Prevalence and Incidence of Mild Cognitive Impairment across Subtypes, Age, and Sex

Longitudinal patterns of cognitive function and depression: insights from the China Health and Retirement Longitudinal Study

Background

With the acceleration of population aging, cognitive impairment and depression have become serious public health challenges in countries around the world. The influencing factors of cognitive trajectory, depression trajectory, and dual trajectories in middle-aged and elderly adults have not been fully studied.

Methods

This study used data from the China Health and Retirement Longitudinal Study database spanning from 2011-2018. Group-based trajectory modelling and group-based dual trajectory modelling were employed to examine different trajectories. Restricted cubic spline and multivariate logistic regression analysis were used to elucidate the relationship between sleep duration and grip strength with these different trajectories. Mediation analysis was conducted to explore the mediating roles of sleep duration and grip strength in the activities of daily living (ADLs) and their impact on these trajectories.

Results

Trajectory analysis identified two longitudinal patterns of cognitive function and depression scores: low and high cognitive group, low and high depression group, respectively, and two states of the dual trajectories of cognition and depression: the stable state group and the state decline group. Sleep duration and grip strength were associated with the cognitive trajectory, depression trajectory and dual trajectories. Sleep duration has an inverted U-shaped relationship with cognitive trajectory. Grip strength was nonlinearly associated with the above trajectories. The mediation effects of sleep duration in the association between ADLs and cognitive, depression and dual trajectories were 3.14, 6.14, and 2.70%. While the mediation effects of grip strength were 7.21, 1.67 and 6.24%, respectively (P < 0.05).

Conclusions

Sleep duration and grip strength were not only associated with cognitive, depression, and dual trajectories, but also partially mediate the relationship between ADLs and these trajectories. This study will provide a basis for how to intervene in the cognitive and mental health of middle-aged and elderly adults.

Education level and health profile related to global cognitive impairment in an urban community in West Jakarta, Indonesia

OBJECTIVES

This study aims to investigate the association of global cognitive with chronic conditions, physical impairment, olfactory function, socio-demographics and other factors among older adults in the urban community, West Jakarta.

MATERIALS AND METHODS

The cross-sectional study involved 334 older adults aged 60 years and older who resided in urban community Jakarta, Indonesia. Trained interviewers visited and evaluated the respondents in the sub-district office. Cognitive function is examined using Montreal Cognitive Assessment-Indonesian Version (MoCA-INA). Respondents were clinically examined using a standardized protocol, which included medical history, general physical examination, cognitive assessment, and blood test for diabetes.

RESULTS

Global cognitive impairment was significantly associated with being female (adjusted odd ratio [AOR]: 1.99, 95% CI: 1.14-3.50) and low education (AOR: 4.79, 95% CI: 2.80-8.18). Moreover diabetes, impaired balance, and olfactory dysfunction have AOR:3.23 (95% CI: 1.39-7.51), 2.55% (95% CI: 1.07-6.07), and 2.26 (95% CI: 1.32-3.85) respectively.

CONCLUSION

This paper highlights that cognitively impaired and diabetic as well as low education subject in urban community, West Jakarta, Indonesia. Global cognitive impairment was associated with being female, having obtained low levels of education, having diabetes, impaired balance and olfactory dysfunction.

Recognition of static and dynamic emotional facial expressions in mild cognitive impairment, healthy elderly and young people

INTRODUCTION

The ability to recognize emotions is essential for social cognition, and its impairment can affect social interactions, contributing to loneliness and the worsening of issues in individuals with mild cognitive impairment (MCI). This study aims to investigate the ability to recognize emotional facial expressions in MCI individuals compared to healthy elderly and young individuals.

METHOD

We evaluated 27 MCI individuals, 31 healthy elderly, and 29 healthy young participants using two tasks: one with static facial expressions (photographs) and another with dynamic ones (video clips).

RESULTS

The younger group recognized all negative emotional expressions better than the other two groups and also performed better on neutral expressions compared to MCI patients. The healthy elderly group outperformed MCI patients in recognizing most expressions, except for happiness and neutral. Additionally, the ability to recognize dynamic expressions was superior to static ones across all groups for several emotions.

DISCUSSION

These results emphasize the importance of assessing the ability to recognize emotional facial expressions within neuropsychological protocols, to help detect this condition early on. Given the pivotal role that emotional facial expressions play in social interactions, these difficulties can contribute to a decline in such interactions and an increase in social isolation.

Mediterranean diet related to 3-year incidence of cognitive decline: results from a cohort study in Chinese rural elders

OBJECTIVE

This study aims to examine the effect of the Mediterranean diet (MeDi) on cognitive decline among the Chinese elderly with a 3-year follow-up.

METHODS

This study is divided into two waves: wave-1 January 2019 to June 2019 (n = 2313); wave-2 January 2022 to March 2022 (n = 1648). MeDi scores were calculated from the Mediterranean Diet Adherence Screener (MEDAS), with the scoring of low compliance (0-6 points) and high compliance (7-14 points). The Mini-Mental State Examination (MMSE) was used to assess cognitive function. An MMSE score dropping ≥ 2 points from baseline was defined as cognitive decline. The relationships between MeDi score and cognitive decline were analyzed by linear regression models or Binary logistic regression.

RESULTS

During the 3-year follow-up, 23.8% of patients exhibited cognitive decline. The study revealed a significant difference in MMSE score changes between low and high MeDi adherence groups (p < 0.001). MeDi score was negatively correlated with cognitive deterioration (β = -0.020, p = 0.026). MeDi score was only negatively associated with cognitive decline in the female subgroup aged ≥65 years (β = -0.034, p = 0.033). The food beans (OR = 0.65, 95%CI:0.51, 0.84), fish (OR = 0.72, 95%CI:0.54, 0.97), and cooked vegetables (OR = 0.68, 95%CI:0.53, 0.84) were protective factors for cognitive decline.

CONCLUSIONS

This study suggests that greater adherence to the MeDi is linked to a reduced risk of cognitive decline in elderly people. However, this is found only in women who are 65 years old or older. It also found long-term adherence to beans, fish, and vegetables are more effective in improving cognitive function.

Associations between sleep duration, depression status, and cognitive function among Chinese elderly: A community-based study

BACKGROUND

The associations of sleep duration and depressive status on cognitive function among the elderly remain controversial. This study aimed to investigate the associative effects and mediating mechanisms between sleep duration and depressive status on cognitive function in elderly adults.

METHODS

Participants were recruited from cross-sectional and cohort surveys of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We identified thresholds for sleep duration and depression and used logistic regression to explore their independent and joint effects on cognitive impairment. Further, we analyze the mediating effects of depressive status on the association between sleep duration and cognitive function.

RESULTS

Of 13840 elderly (median age: 84 years, female: 54.6 %), 2835 (20.5 %) had cognitive impairment. Compared with those who slept 6-8 h, the ORs (95%CIs) for those who slept < 6 h and > 8 h were 0.98 (0.85, 1.12) and 1.48 (1.32, 1.66). Compared with non-depressed, the OR (95%CI) for the depressed participants was 1.74 (1.53, 1.98). Compared with those with sleep 6-8 h and none-depression, those with sleep > 8 h and depression had the highest odds of cognitive impairment (OR = 2.40, 95%CI: 1.88-3.07). Additionally, Compared with those who slept 6-8 h, the associations between depression-mediated short and long sleep and cognitive impairment were 51.1 % and 6.5 %, respectively.

LIMITATIONS

Cross-sectional studies require caution in the interpretation of causal associations.

CONCLUSIONS

Long sleep and depression were independently and jointly associated with higher odds of cognitive impairment among the Chinese elderly, and short sleep increased the risk of cognitive impairment by promoting the prevalence of depression.

A non-linear relationship between blood pressure and mild cognitive impairment in elderly individuals: A cohort study based on the Chinese longitudinal healthy longevity survey (CLHLS)

BACKGROUND

Hypertension is an established risk factor for mild cognitive impairment (MCI) in elderly individuals. Nevertheless, the impact of different levels of blood pressure on the progression of MCI remains uncertain. This study aims to investigate the non-linear relationship between blood pressure and MCI in the elderly and detect the critical blood pressure threshold, thus, improving blood pressure management for individuals at high risk of MCI.

METHODS

Data was obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) cohort. We chose normal cognitive elderly individuals who entered the cohort in 2014 for a 5-year follow-up to observe the progression of MCI. Subsequently, we utilized the Cox regression model to identify risk factors for MCI and conducted a Cox-based restricted cubic spline regression (RCS) model to examine the non-linear relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) with MCI, determining the critical blood pressure threshold for MCI progression.

RESULTS

In the elderly population, female (HR = 1.489, 95% CI: 1.017-2.180), lacking of exercise in the past (HR = 1.714, 95% CI: 1.108-2.653), preferring animal fats (HR = 2.340, 95% CI: 1.348-4.061), increased age (HR = 1.061, 95% CI: 1.038-1.084), increased SBP (HR = 1.036, 95% CI: 1.024-1.048), and increased DBP (HR = 1.056, 95% CI: 1.031-1.081) were associated with MCI progression. After adjusting factors such as gender, exercise, preferred types of fats, and age, both SBP (P non-linear < 0.001) and DBP (P non-linear < 0.001) in elderly individuals exhibited a non-linear association with MCI. The risk of MCI rose when SBP exceeded 135 mmHg and DBP was in the range of 80-88 mmHg. However, when DBP exceeded 88 mmHg, there was a declining trend in MCI progression, although the HR remained above 1. The identified critical blood pressure management threshold for MCI was 135/80 mmHg.

CONCLUSION

In this study, we discovered that risk factors affecting the progression of MCI in elderly individuals comprise gender (female), preferring to use animal fat, lack of exercise in the past, increased age, increased SBP, and increased DBP. Additionally, a non-linear relationship between blood pressure levels and MCI progression was confirmed, with the critical blood pressure management threshold for MCI onset falling within the prehypertensive range.

Prevalence of dementia diagnosis in Sweden by geographical region and sociodemographic subgroups: a nationwide observational study

Background

Although dementia incidence has decreased in high-income countries, it is important to monitor the prevalence of dementia and identify potential underdiagnosis in population subgroups. This study provides the most up-to-date prevalence of dementia diagnosis in Sweden, by geographical regions and sociodemographic groups.

Methods

We identified all individuals aged ≥62 years, registered and alive in Sweden at the end of 2022 (n = 2.48 million). Dementia diagnoses were identified using ICD-9/10 codes in the National Patient Register since 1987, as well as anti-dementia drug use from the Prescribed Drug Register since 2005.

Findings

At the end of 2022, 3.7% (92,293/2,483,798) of people aged ≥62 years in Sweden had a dementia diagnosis from specialist care or drug prescriptions and varied from 0.6% in ages 62-69 to 14.8% in ages ≥90. The prevalence of cognitive impairment diagnosis was 2.5%. There was some geographical variation in the prevalence of dementia diagnosis, with a larger proportion of diagnoses coming from drug prescriptions than from specialist care in northern Sweden. While people born abroad and people without a close relative had a slightly higher prevalence of dementia diagnosis than Swedish born and those with close relatives, the prevalence was substantially lower for people living alone than for cohabiting individuals.

Interpretation

Comparing case estimates from previous screening cohorts, our results suggest underdiagnosis of dementia in the general older population, particularly among people who live alone. In more rural areas with lower availability of memory clinics, primary care may play an important role in diagnosing older adults with dementia.

Funding

Swedish Research Council for Health, Working Life and Welfare; Swedish Research Council; Region Stockholm.

Personality and Transition From Mild Cognitive Impairment to Normal Cognition vs Dementia

OBJECTIVES

Mild cognitive impairment (MCI) is a critical stage preceding incident dementia, but not all individuals with MCI progress to dementia and some revert to normal cognition. This study examined whether personality is associated with the probability of transition from MCI to normal cognition or dementia.

DESIGN

Longitudinal observational study.

SETTING AND PARTICIPANTS

Older adults with MCI from the Health and Retirement Study (N = 1608, 56% female, mean age = 72.29, SD = 9.91). Personality traits; cognitive status; and demographic (age, sex, education, race, and ethnicity), clinical (diabetes, hypertension), behavioral (smoking, physical activity), psychological (depressive symptoms), and genetic (apolipoprotein E ε4) covariates were obtained in 2006/2008. Follow-up data on cognitive status were collected every 2 years up to the 2020 wave.

METHODS

Cox regression analyses tested the association between personality and reversion from MCI to normal cognition and progression to dementia, controlling for demographic, clinical, behavioral, psychological, and genetic covariates.

RESULTS

Controlling for demographic factors, lower neuroticism and higher openness and conscientiousness were associated with a higher likelihood of reversion from MCI to normal cognition and a lower risk of progression to dementia over time. Higher agreeableness was related to a lower risk of progression to dementia. Clinical, behavioral, psychological, and genetic factors partially accounted for these associations. There was little evidence that demographic, genetic factors, or baseline cognition moderated these associations.

CONCLUSIONS AND IMPLICATIONS

Personality traits can help identify individuals who are more likely to revert from MCI and not progress to dementia. These findings suggest that even during mild impairment, personality may modulate dementia risk and thus inform targeted interventions.

Do people with cognitive impairment benefit from cochlear implants? A scoping review

PURPOSE

To identify and evaluate the evidence for the benefits of cochlear implants for people with cognitive impairment or dementia in terms of speech recognition, quality of life, behavioural and psychological symptoms of dementia, cognition, function in daily life, mental well-being, and caregiver burden.

METHODS

Ten electronic databases were searched systematically from inception to December 2023 for studies reporting on outcomes for cochlear implants that included adults identified with cognitive impairment, mild cognitive impairment, or dementia.

RESULTS

Thirteen studies were included in this review with a combined total of 222 cochlear implant patients with cognitive impairment, mild cognitive impairment. Two studies were non-randomised controlled design, the remainder were single group studies, case series or single case studies. Evidence suggested that people with cognitive impairment benefit in terms of improved speech recognition from cochlear implants, although they may benefit less than those with healthy cognition and the degree of benefit depends on the level of cognitive impairment. There was no evidence for increased adverse events among those with cognitive impairment. There was limited or no evidence for any other outcome.

CONCLUSION

People with cognitive impairment or dementia do benefit from cochlear implants. To inform policy and clinical practice, further data are needed about the broader benefits of cochlear implants for people with cognitive impairment or dementia, and referral, eligibility, and cochlear implant support needs for people with cognitive impairment and their caregivers.

Quality of life in persons with mild cognitive impairment: a systematic review and meta-analysis

The global increase in the aging population has raised concerns over various age-related conditions like dementia and mild cognitive impairment (MCI) and their consequences on the affected persons. People with MCI exhibit cognitive deficits more significantly than expected for their age and literacy level. Though the nature of this condition is considered "mild", studies have reported that even more subtle deficits can influence the quality of life (QOL).

Objective

The present work aimed at exploring and comparing QOL in older adults with and without MCI through a systematic review and meta-analysis.

Methods

After a detailed search of articles till May 2021 in the relevant electronic databases (PubMed Central, PubMed, Scopus, CINAHL Plus, Web of Science, ProQuest, and Cochrane) using the keywords "mild cognitive impairment", "quality of life", "old", "old aged", "aged", "older adult", "geriatrics", "healthy controls", "healthy participants", and "normal controls", we included 23 articles in the systematic review and 12 in the meta-analysis.

Results

The quality of all the included articles were assessed using the Modified Downs and Black tool. Most of the studies in the systematic review demonstrated differences in QOL scores in older adults with MCI compared to healthy older adults. However, meta-analysis findings suggest that older adults with MCI had statistically non-significant yet lower differences in QOL compared to their healthy counterparts.

Conclusion

Future research should focus on developing QOL assessment tools specifically for older adults with MCI and follow-up studies that could provide better knowledge of their changing cognitive profile and life quality.

Radiographic Knee Osteoarthritis Is a Risk Factor for the Development of Dementia: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study

OBJECTIVE

Osteoarthritis is linked to dementia, but no longitudinal studies have established this connection. This prospective cohort study from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) aimed to determine if knee osteoarthritis (KOA) independently predicts dementia in adults aged 65 and above.

METHODS

Participants were classified by the Kellgren-Laurence scale into no/minimal KOA (grades 0 and I) and definitive KOA (grade II or higher). We analyzed dementia incidence from 2009 to 2015 using long-term care insurance data, adjusting for age, sex, vascular risks, depressive symptoms, and activity levels.

RESULTS

Out of 1089 participants (58.9% female, average age 72.5), 72.0% had definitive KOA. Dementia occurrence was significantly higher in the definitive group (8.4%) compared to the no/minimal group (3.0%) (p < 0.001). A log-rank test and Cox regression analysis confirmed these findings, showing an adjusted hazard ratio of 2.29 (confidence interval: 1.12-4.68) for dementia in those with definitive KOA.

CONCLUSIONS

These results suggest that KOA is a significant risk factor for dementia, highlighting the importance of addressing contributing factors in KOA patients to potentially slow the progression of dementia.

A nomogram for individualized prediction of mild cognitive impairment in patients with subjective cognitive decline during physical examinations: a cross-sectional study

Background and objectives

To develop a nomogram for mild cognitive impairment (MCI) in patients with subjective cognitive decline (SCD) undergoing physical examinations in China.

Methods

We enrolled 370 patients undergoing physical examinations at the Medical Center of the First Hospital of Jilin University, Jilin Province, China, from October 2022 to March 2023. Of the participants, 256 were placed in the SCD group, and 74 were placed in the MCI group. The population was randomly divided into a training set and a validation set at a 7:3 ratio. A least absolute shrinkage and selection operator (LASSO) regression model was applied to optimize feature selection for the model. Multivariable logistic regression analysis was applied to construct a predictive model. The performance and clinical utility of the nomogram were determined using Harrell's concordance index, calibration curves, and decision curve analysis (DCA).

Results

Cognitive reserve (CR), age, and a family history of hypertension were associated with the occurrence of MCI. The predictive nomogram showed satisfactory performance, with a concordance index of 0.755 (95% CI: 0.681-0.830) in internal verification. The Hosmer-Lemeshow test results suggested that the model exhibited good fit (p = 0.824). In addition, DCA demonstrated that the predictive nomogram had a good clinical net benefit.

Discussion

We developed a simple nomogram that could help secondary preventive health care workers to identify elderly individuals with SCD at high risk of MCI during physical examinations to enable early intervention.

Identifying Critical Nodes in the Cognitive Decline Process through EEG Network Community Detection Based on Autoencoder

Cognitive impairment is a neurodegenerative disease characterized by a decline in cognitive functions. In recent years, the application of non-pharmacological interventions such as physical stimuli has garnered attention due to their convenience and efficacy. However, the selection of stimulation targets significantly impacts the therapeutic outcomes, and there is yet to be a mature method for specific target selection. This study considers the neural network alterations during the progression from healthy individuals to those with Mild Cognitive Impairment (MCI), utilizing autoencoders to encode the network structure of resting-state Electroencephalography (EEG) to reveal its community information. By integrating node behavior analysis, the dynamic influence of network nodes was calculated to explore the critical brain regions during disease progression. The findings demonstrate that Transcranial Magnetic Stimulation (TMS) treatment targeting these key nodes significantly improved the cognitive performance of MCI patients. Our research introduces a novel method for discovering critical brain regions, providing a new avenue for non-pharmacological treatment of MCI. By elucidating the neural network alterations and key nodes during MCI progression, our work offers valuable insights for early diagnosis and treatment of neurodegenerative diseases in the future.

Assessment of Cognitive Function in European Adults Aged 50+in Relation to Their Handgrip Strength and Physical Inactivity: The SHARE Study During 2019-2020

BACKGROUND

Cognitive function is crucial during aging. This study assessed the cognitive function of European adults aged 50 and over in relation to handgrip strength and physical inactivity. Study Design: This was a cross-sectional survey.

METHODS

Data were collected from 41,395 adults from 27 European countries participating in the Survey of Health, Ageing, and Retirement in Europe (SHARE) during 2019-2020. Cognitive function was assessed based on five tests, and cognitive impairment was defined using 3+tests. Handgrip strength and physical inactivity were also correlated through the analysis of covariance using a complex study design.

RESULTS

The majority of participants were female (56.6%), with a mean age of 70.9 years, and 22.6% presented multimorbidity. Furthermore, 51.1% had a normal cognitive function, while 13.3% had cognitive impairment (The estimated population was 21,944,722). Moreover, cognitive impairment was more prevalent in females than in males (14.4% vs. 12.0%, P<0.001) in patients with no years of education (P<0.001) and origin from southern European countries (P<0.001). Additionally, participants with cognitive impairment had lower mean handgrip strength compared to those with cognitive impairment in 1-2 criteria or with normal cognitive function (29.3 vs. 33.4 and 35.1 kg, respectively, P<0.001). Physically inactive participants had higher odds ratio (OR) of cognitive impairment than those engaging in moderate/vigorous physical activity, both in 1-2 tests (OR:1.73, 95% confidence interval (CI): 1.32-2.26) and in 3+tests (OR: 3.36, 95% CI: 2.57-4.40).

CONCLUSION

Cognitive impairment presented low prevalence and was associated with low levels of handgrip strength and physical inactivity. These specific factors may play a special role in early detection, diagnosis, and treatment or may slow down the progression of cognitive impairment.

From Gut to Brain: Uncovering Potential Serum Biomarkers Connecting Inflammatory Bowel Diseases to Neurodegenerative Diseases

Inflammatory bowel diseases (IBDs) are characterized by chronic gastrointestinal inflammation due to abnormal immune responses to gut microflora. The gut-brain axis is disrupted in IBDs, leading to neurobiological imbalances and affective symptoms. Systemic inflammation in IBDs affects the brain's inflammatory response system, hormonal axis, and blood-brain barrier integrity, influencing the gut microbiota. This review aims to explore the association between dysregulations in the gut-brain axis, serum biomarkers, and the development of cognitive disorders. Studies suggest a potential association between IBDs and the development of neurodegeneration. The mechanisms include systemic inflammation, nutritional deficiency, GBA dysfunction, and the effect of genetics and comorbidities. The objective is to identify potential correlations and propose future research directions to understand the impact of altered microbiomes and intestinal barrier functions on neurodegeneration. Serum levels of vitamins, inflammatory and neuronal damage biomarkers, and neuronal growth factors have been investigated for their potential to predict the development of neurodegenerative diseases, but current results are inconclusive and require more studies.

Prediction of Cognitive Impairment Risk among Older Adults: A Machine Learning-Based Comparative Study and Model Development

INTRODUCTION

The prevalence of cognitive impairment and dementia in the older population is increasing, and thereby, early detection of cognitive decline is essential for effective intervention.

METHODS

This study included 2,288 participants with normal cognitive function from the Ma'anshan Healthy Aging Cohort Study. Forty-two potential predictors, including demographic characteristics, chronic diseases, lifestyle factors, anthropometric indices, physical function, and baseline cognitive function, were selected based on clinical importance and previous research. The dataset was partitioned into training, validation, and test sets in a proportion of 60% for training, 20% for validation, and 20% for testing, respectively. Recursive feature elimination was used for feature selection, followed by six machine learning algorithms that were employed for model development. The performance of the models was evaluated using area under the curve (AUC), specificity, sensitivity, and accuracy. Moreover, SHapley Additive exPlanations (SHAP) was conducted to access the interpretability of the final selected model and to gain insights into the impact of features on the prediction outcomes. SHAP force plots were established to vividly show the application of the prediction model at the individual level.

RESULTS

The final predictive model based on the Naive Bayes algorithm achieved an AUC of 0.820 (95% CI, 0.773-0.887) on the test set, outperforming other algorithms. The top ten influential features in the model included baseline Mini-Mental State Examination (MMSE), education, self-reported economic status, collective or social activities, Pittsburgh sleep quality index (PSQI), body mass index, systolic blood pressure, diastolic blood pressure, instrumental activities of daily living, and age. The model demonstrated the potential to identify individuals at a higher risk of cognitive impairment within 3 years from older adults.

CONCLUSION

The predictive model developed in this study contributes to the early detection of cognitive impairment in older adults by primary healthcare staff in community settings.

Social networking older adults with mild cognitive impairment: Systematic review protocol on their use of information and communication technology

This systematic review will identify and synthesize the emerging evidence on older adults with Mild Cognitive Impairment (MCI) utilizing Information and Communication Technology (ICT) to maintain, restore, or augment social networks. The systematic review will consider the evidence on contextual and personal factors of older adults with MCI and their ICT use for social connectedness. The evidence searches will be implemented in PsycINFO, Academic Search Complete, Medline, PubMed, and manual searches. We shall review articles that were published between January 2010 and October 2023 in English and on Information and Communication Technology utility in social networking among older adults with MCI. The process of article selection will be conducted through title screening, abstract screening; and full article screening, following the Population, Intervention, Control, Outcomes (PICO) criteria. Given that all the studies included in this review are publicly accessible and have already obtained ethical approval from their respective institutions, there is no obligation for us to seek additional ethical clearance for our systematic review. We plan to share the outcomes of the systematic review through online presentations and dissemination within the research community. The findings from this review will identify the extent of empirical evidence on older adults with MCI utilizing ICTs to maintain, restore or augment their social networks. This review will provide evidence for contextual and personal factors in older adults with MCI for the social networks with ICT use. This review will propose practical implications for the effective utilization of ICT by older adults with MCI.

Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults: a competing risk analysis

Background

Depressive symptoms and cognitive impairment often interact, rendering their associations controversial. To date, their joint trajectories and associations with dementia and death remain underexplored.

Aims

To explore the interactions between depressive symptoms and cognitive function, their developmental trajectories and the associations with all-cause dementia, Alzheimer's disease (AD) and all-cause death in older adults.

Methods

Data were from the Health and Retirement Study. Depressive symptoms and cognitive function were measured using the 8-item Centre for Epidemiologic Studies Depression Scale and the Telephone Interview of Cognitive Status, respectively. All-cause dementia and AD were defined by self-reported or proxy-reported physician diagnoses. All-cause death was determined by interviews. The restricted cubic spline, group-based trajectory modelling and subdistribution hazard regression were used.

Results

Significant interactions between depressive symptoms and cognitive function in 2010 in their association with new-onset all-cause dementia and AD from 2010 to 2020 were found, especially in women (p for interaction <0.05). Independent trajectory analysis showed that emerging or high (vs no) depressive trajectories and poor or rapidly decreased cognitive trajectories (vs very good) from 1996 to 2010 were at significantly higher risk of subsequent all-cause dementia, AD and all-cause death. 15 joint trajectories of depressive symptoms and cognitive function from 1996 to 2010 were determined, where rapidly decreased cognitive function was more common in those with no depressive symptoms. Compared with older adults with the trajectory of no depressive symptoms and very good cognitive function, those with the trajectory of no depressive symptoms but rapidly decreased cognitive function were much more likely to develop new-onset all-cause dementia and death, with subdistribution hazard ratios (95% confidence intervals) of 4.47 (2.99 to 6.67) and 1.84 (1.43 to 2.36), especially in women.

Conclusions

To effectively mitigate the risk of dementia and death, it is crucial to acknowledge the importance of preventing cognitive decline in older adults without depressive symptoms, particularly in women.

Cognitive and physical declines and falls in older people with and without mild cognitive impairment: a 7-year longitudinal study

OBJECTIVES

We examined longitudinal changes in cognitive and physical function and associations between change in function and falls in people with and without mild cognitive impairment (MCI).

DESIGN

Prospective cohort study with assessments every 2 years (for up to 6 years).

SETTING

Community, Sydney, Australia.

PARTICIPANTS

Four hundred and eighty one people were classified into three groups: those with MCI at baseline and MCI or dementia at follow-up assessments (n = 92); those who fluctuated between cognitively normal and MCI throughout follow-up (cognitively fluctuating) (n = 157), and those who were cognitively normal at baseline and all reassessments (n = 232).

MEASUREMENTS

Cognitive and physical function measured over 2-6 years follow-up. Falls in the year following participants' final assessment.

RESULTS

In summary, 27.4%, 38.5%, and 34.1% of participants completed 2, 4, and 6 years follow-up of cognitive and physical performance, respectively. The MCI and cognitive fluctuating groups demonstrated cognitive decline, whereas the cognitively normal group did not. The MCI group had worse physical function than the cognitively normal group at baseline but decline over time in physical performance was similar across all groups. Decline in global cognitive function and sensorimotor performance were associated with multiple falls in the cognitively normal group and decline in mobility (timed-up-and-go test) was associated with multiple falls across the whole sample.

CONCLUSIONS

Cognitive declines were not associated with falls in people with MCI and fluctuating cognition. Declines in physical function were similar between groups and decline in mobility was associated with falls in the whole sample. As exercise has multiple health benefits including maintaining physical function, it should be recommended for all older people. Programs aimed at mitigating cognitive decline should be encouraged in people with MCI.

Interaction between Aβ and tau on reversion and conversion in mild cognitive impairment patients: After 2-year follow-up

Background

The role of amyloid-β (Aβ) and tau in reversion and conversion in patients with mild cognitive impairment (MCI) remains unclear. This study aimed to investigate the influence of cerebrospinal fluid (CSF) Aβ and tau on reversion and conversion and the temporal sequence of their pathogenicity in MCI patients.

Methods

179 MCI patients were recruited from the Alzheimer's Disease Neuroimaging Initiative database and classified into two groups based on cognitive changes after follow-up: reversal group (MCI to cognitively normal) and conversion group (MCI to Alzheimer's disease). CSF biomarkers and cognitive function were measured at baseline and 2-year follow-up. Partial correlation was used to analyze the association between CSF biomarkers and cognitive function, and multivariable logistic regression to identify independent risk factors for cognitive changes at baseline and 2-year follow-up. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive ability of these risk factors for cognitive changes.

Results

The differences in cognitive function and CSF biomarkers between the two groups remained consistent with baseline after 2-year follow-up. After controlling for confounding variables, there was still a correlation between CSF biomarkers and cognitive function at baseline and 2-year follow-up. Multivariable regression analysis found that at baseline, only Aβ level was independently associated with cognitive changes, while Aβ and tau were both predictive factors after 2-year follow-up. ROC curve analysis revealed that the combination of Aβ and tau [area under the curve (AUC) 0.91, sensitivity 84%, specificity 86%] in predicting cognitive changes after 2-year follow-up had better efficacy than baseline Aβ alone (AUC 0.81).

Conclusion

Aβ may precede Tau in causing cognitive changes, and the interaction between the two mediates cognitive changes in patients. This study provides new clinical evidence to support the view that Aβ pathology precedes tau pathology, which together contribute to the changes in cognitive function.

Higher remnant cholesterol is associated with an increased risk of amnestic mild cognitive impairment: a community-based cross-sectional study

Background and aims

Amnestic mild cognitive impairment (aMCI) is the most common subtype of MCI, which carries a significantly high risk of transitioning to Alzheimer's disease. Recently, increasing attention has been given to remnant cholesterol (RC), a non-traditional and previously overlooked risk factor. The aim of this study was to explore the association between plasma RC levels and aMCI.

Methods

Data were obtained from Brain Health Cognitive Management Team in Wuhan (https://hbtcm.66nao.com/admin/). A total of 1,007 community-dwelling elders were recruited for this project. Based on ten tools including general demographic data, cognitive screening and some exclusion scales, these participants were divided into the aMCI (n = 401) and normal cognitive groups (n = 606). Physical examinations were conducted on all participants, with clinical indicators such as blood pressure, blood sugar, and blood lipids collected.

Results

The aMCI group had significantly higher RC levels compared to the normal cognitive group (0.64 ± 0.431 vs. 0.52 ± 0.447 mmol/L, p < 0.05). Binary logistics regression revealed that occupation (P<0.001, OR = 0.533, 95%CI: 0.423-0.673) and RC (p = 0.014, OR = 1.477, 95% CI:1.081-2.018) were associated factors for aMCI. Partial correlation analysis, after controlling for occupation, showed a significant negative correlation between RC levels and MoCA scores (r = 0.059, p = 0.046), as well as Naming scores (r = 0.070, p = 0.026). ROC curve analysis demonstrated that RC levels had an independent predictive efficacy in predicting aMCI (AUC = 0.580, 95%CI: 0.544 ~ 0.615, P < 0.001).

Conclusion

Higher RC levels were identified as an independent indicator for aMCI, particularly in the naming cognitive domain among older individuals. Further longitudinal studies are necessary to validate the predictive efficacy of RC.

Are demographic factors, masticatory performance and structural brain signatures associated with cognitive impairment in older people? A pilot study of cross-sectional neuroimaging data

BACKGROUND

The occurrence of cognitive impairment (CI) is expected to increase within an ageing population. CI is associated with tooth loss, which influences masticatory performance. A decrease in masticatory performance may cause functional and morphological changes in the brain. However, whether CI is associated with masticatory performance, demographics, and structural brain signatures has not been studied yet.

OBJECTIVES

To assess the associations between CI on the one hand, and masticatory performance, demographic factors, and structural brain signatures (i.e. cortical volume and thickness) on the other hand.

METHODS

In total, 18 older adults with CI (mean ± SD age = 72.2 ± 9.5 years) and 68 older adults without CI (65.7 ± 7.5 years) were included in this study. Masticatory performance was quantified using a colour-changeable chewing gum. A Magnetic Resonance Imaging (MRI) scan was used to map structural brain signatures. To study our aim, a multivariate binary logistic regression analysis with backward selection was performed.

RESULTS

The cortical volume of the right entorhinal cortex was negatively associated with CI (p < .01). However, demographic factors, masticatory performance, and the other structural brain signatures under investigation were not associated with CI.

CONCLUSION

A decrease in the volume of the right entorhinal cortex is associated with CI in older people.

Prevalence, cognitive characteristics, and influencing factors of amnestic mild cognitive impairment among older adults residing in an urban community in Chengdu, China

Objective

Dementia is a significant public health concern, and mild cognitive impairment (MCI) serves as a transitional stage between normal aging and dementia. Among the various types of MCI, amnestic MCI (aMCI) has been identified as having a higher likelihood of progressing to Alzheimer's dimension. However, limited research has been conducted on the prevalence of aMCI in China. Therefore, the objective of this study is to investigate the prevalence of aMCI, examine its cognitive characteristics, and identify associated risk factors.

Methods

In this cross-sectional study, we investigated a sample of 368 older adults aged 60 years and above in the urban communities of Chengdu, China. The participants underwent a battery of neuropsychological assessments, including the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), Auditory Verbal Learning Test (AVLT), Wechsler's Logical Memory Task (LMT), Boston Naming Test (BNT) and Trail Making Test Part A (TMT-A). Social information was collected by standard questionnaire. Multiple logistic regression analysis was utilized to screen for the risk and protective factors of aMCI.

Results

The data analysis included 309 subjects with normal cognitive function and 59 with aMCI, resulting in a prevalence of 16.0% for aMCI. The average age of participants was 69.06 ± 7.30 years, with 56.0% being females. After controlling for age, gender and education, the Spearman partial correlation coefficient between various cognitive assessments and aMCI ranged from -0.52 for the long-term delayed recall scores in AVLT to 0.19 for the time-usage scores in TMT-A. The results indicated that all cognitive domains, except for naming scores (after semantic cue of BNT) and error quantity (in TMT-A), showed statistically significant associations with aMCI. Furthermore, the multiple logistic regression analysis revealed that older age (OR = 1.044, 95%CI: 1.002~1.087), lower educational level, and diabetes (OR = 2.450, 95%CI: 1.246~4.818) were risk factors of aMCI.

Conclusion

This study found a high prevalence of aMCI among older adults in Chengdu, China. Individuals with aMCI exhibited lower cognitive function in memory, language, and executive domains, with long-term delayed recall showing the strongest association. Clinicians should prioritize individuals with verbal learning and memory difficulties, especially long-term delayed recall, in clinical practice.

Slovenian Memory Clinic Organization with the Introduction of Potential New Alzheimer's Disease Treatment

Slovenia, situated in Central Europe with a population of 2.1 million, has an estimated 44,278 individuals with mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's dementia, rendering them potential candidates for disease-modifying treatment (DMT), such as lecanemab. We identified 114 potential candidates whose real-life expenses for diagnostic process surmount to more than €80,000. Treating all potential candidates nationwide would amount to €1.06 billion, surpassing Slovenia's entire annual medication expenditure for 2022 (€743 million). The introduction of DMTs and the associated logistics, along with potential complications, will significantly change societal, professional, and patient approach to treatment of Alzheimer's disease.

The Association between Kidney Function Biomarkers and Delayed Memory Impairments among Older Adults in the European North of Russia

The prevention of memory decline requires better knowledge of biological markers. We studied the associations between kidney function biomarkers and memory decline (assessed with the Mini-Mental State Examination-MMSE) in elderly individuals without dementia (MMSE 24-30, age 60-74 years, n = 643, Arkhangelsk, Russia). Participants were divided by sex and into three groups according to the delayed memory performance: recall of 0-1, 2, and 3 out of 3 words. The median of serum creatinine was 82 μmol/L in men who recalled 2 words and both medians in those recalling 3 and 0-1 words were 87 μmol/L. The 90th percentile for creatinine in men recalling 0-1 words (115.0 μmol/L) exceeded the upper limit of the normal range (110.5 μmol/L), while those who recalled 3 and 2 words had 90th percentiles within the normal range (109 and 101 μmol/L, respectively). Glomerular filtration rates were normal (≥60 mL/min/1.73 m2) with a median of 92.0 mL/min/1.73 m2 in men who recalled 2 words, 84.4 and 84.9 mL/min/1.73 m2 in men who recalled 3 and 0-1 words, respectively. None of these associations were observed in women. A reduced serum creatinine in older non-demented men may indicate the initial stages of memory decline, while the increased creatinine may reflect further stages of memory impairment.

Analysis of Convergent Validity of Performance-Based Activities of Daily Living Assessed by PA-IADL Test in Relation to Traditional (Standard) Cognitive Assessment to Identify Older Adults with Mild Cognitive Impairment

Difficulty in performing instrumental activities of daily living (IADLs) is currently considered an important indicator of cognitive impairment in the elderly. A non-experimental case-control investigation was conducted to assess the convergent validity of the PA-IADL with traditional (standard) cognitive assessment tests in its ability to identify adults with mild cognitive impairment. The analysis of the data was carried out by means of various multivariate statistical tests, and the sequence in its execution led to the conclusion that 8 of the 12 Tasks that make up the PA-IADL allow for the identification of people with mild cognitive impairment (MCI) to the same extent as traditional cognitive assessment tests and regardless of age. Age was found to be a moderating variable in the performance of the eight tasks; however, the results allow us to hypothesize that people with MCI experience a significant decline when it happens but thereafter, the deterioration that occurs does so at the same rate as the deterioration experienced by healthy people. They also allow us to hypothesize that the difference in the cognitive skills required by the eight functional tasks, and therefore also in the cognitive skills required by the traditional (standard) tests of a person with MCI compared to a person of the same age without MCI (Healthy), is approximately 10 years. These hypotheses have remarkable relevance and should be tested via longitudinal research. In the meantime, the results highlight the importance of the IADL assessment for the diagnosis of MCI as a complement to the standard cognitive assessment.

Computerized Cognitive Training Enhances Episodic Memory by Down-Modulating Posterior Cingulate-Precuneus Connectivity in Older Persons With Mild Cognitive Impairment: A Randomized Controlled Trial

OBJECTIVE

The neural mechanisms underlying the beneficial effects of a computerized cognitive training (CCT) program for improving episodic memory in older persons with mild cognitive impairment (MCI) remain unclear. This study aimed to use both functional and structural brain changes to elucidate the treatment effects of CCT on enhancing episodic memory.

DESIGN, SETTING, AND PARTICIPANTS

Single-blinded, multicenter randomized controlled trial on 60 older adults with MCI in Fuzhou, China.

INTERVENTION

Participants were randomly assigned to either an 8-week 24-hour CCT program or a health education program as the control.

MEASUREMENTS

Clinical outcomes included changes in scores on the immediate and/or delayed recall subtests of the Chinese auditory verbal learning test (CAVLT) and rey complex figure test (CFT), and changes in gray matter volume and the functional connectivity of the posterior cingulate cortex (PCC) and hippocampus in the Papez circuit on magnetic resonance imaging.

RESULTS

Significant group-by-time effects showed greater improvements in both immediate and delayed recall scores of CAVLT and delayed recall scores of Rey CFT in participants receiving the CCT program compared to those in the health education program. Among the CCT participants, seed-based analyses revealed decreases in functional connectivity of the PCC and hippocampus with neural substrates in the parietal and occipital regions. The decreased PCC and precuneus connectivity were found to mediate patients' improvements in immediate recall function.

CONCLUSION

An 8-week CCT program was effective for improving episodic memory in older individuals with MCI. The decrease in connectivity originating from the PCC and hippocampus is suggestive of potential plastic changes in the Papez circuit, which could have alleviated the age-related compensatory mechanism. The findings of this study also shed light on expanding the content and extending the frequency and duration of the CCT program in future studies.

Exploring the Impact of Age of Onset of Mild Cognitive Impairment on the Profile of Cognitive and Psychiatric Symptoms

The present study aims to explore the differences in the manifestation of cognitive decline and psychiatric symptoms across the different ages of MCI onset: early onset (EOMCI: <65 years old), middle onset (MOMCI: 65-75 years old), and late onset (LOMCI: >75 years old). It was hypothesized that individuals with EOMCI will preserve their cognitive functions to a greater extent as compared to individuals with LOMCI, even after adjusting the cognitive performance for age and education through the use of published Greek norms. The level of cognitive decline concerning MOMCI was evaluated for extracting more precise conclusions regarding the impact of the age of onset on the patterns of MCI symptomatology. The analyses of data were conducted in a Greek population of individuals with MCI, who were consecutive visitors of the Outpatient Memory Clinic of Nestor Alzheimer's Centre in Athens, Greece. The sample consisted of 297 participants who fulfilled the following inclusion criteria: MCI diagnosis based on Petersen's criteria, Greek mother language, and absence of a psychiatric history or chronic and incurable organic disease. The overall results support the presence of a cognitive advantage of the EOMCI group compared to the LOMCI group. In the MOMCI group, cognitive performance displayed a tendency to remain intermediate compared to the other two groups. Nonetheless, significant differences were observed when this group was compared with the LOMCI group. The current findings indicate that the age of onset should be taken under consideration in the neuropsychological assessment of individuals with MCI. The specific parameters could have implications in terms of prognosis as well as the design and implementation of tailored interventions.

A graph theoretic approach to neurodegeneration: five data-driven neuropsychological subtypes in mild cognitive impairment

Mild cognitive Impairment (MCI) is notoriously heterogenous in terms of clinical presentation, neuroimaging correlates, and subsequent progression. Predicting who will progress to dementia, which type of dementia, and over what timeframe is challenging. Previous work has attempted to identify MCI subtypes using neuropsychological measures in an effort to address this challenge; however, there is no consensus on approach, which may account for some of the variability. Using a hierarchical community detection approach, we examined cognitive subtypes within an MCI sample (from the Alzheimer's Disease Neuroimaging Initiative [ADNI] study). We then examined whether these subtypes were related to biomarkers (e.g., cortical volumes, fluorodeoxyglucose (FDG)-positron emission tomography (PET) hypometabolism) or clinical progression. We identified five communities (i.e., cognitive subtypes) within the MCI sample: 1) predominantly memory impairment, 2) predominantly language impairment, 3) cognitively normal, 4) multidomain, with notable executive dysfunction, 5) multidomain, with notable processing speed impairment. Community membership was significantly associated with 1) cortical volume in the hippocampus, entorhinal cortex, and fusiform cortex; 2) FDG PET hypometabolism in the posterior cingulate, angular gyrus, and inferior/middle temporal gyrus; and 3) conversion to dementia at follow up. Overall, community detection as an approach appears a viable method for identifying unique cognitive subtypes in a neurodegenerative sample that were linked to several meaningful biomarkers and modestly with progression at one year follow up.

Characteristics of macroscopic sleep structure in patients with mild cognitive impairment: a systematic review

Objectives

Conducting a systematic analysis of objective measurement tools to assess the characteristics of macroscopic sleep architecture in patients with mild cognitive impairment (MCI), amnestic MCI (aMCI), and non-amnestic MCI (naMCI) in order to provide sleep disorder guidance for MCI patients.

Methods

PubMed, EMbase, Web of Science, Cochrane Library, CNKI, SinoMed, Wanfang Data, and VIP Data were examined to find literature relating to sleep in patients with MCI, aMCI, and naMCI, with a search time frame of build to April 2023. Following independent literature screening, data extraction, and quality evaluation by two researchers, statistical analysis was performed using RevMan 5.4 software.

Results

Twenty-five papers with 1,165 study subjects were included. Patients with MCI and aMCI were found to have altered total sleep time (TST), reduced sleep efficiency (SE), more wake-time after sleep onset (WASO), longer sleep latency (SL), a higher proportion of N1 stage and a lower proportion of N2 and N3 stage. naMCI was only found to have statistically significant differences in WASO.

Conclusions

The results of this study provide evidence for macroscopic sleep architecture abnormalities among MCI patients with sleep disorders. Maintaining a normal sleep time, improving SE, and reducing sleep fragmentation may have an association with a slowed development of cognitive impairment. Further exploration is required of the effects each component of macroscopic sleep structure after the intervention has on altered sleep disturbance and cognition in MCI, aMCI, and naMCI.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023401937, identifier: CRD42023401937.

Predictors of probable attention deficit hyperactivity disorder in elderly patients with mild cognitive impairment visiting a memory clinic

Aim

Characteristics of attention deficit hyperactivity disorder (ADHD) that persist into old age are often confused with symptoms of mild cognitive impairment (MCI), and the actual rate of probable ADHD in people with MCI is unknown. This study estimated the proportion of MCI patients with probable ADHD and investigated the factors to identify MCI patients with probable ADHD.

Methods

We recruited 36 elderly patients (11 males, 25 females, mean age 72.4 ± 7.6 years) who met the MCI criteria. The MCI patients were classified as those with [MCI/ADHD (+)] and without [MCI/ADHD (-)] probable ADHD, according to the Wender Utah Rating Scale scores. The autism features, inattention, and hyperactivity features during childhood and current periods, estimated intelligence quotient, and demographic data were compared between the groups. Multiple logistic regression analysis was performed to identify factors of MCI/ADHD (+) patients.

Results

Nine (25.0%) and 27 patients were added into the MCI/ADHD (+) and MCI/ADHD (-) groups, respectively. The MCI/ADHD (+) group mostly comprised men, those who visited the clinic at a younger age, had more years of schooling, and had strong autism spectrum disorder tendencies. Multiple logistic regression analysis indicated male sex and current hyperactivity as significant predictors of probable ADHD in MCI patients.

Conclusion

A quarter of the patients with MCI had probable ADHD. Male sex and hyperactivity at the time of MCI diagnosis might help in predicting probable ADHD in MCI patients. However, these results were obtained from a single-center, small-case study and should be confirmed via longitudinal studies with a large number of cases.

Integrated algorithm combining plasma biomarkers and cognitive assessments accurately predicts brain β-amyloid pathology

BACKGROUND

Accurate prediction of cerebral amyloidosis with easily available indicators is urgently needed for diagnosis and treatment of Alzheimer's disease (AD).

METHODS

We examined plasma Aβ42, Aβ40, T-tau, P-tau181, and NfL, with APOE genotypes, cognitive test scores and key demographics in a large Chinese cohort (N = 609, aged 40 to 84 years) covering full AD spectrum. Data-driven integrated computational models were developed to predict brain β-amyloid (Aβ) pathology.

RESULTS

Our computational models accurately predict brain Aβ positivity (area under the ROC curves (AUC) = 0.94). The results are validated in Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. Particularly, the models have the highest prediction power (AUC = 0.97) in mild cognitive impairment (MCI) participants. Three levels of models are designed with different accuracies and complexities. The model which only consists of plasma biomarkers can predict Aβ positivity in amnestic MCI (aMCI) patients with AUC = 0.89. Generally the models perform better in participants without comorbidities or family histories.

CONCLUSIONS

The innovative integrated models provide opportunity to assess Aβ pathology in a non-invasive and cost-effective way, which might facilitate AD-drug development, early screening, clinical diagnosis and prognosis evaluation.

Comorbid Cognitive Impairment in Chronic Obstructive Pulmonary Disease (COPD): Current Understanding, Risk Factors, Implications for Clinical Practice, and Suggested Interventions

Cognitive impairment is a common comorbidity in patients with COPD, significantly impacting health and clinical outcomes. Yet it remains under investigated and is largely overlooked. Although the exact cause of cognitive impairment in patients with COPD is still unclear, factors such as hypoxemia, vascular disease, smoking, exacerbation, and physical inactivity have been suggested. While international guidelines recommend identifying comorbidity in patients with COPD, such as cognitive impairment, cognitive assessment is not yet part of the routine assessment. Unidentified cognitive deficits in patients with COPD may have severe impacts on clinical management, resulting in an inability to maintain functional independence, poor self-management, and a greater dropout from pulmonary rehabilitation programs. There is a need to consider cognitive screening as a part of COPD assessment to promote early detection of cognitive impairment. Recognizing cognitive impairment early in the course of the illness allows the development of individualized interventions to meet patients' needs and improve clinical outcomes. Pulmonary rehabilitation should be tailored to cognitively impaired patients with COPD to maximize the benefits and minimize the incompletion rate.

The Chinese version of informant AD8 for mild cognitive impairment and dementia screening in community-dwelling older adults

BACKGROUND

Conducting routine mild cognitive impairment (MCI) and dementia screening for older adults in the community is important, which not only can improve our understanding of these diseases but also can increase early detection and treatment.

METHODS

To analyze the reliability and validity of the informant AD8 and explore the cut-off values for screening MCI and dementia in the community-dwelling older adults, this study adopted a multi-stage cluster sampling method to recruit 327 participants aged 60 and over in communities. The informant AD8 and Clinical Dementia Rating (CDR) scales were used to evaluate cognitive function of the subjects, and the receiver operating characteristic curves (ROC) was conducted to test the screening efficacy.

RESULTS

Among the 327 participants, 33.0% of them met the criteria of MCI, and 3.4% of them met the criteria of dementia. The area under the receiver operating characteristic curve (AUC) of the informant AD8 for screening dementia was 0.974, with a screening cut-off of three, sensitivity of 90.9% and specificity of 89.0%. But it has a poor discriminability in MCI screening [AUC = 0.645, 95% confidence interval (CI): 0.578-0.711].

CONCLUSIONS

This study suggests that the informant AD8 is an ideal and useful tool for dementia screening in community-dwelling older adults. However, it is less capable to distinguish older adults with MCI from those with normal cognitive function.

Acupuncture on mild cognitive impairment: A systematic review of neuroimaging studies

Mild cognitive impairment (MCI) is a multifactorial and complex central neurodegenerative disease. Acupuncture appears to be an effective method for cognitive function improvement in MCI patients. Neural plasticity remaining in the MCI brain implies that acupuncture-associated benefits may not be limited to the cognitive function. Instead, neurological alternations in the brain play a vital role in corresponding to the cognitive improvement. However, previous studies have mainly focused on the effects of cognitive function, leaving neurological findings relatively unclear. This systematic review summarized existing studies that used various brain imaging techniques to explore the neurological effect regarding acupuncture use for MCI treatment. Potential neuroimaging trials were searched, collected, and identified independently by two researchers. Four Chinese databases, four English databases, and additional sources were searched to identify studies reporting the use of acupuncture for MCI from the inception of databases until 1 June 2022. Methodological quality was appraised using the Cochrane risk-of-bias tool. In addition, general, methodological, and brain neuroimaging information was extracted and summarized to investigate the potential neural mechanisms by which acupuncture affects patients with MCI. In total, 22 studies involving 647 participants were included. The methodological quality of the included studies was moderate to high. The methods used included functional magnetic resonance imaging, diffusion tensor imaging, functional near-infrared spectroscopy, and magnetic resonance spectroscopy. Acupuncture-induced brain alterations observed in those patients with MCI tended to be observable in the cingulate cortex, prefrontal cortex, and hippocampus. The effect of acupuncture on MCI may play a role in regulating the default mode network, central executive network, and salience network. Based on these studies, researchers could extend the recent research focus from the cognitive domain to the neurological level. Future researches should develop additional relevant, well-designed, high-quality, and multimodal neuroimaging researches to detect the effects of acupuncture on the brains of MCI patients.

Sex differences in subjective cognitive impairment and clinical correlates in Chinese patients with subthreshold depression

OBJECTIVE

Subthreshold depression (SD) is a global mental health problem given its high prevalence, comorbidity, functional impairment, and its association with increased service utilization. However, currently little is known about sex differences of SD in cognitive impairment with clinical correlates. This study aims to explore sex differences in subjective cognitive impairment and clinically associated risk factors in Chinese patients with subthreshold depression (SD).

METHODS

A total of 126 patients with SD, 40 males and 86 females, aged 18-45 years, were included in this cross-sectional observational study. Their general information, psychological assessments, and psychiatric symptom assessments were collected online. The Patient Health Questionnaire depression-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Perceived Deficits Questionnaire-Depression (PDQ-D), and Toronto Alexithymia Scale (TAS-20) with 3 subdomains were used. The obtained scores were analyzed with partial correlation and multiple linear regression analysis models.

RESULTS

Our results showed that females had significantly higher PDQ-D-20 total score than males. However, the differences in TAS-20 and subdomain score according to sex were not significant. Notably, TAS-20 and DDF (difficulty describing feelings) subdomain contributed to cognitive impairment in males, whereas both PHQ-9 total score and TAS-20 or DDF subdomain contributed to cognitive impairment in females.

CONCLUSION

These findings revealed significant sex differences in cognitive impairment and clinical correlates in SD, which should be further followed-up in the future.

Screening for Mild Cognitive Impairment Using a Machine Learning Classifier and the Remote Speech Biomarker for Cognition: Evidence from Two Clinically Relevant Cohorts

BACKGROUND

Modern prodromal Alzheimer's disease (AD) clinical trials might extend outreach to a general population, causing high screen-out rates and thereby increasing study time and costs. Thus, screening tools that cost-effectively detect mild cognitive impairment (MCI) at scale are needed.

OBJECTIVE

Develop a screening algorithm that can differentiate between healthy and MCI participants in different clinically relevant populations.

METHODS

Two screening algorithms based on the remote ki:e speech biomarker for cognition (ki:e SB-C) were designed on a Dutch memory clinic cohort (N = 121) and a Swedish birth cohort (N = 404). MCI classification was each evaluated on the training cohort as well as on the unrelated validation cohort.

RESULTS

The algorithms achieved a performance of AUC  0.73 and AUC  0.77 in the respective training cohorts and AUC  0.81 in the unseen validation cohorts.

CONCLUSION

The results indicate that a ki:e SB-C based algorithm robustly detects MCI across different cohorts and languages, which has the potential to make current trials more efficient and improve future primary health care.

High-Sensitivity Cardiac Troponin T and Cognitive Decline in Older Adults: Results of the Berlin Aging Study II

INTRODUCTION

There is evidence of an association between markers of cardiac injury and cognition in patients with cardiovascular disease. We hypothesized that levels of high-sensitivity cardiac troponin T (hs-cTnT) are associated with cognitive performance and cognitive decline in a population of predominantly healthy older adults.

METHODS

We included 1,226 predominantly healthy adults ≥60 years from the Berlin Aging Study II. Participants were recruited from the general population of the Berlin metropolitan area from 2009 to 2014. At baseline, participants underwent measurement of hs-cTnT and cognitive testing using the extended Consortium to Establish a Registry for Alzheimer's Disease (CERAD-Plus) battery. In addition, the Digit Symbol Substitution Test (DSST) was performed at baseline and at follow-up (7.3 ± 1.4 years after the baseline visit). The CERAD test results were summarized into four cognitive domains (processing speed, executive function, visuo-construction, and memory). After summing-up the respective raw scores, we calculated standardized z scores. We performed unadjusted and adjusted linear regression models to assess links between hs-cTnT and cognitive domains. We used linear mixed models to analyze associations between hs-cTnT and cognitive decline according to changes in DSST scores over time.

RESULTS

The mean age of study participants at baseline was 68.5 (±3.6) years, 49% were female, and median hs-cTnT levels were 6 ng/L (IQR 4-8 ng/L). We detected no significant association between hs-cTnT and different cognitive domains at baseline after adjustment for age, sex, education, and cardiovascular risk factors. Hs-cTnT was associated with cognitive decline, which remained statistically significant after full adjustment (adjusted beta-coefficient -0.82 (-1.28 to -0.36), p = 0.001). After stratification for sex, the association with hs-cTnT remained statistically significant in men but not in women.

CONCLUSION

Higher hs-cTnT levels in older men are associated with cognitive decline measured with the DSST.

Clinical prediction of magnetic resonance image compilation in patients with mild cognitive impairment

This study aims to investigate the clinical prediction of magnetic resonance image compilation (MAGiC) and magnetic resonance image (MRI) in early diagnosis of the patients with mild cognitive impairment. This study is a retrospective randomized controlled clinical trial, and all patients are divided into following two groups: experiment group and control group. Patients in the experiment group are detected by MAGiC, and patients in the control group are detected by MRI; the clinical material from the two groups of patients with MCI are collected, and then Wechsler Memory Scale-Logical Memory (WMS-LM) and Mini-Mental State Examination (MMSE) are recorded by follow-up. Images by MAGiC have higher accuracy and definition compared with those by MRI. WMS-LM score and MMSE score in the experiment group are significantly better than those in the control group. We can conclude that MAGiC is a promising way to evaluate the clinical prediction in patients with MCI.

Is physical exercise effective at improving body structure & function and activity outcomes in individuals with Mild Cognitive Impairment? a systematic review with quality of evidence assessment

PURPOSE

To investigate the effect of physical exercise on body structure & function and activity outcomes in individuals with Mild Cognitive Impairment (MCI).

METHODS

Six databases were searched from inception until January 2021. Randomized controlled trials (RCTs) comparing physical exercise with a control group were included.

RESULTS

Fourteen RCTs were included. Three types of physical exercise were identified: aerobic (AE), resistance (RE), and multimodal (ME). Regarding body structure & function outcomes, evidence for RE was very low and with effect for improvement in upper limb muscle strength and very low and without effect for lower limbs. For improvement in postural balance, evidence was very low and with effect with AE and very low and without effect with RE and ME. Evidence for cardiorespiratory function was very low and without effect with AE and RE. Regarding activity outcomes, evidence was low and without effect for mobility with AE and very low and without effect with RE and ME.

CONCLUSIONS

Physical exercise promoted improvements in body structure & function outcomes in individuals with MCI. Resistance exercise improvement upper limb muscle strength and AE enhanced postural balance. In contrast, physical exercise did not promote a significant benefit in activity outcomes.Implications for rehabilitationResults of this systematic review have shown that physical exercise promoted improvements in body structure & function outcomes in individuals with Mild Cognitive Impairment (MCI).Resistance exercise with elastic bands for approximately 60 minutes twice a week for a total of three months improved upper limb muscle strength.Aerobic exercise with walking for approximately 60 minutes twice per week for a total of six months enhanced postural balance.Considering the potential benefits identified in this systematic review, physical exercise can be recommended for individuals with MCI.We also highlight the importance of the use of the International Classification of Functioning, Disability and Health for rehabilitation planning.

Is Citicoline Effective in Preventing and Slowing Down Dementia?-A Systematic Review and a Meta-Analysis

BACKGROUND

Cognitive impairment is a staggering personal and societal burden; accordingly, there is a strong interest in potential strategies for its prevention and treatment. Nutritional supplements have been extensively investigated, and citicoline seems to be a promising agent; its role in clinical practice, however, has not been established. We systematically reviewed studies on the effect of citicoline on cognitive performance.

METHODS

We searched the PubMed and Cochrane Library databases for articles published between 2010 and 2022. Relevant information was extracted and presented following the PRISMA recommendations. Data were pooled using the inverse-variance method with random effects models.

RESULTS

We selected seven studies including patients with mild cognitive impairment, Alzheimer's disease or post-stroke dementia. All the studies showed a positive effect of citicoline on cognitive functions. Six studies could be included in the meta-analysis. Overall, citicoline improved cognitive status, with pooled standardized mean differences ranging from 0.56 (95% CI: 0.37-0.75) to 1.57 (95% CI: 0.77-2.37) in different sensitivity analyses. The overall quality of the studies was poor.

DISCUSSION

Available data indicate that citicoline has positive effects on cognitive function. The general quality of the studies, however, is poor with significant risk of bias in favor of the intervention. Other: PubMed and the Cochrane Library.

Fatness, fitness and the aging brain: A cross sectional study of the associations between a physiological estimate of brain age and physical fitness, activity, sleep, and body composition

Introduction

Changes in brain structure and function occur with aging. However, there is substantial heterogeneity both in terms of when these changes begin, and the rate at which they progress. Understanding the mechanisms and/or behaviors underlying this heterogeneity may allow us to act to target and slow negative changes associated with aging.

Methods

Using T1 weighted MRI images, we applied a novel algorithm to determine the physiological age of the brain (brain-predicted age) and the predicted age difference between this physiologically based estimate and chronological age (BrainPAD) to 551 sedentary adults aged 65 to 84 with self-reported cognitive complaint measured at baseline as part of a larger study. We also assessed maximal aerobic capacity with a graded exercise test, physical activity and sleep with accelerometers, and body composition with dual energy x-ray absorptiometry. Associations were explored both linearly and logistically using categorical groupings.

Results

Visceral Adipose Tissue (VAT), Total Sleep Time (TST) and maximal aerobic capacity all showed significant associations with BrainPAD. Greater VAT was associated with higher (i.e,. older than chronological) BrainPAD (r = 0.149 p = 0.001)Greater TST was associated with higher BrainPAD (r = 0.087 p = 0.042) and greater aerobic capacity was associated with lower BrainPAD (r = - 0.088 p = 0.040). With linear regression, both VAT and TST remained significant (p = 0.036 and 0.008 respectively). Each kg of VAT predicted a 0.741 year increase in BrainPAD, and each hour of increased TST predicted a 0.735 year increase in BrainPAD. Maximal aerobic capacity did not retain statistical significance in fully adjusted linear models.

Discussion

Accumulation of visceral adipose tissue and greater total sleep time, but not aerobic capacity, total daily physical activity, or sleep quantity and/or quality are associated with brains that are physiologically older than would be expected based upon chronological age alone (BrainPAD).

Association between the domestic use of solid cooking fuel and increased prevalence of depression and cognitive impairment in a big developing country: A large-scale population-based study

Background

Previous studies have suggested that air pollution affects physiological and psychological health. Using solid fuel at home is a significant source of indoor air pollution. The associations between solid fuel use and depressive symptoms and cognitive health were unclear among older adults from low- and middle-income countries (LMICs).

Methods

To evaluate the association of solid fuel use with depressive symptoms and cognitive health among older adults, we obtained data from the Longitudinal Aging Study in India (LASI) and excluded subjects younger than 60 years and without critical data (solid fuel use, depressive symptoms, and cognitive health). The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to assess depressive symptoms, with more than ten indicative of depression. Cognitive health was assessed using measures from the Health and Retirement Study (HRS), and subjects with the lowest 10th percentile were considered to have cognitive impairment. The participants' responses defined solid fuel use. Multivariable logistic regression, linear regression, subgroup analysis, and interaction tests were performed to appraise the relationship between solid fuel use and depression and cognitive impairment.

Results

A total of 29,789 participants over 60 years old were involved in this study. Almost half of the participants (47.5%) reported using solid fuel for home cooking. Compared with clean fuel use, solid fuel use was related to an increased prevalence of depression [odds ratio (OR) 1.09, 95% CI 1.03-1.16] and higher CES-D-10 scores (β 0.23, 95% CI 0.12-0.35) after fully adjusted covariables. Using solid fuel was also related to a higher risk of cognitive impairment (OR 1.21, 95% CI 1.11-1.32) and a lower cognitive score (β -0.63, 95% CI -0.79 to -0.47) compared with those who used clean fuel. In the subgroup analysis, the prevalence of depression increased in females and non-smokers. The association of solid fuel use with depression and cognitive impairment exists in subgroups of BMI, economic status, caste, living area, education, and drinking.

Conclusions

The use of solid fuel at home was associated with an increased prevalence of depression and cognitive impairment among older adults in India.

The link between cutaneous inflammation and cognitive impairment

Cognitive impairment is a symptom of neurological disorders, including dementia and Alzheimer's disease; and mild cognitive impairment can be a precursor of both disorders. Aged humans and animal models with other systemic disorders, such as cardiovascular diseases and diabetes, display a higher incidence of cognitive decline. Epidemiological studies have shown that the incidence of cognitive impairment also is higher in subjects with certain inflammatory skin disorders, including psoriasis and chronic eczematous dermatitis. Chronologically aged individuals exhibit increased cutaneous inflammation and elevated circulating cytokine levels, linked to alterations in epidermal function, which itself can induce cutaneous inflammation. Conversely, strategies that improve epidermal function can lower cytokine levels in both the skin and circulation. Thus, it seems likely that epidermal dysfunction could contribute, at least in part, to the development of chronic low-grade inflammation, also termed 'inflammaging', in the elderly. The evidence of cognitive impairment in patients with inflammatory dermatoses suggests a link between cutaneous inflammation and cognitive impairment. Because of the pathogenic role of epidermal dysfunction in ageing-associated cutaneous inflammation, improvements in epidermal function could be an alternative approach for mitigation of the ageing-associated decline in cognitive function.

Subjective cognitive decline, mild cognitive impairment, and dementia - syndromic approach: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

ABSTRACT This consensus, performed by the Brazilian Academy of Neurology (BAN) will approach practically how to evaluate patients with cognitive complaints and how to clinically and etiologically diagnose the three clinical syndromes associated with the different stages of cognitive decline: subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia. This BAN consensus discusses SCD diagnosis for the first time, updates MCI and dementia diagnoses, recommends the adequate cognitive tests and the relevant etiological work-up and care of patients with cognitive decline at different levels of care within the Brazilian Unified Health System. We also review the main assessment instruments used in Brazil and Latin America.

Declínio cognitivo subjetivo, comprometimento cognitivo leve e demência - diagnóstico sindrômico: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

RESUMO Este consenso realizado pela Academia Brasileira de Neurologia (ABN) abordará de maneira prática como avaliar pacientes com queixas cognitivas e como realizar o diagnóstico clínico e etiológico das três síndromes clínicas associadas aos estágios de declínio cognitivo: declínio cognitivo subjetivo (DCS), comprometimento cognitivo leve (CCL) e demência. O diagnóstico de DCS é discutido pela primeira vez em consenso da ABN e as atualizações para o diagnóstico de CCL e demência são abordadas, bem como a recomendação para o uso de testes cognitivos apropriados, investigação etiológica pertinente e cuidados aos pacientes com declínio cognitivo nos diferentes níveis de atenção do Sistema Único de Saúde. Foi realizada pesquisa dos principais instrumentos de avaliação utilizados em nosso meio e na América Latina.

Gender-specific prevalence and risk factors of mild cognitive impairment among older adults in Chongming, Shanghai, China

Objective

This study explores the gender differences in the prevalence of mild cognitive impairment (MCI) and the correlation between multiple influencing factors.

Materials and methods

The sample was comprised of 1325 relatively healthy participants aged ≥ 60 years in a Shanghai community-dwelling (557 males and 768 females). Cognitive function was assessed by Mini-Mental State Examination (MMSE). The Instrumental Activities of Daily Living (IADL) scale was used to assess the activities of daily living.

Results

The overall prevalence of MCI was 15.2%, with 10.2% in men and 18.9% in women. In older male subjects, those with higher the Geriatric Depression Scale (GDS) scores [odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.01–1.14] and hypertension (OR = 2.33, 95% CI = 1.15–4.73) had a higher risk of MCI. female subjects who were illiterate (OR = 2.95, 95% CI = 1.82–4.78), had a farming background (OR = 1.69, 95% CI = 1.05–2.72), and a history of stroke (OR = 1.96, 95% CI = 1.07–3.59) had a higher risk of MCI, but this was not true for males. However, Male subjects who never smoked were less likely to have MCI (OR = 0.22, 95% CI = 0.09–0.54). Additionally, the prevalence of MCI was lower in older women with high grip strength (OR = 0.96, 95% CI = 0.92–0.99) and hyperlipidemia (OR = 0.45, 95% CI = 0.22–0.96).

Conclusion

The prevalence of MCI was higher in the population of elderly women compared to men. Moreover, it was found that members with MCI tended to having higher GDS scores, smoking, and hypertension; whereas a history of farming, illiteracy, stroke, grip strength, and hyperlipidemia were correlated with MCI in women.

High serum amyloid A predicts risk of cognitive impairment after lacunar infarction: Development and validation of a nomogram

Background

Post-stroke cognitive impairment (PSCI) after lacunar infarction was worth attention in recent years. An easy-to-use score model to predict the risk of PSCI was rare. This study aimed to explore the association between serum amyloid A (SAA) and cognitive impairment, and it also developed a nomogram for predicting the risk of PSCI in lacunar infarction patients.

Methods

A total of 313 patients with lacunar infarction were enrolled in this retrospective study between January 2021 and December 2021. They were divided into a training set and a validation set at 70%:30% randomly. The Chinese version of the Mini-Mental State Examination (MMSE) was performed to identify cognitive impairment 3 months after discharge. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for PSCI in the training set. A nomogram was developed based on the five variables, and the calibration curve and the receiver operating characteristic (ROC) curve were drawn to assess the predictive ability of the nomogram between the training set and the validation set. The decision curve analysis (DCA) was also conducted in both sets.

Results

In total, 52/313 (16.61%) participants were identified with PSCI. The SAA levels in patients with PSCI were significantly higher than non-PSCI patients in the training set (P < 0.001). After multivariate analysis, age, diabetes mellitus, white blood count, cystatin C, and SAA were independent risk predictors of PSCI. The nomogram demonstrated a good discrimination performance between the training set (AUC = 0.860) and the validation set (AUC = 0.811). The DCA showed that the nomogram had a well clinical utility in the two sets.

Conclusion

The increased SAA is associated with PSCI in lacunar infarction patients, and the nomogram developed with SAA can increase prognostic information for the early detection of PSCI.