Impairment In Adults Research Articles

APOE ε4 and Dietary Patterns in Relation to Cognitive Function: An Umbrella Review of Systematic Reviews.

Carrying the apolipoprotein ε4 allele (APOE ε4) is the strongest genetic risk factor for late-onset Alzheimer's disease. There is some evidence suggesting that APOE ε4 may modulate the influence of diet on cognitive function. This umbrella review of systematic reviews evaluates the existing literature on the effect of dietary interventions on cognitive and brain-imaging outcomes by APOE status. PubMed, EMBASE, Web of Science, and Scopus were searched using terms appropriate to each area of research, from their respective starting dates of coverage until March 2023. Two independent reviewers conducted data extraction and performed a quality appraisal using the Measurement Tool to Assess Systematic Reviews (AMSTAR) 2. Six total reviews were included in the final analysis. Four reviews evaluated randomized controlled trials on individuals aged 50-93 years ranging the entire cognitive continuum. One review combined observational studies and clinical trials conducted on both cognitively healthy and cognitively impaired individuals (age range: 50-90), and 1 review included observational studies of both cognitively healthy and cognitively impaired adults (age range: 50-75). Both observational studies and clinical trials yielded inconclusive results attributed to both practical limitations associated with longitudinal follow-up and issues of methodological quality. Except for the Mediterranean diet, dietary interventions, such as the ketogenic diet, nutraceuticals, and supplements, were generally not effective in older APOE ε4 carriers. This review considers plausible biological mechanisms that might explain why older and cognitively impaired APOE ε4 carriers were less likely to benefit. This review identifies notable gaps in the literature, such as a shortage of studies conducted in middle-aged and cognitively healthy APOE ε4 carriers assessing the impact of dietary interventions and provides suggestions for novel trial designs.

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.

Psychosocial Impact of the COVID-19 Pandemic on Older Adults With and Without Cognitive Impairment: A Cross-Sectional Study

Objectives1) To develop and test the validity of the Psychosocial Pandemic Impact Scale (PPIS); 2) test associations between PPIS scores and demographics/cognitive performance in older adults; 3) answer whether the PPIS scores would differ between cognitively healthy (HOA) or mildly impaired older adults (MCI), and between those assessed before and after vaccines were available in Brazil. DesignCross-sectional study. SettingCommunity-dwelling older adults registered to participate in a remote randomized clinical trial of computerized cognitive training were assessed online during the COVID-19 pandemic in Brazil. ParticipantsA sample of 181 older adults (>60 years) was used for the PPIS psychometric analysis, from which 120 who completed baseline cognitive, quality of life, and mood assessments were included in the group comparisons and correlational analysis. MeasurementsThe psychosocial pandemic impact scale (PPIS); The Montreal Cognitive Assessment (MoCA; used as a brief screening tool); The verbal fluency test (to assess executive function) and the Verbal memory and learning with the Portuguese version of the rey auditory verbal learning test (RAVLT); The geriatric anxiety inventory (GAI); The Geriatric Depression Scale - Short Form (GDS); The WHOQOL-BREF and WHOQOL-OLD quality of life questionnaires; The Katz and Lawton scales and the Activities of Daily Living Questionnaire (ADLQ) to measure daily function. ResultsThe PPIS demonstrated good internal consistency (α = .84) and sampling adequacy (MSA= .85) and was significantly associated with validated measures of anxiety and depression (GAI: ρ = 0.49, p< 0.001; GDS: ρ = 0.48, p = 0.006) and quality of life (WHOQOL-Bref: ρ = -0.46, p< 0.001; WHOQOL-Old: ρ = -0.24, p = 0.03), confirming construct validity and scale reliability. HOA who were female and had more years of education and those with MCI who were younger and had better memory reported higher PPIS scores. One-way ANOVAs including age and education as covariates revealed that people with MCI reported higher PPIS scores than HOA before vaccination (p = 0.01), but not after. While HOA assessed before and after vaccines were available showed similar PPIS scores, those with MCI assessed after had a trend towards lower scores than those assessed before (p = 0.06). ConclusionsOur study provides a reliable instrument for assessing older adults' psychosocial pandemic impact and shows that people with MCI might be more vulnerable to such effects—which are mediated by memory performance, age, education, and gender. This data can help clinicians to identify and propose interventions targeting vulnerable populations during public health emergencies.

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.

B - 123 Examining the Utility of a Short-Form Letter Fluency Task: a Lifespan Analysis Using the D-KEFS Verbal Fluency Test

Abstract Objective The D-KEFS Verbal Fluency Test (VF) is a commonly used measure of a variety of executive functions with three separate components: Letter Fluency (FAS), Category Fluency and Category Switching. This study will solely explore the FAS, a measure of phonemic fluency and lexical access. Prior research in cognitively impaired adults suggested a potential for a short-form version of the test. This project seeks to validate these findings across different age groups. The hypothesis predicts a positive correlation between words produced in the 1–15 second interval for the letter F and the total FAS score, which includes three 60-second intervals for each letter. Method The study involved 99 patients aged 10 to 88 (X ̅: 38.77; males = 50) referred for outpatient neuropsychological evaluation. Pearson’s correlation coefficient assessed the relationship between the initial 15-second FAS interval and the total raw score. Results The Pearson correlation coefficient shows a moderate positive correlation between the 15 second interval for the letter F and FAS total score (r = 0.435). Further, this correlation is significant, (p &amp;lt; 0.001). Conclusions The study suggests that the initial 15-second FAS interval effectively predicts overall performance across pediatric and adult populations. This underscores the potential for a short-form Letter Fluency component as a valuable addition to clinical assessments. Short forms could alleviate patient frustration and maintain motivation during testing, enhancing the utility of cognitive measures like the D-KEFS FAS in clinical settings.

Acute exercise alters brain glucose metabolism in aging and Alzheimer's disease.

There is evidence that aerobic exercise improves brain health. Benefits may be modulated by acute physiological responses to exercise, but this has not been well characterized in older or cognitively impaired adults. The randomized controlled trial 'AEROBIC' (NCT04299308) enrolled 60 older adults who were cognitively healthy (n=30) or cognitively impaired (n=30) to characterize the acute brain responses to moderate [45-55% heart rate reserve (HRR)] and higher (65-75% HRR) intensity acute exercise. Each participant received two fluorodeoxyglucose positron emission tomography (FDG-PET) scans, one at rest and one following acute exercise. Change in cerebral glucose metabolism from rest to exercise was the primary outcome. Blood biomarker responses were also characterized as secondary outcomes. Whole grey matter FDG-PET standardized uptake value ratio (SUVR) differed between exercise (1.045±0.082) and rest (0.985±0.077) across subjects [Diff=-0.060, t(58)=13.8, P<0.001] regardless of diagnosis. Exercise increased lactate area under the curve (AUC) [F(1,56)=161.99, P<0.001] more in the higher intensity group [mean difference (MD)=97.0±50.8] than the moderate intensity group (MD=40.3±27.5; t=-5.252, P<0.001). Change in lactate AUC and FDG-PET SUVR correlated significantly (R2=0.179, P<0.001). Acute exercise decreased whole grey matter cerebral glucose metabolism. This effect tracked with the systemic lactate response, suggesting that lactate may serve as a key brain fuel during exercise. Direct measurements of brain lactate metabolism in response to exercise are warranted. KEY POINTS: Acute exercise is associated with a drop in global brain glucose metabolism in both cognitively healthy older adults and those with Alzheimer's disease. Blood lactate levels increase following acute exercise. Change in brain metabolism tracks with blood lactate, suggesting it may be an important brain fuel. Acute exercise stimulates changes in brain-derived neurotrophic factor and other blood biomarkers.

Automated visual acuity estimation by optokinetic nystagmus using a stepped sweep stimulus.

To describe an automatic system for objective measurement of visual acuity (VA) using optokinetic nystagmus (OKN). This pilot study tested the system's sensitivity and specificity for detecting reduced VA in healthy adults by comparing VA-OKN to VA with an Early Treatment of Diabetic Retinopathy Study (ETDRS) chart (VA-ETDRS). Adult participants (age 30 ± 12 years) with either reduced VA (n = 11, VA-ETDRS > 0.20 logMAR) or normal VA (n = 12, VA-ETDRS ≤ 0.20 logMAR) completed monocular VA-OKN measurements in each eye. The VA-OKN stimulus was an array of drifting (5°/s) vanishing discs presented in descending/ascending size order (0.00-1.00 logMAR in 0.10 steps). The stimulus was stepped every 2 s, and 10 sweeps were shown per eye (five ascending and five descending). Eye-tracking data determined when OKN activity ceased (descending sweep) or began (ascending sweep), which was used to determine VA-OKN for each sweep. The estimates were averaged across sweeps to produce an automated VA-OKN. The automated sweeps were then provided in randomised order to a reviewer blinded to the VA-ETDRS findings who determined a final VA-OKN for an eye. A single randomly selected eye from each observer was used for analysis. The sensitivity and specificity of VA-OKN using the same 0.20 logMAR threshold as VA-ETDRS was 100%. Comparisons between the VA-OKN and VA-ETDRS measures were made for participants in the reduced VA group. There was no significant difference between VA-OKN and VA-ETDRS (p = 0.55) and the two measures produced comparable values (r2 = 0.84, 95% limits of agreement = 0.19 logMAR, intra-class correlation coefficient = 0.90 [95% CI:0.68-0.97]). Visual acuity using optokinetic nystagmus correctly identified a VA deficit in adults and for those with a VA deficit, VA-OKN was strongly correlated with the gold-standard clinical measure of VA. OKN is a promising method which has the potential for use in cognitively impaired adults and pre-verbal children.

Examining Ableism Through the Physical Activity Experiences of Blind and Visually Impaired Women.

This study examined how ableism influences blind and visually impaired women's experiences accessing and engaging in exercise, physical activity, and sport. Ten women between the ages of 27 and 45years completed a one-on-one audio-recorded virtual interview where they reflected on the meaningfulness of their exercise, physical activity, and/or sport experiences, as well as described any experiences related to direct, indirect, systemic, or internalized ableism within or when attempting to access those physical activity experiences. The interview transcripts were analyzed using reflexive thematic analysis. The analysis resulted in the construction of 2 themes that depicted the participants' experiences: (1)"It's exhausting": navigating inaccessibility and (2)"You feel like a fish out of water": internalized ableism. The themes highlight the participants' experiences which were largely focused on being forced to navigate inaccessible environments which resulted in exhaustion and expressions of internalized ableism. These findings provide insight into what makes and does not make a physical activity space accessible and welcoming for blind and visually impaired adults.

Comparison, othering, and surveillance: Foucauldian discourse analysis of peer support in visual impairment rehabilitation services in South Africa.

Peer support has been identified as an important aspect of rehabilitation for visually impaired adults. However, there is a limited exploration in rehabilitation studies literature of the identity-related impact of these interventions, both at an individual and collective level. Through attending to the discourses on blindness, well-being, and social inclusion that circulate in organization cultures, this article considers the role that peer support plays in forming "blind communities" with particular characteristics, and what these communities might model about life with blindness, both to newly blind persons and to society. Foucauldian discourse analysis was conducted on semi-structured interviews with 18 visual impairment rehabilitation service users and eight rehabilitation practitioners at four organizations providing services in the Western Cape, South Africa. Formal peer support is lacking in the sampled organizations, suggesting that relational aspects are not a priority in rehabilitation practice. The formal and informal peer support that does exist in these services is shadowed by largely negative sociocultural beliefs about blindness. Participants described a culture of comparison, othering, and surveillance within which, the article suggests, they are unable to explore and embrace authentic and positive blind identities. This has implications for both individual and collective empowerment. Greater attention must be paid to both rehabilitation practitioner training and the design and implementation of rehabilitation services to the identity-level impact of rehabilitation. This is essential to develop services that promote individual and collective empowerment and that respond to the multilayered practical, social, and psychoemotional needs of blind adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Performance of Plasma Biomarkers Combined with Structural MRI to Identify Candidate Participants for Alzheimer’s Disease-Modifying Therapy

BackgroundRecently, two monoclonal antibodies that lower amyloid plaques have shown promising results for the treatment of Mild Cognitive Impairment (MCI) and mild dementia due to Alzheimer’s disease (AD). These treatments require the identification of cognitively impaired older adults with biomarker evidence of AD pathology using CSF biomarkers or amyloid-PET. Previous studies showed plasma biomarkers (plasma Aβ42/Aβ40 and p-tau181) and hippocampal volume from structural MRI correlated with brain amyloid pathology. We hypothesized plasma biomarkers with hippocampal volume would identify patients who are suitable candidates for disease-modifying therapy.ObjectivesTo evaluate the performance of plasma AD biomarkers and hippocampal atrophy to detect MCI or AD with amyloid pathology confirmed by amyloid-PET or CSF biomarkers in ADNI.DesignA cross-sectional and longitudinal study.Setting and ParticipantsData were from the Alzheimer’s Disease Neuroimaging Initiative. Participants were aged 55–90 years old with plasma biomarker and structural MRI brain data.MeasurementsThe optimum cut-off point for plasma Aβ42/Aβ40, p-tau181, and NFL and the performance of combined biomarkers and hippocampal atrophy for detecting cognitive impairment with brain amyloid pathology were evaluated. The association between baseline plasma biomarkers and clinical progression, defined by CDR-Sum of Boxes (CDR-SB) and diagnostic conversion over two years, was evaluated using a Weibull time-to-event analysis.ResultsA total of 428 participants were included; 167 had normal cognition, 245 had MCI, and 16 had mild AD. Among MCI and AD, 140 participants had elevated amyloid levels by PET or CSF. Plasma Aβ42/Aβ40 provided the best accuracy (sensitivity 79%, specificity 66%, AUC 0.73, 95% CI 0.68–0.77) to detect drug candidate participants at baseline. Combined plasma Aβ42/40, p-tau181, and hippocampal atrophy increased the specificity for diagnosis (96%), but had lower sensitivity (34%), and AUC (0.65). Hippocampal atrophy combined with the abnormal plasma p-tau181 or hippocampal atrophy alone showed high sensitivity to detect clinical progression (by CDR-SB worsening) of the drug-candidate participants within the next 2 years (sensitivity 93% and 89%, respectively).ConclusionPlasma biomarkers and structural MRI can help identify patients who are currently eligible for anti-amyloid treatment and are likely to progress clinically, in cases where amyloid-PET or CSF biomarkers are not available.

Life space limitations in visually impaired older adults.

Future work should develop and evaluate interventional strategies to help overcome visual and health-related barriers to travel in visually impaired seniors and mitigate adverse impacts of loneliness for those who do not leave town. Life space refers to the area in which a person travels within a given time period. We explored whether demographics, vision, and/or health characteristics were related to restrictions in self-reported life space for visually impaired seniors. Visually impaired (n = 114) clinical trial participants aged ≥55 years learned visual assistive iPhone apps and completed the following baseline questionnaires: Life Space, 36-Item Short-Form Health Survey, University of California, Los Angeles Loneliness Scale, and New-General Self-efficacy Scale. Multiple logistic regressions evaluated associations between life space and patient factors after accounting for their distance to the next county or state. During 2021 to 2023, 17%, 43%, and 70% of participants had not left their town, county, or state, respectively, in the past 3 months, or planned to in the next 3 months. Those with reduced distance best-corrected visual acuity had greater odds of not leaving the county in these time frames (odds ratio [OR] = 3.5; p=0.04). Minority race was associated with greater odds of not leaving town or the county in the past 2 weeks or future 3 months (OR = 4.3 to 6.4; p=0.009 to 0.049). Increased self-efficacy was associated with reduced odds of not leaving the state in the past 3 months, next 3 months, or past and/or future 3 months (OR = 0.54 to 0.55; p=0.02 to 0.03). Better physical function was associated with reduced odds of not leaving the state in the past 2 weeks or 3 months (OR = 0.96 to 0.98; p=0.01 to 0.04). Increased loneliness was related to greater odds of not leaving town in the past and/or future 3 months (OR = 1.8 to 2.0; p=0.007 to 0.009). Minority race, reduced vision, self-efficacy, and physical health were related to life space restrictions in this cohort of visually impaired seniors, whereas loneliness was greater among those who were not leaving town.

Factors related to training time and achieving proficiency with visual-assistive mobile applications in visually impaired older adults.

A majority of visually impaired older adults were able to learn to proficiently use visual-assistive iPhone applications (apps) following a median 1 hour and/or multiple training sessions, which should be considered when planning vision rehabilitation service delivery, including the option for remote telerehabilitation for those who prefer that modality. Older adults with low vision are increasingly using technology to improve their visual functioning. We examined whether age-related comorbidities were potential barriers to success in learning to use visual-assistive apps on a smartphone. A clinical trial assessed visual-assistive apps in 116 older adults aged 55+ years (mean [standard deviation], 72 [10] years). Subjects were randomized to use an app (SuperVision+, Seeing AI, or Aira) preloaded to a loaner iPhone and completed one-on-one training. App proficiency was measured by the participant's ability to use the iPhone/app without cueing at the end of training sessions. Training time was recorded for the initial session and totaled after subsequent sessions. Multiple regression models explored significant factors associated with training time and proficiency. Median initial and total training times were 45 and 60 minutes, respectively. Increased initial and total training times were both significantly related to increased age (p<0.001), legal blindness (p<0.007), Seeing AI versus SuperVision+ app (p<0.03), and participants from New England versus California (p<0.001). Most (71%) achieved proficiency after the initial training session; those odds were significantly greater among younger participants (p=0.04), those who opted for telerehabilitation (p=0.03), those who had higher cognitive scores (p=0.04), or those who were from New England (p=0.04). The majority (90%) was ultimately proficient with the app; those odds were significantly greater among participants who already had an optical magnifier (p=0.008), but were unrelated to other factors including study site. Following multiple, extensive training sessions, age, mild cognitive loss, or level of visual impairment did not preclude gaining proficiency with visual-assistive apps by visually impaired seniors, but those factors were associated with longer training times. Telerehabilitation can be a viable option to provide app training remotely for visually impaired seniors who choose that modality.

The role of cognitive flexibility on higher level executive functions in mild cognitive impairment and healthy older adults

BackgroundMild Cognitive Impairment (MCI) is a preclinical condition between healthy and pathological aging, which is characterized by impairments in executive functions (EFs), including cognitive flexibility. According to Diamond’s model, cognitive flexibility is a core executive function, along with working memory and inhibition, but it requires the development of these last EFs to reach its full potential. In this model, planning and fluid intelligence are considered higher-level EFs. Given their central role in enabling individuals to adapt their daily life behavior efficiently, the goal is to gain valuable insight into the functionality of cognitive flexibility in a preclinical form of cognitive decline. This study aims to investigate the role of cognitive flexibility and its components, set-shifting and switching, in MCI. The hypotheses are as follows: (I) healthy participants are expected to perform better than those with MCI on cognitive flexibility and higher-level EFs tasks, taking into account the mediating role of global cognitive functioning; (II) cognitive flexibility can predict performance on higher-level EFs (i.e., planning and fluid intelligence) tasks differently in healthy individuals and those diagnosed with MCI.MethodsNinety participants were selected and divided into a healthy control group (N = 45; mean age 64.1 ± 6.80; 66.6% female) and an MCI group (N = 45; mean age 65.2 ± 8.14; 40% female). Cognitive flexibility, fluid intelligence, planning, and global cognitive functioning of all participants were assessed using standardized tasks.ResultsResults indicated that individuals with MCI showed greater impairment in global cognitive functioning and EFs performance. Furthermore, the study confirms the predictive role of cognitive flexibility for higher EFs in individuals with MCI and only partially in healthy older adults.

A pilot rating system to evaluate the quality of goal attainment scales used as outcome measures in rehabilitation

ABSTRACT Goal Attainment Scaling (GAS) is a method for writing person-centred approach evaluation scales that can be used as an outcome measure in clinical or research settings in rehabilitation. To be used in a research setting, it requires a high methodological quality approach. The aim of this study was to explore the feasibility and reliability of the GAS quality rating system, to ensure that GAS scales used as outcome measures are valid and reliable. Secondary objectives were: (1) to compare goal attainment scores’ reliability according to how many GAS levels are described in the scale; and (2) to explore if GAS scorings are influenced by who scores goal attainment. The GAS scales analysed here were set collaboratively by 57 cognitively impaired adults clients and their occupational therapist. Goals had to be achieved within an inpatient one-month stay, during which clients participated in an intervention aimed at improving planning skills in daily life. The GAS quality rating system proved to be feasible and reliable. Regarding GAS scores, interrater reliability was higher when only three of the five GAS levels were described, i.e., “three milestone GAS” (0.74–0.92), than when all five levels were described (0.5–0.88), especially when scored by the clients (0.5 –0.88).

Eating Frequency, Timing, and Duration in Relation to Cognitive Performance and Alzheimer Disease Biomarkers in Adults

BackgroundThe potential association between temporal dimensions of eating and cognition/cognitive declines has been poorly investigated so far. ObjectivesThe aim of this study was to examine relationships among eating frequency, timing and time window, and cognitive performance and novel Alzheimer disease (AD) biomarkers in cognitively healthy and mildly cognitively impaired middle-aged and older adults. MethodsCross-sectional data were derived from the Aiginition Longitudinal Biomarker Investigation of Neurodegeneration (ALBION) cohort study, including people aged 40 y or older who have a positive family history of cognitive disorder or cognition-related concerns. Cognitive performance was assessed by a battery of neuropsychological tests. Amyloid β (Αβ42), a biomarker of AD-related pathology, was measured in cerebrospinal fluid. Eating frequency, timing, and the eating time window between the first and the last meal were estimated using time-related information recorded in four 24-h recalls. ResultsStudy participants had, on average, 5.3 ± 1.2 eating episodes per day, consumed at 8:20 ± 1.3 and 21:14 ± 1.3 h their first and their last eating episode, respectively, while their eating time window was 12.9 ± 1.6 h. Eating frequency, but not eating time window, was positively associated with global cognition, executive and language performance even after controlling for age, sex, education, BMI, and Mediterranean diet. Increasing eating frequency by 1 eating episode per day was associated with 0.169 higher global z-score. Furthermore, compared with ≤4, having 5–6 or >6 eating episodes per day was associated with better global and memory z-scores. Time of last eating episode was also positively associated with language performance. No associations were detected among eating frequency, timing and window, and AD pathology. ConclusionsAn eating pattern characterized by less frequent eating and/or by earlier times is present in individuals with worse cognitive performance. Our results shed light on the relevance of temporal eating patterns as potential early markers of behavioral or metabolic changes related to AD pathology.

Diabetes mellitus in older persons with neurocognitive disorder: overtreatment prevalence and associated structural brain MRI findings

BackgroundTight diabetes control is often applied in older persons with neurocognitive disorder resulting in increased hypoglycemic episodes but little is known about the pattern of brain injury in these overtreated patients. This study aims to: (a) quantify the prevalence of diabetes overtreatment in cognitively impaired older adults in a clinical population followed in an academic memory clinic (b) identify risk factors contributing to overtreatment; and (c) explore the association between diabetes overtreatment and specific brain region volume changes.MethodsRetrospective study of older patients with type 2 diabetes and cognitive impairment who were diagnosed in a memory clinic from 2013 to 2020. Patients were classified into vulnerable and dependent according to their health profile. Overtreatment was defined when glycated hemoglobin was under 7% for vulnerable and 7.6% for dependent patients. Characteristics associated to overtreatment were examined in multivariable analysis. Grey matter volume in defined brain regions was measured from MRI using voxel-based morphometry and compared in patients over- vs. adequately treated.ResultsAmong 161 patients included (median age 76.8 years, range 60.8–93.3 years, 32.9% women), 29.8% were considered as adequately treated, 54.0% as overtreated, and 16.2% as undertreated. In multivariable analyses, no association was observed between diabetes overtreatment and age or the severity of cognitive impairment. Among patients with neuroimaging data (N = 71), associations between overtreatment and grey matter loss were observed in several brain regions. Specifically, significant reductions in grey matter were found in the caudate (adj β coeff: -0.217, 95%CI: [-0.416 to -0.018], p = .033), the precentral gyri (adj βcoeff:-0.277, 95%CI: [-0.482 to -0.073], p = .009), the superior frontal gyri (adj βcoeff: -0.244, 95%CI: [-0.458 to -0.030], p = .026), the calcarine cortex (adj βcoeff:-0.193, 95%CI: [-0.386 to -0.001], p = .049), the superior occipital gyri (adj βcoeff: -0.291, 95%CI: [-0.521 to -0.061], p = .014) and the inferior occipital gyri (adj βcoeff: -0.236, 95%CI: [-0.456 to – 0.015], p = .036).ConclusionA significant proportion of older patients with diabetes and neurocognitive disorder were subjected to excessively intensive treatment. The association identified with volume loss in several specific brain regions highlights the need to further investigate the potential cerebral damages associated with overtreatment and related hypoglycemia in larger sample.

“Every day you are working you have to prove it”: Navigating the costs of work and ableism with visual impairment

BACKGROUND: People with visual impairment often need many items that their sighted counterparts do not, such as assistive devices, transportation services, and other disability-related goods and services. Acquiring these items represents a major barrier to the employment of people with visual impairment. OBJECTIVE: This study aimed to explore the nature of disability-related employment costs as they relate to engagement in the labor market of people with visual impairment. METHODS: The research consisted of a qualitative analysis of interviews and focus groups with 15 visually impaired adults from the New York metro area. RESULTS: What emerged were the costs of accessing and maintaining employment— particularly related to meeting the expectations of expediency in the modern world— in areas like communication and transportation. These costs interacted with perceived ableism in the labor market and created a climate of job scarcity and anxiety, which came at additional cost to participants who felt stuck in low-paying work. CONCLUSIONS: Further research is needed on the impact of perceived ableism and disability-related employment costs, and on decreasing barriers to programs that may ameliorate these costs, such as vocational rehabilitation services. Such research would inform policy interventions geared toward enhancing disabled people’s participation in the labor market.

Association of Family Support With Lower Modifiable Risk Factors for Dementia Among Cognitively Impaired Older Adults

ObjectivesCognitive impairment poses considerable challenges among older adults, with the role of family support becoming increasingly crucial. This study examines the association of children's residential proximity and spousal presence with key modifiable risk factors for dementia in cognitively impaired older adults. MethodsWe analyzed 14,600 individuals (35,165 observations) aged 50 and older with cognitive impairment from the Health and Retirement Study (1995–2018). Family support was categorized by spousal presence and children's residential proximity. Modifiable risk factors, including smoking, depressive symptoms, and social isolation, were assessed. Associations between family support and the modifiable risk factors were determined using mixed-effects logistic regressions. ResultsA significant proportion of older adults with cognitive impairment lacked access to family support, with either no spouse (46.9%) or all children living over 10 miles away (25.3%). Those with less available family support, characterized by distant-residing children and the absence of a spouse, had a significantly higher percentage of smoking, depressive symptoms, and social isolation. Moreover, we revealed a consistent gradient in the percentage of the risk factors by the degree of family support. Relative to older adults with a spouse and co-resident children, those without a spouse and with all children residing further than 10 miles displayed the highest percentage of the risk factors. These findings were robust to various sensitivity analyses. ConclusionsFamily support from spouses and nearby children serves as a protective factor against modifiable dementia risk factors in cognitively impaired older adults. Policies that strengthen family and social support may benefit this population.

Vision impairment and food insecurity in the national health and aging trends study

Vision impairment and food insecurity in the national health and aging trends study

Comparison of Self-Esteem in Visually Impaired Adults who Participate in Sport and those who do not: A Cross-Sectional Study

Aim: Self-esteem is an important psychological concept for mental health. The aim of our study was to compare the levels of self-esteem between visually impaired adults who participate in sports and those who do not. Method: A total of 85 visually impaired adults were included in the study, including 42 who participate in sports and 43 who do not. A personal information form and the Rosenberg Self-Esteem Scale were used for data collection. Results: The mean age of the visually impaired adults who participate in sports was 20.86±3.0 years, while it was 20.88±2.92 years for those who do not participate in sports. Among the visually impaired adults who participate in sports, 22 were female and 20 were male, while among those who do not participate in sports, 26 were female and 17 were male. The analysis revealed that the self-esteem of visually impaired adults who participate in sports was statistically significantly higher than that of those who do not participate in sports (p=0.001). It was also observed that the self-esteem of both female and male visually impaired adults who participate in sports was statistically significantly higher than their counterparts who do not participate in sports (female p=0.001, male p=0.020). Conclusion: It was concluded that participation in sports increases self-esteem in visually impaired adults regardless of gender. In this context, it should be emphasized that participation in sports should be expanded among visually impaired individuals.