Cognition and Chronic Disease

Association between cognitive dysfunction and diabetes in patients over 65 years old: a cross-sectional study using propensity score matching

OBJECTIVES

To investigate the association between diabetes and cognitive dysfunction in the elderly population, and examine the impact of cognitive dysfunction on level of activities of daily living (ADL) in patients with diabetes.

METHODS

Data analysis was conducted on 2,951 individuals aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey cohort. Propensity score matching was utilized to mitigate selection bias. Multivariate binary logistic regression was performed to analyse the association between diabetes and cognitive dysfunction in the study subjects. In addition, the relationship between ADL and cognitive function in patients with diabetes was analysed using the Wilcoxon rank-sum test.

RESULTS

A significant association (p = 0.017) was found between diabetes and the occurrence of cognitive dysfunction in older adults. Subgroup analyses revealed that diabetes patients with cognitive dysfunction exhibited a worse ADL dependence compared with those without cognitive dysfunction (p < 0.001).

CONCLUSION

These findings indicate that diabetes is associated with cognitive dysfunction in older adults. Meanwhile, there is an association between cognitive impairment and ADL level in subjects with diabetes. As such, healthcare professionals should pay close attention to the occurrence of cognitive dysfunction and ADL decline during diagnosis and treatment, and proactive prevention and intervention strategies should be implemented.

Association of Anemia with Cognitive Function and Dementia Among Older Adults: The Role of Inflammation

BACKGROUND

The association of anemia with cognitive function and dementia remains unclear.

OBJECTIVE

We aimed to investigate the association of anemia with cognitive function and dementia risk and to explore the role of inflammation in these associations.

METHODS

Within the UK Biobank, 207,203 dementia-free participants aged 60+ were followed for up to 16 years. Hemoglobin (HGB) and C-creative protein (CRP) were measured from blood samples taken at baseline. Anemia was defined as HGB <13 g/dL for males and <12 g/dL for females. Inflammation was categorized as low or high according to the median CRP level (1.50 mg/L). A subset of 18,211 participants underwent cognitive assessments (including global and domain-specific cognitive). Data were analyzed using linear mixed-effects model, Cox regression, and Laplace regression.

RESULTS

Anemia was associated with faster declines in global cognition (β= -0.08, 95% confidence interval [CI]: -0.14, -0.01) and processing speed (β= -0.10, 95% CI: -0.19, -0.01). During the follow-up of 9.76 years (interquartile range 7.55 to 11.39), 6,272 developed dementia. The hazard ratio of dementia was 1.57 (95% CI: 1.38, 1.78) for people with anemia, and anemia accelerated dementia onset by 1.53 (95% CI: 1.08, 1.97) years. The risk of dementia tended to be higher in people with both anemia and high CRP (1.89, 95% CI: 1.60, 2.22). There was a statistically significant interaction between anemia and CRP on dementia risk (p-interaction = 0.032).

CONCLUSIONS

Anemia is associated with cognitive decline (specifically for processing speed) and increased risk of dementia, especially in people with high inflammation.

Meta-analysis of sugar-sweetened beverage intake and the risk of cognitive disorders

BACKGROUND

Previous epidemiological studies revealed inconsistent associations between sugar-sweetened beverage (SSB) consumption and cognitive disorders, but there have been no meta-analyses of the pooled results. Thus, a meta-analysis was performed to determine the association between SSB consumption and cognitive disorders.

METHODS

A systematic search of the literature prior to May 20, 2022 was performed using the PubMed and Web of Science databases. Random effects models were used to calculate and combine odds ratios (ORs) depending on the degree of heterogeneity.

RESULTS

13 studies met the inclusion criteria. A total of 242,014 participants (2752 in three cross-sectional studies and 239,262 in ten cohort studies) were included. A random effects meta-analysis, according to the comprehensive analysis of SSB consumption, was associated with a greater prevalence of cognitive disorders (OR = 1.17, 95 % CI = 1.05-1.29; I² = 90.1 %). Subgroup analyses of study design, type of SSB, or cognitive disorders outcome was performed. In subgroup analyses, we found that SSB intake was associated with a higher prevalence of cognitive disorders in cohort studies, middle-aged and elderly population, and participants with sugar-sweetened soft drinks. However, no significant association was found in other subgroups.

CONCLUSION

Our results indicate that SSB intake is positively associated with the prevalence of cognitive disorders. Therefore, attention should be paid to reducing SSB intake as an early intervention for cognitive disorders.

Fertility History and Risk of Cognitive Impairment Among Older Parents in the United States

OBJECTIVES

I work from a gendered life-course perspective to examine the association between older parents' fertility history (i.e., timing and parity) and their risk of cognitive impairment in the United States.

METHODS

I analyze nationally representative data from 9 waves over 16 years of the Health and Retirement Study (2000-2016). The sample includes 14,543 respondents (6,108 men and 8,435 women) aged 50 and older at the baseline survey. I examine the relationship between parity, age at first birth, and age at last birth with risk of cognitive impairment using nonlinear discrete-time hazard models.

RESULTS

Adjusting for the effects of full covariates, there are U-shaped relationships between women's age at last birth and risk of cognitive impairment and between women's parity and risk of cognitive impairment. In the sensitivity tests, the relationships remain robust when sampling weights are applied, or mortality selection is corrected.

DISCUSSION

Fertility timing and parity are likely factors associated with the risk of cognitive impairment for older women. Understanding fertility history and its impact on cognition can help identify the most vulnerable subpopulations, so that more effective interventions can be made to improve cognitive functioning among older adults.

Marital Loss and Cognitive Function: Does Timing Matter?

OBJECTIVES

This study examines the association between age at marital loss (i.e., divorce or widowhood) and cognitive function in later life and whether the association differs by gender.

METHODS

We used mixed-effects models, drawing on longitudinal data from the Health and Retirement Study (1998-2016). The analytical samples included older adults aged 51 and older who had ever been widowed (N=5,639 with 25,537 person-waves) or divorced (N=10,685 with 50,689 person-waves).

RESULTS

We find that those who were widowed at younger ages had lower cognitive function than their counterparts who were widowed at older ages, for both men and women, after controlling for covariates. Household income and health-related factors partially accounted for the positive association between age at widowhood and cognitive function. Those who divorced at younger ages also had lower cognitive function than their counterparts who divorced at older ages, but this association was only present among men, not women. Health-related factors partially accounted for the associations between age at divorce and cognitive function among men.

DISCUSSION

Findings highlight the importance of considering the role of timing of marital loss in cognitive health among older adults.

The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly

Both cognitive impairment and cardiovascular diseases have a high incidence in the elderly population, increasing the burden of care and reducing the quality of life. Studies have suggested that cognitive impairment interacts with cardiovascular diseases such as coronary heart disease, abnormal blood pressure, heart failure, and arrhythmia. On one hand, cognitive impairment in the elderly influences the progression and self-management of cardiovascular diseases and increases the risk of cardiovascular-related adverse events. On the other hand, coronary heart disease, heart failure, higher blood pressure variability, orthostatic hypotension, and atrial fibrillation may aggravate cognitive impairment. The role of blood pressure levels on cognition remains controversial. Several shared biological pathways have been proposed as the underlying mechanism for the association. Cardiovascular diseases may lead to cognitive decline even dementia through cerebral perfusion damage, brain structural changes, inflammation, β-amyloid deposition, and neuroendocrine disorders. It is of great significance to study the interaction and put forward effective interventions in an overall perspective to reduce care burden and improve the quality of life of the elderly patients.

Parental status in later life and parents' risk of cognitive impairment

Parental status can influence parents’ well-being in significant ways, but little research has examined its impact on older adults’ cognitive health in the U.S. Using data from the National Health and Aging Trends Study (NHATS) 2011–2019, this study examines whether parental status is related to the risk of cognitive impairment among older adults in the U.S. We found that the presence of adult children (i.e., having at least one living adult child) was associated with a lower risk of cognitive impairment for older parents. Moreover, compared to childless older adults, older parents who had three and more children, who had adult daughter(s), and who had biological/adopted adult children displayed a significantly lower risk of cognitive impairment. This study highlights the importance of adult children as resources of support and caring that may benefit older parents’ cognitive health. The findings can help to identify the most vulnerable subpopulations among aging adults so that medical workers and policy makers can design effective strategies to protect cognitive function for those “at risk” older adults.

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Parental status is an important factor related to older adults’ cognitive health.

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Presence of adult children was associated with a lower risk of cognitive impairment than being childlessness.

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Having 3+ children, adult daughter(s), or biological children was associated with lower risk of cognitive impairment.

Stage II and stage III periodontitis clinical burdens of HIV-1 undergoing antiretroviral therapy

Objectives

The aim of this retrospective cross-sectional study was to estimate the association of HIV-1 infection under highly active antiretroviral treatment (HAART) on the clinical parameters of periodontitis.

Materials and methods

A total of 205 patients were divided in two groups: 74 HIV + and 131 HIV − . Periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and visible supragingival biofilm (VSB) were recorded. The association of HIV-1 infection with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm in non-adjacent teeth was estimated using binary logistic regression models.

Results

The variables HIV-1 infection (OR = 5.53, p < 0.0001, 95% CI: 2.45–13.64), age [range 35–50 years old (OR = 5.73, p < 0.0001, 95% CI: 2.49–13.20); > 50 years old (OR = 6.29, p = 0.002, 95% CI: 1.94–20.42)], and VSB (OR = 23.68, p < 0.0001, 95% CI: 8.07–69.53) showed a significant direct association with BOP outcome.

Conclusions

HIV-1 infection under HAART did not have association with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm. However, HIV patients on HAART had direct association of HIV-1 infection with BOP and an inverse association with PPD.

Clinical relevance

These results support that monitoring gingival bleeding associated with oral prophylaxis would be beneficial in the prevention and management of periodontitis in HIV-1 patients on HAART.

A Narrative Review of Handgrip Strength and Cognitive Functioning: Bringing a New Characteristic to Muscle Memory

BACKGROUND

Measures of handgrip strength have not only emerged as a clinically viable screening tool for determining risk for morbidity, functional disability, and early mortality, but also for helping to identify cognitive deficits. However, the phenomena that links low handgrip strength with cognitive decline remains unclear. The role of the muscular and neural systems, and their adaptations to muscle strengthening activities over the life course, may provide important information for how age-related changes to muscle mass, strength, and neural capacity influence cognition. Moreover, disentangling how handgrip strength and cognitive function are associated may help to inform healthcare providers working with aging adults and guide targeted interventions aiming to preserve muscle and cognitive functioning.

OBJECTIVE

To 1) highlight and summarize evidence examining the associations of handgrip strength and cognitive functioning, and 2) provide directions for future research in this area.

METHODS

Articles from the PubMed database were searched from November 2018-May 2019. The search term algorithm, inclusion and exclusion criteria were pre-specified by investigators.

RESULTS

Several cross-sectional and longitudinal studies have revealed that measures of handgrip strength were associated with cognitive declines regardless of age demographics and the presence of comorbidities.

CONCLUSION

Handgrip strength can be used in clinical and epidemiological settings for helping to determine the onset and progression of cognitive impairment. Future research should continue to examine how handgrip strength and cognitive function are linked.

Marital loss and risk of dementia: Do race and gender matter?

Recent studies have found that marital loss through divorce or widowhood is associated with a higher risk of dementia for older adults. However, whether these associations vary by race and gender is less clear. To address this gap, we drew upon longitudinal data from the Health and Retirement Study (2000-2016) to investigate the association between marital loss and dementia risk, separately for non-Hispanic Whites and non-Hispanic Blacks. We further examined gender variations in the link between marital loss and dementia risk within each racial group. Results from discrete-time event history models suggested that widowhood is significantly associated with a higher risk of dementia for both Whites and Blacks, controlling for basic demographic characteristics. However, while divorce is significantly associated with a higher risk of dementia for Blacks, the association is marginally significant (p < 0.1) for Whites. There are few significant gender variations in these associations except for the effect of divorce among Whites. Even after controlling for economic and health-related factors, we found that divorce is associated with a higher risk of dementia among White men but not among White women. Economic resources explain a significant portion of the association between widowhood and dementia risk, more so for Whites than for Blacks. Our findings call for more research into the pathways through which marital loss shapes the risk of dementia across racial and ethnic groups.

Exhaustive Description of the System Architecture and Prototype Implementation of an IoT-Based eHealth Biometric Monitoring System for Elders in Independent Living

In this paper, we present an exhaustive description of an extensible e-Health Internet-connected embedded system, which allows the measurement of three biometric parameters: pulse rate, oxygen saturation and temperature, via several wired and wireless sensors residing to the realm of Noncommunicable Diseases (NCDs) and cognitive assessment through Choice Reaction Time (CRT) analysis. The hardware used is based on ATMEGA AVR + MySignals Hardware printed circuit board (Hardware PCB), but with multiple upgrades (including porting from ATMEGA328P to ATMEGA2560). Multiple software improvements were made (by writing high-level device drivers, text-mode and graphic-mode display driver) for increasing functionality, portability, speed, and latency. A top-level embedded application was developed and benchmarked. A custom wireless AT command firmware was developed, based on ESP8266 firmware to allow AP-mode configuration and single-command JavaScript Object Notation (JSON) data-packet pushing towards the cloud platform. All software is available in a git repository, including the measurement results. The proposed eHealth system provides with specific NCDs and cognitive views fostering the potential to exploit correlations between physiological and cognitive data and to generate predictive analysis in the field of eldercare.

Which Occupation is Highly Associated with Cognitive Impairment? A Gender-Specific Longitudinal Study of Paid and Unpaid Occupations in South Korea

Background: To examine the associations between paid and unpaid occupations and the risk of cognitive impairment with respect to gender in a middle-aged population using the dataset of a nationally representative longitudinal survey. Methods: Overall, 24,925 observations of 5865 participants aged 45–64 years were sampled from the seven waves of the Korean Longitudinal Study of Ageing (2006–2018). A dichotomous outcome variable was derived based on the Korean version of the Mini-Mental State Examination scores, and occupations were grouped into 12 categories, including three unpaid ones. Sociodemographics, lifestyle, and medical conditions were included as covariates in the mixed logistic regression models. Adjusted odds ratios and predicted probabilities of cognitive impairment were estimated. Results: In the longitudinal models with all-studied covariates, the risk of cognitive impairment was similar between genders but differed across occupation categories for each gender. Moreover, the association between occupation and cognitive impairment varied between genders. Regarding the predicted probability, in men, the retired category exhibited the highest risk of cognitive impairment. However, in women, the highest risk was related to the homemakers category, with the risk being more than five times higher than those in the professionals and related workers category. Conclusions: Public health policies to reduce the risk of cognitive impairment in the middle-aged population need to be designed and implemented with respect to both gender and occupation.

The dietary inflammatory index (DII®) and its association with cognition, frailty, and risk of disabilities in older adults: A systematic review

BACKGROUND & AIMS

Systemic inflammation is considered an important issue in older adults and is associated with adverse health outcomes, such as frailty and cognitive impairment. Diet is a critical associated factor, and the dietary inflammatory index (DII®) is proposed as a promising tool to identify the association between diet and health outcomes. Our aims were: (i) to investigate the association between the DII® and frailty, cognition, and the consequent risk of disability in older adults; (ii) to discuss particularities of the use of DII® with older adults.

METHODS

The research question was based on the PICOS strategy: Population = older adults; Intervention or Exposure = DII; Comparison = any comparator; Outcomes = frailty, cognition, and risk of disability; Type of study = cohort, cross-sectional or case-control studies. We searched publications in two electronic databases (PUBMED and Web of Science) up to May 20th, 2020.

RESULTS

Seven studies met our criteria. Three investigated cognition (one cohort and two cross-sectional), and four investigated frailty or risk of disability (one cohort and three cross-sectional); none of the studies investigated both outcomes (frailty and cognition) simultaneously. The studies presented some issues, mainly concerning: (i) the collection of dietary data and calculation of the DII; (ii) the study design; (iii) calculation of the sample size; (iv) eligibility criteria; (v) time for follow-up; (vi) and choice of covariates.

CONCLUSION

despite the issues, the use of DII resulted in a significant association, or predictive value, with variables related to frailty and cognitive decline. Further studies, with sensitivity analysis of the different components of this index, are needed. DII showed to be a promising tool in the investigation of geriatric syndromes. This systematic review was registered in PROSPERO (CRD42020155672).

Differential Risk of Cognitive Impairment across Paid and Unpaid Occupations in the Middle-Age Population: Evidence from the Korean Longitudinal Study of Aging, 2006-2016

To examine and quantify the risk of cognitive impairment across a variety of occupations including unpaid work in a middle-age population using the dataset of a nationally representative longitudinal survey. A total of 20,932 observations of 5865 subjects aged 45–64 were obtained from six waves of the Korean Longitudinal Study of Aging (2006–2016). A dichotomous outcome variable was constructed on the basis of the Korean Versions of the Mini-Mental State Examination scores, and occupations were grouped into 10 occupation categories, including unpaid housekeepers. Socio-demographics, lifestyle, and medical conditions were used as covariates in mixed logistic regression models. Adjusted odds ratios and predicted probabilities of cognitive impairment were computed and adjusted for a complex survey design. In longitudinal models with all studied covariates, the risk of cognitive impairment differed significantly across occupation categories, but the association of occupation with the risk of cognitive impairment was the same between genders. In terms of the predicted probability, the risk of cognitive impairment in the unpaid housekeepers’ category (11.2%, 95% confidence interval (CI): 10.4% to 11.9%) was the highest among occupation categories, being three times higher than in the professionals’ and related workers’ category (3.7%, 95% CI: 1.6% to 5.7%). Public policies based on studies of the risk of cognitive impairment across different occupations in the middle-age population should be designed so as to prevent cognitive impairment in the middle-age population as well as their older life stages, particularly targeting high-risk groups such as people engaged in unpaid domestic and care activities.

Chronic Disease Onset Among People Living with HIV and AIDS in a Large Private Insurance Claims Dataset

People living with HIV/AIDS (PLWHA) have a growing life expectancy in the US due to early provision of effective antiretroviral treatment. This has resulted in increasing exposure to age-related chronic illness that may be exacerbated by HIV/AIDS or antiretroviral treatment. Prior work has suggested that PLWHA may be subject to accelerated aging, with earlier onset and higher risk of acquiring many chronic illnesses. However, the magnitude of these effects, controlling for chronic co-morbidities, has not been fully quantified. We evaluate the magnitude of association of HIV infection on developing chronic conditions while controlling for demographics, behavioral risk factors, and chronic comorbidities. We compare chronic disease risks of diabetes, hypertension, stroke, cancers, lung diseases, cardiovascular diseases, and cognitive impairment between PLWHA and HIV- individuals in a large, de-identified private insurance claims dataset (~24,000 PLWHA) using logistic regressions. HIV status is statistically significantly associated with higher levels for all chronic illnesses examined, a result which is robust to multiple model specifications and duration of analysis (2, 5, and 10 years from enrollment). Our results suggest that PLWHA may be at elevated risk for a wide variety of chronic illnesses and may require additional care as the aging PLWHA population grows.

Does widowhood affect cognitive function among Chinese older adults?

There is growing evidence from Western countries that widowhood may affect cognitive health in later life. However, little is known about whether widowhood is associated with cognitive health in Eastern Asian countries such as China and what factors may explain the association between widowhood and cognitive health. We add to this line of research by investigating the effect of widowhood on 2-year change in cognitive function among Chinese adults ages 55 and older from 2011 to 2013, using data from the China Health and Retirement Longitudinal Study. Cognitive function was measured by episodic memory and mental intactness (i.e., attention and time orientation). Our results showed that Chinese older adults who were continually widowed at both waves had significantly lower episodic memory scores at Wave 2 than their continually married counterparts, controlling for episodic memory at Wave 1, age, gender, education, and other sociodemographic variables. This suggests that the continually widowed experienced greater decline in episodic memory than the continually married over the 2-year period. After further controlling for economic resources, health, and social engagement, the difference in memory decline between the continually widowed and the continually married barely changed. The effect of widowhood on memory decline was similar for men and women. However, the continually widowed were not significantly different from the continually married in the decline of mental intactness. In addition, newly widowed adults were not significantly different from the continually married in the change of episodic memory and mental intactness. We conclude that staying widowed for 2 years or more may be an independent risk factor for episodic memory decline in China. More research is needed to investigate the mediating and moderating mechanisms underlying the association between widowhood and memory decline.