"Mini-mental state". A practical method for grading the cognitive state of patients for the clinician

The psychometric properties and applicability of subjective cognitive measures used in menopause research: a systematic review

IMPORTANCE

Many midlife women report cognitive issues when they transition through menopause. These cognitive complaints affect women's mental health and quality of life. However, the current understanding of women's cognitive experiences during the menopause transition has been limited by the lack of validated self-reported cognitive measures.

OBJECTIVE

This systematic review aimed to identify existing self-reported, or subjective, cognitive measures used in menopause research and evaluate their psychometric properties and applicability.

EVIDENCE REVIEW

Three databases, Medline, Embase, and PsycINFO, were searched in March 2024 with no restriction on publication year. Studies investigating women transitioning into postmenopause and with cognitive experiences measured using validated subjective cognitive measures were selected. The assessment of psychometric properties and applicability of included measures was conducted based on their development process and their performance in the menopause studies selected.

FINDING

Twenty-eight menopause studies involving 15 measures were included. Included measures showed adequate content validity, internal consistency, and construct validity when they were developed, yet other psychometric properties were either poor or not reported. Hence, the overall performance of included measures was generally moderate to poor. Information relating to psychometric properties of included measures in menopause studies was also lacking, indicating doubtful applicability.

CONCLUSIONS AND RELEVANCE

Poor psychometric properties or the lack of psychometric assessment of existing subjective cognitive measures may indicate doubt or uncertainty regarding their applicability in women transitioning through menopause. This review recommends the use of subjective cognitive measures that assess more than one cognitive domain, as well as further assessment of the psychometric properties of these measures before their use in menopause research or clinical settings, particularly those measures initially developed for clinical practice. It also highlights the need for future development of a subjective cognitive measure for women transitioning through menopause to improve the current understanding of their cognitive challenges.

Translational research on cognitive impairment in chronic kidney disease

Cognitive decline is common in patients with acute or chronic kidney disease. Several areas of brain function can be affected, including short- and long-term memory, attention and inhibitory control, sleep, mood, eating control and motor function. Cognitive decline in kidney disease shares risk factors with cognitive dysfunction in people without kidney disease, such as diabetes, high blood pressure, sedentary lifestyle and unhealthy diet. However, additional kidney-specific risk factors may contribute, such as uremic toxins, electrolyte imbalances, chronic inflammation, acid-base disorders or endocrine dysregulation. Traditional and kidney-specific risk factors may interact to cause damage to the blood-brain barrier, induce vascular damage in the brain and cause neurotoxicity or neuroinflammation. Here, we discuss recent insights into the pathomechanisms of cognitive decline from animal models and novel avenues for prevention and therapy. We focus on a several areas that influence cognition: blood-brain barrier disruption, the role of skeletal muscle, physical activity and the endocrine factor irisin, and the emerging therapeutic role of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. Taken together, these studies demonstrate the importance of animal models in providing a mechanistic understanding of this complex condition and their potential to explain the mechanisms of novel therapies.

Association between objective physical activity and frailty transition in community-dwelling prefrail Japanese older adults

BACKGROUND

Frailty transition is common, and increased physical activity can prevent it. An objective assessment of physical activity could eliminate bias and provide more precise information on the association between frailty transitions and physical activity.

OBJECTIVES

This study aimed to examine the association between objective physical activity and frailty transition in community-dwelling prefrail Japanese older adults.

DESIGN

This is a retrospective cohort study based on the National Institute for Longevity Science-Longitudinal Study of Aging data.

PARTICIPANTS

A total of 387 community-dwelling older adults with prefrailty were enrolled (mean age 72.0 years).

MEASUREMENTS

Frailty was assessed using modified components of the Cardiovascular Health Study criteria, and frailty statuses were reassessed two years later. The frailty transitions were categorized into three groups: deterioration, persistence, and reversal. Participants wore a uniaxial accelerometer to assess the physical activities. Differences in baseline characteristics according to frailty transitions were assessed. To compare the baseline objective physical activities based on frailty transition, a general linear model and a logistic regression model were used.

RESULTS

Among the 387 participants, 40 (10.3%) deteriorated to frailty, 97 (25.0%) reversed to robust, and the majority (n = 250, 64.6%) remained prefrail after a 2-year follow-up. Using the general linear model, after adjusting for other factors, total energy expenditure (TEE) in the reversal group was significantly higher than that in the deterioration and persistence groups. No differences in TEE were observed between the persistence and deterioration groups. No significant differences existed in the numbers of daily steps, exercise energy expenditure (EEE) and physical activity with different intensity among these three groups. The logistic model also showed a significant association between TEE and the reversal of frailty.

CONCLUSION

Frailty transitions were common in the Japanese prefrail population. This study showed that a higher TEE was positively associated with frailty reversal in prefrail older adults. Promoting proactive programs for older adults to increase physical activity could help them stay healthy and prevent frailty deterioration.

Exploring the domain specificity and the neural correlates of memory unawareness in Alzheimer's disease

Patients with Alzheimer's disease (AD) are less accurate than controls to predict their episodic performance, but they are as accurate as controls to predict their semantic performance. However, the dissociation between episodic and semantic metamemory had never been tested directly in the same patients. This study aimed to explore the dissociation between episodic and semantic metamemory in AD using the feeling-of-knowing paradigm. In addition, we investigated the link between memory awareness and resting-state cerebral glucose metabolism and gray matter density, in episodic and semantic tasks independently. Data from 50 patients with AD were compared to data from 30 healthy controls. Results showed that patients with AD had more difficulties to predict their recognition in the episodic task than in the semantic task, while this difference was smaller in controls. However, this dissociation was only shown with a measure of absolute accuracy, but not with a measure of relative accuracy. Lack of awareness in the episodic task was associated with hypometabolism in right frontoparietal areas in patients with AD, while semantic metamemory was associated with gray matter integrity in the left angular gyrus. The consequence of metacognitive bias and memory status on metamemory judgments are discussed.

Bidirectional associations of grip strength-gait speed with mild cognitive impairment and specific cognitive abilities among older adults: A longitudinal analysis

BACKGROUND

Previous studies showed that physical performance was associated with mild cognitive impairment (MCI). As the easily measured aging biomarkers, grip strength and gait speed could effectively reflect physical function. However, whether grip strength, gait speed, and the combination of the two were bidirectionally associated with MCI and specific cognitive function domains, have not been explored.

METHODS

The bidirectional relationships between grip strength and MCI, gait speed and MCI, and the combination of grip strength with gait speed and MCI, were examined by generalized estimating equation (GEE). GEE was performed to further estimate the bidirectional relationships between grip strength combined with gait speed and the five domains of cognitive function, respectively.

RESULTS

In total, 2,227 older adults (3 waves) were included. The MCI risk was higher for low grip strength group (OR = 1.78; P < 0.001) compared to normal grip strength group, as well as higher for low gait speed group (OR = 1.71; P < 0.001) compared to normal gait speed group. Low grip strength combined with low gait speed had the maximum associations with MCI (OR = 4.13; P < 0.001) and decline in orientation, immediate memory, delayed memory, attention and calculation, and language. Older adults with MCI and decline in those five domains of cognition also longitudinally related to lower grip strength and lower gait speed.

CONCLUSION

The main findings revealed the importance of regularly monitoring grip strength, gait speed, global cognition, and specific cognitive function domains among older people. Early interventions for grip strength, gait speed, and cognition function might achieve reciprocal benefits.

Comparison of non-exercise physical activity and exercise habits for preventing frailty among community-dwelling older adults: A 7-year follow-up from the Kashiwa cohort study

BACKGROUND

Engagement in non-exercise physical activities (NEPA) has a significant correlation with health. This study aimed to compare the impact of moderate-to-vigorous-intensity NEPA and exercise habit (EH) on frailty among community-dwelling older adults.

METHODS

This study utilized data from the Kashiwa cohort study in Japan, with baseline assessments in 2014 with a 7-year follow ups (4.0 [2.0-7.0]). A total of 1,288 participants were included. Frailty was assessed using the Cardiovascular Health Study Index, NEPA through the Global Physical Activity Questionnaire, and EH via self-reported exercise engagement at each follow-up examination. Generalized estimating equations (GEE) and Cox regression analyses were used to estimate associations between NEPA, EH, and frailty.

RESULTS

Compared to participants with no NEPA nor EH, those with NEPA only, with EH only, and with both showed significantly lower adjusted odds ratio (95 %CI) of frailty: 0.29 (0.16-0.52), 0.21 (0.11-0.41) and 0.21 (0.12-0.36). NEPA and EH at baseline were predictor variables for new-onset frailty during the 7-year follow-up period, with adjusted hazard ratios (95 % CI) of 0.55 (0.33-0.92) for NEPA only, 0.51 (0.29-0.90) for EH only, and 0.42 (0.25-0.70) for both. No significant differences were observed between the associations of NEPA and EH with frailty.

CONCLUSIONS

NEPA is associated with lower frailty risk in older adults, with a similar but non-additive effect to that of EH. These findings highlight the importance of NEPA for frailty prevention, particularly for those not engaged in formal exercise programs.

Combined effects of social isolation and loneliness on disability incidence in older adults

OBJECTIVES

Relationships among social isolation, loneliness, and disability onset remain unclear. We investigated the distinct patterns of disability development among Japanese older adults who experience social isolation and loneliness.

DESIGN

This study applied a prospective observational approach.

PARTICIPANTS

Data from 4,716 community-dwelling independent older adults were analyzed.

MEASUREMENTS

The Japanese version of the University of California, Los Angeles Loneliness Scale Version 3 and the Social Isolation Scale were used to measure loneliness and social isolation, respectively. The long-term care insurer conducted monthly follow-ups with participants over two years to determine their care needs. Disability onset was defined as the point at which participants were certified by a care manager as requiring long-term care.

RESULTS

During the follow-up period, 265 participants (5.6 %) required long-term care insurance certification due to disability onset. The incidence of disability in the lonely and not lonely groups was 8.0 % and 4.5 %, respectively. In the socially isolated and not socially isolated groups, it was 7.1 % and 4.4 %, respectively. The Cox proportional hazards regression model revealed a significantly higher risk of disability incidence in the lonely and socially isolated groups. The high-risk group experiencing both loneliness and social isolation exhibited significantly higher hazard ratios than the low-risk group without these symptoms.

CONCLUSIONS

The results indicated that older adults experiencing both social isolation and loneliness were at high-risk for future disability incidence. This finding provides insight into the complex interplay between social factors and disability, which can contribute to the development of effective interventions to promote healthy aging and prevent disability.

Anticholinergic burden quantified using the Japanese risk scale as a predictor of frailty and sarcopenia among community-dwelling older adults: A 9-year Kashiwa cohort study

AIM

Given the adverse effects of anticholinergic drugs and the necessity for medication evaluation tools in the aging population, a comprehensive scale to assess the total anticholinergic burden in Japan was developed. We examined the longitudinal association between the anticholinergic burden, quantified using the Japanese Anticholinergic Drug Risk Scale, and the development of frailty and sarcopenia in older adults.

METHODS

In this longitudinal population-based cohort study, 2044 older residents without long-term care needs were randomly selected from a community in Kashiwa, Japan. Baseline data were collected in 2012, with follow-ups in 2013, 2014, 2016, 2018, and 2021. Medications were identified through interviews and assessed with the Screening Tool for Older Persons' Appropriate Prescriptions for the Japanese. The anticholinergic burden was quantified using the Japanese Anticholinergic Risk Scale. We evaluated new-onset frailty and sarcopenia using the Cardiovascular Health Study Index and Asian Working Group for Sarcopenia 2019 criteria, respectively.

RESULTS

Of the 1549 participants without sarcopenia or frailty at baseline (age 72.5 ± 5.5 years; 49.1% women; median follow-up 6.0 years), 274 and 230 developed new-onset frailty and sarcopenia, respectively, during follow-up. After adjusting for potential confounders, an anticholinergic burden score ≥3 was strongly associated with new-onset frailty and sarcopenia (adjusted hazard ratio [95% confidence interval]: 2.45 [1.52-3.94] and 2.01 [1.20-3.35], respectively).

CONCLUSIONS

Anticholinergic burden is a predictor of frailty and sarcopenia in community-dwelling older adults. Effective evaluation and management of anticholinergic burden using the Japanese Anticholinergic Drug Risk Scale are crucial for promoting healthy aging and mitigating adverse health outcomes. Geriatr Gerontol Int 2025; 25: 520-527.

Impact of postmenopause on bipolar depression: Insights from a prospective study

BACKGROUND

Existing research on menopause and Bipolar Disorder indicates a general exacerbation in depressive symptoms but lacks clear distinctions between menopausal stages, despite their specific hormonal and symptomatic profiles. This study assesses how postmenopause versus the reproductive phase impacts the progression and antidepressant responsiveness of bipolar depression in women with Bipolar I Disorder.

METHODS

This prospective cohort study included 364 women with moderate to severe depressive episodes. Participants were classified into postmenopausal and reproductive groups based on the Stages of Reproductive Aging Workshop + 10 criteria. Over four weeks, all participants received a personalized treatment, with depressive symptoms assessed weekly.

RESULTS

Similar depression severity was observed between groups at the outset of the study. However, women in postmenopause experienced worse treatment responses and lower remission rates, despite the application of more complex treatment strategies. Notably, the impact of postmenopause on treatment outcomes, despite a small effect size, proved independent of age and comorbidities.

CONCLUSIONS

This exploratory research is the first to specifically assess the impact of postmenopause on bipolar depression, revealing its independent and negative influence on treatment outcomes. The small outcomes differences observed between groups, achieved through the use of more complex treatment strategies, suggest that developing tailored therapeutic protocols could significantly improve the clinical management of these patients.

Characterization of subclinical depressive and anxiety symptoms in older adults with subjective cognitive decline progressing to objective cognitive impairment: A prospective 4-year follow-up study

BackgroundSubjective cognitive decline (SCD) is linked to a more rapid progression to the development of mild cognitive impairment (MCI) or Alzheimer's disease (AD). SCD has been correlated with affective symptoms such as depression and anxiety. Recent research aimed to shed light on the relationship between these affective symptoms and how they might correlate to a more rapid progression to objective cognitive impairment. No studies have assessed the presence, type, and intensity of depressive and anxiety symptoms between SCD individuals who progressed versus those who did not.ObjectiveThis study aimed to establish whether there are differences between subclinical depressive and anxiety symptoms in terms of presence, type, and intensity of symptoms presented by individuals with SCD who progressed to an objective cognitive decline.MethodsThe recruited participants originated from the Consortium for the Early Identification of Alzheimer's Disease - Québec (CIMA-Q) cohort. They were assessed twice, with an interval of 4 years separating the evaluations. Anxiety symptoms were assessed using the Geriatric Anxiety Inventory (GAI) and depression symptoms using the Geriatric Depression Scale (GDS-30).ResultsThe presence, type and intensity of anxiety symptoms did not significantly distinguish the two groups. Only one type of hopelessness-related depressive symptom was significantly higher in SCD participants who had progressed to objective cognitive decline compared with those who had not.ConclusionsOur results suggest that it may be beneficial to target hopelessness in non-pharmacological interventions aimed at preventing the progression of people with SCD to MCI or AD.

Validating a brief performance-based measure of cognition and daily functioning in amnestic mild cognitive impairment and mild Alzheimer's disease

BackgroundThe Clinical Dementia Rating (CDR) scale is widely used as a cognitive and functional measure in Alzheimer's disease (AD) clinical trials. Given its time and personnel burden, there is a need to more efficiently identify patients who warrant further evaluation or clinical trial qualification. To potentially address this need, a novel performance-based test of cognition and daily functioning has been developed for use in AD research and clinical care.ObjectiveTo test whether this novel performance-based test is associated with levels of daily functioning in both impaired and unimpaired individuals.MethodsOne-hundred-seventy-one participants (72 cognitively unimpaired; 53 amnestic mild cognitive impairment; 46 mild AD) completed the novel performance-based test of cognition and daily functioning, as well as the Quick Dementia Rating System (QDRS) for estimating global CDR.ResultsThe novel test was significantly associated with the QDRS Total, as well as the Behavioral and Cognitive subdomains, and differentiated between estimated global CDR scores of 0 versus ≥0.5. No significant effect of age, sex, or education on the performance-based test was observed.ConclusionsThe performance-based test used in this study can be considered a measure of cognition and daily functioning. As such, it may be a quick, objective method for identifying impaired individuals who may qualify for clinical trial enrollment or may warrant further evaluation without the need for informant input.

Long-term frailty and physical performance transitions in older people with type-2 diabetes. The MIDFRAIL randomized clinical study

AIMS

Type 2 diabetes (T2D) is associated with frailty in older people. We aim to explore changes in frailty status after ≥18 months of intervention.

METHODS

298 community-dwelling older adults (>70 years) participating in MIDFRAIL followed-up for 18-24 months were randomly allocated by trial site (cluster) to intervention IG (16-weeks resistance exercise program, nutritional-educational sessions, optimization of diabetes care), or usual care group (UCG). Frailty status was assessed by the Fried Frailty Phenotype criteria at baseline and final visit. Functional status was assessed by the SPPB in every visit. We used multivariate linear and logistic regression for continuous and dichotomous outcomes. This study was registered at Clinicaltrials.gov (NCT01654341).

RESULTS

Mean age was 77.7 (SD 5.54), 47% were male, 32.9% frail and 67.1% prefrail. The probability of improving the frailty status and decreasing the number of Fried's frailty criteria was higher in the IG than in the UCG (OR 2.6, 95%CI 1.3-5.4; p = 0.009 and OR 1.9; 95%CI 1.1-3.1; p = 0.02, respectively). IG participants more frequently improved ≥1 point in SPPB score (OR 1.85; 95%CI 1.09-3.12; p = 0.022). These benefits were mainly accounted for the prefrail participants.

CONCLUSIONS

The MIDFRAIL intervention improved frailty status and physical function at long-term follow-up in older people with T2D.

Effect of individually tailored nutritional counseling on frailty status in older adults with protein-energy malnutrition or risk of it: an intervention study among home care clients

BACKGROUND

Frailty and protein-energy malnutrition (PEM) are common in older home care clients. In this study, we evaluate the effect of individually tailored dietary counseling on frailty status among home care clients with PEM or its risk aged 75 or older with a follow-up of six months.

METHODS

This intervention study is part of the non-randomized population-based Nutrition, Oral Health and Medication (NutOrMed) study in Finland. The frailty was assessed using the abbreviated Comprehensive Geriatric Assessment (aCGA) and included 15 questions from three different domains: cognitive status (MMSE), functional status (ADL, IADL) and depression (GDS-15). The study population consisted of persons with PEM or its risk (intervention group n = 90, control group n = 55). PEM or its risk was defined by MNA score <24 and/or plasma albumin <35 g/l. Registered nutritionist gave individually tailored nutritional counseling for participants at the baseline and nutritional treatment included conventional food items.

RESULTS

The mean age was 83.9 in the intervention and 84.3 in the control group. At the baseline frailty prevalence was 74.4% (n = 67) and after six-month 61.1% (n = 55) in the intervention group and, respectively 74.5% (n = 41) and 80.0% (n = 44) in the control group. The intervention decreased significantly (p < 0.001) the prevalence of frailty in the intervention group, while it increased in the control group.

CONCLUSIONS

Individually tailored nutritional counseling reduces the prevalence of frailty among vulnerable home care clients with PEM or its risk. In the nutritional treatment of frailty, adequate intake of protein and energy should be a cornerstone of treatment.

Comparing high and low amyloid producers in Alzheimer's disease: An in-depth analysis

BACKGROUND

The cerebrospinal fluid (CSF) Aβ42/40 ratio has proven to be a more reliable biomarker for amyloid pathology than CSF Aβ42 in Alzheimer's disease (AD), helping to correctly classify patients with positive tau biomarkers (T+) that would otherwise have remained outside of the AD continuum. It was shown that the Aβ42/40 ratio better captures a relative decrease of Aβ42 in patients with high CSF Aβ. However, whether patients with high-amyloid (HiA) AD, in whom A+ is defined by the Aβ42/40 ratio, exactly compare with their low-amyloid (LoA) counterparts, in whom A+ is defined by Aβ42 solely, deserves further analysis.

METHODS

We retrospectively included patients with A+T+ AD and evidence of cognitive and neurodegenerative changes (N+). LoA patients were operationally defined as patients with T+N+ and low CSF Aβ42, while HiA patients were defined as patients with T+N+ and normal CSF Aβ42 but abnormal Aβ42/40 ratio. Tau CSF biomarkers, neuropsychological profile, rates of cognitive decline, structural and metabolic imaging, ApoE genotype and brain neuropathology were compared between the HiA and LoA groups.

RESULTS

At the time of the lumbar puncture, LoA patients were significantly younger than the HiA patients (68.9±8.7years vs. 71.8±9.4; P=0.0015) and had a lower Mini-Mental Status Examination (MMSE) (18.7±6.4 vs. 20.7±6.2; P=0.0005). There was no difference in the neuropsychological profile nor in the annual rates of cognitive decline between the two groups with early AD. No differences were retrieved between groups on CSF Tau and P-Tau biomarkers, atrophy and brain metabolism, distribution of the APOE4 allele and APOE4/E4 genotype, and neuropathology.

CONCLUSIONS

Overall, our study supports the surrogate use of the Aβ42/40 ratio as an equivalent to Aβ42 to define AD. We showed that HiA CSF profiles were not associated with differences in cognition, brain structures and metabolism, APOE genotype tau CSF biomarkers or the rates of cognitive decline, but may be the associated with later-onset and early-stage AD.

Validation of the Brief Assessment of Impaired Cognition and Brief Assessment of Impaired Cognition Questionnaire in a multicultural memory clinic sample across six European countries

BackgroundWith the changing demographic landscape in most countries worldwide, accurate and brief culture-sensitive case-finding instruments are needed to identify patients with possible cognitive disorders.ObjectiveTo investigate the discriminative validity of the Brief Assessment of Impaired Cognition (BASIC) and BASIC Questionnaire (BASIC-Q) in a multicultural memory clinic sample across six European countries.MethodsThe study was a European cross-sectional multi-center study. Receiver operating characteristic curve analysis was used to examine discriminative validity of BASIC and BASIC-Q in identifying cognitive impairment (mild cognitive impairment (MCI) or dementia) as compared to specialist diagnosis. Regression analysis was used to assess the influence of sociodemographic variables and assessment in a second language on scores.ResultsThe study included a total of 479 participants of which 169 (36%) had immigrant background. BASIC and BASIC-Q had high diagnostic accuracy for cognitive impairment (MCI or dementia) with areas under the curve (AUC) of 0.93 and 0.92, respectively. Age had a significant, but small effect on BASIC, while both BASIC and BASIC-Q were unaffected by sex, education, immigrant status, and assessment in a second language. Among patients with affective/anxiety disorder, 80% scored below cutoff for cognitive impairment on BASIC and 94% on BASIC-Q. However, applying an Objective Performance vs. Subjective Complaints ratio to differentiate between patients with cognitive impairment and affective/anxiety disorder resulted in high overall classification accuracies, with AUC values of 0.80 and 0.74, respectively.ConclusionsThe present study suggests that BASIC and BASIC-Q are valid brief case-finding instruments for cognitive impairment in a multicultural setting.

Association of objective and subjective socioeconomic status with intrinsic capacity deficits among community-dwelling middle-aged and older adults in China: A cross-sectional study

BACKGROUND

Intrinsic capacity (IC), representing an individual's full range of physical and mental abilities, is influenced by objective socioeconomic status (SES); however, the impact of subjective SES remains unclear.

OBJECTIVES

This study aims to assess IC and investigate the relationship between SES and IC deficits, with a particular focus on the role of subjective SES.

DESIGN

Cross-sectional study SETTING: 45 communities in two provinces in China PARTICIPANTS: Community-dwelling middle-aged and older adults aged 50 and above MEASUREMENTS: IC was assessed following the Integrated Care for Older People guideline. SES was measured through objective SES (education and occupation) and subjective SES (measured by MacArthur Scale). Ordinal logistic regression models were performed to estimate the association between SES and IC.

RESULTS

Among 3,058 participants (61.3 ± 8.05 years, 54.8 % women), 2,333 (76.3 %) showed deficits in at least one IC subdomain, particularly sensory (63.5 %), vitality (25.8 %) and cognition (18.4 %). A dose-response association was observed between SES and IC deficits. Individuals with high subjective SES (OR: 0.72, 0.60-0.87), high education (OR: 0.54, 0.38-0.75), and high occupation (OR: 0.64 0.50-0.81) exhibited lower IC deficits risk compared with counterparts. Individuals with high education and middle subjective SES or high occupation and middle subjective SES had 67 % (OR: 0.33, 0.18-0.60) and 49 % (OR: 0.51, 0.35-0.74) lower risk than those with low SES.

CONCLUSIONS

These findings suggest that individuals with low SES may be more vulnerable to IC deficits. Addressing social inequalities in the early assessment of IC is crucial for reducing health disparities and promoting healthy ageing.

A statistical method for predicting amyloid-β deposits from severity, extend, and ratio indices of the 99mTc-ECD SPECT

BackgroundAmyloid-β (Aβ) deposit prediction accuracy is necessary for clinicians treating patients desiring Alzheimer's disease (AD) modifying drugs. Aβ-PET imaging is useful for diagnosis, but high in cost compared to brain perfusion SPECT. However, SPECT displays regional cerebral blood flow (rCBF) and does not detect Aβ deposits, therefore requiring additional clinical information.ObjectiveThis article describes a novel statistical method to predict amyloid deposits via PET images (Aβ+ or Aβ-) using the three indices of the 99mTc-ECD SPECT - severity, extend, and ratio - for the three ROIs.MethodsCandidate patients (N = 114 patients [55% male], 81 Aβ+ 33 Aβ-, mean age 74.2 ± 6.6 years, mean MMSE score 23.7 ± 2.8) underwent MRI and 99mTc-ECD SPECT scanning. After examining SPECT index, demographic, and age data, age and sex were treated as confounders in one, two, and three-index logistic additive models with severity, extend, and ratio as explanatory variables. Area under curve (AUC), sensitivity and specificity were used as statistical indices for model fitness and accuracies. Three-hold cross validation analyses were conducted to evaluate error rates.ResultsAccording to ROC analysis, best scores for fitness and accuracy were obtained from the three-index model with patients' age and sex for the configured ROIs including precuneus, posterior cingulate and temporal-parietal region of SPECT (AUC: 0.818, Sensitivity: 0.803, Specificity: 0.727).ConclusionsThis technique using 99mTc-ECD SPECT data can predict amyloid deposits with acceptable accuracy. To confirm the reliability and validity, a multicenter SPECT study is needed.

Reducing the burden of informal care through lecanemab: A case of a patient with mild cognitive impairment who continues to drive

This case report discusses a 75-year-old patient with mild cognitive impairment who successfully continued driving while treated with lecanemab. The treatment appeared to stabilize cognitive function and facilitate ongoing physical activity, potentially reducing informal care burdens associated with driving cessation. Further research is warranted to explore long-term impacts.

Biofeedback and Exercise Load Affect Accuracy of Tongue Strength Exercise Performance

Rehabilitative exercises require precise movement coordination and target accuracy for optimal effectiveness. This paper explores the impact of tongue strength exercises (TSE) performance accuracy on exercise outcomes, adherence, and participant confidence and motivation. An 8-week randomized clinical trial included 84 typically aging participants divided into four groups defined by access to biofeedback (present/absent) and TSE intensity dosing (maximal/submaximal) during a home exercise program (HEP). Retention, training, and HEP accuracy were tracked at biweekly visits and during HEP for participants with access to a biofeedback device. Associations with tongue strength outcomes, participant factors, biofeedback, and intensity dosing were analyzed. Exercise accuracy measures did not contribute to tongue strength outcomes at the end of 8 weeks. Increased training accuracy (less practice required to achieve competency) was associated with higher participant confidence and better adherence to the HEP. The presence of biofeedback was associated with reduced adherence but better retention accuracy, while maximal intensity was associated with improvements in all accuracy measures compared to submaximal intensity exercise. These findings in typically aging participants suggest the need for tailored approaches in swallowing-related exercise programs, given the effects of biofeedback and exercise intensity on motor learning and exercise retention. Accuracy performance and its effect on clinical outcomes warrants study in clinical populations with dysphagia and with various rehabilitative approaches.Trial Registration Clincialtrials.gov: NCT04809558.

Role of obesity-related anthropometric indicators on cognitive function in obese older adults: A systematic review and meta-analysis

OBJECTIVES

The association between obesity and cognitive function in older adults remains inconsistent due to the use of various anthropometric indicators, such as body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). More conclusive evidence is warranted. The aim of this study was to systematically summarize and synthesize the association between specific obesity-related anthropometric indicators (BMI, WC, and WHR) and cognitive function in obese older adults. Higher BMI, WC, or WHR is linked to cognitive decline in this population.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive literature search was carried out using PubMed, CINAHL, Scopus, Embase, and the Cochrane Library (from their inception to October 2023). Studies investigating the association between obesity indicators, including BMI, WC, WHR, and cognitive performance in older adults were included. The weighted mean difference (WMD), Odds Ratio, and 95 % confidence interval (CI) were used to estimate the pooled effect size. A random-effects model was employed as the main method. Subgroup analyses and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were assessed (registered number: CRD42023461770).

RESULTS

Thirty-three eligible studies, involving 83,251 participants, were included. Obese older adults, as assessed by WC, had lower Mini-Mental State Examination (MMSE) scores than non-obese counterparts (WMD -0.84, 95 % CI -1.64 to -0.05, very low certainty). Those measured by WHR had a 31 % higher risk of cognitive impairment (OR 1.31, 95 % CI 1.12 to 1.53, moderate certainty). Subgroup analysis revealed a lower Montreal Cognitive Assessment (MoCA) score in obese group classified by WHO criteria compared to controls (WMD -1.67, 95 % CI -2.94 to -0.39).

CONCLUSION

This review suggests an association between obesity, as measured by WHR and WC, and poorer cognitive performance in older adults. WHR is moderately recommended for identifying cognitive impairment-related obesity, while WC recommendations are limited by very low evidence certainty.

Occupational Therapy Practitioners' Perceptions on Addressing Cognition in Acute Care: A National Survey

This study aimed to identify commonly used standardized cognitive screens and functional performance assessments among occupational therapy practitioners at level 1 trauma centers in the USA. A survey completed by 269 occupational therapy practitioners revealed the most common cognitive screens and the association between cognitive tool training and standardized cognitive tool implementation. Implications for practice are discussed with suggestions for improving occupational therapy practice.

Cognitive Function in Patients With Mild Idiopathic Pulmonary Fibrosis: A Case-Control Pilot Study

This case-control study examined cognitive function in patients with mild idiopathic pulmonary fibrosis (IPF), in comparison with controls or moderate-to-severe IPF. Ten mild IPF, 10 moderate-to-severe IPF, and 16 controls were enrolled, and performance on seven different cognitive function tests was compared in each group. IPF showed decreased cognitive function compared to controls in verbal memory, cognitive flexibility and information processing speed. As the scores were lower even in mild IPF, this study suggests that cognitive function declines early in the disease process of IPF. Thus, occupational therapy for IPF should require an assessment of cognitive function and assistance appropriate to the client's function.

Associations Between Cognitive Performance and Self-Efficacy for Pain Management in Older Adults With Chronic Pain

BACKGROUND

Self-efficacy for pain management is the key to successful pain management, yet little is known about the effect of cognitive performance on self-efficacy for pain management. This study aimed to examine to what extent cognitive performance is related to self-efficacy for pain management in older adults with chronic pain.

METHODS

The analyses utilized data from the baseline assessment of the MOBILIZE Boston Study. Five neuropsychological tests-the Clock in the Box Test, Letter Fluency Test, Trail-making Test, Hopkins Verbal Learning Test, and WORLD Test-were performed to measure the cognitive performance domains of 458 participants, aged 70 years and reporting chronic pain and self-efficacy for pain management. We measured self-efficacy for pain management using the Chronic Pain Self-Efficacy Scale. Statistical analyses were done using multiple linear regression analysis.

RESULTS

After adjusting for sociodemographic factors, general cognitive performance, executive function, as measured by the Clock in the Box Test, and attention, as measured by the Trail-Making Test Part A, were significantly associated with self-efficacy for pain management in older adults with chronic pain. However, after controlling for sociodemographic factors, chronic conditions, pain interference, and physical performance, the associations between cognitive performance measures and self-efficacy for pain management weakened.

CONCLUSION

Greater cognitive performance in attention and executive function might be associated with better self-efficacy for pain management. Future longitudinal research is required to investigate the long-term implications of cognitive performance changes on the progress of self-efficacy for pain management in community-dwelling older adults.

Association between Copper Exposure and Cognitive Function: A Cross-Sectional Study in a County, Guangxi, China

There has been growing attention to the impact of copper exposure on cognitive function; however, current research on the specific information regarding urinary copper and cognitive function is limited, particularly detailed analyses in the Chinese adult population. This study aimed to explore the association between copper exposure and cognitive function in a cross-sectional design. A total of 2617 participants in a county, Guangxi Zhuang Autonomous Region (Guangxi), China, were included. The mini-mental state examination (MMSE) was used to assess cognitive function, and inductively coupled plasma mass spectrometry was used to measure urinary metal levels. Spearman's rank correlation was used to analyze the correlation between urinary copper levels and various cognitive function assessment indices. After adjusting for potential confounders, binary logistic regression was used to explore the association between urinary copper levels and the risk of cognitive impairment (CI) as revealed by MMSE, and restricted cubic spline regression was further used to explore the dose-response relationship. The results showed a negative correlation between urinary copper levels and orientation, attention and calculation, memory, language ability, and MMSE total scores (P < 0.05). Compared with the low copper exposure group, the high exposure group showed a 58.5% increased risk of CI (OR = 1.585, 95%CI: 1.125 to 2.235, P = 0.008). A significant linear dose-response relationship was observed between urinary copper levels and the risk of CI (P overall = 0.045, P nonlinearity = 0.081). Our findings suggest that higher copper exposure may be associated with CI in the population of a county, Guangxi, China.

Relationships of Physical Activity and Type 2 Diabetes With Cognition in Mexican Americans and Non-Hispanic Whites

Problem, Research Strategy, and Findings: Low physical activity (PA) and Type 2 diabetes are associated with cognitive aging and Alzheimer's disease, but the evidence is inconsistent and particularly limited by ethnicity. The purpose of this study was to examine the relationships of PA and Type 2 diabetes with cognition in Mexican Americans and non-Hispanic Whites. The study was a cross-sectional analysis of the Health and Aging Brain Study-Health Disparities (n = 1,982-2,000 after removing outliers). Predictors included Rapid Assessment of Physical Activity and hemoglobin A1c (HbA1c). Episodic memory was assessed by Weschler Memory Scale-Third Edition Logical Memory and Spanish-English Verbal Learning Test, executive function by Weschler Memory Scale-Third Edition Digit Span and Digit Symbol Substitution Test, verbal fluency by FAS and animal naming, and global cognition by the Mini-Mental State Examination. Results show that aerobic PA and HbA1c were not associated with domain-specific, or global cognition, but strength/flexibility PA was associated with FAS (b = 0.404, 95% CI [0.023, 0.761]). Higher aerobic PA was associated with greater verbal fluency for Mexican Americans (b = 0.294, 95% CI [0.96, 0.497]) only. HbA1c was negatively associated with Mini-Mental State Examination (b = 0.838, 95% CI [0.008, 1.656]). For low HbA1c, the association between aerobic PA and Digit Symbol Substitution Test was significant for non-Hispanic Whites (b = 0.838, 95% CI [0.008, 1.656]) in comparison to Mexican Americans. Takeaway for Practice: The relationships between PA, Type 2 diabetes, and cognition vary by cognitive domains and ethnicity. Increasing aerobic activities may be particularly important for Mexican Americans who have elevated HbA1c to potentially improve fluency or executive function.

Impact of deep brain stimulation on cognitive impairment in Parkinson's disease: A retrospective longitudinal study

Subthalamic nucleus deep brain stimulation (STN-DBS) is a well-established treatment for improving motor symptoms, non-motor symptoms, and quality of life (QOL) in patients with advanced Parkinson's disease (PD). However, its effects on patients with cognitive impairment (CI) remain controversial due to the unique challenges and risks posed by cognitive decline. This study aimed to evaluate the mid- to long-term impact of STN-DBS on motor function, non-motor symptoms, and QOL in PD patients with CI. A retrospective cohort of 72 PD patients who underwent STN-DBS and 73 non-DBS patients was analyzed. Baseline and follow-up assessments (minimum one-year follow-up) included motor function (MDS-UPDRS III "off"), non-motor symptoms (NMSS), QOL (PDQ-8), and cognitive function (MMSE). Patients were stratified into a CI cohort based on education-adjusted MMSE cutoffs, with 30 patients in the STN-DBS group and 23 in the non-DBS group. Over two years, the STN-DBS group showed significant improvements in motor function, reduced medication burden (LEDD), and enhanced QOL. Notably, patients with CI in the STN-DBS group achieved better long-term motor and non-motor outcomes compared to the non-DBS group. These results highlight the potential of STN-DBS to offer sustained benefits for cognitively impaired PD patients, though further research is necessary to confirm its long-term safety and efficacy.

Comparison of appetite assessment methods in older adults from the APPETITE study

Poor appetite is an important health concern in older adults. Numerous methods exist for appetite assessment, without a consensual gold standard. This study aims to compare Simplified Nutritional Appetite Questionnaire (SNAQ) and two single-item appetite questions with appetite ratings from visual analogue scales (VAS) and energy intake (EI). In 126 community-dwelling adults aged ≥65 years from the APPETITE trial, appetite was assessed using SNAQ, SNAQ 1st item, Center for Epidemiologic Studies-Depression scale (CES-D) 2nd item and using VAS appetite ratings (fasting, 0, 30, 60, 120, 180 min post-breakfast, post-lunch) and EI (ad libitum lunch) in a test meal setting. Spearman correlations were calculated between SNAQ, single-items, VAS-fasting, and EI. Differences in VAS-fasting and EI between normal and poor appetite groups (based on SNAQ, single-items) were examined using Mann-Whitney-U-test. Repeated measures Generalized Linear Models were used to compare all VAS ratings across the test morning and post-breakfast response ratings with VAS-fasting as a covariate between appetite groups. SNAQ score was correlated with VAS-fasting (r = 0.26, p < 0.001) and EI (r = 0.22, p < 0.05). VAS-fasting was lower in the SNAQ-based poor appetite group (p = 0.01). Time/group interaction effects (SNAQ, ηp2 = 0.02; CES-D-item, ηp2 = 0.02) for all VAS ratings, and group (SNAQ-item, ηp2 = 0.04) and interaction effects (CES-D-item, ηp2 = 0.03) for post-breakfast ratings were observed (p < 0.05, respectively). SNAQ identified differences in VAS-fasting, possibly reflecting processes related to the drive to eat, while the two single-items identified appetite differences in response to a standardised breakfast. Different methods appear to capture different aspects of appetite, which should be considered when choosing an assessment method.

Tactile acuity, left/right judgment performance, motor imagery ability, and pressure-pain threshold in patients with chronic rotator cuff-related shoulder pain: a cross-sectional case-control study

BACKGROUND

Chronic pain can alter cortical pain representation, and tests like Two-Point Discrimination Test (TPDT), Left/Right Judgment Task (LRJT), motor imagery, and Pressure-Pain Threshold (PPT) can assess these changes. However, their applicability to all pain mechanisms is uncertain.

OBJECTIVE

To compare the TPDT, LRJT, motor imagery ability, and PPT of chronic rotator cuff-related shoulder pain (C-RCRSP) patients with asymptomatic and pain-free controls.

METHODS

Forty-eight C-RCRSP patients and 45 pain-free controls were assessed using a caliper for TPDT and the Recognize® application for LRJT. Motor ability, PPT, physical function, fear avoidance, pain catastrophizing, and Central Sensitization Inventory (CSI) were also evaluated. As part of the subgroup analysis, C-RCRSP patients were divided into two groups based on their CSI (≥40, n = 19; <40, n = 29).

RESULTS

C-RCRSP patients demonstrated higher TPDT thresholds [acromion (F = 5.41, p = 0.001) and deltoid (F = 26.67, p < 0.001)] but no significant differences in LRJT performance [recognition accuracy (F = 2.47, p = 0.063) and response time (F = 0.98, p = 0.414)] than pain-free controls in both shoulder joints. C-RCRSP patients had poorer motor imagery abilities (p < 0.001). The deltoid region PPT differed significantly between the groups (F = 17.45, p < 0.001), but it was not significant for the tibialis anterior region (F = 1.16, p = 0.33). C-RCRSP patients with a CSI≥40 reported higher night pain, reduced shoulder range of motion, slower response times, poorer motor imagery ability, and higher scores on pain-related questionnaires compared to those with a CSI<40 (p = 0.043-<0.001).

CONCLUSION

C-RCRSP patients demonstrated poorer tactile acuity, mechanical sensitivity, and motor imagery ability especially in those with central sensitization, which should be considered in treatment planning.

Generalisability of the Barthel Index and the Functional Independence Measure: robustness of disability measures to Differential Item Functioning

PURPOSE

Differential Item Functioning (DIF), an item malfunctioning, causes Differential Test Functioning (DTF), thus biasing questionnaire measures. The current study evaluates the relationship between DIF and DTF for the Barthel Index and the Functional Independence Measure, likely the most used disability measures. The aim is to understand under which conditions DIF can be ignored as its DTF is negligible.

METHODS

A simulation study was run. Disability measures were obtained for the Barthel Index and FIM motor domain using Rasch analysis with previously published item calibrations. Several DIF scenarios have been assessed. DTF was tolerable if ≤0.50 logits.

RESULTS

Simulations showed that the larger the DIF, the larger the DTF and that, keeping the overall DIF constant, the total number of items with DIF does not affect DTF. DIF of the items with the lowest or highest calibrations is the most dangerous. The DIF of central items should be so massive to matter in DTF terms that it is unlikely to happen in practice. The FIM robustness to DIF is better than that of the Barthel Index.

CONCLUSIONS

The FIM and the Barthel Index show remarkable robustness to DIF. Thanks to this feature, sample invariant, generalisable disability measures are available.

Comparing patterns of impairment in social cognition between young-onset and late-onset Alzheimer's disease

BackgroundYoung-onset Alzheimer's disease (YOAD) is defined as when the disease starts before 65 years old. Compared with late-onset AD (LOAD), the progression is faster and more aggressive. However, the impact on social cognition deficits may not follow the same clear pattern.ObjectiveThe present study aims to investigate the relationship between social cognition, global cognition, and other clinical variables in people with YOAD and LOAD and their caregivers.MethodsUsing a cross-sectional design, we included 48 people with YOAD and 118 with LOAD, and their caregivers. We assessed social cognition, global cognition, quality of life, dementia severity, mood, functionality, neuropsychiatric symptoms, and caregiver burden.ResultsThe YOAD group was more impaired in general cognition (p = 0.002, d = 0.06), had a worse quality of life (p = 0.036, d = 0.36), and presented more neuropsychiatric symptoms (p = 0.044, d = 0.35). However, social cognition did not exhibit the same disease progression and showed no difference when compared with the reports of their caregivers or with individuals with LOAD. The multifactorial regression analyses showed that functionality was related to social cognition impairment in YOAD (p = 0.035), and LOAD (p = 0.001).ConclusionsOur study found that people diagnosed with YOAD showed more global cognitive impairment but maintained social and emotional functioning.

Tea consumption and cognitive health in Chinese older adults: A propensity score matching and weighting analysis

BACKGROUND

The association between tea consumption, especially different types, and cognitive function has not been adequately explored. This study aimed to investigate the associations of tea consumption, including status, frequency, and type, with cognitive function, considering selection bias.

METHODS

We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018(N = 8498). Cognitive function was measured by Mini-Mental State Examination (MMSE). Logistic and linear regression were applied to assess the associations of tea consumption with cognitive impairment and cognitive scores, respectively. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balance characteristic differences between groups.

RESULTS

The characteristics of tea consumption status, frequency and type were well balanced between groups after using PSM and IPTW. Drinking tea was associated with less cognitive impairment (ORadjusted:0.84, ORPSM:0.84, ORIPTW:0.87) and higher cognitive scores (Coefficientadjusted:0.29, CoefficientPSM:0.33, CoefficientIPTW:0.29). Regular tea drinkers may have better cognitive function than those who never or rarely consumed (Ptrend < 0.05 for both methods). Green tea drinkers had lower prevalence of cognitive impairment (ORadjusted:0.71, ORIPTW:0.75) and higher cognitive scores (Coefficientadjusted:0.45, CoefficientIPTW:0.54). Men, uneducated, and those with annual income>10,000 RMB were more likely to benefit from flower tea. Significant interactions of tea consumption with age, education and income were observed.

CONCLUSIONS

Tea consumption, especially regular and green tea consumption, was associated with less cognitive impairment and higher cognitive scores, even after PSM and IPTW adjustments. Flower teas may have potential protective effect that is worth further study. Age, education and income have synergistic effects with tea consumption on cognitive function.

Propranolol Reduces Parkinson's Tremor and Inhibits Tremor-Related Activity in the Motor Cortex: A Placebo-Controlled Crossover Trial

OBJECTIVE

Parkinson's disease (PD) resting tremor is thought to be initiated in the basal ganglia and amplified in the cerebello-thalamo-cortical circuit. Because stress worsens tremor, the noradrenergic system may play a role in amplifying tremor. We tested if and how propranolol, a non-selective beta-adrenergic receptor antagonist, reduces PD tremor and whether or not this effect is specific to stressful conditions.

METHODS

In a cross-over, double-blind intervention study, participants with PD resting tremor received propranolol (40 mg, single dose) or placebo (counter-balanced) on 2 different days. During both days, we assessed tremor severity (with accelerometry) and tremor-related brain activity (with functional magnetic resonance imaging), as well as heart rate and pupil diameter, while subjects performed a stressful cognitive load task that has been linked to the noradrenergic system. We tested for effects of drug (propranolol vs placebo) and stress (cognitive load vs rest) on tremor power and tremor-related brain activity.

RESULTS

We included 27 PD patients with prominent resting tremor. Tremor power significantly increased during cognitive load versus rest (F[1,19] = 13.8; p = 0.001;η p 2  = 0.42) and decreased by propranolol versus placebo (F[1,19] = 6.4; p = 0.02;η p 2  = 0.25), but there was no interaction. We observed task-related brain activity in a stress-sensitive cognitive control network and tremor power-related activity in the cerebello-thalamo-cortical circuit. Propranolol significantly reduced tremor-related activity in the motor cortex compared to placebo (F[1,21] = 5.3; p = 0.03;η p 2  = 0.20), irrespective of cognitive load.

INTERPRETATION

Our findings indicate that propranolol has a general, context-independent, tremor-reducing effect that may be implemented at the level of the primary motor cortex. ANN NEUROL 2025;97:741-752.

Itel MMSE: a short phone screening test for cognitive decline. Italian Validation study by the SINdem Neuropsychology Working Group

INTRODUCTION

The Italian telephone-based Mini-Mental State Examination (Itel-MMSE) is considered a very easy tool for screening individuals with dementia, gained importance during COVID-19, but lacks validation and faces a ceiling effect.

AIM

In the present study, we conducted a study standardizing and validating it, establishing cut-off values for two versions.

METHODS

Across 24 Italian sites, 707 healthy individuals (50-89 years, men: 268, women: 439) with diverse educational levels (3-24 years) were recruited. Subjects met criteria for normal conditions investigated through a semi-structured interview covering neurological, psychiatric, general medical, and psychopharmacological history. Two test versions were created to assess test-retest reliability at 45-day intervals. We also enrolled 187 subjects with Mild Cognitive Impairment (MCI) and 181 with Alzheimer's Disease (AD) for validation. The raw scores obtained on both versions of Itel-MMSE were set as dependent variables in linear regression models that included age, education, and gender as independent variables. RESULTS : Mean raw Itel-MMSE1 score was 20.82 (range: 13-22). Multiple linear regression demonstrated significant effects of sociodemographic variables for age and education, establishing a new cut-off ≥ 18.49. Mean raw Itel-MMSE2 score was 20.97 (range: 10-22), with a new cut-off ≥ 18.45. Validation showed high informative values, with areas under the curve (AUCs) for MCI and AD conditions and both versions (Itel-MMSE1: MCI AUC = 0.801, AD AUC = 0.907; Itel-MMSE2: MCI AUC = 0.827, AD AUC = 0.977).

CONCLUSION

The Itel-MMSE proves valuable as a screening method for detecting and monitoring dementia in remote phone screenings, with different cut-offs aiding MCI patient identification in clinical settings.

Comparing a BCI communication system in a patient with Multiple System Atrophy, with an animal model

Paralysis affects many people worldwide, and the people affected often suffer from impaired communication. We developed a microelectrode-based Brain-Computer Interface (BCI) for enabling communication in patients affected by paralysis, and implanted it in a patient with Multiple System Atrophy (MSA), a neurodegenerative disease that causes widespread neural symptoms including paralysis. To verify the effectiveness of the BCI system, it was also tested by implanting it in a non-human primate (NHP). Data from the human and NHP were used to train binary classifiers two different types of machine learning models: a Linear Discriminant Analysis (LDA) model, and a Long Short-Term Memory (LSTM)-based Artificial Neural Network (ANN). The LDA model performed at up to 72.7 % accuracy for binary decoding in the human patient, however, performance was highly variable and was much lower on most recording days. The BCI system was able to accurately decode movement vs non-movement in the NHP (accuracy using LDA: 82.7 ± 3.3 %, LSTM: 83.7 ± 2.2 %, 95 % confidence intervals), however it was not able to with recordings from the human patient (accuracy using LDA: 47.0 ± 5.1 %, LSTM: 44.6 ± 9.9 %, 95 % confidence intervals). We discuss how neurodegenerative diseases such as MSA can impede BCI-based communication, and postulate on the mechanisms by which this may occur.

Challenges and Opportunities in Using Cognitive Screeners for Adolescents and Young Adults With Bipolar Disorder

Adolescents and young adults with bipolar disorder often experience cognitive deficits that hinder academic performance and social interactions, affecting long-term outcomes. Identifying cognitive impairments is crucial for improving clinical management of bipolar disorder. Use of cognitive screeners is recommended to identify cognitive difficulties and for ongoing assessment. Although cognitive screeners are effective with adults, their use with adolescents and young adults is limited. This project assessed clinicians' attitudes and practices regarding cognitive screening of adolescents and young adults with bipolar disorder. The National Network of Depression Centers (NNDC) Child and Adolescent Mood Disorders Task Group developed a survey for clinicians treating adolescents and young adults (ages 14-25) with bipolar disorder, evaluating their knowledge of and attitudes toward cognitive screening and barriers to implementation. A total of 163 clinicians across 23 NNDC sites completed the survey. Most recognized the impact of cognitive deficits on functioning (87%) and treatment response (76%). More than 90% reported that cognitive assessments would be beneficial; however, 78% were unaware of available tools, and 64% reported barriers to implementation. Findings highlight a need for clinician education and addressing barriers to implementation. This article outlines the importance of using screeners in treatment of adolescents and young adults with bipolar disorder and provides practical information for using screeners and recommendations for implementation.

Plasma MTBR-tau243 biomarker identifies tau tangle pathology in Alzheimer's disease

Insoluble tau aggregates within neurofibrillary tangles are a defining neuropathological feature of Alzheimer's disease (AD) and closely correlate with clinical symptoms. Although tau pathology can be assessed using tau positron emission tomography, a more accessible biomarker is needed for diagnosis, prognosis and tracking treatment effects. Here we present a new plasma tau species, the endogenously cleaved, microtubule-binding region containing residue 243 (eMTBR-tau243), which specifically reflects tau tangle pathology. Across the AD spectrum in three different cohorts (n = 108, 55 and 739), plasma eMTBR-tau243 levels were significantly elevated at the mild cognitive impairment stage and increased further in dementia. Plasma eMTBR-tau243 showed strong associations with tau positron emission tomography binding (β = 0.72, R2 = 0.56) and cognitive performance (β = 0.60, R2 = 0.40), outperforming other plasma tau (%p-tau217 and %p-tau205) biomarkers. These results suggest that plasma eMTBR-tau243 may be useful for estimating the tauopathy load in AD, thereby improving the diagnostic evaluation of AD in clinical practice and monitoring the efficacy of tau-targeted therapies in clinical trials.

Allostatic load, a measure of cumulative physiological stress, impairs brain structure but not β-accumulation in older adults: an exploratory study

Introduction

Allostatic load (AL) is a composite score of progressive physiological dysregulations in response to long-term exposure to everyday stress. Despite growing interest, limited research has focused on links with cerebral and cognitive aspects of aging and with markers sensitive to Alzheimer's disease (AD) in a healthy elderly population and with a multimodal approach.

Methods

At baseline, 111 older adults (without cognitive impairment) from the Age-Well trial completed blood and anthropometric markers collection, cognitive assessments and multimodal neuroimaging within 3 months.

Results

AL was negatively associated with gray matter volume and white matter integrity within frontal and temporal regions and poorer attentional performance.

Discussion

AL is linked to structural brain integrity in aging- and stress-sensitive regions but not with AD-related markers (β-amyloid load) and only in two AD-sensitive brain regions in older adults. These results highlight the potential interest of AL as a sensitive index of stress-induced brain aging.

Longitudinal associations between pain and cognitive decline in middle-aged and older Chinese adults: the mediating role of depressive symptoms

Objective

The primary aim of this scholarly investigation was to elucidate the correlation between Number of Pain Sites and cognitive decline within the older adult population. Additionally, the study sought to examine the potential mediating influence of depressive symptoms in moderating the association between pain and cognitive deterioration.

Methods

We analyzed 8,835 participants aged 45 and above, with data collected from 2011 to 2018. Participants were categorized into two groups-stable and rapidly declining cognitive function-using the KML3D clustering method. Binary logistic regression analysis was conducted to examine the association between pain status, depressive symptoms, and cognitive trajectories, and mediation analysis was used to assess the mediating role of depression.

Results

Multi-site pain was significantly associated with the risk of rapid cognitive decline (adjusted OR = 1.30, 95% CI: 1.14-1.48), and depressive symptoms were also a significant predictor of rapid cognitive decline (adjusted OR = 1.49, 95% CI: 1.32-1.68). Mediation analysis revealed that depression mediated the effect of pain on cognitive decline, accounting for 25.71% of the total effect.

Conclusion

Our study establishes a significant longitudinal link between Number of Pain Sites and cognitive decline, mediated in part by depressive symptoms. This finding underscores the need for interventions that address pain and depression to potentially decelerate cognitive decline in older adults.

A Comprehensive Understanding of Postural Tone Biomechanics: Intrinsic Stiffness, Functional Stiffness, Antagonist Coactivation, and COP Dynamics in Post-Stroke Adults

OBJECTIVE

To analyse the relationship between traditional stiffness and muscle antagonist coactivation in both stroke and healthy participants, using linear and non-linear measures of coactivation and COP during standing, stand-to-sit, and gait initiation.

METHODS

Participants were evaluated through a cross-sectional design. Electromyography, isokinetic dynamometer, and force plate were used to calculate coactivation, intrinsic and functional stiffness, and COP displacement, with both linear and non-linear metrics. Spearman's correlations and Mann-Whitney tests were applied (p < 0.05).

RESULTS

Post-stroke participants showed higher contralesional intrinsic stiffness (p = 0.041) and higher functional stiffness (p = 0.047). Coactivation was higher on the ipsilesional side during standing (p = 0.012) and reduced on the contralesional side during standing and transitions (p < 0.01). Moderate correlations were found between intrinsic and functional stiffness (p = 0.030) and between coactivation and intrinsic stiffness (standing and stand-to-sit: p = 0.048) and functional stiffness (gait initiation: p = 0.045). COP displacement was reduced in post-stroke participants during standing (p < 0.001) and increased during gait initiation (p = 0.001). Post-stroke participants exhibited increased gastrocnemius/tibialis anterior coactivation during gait initiation (p = 0.038) and higher entropy and stability across tasks (p < 0.001).

CONCLUSION

Post-stroke participants showed higher contralesional intrinsic and functional stiffness, reduced coactivation in static tasks, and increased coactivation in dynamic tasks. COP and coactivation analyses revealed impaired stability and random control, highlighting the importance of multidimensional evaluations of postural tone.

Dancing Through Parkinson's: Impacts on Quality of Life and Socioemotional Experiences

Introduction: Dance has been studied as a beneficial intervention that enhances the physical and socioemotional well-being of individuals with Parkinson's disease (PD). This study explores how regular dance practice can enhance the quality of life for individuals with PD, focusing on their perceptions and socioemotional experiences. Methods: Adopting a phenomenological approach, the research employed qualitative methods, specifically semi-structured interviews. The collected data were transcribed, categorized, and analyzed using IRAMUTEQ® software. Results: Over 11 months, 20 interviews were conducted, yielding 7 subcategories. Participants were selected based on their involvement in a dance program tailored to individuals with PD, irrespective of gender, and if they maintained preserved cognitive function. The participants' narratives revealed a strong perceived relationship between dance and an enhanced quality of life. Participants described dance as a therapeutic activity that fosters improved self-esteem, joy, and social interaction. Conclusion: The qualitative analysis indicated that regular dance practice positively impacts the physical, social, and emotional dimensions of life for individuals with PD.

Prevalence of pre-existing cognitive impairment in patients treated for cancer and the impact of cancer treatment on cognitive outcomes: A scoping review

INTRODUCTION

Pre-existing cognitive impairment (CI) is likely underreported in patients treated for cancer, and its prevalence remains unclear. Older adults with CI may have a greater risk of treatment failure and increased morbidity and mortality than patients with intact cognition. To our knowledge, there has not been a previous review summarizing data on the prevalence of pre-existing CI in patients with cancer. This review addresses: (1) What is the prevalence of pre-existing CI in patients treated for cancer and (2) What is the impact of cancer treatment on cognitive outcomes among patients exhibiting pre-existing CI before planned cancer treatment?

MATERIALS AND METHODS

We defined CI as a diagnosis of dementia or mild or unspecified CI before any cancer treatment, including surgery. This scoping review followed the Arksey and O'Malley framework and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Two reviewers independently screened titles, abstracts, and full-text articles, resolving disagreements with a third reviewer. The reviewers systematically searched MEDLINE, Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception until July 15, 2023, including original research focused on participants aged 60 or older reporting the prevalence of pre-existing CI before any cancer treatment.

RESULTS

Among the 10,490 screened citations, 23 manuscripts reporting on 21 studies met the inclusion criteria for both review questions. Pre-existing CI was prevalent at a mean rate of 6 % in administrative database studies, while clinical studies employing pre-treatment cognitive screening tools, primarily the Mini-Mental State Examination and Mini-Cog, reported a higher mean prevalence of 26 % (range 2.6 to 52 %). Only one study reported postoperative delirium in 27.9 % of patients with CI following cancer surgery, suggesting a higher risk of delirium in this population. However, none of the reviewed studies provided data on other cognitive outcomes, such as chemotherapy-related CI or treatment toxicity, in these individuals.

DISCUSSION

Pre-existing CI is common but highly variable. The variability in reported prevalence rates can largely be attributed to significant differences in study inclusion criteria of participants and sample size, with some studies relying on regionally limited datasets.

Handwriting strokes as biomarkers for Alzheimer's disease prediction: A novel machine learning approach

In recent years, machine learning-based handwriting analysis has emerged as a valuable tool for supporting the early diagnosis of Alzheimer's disease and predicting its progression. Traditional approaches represent handwriting tasks using a single feature vector, where each feature is computed as the mean over elementary handwriting traits or strokes. We propose a novel approach that analyzes each stroke individually, preserving fine-grained movement information that is critical for detecting subtle handwriting changes that may indicate cognitive decline. We evaluated this method on 34 handwriting tasks collected from 174 participants, extracting dynamic and static features from both on-paper and in-air movements. Using a machine learning framework including classification strategies, feature selection techniques, and ensemble methods like ranking-based and stacking approaches, we were able to effectively model stroke-level variations. The ranking-based ensemble achieved the highest accuracy of 80.18% using all features while stacking performed best for in-air movements with 76.67% accuracy. Feature importance analysis through SHAP revealed that certain tasks, particularly sentence writing under dictation, were consistently more predictive. The experimental results demonstrate the effectiveness of our stroke-level analysis approach, which outperformed aggregated statistical methods on 24 out of 34 handwriting tasks, validating the diagnostic value of examining individual movement patterns.

Gamma oscillation modulation for cognitive impairment: A systematic review

BackgroundGamma oscillation modulation has emerged as a potential non-invasive treatment to counteract cognitive impairment in Alzheimer's disease (AD) and mild cognitive impairment (MCI). Non-invasive brain stimulation techniques like transcranial alternating current stimulation (tACS), gamma sensory stimulation (GSS), and transcranial magnetic stimulation (TMS) show promise in supporting specific cognitive functions.ObjectiveTo review and evaluate the efficacy of gamma oscillation modulation techniques in benefiting cognitive functions among individuals with AD and MCI.MethodsA systematic review was conducted, analyzing studies from 2015 to 2023 across databases such as PubMed, Web of Science, and Scopus. Inclusion criteria focused on studies involving tACS, GSS, or TMS applied to older adults with MCI or AD. A total of 438 articles were screened, of which 10 met the eligibility criteria.ResultsFindings suggest that gamma tACS, especially targeting the precuneus and dorsolateral prefrontal cortex, benefits episodic memory and cognitive performance. GSS also showed potential in supporting memory and attention, while TMS exhibited inconsistent but promising results when applied to the angular gyrus. However, heterogeneity in study designs and small sample sizes limit the generalizability of these outcomes.ConclusionsGamma oscillation modulation offers potential cognitive benefits for patients with AD and MCI, particularly in memory support. Further studies with larger samples and well-designed protocols are needed to confirm its therapeutic efficacy and optimize intervention parameters.

Exploring the effects of olfactory VR on visuospatial memory and cognitive processing in older adults

This study examined the effects of Olfactory Virtual Reality (VR) Gaming on cognitive performance in older adults. A VR game environment ("Interactive Smellscape") was created to enable this, and 30 participants aged 63-90 years completed both VR gaming sessions and cognitive assessments, conducted with a 6-day interval between the two sessions. Significant improvements were observed in spatial tasks of Japanese characters and words, with notable enhancements specifically in visuospatial rotation performance and word-location recall accuracy. However, no significant changes were detected in olfactory identification or other general cognitive tasks. These findings suggest potential cognitive benefits of incorporating VR and olfactory stimuli into interventions for older populations, particularly for tasks requiring attention and spatial processing. The results further underscore the importance of task-specific designs to maximize the utility of multisensory VR systems for cognitive rehabilitation.

Age-Related differences in the relationship between sustained attention and associative memory and Memory-Guided inference

Episodic memory enables the encoding and retrieval of novel associations, as well as the bridging across learned associations to draw novel inferences. A fundamental goal of memory science is to understand the factors that give rise to individual and age-related differences in memory-dependent cognition. Variability in episodic memory could arise, in part, from both individual differences in sustained attention and diminished attention in aging. We first report that, relative to young adults (N = 23; M = 20.0 years), older adults (N = 26, M = 68.7 years) demonstrated lower associative memory and memory-guided associative inference performance and that this age-related reduction in associative inference occurs even when controlling for associative memory performance. Next, we confirm these age-related memory differences by using a high-powered, online replication study (young adults: N = 143, M = 26.2 years; older adults N = 133, M = 67.7 years), further demonstrating that age-related differences in memory do not reflect group differences in sustained attention (as assayed by the gradual-onset continuous performance task; gradCPT). Finally, we report that individual differences in sustained attention explain between-person variability in associative memory and inference performance in the present, online young adult sample, but not in the older adult sample. These findings extend understanding of the links between attention and memory in young adults, demonstrating that differences in sustained attention was related to differences in memory-guided inference. By contrast, our data suggest that the present age-related differences in memory-dependent behavior and the memory differences between older adults are due to attention-independent mechanisms.

Multivariate longitudinal clustering reveals neuropsychological factors as dementia predictors in an Alzheimer's disease progression study

Dementia due to Alzheimer's disease (AD) is a multifaceted neurodegenerative disorder characterized by various cognitive and behavioral decline factors. In this work, we propose an extension of the traditional k-means clustering for multivariate time series data to cluster joint trajectories of different features describing progression over time. The algorithm we propose here enables the joint analysis of various longitudinal features to explore co-occurring trajectory factors among markers indicative of cognitive decline in individuals participating in an AD progression study. By examining how multiple variables co-vary and evolve together, we identify distinct subgroups within the cohort based on their longitudinal trajectories. Our clustering method enhances the understanding of individual development across multiple dimensions and provides deeper medical insights into the trajectories of cognitive decline. In addition, the proposed algorithm is also able to make a selection of the most significant features in separating clusters by considering trajectories over time. This process, together with a preliminary pre-processing on the OASIS-3 dataset, reveals an important role of some neuropsychological factors. In particular, the proposed method has identified a significant profile compatible with a syndrome known as Mild Behavioral Impairment (MBI), displaying behavioral manifestations of individuals that may precede the cognitive symptoms typically observed in AD patients. The findings underscore the importance of considering multiple longitudinal features in clinical modeling, ultimately supporting more effective and individualized patient management strategies.

Natural history of lower urinary tract symptoms and voiding parameters in ageing men with 5-year follow-up-the concord health and ageing in men project (CHAMP)

BACKGROUND

Natural history of voiding parameters with age is poorly understood. We aim to understand both subjective and objective lower urinary tract parameters in older men over 5 years.

METHODS

The Concord Health and Ageing in Men Project is a prospective cohort study of older men, involving 1705 men aged 70 years and over living in Sydney, Australia. Men were assessed at 0, 2 and 5 years. Demographic information, medical history, International Prostate Symptom Score (IPSS), flow rate and post-void volume were collected at three timepoints.

RESULTS

A total of 1705 men aged 70-97 years participated. At 2 and 5 year follow-up, 1367 and 940 men presented for assessment. Mean IPSS was 7.35 at baseline, 6.96 at 2 years (P = .9) and 7.18 at 5 years (P = .30). Mean flow rate at baseline was 15.0 ml/s, 14.6 ml/s at 2 years (P = .001) and 15.3 ml/s at 5 years (P = .42). Adjusting for age at baseline, the change in flow over 5 years was not significant (P = .93). Mean post-void residual was 72.4 ml at baseline, 84.0 ml at 2 years (P = .003) and 93.2 ml at 5 years (P = .001). Men with residual volume >200 ml at baseline had no significant change in residual over 5 years (P = .51).

CONCLUSIONS

Urinary symptoms and voiding parameters remain stable over 5 years. Men with elevated post-void volume did not deteriorate significantly. Conservative management of lower urinary tract symptoms appears a reasonable strategy in older men.

Sex differences on tau, astrocytic, and neurodegenerative plasma biomarkers

BackgroundSex differences have consistently been identified on autopsy, neuroimaging, and cerebrospinal fluid outcomes related to Alzheimer's disease (AD), but the exact mechanisms for these associations are unclear. Blood-based biomarkers are practical alternatives for the investigation of mechanisms of AD, in addition to accurate disease detection and monitoring.ObjectiveThe objective of this study was to examine sex differences across a panel of blood-based plasma biomarkers in participants with and without cognitive impairment due to AD.MethodsPlasma samples were collected from 567 participants from across the AD diagnostic continuum (i.e., normal cognition (NC), mild cognitive impairment (MCI), and dementia) and analyzed for glial fibrillary acidic protein (GFAP), neurofilament light (NfL), phosphorylated tau at threonine 181 (p-tau181), and total tau (t-tau). Baseline and longitudinal analyses evaluated for any significant associations between sex and AD-related plasma biomarkers.ResultsFemales were found to have higher plasma GFAP compared to males at baseline regardless of cognitive diagnosis. Among those with AD dementia, females were also found to have higher NfL levels compared to males. Longitudinal analyses found that higher plasma NfL at baseline was associated with an increased risk of worsening AD dementia status only in females. No significant findings were observed for p-tau181 or t-tau.ConclusionsThis study found significant sex differences in plasma biomarkers of GFAP and NfL. Further research is needed to better understand the underlying mechanisms mediating these differences.

Hypertension and orthostatic hypertension in 85-year-olds and associations with mortality and cognitive decline in a longitudinal cohort study

Hypertension is a risk factor for cardiovascular disease, but the evidence for treatment and blood pressure (BP) targets in the elderly is less robust. Orthostatic hypertension is a potential risk factor for cardiovascular mortality and cognitive decline. All 85-years-olds in Linköping municipality, Sweden, were invited to a prospective birth cohort study including questionnaires, cognitive testing and physical examinations, including supine and orthostatic BP measurements. Logistic regression and Cox proportional hazard models were used to assess the impact of baseline supine and orthostatic BP on cognitive decline and all-cause mortality after 5- and 7.2 years respectively. Of 650 invited 85-year-olds, 322 were included. During follow-up, 190 persons died, and 28 persons developed cognitive decline. Neither elevated supine BP nor orthostatic hypertension were associated with cognitive decline. After adjustments, elevated supine BP was not associated with mortality in all participants, but was associated with lower all-cause mortality in participants with previously diagnosed hypertension, HR 0.59 (95% CI 0.41-0.85). Orthostatic hypertension was not associated with all-cause mortality, HR 0.56 (95% CI 0.26-1.22) after multiple adjustments. In 85-year-olds with known hypertension, elevated supine BP was associated with lower all-cause mortality. Orthostatic hypertension was not associated with cognitive decline but trended towards a lower all-cause mortality.

Diagnostic performance of plasma p-tau217 in a memory clinic cohort using the Lumipulse automated platform

BACKGROUND

Plasma biomarkers for Alzheimer's disease (AD) are a promising tool for accessible and accurate biological diagnostics. However, data in clinical practice are needed to better understand their diagnostic and prognostic ability in memory unit patients.

METHODS

We analyzed plasma phosphorylated tau at threonine 217 (p-tau217) and neuroflament light chain (NfL) levels and AD cerebrospinal fluid (CSF) biomarkers in a group of 493 subjects using the Lumipulse G600II platform. The sample includes 340 patients from our memory unit (142 dementia, 186 mild cognitive impairment, and 12 with subjective complaints) and 153 cognitively unimpaired volunteers. We have correlated plasma and CSF biomarkers; we have analyzed plasma biomarker levels as a function of clinical diagnosis, cognitive status and amyloid status. We have also studied the ability of p-tau217 to discriminate between amyloid-positive and -negative subjects according to CSF using receiver operating characteristic curves.

RESULTS

Plasma p-tau217 correlated significantly with CSF Aβ42/Aβ40 (Rho = -0.75; p-value < 0.001), p-tau181 (r = 0.66; p-value < 0.001), and t-tau (r = 0.59; p-value < 0.001). Plasma NfL correlated with CSF NfL (r = 0.48; p-value < 0.001). By clinical diagnosis, plasma p-tau217 levels showed to be higher in AD patients than in healthy controls (difference = 0.63 pg/ml; p-value < 0.001), FTD (difference = 0.60 pg/ml; p-value < 0.001), and nondegenerative dementias (difference = 0.61 pg/ml; p-value < 0.001). Plasma p-tau217 showed an area under the curve of 0.95 to discriminate between A + and A- subjects (95%CI 0.93-0.97).

CONCLUSION

Plasma p-tau217 shows excellent results for detecting amyloid pathology at brain level in a clinical setting with an AUC of 0.95. It is a highly specific marker of AD and increases progressively along the disease continuum. Using plasma p-tau217 as an initial diagnostic tool with cut-offs at sensitivities and specificities of 95 or 97.5% could save between 57.4-84.8% of LP/PETs with diagnostic accuracies of 95-97%. Plasma NfL increases progressively at different cognitive stages.