Trajectories of cognitive decline over 10 years in a Brazilian elderly population: the Bambuí cohort study of aging

Trajectories and influencing factors of cognitive function and physical disability in Chinese older people

Introduction

Dementia and physical disability are serious problems faced by the aging population, and their occurrence and development interact.

Methods

Based on data from a national cohort of Chinese people aged 60 years and above from the China Health and Retirement Longitudinal Survey from 2011 to 2018, we applied the group-based trajectory model to identify the heterogeneous trajectories of cognitive function and physical disability in participants with different physical disability levels. Next, multinomial logistic regression models were used to explore the factors affecting these trajectories.

Results

The cognitive function trajectories of the Chinese older people could be divided into three characteristic groups: those who maintained the highest baseline level of cognitive function, those with a moderate baseline cognitive function and dramatic progression, and those with the worst baseline cognitive function and rapid-slow-rapid progression. The disability trajectories also fell into three characteristic groups: a consistently low baseline disability level, a low initial disability level with rapid development, and a high baseline disability level with rapid development. Compared with those free of physical disability at baseline, a greater proportion of participants who had physical disability at baseline experienced rapid cognitive deterioration. Education, income, type of medical insurance, gender, and marital status were instrumental in the progression of disability and cognitive decline in the participants.

Discussion

We suggest that the Chinese government, focusing on the central and western regions and rural areas, should develop education for the older people and increase their level of economic security to slow the rate of cognitive decline and disability among this age group. These could become important measures to cope with population aging.

Risco para desenvolvimento de transtorno cognitivo em um grupo de idosos ativos

Objetivo: apresentar os fatores envolvidos no risco para o surgimento de transtornos cognitivos em um grupo de idosos ativos que participa de um Núcleo de Convivência para Idosos localizado na zona leste da cidade de São Paulo.Métodos: pesquisa desenvolvida a partir da aplicação de avaliação interdisciplinar a 68 idosos ativos entre os meses de janeiro a julho de 2019. Realizou-se a coleta de dados sociodemográficos, de funcionalidade e de morbidade, sendo utilizado o instrumento Miniexame do Estado Mental para categorização de dois grupos: idosos com risco e idosos sem risco para transtornos cognitivos. Esses grupos foram, então, comparados.Resultados: observou-se que 38,2% dos idosos participantes apresentaram risco para transtornos cognitivos e que a variável idade avançada obteve associação significativa com esse risco: o avançar da idade aumenta o risco para o desfecho em 1,10 vezes. Observou-se ainda dado controverso quanto ao excesso de peso, o qual associou-se inversamente ao desfecho estudado.Conclusão: para esse grupo de pessoas idosas, a idade avançada demonstrou ser fator de risco associado ao desenvolvimento de transtorno cognitivo, ao contrário do excesso de peso.

Distinct Cognitive Trajectories in Late Life and Associated Predictors and Outcomes: A Systematic Review

Background

Cognitive aging is a dynamic process in late life with significant heterogeneity across individuals.

Objective

To review the evidence for latent classes of cognitive trajectories and to identify the associated predictors and outcomes.

Methods

A systematic search was performed in MEDLINE and EMBASE for articles that identified two or more cognitive trajectories in adults. The study was conducted following the PRISMA statement.

Results

Thirty-seven studies were included, ranging from 219 to 9,704 participants, with a mean age of 60 to 93.4 years. Most studies (n = 30) identified distinct cognitive trajectories using latent class growth analysis. The trajectory profile commonly consisted of three to four classes with progressively decreasing baseline and increasing rate of decline-a 'stable-high' class characterized as maintenance of cognitive function at high level, a 'minor-decline' class or 'stable-medium' class that declines gradually over time, and a 'rapid-decline' class with the steepest downward slope. Generally, membership of better classes was predicted by younger age, being female, more years of education, better health, healthier lifestyle, higher social engagement and lack of genetic risk variants. Some factors (e.g., education) were found to be associated with cognitive function over time only within individual classes.

Conclusion

Cognitive aging in late life is a dynamic process with significant inter-individual variability. However, it remains unclear whether similar patterns of cognitive aging are observed across all cognitive domains. Further research into unique factors which promote the maintenance of high-cognitive function is needed to help inform public policy.

Factors associated with cognitive performance in elderly caregivers

OBJECTIVE

To explore the socioeconomic, demographic and psychosocial factors associated with cognitive performance in elderly caregivers from Brazil.

METHODS

We evaluated 351 Brazilian elderly caregivers attending primary healthcare services regarding sociodemographic and care variables. Addenbrooke's Cognitive Examination-Revised (ACE-R) domains of orientation/attention, memory, verbal fluency, language and visuospatial were used as dependent variables in the Tobit model.

RESULTS

Literacy and family income were positively associated with all ACE-R domains. Age, gender, time of care (days/week) were negatively associated with some cognitive domains. Moreover, receiving emotional help and the level of hope were positively associated with specific domains.

DISCUSSION

The results may be useful for planning interventions aimed at elderly caregivers in order to prevent deficits in the different cognitive domains.

[Memory stimulation training and the functionality of the elderly without cognitive impairment: an integrative review]

The scope of this article is to identify the repercussions of the effect of memory stimulation in healthy elderly individuals. It is an integrative review of the literature, namely of articles published in the last seven years in English, Portuguese and Spanish. The selection was performed through cross-checking of key words: health of the elderly, memory and cognition in the Lilacs, Medline and IBECS databases. The inclusion criteria were: original article; addressing key issue; full text electronically available; population 60 years and above without diagnosis of cognitive impairment. Twelve articles were selected and it was identified that the effect of memory stimulation in the elderly without cognitive impairment can improve performance in advanced, instrumental and basic activities of daily living and in psychological, social and quality of life components in the elderly. Based on analysis of the articles it is important to emphasize the need for further longitudinal and intervention studies focused on cognitive stimulation in the elderly without cognitive impairment and that future research can overcome such limitations by working towards efficient monitoring and evaluation, which is more rigorous and committed to facilitate the cognitive performance of the elderly in daily activities.

Episodic memory performance in a multi-ethnic longitudinal study of 13,037 elderly

Age-related changes in memory are not uniform, even in the absence of dementia. Characterization of non-disease associated cognitive changes is crucial to gain a more complete understanding of brain aging. Episodic memory was investigated in 13,037 ethnically diverse elderly (ages 72 to 85 years) with two to 15 years of follow-up, and with known dementia status, age, sex, education, and APOE genotypes. Adjusted trajectories of episodic memory performance over time were estimated using Latent Class Mixed Models. Analysis was conducted using two samples at baseline evaluation: i) non-cognitively impaired individuals, and ii) all individuals regardless of dementia status. We calculated the age-specific annual incidence rates of dementia in the non-demented elderly (n = 10,220). Two major episodic memory trajectories were estimated: 1) Stable-consisting of individuals exhibiting a constant or improved memory function, and 2) Decliner-consisting of individuals whose memory function declined. The majority of the study participants maintain their memory performance over time. Compared to those with Stable trajectory, individuals characterized as Decliners were more likely to have non-white ethnic background, fewer years of education, a higher frequency of ε4 allele at APOE gene and five times more likely to develop dementia. The steepest decline in episodic memory was observed in Caribbean-Hispanics compared to non-Hispanic whites (p = 4.3 x 10(-15)). The highest incident rates of dementia were observed in the oldest age group, among those of Caribbean-Hispanics ancestry and among Decliners who exhibited rates five times higher than those with Stable trajectories (11 per 100 person-years versus 3 per 100 person-years. Age, education, ethnic background and APOE genotype influence the maintenance of episodic memory. Declining memory is one of the strongest predictors of incident dementia.

Factors associated with dementia in elderly

We analyzed the factors associated with dementia in the elderly attended at a memory outpatient clinic of the University of Southern Santa Catarina (UNISUL). This is a cross-sectional study with data analysis of medical records from January 2013 to April 2016. The outcome was the clinical diagnosis of dementia. The control variables were: serum vitamin D level at the time of diagnosis, gender, skin color, schooling, age, type 2 diabetes, hypertension, and depression. We performed a crude and adjusted analysis with logistic regression. The sample consisted of 287 elderly, with the predominance of age between 60 and 69 years (48.78%), female (79.09%) and white (92.33%). The mean number of years of study was 6.95 years (SD ± 4.95) and mean vitamin D was 26.09 ng/mL (SD ± 9,20). The prevalence of elderly with dementia was 16.72%. Depression was the most prevalent (42.50%) among the morbidities, followed by hypertension (31.71%). The following were independently associated with dementia: vitamin D (OR = 0.92, 95%CI, 0.88;0.97), depression (OR = 4.09, 95%CI, 1.87;8.94), hypertension (OR = 2.65, 95%CI, 1.15;6.08) and individuals aged 80 years and over (OR = 3.97 95%CI, 1.59;9.91). Dementia prevalence was high and diagnosed dementia was associated with lower levels of vitamin D. Vitamin D is a modifiable factor, opening up essential perspectives for public health policies.

Performance on cognitive tests, instrumental activities of daily living and depressive symptoms of a community-based sample of elderly adults in Rio de Janeiro, Brazil

Objective

To describe the performance on basic cognitive tasks, instrumental activities of daily living, and depressive symptoms of a community-based sample of elderly adults in Rio de Janeiro (Brazil) who participated in multiple physical, social, and cognitive activities at government-run community centers.

Methods

A total of 264 educated older adults (> 60 years of age of both genders) were evaluated by the Brief Cognitive Screening Battery (BCSB), Lawton's and Pfeffer's activities of daily living indexes, and the Geriatric Depressive Scale (GDS).

Results

The mean age of the sample was 75.7 years. The participants had a mean of 9.3 years of formal education. With the exception of the Clock Drawing Test (CDT), mean scores on the cognitive tests were consistent with the values in the literature. Only 6.4% of the sample had some kind of dependence for activities of daily living. The results of the Geriatric Depression Scale (GDS-15) indicated mild symptoms of depression in 16.8% of the sample

Conclusion

This study provided important demographic, cognitive, and functional characteristics of a specific community-based sample of elderly adults in Rio de Janeiro, Brazil.

Trajectories of Nutritional Status and Cognitive Impairment among Older Taiwanese with Hip Fracture

OBJECTIVE

This paper describes the trajectories of nutritional status and cognitive impairment and their correlation among older Taiwanese over 1 year after hip-fracture surgery.

DESIGN

Secondary analysis of data from a clinical trial evaluating the effects of three types of post-discharge care for 292 older hip-fracture patients (age >60 years).

MEASUREMENTS

Nutritional status was assessed by the Mini Nutritional Assessment before and 1, 3, 6, 12 months after hospital discharge. Cognitive function was measured by the Mini-Mental State Examination before surgery, at hospital discharge, 6 and 12 months after discharge. Trajectories of nutritional status and cognitive impairment were depicted by latent class growth modeling, whereas linkages between nutritional-status and cognitive-impairment trajectories were assessed by multinomial logistic regression.

RESULTS

Nutritional status in general improved significantly, particularly during the first 3 months after discharge. We identified three trajectories of nutritional status: malnourished (15.4%), at risk for malnutrition (38.9%), and well-nourished (45.7%). In contrast, cognitive changes followed four largely linear but distinct trajectories: moderately impaired (12.2%), mildly impaired (27.8%), borderline impaired (21.8%), and cognitively intact (38.2%). Trajectories of nutritional status were significantly associated with cognitive-function trajectories. For instance, relative to malnourished patients, well-nourished patients were 95% less likely (OR=0.05, CI =0.01-0.24) to be moderately cognitively impaired.

CONCLUSION

A good nutritional-status trajectory after hip fracture was associated with better cognitive function. To treat and care for elderly hip-fractured patients, specific interventions need to target those who are malnourished or at risk of malnutrition to decrease their risk for cognitive impairment.

Advanced activities of daily living and incidence of cognitive decline in the elderly: the SABE Study

The objective of this study was to evaluate the association between advanced activities of daily living (AADL) and incidence of cognitive decline. The sample consisted of non-institutionalized older adults who participated in the second (2006) and third (2010) waves of the Health, Wellbeing, and Aging (SABE) cohort study in São Paulo, Brazil. Cognitive decline was measured using a modified Mini-Mental State Examination. Advanced activities of daily living covered 12 social, productive, physical, and leisure-time activities that involve higher cognitive functions. Other covariates included socio-demographic conditions, overall health, lifestyle, and functional disability. The association between the independent variables and incidence of cognitive decline was assessed by multiple Poisson regression. Incidence of cognitive decline was 7.9%. Mean number of AADL in 2006 was significantly higher among elders who had not developed cognitive decline. Multivariate analysis showed that the number of AADL performed was a significant inverse predictor of cognitive decline.

Advanced Activities of Daily Living (AADLs) and cognitive performance in community-dwelling elderly persons: Data from the FIBRA Study - UNICAMP

Objective The aim of this study was to investigate the relationship between participation in advanced activities of daily living (AADLs) and cognitive performance in community-dwelling elderly persons. Method The data presented is drawn from the population-based study entitled Frailty Profile of Elderly Brazilians (FIBRA-Unicamp). The sample comprised 2,549 older adults without cognitive impairments suggestive of dementia. Data was collected relating to socio-demographic characteristics (sex, age, years of education and family income), health status (number of diseases and depressive symptoms), cognitive performance (Mini-Mental State Examination - MMSE) and self-reported social, physical and intellectual AADLs. Results Mean MMSE scores were significantly higher among men, younger individuals and those with more years of education, higher income, fewer diseases and fewer depressive symptoms. Multivariate linear regression analysis and hierarchical regression analysis showed that years of education, family income and participation in intellectual AADLs were positively associated with cognitive performance. Conclusion The findings suggest that these factors may have a protective role in cognitive aging and that participation in intellectual AADLs can represent a feasible strategy for the promotion of mental health among older adults.

Prevalência e fatores associados ao declínio cognitivo em idosos com baixa condição econômica: estudo MONIDI

RESUMO Objetivo Avaliar a prevalência e os fatores associados ao declínio cognitivo em idosos com baixa condição econômica. Métodos Estudo transversal com amostra constituída de 310 idosos residentes no município de Ibicuí/BA. Foi utilizado o Miniexame do Estado Mental para a avaliação do estado cognitivo global. Para a avaliação das variáveis categóricas e análise simultânea, foram utilizados o teste qui-quadrado χ2 e a análise de regressão logística múltipla. A análise estatística foi realizada com nível de significância p ≤ 0,05, cálculo da razão de chances e intervalos de confiança de 95%. Resultados A prevalência global do declínio cognitivo foi de 18,7%. A análise dos dados revelou que as variáveis faixa etária e escolaridade estavam estatisticamente associadas ao maior comprometimento cognitivo entre idosos (p ≤ 0,05). Conclusão A prevalência de declínio cognitivo observada foi elevada e associou-se a maior faixa etária e menos anos de estudo. Nesse sentido, as ações direcionadas a atenção à saúde do idoso devem fortalecer o cuidado, a prevenção e o controle das perdas cognitivas, principalmente na atenção primária.

Cognitive Outcomes following Transcatheter Aortic Valve Implantation: A Systematic Review

Severe aortic stenosis is the most common valvular heart disease in the elderly in the Western world and contributes to a large proportion of all deaths over the age of 70. Severe aortic stenosis is conventionally treated with surgical aortic valve replacement; however, the less invasive transcatheter aortic valve implantation (TAVI) is suggested for those at high surgical risk. While TAVI has been associated with improved survival and favourable outcomes, there is a higher incidence of cerebral microembolisms in TAVI patients. This finding is of concern given mechanistic links with cognitive decline, a symptom highly prevalent in those with cardiovascular disease. This paper reviews the literature assessing the possible link between TAVI and cognitive changes. Studies to date have shown that global cognition improves or remains unchanged over 3 months following TAVI while individual cognitive domains remain preserved over time. However, the association between TAVI and cognition remains unclear due to methodological limitations. Furthermore, while these studies have largely focused on memory, cognitive impairment in this population may be predominantly of vascular origin. Therefore, cognitive assessment focusing on domains important in vascular cognitive impairment, such as executive dysfunction, may be more helpful in elucidating the association between TAVI and cognition in the long term.

Construct validity of the mini mental state examination across time in a sample with low-education levels: 10-year follow-up of the Bambuí Cohort Study of Ageing

OBJECTIVE

The study aims to investigate whether longitudinal data on the structure of the mini mental state examination (MMSE) collected in an older Brazilian cohort support factorial invariance over time.

DESIGN

Analysis of 10-year data from a community-based cohort study was performed.

SETTING

The study took place in Bambuí, Brazil.

PARTICIPANTS

The study sample comprised 1558 (89.4%) of all eligible 1742 elderly residents.

MEASUREMENTS

A standard Brazilian version of the MMSE was used.

RESULTS

A five-factor solution (developed on the baseline of the cohort) either with no constraints or with loadings constrained to equality across time provided a reasonable fit for the MMSE. A comparison between both models suggested that the model with no constraints was superior. However, the five absolute goodness-of-fit indices suggest that the fully constrained model was also adequate and did not differ substantively from the model without any restriction.

CONCLUSION

The structure of the MMSE remained relatively unchanged across the 10 measurement times, thus providing evidence for the good construct validity of the scale across time.

Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis

Background

Cognitive impairment, including dementia, is a major health concern with the increasing aging population. Preventive measures to delay cognitive decline are of utmost importance. Alzheimer’s disease (AD) is the most frequent cause of dementia, increasing in prevalence from <1% below the age of 60 years to >40% above 85 years of age.

Methods

We systematically reviewed selected modifiable factors such as education, smoking, alcohol, physical activity, caffeine, antioxidants, homocysteine (Hcy), n-3 fatty acids that were studied in relation to various cognitive health outcomes, including incident AD. We searched MEDLINE for published literature (January 1990 through October 2012), including cross-sectional and cohort studies (sample sizes > 300). Analyses compared study finding consistency across factors, study designs and study-level characteristics. Selecting studies of incident AD, our meta-analysis estimated pooled risk ratios (RR), population attributable risk percent (PAR%) and assessed publication bias.

Results

In total, 247 studies were retrieved for systematic review. Consistency analysis for each risk factor suggested positive findings ranging from ~38.9% for caffeine to ~89% for physical activity. Education also had a significantly higher propensity for “a positive finding” compared to caffeine, smoking and antioxidant-related studies. Meta-analysis of 31 studies with incident AD yielded pooled RR for low education (RR = 1.99; 95% CI: 1.30-3.04), high Hcy (RR = 1.93; 95% CI: 1.50-2.49), and current/ever smoking status (RR = 1.37; 95% CI: 1.23-1.52) while indicating protective effects of higher physical activity and n-3 fatty acids. Estimated PAR% were particularly high for physical activity (PAR% = 31.9; 95% CI: 22.7-41.2) and smoking (PAR%=31.09%; 95% CI: 17.9-44.3). Overall, no significant publication bias was found.

Conclusions

Higher Hcy levels, lower educational attainment, and decreased physical activity were particularly strong predictors of incident AD. Further studies are needed to support other potential modifiable protective factors, such as caffeine.

Qualidade de vida, depressão e cognição a partir da educação gerontológica mediada por uma rádio-poste em instituições de longa permanência para idosos

Objetivo: identificar possíveis mudanças na qualidade de vida, cognição e depressão advindas de oficinas de educação gerontológica mediadas por uma rádio-poste em instituições de longa permanência para idosos. Métodos: estudo observacional, de natureza quali-quantitativa, que contemplou variáveis descritivas e de associação. Após estudo piloto em um grupo de terceira idade, foram selecionadas por conveniência quatro instituições, e delas os idosos cujas características contemplavam os critérios de inclusão. Foram aplicados questionários relacionados com qualidade de vida, depressão, estado cognitivo, características sociodemográficas e realidade tecnológica. Para analisar os efeitos pré e pós-processo de intervenção, foram realizadas estatísticas descritiva e analítica, por meio dos testes não paramétricos de Mann-Whitney, Kolmogorov-Smirnov, Exato de Fisher, Alfa de Cronbach, Correlação linear de Spearman, todos com nível de significância de p≤0,05. Foram elaborados roteiros de rádio para as oficinas, que aconteceram em oito encontros em cada instituição, duas vezes semanais, duas horas cada, durante seis meses. Resultados: ocorreram incrementos na qualidade de vida e cognição, de forma estatisticamente significativa nos domínios "recreação", "intimidade" e na "memória imediata". Conclusões: os ganhos significativos em qualidade de vida e cognição sugerem que essa prática pode ser válida para melhorar as condições de saúde de idosos de instituições de longa permanência.

Life expectancy with and without cognitive impairment among Brazilian older adults

Estimating the life expectancy with and without cognitive impairment in an older adult population is critical for understanding the burden of illness on individuals and their families, the health care system, and society at large. This paper presents and compares estimates of life expectancy with and without cognitive impairment for the noninstitutionalized population ages 60 years and older in São Paulo, Brazil, for the years 2000 and 2010. Life expectancy with and without cognitive impairment was calculated using the Sullivan method and prevalence estimates from data collection at two points (2000 and 2010) of the Health, Well-Being, and Aging (SABE) Study. Results indicate that 60-year-old men in São Paulo in 2000 could expect to live 14.8 years and women 17.9 years without cognitive impairment. By 2010, life expectancy without cognitive impairment had increased to 17.1 years for men and 20.0 years for women. Length of life with cognitive impairment differed by gender (2.3 years for men and 3.7 years for women at age 60 in 2010). However, the absolute number of years with cognitive impairment remained relatively constant with age. The results indicate a trend for improvements in life expectancy without cognitive impairment over time in São Paulo. Adults in Brazil still face many years of cognitive impairment in their older years, particularly when compared with estimates from developed countries.

Maternal hypertensive disorders in pregnancy and self-reported cognitive impairment of the offspring 70 years later: the Helsinki Birth Cohort Study

OBJECTIVE

We tested whether maternal hypertensive disorders during pregnancy predict self-reported cognitive impairment, which is one of the earliest behavioral markers of dementia, of the offspring 70 years later.

STUDY DESIGN

We included 876 participants of the Helsinki Birth Cohort Study 1934-44 who were born after normotensive, preeclamptic, or hypertensive pregnancies that were defined by the use of the mother's blood pressure and urinary protein measurements at maternity clinics and birth hospitals. The participants completed a psychological questionnaire that included questions on cognitive failures and dysexecutive functioning at an average age of 69.3 ± 3.1 (SD) years.

RESULTS

In comparison with the offspring who were born after normotensive pregnancies, the offspring who were born after preeclamptic pregnancies reported more frequent complaints of cognitive failures, distractibility, and false triggering. Further, among women we found maternal hypertension without proteinuria that was associated with more frequent complaints of cognitive failures, forgetfulness, and false triggering.

CONCLUSION

Hypertensive disorders during pregnancy are associated with more frequent subjective complaints of cognitive failures of the offspring in old age.

Determinants of cognitive performance among community dwelling older adults in an impoverished sub-district of São Paulo in Brazil

Determinants of cognitive performance in old age have received limited attention in Latin America. We investigated the association of socio-demographic and health-related variables with cognitive performance in a sample of older adults with limited educational experience living in a poor sub-district of the city of São Paulo. This was a cross-sectional population-based study which included a sample of 384 seniors 65 years and older. Cognition was assessed by the Mini-Mental State Examination (MMSE) and the Brief Cognitive Screening Battery (BCSB) (episodic memory test with 10 pictures, verbal fluency (VF), Clock Drawing Test (CDT)). Results indicated that age, sex, schooling, depressive symptoms, and systolic blood pressure (SBP) level had a significant impact on the cognitive performance of the sample. Therefore, pharmacological and psychosocial interventions with a focus on improving mood and controlling hypertension may have beneficial effects on cognition among seniors with similar socio-demographic characteristics.