High Prevalence Of Cognitive Impairment Research Articles

The prevalence and clinical correlation factors of cognitive impairment in patients with major depressive disorder hospitalized during the acute phase

ObjectiveThis study aimed to investigate the prevalence of cognitive impairment among patients with major depressive disorder (MDD) hospitalized during the acute phase and to analyze the in-depth association between this cognitive impairment and clinical correlation factors.MethodsIn this cross-sectional study, we recruited 126 patients aged between 18 and 65 years who were diagnosed with MDD. All these patients were inpatients from the Department of Psychiatry at the Second People’s Hospital of Hunan Province. We employed a series of assessment tools, including the Pittsburgh Sleep Quality Index (PSQI), the 16-item Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the Pre-sleep Arousal Scale (PSAS), the Morningness-Eveningness Questionnaire (MEQ), the Hamilton Anxiety Rating Scale (HAMA), and the 17-item Hamilton Depression Rating Scale (HAMD-17). The patients were divided into a cognitive impairment group and a non-cognitive impairment group based on their scores on the Montreal Cognitive Assessment Scale (MoCA). Through Spearman’s correlation analysis, we explored the correlation between the total MoCA score and the score of each factor. Additionally, we utilized binary logistic regression analysis to investigate the relationship between cognitive impairment and clinically relevant factors in MDD patients hospitalized during the acute phase and plotted ROC curves to evaluate their clinical efficacy.ResultsIn this study, we found that the prevalence of cognitive impairment among MDD patients hospitalized during the acute phase was as high as 63.49%. Through statistical analysis, we observed significant differences between the cognitive impairment group and the non-cognitive impairment group in terms of age, place of residence, education level, and HAMD-17 scores. In the Spearman correlation analysis, we noted the following trends: visuospatial and executive abilities were negatively correlated with the HAMD-17 score (P < 0.05); naming ability was positively correlated with the PSAS score but negatively correlated with the MEQ score (P < 0.05); memory was also negatively correlated with the MEQ score (P < 0.05); attention was negatively correlated with the HAMA score; and abstract cognitive ability was negatively correlated with the MEQ score (P < 0.05). Through binary logistic regression analysis, we further revealed the relationship between cognitive impairment and factors such as living in a rural area (OR = 2.7, 95% CI = 1.083-6.731, P < 0.05), increased age (OR = 1.049, 95% CI = 1.013-1.087, P < 0.01), and the HAMD-17 score (OR = 1.10295, 95% CI = 1.031-11.79, P < 0.01). Additionally, ROC curve analysis demonstrated a significant correlation between the HAMD-17 score and the prediction of cognitive function in MDD patients hospitalized during the acute phase (P < 0.001). Specifically, the AUC for the HAMD-17 score was 0.73, with an optimal cut-off value of 19.5, sensitivity of 70.0%, and specificity of 63.0%. Furthermore, the AUC for age was 0.71, with an optimal cut-off value of 33.5, sensitivity of 59.0%, and specificity of 80.0%.ConclusionsThis study indicates that MDD patients hospitalized during the acute phase have a higher prevalence of cognitive impairment. This phenomenon reflects a significant correlation between clinical factors such as age, sleep-related characteristics, and the severity of depression with cognitive impairment. Therefore, regular assessment of cognitive function in MDD patients and early intervention may be crucial for the treatment and prognosis of the disease.

Cognitive patterns according to mini-mental state examination domains in patients with AF and association with all-cause mortality: a cluster analysis from a contemporary prospective study

Abstract Background Atrial fibrillation (AF) is associated with cognitive impairment even in the absence of previous stroke. However, data on specific patterns of cognitive impairment and their association with outcomes are limited. Purpose We aimed to identify different phenotypic groups of AF patients stratified according to specific cognitive domains using cluster analysis and evaluate the association between identified clusters and adverse outcomes. Methods We used data from a prospective observational study on AF patients excluding those with previous clinically overt stroke. We performed a hierarchical cluster analysis based on Ward’s Method using data from the Mini-Mental State Examination (MMSE) administered during the enrollment. The MMSE includes 6 distinct cognitive domains. We normalized each domain’s score from 0 to 100 to preserve the ranking and the interpretability of the test. Patients’ clusters were identified by examining the distance between cluster coefficients and by visual inspection of the dendrogram. All-cause mortality was the primary endpoint. Results A total of 872 stroke-free AF patients were included. Three clusters based on MMSE domains were identified: Cluster 1 (n=494, 56.7%); Cluster 2 (n=243, 27.9%) and Cluster 3 (n=135, 15.5%). The clusters greatly differed according to the cognitive domains affected and baseline characteristics (Table). The use of oral anticoagulants did not differ among clusters and it was substantially high (88.6%). Cluster 2 had a higher prevalence of cognitive impairment (37.9% vs 35.6% for Cluster 3 and 1.0% for Cluster 1, p<0.001) with a lower mean MMSE score compared to other clusters. The analysis of MMSE domains showed substantial deficits in the orientation, attention/calculation, and recall domains with peculiar differences among the clusters. Cluster 2 showed the most significant impairment in the copying domain (100%) while Cluster 3 had a higher impairment in attention/calculation and recall domains. After a median follow-up of 629 days, all-cause mortality was 15.9% with a significantly higher prevalence in Cluster 2 (26.9% vs 10.0% and 15.5% for Cluster 1 and Cluster 3 respectively, p<0.001). At the adjusted Cox regression analysis, Cluster 2 was independently associated with a higher risk of all-cause mortality compared with Cluster 1 (HR 1.83, 95% CI 1.18-2.82) while Cluster 3 was not independently associated with the outcome (Figure). Conclusions In a prospective observational cohort of stroke-free AF patients, we identified three clusters showing different patterns of cognitive impairment, affecting specific MMSE domains and resulting in a different risk of mortality. Our findings highlight the clinical implications of cognitive impairment and stress the need for a more holistic approach to AF patients including a comprehensive cognitive assessment, as well as the need for studies on interventions able to positively affect cognitive impairment.Figure

Contemporary Incidence of Cognitive Impairment or Dementia in Patients undergoing Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis.

Despite the high prevalence of cognitive impairment or dementia post coronary artery bypass grafting (CABG), the incidence of cognitive impairment or dementia post-CABG in contemporary practice is currently unclear. Therefore, this paper aims to investigate the incidence and associated risk factors of cognitive impairment or dementia in patients post-CABG. A systematic search across three databases (PubMed, SCOPUS and Embase) was conducted for studies published in or after 2013 that reported cognitive impairment or dementia post-CABG. Subgroup analyses and meta-regression by risk factors were performed to determine their influence on the results. This analysis included 23 studies with a total of 2620 patients. The incidence of cognitive impairment or dementia less than one month, two to six months, and more than twelve months post-CABG was 35.96% (95%CI: 28.22-44.51, I2=87%), 21.33% (95%CI: 13.44-32.15, I2=88%) and 39.13% (95%CI: 21.72-58.84, I2=84%), respectively. Meta-regression revealed that studies with more than 80% of the cohort diagnosed with hypertension were significantly associated with incidence of cognitive impairment or dementia less than one-month post-CABG. This meta-analysis demonstrates a high incidence of cognitive impairment or dementia in patients post-CABG in contemporary practice, particularly less than one month post-CABG. We found that hypertension was a significant risk factor in the short term (less than one month) follow-up period for cognitive impairment or dementia post-CABG. Future research should be done to assess strategies to reduce cognitive impairment post-CABG. .

Association of Childhood Exposure to School Racial Segregation with Late-Life Cognitive Outcomes among Older Americans.

Disparities in cognition, including dementia occurrence, persist between White and Black older adults, and are possibly influenced by early educational differences stemming from structural racism. However, the relationship between school racial segregation and later-life cognition remains underexplored. To investigate the association between childhood contextual exposure to school racial segregation and cognitive outcomes in later life. Data from 16,625 non-Hispanic White (hereafter, White) and 3,335 non-Hispanic Black (hereafter, Black) Americans aged 65 or older were analyzed from the Health and Retirement Study. State-level White-Black dissimilarity index for public elementary schools in the late 1960s (range: 0-100) was used to measure school segregation. States were categorized into high segregation (383.6) and low segregation (<83.6) based on the top quintile. Cognitive scores, cognitive impairment (with or without dementia), and dementia were assessed using the Telephone Interview for Cognitive Status (TICS) and proxy assessment. Multilevel regression analyses were conducted, adjusting for demographic covariates, socioeconomic status, and health factors. Stratified analyses by race were performed. The mean (SD) age of participants was 78.5 (5.7) years, and 11,208 (56.2%) were female. Participants exposed to high segregation exhibited lower cognitive scores (12.6 vs. 13.6; P<0.001) and higher prevalence of cognitive impairment (50.8% vs 41.4%; P<0.001) and dementia (26.0% vs. 19.5%; P<0.001), compared to those with low segregation exposure. Multilevel analyses revealed a significant negative association between school segregation and later-life cognitive even after adjusting sequentially for potential confounders, and these associations were stronger among Black than White participants. Notably, in the fully adjusted model, Black participants exposed to high segregation displayed significantly lower cognitive scores (-0.51; 95% CI: -0.94, -0.09) and higher likelihood of cognitive impairment (adjusted Odds Ratio [aOR]: 1.45, 95% CI: 1.22, 1.72) and dementia (aOR: 1.31, 95% CI: 1.06, 1.63). Our study underscores that childhood exposure to state-level school segregation is associated with late-life cognition, especially for Black Americans. Given the rising trend of school segregation in the US, educational policies aimed at reducing segregation are crucial to address health inequities. Clinicians can leverage patients' early-life educational circumstances to promote screening, prevention, and management of cognitive disorders.

Prevalence of cognitive impairment and its predictors among chronic kidney disease patients: A systematic review and meta-analysis.

Cognitive impairment (CI) is common among patients with chronic kidney disease (CKD), and is associated with a poor prognosis. We assessed the prevalence and associated factors of CI in patients with CKD. A systematic review and meta-analysis were conducted by searching PubMed, Embase, and the Web of Science through December 1, 2023. Random effects models were performed with subgroup analyses to further explore the heterogeneity. 50 studies involving 25,289 CKD patients were included. The overall prevalence of CI was 40% (95% confidence interval 33-46). The pooled prevalence of CI was relatively higher in CKD patients from Africa (58%), Asia (44%) and America (37%). Attention and executive dysfunction appeared to be the most common manifestations. The prevalence of CI was higher among patients with hemodialysis (53%) and peritoneal dialysis (39%) than those without dialysis (32%) and post-kidney transplanted (26%). In addition, advanced age, the presence of diabetes and hypertension might increase the risk of CI in CKD patients. People with CKD have a high prevalence of CI, especially in patients with hemodialysis. An early and comprehensive screening for CI in CKD patients is needed to improve clinical outcomes. Registration number: PROSPERO (CRD42023412864).

Moderate-to-severe cognitive impairment is associated with both recent and chronic alcohol misuse in people with HIV: The New Orleans alcohol use in HIV (NOAH) study.

Human immunodeficiency virus (HIV) profoundly impacts the nervous system, leading to neurological deficits including HIV-associated neurocognitive disorder (HAND). HAND represents the most common neurological comorbidity among people with HIV (PWH), and alcohol use may exacerbate cognitive deficits, especially in vulnerable populations. This study investigated relationships between alcohol use and cognition in an underserved cohort of PWH, on the hypothesis that alcohol misuse exacerbates cognitive deficits. Data collected from participants (n = 259; 66.7% male; mean age 52 ± 10 years) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study were utilized for cross-sectional analysis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and alcohol use was comprehensively measured using four metrics: the Alcohol Use Disorders Identification Test (AUDIT), 30-day timeline follow back (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) levels. The average MoCA score among participants was 20.7 ± 4.5, with 86.5% demonstrating cognitive impairment (MoCA < 26). Individuals with MoCA scores below 18 (moderately or severely cognitively impaired) had a higher frequency of recent severe alcohol misuse and greater lifetime alcohol consumption. Participants at increased risk for AUD (AUDIT ≥ 16) also had worse global cognition and memory task performance than those with lower AUDIT scores; this was particularly true among those aged 50 and older. Analysis of the MoCA sub-score data indicated that participants with increased AUD risk had impairments in the cognitive domains of language and memory. Our findings demonstrate a high prevalence of cognitive impairment in the NOAH cohort and suggest that alcohol misuse contributes to global cognitive deficits in PWH, especially among individuals aged 50 and older. Further exploration of the impact of alcohol use on specific cognitive domains, including memory and language, should incorporate additional cognitive tasks. These findings highlight the importance of considering alcohol use and AUD risk as significant factors that may exacerbate cognitive deficits in vulnerable populations, including older PWH.

Examining interrater agreement between self-report and proxy-report responses for the quality of life-aged care consumers (QOL-ACC) instrument

BackgroundQuality of life is an important quality indicator for health and aged care sectors. However, self-reporting of quality of life is not always possible given the relatively high prevalence of cognitive impairment amongst older people, hence proxy reporting is often utilised as the default option. Internationally, there is little evidence on the impact of proxy perspective on interrater agreement between self and proxy report.ObjectivesTo assess the impacts of (i) cognition level and (ii) proxy perspective on interrater agreement using a utility instrument, the Quality of Life-Aged Care Consumers (QOL-ACC).MethodsA cross-sectional study was undertaken with aged care residents and family member proxies. Residents completed the self-report QOL-ACC, while proxies completed two proxy versions: proxy-proxy perspective (their own opinion), and proxy-person perspective (how they believe the resident would respond). Interrater agreement was assessed using quadratic weighted kappas for dimension-level data and concordance correlation coefficients and Bland-Altman plots for utility scores.ResultsSixty-three residents (22, no cognitive impairment; 41, mild-to-moderate cognitive impairment) and proxies participated. In the full sample and in the mild-to-moderate impairment group, the mean self-reported QOL-ACC utility score was significantly higher than the means reported by proxies, regardless of perspective (p < 0.01). Agreement with self-reported QOL-ACC utility scores was higher when proxies adopted a proxy-person perspective.ConclusionRegardless of cognition level and proxy perspective, proxies tend to rate quality of life lower than residents. Further research is needed to explore the impact of such divergences for quality assessment and economic evaluation in aged care.

Changes in Psychological Profile and Cognitive Function in Patients with Arterial Hypertension Who Have Suffered From COVID-19 Under the Influence of Treatment

Today, the issue of treatment and rehabilitation of patients with COVID-19 is extremely relevant. A disease that has shaken the medical community, even after the patient recovers, can have serious consequences for health in the future. The greatest concern in the post-covid period is caused by rather serious and long-term complications (especially in patients who have experienced a severe form of COVID-19), which include: cardiovascular (damage to the heart muscle, exacerbation and progression of hypertension), respiratory, neurological (disturbance of sensation taste and smell, sleep disorders), psychological (depression, anxiety, mood swings) outcomes. In the modern population, there is an increased level of cognitive disorders. They have multifactorial nature, in particular, one of such pathogenetic factors is arterial hypertension (AH) and its complications, the frequency of post-stroke cognitive impairment from mild to severe grade reaches 60% during the first year. On the other hand, according to observations, treatment of AH can reduce the risk of dementia development. The results of the data analysis showed a higher prevalence of cognitive impairment in patients with AH in the post-epidemic period than in patients with elevated blood pressure (BP) who did not suffer from COVID-19. The objective: to analyze the frequency of anxiety-depressive disorders and cognitive function in patients with medically controlled AH who experienced COVID-19, and to evaluate the effectiveness of additional use of a combination of L-carnitine, L-arginine and coenzyme Q10 in the post-covid period. Materials and methods. 53 patients (24 women and 29 men) with a diagnosis of AH who treated with drug antihypertensive therapy and who recovered from COVID-19, were included in a prospective single-center study. Questionnaires (MMSE, SSS-8, PHQ-9) were chosen to assess anxiety-depressive disorders and cognitive function. The study participants were divided into two groups that did not differ in age and gender. In the first group standard treatment was added with a combination of L-arginine, L-carnitine and coenzyme Q10, the patients in the second group received standard therapy. Results. An additional effect on improved BP control only when used drug therapy in a complex with a combination of L-arginine, L-carnitine and coenzyme Q10 was determined, as well as a positive effect on improved the clinical condition of patients with AH, restoration of the psychological state after a recovery from respiratory infection SARS-COV- 2. Conclusions. The patients with AH who have suffered from COVID-19 often have psychological changes and impaired cognitive function under the conditions of medical BP control. The use of a combination of L-arginine, L-carnitine and coenzyme Q10 as part of complex therapy contributed to a more effective recovery of psychological and cognitive disorders, improvement of the subjective condition of patients due to the additional positive effect on the control of BP and heart rate.

CLINICO-DEMOGRAPHIC CORRELATES OF COGNITIVE IMPAIRMENT AMONG THE OLDER ADULTS IN SELECTED SPECIALTY CLINICS IN MAIDUGURI, NIGERIA.

Background: Older adults with chronic medical conditions have a high prevalence of cognitive impairment, which may be linked to the chronicity of their illnesses. This study aimed to identify demographic and clinical factors associated with cognitive impairment in older adults with chronic medical conditions attending specialty clinics in Maiduguri. Methods: A cross-sectional analytical study was conducted involving older adults aged 60 years and above, utilizing a consecutive sampling approach over a period of six months. Participants completed the sociodemographic questionnaire, clinical proforma and assessment using Community Screening Instrument for Dementia (CSID). Data analysis was performed using SPSS version 26.0, with significance level set at 0.05. Non-parametric tests were employed to compare continuous dependent variables that were not normally distributed across different groups of independent variables. Results: The mean age (±SD) of the respondents was 66.6 (±5.5) years. The prevalence of cognitive impairment was 14.7%. It was higher among the 70-79 age group, the widowed, and those with no formal education. There was a significant association of cognitive impairment with the medical conditions (p = 0.001). It was worst among those with hypertension-diabetes comorbidity, those with the longest duration for ≥21 years, those using ≥5 medications, and those with 3-4 previous admissions. Conclusion: The present findings hold significance for the healthcare of older adults, as they can enhance clinical procedures by raising awareness regarding cognitive impairment. Additionally, these findings may contribute to the establishment of a comprehensive approach to their care, bridging the gap between psychiatric and medical practices.

Single-centre prospective cohort study investigating the associations and one-year trends of frailty, cognition, disability and quality of life pre- and post-intervention for chronic limb-threatening ischaemia

Abstract Background: Half of people with chronic limb-threatening ischaemia (CLTI) have frailty. This study aimed to describe the associations of frailty with cognition, disability and quality of life (QoL) among CLTI patients over 1 year following surgical or endovascular procedures. Methods: A single-centre prospective cohort study was undertaken. Patients undergoing a procedure for CLTI between May 2019 and May 2021 were eligible (minimum age &gt;65 initially; &gt;50 from November 2019). Participants underwent preoperative assessments for frailty, physical and cognitive function, disability, mood, disease-specific QoL (Vascular QoL questionnaire (VascuQoL)) and generic health-related QoL (EuroQoL EQ-5D-5L). Follow-up was at 3 months (clinic or telephone) and 12 months (telephone). Baseline frailty was assessed using both the Edmonton frail scale (EFS) and the clinical frailty scale (CFS). Frailty during follow-up was re-assessed at 3 and 12 months using the CFS as it can be performed via telephone. Associations of baseline frailty with disability, QoL and mood scores during follow-up were investigated using repeated measures mixed models. Results: Ninety-nine patients completed the baseline assessments. Forty-five (45%) were classified as frail by the EFS. Frailty was associated with a higher prevalence of cognitive impairment based on the Montreal cognitive assessment (52% vs 17%; p&lt;0.001). Eighty-seven patients were eligible for follow-up. Baseline frailty (EFS) was associated with worse QoL scores at all timepoints (VascuQoL p=0.001; EQ-5D-5L p&lt;0.001). Both those with and without frailty at baseline (EFS) had modest improvement in QoL scores at 12 months (VascuQoL p&lt;0.001; EQ-5D-5L p=0.001). Barthel index (disability) scores were lower for those with frailty at baseline (EFS) (p&lt;0.001) and decreased slightly over 12 months for both groups (p=0.007). Five patients (12%) transitioned from frailty to non-frailty at 12 months based on the CFS. However, 10 patients (23%) transitioned from non-frailty to frailty. Conclusions: CLTI patients with frailty have worse QoL and greater disability both pre- and post-intervention. However, they demonstrate similar QoL benefit to those without frailty at 1 year following intervention. Baseline frailty assessment is important to inform prognostic discussions, expectations and shared decision making in CLTI.

DEVELOPMENT OF A COMMUNITY-ENGAGED DEMENTIA EDUCATION PROGRAM FOR THE VIETNAMESE AMERICAN COMMUNITY

Abstract Despite the life-threatening escape from Vietnam, Vietnamese refugees’ health data are scarce. To fill this knowledge gap, we developed the Vietnamese Aging and Care Survey (VACS) and examined the health of community-dwelling older Vietnamese (≥65 years) in Houston, Texas, the 2nd largest Vietnamese-populated metropolitan area in the U.S. The data revealed their adverse health conditions including a high prevalence of cognitive impairment. We proposed a Community-Engaged Dementia Education Program to improve the community’s dementia literacy based on the Cultural Exchange Model as a conceptual framework. Using Edwards’ 9-stage Community Readiness Model, 14 Vietnamese key informants assessed their current literacy level (Aim 1). To develop dementia educational materials (Aim 2), the informants formed focus-group discussions. We used thematic analysis to analyze the community’s understanding of dementia and developed educational materials. Key informants were aged 58 years (mean), Vietnam-born (93%), married (79%), college-educated (72%), women (86%), and full-time employees (79%). They lived in the U.S. for 39 years and in Houston for 30 years. Themes such as the Vietnamese community’s low dementia literacy, their perception of dementia as a normal part of aging, and suggestions for introducing dementia conversations to the community emerged. We considered a one-pager as appropriate educational material, and included culturally- and linguistically-appropriate content and its translation, a target population’s image, and dementia warning signs encouraging them to see their doctors for cognitive check-ups. Our next steps include utilizing local ethnic social media, disseminating the one-pager, and offering a “Brain Booth” at various Vietnamese health fairs.

COGNITIVE IMPAIRMENT AMONG OLDER ADULTS WITH INTERSECTING SEXUAL, GENDER, RACIAL, AND ETHNIC MINORITY IDENTITIES

Abstract Emerging research shows Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults experience higher prevalence of cognitive impairment when compared to their heterosexual and cisgender peers of a similar age. The same is true for racial and ethnic minority older adults when compared to their White counterparts. Little is known about the cognitive health of older adults with intersecting sexual, gender, racial, and ethnic minority identities, highlighting a critical gap in gerontological research that requires further investigation. This study utilizes four time-point data from the first longitudinal study of a racially and ethnically diverse sample of LGBTQ older adults. Multilevel mixed models accounting for intersecting sexual, gender, racial, and ethnic identities were applied to examine subgroup differences in cognitive impairment as well as risk and protective factors after controlling for confounding factors. Black and Hispanic LGBTQ minority older adults (b=5.20, p&amp;lt;.01; b=4.05, p&amp;lt;.01) experience higher levels of cognitive impairment over time when compared to their White LGBTQ peers. Day-to-day discrimination targeting the confluence of sexual/gender and racial/ethnic minority status (b=2.78, p&amp;lt;.05) was positively associated with higher cognitive impairment. Community engagement (b=-.46, p&amp;lt;.05) was negatively associated with cognitive impairment regardless of race and ethnicity whereas network size was exclusively negatively associated with cognitive impairment for Black LGBTQ older adults. The overall findings demonstrate racial and ethnic differences in cognitive impairment among LGBTQ older adults and illuminate the importance of culturally tailored interventions that account for intersectionality, social connectivity, and discrimination to promote cognitive health for specific subgroups.

Interaction between composite dietary antioxidant index and physical activity on cognitive impairment in the elderly: NHANES 2011–2014

ObjectiveWe aim to explore the association between the Composite Dietary Antioxidant Index (CDAI), physical activity, and cognitive impairment. Methods2395 participants from the 2011–2014 National Health and Nutrition Examination Survey (NHANES) were included in this study. The association of CDAI and physical activity with cognitive impairment was analyzed using binary logistic regression. A stratified analysis was employed for a sensitivity analysis of the logistic regression, examining the interaction between CDAI and each stratified variable. ResultsBoth low scores on CDAI and physical inactivity are associated with higher prevalence of cognitive impairment. Compared to the fourth quartile of CDAI and active group, the prevalence of cognitive impairment is statistically increased in other sub-groups. ConclusionThere is an interaction between CDAI and physical activity. The elderly population with low scores on CDAI especially combined with physical inactivity should be focused, so as to reduce the adverse effects of cognitive impairment.

Dynamic Changes in Brain Perfusion after Cognitive Rehabilitation in Patients with Type 1 and Type 2 Diabetes Mellitus

INTRODUCTION: The results of numerous studies indicate a high prevalence of cognitive impairment among patients with diabetes mellitus (DM).&#x0D; AIM: To evaluate the effectiveness of computerized training in cognitive rehabilitation in individuals with type 1 and type 2 DM, taking into account the dynamics of brain perfusion.&#x0D; MATERIALS AND METHODS: A randomized controlled study. The study group consisted of 25 patients with type 1 DM and 30 patients with type 2 DM aged 23 to 67 years. The comparison group included 20 patients with type 1 DM (mean age 28.4 years) and 20 patients with type 2 DM (mean age 56.0 years). Before and after the rehabilitation course, the patients of the study group underwent a general clinical examination, a blood test for carbohydrate metabolism, cognitive function testing using the Montreal Scale (MoCA test), contrast-free perfusion magnetic resonance imaging (MRI) of the brain. Active rehabilitation lasted 6 month; it was based on a computerized training, including exercises on verbal and nonverbal intelligence.&#x0D; RESULTS: On the initial examination, all the subjects did not have the achieved target level of glycated hemoglobin. After completion of the training program, a decrease in the parameter in both groups was noted, as well as a decrease in the mean level of fasting glycemia in people with type 1 DM. The result of neuropsychological testing in all patients at the initial stage corresponded to the diagnosis of ‘cognitive dysfunction’. The control test revealed an improvement in cognitive status according to the overall score, the abstraction scale, speech, memory and visual-constructive skills. Correlation analysis in the group with type 1 DM showed that the result of exercises on visual attention and auditory perception was influenced by memory function. In individuals with type 2 DM, increased glycated hemoglobin was associated with a decrease in cognitive functions according to the overall score of the MoCA test, as well as in tasks for speech, memory, visual-constructive skills. Dynamic analysis of changes in the MRI picture revealed hypoperfusion in the area of the right and left thalamus in patients with type 1 and type 2 DM, respectively, as well as increased perfusion of the white matter of the right parietal lobe in the group with type 1 DM, and in the putamen area on the left in the group with type 2 DM.&#x0D; CONCLUSION: In patients with type 1 and type 2 DM, as well as with cognitive deficit, who underwent a course of cognitive rehabilitation using computerized training, an improvement in cognitive status was noted, which was confirmed by the results of contrast-free perfusion MRI. to evaluate the effectiveness of computerized training in cognitive rehabilitation in people with type 1 and type 2 diabetes mellitus, taking into account the dynamics of brain perfusion.

High prevalence of cognitive impairment in an unselected pre-operative population: A prospective single centre cohort study.

High prevalence of cognitive impairment in an unselected pre-operative population: A prospective single centre cohort study.

The Association of Allergy-Related and Non-Allergy-Related Olfactory Impairment with Cognitive Function in Older Adults: Two Cross- Sectional Studies.

Evidence on the association of Olfactory Impairment (OI) with age-related cognitive decline is inconclusive, and the potential influence of allergy remains unclear. We aimed to evaluate the cross-sectional associations of allergy-related and non-allergy- related OI to cognitive function. We included 2,499 participants from the Health and Retirement Study (HRS)-Harmonized Cognitive Assessment Protocol (HCAP) sub-study and 1,086 participants from the English Longitudinal Study of Ageing (ELSA)-HCAP. The Olfactory Function Field Exam (OFFE) using Sniffin' Stick odor pens was used to objectively assess olfactory function and an olfactory score <6/11 indicated OI. Mini-Mental Status Examination (MMSE) was used to assess global cognitive function and define cognitive impairment (<24/30). A neuropsychologic battery was used to assess five cognitive domains. Compared to non-OI participants, individuals with OI had lower MMSE z-score [βHRS = -0.33, 95% Confidence Interval (CI): -0.41 to -0.24; βELSA = -0.31, -0.43 to -0.18] and higher prevalence of cognitive impairment (Prevalence Ratio (PR)HRS = 1.46, 1.06 to 2.01; PRELSA = 1.63, 1.26 to 2.11). The associations were stronger for non-allergy-related OI (βHRS = -0.36; βELSA = -0.34) than for allergy-related OI (βHRS = -0.26; βELSA = 0.13). Similar associations were observed with domain- specific cognitive function measures. OI, particularly non-allergy-related OI, was related to poorer cognitive function in older adults. Although the current cross-sectional study is subject to several limitations, such as reverse causality and residual confounding, the findings will provide insights into the OI-cognition association and enlighten future attention to non-allergy-related OI for the prevention of potential cognitive impairment.

Cognitive impairment and the associated factors among women with a history of pregnancy complications in rural southwestern Uganda.

Worldwide, there is a growing concern about the rising number of people with declining cognitive functioning. However, findings on this phenomenon are inconclusive. Our study aimed to assess the prevalence of cognitive impairment and the associated factors in women with a history of pregnancy complications in rural southwestern Uganda. This was a cross-sectional study carried out among women above 40 years of age in the greater Kabale district of southwestern Uganda between March and April 2022. Study participants were identified using a consecutive sampling method. Predictor variables included pregnancy complications and other social demographic factors that were assessed by semi-structured interviews while cognitive functioning as an outcome variable was assessed by Montreal Cognitive Assessment (MoCA-B) tool. Data were analyzed using STATA at a 95% Confidence level. Logistic regression analyses were selected for statistical modelling while odds ratios were calculated to assess the strength of associations between the predictor and outcome variables. In total, 75% (212/280) of participants had some form of cognitive impairment, with 45% (123/280) falling into mild CI, 31% (86/280) moderate CI and 4% (10/280) severe CI. Twenty-three percent (68/280) of participants fell into category of normal cognitive functioning. Participants with >65 years of age had higher odds of developing cognitive impairment (OR = 2.94; 95%CI: 0.96-9.04, p = 0.06) than those with < 65 years of age. Protective factors to cognitive impairment include delivering from a health facility (OR = 0.31,95% CI:0.16-0.60, p = < .001), primary and post primary levels of education (OR = 0.05; 95% CI: 0.02-0.13, p<0.001, OR = 0.04; 95%CI: 0.02-0.23, p<0.001) respectively. Results from this study show a high prevalence of cognitive impairment among women with a history of pregnancy complications in rural southwestern Uganda. Interventions geared toward preventing cognitive impairment among females with a history of pregnancy complications should be emphasized.

Cognitive phenotypes in late-onset epilepsy: results from the atherosclerosis risk in communities study.

Cognitive phenotyping is a widely used approach to characterize the heterogeneity of deficits in patients with a range of neurological disorders but has only recently been applied to patients with epilepsy. In this study, we identify cognitive phenotypes in older adults with late-onset epilepsy (LOE) and examine their demographic, clinical, and vascular profiles. Further, we examine whether specific phenotypes pose an increased risk for progressive cognitive decline. Participants were part of the Atherosclerosis Risk in Communities Study (ARIC), a prospective longitudinal community-based cohort study of 15,792 individuals initially enrolled in 1987-1989. LOE was identified from linked Centers for Medicare and Medicaid Services claims data. Ninety-one participants with LOE completed comprehensive testing either prior to or after seizure onset as part of a larger cohort in the ARIC Neurocognitive Study in either 2011-2013 or 2016-2017 (follow-up mean = 4.9 years). Cognitive phenotypes in individuals with LOE were derived by calculating test-level impairments for each participant (i.e., ≤1 SD below cognitively normal participants on measures of language, memory, and executive function/processing speed); and then assigning participants to phenotypes if they were impaired on at least two tests within a domain. The total number of impaired domains was used to determine the cognitive phenotypes (i.e., Minimal/No Impairment, Single Domain, or Multidomain). At our baseline (Visit 5), 36.3% met criteria for Minimal/No Impairment, 35% for Single Domain Impairment (with executive functioning/ processing speed impaired in 53.6%), and 28.7% for Multidomain Impairment. The Minimal/No Impairment group had higher education and occupational complexity. There were no differences in clinical or vascular risk factors across phenotypes. Of those participants with longitudinal data (Visit 6; n = 24), 62.5% declined (i.e., progressed to a more impaired phenotype) and 37.5% remained stable. Those who remained stable were more highly educated compared to those that declined. Our results demonstrate the presence of identifiable cognitive phenotypes in older adults with LOE. These results also highlight the high prevalence of cognitive impairments across domains, with deficits in executive function/processing speed the most common isolated impairment. We also demonstrate that higher education was associated with a Minimal/No Impairment phenotype and lower risk for cognitive decline over time.

Cognitive Impairment in Cardiovascular Patients after Myocardial Infarction: Prospective Clinical Study.

(1) Background: Assessment of cognitive function is not routine in cardiac patients, and knowledge on the subject remains limited. The aim of this study was to assess post-myocardial infarction (MI) cognitive functioning in order to determine the frequency of cognitive impairment (CI) and to identify factors that may influence it. (2) Methods: A prospective study included 468 patients hospitalized for MI. Participants were assessed twice: during the first hospitalization and 6 months later. The Mini-Mental State Examination was used to assess the occurrence of CI. (3) Results: Cognitive dysfunction based on the MMSE was found in 37% (N-174) of patients during the first hospitalization. After 6 months, the prevalence of deficits decreased significantly to 25% (N-91) (p < 0.001). Patients with CI significantly differed from those without peri-infarction deficits in the GFR, BNP, ejection fraction and SYNTAX score, while after 6 months, significant differences were observed in LDL and HCT levels. There was a high prevalence of non-cognitive mental disorders among post-MI patients. (4) Conclusions: There is a high prevalence of CI and other non-cognitive mental disorders, such as depression, sleep disorders and a tendency to aggression, among post-MI patients. The analysis of the collected material indicates a significant impact of worse cardiac function expressed as EF and BNP, greater severity of coronary atherosclerosis expressed by SYNTAX results, and red blood cell parameters and LDL levels on the occurrence of CI in the post-MI patient population.

Nursing Home Resident Preferences for Daily Care and Activities: A Latent Class Analysis of National Data.

Uncovering subgroups of nursing home residents sharing similar preference patterns is useful for developing systematic approaches to person-centered care. This study aimed to (i) identify preference patterns among long-stay residents, and (ii) examine the associations of preference patterns with resident and facility characteristics. This study was a national cross-sectional analysis of Minimum Data Set assessments in 2016. Using resident-rated importance for 16 preference items in the Preference Assessment Tool as indicators, we conducted latent class analysis to identify preference patterns and examined their associations with resident and facility characteristics. We identified 4 preference patterns. The high salience group (43.5% of the sample) was the most likely to rate all preferences as important, whereas the low salience group (8.7%) was the least likely. The socially engaged (27.2%) and the socially independent groups (20.6%) featured high importance ratings on social/recreational activities and maintaining privacy/autonomy, respectively. The high salience group reported more favorable physical and sensory function than the other 3 groups and lived in facilities with higher staffing of activity staff. The low salience and socially independent groups reported a higher prevalence of depressive symptoms, whereas the low salience or socially engaged groups reported a higher prevalence of cognitive impairment. Preference patterns also varied by race/ethnicity and gender. Our study advanced the understanding of within-individual variations in preferences, and the role of individual and environmental factors in shaping preferences. The findings provided implications for providing person-centered care in NHs.