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“Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician

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... In fact, it remains challenging to discriminate AD from other neuropathological dementia despite the advances in research protocols and current diagnostic tools [11]. Currently, AD diagnosis is based on confirming memory loss and cognitive impairments using neurological tests, such as the Montreal Cognitive Assessment (MOCA) [160] and Mini-Mental Status Examination (MMSE) [161]. However, the ultimate AD diagnostic protocol can only be performed post-mortem to detect Aβ and tau NFTs in brains of deceased patients [11]. ...
... It was proposed that targeting γ-secretase might reduce amyloid production, particularly Aβ42 isoform [160][161][162][163]. Phase II trials showed a dose-dependent decrease in both Aβ isoforms (Aβ40 and Aβ42) without significant decrease in tau protein, though the magnetic resonance No distinct response of improvement nor worsening could be traced after 3 months of treatment [154,162]. ...
... It was proposed that targeting γ-secretase might reduce amyloid production, particularly Aβ42 isoform [160][161][162][163]. Phase II trials showed a dose-dependent decrease in both Aβ isoforms (Aβ40 and Aβ42) without significant decrease in tau protein, though the magnetic resonance imaging (MRI) recorded a cerebral atrophy following such treatment [154,165]. ...
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Alzheimer’s disease (AD) is a polygenic multifactorial neurodegenerative disease that, after decades of research and development, is still without a cure. There are some symptomatic treatments to manage the psychological symptoms but none of these drugs can halt disease progression. Additionally, over the last few years, many anti-AD drugs failed in late stages of clinical trials and many hypotheses surfaced to explain these failures, including the lack of clear understanding of disease pathways and processes. Recently, different epigenetic factors have been implicated in AD pathogenesis; thus, they could serve as promising AD diagnostic biomarkers. Additionally, network biology approaches have been suggested as effective tools to study AD on the systems level and discover multi-target-directed ligands as novel treatments for AD. Herein, we provide a comprehensive review on Alzheimer’s disease pathophysiology to provide a better understanding of disease pathogenesis hypotheses and decipher the role of genetic and epigenetic factors in disease development and progression. We also provide an overview of disease biomarkers and drug targets and suggest network biology approaches as new tools for identifying novel biomarkers and drugs. We also posit that the application of machine learning and artificial intelligence to mining Alzheimer’s disease multi-omics data will facilitate drug and biomarker discovery efforts and lead to effective individualized anti-Alzheimer treatments.
... The participants also had the possibility to end the examination and continue at another time, if so desired. Only participants that had completed all previous steps of the study were included in each successive follow-up and only those who had fulfilled the Mini Mental State Examination (MMSE; Folstein et al., 1975) were included in this study (Figure 1). At 90 years of age, 45% (n ¼ 153) of the participants were deceased, 17% (n ¼ 58) declined participation and 4% (n ¼ 14) did not answer or were excluded from the study for other reasons (e.g., moved to another municipality). ...
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Naming ability and verbal comprehension are cognitive functions that may be affected both by normal aging and by disease. Neuropsychological testing is crucial to evaluate changes in language ability and reliable normative data for all ages are needed. We present clinically useful test norms, together with subsample analysis of longitudinal effects of aging, for two robust and well-known tests that evaluate naming ability and verbal comprehension where the present norms for older adults (aged 85 and older) are sparse or missing. Participants (n = 338) from a Swedish population-based study, the Elderly in Linköping Screening Assessment, were cognitively evaluated with a cognitive screening battery at the age of 85 years and followed to the age of 93 years. Normative data at age 85 years were calculated from a sample (n = 207) that was determined as cognitively healthy after application of rigorous exclusion criteria. Effects of normal aging were investigated by analyzing follow-up performance at age 90 and 93 years for the subsample of cognitively healthy that completed the entire study. The evaluated tests in this study are Swedish versions of the Boston Naming Test 30-item Odd Version (BNT-30) and a short form of the Token Test, Part V (TokV). Analyzes of effects of aging showed that performance decreased with age for BNT-30, but not for TokV. Higher education was associated with better performance in both tests and men performed better than women on the BNT-30. Results also showed naming ability to be more sensitive to aging than verbal comprehension.
... The Mini-Mental State Examination (MMSE) is an 11-item screening tool to evaluate cognitive function in communitydwelling, hospitalized, and institutionalized older adults. 16 The score ranges from 0 to 30 points, with higher scores indicating a better cognitive function. A score of ≤ 17, 20, or 24 points for illiterate, elementary school, and college students indicates cognitive impairment. ...
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Xiangfeng He,1,2,* Yanping Song,2,* Lin Ma,2,* Barbara E Ainsworth,3 Yu Liu,4 Nan Chen1,2,4 1Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People’s Republic of China; 3College of Health Solutions, Arizona State University, Phoenix, AZ, USA; 4School of Kinesiology, Shanghai University of Sport, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yu Liu, School of kinesiology, Shanghai University of Sport, No. 399 Changhai Road, Yangpu District, Shanghai, People’s Republic of China, Tel +86-21-65507860, Email yuliu@sus.edu.cn Nan Chen, Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No. 1665 Kongjiang Road, Yangpu District, Shanghai, People’s Republic of China, Email chennanreh2020@126.comObjective: This study aimed to explore the prevalence and impact of related factors for sarcopenia among community-dwelling older people in Chongming district, China, according to the diagnostic criteria of the Asia Working Group for Sarcopenia-2019.Methods: We conducted a cross-sectional study from April 2021 to December 2021. Diagnosis of sarcopenia (non-sarcopenia, possible sarcopenia, sarcopenia, and severe sarcopenia) was based on appendicular skeletal muscle mass index, handgrip strength, gait speed, and the 5-time chair stand test. Staff collected all subjects’ clinical and sociodemographic characteristics, cardiovascular disease (CVD) risk factors, inflammatory markers, physical activity (PA), and daily lifestyle activities to identify sarcopenia-related factors.Results: A total of 1407 older people aged ≥ 65 years were enrolled into the study (58.7% female). The prevalence of confirmed sarcopenia was 19.6% (17.1% in females and 23.1% in males). The prevalence of possible sarcopenia, sarcopenia, and severe sarcopenia were 19.7% (22.2% in females, 16.2% in males), 11.9% (10.1% in females, 14.5% in males), and 7.7% (7% in females, 8.6% in males), respectively. Increasing age, gender, depression status, and high-fat mass were associated with an increased likelihood of sarcopenia in all subjects. In females, living alone, high-fat mass, lower body mass index (BMI), lower body weight, and have no time spent doing housework increased the likelihood of sarcopenia. In males, depression status, high-fat mass, higher neutrophils-to-lymphocytes ratio (NLR), lower BMI, lower body weight increased the likelihood of sarcopenia.Conclusion: Our study showed a high prevalence of sarcopenia among community-dwelling older people in the Chongming district. Detection, prevention, and treatment efforts are needed to reduce the impact of sarcopenia in older, rural communities in China.Keywords: sarcopenia, prevalence, risk factor, older people, rural area
... Patients with a score ≤ 24 were considered as having cognitive impairment. 39 According to the frailty and cognitive impairment criteria, all participants were classified into four groups: 1) the healthy group; 2) the cognitive impairment group only; 3) the frailty group only; and 4) coexisting frailty and cognitive impairment group. ...
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Xing-Kun Zeng,* Shan-Shan Shen,* Hui-Lan Guan, Ling-Yan Chen, Xu-Jiao Chen Department of Geriatrics, Zhejiang Hospital, Hangzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xu-Jiao Chen, Department of Geriatrics, Zhejiang Hospital, Lingyin Road #12, Hangzhou, 310013, People’s Republic of China, Tel +86 180 6989 7567, Fax +86 571 8798 5100, Email lily197459@163.comPurpose: This study aimed to investigate the combined effects of frailty and cognitive impairment on adverse outcomes, including new falls and new activities of daily living (ADL) dependency over a 1-year follow-up.Patients and Methods: A total of 311 older hospitalized patients participated in this retrospective observational study and completed a 1-year follow-up. Frailty was assessed by the Clinical Frailty Scale (CFS). Cognitive function was evaluated by the Mini-Mental State Examination (MMSE). All participants were classified into four groups: 1) the healthy group (n=180); 2) the cognitive impairment group only (n=38); 3) the frailty group only (n=44); and 4) coexisting frailty and cognitive impairment group (n=49). The follow-up data of adverse outcomes include the incidences of new falls and new ADL dependence. Binary logistic regression analysis was used to explore the associations of frailty and/or cognitive impairment with adverse outcomes.Results: The prevalence rates of frailty, cognitive impairment, and co-occurring frailty with cognitive impairment were 29.9%, 28%, and 15.8%, respectively. Among these four groups, there was a statistical difference in the incidence of new ADL dependence during the follow-up period (9.5% vs 11.4% vs 35.9% vs 61.9%, P < 0.001). After adjusting the confounding variables, older hospitalized patients with frailty and cognitive impairment had a higher risk of new ADL dependence when compared with the healthy group (OR: 4.786, 95% CI: 1.492– 15.355), but frailty only or cognitive impairment only was not associated with new ADL dependency.Conclusion: Elderly inpatients with comorbid frailty and cognitive impairment on admission were significantly associated with an increased risk of new ADL dependency 1 year after discharge. Therefore, it is necessary for the early identification of frailty and cognitive impairment, and effective interventions should be implemented.Keywords: cognitive impairment, frailty, older adults, ADL dependency, fall
... All subjects underwent a clinical and neuropsychological evaluation to assess their global cognitive status using the MMSE (Folstein et al., 1975) and the following cognitive domains: attention [Color-Word Stroop Test (CSWT)] (Stroop, 1935), Benton Face Recognition Test (Benton et al., 1994), memory (Wechsler Memory Scale-Revised Form (WMS-R)) (Wechsler, 1987), Verbal Memory Processes Test (SBST), language (Boston Naming Test) (Kaplan et al., 1983), visuospatial skills (Benton Judgement of Line Orientation Test) (Benton et al., 1994), Clinical Dementia Rating Scale (CDR) (Morris, 1993), Geriatric Depression Scale (GDS) (Yesavage, 1988), and Neuropsychiatric Inventory were also used for neuropsychological evaluation. ...
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Introduction Alzheimer's disease (AD) is neurodegenerative dementia that causes neurovascular dysfunction and cognitive impairment. Currently, 50 million people live with dementia worldwide, and there are nearly 10 million new cases every year. There is a need for relatively less costly and more objective methods of screening and early diagnosis. Methods Functional near-infrared spectroscopy (fNIRS) systems are a promising solution for the early Detection of AD. For a practical clinically relevant system, a smaller number of optimally placed channels are clearly preferable. In this study, we investigated the number and locations of the best-performing fNIRS channels measuring prefrontal cortex activations. Twenty-one subjects diagnosed with AD and eighteen healthy controls were recruited for the study. Results We have shown that resting-state fNIRS recordings from a small number of prefrontal locations provide a promising methodology for detecting AD and monitoring its progression. A high-density continuous-wave fNIRS system was first used to verify the relatively lower hemodynamic activity in the prefrontal cortical areas observed in patients with AD. By using the episode averaged standard deviation of the oxyhemoglobin concentration changes as features that were fed into a Support Vector Machine; we then showed that the accuracy of subsets of optical channels in predicting the presence and severity of AD was significantly above chance. The results suggest that AD can be detected with a 0.76 sensitivity score and a 0.68 specificity score while the severity of AD could be detected with a 0.75 sensitivity score and a 0.72 specificity score with ≤5 channels. Discussion These scores suggest that fNIRS is a viable technology for conveniently detecting and monitoring AD as well as investigating underlying mechanisms of disease progression.
... A 43-item FI was constructed following the procedures outlined by Searle et al. [5]. Items selected included, reported difficulty with 15 basic and instrumental activities of daily living (ADL/IADL: walking up 10 steps, lifting and carrying 10 lbs, getting in and out of bed/chairs, bathing and showering, dressing, eating, using the toilet, walking across a small room, doing heavy housework, preparing your own meals, shopping for personal items, using the telephone, taking medication, managing finances, urinary or fecal incontinence), self-rated health assessed using short form health survey SF-12 [17], five items from the Center for Epidemiologic Studies Depression (CES-D) scale [18] (feel depressed, feel everything is an effort, could not get going, feel lonely, and feel happy), four items of the Mini-Mental State Examination [19] (MMSE: orientation to time, orientation to place, attention, and recall), and presence vs. absence of 14 common age-related conditions (cancer, anemia, hypertension, heart disease, congestive heart failure, stroke, peripheral artery disease, COPD, chronic kidney disease, hip replacement, joint pain, depression, Parkinson's, cognitive impairment), 5% weight loss in the past year, low physical activity (lowest quartile of physical activity in the past year), slowness (lowest quintile walking speed stratified by sex and height), and weakness (lowest quintile grip strength stratified by sex and BMI). FI was calculated for participants with less than 20% missing data at each study visit. ...
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Background: The quality of carbohydrate consumed may influence the risk of frailty. In this study, we tested the hypothesis that indices of carbohydrate intake are associated with trajectories of frailty in participants of the Baltimore Longitudinal Study of Aging (BLSA). Methods: Cross sectional and longitudinal analyses were conducted in 1024 BLSA participants to examine the association between usual intake of carbohydrate and frailty index. Seven measures of carbohydrate consumption were estimated using data derived from Food Frequency Questionnaires (FFQs) and examined in association with a 43-item Frailty Index (FI). Results: In cross-sectional analyses, there was a significant, positive association between higher tertiles of total carbohydrate, glycemic load, and non-whole grains and FI. Conversely, higher tertiles of fiber-to-carbohydrate ratio was associated with lower FI. These differences persisted over the follow-up period of up to 13.8 years. Women in the highest tertile of the fiber-to-carbohydrate ratio showed a less steep increase in FI over time. Conclusions: Carbohydrate intake was positively associated with increased frailty risk in the BLSA participants, whereas a higher fiber-to-carbohydrate ratio was related to reduced risk for frailty.
... Cognition was assessed with the following tests: mini-mental state examination (MMSE) 26 , frontal assessment battery (FAB) 27 , digit symbol substitution test (DSST) of the Wechsler adult intelligence scale-III, a subtest of immediate and delayed recall of a short story of the Rivermead behavioral memory test (RBMT) 28 , and the Japanese version of the Addenbrooke's cognitive examination 3 (ACE-3) 29,30 . The everyday memory checklist (EMC) 31 was used to assess amnesia of the patient in daily life for the patient and caregivers. ...
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Apathy is frequently observed in idiopathic normal pressure hydrocephalus (iNPH) and worsens cognitive impairment and gait disturbance. In this study, we evaluated the regions associated with apathy in iNPH using statistical imaging analysis on the whole brain, both in terms of cerebral blood flow and gray matter volume. Twenty-seven patients with iNPH were assigned to two groups based on their scores on the neuropsychiatric inventory items related to apathy; 18 patients were assigned to the group with apathy (iNPH + APA) and 9 to the group without apathy (iNPH − APA). The magnetic resonance images and cerebral blood flow single-photon emission computed tomography data of the two groups were compared using statistical parametric mapping 12. The regional gray matter volume of the right precuneus was significantly larger in the iNPH + APA group than in the iNPH − APA group, but the regional cerebral blood flow in any region of the brain was not significantly different between the two groups. These results suggested that the larger gray matter volume, which is thought to reflect gray matter compression, in the precuneus might be involved in apathy in iNPH.
... Notably, among the dementia subtypes, vascular dementias were most frequently recorded as diagnoses ( Figure 4B), despite dementia in Alzheimer's disease being the most common form of dementia in the population (19). The MMSE (20) was performed in 40 patients ( Figure 4C), and the average MMSE score was lower in patients with a diagnosis of dementia (18.86 ± 5.16) than in those with other diagnoses (22.75 ± 5.01; t (21.7) = 22.23, p = 0.016). As expected, polypharmacy was highly prevalent among the patients referred for consultation, with a median number of 10 different medications (range: 2 -23; mean = 10.31 ± 5.01; Figure 4D). ...
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Objective: The treatment of patients with dementia poses a considerable challenge to regional district general hospitals, particularly in rural areas. Here we report the establishment and initial evaluation of a dementia-specific consultation service provided by a teaching hospital-based Psychiatry Department to regional district general hospitals in surrounding smaller towns. Methods: The consultation service was provided to patients with pre-existing or newly suspected dementia, who were in acute hospital care for concurrent conditions. An evaluation of 61 consultations – 49 on-site and 12 via telemedicine – was performed to assess the needs of the participating hospitals and the specific nature of the referrals to the consultation service. Results: Suspected dementia or cognitive dysfunction was the primary reason for consultation requests (>50% of cases). Other common requests concerned suspected delirium, behavioral symptoms, and therapeutic recommendations. During the consultations, a diagnosis of dementia was reached in 52.5% of cases, with other common diagnoses including delirium and depression. Recommendations related to pharmacotherapy were given in 54.1% of consultations. Other recommendations included referral for outpatient neurological or psychiatric follow-up, further diagnostic assessment, or assessment in a memory clinic. Geriatric psychiatric inpatient treatment was recommended in only seven cases (11.5 %). Conclusion: Our initial evaluation demonstrates the feasibility of providing a dementia-specific consultation service in rural areas. The service has the potential to reduce acute transfers to inpatient geriatric psychiatry and enables older patients with dementia or delirium to be treated locally by helping and empowering rurally-based regional hospitals to manage these problems and associated complications.
... Future studies might use specific spatial ability tests. Standard neuropsychological tests, such as the Mini-Mental State Examination (MMSE) [47], are also necessary. Second, the sample size is insufficient for comprehensive hierarchical analysis. ...
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Objective: The virtual reality (VR)-based path integration task shows substantial promise in predicting dementia risk. However, the reliability and validity in healthy populations need further exploration. The present study investigates the relationship between task indicators and brain structures in a healthy population using a VR-based navigation task, particularly the entorhinal cortex (EC) and hippocampus. Methods: Sixty healthy adults were randomly recruited to perform a VR-based path integration task, the digit span task (DST), and an MRI scan. The indicators of the VR-based path integration task were calculated, including the absolute distance error (ADE), degree of angle deviation (DAD), degree of path deviation (DPD), and return time (Time). The reliability of the above indicators was then estimated using the split-half method and Cronbach’s alpha. Correlation and regression analyses were then performed to examine the associations between these indicators and age, general cognitive ability (DST), and brain structural measures. Results: ADE, DAD, and DPD showed reasonable split-half reliability estimates (0.84, 0.81, and 0.72) and nice Cronbach’s alpha estimates (0.90, 0.86, and 0.96). All indicators correlated with age and DST. ADE and DAD were sensitive predictors of hippocampal volume, and return time was a predictor of EC thickness. Conclusion: Our findings demonstrate that the VR-based path integration task exhibits good reliability and validity in the healthy population. The task indicators are age-sensitive, can capture working memory capacity, and are closely related to the integrity of individual EC and hippocampal structures.
... Walking speed (m/s) was assessed by asking participants to walk 6 m at their usual speed or 2.44 m if the participant reported walking quite slowly [24]. Cognitive status was assessed by physicians using the Mini-Mental State Examination (MMSE), with a score range of 30 at best to 0 at worst [25]. ...
Article
Background: The evolution of multimorbidity patterns during aging is still an under-researched area. We lack evidence concerning the time spent by older adults within one same multimorbidity pattern, and their transitional probability across different patterns when further chronic diseases arise. The aim of this study is to fill this gap by exploring multimorbidity patterns across decades of age in older adults, and longitudinal dynamics among these patterns. Methods: Longitudinal study based on the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) on adults ≥60 years (N=3,363). Hidden Markov Models were applied to model the temporal evolution of both multimorbidity patterns and individuals' transitions over a 12-year follow-up. Findings: Within the study population (mean age 76.1 years, 66.6% female), 87.2% had ≥2 chronic conditions at baseline. Four longitudinal multimorbidity patterns were identified for each decade. Individuals in all decades showed the shortest permanence time in an Unspecific pattern lacking any overrepresented diseases (range: 4.6-10.9 years), but the pattern with the longest permanence time varied by age. Sexagenarians remained longest in the Psychiatric-endocrine and sensorial pattern (15.4 years); septuagenarians in the Neuro-vascular and skin-sensorial pattern (11.0 years); and octogenarians and beyond in the Neuro-sensorial pattern (8.9 years). Transition probabilities varied across decades, sexagenarians showing the highest levels of stability. Interpretation: Our findings highlight the dynamism and heterogeneity underlying multimorbidity by quantifying the varying permanence times and transition probabilities across patterns in different decades. With increasing age, older adults experience decreasing stability and progressively shorter permanence time within one same multimorbidity pattern.
... Cognitive status: The Mini-Mental State Examination (45,46) was used to assess the cognitive performance of care receivers. The final score ranges from 0 to 30 points and the lower the scores, the worst the cognitive performance. ...
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Experiencing bereavement may be challenging. Despite the oldest-old population increase, a subgroup at greater risk of death, few studies focus on the grieving process of informal caregivers (ICs). This study analyzed the transition to bereavement of ICs of oldest-old individuals (≥80 years) over 1-year and compares the evolution of the health-related quality of life (HrQoL) between those experiencing bereavement and those who continued care through the study period. A prospective longitudinal observational study was conducted enrolling 204 ICs of the Metropolitan Area of Porto (North Portugal), of which 36 experienced the death of care receiver (CR). ICs’ health profile and burden were assessed. CRs’ functional and cognitive status were also appraised. Bereaving caregivers were mostly female, CRs’ children, and had on average 60.4 years at baseline. Caregivers spent a mean of 10.1 h/day (SD = 7.7) caring, for 80.6 months (SD = 57.5). The time elapsed since CR’s death was 6 months (SD = 3.5) from entering in the study. CRs who died had a mean age of 88.3 (SD = 5.4) years at baseline, and were very dependent. Over a 1-year follow-up, bereaving caregivers showed a significant decrease in mental health following CR’s death; on the other hand, caregivers who continued caring improved mental health [F(1, 159) = 4.249, p = 0.041]. Ending the caregiver career was marked by a decline in mental health whereas to continue caring was marked by an improvement in this outcome. While it is highly expected that the CR’s death will be perceived as a relief considering both the caregiver’s characteristics (e.g., medicines) and the CR condition (e.g., high dependence levels), the results suggest an opposite direction. CRs’ death seems to arise an emotional burden for IC, at least during the first year, possibly triggering feelings of loneliness and a life without purpose that seems to aggravate mental health issues. The transition to bereavement among ICs seems to lead to a caregiver mental health decline while those who continued caring (and thereby, experiencing caregiving stressors) seems to improve in this outcome. Ceasing caregiving stressors does not seem to contribute better experiencing bereavement among ICs, suggesting the need for support throughout this phase.
... In order to be eligible for participation, participants had to be aged between 70 and 85 years, literate, immigrants from Greece, and to have Greek as their dominant language. The exclusion criteria for the participants were: a score on the Mini-Mental State Examination below 22/30 (MMSE; Folstein, Folstein, & McHugh, 1975;Fountoulakis, Tsolaki, Chantzi, & Kazis, 2000;Plitas et al., 2009); self-reported functional or memory decline; history of serious neurological or psychiatric conditions known to impact cognition; a score >6/15 on the Geriatric Depression Scale-15 (Fountoulakis et al., 1999) or a score of ≥8/20 on the Geriatric Anxiety Inventory (GAI; Pachana et al., 2006); uncorrected visual and/or auditory deficits; history or current consumption of more than 10 standard alcoholic drinks per week and/or more than four standard drinks on any one day (National Health & Medical Research Council, 2022), and a history or current substance use as identified on a clinical screening interview. ...
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Aims: Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer's disease (AD). Method: We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of AD on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube. Results: While healthy participants tended to outperform the AD group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates, respectively) when using established clinical cut-off scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with AD. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube. Conclusion: Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in culturally and linguistically diverse older cohorts with limited education.
... The second part measures the ability to follow a verbal and written command and to copy a complex drawing of a polygon, totaling nine points. The total score is 30 points, and the cutoff point is 23/24, which is a score that suggests a cognitive deficit [11]. This mini mental state examination enabled the exclusion of elderly subjects who did not have enough cognition ability to participate in the study. ...
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This article aims to analyze the memories of incarcerated elderly people about family. This is an exploratory and analytical study, with a qualitative approach, carried out in three prison units in Bahia, with 31 incarcerated elderly people, through semi-structured interview. Most are male (30), between 60 to 65-years-old (21), married (12) and with three to four children (10). The results show that the 10 most evoked words were: family; sons; mom; father; women; life; cry; today; brothers; and longing. The study showed that the family constitution is maintained because the experiences that are symbolized in it have socially crystallized definitions as references. Anchored by social frames of memories that remain, since they remain alive in the groups and are permanently maintained. It was also found that the family plays an extremely important role in their lives and that the mother is the central point of this family
... The Mini-Mental State Examination (MMSE), developed by Folstein and Mc Huge [32], includes sense of orientation, attention, memory, language, oral understanding and behavior, construction, and other items. The evaluation process has no time limit. ...
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Background: The number of elderly diabetic patients has been increasing recently, and these patients have a higher morbidity of dementia than those without diabetes. Diabetes is associated with an increased risk for the development of dementia in elderly individuals, which is a serious health problem. Objectives: The primary aim was to examine whether diabetes is a risk factor for dementia among elderly individuals. The secondary aim was to apply grey theory to integrate the results and how they relate to cognitive impairments in elderly diabetic patients and to predict which participants are at high risk of developing dementia. Methods: Two hundred and twenty patients aged 50 years or older who were diagnosed with diabetes mellitus were recruited. Information on demographics, disease characteristics, activities of daily living, Mini Mental State Examination, sleep quality, depressive symptoms, and health-related quality of life was collected via questionnaires. The grey relational analysis approach was applied to evaluate the relationship between the results and health outcomes. Results: A total of 13.6% of participants had cognitive disturbances, of whom 1.4% had severe cognitive dysfunction. However, with regard to sleep disorders, 56.4% had sleep disturbances of varying degrees from light to severe. Further investigation is needed to address this problem. A higher prevalence of sleep disturbances among diabetic patients translates to a higher degree of depressive symptoms and a worse physical and mental health-related quality of life. Furthermore, based on the grey relational analysis, the grey relation coefficient varies from 0.6217~0.7540. Among the subjects, Participant 101 had the highest value, suggesting a need for immediate medical care. In this study, we observed that 20% of the total participants, for whom the grey relation coefficient was 0.6730, needed further and immediate medical care.
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Enhanced Recovery in Liver Surgery (ERILS) represents the modern preoperative and postoperative care model for the hepatectomy patient. The standardized multidisciplinary and evidence-based plan stands on a foundation of Patient Education/Engagement with four principle pillars of early feeding, goal-directed fluid therapy (GDFT), perioperative pain control, and early ambulation. The objective of this review is to expand upon each of these pillars and highlight the evidence for its use. These pathways should be used in the vast majority of hepatectomy patients to optimize both patient-centric and hospital-centric outcomes.
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Background This study aimed to investigate associations of serum high-sensitivity C-reactive protein (hsCRP) and social support (SS) levels with suicidal ideation (SI), and to evaluate potential modifying effects of SS on the associations between serum hsCRP levels and SI in two longitudinal cohorts with cardio-/cerebrovascular diseases. Methods 1152 acute coronary syndrome (ACS) and 423 stroke patients were recruited at baseline within 2 weeks of disease onset, and evaluated for: i) serum hsCRP levels; ii) SS by the Social Support Scale and Social Undermining Scale; iii) SI by the “suicidal thoughts” item of the Montgomery–Åsberg Depression Rating Scale; and iv) covariates including socio-demographics, depression, vascular risk factors, and index disease severity. At 12-month follow-up, SI was re-evaluated. Logistic regression models were used to adjust for potential covariates. Results In the ACS cohort, higher serum hsCRP and lower SS levels were significantly associated with SI at baseline; and only lower SS levels were significantly associated with SI at follow-up. In the stroke cohort, lower SS levels were significantly associated with SI at baseline; but no other association was found. Associations of serum hsCRP levels with SI at both baseline and follow-up were only significant at higher SS levels with significant interaction terms in both cohorts. Limitations This study evaluated SI, but not suicide attempts or death; it also used a single-center design. Conclusions By considering SS evaluations with routine serum hsCRP levels in cardio-/cerebrovascular disease, clinical prediction of SI both at acute and chronic phases of the diseases might be improved.
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Objective To examine sex-specific associations of sleep duration and napping self-reported at mean age of 69 years (range: 53–81) with risk of incident dementia 24 years later at age 90 +. Method Analytic sample included individuals from a population-based study who reported sleep and napping once in the 1980s and 24 years later (range: 16–38) joined The 90+ Study and were evaluated in-person. Those without dementia at baseline of The 90+ Study were prospectively followed. Hazard ratios [HR] and 95% confidence intervals [CI] of dementia risk were estimated by Cox regression. Results Of 574 participants 71% were women, mean age at start of dementia follow-up with The 90+ Study was 93 years (range: 90–102). After 3.3 years (range: 0.4–13.8) of follow-up 47% developed dementia. Higher risk of dementia at age 90+ was seen in women with <6 hours of self-reported sleep per night (adjusted HR = 2.00; 95% CI = 1.15–3.50; p = .01) compared with 8 hours. Lower risk of dementia at 90+ was seen in men with short-to-moderate (<60 minutes) self-reported naps compared with no naps (HR = 0.33; 95% CI = 0.18–0.63; p < .01). Conclusions Sleep and nap 24 years earlier are important risk factors for dementia after age 90.
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Background Social functioning is crucial for daily living and is an essential indicator of dementia in patients with Parkinson's disease. The pattern of social functioning in patients with Parkinson's disease without dementia (i.e. those who are cognitively intact or have mild cognitive impairment (PD-MCI)) and its determinants are unclear. Aims In exploring the heterogeneity of social functioning among patients with Parkinson's disease-associated dementia, we determined the optimal cut-off score of the Parkinson's Disease Social Functioning Scale (PDSFS) for patients with PD-MCI, and the variables influencing patients’ social functioning. Method A total of 302 participants underwent the Mini-Mental State Examination (MMSE) and PDSFS; 120 patients with Parkinson's disease completed the measurements (MMSE, Activities of Daily Living Scale and Neuropsychiatric Inventory). Group comparisons, receiver operating characteristic curves, Spearman correlation and multiple and hierarchical regression analyses were conducted. Results The PD-MCI group scored the lowest on the PDSFS ( F = 10.10, P < 0.001). The PDSFS cut-off score was 53 (area under the curve 0.700, sensitivity 0.800, specificity 0.534). The MMSE ( β = 0.293, P = 0.002), Activities of Daily Living Scale ( β = 0.189, P = 0.028) and Neuropsychiatric Inventory ( β = −0.216, P = 0.005) scores predicted the PDSFS score. Further, there was an interaction effect between the Activities of Daily Living Scale and Neuropsychiatric Inventory scores on the PDSFS score ( β = 0.305, P < 0.001). Conclusions We determined a PDSFS cut-off score for detecting PD-MCI and found that patients with PD-MCI have social dysfunction. Future research should focus on the effects of neuropsychiatry symptoms and activities of daily living on social functioning, and tailor the intervention programme for patients with Parkinson's disease.
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First-line treatment in postmenopausal women with estrogen- and/or progesterone-positive breast cancer consists of aromatase inhibitors (AROi). The ability of AROi to promote or worsen cognitive function, depressive symptoms, sleep quality and performance in basic activities of daily life as primary and concomitant outcomes in long longitudinal studies in post-menopausal women has been seldom investigated. This study is a cohort trial which aimed to determine if there were differences in cognitive function assessment, depressive symptoms, and sleep quality after 1 year under AROi treatment and to determine the interrelations between these symptoms. Methods: A prospective 1-year longitudinal study was performed in a representative sample of tertiary hospital. Women with localized breast cancer newly treated with AROi therapy were evaluated for cognitive functions, depressive symptoms, sleep problems and ability to perform basic activities of the daily life at baseline and after 6 months and 12 months under adjuvant AROi treatment. Results: Analysis of cognitive functions by the Mini-Mental State Examination (MMSE) scores did not show significantly worsening under AROi treatment after 6 months and 12 months of treatment compared to the baseline. Analysis of depressive symptoms with the Geriatric Depression Scale and sleep quality with the Athens Insomnia Scale (AIS) scores showed significant (p < 0.05) changes after 6 and 12 months of treatment with AROi, with women describing more depressive symptoms and more sleep disturbances. Conclusions: Our study found impairments in sleep quality and an increase in depressive symptoms, which has important implications for clinicians as they impair quality of life and adherence to treatment.
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Background A fraction of patients with asymptomatic to mild/moderate acute COVID-19 disease report cognitive deficits as part of the post-COVID-19 syndrome. This study aimed to assess the neuropsychological profile of these patients. Methods Assessment at baseline (three months or more following acute COVID-19) of a monocentric prospective cohort of patients with post-COVID-19 syndrome. Multidomain neuropsychological tests were performed, and questionnaires on depression, anxiety, fatigue, sleep, and general health status were administered. Results Of the 58 patients screened, six were excluded due to possible alternative causes of cognitive impairment (major depression, neurodegenerative disease). Of the remaining 52 individuals, only one had a below-threshold screening result on Mini-Mental State Examination, and 13 scored below the cut-off on Montreal Cognitive Assessment. Extended neuropsychological testing revealed a neurocognitive disorder (NCD) in 31 (59.6%) participants with minor NCD in the majority of cases ( n = 26). In patients with NCD, the cognitive domains learning/memory and executive functions were impaired in 60.7%, complex attention in 51.6%, language in 35.5%, and perceptual-motor function in 29.0%. Cognitive profiles were associated with daytime sleepiness but not with depression, anxiety, sleep quality, total general health status, or fatigue. Conclusion Neurocognitive impairment can be confirmed in around 60% of individuals with self-reported deficits as part of post-COVID-19 syndrome following a mild acute COVID-19 disease course. Notably, screening tests cannot reliably detect this dysfunction. Standard psychiatric assessments showed no association with cognitive profiles. Longitudinal studies are needed to further evaluate the course of neurocognitive deficits and clarify pathophysiology.
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Purpose CAG/CAA repeat expansions in TBP>49 are responsible for spinocerebellar ataxia (SCA) type 17 (SCA17). We previously detected cosegregation of STUB1 variants causing SCA48 with intermediate alleles of TBP in 2 families. This cosegregation questions the existence of SCA48 as a monogenic disease. Methods We systematically sequenced TBP repeats in 34 probands of dominant ataxia families with STUB1 variants. In addition, we searched for pathogenic STUB1 variants in probands with expanded alleles of TBP>49 (n = 2) or intermediate alleles of TBP≥40 (n = 47). Results STUB1 variants were found in half of the TBP40-49 cohort. Mirroring this finding, TBP40-49 alleles were detected in 40% of STUB1 probands. The longer the TBP repeat length, the more likely the occurrence of cognitive impairment (P = .0129) and the faster the disease progression until death (P = .0003). Importantly, 13 STUB1 probands presenting with the full SCA48 clinical phenotype had normal TBP37-39 alleles, excluding digenic inheritance as the sole mode. Conclusion We show that intermediate TBP40-49 alleles act as disease modifiers of SCA48 rather than a STUB1/TBP digenic model. This distinction from what has been proposed before has crucial consequences for genetic counseling in SCA48.
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Background: Cognitive deficits are common in people who have received cranial irradiation and have a serious impact on daily functioning and quality of life. The benefit of pharmacological and non-pharmacological treatment of cognitive deficits in this population is unclear. This is an updated version of the original Cochrane Review published in Issue 12, 2014. Objectives: To assess the effectiveness of interventions for preventing or ameliorating cognitive deficits in adults treated with cranial irradiation. Search methods: For this review update we searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Embase via Ovid, and PsycInfo via Ovid to 12 September 2022. Selection criteria: We included randomised controlled (RCTs) trials that evaluated pharmacological or non-pharmacological interventions in cranial irradiated adults, with objective cognitive functioning as a primary or secondary outcome measure. Data collection and analysis: Two review authors (MK, JD) independently extracted data from selected studies and carried out a risk of bias assessment. Cognitive function, fatigue and mood outcomes were reported. No data were pooled. Main results: Eight studies met the inclusion criteria and were included in this updated review. Six were from the original version of the review, and two more were added when the search was updated. Nineteen further studies were assessed as part of this update but did not fulfil the inclusion criteria. Of the eight included studies, four studies investigated "prevention" of cognitive problems (during radiotherapy and follow-up) and four studies investigated "amelioration" (interventions to treat cognitive impairment as a late complication of radiotherapy). There were five pharmacological studies (two studies on prevention and three in amelioration) and three non-pharmacological studies (two on prevention and one in amelioration). Due to differences between studies in the interventions being evaluated, a meta-analysis was not possible. Studies in early radiotherapy treatment phase (five studies) Pharmacological studies in the "early radiotherapy treatment phase" were designed to prevent or ameliorate cognitive deficits and included drugs used in dementia (memantine) and fatigue (d-threo-methylphenidate hydrochloride). Non-pharmacological studies in the "early radiotherapy treatment phase" included a ketogenic diet and a two-week cognitive rehabilitation and problem-solving programme. In the memantine study, the primary cognitive outcome of memory at six months did not reach significance, but there was significant improvement in overall cognitive function compared to placebo, with similar adverse events across groups. The d-threo-methylphenidate hydrochloride study found no statistically significant difference between arms, with few adverse events. The study of a calorie-restricted ketogenic diet found no effect, although a lower than expected calorie intake in the control group complicates interpretation of the results. The study investigating the utility of a rehabilitation program did not carry out a statistical comparison of cognitive performance between groups. Studies in delayed radiation or late effect phase (four studies) The "amelioration" pharmacological studies to treat cognitive complications of radiotherapy included drugs used in dementia (donepezil) or psychostimulants (methylphenidate and modafinil). Non-pharmacological measures included cognitive rehabilitation and problem solving (Goal Management Training). These studies included patients with cognitive problems at entry who had "stable" brain cancer. The donepezil study did not find an improvement in the primary cognitive outcome of overall cognitive performance, but did find improvement in an individual test of memory, compared to placebo; adverse events were not reported. A study comparing methylphenidate with modafinil found improvements in cognitive function in both the methylphenidate and modafinil arms; few adverse events were reported. Another study comparing two different doses of modafinil combined treatment arms and found improvements across all cognitive tests, however, a number of adverse events were reported. Both studies were limited by a small sample size. The Goal Management Training study suggested a benefit of the intervention, a behavioural intervention that combined mindfulness and strategy training, on executive function and processing speed. There were a number of limitations across studies and few were without high risks of bias. Authors' conclusions: In this update, limited additional evidence was found for the treatment or amelioration of cognitive deficits in adults treated with cranial irradiation. As concluded in the original review, there is supportive evidence that memantine may help prevent cognitive deficits for adults with brain metastases receiving cranial irradiation. There is supportive evidence that donepezil, methylphenidate and modafinil may have a role in treating cognitive deficits in adults with brain tumours who have been treated with cranial irradiation; patient withdrawal affected the statistical power of these studies. Further research that tries to minimise the withdrawal of consent, and subsequently reduce the requirement for imputation procedures, may offer a higher certainty of evidence. There is evidence from only a single small study to support non-pharmacological interventions in the amelioration of cognitive deficits. Further research is required.
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Purpose To assess the relationship between anticoagulant use and rehabilitation outcomes in post-acute hip fracture patients. Methods A retrospective study (1/2017 to 5/2019) of 299 hip fractured patients. Outcome measures Functional Independence Measure (FIM) and the motor FIM’s effectiveness. Results Patients treated with anticoagulation drugs exhibited a significant longer latency time from fracture to surgery (U = –4.37, p < 0.001) and from surgery to rehabilitation (U=–2.27, p = 0.023), and a significantly higher rate of cardiovascular diseases (χ²=0.15, p= 0.023) compared with untreated patients. No significant differences between the two patient groups were found regarding the rate of blood transfusions, perioperative complications (infections, reoperation), or functional outcome measures. Conclusions Oral anticoagulants are not associated with rehabilitation outcomes of hip fracture patients. • Implications rehabilitation • Anticoagulation drug use is not associated with functional outcome of post-acute hip fracture patients. • It is recommended to renew oral anticoagulants for patients on chronic treatment after surgery since no negative outcomes were found during rehabilitation under anticoagulant treatment and in light of the importance of these drugs in preventing thromboembolic complications.
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Background: Preoperative anxiety is common among patients, particularly in neurosurgical patients. The aim of the study was to evaluate the incidence and predictive factors of preoperative anxiety using the state anxiety scale of the State-Trait Anxiety Inventory (STAI-S) among patients undergoing elective craniotomy for a supratentorial neoplasm. This study also determined the optimal Amsterdam Preoperative Anxiety and Information Scale (APAIS) score for the identification of preoperative anxiety in this cohort. Methods: Sixty patients aged 18 to 65 years with American Society of Anesthesiologists physical status score I/II scheduled for elective craniotomy for a supratentorial neoplasm were recruited into this prospective, observational study. Preoperative anxiety was assessed using STAI-S and APAIS questionnaires. Using STAI-S ≥37 to define preoperative anxiety, the optimal APAIS to identify preoperative anxiety was determined using receiver operating characteristic curve analysis. Logistic regression was performed to identify independent predictive factors for preoperative anxiety. Results: Sixty percent of patients had preoperative anxiety (STAI-S ≥37). An APAIS score of 10 identified preoperative anxiety with a sensitivity, specificity, and positive predictive value of 97%, 96%, and 97%, respectively. Right-sided tumor location (P=0.047) and need-for-information on surgery (P=0.007) were independent predictors of preoperative anxiety. Conclusions: Patients with supratentorial neoplasms have a high incidence of preoperative anxiety; an APAIS score of 10 is the optimal cutoff to identify anxious patients in the preoperative period. Need-for-information about surgery and right-sided tumor laterality are independent predictors of preoperative anxiety.
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Type 2 diabetes mellitus (T2DM) is an independent risk factor of Alzheimer’s disease (AD), and thus identifying who among the increasing T2DM populations may develop into AD is important for early intervention. By using TMT-labeling coupled high-throughput mass spectrometry, we conducted a comprehensive plasma proteomic analysis in none-T2DM people (Ctrl, n = 30), and the age-/sex-matched T2DM patients with mild cognitive impairment (T2DM-MCI, n = 30) or T2DM without MCI (T2DM-nMCI, n = 25). The candidate biomarkers identified by proteomics and bioinformatics analyses were verified by ELISA, and their diagnostic capabilities were evaluated with machine learning. A total of 53 differentially expressed proteins (DEPs) were identified in T2DM-MCI compared with T2DM-nMCI patients. These DEPs were significantly enriched in multiple biological processes, such as amyloid neuropathies, CNS disorders, and metabolic acidosis. Among the DEPs, alpha-1-antitrypsin (SERPINA1), major viral protein (PRNP), and valosin-containing protein (VCP) showed strong correlation with AD high-risk genes APP, MAPT, APOE, PSEN1, and PSEN2. Also, the levels of PP2A cancer inhibitor (CIP2A), PRNP, corticotropin-releasing factor-binding protein (CRHBP) were significantly increased, while the level of VCP was decreased in T2DM-MCI patients compared with that of the T2DM-nMCI, and these changes were correlated with the Mini-Mental State Examination (MMSE) score. Further machine learning data showed that increases in PRNP, CRHBP, VCP, and rGSK-3β(T/S9) (ratio of total to serine-9-phosphorylated glycogen synthase kinase-3β) had the greatest power to identify mild cognitive decline in T2DM patients.
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Objectives Patients with dementia show dissociations between musical semantic memory (i.e., spared musical lexicon) and other memory modalities, except in some severe cases. We aim to study, from a neuropsychological point of view, the dissociation between musical semantic memory compared to language and verbal memory in a patient with severe Behavioral Variant Frontotemporal Dementia (bvFTD). We hypothesize a single dissociation between these domains will be found, with sparing of musical semantic memory. Methods LC, a patient with severe bvFTD, and three matched controls were assessed through language, semantic, and episodic memory, and musical semantic memory tasks. The control group had similar music taste as LC: to participate as controls, tango must be one of their favorite musical genres. Results LC showed impairment in all Verbal Memory tasks, but not in musical tasks. There was a dissociation between musical semantic memory, and language and verbal semantic memory. Conclusions The musical lexicon can be preserved in advanced stages of dementia, which supports the idea that music can be a therapeutic tool in patients with severe dementia.
Article
Aims To explore and summarize studies investigating the effect of arts and culture interventions for people living with dementia and their caregivers on the well-being and cognition of the person living with dementia and, caregiver strain. Methods We carried out a systematic search of five electronic databases (PubMed, PsychINFO, Embase, CINAHL, and Cochrane Library). We included original research published in peer-reviewed journals including both qualitative and quantitative studies. We assessed quality of included studies using the Cochrane Collaboration’s Risk of Bias tools. A narrative synthesis was conducted of all included studies. Results Of the 4827 articles screened, 34 articles met inclusion criteria. A variety of interventions were identified, with more than half taking place in a museum or gallery. Five RCTs showed improvements in wellbeing outcomes but no cognitive improvements except in some subscales in a music intervention. Most non-randomised studies reported cognitive improvements and well-being improvements for people living with dementia and their caregivers. Studies primarily focused on individuals with mild to moderate dementia. Conclusions The use of arts and culture interventions may provide benefits for people living with dementia and their caregivers. However, heterogeneity of the interventions and outcome measures prevented generalization of the results. Further research of arts and culture interventions for people living with dementia and their caregivers should utilize larger controlled trials, standardized outcome measures and include individuals with moderate to severe dementia.
Article
Objective: Dementia among migrants is an emerging phenomenon worldwide and the development of neuropsychological tests sensitive to cultural differences is increasingly regarded as a priority. The Clock Drawing Test (CDT) is one of the most used screening tools for the detection of cognitive decline. Nevertheless, there is still a debate about its adoption as a cross-cultural assessment. Methods: To identify cultural variables influencing performance at CDT, we performed a systematic review of literature on three databases of all studies considering the role of at least one of the following: (1) language; (2) education; (3) literacy; (4) acculturation; and (5) ethnicity. Results: We extrapolated 160 analyses from 105 studies. Overall, an influence of cultural determinants on performance at CDT was found in 127 analyses (79.4%). Regarding specific cultural factors, 22 analyses investigated the effect of ethnicity on CDT scores, reporting conflicting results. Only two scoring systems turned out to be sufficiently accurate in a multicultural population. Language influenced performance in only 1 out of 8 analyses. A higher level of education positively influenced test performance in 118 out of 154 analyses (76.6%), and a better quality of education in 1 analysis out of 2. A negative influence of illiteracy on CDT performance emerged in 9 out of 10 analyses. Acculturation affected performances at CDT in 1 out of 2 studies. Conclusions: Based on the present findings, caution is needed when using CDT in a multicultural context, even if it requires limited linguistic competence.
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The COVID‐19 pandemic has highlighted the need for further research evaluating the validity of conducting a battery of neuropsychological assessments virtually compared with face‐to‐face administration. Previous research has suggested that some neuropsychological assessments yield valid results when administered virtually, however, much of the previous research focused on older adults. To determine the validity of virtually administered neuropsychological tests, 28 healthy participants were assessed using a within‐subjects, counter‐balanced design. Participants completed a neuropsychological assessment battery covering tests of general intellectual functioning, memory and attention, executive functioning, language and information processing speed, as well as effort. There was no significant difference between face‐to‐face administration of the neuropsychological battery compared with virtual administration for the majority of the tests used. However, there were significant differences in the Colour Naming Task, with participants making fewer errors on the colour naming task and inhibition/switching task when administered virtually compared with face‐to‐face administration. There was also a significant age cohort effect in the inhibition/switching task. There was also a trending significant difference in mode of administration for the Verbal Fluency Task. Virtually administered neuropsychological assessments largely provide a valid alternative to face‐to‐face assessments; however, consideration must be given to test selection as well as the population of participants that are being assessed. Other important considerations must focus on preserving the security and integrity of test materials, as well as administration in a medico‐legal setting. Future research should focus on validating assessments with specific patient populations and developing a neuropsychological assessment battery using information technology.
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Propofol is widely used in clinical anesthesia due to its advantages of rapid onset and less adverse reactions. This study focused on the role of propofol in the balance of Th17/Treg in elderly patients with lung cancer during perioperative period. Patients undergoing lung cancer surgery were anesthetized by propofol or sevoflurane. Veinal blood was collected at different time points to evaluate the changes of Th17/Treg cell. Propofol better maintained the balance of Th17/Treg in vivo. The peripheral blood of patients with lung cancer was collected in vitro before surgery. Cluster of differentiation (CD)4 ⁺ T cells were obtained and then treated with propofol at different concentrations and γ-aminobutyric acid A (GABAA) receptor antagonists. Propofol affected Th17/Treg cell balance by increasing Th17 cells, decreasing Treg cells, thus elevating Th17/Treg ratio, and inhibited invasion and migration of lung cancer cells through GABAA receptor, which was counteracted by GABAA receptor inhibitors. Subsequently, tumor in situ model of lung cancer in aged mice was established. Propofol anesthetized mice had lower change of Th17/Treg ratio, higher survival rate and less metastasis. In brief, propofol regulated balance of Th17/Treg in elderly patients undergoing lung cancer surgery through GABAA receptor. Additionally, propofol could inhibit metastasis of lung cancer.
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This study aims to analyse the association between walkability index and depressive symptoms and cognitive impairment and test the mediating role of moderate-vigorous physical activity (MVPA) in this relationship among older adults from Florianópolis, Brazil. This is cross-sectional research with data from the third wave of the EpiFloripa Aging cohort study, conducted in 2017–2019. Depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS), and cognitive impairment, using the Mini-Mental State Examination (MMSE) scales. The neighbourhood environment was assessed using a walkability index, which considered 500-m network buffers around the participants’ homes. Binary logistic regression analysis the association between the walkability index (quartile) and mental health outcomes (yes vs . no). Structural equation modelling evaluated the mediation between the walkability index and cognitive impairment by MVPA with an estimator of dichotomous variables. 1,162 people participated in the study (61.5% women, average age = 73.1). Older adults residing in places with a high and highest walkability index were 38% and 44% less likely to have cognitive impairment, respective. There was no association between depressive symptoms and walkability index in crude nor adjusted analysis. Engaging in MVPA had a partial but not significant effect (14%; p = 0.087), showing a tendency for this relationship to be partially explained by the greater engagement in physical activities in places with greater walkability. Policy planning to prevent and reduce the risks of cognitive impairment should consider factors of the physical environment as determinants in older adults.
Article
Purpose: Dehydration is highly prevalent in hospitalized older adults and has been linked to poor outcomes. It is considered a modifiable factor, so early identification and intervention may avoid adverse events and improve quality of life after discharge. Hospital-associated disability (HAD) is known to be a poor prognostic factor and can be categorized into mobility impairment and self-care impairment in setting goals for management. Few studies have directly examined the association between dehydration and HAD and therefore here we examined whether dehydration is a predictor of HAD categorized into mobility and self-care impairment among acute hospitalized older adults. Methods: Patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital were recruited for this prospective cohort study. Estimated serum osmolarity > 300 mOsm/kg was defined as current dehydration. HAD was assessed between baseline and discharge and at 3 months after discharge, and was evaluated separately for mobility and self-care impairments. Results: In total, 192 patients (mean age, 84.7 years; male, 41.1%; dehydration, 31.3%) were analyzed. The occurrence of HAD was significantly higher in the dehydrated group than in the non-dehydrated group (42.4% vs 26.5%) from baseline to 3 months after discharge. In multiple logistic regression analysis, dehydration was significantly associated with HAD in self-care from baseline to 3 months after discharge (odds ratio, 2.25; 95% confidence interval, 1.03-4.94). Conclusions: Dehydration could predict the occurrence of HAD in acute hospitalized older adults. A multifaceted approach may be necessary to improve the management of dehydration in these patients.
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Introduction Alzheimer’s disease (AD) is a neurodegenerative disorder that affects memory, thinking, attention, and emotion or AD. Smelling problems are frequent symptoms of dementia. The aim of this study was to evaluate whether it is possible to predict if someone with anosmia or hyposmia has a higher risk of getting dementia or even AD. Methods This study was a retrospective longitudinal study, and the data used were part of a larger research project, the Vienna Conversion to Dementia Study. The 173 participants were divided into four groups based on cognitive features such as healthy control (HC), subjective cognitive decline (SCD), non-amnestic mild cognitive impairment (naMCI), and amnestic mild cognitive impairment (aMCI). Olfactory assessment and neurocognitive assessment were administered. Results We found that 30.5% of aMCI patients converted into AD after an average of about two years. The corresponding ROC analyses for olfactory testing showed that Sniffin’ Sticks revealed significant results regarding the conversion to AD, whereas the Assessment of Self-Reported Olfactory Functioning and olfaction-related quality of life (ASOF) inventory using the Subjective Olfactory Capability (SOC) subscale, the Smell-Related Problems (SRP) subscale, and the Olfaction-Related Quality of life (ORQ) did not. A logistic regression showed that among the olfactory test procedures, only the Sniffin’ Sticks enabled a relevant prognosis. Including neurocognitive measures in the model, only VSRT and the Trail Making Test-B. The other predictors did not contribute to the prediction of conversion to AD. Conclusion Unlike self-reporting of olfactory functioning, olfactory testing using standardized tests may have potential for predicting dementia, especially AD. However, olfactory tests have lower predictive power than neurocognitive tests such as verbal memory and divided attention tests. Implications Diagnostic tools for predicting dementia as accurately and early as possible are important. Olfactory assessment, compared to neurocognitive tests for verbal memory and divided attention, is inferior in predicting the prognosis of AD.
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Little research examined the decision-making preferences of older, racially and ethnically diverse minority patients with untreated depression. The study’s aims were to identify decision-making preferences and the characteristics associated with a more active preference in the decision-making process for general medical and depression treatment decisions. We assessed the preferred involvement in making general medical and depression treatment decisions of 201 older primary care patients with untreated depression. Linear regressions examined the association of sociodemographic and clinical characteristics with decision-making preference for both decision types. Majority of patients preferred shared decision-making for general medical and depression treatments. Female gender was associated with a preference for active decision-making for depression treatment. For this sample older depressed patients preferred sharing the decision-making responsibilities with physicians. To improve communication and the initiation and adherence to mental health care, physicians must consider older, minority patients’ preferences for involvement in the decision-making process.
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Background: Considering the strong correlation made between Alzheimer’s disease (AD) and the pathology of glucose metabolism disorder, we sought to analyze the effects of fasting blood glucose (FBG) level, fasting plasma insulin (FINS) level, and insulin resistance index (HOMA-IR) on the risk and severity of AD. Objective: Reveal the pathological relationship between AD and insulin resistance. Methods: We searched 5 databases from inception through April 4, 2022. Meta-regression was conducted to identify if there were significant differences between groups. Shapiro-Wilk test and the Q-Q diagram were applied to evaluate the normality of variables. A multiple logistic regression model was employed to explore the association between FBG, FINS, HOMA-IR, and Mini-Mental State Examination scale score (MMSE). Results: 47 qualified articles including 2,981 patients were enrolled in our study. FBG (p < 0.001), FINS (p < 0.001), and HOMA-IR (p < 0.001) were higher in AD patients than in controls. HOMA-IR was negatively correlated with MMSE (p = 0.001) and positively related to the sex ratio (male versus female) (p < 0.05). HOMA-IR obeyed lognormal distribution (p > 0.05), and the 95% bilateral boundary values were 0.73 and 10.67. FBG (p = 0.479) was positively correlated to MMSE, while FINS (p = 0.1657) was negatively correlated with MMSE. Conclusion: The increase in the levels of FBG, FINS, and HOMA-IR served as precise indicators of the risk of AD. HOMA-IR was found to be correlated to the increasing severity of AD, especially in male AD patients.
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Background: Amyloid-β (Aβ) plaques and tau protein tangles in the brain are the defining ‘A’ and ‘T’ hallmarks of Alzheimer’s disease (AD), and together with structural atrophy detectable on brain magnetic resonance imaging (MRI) scans as one of the neurodegenerative (‘N’) biomarkers comprise the “ATN framework” of AD. Current methods to detect Aβ/tau pathology include cerebrospinal fluid (invasive), positron emission tomography (PET; costly and not widely available), and blood-based biomarkers (promising but mainly still in development). Objective: To develop a non-invasive and widely available structural MRI-based framework to quantitatively predict the amyloid and tau measurements. Methods: With MRI-based hippocampal multivariate morphometry statistics (MMS) features, we apply our Patch Analysis-based Surface Correntropy-induced Sparse coding and max-pooling (PASCS-MP) method combined with the ridge regression model to individual amyloid/tau measure prediction. Results: We evaluate our framework on amyloid PET/MRI and tau PET/MRI datasets from the Alzheimer’s Disease Neuroimaging Initiative. Each subject has one pair consisting of a PET image and MRI scan, collected at about the same time. Experimental results suggest that amyloid/tau measurements predicted with our PASCP-MP representations are closer to the real values than the measures derived from other approaches, such as hippocampal surface area, volume, and shape morphometry features based on spherical harmonics. Conclusion: The MMS-based PASCP-MP is an efficient tool that can bridge hippocampal atrophy with amyloid and tau pathology and thus help assess disease burden, progression, and treatment effects.
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Tanımlayıcı ve kesitsel tipteki bu çalışmanın amacı, 65 yaş ve üstü bireylerde sosyal dışlanma ile başarılı yaşlanma durumlarının incelenmesidir. Çalışma, Şubat - Nisan 2022 tarihleri arasında bir eğitim ve araştırma hastanesinin genel cerrahi polikliniğine gelen 65 yaş ve üzeri bireylerle gerçekleştirildi. Araştırmada, ilgili tarihlerde dahil edilme kriterlerine uyan tüm yaşlı bireyler araştırmaya dahil edildi. Kriterlere uyan 116 birey çalışma kapsamına alındı. Çalışmaya katılan bireylerin yaş ortalaması 71.30±3.82 (min.65, max.80) olup, %65.5’inin evli olduğu, %56’sının kendi evinde oturduğu, %80.2’sinin sosyal güvencesi olduğu ve %88.8’inin devlet yardımı almadığı belirlendi. Bireylerin sosyodemografik özellikleri ile Başarılı Yaşlanma ve Sosyal Dışlanmışlık ölçek puanları arasında anlamlı bir farklılık bulunmadı. Başarılı Yaşlanma ve Sosyal Dışlanmışlık ölçek puanları arasında ise, negatif yönde zayıf düzeyde bir ilişki saptandı. Bu çalışmanın sonucunda, sosyal dışlanmanın ve başarılı yaşlanmanın sosyodemografik özelliklerden etkilenmediği; ancak sosyal dışlanması yüksek olan yaşlılarda başarılı yaşlanmaya ilişkin durumlarının daha düşük olduğu görülmektedir.
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Objective: To evaluate the main symptoms of the upper gastrointestinal dysfunction (salivation and swallowing disorders) and to determine their impact on the quality of life for patients with PD of stages I-III, as well as the possibility of their correction by dopamine receptor agonists. Material and methods: 252 patients (128 women and 124 men, 42-80 years old) with PD of stages I-III were examined using: UPDRS items «salivation», «swallowing» and «anorexia», scale of daily activity (Schwab and England ADL scale), questionnaire quality of life (PDQ-39), measurement of saliva amount, BMI, MMSE scale; 53 patients were treated with piribedil during 6 months. Results: The upper gastrointestinal tract dysfunction of mild to moderate severity was detected in 51.2% of patients. The prevalence of sialorrhea was 38.9, 42.9 and 46.2%, and that of dysphagia was 22.2, 24.3 and 17.3% at stages I-III, respectively. According to the results of the correlation analysis dysphagia is associated with a long history of PD, low BMI, high doses of levodopa and low Sch & En score; and sialorrhea is also associated with low BMI and with old age. For the early stages of PD we can tell, that the quality of patients' life deteriorates, and this to a large extent is due to impaired salivation and swallowing, which manifest themselves in daily activity and communication difficulties. Conclusions: The inclusion of piribedil (150-250 mg/day) in the 6-months therapy reduces the dysfunction of the upper gastrointestinal tract (by 61 and 74% of the initial level of dysphagia and sialorrhea, respectively) regardless the drug use in monotherapy or in complex therapy with levodopa.
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The objective of this study was to validate the Attention, Memory, and Frontal-Executive Abilities Screening Test (AMFAST) in a sample of children, adolescents, and young adults with complex medical conditions characterized by frontal-subcortical dysfunction. Toward this goal, we first report on scoring corrections to the AMFAST for younger participants (ages 8–10), thereby expanding its use beyond the age range (i.e., ages 11+) that we had validated in our previous study. We then examined the diagnostic utility of the AMFAST at identifying different levels of neurocognitive dysfunction in a clinical sample of 61 children, adolescents, and young adults (ages 8–20) with complex medical conditions who also underwent comprehensive neuropsychological testing. We identified two AMFAST cutoff scores; one that optimally distinguished participants with significant neurocognitive dysfunction from non-impaired participants and another that differentiated participants with more subtle, mild neurocognitive dysfunction from non-impaired participants. These findings demonstrate that the AMFAST is a highly effective screening test that can be used to identify varying levels of frontal-subcortical deficits in younger patient populations.
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Levodopa-induced dyskinesia (LID) is a common motor complication in Parkinson disease (PD). Abnormal substantia nigra hyperechogenicity (SN+), detected by transcranial sonography (TCS), plays an important role in the differential diagnosis of PD. The purpose of this study was to investigate the predictive performance of quantitative SN+ evaluations for LID. Five hundred sixty-two individuals were included in our analysis, and 198 individuals were followed up. These individuals were divided into two groups at baseline: the PD with LID (PD+LID) group and the PD without LID (PD-LID) group. The association between total hyperechogenic area of the SN on both sides (SNT) and LID was analyzed by binary logistic analysis. A binary logistic regression model including SNT was applied to establish a model for discriminating LID. At baseline, 105 (18.7%) individuals were diagnosed with LID. The PD+LID group had a longer disease duration, shorter education duration, higher levodopa equivalent doses, greater disease severity and larger SNT. A model combining clinical features and SNT was further established with better efficiency (area under the receiver operating characteristic curve = 0.839). One hundred ninety-eight individuals were followed up; individuals with a larger SNT and a higher predicted probability were more likely to develop LID in our follow-up. Our study determined that quantitative TCS evaluation of SN echogenicity is useful in predicting LID in PD.
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Introduction Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an innovative method for the unilateral treatment of essential tremor (ET) and Parkinson's disease (PD) related tremor. Our aim was to assess cognitive changes following MRgFUS thalamotomy to better investigate its safety profile. Methods We prospectively investigated the cognitive and neurobehavioral profile of patients consecutively undergoing MRgFUS within a 2-year period. Patients had a comprehensive clinical and neuropsychological assessment before and six months after MRgFUS thalamotomy. Results The final sample consisted of 40 patients (males 38; mean age±SD 67.7 ± 10.7; mean disease duration±SD 9.3 ± 5.6; ET 22, PD 18 patients). For the whole sample, improvements were detected in tremor (Fahn-Tolosa-Marin Clinical Rating Scale for tremor 35.79 ± 14.39 vs 23.03 ± 10.95; p < 0.001), anxiety feelings (Hamilton Anxiety rating scale 5.36 ± 3.80 vs 2.54 ± 3.28, p < 0.001), in the overall cognitive status (MMSE 25.93 ± 3.76 vs 27.54 ± 2.46, p 0.003; MOCA 22.80 ± 4.08 vs 24.48 ± 3.13, p < 0.001), and in quality of life (Quality of life in Essential Tremor Questionnaire 36.14 ± 12.91 vs 5.14 ± 6.90, p < 0.001 and PD Questionnaire-8 5.61 ± 4.65 vs 1.39 ± 2.33, p 0.001). No changes were detected in frontal and executive functions, verbal fluency and memory, abstract reasoning and problem-solving abilities. Conclusion Our study moves a step forward in establishing the cognitive sequelae of MRgFUS thalamotomy and in endorsing effectiveness and safety.
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Genetic variants in UMOD associate with kidney function and hypertension. These phenotypes are also linked to sex-related differences and impairment in cognitive and physical function in older age. Here we evaluate longitudinal associations between a common UMOD rs4293393-A>G variant and changes in estimated glomerular filtration rate (eGFR), blood pressure (BP), cognitive and physical function parameters in older participants in the BASE-II after long-term follow-up as part of the GendAge study. Overall, 1010 older participants (mean age 75.7 ± 3.7 years, 51.6% women) were analyzed after follow-up (mean 7.4 years) both in cross-sectional analysis and in longitudinal analysis as compared to baseline. In cross-sectional analysis, heterozygous G–allele carriers exhibited significantly higher eGFR values (AA, 71.3 ml/min/1.73 m2, 95% CI, 70.3–72.3 vs. AG, 73.5 ml/min/1.73 m2, 95% CI, 72.1–74.9, P = 0.033). Male heterozygous G-allele carriers had lower odds of eGFR < 60 mL/min/1.73 m2 (OR 0.51, 95% CI, 0.28–0.95, P = 0.032) and in Timed Up and Go-Test ≥ 10 s (OR 0.50, 95% CI, 0.29–0.85, P = 0.011) whereas women were less likely to have hypertension (OR 0.58, CI, 0.37–0.91, P = 0.018). UMOD genotypes were not significantly associated with longitudinal changes in any investigated phenotype. Thus, while the impact of UMOD rs4293393 on kidney function is maintained in aging individuals, this variant has overall no impact on longitudinal changes in BP, kidney, cognitive or functional phenotypes. However, our results suggest a possible sex-specific modifying effect of UMOD on eGFR and physical function in men and hypertension prevalence in women.
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Background Given the extensive evidence on improvements in cognitive inhibition immediately following exercise, and the literature indicating that cognitive and motor inhibitory functions are mediated by overlapping brain networks, the aim of this study was to assess, for the first time, the effect of moderate intensity acute aerobic exercise on multi-limb motor inhibition, as compared to cognitive inhibition. Method Participants were 36 healthy adults aged 40–60 years old (mean age 46.8 ± 5.7), who were randomly assigned to experimental or control groups. One-to-two weeks following baseline assessment, participants were asked to perform a three-limb (3-Limb) inhibition task and a vocal version of the Stroop before and after either acute moderate-intense aerobic exercise (experimental group) or rest (control). Results Similar rates of improvement were observed among both groups from baseline to the pre-test. Conversely, a meaningful, yet non-significant trend was seen among the experimental group in their pretest to posttest improvement in both cognitive and motor tasks. In addition, exploratory analysis revealed significant group differences in favor of the experimental group among highly fit participants on the 3-Limb task. A significant correlation was indicated between the inhibition conditions, i.e., choice in the motor inhibition and color/word (incongruent) in the cognitive inhibition, especially in the improvement observed following the exercise. Discussion Moderate-intensity acute aerobic exercise is a potential stimulator of both multi-limb motor inhibition and cognitive inhibition. It appears that high-fit participants benefit from exercise more than low-fit people. Additionally, performance on behavioral tasks that represent motor and cognitive inhibition is related. This observation suggests that fitness levels and acute exercise contribute to the coupling between cognitive and motor inhibition. Neuroimaging methods would allow examining brain-behavior associations of exercise-induced changes in the brain.
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Background Obesity and cognitive impairment prevalence increases as age increases. Recent growing evidence finds links between obesity and cognitive impairment in older adults. However, the association between the two is controversial. This study aims to identify obesity marker trajectory patterns, and to assess whether these patterns are associated with cognitive impairment and cognitive decline during a 10-year follow-up period among community-dwelling older adults. Methods A total of 626 older adults aged 65 and older were involved in the study, with at least two repeated measurements at baseline, one-year or 10-year follow-up. Cognitive function was measured through the Mini Mental State Examination. Obesity markers included body mass index, waist circumference, waist-to-hip (WHR), fat mass (FM), and abdominal fat (AF) measured by dual-energy X-ray absorptiometry. Multivariate logistic regression analyses were performed to estimate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of cognitive impairment and cognitive decline for obesity marker trajectory patterns. Results After a 10-year follow-up, 168 older adults with incident cognitive impairment and 156 with rapid cognitive decline were defined as the top 25th percentile of cognitive decline. Four distinct trajectory groups of obesity markers were identified. In multivariate logistic regression analyses, a low likelihood of cognitive impairment was observed in the consistently high-level group from FM trajectory (ORs = 0.41, 95% CI = 0.20–0.85); the high-level U-shaped group from WHR trajectory (0.43, 0.22–0.84); and the median-level flat inverse U-shaped, consistently high-level, and low-level flat U-shaped groups from AF trajectory (0.44, 0.26–0.77; 0.33, 0.18–0.61; 0.39, 0.18–0.82). In addition, a low likelihood of rapid decline was found in the low-level, slightly increasing trend group from WHR trajectory (0.43, 0.22–0.85). Conclusion FM and AF trajectories with consistent high levels and WHR trajectory with high level with U-shaped group are associated with low risks of incident cognitive impairment in older adults. Similarly, WHR trajectory with a low but slowly increasing trend is associated with a decreased risk of cognitive decline.
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Objective The study aimed to investigate predictive factors associated with outcome six months after mild to moderate aneurysmal subarachnoid hemorrhage (SAH). Methods We divided 136 patients (51 men and 85 women) after SAH (Hunt & Kosnik [H&K] grade I to III) into groups with good and poor outcome according to scores on the modified Rankin Scale (mRS) at six months after SAH onset: good outcome (mRS score, 0-1; n = 105) and poor outcome (mRS score, 2-6; n = 31). At admission, we assessed age, sex, H&K grade, and Fisher grade, and one month after aneurysmal SAH, we evaluated aneurysm location, treatment modality (coil embolization, clipping, or no surgical treatment), proportion of patients who underwent shunt placement, proportion of patients with delayed cerebral ischemia, and scores on neuropsychological tests (Mini-Mental State Examination, Raven’s Colored Progressive Matrices, Kana-hiroi Test, Trail Making Test, and Rey-Osterrieth Complex Figure Test, immediate recall). Results H&K grade was associated with outcome (χ²=6.220, P=0.005), and a significantly higher proportion of the good outcome group had an H&K grade II (P=0.025). The good outcome group had significantly better scores on the Mini-Mental State Examination (U=1251, P=0.045), Raven’s Colored Progressive Matrices (U=1224, P=0.036), and Trail Making Test parts A (U=1238, P=0.043) and B (U=1247, P=0.048). However, we found no significant intergroup differences in the other patient demographic and disease characteristics, including age, treatment modality, and delayed cerebral ischemia, or in the other neuropsychological assessments. Binary logistic regression analysis identified H&K grade I and II as predictive factors associated with good outcome. Conclusion Besides severity at admission as indicated by H&K grade, neuropsychological tests explicitly performed one month after mild to moderate aneurysmal SAH may help nursing staff to predict patient outcome, including possible symptoms after discharge.
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Background Older people with dementia (PWD) in nursing homes (NHs) tend to have decreased cognitive function, which may cause behavioral and psychological symptoms of dementia (BPSDs) and hinder activities of daily living (ADLs). Therefore, taking measures against the cognitive decline of PWD in NH and, in turn, the decline of BPSDs and ADLs is crucial. The purpose of this study was to test whether a multimodal non-pharmacological intervention (MNPI) is effective in maintaining and improving global cognitive function, BPSDs, and ADLs in PWD in NHs. Methods An intervention study using a single-case AB design was conducted in three subjects in NHs. During the non-intervention phase, participants underwent follow-up assessments, and during the intervention phase, they participated in an MNPI. The ABC Dementia Scale (which concurrently assesses ADLs [“A”], BPSDs [“B”], and cognitive function [“C”]) was used for the assessment. Results One of the three patients showed improvement in dementia severity, global cognitive function, ADLs, and BPSDs. However, the other two participants showed no improvement following the MNPI, although the possibility of a maintenance effect remained. Conclusion Although there is room for improvement of the MNPI, it may be effective in maintaining and improving cognitive function, ADLs, and BPSD, in PWD in NHs. Trial registration The University Hospital Medical Information Network Clinical Trials Registry ( http://www.umin.ac.jp/ , No. UMIN000045858, registration date: November 1, 2021).
Article
Introduction: Embedded performance validity tests (PVTs) may show increased positive findings in racially diverse examinees. This study examined positive findings in an older adult sample of African American (AA) and European American (EA) individuals recruited as part of a study on aging and cognition. Method: The project involved secondary analysis of deidentified National Alzheimer's Coordinating Center data (N = 22,688). Exclusion criteria included diagnosis of dementia (n = 5,550), mild cognitive impairment (MCI; n = 5,160), impaired but not MCI (n = 1,126), other race (n = 864), and abnormal Mini Mental State Examination (MMSE < 25; n = 135). The initial sample included 9,853 participants (16.4% AA). Propensity score matching matched AA and EA participants on age, education, sex, and MMSE score. The final sample included 3,024 individuals with 50% of participants identifying as AA. Premorbid ability estimates were calculated based on demographics. Failure rates on five raw score and six age-adjusted scaled score PVTs were examined by race. Results: Age, education, sex, MMSE, and premorbid ability estimate were not significantly different by race. Thirteen percent of AA and 3.8% of EA participants failed two or more raw score PVTs (p < .0001). On age-adjusted PVTs, 20.6% of AA and 5.9% of EA participants failed two or more (p < .0001). Conclusions: PVT failure rates were significantly higher among AA participants. Findings indicate a need for cautious interpretation of embedded PVTs with underrepresented groups. Adjustments to embedded PVT cutoffs may need to be considered to improve diagnostic accuracy.
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Three parallel forms of the clinical tests of the sensorium were devised, tried out and modified on two groups of 24 subjects. The final versions were further assessed by using each form in turn with 108 psychiatric patients. The three forms of tests gave scores with very similar means and standard deviations. They correlated moderately well when repeated.
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The aim of the research of which this study forms part, is to examine the relationship of certain aspects of mental functioning to the psychiatric illnesses of old age. One of the apparent deficits of function to which psychiatrists commonly attach importance is “memory impairment“. This is considered part of various clinical syndromes, especially of the “organic” disorders of senility. The assessment of memory is, therefore, of considerable practical importance and most psychiatrists working with elderly patients use some kind of “memory tests”. Such tests are usually unstandardized and lack objective scoring criteria. There are, in relation to memory assessment, some points of conflict between clinical usage and the evidence of objective psychological investigations. For example, the existence of a “memory function” which could be considered as relatively independent of general mental functioning or intelligence, has not been well substantiated when some such clinical tests have been put to critical examination. Eysenck and Halstead (2) after a brief review of the literature and an experimental attack on this problem, conclude that “… the ability involved in the clinical tests of memory studied in this research was identical with that involved in the intelligence test used, and that, therefore, it was misleading to accept scores on these various tests as estimates of a person's ‘memory’ ability.”