Nutritional Status and Cognitive Impairment among the Very Old in a Community Sample from Southern Brazil

Pathway linking nutritional status to cognitive function in older adults with chronic diseases: Exploring the mediating role of sleep quality

OBJECTIVE

This study aimed to explore the pathway linking nutritional status to cognitive function in older adults with chronic diseases, and whether sleep quality potentially mediates their association.

METHODS

A cross-sectional study was conducted among 248 older adults with chronic diseases who were admitted in a district tertiary hospital, Shenzhen, China from January to December 2022. The participants completed the sociodemographic and clinical characteristics questionnaire, the Mini Nutritional Assessment Short Form (MNA-SF), the Montreal Cognitive Assessment (MoCA), and the Pittsburgh Sleep Quality Scale (PSQI). Linear regression and the bootstrap method were employed for data analysis.

RESULTS

We observed that older adults with chronic diseases showed notable cognitive decline, as indicated by a MoCA score (mean = 23.60, SD = 4.68). The direct effect analysis indicated that older adults with compromised nutritional status were more likely to experience cognitive decline (β = 1.006, P < 0.001). The mediation analysis revealed that sleep quality partially mediated the relationship between nutrition and cognitive function, accounting for 17.59 % of the overall effect. Specifically, poor sleep quality may increase the risk of subsequent cognitive decline among older adults with compromised nutritional status.

CONCLUSIONS

This study identified that the impact of nutritional status on cognitive performance was partially mediated by sleep quality in older adults with chronic diseases. Further supporting the importance of high-quality sleep in maintaining brain health during aging. Monitoring and enhancing nutritional status and sleep quality may contribute to mitigating the progression of cognitive decline.

Prevalence, associated factors, and impact of vitamin B12 deficiency in older medical inpatients

PURPOSE

This retrospective cohort study aims to explore the prevalence of vitamin B12 deficiency in older hospitalized adults and identify key factors associated with this deficiency, as well as its impact on frailty and functional decline.

METHODS

Data were collected from older adults (≥65 years) sequentially admitted to the Internal Medicine Department of a tertiary university hospital. Clinical and laboratory characteristics, including age, sex, somatometric data, cause of admission, past medical history, chronic medication use, and laboratory tests, were recorded. Frailty and functional status were assessed using the Fried Frailty Scale (FFS), Clinical Frailty Scale (CFS), Barthel Index, and Katz Index. Vitamin B12 levels on admission were categorised as deficient (<200 pg/ml), borderline (200-300 pg/ml), normal (300-999 pg/ml), and high (≥1000 pg/ml).

RESULTS

A total of 894 patients were included. The median age was 83 years and 487 (54.5%) were females. The prevalence of vitamin B12 deficiency was found in 9.1%, while 17.3% of the sample had borderline levels. Multivariate analysis identified polypharmacy (≥5 drugs), low albumin levels/Geriatric Nutritional Risk Index (GNRI), and nursing home residency as independent factors associated with low B12 levels. Multivariate analyses showed that B12 deficiency was significantly associated with higher frailty rates and lower functional status.

CONCLUSION

Vitamin B12 deficiency is prevalent among hospitalized older patients and is significantly associated with increased frailty and reduced functional status. These findings underscore the importance of routine screening for B12 deficiency in this vulnerable population to improve clinical outcomes and quality of life.

Prevalence and correlates of malnutrition risk among Chinese centenarians and oldest-old adults

This study was to explore epidemiological characteristics of malnutrition and factors associated with malnutrition in centenarians and oldest-old adults, so as to provide a reference for family members and government departments to take effective measures and promote healthy aging. Median age of all 1,654 participants was 100 (85, 102) years old, and prevalence of high malnutrition risk was 65.54% in all participants. Proportion of high-malnutrition risk was higher, and proportion of normal physical function was lower, in centenarians than those in oldest-old adults (p < 0.05 for all). Univariate and multivariate Poisson regression analyses showed that normal physical function was negatively associated with malnutrition risk in all participants, centenarians, and oldest-old adults (p < 0.05 for all). In conclusion, proportion of centenarians at malnutrition risk was significantly higher than that of oldest-old adults, and the independent factor associated with malnutrition in people aged over 80 years was physical function.

Association Between Cognitive Performance and Nutritional Status: Analysis From LASI-DAD

Malnutrition in low- and middle-income countries causes cognitive decline and other health problems. Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI DAD) is an extensive study on late-life cognition and dementia. This study examines the link between nutrition and cognitive abilities in older adults using data from the LASI DAD. We conducted descriptive statistics on nutritional parameters (body-mass index, waist-hip ratio, and Mini-Nutritional Assessment), cognitive functions, and socio-demographic variables in 2,892 adults aged ≥60 years. Cognitive domains assessed included delayed recall, orientation, language, executive function, abstract reasoning, and attention. Cognitive impairment was defined as impaired performance in two or more domains. Mean age was 69.3 ± 7.1 years, 52.9% were female, and 57.5% were illiterate. Low body-mass index (adjusted OR: 1.88, p < .001), at risk of malnutrition (adjusted OR: 1.89, p < .001) and malnourished (adjusted OR: 2.86, p < .001) on Mini-Nutritional Assessment were associated with the presence of cognitive impairment. Better cognitive performance was associated with increased body mass index (adjusted OR: 0.74, p-.03), hemoglobin (adjusted OR: 0.91, p-.006), and serum albumin (adjusted OR: 0.38, p < .001). This study shows that nutritional status assessed by anthropometric measures and blood markers is strongly linked to cognitive performance in older adults.

Cultural influence on clock drawing test: A systematic review

OBJECTIVE

Dementia among migrants is an emerging phenomenon worldwide and the development of neuropsychological tests sensitive to cultural differences is increasingly regarded as a priority. The Clock Drawing Test (CDT) is one of the most used screening tools for the detection of cognitive decline. Nevertheless, there is still a debate about its adoption as a cross-cultural assessment.

METHODS

To identify cultural variables influencing performance at CDT, we performed a systematic review of literature on three databases of all studies considering the role of at least one of the following: (1) language; (2) education; (3) literacy; (4) acculturation; and (5) ethnicity.

RESULTS

We extrapolated 160 analyses from 105 studies. Overall, an influence of cultural determinants on performance at CDT was found in 127 analyses (79.4%). Regarding specific cultural factors, 22 analyses investigated the effect of ethnicity on CDT scores, reporting conflicting results. Only two scoring systems turned out to be sufficiently accurate in a multicultural population. Language influenced performance in only 1 out of 8 analyses. A higher level of education positively influenced test performance in 118 out of 154 analyses (76.6%), and a better quality of education in 1 analysis out of 2. A negative influence of illiteracy on CDT performance emerged in 9 out of 10 analyses. Acculturation affected performances at CDT in 1 out of 2 studies.

CONCLUSIONS

Based on the present findings, caution is needed when using CDT in a multicultural context, even if it requires limited linguistic competence.

Current Evidence on the Association of Micronutrient Malnutrition with Mild Cognitive Impairment, Frailty, and Cognitive Frailty among Older Adults: A Scoping Review

Micronutrient malnutrition is thought to play an important role in the cause of cognitive impairment and physical frailty. The purpose of this scoping review was to map current evidence on the association between micronutrient deficiency in blood and mild cognitive impairment, frailty, and cognitive frailty among older adults. The scoping review was conducted based on the 2005 methodological framework by Arksey and O'Malley. The search strategy for potential literature on micronutrient concentration in blood and cognitive frailty was retrieved based on the keywords using electronic databases (PubMed, Cochrane Library, Google Scholar, Ovid, and Science Direct) from January 2010 to December 2021. Gray literature was also included in the searches. A total of 4310 articles were retrieved and 43 articles were incorporated in the review. Findings revealed a trend of significant association between low levels of B vitamins (folate and vitamin B12), vitamin D, vitamin A, vitamin E, omega 3 fatty acid, and albumin, and high homocysteine levels in blood with an increased risk of mild cognitive impairment among older adults. The results also indicated that low vitamin D levels, albumin, and antioxidants (lutein and zeaxanthin) in blood were significantly associated with frailty among older adults, while β-cryptoxanthin and zeaxanthin in blood were inversely associated with the risk of cognitive frailty. Vitamin D and antioxidants seemed to be targeted nutrients for the prevention of cognitive frailty. In conclusion, a wide range of micronutrient deficiency was associated with either mild cognitive impairment or frailty; however, little evidence exists on the dual impairment, i.e., cognitive frailty. This scoping review can serve as preliminary evidence for the association between micronutrient deficiency in blood and mild cognitive impairment, frailty, and cognitive frailty among older adults and prove the relevancy of the topic for future systematic reviews.

Thyroid Dysfunction, Vitamin B12, and Folic Acid Deficiencies Are Not Associated With Cognitive Impairment in Older Adults in Lima, Peru

Background: Reversible etiologies of cognitive impairment are common and treatable, yet the majority of mild cognitive impairment (MCI) and dementia research in Latin America has focused on irreversible, neurodegenerative etiologies. Objective: We sought to determine if thyroid dysfunction and vitamin B12 and folate deficiencies are associated with cognitive disorders among older adults with memory complaints in Lima, Peru. Methods: This was a retrospective review of patients who presented for cognitive evaluations to a multidisciplinary neurology clinic in Lima, Peru from January 2014 to February 2020. We included individuals aged ≥60 years, native Spanish-speakers, with at least a primary school educational level and a complete clinical assessment. Patients had either subjective cognitive decline (SCD), MCI, or dementia. One-way ANOVA and multiple logistic regression analyses were performed. Results: We included 720 patients (330 SCD, 154 MCI, and 236 dementia); the dementia group was significantly older [mean age SCD 69.7 ± 4.1, dementia 72.4 ± 3.7 (p = 0.000)] and had lower folate levels than SCD patients. The MCI group had higher free T3 levels compared with SCD patients. Those with lower TSH had greater dementia risk (OR = 2.91, 95%CI: 1.15-6.86) but not MCI risk in unadjusted models. B12 deficiency or borderline B12 deficiency was present in 34% of the dementia group, yet no clear correlation was seen between neuropsychological test results and B12 levels in our study. There was no association between MCI or dementia and thyroid hormone, B12 nor folate levels in adjusted models. Conclusion: Our findings do not support an association between metabolic and endocrine disorders and cognitive impairment in older Peruvians from Lima despite a high prevalence of B12 deficiency. Future work may determine if cognitive decline is associated with metabolic or endocrine changes in Latin America.

Environmental Factors Affecting Cognitive Function among Community-Dwelling Older Adults: A Longitudinal Study

Although neighborhood environmental factors have been found to be associated with cognitive decline, few longitudinal studies have focused on their effect on older adults living in rural areas. This longitudinal study aimed to investigate the role of neighborhood environmental factors in cognitive decline among rural older adults. The data of 485 older adults aged ≥60 years who were living in Unnan City in Japan and had participated in two surveys conducted between 2014 and 2018 were analyzed. Cognitive function was assessed using the Cognitive Assessment for Dementia, iPad version 2. Elevation, hilliness, residential density, and proximity to a community center were determined using geographic information system. We applied a generalized estimating equation with odds ratios (OR) and 95% confidence intervals (CIs) of cognitive decline in the quartiles of neighborhood environmental factors. A total of 56 (11.6%) participants demonstrated a decrease in cognitive function at follow up. Elevation (adjusted OR 2.58, 95% CI (1.39, 4.77) for Q4 vs. Q1) and hilliness (adjusted OR 1.93, 95% CI (1.03, 3.63) for Q4 vs. Q1) were associated with a higher likelihood of cognitive decline. The second quartiles of residential density showed significantly lower likelihoods of cognitive decline compared with the first quartiles (adjusted OR 0.36, 95% CI (0.19, 0.71) for Q2 vs. Q1). Thus, an elevated hilly environment and residential density predicted cognitive decline among rural older adults.

Interactions Between Handgrip Strength and Serum Folate and Homocysteine Levels on Cognitive Function in the Elderly Chinese Population

BACKGROUND

Handgrip strength (HGS) and serum folate and homocysteine (Hcy) levels were associated with cognitive function. However, little was known whether there were interactions between HGS and serum folate and Hcy levels on cognitive function.

OBJECTIVE

To examine the interactions between HGS and serum folate and Hcy levels on cognitive function.

METHODS

This study analyzed the baseline data of the Tianjin Elderly Nutrition and Cognition Cohort study. All participants aged ≥60 years were potential eligible. HGS was measured using a grip strength dynamometer. Serum folate and Hcy levels were assayed using standard laboratory protocol. A Mini-Mental State Examination was used to assess cognitive function. Linear regressions were employed to examine the interactions between HGS and serum folate and Hcy levels on cognitive function.

RESULTS

4,484 participants were included in this study. There were interactions between HGS and serum folate and Hcy levels on cognitive function. Furthermore, subjects with strong HGS and sufficient folate level had the best cognitive function (β= 2.018), sequentially followed by those with strong HGS and insufficient folate level (β= 1.698) and with poor HGS and sufficient folate level (β= 0.873). Similarly, cognitive function was ranked in the descending order of subjects with strong HGS and normal Hcy level (β= 1.971), strong HGS and high Hcy level (β= 1.467), and poor HGS and normal Hcy level (β= 0.657).

CONCLUSION

There were interactions between HGS and serum folate and Hcy levels on cognitive function. However, the temporal associations cannot be examined in a cross-sectional study. Further cohort study should be conducted to confirm these associations in the future.

Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next?

A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.

Associations of health behaviors, food preferences, and obesity patterns with the incidence of mild cognitive impairment in the middle-aged and elderly population: An 18-year cohort study

BACKGROUND

There were few studies to examine the associations of food preferences and obesity patterns with the incident mild cognitive impairment (MCI). Therefore, this study aimed to examine the associations of health behaviors, food preferences, and with the incidence of MCI.

METHODS

All participants aged ≥ 55 years were potential eligible. The types of health behaviors and food preferences were recorded using the valid questionnaire. The obesity patterns were defined as follows:G-/A-, G+/A- or G-/A+, and G+/A+. The cognition tests included immediate and delayed recall, counting backward from 20, and serial 7 subtraction. The total cognitive score ranged from 0 to 27. Subjects with a score < 7 were considered as MCI.

RESULTS

There were 8236 subjects included in this study. Martial arts, ping pong, and reading or writing were associated with the lower incident MCI (P = 0.039, 0.006, and 0.016, respectively). However, TV or computer usage was associated with the higher incident MCI (P = 0.029; HR: 1.455; and HR 95% CI: 1.040- 2.036). Fast foods, soft/sugared drinks, and salty snack foods increased the incident MCI (P< 0.001, = 0.032, and 0.002, respectively). G+/A- or G-/A+ and G+/A+ were associated with the lower incident MCI (P = 0.018 and < 0.001, respectively).

LIMITATIONS

The basic mechanisms of health behaviors, food preferences, and obesity patterns on the risk of MCI were not fully explained.

CONCLUSION

Reading or writing and G+/A+ were associated with the lower incident MCI. However, TV or computer usage and fast foods were associated with the higher incident MCI.

The association between nutritional status, advanced activities of daily living, and cognitive function among Brazilian older adults living in care homes

Institutionalized older adults are at greater risk of malnutrition, which is associated with cognitive impairment. This study investigated the association between nutritional status, advanced activities of daily living (AADL), and cognitive function among Brazilian older adults living in care homes. This cross-sectional study was conducted on 95 older adults (73.3 ± 12.5 years). Socio-demographic variables, cognitive function (measured by Mini Mental State Examination - MMSE), AADL, Mini Nutritional Assessment (MNA), and anthropometric variables were assessed. Regarding MNA, 37.8% were malnourished, 47.3% were at risk of malnutrition, and 14.9% were well-nourished. Malnourished participants (37.8%) and those with fewer number of AADL (82.3%) showed cognitive decline (MMSE < 24) (p = 0.000 and 0.030, respectively). Inadequate waist-hip ratio was associated with cognitive decline (OR 9.3; 95% IC, 9.06 - 9.85; p = 0.03). Nutritional status and AADL were associated with cognitive function. Nutritional assessment helps to early identify malnutrition and possibly to prevent cognitive impairment.

Cognitive, functional, physical, and nutritional status of the oldest old encountered in primary care: a systematic review

Background

The oldest old (individuals over 90 years) are a fast-growing population. Characterizing their specificity would be helpful to adapt health care. This study aimed to characterize the cognitive, functional, nutritional, and physical status of individuals over 90.

Methods

We conducted a systematic review of cross-sectional or cohort studies of individuals aged 90 years old or more, living at home or in a nursing home, in April 2018. Two reviewers selected eligible articles, extracted data, and evaluated the risk of bias (assessed by the Newcastle-Ottawa Scale).

Results

The search strategy identified 3086 references; 35 articles were included referring to 8 cross-sectional and 27 longitudinal studies. Dementia was diagnosed in 30–42.9% of study participants, cognitive impairment in 12–50%, and 31–65% had no cognitive impairment. In terms of activities of daily living, 14–72.6% of individuals had no difficulty, 35.6–38% had difficulty, and 14.4–55.5% were dependent. For instrumental activities of daily living, 20–67.9% needed help. Regarding nutritional status, the Mini Nutritional Assessment Short Form mean score ranged from 10.3 (SD: 1.8) to 11.1 (SD: 2.4). Eight to 32% of individuals could not stand up from a chair, 19–47% could stand without the use of their arms; and 12.9–15% were not able to walk 4 m.

Conclusions

These results suggest a heterogeneous population with a certain proportion of oldest old with a low level of disability. These findings suggest that a specific approach in the care of the oldest old could help prevent disability.