Telephone Interview For Cognitive Status Research Articles

Early-Life Circumstances and Racial Disparities in Cognition Among Older Adults in the US.

Given the critical role of neurocognitive development in early life, understanding the association between early-life circumstances and racial disparities in cognition has important implications. To assess whether racial differences in early-life circumstances are collectively and individually associated with racial disparities in late-life cognition among older adults in the US. This cross-sectional study used comprehensive life history data from the Health and Retirement Study, a nationally representative survey of US adults 50 years or older. Data analyses were performed from August 9, 2022, to January 20, 2024. Racial differences in early-life circumstances and racial disparities in late-life cognition were investigated using a Blinder-Oaxaca decomposition regression model. Cognitive outcomes, including cognitive score and cognitive impairment, were evaluated using the Telephone Interview for Cognitive Status. Early-life educational experiences were primary explanatory variables; early-life cohort, regional, financial, health, trauma, family relationship factors, and educational attainment were additional explanatory variables; demographic and genetic factors were covariates. The study sample comprised 9015 participants; 1634 non-Hispanic Black (hereafter, Black) individuals (18.1%) and 7381 non-Hispanic White (hereafter, White) individuals (81.9%). Among Black participants, the mean (SD) age was 69.2 (9.2) years and 1094 (67.0%) were women. Among White participants, the mean (SD) age was 73.2 (10.1) years and 4410 (59.7%) were women. Cognitive scores (scale, 0-27) were significantly lower among Black participants (13.5 [95% CI, 13.3-13.7] points) than among White participants (15.8 [95% CI, 15.7-15.9] points), while the prevalence of cognitive impairment (cognitive score <12) was significantly higher among Black participants (33.6 [95% CI, 31.3-35.9] percentage points [ppt]) than among White participants (16.4 [95% CI, 15.6-17.2] ppt). Substantial racial differences were observed in early-life circumstances. Overall, differences in early-life circumstances were associated with 61.5% of the racial disparities in cognitive score (1.4 [95% CI, 0.88-2.0] points), and 82.3% of the racial disparities in cognitive impairment (14.2 [95% CI, 8.8-19.5] ppt), respectively. In multivariable analyses, early-life educational experiences were associated with 35.2% of the disparities in cognitive score and 48.6% in cognitive impairment. Notably, school racial segregation (all segregated schooling before college) was associated with 28.8% to 39.7% of the racial disparities in cognition. These findings were consistent in a series of sensitivity analyses. The findings of this cross-sectional study suggest that less favorable early-life circumstances are associated with clinically meaningful racial disparities in late-life cognition. Policies that improve educational equity have the potential to reduce racial disparities in cognition in older ages. Clinicians may leverage early-life circumstances to promote the screening, prevention, and interventions of cognitive impairment more efficiently, thereby promoting health equity.

Independent and combined associations of handgrip strength and walking speed with cognitive function in older adults: evidence from a national cross-sectional study

Objectives Although there have been studies on the association of handgrip strength or walking speed alone with cognitive abilities, few studies have determined the combined associations of handgrip strength and walking speed with cognitive function. Therefore we aimed to explore the independent and combined associations of handgrip strength and walking speed with cognitive function in Chinese older adults using a nationally representative sample. Method This cross-sectional study included 4,577 adults aged 60 and older. Handgrip strength was measured using a dynamometer and walking speed was assessed using a 2.5-meter walking test. Both handgrip strength and walking speed were organized into low, normal, and high tertiles according to the sample distribution. Cognitive function was measured using the Telephone Interview for Cognitive Status. Results Handgrip strength and walking speed were significantly associated with cognitive function. Participants with low handgrip strength or low walking speed separately had a higher rate of lower cognitive function (adjusted odds ratio (OR): 1.22 (95% CI: 1.04 − 1.44) for low handgrip strength; 1.54 (95% CI: 1.31 − 1.81) for low walking speed). Those with both low handgrip strength and low walking speed had an additively higher rate of lower cognitive function (adjusted OR: 1.72 (95% CI: 1.32 − 2.24)). Conclusion Having low handgrip strength or low walking speed is associated with a greater likelihood of lower cognitive function and vice versa. The concurrence of having low handgrip strength and low walking speed has an additive effect on cognitive function in older adults.

Trajectories of cognitive function among people aged 45 years and older living with diabetes in China: Results from a nationally representative longitudinal study (2011~2018).

Diabetes is associated with decline of cognitive function. Exploring different trajectories of cognitive function occurring in people with diabetes is important to improved prognosis. This study aimed to investigate differential patterns of trajectories of cognitive function and baseline determinants of trajectory group membership utilizing data from middle-aged and older Chinese adults with diabetes. Participants of the Chinese Health And Retirement Longitudinal Study (CHARLS) aged 45 years and above received biennial assessments between 2011 and 2018. The primary outcome was overall cognitive function score operationalized as sum of mental intactness and episodic memory scores derived from the Telephone Interview of Cognitive Status (TICS). A weighted growth mixture model was used to estimate cognitive function trajectories of CHARLS participants with diabetes, and baseline factors associated with trajectory group membership were investigated with weighted multinomial logistic regression. Data from 1,463 participants with diabetes aged 45 years and above were analyzed, a three-group trajectory model showed the best fit for overall cognitive scores: low baseline, linear declining (22.1%); moderate baseline, linear declining (37.5%) and high-stable (40.3%). Older participants, females, participants with low education, with nighttime sleep <6 h, without daytime napping habits, and with depressive symptoms were at a higher risk of unfavorable cognitive function trajectories. We identified heterogeneous trajectories of cognitive function among middle-aged and older people living with diabetes in China. Socially vulnerable groups including females, rural residents, and those with low education were at a higher risk for unfavorable trajectories. In health programs aimed at preventing and mitigating cognitive decline in individuals with diabetes more attention should be given to vulnerable groups. Reduced nighttime sleep, lack of daytime napping, and depressive symptoms appear to be modifiable risk factors.

Weakness Thresholds Are Differentially Linked to Cognitive Function by Obesity Status in Older Americans.

Weakness can be operationalized with several thresholds, which in turn, could impact associations with cognitive impairment when considering obesity status. We examined the associations of absolute, normalized, and collective weakness thresholds on future cognitive impairment by obesity status in older adults. We performed a secondary data analysis on the 2006-2018 waves of the Health and Retirement Study. A spring-type dynamometer collected handgrip strength (HGS). Males were categorized weak if their HGS was <35.5-kg (absolute), <0.45-kg/kg (body mass normalized), or <1.05-kg/kg/m2 (body mass index (BMI) normalized), while females were defined as weak if their HGS was <20.0-kg, <0.337-kg/kg, or <0.79-kg/kg/m2. The modified Telephone Interview of Cognitive Status examined cognitive function. Persons scoring ≤10 had a cognitive impairment. Obesity was categorized as BMI ≥30 kg/m2. We included 7,532 and 3,584 persons aged ≥65-years living without and with obesity, respectively. Those without obesity but beneath the absolute weakness threshold had 1.54 (95% confidence interval (CI): 1.24-1.91) greater odds for future cognitive impairment. Persons with obesity and beneath each threshold also had greater odds for future cognitive impairment: 1.89 (95% CI: 1.28-2.78) for absolute, 2.17 (95% CI: 1.02-4.62) for body mass normalized, and 1.75 (95% CI: 1.10-2.80) for BMI normalized. Older Americans without obesity but underneath all the weakness thresholds had 1.32 (95% CI: 1.00-1.74) greater odds for impairment in cognitive function, while persons with obesity had 2.76 (95% CI: 1.29-5.93) greater odds. There should be consideration for how body size and different weakness thresholds may influence future cognitive outcomes.

The dynamic and reciprocal relationship between perceived everyday discrimination and cognitive function in later life

Objectives This study, based on socioemotional selectivity theory and cognitive theory, investigates the dynamic and reciprocal relationship between perceived discrimination and cognitive function in later life. Methods Data were drawn from four waves of the Health and Retirement Study (HRS 2006, 2010, 2014, and 2018). A total of 4,125 people who were 51 and older were included. Cognitive function was measured by the telephone interview for cognitive status (TICS-27). Perceived discrimination was measured using scores of the perceived everyday discrimination scale. Random intercept cross-lagged panel model (RI-CLPM) was utilized. The model was adjusted for a range of covariates. Subgroup analysis by ethnoracial groups was conducted. Results Cross-sectionally, while lower cognitive function was associated with higher perceived discrimination, this relationship was unidirectional. Longitudinally, higher perceived discrimination predicted lower cognitive function in later waves only among non-Hispanic White individuals. Conclusion Results suggested that a decline in cognitive function may precede and contribute to the worsening of perceived discrimination, which may result in further decline in cognitive function. Lifetime experience of discrimination was discussed as a possible source of the racial/ethnic variations in the relationship. Further study is needed to examine whether this relationship holds among people with cognitive impairment and dementia.

Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults: a competing risk analysis

BackgroundDepressive symptoms and cognitive impairment often interact, rendering their associations controversial. To date, their joint trajectories and associations with dementia and death remain underexplored.AimsTo explore the interactions between depressive symptoms...

Long-term outcomes after treatment of delirium during critical illness with antipsychotics (MIND-USA): a randomised, placebo-controlled, phase 3 trial

Delirium is common during critical illness and is associated with long-term cognitive impairment and disability. Antipsychotics are frequently used to treat delirium, but their effects on long-term outcomes are unknown. We aimed to investigate the effects of antipsychotic treatment of delirious, critically ill patients on long-term cognitive, functional, psychological, and quality-of-life outcomes. This prespecified, long-term follow-up to the randomised, double-blind, placebo-controlled phase 3 MIND-USA Study was conducted in 16 hospitals throughout the USA. Adults (aged ≥18 years) who had been admitted to an intensive care unit with respiratory failure or septic or cardiogenic shock were eligible for inclusion in the study if they had delirium. Participants were randomly assigned-using a computer-generated, permuted-block randomisation scheme with stratification by trial site and age-in a 1:1:1 ratio to receive intravenous placebo, haloperidol, or ziprasidone for up to 14 days. Investigators and participants were masked to treatment group assignment. 3 months and 12 months after randomisation, we assessed survivors' cognitive, functional, psychological, quality-of-life, and employment outcomes using validated telephone-administered tests and questionnaires. This trial was registered with ClinicalTrials.gov, NCT01211522, and is complete. Between Dec 7, 2011, and Aug 12, 2017, we screened 20 914 individuals, of whom 566 were eligible and consented or had consent provided to participate. Of these 566 patients, 184 were assigned to the placebo group, 192 to the haloperidol group, and 190 to the ziprasidone group. 1-year survival and follow-up rates were similar between groups. Cognitive impairment was common in all three treatment groups, with a third of survivors impaired at both 3-month and 12-month follow-up in all groups. More than half of the surveyed survivors in each group had cognitive or physical limitations (or both) that precluded employment at both 3-month and 12-month follow-up. At both 3 months and 12 months, neither haloperidol (adjusted odds ratio 1·22 [95% CI 0·73-2.04] at 3 months and 1·12 [0·60-2·11] at 12 months) nor ziprasidone (1·07 [0·59-1·96] at 3 months and 0·94 [0·62-1·44] at 12 months) significantly altered cognitive outcomes, as measured by the Telephone Interview for Cognitive Status T score, compared with placebo. We also found no evidence that functional, psychological, quality-of-life, or employment outcomes improved with haloperidol or ziprasidone compared with placebo. In delirious, critically ill patients, neither haloperidol nor ziprasidone had a significant effect on cognitive, functional, psychological, or quality-of-life outcomes among survivors. Our findings, along with insufficient evidence of short-term benefit and frequent inappropriate continuation of antipsychotics at hospital discharge, indicate that antipsychotics should not be used routinely to treat delirium in critically ill adults. National Institutes of Health and the US Department of Veterans Affairs.

"Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black.

Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies. We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models. Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts. These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.

Abstract P252: Baseline Cognitive and Physical Function and Subsequent Occupational Status in Chinese Adults

Background: Declines in cognitive and physical function in later adulthood can have an impact whether or not individuals remain in the workforce, although the relationship is complex and often bidirectional. Little is also known about how this relationship differs in rural versus urban populations. We capitalized on longitudinal data in an urbanizing population to estimate the differential impact of urbanization level with cognitive and physical function on remaining in the work force. Methods: We used longitudinal data from 5,228 adults in the China Health and Nutrition Survey aged 58+ to assess the association between cognitive and physical function at the 2015 survey with whether older adults remained in the work force, based on self-report of either formal or informal work, in 2018. We defined cognitive function using a global cognitive score based on a subset of the modified Telephone Interview for Cognitive Status (TICS) and physical function using limitations as measured by instrumental activities of daily living (IADLs). Given differences in demographics of working status in urban (urban areas or small towns) versus rural villages, we included an interaction term for cognitive function by urban versus rural village residence. In minimally adjusted models, we controlled for age and gender and in fully adjusted models we additionally adjusted for birth cohort, education, region, marital status, and income. Results: In 2018, 48% of adults lived in rural villages and 41% were currently working. In rural villages, we found individuals with any (versus no) physical limitations in 2015 in were more likely to be working in 2018: Any IADL limitations versus no limitations: (OR=0.47 [95% confidence interval (CI) of 0.34-0.65). However, in urban areas, individuals with any (versus no) physical limitations in 2015 were more likely to be working in 2018: Any IADL limitations versus no limitations: OR=2.44 (1.18,5.03). We found no evidence of differential association between cognitive function and subsequent working status in the total sample or by rural village residence in the minimally or fully adjusted models. Conclusion: Physical (but not cognitive) function at baseline impacts future occupational status differently for those in rural versus urban areas which could reflect differences in the types of work being done as well as differences in the availability of economic resources between rural versus urban areas.

Purpose in life and cognitive health: a 28-year prospective study.

To examine the prospective association between purpose in life measured at three points across middle and older adulthood and cognitive outcomes assessed 8-28 years later. Prospective Study. Wisconsin Longitudinal Study of Aging (WLS). WLS participants who reported on their purpose in life at Round 4 (1992-1994; Mage = 52.58), Round 5 (2003-2007; Mage = 63.74), and/or Round 6 (2010-2012; Mage = 70.25) and were administered a cognitive battery at Round 7 (2020; Mage = 79.94) were included in the analysis (N = 4,632). Participants completed the Ryff measure of purpose in life and were administered the telephone interview for cognitive status and measures of verbal fluency, digit ordering, and numeric reasoning. Purpose in life measured at age 52 was related to better global cognitive function and verbal fluency but unrelated to dementia at age 80. In contrast, purpose in life at ages 63-70 was associated with lower likelihood of dementia, as well as better global cognitive function and verbal fluency at age 80. The effect sizes were modest (median Beta coefficient = .05; median odds ratio = .85). A slightly steeper decline in purpose in life between ages 52 and 70 was found for individuals with dementia at age 80. Purpose in life is associated with healthier cognitive function measured up to 28 years later. Individuals with lower purpose, especially in their 60s or older, and with steeper declines in purpose, are more likely to have dementia at age 80.

Emotional distress, social support, and functional dependence predict readiness for hospital discharge in a prospective sample of cognitively intact cardiac arrest survivors

AimTo inform screening, referral and treatment initiatives, we tested the hypothesis that emotional distress, social support, functional dependence, and cognitive impairment within 72 hours prior to discharge predict readiness for discharge in awake and alert cardiac arrest (CA) survivors. MethodsThis was a secondary analysis of a prospective single-center cohort of CA survivors enrolled between 4/2021 and 9/2022. We quantified emotional distress using the Posttraumatic Stress Disorder Checklist-5 and PROMIS Emotional Distress – Anxiety and Depression Short Forms 4a; perceived social support using the ENRICHD Social Support Inventory; functional dependence using the modified Rankin Scale; and cognitive impairment using the Telephone Interview for Cognitive Status. Our primary outcome was readiness for discharge, measured using the Readiness for Hospital Discharge Scale. We used multivariable linear regression to test the independent association of each survivorship factor and readiness for discharge. ResultsWe included 110 patients (64% male, 88% white, mean age 59 [standard deviation ± 13.1 years]). Emotional distress, functional dependence, and social support were independently associated with readiness for discharge (adjusted β’s [absolute value]: 0.25–0.30, all p < 0.05). ConclusionsHospital systems should consider implementing routine in-hospital screening for emotional distress, social support, and functional dependence for CA survivors who are awake, alert and approaching hospital discharge, and prioritize brief in hospital treatment or post-discharge referrals.

Association between experiencing low healthcare quality and developing dementia.

Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older. Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors. Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk. As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.

Is Early-Life Enrichment Associated With Better Cognitive Function Among Older Adults? Examining Home and School Environments.

Objectives: We examine whether early-life enrichment, involving varied and stimulating activities to enhance cognitive function during childhood and adolescence, is associated with cognitive function in later life and whether the benefits persist over time. Methods: Growth curve models were used to examine up to five waves of data from the Health and Retirement Study-a nationally representative survey of adults 50years and older (N = 10,070). We constructed separate measures of early-life enrichment to distinguish sources of influence (i.e., enriched home environment and enriched school environment). Global cognitive function was assessed with a modified version of the Telephone Interview for Cognitive Status. Results: Greater enrichment in each environment was incrementally associated with better cognitive function at baseline, but enrichment was not associated with change in cognitive function over time. Discussion: Receiving enrichment from multiple environments during sensitive periods of cognitive development may be advantageous for cognitive functioning in later life.

Abstract WP240: Long Term Impact of the Los Angeles Barbershop Blood Pressure Study on Stroke/TIA and Cognitive Impairment

Background: Individuals with poorly controlled blood pressure (BP) have a heightened risk of stroke and vascular cognitive impairment. BP reduction has been associated with reduced risk of future stroke and cognitive impairment. Black Americans are disproportionately affected by hypertension and neurologic-target organ damage. Interventions targeted to reduce these disparities are greatly needed. From 2/2015 - 7/2017, 307 Black men were enrolled into a cluster randomised, pharmacist-led BP reduction intervention at 52 Black-owned barbershops in Los Angeles, CA [the Los Angeles Barbershop BP Study (LABBPS)] which demonstrated significant improvement in BP control sustained over a 12-month period. The current study evaluates the long-term impact of the intervention on incident stroke/TIA and prevalent mild cognitive impairment (MCI). Methods: Living participants from the LABBPS were contacted via telephone for interval health history inquiring about the development of symptoms consistent with stroke/TIA since trial end and via telephone interview for Cognitive Status (TICS-M); whereby a score ≤34 was considered positive for possible amnestic MCI. Rates of stroke/TIA were compared using a Pearson’s Chi-squared test. Results: Out of 288 participants, 115 men (50%) with mean (SD) age 62 (9) years, were successfully contacted a median of 6 years after trial end. The distribution of TICS-M scores was similar between groups with 71% and 70% having an abnormal result in the intervention and control groups respectively. Self-reported stroke/TIA occurred in 4 men in the intervention group and 9 in the control group (p = 0.13). Conclusion: Barbershop-based interventions have proven effective in lowering BP in Black men, a group at disparate risk for neurovascular complications. The preliminary results of our follow-up study do not show a significant difference in possible MCI between treatment arms, though there was a trend towards lower incident stroke/TIA seen in the intervention group. Limitations include a lack of interval BP values, unknown durability of the intervention beyond 12 months, and disproportionate impact of COVID-19 pandemic on the health of African American communities which is not accounted for in this analysis.

Evaluation of FRESH scores in predicting outcome and quality of life after aneurysmal subarachnoid haemorrhage in a European patient cohort

BackgroundDespite aneurysmal subarachnoid haemorrhage (aSAH) patients often experiencing physical and mental disabilities impacting their quality of life (QoL), routine assessment of long-term QoL data and predictive tools are limited. This study evaluates the newly developed “functional recovery expected after subarachnoid haemorrhage” (FRESH) scores with long-term outcomes and QoL in European aSAH patients.MethodsFRESH, FRESH-cog, and FRESH-quol scores were retrospectively obtained from aSAH patients. Patients were contacted, and the modified Rankin Scale (mRS), extended short form-36 (SF-36), and telephone interview for cognitive status (TICS) were collected and performed. The prognostic and empirical outcomes were compared.ResultsOut of 374 patients, 171 patients (54.1%) completed the SF-36, and 154 patients completed the TICS. The SF-36 analysis showed that 32.7% had below-average physical component summary (PCS) scores, and 39.8% had below-average mental component summary (MCS) scores. There was no significant correlation between the FRESH score and PCS (p = 0.09736), MCS (p = 0.1796), TICS (p = 0.7484), or mRS 10–82 months (average 46 months) post bleeding (p = 0.024), respectively. There was also no significant correlation found for “FRESH-cog vs. TICS” (p = 0.0311), “FRESH-quol vs. PCS” (p = 0.0204), “FRESH-quol vs. MCS” (p = 0.1361) and “FRESH-quol vs. TICS” (p = 0.1608).ConclusionsThis study found no correlation between FRESH scores and validated QoL tools in a European population of aSAH patients. The study highlights the complexity of reliable long-term QoL prognostication in aSAH patients and emphasises the need for further prospective research to also focus on QoL as an important outcome parameter.

Separate and combined associations of obesity and handgrip strength with cognitive function in older adults: A national cross-sectional study in China

ABSTRACT This study examined the separate and combined associations of obesity and handgrip strength with cognitive function in older adults. In total 4,839 older adults were included in this cross-sectional study, and their body mass index (BMI) and handgrip strength were measured. Cognitive function was evaluated using the Telephone Interview for Cognitive Status. Three individual categories were created for BMI (normal weight: 18.5≤ BMI < 24.0 kg/m2 overweight: 24.0≤ BMI < 28.0 kg/m2 and obesity: BMI ≥ 28.0 kg/m2 and handgrip strength (low, normal, and high tertiles), and then these categories were pooled together. Logistic regression analyses were used to examine the individual and combined associations of obesity and handgrip strength with cognitive function. Results indicated that overweight adults had a lower rate of lower cognitive function than normal weight adults. There was an inverse association between handgrip strength and cognitive function. Participants with overweight and high handgrip strength had a lower likelihood of lower cognitive function compared to those with normal weight and normal handgrip strength. The findings suggested that overweight or high handgrip strength was associated with lower odds of cognitive decline. Moreover, the concurrence of overweight and high handgrip strength had an additive effect on cognitive function in older adults.

Preventing cognitive decline by reducing BP target (PCOT): A randomized, pragmatic, multi-health systems clinical trial

BackgroundGrowing evidence suggests that intensive lowering of systolic blood pressure (BP) may prevent mild cognitive impairment (MCI) and dementia. However, current guidelines provide inconsistent recommendations regarding optimal BP targets, citing safety concerns of excessive BP lowering in the diverse population of older adults. We are conducting a pragmatic trial to determine if an implementation strategy to reduce systolic BP to <130 and diastolic BP to <80 mmHg will safely slow cognitive decline in older adults with hypertension when compared to patients receiving usual care. MethodsThe Preventing Cognitive Decline by Reducing BP Target Trial (PCOT) is an embedded randomized pragmatic clinical trial in 4000 patients from two diverse health-systems who are age ≥ 70 years with BP >130/80 mmHg. Participants are randomized to the intervention arm or usual care using a permuted block randomization within each health system. The intervention is a combination of team-based care with clinical decision support to lower home BP to <130/80 mmHg. The primary outcome is cognitive decline as determined by the change in the modified Telephone Interview for Cognitive Status (TICS-m) scores from baseline. As a secondary outcome, patients who decline ≥3 points on the TICS-m will complete additional cognitive assessments and this information will be reviewed by an expert panel to determine if they meet criteria for MCI or dementia. ConclusionThe PCOT trial will address the effectiveness and safety of hypertension treatment in two large health systems to lower BP targets to reduce risk of cognitive decline in real-world settings.

Assessing patterns of delirium symptoms reveals a novel subtype among elective surgical patients with postoperative delirium.

Prior studies reported incidence of hypoactive and hyperactive subtypes of postoperative delirium, but did not consider cognitive symptoms of delirium which are highlighted in the DSM-5 criteria for delirium. This study aims to address this gap in the literature by classifying cases of delirium according to their constellation of cognitive and motoric symptoms of delirium using a statistical technique called Latent Class Analysis (LCA). Data were from five independent study cohorts (N=1968) of patients who underwent elective spine, knee/hip, or elective gastrointestinal and thoracic procedures, between 2001 and 2017. Assessments of delirium symptoms were conducted using the long form of the Confusion Assessment Method (CAM) pre- and post-surgery. Latent class analyses of CAM data from the first 2days after surgery were conducted to determine subtypes of delirium based on patterns of cognitive and motoric symptoms of delirium. We also determined perioperative patient characteristics associated with each latent class of delirium and assessed whether the length of delirium for each of the patterns of delirium symptoms identified by the latent class analysis. The latent class model from postoperative day 1 revealed three distinct patterns of delirium symptoms. One pattern of symptoms, denoted as the Hyperalert class, included patients whose predominant symptoms were being hyperalert or overly sensitive to environmental stimuli and having a low level of motor activity. Another pattern of symptoms, denoted as the Hypoalert class, included patients whose predominant symptom was being hypoalert (lethargic or drowsy). A third pattern of symptoms, denoted as the Cognitive Changes class, included patients who experienced new onset of disorganized thinking, memory impairment, and disorientation. Among 352 patients who met CAM criteria for delirium on postoperative day 1, 34% had symptoms that fit within the Hyperalert latent class, 39% had symptoms that fit within the Hypoalert latent class, and 27% had symptoms that fit within the Cognitive Changes latent class. Similar findings were found when latent class analysis was applied to those who met CAM criteria for delirium on postoperative day 2. Multinomial regression analyses revealed that ASA class, surgery type, and preoperative cognitive status as measured by the Telephone Interview for Cognitive Status (TICS) scores were associated with class membership. Length of delirium differed between the latent classes with the Cognitive Changes latent class having a longer duration compared to the other two classes. Older elective surgery patients who did not have acute events or illnesses or a diagnosis of dementia prior to surgery displayed varying symptoms of delirium after surgery. Compared to prior studies that described hypoactive and hyperactive subtypes of delirium, we identified a novel subtype of delirium that reflects cognitive symptoms of delirium. The three subtypes of delirium reveal distinct patterns of delirium symptoms which provide insight into varying risks and care needs of patients with delirium, indicating the necessity of future research on reducing risk for cognitive symptoms of delirium.

Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

As a financial hardship, negative wealth shock has been implicated in some adverse health outcomes. However, associations between negative wealth shock and cognitive decline and dementia have not been examined. To investigate whether negative wealth shock was associated with cognitive decline and incident dementia among middle-aged and older US adults. The Health and Retirement Study (HRS) is a prospective cohort study conducted biennially among US adults older than 50 years. Data from the HRS from calendar years 1996 to 2020 were analyzed from July 1 to 31, 2023. The final sample included 8082 participants with complete data of interest. Wealth status was quantified with questionnaires. Negative wealth shock was defined as a loss of 75% or more in total wealth over a 2-year period. Asset poverty was defined as zero or less total net wealth. Cognitive function was assessed with the modified Telephone Interview for Cognitive Status (TICS-m). Dementia status was determined with TICS-m scores and proxy assessment. Among 8082 participants included (mean [SD] age, 63.7 [5.7] years; 4179 women [51.7%] and 3903 men [48.3%]; 1111 Black [13.7%], 6689 White [82.7%], and 282 other [3.5%]), 1441 developed incident dementia over a median follow-up time of 14 (IQR, 7-20) years. Compared with participants who had positive wealth without shock, those with negative wealth shock had accelerated cognitive decline (β coefficient, -0.014 [95% CI, -0.027 to -0.001]; P = .03) and increased risks of dementia (hazard ratio [HR], 1.27 [95% CI, 1.11-1.46]; P < .001). Higher dementia risks were also found in participants with asset poverty at baseline (HR, 1.61 [95% CI, 1.30-2.00]; P < .001). Associations were found in White participants (HR, 1.34 [95% CI, 1.14-1.58]; P < .001) and participants younger than 65 years (HR, 1.38 [95% CI, 1.13-1.68]; P = .001) but not in other races and ethnicities or those 65 years or older. In this cohort study, negative wealth shock was associated with accelerated cognitive decline and elevated risks of dementia among middle-aged and older US adults, with modifications by age and ethnicity. These findings should be confirmed by further prospective and interventional studies.

RELIGIOSITY, RELIGIOUS BELIEFS, AND COGNITIVE STATUS AMONG BLACK AND WHITE MEN WITH SIMILAR INCOMES

Abstract Black men experience multiple stressors linked with cognitive impairment and have higher risks for Alzheimer’s Disease and related dementias than their White peers. Yet, few studies have focused on coping resources. Religious beliefs and institutions are thought to have health benefits; however, no study to our knowledge has examined religious practices or beliefs and their association with cognitive impairment disparities among Black and White men. The purpose of this study was to examine the association between religious practices and/or beliefs and cognitive status among Black and White men in the Health and Retirement Study (HRS). Data were drawn from Black and White men who reported incomes at or below $50,000 and completed the Core and Leave Behind Questionnaires in the 2016 HRS. The primary outcome was any cognitive impairment, a dichotomous variable derived from a modified version of the Telephone Interview for Cognitive Status (TICS). Religious service attendance, private prayer frequency, and religious beliefs were the primary independent variables. The proportion of Black men was 24.2% and had a larger proportion of individuals with any cognitive impairment than their White peers (47.2% vs 29.4%). Results from race-stratified Modified Poisson Regression models indicated that occasional religious service attendance was beneficial for White men (PR=0.68, CI:0.52-0.89) while private prayer (PR=0.71, CI:0.52-0.98) and religious beliefs (PR=0.90, CI:0.83-0.97) were inversely related to any cognitive impairment among Black men. Full-scale studies of Black men with robust religiosity measures are needed to further examine the association between religious factors and cognitive functioning among this group.