Influence of mild cognitive impairment on activities of daily living in patients with cardiovascular disease

Linguistic, visuospatial, and kinematic writing characteristics in cognitively impaired patients with beta-amyloid deposition

Introduction

Beta-amyloid (Aβ) deposition, a hallmark of Alzheimer's disease (AD), begins before dementia and is an important factor in mild cognitive impairment (MCI). Aβ deposition is a recognized risk factor for various cognitive impairments and has been reported to affect motor performance as well. This study aimed to identify the linguistic, visuospatial, and kinematic characteristics evident in the writing performance of patients with cognitive impairment (CI) who exhibit Aβ deposition.

Methods

A total of 31 patients diagnosed with amnestic mild cognitive impairment (aMCI) with Aβ deposition, 26 patients with Alzheimer's-type dementia, and 33 healthy control (HC) participants without deposition were administered tasks involving dictation of 60 regular words, irregular words, and non-words consisting of 1-4 syllables. Responses from all participants were collected and analyzed through digitized writing tests and analysis tools.

Results

In terms of linguistic aspects, as cognitive decline progressed, performance in the dictation of irregular words decreased, with errors observed in substituting the target grapheme with other graphemes. The aMCI group frequently exhibited corrective aspects involving letter rewriting during the task. In terms of visuospatial aspects, the AD group displayed more errors in grapheme combination compared to the HC group. Lastly, in the kinematic aspects, both the aMCI group and the AD group exhibited slower writing speeds compared to the HC group.

Discussion

The findings suggest that individuals in the CI group exhibited lower performance in word dictation tasks than those in the HC group, and these results possibly indicate complex cognitive-language-motor deficits resulting from temporal-parietal lobe damage, particularly affecting spelling processing. These results provide valuable clinical insights into understanding linguistic-visuospatial-kinematic aspects that contribute to the early diagnosis of CI with Aβ deposition.

Executive Attentional Dyscontrol as a Core Cognitive and Behavioral Feature of Individuals with Obesity and Cardiovascular Disease: A Cross-Sectional Investigation

Executive attention as a frontal domain ability that is effective in potentially blocking distracting information, reconciling conflicts among simultaneous attentional demands, and regulating impulsive behavior may be impaired in individuals with obesity and cardiovascular disease (CVD). This study aimed (i) to explore the presence of selected cognitive (global cognitive impairment, sensitivity to interference, and attention) and psychological (quality of life, depression, anxiety, and impulsivity) dimensions and (ii) to examine the interactive relationship between attentional dyscontrol-both as a psychological and as a cognitive measure-and the above-mentioned variables in a sample of patients with CVD attending a cardiac rehabilitation program across different body mass index (BMI) levels. Clinical information of 104 patients with CVD was retrospectively collected. Participants were classified into three groups according to their BMI as follows: normal weight (NW = 30), overweight (OW = 19), and obese (OB = 55). Individuals with CVD and a higher BMI showed problems in controlling executive attention-through both neuropsychological and behavioral measures. Specifically, OB patients demonstrated reduced sensitivity to cognitive interference, lower capabilities in divided attention during visual-tracking tasks, and greater impulsivity compared to NW patients. This behavioral characteristic was also found to be correlated with higher levels of anxiety and depression and a lower quality of life. Implications for cognitive rehabilitation were discussed to offer directions for better management of patients with CVD and obesity.

The effect of rhythmic movement on physical and cognitive functions among cognitively healthy older adults: A systematic review and meta-analysis

OBJECTIVE

To explore the effects of rhythmic movement interventions on the physical and cognitive functions among cognitively healthy older adults.

METHODS

We searched PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, CBM, Wanfang Data, and VIP databases from inception to March 30, 2022. The inclusion criteria were: ① randomized controlled trials (RCTs); ② older adults (aged ≥ 60 years) without cognitive impairments or neurological or neurodegenerative diseases; ③ intervention: rhythmic movement (rhythmic exercise or physical activities performed to music); ④ outcomes: physical or cognitive function. Overall, 44 RCTs across 20 countries (n = 2752 participants) were included.

RESULTS

An association was found between rhythmic movement and improved physical function (mobility, cardiopulmonary endurance, muscle strength, flexibility, and balance), global cognitive function, and quality of life (QOL). The physical function outcomes suggested additional significant benefits when using control groups with no exercise than when using control groups with exercise. No significant improvement was found in executive function.

CONCLUSION

Regular rhythmic movement likely improves physical function, global cognitive function, and QOL in healthy older adults. The effect of rhythmic movement on the physical function in older adults is similar to that of routine exercise. Further studies on cognitive function of healthy older adults using larger samples of populations with more balanced sex ratios with long-term follow-up are particularly encouraged.

Cognitive impairment in daily life (CID): A double-faced instrument to detect changes and impairments in activities of daily living for people with suspected cognitive impairment

BACKGROUND

Assessment of cognitive function and its consequences for activities of daily living is an important part of a dementia evaluation. To describe patients' functional impairment accurately, a feasible instrument is needed. The Cognitive Impairment in Daily Life (CID) is an instrument developed with that purpose.

AIM

To describe and compare self- and proxy-reported difficulties in everyday life in patients undergoing a dementia investigation, measured by CID. A secondary aim was to compare the results between those who were diagnosed with dementia versus those without dementia.

METHOD

Self- and proxy-reported data using CID in 77 cases in dementia investigations. Of those, 32 were diagnosed with dementia and were compared to those without dementia (n = 45). Descriptive statistics.

RESULTS

When comparing self-reported and proxy-reported activity problems, most activities differed significantly. Proxies reported more difficulties than patients did. When comparing no dementia and dementia groups, significant differences were shown regarding initiative, planning and performance but not for memory and attention estimated by the patient themselves. Proxies differed significantly from patients in all tasks.

CONCLUSION

Overall, proxies reported that patients had more difficulties than patients reported themselves. The CID seems to be usable in dementia investigations and the results highlight the importance of involving both patients and relatives.

Health Literacy Is Associated with Activities of Daily Living of Patients Participating in Cardiac Rehabilitation: A Multicenter Clinical Study

The activities of daily living (ADL) in patients with cardiac disease tend to decline. A previous study revealed that ADL relates to physical and cognitive functions associated with health literacy (HL). However, the relationship between HL and ADL is not well documented. This study aimed to clarify this relationship among patients participating in cardiac rehabilitation. This multicenter study, the Kobe-Cardiac Rehabilitation project for people around the World (K-CREW), included patients who participated in cardiac rehabilitation from October 2020 to December 2021. Patients with probable dementia and difficulty walking alone were excluded. We used the 14-item Health Literacy Scale (HLS-14) to assess HL and the Functional Independence Measure (FIM) to assess ADL at discharge. Patients were divided by their HLS-14 score into the low HL group (<50 points) or the high HL group (≥50 points). We analyzed the relationship between the HLS-14 and FIM scores. We investigated 268 cardiac rehabilitation patients (median age, 71.0 years; male ratio, 76.9%). Low HL patients accounted for 51.1% of all patients and had significantly lower motor and cognitive FIM scores. Functional HL related better to the FIM scores (r = 0.28-0.36) than did other HL subclasses. Multiple regression analysis identified HLS-14 as an explanatory variable (p = 0.002) for the total FIM score. Patients with low HL had significantly lower ADL than those with high HL. These findings underscore the importance of considering HL in cardiac rehabilitation.

Impact of health literacy in patients with cardiovascular diseases: A systematic review and meta-analysis

OBJECTIVE

To clarify the impacts of health literacy on mortality, readmission, and quality of life (QOL) in the secondary or tertiary prevention of cardiovascular diseases (CVD) through a meta-analysis.

METHODS

Six electronic databases were searched on June 11, 2020. Observational studies involving patients with CVD, health literacy as an exposure factor and mortality, readmission, or QOL as outcomes were included in this study. Two researchers screened the retrieved articles and extracted data independently. The meta-analysis calculated the pooled relative risk of mortality and readmission. We also assessed the body of evidence based on Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

Following screening of 1616 studies, 16 observational studies were included. The mean rate of low health literacy was 32.8%. All studies focusing on QOL showed significant impacts of health literacy. Pooled relative risk was 1.621 (95% confidence interval: 1.089-2.412) for mortality and 1.184 (95% confidence interval: 1.035-1.355) for readmission, indicating significant effects of health literacy. GRADE assessment showed "LOW" certainty for each outcome.

CONCLUSION

Low health literacy was significantly associated with increased mortality and hospital readmission and decreased QOL in patients with CVD.

PRACTICE IMPLICATIONS

Considering low health literacy in clinical practice is very important to improve prognosis of CVD patients.

Mild cognitive impairment in patients with acute heart failure does not limit the effectiveness of early phase II cardiac rehabilitation

BACKGROUND

Cardiac rehabilitation (CR) is commonly performed in patients with heart failure (HF) with mild cognitive impairment (MCI). However, whether MCI diminishes the benefit of early phase II CR is unclear.

AIM

This study aimed to clarify whether MCI diminishes the benefit of early phase II CR in patients hospitalized for HF.

DESIGN

The design of the work is a case-control study.

SETTING

All HF patients who underwent CR in acute care hospitals in Japan from April 2016 to March 2021.

POPULATION

Among the 574 patients who underwent CR, 204 were included in this study. Exclusion criteria were age <65 years, dependence for activities of daily living (ADLs) prior to admission, diagnosis of dementia or delirium, mini-mental state examination (MMSE) score at the commencement of CR<19, missing data, in-hospital death, and transfer to another department during hospitalization.

METHODS

Patients were divided into two groups, those with MCI (MCI group, N.=134) and those without MCI (non-MCI group, N.=70), based on MMSE score at the commencement of CR. Cognitive impairment was defined as a score of <19. MCI was defined as an MMSE score between 19 and 26, and normal cognitive function was defined as MMSE >26. The primary outcomes were the 6-minute walking distance (6MWD), Barthel Index (BI), and Short Physical Performance Battery (SPPB). All patients underwent guideline-based CR programs.

RESULTS

On admission, MCI patients had significantly lower BI (P<0.01, confidence interval [CI]: 4.9-20.4) and SPPB (P<0.01, CI: 1.1-3.1), despite being independent for ADLs before admission. In addition, 6MWD (P<0.01, CI: 31.2-97.2), BI (P=0.01, CI: 1.0-8.4), and SPPB (P<0.01, CI: 0.6-2.5) were significantly lower in the MCI group at the time of discharge. However, after propensity score matching to adjust for baseline characteristics, no significant differences in any primary outcome were found between the two groups.

CONCLUSIONS

The BI, SPPB, and 6MWD improvements due to CR were similar, regardless of MCI.

CLINICAL REHABILITATION IMPACT

Our results may inform the selection of appropriate rehabilitation interventions for patients with HF and MCI.

Factors Associated With Hope and Quality of Life in Patients With Coronary Artery Disease

BACKGROUND

Psychological resources such as hope have been suggested to affect quality of life (QoL) positively in patients with heart disease. However, little information regarding the relationship between these two constructs is available.

PURPOSE

This work was aimed at examining the factors associated with hope and QoL in patients with coronary artery disease.

METHODS

In this descriptive work, perceived QoL and hope were assessed in 500 patients with heart disease. The information was collected using the McGill QoL Questionnaire, demographic variables, and the Herth Hope Index. The Pearson correlation test and general linear model were used to examine correlations through SPSS Version 22.

RESULTS

A considerable correlation was discovered between QoL and hope (r = .337, p < .001). Multivariate analyses with regression revealed that religious beliefs and social support both had significant and positive effects on the total perceived hope of patients and that patient age had a considerable negative impact on QoL (p < .05). None of these factors had a significant impact on hope (p < .05). In addition, the total QoL had a significant and positive effect on patient feelings and thoughts, whereas the physical problems component of QoL had a significant and negative effect on hope (p < .05). Participants with higher levels of education reported more hope.

CONCLUSIONS

QoL relates significantly to self-perceived hope in patients. Understanding QoL and hopefulness in patients with coronary artery disease has implications for nurses and other healthcare professionals.

Physical and Mental Functions of Cardiovascular Diseased Patients Decrease During the State of Emergency Initiated by the COVID-19 Pandemic in Japan

BACKGROUND AND OBJECTIVE

We aimed to examine the differences in life-space mobility and quality of life (QoL) of patients with cardiovascular disease (CVD) between the pre- and postnationwide state of emergency initiated by the Coronavirus disease 2019 (COVID-19) pandemic in Japan and to show the factors associated with the decrease in life-space mobility and QoL in these patients.

METHODS

We undertook a longitudinal study of 20 out of 51 consecutive CVD patients with coronary artery disease (CAD) who met the study criteria. We used the Life-Space Assessment (LSA) tool to evaluate Life-space mobility and assessed QoL with the five-level EuroQoL five-dimensional questionnaire (EQ-5D-5L) in Japanese.

RESULTS

The LSA scores and EQ-5D-5L QoL score decreased significantly from the pre- to postnationwide state of emergency in Japan (p < 0.01). ΔLSA was significantly positively associated with body mass index and significantly negatively associated with knee extensor muscle strength and pre-LSA score (p < 0.05). There were no significant relationships between ΔLSA and ΔEQ- 5D-5L QoL scores and between ΔEQ-5D-5L QoL scores and patient characteristics.

CONCLUSION

The policies promoted to address the state of emergency in Japan might affect life-space mobility and QoL of CAD patients. Moreover, CAD patients in Japan who were not obese and maintained their physical function and activity tended to refrain from activity during the period between the pre- and post-nationwide state of emergency. Clarification of the effects of the COVID-19 pandemic on the relationship between living space motility and QoL in CAD patients will require further study.

Comparison of exergames versus conventional exercises on the cognitive skills of older adults: a systematic review with meta-analysis

PURPOSE

To compare the effects of exergames versus conventional physical training on the cognitive skills of older adults.

MATERIALS AND METHODS

Scientific studies published in PubMed, Web of Science, and Cochrane Library databases were searched. Individual studies were assessed using the Cochrane Risk-of-bias tool for randomized trials (RoB 2). The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE Pro). The cognitive outcomes were Trail Making Test (TMT)-A, TMT-B, Stroop Word-Color test, Mini Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA).

RESULTS

We identified 256 studies, in which 13 studies were included in the systematic review and 11 in the meta-analysis. The majority of the exergame interventions were based on the Xbox 360's Kinect, followed by the Impact Dance Platform, Nintendo Wii, and the Bike Labyrinth. We observed heterogeneity in the conventional exercise group and in the duration of training, which ranged from 12 to 52 sessions. There was no statistically significant difference between groups in TMT-A (p=0.083), TMT-B (p=0.122), and Stroop (p=0.191). There were differences in favor of exergames in MMSE (raw mean difference=-1.58, 95% CI: -2.87 to -0.28, p<0.001) and MoCA (raw mean difference=-1.22, 95% CI: -2.24 to -0.20, p=0.019).

CONCLUSIONS

Despite statistical differences in MMSE and MoCA, these results should be interpreted with caution due to methodological heterogeneity. Some studies reported possible neurophysiological benefits induced by exergames, which should be explored in future investigations.

Ankle-Brachial Index Is a Predictor of In-Hospital Functional Status but Not of Complications in Hospitalized Elderly Patients

INTRODUCTION

Atherosclerosis causes a chronic reduction of vascularization with consequent impairment of the performance of organs, like the brain or muscles, which determines the functional and cognitive decline of the elderly and their ability to respond to acute stressful condition. Therefore, our aim was to evaluate if ankle brachial index (ABI) could effectively be a determinant of in-hospital functional status and complications in elderly hospitalized patients.

METHODS

This is a monocentric cross-sectional study of 189 patients aged 65 years or older. The study was undertaken at the Internal Medicine ward of Niguarda Hospital in Milan. ABI (BOSO ABY-System 100) and in-hospital status (activities of daily living, ADL and instrumental activities of daily living, IADL) were collected on the second day of hospitalization. Complications (falls and delirium episodes) were also recorded during the whole hospitalization period.

RESULTS

The average age of patients was 79.3 ± 6.9 years. Among outcomes, only ADL (r = 0.192, p = 0.007) and IADL score (r = 0.200, p = 0.005) showed significant correlation with ABI. Moreover, during the subsequent logistic regression, ABI remained among the statistically significant determinants of both scores (β = 0.231, p = 0.013 and β = 0.314, p = 0.001, respectively).

CONCLUSIONS

The main result of our study is the finding of ABI as a significant determinant of acute in-hospital functional impairment (evaluated as ADL and IADL scores). The continuous exposure of the brain and muscles to the reduced perfusions induced by vascular atherosclerosis, probably determined the reduced ability to respond to stressful conditions.

Association between physical functioning with cognition among community-dwelling older adults: a cross-sectional study

Objective: Declines in physical and cognitive functioning often co-exist through aging. Gait-related parameters have been related to cognitive function, although it is unclear whether other measures of physical functioning are similarly related to cognition. Here, we analyzed the relationship between physical functioning with cognition in older adults. Methods: In total, 116 participants were included (M age = 69 years, SD = 6; 71% women). We quantified cognitive functioning using the Montreal Cognitive Assessment (MoCA) and executive functioning tasks (Digit Span Forward minus Backward and verbal fluency tests). Physical function measures included gait speed, Short-physical Performance Battery (SPPB), five-times Sit-to-Stand Test, the Timed Up and Go (TUG) test, the Six-minute Walk Test (6MWT), and lower extremity muscle strength. We used multiple linear regression analyses to explore the association between cognitive measures and each measure of physical functioning, adjusting for age, sex, education, and RCT. Results: We observed a positive association between muscle strength and the MoCA (b = 0.84, SE = 0.40, 95%CI 0.05–1.64) after controlling for covariates. Significant associations were also found between the five-times-sit-to-stand test (b = -0.63, SE = 0.26, 95%CI -1.15–-0.12), TUG (b = -1.13, SE = 0.57, 95%CI -2.26–-0.01), 6MWT (b = 0.04, SE = 0.02, 95%CI 0.01–0.07), and lower extremity muscle strength (b = 1.92, SE = 0.93, 95%CI 0.09–3.77) with the FAS verbal fluency test, and between the TUG (b = -0.62, SE = 0.24, 95%CI -1.11–-0.14) with animal naming. Conclusion: In community-dwelling older adults, higher levels of muscle strength, dynamic balance and cardiorespiratory fitness were positively related with global cognition and executive control measures.

Predictors of activities of daily living at discharge in elderly patients with heart failure with preserved ejection fraction

The purpose of this study was to clarify the predictive factors of activities of daily living (ADL) at discharge in elderly patients with heart failure with preserved ejection fraction (HFpEF). Participants were selected from among 598 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics, and ADL with the motor and cognitive items of the Functional Independence Measure (FIM). We analyzed the data with the unpaired t test, Mann-Whitney U test, χ² test, logistic regression analysis, and receiver operating characteristic (ROC) curves. We included 154 patients for further analyses who were divided into the low ADL group (n = 75) and high ADL group (n = 79). There were significant differences between the two groups in age, long-term care insurance (LTCI) level, New York Heart Association class, creatinine level, albumin level, β-blocker, sitting, standing and walking exercise start days, length of hospital stay, and motor- and cognitive-FIM scores at admission and discharge (p < 0.05). The cutoff values of the ROC curves predicting ADL at discharge were LTCL: support level 2 (area under the curve [AUC]: 0.672, p < 0.001, sensitivity: 0.573, false-positive rate: 0.278); walking exercise start day: 4.5 days (AUC 0.694, p < 0.001, sensitivity: 0.609, false-positive rate: 0.299); motor FIM score: 34.5 points (AUC 0.710, p < 0.001, sensitivity: 0.633, false-positive rate: 0.280); and cognitive FIM score: 28.5 points (AUC 0.806, p < 0.001, sensitivity: 0.759, false-positive rate: 0.227). This study revealed several predictors of ADL at discharge and their associated cutoff values in elderly patients with HFpEF.

Worsening renal function during hospitalization in elderly patients with heart failure: an independent factor of activities of daily living decline

This study aimed to clarify the effects of worsening renal function (WRF) during hospitalization on activities of daily living (ADL) at discharge of elderly heart failure (HF) patients. We included 323 consecutive patients hospitalized for HF who were prescribed phase I cardiac rehabilitation (CR) from November 2017 to April 2019. WRF was defined as a relative increase from baseline in serum creatinine of 25% or that in serum creatinine ≥ 0.3 mg/dL during hospitalization. The indices of ADL and physical function were the functional independence measure (FIM), short physical performance battery (SPPB) and 10-m comfortable gait speed as assessed at discharge. We compared background factors, clinical parameters, walking level before hospitalization, physical function, and FIM in two groups. Multiple regression analysis was performed with FIM at discharge as the dependent variable and items with P < 0.05 in bivariate correlation as independent variables. Ultimately, 160 patients were included and divided into the WRF group (n = 72) and non-WRF group (n = 88). FIM, SPPB, and 10-m comfortable walking speed were significantly lower in the WRF group. Moreover, even after adjustment for confounding factors (age, Hb, eGFR, CKD, GNRI, start day of standing), eGFR on admission (β = 0.12), WRF (β =  - 6.42) and walking level before hospitalization (β = - 10.00) were independent factors of ADL decline at discharge (adjusted R² = 0.46). WRF during hospitalization of elderly HF patients was a factor affecting ADL decline at discharge along with walking level before hospitalization and renal function at admission.

Cognitive function in post-cardiac intensive care: patient characteristics and impact of multidisciplinary cardiac rehabilitation

New/worsening cognitive and physical impairments following critical care pose significant problems. Multidisciplinary cardiac rehabilitation (CR) can improve physical function after cardiac intensive care (CIC). This observational study aimed to evaluate cognitive function in patients participating in multidisciplinary CR and to identify correlates of impaired cognitive function after CIC. We analyzed 111 consecutive patients admitted to our comprehensive care ward at least 7 days after CIC and assessed factors associated with cognitive function using the Functional Independence Measure (FIM). Patients were stratified into two groups based on the median FIM-Cognitive scores: impaired (n = 56) and preserved cognition (n = 55) groups. Multiple logistic regression analysis identified age [odds ratio (OR) 1.06; 95% confidence interval (CI) 1.00-1.13; p = 0.042], Mini-Nutrition Assessment-Short Form (MNA-SF; OR 0.73; 95% CI 0.56-0.95; p = 0.017), and FIM-Physical scores (OR: 0.94; 95% CI 0.90-0.99; p = 0.012) as significant and independent factors associated with impaired cognition. The median length of hospital stay was 28 (interquartile range: 18, 43) days. The FIM-Cognitive and FIM-Physical scores significantly increased from admission to discharge [32.0 (27.0, 35.0) vs. 34.0 (29.0, 35.0) points; p < 0.001; 67.0 (53.0, 75.0) vs. 85.0 (73.5, 89.0) points; p < 0.001, respectively]. On subgroup analysis within the impaired cognition group, increased FIM-Cognitive scores positively and significantly correlated with increased FIM-Physical scores (ρ = 0.450; p = 0.001). Multiple linear regression analysis identified atrial fibrillation (AF; β = - 0.29; p = 0.016), ln(glycated hemoglobin; HbA1c) (β = 0.29; p = 0.018), and ln(high-sensitivity C-reactive protein; hs-CRP) (β = - 0.26; p = 0.034) as significant and independent factors correlated with increased FIM-Cognitive scores. In conclusion, advanced age, low MNA-SF score, and FIM-Physical score were independent factors associated with impaired cognition in post-CIC patients. Multidisciplinary CR improved both physical and cognitive functions, and AF, HbA1c, and hs-CRP were independent factors correlated with increased FIM-Cognitive score.