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Objective: To evaluate the effectiveness of multimodal features based on gait analysis and eye tracking for elderly people screening with subjective cognitive decline in the community. Methods: In the study, 412 cognitively normal older adults aged over 65 years were included. Among them, 230 individuals were diagnosed with nonsubjective cognitive decline and 182 with subjective cognitive decline. All participants underwent assessments using three screening tools: the traditional SCD9 scale, gait analysis, and eye tracking. The gait analysis involved three tasks: the single task, the counting backwards dual task, and the naming animals dual task. Eye tracking included six paradigms: smooth pursuit, median fixation, lateral fixation, overlap saccade, gap saccade, and anti-saccade tasks. Using the XGBoost machine learning algorithm, several models were developed based on gait analysis and eye tracking to classify subjective cognitive decline. Results: A total of 161 gait and eye-tracking features were measured. 22 parameters, including 9 gait and 13 eye-tracking features, showed significant differences between the two groups (p < 0.05). The top three eye-tracking paradigms were anti-saccade, gap saccade, and median fixation, with AUCs of 0.911, 0.904, and 0.891, respectively. The gait analysis features had an AUC of 0.862, indicating better discriminatory efficacy compared to the SCD9 scale, which had an AUC of 0.762. The model based on single and dual task gait, antisaccade, gap saccade, and median fixation achieved the best efficacy in SCD screening (AUC = 0.969). Conclusion: The gait analysis, eye-tracking multimodal assessment tool is an objective and accurate screening method that showed better detection of subjective cognitive decline. This finding provides another option for early identification of subjective cognitive decline in the community. [ABSTRACT FROM AUTHOR]

Perceived threat of Alzheimer's disease and related dementias (ADRD) has been found a widespread phenomenon in developed countries, but has not yet been fully explored in developing countries. Analyzing data from 300 family caregivers of older adults with cognitive impairment in China, this study found caregiver burden was positively associated with the perceived threat of ADRD, and this association was buffered by higher family income and longer caregiving time. To alleviate undue ADRD concerns, it suggests expanding respite care and community elder care beds, and initiating education programs on reducing unnecessary worries about developing ADRD. [ABSTRACT FROM AUTHOR]

Background: The mechanism of cognitive impairment in hemodialysis patients is multifactorial. The relationship between cerebral blood flow and the decline of cognitive function is poorly understood. Objective: To investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis. Methods: In this prospective observational cohort study of 121 older patients undergoing hemodialysis, we used transcranial Doppler ultrasound (TCD) to measure cerebral arterial mean flow velocity (MFV) throughout dialysis, assessed cognitive function at baseline and 12-month follow-up, and then analyzed associations between MFV and changes on cognitive scores. Results: TCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, p < 0.001), ΔSBP (rho 0.251, p = 0.005), and ΔMAP (rho 0.194, p = 0.032). Compared with the baseline assessments, cognitive scores of participants at the 12-month follow-up were significantly worsened in global cognition (MOCA), some tests of memory (CFT-memory), executive function (TMT-B, SCWT-C, and SCWT-T), attention/processing speed (SDMT), and visuospatial function (CFT-copy) (p < 0.05). The worsening scores in global cognition (MOCA) (β = 0.066, 95% CI 0.018-0.113, p = 0.007) and some tests of memory (AVLT5) (β = 0.050, 95% CI 0.004-0.097, p = 0.035) and executive function (TMT-B, SCWT-C, SCWT-T) (β = 1.955, 95% CI 0.457--3.453, p = 0.011; β = 0.298, 95% CI 0.112-0.484, p = 0.002 and β = 1.371, 95% CI 0.429-2.303, p = 0.004, respectively) were significantly associated with the reduction of MFV. Conclusion: Hemodialysis may significantly reduce cerebral blood flow in older patients; Repetitive intradialytic decreases in CBF may be one of the mechanisms underlying the decline of cognitive function. [ABSTRACT FROM AUTHOR]

Background: Mobile device-based cognitive screening has the potential to overcome the limitations in diagnostic precision and efficiency that characterize conventional pen and paper cognitive screening. Several mobile device-based cognitive testing platforms have demonstrated usability, but the usability of take-home mobile device-based cognitive screening in typical adult primary care patients requires further investigation. Methods: This study set out to test the usability of a prototype mobile device-based cognitive screening test in older adult primary care patients across a range of cognitive performance. Participants completed the St. Louis University Mental Status Examination (SLUMS) and then used a study-supplied mobile device application at home for 5 days. The application presented 7 modules lasting approximately 15 min. Participants completed the System Usability Scale (SUS) after using the application. Results: A total of 51 individuals participated, with a median (IQR) age of 81 (74–85) years. Cognitive impairment (SLUMS score < 27) was present in 30 (59%) of participants. The mean (95% Confidence Interval [CI]) SUS score was 76 (71–81), which indicates good usability. Usability scores were similar across ranges of cognitive impairment. A Lower SLUMS score predicted early withdrawal from the study with an area under the receiver operating characteristic curve (95% CI) of 0.78 (0.58–0.97). Conclusion: Take-home mobile device-based cognitive testing is a usable strategy for many older adult primary care patients. Depending on patient preferences and abilities, it could be part of a flexible cognitive testing and follow-up strategy that includes mobile device-based testing in healthcare settings and pen-and-paper cognitive testing. [ABSTRACT FROM AUTHOR]

The global healthcare sector, deeply impacted by Covid 19, faced unprecedented challenges in resilience and organisational complexity. Resilience in organisations where health and human services combined are served, especially in the disability sector, has often been less visible than that of healthcare professionals. This article explores the post- Covid reconstruction of one such organisation, aiming to co-create an inspiring shared vision for a post-pandemic future. [ABSTRACT FROM AUTHOR]

Vaccination, particularly against pneumococcus and influenza, is a low-cost primary prevention, useful to avoid hard complications, particularly among frail older people. In this pilot study, we aimed to assess the effect of a strategy for influenza and pneumococcal vaccination for outpatients mainly affected by cognitive or endocrinological conditions, evaluating what could stimulate or demotivate vaccination among older people. This study was conducted during the 2023–2024 influenza season at the outpatient clinics in Palermo, Italy. A total 76 patients were included. More than half of the patients could be considered as pre-frail and about 20% frail, according to a comprehensive geriatric evaluation. Among patients, 46.05% received only vaccination against pneumococcus, 28.95% both vaccinations, and 25.0% only against influenza. Compared with the previous seasons, a 19.5% increase of influenza and 90.2% of pneumococcal vaccine uptake was observed. Side effects of vaccination were the main reason of the previous rejection, namely 76.9% for influenza and 53.8% for anti-pneumococcal vaccination. In conclusion, our study indicates how a new vaccination strategy in different settings could be feasible. Proposing influenza and pneumococcal vaccination for frail older outpatients could be an effective instrument to improve immunization coverage that is still low among older people. [ABSTRACT FROM AUTHOR]

Objective. This study used a random‐intercept cross‐lagged panel model (RI‐CLPM) to explore the longitudinal relationship between cognitive function (CF) and subjective well‐being (SWB) for older adults and investigate if older adults with cognitive decline can be happy. Older adults were divided into two groups according to gender, and the effect of gender with different groups on CF and SWB was discussed. The effects of age, marital status, self‐rated health, exercise, and education level on the CF and SWB were investigated. Methods. This study adopted a longitudinal design and selected 4,672 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which spanned 3 time points from 2008 to 2014 (N = 4,672). The mean age was 78.18 years (SD = 9.75, range = 61–111) and 2,238 (47.9%) were males. The CF was measured using the cognitive function scale, and the SWB was measured using 6 questions related to positive and negative emotions from CLHLS. Results. (1) The chi‐square difference test between the two models further showed that the RI‐CLPM fitted data significantly better than traditional CLPM (∆χ2 (3) = 203.656, p < 0.001). The RI‐CLPM was more suitable for this study than the CLPM. (2) This study examined whether the relationship between CF and SWB for older adults was bidirectional or unidirectional. The article only partially supported them, which indicates that including the gender role was successful. (3) Self‐rated health, exercise, and education level had a significant positive impact on both CF and SWB. The only distinguishable factor that affects CF between males and females is the marital status. The effect for female CF is not significant (β = −0.001, p = 0.961), but the effect for male CF is significant (β = −0.146, p < 0.001). Conclusion. Gender discrimination is necessary to better understand the impact of cognitive decline on SWB. Female older adults with cognitive decline could be happy, but male older adults could not. Male CF is more affected by marital status than females. It is more important to care about the cognitive decline of unmarried male older adults. Older age and unmarried males are risk factors for older adults, but better self‐rated health, more regular exercise, and continuous learning are the protective factors for older adults. These risk factors need to be prevented and these protective factors should be strengthened. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment in the elderly may lead to potential increased sensitivity to anesthetic agents targeting receptors associated with cognition. This study aimed to explore the effect of cognitive status on propofol consumption during surgery in elderly patients. Methods: Sixty elderly patients scheduled for laparoscopic radical prostatectomy were allocated to either a cognitively normal [CogN, Montreal Cognitive Assessment (MoCA) score ≥26] or cognitively impaired (CogI, MoCA <26) group. Propofol was administered via target-controlled infusion to maintain a bispectral index (BIS) between 55-65 during surgery. Propofol consumption was recorded at three time points: T1 (abolished eyelash reflex), T2 (BIS = 50), T3 (extubation). BIS values at eyelash reflex abolition were also recorded. Postoperative MoCA, Visual Analogue Scale (VAS) scores, and remifentanil/sufentanil consumption were assessed. Results: BIS values before induction were similar between CogN and CogI groups. However, at eyelash reflex abolition, BIS was significantly higher in CogI than CogN (mean ± SD: 65.3 ± 7.2 vs. 61.1 ± 6.8, p = 0.031). Propofol requirement to reach BIS 50 was lower in CogI vs. CogN (1.24 ± 0.19 mg/kg vs. 1.46 ± 0.12 mg/kg, p = 0.003). Postoperative MoCA, VAS scores, and remifentanil/sufentanil consumption did not differ significantly between groups. Conclusion: Compared to cognitively intact elderly, those with cognitive impairment exhibited higher BIS at eyelash reflex abolition and required lower propofol doses to achieve the same BIS level, suggesting increased propofol sensitivity. Cognitive status may impact anesthetic medication requirements in the elderly. [ABSTRACT FROM AUTHOR]

Background and objectives: To develop a nomogram for mild cognitive impairment (MCI) in patients with subjective cognitive decline (SCD) undergoing physical examinations in China. Methods: We enrolled 370 patients undergoing physical examinations at the Medical Center of the First Hospital of Jilin University, Jilin Province, China, from October 2022 to March 2023. Of the participants, 256 were placed in the SCD group, and 74 were placed in the MCI group. The population was randomly divided into a training set and a validation set at a 7:3 ratio. A least absolute shrinkage and selection operator (LASSO) regression model was applied to optimize feature selection for the model. Multivariable logistic regression analysis was applied to construct a predictive model. The performance and clinical utility of the nomogram were determined using Harrell's concordance index, calibration curves, and decision curve analysis (DCA). Results: Cognitive reserve (CR), age, and a family history of hypertension were associated with the occurrence of MCI. The predictive nomogram showed satisfactory performance, with a concordance index of 0.755 (95% CI: 0.681-0.830) in internal verification. The Hosmer-Lemeshow test results suggested that the model exhibited good fit (p = 0.824). In addition, DCA demonstrated that the predictive nomogram had a good clinical net benefit. Discussion: We developed a simple nomogram that could help secondary preventive health care workers to identify elderly individuals with SCD at high risk of MCI during physical examinations to enable early intervention. [ABSTRACT FROM AUTHOR]

Cognitive frailty, which is characterized by the co-occurrence of physical frailty and cognitive impairment, poses significant risks to the well-being and independence of elderly individuals. Previous research has established that demographic, health-related, and social factors contribute to both physical frailty and cognitive decline. However, the role of social factors in influencing cognitive frailty remains unclear. This study aims to identify the relationship between social factors and cognitive frailty among Korean older adults living in the community. We performed secondary analyses of data from the 2020 Survey on Older Adults. After entering demographic factors and health-related factors into the logistic model as covariates, this study explored the association between cognitive frailty and social factors, including living arrangements, social support, the frequency of engagement in social activities per week, and satisfaction with friends and community. Among participants, approximately 2.9% had cognitive frailty, 3.2% had only physical frailty, and 21.9% had only cognitive decline. Lower levels of satisfaction with friends and the community and infrequent participation in social activities were strongly correlated with cognitive frailty. These findings emphasize the necessity of public health programs that encourage older individuals' social involvement. A supportive social environment can be fostered through initiatives that promote community events, group activities, and volunteerism. Public health policies should prioritize the development and maintenance of social activity centers that offer various programs to prevent progression to cognitive frailty in older adults. [ABSTRACT FROM AUTHOR]

The predictive abilities of computer-based screening devices for early cognitive decline (CD) in older adults have rarely been longitudinally examined. Therefore, this study examined the ability of CogEvo, a short-duration, computer-based cognitive screening device requiring little professional involvement, to predict CD among community-dwelling older adults. We determined whether 119 individuals aged ≥ 65 years living in Japanese rural communities who scored ≥ 24 on the Mini-Mental State Examination (MMSE) at baseline developed CD by annually administering the MMSE to them. CD was defined as an MMSE score of ≤23. At baseline, the overall CogEvo judgment grade, with lower grades indicating better cognitive function, was calculated from the results of various cognitive tasks. Over 2 years, 10 participants developed CD. Participants with grades of 4 had a higher percentage of CD cases than those with grades of ≤3 (p < 0.01). This relationship remained significant after controlling for possible confounders, including the MMSE score at baseline. The sensitivity and specificity of the CogEvo grade cutoff of 4 were 50.0% and 93.6%, respectively. In conclusion, CogEvo may be an efficient tool for identifying individuals at a high risk for dementia. The possibility of missing CD cases should be considered when using CogEvo for screening. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the longitudinal impact of different levels of leisure‐time physical activity (LTPA) participation on positive and negative affect among older foreign‐born adults with mild cognitive impairment (MCI). Methods: This study used 2012 to 2020 data from the Health and Retirement Study data (n = 1206) that was analyzed using repeated measured multivariate analysis of covariance. Results: The high‐level participation LTPA group reported higher positive affect and lower negative affect than the mid and low‐level participation groups. The mid‐level LTPA group also reported higher positive and lower negative affect than the low‐level LTPA group. Conclusions: This study provides evidence that high levels of LTPA participation contribute to an increase in positive affect and a reduction of negative affect among older foreign‐born adults with MCI. The findings of this study will help fill the gap in research on the longitudinal relationship between levels of LTPA participation and positive and negative affect among older foreign‐born adults. [ABSTRACT FROM AUTHOR]

The article presents a study which determined the national prevalence of overlapping and compounding cognitive, physical, and sensory impairments that can impact medication management abilities, how these impairments vary across living sites, and whether one receives help with medication management. Topics discussed include factors that can impact a person's ability to manage medications, and common things among older adults who take prescription medications.

Background: Although gabapentin has been increasingly prescribed to older adults, the relation between gabapentin initiation and longer-term neurocognitive changes is not well understood. Thus, this study aimed to examine the association of gabapentin initiation with cognitive and motor function decline in older adult participants with cognitive impairment. Methods: A retrospective cohort study was conducted using the National Alzheimer's Coordinating Center Uniform Data Set (2005–March 2023). Participants with cognitive impairment at the visit of gabapentin initiation (i.e., index visit) were included. Using the incidence density sampling method, up to nine non-users were randomly selected for each initiator. Cognitive decline over 1 year was defined as any increase in Clinical Dementia Rating global score (CDR®GLOB) or a 1-point increase in CDR® sum of boxes (CDR®SB). Functional status decline over 1 year was defined as at least a 3-point increase in the Functional Activities Questionnaire (FAQ) sum or a 0.3-point increase of mean of FAQ. Motoric decline over 1 year was defined as new clinician reports of gait disorder, falls, and slowness. To mitigate confounding and selection bias, joint stabilized inverse probability of treatment weights and censoring weights were used. Analyses compared index with index + 1 and index + 2 visits. Results: For the study of cognitive and functional status decline, we included 505 initiators (mean age [SD] 78.8 [7.4]; male = 45%) and 4545 non-users (79.2 [7.6]; 50.1%). For the study of motor decline, we included 353 initiators (78.3 [7.2]; 42.8%) and 3177 non-users (78.5 [7.4]; 48.1%). Gabapentin initiation was not statistically associated with decline on CDR®GLOB, CDR®SB, FAQ sum, or mean FAQ at the index + 1 or index + 2 visits. However, gabapentin initiation was significantly associated with increased odds of new falls at the index + 2 visit (odds ratio [95% confidence interval] 2.5 [1.3, 4.6]). Conclusions: Over 1 or 2 years of follow-up, gabapentin initiation was not associated with decline in cognitive or functional status but was associated with increased odds of falling among research participants with cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Olfactory dysfunction was associated with poorer cognition. However, the association between transient receptor potential cation channel subfamily A member 1 (TRPA1) and cognitive function have not been studied. This study aimed to evaluate the mediation effect of TRPA1 on the association between olfactory and cognitive function among Chinese older adults. Methods: We recruited 121 participants with cognitive impairment (CI) and 135 participants with normal cognition (NC) from a memory clinic and the "Shanghai Aging Study." Olfactory identification of each participant was measured by the Sniffin' Sticks Screening Test 12 (SSST-12). Serum TRPA1 were quantified using the Enzyme-Linked Immunosorbent Assay. The mediation effects of TRPA1 on the association between olfactory function and cognitive function were explored using mediation analysis. Results: The CI group had a significantly higher proportion of the high level of serum TRPA1 (58.7%) than the NC group (42.2%) (p = 0.0086). After adjusted for gender, age, and years of education, mediation analysis verified that TRPA1 partially mediated the association between SSST-12 and Mini Mental State Examination (MMSE). It also verified that TRPA1 partially mediated the association between the identification of peppermint and MMSE. Conclusion: Our study emphasizes the mediation role of TRPA1 in the relationship between olfactory and cognitive function among older adults. Further research is necessary to explore the mechanism of TRPA1 on the relationship between olfactory and cognitive decline. [ABSTRACT FROM AUTHOR]

Background Resistance training with instability (REI) emerged as a promising training modality for older adults aiming to counteract age-related changes. Objectives We compared the effects of 12 weeks of REI and traditional resistance exercise (RE) on muscle strength in older adults with cognitive impairment. We further explored if total training volume (TTV) significantly differs among training groups. Methods This is a secondary analysis of the REI study. Participants were randomly assigned to REI (n=22) or RE (n=23). RE protocol involved moderate-intensity, free-weight, and machines-based resistance exercises (3 sets, 10-15 repetitions). REI received a similar training protocol, in which exercises were simultaneously performed with instability/unstable devices (e.g., squat exercise under a foam pad or Bosu® ball). Maximal isometric strength and isokinetic parameters were assessed at baseline and after completion of a 12-week intervention through a hydraulic handgrip and isokinetic dynamometer, respectively. TTV (sets x repetitions x load) was computed based on external training load over the 12 weeks. Results No differences were observed between groups (p=.35) after the intervention. Over 12 weeks, REI and RE improved isometric handgrip strength (p<.001) and isokinetic performance (p=.04). We also did not find differences in the TTV between training groups (p=.28). Conclusion We demonstrated that both REI and RE training induced similar gains in muscle strength. Combining unstable surfaces/instability devices did not hamper TTV, which may have clinical applications in the context of exercise for older adults. [ABSTRACT FROM AUTHOR]

As the population is ageing, the number of older adults with cognitive impairment (CI) is increasing. Automated vehicles (AVs) can improve independence and enhance the mobility of these individuals. This study aimed to: (1) understand the perception of older adults (with and without CI) and stakeholders providing services and supports regarding care and transportation about AVs, and (2) suggest potential solutions to improve the perception of AVs for older adults with mild or moderate CI. A survey was conducted with 435 older adults with and without CI and 188 stakeholders (e.g. caregivers). The results were analysed using partial least square – structural equation modelling and multiple correspondence analysis. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided recommendations to improve older adults' perception of AVs including education and adaptive driving simulation-based training. Practitioner summary: This study investigated the perception of older adults and other stakeholders regarding AVs. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided guidelines to improve older adults' perception of AVs. [ABSTRACT FROM AUTHOR]

Background: Dementia is the one of the most common and prominent disease in the elderly person that results in the Cognitive interventions. In this study, we aim to conceptualize the cognitive intervention for older adults with and without cognitive dysfunction and to clarify the heterogeneity existing in this literature field by determining the main variables implicated. Methods: We conducted a study analysis using previous literature highlighting the significant data reporting empirical results from cognitive intervention for healthy older adults and other seniors with different types of dementia. Each paper was reviewed in terms of compensatory cognitive training, cognitive remediation, enrichment, cognitive activation, brain training, cognitive stimulation, cognitive training, and cognitive rehabilitation. The research analysis was performed following rigorous inclusion and exclusion criteria with the purpose of collecting relevant answers to our research questions. Results: We included a total of 168 studies in our review. Our findings indicated heterogeneity regarding methods, concepts, and procedures. Additionally, the values were integrated using different information existing in this field. Conclusion: In conclusion, we highlighted that this is the first review that clarify the discrepancy of various existing definitions, methods, and procedures, as well as the overlapping information in the cognitive interventions. [ABSTRACT FROM AUTHOR]

Objective: To describe the 10-year preclinical cognitive trajectories of older, non-demented individuals towards the onset of the four most prevalent types of dementia, i.e., Alzheimer's disease(AD), Lewy body(LBD), vascular(VD) and frontotemporal dementia(FTD). Methods: Our analysis focused on data from older (≥ 60years) NACC (National Alzheimer's Coordinating Center) participants. Four distinct presymptomatic dementia groups (AD-LBD-VD-FTD) and a comparison group of cognitively unimpaired(CU) participants were formed. Comprehensive cognitive assessments involving verbal episodic memory, semantic verbal fluency, confrontation naming, mental processing speed – attention and executive function – cognitive flexibility were conducted at baseline and on an approximately yearly basis. Descriptive analyses (adjusted general linear models) were performed to determine and compare the yearly cognitive scores of each group throughout the follow-up. Exploratory analyses were conducted to estimate the rates of cognitive decline. Results: There were 3343 participants who developed AD, 247 LBD, 108 FTD, 155 VD and 3398 composed the CU group. Participants with AD performed worse on episodic memory than those with VD and LBD for about 3 to 4 years prior to dementia onset (the FTD group documented an intermediate course). Presymptomatic verbal fluency and confrontation naming trajectories differentiated quite well between the FTD group and the remaining dementia entities. Participants with incident LBD and VD performed worse than those with AD on executive functions and mental processing speed-attention since about 5 years prior to the onset of dementia, and worse than those with FTD more proximally to the diagnosis of the disorder. Conclusions: Heterogeneous cognitive trajectories characterize the presymptomatic courses of the most prevalent dementia entities. [ABSTRACT FROM AUTHOR]

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]

Background: It has been shown that inflammation may be associated with cognitive impairment (CI). Diet modulates inflammation. However, there is currently a scarcity of epidemiological studies exploring the connection between the inflammatory potential of diet and CI. The objective was to investigate the correlation between the dietary inflammatory index (DII) and cognitive impairment in older adults in the United States. Methods: The present investigation utilized a cross-sectional dataset obtained from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. Dietary intake data was used to calculate DII scores, which were then used to categorize participants into quartiles. Participants' cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). Individuals who scored in the lowest quartile on any of these tests were classified as exhibiting low cognitive performance. The association between DII and cognitive impairment was investigated by multivariate logistic regression, smooth curve fitting, and subgroup analysis. Results: A total of 947 older adults were enrolled in the study. Following the adjustment of confounding variables, DII scores exhibited a significant and positive correlation with low cognitive performance, as measured by AFT (OR 1.15, 95% CI 1.02-1.28, p = 0.02) and the DSST (OR 1.38, 95% CI 1.13-1.68, p = 0.004). Compared with the lowest quartile of DII, the highest weighted odds ratio of cognitive impairment based on AFT was observed in the fourth quartile group (OR 1.89, 95% CI 1.05-3.38, p = 0.03). Similarly, a comparable pattern was evident in DSST (OR 4.30, 95% CI 1.85-9.98, p = 0.003). Additionally, the smooth curve fitting results showed a nonlinear relationship between DII and cognitive decline evaluated by DSST (p for nonlinearity = 0.016). No interaction effects between cognitive impairment and age or gender were observed in relation to all cognitive test scores. Conclusion: This research reveals a positive link between diet with higher inflammatory potential and cognitive decline among elderly individuals in America. However, additional studies on dietary interventions are necessary to explore the cause-and-effect relationship. [ABSTRACT FROM AUTHOR]

Aim: Muscle mass and strength correlate with cognitive function; however, it remains unclear whether dynapenia (i.e., muscle weakness with preserved muscle mass) is relevant. This study aimed to explore whether dynapenia is associated with global cognitive function in community‐dwelling older Japanese adults. Methods: This cross‐sectional study used data from the Integrated Research Initiative for Living Well with Dementia Cohort Study, which pooled data from five community‐based geriatric cohorts. Dynapenia was defined as muscle weakness without muscle mass loss according to the Asian Working Group for Sarcopenia criteria. Cognitive function was assessed using the Mini‐Mental State Examination (MMSE). An ordered logistic regression analysis was conducted with dynapenia as the exposure and with cognitive decline stages, defined as an MMSE score of 27–30 for normal cognition, 24–26 for possible cognitive decline, and <24 for cognitive decline, as the outcome, stratified by sex and adjusted for age, muscle mass, education, alcohol consumption, smoking habits, living alone, and non‐communicable diseases. Results: We analyzed data for 3338 participants (2162 female) with preserved muscle mass. Of these, 449 (13.5%) had dynapenia, and 79 (2.4%) exhibited cognitive decline. Multivariate odds ratios (95% confidence interval) for cognitive decline among those with dynapenia, compared with those without dynapenia, were 1.51 (1.02–2.24) for males and 2.08 (1.51–2.86) for females. Conclusions: Muscle weakness is associated with cognitive decline, even in individuals with preserved muscle mass. Further studies are needed to better understand the association between muscle weakness and cognitive decline over time in order to develop dementia prevention strategies for those with dynapenia. Geriatr Gerontol Int 2024; 24: 123–129. [ABSTRACT FROM AUTHOR]

Aim: Mild cognitive impairment (MCI) in older adults is potentially devastating, but an accurate prediction model is still lacking. We hypothesized that neuropsychological tests and MRI‐related markers could predict the onset of MCI early. Methods: We analyzed data from 306 older adults who were cognitive normal (CN) attending the Alzheimer's Disease Neuroimaging Initiative sequentially (474 pairs of visits) within 3 years. There were 231 pairs of MCI conversion (CN to MCI), and 242 pairs of CN maintenance (CN to CN). Variables on demographic, neuropsychological tests, genetic, and MRI‐related markers were collected. Machine learning was used to construct MCI prediction models, comparing the area under the receiver operating characteristic curve (AUC) as the primary metric of performance. Important predictors were ranked for the optimal model. Results: The baseline age of the study sample was 74.8 years old. The best‐performing model (gradient boosting decision tree) with 13 variables predicted MCI with an AUC of 0.819, and the rank of variable importance showed that intracranial volume, hippocampal volume, and score from task 4 (word recognition) of the Alzheimer's Disease Assessment Scale were important predictors of MCI. Conclusions: With the help of machine learning, fewer neuropsychological tests and MRI‐related markers are required to accurately predict MCI within 3 years, thereby facilitating targeted intervention. Geriatr Gerontol Int 2024; 24: 96–101. [ABSTRACT FROM AUTHOR]

Background: Bidirectional association between oral health, including tooth loss and oral hypofunction, and cognitive impairment can induce time‐varying confounding in association with dementia. This study aimed to investigate the association between oral health and the development of dementia among older adults, considering cognitive impairment as a time‐varying confounder. Methods: This nine‐year follow‐up cohort study targeted independent older adults aged ≥65 years who participated in the Japan Gerontological Evaluation Study. The exposure variables were self‐reported poor oral health (≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia), which were assessed in 2010 and 2013. The outcome variable was the incidence of dementia between 2013 and 2019, which was obtained from the municipalities' administrative database. Furthermore, in 2010 and 2013, we considered cognitive impairment as a time‐varying confounder and treated it based on a marginal structural model (MSM), including possible baseline confounders. Oral health and cognitive impairment were assessed using the items of Kihon checklist. We employed a Cox proportional hazards model with a stabilized inverse probability weight and estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among 37,556 participants (mean age: 72.8 years [1 SD = 5.5], males: 46.8%), the dementia incidence rate was 2.2/100 person‐year. The proportions of those with ≤19 remaining teeth, edentulousness, chewing difficulty, swallowing problems, and xerostomia were 61.3%, 11.0%, 24.4%, 14.7%, and 19.2%, respectively. From the regression analysis based on MSM, ≤19 remaining teeth (HR = 1.12, 95% CI = 1.03–1.23), edentulousness (HR = 1.20, 95% CI = 1.09–1.32), chewing difficulty (HR = 1.11, 95% CI = 1.02–1.21), and xerostomia (HR = 1.10, 95% CI = 1.01–1.20) were significantly associated with an increased risk of dementia; however, swallowing problems were not significantly associated with dementia onset (p > 0.05). Conclusions: Even after considering time‐varying confounding by cognitive function at baseline and follow‐up, we observed significant associations between poor oral health and increased risk of dementia among older adults. [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: The relationship between plasma metal elements and cognitive function is unclear, especially in extremely older individuals. This present study aimed to explore the association between plasma metal concentrations and the risk of cognitive impairment (CI) in Chinese extremely older adults. Methods: Individuals aged =90 years with plasm metal concentration data from the fifth wave of the 2008 Chinese Longitudinal Healthy Longevity Survey were included. Plasma selenium (Se), manganese (Mn), magnesium (Mg), calcium (Ca), iron (Fe), copper (Cu), and zinc (Zn) concentrations were measured using inductively coupled plasma optical emission spectroscopy. Cognitive function was assessed by the Chinese version of the mini-mental state examination. Results: The study enrolled 408 participants. Participants with CI had significantly lower plasma Se, Mn, and Fe levels and higher Ca levels than those with normal cognitive function (p < 0.05). Plasma Se, Mn, Ca, and Fe concentrations were significantly associated with CI risk in both single- and multiple-element logistic regression models. Additionally, the multiple-element model results showed that the adjusted odds ratios for CI were 0.042 (95% confidence interval 0.016-0.109), 0.106 (0.044-0.255), 7.629 (3.211-18.124) and 0.092 (0.036-0.233) for the highest quartiles compared to the lowest quartiles of Se, Mn, Ca, and Fe, respectively. Moreover, subgroup analyses by age, sex, and body mass index suggested a consistent significant correlation (p < 0.05). Conclusion: Therefore, decreased plasma Se, Mn, and Fe and increased plasma Ca levels were associated with CI risk in Chinese older adults. These findings are of great significance for the development of programs to delay cognitive decline in the elderly. [ABSTRACT FROM AUTHOR]

Background: With the aging population, depressive symptoms and impaired Activities of Daily Living have increased medical costs and mortality, generating severe public health issues. This study reconsiders the potential classification of depressive symptoms and ADL impairment in older adults and identifies various factors that may affect classifications. Methods: This study focused on 6270 Chinese adults aged 65 years or older. We used latent profile analysis to explore depressive symptoms and ADL impairment (basic ADLs and instrumental ADLs) in various subgroups of older adults. We used Chi-square analysis and multivariate logistic regression to examine the determinants of depressive symptoms and ADL impairment among subgroups. Results: The study's results classified older adults into three subgroups: those with high level depressive symptoms and BADLs and IADLs impairment, those with moderate level depressive symptoms and IADLs impairment, and those with no to low level depressive symptoms and without BADLs and IADLs impairment. Illiterate, having fallen in the past year, as well as having hearing difficulties all predicted high level depressive symptoms and severe BADLs and IADLs impairment. In contrast, regular exercise, contact with friends, playing cards/mahjong, participating in organized social activities, and visiting siblings predicted moderate level depressive symptoms and IADLs impairment. Conclusion: This paper discusses what is known about the various subgroups as well as the treatment of depressive symptoms and ADL impairment in older populations. It also gives policy and practice recommendations for the future that may help rehabilitate and maintain the mental health and ADLs independence of older adults. Impact and Implications: Findings highlight how depression symptoms in older adults are associated with ADL impairment level and provide a reliable basis for future interventions according to the classification. The policy recommendations provided by this study assist in addressing significant challenges in terms of mental illness and ADL impairments in the older population to support the goals of the government's Healthy China 2030 national program. [ABSTRACT FROM AUTHOR]

Introduction: Bed and chair sensor alarms are commonly used for falls prevention in hospitals, despite questionable efficacy. Research analysing older adults' experiences of alarms is scarce, and adults with cognitive impairment are consistently excluded. Aim: The aim of this study was to explore how older adults with cognitive impairment perceive and experience falls prevention alarms in hospital. Method: A qualitative descriptive design investigated older adults' experiences of alarms in a Geriatric Evaluation and Management ward in Melbourne. Patients were included if they had been provided an alarm. Semi‐structured interviews were the primary method of data collection with two observation sessions and medical record analyses completed to enable triangulation of findings. Data were subjected to thematic analysis, and the Person‐Environment‐Occupation framework was chosen to add insight into the complexities of older adults' experiences of alarms. Findings: All 11 participants had a level of cognitive impairment with delirium, confusion, or impulsiveness recorded in their medical file. Two overarching themes were identified: communication and collaboration with staff and rationalisation of alarm use. Participants' perceived staff were focussed on falls prevention but experienced a lack of communication about the purpose of alarms. Participants wanted an individualised approach to alarms. Some were comforted with the thought of alarms alerting staff, making them feel well cared for and believed alarms were a useful 'back‐up'. Others found alarms uncomfortable, frustrating, and restricting. Application of the Person‐Environment‐Occupation framework provided insight into how enabling and restrictive factors can impact whether the alarm is experienced positively or negatively. Seven unwitnessed falls occurred during the participants' admissions. Thirty‐four per cent of alarm triggers observed were considered false alerts. Conclusion: Older adults commonly reported negative experiences using bed/chair sensor alarms. Occupational therapists have the training to collaborate with people with cognitive impairment and assess the usefulness of alarms in reducing falls, based on how they interact with the older adult's unique person, environment, and occupation domains. [ABSTRACT FROM AUTHOR]

Introduction: SuperAgers (SA) are older adults who exhibit cognitive capacities comparable to individuals who are three or more decades younger than them. The current study aimed to identify the characteristics of Indian SA by categorizing 55 older adults into SA and Typical Older Adults (TOA) and comparing their performance with a group of 50 younger participants (YP) (aged 25–50). Methods: A total of 105 participants were recruited after obtaining informed written consent. The cognitive abilities of the participants were assessed using Wechsler Adult Intelligence Scale (WAIS)‐IVINDIA, Color Trails Test, Boston Naming Test (BNT), and Rey Auditory Verbal Learning Test. Results: SA outperformed TOA in all cognitive assessments (P < 0.001) and surpassed YP in BNT and WAIS‐IV. SA's delayed recall scores were notably higher (12.29 ± 1.51) than TOA (6.32 ± 1.44). Conclusion: SA excelled in all cognitive domains demonstrating resilience to age‐related cognitive decline. This study highlights Indian SuperAgers' exceptional cognitive prowess. [ABSTRACT FROM AUTHOR]

With the aggravation of population aging, the health of the elderly has become an important issue in the aging society. The Mediterranean diet (MD) contributes to healthy aging by changing dietary patterns to delay and prevent disease onset. This paper summarizes the concepts related to the MD pattern and its relationship with cardiovascular diseases, cognitive dysfunction, depression, chronic inflammation and other brain and heart comorbidity in the elderly, so as to provide thinking and reference for the optimization and upgrading of the elderly, and contribute to the development of healthy China. [ABSTRACT FROM AUTHOR]

The relationship between age-related hearing loss (ARHL) and cognitive impairment (CI) remains intricate. However, there is no robust evidence from experimental or clinical studies to elucidate their relationship. The key unaddressed questions are (a) whether there is a causal effect of ARHL on CI and (b) whether efficacious treatment of ARHL (such as hearing-aid use) ameliorates CI and dementia-related behavioral symptoms. Because of several methodological and systematic flaws/challenges, rigorous verification has not been conducted. Addressing these stumbling blocks is essential to unraveling the relationship between ARHL and CI, which motivated us to undertake this review. Here, we discuss the methodological problems from the perspectives of potential confounding bias, assessments of CI and ARHL, hearing-aid use, functional-imaging studies, and animal models based on the latest information and our experiences. We also identify potential solutions for each problem from the viewpoints of clinical epidemiology. We believe that "objectivity," specifically the use of more objective behavioral assessments and new computerized technologies, may be the key to improving experimental designs for studying the relationship between ARHL and CI. [ABSTRACT FROM AUTHOR]

Background: Studies have investigated the association between pain and cognitive impairment among older adults, but the findings are mixed. We assessed the relationship of activity‐limiting pain (pain interference) with incident cognitive impairment and the mediating effect of depressive symptoms among Mexican American adults aged ≥80. Methods: Data were taken from the Hispanic Established Population for the Epidemiological Study of the Elderly (2010–2016). Pain interference, or pain that limited daily activities in the last 12 months, was categorized into none, untreated pain interference, and treated pain interference. Cognitive impairment was defined as scoring <21 on the Mini‐Mental State Examination and difficulty with at least one instrumental activity of daily living. We used general estimation equations to assess this relationship between pain and incident cognitive impairment over the 6‐year period (n = 313). Results: Participants reporting both untreated and treated pain interference had higher odds of incident cognitive impairment than those reporting no pain or pain interference (untreated adjusted odds ratio [aOR]: 2.18; 95% confidence interval [CI]: 1.09–4.36; treated aOR: 1.99; 95% CI: 1.15–3.44). Depressive symptoms explained 15.0% of the total effect of untreated pain and 25.3% of treated pain. Conclusions: Among very old Mexican American adults, both treated and untreated pain interference was associated with incident cognitive impairment. This association was partially mediated by depressive symptoms, underscoring a need for depression screening in patients with chronic pain. Future work is needed to examine mechanistic/causal pathways between pain and subsequent cognitive impairment and the role of pharmacological and non‐pharmacological treatments in these pathways. [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]

The current review sought to identify and synthesize the evidence on available interventions that include walking and their impact on fear of falling (FOF) among community-dwelling older adults without cognitive impairment. A 10-year search was conducted (January 2012 to January 2022) in two peer-reviewed databases. A total of 116 articles were identified, and 22 articles were reviewed. Most studies included multicomponent walking interventions, such as walking and another type of intervention or exercise. Among the different questionnaires to assess FOF, the Falls Efficacy Scale–International was the most used in 77.3% (n = 17) of studies. In addition to walking, interventions to reduce FOF mainly included balance training, lower extremity strengthening, cardio or aerobic exercises, or a combination of these exercises. Further research is needed to evaluate the impact of unidimensional walking interventions, as well as those that incorporate psychological and technological elements targeted to FOF prevention and management. [Journal of Gerontological Nursing, 50(1), 15–21.] [ABSTRACT FROM AUTHOR]

Malnutrition is correlated with poor cognition; however, an understanding of the association between nutrition risk, which precedes malnutrition, and cognition is lacking. This study aimed to determine if nutrition risk measured with the SCREEN-8 tool is associated with cognitive performance among cognitively healthy adults aged 55+, after adjusting for demographic and lifestyle covariates. Sex- and age-stratified analyses were also explored. Baseline data from the Canadian Longitudinal Study on Aging was used. Cognition was determined using a 6-measure composite score based on four executive functions and two memory tasks, taking into account age, sex, and education. Multivariable linear regression was performed while adjusting for body mass index (BMI), lifestyle, and health covariates in the entire sample (n = 11 378) and then stratified by sex and age. Approximately half of participants were female (54.5%) aged 65+ (54.1%). Greater nutrition risk was associated with poorer cognitive performance in the entire sample (F[1, 11 368] = 5.36, p = 0.021) and among participants aged 55–64 (n = 5227; F[1, 5217] = 5.45, p = 0.020). Sex differences in lifestyle and health factors associated with cognition were apparent, but nutrition risk was not associated with cognition in sex-stratified models. Based on this analysis, there may be an association between nutrition risk and cognitive performance in older adults. When screening for either cognitive impairment or nutrition risk, complementary assessments for these conditions is warranted, as early intervention may provide benefit. [ABSTRACT FROM AUTHOR]

Many older people are facing various risks of cognitive impairment, while outdoor activities in open spaces may be helpful for their cognitive health. However, the effect of open spaces on cognitive health is unclear. This study aims to investigate the relationships between the cognitive health of older people and the built environment of open spaces. A questionnaire survey of 60 older people aged 60 and above was conducted. Results identified three major components of the built environment of open spaces, namely, planning, supporting facilities, and building services. According to the correlation and regression analysis, it is revealed that 8 BEOS items, including green ratio, a width of the pathway, maintenance of the whole garden, the color of green space, diversity of plants, location, and font of signage, artificial light of sitting area were positively related to memory, while only the size was negatively associated with memory. Only the green ratio could positively predict the concentration. The judgment was positively influenced by the green ratio, width of pathways, maintenance of the whole garden, color of green space and diversity of plants. A BEOS - cognitive health model for older people was built in this study. The results highlighted the importance of plants for cognitive health. Several recommendations, such as not-so-large sizes and diverse plants with vivid colors and signages with big fonts, etc., were proposed to improve the built environment of the open spaces and support the declining cognitive health of older people. [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: The health issues presented by the aging population can result in reduced muscle mass, poorer physical function, and cognitive impairment. The goal of this study was to determine how nutritional status and physical fitness relate to cognitive impairment in older adults. Methods: A cross-sectional descriptive and analytical study involving 100 participants was carried out to analyze the impact of nutritional status and physical fitness on cognitive impairment. Nutritional status was assessed with the Eating Assessment Tool (EAT-10) and The Mini Nutritional Assessment—Short Form (MNA-SF); physical fitness via the implementation of manual grip evaluation, the 4-m walking test (4-MWT), and the Timed Up and Go (TUG) test; and cognitive impairment evaluation was conducted using the Mini-Mental State Examination (MMSE), the Boston Naming Test (BNT) and the Controlled Oral Word Association Test (COWAT). Results: Data analysis revealed that higher malnutrition status was associated with fewer correct responses in the COWAT (R2 = 0.421), while a correlation between higher MMSE and BNT scores, faster completion times for the 4-m walking and TUG tests, and an increase in handgrip strength load was also observed. Conclusion: The analysis of the data revealed that those individuals with superior nutritional status and greater levels of physical fitness outperformed others on the cognitive evaluation. [ABSTRACT FROM AUTHOR]

Postoperative cognitive dysfunction (POCD) is a cluster of cognitive problems that may arise after surgery. POCD symptoms include memory loss, focus inattention, and communication difficulties. Inflammasomes, intracellular multiprotein complexes that control inflammation, may have a significant role in the development of POCD. It has been postulated that the NLRP3 inflammasome promotes cognitive impairment by triggering the inflammatory response in the brain. Nevertheless, there are many gaps in the current literature to understand the underlying pathophysiological mechanisms and develop future therapy. This review article underlines the limits of our current knowledge about the NLRP3 (NOD-, LRR- and pyrin domain-containing protein 3) inflammasome and POCD. We first discuss inflammasomes and their types, structures, and functions, then summarize recent evidence of the NLRP3 inflammasome's involvement in POCD. Next, we propose a hypothesis that suggests the involvement of inflammasomes in multiple organs, including local surgical sites, blood circulation, and other peripheral organs, leading to systemic inflammation and subsequent neuronal dysfunction in the brain, resulting in POCD. Research directions are then discussed, including analyses of inflammasomes in more clinical POCD animal models and clinical trials, studies of inflammasome types that are involved in POCD, and investigations into whether inflammasomes occur at the surgical site, in circulating blood, and in peripheral organs. Finally, we discuss the potential benefits of using new technologies and approaches to study inflammasomes in POCD. A thorough investigation of inflammasomes in POCD might substantially affect clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To assess whether periodontitis is associated with cognitive decline and its progression as well as with certain blood‐based markers of Alzheimer's disease. Materials and Methods: Data from a 2‐year follow‐up prospective cohort study (n = 101) was analysed. Participants with a previous history of hypertension and aged ≥60 years were included in the analysis. All of them received a full‐mouth periodontal examination and cognitive function assessments (Addenbrooke's Cognitive Examination (ACE) and Mini‐Mental State Examination [MMSE]). Plasma levels of amyloid beta (Aβ)1‐40, Aβ1‐42, phosphorylated and total Tau (p‐Tau and t‐Tau) were determined at baseline, 12 and 24 months. Results: Periodontitis was associated with poor cognitive performance (MMSE: β = −1.5 [0.6]) and progression of cognitive impairment (hazard ratio [HR] = 1.8; 95% confidence interval: 1.0–3.1). Subjects with periodontitis showed greater baseline levels of p‐Tau (1.6 [0.7] vs. 1.2 [0.2] pg/mL, p <.001) and Aβ1‐40 (242.1 [77.3] vs. 208.2 [73.8] pg/mL, p =.036) compared with those without periodontitis. Concentrations of the latter protein also increased over time only in the periodontitis group (p =.005). Conclusions: Periodontitis is associated with cognitive decline and its progression in elderly patients with a previous history of hypertension. Overexpression of p‐Tau and Aβ1‐40 may play a role in this association. [ABSTRACT FROM AUTHOR]

Older adults may have difficulties in daily time management due to age-related or disease-related cognitive impairment. Standardised assessments for time-related abilities are currently unavailable in India. The study aimed to adapt the Kit for Assessing Time-processing Ability–Senior (KaTid-Senior) and Time-Self rating, Senior (Time-S Senior) for daily time management of Indian older adults, translate these into an Indian language, and evaluate the reliability and validity of the adapted assessments. The two Swedish-origin assessments were reviewed, adapted for linguistic and cultural relevance into English, and translated into Kannada language. Older adults (n = 128) were conveniently selected, assessed with the Montreal Cognitive Assessment, and assigned to age and gender-matched groups: cognitively-impaired and cognitively-normal. Data was then collected with the adapted assessments. Both adapted assessments demonstrated acceptable reliability (internal consistency) in this sample (α =0.89 − 0.90). The cognitively-impaired group had significantly (p < 0.001) lower scores on the assessments as compared to the cognitively-normal group. There was a strong to moderate correlation between the assessments supporting their convergent validity. The adapted assessments are reliable and valid in the Indian context. The study would facilitate contextually-relevant assessment and management of time-related abilities in Indian older adults. [ABSTRACT FROM AUTHOR]

Background: The effect of years of education on the maintenance of healthy cognitive functioning may differ by race and ethnicity given historical and ongoing inequities in educational quality. Methods: We examined 20,311 Black, Latinx, and White adults aged 51–100 from the Health and Retirement Study (2008–2016). Telephone Interview for Cognitive Status‐27 data was used to measure cognitive functioning. Generalized additive mixed models were stratified by race and ethnicity and educational attainment (≥12 vs. <12 years). Selected social determinants of health, all‐cause mortality, time‐varying health and healthcare utilization characteristics, and study wave were included as covariates. Results: On average, Black and Latinx adults scored lower at baseline compared to White adults regardless of educational attainment (p < 0.001), with a significant overlap in the distributions of scores. The rate of cognitive decline was non‐linear for Black, Latinx, and White adults (p < 0.001), and a period of stability was witnessed for those with higher educational attainment irrespective of race and ethnicity. Compared to Black, Latinx, and White adults with lower educational attainment, higher‐educated White adults received the greatest protection from cognitive decline (13 years; 64 vs. 51), followed by Latinx (12 years; 67 vs. 55), and Black adults (10 years; 61 vs. 51). Latinx adults experienced cognitive decline beginning at a later age. Conclusions: The extent to which higher educational attainment protects adults from cognitive decline differs by race and ethnicity, such that higher‐educated White adults received a greater benefit than higher‐educated Black or Latinx adults. [ABSTRACT FROM AUTHOR]

Objectives: Diffusion tensor image analysis along the perivascular space (DTI- ALPS) is a recently introduced method for the assessment of the glymphatic system without the need for contrast injection. The purpose of our study was to assess the glymphatic system in cognitively normal older adults with or without subjective cognitive decline (SCD) using DTI-ALPS, and correlating with amyloid PET. Design and participants: To evaluate the glymphatic system in cognitively normal older adults using DTI-ALPS, we built a prospective cohort including a total of 123 objectively cognitively normal older adults with or without SCD. The ALPS index was calculated from DTI MRI and was assessed by correlating it with standardized uptake value ratios (SUVRs) from amyloid PET and clinically relevant variables. The study subjects were also divided into amyloid “positive” and “negative” groups based on the result of amyloid PET, and the ALPS indices between those two groups were compared. Results: The ALPS index was not significantly different between the normal and SCD groups (P = 0.897). The mean ALPS index from the amyloid positive and amyloid negative group was 1.31 and 1.35, respectively, which showed no significant difference (P = 0.308). Among the SUVRs from variable cortices, that of the paracentral cortex was negatively correlated with the ALPS index (r = −0.218, P = 0.016). Multivariate linear regression revealed that older age (coefficient, −0.007) and higher SUVR from the paracentral cortex (coefficient, −0.101) were wo independent variables with a significant association with a lower ALPS index (P = 0.015 and 0.045, respectively). Conclusion: DTI-ALPS may not be useful for evaluation of the glymphatic system in subjects with SCD. Older age was significantly associated with lower ALPS index. Greater amyloid deposition in the paracentral cortex was significantly associated with lower glymphatic activity in cognitively normal older adults. These results should be validated in future studies on the relationships between ALPS index and other fundamental compartments in glymphatic system, such as perivenous space and the meningeal lymphatic vessels. [ABSTRACT FROM AUTHOR]

In residential care, 50% of older adults are sedentary in most of their time, regardless of the positive impact of physical exercise on health. This study analysed whether television images positively impact the motivation and exercise intensity of cycling exercises of older adults in residential care. In this randomised controlled cross-over study, 10 residential older adults (mean age 85.0 ± 5.7 years) with Mild Cognitive Impairment (MCI) participated in 3 different cycling exercise interventions (TV off, TV turned on the National Geographic channel (NG) and TV with MemoRide software (Activ84Health®, Leuven, Belgium) (MR) (cybercycling)) compared with a rest condition. The participants cycled significantly more distance during NG compared with TVoff (p = 0.024). In comparison to the rest condition, the mean heart rate was significantly higher in all exercise conditions while the maximal heart rate was only higher during NG (p = 0.022). There was no difference in the Borg scale between the different exercise interventions. Interest and enjoyment scored significantly higher during NG (p = 0.014) and MR (p = 0.047) compared to the rest condition and in the NG versus TVoff (p = 0.018). No significant differences were observed in the emotions of the participants. This study has shown indications that the addition of television images may increase the exercise intensity and motivation to exercise in residential older adults with MCI. However, the overall levels of physical activity were insufficient to meet the recommendations for moderate-intense aerobic exercise according to the International Association of Gerontology and Geriatrics and Global Ageing Research Network. Cycling in front of a television increases the exercise volume and motivation to exercise in residential (pre)frail older adults with MCI Cybercycling had no additional effect in comparison to television images not linked to the exercise. Even with television images (pre)frail older adults with MCI did not meet the recommendations for moderate-intense aerobic exercise for residential older adults according to the IAGG-GARN. [ABSTRACT FROM AUTHOR]

Background: Social workers have a key role in needs assessment meetings with families dealing with dementia, providing information, support, and advocacy, while also assessing needs and making decisions about care services for several parties. These contacts are especially important during the introduction of home care services, where often the person has previously relied on informal support from relatives. The needs assessment process entails the involvement of all present parties, with the aim to reach a mutual agreement, a working alliance, regarding which services to apply for. Purpose: The aim of this case study is to explore how the participants, by means of different conversational practices, jointly create a working alliance between the different parties in one family. The study provides insights into the process of co-constructing a working alliance in the needs assessment process for elder care services. Methods: This article addresses the process by which social workers build a working alliance in a multi-party conversation with a family living with cognitive decline; a meeting that lasted 50 min. In this case study, we benefit from an inductive and detailed conversation analytic methodology. The theoretical framework of working alliances in institutional interaction has informed the analysis. Results: The findings illustrate how the social worker in this case study involves all parties in the decision regarding care services and explores the use of the conversational practices of mitigations, positive framing, adding information, and positioning, as a "we" achieve mutual agreement toward the end of several sequences. Conclusions: Drawing on the results of this case study, we argue that multi-party interaction involving relatives enables diversity in role-taking, where the professional, for instance, can pursue a more empathic role. Also, our results indicate that minimal agreement to a proposal is sufficient in a multi-party interaction involving clients with cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Cognitive assessment through communication has been the focus of recent studies because the conventional cognitive tests are often considered invasive for older people. Although the Conversational Assessment of Neurocognitive Dysfunction is designed to assess cognitive function non‐invasively, inter‐rater reliability remains unclear. The current study investigated the Conversational Assessment of Neurocognitive Dysfunction's reliability. Methods: The Conversational Assessment of Neurocognitive Dysfunction was used by four clinical psychologists, who evaluated 38 older people with and without cognitive dysfunction. One clinical psychologist evaluated the assessment based on face‐to‐face communication with participants, while the other clinical psychologists evaluated it according to the audio data in the digital voice recorder. All clinical psychologists were blind to the results of other conventional cognitive tests and details surrounding participants' daily living activities. Results: The univariate correlation scores of the Conversational Assessment of Neurocognitive Dysfunction among evaluators ranged from 0.61 to 0.79, all of which were significant (P < 0.001). The intraclass correlation coefficient was 0.64 (P < 0.001, 95% CI: 0.53–0.79 for agreement) and 0.67 (P < 0.001, 95% CI: 0.45–0.77 for consistency). The Conversational Assessment of Neurocognitive Dysfunction score of all evaluators was significantly associated with conventional cognitive tests like the Mini‐Mental State Examination (P < 0.001). Conclusions: The findings suggested that the Conversational Assessment of Neurocognitive Dysfunction has moderate to good inter‐rater reliability and high concurrent validity as a cognitive assessment tool, and it would be useful in clinical practice. [ABSTRACT FROM AUTHOR]