Mini-Cog versus Codex (cognitive disorders examination) Is there a difference?

The interaction effect of metals exposure and dietary habit on cognitive function in Chinese older adult cohort

BACKGROUND

As the important factors in cognitive function, dietary habits and metal exposures are interactive with each other. However, fewer studies have investigated the interaction effect of them on cognitive dysfunction in older adults.

METHODS

2,445 registered citizens aged 60-85 years from 51 community health centers in Luohu District, Shenzhen, were recruited in this study based on the Chinese older adult cohort. All subjects underwent physical examination and Mini-cognitive assessment scale. A semi quantitative food frequency questionnaire was used to obtain their food intake frequency, and 21 metal concentrations in their urine were measured.

RESULTS

Elastic-net regression model, a machine learning technique, identified six variables that were significantly associated with cognitive dysfunction in older adults. These variables included education level, gender, urinary concentration of arsenic (As) and cadmium (Cd), and the frequency of monthly intake of egg and bean products. After adjusting for multiple factors, As and Cd concentrations were positively associated with increased risk of mild cognitive impairment (MCI) in the older people, with OR values of 1.19 (95% CI: 1.05-1.42) and 1.32 (95% CI: 1.01-1.74), respectively. In addition, older adults with high frequency of egg intake (≥30 times/month) and bean products intake (≥8 times/month) had a reduced risk of MCI than those with low protein egg intake (<30 times/month) and low bean products intake (<8 times/month), respectively. Furthermore, additive interaction were observed between the As exposure and egg products intake, as well as bean products. Cd exposure also showed additive interactions with egg and bean products intake.

CONCLUSIONS

The consumption of eggs and bean products, as well as the levels of exposure to the heavy metals Cd and As, have been shown to have a substantial influence on cognitive impairment in the elderly population.

Free-Cog revisited: the diagnostic contribution of cognitive and executive function

Aim: To examine Free-Cog, a recently described, hybrid screening instrument, as separate tests of cognitive (Free-Cog-Cog) and executive function (Free-Cog-Exec) to see if this improved screening accuracy for cognitive impairment compared with standard Free-Cog. Materials & methods: Free-Cog-Cog and Free-Cog-Exec were combined using Boolean logical 'AND' and 'OR' operators (serial and parallel combination), and also used to construct a stepwise decision tree. Results: Serial combination improved specificity and positive predictive value whereas parallel combination improved sensitivity, typical findings with these operators. Stepwise application identified groups with high and low probability of cognitive impairment but failed to differentiate adequately those in the intermediate uncertain diagnosis group. Conclusion: Study findings suggest limited benefit from reformulations of Free-Cog compared with the standard instrument.

Cognitive testing in the COVID-19 era: can existing screeners be adapted for telephone use?

Aim: To examine whether two existing cognitive screeners might be adapted for telephone administration by omission of item content requiring visual cues or assessment. Materials & methods: Data from a test accuracy study of Mini-Addenbrooke's Cognitive Examination (MACE) and Free-Cog were used to derive scores for 'Tele-MACE' and 'Tele-Free-Cog'. Results: As in the index study, both Tele-MACE and Tele-Free-Cog proved sensitive for dementia diagnosis. Tele-MACE had a better balance of sensitivity and specificity than observed with MACE. Tele-MACE was sensitive for mild cognitive impairment diagnosis, whereas Tele-Free-Cog was more specific for mild cognitive impairment. Conclusion: Existing cognitive screeners may be adapted for telephone administration. Such developments may prove necessary in the COVID-19 era as remote rather than face-to-face cognitive assessment increasingly becomes the established norm.