Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study

ORIENT Diet: A Potential Neuroprotective Dietary Pattern for Chinese Stroke High-Risk Population

OBJECTIVES

Given the particularity of Asian cultures and dietary habits, there is a need to establish a neuroprotective dietary pattern specially for the Asian stroke high-risk population, to prevent cognitive impairment.

DESIGN

A systematic review and cross-sectional study.

SETTING AND PARTICIPANTS

Chinese stroke high-risk population from the CIRCLE (NCT03542734) study.

METHODS

The Oriental Intervention for Enhanced Neurocognitive healTh (ORIENT) diet was developed by replacing the western foods in the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diet with appropriate Asian alternatives, and refining the recommended intake frequency based on a systematic review, which examined Asian studies in the cognition-diet field. Cognitive impairment was defined as a global cognitive score ≥1 SD below the sample mean, based on the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network vascular cognitive impairment battery.

RESULTS

A total of 568 participants were finally included, with 325 men (57.2%) and a mean age of 60.5 ± 7.3 years. Participants in the highest tertile of ORIENT score had 60.5% lower odds of cognitive impairment than those in the lowest tertile (odds ratio = 0.395, 95% CI = 0.165-0.944, P = .044) when adjusted for demographic variables, lifestyle factors, and health status. Multiple linear regression analysis showed that each 1-point increase in ORIENT score was associated with 0.048 higher global cognitive score, 0.281 higher Mini-Mental State Examination score, and 0.344 higher Montreal Cognitive Assessment score.

CONCLUSIONS AND IMPLICATIONS

High adherence to ORIENT diet was associated with lower odds of cognitive impairment, providing a potential neuroprotective dietary pattern for Chinese stroke high-risk population.

Factors Associated with Cognitive Impairment among Adults of 55 Years and Older in Cameroon

Introduction

Cognitive impairment is a major cause of dependency in older people. The aim of this study was to identify factors associated with severe cognitive decline, as assessed by the mini-mental state examination (MMSE), in community-dwelling adults aged 55+ in Cameroon.

Method

Data are from a cross-sectional survey carried out in Cameroon. The cognitive status was assessed using the MMSE and a score of 18/30 or lower is considered as a proxy of severe cognitive decline.

Result

A total of 403 adults participated in the study. Of these, 16 (3.9%) had an MMSE score <18 and were considered to have cognitive impairment. The rate of severe cognitive decline increased with rising age, from 2.1% in those aged 55-64 years, to 3.3% in those aged 65-74, and 11% in those aged 75 and older. The factors associated with cognitive impairment (MMSE score <18) by multivariate analysis in our population are level of education (OR 0.10 [95% CI: 0.02-0.37], p < 0.01), body mass index (BMI) (OR 0.88 [95% CI: 0.78-0.99], p = 0.03), and IADL score (OR 0.12 [95% CI: 0.03-0.38], p < 0.001).

Conclusion

The three main factors associated with cognitive impairment were education, IADL (Instrumental Activity of Daily Living) dependency, and BMI. This study shows that among older people in sub-Saharan Africa, the effect of BMI, IADL dependency, and education on cognitive function appears similar to that observed in middle- and high-income countries.

Association between plant-based dietary patterns and cognitive function in middle-aged and older residents of China

BACKGROUND

Plant-based diets may protect against cognitive impairment; however, observational data have not been consistent.

OBJECTIVE

This study aimed to evaluate the association between plant-based dietary patterns and cognitive function.

METHODS

The study recruited 937 participants who were asked to complete food frequency questionnaires to assess the quality of their plant-based diets using the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Cognitive function evaluated using the Montreal Cognitive Assessment (MoCA) test. Logistic regression was used to explore the association between plant-based dietary patterns and the prevalence of mild cognitive impairment (MCI), while multiple linear regression was used to analyze the association between plant-based dietary patterns and cognitive scores.

RESULTS

The prevalence of MCI was 26% among the 937 participants. There was a significant association between higher uPDI scores and higher odds of MCI, with Quintile 4 compared with Quintile 1 showing an odds ratio of 2.21 (95% confidence interval 1.35, 3.60). Higher uPDI scores were associated with a lower total MoCA score and poorer performance in various cognitive domains. There were no significant associations between the PDI, the hPDI, and cognitive function. Consuming whole grains, nuts, and eggs once a week or more were associated with a lower risk of MCI, whereas frequently consumption of pickled vegetables was associated with an increased risk of MCI.

CONCLUSIONS

Unhealthy plant-based diets were associated with cognitive impairment, while whole grains, nuts, and eggs may protect cognitive function; pickled vegetables are associated with cognitive impairment.

Mediation effect of neuropsychological factors on the relationship between social networks and mild cognitive impairment in older adults

BACKGROUND

Although links between social networks and mild cognitive impairment (MCI) have been suggested. The pathway between social networks and MCI from the Person-Environment-Occupation (PEO) model perspective among older adults remains inconclusive.

OBJECTIVE

To examine the relationship between social networks and MCI, and further identify whether neuropsychological factors mediate the relationship.

METHODS

1036 participants aged 55 to 75 years were recruited from two districts of Fuzhou, China, from December 2020 to December 2022. Data were obtained via a face-to-face neuropsychological scale assessment. Social networks and cognitive function were assessed by the Lubben Social Network Scale and the Montreal Cognitive Assessment, respectively. The mediation model and structural equation model (SEM) pathway analysis were used to examine the direct and indirect effects of social networks on MCI via neuropsychological factors.

RESULTS

Data from 580 participants were analyzed (year: 65.16 ± 5.38). Regression analysis indicated that higher levels of social networks and psychological resilience were positively correlated with improved cognitive function, even after adjusting for demographic data. Increased depressive symptoms and poor sleep quality were linked to cognitive decline. Support from family members had a greater impact than support from friends in reducing the risk of developing MCI. The SEM model supported the hypothesis that significant indirect effects of social networks on MCI via psychological resilience, depressive tendencies, and sleep quality.

CONCLUSIONS

The effects of social networks on MCI are mediated by psychological resilience, depressive tendencies, and sleep quality.

A nested case-control study on the effect of sarcopenia on mild cognitive impairment using the CHARLS database

OBJECTIVE

This study aimed to assess the influence of sarcopenia on mild cognitive impairment (MCI) through a nationally representative survey.

METHOD

Participants in this nested case-control study were from the China Health and Retirement Longitudinal Study (CHARLS) cohort. In 2015, 3222 participants were included, with 2304 participants were followed up in 2018. Propensity score matching (PSM) was utilized to equalize the distribution of covariates between the two groups.

RESULTS

MCI was observed in 268 participants. After PSM, 263 participants with MCI were compared with 1052 participants without MCI. The study revealed that participants with sarcopenia had a 1.625 (p = 0.002) times higher risk of MCI.

CONCLUSION

The study determined a causal link between sarcopenia and the onset of MCI, with sarcopenia identified as an independent risk factor for MCI development. It is recommended that healthcare providers incorporate muscle training into the care and health education for individuals with MCI.

The mediating role of depression and disability in the association between widowhood and cognitive function among elderly Chinese individuals

OBJECTIVE

The incidence of mild cognitive impairment among the elderly in China was increasing. Widowhood, depression, and disability were significant factors that impacted cognitive function. Yet, there was currently no research, both domestically and internationally, that comprehensively examines all these factors together. Therefore, in order to achieve successful aging, the objective of this study is to investigate the impact and pathway of depression and disability on the association between widowhood and cognitive function in the elderly population of China, with the aim of establishing a robust foundation for developing evidence-based strategies to prevent and manage cognitive impairment among older adults in China.

METHODS

The 2018 Chinese Longitudinal Healthy Longevity Survey data was utilized to assess cognitive function, depression level, and disability status using the Mini-Mental State Examination, The Center for Epidemiological Studies Depression-10 scale, and the Katz scale. The mediating role of depression and disability in the association widowhood and cognitive function were tested by the bruceR package in R Studio.

RESULTS

A total of 7973 elderly individuals aged over 65 were included in the study, with nearly 50% being widowed. Widowhood was identified as a significant risk factor for cognitive impairment in the elderly population. The results from the analysis of mediating effects indicated that both depression and disability independently mediated this relationship, while also contributing to a chain-mediated effect on the association between widowhood and cognitive function in the population.

CONCLUSION

We recommend that greater attention be dedicated to this population, and measures be implemented to enhance their mental well-being and disability management, thereby improving cognitive function.

The bidirectional relationships between social isolation and cognitive function among older adults in China: separating between-person effects from within-person effects

This study investigates the bidirectional relationship between social isolation and cognitive function among older adults in China, utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The baseline survey, which commenced in 2008, tracked 1,662 participants over four waves of data collection spanning a decade. We employed Cross-Lagged Panel Models (CLPM) and Random Intercept Cross-Lagged Panel Models (RI-CLPM) to analyze these relationships at both the between-person and within-person levels. CLPM results indicated significant cross-lagged effects between social isolation (β = - 0.119, p < 0.001; β = - 0.162, p < 0.001) and cognitive function (β = - 0.073, p < 0.001; β = - 0.091, p < 0.001) at the between-person level over the last three waves. Specifically, higher prior levels of social isolation were associated with a significant decline in subsequent cognitive function, and vice versa. Furthermore, RI-CLPM results showed that, after controlling for random intercepts and covariates, only social isolation had a significant negative impact on cognitive function across all waves (β = - 0.051, p < 0.05; β = - 0.047, p < 0.05; β = - 0.028, p < 0.05). Overall, this study demonstrates that, when considering both between-person and within-person effects, social isolation exerts a stronger lag effect on cognitive function among older adults in China. This suggests that, over a specific timeframe, reducing social isolation is crucial for promoting healthy aging in this population.

Construction of a prediction model for Alzheimer's disease using an AI-driven eye-tracking task on mobile devices

BACKGROUND

Eye-movement can reflect cognition and provide information on the neurodegeneration, such as Alzheimer's disease (AD). The high cost and limited accessibility of eye-movement recordings have hindered their use in clinics.

AIMS

We aim to develop an AI-driven eye-tracking tool for assessing AD using mobile devices with embedded cameras.

METHODS

166 AD patients and 107 normal controls (NC) were enrolled. The subjects completed eye-movement tasks on a pad. We compared the demographics and clinical features of two groups. The eye-movement features were selected using least absolute shrinkage and selection operator (LASSO). Logistic regression (LR) model was trained to classify AD and NC, and its performance was evaluated. A nomogram was established to predict AD.

RESULTS

In training set, the model showed a good area under curve (AUC) of 0.85 for identifying AD from NC, with a sensitivity of 71%, specificity of 84%, positive predictive value of 0.87, and negative predictive value of 0.65. The validation of the model also yielded a favorable discriminatory ability with the AUC of 0.91, sensitivity, specificity, positive predictive value, and negative predictive value of 82%, 91%, 0.93, and 0.77 to identify AD patients from NC.

DISCUSSION AND CONCLUSIONS

This novel AI-driven eye-tracking technology has the potential to reliably identify differences in eye-movement abnormalities in AD. The model shows excellent diagnostic performance in identifying AD based on the current data collected. The use of mobile devices makes it accessible for AD patients to complete tasks in primary clinical settings or follow up at home.

Effects of mild cognitive impairment and sleep disorders on the minimum alveolar concentration value of sevoflurane

OBJECTIVES

To explore the effect of mild cognitive impairment (MCI) and MCI with sleep disorders on the potency of sevoflurane anesthesia in the elderly.

DESIGN

Prospective study methods. Dixon up-and-down methods.

SETTING

Comprehensive public tertiary hospital, Cangzhou City, Hebei Province, China.

PARTICIPANTS

70 elderly patients scheduled for elective unilateral breast cancer surgery and finally analyzed 58 patients, including 30 patients with MCI (group M) and 28 patients with MCI with sleep disorders (group MS).

OUTCOME MEASURES

The required minimum alveolar concentration (MAC) value of sevoflurane in the two groups was determined using the Dixon up-and-down method. The MAC value of sevoflurane and its 95% confidence interval (CI) were calculated using the logistic regression method. Serum melanin-concentrating hormone concentrations were determined by Elisa kits.

RESULTS

The MAC value of sevoflurane in group M was 1.43 (95% CI 1.05-1.61%), and the MAC value of sevoflurane in group MS was 1.93 (95% CI 1.78-2.08%), There were notable differences between the two groups (P < 0.0001). The level of melanin-concentrating hormone (MCH) in the MS group was significantly lower than that in the M group (21.52 ± 3.82 vs. 37.17 ± 3.66 pg/ml, P < 0.0001). There was a significant negative correlation between MCH levels and the probability of body movement during skin incision (OR = 0.844, 95% CI: 0.715-0.996, P = 0.045).

CONCLUSIONS

Patients with MCI with sleep disorders required higher doses of sevoflurane than those with MCI alone. Changes in anesthetic requirements may be related to changes in MCH levels.

Gut microbiota-mediated choline metabolism exacerbates cognitive impairment induced by chronic cerebral hypoperfusion

Chronic cerebral hypoperfusion (CCH) is a crucial mechanism causing vascular cognitive impairment (VCI). Choline is metabolized by gut microbiota into trimethylamine N-oxide (TMAO), a risk factor of cardiovascular diseases and cognitive impairment. However, the impact of choline-TMAO pathway on CCH-induced VCI is elusive. We performed a cross-sectional clinical study to investigate the relationship between the choline-TMAO pathway and cognitive outcome and used a bilateral common carotid artery occlusion rat model to explore the effect of a choline-rich diet on cognition and underlying mechanisms. Plasma choline and TMAO levels were negatively correlated with cognitive scores in CCH patients. A choline-rich diet exacerbated CCH-induced cognitive impairment by encouraging the proliferation of choline-metabolizing bacteria in the gut and subsequent generation of TMAO. The choline-TMAO pathway, mediated by gut microbiota, exacerbates cognitive impairment induced by CCH. Targeted dietary choline regulation based on gut microbiota modulation may ameliorate long-term cognitive impairment.

Why are people with dementia overlooked in long-term care insurance policy in Guangzhou, China?

BACKGROUND AND OBJECTIVES

There is a growing demand for dementia care to be funded by long-term care insurance (LTCI). However, evidence indicates that people with dementia are overlooked in China's LTCI policy and empirical research on this issue is notably scarce. Among the first seven LTCI pilot cities that officially enrolled people with dementia, Guangzhou is unique for roll-back LTCI policies related to eligibility criteria and benefits. This study aims to explore why people with dementia are overlooked in China's LTCI policy, using Guangzhou as a case study.

METHODS

Semi-structured interviews were conducted with stakeholders involved in LTCI need assessment and care delivery in Guangzhou. Eight LTCI assessment specialists, 22 formal caregivers, and six informal caregivers were interviewed from December 2021 to October 2022. Data was analyzed using NVivo 11.0 software and the Gilbert welfare framework to identify themes.

RESULTS

Interviewees reported that need assessment lacked a clear definition, were poorly supervised, and had high moral hazards. Challenges to care delivery included unprofessionalism of formal caregivers, shortage of resources, unprepared informal caregivers, a lack of a supportive environment and the negative impact of COVID-19. DISCUSSION AND IMPLICATIONS: People with dementia are overlooked in LTCI policy which may result from difficulties in implementing dementia-related assessment criteria, and hampered service delivery due to a shortage of skilled caregivers. These issues need to be carefully considered before scaling up the coverage of LTCI policy nationwide.

Prevalence of cognitive impairment and its related factors among Chinese older adults: an analysis based on the 2018 CHARLS data

Background

Cognitive impairment is a major public health concern in aging societies. This study aimed to investigate the prevalence of cognitive impairment and its associated factors among Chinese adults aged 60 years and older using data from the 2018 China Health and Retirement Longitudinal Study (CHARLS).

Methods

Utilizing data from the 2018 wave of CHARLS, we assessed participants' cognitive status using the Mini-Mental State Examination (MMSE), and the influencing factors related to cognitive impairment were analyzed by using the chi-square test and multifactor logistic regression. The prevalence of cognitive impairment was stratified by gender, education level, residence, marital status, daytime napping, and nighttime sleep duration, and the trend of cognitive impairment prevalence with age was observed.

Results

9,804 participants were finally included in the study and the overall prevalence of cognitive impairment was 44.04% (95%CI, 43.02-45.06%). The prevalence was significantly higher in females (50.8%) than males (37.1%), and increased with age, from 41.5% in those aged 60-64 years to 57.7% in those aged ≥75 years. Lower educational level, rural residence, and being divorced/ widowed/unmarried were associated with a higher prevalence of cognitive impairment (all p < 0.001). Multifactor logistic regression indicated that older age (OR = 1.51, 95%CI, 1.33-1.73 for ≥75 vs. 60-64 years), female gender (OR = 1.54, 95%CI, 1.35-1.77), higher education (OR = 0.46, 95%CI, 0.42-0.51 for primary school and below vs. illiteracy), rural areas (OR = 2.35, 95%CI, 2.07-2.65 for village vs. the center of city/town), divorced/ widowed/unmarried status (OR = 1.40, 95%CI, 1.25-1.57) and participation in physical activity (OR = 0.80, 95%CI, 0.73-0.87) were significantly associated with cognitive impairment.

Conclusion

Cognitive impairment is highly prevalent among older adults in China with substantial demographic disparities. Targeted interventions and public health strategies are needed to promote cognitive health in this rapidly aging population.

Association between pulmonary ventilation function and cognitive function among middle-aged and older adults: an observational study from Southwest China

BACKGROUND

Despite the significant prevalence of chronic obstructive pulmonary disease (COPD) in Southwest China, cognitive function among middle-aged and elderly individuals in this area surpasses the national average. This study aims to reveal the overall pulmonary ventilation function status of this population, and investigate whether pulmonary ventilation dysfunction is a risk factor for mild cognitive impairment (MCI) in this region, as suggested by previous researches.

METHODS

Data were obtained from the 2019-2021 baseline survey of a natural population cohort study conducted in Southwest China. Pulmonary function was tested by experienced and well-trained medical personnel using a spirometer. The Mini-Mental State Examination was used to evaluate cognitive function. Subsequently, multiple logistic regression analysis was employed to examine the associations between pulmonary function and cognitive levels.

RESULTS

A total of 2,337 middle-aged and elderly adults were included in this study, with 10.18% (238 individuals) classified as having mild cognitive impairment. According to the Chinese experts' consensus on the standardization of adult lung function diagnosis, approximately 41.16% (962/2,337) of middle-aged and elderly individuals in Southwest China suffer from pulmonary ventilation dysfunction, predominantly mild (37.53%, 877/2,337), with the primary type being obstructive ventilation dysfunction (38.60%, 902/2,337; COPD: 14.21%, 332 participants). And 81.56% participants (1,906/2,337) were found to have small airway dysfunction. Multiple logistic regression analyses showed that individuals with poor pulmonary ventilation function (PPF) were associated with an increased risk of MCI (OR [95% CI]: 1.38 [1.04, 1.83], P = 0.026). Moreover, the more severe the pulmonary ventilation dysfunction, the higher the risk of cognitive impairment (P for trend = 0.009). Similar association were found between PPF and MCI when we use ATS/ERS technical standards. No significant association was observed between small airway dysfunction and cognitive impairment (OR [95% CI]: 1.05 [0.72, 1.56], P = 0.819).

CONCLUSIONS

The pulmonary function status of middle-aged and elderly individuals in Southwest China requires attention, particularly regarding obstructive pulmonary ventilation dysfunction. We recommend integrating pulmonary health assessments into routine care for these populations to raise awareness of lung health, improve lung function, and ultimately enhance cognitive function.

Predictive value of nutritional status and serological indicators in elderly patients with mild cognitive impairment

BACKGROUND

Mild cognitive impairment (MCI) in elderly individuals is a transitional stage between normal cognition and dementia. Understanding the risk factors for MCI and identifying those at high risk are extremely important for the elderly population.

AIM

To analyze the risk factors for MCI in the elderly population and construct a clinical prediction model.

METHODS

Total 295 elderly individuals presenting with memory loss diagnosed at Wuxi People's Hospital between March 2021 and March 2024 were included. Comprehensive demographic, clinical, and serological data were collected for analysis. Participants were categorized into either an MCI group or a normal group based on their performance on the Montreal Cognitive Assessment Scale. An elaborate clinical predictive model was developed to predict the likelihood of MCI in stroke patients; its accuracy was evaluated using area under curve values and calibration curves.

RESULTS

The results of the study showed that old age, hypertension, diabetes, hyperlipidemia, smoking, high-salt diet, high-cholesterol diet, decreased red blood count, increased neutrophil lymphocyte ratio and increased low-density lipoprotein cholesterol were risk factors for the onset of MCI, with A high vitamin diet and elevated high-density lipoprotein cholesterol being protective factors. In addition, the prediction model constructed in this study exhibits good degrees of differentiation and calibration.

CONCLUSION

The risk factors for MCI are diverse. Early identification of individuals at high risk of MCI can better intervene and improve their quality of life of MCI patients.

Effects of Probucol on plasma amyloid-β transport in patients with hyperlipidemia: a 12-week randomized, double-blind, placebo-controlled trial

BACKGROUND

Although dyslipidemia has been acknowledged as a risk factor for Alzheimer's disease (AD), the effects of lipid-lowering drugs on AD have not been determined. The primary pathophysiological hallmark of AD is the deposition of amyloid-β (Aβ) plaques in the brain. Plasma Aβ levels are influenced by the transport of Aβ from the central nervous system to the peripheral blood. This study investigates the effects of Probucol, a lipid-lowering and antioxidant drug, on plasma Aβ transport.

METHODS

A total of 120 hyperlipidemic patients with normal cognition were randomly assigned (1:1 ratio) to receive either Probucol (1000 mg daily for 12 weeks) or a placebo. Plasma Aβ, soluble receptor of advanced glycation end products (sRAGE), and fasting lipid profiles were measured at baseline and every 6 weeks.

RESULTS

A total of 108 participants completed the study, with 55 in the Probucol group. The cohort consisted of 58 (53.7%) women, with a mean age of 58.4 ± 8.0 (range, 45-80) years. After 12 weeks of treatment, the changes in plasma Aβ42 and sRAGE levels significantly differed between the Probucol and placebo groups (ΔAβ42: β = 6.827, P = 0.030; ΔsRAGE: β = 98.668, P = 0.004). Furthermore, ΔsRAGE was positively correlated with the change in Aβ42 (β = 0.018, P = 0.048). When adjusted for ΔsRAGE, the effect of Probucol on plasma Aβ42 levels was attenuated (β = 5.065, P = 0.116). In the Probucol group only, ΔsRAGE was significantly correlated with oxidized low-density lipoproteins (β = 4.27, P = 0.011), total cholesterol (β = 67.50, P = 0.046), and low-density lipoproteins (β = - 91.01, P = 0.011).

CONCLUSIONS

Daily oral administration of Probucol (1000 mg) for 12 weeks significantly increased plasma Aβ42 levels, likely through modulation of sRAGE. This effect may be attributed to the antioxidant and lipid-lowering properties of Probucol. These findings suggest that Probucol could potentially serve as a protective agent against the pathological processes of AD.

TRIAL REGISTRATION

This study was registered on the Chinese Clinical Trial Registry platform in June 2019 (Trial registration number: ChiCTR-1900023542).

Hypertension may lead to cognitive dysfunction in older adults via methylmalonic acid: evidence from NHANES 2011-2014 population

BACKGROUND

An enriched understanding is necessary concerning the association between hypertension and cognitive impairment in older adults, particularly regarding the potential underlying mechanisms at a biological level. This study aimed to explore the mediating role of methylmalonic acid (MMA) in the hypertension-cognition link in the older population.

METHODS

A total of 2762 adults (age > = 60 years) from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 participated. Cognitive function was assessed using a combination of the Animal Fluency Test (AFT), the Digit Symbol Substitution Test (DSST), and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test. Self-reported hypertension diagnosis, antihypertensive medications use, and blood pressure examinations were used to identify hypertension. Serum MMA (sMMA) levels were collected. Weighted multiple linear regressions and mediation analysis were applied. A subgroup analysis by sex and age was performed.

RESULTS

After adjusting for potential confounding factors, we observed a significant mediating effect of the sMMA level in the hypertension-cognition link, accounting for 11.14% (95% CI 4.09%-14.00%, p < 0.001) of the relationship in older adults. The proportion mediated by the sMMA level in the relationship between hypertension and cognitive function was higher in males (15.23%, 95%CI 1.32%-27.00%, p < 0.001) than in females (6.61%, 95%CI 2.12%-10.00%, p < 0.001). This mediating effect of sMMA was observed only in individuals aged 68 years and older (11.31%, 95%CI 3.80%-16.00%, p < 0.001), with no significant mediation detected in those younger than 68 years.

CONCLUSION

Hypertension may lead to cognitive dysfunction in older adults through MMA. Apart from its role as a biomarker reflecting vitamin B12, MMA may act as an independent neurotoxin capable of inducing brain injury and cognitive impairment. Addressing MMA accumulation, such as through Vitamin B12 supplementation, may have a potential to mitigate hypertension-induced cognitive decline in older adults. Special attention could be paid to hypertensive males with an advanced age (> = 68) to address MMA-related cognitive decline.

Prevalence of cognitive impairment and its associated factors in type 2 diabetes mellitus patients with hypertension in Hunan, China: a cross-sectional study

Background

Individuals with both type 2 diabetes mellitus (T2DM) and hypertension have an increased risk of cognitive impairment (CI) compared to those with either T2DM or hypertension. Therefore, this study aims to identify the prevalence of CI and its associated factors in T2DM patients with hypertension in Hunan, China.

Methods

This cross-sectional study included T2DM patients with hypertension admitted to the Department of Endocrinology of Yuanjiang People's Hospital in Hunan Province from July 2022 to February 2023. Data on sociodemographic, lifestyle, disease-related characteristics, and cognitive function were collected through face-to-face interviews. Cognitive function was assessed using the Mini-Mental State Examination. Backward stepwise multivariable logistic regression analysis was used to identify factors associated with CI. The predictive power was examined using the receiver operating characteristic (ROC) curve.

Results

A total of 475 participants were included. The prevalence of CI was 38.9% (95% confidence interval [95% CI]: 34.5%-43.3%). Multivariable logistic regression analysis showed that advanced age (odds ratio [OR]=3.21, 95% CI: 1.74-5.93), elementary school or below (OR=3.51, 95% CI: 1.19-10.31), per capita monthly household income ≤2000 RMB (OR=5.29, 95% CI: 2.66-10.51), not current reading books or newspapers (OR=4.48, 95% CI: 1.26-15.99), not current playing cards or mahjong (OR=3.52, 95% CI: 1.91-6.47), current average time of physical activity ≤30 minutes per day (OR=8.66, 95% CI: 4.65-16.12), diabetic nephropathy (OR=1.95, 95% CI: 1.05-3.61) and stroke (OR=7.41, 95% CI: 3.41-16.11) were associated with a higher risk of CI in T2DM patients with hypertension. The area under the ROC curve of this model was 0.925 (95% CI: 0.902-0.949).

Conclusions

The prevalence of CI was high in T2DM patients with hypertension in Hunan, China. Age, educational level, household income, current reading books or newspapers status, current playing cards or mahjong status, current average time of physical activity per day, diabetic nephropathy, and stroke were associated with CI in T2DM patients with hypertension.

Striking a balance: health behaviour changes in Chinese spouses of people with dementia to manage dementia risk: a qualitative study

BACKGROUND

Multiple studies have shown that spouses of people with dementia (PwD) are two to six times more likely to develop dementia compared to the general population. Encouraging healthy behaviours and addressing modifiable risk factors could potentially prevent or delay up to 40% of dementia cases. However, little is known about how health behaviours change when a spouse assumes the role of primary caregiver. Therefore, the aim of this study was to explore the shared lived experience of spousal caregivers of PwD, focusing on identifying the trajectory and key events of that shape health behaviour changes after their partner's diagnosis. These findings seek to inform strategies for adopting and sustaining healthy behaviours among spousal caregivers.

METHOD

A qualitative descriptive study was conducted. Using maximum variation and purposive sampling, 20 spouses of PwD who exhibited two or more risk factors were recruited for semistructured interviews. The interviews were transcribed verbatim and analysed using thematic analysis.

RESULTS

We found that in traditional Chinese culture health behaviour changes for spouses and people with dementia coping with the challenges of dementia occurred in two directions; (a) priming-leaping-coping: becoming a "smart" caregiver and (b) struggling-trudging-silence: the process by which the self is "swallowed."

CONCLUSION

This study highlights how caregiving experiences influence spouses' health behaviors and dementia prevention, particularly in the Chinese context. The findings underscore the challenges of balancing caregiving with self-care. Culturally tailored, family-centered interventions are needed to support both caregivers and their long-term well-being.

Prevalence and influencing factors of medication-related burden among patients with late-life depression in typical city of eastern China: a cross-sectional study

AIM

To evaluate the medication-related burden (MRB) of patients with late-life depression (LLD) and its influencing factors in China using the Living with Medicines Questionnaire-3 (LMQ-3), providing reference for reducing the MRB of those patients.

METHOD

A cross-sectional study was conducted between September 2023 and January 2024 on 588 patients with LLD. LMQ-3 and MRB factors questionnaire were used for data collection. The distribution of variables was assessed using descriptive analysis, while analyses of Mann-Whitney and Kruskal-Wallis were performed to evaluate inter-group differences. To explore the MRB among patients with LLD and influencing factors, multiple linear regression analysis was performed.

RESULTS

The median (IQR) LMQ-3 score of 588 participants was 102 (18), indicating a moderate MRB level. Regression analysis revealed a significant trend toward higher perceived burden among patients aged 70-79 years old, living in rural areas, receiving more medical insurance settlements, using all cash, taking more than 5 drugs each time, and taking medicine more than 3 times a day (p < 0.05), which were risk factors for higher MRB. Conversely, patients who lived with their children, had an annual household income (including adult children) more than 50,000 Chinese Yuan, and no adverse drug reactions had lower LMQ-3 scores (p < 0.05), which were protective factors. Patients' concerns about medicine, their lack of autonomy in medicine regimens, and the lack of communication between patients and doctors on treatment regimens were the main causes of the burden.

CONCLUSIONS

Results of this study provided preliminary evidence of the MRB among patients with LLD. Age, residence, living status, annual household income, type of drug payment, quantity and frequency of medication, and adverse reactions significantly affected the perceived medication burden. It is advisable for health policy makers and health care providers to implement appropriate intervention strategies and burden reduction programs for this vulnerable group.

Now and future: Strategies for diagnosis, prevention and therapies for Alzheimer's disease

After a number of failed drug studies on Alzheimer's disease (AD) over the past decade, clinical trials of AD started to show encouraging results and were approved or pending approval for clinical use. However, controversies on the clinically meaningful benefits and risks of brain edema and microhemorrhages have reminded us to think further about monitoring treatment and developing new drug targets. The goal of this review is to find insights from clinical trials that aimed at two key pathological features of AD, i.e., amyloid-β (Aβ) and tau protein, and to explore other targets such as anti-inflammation in AD. The complex pathophysiology of AD may require combination therapies rather than monotherapy. Throughout the course of AD, multiple pathways are disrupted, presenting a multitude of possible therapeutic targets for designing prevention and intervention for AD.

Associations between multiple metals exposure and cognitive function in the middle-aged and older adults from China: A cross-sectional study

The rapidly rising risk of cognitive decline is a serious challenge for the elderly. As the wide-distributed environmental chemicals, the effects of metals exposure on cognitive function have attracted much attention, but the results remain inclusive. This study aimed to investigate the roles of multiple metals co-exposure on cognition. We included a total of 6112 middle-aged and older participants, detected their plasma levels of 23 metals by using inductively coupled plasma mass spectrometry, and assessed their cognitive function by using the Mini-Mental State Examination (MMSE). The results showed that increased plasma levels of iron (Fe) and zinc (Zn) were positively associated with MMSE score, but the increased levels of nickel (Ni) and lead (Pb) were associated with decreased MMSE score (all FDR < 0.05). Subjects exposed to both high levels of Ni and Pb showed the lowest MMSE score [β (95% CI) = -0.310 (-0.519, -0.100)], suggesting that Ni and Pb had a synergistic toxic effect on cognitive function. In addition, the hazardous roles of Ni and Pb were mainly found among subjects with low plasma level of Zn, but were not significant among those with high-Zn level [Ni: β (95% CI) = -0.281 (-0.546, -0.015) vs. -0.146 (-0.351, 0.058); Pb: β (95% CI) = -0.410 (-0.651, -0.169) vs. -0.060 (-0.275, 0.155)], which suggested that Zn could attenuate the adverse effects of Pb and Ni on cognitive function. The cognitive function was gradually decreased among subjects with increased number of adverse exposures to the above four metals (Ptrend < 0.001). In conclusion, our findings revealed the individual, interactive, and combined effects of Fe, Ni, Pb, and Zn on cognitive function, which may provide new perspectives on cognitive protection, but further prospective cohort studies and biological researches are needed to validate these findings.

Association between residential environment quality with mild cognitive impairment among middle and elderly adults in China

BACKGROUND

Most studies have focused on the effects of individual environmental risk factors on cognitive function; however, none have evaluated the association between residential environmental quality and cognitive impairment.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) were used to include 12,801 participants in a cross-sectional study and 8781 participants in a cohort study. Residential environmental quality was assessed using indicators such as particulate matter, types of household fuel, water sources, indoor temperature, and building types. Based on the residential environment quality score, participants were classified into three groups: comfortable (0-1 points), moderate (2-3 points), and poor (4-6 points). To evaluate the association between residential environmental quality and cognitive scores in the cross-sectional study, as well as the development of mild cognitive impairment (MCI) in the cohort study, ordinary least squares (OLS) regression and logistic regression models were applied.

RESULTS

In the cross-sectional study, cognitive scores and performance across four dimensions-orientation, computation, memory, and drawing-showed a significant decline from the comfortable to the poor residential environment groups. In the fully adjusted OLS regression model, scores across these dimensions were significantly reduced in the moderate and poor groups compared to the comfortable group (P for trend <0.001). The incidence of MCI from 2011 to 2018 was 10.1 %, 16.8 %, and 18.8 % for participants living in comfortable, moderate, and poor environments, respectively, with statistically significant differences among groups (all P < 0.07). Logistic regression analysis revealed an odds ratio of 1.25 (95 % CI: 1.02-1.53) for the moderate group and 1.31 (95 % CI: 1.04-1.65) for the poor group, compared to the comfortable group (P for trend<0.05).

CONCLUSIONS

An inferior residential environment is associated with lower cognitive scores and a higher rik of developing MCI in middle-aged and older Chinese adults.

The mechanisms, hallmarks, and therapies for brain aging and age-related dementia

Age-related cognitive decline and dementia are significant manifestations of brain aging. As the elderly population grows rapidly, the health and socio-economic impacts of cognitive dysfunction have become increasingly significant. Although clinical treatment of dementia has faced considerable challenges over the past few decades, with limited breakthroughs in slowing its progression, there has been substantial progress in understanding the molecular mechanisms and hallmarks of age-related dementia (ARD). This progress brings new hope for the intervention and treatment of this disease. In this review, we categorize the latest findings in ARD biomarkers into four stages based on disease progression: Healthy brain, pre-clinical, mild cognitive impairment, and dementia. We then systematically summarize the most promising therapeutic approaches to prevent or slow ARD at four levels: Genome and epigenome, organelle, cell, and organ and organism. We emphasize the importance of early prevention and detection, along with the implementation of combined treatments as multimodal intervention strategies, to address brain aging and ARD in the future.

Early Detection of Dementia in Populations With Type 2 Diabetes: Predictive Analytics Using Machine Learning Approach

BACKGROUND

The possible association between diabetes mellitus and dementia has raised concerns, given the observed coincidental occurrences.

OBJECTIVE

This study aimed to develop a personalized predictive model, using artificial intelligence, to assess the 5-year and 10-year dementia risk among patients with type 2 diabetes mellitus (T2DM) who are prescribed antidiabetic medications.

METHODS

This retrospective multicenter study used data from the Taipei Medical University Clinical Research Database, which comprises electronic medical records from 3 hospitals in Taiwan. This study applied 8 machine learning algorithms to develop prediction models, including logistic regression, linear discriminant analysis, gradient boosting machine, light gradient boosting machine, AdaBoost, random forest, extreme gradient boosting, and artificial neural network (ANN). These models incorporated a range of variables, encompassing patient characteristics, comorbidities, medication usage, laboratory results, and examination data.

RESULTS

This study involved a cohort of 43,068 patients diagnosed with type 2 diabetes mellitus, which accounted for a total of 1,937,692 visits. For model development and validation, 1,300,829 visits were used, while an additional 636,863 visits were reserved for external testing. The area under the curve of the prediction models range from 0.67 for the logistic regression to 0.98 for the ANNs. Based on the external test results, the model built using the ANN algorithm had the best area under the curve (0.97 for 5-year follow-up period and 0.98 for 10-year follow-up period). Based on the best model (ANN), age, gender, triglyceride, hemoglobin A1c, antidiabetic agents, stroke history, and other long-term medications were the most important predictors.

CONCLUSIONS

We have successfully developed a novel, computer-aided, dementia risk prediction model that can facilitate the clinical diagnosis and management of patients prescribed with antidiabetic medications. However, further investigation is required to assess the model's feasibility and external validity.

Depression in middle-aged and older adults with hearing loss: the use and construction of a nomogram tool

Objective

This study aims to explore the influencing factors of depressive symptoms in middle-aged and older adult patients with hearing loss and to construct a nomogram risk prediction model.

Methods

A total of 2,729 middle-aged and older adult patients with hearing loss from the community were selected as the study subjects. Single-factor and multifactorial stepwise logistic regression analyses were used to screen influencing factors. Based on these predictive factors, a nomogram prediction model was constructed. The model's efficacy was validated using the area under the receiver operating characteristic curve (AUC) and 1,000 bootstrap resamples.

Results

Multifactorial logistic regression analysis revealed that age, gender, pain, cognitive abilities, daily living abilities, sleep duration, and self-rated health status are the main influencing factors for depressive symptoms. Based on these factors, the constructed nomogram model demonstrated good calibration (χ2 = 3.367, p = 0.909), with an AUC value of 0.741 (95% CI: 0.723-0.759), and a sensitivity of 0.683, showing good discriminative ability and accuracy.

Conclusion

The incidence of depressive symptoms is relatively high among middle-aged and older adult individuals with hearing loss. The model developed in this study can effectively identify middle-aged and older adult patients with hearing loss who are at risk of depressive symptoms. This provides strong empirical support for the early detection, diagnosis, and intervention of depressive symptoms in middle-aged and older adult patients with hearing loss.

Perception and Identification of Behavioral and Psychological Symptoms of Dementia (BPSD) in China Medical Community

Background

Behavioral and psychological symptoms of dementia (BPSD), as neuropsychiatric manifestations within dementia, constitute core features of dementia. However, there remains a gap in understanding the recognition of BPSD in China. Our current study was to explore the clinical awareness and treatment approaches for BPSD in China, focusing especially on the perspectives of neurologists and psychiatrists.

Methods

A multicenter national survey was designed and a semi-structured questionnaire was distributed to healthcare professionals including doctors and nurses across all provinces of China. The questionnaire incorporated either closed (yes/no) and multiple-choice questions. The questions centered on the following areas: the perceived global frequency and relevance of BPSD; the assessment tools employed for evaluating BPSD; pharmacological approaches for addressing psychosis, apathy, agitation, aggression, depression, anxiety, sleep, and nutrition disorders; drug-related side effects; non-pharmacological treatment strategies. The anonymity of questionnaire responses was maintained to encourage participants to candidly express their viewpoints.

Results

The majorities of respondents recognized the importance of BPSD. There were apparent differences in the perception of BPSD between neurologists and psychiatrists, encompassing variances in symptoms recognition, diagnostic approaches, and treatment strategies. A notable high percentage of neurology (27.8%) and psychiatry staff (23.6%) would not choose non-pharmacological interventions. Meanwhile, antipsychotics was overused in China. For aggression and agitation, more than half of neurologist and psychiatrist preferred antipsychotics. For psychosis, more than 80% of doctors chose antipsychotics. Nearly one-third of the medical staff expressed a preference for traditional Chinese medicine including ginkgo biloba extract.

Conclusion

In summary, this study in China has shed light on the features related to perception, recognition, management, treatment options, and observed side effects associated with BPSD. Our findings have the potential to significantly enhance the understanding of BPSD characteristics among medical practitioners and offering valuable insights into improved management and treatment strategies of neuropsychic symptoms of dementia in China.

Gender-specification lifestyle factors associated with mild cognitive impairment among young-old adults in Taiwan

BACKGROUND

The prevalence of mild cognitive impairment (MCI) exhibits a positive correlation with age, particularly evident in the old-old female population. Lifestyle factors have been identified as crucial risk determinants for MCI. However, there is a scarcity of research focusing on lifestyle factors among young-old population.

OBJECTIVE

This study aimed to explore the lifestyle factors associated with MCI in young-old male and female.

METHODS

This study employed a cross-sectional design and utilized demographic and lifestyle data obtained from participants enrolled in the Taiwan Biobank (TWB) between 2008 and 2021, with 32,897 individuals aged 60 to 70 years old. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), with a total score ranging from 0 to 30 points. The cut-off of MCI scores was ≤18, ≤21, and ≤25 according to the education level, respectively. Logistic regression analysis was employed to assess the association between lifestyles and cognitive function.

RESULTS

3,878 individuals (11.78%) suffered from MCI. Upon gender stratification, high exercise metabolic equivalents in male (OR = 0.8, 95% CI: 0.70 - 0.92) and moderate exercise in female serve as protective factors for MCI (OR = 0.78, 95% CI: 0.70 - 0.87). Additionally, diversified dietary preferences among female (OR = 0.80, 95% CI: 0.66 - 0.97) also emerge as protective factors for cognitive function.

CONCLUSIONS

It is worth noting that male is advised to target a higher exercise metabolic equivalent, while female can attain cognitive benefits with moderate exercise and diversified dietary.

Effects of fully immersive virtual reality training on cognitive function in patients with mild cognitive impairment: a systematic review and meta-analysis

Background

Mild cognitive impairment (MCI) is a prodromal stage of dementia. There is no specific medication to slow the progression of MCI. Recent studies have confirmed the positive effects of virtual reality (VR). However, the results are inconsistent due to different types of VR interventions, small sample sizes, and the varying quality of the literature. This study aimed to assess the effects of fully immersive VR on cognitive function in MCI patients.

Methods

A systematic review of published literature was conducted using PubMed, Cochrane Library, Embase, CINAHL, Web of Science, SinoMed, CNKI, Wanfang, and VIP Database. The search period was from inception through March 1, 2024. Eligible studies were randomized controlled trials evaluating the effects of fully immersive virtual reality training on cognitive function in MCI patients. Two investigators independently performed literature screening, data extraction, and quality assessment; a meta-analysis of the included literature was performed using RevMan 5.4. The Cochrane Risk of Bias tool was used to assess the methodological quality.

Results

A total of 11 randomized controlled trials with 525 patients were included. The meta-analysis showed that fully immersive virtual reality training had significant effects on global cognitive function (MD = 2.34, 95% CI [0.55, 4.12], p = 0.01); (MD = 0.93, 95% CI [0.30, 1.56], p < 0.01), executive function (SMD = -0.60, 95% CI [-0.84, -0.35], p < 0.01), and attention (MD = 0.69, 95% CI [0.15, 1.23], p = 0.01). Still, the difference in memory (SMD = 0.27, 95% CI [-0.24, 0.78], p = 0.30) was not statistically significant. Subgroup analyses showed that executive function could be improved only when the intervention duration was ≥40 h. In contrast, excessive training (≥30 times) was counterproductive.

Conclusion

Fully immersive virtual reality training improved cognitive functioning, executive functioning, and attention in MCI patients but was less effective in improving memory. Subgroup analysis suggests that fully immersive VR training must ensure sufficient intervention duration while avoiding frequent interventions.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, PROSPERO (CRD42024498629).

The associations of dietary manganese, iron, copper, zinc, selenium and magnesium with cognitive outcomes in Chinese adults: a cross sectional study in Shanghai

Introduction

The role of individual nutrients including vitamins and minerals in cognitive function gained increasing attention in recent years. With regard to the association between dietary minerals and cognitive function, the results of human studies are inconclusive. The objective of this study was to explore the association between mineral intake and cognitive function using the data from Shanghai Health and Nutrition Survey (SHNS) in 2018.

Methods

In total, 835 adults were included in a crosssectional study, and completed a three-day dietary record to estimate their average daily intake of minerals. Mini-Mental State Examination (MMSE) was used for the assessment of cognitive function, and logistic regression analyses were performed on participants to examine the association between dietary mineral intake and cognitive performance. The participants were divided into tertiles according to their mineral intake.

Results

Participants in the second and third tertile of the dietary copper intake had lower rates of low MMSE scores compared to those in the lowest tertile. We found the adjusted OR and 95%CI values were 0.44 (0.21-0.89) and 0.40 (0.16-0.94), respectively. Participants in the second tertile of dietary magnesium intake showed a trend of lower rates of low MMSE score compared to those in the lowest tertile (p = 0.06). The adjusted OR and 95%CI values were 0.35 (0.16-0.72). No significant association were observed between any of the other minerals including iron, zinc, selenium and manganese and cognitive function.

Discussion

Our findings suggest that dietary intake of copper and magnesium may have a protective effect on cognitive performance in elderly over 60 years old. To prevent cognitive decline, elderly should get recommended amounts of copper and magnesium from diet or supplements.

Study on the age-period-cohort effects of cognitive abilities among older Chinese adults based on the cognitive reserve hypothesis

BACKGROUND

Cognitive abilities serves as a critical indicator of healthy aging. As China progresses into a stage of advanced population aging, there has been a significant increase in the number of elderly individuals experiencing age-related cognitive decline. Despite this demographic shift, there is a paucity of longitudinal research examining cognitive abilities among older Chinese adults over extended time periods. This study aims to investigate changes in cognitive abilities and explore group differences among older Chinese adults aged 65 to 110 years, employing a multidimensional temporal approach that encompasses age, period, and birth cohort effects.

METHODS

This study utilizes data from eight waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), spanning from 1998 to 2018. The dataset comprises 94,116 observations from 36,157 unique participants. Cognitive abilities are assessed using Mini-Mental State Examination (MMSE) scores as a proxy measure. To address the issue of perfect collinearity in the temporal dimension, the study employs the Hierarchical Age-Period-Cohort Cross-Classified Random Effects Model (HAPC-CCREM). This model allows for the examination of age effects, period effects, and cohort effects on cognitive abilities among older Chinese adults. In the model specification, age is treated as a fixed effect, while period and birth cohort are incorporated as random effects. Drawing upon the cognitive reserve hypothesis, the study investigates significant factors influencing cognitive abilities in this population.

RESULTS

At the fixed-effect level, demographic factors, health behaviors, self-rated health, subjective well-being, and childhood adversity significantly influence cognitive abilities among older Chinese adults. The age effects are significant, with cognitive abilities exhibiting an inverted U-shaped curve across the lifespan. At the random-effect level, period effects are significant, revealing a gradual annual increase in overall cognitive levels among older Chinese adults since 2008. Cohort effects are also significant, demonstrating an increasing trend in overall cognitive levels for the earlier-born cohorts in the first six groups. Conversely, later-born cohorts in the latter five groups show a declining trend in overall cognitive levels. Notably, period effects significantly enhance cohort effects.

CONCLUSIONS

The cognitive reserve hypothesis supports the significance of the majority of identified influencing factors. Cognitive abilities demonstrate an accelerating decline with increasing age, following an evolutionary trajectory consistent with physiological principles among older Chinese adults. Since 2008, cognitive abilities have shown a monotonic increasing trend annually, further validating the Flynn effect in this population. The cognitive abilities of the six earlier-born cohorts exhibit an increasing trend, supporting the compression of morbidity hypothesis. Conversely, the cognitive abilities of the five later-born cohorts show a declining trend, supporting the expansion of morbidity hypothesis. These findings collectively contribute to our understanding of cognitive aging patterns and their underlying mechanisms among older Chinese adults.

Relationship Between Internet Use and Cognitive Function Among Middle-Aged and Older Chinese Adults: 5-Year Longitudinal Study

BACKGROUND

Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults.

OBJECTIVE

This study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis.

METHODS

We analyzed data based on 12,770 dementia-free participants aged ≥45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap.

RESULTS

Participants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function (β=0.551, 95% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2% (15/671), compared with nonusers, at 5.3% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones (β=0.398, 95% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers (β=0.147, 95% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2% of the total effect, P<.001).

CONCLUSIONS

This study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use has the potential to be a viable, cost-effective, nonpharmacological intervention for cognitive decline among middle-aged and older adults.

Characteristics of relatives with high expressed emotion and related factors: a study of relatives of people with dementia in China

BACKGROUND

China has the highest number of people with dementia globally, and the responsibility of caring for people with dementia primarily falls on relatives, who bear heavy caregiving burdens and pressure. Providing care for an individual with dementia is emotionally and physically demanding, particularly due to the frequent manifestation of behavioral and psychological symptoms associated with dementia (BPSD). This underscores the crucial need to comprehend and address caregivers' emotional expression (EE).

AIM

To explore the characteristics of relatives with high expressed emotion of people with dementia and related factors in mainland China.

METHODS

A survey using cross-sectional questionnaires conducted with 165 relatives of individuals with dementia in China.

RESULTS

A significant number of relatives had high EE (n = 61, 39%). The variation in EE, about 37.8%, is explained by seven independent variables. The proportion of psychological distress among relatives in EE variation is 14.5%. (b = 0.387, p < 0.001). Length of care-taking, active coping, and chronic diseases accounted for 6.5% (b = 0.264, p < 0.001), 5.1% (b=-0.239, p = 0.001) and 4.1% (b = 0.211, p = 0.002) of the variance in EE, respectively.

CONCLUSIONS

Chinese health care providers can identify high-risk groups for assistance based on the severity of dementia, age, health status and duration of care. Enhancing coping styles and alleviating emotional distress among relatives could be advantageous in decreasing EE.

CLINICAL EVIDENCE

Understanding the risk factors for high EE in different cultures can help guide practice on a global scale to improve the quality of life of people with dementia.

Exercise intervention on the brain structure and function of patients with mild cognitive impairment: systematic review based on magnetic resonance imaging studies

Objective

This systematic review evaluates the impact of exercise intervention in MCI patients and discusses the potential neural mechanisms.

Methods

A systematic search and screening of relevant literature was conducted in English and Chinese databases. Based on predefined keywords and criteria, 24 articles were assessed and analyzed.

Results

Structurally, a significant increase was observed in the hippocampal and gray matter volumes of MCI patients following exercise intervention, with a trend of improvement in cortical thickness and white matter integrity. Functionally, after the exercise intervention, there were significant changes in the local spontaneous brain activity levels, cerebral blood flow, and functional connectivity during rest and memory encoding and retrieval tasks in MCI patients.

Conclusion

Exercise may contribute to delaying neurodegenerative changes in brain structure and function in patients with MCI. However, the underlying neural mechanisms require further research.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023482419.

Development and Validation of a Predictive Model for Early Identification of Cognitive Impairment Risk in Community-Based Hypertensive Patients

Objective: To investigate the risk factors for the development of mild cognitive dysfunction in hypertensive patients in the community and to develop a risk prediction model. Method: The data used in this study were obtained from two sources: the China Health and Retirement Longitudinal Study (CHARLS) and the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 1121 participants from CHARLS were randomly allocated into a training set and a validation set, following a 70:30 ratio. Meanwhile, an additional 4016 participants from CLHLS were employed for external validation of the model. The patients in this study were divided into two groups: those with mild cognitive impairment and those without. General information, employment status, pension, health insurance, and presence of depressive symptoms were compared between the two groups. LASSO regression analysis was employed to identify the most predictive variables for the model, utilizing 14-fold cross-validation. The risk prediction model for cognitive impairment in hypertensive populations was developed using generalized linear models. The model's discriminatory power was evaluated through the area under the receiver operating characteristic (ROC) curve and calibration curves. Results: In the modeling group, eight variables such as gender, age, residence, education, alcohol use, depression, employment status, and health insurance were ultimately selected from an initial pool of 21 potential predictors to construct the risk prediction model. The area under the curve (AUC) values for the training, internal, and external validation sets were 0.777, 0.785, and 0.782, respectively. All exceeded the threshold of 0.7, suggesting that the model effectively predicts the incidence of mild cognitive dysfunction in community-based hypertensive patients. A risk prediction model was developed using a generalized linear model in conjunction with Lasso regression. The model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve. Hosmer-Lemeshow test values yielded p = .346 and p = .626, both of which exceeded the 0.05 threshold. Calibration curves demonstrated a significant agreement between the nomogram model and observed outcomes, serving as an effective tool for evaluating the model's predictive performance. Discussion: The predictive model developed in this study serves as a promising and efficient tool for evaluating cognitive impairment in hypertensive patients, aiding community healthcare workers in identifying at-risk populations.

The updated prevalence and risk factors of dementia in old adults in China: A cross-sectional study

BACKGROUND

The continuously increasing aging population and life expectancy have led to an inconsistent and underestimated dementia prevalence in China. An updated epidemiologic study is urgently needed.

OBJECTIVE

To update the prevalence rate and risk factors of dementia in China.

METHODS

For this national cross-sectional study, 20,438 participants aged ≥65 from 28 communities and 56 villages from 14 centers were recruited using a multistage cluster sampling design between May 2019 and December 2019. Participants were assessed with a series of clinical and neuropsychological measurements. The prevalence rates of dementia, Alzheimer's disease (AD), and vascular dementia (VaD), as well as the risk factors, were calculated using multivariate-adjusted models.

RESULTS

The crude prevalence rates were 9.1% (95% CI, 8.7%-9.5%) for dementia, 6.0% (95% CI, 5.7%-6.3%) for AD, 1.4% (95% CI, 1.2%-1.5%) for VaD, and 1.8% (95% CI, 1.6%-2.0%) for other dementias in a population aged ≥65 years. The overall sex- and age-standardized prevalence was 8.8%. Apart from VaD, the prevalence rates of dementia and AD were higher in females than males (10.3% versus 7.7%, respectively). Moreover, the prevalence rates of dementia and AD increased significantly with age. Being unmarried and having fewer social activities increased the risks of dementia and main subtypes. Risk factors were not exactly the same for participants with AD and VaD.

CONCLUSIONS

The prevalence of dementia is increased and almost comparable with that of developed countries for individuals aged ≥65 years. These findings may serve as new evidence for government interventions in aging.

Association between childhood parental literacy and late-life cognitive function: The Guangzhou Biobank Cohort Study

OBJECTIVES

Evidence on the associations of childhood parental education with late-life cognitive function remains inconsistent. Additionally, studies focusing on dimensions of cognitive function are scarce, with none from China. Therefore, we examined the associations of childhood parental education with late-life cognitive function and it's dimensions and investigated potential interactions.

STUDY DESIGN

A cross-sectional study.

METHODS

Participants were included from the third phase of Guangzhou Biobank Cohort Study. Mini-Mental State Examination (MMSE), Delayed 10-Word Recall Test (DWRT), and childhood parental literacy (could read or write) were collected. Multivariate linear and logistic regression were used.

RESULTS

Among 8891 participants aged ≥50 years, compared with those whose childhood parents could not read/write, those with only the father, only the mother, or both parents able to read/write during childhood had higher scores on the MMSE and its dimensions, and lower odds of mild cognitive impairment (MCI). The coefficients (β) and 95 % confidence intervals (CI) for scores of MMSE were 1.25 (1.10, 1.41), 1.36 (0.86, 1.86), and 2.05 (1.89, 2.21) respectively; the odds ratios and 95 % CIs for MCI were 0.38 (0.33, 0.45), 0.35 (0.18, 0.67), and 0.15 (0.12, 0.19) respectively. More pronounced effects were found in women, those aged ≥60, those with ≤ primary education, and in those whose childhood parents could read/write. Socioeconomic position mediated the association. Cognitive functions of attention and calculation in children of only fathers who could read/write (β = 0.43, 95%CI: 0.35, 0.50) and memory in children of only mothers who could read/write (β = 0.34, 95%CI: 0.16, 0.51) were associated with better outcomes. Consistent results were also found using scores from the DWRT.

CONCLUSIONS

Childhood parental literacy was associated with late-life cognitive function and it's dimensions, which mediated by socioeconomic position. Specifically, having only a father or only a mother who could read/write during childhood was associated with better cognitive function in attention/calculation and memory, respectively. These results add new evidence to support strategies for elderly cognitive health care.

Associations between measured masticatory function and cognitive status: A systematic review

OBJECTIVE

This systematic review aimed to provide an overview of the most recent evidence on the association between measured masticatory function and cognitive status.

MATERIALS AND METHODS

Literature and manual searches were conducted using three electronic databases (PubMed, Web of Science and CINAHL). Observational studies published between 2011 and 2021 investigating the association between masticatory function, dementia and cognitive status in adult humans were abstracted and reviewed by three reviewers. Studies that assessed participants' masticatory function using objective and subjective measurements and that individually examined its association with cognitive function were included. The included studies were divided into cross-sectional and cohort studies, and the quality of each study was analysed using critical appraisal skills checklists. Additionally, the main conclusions and strength of the evidence were assessed for each article.

RESULTS

A total of 21 studies (11 cross-sectional studies that objectively evaluated masticatory function, 9 cross-sectional studies that subjectively evaluated masticatory function and 1 prospective cohort study) were evaluated. The poorer masticatory function was associated with lower cognitive status even after adjusting for potential risk factors of dementia in four of 11 and six of nine cross-sectional studies where the masticatory function was respectively evaluated objectively and subjectively. One prospective cohort study also demonstrated that masticatory function, as evaluated based on measurements of occlusal force, predicted cognitive decline during the follow-up period.

CONCLUSION

Several studies demonstrated a positive association between masticatory function and cognitive status. However, further studies, particularly longitudinal studies, are required to determine whether the association is causal.

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

OBJECTIVES

Although there have been studies on the association of handgrip strength or walking speed alone with cognitive abilities, few studies have determined the combined associations of handgrip strength and walking speed with cognitive function. Therefore we aimed to explore the independent and combined associations of handgrip strength and walking speed with cognitive function in Chinese older adults using a nationally representative sample.

METHOD

This cross-sectional study included 4,577 adults aged 60 and older. Handgrip strength was measured using a dynamometer and walking speed was assessed using a 2.5-meter walking test. Both handgrip strength and walking speed were organized into low, normal, and high tertiles according to the sample distribution. Cognitive function was measured using the Telephone Interview for Cognitive Status.

RESULTS

Handgrip strength and walking speed were significantly associated with cognitive function. Participants with low handgrip strength or low walking speed separately had a higher rate of lower cognitive function (adjusted odds ratio (OR): 1.22 (95% CI: 1.04 - 1.44) for low handgrip strength; 1.54 (95% CI: 1.31 - 1.81) for low walking speed). Those with both low handgrip strength and low walking speed had an additively higher rate of lower cognitive function (adjusted OR: 1.72 (95% CI: 1.32 - 2.24)).

CONCLUSION

Having low handgrip strength or low walking speed is associated with a greater likelihood of lower cognitive function and vice versa. The concurrence of having low handgrip strength and low walking speed has an additive effect on cognitive function in older adults.

Proteomic analysis by 4D label-free MS-PRM identified that Nptx1, Ptpmt1, Slc25a11, and Cpt1c are involved in diabetes-associated cognitive dysfunction

BACKGROUND

Diabetes-associated cognitive dysfunction (DACD) is a chronic ailment that exerts a substantial influence on the overall well-being of individuals. The hippocampus assumes a pivotal role in the progression and sustenance of cognitive impairment. The identification of differentially expressed proteins (DEPs) in the hippocampus is crucial for understanding the mechanisms of DACD.

METHODS

A rat model of DACD was established by a high-fat diet combined with streptozotocin intraperitoneal injection. The Morris water maze (MWM), hematoxylin and eosin (H&E) staining, Nissl staining, and transmission electron microscope (TEM) were performed on the rats. The proteins expressed in the hippocampus were detected using 4D label-free quantitative proteomics. Four DEPs, namely Nptx1, Ptpmt1, Slc25a11, and Cpt1c, were validated using parallel reaction monitoring (PRM).

RESULT

Our study found that hippocampal lesions were present in the DACD rat models. There were 59 up-regulated and 98 down-regulated DEPs in the Model group compared to the Control group. We found that the levels of Nptx1, Ptpmt1, Slc25a11, and Cpt1c were elevated in the Model group, which are important for cell mitochondrial function. It should be noted that in our study, we only used PRM to validate the expression of these proteins. However, more evidence is needed to establish the relationship between these protein changes and DACD.

CONCLUSION

Our research results may provide further insight into the molecular pathology of hippocampal injury in DACD. In addition, further studies and clinical trials are required to confirm our findings and establish a more conclusive molecular mechanism for DACD.

Biofluid biomarkers for Alzheimer's disease: past, present, and future

Alzheimer's disease (AD) is a gradually progressive neurodegenerative disease with tremendous social and economic burden. Therefore, early and accurate diagnosis is imperative for effective treatment or prevention of the disease. Cerebrospinal fluid and blood biomarkers emerge as favorable diagnostic tools due to their relative accessibility and potential for widespread clinical use. This review focuses on the AT(N) biomarker system, which includes biomarkers reflecting AD core pathologies, amyloid deposition, and pathological tau, as well as neurodegeneration. Novel biomarkers associated with inflammation/immunity, synaptic dysfunction, vascular pathology, and α-synucleinopathy, which might contribute to either the pathogenesis or the clinical progression of AD, have also been discussed. Other emerging candidates including non-coding RNAs, metabolites, and extracellular vesicle-based markers have also enriched the biofluid biomarker landscape for AD. Moreover, the review discusses the current challenges of biofluid biomarkers in AD diagnosis and offers insights into the prospective future development.

Diabetes in China part 1: epidemiology and risk factors

The prevalence of diabetes in China is rapidly increasing. China now has the largest number of people living with diabetes worldwide, accounting for approximately one-quarter of the global diabetes population. Since the late 1970s, China has experienced profound changes and rapid economic growth, leading to shifts in lifestyle. Changing dietary patterns, reduced physical activity, and stress have contributed to the growing prevalence of overweight and obesity, which are important determinants potentiating the link between insulin resistance and diabetes. Social and environmental factors, such as education, air pollution, and exposure to endocrine-disrupting chemicals, have also contributed to the growing diabetes epidemic in China. The country has one of the fastest ageing populations in the world, which forecasts continued increases in the prevalence of diabetes and its complications. This Review provides an overview of the ongoing diabetes epidemic and risk factors, providing evidence to support effective implementation of public health interventions to slow and prevent the diabetes epidemic in China.

Correlation Between Lifestyle Patterns and Cognitive Function Among Community-Dwelling Older Chinese Adults in the Pre-Dementia Stages: A Latent Class Analysis

Lifestyle activity engagement is a modifiable factor for cognitive decline. We aimed to identify lifestyle patterns (LPs) among community-dwelling older adults in the pre-dementia stages and to explore the links between LPs, cognitive function, and individual characteristics. 702 older Chinese adults were recruited. Three LPs were identified by latent class analysis: active aging lifestyle pattern (AALP), leisure lifestyle pattern (LLP), and work-centered lifestyle pattern (WLP). AALP refers to participation in various activities that are meaningful to individuals and benefit their well-being. LLP is the pattern of activities aimed at recreation. WLP refers to the LP where individuals are most likely to engage in work-related activities. However, only AALP is protected against mild cognitive impairment (MCI). Multinomial logistic regression models revealed the differences in individual characteristics among participants with different LPs, indicating the importance of tailored intervention strategies. As a protective factor against MCI, AALP should be highlighted in community-based care.

Sleep disturbance impaired memory consolidation via lateralized disruption of metabolite in the thalamus and hippocampus: A cross-sectional proton magnetic resonance spectroscopy study

BACKGROUND

Memory consolidation in sleep-dependent individuals involves the circuitry connections of cortex, thalamus and hippocampus, regulating via neural metabolites. However, the disruption of metabolic pattern in thalamus and hippocampus remains unclear.

OBJECTIVE

We aim to explore the disruptive effects of insomnia on the metabolites during memory consolidation, particularly the underlying neurometabolic mechanisms in comorbidity of failed memory consolidation.

METHODS

This study integrates clinical research with animal experiment. In clinical research, 49 participants were divided into four groups: healthy controls (HC, n = 11), insomnia with normal cognition (IS, n = 14), mild cognitive impairment without insomnia (MCI, n = 10), and insomnia with mild cognitive impairment (IS-MCI, n = 14). Magnetic resonance spectroscopy (MRS) was used to evaluate the neural γ-aminobutyric acid (GABA) and glutamate-glutamine (Glx) in bilateral thalamus. In experimental studies, the rat model of sleep deprivation combined with amyloid-β (Aβ) injection was established, after behavior testing, the levels of Glx, choline (Cho) and N-acetyl aspartate (NAA) in the bilateral hippocampus were evaluated with MRS.

RESULTS

The patients in the IS-MCI group exhibited significantly lower GABA level than IS, MCI and HC groups. Results from rat studies showed that sleep deprivation exacerbated asymmetric alterations in Aβ-induced bilateral hippocampal metabolite abnormalities, which correlated with cognition. These neuro-metabolite disruption accompanied with synaptic loss and activation of astrocytes.

CONCLUSIONS

The lateralized decrease in GABA levels of thalamus and NAA, Cho, and Glx levels of hippocampus under conditions of sleep disturbance with cognitive decline may provide evidence for the neural metabolic mechanisms underlying the disruption of memory consolidation.

Network-based identification and mechanism exploration of active ingredients against Alzheimer's disease via targeting endoplasmic reticulum stress from traditional chinese medicine

Alzheimer's disease is a neurodegenerative disease that leads to dementia and poses a serious threat to the health of the elderly. Traditional Chinese medicine (TCM) presents as a promising novel therapeutic therapy for preventing and treating dementia. Studies have shown that natural products derived from kidney-tonifying herbs can effectively inhibit AD. Furthermore, endoplasmic reticulum (ER) stress is a critical factor in the pathology of AD. Regulation of ER stress is a crucial approach to prevent and treat AD. Thus, in this study, we first collected kidney-tonifying herbs, integrated chemical ingredients from multiple TCM databases, and constructed a comprehensive drug-target network. Subsequently, we employed the endophenotype network (network proximity) method to identify potential active ingredients in kidney-tonifying herbs that prevented AD via regulating ER stress. By combining the predicted outcomes, we discovered that 32 natural products could ameliorate AD pathology via regulating ER stress. After a comprehensive evaluation of the multi-network model and systematic pharmacological analyses, we further selected several promising compounds for in vitro testing in the APP-SH-SY5Y cell model. Experimental results showed that echinacoside and danthron were able to effectively reduce ER stress-mediated neuronal apoptosis by inhibiting the expression levels of BIP, p-PERK, ATF6, and CHOP in APP-SH-SY5Y cells. Overall, this study utilized the endophenotype network to preliminarily decipher the effective material basis and potential molecular mechanism of kidney-tonifying Chinese medicine for prevention and treatment of AD.

Association of triglyceride glucose index combined with obesity indicators with cognitive impairment

BACKGROUND

The association of a combination of the TyG index and obesity markers, specifically waist circumference (WC), with cognitive function is unknown. This research investigated the relationship between TyG-WC measurements and cognitive impairment in a low-income population in China; moreover, this study evaluated the role of diabetes mellitus and body mass index (BMI) in modulating this relationship.

METHODS

1125 eligible individuals aged ≥ 60 years participated in this study. The TyG index and obesity indicators (BMI, WC, and waist-to-height ratio) were calculated for individual participants and categorized into quartiles. Multivariate logistic regression analysis was used to evaluate the correlation between TyG-WC values and cognitive impairment; the possibility of a nonlinear relationship was explored using constrained cubic spline analysis. The participants were divided into different groups according to their diabetes status and BMI category for subgroup analyses. Linear regression was used to investigate the correlation between TyG-WC values and MMSE scores.

RESULTS

The prevalence of cognitive impairment in the study participants was 47.3%, with a significant negative association between TyG-WC values and cognitive impairment, (odds ratio [OR] = 0.999; 95% confidence interval [CI], 0.997-1.00, P = 0.009). A U-shaped correlation was observed between the TyG-WC values and cognitive impairment (P = 0.008). Subgroup analyses showed that the inverse association between TyG-WC values and cognitive impairment was stronger in non-diabetic individuals (OR = 0.998; 95% CI, 0.997-0.999; P = 0.002) and in those with a lower BMI (< 24 kg/m2; OR = 0.996; 95% CI, 0.994-0.998; P = 0.001). A positive correlation was found between TyG-WC values and MMSE scores, particularly in men and non-diabetic individuals (β = 0.003; 95% CI, 0.0002-0.005; P = 0.031).

CONCLUSION

This study demonstrates a nonlinear U-shaped relationship between TyG-WC values and cognitive function. The stronger inverse association between TyG-WC values and cognitive decline in the non-diabetic and low-BMI subgroups suggests that these populations may benefit the most from targeted interventions. These findings are important for clinical practice and formulating disease-prevention policies, emphasizing the need for metabolic health management to prevent cognitive decline, particularly in low-income populations.

A Survey on the Status Quo and Influencing Factors of Health-Related Quality of Life Among Family Caregivers of People with Dementia: A Cross-Sectional Study

Background

This study examined the current state of health-related quality of life among family caregivers of elderly individuals with dementia, analyzing associated influencing factors to provide a foundation for enhancing their health-related quality of life and developing pertinent intervention strategies and measures.

Methods

From September 2023 to February 2024, a convenient sampling method was used to investigate the status quo of Health-Related Quality of Life (HRQOL) among family caregivers for dementia patients, family caregivers for non-dementia patients, and people with no caregiving burdens in Sichuan, Chongqing and Guizhou in southwest China. The risk factors were analyzed by multiple regression.

Results

A total of 678 questionnaires were distributed, and 630 valid questionnaires were obtained, resulting in a response rate of 92.92%. The study found that family caregivers for elderly individuals with dementia exhibited the lowest scores in both physical and mental health, followed by family caregivers for elderly individuals without dementia, while people with no caregiving burdens scored the highest. The multiple linear regression analysis demonstrated that age, chronic disease, the relationship between the family caregiver and the person being cared for were dependent of physiological health scores. While females, caregivers with secondary-education, and caregivers with a chronic disease showed poorer mental health scores.

Conclusion

We need to focus on the role that family caregivers for dementia patients play in the health and quality of life of older people with dementia. Therefore, we should pay more attention to the physical and mental health of family caregivers for dementia patients and ensure that this should be taken into consideration in policy-making, which will contribute to a better quality of life for theses caregivers.

Serum trimethylamine N-oxide and its precursors are associated with the occurrence of mild cognition impairment as well as changes in neurocognitive status

Background

This study aims to examine the association between gut microbe-dependent trimethylamine N-oxide (TMAO) and its precursors (choline, betaine, and carnitine) levels and mild cognition impairment (MCI), alongside changes in the Chinese version of the Montreal Cognitive Assessment-Basic (ΔMoCA-BC) score in rural adults.

Methods

Drawing data from a large-scale epidemiological study conducted in rural areas of Fuxin County, Liaoning Province, China. 1,535 participants free from brain-related ailments were initially surveyed. MCI was assessed through the MoCA-BC score. Logistic regression models and restricted cubic spline were used to investigate the association between TMAO and its precursors levels and MCI. Additionally, the association between TMAO and its precursors levels and ΔMoCA-BC was analyzed using a generalized linear model in the longitudinal study.

Results

The average age of the study participants was 58.6 ± 9.4 years and the prevalence rate of MCI was 34.5%. With the second quartile as the reference in the logistic regression model, the OR for risk of MCI in the highest quartile for TMAO, betaine, and carnitine was 1.685 (95% CI: 1.232-2.303, p = 0.001), 2.367 (95% CI: 1.722-3.255, p < 0.001), and 2.239 (95% CI: 1.742-3.295, p < 0.001), respectively. The OR of choline for the highest versus lowest quartile was 2.711 (95% CI: 2.012-3.817, p < 0.001) for the risk of MCI. We find a J-shaped association between betaine (P non-linear = 0.001) and carnitine (P non-linear = 0.003) levels and MCI. Furthermore, TMAO and its precursors levels were associated with ΔMoCA-BC in the third and fourth quartiles group (All p < 0.05).

Conclusion

The findings suggest the existence of an optimal concentration range for serum levels of TMAO, betaine, and carnitine that mitigates MCI risk, paving the way for enhanced dietary interventions aimed at preventing and treating MCI.

Age and Gender Disparities in the Association of Long-Term Dietary Choline and Choline Compound Intakes with Incident Cognitive Decline in Middle-Aged and Older Chinese Adults: A Prospective Cohort Study

Background/Objectives: The neuroprotective role of dietary choline during adulthood has not yet been conclusively proven. This study aims to investigate the influence of long-term choline and its constituent intakes on cognitive decline in the Chinese population. Methods: A total of 4502 subjects (≥55 years) with at least two waves of completed data and without cognitive decline at baseline were selected from the China Health and Nutrition Survey 1997-2018. Three consecutive 24 h dietary recalls were performed to collect dietary intake information for choline, phosphatidylcholine (PC), and glycerophosphocholine (GPC) measures. Several items from the Telephone Interview for Cognitive Status (Modified) were employed to perform a cognitive assessment. Cox frailty models were used to estimate hazard ratios (HRs) and 95% CIs. Results: A total of 783 participants developed cognitive decline during 26,080 person-years of follow-up. Cumulative average intakes of choline, PC, and GPC were 188.0, 126.7, and 17.1 mg/d, respectively. In the total population, after full adjustment, subjects in the lower (Q2), medium (Q3), higher (Q4), and highest (Q5) quintiles of dietary choline showed 27.8% (95% CI: 0.584, 0.894), 33.9% (95% CI: 0.522, 0.836), 23.0% (95% CI: 0.599, 0.990), and 29.3% (95% CI: 0.526, 0.949) decreases in the risk of cognitive decline compared to the lowest (Q1), respectively. Similar results were observed in PC but not GPC measures. Both higher choline and PC intakes induced a lower risk of cognitive decline for subjects ≥ 65 years at baseline (Q3 and Q4) and females (Q2-Q5). A marginally significant association of GPC was found for subjects ≥ 65 years (Q5) and males (Q4). Conclusions: These findings identify age and gender disparities relating to the protective associations of dietary choline, PC, and GPC with incident cognitive decline in middle-aged and older Chinese populations.

The Mediating Role of Oxidative Stress on the Association Between Oxidative Balance Score and Cancer-Related Cognitive Impairment in Lung Cancer Patients: A Cross-Sectional Study

OBJECTIVES

To explore the association between the oxidative balance score (OBS) and cancer-related cognitive impairment (CRCI) in patients with lung cancer, as well as the oxidative stress biomarkers involved.

METHODS

In this cross-sectional study, 315 lung cancer patients were recruited, from whom 142 blood samples were collected to determine oxidative stress biomarkers. Dietary intake was assessed using 3-day, 24 h dietary recalls. The OBS was calculated by summing up pro- and antioxidant factors from a diet and lifestyles assessment. CRCI was evaluated using the Montreal Cognitive Assessment (MoCA) test.

RESULTS

A total of 103 patients (32.7%) developed CRCI, with significantly lower OBS and dietary OBS and lower superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities than non-CRCI patients (p < 0.05). For every 1-point increase in OBS, the risk of CRCI was reduced by 10.6% (OR = 0.894; 95% CI 0.819, 0.977; p = 0.013). Both vitamin E (OR = 0.922; 95% CI 0.868, 0.980; p = 0.009) and dietary fiber (OR = 0.909; 95% CI 0.832, 0.992; p = 0.032) were significantly inversely related to CRCI. The association between the total OBS and CRCI was mediated by SOD (ACME = -0.0061; 95% CI -0.0170, -0.0004; p = 0.015) and GPx (ACME = -0.0069; 95% CI -0.0203, -0.0002; p = 0.032), respectively.

CONCLUSIONS

Lung cancer patients with a greater balance of antioxidant to pro-oxidant diet, especially rich in dietary fiber and vitamin E, may decrease their CRCI in part by affecting SOD and GPx activities.

Predicting poor performance on cognitive tests among older adults using wearable device data and machine learning: a feasibility study

Timely implementation of interventions to slow cognitive decline among older adults requires accurate monitoring to detect changes in cognitive function. Factors known to be associated with cognition that can be gathered from accelerometers, user interfaces, and other sensors within wearable devices could be used to train machine learning models and develop wearable-based cognitive monitoring systems. Using data from over 2400 older adults in the National Health and Nutrition Examination Survey (NHANES) we developed prediction models to differentiate older adults with normal cognition from those with poor cognition based on outcomes from three cognitive tests measuring different domains of cognitive function. During repeated cross-validation CatBoost, XGBoost, and Random Forest models performed best when predicting poor cognition based on tests measuring processing speed, working memory, and attention (median AUCs ≥0.82) compared to immediate and delayed recall (median AUCs ≥0.72) and categorical verbal fluency (median AUC ≥ 0.68). Activity and sleep parameters were also more strongly associated with poor cognition based on tests assessing processing speed, working memory, and attention compared to other cognitive subdomains. Our work provides proof of concept that data collatable through wearable devices such as age, education, sleep parameters, activity summaries, and light exposure metrics could be used to differentiate between older adults with normal versus poor cognition. We further identified metrics that could be targets in future causal studies seeking to better understand how sleep and activity parameters influence cognitive function among older adults.