The MMSE orientation for time domain is a strong predictor of subsequent cognitive decline in the elderly

Lifetime adversity predicts depression, anxiety, and cognitive impairment in a nationally representative sample of older adults in the United States

OBJECTIVE

Although life stress and adversity are well-known risk factors for mental health problems and cognitive impairment among older adults, limited research has comprehensively examined the impact of both childhood and adulthood adversity on psychiatric and cognitive impairment symptoms over a prolonged period. To address this issue, we investigated how lifetime adversity exposure is related to symptoms of depression, anxiety, and cognitive impairment in a nationally representative, longitudinal sample of older adults in the United States.

METHOD

We analyzed data from the Health and Retirement Study (1992-2016). The sample included 3496 individuals (59.9% female), aged ≥64 years old (Mage = 76.0 ± 7.6 years in 2016). We used the individual-level panel data and ordinary least squares regressions to estimate associations between childhood and adulthood adversities, and later-life depression, anxiety, and cognitive impairment.

RESULTS

Many participants experienced a significant early life (38%) or adulthood (79%) stressor. Moreover, experiencing one childhood adversity (vs. none) was associated with a 17.4% increased risk of adulthood adversity. Finally, as hypothesized, childhood adversity exposure was related to experiencing more depression and anxiety symptoms in later life, whereas adulthood stressor exposure predicted more cognitive impairment as well as more depression and anxiety symptoms.

DISCUSSION

These findings demonstrate significant associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in older adults. Screening for lifetime stressors may thus help healthcare professionals and policymakers identify individuals who could potentially benefit from interventions designed to reduce stress and enhance resilience.

Predictive factors and risk and protection groups for loneliness in older adults: a population-based study

BACKGROUND

Loneliness is considered a public health problem, particularly among older adults. Although risk factors for loneliness have been studied extensively, fewer studies have focused on the protected and risk groups that these factors configure. Our objective is to analyze the variables and latent factors that predict loneliness in older adults and that enable risk and protected groups to be configured.

METHODS

We employed an epidemiological, cross-sectional survey that was carried out on a random sample of 2060 people over 65 years extracted from the census. A structured telephone interview was used to assess mental and physical health, habits, quality of life, and loneliness, applying the COOP-Wonca, Goldberg General Health (GHQ-12), and Barber Questionnaires.

RESULTS

Predictors of loneliness were: mental health, living alone, quality of life, depressive symptoms, low educational level, and some deficiency situations such as having no one to turn to for help. The factors extracted (Factorial Analysis) were: a subjective experience of poor health, objective isolation, and psychological isolation. We established at risk and protected groups ("Decision Tree" procedure), and loneliness was referred to by 73.2% of the people living alone and with poor mental health and quality of life (risk group). By contrast, only 0.8% of people living with others, with good mental health and good quality of life felt loneliness (protected group).

CONCLUSION

In a well-developed city, subjective and objective factors are associated with loneliness. These factors, especially those associated with at risk or protected groups, must be considered to develop strategies that address loneliness.

Social and Leisure Activities Predict Transitions in Cognitive Functioning in Older Mexican Adults: A Latent Transition Analysis of the Mexican Health and Aging Study

OBJECTIVES

Mexico has a rapidly aging population at risk for cognitive impairment. Social and leisure activities may protect against cognitive decline in older adults. The benefits of these behaviors may vary by patterns of cognitive impairment. The objectives of this study were to identify latent states of cognitive functioning, model the incidence of transitions between these states, and investigate how social and leisure activities were associated with state transitions over a 6-year period in Mexican adults aged 60 and older.

METHODS

We performed latent transition analyses to identify distinct cognitive statuses in the 2012 and 2018 waves of the Mexican Health and Aging Study (N = 9,091). We examined the transition probabilities between these states and their associations with social and leisure activities.

RESULTS

We identified 4 cognitive statuses at baseline: normal cognition (43%), temporal disorientation (30%), perceptual-motor function impairment (7%), and learning and memory impairment (20%). Various social and leisure activities were associated with reduced odds of death and disadvantageous cognitive transitions, as well as increased odds of beneficial transitions.

DISCUSSION

Mapping the effects of popular social and leisure activities onto common patterns in cognitive functioning may inform the development of more enjoyable and effective health-protective behavioral interventions.

The Mex-Cog cognitive assessment battery: discriminant analysis of the cognitive performance profile in older adults

OBJECTIVE

To analyze the cognitive profile of a clinical sample using the Mex-Cog cognitive battery and establish which cognitive measures and domains contribute most to group separation.

MATERIALS AND METHODS

A group of 145 older adults previously diagnosed with dementia (n= 47), mild cognitive impairment MCI (n= 47), or as cognitively normal (n= 51) were assessed with the Mex-Cog cognitive battery. Six linear discriminant analyses (LDA) were estimated to compare dementia vs. cognitively normal, MCI vs. cognitively normal, and MCI vs. dementia, using ten individual measures and six cognitive domains. We used a leave-one-out cross-validation procedure to evaluate the predictive capacity of LDA models.

RESULTS

Discriminant functions using individual measures and domains distinguished correctly 100% of dementia and cognitively normal groups showing a memory and executive function profile. The predictive group membership for MCI versus cognitively normal varied between 82 and 85%, with a cognitive profile associated with attention-executive function followed by memory. Group separation between MCI and dementia was between 80 and 87%, characterized by orientation, memory, and visuospatial abilities.

CONCLUSIONS

The Mex-Cog cognitive battery is useful for identifying cognitive impairment in older adults.

Identifying predictors of cognitive decline in long-term care: a scoping review

BACKGROUND

Cognitive impairment can cause social, emotional, and financial burdens on individuals, caregivers, and healthcare providers. This is especially important in settings such as long-term care (LTC) homes which largely consist of vulnerable older adults. Thus, the objective of this study is to review and summarize current research examining risk factors of cognitive decline in older adults within LTC.

METHODS

This scoping review includes primary observational research studies assessing within-person change in cognition over time in LTC or equivalent settings in high resource countries. A mean participant age of ≥ 65 years was required. Searches were conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PyscInfo on June 27th, 2022 and included articles published during or after the year 2000. Title, abstract, and full-text screening was performed by two independent reviewers using Covidence. Specific predictors along with their associated relation with cognitive decline were extracted by a team of reviewers into a spreadsheet.

RESULTS

Thirty-eight studies were included in this review. The mean sample size was 14 620. Eighty-seven unique predictors were examined in relation to cognitive decline. Dementia was the most studied predictor (examined by 9 of 38 studies), and the most conclusive, with eight of those studies identifying it as a risk factor for cognitive decline. Other predictors that were identified as risk factors included arterial stiffness (identified by 2 of 2 studies), physical frailty (2 of 2 studies), sub-syndromal delirium (2 of 2 studies), and undergoing the first wave of COVID-19 lockdowns (2 of 2 studies). ADL independence was the most conclusive protective factor (3 of 4 studies), followed by social engagement (2 of 3 studies). Many remaining predictors showed no association and/or conflicting results.

CONCLUSIONS

Dementia was the most common risk factor, while ADL independence was the most common protective factor associated with cognitive decline in LTC residents. This information can be used to stratify residents by risk severity and provide better personalized care for older adults through the targeted management of cognitive decline.

Localization of a Medial Temporal Lobe-Precuneus Network for Time Orientation

OBJECTIVE

Time orientation is a fundamental cognitive process in which one's personal sense of time is matched with a universal reference. Time orientation is commonly assessed through mental status examination, yet its neural correlates remain unclear. Large lesions have been associated with deficits in time orientation, but the regional anatomy implicated in time disorientation is not well established. The current study investigates the anatomy of time disorientation and its network correlates in patients with focal brain lesions.

METHODS

Time orientation was assessed 3 months or more after lesion onset using the Benton Temporal Orientation Test (BTOT) in 550 patients with acquired, focal brain lesions, 39 of whom were impaired. Multivariate lesion-symptom mapping and lesion network mapping were used to evaluate the anatomy and networks associated with time disorientation. Performance on a variety of neuropsychological tests was compared between the time oriented and time disoriented group.

RESULTS

Lesion-symptom mapping showed that lesions of the precuneus, medial temporal lobes (MTL), and occipito-temporal cortex were associated with time disorientation (r = 0.264, p < 0.001). Lesion network mapping using normative connectome data demonstrated that these regional findings occurred along a network that includes white and gray matter connecting the precuneus and MTL. There was a strong behavioral and anatomical association of time disorientation with memory impairment, such that the 2 processes could not be fully disentangled.

INTERPRETATION

We interpret these findings as novel evidence for a network involving the precuneus and the medial temporal lobe in supporting time orientation. ANN NEUROL 2023;94:421-433.

Posttraumatic stress symptom severity predicts cognitive decline beyond the effect of Alzheimer's disease biomarkers in Veterans

Chronic stress is a risk factor for dementia but whether it explains unique variance in cognitive decline in older adults above Alzheimer's disease (AD) biomarkers is unknown. In a preclinical cohort of Vietnam Veterans, we examined the relationship between posttraumatic stress disorder (PTSD) symptom severity, AD biomarkers of beta-amyloid (Aβ) and tau, and change in cognitive performance on two widely-used screeners, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Analyses indicated that PTSD symptom severity was associated with a greater decline on the MMSE (p < 0.04) and MoCA (p < 0.024) after adjusting for biomarkers of AD, notably on the attention scale of the MoCA and the memory index of the MMSE. These analyses survived multiple comparison corrections. Taken together, PTSD symptom severity is associated with accelerated cognitive decline. Treating PTSD should be considered instrumental to maintaining cognitive function as adults age.

Cognitive impairment assessed by Mini-Mental State Examination predicts all-cause and CVD mortality in Chinese older adults: A 10-year follow-up study

Objective

Cognitive impairment (CI) has been demonstrated as a useful proxy measure of mortality in Western populations. However, the predictive value of CI in Chinese populations is unknown. We aimed to explore whether CI is independently associated with increased long-term all-cause and cardiovascular disease (CVD) mortality in Chinese older adults and the association of performance in specific MMSE sub-domains to subsequent mortality.

Methods and results

A total of 4,499 older adults [mean (SD) age, 70.3(6.7) years] who received a sample investigation from 2011 to 2014 were followed up till 2021 for mortality. The Mini-Mental State Examination was used to assess cognitive function, and Cox's proportional hazard models were used to evaluate the effects of cognitive function on the risk of all-cause and CVD mortality. Demographic characteristics, lifestyle, and health status were included as covariates. During a 10-year follow-up, a total of 667 (14.8%) died. In the fully adjusted model, compared with cognitively normal participants with CI had a 1.33-fold [HR, 1.33; (95% CI, 1.10-1.61)] greater risk of all-cause mortality and a 1.45-fold [HR, 1.45; (95% CIs, 1.11-1.92)] greater risk of CVD mortality. After a similar multivariable adjustment, a per-SD increase in MMSE scores was associated with a reduced risk of all-cause mortality [HR, 0.85; (95% CI, 0.78-0.93)] and CVD mortality [HR, 0.74; (95% CI, 0.65-0.84)]. In the unadjusted model, MMSE sub-domains (apart from immediate recall) were associated with mortality. But only orientation and calculation and attention were still independently associated with all-cause and CVD mortality in a multivariable model.

Conclusion

These findings confirmed that CI is a marker of all-cause and CVD mortality risk in Chinese older adults, independently of other commonly assessed risk factors, and some sub-domains of the MMSE may have stronger associations with mortality. Further research is needed to identify the mechanisms underlying the observed associations.

The Impact of Death Anxiety, Meaning and Coping on Posttraumatic Stress Disorder and Psychiatric Co-Morbidity Among Iraqi Civilians Exposed to a Car Bomb Attack A Latent Class Analysis

Much has been documented that the experience of a bombing is associated with posttraumatic stress disorder and psychiatric co-morbidity. Whether the co-existing relationship between death anxiety, meaning in life and coping styles would influence the aforementioned association is unknown. The present study aimed to identify latent classes of victims with different levels of death anxiety, meaning in life and coping styles, and to examine whether the severity of PTSD and co-morbid psychiatric symptoms differed between classes. One hundred and eighty-five victims who had experienced the first car bombing completed a demographic page, the Posttraumatic Stress Diagnosis Scale, General Health Questionnaire-28, Multidimensional Fear of Death Scale, Meaning in Life Questionnaire and Coping Responses Inventory. The results showed that 82% and 18% of the victims met the criteria for PTSD and no-PTSD, respectively. Four classes of victims were identified: Class 1 victims were approach copers with low levels of death anxiety and meaning. Class 2 victims were minimal copers with high levels of death anxiety and meaning. Class 3 victims were approach copers with a high level of death anxiety and meaning. Class 4 victims were avoidance copers with high levels of death anxiety. Individuals in Class 1 reported significantly lower levels of PTSD and psychiatric co-morbidity than the other three classes. Class 3 victims also reported significantly lower levels of psychiatric co-morbidity than Class 2 victims. To conclude, victims exposed to a car bombing were likely to exhibit posttraumatic stress symptoms in addition to other psychological symptoms. The severity of these symptoms tended to be lower among those who had little fear of death, did not search for meaning in life and approached their distress proactively.

Fecal microbiota transplantation can improve cognition in patients with cognitive decline and Clostridioides difficile infection

After fecal microbiota transplantation (FMT) to treat Clostridioides difficile infection (CDI), cognitive improvement is noticeable, suggesting an essential association between the gut microbiome and neural function. Although the gut microbiome has been associated with cognitive function, it remains to be elucidated whether fecal microbiota transplantation can improve cognition in patients with cognitive decline. The study included 10 patients (age range, 63-90 years; female, 80%) with dementia and severe CDI who were receiving FMT. Also, 10 patients (age range, 62-91; female, 80%) with dementia and severe CDI who were not receiving FMT. They were evaluated using cognitive function tests (Mini-Mental State Examination [MMSE] and Clinical Dementia Rating scale Sum of Boxes [CDR-SB]) at 1 month before and after FMT or antibiotics treatment (control group). The patients' fecal samples were analyzed to compare the composition of their gut microbiota before and 3 weeks after FMT or antibiotics treatment. Ten patients receiving FMT showed significantly improvements in clinical symptoms and cognitive functions compared to control group. The MMSE and CDR-SB of FMT group were improved compare to antibiotics treatment (MMSE: 16.00, median, 13.00-18.00 [IQR] vs. 10.0, median, 9.8-15.3 [IQR]); CDR-SB: 5.50, median, 4.00-8.00 [IQR]) vs. 8.0, median, 7.9-12.5, [IQR]). FMT led to changes in the recipient's gut microbiota composition, with enrichment of Proteobacteria and Bacteroidetes. Alanine, aspartate, and glutamate metabolism pathways were also significantly different after FMT. This study revealed important interactions between the gut microbiome and cognitive function. Moreover, it suggested that FMT may effectively delay cognitive decline in patients with dementia.

Analysis of the Clock-Reading Ability in Patients with Cognitive Impairment: Comparison of Analog Clocks and Digital Clocks

Background: Time disorientation is one of the main symptoms observed in patients with dementia; however, their clock-reading ability has not been fully reported. Objective: This study aimed to investigate the clock-reading ability of both digital and analog clocks in patients with dementia. We newly devised the clock-reading test (CRT) and the number-reading test (NRT) to assess cognitive factors that may affect clock-reading ability. Furthermore, the discriminating power of the CRT was calculated. Methods: 104 participants were categorized based on their Mini-Mental State Examination (MMSE) scores as follows: subjective cognitive decline ∼ mild cognitive impairment (SCD∼MCI, N = 43), early Alzheimer’s disease (AD) (N = 26), and middle-to-late AD (N = 35). Their cognitive abilities were evaluated using the clock-drawing test (CDT), CRT, and NRT. Results: Cognitive decline leads to impairment of clock-reading ability which is more pronounced in the analog clocks than digital ones. This deficit in clock-reading is attributed to a loss of semantic memory regarding clocks at all stages. Additionally, visuospatial dysfunction and reduced ability of number recognition may lead to deficit in clock-reading in the advanced stage of AD. The discriminating power of the CRT (analog) (AUC = 0.853) was high enough to detect cognitive decline. Conclusion: Digital clocks are more readable by patients with dementia. Since reading clocks is closely associated with daily life, the CRT has proved to be a useful tool. A decline of analog clock-reading may be an early detector for the onset of dementia in elderly patients.

Associations between Time Processing Ability, Daily Time Management, and Dementia Severity

This study investigated associations between time processing ability (TPA), daily time management (DTM), and dementia severity. Persons with dementia (PwDs) (n = 53) and their significant others (n = 49) participated in this cross-sectional study. Bivariate analyses were used to investigate associations between TPA and DTM and the dementia severity. Linear regression models were used to further predict the contribution of the subtests in the Mini Mental State Examination (MMSE) for TPA results. The results showed significant correlations between TPA and dementia severity, where visuospatial functions were the most highly correlated. TPA also showed a significant correlation to proxy-rated DTM. In addition, proxy-rated DTM was significantly correlated with dementia severity and PwDs' own self-ratings of their DTM. Knowledge of the association between TPA, dementia severity, and visuospatial functions can enable early detection of TPA impairments. For a comprehensive assessment of TPA and DTM, objective measures should be used in combination with self-ratings and proxy-ratings. The findings can be used in clinical research and healthcare settings to develop methods to compensate for impaired TPA and support DTM in PwDs.

Quality of life and cognitive assessment in healthy older Asian people with early and moderate chronic kidney disease: The NAHSIT 2013–2016 and validation study

Background

Taiwan has the highest prevalence of chronic kidney disease (CKD). Impaired cognition and quality of life are significant phenomena in the late stages of CKD. We sought to obtain an overview and the attributable effect of impaired glomerular filtration on multiple domains in cognition and dimensions of quality of life for community-based healthy older adults in Taiwan.

Methods

The study was derived from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013–2016, a nationwide cross-sectional study conducted to sample healthy, community-based older adults aged ≥65 years in Taiwan. Participants were categorized into four CKD groups: CKD stage 1, stage 2, stages 3a and 3b, and stages 4–5. The Mini-Mental State Examination (MMSE) and the QoL questionnaire derived from the 12-item Short Form Health Survey (SF-12) were measured. Generalized linear mixed models (GLMMs) and principal component regressions were employed for the analysis and validation, respectively.

Results

Participants with moderate CKD (stages 3a and 3b) showed deficits in global MMSE, domain orientation to time, calculation, complex commands, and role-physical and vitality in QoL questionnaires. In GLMMs, impaired eGFR per 30 mL/min/1.73 m² was associated with lower global MMSE scores (β = -0.807, standard error [SE] = 0.235, P = 0.0007), domain orientation to time (β = -0.155, SE = 0.047, P = 0.0011), calculation (β = -0.338, SE = 0.109, P = 0.0020), complex commands (β = -0.156, SE = 0.079, P = 0.0494), and role-physical (β = -2.219, SE = 0.779, P = 0.0046) dimensions of QoL.

Conclusions

Elderly Han Chinese adults with moderately impaired renal filtration could manifest cognitive deficits in orientation to time, calculation, and impaired quality of life in physical role functioning.

Correlations of frontal resting-state EEG markers with MMSE scores in patients with Alzheimer’s disease

Background

A previous study suggests that resting-state EEG biomarkers measured at prefrontal region (Fp1, and Fp2) are moderately correlated with Mini-Mental State Examination (MMSE) scores of elderly people with Alzheimer’s disease. In this study, our objective was to investigate whether resting-state EEG biomarkers recorded from frontal region are correlated with each MMSE sub-scores. 20 elderly patients diagnosed as Alzheimer’s disease entered to the study. After completion of MMSE, subjects underwent EEG for 5 min with closed eyes condition. We measured median frequency, theta/alpha power ratio, and relative powers. To examine the relationship between these features and MMSE sub-scores first, Pearson correlation coefficients were computed for each feature and MMSE sub-scores. Then, p values were computed for each correlation. Finally, a Bonferroni correction was done.

Results

Nine correlations have been found for markers recorded from F3, F7, and Fz. Alpha and beta relative powers were the markers which shows correlations. We found that MMSE overall, attention, and calculation scores are significantly correlated with beta relative powers recorded from F3, and Fz, and alpha relative power from F7. Orientation to time scores were correlated with F3, and Fz beta relative powers. The only correlation found for orientation to place was beta relative power of F3.

Conclusions

Our results indicate that there are correlations between frontal EEG markers and MMSE sub-scores of patients with Alzheimer’s disease. The results show that alpha and beta relative powers are markers correlated with MMSE scores. It seems that if we want to develop predicting models for Alzheimer’s disease, using data recorded from other frontal electrodes, especially what we have introduced should be considered.

Different MMSE domains are associated to cognitive decline and education

The Mini-Mental State Examination (MMSE) is a long-established test to screen for dementia, estimate the severity and monitor the progression of cognitive impairment. The MMSE total score is dependent upon demographic factors, particularly education, but little is known about how education influences the 6 distinct MMSE cognitive domains. The present study aims to understand how the performances in the MMSE cognitive domains reflect clinical diagnosis and educational level. The study recruited 1043 participants, comprising 388 healthy controls, 360 patients with Mild Cognitive Impairment (MCI) and 295 patients with dementia. The association of the MMSE cognitive domains scores with clinical diagnosis (healthy, MCI, dementia) and educational level (primary education, middle school, high school and university/college) was analyzed with a multivariate ordinal regression model. The scores in all MMSE domains were generally higher in healthy controls as compared to patients with MCI, and higher in these as compared to patients with dementia. The MMSE domain Constructional ability was associated to the education level, the domains Orientation, Recall and Language were associated to diagnosis, Attention and calculation was associated to both education level and diagnosis, and Registration was not associated to either education or diagnosis. In conclusion, impairment in specific MMSE domains pinpoints cognitive decline, probably indicating brain areas affected by neurodegeneration, and impairment in others reflects lower education levels and the lack of acquisition of relevant schooling abilities.

Cognitive Function Characterization Using Electronic Health Records Notes

Cognitive impairment is a defining feature of neurological disorders such as Alzheimer's disease (AD), one of the leading causes of disability and mortality in the elderly population. Assessing cognitive impairment is important for diagnostic, clinical management, and research purposes. The Folstein Mini-Mental State Examination (MMSE) is the most common screening measure of cognitive function, yet this score is not consistently available in the electronic health records. We conducted a pilot study to extract frequently used concepts characterizing cognitive function from the clinical notes of AD patients in an Aging and Dementia clinical practice. Then we developed a model to infer the severity of cognitive impairment and created a subspecialized taxonomy for concepts associated with MMSE scores. We evaluated the taxonomy and the severity prediction model and presented example use cases of this model.

Intake of Docosahexaenoic Acid-Enriched Milk Beverage Prevents Age-Related Cognitive Decline and Decreases Serum Bone Resorption Marker Levels

The pathogenic mechanism of dementia is still unknown, and the fundamental treatment remains to be established. Thus, there is growing interest in preventing dementia through diet. One of the functional ingredients attracting attention is docosahexaenoic acid. We conducted a 12-month, randomized, double-blind, placebo-controlled clinical trial in healthy elderly Japanese individuals with a Mini-Mental State Examination score of 28 or higher at baseline using a docosahexaenoic acid-enriched milk beverage containing 297 mg docosahexaenoic acid and 137 mg eicosapentaenoic acid. Consumption of a docosahexaenoic acid-enriched milk beverage increased the fatty acid levels of docosahexaenoic acid and eicosapentaenoic acid in erythrocyte membranes, which was the primary outcome of this study. Moreover, intake of this beverage prevented age-related cognitive decline and decreased serum bone resorption marker levels. Our data demonstrate that, even at a low dose, long-term daily intake of docosahexaenoic acid prevents dementia and may show beneficial effect on bone health.

Physical activity attenuates the risk for dementia associated with aging in older adults with mild cognitive impairment. Findings from a population-based cohort study

From 2016 to 2040 the number of people with dementia in the United Kingdom is expected to increase by 57%, while 70% percent of it is due to a higher life expectancy. Thus, we analyzed the overall and age-stratified effect of physical activity on risk of dementia in participants with mild cognitive impairment (MCI) of the English Longitudinal Study of Ageing (ELSA). Participants of the ELSA, aged over 50 with MCI, were followed-up nine times between 2002 and 2019. Physical activity was assessed using a self-reported, validated questionnaire and participants were classified as inactive, low, or moderate-to-high active. Medical diagnosis of dementia was self-reported or determined using the Informant Questionnaire on Cognitive Decline in the Elderly. Data from 521 participants with MCI were analyzed (56% women; mean [SD] age, 68.7 [10.6]). Over 17-year follow-up, 20.5 (95%CI: 17.3 to 24.2)% were diagnosed with dementia. The risk of incident dementia was reduced in participants engaging in low (HR: 0.34; 95%CI: 0.22 to 0.54) or moderate-to-high (HR: 0.16; 95%CI: 0.08 to 0.33) levels of physical activity. Risk of dementia in adults aged 80 or more engaging in low or moderate-to-high levels of physical activity was not different from inactive adults aged between 50 and 69 years. Results were sustained after competing risk regression model and sensitivity analyses to reduce the impact of reverse causality. Physical activity appears to minimize the risk associated with aging in older adults with MCI.

Decreased Resting-State Functional Connectivity of Periaqueductal Gray in Temporal Lobe Epilepsy Comorbid With Migraine

Objective: Patients with temporal lobe epilepsy (TLE) are at high risk for having a comorbid condition of migraine, and these two common diseases are proposed to have some shared pathophysiological mechanisms. Our recent study indicated the dysfunction of periaqueductal gray (PAG), a key pain-modulating structure, contributes to the development of pain hypersensitivity and epileptogenesis in epilepsy. This study is to investigate the functional connectivity of PAG network in epilepsy comorbid with migraine.

Methods: Thirty-two patients with TLE, including 16 epilepsy patients without migraine (EwoM) and 16 epilepsy patients with comorbid migraine (EwM), and 14 matched healthy controls (HCs) were recruited and underwent resting functional magnetic resonance imaging (fMRI) scans to measure the resting-state functional connectivity (RsFC) of PAG network. The frequency and severity of migraine attacks were assessed using the Migraine Disability Assessment Questionnaire (MIDAS) and Visual Analog Scale/Score (VAS). In animal experiments, FluoroGold (FG), a retrograde tracing agent, was injected into PPN and its fluorescence detected in vlPAG to trace the neuronal projection from vlPAG to PPN. FG traced neuron number was used to evaluate the neural transmission activity of vlPAG-PPN pathway. The data were processed and analyzed using DPARSF and SPSS17.0 software. Based on the RsFC finding, the excitatory transmission of PAG and the associated brain structure was studied via retrograde tracing in combination with immunohistochemical labeling of excitatory neurons.

Results: Compared to HCs group, the RsFC between PAG and the left pedunculopontine nucleus (PPN), between PAG and the corpus callosum (CC), was decreased both in EwoM and EwM group, while the RsFC between PAG and the right PPN was increased only in EwoM group but not in EwM group. Compared to EwoM group, the RsFC between PAG and the right PPN was decreased in EwM group. Furthermore, the RsFC between PAG and PPN was negatively correlated with the frequency and severity of migraine attacks. In animal study, a seizure stimulation induced excitatory transmission from PAG to PPN was decreased in rats with chronic epilepsy as compared to that in normal control rats.

Conclusion: The comorbidity of epilepsy and migraine is associated with the decreased RsFC between PAG and PPN.

ω-3 Ethyl ester results in better cognitive function at 12 and 30 months than control in cognitively healthy subjects with coronary artery disease: a secondary analysis of a randomized clinical trial

BACKGROUND

Omega-3 (n-3) fatty acids have shown benefit in cognitively impaired subjects, but the effect on cognitively healthy older subjects is unclear.

OBJECTIVES

Our aim was to determine if long-term, high-dose ω-3 ethyl esters, EPA (20:5n-3) and DHA (22:6n-3), prevent deterioration of cognitive function in cognitively healthy older adults.

METHODS

A total of 285 subjects with stable coronary artery disease (CAD) on statin treatment were randomly assigned to 3.36 g EPA and DHA or none (control) for 30 mo. Cognitive function was assessed in all 285 subjects at baseline and in 268 and 250 subjects who returned at 12- and 30-mo follow-up, respectively, with neuropsychological testing as a prespecified secondary outcome. A completer's analysis, along with a sensitivity analysis carrying forward the last observation, was performed.

RESULTS

Over the 30-mo period, subjects randomly assigned to EPA and DHA had significantly better scores than control for verbal fluency, language, and memory (mean: 1.08; 95% CI: 0.25, 1.91; P = 0.011) and 2 tests of visual-motor coordination (mean: -2.95; 95% CI: -5.33, -0.57; P = 0.015 and mean: -9.44; 95% CI: -18.60, -0.30; P = 0.043, respectively). The better scores for EPA and DHA were due to an improvement at 12 mo compared with baseline in verbal fluency, language, and memory (P = 0.047) and 2 tests of visual-motor coordination (P = 0.033 and P < 0.001, respectively), whereas control had no change. Post hoc analyses indicated no difference by age, sex, or diabetes status.

CONCLUSIONS

Cognitively healthy older adults with stable CAD randomly assigned to high-dose EPA and DHA had improved cognitive function over a 30-mo period compared with control. These findings may be especially important for CAD patients because CAD is a risk factor for cognitive decline.This trial was registered at clinicaltrials.gov as NCT01624727.

Usefulness of CogEvo, a computerized cognitive assessment and training tool, for distinguishing patients with mild Alzheimer's disease and mild cognitive impairment from cognitively normal older people

Aim

This study aimed to assess whether CogEvo, a computerized cognitive assessment and training tool, could distinguish patients with mild Alzheimer's disease and mild cognitive impairment from cognitively normal older people.

Methods

This cross‐sectional study enrolled 166 participants with Alzheimer's disease, mild cognitive impairment and cognitively normal older people. In CogEvo, five types of cognitive tasks were carried out, and the z‐scores were used as a composite score. Logistic regression and receiver operating characteristics analyses were then carried out to evaluate the usefulness of CogEvo in distinguishing between the three groups.

Results

CogEvo and Mini‐Mental State Examination scores showed excellent correlation, and could significantly differentiate between the Alzheimer's disease, mild cognitive impairment and cognitively normal older people groups (Mini‐Mental State Examination 20.4 ± 3.5, 25.5 ± 1.6 and 27.6 ± 2.0, respectively; CogEvo: −1.9 ± 0.9, −0.8 ± 0.8 and 0.0 ± 1.0, respectively; both P < 0.001 by analysis of variance). Logistic regression analysis adjusted for age, sex and years of education significantly differentiated the mild cognitive dysfunction group (mild cognitive impairment plus mild Alzheimer's disease; n = 78) from the cognitively normal group (n = 88) (P < 0.001), whereas receiver operating characteristics analysis showed moderate accuracy (area under the receiver operating characteristic curve 0.830).

Conclusions

These results suggest that CogEvo, a computerized cognitive assessment tool, is useful for evaluating early‐stage cognitive impairment. Further studies are required to assess its effectiveness as a combination assessment and training tool. Geriatr Gerontol Int 2021; 21: 192–196.

Cognitive Impairment and Dementia in Primary Care: Current Knowledge and Future Directions Based on Findings From a Large Cross-Sectional Study in Crete, Greece

Introduction: Dementia severely affects the quality of life of patients and their caregivers; however, it is often not adequately addressed in the context of a primary care consultation, especially in patients with multi-morbidity. Study Population and Methods: A cross-sectional study was conducted between March-2013 and December-2014 among 3,140 consecutive patients aged >60 years visiting 14 primary health care practices in Crete, Greece. The Mini-Mental-State-Examination [MMSE] was used to measure cognitive status using the conventional 24-point cut-off. Participants who scored low on MMSE were matched with a group of elders scoring >24 points, according to age and education; both groups underwent comprehensive neuropsychiatric and neuropsychological assessment. For the diagnosis of dementia and Mild-Cognitive-Impairment (MCI), the Diagnostic and Statistical Manual-of-Mental-Disorders (DSM-IV) criteria and the International-Working-Group (IWG) criteria were used. Chronic conditions were categorized according to ICD-10 categories. Logistic regression was used to provide associations between chronic illnesses and cognitive impairment according to MMSE scores. Generalized Linear Model Lasso Regularization was used for feature selection in MMSE items. A two-layer artificial neural network model was used to classify participants as impaired (dementia/MCI) vs. non-impaired. Results: In the total sample of 3,140 participants (42.1% men; mean age 73.7 SD = 7.8 years), low MMSE scores were identified in 645 (20.5%) participants. Among participants with low MMSE scores 344 (54.1%) underwent comprehensive neuropsychiatric evaluation and 185 (53.8%) were diagnosed with Mild-Cognitive-Impairment (MCI) and 118 (34.3%) with dementia. Mental and behavioral disorders (F00-F99) and diseases of the nervous system (G00-G99) increased the odds of low MMSE scores in both genders. Generalized linear model lasso regularization indicated that 7/30 MMSE questions contributed the most to the classification of patients as impaired (dementia/MCI) vs. non-impaired with a combined accuracy of 82.0%. These MMSE items were questions 5, 13, 19, 20, 22, 23, and 26 of the Greek version of MMSE assessing orientation in time, repetition, calculation, registration, and visuo-constructive ability. Conclusions: Our study identified certain chronic illness-complexes that were associated with low MMSE scores within the context of primary care consultation. Also, our analysis indicated that seven MMSE items provide strong evidence for the presence of dementia or MCI.

Predicting Cognitive Decline in Parkinson's Disease with Mild Cognitive Impairment: A One-Year Observational Study

We conducted an observational study to investigate clinical predictors of cognitive decline in patients with mild cognitive impairment (MCI), with a focus on patients with Parkinson's disease (PD) and Alzheimer's disease (AD). The study was performed with detailed neuropsychological testing, a portable device for gait analysis, and a comprehensive geriatric assessment for patients with MCI. Cognitive decline was defined as subjective cognitive impairment with an objective decline in the Mini-Mental State Examination (MMSE) ≥2 points at the one-year follow-up. Participants (n = 74) had a median age of 70 (interquartile range 60–79) years, and 45.9% of them were women. At the end of the study, 17.6% of the patients with MCI had a cognitive decline. Although no differences were observed between groups at the baseline cognitive study, patients with PD-MCI demonstrated more cognitive decline than patients with AD-MCI (28.6% vs. 7.7% p = 0.03). Patients with PD-MCI had more physical disabilities, including scores of instrumental activities of daily living (IADL), Tinetti balance, and gait scores, and some Timed Up and Go components. Initial Clinical Dementia Rating—Sum of Boxes score was a better predictor of future cognitive decline than MMSE in PD-MCI. For predicting the occurrence of cognitive decline in PD-MCI, the prediction accuracy increased from the reduced model (AUC = 0.822, p < 0.001) to the full model (a total of five independent variables, AUC = 0.974, p < 0.001). Given the potentially modifiable predictor, our findings also highlight the importance of identifying sleep quality and the ability to perform IADL.

Association between cognitive declines and disability in activities of daily living in older adults with COPD: evidence from the China health and retirement longitudinal study

OBJECTIVES

This study aimed to investigate the relationship between disability and domain-specific cognitive function in older adults with chronic obstructive pulmonary disease (COPD).

DESIGN

Cross-sectional analyses combined with retrospective longitudinal analyses.

SETTING

We included 450 communities in China.

PARTICIPANTS

In this study, 1022 (mean age: 68.6±6.3; 612 males) and 152 (mean age: 67.0±5.2; 83 males) older adults with COPD from the China Health and Retirement Longitudinal Study were included in a cross-sectional multivariate linear regression analysis and a longitudinal logistic regression analysis, respectively.

OUTCOME MEASURES

Disability was determined by the difficulty or inability to complete 1 of the 12 activity items in basic activities of daily living (ADL) and instrumental ADL. The cognitive dimensions of episodic memory, attention/numerical ability, orientation to time, and visuospatial ability were assessed via the immediate/delayed recall task, serial sevens task, naming the current date and pentagon-figure-drawing tasks, respectively.

RESULTS

Of 1022 older respondents with COPD at wave-4, 48.5% had ADL disability. Declines in the global cognitive function (β (95% CI)=-0.627 (-1.214 to -0.040)), orientation to time (β (95% CI)=-0.207 (-0.364 to -0.050)) and visuospatial ability (β (95% CI)=-0.068 (-0.127 to -0.009)) were significantly associated with the presence of ADL disability, when demographic and health-related variables were adjusted. Of 152 older participants with COPD and without ADL disability in wave-2, 61 (40.1 %) developed disability over a 2-year follow-up. Relative to the participants without a decline in orientation to tine, those with the condition had greater odds of incidence of ADL disability increased by a factor of about 1.46 over a 2-year follow-up.

CONCLUSIONS

In older adults with COPD, orientation to time and visuospatial inability are vulnerable to the presence of a disability. Prevention of a decline in orientation to time might help prevent disability in older people with COPD.

Network analysis of the structure and change in the mini-mental state examination: a nationally representative sample

PURPOSE

The structure of the mini-mental state examination (MMSE) is inconsistent across factor analytic studies, and yet to be examined based on network analysis. The current study aims to identify the (I) cross-sectional network structure and (II) longitudinal network changes of the MMSE.

METHODS

The MMSE was administered to a nationally representative sample of older adults (age 50 and over) in Ireland twice over 4 years (2012-2013: N = 7207; 2016: N = 5715). Psychometric network analysis was computed at each time point to identify structure, strength and magnitude of the network associations. Item clustering was examined, and modularity scores were computed to measure the overall strength of clustering. Centrality indices were used to identify the main aspects of the MMSE. Longitudinal differences between the networks were examined.

RESULTS

Cross-sectionally, the MMSE network structure clustered into a single community (modularity score = 0) with orientation items identified as most central. Longitudinally, the MMSE was time invariant regarding structure, centrality and magnitude of the positive associations between the items. The average magnitude of the negative associations increased over time[(t(65.15) = 3.78, p < 0.001; time 1: M = - 0.59, SD = 0.58 time 2: M = - 1.65, SD = 1.97] as did their percentage.

CONCLUSION

Network analysis of the MMSE showed that the measure consisted of a single entity of cognitive functioning irrespective of time. Orientation items were repeatedly identified as most central. Longitudinal changes of the network were evident in increased negative associations between selected cognitive components after 4 years of follow-up. These changes may be explained by neuro-cognitive compensation processes.

Dementia medical screening using mobile applications: A systematic review with a new mapping model

Early detection is the key to successfully tackling dementia, a neurocognitive condition common among the elderly. Therefore, screening using technological platforms such as mobile applications (apps) may provide an important opportunity to speed up the diagnosis process and improve accessibility. Due to the lack of research into dementia diagnosis and screening tools based on mobile apps, this systematic review aims to identify the available mobile-based dementia and mild cognitive impairment (MCI) apps using specific inclusion and exclusion criteria. More importantly, we critically analyse these tools in terms of their comprehensiveness, validity, performance, and the use of artificial intelligence (AI) techniques. The research findings suggest diagnosticians in a clinical setting use dementia screening apps such as ALZ and CognitiveExams since they cover most of the domains for the diagnosis of neurocognitive disorders. Further, apps such as Cognity and ACE-Mobile have great potential as they use machine learning (ML) and AI techniques, thus improving the accuracy of the outcome and the efficiency of the screening process. Lastly, there was overlapping among the dementia screening apps in terms of activities and questions they contain therefore mapping these apps to the designated cognitive domains is a challenging task, which has been done in this research.

Relationship between radiological severity and physical and mental health in elderly individuals with knee osteoarthritis

Background

This study aimed to investigate the relationship between radiological severity, as assessed by the individual grades and grouped grades (grades “0 and 1” and “2 to 4”) of the Kellgren-Lawrence scale (K&Ls), and depression symptoms, cognitive loss, risk of falls, and quality of life in relation to knee osteoarthritis, as assessed by other instruments.

Methods

Data recorded between 2013 and 2014 in Amparo (São Paulo, Brazil) were retrieved for analysis. A total of 181 elderly patients who had knee osteoarthritis and underwent a radiologic exam were evaluated for depressive symptoms, cognitive loss, quality of life, and risk of falls by the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), timed up and go test (TUG), and Berg balance scale (BBS). For statistical analyses, Fisher’s exact test, Mann-Whitney test, Kruskal-Wallis test, and Spearman’s coefficient analysis were used.

Results

There was no significant relationship between the scores of the instruments investigated and the individual K&Ls grades. However, when the K&Ls scores were assessed by groups, grades “2 to 4” were associated with the worst WOMAC score and the highest frequency and risk of falls according to the BBS but not according to TUG. For the GDS and MMSE, no significant relationships with the K&Ls grades were found. In addition, the K&Ls grade was correlated with the WOMAC score, regardless of the domain.

Conclusion

The radiological scores of the Kellgren-Lawrence (K&L) scale were associated with poorer WOMAC and BBS scores only when the K&Ls scores were evaluated in groups, and the WOMAC score was associated with an increase in the radiological grade.

MMSE Subscale Scores as Useful Predictors of AD Conversion in Mild Cognitive Impairment

PURPOSE

This study was performed to examine the usefulness of subscores on the Mini-Mental State Examination (MMSE) for predicting the progression of Alzheimer's disease (AD) dementia in individuals with mild cognitive impairment (MCI).

PATIENTS AND METHODS

A total of 306 MCI individuals in the Alzheimer's Disease Neuroimaging Initiative database were included in the study. Standardized clinical and neuropsychological tests were performed at baseline and at 2-year follow-up. Logistic regression analysis was conducted to examine the MMSE total and subscale scores to predict progression to AD dementia in MCI individuals.

RESULTS

The MMSE total score and the MMSE memory, orientation, and construction subscores were inversely associated with AD progression after controlling for all potential confounders; MMSE attention and language subscores were not correlated with AD progression. The MMSE delayed recall score among the MMSE memory subscores and the MMSE time score among the orientation subscores, especially week and day, were inversely associated with AD progression; the MMSE immediate recall and place scores were not correlated with progression.

CONCLUSION

Our findings suggest that the MMSE memory, orientation, and construction subscores, which are simple and readily available clinical measures, could provide useful information to predict AD dementia progression in MCI individuals in practical clinical settings.

Brief Assessment of Impaired Cognition Questionnaire (BASIC-Q)-Development and validation of a new tool for identification of cognitive impairment in community settings

OBJECTIVES

Brief Assessment of Impaired Cognition (BASIC), which combines self- and informant report with cognitive testing, was previously found to be highly accurate in identification of dementia and cognitive impairment. The aim of the present study was to develop and validate a questionnaire version of BASIC, the BASIC-Q, for use in community settings.

METHODS

In order to construct a questionnaire version of BASIC, we substituted cognitive testing with questions regarding orientation. BASIC-Q was validated based on further analysis of data from the primary BASIC validation study, where patients consecutively referred from general practice were tested at their first memory clinic admission prior to diagnosis. Control participants were primarily recruited among participating patients' relatives. Expert clinical diagnosis was subsequently used as reference standard for estimation of classification accuracy.

RESULTS

A high discriminative validity (sensitivity 0.92, specificity 0.97) for cognitive impairment (n = 159) vs socio-demographically matched control participants (n = 109) was found. In comparison, the MMSE had 0.76 sensitivity and 0.81 specificity. Administration time for BASIC-Q was less than 5 minutes compared to approximately 10 minutes for the MMSE.

CONCLUSIONS

BASIC-Q is a brief, efficient and valid tool for identification of cognitive impairment in a clinical setting. Further validation in a community setting is needed.

Effect of the Casein-Derived Peptide Met-Lys-Pro on Cognitive Function in Community-Dwelling Adults Without Dementia: A Randomized, Double-Blind, Placebo-Controlled Trial

Background

Preventative measures have recently been taken to reduce the incidence of Alzheimer’s disease worldwide. We previously showed that Met-Lys-Pro (MKP), a casein-derived angiotensin-converting enzyme inhibitory peptide with the potential to cross the blood–brain barrier, attenuated cognitive decline in a mouse model of Alzheimer’s disease. However, the effect of MKP on cognitive function improvement in humans remains unknown. This exploratory study sought to investigate whether MKP intake could improve cognitive function in adults without dementia.

Methods

A total of 268 community-dwelling adults without dementia participated in this 24-week randomized controlled trial. Participants were randomly allocated to the MKP (n = 134) or placebo (n = 134) group. The MKP group received four tablets daily, each containing 50 μg MKP, while the placebo group received four dextrin tablets containing no detectable MKP for 24 weeks. Scores on the Japanese version of the cognitive subscale of the Alzheimer’s Disease Assessment Scale (ADAS-cog) were used as the primary outcome to compare cognitive function between the MKP and placebo groups. The study products were also evaluated for safety.

Results

The intention-to-treat analysis showed that there was no significant difference between the groups in terms of the ADAS-cog total score. Orientation, as measured by the respective ADAS-cog subscale, was significantly improved compared to placebo at 24 weeks post-MKP administration (P = 0.022). No serious adverse events due to MKP intake were observed.

Conclusion

To the best of our knowledge, this is the first study to report the effects of MKP on human cognition. These preliminary results suggested the safety of daily MKP intake and its potential to improve orientation in adults without dementia. Further clinical studies are needed to confirm the present findings and the benefits of MKP on cognitive function.

Characteristics of decline in cognition and locomotion among the elderly in seven provinces of China

BACKGROUND

Decline in cognition and in locomotion is associated with aging. However, the relationship between them and the current occurrence of them in Chinese elderly people was weak.

METHODS

To investigate the details of these two functions in Chinese elderly people and to try to find some early recognition and intervention clues, data of MMSE test and usual gait speed from 4487 elderly people from seven provinces in China were analysed.

RESULTS

The prevalence of mild cognitive impairment (MCI) and dementia in persons aged 60 and over was 17.83% and 4.08%, respectively. Among 11 items of MMSE, calculation, three-word recall, drawing two pentagons, and temporal orientation were the most commonly impaired items in persons with MCI or dementia. The gait speed of old persons with dementia was significantly slower than that of persons with MCI or NCI. Meanwhile, old persons with gait speed >1.39 m/s fast gait speed also had high MMSE scores and no dementia was detected by MMSE.

CONCLUSION

The prevalence of dementia observed in this population was similar to that reported 20 years ago. Loss of temporal orientation and drawing two pentagons may supply more information for early recognition of cognitive impairment. Maintaining locomotion in a proper way may help old persons to prevent cognitive function decline.

Effectiveness of using assistive technology for time orientation and memory, in older adults with or without dementia

AIMS

The purposes of this study were to reveal the effectiveness of an electric calendar, showing the date and schedule automatically for older people, and to prove the characteristics of appropriate users.

MATERIAL AND METHODS

The participants were 27 older adults with or without dementia (9 men and 18 women, mean age: 81.5 ± 6.9 years, range: 72-94 years). The study design was a cross-over randomized controlled trial, with 15 participants (55.6%) allocated to the first group to use the electric calendar, and 12 participants (44.4%) to the second intervention group. The outcome measures are daily behaviors and cognitive function assessed by the Mini-Mental State Examination and Neurobehavioral Cognitive Status Examination.

RESULTS

Participants showed significant increase in total Mini-Mental State Examination score (p = 0.020, a paired t-test) after intervention period, whereas there was no significant difference after no intervention. Daily activities related healthcare were improved. The participants with positive outcomes showed higher motivations, and around 18 points in Mini-Mental State Examination. Most healthy older adults mentioned that electric calendars were useful, but unnecessary.

CONCLUSION AND SIGNIFICANCE

Using the electric calendar was effective in improving global cognitive function and daily activities. The target users are older people, who (1) might have mild dementia, (2) have difficulties in daily activities, (3) can be supported by caregivers, and (4) have positive motivation to new technologies.IMPLICATIONS FOR REHABILITATIONAn electric calendar is effective on grovel cognitive function, and activities of daily living related to healthcare in older adults, as well as reality orientation therapy.The electric calendar can be useful for older people with mild dementia or mild cognitive impairment, having difficulties activities of daily living, supported by caregivers at regular intervals.

Vascular risk factors are associated with longitudinal changes in cerebrospinal fluid tau markers and cognition in preclinical Alzheimer's disease

INTRODUCTION

Vascular factors increase the risk of Alzheimer's disease (AD). We investigated the associations between such factors, longitudinal AD cerebrospinal fluid biomarkers, and cognition.

METHODS

433 cognitively normal participants were classified into four biomarker groups using their baseline amyloid (A+/-) and tau status (T+/-). 184 participants had undergone serial cerebrospinal fluid collection. Frequencies of risk factors and the Framingham Risk Score (FRS) were compared, and we tested the influence of risk factors on change in biomarker concentrations and cognition.

RESULTS

The absence of obesity, presence of hypertension, and a high FRS were associated with an increase in tau levels, particularly in A+T+ individuals. Risk factors were not associated with amyloid. Depression was associated with higher cognitive scores, whereas high FRS was associated with lower scores and a faster decline.

DISCUSSION

Our results demonstrate that vascular risk factors may enhance neurodegeneration but not amyloid accumulation in preclinical AD.

Hydroxy-α-sanshool isolated from Zanthoxylum bungeanum attenuates learning and memory impairments in scopolamine-treated mice

Learning and memory impairments are common symptoms of dementia in neurodegenerative disorders.

Decreased Gray Matter Volume of Right Inferior Parietal Lobule Is Associated With Severity of Mental Disorientation in Patients With Mild Cognitive Impairment

Background: Mental disorientation in time, space, and with respect to people is common in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Recently, a high-resolution functional MRI (fMRI) study revealed that the inferior parietal lobule (IPL) and precuneus are important regions related to mental orientation in healthy individuals. We hypothesized that the IPL and/or precuneus are crucial regions for mental disorientation in patients with amnestic MCI (aMCI). Therefore, our aim was to assess our hypothesis in these patients using voxel-based morphometry (VBM).

Methods: Fifteen patients with aMCI participated. The Neurobehavioral Cognitive Status Examination (COGNISTAT) as well as the Mini-Mental State Examination (MMSE) were used to evaluate mental disorientation. Subsequently, we used VBM analysis to identify brain regions that exhibited gray matter (GM) volume loss associated with mental disorientation. Based on our hypothesis, four brain regions (bilateral IPLs and precuneus) were selected as regions of interest (ROIs).

Results: We found a significant decreased GM volume in the right IPL, which was correlated with lower orientation scores on the COGNISTAT. In contrast, GM volume in other ROIs did not show a significant positive correlation with mental disorientation. Regarding the MMSE, no significant reduction in GM associated with decline in orientation were observed in any ROI.

Conclusion: We found the significant relationship between low GM volume in the right IPL and severity of mental disorientation. Therefore, the right IPL is responsible for mental disorientation in aMCI.

Accessing knowledge of the 'here and now': a new technique for capturing electromagnetic markers of orientation processing

OBJECTIVE

The ability to orient with respect to the current context (e.g. current time or location) is crucial for daily functioning, and is used to measure overall cognitive health across many frontline clinical assessments. However, these tests are often hampered by their reliance on verbal probes (e.g. 'What city are we in?') in evaluating orientation. Objective, physiology-based measures of orientation processing are needed, but no such measures are currently in existence. We report the initial development of potential brainwave-based markers of orientation processing as characterized using electroencephlography (EEG) and magnetoencephalography (MEG).

APPROACH

An auditory stimulus sequence embedded with words corresponding to orientation-relevant (i.e. related to the 'here and now') and orientation-irrelevant (i.e. unrelated to the current context) conditions was used to elicit orientation processing responses. EEG/MEG data, in concert with clinical assessments, were collected from 29 healthy adults. Analysis at sensor and source levels identified and characterized neural signals related to orientation processing.

MAIN RESULTS

Orientation-irrelevant stimuli elicited increased negative amplitude in EEG-derived event-related potential (ERP) waveforms during the 390-570 ms window (p  <  0.05), with cortical activations across the left frontal, temporal, and parietal regions. These effects are consistent with the well-known N400 response to semantic incongruence. In contrast, ERP responses to orientation-relevant stimuli exhibited increased positive amplitude during the same interval (p  <  0.05), with activations across the bilateral temporal and parietal regions. Importantly, these differential responses were robust at the individual level, with machine-learning classification showing high accuracy (89%), sensitivity (0.88) and specificity (0.90).

SIGNIFICANCE

This is the first demonstration of a neurotechnology platform that elicits, captures, and evaluates electrophysiological markers of orientation processing. We demonstrate neural responses to orientation stimuli that are validated across EEG and MEG modalities and robust at the individual level. The extraction of physiology-based markers through this technique may enable improved objective brain functional evaluation in clinical applications.

One Size Does Not Fit All: Comparative Diagnostic Accuracy of the Rowland Universal Dementia Assessment Scale and the Mini Mental State Examination in a Memory Clinic Population with Very Low Education

Background

Diagnosing dementia in elderly immigrants is often difficult due to language and cultural barriers, low education, and illiteracy. We compared the diagnostic accuracy of the Rowland Universal Dementia Assessment Scale (RUDAS) to that of the Mini Mental State Examination (MMSE).

Methods

A total of 144 patients (42 with intact cognition, 44 with mild cognitive impairment [MCI], and 58 with dementia) were administered both instruments and were diagnosed by specialists blinded for MMSE and RUDAS results.

Results

Areas under the curve for discriminating intact cognition from MCI and dementia were comparable for RUDAS (0.81; 95% confidence interval 0.74–0.88) and MMSE (0.75; 95% confidence interval 0.69–0.85). Education and literacy were not correlated with the RUDAS but had a medium-large correlation with the MMSE (rho = 0.39).

Conclusions

The study provides additional evidence for the usefulness of the RUDAS in a highly illiterate, culturally diverse geriatric outpatient population.

Relationship between areas of cognitive functioning on the Mini-Mental State Examination and crash risk

Previous studies have suggested that the pattern of cognitive impairment in crash-involved older drivers is different from non-crash-involved older drivers. This study assessed the relationship between seven areas of cognitive functioning (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction) on the Mini-Mental State Examination (MMSE) collected at baseline and rates of future crash involvement in a prospective population-based sample of older drivers. Motor vehicle collision (MVC) involvement was obtained from the Alabama Department of Public Safety. Poisson regression was used to calculate crude and adjusted rate ratios (RR). Older drivers having difficulties in place orientation were more than 6 times (95% CI 1.90–19.86) more likely to be involved in a future crash (adjusted RR = 6.14, 95% confidence interval (CI) 1.90–19.86) and at-fault crash (adjusted RR = 6.39, 95% CI 1.51–27.10). Impairment in the other cognitive areas was not associated with higher rates of crash or at-fault crash involvement. The findings were validated in an independent sample of high-risk older drivers and a similar pattern of results was observed. Spatial orientation impairment can help identify older drivers who are more likely to crash in the future.

Time Orientation and 10 Years Risk of Dementia in Elderly Adults: The Three-City Study

Time disorientation is commonly observed in dementia, however very little is known about the pathological significance of minor time errors in community-dwelling population. Our objective was to investigate the relationship between time orientation and risk of dementia in a population of older adults. Analyses relies on 8611 dementia-free subjects from the Three-City Study, France. Participants were followed up for 10 years for incident dementia. Time orientation was assessed by asking for the date, the day of the week, the month, the season and the year. At baseline, 905 subjects made at least one error in time orientation. During 57,073 person-years of follow-up, 827 participants developed dementia. After controlling for age, gender and education level, subjects with one error in time had a greater risk of dementia (hazard ratio [HR] 1.44 [1.18-1.77]), while those with at least 2 errors had a more than three-fold increased risk (HR 3.10 [1.98-4.83]). This association was particularly marked for the diagnosis of probable Alzheimer's disease. Time disorientation was associated with an increased risk of dementia in a large population of cognitively normal older people followed during up to 10 years and should not be underestimated in clinical setting.

Lower Performance in Orientation to Time and Place Associates with Greater Risk of Cardiovascular Events and Mortality in the Oldest Old: Leiden 85-Plus Study

Background: Impairment in orientation to time and place is commonly observed in community-dwelling older individuals. Nevertheless, the clinical significance of this has been not fully explored. In this study, we investigated the link between performance in orientation domains and future risk of cardiovascular events and mortality in a non-hospital setting of the oldest old adults. Methods: We included 528 subjects free of myocardial infarction (Group A), 477 individuals free of stroke/transient ischemic attack (Group B), and 432 subjects free of both myocardial infarction and stroke/transient ischemic attack (Group C) at baseline from the population-based Leiden 85-plus cohort study. Participants were asked to answer five questions related to orientation to time and five questions related to orientation to place. 5-year risks of first-time fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, as well as cardiovascular and non-cardiovascular mortality, were estimated using the multivariate Cox regression analysis. Results: In the multivariable analyses, adjusted for sociodemographic characteristics and cardiovascular risk factors, each point lower performance in "orientation to time" was significantly associated with higher risk of first-time myocardial infarction (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.09-1.67, P = 0.007), first-time stroke (HR 1.35, 95% CI 1.12-1.64, P = 0.002), cardiovascular mortality (HR 1.28, 95% CI 1.06-1.54, P = 0.009) and non-cardiovascular mortality (HR 1.37, 95% CI 1.20-1.56, P < 0.001). Similarly, each point lower performance in "orientation to place" was significantly associated with higher risk of first-time myocardial infarction (HR 1.67, 95% CI 1.25-2.22, P = 0.001), first-time stroke (HR 1.39, 95% CI 1.05-1.82, P = 0.016), cardiovascular mortality (HR 1.35, 95% CI 1.00-1.82, P = 0.054) and non-cardiovascular mortality (HR 1.45, 95% CI 1.20-1.77, P < 0.001). Conclusions: Lower performance in orientation to time and place in advanced age is independently related to higher risk of myocardial infarction, stroke and mortality. Impaired orientation might be an early sign of covert vascular injuries, putting subjects at greater risk of cardiovascular events and mortality.

Delayed Recall and Working Memory MMSE Domains Predict Delirium following Cardiac Surgery

BACKGROUND

Reduced preoperative cognition is a risk factor for postoperative delirium. The significance for type of preoperative cognitive deficit, however, has yet to be explored and could provide important insights into mechanisms and prediction of delirium.

OBJECTIVE

Our goal was to determine if certain cognitive domains from the general cognitive screener, the Mini-Mental State Exam (MMSE), predict delirium after cardiac surgery.

METHODS

Patients completed a preoperative MMSE prior to undergoing elective cardiac surgery. Following surgery, delirium was assessed throughout ICU stay using the Confusion Assessment Method for ICU delirium and the Richmond Agitation and Sedation Scale.

RESULTS

Cardiac surgery patients who developed delirium (n = 137) had lower total MMSE scores than patients who did not develop delirium (n = 457). In particular, orientation to place, working memory, delayed recall, and language domain scores were lower. Of these, only the working memory and delayed recall domains predicted delirium in a regression model adjusting for history of chronic obstructive pulmonary disease, age, sex, and duration of cardiopulmonary bypass. For each word not recalled on the three-word delayed recall assessment, the odds of delirium increased by 50%. For each item missed on the working memory index, the odds of delirium increased by 36%. Of the patients who developed delirium, 47% had a primary impairment in memory, 21% in working memory, and 33% in both domains. The area under the receiver operating characteristics curve using only the working memory and delayed recall domains was 0.75, compared to 0.76 for total MMSE score.

CONCLUSION

Delirium risk is greater for individuals with reduced MMSE scores on the delayed recall and working memory domains. Research should address why patients with memory and executive vulnerabilities are more prone to postoperative delirium than those with other cognitive limitations.

Cognitive Changes with Omega-3 Polyunsaturated Fatty Acids in Non-Demented Older Adults with Low Omega-3 Index

OBJECTIVES

To investigate the changes in specific domains of cognitive function in older adults reporting subjective memory complaints with a low omega-3 index receiving omega 3 polyunsaturated fatty acid (n-3 PUFA) supplementation or placebo.

DESIGN

This is a secondary exploratory analysis of the Multidomain Alzheimer Preventive Trial (MAPT) using subjects randomized to the n-3 PUFA supplementation or placebo group.

SETTING

French community dwellers aged 70 or over reporting subjective memory complaints, but free from clinical dementia.

PARTICIPANTS

A subgroup of MAPT subjects in the lowest quartile of omega-3 index distribution with baseline values ≤ 4.83 % (n = 183).

INTERVENTION

The n-3 PUFA supplementation group consumed a daily dose of DHA (800 mg) and EPA (a maximum amount of 225 mg) for 3 years. The placebo group received identical capsules comprising liquid paraffin oil.

MEASUREMENTS

Linear mixed-model repeated-measures analyses were used including baseline, 6, 12, 24 and 36-month follow-up data to assess between-group differences in the change in eight cognitive tests over 36 months.

RESULTS

There was less decline on the Controlled Oral Word Association Test (COWAT) in the n-3 PUFA supplementation group compared to placebo (p = 0.009; between group mean difference over 36 months, 2.3; 95% CI, 0.6,4.0). No significant differences for any of the other cognitive tests were found, including other tests of executive functioning, although, numerically all results were in favour of the n-3 PUFA supplementation.

CONCLUSIONS

We found some evidence that n-3 PUFAs might be beneficial for the maintenance of executive functioning in older adults at risk of dementia with low omega-3 index, but this exploratory finding requires further confirmation. A larger specifically designed randomised controlled trial could be merited.

The Relationship Between Cognitive Impairment and Global DNA Methylation Decrease Among Aluminum Potroom Workers

OBJECTIVE

To investigate the relationship between cognitive impairment and global DNA methylation in aluminum (Al) potroom workers.

METHODS

A total of 366 Al-exposed workers were investigated, and their cognitive functions were assessed with the Mini-Mental State Examination (MMSE). Aluminum in serum was quantified using graphite furnace atomic absorption spectrometry. Global DNA methylation was analyzed in whole blood using an enzyme-linked immunosorbent assay-like reaction.

RESULTS

Mini-Mental State Examination scores and global DNA methylation decreased with the increase of serum Al concentration. Forty-three mild cognitive impairment (MCI) people were diagnosed. Global DNA methylation of the MCI was lower than the non-MCI. Multiple logistic analysis showed that the Al-exposed workers had lower global DNA methylation and higher serum Al concentration and were at the higher risk of MCI.

CONCLUSIONS

Long-term exposure to Al may cause MCI. Mild cognitive impairment was significantly associated with global DNA methylation in blood.

Place orientation and visual construction subdomains of the Mini Mental State Examination test as predictors of rehabilitation outcome of post-acute hip-fractured patients

PURPOSE

The study aimed at assessing the relationship between various Mini Mental State Examination (MMSE) subdomains and rehabilitation achievements in post-acute hip-fractured patients.

METHOD

Six hundred and five hip-fractured patients admitted during 2010-2013 to a post-acute geriatric rehabilitation center were included in the study. Main outcome measures were the Functional Independence Measure (FIM) instrument, the motor FIM (mFIM), the Montebello Rehabilitation Factor Score (MRFS) on the mFIM and length of stay (LOS). A logistic regression analysis tested the predictive value of MMSE subdomains for achieving a satisfactory functional gain (mFIM MRFS >30%) on operated patients admitted from community.

RESULTS

Of all the six MMSE subdomains, place orientation and visual construction demonstrated significant predictive values for rehabilitation outcome. Patients who did not err on place orientation and visual construction MMSE domains had better probabilities [(OR 1.28, 95%CI, 1.05-1.58; p = 0.017); (OR 2.15, 95%CI, 1.28-3.59; p = 0.004), respectively] of achieving better rehabilitation achievements. Similar results were obtained for cognitively impaired patient groups [(OR 1.40 95%CI, 1.11-1.77; p = 0.005); (OR 2.47, 95%CI, 1.15-5.30; p = 0.021), respectively]. For the cognitively intact patient group, the variables with significant predictive value were time orientation and visual construction MMSE subdomains [(OR 2.26, 95%CI, 1.18-4.33; p = 0.014); (OR 2.87, 95%CI, 1.16-7.09; p = 0.022), respectively].

CONCLUSIONS

Post-acute hip-fractured patients scoring normally on place orientation and visual construction MMSE subdomains have a better chance of achieving favorable rehabilitation outcome. Implications for Rehabilitation Post-acute hip-fractured patients have a better chance to achieve a favorable rehabilitation outcome when scoring normally on place orientation and visual construction MMSE subdomains. Patients having difficulties in orientation and visual construction may need more rehabilitation time as they lack planning and organizational capacity to follow instructions. Assessing MMSE subdomains may reveal subtle cognitive impairment in patients scored within the normal range on the MMSE test. Identifying subtle cognitive impairment may assist in coordinating the patients and their caregivers' expectations, efficiently allocating resources and help in advanced care planning.

Cognitive and Language Function in Aphasic Patients Assessed With the Korean Version of Mini-Mental Status Examination

Objective

To assess the clinical usefulness of the relatively short instrument, the Korean version of the Mini-Mental State Examination (MMSE-K), for testing the association between cognition and language function in subacute post-stroke aphasia patients.

Methods

Medical charts of 111 post-stroke patients (65 men; age 69.6±10.0 years; 124.6±80.6 days post-onset) were reviewed retrospectively. All patients were assessed longitudinally for aphasia using the validated Korean version of the Western Aphasia Battery (K-WAB) and for cognition using the MMSE-K. Patients were categorized and analyzed according to 3 aphasia-severity clusters.

Results

All subscales of the K-WAB showed significant improvement in follow-up assessments in all groups (p<0.05 or p<0.01). Only the scores of orientation, language function, and total score of MMSE-K showed significant improvement in all groups (p<0.01). The more severely impaired group showed stronger Pearson correlation coefficients between cognition and language function. Additionally, comparisons between correlation coefficients showed that the association of improvement in orientation with that of fluency and AQ% (aphasia quotient %) was significant in the more severely impaired group.

Conclusion

Among subacute post-stroke aphasic patients, patients with more severe aphasia showed greater impairments to cognitive function; in addition, recovery of orientation may be related to recovery of language function.

Neural and behavioral substrates of disorientation in mild cognitive impairment and Alzheimer's disease

Background

The neural and cognitive substrates of measures of orientation as used in clinical trials and examinations have not been comprehensively examined.

Methods

We studied 473 subjects diagnosed with mild cognitive impairment (MCI) and Alzheimer's disease (AD) at baseline in Alzheimer's Disease Neuroimaging Initiative. Regression analyses at baseline were conducted to find significant predictors of orientation score among cognitive, brain morphometry, and glucose metabolism measures. Mixed model longitudinal analysis was performed to examine consequences of orientation on functional decline, and Cox hazard models examined the risk of conversion to AD in the MCI group.

Results

In MCI and AD subjects, orientation was predicted by poorer neurocognitive performance on immediate and delayed episodic memory and attention and processing speed. Among magnetic resonance imaging measures, orientation was predicted by entorhinal cortex thickness, hippocampal volume, and inferior temporal cortex thickness. Glucose metabolism in both middle-inferior temporal cortex and hippocampus were also predictive of orientation score. Functioning was significantly lower in disoriented subjects after 4 years of follow-up, and MCI patients who also were disoriented showed a higher rate of conversion to AD with a hazard ratio of 1.5.

Conclusions

Orientation is associated with medial temporal lobe structure, temporal lobe glucose metabolism, and episodic memory function. In MCI individuals orientation was a risk factor for progression to AD, also associated with rapid functional decline and worse prognosis. Thus, orientation may serve as a surrogate for episodic memory in clinical examination. These results have direct implications for the use of orientation in MCI and AD clinical trials including ceiling effects in healthy controls and issues of redundancy with measures of memory, when both are used in composite scores.