Self-reported tooth loss and cognitive function: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (Hispanic EPESE)

Objective:

To explore the association between tooth loss and cognitive functioning among persons 65 years and older.

Methods:

Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (Wave 1: 1993-1994, n= 3,032; Wave 2: 1995-1996, n= 2,424; and Wave 3: 1998-1999, n= 1,967). The dependent variables were the scores from the total Mini-Mental State Examination (MMSE: score 0-30) and its global domains (memory: score 0-6; and no-memory: score 0-24). Independent variables included the number of teeth (0-12 vs. 13-32), socio-demographic characteristics, last dental office visit, medical conditions, depressive symptoms, and functional limitations which were tested for associations with the dependent variables.

Results:

In bivariate analyses, participants with fewer teeth (0-12) tended to have significantly lower mean scores for memory, no-memory, and total MMSE when compared to those with more teeth (13-32), both at baseline and at follow-up. In fully adjusted longitudinal-mixed models, participants with fewer teeth had a greater decline in total MMSE through five years of follow-up with a decrease of 0.12 fewer points each year (SE ± 0.05, p <0.01), when compared to those with more teeth.

Conclusion:

Having fewer teeth was associated with greater cognitive decline over time.     

Community Integration and Quality of Life in Aphasia after Stroke

Purpose

To examine community integration and contributing factors in people with aphasia (PWA) following stroke and to investigate the relationship between community integration and quality of life (QOL).

Materials and Methods

Thirty PWA and 42 age-and education-matched control subjects were involved. Main variables were as follows: socioeconomic status, mobility, and activity of daily living (ADL) (Modified Barthel Index), language function [Frenchay Aphasia Screening Test (FAST)], depression [Geriatric Depression Scale (GDS)], Community Integration Questionnaire (CIQ) and Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39). Differences between aphasia and control groups and factors affecting community integration and QOL were analyzed.

Results

Home and social integration and productive activity were significantly decreased in the aphasia group compared to the control group; 8.5 and 18.3 points in total CIQ score, respectively. Amount of time spent outside the home and frequency of social contact were also significantly reduced in the aphasia group. Total mean score on the SAQOL-39 was 2.75±0.80 points and was significantly correlated with economic status, gait performance, ADL, depressive mood, and social domain score on the CIQ. Depression score measured by GDS was the single most important factor for the prediction of QOL, but the FAST score was significantly correlated only with the communication domain of the SAQOL-39.

Conclusion

Community activities of PWA were very limited, and depression was highly associated with decreased community integration and QOL. Enhancing social participation and reducing emotional distress should be emphasized for rehabilitation of PWA.     

Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro,Brazil: the FIBRA-RJ Study

OBJECTIVE:

Frailty syndrome can be defined as a state of vulnerability to stressors resulting from a decrease in functional reserve across multiple systems and compromising an individual''s capacity to maintain homeostasis. The purpose of this study was to determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities in a sample of community-dwelling older individuals who are clients of a healthcare plan.

METHODS:

We evaluated 847 individuals aged 65 years or older who lived in the northern area of the city of Rio de Janeiro, Brazil. The subjects were selected by inverse random sampling and stratified by gender and age. To diagnose frailty, we used the scale proposed by the Cardiovascular Health Study, which consisted of the following items: low gait speed, grip strength reduction, feeling of exhaustion, low physical activity and weight loss. The data were collected between 2009 and 2010, and the frailty prevalence was calculated as the proportion of individuals who scored positive for three or more of the five items listed above. To verify the association between frailty and risk factors, we applied a logistic regression analysis.

RESULTS:

The prevalence of frailty syndrome was 9.1% (95% confidence interval [CI], 7.3-11.3); 43.6% (95% CI, 40.3-47) of the individuals were considered robust, and 47.3% (95% CI 43.8-50.8) were considered pre-frail (p<0.001). The frail individuals tended to be older (odds ratio [OR] 13.2, 95% CI, 8.7-20) and have lower education levels (OR 2.1, 95% CI, 1-4.6), lower cognitive performance (OR 0.76, 95% CI, 0.73-0.79) and reduced health perception (OR 65.8, 95% CI, 39.1-110.8). Frail individuals also had a greater number of comorbidities (OR 6.6, 95% CI, 4.4-9.9) and worse functional capacity (OR 3.8, 95% CI, 2.9-5).

CONCLUSION:

The prevalence of frailty was similar to that seen in other international studies and was significantly associated with educational level, cognition, comorbidities, functional capacity, perception of health and old age.     

The influence of vascular risk factors on cognitive decline in patients with Alzheimer's Disease

Introduction

The influence of vascular risk factors (VRFs) on the rate of cognitive decline in patients with established dementia is unclear. This study aims to examine the association between VRFs and the rate of cognitive decline in patients with Alzheimer's disease (AD).

Methods

Data were obtained from patients visiting a memory clinic between 2004 and 2012. VRFs were determined at baseline and included hypertension, hypercholesterolemia, diabetes mellitus, overweight and smoking. Continuous values of blood pressure, total cholesterol, glucose level and body mass index were also obtained. Mini-Mental State Exam (MMSE) scores were obtained at baseline and during follow-up visits. The association between VRFs and the annual change in MMSE scores was analysed with a multivariable linear mixed model adjusted for age, sex and the aforementioned VRFs.

Results

From 174 patients (mean age 78.3 years), with a follow-up time up to 5.8 years (mean 1.1 year), in total 447 MMSE scores were obtained. The multivariable analyses showed an association between age as well as systolic blood pressure and a decline in annual rates of change in MMSE scores of −0.05 (95% confidence interval (CI): −0.09 to 0.00) and −0.01 (CI: −0.03 to 0.00), respectively. For all other VRFs, including sex, patients did not show a significant difference.

Conclusion

This study did not find an association between preventable vascular risk factors and cognitive decline in patients with AD, except for systolic blood pressure. As the association between systolic blood pressure and decline in MMSE was small, clinical relevance may be limited.     

Detection of cognitive impairment in the elderly by general internists in Brazil

BACKGROUND:

Cognitive impairment, from mild forms to dementia, is an important social and health concern, principally among older individuals. Elderly patients are usually followed by general internists, who may overlook this condition.

OBJECTIVE:

Our aim was to determine whether cognitive impairment diagnosed by specialists had been previously detected by general internists.

SUBJECTS AND METHODS:

A total of 248 elderly individuals randomly selected from a list of outpatients seen by general internists in a public university hospital in São Paulo, Brazil, were evaluated by a geriatrician. Patients were then classified as having probable cognitive impairment or not, based on their performance on the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly. Cases of probable impairment were submitted to routine laboratory investigation, brain computed tomography, and neuropsychological evaluation. The final diagnoses were established by a consensus panel comprising two neurologists and the geriatrician who evaluated the patients using all available data. General internists'' files for all cognitively impaired cases and for a selected sample of individuals without cognitive impairment were checked for any record of cognitive complaints or decline.

RESULTS:

Forty-three patients were classified as demented (n = 21) or as cognitively impaired but not demented (n = 22). The evaluation of the general internists'' files revealed that information on cognitive complaints or decline was recorded for seven (16.3%) of the 43 patients with dementia or cognitive impairment without dementia.

CONCLUSIONS:

General internists seldom detected cognitive decline in elderly patients in Brazil. Further studies should be conducted to elucidate the reasons for this low rate of detection.     

Sleep deprivation and interference by emotional distracters

Study Objectives:

We determined if sleep deprivation would amplify the effect of negative emotional distracters on working memory.

Design:

A crossover design involving 2 functional neuroimaging scans conducted at least one week apart. One scan followed a normal night of sleep and the other followed 24 h of sleep deprivation. Scanning order was counterbalanced across subjects.

Setting:

The study took place in a research laboratory.

Participants:

24 young, healthy volunteers with no history of any sleep, psychiatric, or neurologic disorders.

Interventions:

N/A

Measurements and Results:

Study participants were scanned while performing a delayed-response working memory task. Two distracters were presented during the maintenance phase, and these differed in content: highly arousing, negative emotional scenes; low-arousing, neutral scenes; and digitally scrambled versions of the pictures. Irrespective of whether volunteers were sleep deprived, negative emotional (relative to neutral) distracters elicited greater maintenance-related activity in the amygdala, ventrolateral prefrontal cortex, and fusiform gyri, while concurrently depressing activity in cognitive control regions. Individuals who maintained or increased distracter-related amygdala activation after sleep deprivation showed increased working memory disruptions by negative emotional distracters. These individuals also showed reduced functional connectivity between the amygdala and the ventromedial and dorsolateral prefrontal cortices, regions postulated to mediate cognitive control against emtional distraction.

Conclusions:

Increased distraction by emotional stimuli following sleep deprivation is accompanied by increases in amygdala activation and reduced functional connectivity between the amygdala and prefrontal cognitive control regions. These findings shed light on the neural basis for interindividual variation in how negative emotional stimuli might distract sleep deprived persons.

Citation:

Chuah LYM; Dolcos F; Chen AK; Zheng H; Parimal S; Chee MWL. Sleep deprivation and interference by emotional distracters. SLEEP 2010;33(10):1305-1313.     

Severity classification for idiopathic pulmonary fibrosis by using fuzzy logic

OBJECTIVE:

To set out a severity classification for idiopathic pulmonary fibrosis (IPF) based on the interaction of pulmonary function parameters with high resolution computed tomography (CT) findings.

INTRODUCTION:

Despite the contribution of functional and radiological methods in the study of IPF, there are few classification proposals for the disease based on these examinations.

METHODS:

A cross-sectional study was carried out, in which 41 non-smoking patients with IPF were evaluated. The following high resolution CT findings were quantified using a semi-quantitative scoring system: reticular abnormality, honeycombing and ground-glass opacity. The functional variables were measured by spirometry, forced oscillation technique, helium dilution method, as well as the single-breath method of diffusing capacity of carbon monoxide. With the interaction between functional indexes and high resolution CT scores through fuzzy logic, a classification for IPF has been built.

RESULTS:

Out of 41 patients studied, 26 were male and 15 female, with a mean age of 70.8 years. Volume measurements were the variables which showed the best interaction with the disease extension on high resolution CT, while the forced vital capacity showed the lowest estimative errors in comparison to total lung capacity. A classification for IPF was suggested based on the 95% confidence interval of the forced vital capacity %: mild group (≥92.7); moderately mild (76.9–92.6); moderate (64.3–76.8%); moderately severe (47.1–64.2); severe (24.3–47.0); and very severe (<24.3).

CONCLUSION:

Through fuzzy logic, an IPF classification was built based on forced vital capacity measurement with a simple practical application.     

The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood

Study Objectives:

(1) to determine the associations of sleep disordered breathing (SDB) with behavioral functioning, cognitive test scores, and school grades during middle- to late-childhood, an under-researched developmental period in the SDB literature, and (2) to clarify whether associations between SDB and school grades are mediated by deficits in cognitive or behavioral functioning.

Design:

Cross-sectional correlative study.

Setting:

Office/hospital, plus reported functioning at home and at school.

Participants:

163 overweight subjects aged 10-16.9 years were divided into 4 groups based upon their obstructive apnea+hypopnea index (AHI) during overnight polysomnography and parent report of snoring: Moderate-Severe OSA (AHI > 5, n = 42), Mild OSA (AHI = 1-5, n = 58), Snorers (AHI < 1 + snoring, n = 26), and No SDB (AHI < 1 and nonsnoring, n = 37).

Measurements:

Inpatient overnight polysomnography, parent- and self-report of school grades and sleep, parent- and teacher-report of daytime behaviors, and office-based neuropsychological testing.

Results:

The 4 groups significantly differed in academic grades and parent- and teacher-reported behaviors, particularly inattention and learning problems. These findings remained significant after adjusting for subject sex, race, socioeconomic status, and school night sleep duration. Associations with SDB were confined to reports of behavioral difficulties in real-world situations, and did not extend to office-based neuropsychological tests. Findings from secondary analyses were consistent with, but could not definitively confirm, a causal model in which SDB affects school grades via its impact on behavioral functioning.

Conclusions:

SDB during middle- to late-childhood is related to important aspects of behavioral functioning, especially inattention and learning difficulties, that may result in significant functional impairment at school.

Citation:

Beebe DW; Ris MD; Kramer ME; Long E; Amin R. The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. SLEEP 2010;33(11):1447-1456.     

Using a patient-generated mental-health measure ‘PSYCHLOPS’ to explore problems in patients with coronary heart disease

Background

Patients with coronary heart disease (CHD) who are depressed have an increased risk of further cardiac events and higher mortality.

Aim

To use a patient generated instrument (PSYCHLOPS) to define categories of concerns in patients with CHD. To define the psychometric characteristics of patients in each category.

Design and setting

Cross-sectional study set in general practices in south London.

Method

Of 3325 patients on the CHD registers in 15 general practices, 655 completed six baseline psychometric and functional instruments: PSYCHLOPS, HADS-Depression, HADS-Anxiety, Clinical Interview Schedule – Revised, SF12-Mental and SF12-Physical. Content analysis was used to categorise patients based on their main problem, as elicited by PSYCHLOPS. Mean psychometric scores were adjusted for confounding by age, sex, deprivation and ethnicity and calculated for each response category.

Results

Response categories were: physical problems, both non-cardiac (23.2%) and cardiac (6.0%); social problems: relationship/family (18.2%), money (7.5%), work (3.1%); functional (9.8%); psychological (6.9%); miscellaneous (7.3%); ‘no problem’ (18.2%). The highest psychological distress scores were found in ‘physical, cardiac’ and ‘psychological’ categories. The ‘no problem’ category had significantly lower psychological distress and higher functional capacity than other categories.

Conclusions

PSYCHLOPS enabled the identification of subtypes of CHD patients, based on a classification of self-reported problems. A high proportion of CHD patients report social problems. Psychological distress was highest in those reporting cardiac or psychological symptoms. Services should be aligned to the reported needs of patients.     

Brain Activation Changes Before and After PAP Treatment in Obstructive Sleep Apnea

Study Objectives:

Obstructive sleep apnea syndrome (OSAS) is associated with cognitive and functional deficits, most of which are corrected after positive airway pressure (PAP) treatment. Previous studies investigating the neural underpinnings of OSAS failed to provide consistent results both on the cerebral substrates underlying cognitive deficits and on the effect of treatment on these anomalies. The aims of the study were a) to investigate whether never-treated OSA patients demonstrated differences in brain activation compared to healthy controls during a cognitive task; and b) to investigate whether any improvements in cognitive functioning found in OSA patients after treatment reflected a change in the underlying cerebral activity.

Design:

OSA patients and healthy controls underwent functional magnetic resonance imaging (fMRI) scanning. They were compared on performance and brain activation during a 2-back working-memory task. Patients were also re-evaluated after 3 months treatment with PAP. Cognitive functions were evaluated using neurocognitive tests. Sleepiness (ESS), mood (Beck Depression Inventory) and, quality-of-life (SF-36) were also assessed.

Setting:

The Sleep Disorders Center and CERMAC at the Vita-Salute San Raffaele University.

Patients or Participants:

17 OSA patients and 15 age- and education-matched healthy controls.

Interventions:

PAP treatment for 3 months.

Measurements and Results:

Compared to controls, never-treated OSA patients showed increased activations in the left frontal cortex, medial precuneus, and hippocampus, and decreased activations in the caudal pons. OSA patients showed decreases in activation with treatment in the left inferior frontal gyrus and anterior cingulate cortex, and bilaterally in the hippocampus. Most neurocognitive domains, impaired at baseline, showed significant improvement after treatment.

Conclusions:

OSA patients showed an overrecruitment of brain regions compared to controls, in the presence of the same level of performance on a working-memory task. Decreases of activation in prefrontal and hippocampal structures were observed after treatment in comparison to baseline. These findings may reflect a neural compensation mechanism in never-treated patients, which is reduced by effective treatment.

Citation:

Castronovo V; Canessa N; Ferini Strambi L; Aloia MS; Consonni M; Marelli S; Iadanza A; BruschiA; Falini A; Cappa SF. Brain activation changes before and after PAP treatment in obstructive sleep apnea. SLEEP 2009;32(9):1161-1172.     

Correlation of anthropometric variables,conditional and exercise habits in activite olders

Objective:

This study sought to correlate the anthropometric and functional variables, and exercise habits in a group of elderly adults who regularly attend exercise programs.

Method:

Participation of 217 subjects between 60 and 85 years of age, from 13 regions of Colombia. Anthropometric and functional assessment was conducted as a questionnaire on exercise habits.

Results:

Negative correlations were shown between exercise habits and body fat and positive correlations between hand strength and VO2 max. (r = 0.4), age was negatively associated to functional variables.

Conclusions:

The functional capacity is influenced by increased age and body fat. With higher frequencies of physical exercise, VO2 max. and strength improved, but less body fat was observed.     

Circadian and Wake-Dependent Influences on Subjective Sleepiness,Cognitive Throughput,and Reaction Time Performance in Older and Young Adults

Study Objectives:

To assess circadian and homeostatic influences on subjective sleepiness and cognitive performance in older adults when sleep and waking are scheduled at different times of day; to assess changes in subjective sleepiness and cognitive performance across several weeks of an inpatient study; and to compare these findings with results from younger adults.

Design:

Three 24-h baseline days consisting of 16 h of wakefulness and an 8-h sleep opportunity followed by 3-beat cycles of a 20-h forced desynchrony (FD) condition; 18 20-h “days,” each consisting of 13.33 h of scheduled wakefulness and 6.67 h of scheduled sleep opportunity.

Setting:

Intensive Physiological Monitoring Unit of the Brigham and Women''s Hospital General Clinical Research Center.

Participants:

10 healthy older adults (age 64.00 ± 5.98 y, 5 females) and 10 healthy younger adults (age 24.50 ± 3.54 y, 5 females).

Interventions:

Wake episodes during FD scheduled to begin 4 h earlier each day allowing for data collection at a full range of circadian phases.

Measurements and Results:

Subjective sleepiness, cognitive throughput, and psychomotor vigilance assessed every 2 h throughout the study. Core body temperature (CBT) data collected throughout to assess circadian phase. Older subjects were less sleepy and performed significantly better on reaction time (RT) measures than younger subjects. Decrements among younger subjects increased in magnitude further into the experiment, while the performance of older subjects remained stable.

Conclusions:

Our findings demonstrate that the waking performance and alertness of healthy older subjects are less impacted by the cumulative effects of repeated exposure to adverse circadian phase than that of young adults. This suggests that there are age-related changes in the circadian promotion of alertness, in the wake-dependent decline of alertness, and/or in how these 2 regulatory systems interact in healthy aging.

Citation:

Silva EJ; Wang W; Ronda JM; Wyatt JK; Duffy JF. Circadian and wake-dependent influences on subjective sleepiness, cognitive throughput, and reaction time performance in older and young adults. SLEEP 2010;33(4):481-490.     

Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance

Context:

Evidence suggests that athletes engaging in high-intensity activities after concussion have more difficulties with cognitive recovery.

Objective:

To examine the role postinjury activity level plays in postconcussive symptoms and performance on neurocognitive tests in a population of student-athletes.

Design:

Retrospective cohort study with repeated measures of neurocognitive performance and symptom reporting.

Setting:

University-based sports concussion clinic.

Patients or Other Participants:

Ninety-five student-athletes (80 males, 15 females: age  =  15.88 ± 1.35 years) were retrospectively assigned to 1 of 5 groups based on a postinjury activity intensity scale.

Main Outcome Measure(s):

We employed a regression analysis for repeated measures to evaluate the relationship of activity intensity to symptoms and neurocognitive outcome up to 33 days after concussion. Postconcussion symptom scores and neurocognitive (verbal memory, visual memory, visual motor speed, and reaction time) scores served as the primary outcome measures.

Results:

Level of exertion was significantly related to all outcome variables (P < .02 for all comparisons). With multivariate analysis, activity intensity remained significant with respect to visual memory (P  =  .003) and reaction time (P < .001).

Conclusions:

Activity level after concussion affected symptoms and neurocognitive recovery. Athletes engaging in high levels of activity after concussion demonstrated worse neurocognitive performance. For these tasks, those engaging in moderate levels of activity demonstrated the best performance.     

The impact of foot arch height on quality of life in 6-12 year olds

Objective:

To determine whether arch height has an effect on the health-related quality of life of schoolchildren.

Methods:

One hundred and thirteen schoolchildren attended an out-patient centre where self-reported data were recorded, their feet were classified into one of three groups according to their arch index (high, normal or low) and the scores obtained from the Foot Health Status Questionnaire (FHSQ - Spanish version) were compared.

Results:

The groups with high, low and normal arch recorded lower scores in Section One for the general foot health and footwear domains and higher scores in foot pain and foot function. In Section Two they obtained lower scores in general health and higher scores in physical activity, social capacity and vigour.

Conclusions:

Comparison of the scores obtained reveals that arch height has a negative impact on quality of life. Given the limited extent of available evidence in respect of the aetiology and treatment of foot diseases and deformities, these findings reveal the need to implement programmes to promote foot health and carry out further research into this commonly occurring disabling condition.     

Physical and Mental Factors Associated with Obesity in Individuals with Mental Disorders Attending Psychiatric Day-Care Facilities

Background

Individuals with mental disorders have increased rates of obesity and metabolic syndrome. Here we evaluated factors influencing obesity in individuals with mental disorders who were attending psychiatric day-care facilities on an outpatient basis.

Methods

The subjects (n = 108) were outpatients attending hospital-based rehabilitation programs. We assessed body fat, weight, height, waist circumference, body mass index (BMI), blood pressure, Geriatric Depression Scale-15 (GDS) scores, frequency of day-care visits, satisfaction with body shape, physical comorbidity and lifestyle habits. Lifestyle habits were evaluated using Breslow''s health index based on health-related choices.

Results

The subjects were divided into 2 groups: obese group (BMI ≥ 25 kg/m²) and non-obese group (BMI < 25 kg/m²). The physical parameters and attributes of both groups were compared, and factors related to BMI were statistically analyzed. The prevalence of obesity was 47.2% in all patients, 42.4% in males and 54.8% in females. Weight, waist circumference, body fat and systolic and diastolic blood pressure were significantly higher in the obese group than in the non-obese group. Body fat, waist circumference, systolic blood pressure and diastolic blood pressure exhibited significant positive correlations with BMI, whereas the frequency of day-care visits, satisfaction with body shape, GDS score and Breslow''s health index exhibited significant negative correlations with BMI.

Conclusion

The present results showed that the prevalence of obesity was high in outpatients with mental disorders. Improvement in lifestyle choices is necessary to prevent obesity and the onset of metabolic syndrome in such patients.     

Intersecting pentagons as surrogate for identifying the use of mini mental state examination in assessment of dementia in a largely illiterate population

Background and Rationale:

The mini-mental state evaluation (MMSE) is often used to identify patients with dementia. One component of the MMSE is the intersecting pentagon copying (IPC) test, which may be difficult to be used in an illiterate population.

Materials and Methods:

A post hoc analysis on an elderly population (60 years and above) from Himachal Pradesh was carried out. The data of only 1,513 elderly individuals out of a total of 2,000 participants with a score of more than 26 (nondemented) out of a possible score of 30 on cognitive battery available were used. The scores on the IPC were evaluated and their association with some demographic variables was also assessed.

Results:

Illiterate participants, female participants, those with greater age, and the rural/tribal population groups faced the most difficulty in drawing the intersecting pentagons and even greater difficulty in drawing them correctly.

Discussion:

The IPC presents challenges for people who are illiterate and the scoring method needs to be addressed and changed particularly when the test is used in largely illiterate populations.KEY WORDS: Intersecting pentagons, mini-mental state examination (MMSE), surrogate, use     

Effect of low-intensity continuous training on lung function and cardiorespiratory fitness in both cigarette and hookah smokers

Background

The decline in cardiorespiratory fitness and lung function was higher in smokers. Training method could mitigate some of the negative consequences of smoking among smokers unable or unwilling to quit.

Objective

To examine the effects of continuous training on lungs functional capability and cardiorespiratory fitness in smokers.

Methods

Fifteen cigarette smokers, 14 hookah smokers, and 14 nonsmokers were assigned to low-intensity continuous training (20–30 minutes of running at 40% of maximum oxygen uptake (O₂max)). Lung function and cardiorespiratory fitness parameters were determined using respectively spirometer and treadmill maximal exercise test.

Results

Continuous training improved forced expiratory volume in one second (FEV₁) and forced expiratory flow at 50% of FVC (FEF50 %) in all participants, smokers and nonsmokers (p < 0.05). In contrast, forced vital capacity (FVC) improvement was significant only among cigarette smokers (CS) (+1.7±2.21%, p < 0.01) and hookah smokers (HS) (+1.3±1.7 %, p < 0.05). Likewise, an improvement in cardiorespiratory fitness in both smokers groups without significant changes in diastolic blood pressure (DBP) for CS group and in velocity at maximum oxygen uptake (vO₂max) for HS group.

Conclusion

The low-intensity continuous training improves cardiorespiratory fitness and reduces lung function decline in both cigarette and hookah smokers. It seems to be beneficial in the prevention programs of hypertension. It could have important implications in prevention and treatment programs in smokers unable or unwilling to quit.     

Combining Cognitive Screening Tests for the Evaluation of Mild Cognitive Impairment in the Elderly

OBJECTIVE

To determine the accuracy of the Mini-Mental State Examination combined with the Verbal Fluency Test and Clock Drawing Test for the identification of patients with mild cognitive impairment and Alzheimer’s disease (AD).

METHOD

These tests were used to evaluate cognitive function in 247 older adults. Subjects were divided into three groups according to their cognitive state: mild cognitive impairment (n=83), AD (n=81), cognitively unimpaired controls (n=83), based on clinical and neuropsychological data. The diagnostic accuracy of each test for discriminating between these diagnostic groups (mild cognitive impairment or AD vs. controls) was examined with the aid of Receiver Operating Characteristic (ROC) curves. Additionally, we evaluated the benefit of the combination of tests on diagnostic accuracy.

RESULTS

Although they were accurate enough for the identification of Alzheimer’s disease, neither test alone proved adequate for the correct separation of patients with mild cognitive impairment from healthy subjects. Combining these tests did not improve diagnostic accuracy, as compared to the Mini-Mental State Examination alone, in the identification of patients with mild cognitive impairment or Alzheimer’s disease.

CONCLUSIONS

The present data do not warrant the combined use of the Mini-Mental State Examination, the Verbal Fluency Test and the Clock Drawing Test as a sufficient diagnostic schedule in screening for mild cognitive impairment. The present data do not support the notion that the combination of test scores is better that the use of Mini-Mental State Examination scores alone in the screening for Alzheimer’s disease.