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Objectives Previous studies on sex differences in cognitive decline provide inconsistent findings, with many European countries being underrepresented. We determined the association between sex and cognitive decline in a sample of Europeans and explored differences across birth cohorts and regions. Methods Participants 50+ years old enrolled in the Survey of Health, Ageing and Retirement in Europe had their cognition measured by tests of immediate recall, delayed recall and verbal fluency biennially up to 17 years of follow-up (median 6, interquartile range 3–9 years). We used linear mixed-effects models to assess the relationship between sex and the rate of cognitive decline, adjusting for sociodemographic and health-related characteristics. Results Of 66,670 participants (mean baseline age 63.5 ± standard deviation 9.4), 55% were female. Males and females had similar rates of decline in the whole sample in immediate recall (beta for interaction sex × time B = 0.002, 95% CI -0.001 to 0.006), delayed recall (B = 0.000, 95% CI −0.004 to 0.004), and verbal fluency (B = 0.008, 95% CI −0.005 to 0.020). Females born before World War II had a faster rate of decline in immediate recall and delayed recall compared to males, while females born during or after World War II had a slower rate of decline in immediate recall. Females in Central and Eastern Europe had a slower rate of cognitive decline in delayed recall compared to males. Discussion Our study does not provide strong evidence of sex differences in cognitive decline among older Europeans. However, we identified heterogeneity across birth cohorts and regions. [ABSTRACT FROM AUTHOR]

Purpose Cancer survivors commonly report cognitive declines after cancer therapy. Due to the complex etiology of cancer-related cognitive decline (CRCD), predicting who will be at risk of CRCD remains a clinical challenge. We developed a model to predict breast cancer survivors who would experience CRCD after systematic treatment. Methods We used the Thinking and Living with Cancer study, a large ongoing multisite prospective study of older breast cancer survivors with complete assessments pre-systemic therapy, 12 months and 24 months after initiation of systemic therapy. Cognition was measured using neuropsychological testing of attention, processing speed, and executive function (APE). CRCD was defined as a 0.25 SD (of observed changes from baseline to 12 months in matched controls) decline or greater in APE score from baseline to 12 months (transient) or persistent as a decline 0.25 SD or greater sustained to 24 months. We used machine learning approaches to predict CRCD using baseline demographics, tumor characteristics and treatment, genotypes, comorbidity, and self-reported physical, psychosocial, and cognitive function. Results Thirty-two percent of survivors had transient cognitive decline, and 41% of these women experienced persistent decline. Prediction of CRCD was good: yielding an area under the curve of 0.75 and 0.79 for transient and persistent decline, respectively. Variables most informative in predicting CRCD included apolipoprotein E4 positivity, tumor HER2 positivity, obesity, cardiovascular comorbidities, more prescription medications, and higher baseline APE score. Conclusions Our proof-of-concept tool demonstrates our prediction models are potentially useful to predict risk of CRCD. Future research is needed to validate this approach for predicting CRCD in routine practice settings. [ABSTRACT FROM AUTHOR]

Objectives The sociohistorical experiences of Asian American older adults (AAOA) vary, but limited research has examined how immigration status operates as social determinants. This study builds on an existing framework to examine the relationship among social determinants and the differential effects of immigration status on cognitive difficulties among AAOA. Methods Using 5-year estimate data from the 2019 American Community Survey, the study sample consisted of AAOA aged 65 years and older identifying as Chinese, Filipino, Indian, Japanese, Korean, or Vietnamese (N  = 100,584). AAOA were categorized as noncitizens, naturalized, or U.S. born for their immigration status. Participants who indicated having difficulty concentrating, remembering, or making decisions were categorized as having cognitive difficulties. Results Chinese were the most prevalent ethnic group (30%). Over 70% were naturalized citizens. About 8% endorsed having cognitive difficulties. According to bivariate analyses, there were considerable differences in AAOA's characteristics (e.g. age, gender, marital status, medical insurance, employment status) by their immigration status. The results from the logistic regressions showed that immigration status was independently associated with poor cognitive difficulties. By AAOA's immigration status, unique protective and risk factors were presented for cognitive difficulties. Discussion The differential pattern of cognitive difficulties among AAOA reveals a fuller picture of variations within AAOA by immigration status. The results imply that more research is needed to develop culturally sensitive practices that account for the racialized differences by AAOA's immigration status. Further research into the interplay between structural determinants is necessary to formulate practice and policy interventions to address better successful aging for AAOA. [ABSTRACT FROM AUTHOR]

Background and Objective The prospective association between dietary zinc (Zn) intake and cognitive decline remains uncertain. We aimed to assess the relationship of dietary Zn intake with the risk of cognitive decline in the Chinese older people, and examine the possible effect modifiers on this association. Methods A total of 3,106 older Chinese adults aged 55 years or older from China Health and Nutrition Survey were included. Dietary nutrients intake information was collected by combined 24-h dietary recalls with weighing food inventory. The cognitive decline was defined as the 5-year decline rate in global and composite cognitive scores, based on a subset of items from the Telephone Interview for Cognitive Status–modified. Results The median follow-up duration was 5.9 years. There was an L-shaped association between dietary Zn intake and the 5-year decline rates in global and composite cognitive scores, with an inflection point at 8.8 mg/day of dietary Zn. For the composite cognitive scores, compared with the first quantile (<7.9 mg/day) of dietary Zn intake, quantiles 2–6 (≥7.9 mg/day) had a significantly slower cognitive decline rate (β : −0.24; 95% confidence interval: −0.40 to −0.07). Similar results were found for the global cognitive scores. Moreover, the inverse association between dietary Zn intake and cognitive decline in composite cognitive scores was significantly stronger in those with lower levels of physical activity (P -interactions = 0.041). Conclusion Dietary Zn intake was negatively associated with cognitive decline in the older people. Maintaining appropriate dietary Zn levels may prevent cognitive decline. [ABSTRACT FROM AUTHOR]

Objectives Frailty is a risk factor for faster cognitive decline, while plant-based dietary patterns are associated with decreased risk of cognitive decline. We aimed to explore their interaction with cognitive function among older adults. Methods We used data from the Chinese Longitudinal Healthy Longevity Survey between 2008 and 2018. Frailty was evaluated based on the frailty index (FI), and the plant-based diet index (PDI) was calculated using food frequency questionnaire at baseline. Repeated measures of the Mini-Mental State Examination (MMSE) were utilised to assess cognitive function. We used linear mixed models to estimate regression coefficients (β) and 95% confidence intervals (CI). Results We included 7,166 participants with a median follow-up of 5.8 years. Participants in pre-frail (β = −0.18, 95% CI: −0.24, −0.13) and frail (β = −0.39, 95% CI: −0.48, −0.30) groups experienced an accelerated decline in MMSE score compared with the robust group. The PDI modified the above association, with corresponding associations with frailty being much more pronounced among participants with a lower PDI (frail vs. robust β = −0.44, 95% CI: −0.56, −0.32), compared with those with a higher PDI (frail vs. robust β = −0.27, 95% CI: −0.40, −0.13). In addition, A combination of frailty and a low PDI was strongly associated with a faster decline in MMSE score (β = −0.52, 95% CI: −0.63, −0.41). Conclusion Adherence to plant-based dietary patterns attenuates the association between frailty and cognitive decline. If the observed association is causal, promoting plant-based dietary patterns may be a strategy to reduce the effects of frailty on neurological health. [ABSTRACT FROM AUTHOR]

Background and Objectives Previous studies have found that pain is associated with fall worry among community-dwelling older people. However, both pain and fall worry are poorly understood and underaddressed among community-dwelling older people with cognitive impairment (CI). It is essential to examine the association between pain and fall worry, and how sociodemographic and health characteristics may shape fall worry among this subgroup. Research Design and Methods We used data from the 2015 National Health and Aging Trends Study (analytic sample: n = 1150 community-dwelling older people with CI; were self-interviewed; mean age: 81; age range: 65–107). The number of pain sites in the prior month was assessed by presenting a card listing common pain sites (eg, back, knees). Two questions assessed past-month fall worry, "did you worry about falling down" and "did this worry ever limit your activities." Following descriptive statistics, we fit multinomial logistic regression models to examine the associations between different pain characteristics (number of sites, severity, location) and non-activity-limiting and activity-limiting fall worry. Results Non-activity-limiting fall worry was endorsed by 21.1% and activity-limiting fall worry by 13.6% of community-dwelling older people with CI. After adjusting for sociodemographic characteristics and fall-worry-related covariates, multinomial logistic regression analysis found that a greater number of pain sites (relative risk ratio [RRR] = 1.22, 95% Confidence Interval [95% CI] = 1.12–1.33, p <.001) and severe pain (RRR = 2.05, 95% CI = 1.12–3.75, p =.020) was associated with activity-limiting fall worry. Both lower body (knee, foot, and leg) and upper body (hand, wrist, shoulder, neck, and stomach) pain were found to be associated with a high risk of activity-limiting fall worry. Discussion and Implications These findings suggest pain and fall worry are common among community-dwelling older people with CI and can be elicited directly from those who are communicative. Fall prevention for this population should prioritize pain management to mitigate activity-limiting fall worry because activity limitation increases the risk of falls. [ABSTRACT FROM AUTHOR]

Background and Objectives Physical function deterioration is always accompanied by a cognitive decline in older adults. However, evidence is lacking for the long-term simultaneous changing patterns of cognition and physical frailty and their associations with mortality among older adults. Research Design and Methods This study included 8,231 adults aged ≥65 with a baseline and at least one follow-up assessment of both cognition and physical frailty from the 2007–2018 Chinese Longitudinal Healthy Longevity Survey. Physical frailty (FRAIL phenotype) and cognition (Mini-Mental State Examination) were applied. Group-based joint trajectory modeling was used to fit the joint trajectories of cognition and physical frailty. Cox proportional hazards model was used to evaluate the trajectory-mortality associations. Results Three distinct joint trajectories were identified: no joint progression (34.4%), moderate joint progression (47.0%), and rapid joint progression (18.6%). During a median follow-up of 8.3 years, the rapid joint progression group, compared to the no joint progression , had the highest risk for all-cause mortality (hazard ratio (HR), 3.37 [95% CI: 2.99–3.81]), cardiovascular (CVD) mortality (3.21 [2.08–4.96]) and non-CVD mortality (2.99 [2.28–3.92]), respectively. Joint trajectory was found to be more predictive of mortality as compared to baseline measures of cognition and/or frailty (C -statistic ranged from 0.774 to 0.798). Higher changing rates of cognition and frailty were observed among all-cause decedents compared to CVD and non-CVD decedents over a 45-year span (aged 65–110) before death. Discussion and Implications Our study suggested that subjects with the worst cognitive decline and severest physical frailty progression were at the highest risk for all-cause and cause-specific mortality. Our findings expand the limited prior knowledge on the dynamic course of cognition and frailty. [ABSTRACT FROM AUTHOR]

Background and Objectives We work from a gendered life-course perspective to examine the relationship between cognitive impairment and feelings of sexual obligation among U.S. older adults. Research Design and Methods Data are drawn from 2 rounds of the National Social Life, Health, and Aging Project (2010/2011 and 2015/2016). The analytic sample includes 575 sexually active respondents aged 62–86 at baseline. Cognitive impairment is measured using a survey-adapted version of the Montreal Cognitive Assessment, with categories of normal, mild cognitive impairment, and dementia. We estimate cross-lagged models to test the potential reciprocal relationships between cognitive impairment and feelings of sexual obligation. Results Older adults with dementia at baseline had significantly higher odds of sexual obligation 5 years later than their peers with normal cognition at baseline, after adjusting for gender, race/ethnicity, education, income, age, marital status, self-rated health, depression, comorbidities, and sexual obligation at baseline. We find no evidence of a reciprocal relationship, as sexual obligation at baseline did not predict later cognitive status. Discussion and Implications Older adults with dementia often remain sexually active after their 60s, and many of them feel obligated to have sex with their partner. Our study highlights the importance of understanding the context of their sexual lives. The quality of their sexual relationship, such as whether they feel a duty to maintain their earlier sexual activity or please their partner, and the health implications of sexual obligation should be considered alongside the increase of older adults with dementia. [ABSTRACT FROM AUTHOR]

Objectives Participation in the Supplemental Nutrition Assistance Program (SNAP) among eligible adults aged 60 and older is much lower than among the younger population, and rates continue to decline throughout the life course while at the same time the risk of cognitive impairment increases. Due to the high administrative burden associated with SNAP application processes, cognitive impairment may be associated with low uptake of SNAP among the low-income older adult population, particularly among more socially disadvantaged groups (females, Blacks, and those living alone). We provide new evidence that changes in cognitive functioning are associated with reductions in the probability of SNAP take-up among eligible older adults. Methods Using panel data from the Health and Retirement Study, we estimate linear probability fixed-effects models to assess the effect of cognitive decline on the likelihood of SNAP participation among eligible adults aged 60 and older, controlling for observed characteristics that change over time as well as individual, time, and state fixed effects. Results Reduced levels of cognitive functioning that rise to the classification of dementia were strongly associated with reductions in the probability of SNAP take-up among eligible older adults. Results were particularly salient for females and those living alone. Discussion One barrier to SNAP take-up among older adults may be cognitive impairment with the size of effect differing by gender and living arrangement. Policymakers may want to consider initiatives to increase SNAP participation among older adults, including a focus on further simplification of eligibility and recertification processes that reduce administrative burden. [ABSTRACT FROM AUTHOR]

Objectives With advancing age, older drivers experience greater fatal crash risks due to age-related declines in cognitive and physical capabilities. Being informed of the age-related increased risks could help older drivers form compensatory strategies and determine when to seek further help to stay on the road safely for longer. Using a self-report assessment tool, the Attentional Failure during Driving Questionnaire (AFDQ), we examined older drivers' experience of various attentional failures during daily driving and how the measures could predict their crash risks. Methods We used a new methodological approach distinguishing the occurrences of attentional failures during driving and the frequency of those occurrences. The individuals' AFDQ occurrence and frequency scores were compared with prior driving outcomes and simulated driving performance. Results Unlike middle-aged drivers, frequency rather than occurrence of attentional failures was a significant predictor of prior traffic violations and crashes among older drivers. Also, attentional failures, but not chronological age, predicted older drivers' crash risks. AFDQ frequency was also associated with older drivers' poorer performance in simulated driving. Discussion The findings suggest that the self-report assessment for attention-related driving failures can predict older drivers' crash risks. Furthermore, the two-part approach of AFDQ provides an opportunity to do a more comprehensive investigation of the associations between attentional declines and crash risks among older drivers. [ABSTRACT FROM AUTHOR]

Background and Objectives The prevalence of cognitive impairment and sensory loss in hearing or vision increases with age. Based on the Information Processing Model, cognitive impairment coupled with sensory loss may exacerbate disability in late life. Yet this issue has not been systematically studied. The purpose of this scoping review was to examine the literature that studied the relationship between cognitive impairment, sensory loss, and activities of daily living in older adults. Research Design and Methods Two reviewers independently screened 1,410 studies identified from 5 electronic databases (Medline, EMBASE, PsycINFO, CINHAL, and Web of Science). The search was completed in June 2020. A study was eligible if it included measurements of cognitive function, vision or hearing, and activities of daily living. Additionally, the data analyses must address how cognitive impairment and sensory loss are related to the performance of activities of daily living. Results The final review included 15 studies. Findings show an additive effect of cognitive impairment and sensory loss on the activities of daily living. Cognitive impairment or vision loss independently relates to the decline in activities of daily living. Hearing loss relates to the decline only when the loss is severe, or if the daily task is hearing - specific. Discussion and Implications Older adults with coexisting sensory loss and cognitive impairment have the highest risk or prevalence of disability, comparing to cognitive impairment or sensory loss alone. This finding highlights the importance of developing interventions to reduce the risk of disability for older adults experiencing multiple impairments. [ABSTRACT FROM AUTHOR]

Background and Objectives The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out-of-pocket (OOP) expenditures. Research Design and Methods We use prospective data from the Health and Retirement Study (2007/2008–2015/2016) on adults 70 years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (unweighted n = 1,692) to fit 2-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing home use, hospitalizations, and OOP expenditures. Results Over 8 years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use which were particularly pronounced among those who transitioned or died during follow-up and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval = 832–1,479]), maintainers ($1,145 [993–1,296]), and transitioners ($1,385 [1,041–1,730]). Individuals who died during follow-up spent $2,529 (2,101–2,957). By the eighth year of follow-up, spending among reverters increased to $1,402 (869–1,934) and $2,188 (1,402–2,974) and $8,988 (5,820–12,157) for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 (4,345–11,094). Estimates were only partly attenuated through adjustment to covariables. Discussion and Implications A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning. [ABSTRACT FROM AUTHOR]

Background cognitively impaired hospital patients often experience agitation and aggression due to pain. Agitation complicates care, increasing the risk of adverse outcomes and patient-to-nurse violence. Managing agitation is challenging for nurses. Literature suggests they may rely on antipsychotics while missing other more appropriately targeted treatments. However, nurses' management of agitation remains unclear and under-researched. Objective the aim of this study was to investigate hospital nurses' management of agitation in older cognitively impaired patients with pain. Design this was a descriptive correlational study using virtual simulation. Setting and participants a total of 274 registered medical and surgical nurses from 10 public hospitals in Queensland, Australia participated in the study. Methods nurses undertook a virtual simulation requiring them to manage agitation in a patient with dementia and an injury. Nurses also completed a post-simulation questionnaire. Their simulation performances were correlated with demographics such as seniority, workplace, training, experience and gerontology-specific knowledge. Constructed from an original, validated vignette, the simulation included branching pathways, video scenarios and an avatar that could converse with participants. Results thirteen nurses (4.7%) recognised and treated the virtual patient's agitation as pain-related. Most nurses (89%) gave antipsychotics of which 207 (78%) gave these first-line and 102 (38%) used them twice. Independent of other variables, nurses most likely to diagnose pain were dementia-unit nurses (OR = 8.7), surgical-unit nurses (OR = 7.3) and senior nurses (OR = 5). Conclusions hospital nurses predominately managed agitation with antipsychotics, a decision that most made after undertaking inadequate patient assessments. This confirmed a common gap in practice that may lead to the missing of pain in the clinical care of agitated patients with dementia and/or delirium. [ABSTRACT FROM AUTHOR]

Background The relationship between baseline cognitive impairment (CI) and incident visual impairment (VI) in Asians is unclear. Objective To determine the associations between baseline CI with incident VI and visual acuity (VA) at 6-year follow-up in multiethnic Asians. Design Cohort. Setting Population-based. Subjects Two thousand three hundred and twenty-four adults aged ≥60 years from the Singapore Epidemiology of Eye Diseases Study (response rate 64%). Methods CI was defined using the validated Abbreviated Mental Test (AMT). VA was objectively measured using a LogMAR chart. Any incident VI was defined as having no VI (Snellen's VA better than or equal to 20/40) at baseline but present (VA worse than 20/40) at 6-year follow-up. VI severity was defined according to the International Classification of Diseases, 11th Revision. Associations were assessed using logistic and linear regression models. Results Of the 2,324 participants, 248 had CI at baseline. Presence of baseline CI was associated with more than twice the odds of any incident VI, incident mild and moderate–severe VI (OR [95% confidence interval]: 2.48 [1.55–3.90], 2.07 [1.17–3.55], and 2.61 [1.36–4.93], respectively) and worse VA (β [95% confidence interval]: 0.026 [0.006–0.046]) at 6-year follow-up. The leading causes of incident VI were cataract and under-corrected refractive error. Conclusions Older adults with CI had more than double the odds of VI development and poorer VA than their cognitively intact counterparts, and most causes of incident VI were correctable. Strategies such as targeted vision screening and early intervention for early detection and management of vision loss in patients with cognitive decline are warranted. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of functional task exercise on everyday problem-solving ability and functional status in older adults with mild cognitive impairment compared to single exercise or cognitive training and no treatment control. Design A single-blind, four-arm randomised controlled trial. Setting Out-patient clinic and community centre. Participants Older adults with mild cognitive impairment aged ≥60 living in community. Methods Participants (N  = 145) were randomised to 8-week functional task exercise (N  = 34), cognitive training (N  = 38), exercise training (N  = 37), or wait-list control (N  = 36) group. Outcomes measures: Neurobehavioral Cognitive Status Examination, Category Verbal Fluency Test, Trail Making Test, Problems in Everyday Living Test, Activities of Daily Living Questionnaire, Instrumental Activities of Daily Living Scale; Chair stand test, Berg Balance Scale, and Short Form-12 Health Survey were conducted at baseline, post-intervention and 5-months follow-up. Results Post-intervention results of ANCOVA revealed cognitive training improved everyday problem-solving (P  = 0.012) and exercise training improved functional status (P  = 0.003) compared to wait-list control. Functional task exercise group demonstrated highest improvement compared to cognitive training, exercise training and wait-list control groups in executive function (P range = 0.003–0.018); everyday problem-solving (P  < 0.001); functional status (P range = <.001–0.002); and physical performance (P  = 0.008) at post-intervention, with all remained significant at 5-month follow-up, and further significant improvement in mental well-being (P  = 0.043). Conclusions Functional task exercise could be an effective intervention to improve everyday problem-solving ability and functional status in older adults with mild cognitive impairment. The findings support combining cognitive and exercise intervention may give additive and even synergistic effects. [ABSTRACT FROM AUTHOR]

Background Neurocognitive impairment (NCI) and frailty are more prevalent among persons with human immunodeficiency virus (HIV, PWH) compared to those without HIV. Frailty and NCI often overlap with one another. Whether frailty precedes declines in neurocognitive function among PWH or vice versa has not been well established. Methods AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH. Participants undergo annual assessments for NCI and frailty. ACTG A5322 participants who developed NCI as indexed by tests of impaired executive functioning and processing speed during the first 3 years were compared to persons who maintained normal cognitive function; those who demonstrated resolution of NCI were compared to those who had persistent NCI. Participants were similarly compared by frailty trajectory. We fit multinomial logistic regression models to assess associations between baseline covariates (including NCI) and frailty, and associations between baseline covariates (including frailty) and NCI. Results In total, 929 participants were included with a median age of 51 years (interquartile range [IQR] 46–56). At study entry, 16% had NCI, and 6% were frail. Over 3 years, 6% of participants developed NCI; 5% developed frailty. NCI was associated with development of frailty (odds ratio [OR] = 2.06; 95% confidence interval [CI] = .94, 4.48; P  = .07). Further adjustment for confounding strengthened this association (OR = 2.79; 95% CI = 1.21, 6.43; P  = .02). Baseline frailty however was not associated with NCI development. Conclusions NCI was associated with increased risk of frailty, but frailty was not associated with development of NCI. These findings suggest that the presence of NCI in PWH should prompt monitoring for the development of frailty and interventions to prevent frailty in this population. [ABSTRACT FROM AUTHOR]

Milk and dairy (M&D) is a longstanding human food with widespread use. Many studies showed the preventive capacity of M&D in several human health disorders, but its utility in others is under discussion. Aging has been associated to elderly cognitive decline including dementia-Alzheimer syndrome (Dem-AD). The absence of a therapy to impede or postpone Dem-AD determines the need for its prevention, including nutritional factors. To evaluate the preventive capacity of M&D consumption in elderly Dem-AD we performed a systematic review in the main biomedical databases and information resources, but we present this study as a narrative review to discuss better the complexity of this subject. The elderly Dem-AD has a long pre-symptomatic period and the M&D intake has a widespread use. These determinants and the quality flaws of published studies impeach us to answer whether M&D consumption is preventive for Dem-AD. Moreover, two long Japanese cohorts suggest that M&D intake could prevent Dem-AD. Prospective cohorts beginning in midlife (or early life) could answer this question in the future. [ABSTRACT FROM AUTHOR]

The article describes the case of an 82-year-old woman with significant cognitive decline, somnolence and loss of mobility. Topics discussed include evidence of proximal myopathy found on examination with difficulty standing from seated position and evidence of osteoarthritis with deformity of her right knee without joint effusion, relevant biochemical findings and hospital admissions, and a positive diagnosis of central hypothyroidism.

Background and Objectives This study tests the feasibility of using virtual reality (VR) with older adults with mild cognitive impairment (MCI) or mild-to-moderate dementia with a family member who lives at a distance. Research Design and Methods 21 residents in a senior living community and a family member (who participated in the VR with the older adult from a distance) engaged in a baseline telephone call, followed by 3 weekly VR sessions. Results Residents and family members alike found the VR safe, extremely enjoyable, and easy to use. The VR was also acceptable and highly satisfying for residents with MCI and dementia. Human and automated coding revealed that residents were more conversationally and behaviorally engaged with their family member in the VR sessions compared to the baseline telephone call and in the VR sessions that used reminiscence therapy. The results also illustrate the importance of using multiple methods to assess engagement. Residents with dementia reported greater immersion in the VR than residents with MCI. However, the automated coding indicated that residents with MCI were more kinesically engaged while using the VR than residents with dementia. Discussion and Implications Combining networking and livestreaming features in a single VR platform can allow older adults in senior living communities to still travel, relive their past, and engage fully with life with their family members, despite geographical separation and physical and cognitive challenges. [ABSTRACT FROM AUTHOR]

Background and Objectives Even before the COVID-19 pandemic, older adults with cognitive impairment living alone (an estimated 4.3 million individuals in the United States) were at high risk for negative health outcomes. There is an urgent need to learn how this population is managing during the pandemic. Research Design and Methods This is a qualitative study of 24 adults aged 55 and older living alone with cognitive impairment from diverse racial/ethnic backgrounds. Participants' lived experiences during the pandemic were elicited via 59 ethnographic interviews conducted over the phone either in English, Spanish, or Cantonese. Using a qualitative content analysis approach, interview transcripts were analyzed to identify codes and themes. Results Qualitative analysis of transcripts revealed 5 themes: (a) fear generated by the pandemic, (b) distress stemming from feeling extremely isolated, (c) belief in misinformation, (d) strategies for coping during the pandemic, and (e) the importance of access to essential services. Discussion and Implications This pandemic put a spotlight on the precarity and unmet needs of older adults living alone with cognitive impairment. Findings underscore the need to expand access to home care aides and mental health services for this population. [ABSTRACT FROM AUTHOR]

Background the aim of this study was to evaluate the impact of emergency department (ED) stay-associated delirium on older patient's functional and cognitive status at 60 days post ED visit. Methods this study was part of the multi-centre prospective cohort INDEED study. This project took place between March 2015 and July 2016 in five participating EDs across the province of Quebec. Independent non-delirious patients aged ≥65, with an ED stay ≥8 hours, were monitored for delirium until 24 hours post ward admission. A 60-day follow-up phone assessment was conducted. Participants were screened for delirium using the Confusion Assessment Method. Functional and cognitive statuses were assessed at baseline and at the 60-day follow-up using OARS and TICS-m. Results a total of 608 patients were recruited, 393 of which completed the 60-day follow-up. The Confusion Assessment Method was positive in 69 patients (11.8%) during ED stay or within the first 24 hours following ward admission. At 60 days, delirium patients experienced an adjusted loss of −2.9/28 [95%CI: −3.9, −2.0] points on the OARS scale compared to non-delirious patients who lost −1.6 [95%CI: −1.9, −1.3] (P  = 0.006). A significant adjusted difference in cognitive function was also noted at 60 days, as TICS-m scores in delirious patients decreased by −1.6 [95%CI: −3.5, 0.2] compared to non-delirious patients, who showed a minor improvement of 0.5 [95%CI: −0.1, 1.1] (P  = 0.03). Conclusion seniors who developed ED stay-associated delirium have lower baseline functional and cognitive status than non-delirious patients, and they will experience a more significant decline at 60 days post ED visit. [ABSTRACT FROM AUTHOR]

Background the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear. Methods we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I 2 statistic and risk of bias using ROBINS-I. Results twenty-six studies (including 621,548 participants) met our inclusion criteria. 'Any' anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09–1.32, I 2 = 86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17–1.29, I 2 = 2%; and OR 1.50, 95% CI 1.22–1.85, I 2 = 90%). 'Any' anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09–0.21, I 2 = 3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97–1.59, I 2 = 0%). Conclusions anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use. [ABSTRACT FROM AUTHOR]

Objectives This article asks how the educational attainments of multiple family members, including parents and offspring, are associated with the cognitive health of older adults in the United States. Methods We use panel data from the U.S. Health and Retirement Study (2000–2012) to examine how the education of an individual, their parent(s), and their offspring are associated with the prevalence of moderate/severe cognitive impairment and the onset of cognitive impairment among older adults using logistic regression and discrete-time event history analysis, respectively. Results We found that when combined, only the education of the individual is inversely associated with cognitive impairment at baseline. However, both the educational attainments of an individual and their offspring are negatively associated with the risk of becoming cognitively impaired, among individuals who were not already cognitively impaired. Conversely, parental education was not predictive of being cognitively impaired or the onset of impairment. Furthermore, we found that respondent gender did not moderate the relationship between a family member's education and respondent cognitive health. Discussion This study adds to current research by asking how resources from earlier and subsequent generations matter for older adults' cognitive health. Although we found little evidence that parental education matters at this life stage, results suggest that offspring education has a salient positive effect on later-life cognitive health. This finding underscores an overlooked source of health disparities—offspring resources—and highlights how a family perspective remains a powerful tool for understanding health inequalities in later life. [ABSTRACT FROM AUTHOR]

Background and Objectives While older adults' social participation has attracted sustained attention, the realities faced by seniors with impairments in this area are still understudied. Social representations are formed from socially constructed opinions regarding a given object and have four functions (knowledge, identity, orientation, justification). The purpose of this article is to document the social representations that exist within seniors' organizations regarding participation by older people with impairments. Research Design and Methods In this mixed-methods study, an exploratory sequential design was applied. First, a qualitative phase involved meetings with five focus groups to explore how participants would manage difficult situations in which the inclusion of an older person with impairments must be addressed. Second, a quantitative phase consisted of a questionnaire administered to 86 respondents to examine the components of social representations about the participation of older people with impairments. Results Results show that, although research participants acknowledge that all seniors have the right to participate, this right confronts a collective identity infused with aging model that demands a youthful, "un-disabled" appearance and activities. In terms of the orientation function, making participation a reality is seen as relying on the efforts of people with impairments, but when there is a failure of inclusiveness, the reasons offered to justify it concern the resources available, rather than possible prejudices. Discussion and Implications Interpretation of the results leads to recommendations for both implementing an inclusion philosophy and practices in seniors' organizations and revisiting the view of impairment in old age as otherness. [ABSTRACT FROM AUTHOR]

Low- and middle-income countries (LMICs) are experiencing rapid aging, a growing dementia burden, and relatively high rates of out-migration among working-age adults. Family member migration status may be a unique societal determinant of cognitive aging in LMIC settings. We aimed to evaluate the association between adult child US migration status and change in cognitive performance scores using data from the Mexican Health and Aging Study, a population-based, national-level cohort study of Mexico adults aged ≥50 years at baseline (2001), with 2-, 12-, and 14-year follow-up waves (2003, 2012, and 2015). Cognitive performance assessments were completed by 5,972 and 4,939 respondents at 11 years and 14 years of follow-up, respectively. For women, having an adult child in the United States was associated with steeper decline in verbal memory scores (e.g. for 9-year change in immediate verbal recall z score, marginal risk difference (RD) = –0.09 (95% confidence interval (CI): −0.16, −0.03); for delayed verbal recall z score, RD = –0.10 (95% CI: −0.17, −0.03)) and overall cognitive performance (for overall cognitive performance z score, RD = –0.04, 95% CI: −0.07, −0.00). There were mostly null associations for men. To our knowledge, this is the first study to have evaluated the association between family member migration status and cognitive decline; future work should be extended to other LMICs facing population aging. [ABSTRACT FROM AUTHOR]

Background and Objectives Informal caregivers are rarely as involved as they want to be in the housing decisions of cognitively impaired older adults. Lack of awareness of available options and their benefits and risks may lead to decisions that do not reflect older adults' preferences, and to guilt and regret. We assessed the effect of training home care teams in interprofessional shared decision-making (SDM) on the proportion of caregivers who report being active in this decision. Research Design and Methods In a two-arm pragmatic cluster randomized trial with home care teams working in health centers in the Province of Quebec, we randomized health centers to receive training in interprofessional SDM (intervention) or not (control). Eligible caregivers had made a housing decision for a cognitively impaired adult aged 65 years or older who was receiving services from a home care team. The primary outcome was the proportion of caregivers reporting an active role in decision making. We performed intention-to-treat multilevel analysis. Results We consecutively enrolled a random group of 16 health centers and recruited 309 caregivers, among whom 296 were included in the analysis. In the intervention arm, the proportion of caregivers reporting an active role in decision making increased by 12% (95% CI −2% to 27%; p =.10). After removal of an influential cluster outlier, the proportion increased to 18% (95% CI: 7%–29%; p <.01). Discussion and Implications Training home care teams in interprofessional SDM increased caregiver involvement in health-related housing decisions for cognitively impaired older adults. [ABSTRACT FROM AUTHOR]

Objectives Because sequence learning is integral to cognitive functions across the life span, the present study examined the effect of healthy aging on deterministic judgment-based sequence learning. Methods College-aged, younger–old (YO), and older–old (OO) adults completed a judgment-based sequence learning task which required them to learn a full sequence by chaining together single stimulus–response associations in a step-by-step fashion. Results Results showed that younger adults outperformed YO and OO adults; older adults were less able to acquire the full sequence and committed significantly more errors during learning. Additionally, higher sequence learning errors were associated with advancing age among older adults, even when controlling for other factors known to contribute to sequence learning abilities. Such impairments were selective to learning sequential information, because adults of all ages performed equivalently on postlearning probe trials, as well as on learning simple stimulus–response associations. Discussion This pattern of age deficits during deterministic sequence learning challenges past reports of age preservation. Though the neural processes underlying learning cannot be determined here, our patterns of age deficits and preservation may reflect different brain regions that are involved in the task phases, adding behavioral evidence to the emerging hypothesis of frontostriatal declines despite spared hippocampal function with age. [ABSTRACT FROM AUTHOR]

Background Research into dementia and other conditions connected with cognitive impairments is essential but conducting research with populations who lack capacity to provide consent involves a number of ethical, legal and practical challenges. In England and Wales, family members can act as a consultee or legal representative on behalf of someone who lacks capacity. However, there is a paucity of research about how family members make decisions concerning research participation. Objective To explore family members' experiences of proxy decision-making for research. Understanding how proxy decisions are made could lead to interventions to support greater inclusion of individuals in research who have impaired decision-making capacity. Methods Semi-structured interviews were conducted with a purposive sample of 17 family members who had experience as a proxy for making decisions about participation in research, including those who had agreed to participation and those who declined. Thematic analysis was used to examine experiences and generate findings for research practice and to develop future supportive interventions. Results Proxy decision-making is highly contextualised. Proxies balance a number of factors when deciding about research participation, including the person's values and preferences, within the specific context of the study, and the practicalities of being involved. Proxies use these factors to construct a decision that is authentic to the person they care for. Conclusions Proxy decision-making for research is a complex process with inter-woven layers of decision-making. Decisions can be problematic for some proxies who may benefit from decision support to make an informed decision about research participation on behalf of a family member. [ABSTRACT FROM AUTHOR]

Background: Hypertension and cognitive impairment often coexist in older people. Office blood pressure measurement is a poor indicator for diagnosing hypertension in the general population. However, its diagnostic accuracy has not been substantially studied in patients with cognitive impairment. Aim: The aim of this study was to determine the proportion of misdiagnosis of hypertension in patients with mild cognitive impairment and dementia compared to no cognitive impairment, by comparing office blood pressure measurement with home blood pressure measurement. Methods: A cross-sectional study including consecutive patients visiting a memory clinic between 2014 and 2017. Home blood pressure was measured for one week according to the European guidelines. Office blood pressure was assessed during routine clinical practice. Using guideline definitions for normal blood pressure and hypertension, we investigated the proportion of disagreement between office blood pressure measurement and home blood pressure measurement. Univariable and multivariable logistic regression compared disagreement in diagnosis between patients with dementia, mild cognitive impairment and no cognitive impairment. Results: Of 213 patients (aged 73.4±9.0 years, 42% women) 82 had dementia, 65 had mild cognitive impairment and 66 had no cognitive impairment. Mean office blood pressure was 156/84±23/11 mmHg and mean home blood pressure was 139/79±16/10 mmHg. In 31% of patients, there was disagreement in hypertension diagnosis. This proportion was higher for mild cognitive impairment (38.5%) and dementia (35.4%) compared to no cognitive impairment (18.2%), with adjusted odds ratios of 3.7 (95% confidence interval 1.5–9.0), P =0.005 for mild cognitive impairment and 3.4 (1.3–8.6), P =0.011 for dementia. Conclusions: In memory clinic patients with dementia and mild cognitive impairment, the diagnostic accuracy of office blood pressure measurement is lower compared to patients without cognitive impairment. To avoid the risk of making improper treatment decisions in this vulnerable group, a diagnosis of hypertension should be based on home blood pressure measurement, not office blood pressure measurement. [ABSTRACT FROM AUTHOR]

Objectives Despite the growing interest in the effects of neighborhood environments on cognitive function, most studies on older people are based on cross-sectional survey data from developed countries. This study examines the relationship between neighborhood environments and decline in cognitive function over time among middle-aged and older people in China and whether this relationship varies between rural and urban residents. Methods The three waves of China Health and Retirement Longitudinal Study (CHARLS 2011–2015) were used. The sample included 12,131 respondents living in 298 rural villages and 4,059 respondents living in 150 urban communities. Three-level linear growth curve models were estimated to track trajectories of cognitive change over a 4-year period. Results Chinese older people who lived in neighborhoods with more handicap access, more bus lines, employment service, and higher socioeconomic status (SES) had slower cognitive decline. Neighborhood basic infrastructures, number of days that roads were unpassable, outdoor exercise facilities, and average social activity participation were associated with baseline cognitive function in both rural and urban areas, but neighborhood environments had more impact on cognitive decline among rural older adults than urban older adults. Discussions Findings from this study call for increased infrastructure development and community building programs in rural China. [ABSTRACT FROM AUTHOR]

Objectives The current study examined recognition memory dysfunction and its neuroanatomical substrates in cognitively normal older adults and those diagnosed with mild cognitive impairment (MCI). Methods Participants completed the Mnemonic Similarity Task, which provides simultaneous measures of recognition memory and mnemonic discrimination. They also underwent structural neuroimaging to assess volume of medial temporal cortex and hippocampal subfields. Results As expected, individuals diagnosed with MCI had significantly worse recognition memory performance and reduced volume across medial temporal cortex and hippocampal subfields relative to cognitively normal older adults. After controlling for diagnostic group differences, however, recognition memory was significantly related to whole hippocampus volume, and to volume of the dentate gyrus/CA3 subfield in particular. Recognition memory was also related to mnemonic discrimination, a fundamental component of episodic memory that has previously been linked to dentate gyrus/CA3 structure and function. Discussion Results reveal that hippocampal subfield volume is sensitive to individual differences in recognition memory in older adults independent of clinical diagnosis. This supports the notion that episodic memory declines along a continuum within this age group, not just between diagnostic groups. [ABSTRACT FROM AUTHOR]

Background Disorientation to time can be used as a guide to determining the presence and severity of dementia. The inability to maintain one's wrist watch at the correct time is assessed as a possible marker of dementia. Methods Inpatients in a post-acute care unit with a mean age of 76.2 (±12.4 years) were assessed with regard to the time on their wristwatch. The time was recorded as correct or incorrect with a permitted discrepancy of 15 minutes. A current Mini-Mental State Examination (MMSE) score was obtained and patients were divided into two groups: MMSE above/equal to or below 24, with the latter defined as an abnormal result. Results The most striking finding of this study was that any patient with an incorrectly set watch had an abnormal MMSE. The majority of patients with an abnormal MMSE had their watch set correctly (n=17, 38%), while only 10 (22%) were found to have an incorrectly set watch. All patients with a normal MMSE had their watch set correctly, n=18 (40%). Acknowledging the fact that conclusions of statistical methods used on a small sample size should be interpreted with caution, we report that the two-tailed Z score for 2 population proportions was 2.9277 (p=0.00338), significant at p<0.05. Conclusion This study presents evidence to suggest a relationship between the correctness of the older patient's watch and their cognitive status. Assessment of time on the patient's watch could be considered as an instantaneous, approximate "test" for dementia in clinical practice. This test would have a sensitivity of 37% and specificity of 100%. [ABSTRACT FROM AUTHOR]

Background Visual impairment is a leading chronic condition among older adults and is usually connected with a decline in their performance of instrumental activities of daily living. Understanding the challenges of those with visual impairment is paramount as the population ages over the next four decades. This study examined the hypothesis that older adults who were diagnosed with juvenile macular degeneration as young adults and now have a mild cognitive impairment have better coping mechanisms than older adults who were recently diagnosed with age-related macular degeneration. Methods This study utilized a mixed-methods approach to address the complexities in health science research and align with the interdisciplinary field of gerontology. Results Participants were 27 older adults aged 65 years of age and older. There was no quantitative difference in resiliency between participants with juvenile macular degeneration (n  = 7, M = 77.71, SD = 9.46) and those with age-related macular degeneration (n = 10, M = 72.60, SD = 8.25),  t (15) = 1.185,  p  =.254. Conclusion The qualitative results revealed that older adults living with visual impairment develop strategies to improve their quality of life and help them age in place. [ABSTRACT FROM AUTHOR]

Background Dementia, and related cognitive impairment, is prevalent in dependent older adults in receipt of formal home care; importantly, this is a determinant of transition into long-term care (Aspell. 2019). Our study aimed to explore social and socioeconomic factors in community dwelling older people in receipt of formal home care. To our knowledge social deprivation has not been previously investigated in this population in Ireland. Methods This study comprised a large cohort (n=1597) of community-dwelling adults aged 65 years or older who were in receipt of formal home care. Demographic, living setting, dependency (Barthel Index) were recorded; cognitive dysfunction (CD) included dementia and related cognitive impairment (Aspell. 2019). Social deprivation was captured by the Pobal HP Deprivation index which categorises affluence or disadvantage by residential area in Ireland. Results The study population (n=1597) was of mean age 83.3 ± 7.2, supported by 11.1 ± 7.2 hours of home care per week and 10.8% and 31.7% were categorised as of disadvantaged and affluent deprivation status, respectively. Those who received home support in areas of disadvantage were significantly younger than in affluent areas (79.1 ± 7.3 v 85.6 ± 6.87 years, p< 0.001). Prevalence of CD was 43.3%. CD vs non-documented CD were characterised by a significantly higher proportion of females (66.5% v 61.4%, p <0.05), widowed (47.4% v 41.8%, p <0.05) and very disadvantaged (7.4% vs 5.0%, p <0.05). Furthermore, the CD group had a significantly higher falls risk but lower physical dependency (Barthel), lower requirement for mobility support and higher need for meal assistance. Home care hours were higher (11.6 ± 7.2 v 10.8 ± 7.2 p <0.001) for the CD group, and comprised generic, rather than dementia-specific support. Conclusion The findings have implications for developing personalised dementia-specific home support and interventions. Further research is needed into disadvantaged deprivation and the need for home support at a younger age. [ABSTRACT FROM AUTHOR]