Health Variables Are Informative in Screening for Mild Cognitive Impairment Among Elderly African Americans

Thoracic delirium index for predicting postoperative delirium in elderly patients following thoracic surgery: A retrospective case-control study

BACKGROUND

Postoperative delirium (POD) is an acute neurological complication in the elderly undergoing thoracic surgery and can result in serious adverse consequences.

AIMS

This study aimed to identify the related risk factors for POD following thoracic surgery, primarily focusing on preoperative serum biomarkers, and further to establish a novel delirium index to better predict POD.

METHODS

A total of 279 patients aged ≥60 years who underwent elective thoracic surgery from August 2021 to August 2022 were enrolled in this observational study. The platelet-to-white blood cell ratio (PWR) was calculated as number the of platelets divided by the number of white blood cells. POD was defined by the confusion assessment method twice daily during the postoperative first 3 days. Multivariate regression analysis was performed to identify all potential variables for POD. Moreover, a novel thoracic delirium index (TDI) was developed based on the related risk factors. The accuracy of TDI and its component factors in predicting POD was determined by the curve of receiver operating characteristic (ROC).

RESULTS

In total, 25 of 279 patients developed POD (8.96%). Age, PWR, and average pain scores within the first 3 days after surgery were regarded as the independent risk factors for POD. Moreover, the ROC analysis showed the TDI, including age, PWR, and average pain scores within the first 3 days after surgery, can more accurately predict POD with the largest area under the curve of 0.790 and the optimal cutoff value of 9.072, respectively.

CONCLUSION

The TDI can scientifically and effectively predict POD to provide optimal clinical guidance for older patients after thoracic surgery.

Subjective Aging Difficulties among Older Adults with Subjective Cognitive Decline

In older adults, subjective cognitive decline (SCD) may progress to an early stage of dementia. Yet, its association with subjective daily functional difficulties in aging is less well studied by experiences of mentally unhealthy days (MUDs). Employing a cross-sectional design approach, we analyzed the Behavioral Risk Factor Surveillance System dataset on 7429 older adults with SCD (aged 65 to >80, 45% males, 55% females) to explore SCD in instrumental daily activities of living (SCD-IADLs) and healthcare access mediation by MUDs and moderated mediation by age cohort, controlling gender and education. The bias-corrected percentile bootstrap with 5000 samplings revealed that MUDs partially mediate the relationship between SCD-IADLs and healthcare access, with a 28.2% mediating effect. Age cohort moderated the relationship between healthcare access and MUDs, MUDs and SCD-IADLs. Specifically, the predictive effects from healthcare access to MUDs and MUDs to SCD-IADLs were more profound in the 70-74 age cohort.

Mental health promotion and protection actions aimed at the elderly in the context of primary health care: an integrative review

The increase in the elderly population requires rethinking the organization of society, especially health services. The aim was to analyze actions aimed at promoting and protecting the mental health of the elderly in the context of primary health care, through an integrative review. The databases used were: Lilacs, Scopus, IBECS, Medline, CINAHL, BDENF and Index Psicologia. The descriptors used were "elderly", "health promotion", "mental health" and "primary health care". The final sample included 15 articles. The results indicate that group actions contribute to the reduction of depressive symptoms; health education in the perspective of active learning, aiming at health literacy and memory workshop strengthening spaces for socialization. Matrix support is highlighted as an indispensable tool for new mental health practices. We conclude that the moment is right for expanding the scope of actions offered to the elderly in psychological distress. Efforts have been detected in the production of care aiming at integrality, which is still incipient.

Mental health promotion and protection actions aimed at the elderly in the context of primary health care: an integrative review

Abstract The increase in the elderly population requires rethinking the organization of society, especially health services. The aim was to analyze actions aimed at promoting and protecting the mental health of the elderly in the context of primary health care, through an integrative review. The databases used were: Lilacs, Scopus, IBECS, Medline, CINAHL, BDENF and Index Psicologia. The descriptors used were “elderly”, “health promotion”, “mental health” and “primary health care”. The final sample included 15 articles. The results indicate that group actions contribute to the reduction of depressive symptoms; health education in the perspective of active learning, aiming at health literacy and memory workshop strengthening spaces for socialization. Matrix support is highlighted as an indispensable tool for new mental health practices. We conclude that the moment is right for expanding the scope of actions offered to the elderly in psychological distress. Efforts have been detected in the production of care aiming at integrality, which is still incipient.

Participation Predicts Cognitive Functioning in Older Adults Using the PART-O Transformed Scores Systems

Participation has been shown to be a protective factor for cognition in older adults, but instruments to assess it are limited. The main objective was to determine the validity of two scoring systems (direct vs transformed) for the Participation Assessment with Recombined Tools-Objective (PART-O) by applying structural equation modeling to the relationship between the subscales and the cognitive functions, in a sample of 245 people over 60 years of age. The transformed scores model showed stronger relationships and larger explained variance in overall participation (55.4% vs 37.4%), especially in the Social Relations subscale (31.4% vs 14.6%). Participation was a direct predictor of cognitive functions in both models. Age and depression inversely influenced participation in the transformed scores model. The proposed score transformation for the PART-O provides a more appropriate measurement of the older adults' participation. Participation has a mediating role in the relationship between cognition and both age and depression.

Increased dynamic flexibility in the medial temporal lobe network following an exercise intervention mediates generalization of prior learning

Recent work has conceptualized the brain as a network comprised of groups of sub-networks or modules. "Flexibility" of brain network(s) indexes the dynamic reconfiguration of comprising modules. Using novel techniques from dynamic network neuroscience applied to high-resolution resting-state functional magnetic resonance imaging (fMRI), the present study investigated the effects of an aerobic exercise intervention on the dynamic rearrangement of modular community structure-a measure of neural flexibility-within the medial temporal lobe (MTL) network. The MTL is one of the earliest brain regions impacted by Alzheimer's disease. It is also a major site of neuroplasticity that is sensitive to the effects of exercise. In a two-group non-randomized, repeated measures and matched control design with 34 healthy older adults, we observed an exercise-related increase in flexibility within the MTL network. Furthermore, MTL network flexibility mediated the beneficial effect aerobic exercise had on mnemonic flexibility, as measured by the ability to generalize past learning to novel task demands. Our results suggest that exercise exerts a rehabilitative and protective effect on MTL function, resulting in dynamically evolving networks of regions that interact in complex communication patterns. These reconfigurations may underlie exercise-induced improvements on cognitive measures of generalization, which are sensitive to subtle changes in the MTL.

Education Differentially Buffers Cognitive Performance in Black and White Older Adults

OBJECTIVES

Given that black American older adults are more likely to have lower educational attainment and perform worse on cognitive tests than white Americans, we examined whether increased education would confer greater cognitive advantage to black Americans on measures of global and specific domains of cognitive function.

METHODS

The sample included 522 community-dwelling older adults from a larger study. An analysis of covariance was conducted with race and education as between-participant factors and global cognition as the dependent variable. A multivariate analysis of covariance was conducted with five cognitive domains (immediate memory, visuospatial/constructional ability, language, attention, and delayed memory) as the dependent variables.

RESULTS

Significant main effects indicated that black Americans, F(1,516) = 29.18, p < .001, and individuals with less education, F(1,516) = 44.93, p < .001, evidenced lower cognitive functioning, controlling for age and overall health status, and the interaction term reached statistical significance, F(1,516) = 7.95, p = .005. The impact of education on global cognitive function for black participants was more than twice as large (Cohen's d = 1.30) than for white participants (Cohen's d = .52). There was a significant race × education interaction for the cognitive domain of attention (p < .001) and a composite measure of non-memory domains (i.e., language, visuospatial/constructional, and attention; p < .001).

DISCUSSION

Our findings suggest that educational attainment is particularly important for black Americans with respect to global cognitive function, attention, and non-memory domains.

Things Are Changing so Fast: Integrative Technology for Preserving Cognitive Health and Community History

Background and Objectives

Multimodal interventions are increasingly targeting multiple cognitive decline risk factors. However, technology remains mostly adjunctive, largely prioritizes age relevancy over cultural relevancy, and often targets individual health without lasting, community-wide deliverables. Meanwhile, African Americans remain overburdened by cognitive risk factors yet underrepresented in cognitive health and technology studies. The Sharing History through Active Reminiscence and Photo-imagery (SHARP) program increases physical, social, and cognitive activity within a culturally meaningful context that produces community deliverables-an oral history archive and cognitive health education.

Design and Methods

The SHARP application was tested with 19 African Americans ≥55 years, aiming for an easy, integrative, and culturally meaningful experience. The application guided triads in walks 3 times weekly for 6 months in Portland, Oregon's historically Black neighborhoods; local historical images prompted recorded conversational reminiscence. Focus groups evaluated factors influencing technology acceptance-attitudes about technology, usefulness, usability, and relevance to integrating program goals. Thematic analysis guided qualitative interpretation.

Results

Technology acceptance was influenced by group learning, paper-copy replicas for reluctant users, ease of navigation, usefulness for integrating and engaging in health behaviors, relevance to integrating individual benefit and the community priority of preserving history amidst gentrification, and flexibility in how the community uses deliverables. Perceived community benefits sustained acceptance despite intermittent technology failure.

Discussion and Implications

We offer applicable considerations for brain health technology design, implementation, and deliverables that integrate modalities, age, and cultural relevance, and individual and community benefit for more meaningful, and thus more motivated community engagement.

Blood Pressure Variability and Cognitive Function Among Older African Americans: Introducing a New Blood Pressure Variability Measure

BACKGROUND

Although blood pressure (BP) variability has been reported to be associated with cognitive impairment, whether this relationship affects African Americans has been unclear. We sought correlations between systolic and diastolic BP variability and cognitive function in community-dwelling older African Americans, and introduced a new BP variability measure that can be applied to BP data collected in clinical practice.

METHODS

We assessed cognitive function in 94 cognitively normal older African Americans using the Mini-Mental State Examination (MMSE) and the Computer Assessment of Mild Cognitive Impairment (CAMCI). We used BP measurements taken at the patients' three most recent primary care clinic visits to generate three traditional BP variability indices, range, standard deviation, and coefficient of variation, plus a new index, random slope, which accounts for unequal BP measurement intervals within and across patients.

RESULTS

MMSE scores did not correlate with any of the BP variability indices. Patients with greater diastolic BP variability were less accurate on the CAMCI verbal memory and incidental memory tasks. Results were similar across the four BP variability indices.

CONCLUSIONS

In a sample of cognitively intact older African American adults, BP variability did not correlate with global cognitive function, as measured by the MMSE. However, higher diastolic BP variability correlated with poorer verbal and incidental memory. By accounting for differences in BP measurement intervals, our new BP variability index may help alert primary care physicians to patients at particular risk for cognitive decline.