Global Cognitive Measures Research Articles

Dual-task gait and white matter hyperintensities in Lewy body diseases: An exploratory analysis.

Parkinson's disease (PD) and dementia with Lewy bodies (DLB) are part of a spectrum of Lewy body disorders, who exhibit a range of cognitive and gait impairments. Cognitive-motor interactions can be examined by performing a cognitive task while walking and quantified by a dual task cost (DTC). White matter hyperintensities (WMH) on magnetic resonance imaging have also been associated with both gait and cognition. Our goal was to examine the relationship between DTC and WMH in the Lewy body spectrum, hypothesizing DTC would be associated with increased WMH volume. Seventy-eight participants with PD, PD with mild cognitive impairment (PD-MCI), PD with dementia or DLB (PDD/DLB), and 20 cognitively unimpaired participants were examined in a multi-site study. Gait was measured on an electronic walkway during usual gait, counting backward, animal fluency, and subtracting sevens. WMH were quantified from magnetic resonance imaging using an automated pipeline and visual rating. A median split based on DTC was performed. Models included age as well as measures of global cognition and cardiovascular risk. Compared to cognitively unimpaired participants, usual gait speed was lower and DTC was higher in PD-MCI and PDD/DLB. Low DTC participants had higher usual gait speed. WMH burden was greater in high counting DTC participants. Frontal WMH burden remained significant after adjusting for age, cardiovascular risk and global cognition. Increased DTC was associated with higher frontal WMH burden in Lewy body disorders after adjusting for age, cardiovascular risk, and global cognition. Higher DTC was associated with age.

Grip Strength and Sarcopenia Predict 2-Year Cognitive Impairment in Community-Dwelling Older Adults.

Using the Asian Working Group for Sarcopenia (AWGS2019) and the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, this study examined associations of sarcopenia and its components with specific domains of cognitive impairment over time. A prospective cohort study with a 2-year follow-up. This study is part of the Taiwan Initiatives for Geriatric Epidemiological Research (TIGER), which recruited participants aged 65years old who attended the senior health checkup program at National Taiwan University Hospital (NTUH). Grip strength was measured using a handgrip dynamometer. Walking speed (m/s) was measured as the time required to walk 8 feet. Muscle mass was measured by performing a bioelectrical impedance analysis. Global cognition (assessed using the Taiwanese version of the Montreal Cognitive Assessment) and 4 cognitive domains (memory, executive function, verbal fluency, and attention) were assessed over time. Associations of sarcopenia and its components with cognitive impairment were evaluated after stratification by sex using generalized linear mixed models adjusted for essential covariates for cognitive impairment. Compared with robust women, those with severe sarcopenia were more likely to have a global cognitive impairment over time (β=-0.87, P= .03 based on AWGS2019 criteria and β=-1.07, P= .02 based on the EWGSOP2 criteria). Among men, low grip strength was associated with poor scores on measures of global cognition (β=-0.80, P= .03), executive function (β=-0.35, P= .001), verbal fluency (β=-0.31, P= .02), and attention (β=-0.34, P= .008) over time. Severe sarcopenia predicted global and specific domains of cognitive impairment in older adults. Poor grip strength predicted cognitive impairment in men but not in women. A screen for sarcopenia severity and low muscle strength may be used to identify the risk of cognitive impairment.

Examining the Impact of Socioeconomic Position Across the Life Course on Cognitive Function and Brain Structure in Healthy Aging.

This study explores the relationship of life-course intergenerational social mobility with cognitive function and brain structure in older adults using Diagonal Reference Models. Data from the Irish Longitudinal Study on Ageing, a population-based cohort of adults aged 50years and older (N=4620 participants; mean age: 66.1; standard deviation: 9.1; 55% female) was used for analysis. Brain magnetic resonance imaging data were available for 464 participants. Social mobility was characterized as the difference between childhood socioeconomic position (SEP; ie, father's occupation) and adulthood SEP (ie, own occupation). The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), cortical thickness, and total gray matter volume (GMV) served as global cognitive and brain measures. Exploratory analyses included the volumes of the ventromedial prefrontal cortex (vmPFC), anterior cingulate (AC), hippocampus, and amygdala. Asocial gradient in cognitive function was observed among the intergenerationally stable; brain structure was not as clearly socially patterned. Adulthood SEP was significantly associated with MoCA (weight=0.76; p < .001), MMSE (weight=0.91; p < .001), GMV (weight=0.77; p=.002), and AC volume (weight=0.76; p < .001), whereas childhood SEP was associated with vmPFC volume (weight=1.00; p=.003). There was no independent association of social mobility with any of the outcomes. Together our results suggest that both childhood and adulthood SEP are important in shaping later-life brain health, but that adulthood SEP predominates in terms of its influence. This is potentially an important insight as it suggests that brain health may be modifiable if socioeconomic circumstances change.

Latent trajectories of recent and delayed memory and their predictors: evidence from SHARE.

Cognitive decline is common in the old age, but some evidence suggests it may already occur during adulthood. Previous studies have linked age, gender, educational attainment, depression, physical activity, and social engagement to better cognitive performance over time. However, most studies have used global measures of cognition, which could mask subtle changes in specific cognitive domains. The aim of this study is to examine trajectories of recent and delayed memory recall from a variable-centered perspective, in order to elucidate the impact of age, gender, educational attainment, depression, physical activity, and social engagement on recent and delayed memory both at initial time and across a 10-year period. The sample was formed by 56,616 adults and older adults that participated in waves 4 to 8 of the Survey of Health, Aging and Retirement in Europe (SHARE). We used latent growth modeling to establish latent recent and delayed memory trajectories, and then tested the effects of the aforementioned covariates on the latent intercept and slopes. Results showed that both recent and delayed recall display a quadratic trajectory of decline. All covariates significantly explained initial levels of immediate and delayed recall, but only a few had statistically significant effects on the slope terms. We discuss differences between present results and those previously reported in studies using a person-centered approach. This study provides evidence of memory decline during adulthood and old adulthood. Further, results provide support for the neural compensation reserve theory.

Social Health and Cognitive Change in Old Age: Role of Brain Reserve.

Individual aspects of social health (SH; eg, network, engagement, support) have been linked to cognitive health. However, their combined effect and the role of the structural properties of the brain (brain reserve [BR]) remain unclear. We investigated the interplay of SH and BR on cognitive change in older adults. Within the Swedish National Study on Aging and Care-Kungsholmen, 368 dementia-free adults aged ≥60 years with baseline brain magnetic resonance imaging were followed over 12 years to assess cognitive change. A measure of global cognition was computed at each of the 5 waves of assessment by averaging domain-specific Z scores for episodic memory, perceptual speed, semantic memory, and letter and category fluency. An SH composite score was computed at baseline by combining leisure activities and social network. BR was proxied by total brain tissue volume (TBTV). Linear mixed models (adjusted for sociodemographic, vascular, and genetic factors) were used to estimate cognitive trajectories in relation to SH and TBTV. Interaction analysis and stratification were used to examine the interplay between SH and TBTV. Moderate-good SH (n=245; vs poor, β-slope=0.01, 95% confidence interval [CI] = 0.002-0.02, p= 0.018) and moderate-to-large TBTV (n=245; vs small, β-slope=0.03, 95% CI=0.02-0.04, p< 0.001) were separately associated with slower cognitive decline. In stratified analysis, moderate-good SH was associated with higher cognitive levels (but not change) only in participants with moderate-to-large TBTV (β-intercept=0.21, 95% CI=0.06-0.37, p< 0.01; interaction SH * TBTV, p< 0.05). Our findings highlight the interplay between SH and BR that likely unfolds throughout the entire life course to shape old-age cognitive outcomes. ANN NEUROL 2023;93:844-855.

Neurofilament light level correlates with brain atrophy, and cognitive and motor performance.

The usefulness of neurofilament light (NfL) as a biomarker for small vessel disease has not been established. We examined the relationship between NfL, neuroimaging changes, and clinical findings in subjects with varying degrees of white matter hyperintensity (WMH). A subgroup of participants (n = 35) in the Helsinki Small Vessel Disease Study underwent an analysis of NfL in cerebrospinal fluid (CSF) as well as brain magnetic resonance imaging (MRI) and neuropsychological and motor performance assessments. WMH and structural brain volumes were obtained with automatic segmentation. CSF NfL did not correlate significantly with total WMH volume (r = 0.278, p = 0.105). However, strong correlations were observed between CSF NfL and volumes of cerebral grey matter (r = -0.569, p < 0.001), cerebral cortex (r = -0.563, p < 0.001), and hippocampi (r = -0.492, p = 0.003). CSF NfL also correlated with composite measures of global cognition (r = -0.403, p = 0.016), executive functions (r = -0.402, p = 0.017), memory (r = -0.463, p = 0.005), and processing speed (r = -0.386, p = 0.022). Regarding motor performance, CSF NfL was correlated with Timed Up and Go (TUG) test (r = 0.531, p = 0.001), and gait speed (r = -0.450, p = 0.007), but not with single-leg stance. After adjusting for age, associations with volumes in MRI, functional mobility (TUG), and gait speed remained significant, whereas associations with cognitive performance attenuated below the significance level despite medium to large effect sizes. NfL was strongly related to global gray matter and hippocampal atrophy, but not to WMH severity. NfL was also associated with motor performance. Our results suggest that NfL is independently associated with brain atrophy and functional mobility, but is not a reliable marker for cerebral small vessel disease.

Connectome-based predictive modelling of cognitive reserve using task-based functional connectivity.

Cognitive reserve supports cognitive function in the presence of pathology or atrophy. Functional neuroimaging may enable direct and accurate measurement of cognitive reserve which could have considerable clinical potential. The present study aimed to develop and validate a measure of cognitive reserve using task-based fMRI data that could then be applied to independent resting-state data. Connectome-based predictive modelling with leave-one-out cross-validation was applied to predict a residual measure of cognitive reserve using task-based functional connectivity from the Cognitive Reserve/Reference Ability Neural Network studies (n = 220, mean age = 51.91 years, SD = 17.04 years). This model generated summary measures of connectivity strength that accurately predicted a residual measure of cognitive reserve in unseen participants. The theoretical validity of these measures was established via a positive correlation with a socio-behavioural proxy of cognitive reserve (verbal intelligence) and a positive correlation with global cognition, independent of brain structure. This fitted model was then applied to external test data: resting-state functional connectivity data from The Irish Longitudinal Study on Ageing (TILDA, n = 294, mean age = 68.3 years, SD = 7.18 years). The network-strength predicted measures were not positively associated with a residual measure of cognitive reserve nor with measures of verbal intelligence and global cognition. The present study demonstrated that task-based functional connectivity data can be used to generate theoretically valid measures of cognitive reserve. Further work is needed to establish if, and how, measures of cognitive reserve derived from task-based functional connectivity can be applied to independent resting-state data.

Bilingualism Appears to be Protective Against Cognitive Decline Related to Cerebral Tau in Mexican Americans: An HABS‐HD Study

AbstractBackgroundBilingualism is thought to provide protective effects from neurodegeneration and age‐related diseases such as Alzheimer’s Disease (AD). The protective effect is considered to be due to differences in grey and white matter between monolingual and bilinguals; however, no work to date has looked at differences in additional AD brain pathology. The aim of this study was to examine among Mexican Americans the impact of cerebral tau levels on cognitive functioning stratified by language status.MethodData were analyzed on a combined sample of n=44 Mexican American (n=15 Monolingual [n=9 Cognitively Normal; n=6 Cognitively Impaired {Mild Cognitive Impairment/Dementia}]; n=29 Bilingual [n=19 Cognitively Normal; n=10 Cognitively Impaired]) participants. One outlier case (Cognitively Impaired, Monolingual participant) was removed from subsequent analyses. All participants underwent cognitive testing and PET tau imaging using Siemens Biograph Vision 450 PET/CT scanner with PI‐2620. PET scans were co‐registered with 3T MRI scans (Siemens Vida). PET tau scans were processed using FreeSurfer‐defined regions of interest (ROIs) focused on the medial temporal lobe (average across entorhinal, hippocampus and amygdala), posterior cingulate cortex (isthmus cingulate and posterior cingulate) and lateral parietal cortex (inferior parietal, superior parietal and supramarginal). Linear regression models were generated for each language status group (monolingual, bilingual) examining the impact of each ROI on cognitive outcomes covarying for age, sex, and education.ResultAmong monolingual Mexican Americans, higher Medial Temporal SUVR was significantly related to poorer performance across measures of global cognition (MMSE p&lt;0.001), processing speed (DSST p=0.038), episodic learning and memory (WMS‐III LM I p&lt;0.001; WMS‐III LM II p&lt;0.001) as well as rote verbal learning (SEVLT Immediate Recall p=0.004). Posterior Cingulate and Lateral Parietal SUVRs were not found to be significantly related to cognitive functioning among monolinguals. Additionally, among bilinguals, cerebral tau (derived from select ROIs) was not found to be significantly related to cognition.ConclusionHigher cerebral tau, specifically in the Medial Temporal ROI, was found to be related to poorer cognitive functioning across multiple domains but only among those who were monolingual. Results provide further support for the protective effect of bilingualism.

Bilingualism Appears to be Protective Against Cognitive Decline Related to Amyloid Burden in Mexican Americans: An HABS‐HD Study

AbstractBackgroundBilingualism has been considered to exert protective effects from neurodegeneration and age‐related diseases such as Alzheimer’s Disease (AD). The protective effect is considered to be due to differences in grey and white matter between monolingual and bilinguals; however, no work to date has looked at differences in additional AD brain pathology. The aim of this study was to fill this gap and examine among Mexican Americans the impact of amyloid burden on cognitive functioning stratified by language status.MethodData were analyzed on n = 111 Mexican Americans (n = 45 Monolingual; n = 66 Bilingual) participants from a study of health disparities. All participants underwent cognitive testing and PET amyloid imaging, which was conducted using a Siemens Biograph Vision 450 PET/CT scanner with florbetaben. SUVR regions of interest (ROIs) included Frontal, Anterior/Posterior Cingulate, Lateral Parietal, and Lateral Temporal cortex and were derived using the cerebellum as a reference region in FreeSurfer. Linear regressions were conducted with each ROI included as a predictor variable and cognitive functioning as the outcome variable. Covariates included age, sex, and education. Analyses were split by language status (monolingual, bilingual).ResultAmong monolingual Mexican Americans, higher Global and Lateral Temporal SUVR were significantly related to poorer performance across measures of executive functioning (p = 0.039 and p = 0.038) and processing speed (p = 0.013 and p = 0.027); Global SUVR showed a trend towards significance on a measure of verbal fluency (p = 0.052). In the same group, Frontal SUVR was significant related to poorer performance across measures of global cognition (p = 0.046), executive functioning (p = 0.015), processing speed (p = 0.007) and verbal fluency (p = 0.037), the latter two were also significantly related to Anterior/Posterior Cingulate SUVR (p = 0.008 and p = 0.029). In addition, higher Lateral Parietal SUVR was significantly related to poorer performance on a measure of processing speed (p = 0.030). Among bilingual Mexican Americans, Frontal and Anterior/Posterior Cingulate SUVR were positively associated with semantic fluency (p = 0.049 and p = 0.043).ConclusionAmyloid burden was found to be related to poorer cognitive functioning across multiple domains specifically among monolinguals. Those who identified as bilingual did not present with the same relationship between amyloid uptake and cognitive functioning further supporting the potential protective effect of bilingualism.

The Relationship Between Cognitive-Linguistic Performance and Sleep Problems In Adults With Mild Traumatic Brain Injury

<h3>Research Objectives</h3> To determine the relationship between cognitive-linguistic performance and self-reported sleep problems. Hypothesis: Sleep problems, as assessed by global Pittsburgh Sleep Quality Assessment (PSQI) and measures of cognition (processing speed, memory, verbal fluency) will be significantly correlated and those with mTBI history will have reduced cognitive-linguistic performance compared to healthy controls. <h3>Design</h3> Retrospective, cross-sectional study. <h3>Setting</h3> Academic medical center. <h3>Participants</h3> Community-dwelling adults with (n=16) and without mTBI (n=23) were included in the sample. Inclusion criteria: age 18-55, native English speaker, normal to corrected vision and hearing. Exclusion criteria: history of neurological diseases (except mTBI), diagnosed speech or language disorder, presence of sleep disorders, and medications that may affect the brain. Individuals with mTBI were included if they met established clinical criteria for mTBI. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Measures included the Pittsburgh Sleep Quality Index (PSQI), WAIS-IV Symbol Search/Coding Tasks, Control Oral Word Association Task (COWAT) and NIH Toolbox Cognition Battery. Demographic and injury information was collected via an intake form. Neurobehavioral symptoms were measured using the Neurobehavioral Symptom Inventory (NSI). <h3>Results</h3> An independent samples t-test revealed significantly different PQSI, t(37) = 2.011, p = 0.026. and NSI, t(20.665) = 2.634, p = 0.008 group differences. No significant differences in verbal fluency, processing speed, or NIH cognitive scores were observed. Sleep quality (global PSQI score) and processing speed performance were found to be moderately negatively correlated, r(39)= -.357, p< 0.05 (1-tailed). <h3>Conclusions</h3> Results of this study indicate that sleep quality is an important measure to consider in the clinical assessment and management of mTBI-related cognitive-communication disorders. Future research should include objective measures of sleep when examining cognitive-linguistic performance in individuals with mTBI. <h3>Author(s) Disclosures</h3> There are no conflicts of interest to disclose.

Digital Cognitive Training in MCI and Early AD: Real World Evidence and Insights from a Large Online Cohort

AbstractBackgroundThe 21st Century Cures Act highlights the value of evidence obtained outside of traditional clinical trials (real world evidence, RWE) to enhance trial design and support health care decision making. Increasing use of computers and smartphones has accelerated the generation of RWE and enabled digital therapies including computerized cognitive training (CCT). CCT offers promise for improving cognitive outcomes in MCI and AD, but its effectiveness has not been fully established. Toward this end, we examined RWE on the effectiveness of CCT in MCI/AD using a large online dataset.MethodWe analyzed de‐identified data from a cohort of 82,984 individuals who participated in an online CCT program (Lumosity). Of these, 3514 reported a diagnosis of MCI or AD while the rest served as controls (N = 79,470). Participants completed the NeuroCognitive Performance Test (NCPT), a validated, computerized, online neuropsychological battery. A subset also completed a survey assessing real‐world cognitive functioning (RWC survey). Measures on both instruments were examined at baseline and after varying doses of CCT.ResultAt baseline, the MCI/AD cohort was significantly impaired on all eight NCPT cognitive subtests and the NCPT composite measure of global cognition compared to demographics‐matched controls (p&lt;0.0001, N = 3514 MCI/AD, 79,470 healthy). The MCI/AD cohort was also impaired on the RWC survey (p&lt;0.0001 for the composite score), particularly on items related to concentration or forgetfulness. Engagement with CCT varied among MCI/AD subjects with 2+ assessment timepoints (N = 1934), with an average of 340 CCT games played (SD = 482) over 112 days between assessments (SD = 104). The change from baseline in the NCPT composite measure increased with amount of CCT (p&lt;0.0001, Cohen’s d = 0.31). RWC survey items also improved with training in a subset who completed them at multiple timepoints (p = 0.0530, N = 162).ConclusionThis study provides RWE for the efficacy of CCT in MCI/AD on both objective and patient rated cognitive outcomes. The study also provides insights into dose effects. Such RWE will help optimize CCT interventions to improve cognitive symptoms of MCI and AD.

Exploring Cognitive Impairment in a Community‐Based Sample of LGBTQ+ Older Adults

AbstractBackgroundOver three million adults aged 60+ in the U.S. identify as lesbian, gay, bisexual, transgender, queer, or another sexual and/or gender minority identity (LGBTQ+). Population‐based studies have found a higher prevalence of subjective cognitive decline among LGBTQ+ adults compared to non‐LGBTQ+ adults. Less is known about objective cognitive impairment in LGBTQ+ older adults.MethodWe recruited a community‐based sample of LGBTQ+ older adults (n = 61) from low‐income housing registries. The Telephone Interview for Cognitive Status (TICS; Brandt et al., 1988), an 11‐item screening test of global cognition. Descriptive statistics were used to summarize demographic characteristics, TICS scores, and the prevalence of cognitive impairment. We also examined associations between TICS score (adjusted for age and education) and self‐reported physical and mental health limitations.ResultMean age was 70.8 (SD = 5.8, range = 58‐84). Most reported their sex assigned at birth as male (67%), and 5% identified their gender as transgender or non‐binary. Most participants identified as lesbian or gay (85%), with 7% identifying as bisexual, and 8% queer or another sexual orientation. The majority (90%) identified as White, 7% Black, and 3% Latino. Over 62% of participants had a four‐year college degree or higher. Nearly 80% reported an annual income ≤$30,000. Common chronic health conditions included depression (57%), anxiety (48%), hypertension (46%), post‐traumatic stress disorder (26%), and human immunodeficiency virus infection (21%). About 40% (n = 24) reported problems with their memory. TICS median score was 33.0 (SD = 3.55, range = 21‐39). Nearly 43% (n = 26) may have cognitive impairment (i.e., TICS score of ≤32). A lower TICS score was associated with reporting limitations in daily activities (p = 0.02) and social activities with family and friends (p = 0.04) over the past four weeks.ConclusionOver 40% of LGBTQ+ older adults scored in the impaired range on a screening measure of global cognition. Clinically, more comprehensive evaluations would clarify the extent of decline present among the current sample. Follow‐up studies are needed to better understand the cognitive functioning of LGBTQ+ older adults as some subgroups report more memory problems relative to non‐LGBTQ+ groups. Moreover, inclusive recruitment and outreach efforts are essential so the voices of all LGBTQ+ subgroups can be accurately portrayed in clinical research.

Proxy measures of cognitive reserve and trajectories of gait and cognitive decline in older adults

AbstractBackgroundLifestyle interventions are an emerging area of interest in dementia prevention. Education, physical activity, and social interactions are potentially modifiable lifestyle factors that are considered proxies of cognitive reserve. People with greater cognitive reserve could be protected against decline in gait and cognition, two interrelated problems associated with dementia, by coping better with age‐ or pathology‐related brain changes. We examined whether decline in gait and cognitive functions are different in those with higher versus lower levels of education, physical activity, and social interactions.MethodGait and cognitive performance in 1,095 LonGenity study participants (mean age = 75.4±6.7 years) that were free of dementia at baseline were examined up to 12 years. Gait speed was measured during usual pace (single‐task walking, STW‐speed) and walking‐while‐talking (WWT‐speed). Cognitive performance was measured with standard neuropsychological tests and a standardized composite global cognitive measure was derived. Years of education, number of blocks walked per day, living with someone and engaging in paid or volunteer work (markers of social interactions) were obtained from self‐report. Linear mixed‐effects models adjusted for sex, parental longevity, cognitive impairment, and global health were used to examine age‐associated changes in gait and cognition in those with and without greater cognitive reserve.ResultSTW‐speed and WWT‐speed did not vary as a function of education, physical activity, or social interactions. Greater number of blocks walked per day was associated with slower decline in global cognition, Trail Making Test (TMT)‐A, TMT‐interference, digit symbol substitution, logical memory, figure recall, free recall, category and phonemic fluency tests. Higher education was associated with slower decline in global cognition, TMT‐interference, TMT‐A and figure copy task. Living with someone was associated with slower decline in global cognition, digit symbol substitution and logical memory. Paid or volunteer work was associated slower decline in global cognition.ConclusionHaving higher education, more physical activity and social interactions appear to protect against cognitive, but not gait decline, potentially by building up cognitive reserve. The multifaceted etiology and relatively earlier decline of gait may render it less influenced by potentially modifiable risk factors in late life than cognition.

Perceived social support declines after deep brain stimulation surgery in patients with Parkinson's disease.

The Social Provisions Scale (SPS) measures a person's perceived social support. We evaluated the perceived social support in Parkinson's disease (PD) patients before and after subthalamic nucleus (STN) deep brain stimulation (DBS) and its impact on clinical outcomes following DBS. We analyzed 55 PD patients who underwent STN DBS surgery and completed the SPS, PDQ-39, and MDS-UPDRS Parts I-IV before and 6-12months after surgery. Some patients also completed global cognitive, mood and apathy scales. Caregivers completed the CBI at each visit. Linear regression models and linear mixed models evaluated the association between the SPS baseline score, MDS-UPDRS and PDQ-39 scores, the association between MDS-UPDRS, CBI and the SPS follow-up score, and the association between SPS, global cognition and other psychological variables. DBS implantation improved MDS-UPDRS I-IV and PDQ-39 scores. Perceived social support declined after DBS (baseline SPS total 82.55 ± 7.52 vs. follow-up SPS total 78.83 ± 9.02, p = 0.0001). Baseline SPS total score was not significantly associated with the MDS-UPDRS or PDQ-39 scores at follow-up. MDS-UPDRS scores and the CBI at follow-up had no significant association with SPS total score at follow-up. Measures of global cognition, mood and apathy were associated with the SPS before and after DBS, and the association was independent of STN DBS. After STN DBS, PD patients experienced a decrease in perceived social support, but baseline perceived social support did not impact clinical outcomes. It is important to further identify factors that may contribute to this perception of worsened social support.

The contribution of functional cognition screening during acute illness hospitalization of older adults in predicting participation in daily life after discharge

BackgroundCognitive assessment in acutely hospitalized older adults is mainly limited to neuropsychological screening measures of global cognition. Performance-based assessments of functional cognition better indicate functioning in real-life situations. However, their predictive validity has been less studied in acute hospital settings. The aim of this study was to explore the unique contribution of functional cognition screening during acute illness hospitalization in predicting participation of older adults one and three months after discharge beyond traditional neuropsychological measures.MethodsThis prospective longitudinal study included 84 older adults ≥ 65 years hospitalized in internal medicine wards due to acute illness, followed by home visits at one month and telephone interviews at three months (n = 77). Participation in instrumental activities of daily living, social and leisure activities was measured by the Activity Card Sort. In-hospital factors included cognitive status (telephone version of the Mini-Mental State Examination, Color Trails Test), functional cognition screening (medication sorting task from the alternative Executive Function Performance Test), emotional status (Hospital Anxiety and Depression scale), functional decline during hospitalization (modified Barthel index), length of hospital stay, the severity of the acute illness, symptoms severity and comorbidities.ResultsFunctional cognition outperformed the neuropsychological measures in predicting participation declines in a sample of relatively high-functioning older adults. According to a hierarchical multiple linear regression analysis, the overall model explained 28.4% of the variance in participation after one month and 19.5% after three months. Age and gender explained 18.6% of the variance after one month and 13.5% after three months. The medication sorting task explained an additional 5.5% of the variance of participation after one month and 5.1% after three months, beyond age and gender. Length of stay and the Color Trails Test were not significant contributors to the change in participation.ConclusionsBy incorporating functional cognition into acute settings, healthcare professionals would be able to better detect older adults with mild executive dysfunctions who are at risk for participation declines. Early identification of executive dysfunctions can improve continuity of care and planning of tailored post-discharge rehabilitation services, especially for high-functioning older adults, a mostly overlooked population in acute settings. The results support the use of functional cognition screening measure of medication management ability in acute settings.

DMapp: a developing promising approach to monitor symptoms progression and stimulate memory in Italian people with cognitive impairments.

Based on recent researches on the use of natural language processing techniques for very early detection of cognitive decline and the benefits of cognitive stimulation for people with cognitive impairments, the Dementia Monitoring application (DMapp) is developed inside the Memento project. The aims of this work are: (1) to present DMapp; (2) to report the results of two preliminary studies on DMapp; (3) to describe the clinical and experimental potentiality of DMapp. Italian people with the diagnosis of mild cognitive impairment due to Alzheimer's disease or dementia due to Alzheimer's Disease with a Mini-Mental-State-Examination between 24 and 28 (inclusive) were involved in the DMapp development prototype during the Lab Trial (4 subjects) and Filed Trial (5 subjects) of the Memento project. Qualitative and quantitative data were collected to evaluate participants' opinions, the DMapp ability to perform the automatic analysis of the speech and participants' visible emotional state effective. Ad hoc interviews, the Observed Emotion Rating Scale and performance metrics to solve different tasks were used. The relation between cognitive measures (global cognitive measures) and linguistic indexes values was considered using Euclidean distances between the participants. Linguistic indexes were calculated and seemed to classify the participants' performance as expected from cognitive measures. The DMapp was appreciated by people with cognitive impairment. Positive emotions were present. DMapp seems an interesting approach to monitor dementia symptoms progression and stimulate memory. Possible developments and open questions are discussed.

Identification and validation of Alzheimer’s disease-related metabolic brain pattern in biomarker confirmed Alzheimer’s dementia patients

Metabolic brain biomarkers have been incorporated in various diagnostic guidelines of neurodegenerative diseases, recently. To improve their diagnostic accuracy a biologically and clinically homogeneous sample is needed for their identification. Alzheimer’s disease-related pattern (ADRP) has been identified previously in cohorts of clinically diagnosed patients with dementia due to Alzheimer’s disease (AD), meaning that its diagnostic accuracy might have been reduced due to common clinical misdiagnosis. In our study, we aimed to identify ADRP in a cohort of AD patients with CSF confirmed diagnosis, validate it in large out-of-sample cohorts and explore its relationship with patients’ clinical status. For identification we analyzed 2-[18F]FDG PET brain scans of 20 AD patients and 20 normal controls (NCs). For validation, 2-[18F]FDG PET scans from 261 individuals with AD, behavioral variant of frontotemporal dementia, mild cognitive impairment and NC were analyzed. We identified an ADRP that is characterized by relatively reduced metabolic activity in temporoparietal cortices, posterior cingulate and precuneus which co-varied with relatively increased metabolic activity in the cerebellum. ADRP expression significantly differentiated AD from NC (AUC = 0.95) and other dementia types (AUC = 0.76–0.85) and its expression correlated with clinical measures of global cognition and neuropsychological indices in all cohorts.

Executive and Motor Functions in Older Individuals with Cognitive Impairment.

Background: A current research trend is the examination of the interplay between cognitive functioning, higher-order processes, and motor efficiency in late adulthood. However, the association between motor and cognitive functions when cognitive decline occurs has not been extensively explored. This study investigated whether gait features, functional mobility, and handgrip strength were associated with executive functions in older people with mild cognitive impairment (MCI) or dementia. Methods: 127 older participants (Mage = 77.9 years, SD = 5.8 years) who had received a diagnosis of MCI and dementia voluntarily took part in the study. A battery of tests assessing global cognitive function, executive functions, muscular strength, functional mobility, and spatio-temporal parameters of gait was completed by the participants. Results: Statistically significant correlations were obtained between global cognitive function, executive functions, and motor efficiency measures. Moreover, a series of regression analyses showed that 8–13% of the variance of several motor parameters was predicted by several executive functions. Additionally, walking, functional mobility, and global cognitive function predicted 53–71% of the variance relative to the occurrence of dementia. In conclusion, motor functioning is closely related to cognitive functioning in late adulthood. Conclusions: The assessment of muscular strength and functional mobility should be promoted in clinical settings.

Cognitive remediation for people with bipolar disorder: The contribution of session attendance and therapy components to cognitive and functional outcomes

BackgroundCognitive remediation (CR) can reduce cognitive and functional difficulties in people with bipolar disorder (BD). To date, there is limited evidence on the contribution of session attendance and therapy components to treatment outcomes. This study explores whether attendance and core CR components contribute to treatment outcomes. MethodsThis is a secondary analysis using data from a randomized controlled trial comparing CR plus treatment-as-usual (TAU; n = 40) to TAU only (n = 40) in euthymic people with BD. Session attendance was measured by number of sessions and by achieving therapy completion, pre-defined as attending ≥20 sessions. We used instrumental variable analysis to examine the effect of attendance on treatment outcomes. We then considered the association between core therapy components (i.e., massed practice, errorless learning, strategy use, therapist contact) and post-treatment outcome changes using correlation. ResultsThe CR group improved significantly in measure of global cognition, psychosocial functioning, and goal attainment. Therapy recipients attended 27.1 sessions on average, with 32 (80%) completing the minimum number of 20 sessions. Attending more sessions and achieving therapy completion were associated with improved treatment outcomes, but this relationship was not significant within the subgroup of CR completers. Improvement in psychosocial functioning was associated with therapist contact and goal attainment with selecting useful strategies during therapy. ConclusionsOur findings highlight the relevance of session attendance, specifically the importance of achieving a minimum threshold of CR sessions, for outcome improvement. Strategy use and therapist contact might facilitate improvements in psychosocial functioning and personal recovery goals.

APOE4 and Confluent White Matter Hyperintensities Have a Synergistic Effect on Episodic Memory Impairment in Prodromal Dementia.

White matter hyperintensities (WMH) are a known risk factor for cognitive decline. While the ɛ4 allele of apolipoprotein E gene (APOE4) is another risk factor for cognitive decline, it remains unclear how APOE4 affects the relationship between WMH and cognitive decline, specifically in the prodromal stage of dementia. To determine how APOE4 moderates the relationship between WMH and cognition in prodromal dementia. Two-hundred-sixteen participants with prodromal dementia underwent magnetic resonance imaging (MRI), neuropsychological testing (global and domain wise), cardiovascular risk factor assessments, and APOE genotyping. Visual ratings for WMH as well as total and lobar WMH volumes were quantified. Moderation analysis was performed to determine the influence of APOE4 on the relationship between WMH and performance on global and domain-specific cognitive measures. The role of confluent and non-confluent WMH on cognition was additionally studied using logistic regression. APOE4 carriers (n = 49) had poorer memory and higher global WMH (10.01 mL versus 6.23 mL, p = 0.04), temporal WMH (1.17 mL versus 0.58 mL, p = 0.01), and occipital WMH (0.38mL versus 0.22 mL, p = 0.02) compared to APOE4 non-carriers (n = 167). Moderation analysis revealed that APOE4 positivity strengthened the relationship between higher global as well as lobar WMH burden and poorer episodic memory. Furthermore, APOE4 carriers with confluent WMH were 4.81 times more likely to have impaired episodic memory compared to non-confluent WMH and non-APOE carriers. The impact of WMH on memory may be strongest among APOE4 carriers. Clinicians targeting WMH would need to consider the APOE4 allele and WMH severity status to strategize cognitive interventions.