Early Detection Of Cognitive Impairment Research Articles

Mixed Reality Prototype of Multimodal Screening for Early Detection of Cognitive Impairments in Older Adults: Protocol Development and Usability Study.

BackgroundThe early diagnosis of cognitive impairments is an important step in the adequate management of dementia. The project “Smart Cognition & Behaviour Screening powered by Augmented Reality” (SCOBES-AR) aims to develop a multimodal screening tool (MST) for the early detection of cognitive impairments using augmented and virtual reality. The first project phase selected validated assessments for combination with the MST and tested it in 300 healthy older adults.ObjectiveThis study established a protocol for the implementation and usability of a mixed reality (MR)–enhanced multidisciplinary screening tool for the early detection of cognitive impairments in older adults. The developed MST will be partially enhanced by MR, which is a combination of augmented reality (AR) and virtual reality (VR). This MR-enhanced prototype of the screening tool (MR-MST) will be tested and compared to the previously developed MST. The usability of the prototype will also be examined.MethodsThis single-center observational crossover design study screens 100 healthy participants (aged 60-75 years) for cognitive decline using a specially developed MST (assessment of cognitive functions, olfactory sensitivity, nutritional preferences, gait parameters, reaction times, and activities of daily living) and an MR-enhanced MST in which the assessments of cognitive functions, reaction time, activities of daily living, and gait will be performed using tailor-made software and AR and VR hardware. The results of the MR-enhanced MST will be compared to those without MR. The usability of the developed MR-enhanced MST will be tested on 10 investigators and 10 test participants using observed summative evaluation and the codiscovery method, and on 2 usability experts using the codiscovery and cognitive walkthrough methods.ResultsThis study was funded by the Austrian Research Promotion Agency (grant 866873) and received approval from the ethics committee of the Medical University of Graz. The MR-MST and the experimental protocol for this study were developed. All participants gave written informed consent. As of July 15, 2022, a total of 70 participants have been screened. Data analysis and dissemination are scheduled for completion by September 2023.ConclusionsThe development and testing of the MR-MST is an important step toward the establishment of the best practice procedure for the implementation of AR and VR in the screening of cognitive declines in older adults. It will help improve our knowledge of the usability and applicability of the developed prototype and promote further advancement in AR and VR technologies to be used in therapeutic settings.International Registered Report Identifier (IRRID)DERR1-10.2196/39513

Neurofilaments in heart failure-depicting the brain-heart axis

Abstract Introduction Experimental studies have fueled theoretical concerns about neurocognitive side effects of the angiotensin-receptor-neprilysin-inhibitor (ARNi) sacubitril/valsartan as neprilysin is not only involved in the degradation of vasoactive peptides, but also in the degradation of amyloid-β in the brain. To date, no study could demonstrate cognition- and dementia-related adverse effects following neprilysin-inhibition. Recent advances in blood-based tests made it feasible to precisely measure the concentration of neurofilament light chain in plasma (sNfL).sNfl has been found to be altered in neurodegenerative disease, making it a potential biomarker for screening and early detection of cognitive impairment. This study investigated the association of sNfL levels with the severity of disease and prognosis in heart failure with reduced ejection fraction (HFrEF) and explored the response of sNfL levels to the initiation of ARNi. Methods HFrEF patients were prospectively enrolled and clinically followed-up.sNfL levels were measured by a single-molecule array assay. The association of sNfL with heart failure (HF) severity and outcome was assessed. The discriminatory power of sNFL was assessed using Harrell's C-statistic and was compared to NT-proBNP. In a subset of 47 patients, sNfL levels were determined before the initiation of ARNi (baseline), 3±2 months (short-term) and 12±3 months (long-term) after. Results A total of 177 HFrEF patients were included into the study. Median age was 61 years (IQR: 51–72) and 75% of patients were male. Median sNfL levels were 26.2 pg/ml (IQR: 14.1–43.8).sNfL concentration was significantly associated with HF severity reflected by NT-proBNP (rs=0.361, p<0.001) and NYHA class (p<0.001) (Figure 1A). Thirty-one (17.5%) patients died during a median follow-up time of 2.8 years (IQR: 2.3–3.3). Increased sNfL concentration was indicative for worse overall survival even after adjustment for age, sex, kidney function and NT-proBNP [adj. HR for ln[sNfL]: 1.78 (95% CI: 1.13–2.80, p=0.012] (Figure 1B). In terms of discriminatory accuracy, sNfl was comparable with NT-proBNP (C-index: 0.75 [CI: 0.67–0.83] vs. 0.71 [CI: 0.63–0.80], p=0.299). Regarding the effect of ARNi-therapy no significant change in sNfL was observed at short- and long-term follow-up (26.0 pg/ml [IQR: 15.1–51.4] vs. 31.5 pg/ml [IQR: 15.8–51.3]; vs. 31.3 pg/ml [IQR: 15.5–54.0], p>0.05 for all) (Figure 2). Conclusions This study suggests that sNFL is a high performing marker to predict outcome in HFrEF independent of NT-proBNP. NEP-inhibition by ARNi does not seem to reasonably influence sNfL levels. The nature of sNfL release is uncertain. As sNfL is assumed to be specific for axonal injury, sNfL increase in HFrEF may be driven by hypoperfusion due to fixed peripheral vasoconstriction characteristic for more severe disease states. Whether sNfL levels are able to aid screening and early therapy of neurocognitive decline in HFrEF has to be elucidated in further studies. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Austrian Society of Cardiology - Research Grant

Understanding the Relationship Between Age-Related Hearing Loss and Alzheimer's Disease: A Narrative Review.

Evidence suggests that hearing loss (HL), even at mild levels, increases the long-term risk of cognitive decline and incident dementia. Hearing loss is one of the modifiable risk factors for dementia, with approximately 4 million of the 50 million cases of dementia worldwide possibly attributed to untreated HL. This paper describes four possible mechanisms that have been suggested for the relationship between age-related hearing loss (ARHL) and Alzheimer’s disease (AD), which is the most common form of dementia. The first mechanism suggests mitochondrial dysfunction and altered signal pathways due to aging as a possible link between ARHL and AD. The second mechanism proposes that sensory degradation in hearing impaired people could explain the relationship between ARHL and AD. The occupation of cognitive resource (third) mechanism indicates that the association between ARHL and AD is a result of increased cognitive processing that is required to compensate for the degraded sensory input. The fourth mechanism is an expansion of the third mechanism, i.e., the function and structure interaction involves both cognitive resource occupation (neural activity) and AD pathology as the link between ARHL and AD. Exploring the specific mechanisms that provide the link between ARHL and AD has the potential to lead to innovative ideas for the diagnosis, prevention, and/or treatment of AD. This paper also provides insight into the current evidence for the use of hearing treatments as a possible treatment/prevention for AD, and if auditory assessments could provide an avenue for early detection of cognitive impairment associated with AD.

Cognition is a Critical Vital Sign for Older Adults: The Need for Early Detection of Cognitive Impairment is Now

The number of older adults in America is increasing every year, and in just over one decade, people aged 65 and older will surpass the number of children under age 18 for the first time in history. Along with the aging of America comes increase in the prevalence of cognitive impairment because age is the primary risk factor for neurodegenerative conditions such as Alzheimer disease and related disorders. There is an urgent need to identify cognitive impairment as early as possible so interventions can be deployed to reduce the associated medical, behavioral, and economic burden on patients, families, and society in general. Launching public health campaigns, investing in a workforce that is trained and incentivized to detect and manage cognitive impairment, and leveraging technology to facilitate and improve early detection are a few strategies that may help address this growing healthcare crisis.

Cognitive Screening via Comprehensive Geriatric Assessment of Older Patients for the Risk Factors of Hospital Revisit/Readmission after Emergency Department Visit at 3-Month Follow-Up

Introduction: Cognitive impairment (COIM) is a major challenge for healthcare systems and is associated with an increased risk of adverse outcomes in older people visiting emergency departments (EDs). Owing to global aging, both cognitive screening and comprehensive geriatric assessment (CGA) application in ED settings are developing areas of geriatric emergency medicine. Meanwhile, the association between clinical outcomes of COIM; cognitive impairment, no dementia (CIND); and dementia in the ED could be better investigated. Our study aims to identify individuals with COIM from older patients in the ED via CGA and to describe the association of CIND and dementia with prognosis in ED visits. Methods: A prospective cross-sectional study was conducted in the ED of the Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from August 2018 to November 2020. Patients aged ≥75 years with and without COIM were compared using data obtained from the CGAs conducted by trained nurses. Results: A total of 823 older patients were enrolled in the study and underwent CGA. Of these, 463 (56.3%) were diagnosed with COIM, of which 292 (35.5%) were diagnosed with dementia; and 171 (20.8%), CIND. Between the no-COIM and COIM groups, the COIM group had a higher rate of hospital admission (p = 0.002) and mortality at 3 months (p < 0.05). Among the no-COIM, CIND, and dementia groups, ED disposition (p = 0.001) and the rate of revisit/readmission (p < 0.05) showed significant differences. In particular, the dementia group had a significantly higher rate of revisit/readmission as compared to the CIND group among the three groups. Discussion/Conclusion: Older patients with COIM had a higher rate of hospital admission and mortality at the 3-month follow-up than older patients without COIM. Among the no-COIM, CIND, and dementia groups, patients with dementia had significantly increased risks of hospital admission and revisit/readmission. The early detection of COIM, and even dementia, could help ED physicians formulate strategies with geriatric specialists to improve mortality outcomes and revisit/readmission.

Clinical utility of the Saint Louis University Mental Status Examination (SLUMS) in a mixed neurological sample: Proposed revised cutoff scores for normal cognition, mild cognitive impairment, and dementia

Early detection of cognitive impairment is of paramount importance in clinical settings, with several brief screening tools having been developed for that purpose. The present study sought to evaluate the clinical utility of the Saint Louis University Mental Status examination (SLUMS) at identifying examinees with normal cognition, mild cognitive impairment, or dementia syndrome using the criterion of a comprehensive neuropsychological assessment. Two hundred sixty-three examinees (M age = 67.84 ± 12.72; 59.3% female; 81.4% white) were referred for comprehensive neuropsychological evaluation at a private, Mid-Atlantic medical center. Using original cutoff scores, the SLUMS correctly classified just over half (55.1%) of examinees. Classification statistics suggested modified cutoff scores for mild cognitive impairment (≤24) and dementia (≤17) with strong discriminability between cognitive status groups (AUCs ranged from .834 to .986). These proposed revised cutoff scores improved overall concordance between SLUMS and diagnostic conclusions from comprehensive clinical neuropsychological testing, correctly classifying nearly two-thirds of examinees (65.4%). The SLUMS and its revised cutoff scores appear to have clinical utility for cognitive screening in primary care and neurological settings to inform treatment plans and appropriate referrals for comprehensive neuropsychological assessment.

The relevance of screening for cognitive and psychoemotional disorders in patients with metabolic syndrome and insulin resistance: A review

Studying the issues of pathogenetic interaction in the development and progression of cognitive, psycho-emotional and vascular-metabolic disorders is the most relevant area of modern clinical research. Over the past decade, there has been a surge of interest in the scientific literature and a detailed discussion of current trends in the prevalence of diseases and conditions associated with insulin resistance and metabolic syndrome, with a particularly strong focus on the global problems of obesity and type 2 diabetes mellitus (DM). The models proposed by experts for the interaction of neurohumoral, metabolic, social and psychoemotional factors are important in understanding the processes leading to an increase in the prevalence of these conditions associated with insulin resistance throughout the world. The mechanisms of reciprocal development of such common psycho-emotional disorders as anxiety and depression in obese patients are evaluated from the standpoint of their socio-psychological relationship, as well as key triggers for the development of eating disorders. Thus, modern clinicians are gradually immersed in the need to understand the intricacies of the processes of formation of psycho-emotional disorders and master the optimal screening skills for their detection in patients with obesity and DM. The issues of studying the formation of neuronal damage in patients with insulin resistance and DM are also a priority for modern diabetologists. Possible options for the development of cerebrovascular complications, including cognitive impairment in patients with DM, described in the literature, require additional attention. A number of diagnostic tests for early detection of cognitive impairments include screening scales: MMSE (Mini-Mental State Examination), Montreal Cognitive Assessment Scale (MoCA) and Mini-Cog-test. Thus, cognitive and psychoemotional disorders, along with the developing vascular and metabolic complications of diabetes and obesity, are gradually becoming a new therapeutic target for improving the condition and prognosis of patients.

893-P: Incremental Health Care Utilizations and Medical Expenditures Associated with Cognitive Impairment among Older Adults with Diabetes

Cognitive impairment (CI) poses a large economic burden on the US health care system, but little is known about how CI impacts health care (HC) utilization and medical expenditures among people with diabetes. Using data from the 2016-20Medical Expenditure Panel Survey, we quantified the incremental HC utilization and medical expenditures associated with CI among adults aged ≥ 60 years with diabetes. Diabetes status was based on self-report. Participants who reported having difficulty concentrating, remembering, or making decisions were defined as having CI. We used negative binomial regressions to model the number of ambulatory visits, prescriptions, and home health care days; logistic regressions to model the probabilities of ER visits and hospital admissions; and gamma regressions to model medical expenditures in total and by category. All models were adjusted for age, sex, race and ethnicity, income, education, and comorbidities. We included 6,714 adults ≥ 60 years with diabetes, of which 1,025 (15.27%) had CI. CI was associated with additional ambulatory visits (+4.7 [95% CI, 3.5-5.8]) , drug prescriptions (+10.6 [8.1-13.1]) , and home health care days (+32.6 [19.2-52.2]) ; and higher odds of ER visits (Odds Ratio (OR) : 1.55 [95% CI, 1.27-1.89]) and hospital admissions (OR: 1.27 [1.02-1.58]) . CI was also associated with additional expenditures for outpatient care (+$12[$731-$1720], or 28% higher than those without CI [17%-40%]) , prescription drugs (+$17[$1103-$2372], or 31% higher [20%-43%]) , and home health care (+$25[$445-$7060], or 197% higher [35%-555%]) . Overall, those with CI spent $70[$5168-$8835], or 42% [31%-53%] more than those without CI. All p &amp;lt; 0.05. CI is associated with higher HC utilization and medical expenditures among older adults with diabetes. Early detection of CI and additional assistance to those with CI may lower CI-related HC utilization and expenditure in this population. Disclosure D.Guan: None. P.Zhang: None. S.Tang: None. J.D.Brown: None. R.R.Fang: None. J.Guo: None. Y.Zhang: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.

Automated Analysis of Drawing Process to Estimate Global Cognition in Older Adults: Preliminary International Validation on the US and Japan Data Sets.

BackgroundWith the aging of populations worldwide, early detection of cognitive impairments has become a research and clinical priority, particularly to enable preventive intervention for dementia. Automated analysis of the drawing process has been studied as a promising means for lightweight, self-administered cognitive assessment. However, this approach has not been sufficiently tested for its applicability across populations.ObjectiveThe aim of this study was to evaluate the applicability of automated analysis of the drawing process for estimating global cognition in community-dwelling older adults across populations in different nations.MethodsWe collected drawing data with a digital tablet, along with Montreal Cognitive Assessment (MoCA) scores for assessment of global cognition, from 92 community-dwelling older adults in the United States and Japan. We automatically extracted 6 drawing features that characterize the drawing process in terms of the drawing speed, pauses between drawings, pen pressure, and pen inclinations. We then investigated the association between the drawing features and MoCA scores through correlation and machine learning–based regression analyses.ResultsWe found that, with low MoCA scores, there tended to be higher variability in the drawing speed, a higher pause:drawing duration ratio, and lower variability in the pen’s horizontal inclination in both the US and Japan data sets. A machine learning model that used drawing features to estimate MoCA scores demonstrated its capability to generalize from the US dataset to the Japan dataset (R2=0.35; permutation test, P<.001).ConclusionsThis study presents initial empirical evidence of the capability of automated analysis of the drawing process as an estimator of global cognition that is applicable across populations. Our results suggest that such automated analysis may enable the development of a practical tool for international use in self-administered, automated cognitive assessment.

A Computerized Cognitive Test Battery for Detection of Dementia and Mild Cognitive Impairment: Instrument Validation Study.

BackgroundEarly detection of dementia is critical for intervention and care planning but remains difficult. Computerized cognitive testing provides an accessible and promising solution to address these current challenges.ObjectiveThe aim of this study was to evaluate a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment.MethodsA total of 99 participants diagnosed with dementia, mild cognitive impairment (MCI), or normal cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group.ResultsBrainCheck battery performance showed significant differences between the NC, MCI, and dementia groups, achieving 88% or higher sensitivity and specificity (ie, true positive and true negative rates) for separating dementia from NC, and 77% or higher sensitivity and specificity in separating the MCI group from the NC and dementia groups. Three-group classification found true positive rates of 80% or higher for the NC and dementia groups and true positive rates of 64% or higher for the MCI group.ConclusionsBrainCheck was able to distinguish between diagnoses of dementia, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment.

Cognitive screening in HTLV-1-infected people using a self-perceived memory score and auditory P300.

The HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most common neurological manifestation associated with human T-cell lymphotropic virus type-1 (HTLV-1) infection. Although cognitive impairment has been highlighted in the spectrum of HTLV-1 neurological manifestations, it may go unnoticed in those who do not spontaneously report it. We aimed at evaluating the applicability of a self-perceived memory score (SMS) and the cognitive event-related potential (P300) for early detection of cognitive impairment in HTLV-1-infected people. The SMS was measured by a 0-10 point numeric scale combined with a sad-happy face rating scale. The higher the number, the better was the SMS. The P300 was obtained through an oddball paradigm with a mental counting task. The participants were 15 (21.4%) individuals with HAM/TSP, 20 (28.6%) HTLV-1 asymptomatic carriers, and 35 (50%) seronegative controls. We found that SMS (p < 0.001) and P300 latency (p < 0.001) got progressively worse from the seronegative controls to the asymptomatic carriers and then to the HAM/TSP. The results that indicated cognitive impairment were SMS < 7.2 points and P300 latency > 369.0ms. The HAM/TSP group showed the highest prevalence of altered P300 (80%) and SMS (87%). Interestingly, the asymptomatic group also presented significantly higher prevalence of altered SMS (60%) and P300 (35%) when compared to controls (< 10%). The frequency of cognitive impairment was 16 times higher in the HTLV-1 asymptomatic group and 69 times higher in the HAM/TSP group when compared to controls. The use of SMS in the medical consultation was a useful and easy-to-apply method to screen HTLV-1-infected subjects for everyday memory complaints.

Early prediction of cognitive impairments using physiological signal for enhanced socioeconomic status

Cognitive impairments like memory disorder and depressive disorders lead to fatal consequences if proper attention is not given to such health hazards. Their impact is extended to the socioeconomic status of the developed and low or middle-income countries in terms of loss of talented and skilled population. Additionally, financial burden is borne by the countries in terms of additional health budget allotment. This paper presents a novel strategy for early detection of cognitive deficiency to eliminate the economic repercussions caused by memory disorder and depressive disorders. In this work, Electroencephalogram (EEG) and a word learning neuropsychological test, i.e. California Verbal Learning Task (CVLT), are conjunctively used for memory assessment. The features of EEG and scores of CVLT are modeled by applying different machine learning techniques, namely K-Nearest Neighbor (KNN), Gaussian Naive Bayes (GNB), Decision Tree (DT), Random Forest (RF), and Support Vector Machine (SVM). Comparatively, experimental results have better classification accuracy than the existing schemes that considered EEG for estimating cognitive heuristics. More specifically, SVM attains the highest accuracy score of 81.56% among all machine learning algorithms, which can assist in the early detection of cognitive impairments. The proposed strategy can be helpful in clinical diagnosis of psychological health and improving quality of life as a whole.

Perspective of caregivers towards early signs of memory decline in their elderly relatives among the Saudi population

Objectives: World aging poses a big challenge with the rise of people with cognitive impairment. We aim in this study to understand the perspective of the caregivers towards the early signs of memory decline and cognitive impairment in their elderly relatives; we also aim to understand the impact of culture on their perspective. Methods: This is a cross-sectional, descriptive study with a quantitative approach. It was approved by the Institutional Review Board prior to data collection, using a survey containing 41 items of collected data from 101 caregivers. We obtained signed written informed consent from each subject. Results: A sample of 101 participants enrolled in this study, of whom about 60.4% (n=61) were males and 39.6% (n=40) were females. The mean age of the elderly relatives of the caregivers was (73.5±10.0) years and mean years of education was (6.5±7.5) years. Significant differences between males and females were found in terms of driving and using public transportation as this might alert the caregiver about early signs of memory decline (2=6.785, p=0.009). Conclusion: Some cultural perspective could be identified that could help earlier detection of cognitive impairment in elderly people who rely largely on their caregivers. Caregivers are the first people to encounter the early changes in the behavior of the demented elderly; understanding their perspective can help providing more efficient health care. Key words: dementia, caregivers, perspective, memory decline, culture

A highly feasible, reliable, and fully remote protocol for mobile app-based cognitive assessment in cognitively healthy older adults.

IntroductionThe early detection of cognitive impairment is one of the most important challenges in Alzheimer's disease (AD) research. The use of brief, short‐term repeated test sessions via mobile app has demonstrated similar or better reliability and validity compared to standard in‐clinic assessments in adult samples. The present study examined adherence, acceptability, and reliability for a remote, app‐based cognitive screening protocol in healthy older adults.MethodsCognitively unimpaired older adults (N = 52, ages 60–80) completed three brief cognitive testing sessions per day within morning, afternoon, and evening time windows, for 8 consecutive days using a mobile app‐based cognitive testing platform. Cognitive tasks assessed visual working memory, processing speed, and episodic memory.ResultsParticipants completed an average of 93% (M = 22.3 sessions, standard deviation = 10.2) of the 24 assigned sessions within 8 to 9 days. Average daily adherence ranged from 95% of sessions completed on day 2 to 88% of sessions completed on day 8. There was a statistically significant effect of session time on adherence between the morning and afternoon sessions only F (1, 51) = 9.15, P = .004, η p 2 = 0.152, with fewer afternoon sessions completed on average. The within‐person reliabilities of average scores, aggregated across all 24 sessions, were exceptionally high, ranging from 0.89 to 0.97. Performance on the episodic memory task was positively and significantly associated with total score and word list recall score on the Telephone Interview for Cognitive Status. In an exit survey, 65% of participants reported that they “definitely” would complete the sessions again.DiscussionThese findings suggests that remote, mobile app–based cognitive testing in short bursts is both highly feasible and reliable in a motivated sample of cognitively normal older adults. Limitations include the limited diversity and generalizability of the sample; this was a largely White, highly educated, and motivated sample self‐selected for AD research.

Patient, Family Caregiver, and Provider Perceptions on Self-Assessment Screening for Cognitive Impairment in Primary Care: Findings From a Qualitative Study.

The purpose of this study was to evaluate patient, family, and provider perspectives on routine cognitive screening of older adults in primary care using a novel self-assessment tool for detection of early cognitive impairment (CI). We conducted four virtual focus groups with patients aged 65 and older with no CI (n = 18) and family caregivers of patients with CI (n = 5) and interviews with primary care providers (n = 11). Patient and family caregiver participants felt that early detection of CI was important in primary care and may facilitate planning for the future including finances, living arrangements, and advance care planning. Providers reported that they do not use a standardized tool to routinely screen patients for CI yet endorsed the use of a self-assessment CI screening tool. These results suggest that routine screening of older adults using a brief, self-assessment screening tool for CI in primary care may be acceptable to patients, family caregivers, and providers. The findings from this study will inform the development of a brief self-assessment CI screening tool for use in primary care.

Cognitive Evoked Potentials in Anaemic Women: A Cross-sectional Study

Introduction: Iron Deficiency Anaemia (IDA) is a globally prevalent nutritional disorder and an important risk factor for the development of Mild Cognitive Impairment (MCI). A manifestation of IDA is altered electrogenesis in the central nervous system. As women of reproductive age are more susceptible to this form of anaemia it is important to assess their cognitive function. Auditory cognitive evoked potentials/P300 are sensitive in detecting MCI which is indicated by prolonged latency and reduced amplitude. Aim: To investigate the effect of IDA on cognitive function using cognitive evoked potentials/P300 in neurologically intact women. Materials and Methods: A cross-sectional study was conducted at the Central Neuro Physiology lab, Acharya Vinobha Bhave Rural hospital (AVBRH) attached to Jawaharlal Nehru Medical College (JNMC), Wardha, Maharashtra, India, from January 2018 to February 2022. A total of 260 women were recruited for the study. Based on their blood haemoglobin and serum ferritin levels, 130 women were grouped as anaemic and 130 as non anaemic. The P300 was used as an objective tool to assess cognitive function. Haematological parameters like blood haemoglobin and serum ferritin levels were compared (‘t’ test) and correlated (Spearman correlation) with the latency and amplitude of the P300 wave in the two groups. Results: The mean age (years) and Body Mass Index (BMI) (kg/m2 ) of anaemic women were 23.88±3.67 and 20.98±1.45, respectively; and that of non anaemic women were 24.09±3.41, and 21.25±1.27 (p&gt;0.05) respectively. The blood haemoglobin (mg/dL) and serum ferritin (ng/mL) were significantly (p&lt;0.001) lower in anaemic group (10.37±0.95, 8.55±3.78) compared to non anaemic group (13.02±0.70, 27.61±10.52). The latency of P300 wave (ms) was significantly prolonged (p&lt;0.001) in anaemic women (317.75±7.34) in comparison to non anaemic women (311.71±9.02), while the P300 amplitude did not differ between the two groups (p&gt;0.05). A highly significant low negative correlation of P300 latency with haemoglobin (r= -0.48, p&lt;0.001) and highly significant moderate negative correlation with serum ferritin (r= -0.55, p&lt;0.001) was observed. And a negligible positive correlation of P300 amplitude with haemoglobin (r= 0.26, p&lt;0.05) and serum ferritin (r=0.24, p&lt;0.05) was observed. Conclusion: Cognitive evoked potential is an objective method that aids in the early detection of cognitive impairment. Evaluating the cognitive function in anaemic women and ensuring adequate iron treatment can prevent MCI from progressing to severe forms like dementia and other neuropsychological disorders.

Detecting Cognitive Impairment Status Using Keystroke Patterns and Physical Activity Data among the Older Adults: A Machine Learning Approach.

Cognitive impairment has a significantly negative impact on global healthcare and the community. Holding a person's cognition and mental retention among older adults is improbable with aging. Early detection of cognitive impairment will decline the most significant impact of extended disease to permanent mental damage. This paper aims to develop a machine learning model to detect and differentiate cognitive impairment categories like severe, moderate, mild, and normal by analyzing neurophysical and physical data. Keystroke and smartwatch have been used to extract individuals' neurophysical and physical data, respectively. An advanced ensemble learning algorithm named Gradient Boosting Machine (GBM) is proposed to classify the cognitive severity level (absence, mild, moderate, and severe) based on the Standardised Mini-Mental State Examination (SMMSE) questionnaire scores. The statistical method “Pearson's correlation” and the wrapper feature selection technique have been used to analyze and select the best features. Then, we have conducted our proposed algorithm GBM on those features. And the result has shown an accuracy of more than 94%. This paper has added a new dimension to the state-of-the-art to predict cognitive impairment by implementing neurophysical data and physical data together.

The Modified Mini Mental State (3MS) Test - Development of an Online Training Program

Within healthcare settings, screening of cognitive abilities in older adults is routinely conducted for the detection, early intervention, and management of cognitive impairments. The Modified Mini Mental State (3MS) test takes approximately 10 minutes to administer and has a score range of 0 - 100. It can provide an estimated MMSE score, and has been used in multiple countries since 1987 with approximately 1,900 publications. The United States has many diverse populations with different languages and cultural backgrounds. How to appropriately translate and adapt the original 3MS test in English for each minority group in order to better serve them is an important issue. Cross-cultural assessment involves much more than accurate translation of test items across languages. One needs to know not only the oral and written languages involved, but also the life experiences and circumstances of the target populations. This presentation first covers some general considerations in test translation and adaptation, including attention to cultural, ecological, and language specifics. We shall then present Chinese, Korean, and Hindi 3MS record forms to illustrate the reasons and ways for modification of some of the test items. To accommodate different writing systems, for example, 3MS test versions with an alphabet are different from ones with logographic character representations. Modifications of the 3MS items include those on temporal orientation, spatial orientation, naming, and repetition. In summary, cultural, ecological, and linguistic differences must be taken into account for cognitive screening in order to enhance cross-population comparability and be more inclusive for aging ethnic minorities.

Emerging Biotechnology Markers of Cognitive Impairment

The early detection of cognitive impairment is among the National Institute on Aging’s (NIA) current research priorities. Sensor-based technologies have exploded in recent years allowing remote, continuous measurement of older adults’ free-living activity. This highly granular data has stimulated exciting new research exploring how change in health can be detected remotely using novel “biotechnology” markers. Yet, this area of research is in its infancy as it relates to predicting cognitive function. This symposium will provide an overview of the sensor-cognition research landscape and will feature 5 new studies exploring the relationship between biotechnology markers and cognitive function, each with unique sensors, cognitive measures and samples. The first three presentations will report associations between accelerometry-based activity measures (chest or wrist devices) and cognitive function (assessed by diagnosis, a neurocognitive assessment, or microstructural changes on DTI) in the Baltimore Longitudinal Study on Aging, a large, NIA-funded epidemiologic dataset. The fourth presentation will report the significance of free-living hip accelerometry activity measures beyond clinically-available information in a random forest prediction model of 1-year change in Montreal Cognitive Assessment scores among urban, predominantly African-American older adults without moderate-severe dementia residing in the community. The final presentation will report associations between room-to-room transitions as detected by in-home, infrared motion sensors and mild cognitive impairment using data from a community-dwelling sample of older adults residing alone. This symposium will provide a substantial expansion of current knowledge in this research space and will be relevant to clinicians or researchers with an interest in sensor technology or dementia.

Investigation of Possible Correlation Between Retinal Neurovascular Biomarkers and Early Cognitive Impairment in Patients With Chronic Kidney Disease.

PurposeTo investigate the association between retinal neurovascular biomarkers and early cognitive impairment among patients with chronic kidney disease (CKD).MethodsPatients with CKD stage ≥3 were evaluated using the standardized Mini-Mental State Examination (MMSE). Patients were classified as having a low (<24), middle (24 to 27), and high (>27) MMSE level. Retinal nerve fiber layer thickness, ganglion cell complex (GCC) thickness, GCC global loss volume, and GCC focal loss volume were measured using optical coherence tomography (OCT). Superficial vascular plexus vessel density, deep vascular plexus vessel density (DVP-VD), and size of the foveal avascular zone were obtained by OCT angiography.ResultsThe study enrolled 177 patients with a mean ± SD age of 64.7 ± 6.6 years. The mean ± SD MMSE score was 27.25 ± 2.30. Thirteen, 65, and 99 patients were classified as having a low, middle, and high MMSE level, respectively. The patients with a high MMSE level were younger, had more years of education, had less severe CKD, and had higher DVP-VD than patients with a low MMSE level. The multivariable regression revealed that age (coefficient, 0.294; 95% confidence interval [CI], 0.195–0.393; P = 0.041), years of education (coefficient, 0.294; 95% CI, 0.195–0.393; P < 0.001), estimated glomerular filtration rate (coefficient, 0.019; 95% CI, 0.004–0.035; P = 0.016), and DVP-VD (coefficient, 0.109; 95% CI, 0.007–0.212; P = 0.037) were independent factors associated with MMSE score.ConclusionsRetinal DVP-VD was associated with early cognitive impairment among patients with CKD.Translational RelevanceDVP-VD measured by OCT angiography may facilitate early detection of cognitive impairment.