Impairment In Older Adults Research Articles

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 < 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 <0.05) in the experimental group in comparison to the control group. Between-group analysis showed that all parameters were significantly improved (P <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.

The mediating role of nutritional indicators in the association between estimated glomerular filtration rate and cognitive impairment in older adults.

Cognitive impairment (CI) is common in older adults, especially those with renal dysfunction. We aimed to investigate the complex relationships among renal function, nutritional status, and CI in older people free from late chronic kidney disease (CKD) and severe CI. A study of older people (≥60 years old) with an estimated glomerular filtration rate (eGFR) of >30 mL/min/1.73 m2 and Montreal Cognitive Assessment (MoCA) scores of >10 (n = 237) was conducted at Beijing Tongren Hospital. Their eGFR was determined using the CKD-EPI-cr-Cysc equation. Cognitive function was evaluated with the MoCA. We tested the relationship between eGFR and MoCA scores using Spearman correlation analysis and multivariate logistic regression analysis. We then conducted a mediation analysis to figure out the mediating roles of nutritional indicators (Mini Nutritional Assessment-Short Form (MNA-SF) scores, albumin (ALB), and haemoglobin (HGB)) between the eGFR and MoCA scores. The incidence of CI was 48.5% (115/237) in older people. Spearman correlation analysis revealed that the better the kidney function, the better the cognitive function (R = 0.297, P < 0.001). Multivariate logistic regression analysis revealed that eGFR decrease per 15 mL/min/1.73 m2 (OR: 1.415, 95% confidence interval: 1.055-1.896, P = 0.020) was related to CI after adjusting for age and sex. However, the eGFR was not associated with cognitive decline after adjusting for nutritional indicators, behavioural risk factors, other biomarkers, and chronic conditions, suggesting that eGFR is not independently associated with CI. Mediation analysis revealed that the MNA-SF scores (a*b = 0.006 (0.0002-0.012)) and HGB (a*b = 0.008 (0.001-0.017)) were mediating factors between the eGFR and MoCA scores. A decline in renal function can directly lead to CI and can also exacerbate cognitive deficits through intermediary factors such as MNA-SF scores and HGB. Therefore, correcting anaemia and improving nutritional status are significantly important for enhancing cognitive function in older patients, especially those with renal dysfunction.

Association between neighborhood characteristics, functional limitations, falls, chronic pain, and cognitive impairments in older adults

Association between neighborhood characteristics, functional limitations, falls, chronic pain, and cognitive impairments in older adults

Prevalence of mild cognitive impairment and its association with malnutrition in older Chinese adults in the community.

This study aims to characterize the prevalence and associated factors of cognitive impairment in older adults within Chinese community settings. Research exploring the interrelation between malnutrition and cognitive impairment in the older adult community-dwelling population is scarce. The impact of nutritional status on cognitive function in aging adults has not been definitively established. A cross-sectional survey was conducted in one urban and one rural community in Chengdu, China, from October 2022 to March 2023. The sample included 706 older adults. Logistic regression was utilized to determine independent risk factors for mild cognitive impairment (MCI). The study found a significant prevalence of MCI at 32.0% among the older adult population. Among those suffering from malnutrition, 55.6% were affected by MCI. The logistic regression analysis indicated that malnutrition risk (OR = 2.192, 95% CI 1.431 to 3.357, p < 0.001), rural residence (OR = 1.475, 95% CI 1.003 to 2.170, p = 0.048), age (70-79 years old; OR = 2.425, 95% CI 1.611 to 3.651, p < 0.001; ≥80 years old: OR = 4.773, 95% CI 2.571 to 8.859, p < 0.001), male (OR = 1.584, 95% CI 1.085 to 2.313, p = 0.017), middle education level (OR = 0.986, 95% CI 1.627 to 5.482, p < 0.001), and ADL dependence (OR = 1.810, 95% CI 1.158 to 2.827, p = 0.009) were significantly associated with the occurrence of MCI. The findings indicate a widespread occurrence of MCI in community-dwelling older Chinese adults. The association between malnutrition, as measured by the Mini Nutritional Assessment-Short Form (MNA-SF), and cognitive decline is evident. Older adult individuals with nutritional risk, advancing age, rural residence, male gender, moderate education, and ADL dependency are at increased likelihood of developing MCI. Longitudinal research is needed to clarify the temporal relationships between MCI, demographic factors, and whether improvements in nutritional status or ADL can reduce the incidence of MCI in this population.

Comparison of Surgical Times Between Manual and Robot-Assisted Epiretinal Membrane Peeling.

Epiretinal membranes (ERM) pose a common challenge in vitreoretinal pathology, often causing vision impairment in older adults. The Preceyes Surgical System (PSS) supports the surgical removal of ERM through robot-assisted membrane peeling (RA-MP). This study compares surgical times and iatrogenic hemorrhages between manual membrane peeling (MMP) and RA-MP using PSS. Nine patients underwent RA-MP with PSS, whereas 16 patients (18 eyes) underwent MMP for comparative analysis. Surgical durations were categorized into RA-MP, manual forceps utilization in PSS surgeries (mRA-MP), and traditional MMP. Cumulative manual manipulation duration (cMMP), instrument grasps, and intraoperative hemorrhages were statistically analyzed using the Mann-Whitney U test. RA-MP showed significantly longer peeling times compared to MMP (P < 0.001). Flap initiation grasps were similar between methods (P = 0.86), RA-MP demonstrated a significant reduction in peeling grasps (P = 0.01) and mean grasps per minute (P < 0.001). Although RA-MP resulted in fewer hemorrhages, the difference did not reach statistical significance relative to MMP (P = 0.08). Although RA-MP tended to extend surgical time, it offered advantages in reducing tissue trauma and intraoperative hemorrhages. Further research is needed to explore the learning curve for novice surgeons and evaluate the safety profile of RA-MP. RA-MP may offer potential advantages over manual surgery, particularly in terms of reduced tissue trauma and intraoperative hemorrhages. Despite its longer duration compared with manual techniques, RA-MP may lead to fewer grasping maneuvers and lower rates of hemorrhages, thereby enhancing the safety and precision of vitreoretinal surgeries.

Effects of Dance-Based Aerobic Training on Mental Health and Quality of Life in Older Adults with Mild Cognitive Impairment.

(1) Background: Mild cognitive impairment in older adults is a condition characterized by a decrease in mental abilities that affects their quality of life. The aim of this study is to evaluate the effects of an aerobic training program based on dance on depression, sleep quality, and quality of life in older adults with mild cognitive impairment. (2) Methods: This study employed a randomized controlled trial design with a total of 92 older adults with cognitive impairment, randomly assigned to an experimental group (n = 47) undergoing dance-based aerobic training and a control group (n = 45) who did not receive any intervention. Depression was assessed using the Yesavage Geriatric Depression Scale, sleep quality through the Pittsburgh Sleep Quality Index (PSQI), and quality of life through the SF-36 questionnaire. (3) Results: Statistically significant improvements were observed in depression (t(46) = 4.783, p = 0.000) and in the PSQI domains: subjective sleep quality (t(46) = 3.333, p = 0.002, and Cohen's d = 0.35), sleep duration (t(46) = 5.511, p = 0.000, and Cohen's d = 0.73) and PSQI total score (t(46) = 2.116, p = 0.040, and Cohen's d = 0.20). Regarding quality of life, improvements were observed in all domains of the questionnaire: the general health (t(46) = -9.374, p = 0.000, and Cohen's d = 0.03), physical function (t(46) = -9.374, p = 0.000, and Cohen's d = 0.03), the physical role (t(46) = -5.954, p = 0.000, and Cohen's d = 1.06), the emotional role (t(46) = -6.200, p = 0.000, and Cohen's d = 0.80), social function (t(46) = -5.585, p = 0.000, and Cohen's d = 0.53), physical pain, (t(46) = -9.224, p = 0.000, and Cohen's d = 1.04), vitality (t(46) = 2.289, p = 0.027, and Cohen's d = 1.27), mental health, (t(46) = -7.985, p = 0.000, and Cohen's d = 1.33), the physical summary component, (t(46) = -13.532, p = 0.000, and Cohen's d = 1.81), and in the mental summary component (t(46) = -10.6 81, p = 0.000, and Cohen's d = 0.06); (4) Conclusions: The results of the present study showed that they suggest that a dance-based aerobic training program improves mental health and quality of life in older people with mild cognitive impairment, providing a non-pharmacological approach to improve general well-being in this population.

Beat-to-beat blood pressure variability, hippocampal atrophy, and memory impairment in older adults.

Visit-to-visit blood pressure variability (BPV) predicts age-related hippocampal atrophy, neurodegeneration, and memory decline in older adults. Beat-to-beat BPV may represent a more reliable and efficient tool for prospective risk assessment, but it is unknown whether beat-to-beat BPV is similarly associated with hippocampal neurodegeneration, or with plasma markers of neuroaxonal/neuroglial injury. Independently living older adults without a history of dementia, stroke, or other major neurological disorders were recruited from the community (N = 104; age = 69.5 ± 6.7 (range 55-89); 63% female). Participants underwent continuous blood pressure monitoring, brain MRI, venipuncture, and cognitive testing over two visits. Hippocampal volumes, plasma neurofilament light, and glial fibrillary acidic protein levels were assessed. Beat-to-beat BPV was quantified as systolic blood pressure average real variability during 7-min of supine continuous blood pressure monitoring. The cross-sectional relationship between beat-to-beat BPV and hippocampal volumes, cognitive domain measures, and plasma biomarkers was assessed using multiple linear regression with adjustment for demographic covariates, vascular risk factors, and average systolic blood pressure. Elevated beat-to-beat BPV was associated with decreased left hippocampal volume (P = .008), increased plasma concentration of glial fibrillary acidic protein (P = .006), and decreased memory composite score (P = .02), independent of age, sex, average systolic blood pressure, total intracranial volume, and vascular risk factor burden. In summary,beat-to-beat BPV is independently associated with decreased left hippocampal volume, increased neuroglial injury, and worse memory ability. Findings are consistent with prior studies examining visit-to-visit BPV and suggest beat-to-beat BPV may be a useful marker of hemodynamic brain injury in older adults.

Development of the Brazilian version of the Mini-Addenbrooke Cognitive Examination (M-ACE BR) to screen for cognitive impairment in older adults.

Age is the most important risk factor for develop dementia, and the recommendation is that older adults are cognitively tested to detect impairment in the initial stage for adequate treatment. The demand for the care of these older adults is great, drawing attention to the need for rapid tests, with good accuracy and simple application to identify cognitive impairment. To develop and validate the Brazilian Mini-Addenbrooke Cognitive Examination (M-ACE BR) as a short screening test for cognitive impairment in older adults. The M-ACE BR was developed using the Mokken scaling analysis in 352 participants (cognitively unimpaired [CU] = 232, cognitive impairment no dementia [CIND] = 82; and dementia = 38) and validated in an independent sample of 117 participants (CU = 25; CIND = 88; and dementia = 4). The Mokken scaling analysis derived 9 items (spatial orientation, anterograde memory, retrograde memory, delayed recall, recognition [name and address], letter verbal fluency, repetition of 4 words, naming of 10 items, and comprehension) with a maximum score of 51 points and an average duration time of 7 minutes. The cut-off score ≤ 43/51 for CIND had a sensitivity of 59.09% and a specificity of 80%. For a screening test in which sensitivity is prioritized for further investigation, we suggest using a cutoff of ≤ 47 (sensitivity 85.23% and specificity 24%), maintaining a good positive predictive value (79.8%). The M-ACE BR is a brief and adequate instrument to detect cognitive impairment in older Brazilian adults. However, screening for CIND and for different educational levels should be further explored.

Correlates of Mild Behavioral Impairment in Older Adults: Protocol for a Scoping Review.

Understanding mild behavioral impairment, a relatively recent notion in neuropsychological studies, provides significant insights into early behavioral indicators of cognitive decline and predicts the onset of dementia in older adults. Although the importance of understanding mild behavioral impairment is acknowledged, comprehensive reviews of its correlates with older adults are limited. This scoping review aims to identify the impact of mild behavioral impairment on health outcomes in older adults and the factors associated with mild behavioral impairment. The review will adhere to the Joanna Briggs Institute's methodological principles for scoping reviews. We will include studies focusing mainly on mild behavioral impairment in older adults, with the literature on this topic being limited to the period from 2003 to the present. Other clinical diagnoses, such as cognitive impairment, Parkinson disease, and multiple sclerosis, will not be included. We will use databases including PubMed (MEDLINE), CINAHL, Web of Science, Embase, PsycINFO, Cochrane, and Scopus for relevant articles published in English. Both gray literature and peer-reviewed articles will be considered during screening. Three independent reviewers will extract data using a predefined data extraction tool. Extracted data will be presented using tables, figures, and a narrative summary aligned with review questions, accompanied by an analysis of study characteristics and categorization of mild behavioral impairment correlates. The results will be presented as a descriptive summary, structured according to the associated factors related to mild behavioral impairment, and the health outcomes. Additionally, the data on study characteristics will be presented in tabular format. An exploratory search was conducted in July 2023 to establish a comprehensive search strategy, and iterative refinements to the scoping review protocol and formalization of methods were completed. A follow-up search is planned for May 2024, with the aim of submitting the findings for publication in peer-reviewed journals. To our knowledge, this would be the first study to map the literature on the health-related factors and outcomes of mild behavioral impairment. The findings will support the development of interventions to prevent the occurrence of mild behavioral impairment and mitigate the negative outcomes of mild behavioral impairment. DERR1-10.2196/60009.

Depressive symptom mediates the association between the number of chronic diseases and cognitive impairment: a multi-center cross-sectional study based on community older adults.

The purpose of this study was to understand the relationship between the multiple chronic conditions (MCC), mental health and cognitive function of older adults in the community, and to propose a hypothesis that depressive symptom mediate the number of chronic diseases and cognitive impairment in older adults. Participants aged 65 years and older from 35 communities in 14 cities in Guangxi, China were recruited. The residents' depressive symptom (PHQ-9) and cognitive status (AD-8) were evaluated, Chi-square test was used to explore the effects of different socio-demographic characteristics on depressive symptom and cognitive impairment. Pearson correlation analysis and the process model 4 were used to explore the relationship between the number of chronic diseases, depressive symptom and cognitive impairment. A total of 11,582 older adults were included in our analysis. The rate of MCC reaching 26.53%. Hypertension combined with diabetes accounts for the highest proportion of two chronic diseases (13.2%). Among the combination of three chronic diseases, the highest incidence of coexisting hypertension combined with cervical/lumbar spondylosis, and rheumatoid arthritis (7.1%). In this study, depression symptoms accounted for 12.9% of older adults aged 65 and above, and cognitive impairment accounted for 27.4%. Female, older age, reside in urban areas, lower educational levels, no spouse, live alone, and MCC were risk factors for depressive symptom and cognitive impairment in older adults (P<0.05). Depressive symptom had a mediating effect in the number of chronic diseases and cognitive impairment, and the mediating effect (1.109) accounted for 44.13% of the total effect (0.247). The mental health of the older adult needs to be taken seriously, and improving depressive symptom can reduce the occurrence of cognitive impairment in older patients with MCC to a certain extent.

Very high high-density lipoprotein cholesterol may be associated with higher risk of cognitive impairment in older adults

BackgroundPrevious studies have shown that high-density lipoprotein cholesterol (HDL-C) levels are positively associated with cognitive function across a range of concentrations. However, recent studies have suggested that very high HDL-C levels may lead to poorer outcomes. Therefore, we aimed to investigate the relationship between different concentrations of HDL-C and cognitive impairment risk.MethodsWe collected data from 3632 participants aged over 60 years from the U.S. National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014 to assess the relationship between HDL-C and cognitive function. Cognitive function was evaluated with the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) test, the animal fluency test (AFT), and the digit symbol substitution test (DSST). We used restricted cubic spline models and logistic regression to examine the association between HDL-C and cognitive function.ResultsA U-shaped was observed between HDL-C and cognitive outcomes, individuals with higher risk in those with both low and very high HDL-C levels compared with those with midrange values. Very high HDL-C levels (≥ 2.50 mmol/L) were associated with increased risk of cognitive impairment (OR = 2.19; 95% CI, 1.12–4.28) compared with those with HDL-C levels in the range of 1.50 to 1.99 mmol/L in older adults after adjustment for confounding factors. Interaction test demonstrated that relationship between very high HDL-C and the risk of cognitive impairment was not changed in different sex and race group (P for interaction > 0.05).ConclusionsVery high HDL-C levels were associated with an increased risk of cognitive impairment. HDL-C may not be a protective factor for maintaining brain health in older adults at very high levels.

A Comparative Study Evaluating the Effectiveness of Folate-Based B Vitamin Intervention on Cognitive Function of Older Adults under Mandatory Folic Acid Fortification Policy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The policies regarding the mandatory fortification of food with folic acid (FA) may impact the effectiveness of folate-based B vitamin treatment on cognitive function in older adults. We critically and systematically review the literature to assess whether food fortification policies affect folate-based B vitamin treatment efficacy on cognition function in older adults. Electronic databases, including PubMed, Web of Science, and CNKI, were searched for "Cognitive Function", "Folate", and "Older Adults". The study had specific criteria for inclusion, which were as follows: (1) the studies should initially have randomized controlled trials that were conducted on older adults aged 60 or above; (2) the studies must assess the relationship between folate status and cognitive performance; and (3) the studies should clarify the policies regarding food fortification with FA. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Two reviewers independently extracted all the data, and any discrepancies were resolved by consensus. All the data collected were compiled, compared, and analyzed critically. Random effects models were used to assess the effects of interventions. The systematic review included fifty-one articles involving 42,768 participants. Of these, the 23 articles were included in the meta-analysis. The meta-analysis on the effects of folate-based B vitamin supplementation on cognitive function showed a significant overall impact (Z = 3.84; p = 0.0001; SMD, 0.18; 95% CI, 0.09, 0.28). Further analysis revealed that FA food fortification policies were not implemented in countries where folate-based B vitamin supplementation improved cognitive impairment in older adults (Z = 3.75; p = 0.0002; SMD, 0.27; 95% CI, 0.13, 0.40). However, the FA intervention did not have significant outcomes in areas where FA food fortification policies were mandatory (Z = 0.75; p = 0.45; SMD, 0.03; 95% CI, -0.06, 0.13). Supplementing with oral folic acid, alone or in combination, has been linked to improved cognitive performance in older adults. While mandatory FA fortification has the improved folic acid status, additional folate-based B vitamin supplements do not appear to influence cognitive function.

Association of the combination of social isolation and living alone with cognitive impairment in community-dwelling older adults: The IRIDE Cohort Study

BackgroundLiving alone has been associated with cognitive impairment; however, findings have been inconsistent. Social isolation among older adults who live alone may contribute to cognitive impairment. This study was carried out to examine the association of social isolation and living alone with cognitive impairment in community-dwelling older adults. MethodsIn this cross-sectional study, data from the Integrated Research Initiative for Living Well with Dementia Cohort Study, which comprises pooled data from five community-based geriatric cohorts, was used. Social isolation was defined as infrequent interactions with others. Participants were categorized into four groups based on their social isolation and living alone statuses. Cognitive function was assessed using the Mini-Mental State Examination, with a score <24 indicating cognitive impairment. The association between social isolation combined with living alone and cognitive impairment was analyzed using logistic regression. ResultsOf the 4362 participants included in the analysis (mean age 75.6 years, 44.3 % male), 11 % had cognitive impairment. Regardless of living alone, social isolation was associated with cognitive impairment (no social isolation x not living alone: reference, social isolation x not living alone; odds ratio (OR): 1.74, 95 % confidence interval (CI): 1.29–2.33, social isolation x living alone; OR: 2.10, 95 % CI: 1.46–3.01). ConclusionsSocial isolation is associated with cognitive impairment; however, living alone is not intrinsically associated with cognitive impairment in older adults. Healthcare providers must focus on social interactions to prevent cognitive impairment in older adults rather than simply focusing on living arrangements.

Hearing Screening for Older Adults With Cognitive Impairment: A Systematic Review.

: Hearing loss is the largest potentially modifiable risk factor for dementia. Early evaluation and intervention are crucial for older adults with cognitive impairment. However, pure-tone audiometry (PTA), the gold standard, may have limitations. This study reviewed auditory tests for detecting hearing loss in this population, comparing to PTA. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review in PubMed, Scopus, and Embase. Ten studies (1,071 participants) comparing auditory tests and PTA in patients with dementia and mild cognitive impairment were included. : Electrophysiological and behavioral tests demonstrated strong correlation and accurate hearing impairment detection compared to PTA. Conversely, self-reported assessment showed weaker correlations when aligned with hearing thresholds. : This study highlights the potential of electrophysiological and behavioral auditory tests in detecting hearing impairment in older adults with cognitive impairment, emphasizing the need for further research to develop practical screening protocols for this vulnerable population.

High rate of potentially inappropriate medication use in older people: a case–control study

Annually, 172 million fall events cause temporary or permanent impairment in older adults, and this number is increasing. Contributing factors that increase the risk for falls include age, polypharmacy, and malnutrition. This study evaluated medications mainly included in the EU(7)-PIM (potentially inappropriate medication) list. From March 21, 2022, to July 6, 2022, 945 patients who experienced a fall and visited the Department of Emergency Medicine at the Albert Szent-Györgyi Health Centre of the University of Szeged in Hungary. Data from 886 patients were collected (study group). The control group included 1364 patient data collected from three general practice in Hungary. The use of ≥ 2 EU(7)-PIM drugs was found to be associated with increased risk for falls (adjusted odds ratio [AOR], 1.38; 95% confidence interval [CI] 1.01–1.88). Piracetam (AOR, 1.81; 95% CI, 1.28–2.57) and trimetazidine (AOR, 1.62; 95% CI, 1.17–2.24) were associated with increased risk for falls. Doxazosin was associated with a low risk for falls (AOR, 0.59; 95% CI, 0.41–0.86). Tiapride (AOR, 3.54; 95% CI, 1.75–7.17), gliclazide (AOR, 1.57; 95% CI, 1.02–2.43), and vinpocetine (AOR, 1.95; 95% CI, 1.29–2.95) are not included in the EU(7)-PIM list; however, they are associated with increased risk for falls. Long-acting benzodiazepines (AOR, 1.79; 95% CI, 1.20–2.68), antidepressants (AOR, 1.89; 95% 95% CI, 1.37–2.61), serotonin–norepinephrine reuptake inhibitor (AOR, 2.82; 95% CI, 1.41–5.67; p < 0.01), and selective serotonin reuptake inhibitor (AOR, 1.88; 95% CI, 1.24–2.85) were also associated with increased risk for falls. However, Z-drugs were associated with a low risk for falls (AOR, 0.57; 95% CI, 0.36–0.92). With the help of this tool, trimetazidine and piracetam are filtered as EU(7)-PIM drugs associated with increased risk for falls.