Trajectory Of Decline Research Articles

Food Insecurity and the Trajectory of Cognitive Function: A Longitudinal Study Using Data From the National Health and Aging Trends Study, 2012–2020

ObjectivesDespite plausible mechanisms, the association of food insecurity with trajectories of cognitive decline over time has only been investigated in a few studies. Our study aims to examine the longitudinal associations between food insecurity and cognitive function in a large nationally representative sample of older adults (≥65 y). MethodsCohort data from the National Health and Aging Trends Study 2012–2020 were analyzed (n = 5,524). In 2012, participants reported their food insecurity experience due to financial, social, and functional limitations (5 items) and their utilization of food assistance programs (FAP, 2 items). Participants were then classified as food secure (FS) without FAP, FS with FAP, and food insecure (FI). Cognitive function was measured via validated tests in three domains, i.e., immediate and delayed memory, executive function, and orientation. All individual test scores were standardized into z-scores, the mean of which was calculated as a combined cognitive function z-score. Mixed-effect models with a random intercept were used to examine how baseline food insecurity was associated with the combined and individual cognitive z-scores over time. Models were adjusted for baseline sociodemographic variables, cognitive z-score, depressive and anxiety symptoms, BMI, diabetes, and hypertension. ResultsIn 2012, 86.4% of the participants were FS without FAP, 10.6% were FS with FAP, and 3.0% were FI. In adjusted models, except for executive function z-score, cognitive decline over time was significant in all cognitive function z-scores (beta coefficients ranged from –0.06 to –0.03 SD per year, all p-values < 0.001). Baseline food insecurity status was not associated with any baseline cognitive z-scores; however, it was associated with cognitive decline in combined cognitive function z-score (p for interaction = 0.0002) and orientation z-score (p for interaction < 0.0001). ConclusionsCompared to participants who were FS without FAP, older adults who were FS using FAP or FI had faster deterioration of cognitive function as observed in the combined and the orientation cognitive z-scores. Funding SourcesThe Broadhurst Career Development Professorship for the Study of Health Promotion and Disease Prevention (MN). The National Institute of Mental Health: K01MH115794 (MJB).

Approaching person-centered long-term care: The trajectories of intrinsic capacity and functional decline in Taiwan.

To examine the longitudinal trajectory of intrinsic capacity over a 3-year period among long-term care recipients in Taiwan, its association with functional decline and the onset of severe dependency. A total of 9448 individuals aged ≥50 years utilizing home and community-based long-term care services with complete data from three separate evaluations in Taiwan were included in the study. We carried out a latent class linear mixed model to identify heterogeneous patterns of intrinsic capacity over time, a mixed-effects model to investigate their impact on activities of daily living and a Kaplan-Meier analysis to examine the onset year of severe dependency among different intrinsic capacity classes. The results identified four classes sharing similar longitudinal the intrinsic capacity trajectories: "high-stable" (20.13%), "normal-stable" (40.58%), "sensory-dysfunction" (29.53%) and "all-dysfunction" (9.76%). Individuals with predisposing characteristics were associated with lower activities of daily living, with the exception of age and education level. In addition, the poor intrinsic capacity class (b from -16.94 to -6.61, P < 0.001) had a worse evolution in terms of activity of daily living scores, and was associated with an earlier onset of severe dependency in 2.5 years in the all-dysfunction class. Heterogeneous patterns of intrinsic capacity that delay further functional decline are promising markers of function trajectories for a person-centered care approach in long-term care services. Targeting the needs of intrinsic capacity groups to prevent functional decline offer insights into: (i) strengthening function-centered care modalities to delay severe dependency as individuals get older; and (ii) validating regular monitoring intrinsic capacity as an early warning system to achieve healthy aging. Geriatr Gerontol Int 2022; 22: 516-522.

Changes in glial cell phenotypes precede overt neurofibrillary tangle formation, correlate with markers of cortical cell damage, and predict cognitive status of individuals at Braak III-IV stages

Clinico-pathological correlation studies show that some otherwise healthy elderly individuals who never developed cognitive impairment harbor a burden of Alzheimer’s disease lesions (plaques and tangles) that would be expected to result in dementia. In the absence of comorbidities explaining such discrepancies, there is a need to identify other brain changes that meaningfully contribute to the cognitive status of an individual in the face of such burdens of plaques and tangles. Glial inflammatory responses, a universal phenomenon in symptomatic AD, show robust association with degree of cognitive impairment, but their significance in early tau pathology stages and contribution to the trajectory of cognitive decline at an individual level remain widely unexplored. We studied 55 brains from individuals at intermediate stages of tau tangle pathology (Braak III-IV) with diverging antemortem cognition (demented vs. non-demented, here termed `resilient’), and age-matched cognitively normal controls (Braak 0-II). We conducted quantitative assessments of amyloid and tau lesions, cellular vulnerability markers, and glial phenotypes in temporal pole (Braak III-IV region) and visual cortex (Braak V-VI region) using artificial-intelligence based semiautomated quantifications. We found distinct glial responses with increased proinflammatory and decreased homeostatic markers, both in regions with tau tangles (temporal pole) and without overt tau deposits (visual cortex) in demented but not in resilient. These changes were significantly associated with markers of cortical cell damage. Similar phenotypic glial changes were detected in the white matter of demented but not resilient and were associated with higher burden of overlying cortical cellular damage in regions with and without tangles. Our data suggest that changes in glial phenotypes in cortical and subcortical regions represent an early phenomenon that precedes overt tau deposition and likely contributes to cell damage and loss of brain function predicting the cognitive status of individuals at intermediate stages of tau aggregate burden (Braak III-IV).

MO187: Healthcare Costs based on Risk of Progression in Patients with Chronic Kidney Disease

Abstract BACKGROUND AND AIMS Nephrologists follow patients with chronic kidney disease (CKD) stage G3 and G4 as a homogeneous group with the assumption that everyone had similar rates of progression with scheduled visits and lab investigations based on the stage of the disease. We now recognize that not all patients progress at similar rates to kidney failure and treatment and follow-up needs vary. The Kidney Failure Risk Equation (KFRE) identifies patients at different risks of progression to kidney failure (low, medium and high risk) in each stage of the disease. Previous studies had looked at resource utilization of patients based on the stage of the CKD. The purpose of our analysis was to examine resource utilization and associated costs based on the risk of progression by KFRE in the setting of a universal healthcare system. METHOD We conducted a retrospective cohort study of adults with CKD G3 and G4 enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data was collected from January 2004 through December 2012 and patients were followed for 5 years. The predicted risk of kidney failure for each patient was calculated using the 8-variable KFRE. The equation used clinical and routine laboratory data, to stratify patients into three risk categories (low, medium and high risk) of progression. We compared the number and cost of hospital admissions, physician visits and prescription drugs by risk within G3 and G4. Negative binomial regression and generalized linear model were used to compare healthcare utilization and cost between the groups respectively (α = 0.05). RESULTS A total of 1003 adults with CKD G3 and G4 were included in the study. In patients with stage G3 CKD, 311 (59%), 150 (28%) and 68 (13%) were in low, medium and high-risk categories, respectively. Amongst patients with CKD stage G4, 275 (58%), 86 (18%) and 113 (24%) were in similar categories respectively. The cost of hospital admissions, physician visits and drug dispensations in stage G4 high risk in comparison to low risk over the 5-year study period was CAD $89 265 versus $48 374 (P = .008), $23 423 versus $11 231 (P &amp;lt; .001) and $21 853 versus $16 757 (P = .01), respectively. In stage G3, the cost of hospital admissions was CAD $55 944 versus $36 740 (P = 0.10), physician visits $13 414 versus $10 370 (P = .08) and prescription drugs $20 394 versus $14 902 (P = .02) in high-risk patients in comparison to low-risk patients (Figure 1). CONCLUSION In patients followed in multidisciplinary clinics with CKD stages G3 and G4, the cost of hospital admissions, physician visits and prescription drugs were higher in high-risk patients compared to patients in low-risk category. In our study, the KFRE, designed to predict the risk of progression to dialysis in patients with CKD, also assisted in identifying patients with higher health resource utilization and healthcare costs compared to those with lower health resource use. We additionally suggest that patients who are in medium and high-risk categories be followed in multidisciplinary clinics rather than individual physician offices to delay the trajectory of decline to kidney failure.

Trajectories of cognitive change following stroke: stepwise decline towards dementia in the elderly.

Stroke events increase the risk of developing dementia, 10% for a first-ever stroke and 30% for recurrent strokes. However, the effects of stroke on global cognition, leading up to dementia, remain poorly understood. We investigated: (i) post-stroke trajectories of cognitive change, (ii) trajectories of cognitive decline in those who develop dementia over periods of follow-up length and (iii) risk factors precipitating the onset of dementia. Prospective cohort of hospital-based stroke survivors in North-East England was followed for up to 12 years. In this study, we included 355 stroke survivors of ≥75 years of age, not demented 3 months post-stroke, who had had annual assessments during follow-up. Global cognition was measured annually and characterized using standardized tests: Cambridge Cognition Examination—Revised and Mini-Mental State Examination. Demographic data and risk factors were recorded at baseline. Mixed-effects models were used to study trajectories in global cognition, and logistic models to test associations between the onset of dementia and key risk factors, adjusted for age and sex. Of the 355 participants, 91 (25.6%) developed dementia during follow-up. The dementia group had a sharper decline in Cambridge Cognition Examination—Revised (coeff. = −1.91, 95% confidence interval = −2.23 to −1.59, P < 0.01) and Mini-Mental State Examination (coeff. = −0.46, 95% confidence interval = −0.58 to −0.34, P < 0.01) scores during follow-up. Stroke survivors who developed dementia within 3 years after stroke showed a steep decline in global cognition. However, a period of cognitive stability after stroke lasting 3 years was identified for individuals diagnosed with dementia in 4–6 years (coeff. = 0.28, 95% confidence interval = −3.28 to 3.8, P = 0.88) of 4 years when diagnosed at 7–9 years (coeff. = −3.00, 95% confidence interval = −6.45 to 0.45, P = 0.09); and of 6 years when diagnosed at 10–12 years (coeff. = −6.50, 95% confidence interval = −13.27 to 0.27, P = 0.06). These groups then showed a steep decline in Cambridge Cognition Examination—Revised in the 3 years prior to diagnosis of dementia. Risk factors for dementia within 3 years include recurrent stroke (odds ratio = 3.99, 95% confidence interval = 1.30–12.25, P = 0.016) and previous disabling stroke, total number of risk factors for dementia (odds ratio = 2.02, 95% confidence interval = 1.26–3.25, P = 0.004) and a Cambridge Cognition Examination—Revised score below 80 at baseline (odds ratio = 3.50, 95% confidence interval = 1.29–9.49, P = 0.014). Our unique longitudinal study showed cognitive decline following stroke occurs in two stages, a period of cognitive stability followed by rapid decline before a diagnosis of dementia. This pattern suggests stroke may predispose survivors for dementia by diminishing cognitive reserve but with a smaller impact on cognitive function, where cognitive decline may be precipitated by subsequent events, e.g. another cerebrovascular event. This supports the assertion that the development of vascular dementia can be stepwise even when patients have small stroke lesions.

Inter- and intra-individual variation in brain structural-cognition relationships in aging

The sources of inter- and intra-individual variability in age-related cognitive decline remain poorly understood. We examined the association between 20-year trajectories of cognitive decline and multimodal brain structure and morphology in older age. We used the Whitehall II Study, an extensively characterised cohort with 3T brain magnetic resonance images acquired at older age (mean age = 69.52 ± 4.9) and 5 repeated cognitive performance assessments between mid-life (mean age = 53.2 ±4.9 years) and late-life (mean age = 67.7 ± 4.9). Using non-negative matrix factorization, we identified 10 brain components integrating cortical thickness, surface area, fractional anisotropy, and mean and radial diffusivities. We observed two latent variables describing distinct brain-cognition associations. The first describes variations in 5 structural components associated with low mid-life performance across multiple cognitive domains, decline in reasoning, but maintenance of fluency abilities. The second describes variations in 6 structural components associated with low mid-life performance in fluency and memory, but retention of multiple abilities. Expression of latent variables predicts future cognition 3.2 years later (mean age = 70.87 ± 4.9). This data-driven approach highlights brain-cognition relationships wherein individuals degrees of cognitive decline and maintenance across diverse cognitive functions are both positively and negatively associated with markers of cortical structure.

What Does the Brain Have to Keep Working at Its Best? Resilience Mechanisms Such as Antioxidants and Brain/Cognitive Reserve for Counteracting Alzheimer's Disease Degeneration.

Simple SummaryAlzheimer’s disease currently represents one of the major challenges of modern society in relation to social and medical costs. As people age, they often experience mild changes in cognitive functioning that may be due to an initial degeneration of cerebral networks. Advances in neurobiology research including antioxidants intake and brain capacity to resist damage is relevant in order to support elderly people in the adoption of healthy lifestyles able to counteract dementia onset.Here we performed a narrative review highlighting the effect of brain/cognitive reserve and natural/synthetic antioxidants in exerting a neuroprotective effect against cognitive deterioration during physiological and pathological aging. Particularly, we discussed pathogenesis of Alzheimer’s disease, brain and cognitive reserve as means of resilience towards deterioration, and evidence from the literature about antioxidants’ role in sustaining cognitive functioning in the preclinical phase of dementia. During aging, the effects of disease-related brain changes upon cognition are reduced in individuals with higher cognitive reserve, which might lose its potential with emerging cognitive symptoms in the transitional phase over the continuum normal aging-dementia (i.e., Mild Cognitive Impairment). Starting from this assumption, MCI should represent a potential target of intervention in which antioxidants effects may contribute—in part—to counteract a more severe brain deterioration (alongside to cognitive stimulation) causing a rightward shift in the trajectory of cognitive decline, leading patients to cross the threshold for clinical dementia later.

Restoration promotes recovery of woodland birds in agricultural environments: A comparison of ‘revegetation’ and ‘remnant’ landscapes

Abstract Ecological restoration in rural environments is a global challenge for the 21st century. Restoration measures—such as agri‐environment activities, woodlots, natural regeneration and conservation plantings—collectively alter landscape structure with the aim of restoring conservation values that are characteristic of natural ecosystems. We tested the landscape‐scale benefits of restoration for woodland birds, species of conservation concern in southern Australia, by assessing the richness and composition of avian communities in rural landscapes along a gradient in habitat restoration, benchmarked against landscapes with comparable extent of native vegetation. We selected 43 landscapes (each 8 km2) in Victoria, Australia, representing: (a) a trajectory of decline in the extent of remnant native wooded vegetation (‘remnant’ landscapes), (b) a trajectory of gain in planted vegetation (‘revegetation’ landscapes) and (c) a similar gradient comprising a mix of remnants and planted vegetation (‘mixed’ landscapes). In each landscape, repeat surveys of birds were undertaken at 12 sites, stratified in relation to land cover. Species richness of all terrestrial and woodland birds showed similar positive responses to total wooded cover in each landscape type, but woodland birds had reduced richness in ‘revegetation’ relative to ‘remnant’ and ‘mixed’ landscapes. Across all landscapes, key factors influencing richness were the extent of wooded cover and proportion comprised of plantings, scattered trees in farmland and mean annual rainfall. The composition of woodland bird assemblages differed between ‘remnant’ and ‘revegetation’ landscapes with predictable differences associated with foraging traits. Synthesis and applications. Restoration plantings stimulate recolonisation of otherwise‐depleted landscapes, effectively reversing a decline in woodland birds. Key insights include: (a) benchmarking ‘revegetation’ against ‘remnant’ landscapes provides a valuable means to quantify restoration outcomes at the landscape scale; (b) time‐lags in vegetation maturation contribute to a trajectory of recovery that differs from a trajectory of decline, in both richness and composition of the avifauna; (c) scattered trees have a critical role for avifaunal conservation in farm landscapes; (d) restoration plantings are most effective in ‘mixed’ landscapes, where complementary resources from remnant and planted vegetation are juxtaposed; and (e) restoration plantings on individual farms contribute to landscape‐scale biodiversity gains while also having socio‐ecological and production benefits.

Clinical Trajectories at the End of Life in Autopsy-Confirmed Dementia Patients With Alzheimer Disease and Lewy Bodies Pathologies.

Evaluating and understanding the heterogeneity in dementia course has important implications for clinical practice, health care decision-making, and research. However, inconsistent findings have been reported with regard to the disease courses of the 2 most common dementias: Alzheimer disease (AD) and dementia with Lewy bodies (DLB). Using autopsy-confirmed diagnoses, we aimed to examine the disease trajectories in the years before death among patients with dementia with pure AD, pure DLB, or mixed (AD and DLB) pathologies. The current retrospective longitudinal study included 62 participants with autopsy-confirmed diagnoses of pure AD (n = 34), mixed AD and DLB (AD + DLB; n = 17), or pure DLB (n = 11) from the Predictors 2 Cohort Study, a prospective, clinic-based, cohort of patients with dementia. Generalized estimating equation models, with time zero at death, were used to examine the trajectory of cognition (Folstein Mini-Mental State Examination [MMSE]), function (activities of daily living [ADL]), and Dependence Scale among patients with different autopsy-confirmed diagnosis (pure AD, AD + DLB, and pure DLB). The models were adjusted for age, sex, education, and baseline features including extrapyramidal signs, MMSE, ADL, and Dependence Scale. The participants on average received 9.4 ± 4.6 assessments at 6-month intervals during a mean 5.4 ± 2.9 years of follow-up. The 3 groups were similar in both cognition and function status at baseline. Cognition and function were highly correlated among patients with AD + DLB but not in pure AD or pure DLB at baseline. Patients of the 3 groups all declined in both cognition and function but had different trajectories of decline. More specifically, the patients with pure DLB experienced approximately double the rate of both cognitive decline and functional decline than the patients with pure AD, and the mixed pathology group showed double the rate of functional decline as compared to pure AD. In this longitudinal study, we found that among patients with dementia, those with Lewy body pathology experienced faster cognitive and functional decline than those with pure AD pathology.

A global indicator of utilized wildlife populations: Regional trends and the impact of management

A global indicator of utilized wildlife populations: Regional trends and the impact of management

Identification and Characterization of Trajectories of Renal Function Decline After Heart Transplantation

<h3>Purpose</h3> Renal function in heart transplant (HT) recipients usually decreases progressively over time. However, the rate of decline may be highly variable among patients. A variety of mechanisms may be involved with the different progression patterns, with modifiable factors associated with the evolution of the disease. We aimed to identify subgroups of renal function trajectories in HT recipients. <h3>Methods</h3> Glomerular filtration rate was estimated (eGFR) using the CKD-EPI equation, from immediate post HT. The latent class linear mixed model was used to identify subgroups of eGFR trajectories, and patient characteristics were compared between these subgroups. <h3>Results</h3> We identified six distinct trajectories of eGFR among 166 cohort members over 9 [6,14] years follow up (Fig. 1A). The model adequately separated the trajectories, showing a discrimination probability of 0.82 -0.97. Most patients had persistently low levels of eGFR<50 ml/min/1.73m² (34%, Group 5) or experienced a slow decline of eGFR from levels of ∼70 ml/min/1.73m², within the first year, followed by eGFR stabilization (35%, Group 3). Two groups had a strong decline of eGFR within the first year, from different levels of eGFR (80 vs 120 ml/min/1.73m²; Group 4 vs 1), followed either by a progressive slow decline (13%, Group 4) or by eGFR stabilization (5%, Group 1). A further 8% of patients had accelerated loss of eGFR from ∼60 ml/min/1.73m² (Group 6). Finally, 5% experienced an accelerated increase in eGFR from levels of ∼50 ml/min/1.73m² (Group 2). Patients with progressive loss of eGFR (Groups 4,5 & 6) were older with frequent comorbidities. Multivariable analysis showed older recipient age as the stronger independent predictor for progressive loss of eGFR over time (OR 1.29, p=0.01; Fig. 1B). <h3>Conclusion</h3> We identified six clinically relevant subgroups of renal function trajectories. These different progression trajectories of eGFR among HT recipients can serve to investigate modifiable risk factors for renal function deterioration.

Modeling population trajectory and probability of decline in northern Hudson Bay narwhals (Monodon monoceros)

AbstractNarwhals (Monodon monoceros) are an important subsistence harvest species for Inuit communities and their conservation is important for Inuit culture and ecosystem function. The northern Hudson Bay (NHB) narwhal population, which spends summer in northern Hudson Bay, Canada, has been assessed through periodic aerial surveys from 1981 to 2018. To estimate the population trajectory and predict future population trends under various harvest scenarios, a Bayesian population model was fit to four aerial survey estimates and harvest data from 1951 to 2018. The model resulted in a 2019 population estimate of ~14,400, 95% CI [10,300, 20,400] and an estimated starting population of 7,200, 95% CI [1,400, 19,000] in 1951. The model was extended 10 years into the future under three annual harvest scenarios (current harvest: 157, low harvest: 50, and high harvest: 300) and the probability of population decline was estimated. The model predicted a 6% chance of decline with an annual harvest quota of 50 narwhals, 78% for a harvest of 157, and 95% for a harvest of 300. This updated model provides the opportunity to shape conservation efforts by estimating past population trends and how those trends, combined with management action, can affect future population dynamics.

Social Gradient in Physical Mobility: An Investigation Among the OlderPopulation in India

In densely populated developing countries like India, the constant rise in the older population has worsened the burden of palliative care. Palliative care is primarily required for older people who are physically disabled. To address the issue of palliative care, a thorough understanding of physical immobility among the older population is required. Therefore, the present study aims at an in-depth understanding of the trajectory of mobility decline as well as the critical nexus between physical immobility and social status in late life.The study uses nationally representative unit-level secondary data from two rounds of the National Sample Survey of India conducted in 2004 and 2014 to examine the underlying association between socioeconomic class and physical mobility loss among older individuals. The findings suggest that physical immobility among older adults is closely related to the social gradient. Socioeconomic factors like socioreligious identity, income, education level, household type, living environment, and gender significantly influence the physical immobility in old age. The results of this study contribute to understanding the dynamics and variability of physical immobility among older individuals and help in developing policies to reduce the future burden of palliative care.

Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand

BackgroundMaintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanāu (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing.MethodsWell-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whānau (family) centred initiative (Ngā Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum.DiscussionAWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age.Trial registrationThe At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875).

A possible case of Limbic-predominant age-related TDP-43 encephalopathy (LATE) in a Black Female with caregiver burden and limited resources: A Novel Diagnosis with presentation similar to Alzheimer's

<h3>Introduction</h3> Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a proposed neurodegenerative disorder of older adults (typically >80 years old)⁽¹⁾. It presents primarily as an amnestic dementia and is thought to be due to a TDP-43 proteinopathy in limbic system structures, including the hippocampus. There could be coexisting hippocampal sclerosis pathology in some patients presenting with LATE. In community-based autopsy cohorts, ∼25% of brains had a sufficient burden of LATE-neuropathology changes (LATE- NC) to be associated with discernible cognitive impairment. (ADNC) ⁽³⁾. In a retrospective study described by Kapasi et Al, there exist a class I evidence that LATE-NC and Alzheimer's disease pathologic changes are associated with different trajectories of late-life cognitive decline. Persons with pure LATE-NC follow a slower trajectory compared to those with pure ADNC. LATE-neuropathology changes may be co-morbid with Alzheimer's disease neuropathological changes. Those with mixed LATE/ADNC have a steeper decline than individuals with either pathology alone ⁽⁴⁾. The following is a unique case presentation of a patient with possible LATE or a combination of LATE/AD NC as demonstrated by rapid amnestic dementia and changes in brain MRI. In addition, this case shows how the treatment is tailored based on family preference and available resources <h3>Methods</h3> A single patient case of interest was chosen and verbal consent was obtained from the patient. Our initial review was conducted with a literature search at Pubmed. 57 articles were retrieved which was narrowed down to 10 articles after irrelevant topics were excluded. The clinical presentation of the case was found to be correlated with the relevant reports in the research literature implying a possible rationale for LATE vs ADNC for the patient. <h3>Results</h3> Case presentation: This is a case of a 91-year-old female with no past psychiatric history, a medical history significant of HTN, and stable angina who presented to the memory clinic with a decline in short-term memory in the past 18 months that has progressively worsened over the past 6 -8 months. The patient would forget conversations and has been misplacing items at home. The patient would engage in dangerous behaviors to include forgetting the stove on. Also associated were neuropsychiatric symptoms of agitation, irritability, and insomnia. The patient became easily irritable and would attempt to hit others. These behaviors were all new to this patient and her family was very concerned. Taking care of her became increasingly challenging and they decided to consult professional help. The patient became increasingly dependent on all ADLs except feeding and toileting. She had been unable to perform all IADLS for the past two years. On MMSE, she scored 24/30 with most points lost in immediate recall. Further neuropsychiatric testing revealed deficiency in verbal fluency, clock drawing, delay recall, and word list learning. The MRI of the brain indicated a decrease in Hippocampal volume at 7 percentiles for her age as per NEUROQUANT evaluation; almost 2 standard deviations below the mean. Mild/moderate chronic white matter microvascular ischemic changes were also seen. No acute ischemia was noted. The caregiver burden was extremely high and memory medication was not a priority for the family. The family did not qualify for Medicaid and declined much-needed social services that could provide respite and promote social engagement. Paying out of pocket was a hindering factor. A low-dose second-generation antipsychotic was initiated with good remission of agitative symptoms. <h3>Conclusions</h3> The patient's advanced age, delayed onset of the cognitive impairment, precipitous memory decline, and the findings on brain MRI are suggestive of a possible diagnosis of LATE versus LATE ADNC. However, this diagnosis or other forms of dementia cannot be ruled out without a brain biopsy. This case indicates that further research on diagnosing and targeting patients with TDP-43 might greatly improve the disease burden. Furthermore, the differences in social-economic status can greatly add to disparities in dementia care. <h3>This research was funded by</h3> None

Safeguarding marine life: conservation of biodiversity and ecosystems

Marine ecosystems and their associated biodiversity sustain life on Earth and hold intrinsic value. Critical marine ecosystem services include maintenance of global oxygen and carbon cycles, production of food and energy, and sustenance of human wellbeing. However marine ecosystems are swiftly being degraded due to the unsustainable use of marine environments and a rapidly changing climate. The fundamental challenge for the future is therefore to safeguard marine ecosystem biodiversity, function, and adaptive capacity whilst continuing to provide vital resources for the global population. Here, we use foresighting/hindcasting to consider two plausible futures towards 2030: a business-as-usual trajectory (i.e. continuation of current trends), and a more sustainable but technically achievable future in line with the UN Sustainable Development Goals. We identify key drivers that differentiate these alternative futures and use these to develop an action pathway towards the desirable, more sustainable future. Key to achieving the more sustainable future will be establishing integrative (i.e. across jurisdictions and sectors), adaptive management that supports equitable and sustainable stewardship of marine environments. Conserving marine ecosystems will require recalibrating our social, financial, and industrial relationships with the marine environment. While a sustainable future requires long-term planning and commitment beyond 2030, immediate action is needed to avoid tipping points and avert trajectories of ecosystem decline. By acting now to optimise management and protection of marine ecosystems, building upon existing technologies, and conserving the remaining biodiversity, we can create the best opportunity for a sustainable future in 2030 and beyond.

Bilingual experience affects white matter integrity across the lifespan

Bilingualism has been associated with increases in compensatory mechanisms to age-related neurocognitive decline thus delaying dementia symptom onset and leading to a more favorable trajectory of neurocognitive aging. However, most research to date has examined bilingualism-induced effects on neurocognition within older age ranges or young adults – with middle-aged individuals typically not being a population of interest. Furthermore, bilingualism is often treated as a dichotomous variable, despite it being a heterogeneous experience on an individual level. In the present study, we employed diffusion tensor imaging (DTI) to examine whether bilingualism, and the degree of engagement in bilingual experience, modulates the nature or rate of white matter decline associated with aging. DTI data and language history data were collected from a cohort of monolingual and bilingual individuals spanning a wide age range. Two separate analyses were run. First, generalized additive models were run on matched monolingual and bilingual samples, examining effects of age on the trajectory of white matter integrity and how bilingualism modulates this effect. This analysis revealed a significant effect of age within the monolingual group for fractional anisotropy values in the right superior longitudinal fasciculus. However, the age effect within the bilingual group was not significant, indicating a faster decline in white matter integrity within the monolingual cohort. Second, general linear models were run on the entire participant sample, examining an interaction between age and degree of bilingual engagement on white matter integrity. Results from this analysis indicate that increased engagement in bilingual language use across the lifespan correlates with a slower decline in white matter integrity with age. Together these results indicate bilingualism, and specifically degree of bilingual engagement, impacts the trajectory of age-related decline in white matter integrity across the lifespan.

Associations of cardiorespiratory fitness and moderate-to-vigorous physical activity with latent cognitive abilities in older adults

It has been demonstrated that physical activity has a small but positive effect on cognition in old age, which suggests that it may be possible to alter the trajectory of age-related cognitive decline. However, our understanding of which aspects of physical activity that are important for modifying cognition remains incomplete. Adopting an exploratory approach in a sample of 115 healthy older adults (65–75 years), the present cross-sectional study used structural equation modelling to investigate the dissociable associations of physical activity (moderate-to-vigorous activity, derived from 7-day accelerometry) and cardiorespiratory fitness (VO2 max, derived from maximal treadmill ergometer test) with multiple latent cognitive abilities (working memory, episodic memory, spatial and verbal reasoning). The results showed a significant positive association between fitness and working memory, when physical activity was statistically controlled for, and a positive association of similar point magnitude between physical activity and episodic memory, when fitness was statistically controlled for, although the latter association did not reach statistical significance. The results add to the foundation for a more careful investigation of the dissociable associations of moderate-to-vigorous physical activity and fitness with cognition in old age, and encourages future research to test the hypothesis that cardiorespiratory fitness benefits working memory via general cerebrovascular effects on grey matter volume, whilst moderate-to-vigorous physical activity benefits episodic memory via effects on neuroplastic processes.

Incidence of potentially disruptive medical and social events in older adults with and without dementia.

Potentially disruptive medical, surgical, and social events-such as pneumonia, hip fracture, and widowhood-may accelerate the trajectory of decline and impact caregiving needs in older adults, especially among people with dementia (PWD). Prior research has focused primarily on nursing home residents with dementia. We sought to assess the incidence of potentially disruptive events in community-dwelling people with and without dementia. Retrospective cohort study of participants aged 65+ enrolled in the Health and Retirement Study between 2010 and 2018 (n=9346), including a subset who were married-partnered at baseline (n=5105). Dementia was defined with a previously validated algorithm. We calculated age-adjusted and gender-stratified incidence per 1000 person-years and incidence rate ratios of: 1) hospitalization for pneumonia, 2) hip fracture, and 3) widowhood in people with and without dementia. PWD (n=596) were older (mean age 84 vs. 75) and a higher proportion were female (67% vs. 57%) than people without dementia (PWoD) (n=8750). Age-adjusted incidence rates (per 1000 person-years) of pneumonia were higher in PWD (113.1; 95% CI 94.3, 131.9) compared to PWoD (62.1; 95% CI 54.7, 69.5), as were hip fractures (12.3; 95% CI 9.1, 15.6 for PWD compared to 8.1; 95% CI 6.9, 9.2 in PWoD). Point estimates of widowhood incidence were slightly higher for PWD (25.3; 95% CI 20.1, 30.5) compared to PWoD (21.9; 95% CI 20.3, 23.5), but differences were not statistically significant. The association of dementia with hip fracture-but not pneumonia or widowhood-was modified by gender (male incidence rate ratio [IRR] 2.24, 95% CI 1.34, 3.75 versus female IRR 1.31 95% CI 0.92,1.86); interaction term p=0.02). Compared to PWoD, community-dwelling PWD had higher rates of pneumonia and hip fracture, but not widowhood. Knowing how often PWD experience these events can aid in anticipatory guidance and care planning for this growing population.

Cognitive reserve over life course and 7-year trajectories of cognitive decline: results from China health and retirement longitudinal study

BackgroundCognitive reserve (CR) could partly explain the individual heterogeneity in cognitive decline. No study measured CR from a life course perspective and investigated the association between CR and trajectories of cognitive decline in older Chinese adults.MethodsData of 6795 Chinese adults aged 60+ from China Health and Retirement Longitudinal Study were used. Global cognition score (0–32) was assessed in all four waves. A life-course CR score was constructed using markers of childhood circumstance, education, highest occupational class, and leisure activities in later life. Latent growth curve modelling (LGCM) was applied to assess the association between CR and trajectories of cognitive decline.ResultsFor the life-course CR, factor loadings of markers in adulthood and later life were larger than that of markers in childhood. The life-course CR score (ranged between − 2.727 and 6.537, SD: 1.74) was higher in urban Chinese adults (0.75, SD: 1.90) than in rural Chinese adults (− 0.50, SD: 1.43). The unconditional LGCM results showed that urban older Chinese adults had better global cognition at baseline (intercept: 15.010, 95% CI: 14.783, 15.237) and a slower rate of cognitive decline per year (linear slope: -0.394, 95% CI: − 0.508, − 0.281) than their rural counterparts (intercept: 12.144, 95% CI: 11.960, 12.329; linear slope: -0.498, 95% CI: − 0.588, − 0.408). After controlling for all covariates, one-unit higher CR score was associated with 1.615 (95% CI: 1.521, 1.709) and 1.768 (95% CI: 1.659, 1.876) unit higher global cognition at baseline for urban and rural older Chinese adults, respectively. The slower rate of cognitive decline associated with higher CR was more evident in rural residents (slope: 0.083, 95% CI: 0.057, 0.108) than in their urban counterparts (0.054, 95% CI: 0.031, 0.077).ConclusionsCR was associated with better baseline cognition and slower cognitive decline in Chinese older adults. Although rural residents were disadvantaged in both CR and cognition, the protective effect of CR against cognitive decline was stronger for them than in those who live in urban area.