Socioeconomic Disparities and Gender Inequalities in Dementia: a Community-Dwelling Population Study from a Middle-Income Country

Sex Differences in Healthcare Utilization in Persons Living with Dementia Between 2000 and 2017: A Population-Based Study in Quebec, Canada

Objectives: Describe sex differences in healthcare utilization and mortality in persons with new dementia in Quebec, Canada. Methods: We conducted a repeated cohort study from 2000 to 2017 using health administrative databases. Community-dwelling persons aged 65+ with a new diagnosis of dementia were included. We measured 23 indicators of healthcare use across five care settings: ambulatory care, pharmacological care, acute hospital care, long-term care, and mortality. Clinically meaningful sex differences in age-standardized rates were determined graphically through expert consultations. Results: Women with dementia had higher rates of ambulatory care and pharmacological care, while men with dementia had higher acute hospital care, admission to long-term care, and mortality. There was no meaningful difference in visits to cognition specialists, antipsychotic prescriptions, and hospital death. Discussion: Men and women with dementia demonstrate differences in healthcare utilization and mortality. Addressing these differences will inform decision-makers, care providers and researchers and guide more equitable policy and interventions in dementia care.

Association between ethylene oxide exposure and cognitive function in older adults from NHANES data

Ethylene Oxide (EO), a volatile organic compound, has garnered considerable attention for its potential impact on human health. Yet, the ramifications of EO exposure on the cognitive functionality of the elderly remain unclear. The aim of this study is to determine whether EO exposure in the elderly correlates with cognitive function. In this cross-sectional study, an analysis was conducted on 471 participants from the 2013 to 2014 United States National Health and Nutrition Examination Survey (NHANES). T1, T2, and T3 was used to represent the low, moderate, and high tertiles of log10-transformed HbEO levels, respectively. Weighted linear regression analysis, weighted logistic regression analysis, and restricted cubic spline models were employed to assess the association between HbEO and standardized z-scores of four cognitive tests. Firstly, analysis of variable characteristics across the different log10-transformed HbEO groups revealed that HbEO was higher in males, non-Hispanic whites, and smokers and that Z scores for Delayed Recall Test (DRT), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST) decreased as HbEO increased (p < 0.05). After adjusting for confounding factors, the log10-transformed HbEO levels were found to be negatively correlated with DRT-Z scores (T3 vs. T1 in Model 3: β (95% CI) = - 0.35 (- 0.54, - 0.15), p = 0.002, p for trend = 0.002). In addition, Stratified analyses showed that the four cognitive scores were negatively correlated with HbEO levels in those under 80 years of age. And men had worse AFT scores compared to women. Overall, the four Z-scores roughly trended downward as log10-transformed HbEO rose. Based on the findings of this research, EO exposure may be associated with adverse performance in the DRT among elderly individuals in the United States.

The Interaction Between Indigenous Identity and Rural Residency in Dementia Prevalence Among Ecuadorian Older Adults

BACKGROUND AND OBJECTIVES

While recognizing the acknowledged difference in dementia prevalence between Indigenous and non-Indigenous populations, most previous studies were conducted in the Global North. This study aims to examine the relationship between Indigenous ethnic identity and dementia status with a special focus on urban-rural differences among older adults in Ecuador.

RESEARCH DESIGN AND METHODS

Data came from Ecuador's Survey of Health, Welfare, and Aging, derived from a probability sample of households in Ecuador. The final sample comprised 4,984 adults aged 60 or older. Dementia status was assessed through 3 indicators: low scores on a cognitive assessment, the number of difficulties in instrumental activities of daily living, and self-reported dementia diagnosis. Logistic regression and multivariate decomposition analyses were utilized.

RESULTS

Indigenous participants, even after adjusting for sociodemographic and health-related factors, exhibited a higher likelihood of having dementia compared to their non-Indigenous counterparts. Among Indigenous participants, those residing in rural areas had a higher likelihood of having dementia status, while there was no significant urban-rural difference observed among non-Indigenous participants. Rural residency and covariates explain 91.0% of the observed difference in dementia prevalence between Indigenous and non-Indigenous older adults.

DISCUSSION AND IMPLICATIONS

Indigenous older adults who are living in rural areas are at particularly high risk of having dementia largely because they have presently recognized modifiable risk factors. These findings underscore the urgent need to prioritize provisions of appropriate and equitable service related to dementia for Indigenous people living in rural areas outside high-income countries.

Predictors of cognitive change in cognitively healthy older women in Panama: the PARI-HD study

Background

Evidence suggests that a combination of biological and social factors influence risk of dementia differently for women and men. In healthy older women, several factors may contribute to changes in cognition.

Objective

Describe the characteristics associated with variation in cognition in a sample of cognitively healthy older Panamanian women.

Methods

The study includes cross-sectional analyses of cognitive domains at baseline (n = 357) and 17-month (SD = 2.0) follow-up (n = 200) for women aged 60 years and older enrolled in the Panama Aging Research Initiative-Health Disparities (PARI-HD) study. Instruments included clinical questionnaires, physiological measures, and a neuropsychological test battery assessing global cognition and seven cognitive domains. Multiple regression analyses examined the associations between demographic and clinical characteristics and cognition at baseline. Repeated measures analyses were used to investigate changes in cognition from baseline to follow-up.

Results

On average, participants were 68.6 years of age (SD = 5.9) with 16.1 years of education (SD = 4.7). Age, income, and education showed robust associations with baseline cognition. Subjective cognitive impairment was associated with lower performance in global cognition, verbal learning, and memory domains. Only performance in the attention domain decreased at follow-up, and subjective health state and depressive symptoms significantly predicted the change in attention.

Discussion

Our study findings contribute to the investigation of cognitive health in older Hispanic women and to the understanding of sociodemographic and health-related factors associated with cognitive decline and the progression to cognitive impairment and dementia.

Risk of impairment in cognitive instrumental activities of daily living for sexual and gender minority adults with reported Parkinson's disease

Objective: To investigate the risk of impairment in cognitive instrumental activities of daily living (IADL) for people with Parkinson's (PwP) identifying as sexual and/or gender minorities (SGM). Method: Data were obtained from Fox Insight, an online, longitudinal study with self/informant-report questionnaires from PwP and people without Parkinson's. Groups consisted of PwP without cognitive IADL impairment at baseline, identifying as (1) SGM with female sex assigned at birth (SGM-F, n = 75); (2) cisgender, heterosexual with female sex assigned at birth (CH-F, n = 2046); (3) SGM with male sex assigned at birth (SGM-M, n = 84); (4) cisgender, heterosexual with male sex assigned at birth (CH-M, n = 2056). Impairment in cognitive IADL was based on Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15). Group differences for PDAQ-15 and impairment likelihood during follow-up were assessed with unadjusted models and adjusting for variables that differed between the groups. Results: SGM-F were the youngest at Parkinson's diagnosis; SGM-M had the lowest PDAQ-15 at baseline (p ≤ .014 for all). Scores declined more for males than females in unadjusted and adjusted models (p < .001 for both). In unadjusted models, SGM-M had a higher impairment risk than PwP identifying as cisgender and heterosexual (p ≤ .018). In adjusted models, females had a lower impairment risk than males (p < .001). Age, education, and discrimination level were significant moderators (p < .001 for all). Conclusions: SGM-M can be at a higher risk for impairment in cognitive IADL, associated with social determinants. Female sex assigned at birth may be associated with a lower level of impairment risk, although this advantage can disappear with social determinants.

Serum neurofilament light chain and cognition decline in US elderly: A cross-sectional study

OBJECTIVE

Early identification of cognitive impairment in neurodegenerative diseases like Alzheimer's disease (AD) is crucial. Neurofilament, a potential biomarker for neurological disorders, has gained attention. Our study aims to investigate the relationship between serum neurofilament light (sNfL) levels and cognitive function in elderly individuals in the United States.

METHODS

This cross-sectional study analyzed data from participants aged 60 and above in the National Health and Nutrition Examination Survey (2013-2014). We collected sNfL levels, cognitive function tests, sociodemographic characteristics, comorbidities, and other variables. Weighted multiple linear regression models examined the relationship between ln(sNfL) and cognitive scores. Restricted cubic spline (RCS) visualization explored nonlinear relationships. The stratified analysis examined subgroups' ln(sNfL) and cognitive function association.

RESULTS

The study included 446 participants (47.73% male). Participants with ln(sNfL) levels between 2.58 and 2.81 pg/mL (second quintile) performed relatively well in cognitive tests. After adjusting for multiple factors, ln(sNfL) levels were negatively correlated with cognitive function, with adjusted β (95% CI) as follows: immediate recall test (IRT): -0.763 (-1.301 to -0.224), delayed recall test (DRT): -0.308 (-0.576 to -0.04), animal fluency test (AFT): -1.616 (-2.639 to -0.594), and digit symbol substitution test (DSST): -2.790 (-4.369 to -1.21). RCS curves showed nonlinear relationships between ln(sNfL) and DRT, AFT, with inflection points around 2.7 pg/mL. The stratified analysis revealed a negative correlation between ln(sNfL) and cognition in specific subgroups with distinct features, with an interaction between diabetes and ln(sNfL).

INTERPRETATION

Higher sNfL levels are associated with poorer cognitive function in the elderly population of the United States. sNfL shows promise as a potential biomarker for early identification of cognitive decline.

Empathy as a crucial skill in disrupting disparities in global brain health

Brain health refers to the state of a person's brain function across various domains, including cognitive, behavioral and motor functions. Healthy brains are associated with better individual health, increased creativity, and enhanced productivity. A person's brain health is intricately connected to personal, social and environmental factors. Racial, ethnic, and social disparities affect brain health and on the global scale these disparities within and between regions present a hurdle to brain health. To overcome global disparities, greater collaboration between practitioners and healthcare providers and the people they serve is essential. This requires cultural humility driven by empathy. Empathy is a core prosocial value, a cognitive-emotional skill that helps us understand ourselves and others. This position paper aims to provide an overview of the vital roles of empathy, cooperation, and interdisciplinary partnerships. By consciously integrating this understanding in practice, leaders can better position themselves to address the diverse challenges faced by communities, promote inclusivity in policies and practices, and further more equitable solutions to the problem of global brain health.

Gait speed according to cognitive status in older adults: a cross-sectional study in a resource-limited country

OBJECTIVE

We aimed to investigate the association between gait speed and cognitive status in outpatient older adults from a resource-limited setting in Peru.

METHODS

We performed a cross-sectional study including older adults aged ≥60 years attending a geriatrics outpatient clinic between July 2017 and February 2020. Gait speed was measured over a 10-meters distance without considering the first and last meter traveled. Cognitive status was assessed through the Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE). We used a multivariate binomial logistic regression to conduct both an epidemiological and fully adjusted models.

RESULTS

We included 519 older adults (mean age: 75 years; IQR = 10), of whom 95 (18.3%) and 151 (31.5%) were cognitively impaired according to the SPMSQ and MMSE, respectively. Gait speed was slower among patients with poorer cognitive status as assessed by both tools (p < 0.001). Malnutrition (PR: 1.74; CI: 1.45-2.08) and functional dependency (PR: 4.35; CI: 2.68-7.08) were associated with a greater prevalence of cognitive impairment according to the SPMSQ, whereas a faster gait speed (PR: 0.27, CI: 0.14-0.52) and longer years of education (PR: 0.83, CI: 0.77-0.88) were associated with a less prevalence.

CONCLUSIONS

Slower gait speed was associated with poorer cognitive status in outpatient older adults. Gait speed may be a complementary tool in the cognitive assessment of older adults from resource-limited settings.

The impacts of social determinants of health and cardiometabolic factors on cognitive and functional aging in Colombian underserved populations

Global initiatives call for further understanding of the impact of inequity on aging across underserved populations. Previous research in low- and middle-income countries (LMICs) presents limitations in assessing combined sources of inequity and outcomes (i.e., cognition and functionality). In this study, we assessed how social determinants of health (SDH), cardiometabolic factors (CMFs), and other medical/social factors predict cognition and functionality in an aging Colombian population. We ran a cross-sectional study that combined theory- (structural equation models) and data-driven (machine learning) approaches in a population-based study (N = 23,694; M = 69.8 years) to assess the best predictors of cognition and functionality. We found that a combination of SDH and CMF accurately predicted cognition and functionality, although SDH was the stronger predictor. Cognition was predicted with the highest accuracy by SDH, followed by demographics, CMF, and other factors. A combination of SDH, age, CMF, and additional physical/psychological factors were the best predictors of functional status. Results highlight the role of inequity in predicting brain health and advancing solutions to reduce the cognitive and functional decline in LMICs.

Six-item cognitive impairment test (6-CIT)'s accuracy as a cognitive screening tool: best cut-off levels in emergency department setting

Background

Nowadays, elderly patients represent a significant number of accesses to the Emergency Department (ED). Working rhythms do not allow to perform complete cognitive analysis, which would, however, be useful for the health care. This study aims to define the optimal cut-off values of the six-item Cognitive Impairment Test (6-CIT) as a cognitive screening tool in ED.

Methods

This study included 215 subjects, evaluated at the Emergency Department of the University Hospital of Monserrato, Cagliari, Italy, from July to December 2021. The accuracy of 6-CIT as a cognitive screening tool was assessed by comparison with Mini Mental State Examination (MMSE).

Results

The correlation coefficient between the two tests was -0.836 (CI: -0.87 to -0.79; p < 0.0001), and 6-CIT showed AUC = 0.947 (CI: 0.908-0.973; p < 0.0001). The 8/9 6-CIT cut-off score presented 86.76% sensitivity (CI: 76.4-93.8) and 91.84% specificity (CI: 86.2-95.7), and Youden index for this score was 0.786.

Conclusion

Our study demonstrates that 6-CIT is a reliable cognitive screening tool in ED, offering excellent sensitivity and specificity with a 8/9 points cut-off score.

Ameliorative Processes of Beta-Carotene in Streptozotocin-Induced Diabetic Vascular Dementia in Rats

Beta-carotene (BC) is a precursor of vitamin A and an excellent antioxidant. It protects the vascular system. Vascular dementia (VaD) is one of the aging disorders causing memory dysfunction. The available medicines for the management of VaD are limited. The present study aimed to evaluate the ameliorative effect of BC in streptozotocin (STZ)-induced diabetic VaD in rats. Diabetic VaD was induced through the administration of nicotinamide (NA, 50 mg/kg; i.p.) and STZ (50 mg/kg; i.p.). The test compound BC (50 and 100 mg/kg; p.o.) and reference compound donepezil (1 mg/kg; p.o.) were administered for 15 consecutive days. Cognitive changes were assessed by transfer latency (TL) using the elevated plus maze (EPM) test. The changes in acetylcholinesterase (AChE) activity were estimated in the septohippocampal system of rat brains. The administration of STZ caused significant changes in cognitive functions (increased TL) as compared to the normal group. BC ameliorated the anxiety-related cognitive behavior and neurotransmitter (elevated AChE) changes provoked by diabetic VaD. Therefore, BC could be a potential therapeutic candidate in the management of VaD.

Association between mixed exposure of phthalates and cognitive function among the U.S. elderly from NHANES 2011-2014: Three statistical models

BACKGROUND

Studies on the relationship between phthalate exposure and cognition in adults are sparse and inconsistent. These studies only assessed their association of single phthalates for one-time and the tools for assessing cognitive function were different.

OBJECTIVE

We aimed to examine the association between mixed phthalates and cognition in the U.S elderly using three statistical models.

METHODS

The generalized linear (GLM), weighted quantile sum (WQS), and Bayesian kernel machine regression (BKMR) models were used to evaluate the associations between mixed phthalates and the standardized z-scores of four cognitive tests [Immediate Recall test (IRT), Delayed Recall test (DRT), Animal Fluency test (AFT), and Digit Symbol Substitution test (DSST)] in participants aged over 60 years from NHANES 2011-2014.

RESULTS

835 individuals were included and the median raw scores of IRT, DRT, AFT, and DSST were 19 (IQR: 16-23), 6 (IQR: 5-8), 16 (IQR: 13-20), 46 (IQR: 35-59). In adjusted GLM, negative associations were observed between MECPP, MnBP, MCOP, MCPP, and the IRT z-scores; MCPP, MBzP, and the DRT z-scores. Positive relationships were found between MCOP, MCPP, and the AFT z-scores; MCPP and the DSST z-scores. The WQS index was associated with the IRT z-scores (β(95%CI): -0.069(-0.118, -0.020)), where MCPP weighted the highest. In the BKMR, negative overall trends between the mixture and the IRT, DRT z-scores were observed when the mixture was at 40th to 65th percentile, 65th percentile or above it, respectively, where MnBP and MBzP drove the main effect of the mixture.

CONCLUSION

This study is an academic exploration of the association between phthalates exposure and cognitive function, suggesting that exposure to phthalates might be associated with bad performance in IRT and DRT in the U.S. elderly.

Subjective social position and cognitive function in a longitudinal cohort of older, rural South African adults, 2014-2019

Background

The relationship between subjective social position (SSP) and cognitive ageing unclear, especially in low-income settings. We aimed to investigate the relationship between SSP and cognitive function over time among older adults in rural South Africa.

Methods

Data were from 3771 adults aged ≥40 in the population-representative ‘Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa’ from 2014/2015 (baseline) to 2018/2019 (follow-up). SSP was assessed at baseline with the 10-rung MacArthur Network social position ladder. Outcomes were composite orientation and episodic memory scores at baseline and follow-up (range: 0–24). Mortality- and attrition-weighted linear regression estimated the associations between baseline SSP with cognitive scores at each of the baseline and follow-up. Models were adjusted for age, age², sex, country of birth, father’s occupation, education, employment, household assets, literacy, marital status and health-related covariates.

Results

SSP responses ranged from 0 (bottom ladder rung/lowest social position) to 10 (top ladder rung/highest social position), with a mean of 6.6 (SD: 2.3). SSP was positively associated with baseline cognitive score (adjusted β=0.198 points per ladder rung increase; 95% CI 0.145 to 0.253) and follow-up cognitive score (adjusted β=0.078 points per ladder rung increase; 95% CI 0.021 to 0.136).

Conclusion

Independent of objective socioeconomic position measures, SSP is associated with orientation and episodic memory scores over two time points approximately 3 years apart among older rural South Africans. Future research is needed to establish the causality of the observed relationships, whether they persist over longer follow-up periods and their consistency in other populations.