Cognitive Impairment and Associated Factors in Rural Elderly in North China

The impact of education and occupation on cognitive impairment: a cross-sectional study in China

Background and objectives

Education, occupation, and cognitive activity are key indicators of cognitive reserve and are thought to influence cognitive impairment. However, the individual and combined impacts of these factors are not fully understood. This study aims to investigate the roles of education and occupation in cognitive impairment while controlling for brain reserve and cognitive activity.

Methods

This cross-sectional study involved 369 participants aged 50 years or older from urban outpatient clinics in Jilin Province, China. Cognitive impairment was assessed using neuropsychological scales and brain imaging. Cognitive activity was evaluated with the Cognitive Reserve Scale (CRS). Covariance analysis and logistic regression models were used to analyze the associations, adjusting for age, sex, education, and occupation.

Results

Higher education was significantly associated with a lower risk of cognitive impairment (p < 0.001), regardless of occupation. In contrast, occupational complexity and cognitive activity did not show a significant relationship with cognitive impairment (p > 0.05).

Conclusion

Education, rather than occupation or cognitive activities, is a significant predictor of cognitive impairment, highlighting the importance of educational attainment in cognitive health.

U-shaped relationship between non-high-density lipoprotein cholesterol and cognitive impairment in Chinese middle-aged and elderly: a cross-sectional study

BACKGROUND

The relationship between blood lipids and cognitive function has long been a subject of interest, and the association between serum non-high-density lipoprotein cholesterol (non-HDL-C) levels and cognitive impairment remains contentious.

METHODS

We utilized data from the 2011 CHARLS national baseline survey, which after screening, included a final sample of 10,982 participants. Cognitive function was assessed using tests of episodic memory and cognitive intactness. We used multiple logistic regression models to estimate the relationship between non-HDL-C and cognitive impairment. Subsequently, utilizing regression analysis results from fully adjusted models, we explored the nonlinear relationship between non-HDL-C as well as cognitive impairment using smooth curve fitting and sought potential inflection points through saturation threshold effect analysis.

RESULTS

The results showed that each unit increase in non-HDL-C levels was associated with a 5.5% reduction in the odds of cognitive impairment (OR = 0.945, 95% CI: 0.897-0.996; p < 0.05). When non-HDL-C was used as a categorical variable, the results showed that or each unit increase in non-HDL-C levels, the odds of cognitive impairment were reduced by 14.2%, 20.9%, and 24% in the Q2, Q3, and Q4 groups, respectively, compared with Q1. In addition, in the fully adjusted model, analysis of the potential nonlinear relationship by smoothed curve fitting and saturation threshold effects revealed a U-shaped relationship between non-HDL-C and the risk of cognitive impairment, with an inflection point of 4.83. Before the inflection point, each unit increase in non-HDL-C levels was associated with a 12.3% decrease in the odds of cognitive impairment. After the tipping point, each unit increase in non-HDL-C levels was associated with an 18.8% increase in the odds of cognitive impairment (All p < 0.05).

CONCLUSION

There exists a U-shaped relationship between non-HDL-C and the risk of cognitive impairment in Chinese middle-aged and elderly individuals, with statistical significance on both sides of the turning points. This suggests that both lower and higher levels of serum non-high-density lipoprotein cholesterol increase the risk of cognitive impairment in middle-aged and elderly individuals.

A study on the falls factors among the older adult with cognitive impairment based on large-sample data

Introduction

This study explored the correlative factors of falls among the older adult with cognitive impairment, to provide distinct evidence for preventing falls in the older adult with cognitive impairment compared with the general older adult population.

Methods

This study was based on a cross-sectional survey, with an older adult population of 124,124 was included. The data was sourced from the Elderly Care Unified Needs Assessment for Long-Term Care Insurance in Shanghai. Binary and multivariable logistic regression analyses were conducted sequentially on the correlative factors of falls. Multivariable logistic regression was performed on variables that were significant, stratified by cognitive function levels.

Results

The incidence of fall in the past 90 days was 17.67% in this study. Specific variables such as gender (male), advanced age (≥80), residence with a elevator (or lift), mild or moderate disability, quality of sleep (acceptable/poor) were negatively correlated with falls, while higher education level, living alone, residence with indoor steps, unclean and untidy living environment, MCI or dementia, chronic diseases, restricted joints, impaired vision, and the use of diaper were positively correlative factors of falls. Comparing with older adult with normal cognitive functions, older adult with dementia faced a higher risk of falling due to accessibility barrier in the residence. For general older adults, less frequency of going outside and poor social interactions were positively correlated with falls, while for older adult with cognitive impairments, going outside moderately (sometimes) was found positively correlated with falls. Older adults with cognitive impairments have increased fall risks associated with chronic diseases, restricted joints, and the use of diaper. The risk of falling escalated with the greater number of chronic diseases.

Discussion

For older adult with cognitive impairments, it is advisable to live with others. Additionally, creating an accessible living environment and maintaining the cleanness and tidiness can effectively reduce the risk of falls, particularly for those with MCI or dementia. Optimal outdoor activity plans should be developed separately based on the cognitive function of older adults. Older adult with dementia who have comorbidities should be paid special attention in fall prevention compared to the general older adult population.

Community screening for dementia among older adults in China: a machine learning-based strategy

BACKGROUND

Dementia is a leading cause of disability in people older than 65 years worldwide. However, diagnosing dementia in its earliest symptomatic stages remains challenging. This study combined specific questions from the AD8 scale with comprehensive health-related characteristics, and used machine learning (ML) to construct diagnostic models of cognitive impairment (CI).

METHODS

The study was based on the Shenzhen Healthy Ageing Research (SHARE) project, and we recruited 823 participants aged 65 years and older, who completed a comprehensive health assessment and cognitive function assessments. Permutation importance was used to select features. Five ML models using BalanceCascade were applied to predict CI: a support vector machine (SVM), multilayer perceptron (MLP), AdaBoost, gradient boosting decision tree (GBDT), and logistic regression (LR). An AD8 score ≥ 2 was used to define CI as a baseline. SHapley Additive exPlanations (SHAP) values were used to interpret the results of ML models.

RESULTS

The first and sixth items of AD8, platelets, waist circumference, body mass index, carcinoembryonic antigens, age, serum uric acid, white blood cells, abnormal electrocardiogram, heart rate, and sex were selected as predictive features. Compared to the baseline (AUC = 0.65), the MLP showed the highest performance (AUC: 0.83 ± 0.04), followed by AdaBoost (AUC: 0.80 ± 0.04), SVM (AUC: 0.78 ± 0.04), GBDT (0.76 ± 0.04). Furthermore, the accuracy, sensitivity and specificity of four ML models were higher than the baseline. SHAP summary plots based on MLP showed the most influential feature on model decision for positive CI prediction was female sex, followed by older age and lower waist circumference.

CONCLUSIONS

The diagnostic models of CI applying ML, especially the MLP, were substantially more effective than the traditional AD8 scale with a score of ≥ 2 points. Our findings may provide new ideas for community dementia screening and to promote such screening while minimizing medical and health resources.

Late Life Cognitive Function Trajectory Among the Chinese Oldest-Old Population-A Machine Learning Approach

Informed by the biopsychosocial framework, our study uses the Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset to examine cognitive function trajectories among the oldest-old (80+). Employing K-means clustering, we identified two latent groups: High Stability (HS) and Low Stability (LS). The HS group maintained satisfactory cognitive function, while the LS group exhibited consistently low function. Lasso regression revealed predictive factors, including socioeconomic status, biological conditions, mental health, lifestyle, psychological, and behavioral factors. This data-driven approach sheds light on cognitive aging patterns and informs policies for healthy aging. Our study pioneers non-parametric machine learning methods in this context.

Acupuncture and moxibustion therapy for cognitive impairment: the microbiome-gut-brain axis and its role

Cognitive impairment poses a significant burden on individuals, families, and society worldwide. Despite the lack of effective treatment strategies, emerging evidence suggests that the microbiome-gut-brain (MGB) axis may play a critical role in the pathogenesis of cognitive impairment. While targeted treatment is not yet comprehensive, recently, acupuncture and moxibustion therapy has participated increasingly in the treatment of degenerative diseases and has achieved a certain therapeutic effect. In this review, the possible mechanisms by which acupuncture and moxibustion therapy may improve cognitive impairment through the MGB axis are reviewed, including regulating gut microbial homeostasis, improving intestinal inflammation mediated by the neuroendocrine-immune system, and enhancing intestinal barrier function. We also discuss common acupoints and corresponding mechanism analysis to provide insights into further exploration of mechanisms that target the MGB axis and thereby intervene in cognitive impairment.

Developing and validating a nomogram for cognitive impairment in the older people based on the NHANES

Objective

To use the United States National Health and Nutrition Examination Study (NHANES) to develop and validate a risk-prediction nomogram for cognitive impairment in people aged over 60 years.

Methods

A total of 2,802 participants (aged ≥ 60 years) from NHANES were analyzed. The least absolute shrinkage and selection operator (LASSO) regression model and multivariable logistic regression analysis were used for variable selection and model development. ROC-AUC, calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram's performance.

Results

The nomogram included five predictors, namely sex, moderate activity, taste problem, age, and education. It demonstrated satisfying discrimination with a AUC of 0.744 (95% confidence interval, 0.696-0.791). The nomogram was well-calibrated according to the calibration curve. The DCA demonstrated that the nomogram was clinically useful.

Conclusion

The risk-prediction nomogram for cognitive impairment in people aged over 60 years was effective. All predictors included in this nomogram can be easily accessed from its' user.

Association between self-reported oral health and cognitive function among the community-dwelling elderly in Jinan, China: the mediating effect of life satisfaction

Background

Deterioration of self-reported oral health and decline in cognitive function are two main adverse health outcomes experienced by the older adults. Little evidence was found on the psychosocial mechanism between self-reported oral health and cognitive function. This study explores the association between self-reported oral health and cognitive function and examines the mediating effect of life satisfaction among the community-dwelling elderly in Jinan, China.

Methods

A total of 512 older individuals (60+) were included in the study. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination scale (MMSE), and self-reported oral health was measured using the Chinese version of the Geriatric Oral Health Assessment Index (GOHAI). Pearson correlation analysis was used to determine the relationship between self-reported oral health, life satisfaction, and cognitive function. Multivariate linear regression analysis was conducted to explore the possible effect of covariates. Structural equation modelling and Bootstrap analyses were conducted to verify the mediating role of life satisfaction.

Results

The mean MMSE score was 25.65 ± 4.42. Better self-reported oral health was significantly associated with a higher level of life satisfaction, and those with higher life satisfaction experienced better cognitive function. Age, educational level and source of living expenses were found to be cofounding variables. Life satisfaction partially mediated the effect of self-reported oral health on cognitive function (95% confidence interval [CI]: 0.010 to 0.075). The mediating effect of life satisfaction accounted for 24% of the total effect.

Conclusion

The level of cognitive function was relatively high. Self-reported oral health was positively associated with cognitive function, and the mediating effect of life satisfaction was proven to exist in the community-dwelling older individuals. Early screening for oral diseases and a greater focus on life satisfaction are recommended.

Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda

BACKGROUND

Little is known about the characteristics and determinants of post-stroke cognitive impairment in residents of low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda's Mulago Hospital, located in sub-Saharan Africa.

METHODS

131 patients were enrolled a minimum of 3-months after hospital admission for stroke. A questionnaire, clinical examination findings, and laboratory test results were used to collect demographic information and data on vascular risk factors and clinical characteristics. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants' cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment.

RESULTS

The overall mean MoCA score was 11.7-points (range 0.0-28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25-8.33; p = 0.016), functional handicap (mRS 3-5; OR 1.84, 95% CI 1.28-2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14-6.56; p = 0.024) were independently associated with cognitive impairment.

CONCLUSIONS

Our findings highlight the high burden and need for awareness of cognitive impairment in post stroke populations in the sub-Saharan region and serve to emphasize the importance of detailed cognitive assessment as part of routine clinical evaluation of patients who have had a stroke.

Cognitive Impairment and the Associated Factors Among Older People in Rural Central Tanzania

AIM

This study examined the profile of cognitive impairment and associated factors among older people in rural central Tanzania.

METHODS

We conducted a cross-sectional study involving 462 community-dwelling older adults. We performed cognitive, psychosocial, and clinical assessments and face-to-face interviews with all older adults. Descriptive, bivariate and multivariate linear regression analyses were performed to determine the participant's cognitive performance and the associated factors.

RESULTS

The mean cognitive score on the Identification and Intervention for Dementia in Elderly Africans cognitive test was 11.04 (SD=2.89). Per the proposed cut-off scores to define probable and possible dementia, 13.2% of the population had probable dementia and another 13.9% had possible dementia. Increase in age was associated with poor cognitive performance (β=-0.076, 95% CI=-0.109 to -0.043, P<0.001); whereas male sex (β=0.989, 95% CI=0.333 to 1.645, P=0.003), higher educational attainment (β=2.575, 95% CI=0.557 to 4.594, P=0.013) and performance in instrumental activities of daily living (β=0.552, 95% CI=0.376 to 0.729, P<0.001) were associated with higher cognitive performance.

DISCUSSION

Older people in rural settings of central Tanzania have poor cognitive functions and are at high risk of further cognitive decline. Preventive and therapeutic programs for the affected older people are warranted to prevent further decline and maintain quality of life.

Memory impairment and its associated risk and protective factors among older adults in Indonesia

AIMS

This study aimed to evaluate the association between memory impairment and its risk and protective factors, focusing on demographic and health-related variables among older adults in Indonesia.

METHOD

The data analyzed were the Indonesian Family Life Survey-5 (IFLS-5) using cross-sectional variables of 4236 older adults aged 60 years and over included in the 2015 round. Memory impairment was assessed by immediate word list recall from the Telephone Interview for Cognitive Status (TICS). Sociodemographic factors and multiple health variables were included as predictors. Data were analyzed using frequency analyses bivariate and stepwise logistic regression tests.

RESULT

Among 4236 older adults, 49.7% were male and 50.3% were female. Stepwise backward analyses showed that memory impairment was independently associated with older age, being female, or not in a union (unmarried, separated, divorced, or widowed), having obtained low levels of education, living in a rural area, reporting low life satisfaction, low social capital, higher dependency, and having clinical depression. Only moderate (but not high or low) physical activity levels were associated with a lower risk. Being underweight increased the risk, but being overweight/obese (as assessed by BMI) protective factors for a lower immediate recall score.

CONCLUSION

Increasing education and continued engagement of older adults in psychosocial activities, including moderate physical activity, improving mental health, preventing weight loss, and maintaining functional ability to decrease dependency, are associated with increased episodic memory, especially in non-married and older women in rural areas of Indonesia.

Prevalence and Predictors of Post-stroke Cognitive Impairment among Stroke Survivors in Uganda

Background Little is known about the characteristics and determinants of post-stroke cognitive impairments in low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda's Mulago Hospital, located in sub-Saharan Africa. Methods From August 2019 to July 2020, patients were enrolled a minimum of 3-months post-stroke hospital admission. We collected data on their demographics, vascular risk factors and clinical factors using a questionnaire, clinical examination findings, and test results. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants' cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. Results The overall mean MoCA score was 11.7-points (range 0.0-28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25-8.33; p = 0.016), functional handicap (mRS 3-5; OR 1.84, 95% CI 1.28-2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14-6.56; p = 0.024) were independently associated with cognitive impairment. Discussion Further longitudinal, prospective studies are required to confirm these findings and identify strategies for reducing the risk of post-stroke cognitive impairment in this population.

Correlation between dietary patterns and cognitive function in older Chinese adults: A representative cross-sectional study

Objective

The objective of this study was to investigate the relationship between dietary patterns and cognitive function in older adults (≥60 years old).

Methods

Food intake was quantitatively assessed by the Food Frequency Questionnaire (FFQ), and cognitive function was assessed by the Chinese version of the Simple Mental State Examination Scale (MMSE). Four major dietary patterns were identified by the factor analysis (FA) method. The relationship between dietary patterns and cognitive function was evaluated by logistic regression.

Results

A total of 884 participants were included in the study. Four dietary patterns (vegetable and mushroom, oil and salt, seafood and alcohol, and oil tea dietary patterns) were extracted. In the total population, Model III results showed that the fourth quartile of dietary pattern factor scores for the vegetable and mushroom pattern was 0.399 and 7.056. The vegetable and mushroom dietary pattern may be a protective factor for cognitive function, with p-value = 0.033, OR (95% CI): 0.578 (0.348, 0.951) in Model III (adjusted for covariates: sex, ethnic, marital, agricultural activities, smoking, drinking, hypertension, diabetes, dyslipidemia, BMI, and dietary fiber). In the ethnic stratification analysis, the scores of dietary pattern factors of the vegetable and mushroom among the Yao participants were 0.333 and 5.064. The Vegetable and mushroom diet pattern may be a protective factor for cognitive function, p-value = 0.012, OR (95% CI): 0.415 (0.206, 0.815).

Conclusion

The fourth quartile of the vegetable and mushroom dietary pattern scores showed dose-dependent and a strong correlation with cognitive function. Currently, increasing vegetable and mushroom intake may be one of the effective ways to prevent and mitigate cognitive decline. It is recommended to increase the dietary intake of vegetables and mushroom foods.

The Association of Sleep Duration With Vision Impairment in Middle-Aged and Elderly Adults: Evidence From the China Health and Retirement Longitudinal Study

Objective: This study aims to investigate the association of sleep duration with vision impairment (VI) in middle-aged and elderly adults.

Methods: This cross-sectional study used the data from the baseline survey of the China Health and Retirement Longitudinal Study (CHARLS) 2011–2012, a national survey of adults aged 45 years or older. Weighted multilevel logistic regression models were used to evaluate the association between self-reported sleep duration and VI.

Results: Of the 13,959 survey respondents, a total of 4,776 (34.2%) reported VI. The prevalence of short (≤6 h/night) and long (>8 h/night) sleep durations was higher among respondents with VI than those without VI (P < 0.001). Multilevel logistic regression models showed that compared with a sleep duration of 6–8 h/night, a sleep duration of ≤6 h/night was associated with a 1.45-fold [95% confidence interval (CI) = 1.34–1.56] higher VI risk, and a sleep duration of >8 h/night was associated with a 1.18-fold (95% CI = 1.03–1.34) higher VI risk, after adjusting for sociodemographic data, lifestyle factors, and health conditions. Vision impairment was associated with short sleep duration in respondents from all age or gender categories. However, VI was associated with long sleep duration in respondents from the elderly or female categories. The association between VI and long sleep duration disappeared in respondents of middle-aged or male categories.

Conclusions: The potential impact of sleep on the risk of visual functions requires further attention. A more comprehensive and integrated health care and rehabilitation system covering vision and sleep is also needed.

The Influence of Dementia Beliefs and Knowledge on Perceived Dementia Worry: An Empirical Study Among Adults in Rural China

Alzheimer's disease and related dementias are more prevalent in rural areas than in urban areas in China. This study aims to examine the role of dementia beliefs and knowledge in influencing dementia worry among rural adults in China. Data were generated in a cross-sectional survey of 577 participants. Hierarchical regression analyses found that both the beliefs and knowledge of dementia contributed to higher levels of dementia worry. The propensity score matching method affirmed the robustness of regression results. In addition, those aged 45-64 reported higher worry about dementia than those aged 65 or older, while being married was related to lower dementia worry. As one of the first kind studies that examined dementia worry in rural Chinese population, our findings suggest that policy and practice efforts should address cultural beliefs of dementia as they contributed to higher worry about dementia in rural areas.

Urban-rural disparities in mild cognitive impairment and its functional subtypes among community-dwelling older residents in central China

BACKGROUND

Substantial variations in the prevalence of mild cognitive impairment (MCI) and its subtypes have been reported, although mostly in geographically defined developed countries and regions. Less is known about MCI and its subtypes in rural areas of less developed central China.

AIMS

The study aimed to compare the prevalence of MCI and its subtypes in residents aged 65 years or older in urban and rural areas of Hubei Province, China.

METHODS

Participants aged 65 years or older were recruited between 2018 and 2019. Inperson structured interviews and clinical and neuropsychological assessments were performed at city health community centres and township hospitals.

RESULTS

Among 2644 participants without dementia, 735 had MCI, resulting in a prevalence of 27.8% for total MCI, 20.9% for amnestic MCI (aMCI) and 6.9% for non-amnestic MCI (naMCI). The prevalence of MCI in urban and rural areas was 20.2% and 44.1%, respectively. After adjusting for demographic factors, the prevalence of total MCI, aMCI and naMCI differed significantly between rural and urban areas (adjusted odds ratio (OR) 2.10, 1.44 and 3.76, respectively). Subgroup analysis revealed an association between rural socioeconomic and lifestyle disadvantage and MCI and its subtypes.

CONCLUSIONS

Our findings suggest that the prevalence of MCI among urban residents in central China is consistent with that in other metropolis areas, such as Shanghai, but the prevalence in rural areas is twice that in urban areas. Prospective studies and dementia prevention in China should focus on rural areas.

The Association between Social Support and Cognitive Impairment among the Urban Elderly in Jinan, China

China is currently facing a severe challenge of population ageing. However, no study has specifically explored the association between social support and cognitive impairment in Chinese urban elderly aged 60 and older. We explored the prevalence of cognitive impairment and its relationship with social support among the urban elderly aged above 60 years in Jinan, China. A total of 522 urban elderly individuals were recruited using multi-stage cluster random sampling, of which 35.55% were males and 64.45% were females. The average age of all participants was 69.66 ± 8.91 years old. Social support was assessed using the Social Support Rating Scale. Cognitive status was assessed using the Mini-Mental State Examination. Data were collected through face-to-face interviews using structured questionnaires. Descriptive analysis, chi-square tests, and logistic regression analyses were conducted. After analysing the data from 512 participants, 154 (30.1%), 352 (68.8%), and 6 (1.2%) participants had high, moderate, and low levels of social support, respectively. In addition, 125 participants (24.4%) had a cognitive impairment, while the other 387 participants (75.6%) had a normal cognitive status. Binary logistic regression analyses showed that age, educational level, occupation or pre-retirement occupation, and social support were statistically associated with cognitive impairment. A significant association between social support and cognitive impairment was found among the urban elderly in Jinan, China, which provided useful information for the intervention of cognitive impairment. More attention should be paid to the social support of the urban elderly to effectively reduce the occurrence of cognitive impairment.

Environmental Factors Affecting Cognitive Function among Community-Dwelling Older Adults: A Longitudinal Study

Although neighborhood environmental factors have been found to be associated with cognitive decline, few longitudinal studies have focused on their effect on older adults living in rural areas. This longitudinal study aimed to investigate the role of neighborhood environmental factors in cognitive decline among rural older adults. The data of 485 older adults aged ≥60 years who were living in Unnan City in Japan and had participated in two surveys conducted between 2014 and 2018 were analyzed. Cognitive function was assessed using the Cognitive Assessment for Dementia, iPad version 2. Elevation, hilliness, residential density, and proximity to a community center were determined using geographic information system. We applied a generalized estimating equation with odds ratios (OR) and 95% confidence intervals (CIs) of cognitive decline in the quartiles of neighborhood environmental factors. A total of 56 (11.6%) participants demonstrated a decrease in cognitive function at follow up. Elevation (adjusted OR 2.58, 95% CI (1.39, 4.77) for Q4 vs. Q1) and hilliness (adjusted OR 1.93, 95% CI (1.03, 3.63) for Q4 vs. Q1) were associated with a higher likelihood of cognitive decline. The second quartiles of residential density showed significantly lower likelihoods of cognitive decline compared with the first quartiles (adjusted OR 0.36, 95% CI (0.19, 0.71) for Q2 vs. Q1). Thus, an elevated hilly environment and residential density predicted cognitive decline among rural older adults.

Cognitive Differences in the Older Adults Living in the General Community: Gender and Mental Occupational State Study

Older adults are particularly vulnerable to cognitive impairment with age, and gender differences are remarkable. However, there is very little evidence to identify both baseline cognitive and occupational gender differences prior to older adults' retirement to design more efficient personalized cognitive interventions. This descriptive observational study examined gender differences in initial cognitive performance in 367 older adults with subjective memory complaints from a primary healthcare center in Zaragoza (Spain). To evaluate initial cognitive performance, the Spanish version of the Mini-Mental State Examination (MEC-35) and the set test were used to measure verbal fluency. Sociodemographic and clinical characteristics were evaluated, and cognitive and occupational differences were analyzed per gender. Men had higher educational and occupational levels, were older and more of them were married (p < 0.001) than women. Regarding cardiovascular risk factors, diabetes and cerebrovascular accidents were more frequent in women, while hypercholesterolemia and obesity were more frequent in men (p < 0.001). High blood pressure was more frequent in women, but not significantly so (p = 0.639). Global cognition was higher in men (p < 0.001) for attention, calculation, and language (p < 0.001). Verbal fluency was higher in women, but the difference was not statistically significant (p = 0.105). These results could be generalized to other health centers in the province and other Spanish autonomous communities as their sociodemographic variables are similar. Individualized interventions that adapt to gender, cognitive and initial occupational performance should be developed and adapted to elderly populations living in the general community to maintain their cognitive capacity and prevent their cognitive impairment and the social health costs this would imply.

Relationship Between Metabolic Syndrome and Cognitive Function: A Population-Based Study of Middle-Aged and Elderly Adults in Rural China

INTRODUCTION

To explore the relationship between metabolic syndrome (MetS) and cognitive impairment in a low-income and low-education population.

METHODS

All residents aged ≥45 years in a low-income population in Tianjin, China, were eligible to participate in this study. The Mini-Mental State Examination (MMSE) scale was used to conduct a preliminary screening and assessment of the participants' cognitive statuses. The MMSE components are orientation, registration, attention and calculation, recall, and language.

RESULTS

In this population, the prevalences of MetS and cognitive impairment were 54.1% and 44.5%, respectively. In the overall population, the registration score was 0.105 points lower in the elevated triglycerides (TG) group than in the normal TG group (β, -0.105; 95% confidence interval [CI]: -0.201, -0.010; P=0.030). In men, high TG was associated with registration scores that were 0.152 points lower than those in the normal TG group (95% CI: -0.281, -0.022; P=0.022), while larger WC and lower HDL-C had positive effects on cognitive scores (all P<0.05). However, in women, there were no significant differences between cognitive scores and MetS or its components.

CONCLUSION

In this population, first, TG had a great impact on cognition, even greater than the impact of MetS on cognition. Second, the impact of MetS components on cognition was more obvious in men, and not all of the effects were negative. Therefore, the effect of MetS on cognition may need to be analyzed separately for different populations, and it may be that the effect of a single component is greater than the overall effect. When formulating prevention strategies for cognitive impairments, population differences must also be taken into consideration.