Modified Mini Mental State Examination Research Articles

Total Tau Protein Mediates the Association of Ischemic Cerebrovascular Disease with Cognitive Decline

Background: Patients with transient ischemic attack (TIA) or ischemic stroke demonstrate an increased risk of cognitive dysfunction. Accumulating evidence indicates that ischemic cerebrovascular disease (ICVD) may interact with the amyloid/tau/neurodegeneration (AT[N]) biomarkers to promote dementia. However, the precise pathological mechanisms remain to be fully characterized. Objective: To elucidate the interrelationships among ICVD, ATN biomarkers in cerebrospinal fluid (CSF), and cognition. Methods: A total of 2524 participants were recruited from the CABLE study. ICVD referred to TIA/ischemic stroke. Cognitive performance was assessed by China Modified Mini-Mental State Examination (CM-MMSE) and Montreal Cognitive Assessment-b (MoCA-b). Multivariate linear regression analyses were performed to evaluate the associations of ICVD with CSF ATN biomarkers and cognition. Causal mediation analyses were used to identify whether the association was mediated by ATN biomarkers. Results: ICVD was associated with higher total-tau (t-tau) (p = 2.828×10–2) and poorer cognition (CM-MMSE: p = 1.539×10–5, MoCA-b: p = 4.552×10–6). Additionally, no discernible correlation surfaced between ICVD and amyloid-β (Aβ) 42 (p = 6.910×10–1) or phosphorylated tau (p-tau) (p = 4.324×10–1). The influence of ICVD on cognitive function was partially mediated by CSF t-tau (CM-MMSE: proportion: 2.74%, MoCA-b: proportion: 2.51%). Subgroup analyses revealed the influences of t-tau were especially evident in male (CM-MMSE: proportion: 5.45%, MoCA-b: proportion: 5.38%) and mid-life group (CM-MMSE: proportion: 9.83%, MoCA-b: proportion: 5.31%). Conclusions: These results delineated t-tau as a potential mediator for the influence of ICVD on cognition. Targeting brain ischemia and alleviating neuronal injury induced by ischemia may be a promising approach for preventing cognitive decline.

Effect of cognitive stimulation therapy in combination with other intervention modalities on cognitive ability in elderly with cognitive impairment: a quasi-experimental study

BackgroundCognitive stimulation therapy (CST) has been proven to be beneficial in improving cognition and quality of life in people with mild cognitive impairment (MCI) and mild dementia (MD). This study investigates the benefit of more frequent exclusively CST intervention compared to less-frequent CST-exercise combination on cognitive ability among elderly people with cognitive impairment. MethodsA quasi-experimental controlled study involving 22 subjects aged = 60 years with cognitive impairment. They were divided into three groups: group A (6 months, weekly CST + exercise sessions, n=13), Group B (3 months, twice-weekly CST-only sessions, n=5), group C (3 months, no intervention, n=4) as control. The Modified Mini Mental State Examination Indonesian Version was used for evaluating the cognitive ability of the elderly subjects. Data were analyzed using one-way Anova and Kruskal-Wallis tests ResultsAll participants completed the study, the majority being female with mean age of 70.43 ± 6.97 years and differences in education level distribution across the three groups. The scores before and after the intervention showed a significant difference in the registration and construction domains (p<0.005). However, there was a greater improvement of the mean difference in cognitive scores in groups A and B compared to the control group, although the difference was not statistically significant (p >0.05). ConclusionA twice-weekly CST-only intervention and a once-a-week CST-exercise combination provide better cognitive improvement than no intervention (control). Therefore, elderly people with cognitive impairment should be encouraged to engage in physical activities, brain training, and group activities for promoting the brain’s ability.

9 Predictive Ability of the Performance Assessment of Self-Care Skills (PASS) in a Sample of Predominantly Low-Income, Community Dwelling, African American Older Adults

Objective:Mild decline in independent functioning is a core diagnostic criterion for Mild Cognitive Impairment. Performance-based assessments have been considered the gold standard to identify subtle deficits in functioning. Existing assessments were largely designed using demographically homogenous samples (white, highly educated, middle class) and often assume tasks are performed similarly across populations. The current study aimed to validate the utility of the Performance Assessment of Self-Care Skills (PASS) in determining cognitive status in a sample of predominantly African American, low-income older adults.Participants and Methods:Cognition and functional capacity were measured in n=245 older participants (aged 50+ years) who were recruited from a larger community study located in Pittsburgh, PA. Cognitive status was defined by a mean split on the Modified Mini Mental Status Examination (3MS) score (84/100). Participants above the cutoff were classified as unlikely cognitive impairment (UCI) and those below classified as potential cognitive impairment (PCI). Functional capacity was assessed using the number of cues provided on three PASS subtasks: shopping, medication management, and critical information retrieval (higher score = worse functioning). Self-reported cognitive and functional decline was assessed via the Everyday Cognition (ECog) questionnaire (higher score = greater decline). Generalized linear models compared performance scores between groups adjusting for literacy (WRAT3), age, and education. Receiver operating characteristic curve (ROC) analyses were run for select functional performance scores to assess their predictive ability in discriminating between PCI and UCI.Results:Compared to the UCI group (N = 179), the PCI group (N = 66) was older (68 vs. 65 years, p = 0.05), less educated (11 years vs. 12 years, p < 0.01), had lower WRAT3 z-scores (0.19 vs. -0.55, p < .01), and required more cues on the shopping (4.33 vs. 8.54, p < 0.01) and medication management PASS subtasks (2.74 vs. 6.56, p < .01). Both groups reported elevated levels of subjective cognitive complaints on the ECog (1.46 vs. 1.56, p = .09) and performed similarly on the critical information retrieval PASS subtask (0.25 vs 0.54, p = .06). When discerning between UCI and PCI groups, the PASS Shopping subtask had an optimal cut-off score of 4, sensitivity of 0.86, specificity of 0.47, positive predictive value (PPV) of 0.37, and area under the curve (AUC) of 0.71. PASS Medication Management had an optimal cut-off score of 3, sensitivity of 0.77, specificity of 0.56, PPV of 0.39, and AUC of 0.74.Conclusions:Subjective functional decline and performance on the critical information retrieval subtask were not associated with cognitive groups. PASS shopping and medication management had moderately high AUCs, suggesting they can reliably distinguish between groups. However, both tasks also exhibited low PPVs, low levels of specificity, and high levels of sensitivity, making them strong “rule-out” tests but poor “rule-in” tests in this sample. Because accurate assessment of functioning is useful for MCI and critical to dementia diagnosis, it is imperative we understand how these tasks function across different populations. Future work should 1) validate measures of functional ability across different populations and 2) develop population-appropriate assessments for use in clinical and research settings.

Associations of epigenetic age acceleration with cognitive function trajectories in the women’s health initiative memory study

AbstractBackgroundEpigenetic age acceleration (AgeAccel) indicates faster biological aging relative to chronological age and has been independently associated with several age‐related outcomes. However, the cross‐sectional and longitudinal associations of AgeAccel with global cognitive function is understudied.MethodWe therefore studied 734 women (mean±SD baseline age = 70.3±4 years; 7.9% Black, 3.5% Hispanic/Latina, 88.6% White) who were free of cognitive impairment at the baseline examination of the Women’s Health Initiative (WHI) Memory Study (WHIMS,≥65 years enrolled in the WHI Hormone Therapy clinical trials between 1993‐1998). We measured global cognitive function annually with the Modified Mini Mental State Examination (3MS) through 2007 and the modified Telephone Interview for Cognitive Status (TICS‐m) from 2008‐2021. We measured extrinsic AgeAccel [EEAA] intrinsic AgeAccel [IEAA], AgeAccelPheno, and AgeAccelGrim in blood collected at baseline. AgeAccel measures were derived from chronological age and white blood cell counts (EEAA and IEAA), phenotypic age (AgeAccelPheno), or mortality (AgeAccelGrim). We estimated cross‐sectional AgeAccel‐3MS score associations in linear regression models and longitudinal AgeAccel‐3MS and TICS‐m score associations in linear mixed effects (LME) models adjusting for age, educational attainment, race, ethnicity, marital status, alcohol use, smoking, body mass index, comorbidities, hormone trial group assignment and physical activity.ResultAgeAccel measures were not cross‐sectionally associated with 3MS scores or longitudinally associated with 3MS or TICS‐m scores over a mean (SD) follow‐up of 6.4 (2.0) and 17.2 (3.6) years, respectively. Cross‐sectional AgeAccel‐3MS associations (95% confidence intervals) per 1‐year increment in AgeAccel were ‐0.03 (‐0.08, 0.02) for EEAA, ‐0.01 (‐0.08, 0.05) for IEAA, ‐0.02 (‐0.07, 0.03) for AgeAccelPheno, and 0 (‐0.10, 0.10) for AgeAccelGrim. Corresponding annual 3MS changes per 1‐year increment in AgeAccel were 0 (‐0.01, 0.01) for EEAA, 0 (‐0.01, 0.01) for IEAA, 0 (‐0.01, 0.01) for AgeAccelPheno, and 0 (‐0.02, 0.02) for AgeAccelGrim. Annual TICS‐m changes per 1‐year increment in AgeAccel were 0.01 (‐0.01, 0.03) for EEAA, 0 (‐0.02, 0.02) for IEAA, ‐0.01 (‐0.02, 0.01) for AgeAccelPheno, and 0.01 (‐0.02, 0.04) for AgeAccelGrim.ConclusionBlood‐based AgeAccel measures were not significantly associated with global cognitive function among older women. Larger studies are needed to further examine AgeAccel‐global cognitive function associations.

Association of Hearing Status and Cognition With Fall Among the Oldest-Old Chinese: A Nationally Representative Cohort Study.

The oldest-old (aged ≥80 years) are the most rapidly growing population and age is related to hearing impairment (HI) and cognitive decline. We aimed to estimate the association between HI and fall, and the effect of different cognitive states on this association among the oldest-old Chinese population. A total of 6931 Chinese oldest-old were included in the 2018 cross-cohort from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The presence of HI was identified by using a dichotomized metric of self-reported hearing status. Cognitive function was evaluated by using the modified Mini-Mental State Examination (MMSE). Cognitive impairment was defined as the MMSE score below 24 points. Data on fall history were collected by questionnaires survey from the participants or their relatives. We studied the association of hearing status and cognitive function with fall by using multivariable logistic regressions, upon adjustment of sociodemographic characteristics, lifestyles, and health conditions. Our participants were aged 92 (range 80 to 117) on average, with 60.1% being women. In total, 39.1% of the participants had reported HI, 50.1% had cognitive impairment, and 26.2% had a history of falling. Participants with HI had a higher incidence of cognitive impairment (79.4%), as compared with their counterparts without HI (31.3%). Compared with those without HI, HI patients had a higher risk of falling after full adjustment for potential confounders (OR = 1.16 [95% confidence interval, CI, 1.01, 1.32], p = 0.031). In comparison with HI participants without cognitive impairment, HI patients with cognitive impairment had a higher fall risk (OR = 1.45 [95% CI = 1.23, 1.72], p < 0.001). Association of hearing status and cognition with fall was, for the first time, examined on the basis of a nationally-representative oldest-old Chinese population. Poor cognitive performance was common in individuals with HI, and those with HI and cognitive impairment further increased the risk of falling.

The Longitudinal Relationship Between Hearing Loss and Cognitive Decline

The Longitudinal Relationship Between Hearing Loss and Cognitive Decline

Cognitive Impairment in Children with BetaThalassaemia Major at a Tertiary Care Centre, Rajasthan, India: A Cross-sectional Study

Introduction: Thalassaemia is one of the most common genetic disorders. Iron overload due to repeated blood transfusions and chelating therapy leads to oxidative stress and possible irreversible brain tissue damage, causing cognitive impairment in these children. Aim: To study cognitive impairment in children with beta thalassaemia major in a tertiary care centre in Bikaner, Rajasthan, India. Materials and Methods: This was a hospital-based crosssectional observational study conducted in the Department of Paediatrics, Sardar Patel Medical College, Bikaner, Rajasthan, India from September 2019 to August 2020. Sixty-five children with thalassaemia and 65 children without thalassaemia (as controls) were recruited and assessed using modified MiniMental State Examination (MMSE) for cognitive impairment. Results: Majority of children belonged to age group 6-11 years (67.7% in cases and 68.8% in controls). The mean MMSE scores were significantly lower among children with thalassaemia (26.82±6.45) compared to the controls (29.08±5.71). There was a significantly higher prevalence of cognitive dysfunction in thalassaemia children (72.3%) as compared to controls (33.8%). Children who were compliant with chelation medications (n=30) were found to have a lesser prevalence of cognitive dysfunction (60%) than those who were not compliant (n=35) with medications (82.86%) (p-value=0.013). Among cases, the mean ferritin levels were higher in children with cognitive dysfunction (3399.00±1489.18) compared to those with normal cognitive function (2412.38±1117.26) (p-value=0.046). There was moderate positive correlation between thalassaemia child’s Body Mass Index (BMI) and modified MMSE score. Conclusion: This study highlights the higher prevalence of cognitive impairment in children with thalassaemia (72.3%). The key contributing factors were- lack of compliance to chelation therapy, higher serum ferritin levels and low BMI.

Cognitive recovery trajectories 3 months following stroke in Mexican American and non-Hispanic white adults

ObjectivesWe examined whether cognitive trajectories from 0-3 months after stroke differ between Mexican Americans (MAs) and non-Hispanic white (NHW) adults. Materials and MethodsThe sample included 701 participants with ischemic stroke (62% MA; 38% NHW) from the population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) Project, between 2008-2013. The outcome was the modified Mini Mental State Examination (3MSE, range 0-100 lower scores worse). Linear mixed effects models were utilized to examine the association between ethnicity and cognitive trajectories from 0-3 months following stroke, adjusting for confounders. ResultsMAs were younger, had lower educational attainment, and fewer had health insurance than NHWs (all p< 0.01). A smaller proportion of MAs were rated by informants as exhibiting pre-stroke cognitive decline than NHW (p < .0.05). After accounting for confounders, MAs demonstrated lower cognitive performance at post-stroke baseline and at 3-months following stroke (-2.00; 95% CI =-3.92, -0.07). Cognitive trajectories from 0-3 months following stroke were indicative of modest cognitive recovery (increase of 0.034/day, 95% CI =0.030-0.036) and did not differ between MAs and NHWs (p = 0.68). ConclusionWe found no evidence that cognitive trajectories in the first three months following stroke differed between MAs and NHWs. MAs demonstrated lower cognitive performance shortly after stroke and at three months following stroke compared to NHWs. Further research is needed to identify factors contributing to ethnic disparities in cognitive outcomes after stroke.

Educational and Clinical Associations With Longitudinal Cognitive Function and Brain Imaging in American Indians: The Strong Heart Study.

Little is known about incidence of vascular and Alzheimer dementias in American Indians. We conducted a large, heterogeneous, population-based, longitudinal cohort study of brain aging in community-dwelling American Indians aged 64-95 years from 11 tribes across 3 states, with neurologic examinations, 1.5T MRI, and extensive cognitive testing. Visit 1 in 2010-2013 (n = 817) and visit 2 in 2017-2019 (n = 403) included all willing, surviving participants. Standardized cognitive tests at both visits included Modified Mini-Mental Status Examination (MMSE), Wechsler Adult Intelligence Scale digit symbol coding (WAIS), Controlled Oral Word Association (COWA), and California Verbal Learning Test short form (CVLT). Test materials added at follow-up included Wide Range Achievement (reading) Test (WRAT) and National Alzheimer Coordinating Center Uniform Data Set cognitive battery (v3 form C2), including Montreal Cognitive Assessment (MoCA). MRI neuroradiologists coded infarcts, hemorrhages, white matter hyperintensities, sulcal atrophy, and ventricle enlargement. The mean time between examinations was 6.7 years (SD 1.1, range 3.8-9.1 years). Years of formal education had modest correlation with WRAT reading score (r = 0.45). Prevalence and incidence (respectively) of infarcts were 32% and 12.8/1,000 person-years (PYs) hemorrhages 6% and 4.4/1000 PY worsening sulci 74% and 19.0/1000 PY worsening ventricle 79% and 30.1/1000 PY worsening leukoaraiosis 44% and 26.1/1000 PY. Linear losses per year in cognitive scores were 0.6% MMSE, 1.2% WAIS, 0.6% COWA, and 2.2% CVLT. The mean MoCA scores were 18.9 (SD 4.3). These are the first data on longitudinal cognitive and imaging changes in American Indians and first reports of Alzheimer disease-related features. The mean scores in MoCA were similar or lower than standard cutoffs used to diagnose dementia in other racial/ethnic groups, suggesting that standardized cognitive tests may not perform well in this population. Test validation, adaptation, and score adjustment are warranted. Years of education were a poor proxy for premorbid function, suggesting novel methods for cognitive score contextualization is also needed in this population. Evaluation of selective survival suggests attrition from death, and frailty should be accounted for in causal analyses. Overall, these data represent a unique opportunity to examine neurology topics of critical importance to an understudied population.

Relationship between physical performance and mild cognitive impairment in elderly hemodialysis patients is modified by the presence of diabetes: A multicenter cross-sectional study.

ObjectiveThe purpose of this study was to observe the relationship between physical performance and mild cognitive impairment (MCI) in the presence or absence of type 2 diabetes in elderly hemodialysis patients.MethodsIn this multicenter cross-sectional study, 396 clinically stable and aged ≥60 years hemodialysis patients (255 men; mean age: 68.3 ± 5.9 years) were included from seven dialysis units in Shanghai, China. The Chinese version of the Modified Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were utilized to assess MCI. The performance-based assessments consisted of three physical tests, grip strength (GS), Timed Up and Go Test (TUGT), and 4-m walking test, which respectively represent muscle strength, mobility, and walking speed (WS). Logistic regression and multivariate linear regression were used for analysis.ResultsHemodialysis patients with diabetes had a high prevalence of MCI (20.6%). The odds ratio (OR) of MCI for the interacted items [(TUGT) * (diabetes) and (WS) * (diabetes)] was significant (p < 0.05). In diabetes patients, TUGT was positively associated with MCI, and WS was negatively associated with MCI after adjusting covariates [OR = 0.129; 95% confidence interval (CI) = 0.028–0.704, p = 0.021]. However, no significant association was found between physical performance and MCI in the non-diabetes hemodialysis patients (p > 0.05). Further analysis showed that TUGT was negatively associated with attention and calculation and language. WS was positively associated with recall and language in diabetic hemodialysis patients.ConclusionsPhysical performance was associated with MCI in diabetic hemodialysis patients rather than the non-diabetes group. Whether increasing mobility or WS can positively influence MCI in individuals with type 2 diabetes requires further study.

Prospective association between sleep duration and cognitive impairment: Findings from the China Health and Retirement Longitudinal Study (CHARLS).

ObjectiveThe association between sleep duration and cognition are inconclusive. Our study aimed to comprehensively investigate the effects of sleep duration on the risk of cognitive impairment in the middle-aged and older Chinese population.MethodsWe used the longitudinal cohort data from waves 1–4 (2011–2018) of the China Health and Retirement Longitudinal Study (CHARLS). Self-reported exposures included total sleep duration, nocturnal sleep duration, post-lunch napping, and changes in sleep duration over time according to face-to-face interviews. Cognitive function was assessed by a Chinese version of the Modified Mini-Mental State Examination (MMSE).ResultsA total of 7,342 eligible participants were included. The mean age was 61.5 ± 6.5 years, and 48.9% (3,588/7,342) were male. We identified a U-shaped association of total sleep duration as well as nocturnal sleep duration with the risk of cognitive impairment. People with 7–8 h of total sleep duration and 6–7 h of nocturnal sleep had the lowest risk of cognitive impairment. Further results showed that post-lunch napping within 2 h was beneficial to cognition and 60 min was optimal. Moreover, analyses of changes in sleep duration further supported that sleeping less or more was harmful to cognition. Notably, those “excessive-change” sleepers (from ≤6 to ≥9 h, or from ≥9 to ≤6 h) had more risks.ConclusionsKeeping 7–8 h per day was related to the lowest risk of cognitive impairment in midlife and late life, and an optimal post-lunch napping was 60 min for these stable sleepers. Especially, excessive changes in sleep duration over time led to poorer cognition. Our work highlights the importance of optimal sleep habits to cognitive function. The self-reported sleep measures limited our findings, and further studies are needed for verification.

Association of Playing Cards or Mahjong with Cognitive Function in Chinese Older Adults.

Cognitive decline in older adults is a major public health threat. This study aimed to explore the association of participation in cards or mahjong with cognitive function in older adults. A total of 7308 older adults were selected from the 2018 Chinese Longitudinal Healthy Longevity Survey. A modified Mini-Mental State Examination (MMSE) was used to assess cognitive function. The participants were classified according to the frequency of playing cards or mahjong into the “regularly” (R) group, “occasionally” (O) group, or “never” (N) group. The results showed that older persons in the R group and O group had better cognitive function than those in the N group. Specifically, significant differences were found in attention and calculation, language, and total MMSE score between the R group and the N group. However, significant differences were not observed for adults aged 60–69 years old. Regression analysis indicated that playing cards or mahjong, together with age, educational level, sex, marital status, and occupation before age 60 could explain the cognitive function. The findings suggest that there is an association between participation in cards or mahjong and cognitive function in the population of Chinese older adults, and that the frequency of participation plays an important role in the association.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults.

This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

Hearing Impairment With Cognitive Decline Increases All-Cause Mortality Risk in Chinese Adults Aged 65 Years or Older: A Population-Based Longitudinal Study.

BackgroundHearing impairment (HI), a highly prevalent sensory impairment affecting older adults, is a risk factor for cognitive decline. However, few studies examined the association between HI and all-cause mortality, and the role of different cognitive states on this relationship in Chinese older adults is poorly understood.MethodsA total of 10,744 Chinese older adults aged 65 years or older were included in the 2011/2012 and 2014 cohorts from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with the longest follow-up period lasting for up to 8 years. The presence of HI was identified by using a dichotomized metric of self-reported hearing status. All-cause mortality data were ascertained from interviews with family members or relatives of the participants. Cognitive function was evaluated by employing the modified Mini-Mental State Examination (MMSE), which consisted of seven subdomains (orientation, naming foods, registration, attention and calculation, copy figure, delayed recall, and speech and language). Kaplan–Meier survival curves were constructed to evaluate the different hearing states on overall survival. The risk of mortality over the follow-up period was estimated by using Cox proportional hazard ratios (HRs) models.ResultsA conspicuous probability was revealed in the survival relationship between hearing status and all-cause mortality for the total population (p < 0.001). Participants with HI had a higher risk of all-cause mortality (HR = 2.29, 95% CI: 2.16, 2.42), as compared with their counterparts without HI. The association was robust upon fully adjustment for potential confounders (HR = 1.07, 95% CI: 1.00, 1.14). Compared to HI participants with no cognitive impairment, HI patients with cognitive impairment had a higher mortality risk (HR = 2.31, 95% CI: 2.13, 2.51). Impairment in the subdomains of cognitive function were independently associated with elevated mortality risk in the participants with HI, with an HR ranging from 1.28 (copy figure) to 1.46 (speech and language).ConclusionsCognitive decline was common in individuals with HI, and those with HI and cognitive impairment further increased mortality risk. Our findings prompt a call for actions to improve the hearing status and cognitive function of older people to minimize health risks and improve longevity.

Comparative assessment of cognitive impairment and oxidative stress markers among vitamin D insufficient elderly patients with and without type 2 diabetes mellitus (T2DM).

BackgroundDisorders of mental health are known to affect cognitive functions, hence called as cognitive disorders. Impaired glucose metabolism, insulin resistance, vitamin-D deficiency and oxidative stress are some of the key early events reported to be involved in the pathogenesis of most common cognitive disorders, which include Alzheimer’s disease. Type-2 diabetes mellitus (T2DM) is one of the known contributing factors of cognitive impairment and dementia.MethodsA cross sectional study was carried out in 145 subjects, who were assessed for cognitive function by modified mini mental status examination (3MS). In addition, measurement of fasting blood sugar (FBS), fasting insulin, HbA1c, lipid profile, vitamin D and oxidative markers was performed. Participants were divided into different groups based on (a) vitamin D insufficiency and sufficiency; (b) diabetic and non-diabetic with and without cognitive impairment.ResultsThe study included a total of 145 subjects; 51 males and 94 females and the mean age was 68.24±9.70 years. Among diabetics with vitamin D insufficiency, 35 subjects (71.43%) had cognitive impairment, but, among non-diabetics with vitamin D insufficiency, 27 subjects (62.79%) had cognitive impairment. Chi square test showed no significant association between diabetes, vitamin D insufficiency and cognitive impairment. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) levels were non-significantly lower in cognition-impaired subjects, when compared to cognition normal subjects in diabetics with vitamin D insufficiency.ConclusionOur study showed that cognitive impairment is more predominant in individuals with diabetes. However, our study did not find any significant relationship between T2DM, vitamin D deficiency, cognitive impairment, and oxidative stress. A significant association was found only with GPx and 3MSE score in vitamin D insufficient non-diabetics.

Gradient and Acceleration of Decline in Physical and Cognitive Functions in Older Adults: A Disparity Analysis.

Substantive previous work has shown that both gait speed and global cognition decline as people age. Rates of their decline, as opposed to cross-sectional measurements, could be more informative of future functional status and other clinical outcomes because they more accurately represent deteriorating systems. Additionally, understanding the sex and racial disparity in the speed of deterioration, if any, is also important as ethnic minorities are at an increased risk of mobility disability and dementia. Data from 2 large longitudinal intervention studies were integrated. Rates of decline were derived from individual-level measures of gait speed of 400-m walk and scores on the Modified Mini Mental State Examination (3MSE). We also assessed age-associated declines and accelerations in changes across the ages represented in the studies (age range 53-90). The mean rate of decline in 400-m gait speed across individuals was 0.03 m/s per year, and multivariable analysis showed a significant acceleration in decline of -0.0013 m/s/y2 (p < .001). Both race and sex moderated the rate of decline. For global cognition, the mean rate of decline was 0.05 of a point per year on the 3MSE scale, and acceleration in the rate of decline was significant (-0.017 point/y2, p < .001), but neither sex nor race moderated the decline. Rate of decline in physical but not cognitive function appears moderated by sex and race. This finding, as well as rates and accelerations of decline estimated herein, could inform future intervention studies. NCT00017953 (Look AHEAD); NCT01410097 (Look AHEAD ancillary); NCT00116194 (LIFE).

The Longitudinal Association of Subclinical Hearing Loss With Cognition in the Health, Aging and Body Composition Study.

ObjectivesTo examine the longitudinal association between subclinical hearing loss (SCHL) and neurocognitive performance.DesignLongitudinal analyses were conducted among 2,110 subjects who underwent audiometric testing in a US multi-centered epidemiologic cohort study. The primary exposure was better ear hearing (pure tone average). SCHL was defined as hearing ≤ 25 dB. The primary outcome was neurocognitive performance, measured by Digit Symbol Substitution Test (DSST), Modified Mini Mental State Examination (3MS), and CLOX1. Linear mixed models were performed to assess the longitudinal association between hearing and cognitive performance, adjusting for covariates. Models were fit among all individuals and among individuals with SCHL only.ResultsAmong 2,110 participants, mean (SD) age was 73.5 (2.9) years; 52.3% were women. Mean (SD) better ear pure tone average was 30.0 (13.1) dB. Mean follow-up was 9.1 years (range 3–16). Among all participants, worse hearing was associated with significantly steeper cognitive decline measured by the DSST [0.054-point/year steeper decrease per 10 dB worse hearing, 95% confidence interval (CI): 0.026–0.082] and 3MS (0.044-point/year steeper decrease per 10 dB worse hearing, CI: 0.026–0.062), but not CLOX1. Among those with SCHL, worse hearing was associated with significantly steeper cognitive performance decline as measured by DSST (0.121-point/year steeper decrease per 10 dB worse hearing, CI: 0.013–0.228), but not CLOX1 or 3MS.ConclusionAmong those with SCHL, worse hearing was associated with steeper cognitive performance declines over time as measured by DSST. The relationship between hearing loss and cognition may begin at earlier levels of hearing loss than previously recognized.

Adolescents with Internet Gaming Disorder are more likely to have Lower Score of Cognitive Function: A Cross-sectional Study among Junior High School Students in Yogyakarta, Indonesia

BACKGROUND: Internet Gaming Disorder (IGD) has emerged as a rapidly rising public health problem mostly affecting children and adolescent worldwide, as a result of massive growth of technology and internet usage in recent years. Adolescents are the most vulnerable age group to problematic internet gaming use due to lack of cognitive control. AIM: This study aims to investigate the association between IGD and cognitive function among junior high school- students in Indonesia. METHODS: The subjects of this cross-sectional study were students at two randomly selected junior high schools in Yogyakarta, Indonesia. The Game Addiction Scale-7 Indonesian version and the Modified Mini Mental State Examination for Children-Indonesian version were used to assess IGD and cognitive function, respectively. Multivariate analysis with linear regression was used to determine the relationship between IGD and cognitive function. RESULTS: There were 142 subjects with a mean age of 14 years. Students with IGD significantly had lower score of cognitive function, particularly for domains of attention (p = 0.000), recall memory (p = 0.000), and language (p = 0.002), compared with the counterpart group. Furthermore, multivariate analysis showed that students with IGD were more likely to have lower cognitive function score by 1.40 points than those without IGD (B = –1.40, 95% CI -2.51–-0.29, R2 = 0.469). CONCLUSIONS: IGD was negatively associated with cognitive function. Junior high school students with IGD in Indonesia had lower score of cognitive function compared with students without IGD, particularly in the domains of attention, recall memory, and language. Clinicians, teachers, and parents should be more aware of the detrimental effect of IGD. Further study with larger sample size, diverse subjects, and wider age range is still needed.

The efficacy of modified mini-mental state examination in patients with severe to profound hearing loss

Objective:To evaluate the efficacy of modified mini-mental state examination（MMSE） in elderly patients with severe to profound hearing loss. Methods:A total of 24 elderly patients with severe to profound hearing loss from April to June 2019 were involved. Severe to profound hearing loss was defined by a pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear. Modified and original MMSE was completed for the patients at first visit. Two weeks later, they all return hospital and MMSE were carried out by the other method. The aggregate score and subitem score of MMSE by modified and original instrument were analyzed. The degree of cognitive impairment evaluated by two methods were compared. Results:Among the 24 patients, the mean MMSE score by routine method and improved method were 10.88±9.70 and 25.29±3.70（P<0.01）. The average score of sub-items of MMSE with routine method and improved method are as follows: orientation 3.21±4.03 vs 8.71±1.92（P<0.01）, registration 1.04±1.33 vs 2.79±0.51（P<0.01）, attention and calculation 1.63±2.02 vs 4.00±1.41（P<0.01）, recall 0.79±1.14 vs 2.50±0.72（P<0.01）, language 4.21±2.11 vs 7.29±1.33（P<0.01）. Compared with the routine method, the degree of cognitive impairment getting better in 83.3% patients with improved method, meanwhile, 16.7% of the patients remain the same and no deterioration. Conclusion:The routine method of MMSE should be improved to seek the real cognitive state of the patients with severe to profound hearing loss.

Application of diffusion tensor imaging in Alzheimer\u2019s disease: quantification of white matter microstructural changes

BackgroundAlzheimer’s disease (AD) is the most common cause of dementia in the aging population, responsible for 60–70% of all demented cases. Diffusion tensor imaging (DTI) is a very recent technique that allows the mapping of white matter (WM) microstructure changes in neurological disorders. The current study was conducted to compare DTI parameters between AD patients and healthy elderly subjects and to determine whether DTI can act as a potential biomarker for AD.ResultsThere were significant differences in Modified Mini-Mental State Examination (MMMSE) and Clinical Dementia Rating (CDR) between the two groups. As regards the DTI parameters, significant differences were found between AD patients versus healthy subjects, in the mean diffusivity (MD) of the splenium [(1.05 ± 0.19) vs. (0.92 ± 0.22) , P=0.03], the MD of the right uncinate fasciculus [(0.92 ± 0.04) vs. (0.87 ± 0.05), P= 0.01], and MD of the right arcuate fasciculus (AF) [(0.83 ± 0.04) vs. (0.79 ± 0.04) P =0.01], as well as the MD of the right and left inferior fronto-occipital fasiculus (IFOF) [(0.89 ± 0.06) vs. (0.83 ± 0.04), P=0.01]. In addition, there were significant differences in the fractional anisotropy (FA) of the right and left cingulum between both groups [(0.45 ± 0.02) vs. (0.47 ± 0.03), P=0.01 and (0.45 ± 0.03) vs. 0.49± 0.04), P=0.01, respectively]. The overall accuracy of the aforementioned parameters ranged between 73 and 81% with the MD of the left cingulum revealing the highest accuracy.ConclusionDTI proofed to be a useful tool in differentiating AD patients from healthy subjects. In our study, we found that the splenium, cingulum, IFOF, and the right UF and right AF are the main tracts involved in AD. The left cingulum provided the highest accuracy in differentiating AD from normal subjects.