Prevalence Of Cognitive Decline Research Articles

Cognitive decline and diabetes in the clinical setting

Objective. The aim of our study was to evaluate the prevalence of cognitive decline in patients with diabetes in the clinical setting and to identify patient characteristics directly associated with this condition. patients with diabetes in the clinical setting and to identify patient characteristics directly associated with this condition.
 Methods. In our cross-sectional study, we applied the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to determine cognitive function in 172 diabetic patients, in the clinical setting. We included 120 patients with type 2 diabetes (T2DM), 42 cases with type 1 diabetes (T1DM) and 10 patients with confirmed secondary diabetes (SDM). The mean age of the participants was 62.4 years (±1.01, min: 26 years, Max: 87 years), with median diabetes duration of 15±11.8 years.
 Results. More than half (55.23%) of the subjects presented cognitive deterioration, which was diabetes type-specific (p<0.05). Mild forms affected mostly T1DM and SDM cases (31.5% and 30% vs. T2DM: 14.5%, p=0.00), whereas moderate cognitive decline was more predominant in T2DM (21.9% vs. T1DM: 7.1%, p=0.1). A higher prevalence of severe cognitive impairment was present in T1DM (14.5% vs. T2DM: 8.7%, p=0.1).
 The middle-aged category (40-64 years) was characterized by a more significant reduction of cognitive function in comparison with other age groups (p=0.02).
 No gender-related difference in the prevalence of cognitive decline was found (female: 45.83% vs male: 45.71%, p=0.98), although severe forms were significantly more suggestive for men (15.27% vs. 4.18%, p=0.04).
 Diabetic ketoacidosis (DKA) at admission was more frequently associated with cognitive deterioration, in comparison with hypoglycemic events (p=0.03).
 In T2DM, cognitive decline (p=0.006, r=-0.342) was associated with the presence of anemia.
 In T2DM women, treatment with calcium-channel blockers facilitated cognitive decrement (p=0.01, r=-0.339), whereas in men, therapy for distal symmetric polyneuropathy resulted in higher MMSE/ MoCA test scores (p=0.00, r=0.72).
 In T1DM, a higher glycemic burden evidenced by increased HbA1c (p=0.03, r=- 0.364) and glycemia at admission (p=0.01, r=-0.389) was suggestive to a more severe form of cognitive impairment. Distal symmetrical polyneuropathy (p=0.05, r=-0.305) and diabetic retinopathy (p=0.03, r=-0.102) was often co-occurring with cognitive decline.
 Cognitive deterioration was associated with insulin therapy (p=0.05, r=-0.232).
 Conclusion. The prevalence of cognitive decline is high in the diabetic population. Risk stratification must start at diagnosis and physicians should follow disease progression periodically, with special attention attributed to T1DM and the middle-aged population.

Exploring the chain mediating roles of frailty and depressive symptoms in the relationship between pain and cognitive function among nursing home older adults.

The prevalence of cognitive decline is high among nursing home older adults. Pain is a vital factor in cognitive function. Furthermore, the current literature lacks the complex association between pain, frailty, depressive symptoms, and cognitive function. The aim of this study was to explore the chain mediating roles of frailty and depressive symptoms in the association between pain and cognitive function among nursing home older adults. This is a population-based cross-sectional study, conducted in China, of 210 nursing home older adults aged 64-98 years old, who completed the measurements of sociodemographic information, pain, frailty, depressive symptoms, and cognitive function. Mediation analyses tested the indirect effect of frailty and depressive symptoms in the relationship between pain and cognitive function by PROCESS macro. Pain, frailty, as well as depressive symptoms, were negatively related to cognitive function. Frailty mediated the association between pain and cognitive function. Importantly, mediation analyses showed that frailty and depressive symptoms acted as sequential mediators of pain and cognitive function. These findings have crucial clinical implications, as they suggest targeting physiological and psychological factors in older adults with chronic pain to alleviate cognitive decline.

Prognosis of impulse control disorders in Parkinson's disease: a prospective controlled study.

The long-term prognosis of impulsive compulsive disorders (ICD) remains poorly studied in Parkinson's disease (PD). Evaluating the natural history of ICD and its impact on PD symptoms including cognition and treatment adjustments. We assessed PD patients at baseline (BL) with (BL-ICD+) or without (BL-ICD-) ICD despite dopamine agonist (DA) exposure of > 300mg levodopa-equivalent daily dose for > 12months at baseline and after more than two years of follow-up. ICD were assessed using the Ardouin's Scale of Behaviors in PD (ASBPD), cognition using the Mattis scale, and PD symptoms using the UPDRS score. Treatment adjustments, DA withdrawal-associated symptoms, and ICDs social consequences were recorded. 149 patients were included (78 cases and 71 controls), mean duration of follow-up was 4.4 ± 1years. At baseline, psychiatric disorders were more common among BL-ICD + (42.3 vs 12.3% among BL-ICD-, p < 0.01). At follow-up, 53.8% of BL-ICD + were not ICD-free while 21.1% of BL-ICD- had developed ICD. BL-ICD + more frequently experienced akinesia (21.8 vs 8.5%, p = 0.043) and rigidity worsening (11.5 vs 1.4%, p = 0.019) following therapeutic modifications. Decision to decrease > 50% DA doses (12.8 vs 1.4%, p = 0.019) or to withdraw DA (19.2 vs 5.6%, p = 0.025) was more frequently considered among BL-ICD+ . At follow-up, the prevalence of cognitive decline was lower among BL-ICD + (19.2 vs 37.1%, p = 0.025). ICDs were associated with increased psychiatric burden at baseline and better cognitive prognosis. Most patients were still showing ICDs at the follow-up visit, suggesting ICD to be considered as a chronic, neuropsychiatric disorder.

Insulin resistance is associated with cognitive dysfunction in multiple sclerosis patients: A cross-sectional study.

Multiple sclerosis (MS) is a progressive inflammatory neurodegenerative disease of the nervous system accompanied by demyelination. MS-associated cognitive impairments mainly involve recent memory, information processing speed, stable memory, and executive function. Moreover, MS is associated with impaired glucose and insulin metabolism, which can exacerbate cognitive decline. The present study aimed to compare the cognitive status of MS patients with and without insulin resistance. In this cross-sectional study, 74 relapsing-remitting multiple sclerosis diagnosed patients were enrolled. Indicators of insulin resistance, including fasting blood glucose, insulin level, and homeostatic model assessment of insulin resistance (HOMA-IR) index, were measured. They were then divided into two groups based on the results of the HOMA-IR index. Cognition status was evaluated by the minimal assessment of cognitive function in multiple sclerosis battery. The prevalence of insulin resistance was 37.8%, and the prevalence of cognitive decline was estimated to be 67.56%. Mean scores of the California verbal learning test (CVLT), CVLT delayed free recall, controlled oral word association test, and judgment of line orientation tests were significantly lower in MS patients with insulin resistance than without. In addition, a negative correlation was demonstrated between the results of the CVLT, CVLT delayed free recall, controlled oral word association test, judgment of line orientation tests, brief visuospatial memory test, and Delis-Kaplan executive function system sorting tests and fasting insulin levels. Greater verbal memory and spatial comprehension impairments were observed in MS patients with insulin resistance.

Yoga, aerobic and stretching exercise effects on neurocognition: Randomized controlled trial protocol

As the global population ages, the prevalence of cognitive decline and dementia is expected to rise, creating a significant health and economic burden. The purpose of this trial is to rigorously test, for the first time, the efficacy of yoga training as a physical activity intervention to mitigate age-related cognitive decline and impairment. We are conducting a 6-month randomized controlled trial (RCT) of exercise among 168 middle aged and older adults to compare the efficacy of yoga vs. aerobic exercise on cognitive function, brain structure and function, cardiorespiratory fitness, and circulating inflammatory and molecular markers. Using a single-blind, three arm RCT, 168 older adults ages 55-79 will be assigned to either: a Hatha yoga group, an aerobic exercise group or a stretching-toning active control group. Participants will engage in hour long group exercise 3x/week for 6-months. A comprehensive neurocognitive test battery, brain imaging, cardiovascular fitness test, and a blood draw will take place at baseline; end of the 6-month intervention, and at 12-month follow-up. Our primary outcomes of interest are brain regions, such as hippocampal volume and prefrontal cortex, and cognitive functions, such as episodic memory, working memory and executive functions, that are typically affected by aging and Alzheimer's disease. Not only will this RCT test whether yoga is a means to mitigate age-related cognitive decline, but it may also offer an alternative to aerobic exercise, which could be particularly appealing to older adults with compromised physical functioning.ClinicalTrials.gov Identifier: NCT04323163

Early Diagnosis of Atrial Fibrillation and Stroke Incidence in Primary Care: Translating Measurements into Actions-A Retrospective Cohort Study.

(1) Background: AF-related strokes will triple by 2060, are associated with an increased risk of cognitive decline, and alone or in combination, will be one of the main health and economic burdens on the European population. The main goal of this paper is to describe the incidence of new AF associated with stroke, cognitive decline and mortality among people at high risk for AF. (2) Methods: Multicenter, observational, retrospective, community-based studies were conducted from 1 January 2015 to 31 December 2021. The setting was primary care centers. A total of 40,297 people aged ≥65 years without previous AF or stroke were stratified by AFrisk at 5 years. The main measurements were the overall incidence density/1000 person-years (CI95%) of AF and stroke, prevalence of cognitive decline, and Kaplan-Meier curve. (3) Results: In total, 46.4% women, 77.65 ± 8.46 years old on average showed anAF incidence of 9.9/103/year (CI95% 9.5-10.3), associated with a four-fold higher risk of stroke (CI95% 3.4-4.7), cognitive impairment(OR 1.34 (CI95% 1.1-1.5)), and all-cause mortality (OR 1.14 (CI95% 1.0-1.2)), but there was no significant difference in ischemic heart disease, chronic kidney disease, or peripheral arteriopathy. Unknown AF was diagnosed in 9.4% and of these patients, 21.1% were diagnosed with new stroke. (4) Conclusions: The patients at high AF risk (Q4th) already had an increased cardiovascular risk before they were diagnosed with AF.

Cognitive impairment in COVID‐19 Survivors: Analysis and Extensions on Population Studies in Greece

AbstractBackgroundThe aim of our study was to investigate the prevalence and associations of cognitive impairment in COVID‐19 survivors in the post‐acute setting.MethodOur study is conducted in three post‐COVID‐19 outpatient clinics in tertiary hospitals in Greece. Eligible subjects included previously hospitalized COVID‐19 survivors with mild to moderate disease, returning for follow‐up at least two months post‐discharge. Exclusion criteria included intensive care unit admission, intubation, a history of neurodegenerative disease and other significant comorbidities. Study measurements included demographics, clinical evaluation, medical, family history, anthropometrics, 6‐minute walk test (6MWT), 30 seconds sit‐to‐stand (30STS), handgrip strength, spirometry, Pittsburgh Sleep Quality Index (PSQI), the Montreal Cognitive Assessment (MoCA), reactive oxygen metabolites (dROMs) and plasma antioxidant capacity (PAT). Cognitive impairment was considered on MoCA ≤24.Result142 COVID‐19 survivors were included in the study (110 Male, 32 Female; Mean age of 56.16±10.92). A total of 47.2% presented with cognitive decline (CD) as indicated by a MoCA score ≤24. Cognitive decline prevalence by SARS‐CoV‐2 variant of concern (VOC) was 39.5%, 50% and 62.5% for Alpha, Beta and Delta, correspondingly. A binary logistic regression model controlling for age, gender and VOC indicated that the diffusing capacity for carbon monoxide (DLCO) was independently associated with MoCA ≤24 (p = 0.014, OR = 0.669, 95%CI: 0.484‐0.923). Compared to severe untreated OSAS (n = 28), distinct domains but similar prevalence of cognitive impairment was noted.ConclusionDiffusion capacity abnormalities for carbon monoxide in COVID‐19 survivors as noted in other studies, may be implicated in the development of cognitive impairment.

Short Sleep Duration on the Night Before Surgery Is Associated With Postoperative Cognitive Decline in Elderly Patients: A Prospective Cohort Study.

As the world is rapidly aging, and the number of elderly patients who undergo surgery is rising, postoperative cognitive decline among those patients has become an increasing healthcare problem. Although understanding the risk factors and mechanisms underlying the pathogenesis of postoperative cognitive decline is critically important from a preventative viewpoint, such knowledge and evidence are lacking. A growing body of evidence suggest an association between cognitive function and sleep duration. The purpose of this study was to investigate the association between postoperative cognitive function and sleep duration on the night before surgery using a wearable sleep tracker. In this 6-month prospective cohort study, we analyzed data from 194 patients aged ≥ 65 years who underwent elective non-cardiac and non-cranial surgery under general anesthesia. According to the sleep duration on the night before surgery, patients were categorized into following four groups: <5, 5–7, 7–9, and >9 h. Perioperative cognitive function and domains were assessed using a neuropsychological test battery, and the incidence and prevalence of cognitive decline over 6 months after surgery were analyzed using the multiple logistic regression analysis. During the 6-month follow-up period, 41 patients (21%) developed cognitive decline. The incidence of cognitive decline was significantly elevated for the patients with sleep duration < 5 h (vs. 7–9 h; surgical duration-adjusted odds ratio, 3.50; 95% confidence interval, 1.20–10.2; P < 0.05). The association between sleep duration and prevalence of cognitive decline was limited to the early postoperative period (at 1 week and 1 month). Among the cognitive domains assessed, attentional function was significantly impaired in patients with a sleep duration < 5 h [vs. 7–9 h at 1 week; 4/37 (10.8%) vs. 0/73 (0%); P < 0.05]. In conclusion, sleep duration < 5 h on the night before surgery was significantly associated with worse attentional function after surgery and higher incidence of cognitive decline. The present results indicate that sleep deprivation on the night before surgery may have a temporary but significantly negative influence on the patient's postoperative cognitive function and is a potential target for preventing cognitive decline.

Transforming Aging: Increased Access to Care Minimizes Rural and Urban Differences in Cognitive Change

Rural-urban disparities in cognitive health outcomes, such as greater prevalence of cognitive decline among rural-dwelling older adults, have been linked to inequity in access to care. However, few studies have demonstrated whether longitudinal increased access to care may mitigate such disparities. This paper presents data from ongoing systematically collected behavioral health data on new and returning patients at an interdisciplinary geriatrics clinic at the University of Alabama Medical Center. The aim of this study was to determine baseline predictors of cognitive change across three annual visits (n = 42, mean age of 75.63 years (SD = 9.15)). Adjusting for baseline cognitive status, baseline subjective health literacy, and baseline depression and anxiety, results from a univariate ANCOVA showed that age at first visit (B = -.024, 95% CI [-.041, -.008], t(35) = -2.990, p = .005) and rural-urban status (B = .555, 95% CI [.123, .988], t(35) = 2.608, p = .013) predicted cognitive change at timepoint three (T3). Specifically, individuals from rural areas were less likely to experience cognitive decline and scored .555 points better than individuals from urban areas on cognitive screeners at T3 compared with baseline cognitive status. These results suggest that increased access to and utilization of care may ameliorate traditional disparate rates of cognitive decline between rural- and urban-dwelling older adults. Moreover, behavioral health screenings in primary geriatrics clinic care may help identify patient cognitive needs and facilitate integrated care through combined medical, pharmacological, and behavioral interventions to promote positive cognitive health outcomes.

Regression based machine learning model for dementia diagnosis in a community setting

AbstractBackgroundAs the world’s population ages, the prevalence of cognitive decline, dementia and Alzheimer’s disease is on the increasing trend. From a public health perspective and the absence of a cure, the early identification of individuals at risk of dementia becomes of paramount importance for proper early prevention. We developed a ML application for dementia diagnosis that is based on the 10/66 one stage dementia diagnostic algorithm.MethodTraining and testing data belonged to three community based surveys conducted in Lebanon as part of a larger dementia cohort study. Our training sample was 802, our testing sample 200, with the dataset showing imbalance (20% positive, 80% negative). In our supervised approach, we explore techniques for imbalanced learning beginning with artificially oversampling the minority class and undersampling the majority class, in order to decrease the bias of any model to be trained on the dataset. Additionally, we incorporate cost‐sensitive techniques to over‐penalise the models when misclassifying an instance in the minority class. We explore both models that produce a probability that a person has dementia, as well as models that produce a crisp class label (dementia or not).ResultThe best model hyperparameters including the cost to be incorporated and the percentage of oversampling/undersampling are tuned via three times repeated, 10‐fold stratified cross validation. The balanced random forest was considered as our most robust probabilistic model ‐ using only 20 features/variables‐ with a F2 score=0.82 and G‐Mean= 0.88 and ROC AUC=0.88. The Calibrated Weighted SVM for the same number of features was our best classification model with F2‐score=0.74 and a ROC AUC=0.80ConclusionCompared to the regular 10/66 one stage dementia diagnostic algorithm, our proposed models show very promising results and high level of accuracy by using only a 20 variables predictive model. With additional data, such models can gain in accuracy, precision and efficiency. Machine learning based models would serve as a valuable community dementia screening and diagnostic tools.

Ideational Fluency in Patients with Rheumatoid Arthritis.

Neuropsychiatric symptoms have been well documented in several systemic inflammatory conditions, for example, systemic lupus erythematosus (SLE). Increased prevalence of cognitive decline and psychiatric issues has been reported in patients with rheumatoid arthritis (RA). However, there is limited evidence of which exact cognitive domains are affected and to what degree. To test the performance of cognition in the domain of ideational fluency (Thing Categories Test in particular) in patients with RA and compare the results with the general population and to the results with cognitive and depression screening scores in both groups. Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) assessment, Montreal Cognitive Assessment (MoCA), and Thing Categories Test (TCT) were used to evaluate patients with RA, as well as the control group. Twenty patients with RA and 20 controls were tested, with 7 and 4 men, and 13 and 16 women in the study and control group, respectively. Average scores in TCT at three minutes were 7.50 (IQR6.0-10.0) and 6.0 (IQR3.0-8.0) for category "blue"; 17.50 (IQR15.0-19.0) and 16.0 (10.0-18.0) for category "round" in the control and study group, respectively. A statistically significant difference was established between the study and the control group in TCT for the category "blue" (p<0.025). The average score for GAD7 was 2.0 (IQR 0.0-5.75) and 3.0 (IQR0.50-6.00) in the control and study group, respectively. The average score for PHQ-9 was 2.0 (IQR0.25-4.75) and 4.0 (IQR2.00-5.50) in the control and study group, respectively. Finally, the average score for the MoCA scale was 27.0 (IQR25.25-28.00) and 26.0 (IQR23.50-28.00) in the control and study group, respectively. Preliminary evidence suggests that RA at least partially affects the cognitive domain of ideational fluency. However, further research with larger experimental groups is needed to provide more conclusive evidence.

Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment: Study of a Population Cohort ≥65 Years of Age.

PurposeTo evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline.Materials and MethodsIt was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated.ResultsThe prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19.ConclusionRisk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive status.

Cognitive Decline and Treatment Strategies in Multiple Sclerosis Patients

Multiple Sclerosis (MS) is an autoimmune disease of the Central Nervous System (CNS), mainly appeared in young adults, characterized by neuroinflammation, demyelination, neurodegeneration and remyelination and with a variety of CNS-related symptoms. The prevalence of cognitive decline in MS patients has been reported to range widely, from 13% to 72%, occurring in all stages of the disease, and can lead to mental disability, social impairment, and an impoverished quality of life. The pathogenetic mechanism of the cognitive decline in MS has yet to be revealed, and, thus, we are still unable to predict which patients are more likely to manifest such a decline and at what stage of the disease. Clinical factors, including the type and the course of the disease, but also fatigue and emotional disturbances, can impact the degree of MSrelated cognitive impairment. It has been reported that almost 40% of the MS patients demonstrate a significant deficit in recognizing and recalling verbal and visual memories, either at the onset of the disease or at its later stages, whereas short-term memory remains almost intact. Many patients also demonstrate deficits in complex attention, a slower efficiency in information processing, a declined ability of problemsolving, planning, and prioritization tasks or even visual agnosia and aphasia. Most of the MS-specific disease-modifying treatments seem to reduce the rate of MS attacks and slower the progression; however, their impact on cognitive impairment remains unclear. We propose that cognitive function evaluations should be incorporated in the regular assessment and monitoring of MS patients since they seem to be well correlated with the progression of the disease. Even if the effect of the neuropsychological batteries used for diagnostic and therapeutic purposes still remains very much limited, especially due to the validation and standardization issues, specific cognitive functions treatment strategies should be implemented in the therapeutic scheme of MS patients.

Cerebrovascular reactivity: a new frontier for measuring cognitive health in models of accelerated ageing?

Cerebrovascular reactivity: a new frontier for measuring cognitive health in models of accelerated ageing?

HIITing the brain with exercise: mechanisms, consequences and practical recommendations.

The increasing number of older adults has seen a corresponding growth in those affected by neurovascular diseases, including stroke and dementia. Since cures are currently unavailable, major efforts in improving brain health need to focus on prevention, with emphasis on modifiable risk factors such as promoting physical activity. Moderate-intensity continuous training (MICT) paradigms have been shown to confer vascular benefits translating into improved musculoskeletal, cardiopulmonary and cerebrovascular function. However, the time commitment associated with MICT is a potential barrier to participation, and high-intensity interval training (HIIT) has since emerged as a more time-efficient mode of exercise that can promote similar if not indeed superior improvements in cardiorespiratory fitness for a given training volume and further promote vascular adaptation. However, randomised controlled trials (RCTs) investigating the impact of HIIT on the brain are surprisingly limited. The present review outlines how the HIIT paradigm has evolved from a historical perspective and describes the established physiological changes including its mechanistic bases. Given the dearth of RCTs, the vascular benefits of MICT are discussed with a focus on the translational neuroprotective benefits including their mechanistic bases that could be further potentiated through HIIT. Safety implications are highlighted and components of an optimal HIIT intervention are discussed including practical recommendations. Finally, statistical effect sizes have been calculated to allow prospective research to be appropriately powered and optimise the potential for detecting treatment effects. Future RCTs that focus on the potential clinical benefits of HIIT are encouraged given the prevalence of cognitive decline in an ever-ageing population.

Sarcopenia Is Associated with Cognitive Decline and Falls but Not Hospitalization in Community-Dwelling Oldest Old in China: A Cross-Sectional Study.

BackgroundThe aim of this study was to investigate the association between sarcopenia and cognitive decline, falls, and hospitalization in a Chinese elderly population.Material/MethodsThis cross-sectional survey was conducted between November 2018 and May 2019, and enrolled only older adults aged 80 years or over (oldest old). We diagnosed sarcopenia using the Asian Working Group for Sarcopenia criteria. Demographic characteristics, disease history, smoking status, drinking status, cognitive function, falls, and hospitalization events in the previous 12 months were acquired by face-to-face interview. Cognitive status was evaluated by the Montreal Cognitive Assessment. Falls was ascertained by the question “Have you fallen down in the last 12 months?” Hospitalization was ascertained by the question “Have you received inpatient care in the past year?”ResultsA total of 582 participants (aged 80–99 years and 42.3% male) were included. The prevalence of sarcopenia was 21.7% (95% confidence interval [CI]: 17.3–26.2%) and 33.3% (95% CI: 27.4–39.3%) for females and males, respectively. Among the study population, the prevalence of cognitive decline was 60.8%; the proportions of the oldest old who had falls or hospitalization in the past 12 months were 18.1% and 34.3%, respectively. Multivariate analyses showed that sarcopenia was significantly and independently associated with cognitive decline [odds ratio (OR)=1.96, 95% CI: 1.17–3.27] and falls (OR=2.00, 95% CI: 1.17–3.43) but not associated with hospitalization (OR=1.32, 95% CI: 0.83–2.08).ConclusionsOur results showed that sarcopenia was significantly and independently associated with cognitive decline and falls, but not associated with hospitalization, in the community-dwelling oldest old.

Lifestyle Modifications and Nutritional Interventions in Aging-Associated Cognitive Decline and Alzheimer's Disease.

Alzheimer’s disease (AD) is a type of incurable neurodegenerative disease that is characterized by the accumulation of amyloid-β (Aβ; plaques) and tau hyperphosphorylation as neurofibrillary tangles (NFTs) in the brain followed by neuronal death, cognitive decline, and memory loss. The high prevalence of AD in the developed world has become a major public health challenge associated with social and economic burdens on individuals and society. Due to there being limited options for early diagnosis and determining the exact pathophysiology of AD, finding effective therapeutic strategies has become a great challenge. Several possible risk factors associated with AD pathology have been identified; however, their roles are still inconclusive. Recent clinical trials of the drugs targeting Aβ and tau have failed to find a cure for the AD pathology. Therefore, effective preventive strategies should be followed to reduce the exponential increase in the prevalence of cognitive decline and dementia, especially AD. Although the search for new therapeutic targets is a great challenge for the scientific community, the roles of lifestyle interventions and nutraceuticals in the prevention of many metabolic and neurodegenerative diseases are highly appreciated in the literature. In this article, we summarize the molecular mechanisms involved in AD pathology and the possible ameliorative action of lifestyle and nutritional interventions including diet, exercise, Calorie restriction (CR), and various bioactive compounds on cognitive decline and dementia. This article will provide insights into the role of non-pharmacologic interventions in the modulation of AD pathology, which may offer the benefit of improving quality of life by reducing cognitive decline and incident AD.

Citrulline prevents age-related LTP decline in old rats

The prevalence of cognitive decline is increasing as the ageing population is considerably growing. Restricting this age-associated process has become a challenging public health issue. The age-related increase in oxidative stress plays a major role in cognitive decline, because of its harmful effect on functional plasticity of the brain, such as long-term potentiation (LTP). Here, we show that citrulline (Cit) has powerful antioxidant properties that can limit ex vivo oxidative stress-induced LTP impairment in the hippocampus. We also illustrate that a three-month Cit supplementation has a protective effect on LTP in aged rats in vivo. The identification of a Cit oxidation byproduct in vitro suggests that the antioxidant properties of Cit could result from its own oxidation. Cit supplementation may be a promising preventive nutritional approach to limit age-related cognitive decline.

Association of sickle cell trait with measures of cognitive function and dementia in African Americans.

ObjectiveThe incidence and prevalence of cognitive decline and dementia are significantly higher among African Americans compared with non-Hispanic Whites. The aim of this study was to determine whether inheritance of the sickle cell trait (SCT) i.e. heterozygosity for the sickle cell mutation increases the risk of cognitive decline or dementia Among African Americans.MethodsWe studied African American participants enrolled in the Atherosclerosis Risk in Communities study. SCT genotype at baseline and outcome data from cognitive assessments at visits 2, 4 and 5, and an MRI performed at visit 5 were analyzed for the association between SCT and risk of cognitive impairment and/or dementia.ResultsThere was no significant difference in risk factors profile between participants with SCT (N = 176) and those without SCT (N = 2532). SCT was not independently associated with a higher prevalence of global or domain-specific cognitive impairment at baseline or with more rapid cognitive decline. Participants with SCT had slightly lower incidence of dementia (HR = 0.63 [0.38, 1.05]). On the other hand, SCT seems to interact with the apolipoprotein E ε4 risk allele resulting in poor performance on digit symbol substitution test at baseline (z-score = −0.08, Pinteraction = 0.05) and over time (z-score = −0.12, Pinteraction = 0.04); and with diabetes mellitus leading to a moderately increased risk of dementia (HR = 2.06 [0.89, 4.78], Pinteraction = 0.01).ConclusionsSCT was not an independent risk factor for prevalence or incidence of cognitive decline or dementia, although it may interact with and modify other putative risk factors for cognitive decline and dementia.

Poststroke Cognitive Decline: A Longitudinal Study from a Tertiary Care Center.

Objectives Poststroke cognitive decline (PSCD) is a serious disabling consequence of stroke. The purpose of this study is to find the prevalence of PSCD and sociodemographic and clinical determinants of risk factors of PSCD. Materials and Methods This study was a prospective, hospital-based study conducted on 200 stroke patients from stroke registry during October 2015 to April 2017. Detailed clinical evaluation was done. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores were used to determine PSCD after 3 and 6 months as per the Diagnostic and Statistical Manual of Mental Disorders V . Chi-squared test was used to find the association between two variables. The Wilcoxon signed-rank test was used to compare the difference in cognitive impairment between two follow-ups at 3 and 6 months, respectively. A p-value < 0.05 was considered statistically significant. Results The prevalence of PSCD measured by MoCA scale at 3 and 6 months was 67 and 31.6%, respectively. By MMSE scale, cognitive decline prevalence at 3 months was found to be 87 (46.3%), which reduced to 22 (17.1%) at 6 months. The association between MMSE scale and type of stroke was significant at 3 months. Conclusion One-third of the stroke patients developed PSCD within 3 months of onset of stroke, with different levels of severity. The major predictors of new-onset poststroke cognitive impairment were diabetes and hypertension. The prevalence of PSCD reduced significantly at 6 months of stroke on follow-up.