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Background: The aim of the Japan‐Multidomain Intervention Trial for Prevention of Dementia in Older Adults with Diabetes (J‐MIND‐Diabetes) was to examine the efficacy of multi‐domain intervention in prevention of cognitive decline in older adults with type 2 diabetes and mild cognitive impairment (MCI). Method: The J‐MIND‐Diabetes is an 18‐month, multi‐centered, randomized controlled trial. Outpatients with type 2 diabetes aged 70‐85 years with MCI were recruited and randomized into multi‐domain intervention (management of metabolic and vascular risk factors, physical exercise, nutritional guidance, and promotion of social participation) and control groups (general instructions on dementia prevention) at a 1:1 allocation ratio using the stratified permuted‐block randomization methods. The primary outcome was a change from baseline to 18‐month follow‐up in a global composite score combining several neuropsychological tests, which include the MoCA‐J, the MMSE, the Rey‐Osterrieth Complex Figure Test (ROCFT), delayed recall test of a 10‐word list, the Digit Span, the Trail Making Test, the Digit Symbol Substitution Test, and the Letter Word Fluency Test. Result: Between March 13, 2019, and May 8, 2020, 361 patients were screened and 154 were randomly assigned to the multi‐domain intervention group (n = 81) or control group (n = 73). 110 (71%) participants completed the trial. The full analysis set included 136 patients. In the primary efficacy analysis, there was no significant differences in the change of composite score from baseline to 18‐month follow‐up between the intervention group and the control group (mean difference 0.066 [95% CI ‐0.089 to 0.222]). In the analysis for each neuropsychological test, scores of immediate and delayed recall tests of the ROCFT in the intervention group significantly improved by a mean of 1.627 points and 1.793 points, respectively. The mean difference in the change of score of delayed recall test of the ROCFT between intervention group and control group was significant (mean difference 1.803 [95% CI 0.169 to 3.436]). In subgroup analyses, intervention effect on composite score was significant among patients with moderate to severe white matter hyperintensities (mean difference 0.351 [95% CI 0.088 to 0.614]). Conclusion: The multi‐domain intervention could improve memory function in older adults with type 2 diabetes and MCI. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study that examined the relationship between continuous glucose monitoring (CGM) metrics and cognitive decline in older adults with type 2 diabetes. The study found that higher mean sensor glucose (SG) and time above range (TAR) were associated with a decrease in cognitive function over a one-year period. On the other hand, a higher time in range (TIR) was associated with a lower risk of cognitive decline. These results suggest that maintaining glucose levels within the target range may be important for preventing cognitive decline in older adults with type 2 diabetes. However, more research is needed to confirm these findings. [Extracted from the article]

Aim: To examine the association between continuous glucose monitoring (CGM)‐derived metrics and cognitive performance in older adults with type 2 diabetes (T2D). Materials and methods: A total of 100 outpatients with T2D aged 70 years or older were analysed. Participants underwent CGM for 14 days. As CGM‐derived metrics, mean sensor glucose (SG), glucose coefficient of variation (CV), time in range (TIR; 70‐180 mg/dl), time above range (TAR; > 180 mg/dl) and time below range (TBR; < 70 mg/dl), were calculated. Participants underwent cognitive tests, including the Japanese version of the Montreal Cognitive Assessment (MoCA‐J), a delayed word‐recall test from the Alzheimer's Disease Assessment Scale‐cognitive subscale, a digit symbol substitution test, a letter word fluency test, a trail‐making test (TMT) and digit span test (DSP). Results: In multiple regression analyses adjusted for confounders, a higher mean SG was associated with a lower performance in MoCA‐J and TMT part B (TMT‐B) (P <.05). A higher TAR was associated with a lower performance in TMT‐B and DSP‐backward (P <.05). By contrast, a higher TIR was associated with better function in TMT‐B and DSP‐backward (P <.05). Furthermore, CV and TBR were not associated with any cognitive function. Conclusion: Hyperglycaemia metrics and TIR derived from CGM are associated with cognitive functions, especially with executive function and working memory, in older adults with T2D. [ABSTRACT FROM AUTHOR]

Background: The association of Mini-Mental State Examination (MMSE) with microstructure of individual regions across the entire brain remains unexplored., Purpose: To investigate the relationship between cognitive function and the microstructure of each brain region in the gray matter using diffusion kurtosis imaging (DKI) in older adults with mild cognitive impairment (MCI), which is the transitional stage before the onset of dementia., Material and Methods: DKI and MMSE were obtained for 34 older adults with MCI and 16 cognitively normal (CN) individuals aged 65-85 years. The DKI parameters were measured from 31 distinct regions of interest in the gray matter. A multiple regression analysis was used to examine the association between DKI parameters and MMSE scores; subsequently, interactions between the DKI parameters and the groups (MCI and CN) were examined., Results: The mean (±SD) MMSE score for the MCI group was 27.67 ± 1.90. Significant positive correlations were observed between MMSE score and mean kurtosis (MK) in the superior frontal, middle frontal, inferior frontal, precentral, postcentral, angular, middle temporal, and inferior occipital gyri, and superior parietal lobe for the MCI group. In addition, the interaction term of the MK in the middle frontal, precentral, postcentral, and angular gyri, and the groups was statistically significant., Conclusion: Older adults with MCI may exhibit histological damage in certain regions of the brain, such as the middle frontal and angular gyri, as observed in this study. The findings could provide insights into understanding the pathophysiology of cognitive decline in this population group., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To develop a combined index using cognitive function and instrumental activities of daily living (IADL) to discriminate between Clinical Dementia Rating (CDR) scores of 0.5 and 1 in the clinical setting, and to investigate its optimal cutoff values and internal and external validities., Methods: We included outpatients aged 65-89 years with CDR scores of 0.5 or 1. The optimal cutoff values and internal validity were verified using Japanese memory clinic-based datasets between September 2010 and October 2021 [National Center for Geriatrics and Gerontology (NCGG) datasets]. Cognitive function and IADL were assessed using the Mini-Mental State Examination (MMSE) and Lawton Index (LI), respectively. The optimal cutoff values were defined using the Youden Index. To verify internal validity, sensitivity and specificity were calculated using stratified 5-fold cross-validation. To verify external validity, sensitivity and specificity of the optimal cutoff values were assessed in the Organized Registration for the Assessment of dementia on Nationwide General consortium toward Effective treatment (ORANGE) Registry dataset between July 2015 and March 2022, which has multicenter clinical data., Results: A total of 800 (mean age, 77.53 years; men, 50.1%) and 1494 (mean age, 77.97 years; men, 43.3%) participants comprised the NCGG and ORANGE Registry datasets, respectively. The optimum cutoff values for men and women were determined as MMSE < 25 and LI < 5 and MMSE < 25 and LI < 8, respectively; such a combined index showed good discriminative performance in internal (sensitivity/specificity: men, 92.50/73.52; women, 88.57/65.65) and external validities (men, 81.43/77.62; women, 77.64/74.67)., Conclusion: The index developed is useful in discriminating between CDR scores of 0.5 and 1 and should be applicable to various settings, such as memory clinics and clinical research., (© Copyright 2024 Physicians Postgraduate Press, Inc.)