High Prevalence Of Dementia Research Articles

National outcomes for dementia patients undergoing cardiac surgery in a pre-structural era.

With an aging population and higher prevalence of dementia, there is a paucity of data regarding dementia patients undergoing cardiovascular surgery. We examined the nationwide trends and outcomes of cardiovascular surgery patients with dementia to determine its effect on morbidity, mortality, and discharge disposition. From 2002 to 2014, 11,414 (0.27%) of the 4,201,697 cardiac surgery patients from the Nationwide Inpatient Sample had a preoperative diagnosis of dementia. Propensity-score matching was used to balance dementia and non-dementia groups. Primary outcomes included postoperative morbidity, mortality, and discharge to skilled nursing facility (SNF). Dementia patients were more often male (67%) and 65-84 years old (84%). Postoperative mortality among patients with dementia was lower compared to patients without dementia (3.4% vs. 4.6%, p < 0.05). In dementia patients, there were more complications (65% vs. 60%, p < 0.01), more blood transfusions [OR 1.3, 95%CI (1.1, 1.5), p < 0.01] and delirium [OR 3.6, 95%CI (2.9, 4.5), p < 0.0001). Dementia patients (n = 5,623, 49.8%) were twice as likely to be discharged to SNF [OR 2.1, 95%CI (1.9, 2.4), p < 0.0001]. Dementia patients discharged to SNF more often had delirium (18.2% vs. 12%, p < 0.01), renal complications (17% vs. 8%, p < 0.01), and prolonged mechanical ventilation (15% vs. 8%, p < 0.01). Despite an aging population with increasing prevalence of dementia, patients with dementia can undergo cardiovascular surgery with a lower in-hospital mortality and similar hospitalization costs compared to their non-dementia counterparts. Dementia patients are more likely to experience complications and require discharge to skilled nursing facility. Careful patient selection and targeted physical therapy may help mitigate some dementia associated complications.

Relationship of Hearing Loss to Parkinson's Disease, Dementia, and APOE Genotype in Adults.

Background: Hearing loss has been recognized as a risk factor for dementia and non-motor features of Parkinson's disease (PD). The apolipoprotein E (APOE) protein contributes to maintenance and repair of neuronal cell membranes, causing age-related disorders. This study aimed to analyze the impact of hearing loss on cognitive impairment, PD severity, and APOE gene expression in these patients. Methods: A total of 72 out-patients diagnosed with either PD or hearing loss were enrolled in this study. The hearing assessment included pure-tone audiometry, speech reception thresholds, and speech discrimination ability. Dementia was assessed by filling out the Clinical Dementia Rating and Mini-Mental State Examination questionnaires. The severity of PD was assessed using the Modified Hoehn and Yahr scale. Blood samples were tested for the gene expression of APOE. Results: Out of the 72 cases, there were 44 males and 28 females, with an average age of 64.4 ± 9.1 years. A total of 41 out of 72 cases had dementia and had a worse hearing threshold than those without dementia (47.1 ± 24.4 vs. 31.7 ± 22.1 dB, p = 0.006). A total of 58 patients were diagnosed with PD, with 14 of them classified as having severe symptoms (Modified Hoehn and Yahr scale > 2). Patients with severe PD were found to have a worse hearing threshold (49.6 ± 28.3 vs. 30.3 ± 17.8 dB, p = 0.028) and higher prevalence of dementia (12/14 vs. 18/44, p = 0.006). Among 10 individuals with the APOE ε4 gene, the prevalence of dementia was higher than those without the ε4 allele (9/10 vs. 32/62, p = 0.036). Conclusions: Hearing loss is common in severe PD and in dementia patients. Severe PD has a negative impact on the hearing threshold and cognitive dysfunction. Patients with APOE ε4 have a higher prevalence of dementia.

Depression, Vascular Burden, and Dementia Prevalence in Late Middle-Aged and Older Black Adults.

Late-life depression and white matter hyperintensities (WMH) have been linked to increased dementia risk. However, there is a dearth of literature examining these relationships in Black adults. We investigated whether depression or WMH volume are associated with a higher likelihood of dementia diagnosis in a sample of late middle-aged to older Black adults, and whether dementia prevalence is highest in individuals with both depression and higher WMH volume. Secondary data analysis involved 443 Black participants aged 55+ with brain imaging within 1 year of baseline visit in the National Alzheimer's Coordinating Center Uniform Data Set. Chi-square analyses and logistic regression models controlling for demographic variables examined whether active depression in the past 2 years, WMH volume, or their combination were associated with higher odds of all-cause dementia. Depression and higher WMH volume were associated with a higher prevalence of dementia. These associations remained after controlling for demographic factors, as well as vascular disease burden. Dementia risk was highest in the depression/high WMH volume group compared to the depression-only group, high WMH volume-only group, and the no depression/low WMH volume group. Post hoc analyses comparing the Black sample to a demographically matched non-Hispanic White sample showed associations of depression and the combination of depression and higher WMH burden with dementia were greater in Black compared to non-Hispanic White individuals. Results suggest late-life depression and WMH have independent and joint relationships with dementia and that Black individuals may be particularly at risk due to these factors.

Willingness to institutionalize a relative with dementia: a web-platform assessment with the Portuguese adapted version of the Desire-to-Institutionalize Scale.

Older persons with dementia (PwD) are more likely to be institutionalized than their counterparts without dementia. The caregiver's desire to institutionalize has been suggested as the most important predictor of actual institutionalization. This cross-sectional study aimed to culturally adapt the Desire to Institutionalize Scale (DIS) to a country with a high prevalence of dementia (Portugal) and examine its psychometric properties. The reliability, structural validity, and criterion validity of the DIS-PT were assessed by applying the scale using a remote measurement web platform. A sample of 105 dementia caregivers completed the DIS-PT and several psychosocial measures, including caregiver burden, anxiety, depression, quality of life, PwD functional independence, and neuropsychiatric symptoms. The DIS-PT demonstrated good structural validity, with one factor explaining 75% of the total variance. The internal consistency of the scale was high (α = 0.802). Most caregivers (65.7%) endorsed at least one item on the DIS-PT (Mdn 2). The caregiver's desire to institutionalize was significantly associated with the caregiver, care recipient, and contextual variables previously known to affect institutional placement. These included the caregivers' occupational status, perceived burden, anxiety (but not depression), physical and psychological quality of life, care recipient education, severity of neuropsychiatric symptoms, and cohabitation with the caregiver. This study offers preliminary support for the psychometric quality of the DIS-PT. The scale has practical applications in the early identification of caregivers considering nursing home placement, providing room for intervention in modifiable risk factors that may otherwise lead to the institutionalization of PwD. Remote measurement tools may hold value in assessing caregiving dyads non-intrusively and inexpensively.

Lay Knowledge and Beliefs Toward Dementia Among the Black African Populations in the UK and Africa: Evidence Synthesis of Qualitative Studies.

The high prevalence of dementia among Black Africans, coupled with their lower engagement with dementia specialist services in the UK, underscores the urgency of understanding lay knowledge and beliefs about dementia in the group. Studies reporting lay knowledge of dementia in the UK tended to conclude that Black Africans lack dementia knowledge, presumably based on biomedical assumptions, without taking into consideration the Black Africans' lay dementia knowledge and beliefs about dementia. The current study, therefore, investigated the Black African populations' lay knowledge and beliefs toward dementia in Africa, comparing how this relates to the findings in the UK literature. Methodology: The researcher thoroughly searched electronic databases from September 2017 to October 2022 for qualitative research exploring how Black African populations perceived and experienced dementia, which informed the Black Africans' dementia knowledge in Africa and the UK. The review included qualitative studies with African populations published in peer-reviewed journals with available abstracts and full text in English. Studies outside the UK and Africa, as well as quantitative research and studies with health practitioners, were excluded. A grounded theory approach informed the thematic analysis. The researcher reported the Black Africans' lay knowledge and beliefs toward dementia, informed by participants' experiences and meanings of dementia. Results: Twenty-two studies (n = 22) met the eligibility criteria and were appraised and included in the review. All the UK papers were a multi-modeling of ethnicity in the study. Nine studies (n = 9) were conducted in the UK. Thirteen studies (n = 13) are conducted in Africa, (5 [n = 5] studies from South Africa, 2 [n = 2] from Tanzania, 1 [n = 1] from Congo, 2 [n = 2] from Uganda, 2 [n = 2] from Nigeria, and 1 [n = 1] from Ghana). All the studies were valuable. The researcher identified and developed 4 themes as they emerged from the studies: (i) Dementia witchcraft paradigm, (ii) Dementia older age paradigm, (iii) Dementia disease and illness paradigm, and (iv) Dementia identity paradigm. Discussion/Conclusion: The lay knowledge and beliefs about dementia among Black African populations were foregrounded in sociocultural distinctiveness, and some understanding intersected with biomedical knowledge about dementia. Further empirical study in the UK is essential. Implications for policy and practice: A better understanding of lay knowledge and beliefs about dementia among Black African populations can improve dementia care, providing culturally sensitive and tailored support for Black African communities.

Исследование распространенности сочетанного поражения органов зрения, слуха и нарушений когнитивной функции у населения Южного Урала в возрасте 85 лет и старше

Material and methods. This study was carried out as part of the research project Ural Eye Study of Very Old People. The study involved 1526 respondents aged 85 years and older. Results. This study was conducted on 731 (47.9%) respondents (mean age 88.1±2.7 years; median 87 years, range 85–98 years) with available data on measures of vision, hearing, and cognitive function. The prevalence of low vision and blindness, hearing impairment, combined disorders and the presence of dementia was 51.8% (95% CI 48.2 to 55.5%), 33.1% (95% CI 29.7 to 36.5%), 20.5% (95% CI 17.8 to 23.5%) and 48.2% (95% CI 44.5 to 51.8%), respectively. A lower cognitive function score was associated with lower visual acuity (p&lt;0.001) and a higher degree of hearing loss (p=0.03), adjusted for older age (p=0.001), rural region of residence (p=0.003), lower level of education (p&lt;0.001) and higher depression scores (p&lt;0.001). Higher prevalence of dementia was associated with higher incidence of hearing impairment (OR 2.18, 95% CI 1.59 to 2.98; p&lt;0.001), higher incidence of low vision/blindness (OR 2.09, 95% CI 1.55 to 2.81; p&lt;0.001) and a higher prevalence of combined visual and hearing impairment (OR 2.80, 95% CI 1.92 to 4.07; p&lt;0.001). Conclusion. This study showed a stronger association of combined visual and hearing impairment (prevalence 20.5%) (OR 2.80) with dementia compared with hearing impairment alone (OR 2.18) or visual impairment alone (OR 2.09). The findings show the importance of correcting sensory impairments for the prevention of dementia. Key words: very old population, population-based study, blindness, low vision, hearing loss, dementia

SENSORIMOTOR IMPAIRMENTS AND DEMENTIA: A CROSS-SECTIONAL ANALYSIS OF NATIONAL HEALTH AND AGING TRENDS STUDY

Abstract Sensory impairments in vision and hearing are linked to dementia in older adults. However, this association has not been investigated in conjunction with motor function performance. We examined cross-sectional sensory and motor function and dementia status data from 1,765 participants in the National Health and Aging Trends Study (NHATS R11, 2021) (32.7% aged ≥80 years; 55% women) who completed objective physical function and sensory testing. Motor function was defined using grip strength (kg), gait speed (m/s), standing balance, and chair stand speed (stands/sec). Sensory function was defined using hearing (pure tone average for better ear (BPTA) (dB)) and vision (contrast sensitivity (logCS)). Dementia was categorized as possible or probable using NHATS dementia classification. Survey-weighted logistic regression models estimated the likelihood of dementia by impairment in sensory and motor function, adjusted for demographic and medical conditions. 185 (10.5%) participants had possible or probable dementia. In models incorporating both motor and sensory impairments, impaired standing balance (&amp;lt;3 standing balance score in SPPB) and slow walking speed (&amp;lt;0.8m/s) were associated with higher odds of dementia (OR=1.75; 95%CI 1.10-2.79; and 2.39 95%CI 1.37-4.15, respectively), while hearing impairment (BPTA&amp;gt;25dB) and contrast sensitivity (&amp;lt;1.55logCS) were not associated with higher prevalence of dementia. In this nationally representative sample of older US adults, results suggest motor function is more strongly associated with dementia relative to sensory function among participants able to complete physical function testing. Future research is needed to understand how the associations of sensory and motor function with dementia change from mid-to-late life.

MODIFICATION OF THE ASSOCIATION BETWEEN HEARING LOSS AND DEMENTIA PREVALENCE BY SELF-REPORTED SLEEP DISTURBANCES

Abstract Hearing loss and sleep disturbances are both known risk factors for dementia. High prevalence and modifiability in late life make them potential targets for dementia prevention. However, their combined contribution to dementia is unknown. The National Health and Aging Trends Study (NHATS) is a longitudinal panel survey of a nationally representative sample of Medicare beneficiaries. A validated algorithm based on self- or proxy-reported diagnosis, AD8 dementia screening, and cognitive tests was used to classify participants as having probable/possible vs. no dementia. Pure-tone audiometry was added to the 2021 round of NHATS; participants with better-ear 4-frequency (0.5, 1, 2, 4 kilohertz) pure-tone average above 25 decibels were categorized as having hearing loss. Participants reported their frequencies of taking &amp;gt;30 minutes to fall asleep and having trouble falling back asleep and were defined as having each symptom if it was experienced ≥2 nights/week. We used Poisson regression with robust standard errors and included an interaction term between sleep disturbances and hearing loss, adjusting for demographics, smoking, body mass index and comorbidities. Among 2,383 participants aged 71+ years (46% male, 7% Black), hearing loss was cross-sectionally associated with higher dementia prevalence only among participants with sleep disturbances (&amp;gt;30 minutes to fall asleep: prevalence ratio [PR]=1.81, 95% CI:0.99, 3.31; difficulties falling back asleep: PR=1.82, 95% CI:1.02, 3.26). Older adults with both hearing loss and sleep disturbances might represent a high-risk subgroup that needs to be prioritized. With the complex etiology of dementia, a better understanding of the co-occurrence of multiple risk factors is needed.

HIDDEN BARRIERS TO ENGAGING HOME- AND COMMUNITY-BASED SERVICES IN DEMENTIA CARE RESEARCH

Abstract The high prevalence of dementia in the United States has resulted in a reliance on home-and community-based services (HCBS) to assist in the provision of care for community-dwelling persons living with dementia. Partnering with HCBS organizations, like Adult Day Services (ADS), is beneficial to disseminating evidence-based dementia care interventions as it is an existing service that can be leveraged to foster relationships between research staff and clients. While benefits exist, challenges in identifying community-partner organization, ethical approval, and community-partner staffing can be unintended barriers. Using the ADS Plus Program as a case-study, this presentation will detail hidden barriers in engaging HCBS partnerships into dementia care research. Specifically, we will discuss barriers to 1) developing relationships to implement a multi-site national-trial, 2) high touch points necessary to engage sites from underrepresented populations, 3) institutional review board requirements (e.g. CiTi training, Federal Wide Assurance Forms), and 4) staff readiness to participate in research. We also offer recommendations based on lessons learned from the ADS Plus Program to enhance the pipeline from engagement with HCBS to participate in research to implementing an evidence-based interventions. Lessons learned from the ADS Plus Program demonstrates that changes are needed to improve the efficiency of the pipeline from community-based participation into dementia care research and implementation of evidence-based interventions.

The evaluation of translated neuropsychological assessments tools for the early detection of mild cognitive impairment (MCI) in low‐ and middle‐income countries (LMICs)

AbstractBackgroundThe incidence of mild cognitive impairment (MCI), particularly in low and middle‐income countries (LMICs) has been noticeably on the rise. With the high cost of dementia care, the need for tools that aid with the early detection of MCI is becoming of high importance, especially in LMICs. As a part of screening for MCI, many tests have been proposed evaluating for impairments in cognitive, behavioral, and functional domains, which are important for ruling out and evaluating for any reversible causes. While useful, most of these tests were developed in the west, limited works exist reporting the appropriateness and experience of using such tests for patients from LMICs.MethodIn this work, we aim to evaluate the use of translated digital assessment for detecting MCI in an Arabic‐speaking population in Palestine. For this purpose, we developed a digital test covering three cognitive, behavioral, and functional domains, where MMSE and the Neuropsychiatric Inventory ‐ Questionnaire (NPI‐Q) together with two functional assessment questionnaires were translated to Modern Standard Arabic (MSA) and presented in a digital interface. Upon the development and translation of the digital tests, field testing was conducted to check for use experience and appropriate patient comprehension of the questions to match their intended use.ResultFollowing the implementation of the digital assessment tools, quantitative and qualitative data was collected summarizing the user experience, where numerous limitations were noted. Despite being asked in their native language, several patients expressed the need for more clarifying questions. While all patients were Arabic speakers, some patients required the use of simpler terminology that matches their local dialects. Other patients reported the lack of relevance of certain questions, regarding the activities of daily living in the functional assessments. Overall, the patient’s experience and comprehension of questions varied with their age and literacy level.ConclusionDespite the high prevalence of dementia in LMICs, there are limited available neuropsychological assessment tools that are fit for the local cultural and linguistic. The findings suggest the need for the development of culturally and linguistically appropriate assessments to ensure appropriate patient comprehension, and avoid misdiagnosis of patients.

INCREASED CATALASE ACTIVITY IN AGING ADULTS WITH DOWN SYNDROME: ASSOCIATIONS WITH AGE AND COGNITIVE DECLINE

AbstractBackgroundThe aging process in Down syndrome (DS) is associated with a high prevalence of dementia, which is regarded as a variant form of early‐onset Alzheimer’s disease (AD). In addition to the central role played by amyloid pathology, DS‐dementia (DS‐D) may also be related to abnormal regulation of oxidative stress. The copper/zinc‐dependent superoxide dismutase (SOD1) gene is also located on chromosome 21, and studies have suggested an association of SOD1 overexpression with disrupted redox homeostasis. We hypothesize that such abnormalities may be further related to cognitive decline in DS.Method30 aging adults with DS were enrolled to the study, of whom 14 were cognitively stable (DS‐S) and 16 had evidence of cognitive decline (DS‐D). Two comparison groups were constituted with euploid volunteers, i.e., 30 age‐matched, cognitively healthy subjects (euploid controls, EU‐C); and 60 MCI and AD patients (EU‐MCI‐AD). We used an enzymatic assay to determine catalase activity.ResultAs compared to euploid controls, catalase activity was increased in DS irrespective of the presence of cognitive decline (p&lt;0.004). This finding was also observed when the DS group was stratified according to the presence of cognitive decline (EU‐C vs. DS‐S, p&lt;0.001; EU‐C vs. DS‐D, p&lt;0.01). Catalase activity was also increased among cognitively stable DS as compared to MCI‐AD (DS‐S vs. EU‐MCI‐AD, p&lt;0.027).When the DS group was stratified by age (18‐34y, 35‐49y, and ≥ 50y), catalase activity was found to be increased in younger and middle‐aged DS‐S as compared to EU‐C (18‐34y, p&lt;0.01; 35‐49y, p&lt;0.01) and in middle‐aged DS‐S as compared to SD‐D (35‐49y: p&lt; 0.03).ConclusionOur preliminary findings suggest a systemic pro‐oxidant status in DS, evidenced by the increased catalase activity, presumably as a physiological compensation for redox imbalance due to the upregulation of SOD1 (data not shown). Furthermore, antioxidant defense functions decline with aging in the DS carrying. Thus, catalase could be a predictive biomarker candidate for AD.

Modifiable risk factors for dementia in Indonesia: Results from STRiDE project

Background &amp; Objective: Indonesia’s ageing population and increasing number of people living with dementia poses significant challenge to the health system. Better understanding of factors related to dementia prevalence is needed to mitigate risk, improve care, and ultimately reduce the incidence of dementia. In this study, we aimed to describe associations between potential risk factors and dementia in Indonesia. Methods: A cross-sectional study, part of the Strengthening Responses to Dementia in Developing Countries (STRiDE) project, was conducted in two provinces in Indonesia, Jakarta and North Sumatra between September and December 2021. A total of 2,110 older adults and their informants completed questionnaires covering cognitive and functional status, socioeconomic, medical and lifestyle factors. Models for each potential modifiable risk factor were created and then adjusted by age, sex and literacy. Prevalence ratios (PRs) were calculated for each risk factor. Results: In the adjusted models, lower education, lower occupational attainment, unmanaged diabetes, stroke, head trauma within the past 5 years, hearing loss, and chronic obstructive airway disease were all associated with higher prevalence of dementia in Indonesia. Current smoking, historic depression and high blood pressure were associated with higher dementia prevalence, but not statistically significant. Conclusion: Improving socioeconomic status (i.e., education and employment) and reducing health- related risk factors may be viable solutions to reduce the high prevalence rates of dementia in Indonesia. Further longitudinal research is needed to confirm direction of effect and causality.

A systematic review of measures of social connection for people living in long‐term care homes

AbstractBackgroundSocial connection is important for quality of life and care in long‐term care (LTC) homes. However, measuring social connection in LTC residents is challenging due to the high prevalence of dementia and the distinct care environment and activities, so research is limited by a lack of consensus on best approaches to measurement. The objective of our study is to systematically review measures of social connection developed for LTC residents, including those with dementia, by evaluating their measurement properties including structural validity, internal consistency, reliability and construct validity.MethodWe are following COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) systematic review methods. We searched multiple bibliographic databases to November 2021 for studies conducted in LTC residents, which quantified any aspect(s) of social connection, and reported at least one psychometric property for the measure(s) of social connection. We conducted a second targeted search in April 2022 using our list of identified measures, supplemented with a list of measures used in previous research in this population. We are using COSMIN guidelines to evaluate the measurement properties reported for each identified measure.ResultWe identified 68 studies reporting on 35 measures that assess social connection in LTC homes. Twenty‐five were measures of quality of life, wellbeing or life satisfaction and included a social connection subdomain. Only 10 measures specifically targeted social connection. From our pooled evaluation of 20 measures to date, we found that 20% (n = 4) have sufficient structural validity, 15% (n = 3) have sufficient internal consistency, 25% (n = 5) have sufficient reliability, and 15% (n = 3) have sufficient construct validity.ConclusionMany measures have assessed social connection in LTC settings for people living with dementia, but few are designed for this purpose and they often have insufficient psychometric properties. This review will provide detailed evidence of the quality of these measures to enable researchers to prioritize valid and reliable tools. Our results will inform our development of a new person‐centred social connection measurement tool for LTC residents in the Alzheimer’s Association/Brain Canada‐funded Social Connection in Long‐Term Care Home Residents (SONNET) study.

인지기능 저하 노인의 영양상태와 우울 간의 관계

This study aims to examine the moderating effect of social support on the relationship between nutritional status and depression in the older adults with cognitive impairment group. For this purpose, 2,545 older adults with cognitive impairment group and 7,281 normal older adults selected based on a cognitive function diagnostic test were selected as final analysis subjects among all respondents in the 2020 survey of living conditions and welfare needs of Korean older persons. As a result of the study, it was found that both the nutritional status and depression relationship between cognitive impairment group and normal older adults were negatively significant. It was found that the elderly with cognitive impairment group had a significant the blood relation social support system among social support, and normal older adults had a significant non-blood relation social support system among social support. In other words, the lower the blood relation social support system for the elderly with cognitive impairment group, and the lower the non-blood relation social support system for the normal older adults, the higher the depression. Finally, as a result of examining the moderating effect of social support, it was found that the elderly with reduced cognitive function had a moderating effect in the blood relation social support system and the normal older adults elderly in the non-blood relation social support. Therefore, this study expanded the academic discussion by examining the moderating effect of social support on nutritional status and depression in the elderly based on NSS (New Nutrition Science), which emphasizes theories related to nutrition, depression, and social support. In particular, it is meaningful in that it can be used as basic data for practical and policy measures by conducting research on the elderly with cognitive decline, who have a high prevalence of dementia and mild cognitive impairment.

Modified Korean MIND Diet: A Nutritional Intervention for Improved Cognitive Function in Elderly Women through Mitochondrial Respiration, Inflammation Suppression, and Amino Acid Metabolism Regulation.

Mild cognitive impairment is associated with a high prevalence of dementia. The study examines the benefits of a modified Korean MIND (K-MIND) diet and explores biomarkers using multi-omics analysis. The K-MIND diet, tailored to the elderly Korean population, includes perilla oil, milk, or fermented milk, and avoids alcohol consumption. As a result, the K-MIND diet significantly improves subjects "orientation to place" in the Korean version of the Mini-Mental State Examination, 2nd edition test. According to multi-omics analysis, the K-MIND diet upregulates genes associated with mitochondrial respiration, including ubiquinone oxidoreductase, cytochrome C oxidase, and ATP synthase, and immune system processes, and downregulates genes related to nuclear factor kappa B activity and inflammatory responses. In addition, K-MIND affects the metabolic pathways of glycine, serine, threonine, tryptophan, and sphingolipids, which are closely linked to cognitive function through synthesis of neurotransmitters and structures of brain cell membranes. The findings imply that the K-MIND diet improves cognitive function by upregulating key genes involved in oxidative phosphorylation and downregulating pro-inflammatory cytokines.

Prognosis, characteristics, and provision of care for patients with the unspecified heart failure electronic health record phenotype: a population-based linked cohort study of 95262 individuals

Whether the accuracy of the phenotype ascribed to patients in electronic health records (EHRs) is associated with variation in prognosis and care provision is unknown. We investigated this for heart failure (HF, characterised as HF with preserved ejection fraction [HFpEF], HF with reduced ejection fraction [HFrEF] and unspecified HF). We included individuals aged 16 years and older with a new diagnosis of HF between January 2, 1998 and February 28, 2022 from linked primary and secondary care records in the Clinical Practice Research Datalink in England. We investigated the provision of guideline-recommended diagnostic investigations and pharmacological treatments. The primary outcome was a composite of HF hospitalisation or all-cause death, and secondary outcomes were time to HF hospitalisation, all-cause death and death from cardiovascular causes. We used Kaplan-Meier curves and log rank tests to compare survival across HF phenotypes and adjusted for potential confounders in Cox proportional hazards regression analyses. Of a cohort of 95,262 individuals, 1271 (1.3%) were recorded as having HFpEF, 10,793 (11.3%) as HFrEF and 83,198 (87.3%) as unspecified HF. Individuals recorded as unspecified HF were older with a higher prevalence of dementia. Unspecified HF, compared to patients with a recorded HF phenotype, were less likely to receive specialist assessment, echocardiography or natriuretic peptide testing in the peri-diagnostic period, or receive angiotensin-converting enzyme inhibitors, beta blockers or mineralocorticoid receptor antagonists up to 12 months after diagnosis (risk ratios compared to HFrEF, 0.64, 95% CI 0.63-0.64; 0.59, 0.58-0.60; 0.57, 0.55-0.59; respectively) and had significantly worse outcomes (adjusted hazard ratios compared to HFrEF, HF hospitalisation and death 1.66, 95% CI 1.59-1.74; all-cause mortality 2.00, 1.90-2.10; cardiovascular death 1.77, 1.65-1.90). Our findings suggested that absence of specification of HF phenotype in routine EHRs is inversely associated with clinical investigations, treatments and survival, representing an actionable target to mitigate prognostic and health resource burden. Japan Research Foundation for Healthy Aging and British Heart Foundation.

Associations among multidomain lifestyles, chronic diseases, and dementia in older adults: a cross-sectional analysis of a cohort study.

Unhealthy lifestyles and chronic diseases are commonly seen and treatable factors in older adults and are both associated with dementia. However, the synergistic effect of the interaction of lifestyles and chronic diseases on dementia is unknown. We determined independent associations of multidomain lifestyles and chronic diseases (cerebrovascular disease, diabetes, and hypertension) with dementia and examined their synergistic impact on dementia among older adults. The data were drawn from the Hubei Memory and Aging Cohort Study. We created a summary score of six factors for multidomain lifestyles. Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders IV. Logistic regression and multiple correspondence analyses were used to explore the relationships among multidomain lifestyles, chronic diseases, and dementia. A sensitivity analysis was performed to minimize the interference of reverse causality and potential confounders. Independent associations with dementia were found in unhealthy (OR = 1.90, 95% CI: 1.38-2.61) and intermediate healthy lifestyles (OR, 3.29, 2.32-4.68), hypertension (OR, 1.21, 1.01-1.46), diabetes (OR, 1.30, 1.04-1.63), and cerebrovascular disease (OR, 1.39, 1.12-1.72). Interactions of diabetes (p = 0.004), hypertension (p = 0.004), and lifestyles were significant, suggesting a combined impact on dementia. Sensitivity analysis supported the strong association among multidomain lifestyles, chronic diseases, and dementia prevalence. An unhealthy lifestyle was associated with a higher prevalence of dementia, regardless of whether the participants had chronic diseases; however, this association was stronger in individuals with chronic diseases. Multidomain lifestyles and chronic diseases may have an enhanced impact on dementia.

Feasibility of self-reported health related quality of life assessment with older people in residential care: insights from the application of eye tracking technology

PurposeIncreasingly there are calls to routinely assess the health-related quality of life (HRQoL) of older people receiving aged care services, however the high prevalence of dementia and cognitive impairment remains a challenge to implementation. Eye-tracking technology facilitates detailed assessment of engagement and comprehension of visual stimuli, and may be useful in flagging individuals and populations who cannot reliably self-complete HRQoL instruments. The aim of this study was to apply eye-tracking technology to provide insights into self-reporting of HRQoL among older people in residential care with and without cognitive impairment.MethodsResidents (n = 41), recruited based on one of three cognition subgroups (no, mild, or moderate cognitive impairment), completed the EQ-5D-5L on a computer with eye tracking technology embedded. Number and length of fixations (i.e., eye gaze in seconds) for key components of the EQ-5D-5L descriptive system were calculated.ResultsFor all dimensions, participants with no cognitive impairment fixated for longer on the Area of Interest (AOI) for the response option they finally chose, relative to those with mild or moderate cognitive impairment. Participants with cognitive impairment followed similar fixation patterns to those without. There was some evidence that participants with cognitive impairment took longer to complete and spent relatively less time attending to the relevant AOIs, but these differences did not reach statistical significance generally.ConclusionsThis exploratory study applying eye tracking technology provides novel insights and evidence of the feasibility of self-reported HRQoL assessments in older people in aged care settings where cognitive impairment and dementia are highly prevalent.

PREVALENCE AND CLINICAL CORRELATES OF HYPOTENSIVE EPISODES AMONG OLDER HYPERTENSIVE ADULTS UNDERGOING 24-H AMBULATORY BLOOD PRESSURE MONITORING

Objective: Older adults have increased susceptibility to hypotension. Hypotensive episodes have a negative prognostic impact at old age, being associated with adverse events such as syncope, falls and injuries, which impair quality of life and functional autonomy. 24-hour ambulatory blood pressure monitoring (ABPM) is a useful diagnostic tool to detect hypotension, although it is rarely used for this purpose. The present study aimed at assessing the prevalence and the clinical variables associated with hypotensive episodes on ABPM among older hypertensive adults. Design and method: prospective observational study involving hypertensive patients aged 75 or older evaluated at two outpatient clinics of Careggi Hospital, Florence, Italy. All participants underwent a comprehensive geriatric assessment, office blood pressure measurement and ABPM. Hypotensive episodes were defined as single daytime systolic blood pressure (SBP) measures &lt;90 mmHg. Clinical variables associated with hypotensive episodes were investigated using multivariable logistic regression. Results: Among 123 participants (mean age 81 years, 59% female), the 16% showed hypotensive episodes on ABPM. Patients with hypotensive episodes were older (84±5 vs 81±4 years, p = 0.002), had a higher prevalence of dementia (50% vs 26%, p = 0.034) and received a higher number of daily medications (8[6-10] vs 6 [5-9], p = 0.036). Moreover, they showed lower 24h-SBP (139±15 vs 149±15, p = 0.008), daytime SBP (141±15 vs 151±15, p = 0.005) and night-time SBP (129±18 vs 140±20, p = 0.005) and a higher prevalence of white coat effect (30% vs 12%, p = 0.034). At multivariable analysis, hypotensive episodes were associated with use of angiotensin-receptor blockers (ARBs, OR 24.325, p = 0.002), independently of age, sex, dementia, 24h-SBP and number of medications. By contrast, use of ACE-inhibitors (OR 0.719, p = 0.013) and thiazide diuretics (OR 0.978, p = 0.048) were inversely associated with hypotension on ABPM. Conclusions: Hypotensive episodes are a common finding in older adults undergoing ABPM. Hypotensive episodes more frequently occur in patients with lower SBP and white coat effect and are independently associated with ARBs use. ACE-inhibitors and thiazides are inversely associated with hypotensive episodes on ABPM.

Association between dual-task function and neuropsychological testing in older adults with cognitive impairment

IntroductionDespite the current high prevalence of dementia, more than half of older adult patients never receive an evaluation. Current evaluation methods are lengthy, cumbersome, and not viable for busy clinics. This indicates that, despite recent improvements, a quick and objective routine test for screening cognitive decline in older adults is still needed. Poor dual-task gait performance has been previously associated with decreased executive and neuropsychological function. However, gait tests are not always viable for clinics or older patients. MethodsThe aim of this study was to assess the relationship between a novel upper-extremity function (UEF) dual-task performance and neuropsychological test results in older adults. For UEF dual-tasks, participants performed a consistent elbow flexion and extension, while counting backwards in increments of threes or ones. Wearable motion sensors were attached to the forearm and upper-arm to measure accuracy and speed of elbow flexion kinematics to calculate a UEF cognitive score. ResultsWe recruited older adults at three stages: cognitively normal (CN) (n = 35), mild cognitively impaired (MCI) of the Alzheimer's type (n = 34), and Alzheimer's disease (AD) (n = 22). The results demonstrate significant correlations between UEF cognitive score and mini-mental state examination (MMSE), Mini-Cog, Category fluency, Benson complex figure copy, Trail making test, and Montreal cognitive assessment (MOCA) (r values between −0.2355 and −0.6037 and p < 0.0288). DiscussionUEF dual-task was associated with executive function, orientation, repetition, abstraction, verbal recall, attention and calculation, language and visual construction. Of the associated brain domains, UEF dual-task was most significantly associated with executive function, visual construction, and delayed recall. The results from this study convey potential for UEF dual-task as a safe and convenient cognitive impairment screening method.