Lower Montreal Cognitive Assessment Scores Research Articles

Strong Association of Serum GSK-3β/BDNF Ratio with Mild Cognitive Impairment in Elderly Type 2 Diabetic Patients.

Glycogen Synthase Kinase (GSK)-3β and Brain-derived Neurotrophic Factor (BDNF) play vital roles in both Mild Cognitive Impairment (MCI) and Type 2 Diabetes Mellitus (T2DM). The underlying mechanisms may involve inflammation and oxidative stress. To investigate the association of the GSK-3β/BDNF ratio with MCI in elderly patients with T2DM and whether GSK-3β/BDNF ratio can serve as a new diagnostic biomarker for MCI in comorbid with T2DM (MD). A total of 326 old Chinese T2DM patients were included and stratified according to cognition and GSK-3β/BDNF ratio quartiles. MCI was diagnosed according to the National Institute on Aging Alzheimer's Association workgroups criteria. In addition to routine hematuria and biochemical examinations, Montreal Cognitive Assessment (MoCA) scale was also used to evaluate the cognitive function, and ELISA method was used to measure GSK-3β activity and the serum levels of BDNF, interleukin 1β (IL-1β), high mobility group box-1 (HMGB1) protein, Malonaldehyde (MDA) and 8-isoprostaglandinF2α (8-iso-PGF2α). We found that GSK-3β activity was negatively correlated with BDNF (r=-0.270, P=0.008), and patients with higher GSK-3β/BDNF ratio had lower MoCA scores (P=0.001). When compared with T2DM patients without MCI (nMD), MD patients had higher GSK-3β activity and GSK-3β/BDNF ratio, but lower BDNF levels. As for inflammation and oxidative stress, IL-1β was inversely correlated with GSK-3β activity, while 8-isoPGF2α was positively correlated with GSK-3β activity and GSK-3β/BDNF ratio. The odds ratio for MCI increased gradually when GSK-3β/BDNF ratio quartile rose from the lowest to the highest (6.90, 95% CI 3.22-14.78). MoCA score was conversely related to GSK-3β/BDNF ratio, age and fast blood glucose (FBG), with GSK-3β/BDNF ratio having the most significant influence on cognition (β=-0.199, P<0.001). Our data provide evidence for a strong link between GSK-3β/BDNF ratio and MCI. GSK- 3β/BDNF ratio may serve as a better diagnostic biomarker for MD than either GSK-3β or BDNF alone and increased GSK-3β/BDNF ratio indicates a worse cognitive function.

Age Moderates Associations of Hypertension, White Matter Hyperintensities, and Cognition.

Hypertension and white matter hyperintensities (WMH) are mutually associated risk factors for cognitive impairment. However, age may modify the associations between hypertension and WMH, and their links to cognitive impairment. We evaluated the interaction between age and hypertension on WMH, and the age-stratified associations of hypertension and WMH with cognition. Key measures include systolic blood pressure (SBP), WMH (modified Fazekas visual ratings of cranial MRI), and the Montreal Cognitive Assessment (MoCA). Participants (N = 488) with prodromal and mild dementia were age-stratified (≤49, 50-59, 60-69,≥70), and considered hypertensive if their SBP≥140 mmHg. The interaction between age strata and hypertension on WMH, and age-stratified associations of hypertension and WMH with cognition, were evaluated using multiple linear regression analyses. Analyses controlled for other risk factors for WMH and cognitive impairment. Age moderated the association between SBP and WMH. Hypertension was associated with higher WMH only in those aged 60-69, and WMH trends across age bands differed between those with and without hypertension. Finally, WMH and SBP≥140 were independently associated with lower MoCA scores within the 50-59 age band, while WMH alone was associated with poorer MoCA scores in the≥70 age band. In adults with prodromal or mild dementia, hypertension was associated with WMH specifically in the 60-69 age strata. Associations between hypertension and WMH with poorer cognition also differed across age bands. Future studies will be needed to investigate whether blood pressure management to slow cognitive decline by targeting WMH may be age dependent.

37 Postural Instability in Parkinson’s Disease: The Association of Cognitive Impairment and Non-Motor Symptoms

Abstract Introduction Parkinson’s disease (PD) is the second most common neurodegenerative condition after Alzheimer’s. Historically considered as a movement disorder, the multitude of non-motor symptoms (NMS) are now a recognised cause of significant disease burden. This study aimed to explore the relationship between postural instability and NMS in PD. Methodology We recruited individuals (n=100) in South East Queensland with a pre-existing diagnosis of idiopathic PD into this prospective observational study. Motor assessment was performed via the Movement Disorders Society-revised Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Assessment of postural instability was based on the Hoehn &amp; Yahr Scale (H&amp;Y) with a score of ≥3 considered indicative of postural instability. NMS were assessed via the Non-Motor Symptoms Scale (NMSS). Further neuropsychiatric and affective assessment was evaluated with the Geriatric Depression Scale (GDS-15), Geriatric Anxiety Inventory (GAI), Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI) and Montreal Cognitive Assessment (MoCA). Results Cohort demographics comprised of 62% male and 38% female with a mean age of 69.1 years (SD 7.35) and mean H&amp;Y 2.34 (SD 0.59). Sixty four participants were H&amp;Y 1 &amp; 2 whilst 36 participants were H&amp;Y ≥3. Participants with postural instability were significantly older (p = 0.033) and had lower MoCA scores (p=0.039). Among the MoCA domains, only the Visuospatial / Executive domain was associated with postural instability (p= 0.005). Among the NMSS domains, only the sexual function domain was significantly associated with the latter group (p=0.029). GDS scores tended to be higher in the postural instability group (p=0.054) but there was no significance in major depressive disorder (p=0.436). Conclusion Postural instability in PD is significantly associated with age and cognitive impairment, in-particular frontal lobe function. The association of sexual dysfunction is supportive of the notion that disorders in dopaminergic and non-dopaminergic systems underpin the pathophysiology substrate of postural instability.

RACE, BIOLOGICAL AGE, AND COGNITION: THE SYSTEMATIC ASSESSMENT OF GERIATRIC ELEMENTS IN ATRIAL FIBRILLATION STUDY

Atrial Fibrillation (AF) is associated with dementia and cognitive decline. AF is less prevalent among Blacks than Whites, although AF-related complications are more common in Blacks. In the general population, all-cause cognitive decline and dementia are more prevalent among Blacks than Whites. Thus, studying diverse populations with AF may advance our understanding of racial disparities in cognitive functioning. We created a measure of multisystem dysregulation (weathering), which includes but is more encompassing than aging, and examined its association with racial differences in cognition using data from the SAGE-AF study, a prospective cohort of >65-year olds with AF, at high stroke risk, and eligible for anticoagulation. Biological (as opposed to chronological) age among 974 participants was calculated using the Klemera and Doubal method using biomarkers representing physiological functioning, metabolism, and blood pressure. We defined weathering as the difference between biological and chronological age (weathering >0 indicates that biological age is higher than chronological age). We measured the association between weathering and the Montreal Cognitive Assessment (MoCA) score. Mean weathering (SD) was -0.7 (11.5) and 4.3 (12.6) for whites and non-whites, respectively. There was an interaction between race/ethnicity and weathering on cognition (P=0.004). In stratified analyses, higher weathering was associated with a lower MoCA score among both Whites and non-Whites but more so among non-whites (B = -0.09, 95% CI: -0.17, -0.02) for Whites (B = -0.03, 95% CI: -0.06, -0.01) for non-whites. Aging-related multisystem dysregulation is more strongly associated with worse cognition in non-whites than in whites.

Voxel-wise analysis of 18F-fluorodeoxyglucose metabolism in correlation with variations in the presentation of Alzheimer’s disease: a clinician’s guide

BACKGROUND Diagnostic imaging can be applied in the management of Alzheimer’s disease as it provides structural and functional information to exclude possible secondary causes and offers additional information, especially in atypical cases of Alzheimer’s disease. The utility of positron emission tomography/computed tomography (PET/CT) can help in the noninvasive diagnosis of Alzheimer’s disease by voxel-wise quantification of cerebral 18F-fluorodeoxyglucose (FDG) metabolism. &#x0D; METHODS This prospective study was conducted among 10 subjects with Alzheimer’s disease and 10 healthy control subjects who underwent neuropsychological testing and 18F-FDG PET/CT scans. Images of the brain were postprocessed using voxel-wise analysis and segmented into 20 regions of interest. The standardized uptake value (SUV)max/SUVmean/standard deviation of SUVmean results were analyzed accordingly and correlated with the subjects’ Montreal cognitive assessment (MoCA) results that were adjusted for age and education level. &#x0D; RESULTS Hypometabolism at the right parietal lobe significantly correlated with increasing age and lower MoCA scores. Global hypometabolism was observed in subjects who had advanced Alzheimer’s disease but preserved primary somatosensory cortices (S1) region metabolism. Predominance of frontal lobe hypometabolism was a feature of subjects with Alzheimer’s disease having associated depressive symptoms. &#x0D; CONCLUSIONS 18F-FDG PET/CT voxel-wise analysis can be used for quantitative assessment and can assist clinicians in the diagnosis of Alzheimer’s disease and other variations of the disease spectrum.

Profiles of Normal Cognition in Essential Tremor.

Patients with essential tremor exhibit heterogeneous cognitive functioning. Although the majority of patients fall under the broad classification of cognitively "normal," essential tremor is associated with increased risk for mild cognitive impairment and dementia. It is possible that patterns of cognitive performance within the wide range of normal functioning have predictive utility for mild cognitive impairment or dementia. These cross-sectional analyses sought to determine whether cognitive patterns, or "clusters," could be identified among individuals with essential tremor diagnosed as cognitively normal. We also determined whether such clusters, if identified, were associated with demographic or clinical characteristics of patients. Elderly subjects with essential tremor (age >55years) underwent comprehensive neuropsychological testing. Domain means (memory, executive function, attention, visuospatial abilities, and language) from 148 individuals diagnosed as cognitively normal were partitioned using k-means cluster analysis. Individuals in each cluster were compared according to cognitive functioning (domain means and test scores), demographic factors, and clinical variables. There were three clusters. Cluster 1 (n = 64) was characterized by comparatively low memory scores (p < .001), Cluster 2 (n = 39) had relatively low attention and visuospatial scores (p < .001), and Cluster 3 (n = 45) exhibited consistently high performance across all domains. Cluster 1 had lower Montreal Cognitive Assessment scores and reported more prescription medication use and lower balance confidence. Three patterns of cognitive functioning within the normal range were evident and tracked with certain clinical features. Future work will examine the extent to which such patterns predict conversion to mild cognitive impairment and/or dementia.

Cognitive decline is not influenced by the marital status or living arrangements in community-dwelling adults living in a rural setting. A population-based prospective cohort study

Little is known on factors influencing cognitive decline in rural communities. Using the Atahualpa Project cohort, we aimed to assess whether the marital status or living arrangements influenced cognitive decline in community-dwelling adults living in an Ecuadorian rural village. The study included 629 Atahualpa residents aged ≥40 years who had a follow-up Montreal Cognitive Assessment (MoCA) repeated at least one year after baseline. Multivariate longitudinal linear models were fitted to assess differences between the marital status and living arrangements and cognitive decline (as the outcome). A total of 411 participants were married. The remaining 218 were either single, divorced or widowed (191 of them lived with family members and the others lived alone). Enrolled individuals contributed 2088.4 person-years of follow-up (mean: 3.3 ± 1.1 years). The mean baseline MoCA was 22.1 ± 4.5 points and the follow-up MoCA was 20.6 ± 4.8 points (p = 0.001). Overall, 394 (63%) individuals had lower MoCA scores at follow-up. A fully-adjusted longitudinal linear model showed no differences in MoCA decline across married and non-married individuals (β: −0.15; 95% C.I.: −0.55 – 0.26; p = 0.477). When the subset of non-married individuals was taken into account for analyses, multivariate longitudinal linear models showed no differences in the severity of cognitive decline across individuals living alone versus those living with family members (β: 0.28; 95% C.I.: −0.68 – 1.24; p = 0.572). In this study, the marital status or living arrangements had no influence on cognitive decline in the follow-up.

Carotid Atherosclerosis and Cognitive Function in a General Population Aged 63-65 Years: Data from the Akershus Cardiac Examination (ACE) 1950 Study.

Studies on the relationship between carotid atherosclerosis and cognitive function in subjects from the general population are few and results have been inconsistent. We aimed to investigate the association between carotid atherosclerotic burden and cognitive function in a cross-sectional analysis of a population-based cohort aged 63-65 years. All habitants born in 1950 from Akershus County, Norway were invited to participate. A linear regression model was used to assess the association between carotid atherosclerosis and cognitive function. We used carotid plaque score as a measure of carotid atherosclerotic burden and the Montreal Cognitive Assessment (MoCA) for global cognitive function. We analyzed 3,413 individuals aged 63-65 with mean MoCA score 25.3±2.9 and 87% visible carotid plaques. We found a negative correlation between carotid plaque score and MoCA score (r = -0.14, p < 0.001), but this association was lost in multivariable analysis. In contrast, diameter or area of the thickest plaque was independently associated with MoCA score. Lower educational level, male sex, current smoking, and diabetes were also associated with lower MoCA score in multivariable analysis. Carotid atherosclerotic burden was, unlike other measures of advanced carotid atherosclerosis, not independently associated with global cognitive function.

A Low Ankle-Brachial Index and High Brachial-Ankle Pulse Wave Velocity Are Associated with Poor Cognitive Function in Patients Undergoing Hemodialysis.

Patients with end-stage renal disease (ESRD) have an increased risk of both impaired cognitive function and peripheral artery disease (PAD) than the general population. The association between PAD and dementia is recognized, but there are limited studies in patients with ESRD. The aim of this study was to evaluate the relationship between ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) and cognitive impairment in patients receiving hemodialysis (HD). We enrolled 136 prevalent HD patients (mean age 59.3 ± 10.5 years, 55.9% male). Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI) by trained psychiatrists. Associations between the cognitive function and ABI and baPWV were assessed using multiple linear regression analysis. Compared with HD patients with ABI ≥ 0.9, patients with ABI < 0.9 had lower MoCA score (p = 0.027) and lower CASI score but did not achieve significant level (p = 0.056). In the multivariate stepwise linear regression analysis, ABI (per 0.1) was independently positively associated with the MoCA score (β coefficient = 0.62, p = 0.011) and the CASI score (β coefficient = 1.43, p = 0.026). There is a negative association between baPWV (per 100 cm/s) and CASI (β coefficient = −0.70, p = 0.009). In conclusion, a low ABI or high baPWV was associated with a lower cognitive function in HD patients.

Cognitive assessment in a predominantly Hispanic and Native American population in New Mexico and its association with kidney transplant wait-listing.

The association between cognitive function and the likelihood of kidney transplant (KT) wait-listing, especially in minority populations, has not been clearly delineated. We performed a retrospective review of our pre-KT patients, who consist mainly of Hispanics and Native Americans, over a 16-month period. We collected data on baseline demographics and the Montreal Cognitive Assessment (MoCA) score, at the initial KT evaluation. We defined cognitive impairment as MoCA scores of <24. We constructed linear regression models to identify associations between baseline characteristics with MoCA scores and used Cox proportional hazards models to assess associations between MoCA score and KT wait-listing. During the study period, 154 patients completed the MoCA during their initial evaluation. Mean (standard deviation) MoCA scores were 23.9 (4.6), with 58 (38%) participants scoring <24. Advanced age, lower education and being on dialysis were associated with lower MoCA scores. For every one-point increase in MoCA, the likelihood of being wait-listed increased 1.10-fold (95% CI 1.01-1.19, P=.022). Being Native American and having kidney disease due to diabetes or hypertension were associated with longer time to wait-listing. Cognitive impairment was common in our pre-KT patients and was associated with a lower likelihood of KT wait-listing.

Identifying an Optimal Cutoff of the Montreal Cognitive Assessment to Predict Amyloid-PET Positivity in a Referral Memory Clinic.

Brain amyloid- positron emission tomography (PET) imaging is highly sensitive for identifying Alzheimer disease. Currently, there is a lack of insight on the association between amyloid-PET status and the widely used Montreal cognitive assessment (MoCA). Studying this relationship may optimize the clinical use of amyloid-PET imaging. To evaluate the relationship between amyloid-PET status and MoCA scores and to identify a MoCA score cutoff that translates to amyloid-PET positivity. Using retrospective chart review, patients from 2010 to 2017 with amyloid-PET scans (positive or negative) and MoCA test scores were included. We studied the relationship between amyloid-PET status and MoCA scores and the influence of age, sex, education, and race. A MoCA score cutoff for amyloid-PET positivity was estimated. Among the 684 clinic patients with dementia, 99 fulfilled inclusion criteria. Amyloid-PET positivity was associated significantly with lower MoCA scores (median=19, U=847, P=0.01). The MoCA score cutoff (25) used for minimal cognitive impairment (MCI) predicted amyloid-PET positivity suboptimally (sensitivity=94.6%, specificity=13.9%). A MoCA score cutoff of 20 patients had optimal sensitivity (64.2%) and specificity (67.4%). Amyloid-PET positivity is associated with lower MoCA scores. Clinical utility of amyloid-PET scan is likely to be suboptimal at the MoCA score cutoff for minimal cognitive impairment.

Age-dependent association of white matter abnormality with cognition after TIA or minor stroke

ObjectiveTo investigate if the association between MRI-detectable white matter hyperintensity (WMH) and cognitive status reported in previous studies persists at older ages (>80 years), when some white matter abnormality is almost universally reported in clinical practice.MethodsConsecutive eligible patients from a population-based cohort of all TIA/nondisabling stroke (Oxford Vascular Study) underwent multimodal MRI, including fluid-attenuated inversion recovery and diffusion-weighted imaging, allowing automated measurement of WMH volume, mean diffusivity (MD), and fractional anisotropy (FA) in normal-appearing white matter using FSL tools. These measures were related to cognitive status (Montreal Cognitive Assessment) at age ≤80 vs >80 years.ResultsOf 566 patients (mean [range] age 66.7 [20–102] years), 107 were aged >80 years. WMH volumes and MD/FA were strongly associated with cognitive status in patients aged ≤80 years (all p < 0.001 for WMH, MD, and FA) but not in patients aged >80 years (not significant for WMH, MD, and FA), with age interactions for WMH volume (pinteraction = 0.016) and MD (pinteraction = 0.037). Voxel-wise analyses also showed that lower Montreal Cognitive Assessment scores were associated with frontal WMH in patients ≤80 years, but not >80 years.ConclusionMRI markers of white matter damage are strongly related to cognition in patients with TIA/minor stroke at younger ages, but not at age >80 years. Clinicians and patients should not overinterpret the significance of these abnormalities at older ages.

Joint associations of smartphone use and gender on multidimensional cognitive health among community-dwelling older adults: a cross-sectional study

BackgroundSmartphone use has become an increasingly pervasive part of our daily lives, and as a portable media device, smartphones provide good support for cognitive training during aging. However, little is known about the joint association of smartphone use and gender on the cognitive health of older adults, particularly with regard to multi-domain cognition.MethodsA face-to-face survey of 3230 older adults aged 60+ years was conducted in Xiamen, China, in 2016. The Montreal Cognitive Assessment (MoCA) score was used to measure both general and multi-domain cognition. Smartphone use was self-reported and the number of the smartphone functions used (NSFU) was classified as 0, 1, and 2+. General and subdomain cognitive functions were modelled on NSFU only, gender only, and NSFU and gender combined by using a series of proportional-odds cumulative logit models. Furthermore, joint associations of gender and NSFU on both general and multi-domain cognition were estimated, and a four-category quantile classification was used to evaluate the total MoCA score.ResultsAmong all 3230 respondents, 2600 remained after exclusion of respondents with very low MoCA scores (below the education-adjusted cut-offs for dementia). Only 29.96% of older adults used smartphones, 473 (60.72%) of which were men. Respondents who had a higher NSFU maintained a better general and sub-domain cognition except for memory and orientation. Although women had lower values compared to men in visuospatial ability (OR (95% CI): 0.46 (0.37–0.57)), they outperformed their male counterparts in memory (OR (95% CI): 1.38 (1.10–1.73)). The results of the joint association showed that women’s inferiority in visuospatial ability diminished when they had a NSFU of 2+. However, a significantly better improvement in memory for male was achieved when they had a NSFU of 1 rather than 2 + .ConclusionsA higher NSFU was positively associated with increased general and partial subdomain cognitive functions. However, gender differences were found in visuospatial ability and memory, which could be alleviated by smartphone use.

Subclinical Cognitive Impairment and Listing for Kidney Transplantation.

Cognitive impairment is common in patients with kidney disease and can affect physicians' perception and/or patients' ability to complete the pretransplant evaluation. We examined whether cognitive impairment influences the likelihood for transplant listing and whether patients with cognitive impairment take longer to be listed. We conducted a single-center longitudinal cohort study. Patients presenting for their index kidney transplant evaluation were screened for cognitive impairment using the Montreal Cognitive Assessment. A score <26 indicated cognitive impairment. The transplant selection committee was blinded to the scores. Kaplan-Meier analysis assessed time to active listing by level of cognition. A Cox proportional hazards model that included age, sex, race/ethnicity, smoking, coronary artery disease, and diabetes was constructed to evaluate the association between Montreal Cognitive Assessment score and listing for transplant. In total, 349 patients who underwent Montreal Cognitive Assessment testing at their initial visit were included in the analysis. Patients with cognitive impairment were more likely to be older, black, and smokers. The time to listing in patients with cognitive impairment was longer than the time to listing in those with no cognitive impairment (median time, 10.6 versus 6.3 months; log rank test P=0.01). Cognitive impairment was independently associated with a lower likelihood of being listed for transplant (hazard ratio, 0.93 per unit lower Montreal Cognitive Assessment score; 95% confidence interval, 0.88 to 0.99; P=0.02). A lower proportion of patients with cognitive impairment were listed compared with patients without cognitive impairment at 1 month (2% versus 11%), 6 months (17% versus 37%), and 1 year (23% versus 41%), (P<0.001 for all). Cognitive impairment is associated with a lower likelihood of being listed for kidney transplant, and is associated with longer time to transplant listing.

CARDIOVASCULAR BURDEN AND COGNITION IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT AND MAJOR DEPRESSIVE DISORDER

Introduction Cardiovascular risk factors are associated with both cognitive impairment and depression. However, the extent to which these factors are associated with cognitive impairment in patients with mild neurocognitive disorder with and without a history of lifetime depression needs to be clarified. Methods We looked at the distribution of Framingham Risk Scores (FRS) for cardiovascular disease in three groups of participants age 60 years and older in the Prevention of Alzheimer's Dementia with Cognitive Remediation plus Transcranial Direct Current Stimulation (PACt-MD) study: those with mild cognitive impairment (MCI; n = 42), remitted major depressive disorder (MDD, n =29), or MCI plus remitted MDD (n = 21). We also examined the association between cardiovascular risk factors and cognitive scores on the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MOCA), and the Montgomery–Asberg Depression Rating Scale (MADRS) using the non-parametric Spearman's rank order correlation test. Results There were no differences in the severity of FRS across the three diagnostic groups (p=0.281). Comparison of age, gender, education, and cognitive scores across FRS severity groups showed a significant correlation of increased FRS severity with higher age (p=0.016) and lower MOCA (p=0.023). When we assessed the correlation between specific cardiovascular risk factors (i.e hypertension, hypercholesterolemia, smoking, diabetes, hyperlipidemia) and MMSE, MOCA, and MADRS, the only significant correlation was found to be between a history of hypertension and lower MOCA scores (p=0.001). Conclusions The similar FRS distribution across MDD and MCI provides further support for the association of cardiovascular burden with both MDD and cognitive impairment. Hypertension was the only cardiovascular risk factor that was correlated with cognitive impairment. Future research is needed to clarify the mechanism behind this association. This research was funded by This Project has been made possible by Brain Canada through the Canada Brain Research Fund, with the financial support of Health Canada and the Chagnon Family.

Discharge Destination from a Rehabilitation Unit After Acute Ischemic Stroke.

We reviewed numerous variables for ischemic stroke patients admitted to a rehabilitation unit to determine those that were statistically associated with discharge destination. A retrospective chart review of patients with ischemic stroke discharged from the rehabilitation unit between January 1, 2005 and December 31, 2015. Variables were examined for their association with discharge destination (home versus long-term care (LTC)). Univariable relationships with discharge destination were assessed, and a multivariable logistic regression model was built. Univariate predictors of discharge to LTC: advanced age, decreasing admission and discharge functional independence measure (FIM) scores, increasing change in FIM score from admission to discharge, dependency, residence outside of home before the stroke, absence of a caregiver, urinary and bowel incontinence, low Berg balance score at admission and discharge, low Montreal Cognitive Assessment scores, smoking, chronic heart failure, and an inability to transfer. Multivariable logistic regression: five factors remained significant predictors with LTC disposition: advanced age, bowel incontinence, residence outside of the home prior to stroke, right hemisphere site of the stroke, and absence of a caregiver. Several easily measured variables were significantly associated with discharge to LTC versus home following stroke rehabilitation.

Abstract # 3161 Beta-adrenergic receptor mediated inflammation regulation and cardiometabolic risk factors interact to influence cognition in the elderly

Inflammation, cardiometabolic risk (CMR) factors, and autonomic imbalance have been independently associated with cognitive declines in aging, but their interactive effect on cognition remains unclear. We quantified the magnitude of their associations with cognitive function and the extent to which links were synergistic. In eighty dementia-free participants (mean = 73.6 years), cognitive function was assessed with the Montreal Cognitive Assessment (MoCA) and CMR was ascertained using principal components analysis on nine serum and blood pressure (BP) measures. Autonomic balance was estimated by delta-BP between 10-min exercise and 1-min cool-down. Beta-adrenergic receptor-mediated inflammation control (BARIC) was quantified by co-incubating immune cells with lipopolysaccharide and beta-agonist for monocyte TNF-alpha expression. Data were analyzed using multivariate linear regression. Of 76 participants who completed MoCA, cognition was impaired in 21 (27.6%; MoCA ⩽ 23) and correlated with age (beta = −0.30, t = −2.56, p = 0.013), but not BMI or gender. Impaired BARIC and higher delta-BP were independently associated with lower MoCA scores (beta = −1.14, t = −2.94, p = 0.005; beta = 0.86, t = 2.32, p = 0.025), adjusted for CMR. For CMR factors, the first component explained 31.5% of total variance, for which higher values reflected hyperglycemia and hyperlipidemia, and significantly predicted lower MoCA scores (beta = −1.20, t = −2.92,p = 0.005). Furthermore, a synergistic effect of BARIC and CMR on MoCA scores was observed (beta = −1.01, t = −3.62, p 0.001). Sympathoadrenal regulation of inflammation, CMR factors, and autonomic balance exert both independent and synergistic effects on cognitive function in older adults, highlighting a critical role of ANS-immune interactions in aging and cognition.

Abstract WP567: The Association Between Decreased Cerebral Blood Flow in Transient Ischemic Attack Patients and Cognition

Patients with transient ischemic attack (TIA) have a 4-fold increase in developing late-life dementia. Cerebral blood flow has shown to be reduced approximately 30% in patients with Alzheimer’s disease (AD). Vascular abnormalities may initiate and aggravate AD pathology prior to the development of clinical symptoms. We hypothesize that middle-aged patients with a history of TIA will have lower cerebral blood flow (CBF) in the hippocampus, thalamus, white matter and grey matter compared to healthy controls. Additionally, we hypothesize that individuals with lower cerebral blood flow in our regions of interest will have lower cognitive scores. Participants between the ages of 45-85 years old without dementia were subject to a clinical brain MRI arterial-spin-labelling CBF sequence accompanied by a cognitive battery. The cognitive battery included the Montreal Cognitive Assessment (MOCA) and a composite memory score created with the Addenbrooke’s Cognitive Examination, the Brief Visuospatial Memory Test Revised, and the Rey Auditory Verbal Learning Test. TIA patients had their assessments within 14-days of ictus. Atlas-based imaging analysis was performed using FSL. Sixty-three (63) healthy controls (63 + 10 years of age) and 51 TIA (69 + 9 years of age) participants were analyzed. In an independent one-tailed t-test, TIA patients had significantly (p&lt;0.05) lower CBF than healthy controls in the left/right hippocampus and thalamus, and right white matter. A multiple regression was performed to predict MOCA and composite memory scores from CBF, while correcting for age, gender and premorbid intelligence. Lower hemispheric CBF in the hippocampus, thalamus, white matter and grey matter each significantly predicted lower MOCA scores (F(4,101), R 2 =[0.1701-0.2013], p&lt;0.05) and lower composite memory scores (F(4,101), R 2 =[0.2429-0.2864], p&lt;0.05) in all participants. In conclusion , TIA patients have significantly lower CBF values in regions of interest compared to healthy control subjects and decreased CBF values in all participants are associated with poorer cognitive scores. By investigating neuroimaging biomarkers associated with cognition in mid-life, we may begin to understand why TIA patients have a higher risk of developing AD in late-life.

Clinical and neuroimaging risk factors for cognitive decline in community-dwelling older adults living in rural Ecuador. A population-based prospective cohort study.

There is limited information on factors influencing cognitive decline in rural settings from low- and middle-income countries. Using the Atahualpa Project cohort, we aimed to assess the burden of cognitive decline in older adults living in a rural Ecuadorian village. The study included Atahualpa residents aged greater than or equal to 60years who had a follow-up Montreal Cognitive Assessment (MoCA) repeated at least 1year after baseline. MoCA decline was assessed by multivariable longitudinal linear models, adjusted for demographics, days between MoCA tests, cardiovascular risk factors, and neuroimaging signatures of structural brain damage. We included 252 individuals who contributed 923.7 person-years of follow-up (mean: 3.7±0.7years). The mean baseline MoCA was 19.5±4.5 points, and the follow-up MoCA was 18.1±4.9 points (P=0.001). Overall, 154 individuals (61%) had lower MoCA scores at follow-up. The best fitted longitudinal linear model showed a decline of follow-up MoCA from baseline (β: 0.14; 95% CI, 0.0-0.21; P<0.001). High glucose levels, global cortical atrophy, and white matter hyperintensities were independently and significantly associated with greater MoCA decline. This study provides evidence of cognitive decline in older adults living in a rural setting. Main targets for prevention should include glucose control and the control of factors that are deleterious for the development of cortical atrophy and white matter hyperintensities.

What Predicts Mortality in Essential Tremor? A Prospective, Longitudinal Study of Elders.

Objective: Essential tremor (ET) is among the most common neurologic diseases. Although in the past it was considered a benign condition, recent research has demonstrated increased risk of mortality. To date, however, no studies have examined predictors of mortality in ET.Methods: In a longitudinal, prospective study of 141 elders with ET, we used Cox proportional-hazards models to estimate hazard ratios (HRs) for death.Results: The mean baseline age was 81.1 ± 8.8 years. During the follow-up interval, 27 (19.1%) died. Average time from baseline to death was 12.3 ± 8.7 months (range = 0.3–31.2). In univariate Cox regression models, older age (HR = 1.16, p < 0.001), lower Montreal Cognitive Assessment score (HR = 0.88, p = 0.004), higher Clinical Dementia Rating (CDR) score (HR = 4.53, p < 0.001), higher score on the Geriatric Depression scale (GDS) (HR = 1.07, p = 0.048), less balance confidence (HR = 0.98, p = 0.006), more falls (HR = 1.11, p = 0.003), and more tandem mis-steps (HR = 1.53, p = 0.004) were associated with increased risk of mortality. In the final multivariate Cox model, older age (HR = 1.14, p = 0.005), higher CDR score (HR = 3.80, p = 0.002) and higher GDS (HR = 1.11, p = 0.01) were independently associated with increased risk of mortality.Conclusions: This study highlights several independent predictors of mortality in elderly ET; clinicians should consider screening for depressive symptoms, assessing cognition and tracking CDR scores, and assessing balance while evaluating patients with ET.