Impairment In Older Adults Research Articles

Onset of cognitive impairment, diet quality and adherence to dietary guidelines over 12 years: the Personality and Total Health Cohort Study.

Around 55 million people worldwide live with dementia, and more are expected due to population ageing. We aimed to investigate associations between healthy diet and mild cognitive impairment and dementia in 1753 older adults aged 60-64 from the PATH (Personality and Total Health Through Life Cohort) study. Healthy diet was defined by the Mediterranean-DASH diet Intervention for Neurological Delay (MIND) and two dietary guideline quality scores (Dietary Guideline Index (DGI) and Index Diet Quality (IDQ)), which were calculated from baseline FFQ. Higher dietary scores indicated higher diet quality. Incidence of Alzheimer's disease/vascular dementia (National Institute of Neurological Disorders criteria) and mild cognitive impairment (Winbald criteria) was assessed after 12 years of follow-up using validated questionnaires with nominated proxies. Logistic regression explored associations between dietary scores and cognitive function, adjusting for demographics, lifestyle factors and medical preconditions. Adjusted logistic regression comparing the per unit linear increase in diet scores showed MIND (OR = 0·82, 95 % CI = 0·68, 0·99), but not DGI (0·99 (0·97, 1·00)) or IDQ (1·12 (0·95, 1·32)), was significantly associated with lower odds of developing cognitive impairment. In conclusion, a healthier neuroprotective dietary pattern is associated with better cognitive function over time, whereas dietary patterns generated from general dietary guidelines did not show a significant association. Further research and well-designed clinical studies are needed to determine the effects of the MIND diet on cognitive impairment in older adults without a family history of dementia.

Effectiveness of combined physical exercise and cognitive training in older adults with cognitive impairment: A systematic review and meta-analysis

Falls among cognitively impaired older adults are a global concern. The aim of this study was to assess the efficacy of combining physical exercise and cognitive training to improve balance among older adults. A systematic search of databases, including Embase, Medline-OVID, CINAHL-EBSCOhost, and Central-Cochrane Library, was conducted from March 9 to April 6, 2023. The search used keywords based on the PICO question, where the population was older adults with cognitive impairment. Compared to a single therapy, the intervention involved a combination of muscle strengthening and cognitive therapy, with the outcome of falls or balance. Inclusion criteria were randomized controlled trials (RCTs) in any setting. Studies with participants under 60 years old and lacking baseline clinical assessments were excluded. EndNote 20 was used as a reference manager tool, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow diagram was used to map out the number of identified records. Two investigators worked independently, and the Jadad scale was used for critical appraisal. The PROSPERO registration number is CRD42023454876. A fixed-effects meta-analysis was performed using an inverse-variance method. Four articles met the inclusion criteria, three of which were included in the meta-analysis. Studies were from Europe, New Zealand, and the Philippines, with a total sample of 255 participants and mean ages of 65.9–87.5 years. The studies used combined physical and cognitive training in one group. Results showed a significant moderate effect size (effect size (ES): 2.29; standardized mean difference (SMD): 0.41; p<0.05; heterogeneity (I2): 0%) indicating no heterogeneity. In conclusion, the combined intervention displayed the potential to improve balance for cognitively impaired older adults.

Prevalence and influencing factors of cognitive frailty among Chinese older adults: A systematic review and meta-analysis.

Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment in older adults, without a concurrent diagnosis of Alzheimer's disease or other dementias. This review aims to evaluate the prevalence of CF subtypes and identify influencing factors among Chinese older adults. The following databases were searched: PubMed/Medline, Embase, Cochrane Library, WOS, PsycINFO and CNKI et al (1 January 2001 to 20 October 2022). The risk of bias was assessed using the Agency for Healthcare Research and Quality Evidence-based Practice Center Methods Guide. Stata 17.0 software was used to pool the prevalence of cognitive frailty, and the pooled odds ratio and 95% CI of the influencing factors were calculated. The meta-analysis (56 studies and 80,320 participants) revealed the following prevalence rates: CF (18.9%), reversible CF (19.5%), potentially reversible CF (17.5%), CF in community-dwelling older adults (14.3%), CF in nursing homes (22.7%) and CF in older inpatients (25.2%). Influential factors identified included age, gender, education, nutrition, depression, exercise, sleep and comorbidity. The prevalence of CF among Chinese older adults is notably high, and it probably underestimates the prevalence of reversible cognitive frailty. It is crucial to encourage adherence to healthy behaviours, as it can effectively reduce and delay the onset of cognitive frailty.

Bibliometric study of scientific productivity in intervention programs that improve cognitive impairment in older adults.

Realizar un análisis bibliométrico integral de la productividad científica relacionada con programas de intervención que buscan mejorar la función cognitiva en adultos mayores, según revista, país y tema de intervención en la base de datos pubmed. Se realizó un estudio bibliométrico durante el periodo 2018 al 2023. La búsqueda bibliográfica se realizó en la base de datos PubMed. Los términos de búsqueda fueron: cognitivecayden, cognitivecayden, exercise program, intervention program, physical exercise,older adult, elderly. Cada artículo identificó: año de publicación, idioma de publicación, país de publicación, nombre de la revista y tema del estudio. Se utilizaron los lineamientos establecidos por PRISMA. Se incluyeron 51 publicaciones científicas, analizadas en 34 revistas. China lidera con 14 estudios (27,5%), seguido de Estados Unidos con 5 artículos (9,8%). Corea y Singapur están en tercer lugar con 4 estudios cada uno (7,8%), seguido de Japón con 3 estudios (5,9%). En cuanto al idioma de publicación, el 96,1% (n=49) fueron publicados en inglés. Solo el 3,9% (n=2) fueron publicados en español. La revista con mayor frecuencia de publicaciones fue Nutrients, con 6 artículos publicados, lo que representa el 11,8% del total y destaca como líder en este campo. Le siguió BMC Geriatrics con 3 artículos publicados, lo que representa el 5,9% del total. Destaca el aumento de las investigaciones sobre intervenciones para el deterioro cognitivo en OA, concentradas principalmente en los años 2020 y 2023. China lidera la producción de estudios seguida de Estados Unidos, Corea y Singapur. Los programas de intervención más estudiados incluyen el ejercicio y el deporte, seguido de la nutrición y el entrenamiento computarizado. Destaca la revista "Nutrients" con mayor número de artículos, seguida de "BMC Geriatrics".

The Relationship between Delirium and Dementia.

Delirium and dementia are common causes of cognitive impairment in older adults. They are distinct but interrelated. Delirium, an acute confusional state, has been linked to the chronic and progressive loss of cognitive ability seen in dementia. Individuals with dementia are at higher risk for delirium, and delirium itself is a risk factor for incident dementia. Additionally, delirium in individuals with dementia can hasten underlying cognitive decline. In this review, we summarize recent literature linking these conditions, including epidemiological, clinicopathological, neuroimaging, biomarker, and experimental evidence supporting the intersection between these conditions. Strategies for evaluation and diagnosis that focus on distinguishing delirium from dementia in clinical settings and recommendations for delirium prevention interventions for patients with dementia are presented. We also discuss studies that provide evidence that delirium may be a modifiable risk factor for dementia and consider the impact of delirium prevention interventions on long-term outcomes.

Does Dialysis Therapy Cause Cognitive Impairment in Older Adults? A Propensity Score Matching Retrospective Study From a Japanese Long-Term Care Insurance Certification Survey.

This study explores the longitudinal connection between dialysis therapy in older adults and the incidence of cognitive impairment, and trends of general abilities. We conducted a retrospective propensity score matching (PSM) analysis of data from the care-needs certification survey in City A, Japan, spanning 2017 to 2021. Our sample comprised 11 443 initially cognitively intact older adults from the baseline year 2017. Among them, individuals had received dialysis therapy at baseline, and 216 individuals were included after PSM. The dialysis group had a significantly lower incidence of cognitive impairment during follow-up than the control group (P = 0.02). The competing risk of death was significantly higher in the dialysis group than in the control group (P < .001). Both groups showed a decline in their comprehensive ability over the time. There have been several reports of a negative association between dialysis and cognitive impairment, but more detailed investigation of the longitudinal relationship may be needed. Comprehensive support remains critical for both dialysis and non-dialysis older adults.

12521 Electrical Impedance Myography And Muscle Health In Older Adults With Type 1 Diabetes

Abstract Disclosure: A. Fremaint: None. G. Jung: None. E. Yu: None. M. Bouxsein: None. Introduction: Recent studies indicate that individuals with Type 1 diabetes mellitus (T1D) develop skeletal muscle health impairments which might contribute to falls and explain their high fracture risk. A novel handheld Electrical Impedance Myography (EIM) device (mScan model 1301, Myolex) has been developed to assess muscle quality by calculating tissue impedance. We hypothesized that mScan could identify individuals with worse strength and body composition outcomes among older adults with and without T1D. Methods: We studied participants of the T1D Bone Health Connection (BEACON) Study who were aged 50+ and who had undergone EIM testing (n=63 T1D, n=50 non-diabetic controls). We analyzed EIM-derived phase angle [Phase = arctan(reactance/resistance)] at 100 kHz in 3 upper extremity muscles (biceps brachii, lateral deltoid, and wrist extensors), where lower phase values indicate poorer muscle quality. Correlations of EIM data were performed with grip strength measured by a handheld dynamometer and appendicular lean mass/height2 (ALM/ht2) and visceral adipose tissue (VAT) from whole-body DXA scans. Pearson’s correlations were used for all statistical analyses. Results: Mean age (63±7 years), sex (54% female), and BMI (26.5 kg/m2) were similar between T1D and control groups. Adults with T1D had a nonsignificant trend towards lower muscle quality at the biceps brachii than controls (8.9±5.4 vs 10.9 ±6.0 degrees, p=0.078). There were no differences between groups in phase angle for lateral deltoid nor wrist extensors. Higher muscle quality at the biceps brachii was associated with higher grip strength (r=0.28, p=0.005) in the full cohort as well as in the T1D group (r=0.40, p &amp;lt;0.001). In the full cohort, greater VAT was associated with lower muscle health at the biceps brachii (r = -0.34, p=0.003) and lateral deltoid (r = -0.23, p&amp;lt;0.014), with similar patterns in both T1D and controls. There were no correlations of muscle quality with ALM/ht2. Conclusion: Our data suggest that mScan holds promise for detection of skeletal muscle health impairments in older adults, including those with T1D, potentially aiding in the diagnosis and prevention of related falls and fractures. Further research is required to investigate the association between VAT and muscle health and to validate the effectiveness of mScan in T1D and other populations. Presentation: 6/3/2024

Interactive effect of diabetes mellitus and subclinical MRI markers of cerebrovascular disease on cognitive decline and incident dementia: a memory-clinic study

BackgroundCognitive impairment is an increasingly recognized comorbidity of diabetes, yet the mechanisms underlying this association remain poorly understood. This knowledge gap has contributed to conflicting findings regarding the impact of diabetes on long-term cognitive outcomes in older adults. The presence of cerebrovascular disease (CeVD) may potentially modify this relationship. However, interactive effect between diabetes and subclinical MRI markers of CeVD on cognitive trajectories and incident dementia remains unexplored.MethodsA total of 654 participants underwent brain MRI at baseline, from whom 614 with at least one follow-up were selected for longitudinal analysis. Cognitive tests were performed annually up to 5 years. CeVD markers of interest were lacunes, white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), cortical microinfarcts (CMIs), intracranial stenosis (ICS), and cortical infarcts. Blood-based Alzheimer biomarkers, including p-tau181 and p-tau181/Aβ42 ratio, were used as indicators of Alzheimer pathology.ResultsAt baseline, diabetes was associated with lower cognitive performance and higher burden of CeVD, but not p-tau181 or p-tau181/Aβ42 ratio. Longitudinally, we found an interactive effect of diabetes and WMHs, rather than an independent effect of diabetes, on cognitive decline and dementia risk. Subgroup analyses showed association of diabetes with cognitive outcomes was stronger in participants with high WMHs load but non-significant in those with low WMHs load. Moreover, these associations remained unchanged after adjusting for blood-based Alzheimer biomarkers.ConclusionsThe effect of diabetes on cognitive decline is contingent upon the presence of WMHs and independent of Alzheimer’s pathology. This finding raises the possibility of utilizing WMHs as an imaging biomarker to identify diabetic subgroup at greater risk of developing cognitive impairment. Furthermore, therapeutic interventions targeting WMHs may prevent cognitive deterioration in older adults with diabetes.

Hypoxemia during rapid eye movement sleep mediates memory impairment in older adults at risk for dementia via CA1 hippocampal volume loss

AbstractBackground and PurposeObstructive sleep apnea is associated with increased dementia risk. Nocturnal hypoxemia, which can be more severe during rapid eye movement (REM) sleep, may be a key mechanism. This study examines how REM hypoxemia affects memory and explores whether hippocampal vulnerability to hypoxemia mediates this effect in older adults at risk for dementia.MethodsOlder adults aged ≥50 years (N = 338) with subjective or mild cognitive impairment (i.e., objective impairment) underwent neuropsychological, mood, and medical assessment, magnetic resonance imaging scanning (n = 135), and overnight polysomnography. Verbal learning and memory were assessed with the Rey Auditory Verbal Learning Test. REM sleep hypoxemia was measured using the Oxygen Desaturation Index‐3% (REM‐ODI). Hippocampal subfield (CA1, CA3, subiculum, and dentate gyrus) volumes were derived from T1 and high‐resolution hippocampus T2 scans. We determined whether the relationship between REM‐ODI and learning and memory was mediated by hippocampal subfield volume. Analyses were repeated in non‐REM sleep to determine whether the effects were REM‐specific.ResultsAlthough there was not a direct effect of REM‐ODI on verbal learning (p &gt; 0.05) or memory (p &gt; 0.05), mediation analyses showed a significant indirect effect of high REM‐ODI on poorer verbal learning (β = −0.09, 95% confidence interval [CI] = −0.238 to −0.005) and memory (β = −0.100, 95% CI = −0.255 to −0.005), which was mediated by CA1 volume. These associations were absent in non‐REM sleep (p &gt; 0.05).ConclusionsHypoxemia during REM sleep may impair memory in people at risk for dementia by reducing CA1 hippocampal volume. Research is needed to explore whether interventions targeting REM sleep hypoxemia are protective against memory decline.

Story Recall in Peer Conflict Resolution Discourse Task to Identify Older Adults Testing Within Range of Cognitive Impairment.

The current study used behavioral measures of discourse complexity and story recall accuracy in an expository discourse task to distinguish older adults testing within range of cognitive impairment according to a standardized cognitive screening tool in a sample of self-reported healthy older adults. Seventy-three older adults who self-identified as healthy completed an expository discourse task and neuropsychological screener. Discourse data were used to classify participants testing within range of cognitive impairment using multiple machine learning algorithms and stability analysis for identifying reliably predictive features in an effort to maximize prediction accuracy. We hypothesized that a higher rate of pronoun use and lower scores on story recall would best classify older adults testing within range of cognitive impairment. The highest classification accuracy exploited a single variable in a remarkably intuitive way: using 66% story recall as a cutoff for cognitive impairment. Forcing this decision tree model to use more features or increasing its complexity did not improve accuracy. Permutation testing confirmed that the 77% accuracy and 0.18 Brier skill score achieved by the model were statistically significant (p < .00001). These results suggest that expository discourse tasks that place demands on executive functions, such as working memory, can be used to identify aging adults who test within range of cognitive impairment. Accurate representation of story elements in working memory is critical for coherent discourse. Our simple yet highly accurate predictive model of expository discourse provides a promising assessment for easy identification of cognitive impairment in older adults. https://doi.org/10.23641/asha.26543824.

Association between widowhood and cognitive function among Chinese older adults with hearing impairment: the moderating effect of social support and participation

BackgroundOlder adults with hearing impairments are vulnerable to cognitive impairment. Although previous reports suggest a correlation between widowhood and cognitive impairment, further investigation is needed to elucidate the effect of widowhood on cognitive function and the moderating effects of social support and participation on widowhood-related cognitive impairment in this vulnerable demographic.MethodsThe study’s data were sourced from the nationally representative Chinese Longitudinal Healthy Longevity Survey (CLHLS) for the years 2011, 2014, and 2018. Multiple linear regression was used to analyze the association between widowhood and cognitive function among older adults. Multivariate logistic regression examined the effect of widowhood on the likelihood of experiencing various levels of cognitive impairment in older adults with hearing impairments. A moderating effect model explored the roles of social support and participation in mitigating widowhood-related cognitive impairment.ResultsThe cognitive function of older adults with hearing impairment was found to be lower than that of those without hearing impairment. Widowhood was significantly negatively correlated with Mini-Mental State Examination (MMSE) scores in older adults, both with (Coef. = -0.898) and without (Coef.: = -0.680) hearing impairments. A stronger association was observed between widowhood and declining cognitive function among older adults with hearing impairment. Specifically, widowhood may be more likely to significantly increase the likelihood of moderate and severe cognitive impairment (RRR = 1.326, 1.538) among older adults with hearing impairments. Social support and social participation significantly moderated the cognitive impairment associated with widowhood among hearing-impaired older adults. These forms of support and engagement are buffers against the risk of widowhood-related cognitive impairment among this demographic.ConclusionsOur findings indicate that widowhood is significantly associated with cognitive impairment in older adults with hearing impairment. Social support and participation help mitigate this risk. Strategies should prioritize early screening, specialized cognitive rehabilitation, comprehensive care, and enhancing social support and participation to maintain cognitive health in this vulnerable population following widowhood.

Investigating Acoustic and Psycholinguistic Predictors of Cognitive Impairment in Older Adults: Modeling Study.

About one-third of older adults aged 65 years and older often have mild cognitive impairment or dementia. Acoustic and psycho-linguistic features derived from conversation may be of great diagnostic value because speech involves verbal memory and cognitive and neuromuscular processes. The relative decline in these processes, however, may not be linear and remains understudied. This study aims to establish associations between cognitive abilities and various attributes of speech and natural language production. To date, the majority of research has been cross-sectional, relying mostly on data from structured interactions and restricted to textual versus acoustic analyses. In a sample of 71 older (mean age 83.3, SD 7.0 years) community-dwelling adults who completed qualitative interviews and cognitive testing, we investigated the performance of both acoustic and psycholinguistic features associated with cognitive deficits contemporaneously and at a 1-2 years follow up (mean follow-up time 512.3, SD 84.5 days). Combined acoustic and psycholinguistic features achieved high performance (F1-scores 0.73-0.86) and sensitivity (up to 0.90) in estimating cognitive deficits across multiple domains. Performance remained high when acoustic and psycholinguistic features were used to predict follow-up cognitive performance. The psycholinguistic features that were most successful at classifying high cognitive impairment reflected vocabulary richness, the quantity of speech produced, and the fragmentation of speech, whereas the analogous top-ranked acoustic features reflected breathing and nonverbal vocalizations such as giggles or laughter. These results suggest that both acoustic and psycholinguistic features extracted from qualitative interviews may be reliable markers of cognitive deficits in late life.

A - 10 Selective Serotonin Reuptake Inhibitors Do Not Alter HD-tDCS Effects on Episodic Memory in Cognitively Impaired Older Adults

Abstract Objective High-Definition Transcranial Direct Current Stimulation (HD-tDCS) is a potential new intervention for mild cognitive impairment (MCI) and Alzheimer’s Dementia (ad) involving small doses of electrical stimulation. Prior studies suggest potential interactions with Selective Serotonin Reuptake Inhibitors (SSRIs) that could alter HD-tDCS’s effectiveness on cognitive outcomes. This study evaluated if SSRIs altered HD-tDCS response to episodic memory functioning in individuals with MCI and ad. Method Eighteen individuals (M age = 70.5; 27.8% female; 8 stable on SSRIs), 9 with MCI and 9 with ad, underwent ten 20-minute HD-tDCS sessions of 1 milliampere over the medial frontal cortex. Neuropsychological testing assessed learning and delayed recall for visual (Brief Visuospatial Memory Test-Revised) and verbal (Rey Auditory Verbal Learning Test or Hopkins Verbal Learning Test-Revised) episodic memory at baseline and immediately post-treatment. Linear regressions evaluated SSRI use as a predictor of post-treatment episodic memory performance controlling for baseline scores. Results Ten participants demonstrated improvement on at least one measure by 0.5 standard deviation (SD; 5 T-score points), with 5 showing 1 SD improvement. Eleven showed a decline by 0.5 SD on at least one measure, with 7 showing 1 SD decline. SSRI use did not significantly predict better or worse verbal learning (β = −4.285, p = 0.194), verbal delayed recall (β-0.408, p = 0.883), visual learning (β = −2.788, p = 0.405), and visual delayed recall (β = −6.673, p = 0.150) performance post-HD-tDCS. Conclusion Preliminary findings suggest SSRIs may not impact HD-tDCS outcomes in cognitively impaired older adults, specifically for episodic memory. These results may not translate to other neuropsychological domains; however, larger samples are needed for further investigation.

Machine learning algorithms to predict mild cognitive impairment in older adults in China: A cross-sectional study

ObjectiveThis study aimed to explore the predictive value of machine learning (ML) in mild cognitive impairment (MCI) among older adults in China and to identify important factors causing MCI. MethodsIn this study, 6434 older adults were selected based on the data of the China Health and Elderly Care Longitudinal Survey (CHARLS) in 2020, and the dataset was subsequently divided into the training set and the test set, with a ratio of 6:4. To construct a prediction model for MCI in older adults, six ML algorithms were used, including logistic regression, KNN, SVM, decision tree (DT), LightGBM, and random forest (RF). The Delong test was used to compare the differences of ROC curves of different models, while decision curve analysis (DCA) was used to evaluate the model performance. The important contributions of the prediction results were then used to explain the model by the SHAP value.The Matthews correlation coefficient (MCC) was calculated to evaluate the performance of the models on imbalanced datasets. Additionally, causal analysis and counterfactual analysis were conducted to understand the feature importance and variable effects. ResultsThe area under the ROC curve of each model range from 0.71 to 0.77, indicating significant difference (P < 0.01). The DCA results show that the net benefits of LightGBM is the largest within various probability thresholds. Among all the models, the LightGBM model demonstrated the highest performance and stability. The five most important characteristics for predicting MCI were educational level, social events, gender, relationship with children, and age. Causal analysis revealed that these variables had a significant impact on MCI, with an average treatment effect of −0.144. Counterfactual analysis further validated these findings by simulating different scenarios, such as improving educational level, increasing age, and increasing social events. ConclusionThe ML algorithm can effectively predict the MCI of older adults in China and identify the important factors causing MCI.

Assessment of fall risk, cognitive impairment, fear of falling in relation to functional mobility, and balance impairments in older adults

Among older adults, falls are the most common injury and may increase the risk of mortality. This study aimed to investigate factors associated with functional mobility and balance impairments among community-dwelling older adults. A cross-sectional study was conducted among a total of 515 older adults. The questionnaires recorded demographic characteristics and health data, including the mental state examination T10 version (MSET10) and fear of falling (FOF). Functional mobility and balance impairments were assessed using the timed up and go (TUG) test. Leg strength and endurance were assessed using the sit to stand (STS) test. Demographic factors that were associated with significant differences for TUG and TUG-cognitive included age, education, occupation, history of falls in the previous year, and comorbidities. The TUG-cognitive, STS, and TUG tests at higher risk of falling were 42.5%, 18.6%, and 14.2%, respectively. The Pearson correlation coefficient analysis showed that STS and FOF were positively associated with TUG and TUG-cognitive, while the MSET10 was negatively associated with TUG and TUG-cognitive. Multiple linear regression analysis showed that increasing FOF was associated with increasing TUG and TUG-cognitive after adjusting for confounding variables (p &lt; 0.001 and p = 0.015, respectively). Several risk factors need to be considered to determine the effectiveness of preventive measures and interventions to reduce the risk of falling. In particular, interventions for older adults should focus on functional mobility and balance impairments.

Sarcopenia and cognitive impairment in older adults: Long-term prognostic implications based on the National Health and Nutrition Examination Survey (2011–2014)

AimsThe relationship between sarcopenia and cognitive impairment in older adults remains contentious. This study investigates this association and examines the long-term prognosis for individuals with both conditions. MethodsUtilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014, this study focuses on the correlation between sarcopenia and cognitive impairment, as well as the extended prognosis for individuals managing these conditions. ResultsThe study cohort comprised 2890 participants, with 648 (22.4 %) diagnosed with sarcopenia. Multivariable logistic regression analysis identified a significant association between sarcopenia and an increased risk of cognitive impairment (adjusted odds ratio [aOR]: 1.68, 95 % confidence interval [CI]: 1.30–2.17). Over a median follow-up period of 48 months, 200 individuals (6.9 %) succumbed to cardiovascular and cerebrovascular diseases (CCVDs), including hypertension, congestive heart failure, coronary artery disease, and stroke, as well as Alzheimer's disease (AD). Participants had comorbid conditions such as CCVDs and diabetes mellitus. Kaplan–Meier survival analysis and the Cox proportional hazards model indicated that individuals with both sarcopenia and cognitive impairment had the highest mortality risk from CCVDs and AD (adjusted hazard ratio [aHR]: 2.73, 95 % CI: 1.48–5.02). Individuals with sarcopenia and comorbidities exhibited a higher mortality risk from CCVDs or AD compared to those without sarcopenia but with comorbidities (aHR: 2.71, 95 % CI: 1.37–5.37). ConclusionSarcopenia is independently associated with cognitive impairment. Older adults with both sarcopenia and cognitive impairment or concurrent comorbidities face increased mortality risks from CCVDs or AD compared to their healthy counterparts. Clinical implication•Sarcopenia is associated with cognitive impairment.•Cognitive impairment and comorbidities increased the risk of mortality from CCVDs and AD for sarcopenia patients.

THE EFFECTS OF MULTICOMPONENT EXERCISE ON MILD COGNITIVE IMPAIRMENT IN ELDERLY POPULATION: A RANDOMIZED CONTROL TRIAL

Objective: To determine the effectiveness of multicomponent exercise on mild cognitive impairment in older adults. Materials and Methods: This randomized control trial was conducted at the Department of Rehabilitation at Pakistan Railway General Hospital, Rawalpindi. Fifty-eight older persons with mild cognition impairment were allocated randomly into 2 groups. The participants of the experimental group (n=29) performed multicomponent exercises two times a week for 55-60 minutes. In the control group (n=29), participants performed 20 minutes of treadmill walking thrice a week. Both groups performed these exercises for 6 weeks. Pre and post assessment was carried out at baseline and after 6 weeks of intervention for the following test: Mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), Trail-making test A (TMT-A) and Trail making test-B (TMT-B). Data was analyzed using SPSS 21. Results: The overall mean age of study participants was 62.74±74 years. Within-group analysis for MMSE, MoCA, TMT-A, and TMT-B significantly improved (p &lt;0.05) in the experimental group in comparison to the control group. Between-group analysis showed that all parameters were significantly improved (P &lt;0.05) at post-intervention assessment. Conclusion: Multicomponent exercise training was found to be effective in the elderly with mild cognitive impairment. A combination of exercise can enhance cognitive function, help in the prevention of the decline in cognitive function, and reduce the risk for dementia. Keywords: Mild Cognitive Impairment, Cognition, Trail Making Test, Dementia Trial Registration number: NCT03938051

The Trail Walking Test to predict probable mild cognitive impairment in older adults

The Trail Walking Test to predict probable mild cognitive impairment in older adults

Aortic reservoir-excess pressure parameters are associated with worse cognitive function in people with untreated stage II/III hypertension.

Hypertension is a recognized risk factor for the development of cognitive impairment and dementia in older adults. Aortic stiffness and altered haemodynamics could promote the transmission of detrimental high pressure pulsatility into the cerebral circulation, potentially damaging brain microvasculature and leading to cognitive impairment. We determined whether reservoir-excess pressure parameters were associated with cognitive function in people with hypertension (HT) and normotension (NT). We studied 35 middle-aged and older treatment-naïve stage II/III HT (office systolic BP 176 ± 17 mmHg) and 35 age-, sex- and body mass index-matched NT (office systolic BP 127 ± 8 mmHg). Parameters derived from reservoir-excess pressure analysis including reservoir pressure integral (INTPR), excess pressure integral (INTXSP), systolic rate constant (SRC), diastolic rate constant (DRC) and pulse wave velocity (PWV) were calculated from an ensemble-averaged aortic pressure waveform derived from radial artery tonometry. Cognitive function was assessed using the Addenbrooke's Cognitive Examination Revised (ACE-R), Trail Making Test Part A (TMT-A) and Part B (TMT-B). All reservoir-excess pressure parameters were greater in HT than NT (all P < 0.05). Greater INTXSP was associated with lower ACE-R score (rs = -0.31), longer TMT-A (r = 0.31) and TMT-B (r = 0.38). Likewise, greater DRC and PWV were also associated with lower ACE-R score (rs = -0.27 and rs = -0.33), longer TMT-A (r = 0.51 and r = 0.40) and TMT-B (r = 0.38 and r = 0.32). Greater INTXSP, DRC and PWV are consistently associated with worse cognitive function in this study. These observations support a potential mechanistic link between adverse haemodynamics and a heightened risk of cognitive impairment in older adults with hypertension.

Gait performance in older adults across the cognitive spectrum: Results from the GAIT cohort.

Gait performance can provide valuable insights into cognitive functioning in older adult and may be used to screen for cognitive impairment. However, the optimal test condition and spatiotemporal parameter for accuracy have not yet been determined. This study aims to determine the gait measure with the highest accuracy identifying cognitive decline. A total of 711 participants were recruited, including 332 cognitively healthy individuals, 264 with mild cognitive impairment (MCI), and 115 with dementia, with a mean age of 72 years (interquartile range 69-76), and 43% (n = 307) of women. The participants underwent gait assessment in three different conditions, including a single task and dual tasks of counting backward by ones and naming animals. Gait performance was deteriorated as cognitive impairment progressed. The gait test performed during naming animals condition was the most accurate in differentiating between cognitive groups. Specifically, the naming animals gait speed was more accurate in discriminating control participants from those with cognitive impairment (area under the curve [AUC] = 76.9% for MCI and 99.7% for people with dementia with control group as reference). The coefficient of stride length variability while naming animals was the most effective parameter in discriminating between MCI and dementia groups (AUC = 96.7%). The naming animals dual-task gait test can be a valuable assessment for screening cognitive impairment in older adults, regardless of their cognitive abilities. The test is useful in clinical settings for subjects with a range of cognitive profiles.