Prevention Of Cognitive Decline Research Articles

Effect of dietary patterns on mild cognitive impairment and dementia: a machine learning bibliometric and visualization analysis.

As a spectrum of neurodegenerative conditions, dementia presents a significant challenge to worldwide health. Mild cognitive impairment (MCI) is recognized as the intermediate stage between normal cognitive functioning and dementia. Studies highlight the significant impact of dietary patterns on the management of MCI and dementia. Currently, comprehensive research on dietary patterns specific to MCI and dementia is limited, but bibliometric analysis offers a method to pinpoint essential research directions. On November 18, 2023, a search was conducted in the Web of Science Core Collection (WoSCC) for publications on diet and MCI/dementia. Tools such as Rstudio, CiteSpace, and VOSviewer were employed to create a knowledge atlas. This atlas analyzed collaborations, reference co-citations, keyword patterns, and emerging trends. The search yielded 1,493 publications on diet and MCI/dementia, indicating a growing interest despite fluctuations. Contributions came from 70 countries/regions and 410 organizations across 456 journals. The USA and China led in publication numbers, with significant contributions from Columbia University and Harvard Medical School. Top authors include Scarmeas Nikolaos, Morris Martha Clare, and Samieri Cecilia. The Ketogenic, Mediterranean, and MIND diets emerged as key dietary patterns for cognitive decline prevention, highlighting the role of genetic factors, especially ApoE polymorphisms, in cognitive deterioration. This study provides core countries, institutions, and authors in the field, and points out the development directions in the field. Future research directions in dietary for MCI and dementia will focus on: (1) the potential effects of the KD in alleviating oxidative stress and modulating gut microbiota in neurodegenerative diseases; (2) how diet influences cognitive health through patterns of ApoE and protein expression; (3) investigating the interactions between gut microbiota and brain function, known as the "gut-brain axis."

Associations between sleep duration trajectories and cognitive decline: A longitudinal cohort study in China

ObjectThe relationship between sleep duration trajectories and cognitive decline remains uncertain. This study aims to examine the connections between various patterns of sleep duration and cognitive function. MethodsGroup-based trajectory modeling (GBTM) was employed to identify longitudinal trajectories of sleep duration over four-year follow-up period, while considering age, sex and nap duration as adjustments. Logistic regression was utilized to analyze the association between sleep trajectories and cognition, with odds ratios (OR) and 95 % confidence intervals (CI) reported. Subgroup analyses based on various demographic characteristics were conducted to explore potential differences in sleep trajectories and cognitive decline across different population subgroups. ResultsA total of 5061 participants were followed for four years, and three sleep duration trajectories were identified: high increasing (n = 2101, 41.6 %), stable increasing (n = 2087, 40.7 %), and low decreasing (n = 873, 17.7 %). After adjustment for basic demographic information, health status, and baseline cognition, the high increasing trajectory was found to be associated with cognitive decline in terms of global cognition (OR:1.52,95 %CI:1.18–1.96), mental intactness (OR:1.36,95 %CI:1.07–1.73) and episodic memory (OR:1.33, 95 %CI:1.05–1.67), as compared to stable increasing trajectory. These associations were particularly prominent among the non-elderly population (≤65 years) and those without depressive symptoms. ConclusionThis study suggests that both high increasing and low decreasing sleep duration trajectories are linked to cognitive decline, as compared to the stable increasing trajectory. Long-term attention to changes in sleep duration facilitates early prevention of cognitive decline.

A systematic review about the importance of neuropsychological features in heart failure: is at heart the only failure?

Heart failure can lead to cognitive impairment that is estimated to be present in over a quarter of patients. It is important to intervene at a cognitive level to promote brain plasticity through cognitive training programs. Interventions transformed by technology offer the promise of improved cognitive health for heart failure patients. This review was conducted on studies evaluating the role of cognitive rehabilitation in patients with heart failure. We examined clinical trials involving patients with heart failure. Our search was performed on Pubmed, Web of Science and Cochrane library databases. Of the initial 256 studies, 10 studies met the inclusion criteria. Cognitive rehabilitation training has important implications for the treatment and prevention of cognitive decline in heart failure patients with significant recovery for delayed recall memory and a significant time effect for total recall memory and delayed, psychomotor speed and IADL performance. It is important to include the assessment of cognitive functioning in the routine clinical examinations of patients with heart failure, discover the relationship between cognitive function and heart failure, and target cognitive rehabilitation programs that promote brain plasticity.

Critical Steps and Common Mistakes during Temporal Bone Dissection: A Survey among Residents and a Step-by-Step Guide Analysis.

Given that the temporal bone is one of the most complex regions of the human body, cadaveric dissection of this anatomical area represents the first necessary step for the learning and training of the young oto-surgeon in order to perform middle ear surgery, which includes the management of inflammatory pathology, hearing rehabilitation, and also cognitive decline prevention surgery. The primary objective of this study was to identify common mistakes and critical passages during the initial steps of temporal bone dissection, specifically cortical mastoidectomy and posterior tympanotomy. A survey among 100 ENT residents was conducted, gathering insights into the most prevalent errors encountered during their training to uncover the most challenging aspects faced by novice surgeons during these procedures. The most common mistakes included opening the dura of the middle cranial fossa (MCF), injury of the sigmoid sinus (SS), chorda tympani (CT), and facial nerve (FN) injury while performing the posterior tympanotomy. The most important critical steps to prevent mistakes are related to the absence of wide exposure during cortical mastoidectomy and the consequent impossibility of identifying the landmarks of the facial recess before performing posterior tympanotomy. Injury of these structures was more common in younger surgeons and in the ones who performed less than five temporal bone dissection courses. Numerous temporal bone dissections on cadavers are mandatory for ENT residents looking forward to performing middle ear surgery.

Healthy Aging in Menopause: Prevention of Cognitive Decline, Depression and Dementia through Physical Exercise

The aging of the global population is a significant and complex phenomenon with far-reaching implications for healthcare systems and society. By 2030, it is projected that the number of individuals over the age of 65 will increase by nearly 1 billion, largely due to advancements in healthcare and improvements in quality of life. Aging is a multifaceted process that encompasses a wide array of changes, spanning from the cellular level to the intricate physiological systems of the human body. At the central nervous system level, aging represents a major risk factor for conditions such as depression and cognitive impairment, which are likely linked to neuroinflammatory processes and can potentially lead to more severe dementias, including Alzheimer’s disease (AD). The higher prevalence of AD in women compared to men has led to speculation that the onset of menopause and associated phenomena, particularly the decline in estrogen levels, may play a role in the development of the disease. Furthermore, research has shown that physical exercise confers both physical and mental health benefits to older adults, with women potentially experiencing the greatest advantages. Understanding the multifaceted nature of aging and its implications for health will ensure that older adults receive the support and care essential for maintaining their health and quality of life.

The influence of intergenerational support on cognitive functioning among middle-aged Chinese: Moderation by personal income

ObjectiveTo analyze the effects of personal income on the relationship between intergenerational support (IS) and cognitive functioning. MethodsData were obtained from four waves of nationally representative surveys of the 2011–2018 China Health and Retirement Longitudinal Study (CHARLS), involving 8,207 participants aged 45 ∼ 60 at baseline. Multivariate linear regression models using generalized estimating equations were used to analyze the effects of three forms of intergenerational mutual supports on cognitive functioning in middle-aged adults, and subgroup regressions were used to analyze the moderating role of personal income in this relationship. ResultsThe results showed that financial and caregiving support from children impaired the cognitive functioning of their parents; whereas providing financial support to children and mutual emotional support with them positively affected their cognition; however, childcare was not significantly associated with cognitive levels in middle-aged adults. Moreover, the effect of IS on the cognitive level of Chinese middle-aged people disappeared or was attenuated by having pensions or earning their own post-tax income. ConclusionIS has a significant effect on cognitive functioning in middle-aged adults, but this effect is moderated by personal income. These results are informative for the development of intergenerational relationship intervention programs for the prevention of cognitive decline in middle-aged adults with different personal income.

Influence of cooking methods and storage time on colour, texture, and fatty acid profile of a novel fish burger for the prevention of cognitive decline

Western diets are poor in healthy n-3 polyunsaturated fatty acids (n-3 PUFA), namely eicosapentaenoic (EPA) and docosahexaenoic acid (DHA), iodine (I), and other nutrients that may protect against cognitive ageing. Given DHA richness in chub mackerel (Scomber colias), high vitamin B9 levels in quinoa (Chenopodium quinoa), and I abundance in the seaweed Saccorhiza polyschides, a functional hamburger rich in these nutrients by using these ingredients was developed. This research focused on the factors affecting its quality by examining the impact of cooking (steaming at 100 °C, roasting at 180 °C, grilling at 180 °C) and storage time (after 4 and 6 months at −20 °C) upon the product's properties.Cooking treatments were found to influence the burger's colour and texture, whereas storage duration impacted FA levels and the polyene index. Cooked burgers presented lighter (L*, 45.1–55.0 vs 36.9 ± 2.4) and more yellow colouration (b*, 15.8–17.8 vs 13.6 ± 1.0) than raw burgers. Cooked burgers also exhibited higher textural values across various parameters than their raw versions. Grilled burgers (excluding initial time) were firmer (50.0 ± 5.1 N) than those cooked otherwise (37.0–39.9 N). Regarding FA levels, a decrease in DHA was recorded after four months (21.8–23.0% vs 26.4–30.6%). The polyene index followed a similar trajectory, declining from 2.6 to 3.6 initially to 1.8–1.9 in the fourth month. Hence, the studied mackerel burger could be a promising source of EPA, DHA, and other n-3 PUFAs in human diets, optimally with a frozen storage duration of fewer than four months to preserve nutritional integrity.

Nutritional Interventions for the Prevention of Cognitive Decline in Patients With Mild Cognitive Impairment and Alzheimer Disease: Protocol for a Network Meta-Analysis of Randomized Controlled Trials.

Mild cognitive impairment (MCI) is the stage between cognitive decline due to physiological aging and the severity of decline seen in neurodegenerative disorders like Alzheimer disease (AD), which is among the most prevalent neurodegenerative disorders characterized by cognitive impairment. People with MCI are at increased risk of developing AD. Although MCI and AD are incurable, nutritional interventions can potentially delay or prevent their onset. Consequently, effective interventions used to decelerate or alleviate the progress of cognitive impairment in older people are a significant focus in geriatric care. Given the synergistic effects of nutrition on health, assessing the effectiveness of nutritional supplements or dietary composition in preventing MCI or AD is essential for developing interventional strategies. Our study aims to assess the effectiveness of various nutritional interventions, including special dietary types, dietary patterns, specific foods, nutritional intake, and nutritional supplements, in preventing cognitive decline among patients diagnosed with MCI or AD. To achieve this, we will use a comprehensive approach, including network meta-analysis, pairwise meta-analysis, and systematic review of randomized controlled trials (RCTs). The review will follow the Population, Intervention, Comparison, Outcome (PICO) model and the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Two investigators will independently search PubMed electronically. Data extraction will follow the inclusion criteria, and data will be assessed for risk of bias using a revised tool. Additionally, evidence quality will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. The outcomes of interest are assessing the cognitive outcomes in patients with MCI or AD. A systematic literature search will be conducted, identifying randomized controlled trials that investigate the impact of these nutritional interventions on cognitive function decline in individuals with MCI and AD. Network meta-analyses (random-effects model) and pairwise meta-analyses will then estimate the relative effectiveness of different nutritional interventions. We included 51 studies, published between 1999 and 2023 (27 studies for AD and 24 studies for MCI) and involving 8420 participants. We completed data extraction for all 51 studies by December 2023. Currently, we are actively engaged in data analysis and manuscript preparation. We plan to finalize the manuscript and publish the comprehensive results by the end of 2024. Our study holds significant clinical relevance given the rising prevalence of AD and the potential influence of nutritional interventions on cognitive function in individuals with MCI and AD. By investigating this relationship, our research aims to inform evidence-based decision-making in the development of prevention strategies for MCI and AD. The outcomes are expected to contribute to the establishment of reliable recommendations for MCI or AD management, providing substantial support in the field. PROSPERO CRD42022331173; http://tinyurl.com/3snjp7a4. PRR1-10.2196/47196.

A mixture of extracts from natural ingredients reduces the neurotoxic polarization of microglia via modulating NF-κB/NF-E2-related factor 2 activation.

Neurotoxic microglia-provoked neuroinflammation is implicated in cognitive decline in Alzheimer's disease (AD). Supplementation with Ginkgo biloba, phosphatidylserine, Curcuma longa, and propolis is reported to improve the cognitive functions of elderly people; however, the underlying mechanisms of this combination of natural ingredients are unknown. We investigated the effects of a mixture of extracts from propolis, Coffea arabica, Gotu kola, phosphatidylserine, Ginkgo biloba, and Curcuma longa (mixture) on microglia polarization after exposure to amyloid β1-42 (Aβ1-42, 1 μM) and lipopolysaccharide from Porphyromonas gingivalis (PgLPS, 1 μg/mL), using MG6 and BV2 microglial cells. Exposure to Aβ1-42 and PgLPS (AL) raised the mRNA expression of IL-1β, TNF-α, and IL-6, nuclear translocation of p65 NF-κB in MG6 cells and BV2 cells, and mitochondrial reactive oxygen species (ROS) production in MG6 cells. The mixture dramatically suppressed the mRNA expression of IL-1β, TNF-α, and IL-6, but significantly promoted that of IL-10, TGFβ1, and BDNF in AL-exposed MG6 and BV2 cells. Furthermore, the mixture significantly suppressed the nuclear translocation of p65 NF-κB but significantly promoted that of NF-E2-related factor 2 (Nrf2) in AL-exposed MG6 and BV2 cells. Furthermore, the mixture significantly ameliorated mitochondrial ROS production but increased mitochondrial membrane potential in MG6 cells. These observations strongly suggest that the mixture demotes the neuropathic polarization of microglia by modulating NF-κB/Nrf2 activation and improving mitochondrial functions. This study supplies the potential mechanisms of the efficacy of a combination of natural ingredients that can be applied in the prevention of cognitive decline in AD and aging by targeting microglia-mediated neuroinflammation.

Oxidative stress marker changes and cognitive decline prevention in Pb contaminated mice by Crocus sativus L. Supplementation and interval training

Heavy metals are contaminants hazardously affecting the animals’ and humans’ health since they are extensively utilized in the industry where proper physical activity and consuming antioxidant ingredients can be an appropriate solution for decreasing the resultant damages. This work deals with assessing the effects of Crocus sativus L. (saffron) petal extract (SPE) along with eight weeks of interval training on the cytotoxicity of lead (Pb) investigated in exposed adult male mice. SPE reduced the toxic effects of Pb that were indicated by the MTT assay. The morphological alterations of Pb-treated cells were found by fluorescent and normal microscopes when it was co-incubated with SPE. Accordingly, the 50% inhibitory concentration and the 50% lethal dose were calculated. The adult male mice were randomly placed into seven groups (six mice/group) of positive and negative controls, interval training group (Exr), Exr & Pb, SPE, SPE & Pb, and Exr & SPE & Pb treated groups. From the results, SPE did not affect catalase (CAT) activity, but it induced a significant increment of antioxidant enzyme SOD and the levels of malondialdehyde (MDA) is reduced remarkably in the brain. In the last part of the research, mice were exposed to the behavioral tasks examined by step-through ORT, MWM, and YM tests. Having interval training and SPE consumption could reverse the most defective behavioral indicators that may be protecting potential agents inspiringly to the Pb toxicity in the areas with higher heavy metals pollution.

Sex-Specific Association of Body Mass Index with Hippocampal Subfield Volume and Cognitive Function in Non-Demented Chinese Older Adults.

Recent research suggests a possible association between midlife obesity and an increased risk of dementia in later life. However, the underlying mechanisms remain unclear. Little is known about the relationship between body mass index (BMI) and hippocampal subfield atrophy. In this study, we aimed to explore the associations between BMI and hippocampal subfield volumes and cognitive function in non-demented Chinese older adults. Hippocampal volumes were assessed using structural magnetic resonance imaging. Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). A total of 66 participants were included in the final analysis, with 35 females and 31 males. We observed a significant correlation between BMI and the hippocampal fissure volume in older females. In addition, there was a negative association between BMI and the RBANS total scale score, the coding score, and the story recall score, whereas no significant correlations were observed in older males. In conclusion, our findings revealed sex-specific associations between BMI and hippocampal subfield volumes and cognitive performance, providing valuable insights into the development of effective interventions for the early prevention of cognitive decline.

노인의 인지기능 저하 예방을 위한 청각 집중력 게임 개발에 관한 연구

The purpose of this study is to develop an auditory concentration game to prevent cognitive decline in the elderly. Previous studies have identified that hearing loss affects cognitive function due to the process of aging, and it has been confirmed that it is necessary to prevent this. Accordingly, based on Keller's (2013) ARCS model, an auditory concentration game was developed to prevent cognitive decline in the elderly with advice from two board game developers and an education expert. The auditory concentration game is, first, a card image and sound source that consider the emotions of the elderly with the goal of maintaining and improving cognitive function of the elderly. Through the auditory concentration game, interest and motivation for the prevention of cognitive decline were induced through the auditory concentration game, and the will to prevent dementia was promoted to improve cognitive function. Second, the stage of game development was reorganized into ideas and concept planning → category and mechanism → game rule production → game design and component production → game test five-step procedure, and it was produced with images and sound source considering the emotions of the elderly. Third, the sound source is significant in that it can be recorded in consideration of the emotions of the elderly and enjoyed various game methods, and can be applied to the cognitive program of the elderly by adjusting the difficulty of the game. Based on this study, the following studies are needed in subsequent studies. First, since it was developed as an auditory concentration game to prevent cognitive decline in the elderly, it is necessary to analyze whether it has an effect on the improvement of cognitive function. Second, it is necessary to analyze the correlation or difference because it was targeted at the entire elderly regardless of gender. Third, it is necessary to develop a specific instructional plan that can be used for the cognitive program of the elderly, and it is expected to be used as a cognitive program for the elderly such as senior citizen centers after supplementing and modifying the currently developed auditory concentration game to produce a complete game.

PTSD IS ASSOCIATED WITH LONGITUDINAL CHANGES IN DOMAIN-SPECIFIC COGNITIVE FUNCTION IN OLDER ADULTS

Abstract Posttraumatic stress disorder (PTSD) is associated with an increased risk for all-type dementia yet whether PTSD is associated with domain-specific cognitive decline, that may lead to dementia, is unknown. Using existing data from the National Alzheimer’s Coordinating Center, we tested the hypothesis that PTSD is associated with cognitive decline in episodic memory, working memory and attention, and executive function. After exclusion for history of dementia, stroke, Down syndrome, Parkinson’s and Alzheimer’s diseases, schizophrenia, and neurodevelopmental disorders, 130 (1.25%) participants with PTSD and 10,261 (98.75%) without PTSD remained. Prior to analysis, inverse probability of treatment weighting was used to adjust for confounding. Inverse probability estimates were based on PTSD status and conditional on covariates for age, sex, race, ethnicity, APOE ɛ4 status, anxiety, depression, TBI status, diabetes, and hypertension. Generalized estimating equations (GEE)-type linear regression models with robust standard errors were fit to the weighted data for z-scores for each cognitive domain. During the study, unexpectedly, PTSD was associated with an additional .043 standard deviations of improvement in episodic memory (b = .043, 95%CI: .020, .066) compared to the same population without PTSD. Expectedly, PTSD was associated with an additional .143 standard deviations of decline in working memory and attention (b = -.143, 95% CI: -.225, -.062) and an additional .415 standard deviations of decline in executive function (b = -.415, 95%CI: -.563, -.267). Investigations are ongoing to probe the unexpected finding for episodic memory. These findings suggest that PTSD should potentially be a target for early prevention of cognitive decline.

Changes in cognitive functioning by a multifactorial intervention to prevent dementia‐The Japan‐Multimodal Intervention Trial for Prevention of Dementia PRIME Tamba‐

AbstractBackgroundMany efforts for early detection and prevention of cognitive decline have been reported. In this study, we examined the changes in possible Nou‐KNOW (Cognigram by Cogstate; Japanese version Cognigram) after an 18‐month multifactorial intervention to prevent dementia in cognitively normal elderly subjects living in areas at risk for dementia.MethodThe Japan‐Multimodal Intervention Trial for Prevention of Dementia PRIME Tamba (J‐MINT), a randomized controlled trial to prevent cognitive decline in cognitively normal older people living in areas at risk of dementia, was conducted. PRIME Tamba), a randomized controlled trial to prevent cognitive decline. 203 participants (male: 57 participants, mean age: 73.86±4.84, mean MMSE score: 28.65±1.36) were randomly assigned to the intervention group (101 participants) or the control group (102 participants). The intervention group received 90 minutes of group‐based physical exercise once a week, cognitive training, nutritional counseling, and vascular risk factor management for 18 months (78 sessions in total). Reaction speed, attention, visual learning, and attentional scores were measured twice (Baseline and 18 months after intervention) by the Nou‐KNOW. Statistical analyses were conducted using a general linear mixed‐effects model with a significance level of less than 5%.ResultThere was a statistically significant difference in the Reaction time score (intervention group vs. control group; 101.62 ± 7.07 vs. 98.63 ± 9.75, p<0.01) and Attention score (100.19 ± 7.19 vs. 98.16 ± 7.56, p = 0.02) in the Cognigram at the 18‐month measurement in the intervention group. On the other hand, no statistically significant differences were found in the Visual memory score (100.26±13.26 vs. 98.63±13.71, p = 0.89) and Working memory score (98.99 ± 8.13 vs. 96.71 ± 7.39, p = 0.29).ConclusionAn 18‐month multifactorial intervention to prevent dementia in cognitively normal older adults living in areas at risk for dementia was suggested to improve reaction time and attention.

Sex‐specific plasma markers of cholesterol‐metabolism and plant sterols predict cognitive decline in older people – a ten years follow‐up study

AbstractBackgroundMultiple studies in clinical settings show that there is a link between a dysregulation of cholesterol metabolism and neurodegenerative pathologies and dementia. Diet‐based plant sterols may also interfere with neurodegeneration and cognitive decline through cholesterol‐lowering properties. In this study, we investigate whether circulating levels of cholesterol, its precursors, and metabolites, as well as triglycerides, and phytosterols predict cognitive decline ten years later in the general population. As a secondary objective we address the role of sex and the APOE genotype on these relationships.MethodWe considered 206 individuals aged 65 and older from a population‐based prospective study from Lausanne, Switzerland. A comprehensive cognitive assessment was performed at baseline and after ten years. We quantified the plasma levels of cholesterol, high‐density lipoprotein (HDL‐) cholesterol, triglyceride, cholesterol precursors (lathosterol, lanosterol, desmosterol, dihydrolanosterol), cholesterol derivatives (cholestanol), oxysterols (24S‐hydroxycholesterol [24S‐OHC], 7α‐hydroxycholesterol, 27‐hydroxycholesterol), and phytosterols (campesterol, campestanol, stigmasterol, sitosterol, sitostanol and brassicasterol) at baseline and after five years. Regression analysis (considering several possible confounder including APOE‐genotype) determined the relationship between baseline sterol levels, and their changes between baseline and five‐year follow‐up, with measures of cognitive decline (i.e. changes in Clinical Dementia Rating (CDR), Mini‐Mental State Exam and CDR Sum of Boxes) at ten years. Analyses were performed in the whole cohort, and in males and females independently.ResultHigher levels of baseline HDL‐cholesterol and lanosterol were associated with cognitive decline after ten years in the whole cohort. Decrease over time of 24S‐OHC was also associated with cognitive decline. In males, several cholesterol‐related sterols (cholestanol, lathosterol, lanosterol, 7α‐hydroxy‐cholesterol) and the phytosterol sitosterol were associated with cognitive decline. In females, only cholesterol and campestanol were associated with cognitive decline. The APOE genotype did not affect these associations.ConclusionIn this cohort of older people from the general population, plasma markers of cholesterol synthesis and metabolism and as well as phytosterols are associated with cognitive decline after ten years. These findings have potential relevance for sex‐specific risk assessment and prevention of cognitive decline in older people.

To evaluate the prevalence, subtypes and risk associations of mild cognitive impairment in elderly Indian individuals with type 2 diabetes

AbstractBackgroundDiabetes is an important modifiable risk factor for dementia. The prevalence of mild cognitive impairment (MCI) in type 2 diabetes (T2D) is high (You et al, 2021). This data is largely derived using screening tools (MMSE or MoCA), with little information on MCI subtypes. Evidence from the South Asian region is particularly scarce, where prevalence of diabetes is high, and is seen a decade earlier compared to Caucasians.MethodWe have established a cohort of elders (³ 60 years of age), with and without diabetes, visiting a tertiary care hospital in North India (from 2019, ongoing). The participants underwent an interview to collect information on their demographic profile, risk associations, vascular health, and other comorbidities. Culturally validated neuropsychological battery was used for cognitive evaluation. MoCA was done in a subset of patients.ResultWe recruited 840 participants in the cohort, 683 with T2DM and 157 without T2DM (controls). The mean age of the cohort was 65.3±4.5 years, 65.2% were males. Risk profile is described in Table 1. The cognitive z scores of participants with T2DM ranged from ‐0.25 to +0.44. The worst affected domain was attention, working memory and executive functions (Table 2). Using an actuarial definition of MCI (Bondi MW et al, 2014), the prevalence in participants with T2D was 29.7%. 17.3% had amnestic impairment, 14.8% dysexecutive, 14.2% language, 2.4% visuo‐perceptual and 9.1% multidomain impairment. The cognitive raw scores (by dementia risk stratification) are provided in Table 3. On logistic regression, lower education 3.45(2.09,5.68), depression 2.04(1.26,3.29), poor sleep quality 1.77(1.15,2.71), family income 1.70(1.22,2.38), followed by age 1.05(1.00,1.10) had a significant association with global low cognition.ConclusionRoughly one‐third of elders with T2D visiting tertiary care services in North India have mild cognitive impairment. Amnestic subtype is the most frequent. Attention, working memory and executive functions are worst affected. Enhancing the cognitive reserve, mood and sleep quality may be important targets in prevention of cognitive decline in the elderly population with T2D.

E‐FINGERPRINT Pilot Study: Assessing the feasibility of digital data collection and multidomain lifestyle guidance towards the prevention of cognitive decline and dementia

AbstractBackgroundThe ongoing eFINGER‐PRINT Pilot Study is a is a pioneering virtual feasibility study to evaluate different methodologies for recruitment and digital phenotyping in the context of readiness cohorts. In addition, the pilot aims to test virtual cognitive and other tools in their ability to detect changes in cognitive performance and lifestyle parameters over time, and associations between changes across other key health outcomes. The one‐year study was initiated in May 2022.MethodCognitively unimpaired individuals (up to 500) aged 60+ years residing in London, were recruited through the Cognitive Health in Ageing Register for Investigational and Observational Trials (CHARIOT). Inclusion criteria include no dementia diagnosis, access to the internet and a suitable device and English competency with no significant visual or auditory disability. The study collects subjective demographics, comorbidities, and health behaviours, sleep, frailty, functional abilities, and subjective memory symptoms, through repeated 4‐monthly questionnaire surveys administered online. Longitudinal cognitive data were obtained via a validated online cognitive assessment platform, and included customised assessments shown to be sensitive to AD related cognitive decline. Furthermore, participants are invited to join a preventative multi‐domain lifestyle guidance, based on repeated self‐reported evaluations of modifiable risk factors and a healthy lifestyle index, using a mobile, application. By joining the application, participants receive also bi‐monthly online educational literature on dementia prevention and healthy ageing, including guidance on nutrition and physical exercise and are asked to complete a variety of e‐based mental activities, targeting cognitive domains, such as memory, mental agility, visuospatial, and attention.ResultA minimum recruitment rate of 20% and a retention rate of 50% will provide a methodological template for the e‐FINGER PRINT study. Furthermore, participant feedback and experience will aid in optimising recruitment processes, user acceptability and sustainability of the selected digital tools. A low attrition rate will indicate a positive user experience.ConclusionThe pilot study will inform the design of the eFINGER PRINT main study, a five years’ large‐scale virtual FINGER‐based study that will be conducted in Greater London (2023‐2028). Given the promise of economic sustainability, utility of e‐based tools for disease prevention can offer dramatic up‐scalability and allow for the implementation of a prescriptive medicinal approach.

The Japan‐multimodal intervention trial for prevention of dementia (J‐MINT): a multi‐center, randomized, 18‐month controlled trial

AbstractBackgroundThe Japan‐multimodal intervention trial for prevention of dementia (J‐MINT) aimed to examine the efficacy of the multi‐domain intervention in the prevention of cognitive decline in older adults at high risk of dementia.MethodThe J‐MINT is an 18‐month, multi‐centered, randomized controlled trial. Participants aged 65‐85 years with mild cognitive deficits were recruited and randomized into multi‐domain intervention (management of vascular risk factors, group‐based physical exercise, nutritional counseling, and cognitive training) and control groups (health‐related information in writing every 2 months) at a 1:1 allocation ratio using the dynamic allocation method. The primary outcome was a change from baseline to 18‐month follow‐up in a composite Z score combining several neuropsychological tests, which include tests of global cognitive function (MMSE); memory (Logical memory I and II subset of the Wechsler Memory Scale‐Revised and the Free and Cued Selective Reminding Test); attention (Digit Span); executive function/processing speed (Trail Making Test, Digit Symbol Substitution Test, and Letter word fluency test).ResultBetween November 26, 2019, and December 28, 2020, 1677 participants were screened and 531 were randomly assigned to the multi‐domain intervention group (n = 265) or control group (n = 266). Four hundred and three (75.9%) participants completed the trial. The full analysis set included 433 patients who received the intervention program/health‐related information at least once. In the primary efficacy analysis, there were no significant differences in the change of composite Z score between the intervention group and the control group (mean difference 0.047 [95% CI ‐0.029 to 0.124]). In the analysis for each neuropsychological test, the score of the letter word fluency test in the intervention group significantly improved by a mean of 0.827 (95% CI = 0.356 to 1.298) points, whereas the mean difference between the intervention group and control group was not significant (mean difference 0.625 [95% CI ‐0.039 to 1.289]). In subgroup analyses, the intervention effect on composite Z score was significant among older adults with the apolipoprotein‐E (APOE) ε4 allele (mean difference 0.164 [95% CI 0.011 to 0.317]).ConclusionThe multi‐domain intervention showed significant efficacy for the prevention of cognitive decline among Japanese older adults with the APOE ε4 allele.

Health care service use in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) during an extended follow‐up period

AbstractBackgroundFinnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized trial aiming to prevent cognitive decline with a 2‐year multidomain lifestyle intervention. Beneficial effects were detected not only in cognition, but also for co‐morbidity, as reported earlier. Aim of this work was to investigate, if the multidomain intervention also had an impact on the health care use and to evaluate possible cost‐effectiveness of the interventions in terms of health care costs.MethodThe FINGER trial recruited a population‐based cohort of 1259 at‐risk individuals aged 60‐77 living in six areas of Finland. They were randomized into a multidomain lifestyle intervention consisting of diet, exercise, cognitive training and vascular risk management (n = 631) or a regular health advice (control) (n = 628) group for two years and followed on average for 8 years. Health care use was obtained from nationwide registers where all primary and specialized care visits are recorded. We calculated days spent in hospital, ambulatory visits, outpatient visits in hospitals and primary care, and home care. Costs will be evaluated based on national reference prices.ResultAltogether 99% of the population used some health care services and 66% were hospitalized at least for one day during the 8 years. 128 (10%) participants died during the follow‐up. Preliminary data indicated that the intervention group spent less days in the hospital, but there were no differences in outpatient visits. Further analyses are ongoing to evaluate the costs related to these visits.ConclusionMultidomain lifestyle intervention which is effective in prevention of cognitive decline can also help in reducing health care use at least in terms of hospital stays.

The multidomain intervention trial for prevention of dementia among older adults with type 2 diabetes: a multi‐center, randomized, 18‐month controlled trial

AbstractBackgroundThe aim of the Japan‐Multidomain Intervention Trial for Prevention of Dementia in Older Adults with Diabetes (J‐MIND‐Diabetes) was to examine the efficacy of multi‐domain intervention in prevention of cognitive decline in older adults with type 2 diabetes and mild cognitive impairment (MCI).MethodThe J‐MIND‐Diabetes is an 18‐month, multi‐centered, randomized controlled trial. Outpatients with type 2 diabetes aged 70‐85 years with MCI were recruited and randomized into multi‐domain intervention (management of metabolic and vascular risk factors, physical exercise, nutritional guidance, and promotion of social participation) and control groups (general instructions on dementia prevention) at a 1:1 allocation ratio using the stratified permuted‐block randomization methods. The primary outcome was a change from baseline to 18‐month follow‐up in a global composite score combining several neuropsychological tests, which include the MoCA‐J, the MMSE, the Rey‐Osterrieth Complex Figure Test (ROCFT), delayed recall test of a 10‐word list, the Digit Span, the Trail Making Test, the Digit Symbol Substitution Test, and the Letter Word Fluency Test.ResultBetween March 13, 2019, and May 8, 2020, 361 patients were screened and 154 were randomly assigned to the multi‐domain intervention group (n = 81) or control group (n = 73). 110 (71%) participants completed the trial. The full analysis set included 136 patients. In the primary efficacy analysis, there was no significant differences in the change of composite score from baseline to 18‐month follow‐up between the intervention group and the control group (mean difference 0.066 [95% CI ‐0.089 to 0.222]). In the analysis for each neuropsychological test, scores of immediate and delayed recall tests of the ROCFT in the intervention group significantly improved by a mean of 1.627 points and 1.793 points, respectively. The mean difference in the change of score of delayed recall test of the ROCFT between intervention group and control group was significant (mean difference 1.803 [95% CI 0.169 to 3.436]). In subgroup analyses, intervention effect on composite score was significant among patients with moderate to severe white matter hyperintensities (mean difference 0.351 [95% CI 0.088 to 0.614]).ConclusionThe multi‐domain intervention could improve memory function in older adults with type 2 diabetes and MCI.