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• What is the primary question addressed by this study? Do depressive symptoms in cognitively normal older adults constitute a risk factor for cognitive decline? • What is the main finding of this study? We examined depressive symptoms as predictors of cognition in 3088 Japanese-American men who at baseline were dementia-free and an average of 77 years old. Depressive symptoms correlated with poorer cognitive performance at baseline, but did not predict fluid ability, crystallized ability, or global cognitive functioning over a 20-year period. • What is the meaning of the finding? As depressive symptoms reflecting psychological and physical well-being were associated with contemporaneous cognitive function, screening for depressive symptoms may identify individuals likely to benefit from interventions to improve mood and thereby maintain or enhance cognition. To examine depressed affect, somatic complaints, and positive affect as longitudinal predictors of fluid, crystallized and global cognitive performance in the Kuakini Honolulu-Asia Aging Study (HAAS), a large prospective cohort study of Japanese-American men. We assessed 3,088 dementia-free Kuakini-HAAS participants aged 71–93 (77.1 ± 4.2) years at baseline (1991–1993). Depressive symptoms were evaluated by the Center for Epidemiologic Studies Depression (CES-D) Scale. Baseline CES-D depression subscales (depressed and positive affects; somatic complaints) were computed. The Cognitive Abilities Screening Instrument (CASI) measured cognitive performance on a 100-point scale; fluid and crystallized cognitive abilities were derived from CASI factor analysis. Cognition was also evaluated at 4 follow-up examinations over a 20-year period. Multiple regression assessed baseline CES-D subscales as predictors of cognitive change. The baseline covariates analyzed were CASI, age, education, prevalent stroke, APOE ε4 presence, and the longevity-associated FOXO3 genotype. Cross-sectionally, baseline CES-D subscales were related to cognitive measures; e.g., higher depressed affect was associated with lower crystallized ability (β = −0.058, p ≤ 0.01), and somatic complaints were linked to poorer fluid ability (β = −0.045, p ≤ 0.05) and to worse global cognitive function as measured by total CASI score (β = −0.038, p ≤ 0.05). However, depression subscales did not significantly or consistently predict fluid ability, crystallized ability, or global cognitive performance over time. Psychological and physical well-being were associated with contemporaneous but not subsequent cognitive functioning. Assessment of depressive symptoms may identify individuals who are likely to benefit from interventions to improve mood and somatic health and thereby maintain or enhance cognition. [ABSTRACT FROM AUTHOR]

• Discharge to LTCFs instead of home can impose social and financial burdens. • DASC-8 is a clinical tool that assesses functional and cognitive impairment severity. • Patients with moderate/severe impairment have a higher risk of discharge to LTCFs. • Identifying at-risk patients may aid interventions that promote discharge to home. The early recognition of hospitalized patients at risk of being discharged to long-term care facilities (LTCFs) may help to identify those who require transitional care programs and interventions that support discharge to home. We examined the association of functional and cognitive impairment severity with discharge to LTCFs among older hospitalized patients. In this retrospective cohort study, we used an administrative claims database linked with geriatric assessment data from a general acute care hospital in Japan. We analyzed patients aged ≥65 years discharged between July 2016 and December 2018. The severity of functional and cognitive impairments was assessed using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) scale. Based on their DASC-8 scores, patients were designated as Category I (no impairment), Category Ⅱ (mild impairment), or Category III (moderate/severe impairment). We conducted logistic regression analyses to examine the association between the severity of impairments and discharge to LTCFs after adjusting for patient-level factors. We analyzed 9,060 patients (mean age: 79.4 years). Among the 112 patients (1.2%) discharged to LTCFs, 62.3%, 18.6%, and 19.2% fell under Category I, Category Ⅱ, and Category III, respectively. Category II was not significantly associated with discharge to LTCFs. However, Category III had a significantly higher odds of discharge to LTCFs than Category I (Adjusted odds ratio: 2.812, 95% confidence interval: 1.452–5.449). Patients identified as Category III by the DASC-8 on admission may benefit from enhanced transitional care and interventions that promote discharge to home. [ABSTRACT FROM AUTHOR]

New absolute and normalized handgrip strength (HGS) cut-points may not yield similar predictive value for cognitive performance. We sought to determine the associations of (1) each absolute and normalized weakness cut-point, and (2) compounding weakness on future cognitive impairment in older Americans. Longitudinal panel. The analytic sample included 11,116 participants aged ≥65 years from the 2006 to 2018 waves of the Health and Retirement Study. Participants from the Health and Retirement Study completed detailed interviews that included physical measures and core interviews. The modified Telephone Interview of Cognitive Status assessed cognitive function and persons scoring <11 were classified as having a cognitive impairment. A handgrip dynamometer measured HGS. Men were considered weak if their HGS was <35.5 kg (absolute), <0.45 kg/kg (body mass normalized), or <1.05 kg (body mass index normalized), whereas women were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg. Compounding weakness included those below 1, 2, or all 3 cut-points. Generalized estimating equations quantified the associations. Persons considered weak under the absolute cut-point had 1.62 (95% CI 1.34–1.96) greater odds for future cognitive impairment, but no significant associations were observed for those classified as weak under the body mass [odds ratio (OR) 1.12, CI 0.91–1.36] and body mass index normalized (OR 1.17, CI 0.95–1.43) cut-points. Older Americans below all 3 weakness cut-points had 1.47 (CI 1.15–1.88) greater odds for future cognitive impairment, but no significant associations were found for persons classified as weak under 1 (OR 1.08, CI 0.83–1.42) or 2 (OR 1.19, CI 0.91–1.55) cut-points. Our findings suggest that each weakness cut-point has differential prognostic value for future cognitive impairment, and aggregating weakness cut-points may improve their predictive utility. Consideration should be given to how weakness categories are uniquely linked to cognitive function. [ABSTRACT FROM AUTHOR]

This study examines the relationships between productive social engagement and cognitive functioning trajectories of older adults in South Korea and how the nature of the relationships differs for men and women. We exploit data from a nationally representative longitudinal survey of South Korea from 2006 to 2014 and apply the Growth Mixture Modeling approach to disentangle health causation from health selection processes. We find that socially productive activities are associated with more favorable cognitive functioning trajectories, independent of an individual's baseline health and cognitive status. The odds of maintaining higher cognitive functioning are greater for men who had participated in socially productive activities on a monthly basis. Social engagement protects against rapid cognitive decline for women, particularly for those with lower education. Among men, social activities in friendship/alumni organizations are likely to help maintain good cognitive functioning in older age while for women with lower cognition, religious activities may protect against cognitive decline. • Social engagement is positively related to cognitive function among older Koreans. • The relationship remained significant after adjusting for the selection effect. • The protective effect of social engagement varies by the gender and schooling. • Older men benefit more from friendship/alumni associations. • Older women benefit more from religious participation. [ABSTRACT FROM AUTHOR]

Abstract Background The association of type 2 Diabetes Mellitus (DM2) with depressive symptoms may affect the quality of life of older adults and increase their risk of morbidity and deterioration in functional activities. This study aimed to investigate the variables related to depressive symptoms in older adult patients with DM2. Methods This cross-sectional, descriptive, analytical study included 102 older adult patients with DM2, treated in northeastern Brazil. We evaluated demographic, clinical, and functional variables [ Timed Up and Go (TUG) test, a scale to assess performance (WHO Disability Assessment Schedule), and psycho-cognitive variables (using the Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS)). Results There was a significant correlation between the GDS and body mass index (p = 0.04, ρ = 0.20) and intensity of pain (p = 0.09, ρ = 0.26); and scores on the MMSE (p = 0.01, ρ = −0.25); WHODAS (p < 0.001, ρ = 0.61); TUG test (p = 0.016, ρ = 0.25), and TUG dual task (p = 0.029, ρ = 0.23). Conclusion Depressive symptoms in older adult patients with DM2 were associated with being female, being single, being illiterate, having poor overall health, using a walking aid, having higher body mass index, having a greater intensity of dizziness, exhibiting functional impairment, and having gait and cognition deficits. [ABSTRACT FROM AUTHOR]

Study Objective: To assess the effect of different intraoperative blood pressure targets on the development of POCD and test the feasibility of a larger trial.Design: Randomized controlled pilot trial.Setting: Perioperative care in a tertiary care teaching hospital with outpatient follow-up.Patients: One hundred one patients aged ≥75 years with ASA physical status <4, undergoing elective, non-cardiac surgery under general anesthesia and 33 age-matched healthy controls.Interventions: Randomization to a personalized intraoperative blood pressure target, mean arterial pressure (MAP) ≥ 90% of preoperative values (Target group), or to a more liberal intraoperative blood pressure management (No-Target group). Strategies to reach intraoperative blood pressure target were at discretion of anesthesiologists.Measurements: An experienced neuropsychologist performed a validated battery of neurocognitive tests preoperatively and 3 months after surgery. Incidence of POCD at three months and postoperative delirium were assessed. Intraoperative time spent with MAP ≥ 90% of preoperative values, recruitment and drop-out rate at 3 months were feasibility outcomes.Main Results: The Target group spent a higher percentage of intraoperative time with MAP ≥90% of preoperative values (65 ± 25% vs. 49 ± 28%, p < 0.01). Incidence of POCD (11% vs. 7%, relative risk 1.52; 95% CI, 0.41 to 6.3; p = 0.56) and delirium (6% vs. 14%, relative risk, 0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not differ between groups. No correlation was found between intraoperative hypotension and postoperative cognitive performance (p = 0.75) or delirium (p = 0.19). Recruitment rate was of 6 patients/month (95% confidential interval (CI), 5 to 7) and drop-out rate at 3 months was 24% (95% CI, 14 to 33%).Conclusions: Intraoperative hypotension did not correlate with postoperative cognitive dysfunction or delirium occurrence in elderly patients undergoing general anesthesia for non-cardiac surgery. A multicenter randomized controlled trial is needed in order to confirm the effect of intraoperative blood pressure on the development of POCD.Trial Registration Number: NCT02428062www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Abstract Background Awareness of physical ability may impact fall risk during everyday tasks. Therefore, we investigated perceived reach (PR; estimation of furthest reach distance), maximal reach (MR) and reach judgement error (RJE), and their relationships with neuropsychological and physical performance, and falls in older people with cognitive impairment (CI). Methods Prospective cohort study of 110 (mean age = 82 ± 7 years; female = 52%) older people with mild-moderate CI (MMSE 11–23; Addenbrooke's Cognitive Examination-Revised (ACE-R) < 83). PR, MR and detailed neuropsychological and physical assessments were assessed at baseline. Participants were divided into tertiles based on their absolute RJE. Falls were recorded prospectively over 12 months with the assistance of carers. Results The populations mean MR was 79 ± 10 cm and PR was 75 ± 13 cm, indicating participants tended to underestimate their reach ability. The large RJE tertile performed significantly poorer in measures of global cognition (ACE-R; OR 0.54 95%CI 0.31–0.95) and executive function (Trail Making Test B; OR 1.84 95%CI 1.00–3.36) and had increased concern about falling (Falls Efficacy Scale-International; OR 2.01 95% CI 1.06–3.79) compared to the minimal RJE tertile. The moderate and large RJE tertile groups had significantly slower hand reaction time and larger postural sway on foam compared to the minimal RJE tertile. Each 1% increase in RJE increased the risk of falls by 2% (RR 1.02 95%CI 1.01–1.03). This relationship withstood adjustment for other fall risk factors (sway on foam, Trail Making Test B and ACE-R). Conclusions Inaccurate reach judgement predicts future falls and is associated with poorer global cognitive performance and executive function, increased concern about falling, slower reaction time and poorer balance. Our results offer insight into the disparity between actual and perceived physical capabilities in people with CI, and how this impacts their risk of falling. Highlights • Judgement error measures the disparity between perceived and actual ability. • Absolute reach judgement error (RJE) predicts falls in cognitively impaired older people. • Larger RJEs were associated with poorer physical and cognitive abilities. • Even so, the RJE-falls relationship was independent of balance, executive and global cognitive function. • RJE may represent a new, complementary, fall risk assessment measure. [ABSTRACT FROM AUTHOR]

• This research focused on the effect of gender differences. • The joint effects of HI and VI on cognitive decline and CIND were explored. • A nationally representative population with a follow-up period of 7-year was used. • The effect of time-varying variables was considered. To explore the gender differences of the association between sensory impairment (SI) and the risk of cognitive decline and possible cognitive impairment, no dementia (CIND). Data were drawn from three waves of the nationally representative survey of China Longitudinal Healthy Longevity Survey (CLHLS) between 2011/12-2018 surveys, involving 6138 participants aged 65 or older who had no CIND at the baseline. Multivariate linear or logistic regression models were employed to examine the effect of SI on cognitive decline and CIND risk by gender stratification, respectively. Hearing impairment and visual impairment were associated with lower MMSE scores, and the strength of the association was stronger in men than in women. Hearing impairment was related to an elevated risk of CIND both in men and women (Men: OR =2.46; 95% CI =1.81, 3.35; Women: OR =1.43; 95% CI =1.09, 1.88). However, the effect of visual impairment on CIND was statistically significant only in men (OR =1.43; 95% CI =1.09, 1.88). The risk of cognitive decline and CIND were significantly higher with single and dual SI than those without SI, except for women with single visual impairment. SI is independently associated with cognitive decline and CIND risk, and the association differed by gender. Further researches should clarify the mechanism between SI and cognitive function among older adults, especially for gender differences. [ABSTRACT FROM AUTHOR]

It is well established that cerebral white matter lesions (WML), present in the majority of older adults, are associated with cardiovascular and cerebrovascular diseases and also with cognitive decline. However, much less is known about how WML are related to other important individual characteristics and about the generality vs. brain region-specificity of WML. In a longitudinal study of 112 community-dwelling adults (age 50–71 years at study entry), we used a machine learning approach to evaluate the relative strength of 52 variables in association with WML burden. Variables included socio-demographic, lifestyle, and health indices—as well as multiple cognitive abilities (modeled as latent constructs using factor analysis)—repeatedly measured at three- to six-year intervals. Greater chronological age, symptoms of cardiovascular disease, and processing speed declines were most strongly linked to elevated WML burden (accounting for ∼49% of variability in WML). Whereas frontal lobe WML burden was associated both with elevated cardiovascular symptoms and declines in processing speed, temporal lobe WML burden was only significantly associated with declines in processing speed. These latter outcomes suggest that age-related WML-cognition associations may be etiologically heterogeneous across fronto-temporal cerebral regions. [ABSTRACT FROM AUTHOR]

Highlights • Older people with MCI or mild AD presented a high prevalence of falls during the 6-month follow up. • A dual-task test can be used as a screening tool for determining risk of falls in people with MCI. • The dual-task in this experiment did not predict falls among people with mild AD. Abstract Background A dual-task tool with a challenging and daily secondary task, which involves executive functions, could facilitate the screening for risk of falls in older people with mild cognitive impairment or mild Alzheimer's disease. Objective To verify if a motor-cognitive dual-task test could predict falls in older people with mild cognitive impairment or mild Alzheimer's disease, and to establish cutoff scores for the tool for both groups. Methods A prospective study was conducted with community-dwelling older adults, including 40 with mild cognitive impairment and 38 with mild Alzheimer's disease. The dual-task test consisted of the Timed up and Go Test associated with a motor-cognitive task using a phone to call. Falls were recorded during six months by calendar and monthly telephone calls and the participants were categorized as fallers or non-fallers. Results In the Mild cognitive impairment Group, fallers presented higher values in time (35.2 s), number of steps (33.7 steps) and motor task cost (116%) on dual-task compared to non-fallers. Time, number of steps and motor task cost were significantly associated with falls in people with mild cognitive impairment. Multivariate analysis identified higher number of steps spent on the test to be independently associated with falls. A time greater than 23.88 s (sensitivity = 80%; specificity = 61%) and a number of steps over 29.50 (sensitivity = 65%; specificity = 83%) indicated prediction of risk of falls in the Mild cognitive impairment Group. Among people with Alzheimer's disease, no differences in dual-task between fallers and non-fallers were found and no variable of the tool was able to predict falls. Conclusion The dual-task predicts falls only in older people with mild cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective To study the factors associated with hospital readmission. Methods Data used in this study came from a population-based survey of older adults without cognitive impairment. Cox regression was used to assess the factors associated with readmission within a 2-year follow-up period. According to Andersen's model of healthcare seeking behavior, study variables considered included predisposing, enabling and need factors at the individual and health system levels. Results Of the 433 participants with an index hospitalization, 97% were discharged with a physical and 3% with a psychiatric disorder. During follow-up, 29% (128/433) were readmitted with a median time to readmission reaching 83 days. The risk of readmission was associated with the following: age, marital status, attraction index of the region of residence for psychiatric services, the presence of an anxio-depressive and other mental disorder, as well as a disorder of the musculoskeletal system. The presence of a physical and psychiatric comorbidity was also associated with readmission. Conclusions Post-discharge follow-up of vulnerable populations with a history of mental disorders and improved availability of psychiatric services in the community are associated with a reduced risk of readmission. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between each type of frailty status and the incidence rate of depressive symptoms among community-dwelling older adults. Design Prospective cohort study. Setting General communities in Japan. Participants Participants comprised 3538 older Japanese adults. Measurements We assessed our participants in terms of frailty status (physical frailty, cognitive impairment, and social frailty), depressive symptoms (geriatric depression scale ≥6), and other covariates, and excluded those who showed evidence of depression. Then, after a 4-year interval, we again assessed the participants for depressive symptoms. Physical frailty was defined by the Fried criteria, showing 1 or more of these were physical frailty. To screen for cognitive impairment, receiving a score below an age-education adjusted reference threshold in 1 or more tests was cognitive impairment. Finally, social frailty was defined using 5 questions, and those who answered positively to 1 or more of these were considered to have social frailty. Results After multiple imputations, the incidence rate of depressive symptoms after 4 years of follow-up was 7.2%. The incidence rates of depressive symptoms for each frailty status were as follows: 9.6% for physical frailty vs 4.6% without, 9.3% for cognitive impairment vs 6.5% without, and 12.0% for social frailty vs 5.1% without. Finally, through the application of multivariable logistic regression analysis, the incidence of depressive symptoms was found to have a significant association with social frailty (odds ratio 1.55; 95% confidence interval 1.10–2.20) but not with physical frailty or cognitive impairment. Conclusions This study revealed that social frailty, in comparison with physical frailty and cognitive impairment, is more strongly associated with incidences of depressive symptoms among elderly. [ABSTRACT FROM AUTHOR]

Given evidence that eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and anthocyanin-rich blueberries provide neurocognitive benefit, we investigated long-term supplementation in older adults with cognitive complaints. In a 24-week randomized, double-blind, placebo-controlled trial, elderly men and women received daily fish oil (FO) or blueberry (BB) or both. Diet records confirmed that participants reduced background consumption of EPA, DHA, and anthocyanins as prescribed. Erythrocyte EPA + DHA composition increased in the FO groups ( p = 0.0001). Total urinary anthocyanins did not differ between the groups after supplementation but glycoside and native (food) forms increased only in the BB-supplemented groups. The FO ( p = 0.03) and BB ( p = 0.05) groups reported fewer cognitive symptoms, and the BB group showed improved memory discrimination ( p = 0.04), indicating that supplementation improved cognition. Cognitive benefit in the BB group was associated with the presence of urinary anthocyanins reflecting recent BB intake but not with anthocyanin metabolites. However, combined FO + BB treatment was not associated with cognitive enhancement as expected. [ABSTRACT FROM AUTHOR]

Background Older adults with cognitive complaints are vulnerable to dementia, physical impairments, and poor quality of life. Exercise and mental activity may improve physical function and health-related quality of life (HRQOL) but combinations have not been investigated systematically. The Mental Activity and eXercise (MAX) trial found that mental activity plus exercise over 12 weeks improved cognitive function (primary outcome) in sedentary older adults with cognitive complaints. Objective To investigate the effects of combinations of two mental activity and exercise programs on physical function and HRQOL (secondary outcomes). Methods Participants ( n = 126, age 73 ± 6 years, 65% women) were randomized to 12 weeks of exercise (aerobic exercise or stretching/toning, 3 × 60 min/week) plus mental activity (computer-based cognitive training or educational DVDs, 3 × 60 min/week) using a factorial design. Assessments included the Senior Fitness Test (physical function), Short Form-12 physical and mental sub-scales (HRQOL), and CHAMPS questionnaire (physical activity). Results There were no differences between groups at baseline ( p > 0.05). We observed improvements over time in most physical function measures [chair stands ( p -for-time = 0.001), arm curls ( p -for-time < 0.001), step test ( p -for-time = 0.003), sit & reach ( p -for-time = 0.01), and back scratch ( p -for-time = 0.04)] and in physical HRQOL ( p -for-time = 0.04). There were no differences in change between groups (group ∗ time p > 0.05). Changes in most physical function measures and physical HRQOL correlated with physical activity changes. Conclusion Combined mental activity and exercise interventions of various types can improve both physical function and physical HRQOL among sedentary older adults with cognitive complaints. Exercise control group design should be carefully considered as even light exercise may induce benefits in vulnerable older adults. [ABSTRACT FROM AUTHOR]

Introduction Research indicate that cognitive impairment might be related to hospitalization, but little is known about these effects over time. Objective To assess cognitive change before and after hospitalization among older adults in a population-based longitudinal study with up to 25 years of follow-up. Method A longitudinal study on 828 community living men and women aged 50–86 from the Swedish Adoption/Twin Study of Ageing (SATSA) were linked to The Swedish National Inpatient Register. Up to 8 assessments of cognitive performance (general cognitive ability, verbal, spatial/fluid, memory, and processing speed) from 1986 to 2010 were available. Latent growth curve modelling was used to assess the association between cognitive performance and hospitalization including spline models to analyse cognitive trajectories pre- and post-hospitalization. Results A total of 735 persons (89%) had at least one hospital admission during the follow-up. Mean age at first hospitalization was 70.2 (±9.3) years. Persons who were hospitalized exhibited a lower mean level of cognitive performance in general ability, processing speed and spatial/fluid ability compared with those who were not hospitalized. The two-slope models revealed steeper cognitive decline before hospitalization than after among those with at least one hospitalization event, as compared to non-hospitalized persons who showed steeper cognitive decline after the centering age of 70 years. Conclusions Persons being hospitalized in late life have lower cognitive performance across all assessed domains. The results indicate that the main decline occurs before the hospitalization, and not after. This might indicate that when you get treatment you also benefit cognitively. [ABSTRACT FROM AUTHOR]

Combined cognitive and physical exercise interventions have potential to elicit cognitive benefits in older adults with mild cognitive impairment (MCI) or dementia. This meta-analysis aims to quantify the overall effect of these interventions on global cognitive functioning in older adults with MCI or dementia. Ten randomized controlled trials that applied a combined cognitive-physical intervention with cognitive function as an outcome measure were included. For each study effect sizes were computed (i.e., post-intervention standardized mean difference (SMD) scores) and pooled, using a random-effects meta-analysis. The primary analysis showed a small-to-medium positive effect of combined cognitive-physical interventions on global cognitive function in older adults with MCI or dementia (SMD[95% confidence interval] = 0.32[0.17;0.47], p < 0.00). A combined intervention was equally beneficial in patients with dementia (SMD = 0.36[0.12;0.60], p < 0.00) and MCI (SMD = 0.39[0.15;0.63], p < 0.05). In addition, the analysis showed a moderate-to-large positive effect after combined cognitive-physical interventions for activities of daily living (ADL) (SMD = 0.65[0.09;1.21], p < 0.01)and a small-to-medium positive effect for mood (SMD = 0.27[0.04;0.50], p < 0.01). These functional benefits emphasize the clinical relevance of combined cognitive and physical training strategies. [ABSTRACT FROM AUTHOR]

We studied whether electroencephalography (EEG)-derived measures of brain oscillatory activity are related to clinical progression in nondemented, amyloid positive subjects. We included 205 nondemented amyloid positive subjects (63 subjective cognitive decline [SCD]; 142 mild cognitive impairment [MCI]) with a baseline resting-state EEG data and ≥1-year follow-up. Peak frequency and relative power of 4 frequency bands were calculated. Relationships between normalized EEG measures and time to clinical progression (conversion from SCD to MCI/dementia or from MCI to dementia) were analyzed using Cox proportional hazard models. One hundred eight (53%) subjects clinically progressed after 2.1 (IQR 1.3–3.0) years. In the total sample, none of the EEG spectral measures were significant predictors. Stratified for baseline diagnosis, we found that in SCD patients higher delta and theta power (HR [95% CI] = 1.7 [1.0–2.7] resp. 2.3 [1.2–4.4]), and lower alpha power and peak frequency (HR [95% CI] = 0.5 [0.3–1.0] resp. 0.6 [0.4–1.0]) were associated with clinical progression over time. In amyloid positive subjects with normal cognition, slowing of oscillatory brain activity is related to clinical progression. [ABSTRACT FROM AUTHOR]

Study Objective: To compare the incidence of postoperative cognitive dysfunction (POCD) in elderly surgical patients (>60years) receiving different anesthetics (propofol, sevoflurane, or isoflurane) and to identify potential biomarkers of POCD in this patient population.Design: Prospective, randomized, double-blind clinical trial.Setting: University-affiliated teaching hospital.Patients: One hundred and fifty elderly patients scheduled for laparoscopic cholecystectomy.Interventions: Elderly patients undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol, sevoflurane, or isoflurane anesthesia.Measurements: Cognitive function was assessed using neuropsychological tests at baseline (1day before surgery [D0]), and on postoperative day 1 (D1) and day 3 (D3). Plasma S-100β and Aβ1-40 protein, IL-1β, IL-6 and TNF-α concentrations were assessed before induction of anesthesia (T0), after extubation (T1), and 1h (T2) and 24h (T3) postoperatively.Main Results: The incidence of POCD was significantly lower in the propofol group compared to the isoflurane group and the sevoflurane group at D1 and D3 (propofol vs. isoflurane: D1 and D3, P<0.001; propofol vs. sevoflurane: D1, P=0.012; D3, P=0.013). The incidence of POCD was significantly lower in the sevoflurane group compared to the isoflurane group at D1 (P=0.041), but not at D3. Postoperatively, plasma S-100β and Aβ1-40 protein, IL-1β, IL-6, and TNF-α concentrations were significantly decreased in the propofol group compared to the isoflurane group.Conclusions: Propofol anesthesia may be an option for elderly surgical patients. [ABSTRACT FROM AUTHOR]

Human brain aging is the physiological process which underlies as cause of cognitive decline in the elderly and the main risk factor for neurodegenerative diseases such as Alzheimer's disease. Human neurons are functional throughout a healthy adult lifespan, yet the mechanisms that maintain function and protect against neurodegenerative processes during aging are unknown. Here we show that protein oxidative and glycoxidative damage significantly increases during human brain aging, with a breakpoint at 60 years old. This trajectory is coincident with a decrease in the content of the mitochondrial respiratory chain complex I–IV. We suggest that the deterioration in oxidative stress homeostasis during aging induces an adaptive response of stress resistance mechanisms based on the sustained expression of REST, and increased or decreased expression of Akt and mTOR, respectively, over the adult lifespan in order to preserve cell neural survival and function. [ABSTRACT FROM AUTHOR]

Possession of the Apolipoprotein E (APOE) gene ε4 allele is the most prevalent genetic risk factor for late onset Alzheimer's disease (AD). Recent evidence suggests that APOE genotype differentially affects the expression of brain-derived neurotrophic factor (BDNF). Notably, aerobic exercise-induced upregulation of BDNF is well documented; and exercise has been shown to improve cognitive function. As BDNF is known for its role in neuroplasticity and survival, its upregulation is a proposed mechanism for the neuroprotective effects of physical exercise. In this pilot study designed to analyze exercise-induced BDNF upregulation in an understudied population, we examined the effects of APOEε4 (ε4) carrier status on changes in BDNF expression after a standardized exercise program. African Americans, age 55 years and older, diagnosed with mild cognitive impairment participated in a six-month, supervised program of either stretch (control treatment) or aerobic (experimental treatment) exercise. An exercise-induced increase in VO 2 Max was detected only in male participants. BDNF levels in serum were measured using ELISA. Age, screening MMSE scores and baseline measures of BMI, VO 2 Max, and BDNF did not differ between ε4 carriers and non-ε4 carriers. A significant association between ε4 status and serum BDNF levels was detected. Non-ε4 carriers showed a significant increase in BDNF levels at the 6 month time point while ε4 carriers did not. We believe we have identified a relationship between the ε4 allele and BDNF response to physiologic adaptation which likely impacts the extent of neuroprotective benefit gained from engagement in physical exercise. Replication of our results with inclusion of diverse racial cohorts, and a no-exercise control group will be necessary to determine the scope of this association in the general population. [ABSTRACT FROM AUTHOR]

Social support networks are crucial for the health of older adults; however, personal characteristics and time of life may diminish the protective effect of social support. Objective to determine if the presence of social support networks were associated with cognitive impairment among Mexican adults aged 50 or older and if this relationship was different based on age. Method This study analyzed data from the National Representation Survey performed in Mexico, Study on Global Ageing (SAGE) wave 1. Cognitive function was evaluated by a standardized test, social support was evaluated through latent class analysis (LCA). The LCA was run to obtain three subgroups of different Social Support Levels (SSL): low, medium, and high. Logistic regression models, stratified by age, were performed to analyze the association between SSL and cognitive function. Results For respondents ages 71–80 y/o, there was an inverse relationship with cognitive impairment for those with medium (OR 0.23, p = 0.020) and high (OR 0.07, p = 0.000) SSL in comparison with low SSL. While social support helped to improve cognitive function in older adults aged 71–80, this same association was not observed in adults of other ages. Those younger than 70 y/o may not need such a strong support network as a result of being more self-sufficient. After 80, social networks were not enough to help diminish the negative impact of cognitive impairment. Conclusion Social support could improve the cognitive function of adults ages 71 and 80; suggesting there could be a window of opportunity to improve cognitive functioning for this group. [ABSTRACT FROM AUTHOR]

• High performance in handgrip strength is associated with slower cognitive decline in older Mexican Americans. • Foreign-born older Mexican Americans with high performance in handgrip strength had lower odds of cognitive impairment over time compared with US-born older Mexican Americans. • Interventions to improve muscle strength may preserve cognitive function in older Mexican Americans. To examine nativity differences in the relationship between handgrip strength (HGS) and cognitive impairment among Mexican Americans aged ≥ 65 years with normal or high cognitive function at baseline over a 20-year period. Prospective cohort study of 2,155 non-institutionalized Mexican Americans aged ≥ 65 years from the Hispanic Established Population for the Epidemiological Study of the Elderly) who scored ≥ 21 in the Mini Mental State Examination (MMSE) at baseline. Measures included socio-demographics, body mass index, medical conditions, depressive symptoms, physical function, disability, HGS quartiles (sex-adjusted), and MMSE. We used generalized estimating equation models to estimate the odds ratio (OR) and 95% Confidence Interval (CI) of cognitive impairment (MMSE < 21) as a function of HGS quartile by nativity and adjusted for covariates. US-born and foreign-born participants in the 4th quartile (highest) of HGS at baseline had lower odds of cognitive impairment over time compared with those in the 1st (lowest) HGS quartile (OR=0.95, 95% CI=0.90-0.99 and OR=0.93, 95% CI=0.89-0.98, respectively), after controlling for all covariates. When we analyzed HGS quartiles as time-varying, we found that US-born participants in the 3rd and 4th HGS quartile had 25% and 30% lower odds of cognitive impairment, respectively, while foreign-born participants in the 3rd and 4th HGS quartile had 27% and 49% lower odds of cognitive impairment over time, respectively, after controlling for all covariates. Foreign-born older Mexican Americans who performed high in HGS experienced 7% lower odds of cognitive impairment over time compared with US-born older Mexican Americans. [ABSTRACT FROM AUTHOR]

• Technology use might increase distractibility or forgetfulness in older adults. • However, some evidence suggests technology use might provide cognitive benefit. • We evaluated cognitive concerns and technology use in 219 older adults. • Higher use of digital devices was associated with fewer cognitive concerns. • Implications for the development of technological reserve is discussed. How technology impacts the day to day cognitive functioning of older adults is a matter of some debate. On the one hand, the use of technologies such as smartphones and social media, may lead to more subjective cognitive concerns (SCC) by promoting distractibility and reliance on devices to perform memory tasks. However, continued digital engagement in older adults may also be related to better cognitive functioning. Given these competing viewpoints, our study evaluated if frequency of digital device use was associated with greater or less subjective cognitive concerns. Participants were 219 adults over the age of 65 (mean age =75 years) who had internet access. Measures assessing frequency of digital device use along with SCC were administered. Hierarchical multiple regression was used to gage association between frequency of device use and SCC, controlling for relevant demographic and lifestyle factors. Increased frequency of digital device use was associated with less SCC, over and above the influence of demographic factors, across cognitive (but especially in executive) domains. This effect was observed for general device usage, with no statistically significant associations were observed between texting/video call, social media use and SCC. Results were broadly consistent with the technological reserve hypothesis in that digital engagement was associated with better experienced cognitive functioning in older adults. While device use may contribute to distractibility in certain cases, the current results add to a burgeoning literature that digital engagement may be a protective factor for cognitive changes with age. [ABSTRACT FROM AUTHOR]

Objective Factors associated with perceived stress in older people have been studied previously, but this investigation in elderly caregivers is still scarce in the literature. Our aim was to assess factors that are associated with perceived stress in a sample of elderly caregivers. Methods This cross-sectional investigation assessed 341 elderly caregivers who cared for a dependent older person at home. They answered questionnaires including the Perceived Stress Scale (PSS-14), a sociodemographic and care characterization, health and cognitive status, and burden related to care. Results The mean score in PSS-14 was 18.5 ± 9.9. Self-reported pain, difficult to sleep, “very poor/poor” self-rated health, impaired cognitive status, more people living in the house and higher levels of burden related to care were associated with higher levels of perceived stress. Discussion The results highlight the importance of the development of stress-reduced interventions directed to elderly caregivers focusing on the associated variables in this study. Attention should be given to cognitive decline prevention and strategies to avoid or reduce burden in the elderly caregivers. [ABSTRACT FROM AUTHOR]

Cognitive decline is one of the major causes of disability in older people. A high level of homocysteine, a byproduct of vitamin B, has been linked to brain atrophy, which itself is a precursor to cognitive decline leading to dementia and Alzheimer's disease. In addition, a low level of vitamin B is often noted in patients with dementia and Alzheimer's disease and its supplementation has been shown to improve memory and to slow the progress of brain atrophy. This information may aid in the use of vitamin B as a preventative measure against severe cognitive decline, and thus reduce the onset of conditions such as dementia and Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Cognitive difficulties and gait abnormalities both increase with age. We review normal and pathologic changes in both gait and cognition in older adults. Gait performance in older individuals is linked to specific cognitive changes, in particular in executive function. Structural and functional assays highlight the shared anatomic control of cognitive and gait function, mostly in the prefrontal cortices. Cognitive impairment can be used to predict incident gait difficulties. Changes in gait, especially decreased gait velocity, may be a harbinger of impending cognitive decline. The combination of slow gait and cognitive complaints (the Motoric Cognitive Risk syndrome) is a powerful new clinical tool to identify those at high risk of developing dementia and therefore may be used to target interventions. Evidence is limited, but cognitive training and targeted physical activity may be useful to mitigate or prevent gait and cognitive decline with age. [ABSTRACT FROM AUTHOR]

Elevations in intraindividual variability (IIV) are an indicator of neurocognitive compromise and are seen on reaction time tasks in individuals with mild cognitive impairment (MCI). We examined IIV on memory tasks known to be sensitive to early cognitive change in a group of 24 individuals with amnestic MCI and 21 matched controls. Traditional measures of accuracy and speed, as well as indices of IIV statistically purified for systematic between-group and trial effects, were derived from performance on two computer-based associative recognition tests of word–word and face-name pairs. Accuracy and speed were reduced and IIV was elevated in the MCI group compared to controls on both tasks. Logistic regression analyses demonstrated that IIV, but not speed, was a unique predictor of group membership, over and above performance accuracy. Observed elevations in IIV in MCI are congruent with the notion that IIV may reflect disturbance in distributed neural networks, including medial temporal regions, in addition to frontal systems dysfunction. Present findings have diagnostic implications for accurate identification of individuals with MCI and add to the growing literature on IIV as an early indicator of cognitive decline in older adults. [ABSTRACT FROM AUTHOR]

Reductions in physical performance, cognitive impairment (CI) and decline (CD), are common in older age, but few prospective cohort studies have considered the relationship between these domains. In this study we investigated whether reduced physical performance and low handgrip/lower limbs strength, could predict a higher incidence of CI/CD during a 4-year follow-up among a cohort of elderly individuals. From 3099 older community-dwelling individuals initially enrolled in the Progetto Veneto Anziani (PRO.V.A.) study, 1249 participants without CI at the baseline were included (mean age 72.2 years, 59.5% females). Physical performance measures included the Short Physical Performance Battery (SPPB), 4 m gait speed, chair stands time, leg extension and flexion, handgrip strength, and 6-Minute Walking Test (6MWT), categorized in gender-specific tertiles. CI was defined as a Mini-Mental State Examination (MMSE) score below 24; CD a decline of 3 or more points in the MMSE without CI. At baseline, participants developing CI during follow-up scored significantly worse across all physical performance measures compared to those that retained normal cognitive status. After adjusting for potential confounders, a significant trend for MMSE changes was noted for all physical performance tests, except for the SPPB and chair stands time. Multinomial logistic regression revealed that slow gait speed at baseline significantly predicted CD at follow up. Poor SPPB performance and slower gait speed predicted the onset of CI at the follow-up. In conclusion, slow walking speed appears to be the best independent predictor of poor cognitive status over a 4.4-year follow-up, while other items of SPPB were also significantly associated with CI. [ABSTRACT FROM AUTHOR]

Senescence-accelerated mouse (SAM) is inbred lines of mice originally developed from AKR/J mice. Among the six SAM prone (SAMP) substrains, 8- to 12-month-old SAMP8 have long been used as a model of age-related cognitive impairments. However, little is still known for younger SAMP8 mice. Here, we examined the phenotypical characteristics of 4-month-old SAMP8 using a battery of behavioral tests. Four-month-old SAMP8 mice failed to recognize spatially displaced object in an object recognition task and performed poorly in the probe test of the Morris water maze task compared to SAMR1, suggesting that SAMP8 have impaired spatial memory. In addition, young SAMP8 exhibited enhanced anxiety-like behavior in an open field test and showed depression-like behavior in the forced-swim test. Their circadian rhythm was also disrupted. These abnormal behaviors of young SAMP8 are similar to behavioral alterations also observed in aged mice. In summary, age-related behavioral alterations occur in SAMP8 as young as 4 months old. [ABSTRACT FROM AUTHOR]

Objective We aimed to understand conversion characteristics of mild cognitive impairment (MCI) in elderly Koreans. Methods We analyzed clinical data of 760 individuals who participated in a two-year follow-up study. Neuropsychological assessments and clinical examination were conducted in the follow-ups. Logistic regression model was used to estimate predictive risk factors of MCI conversion. Result The participants at baseline ( n = 760) represented 462 cognitively normal individuals (60.8%), 286 individuals with MCI (37.6%), and 12 individuals with dementia (1.6%). Among the cognitively normal individuals ( n = 462), 108 (23.4%) progressed to MCI during the two-year follow-up period, including 92 with amnestic mild cognitive impairment (aMCI; 19.9%) and 16 with non-amnestic mild cognitive impairment (non-aMCI; 3.5%). Interestingly, 3.7% of participants with aMCI converted to non-aMCI, while 45.5% of participants with non-aMCI converted to aMCI. Moreover, a higher proportion of non-aMCI (27.3%) reverted to a cognitively normal state, compared to aMCI participants (18.6%), indicating that non-amnestic cognitive impairment is more unstable than amnestic cognitive impairment, and probably converges toward aMCI. Additionally, we found that weight loss was associated with incident MCI and future MCI. Weight loss was negatively correlated with Clinical Dementia Rating ( p = 0.005), and significantly associated with a higher risk of MCI conversion from a cognitively normal state (OR = 1.10, 95% CI: 1.00–1.21, p = 0.042). Conclusion This study supports that non-amnestic MCI is prone to converge toward amnestic MCI, and the elderly people with weight loss are at risk for developing cognitive decline. [ABSTRACT FROM AUTHOR]

This study investigated associative recognition memory by using unique features of the Chinese language and the underlying neuroanatomical correlates. The study participants were 22 Chinese speakers with mild cognitive impairment (MCI) and 25 cognitively normal (CN) Chinese speakers. The results revealed that the MCI group demonstrated impaired associative memory performance, despite exhibiting item memory performance comparable with that of the CN group, and that associative memory performance in older adults was associated with gray matter integrity in the medial temporal regions as well as executive function. An abnormal elevation was also observed in false-positive errors related to features unique to Chinese characters, namely orthographical errors, in addition to rearranged and semantic errors in the MCI group relative to the CN group, and the three error subtypes were differentially associated with gray matter integrity in the hippocampus or lateral prefrontal regions. Overall, these results demonstrate the value of evaluating associative memory in people with prodromal Alzheimer's disease (AD), and further elucidate the underlying neural substrates related to associative recognition memory in older adults. [ABSTRACT FROM AUTHOR]

Summary Objective The objective of this paper is to describe the profile of older people with cognitive impairment (CI) presenting to emergency departments (EDs). Methods This was a multi-centre ( n = 8) observational study of a convenience sample of older (≥70 y) ED patients ( n = 579). Participants were prospectively assessed for CI and surveyed for the duration of their ED stay ( n = 191). A picture of patients’ health status and ED responses to care needs was obtained through application of standardised assessment tools. Additionally, observations of care processes in ED were undertaken. Demographic data were collected through both ED's information system and survey. Outcome data were collected 28 days post-ED visit using follow-up telephone interviews. Results Of 579 older persons, 191 (33%) persons met criteria for CI. The majority of older ED patients with CI in ED lived in the community (157/177, 88.7%), arrived by ambulance (116/172, 67%), were accompanied by a support person (94/149, 63%), were triaged as urgent to semi-urgent (157/191, 82%), and were hospitalised (108/172, 57%). The median ED length of stay was 6 h. In ED, 53% of the sample experienced pain (92/173). Older ED patients with CI pose the following characteristics: prior hospital admissions (43/129, 33%), incontinence (61/178, 34%), dependence in activities in daily living (81/190, 43%), issues in nutrition (73/182, 40%), vision and hearing impairment (93% (160/172) and 26% (44/171) respectively). Conclusion Increased understanding of these presenting characteristics and their impacts on patient risk facilitates tailoring the quality of emergency care to better suit the needs and improve outcomes of this increasing ED population. [ABSTRACT FROM AUTHOR]

Background & aims Brain white-matter lesions and cognitive impairment are increasing because of the increasing number of patients aged ≥80 y. Wall shear stress (WSS) plays a pivotal role as a fluid mechanical mediator in vascular reactivity and atherosclerosis. In this study, we investigated the associations among common carotid artery (CCA) WSS, white-matter lesions, and cognitive impairment in patients aged ≥80 y Methods We enrolled 384 patients aged ≥80 y. All subjects had CCA-WSS, brain white-matter hyperintensities (WMH), and Mini-Mental State Examination (MMSE) assessments and were divided into three groups using tertiles of mean and peak CCA-WSS. Results For groups classified by the tertile of mean CCA-WSS, WMH, and WMH fraction were decreased; the MMSE score increased from low to high in the respective groups. Differences in WMH, WMH fraction, and the MMSE score were significant between any two groups (all adjusted p < 0.001). Groups classified by the tertile of peak CCA-WSS had the same pattern. Mean and peak CCA-WSS were significantly and inversely correlated with WMH ( r = −0.575 and −0.570, respectively; p < 0.001) and WMH fraction ( r = −0.574 and −0.569, respectively; p < 0.001) but positively correlated with the MMSE score ( r = 0.390 and 0.278, respectively; p < 0.001). Multiple linear backward stepwise regression indicated the mean and peak CCA-WSS were significantly and independently associated with WMH, WMH fraction, and the MMSE score (all adjusted p < 0.001). Conclusion Carotid artery WSS was independently associated with brain white-matter lesions and cognitive impairment in patients aged ≥80 y [ABSTRACT FROM AUTHOR]

Purpose of the study Brain hyperintensities, detectable with MRI, increase with age. They are associated with a triad of impairment in cognitive ability, depression and physical health. Here we test the hypothesis that the association between hyperintensities and cognitive ability, physical health and depressive symptoms depends on lesion location. Design and methods 244 members of the Aberdeen 1936 Birth Cohort were recruited to this study. 227 participants completed brain MRI and their hyperintensities were scored using Scheltens’s scale. 205 had complete imaging, cognitive, physical health and depressive symptom score data. The relationships between hyperintensity location and depressive symptoms, cognitive ability and physical health were examined by correlation and structural equation analysis. Results We found that depressive symptoms correlated with hyperintensity burden in the grey matter ( r = 0.14, p = 0.04) and infratentorial regions ( r = 0.17, p = 0.01). Infratentorial hyperintensities correlated with reduced peak expiratory flow rate ( r = −0.26, p < 0.001) and impaired gait ( r = 0.13, p = 0.05). No relationship was found between white matter and periventricular (supratentoral) hyperintensities and depressive symptoms. Hyperintensities in the supratentorial and infratentorial regions were associated with reduced cognitive performance. Using structural equation modelling we found that the association between hyperintensities and depressive symptoms was mediated by negative effects on physical health and cognitive ability. Conclusions Hyperintensities in deep brain structures are associated with depressive symptoms, mediated via impaired physical health and cognitive ability. Participants with higher cognitive ability and better physical health are at lower risk of depressive symptoms. [ABSTRACT FROM AUTHOR]

Background/Objectives Informal caregivers of patients with a cognitive impairment may face exhaustion while taking care of their relatives, and are themselves at higher risk of disease. The objective was to assess the relationship between patients' comorbidities evaluated with the Charlson index, and the caregiver burden, independently of health disorders related to cognitive impairment. Design Cross-sectional observational study. Setting Memory clinic at the University Hospital of Lyon. Participants Outpatients with cognitive complaint and consulting a Clinical and Research Memory Centre of Lyon (n = 1300). Measurements Comorbidity was measured using the Charlson Comorbidity Index related to age (CCI). The caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). The relationship was assessed between the CCI and the mini-Zarit and other patients' characteristics: behavior, cognition, autonomy as assessed respectively by the Neuropsychiatric Inventory (NPI), Mini Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL), etiology, and stage of the cognitive impairment. Results The study included 1300 outpatients: mean age: 80.8 ± 7 years. The mean CCI was 4.8 ± 1.7. The mini-Zarit score: 3.1 ± 2.0. The caregiver burden increased by 0.22 per unit of CCI (95% confidence interval 0.15–0.28, P < .001) in unadjusted analysis. The caregiver burden remained significantly associated with CCI, after adjustment for the MMSE, IADL, and NPI. Conclusion The caregiver burden is higher when patients' comorbidities increase, independently of behavioral and psychological symptoms, level of functional autonomy, and the stage of the cognitive disease. However, dementia may be the comorbidity that contributes the most to caregiver burden. [ABSTRACT FROM AUTHOR]

Purpose Currently, most rehabilitation services for individuals who sustain a hip fracture are not designed to meet the complex needs of those who also have cognitive impairment. The goal of this review was to identify current best practices for rehabilitation in long-term care settings and approaches to optimize outcomes among individuals with dementia and other cognitive impairments post-hip fracture. Procedures The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was used to guide the review. Five electronic databases, including PubMed, EMBASE, CINAHL (EBSCO), Medline (EBSCO), and PsycINFO (EBSCO), were searched for intervention studies published in English language journals. Studies were eligible if they focused on rehabilitation interventions post-hip fracture among older individuals (≥65 years) with cognitive impairment who were living in or transferred to long-term care or postacute/rehabilitation settings post-hip fracture. Studies were excluded if they did not enroll individuals with cognitive impairment, the study was descriptive without any intervention content, or the intervention components were only medication, surgical approach or medical treatment. Main Findings A total of 4478 records were identified, 1915 of which were duplicative, 2563 were relevant based on title, and after careful review 7 studies were included. Two included studies were randomized controlled trials, one was a single group pre- and post-test, one a descriptive comparison between those with and without cognitive impairment, one a case controlled matched trial, one a nonequivalent groups trial, and one a case report. The interventions varied between manipulating the type and amount of exercise or testing multifactorial issues including environmental interventions and the use of an interdisciplinary team to address psychosocial factors, medication management, use of assistive devices, and specific preferences or concerns of the individuals. Conclusions The evidence summarized in this review suggests that it is feasible to implement rehabilitation programs focused on individuals with cognitive impairment in postacute care settings. Moreover, there was evidence to suggest that intensive rehabilitation and exercise activities are beneficial, although innovative approaches may be needed to engage individuals with cognitive impairment. [ABSTRACT FROM AUTHOR]

Objectives Mild cognitive impairment (MCI) may be a risk for disability, and co-occurrence of slow gait (SG) and MCI may increase this risk. Design Prospective study. Setting General community. Participants The study included 3482 older adults (mean age: 71.4 years) without disability at baseline. Measurements We collected information on demographic variables, measured gait speed and cognitive function to diagnose MCI at baseline. During the follow-up period, the incident disability was monitored. Participants were divided into groups without MCI and SG (control), with SG without MCI (SG), without SG and with MCI in single (sMCI) or multiple (mMCI) domains, and with SG and MCI in single (sMCI + SG) and multiple (mMCI + SG) domains. Results During follow-up, 134 participants developed disability (mean follow-up: 29.4 months). The proportions of incident disability were higher in the MCI with SG, MCI, and SG groups, compared with the control group. SG [hazard ratio 2.27 (95% confidence interval: 1.38–3.73)], mMCI [2.56 (1.31–5.02)], sMCI + SG [2.46 (1.21–5.00)], and mMCI + SG [3.48 (1.79–6.76)] participants had risks for disability. Conclusions Co-occurrence of SG and MCI in multiple domains has a higher risk of disability than each condition alone. [ABSTRACT FROM AUTHOR]

Global ageing demographics coupled with increased urbanisation pose major challenges to the provision of optimal living environments for older persons, particularly in relation to cognitive health. Although animal studies emphasize the benefits of enriched environments for cognition, and brain training interventions have shown that maintaining or improving cognitive vitality in older age is possible, our knowledge of the characteristics of our physical environment which are protective for cognitive ageing is lacking. The present review analyses different environmental characteristics (e.g. urban vs. rural settings, presence of green) in relation to cognitive performance in ageing. Studies of direct and indirect associations between physical environment and cognitive performance are reviewed in order to describe the evidence that our living contexts constitute a measurable factor in determining cognitive ageing. [ABSTRACT FROM AUTHOR]

Accumulating evidence points to a link between age-related hearing loss and cognitive decline, but their relationship is not clear. Does one cause the other, or does some third factor produce both? The answer has critical implications for prevention, rehabilitation, and health policy but has been difficult to establish for several reasons. First, determining a causal relationship in natural, correlational samples is problematic, and hearing and cognition are difficult to measure independently. Here, we critically review the evidence for a link between hearing loss and cognitive decline. We conclude that the evidence is convincing, but that the effects are small when hearing is measured audiometrically. We review four different directional hypotheses that have been offered as explanations for such a link, and conclude that no single hypothesis is sufficient. We introduce a framework that highlights that hearing and cognition rely on shared neurocognitive resources, and relate to each other in several different ways. We also discuss interventions for sensory and cognitive decline that may permit more causal inferences. [ABSTRACT FROM AUTHOR]

It is important to maintain adequate food consumption in older adults so as to prevent malnutrition, particularly among those with cognitive impairments who represent the majority of patients living in nursing homes. Indeed, these patients may reduce their food intake, which can be explained by a lack of pleasure in eating food. Few studies have tested the efficiency of strategies based on food pleasure to increase food intake in this population. To our knowledge, the influence of flavour enhancement has been widely investigated in non-cognitively impaired older adults, but not in those with cognitive impairments. Our objective was therefore to study the influence of flavour enhancement on food liking and then on food intake in older adults with different degrees of cognitive impairments. To achieve this, two food testing methods were compared: paired comparison and sequential monadic tests. 104 subjects were recruited in four nursing homes and clustered into three groups as a function of their cognitive impairments (severe, moderate and without marked cognitive impairments). Two different samples of an appetizer were formulated: a reference sample and a flavour-enhanced sample. These appetizers were offered to the participants before lunch in standardised small portions during three tasting sessions organised at intervals of one week. During one session, the participants received both samples at the same time (paired comparison test) and during the two others, they were given a single sample at each session (sequential monadic test). Food intake and food liking were then evaluated with respect to each participant and each sample. The results showed a positive correlation between food liking and food intake, and a positive influence of flavour enhancement on food intake, regardless of the cognitive status of the participants. The sequential monadic test produced results similar to those of the paired-comparison test in terms of the effects of flavour enhancement. These findings suggest that this method could be used to investigate the influence of food interventions at mealtimes in older adults with cognitive impairments. Finally, this study shows that food intake could be increased by optimising the sensory properties of foods served to cognitively impaired older patients. [ABSTRACT FROM AUTHOR]

Background: Increased brain atrophy rates are common in older people with cognitive impairment, particularly in those who eventually convert to Alzheimer disease. Plasma concentrations of omega-3 (ω-3) fatty acids and homocysteine are associated with the development of brain atrophy and dementia. Objective: We investigated whether plasma ω-3 fatty acid concentrations (eicosapentaenoic acid and docosahexaenoic acid) modify the treatment effect of homocysteine-lowering B vitamins on brain atrophy rates in a placebo-controlled trial (VITACOG). Design: This retrospective analysis included 168 elderly people (≥70 y) with mild cognitive impairment, randomly assigned either to placebo (n = 83) or to daily high-dose B vitamin supplementation (folic acid, 0.8 mg; vitamin B-6, 20 mg; vitamin B-12, 0.5 mg) (n = 85). The subjects underwent cranial magnetic resonance imaging scans at baseline and 2 y later. The effect of the intervention was analyzed according to tertiles of baseline ω-3 fatty acid concentrations. Results: There was a significant interaction (P = 0.024) between B vitamin treatment and plasma combined ω-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid) on brain atrophy rates. In subjects with high baseline ω-3 fatty acids (>590 µmol/L), B vitamin treatment slowed the mean atrophy rate by 40.0% compared with placebo (P = 0.023). B vitamin treatment had no significant effect on the rate of atrophy among subjects with low baseline ω-3 fatty acids (<390 µmol/L). High baseline ω-3 fatty acids were associated with a slower rate of brain atrophy in the B vitamin group but not in the placebo group. Conclusions: The beneficial effect of B vitamin treatment on brain atrophy was observed only in subjects with high plasma ω-3 fatty acids. It is also suggested that the beneficial effect of ω-3 fatty acids on brain atrophy may be confined to subjects with good B vitamin status. The results highlight the importance of identifying subgroups likely to benefit in clinical trials. This trial was registered at www.controlled-trials.com as ISRCTN94410159. [ABSTRACT FROM AUTHOR]

Objective Numerous studies have reported the prevention of falls through exercise among cognitively healthy older people. This study aimed to determine whether the current evidence supports that physical exercise is also efficacious in preventing falls in older adults with cognitive impairment. Methods Two independent reviewers searched MEDLINE; EMBASE; PsycINFO; the Cumulative Index to Nursing & Allied Health Literature; the Cochrane Central Register of Controlled Trials; the Cochrane Bone, Joint, and Muscle Trauma Group Specialized Register; ClinicalTrials.gov ; and the UK Clinical Research Network Study Portfolio up to July 2013 without language restriction. We included randomized controlled trials that examined the efficacy of physical exercise in older adults with cognitive impairment. The methodological qualities of the included trials were appraised according to the criteria developed for the Cochrane review of fall prevention trials. The primary outcome measure was the rate ratio of falls. A meta-analysis was performed to estimate the pooled rate ratio and summarize the results of the trials on fall prevention through physical exercise. Results Seven randomized controlled trials involving 781 participants were included, 4 of which examined solely older people with cognitive impairment. Subgroup data on persons with cognitive impairment were obtained from the other 3 trials that targeted older populations in general. The meta-analysis showed that physical exercise had a significant effect in preventing falls in older adults with cognitive impairment, with a pooled estimate of rate ratio of 0.68 (95% confidence interval 0.51–0.91). Conclusions The present analysis suggests that physical exercise has a positive effect on preventing falls in older adults with cognitive impairment. Further studies will be required to determine the modality and frequency of exercise that are optimal for the prevention of falls in this population. [ABSTRACT FROM AUTHOR]

Serum uric acid is a powerful antioxidant that may have neuroprotective properties. While some studies have found that greater serum uric acid is associated with better cognition in older adults, it is also associated with numerous vascular risk factors that increase risk for dementia. Women may also be particularly vulnerable to the vascular effects of elevated uric acid. We previously found that mildly elevated serum uric acid is a biomarker of cognitive dysfunction in older adults, and that this likely is mediated by cerebral ischemic burden. Here we examine both cross-sectional and longitudinal associations between serum uric acid and declines in cognition and functioning in 423 cognitively healthy community-dwelling older women in the Women's Health and Aging Study (WHAS II). We hypothesized that higher serum uric acid would be associated with poorer concurrent functioning and greater declines over 9 years. In linear regression analyses, higher baseline serum uric acid was associated with poorer working memory, with a trend toward slower manual speed and dexterity before and after adjusting for baseline serum uric acid, demographic and health/cardiovascular variables. However, there were no associations for global cognitive functioning, learning/memory, sequencing, verbal fluency, or visuoconstruction. Mixed effects models also revealed no association with subsequent cognitive declines. Future research should examine changes in serum uric acid at earlier periods in the lifespan and their relationships with later cognitive declines. [ABSTRACT FROM AUTHOR]

We aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation. Systematic scoping review. ED patients with cognitive impairment and/or their care partners. Informed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations. From 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage. This scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends. [ABSTRACT FROM AUTHOR]

The aging population is increasing and, therefore, a higher prevalence of cardiac disease is emerging; including hypertension, coronary artery disease, atrial fibrillation and chronic heart failure. Large cohort studies have revealed a relationship among increased risk for cognitive impairment and dementia in cardiovascular diseases probably due to embolic stroke or chronic cerebral hypoperfusion. Thus, the aim of the present review is to overview the studies that investigate the presence and/or the development of cognitive impairments and dementia in patients with varied types of cardiovascular disease. Finally, a continuum among hypertension, coronary artery disease, atrial fibrillation and chronic heart failure with to the development of cognitive impairment and progression to dementia has been hypothesized. [ABSTRACT FROM AUTHOR]

To investigate the effects of dobutamine hydrochloride on early postoperative cognitive dysfunction (POCD) and plasma tumor necrosis factor (TNF)-α concentration in patients undergoing hip arthroplasty, 124 patients undergoing unilateral total hip arthroplasty, aged 70–92 years old, were randomly assigned to four groups ( n =31) as follows: a control group of patients receiving only saline (intravenous infusion, i.v.); and groups receiving 2, 4, or 6 μg kg −1 min −1 (i.v.) of dobutamine hydrochloride. Cognitive functions were assessed on the day before surgery (T1), and the 1st day (T2), 3rd day (T3), and 7th day (T4) postsurgery using the Mini Mental State Examination (MMSE). The plasma TNF-α protein level was determined 10 min before anesthesia (Ta), and 10 min (Tb), 30 min (Tc), and 60 min (Td) after anesthesia by an enzyme-linked immunosorbent assay. Cognitive disorder was observed within the first 3 days after hip arthroplastic surgery, and it had recovered 7 days after the operation in the control group of patients. Administration of 2 or 4 μg kg −1 min −1 dobutamine hydrochloride was able to reverse the early POCD. Simultaneously, an increase of plasma TNF-α levels 30 min after anesthesia was observed (41.34±9.61 vs. 27.75±5.45), which was significantly suppressed by the administration of low-dose dobutamine hydrochloride (29.23±7.32 vs. 41.34±9.61) but not by high-dose dobutamine hydrochloride (45.9±12.11 vs. 41.34±9.61). Together, our data indicated that the plasma concentration of TNFα was engaged in the effect of dobutamine hydrochloride on POCD. [ABSTRACT FROM AUTHOR]

Background: Around half of people aged over 70 years admitted as an emergency to general hospital have dementia, delirium or both. Dissatisfaction is often expressed about the quality of hospital care. A Medical and Mental Health Unit was developed to provide best practice care to cognitively impaired older patients. The Unit was evaluated by randomised controlled trial compared to standard care wards. Part of this evaluation involved structured non-participant observations of a random subample of participants and the recording of field notes. Objectives: The aim of this paper is to compare and contrast the behaviours of staff and patients on the Medical and Mental Health Unit and standard care wards and to provide a narrative account that helps to explain the link between structure, process and reported outcomes. Design: Field notes were analysed using the constant comparison method. Setting: A large hospital within the East Midlands region of the United Kingdom. Participants: Patient participants were aged over 65, and identified by Admissions Unit physicians as being 'confused'. Most patients had delirium or dementia. Results: Sixty observations (360 h) were made between March and December 2011. Cognitively impaired older patients had high physical and psychological needs, and were cared for in environments which were crowded, noisy and lacked privacy. Staff mostly prioritised physical over psychological needs. Person-centred care on the Medical and Mental Health Unit was mostly delivered during activity sessions or meal times by activities coordinators. Patients on this unit were able to walk around more freely than on other wards. Mental health needs were addressed more often on the Medical and Mental Health Unit than on standard care wards but most staff time was still taken up delivering physical care. More patients called out repetitively on the Unit and staff were not always able to meet the high needs of these patients. Conclusion: Care provided on the Medical and Mental Health Unit was distinctly different from standard care wards. Improvements were worthwhile, but care remained challenging and consistent good practice was difficult to maintain. Disruptive vocalisation may have been provoked by concentrating cognitively impaired patients on one ward. [ABSTRACT FROM AUTHOR]

Different subtypes of depressive syndromes exist in late life; many of them have cognitive impairment and sometimes it is difficult to differentiate them from dementia. This research aimed to investigate subtypes of geriatric depression associated with cognitive impairment, searched for differential variables and tried to propose a study model. A hundred and eighteen depressive patients and forty normal subjects matched by age and educational level were evaluated with an extensive neuropsychological battery, scales to evaluate neuropsychiatric symptoms and daily life activities (DLA). Depressive patients were classified in groups by SCAN 2.1: Major Depression Disorder (MDD) (n: 31), Dysthymia Disorder (DD) (n: 31), Subsyndromal Depression Disorder (SSD) (n: 29), Depression due to Dementia (n: 27) (DdD). Neuropsychological significant differences (p < 0.05) were observed between depressive groups, demonstrating distinctive cognitive profiles. Moreover, significant differences (p < 0.05) were found in DLA between DdD vs all groups and MDD vs controls and vs SSD. Age of onset varied in the different subtypes of depression. Beck Depression Inventory (BDI) and Mini Mental State Examination (MMSE) were significant variables that helped to differentiate depressive groups. Significant correlations between BDI and Neuropsychological tests were found in MDD and DD groups. Depressive symptoms and its relation with neuropsychological variables, MMSE, cognitive profiles, DLA and age of onset of depression should be taken into consideration for the study of subtypes of geriatric depression. [ABSTRACT FROM AUTHOR]

Abstract: Age-associated white matter degeneration has been well documented and is likely an important mechanism contributing to cognitive decline in older adults. Recent work has explored a range of noninvasive neuroimaging procedures to differentially highlight alterations in the tissue microenvironment. Diffusional kurtosis imaging (DKI) is an extension of diffusion tensor imaging (DTI) that accounts for non-Gaussian water diffusion and can reflect alterations in the distribution and diffusion properties of tissue compartments. We used DKI to produce whole-brain voxel-based maps of mean, axial, and radial diffusional kurtoses, quantitative indices of the tissue microstructure's diffusional heterogeneity, in 111 participants ranging from the age of 33 to 91 years. As suggested from prior DTI studies, greater age was associated with alterations in white-matter tissue microstructure, which was reflected by a reduction in all 3 DKI metrics. Prominent effects were found in prefrontal and association white matter compared with relatively preserved primary motor and visual areas. Although DKI metrics co-varied with DTI metrics on a global level, DKI provided unique regional sensitivity to the effects of age not available with DTI. DKI metrics were additionally useful in combination with DTI metrics for the classification of regions according to their multivariate “diffusion footprint”, or pattern of relative age effect sizes. It is possible that the specific multivariate patterns of age-associated changes measured are representative of different types of microstructural pathology. These results suggest that DKI provides important complementary indices of brain microstructure for the study of brain aging and neurologic disease. [Copyright &y& Elsevier]