Global Cognitive Assessment Research Articles

Normative study of SATURN: a digital, self-administered, open-source cognitive assessment tool for Italians aged 50-80.

This study aimed to establish normative data for the Self-Administered Tasks Uncovering Risk of Neurodegeneration (SATURN), a brief computer-based test for global cognitive assessment through accuracy and response times on tasks related to memory, attention, temporal orientation, visuo-constructional abilities, math (calculation), executive functions, and reading speed. A sample of 323 Italian individuals with Montreal Cognitive Assessment (MoCA) equivalent score ≥1 (180 females; average age: 61.33 years; average education: 11.32 years), stratified by age, education, and sex, completed SATURN using PsychoPy, and a paper-and-pencil protocol consisting of Mini-Mental State Examination (MMSE) and MoCA. Data analyses included: (i) correlations between the total accuracy scores of SATURN and those of MMSE and MoCA; (ii) multiple regressions to determine the impact of sex, age, and education, along with the computation of adjusted scores; (iii) the calculation of inner and outer tolerance limits, equivalent scores, and the development of correction grids. The mean total time on tasks was 6.72 ± 3.24 min. Age and education significantly influence the SATURN total accuracy, while sex influences the total time on tasks. Specific sociodemographic characteristics influence subdomain accuracies and times on task differently. For the adjusted SATURN total score, the outer limit corresponds to 16.56 out of 29.00 (cut-off), while the inner limit is 18.57. SATURN significantly correlates with MMSE and MoCA. In conclusion, SATURN is the first open-source digital tool for initial cognitive assessment in Italy, showing potential for self-administration in primary care, and remote administration. Future studies need to assess its sensitivity and specificity in detecting pathological cognitive decline.

Comparable cognitive impairment was detected in MACS and CS and alleviated after remission of hypercortisolism in MACS.

Few studies have directly compared the cognitive characteristics of patients with mild autonomous cortisol secretion (MACS) and Cushing's syndrome (CS). The effect of surgical or conservative treatment on cognitive function in patients with MACS is still unclear. To compare the differences in cognitive function between patients with MACS and CS and evaluate the effect of surgery or conservative treatment on cognitive function. We prospectively recruited 59 patients with nonfunctional adrenal adenoma (NFA), 36 patients with MACS, and 20 patients with adrenal CS who completed the global cognition and cognitive subdomains assessments. Seventeen MACS patients were re-evaluated for cognitive function after a 12-month follow-up period; of these, eleven underwent laparoscopic adrenalectomy and six received conservative treatment. Patients with MACS and CS performed worse in the global cognition and multiple cognitive domains than those with NFA (all P<0.05). No statistical difference was found in cognitive functions between patients with MACS and CS. Logistic regression analysis showed that patients with MACS (odds ratio [OR]=3.738, 95% confidence intervals [CI]: 1.329-10.515, P=0.012) and CS (OR=6.026, 95% CI: 1.411-25.730, P=0.015) were associated with an increased risk of immediate memory impairment. Visuospatial/constructional, immediate and delayed memory scores of MACS patients were significantly improved at 12 months compared with pre-operation in the surgical treatment group (all P<0.05), whereas there was no improvement in the conservative treatment group. Patients with MACS have comparable cognitive impairment as patients with CS. Cognitive function was partially improved in patients with MACS after adrenalectomy. The current data support the inclusion of cognitive function assessment in the clinical management of patients with MACS.

Cohort profile: the Taiwan Initiative for Geriatric Epidemiological Research - a prospective cohort study on cognition.

The Taiwan Initiative for Geriatric Epidemiological Research (TIGER) was founded in 2011 to elucidate the interrelationships among various predictors of global and domain-specific cognitive impairment, with the aim of identifying older adults with an increased risk of dementia in the preclinical phase. TIGER, a population-based prospective cohort, recruited 605 and 629 (total of 1,234) older adults (aged 65 and above) at baseline (2011-2013 and 2019-2022) of phase I and II, respectively. Participants have undergone structured questionnaires, global and domain-specific cognitive assessments, physical exams, and biological specimen collections at baseline and biennial follow-ups to date. By 2022, TIGER I has included 4 biennial follow-ups, with the participants comprising 53.9% female and having a mean age of 73.2 years at baseline. After an 8-year follow-up, the annual attrition rate was 6.1%, reflecting a combination of 9.9% of participants who passed away and 36.2% who dropped out. TIGER has published novel and multidisciplinary research on cognitive-related outcomes in older adults, including environmental exposures (indoor and ambient air pollution), multimorbidity, sarcopenia, frailty, biomarkers (brain and retinal images, renal and inflammatory markers), and diet. TIGER's meticulous design, multidisciplinary data, and novel findings elucidate the complex etiology of cognitive impairment and frailty, offering valuable insights into factors that can be used to predict and prevent dementia in the preclinical phase.

Coronavirus disease 2019 and its impact on the cognition of older adults: Unraveling the role of inflammation

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic significantly impacted the older adult population globally. This study aimed to investigate cognitive function and its relationship with inflammation in older COVID-19 survivors over a three-month follow-up to address concerns about cognitive impairment and its risk factors. MethodsIn this descriptive-analytical study, 177 hospitalized COVID-19 patients aged >60 were assessed from July 2021 to February 2022. Psychiatric, global cognitive assessments and activities of daily living were conducted at discharge, 1 month, and 3 months post-discharge. Statistical analyses were conducted using SPSS Version 24. The evolution of cognitive status over time was evaluated using the Repeated Measures Test. The study probed into the association between inflammatory markers and cognitive function through the Pearson correlation test and the Mann–Whitney U test. Additionally, the link between anxiety/depression and cognitive performance was examined using the Pearson correlation. ResultsResults indicated that higher levels of C-reactive protein (CRP), D-dimer, and Lactate Dehydrogenase (LDH) were correlated to reduced cognitive performance. Conversely, Erythrocyte Sedimentation Rate (ESR) and Creatine Phosphokinase (CPK) did not exhibit a significant relationship with cognitive scores. A positive correlation was observed between improved cognitive function (reflected by higher GPCOG scores) and lower levels of anxiety and depression (indicated by lower scores on the Hospital Anxiety and Depression Scale). Over the study period, cognitive function and anxiety scores showed an upward trend, whereas symptoms of depression and challenges in daily activities remained consistent. ConclusionsThe study highlights the enduring effects and detrimental role of inflammation on overall cognitive abilities among older survivors of COVID-19. It underscores the urgent need for specialized interventions and rehabilitative strategies to facilitate sustained cognitive recuperation among these individuals.

Associations between psychological risk and protective profiles and cognitive status in two independent cohorts

AbstractBackgroundPositive and negative psychological factors represent pertinent moderators of relative risk and protection for cognitive decline and dementia. For example, repetitive negative thinking has been associated with accelerated cognitive decline and AD pathology1, whereas self‐reflection and purpose in life have been related to better cognition and cognitive resilience2,3. Existing studies predominately focus on individual factors, thus it is unknown whether psychological profiles, combining risk and protective features, are differentially associated with cognitive function.MethodIndividuals without objective cognitive impairment were included from two European studies: the middle‐aged Barcelona Brain Health Initiative (N = 741) 4 and the older‐adult Medit‐Ageing (N = 279)5,6 cohorts. Self‐report questionnaires to assess levels of psychological risk and protective factors were completed and global cognitive assessments obtained in both studies (Table 1). Latent Profile Analysis (LPA) was performed on psychological questionnaire data to identify statistically different groups of individuals in each cohort separately. ANCOVA (adjusting for age, sex, and education), were then conducted to compare different psychological profiles according to cognitive status.ResultLPA identified a three‐class solution in both cohorts (Table 1 and Figure 1): “low levels of psychological protective factors” (class‐1), “high levels of psychological risk factors” (class‐2), and “average levels of psychological risk and protective factors” (class‐3). In both cohorts, psychological profile membership was significantly associated with cognition. Specifically, individuals with low levels of psychological protective factors had worse global cognitive function compared with individuals with other profiles (BBHI: F:6.05, p&lt;0.002; Medit‐Ageing: F:7.99, p&lt;0.001; Figure 2).ConclusionIndividual psychological risk and protective factors aggregated into three identifiable psychological profiles that were evident across two independent cohorts. In both cohorts, having a psychological profile with low levels of protective factors rather than high levels of risk factors, was associated with worse global cognitive function. Such observations may have implications for future, more personalized, application of psychological therapies contributing to dementia prevention.

Bradyphrenia and Tachyphrenia in Idiopathic Parkinsonism Appear, in Part, Iatrogenic: An Observational Study with Systematic Review Background.

We question whether bradyphrenia, slowing of cognitive processing not explained by depression or a global cognitive assessment, is a nosological entity in idiopathic parkinsonism (IP). The time taken to break contact of an index finger with a touch-sensitive plate was measured, with and without a warning in the alerting signal as to which side the imperative would indicate, in 77 people diagnosed with IP and in 124 people without an IP diagnosis. The ability to utilise a warning, measured by the difference between loge-transformed reaction times (unwarned minus warned), was termed 'cognitive efficiency'. It was approximately normally distributed. A questionnaire on self- and partner perception of proband's bradyphrenia was applied. A multivariable model showed that those prescribed levodopa were less cognitively efficient (mean -5.2 (CI -9.5, -1.0)% per 300 mg/day, p = 0.02), but those prescribed the anti-muscarinic trihexyphenidyl were more efficient (14.7 (0.2, 31.3)% per 4 mg/day, p < 0.05) and those prescribed monoamine oxidase-B inhibitor (MAOBI) tended to be more efficient (8.3 (0.0, 17.4)%, p = 0.07). The variance in efficiency was greater within IP (F-test, p = 0.01 adjusted for any demographic covariates: coefficient of variation, with and without IP, 0.68 and 0.46, respectively), but not so after adjustment for anti-parkinsonian medication (p = 0.13: coefficient of variation 0.62). The within-participant follow-up time, a median of 4.8 (interquartile range 3.1, 5.5) years (101 participants), did not influence efficiency, irrespective of IP status. Perception of bradyphrenia did not usefully predict efficiency. We conclude that both bradyphrenia and 'tachyphrenia' in IP appear to have iatrogenic components, of clinically important size, related to the dose of antiparkinsonian medication. Levodopa is the most commonly prescribed first-line medication: co-prescribing a MAOBI may circumvent its associated bradyphrenia. The previously reported greater efficiency associated with (low-dose) anti-muscarinic was confirmed.

Tools for the Assessment of Risk-Taking Behavior in Older Adults with Mild Dementia: A Cross-Sectional Clinical Study.

Diseases such as Alzheimer's cause an alteration of cognitive functions, which can lead to increased daily risk-taking in older adults living at home. The assessment of decision-making abilities is primarily based on clinicians' global analysis. Usual neuropsychological tests such as the MoCA (Montreal Cognitive Assessment) cover most of the cognitive domains and include mental flexibility tasks. Specific behavioral tasks for risk-taking, such as the Balloon Analogue Risk Task (BART) or the Iowa Gambling Task (IGT), have been developed to assess risk-taking behavior, particularly in the field of addictology. Our cross-sectional study aims to determine whether the MoCA global cognitive assessment could be used as a substitute for behavioral tasks in the assessment of risky behavior. In the current study, 24 patients (age: 82.1 ± 5.9) diagnosed with mild dementia completed the cognitive assessment (MoCA and executive function assessment) and two behavioral risk-taking tasks (BART, simplified version of the IGT). Results revealed no relationship between scores obtained in the MoCA and behavioral decision-making tasks. However, the two tasks assessing risk-taking behavior resulted in concordant risk profiles. In addition, patients with a high risk-taking behavior profile on the BART had better Trail Making Test (TMT) scores and thus retained mental flexibility. These findings suggest that MoCA scores are not representative of risk-taking behavioral inclinations. Thus, additional clinical tests should be used to assess risk-taking behavior in geriatric settings. Executive function measures, such as the TMT, and behavioral laboratory measures, such as the BART, are recommended for this purpose.

Dementia Modulates the Distributed Representations of Cognitive Functions (P4-12.011)

<h3>Objective:</h3> To investigate how cognitive decline affects psychometric representations of global (Mini-Mental State Examination (MMSE) and Clinical Dementia Rating scale (CDR)) and domain-specific neuropsychological measures. To examine the association between cognitive decline and β-amyloid burden using tracer Positron Emission Tomography (PET) imaging. <h3>Background:</h3> One of the central goals of cognitive neuroscience is to understand how anatomical structure relates to function. In dementia, cognitive functions are disrupted and brain regions are selectively involved. It is unclear, however, how the anatomical distribution of pathological changes relates to cognitive functions as measured by clinical assessments. <h3>Design/Methods:</h3> OASIS-3 dataset was used to evaluate the psychometric correlates of cognitive decline in cognitively normal (n=755), and cognitively impaired subjects (n=655) with ages ranging from 42 to 95 years. Anatomical distribution of β-amyloid burden was assessed using florbetapir (AV-45) and Pittsburgh compound B (PIB) PET imaging. Analysis was limited to subjects who underwent cognitive testing and PET imaging within six months. <h3>Results:</h3> Global cognitive decline as measured with MMSE and CDR is associated with brain-wide β-amyloid deposition (randomization test, false detection rate adjusted p-values (q-values) &lt;0.001). Both PIB and AV-45 capture similar neural correlates of global cognitive measures, but show differential selectivity for individual neuropsychological measures (Pearson correlation coefficients, q-values &lt;0.05). Representational similarity analysis of β-amyloid deposition further confirmed these findings, revealing distributed patterns of global cognitive decline across the cortical and subcortical regions (q-values &lt;0.05). There is a continuum in the low-dimensional psychometric and β-amyloid deposition representation (binomial test, q-values &lt;0.001), suggesting behavioral and anatomical heterogeneity within subjects with a diagnosis of cognitive impairment. <h3>Conclusions:</h3> Global cognitive assessments are associated with distributed cortical and subcortical representation. There is a distributed rather than a localized system of cortical and subcortical regions that maintain cognitive function. Behavioral and anatomical heterogeneity exists among subjects with cognitive impairment. <b>Disclosure:</b> Dr. Verma has nothing to disclose. Dr. Kumar has received research support from Texas Advance Computing Center.

Impaired cognitive performance in older adults is associated with deficits in item memory and memory for object features

Amnestic mild cognitive impairment (aMCI) is associated with damage to the perirhinal/entorhinal cortex, and consequently, deficits in item/object memory. However, cognitive assessments commonly used to identify individuals with aMCI require a clinician to administer and interpret the test. We developed a novel self-administered global cognitive assessment, called the Cognitive Assessment via Keyboard (CAKe). To assess the relationship between CAKe performance and perirhinal/entorhinal cortex-dependent memory function, participants completed the CAKe, a feature source memory task, and a context memory task. During the memory tasks, participants studied line drawings with either a green or orange internal color (feature memory runs) or external color (context memory runs) and then classified each item as old and previously presented with a “green” or “orange” color, or “new”. CAKe scores were correlated with item memory accuracies and source memory accuracies on both tasks. Participants with ‘impaired’ CAKe performance had worse item memory and worse feature source memory accuracies than those with ‘normal’ CAKe performance. These results demonstrate specific deficits in item memory and feature source memory and suggest that our assessments may be a valid predictor of aMCI memory deficits.

Microglial activation protects against accumulation of tau aggregates in nondemented individuals with underlying Alzheimer’s disease pathology

The role of microglia in tau accumulation is currently unclear but could provide an important insight into the mechanisms underlying Alzheimer’s disease (AD)1. Here, we measured the microglial marker soluble TREM2 and the disease-associated microglial activation stage 2 markers AXL, MERTK, GAS6, LPL, CST7, SPP1 and CSF1 in nondemented individuals from the Swedish BioFINDER-2 cohort who underwent longitudinal tau-positron emission tomography (PET), amyloid-PET and global cognitive assessment. To assess whether baseline microglial markers had an effect on AD-related changes, we studied three sub-groups of individuals: 121 with evidence of amyloid-PET pathology (A+), 64 with additional evidence of tau-PET pathology (A+T+) and 159 without amyloid- or tau-PET pathology (A−T−). Our results showed that increased levels of TREM2 were associated with slower amyloid accumulation in A+ individuals in addition to slower tau deposition and cognitive decline in A+T+ subjects. Similarly, higher levels of AXL, MERTK, GAS6, LPL, CST7 and CSF1 predicted slower tau accumulation and/or cognitive decline in the A+T+ group. These findings have important implications for future therapeutic strategies aiming to boost microglial protective functions in AD.

858P Automated detection of melanoma: Comparing a convolutional neural network (CNN) approach with an algorithm assessing disorder in the pattern of pigmented lesions, intended to mimick onco-dermatologists' visual analysis

Among Computer Aided Diagnosis (CAD) systems for melanoma detection, CNN behaves as a “black box”, using a huge number of unknown features from a lesion’s image to come to a classification and where no expert input can be implemented. Conversely of hand-crafted methods, the expert is selecting features to be used for the lesions' classification. Most of these hand-crafted algorithms were based on ABCD criteria (asymmetry, border, color, diameter). However the unconscious process leading onco-dermatologists to arbitrate between nevi and melanoma is more likely based on a global cognitive assessment, which we hypothezise to be an overall perception of order/disorder in the pattern of pigmented lesions. Our objective was to design an hand-crafted model based on the concept of ordered/disordered pattern, and to assess its performances by comparison to a CNN model, for the classification melanoma versus nevus. We trained and tested 2 algorithms on a dermoscopic images dataset of 1533 melanomas and 6124 nevi. First, we developped The "Disorder model" based on a hand-crafted method, we extracted 4 specific features to characterize melanoma disorder named entropy, skewness, standard deviation and kurtosis, from 4 colors spaces. The classification of melanoma versus nevi was based on a statistical clustering method (KNN algorithm). Second, we developped a CNN model on the same dataset. Performances of the CNN model yielded: AUC 0.89, sensitivity 86%, specificity 75%, balanced accuracy 81%. The “Disorder model” reached similar high performances: AUC 0.91, sensitivity 91%, specificity 74%, balanced accuracy 82.5%. A statistical χ2 test revealed that entropy, characterizing color disorder, was the most discriminative feature for melanoma detection. This study shows that an algorithm attempting to mimick human brain ability, using a few features to assess the disorder pattern in pigmented lesions, can reach a level of performance for melanoma detection equivalent to CNN-based algorithm, which is using much more features. Entropy seems to be a key feature to assess pattern disorder of pigmented lesions.

Serial neurocognitive changes following transcatheter aortic valve replacement: comparison between low and intermediate-high risk groups.

Background: Data comparing the neurocognitive trajectory between low and intermediate-high risk patients following transcatheter aortic valve replacement (TAVR) is never reported.Aims: To report serial neurocognitive changes up to 1 year post-TAVR in low and intermediate-high risk groups as well as overall cohort.Methods: Prospective neurological assessments (NIHSS and Barthel Index), global cognitive tests (MMSE and Alzheimer Disease Assessment Scale–Cognitive Subtest, ADAS-cog) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR.Results: In overall cohort, persistent improvement to 1 year in MMSE, ADAS-cog, Color Trail Test A and B was found. According to the STS score, the study cohort was divided into low (<4%, N = 81) and intermediate-high (≧4%, N = 75) risk groups. The baseline neurologic and cognitive performance was significantly worse in intermediate-high risk group. Slight improvement on general neurological functions (Barthel index and proportion of NIHSS>0 patients) at 1 year could be observed only in intermediate-high risk group. In global cognitive assessments, improvement in MMSE and ADAS-cog at 1 year was found in both groups, but the proportion of cognitive improvement was more obvious in intermediate-high risk group. In Color Trail Tests and verbal fluency, significant and persistent improvement up to 1 year could be observed only in low risk group.Conclusions: TAVR was associated with persistent improvement in global cognitive function, as well as in attention and psychomotor processing speed, up to 1 year in overall cohort. However, improvement in tests for executive functions can only be seen in low risk group.

EEG Evaluation of Stress Exposure on Healthcare Workers During COVID-19 Emergency: Not Just an Impression.

Psychological distress among healthcare professionals, although already a common condition, was exacerbated by the COVID-19 pandemic. This effect has been generally self-reported or assessed through questionnaires. We aimed to identify potential abnormalities in the electrical activity of the brain of healthcare workers, operating in different roles during the pandemic. Cortical activity, cognitive performances, sleep, and burnout were evaluated two times in 20 COVID-19 frontline operators (FLCO, median age 29.5 years) and 20 operators who worked in COVID-19-free units (CFO, median 32 years): immediately after the outbreak of the pandemic (first session) and almost 6 months later (second session). FLCO showed higher theta relative power over the entire scalp (FLCO = 19.4%; CFO = 13.9%; p = 0.04) and lower peak alpha frequency of electrodes F7 (FLCO = 10.4 Hz; CFO = 10.87 Hz; p = 0.017) and F8 (FLCO = 10.47 Hz; CFO = 10.87 Hz; p = 0.017) in the first session. FLCO parietal interhemispheric coherence of theta (FLCO I = 0.607; FLCO II = 0.478; p = 0.025) and alpha (FLCO I = 0.578; FLCO II = 0.478; p = 0.007) rhythms decreased over time. FLCO also showed lower scores in the global cognitive assessment test (FLCO = 22.72 points; CFO = 25.56; p = 0.006) during the first session. The quantitative evaluation of the cortical activity might therefore reveal early signs of changes secondary to stress exposure in healthcare professionals, suggesting the implementation of measures to prevent serious social and professional consequences.

Impact on quitting smoking of cognitive impairment in stroke patients

IntroductionSmoking is a well-established risk factor for strokes, leading to a high incidence of cognitive deficits. Since the impact of cognitive impairment on the effectiveness of interventions for smoking cessation is not yet known, we considered important to assess it. MethodsWe compared, from April 2012 to November 2015, the success rate of quitting smoking in two groups of acutely hospitalised adult smokers. The first group consisted of stroke patients (SP, n = 54) with lesions confirmed by cerebral imaging. The second used as a control group (NSP, n = 38), included patients hospitalised for any reason other than stroke and characterised by normal global cognition. All participants were assessed twice, in acute phase (T0) and 3 months later (T1), using exhaled carbon monoxide (CO) and several questionnaires. ResultsAt T1, we observed in SP group an inverse correlation between the Montreal Cognitive Assessment (MoCA) and CO (r = −0.33, p = 0.015). Amongst patients who continued smoking, a higher increase in CO between T0 and T1 was observed in SP group (average 20 ± 15, p < 0.001) than NSP (average 9 ± 13, p = 0.002). ConclusionsThe inverse correlation between CO and cognitive parameters at T1 in SP group suggests an increased susceptibility to tobacco dependency in case of residual cognitive impairment. The global cognitive assessment should thus be taken into consideration when providing assistance with quitting smoking, especially in case of stroke patients.

Functional Brain Dysconnectivity in Parkinson's Disease: A 5-Year Longitudinal Study.

BackgroundTracking longitudinal functional brain dysconnectivity in Parkinson's disease (PD) is a key element to decoding the underlying physiopathology and understanding PD progression.ObjectivesThe objectives of this follow‐up study were to explore, for the first time, the longitudinal changes in the functional brain networks of PD patients over 5 years and to associate them with their cognitive performance and the lateralization of motor symptoms.MethodsWe used a 5‐year longitudinal cohort of PD patients (n = 35) who completed motor and non‐motor assessments and sequent resting state (RS) high‐density electroencephalography (HD‐EEG) recordings at three timepoints: baseline (BL), 3 years follow‐up (3YFU) and 5 years follow‐up (5YFU). We assessed disruptions in frequency‐dependent functional networks over the course of the disease and explored their relation to clinical symptomatology.ResultsIn contrast with HC (n = 32), PD patients showed a gradual connectivity impairment in α2 (10‐13 Hz) and β (13–30 Hz) frequency bands. The deterioration in the global cognitive assessment was strongly correlated with the disconnected networks. These disconnected networks were also associated with the lateralization of motor symptoms, revealing a dominance of the right hemisphere in terms of impaired connections in the left‐affected PD patients in contrast to dominance of the left hemisphere in the right‐affected PD patients.ConclusionsTaken together, our findings suggest that with disease progression, dysconnectivity in the brain networks in PD can reflect the deterioration of global cognitive deficits and the lateralization of motor symptoms. RS HD‐EEG may be an early biomarker of PD motor and non‐motor progression. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Inflammation and Cognitive Functioning in Older Adults: The Role of Gender and Obesity

Systemic inflammation is associated with steeper cognitive decline over time. Identifying potential moderators of inflammation is crucial for understanding inflammation’s contribution to abnormal cognitive decline. This study examined whether inflammation predicted changes in cognitive functioning over time and explored the moderating effects of sex and BMI on this association. Data was collected from a longitudinal nationally representative data set. (Health & Retirement Study). C-reactive protein (CRP) and global cognitive functioning assessments were collected from the 2006/2008 and 2010/2012 waves. Participants, n= 7,483, Age =71.39 years (SD = 9.24) , 60.2% female, were categorized into groups based on BMI (i.e. normal, overweight, and obese). Sex and BMI significantly moderated the association between increased hs-CRP and lower cognitive functioning, b = -.22 (SE = .09), p = .017. Women with high BMI exhibit twice the risk of low cognitive functioning, b = -.49 (SE = .07), p < .0001, compared to men with high BMI, b = -.21 (SE = .08), p = .01. Men with normal BMI exhibited twice the risk of low cognitive functioning, b = -.49 (SE = .08), p < .0001, compared to women with normal BMI, b = -.24 (SE = .06), p = .0001. Inflammation and BMI are modifiable factors that may prevent or slow -down abnormal cognitive decline. Understanding the potentially sex-dependent role of adipose tissue in the impact of inflammation on cognitive function may be critical to understanding the pathogenesis of cognitive impairment late in life as well as identifying efficacious intervention targets.

Time-Varying Insomnia Symptoms and Incidence of Cognitive Impairment and Dementia among Older US Adults

There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study (n = 13,833) from 2002 to 2014 were used (59.4% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms compiled in an insomnia severity index, ranging from 0 to 4. In the analysis, participants’ symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive assessment tool. Respondents were classified as either having dementia, MCI or being cognitively healthy. Cox proportional hazards models with time-dependent exposure using the counting process (start-stop time) were used for analysis. For each one-unit increase in the insomnia symptom index, there was a 5-percent greater hazard of MCI (HR = 1.05; 95% CI: 1.04–1.06) and dementia (HR = 1.05; 95% CI: 1.03–1.05), after fully adjusting. Using a nationally representative sample of adults aged 51 and older, this study found that time-varying insomnia symptoms are associated with the risk of MCI and dementia. This highlights the importance of identifying sleep disturbances and their change over time as potentially important risk factors for MCI and dementia.

The association between carotid intima-media thickness and cognitive performance is affected by intracranial artery stenosis in Chinese elderly people: An outpatient-based study

Background and AimsThe association between carotid intima-media thickness (cIMT) and cognitive function remains controversial, and whether this relationship is affected by intracranial artery stenosis (ICAS) remains unclear. We investigated these questions among elderly participants who sought health consultations in an outpatient clinic. MethodsWe conducted a cross-sectional study based on participants from an outpatient clinic, enrolling residents over 60 years of age seeking outpatient services because of abnormal transcranial Doppler reports at Shandong Provincial Third Hospital in Jinan, Shandong province. We performed physical examinations, blood tests, cIMT measurement using carotid ultrasonography, ICAS measurement using brain magnetic resonance angiography scanning, and global cognitive function assessment using the Montreal Cognitive Assessment (MoCA)in the outpatient clinic from May 2020 to December 2020. We subsequently performed a regression analysis to explore the relationship between cIMT and cognitive function and a stratified analysis to explore whether the relationship was different between the ICAS and non-ICAS participants. ResultsIn total, 167 participants (age: 65.56 ± 10.39 years, female: 53.89%) were included in the present study. The MoCA score was significantly lower in the intimal thickening group (cIMT ≥ 1.0 mm) than in the normal group (mean [SD]: 16.23 [5.16] vs. 19.97 [4.59], P < 0.001). Univariate analysis showed that a greater cIMT was negatively correlated with cognitive function. After adjustment for several potential confounders in the multivariable analyses, the association between cIMT and cognitive function disappeared. When further stratified by ICAS, a negative association between increased cIMT (cIMT ≥ 1.0 mm) and cognitive function was found in those without ICAS (β: −2.80 [-5.13, −0.48], p = 0.021); however, in subjects with ICAS, the relationship between cIMT and cognitive function was insignificant. ConclusionGreater cIMT was associated with low cognitive function in participants without ICAS who sought consultation due to abnormal transcranial Doppler reports in outpatient clinics.

Time-Varying Insomnia Symptoms and Incidence of Cognitive Impairment and Dementia among Older US Adults.

There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study (n = 13,833) from 2002 to 2014 were used (59.4% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms which were compiled in an insomnia severity index, ranging from 0 to 4. In analysis, participants’ symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive assessment tool. Respondents were classified as either having dementia, MCI, or being cognitively healthy. Cox proportional hazards models with time-dependent exposure using the counting process (start-stop time) were used for analysis. For each one-unit increase in the insomnia symptom index, there was a 5-percent greater hazard of MCI (HR = 1.05; 95% CI: 1.04–1.06) and dementia (HR = 1.05; 95% CI: 1.03–1.05), after fully adjusting. Using a nationally representative sample of adults age 51 and older, this study found that time-varying insomnia symptoms are associated with risk of MCI and dementia. This highlights the importance of identifying sleep disturbances and their change over time as potentially important risk factors for MCI and dementia.

Neuropsychiatric Symptoms Among Hispanics: Results of the Maracaibo Aging Study.

Neuropsychiatric symptoms play an important role in diagnosing and clinical follow-up of cognitive impairment and dementia. We investigated the relationship between neuropsychiatric symptoms, cognitive impairment, and dementia in Hispanics. We included 529 participants (age ≥40 years) from the Maracaibo Aging Study with standardized neuropsychiatric assessments, including the Neuropsychiatric Inventory (NPI). Based on the Clinical Dementia Rating and the Mini-Mental State Examination scores, participants' cognitive status was categorized into normal cognition, mild/moderate, and severe cognitive impairment. Diagnosis of dementia was established in a consensus conference. Statistical analyses included multivariable logistic regression models and area under the curve (AUC). The mean age of participants was 59.3 years, and 71.8%were women. The proportion of dementia was 6.8%. Disturbed sleep, anxiety, and depression were the most common neuropsychiatric symptoms in the study sample. In crude analyses, the proportions of hallucinations, aberrant motor behavior, agitation/aggression, apathy, delusions, irritability, eating disturbance, depression, and euphoria were differently distributed among cognitive status groups (p < 0.05). After accounting for confounders, aberrant motor behavior and agitation/aggression remained significantly associated with cognitive impairment and dementia (p < 0.05). The inclusion of the NPI domains significantly improved the AUC to discriminate severe cognitive impairment and dementia compared to a basic model that included sex, age, education, alcohol, obesity, serum glucose, total cholesterol, hypertension, and stroke. Neuropsychiatric symptoms are associated with severe cognitive impairment and dementia. The addition of NPI items to the global cognitive assessment might help early detection of dementia in primary care settings.