessions or were reluctant to participate in group-based classes. Additionally, experienced instructors for traditional cognitive intervention may be unavailable in some chronic-care facilities or community centers. Considering these reasons, we have developed 5 programs for home-based cognitive intervention using a personal robot for MCI patients. In this preliminary study, we aimed to demonstrate the effects of our newly developed home-based cognitive intervention with robots on cognitive function in MCI patients.MethodsWe conducted a single-blind randomized controlled trial enrolling 46 MCI patients. Participants were randomized into 2 groups: the robot cognitive intervention (robot) (n=24) group and without cognitive intervention (control) (n=22) group. The interventions comprised 60-min sessions per day for 4 weeks. The primary outcome was the change in cognitive function measured using the Cambridge Neuropsychological Test Automated Battery.ResultsThere were no significant baseline demographic or clinical differences between the robot and control groups. After the 4-week cognitive intervention, the robot group showed greater improvement in working memory than did the control group.ConclusionsOur home-based cognitive intervention with a personal robot improved the working memory in MCI patients. Further studies with larger samples and longer study periods are required to demonstrate the effects of these programs in other cognitive domains in MCI patients.

Cumulative use of therapeutic bladder anticholinergics and the risk of dementia in patients with lower urinary tract symptoms: a nationwide 12-year cohort study

BackgroundStudies have shown an association between lower urinary tract symptoms (LUTS) and an increased risk of dementia. Whether anticholinergic use contributes to the development of dementia in patients with LUTS remains unknown, especially in Asian populations. This study aims to investigate the association between anticholinergic use and dementia in patients with LUTS.MethodsThis study included patients aged 50 years and over with newly diagnosed LUTS (January 2001 to December 2005), divided into four groups according to their cumulative defined daily doses (cDDDs) of anticholinergics: < 28 cDDDs, 28–84 cDDDs, 85–336 cDDDs, ≥337 cDDDs. Patients were followed up until dementia developed or until the end of 2012.ResultsWe recruited a total of 16,412 patients. The incidence of dementia was 10% in the < 28 cDDD group, 8.9% in the 28–84 cDDD group, 11.5% in the 85–336 cDDD group, and 14.4% in the ≥337 cDDD group (p = .005). In a Cox proportional hazards analysis, the adjusted hazard ratio of dementia was 1.15 (95% CI = 0.97–1.37) in the 85–336 cDDD group, and 1.40 (95% CI = 1.12–1.75) in the ≥337 cDDD group after adjusting for covariates.ConclusionsOur study indicates that higher cumulative anticholinergic exposure is associated with an increase in the risk of incident dementia in patients with LUTS aged 50 years of age and over. Either using one anticholinergic agent or switching anticholinergic agents cumulatively increases this risk. Therapeutic risks and benefits of using anticholinergics in LUTS treatment should be clinically reviewed and weighed.

Polypharmacy Associated with Cognitive Decline in Newly Diagnosed Parkinson’s Disease: A Cross-Sectional Study

Aims: Polypharmacy is well known to affect cognitive function in community-dwelling older adults. However, the effect of polypharmacy on cognitive function in patients with newly diagnosed Parkinson’s disease remains unknown. Here, we evaluated the association between polypharmacy and cognitive function in patients with newly diagnosed Parkinson’s disease. Methods: This cross-sectional study enrolled 131 consecutive hospitalized patients with newly diagnosed Parkinson’s disease. Cognitive function was evaluated with the Mini-Mental State Examination and analyzed between groups of patients with or without polypharmacy. Comparisons were adjusted for confounders by performing inverse probability weighting with propensity scores. Results: After inverse probability weighting, patients in the polypharmacy group had a significantly lower Mini-Mental State Examination score than patients in the nonpolypharmacy group (26.2 vs. 27.7, p = 0.001). Conclusion: Polypharmacy was associated with cognitive decline in patients with newly diagnosed Parkinson’s disease. This finding suggests that medication reduction might serve as a promising intervention to prevent the development of dementia in patients with early Parkinson’s disease. Further prospective studies are needed to determine whether medication reduction improves cognitive function in patients with newly diagnosed Parkinson’s disease.

THE EFFECTS OF HOME-BASED COGNITIVE INTERVENTION WITH ROBOTS ON COGNITIVE PERFORMANCE IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT

Previous studies showed that cognitive intervention helped mitigating the development of dementia in patients with mild cognitive impairment (MCI). However, the cognitive intervention programs of the previous studies were mostly provided as a group-session in a local hospital, which often made patients with MCI having difficulty in regularly attending sessions or reluctant to participate in group-based classes. In addition, traditional cognitive intervention usually needs experienced instructors, but those qualified instructors may be unavailable in some chronic care facilities or community centers. For this reason, we have developed a total of 20 programs for home-based cognitive intervention with robots for the patients with MCI. The purpose of this study was to demonstrate the effects of our newly developed home-based cognitive training with robots on the cognitive performance in patients with MCI. A single-blind randomized controlled trial was conducted in 48 volunteers aged 60 years or older with mild cognitive impairment. Participants were randomized into two groups: 24 with robot intervention, and 24 without cognitive training. The interventions consisted of 60-min-session per day for 4 weeks. The primary outcome was the changes in cognitive function measured by Cambridge Neuropsychological Test Automated Battery. There were no demographic differences between the robot intervention and the control groups. The robot intervention group showed a greater improvement in the attention function than the control group after 4-week training. Our home-based cognitive training with robots helped improve attention in patients with MCI. The further study with larger samples for a longer duration would be warranted to demonstrate the effects of those programs in other cognitive domains in MCI patients.