Indicator Of Cognitive Impairment Research Articles

Does neuropsychological intraindividual variability index cognitive dysfunction, an invalid presentation, or both? Preliminary findings from a mixed clinical older adult veteran sample

ABSTRACT Introduction Intraindividual variability across a battery of neuropsychological tests (IIV-dispersion) can reflect normal variation in scores or arise from cognitive impairment. An alternate interpretation is IIV-dispersion reflects reduced engagement/invalid test data, although extant research addressing this interpretation is significantly limited. Method We used a sample of 97 older adult (mean age: 69.92), predominantly White (57%) or Black/African American (34%), and predominantly cis-gender male (87%) veterans. Examinees completed a comprehensive neuropsychological battery, including measures of reduced engagement/invalid test data (a symptom validity test [SVT], multiple performance validity tests [PVTs]), as part of a clinical evaluation. IIV-dispersion was indexed using the coefficient of variance (CoV). We tested 1) the relationships of raw scores and “failures” on SVT/PVTs with IIV-dispersion, 2) the relationship between IIV-dispersion and validity/neurocognitive disorder status, and 3) whether IIV-dispersion discriminated the validity/neurocognitive disorder groups using receiver operating characteristic (ROC) curves. Results IIV-dispersion was significantly and independently associated with a selection of PVTs, with small to very large effect sizes. Participants with invalid profiles and cognitively impaired participants with valid profiles exhibited medium to large (d = .55–1.09) elevations in IIV-dispersion compared to cognitively unimpaired participants with valid profiles. A non-significant but small to medium (d = .35–.60) elevation in IIV-dispersion was observed for participants with invalid profiles compared to those with a neurocognitive disorder. IIV-dispersion was largely accurate at differentiating participants without a neurocognitive disorder from invalid participants and those with a neurocognitive disorder (areas under the Curve [AUCs]=.69–.83), while accuracy was low for differentiating invalid participants from those with a neurocognitive disorder (AUCs=.58–.65). Conclusions These preliminary data suggest IIV-dispersion may be sensitive to both neurocognitive disorders and compromised engagement. Clinicians and researchers should exercise due diligence and consider test validity (e.g. PVTs, behavioral signs of engagement) as an alternate explanation prior to interpretation of intraindividual variability as an indicator of cognitive impairment.

Assessing Advance Care Planning Fidelity within the Context of Cognitive Impairment: The SHARE Trial

ContextAdvance care planning (ACP) is critical among primary care patients with cognitive impairment, but few interventions have tested ACP with this population. ObjectiveDescribe the development and evaluation of a tool for assessing ACP fidelity within the context of cognitive impairment, including inter-rater reliability, convergent validity, and overall fidelity using clinical trial data. DesignSHARE is a multicomponent intervention inclusive of facilitated ACP conversations. From a two group, single blind, randomized controlled trial, recorded ACP conversations were rated for fidelity. 145 primary care patients and their care partners were randomized to receive the intervention. Participating patients were 80+ years, had a care partner, and indications of cognitive impairment. An ACP Fidelity Checklist was developed with three subscales: Meeting Set-Up; ACP Meeting Topics; and Communication Skills. Scores were converted to percentages (100% = perfect fidelity) with a target of ≥80% fidelity. A post-ACP meeting report completed by ACP facilitators was used to assess convergent validity of the checklist. Intra-class correlation (ICC) was to evaluate inter-rater reliability. ResultsACP conversations averaged 33.6 minutes (SD = 14.1). The mean fidelity score across N = 91 rated meetings was 82.9%, with a range of 77.3%-90.6% for subscales. 63.7% of meetings achieved a rating of ≥80%. Cognitive function was positively associated with patient participation (rho = .59, P < 0.001). For checklist items, ICC scores ranged from 0.43–0.96. Post-ACP meeting form scores were correlated with the checklist Meeting Topics subscale (r = 0.36, P = 0.001). ConclusionsAssessing the fidelity of ACP conversations involving primary care patients living with cognitive impairment and their care partners is feasible.

Antidepressant use in relation to dementia risk, cognitive decline, and brain atrophy.

We aimed to assess the effect of antidepressant use on dementia risk, cognitive decline, and brain atrophy. In this prospective cohort study, we included 5511 dementia-free participants (Mini-Mental State Examination [MMSE]>25) of the Rotterdam study (57.5% women, mean age 70.6 years). Antidepressant use was extracted from pharmacy records from 1991 until baseline (2002-2008). Incident dementia was monitored from baseline until 2018, with repeated cognitive assessment and magnetic resonance imaging (MRI) every 4 years. Compared to never use, any antidepressant use was not associated with dementia risk (hazard ratio [HR] 1.14, 95% confidence interval [CI] 0.92-1.41), or with accelerated cognitive decline or atrophy of white and gray matter. Compared to never use, dementia risk was somewhat higher with tricyclic antidepressants (HR 1.36, 95% CI 1.01-1.83) than with selective serotonin reuptake inhibitors (HR 1.12, 95% CI 0.81-1.54), but without dose-response relationships, accelerated cognitive decline, or atrophy in either group. Antidepressant medication in adults without indication of cognitive impairment was not consistently associated with long-term adverse cognitive effects. Antidepressant medications are frequently prescribed, especially among older adults. In this study, antidepressant use was not associated with long-term dementia risk. Antidepressant use was not associated with cognitive decline or brain atrophy. Our results support safe prescription in an older, cognitively healthy population.

Carbon Monoxide Exposure and Risk of Cognitive Impairment Among Cooks in Africa

We use air pollution exposure measurements and household survey data from four studies conducted across three countries in sub‐Saharan Africa (SSA) to analyze the association between carbon monoxide (CO) exposure from cooking with biomass and indicators of cognitive impairment. While there is strong evidence on the relationship between ambient air pollution exposure and cognitive impairment from studies in high‐income countries, relatively little research has focused on household air pollution (HAP) in low‐income country settings where risks of HAP exposure are high. This study is the first to our knowledge to focus on the association between HAP exposure (specifically CO exposure) and cognitive impairment across diverse settings in SSA. We use 24‐hour measurements of primary cooks’ exposure to CO across four study sites: urban Zambia (n = 493); urban Malawi (n = 130); rural Malawi (n = 102); and urban Rwanda (n = 2,576). We model the estimated percent carboxyhemoglobin (%COHb) of cooks and map values to a toxicological profile for risk of cognitive impairment. We find that across all study settings, cooks’ average %COHb levels are below levels of daily concern, but that cooks who use charcoal for preparing greater than 40% of meals are more likely to spend additional time at higher levels of risk. For the urban Zambia sample, we compare %COHb and frequency of charcoal use to a series of cognitive test scores and find no consistent relationships between %COHb and cognitive test scores. High levels of daily CO exposure from cooks across SSA highlight the potential for longer‐term negative cognitive (and other) health outcomes motivating additional research and efforts to characterize and mitigate risk.

37 Assessment of Social Cognition in Patients with Multiple Sclerosis

Objective:Multiple sclerosis (MS) is a persistent neuroinflammatory disease of the central nervous system that affects young adults, and is pathologically characterized by multiple and distributed focal white matter lesions, although they are characteristically located in periventricular regions. Cognitive impairment occurs in all clinical forms of the disease, with great variability and great impact on the quality of life of patients. Recent research indicates that in addition to cognitive and physical deficits, they also have deficits in social cognition, such as Theory of Mind. Although social cognition in patients with multiple sclerosis has begun to be studied in recent years, there is still little knowledge about its impact in the early stages of the disease, when the load of injuries is low and physical disability is not yet present. A series of 7 cases of patients diagnosed with MS in follow-up by the Multiple Sclerosis polyclinic of the Institute of Neurology of the Hospital de Clínicas is presented.Participants and Methods:Clinically stable patients with no recent urges and no cognitive complaint were included. They were evaluated with the ACE-R screening test and Theory of Mind tests: Reading the mind in the eyes and Faux Pas tests.Results:All patients presented normal ACE results, without indicators of cognitive impairment and poor performance in the emotion reading test. In two cases, poor yields in Faux Pas were also found.Conclusions:Social cognition has a great impact on quality of life, and there are indicators of involvement in early stages of the disease in which other typical cognitive deficits are not yet evident, and may constitute the first indicator of deterioration. The evaluation and early detection of deficits in social cognition could contribute to the treatment and quality of life of patients.

Cognitive intraindividual variability, cognitive impairment and psychosocial functioning in first-episode psychosis patients

Cognitive intraindividual variability (IIV) refers to fluctuations in performance across tasks (i.e. dispersion) or in a single task on multiple occasions (i.e. inconsistency). Little is known about IIV in patients with first-episode psychosis (FEP). We aimed to explore the association between IIV and both global cognitive performance and psychosocial functioning in a sample of 103 FEP patients.Patients were recruited at discharge from the PEPsNa program, a FEP follow-up intervention program lasting 24 months. The Social and Occupational Functioning Scale (SOFAS) and the Cognitive Assessment Interview (CAI-Sp) were employed for assessing psychosocial functioning. Cognitive assessments were performed using the MATRICS Cognitive Assessment Battery (MCCB), and the variability in the cognitive functions assessed with the MCCB was used to calculate the IIV.Significant correlations were obtained between IIV and global MCCB scores, the CAI-Sp and the SOFAS. We found significant differences in psychosocial functioning and cognitive performance between patients with high and low IIV. A higher IIV in FEP patients was related both to worse psychosocial functioning and worse global cognitive performance. Unlike global cognitive performance, IIV was not related to clinical characteristics, suggesting that it could be an indicator of cognitive impairment even in the absence of global impairment.

Intracranial Atherosclerotic Stenosis Is Associated with Cognitive Impairment in Patients with Nondisabling Ischemic Stroke: A pCASL-Based Study.

Background: Intracranial atherosclerotic stenosis (ICAS) is a key risk factor for vascular cognitive impairment. Cerebral blood flow (CBF) and the spatial coefficient of variation (sCoV) of CBF images (based on pseudocontinuous arterial spin labeling) are used to explore abnormal cerebral perfusion. We aimed to probe the mechanisms underlying cognitive impairment in patients with nondisabling anterior circulation macrovascular disease. Methods: This study included 47 patients with ICAS or occlusion and 40 controls. All participants underwent global and individual neuropsychology assessments and magnetic resonance imaging scan. The correlations between cognitive function and abnormal perfusion were explored. Results: The CBF in the ipsilateral middle cerebral artery (MCA) territory of the lesion side decreased significantly, while it increased on the contralateral side. CBF value had a significant correlation with the memory function in the right cerebral artery lesion group. The sCoV in both gray matter (GM) and the ipsilateral MCA territory of the lesion increased significantly. The sCoV value based on the GM territory or MCA territory was significantly correlated with global cognitive function, memory function, and executive function in patients with ICAS. Conclusions: The cognitive function of patients with severe ICAS or occlusion in anterior circulation was significantly impaired. sCoV could be a better indicator of cognitive impairment than CBF. Interventions to relieve vascular stenosis or occlusion and delay cognitive impairment or improve cognitive function should be actively considered. Impact statement Intracranial atherosclerotic stenosis (ICAS) is a key risk factor for stroke and vascular cognitive impairment (VCI). VCI seriously affects the physical and mental health of patients and their caregivers, significantly increasing the social burden. The most direct changes in patients with ICAS are the decrease of cerebral blood flow in the blood supply area and the abnormality of local or whole cerebral perfusion. This study explores the relationship between abnormal cerebral perfusion and cognitive impairment in patients with ICAS, which helps to increase the attention paid to VCI and promote the improvement of diagnosis and treatment measures.

Theta‐Gamma Phase‐Amplitude Coupling Deficit in Streptozotocin AD Rat Model

AbstractBackgroundTheta rhythms are known to encode sensory information and reflect their effect into gamma oscillations through a modulation process known as theta‐gamma phase‐amplitude coupling (PAC) (Amemiya et al., Cell Reports 2018). The role of the PAC as a network‐level indicator of cognitive impairment in disorders such as dementia and Alzheimer’s disease has received much attention recently (Zheng et al. Nature communication 2020).Injection of Streptozotocin (STZ) in animals is reported to cause resistance to insulin uptake in the brain, leading to memory and cognitive impairment (Kamat, Neural Regeneration Research 2015). The current study examines the induced deficit in the PAC as an early indicator of neurodegenerative effects of STZ.Method3 adult male Wistar rats were included in this study (270 – 300 g). Intraventricular injection of STZ was performed at a dose of 3 mg / Kg with a volume of 10 μl. Two stainless steel electrodes were implanted in the hippocampus (CA1) and medial prefrontal cortex (mPFC). The rats were free to move during recording. LFP data were recorded and segmented into windows of 20 s. Preprocessing and noisy trial rejection were employed for artifact removal, and the theta‐gamma PAC was measured using the mean vector length (tf‐MVL) method (Munia et al., Scientific Reports 2019).ResultOne week after STZ injection, the theta‐gamma PAC values did not show a significant change but after two weeks variation was observed. During this period, the power of different frequency bands was also measured and no significant change was observed even after two weeks. Theta‐gamma PAC deficiency was observed in both regions (CA1 and mPFC).ConclusionSTZ’s intracerebro‐ventricular injection is known to produce cognitive deficits along with an increase in Aβ deposition. This study reports that cross‐frequency coupling deficiency is also observed in this AD mouse model. Moreover, the PAC deficit was detected earlier than any change was observed in the spectral analysis of the data, suggesting that it can serve as a diagnosis tool for memory impairment due to neurodegeneration in the STZ mouse model of AD.

The clock drawing test is an important contribution to the Mini Mental State Examination in screening for cognitive impairment

The clock drawing test (CDT) and the Mini Mental State Examination (MMSE) are frequently used screening instruments for cognitive impairment, however, the precise contribution of the CDT to the MMSE is largely unknown. We studied patients with subjective cognitive impairment (SCI, n=481), mild cognitive impairment (MCI, n=628) and Alzheimer's disease (AD, n=1099). Discrimination between patients was examined with multiple logistic regression, adjusted for age, sex, and education. Four groups were constructed based on a normal/abnormal MMSE (cut-off <24/30) versus normal/abnormal CDT (cut-off ≤2/3). Visually rated medial temporal lobe atrophy (MTA) on CT was used as parameter of neurodegeneration. The CDT significantly contributed to the MMSE in discriminating SCI from both MCI and AD patients. Our four group analyses showed that of those patients with a normal MMSE and incorrectly classified as SCI, an abnormal CDT could significantly identify 10.0% as MCI and 13.2% as AD. Among those with an abnormal MMSE, the percentage AD patients shifted from 53.1% to 82.1% due to an abnormal CDT. Presence of an abnormal CDT was significantly related to MTA increase, regardless of the MMSE score. The CDT is an important additional screening tool to the MMSE. An abnormal CDT with a normal MMSE is an indicator for cognitive impairment. An abnormal CDT in combination with an abnormal MMSE can be considered as an indicator of disease progression.

Handgrip Strength And Cognitive Impairment In Midlife And Older Adults: Cooper Center Longitudinal Study (CCLS)

PURPOSE: Handgrip strength (HGS), an evidence-based indicator of overall muscular strength, has been linked to numerous health-related outcomes. The purpose of the study was to examine the relationship between HGS and cognitive impairment in a healthy, older population. METHODS: A cross-sectional study of 927 CCLS participants (male n = 653, female n = 274), age of 55 years and older, completed HGS and cognitive function assessment as part of their clinical examination at Cooper Clinic in Dallas, TX between 2019 and 2021. HGS was measured 3 times on each hand, and the average of the maximum result on each hand was utilized in the analysis. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA); scores <26 were used as an indicator of cognitive impairment. Adjusted relative risk (RR) and 95% confidence intervals (CI) were estimated using multiple regression of cognitive impairment on HGS adjusted for age, sex, education, current smoking, BMI, glucose, cholesterol, and systolic blood pressure. RESULTS: The mean age was 62.8 ± 7.1 years; mean HGS was 37.6 + 12.0 kg, and the mean MoCA score was 26.7 + 2.5. The prevalence of cognitive impairment was 26.4. The risk of cognitive impairment was higher for older age (RR: 1.19, 95% CI: 1.02 – 1.39 per decade) and male sex (RR: 1.45, 95% CI: 1.11 – 1.88) and lower for college graduates (RR: 0.84, 95% CI: 0.41 – 0.67). The adjusted RR for cognitive impairment was 0.92 (95% CI: 0.86 – 0.99) per 5 kg increment in HGS. Additionally, when the sample was divided into sex-specific tertiles of HGS, participants in the lowest tertile had the largest unadjusted prevalence of cognitive impairment (Tertile 1: 34.4%, Tertile 2: 23.1%, and Tertile 3: 22.7%, p for trend = 0.002). However, when adjusted for age, sex, and education, the trend was no longer significant (p = 0.06). CONCLUSION: Higher levels of HGS spear to be inversely related to cognitive impairment. Therefore, regular participation in muscle strengthening activities may play a protective role against cognitive decline.

Motor features associated with cognition in non-demented individuals with essential tremor

IntroductionEssential tremor (ET) is a clinically heterogeneous disease characterized by motor and non-motor features, including cognitive impairment. In a cross-sectional analysis, we determined whether the presence and severity of motor features of ET are associated with cognitive performance. MethodsParticipants enrolled in a study that used motor and neuropsychological measures to characterize a cohort of ET subjects. Action tremor severity and additional motor features (rest tremor, intention tremor, cranial tremor, dystonia, tandem gait missteps) were assessed in non-demented participants. Participants completed a cognitive test protocol assessing domains of memory, executive function, attention, visuospatial ability, and language. An average z-score was calculated to represent global cognition. ResultsThere were 204 ET participants (mean age 78.6, range 55–95). Participants with 10 missteps were more likely to have MCI than those with 0 or 1 misstep (p < 0.001). In unadjusted linear regression models, action tremor severity (p = 0.010), rest tremor (p < 0.001), and tandem gait missteps (p < 0.001) were negatively associated with global cognition. In adjusted models, only tandem gait missteps were negatively associated with global cognition (p < 0.001). Missteps were also negatively associated with memory (p < 0.001), executive function (p < 0.001), attention (p = 0.011), and visuospatial function (p = 0.043). No other motor features were associated with global cognition in adjusted models (p > 0.05). ConclusionAmong non-demented participants with ET, there is an association between cognitive performance and tandem gait missteps, but no other motor features of ET. This is a first step in establishing impaired tandem gait as a possible indicator of cognitive impairment in patients with ET.

Assessment of the effect of methods of robotic medical rehabilitation with biofeedback on quality of life and psychoemotional status in patients after CVA with hemiparesis

Recently, to restore the functions of the affected limbs in patients who have had an ischemic stroke with movement disorders in the form of hemiparesis, non-drug methods have been actively used, including physiotherapy, physiotherapy exercises, kinesiotherapy and, especially, robotic biomechanics. The paper presents data on the effectiveness of using gait training on the BFB equipment with video gait reconstruction and biofeedback (BFB) in the late recovery period of medical rehabilitation. Material and methods. The study included 80 patients who underwent ischemic stroke with movement disorders in the form of hemiparesis with increased muscle tone by the type of spasticity. The patients were divided into 2 groups comparable in terms of clinical and functional characteristics: control group — 40 patients who received standard drug therapy and medical rehabilitation and the main group — 40 patients receiving standard drug therapy and medical rehabilitation (exercise therapy, medical massage, mechanotherapy) who were prescribed gait training with video reconstruction on a biofeedback system (BFB) «C-Mill». Subjective indicators of cognitive impairment (Montreal Cognitive Assessment), psychoemotional defects (Hospital Anxiety and Depression Scale) and quality of life (EQ-5D questionnaire) were assessed. Results. As a result of the studies, it has been proved that the inclusion of a gait stereotype with video reconstruction on a biofeedback system (BFB) «C-Mill» in the rehabilitation training program contributes to a significantly more pronounced improvement of cognitive functions and the quality of life, as well as to a decrease in the degree of psychoemotional disorders in patients after ischemic stroke with movement disorders in the form of hemiparesis with increased muscle tone by the type of spasticity. This is confirmed by the increase in the total indicator of the MoCA scale to 26,5±0,5 points, which corresponds to the reference values. In the patients of the control group, less pronounced results were obtained; the total indicator of the MoCA scale was 25,0±1,0 points, which is lower than normal; similar dynamics was observed when studying the data of the Hospital Anxiety and Depression Scale (HADS) and the EQ-5D questionnaire, which indicated the quality of life improvement. Conclusion. The inclusion of gait training on a biofeedback system (BFB) «C-Mill» by the method of «imposing» in medical rehabilitation of patients after ischemic stroke with motor impairments in the form of hemiparesis with increased muscle tone contributes to a significant improvement in cognitive functions, a decrease in the level of anxiety and depression and improved quality of life.

Association between ankle brachial index and development of postoperative intensive care unit delirium in patients with peripheral arterial disease

Patients with vascular diseases are prone to developing postoperative delirium (POD). Ankle brachial index (ABI) is a non-invasive clinical indicator of lower-extremities peripheral arterial disease (PAD) and has been identified as an indicator of cognitive impairment. We investigated the association between ABI and POD. 683 PAD patients who underwent elective leg arterial bypass surgery between October 1998 and August 2019 were collected for retrospective analysis. Demographic information, comorbidities, preoperative ABI and the Rutherford classification within one month prior to surgery were obtained. POD was assessed using the Confusion assessment method -intensive care unit. Logistic regression and receiver operating characteristics (ROC) curve analysis were used to assess the association between ABI and POD. The mean value of ABI was significantly lower in patients with POD than it was those without POD. Older age, more medical comorbidities, longer length of surgery, decreased ABI, and higher Rutherford class were all significantly associated with POD. The area under ROC (0.74) revealed that ABI below 0.35 was associated with development of POD. Lower preoperative ABI was associated with POD in PAD patients who underwent arterial bypass surgery.

Childhood Socioeconomic Status, Adult Personality, and Cognition: Early Indicators of Cognitive Impairment in Old Age

This study investigated the association between childhood socioeconomic status (cSES) risk of cognitive impairment but not dementia (CIND), cognitive impairment (dementia or CIND), and dementia and whether adult personality mediated this association. A sample of 10,289 participants (aged 50 and older) from the Health and Retirement Study (HRS) were followed across 2-year periods between 2006 - 2018. Estimates of mediation effects in Cox Proportional Hazards regressions were conducted using Mplus software to approximate the total effects of cSES on the cognitive outcomes and the natural indirect effects and natural direct effects derived when personality causally mediated this outcome. cSES was associated with increased risk of all three cognitive outcomes. Conscientiousness partially mediated the relationship between cSES and dementia, CIND, and cognitive impairment risk while neuroticism partially mediated dementia and impairment, but not CIND. Personality improved the overall model fit between cSES and both CIND and impairment, and conscientiousness was specifically associated with significantly lowered cognitive impairment risk over time. Conscientiousness and neuroticism substantially mediated the relationship between cSES and risk of impairment in old age. This research adds to lifespan models and suggests that distinct personality traits attenuate early childhood factors that contribute to lifespan development and cognitive aging. Conscientiousness in particular may act as a protective buffer mediating risk factors associated with cognitive impairment in old age.

Longitudinal change in CSF biomarkers, especially NPTX2, in non‐demented elderly predicts cognitive decline and conversion to dementia

AbstractBackgroundWe have previously shown that markers of synaptic dysfunction (e.g. NPTX2) measured cross‐sectionally in CSF improve prediction of current cognitive status and future cognitive decline above and beyond amyloid (i.e., Aβ1‐42) alone (Galasko et al, 2019). Here we assess if longitudinal change in these and other candidate CSF biomarkers (NPTX2, VGF, SCG2, CMGA, FAPBH), with total tau (T‐Tau), correlate with cognitive decline and predict conversion to dementia.MethodsLongitudinal CSF samples collected over 4 years from 193 non‐demented elderly from ADNI (81 NC, 45 EMCI, 67 MCI, age = 72.6±7, 45% Female, MMSE = 28.4±1.7) were analyzed by mass spectrometry for absolute concentration of NPTX2, VGF, SCG2, CMGA, and FAPBH. Elecsys data for Aβ1‐42 and T‐Tau were also available. All biomarker values were log transformed. Rates of change (Δ) were calculated from regression on age. Linear mixed effects models assessed the ability of the slope of each marker over the same time period to predict the rate of longitudinal cognitive decline on the cognitive tests of the ADNI cognitive battery, adjusted for age, sex, education, baseline cognitive performance, and baseline CSF Aβ1‐42 levels. Cox Proportional Hazard models were fit for progression to dementia (CDR &gt;= 1.0), adjusting for the same covariates.ResultsAlthough the candidate markers were all highly intercorrelated (r= .42‐.95), their change over time was differentially associated with amyloid status (Figure 1) and to longitudinal decline on cognitive test score and functional measures (Table 1, e.g. Figure 2). Slopes of NPTX2 (p=0.0008), SCG2 (p=0.03), CMGA (p=0.04) and VGF (p=0.01) each predicted conversion to dementia (Table 2, e.g. Figure 3) and MMSE decline. Change in T‐tau only predicted MMSE decline.ConclusionsLongitudinal change of candidate markers, especially NPTX2, has utility for predicting degree of prodromal/early cognitive decline and transition to dementia, beyond the ability of amyloid alone or change in CSF T‐tau. Thus, these candidate CSF biomarkers may have utility as indicators of cognitive impairment and predictors of cognitive decline.

Effect of an art therapy and cognitive stimulation program in older adults with indicators of cognitive impairment

AbstractBackgroundNeurodegenerative disease affects the cognitive, behavioral and functional status in older people. Non pharmacological interventions has shown improvement in cognitive, emotional and functional performance. For this reason, we set out to analyze the effect of a combined nonpharmacological intervention program of cognitive stimulation (CS) and art therapy (AT).MethodA mixed factorial quasi‐experimental repeated measures design was used. 127 older adults were evaluated with clinical screening tests. Twenty‐seven participants were selected to whom a neuropsychological battery composed of measures of memory, executive function, verbal fluency and attention. The final group was made up of 13 participants who were divided into two homogeneous groups (Group 1, n = 6 and Group 2, n = 7). The treatment was applied to each group in parallel with 18 sessions (G1 = CS, G2 = AT), after which an intermediate neuropsychological evaluation was carried out. Later the treatments were changed (G1 = AT, G2 = CS). Finally, a cognitive evaluation was carried out in both groups.ResultThe results show that both groups had a significant improvement in working memory and semantic and phonological fluency tasks after cognitive and art therapy intervention. These improvements were maintained after the second treatment, being more noticeable in the group that started with CS and continued with art therapy.ConclusionThese results show us the importance of working with non‐pharmacological strategies for the treatment of patients with indicators of cognitive impairment and the importance of working on combined interventions to improve the cognitive and functional status.

A Stepping Trail Making Test as an Indicator of Cognitive Impairment in Older Adults.

This study aimed to examine the concurrent validity of a novel motor-cognitive dual-task test, the Stepping Trail Making Test (S-TMT), as an indicator of cognitive impairment (CI), and compare its screening performance to that of motor or cognitive tests alone. This was a population-based cross-sectional study including 965 Japanese adults aged ≥ 70 years. To measure the time taken to perform the S-TMT, the participants were instructed to step on 16 numbers in sequence as quickly and accurately as possible. Motor and cognitive functions were assessed by gait speed and TMT part A (TMT-A), respectively. Participants were classified into CI (< 24 points), mild CI (MCI, 24–27 points), and intact cognition (> 27 points) categories based on their Mini-Mental State Examination score. Binary logistic regression models showed that the addition of the S-TMT to the covariates model gave the highest discrimination index (c-statistics), and significantly improved reclassification indices (net reclassification improvement and integrated discrimination improvement) for screening both CI and MCI compared to those of gait speed or TMT-A alone. These results show that S-TMT has a concurrent validity as a dual-task test for screening CI and MCI and better discrimination and reclassification performance than motor or cognitive tests alone in older adults.

P0947DIETARY HABITS, BODY COMPOSITION AND MUSCULAR STRENGTH ARE CORRELATED TO COGNITIVE IMPAIRMENT IN DALMATIAN HYPERTENSIVE KIDNEY TRANSPLANT RECIPIENTS (KTRS)

Abstract Background and Aims Cognitive impairment is correlated with increased mortality of chronic kidney disease patients and hypertension is a well known comorbidity. While transplantation offers various general health and cognitive function improvement over dialysis, kidney transplant recipients (KTRs) still show greater cognitive impairment than healthy control. Researched pathophysiological mechanisms in KTR population include infection and immunosuppressive induced neurotoxicity. The aim of this study was to determine what impact do body composition, dietary habits and muscular strength have on cognitive impairment of hypertensive KTRs. Method 48 (52.17 %) men and 44 (47.83%) women, aged 59.7 (range25-83) years were included. For each patient data about duration after Ktx, duration of dialysis before Ktx, age, gender, body weight and height were collected and BMI and waist-to-height ratio (WHtR) were calculated. Tanita MC780 Multi Frequency segmental body composition analyser was used to measure content of body fat, muscle mass, and visceral fat each study subject measured in kilograms (kg) and percentage (%.) Peripheral muscle strength of KtR was measured by using a standardized handgrip dynamometry protocol. The Mini Mental State Exam (MMSE) was used as an indicator of cognitive impairment. Mediterranean Diet Serving Score (MDSS) questionnaire was used to determine adherence to Mediterranean Diet (MeDi) considering the consumption of foods and food groups per meal, day or week. Results Out of 92 KTR patients with hypertension, 5 of them scored ≤ 24 points on MMSE scale implying serious cognitive dysfunction. Mean score of MMSE was 28.2, (range 22-30) Regarding MDSS score, 11 patients scored ≥ 16 meaning highest adherence, while 67 KTRs scored &amp;lt; 16 meaning low adherence to MeDi, (results range 2-18) . Positive correlations were found between MMSE score (higher score meaning better cognitive functioning) and MDSS score ( higher score implying better adherence to MeDi)( R=0,282, p=0,012), consuming 1-2 portions of fruits( R=0,266,p=0,016) or ≥ 2 portions of vegetables ( R=0,241,p=0,03) per main meal, skeletal muscle mass (%) (R=0,278, p=0,008), peripheral muscular strength( R=0,325,p=0,003) and fat free mass (kg)(R=0,212,p=0,045). On the other hand we found statistically significant negative correlation between MMSE score and WHtR ( R=-0,255, p= 0,023) . as well as PWV(R=-0,244, p=0,022). Conclusion Cognitive impairment correlations in this study are similar to ones in general population specially regarding Mediterrranean diet and muscle mass . Possible explanation of positive MeDi impact on cognitive function in KTRs could be its low phosphate intake which prevents vascular calcification and negative effects of hyperparatiroidism. Although benefits of MeDi in CKD patients can be argued due to high pottasium levels, after kidney Tx it should not be an obstacle anymore. These results suggest that lifestyle interventions such as following MeDi, building more muscle and reducing fat could provide hypertensive KTR patients with longer preservation of cognitive function.

Steady-state visual evoked potential temporal dynamics reveal correlates of cognitive decline

ObjectiveA central concern in aging is the preservation of cognitive skills. Tools to detect cognitive decline are sparse. The aim of this study was to ascertain whether cognitive decline is accompanied by alterations in the temporal dynamics of steady-state visual evoked potentials (SSVEPs). MethodsWe included 162 men from the Danish Metropolit birth cohort. Their cognitive trajectory was based on their intelligence test score at youth (age ~18), middle age (age ~56), and late middle age (age ~62). Subjects underwent cognitive tests and steady-state visual stimulation. Temporal dynamics of SSVEPs were assessed in terms of amplitude and phase coherence. ResultsThe latency and magnitude of the amplitude modulation of the 36-Hz response correlated negatively with subjects’ cognition indices. Furthermore, negative cognition index was associated with loss of SSVEPs at 36 Hz, and both 8 Hz and 36 Hz in severe cases. ConclusionLatency and magnitude of gamma frequency SSVEPs increase with cognitive decline. This suggests that the facilitation of SSVEPs first becomes problematic at gamma frequencies, then at alpha frequencies. SignificanceOur data suggests that the temporal dynamics of SSVEPs can be used as an indicator of cognitive impairment. Furthermore, evoked gamma oscillations are especially vulnerable in cognitive decline.

Resting heart rate variability as a possible marker of cognitive decline

Cognition is a major subject to be addressed nowadays due to the increasing number of cognitively affected people in most societies. Because of a lack of pharmaceutical therapies treating cognitive decline, its indicators should be diagnosed before it becomes prevalent. Scientific evidence indicates a relationship between cognition and the nervous system, especially its autonomic part. Heart rate variability (HRV) as an indicator of the autonomic nervous system functioning has been studied as a biological marker for the evaluation of cognitive performance. Therefore, HRV is a possible indicator of cognitive impairment. The aim was to provide a systematic literature review about the association between resting HRV and the cognitive performance. Five cognitive functions were analysed separately: executive functions, memory and learning, language abilities, visuospatial functioning, and processing speed. Furthermore, the global cognitive function evaluated with cognitive test batteries was considered too. An electronic database search was conducted with five databases. Three search fields comprised HRV, cognitive performance, and adult subjects. The final dataset consisted of 27 articles. Significant correlations in each cognitive function were found, except for processing speed, suggesting a positive association between resting HRV and cognitive performance. Mechanisms underlying this association between cardiovascular health and cognition are discussed. For the future, HRV could be used in diagnostics as an indicator of cognitive impairment before symptoms of dementia get apparent. With a timely diagnosis, preventative tools could be initiated at an early stage of dementia.