Subjective Cognitive Decline Risk Research Articles

Long-Term Intake of Red Meat in Relation to Dementia Risk and Cognitive Function in US Adults.

Previous studies have shown inconsistent associations between red meat intake and cognitive health. Our objective was to examine the association between red meat intake and multiple cognitive outcomes. In this prospective cohort study, we included participants free of dementia at baseline from 2 nationwide cohort studies in the United States: the Nurses' Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS). Diets were assessed using a validated semiquantitative food frequency questionnaire. We ascertained incident dementia cases from both NHS participants (1980-2023) and HPFS participants (1986-2023). Objective cognitive function was assessed using the Telephone Interview for Cognitive Status (1995-2008) among a subset of NHS participants. Subjective cognitive decline (SCD) was self-reported by NHS participants (2012, 2014) and HPFS participants (2012, 2016). Cox proportional hazards models, general linear regression, and Poisson regression models were applied to assess the associations between red meat intake and different cognitive outcomes. The dementia analysis included 133,771 participants (65.4% female) with a mean baseline age of 48.9 years, the objective cognitive function analysis included 17,458 female participants with a mean baseline age of 74.3 years, and SCD analysis included 43,966 participants (77.1% female) with a mean baseline age of 77.9 years. Participants with processed red meat intake ≥0.25 serving per day, compared with <0.10 serving per day, had a 13% higher risk of dementia (hazard ratio [HR] 1.13; 95% CI 1.08-1.19; plinearity < 0.001) and a 14% higher risk of SCD (relative risk [RR] 1.14; 95% CI 1.04-1.25; plinearity = 0.004). Higher processed red meat intake was associated with accelerated aging in global cognition (1.61 years per 1 serving per day increment [95% CI 0.20-3.03]) and in verbal memory (1.69 years per 1 serving per day increment [95% CI 0.13-3.25], both plinearity = 0.03). Unprocessed red meat intake of ≥1.00 serving per day, compared with <0.50 serving per day, was associated with a 16% higher risk of SCD (RR 1.16; 95% CI 1.03-1.30; plinearity = 0.04). Replacing 1 serving per day of nuts and legumes for processed red meat was associated with a 19% lower risk of dementia (HR 0.81, 95% CI 0.75-0.86), 1.37 fewer years of cognitive aging (95% CI -2.49 to -0.25), and a 21% lower risk of SCD (RR 0.79, 95% CI 0.68-0.92). Higher intake of red meat, particularly processed red meat, was associated with a higher risk of developing dementia and worse cognition. Reducing red meat consumption could be included in dietary guidelines to promote cognitive health. Further research is needed to assess the generalizability of these findings to populations with diverse ethnic backgrounds.

Adverse Childhood Experiences and Subjective Cognitive Decline Among Transgender Adults.

Adverse childhood experiences (ACEs) are associated with an increased risk of developing chronic health conditions, including Alzheimer's disease and related dementias (ADRD) and subjective cognitive decline (SCD), self-reported confusion/memory loss, and an early clinical manifestation of ADRD. While ACEs and SCD have both been individually studied in transgender and nonbinary (TGN) adults, no study has examined the relationship between the two among this population. This study sought to establish the prevalence of ACEs and their association with SCD among TGN adults. Cross-sectional, secondary analysis of publicly available data. 2019-2021 Behavioral Risk Factor Surveillance System data, representing 16 US states that assessed ACEs, SCD, and self-reported gender identity were used to determine the association between ACEs and SCD among TGN adults aged 45+ (N = 206). Pearson's chi-squared/Fisher's exact tests assessed the association between ACEs (individual, categorical, sum score) and SCD. Crude and adjusted odds ratios (aORs) along with 95% confidence intervals (CIs) were calculated to investigate the associations between ACEs and SCD. 18% (n = 38) of TGN adults in the sample endorsed SCD, 60% (n = 120) experienced any ACE, 20% (n = 41) 1 ACE, and 18% (n = 37) experienced > 4 ACEs. Nearly 50% experienced childhood abuse (n = 94) or household dysfunction (n = 92). Among those with SCD, 34% (n = 13) reported > 4 ACEs, and 73% (n = 26) reported childhood abuse or household dysfunction (n = 27). Most ACES were associated with and increased the risk of SCD, even after adjusting for BRFSS year, age, race, education, and employment. The odds of SCD increased 40% as the number of ACEs increased (aOR = 1.4, 95% CI: 1.2-1.6, p < 0.0001). The odds of SCD were higher with childhood abuse (aOR = 4.3, 95% CI: 1.88-10.02, p < 0.01) or household dysfunction (aOR = 4.7, 95% CI: 2.00-11.07, p < 0.01). ACEs increase the risk of SCD among TGN adults. Gender-affirming and trauma-informed nursing care are important, and screening and interventions for ACEs and SCD are needed to help reduce the risk of SCD and ADRD. Examining how adverse childhood experiences impact different aspects of health, including brain health, is important to nursing practice as it can provide clinical care strategies and identify interventions to specifically address ways to improve the health and well-being of transgender and nonbinary people.

A mobile-based multidomain lifestyle intervention using Cognitive Evergreenland for older adults with subjective cognitive decline: a feasibility study

BackgroundDementia is a growing public health issue. Non-drug interventions targeting individuals before the onset of overt cognitive decline may be effective. Subjective cognitive decline (SCD) is present in > 50% of older adults and associated with progression to dementia. Here, we tested the compliance and effectiveness of a Multidomain Lifestyle Intervention Program using the mini-program, Cognitive Evergreenland, (MLIP-CE), based on the Health Action Process Approach model to support home-based intervention in older adults with SCD.MethodsCognitive Evergreenland was designed to improve cognitive reserve and maintain brain function in people at high risk of dementia and included: cognitive stimulation, cognitive training, health education, vascular risk monitoring, social support, and functional assessment, among other features. This was an exploratory trial designed to examine participant compliance with the mobile lifestyle intervention and its effectiveness, as well as changes in health-related indicators and cognitive function of older adults with SCD from baseline to 12 and 24 weeks post-intervention.ResultsThe retention rate for MLIP-CE was 90.2% (37/41). Mean participant age was 70.93 ± 6.91 years, 73.2% of participants were female, and mean Montreal Cognitive Assessment score was 24.51 ± 2.87. Throughout the 24 weeks of the prescribed intervention, app usage remained consistently high, with over 92% of participants using the mini-program at least once a week and successfully completing corresponding health management tasks. In terms of average usage, cognitive training emerged as the most frequently used functional module (95.73%), closely followed by health education (95.02%). The health behavior levels of older adults with SCD, measured in terms of ability, opportunity, and motivation, were significantly increased relative to baseline (p < 0.001). Regarding cognitive function, Mini-Mental State Examination scores were significantly improved post-intervention, with a moderate effect size (Hedges’ g = 0.60).ConclusionsThese findings suggest that MLIP-CE, which was designed based on a theoretical framework, has potential for implementation, and support ongoing research into use of MLIP-CE for individuals at high risk of SCD or other dementia conditions.Trial registrationThe trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR2200058665 on 13 April 2022.

Differential Impact of Risk Factors for Cognitive Decline in Heterosexual and Sexual Minority Older Adults in England.

Sexual minority older adults (SMOAs) report greater subjective cognitive decline (SCD) than heterosexual older adults (HOAs). This study aimed to compare the impact of multiple psycho-social risk factors on objective and subjective cognitive decline in HOAs and SMOAs. Two samples of self-identified HOAs and SMOAs were selected from the English Longitudinal Study of Ageing. Reliable change indices for episodic and semantic memory were created to assess cognitive decline. SCD was self-reported for memory and general cognition. Depressive symptoms, loneliness, marital status and socio-economic status were investigated as risk factors. No between-group differences were found in cognitive decline. Higher depression was associated with greater SCD risk and worse semantic memory decline. The latter effect was stronger in SMOAs. The findings were largely replicated in the sensitivity analysis. Poor mental health may represent the strongest driver of cognitive decline in SMOAs and to a greater extent than in HOAs.

Early detection of subjective cognitive decline from self-reported symptoms: An interpretable attention-cost fusion approach.

Subjective cognitive decline (SCD) refers to self-reported difficulties in concentration, memory, and decision-making. Since SCD is based on subjective experiences, no specific medical test can definitively confirm its presence, making early detection challenging. Thus, it is advantageous to develop an AI model to capitalize on self-reported health complications, personality traits, and sociodemographic factors for early detection of SCD. This research has proposed an AI-based framework for SCD detection using self-reported measures from the BRFSS 2021 dataset. A novel Weighted Fusion Selection (WFS) approach has been introduced, which combines multiple feature selection techniques to address class imbalance and identify relevant features associated with less frequent classes. The data set has shown a significant imbalance, with individuals at risk of SCD being 81.76% fewer than those not at risk. An Attention Cost Convolutional Neural Network (AC-CNN) has been developed to address this, integrating channel-wise attention mechanisms and cost-sensitive learning to enhance performance across imbalanced data. The AC-CNN model has achieved a balance between specificity (77%) and sensitivity (81%), with an AUC-ROC of 0.87. This has represented an overall 24.8% improvement in handling class imbalance compared to prior studies. Additional testing on the NHIS 2022 dataset has shown that AC-CNN has maintained balanced performance, confirming its robust generalizability, while other models have remained unstable. Further, applying SHapley Additive exPlanations (SHAP) explainable techniques to the AC-CNN model has revealed how individual aspects of an individual's health records, lifestyle, and demographics contribute to the prediction of SCD. For example, depression, low education, poor income, inadequate healthcare, and poor overall health have all been strongly linked to an increased risk of SCD.

Associations between adverse childhood experiences and subjective cognitive decline: A scoping review.

Long-term health effects of adverse childhood experiences (ACEs) include cognitive decline that occurs later in life. Subjective cognitive decline (SCD), recognized as an early indicator of Alzheimer's disease, may present an essential period for intervention in populations with ACEs. This review aims to explore the associations between ACEs and SCD, while examining the potential moderating effects of sociodemographic factors METHODS: A systematic search of four databases (Medline, PsycINFO, CINAHL, and Web of Science) was conducted from inception to July 2024. Eligible studies included adults with a history of ACEs and self-reported SCD. In total, twelve studies were included, primarily using U.S.-based samples, with sample sizes ranging from 46 to over 195,000 participants. The evidence of a dose-response relationship highlights the link between ACEs and SCD. The risk of SCD increases among adults over 65, lower-income groups, and sexual minorities. However, gender differences were inconsistently observed across studies. Mental health conditions, particularly depression is a significant risk factor. Early screening and intervention for SCD among individuals with high ACE exposure may help delay the progression to severe cognitive impairment. However, the reliance on cross-sectional studies and high risk of bias limit causal inferences. Future research should explore longitudinal studies with diverse populations to clarify causal pathways and the role of sociodemographic factors in the ACE-SCD relationship.

IMPACT OF STRUCTURAL RACISM ON COGNITIVE DECLINE

Abstract Black individuals are twice as likely as White individuals to develop cognitive impairment. However, little empirical research has investigated the sources underlying these racial disparities. We examine the effects of exposure to structural racism as a fundamental cause of racial disparities in the risk of subjective cognitive decline among older adults. Data on subjective cognitive decline from the 2015-2016 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed among adults aged 45 years and older. We operationalized structural racism as an index of the number of racist vs. neutral vs. anti-discriminatory state-level policies. BRFSS participants were assigned structural racism exposure based on their state of residence at the time of the survey. The association between exposure to structural racism and the risk of subjective cognitive decline was examined using multilevel logistic regression models. Interaction terms were used to examine how this association was modified by individual-level race. American Indian Alaska Native, multiracial, and Hispanic individuals had the highest reports of experiencing subjective cognitive decline. Black individuals were the most likely to live in states with high levels of structural racism. Greater exposure to structural racism was associated with higher odds of reporting subjective cognitive decline. This association was modified by individual-level race and ethnicity, such that the risk of subjective cognitive decline decreased with increasing exposure to structural racism among Hispanic individuals. These findings warrant further research into exploring the social and emotional factors that offer resilience among Hispanic older adults.

SUBJECTIVE COGNITIVE DECLINE IN OLDER ADULTS BY SEXUAL ORIENTATION AND GENDER IDENTITY

Abstract LGBTQ+ adults experience a high risk of subjective cognitive decline (SCD) due to increased exposure to stressors that threaten cognitive health. Yet, researchers know little about how the risk of SCD varies by sexual orientation and gender identity (SOGI). We examine how SCD differs by SOGI using Wave 1 of the Vanderbilt University Social Networks, Aging, and Policy Study survey of LGBTQ+ adults aged 50-76 residing in the South (n=1256). We assess subjective cognitive health using an index of self-reported cognitive difficulties, many of which have been used in validated instruments. Using linear probability models, we examine the association of SCD with SOGI. To identify significant differences, we use standardized differences &amp;gt;10% in the average predicted probability of reporting ≥1 cognitive difficulty across SOGI, after adjusting for sociodemographic characteristics. Forty percent of respondents reported ≥1 cognitive difficulty. Bisexual individuals have the highest likelihood of SCD (54%), while lesbian/gay respondents had the lowest (39%). Across gender identities, gender non-conforming persons have the highest predicted probability of SCD (57%), followed by transgender men (54%), transgender women (48%), females/assigned female at birth (40%), and males/assigned male at birth (39%). Standardized differences are &amp;gt;10% across all comparisons. We find evidence that the prevalence of ≥1 cognitive difficulty in the sample of LGBTQ+ adults varies significantly by SOGI. Comprehensive SOGI health data from all US states is essential to accurately gauge SCD prevalence among LGBTQ+ older adults and to ensure inclusive clinical and public health interventions for populations at higher risk of cognitive impairment.

Association Between Dietary Diversity and Subjective Cognitive Decline in the Middle-Aged and Elderly Chinese Population: A Cross-Sectional Study.

This cross-sectional study aimed to examine the association between dietary diversity and risk of subjective cognitive decline (SCD), a precursor of dementia, in middle-aged and elderly Chinese populations residing in eastern China. Participants aged ≥ 45 years were recruited from a community in an eastern Chinese city after excluding potential objective cognitive impairment using the Mini-Cognitive Assessment Instrument (Mini-Cog). SCD was assessed using the Subjective Cognitive Decline Questionnaire-9 (SCD-Q9). Dietary data were collected using the Dietary Quality Questionnaire (DQQ), and the Food Group Diversity Score (FGDS) and the Consumed All Five Recommended Food Score (All-5) were calculated as indicators of dietary diversity. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed to evaluate the associations of FGDS and All-5 scores with SCD after adjusting for age, sex, socioeconomic status, lifestyle factors, and health status. Among the 871 participants, 358 (41.1%) were classified as having SCD. Compared with participants with the highest FGDS (≥8) and those with the highest All-5 score (5), those with the lowest FGDS (≤4) and the lowest All-5 score (≤3) exhibited 85% (OR = 1.85; 95% CI: 1.10-3.13; p = 0.02) and 90% (OR = 1.90; 95% CI: 1.21-2.97; p < 0.01) higher risk of SCD, respectively, after adjusting for all covariates. Fruits were the only food group among the All-5 components that demonstrated a significant association with SCD risk. Poor dietary diversity was associated with an elevated risk of SCD in middle-aged and older adults, and fruits were the food group with the most substantial effect.

Herpes zoster and long-term risk of subjective cognitive decline

BackgroundHerpes zoster (HZ), commonly known as “shingles,” may contribute to cognitive decline through mechanisms such as neuroinflammation or direct neuronal injury. However, evidence on the longitudinal association between HZ and cognitive decline is conflicting and whether the risk differs by APOE ε4-carrier status has not been studied; prospective cohort studies on the association between HZ vaccination and cognitive decline are also lacking.MethodsWe included 149,327 participants from three large cohorts—the Nurses’ Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (HPFS)—to prospectively examine the association between HZ and subsequent subjective cognitive decline (SCD). Poisson regression was used to estimate the multivariable-adjusted relative risk (MVRR) of a 3-unit increment in SCD score according to years since HZ compared with participants with no history of HZ.ResultsCompared with individuals with no history of HZ, the MVRR (95% CI) of a 3-unit increment in SCD score was significantly and independently higher among individuals with a history of HZ, but the duration of time since HZ when the elevated risk of SCD was statistically significant differed among the cohorts. In NHS, HZ was associated with higher long-term risk of SCD; compared with individuals with no history of HZ, the MVRR (95% CI) of a 3-unit increment in SCD score was 1.14 (1.01, 1.32) for ≥ 13 years since HZ. In NHS II, HZ was associated with higher risk of SCD in both the short-term [MVRR 1.34 (1.18, 1.53) for 1–4 years] and long-term [MVRR 1.20 (1.08, 1.34) for ≥ 13 years since HZ]. In HPFS, an elevated risk of SCD was suggested across all time points. Among the subset of participants with information on APOE ε4, there was a suggestion that the association differed by APOE ε4 carrier status, but the results were not consistent between women and men. Among the subset of women with information on HZ vaccination, there was a suggestion that the long-term risk of SCD may be greater among women who were not vaccinated against HZ.ConclusionsData from three large independent cohorts of women and men showed that HZ was associated with higher long-term risk of SCD, and the risk may differ by APOE ε4-carrier status.

Subjective Cognitive Decline Plus and Longitudinal Assessment and Risk for Cognitive Impairment

Subjective cognitive decline (SCD) is recognized to be in the Alzheimer disease (AD) cognitive continuum. The SCD Initiative International Working Group recently proposed SCD-plus (SCD+) features that increase risk for future objective cognitive decline but that have not been assessed in a large community-based setting. To assess SCD risk for mild cognitive impairment (MCI), AD, and all-cause dementia, using SCD+ criteria among cognitively normal adults. The Framingham Heart Study, a community-based prospective cohort study, assessed SCD between 2005 and 2019, with up to 12 years of follow-up. Participants 60 years and older with normal cognition at analytic baseline were included. Cox proportional hazards (CPH) models were adjusted for baseline age, sex, education, APOE ε4 status, and tertiles of AD polygenic risk score (PRS), excluding the APOE region. Data were analyzed from May 2021 to November 2023. SCD was assessed longitudinally using a single question and considered present if endorsed at the last cognitively normal visit. It was treated as a time-varying variable, beginning at the first of consecutive, cognitively normal visits, including the last, at which it was endorsed. Consensus-diagnosed MCI, AD, and all-cause dementia. This study included 3585 participants (mean [SD] baseline age, 68.0 [7.7] years; 1975 female [55.1%]). A total of 1596 participants (44.5%) had SCD, and 770 (21.5%) were carriers of APOE ε4. APOE ε4 and tertiles of AD PRS status did not significantly differ between the SCD and non-SCD groups. MCI, AD, and all-cause dementia were diagnosed in 236 participants (6.6%), 73 participants (2.0%), and 89 participants (2.5%), respectively, during follow-up. On average, SCD preceded MCI by 4.4 years, AD by 6.8 years, and all-cause dementia by 6.9 years. SCD was significantly associated with survival time to MCI (hazard ratio [HR], 1.57; 95% CI, 1.22-2.03; P <.001), AD (HR, 2.98; 95% CI, 1.89-4.70; P <.001), and all-cause dementia (HR, 2.14; 95% CI, 1.44-3.18; P <.001). After adjustment for APOE and AD PRS, the hazards of SCD were largely unchanged. Results of this cohort study suggest that in a community setting, SCD reflecting SCD+ features was associated with an increased risk of future MCI, AD, and all-cause dementia with similar hazards estimated in clinic-based settings. SCD may be an independent risk factor for AD and other dementias beyond the risk incurred by APOE ε4 and AD PRS.

Effect of visual impairment on subjective cognitive decline in older adults: a cross-sectional study in China

ObjectivePeople with visual impairment have more functional limitations associated with subjective cognitive decline (SCD), and those with SCD are extremely susceptible to transitioning to irreversible cognitive impairment. This study aimed...

Evaluating disparity of subjective cognitive decline between male veterans and non-veterans in the United States using propensity score matching estimation: A behavioral risk factor surveillance system survey cross-sectional study.

Subjective cognitive decline (SCD) is one of the most important early onset symptoms of Alzheimer's Disease. Previous studies consistently reported that SCD is associated with quality of life, socio-economic factors, and related health comorbidities. However, the impact of veteran status on SCD has been little investigated. This study conducted a cross-sectional study to address disproportionate effects in subjective cognitive decline between veterans and non-veterans in the United States. Propensity score matching (PSM) was applied in this observational study to achieve covariate balancing and reduce selection bias, providing a more accurate estimate of the isolated effect of veteran status on SCD. Our study utilized 32,431 forty-five years or older non-institutionalized White, Black or African-American, and Hispanic or Latin-American male population from the 2019 Behavioral Risk Factor Surveillance System data. We first identified 10,685 paired PSM samples for the binary veteran status using the preselected covariates. Next, we performed a logistic regression for modeling the relationship between the veteran status and the SCD status using the PSM samples along with the covariates selected by a BIC-based stepwise selection. Our analyses revealed a statistically significant causal association between veteran status and SCD after PSM (odds ratio (OR): 1.16 and 95% confidence interval (CI): 1.06-1.27). We obtained a similar result before PSM with an OR of 1.20 and 95% CI of 1.10-1.31. When we focused on a minority group (Black or African-American males), we found a significantly increased veterans' risk of SCD, especially after propensity score matching (OR: 1.69, 95% CI: 1.16-2.45). We also found several factors such as employment status, difficulty dressing/walking/running errands, general health status, physical health status, unaffordability of medical costs, mental health status, and comorbid conditions including stroke, blindness, high cholesterol, and arthritis as statistically significantly associated with SCD (P-value < 0.05). Similar to post-traumatic stress disorder and traumatic brain injury, our study demonstrated a causal association between SCD and military-related activities in the United States, which has a disproportionate impact on the minority population. This study sets the groundwork to further research in this domain to diagnose neurological diseases early among veterans.

Fish and Shellfish Consumption, Cognitive Health and Mortality from Alzheimer's Disease among US Adults Aged 60 and Older.

Relationships of fish-shellfish consumption, cognitive health and mortality from Alzheimer's disease (AD) among US adults aged 60 years and older have not been adequately studied. To determine the relationship of fish-shellfish consumption, cognitive health and mortality from AD in US adults aged 60 years and older. The data of this cross-sectional study of US adults aged 60 years and older were from the National Nutrition and Health Examination Survey (NHANES) datasets. Frequency of fish-shellfish consumption, its association with subjective cognitive decline (SCD) and AD mortality of these participants between 1999 and 2018 and cognitive assessment scores between 2011 and 2014 were analyzed. US adults aged 60 years and older consumed fish-shellfish 1.2 times/week and had a blood Hg of 1.63 ug/L on average between 1999 and 2018. Participants aged 60 years and older in the highest quartile of fish-shellfish consumption (~3 times/week) had significantly higher cognitive assessment scores than those in the lowest quartile (rare or no fish-shellfish consumption). Adults in the highest quartile of fish-shellfish consumption had a 30% lower risk (odds ratio 0.7, 95%CI 0.57-0.87) of SCD, and 44% lower risk (hazard ratio 0.56, 95%CI 0.35-0.9) of AD mortality than those in the lowest quartile. Increased fish-shellfish consumption was associated with improved scores of cognitive assessment and reduced risks of SCD and AD mortality.

Subjective Cognitive Decline Prediction on Imbalanced Data Using Data-Resampling and Cost-Sensitive Training Methods

Subjective Cognitive Decline Prediction on Imbalanced Data Using Data-Resampling and Cost-Sensitive Training Methods

Inadequate sleep associated with increased odds of subjective cognitive decline among transgender and gender nonbinary adults in the U.S., 2016‐2018

AbstractBackgroundInadequate sleep (&lt;7 hours/night) and subjective cognitive decline (SCD), a self‐reported experience of worsening memory or thinking, are independently associated with an increased risk for Alzheimer’s disease and related dementias (ADRD) and cognitive impairment. Transgender and nonbinary (TNB) adults report significantly poorer sleep quality and are more likely to report SCD compared to cisgender adults. However, little is known about ADRD risk or how inadequate sleep is associated with SCD among TNB adults.Method2016‐2018 Behavioral Risk Factor Surveillance System data, representing 14 U.S. states that assessed sleep duration, SCD, and TNB status from adults ages 45+, were analyzed to examine differences in inadequate sleep prevalence and SCD among TNB adults (n = 394) and cisgender adults (n = 120,688). Odds ratios (OR) along with 95% confidence intervals (CI) were calculated to investigate group differences in inadequate sleep prevalence. A separate analysis compared the prevalence of SCD among TNB and cisgender adults with inadequate sleep.ResultInadequate sleep was highest among TNB adults (37.9%) compared to cisgender adults (31.34%). TNB adults were 34% more likely to report inadequate sleep compared to cisgender adults (95% CI: 1.1‐1.7, p = 0.0180). Inadequate sleep significantly increases the likelihood of SCD by 1.3 times (95% CL: 1.2, 1.3) compared to sleeping ≥7 hours/night. Among those with inadequate sleep, TNB adults were 2.3 times more likely to report SCD compared to cisgender adults (95% CI: 1.2‐3.6, p = &lt;0.0001).ConclusionInadequate sleep and its relationship with SCD is not uniformly experienced among TNB and cisgender adults. It is important to explore and address modifiable risk factors affecting sleep duration among TNB adults. Given the literature linking sleep duration, SCD, and ADRD risk, these data highlight the need for additional research focused on better understanding TNB cognitive health. The use of objective measures to assess sleep and cognition will provide more precision, which is needed to develop tailored interventions for TNB adults.

Prediction of subjective cognitive decline after corpus callosum infarction by an interpretable machine learning-derived early warning strategy.

Corpus callosum (CC) infarction is an extremely rare subtype of cerebral ischemic stroke, however, the symptoms of cognitive impairment often fail to attract early attention of patients, which seriously affects the long-term prognosis, such as high mortality, personality changes, mood disorders, psychotic reactions, financial burden and so on. This study seeks to develop and validate models for early predicting the risk of subjective cognitive decline (SCD) after CC infarction by machine learning (ML) algorithms. This is a prospective study that enrolled 213 (only 3.7%) CC infarction patients from a nine-year cohort comprising 8,555 patients with acute ischemic stroke. Telephone follow-up surveys were carried out for the patients with definite diagnosis of CC infarction one-year after disease onset, and SCD was identified by Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. Based on the significant features selected by the least absolute shrinkage and selection operator (LASSO), seven ML models including Extreme Gradient Boosting (XGBoost), Logistic Regression (LR), Light Gradient Boosting Machine (LightGBM), Adaptive Boosting (AdaBoost), Gaussian Naïve Bayes (GNB), Complement Naïve Bayes (CNB), and Support vector machine (SVM) were established and their predictive performances were compared by different metrics. Importantly, the SHapley Additive exPlanations (SHAP) was also utilized to examine internal behavior of the highest-performance ML classifier. The Logistic Regression (LR)-model performed better than other six ML-models in SCD predictability after the CC infarction, with the area under the receiver characteristic operator curve (AUC) of 77.1% in the validation set. Using LASSO and SHAP analysis, we found that infarction subregions of CC infarction, female, 3-month modified Rankin Scale (mRS) score, age, homocysteine, location of angiostenosis, neutrophil to lymphocyte ratio, pure CC infarction, and number of angiostenosis were the top-nine significant predictors in the order of importance for the output of LR-model. Meanwhile, we identified that infarction subregion of CC, female, 3-month mRS score and pure CC infarction were the factors which independently associated with the cognitive outcome. Our study firstly demonstrated that the LR-model with 9 common variables has the best-performance to predict the risk of post-stroke SCD due to CC infarcton. Particularly, the combination of LR-model and SHAP-explainer could aid in achieving personalized risk prediction and be served as a decision-making tool for early intervention since its poor long-term outcome.

The relationship between physical activity and subjective cognitive decline: Evidence from the behavioral risk factor surveillance system (BRFSS)

Studies have shown that subjective cognitive decline (SCD) is a major risk factor for mild cognitive impairment or even dementia, but the relationship between physical activity (PA) and SCD is still unclear. The goal of current study is to address how various physical activities relate to SCD. 216,593 adults from the Behavioral Risk Factor Surveillance System (BRFSS) were included in this study. We measured SCD and PA with participants' self-report. With the unconditional logistic regression model, the association between PA and SCD was investigated. We used a four-way decomposition method to explore the mediation roles of depression between PA and SCD. The nearest matching method of propensity score and multinomial propensity score were used to reduce the effects of confounding factors. Compared with those inactive, the weighted adjusted odds ratios (AORs) of SCD among those who were physically active were <1 (p<0.005), regardless of the type of PA. The top three PA in weighted AORs were: running (AOR: 0.51, 95% CI: 0.50-0.52), aerobics exercise (AOR: 0.55, 95% CI: 0.53-0.56), and weightlifting (AOR: 0.60, 95% CI: 0.59-0.62). The dose-response relationship between PA and SCD was found. Participants who engaged in PA for 241-300min per week (AOR: 0.61, 95% CI: 0.59-0.62) or exercised metabolic equivalent of 801-1000 per week (AOR: 0.62, 95% CI: 0.62-0.65) had the lowest risk of SCD. Regardless of the specific PA types, engaging in PA is associated with a reduced risk of having SCD, and people who engage in running had the lowest risk of SCD. There was a dose-response relationship between PA and SCD, and PA-based interventions should be developed accordingly to prevent cognitive deterioration in older age.

Apathy co-occurs with subjective cognitive decline among community-dwelling older adults

To investigate the relationship between apathy and subjective cognitive decline (SCD) in community-dwelling older adults. A total of 211 participants without objective cognitive impairment were included in this study. Their SCD, apathy, sleep quality, depression, and anxiety were assessed by face-to-face interviews. Multivariate logistic regression was constructed to examine the independent relationship between apathy and SCD with adjustment for confounders. The participants' average SCD-questionnaire and apathy evaluation scale-self scores were 7.13 and 30.65, respectively. Nearly half of the participants were categorized as having SCD. A quarter of participants were identified as apathetic. The apathy score was significantly associated with an increased risk of SCD (odds ratio 1.05, 95% confidence interval 1.01-1.10) after controlling for covariates. Apathy was independently and significantly associated with SCD in community-dwelling older adults without objective cognitive impairment. Thus early intervention on apathy is important to protect elderly cognitive functioning.

Cross-sectional relationship between pain intensity and subjective cognitive decline among middle-aged and older adults with arthritis or joint conditions: Results from a population-based study.

Introduction:We investigated cross-sectional relationships between arthritis or joint-related pain intensity and subjective cognitive decline in middle-aged and older adults.Methods:The sample consisted of 30,150 adults ⩾age 45 years with self-reported arthritis or joint conditions who completed key variables in the 2015 wave of the Behavioral Risk Factor Surveillance System.Results:Using weighted data, 94.2% of the sample reported experiencing joint pain in the last month (35.9% reported moderate pain and 30.6% reported severe pain) and 17.3% reported subjective cognitive decline. In logistic regression models, pain intensity was associated with significantly higher odds of reporting subjective cognitive decline, after controlling for age, race/ethnicity, sex, education, household income, cardiovascular health, mental health, and history of stroke. Those with moderate pain were two times as likely to report subjective cognitive decline and those with severe pain were more than three times as likely to report subjective cognitive decline relative to those without pain, adjusting for covariates.Conclusion:The results of this study highlight a significant relationship between pain intensity and subjective cognitive decline in middle-aged and older adults with arthritis or joint conditions typically associated with joint pain. Moderate and severe joint pain is significantly associated with higher risk of subjective cognitive decline, after controlling for personal and health characteristics. Future studies with more comprehensive assessments of pain and cognition are warranted to further elucidate these relationships and their underlying mechanisms.