Telephone Interview For Cognitive Status Research Articles

Education, Social Engagement, and Cognitive Function: A Cross-Lagged Panel Analysis.

Although education and social engagement are considered cognitive reserves, the pathway of both reserves on cognitive function has been rarely studied. This study aimed to examine the underlying mechanism between education, social engagement, and cognitive function. This study used 2-wave data (2010 and 2014) from Health and Retirement Study in the United States (N = 3,201). Education was measured by years of schooling. Social engagement was evaluated by 20 items including volunteering, physical activities, social activities, and cognitive activities. Cognitive function was assessed by a modified Telephone Interview for Cognitive Status. A cross-lagged panel model was fitted to test the mediating mechanism between education, social engagement, and cognitive function. Controlling for covariates, higher education in early life was associated with better cognitive function in old age (b = 0.211, 95% confidence interval [CI] = [0.163, 0.259], p < .01). Late-life social engagement partially mediated the association between education and cognitive function (indirect effect = 0.021, 95% CI = [0.010, 0.033], p < .01). The indirect path between education and social engagement via cognition also existed (b = 0.009, 95% CI = [0.005, 0.012], p < .001). Education in earlier life stage may exert a lifelong effect on cognitive function as well as an indirect effect via enhancing late-life cognitive reserve such as social engagement. The cross-lagged effect of social engagement on cognitive function is significant and vice versa. Future research may explore other cognitive reserves over the life course and its underlying mechanism to achieve healthy cognitive aging.

Cognitive Impairment and Self-Reported Dementia in UK Retired Professional Soccer Players: A Cross Sectional Comparative Study

BackgroundPrevious studies based on death certificates have found professional soccer players were more likely to die with neurodegenerative diseases, including dementia. Therefore, this study aimed to investigate whether retired professional male soccer players would perform worse on cognitive tests and be more likely to self-report dementia diagnosis than general population control men.MethodsA cross-sectional comparative study was conducted between August 2020 and October 2021 in the United Kingdom (UK). Professional soccer players were recruited through different soccer clubs in England, and general population control men were recruited from the East Midlands in the UK. We obtained self-reported postal questionnaire data on dementia and other neurodegenerative diseases, comorbidities and risk factors from 468 soccer players and 619 general population controls. Of these, 326 soccer players and 395 general population controls underwent telephone assessment for cognitive function.ResultsRetired soccer players were approximately twice as likely to score below established dementia screening cut-off scores on the Hopkins Verbal Learning Test (OR 2.06, 95%CI 1.11–3.83) and Verbal Fluency (OR 1.78, 95% CI 1.18–2.68), but not the Test Your Memory, modified Telephone Interview for Cognitive Status, and Instrumental Activities of Daily Living. Analyses were adjusted for age, education, hearing loss, body mass index, stroke, circulatory problems in the legs and concussion. While retired soccer players were younger, had fewer cardiovascular diseases and other morbidities and reported healthier lifestyles, 2.8% of retired soccer players reported medically diagnosed dementia and other neurodegenerative disease compared to 0.9% of controls (OR = 3.46, 95% CI 1.25–9.63) after adjustment for age and possible confounders.ConclusionsUK male retired soccer players had a higher risk of performing below established cut-off scores of dementia screening tests and were more likely to self-report medically diagnosed dementia and neurodegenerative diseases, despite having better overall physical health and fewer dementia risk factors. Further study is needed to determine specific soccer-related risk factors.

Trends in cognitive function before and after stroke in China

BackgroundWhile cognitive impairment after stroke is common, cognitive trends before stroke are poorly understood, especially among the Chinese population who have a relatively high stroke burden. We aimed to model the trajectories of cognitive function before and after new-onset stroke among Chinese.MethodsA total of 13,311 Chinese participants aged ≥ 45 years and without a history of stroke were assessed at baseline between June 2011 and March 2012 and in at least one cognitive test between 2013 (wave 2) and 2018 (wave 4). Cognitive function was assessed using a global cognition score, which included episodic memory, visuospatial abilities, and a 10-item Telephone Interview of Cognitive Status (TICS-10) test to reflect calculation, attention, and orientation abilities.ResultsDuring the 7-year follow-up, 610 (4.6%) participants experienced a first stroke. Both stroke and non-stroke groups showed declined cognitive function during follow-up. After adjustment for covariates, there was no significant difference in pre-stroke cognitive trajectories between stroke patients and stroke-free participants. The stroke group showed an acute decline in episodic memory (− 0.123 SD), visuospatial abilities (− 0.169 SD), and global cognition (− 0.135 SD) after stroke onset. In the years following stroke, the decline rate of the TICS-10 test was higher than the rate before stroke (− 0.045 SD/year).ConclusionsChinese stroke patients had not experienced steeper declines in cognition before stroke compared with stroke-free individuals. Incident stroke was associated with acute declines in global cognition, episodic memory, visuospatial abilities, and accelerated declines in calculation, attention, and orientation abilities.

Association of Physical Activity With Cognitive Function Among Older Adults in Rural Sichuan, China.

The purpose of this study was to explore the relationship between total physical activity and different dimensions of cognitive function (orientation, attention, and memory) among older adults in rural Sichuan, China. This cross-sectional study involved 715 older adults (average age of 72years). Total PA was measured by the Physical Activity Scale for the Elderly, and cognitive function was assessed by the Telephone Interview for Cognitive Status (TICS) questionnaire. The multivariate linear regression analysis indicated that total PA and household PA were significantly associated with the overall Telephone Interview for Cognitive Status score (β = 0.143, p < .001; β = 0.115, p = .002, respectively), the orientation dimension (β = 0.142, p < .001; β = 0.131, p = .001, respectively), and the memory dimension (β = 0.179, p < .001; β = 0.134, p = .001, respectively). The study showed a positive association between total PA, household PA, and cognitive function in older adults, especially in the orientation dimension and the memory dimension of cognitive function.

Use of modified Telephone Interview for Cognitive Status (TICS‐M) for cognitive impairment analysis one year after COVID‐19 hospitalization in Brazil

AbstractBackgroundCOVID‐19 infection primarily affects the respiratory system despite of short and medium‐term cognitive impairment has been increasingly reported. The Modified Telephone Interview for Cognitive Status (TICS‐M), validated for cognitive screening after stroke, assesses domains such as orientation, attention/calculation, language, and immediate and delayed episodic memory. Thus, the TICS‐M might be useful to remotely screen for cognitive impairment in individuals affected by COVID‐19.MethodCross‐sectional multicenter study in Belo Horizonte, Brazil, with participants hospitalized with COVID‐19 confirmed by RT‐PCR or serology. All patients were aged 18+ years. Clinical and sociodemographic data were obtained through electronic medical records and/or interviews. Cognitive impairment screening was performed one year after hospital admission using the TICS‐M, with a cutoff point of 14 out of 39.ResultNinety‐six patients were submitted to the test, of which 50 (52.1%) were women, 72 (75%) were self‐declared non‐white, 59 (64.15%) did not complete elementary school and the median age was 62 years (interquartile range 49‐69). There was no significant association between lower TICS‐M scores and sociodemographic data or previous medical history, except for higher educational level that appears to be a protective factor to lower scores on TICS‐M (OR 0.089, 95% CI:0,01‐0,7, p 0.008), which is demonstrated in Table 1. There was also no association between the scores and the clinical course during hospitalization as displayed in Table 2. Furthermore, length of hospital stay (p = 0.232) and length of stay in Intensive Care Unit (p = 0.565) did not impact the scores.ConclusionIn this study, 15% of the sample had cognitive impairment one year after hospitalization for COVID‐19 according to TICS‐M. The absence of an association between known risk factors for cognitive deficits and worse scores on the TICS‐M might have been influenced by the fact that only 13.5% of our sample did not have comorbidities. Lower education level was the only factor associated with worse scores, which indicates a possible need to adapt the test or the cutoff point for different educational levels.

Longitudinal body weight dynamics in relation to cognitive decline over 18 years: A prospective cohort study

AbstractBackgroundWeight loss and body weight variability have been related to cognitive decline in old adults, respectively. However, the long‐term and independent associations of the two measures of body weight dynamics with cognitive decline remain unclear.MethodIn the Health and Retirement Study (HRS), we included 10,258 participants (58.4% women; mean age ± standard deviation (SD), 68.0 ± 9.8 years) free from memory‐related diseases in 1998. Body weight was reported biennially from 1993/1994 to 2016. Linear regression of the longitudinal body mass index for each individual was used to estimate body weight change (BWC, slope, kg/m2·year) and body weight variability (BWV, root mean squared error, kg/m2). Both measures were categorized by tertiles, with participants being classified as stable weight, weight loss, and weight gain (median = 0.0, ‐0.3, and 0.2 kg/m2·year, respectively), and small, moderate, and large BWV (median = 0.5, 1.1, and 2.0 kg/m2, respectively). Cognitive function was measured biennially from 1998 to 2016 using the Telephone Interview for Cognitive Status (TICS). We investigated the associations of BWC and BWV with annual rate of cognitive decline using linear mixed models.ResultDuring a median (IQR) follow‐up of 12 (4‐18) years, the average rate of cognitive decline was ‐0.052 z‐score/year. When adjusted for basic demographics, average BMI, and major lifestyle factors, we observed no significant associations of weight gain and moderate BWV with cognitive decline, whereas both weight loss and large BWV were associated with faster cognitive decline in the same model. Compared to those with stable weight, participants with weight loss experienced faster cognitive decline by ‐0.012 (95%CI, ‐0.015, ‐0.009) z‐score/year. Large BWV was also related to faster cognitive decline (β = ‐0.003, 95% CI: ‐0.006, ‐0.001) compared with small BWV. The associations were similar for both episodic memory and working memory, and across prespecified study subgroups.ConclusionWeight loss and large body weight variability were associated with faster cognitive decline in old adults. Our findings suggest the importance of dynamic body weight monitoring and management as a potential strategy to prevent age‐related cognitive decline.

Association of type 2 diabetes mellitus and its management with cognitive function in adults: A prospective cohort study

AbstractBackgroundType 2 Diabetes Mellitus (T2DM) has been associated with lower levels of cognitive function in older adults. However, evidence on the potential role of T2DM management in age‐related cognitive function is limited. To explore the prospective association of T2DM and its management with cognitive function among middle‐aged and older Chinese adults.MethodThis study included 7,230 participants without baseline brain damage, mental retardation, or memory‐related diseases from the China Health and Retirement Longitudinal Study (CHARLS) in 2011‐2012. Fasting plasma glucose and self‐reported information on T2DM diagnosis and treatment was assessed at baseline. Participants were then categorized into normoglycemia, impaired fasting glucose (IFG), and T2DM (including untreated T2DM and treated T2DM) groups. Cognitive function, including episodic memory and executive function, was assessed by the modified Telephone Interview for Cognitive Status (TICS) every two years until 2015. We used the generalized estimating equation (GEE) model to examine the association of baseline T2DM status and cognitive function in succeeding years.ResultCompared to those with normoglycemia, participants with T2DM tended to have lower level of overall cognitive function (β = ‐0.23, 95% CI: ‐0.43, ‐0.02) after controlling for demographic variables, lifestyles, follow‐up time, and major clinical factors. In particular, the strong association was mainly observed for those with untreated T2DM (β = ‐0.31, 95% CI: ‐0.54, ‐0.07), especially in the domain of executive function (β = ‐0.22, 95% CI: ‐0.39, ‐0.06) and among those ≥60 years (β = ‐0.58, 95% CI: ‐0.91, ‐0.23). In general, individuals with IFG and treated T2DM had similar levels of cognitive function with normoglycemia participants.ConclusionOur findings supported the detrimental role of T2DM especially untreated T2DM in cognitive function among middle‐aged and older adults. Screening and early treatment for T2DM are warranted for maintaining better cognitive function in later life.

Associations of self‐rated mental and physical work demands with cognition are dependent in a cross‐sectional sample of the Health and Retirement Study

AbstractBackgroundThe number of older adults remaining in the workforce is growing, but little is known about how physical and mental work demands jointly affect cognitive health. This study assessed whether self‐rated physical and mental work demands were associated with cognition among older working adults and whether their associations were dependent.MethodsOur cross‐sectional sample consisted of 6,376 working older adults in the 2004 wave of the Health and Retirement Study. Self‐rated work demands were summarized from four questions about frequency of mental or physical demands in the respondent’s current job. Cognition was assessed using a subset of the Telephone Interview for Cognitive Status. We used multivariable linear regression to test for associations and additive interaction between physical and mental work demands and cognition, adjusted for age, sex, race, education, and practice effect.ResultIndependently, higher physical work demands were associated (P&lt;0.001) with poorer cognition and higher mental work demands were associated (P&lt;0.001) with better cognition. In an interaction analysis, the effect of one work demand measure became more negative as level of the other increased (B for interaction = ‐0.22, 95% CI: ‐0.42, ‐0.02). A one‐point increase in mental work demands was associated with 0.69 (95% CI: 0.40, 0.99) points higher cognition score when physical work demands were lowest. At the highest level of physical work demands, mental work demands were not associated with cognition (0.11, 95% CI: ‐0.28, 0.49). A one‐point increase in physical work demands was not associated with cognition (0.09, 95% CI: ‐0.30, 0.48) when mental work demands were lowest. At the highest level of mental work demands, physical work demands were associated with ‐0.53 (95% CI: ‐0.78, ‐0.29) points lower cognition score. The highest predicted cognition score was for the highest mental and lowest physical work demands. Results were robust to additional adjustment for health and behavior covariates.ConclusionThe associations of self‐rated mental and physical work demand with cognition were dependent. Beneficial cognitive effects of mental work demands may not apply to workers with physically demanding jobs. Future studies should strongly consider examining interactions to capture the range of work demand effects.

The association between MIND diet and cognitive function among Chinese middle aged and older adults: A 9‐year longitudinal study

AbstractBackgroundEvidence on the association of Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) diet with cognitive function is limited. This study examined how MIND diet is related to cognitive function among Chinese middle aged and older adults.MethodThis longitudinal study comprised 4066 participants aged ≥55 years from the China Health and Nutrition Survey in 1997. Dietary assessment (using 3‐day 24‐hour dietary recalls) and cognitive tests (using modified Telephone Interview for Cognitive Status) were conducted repeatedly from 1997 to 2006. The study MIND diet score was calculated based on 9 healthy food groups and 3 unhealthy food groups. Linear mixed‐effects models were used to investigate the relation of MIND diet adherence to cognitive function (z‐score).ResultThe median MIND score was 4.5 (range: 0‐12) among overall participants at baseline. During a mean follow‐up of 5.9 years, participants with higher scores of MIND diet had significant better global cognitive function in subsequent years. In the multivariable‐adjusted model, the regression coefficients (95% CI) across the tertiles of MIND score were 0 (ref), 0.01 (‐0.03, 0.06), and 0.07 (0.02, 0.11), respectively. For dietary components, highest consumption (T3 vs T1) of nuts (β = 0.24, 95% CI: 0.09, 0.38), fish (β = 0.11, 95% CI: 0.05, 0.16), poultry (β = 0.09, 95% CI: 0.03, 0.16), red meat (β = 0.09, 95% CI: 0.05, 0.14), tea (β = 0.08, 95% CI: 0.03, 0.13), and green leafy vegetable (β = 0.04, 95% CI: ‐0.00, 0.09) were associated with better global cognitive function, whereas highest intake of fried food (β = ‐0.18, 95% CI: ‐0.26, ‐0.10), pastries and sweets (β = ‐0.07, 95% CI: ‐0.16, 0.02) demonstrated opposite associations. Furthermore, the beneficial association of MIND diet with cognitive function was stronger among residents in rural areas, soutern areas, and among illiterate participants though significant effect modifications were not observed.ConclusionOur findings suggest that higher adherence to MIND diet was associated with better cognitive function in later life. Further research is warranted to confirm the findings and to investigate the underlying mechanisms.

Associations of epigenetic age acceleration with cognitive function trajectories in the women’s health initiative memory study

AbstractBackgroundEpigenetic age acceleration (AgeAccel) indicates faster biological aging relative to chronological age and has been independently associated with several age‐related outcomes. However, the cross‐sectional and longitudinal associations of AgeAccel with global cognitive function is understudied.MethodWe therefore studied 734 women (mean±SD baseline age = 70.3±4 years; 7.9% Black, 3.5% Hispanic/Latina, 88.6% White) who were free of cognitive impairment at the baseline examination of the Women’s Health Initiative (WHI) Memory Study (WHIMS,≥65 years enrolled in the WHI Hormone Therapy clinical trials between 1993‐1998). We measured global cognitive function annually with the Modified Mini Mental State Examination (3MS) through 2007 and the modified Telephone Interview for Cognitive Status (TICS‐m) from 2008‐2021. We measured extrinsic AgeAccel [EEAA] intrinsic AgeAccel [IEAA], AgeAccelPheno, and AgeAccelGrim in blood collected at baseline. AgeAccel measures were derived from chronological age and white blood cell counts (EEAA and IEAA), phenotypic age (AgeAccelPheno), or mortality (AgeAccelGrim). We estimated cross‐sectional AgeAccel‐3MS score associations in linear regression models and longitudinal AgeAccel‐3MS and TICS‐m score associations in linear mixed effects (LME) models adjusting for age, educational attainment, race, ethnicity, marital status, alcohol use, smoking, body mass index, comorbidities, hormone trial group assignment and physical activity.ResultAgeAccel measures were not cross‐sectionally associated with 3MS scores or longitudinally associated with 3MS or TICS‐m scores over a mean (SD) follow‐up of 6.4 (2.0) and 17.2 (3.6) years, respectively. Cross‐sectional AgeAccel‐3MS associations (95% confidence intervals) per 1‐year increment in AgeAccel were ‐0.03 (‐0.08, 0.02) for EEAA, ‐0.01 (‐0.08, 0.05) for IEAA, ‐0.02 (‐0.07, 0.03) for AgeAccelPheno, and 0 (‐0.10, 0.10) for AgeAccelGrim. Corresponding annual 3MS changes per 1‐year increment in AgeAccel were 0 (‐0.01, 0.01) for EEAA, 0 (‐0.01, 0.01) for IEAA, 0 (‐0.01, 0.01) for AgeAccelPheno, and 0 (‐0.02, 0.02) for AgeAccelGrim. Annual TICS‐m changes per 1‐year increment in AgeAccel were 0.01 (‐0.01, 0.03) for EEAA, 0 (‐0.02, 0.02) for IEAA, ‐0.01 (‐0.02, 0.01) for AgeAccelPheno, and 0.01 (‐0.02, 0.04) for AgeAccelGrim.ConclusionBlood‐based AgeAccel measures were not significantly associated with global cognitive function among older women. Larger studies are needed to further examine AgeAccel‐global cognitive function associations.

Estimating Transition Probabilities Across the Alzheimer's Disease Continuum Using a Nationally Representative Real-World Database in the United States.

Clinical Alzheimer's disease (AD) begins with mild cognitive impairment (MCI) and progresses to mild, moderate, or severe dementia, constituting a disease continuum that eventually leads to death. This study aimed to estimate the probabilities of transitions across those disease states. We developed a mixed-effects multi-state Markov model to estimate the transition probabilities, adjusted for 5 baseline covariates, using the Health and Retirement Study (HRS) database. HRS surveys older adults in the United States bi-annually. Alzheimer states were defined using the modified Telephone Interview of Cognitive Status (TICS-m). A total of 11,292 AD patients were analyzed. Patients were 70.8±9.0years old, 54.9% female, and with 12.0±3.3years of education. Within 1year from the initial state, the model estimated a higher probability of transition to the next AD state in earlier disease: 12.8% from MCI to mild AD and 5.0% from mild to moderate AD, but<1% from moderate to severe AD. After 10years, the probability of transition to the next state was markedly higher for all states, but still higher in earlier disease: 29.8% from MCI to mild AD, 23.5% from mild to moderate AD, and 5.7% from moderate to severe AD. Across all AD states, the probability of transition to death was<5% after 1year and>15% after 10years. Older age, fewer years of education, unemployment, and nursing home stay were associated with a higher risk of disease progression (p<0.01). This analysis shows that the risk of progression is greater in earlier AD states, increases over time, and is higher in patients who are older, with fewer years of education, unemployed, or in a nursing home at baseline. The estimated transition probabilities can provide guidance for future disease management and clinical trial design optimization, and can be used to refine existing cost-effectiveness frameworks.

Using network analysis to validate domains of the modified telephone interview for cognitive status.

The modified Telephone Interview for Cognitive Status (TICS-M) is a widely used tool for assessing global cognitive functions and screening for cognitive impairments. The tool was conceptualised to capture various cognitive domains, but the validity of such domains has not been investigated against comprehensive neuropsychological assessments tools. Therefore, this study aimed to explore the associations between the TICS-M domains and neuropsychological domains to evaluate the validity of the TICS-M domains using network analysis. A longitudinal research design was used with a large sample of older adults (aged above 70 years; n = 1037 at the baseline assessment) who completed the TICS-M and comprehensive neuropsychological assessments biennially. We applied network analysis to identify unique links between the TICS-M domains and neuropsychological test scores. At baseline, there were weak internal links between the TICS-M domains. The TICS-M memory and language domains were significantly related to their corresponding neuropsychological domains. The TICS-M attention domain had significant associations with executive function and visuospatial abilities. The TICS-M orientation domain was not significantly associated with any of the five neuropsychological domains. Despite an attrition of almost 50% at wave four, weak internal links between the TICS-M domains and most associations between TICS-M and neuropsychological domains that were found initially, remained stable at least over two waves within the 6-year period. This study supports the overall structural validity of the TICS-M screener in assessing enduring global cognitive function. However, separate TICS-M cognitive domains should not be considered equivalent to the analogous neuropsychological domains.

Effect of home-based group conversation intervention using smartphone application on cognitive health and psychological well-being of older adults with subjective cognitive concerns in Japan: a randomized controlled trial protocol.

Social activity is a key component in the prevention of cognitive decline. However, face-to-face social intervention has limited accessibility. To address this issue, we developed the "Photo-Integrated Conversation Moderated by Application" (PICMOA), a home-based group conversation intervention using smartphones. This paper introduces the PICMOA intervention and the protocol of the ongoing randomized controlled trial (RCT), which aims to evaluate the effects of PICMOA on the cognitive functioning and psychological well-being of Japanese community dwelling older adults at the risk of cognitive function decline. This study uses an RCT design in two parallel group trials with 1:1 allocation. The participants are community dwelling older adults aged 65 years and above, living in an urban city in Japan, with subjective cognitive concerns. In total, 81 participants were allocated to the intervention or control groups. The intervention group receives 30 min of weekly PICMOA sessions at their home for 12 weeks. The PICMOA intervention consists of (1) a photo preparation period before the session and (2) a structured group conversation session talking about the photos that participants took according to a specific theme. The control group receives 30 min of weekly health education videos on a tablet device. The primary outcome is cognitive functioning at pre- and post-phases of the 12-week intervention measured using the Telephone Interview for Cognitive Status in Japanese, semantic and phonemic fluency tests, and the Digit Span Forward and Backward tests. The secondary outcomes are psychological and social aspects including mental status, well-being, loneliness, and social support. Interest is growing in internet-based activities for preventing social isolation. However, the effect of remote conversation interventions on cognitive functioning remains unclear. This study addresses this issue and provides a new avenue of social participation for older adults. https://www.umin.ac.jp/ctr/, identifier: UMIN000047247.

Validation of the Self-Assessed Dynamic Gait Index in People with Multiple Sclerosis

Background and Purpose The Dynamic Gait Index (DGI) is a validated clinical measure of walking ability in people with multiple sclerosis (MS). There is need for a self-assessed version of the DGI that can be conducted remotely and that demonstrates concurrent validity with the original DGI in people with MS. We therefore developed a self-assessed Dynamic Gait Index (sDGI). The purpose of this study is to evaluate the relationship between the sDGI, clinically-assessed DGI, and falls in people with MS with gait impairment. Methods We will enroll 50 ambulatory people with MS with gait impairment. Participants will complete the sDGI (online questionnaire) and then, within 4-weeks, the DGI (in-person evaluation by a physical therapist). Other outcome measures include: modified Telephone Interview for Cognitive Status (TICS-M) and self-reported fall history in the past 3 months. We will calculate concordance between the sDGI and DGI, and use linear regression to determine if concordance is impacted by cognition. The ability of the sDGI to identify fallers will be evaluated using the receiver operating characteristic curve. Results At time of submission, 41 participants are enrolled, 31 have completed the study. Anticipated date of study completion is March 2023. Full study results will be presented at the meeting. Discussion The sDGI has potential to be used by physicians, physical therapists, and others to remotely assess walking ability and identify fallers in people with MS. Information from this study will determine how self-assessment of walking ability compares with clinically-assessed walking ability in people with MS. Our study will also determine if cognition impacts the validity of the sDGI. If concordance between sDGI and DGI is lower in those with worse cognitive performance, users of the sDGI might exercise greater caution using this measure to approximate DGI and predict fall risk in individuals with cognitive impairment. The Dynamic Gait Index (DGI) is a validated clinical measure of walking ability in people with multiple sclerosis (MS). There is need for a self-assessed version of the DGI that can be conducted remotely and that demonstrates concurrent validity with the original DGI in people with MS. We therefore developed a self-assessed Dynamic Gait Index (sDGI). The purpose of this study is to evaluate the relationship between the sDGI, clinically-assessed DGI, and falls in people with MS with gait impairment. We will enroll 50 ambulatory people with MS with gait impairment. Participants will complete the sDGI (online questionnaire) and then, within 4-weeks, the DGI (in-person evaluation by a physical therapist). Other outcome measures include: modified Telephone Interview for Cognitive Status (TICS-M) and self-reported fall history in the past 3 months. We will calculate concordance between the sDGI and DGI, and use linear regression to determine if concordance is impacted by cognition. The ability of the sDGI to identify fallers will be evaluated using the receiver operating characteristic curve. At time of submission, 41 participants are enrolled, 31 have completed the study. Anticipated date of study completion is March 2023. Full study results will be presented at the meeting. The sDGI has potential to be used by physicians, physical therapists, and others to remotely assess walking ability and identify fallers in people with MS. Information from this study will determine how self-assessment of walking ability compares with clinically-assessed walking ability in people with MS. Our study will also determine if cognition impacts the validity of the sDGI. If concordance between sDGI and DGI is lower in those with worse cognitive performance, users of the sDGI might exercise greater caution using this measure to approximate DGI and predict fall risk in individuals with cognitive impairment.

Specific olfactory deficit patterns observed in seniors and associated with cognitive decline

Olfactory dysfunction is a common symptom in neurodegenerative disorders and is regarded as a potential early predictor of impending cognitive decline. This study was undertaken in order to determine if olfactory dysfunction observed in the elderly is due to a general loss of smell or the inability to detect specific odours, and if misidentification of odours correlates with cognitive scores. Seniors for the Olfactory Response and Cognition in Aging (ORCA) sub-study were recruited from the Quebec Nutrition and Successful Aging (NuAge) cohort. The University of Pennsylvania smell identification test (UPSIT) was performed to measure olfactory function and the telephone Mini Mental State Examination (t-MMSE) and the French version of the Telephone Interview for Cognitive Status Modified (F-TICS-m) for cognitive status. The results demonstrate that seniors exhibit specific olfactory loss and had severe difficulty in particular in identifying lemon, pizza, fruit punch, cheddar cheese and lime. Furthermore, there was a significant difference in the ability to detect certain odours between the sexes. Results also showed that misidentification of certain scents was associated with cognitive scores, and when the sexes were assessed separately sex-specific misidentification of cognitive-associated odours was observed. The relationship between the cognitive scores and scent misidentification suggests that impending cognitive decline may be highlighted by the inability to smell specific odours. Our study provides additional support for the testing of olfactory function in the elderly and suggests that loss of smell for particular scents may become a useful diagnostic tool.

Decentralized approaches in TRAILBLAZER-ALZ 3 (P7-6.006)

<h3>Objective:</h3> To provide an overview of key decentralized design characteristics utilized in the TRAILBLAZER-ALZ 3 (TB3) (NCT05026866) study, an ongoing Phase 3 research trial with a decentralized design, testing donanemab in preclinical Alzheimer’s disease (AD). <h3>Background:</h3> Decentralized trials (DCTs) offer flexibility typically limited in traditional trial design, which may increase geographical and ethnic/racial diversity in trial populations, improve participant engagement and retention, and reduce trial cost. Clinical trials focused on AD pose specialized challenges to remotely assessing cognitive outcomes. <h3>Design/Methods:</h3> TRAILBLAZER-ALZ 3 is a multicenter, randomized, double-blind, placebo-controlled Phase 3 trial designed to assess the impact of donanemab versus placebo in cognitively unimpaired participants with evidence of AD pathology. <h3>Results:</h3> The remote screening process, which includes mobile research units and health fairs, uses the modified Telephone Interview for Cognitive status (TICS-m) to help select for cognitively unimpaired individuals. Plasma AD assays assess an AD biomarker as part of the inclusion screening criteria and minimize participant burden. Optional remote genetic counseling for APOE disclosure is offered as well as two optional sub-studies testing amyloid PET and tau PET. Clinical outcomes are assessed throughout the study using central raters who administer the Clinical Dementia Rating scale (CDR) to study partners and participants, and psychometric examinations to study participants. Self-administered tests are proctored remotely by a centralized study coordinator who also helps coordinate and facilitate all remote appointments for the participant and study partner. Infusion and imaging centers outside of traditional study “sites” are available to improve participant convenience and access throughout the study. <h3>Conclusions:</h3> TRAILBLAZER-ALZ 3 represents an innovative design that could potentially pave the way for future AD clinical studies by utilizing decentralized trial design with central raters, time-to-clinical-event model, blood-based AD biomarker selection criterion, and limited dosing of anti-amyloid antibody. <b>Disclosure:</b> Dr. Yaari has received personal compensation for serving as an employee of Eli Lilly and Company. Dr. Yaari has stock in Eli Lilly and Company. Karen C. Holdridge, 19157 has received personal compensation for serving as an employee of Eli Lilly and Company. Karen C. Holdridge, 19157 has stock in Eli Lilly and Company. Margaret Ferguson has received personal compensation for serving as an employee of Eli Lilly. Margaret Ferguson has stock in Eli Lilly. Dr. Wessels has received personal compensation for serving as an employee of Eli Lilly and Company. Dr. Wessels has received stock or an ownership interest from Eli Lilly and Company. Dr. Sims has received personal compensation for serving as an employee of Eli Lilly and Company. Dr. Sims has stock in Eli Lilly and Company.

Tooth loss, body mass index and cognitive function among middle-aged and older adults in China: Does gender matter?

BackgroundPrevious studies have shown a longitudinal association between tooth loss and cognitive function. Body mass index (BMI) is an essential applicable indicator of health status screening. However, the underlying mechanism among these factors remains unclear. This study aimed to determine the mediating role of BMI in the tooth loss-cognition relationship by gender among Chinese middle-aged and older adults. MethodsThis is a prospective and cohort study. We used three waves of follow-up data (2011, 2013, and 2015) from the China Health and Retirement Longitudinal Survey, including 10,013 participants aged 45 years or above. Cognitive function was evaluated by Telephone Interview of Cognitive Status, words recall, and figure drawing. The cross-lagged panel model was applied to test the hypothesized model. ResultsTooth loss is associated with higher BMI and lower level of cognitive function. We found significant total effects (B = −0.017, P = 0.008), direct effect (B = −0.015, P = 0.022) and indirect effects (B = −0.002, P = 0.010) of tooth loss on cognition mediated through BMI only among middle-aged and older men. For middle-aged and older women, the total effect (B = −0.010, P = 0.125) and direct effect (B = −0.007, P = 0.249) were no more significant. ConclusionsThe longitudinal association between tooth loss and cognition was primarily indirect through BMI among middle-aged Chinese males but not women. Public health authorities should remind middle-aged and older males with tooth loss and high BMI to participate in timely medical checkups for improving cognition.

Physical Mobility, Social Isolation and Cognitive Function: Are There Really Gender Differences?

ObjectiveThis study aimed to examine the mediating role of social isolation between physical mobility and cognitive function, and whether there are gender differences in the above mediating effects among Chinese older adults. MethodsThis is a prospective and cohort study. We obtained data from the 2011 (Time 1, T1), 2015 (Time 2, T2) and 2018 (Time 3, T3) waves of China Health and Retirement Longitudinal Study, including 3,395 participants aged 60 years or above. Cognition was evaluated by Telephone Interview of Cognitive Status, words recall, and figure drawing, which was widely used in previous research. We used a cross-lagged model to test the hypothesis that social isolation mediated the association between physical mobility and cognitive function among Chinese older adults. ResultsThe total effects of T1 physical mobility limitations on T3 cognitive function (β = -0.055, bootstrap p < 0.001) were significantly negative. Social isolation played a mediating role among both males and females (male: β = -0.008, bootstrap p = 0.012; female: β = -0.006, bootstrap p = 0.023), demonstrating that the mediating effect of social isolation between physical mobility and cognitive function was not gender specific. ConclusionThis study confirmed that social isolation mediated the association between physical mobility and cognitive function among both Chinese male and female older adults. These findings indicate that reversing social isolation can be a priority intervention target for cognitive decline prevention and promote successful ageing, particularly among older adults with impaired physical mobility.

Comparison of the telephone-Montreal Cognitive Assessment (T-MoCA) and Telephone Interview for Cognitive Status (TICS) as screening tests for early Alzheimer's disease.

Remote screening for cognitive impairment associated with Alzheimer's disease (AD) has grown in importance with the expected rise in prevalence of AD in an aging population and with new potential treatment options. The Telephone Interview for Cognitive Status (TICS) and new telephone adaptation of the Montreal Cognitive Assessment (T-MoCA) were administered to participants independently classified through in-person clinical evaluation as cognitively normal (CN; n = 167), mild cognitive impairment (MCI; n = 25), or dementia (n = 23). Cerebrospinal fluid AD biomarkers were measured (n = 79). TICS and T-MoCA were highly correlated (r = 0.787; P <0.001): groups differed on both (CN<MCI<dementia; TICS: F [2212] = 156.66; P <0.001; T-MoCA: F [2210] = 143.72; P <0.001), both effectively detected cognitive impairment (receiver operating characteristic area under the curve: TICS = 0.889; T-MoCA = 0.902), and both negatively correlated with a composite AD biomarker (tau/amyloid beta 1-42; TICS: r = -0.372; P = 0.001; T-MoCA: r = -0.480; P <0.001). TICS and T-MoCA are effective for remotely detecting cognitive impairment associated with AD in older adults. Strong correlation between tests provides construct validity for the newer T-MoCA. Construct validity for the telephone adaptation of the Montreal Cognitive Assessment (T-MoCA) was newly established against the Telephone Interview for Cognitive Status (TICS). TICS and T-MoCA effectively detected cognitive impairment with remote administration. Both tests negatively correlated with a composite cerebrospinal fluid Alzheimer's disease (AD) biomarker (tau/amyloid beta 1-42).

Are Geriatrics-Focused Primary Care Clinics Better at Diagnosing Dementia Than Traditional Clinics? A Matched Cohort Study.

Dementia and mild cognitive impairment (MCI) are prevalent but underdiagnosed. To compare new dementia/MCI diagnosis rates in geriatrics-focused primary care clinics and traditional primary care clinics. Secondary analysis of a prospective matched cohort study that spanned 2017-2021. Community-dwelling Veterans over 65 receiving primary care in a geriatrics-focused medical home (GeriPACT) or traditional primary care home (PACT) at one of 57 Veterans Affairs sites. We excluded individuals with a documented diagnosis of dementia or MCI in the year prior to enrollment. Diagnoses obtained from EHR. Cognitive status was assessed using modified Telephone Interview for Cognitive Status (mTICS) tool. The 470 participants included in this analysis were predominantly white, non-Hispanic males with an average age of 80.3years. 9.4% of participants received a diagnosis of dementia/MCI after 24months: 11.5% in GeriPACT and 7.2% in PACT. Adjusted OR for dementia/MCI diagnosis based on GeriPACT exposure was 1.47 (95% CI 0.65-3.29). Low mTICS score (≤ 27) (OR 4.89, 95% CI 2.36-10.13) and marital status (married/partnered) (OR 1.89, CI 0.99-3.59) were independent predictors of dementia/MCI diagnosis. When stratified by cognitive status: diagnosis rates were 20.8% in GeriPACT and 16.7% in PACT among those who scored lower on the cognitive assessment (mTICS ≤ 27); 7.4% in GeriPACT and 3.6% in PACT among those who scored higher (mTICS > 27). The OR for new dementia/MCI diagnosis in GeriPACT was 1.19 (95% CI 0.49-2.91) among those with a low mTICS score and 1.85 (95% CI 0.70-4.88) among those with a higher mTICS score. Observed rates of new dementia/MCI diagnosis were higher in GeriPACT, but with considerable uncertainty around estimates. Geriatrics-focused primary care clinics may be a promising avenue for improving the detection of dementia in older adults, but further larger studies are needed to confirm this relationship.