Incident Mild Cognitive Impairment Research Articles

ARE RECENTLY INCARCERATED OLDER ADULTS MORE LIKELY TO DEVELOP DEMENTIA THAN THE NEVER INCARCERATED?

Abstract Increasing numbers of older adults are reentering the community following incarceration (i.e., reentry). Yet, their risk of developing dementia and mild cognitive impairment (MCI) is unknown. We leveraged a national cohort of veterans who experienced reentry at age ≥ 65 years (N=5,920) and compared their risk of dementia or MCI to an age- and sex-matched never incarcerated sample (N=29,600). Those in the reentry sample were incarcerated for ≤10 consecutive years, experienced reentry between 10/01/2012 and 9/30/2018, and did not have a pre-incarceration MCI or dementia diagnosis per VA and CMS healthcare records (N=5,920). Fine-Gray models, controlling for race and pre-incarceration chronic conditions, serious mental illness, traumatic brain injury, and posttraumatic stress disorder, derived hazard ratios (HRs) and 95% Confidence Intervals (CIs). Samples were 99% male with average age 70 (±4.3) years. Reentry adults had a higher proportion of non-Whites (29% vs. 17%; p< 0.001) and more chronic conditions (2.1[±1.8] vs. 1.6[±1.6] p< 0.001). MCI incidence did not differ between reentry and never incarcerated groups (3.1% vs. 2.6%; HR=1.03; 95%CI 0.86-1.24). However, risk of any dementia was higher in reentry older adults (7.2% vs. 5.0%; HR=1.27; 95%CI 1.12, 1.44), as was risk of specific subtypes, e.g., vascular dementia (1.9% vs. 1.2%; HR=1.37; 95% CI 1.06-1.75) and frontotemporal dementia (0.2% vs. 0.1%; HR=2.3; 95% CI 1.2, 4.3). Those reentering the community in late life following incarceration may be a group that is especially at risk of developing dementia. These findings raise awareness of the need for appropriate transition planning for this vulnerable group.

Arrhythmia and other modifiable risk factors in incident dementia and MCI among elderly individuals with low educational levels in Taiwan.

There is increasing evidence that arrhythmia is a risk factor for dementia; however, it appears that arrhythmia affects the cognitive function of individuals differentially across age groups, races, and educational levels. Demographic differences including educational level have also been found to moderate the effects of modifiable risk factors for cognitive decline. This study recruited 1,361 individuals including a group of cognitively unimpaired (CU) individuals, a group of patients with mild cognitive impairment (MCI), and a group of patients with dementia with low education levels. The participants were evaluated in terms of modifiable risk factors for dementia, including arrhythmia and neuropsychiatric symptoms. Cox proportional hazard regression models revealed that among older MCI patients (>75 years), those with arrhythmia faced an elevated risk of dementia. Among younger MCI patients, those taking anti-hypertensive drugs faced a relatively low risk of dementia. Among younger MCI patients, male sex and higher educational level were associated with an elevated risk of dementia. Among CU individuals, those with coronary heart disease and taking anti-lipid compounds faced an elevated risk of MCI and those with symptoms of depression faced an elevated risk of dementia. The risk and protective factors mentioned above could potentially be used as markers in predicting the onset of dementia in clinical settings, especially for individuals with low educational levels.

Caregivers' depressive symptom trajectories and risk of cognitive impairment among older adults with functional limitations: A prospective cohort study.

Caregiver (CG)'s depression is common and its prevalence is rising. The relationship of CG depression with care recipients (CR)'s subsequent cognitive impairment remains unclear. This study examines the association of CG depressive symptoms trajectories with 6-year cognitive impairment risk among care recipients (CR) who are older adults with functional limitations. Retrospective analysis of prospectively collected data cohorts from 2010 to 2016. The sample included 810 community-dwelling older adults aged ≥75years, dementia free at baseline, with their primary caregiver dyads. CG's depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. The main outcomes were incident mild, moderate, and severe cognitive impairment of CRs measured using Short Portable Mental Status Questionnaire. Group-based trajectory modeling identified three CG depressive symptom trajectory groups. Competing risks regression analysis modeled the hazards as a function of CG depressive symptom trajectories. Of 810 CRs, 3% developed severe cognitive impairment, 21% had moderate cognitive impairment, and 37% had mild cognitive impairment. Only CG's "Increasing" trajectory group predicted increased risk of CR's mild and moderate cognitive impairment relative to "persistently low" group (subhazard ratio [SHR]=1.52, 95% confidence interval [CI], p<0.05; SHR=1.87, 95% CI, p<0.05, respectively). Finding highlight the intricate and non-linear association between CG depressive trajectory and CR cognitive impairment. This evidence can be used to enlighten policymakers and health providers about the need for risk stratification screening for CG mental health and early treatment for CG depression to prevent or delay CR's cognitive impairment.

Association of social support with mild cognitive impairment and dementia among older women: the Women’s Health Initiative Memory Study

AbstractBackgroundWomen comprise approximately two‐thirds of older adults with Alzheimer’s disease in the United States. Social support may be a modifiable risk factor for cognitive impairment. However, few long‐term, large prospective studies have examined associations of various forms of social support with cognitive impairment. Therefore, we examined the association of perceived social support with incident mild cognitive impairment (MCI) and dementia among older women.MethodThis prospective cohort study included 6,670 older women from the Women’s Health Initiative (WHI) Memory Study (WHIMS), a sub‐cohort of the WHI hormone therapy (HT) trials, who were free of dementia upon enrollment. Perceived social support was assessed at baseline using nine items from the Medical Outcomes Study Social Support Survey. All item ratings were summed to generate a summary score (range = 9‐45), with higher scores indicating greater perceived social support. Incident MCI and dementia were ascertained using a comprehensive neuropsychological battery and central adjudication by a panel of specialists with expertise in dementia diagnosis during up to 25 years of follow‐up. Cox proportional hazards models were used to assess associations of perceived social support with incident MCI, dementia, and overall cognitive impairment (MCI or dementia). We also examined associations of four types of social support (emotional/informational, affection, tangible, and positive social interaction) with MCI/dementia.ResultOverall, (mean age at baseline = 70.0 [SD 3.8] years; 97.0% non‐Hispanic/Latina; 89.8% White) 753 women had incident MCI, 697 had incident dementia, and 1,197 had incident overall cognitive impairment. There were no significant associations of social support with MCI (HR = 0.99; 95%CI = 0.98‐1.00), dementia (HR = 0.99; 95% CI = 0.98‐1.01), or overall cognitive impairment (HR = 0.99; 95% CI = 0.98‐1.00) after adjusting for age, education, income, race, ethnicity, marital status, smoking, alcohol intake, body mass index, history of diabetes, hormone therapy trial assignment, history of hormone therapy use, history of hypertension, and depressive symptom severity. There were no significant associations between the four types of social support and MCI/dementia.ConclusionPerceived social support was not significantly associated with incident cognitive impairment among older women. Future studies should explore other social factors, such as social isolation and loneliness, particularly in larger and racially/ethnically diverse populations.

The association between serum mercury concentration and mild cognitive impairment: the REGARDS study

AbstractBackgroundAnimal studies have demonstrated the toxicology and pathology of mercury in relation to brain function. However, human studies provided mixed findings in relation to cognitive aging. This study aims to examine the association between serum mercury concentration and the incidence of mild cognitive impairment (MCI).MethodParticipants were from a random sub‐cohort (n = 2666) of the REasons for Geographic and Racial Differences in Stroke cohort study (2003–present). After excluding participants with baseline MCI and stroke, and those with missing baseline serum mercury concentration, the final sample size was 2136. Participants were classified into tertiles based on serum mercury concentration (&lt;0.023, 0.023–0.049, and &gt;0.049 µg/dL). MCI was determined primarily based on most recent performance on the enhanced cognitive battery (ECB) containing assessments of Word List Learning, Delayed Recall, Animal Fluency, and letter F Fluency. For those who did not have a score on ECB (n = 474), the Six Item Screener (SIS) was used to determine MCI instead. Therefore, the outcome included three levels: MCI based on the ECB, MCI based on the SIS, and control. Multinomial logistic regression was used to assess serum mercury concentration in relation to incident MCI. We also performed stratified analyses to assess whether gender and race modified the potential associations. All tests were two‐sided with α = 0.05.ResultThe number of participants with MCI on the ECB and SIS were 48 and 36, respectively. After adjustment for the demographic and clinical characteristics in model 2 (Table 1), the direction suggests a positive association between mercury and incident MCI, although this is not statistically significant presumably due to insufficient statistical power (Tertile 3 vs. tertile 1: odds ratio (OR), 1.68; 95% confidence interval (CI), 0.79–3.55; P for trend = 0.025). After further adjustment for fish oil intake, the association became significant (OR: 2.56; 95% CI: 1.003‐6.55; P for trend = 0.043). The observed association was not materially modified by sex or race. We did not observe an association between serum mercury and impairment on SIS.ConclusionThis prospective study suggests that serum mercury concentrations are associated with incident MCI assessed by ECB in US population.

Cohort Profile: The Community‐based Cohort of Functional Decline in Subjective Cognitive Complaint elderly study of the Geroscience Center for Brain Health and Metabolisms (GERO)

AbstractBackgroundDementia worldwide is one of the most important causes of disability in the elderly and the most rapidly growing cause of death in the last 20 years in Chile. Cognitive complaint is considered a predictor for cognitive and functional decline (FD), incident mild cognitive impairment, and incident dementia. The GERO cohort aims to determine multidimensional risks factors associated with the prognosis of elderly with cognitive complaint on DF.MethodThe GERO cohort is a prospective cohort study of community‐dwelling elderly with cognitive complaint, without dementia, aged 70 or older living in 4 municipalities in Santiago, Chile. Participants were identified by a household census and information on demographics, biomedical, psychosocial, neuropsychological, neuropsychiatric, and motor function were collected by means of questionnaires and evaluations. Neuroimaging, blood, and stool samples were also obtained. FD was measured by the Pfeffer (score range 0‐33), Technology Activities of Daily Living Questionnaire (T‐ADLQ, score range 0‐100), and Everyday Cognition (ECOG, score range 0‐36) questionnaires.ResultA total of 17,759 households were successfully approached, identifying 2,533 eligible subjects, accepting to participate 299 (59 men; 240 women). The mean age was 76.8±5.1, 25% older than 79. The average years of schooling was 8.9± 4.8. None of participants showed underweight. The average score for the Mini‐mental State Exam (MMSE) was 27.1± 2.4, with 5.3% of the sample scoring less than 23. The mean values for Pfeffer, T‐ADLQ, and ECOG were 0.8±1.3, were 11.9± 10.3, and 0.4±0.4 respectively. In the multivariate analysis MMSE was inversely correlated with the ECOG score (regression coefficient: ‐0.03 [95%CI ‐0.07; ‐0.002]. Pfeffer also was associated, but its statistical significance was lost after the multivariate adjustment.ConclusionFew other studies addressed cognitive complaint and functionality in elderly recruited at home. Elderly in the GERO‐cohort with cognitive complaint, without dementia, show a good level of functioning at the first assessment. Cognitive function measured by the MMSE seems to be associated to a subtle decline in general functioning as everyday cognition. Future multidimensional and prospective analysis of this cohort could bring more information about this association.

Association of Type D personality and mild cognitive impairment in patients with hypertension.

The aim of this study was to evaluate the association between Type D personality and mild cognitive impairment (MCI) in patients with hypertension. A total of 324 subjects with hypertension were included in the study. All of them completed questionnaires on demographic characteristics, Type D personality Scale, Montreal Cognitive Assessment (MoCA), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The Type D personality effect was analyzed as both dichotomous and continuous methods. The incidence of MCI was 56.5% in hypertensive individuals. Type D personality presenting as a dichotomous construct was an independent risk factor of MCI (odds ratio [OR] = 2.814, 95% confidence interval [CI] = 1.577-5.021, p < 0.001), after adjusting for ages, sex and some clinical factors. Meanwhile, main effect of negative affectivity component was independently related to the prevalence of MCI (OR = 1.087, 95%CI = 1.014-1.165, p = 0.019). However, associations between the main effect of social inhibition component (OR = 1.011, 95%CI = 0.924-1.107, p = 0.811) as well as the interaction of negative affectivity and social inhibition (OR = 1.013, 95%CI = 0.996-1.030, p = 0.127) with MCI were not found. The findings suggest that Type D personality is strongly associated with MCI in patients with hypertension. The negative affectivity component of the Type D appears to drive the correlations between Type D and MCI. These findings provide new ideas for studying the mechanisms underlying the relationship between personality and cognitive decline in hypertensive individuals.

The predictive value of fibrinogen in the occurrence of mild cognitive impairment events in patients with diabetic peripheral neuropathy

BackgroundResearch suggests that fibrinogen (Fib) is related to mild cognitive impairment (MCI) and diabetic peripheral neuropathy (DPN) and the risk of MCI in patients with DPN is greatly increased, although no studies have evaluated the predictive value of Fib for the risk of MCI in patients with DPN.MethodsThis prospective observational clinical study enrolled 207 type 2 diabetes mellitus (T2DM) patients, who were divided into diabetes with no neuropathy (102 cases) and diabetes with neuropathy (105 cases) groups. Meanwhile, 90 healthy unrelated subjects were recruited as controls. The incidence of MCI in the DPN patients was followed up for 2 years. Divide patients in the DPN group into subgroups according to whether MCI occur, use multivariate logistic regression to analyze independent factors of MCIs in DPN patients within 2 years, and use ROC curve to analyze the predictive value of Fib for MCI in DPN patients.ResultsFib levels were significantly higher in diabetic subjects with neuropathy compared with those without (P < 0.001). In further subgroup analysis of DPN patients who were divided according to the occurrence of MCI, baseline data of the MCI subgroup showed Fib levels were higher than that in the non-MCI group while education levels declined (P < 0.001). The education level and increased Fib levels were independent factors for the occurrence of MCI within 2 years after the onset of DPN (OR = 0.769, 95% CI: 0.605 ~ 0.968, P = 0.037; OR = 2.674, 95% CI: 1.094 ~ 3.168, P = 0.002). The ROC curve indicated that the predictive value of Fib was (AUC = 0.764, 95% CI: 0.671 ~ 0.842, P < 0.001).ConclusionsFib may function as a predictor for assessing the risk of MCI in DPN patients.

The Preventing Alzheimer's with Cognitive Training (PACT) randomized clinical trial

BackgroundTo address the rising prevalence of Alzheimer's disease and related dementias, effective interventions that can be widely disseminated are warranted. The Preventing Alzheimer's with Cognitive Training study (PACT) investigates a commercially available computerized cognitive training program targeting improved Useful Field of View Training (UFOVT) performance. The primary goal is to test the effectiveness of UFOVT to reduce incidence of clinically defined mild cognitive impairment (MCI) or dementia with a secondary objective to examine if effects are moderated by plasma β-amyloid level or apolipoprotein E e4 (APOE e4) allele status. Methods/designThis multisite study utilizes a randomized, controlled experimental design with blinded assessors and investigators. Individuals who are 65 years of age and older are recruited from the community. Eligible participants who demonstrate intact cognitive status (Montreal Cognitive Assessment score > 25) are randomized and asked to complete 45 sessions of either a commercially available computerized-cognitive training program (UFOVT) or computerized games across 2.5 years. After three years, participants are screened for cognitive decline. For those demonstrating decline or who are part of a random subsample, a comprehensive neuropsychological assessment is completed. Those who perform below a pre-specified level are asked to complete a clinical evaluation, including an MRI, to ascertain clinical diagnosis of normal cognition, MCI, or dementia. Participants are asked to provide blood samples for analyses of Alzheimer's disease related biomarkers. DiscussionThe PACT study addresses the rapidly increasing prevalence of dementia. Computerized cognitive training may provide a non-pharmaceutical option for reducing incidence of MCI or dementia to improve public health.Registration: The PACT study is registered at http://Clinicaltrials.govNCT03848312

Body Mass Index Trajectories Preceding Incident Mild Cognitive Impairment and Dementia

Body mass index (BMI) trajectories before the onset of mild cognitive impairment (MCI) and during the progression from MCI to dementia remain unclear. To assess the long-term BMI trajectories preceding incident MCI and dementia and explore whether they are associated with brain pathologies. The Rush Memory and Aging Project (MAP) was an ongoing community-based cohort study. This study included cognitively intact participants aged 60 to 90 years at baseline with annual follow-up from October 1997 to December 2020 (maximum follow-up of 22 years). During the follow-up, participants underwent brain autopsies. Data were analyzed from August 2021 to February 2022 using mixed-effect models. BMI was calculated using height and weight measured at baseline and follow-ups. Incident MCI and dementia were diagnosed following standard criteria. Neuropathological assessments (including global Alzheimer disease and vascular pathology) were performed for autopsies. A total of 1390 participants (mean [SD] age, 78.4 [6.5] years; 1063 female [76.5%]) were included in the study. In the analysis of BMI trajectories before MCI (n = 939), during the follow-up (median [IQR] duration, 6 [3-9] years), 371 participants (39.5%) developed MCI, of whom 88 (23.7%) progressed to dementia. Those who developed MCI were older (mean [SD] age, 79.6 [5.9] years vs 76.9 [6.6] years), consumed less alcohol (median [IQR] consumption, 0 [0-5.8] g/day vs 1.1 [0-6.9] g/day), had a lower BMI (mean [SD], 27.2 [4.9] vs 28.2 [5.9]), and were more likely to be apolipoprotein E (APOE) ε4 carriers (89 of 371 [24.0%] vs 98 of 568 [17.3%]) compared with those who remained cognitively intact over follow-up. Those who developed dementia were older (mean [SD] age, 81.0 [5.2] years vs 79.1 [6.0] years), had a lower level of physical activity (median [IQR] activity, 1.0 [0-2.5] h/week vs 1.8 [0.2-3.8] h/week), and were more likely to be APOE ε4 carriers than those who were dementia-free (33 of 88 [37.5%] vs 56 of 283 [19.8%]). Compared with participants who remained cognitively intact, in those with incident MCI, BMI tended to decline earlier and faster. From 7 years before diagnosis, people with incident MCI had an associated significantly lower BMI (mean difference, -0.96; 95% CI, -1.85 to -0.07) than those who were cognitively intact. Among people with incident MCI, the slopes of BMI decline did not differ significantly between those who did and did not develop dementia (β, -0.03; 95% CI, -0.21 to 0.15). In the analysis of BMI trajectories before autopsy (n = 358), BMI was associated with a faster declination among participants with a high burden of global Alzheimer disease pathology (β for pathology × time highest vs lowest tertile, -0.14; 95% CI, -0.26 to -0.02) or vascular pathology (β for pathology × time2 highest vs lowest tertile, 0.02; 95% CI, 0-0.05). Results of this cohort study suggest that among cognitively intact people, significantly lower BMI occurs beginning approximately 7 years before MCI diagnosis. After MCI diagnosis, BMI declines at the same pace in people who develop dementia and those who do not. High brain pathologies may underly the BMI decline preceding dementing disorders.

Fluctuation of depressive symptoms in cognitively unimpaired participants and the risk of mild cognitive impairment 5 years later: Results of the Heinz Nixdorf Recall study.

Depression might be an independent risk factor for cognitive decline, a prodromal dementia symptom or a reaction to cognitive/functional impairment. To investigate the association between (1) depressive symptoms and (2) depressive symptom patterns over 13 years with incident mild cognitive impairment (MCI) 5 years later. We included 724/823 cognitively unimpaired men/women who participated in the population-based Heinz Nixdorf Recall study (t1: 2005-2008, ø62.9 years; t2: 2010-2015, ø68.1 years). Depressive symptoms were assessed in the study center and during six postal follow-ups using the short form of the Center for Epidemiologic Studies Depression Scale (CES-D). Relative risks (RR; 95% confidence intervals) for MCI at t2 (men/women: 71/76) were estimated for CES-D at t1 (linear and dichotomized at ≥17, cut-off for clinically relevant depressive symptoms) and CES-D fluctuations over 13 years (stable low, large fluctuations, stable high/stable around cut-off) using log-linear regression models with Poisson working likelihood adjusted for age, sex, education, diabetes mellitus, coronary heart disease, and stroke. Fully adjusted risk for MCI at t2 (per CES-D point increase at t1) was elevated for the total cohort (1.053, 1.031-1.076), men (1.046, 1.012-1.081), and women (1.059, 1.029-1.090). Applying the dichotomized CES-D, risk for MCI was substantially increased for the total cohort [2.22 (1.38-3.58)] and in women [2.59 (1.46-4.58)]. Large CES-D fluctuations and stable high/stable around cut-off were associated with increased RR for MCI in the total cohort and in women compared to stable low symptoms. Depressive symptoms predicted MCI in cognitively unimpaired participants of our population-based study. Adequate treatment of depression may therefore contribute to the maintenance of normal cognition and delay dementia onset.

Physical Functional Impairment and the Risk of Incident Mild Cognitive Impairment in an Observational Study of World Trade Center Responders.

Posttraumatic stress disorder (PTSD) has been linked to increased risk of cognitive dysfunction and physical functional impairment (PFI). The objective of this prospective cohort study was to examine whether PFI was associated with increased risk of incident mild cognitive impairment (MCI) among World Trade Center (WTC) responders with PTSD. We hypothesized that responders with PTSD would have an elevated risk of incident MCI and that PFI would mediate this increase. We examined responder participants in the WTC Aging Study whose baseline physical assessments were completed by May 2016-April 2017 and were followed up at least once before December 2019. Those without complete demographic, medical, or behavioral data were excluded. PFI was assessed using measures of upper body strength (maximal handgrip strength [HGS]) and lower extremity physical functioning (Short Physical Performance Battery). PTSD was rated using a diagnostic interview and symptom checklist; MCI and dementia were assessed using the Montreal Cognitive Assessment and diagnosed using the National Institute on Aging-Alzheimer's Association criteria. Group differences and longitudinal comparisons were examined. Cox proportional hazards models were evaluated from time to incident MCI and conversion to dementia. A mediation analysis examined whether PFI mediated associations between PTSD and MCI. Within the sample of 2,687 WTC responders, 324 (12.06%, 95% CI = [10.83-13.29]) had lower extremity PFI. Responders with lower extremity PFI were older, had lower education and higher body mass, and were at a higher risk of pulmonary embolisms and PTSD. Responders with lower extremity PFI demonstrated lower baseline cognition and had increased hazards of MCI (multivariable-adjusted hazards ratio [aHR] = 1.55 [95% CI 1.21-1.98]); those with MCI converted to dementia more rapidly than those without PFI (2.73 [1.38-5.39] p = 0.004). In addition, each standard deviation decrease in HGS was associated with increased hazards of developing MCI (aHR = 1.35 [95% CI 1.10-1.66]). A mediation model suggested PFI played an intermediary role in the relationship between PTSD and MCI. WTC responders with PFI demonstrated worse cognitive and behavioral outcomes, and PFI played an intermediary role in the relationship between PTSD and incident MCI, suggesting that PFI may be an early indicator of MCI in responders with PTSD. Regular monitoring of PFI should be considered among PTSD populations.

The relationship between depressive symptoms and subtypes of mild cognitive impairment in post-menopausal women: Results from the Women's Health Initiative Memory Study.

Depressive symptoms are associated with age-related cognitive impairment, but the relative risk of specific subtypes of mild cognitive impairment (MCI) conferred by depressive symptoms is unclear. The purpose of this exploratory study was to determine the longitudinal association between baseline depressive symptoms and incident cases of MCI subtypes (amnestic vs. non-amnestic) and probable dementia (PD) (Alzheimer's disease, vascular, mixed) among postmenopausal women. Depressive symptoms were assessed at study baseline using an 8-item Burnam algorithm in 7043 postmenopausal women who participated in the Women's Health Initiative Memory Study (WHIMS) and the WHIMS-Epidemiology of Cognitive Health Outcomes (WHIMS-ECHO) extension study. During the median 9.4-year follow-up interval, the presence of MCI and PD was classified by a central adjudication committee. Classification of participants by MCI subtype (amnestic single and multi-domain, non-amnestic single and multi-domain) was done algorithmically based on established criteria using data from annual cognitive testing. At baseline, 557 women (7.9%) had clinically significant depressive symptoms based on Burnam algorithm cut-point of 0.06. Depressive symptoms at baseline were associated with an increased risk of incident amnestic MCI (hazard ratio [HR]=1.91, 95% confidence interval [CI] 1.32-2.78, p<0.0001), but not non-amnestic MCI (HR=1.39, 95% CI 0.91-2.14, p=0.13) after controlling for demographic factors. This relationship between depressive symptoms and amnestic MCI remained consistent after controlling for lifestyle variables, cardiovascular risk factors, antidepressant use, and history of hormone therapy. There were no significant associations between depressive symptoms and incidence ofPD. Depressive symptoms at baseline among postmenopausal older women are associated with higher incidence of amnestic MCI, suggesting that they may be an independent risk factor or part of the early prodrome of dementia.

Risk scores of incident mild cognitive impairment in a Beijing community-based older cohort.

Objective: It is very important to identify individuals who are at greatest risk for mild cognitive impairment (MCI) to potentially mitigate or minimize risk factors early in its course. We created a practical MCI risk scoring system and provided individualized estimates of MCI risk.Methods: Using data from 9,000 older adults recruited for the Beijing Ageing Brain Rejuvenation Initiative, we investigated the association of the baseline demographic, medical history, lifestyle and cognitive data with MCI status based on logistic modeling and established risk score (RS) models 1 and 2 for MCI. We evaluated model performance by computing the area under the receiver operating characteristic (ROC) curve (AUC). Finally, RS model 3 was further confirmed and improved based on longitudinal outcome data from the progression of MCI in a sub-cohort who had an average 3-year follow-up.Results: A total of 1,174 subjects (19.8%) were diagnosed with MCI at baseline, and 72 (7.8%) of 849 developed MCI in the follow-up. The AUC values of RS models 1 and 2 were between 0.64 and 0.70 based on baseline age, education, cerebrovascular disease, intelligence and physical activities. Adding baseline memory and language performance, the AUC of RS model 3 more accurately predicted MCI conversion (AUC = 0.785).Conclusion: A combination of risk factors is predictive of the likelihood of MCI. Identifying the RSs may be useful to clinicians as they evaluate their patients and to researchers as they design trials to study possible early non-pharmaceutical interventions to reduce the risk of MCI and dementia.

Sarcopenia and mild cognitive impairment among elderly adults: The first longitudinal evidence from CHARLS.

The association between sarcopenia and mild cognitive impairment (MCI) among elderly adults in China remains unclear. The present study aimed to examine the association based on a nationally representative large-scale survey. The study used two waves of data from China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. All subjects met the inclusion criteria were classified based on Asia Working Group for Sarcopenia 2019 criteria. Aging-associatedcognitive decline is used to define MCI, and cognitive function is measured based on four dimensions: orientation, computation, memory, and drawing. OLS and logistic regression model were conducted to analyse the cross-sectional association between sarcopenia and different cognitive functions. Logistic regression model was conducted to analyse the longitudinal association between sarcopenia and MCI. Totally, 5715 participants aged over 60years (43.8% women; mean age 67.3±6.0years) were enrolled in a cross-sectional association study in 2015, and further 2982 elderly adults were followed up in 2018. During the period, sarcopenia and possible sarcopenia increased from 8.5% to 29.6%. Scores of cognitive and four dimensions (orientation, computation, memory, and drawing) exhibited a decreasing trend from non-sarcopenia to sarcopenia (P<0.001). In the fully adjusted OLS regression model, scores of four dimensions were lower in possible sarcopenia and sarcopenia groups when compared with the non-sarcopenia group (P<0.05) respectively. The incidence of MCI was 10.1%, 16.5%, and 24.2% for non-sarcopenia, possible sarcopenia, and sarcopenia groups from 2015 to 2018, with a significantly statistical difference (P<0.001). Logistic regression model revealed an odds ratio of 1.43 [95% confidence interval (CI): 1.06-1.91, P=0.017] for the possible sarcopenia group and 1.72 (95% CI: 1.04-2.85, P=0.035) for sarcopenia group when compared with the non-sarcopenia group. Sarcopenia is associated with worse cognitive impairment, which provided new evidence for a strong association that warrants further research into mechanistic insights.

Functional mobility decline and incident mild cognitive impairment and early dementia in community-dwelling older adults: the Singapore Longitudinal Ageing Study.

Motor and gait disturbances are evident in early Alzheimer and non-Alzheimer dementias and may predict the likelihood of mild cognitive impairment (MCI) or progression to dementia. We investigated the Timed-Up-and-Go (TUG) measure of functional mobility in predicting cognitive decline and incident MCI or early dementia (MCI-dementia). Prospective cohort study with 4.5years follow-up. Population based. 2,544 community-dwelling older adults aged 55+ years. Participants with baseline data on TUG, fast gait speed (GS), knee extension strength (KES) and performance-oriented mobility assessment (POMA) gait and balance were followed up for cognitive decline (Mini-Mental State Exam; MMSE drop of ≥2, among 1,336 dementia-free participants) and incident MCI-dementia (among 1,208 cognitively normal participants). Odds ratio (OR) and 95% confidence intervals (95% CI) were adjusted for age, sex, education, smoking, physical, social and productive activity, multi-morbidity, metabolic syndrome and MMSE. Per standard deviation increase in TUG, POMA, GS and KES were significantly associated with incident MCI-dementia: TUG (OR = 2.84, 95% CI = 2.02-3.99), GS (OR = 2.17, 95% CI = 1.62-2.91), POMA (OR = 1.88, 95% CI = 1.22-2.92) and KES (OR = 1.52, 95% CI = 1.15-2.02). Adjusted OR remained significant only for TUG (OR = 1.52, 95% CI = 1.01-2.31) and GS (OR = 1.53, 95% CI = 1.08-2.16). Areas under the curve (AUC) for TUG (AUC = 0.729, 95% CI = 0.671-0.787) were significantly greater than GS (AUC = 0.683, 95% CI = 0.619-0.746), KES (AUC = 0.624, 95% CI = 0.558-0.689) and POMA (AUC = 0.561, 95% CI = 0.485-0.637). Similar associations with cognitive decline were significant though less pronounced, and adjusted ORs remained significant for TUG, GS and POMA. Functional mobility decline precedes incident MCI and early dementia. The TUG appears to be especially accurate in predicting the future risks of adverse cognitive outcomes. ClinicalTrials.gov NCT03405675. Registered 23 January 2018 (retrospectively registered).

A-106 Diagnostic Predictive Utility of Perceived Subjective Cognitive Complaints Measured by Ascertain Dementia 8 (AD8)

Abstract Objective: Literature regarding the association between the presence and persistence of subjective cognitive complaints (SCCs) and cognitive impairments is inconsistent. Therefore, we examined whether SCCs status (no/non-persistent/persistent SCCs), predicted the risk of developing incident Mild Cognitive Impairment (MCI). Methods: Participants were dementia-free community-residing older adults. We assessed SCCs at the baseline visit and via bi-monthly structured phone interviews during the first study year using the Ascertain Dementia 8 (AD8). Non-persistent status required one SCCs endorsement and Persistent status required two or more SCCs endorsements. Cognitive status was determined by established case conference diagnostic procedures. Participants were followed annually up to 5 years. Generalized Estimating Equations (GEE), logistic model type, were used to determine the odds of developing MCI during follow-up. The presence and persistence of SCCs served as the three-level predictor. Analyses adjusted for age, sex, education, ethnicity, and health status. Results: The sample (n = 454; mean age = 75.67 ± 6.43; %female = 55.3) included 245 participants who reported no SCCs, 105 who reported 1 SCCs and 104 who reported 2 or more SCCs. 59 participants developed MCI during follow-up. GEE results showed that compared to no SCCs, persistent SCCs (OR = 3.004, 95% CI = 1.503–6.003, p = 0.002), and non-persistent endorsements of SCCs (OR = 3.760, 95%CI = 1.946–7.265, p &amp;lt; 0.001) were significantly associated with increased odds of developing MCI during follow-up. Conclusions: The presence of SCCs regardless of its persistence was associated with increased odds of developing MCI among older adults.

MoCA 7.1: Multicenter Validation of the First Italian Version of Montreal Cognitive Assessment.

Background:The early detection of neurocognitive disorders, especially when mild, is a key issue of health care systems including the Italian Dementia National Plan. The Mini-Mental State Examination (MMSE), i.e., the reference screening tool for dementia in Italian Memory Clinics, has low sensitivity in detecting mild cognitive impairment (MCI) or mild dementia.Objective:Availability of a 10-minute screening test sensitive to MCI and mild dementia, such as the Montreal Cognitive Assessment (MoCA), is relevant in the field. This study presents initial validity and reliability data for the Italian version of MoCA 7.1 that is being collected as part of a large ongoing longitudinal study to evaluate the rate of incident MCI and dementia in older adults.Methods:MoCA 7.1 and MMSE were administered to cognitive impaired patients (n = 469; 214 with MCI, 255 with dementia; mean age: 75.5; 52% females,) and healthy older adults (n = 123, mean age: 69.7, 64 % females).Results:Test-retest (0.945, p < 0.001) and inter-rater (0.999, p < 0.001) reliability of MoCA 7.1, assessed on randomly selected participants with normal cognition, MCI, dementia, were significant. MoCA 7.1 showed adequate sensitivity (95.3%) and specificity (84.5%) in detecting MCI compared to MMSE (sensitivity: 53.8%; specificity: 87.5%). The Area Under the Curve of MoCA 7.1 was significantly greater than that of MMSE (0.963 versus 0.742). MoCA 7.1 showed similar results in detecting both MCI and dementia.Conclusion:MoCA 7.1 is a reliable and useful tool that can aid in the diagnosis of MCI and dementia in the Italian population.

The effect of dietary patterns on mild cognitive impairment and dementia incidence among community-dwelling older adults.

Multiple studies have shown that dietary patterns have beneficial health effects on cognitive function. However, information on this relationship is presently limited, particularly among older adults. Thus, this study aimed to determine the effects of dietary patterns on mild cognitive impairment (MCI) and dementia incidence among Malaysian community-dwelling older adults. In this prospective cohort study, a total of 280 participants aged 60 years and above were included in the 5-year follow-up analysis. Participants’ sociodemographic, medical history, anthropometry, blood pressure, body composition, biochemical indices, cognitive assessments, psychosocial functions, functional status, and dietary intake were obtained. MCI was classified based on Petersen criteria, whereas dementia status was assessed using clinical dementia rating (CDR). Univariate analysis was performed for all variables, followed by multinomial regression analysis to identify the ability of dietary patterns in predicting the incidence of MCI and dementia. After controlling for confounding factors, the findings indicated that “local snacks-fish and seafood-high salt foods” dietary pattern was associated with an increased risk of MCI incidence, where the T3 [adjusted OR = 3.943 (95% CI: 1.212–12.832), p = 0.032] had the highest OR compared to T2 [adjusted OR = 3.252 (95% CI: 1.108–9.546), p = 0.023]. Meanwhile, a negative association across the tertiles of tropical fruits-oats dietary pattern and dementia incidence was observed [T2: adjusted OR = 0.152 (95% CI: 0.026–0.871), p = 0.034; T3: Adjusted OR = 0.101 (95% CI: 0.011–0.967), p = 0.047]. In conclusion, specific dietary patterns, particularly “local snacks-fish and seafoods-high salt foods,” were shown to increase the risk of MCI, while increasing intakes of “tropical fruits-oats” dietary patterns would protect against the dementia incidence among Malaysian older adults.

Non-linear association between serum spermidine and mild cognitive impairment: Results from a cross-sectional and longitudinal study.

BackgroundAlthough animal studies show that spermidine (SPD) affects cognitive function, the relevant evidence among humans is limited. We aim to examine the association between serum SPD levels and cognitive performance.Materials and MethodsWe conducted a cross-sectional and longitudinal study including a baseline and one follow-up survey. The baseline survey was conducted from June 2019 to August 2019, while the follow-up survey was conducted from June 2021 to August 2021. We analyzed 3,774 adult participants aged >35 years, who had no history of dementia.ResultsThe mean (SD) age of the participants was 57.4 (9.8) years. Relative to the first tertile, the multivariate-adjusted ORs (95% CIs) of mild cognitive impairment (MCI) for the second and third tertile groups were 0.78 (0.65, 0.93) and 0.80 (0.67, 0.96), respectively. Restricted cubic spline models show that there is a non-linear association between SPD and MCI. In line with cross-sectional findings, the longitudinal study showed that a high SPD concentration may indicate a lower risk of MCI [ORs (95% CIs) for the third tertile of 0.62 (0.39, 0.99)].ConclusionOur findings suggest that SPD is favorable for cognitive function. Monitoring the SPD levels may help reduce the incidence of MCI, hence decreasing the burden of MCI.