Impact of Mild Behavioral Impairment on Longitudinal Changes in Cognition

BACKGROUND

To examine cross-sectional differences and longitudinal changes in cognitive performance based on the presence of mild behavioral impairment (MBI) among older adults who are cognitively healthy or have mild cognitive impairment (MCI).

METHODS

Secondary data analysis of participants (n = 17 291) who were cognitively healthy (n = 11 771) or diagnosed with MCI (n = 5 520) from the National Alzheimer's Coordinating Center database. Overall, 24.7% of the sample met the criteria for MBI. Cognition was examined through a neuropsychological battery that assessed attention, episodic memory, executive function, language, visuospatial ability, and processing speed.

RESULTS

Older adults with MBI, regardless of whether they were cognitively healthy or diagnosed with MCI, performed significantly worse at baseline on tasks for attention, episodic memory, executive function, language, and processing speed and exhibited greater longitudinal declines on tasks of attention, episodic memory, language, and processing speed. Cognitively healthy older adults with MBI performed significantly worse than those who were cognitively healthy without MBI on tasks of visuospatial ability at baseline and on tasks of processing speed across time. Older adults with MCI and MBI performed significantly worse than those with only MCI on executive function at baseline and visuospatial ability and processing speed tasks across time.

CONCLUSIONS

This study found evidence that MBI is related to poorer cognitive performance cross-sectionally and longitudinally. Additionally, those with MBI and MCI performed worse across multiple tasks of cognition both cross-sectionally and across time. These results provide support for MBI being uniquely associated with different aspects of cognition.

Music Engagement and Episodic Memory Among Middle-Aged and Older Adults: A National Longitudinal Analysis

OBJECTIVES

The objective of this study was to examine associations between music engagement and episodic memory for more than 12 years in a nationally representative sample of middle- and older-aged adults in the United States.

METHODS

This study is based on a secondary analysis of data from a sample (N = 5,021) of cognitively normal adults from the Health and Retirement Study (2006-2018). Episodic memory was measured by immediate and delayed recall tasks. Music engagement was classified as none, passive (i.e., listening to music), active (i.e., singing and/or playing an instrument), or both (i.e., listening to music and singing or playing an instrument).

RESULTS

Compared with those with no music engagement, respondents who reported both passive and active engagement performed 0.258 points better at baseline on episodic memory tasks. This group also performed better across time with scores that declined by 0.043 points fewer per study visit. Additionally, compared to those with no music engagement, participants with passive music engagement had scores that declined by 0.023 points fewer per visit. There were no significant differences in performance at baseline for those with passive or active music engagement, or across time for those with active engagement.

DISCUSSION

The results of this study suggest that engaging in both passive and active music engagement may be superior to engaging with music only passively or actively and that engaging in music both ways may be able to protect against age-related declines in episodic memory. Future research should examine whether community-based music engagement interventions can affect this trajectory of decline.

Psychosis as a Treatment Target in Dementia: A Roadmap for Designing Interventions

Psychotic phenomena are among the most severe and disruptive symptoms of dementias and appear in 30% to 50% of patients. They are associated with a worse evolution and great suffering to patients and caregivers. Their current treatments obtain limited results and are not free of adverse effects, which are sometimes serious. It is therefore crucial to develop new treatments that can improve this situation. We review available data that could enlighten the future design of clinical trials with psychosis in dementia as main target. Along with an explanation of its prevalence in the common diseases that cause dementia, we present proposals aimed at improving the definition of symptoms and what should be included and excluded in clinical trials. A review of the available information regarding the neurobiological basis of symptoms, in terms of pathology, neuroimaging, and genomics, is provided as a guide towards new therapeutic targets. The correct evaluation of symptoms is transcendental in any therapeutic trial and these aspects are extensively addressed. Finally, a critical overview of existing pharmacological and non-pharmacological treatments is made, revealing the unmet needs, in terms of efficacy and safety. Our work emphasizes the need for better definition and measurement of psychotic symptoms in dementias in order to highlight their differences with symptoms that appear in non-dementing diseases such as schizophrenia. Advances in neurobiology should illuminate the development of new, more effective and safer molecules for which this review can serve as a roadmap in the design of future clinical trials.

State Policies Concerning Disaster Preparedness for Home- and Community-Based Service Providers

Older adults are among those most vulnerable to harm in disasters, such as hurricanes and wildfires. Nursing homes and other Medicare providers are subject to federal requirements to develop detailed disaster plans. However, millions of older adults receive care at home from non-Medicare providers who are under federal disaster preparedness rules that are less prescriptive than Medicare rules and subject to state interpretation. This study assessed the disaster preparedness policies for Older Americans Act-funded home- and community-based programs in 10 states with high numbers of older adults and experience with disasters. We found considerable variation by state. The results raise questions about the protection provided to vulnerable individuals who receive care at home in some states. However, the policies of some other states indicate an awareness that government has a significant role in protecting older adults exposed to disasters and that disaster preparedness is a component of aging in place.

Music Engagement and Episodic Memory among Middle-Aged and Older Adults: A National Cross-Sectional Analysis

OBJECTIVES

To determine whether music engagement influences middle-aged and older adults' performance on episodic memory tasks.

METHODS

Secondary data analysis of a sample (N = 4,592) of cognitively healthy adults from the 2016 Health and Retirement Study were used for this study. Multivariable regression models were used to analyze the cross-sectional differences in performance on tasks of episodic memory between participants who listened to music (n= 3,659) or sang or played an instrument (n= 989).

RESULTS

On average, participants recalled 10.3 words out of a possible 20. Regression analyses showed that both music listening and singing or playing an instrument were independently associated with significantly better episodic memory.

DISCUSSION

The findings provide the first population-based evidence that music engagement is associated with better episodic memory among middle-aged and older adults. Future studies should examine whether the association is causal or has a dose response.

Neuropsychiatric symptoms as a distinguishing factor between memory diagnoses

OBJECTIVES

To determine whether neuropsychiatric symptoms (NPS) are able to differentiate those with mild cognitive impairment (MCI) and dementia from persons who are cognitively healthy.

METHODS

Multinomial and binary logistic regressions were used to assess secondary data of a sample (n = 613) of older adults with NPS. Analyses evaluated the ability to differentiate between diagnoses, as well as the influence of these symptoms for individuals with amnestic MCI (MCI-A), non-amnestic MCI (MCI-NA), and dementia compared with those who are cognitively healthy.

RESULTS

Persons with MCI were more likely to have anxiety, apathy, and appetite changes compared with cognitively healthy individuals. Persons with dementia were more likely to have aberrant motor behaviors, anxiety, apathy, appetite changes, and delusions compared with those who were cognitively healthy. Individuals with any type of cognitive impairment were more likely to have anxiety, apathy, appetite changes, and delusions. Specifically, anxiety, apathy, appetite changes, and disinhibition were predictors of MCI-A; agitation and apathy were predictors of MCI-NA; and aberrant motor behaviors, anxiety, apathy, appetite changes, and delusions were predictors of dementia. Finally, nighttime behavior disorders were less likely in individuals with dementia.

CONCLUSIONS

The present study's results demonstrate that specific NPS are differentially represented among types of cognitive impairment and establish the predictive value for one of these cognitive impairment diagnoses.

MILD BEHAVIORAL IMPAIRMENT AS A PREDICTOR OF COGNITIVE FUNCTIONING IN OLDER ADULTS

Background: Mild behavioral impairment (MBI) is considered to be a late life transitional state between normal aging and dementia that describes individuals who have persistent behavioral changes and/or psychiatric symptoms. Individuals with MBI are found to be at greater risk of dementia compared to those without these symptoms. Identifying how MBI might relate to different domains of cognition is of key importance, as it could be an early indicator of a future dementia diagnoses. Method: Secondary data analysis of a sample (n=512) of older adults from the Florida Alzheimer’s Disease Research Center who were either cognitively healthy or presenting with mild cognitive impairment (MCI). Some individuals presented with MBI, as defined by decreased motivation, affective dysregulation, impulse dyscontrol, social inappropriateness, or abnormal perception/thought content. Executive function, attention, short-term memory, and episodic memory, were compared using a battery of neuropsychological assessments. Results: Individuals with MCI performed worse on all tasks across all cognitive domains, where individuals with MBI performed worse on several tasks associated with executive function, attention, and episodic memory. Compared to individuals with only MCI, individuals with MCI and MBI performed significantly worse on tasks associated with executive function and episodic memory. Conclusion: The present study found evidence that individuals with MBI will perform worse on tasks of executive function, attention, and episodic memory. Further, those with MCI and MBI will perform significantly worse on executive function and episodic memory tasks. Future research should explore if these findings can help to predict specific dementia diagnoses.

Assessment of Cognitive Training & Social Interaction in People with Mild to Moderate Dementia: A Pilot Study

Objectives: To evaluate the cognitive, neuropsychiatric, and quality of life outcomes of computer-based cognitive training and social interaction on people with mild to moderate dementia. Methods: Ten individuals with dementia were recruited to complete a cognitive training regimen. They were randomly assigned to a high social interaction (HSI) group (n = 5) and low social interaction (LSI) group (n = 5). Eight of the original 10 participants completed the cognitive training and were evaluated on cognitive abilities, neuropsychiatric symptoms (NPS), and quality of life (QoL). Results: Mean scores for the HSI group increased on cognitive assessments, where mean scores for the LSI group saw decline, or stability. There was an overall reduction in the frequency and severity of NPS presentation in both the HSI and LSI group. Mixed results were found for mean changes in QoL. Discussion: These results support the idea of social interaction influencing cognitive outcomes, cognitive training influencing NPS, and both social interaction and cognitive training influencing QoL. The findings illustrate the feasibility and importance of incorporating social activity to computerized cognitive training for people with dementia. Clinical Implications: Cognitive training that incorporates social interaction may be a promising intervention for individuals with dementia experiencing NPS.