Mini-Mental State Examination Test Research Articles

Dual sensory loss and cognitive impairment: A study in elderly users of gerontological centers in a Galician urban area.

Several studies indicate that dual sensory loss (DSL) is related to cognitive impairment. However, there are still no conclusive data on the role of each individual deficit on cognitive performance when both co-occur in the same person. This study aimed to analyze the possible association between sensory deficit and cognitive impairment in a sample of older adults and whether this association differs in subjects with DSL compared with those with single or no sensory impairment. Participants of this study were older adult users of gerontological centers in an urban area of Galicia (Spain). All subjects underwent visual and auditory screening tests to detect the presence of DSL. The Spanish version of the Mini-Mental State Examination test was used to identify cognitive impairment. Hearing loss was defined according to Ventry and Weinstein's criteria. Visual impairment was defined as a binocular presenting visual acuity <0.5 (20/40). The presence of DSL was established on the basis of the definitions of the single deficits. A total of 534 subjects were examined. Older adults with DSL had the worst results in the Mini-Mental test, and those without sensory impairment had the best. The likelihood of cognitive impairment was greater in older adults with DSL than in those without sensory impairment (odds ratio, 6.06 [3.14 to 11.65]). When only visual impairment was present, the likelihood of cognitive impairment was 3.73 times higher (0.95 to 3.09) than that of subjects with no sensory impairment. Hearing loss alone seems not to be significantly associated with a higher risk of cognitive impairment. The results of this study highlight the importance of continuing research in DSL for the prevention of cognitive impairment, the design of intervention plans, and the optimization of health resources.

Estimated pulse wave velocity associated with cognitive phenotypes in a rural older population in China: A cohort study.

To examine the longitudinal association between estimated pulse wave velocity (ePWV) and cognitive phenotypes in a rural Chinese older population. This population-based study included 1857 dementia-free participants (age≥60 years) who were examined in 2014 and followed in 2018. ePWV was calculated using age and mean blood pressure (MBP). Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and neuropsychological tests. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Data were analyzed using Cox proportional-hazards models, linear regression models, and restricted cubic spline (RCS) curves. Per 1-m/s increase in ePWV was associated with an adjusted hazard ratio (HR) (95% confidence interval [CI]) of 1.51(1.30-1.75) for dementia and 1.58(1.33-1.89) for Alzheimer's disease (AD), and with an MMSE score decline (adjusted β-coefficient=-0.36; 95% CI=-0.52 to -0.21). A nonlinear association was observed between baseline ePWV and follow-up cognitive scores. A higher ePWV is associated with an increased risk of dementia, AD, accelerated cognitive decline, and poorer cognitive performance in older adults. An increased estimated pulse wave velocity (ePWV) was associated with incident dementia, Alzheimer's disease, and accelerated cognitive decline in a rural Chinese older population. A higher ePWV at baseline was associated with lower scores of global cognition and multiple cognitive domains at the 4-year follow-up. An increased ePWV may be a risk factor for dementia and accelerated cognitive deterioration in aging.

Neurocognitive function and health-related quality of life among glioblastoma patients: A prospective study

Background: Glioblastomas are aggressive brain tumours that significantly impact patients’ functional and psychological well-being, making the evaluation of health-related quality of life (HRQoL) essential.Aim: This study aims to assess the quality of life (QoL) and neurocognitive status of glioblastoma patients in Morocco.Setting: Patients were recruited from two renowned oncology centres in Morocco.Methods: Patients receiving care at two renowned oncology centres were enrolled between April 2021 and January 2024. The QLQ-C30 and QLQ-BN20 scales were used to assess QoL, while neurocognitive function was evaluated using the Mini-Mental State Examination (MMSE) test. Data normality were checked using the Shapiro-Wilk test, and non-parametric methods were used to compare scores. Variables such as age, tumour laterality, residence, and educational status were examined for their association with overall QoL. Both univariate linear regression and multivariate regression analyses were conducted. Statistical analyses were performed using the JAMOVI software.Results: The study enrolled 106 patients, with a median age of 56.7 years. Among them, 66% were male, while 34% were female. Multiple linear regression showed that age (B: –15.46; 95% CI: –24.15 to –6.77; p 0.001), education level (B: –9.36; 95% CI: 0.84 to 17.88; p = 0.032), distance from hospital (B: –9.85; 95% CI: –18.34 to –1.36; p = 0.023), and tumour laterality (B= –12.36; 95% CI: –20.65 to –4.06; p = 0.004) were significantly associated with overall QoL at 3 months follow-up.Conclusion: The results indicate a decline in HRQoL during follow-up among glioblastoma patients. Advancing age, tumour location on the left side, education level, and proximity to the hospital significantly influence the overall QoL.Contribution: This study highlights the critical factors impacting HRQoL in glioblastoma patients in Morocco, providing insights for improving patient care.

CLINICAL CORRELATION OF MMSE AND TAU RESULTS FROM BLOOD OR IMAGING REPORTS

Abstract Background A novel blood test for Alzheimer pathology is now available. Abnormal tau measurements from blood or brain PET may indicate brain tau. We analyzed the correlation of Mini Mental Status Examination (MMSE) to tau results disclosed to patients in a memory clinic. Objectives To assess the correlation of blood or PET tau positivity to MMSE test scores. To evaluate an MMSE score cut-off that translates optimally to tau positivity. Method Retrospective observational chart review of patients attending a memory clinic in Boston, MA, with a MMSE test score and blood tau or tau-results were included for analysis. Baseline MMSE and a binary blood or PET scan result were analyzed with covariates age, sex and race. Spearman correlation of MMSE to blood/PET tau. Kruskal Wallis/Chi square tests for relationship of age, sex, gender and education with MMSE score and tau-PET status. ROC analyses and sensitivity/specificity were obtained. Results We disclosed 45 positive and 10 negative tau results. 58.2% were female and 82.7% were white. Mean age was 70.12 ± 14.17, mean MMSE was 21.35±7.36. Tau abnormality trended negatively with MMSE score (r= -0.26, p=0.07). A cut point of 28 for MMSE estimated tau deposition in the brain by PET scan or blood tau, with an AUC of 0.694 (95%CI 0.48 to 0.90). Conclusion In a small pilot study, tau blood or PET results trended negatively with MMSE scores, possibly indicating a ceiling effect as we only analyzed very mildly impaired subjects.

Investigating the Effectiveness of Neuropsychological Rehabilitation on Stroke Patients

Objectives: This study aimed to investigate neuropsychological rehabilitation’s effectiveness on stroke patients’ cognitive status. Methods: This quasi-experimental study examined 22 adults with ischemic stroke of the left hemisphere (with an average age of 64.31 years) before and after the intervention. The patients had fluent aphasia (10 people) and non-fluent aphasia (12 people), along with cognitive disorders such as memory or attention disorder. Medical examination and para-clinical diagnosis of magnetic resonance imaging (MRI) with different causes, along with the Persian diagnostic aphasia battery bedside version (P-DAB-AQ1, 2016), were conducted. The severity of language disorder and type of aphasia were investigated using the Persian diagnostic aphasia battery (P-DAB-1) and Persian picture naming battery tests. Also, the mini-mental state examination (MMSE) test checked the cognitive dimensions. Verb network strengthening therapy, treatment of underlying forms, Persian verb, and sentence production protocol, and semantic feature analysis (SFA) for patients were also used. Results: Findings show that the participants’ average aphasia quotient (AQ1) score increased from 74.80 to 80.12, and the average MMSE score increased from 17 to 22.59. The main variables do not follow a normal distribution (P&lt;0.05), but the difference between scores before and after the intervention follows a normal distribution (P&lt;0.05). Both the AQ1 and MMSE variables significantly differ before and after the intervention, according to the Wilcoxon test. The non-fluent aphasia group has a higher increase in MMSE scores than the fluent aphasia group. Discussion: Neuropsychological rehabilitation interventions can effectively improve AQ1 and MMSE. In addition, further research on neuropsychological rehabilitation interventions with two intervention and control groups and the treatment methods used during this study can be suggested for the treatment of stroke patients.

Significant Association of Cognitive Function With Long-Term Clinical Outcomes After Transcatheter Aortic Valve Implantation: A Retrospective Cohort Study.

Background Patients undergoing transcatheter aortic valve implantation (TAVI) are often elderly, and perioperative and long-term risk assessments should primarily consider cognitive function, comorbidities, and procedural complexity. This study investigated the association between cognitive function and mortality in patients with severe aortic valve stenosis (AS) who underwent TAVI. Methodology This single-center, retrospective cohort study consecutively registered patients who underwent TAVI between December 2014 and December 2018. We divided the patients into two groups using a Mini-Mental State Examination (MMSE) score of 23. All-cause mortality was the primary outcome of this study. Results The study cohort included 114 patients with a follow-up period of five years. The mean age of the patients was 85 years. Overall, 37 of the 104 patients who underwent preoperative MMSE tests were considered to have cognitive impairment. The risk of all-cause death after TAVI was significantly higher in patients with impaired cognitive function than in those with preserved cognitive function (hazard ratio = 4.27; 95% confidence interval = 1.90-9.57). However, there were no significant differences in the function of the left ventricle and prosthetic aortic valve between the groups. Conclusions Impaired cognition significantly and independently affected the long-term outcomes of patients with severe AS who underwent TAVI. Given the age of the patients in this study, the indications for TAVI should be carefully considered for each patient based on their cognitive function.

Combined Assessment of Cognitive and Balance Abilities to Predict Falls in Patients in the Convalescent Rehabilitation Ward.

This study aimed to investigate the relationship between falls and cognitive and balance problems in patients. This retrospective observational study analyzed the medical records of 1010 older patients admitted to a convalescent rehabilitation ward. The primary endpoint was fall occurrence during ward stays. The main outcomes were the Mini-Mental State Examination (MMSE) and Standing Test for Imbalance and Disequilibrium (SIDE), with patients divided into groups of MMSE ≥28 and <28 and SIDE ≥2b and <2b. During ward stays, 220 patients (22%) fell. Estimating the fall risk of the MMSE ≥28 + SIDE ≥2b group compared to that of other groups revealed that only the MMSE <28 + SIDE <2b group had a significantly higher fall risk, with a hazard ratio [95% confidence interval] of 3.13 [1.51-6.46]. Combined MMSE and SIDE assessment at ward admission facilitated the easy identification of individuals at high fall risk.

Comparison of Occupational Performance in Immersive Virtual and Real Environments Among Patients With Stroke: Observational Randomized Crossover Pilot Study.

Conventional rehabilitation approaches involve therapists simulating various occupational tasks in health care settings or recreating real-life situations to assess and train patients in instrumental activities of daily living (IADLs). As an alternative, immersive virtual reality (IVR) has been widely used in stroke rehabilitation for years, but research comparing occupational performance between virtual and real environments is limited. This study aims to introduce a novel IVR shopping system designed for patients with stroke and to investigate the correlation of occupational performance in virtual and real environments among patients with stroke. Ten patients with stroke were recruited from the Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, who met the inclusion and exclusion criteria for this observational, randomized crossover study; the patients were predominantly male (n=7), had experienced ischemic stroke (n=9), were aged 14 to 73 years, and had a time since stroke of 1 to 42 months. All patients attempted shopping tasks in virtual and real environments. The Mini-Mental State Examination (MMSE), Timed Up and Go Test (TUGT), modified Barthel index (MBI), and Lawton index (LI) were used to assess cognition, ambulation, and activities of daily living. Memory capacity and duration in the virtual and real environments were recorded as the primary parameters of occupational performance. The Wilcoxon test and Spearman correlation coefficients were used to analyze the differences and correlations between the 2 environments. The Wilcoxon test showed no significant differences between the virtual and real environments in memory capacity and duration of task completion (P>.99 and P=.99), and memory capacity in both environments correlated with the LI (ρ=0.81; P=.005). Memory duration had a relationship with the TUGT in the virtual environment (ρ=0.68; P=.03) and a borderline negative correlation with MMSE in the real environment (ρ=-0.58; P=.08). Considering the small sample size used in this study and the study's limitations, despite the significant correlation between shopping performance in IVR and the real world, it is still too early to conclude that IVR is a noninferior approach, but it presents the potential to be an alternative for assessment and training in IADLs when resources are limited. However, further research is needed to investigate the psychometric properties, clinical effects, and impact of virtual training on real-world performance. The implications for practice might include the following: (1) occupational performance in virtual shopping might be the same as real-world shopping, and more virtual IADLs could thus be developed; (2) virtual IADL assessment and training systems could be used in remote locations or locations with limited resources; and (3) more objective parameters of IADLs could be extracted from virtual environments.

The Concurrent Association of Magnesium and Calcium Deficiencies with Cognitive Function in Older Hospitalized Adults.

Background/Objectives: Hypomagnesemia and hypocalcemia are common conditions among older adults that may contribute to cognitive decline. However, most of the existing research has focused primarily on dietary intake rather than the actual serum levels of these nutrients or examined them separately. This study aims to investigate the relationship between hypomagnesemia, hypocalcemia, and the concurrent presence of both deficiencies in relation to cognitive performance among seniors. Methods: A total of 1220 hospitalized patients aged 60 and older were included in the analysis. The participants were categorized into four groups: those with normal serum levels of magnesium and calcium, those with hypomagnesemia, those with hypocalcemia, and those with both serum magnesium and calcium deficiencies. To evaluate the potential influence of age, sex, common comorbidities, and disturbances in magnesium and calcium levels on cognitive performance, two general linear models were employed, using the Mini-Mental State Examination (MMSE) and Clock-Drawing Test (CDT) as dependent variables. Results: After adjusting for age, sex, body mass index, and comorbidities, the mean values for the MMSE and CDT were 23.33 (95%CI: 22.89-23.79) and 5.56 (95%CI: 5.29-5.83) for the group with normomagnesemia and normocalcemia, 22.59 (95%CI: 21.94-23.24) and 5.16 (95%CI: 4.77-5.54) for the group with hypomagnesemia, 19.53 (95%CI: 18.36-20.70) and 4.52 (95%CI: 3.83-5.21) for the group with hypocalcemia, and 21.14 (95%CI 19.99-22.29) and 4.28 (95%CI 3.61-4.95) for the group with both hypomagnesemia and hypocalcemia, respectively. Magnesium and calcium deficiencies contributed to MMSE and CDT variance in the general linear models. Conclusions: Our findings indicate that in addition to age, body mass index, and chronic heart failure, both hypomagnesemia and hypocalcemia are associated with reduced cognitive performance.

Prevalence of Cognitive Impairment in Post Stroke Patients

Abstract Background Stroke is a leading cause of vascular dementia. Cognitive dysfunction strongly contributes to disability and loss in quality of life. Objective Our study aimed to detect post stroke cognitive impairment in a sample of Egyptian people with stroke, six months after the last cerebrovascular accident. Methods A cross sectional study was conducted on 120 patients with stroke, six months after the last cerebro vascular accident. Comprehensive Geriatric Assessment was performed. Cognitive assessment was done using MMSE(Mini Mental State Examination) test, functional evaluation using Modified Rankin Scale and Barthel index, Diagnosis of vascular dementia by NINDS AIREN criteria (National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences (AIREN)), Hachiniski ischemic scale and radiological evidence of vascular insult Results Mean age of the patients was 69.17. Prevalence of cognitive impairment assessed by MMSE was 33.3%. Age was the only factor associated with poststroke cognitive impairment in regression analysis (p value 0.01). NINDSAIREN criteria is positive in 80% of patients diagnosed to have cognitive impairment (dementia) by MMSE. Patients with cognitive impairment had depression (p value 0.03), no satisfactory sleep (p value 0.01), longer post-stroke duration (p value 0.04), higher scores in Hachiniski ischemic score (p value 0.002), more than one infarction (p value 0.03) and impaired function by Barthel Index (p value 0.01). Pre stroke cognitive impairment was significantly higher in (patients with post stroke cognitive impairment (p value 0.003 Conclusion Cognitive impairment is prevalent in stroke patients. Age was the only factor associated with poststroke cognitive impairment in regression analysis. NINDSAIREN criteria is positive in 80% of patients diagnosed to have cognitive impairment (dementia) by MMSE. Patients with cognitive impairment had depression, no satisfactory sleep, longer post-stroke duration, higher scores in Hachiniski ischemic score, more than one infarction and impaired function by Barthel Index. Pre stroke cognitive impairment was significantly higher in patients with post stroke cognitive impairment

Cognitive processing speed improvement after cochlear implantation.

Untreated hearing loss has an effect on cognition. It is hypothesized that the additional processing required to compensate for the sensory loss affects the cognitive resources available for other tasks and that this could be mitigated by a hearing device. The impact on cognition of cochlear implants (CIs) was tested in 100 subjects, ≥60 years old, with bilateral moderately-severe to profound post linguistic deafness using hearing aids. Data was compared pre and 12 and 18 months after cochlear implantation for the speech spatial qualities questionnaire, Mini Mental State Examination (MMSE), Trail making test B (TMTB) and digit symbol coding (DSC) from the Wechsler Adult Intelligence Scale version IV and finally the timed up and go test (TUG). Subjects were divided into young old (60-64), middle old (65-75) and old old (75+) groups. Cognitive test scores and times were standardized according to available normative data. Hearing significantly improved pre- to post-operatively across all age groups. There was no change post-implant in outcomes for TMTB, TUG or MMSE tests. Age-corrected values were within normal expectations for all age groups for the TUG and MMSE. However, DSC scores and TMTB times were worse than normal. There was a significant increase in DSC scores between baseline and 12-months for 60- to 64-year-olds (t[153] = 2.608, p = 0.027), which remained at 18 months (t[153] = 2.663, p = 0.023). The improved attention and processing speed in the youngest age group may be a consequence of reallocation of cognitive resources away from auditory processing due to greatly improved hearing. The oldest age group of participants had cognition scores closest to normal values, suggesting that only the most able older seniors tend to come forward for a CI. Severe to profoundly deaf individuals with hearing aids or cochlear implants were still poorer than age-equivalent normally hearing individuals with respect to cognitive flexibility, attention, working memory, processing speed and visuoperceptual functions. Due to a lack of data for the TUG, TMTB and DSC in the literature for hearing impaired individuals, the results reported here provide an important set of reference data for use in future research.

Effectiveness of Serious Games in Evaluating Cognitive Status of the Elderly: A Systematic Review And Meta-Analysis.

Early diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease (AD) is very important in better management of these diseases, and serious games play an effective role in helping to diagnose these diseases more accurately owing to their innovative features. With respect to the diversity of available games, the purpose of this study was to investigate the effectiveness of using serious games to assess the cognitive status of the elderly at risk of MCI/AD. A systematic review was conducted and the correlation of serious game results with cognitive test scores were extracted from eligible studies for meta-analysis. We analyzed the correlation between the results of serious games with the scores of mini-mental state examination (MMSE), Addenbrooke's Cognitive Examination-revised edition (ACE-R), and Montreal Cognitive Assessment (MoCA) tests to evaluate cognitive status of the elderly at risk of MCI/AD, as well as the cognitive aspects examined by these tests. The random-effects model was used to obtain the overall correlation coefficient to assess the relationship between the results of serious games and the above mentioned paper-and-pencil tests. The correlation of game results with the MMSE, ACE-R, and MoCA was 0.604, 0.682, with 0.682, respectively. The correlation between the results of the games with the score of each cognitive aspect was also calculated. Overall, there is a positive correlation between serious game scores in terms of accurate patients' reactions with the scores of MMSE, ACE-R, and MoCA tests. Among the cognitive aspects, the highest correlation was obtained for fluency (0.591). For abstraction, however, the correlation was the lowest (0.036). In all three tests, the correlation was >0.6 and in cognitive aspects was <0.6. Thus, more studies should be conducted to develop serious games that are more in line with cognitive tests.

P18: BDNF levels and affective disorders as a marker of vulnerability to developing cognitive impairment in the Chilean adult population

Summary: Disorders related to progressive cognitive decline constituting an important cause of global death and disability-adjusted life years because conditions are also associated to impairment of several brain functions, psychological and behavioral changes, regardless of economic status. Brain-derived neurotrophic factor (BDNF) is a neurotrophin highly relevant in memory, learning and neuroplasticity processes in adults. The amount of plasma BDNF has been considered to partly reflect its secretion in the brain. Its deficiency is associated with affective disorders and neurodegenerative pathologies such as Alzheimer disease and Parkinson’sdisease.The aim of this study was to identify quantifiable biomarkers (serum levels of BDNF) and clinical marker (state of depression and anxiety) that allow early detection of cognitive impairment risk. We made an analytic and transversal study with a representative sample (n:307) of the population over 50 years old in the south of Chile (X region). We determine the cognitive condition of the population by applying cognitive functionality tests, such as the minimental status examination (MMSE) test and identify demographic and psychosocial characteristics that constitute impairment cognitive risk. Subsequently, we determined depression status (scale of Yesavage) and anxiety status (Beck inventory), and finally we made a quantitative determination of human BDNF at the blood level using ELISA technique.Our results revealed that 26.7% of the participants exhibited some degree of cognitive impairment, being higher in women (55.7%) with average age of 70,7. A 18,2% of subjects manifested indicators of depression and 33,2% have a very hight level of anxiety. The correlation analysis revealed a significant positive correlation between MMSE test (p &lt; 0.001) and both BDNF plasma levels (p &lt; 0.001) and education level (p &lt; 0.001) scores. The results additionally indicated a negative correlation between cognitive functions and age range/anxiety state, suggesting low age level/hight level of anxiety in subjects with more pronounced cognitive decline (p &lt; 0.001),. In consistent, the results of our study point towards decreases plasma BDNF levels and hight levels of anxiety in cognitive impairment subjects compared with cognitive normal subjects, which may be due to the early and middle stages of neurodegeneration process.

Conversion between the Rowland Universal Dementia Assessment Scale and Mini-Mental State Examination test scores in majority and minority populations.

Despite the Rowland Universal Dementia Assessment Scale (RUDAS) having significant advantages as a cognitive screening tool, particularly for minority populations, the Mini-Mental State Examination (MMSE) test is the most widely used test for cognitive screening in Alzheimer's disease (AD). This study aimed to develop a conversion table to predict MMSE scores from observed RUDAS scores, allowing an easy-to-use method to compare both screening tests. The equipercentile equating method was used to develop the conversion table using a training sample consisting of cognitively intact participants and individuals with early-stage AD. The resulting conversion table was validated in two samples, comprising participants from majority and minority populations assessed in Spanish. The conversion table demonstrated excellent reliability with intraclass correlation coefficients of.92 in both validation samples. This study provides a conversion table between RUDAS and MMSE scores, improving the comparability of these cognitive screening tools for use in clinical and research purposes.

The Association of Cerebral Autoregulation Dysfunction and Postoperative Memory Impairment in Cardiac Surgery Patients.

Background and Objectives: Cardiac surgery is associated with various durations of cerebral autoregulation (CA) impairment and can significantly impact cognitive function. Cognitive functions such as memory, psychomotor speed, and attention are significantly impacted after cardiac surgery, necessitating prioritization of these areas in cognitive function tests. There is a lack of research connecting cerebral autoregulation impairment to specific cognitive function domains after cardiac surgery. This study aimed to determine if impaired cerebral autoregulation is associated with postoperative memory impairment and to test the hypothesis that the duration of this impairment affects the development of postoperative memory issues. Materials and Methods: A prospective study was conducted in 2021-2023. After approval of the Ethics Committee and with patient's written consent, 83 adult patients undergoing elective on-pump coronary artery bypass graft (CABG) surgery were enrolled. All patients were assessed for cognitive function 1 day before surgery using the Mini-Mental state examination (MMSE-2) test as a screening tool and the Hopkins Verbal Learning Test-Revised (HVLT-R) to assess memory specifically. To diagnose possible memory impairment (IM), all patients underwent a repeat assessment of cognitive function on the 7th-10th postoperative day. Cerebral autoregulation monitoring using transcranial Doppler was performed. Cerebral autoregulation status index (Mx) was recorded using Intensive Care Brain Monitoring System software, 9.1.5.23 (Cambridge, UK). Results: According to our research, the incidence of postoperative memory impairment is 30.1%. Temporary cerebral autoregulation impairment occurs in all patients undergoing elective in-pump CABG surgery. The duration of the single longest CA impairment event in seconds (LCAI) and the LCAI dose were higher in patients with postoperative memory impairment, p = 0.006 and p < 0.007, respectively. Conclusions: Cerebral autoregulation impairment is important in developing memory loss after cardiac surgery. The duration and dose of the LCAI event are predictive of postoperative memory impairment.

Associations of Amyloid Burden, White Matter Hyperintensities, and Hippocampal Volume With Cognitive Trajectories in the 90+ Study.

Amyloid pathology, vascular disease pathology, and pathologies affecting the medial temporal lobe are associated with cognitive trajectories in older adults. However, only limited evidence exists on how these pathologies influence cognition in the oldest old. We evaluated whether amyloid burden, white matter hyperintensity (WMH) volume, and hippocampal volume (HV) are associated with cognitive level and decline in the oldest old. This was a longitudinal, observational community-based cohort study. We included participants with 18F-florbetapir PET and MRI data from the 90+ Study. Amyloid load was measured using the standardized uptake value ratio in the precuneus/posterior cingulate with eroded white matter mask as reference. WMH volume was log-transformed. All imaging measures were standardized using sample means and SDs. HV and log-WMH volume were normalized by total intracranial volume using the residual approach. Global cognitive performance was measured by the Mini-Mental State Examination (MMSE) and modified MMSE (3MS) tests, repeated every 6 months. We used linear mixed-effects models with random intercepts; random slopes; and interaction between time, time squared, and imaging variables to estimate the associations of imaging variables with cognitive level and cognitive decline. Models were adjusted for demographics, APOE genotype, and health behaviors. The sample included 192 participants. The mean age was 92.9 years, 125 (65.1%) were female, 71 (37.0%) achieved a degree beyond college, and the median follow-up time was 3.0 years. A higher amyloid load was associated with a lower cognitive level (βMMSE = -0.82, 95% CI -1.17 to -0.46; β3MS = -2.77, 95% CI -3.69 to -1.84). A 1-SD decrease in HV was associated with a 0.70-point decrease in the MMSE score (95% CI -1.14 to -0.27) and a 2.27-point decrease in the 3MS score (95% CI -3.40 to -1.14). Clear nonlinear cognitive trajectories were detected. A higher amyloid burden and smaller HV were associated with faster cognitive decline. WMH volume was not significantly associated with cognitive level or decline. Amyloid burden and hippocampal atrophy are associated with both cognitive level and cognitive decline in the oldest old. Our findings shed light on how different pathologies contributed to driving cognitive function in the oldest old.

The relationship between uric acid levels, cognition and inflammation in a cohort of elderly subjects.

Uric acid (UA) is the most powerful antioxidant found among human body fluids. With this effect, UA protects neurons from oxidant effects and ensures the continuation of the structure and functions of neuronal tissue. However, UA has effects on the immune system. This study aims to explain the relationship between UA, cognitive level and inflammation in cases with a wide spectrum of cognitive function. A total of 67 women and 62 men who applied to the psychiatry outpatient clinic to obtain a health report were evaluated. The cognitive states of the individuals were determined with the mini-mental state examination test (MMSE). Additionally, serum uric acid levels and simple inflammatory parameters such as CRP, sedimentation, neutrophil-lymphocyte ratio (NLR), and monocyte-lymphocyte ratio (MLR) were measured. According to the MMSE results, two groups were created. Those with an MMSE score of 24 or above formed the first group, and those with an MMSE score below 24 formed the second group. While a statistically significant positive strong correlation was found between UA and MMSE in all individuals, negative correlations were found between UA and NLR and MLR in men. UA was found to be significantly lower in the group with MMSE scores below 24 and NLR values were higher in the same group. According to these results, UA seems to have a protective effect on cognitive functions. This situation manifests itself more clearly in men. At physiological concentrations, UA may have an anti-inflammatory effect. It appears that there are complex interactions between UA, cognition, and inflammation. Particularly, men appear to be more susceptible to UA effects.

Association of plant-rich dietary patterns of mediterranean and MIND with risk of alzheimer disease

ObjectiveIn recent decades, the possible synergistic power of nutrients in the form of dietary patterns has received attention in preventing diseases. This study aimed to investigate the association between plant-rich Mediterranean (MeDi) and MIND [MeDi-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay] dietary patterns with the risk of Alzheimer's disease (AD). MethodsSixty patients with AD and 29 healthy individuals were recruited. The cognitive functioning of the patients was measured using the Mini-Mental State Examination (MMSE) test. Participants’ food intake was evaluated using the three nonconsecutive days 24-h food recall method, and then MeDi and MIND dietary scores were calculated. ResultsPatients with AD had lower MIND diet scores than healthy subjects (p = 0.06), but the MeDi score did not significantly differ between the two groups. MIND and MeDi scores did not significantly differ between males and females. Each unit increase in MIND diet score was significantly correlated with a 40 % reduced risk of AD, and each unit increase in MeDi score was non-significantly correlated with a 14 % reduced risk of AD. Scores of MIND and MeDi patterns did not remarkably correlate with MMSE total score and cognitive domains. ConclusionThe findings of this study suggest the promising affirmative effects of the MIND diet on reducing the risk of AD, but the protective effect of the MeDi pattern against the AD risk remains inconclusive.

The long-term effect on oral health and quality of life using a powered toothbrush in individuals with mild cognitive impairment. An intervention trial.

The number of older individuals with mild cognitive impairment and neurocognitive diseases is increasing, which may rapidly deteriorate oral health and Quality of life. Therefore, removing dental biofilm is essential for maintaining good oral health. The present study aimed to investigate whether introducing a powered toothbrush reduces the presence of dental plaque, bleeding on probing, and periodontal pockets ≥4mm, leading to maintained or improved oral health and improved Quality of life in a group of older individuals with mild cognitive impairment. Two hundred and thirteen individuals aged 55 or older living without official home care with a Mini-Mental State Examination (MMSE) score between 20 and 28 and a history of memory problems in the previous 6 months were recruited and screened for the study. The individuals received a powered toothbrush and thorough instructions on how to use it. Clinical oral examinations, Quality of life examinations, and MMSE tests were conducted at baseline, 6, 12, and 24 months. The intervention group was compared to control groups at baseline and 24-month examination. It was divided into an MMSE high group with a score of more than 26 and an MMSE low group with a score of 26 and lower or decreasing two steps or more for 12 months. PI, BOP, and PPD≥4mm improved continuously in both MMSE groups during the 24 months of the study. The values for QoL-AD deteriorated over time, while the oral health-related Quality of life did not show any statistically significant changes. Introducing a powered toothbrush improved PI, BOP, and PPD≥4mm over 24 months, even among individuals with low or declining MMSE scores. Improved oral health is associated with a preserved OHR-QoL.

Renal function as an effect modifier of intensive glucose control in delaying cognitive function decline among individuals with type 2 diabetes: A revisit to the ACCORD MIND trial.

Dysglycaemia accelerates cognitive decline. Intensive glucose control may help delay or prevent cognitive function decline (CFD). We aimed to determine how patient characteristics influence the effect of intensive glucose control [glycated haemoglobin (HbA1c) <6.0%] on delaying CFD in people with type 2 diabetes. In this post-hoc analysis of 2977 type 2 diabetes participants from the ACCORD MIND trial, we applied the causal forest and causal tree algorithms to identify the effect modifier of intensive glucose control in delaying CFD from 68 variables (demographics, disease history, medications, vitals and baseline biomarkers). The exposure was intensive versus standard glucose control (HbA1c <6.0% vs. 7.0%-7.9%). The main outcome was cognitive function changes from baseline to the 40th month follow-up, which were evaluated using the digit symbol substitution test, Rey auditory verbal learning test, mini-mental state examination and Stroop test. We used Cohen's d, a measure of standardized difference, to quantify the effect size of intensive glucose control on delaying CFD. Among all the baseline characteristics, renal function was the most significant effect modifier. Participants with urinary albumin levels <0.4 mg/dl [absolute function change (AFC): 0.51 in mini-mental state examination, 95% confidence interval (CI): 0.04, 0.98, Cohen's d: 0.25] had slower CFD with intensive glucose control. Patients with preserved renal function (estimated glomerular filtration rate between 60 and 90 ml/min/1.73 m2) were associated with small benefits (AFC: 1.28 in Stroop, 95% CI: 0.28, 2.27, Cohen's d: 0.12) when undergoing intensive glucose control. Conversely, participants with an estimated glomerular filtration rate <60 ml/min/1.73 m2 (AFC: -0.57 in the Rey auditory verbal learning test, 95% CI: -1.09, -0.05, Cohen's d: -0.30) exhibited faster CFD when undergoing intensive glucose control. Participants who were <60 years old showed a significant benefit from intensive glucose control in delaying CFD (AFC: 1.08 in the digit symbol substitution test, 95% CI: 0.06, 2.10, Cohen's d: 0.13). All p < .05. Our findings linked renal function with the benefits of intensive glucose control in delaying CFD, informing personalized HbA1c goals for those with diabetes and at risk of CFD.