Risk Of Cognitive Dysfunction Research Articles

Cognitive Functioning and Psychosocial Outcomes in Adults with Complex Congenital Heart Disease: A Cross-sectional Pilot Study.

Adults with complex congenital heart disease (CHD) are at risk for cognitive dysfunction. However, associations between cognitive dysfunction and psychosocial outcomes are poorly defined. Between June and November 2022, we prospectively recruited 39 adults with complex CHD who completed a computerized cognitive assessment (Cogstate) and validated psychosocial scales measuring psychological distress, health-related quality of life (HRQOL), and resilience. Participants had a mean age of 36.4 ± 11.2years. Over half (62%) were women, most (79%) had complex biventricular CHD, and 21% had Fontan physiology. Prevalence of cognitive dysfunction was greatest in the domains of attention (29%), working memory (25%), and psychomotor speed (21%). Adjusting for age and sex, Pearson partial correlations between Cogstate z-scores and self-reported cognitive problems were small. Participants who lived in the most disadvantaged areas and those with a below-average annual household income had lower global cognitive z-scores (p = 0.02 and p = 0.03, respectively). Two-thirds (64%) reported elevated symptoms of depression, anxiety, and/or stress. Small correlations were observed between psychological distress and cognitive performance. Greater resilience was associated with lower psychological distress (r ≥ -0.5, p < 0.001) and higher HRQOL (r = 0.33, p = 0.02). Our findings demonstrate that adults with complex CHD have a high risk of cognitive dysfunction, though may not recognize or report their cognitive challenges. Lower socioeconomic status may be an indicator for those at risk of poorer cognitive functioning. Psychological distress is common though may not be a strong correlate of performance-based cognitive functioning. Formal cognitive evaluation in this patient population is essential. Optimizing resilience may be a protective strategy to minimize psychological distress and bolster HRQOL.

Change in life space is associated with cognitive decline and increased risk of incident Alzheimer’s and Parkinson’s disease in older men

AbstractBackgroundLife space measures the range of geospatial movement through one’s environment during daily functioning. Prior studies on the association of life space and cognitive change are mostly cross‐sectional and have mixed results. To clarify this association, we prospectively evaluated change in life space with cognitive decline and incident Alzheimer’s disease (AD) and Parkinson’s disease (PD).MethodWe studied 1,684 men enrolled in a prospective study of aging. We excluded individuals with probable dementia or PD at baseline (Study Year 7). Life space was evaluated with the self‐reported University of Alabama at Birmingham Life Space Assessment at Year 7 and Year 14. The composite life space score ranges from 0 (most restricted) to 120 (least restricted). Incident AD or PD was defined as a self‐reported physician diagnosis or medication use at Year 14. We conducted logistic regression analyses examining change in life space with the odds of our outcomes unadjusted and adjusted for age, clinic site, race, education, living arrangement, vascular risk factors, and depression. We also conducted mixed linear effects models to evaluate the association between change in life space and change in 3MS and Trails B score.ResultOf 1,684 men (mean age 77.1 +/‐ 18.7 SD) in our analytic cohort, 80 (4.8%) developed incident AD and 23 (1.4%) developed PD over 7 years. The mean (SD) life space score at baseline was 92.9 (18.7) and change over 7 years was ‐9.9 (22.3). In the fully adjusted model, each 1 SD decrement in life space was associated with increased odds of AD (OR 1.6, 95% CI 1.3, 2.0) and PD (OR 1.6, 95% CI 1.1, 2.5). For each 1 SD decline in life space, men worsened by 20.6 seconds in their Trails B score and 1.15 points in their 3MS score over 7 years (p&lt;0.001 for both).ConclusionIn this novel longitudinal analysis, decline in life space is associated with cognitive decline and incident AD and PD. Future studies should examine whether decline in life space is a sensitive and practical way to identify older individuals at risk for cognitive dysfunction and neurodegenerative disease.

Correlation between coefficient of variation of blood pressure and cognitive dysfunction in patients with hypertension complicated by cerebral small vessel disease

ABSTRACT To investigate the correlation between the coefficient of variation of blood pressure and cognitive dysfunction in patients with hypertension complicated by cerebral small vessel disease. 415 patients with hypertension complicated by cerebral small vessel disease who received treatment in our hospital from January 2019 to June 2022 were retrospectively included in this study. These patients were divided into a cognitive dysfunction group (n = 74) and a non-cognitive dysfunction group (n = 341) according to whether they had cognitive dysfunction. Blood pressure and general data were recorded for each patient. The logistic regression coefficient was used to analyze the correlation between coefficient of variation of blood pressure and cognitive dysfunction in patients with hypertension complicated by cerebral small vessel disease. Multivariate logistic regression analysis showed that age, the weighted standard deviation of 24-hour systolic blood pressure (24hSBP-wSD), cholesterol level, and triglyceride level were risk factors for cognitive dysfunction in patients with hypertension complicated by cerebral small vessel disease (P < 0.05). The risk for cognitive dysfunction was increased by 3.532-fold in patients aged>65 years, increased by 1.203-fold in patients with a 24hSBP-wSD of 14.9–15.9%, and increased by 3.033-fold in patients with a 24hSBP-wSD>16.0% (P < 0.05). The coefficient of variation of blood pressure is markedly correlated with the risk for cognitive dysfunction; and a higher coefficient of variation of blood pressure leads to a higher risk for cognitive dysfunction in patients with hypertension complicated by cerebral small vessel disease.

Absence of fluctuation and inverted circadian rhythm of blood pressure increase the risk of cognitive dysfunction in cerebral small vessel disease patients

Background and purposeCerebral small vessel disease (CSVD) is a common cause of stroke and senile vascular cognitive impairment, imposing a heavy burden on public health care systems worldwide. Hypertension and 24-hour blood pressure variability (BPV), known to be significant risk factors for cognitive dysfunction, have been found to be associated with cognitive function in CSVD patients in previous studies. However, as a derived part of BPV, there are few studies on the relationship between circadian rhythm of blood pressure and cognitive dysfunction in CSVD patients, and the relationship between them is still unclear. Thus, this study aimed to investigate whether the disturbance of circadian rhythm of blood pressure can affect the cognitive function of patients with CSVD.MethodsA total of 383 CSVD patients hospitalized in the Geriatrics Department of the Lianyungang Second People’s Hospital between May 2018 and June 2022 were enrolled in this study. The clinical information and parameters of 24-hour ambulatory blood pressure monitoring were compared between the cognitive dysfunction group (n = 224) and the normal group (n = 159). Finally, a binary logistic regression model was used to assess the relationship between circadian rhythm of blood pressure and cognitive dysfunction in patients with CSVD.Results(1) Patients in the cognitive dysfunction group were older, had lower blood pressure on admission, and had a greater number of previous cardiovascular and cerebrovascular diseases (P < 0.05). (2) More patients in the cognitive dysfunction group had circadian rhythm abnormalities in blood pressure, especially the non-dipper and reverse-dipper types (P < 0.001). (3) In the elderly, there was a statistical difference in the circadian rhythm of blood pressure between the cognitive dysfunction group and the normal group, but this phenomenon did not exist in the middle-aged. (4) Binary logistic regression analysis showed that after adjusting for confounding factors, the risk of cognitive dysfunction in CSVD patients with non-dipper type was 4.052 times higher than that of dipper type (95% CI, 1.782–9.211; P = 0.001), and reverse-dipper type was 8.002 times higher than those with dipper type (95% CI, 3.367–19.017; P<0.001).ConclusionsThe disturbance of circadian rhythm of blood pressure may affect the cognitive function of patients with CSVD, and the risk of cognitive dysfunction in non-dipper and reverse-dipper types are higher.

Functional Connectivity and Executive Function Abilities Strengthen without Change in Structural Connectivity after Transfusion in Children with Sickle Cell Disease

Introduction Patients with sickle cell anemia (SCA) are at risk for cognitive dysfunction, independent of stroke. Functional connectivity (FC) is a quantitative MR measurement of the interactions between brain regions that compose large-scale networks of activity, giving rise to neurocognitive abilities. Structural connectivity (SC) assesses integrity of white matter axon bundles linking physically distant regions of the brain to allow for interregional interactions. We have shown FC is diminished in patients with SCA compared to healthy controls, and that FC decreases as cerebral metabolic stress, measured by oxygen extraction fraction (OEF, percent of oxygen removed from blood into brain tissue), increases. Paired with evidence that executive function abilities in SCD patients improve as metabolic stress decreases after transfusion of red blood cells (RBCs), we hypothesize that decreasing metabolic stress facilitates the acute reversal of disruptions in FC while SC remains unaffected after a single transfusion in children with SCA. Methods Patients >5 years of age with SCA receiving chronic transfusion therapy (CTT) (excluding those with cerebral vasculopathy), underwent laboratory evaluation, cognitive testing (NIH Toolbox-Cognition Battery [NIHTB-CB]), and a brain MRI on a Siemens 3T Prisma scanner within 4 days before and after RBC exchange transfusion. Brain MRI measured OEF (asymmetric spin echo [ASE]), FC (resting state BOLD) and SC (diffusion tensor imaging [DTI] with fractional anisotropy [FA] and mean diffusivity [MD] in 16 white matter tracts). OEF and FC processing were previously described (Fields et al. Ann Neurol. 2020; 88(5):995). The BOLD signal was correlated over time between 153 regions in 7 networks. Networks with <5 regions were excluded from analyses (Dworetsky et al. Neuroimage 2021; 237:118164). Global probabilistic tractography was used to reconstruct white matter tracts (Yendiki et al. Front Neuroinform 2011; 5:23). The Dimensional Change Card Sort (DCCS), Flanker Inhibitory Control and Attention (FICA), and List Sorting Working Memory (LSWM) metrics of the NIHTB-CB were averaged to calculate a composite executive function score. Post-transfusion cognitive testing was administered at the participant's first study visit, then pre-transfusion testing 3-7 weeks later, before their next transfusion. The learning effect thus biases our results toward the null (Hood et al. Ped Blood & Cancer. 2019; 66:e27899). Pre- and post-transfusion values were analyzed using the Wilcoxon signed-rank test. Significance threshold was set to α<0.05 after multiple comparison correction using the Benjamini-Hochberg procedure. Results Data were collected from 15 participants with SCA receiving CTT. Table 1 describes the cohort. There were significant increases in Hb (p<0.001) and HbA (p<0.001), and a decrease in HbS (p<0.001) after transfusion (Table 1). Consistent with prior work, metabolic stress, as measured by OEF, decreased post-transfusion in the whole brain (p=0.005), grey matter (p=0.006) and white matter (p=0.008). There was a significant increase in FC of the fronto-parietal (FP) network post-transfusion after correcting for multiple comparisons (p<0.001, Table 1) without a significant difference in SC of any white matter tracts. The FP network is a higher-level cognitive association network that facilitates executive function abilities. The LSWM test significantly improved post-transfusion (p=0.007) without a significant difference in the DCCS (p=0.406) or FICA (p=0.092) tests with transfusion. After correcting for multiple comparisons, improvement in the composite executive function score post-transfusion was not significant (raw p=0.033). Conclusion We conclude that there is a decrease in metabolic stress and strengthening of FC within the FP network without a change in SC in children with SCA after receiving a single RBC exchange transfusion. Consistent with the strengthened connectivity within the FP network, we found a significant improvement in executive abilities post-transfusion. These findings suggest MR measures of FC could potentially provide a neuroimaging biomarker for cognitive reversibility in SCA, applicable to emerging therapies in the field. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Association of Hypothyroidism and the Risk of Cognitive Dysfunction: A Meta-Analysis.

The purpose of this meta-analysis was to assess whether there is an association between hypothyroidism and the risk of cognitive dysfunction. PubMed, Cochrane Library, and Embase were searched for relevant studies published from database inception to 4 May 2022, using medical subject headings (MeSHs) and keywords. Eight studies involving 1,092,025 individuals were included, published between 2010 and 2021. The pooled analysis showed that there was no association between hypothyroidism and cognitive dysfunction (OR = 1.13, 95% CI = 0.84-1.51, p = 0.426), including both all-cause dementia (OR = 1.04, 95% CI = 0.76-1.43, p = 0.809) and cognitive impairment (OR = 1.50, 95% CI = 0.68-3.35, p = 0.318). Neither overt hypothyroidism (OR = 1.19, 95% CI = 0.70-2.02, p = 0.525) nor subclinical hypothyroidism (OR = 1.04, 95% CI = 0.73-1.48, p = 0.833) was associated with cognitive dysfunction. Neither prospective cohort (OR = 1.08, 95% CI = 0.77-1.51, p = 0.673) nor cross-sectional studies (OR = 1.23, 95% CI = 0.63-2.42, p = 0.545) had any effect on the association. Interestingly, the risk of cognitive dysfunction was significantly increased in the group not adjusted for vascular comorbidity (OR = 1.47, 95% CI = 1.07-2.01, p = 0.017), while it was reduced in the adjusted group (OR =0.82, 95% CI = 0.79-0.85, p &lt; 0.001). This meta-analysis shows that hypothyroidism was associated with a reduced risk of cognitive dysfunction after adjustment for vascular-disease comorbidities. More prospective observational studies are needed in the future to investigate the relationship between hypothyroidism and cognitive dysfunction.

Cognitive Dysfunction and Diabetes

Diabetes mellitus and cognitive dysfunction are highly prevalent in the aging population. In the aging society, clinicians will be increasingly tasked with managing elderly patients who have both cognitive dysfunction and diabetes. A growing number of epidemiological and clinical studies confirmed that diabetes is associated with an increase in the risk of cognitive dysfunction and dementia. Cognitive dysfunction is of particular importance because it is associated with poor self-management ability, poor diabetes management with more frequent severe hypoglycemic episodes, and increased risk of cardiovascular morbidity and mortality. Current diabetes guidelines recommend screening for cognitive dysfunction in older and high-risk patients and providing individualized guidance for patients with cognitive dysfunction. Nonetheless, there is limited awareness among clinicians regarding this subject compared to other diabetic micro- and macrovascular complications. Recently, there has been increasing understanding in this field through multimodal neuroimaging and biomarkers for early detection of cognitive dysfunction in diabetes. In addition, new agents such as glucagon-like peptide 1 receptor agonists showed promising protective effects against cognitive dysfunction and dementia in patients with type 2 diabetes. In this review, we summarize the relationship between diabetes and cognitive dysfunction, especially dementia, and some contributing factors and pathogenesis of dementia in diabetes. We also review how anti-diabetic medications may influence cognitive dysfunction and clinical management guidance.

Associations between objectively measured sedentary behavior patterns and depressive symptoms in older adults: A cross sectional study

BackgroundThe association between sedentary behavior and geriatric depressive symptoms remains unclear. Moreover, few studies use objective measurement to examine the relationship between comprehensive sedentary behavior patterns and geriatric depressive symptoms. AimsTo investigate the association between sedentary behavior patterns and geriatric depressive symptoms in older adults by objective measurement. MethodsA cross-sectional study was implemented in an outpatient department from September 2020 to September 2021. Participants were community-dwelling older adults aged 65 and older who could walk independently and were not at risk for cognitive dysfunction. Sedentary behavior patterns were measured by a tri-axial accelerometer for 7 consecutive days, and geriatric depressive symptoms were measured via the 15-item Geriatric Depression Scale. A binary logistic regression model and multiple linear regression model were performed to examine the relationship between sedentary behavior patterns and geriatric depressive symptoms scores. ResultsA total of 167 older Taiwanese adults (mean age: 80.2 ± 7.0 years; 50.9% male; 15.6% at risk for geriatric depressive symptoms) were included. After adjusting for potential confounders, achieving sedentary behavior time >9 h/day was not significantly associated with geriatric depressive symptoms; greater times of sedentary bouts and more sedentary breaks were also not associated with geriatric depressive symptoms. ConclusionThis study showed that the sedentary behavior patterns were not associated with geriatric depressive symptoms among older adults in the study sample. However, the important limitation in this study was that passive versus mentally active sedentary behavior were not assessed. It is suggested that further research could simultaneously use objective measurement and self-reported questionnaires to completely clarify the association between sedentary behavior patterns and geriatric depressive symptoms in older adults.

A longitudinal analysis of the effect of anemia on executive functions in children with mild to moderate chronic kidney disease.

Children with chronic kidney disease (CKD) are at risk for cognitive dysfunction. The aim of this study was to investigate associations between executive functions (EF), anemia, and iron deficiency. A total of 688 children > 6years of age enrolled in the Chronic Kidney Disease in Children (CKiD) study who underwent evaluation for EF were included. Hemoglobin (Hgb) was characterized as low (1st-5th percentile) or very low (< 1st percentile) compared to normative values for age, sex, and race irrespective of erythropoiesis-stimulating agent (ESA) usage. Longitudinal analysis was conducted using consecutive visit pairs, with anemia status defined as new onset, resolved, or persistent. Linear mixed models with random intercept were used and adjusted for key covariates. Anemia was present in 41% of children, and median Hgb was 11.8 gm/dl. New onset anemia was associated with lower digit span total score (- 0.75, 95% CI - 1.36, - 0.15, p = 0.01). Persistent anemia was associated with lower scores on color-word inhibition/switching (β = - 0.98; 95% CI - 1.78, - 0.18, p = 0.02). Errors of omission were significantly higher (worse) in those with persistent anemia (β = 2.67, 95% CI 0.18, 5.17, p = 0.04). Very low Hgb levels were significantly associated with lower color-word inhibition/switching scores (β = - 1.33, 95% CI - 2.16, - 0.51; p = 0.002). Anemia and low GFR were associated with lower category fluency scores compared to non-anemic subjects with higher GFR (β = - 1.09, 95% CI - 2.09, - 0.10, p = 0.03). The presence of anemia, in addition to its severity and duration in children with CKD, is associated with poorer scores on select measures of EF. A higher resolution version of the Graphical abstract is available as Supplementary information.

142-LB: Cognitive Screening among Older Adults with Diabetes

Background: Diabetes affects approximately 24.4% of older adults in the United States and increases the risk of cognitive dysfunction and future dementia. Patients with cognitive dysfunction may find it harder to manage their diabetes and have more complications such as hypoglycemia. Yearly cognitive screening is recommended for all older adults with diabetes but may not be widely conducted. Methods: We performed cognitive screening with the Mini-Cog test for a subset of patients with diabetes seen in Endocrine Clinics in one large healthcare system in 2020-21. We used a retrospective chart review to compare patient screening results between Endocrine (Endo) , Geriatric (Geri) and multidisciplinary Endo-Geriatric practices (Geri-Endo) . We used Chi-square tests to examine differences between clinic cohorts and a multivariate logistic regression to predict risk of cognitive dysfunction. We adjusted for age, ethnicity, sex, type of diabetes, Sulfonylurea (SU) use, ACE inhibitors (ACEI) / Angiotensin Receptor Blocker (ARB) use, smoking history, statin use, and BMI. Findings: Among 198 patients screened (Endo=80, Geri=32, Geri-Endo=86) , those seen in Geri-endo (40.7%) and Geri (31.3%) were more likely to have lower Mini-COG scores (lower scores suggest worse cognition) as compared to those in Endo (6.3%) (p&amp;lt;.0001) . Patients in Endo and Geri-Endo had longer duration of diabetes, were more likely to use insulin and had higher incidence of documented hypoglycemia. Higher age &amp;gt; 75 years (p=0.0105) , previous CV events (p=0.0006) and BMI &amp;lt;30 (p=0.0115) were significantly associated with lower Mini-COG scores. Conclusion: Our study shows that cognitive screening can help identify older adults at risk for dementia in diabetes clinic. Patients with older age, previous CV events and lower BMI may be at higher risk for cognitive dysfunction. Older adults should be screened yearly for cognition as part of routine diabetes care. Disclosure D. Gupta: None. H. Wilhalme: None. G. Sauder: None. T. Moin: None. Funding NIH National Center for Advancing Translational Science (NCATS) , UCLA CTSI (UL1TR001881)

Socioeconomic Status and Risks of Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of 39 Prospective Studies.

In recent decades, increased attention has been paid to the impact of socioeconomic status (SES) on cognition function and dementia, however, an ongoing debate continues to exist. The objective of our study was to explore the potential effect of SES on the risks of cognitive dysfunction and dementia. PubMed, Cochrane Library, and EMBASE were searched for prospective studies from inception to 9 January 2022. Meta-analyses using random-effect models were performed, and then subgroup analyses stratified by study characteristics for specific outcomes were conducted. Thirty-nine prospective studies (1,485,702 individuals) were eligible for inclusion, of which 25 reported the incidence of dementia and 14 reported cognitive decline. Primary results of the meta-analyses found an elevated combined risk of cognitive impairment and dementia (relative risk [RR] = 1.31, 95% confidence interval [CI] = 1.16-1.49) in low-SES participants compared with high-SES participants. We also found an elevated risk of all-cause dementia (RR = 1.40, 95% CI = 1.12-1.74) in low-SES participants. Further subgroup analyses stratified by education, occupation, and income showed that low education subgroup (RR = 1.21, 95% CI = 1.04-1.41) and low-income subgroup (RR = 1.22, 95% CI = 1.10-1.35) had an increased combined risks of cognitive impairment and dementia, but only individuals with lower education had a higher risk of dementia (RR = 1.66, 95% CI = 1.20-2.32). Low SES substantially increased the risk of dementia and cognitive dysfunction, suggesting that public health strategies could reduce the dementia burden by reducing social inequalities.

Attitudes towards screening for cognitive dysfunction: Interviews with Latinx adults with type 2 diabetes

AbstractBackgroundOne in nine Latinx adults over 45 years old experience subjective cognitive decline (SCD). Yet less than half of people with SCD discuss symptoms with their provider (BRFSS, 2015‐2018). Because current diagnostic criteria focus on dementia, a later stage pathology, the window of opportunity for effective interventions may be missed. Cognitive screening can help identify pathology, and it can also assist in identifying those at risk for higher health care utilization. In qualitative interviews, Latinx adults with T2DM frequently avoided asking about cognitive problems or cognitive health due to stigma or discrimination (Cuevas &amp; Zuñiga, 2020). The purpose of this project was to understand relevant factors affecting cognitive screening, which is critical for designing effective and timely interventions.MethodData was collected using semi‐structured interviews with Latinx adults with type 2 diabetes. General questions were asked regarding knowledge of cognitive screening, risks for cognitive dysfunction, and attitudes towards screening. Interviews were transcribed, entered into NVivo software, and analyzed using grounded theory techniques.ResultInterviews ranged from 30 minutes to 1 hour. Participants (n= 30) were 53% Female; mean age: 66.4 years; Mean A1C: 9.7%; and 57% Mexican American. Participants who were younger and had higher levels of education were more likely to report comfort with cognitive screening. Inability to work related to a possible diagnosis of dementia was a concern related to screening for most participants. However, that was not a reason to decline screening. Participants (88%) wanted more information on how the results of screening tests would be used as well as information on how to maintain or improve “brain health.” Although not part of the interview guide 45% said they would prefer to see healthcare providers with similar ethnic backgrounds.ConclusionOverall, screening for cognitive dysfunction was well received by participants. Themes included some hesitancy to be screened but also a desire to know more about risks for dementia and how to maintain health. Given the encouraging results, a larger study further exploring these themes with Latinx adults and comparing them with provider and clinic factors affecting screening is being conducted.

Old critically ill COVID‐19 survivors: Patient and in‐hospital factors associated with cognitive dysfunction

BackgroundCognitive dysfunction (CD) commonly occurs in survivors of critical illness, namely in those with severe respiratory failure, invasive mechanical ventilation (IMV), deep sedation and delirium. Many critically ill patients with COVID‐19 are also expected to have an increased risk of CD, which may be exacerbated by specific conditions of hospitalization during COVID‐19 pandemic. This study aimed to estimate the frequency of post‐discharge CD in first wave COVID‐19 survivors and to identify baseline and in‐hospital associated factors.MethodsThis study is part of a multidisciplinary longitudinal project (MAPA‐Mental health in critically ill COVID‐19 patients), that is being conducted in Intensive Care Medicine Department of a Portuguese University Hospital. Patients >60 years, admitted due to COVID‐19‐associated Pneumonia, were included. Exclusion criteria were: Intensive Care Unit (ICU) length of stay (LoS)≤24h, terminal illness, major sensory loss or inability to communicate at the time of follow‐up. Participants were evaluated with Six‐item Cognitive Impairment Test (6CIT) by telephone. Baseline demographic, clinical and in‐hospital data were collected, including sedation, respiratory support, major complications and LoS. Patients with and without CD after‐discharge were compared.ResultsThirty‐two patients were included, with a median age of 72(IQR:64‐76) years, mostly were male (66%) and none had previous clinical registry of cognitive impairment or dementia. Nosocomial infection (75%) and difficult weaning from MV (63%) were the most frequent complications. Deep sedation was used in 81% of the patients (median=20 days; IQR:15‐42). About 81% needed IMV and 13% were supported with Extracorporeal Membrane Oxygenation (ECMO). Median ICU and hospital LoS were 29(IQR:144‐56) and 66(IQR:33‐102) days, respectively. Follow‐up assessment occurred 93.4 days (IQR:68‐120) after‐discharge. Based on 6CIT, 16% of survivors had CD. Comparing both groups, those with CD were older (73vs.64; p=0.020), had a higher duration of IMV (73vs.22; p=0.017) and mostly were supported with ECMO (75%vs.25%; p=0.008).ConclusionData suggest that CD is more frequent among older COVID‐19 survivors, and those who needed prolonged IMV and ECMO support. Despite full clarification of all mechanisms involved, these findings highlight the importance of a timely and organized post‐intensive care response composed by multidisciplinary teams to optimize assistance to survivors of critical illness.

A Novel Game-Based Intelligent Test for Detecting Elderly Cognitive Function Impairment.

Purposes This research explores the game-based intelligent test (GBIT), predicts the possibilities of Mini-Mental State Examination (MMSE) scores and the risk of cognitive impairment, and then verifies GBIT as one of the reliable and valid cognitive assessment tools. Methods This study recruited 117 elderly subjects in Taiwan (average age is 79.92 ± 8.68, average height is 156.91 ± 8.01, average weight is 59.14 ± 9.67, and average MMSE score is 23.33 ± 6.16). A multiple regression model was used to analyze the GBIT parameters of the elderly's reaction, attention, coordination, and memory to predict their MMSE performance. The binary logistic regression was then utilized to predict their risk of cognitive impairment. The statistical significance level was set as α = 0.05. Results Multiple regression analysis showed that gender, the correct number of reactions, and the correct number of memory have a significantly positive predictive power on MMSE of the elderly (F = 37.60, R2 = 0.69, and p < 0.05). Binary logistic regression analysis noted that the correct average number of reactions falls by one question, and the ratio of cognitive dysfunction risk increases 1.09 times (p < 0.05); the correct average number of memory drops by one question, the ratio of cognitive dysfunction risk increases 3.76 times (p < 0.05), and the overall model predictive power is 88.20% (sensitivity: 84.00%; specificity: 92.30%). Conclusions This study verifies that GBIT is reliable and can effectively predict the cognitive function and risk of cognitive impairment in the elderly. Therefore, GBIT can be used as one of the feasible tools for evaluating older people's cognitive function.

Abstract 10820: Atrial Fibrillation Catheter Ablation Reduces the Risk of Dementia: A Systematic Review and Meta-Analysis

Introduction: Although atrial fibrillation (AF) has a risk of cognitive dysfunction, it is not clear whether AF catheter ablation impacts cognitive function. Catheter ablation for AF prolongs the duration of sinus rhythm, thereby improving the quality of life and theoretically reducing the risk of dementia. Objective: We investigated the association of catheter ablation for AF with the occurrence of any dementia. Methods: A systematic search using electronic databases was performed from inception until January 15, 2021. Mantel-Haenszel risk ratio (RR) random-effects model (DerSimonian and Laird method) was used to summarize data. The primary outcome was occurrence of dementia during the follow-up period. Statistical analysis was performed using a meta-package for R version 4.0 and Rstudio version 1.2. Results: A total of 3 eligible studies (retrospective and prospective) consisting of 34,360 patients [Catheter ablation = 10,862 and medical therapy (antiarrhythmic drugs or rate-control drugs) = 23,498] were included in the meta-analysis. Patients in the ablation group were younger compared to medical therapy (59.6 ± 10.4 vs 60.3 ± 10.6 years; p&lt;0.001). Hypertension (55% vs 54.4%, p = 0.31), heart failure (23.7% vs 22.1%, p = 0.001), diabetes (14% vs 15.2%, p = 0.004), cerebrovascular accident (11% vs 10%, p = 0.005) and myocardial infarction (7.5% vs 6.5%, p&lt;0.001) were most common comorbidities, respectively. There was a lower incidence of dementia in AF patients treated with catheter ablation compared to medical therapy (2% vs 3.5%, RR 0.39, 95% CI 0.22-0.70, p&lt;0.01) during a mean follow-up period of 5.44 years. Conclusion: AF ablation patients have a significantly lower risk of dementia in comparison to AF patients without ablation.

Transcriptional Profiles Reveal Deregulation of Lipid Metabolism and Inflammatory Pathways in Neurons Exposed to Palmitic Acid.

The effects of the consumption of high-fat diets (HFD) have been studied to unravel the molecular pathways they are altering in order to understand the link between increased caloric intake, metabolic diseases, and the risk of cognitive dysfunction. The saturated fatty acid, palmitic acid (PA), is the main component of HFD and it has been found increased in the circulation of obese and diabetic people. In the central nervous system, PA has been associated with inflammatory responses in astrocytes, but the effects on neurons exposed to it have not been largely investigated. Given that PA affects a variety of metabolic pathways, we aimed to analyze the transcriptomic profile activated by this fatty acid to shed light on the mechanisms of neuronal dysfunction. In the current study, we profiled the transcriptome response after PA exposition at non-toxic doses in primary hippocampal neurons. Gene ontology and Reactome pathway analysis revealed a pattern of gene expression which is associated with inflammatory pathways, and importantly, with the activation of lipid metabolism that is considered not very active in neurons. Validation by quantitative RT-PCR (qRT-PCR) of Hmgcs2, Angptl4, Ugt8, and Rnf145 support the results obtained by RNAseq. Overall, these findings suggest that neurons are able to respond to saturated fatty acids changing the expression pattern of genes associated with inflammatory response and lipid utilization that may be involved in the neuronal damage associated with metabolic diseases.

155-OR: Diabetes Complications and Cognitive Function in Youth with Type 1 and Type 2 Diabetes: The SEARCH for Diabetes in Youth Study

Both type 1 (T1D) and type 2 diabetes (T2D) impart significant risk for cognitive dysfunction. Adults experiencing diabetes-related complications in particular, have pronounced cognitive deficits. It is unknown whether multiple diabetes complications co-occur with cognitive dysfunction, specifically in youth-onset T1D and T2D. Using data from the SEARCH for Diabetes in Youth cohort study, we examined clustering of diabetes type, complications, and performance on cognitive tests in young adults with youth-onset T1D or T2D. Cognition was assessed via the NIH Toolbox Cognition Battery and age-corrected scores for composite fluid cognition were used. Diabetes complications included retinopathy, microalbuminuria, arterial stiffness, peripheral neuropathy, and cardiac autonomic neuropathy (CAN). Hierarchical clustering was applied with 795 participants (T1D=635; T2D=160). Three clusters emerged. Cluster 1 (C1; n=154) had the lowest composite fluid cognition scores, compared with Clusters 2 (C2; n=603) and 3 (C3; n=38) (mean [SD] 84.3 [17.7], 96.9 [15.7], 97.3 [16.2]; p&amp;lt;0.001). Compared with C2/C3, participants in C1 were predominantly young adults with T2D (79% vs. 4.6% and 28.9%, respectively; p&amp;lt;0.001), with higher prevalence of microvascular complications including, peripheral neuropathy (24% vs. 6.1% and 15.8%; p&amp;lt;0.001), retinopathy (24% vs. 12.3% and 13.2%; p=0.001), and microalbuminuria (24.7% vs. 6.5% and 10.5%; p&amp;lt;0.001). Compared with C1/C3, participants in C2 were predominantly young adults with T1D (95.4% vs. 21.4% and 71.1%; p&amp;lt;0.001). Compared with C1/C2, C3 was unique, with all participants having CAN (100% vs. 1.3% and 0%; p&amp;lt;0.001) and the highest average composite fluid cognition scores. Our data suggest that co-occurrence of microvascular complications coincide with worse cognitive function, especially in youth-onset T2D. Further research would be valuable to explore the relationship between CAN and cognitive performance. Disclosure A. Shapiro: None. S. M. Marcovina: None. A. D. Liese: None. A. K. Mottl: Advisory Panel; Self; Bayer U. S. E. T. Jensen: None. G. Wilkening: None. A. Bellatorre: None. D. Dabelea: None. J. M. Stafford: None. R. Dagostino: Consultant; Self; AstraZeneca, Biogen, Daiichi Sankyo. A. S. Shah: None. E. M. Urbina: None. C. E. Barrett: None. C. Pihoker: None. Funding Centers for Disease Control and Prevention (00097, DP-05-069, DP-10-001, 1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); National Institute of Diabetes and Digestive and Kidney Diseases (1UC4DK108173); Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01DP000246, U18DP002714); University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01DP000247, U18DP000247-06A1); Cincinnati’s Children’s Hospital Medical Center (U18DP006134, U48/CCU519239, U01DP000248, 1U18DP002709); University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01DP000254, U18DP002708); Seattle Children’s Hospital (U18DP006136, U58/CCU019235-4, U01DP000244, U18DP002710-01); Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01DP000250, 200-2010-35171)

Association of language proficiency, sociodemographics, and neurocognitive functioning in dual-language Latino survivors of childhood acute lymphoblastic leukemia and lymphoma.

Survivors of childhood acute lymphoblastic leukemia and lymphoma (ALL/LL) are at risk for cognitive dysfunction, but little is known about its relationship with language proficiency and sociodemographics. In this cross-sectional cohort study of Latino survivors of childhood ALL/LL, English and Spanish language proficiency and cognitive and academic functioning were measured and their associations determined using paired t-tests, Pearson correlations, and linear regressions. Participants (N=57; 50.9% female) had mean ages (years ± SD) of 4.3 ± 2.6 at diagnosis and 10.6 ± 2.9 at testing (range 6-16); mean time post treatment was 3.7 ± 2.6years. The majority (73.7%) had low socioeconomic status (SES). Most (78.8%) were dual-language learners in English and Spanish. English proficiency was graded as limited-to-fluent and was significantly higher than Spanish (p<.001). Higher SES was correlated with higher English proficiency (r=0.31, p=.020). Males had higher Spanish proficiency (r=-0.32, p=.034). Controlling for SES and sex, English proficiency accounted for 43% of cognitive functioning variance (F=14.86, p<.001), 55% of reading comprehension variance (F=22.14, p<.001), and 21% of mathematics variance (F=5.76, p=.002). Low language proficiency correlated with SES but was independently associated with lower cognitive and academic functioning. Research and surveillance for neurocognitive late effects in Latino ALL/LL survivors should incorporate measures of language proficiency and SES to account for their effects on cognitive and academic functioning.

Association Between Childhood Neighborhood Quality and the Risk of Cognitive Dysfunction in Chinese Middle-Aged and Elderly Population: The Moderation Effect of Body Mass Index.

Background: Identification of early modifiable factors is crucial to delay or prevent the development of cognitive impairment and reduce the social and economic burden.Objective: This study aimed to examine the longitudinal associations of childhood neighborhood quality (CNQ) with the risk of later-life cognitive dysfunction and the role of body mass index (BMI) in this association.Methods: A total of 8,289 community-dwelling middle-aged and elderly population from wave 2011, wave 2013, and wave 2015 of the China Health and Retirement Longitudinal Study (CHARLS) were included. Cognitive function and CNQ were measured by standardized questionnaires. Multilevel linear regression models were used to estimate the associations of CNQ and cognitive function. The interactions of BMI with CNQ in the progress of cognitive function were also estimated.Results: The participants with higher CNQ had a significantly low risk of cognitive impairment than those with lower CNQ score (β = 0.067, 95% CI: 0.031, 0.103), and the results remained similar (β = 0.039, 95% CI: 0.004, 0.075) after controlling other confounding variables. Furthermore, there was an interaction between BMI with CNQ score (P < 0.001) for the risk of cognitive impairment. In BMI-stratified analysis, we found that the association of CNQ and cognitive function was not statistically significant in overweight or obese population (β = 0.019, 95% CI: −0.032, 0.070), but was statistically significant in people with lower BMI (β = 0.059, 95% CI: 0.010, 0.107).Conclusions: Higher CNQ score is significantly associated with the lower risk of cognitive dysfunction in adulthood. BMI may moderate the associations of CNQ with the risk of cognitive function.

Investigating Whether Depressed Youth Exhibiting Elevated Inflammation Perform Worse on Measures of Executive Functioning, Verbal Fluency and Episodic Memory in a Large, Population Based Sample of Dutch Adolescents

Cognitive functioning is disrupted during a depressive episode and cognitive dysfunction persists when depression is in remission. Depressed individuals who exhibit elevated basal levels of inflammation may be at particular risk for cognitive dysfunction.