Moderate Cognitive Impairment Research Articles

Prevalence and determinants of cognitive impairment in an elderly population: A hospital based study

: Dementia and cognitive impairment (CI) are some of the common problems associated with ageing. However, a lot of other factors apart from ageing can increase this risk. In this study, prevalence of CI and its correlation with different sociodemographic and clinical factors was assessed among patients attending outpatient department of a geriatric healthcare facility.: A total of 240 elderly OPD patients (>60 years) having recovered from different acute illnesses or making follow-up visits were enrolled in the study. Critically ill, hospitalized patients and those with history of COVID-19 exposure were excluded from the study. Demographic and social profile of the patients was noted. Mini Mental State Examination (MMSE) was used for assessment of cognition. MMSE score <27 was considered as CI. Data was analyzed using chi-square test for univariate and binary logistic regression for multivariate assessment. Mean age of patients was 72.58±6.46 years (range 62-91 years), majority of patients were males (55%). Prevalence of CI was 41.2%. There were 59 (24.6%) elderly with mild and 40 (16.7%) with moderate cognitive impairment. On univariate assessment, older age (p=0.003), male sex (p=0.024), living without spouse (p=0.040) and history of hospitalization in last one year (p=0.031) were found to be significantly associated with CI. On logistic regression age (OR=1.072), female sex (OR=0.561), ability to perform routine work (OR=0.461) and hospitalization history (OR=1.823) were identified as independent predictors of CI.: Prevalence of CI was 41.2% in our study. Age, sex, ability to perform routine works and hospitalization history were independently associated with CI risk.

Incidence of New Dementia Diagnosis in Veterans Admitted to Nursing Homes After Heart Failure Hospitalization.

Hospitalization with heart failure (HF) may signal an increased risk of Alzheimer's disease and related dementias (ADRD). Nursing homes routinely assess cognition but the association of these results with new ADRD diagnosis in a population at high risk of ADRD is not known. To determine the association between nursing home cognitive assessment results and new diagnosis of dementia after heart failure hospitalization. This retrospective cohort study included Veterans hospitalized for HF and discharged to nursing homes, from 2010 to 2015, without a prior diagnosis of ADRD. We determined mild, moderate, or severe cognitive impairment using multiple items of the nursing home admission assessment. We used Cox regression to determine the association of cognitive impairment with new ADRD diagnosis during 365 days of follow-up. The cohort included 7,472 residents, new diagnosis of ADRD occurred in 4,182 (56%). The adjusted hazard ratio of ADRD diagnosis was 4.5 (95% CI 4.2, 4.8) for the mild impairment group, 5.4 (95% CI 4.8, 5.9) for moderate impairment, and 4.0 (95% CI 3.2, 5.0) for severe impairment compared to the cognitively intact group. New ADRD diagnoses occurred in more than half of Veterans with HF admitted to nursing homes for post-acute care.

Objective cognitive functioning in patients with stress-related disorders: a cross-sectional study using remote digital cognitive testing

BackgroundPatients with stress-related mental disorders often report cognitive impairment, but studies investigating objective cognitive impairment in patients with stress-related disorders have produced inconsistent findings.AimThe primary aim of this study was to investigate objective cognitive functioning in patients diagnosed with the stress-related disorders adjustment disorder or exhaustion disorder, compared to a healthy normative group. Secondary aims were to conduct subgroup analyses of cognitive functioning between the diagnostic groups and explore associations between self-reported symptoms and cognitive functioning.MethodsCognitive test results on a digitally self-administered cognitive test battery from 266 patients (adjustment disorder, n = 131; exhaustion disorder, n = 135) were cross-sectionally compared with results from a healthy normative group (N = 184 to 692) using one-tailed t-tests. ANOVAs were conducted for subgroup analyses, and regression analyses for associations between self-reported symptoms and cognitive functioning. Effect sizes were calculated.ResultsPatients performed significantly worse than the normative group on all measures with small to moderate effect sizes ranging from d = -.13 to -.57. Those diagnosed with exhaustion disorder performed worse than norms on more measures than did patients with adjustment disorder, but no significant differences between diagnostic groups were found on any measure. Self-reported memory impairment was weakly associated with one of two memory measures. No clear associations between self-reported burnout symptoms and objective cognitive functioning were found.ConclusionsThis study adds to the literature indicative of small to moderate objective cognitive impairments in patients diagnosed with stress-related mental disorders. Further exploration into mechanisms of cognitive functioning in different populations is needed for development of theoretical models that may explain the weak correlation between self-reported symptoms and objective measures.Trial registrationClinicalTrial.gov: NCT04797273. Trial registration date 15 March 2021. This study was also pre-registered on Open Science Framework (osf.io) with https://doi.org/10.17605/OSF.IO/TQXZV.

ASTUDY TOASSESSTHECOGNITIVEIMPAIRMENTAND QUALITYOFLIFEAMONG ELDERLYINSELECTEDCOMMUNITYAREA, DEHRADUN,UTTARAKHAND

Background: Aging per the biological concept is the results of the build- up of a large type of cellular changes within the bodyovera expanded period of time which results in a decrease in physicality and mentality. The aim of the study to assess cognitiveimpairmentandqualityoflife among elderly inselectedcommunityarea. Methodology: Descriptive survey research design was used, total 130 elderly were selected through total enumerative samplingtechnique . Data was collected by interview method for Socio-demographic variables, Mini Mental StatusExaminationandStructuredtoolonqualityoflifeincommunityareaofMarkhamgrant,Dehradun,Uttarakhand.Frequency,percentagemeanandstandarddeviation,Chi-Square,FishersExactTestwasused. Results:This study showed that (53.8%) of the elderly were having no cognitive impairment, (30.8%) were having mildcognitive impairment, (13.1%) of the elderly were having moderate cognitive impairment, (2.3%) of the elderlywere having severe cognitive impairment. The result also showed that 72.3% were having average quality of life,15.4% were having good quality of life, 12.3% were having poor quality of life and the mean QOL score wasmaximum in Social Relation and Family (21.94±2.951) and minimum in financial circumstances (13.52±2.864).The cognitive function is improving and quality of life is also improving as there is highly significant moderatepositive correlation (0.482)testedat0.05 levelofsignificance. Conclusion:The study concluded that the elderly were having no cognitive impairment and average quality of life.

Aggressive end-of-life care across gradients of cognitive impairment in nursing home patients with metastatic cancer.

Studies examining end-of-life (EOL) care in older cancer patients are scarce, and prior studies have not accounted for gradients of cognitive impairment (COG-I). We examine EOL care patterns across COG-I gradients, hypothesizing that greater COG-I severity is associated with lower odds of receiving aggressive EOL care. Using data from the linked Surveillance Epidemiology and End Results (SEER) -Medicare -Minimum Data Set (MDS) 3.0, we identified patients with nursing facility stays (NFS) and who died with metastatic cancer from 2013 to 2017. Markers of aggressive EOL care were: cancer-directed treatment, intensive care unit admission, >1 emergency department visit, or >1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in-hospital death. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to evaluate the independent association between COG-I severity and receipt of aggressive EOL care. Of the 40,833 patients in our study population, 49.2% were cognitively intact; 24.4% had mild COG-I; 19.7% had moderate COG-I; and 6.7% had severe COG-I. The percent of patients who received aggressive EOL care was 62.6% and 74.2% among those who were cognitively intact and those with severe COG-I, respectively. Compared with cognitively intact patients, those with severe COG-I had 86% higher odds of receiving any type of aggressive EOL care (adjusted odds ratio (aOR): 1.86 (95% confidence interval: 1.70-2.04)), which were primarily associated with higher odds of in-hospital death. The odds of in-hospital death associated with severe COG-I were higher among those with short- than with long-term stays (aOR:2.58 (2.35-2.84) and aOR:1.40 (1.17-1.67), respectively). Contrary to our hypothesis, aggressive EOL care in older metastatic cancer patients with NFSwas highest among those suffering severe COG-I. These findings can inform the development of interventions to help reduce aggressive EOL care in this patient population.

Using Palliative Leaders in Facilities to Transform Care for People with Alzheimer’s Disease (UPLIFT-AD): protocol of a palliative care clinical trial in nursing homes

BackgroundPalliative care is an effective model of care focused on maximizing quality of life and relieving the suffering of people with serious illnesses, including dementia. Evidence shows that many people receiving care in nursing homes are eligible for and would benefit from palliative care services. Yet, palliative care is not consistently available in nursing home settings. There is a need to test pragmatic strategies to implement palliative care programs in nursing homes.Methods/designThe UPLIFT-AD (Utilizing Palliative Leaders in Facilities to Transform care for people with Alzheimer’s Disease) study is a pragmatic stepped wedge trial in 16 nursing homes in Maryland and Indiana, testing the effectiveness of the intervention while assessing its implementation. The proposed intervention is a palliative care program, including 1) training at least two facility staff as Palliative Care Leads, 2) training for all staff in general principles of palliative care, 3) structured screening for palliative care needs, and 4) on-site specialty palliative care consultations for a one-year intervention period. All residents with at least moderate cognitive impairment, present in the facility for at least 30 days, and not on hospice at baseline are considered eligible. Opt-out consent is obtained from legal decision-makers. Outcome assessments measuring symptoms and quality of care are obtained from staff and family proxy respondents at four time points: pre-implementation (baseline), six months after implementation, at 12 months (conclusion of implementation), and six months after the end of implementation. Palliative care attitudes and practices are assessed through surveys of frontline nursing home staff both pre- and post-implementation. Qualitative and quantitative implementation data, including fidelity assessments and interviews with Palliative Care Leads, are also collected. The study will follow the Declaration of Helsinki.DiscussionThis trial assesses the implementation and effectiveness of a robust palliative care intervention for residents with moderate-to-advanced cognitive impairment in 16 diverse nursing homes. The intervention represents an innovative, pragmatic approach that includes both internal capacity-building of frontline nursing home staff, and support from external palliative care specialty consultants.Trial registrationThe project is registered on ClinicalTrials.gov: NCT04520698.

Feasibility of self-reported health related quality of life assessment with older people in residential care: insights from the application of eye tracking technology

PurposeIncreasingly there are calls to routinely assess the health-related quality of life (HRQoL) of older people receiving aged care services, however the high prevalence of dementia and cognitive impairment remains a challenge to implementation. Eye-tracking technology facilitates detailed assessment of engagement and comprehension of visual stimuli, and may be useful in flagging individuals and populations who cannot reliably self-complete HRQoL instruments. The aim of this study was to apply eye-tracking technology to provide insights into self-reporting of HRQoL among older people in residential care with and without cognitive impairment.MethodsResidents (n = 41), recruited based on one of three cognition subgroups (no, mild, or moderate cognitive impairment), completed the EQ-5D-5L on a computer with eye tracking technology embedded. Number and length of fixations (i.e., eye gaze in seconds) for key components of the EQ-5D-5L descriptive system were calculated.ResultsFor all dimensions, participants with no cognitive impairment fixated for longer on the Area of Interest (AOI) for the response option they finally chose, relative to those with mild or moderate cognitive impairment. Participants with cognitive impairment followed similar fixation patterns to those without. There was some evidence that participants with cognitive impairment took longer to complete and spent relatively less time attending to the relevant AOIs, but these differences did not reach statistical significance generally.ConclusionsThis exploratory study applying eye tracking technology provides novel insights and evidence of the feasibility of self-reported HRQoL assessments in older people in aged care settings where cognitive impairment and dementia are highly prevalent.

Discontinuation of oral anticoagulant use among nursing home residents with atrial fibrillation before hospice enrollment.

Oral anticoagulants (OACs) are effective in reducing the risk of cardioembolic stroke due to atrial fibrillation. While most nursing home residents with atrial fibrillation qualify for anticoagulation based on clinical guidelines, the net clinical benefits of OACs may diminish as residents approach the end of life. We conducted a cross-sectional study of 30,503 US nursing home residents with atrial fibrillation (based on Minimum Data Set 3.0 and Medicare Part A records) who used OACs in the year before enrolling in hospice care during 2012-2016. Whether residents discontinued OACs before hospice enrollment was determined using Part D claims and date of hospice enrollment. Modified Poisson models estimated adjusted prevalence ratios (aPR). Almost half (45.7%) of residents who had recent OAC use discontinued prior to hospice enrollment. Residents who were underweight (aPR: 1.02; 95% confidence interval [CI]: 1.01-1.03), those with high bleeding risk (aPR: 1.04, 95% CI: 1.03-1.05), and those with moderate or severe cognitive impairment (aPR: 1.02, 95% CI: 1.02-1.03) had a higher prevalence of OAC discontinuation before entering hospice. Residents with venous thromboembolism (aPR: 0.94, 95% CI: 0.93-0.96), statin users (aPR: 0.88, 95% CI: 0.87-0.89), and those on polypharmacy (≥10 medications, aPR: 0.72; 95% CI: 0.71-0.73) were less likely to discontinue OACs before enrollment in hospice. Anticoagulants are often discontinued among older nursing home residents with atrial fibrillation before hospice enrollment; it is not clear that these decisions are driven solely by net clinical benefit considerations. Further research is needed on comparative outcomes to inform resident-centered decisions regarding OAC use in older adults entering hospice.

Understanding Formal Caregiver Burden in Nursing Assistants in Nursing Homes: A Mixed Methods Approach.

The current study aimed to describe formal caregiver burden of nursing assistants in nursing homes. A descriptive, cross-sectional, convergent mixed methods approach identified attributes of formal caregiver burden using phenomenological interviews and established self-report measures. Themes included nursing assistants' experiences of stress, close relationships, extensive assistance of residents, balancing needs and routines, and feeling accomplished. Self-report measures demonstrated moderate stress, moderate caring behaviors, responsibility, and competence. MDS 3.0 results showed moderate cognitive impairment, minimal depressive symptoms, and decreased functional status of residents. The mixed methods synthesis confirmed the presence of five attributes of formal caregiver burden: perceived stress, caring for another, dependency of the older adult, responsibility, and competence. Burnout was not confirmed. Future investigation of attributes among a larger, diverse sample of nursing assistants, residents, and nursing homes will advance knowledge and inform research design and methods of interventions. [Research in Gerontological Nursing, 16(5), 231-240.].

Cognitive function during 3 years of growth hormone in previously GH-treated young adults with PWS.

Most patients with Prader-Willi syndrome (PWS) have a mild to moderate cognitive impairment. Growth hormone (GH) treatment has positive short- and long-term effects on cognition in children with PWS. Few studies, however, have investigated the effects of GH on cognitive functioning in adults with PWS. To investigate the effects of 3 years GH treatment on cognitive functioning and behavior in young adults with PWS who were treated with GH during childhood. Open-label, prospective study. Dutch PWS Reference Center. Patients were treated with 0.33 mg GH/m²/day (∼0.012 mg/kg/day; 33% of childhood dose). Cognitive functioning was measured by Wechsler Adult Intelligence (WAIS) tests. Behavior was studied by Developmental Behavior Checklist - Parents/caregivers (DBC-P). 46 young adults with PWS with a median age of 19 (IQR 17-21) years were investigated. Estimated mean (95% CI) total, verbal and performance IQ remained stable during 3 years of GH-treatment. Total IQ being 66 (63-69) at start and 67 (64-71) after 3 years (p=0.30); Verbal IQ being 65 (62-68) and 66 (62-70), resp. (p=0.31) and performance IQ being 67 (63-70) and 67 (63-72) resp. (p=0.42). Estimated mean Total DBC score did not significantly change during 3 years of GH-treatment, being 36.3 at start and 36.5 after 3 years (p=0.94) (P50). Three years of GH-treatment in young adults with PWS with 33% of the pediatric dose, maintains total, verbal and performance IQ. The emotional and behavioral disturbances remained stable and were similar compared to peers with other intellectual disabilities.

Multimodal multitask learning for predicting MCI to AD conversion using stacked polynomial attention network and adaptive exponential decay

Early identification and treatment of moderate cognitive impairment (MCI) can halt or postpone Alzheimer’s disease (AD) and preserve brain function. For prompt diagnosis and AD reversal, precise prediction in the early and late phases of MCI is essential. This research investigates multimodal framework-based multitask learning in the following situations: (1) Differentiating early mild cognitive impairment (eMCI) from late MCI and (2) predicting when an MCI patient would acquire AD. Clinical data and two radiomics features on three brain areas deduced from magnetic resonance imaging were investigated (MRI). We proposed an attention-based module, Stack Polynomial Attention Network (SPAN), to firmly encode clinical and radiomics data input characteristics for successful representation from a small dataset. To improve multimodal data learning, we computed a potent factor using adaptive exponential decay (AED). We used experiments from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort study, which included 249 eMCI and 427 lMCI participants at baseline visits. The proposed multimodal strategy yielded the best c-index score in time prediction of MCI to AD conversion (0.85) and the best accuracy in MCI-stage categorization (83.19%). Moreover, our performance was equivalent to that of contemporary research.

Risk factors for vascular dementia

Background. An increase in the number of older people with cognitive disorders, including dementia, is expected.The aim. To study the risk factors for vascular dementia.Material and methods. 39 patients with vascular dementia (ICD-10 diagnosis code F01) were examined. The comparison group consisted of 167 people. According to the MMSE (Mini Mental State Examination) scale, moderate dementia was detected in 56.4 % of cases, severe – in 43.6 %; in the comparison group, 94 % had mild and 6 % – moderate cognitive impairment.Results. In the vascular dementia group, the following risk factors were registered significantly more often: ischemic heart disease – at the age of 70–79 years (57.1 %; p = 0.000) and in the group as a whole (56.4 %; p = 0.000); diabetes mellitus – at the age of 60–69 years (100 %; p = 0.005); arterial hypertension – at the age of 70–79 years (100 %; p = 0.000) and in the group as a whole (87.2 %; p = 0.000). In the comparison group, the frequency of body mass index over 25 was significantly higher at the age of 70–79 years (60 %; p = 0.000), 80 years and older (64.3 %; p = 0.037) and in the group as a whole (68.9 %; p = 0.000). Among people with moderate cognitive impairment, the following risk factors were significantly more common: coronary heart disease – at the age of 60–69 years (10 %; p = 0.001); diabetes mellitus – at the age of 70–79 years (40 %; p = 0.025) and in the group as a whole (50 %; p = 0.033), the frequency of body mass index over 25 – at the age of 80 years and older (70 %; p = 0.000) and in the group as a whole (100 %; p = 0.000).Conclusion. Risk factors for the development of cognitive disorders (coronary heart disease, hypertension, diabetes mellitus, overweight) are potentially reversible; their timely detection can reduce the development of cognitive disorders and dementia.

A novel autonomous vehicle interface for older adults with cognitive impairment

The population of older Americans with cognitive impairments, especially memory loss, is growing. Autonomous vehicles (AVs) have the potential to improve the mobility of older adults with cognitive impairment; however, there are still concerns regarding AVs’ usability and accessibility in this population. Study objectives were to (1) better understand the needs and requirements of older adults with mild and moderate cognitive impairments regarding AVs, and (2) create a prototype for a holistic, user-friendly interface for AV interactions. An initial (Generation 1) prototype was designed based on the literature and usability principles. Based on the findings of phone interviews and focus group meetings with older adults and caregivers (n = 23), an enhanced interface (Generation 2) was developed. This generation 2 prototype has the potential to reduce the mental workload and anxiety of older adults in their interactions with AVs and can inform the design of future in-vehicle information systems for older adults.

PSYCHOGENIC FACTORS AS A CAUSE OF DEPRESSIVE DISORDERS IN THE ELDERLY

Individuals with particular qualities or characteristics are predisposed to develop cognitive impairment non dementia. The mainaim to study socio-demographic factors and personality traits, that contribute tothe development of depressive disorders in elderly patients with cognitive deficits. The purpose of the article was to show that it is important to investigate the socio-psychological factors that can worsen the course of cognitive impairment, which already comes with age.During the research an observational study involving 111 patients from Kazakhstan with cognitive deficits was conducted: 59 patients, whose depressive disorders had been identified by clinical and psychopathological research using the Hamilton Depression Rating Scale (HRSD) and 52 patients for whom psychogenic depressive disorders had not been defined. The recruitment of the study participants was carried out in the state nursing home for the elderly and disabled. The study included male and female individuals aged 60-74 years with different national and ethnic backgrounds, with mild to moderate cognitive impairment, who wished to participate in the study and signed an informed consent to participate in the study.This study uncovered the primary factors that increase the chances of individuals with cognitive impairments developing a depressive disorder. These factors include personal attributes of the patients, such as their sex, whether they are married or not, and the quality of their relationship with their family members. In addition, personality traits from before their cognitive decline, such as a tendency for isolation, insecurity, and passivity, were also significant.This study could have an exceptional value for medicine and psychological workers on the whole and in Republic of Kazakhstan in particular to prevent depressive diseases were mentioned.

Astute exploration of collective mental health events among the residents of elderly care homes

Background & objectiveDeveloping countries are presently witnessing a great burden of rapid aging followed by losing the social values of older adults due to age-related cognitive impairment as well as rising depression levels. This study was designed to assess the cognitive impairment and depression status combinedly among older adults in elderly care homes. MethodsIt was a cross-sectional survey among randomly selected 200 older adults aged between 60 and 80 years residing in some old homes in Dhaka district, Bangladesh. Data were collected through face-to-face interviews while Cognitive function and level of depression were assessed by applying the Standardized Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). ResultsAmong all the respondents, the majority (81.5%) were staying in old homes for 1–5 years. The majority (91.0%) had difficulties with vision, 40.7% had difficulties with hearing and 19.6% had difficulties moving around. The MMSE test revealed that 43% had moderate cognitive impairment, 36% had mild and 19.5% were found normal while more than half (56%) had severe depression. Significant cognitive impairment was found among the illiterate respondents who did not have any family care support. In addition, higher-educated respondents were found to have more severe depression (OR/p = 6.33/<0.01; 95% CI: 2.36–16.96). Furthermore, severely depressed respondents had more severe cognitive impairment (COR/p = 3.83/0.01; 95% CI: 1.66–8.83). Functional disabilities were also a greater concern for cognitive impairment and depression. ConclusionAn increasing number of old home residents are suffering from significant mental disorders while there is no mental health support in the elderly care homes in Bangladesh. Finally, there is a great need to develop packages and programs of mental health care for senior citizens and their caregivers residing in old homes, which can be scaled up across the country’s mixed healthcare delivery system.

ФИТОТЕРАПИЯ В РЕАБИЛИТАЦИИ ЛЕГКИХ И УМЕРЕННЫХ КОГНИТИВНЫХ РАССТРОЙСТВ

An increase in life expectancy creates prerequisites for the appearance of more patients with cognitive impairments. Early diagnosis, treatment and rehabilitation of cognitive disorders improves the quality of life of patients, prevents the development of dementia, and is of great social importance. Herbal medicines are highly effective in the treatment of mild and moderate cognitive impairment, affect various links of pathogenesis, have minor side effects. The most effective of them are: galantamine from snowdrop tubers; hyperzine from sawtooth grass; ginkgo two-lobed flavanoids; biologically active substances of medicinal sage and periwinkle.

Analysis of the Relationship of Moderate Cognitive Impairments with Changes in Synchronization between Photostimulation and Brain Activity

Abstract—The review is devoted to the application of methods of nonlinear dynamics to the analysis of dynamic changes in the patterns of physiological rhythms of the brain in the event of disorders associated with chronically elevated blood pressure and atrial fibrillation-type cardiac arrhythmias in the presence and absence of moderate cognitive impairment. The possibility of using these methods to identify markers of these disorders is shown. These markers are associated with the parameters of phase synchronization between rhythmic photostimuli and brain responses in the form of electroencephalographic patterns.

Effectiveness of Cognitive Orientation to Daily Occupational Performance in Parkinson’s Disease: A Case Report

Introduction: Parkinson’s disease is a chronic progressive neurodegenerative disorder causing impaired motor function and various non-motor symptoms. One of the most common problems in Parkinson’s patients is occupational performance problems. The cognitive orientation to daily occupational performance (CO-OP) is one of the client-centered and problem-solving approaches in occupational therapy evaluations and interventions. This study aims to determine the effectiveness of the CO-OP approach on perceived satisfaction and occupational performance in a 62-year-old woman with Parkinson’s disease.&#x0D; Case Description: The client was a 62-year-old woman with moderate cognitive impairment, stage 3 on the Hoehn and Yahr scale, and signs of depression. In our case study, the outcome measures were the Canadian occupational performance measure (COPM), functional independence measure (FIM), Montreal cognitive assessment (MOCA), and Beck depression inventory-II (BDI-II). We administered the CO-OP intervention for six weeks. Sessions were performed twice a week for one hour per session.&#x0D; Results: The results indicate that the CO-OP intervention improves the client’s satisfaction, occupational performance, and functional independence. Although the results from this single case cannot be generalized, the findings suggest that CO-OP intervention may help improve satisfaction and occupational performance in adults with Parkinson’s disease. Further investigation is necessary.&#x0D; Conclusion: These results suggest that CO-OP can be a valuable occupational therapy interventions for individuals with Parkinson’s disease. We recommend that occupational therapists consider using this approach in their practice to improve the occupational performance of their patients with Parkinson’s disease.

KEJADIAN STUNTING DENGAN KEMAMPUAN KOGNITIF ANAK USIA SEKOLAH

compared to children their age. Stunting can cause children to experience brain development disorders. Studies have found that stuntesd children have lower cognitive abilities and poorer school performance. The impact of child stunting is often associated with lowerintelligence at school age. Cognitive can be defined as the ability to learn new skills and concepts, the ability to understand what is happening in the environment, and the skills to use memory and solve simple problems. The purpose of this study was to determine the relationship between the incidence of stunting and the cognitive abilities of school-age children in Percut Sei Tuan Village. This type of research is cross sectional. The population in this research sample of 107 school-age children was taken using random sampling so that the total sample was 51 school-age children. Data collection through measurement of height, weight and questionnaires. Analysis using chi-square. The results showed that the frequency of stunting was the majority experienced stuntingas much as 82.4% and the frequency of cognitive abilities of the majority experienced moderate cognitive impairment was 68.6% and there was a relationship between the incidence of stunting and the cognitive abilities of school-age children with p-value0.031. Based on the results of this study,it is suggested that the role of the mother plays a very important role in the nutrition and development of children.

Relationships between quantitative retinal microvascular characteristics and cognitive function based on automated artificial intelligence measurements.

Introduction: The purpose of this study is to assess the relationship between retinal vascular characteristics and cognitive function using artificial intelligence techniques to obtain fully automated quantitative measurements of retinal vascular morphological parameters. Methods: A deep learning-based semantic segmentation network ResNet101-UNet was used to construct a vascular segmentation model for fully automated quantitative measurement of retinal vascular parameters on fundus photographs. Retinal photographs centered on the optic disc of 3107 participants (aged 50-93years) from the Beijing Eye Study 2011, a population-based cross-sectional study, were analyzed. The main parameters included the retinal vascular branching angle, vascular fractal dimension, vascular diameter, vascular tortuosity, and vascular density. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Results: The results showed that the mean MMSE score was 26.34 ± 3.64 (median: 27; range: 2-30). Among the participants, 414 (13.3%) were classified as having cognitive impairment (MMSE score < 24), 296 (9.5%) were classified as mild cognitive impairment (MMSE: 19-23), 98 (3.2%) were classified as moderate cognitive impairment (MMSE: 10-18), and 20 (0.6%) were classified as severe cognitive impairment (MMSE < 10). Compared with the normal cognitive function group, the retinal venular average diameter was significantly larger (p = 0.013), and the retinal vascular fractal dimension and vascular density were significantly smaller (both p < 0.001) in the mild cognitive impairment group. The retinal arteriole-to-venular ratio (p = 0.003) and vascular fractal dimension (p = 0.033) were significantly decreased in the severe cognitive impairment group compared to the mild cognitive impairment group. In the multivariate analysis, better cognition (i.e., higher MMSE score) was significantly associated with higher retinal vascular fractal dimension (b = 0.134, p = 0.043) and higher retinal vascular density (b = 0.152, p = 0.023) after adjustment for age, best corrected visual acuity (BCVA) (logMAR) and education level. Discussion: In conclusion, our findings derived from an artificial intelligence-based fully automated retinal vascular parameter measurement method showed that several retinal vascular morphological parameters were correlated with cognitive impairment. The decrease in retinal vascular fractal dimension and decreased vascular density may serve as candidate biomarkers for early identification of cognitive impairment. The observed reduction in the retinal arteriole-to-venular ratio occurs in the late stages of cognitive impairment.