Domains In Older Adults Research Articles

A - 84 Associations between Social Vulnerability, Adaptive Functioning, and Personal Distress in Non-Demented Older Adults

Abstract Objective Though social vulnerability is associated with cognitive decline in older adults, its correlation with socioemotional and functional changes, both common in neurogenerative diseases, is often overlooked. We sought to elucidate the interplay between these critical domains in older adults with varying degrees of cognitive compromise, including participants who presented with mild cognitive impairment (MCI), subjective cognitive decline (SCD), or were cognitively unimpaired (CU), with implications for enhancing risk detection in vulnerable populations. Method Participants (N = 97; Mage = 74.64 ± 7.42 years; Meducation = 15.76 ± 2.42 years; 74.2% female) were community-dwelling older adults, along with their informants, who underwent comprehensive neuropsychological testing and responded to the Social Vulnerability Scale (SVS15), an informant-reported assessment designed to identify potential victims of exploitation. A Kruskal-Wallis test determined group differences on SVS15 (CU, SCD, MCI). Spearman correlations tested relationships among SVS15 and adaptive functioning (Assessment of Functional Capacity Interview, Financial Capacity Instrument) and personal distress, a measure of the tendency to experience anxiety/distress in response to others’ suffering (Interpersonal Reactivity Index–Personal Distress). Results SVS15 scores significantly differed across diagnostic groups, H(2) = 7.060, p < 0.05, with the MCI group performing significantly worse than the CU group, H(2) = 17.703, p < 0.05. SVS15 was significantly associated with worse functional (r = 0.571, p < 0.001) and financial (r = −0.224, p = 0.027) capacity and heightened personal distress (r = 0.390, p < 0.001). Conclusions Increased social vulnerability is associated with functional impairment and personal distress in older adults with and without cognitive impairment. Older adults with elevated emotional reactivity in distressing situations and lower levels of functional and financial capacity may be more susceptible to exploitation.

Diagnosis and management of frailty

Background: Frailty, a syndrome characterized by reduced physiological reserve and heightened susceptibility to stressors, impairs homeostasis across physical, psychological, and physiological domains in older adults. Approximately 50% of older Korean adults are frail or pre-frail, which highlights the need for targeted interventions in community healthcare and primary care settings.Current Concepts: Various methods, including use of physical and biological markers and health deficit analysis are available for frailty assessment; the Frailty Phenotype and Frailty Index are widely used screening tools. Following advances in technology, electronic health records and big data play a key role in identifying potential biomarkers. Considering the multifaceted nature of frailty, comprehensive geriatric assessments are recommended for holistic evaluation and management, based on a patient’s medical, psychological, and functional capabilities. Effective management can reverse frailty, which emphasizes the importance of early detection and multidisciplinary interventions. International and national guidelines propose a comprehensive approach focusing on modifiable risk factors, physical activity, a balanced diet, chronic disease management, social participation, and regular review of medication regimens. Personalized care plans based on comprehensive assessments are essential to enhance or maintain the residual function of frail older adults to improve their quality of life and reduce the need for long-term care.Discussion and Conclusion: Timely and effective management of potentially reversible frailty highlights the importance of prompt detection and a multidisciplinary approach to care. International and national guidelines recommend a holistic management strategy. Tailored care plans based on comprehensive geriatric assessments are pivotal in improving or maintaining the functional capabilities of frail elderly individuals to enhance their quality of life.

Pain trajectories and their associations with cognition among older adults: a 10-year cohort study from network perspective.

Few studies have examined the associations between pain trajectories and cognitive function in older adults. This study explored the associations between pain trajectories and different cognitive domains in older adults from a network perspective. Data on pain trajectories were derived from the Health and Retirement Study between 2010 and 2020 using latent class growth analyses. Measurements of key cognition domains, including memory, attention, calculation, orientation and language, were included. Linear regression and network analysis were performed to evaluate the associations between different pain trajectories and cognition. A total of 9,551 older adults were included in this study and three trajectories of pain were identified. After controlling for the covariates, persistent severe pain trajectory was associated with poorer overall cognition, memory and calculation ability when compared to mild or non-persistent pain trajectory. In the pain and cognition network model, memory (expected influence (EI) = 0.62), language (EI = 0.58) and calculation (EI = 0.41) were the most central domains. Pain trajectories appeared stable over time among older adults in this study. Severity of persistent pain was an important risk factor for poor cognition, especially in relation to memory and calculation domains. Interventions targeting memory, language and calculation domains might be useful in addressing cognitive decline in older adults with persistent pain.

The relationship between metacognitive processes and cognitive performances in older adults with no significant impairment: a cross-sectional study.

Metacognitive dysfunctions have been implicated in several neuropsychiatric conditions, while cognitive performances have been evaluated by measuring cognitive domains in older adults. This study investigated a relationship between metacognitive processes and cognitive performances in older adults. A sociodemographic form, the Standardised Mini-Mental State Examination (SMMSE) and the Metacognitions Questionnaire-30 (MCQ-30) were applied to participants aged >65 years who had no significant cognitive decline defined as normal or with mild cognitive impairment. 'Negative beliefs about worry' and 'need to control thoughts' domains of MCQ-30 were related to cognitive performance measured with SMMSE. Increased negative beliefs about worry were a predicting factor for total cognitive performance as a means of contributing to cognitive impairment, whereas an increased need to control thoughts was related to having a less likely cognitive impairment. Metacognitive dysfunctional processes, in particular about worry, might contribute to determining more decent outcomes for cognitive conditions in older adults with no significant cognitive dysfunction.

Sad Mood Bridges Depressive Symptoms and Cognitive Performance in Community-Dwelling Older Adults: A Network Approach.

Depression and cognitive impairment are common and often coexist in older adults. The network theory of mental disorders provides a novel approach to understanding the pathways between depressive symptoms and cognitive domains and the potential "bridge" that links and perpetuates both conditions. This study aimed to identify pathways and bridge symptoms between depressive symptoms and cognitive domains in older adults. Data were derived from 2,792 older adults aged 60 years and older with mild and more severe depressive symptoms from the community in Hong Kong. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and cognition using the Montreal Cognitive Assessment 5-minute protocol (MoCA-5min). Summary descriptive statistics were calculated, followed by network estimation using graphical LASSO, community detection, centrality analysis using bridge expected influence (BEI), and network stability analyses to assess the structure of the PHQ-9 and MoCA-5min items network, the pathways, and the bridge symptoms. Participants (mean age = 77.3 years, SD = 8.5) scored 8.2 (SD = 3.4) on PHQ-9 and 20.3 (SD = 5.4) on MoCA-5min. Three independent communities were identified in PHQ-9 and MoCA-5min items, suggesting that depression is not a uniform entity (2 communities) and has differential connections with cognition. The network estimation results suggested that the 2 most prominent connections between depressive symptoms and cognitive domains were: (1) anhedonia with executive functions/language and (2) sad mood with memory. Among all depressive symptoms, sad mood had the highest BEI, bridging depressive symptoms and cognitive domains. Sad mood seems to be the pathway between depression and cognition in this sample of older Chinese. This finding highlights the importance of sad mood as a potential mechanism for the co-occurrence of depression and cognitive impairment, implying that intervention targeting sad mood might have rippling effects on cognitive health.

Distinct functional subnetworks of cognitive domains in older adults with minor cognitive deficits.

Although past research has established a relationship between functional connectivity and cognitive function, less is known about which cognitive domains are associated with which specific functional networks. This study investigated associations between functional connectivity and global cognitive function and performance in the domains of memory, executive function and psychomotor speed in 166 older adults aged 75-91 years (mean = 80.3 ± 3.8) with minor cognitive deficits (Mini-Mental State Examination scores between 21 and 27). Functional connectivity was assessed within 10 standard large-scale resting-state networks and on a finer spatial resolution between 300 nodes in a functional connectivity matrix. No domain-specific associations with mean functional connectivity within large-scale resting-state networks were found. Node-level analysis revealed that associations between functional connectivity and cognitive performance differed across cognitive functions in strength, location and direction. Specific subnetworks of functional connections were found for each cognitive domain in which higher connectivity between some nodes but lower connectivity between other nodes were related to better cognitive performance. Our findings add to a growing body of literature showing differential sensitivity of functional connections to specific cognitive functions and may be a valuable resource for hypothesis generation of future studies aiming to investigate specific cognitive dysfunction with resting-state functional connectivity in people with beginning cognitive deficits.

DUAL SENSORY LOSS AND COGNITIVE TEST PERFORMANCE IN OLDER ADULTS IN INDIA

Abstract Dementia is rising in the global population, especially in low- and middle-income countries like India. Hearing and vision loss are risk factors for cognitive decline/dementia, but studies have primarily been in high income countries. This study aims to investigate the association between dual sensory loss and cognitive function with specific domains among the older Indian population. Data was from the 2017-2019 Wave 1 of the population-based Longitudinal Aging Study in India. The analysis sample consists of 27,975 individuals aged 60 years and older in 35 states and union territories. Dual sensory loss was determined by respondents’ self-reported, perceived difficulty regarding hearing and vision function. Linear regression was used to model associations of dual sensory loss with global cognitive performance, summarized as a z-score, and in the domains of memory, orientation, arithmetic, and executive function, adjusted for demographics and health characteristics. Overall, 5.9% had hearing loss, 24.1% had vision loss, and 3.4% had both. In fully adjusted models, hearing loss only, vision loss only, and dual sensory loss were associated with a change of -0.08 (95%CI: -0.1, -0.04), -0.11 (95%CI: -0.12, -0.09), and -0.22 (95%CI: -0.27, -0.18) standard deviations, respectively. Associations were also observed for all domains. Poor hearing and/or vision loss is associated with lower cognitive performance across various cognitive domains in older adults in India. The association was strongest for those with dual sensory loss. Rehabilitative interventions for hearing and vision may be an additional resource in reducing dementia risk in India.

How to perform a general population‐based recruitment strategy for a multidomain intervention trial for dementia prevention—the CITA GO‐ON trial experience

AbstractBackgroundFINGER trial has demonstrated the potential for dementia prevention by targeting different lifestyle domains in older adults. It highlighted the importance of selecting the correct window of opportunity for preventive actions by including participants at high risk of dementia. This approach is being tested worldwide to support future public health interventions, where the selection of the appropriate target population is crucial. Here we share our approach and results in recruiting older adults with increased dementia risk and cognitive frailty from the general population for the CITA Go‐On trial.MethodCITA GO‐ON is a single‐center randomized controlled trial in which non‐demented‐adults between 60‐80y will be allocated to receive standard care or a risk factor control and lifestyle‐based multidomain intervention. It replicates FINGER trial inclusion criteria, but the recruitment strategy is based on the community level in Gipuzkoa (Spain) instead of a previous health registry. Together with press and social media releases, mailing, and small group talks, the main recruitment strategy has been coordinated with local governments. Interested people fulfill an online form that allows identifying those who meet the pre‐established requirements (CAIDE dementia risk score ≥6) prior to attending an individualized face‐to‐face cognitive screening visit (evaluation of exclusion criteria and brief cognitive testing).ResultBy December 2022, we have reached and informed about the trial more 24000 people including all citizens older than 60 in three small municipalities in collaboration with the local town halls. Of these, 1919 completed the pre‐screening questionnaire using REDCap, 868 were screened and 450 recruited (mean age: 68,57 (6,58), 50,87% female, and mean CAIDE: 7,49 (1,39)). In person calculated (mean (sd): 6,98 (1,70)) and self‐reported (mean (sd): 7,23 (1,77)) CAIDE score is similar (p = 0,062) in our experience. Table 1 resumes age, sex, CAIDE and MMSE of the interested sample. Recruitment period is still opened.ConclusionCITA GO‐ON recruitment is a multi‐disciplinary population oriented efficient strategy to identify adults at high risk of dementia understanding and willing to participate in a multi‐modal intervention prevention trial. It allows to select candidates from the whole population, and not only those linked to specialized health care systems or registries.

TSH levels versus impairment of cognitive and affective domains in older adults: A secondary analysis of MHAS

AbstractBackgroundTSH levels are associated to symptoms such as bradypsychia, bradylalia, hypoprosexia, decreased learning ability, memory impairment and even depressive symptoms, affecting cognitive domains.MethodA secondary analysis of National Study of Health and Aging in Mexico (MHAS) from population interviewed in 2012 with TSH levels (1.948) regarding people with (1287) and without (661) congnitive impairment, in comparison to a follow‐up in 2018 (849 people) based on the same cognitive domains and TSH levels.ResultCognitive impairments were higher in women than men, specially around 60 years. The most affected impairment was no amnesic unidomain. People included have mostly normal thyroid function, but people with worst THS levels, commit more than one cognitive domain.ConclusionTSH levels control reduce the progression of cognitive impairment.

The association of hyperglycemia and kidney dysfunction with cognitive impairment in community‐dwelling older adults in Taiwan

AbstractBackgroundDiabetes was considered one of the risk factors for dementia. However, one‐third of diabetic patients also suffer from kidney disease. It remains unclear the intercorrelation between blood sugar and kidney function that affects the occurrence of mild cognitive impairment for people with normal blood sugar levels. This study aimed to explore the relationship between hyperglycemia and kidney dysfunction (KD) on cognitive impairment in older adults.MethodThis is an eight‐year cohort study (2011‐2019). A total of 509 non‐demented older adults were recruited from the elderly health checkup program at baseline (2011‐2013) with three biannual follow‐ups. Global and domain‐specific (memory, attention, executive function, and language) cognition were assessed by the Taiwanese version of Montreal Cognitive Assessment (MoCA‐T) and a battery of neuropsychological tests, respectively. MCI was defined as a MoCA‐T score of 22 or 23. Hyperglycemia was defined as fasting blood glucose greater than 100 mg/dL. KD was defined as having either glomerular filtration rate < 60 ml/min/1.73 m2 or proteinuria. The generalized linear mixed model was utilized to examine the effects of hyperglycemia and KD on cognitive performance.ResultThe prevalence of MCI was 9.4% at baseline. Hyperglycemia [adjusted odds ratio (aOR) = 1.91] and KD (aOR = 1.98) were significantly associated with the risk of MCI over eight years after adjusting for covariates, respectively. In addition, hyperglycemia and KD were significantly associated with poor performance of logical memory (β:‐0.51 to ‐0.01), executive function (β:‐0.25 to ‐0.003), attention (β:‐0.07 to ‐0.03), and verbal fluency (β:‐0.08 to ‐0.005). Hyperglycemia and KD was associated with an increased risk of MCI participants aged less than 75 years (aOR = 2.19–2.21) and in APOE ε4 non‐carriers (aOR = 2.02–2.15).ConclusionOur finding indicated that poor glycemic control and kidney function were associated with an increased risk of MCI or poor performance of cognitive domains in older adults. Cognitive impairment may be reversible through optimal management of glycemia and kidney disease; interventions (e.g., self‐management education, dietary restriction, and sufficient physical activity, etc.) at the early stage will be helpful to prevent dementia.

Dynamic changes in physical function during intensive chemotherapy affect transplant outcomes in older adults with AML.

Intensive chemotherapy (IC) can affect all geriatric assessment (GA) domains in older adults with acute myeloid leukemia (AML), but data on the effects of these changes on transplant outcomes are lacking. Therefore, we prospectively assessed the prognostic role of GA domains at diagnosis and allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 51 patients with AML aged ≥60 years who achieved complete remission after IC. We performed both baseline and pre-allo-HSCT GA; moreover, physical function, including a short physical performance battery (SPPB), cognitive function, psychological function, nutritional status, and social support were examined. All GA domains showed dynamic changes between the two time points. The directions of change were statistically significant for social support, self-reported physical and psychological functions, and distress, but not for nutritional status, cognitive function, or physical function. Among all GA domains at each time point, only poor physical function and its submaneuvers at diagnosis but not at allo-HSCT were significantly associated with inferior survival. In particular, since the direction of change varied between patients, we found that patients whose physical function improved before allo-HSCT were more likely to survive longer than those with persistently impaired SPPB (55.6% vs. 28.6%, p=0.268). Finally, persistent impairment in SPPB (28.6% vs. 65.9%, p=0.006), tandem stand (0% vs. 63.3%, p=0.012), sit-and-stand (41.2% vs. 70.6%, p=0.009), and gait speed (38.5% vs. 68.4%, p=0.027) further strongly predicted inferior survival. This study showed that IC courses can induce dynamic changes in different directions in the GA domains of each patient and that changes in objectively measured physical function can predict transplant outcomes.

B - 98 Interactive Effects of Sleep Apnea and Depression Symptoms on Cognition in Older Adults.

This study examined interactions between symptoms of sleep apnea and depression in predicting cognition in healthy older adults. From the Memory and Aging Project (Rush Alzheimer's Disease Center, Rush University, 2019), the sample consisted of 3345 community dwelling older adults including 2552 women (76.3%) and 1093 men (23.7%) with an average age of 80years. Measures included the Berlin Questionnaire (for sleep apnea symptoms, Center for Epidemiological Studies Depression Scale, and neuropsychological measures of semantic memory, visuospatial ability, and processing speed. ANOVAs indicated significant main effects of depression on visuospatial ability, processing speed, and semantic memory (p's < 0.001), and no main effect for sleep apnea. However, when sleep apnea was analyzed between those with any depressive symptoms versus those without, significant interactions were found for visuospatial ability, processing speed, and semantic memory (ps < 0.05). Sleep apnea symptoms had a detrimental effect on visuospatial skills (p = 0.027) only when any depression symptom was present. In contrast, sleep apnea symptoms predicted slower processing speed when depressive symptoms were not present (p = 0.001) Similarly, depression symptoms had a greater negative effect on semantic memory for those who reported no sleep apnea symptoms compared to those who did (p = 0.016). There seems to be differential main and interactive effects of sleep apnea symptoms and depression on semantic memory, visuospatial ability, and processing speed. Clinicians may need to consider even mild symptoms of sleep problems and depression if they suspect changes in these cognitive domains in older adults.

A systematic review on the effects of tACS on cognitive function within older adults

AbstractBackgroundNovel interventions that delay the onset or delay the progression of cognitive decline in older adults are extremely important, especially as the proportion of older adults steadily grows. Data on transcranial Alternating Current Stimulation (tACS) suggests it may have the potential for improving cognitive function; however, the direct implication for older adults, including those with cognitive impairment is far less understood. It is imperative to better understand the effects of tACS on cognitive function within older adults, along with treatment parameters if the therapeutic utility of tACS is to be realized.MethodFor this reason, we performed a systematic review of the literature to evaluate the effectiveness of tACS on cognitive functions within older adults. Databases were reviewed up to February 2022, which initially produced 347 unique projects. Thirty‐seven articles passed initial screening eligibility and the full texts were reviewed. Eligibility criteria included single and multiple session frequency‐specific tACS applied with the purpose of modulating cognitive performance in one or multiple cognitive domains in older adults. A total of 14 reports met the eligibility criteria and were included in the review, consisting of 294 older adults receiving tACS.ResultThe systematic review revealed that tACS show improvement in cognitive function for cognitively intact older adults (n = 5), those with mild cognitive impairment (n = 3), multi‐etiological dementia (n = 3), and Parkinson’s (n = 2), whereas 2 Alzheimer’s reports and 1 healthy aging report found no improvements. Gamma (n = 7) and Theta (n = 6) frequencies were largely targeted and showed modulations in memory, executive functioning, working memory, and gross cognitive screening measures.ConclusionDiscussion will focus on the impact of various stimulation parameters and experimental methods since significant heterogeneity in these factors indicates the need for greater standardization. In summary, tACS appears beneficial across the ADRD continuum but the intentional mapping of parameter space and standardized outcomes will be vital for future translational efforts.

Loneliness and Cognitive Function in Older Adults Without Dementia: A Systematic Review and Meta-Analysis.

Loneliness has been highlighted as a risk factor for dementia. However, the nature of the relationship between loneliness and cognitive function prior to onset of dementia is unclear. The aim of this systematic review and meta-analysis was to examine the relationship between loneliness and cognitive function in samples screened for dementia at study commencement. Five electronic databases (PubMed, PsycNET, Web of Science, EBSCOhost, Scopus) were searched from inception to August 31, 2021. A narrative review and random-effects meta-analysis were conducted on studies meeting search criteria. PROSPERO registration number: CRD42020155539. The sixteen studies that met inclusion criteria involved 30,267 individuals, with mean age ranging from 63.0 to 84.9 years. Studies varied in dementia screening criteria, measurement of loneliness and cognitive function, and statistical modeling approach. The narrative review indicated that loneliness was associated with poorer global cognition, episodic memory, working memory, visuospatial function, processing speed, and semantic verbal fluency. Results of the meta-analysis indicated that loneliness was negatively associated with global cognitive function (overall r = -0.08; 95% CI = -0.14, -0.02; n = 6). Due to lack of sufficient data and heterogeneity between studies, we were unable to explore associations with other cognitive domains or longitudinal associations. Loneliness is associated with subtle impairment across multiple cognitive domains in older adults who were screened for dementia. Better characterization of this relationship will provide important information about how loneliness contributes to the clinical and pathological sequalae of AD and be informative for risk reduction and early detection strategies.

Effect of exergames by using Xbox 360 Kinect on cognition of older adults with mild cognitive impairment

Objective: To determine the effects of exergames by using Xbox 360 Kinect on cognition in older adults with mild cognitive impairment (MCI). Methodology: This randomized control trial included 56 MCI older adults who were randomly divided into experimental group (n=28) and control group (n=28), using coin and toss method. The experimental group performed X-box 360 Kinect games while the control group received stretching and strength training exercises of upper and lower extremity. The intervention was of 30 min per day/5 days per week for six weeks. Mini-mental state examination, Montreal Cognitive Assessment, Trail making Test A and B, Verbal fluency (Semantic/ Phenomic) were used as outcome measures at baseline and after six weeks of intervention. Data were analyzed by SPSS 26. Results: Final analysis included 51 subjects, out of which 26 were in experimental group with mean age 62.85±5.56 yrs.,16 (61.5%) males and 10 (38.5%) females. In control, there were 25 subjects with mean age 63.24±5.12 yrs., 15 (60.0%) males and 10 (40.0%) females. Inter-group analysis showed significant improvement in outcomes measures after six weeks of intervention in experimental group (p&lt;0.05). Conclusion: Exergames showed positive effects on cognitive domains in older adults with MCI.

Associations between social network components and cognitive domains in older adults.

Previous research shows that social network components are associated with cognitive function later in life. However, fewer studies consider different cognitive domains or disaggregate the social network by relationship type. Using data from 2,553 participants aged 65 or older in the Health and Retirement Study's Harmonized Cognitive Assessment Protocol, this study examined relationships between social network structure (i.e., size, contact frequency) and quality (i.e., support, strain) and performance in five cognitive domains (i.e., episodic memory, executive function, visuoconstruction, language, and processing speed) 2-4 years later, controlling for sociodemographics and previous global cognition. Separate linear regressions were conducted for each cognitive outcome. When averaged across relationship types, network size was not associated with any domain. Contact frequency was positively associated with all domains except episodic memory. Support and strain were negatively associated with all cognitive domains. When considering individual relationship types, larger friend networks were positively associated with visuoconstruction, and greater contact frequency with friends was positively associated with all cognitive domains. Larger family networks were associated with worse executive function, visuoconstruction, and speed. Strain from friends had a negative relationship with every domain except episodic memory. Support from family was negatively associated with episodic memory, executive function, and language. These associations were equivalent to one to 3.5 years of cognitive aging. These results showed that both social network structure and quality may be consequential for cognitive functioning and that links between social relations and cognition differ across domains and as a function of relationship type. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Effect of Exergame Training on Physical Functioning of Healthy Older Adults: A Meta-Analysis.

Exergames have attracted increasing attention from both the public and researchers. Although previous systematic reviews provided evidence that exergame training is beneficial for improving balance or mobility in older adults, multidimensional physical function measurements, including balance, upper body strength, lower body strength, aerobic endurance, and gait, might help us achieve more robust and reliable results. This meta-analysis aims to quantify the effects of exergame training on overall and specific physical function in healthy older adults. We systematically searched exergame training studies published between January 1985 and June 2021. Forty-eight studies were included in the present meta-analysis, with a total of 1099 participants included in the training group and 1098 participants in the control group. Random-effects meta-analyses found that older adults obtained a small benefit in overall physical function performance (g = 0.43, 95% confidence interval [CI] = 0.33 to 0.53), moderate benefits in balance (g = 0.59, 95% CI = 0.46 to 0.71), upper body strength (g = 0.65, 95% CI = 0.20 to 1.10), lower body strength (g = 0.51, 95% CI = 0.37 to 0.65), and aerobic endurance (g = 0.65, 95% CI = 0.44 to 0.86), a small benefit in gait (g = 0.33, 95% CI = 0.08 to 0.59), and negligible effects on upper body flexibility (g = 0.13, 95% CI = -0.06 to 0.32) and lower body flexibility (g = 0.10, 95% CI = -0.45 to 0.67) from exergame training. The mini-mental state examination score was positively associated with the overall training efficacy (β = 0.08, P = 0.01), while body mass index and the sample size in the training group were negatively associated with the overall training efficacy (β = -0.01, P < 0.01; β = -0.004, P < 0.01). The current meta-analytic findings revealed that exergame training produced general benefits for overall physical function and different effects on specific physical function domains in older adults.

0179 Factor Analysis of Multidimensional Sleep Health Domains in Older Adults with Actigraphy: Results from the Einstein Aging Study

Abstract Introduction The concept of Sleep Health, based on self-reports in the RU-SATED model, has been recently extended using parameters derived from 4 days of actigraphy in a cohort of older adults, yielding a 5-component model. Using a longer actigraphy time series from a separate study, the current factor analysis evaluates and extends a theoretically-driven, multi-dimensional sleep health construct in older adults. Methods Participants (N=291, mean age=77.2 years, 33% males; 47% white, 40% Black, 13% Hispanic/others) enrolled in The Einstein Aging Study were included. A random subsample of 100 participants were used for exploratory factor analysis (EFA); data from the remaining participants (N=191) were used for confirmatory factor analyses (CFA). All 23 objective measures (mean 15.6 valid days +/-SD=1.2) were derived from wrist actigraphy, including 16 from the actigraphy summary statistics, and 7 from extended cosinor models. Fit of CFA models were evaluated by CFI, TLI, RMSEA, SRMR. Results Consistent with prior research, beta was not included in the final factor structure because of its low loading on all six factors. CFA was performed on each factor and model fitting results were satisfactory (CFI &amp;gt; 0.94, TLI &amp;gt;0.92, RMSEA 90% confidence interval ranges from 0 to 0.23, and SRMR &amp;lt;0.05). EFA identified 6 factors, 5 consistent with prior research, and a sixth hypothesized factor (Rhythmicity) not identified previously.REGULARITY (of sleep across days): standard deviations of four sleep measures; midpoint, sleep onset time, night total sleep time (TST), and 24h TST.ALERTNESS/Sleepiness (daytime): amplitude, napping (mins and #/day).TIMING: sleep onset, midpoint, wake-time (of nighttime sleep); up-Mesor, acrophase, down-Mesor.EFFICIENCY: sleep maintenance efficiency, wake after sleep onset.DURATION: night sleep duration, night TST, 24h sleep duration, 24h TST.RHYTHMICITY (pattern across days): mesor, alpha, and minimum. Conclusion These findings extend a multidimensional Sleep Health construct to include a Rhythmicity dimension when informed by extended objective data from older adults. Factors can be considered predictors of health outcomes, and targets for sleep interventions. Support (If Any) P01-AG003949, R01-AG062622, NIA-AG03949

0627 The Effects of Insomnia Therapy on Depression, Anxiety, and Daily Functioning in Individuals with Insomnia and Mild Cognitive Impairment

Abstract Introduction Insomnia is common in older adults with and without mild cognitive impairment (MCI), and is associated with worse neuropsychiatric symptoms (NPS) and impaired daily functioning. Evidence suggests treating insomnia may resolve some of these difficulties in cognitively normal adults. However, little is known about the effects of improving sleep on these domains in older adults with MCI. Methods We examined whether MCI status moderates the improvements of a behavioral intervention for insomnia on NPS and daily functioning. 125 adults (mean age=69.18, 34.4% male) with insomnia (38 with MCI as determined by a Montreal Cognitive Assessment; MoCA score &amp;lt; 26) completed the Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and five domains (activity, vigilance, intimacy, productivity, and social) of the Functional Outcomes of Sleep Questionnaire (FOSQ) before (BL) and after (ETX) completing either the behavioral, cognitive, or combined components of Cognitive Behavioral Therapy for Insomnia (CBT-I). Linear mixed effects models were used to determine the effect of MCI status, time, and an MCI-by-time interaction on NPS and daily functioning while covarying for sex. Results Treatment improved BDI (p&amp;lt;0.001), BAI (p&amp;lt;0.001), ISI (p&amp;lt;0.001), productivity (p&amp;lt;0.008), activity (p&amp;lt;0.001), social functioning (p=0.014), and FOSQ total score (p=0.015) regardless of MCI status at ETX compared to BL. Treatment did not significantly improve vigilance (p=0.154) or intimacy (p=0.439). There was a significant MCI-by-time interaction for the FOSQ social domain (p=0.041) with MCI participants showing greater improvements in social functioning compared to non-MCI participants. There were no other significant MCI-by-time interactions. Conclusion These findings suggest insomnia therapy can similarly improve aspects of sleep-related daily functioning, insomnia severity, and NPS regardless of MCI. However, insomnia therapy may be more beneficial in improving social functioning for individuals with MCI. Support (If Any) NIMHR01MH101468-01; Mental Illness Research, Education, and Clinical Center (MIRECC) at the VAPAHCS

Cross‐sectional associations between cortical thickness and independent gait domains in older adults

Although the prevalence of gait disturbance is increasing with population aging, our understanding of its underlying neural basis is still limited. The precise brain regions linked to specific gait domains have not been well defined. In this study, we aim to investigate the associations of cortical thickness and different gait domains, and to explore whether these associations could be explained by cerebral small vessel disease. A total of 707 community-dwelling participants from the Taizhou Imaging Study (mean age: 60.2 ± 3.0 years, 57.4% female) were involved. All participants underwent brain MRI and gait assessment. We obtained quantitative gait parameters using wearable devices and then summarized them into three independent gait domains through factor analysis. Cortical thickness was analyzed and visualized using FreeSurfer and Surfstat. Three independent domains (pace, rhythm, and variability) were summarized from 12 gait parameters. Among gait domains, poorer pace was associated with the thinner cortical thickness of multiple regions, which included areas related with motor function (e.g., the primary motor cortex, premotor cortex, and supplementary motor area), sensory function (e.g., the postcentral gyrus and paracentral lobule), visuospatial attention (e.g., the lateral occipital cortex and lingual gyrus), and identification and cognition (e.g., the fusiform gyrus and entorhinal cortex). Such a relationship was only slightly attenuated after adjustment for cerebrovascular risk factors and cerebral small vessel disease. No statistically significant association was found between cortical thickness and the rhythm or variability domains. Poorer pace is independently associated with thinner cortical thickness in areas important for motor, sensory, cognitive function, and visuospatial attention. Our study emphasizes the importance of cortical thickness in gait control and adds value in investigating neural mechanisms of gait.