Strategies for dementia prevention: latest evidence and implications

Charting Alzheimer's Disease and Dementia: Epidemiological Insights, Risk Factors and Prevention Pathways

Alzheimer's disease (AD), the most common cause of dementia, is a complex and multifactorial condition without cure at present. The latest treatments, based on anti-amyloid monoclonal antibodies, have only a modest effect in reducing the progression of cognitive decline in AD, whereas the possibility of preventing AD has become a crucial area of research. In fact, recent studies have observed a decrease in dementia incidence in developed regions such as the US and Europe. However, these trends have not been mirrored in non-Western countries (Japan or China), and the contributing factors of this reduction remain unclear. The Lancet Commission has delineated a constrained classification of 12 risk factors across different life stages. Nevertheless, the scientific literature has pointed to over 200 factors-including sociodemographic, medical, psychological, and sociocultural conditions-related to the development of dementia/AD. This narrative review aims to synthesize the risk/protective factors of dementia/AD. Essentially, we found that risk/protective factors vary between individuals and populations, complicating the creation of a unified prevention strategy. Moreover, dementia/AD explanatory mechanisms involve a diverse array of genetic and environmental factors that interact from the early stages of life. In the future, studies across different population-based cohorts are essential to validate risk/protective factors of dementia. This evidence would help develop public health policies to decrease the incidence of dementia.

Cardiovascular Disease and Dementia: Exploring Intersections, Risks, and Therapeutic Challenges

This review examines the complex bidirectional relationship between cardiovascular disease and various dementia subtypes, including Alzheimer's disease, vascular dementia, Lewy body dementia, and frontotemporal dementia. Traditional cardiovascular risk factors such as hypertension, coronary artery disease, arrhythmia, and diabetes mellitus are strongly linked to the development of dementia. Emerging evidence indicates that cognitive decline can exacerbate cardiovascular risks through heightened inflammatory responses and compromised autonomic regulation. Additionally, this review explores trials that investigate the impact of cardiovascular medications, such as antihypertensive and statin therapies, on cognitive outcomes, as well as studies examining how dementia treatments like anticholinesterases affect cardiovascular health. This review emphasizes the importance of early identification of at-risk individuals, integrated care approaches, and lifestyle interventions aimed at reducing both cardiovascular disease and dementia risk, ultimately aiming to enhance patient outcomes and quality of life.

Brain Healthcare Quotient as a Tool for Standardized Approach in Brain Healthcare Interventions

In addressing the challenge of assessing healthy brain aging across diverse interventions, this study introduces the use of MRI-derived Brain Healthcare Quotients (BHQ) for comprehensive evaluation. We analyzed BHQ changes in 319 participants aged 24-69, who were allocated into dietary (collagen peptide, euglena, matcha, isohumulone, xanthophyll) and physical activity (hand massage with lavender oil, handwriting, office stretching, pink lens, clinical art) groups, alongside a control group, over a month. These interventions were specifically chosen to test the efficacy of varying health strategies on brain health, measured through BHQ indices: GM-BHQ for gray matter volume, and FA-BHQ for white matter integrity. Notably, significant improvements in FA-BHQ were observed in the collagen peptide group, with marginal increases in the hand massage and office stretching groups. These findings highlight BHQ's potential as a sensitive tool for detecting brain health changes, offering evidence that low-intensity, easily implemented interventions can have beneficial effects on brain health. Moreover, BHQ allows for the systematic evaluation of such interventions using standard statistical approaches, suggesting its value in future brain healthcare research.

The association between depressive symptoms with fear of falling and cognitive decline in older adults in the Korean community: An analysis of the Korean Longitudinal Study of Aging (KLoSA), 2006-2020

OBJECTIVES

This study aimed to investigate the effects of fear of falling (FOF) on cognitive decline in older adults in the Korean community, depending on the presence of accompanying depressive symptoms.

METHODS

A total of 6263 individuals were included in the final analysis. Based on their baseline evaluation results for depressive symptoms and FOF, the subjects were divided into four groups: "normal control" (NC, n = 3783), "depression only" (Dep-only, n = 291), "fear of falling only" (FOF-only, n = 1755), and "depression with fear of falling" (Dep-FOF, n = 434). Cognitive decline was defined as a loss of more than three points in the K-MMSE score in participants with at least two years of follow-up. We examined the association between FOF accompanied by depressive symptoms and cognitive decline using a multivariate Cox proportional hazard model.

RESULTS

Cognitive decline occurred in 76.3%, 68.5%, 63.9%, and 56.4% of the Dep-FOF, FOF-only, Dep-only, and NC groups, respectively. Our findings suggest that individuals with FOF do not always have cognitive decline (HR = 1.03, 95% CI = 0.95-1.12, P = 0.43) compared to individuals without FOF. Furthermore, depressive symptoms with FOF are associated with a higher risk of cognitive decline (HR = 1.23, 95% CI = 1.08-1.41, P = 0.002) in community-dwelling older adults in Korea.

CONCLUSION

Healthcare providers should be attentive to community-dwelling older adults who experience both depressive symptoms and FOF because our findings suggest that this unique combination increases the risk of cognitive decline.

RCT-based Social Return on Investment (SROI) of a Home Exercise Program for People With Early Dementia Comparing In-Person and Blended Delivery Before and During the COVID-19 Pandemic

Regular exercise and community engagement may slow the rate of function loss for people with dementia. However, the evidence is uncertain regarding the cost-effectiveness and social return on investment (SROI) of home exercise with community referral for people with dementia. This study aimed to compare the social value generated from the in-person PrAISED program delivered before March 2020 with a blended PrAISED program delivered after March 2020. SROI methodology compared in-person and blended delivery formats of a home exercise program. Stakeholders were identified, a logic model was developed, outcomes were evidenced and valued, costs were calculated, and SROI ratios were estimated. Five relevant and material outcomes were identified: 3 outcomes for patient participants (fear of falling, health-related quality of life, and social connection); 1 outcome for carer participants (carer strain), and 1 outcome for the National Health Service (NHS) (health service resource use). Data were collected at baseline and at 12-month follow-up. The in-person PrAISED program generated SROI ratios ranging from £0.58 to £2.33 for every £1 invested. In-person PrAISED patient participants gained social value from improved health-related quality of life, social connection, and less fear of falling. In-person PrAISED carer participants acquired social value from less carer strain. The NHS gained benefit from less health care service resource use. However, the blended PrAISED program generated lower SROI ratios ranging from a negative ratio to £0.08:£1. Compared with the blended program, the PrAISED in-person program generated higher SROI ratios for people with early dementia. An in-person PrAISED intervention with community referral is likely to provide better value for money than a blended one with limited community referral, despite the greater costs of the former.Trial registration: ISRCTN Registry ISRCTN15320670.

Artificial intelligence for dementia prevention

INTRODUCTION

A wide range of modifiable risk factors for dementia have been identified. Considerable debate remains about these risk factors, possible interactions between them or with genetic risk, and causality, and how they can help in clinical trial recruitment and drug development. Artificial intelligence (AI) and machine learning (ML) may refine understanding.

METHODS

ML approaches are being developed in dementia prevention. We discuss exemplar uses and evaluate the current applications and limitations in the dementia prevention field.

RESULTS

Risk-profiling tools may help identify high-risk populations for clinical trials; however, their performance needs improvement. New risk-profiling and trial-recruitment tools underpinned by ML models may be effective in reducing costs and improving future trials. ML can inform drug-repurposing efforts and prioritization of disease-modifying therapeutics.

DISCUSSION

ML is not yet widely used but has considerable potential to enhance precision in dementia prevention.

HIGHLIGHTS

Artificial intelligence (AI) is not widely used in the dementia prevention field. Risk-profiling tools are not used in clinical practice. Causal insights are needed to understand risk factors over the lifespan. AI will help personalize risk-management tools for dementia prevention. AI could target specific patient groups that will benefit most for clinical trials.

Neuropsychological Test Norms for the Assessment of HIV-Associated Neurocognitive Impairment Among South African Adults

Reliable and valid neurocognitive (NC) test batteries that assess multiple domains of cognitive functioning are vital tools in the early detection of HIV-associated NC impairment. The HIV Neurobehavioral Research Center's International Neurobehavioral Battery (HNRC Battery) is one such diagnostic tool and has shown cultural validity in several international neuroHIV studies. However, no published norms are currently available for the full HNRC Battery in South Africa. To accurately interpret NC test results, appropriate reference norms are required. In light of this challenge, data were collected from 500 healthy, HIV-uninfected participants to develop demographically corrected South African norms. When demographically corrected United States of America (U.S.) norms were applied to the performance scores of our neurologically intact, HIV-negative sample, an impairment rate of 62.2% was observed compared to a 15.0% impairment rate when the newly generated South African norms were applied. These results reiterate the findings of other low- and middle-income countries, highlighting the need for localized, country-specific norms when interpreting NC performance.

Impact of discontinuing non-pharmacological interventions on cognitive impairment in dementia patients by COVID-19 lockdown. A pilot observational, longitudinal, retrospective study carried out in an adult day center in Spain during the COVID-19 pandemic

Background

The lockdown imposed during the COVID-19 pandemic led to social isolation and prevented patients with dementia from receiving a suite of non-pharmacological interventions (NPIs) that prevent cognitive decline. This discontinuation of NPIs could substantially affect the mental health status of people with dementia in social care settings, such as adult day care centers (ADCs).

Propose

The study aimed to evaluate the effects of the COVID-19 lockdown on mental health and cognitive impairment in patients with dementia who could not attend their usual ADCs and did not receive our NPIs, based on World Health Organization (WHO) Guidelines.

Methods

Observational, longitudinal, retrospective study carried out in an adult day center in Spain and reported it in accordance with the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) statement. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) in 80 patients attending the ADC of the "Leonese Association of Dementia Patients" (León, Spain), who had been evaluated with this instrument before the COVID-19 lockdown.

Results

We observed a 0.4-point decrease in MMSE score/month (IQR = 1.4) during lockdown versus a 0.1-point decrease/month (IQR = 0.3) before this period (p = 0.038). Notably, this translated to >10-point decreases in MMSE score/year in 33.8% of participants during lockdown versus 5.5% earlier (p < 0.001). No statistically significant associations (p < 0.05) were found between the individual characteristics of the caregivers and the occurrence of the event.

Conclusion

The reported declines in MMSE scores reveal a significant acceleration of cognitive decline during the period of inactivity. This could suggest that our NPIs, focused on slowing cognitive decline, are beneficial and, therefore, necessary in patients with dementia.

Radiographers' knowledge and attitudes toward dementia

INTRODUCTION

Dementia is a syndrome associated with a decline in brain function, impacting how we speak, think, feel, and behave. Misunderstanding of dementia and how it affects patients and their carers is common. There is limited research on how radiographers provide adequate care to those with dementia. Radiographers with knowledge and positive attitudes can reduce stigma and fear, improving the quality of care. This study aimed to assess radiographers' knowledge and attitudes towards dementia.

METHODS

A cohort of registered radiographers in Ireland participated in an online survey. Two pre-existing validated questionnaires: The Alzheimer's Disease Knowledge Scale (ADKS) and the Dementia Attitudes Scale (DAS), assessed radiographers' knowledge and attitudes towards dementia and people with dementia. Scores were compared across variables such as gender, age, grade, qualification, work setting, and the number of years qualified.

RESULTS

A total of 123 radiographers responded. Knowledge scores did not significantly differ across demographic groups (p > 0.05). Total knowledge scores ranged from 60% to 100%. Total attitude scores ranged from 50% to 100%. Participants with a BSc, MSc, and other post-graduate degrees scored higher on the attitude scale than those with a diploma qualification (p = 0.027). Those with less than 20 years' experience scored higher than those with more. Knowledge had little correlation with attitude (r = 0.0522; p = 0.5667).

CONCLUSION

Findings indicate variations in attitudes linked to age and experience, and some misconceptions can be observed across varying groups. Interventions to improve attitudes and raise awareness are needed.

IMPLICATIONS FOR PRACTICE

There is a need for further research and education on dementia care in the imaging department. We have identified areas requiring further education.

A Tutorial for Speech-Language Pathologists: Physical Activity and Social Engagement to Prevent or Slow Cognitive Decline in Older Adults

PURPOSE

This tutorial provides an overview of two behavioral approaches, physical activity and social engagement, to prevent or slow cognitive decline in older adults and to increase awareness in the field of speech-language pathology of the important role that speech-language pathologists (SLPs) play in an interprofessional team working with this population.

METHOD

A review of exercise science, neuroscience, and social science literature was used to synthesize evidence and to outline the impact of physical activity and social engagement on cognition. The following topics were explored: How do exercise and social engagement support cognition? What are modifiable risk factors of dementia? What is the impact of inactivity and isolation on cognition? What is the potential role of the SLP on an interprofessional team focusing on preventive measures for cognitive decline? What is the impact of physical exercise and social engagement on nursing home residents?

RESULTS

Research increasingly points to the critical importance of physical activity and social engagement to prevent cognitive decline in normal aging and to slow cognitive decline associated with mild cognitive impairment and dementia. Research suggests that physical activity maintains or improves memory, attention, executive function, visuospatial function, speed of processing, and general cognitive function. Social engagement has been found to maintain and improve general cognitive function.

CONCLUSIONS

Behavioral interventions are an effective strategy to prevent or slow cognitive decline in the older adult population. SLPs have a role to play on an interprofessional team that works to prevent cognitive decline. By considering factors that play a role in the prevention of cognitive decline, such as physical activity and social engagement, the quality of life and overall health of older adults can be improved. Areas of improvement include memory, attention, executive function, visuospatial function, speed of processing, and general cognitive function.

Impact of multidomain preventive strategies on functional brain connectivity in older adults with cognitive complaint: Subset from the Montpellier center of the ancillary MAPT-MRI study

Introduction

The impact of multi-domain preventive interventions on older adults, in particular on those with higher risk to develop Alzheimer's disease (AD), could be beneficial, as it may delay cognitive decline. However, the precise mechanism of such positive impact is not fully understood and may involve brain reserve and adaptability of brain functional connectivity (FC).

Methods

To determine the effect of multidomain interventions (involving physical activity, cognitive training, nutritional counseling alone or in combination with omega-3 fatty acid supplementation and vs. a placebo) on the brain, longitudinal FC changes were assessed after 36 months of intervention on 100 older adults (above 70 year-old) with subjective cognitive complaints.

Results

No global change in FC was detected after uni or multidomain preventive interventions. However, an effect of omega-3 fatty acid supplementation dependent on cognitive decline status was underlined for frontoparietal, salience, visual and sensorimotor networks FC. These findings were independent of the cortical thickness and vascular burden.

Discussion

These results emphasize the importance of patient stratification, based on risk factors, for preventive interventions.

Patterns of depressive symptoms over 16 Years with incident dementia: The Health and Retirement Study

The associations of patterns of depressive symptoms, including trajectories of depressive symptoms and significant depressive symptoms among older adults over a long period of time with incident dementia are not frequently studied. We aimed to examine the associations of patterns of depressive symptoms among older adults with incident dementia. Participants of the Health and Retirement Study from 1994 to 2018 with information of incident dementia and complete measurements of depressive symptoms were included. Depressive symptoms assessed on 8 waves between 1994 and 2010 using the 8-item Center for Epidemiologic Studies Depression (CES-D) Scale. Significant depressive symptoms were defined as ≥4 points in the CES-D. Trajectories of depressive symptoms and significant depressive symptoms were identified. Cox proportional hazards models were used to examine the associations of patterns of depressive symptoms with incident dementia. A total of 6317 participants were included in the analysis. Over the follow-up period of 8 years, trajectories of "increase from mild" (hazards ratio (HR): 1.84, 95% confidence interval (CI): 1.29, 2.63) and "persistently high" (HR: 1.76, 95% CI: 1.17, 2.65) depressive symptoms were associated with higher risk of incident dementia, after adjustment for covariates. Future studies are needed to examine the interaction of depression in different stages of life on incident dementia. Studies are also expected to estimate the effect of preventing dementia through reducing depressive symptoms.

The Neuroprotective Potentiality of Flavonoids on Alzheimer's Disease

Alzheimer's disease (AD), due to its spread, has become a global health priority, and is characterized by senile dementia and progressive disability. The main cause of AD and other neurodegenerations (Huntington, Parkinson, Amyotrophic Lateral Sclerosis) are aggregated protein accumulation and oxidative damage. Recent research on secondary metabolites of plants such as polyphenols demonstrated that they may slow the progression of AD. The flavonoids' mechanism of action in AD involved the inhibition of acetylcholinesterase, butyrylcholinesterase, Tau protein aggregation, β-secretase, oxidative stress, inflammation, and apoptosis through modulation of signaling pathways which are implicated in cognitive and neuroprotective functions, such as ERK, PI3-kinase/Akt, NFKB, MAPKs, and endogenous antioxidant enzymatic systems. This review focuses on flavonoids and their role in AD, in terms of therapeutic potentiality for human health, antioxidant potential, and specific AD molecular targets.

Study protocol to determine the effects of highly absorbable oral curcumin on the indicators of cognitive functioning: a double-blind randomised controlled trial

INTRODUCTION

Mild cognitive impairment (MCI) refers to a state in which cognitive functions, such as memory, have diminished but daily activities are largely unhampered. MCI is often overlooked but carries the risk of leading to development of dementia later. Curcumin is the main component of the natural herbal medicine turmeric. Curcumin is widely used as a health food and is an antioxidant that has anti-inflammatory and anti-amyloid actions. The current trial was designed to determine the effects of curcumin on indicators of cognitive functioning.

METHODS AND ANALYSIS

The current trial will be a single-centre randomised placebo-controlled double-blind parallel group trial. The participants will be 60 members of the general public with potential MCI, based on dementia screening using the Japanese version of the Mini Mental State Examination (MMSE-J). The investigational health food used in this trial will be a recently developed preparation for highly absorbable oral curcumin. This trial will determine the effects of the highly absorbable oral curcumin (brand name: curcuRouge) on the indicators of cognitive functioning, including the scores obtained with the MMSE-J, which is an interview-based measure of cognitive functioning, and the blood biomarkers that have been reported to be associated with dementia.

ETHICS AND DISSEMINATION

Informed written consent will be obtained from all the participants. The Ethical Review Board of the National Hospital Organization Kyoto Medical Center approved the study protocol.

TRIAL REGISTRATION NUMBER

University Hospital Medical Information Network (UMIN000042471).

What Do We Know about Social and Non-Social Factors Influencing the Pathway from Cognitive Health to Dementia? A Systematic Review of Reviews

The heterogeneous and multi-factorial nature of dementia requires the consideration of all health aspects when predicting the risk of its development and planning strategies for its prevention. This systematic review of reviews provides a comprehensive synthesis of those factors associated with cognition in the context of dementia, identifying the role of social aspects and evidencing knowledge gaps in this area of research. Systematic reviews and meta-analyses from 2009–2021 were searched for within Medline, PsycINFO, CINAHL Complete, Cochrane, and Epistemonikos. Reviewers independently screened, reviewed, and assessed the records, following the PRISMA-2020 guidelines. From 314 included studies, 624 cognitive-related factors were identified, most of them risk factors (61.2%), mainly belonging to the group of ‘somatic comorbidities’ (cardiovascular disease and diabetes) and ‘genetic predispositions’. The protective factors (20%) were mainly related to lifestyle, pointing to the Mediterranean diet, regular physical activity, and cognitively stimulating activities. Social factors constituted 9.6% of all identified factors. Research on biological and medical factors dominates the reviewed literature. Greater social support and frequent contact may confer some protection against cognitive decline and dementia by delaying its onset or reducing the overall risk; however, overall, our findings are inconsistent. Further research is needed in the fields of lifestyle, psychology, social health, and the protective factors against cognitive decline and dementia.

Risk factors for dementia in the context of cardiovascular disease: A protocol of an overview of reviews

Background

Dementia is a major public health priority. Although there is abundant evidence of an association between dementia and poor cardiovascular health, findings have been inconsistent and uncertain in identifying which factors increase dementia risk in those with cardiovascular disease. Indeed, multiple variables including sociodemographic, economic, health, lifestyle and education may indicate who is at higher vs. lower dementia risk and could be used in prediction modelling. Therefore, the aim of this review is to synthesise evidence on the key risk factors for dementia in those with a history of cardiovascular disease.

Methods

This is an overview of reviews protocol, registered on PROSPERO (CRD42021265363). Four electronic databases including MEDLINE, EMBASE, PsycINFO, and the Cochrane Database of Systematic Reviews will be searched. Studies will be included if they are systematic reviews and/or meta-analyses that have investigated the risk of incident dementia (all-cause and subtypes including Alzheimer’s disease and vascular dementia) in people with a history of coronary heart disease, heart failure, atrial fibrillation, hypertension, hyperlipidaemia, and vascular stiffness. Study selection will be completed by two independent researchers according to the eligibility criteria, and conflicts resolved by a third reviewer. References will be exported into Covidence for title and abstract sifting, full-text review, and data extraction. Methodological quality will be assessed using the AMSTAR-2 criteria and confidence of evidence will be assessed using the GRADE classification. This overview of reviews will follow PRISMA guidelines. If there is sufficient homogeneity in the data, the results will be pooled, and a meta-analysis conducted to determine the strength of association between each risk factor and incident all-cause dementia and its subtypes for each cardiovascular diagnoses separately.

Discussion

We will create a comprehensive summary of the key risk factors linking cardiovascular diseases to risk of incident dementia. This knowledge is essential for informing risk predictive model development as well as the development of risk reduction and prevention strategies.

Impact of Integrated Care Pathways Within the Framework of Collaborative Care on Older Adults With Anxiety, Depression, or Mild Cognitive Impairment

OBJECTIVES

To evaluate the impact of an Integrated Care Pathway (ICP) within a collaborative care framework for anxiety, depression and mild cognitive impairment (MCI) on clinical outcomes, quality of life, and time to treatment initiation.

DESIGN

Prospective Cohort study.

SETTING

Primary care practices in Toronto and Hamilton, Ontario, Canada.

PARTICIPANTS

Patients of participating primary care practices born in the years 1950 to 1958.

SAMPLE SIZE

Target 150 participants, 75 in ICP and 75 in Treatment-As-Usual (TAU) arm.

INTERVENTION

ICP within a collaborative care framework and TAU.

METHODS AND RESULTS

One hundred forty-five participants with anxiety, depression or MCI, from five primary care practices were enrolled: 69 were managed as per ICP and 76 as per TAU. All underwent outcome assessments at 6, 12, 18, and 24 months. Compared to TAU, ICP participants had a significantly higher rate of improvement in depression symptoms (β = -0.620, F (1, 256) = 4.10, p = 0.044), anxiety symptoms (β = -0.593, F (1, 223) = 4.00, p = 0.047), and quality of life (β = 1.351, F(1, 358) = 6.58, p = 0.011). The ICP group had also a significantly higher "hazard" of treatment initiation (HR = 3.557; 95% CI: [2.228, 5.678]; p < 0.001) after controlling for age, gender and baseline severity of symptoms compared to TAU group.

CONCLUSIONS

Use of an ICP within a collaborative care framework in primary care settings for anxiety, depression and MCI among older adults, results in faster reductions in clinical symptoms and improvement in quality of life compared to usual care, as well as faster access to recommended treatments.

Social Return on Investment of Home Exercise and Community Referral for People With Early Dementia

Exercise can improve physical function and slow the progression of dementia. However, uncertainty exists around the costeffectiveness of exercise programmes for people with early dementia. The aim of this study was to determine whether a home-based supervised exercise programme (PrAISED – promoting activity, independence, and stability in early dementia) could generate a positive social return on investment (SROI). SROI analysis was conducted as part of a randomised controlled feasibility trial comparing PrAISED with usual care. Wellbeing valuation was used to compare the costs of the programme with the monetised benefits to participants, carers, and healthcare service providers. The PrAISED programme generated SROI ratios ranging from £3.46 to £5.94 for every £1 invested. Social value was created from improved physical activity, increased confidence, more social connection and PrAISED participants using healthcare services less often than usual care. This study found that home-based supervised exercise programmes could generate a positive SROI for people with early dementia. Trial registration: ClinicalTrials.gov: NCT02874300 (first posted 22 August 2016), ISRCTN: 10,550,694 (date assigned 31 August 2016).

Identifying predictors of self-perceptions of aging based on a range of cognitive, physical, and mental health indicators: Twenty-year longitudinal findings from the ILSE study

Research exploring whether health predicts self-perceptions of aging (SPA) has mostly focused on single predictors and has been hampered by short observational intervals. We examined whether 20-year changes in cognitive functioning, physical and mental health predict SPA. We used data of 103 German participants who remained of a sample of 500 participants born in 1930-1932 enrolled in the Interdisciplinary Longitudinal Study of Adult Development (ILSE) in 1993/1996 (mean age at fourth measurement wave = 82.5 years). Health indicators included six cognitive tests, objective and subjective physical health, and self-reported depression. We used a new and multidimensional (awareness of age-related gains and losses) and a well-established (attitudes toward own aging) measure of SPA. Linear regression analyses showed that, among the cognitive tests, decline in information processing speed (Digit Symbol) predicted less awareness of age-related gains and more awareness of age-related losses but not attitudes toward own aging. Decline in subjective but not objective physical health, predicted more awareness of age-related losses and negative attitudes toward own aging, but not awareness of age-related gains. Increase in depressive symptoms predicted more awareness of age-related losses and negative attitudes toward own aging, but not awareness of age-related gains. The size of associations suggests that objective cognitive decline has limited influence on older adults' SPA and, if so, only when the decline is related to mental slowing. Similarly, perceived physical and mental health, but not objective health, have a small-to-moderate influence on awareness of age-related losses and attitudes toward own aging. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines

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Self-reported measures of limitation in physical function in late midlife are associated with incident Alzheimer's disease and related dementias

BACKGROUND

Even small improvements in modifiable Alzheimer's disease and related dementias (ADRD) risk factors could lead to a substantial reduction of dementia cases.

AIMS

To determine if self-reported functional limitation associates with ADRD symptoms 4-18 years later.

METHODS

We conducted a prospective longitudinal study using the Health and Retirement Study of adults aged 51-59 years in 1998 without symptoms of ADRD by 2002 and followed them to 2016. Main exposure variables were difficulty with activities of daily living, mobility, large muscle strength, gross motor and upper limb activities. The outcome was incident ADRD identified by the Lange-Weir algorithm, death, or alive without ADRD. We fit two GEE multinomial models for each measure: (1) baseline measure of function and (2) change in function over time.

RESULTS

In the model with baseline only and outcome, only difficulty with mobility associated with future ADRD across levels of difficulty with near dose-response effect (risk ratios (RR) difficulty with 1-5 functions respectively, compared with no difficulty: 1.82; 2.70; 1.73 2.81; 4.03). Mobility also significantly associated with ADRD when allowing for change over time among those with 3, 4 or 5 versus no mobility limitations (RR 1.76; 2.36; 2.37).

DISCUSSION

The results infer that an adult in midlife reporting difficulty with mobility as well as those with no mobility limitations in midlife but who later report severe limitations may be at increased risk of incident ADRD.

CONCLUSIONS

Self-reported measures of mobility limitation may be early indicators of ADRD and may be useful for public health planning.

Dietary Polyphenols as Therapeutic Intervention for Alzheimer’s Disease: A Mechanistic Insight

Dietary polyphenols encompass a diverse range of secondary metabolites found in nature, such as fruits, vegetables, herbal teas, wine, and cocoa products, etc. Structurally, they are either derivatives or isomers of phenol acid, isoflavonoids and possess hidden health promoting characteristics, such as antioxidative, anti-aging, anti-cancerous and many more. The use of such polyphenols in combating the neuropathological war raging in this generation is currently a hotly debated topic. Lately, Alzheimer’s disease (AD) is emerging as the most common neuropathological disease, destroying the livelihoods of millions in one way or another. Any therapeutic intervention to curtail its advancement in the generation to come has been in vain to date. Using dietary polyphenols to construct the barricade around it is going to be an effective strategy, taking into account their hidden potential to counter multifactorial events taking place under such pathology. Besides their strong antioxidant properties, naturally occurring polyphenols are reported to have neuroprotective effects by modulating the Aβ biogenesis pathway in Alzheimer’s disease. Thus, in this review, I am focusing on unlocking the hidden secrets of dietary polyphenols and their mechanistic advantages to fight the war with AD and related pathology.

Short-Term Intake of Chlorogenic Acids Improves Psychomotor Speed and Motor Speed in Adults: A Randomized Crossover Trial

Chlorogenic acid (CGA), a polyphenolic compound found in various plants, has been reported to improve cognitive function. However, it remains unclear how long it takes for CGAs to exert their effects. Here, we evaluated the short-term effects of CGAs on cognitive function. We assessed the effects of 2-week CGA intake on cognitive function. The study was carried out as a randomized, double-blind, placebo-controlled, crossover trial. Twenty-six healthy Japanese participants (50–65 years of age) were randomly assigned to either the active beverage (CGAs: 270 mg) or the placebo beverage group daily for 2 weeks. After a 2-week washout period, the participants consumed the other beverages. We assessed cognitive function at baseline and following the first treatment period using the Japanese version of CNS Vital Signs. CGAs significantly improved the scores for psychomotor speed, motor speed, and right and left finger tapping compared to placebo. In addition, processing speed scores improved significantly from baseline only after CGA intake. In conclusion, CGAs were confirmed to improve cognitive function over a short period of two weeks.

Effects of β-Hydroxy β-Methylbutyrate Supplementation on Working Memory and Hippocampal Long-Term Potentiation in Rodents

β-hydroxy β-methylbutyrate (HMB), a metabolite of the essential amino acid leucine, has been shown to preserve muscle mass and strength during aging. The signaling mechanism by which HMB elicits its favorable effects on protein metabolism in skeletal muscle is also preserved in the brain. However, there are only a few studies, all at relatively high doses, addressing the effect of HMB supplementation on cognition. This study evaluated the effects of different doses of HMB on the potentiation of hippocampal synapses following the experimental induction of long-term potentiation (LTP) in the hippocampus of behaving rats, as well as on working memory test (delayed matching-to-position, DMTP) in mice. HMB doses in rats were 225 (low), 450 (medium), and 900 (high) mg/kg body weight/day and were double in mice. Rats who received medium or high HMB doses improved LTP, suggesting that HMB administration enhances mechanisms related to neuronal plasticity. In the DMTP test, mice that received any of the tested doses of HMB performed better than the control group in the overall test with particularities depending on the dose and the task phase.

Impact of dementia literacy interventions for non-health-professionals: systematic review and meta-analysis

OBJECTIVES

To assess evidence regarding the effects of interventions aimed at improving dementia literacy for different groups of non-health-professionals.

METHODS

A systematic search for relevant interventions was conducted using a range of online databases (e.g. CINAHL, Embase, Medline, ProQuest, and PsycINFO) and hand-searching of reference lists. Eligible interventions were identified based on predefined inclusion/exclusion criteria and methodological quality criteria. Meta analyses were performed using a random-effects model.

RESULTS

The final review included 14 interventions, which were either randomised controlled trials or non-randomised controlled trials. The interventions had varied contents, approaches, settings, and outcome measures. Evidence of improved dementia literacy in various aspects was found, and the intervention effects were strongest on knowledge of dementia.

DISCUSSION

There is evidence for the positive impact of dementia literacy interventions on different groups of non-health-professionals. Best practices in intervention contents, approaches, and outcome measures should be examined to guide future interventions.

Identification of cognitively impaired patients at risk for development of Alzheimer's disease dementia: an analysis of US Medicare claims data

BACKGROUND

Identifying factors associated with transitioning from mild cognitive impairment (MCI) to dementia due to Alzheimer's disease (AD dementia) or dementia due to any cause (all-cause dementia) may inform economic assessments of disease and early care planning.

RESEARCH DESIGN AND METHODS

A multivariate logistic regression approach identified potential predictors of progression to AD dementia or all-cause dementia in individuals with MCI or cognitive impairment (CI). Eligible patients and variables of interest were identified using claims data from the Medicare Advantage Patient Database, by Optum.

RESULTS

Predictors of an AD dementia diagnosis included age (odds ratio [OR], 1.71) and use of antipsychotics (OR, 2.50) and hypertension medication (OR, 1.25). Medication use for comorbid conditions was a better indicator of risk than comorbidity coding. Diagnosis of CI by a neurologist increased the odds of an AD dementia diagnosis. Possible protective factors for progression included the use of anxiolytics (OR, 0.76), inpatient status at time of diagnosis (OR, 0.49), and a history of stroke (OR, 0.87). None of these factors differentiated AD dementia from all-cause dementia.

CONCLUSIONS

Identifying patients at risk for AD dementia allows for improved system-level planning to guide policy and optimize economic and clinical outcomes for patients, caregivers, and society.

Psychotherapeutic interventions in individuals at risk for Alzheimer's dementia: a systematic review

BACKGROUND

Expanding technologies of early detection of Alzheimer's disease allow to identify individuals at risk of dementia in early and asymptomatic disease stages. Neuropsychiatric symptoms, such as anxiety and depression, are common in the course of AD and may be clinically observed many years before the onset of significant cognitive symptoms. To date, therapeutic interventions for AD focus on pharmacological and life style modification-based strategies. However, despite good evidence for psychotherapy in late-life depression, evidence for such therapeutic approaches to improve cognitive and emotional well-being and thereby reduce psychological risk factors in the course of AD are sparse.

METHODS

A systematic review was conducted in PUBMED, PsycINFO, Web of Science, and Clinical Trials to summarize the state of evidence on psychotherapeutic and psychoeducational interventions for individuals at risk for Alzheimer's dementia. Eligible articles needed to apply a manualized and standardized psychotherapeutic or psychoeducational content administered by trained professionals for individuals with subjective cognitive decline or mild cognitive impairment and measure mental health, quality of life or well-being.

RESULTS

The literature search yielded 32 studies that were included in this narrative summary. The data illustrates heterogeneous therapeutic approaches with mostly small sample sizes and short follow-up monitoring. Strength of evidence from randomized-controlled studies for interventions that may improve mood and well-being is scarce. Qualitative data suggests positive impact on cognitive restructuring, and disease acceptance, including positive effects on quality of life. Specific therapeutic determinants of efficacy have not been identified to date.

CONCLUSIONS

This review underlines the need of specific psychotherapeutic and psychoeducational approaches for individuals at risk of Alzheimer's dementia, particularly in terms of an early intervention aiming at improving mental health and well-being. One challenge is the modification of psychotherapeutic techniques according to the different stages of cognitive decline in the course of AD, which is needed to be sensitive to the individual needs.

The role of disability and depressive symptoms in the relation between objective cognitive performance and subjective cognitive decline

BACKGROUND

Subjective cognitive decline (SCD) and subjective memory decline (SMD) are common among older people. Evidence linking SCD and SMD with cognitive and memory impairment is inconsistent. Moreover, little is known about the associations of SCD and SMD with disability. We aimed to explore the associations of SCD and SMD with objective cognitive and memory performance, disability, and depressive symptoms.

MATERIALS AND METHODS

In a cross-sectional study we conducted face to face interviews in a randomized sample of people aged ≥65 years living in the Canton of Ticino, southern Switzerland, between May 2021 and April 2022. We measured subjective cognitive decline with the MyCog, a subsection of the Subjective Cognitive Decline Questionnaire (SCD-Q); cognitive functioning with the Community Screening Instrument for Dementia; memory with the consortium to establish a registry for alzheimer's disease (CERAD) 10-word list learning task; and disability and depressive symptoms with the world health organization disability assessment schedule 2.0 (WHO-DAS 2.0) and the Euro-Depression (EURO-D) scales, respectively.

RESULTS

Of the 250 participants 93.6% reported at least one cognitive difficulty, and 40.0% SMD. Both SCD and SMD were associated with poorer objective cognitive/memory performance, and independently with greater disability, and more depressive symptoms. But in participants with high disability and depressive symptoms subjective and objective cognition were no longer associated. Disability fully mediated the associations of poorer objective cognitive and memory performance with subjective cognitive and memory decline.

CONCLUSION

Routine clinical assessments of cognitive function should include formal enquires about SCD and SMD, and also account for disability and depressive symptoms.

Inflammatory Blood Biomarker Kynurenine Is Linked With Elevated Neuroinflammation and Neurodegeneration in Older Adults: Evidence From Two 1H-MRS Post-Processing Analysis Methods

RATIONALE AND OBJECTIVES

Pro-inflammatory processes have been argued to play a role in conditions associated with cognitive decline and neurodegeneration, like aging and obesity. Only a limited number of studies have tried to measure both peripheral and central biomarkers of inflammation and examined their interrelationship. The primary aim of this study was to examine the hypothesis that chronic peripheral inflammation would be associated with neurometabolic changes that indicate neuroinflammation (the combined elevation of myoinositol and choline), brain gray matter volume decrease, and lower cognitive functioning in older adults.

MATERIALS AND METHODS

Seventy-four older adults underwent bio-impedance body composition analysis, cognitive testing with the Montreal Cognitive Assessment (MoCA), blood serum analysis of inflammatory markers interleukin-6 (IL-6) and kynurenine, magnetic resonance imaging (MRI), and proton magnetic resonance spectroscopy (¹H-MRS) of the brain. Neurometabolic findings from both Tarquin and LCModel ¹H-MRS post-processing software packages were compared. The regions of interest for MRI and ¹H-MRS measurements were dorsal posterior cingulate cortex (DPCC), left hippocampal cortex (HPC), left medial temporal cortex (MTC), left primary sensorimotor cortex (SM1), and right dorsolateral prefrontal cortex (DLPFC).

RESULTS

Elevated serum kynurenine levels were associated with signs of neuroinflammation, specifically in the DPCC, left SM1 and right DLPFC, and signs of neurodegeneration, specifically in the left HPC, left MTC and left SM1, after adjusting for age, sex and fat percentage (fat%). Elevated serum IL-6 levels were associated with increased Glx levels in left HPC, left MTC, and right DLPFC, after processing the ¹H-MRS data with Tarquin. Overall, the agreement between Tarquin and LCModel results was moderate-to-strong for tNAA, tCho, mIns, and tCr, but weak to very weak for Glx. Peripheral inflammatory markers (IL-6 and kynurenine) were not associated with older age, higher fat%, decreased brain gray matter volume loss or decreased cognitive functioning within a cohort of older adults.

CONCLUSION

Our results suggest that serum kynurenine may be used as a peripheral inflammatory marker that is associated with neuroinflammation and neurodegeneration, although not linked to cognition. Future studies should consider longitudinal analysis to assess the causal inferences between chronic peripheral and neuroinflammation, brain structural and neurometabolic changes, and cognitive decline in aging.

A Machine Learning-Based Holistic Approach to Predict the Clinical Course of Patients within the Alzheimer's Disease Spectrum

BACKGROUND

Alzheimer's disease (AD) is a neurodegenerative condition driven by multifactorial etiology. Mild cognitive impairment (MCI) is a transitional condition between healthy aging and dementia. No reliable biomarkers are available to predict the conversion from MCI to AD.

OBJECTIVE

To evaluate the use of machine learning (ML) on a wealth of data offered by the Alzheimer's Disease Neuroimaging Initiative (ADNI) and Alzheimer's Disease Metabolomics Consortium (ADMC) database in the prediction of the MCI to AD conversion.

METHODS

We implemented an ML-based Random Forest (RF) algorithm to predict conversion from MCI to AD. Data related to the study population (587 MCI subjects) were analyzed by RF as separate or combined features and assessed for classification power. Four classes of variables were considered: neuropsychological test scores, AD-related cerebrospinal fluid (CSF) biomarkers, peripheral biomarkers, and structural magnetic resonance imaging (MRI) variables.

RESULTS

The ML-based algorithm exhibited 86% accuracy in predicting the AD conversion of MCI subjects. When assessing the features that helped the most, neuropsychological test scores, MRI data, and CSF biomarkers were the most relevant in the MCI to AD prediction. Peripheral parameters were effective when employed in association with neuropsychological test scores. Age and sex differences modulated the prediction accuracy. AD conversion was more effectively predicted in females and younger subjects.

CONCLUSION

Our findings support the notion that AD-related neurodegenerative processes result from the concerted activity of multiple pathological mechanisms and factors that act inside and outside the brain and are dynamically affected by age and sex.

The additive memory and healthspan enhancement effects by the combined treatment of mature silkworm powders and Korean angelica extracts

ETHNOPHARMACOLOGICAL RELEVANCE

Silkworm (Bombyx mori) and Korean angelica (KoAg; Angelica gigas Nakai) have been widely used as traditional oriental medicines in Korea, China, and Japan to treat various diseases such as anemia, cold, diabetes, palsy, stroke, etc. Steamed and freeze-dried mature silkworm powder, also known as HongJam (HJ), and extracts of KoAg root (KoAgE) are currently sold in Korea as functional foods to improve memory, cognition, and liver functions. However, the molecular and pharmacological basis for the improvement of brain functions of HJ and KoAgE has not yet been elucidated.

AIM OF STUDY

This study aimed to elucidate the molecular basis underlying the memory-enhancing effects of HJ and KoAgE and determine whether administration of HJ and KoAgE complexes (HJ+KoAgC) has additive memory and healthspan-enhancing effects.

MATERIALS AND METHODS

The MCI mouse models generated by intraperitoneal injection of Scopolamine (Sco-IP) were orally administered with HJ and KoAgE alone or as complexes. Their memory-enhancing effects were examined on spatial, fear-aggravated, and social memories and compared with control or Donepezil (Dp) treatment. The activities of mitochondria complex (MitoCom) I-IV and acetylcholinesterase (AChE) and the amounts of ATP in the mouse brains were examined. The Drosophila model was used to investigate lifespan- and healthspan-promoting effects of HJ+KoAgC.

RESULTS

Administration of HJ+KoAgC produced more memory-enhancing effects than administration of HJ or KoAgE alone or Dp. The increase in MitoCom I-IV activities and ATP amounts and the decrease in AChE activities in the mouse brains were the molecular basis for the memory enhancement. The greatest improvement in memory and mitochondrial function was observed when the mice were administered the 1:0.8 ratio of HJ+KoAgC. Administration of HJ+KoAgC to Drosophila prolonged the lifespan and the healthspan and increased the amounts of ATP.

CONCLUSION

HJ+KoAgC had superior effects on memory improvement and healthspan extension by increasing mitochondrial activities and ATP amounts in treated animal models.

A Survey of Dementia Knowledge and Recognition of Dementia Prevention and Practice in Healthy Older Adults

Aim

The aim of this study was to investigate the level of dementia knowledge and behaviors recognized as dementia-preventive and the practice thereof among healthy older adults who are highly motivated to engage in activities.

Methods

The participants were older adults registered at the Silver Human Resource Center of city A, and participants anonymously filled questionnaires through the aggregation method in January 2020.

Results

The analysis included 78 participants (the effective response rate was 49.7%). All participants were aware of at least 4 dementia-preventive behaviors, and about 80% of all participants practiced at least 1 preventive behavior. Approximately 20% of participants were not practicing preventive behaviors at all. The elderly aged 65 to 74 years had more knowledge about dementia and more types of behavior perceived as dementia-preventive than the elderly aged 75 years and older. There was no significant correlation between the level of dementia knowledge and the number of types of dementia-preventive behaviors.

Conclusions

Healthy older adults were aware of numerous behaviors for dementia prevention, and most older adults practiced preventive behaviors. In contrast, even with a high amount of knowledge about dementia, a small number of healthy older adults did not translate this knowledge into preventative behavioral practices. High levels of dementia knowledge do not translate into preventive behavioral practices.

The Association of Periodontitis and Alzheimer's Disease: How to Hit Two Birds with One Stone

Alzheimer's disease (AD) is the leading cause of cognitive impairment in the elderly. Recent evidence suggests that preventive interventional trials could significantly reduce the risk for development of dementia. Periodontitis is the most common dental disease characterized by chronic inflammation and loss of alveolar bone and perialveolar attachment of teeth. Growing number of studies propose a potential link between periodontitis and neurodegeneration. In the first part of the paper, we overview case-control studies analyzing the prevalence of periodontitis among AD patients and healthy controls. Second, we survey observational libraries and cross-sectional studies investigating the risk of cognitive decline in patients with periodontitis. Next, we describe the current view on the mechanism of periodontitis linked neural damage, highlighting bacterial invasion of neural tissue from dental plaques, and periodontitis induced systemic inflammation resulting in a neuroinflammatory process. Later, we summarize reports connecting the four most common periodontal pathogens to AD pathology. Finally, we provide a practical guide for further prevalence and interventional studies on the management of cognitively high-risk patients with and without periodontitis. In this section, we highlight strategies for risk control, patient information, dental evaluation, reporting protocol and dental procedures in the clinical management of patients with a risk for periodontitis and with diagnosed periodontitis. In conclusion, our review summarizes the current view on the association between AD and periodontitis and provides a research and intervention strategy for harmonized interventional trials and for further case-control or cross-sectional studies.

Remote cognitive assessment of older adults in rural areas by telemedicine and automatic speech and video analysis: protocol for a cross-over feasibility study

INTRODUCTION

Early detection of cognitive impairments is crucial for the successful implementation of preventive strategies. However, in rural isolated areas or so-called 'medical deserts', access to diagnosis and care is very limited. With the current pandemic crisis, now even more than ever, remote solutions such as telemedicine platforms represent great potential and can help to overcome this barrier. Moreover, current advances made in voice and image analysis can help overcome the barrier of physical distance by providing additional information on a patients' emotional and cognitive state. Therefore, the aim of this study is to evaluate the feasibility and reliability of a videoconference system for remote cognitive testing empowered by automatic speech and video analysis.

METHODS AND ANALYSIS

60 participants (aged 55 and older) with and without cognitive impairment will be recruited. A complete neuropsychological assessment including a short clinical interview will be administered in two conditions, once by telemedicine and once by face-to-face. The order of administration procedure will be counterbalanced so half of the sample starts with the videoconference condition and the other half with the face-to-face condition. Acceptability and user experience will be assessed among participants and clinicians in a qualitative and quantitative manner. Speech and video features will be extracted and analysed to obtain additional information on mood and engagement levels. In a subgroup, measurements of stress indicators such as heart rate and skin conductance will be compared.

ETHICS AND DISSEMINATION

The procedures are not invasive and there are no expected risks or burdens to participants. All participants will be informed that this is an observational study and their consent taken prior to the experiment. Demonstration of the effectiveness of such technology makes it possible to diffuse its use across all rural areas ('medical deserts') and thus, to improve the early diagnosis of neurodegenerative pathologies, while providing data crucial for basic research. Results from this study will be published in peer-reviewed journals.

The identification of established modifiable mid-life risk factors for cardiovascular disease which contribute to cognitive decline: Korean Longitudinal Study of Aging (KLoSA)

INTRODUCTION

We explored how different chronic diseases, risk factors, and protective factors highly associated with cardiovascular diseases (CVD) are associated with dementia or Mild Cognitive Impairment (MCI) in Korean elders, with a focus on those that manifest in mid-life.

METHODS

A CVD-free cohort (n = 4289) from the Korean Longitudinal Study of Aging was selected to perform Cox mixed-effects proportional hazard regressions. Eighteen control variables with strong associations to CVD were chosen as explanatory variables, and Mini-Mental State Examination (MMSE) score cut-off for dementia and MCI were used as outcome variables.

RESULTS

The statistically significant (P < 0.05) adverse factors that contribute in developing dementia were age (aHR 1.07, 1.05-1.09), Centre for Epidemiological Studies Depression Scale (CESD-10) (aHR 1.17, 1.12-1.23), diagnosis with cerebrovascular disease (aHR 3.73, 1.81-7.66), living with diabetes (aHR 2.30, 1.22-4.35), and living with high blood pressure (HBP) (aHR 2.05, 1.09-3.87). In contrast, the statistically significant protective factors against developing dementia were current alcohol consumption (aHR 0.67, 0.46-0.99), higher educational attainment (aHR 0.36, 0.26-0.56), and regular exercise (aHR 0.37, 0.26-0.51). The factors with a statistically significant adverse association with progression to MCI were age (aHR 1.02, 1.01-1.03) and CESD-10 (aHR 1.17, 1.14-1.19). In contrast, the statistically significant protective factors against developing MCI were BMI (aHR 0.96, 0.94-0.98), higher educational attainment (aHR 0.33, 0.26-0.43), and regular exercise (aHR 0.83, 0.74-0.92).

CONCLUSION

In lieu of the protective factor of MCI and dementia, implementing regular exercise routine well before mid-life and cognitive decline is significant, with adjustments made for those suffering from health conditions, so they can continue exercising despite their morbidity. Further attention in diabetes care and management is needed for patients who already show decline in cognitive ability as it is likely that their MCI impacts their ability to manage their existing chronic conditions, which may adversely affect their cognitive ability furthermore.

Preventing Delirium and Promoting Long-Term Brain Health: A Clinical Trial Design for the Perioperative Cognitive Enhancement (PROTECT) Trial

BACKGROUND

Perioperative neurocognitive disorders (PND), including postoperative delirium (POD), are common in older adults and, for many, precipitate functional decline and/or dementia.

OBJECTIVE

In this protocol, we describe a novel multidisciplinary, multicomponent perioperative intervention that seeks to prevent or reduce POD and associated cognitive decline.

METHODS

We will conduct a prospective, single-blind, pragmatic, randomized-controlled trial to compare our tailored multi-disciplinary perioperative pathway against current standard of care practices. We will recruit a total of 692 elective surgical patients aged 65 years or more and randomize them in a 1:1 design. Our perioperative intervention targets delirium risk reduction strategies by emphasizing the importance of early mobilization, nutrition, hydration, cognitive orientation, sensory aids, and avoiding polypharmacy. To promote healthy behavior change, we will provide a tailored psychoeducation program both pre- and postoperatively, focusing on cardiovascular and psychosocial risks for cognitive and functional decline.

RESULTS

Our primary outcome is the incidence of any PND (encapsulating POD and mild or major postoperative neurocognitive disorder) at three months postoperative. Secondary outcomes include any incidence of POD or neurocognitive disorder at 12 months. A specialized delirium screening instrument, the Confusion Assessment Method (3D-CAM), and a neuropsychological test battery, will inform our primary and secondary outcomes.

CONCLUSION

Delirium is a common and debilitating postoperative complication that contributes to the cognitive and functional decline of older adults. By adopting a multicomponent, multidisciplinary approach to perioperative delirium prevention, we seek to reduce the burden of delirium and subsequent dementia in older adults.

Lifestyle-dependent microglial plasticity: training the brain guardians

Lifestyle is one of the most powerful instruments shaping mankind; the lifestyle includes many aspects of interactions with the environment, from nourishment and education to physical activity and quality of sleep. All these factors taken in complex affect neuroplasticity and define brain performance and cognitive longevity. In particular, physical exercise, exposure to enriched environment and dieting act through complex modifications of microglial cells, which change their phenotype and modulate their functional activity thus translating lifestyle events into remodelling of brain homoeostasis and reshaping neural networks ultimately enhancing neuroprotection and cognitive longevity.

Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer's disease (MCI and dementia) in primary care: a review and synthesis

The critical role of primary care clinicians (PCCs) in Alzheimer's disease (AD) prevention, diagnosis and management must evolve as new treatment paradigms and disease-modifying therapies (DMTs) emerge. Our understanding of AD has grown substantially: no longer conceptualized as a late-in-life syndrome of cognitive and functional impairments, we now recognize that AD pathology builds silently for decades before cognitive impairment is detectable. Clinically, AD first manifests subtly as mild cognitive impairment (MCI) due to AD before progressing to dementia. Emerging optimism for improved outcomes in AD stems from a focus on preventive interventions in midlife and timely, biomarker-confirmed diagnosis at early signs of cognitive deficits (i.e. MCI due to AD and mild AD dementia). A timely AD diagnosis is particularly important for optimizing patient care and enabling the appropriate use of anticipated DMTs. An accelerating challenge for PCCs and AD specialists will be to respond to innovations in diagnostics and therapy for AD in a system that is not currently well positioned to do so. To overcome these challenges, PCCs and AD specialists must collaborate closely to navigate and optimize dynamically evolving AD care in the face of new opportunities. In the spirit of this collaboration, we summarize here some prominent and influential models that inform our current understanding of AD. We also advocate for timely and accurate (i.e. biomarker-defined) diagnosis of early AD. In doing so, we consider evolving issues related to prevention, detecting emerging cognitive impairment and the role of biomarkers in the clinic.

From Exercise to Cognitive Performance: Role of Irisin

The beneficial effects of exercise on the brain are well known. In general, exercise offers an effective way to improve cognitive function in all ages, particularly in the elderly, who are considered the most vulnerable to neurodegenerative disorders. In this regard, myokines, hormones secreted by muscle in response to exercise, have recently gained attention as beneficial mediators. Irisin is a novel exercise-induced myokine, that modulates several bodily processes, such as glucose homeostasis, and reduces systemic inflammation. Irisin is cleaved from fibronectin type III domain containing 5 (FNDC5), a transmembrane precursor protein expressed in muscle under the control of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α). The FNDC5/irisin system is also expressed in the hippocampus, where it stimulates the expression of the neurotrophin brain-derived neurotrophic factor in this area that is associated with learning and memory. In this review, we aimed to discuss the role of irisin as a key mediator of the beneficial effects of exercise on synaptic plasticity and memory in the elderly, suggesting its roles within the main promoters of the beneficial effects of exercise on the brain.

Impact of various intensities and frequencies of non-occupational physical activity on the risk of dementia among physically independent older adults: the Japan Gerontological Evaluation Study

OBJECTIVES

The aim of this study was to investigate the association between different intensities and frequencies of non-occupational physical activity (PA) and the risk of dementia among Japanese older adults.

STUDY DESIGN

This was a prospective cohort study.

METHODS

A total of 2194 participants aged ≥65 years from the Japan Gerontological Evaluation Study were followed up between 2010 and 2016. The standardised dementia scale of the long-term care insurance system was used to identify incident dementia, whereas non-occupational PA (<2 or ≥2 times/week on each intensity: light, moderate and vigorous) was assessed using a questionnaire. Cox regression was used to compute the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident dementia.

RESULTS

After adjustment for sociodemographic and medical characteristics, the following frequencies and intensities of non-occupational PA, compared with no non-occupational PA at all, were associated with a reduced risk of dementia: light PA ≥2 times/week (HR = 0.61, 95% CI: 0.38-0.97), moderate PA <2 times/week (HR = 0.46, 95% CI: 0.28-0.76), moderate PA ≥2 times/week (HR = 0.57, 95% CI: 0.36-0.91), vigorous PA <2 times/week (HR = 0.40, 95% CI: 0.21-0.74) and vigorous PA ≥2 times/week (HR = 0.29, 95% CI: 0.15-0.57). In the sex-specific analysis, moderate PA <2 times/week and vigorous PA ≥2 times/week were associated with a reduced risk of dementia in men, whereas light and moderate PA ≥2 times/week and all frequencies of vigorous PA were associated with a reduced risk of dementia in women.

CONCLUSIONS

Practicing non-occupational PA was associated with a reduced risk of dementia among Japanese older adults.

The effectiveness of Tai Chi Chuan on fear of movement, prevention of falls, physical activity, and cognitive status in older adults with mild cognitive impairment: A randomized controlled trial

PURPOSE

This study aimed to investigate the effectiveness of Tai Chi Chuan (TCC) on fear of movement, prevention of falls, physical activity, and cognitive status in older adults with mild cognitive impairment.

DESIGN AND METHODS

This controlled trial was conducted with 20 participants in the intervention group, and they did exercises for 35-40 min/session, twice a week for 12 weeks.

FINDING

The posttest scores of the scales indicated that the scores of cognitive adaptations, being observant, and changes in level subscales of the fall behavioral scale in the older adults who did Tai Chi exercise in the intervention group significantly increased (p < .01).

PRACTICE IMPLICATIONS

The nursing home provider can safely manage TCC exercise interventions for older adults with MCI.

Cystatin C and Risk of Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

INTRODUCTION

Cystatin C (Cys C) has been found as a novel biomarker of neurodegenerative diseases, such as dementia and Alzheimer's disease. Published studies on the role of Cys C as a biomarker of mild cognitive impairment (MCI) have not been reviewed systematically.

OBJECTIVE

Present meta-analysis was performed to elucidate the association between Cys C and risk of MCI.

METHODS

A comprehensive search was performed in PubMed, EMBASE, Cochrane Library, Trip databases, Worldwide Science, and Google Scholar from January 1, 1950, to April 30, 2020. Standardized mean difference (SMD) with 95% confidence interval (CI) using fixed or random effect models were used to calculate summary estimates. Quality of evidence was also assessed using the Diagnostic Accuracy Quality Scale (DAQS) and grading quality of evidence and strength of recommendations approach.

RESULTS

In our meta-analysis, 12 studies with a total of 2,433 MCI patients and 1,034 controls were included. Our findings suggest a strong association between increased levels of Cys C and risk of MCI as compared to control subjects (SMD = 2.39, 95% CI = 0.22-4.57). Subgroup analysis based on ethnicity, a significant association for the high level of Cys C with the risk of MCI was observed in the Asian population (SMD = 1.63, 95% CI = 0.44-2.82) but not in the Caucasian population (SMD = 2.80, 95% CI = [-0.66]-6.26).

CONCLUSION

Cys C was associated with MCI, and it could be considered as a predictor for the risk of cognitive impairment.

Designing and Implementing an IT Architecture for a Digital Multicenter Dementia Registry: digiDEM Bayern

Background  Registries are an essential research tool to investigate the long-term course of diseases and their impact on the affected. The project digiDEM Bayern will set up a prospective dementia registry to collect long-term data of people with dementia and their caregivers in Bavaria (Germany) supported by more than 300 research partners.

Objective  The objective of this article is to outline an information technology (IT) architecture for the integration of a registry and comprehensive participant management in a dementia study. Measures to ensure high data quality, study governance, along with data privacy, and security are to be included in the architecture.

Methods  The architecture was developed based on an iterative, stakeholder-oriented process. The development was inspired by the Twin Peaks Model that focuses on the codevelopment of requirements and architecture. We gradually moved from a general to a detailed understanding of both the requirements and design through a series of iterations. The experience learned from the pilot phase was integrated into a further iterative process of continuous improvement of the architecture.

Results  The infrastructure provides a standardized workflow to support the electronic data collection and trace each participant's study process. Therefore, the implementation consists of three systems: (1) electronic data capture system for Web-based or offline app-based data collection; (2) participant management system for the administration of the identity data of participants and research partners as well as of the overall study governance process; and (3) videoconferencing software for conducting interviews online. First experiences in the pilot phase have proven the feasibility of the framework.

Conclusion  This article outlines an IT architecture to integrate a registry and participant management in a dementia research project. The framework was discussed and developed with the involvement of numerous stakeholders. Due to its adaptability of used software systems, a transfer to other projects should be easily possible.

Efficacy of interactive video gaming in older adults with memory complaints: A cluster-randomized exercise intervention

Purpose

The effects of aging on physical and mental health may be ameliorated by regular participation in physical activity (PA). There is also evidence for the benefits of various training modalities on cognition and functional ability in older adults. The aim of this study was to compare effects of a 12-week active video gaming intervention (X Box Kinect Sports) to conventional multimodal supervised exercise on fitness, functional ability and cognitive performance in older adults with memory complaints.

Methods

Participants (n = 45, 72±5 yrs.) were recruited from 6 retirement homes and cluster-randomized into the Interactive Video Gaming (IVG) group (N = 23) or Conventional Multimodal (CM) group (N = 22), meeting 2 x 1 hour sessions, weekly for 12 weeks. Pre-post measures included: 6 min walk, timed up and go, dynamic balance, functional reach, Mini-Mental State Examination, N-back Task and the Modified Stroop task.

Results

The IVG group demonstrated significant improvement in the total number correct responses on the Stroop task (P = 0.028) and for average reaction time of correct colour-words (P = 0.024), compared to the CM group. Functional ability improved significantly in the IVG group, including the 6-min walk (P = 0.017), dynamic balance (P = 0.03), timed up and go (P<0.001) and functional reach (P<0.0010).

Conclusion

An active interactive video gaming intervention was more effective than conventional multimodal exercise in improving executive and global cognitive performance and functional capacity in older adults with subjective memory complaints.

Trial registration

Pan African Clinical Trial Registry—PACTR202008547335106.

Associations of subjective cognitive and memory decline with depression, anxiety, and two-year change in objectively-assessed global cognition and memory

Research studies exploring the association of cognitive complaints with objectively assessed cognitive decline report inconsistent results. However, many of these have methodological limitations. We investigated whether 1) more severe subjective cognitive decline (SCD) and subjective memory decline (SMD) predict change in objectively assessed global cognition, remote memory, recent memory, learning; 2) the predictive value of more severe SMD over change in objectively assessed remote memory, recent memory, and learning is stronger for individuals that report an SMD that started within the past five years than for those that report an SMD that started five or more years previously and/or stronger for those that experienced SMD within the past two years than for those who had not; and 3) greater depression and anxiety are associated with more severe SCD and SMD. We used two-year longitudinal data from the CFAS-Wales study (N = 1,531; mean (SD) age = 73.0 (6.0) years). We fitted linear regression models. More severe SCD and SMD did not predict change in objectively assessed global cognition, remote memory, and recent memory but predicted lower scores in learning. The prediction of SMD over change in learning was not stronger when individuals reported an SMD that started within the past five years compared to when they reported an SMD that started five or more years previously nor when individuals reported an SMD that started within the past two years than those who did not. Greater depression and anxiety were associated with more severe SCD and SMD. More severe SMD may be useful for predicting lower learning ability and for identifying individuals experiencing depression and anxiety.

Ambient fine particulate matter exposure and incident mild cognitive impairment and dementia

BACKGROUND/OBJECTIVE

Poor air quality is implicated as a risk factor for cognitive impairment and dementia. Few studies have examined these associations longitudinally in well-characterized population-based cohorts with standardized annual assessment of both mild cognitive impairment (MCI) and dementia. We investigated the association between estimated ambient fine particulate matter (PM_2.5 ) and risk of incident MCI and dementia in a post-industrial region known for historically poor air quality.

SETTING/PARTICIPANTS

Adults aged 65+ years in a population-based cohort (n = 1572).

MEASUREMENTS

Census tract level PM_2.5 from Environmental Protection Agency (EPA) air quality monitors; Clinical Dementia Rating (CDR)®.

DESIGN

We estimated ambient PM_2.5 exposure (μg/m³ , single-year and 5-year averages) by geocoding participants' residential addresses to census tracts with daily EPA PM_2.5 measurements from 2002 to 2014. Using Bayesian spatial regression modeling adjusted for age, sex, education, smoking history, and household income, we examined the association between estimated PM_2.5 exposure and risk of incident MCI (CDR = 0.5) and incident dementia (CDR ≥ 1.0).

RESULTS

Modeling estimated single-year exposure, each 1 μg/m³ higher ambient PM_2.5 was associated with 67% higher adjusted risk of incident dementia (hazard ratio [HR] = 1.669, 95% credible interval [CI]: 1.298, 2.136) and 75% higher adjusted risk of incident MCI (HR = 1.746, 95% CI: 1.518, 2.032). Estimates were higher when modeling 5-year ambient PM_2.5 exposure for incident dementia (HR = 2.082, 95% CI: 1.528, 3.015) and incident MCI (HR = 3.419, 95% CI: 2.806, 4.164).

CONCLUSIONS

Higher estimated ambient PM_2.5 was associated with higher risk of incident MCI and dementia, particularly when considering longer-term exposure, and independent of demographic characteristics and smoking history. Targeting poor air quality may be a reasonable population-wide intervention to reduce the risk of cognitive impairment in older adults, particularly in regions exceeding current recommendations for safe exposure to PM_2.5 .

The relationship between activity level and cognitive function in Chinese community-dwelling elderly

To study the relationship between daily activity level and cognitive function in community-dwelling elderly. We collected demographic features, cognitive function, activity level and self-rating depression scale scores in 53 community-dwelling olderly aged 60 years or above. The activity level and moderate-to-vigorous physical activity (MVPA) time were assessed by using the accelerometer for 7 consecutive days. We compared activity level, MVPA time and depression scores between cognitive impaired and normal groups. Cognitive functions were compared in groups with different MVPA level, and the correlation between cognitive function and MVPA time was analysed. Of the 53 subjects, 27 had varying degrees of cognitive impairment. Individuals with cognitive impairment shown significantly shorter MVPA time and higher depression score compared to the cognitive normal group (P < 0.05). After controlling for confounding factors (age, BMI), MVPA time was associated with cognitive function (r = 0.358, P = 0.009). The memory factor score correlated with MVPA time (r = 0.357, P = 0.012) and mean activity level (r = 0.287, P = 0.046). Moderate-to-vigorous physical activity in the elderly was positively related to their cognitive function. Strengthening daily activities may beneficial for the elderly to maintain better cognitive function.

Sociodemographic and Health-Related Factors Associated with Severity of Cognitive Impairment in Elderly Patients Hospital-ized in a Geriatric Clinic

Identification of risk factors for cognitive impairment is crucial for providing proper care and treatment. The aim of the study was to investigate the relationship between sociodemographic and health-related factors and the severity of cognitive impairment in elderly patients. In this retrospective study, we assessed the medical documentation of 323 patients aged 60+ years hospitalized in a geriatric clinic of university hospital. The patients were classified into five groups of cognitive impairment severity based on the Mini Mental State Examination and Clock Drawing Test. Kruskal-Wallis and Chi square tests and multivariate ordinal logistic regression were used to assess relationships involved. Cognitive impairment was identified in 84.2% of subjects. The following factors were indicative for higher level of cognitive disorders: primary and vocational education, older age, presence of vascular brain injury, and inability of walking independently. On the other hand, the factors associated with lower severity of cognitive impairment were co-morbid anxiety disorders, ischemic heart disease, and a higher BMI index. Dementia is one of the leading causes of disability and mortality in the elderly. Enhancing knowledge about the risk factors that worsen cognition is particularly relevant for accelerating the diagnosis of dementia and improving patient care.