Difficulties with Fine Motor Skills and Cognitive Impairment in an Elderly Population: The Progetto Veneto Anziani

Enhancing diabetes therapy adherence: a comprehensive study on glucometer usability for type 2 diabetes patients

Background

Self-monitoring of blood glucose (SMBG) is a vital practice for type 2 diabetes (T2DM), and glucometers have the potential to improve therapy adherence. However, characteristics of glucometers improving their usability are underexplored. A knowledge gap exists regarding patients under 65, warranting further research for diabetes care improvement. Thus, this study aims to gather insights on glucometer accessibility, by analyzing the case of the Accu-Chek® Instant glucometer by Roche Diabetes Care GmbH.

Methods

Starting from a previous study having the objective of investigating devices' features able to improve SMBG in over 65 T2DM patients, using the same device, we enlarged the scale, designing a survey that collected answers from 1145 patients of the Center and South of Italy, both under and over 65. 957 answers were analyzed, according to a threshold of 50% completion of the answers.

Results

Our results show the major characteristics presented in Accu-Chek® Instant are appreciated differently between patients under 65 and over 65, and between patients with or without previous experience with a glucometer.

Discussions and conclusions

It emerged how Accu-Chek® was perceived as more user-friendly among individuals under 65 compared to those aged 65 and over, where more people had prior experience, indicating how such a glucometer can be particularly helpful for naive patients. The study provides valuable insights to the academic discourse on glucometer features and their influence on therapy adherence.

Deficits in force production during multifinger tasks demarcate cognitive dysfunction

BACKGROUND

The multifinger force deficit (MFFD) is the decline in force generated by each finger as the number of fingers contributing to an action is increased. It has been shown to associate with cognitive status.

AIMS

The aim was to establish whether a particularly challenging form of multifinger grip dynamometry, that provides minimal tactile feedback via cutaneous receptors and requires active compensation for reaction forces, will yield an MFFD that is more sensitive to cognitive status.

METHODS

Associations between measures of motor function, and cognitive status (Montreal Cognitive Assessment [MoCA]) and latent components of cognitive function (derived from 11 tests using principal component analysis), were estimated cross-sectionally using generalized partial rank correlations. The participants (n  =  62) were community dwelling, aged 65-87.

RESULTS

Approximately half the participants were unable to complete the dynamometry task successfully. Cognitive status demarcated individuals who could perform the task from those who could not. Among those who complied with the task requirements, the MFFD was negatively correlated with MoCA scores-those with the highest MoCA scores tended to exhibit the smallest deficits, and vice versa. There were corresponding associations with latent components of cognitive function.

DISCUSSION

The results support the view that neurodegenerative processes that are a feature of normal and pathological aging exert corresponding effects on expressions of motor coordination-in multifinger tasks, and cognitive sufficiency, due to their dependence on shared neural systems.

CONCLUSIONS

The outcomes add weight to the assertion that deficits in force production during multifinger tasks are sensitive to cognitive dysfunction.

Comprehensive assessment of fine motor movement and cognitive function among older adults in China: a cross-sectional study

BACKGROUND

Fine motor skills are closely related to cognitive function. However, there is currently no comprehensive assessment of fine motor movement and how it corresponds with cognitive function. To conduct a complete assessment of fine motor and clarify the relationship between various dimensions of fine motor and cognitive function.

METHODS

We conducted a cross-sectional study with 267 community-based participants aged ≥ 60 years in Beijing, China. We assessed four tests performance and gathered detailed fine motor indicators using Micro-Electro-Mechanical System (MEMS) motion capture technology. The wearable MEMS device provided us with precise fine motion metrics, while Chinese version of the Montreal Cognitive Assessment (MoCA) was used to assess cognitive function. We adopted logistic regression to analyze the relationship between fine motor movement and cognitive function.

RESULTS

129 (48.3%) of the participants had cognitive impairment. The vast majority of fine motor movements have independent linear correlations with MoCA-BJ scores. According to logistic regression analysis, completion time in the Same-pattern tapping test (OR = 1.033, 95%CI = 1.003-1.063), Completion time of non-dominant hand in the Pieces flipping test (OR = 1.006, 95%CI = 1.000-1.011), and trajectory distance of dominant hand in the Pegboard test (OR = 1.044, 95%CI = 1.010-1.068), which represents dexterity, are related to cognitive impairment. Coordination, represented by lag time between hands in the Same-pattern tapping (OR = 1.663, 95%CI = 1.131-2.444), is correlated with cognitive impairment. Coverage in the Dual-hand drawing test as an important indicator of stability is negatively correlated with cognitive function (OR = 0.709, 95%CI = 0.6501-0.959). Based on the above 5-feature model showed consistently high accuracy and sensitivity at the MoCA-BJ score (ACU = 0.80-0.87).

CONCLUSIONS

The results of a comprehensive fine-motor assessment that integrates dexterity, coordination, and stability are closely related to cognitive functioning. Fine motor movement has the potential to be a reliable predictor of cognitive impairment.

Elucidating the role of diet in maintaining gut health to reduce the risk of obesity, cardiovascular and other age-related inflammatory diseases: recent challenges and future recommendations

A healthy balanced diet is crucial in protecting the immune system against infections and diseases. Poor diets, such as the Western diet, contribute to the development of metabolic diseases, hypertension, and obesity. Microbiota, primarily composed of different microorganisms and residing in the gastrointestinal tract (GIT), also play a significant role in maintaining gut health. Polyphenols and probiotics found in fruits, vegetables, whole grains, legumes, nuts, and seeds promote gut health and support the growth of beneficial bacteria. Different types of diets, their categories, and their impact on health are also mentioned. The relationship between diet, gut health, and the risk of developing obesity, cardiovascular diseases, and inflammatory diseases is discussed in this review article. The rationale behind the review concludes future recommendations for maintaining gut health and reducing the occurrence of obesity, cardiometabolic diseases, and other inflammatory diseases. There is also the need for standardized research methods, long-term studies, and translating scientific knowledge into practical dietary recommendations.

The Purdue Pegboard Test: Normative Data From 1,355 Healthy People From Austria

IMPORTANCE

The Purdue Pegboard Test (PPT) is widely used as a measure of manual dexterity. Declining manual dexterity may predict cognitive decline among elderly people, but normative data for this population are scarce.

OBJECTIVE

To identify demographic and clinical predictors of PPT results in normal middle-aged and elderly Austrian people and to provide norms stratified by significant determinants.

DESIGN

A prospective, community-based cohort study using baseline data of participants from two study panels (1991-1994 and 1999-2003).

SETTING

Monocentric study Participants: 1,355 healthy, randomly selected, community-dwelling people ages 40 to 79 yr.

METHOD

Extensive clinical examination, including completion of the PPT.

OUTCOMES AND MEASURES

The number of pegs placed within a 30-s time limit on four subtests: using the right hand, left hand, both hands, and assembly (within 60 s), respectively. Demographic outcomes were the highest grade achieved.

RESULTS

For all four subtests, increasing age (βs = -0.400 to -0.118, SEs = 0.006 to 0.019, p < .001) and male sex (βs = -1.440 to -0.807, SEs = 0.107 to 0.325, p < .001) was related to worse test results. Among vascular risk factors, diabetes (βs = -1.577 to -0.419, SEs = 0.165 to 0.503, p < .001) was related to worse test results but explained only a small portion (0.7%-1.1%) of the variability in PPT performance.

CONCLUSIONS AND RELEVANCE

We provide age- and sex-specific norms of the PPT for a middle-aged and elderly population. The data represent useful reference values when assessing manual dexterity in older age groups. What This Article Adds: Advancing age and male sex relate to worse performance on the PPT in a community-dwelling cohort without signs and symptoms of neurological disease. Vascular risk factors explain only very little of the variance of test results in our population. Our study adds to the limited age- and sex-specific norms of the PPT among middle-aged and older people.

Prevalence and functional impact of parkinsonian signs in older adults from the Good Aging in Skåne study

INTRODUCTION

Mild parkinsonian signs (MPS) have been characterized by several definitions, using the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). We aimed to investigate the prevalence of MPS and their association with functional level and comorbidities in the oldest old.

METHOD

Community-dwelling older adults (n = 559, median age 85, range 80-102 years) were examined regarding MPS, possible parkinsonism (PP) and subthreshold parkinsonism (SP) according to four previously used definitions and concerning the impact of parkinsonian signs on cognitive, physical, and autonomic function. MPS, PP and SP are different terms describing a very similar phenomenon and there is no gradation between these. In two of the four definitions more advanced symptoms were categorized as parkinsonism.

RESULTS

Median UPDRS score in the whole study group was 10 points (range: 0-58) and was predominated by bradykinesia. MPS/PP/SP were present in 17-85%, and parkinsonism in 33-71% of the cohort. Independently of age and gender, MPS/PP/SP and especially parkinsonism, were associated with a higher risk of fear of falling and accomplished falls, with lower: cognition, ADL, physical activity and quality of life, and with urinary incontinence, obstipation and orthostatic intolerance.

CONCLUSIONS

In a population of older adults above 80 years, MPS are highly prevalent as well as more advanced symptoms defined as parkinsonism, and only 9-17% of the cohort is symptom-free. Predominance of bradykinesia in the oldest old might indicate a need for revision of MPS definitions to improve their sensibility.

Effectiveness of Individual Oral Health Care Training in Hospitalized Inpatients in Geriatric Wards

OBJECTIVE

To investigate the effectiveness of individual oral health care training (IndOHCT) on dental plaque removal and denture cleaning in hospitalized geriatric inpatients.

BACKGROUND

The literature reveals neglect of hygiene and oral care in people aged over 65 years, especially in persons in need of care. Hospitalized geriatric inpatients have poorer dental health than those non-hospitalized. Furthermore, the existing literature reporting on oral healthcare training interventions for hospitalized geriatric inpatients is scarce.

MATERIALS AND METHODS

This pre-post-controlled intervention study dichotomized 90 hospitalized geriatric inpatients into an intervention group (IG) and a control group (CG). Inpatients in the IG received IndOHCT. Oral hygiene was assessed using the Turesky modified Quigley-Hein index (TmQHI) and the denture hygiene index (DHI), at baseline (T0), at a second examination (T1a), and after supervised autonomous tooth brushing and denture cleaning (T1b). The influence of the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Barthel Index (BI) scores on oral hygiene was examined.

RESULTS

There was no significant plaque reduction on teeth or dentures between T0 and T1a in either group. Between T1a and T1b, plaque reduction on the teeth was more effective in the IG than in the CG (p < 0.001). Inpatients with 1-9 remaining teeth removed significantly more dental plaque than inpatients with 10 or more remaining teeth. Inpatients with lower MMSE scores (p = 0.021) and higher age (p = 0.044) reached higher plaque reduction on dentures.

CONCLUSIONS

IndOHCT improved oral and denture hygiene in geriatric inpatients by enabling them to clean their teeth and dentures more effectively.

Association between simple test assessing hand dexterity and mild cognitive impairment in independent older adults

OBJECTIVES

This study aimed to clarify the association between hand function, including grip strength and hand dexterity, assessed using snap fasteners, and mild cognitive impairment (MCI) in older adults with normal global cognitive function.

METHODS

A total of 228 functionally independent older adults (mean age 77.7 ± 6.1 years) participated in this study. None of the participants had a history of dementia diagnosis, and all the participants had a Mini-Mental State Examination score of ≥24. Participants were evaluated for hand function using grip strength and snap fastener tests, and for cognitive function using the National Center for Geriatrics and Gerontology-Functional Assessment Tool.

RESULTS

A total of 72 participants (31.6%) were diagnosed with MCI. The slow snap fastener test group had a higher proportion of participants with MCI (p < 0.001) and impairments in memory (p = 0.010), attention (p = 0.043), executive function (p < 0.001), and processing speed (p = 0.044) compared to the fast snap fastener test group. The slow speed of fastening snap fasteners was significantly associated with MCI and impairment in memory, attention, executive function, and processing speed (MCI: adjusted odds ratio (AOR) = 3.88, 95% confidence interval (CI) = 1.64-9.19; memory: AOR = 5.73, 95% CI = 1.58-20.82; attention: AOR = 3.95, 95% CI = 1.10-14.11; executive function: AOR = 7.22, 95% CI = 1.78-29.24; processing speed: AOR = 7.52, 95% CI = 1.19-47.66) according to the multiple logistic regression analysis. Grip strength was not significantly associated with cognitive impairment.

CONCLUSIONS

Thus, hand dexterity assessed using the snap fastener test was associated with MCI in older adults with normal global cognitive function. Hand dexterity assessment using the snap fastener test is useful for detecting MCI in apparently healthy older adults.

Glucometer Usability for 65+ Type 2 Diabetes Patients: Insights on Physical and Cognitive Issues

Background: Self-monitoring of blood glucose (SMBG) is of paramount relevance for type 2 diabetes mellitus (T2DM) patients. However, past evidence shows that there are physical and cognitive issues that might limit the usage of glucometers by T2DM patients aged 65 years and over. Objective: Our aim was to investigate the physical and cognitive issues related to the usage of glucometers by T2DM patients aged 65 years and over. Materials and Methods: The extant literature was analysed to define an original framework showing the logical nexus between physical and cognitive issues and quality of life. Then we collected evidence addressing the specific case of the Accu-Chek^® Instant glucometer produced by Roche Diabetes Care GmbH, which implements new features claiming to improve usability. We conducted 30 interviews with T2DM patients aged 65 years and over, three interviews with senior nurses, and a focus group with three senior physicians and three senior nurses. Results: From the interviews, both patients and nurses declared that they were generally satisfied with the Accu-Chek^® Instant glucometer's characteristics. In the focus group, the results were commented on and, in the light of some diverging answers, improvements have been set up for future implementation. Conclusions: Our study produces evidence and future suggestions about the usage of glucometers by type 2 diabetes patients aged 65 years and over.

Reduced asymmetry of the hand knob area and decreased sensorimotor u-fiber connectivity in middle-aged adults with autism

Individuals with autism spectrum disorder (ASD) frequently present with impairments in motor skills (e.g., limb coordination, handwriting and balance), which are observed across the lifespan but remain largely untreated. Many adults with ASD may thus experience adverse motor outcomes in aging, when physical decline naturally occurs. The 'hand knob' of the sensorimotor cortex is an area that is critical for motor control of the fingers and hands. However, this region has received little attention in ASD research, especially in adults after midlife. The hand knob area of the precentral (PrC_hand) and postcentral (PoC_hand) gyri was semi-manually delineated in 49 right-handed adults (25 ASD, 24 typical comparison [TC] participants, aged 41-70 years). Using multimodal (T1-weighted, diffusion-weighted, and resting-state functional) MRI, we examined the morphology, ipsilateral connectivity and laterality of these regions. We also explored correlations between hand knob measures with motor skills and autism symptoms, and between structural and functional connectivity measures. Bayesian analyses indicated moderate evidence of group effects with greater right PrC_hand volume and reduced leftward laterality of PrC_hand and PoC_hand volume in the ASD relative to TC group. Furthermore, the right PoC-PrC_hand u-fibers showed increased mean diffusivity in the ASD group. In the ASD group, right u-fiber volume positively correlated with corresponding functional connectivity but did not survive multiple comparisons correction. Correlations of hand knob measures and behavior were observed in the ASD group but did not survive multiple comparisons correction. Our findings suggest that morphological laterality and u-fiber connectivity of the sensorimotor network, putatively involved in hand motor/premotor function, may be diminished in middle-aged adults with ASD, perhaps rendering them more vulnerable to motor decline in old age. The altered morphology may relate to atypical functional motor asymmetries found in ASD earlier in life, possibly reflecting altered functional asymmetries over time.

Deficits in rate of force production during multifinger tasks are associated with cognitive status

OBJECTIVES

The multifinger force deficit (MFFD) is the decline in force generated by an individual finger as the number of fingers contributing to the action is increased. It has been proposed that as a measure of neural sufficiency rather than muscle status, it provides a means of detecting individuals at risk of cognitive decline. Age-related deficits in central neural drive exert a disproportionate impact on the rate at which force can be generated. We examined whether a MFFD derived from the maximum rate at which force is generated, is more sensitive to individual differences in cognitive status, than one calculated using the maximum level of force.

METHODS

Monotonic associations between each of two variants of the MFFD, and cognition (measured with the Montreal Cognitive Assessment), were estimated cross sectionally using generalized partial rank correlations, in which age, level of education and degree of handedness were included as covariates. The participants (n=26) were community dwelling adults aged 66-87.

RESULTS

The MFFD derived using the maximum rate of force development was negatively associated with cognitive status. The association for the MFFD based on the maximum level of force, was not statistically reliable. The associations with cognitive status obtained for both variants of the MFFD were of greater magnitude than those reported previously for standard grip strength dynamometry.

CONCLUSION

The sensitivity with which the MFFD detects risk of cognitive decline may be enhanced by using the maximum rate of force developed by each finger, rather than the maximum force generated by each finger.

Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study

BACKGROUND

Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging.

OBJECTIVE

We examined how midlife self-rated physical functioning and health may predict cognitive health in older age.

METHODS

We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications.

RESULTS

After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment.

CONCLUSION

Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

Purdue manual dexterity testing: A cohort study of community-dwelling elderly

INTRODUCTION

The Purdue Pegboard Test is a manual dexterity test that requires the manipulation of pegs, washers, and collars. Our population for this research study focused on the geriatric community owing to the lack of recent available normative data.

PURPOSE OF THE STUDY

The purpose of this study was to provide updated normative data for hand therapists to use in clinical practice to determine if seniors have dexterity deficits.

STUDY DESIGN

This is a cohort study.

METHODS

This study was completed through a convenience sample which included 128 participants. Participants were stratified into three age groups (60-69, 70-79, and 80+). Participants were asked to complete the Purdue Pegboard Test. Mean scores were analyzed using an independent-sample t-test and one-way analysis of variance to compare the mean scores of each designated age group.

RESULTS

A one-way analysis of variance reported statistically significant differences between the 3 age groups (F = 15.03, P < .00). The results supported that those individuals who were younger (60-69) scored better on the assessment than those aged 80+ years. There was not a statistically significant difference between PPT mean scores of males and females.

DISCUSSION

Mean scores for the PPT for community-dwelling seniors were established.

CONCLUSION

The findings from this study support that dexterity may decline with age, which can affect occupational performance over time.

Long-term functional outcomes of artificial urinary sphincter (AMS 800™) implantation in women aged over 75 years and suffering from stress urinary incontinence caused by intrinsic sphincter deficiency

PURPOSE

To assess the outcomes after artificial urinary sphincter (AUS) implantation in older women aged over 75 years.

METHODS

A monocentric retrospective study included all non-neurological women aged over 75 years suffering from stress urinary incontinence (SUI) due to intrinsic sphincter deficiency and undergoing an AUS placement between 1991 and 2015. Early postoperative complications were reported according to Clavien-Dindo classification. Continence, defined as no pad use, was assessed at the end of follow-up. Explantation, revision and deactivation rates of the AUS were reported. A Kaplan-Meier survival curve was generated to evaluate the survival rate of the device without revision or explantation.

RESULTS

Among 393 AUS implantations, a total of 45 patients, median age 77 years (IQR 75-79), were included. Twenty-six early postoperative complications occurred in 18 patients (40%) patients. All were minor Clavien grades (I-II) except one (grade IVa). Median follow-up was 36 months (IQR 16-96). Overall, 32 women (71.1%) still had their AUS in place at the end of the follow-up, without revision or explantation. The AUS was definitively removed in four (8.9%). The AUS required revisions in nine (20%) women. The 5- and 10-year survival rates of the device without revision or explantation were 78 and 50%, respectively. Three patients (6.7%) had their AUS deactivated. At last follow-up, in an intention-to-treat analysis, the continence rate was 68.9%.

CONCLUSION

In women aged over 75-years-old, suffering from SUI, the AUS provides satisfactory functional results comparable to the general population.

Associations between Cognition and Hand Function in Older People Diagnosed with Mild Cognitive Impairment or Dementia

Background/Aims

The aim of this study was to examine the associations between different cognitive domains and hand function in older people diagnosed with mild cognitive impairment (MCI) or dementia.

Methods

This study is cross-sectional, including 98 community-living older people aged ≥65 years with MCI or dementia. Assessments of hand function included grip strength, the Finger Tapping Test, and the Grooved Pegboard. Cognitive assessments were the Mini-Mental State Examination, the Clock Drawing Test, and Trail Making Tests A and B, as well as a 10-word List Learning Test. Statistical analyses were based on descriptive statistics and univariable and multivariable analyses.

Results

Sixty participants were diagnosed with MCI and 38 were diagnosed with dementia. The mean age was 78.8 years (SD 7.4). Analyses of hand function, cognitive tests, and demographic factors showed an association between cognitive tests, in particular executive function (EF), and hand function.

Conclusions

The findings indicated an association between physical and cognitive function. Among the cognitive domains, declines in EF were most related to a reduced physical function.

The aging mouse brain: cognition, connectivity and calcium

Aging is a complex process that differentially impacts multiple cognitive, sensory, neuronal and molecular processes. Technological innovations now allow for parallel investigation of neuronal circuit function, structure and molecular composition in the brain of awake behaving adult mice. Thus, mice have become a critical tool to better understand how aging impacts the brain. However, a more granular systems-based approach, which considers the impact of age on key features relating to neural processing, is required. Here, we review evidence probing the impact of age on the mouse brain. We focus on a range of processes relating to neuronal function, including cognitive abilities, sensory systems, synaptic plasticity and calcium regulation. Across many systems, we find evidence for prominent age-related dysregulation even before 12 months of age, suggesting that emerging age-related alterations can manifest by late adulthood. However, we also find reports suggesting that some processes are remarkably resilient to aging. The evidence suggests that aging does not drive a parallel, linear dysregulation of all systems, but instead impacts some processes earlier, and more severely, than others. We propose that capturing the more fine-scale emerging features of age-related vulnerability and resilience may provide better opportunities for the rejuvenation of the aged brain.

Executive Function, Dexterity, and Discharge Disposition in Older Intensive Care Unit Survivors

BACKGROUND

Dexterity is a component of motor function. Executive function, a subdomain of cognition, may affect dexterity in older adults recovering from critical illness after discharge from an intensive care unit (ICU).

OBJECTIVES

To explore associations between executive function (attention and cognitive flexibility) and dexterity (fine motor coordination) in the early post-ICU period and examine dexterity by acuity of discharge disposition.

METHODS

The study involved 30 older adults who were functionally independent before hospitalization, underwent mechanical ventilation in the ICU, and had been discharged from the ICU 24 to 48 hours previously. Dexterity was evaluated with the National Institutes of Health Toolbox (NIHTB) Motor Battery 9-Hole Pegboard Dexterity Test (PDT); attention, with the NIHTB Cognition Battery Flanker Inhibitory Control and Attention Test (FICAT); and cognitive flexibility, with the NIHTB Cognition Battery Dimensional Change Card Sort Test (DCCST). Exploratory regression was used to examine associations between executive function and dexterity (fully corrected T scores). Independent-samples t tests were used to compare dexterity between participants discharged home and those discharged to a facility.

RESULTS

FICAT (β = 0.375, P = .03) and DCCST (β = 0.698, P = .001) scores were independently and positively associated with PDT scores. Further, PDT scores were worse among participants discharged to a facility than among those discharged home (mean [SD], 26.71 [6.14] vs 36.33 [10.30]; t24 = 3.003; P = .006).

CONCLUSIONS

Poor executive function is associated with worse dexterity; thus, dexterity may be a correlate of both post-ICU cognitive impairment and functional decline. Performance on dexterity tests could identify frail older ICU survivors at risk for worse discharge outcomes.

Hand Fine Motor Skill Disability Correlates with Cognition in Patients with Moderate-to-Advanced Parkinson's Disease

In older individuals, hand fine motor skill disability is associated with cognitive levels. Similarly, patients with moderate-to-advanced Parkinson's disease (PD) often have cognitive dysfunction. Here, we investigated the association between hand fine motor skill and cognitive dysfunction in patients with moderate-to-advanced PD. Moderate and advanced PD patients with and without dementia were identified from the Taiwan Data Bank of Persons with Disability. Hand fine motor capacities, namely pen holding, buttoning, and knotting, were assessed with the World Health Organization Disability Assessment Schedule 2.0. Statistical analyses were performed on Statistical Analysis System (SAS) and a p value of <0.05 was considered significant. In total, 3440 patients with PD were enrolled, of which 612 had dementia, exhibiting significant disability in all three tasks. After adjustments for age, sex, and PD severity, pen holding and knotting were significantly associated with PD dementia. The presence of any disability in either task was not only sensitive to the presence of dementia but also associated with cognitive disability in moderate and advanced PD patients without dementia. In conclusion, hand fine motor skill disability was associated with cognitive disability in patients with moderate-to-advanced PD. These simple hand fine motor skills may thus be applicable in screening tests for the early identification of cognitive dysfunction in patients with moderate-to-advanced PD.

Manual Dexterity and Aging: A Pilot Study Disentangling Sensorimotor From Cognitive Decline

Manual dexterity measures can be useful for early detection of age-related functional decline and for prediction of cognitive decline. However, what aspects of sensorimotor function to assess remains unclear. Manual dexterity markers should be able to separate impairments related to cognitive decline from those related to healthy aging. In this pilot study, we aimed to compare manual dexterity components in patients diagnosed with cognitive decline (mean age: 84 years, N = 11) and in age comparable cognitively intact elderly subjects (mean age: 78 years, N = 11). In order to separate impairments due to healthy aging from deficits due to cognitive decline we also included two groups of healthy young adults (mean age: 26 years, N = 10) and middle-aged adults (mean age: 41 years, N = 8). A comprehensive quantitative evaluation of manual dexterity was performed using three tasks: (i) visuomotor force tracking, (ii) isochronous single finger tapping with auditory cues, and (iii) visuomotor multi-finger tapping. Results showed a highly significant increase in force tracking error with increasing age. Subjects with cognitive decline had increased finger tapping variability and reduced ability to select the correct tapping fingers in the multi-finger tapping task compared to cognitively intact elderly subjects. Cognitively intact elderly subjects and those with cognitive decline had prolonged force release and reduced independence of finger movements compared to young adults and middle-aged adults. The findings suggest two different patterns of impaired manual dexterity: one related to cognitive decline and another related to healthy aging. Manual dexterity tasks requiring updating of performance, in accordance with (temporal or spatial) task rules maintained in short-term memory, are particularly affected in cognitive decline. Conversely, tasks requiring online matching of motor output to sensory cues were affected by age, not by cognitive status. Remarkably, no motor impairments were detected in patients with cognitive decline using clinical scales of hand function. The findings may have consequences for the development of manual dexterity markers of cognitive decline.