Predictors of Changes in Cognitive Function in Older Korean Adults: The 2006-2018 Korean Longitudinal Study of Aging

Change in cognitive performance during seven-year follow-up in midlife is associated with sex, age, and education - The Cardiovascular Risk in Young Finns Study

OBJECTIVE

Sex, age, and education are associated with the level of cognitive performance. We investigated whether these factors modulate the change in cognitive performance in midlife by leveraging the longitudinal data from the Cardiovascular Risk in Young Finns Study (YFS).

METHODS

Participants of the YFS cohort performed a computer-based Cambridge Neuropsychological Test Automated Battery (CANTAB) in 2011 and 2018 (n = 1671, age 41-56 years in 2018). Overall cognitive performance and domains representing learning and memory, working memory, reaction time, and information processing were extracted by common principal component analysis from the longitudinal cognitive data. Linear models adjusted for baseline cognitive performance were used to study the association of sex, age, and education with changes in overall cognitive performance and in the cognitive domains.

RESULTS

Cognitive performance decreased in all domains (overall cognition -0.56 SD, p < 0.001; working memory -0.81 SD, p < 0.001; learning and memory -0.70 SD, p < 0.001; reaction time -0.06 SD, p = 0.019; information processing -0.03 SD, p = 0.016). The decrease in working memory and information processing was greater in females compared to males. Cognitive performance decreased more in older participants in all domains. Education alleviated the decrease in cognitive performance in all domains except reaction time. The beneficial effect of education was greater for males.

CONCLUSIONS

This study describes the natural course of aging-related changes in cognitive performance in midlife, the critical time window for early prevention of clinical cognitive decline. These findings provide a reference for studies focusing on determinants of pathological cognitive decline deviating from normal changes in cognitive performance.

Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis

OBJECTIVES

To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment.

DATA SOURCES

Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library.

REVIEW METHODS

All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures.

RESULTS

Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnesic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found.

CONCLUSIONS

Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.

Community support and promoting cognitive function for the elderly

Proper cognitive functions are critical to the life of the elderly. With the rapid aging of the population, community support plays an important role in cognitive functioning. This study examines the association between community support and the level of cognitive functioning in the elderly, and the mediating effect of social participation in the relationship. Based on the panel data of China Longitudinal Healthy Longevity Survey (CLHLS) in 2005, 2008, 2011, 2014, and 2018, people aged 65 and over are selected as the research object (N = 35,479). The panel Logit model is used to analyze the influence of community support on their cognitive functioning. In addition, the stepwise regression and KHB decomposition methods are used to test the influence mechanism of community support on their cognitive function. The benchmark regression results show that there is a significant correlation between community support and cognitive function in the elderly (OR: 1.64, 95% CI: 1.41–1.91, p &lt; 0.01). Daily care (OR: 1.75, 95% CI: 1.33–2.29, p &lt; 0.01) has the strongest impact on the cognitive function of the elderly, followed by health care (OR: 1.70, 95% CI: 1.43–2.01, p &lt; 0.01) and legal support (OR: 1.64, 95% CI: 1.37–1.95, p &lt; 0.01), while psychological care (OR: 1.62, 95% CI: 1.31–2.01, p &lt; 0.01) has the weakest impact on the cognitive function of the elderly. The results of the mediation effect test show that social participation plays a significant intermediary role in the impact of community support on the cognitive function of the elderly (mediation percentage: 16.89%), demonstrating that community support can improve the cognitive function of the elderly by promoting the social participation of the elderly. In classified community support, social participation plays a significant intermediary role in the impact of psychological care on cognition (mediation percentage: 46.10%).

The effect of risk factors on cognition in adult cochlear implant candidates with severe to profound hearing loss

Hearing loss has been identified as a major modifiable risk factors for dementia. Adult candidates for cochlear implantation (CI) represent a population at risk of hearing loss-associated cognitive decline. This study investigated the effect of demographics, habits, and medical and psychological risk factors on cognition within such a cohort. Data from 34 consecutive adults with post-lingual deafness scheduled for CI were analyzed. Pure tone audiometry (PTA4) and Speech Discrimination Score (SDS) were recorded. The Repeatable Battery for Assessment of Neuropsychological Status for Hearing impaired individuals (RBANS-H) was used to measure cognition. Demographics (sex, age, years of education), habits (smoking, alcohol intake, physical inactivity), and medical factors (hypertension, diabetes, traumatic brain injury) were evaluated. Depression was measured using the Hospital Anxiety and Depression Scale (HADS), and social inhibition with the Type D questionnaire (DS14). All participants (mean age 62 ± 15 years) suffered from severe to profound hearing loss (PTA4:129 ± 60 dB; SDS:14 ± 24%). The mean RBANS-H total score was 83 ± 16. Participants reported a mean of years of formal education of 12 ± 5 years. The prevalence of habits and medical risk factors was: physical inactivity (29%), body mass index >30 (28%), traumatic brain injury (25%), hypertension (24%), heavy alcohol consumption (13%), smoking (13%), and diabetes (0%). Regarding psychological factors, the mean scores of social inhibition and depression were 10 ± 6 and 6 ± 5, respectively. The number of years of education was significantly correlated with the RBANS-H total score (p < 0.001), and with the domains “Immediate memory” (p = 0.003), “Visuospatial/constructional” (p < 0.001), and “Attention” (p < 0.001). The mean RBANS-H total score in participants who had university studies or higher level (12/34) was 97 ± 9, with the remaining participants reporting a mean score of 75 ± 15. Men performed better in the “Visuospatial/constructional” (p = 0.008). Physical inactivity was associated with lower scores in the “Delayed memory” (p = 0.031); hypertension correlated with lower RBANS-H total scores (p = 0.025) and “Attention” (p = 0.006). Depression and social inhibition were negatively correlated with RBANS-H total score and with the “Immediate memory,” “Visuospatial/constructional,” and “Attention” (all p < 0.05). In adults with late-onset deafness scheduled to CI, educational level has a significant effect. Additionally, sex, physical inactivity, hypertension, and psychological traits of social inhibition and depression may also influence cognitive status. Long-term studies with more participants would enable us better understand the effects different risk factors on cognitive status.