Early Indicator Of Cognitive Decline Research Articles

Retinal OCT biomarkers and their association with cognitive function-clinical and AI approaches.

Retinal optical coherence tomography (OCT) biomarkers have the potential to serve as early, noninvasive, and cost-effective markers for identifying individuals at risk for cognitive impairments and neurodegenerative diseases. They may also aid in monitoring disease progression and evaluating the effectiveness of interventions targeting cognitive decline. The association between retinal OCT biomarkers and cognitive performance has been demonstrated in several studies, and their importance in cognitive assessment is increasingly being recognized. Machine learning (ML) is abranch of artificial intelligence (AI) with an exponential number of applications in the medical field, particularly its deep learning (DL) subset, which is widely used for the analysis of medical images. These techniques efficiently deal with novel biomarkers when their outcome for the applications of interest is unclear, e.g., for diagnosis, prognosis prediction, disease staging, or any other relevance to clinical practice. However, using AI-based tools for medical purposes must be approached with caution, despite the many efforts to address the black-box nature of such approaches, especially due to the general underperformance in datasets other than those used for their development. Retinal OCT biomarkers are promising as potential indicators for decline in cognitive function. The underlying mechanisms are currently being explored to gain deeper insights into this relationship linking retinal health and cognitive function. Insights from neurovascular coupling and retinal microvascular changes play an important role. Further research is needed to establish the validity and utility of retinal OCT biomarkers as early indicators of cognitive decline and neurodegenerative diseases in routine clinical practice. Retinal OCT biomarkers could then provide anew avenue for early detection, monitoring and intervention in cognitive impairment with the potential to improve patient care and outcomes.

Retinal optical coherence tomography biomarkers and their association with cognitive functions : Clinical and artificial intelligence approaches. German version

Retinal optical coherence tomography (OCT) biomarkers have the potential to serve as early, noninvasive, and cost-effective markers for identifying individuals at risk for cognitive impairments and neurodegenerative diseases. They may also aid in monitoring disease progression and evaluating the effectiveness of interventions targeting cognitive decline. The association between retinal OCT biomarkers and cognitive performance has been demonstrated in several studies, and their importance in cognitive assessment is increasingly being recognized. Machine learning (ML) is abranch of artificial intelligence (AI) with an exponential number of applications in the medical field, particularly its deep learning (DL) subset, which is widely used for the analysis of medical images. These techniques efficiently deal with novel biomarkers when their outcome for the applications of interest are unclear, e.g., for the diagnosis, prognosis prediction and disease staging. However, using AI-based tools for medical purposes must be approached with caution, despite the many efforts to address the black-box nature of such approaches, especially due to the general underperformance in datasets other than those used for their development. Retinal OCT biomarkers are promising as potential indicators for decline in cognitive function. The underlying mechanisms are currently being explored to gain deeper insights into this relationship linking retinal health and cognitive function. Insights from neurovascular coupling and retinal microvascular changes play an important role. Further research is needed to establish the validity and utility of retinal OCT biomarkers as early indicators of cognitive decline and neurodegenerative diseases in routine clinical practice. Retinal OCT biomarkers could then provide anew avenue for early detection, monitoring and intervention in cognitive impairment with the potential to improve patient care and outcomes.

Self- and interviewer-reported cognitive problems in relation to cognitive decline and dementia: results from two prospective studies.

Little is known regarding the association of interviewer-reported cognitive problems (ICP) with age-related cognitive decline. We aimed to investigate the independent associations of ICP and the combined associations of ICP andself-reported cognitive problems (SCP) with subsequent cognitive decline and dementia in two prospective cohort studies. We included 10,976 Chinese (age = 57.7 ± 8.7) and 40,499 European (age = 64.6 ± 9.4) adults without dementia from the China Health and Retirement Longitudinal Study (CHARLS) and the Survey of Health, Ageing, and Retirement in Europe (SHARE). Self-rated memory (5-point scale) and interviewer-rated frequencies of asking for clarification (6-point scale) were used to define SCP and ICP (dichotomized). Outcomes included objective cognitive test scores (z-score transformation) and incident dementia. Generalized estimating equation models were performed to evaluate mean differences in objective cognitive decline. Logistic and Cox regression models were used to estimate the relative risk of dementia. Results from two cohorts were pooled using the random-effects models. ICP was associated with faster cognitive decline in CHARLS (βCHARLS = -0.025 [-0.044, -0.006] z-score/year). ICP and SCP were also independently associated with higher risk of dementia in two cohorts (pooled relative risk for SCP = 1.73 [1.30, 2.29]; pooled relative risk for ICP = 1.40 [1.10, 1.79]). In the joint analysis, participants with coexistence of SCP and ICP had the fastest cognitive decline (βCHARLS = -0.051 [-0.080, -0.021]; βSHARE = -0.024 [-0.043, -0.004]; pooled β = -0.035 [-0.061, -0.009] z-score/year) and highest risk of dementia (ORCHARLS = 1.77 [1.42, 2.20]; HRSHARE = 2.94 [2.42, 3.59]; pooled relative risk = 2.29 [1.38, 3.77]). The study suggested that interviewer-reported cognitive problems may be early indicators of cognitive decline and dementia in middle-aged and older adults. Acombination of self- and interviewer-reported cognitive problems showed the strongest associations with cognitive decline and dementia.

DOES HEARING LOSS MODERATE THE RELATIONSHIP BETWEEN COGNITION AND DEPRESSION?

Abstract Hearing loss, depression, and cognitive impairment are common, co-occurring conditions experienced by older adults, but the nature of the relationship among these conditions remains unclear. Both depression and hearing loss have been identified as risk factors for dementia, but for different stages of life (e.g., Singh-Manoux et al., 2017; Livingston et al., 2020). Hearing loss is described as the strongest modifiable risk factor in mid-life, and depression is second only to smoking as the strongest modifiable risk factor in late-life (Livingston et al., 2020). The association between hearing loss and depression is well documented in the literature (e.g., Lawrence et al., 2015). It is possible that hearing loss, as an earlier risk factor, moderates the relationship between depression and cognition. Therefore, as part of an ongoing longitudinal study of early indicators of cognitive decline, we examined the moderating effect of two measures of hearing (pure-tone hearing threshold average, Dichotic Sentence Identification test) on the relationship between depression (Geriatric Depression Scale) and cognition (Montreal Cognitive Assessment, Digit Symbol Substitution test) for a group of 65 older adults (mean age 74). Although none of the hearing or cognitive measures were significant predictors of depression scores on their own, there was a significant negative interaction between the Montreal Cognitive Assessment and pure-tone hearing threshold average, p = 0.048. These results may be interpreted to suggest that individuals with higher (poorer) hearing thresholds show a decrease in depression as their cognitive scores improve, whereas individuals with lower (better) hearing thresholds show the opposite pattern.

IN-VEHICLE SENSORS TO DETECT CHANGES IN DRIVING BEHAVIORS WITH EMERGENCE OF MCI

Abstract Driving is a complex behavior requiring attention, judgment, orientation, memory, processing speed, visual acuity, adequate limb strength, and other functional abilities. It has been suggested that a change in driving behavior may be an early indicator of cognitive decline in the aging brain. The literature suggests that older drivers will drive less and more slowly as their cognitive skills begin to decline. In the “In-Vehicle Sensors to Detect Cognitive Change in Older Drivers” study, sensors are installed in participant vehicles and data is downloaded every three months at which time a carefully curated battery of cognitive tests is also administered. Records of those suggesting mild cognitive impairment (MCI) are reviewed by a Consensus Diagnostic Panel for confirmation. In the first 100 participants who have been followed over a year, nine participants evidenced existing or emerging MCI. Of these, six have experienced a decline in cognition in the last year. A comparison of driving behaviors over the year evidenced the previously reported slower, less frequent driving but also a previously unreported increase in hard braking and hard turns. The uniqueness of our longitudinal study is the continuous tracking of vehicle acceleration patterns over time, revealing significant relationships between g-force acceleration and cognition.

SPATIAL NAVIGATION SKILLS IN MILD COGNITIVE IMPAIRMENT (MCI) – A META-ANALYSIS

Abstract Background Dementia has a tremendous impact on societies and individuals world-wide. One of the earliest symptoms of Alzheimer’s Disease (AD) is spatial disorientation (Coughlan et al. 2018). Spatial orientation problems commonly manifest in Mild Cognitive Impairment (MCI), which represents a state between cognitively healthy aging and dementia. It appears that spatial navigation skills might be an early indicator of cognitive decline due to MCI. Methods The present meta-analysis examines the difference between the performance of cognitively healthy older adults and older adults with MCI on spatial navigation tests. The standardized mean difference (Hedge’s g) is used as the effect size measure. In addition to simple characteristics (year of publication, country of study, age of participants, gender, education), we examined the form of test administration (i.e., real-world, virtual reality), type of measure (time, accuracy) and the additional spatial tasks connected with the main spatial navigation test in moderator analyses. Results Current data consists of 69 effect sizes across 26 studies. These studies represent 1359 participants (682 MCI, 677 healthy older adults). The overall result shows that the navigation skills of healthy cognitively older adults are significantly better (p < 0.05) comparing to people with MCI by the standardized mean difference (SMD) = 0.81. Conclusion Given the large effect size, it is worthwhile to examine potential moderators. It would also be useful to assess the effect size for spatial navigation in people with Alzheimer’s Disease.

Associations between NTproBNP and 10‐year cognitive decline in The Irish Longitudinal Study on Ageing (TILDA)

AbstractBackgroundNT‐proB‐type Natriuretic Peptide (NTproBNP) is a hormone released in response to changes in pressure inside the heart often related to heart failure and other cardiac problems. Early evidence shows significant correlations between brain structure and markers of heart failure including ejection fraction and NTproBNP. We sought to investigate if levels of this biomarker are related to cognitive decline over 10 years in older adults participating in the Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of adults aged 50 years and older residing across Ireland.MethodLevels of NTproBNP were measured in 4,105 participants, mean age 61.5 years and 53.8% women, from blood drawn at baseline (Wave 1: 2009‐2011). Verbal memory (10‐word immediate and delayed recall) and verbal fluency/ executive function (animal naming) were measured every two‐years over a 10‐year follow‐up (Wave 1 – 6) and were used to create a composite score at each wave which served as a measure of global cognitive function. Linear mixed effect models with adjustment for covariates were performed. Model 1 included age, age^2, sex, education; Model 2 included Model 1 + cardiovascular diseases (heart failure, heart attack, stroke, tia, hypertension, diabetes), lifestyle factors (smoking, alcohol, physical activity, waist‐hip ratio) and depression.ResultNTproBNP was significantly and negatively associated with cognitive function at Wave 3 (B = ‐0.13, 95%CI = ‐0.20, ‐0.05), Wave 4 (B = ‐0.24, 95%CI = ‐0.31, ‐0.16), Wave 5 (B = ‐0.25, 95%CI = ‐0.32, ‐0.17) and Wave 6 (B = ‐0.26, 95%CI = ‐0.34, ‐0.17) (p<.001) (Figure 1). After further adjustment, the associations remained significant.ConclusionThese results suggest that NTproBNP may be useful as an early indicator of cognitive decline in older adults for those with and without current cardiovascular diseases.

22 Semantic Processing and its Relation to Brain Pathology in Individuals with Autosomal Dominant Alzheimer's Disease: Preliminary Findings from the Colombia-Boston Biomarker Study

Objective:Semantic processing dysfunction has been shown to be an early indicator of cognitive decline in Alzheimer's disease (AD) and has been linked to early accumulation of AD-pathology. We examined semantic processing and its relation to AD pathology in non-demented individuals from a Colombian kindred with autosomal dominant AD due to the Presenilin1 E280A mutation (PSEN1).Participants and Methods:A total of 13 cognitively unimpaired PSEN1 mutation carriers (mean age: 36.92± 4.94), 7 carriers with mild cognitive impairment (MCI; mean age: 45±2.65), and 17 family non-carriers (mean age: 36±6.38) from the Colombia-Boston (COLBOS) longitudinal biomarker study were included. We used the Bateria IV Woodcock-Munoz verbal analogies and text comprehension subtests to examine semantic processing, the Mini-Mental State Examination (MMSE) to assess global cognition and the CERAD word list delayed recall task to measure verbal memory. Participants also underwent PiB and flortaucipir-PET to measure mean cortical amyloid and regional tau burden (entorhinal cortex and precuneus), respectively. Mann-Whitney U tests and Spearman's Rho correlations compared group differences in semantic processing, and its associations with age and pathological markers. Post-hoc analyses excluded carriers with MCI and controlled for education.Results:Carriers (including cognitively unimpaired and symptomatic individuals) performed significantly worse on the MMSE (carriers: 14.55, non-carriers: 24.24; U=81.00, p=.006), CERAD word list delayed recall (carriers: 13.63, non-carriers: 25.32; U=48.00, p=.001), and text comprehension (carriers: 16.36, non-carriers: 23.81; l/=107.00, p=.042,) than non-carriers, and showed a trend towards worse performance on verbal analogies (carriers: 17.16, non-carriers: 23.68; U=124.50, p=.077). There were no differences in text comprehension or verbal analogies performance between cognitively-unimpaired carriers and non-carriers.Across the whole sample, age was negatively associated with performance on verbal analogies (r=-.341, p=.039), but not text comprehension (r=-.136, p=.428). Among carriers only, better MMSE and CERAD delayed recall performance was associated with higher verbal analogies (r=.561, p=<.001; r=.662, p=<.001, respectively) and text comprehension scores (r=.468, p=.004; r=.480, p=.003, respectively). Greater amyloid burden was associated with worse verbal analogies performance (r=-.432, p=.007) and text comprehension (r=-.430, p=.008). Greater entorhinal cortex (r=-.384, p=.016) and precuneus tau burden (r=-.318, p=.049) was associated with worse performance on verbal analogies, but not text comprehension. These associations did not survive when excluding carriers with MCI or controlling for education.Conclusions:Preliminary results show that non-demented mutation carriers had worse performance in semantic processing than non-carriers and performance was associated with markers of AD pathology. These findings suggest that changes in semantic processing may be early indicators of disease progression in individuals at increased risk for Alzheimer's disease dementia. Future studies with larger samples need to examine the role of education and the longitudinal trajectory of semantic processing dysfunction in AD.

Exploring semantic verbal fluency patterns and their relationship to age and Alzheimer's disease in adults with Down syndrome.

Adults with Down syndrome (DS) are at ultra-high risk of developing Alzheimer's disease (AD), characterized by poor episodic memory and semantic fluency in the preclinical phase in the general population. We explored semantic fluency performance in DS and its relationship to age, AD, and blood biomarkers. A total of 302 adults with DS at baseline and 87 at follow-up from the London Down Syndrome Consortium cohort completed neuropsychological assessments. Blood biomarkers were measured with the single molecule array technique in a subset of 94 participants. Poorer verbal fluency performance was observed as age increases. Number of correct words declined in those with AD compared to those without over 2 years and was negatively correlated with neurofilament light (r=-0.37, P=.001) and glial fibrillary acidic protein (r=-0.31, P=.012). Semantic fluency may be useful as an early indicator of cognitive decline and provide additional information on AD-related change, showing associations with biomarkers in DS.

FACTORS THAT IMPACT SUCCESSFUL AGING AMONG OLDER ADULTS LIVING WITH HIV/AIDS

Abstract The past two decades have brought significant medical advances in antiretroviral therapies (ART) for people living with HIV/AIDS (PLWHA). This has enabled PLWHA to live longer and healthier lives than ever before. In fact, nearly half of all PLWHA in the United States are age 50+ and HIV is treated as a chronic disease, instead of a terminal illness. Despite these advancements older adults living with HIV/AIDS (OALWHA) are still a highly stigmatized population who faces challenges with their health and overall well-being. This symposium will highlight recent research on factors that play a role in successful aging among OALWHA. Our first presentation leverages a quantitative dataset of OALWHA and examines the relationship between childhood sexual abuse and ART adherence, with a particular focus on substance abuse as a potential mediator. Our second presentation features a qualitative study with OALWHA that explores their conceptions of successful aging. Our third presentation includes a sample of medical case managers who serve OALWHA and examines the feasibility of using a cognitive screening tool with this population. Cognitive screening with OALWHA can help provide early indicators of cognitive decline and initiate early intervention. Finally, our fourth presentation includes a sample of older women living with HIV/AIDS and examines their support needs and resources, particularly to help understand their complex caregiving needs. Findings from these four studies advance our understanding of OALWHA and their needs to ensure continued successful aging. This symposium informs further research and direct practice with this population.

Interactive Effects of Agitation and Cognitive Impairment on Odor Identification in Patients With Late-Life Depression

BackgroundLate-life depression (LLD) is a risk factor for cognitive decline in older adults, and odor identification (OI) deficits are an early indicator of cognitive decline with LLD. However, neuropsychiatric symptoms (NPSs) are common in LLD and are associated with OI deficits. In subjects with LLD, when OI deficits forecast cognitive decline, whether and how NPS affects the relationship between OI and cognition still must be further explored.ObjectiveTo comprehensively explore the potential effects of various NPSs on the relationship between OI and cognition in participants with LLD.MethodsThere were 167 patients with LLD and 105 normal elderly (NE) participants. The odor identification test (Sniffin' Sticks), cognitive function assessments (global cognition, memory, executive function, attention, language, visual space), and an NPS assessment (the neuropsychiatric inventory questionnaire) were performed on the subjects. In patients with LLD, the relationship among OI, cognition and NPSs was examined using correlation analysis and moderation analysis.ResultsIn patients with LLD, OI was positively correlated with cognition (global cognition, memory, executive function, attention, language) and negatively associated with NPSs (agitation and aberrant motor behavior). In NE group, OI was correlated with executive function. Moderation analysis showed that there was an interactive effect of agitation and cognitive impairment (language deficit or attention deficit) on OI in patients with LLD.ConclusionThe coexistence of agitation and language or attention deficit was associated with worse OI in subjects with LLD. Agitation should be considered since OI predicts cognitive decline in patients with LLD.

Plasma Total Tau and Neurobehavioral Symptoms of Cognitive Decline in Cognitively Normal Older Adults.

Depression and related neurobehavioral symptoms are common features of Alzheimer’s disease and other dementias. The presence of these potentially modifiable neurobehavioral symptoms in cognitively intact older adults may represent an early indication of pathophysiological processes in the brain. Tau pathology is a key feature of a number of dementias. A number of studies have found an association between tau and neurobehavioral symptoms. The current study investigated the relationship of a blood-based biomarker of tau and symptoms of depression, anxiety, worry, and sleep disturbances in 538 community based, cognitively normal older adults. Logistic regression revealed no significant relationship between plasma total tau and any measures of neurobehavioral symptoms. To assess the impact of level of tau on these relationships, participants were divided into those in the highest quintile of tau and those in the lower four quintiles. Regression analyses showed a significant relationship between level of plasma total tau and measures of depression, apathy, anxiety, worry and sleep. The presence of higher levels of plasma tau and elevated neurobehavioral symptoms may be an early indicator of cognitive decline and prodromal Alzheimer’s disease. Longitudinal research is needed to evaluate the impact of these factors on the development of dementia and may suggest areas for early intervention.

Association between widespread pain and dementia, Alzheimer’s disease and stroke: a cohort study from the Framingham Heart Study

Background and objectiveChronic pain may be an early indicator of cognitive decline, but previous studies have not systematically examined the population-level associations between widespread pain and adverse cognitive outcomes and...

Low or Declining Gait Speed is Associated With Risk of Developing Dementia Over 5 Years Among People Aged 85 Years and Over.

Improving dementia screening procedures beyond simple assessment of current cognitive performance is timely given the ongoing phenomenon of population aging. A slow or declining gait speed (GS) is a potential early indicator of cognitive decline scarcely investigated in very old people. Here, we investigated the 5-year associations of baseline GS, change in GS, and cognitive function with subsequent dementia development in people aged 85 years and older (n = 296) without dementia at baseline. Declining and a slow baseline GS were associated with higher odds of dementia development after adjusting for confounders (e.g.,age, sex, and dependency in activities of daily living) and missing GS values at follow-up. The GS decline was associated with cognitive decline in participants who developed dementia. The results support the potential of GS tests to predict future cognitive decline among community- and nursing home-dwelling very old people.

799 Automated Detection of Slow Wave Coherence in Sleep EEG: A potential neurophysiological correlate of cognitive decline

Abstract Introduction A bidirectional relationship exists between sleep disruption and neuropathology in Alzheimer’s disease (AD). The sleep electroencephalogram (EEG) is a highly stereotyped, direct neurophysiological window into brain function; prior studies have identified abnormalities in EEG slow waves in early AD. EEG coherence across channels during sleep, a normally highly coherent brain state, could be an indicator of network coordination across brain regions. Accordingly, altered slow wave coherence during sleep may be an early indicator of cognitive decline. Methods EEG was collected during an attended overnight polysomnogram (PSG) from a community-based cohort of older subjects (n=44, average age = 71), approximately 25% of whom met criteria for mild cognitive impairment or early AD. Files were exported to EDF and a slow wave peak detector was implemented in MATLAB to count the number of slow wave oscillations, with automated artifact rejection, across 6 EEG leads standard for PSG (C3, C4, F3, F4, O1, and O2). Slow wave coherence was inferred when slow waves occurred in temporal synchrony across channels within 100 ms. Results Subjects with cognitive impairment showed significantly reduced total sleep time and time spent in rapid eye movement (REM) sleep compared to age-matched controls. EEG slow wave coherence was reliably quantified during wake, non-REM stages N1, N2, N3, and REM vigilance states as well as during transition periods between sleep stages. Using this algorithm, specific signatures of slow wave propagation during sleep were identified, including increased variability in slow wave activity and coherence, that appeared more prominent in subjects with impaired cognition. Conclusion EEG slow wave coherence during sleep and wake states can be calculated by applying automated algorithms to PSG data, and may be associated with cognitive impairment. Support (if any) NIH R01 AG059507

Early Indicators of Cognitive Decline in Online Financially Active Older Adults

As access to computers and use of technology becomes more common in older adults, the incidence of online financial fraud increases. Law enforcement officials and fraud experts predict this trend to continue as aging baby boomers increasingly become targets. One reason this population might be at risk for financial fraud is due to subtle, undetected decline in cognitive abilities that have been associated with decline in financial capacity. Many cases of incipient cognitive decline go undetected. Further, those with early cognitive decline often have poor insight to its potential impact on daily functioning. Assessment of Activities of Daily Living Skills (ADLs) is paramount to determine early decline in daily activities. The ORCATECH Life Lab was designed to evaluate subtle neurological and other health changes and their relation to changes in daily functioning. Older adults participating in the Life Lab complete annual ADL and neurocognitive assessments. Additionally, 97 participants completed an online technology questionnaire where 64 participants reported participating in online financial activity. Results revealed that within the online financially active group, some assistance in ADL’s was required. However, inconsistencies in ADL change over time highlight the challenges of screening for early signs of mild cognitive impairment (MCI) in patients that fall between normal cognition and MCI. In-home information technology may help overcome these challenges. Defining subtle changes in ADLs is a crucial step to enable early diagnosis of neurocognitive disorders and assist health care providers in improving disease management and to prevent incidents of financial fraud in this vulnerable population.

Diagnostic accuracy of early cognitive indicators in mild cognitive impairment.

ABSTRACTThe aging of the population leads to an increase in the prevalence of dementia and mild cognitive impairment (MCI). Alzheimer's disease (AD) is the most common cause of dementia. Recent studies highlight the early non-amnestic deficits in AD and MCI. The European Union report shows the importance of thoroughly assessing cognitive aspects that have been poorly evaluated, such as processing speed (PS), which could represent early indicators of cognitive decline.Objective:To analyze the diagnostic accuracy of PS measures in older adults with MCI, AD, and those who are cognitively-healthy.Methods:A cross-sectional study was conducted by performing an extensive neuropsychological assessment in three samples: 26 control participants, 22 individuals with MCI, and 21 individuals with AD. Analysis of variance (ANOVA) was employed to test the relationship between dependent variables and the clinical group. Post hoc tests (Bonferroni test) were used when a significant ANOVA result was found. Finally, the Receiver Operating Characteristic (ROC) curve for PS measures was performed in older adults with MCI and AD compared with cognitively-healthy older adults.Results:The results showed that deficits in PS measures can be early indicators of cognitive decline in cases of MCI, even when executive functions (EFs) and functionality are preserved. Conversely, AD versus MCI presented differences in PS, EFs, and functionality.Conclusions:The ROC analyses showed that PS measures had discriminative capacities to differentiate individuals with MCI, AD, and cognitively-healthy older adults.

A sensor technology to continuously monitor changes in cognition

AbstractBackgroundResearchers are increasingly utilizing real‐time sensors with ultra‐wideband radio frequency identification device (UWB RFID) technology to continuously, automatically and unobtrusively track the behavior and movement of older adults across care settings (Bowen, Kearns, Crenshaw, & Stanhope, 2019; Bowen & Rowe, 2019; Bowen & Rowe, 2016). These systems can be integrated into the health care environment and are ecologically valid measures taken concurrently as adults perform everyday activities of daily living (ADL). The purpose of this study is to examine the use of a UWB RFID system for the early recognition of behaviors associated with cognitive decline among skilled nursing residents (N=23) of two health care facilities.MethodResidents were assessed continuously for an average of 10 months (SD=32.16 weeks). Scoring algorithms from the UWB RFID system utilized 1663 data points developed from x, y coordinates to measure the number and distance (meters) of continuous walking activity in a path. A path is defined as at least 60 seconds of walking and ends with a 30‐second stop. Cognitive function was measured by the Montreal Cognitive Assessment (Nasreddine, et al., 2005) and the Physical and Cognitive Performance Test (Bowen, Rowe, Ersek, Ibrahim, & Shea, 2017).ResultOn average, residents walked 1522.8 meters/week (SD=1572.7) with an average of 23.2 paths/week (SD=25.6). In multilevel models, accounting for ADL ability, an increased average number of paths per week was associated with decreased cognitive functioning (β= ‐0.65; p≤0.01).ConclusionContinuous walking in a path may be an early indicator of cognitive decline. Using an UWB RFID system may aid in the early detection and recognition of cognitive changes in this patient population. Importantly, these changes are also associated with other health events (e.g., falls, delirium, urinary tract infection, hospitalization) that may be ameliorable to intervention.

Western Diet Accelerates the Impairment of Odor-Related Learning and Olfactory Memory in the Mouse.

Olfactory dysfunction could be an early indicator of cognitive decline in type 2 diabetes (T2D). However, whether obesity affects olfaction in people with T2D is unclear. This question needs to be addressed, because most people with T2D are obese. Importantly, whether different contributing factors leading to obesity (e.g., different components of diet or gain in weight) affect specific olfactory functions and underlying mechanisms is unknown. We examined whether two T2D-inducing obesogenic diets, one containing a high proportion of fat (HFD) and one with moderate fat and high sugar (Western diet, WD), affect odor detection/discrimination, odor-related learning, and olfactory memory in the mouse. We also investigated whether the diets impair adult neurogenesis, GABAergic interneurons, and neuroblasts in the olfactory system. Here, we further assessed olfactory cortex volume and cFos expression-based neuronal activity. The WD-fed mice showed declined odor-related learning and olfactory memory already after 3 months of diet intake (p = 0.046), although both diets induced similar hyperglycemia and weight gain compared to those of standard diet-fed mice (p = 0.0001 and p < 0.0001, respectively) at this time point. Eight months of HFD and WD diminished odor detection (p = 0.016 and p = 0.045, respectively), odor-related learning (p = 0.015 and p = 0.049, respectively), and olfactory memory. We observed no changes in the investigated cellular mechanisms. We show that the early deterioration of olfactory parameters related to learning and memory is associated with a high content of sugar in the diet rather than with hyperglycemia or weight gain. This finding could be exploited for understanding, and potentially preventing, cognitive decline/dementia in people with T2D. The mechanisms behind this finding remain to be elucidated.

The Nutrition-Focused Physical Examination: Added Value for Patients and Clinicians

The Nutrition-Focused Physical Examination: Added Value for Patients and Clinicians