Telephone Interview For Cognitive Status Score Research Articles

Racial disparities in epigenetic and cognitive aging

AbstractBackgroundRacial disparities in cognitive health are persistent and pervasive among older Americans. Black Americans have higher rates of cognitive impairment and dementia than their White counterparts and a significantly higher gap between epigenetic age and chronological age. Epigenetic aging measured by DNA methylation (DNAm) has been linked to cognitive outcomes in previous research, but these studies lacked racial diversity or did not account for important confounders. Rigorous evaluation of DNAm‐age’s contribution to cognitive health disparities is needed. We hypothesize that DNAm‐age gap, measured by two epigenetic clocks GrimAge and Dunedin Pace of Aging methylation (DPoAm), is associated with cognitive performance and decline and mediates significant portions of the Black‐White disparities in these outcomes.MethodWe performed retrospective analyses among 3278 non‐Hispanic participants (80.3% White, 19.7% Black) in the Health and Retirement Study whose 2016 epigenetic age is linked to survey responses and cognitive data. DNAm‐age gap is defined as the residual after regressing epigenetic age on chronological age. Cognitive outcomes are Telephone Interview for Cognitive Status (TICS) score in 2016 and change in TICS score from 2016 to 2018. We include age, gender, and measures of socioeconomic status, health status, and health behaviors as confounders. We implement multiple linear regression models to evaluate associations between DNAm‐age gap and cognitive outcomes and mediation models to evaluate the extent to which DNAm‐age gap mediates the relationship between race and cognitive outcomes.ResultWe found that although both GrimAge and DPoAm age gaps are associated with baseline cognitive performance and longitudinal decline in minimally adjusted models, only GrimAge remained a significant predictor after adjusting for confounders. Similarly, both GrimAge and DPoAm mediate a small but significant portion (∼6‐10%) of the racial disparities in cognitive performance and decline before adjusting for confounding variables. Socioeconomic status (education, wealth, and income) has the greatest attenuating effect.ConclusionAccelerated epigenetic aging for Black compared to White Americans may play a role in racial cognitive aging disparities. Follow‐up work is ongoing to determine the role of chronic psychosocial stressors and other important determinants of cognitive health in DNAm aging and racial disparities.

Determinants of post-stroke cognitive impairment and dementia: association with objective measures and patient-reported outcomes

BackgroundPost-stroke cognitive impairment and dementia (PSCID) is a sequel of ischemic stroke (IS), highly prevalent and linked to poor long-term outcomes. Thus, early recognition of the clinical determinants of PSCID is urgent for identifying high-risk individuals who are susceptible to PSCID. And investigating objective measures of PSCID in relation to patient-reported outcome measures (PROMs) is essential for understanding the impact of IS. Here we identify the clinical determinants associated with PSCID and the relationship of PSCID to patient-reported outcomes in a population with IS.MethodsThis was a cohort study. We enrolled 138 patients who were admitted to our hospital between February 2017 and February 2020, with IS and no pre-stroke diagnosis of dementia. Clinical variables were acquired on admission. At 3 months, patients underwent a follow-up evaluation including the Telephone Interview for Cognitive Status (TICS), modified Rankin scale (mRS), Barthel Index (BI), and PROMs, using the Patient-Reported Outcomes Measurement information System Global Health (PROMIS GH). MCI/Dementia was defined as a TICS score of <36. Regression analyses were used to identify clinical, functional, and patient-reported outcome determinants of the 3-month TICS score. Analyses were adjusted for age, stroke severity, and prior IS.ResultsAt follow-up, 113 participants (82%) were found to have MCI/Dementia. Patients with PSCID were more likely to be older, and at 3-months post-stroke they had lower rates of PROMIS GH T Mental (mean 47.69 vs. 52.13) and T Physical (mean 46.75 vs. 50.64). In multivariable linear regression analyses, increasing age (β = −0.07, p = 0.03) and Peripheral Artery Disease (PAD; β = −3.60, p = 0.03) were independently associated with a lower TICS score. Functional and patient-reported outcomes were also associated with worse TICS, including mRS ≥ 2, BI, T Mental, Global Mental, T Physical, and Global Physical in adjusted analyses. Individual components of PROMs were also associated with TICS, including quality of life, mental health, social satisfaction, and physical activities.ConclusionsIn patients with IS, increased age and a pre-admission diagnosis of PAD are independently associated with worse objective measures of PSCID. Worse functional and patient-reported outcomes are also strongly linked to PSCID.

Abstract TMP34: Association Of Post-stroke Cognitive Impairment With Long-term Patient-reported Outcome Measures

Introduction: Post-stroke cognitive impairment/dementia (PSCID) is highly prevalent and associated with poor long-term outcomes after acute ischemic stroke (AIS). Recognition of early determinants of PSCID allows for individualized interventions to reduce long-term disability. Furthermore, investigating the relation between PSCID and patient-reported outcomes provides insight into personalized impact of post-stroke cognitive dysfunction. We aimed to identify clinical determinants of PSCID and association with patient-reported outcome measures (PROMs) at 3- and 12-month after AIS. Methods: 138 AIS patients with no previous history of dementia were included. Clinical variables were acquired on hospital admission. Patients underwent a telephone interview at 3- and 12-months post-stroke including the Telephone Interview for Cognitive Status (TICS), modified Rankin scale (mRS), Barthel Index (BI) and PROM-10 questionnaires. PSCID was defined as TICS < 36 at 12-month post-stroke. Linear regression analyses were performed to identify predictors of 12-month TICS score and association with 3- and 12-month PROMs. Results: At 12 months post-stroke, 113 participants (82%) had PSCID. AIS patients with PSCID had higher rates of mRS ≥ 2 at 3-months (61.8% vs. 32%, p = 0.01), worse BI at 12-months (93.12 vs. 102, p < 0.01) and lower 12-month PROMs T Mental scores (48.22 vs. 52.41, p < 0.05). In linear regression analysis, worse functional and patient-reported outcomes at 3- and 12-months were independently associated with lower 12-month TICS (Table) . Conclusions: Large proportion of AIS patients experience PSCID at 12-months after stroke. 3-month PROMs, especially in the physical domain, are independently associated with worse cognitive measures at 12-months post-stroke. Moreover, PROMs at 12-months after AIS are strongly associated with PSCID. Incorporating PROMs in the ambulatory setting may offer additional insight into cognitive impairment after stroke.

Vitamin D supplementation and cognition-Results from analyses of the D-Health trial.

Observational studies have consistently found a link between low serum 25-hydroxyvitamin D concentration and higher risk of cognitive impairment. Results from randomized controlled trials have been mixed, and few have been conducted in the general population. We recruited 21,315 community-dwelling Australians aged between 60 and 84 years to participate in the D-Health Trial, a randomized, double-blind, placebo-controlled trial. The intervention was monthly oral doses of 60,000 international units of vitamin D or placebo for 5 years. We assessed cognitive function in a randomly sampled group of participants aged ≥70 years using the Telephone Interview for Cognitive Status (TICS) at 2 and 5 years after randomization. The primary outcome for this analysis was TICS score; the secondary outcome was the proportion of people who had cognitive impairment (defined as TICS score ≤25). We analyzed data using mixed models (linear and logistic). We interviewed 3887 participants at year 2 and 3614 participants at year 5. The mean TICS score at these time points was 32.3 and 32.2, respectively. Vitamin D supplementation did not affect cognitive function as measured by TICS score (mean difference between vitamin D and placebo groups 0.04; 95% CI -0.14 to 0.23), or alter risk of cognitive impairment (odds ratio 1.00; 95% CI 0.75 to 1.33). Monthly bolus doses of vitamin D supplementation neither enhanced nor hindered cognitive function among older adults. Population-wide vitamin D supplementation of older adults that are largely vitamin D replete is unlikely to substantially benefit cognition.

Association of Greenspace Exposure at Midlife with Cognitive Decline Later in Life in a Study of US Women

Background and aim: Greenspace may slow cognitive decline by increasing opportunities for physical activity and social connection or reducing stress or air pollution. However, studies on the association between greenspace and cognitive decline are sparse. We investigated the prospective association between greenspace at midlife and cognitive decline later in life. Methods: Using data from the US-based Nurses’ Health Study (mean age=61y), we assessed residential greenspace in a 270m buffer as the cumulative average from 1986 to 1994 using Landsat Normalized Difference Vegetation Index data. We examined 16,352 women who were enrolled in a substudy starting in 1995-2001 (74y) through 2008. Participants underwent up to four repeated measures of five cognitive tests. A global composite score was calculated as the average of all z-scores for each task to evaluate overall cognitive functioning. We evaluated the association between greenspace and subsequent cognitive decline using linear mixed models adjusted for age, education, neighborhood socioeconomic status, and depression. Results: In fully adjusted models, those living in the highest quintile of greenspace had an annual slope of decline that was slower by 0.01 units of the global composite score (95%CI 0.00001, 0.012) compared to those in the lowest quintile. To help interpret this estimate, we find that one year of age is related to a -0.01 unit mean annual difference for global cognition; thus, more greenspace appeared equivalent to slowing cognitive aging by one year. We found similar associations for the Telephone Interview for Cognitive Status (TICS); participants living in the highest greenspace quintile had an annual rate of decline that was slower by 0.04 units in the TICS score (95%CI 0.01, 0.07) compared to those in the lowest quintile. Conclusions: Higher greenspace exposure in early adulthood is associated with a slower rate of cognitive decline later in life in this cohort of US women.

Glaucoma and cognitive function trajectories in a population-based study: Findings from the health and retirement study.

Prior studies on the association of glaucoma and cognitive function have reported mixed results. The Health and Retirement Study (HRS) is a nationally representative panel survey of Americans age ≥ 51 years. HRS-linked Medicare claims data were used to identify incident glaucoma cases (by glaucoma type). Cognitive function was measured using the Telephone Interview for Cognitive Status (TICS), administered in each wave (every 2 years). Separate linear mixed models were fitted with either prevalent or incident glaucoma as a predictor of TICS trajectories and adjusting for age, race/ethnicity, educational attainment, gender, and medical history. Negative model estimates indicate associations of glaucoma with worse cognitive function scores or steeper per-year declines in cognitive function scores. Analyses of prevalent glaucoma cases included 1344 cases and 5729 controls. Analyses of incident glaucoma included 886 cases and 4385 controls. In fully-adjusted models, those with prevalent glaucoma had similar TICS scores to controls (β=0.01; 95% Confidence Interval [CI]: -0.15, 0.18; p=0.86). However, in those with incident glaucoma, we detected a statistically significant association between glaucoma and lower TICS scores (β=-0.29; 95% CI: -0.50, -0.08; p=0.007). However, there was no statistically significant association between either prevalent or incident glaucoma and per-year rates of change in TICS scores. When categorizing glaucoma by type (primary open angle glaucoma, normal tension glaucoma, or other glaucoma), no significant associations were detected between either prevalent or incident glaucoma and levels of or rates of change in TICS scores in fully covariate adjusted models. The observed associations between glaucoma and cognitive function were small and unlikely to be clinically meaningful. Compared to prior studies on this topic, this investigation provides robust evidence based on its larger sample size, longitudinal follow-up, and repeated measures of cognitive function in a population-based sample.

Diagnostic Accuracy of the Telephone Interview for Cognitive Status for the Detection of Dementia in Primary Care.

Cognitive diagnostic work-up in primary care is not always physically feasible, owing to chronic disabilities and/or travel restrictions. The identification of dementia might be facilitated with diagnostic instruments that are time efficient and easy to perform, as well as useful in the remote setting. We assessed whether the Telephone Interview for Cognitive Status (TICS) might be a simple and accurate alternative for remote diagnostic cognitive screening in primary care. We administered the TICS (range, 0-41) for 810 of 1,473 older people aged 84.5 (SD, 2.4) years. We scrutinized electronic health records for participants with TICS scores ≤30 and for a random sample of participants with TICS scores >30 for a dementia diagnosis using all data from the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial for 8-12 years of follow-up. We used multiple imputation to correct for verification bias. Of the 810 participants, 155 (19.1%) had a TICS score ≤30, and 655 (80.9%) had a TICS score >30. Electronic health records yielded 8.4% (13/154) dementia diagnoses for participants with TICS ≤30 vs none with TICS >30. Multiple imputation for TICS >30 yielded a median of 7/655 (1.1%; interquartile range, 5-8) estimated dementia cases. After multiple imputation, the optimal cutoff score was ≤29, with mean sensitivity 65.4%, specificity 87.8%, positive predictive value 11.9%, negative predictive value 99.0%, and area under the curve 77.4% (95% CI, 56.3%-90.0%). In the present older population, the TICS performed well as a diagnostic screening instrument for excluding dementia and might be particularly useful when face-to-face diagnostic screening is not feasible in family practice or research settings. The potential reach to large numbers of people at low cost could contribute to more efficient medical management in primary care.

Marginal Effects of Multiple Years of Volunteering on Objective and Subjective Measures of Cognition

Volunteering is conducive to older Americans’ physical and mental health; however, the effect of volunteering on cognitive health is less studied. Using four waves (2010-2016) of the Health and Retirement Study, this study examined the incremental effect of volunteering engagement on older adults’ cognitive health. We included10,718 cognitively unimpaired, community-dwelling individuals aged 51+ in 2010 and were alive through 2016. Volunteering engagement was measured by the number of times respondents participated in volunteering throughout the four waves. Objective cognition was assessed using the Telephone Interview for Cognitive Status (TICS), a standardized test of cognitive functioning. The TICS score was further categorized into three statuses: “No impairment,” “Cognitive impairment no dementia (CIND),” and “Dementia.” Subjective cognition referred to self-rated memory on a 5-point Likert scale. With sampling weights, ordered logit regression was performed controlling for health-related variables (e.g., health conditions, depression), SES (e.g., income, assets), contextual features (e.g., neighborhood safety, urbanicity), and sociodemographics. The average marginal effects (AMEs) were produced. Results show that more volunteering engagement significantly reduced the likelihood of CIND or dementia (OR=0.88, p<0.001). Specifically, every one-time increase in volunteering increased the probability of remaining cognitively normal by 0.01 (p<0.001), whereas it decreased the probability of CIND by 0.008 (p<0.001) and dementia by 0.001 (p<0.001). For subjective cognition, there was no significant relationship with volunteering. Our findings address gaps in literature by adding evidence of the incremental health benefits of volunteering on cognitive functioning. Differences in the findings for subjective and objective cognition warrant further investigation.

ALS Cognitive Behavioral Screen-Phone Version (ALS-CBS™-PhV): norms, psychometrics, and diagnostics in an Italian population sample

BackgroundUp to 50% of motor neuron disease (MND) patients show neuropsychological deficits which negatively affect prognosis and care. However, disability-related logistical issues and uneven geographical coverage of healthcare services may prevent MND patients from accessing neuropsychological evaluations. This study thus aimed to standardize for the Italian population the ALS Cognitive Behavioral Screen-Phone Version (ALS-CBS™-PhV), an MND-specific, telephone-based screening for frontotemporal dysfunction.MethodsThe cognitive section of the ALS-CBS™-PhV, the Italian telephone-based Mini-Mental State Examination (Itel-MMSE), and the Telephone Interview for Cognitive Status (TICS) was administered to 359 healthy individuals (143 males, 216 females; age, 52.7 ± 15.8; education, 13.1 ± 4.4). Norms were derived through equivalent scores. Validity, factorial structure, reliability, diagnostic accuracy, and item difficulty and discrimination were examined. Statistical equivalence between the telephone-based and in-person versions was tested.ResultsALS-CBS™-PhV measures were predicted by age and education. The ALS-CBS™-PhV reflected a mono-component structure, converged with Itel-MMSE and TICS scores (rs = .23–.51) and was equivalent to its in-person format (t = .37; p = .72). Good internal (Cronbach’s α = .61), test–retest (ICC = .69), and inter-rater (ICC = .96) reliability was detected. High accuracy was found when tested against both the Itel-MMSE and the TICS (AUC = .82–89). Backward digit span items were the most discriminative.DiscussionThe ALS-CBS™-PhV is a statistically solid screening test for frontotemporal disorders featuring MND. Its standardization allows for (1) improvements in tele-healthcare for MND patients, (2) epidemiological applications, and (3) effective assessments in decentralized clinical trials. The ALS-CBS™-PhV can be also suitable for assessing bedridden and visually impaired patients with motor disorders.

APOE E2/E2 Is Associated with Slower Rate of Cognitive Decline with Age.

The E4 allele of the APOE gene is known to be associated with cognitive impairment. However, a limited number of studies have examined the association between the E2 allele and longitudinal changes of cognitive function. To determine whether rates of cognitive change differ in carriers of the APOE E2 allele compared to other genotypes. We conducted a secondary analysis of data from two ongoing longitudinal cohort studies, the Long Life Family Study (LLFS) and New England Centenarian Study (NECS). We included participants who had APOE genotyping data, data from longitudinal administrations of the Telephone Interview for Cognitive Status (TICS), and age, sex, and education available. We assessed whether cognitive change as measured by rate of decline in TICS score differed among people with different APOE genotypes. We used a hierarchical mixed effect model with APOE genotypes, their interactions with age, and potential confounders. After adjusting for sex and education, in carriers of the common E3/E3 genotype, TICS score decreased by 0.15 points per year of age. In those with the E2/E2 genotype, TICS score decreased by 0.05 points per year of age, a significantly slower rate of decline (p = 0.017). We observed no protective effect of the E2/E3 genotype on cognitive decline. These results suggest a protective effect of the E2/E2 genotype on a measure of global cognitive function.

Abstract P56: Diffusion Tensor Imaging at the Time of Stroke is Associated With Cognitive Performance 4 Months Later

Introduction: Cognitive impairment after stroke is associated with stroke severity and baseline brain health. We hypothesized that acute diffusion tensor imaging (DTI) metrics would identify patients at risk for post-stroke cognitive impairment. Methods: Patients were enrolled prospectively in an observational study that involves serial MRI and cognitive testing in patients with recent stroke and moderate white matter disease on MRI but without dementia. DTI was performed at the time of stroke; cognitive testing with the MOCA and the Telephone Interview for Cognitive Status (TICS) were performed 3 months later. DTI was used to calculate Peak Skeletonized Mean Diffusivity (PSMD), a measure of global white matter microstructural integrity previously validated in cerebral small vessel disease. Fractional anisotropy maps were skeletonized (figure panel A) and a histogram of the corresponding MD values was used to calculate the peak width in the non-stroke hemisphere (panel B). Linear regression was used to test whether acute PSMD in the non-stroke hemisphere, acute stroke volume, or baseline NIHSS predicted cognitive performance 3 months later. Results: Fourteen patients followed-up at a median of 123 days. Patients had a median age of 73 years, mean baseline NIHSS of 1.2 (IQR 0-1.75), mean infarct volume of 4cc (range 0-16cc), mean MOCA of 25 (range 19-30), mean TICS of 33 (range 23-41), and 50% were women. Using multivariable linear regression, only acute PSMD predicted follow-up MOCA (std beta= -0.64, adj R 2 = 0.37, p= 0.013) while compared to baseline NIHSS, PSMD showed a stronger association with follow-up TICS score (std beta= -0.57 vs -0.44, p= 0.017; model adj R 2 = 0.476, p= 0.011)(Panel C). Conclusions: In this cohort of patients with small strokes we found that acute contralateral PSMD provided a measure of brain health that appears to predict cognitive performance at 3 months better than stroke size or severity. These are preliminary findings from an ongoing study.

REDUCED COGNITIVE DECLINE WITH THE APOE ε2/ε2 GENOTYPE IN THE LONG LIFE FAMILY STUDY AND NEW ENGLAND CENTENARIAN STUDY

A growing body of evidence has suggested a protective effect on cognition of the ε2 allele of APOE. To determine if APOE ε2 is associated with protection against cognitive decline, we analyzed repeated measures of the Telephone Interview for Cognitive Status (TICS) from 2,933 Long Life Family Study subjects and 679 New England Centenarian Study subjects using a multivariable linear mixed effects model. The median age at first TICS administration was 73 (interquartile range [IQR] 64, 83). Subjects had a median of 3 TICS assessments (IQR 2, 4) and a median follow-up time of 5.0 years (IQR 2.9, 7.0). Carriers of the ε2/ε2 genotype had a significantly slower rate of decline in TICS score compared to the ε3/ε3 reference group (-0.05 points per annum for ε2/ε2 carriers compared with -0.15 points for ε3/ε3 carriers, p-value for difference 0.017). These results support a protective effect of the ε2 allele.

Interaction between apolipoprotein E genotype and hypertension on cognitive function in older women in the Nurses' Health Study.

ObjectiveTo examine the interaction between APOE genotypes and both treated and untreated hypertension on cognitive function in an updated analysis of Nurses’ Health Study (NHS) data.DesignAt baseline (1995–2001) and 3 biennial follow-up assessments over ~6 years, cognitive function was assessed.Setting and participants8300 NHS participants aged 70+ years underwent a cognitive battery, which comprised 6 tests including the Telephone Interview for Cognitive Status (TICS) and tests of verbal memory, category fluency, and working memory.MeasuresWe estimated the mean differences in average cognitive scores across up to 4 assessments using multiple linear regression. We also tested for interaction between APOE e4 allele carrier status and hypertension overall, as well as for apparently untreated and treated hypertension.ResultsWe confirmed that, compared with those with APOE e3/3 genotype, APOE e4 allele carriers scored lower by 0.55 units on the average TICS score (95%CI:-0.67,-0.43). We also observed a significantly worse average TICS score among women with untreated hypertension compared with women without hypertension (difference = -0.23, 95%CI:-0.37,-0.09), while no significant difference was observed for women with treated hypertension. Significant interaction was detected between the APOE e4 allele and untreated hypertension (p-int = 0.02 for the TICS; p-int = 0.045 for global score), but not with treated hypertension. Specifically, compared with normotensive women with the APOE e3/3 genotype, APOE e4 allele carriers with treated hypertension scored lower by 0.50 units (95%CI:-0.69,-0.31); however, the APOE e4 allele carriers with untreated hypertension scored lower by 1.02 units on the TICS score (95%CI:-1.29, -0.76). This interaction of APOE e4 and untreated hypertension was also consistently observed for the global score.ConclusionsWomen with hypertension and at least one APOE e4 allele had worse average cognitive function compared with women without hypertension with the e3/3 genotype; this difference was amplified among APOE e4 allele carriers with untreated hypertension.

Abstract TMP111: Prediction of Cognitive Impairment after Intracerebral Hemorrhage using MRI Small Vessel Disease Score

Introduction: Survivors of Intracerebral Hemorrhage (ICH) are at high risk for cognitive impairment. Previous studies clarified that Cerebral Small Vessel Disease (CSVD) is a primary contributor to post-ICH dementia, but these observations have failed to transform clinical or research practice standards to date. We sought to determine whether a validated MRI CSVD scoring system could readily predict cognitive impairment after ICH. Methods: We analyzed data from ICH survivors with no history of prior cognitive impairment, enrolled in a single-center prospective study. We reviewed MRI scans to compute: 1) a validated 6-point score for CSVD burden based on presence of microbleeds, white matter hyperintensities, lacunes and &gt;20 basal ganglia enlarged perivascular spaces; 2) cortical atrophy. We quantified cognitive performance by: 1) administering the Telephone Interview for Cognitive Status (TICS) test; 2) identifying diagnosis of dementia based on medical records. We utilized linear mixed model analyses to identify predictors of changes in TICS score, and Cox regression to identify predictors of new-onset dementia. We calculated CSVD score cut-offs to maximize sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for diagnosis of dementia. Results: We enrolled 612 primary ICH survivors, and followed them for a median of 46.3 months (Inter-Quartile Range: 35.5-58.7). A total of 214/612 (35%) participants developed dementia. Increasing CSVD scores were associated with faster cognitive decline (Coeff -0.25, Standard Error 0.02) and dementia diagnosis (Hazard Ratio 1.33, 95% CI 1.08-1.64). Age, increasing atrophy scale score, lower TICS score at baseline and systolic blood pressure were also independently associated with faster cognitive decline and new-onset dementia (all p&lt;0.001). A CSVD score cut-off of ≥ 2 had highest sensitivity (83%) and specificity (91%) for dementia diagnosis, with PPV of 84% and NPV of 91% respectively. Conclusion: This validated CSVD score is strongly associated with cognitive performance after ICH, with excellent predictive performance for future diagnosis of dementia. Our results support its implementation in clinical care and in future studies of post-ICH dementia.

Sustained Cognitive Competence Between Age 80 and 95: A Prospective Study

1. Abstract 1.1. Objective : To examine the relation of age to sustained cognitive competence in late life among men who underwent a prospective, multidisciplinary assessment from age 19 to 95, with little attrition except death and dementia. 1.2. Method: A prospective 75-year study of 268 Harvard College sophomores was begun in 1939 with data points every 2-5 years and with multiple blinded raters. Measurements included assessment of childhood environment, objective mental and physical health over time, vascular risk factors andexercise. At age 80 the surviving 142 men, wereassessedusing the Telephone Interview for Cognitive Status (TICS). Cognitive status was reassessed at ages 85, 90 and 95. <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.3. <span style=font-size:10.0pt;font-family: times= new= roman,serif=>Results: <span style=font-size:10.0pt; font-family: times= new= roman,serif=>The observed incidence of dementia (14 per 1,000-person years) (age 76-85) was about half that expected. Between age 80 and 90 the mean TICS score the 40 still surviving, cognitively competent men had declined only 0.65 of a point. Between ages 80 and 95 the mean TICS score of the 11 surviving cognitively competent men had declined only 0.55 of a point over 15 years. In both groups almost, half of the men’s TICS scores had not declined at all-or even increased. 1.4 . Conclusions : Excluding those men developing dementia or MCI,age per se from 80 to 95 did not appear to play a very significant role in cognitive decline among unusually long-lived, highly educated men. 2. Keywords: Cognitive Decline; Dementia; Longitudinal; MCI; Prospective; Risk Factors; TICS

Abstract W P291: Long-term Stroke Awareness Among Stroke Survivors is Suboptimal

Background/Objective: Stroke survivors are at high-risk for recurrent stroke. Stroke education attempts to reduce this risk by emphasizing stroke warning signs and need to call 911. Long-term stroke awareness has been under-studied in stroke survivors. We aimed to assess stroke awareness at 1 year among stroke survivors and identify factors associated with poor performance. Methods: From a single center prospective cohort study of consecutive patients diagnosed with acute ischemic stroke or transient ischemic stroke (TIA), we identified stroke survivors able to complete telephone interviews at 1 year. All patients were provided standardized educational materials during index hospitalization. We used the validated Stroke Action Test (STAT) to assess stroke knowledge at 1 year. The STAT is a 28-item questionnaire that asks respondents to choose 1 of 4 answers to each scenario (call 911, call doctor, wait 1 hour, or wait 1 day). We also assessed cognitive status at 1 year using the validated telephone interview for Cognitive Status (TICS). We identified factors associated with STAT score (number of correct responses) using univariate and multivariate regression. Results: Among 254 patients who completed 1 year follow-up (65.8 years; 55.5% male; 68.5% white; 94.1% modified Rankin 0-1 at 1 year), the median STAT score was 57.1% (range 2.1-75.0%). In multivariate regression, TICS score (B=0.533; p&lt;0.001) and ethnicity (B=-2.357, p=0.006) were independently associated with STAT score. Age, race, insurance, arrival by ambulance at time of index hospitalization, stroke unit admission, length of stay, discharge to rehabilitation, post-stroke hospital/clinic visits were not associated with STAT score. Conclusion: Despite hospitalization and standardized education at time of index event, most stroke survivors are unaware of stroke warning signs at 1 year. Besides cognitive status and Hispanic ethnicity, no other factors were identified that predicted STAT score performance. Future studies should focus on improving hospital-based stroke educational programs and consider novel strategies in patients with cognitive impairment and differing language/cultural backgrounds.

Presepsis Depressive Symptoms Are Associated with Incident Cognitive Impairment in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

To test the hypothesis that presepsis depressive symptoms are associated with risk of new cognitive impairment in survivors of severe sepsis. Prospective longitudinal cohort study. Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006). Four hundred forty-seven individuals with normal presepsis cognition who survived 540 hospitalizations for severe sepsis and completed at least one follow-up interview. Severe sepsis was identified using a validated algorithm in Medicare claims. Depressive symptoms were assessed prospectively using a modified version of the Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed using versions of the Telephone Interview for Cognitive Status (TICS). Logistic regression with robust standard errors was used to examine associations between substantial depressive symptoms at any interview before sepsis and incident cognitive impairment (mild or moderate to severe cognitive impairment) at any interview after sepsis. The prevalence of substantial depressive symptoms in participants with normal cognition before sepsis was 38% (95% confidence interval (CI) = 34-42%). After severe sepsis, 18% (95% CI = 15-20%) of survivors had incident cognitive impairment. In unadjusted analyses, presepsis substantial depressive symptoms were associated with postsepsis incident cognitive impairment (odds ratio (OR) = 2.56, 95% CI = 1.53-4.27). After adjustment for demographics, health-risk behaviors, clinical characteristics of the sepsis episode, and presepsis TICS scores, substantial presepsis depressive symptoms remained the strongest factor associated with postsepsis incident cognitive impairment (OR = 2.58, 95% CI = 1.45-4.59). Substantial presepsis depressive symptoms are independently associated with incident postsepsis cognitive impairment. Depressed older adults may be particularly at risk of developing cognitive impairment after a serious medical illness.

Race and cognitive decline among community-dwelling elders with mild cognitive impairment: Findings from the Memory and Medical Care Study

Objective: Previous studies have reported conflicting findings on the relationship between race and cognitive decline in elders with dementia. Few studies have examined the role of race in cognitive decline in mild cognitive impairment (MCI). We investigate the relationship between race and cognitive decline in participants with MCI in a community-based, longitudinal study of cognitively impaired elders. Method: Based on a validated method utilizing a neuropsychiatric battery, 133 subjects [mean age: 78.7 years (SD = 6.5); female: 112 (76.7%); black: 59 (44.4%)] out of 512 participants in the Memory and Medical Care Study were diagnosed with MCI. The main outcome measure was the Telephone Interview for Cognitive Status (TICS) score over three years. Other baseline subject characteristics (demographics, health-related variables, behavioral, and psychiatric symptoms) were included in the analysis. Results: Overall, the three-year decline in mean TICS score was significantly higher among African Americans than non-African Americans [3.31 (SD: 7.5) versus 0.96 (SD: 3.0), t-value = 1.96, p-value = 0.05]. General estimating equation analyses revealed that African American race was associated with a faster rate of cognitive decline in all models. Conclusion: The rate of cognitive decline in MCI appears to be faster in African Americans than non-African Americans in the community. Diagnosis of MCI among African American elders could lead to early interventions to prevent or delay cognitive decline in the future.

Telephone interview for cognitive status (TICS) screening for clinical trials of physical activity and cognitive training: the seniors health and activity research program pilot (SHARP-P) study

To examine the performance of the Telephone Interview for Cognitive Status (TICS) for identifying participants appropriate for trials of physical activity and cognitive training interventions. Volunteers (N=343), ages 70-85 years, who were being recruited for a pilot clinical trial on approaches to prevent cognitive decline, were administered TICS and required to score ≥ 31 prior to an invitation to attend clinic-based assessments. The frequencies of contraindications for physical activity and cognitive training interventions were tallied for individuals grouped by TICS scores. Relationships between TICS scores and other measures of cognitive function were described by scatterplots and correlation coefficients. Eligibility criteria to identify candidates who were appropriate candidates for the trial interventions excluded 51.7% of the volunteers with TICS<31. TICS scores above this range were not strongly related to cognition or attendance at screening visits, however overall enrollment yields were approximately half for participants with TICS=31 versus TICS=41, and increased in a graded fashion throughout the range of scores. Use of TICS to define eligibility criteria in trials of physical activity and cognitive training interventions may not be worthwhile in that many individuals with low scores would already be eliminated by intervention-specific criteria and the relationship of TICS with clinic-based tests of cognitive function among appropriate candidates for these interventions may be weak. TICS may be most useful in these trials to identify candidates for oversampling in order to obtain a balanced cohort of participants at risk for cognitive decline.

Validity of the telephone interview for cognitive status (TICS) and modified TICS (TICSm) for mild cognitive imparment (MCI) and dementia screening

This study aimed to validate the TICS and modified TICS (TICSm) in Korean elderly population and to compare MCI and dementia screening ability between TICS and TICSm. TICS and TICSm were administered to 70 cognitively normal (CN), 75 MCI, and 85 dementia subjects, with mini-mental state examination (MMSE) and other cognitive and functional measures. TICS and TICSm scores were highly correlated with other global cognitive and functional scores. The CN vs. dementia discrimination ability of both instruments was as excellent as that of MMSE (sensitivity/specificity at optimal cutoff: 87.1/90.1 for TICS; 88.2/90.0 for TICSm). Although their CN vs. MCI discrimination performances were comparable to that of MMSE, they were far from perfect (sensitivity/specificity: 69.3/68.6 for TICS; 73.3/67.1 for TICSm). There was no significant difference in dementia or MCI screening accuracy between TICS and TICSm. Both of them also showed high test–retest reliability. Our findings indicate that TICS and TICSm are reliable and as valid as MMSE in regard of screening cognitively impaired elderly. In terms of the comparison between TICSm and TICS, however, TICSm has little advantage over TICS for screening dementia and even MCI, in spite of longer administration time and more efforts required.