Lower Mini-Mental State Examination Scores Research Articles

Association between dietary variety status and sarcopenia as defined by the Asian Working Group for Sarcopenia 2019 consensus in older outpatients at a hospital specializing in geriatric medicine: A cross‑sectional study with baseline data of prospective cohort study (JUSTICE‑TOKYO study).

To the best of our knowledge, little is known about the association between dietary variety status and sarcopenia in university-affiliated geriatric hospital in elderly. The present study aimed to investigate, in a multidisciplinary setting, the prevalence of sarcopenia and association between dietary variety status and sarcopenia in older outpatients at Juntendo Tokyo Koto Geriatric Medical Center (Tokyo, Japan). Between October 2020 and December 2021, a cross-sectional study of outpatients aged ≥65 years [458 male (44%) and 584 female (56%); mean age, 78.2±6.1 years] was conducted to assess prevalence of sarcopenia, according to Asian Working Group for Sarcopenia 2019 criteria, and the relationship between dietary variety status and sarcopenia. Patient profile, comorbidities, drug use, neuropsychological data, abdominal symptoms, pulmonary function and dietary variety status were collected. Of 1,042 subjects, there were 223 (21.4%) with [142 male (63.7%) and 81 female (36.3%); mean age, 80.6±6.3 years] and 819 (78.6%) without sarcopenia [316 male (38.6%) and 503 female (61.4%); mean age, 77.6±5.8]. In multivariate analysis, older age, male sex, low body mass index, high Brinkman Index and phase angle, low quality of life, history of daycare use, diabetes mellitus, osteoporosis and low Mini-Mental State Examination and Dietary Variety Score were related to sarcopenia. The prevalence of sarcopenia was higher in than in community-dwelling individuals. Dietary variety status was associated with sarcopenia.

Depression as a Prognostic Factor in Lower Extremity Amputation for Diabetic Foot: Insights from a Prospective Study on Wound Healing, Infections, and Early Mortality

PurposeThis study addresses the challenges faced by diabetic patients undergoing lower extremity amputation due to diabetic foot, particularly focusing on the implications for wound healing and early mortality. The wounds at the amputation stump may necessitate multiple surgical interventions. The aim is to identify prognostic factors associated with these outcomes, shedding light on the complexities surrounding the post-amputation phase. MethodsA prospective study was conducted on 39 diabetic patients who underwent lower extremity amputation due to diabetic foot between 2021 and 2022. Comprehensive preoperative data, encompassing parameters such as blood count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, hemoglobin A1c, albumin, protein, transferrin, ferritin levels, age, gender, body mass index, smoking habits, dialysis, revascularization, duration of surgery, and the use of tourniquet during the procedure were meticulously recorded. Additionally, cognitive performance and depression status were assessed preoperatively using the Mini-Mental State Examination (MMSE) and Beck Depression Inventory (BDI), respectively. A follow-up period of 3 months post-surgery allowed for the comparison of patients who developed infections at the amputation stump with those who did not, as well as the distinction between patients who survived and those who succumbed to mortality. ResultsThe study revealed that the use of a tourniquet during surgery significantly increased the risk of infection (p=0.027), and higher BDI scores were associated with increased risks of both infection (AUC=0.814) and mortality (AUC=0.769), with cut-off scores of 24.0 and 23.5 predicting these outcomes with high sensitivity and specificity, respectively. Additionally, lower MMSE scores were associated with increased short-term postoperative mortality. There were no statistically significant differences between the groups in parameters such as complete blood count, ESR, CRP, procalcitonin, HbA1c, albumin, total protein, transferrin, ferritin levels, age, gender, BMI, smoking, dialysis, revascularization, and surgery duration. ConclusionsThis investigation highlights the significance of considering tourniquet usage during amputation, preoperative depression status, and cognitive function in patients who undergo amputation due to diabetic foot. The use of a tourniquet during surgery is a significant risk factor for infection, and elevated BDI scores are strong predictors of both infection and mortality in patients undergoing amputations. The findings underscore the importance of a multidisciplinary neuropsychiatric evaluation preoperatively to enhance patient care and outcomes. Level of EvidenceLevel 2 (a prospective cohort study)

Association between reduced plasma BDNF concentration and MMSE scores in both chronic schizophrenia and mild cognitive impairment

Reduced brain derived neurotrophic factor (BDNF) concentration is reported to be associated with a cognitive decline in schizophrenia, depending on the stage of the disease. Aim of the study was to examine the possible association between plasma BDNF and cognitive decline in chronic stable schizophrenia and mild cognitive impairment (MCI). The study included 123 inpatients of both sexes with schizophrenia, 123 patients with MCI and 208 healthy control subjects. Cognitive abilities were assessed using mini mental state examination (MMSE), Clock Drawing test (CDT) and cognitive subscale of the Positive and Negative Syndrome Scale (PANSS). Plasma BDNF concentration was determined using ELISA. BDNF concentration was lower in patients with schizophrenia and MCI compared to age-matched healthy controls and was similar in carriers of different BDNF Val/66Met genotypes. The MMSE and CDT scores were lower in patients with schizophrenia compared to healthy controls and subjects with MCI. Reduced plasma BDNF was significantly associated with lower MMSE scores in all subjects. BDNF concentration in patients with schizophrenia was not affected by clinical and demographic factors. BDNF Val66Met polymorphism was not associated with the MMSE scores in all participants. Further studies should include longitudinal follow-up and other cognitive scales to confirm these results and offer cognition-improving strategies to prevent cognitive decline in chronic schizophrenia.

Association of Plasma Amyloid, P-Tau, GFAP, and NfL With CSF, Clinical, and Cognitive Features in Patients With Dementia With Lewy Bodies.

Plasma β-amyloid-1-42/1-40 (Aβ42/40), phosphorylated-tau (P-tau), glial fibrillary acidic protein (GFAP), and neurofilament light (NfL) have been widely examined in Alzheimer disease (AD), but little is known about their reflection of copathologies, clinical importance, and predictive value in dementia with Lewy bodies (DLB). We aimed to evaluate associations of these biomarkers with CSF amyloid, cognition, and core features in DLB. This cross-sectional multicenter cohort study with prospective component included individuals with DLB, AD, and healthy controls (HCs), recruited from 2002 to 2020 with an annual follow-up of up to 5 years, from the European-Dementia With Lewy Bodies consortium. Plasma biomarkers were measured by single-molecule array (Neurology 4-Plex E kit). Amyloid status was determined by CSF Aβ42 concentrations, and cognition was assessed by Mini-Mental State Examination (MMSE). Biomarker differences across groups, associations with amyloid status, and clinical core features were assessed by analysis of covariance. Associations with cognitive impairment and decline were assessed by linear regression and linear mixed-effects models. In our cohort consisting of 562 individuals (HC n = 89, DLB n = 342, AD n = 131; 250 women [44.5%], mean [SD] age of 71 [8] years), sex distribution did not differ between groups. Patients with DLB were significantly older, and had less years of education and worse baseline cognition than HC, but not AD. DLB participants stratified for amyloid status differed significantly in plasma Aβ42/40 ratio (decreased in amyloid abnormal: β = -0.008, 95% CI -0.016 to -0.0003, p = 0.01) and P-tau (increased in amyloid abnormal, P-tau181: β = 0.246, 95% CI 0.011-0.481; P-tau231: β = 0.227, 95% CI 0.035-0.419, both p < 0.05), but not in GFAP (β = 0.068, 95% CI -0.018 to 0.153, p = 0.119), and NfL (β = 0.004, 95% CI -0.087 to 0.096, p = 0.923) concentrations. Higher baseline GFAP, NfL, and P-tau concentrations were associated with lower MMSE scores in DLB, and GFAP and NfL were associated with a faster cognitive decline (GFAP: annual change of -2.11 MMSE points, 95% CI -2.88 to -1.35 MMSE points, p < 0.001; NfL: annual change of -2.13 MMSE points, 95% CI -2.97 to -1.29 MMSE points, p < 0.001). DLB participants with parkinsonism had higher concentrations of NfL (β = 0.08, 95% CI 0.02-0.14, p = 0.006) than those without. Our study suggests a possible utility of plasma Aβ42/40, P-tau181, and P-tau231 as a noninvasive biomarkers to assess amyloid copathology in DLB, and plasma GFAP and NfL as monitoring biomarkers for cognitive symptoms in DLB.

Superoxide Dismutase Modified the Association of Serum Malondialdehyde Levels with Cognitive Decline Among Older Adults: Findings from the Chinese Longitudinal Healthy Longevity Survey.

Numerous studies have investigated the correlation between malondialdehyde (MDA) and cognitive decline. However, limited research has explored the interplay between superoxide dismutase (SOD), C-reactive protein (CRP), and MDA. This study aims to scrutinize the association between MDA and cognitive function in older adults, while also elucidating the roles of SOD and CRP within this relationship. Utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) spanning 2008-2009, 2011-2012, and 2014, this study included 2,696 eligible subjects. Cognitive function was evaluated using the Chinese version of the Mini-Mental State Examination (MMSE). Linear mixed-effects models were employed to examine the links between MDA, SOD, CRP, and their interactions with cognitive function. Elevated serum levels of MDA and CRP, as well as decreased serum SOD levels, were related to decreased cognitive function (β= -0.220 and -0.346, 95% CI: -0.399, -0.041 and -0.526, -0.167 for MDA and CRP; β= 0.384, 95% CI: 0.204, 0.564 for SOD). Notably, a significant interaction between MDA and SOD was detected (p = 0.001). An increase per standard deviation in serum MDA levels was significantly associated with a 0.347-point lower MMSE score only in participants with normal cognitive function and high SOD levels (β= -0.347, 95% CI: -0.497, -0.197; p < 0.001). Elevated serum MDA levels in the normal population with high SOD levels suggested diminished cognitive performance. Combining MDA with SOD could be pivotal in identifying older adults at risk of cognitive decline in clinical settings.

Normal pressure hydrocephalus and cognitive impairment: The gait phenotype matters too.

Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurological disease resulting in progressive gait and cognitive disorders. We investigated whether the gait phenotype is associated with the severity of cognitive deficits in iNPH. This retrospective study recruited 88 patients (mean age = 76.18 ± 7.21 years, 42% female). Patients were initially referred for suspicion of iNPH and underwent a comprehensive analysis, including gait analysis and cognitive evaluation. In this cohort (27% normal gait, 25% frontal gait, 16% parkinsonian gait, 27% other gait abnormalities), patients with parkinsonian and frontal gait had the lowest Mini-Mental State Examination (MMSE) scores and the slowest gait speed. Patients with normal gait had the highest MMSE scores and gait speed. Frontal gait was associated with lower MMSE score, even after adjusting for age, gender, comorbidities, white matter lesions, and education level (β = -0.221 [95% confidence interval (CI) = -3.718 to -0.150], p = 0.034). Normal gait was associated with the best MMSE scores, even after adjusting for the abovementioned variables (β = 0.231 [95% CI = 0.124-3.639], p = 0.036). Gait phenotypes among iNPH patients are linked to global cognition as assessed with MMSE.

SILENT ATRIAL FIBRILLATION CORRELATES WITH COGNITIVE PERFORMANCE IN OLDER PERSONS

Objective: Atrial fibrillation (AF) coexists with dementia in older population. AF often remains undiagnosed due to the occurrence in an asymptomatic form - silent AF (SAF). The aim of the study is to evaluate the relationships between cognitive performance and AF both symptomatic and silent in a representative Polish older population. Design and method: The study was conducted as a sub-analysis of the NOMED-AF, a cross-sectional observational study aiming to evaluate the epidemiology of AF in a representative, community-dwelling Polish sample of adults aged 65 years or more. Mini-Mental State Examination (MMSE) was used to assess cognitive disorders. Each study participant, regardless of AF history, was equipped with a continuous electrocardiogram wearable recording system and encouraged to wear it for up to 30 days. Results: A sample of 2203 participants from the NOMED-AF study was enrolled in the analyses (mean age 77.1 years, 48.4% female); 491 (22.3%) were diagnosed with AF (41.3% of them with SAF). The mean number of points obtained by the respondents in the MMSE was 25.8±0.1 and was significantly lower in patients with AF (25.2±0.22 vs 26±0.11) This difference between patients with arrhythmia and those without AF was present in the subgroup of subjects aged 65-79 years (26.8±0.21 vs 27.4±0.08) and absent in the older subgroup (23.6±0.36 vs 23.3±0.24) (Fig. 1a). There was a significant difference in the number of points obtained between patients with the symptomatic and silent forms of arrhythmia, with a lower score obtained in the latter group (25.8±0.26 vs 24.3±0.38), which was consistent in both age subgroups (Fig. 1b). Finally, in the multivariate logistic regression model, the impact of SAF (but not overall AF) on MMSE scores has been demonstrated. Conclusions: In the older population the presence of AF is associated with a lower MMSE score. As for the silent form of arrhythmia, this relationship is deeper and independent of other risk factors, what suggests the need for a particularly thorough assessment of cognitive disorders in patients with AF and, on the other hand, active search for asymptomatic AF in the group of patients with dementia.

Tracing Neurogenetic Pathways: SIRT1 Gene's Influence on Autism, Alzheimer's, Type II Diabetes, Dementia, and its role in Neurodevelopmental Dynamics

Background: Autism Spectrum Disorder (ASD) encompasses a range of neurodevelopmental conditions characterized by challenges in social interaction, communication, and repetitive behaviors. Concurrent conditions such as Type II Diabetes Mellitus (DM) and dementia are prevalent comorbidities that exacerbate the cognitive impairments associated with ASD. The SIRT1 gene, known for its role in neuroprotection and longevity, has been implicated in the pathophysiology of these disorders. Objective: To determine the expression of the SIRT1 gene in patients with diabetes and dementia and to investigate its potential as a biomarker for cognitive impairment in these populations. Methods: A cohort of 108 diabetic dementia patients and 32 healthy controls were enrolled. SIRT1 expression levels were quantified using chemiluminescent immunoassay (CLIA) and methylation-specific PCR after bisulfite DNA modification. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and demographic data, along with biochemical parameters such as fasting glucose and HbA1c levels, were analyzed using SPSS version 25. Results: Diabetic dementia patients exhibited significantly lower SIRT1 levels (4.37 ± 1.38 µg/mL) and MMSE scores (12.26 ± 4.56) compared to healthy controls (SIRT1: 11.37 ± 3.64 µg/mL, MMSE: 24.1 ± 3.12). The relative gene expression of SIRT1 in diabetic dementia patients showed a 6.7-fold decrease compared to healthy individuals. Statistical analysis revealed a significant difference in both SIRT1 levels and MMSE scores between the two groups (P&lt;0.05). Conclusion: The underexpression of SIRT1 in diabetic dementia patients and its correlation with lower MMSE scores suggest that SIRT1 could serve as a biomarker for cognitive impairment in this population. The findings advocate for further exploration into SIRT1-targeted interventions, which may improve diagnostics and therapeutic approaches for neurodegenerative conditions associated with ASD.

Comparing the Efficacy of Two Cognitive Screening Tools in Identifying Gray and White Matter Brain Damage among Older Adults.

Ageing is associated with structural changes in brain regions and functional decline in cognitive domains. Noninvasive tools for identifying structural damage in the brains of older adults are relevant for early treatment. This study aims to evaluate and compare the accuracy of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA©) in identifying gray and white matter brain damage in older individuals with varying degrees of cognitive impairment. Ninety older adults (62 women) with an average age of 69 ± 7 years were enrolled and categorized as having no cognitive impairment (NCI), mild cognitive impairment (MCI), or moderate cognitive impairment (MoCI). Magnetic resonance imaging (MRI) was utilized to assess the number, volume, and distribution of brain damage. The Fazekas and Scheltens scales were applied to the brain MRIs, and inferential statistics were employed to compare variables among the groups. Cognitive impairment was observed in 56.7% of the participants (95% confidence interval (CI): 46.4-66.4%), with thirty-six older adults (40%) classified as MCI and 15 (17%) as MoCI. Cognitive impairment and medial temporal lobe (MTL) atrophy were found to be associated (p=0.001), exhibiting higher mean volume scales of the MTL atrophied area in the MoCI group (p < 0.001). The MMSE accurately revealed MTL atrophy based on the Scheltens (p < 0.05) and Fazekas (p < 0.05) scales. At the same time, the MoCA accurately identified periventricular white matter (PWM) abnormalities according to the Fazekas scale (p < 0.05). The MMSE and MoCA screening tools effectively identified gray and white matter brain damage in older adults with varying degrees of cognitive impairment. Lower MMSE scores are associated with MTL atrophy and lesions, and lower MoCA scores are related to PWM lesions. The concurrent use of MMSE and MoCA is recommended for assessing structural changes in distinct brain regions.

Freezing of gait in idiopathic normal pressure hydrocephalus

BackgroundReports of freezing of gait (FoG) in idiopathic normal pressure hydrocephalus (iNPH) are few and results are variable. This study’s objective was to evaluate the frequency of FoG in a large cohort of iNPH patients, identify FoG-associated factors, and assess FoG’s responsiveness to shunt surgery.MethodsVideotaped standardized gait protocols with iNPH patients pre- and post-shunt surgery (n = 139; median age 75 (71–79) years; 48 women) were evaluated for FoG episodes by two observers (Cohens kappa = 0.9, p < 0.001). FoG episodes were categorized. Mini-mental state examination (MMSE) and MRI white matter hyperintensities (WMH) assessment using the Fazekas scale were performed. CSF was analyzed for Beta-amyloid, Tau, and Phospho-tau. Patients with and without FoG were compared.ResultsTwenty-two patients (16%) displayed FoG at baseline, decreasing to seven (8%) after CSF shunt surgery (p = 0.039). The symptom was most frequently exhibited during turning (n = 16, 73%). Patients displaying FoG were older (77.5 vs. 74.6 years; p = 0.029), had a slower walking speed (0.59 vs. 0.89 m/s; p < 0.001), a lower Tinetti POMA score (6.8 vs. 10.8; p < 0.001), lower MMSE score (21.3 vs. 24.0; p = 0.031), and longer disease duration (4.2 vs. 2.3 years; p < 0.001) compared to patients not displaying FoG. WMH or CSF biomarkers did not differ between the groups.ConclusionsFoG is occurring frequently in iNPH patients and may be considered a typical feature of iNPH. FoG in iNPH was associated with higher age, longer disease duration, worse cognitive function, and a more unstable gait. Shunt surgery seems to improve the symptom.

Neighborhood disadvantage reduces cognitive reserve independent of neuropathologic change.

Individuals in socioeconomically disadvantaged neighborhoods exhibit increased risk for impaired cognitive function. Whether this association relates to the major dementia-related neuropathologies is unknown. This cross-sectional study included 469 autopsy cases from 2011 to 2023. The relationships between neighborhood disadvantage measured by Area Deprivation Index (ADI) percentiles categorized into tertiles, cognition evaluated by the last Mini-Mental State Examination (MMSE) scores before death, and 10 dementia-associated proteinopathies and cerebrovascular disease were assessed using regression analyses. Higher ADI was significantly associated with lower MMSE score. This was mitigated by increasing years of education. ADI was not associated with an increase in dementia-associated neuropathologic change. Moreover, the significant association between ADI and cognition remained even after controlling for changes in major dementia-associated proteinopathies or cerebrovascular disease. Neighborhood disadvantage appears to be associated with decreased cognitive reserve. This association is modified by education but is independent of the major dementia-associated neuropathologies.

Impact of frailty severity and severe pain on cognitive function for community-dwelling older adults with arthritis: a cross-sectional study in Korea

Pain is a major symptom of arthritis in older adults, often leading to frailty and cognitive decline. However, few studies have investigated the relationship among pain, frailty, and cognitive function in older adults with arthritis. This study aimed to investigate the factors influencing cognitive function and the impact of frailty severity and pain on cognitive function in older adults with arthritis using a Korean population-based dataset. This cross-sectional descriptive study involved the secondary data of 1089 participants from the seventh and eighth waves of the Korean Longitudinal Study on Aging. We examined general characteristics, health behaviors, health conditions (including severe pain and frailty), and cognitive function. Participants were categorized based on the presence or absence of pain severity and frailty status as follows: robust, only severe pain, only prefrail, prefrail with severe pain, only frail, and frail with severe pain. Multiple linear regression analysis was performed to establish correlations between groups and cognitive function. The only-prefrail group was the largest (19.7%) among participants experiencing either pain or frailty. Advanced age, sex, level of education, and visual and hearing impairments were significantly associated with cognitive function. Compared to the robust group, only prefrail (β = -1.54, confidence interval [CI] = − 2.33; − 0.76), prefrail with severe pain (β = − 2.69, CI = − 3.52; − 1.87), only frail (β = − 4.02, CI = − 5.08; − 2.97), and frail with severe pain (β = − 5.03, CI = − 5.99; − 4.08) groups were associated with lower Mini-Mental State Examination scores. The study confirmed that severe pain alone does not significantly impact cognitive function in older adults with arthritis. To prevent cognitive decline in this group, assessment of both pain and frailty severity is essential to predict high-risk groups and provide appropriate interventions, such as transfer to hospitals or primary clinics according to the severity of pain and frailty.

Hippocampal ΔFosB expression is associated with cognitive impairment in a subgroup of patients with childhood epilepsies.

Epilepsy is a chronic neurological disorder characterized by recurrent seizures, and is often comorbid with other neurological and neurodegenerative diseases, such as Alzheimer's disease (AD). Patients with recurrent seizures often present with cognitive impairment. However, it is unclear how seizures, even when infrequent, produce long-lasting deficits in cognition. One mechanism may be seizure-induced expression of ΔFosB, a long-lived transcription factor that persistently regulates expression of plasticity-related genes and drives cognitive dysfunction. We previously found that, compared with cognitively-intact subjects, the activity-dependent expression of ΔFosB in the hippocampal dentate gyrus (DG) was increased in individuals with mild cognitive impairment (MCI) and in individuals with AD. In MCI patients, higher ΔFosB expression corresponded to lower Mini-Mental State Examination scores. Surgically resected DG tissue from patients with temporal lobe epilepsy also showed robust ΔFosB expression; however, it is unclear whether ΔFosB expression also corresponds to cognitive dysfunction in non-AD-related epilepsy. To test whether DG ΔFosB expression is indicative of cognitive impairment in epilepsies with different etiologies, we assessed ΔFosB expression in surgically-resected hippocampal tissue from 33 patients with childhood epilepsies who had undergone Wechsler Intelligence Scale for Children (WISC) testing prior to surgery. We found that ΔFosB expression is inversely correlated with Full-Scale Intelligence Quotient (FSIQ) in patients with mild to severe intellectual disability (FSIQ < 85). Our data indicate that ΔFosB expression corresponds to cognitive impairment in epilepsies with different etiologies, supporting the hypothesis that ΔFosB may epigenetically regulate gene expression and impair cognition across a wide range of epilepsy syndromes.

Neutrophil to lymphocyte ratio in Alzheimer's disease: A systematic review and meta-analysis.

The Neutrophil-to-Lymphocyte Ratio (NLR) is a clinical indicator of peripheral inflammation that is easily accessible. It is worth noting that the formation of amyloid-β (Aβ) plaques and neurofibrillary tangles has been linked to inflammation and immune dysregulation. The main objective of this systematic review and meta-analysis is to comprehensively evaluate the existing body of research concerning the NLR in the context of Alzheimer's disease (AD) and mild cognitive impairment (MCI). We conducted a comprehensive online search and included studies that evaluated the NLR in 1) patients with AD or MCI and 2) healthy control (HC) participants. We also pooled mean and standard deviation (SD) data for each group. Ultimately, 12 studies encompassed 1,309 individuals diagnosed with AD with mean NLR levels of 2.68, 1,929 individuals with MCI with mean NLR levels of 2.42, and 2,064 HC with mean NLR levels of 2.06 were included in this systematic review and meta-analysis. The mean NLR was 0.59 higher in AD patients compared to HC participants (mean difference (MD) = 0.59 [0.38; 0.80]). Similarly, the mean NLR was higher in AD than MCI patients (MD = 0.23 [0.13; 0.33]). Additionally, the mean NLR was higher in individuals with MCI compared to HC participants (MD = 0.37 [0.22; 0.52]). In the subgroup meta-analysis based on the Mini-Mental State Examination (MMSE), AD patients with lower MMSE scores (using a cut-off of 20) exhibited significantly higher mean NLR (3.10 vs. 2.70, with a p-value for subgroup differences < 0.01). The NLR, which serves as a marker of peripheral inflammation, shows increased levels in individuals with AD and MCI compared to HC participants. Furthermore, our study indicates that NLR levels are significantly higher in AD than MCI. Additionally, our novel finding suggests significantly higher NLR levels among AD patients with more severe cognitive decline compared to AD patients with less severe cognitive decline. So, it can be concluded that the higher cognitive decline in humans is accompanied by higher NLR levels. Further longitudinal researches are needed to explore more details about the relationship between inflammation and dementia.

Clinical Characteristics of Older Adults Living in Foster Families in the French West Indies: Baseline Screening of the KArukera Study of Aging in Foster Families (KASAF) Cohort.

Foster families for older adults could represent a transitional or alternative model to nursing homes. The aim of this study was to describe the clinical characteristics of older adults in foster families and to compare them with those of residents in nursing homes in French West Indies. This study is a cross-sectional analysis of the KArukera Study of Aging in Foster Families (KASAF) cohort. Sociodemographic and clinical characteristics were extracted. Dependency was assessed using the Activities of Daily Living (ADL) scale and cognition using the Mini-Mental State Examination (MMSE) scale. Age, gender, ADL, and MMSE scores were compared with nursing home residents from a twin study of KASAF (n = 332). A total of 107 older adults (mean age 81.8 years; 61.7% women) were recruited in 56 foster families between September 2020 and May 2021. In all, 25.5% had diabetes mellitus and 45.8% suffered from hypertension. The mean MMSE score was 9.3±10.1 and 76.0% had major cognitive impairment (MMSE score <18); 12.5% were diagnosed with Parkinson's disease, and 42.0% of the residents were confined to bed or in a wheelchair, with a mean ADL score of 1.5±1.8. Almost all the residents (96.3%) benefited from a medical follow-up by a nurse who visited once or twice a day. Compared to older adults living in nursing homes, those in foster families were more frequently women (61.7% vs 49.4%) and had lower ADL score (1.5 vs 2.4) and lower MMSE score (9.3 vs 11.3). The clinical profile of foster families' residents was quite similar to that of nursing home residents in terms of demographics, dementia, and dependency. Foster families might represent an interesting strategy to address the unmet clinical and social needs of dependent older adults, especially in countries where nursing homes are not sufficiently developed. NCT04545775.

COGNITIVE AND FUNCTIONAL IMPACTS OF CHILD LABOR IN INDIA: THE MEDIATING ROLE OF EDUCATION

Abstract This study aims to examine how entry into the labor market in childhood is associated with deficits in late-life cognitive and functional health. Using the Cumulative Advantage/Disadvantage Theory, it further explores how educational attainment, an indicator of socio-economic status, mediates the associations between child labor and cognitive and functional health among older adults in India. Lastly, it investigates if the results vary by gender. We use the nationally representative World Health Organization Study on global AGEing and Health (SAGE), and select respondents aged 50 years or older (n = 6,215 for Mini-Mental State Examination (MMSE); n=6,408 for the Functional Limitation (FL)). Mediation models were performed for each dependent variable using the sgmediation2 program, bootstrapped 5,000 resamples, and percentile bootstrap confidence interval. The indirect and total effects of child labor on MMSE were significant, while the direct effect of child labor was not. For FL, the indirect effect was significant, but the direct and total effects were not. Gender difference was found in terms of the direct effect, child work was directly associated with a lower MMSE score in older women (p &amp;lt; .01), whereas it was not significant for older men. Findings suggest that early entry into the labor market (as a child) has a negative impact on older adults’ MMSE and FL through deprivation of educational opportunities. Providing opportunities for completing certain level of education can mitigate the negative impact of child labor on health in old age.

THE ASSOCIATION OF A NOVEL PHYSICAL ACTIVITY METRIC WITH COGNITION AND RISK OF DEMENTIA

Abstract Physical activity (PA) is associated with cognitive function and Alzheimer’s disease and related dementias (ADRD). Although associations between continuously measured PA and ADRD have been assessed, multiscale entropy (MSE), which quantifies dynamics of physiological systems over multiple time scales, has not been used to quantify daily activity rhythms in older adults by cognitive status. We examined the association of this novel metric of PA complexity with cognitive function, mild cognitive impairment (MCI), and dementia in participants of the Baltimore Longitudinal Study of Aging. A total of 615 older adults (mean age=73.9±11.3 years, 54.5% women) completed a 7-day wrist-worn accelerometer assessment between 2015-2019. Global cognitive function was measured using the Mini-Mental State Examination (MMSE). Mild cognitive impairment (MCI) or dementia was diagnosed based on Petersen criteria and Diagnostic and Statistical Manual of Mental Disorders, respectively. Unadjusted logistic regression models showed that participants in the lowest tertile of complexity had 2.31 times the odds of low MMSE score (≤26) compared to those in the highest tertile (odds ratio [OR]=2.31, 95% confidence interval [CI]=1.09-4.89). This association lost significance after adjusting for age, sex, race, and education years. The lowest tertile of complexity was also associated with 2.58 times the odds of MCI/dementia diagnosis, adjusting for demographics (OR=2.58, 95% CI=1.06-6.31). These results suggest that lower complexity of accelerometry-detected movement is associated with poorer cognitive function and greater risk of MCI/dementia. Future longitudinal studies are warranted to examine whether altered complexity of daily activity rhythms may act as a preclinical indicator of ADRD.

RISK AND PROTECTIVE FACTORS OF COGNITIVE FUNCTIONING AND DEMENTIA: COMPARING MEXICAN AND NON-MEXICAN HISPANICS

Abstract This study investigates the cognitive functioning of Hispanic individuals aged 65 and above, focusing on the unique risk and protective factors associated with dementia in Mexican Hispanics and non-Mexican Hispanics. The study utilizes data from the Harmonized Cognitive Assessment Protocol (HCAP) subsample of the Health and Retirement Study (HRS), comprising 388 Hispanic older individuals who participated in the HCAP in 2016 (traced back to 2000), allowing for a comprehensive examination of cognitive health within this population. Cognitive function was measured using the Mini-Mental State Examination (MMSE) score and to classify dementia. The findings reveal distinct patterns in cognitive functioning between Mexican Hispanic and non-Mexican Hispanic populations. Mexican Hispanic males exhibit lower MMSE scores across all age groups, while Mexican Hispanic females show slightly higher scores compared to non-Mexican Hispanic females. Education and wealth levels do not significantly affect cognitive scores in either group. Mexican Hispanics have lower odds of dementia compared to non-Mexican Hispanics, even when accounting for sociodemographic, midlife, and late-life characteristics. Both educational attainment and wealth emerge as protective factors against dementia for both groups. Additionally, midlife obesity, hearing loss, and later-life physical inactivity are identified as specific risk factors for dementia in Mexican Hispanics but have an insignificant impact on non-Mexican Hispanics. These findings have implications for targeted interventions and policies to promote cognitive well-being and address health disparities in older Hispanics. The aim is to improve the overall quality of life and achieve equitable healthcare outcomes.

Determinants of Cognitive Trajectories in Lower Educated Older Adults: Evidence from Brazil.

AbstractBackgroundPatterns of cognitive change and modifiable factors for declining versus stable cognitive trajectories have rarely been described in a lower‐educated older population. Our goal was to identify heterogeneous long‐term trajectories of cognitive functioning and explore possible factors associated with cognitive decline beyond education, among older Brazilian adults.MethodWe used data on n = 1,042 adults aged ≥ 60 from the Health, Welfare and Aging (SABE) without cognitive impairment at baseline over four waves (2000‐2015) in São Paulo, Brazil. We applied group‐based trajectory modelling to identify cognitive trajectories. Cognition was measured using the abbreviated version of the Mini‐Mental State Examination (MMSE).ResultWe identified three cognitive groups: stable (n = 754), mild declining (n = 183), and strongly declining (n = 105). The probability of being in the strongly declining group membership was 10.7%. According to the MMSE classification, the mild declining group reached the average threshold for cognitive impairment on the last follow‐up, while the strongly declining group was on the second follow‐up. Furthermore, respondents in the stable trajectory were more likely to report more than primary education, to be white and married, to earn more than four times the minimum wage/month, to live in urban areas during childhood, and to practice vigorous physical activity at least three times a week. On the other hand, those in the strongly declining trajectory were more likely to identify as black or mixed, to self‐report subjective emptiness, and to have lower BMI, diabetes, and stroke. Moreover, both mild and strongly declining participants presented higher average age and lower MMSE scores at baseline compared to the stable trajectory. The multinomial logistic regression analysis revealed that respondents who self‐reported being mixed, had higher age, had primary education, had a stroke, and smoked at baseline were more likely to be in the strongly declining group.ConclusionOur findings suggest that besides education, interventions to reduce cognitive decline might include health and social policies addressing inequalities and modifiable risk factor burdens to improve later‐life cognitive functioning of at‐risk individuals. Sample attrition suggests estimates of the magnitude of the risk factors for cognitive decline to be conservative.

Anosognosia is associated with increased prevalence and faster development of neuropsychiatric symptoms in Mild Cognitive Impairment

AbstractBackgroundBoth the loss of awareness for cognitive decline (a.k.a anosognosia) and neuropsychiatric symptoms (NPS) are commonly seen in patients with Alzheimer’s disease (AD) dementia, even in the prodromal stages. Anosognosia and NPS may negatively affect caregiver burden and patient’s activities of daily living. Despite the high impact of these symptoms on patients and their caregivers, our knowledge of how they develop across the AD spectrum is limited. Here, we explored the cross‐sectional and longitudinal associations between anosognosia and NPS in individuals with mild cognitive impairment (MCI).MethodWe included 310 participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) with a baseline Clinical Dementia Rating global score of 0.5. Everyday Cognition (ECog) questionnaire scores were used to measure complaints from participants and study‐partners at baseline and annually over a mean of 4 years (SD = 3). Anosognosia was defined as the study‐partner having an ECog score ≥2.5/4 and the participant having an ECog score ≤2.5/4 on their baseline measure and their last observation and without having more than 2 consecutive deviating observations during the follow‐up period. The 12 study‐partner‐rated Neuropsychiatric Inventory items determined the presence or absence of specific NPS (see Table 1). The Mini‐Mental State Examination (MMSE), an assessment used to screen for cognitive impairment, was administered annually. Survival analyses were performed to analyze the rate of appearance of NPS over time in individuals with and without anosognosia.ResultSixty participants displayed anosognosia, while 250 did not. At baseline, groups had similar lengths of follow‐up. Participants with anosognosia had lower MMSE scores and a higher proportion of amyloid positivity (see Table 1). At baseline, the frequency of agitation and disinhibition was higher in the anosognosia group. Survival analyses showed earlier onset of all NPS in the anosognosia group (see Figure 1). Specifically, aberrant motor behavior, irritability, disinhibition, apathy, agitation, and hallucinations were highly significant.ConclusionLoss of awareness for cognitive decline is associated with greater frequency and faster onset of NPS over time in participants with MCI. These results support the hypothesis of a potential common underlying neurophysiological process, a finding that needs to be addressed further in future studies.