Mini-Mental State Examination MMSE Research Articles

A - 76 Associations between Proportion of Life Spent in the U.S. and Cognitive Performance in Spanish-Speaking Older Latino Immigrants: Preliminary Findings from the Boston Latino Aging Study

Abstract Objective Latinos represent the largest immigrant demographic in the U.S. and are the second-fastest growing minority group. Older Latinos face an increased risk of dementia compared to their non-Hispanic white counterparts. However, there is a notable scarcity of research examining how immigration-related factors among Latinos influence their vulnerability to cognitive decline and dementia. We explored the associations between the proportion of life spent in the U.S. and cognitive performance in older Latino immigrants. Method 116 Spanish-speaking participants (mean age: 68.8 ± 8.6, educational attainment: 10.5 ± 4.8, 79% female, MMSE: 25.4 ± 3.8) from the Boston Latino Aging Study were included. The adapted Preclinical Alzheimer’s Cognitive Composite-5 (PACC5), comprising the Mini-Mental State Examination-MMSE, Symbol Digit Modalities Test, NEUROPSI-Historias, Free-and-Cued-Selective-Reminding-Test, and Semantic Fluency was used to assess cognition. Spearman’s correlations examined the association between the proportion of life spent in the U.S. (number of years in the U.S./age) and cognition, controlling for age and education. Results The proportion of life spent in the U.S. (mean: 41.6 ± 22.7 years) did not significantly correlate with PACC5 performance (ρ = 0.02, p > 0.05). Nonetheless, there was a significant association with global cognitive function (MMSE ρ = 0.19, p = 0.04). Conclusions Our initial results did not reveal a correlation between the duration of time spent in the U.S. and the PACC5. However, a higher percentage of years lived in the U.S. correlated with better global cognition. Future studies utilizing larger cohorts are necessary to gain a comprehensive understanding of cognitive health in elderly Latinos, including investigating the effects of immigration-related factors.

The Risk of Atrial Fibrillation and Previous Ischemic Stroke in Cognitive Decline.

Objectives: Our study investigated the inverse relationship between cognitive decline (CD) and the presence of documented atrial fibrillation (AFib), ischemic stroke, heart failure, lower extremity peripheral artery disease, and diabetes mellitus. Methods: We conducted a retrospective cross-sectional study between December 2016 and November 2019. A total of 469 patients were enrolled who underwent cognitive evaluation with three cognitive tests (Montreal Cognitive Assessment-MOCA, Mini-Mental State Examination-MMSE, and General Practitioner Assessment of Cognition-GPCOG). We used the standard cut-off values, and the optimal thresholds were obtained from the receiver operating characteristic curves. Results: The standard cut-off level of the MOCA (<26 points) was associated with the presence of AFib (OR: 1.83, 95% CI: 1.11-3.01) and the optimal cut-off level with <23 points with ischemic stroke (OR: 2.64, 95% CI: 1.47-4.74; p = 0.0011). The optimal cut-off value of the MMSE (<28 points) was associated with the presence of ischemic stroke (OR: 3.07, 95% CI: 1.56-6.07; p = 0.0012), AFib (OR: 1.65, 95% CI: 1.05-2.60; p = 0.0287), and peripheral artery disease (OR: 2.72, 95% CI: 1.38-5.36; p = 0.0039). GPCOG < 8 points were associated with ischemic stroke (OR: 2.18, 95% CI: 1.14-4.14; p = 0.0176) and heart failure (OR: 1.49, 95% CI: 1.01-2.21; p = 0.0430). Conclusions: Our research highlighted the broader utility of cognitive assessment. The MOCA and MMSE scores proved to be associated with documented AFib. Higher cognitive test results than the standard threshold for CD of the MMSE, GPCOG, and lower MOCA scores represented risk factors for the presence of previous ischemic stroke.

Unlocking Cognitive Potential: Association of Sarcopenia and Mediterranean Diet on Cognitive Function in Community-Dwelling Elderly of the Dalmatian Region.

The aim of this study was to determine the association between muscle strength, adherence to the Mediterranean diet (MeDi) and cognitive function in community-dwelling elderly. General data, data of body composition and anthropometric parameters, clinical and laboratory findings, cognitive test questionnaires (Mini-Mental State Examination-MMSE, Trail Making Test-TMT, Symbol Digit Modalities Test-SDMT), and nutritional assessments (Mini Nutritional Assessment-MNA, Mediterranean Diet Serving Score-MDSS) were obtained for each study participant. Handgrip strength (HS) was used as one of the key parameters for defining probable sarcopenia, among the Short Physical Performance Battery test (SPPB) (for defining physical activity) and the strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire (SARC-F). Our cross-sectional study involved 114 participants aged ≥ 60 years, and two-thirds of the participants were female (76.3% vs. 23.7%). Probable sarcopenia was found in 34.7% of them. Using bivariate regression analysis, cognitive deficit among the sarcopenic population was associated with the following groups of collected data: (a) sociodemographic-associated factors-advanced age (OR: 1.07; p = 0.004), single marital status (OR: 3.25; p = 0.03), and low level of education (OR: 0.22; p < 0.003); (b) behavioral-associated factors-duration of institutionalization (OR: 1.05; p = 0.007), performance of heavy physical work (OR: 6.26; p = 0.001), low physical activity (OR: 0.08; p = 0.002), and risk of malnutrition (OR: 3.87; p = 0.005); (c) disease-related factors-loss of appetite (OR: 2.24; p = 0.04), information processing speed (OR: 0.88; p < 0.001), blood pressure systolic/diastolic variables (OR: 0.96/0.96; p = 0.002/0.02), medications (OR: 1.19; p = 0.005), predictive sarcopenia score ≥ 4 (OR: 3.1; p = 0.003), and low muscle strength (OR: 0.92; p = 0.002). Cognitive preservation among the sarcopenic population was associated with married status (OR: 0.23; p = 0.20), a high level of education (OR: 0.18; p = 0.002), smoking (OR: 0.33; p = 0.02), high physical activity (OR: 0.07; p < 0.001), and dietary habits using poultry (OR: 0.12; p = 0.004). The results suggest a significant association between sarcopenia and cognitive function in community-dwelling elderly, highlighting the need for regular nutritional interventions in this special population.

The Association between Kidney Function Biomarkers and Delayed Memory Impairments among Older Adults in the European North of Russia.

The prevention of memory decline requires better knowledge of biological markers. We studied the associations between kidney function biomarkers and memory decline (assessed with the Mini-Mental State Examination-MMSE) in elderly individuals without dementia (MMSE 24-30, age 60-74 years, n = 643, Arkhangelsk, Russia). Participants were divided by sex and into three groups according to the delayed memory performance: recall of 0-1, 2, and 3 out of 3 words. The median of serum creatinine was 82 μmol/L in men who recalled 2 words and both medians in those recalling 3 and 0-1 words were 87 μmol/L. The 90th percentile for creatinine in men recalling 0-1 words (115.0 μmol/L) exceeded the upper limit of the normal range (110.5 μmol/L), while those who recalled 3 and 2 words had 90th percentiles within the normal range (109 and 101 μmol/L, respectively). Glomerular filtration rates were normal (≥60 mL/min/1.73 m2) with a median of 92.0 mL/min/1.73 m2 in men who recalled 2 words, 84.4 and 84.9 mL/min/1.73 m2 in men who recalled 3 and 0-1 words, respectively. None of these associations were observed in women. A reduced serum creatinine in older non-demented men may indicate the initial stages of memory decline, while the increased creatinine may reflect further stages of memory impairment.

Predictors of the Social Participation of Adults with Down Syndrome: An Analysis Based on the Biopsychosocial Model of the International Classification of Functioning, Disability, and Health.

The aim of the study is to identify the predictors of social participation in Down syndrome adults from the biopsychosocial model of the International Classification of Functioning, Disability, and Health. An exploratory, analytical, cross-sectional study was conducted with Down syndrome adults. The social participation was assessed using the Life Habits Assessment. The independent variables were determined using the International Classification of Functioning, Disability, and Health biopsychosocial model: body functions were assessed by body mass index, cognition function (Mini-Mental State Examination), and lower limbs muscle strength (Sit-to-Stand Test). Activities were assessed by the 8-Foot Up and Go Test. Environmental factors were assessed by the measure of the quality of the environment, and personal factors were assessed by age, sex, and education level. The total Life Habits Assessment score indicates that individuals show moderate restriction in social participation, with major restriction in the education, employment, and responsibilities domains. The 8-Foot Up and Go Test was the best social participation predictor variable, followed by Mini-Mental State Examination, and the Sit-to-Stand Test. Contextual factors were not predictors of participation. It was concluded that individuals with Down syndrome present the most restrictions to social participation in activities that involve social roles. The predictors influencing social participation are functional mobility, cognition, and lower limb muscle strength.

The miR-146a-5p and miR-125b-5p levels as biomarkers for early prediction of Alzheimer's disease

BackgroundAlzheimer's disease (AD) is an age-related neurodegenerative disease. Prediction and diagnosis of AD, particularly at the early stages, remain challenging due to the lack of biological biomarkers for diagnosis. microRNAs play an essential role in controlling the gene expression level at the post-transcriptional level of mature mRNA and repression of many target genes. In addition, evidence detects that miRNA has a significant role in the biogenesis of AD, which enhances their utility as promising biomarkers for early disease diagnosis, mainly if directly analyzed from circulation. Therefore, we aimed to possibly use miR-125b-5p and miR-146a-5p levels in circulation as novel biomarkers to detect AD. Materials and methodsLevels of miRNAs from the plasma of 30 Alzheimer's participants were compared with miRNA levels of 30 non-dementia cohorts matched by gender and age. Total RNA was purified, cDNA was synthesized, followed by screening for miR-125b-5p and miR-146a-5p expression by real-time quantitative reverse transcriptase PCR (RT-qPCR) to estimate variations in miR-125b-5p and miR-146a-5p expression levels using relative quantification. ResultsmiR-146a-5p levels were significantly down-regulated in AD patients compared to healthy subjects (P = 0.0013). Similarly, miR-125b-5p levels were detected at a low expression in the dementia cohort (P ≤0.0001). In addition, the mini-mental state examination MMSE score shows a significant difference (P ≤0.0001). Receiver operating characteristic (ROC) analysis confirmed that both miRNAs could use as a diagnostic biomarker for AD. ConclusionOur findings revealed that alterations of circulating plasma levels of miR-125b-5p and miR-146a-5p might serve as early noninvasive diagnostic markers for predicting AD patients.

An exploratory pilot study on the involvement of APOE, HFE, C9ORF72 variants and comorbidities in neurocognitive and physical performance in a group of HIV-infected people

Cognitive decline of aging is modulated by chronic inflammation and comorbidities. In people with HIV-infection (PWH) it may also be affected by HIV-induced inflammation, lifestyle and long-term effects of antiretroviral therapies (ART). The role of genetics in the susceptibility to HIV-associated neurocognitive disorders (HAND) is not fully understood. Here we explored the possible relations among variants in 3 genes involved in inflammation and neurodegenerative disorders (APOE: ε2/ε3/ε4; HFE: H63D; C9ORF72: hexanucleotide expansions ≥ 9 repeats), cognitive/functional impairment (MiniMental State Examination MMSE, Clock Drawing Test CDT, Short Physical Performance Battery SPPB), comorbidities and HIV-related variables in a cohort of > 50 years old PWH (n = 60) with at least 10 years efficient ART. Patients with diabetes or hypertension showed significantly lower MMSE (p = .031) or SPPB (p = .010) scores, respectively, while no relations between HIV-related variables and cognitive/functional scores were observed. Patients with at least one APOEε3 allele had higher CDT scores (p = .019), APOEε2/ε4 patients showing the lowest scores in all tests. Patients with HFE-H63D variant showed more frequently hypertriglyceridemia (p = .023) and those harboring C9ORF72 expansions > 9 repeats had higher CD4+-cell counts (p = .032) and CD4% (p = .041). Multiple linear regression analysis computed to verify possible associations among cognitive/functional scores and all variables further suggested positive association between higher CDT scores and the presence of at least one APOEε3 allele (2,2; 95% CI [0,03 0,8]; p = .037), independent of other variables, although the model did not reach the statistical significance (p = .14). These data suggest that in PWH on efficient ART cognitive abilities and physical performances may be partly associated with comorbidities and genetic background. However, further analyses are needed to establish whether they could be also dependent and influenced by comorbidities and genetic background.

Factors associated with frailty in patients with neurodegenerative diseases.

To identify the factors associated with frailty in patients with neurodegenerative diseases. Cross-sectional study, whose sample consisted of 150 patients diagnosed with neurodegenerative diseases seen at a speech-language therapy clinic in a reference hospital in southern Brazil. A secondary exploratory analysis of the medical records of patients treated at this clinic between April 2016 and May 2019 was performed. The information collected was sex, age, education, type of neurodegenerative disease, time of disease, frailty (Edmonton Frail Scale-EFS), swallowing (Northwestern Dysphagia Patient CheckSheet-NDPCS, Eating Assessment Tool-EAT 10), and cognition (Mini-Mental State Examination-MMSE and Montreal Cognitive Assessment-MoCA). Continuous quantitative variables were analyzed using mean and standard deviation and categorical quantitative variables from absolute and relative frequency, as well as their association with the outcome using the Chi-square test. Crude and adjusted Prevalence Ratios were assessed using Poisson regression with robust variance. All statistical tests were considered significant at a level of 5%. The significant factors associated with frailty were the presence of oropharyngeal dysphagia and altered cognitive performance. Individuals with frailty have a higher prevalence of oropharyngeal dysphagia (PR= 1.772(1.094-2.872)), while cognition alteration presented a lower prevalence (PR= 0.335(0.128-0.873). Oropharyngeal dysphagia can be an important clinical predictive factor for consideration in cases of frailty in patients with neurodegenerative diseases.

315 Cardiac surgery in the elderly: the underestimate role of frailty in the decision making

Abstract Aims Elders represent the most common population with indication to cardiac surgery, also presenting the highest mortality/disability after interventions. Both for valve and coronary artery surgery the estimation of the surgical risk, including the frailty assessment, is recommended to guide the decision making. However, frailty results not exhaustively assessed by the commonly used surgical risk scores such as EuroSCORE I-II and score of the Society of Thoracic Surgeons and is mostly used the Kat’s Index (included in the latest European guidelines). This study aims at establishing the feasibility and the value of a Comprehensive Geriatric Assessment (CGA) in elderly undergoing cardiac surgery. Methods From June 2021we consecutively enrolled 50 elderly patients undergoing cardiac surgery (age &amp;gt; 65 years old). All patients underwent CGA with an expert geriatrician and the demographic, biometrics, clinical and echocardiographic data were collected. We evaluated frailty and disability (Kats index, Barthel Index and Frailty Index FI), cognitive status (Montreal Cognitive Assessment MOCA, Mini Mental State Examination MMSE and Geriatric Depression Scale), physical status (Tinetti test, Short Performance Physical Battery SPPB, Physical Activity Scale for the Elderly PASE and 6-min Walking test), delirium condition, sarcopenia and nutritional status (Mini-Nutritional Assessment MNA). A clinical, echocardiographic, and geriatric 3-month follow-up is planned. In particular, we are evaluating the impact of frailty, assessed by CGA, on peri-surgical outcome and the potential additive value of a CGA on the commonly used surgical risk-scores and Kat’s Index. Furthermore, we are assessing the impact of cardiac surgery of frail elderly at GCA. Results The CGA was feasible in all patients and lasted 1 h/patient. In our baseline data, only 23% of the enrolled patients resulted ‘frail’ according to Kat’s Index. However, in the remaining 77% of the study population, the CGA have identified 30% of patients with increased frailty index and 30% with disability, assessed by Barthel Index and physical function indexes (PASE and SPPB). In these patient, frailty and disability were associated to impaired nutritional status, assessed at MNA. Furthermore, 40% of the patients of this group resulted sarcopenic at the hand grip test. The cognitive valuation has shown a cognitive impairment in the 20% of patients at the MMSE and the 70 % at the MOCA. Of note, the 40% of the patients resulted to suffer of depression, not diagnosed before the GCA. At mid-November 2021 the follow-up will be completed. Conclusions The preliminary results of the presents study suggest that in patients undergoing cardiac surgery frailty is currently underdiagnosed. The follow-up analysis will establish if a CGA has an additive value on common surgical risk estimators. This study has a potential impact on the risk stratification of elderly patients undergoing invasive procedures and defines the need of a geriatrician in the heart team.

Hearing aid use and gender differences in the auditory-cognitive cascade in the oldest old

Objectives This study analyzed cognitive differences between hearing-aid (HA) and non-HA users. We hypothesized that HA-use attenuates the auditory-cognitive cascade, thereby, the latter is more conspicuous in non-HA users. Since hearing impairment (HI) shows male predominance, we hypothesized gender differences within the auditory-cognitive relationship. Methods Non-frail community-dwellers ≥ 80 years were assessed for HI (pure tone audiogram-PTA; speech reception threshold-SRT) and global and domain-specific cognitive impairments (Mini-Mental State Examination-MMSE; Montreal Cognitive Assessment-MOCA; Reaction Time Test-RT1-4). Pearson and partial correlations (correcting for age and PTA) assessed auditory-cognitive associations within gender and HA subgroups. Fisher’s z test compared correlations between HA and non-HA users. Results 126 participants (age range 80–91 years) were included. HA-use prevalence was 21%. HA-users were older with worse HI (mean PTA 49.5dBHL). HA-users exhibited no significant auditory (PTA, SRT) and cognitive (MMSE, MOCA, RT1- RT4) correlations. Male non-HA users, displayed a significant association between HI and global cognition, processing speed, selective and alternating attention. Significant differences were noted between MMSE and PTA and SRT (z-score 2.28, 3.33, p = 0.02, <0.01, respectively) between HA and non-HA users. Conclusion Male non-HA users displayed an association between HI and global and domain-specific (processing speed; selective and alternating attention) cognitive decline. Associations between global cognition and HI were significantly different between HA and non-HA users. This may be partially attributable to underlying subgroups sample sizes and statistical power disparity. If larger scale longitudinal or interventional studies confirm these findings, timely HI assessment and management may be the cornerstone for delaying cognitive decline.

Effect of regional anesthesia as a component of multimodal pain relief on the cognitive status of patients in ophthalmic surgery

This article examines and analyzes the dependence of the state of the central nervous system (CNS) in the postoperative period in patients who underwent penetrating keratoplasty.&#x0D; MATERIAL AND METHODS: The analysis of cognitive status was performed using neuropsychological testing involving the scale of frontal dysfunctions (Frontal Assessment BatteryFAB) and a short scale for assessing mental status (Mini-Mental State ExaminationMMSE). The results were assessed on the eve of the operation, 6 h after the operation, and 7 and 21 days after the operation. Depending on the applied method of anesthesia, several groups were identified. In group d, general anesthesia (OA) was used with dexmedetomidine infusion 40 min before surgery. In group b (before surgery), a wing-palatine fossa block was performed 20 min, in addition to general anesthesia. Anesthesia was maintained with sevofluraneoxygen mixture at a low gas flow. The groups were statistically comparable in terms of age and gender. The depth of anesthesia and sedation was assessed using the bispectral index and analgesia nociception index, respectively.&#x0D; RESULTS: According to the results of testing on the MMSE and FAB scales, the cognitive indicators in the first 6 h after surgery were higher in group d than in group b. However, by day 21, these indicators differed slightly (p 0.05). Thus, the following tendencies were observed in group b 6 h after the operation: a decrease in indicators on the MMSE scale by 20.8% and on the FAB scale by 28.6% from the initial level. For group d, the indicators on the MMSE scale were reduced by 8.3%, and those on the FAB scale were reduced by 13.3% at the same stage of the study. When testing on the same scales 21 days after surgery, the indicators of cognitive functions were restored to the initial level in both groups.&#x0D; CONCLUSION: The levels of cognitive functions of ophthalmic surgical patients after surgery involving regional anesthesia and dexmedetomidine differed significantly in the first hours of the postoperative period. After 21 days, the neuropsychological status did not differ significantly (p 0.05).

Changes in the Brain Extracellular Matrix Sulfation Code in Alzheimer's Disease

Alzheimer's Disease (AD) is a neurodegenerative disorder associated with synapse dysfunction and neurocircuit hyperactivation. Neural networks involved in memory and cognition are regulated by extracellular matrices known as perineuronal nets (PNNs), and these unique matrix structures are reduced in the human AD brain. PNNs are comprised of chondroitin sulfate glycosaminoglycan (CS-GAG) lattices that consist of five differentially-sulfated CS isomers (CS-A, -C, -D, -E and -O), with their relative abundance comprising a “sulfation code” that controls key biological functions including neuroplasticity (CS-A), protein-glycan binding (CS-O, CS-D), and neuroinflammation (CS-C, CS-E). Although changes in CS-GAGs promote PNN dysfunction, synapse reorganization, and neurocircuit hyperactivation in rodents, it is unknown if such changes are features in human AD brain. Using LC-MS/MS analysis, we report a decrease in the nonsulfated ΔO (p=0.0002) in the middle frontal gyrus (MFG) of human AD brain compared to controls. This effect was offset by an increase in the monosulfated ΔC (p=0.024) and trending increase in the disulfated ΔE (p=0.067), which yielded an increase in overall CS-GAG sulfation (p<0.0001). We next sought to determine whether changes in CS-GAGs in AD also associate with Braak stage and topographic distribution of neurofibrillary tangles including phosphorylated tau (P-tau). We found that more advanced Braak stage associated with a decrease in the non-sulfated ΔO (p<0.0001), increases in the sulfated ΔC (p=0.011) and ΔE (p=0.047), and a trending increase in the ΔD (p=0.093), which yielded a Braak stage-dependent increase in overall CS-GAG sulfation (p<0.0001). Antibody labeling against P-tau S396 showed robust accumulation within layer V of the MFG neocortex of AD patients, and whereas P-tau burden was inversely correlated with ΔO (p=0.0017), it was positively correlated with ΔC (p=0.0037), ΔD (p=0.0189), ΔE (p=0.0014), as well as with overall CS sulfation (p<0.0001). Finally, as the increase in Braak stage and P-tau accumulation associate with cognitive decline in AD, we correlated cognitive function (assessed using the Mini-Mental State Examination-MMSE) with changes in CS-GAG sulfation patterns within the MFG. We report that MMSE scoring correlated positively with ΔO (p<0.0006) and negatively with ΔE (p=0.0062) and CS sulfation (p<0.0001) but did not associate with changes in ΔC, ΔD, or ΔA isomer abundance. Since the changes in CS-GAG sulfation reported herein were present prior to the regional onset of classical AD pathology (e.g. Braak III/IV, prior to tangle formation in the MFG), they may play an active role to initiate and/or progress underlying degenerative processes and thus represents a novel target for the prevention and treatment of AD.

Efficacy of Serious exerGame in Alzheimer’s disease and related disorders: Results of the AZgame multicenter study

AbstractBackgroundSerious exerGames (SeG) promotes cognitive simulation with physical activity in a positive emotional context. Results of the first pilot usability study with X‐Torp (Bensadoun &amp; al, JAD, 2016) suggest that this SeG represents a usable as enriched environments, for healthy subjects and persons with MCI and Alzheimer's Disease. The aim of the AZgame multicenter study using X‐Torp is to evaluate the efficacy and the cost‐utility in patients suffering from Alzheimer’s disease in comparison to the usual management.MethodX‐Torp use the Microsoft® Kinect™. The scenario mode combines action game dynamics, with exploration of open environments fin order to stimulate motor activities and mini‐games in order to stimulate cognitive activities. (full description available here: http://www.innovation-alzheimer.fr/azgame-eco-2/). 91 subjects (mean age 81.7 years, mean Minimental state Examination MMSE 18.3 sd 3.6) with a DSM 5 diagnosis of minor (n = 26) or major (n = 65) Neurocognitive disorders were recruited in 16 centres including memory consultation, day care center, nursing home. Center were randomised in Intervention (using XTorp) and control center with regular care.In the intervention group patients used Xtorp for 12 weeks, 2 sessions of 30 mn per week. Patients underwent cognitive (MMSE), functional (EQ5D) and behavioural assessment (NPI and Apathy Inventory) at base line, at the end of the intervention (Week 12) and 12 weeks after the intervention (W 24).ResultWhen comparing cognitive, functional and behavioural scores between base line W12 and W24 mixed model analysis (time x group interaction) indicated no significant interaction for the MMSE and the EQ5D. On the behavioural point of view patients of the Intervention XTorp group showed an improvement at the NPI total score and at the apathy Inventory. Mixed analysis (time BL, W12, W24 x group) indicated a significant interaction for the NPI total score (p value = 0.03) apathy inventory score (p value = 0.008) with a significant increase in apathy in the non‐active subjects.ConclusionAccording to these results use of X‐Torp, a therapeutic video game with motion capture improved neuropsychiatric symptoms and most particularly apathy. This effect is also observed 12 weeks after the end of the intervention.

Prevalence of mild cognitive problems in Flemish Nursing homes

Abstract Background Mild cognitive decline in Nursing Home (NH) residents without dementia is often noted very late since cognitive demands are relatively low in this setting. Therefore, subtle cognitive changes could remain undetected. This study aimed to evaluate the prevalence of mild cognitive problems in NHs. Methods First, a file study was performed to exclude residents with a diagnosis of dementia or known cognitive problems (Mini Mental State Examination-MMSE &amp;lt; 24) in 16 NHs. Second, remaining residents were screened for cognition with the Montreal Cognitive Assessment (MoCA). Also, an evaluation of functionality (ADL-Questionnaire), mood (Geriatric Depression Scale), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire) and subjective memory complaints (Informant Questionnaire on Cognitive Decline) was performed. Results On a total of 1339 residents, 229 persons (17.1%) had no diagnosis of dementia and an MMSE &amp;gt;23. Based on MoCA-cut-offs 2.7% (n = 36), 11.4% (n = 152) and 3.1% (n = 41) could be labelled as cognitively normal (&amp;gt;25), mild cognitive impairment (&amp;gt;16 and &amp;lt;26) and mild dementia (&amp;lt;17) respectively. This resulted in a prevalence of undetected mild cognitive problems of 14.5% (n = 193) in the total NH population. Significant differences between the 3 groups were found for functionality, mood, neuropsychiatric symptoms and subjective memory complaints (all p &amp;lt; 0.05). Conclusions Considering their advanced age NH residents are vulnerable to develop dementia. This study showed that an important part of them has unnoticed mild cognitive problems. NHs should be aware of this risk group in order to provide adequate prevention and support.

Effects of age and cognitive function on data quality of standardized surveys in nursing home populations

BackgroundData quality is of special concern when it comes to survey research in nursing homes. Very little is known about specifics of cognitively impaired elderly in responding to survey questions. This study examines effects of cognitive impairment, age, gender, and interview duration on the data quality in a sample of 659 nursing home residents (NHR).MethodsWithin a cross-sectional design, survey methodology was used to evaluate the pain situation in 13 nursing homes. Residents were stratified into NHR with no/mild (Mini-Mental State Examination MMSE: 18–30) and NHR with moderate (MMSE: 10–17) cognitive impairment. Data quality is measured by item nonresponse (INR). Correlation analyses, ANCOVA, linear and logistic regression models are applied.ResultsNeither interview duration nor gender have effects on item nonresponse. Age accounts for higher INR (β = 0.12, p < 0.001). Cognitive impairment strongly predicts INR (β = − 0.40, p < 0.001). INR significantly differs between NHR with no/mild (3.98%) and moderate cognitive impairment (11.85%). The likelihood of INR > 5% for residents with moderate cognitive impairment is 3.8-times (p < 0.001) of that for those with no/mild impairment.ConclusionsSurveys are adequate for residents with no/mild cognitive impairment but data quality is threatened in residents with moderate impairments. Precision and validity of responses from NHR with progressed cognitive impairment are potentially limited and results may be biased. The results clearly do support the need for a multidisciplinary ‘general theory’ of the question−/answer-process which has to be also inclusive for cognitively impaired elderly persons.

Signs and Symptoms of Low-Intake Dehydration Do Not Work in Older Care Home Residents—DRIE Diagnostic Accuracy Study

ObjectivesTo assess the diagnostic accuracy of commonly used signs and symptoms of low-intake dehydration in older care home residents. DesignProspective diagnostic accuracy study. Setting56 care homes offering residential, nursing, and/or dementia care to older adults in Norfolk and Suffolk, United Kingdom. Participants188 consecutively recruited care home residents aged ≥65 years, without cardiac or renal failure and not receiving palliative care. Overall, 66% were female, the mean age was 85.7 years (standard deviation 7.8), and the median Mini-Mental State Examination MMSE score was 23 (interquartile range 18-26). Index testsOver 2 hours, participants underwent double-blind assessment of 49 signs and symptoms of dehydration and measurement of serum osmolality from a venous blood sample. Signs and symptoms included skin turgor; mouth, skin, and axillary dryness; capillary refill; sunken eyes; blood pressure on resting and after standing; body temperature; pulse rate; and self-reported feelings of thirst and well-being. Reference standardSerum osmolality, with current dehydration defined as >300 mOsm/kg, and impending dehydration ≥295 mOsm/kg. Outcome measuresFor dichotomous tests, we aimed for sensitivity and specificity >70%, and for continuous tests, an area under the curve in receiver operating characteristic plots of >0.7. ResultsAlthough 20% of residents had current low-intake dehydration and a further 28% impending dehydration, none of the commonly used clinical signs and symptoms usefully discriminated between participants with or without low-intake dehydration at either cut-off. Conclusions/implicationsThis study consolidates evidence that commonly used signs and symptoms of dehydration lack even basic levels of diagnostic accuracy in older adults, implying that many who are dehydrated are not being identified, thus compromising their health and well-being. We suggest that these tests be withdrawn from practice and replaced with a 2-stage screening process that includes serum osmolarity, calculated from sodium, potassium, urea, and glucose levels (assessed routinely using the Khajuria and Krahn equation), followed by serum osmolality measurement for those identified as high risk (calculated serum osmolarity >295 mmol/L).

Non-Aβ-Dependent Factors Associated with Global Cognitive and Physical Function in Alzheimer's Disease: A Pilot Multivariate Analysis.

Recent literature highlights the importance of identifying factors associated with mild cognitive impairment (MCI) and Alzheimer’s Disease (AD). Actual validated biomarkers include neuroimaging and cerebrospinal fluid assessments; however, we investigated non-Aβ-dependent factors associated with dementia in 12 MCI and 30 AD patients. Patients were assessed for global cognitive function (Mini-Mental state examination—MMSE), physical function (Physical Performance Test—PPT), exercise capacity (6-min walking test—6MWT), maximal oxygen uptake (VO2max), brain volume, vascular function (flow-mediated dilation—FMD), inflammatory status (tumor necrosis factor—α ,TNF- α, interleukin-6, -10 and -15) and neurotrophin receptors (p75NTR and Tropomyosin receptor kinase A -TrkA). Baseline multifactorial information was submitted to two separate backward stepwise regression analyses to identify the variables associated with cognitive and physical decline in demented patients. A multivariate regression was then applied to verify the stepwise regression. The results indicated that the combination of 6MWT and VO2max was associated with both global cognitive and physical function (MMSE = 11.384 + (0.00599 × 6MWT) − (0.235 × VO2max)); (PPT = 1.848 + (0.0264 × 6MWT) + (19.693 × VO2max)). These results may offer important information that might help to identify specific targets for therapeutic strategies (NIH Clinical trial identification number NCT03034746).

The predictive value of malnutrition for functional and cognitive status in elderly hemodialysis patients.

The study aims to objectively and precisely describe, in elderly dialysis patients from a single center, the prevalence of malnutrition and severe cognitive/functional impairment and to establish the prognostic role of malnutrition assessment for patient's severe cognitive/functional status. Cross-sectional study. A single dialysis center from north-eastern Romania. Eighty-one elderly ambulatory hemodialysis patients. The aim of the study was to establish in hemodialysis elderly patients a correlation between two malnutrition scores [Mini Nutritional Assessment (MNA) and Subjective Global Assessment (SGA)] and geriatric tests (Geriatric Depression Scale-GDS), daily activities (Activities of Daily Living-ADL, Instrumental Activities of Daily Living-IADL), and cognitive impairment scores (Mini Mental State Examination-MMSE). A correlation between objective malnutrition parameters (bioimpedance lean tissue index (LTI) and fat tissue index (FTI) by bioimpedance) was also assessed. Using area under the curve analysis, two malnutrition scores and bioimpedance assessed nutritional status were explored as possible predictors for the most severe category of functional and cognitive status. All patients had mild/moderate malnutrition by SGA, while the MNA test reported malnutrition in 14.5%, and 58% of cases. There was no correlation between subjective scores and objective biomarkers of malnutrition (albumin levels, bioimpedance-derived LTI, FTI). ROC curve analysis showed that MNA and SGA predict the most severe category of depression and functional impairment with relatively good accuracy (specificity, sensibility). The study confirms the important correlation between malnutrition and cognitive/functional impairment and confirms that malnutrition scores could be useful in predicting depression and physical dependance in elderly dialysis patients.

Abstract TMP96: Determining the Relationship Between Cognitive Function and ex-vivo Leptomeningeal Arteriole Function: A Study in Rapid Autopsy Brain Donors

Impaired cerebrovascular function can lead to cognitive dysfunction and is implicated as a potential mechanism by which vascular stressors (Aβ, saturated fatty acids such as palmitic acid PA or high glucose HG) contribute to dementia. We aim to test the hypothesis that cognitive function score correlates significantly with baseline ex-vivo cerebrovascular function and dilator response to vascular stressors. Methods: Under a Brain Donation Rapid Autopsy Program, leptomeningeal arterioles were isolated from 59 donors (87.4±1.1 years, 13 cognitively normal, 46 with various neuropathologies), cannulated, pressurized and endothelium-dependent dilation (EDD, acetylcholine max 10 -4 M) and smooth muscle dilation (SMD, papaverine or DETA-Nonoate) were measured at baseline and following exposure to Aβ42 (0.5 or 2 μM, n=40), PA 150 μM (n=13) or high glucose 33 mM (n=11). Correlation analyses were performed between cognitive function score (last mini mental state examination MMSE) and baseline and post-exposure arteriole function. Results: There was no correlation between MMSE score and baseline EDD and SMD (Fig. A-B). Exposure of arterioles to Aβ and PA significantly impaired EDD (-29.1±4.6% and -27.6±9.1% vs. baseline, p&lt;0.05) but not HG (-2.7±6.6%). Aβ and PA impaired SMD (-7.4±3 and -7.4±6.7% vs. baseline, p&lt;0.05) but not HG (0.1±4.4%). There was no significant correlation between MMSE score and arteriole EDD and SMD response to Aβ and PA. However, there was significant correlation between MMSE score and arteriole SMD response to HG (Fig. C). Conclusions: Contrary to our hypothesis, there was no correlation between cognitive function score and baseline ex-vivo leptomeningeal arteriole function. There was significant correlation between cognitive function score and SMD response to HG (but not Aβ or PA). The role of cerebrovascular smooth muscle reserve against hyperglycemic insult in the pathophysiology of cognitive dysfunction needs to be further explored.

Cognitive stimulation therapy in the Italian context: its efficacy in cognitive and non-cognitive measures in older adults with dementia.

Cognitive stimulation therapy (CST) has been shown to have significant benefits in enhancing cognitive functioning and improving the quality of life of people with mild to moderate dementia. The present study examines the efficacy of the Italian version of the therapy (CST-IT). Older adults with mild to moderate dementia (n = 39) were randomly assigned to two programs: one group participated in the CST-IT, consisting of 14 sessions (twice a week for 7 weeks) and the active control group took part in alternative general activities. The outcome measures were cognitive functioning (measured by the Mini-Mental State Examination-MMSE-, the Alzheimer's Disease Assessment scale-cognitive subscale, the backward digit span test, and a narrative language test); quality of life (Quality of life--Alzheimer's Disease scale); mood (Cornell scale for depression in dementia and the social and emotional loneliness scale); functional activities in daily living (Disability Assessment for Dementia); and behavior (neuropsychiatric inventory). After the intervention, only the CST-IT group maintained its MMSE score, while the control group displayed deterioration. The CST-IT group also performed better in some of the cognitive measures (Alzheimer's Disease Assessment Scale-Cognitive subscale and narrative language), mood measures (Cornell scale, social and emotional loneliness scale with a decrease in reported loneliness), and the Quality of life--Alzheimer's Disease scale. No other treatment effect was observed. The findings confirm the efficacy, at least in the short term, of the CST in sustaining cognitive functions and perceived quality of life in older adults with dementia in the Italian care setting as well.