Screening for cognitive impairment in older African-Caribbeans

BACKGROUND: There are increasing numbers of older African-Caribbeans in the United Kingdom. Screening instruments are commonly used in the detection of cognitive impairment, but have not been assessed within this population. This study aimed to develop culturally modified versions of screening instruments for cognitive impairment (Mini-Mental State Examination (MMSE) and Abbreviated Mental Test (AMT)) and to determine their sensitivity and specificity in the diagnosis of dementia. METHODS: The instruments were modified using a process involving a community group of African-Caribbeans and an academic group of health professionals. They were used in a two-stage study involving community resident African-Caribbeans aged 60 years or over in inner-city Manchester, comparing the screening instruments against a computerized diagnostic interview. RESULTS: One hundred and thirty people completed the study. The results for the largest subgroup, the Jamaicans (N = 96) were analysed. Effects of gender, age and education on the MMSE and AMT scores were evaluated. The correlations between the screening instruments and diagnostic interview were highly significant (P < 0.001). At appropriate cut-offs both screening instruments demonstrated high sensitivity and acceptable specificity levels. CONCLUSIONS: A defined process with lay input has assisted in producing culturally modified versions of the MMSE and AMT that perform well compared with a diagnostic interview, if an appropriate cut-off is used. They are easy to administer and acceptable to older African-Caribbean people. The results need to be viewed within the limitations of the current study.     

Assessing quality of life in older adults with cognitive impairment

OBJECTIVE: This article discusses theoretical, psychometric, and practical considerations of quality of life assessment in older adults with cognitive impairment. It describes a new measure of quality of life in dementia, the QOL-AD, and examines the reliability and validity of patient and caregiver reports of patient quality of life. METHODS: Subjects were 177 patient/caregiver dyads. Patient Mini Mental State Exam scores ranged from 0 to 29, with a mean score of 16 (SD = 7). Each patient and caregiver rated the patient's quality of life on the QOL-AD. Patient functional and cognitive status, psychological state, physical function, and behavior problems were also assessed. Reliability and validity of patient QOL-AD reports were examined across three levels of cognitive impairment. RESULTS: One hundred, fifty-five patients were able to complete the QOL-AD. Completers scored between 4 and 29 on the Mini Mental State Exam, whereas noncompleters all scored 10 or lower. Reliability for both patient and caregiver reports on the QOL-AD was good (alpha values ranged from 0.83 to 0.90). Validity of patient and caregiver reports across cognitive levels was supported by correlation with measures of depression (r = -0.41 to -0.65), day-to-day functioning (r = -0.10 to -0.45), and pleasant events frequency (r = 0.18 to 0.51). Intraclass correlation between patient and caregiver reports was positive across all cognitive levels (r = 0.14 to 0.39). CONCLUSIONS: The QOL-AD seems to be reliable and valid for individuals with MMSE scores greater than 10. Further research is needed to clarify the relationship between patient and caregiver reports of patient quality of life and to identify factors that influence quality of life throughout the progression of dementia.     

Association of HIV infection and cognitive impairment in older adults: A meta-analysis

ObjectiveTo synthesize evidence on the association between human immunodeficiency virus (HIV) infection and cognitive impairment in older adults.DesignMeta-analysis.ParticipantsAdults aged 50 years or older.MethodsIn this systematic literature review and meta-analysis, we searched PubMed, Scopus, Embase, and APA/PsycNet for studies published before July 21, 2020, that assessed the association between HIV-infection and cognitive impairment. We calculated pooled odds ratios (ORs) of cognitive impairment for people living with HIV (PLWH) and 95 % confidence intervals (CIs) using random-effect models and calculated pooled mean difference (MD) for major cognitive domains between PLWH and HIV-uninfected adults. We assessed risk of bias using the Newcastle-Ottawa scale.ResultsOf the 4432 studies identified, 21 cross-sectional studies were eligible for the meta-analysis, including 15 examining global cognitive impairment. The meta-analysis showed that older PLWH were more likely to be cognitively impaired than HIV-uninfected controls (OR = 2.44, 95 % CI = [1.69, 3.53], number of estimates (k) = 15, I² = 71 %). This higher likelihood was shown in studies from high income countries (OR = 2.63, 95 % CI = [1.76, 3.94], k = 12, I² = 55 %), but not from upper-middle income countries (OR = 1.96, 95 % CI = [0.26, 14.68], k = 3, I² = 91 %). PLWH had lower scores than HIV-uninfected adults in 5 out of 7 major cognitive domains, including executive function (MD = -0.42, 95 % CI = [-0.72, -0.11], k = 5, I² = 32 %), processing speed (MD = -0.33, 95 % CI = [-0.59, -0.08], k = 6, I² = 16 %), verbal (MD=-0.29, 95 % CI = [-0.48, -0.10], k = 6, I² = 0%), recall (MD = -0.24, 95 % CI = [-0.38, -0.10], k = 6, I² = 0%) and motor/psychomotor (MD = -0.38, 95 % CI = [-0.59, -0.16], k = 5, I² = 31 %) performance.Conclusions/implicationsOur meta-analysis provides empirical evidence that HIV infection is associated with an increased risk of cognitive impairment among older adults, especially in cognitive domains of executive function, processing speed, verbal, recall, and motor/psychomotor.     

Physical inactivity and cognitive impairment in Korean older adults: gender differences in potential covariates

Background: Physical inactivity is one major lifestyle risk factor of mild cognitive impairment with ageing.

Aim: To investigate whether or not potential covariates modulate the association between physical activity (PA) and cognitive impairment in older adults.

Subjects and methods: Data from 10?245 Korean older adults (5817 women) were used.

Results: High PA older adults were younger and longer educated and had lower comorbidity and depression than low PA older adults. Compared with low PA men, moderate PA men only had a significantly lower odds-ratio (OR) and 95% confidence interval (95% CI) (OR?=?0.795, 95% CI?=?0.654?～?0.965, p?=?0.021) for having cognitive impairment, even after adjusting for measured covariates, which was no longer significant when additionally adjusted for comorbidity (OR?=?0.862, 95% CI?=?0.707?～?1.051, p?=?0.143). Compared with low PA women, moderate and high PA women had significantly lower risks of cognitive impairment (OR?=?0.830, 95% CI?=?0.712?～?0.969, p?=?0.018 and OR?=?0.784, 95% CI?=?0.651?～?0.943, p?=?0.010, respectively), even after adjusting for the measured covariates including comorbidity, which was no longer significant when additionally adjusted for depression (OR?=?0.897, 95% CI?=?0.776?～?1.049, p?=?0.173 and OR?=?0.919, 95% CI?=?0.761?～?1.111, p?=?0.385, respectively).

Conclusion: These findings suggest that gender differences in the covariates modulate the relationship between physical activity and cognitive decline in older Korean adults.     

Visual contrast sensitivity in Alzheimer’s disease,mild cognitive impairment,and older adults with cognitive complaints

Deficits in contrast sensitivity (CS) have been reported in Alzheimer’s disease (AD). However, the extent of these deficits in prodromal AD stages, including mild cognitive impairment (MCI) or even earlier, has not been investigated. In this study, CS was assessed using frequency doubling technology in older adults with AD (n = 10), amnestic MCI (n = 28), cognitive complaints without performance deficits (CC; n = 20), and healthy controls (HC; n = 29). The association between CS and cognition was also evaluated. Finally, the accuracy of CS measures for classifying MCI versus HC was evaluated. CS deficits were found in AD and MCI, while CC showed intermediate performance between MCI and HC. Upper right visual field CS showed the most significant difference among groups. CS was also associated with cognitive performance. Finally, CS measures accurately classified MCI versus HC. The CS deficits in AD and MCI, and intermediate performance in CC, indicate that these measures are sensitive to early AD-associated changes. Therefore, frequency doubling technology-based measures of CS may have promise as a novel AD biomarker.     

Cognitive interventions in healthy older adults and people with mild cognitive impairment: A systematic review

Given that the research area of cognitive intervention studies in the aging population is growing rapidly, it is important to review and gauge more recent intervention studies, in order to determine the evidence for the effectiveness of cognitive interventions. The purpose of the present review was to update the recent systematic reviews of Papp et al. (2009) and Martin et al. (2011), to evaluate the effectiveness of cognitive interventions in healthy older adults and people with MCI, by taking into account the methodological quality of the interventions studies. A systematic review of randomized controlled trials (RCT) and clinical studies published between August 2007 and February 2012 in Pubmed and PsychINFO was performed. The quality of the included RCTs was assessed according to the CONSORT criteria for RCTs. A total of thirty-five studies were included; twenty-seven RTCs and eight clinical studies. The content of the intervention studies differed widely, as did the methodological quality of the included RCTs, but was considerably low with an average of 44% of the Consort items included. The results show evidence that cognitive training can be effective in improving various aspects of objective cognitive functioning; memory performance, executive functioning, processing speed, attention, fluid intelligence, and subjective cognitive performance. However, the issue whether the effects of cognitive interventions generalize to improvement in everyday life activities is still unresolved and needs to be addressed more explicitly in future research.     

Feasibility and effectiveness of cotrimoxazole prophylaxis for HIV-1-infected adults attending an HIV/AIDS clinic in Uganda

BACKGROUND: Cotrimoxazole is recommended for prevention of opportunistic infections in symptomatic HIV patients in sub-Saharan Africa. METHODS: We examined the feasibility and effectiveness of daily cotrimoxazole prophylaxis in a well-established cohort of HIV-infected adults attending clinics in Entebbe, Uganda. We compared mortality and morbidity rates for 12 months before and after the introduction of cotrimoxazole. RESULTS: Between August 2000 and February 2002, 94% of cohort members were enrolled onto cotrimoxazole prophylaxis. Revisits were scheduled every 4 weeks to replenish pills; patients attended 61% of revisits. The main reasons for nonenrollment and defaulting were lack of transport, being away from home, and sickness. Drug-related adverse events, mainly itching and rash, were seen in 4% of participants. Although bacterial resistance rate to cotrimoxazole was high, the adjusted mortality incidence rate ratio was significantly reduced after the introduction of cotrimoxazole (0.76; 95% confidence interval, 0.60-0.96; P = 0.020). Overall febrile events and morbidity rates were unchanged after the introduction of cotrimoxazole, but the incidence of malaria was reduced (incidence rate ratio, 0.31; 95% confidence interval, 0.13-0.72). CONCLUSIONS: Cotrimoxazole prophylaxis can be introduced into routine HIV clinic activities and is associated with a reduction in overall mortality and malaria morbidity, even in an area with high bacterial resistance. These results reinforce the need for large-scale provision of cotrimoxazole prophylaxis for all HIV-positive patients in developing countries.     

Positive effects of combined cognitive and physical exercise training on cognitive function in older adults with mild cognitive impairment or dementia: A meta-analysis

Combined cognitive and physical exercise interventions have potential to elicit cognitive benefits in older adults with mild cognitive impairment (MCI) or dementia. This meta-analysis aims to quantify the overall effect of these interventions on global cognitive functioning in older adults with MCI or dementia. Ten randomized controlled trials that applied a combined cognitive-physical intervention with cognitive function as an outcome measure were included. For each study effect sizes were computed (i.e., post-intervention standardized mean difference (SMD) scores) and pooled, using a random-effects meta-analysis. The primary analysis showed a small-to-medium positive effect of combined cognitive-physical interventions on global cognitive function in older adults with MCI or dementia (SMD[95% confidence interval] = 0.32[0.17;0.47], p < 0.00). A combined intervention was equally beneficial in patients with dementia (SMD = 0.36[0.12;0.60], p < 0.00) and MCI (SMD = 0.39[0.15;0.63], p < 0.05). In addition, the analysis showed a moderate-to-large positive effect after combined cognitive-physical interventions for activities of daily living (ADL) (SMD = 0.65[0.09;1.21], p < 0.01)and a small-to-medium positive effect for mood (SMD = 0.27[0.04;0.50], p < 0.01). These functional benefits emphasize the clinical relevance of combined cognitive and physical training strategies.     

Screening for cognitive impairment in the elderly using the mini-mental state examination

The use by non-medical staff of a brief screening instrument (the mini-mental state examination) to detect cognitive impairment among the elderly in primary care is described. Patients aged 75 years and over registered with nine general practices in north and north west London were invited by their general practitioners to take part in the study and 1170 patients participated, a response rate of 90%. The prevalence of possible or probable cognitive impairment (score below 25 on the mini-mental state examination) was 12.8%. Six per cent of patients scored below 19, at which score a high probability of dementia exists, although less than a third of this group had a diagnosis of dementia in their medical records. There was no significant difference between men and women or by social class in the proportion of patients with low scores, but the proportion with dementia rose from 2.5% in those aged 75-79 years to 29.0% among those aged 90 years and over. Under the new general practitioner contract there is a requirement to provide annual services to the elderly, including a 'mental assessment'. In a practice with a list size of 2000 around 130 patients are likely to be aged 75 years and over. Of these around 17 would require further assessment for possible dementia on the basis of results obtained using the mini-mental state examination.     

Effects of mild and global cognitive impairment on the prevalence of fear of falling in community-dwelling older adults

Objectives

Few studies have reported the relationship between fear of falling (FoF) and mild and global cognitive impairment in community-dwelling older adults. We aimed to determine whether the status of cognitive impairment affects the prevalence of FoF in community-dwelling older adults.

Study design

Cross-sectional study among 4474 community-dwelling older adults who participated in the Obu Study of Health Promotion for the Elderly.

Main outcome measures

Participants underwent cognitive tests and were divided into three groups: cognitive healthy, mild cognitive impairment (MCI), and global cognitive impairment (GCI). FoF and related variables, such as fall history, physical function, and depression, were also investigated.

Results

The prevalence of FoF was significantly different by group (p < 0.001; healthy: 43.6%, MCI: 50.6%, GCI: 40.6%). Logistic regression analysis showed that GCI (odds ratio = 0.63; 95% confidence interval = 0.526–0.76) was independently associated with FoF, after controlling for confounding factors. Older adults with GCI showed the lowest prevalence of FoF, although they had the lowest physical function comparing with the other groups (p < 0.001).

Conclusion

MCI and GCI in community-dwelling older adults affect the prevalence of FoF in a completely different manner. Further study is required to determine whether insensitivity to FoF with GCI increases the risk of falling in older adults.     

Effects of virtual reality combined cognitive and physical interventions on cognitive function in older adults with mild cognitive impairment: A systematic review and meta-analysis

ObjectiveCombined cognitive and physical interventions based on virtual reality may help delay the progression of MCI to dementia or prevent dementia. However, their efficacy is less well studied compared to pharmaceutical treatments. The purpose of this review was to evaluate the effects of cognitive and physical interventions based on virtual reality on cognitive function (global cognition, memory or executive function/attention) of older adults with mild cognitive impairment.MethodsWe searched the PubMed, Web of Science, Scopus, Embase, Cochrane Library, PsycINFO, CINAHL and IEEE from inception to 13 May 2021. Only randomized controlled trials which incorporated virtual reality cognitive and physical components targeted to individuals with mild cognitive impairment were eligible. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation.Result7 randomized controlled trials were included in a total of 8 articles. No studies were rated as having a "high" risk of overall bias. The results of a meta-analysis showed that VR combined cognitive and physical interventions enhanced the global cognitive (MD = 2.66, 95% CI = 1.79–3.54, P = 0.03, I ² = 68%) abilities of older adults with mild cognitive impairment. The meta-analysis indicated that after virtual reality combined cognitive and physical interventions, effects on memory (SMD = −0.03, 95% CI = −0.60 to 0.55, P = 0.78, I ² = 0%) and executive function/attention (SMD = −0.19, 95% CI = −0.74 to 0.36, P = 0.09, I ² = 53%) were not statistically significant.ConclusionsThe present meta-analysis verifies the potential rehabilitative effects of virtual reality combined cognitive and physical interventions for older adults with mild cognitive impairment. More research is also needed to determine the optimal intensity and timing of interventions in the future.     

Combined physical and cognitive training for older adults with and without cognitive impairment: A systematic review and network meta-analysis of randomized controlled trials

Combining physical exercise with cognitive training is a popular intervention in dementia prevention trials and guidelines. However, it remains unclear what combination strategies are most beneficial for cognitive and physical outcomes. We aimed to compare the efficacy of the three main types of combination strategies (simultaneous, sequential or exergaming) to either intervention alone or control in older adults. Randomized controlled trials of combined cognitive and physical training were included in multivariate and network meta-analyses. In cognitively healthy older adults and mild cognitive impairment, the effect of any combined intervention relative to control was small and statistically significant for overall cognitive (k = 41, Hedges’ g = 0.22, 95 % CI 0.14 to 0.30) and physical function (k = 32, g = 0.25, 95 % CI 0.13 to 0.37). Simultaneous training was the most efficacious approach for cognition, followed by sequential combinations and cognitive training alone, and significantly better than physical exercise. For physical outcomes, simultaneous and sequential training showed comparable efficacy as exercise alone and significantly exceeded all other control conditions. Exergaming ranked low for both outcomes. Our findings suggest that simultaneously and sequentially combined interventions are efficacious for promoting cognitive alongside physical health in older adults, and therefore should be preferred over implementation of single-domain training.     

Homocysteine,depression and cognitive function in older adults

Background

Depression and high total plasma homocysteine (tHcy) are independently associated with cognitive impairment in older adults. We designed this study to determine if high tHcy is a mediator of cognitive performance in older adults with major depression.

Methods

We recruited 358 community-dwelling older adults experiencing depressive symptoms, 236 (65.9%) of who met DSM-IV-TR criteria for major depression. Assessment included the Montgomery Asberg Depression Rating Scale (MADRS), fasting tHcy and the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery.

Results

Individuals with major depression and high tHcy had significantly worse immediate verbal and delayed visual recall. Non-depressed participants with high tHcy had lower MMSE, immediate and delayed recall scores than those with normal tHcy. The odds of cognitive inefficiency for those with high tHcy was nearly doubled for the MMSE (OR 1.9, 95%CI 1.1–3.3), immediate (OR 1.9, 95%CI 1.1–3.5) and delayed (OR 1.9, 95%CI 1.1–3.4) word recall after adjusting for age, gender, IHD and MADRS score.

Limitations

The presence of sub-syndromal depressive symptoms in our non-depressed group and exclusion of participants with established cognitive impairment may limit the generalizability of this study.

Conclusions

Elevated tHcy was associated with weaker performance in tests of immediate and delayed memory and global cognitive performance when compared to those with normal tHcy independent of the presence of major depression or the severity of depressive symptoms. Homocysteine lowering B-vitamin supplementation may offer a potential therapeutic target to try and mitigate the often-disabling impact of cognitive deficits found in this population.     

An assessment of mood in males attending an infertility clinic

This study was undertaken to assess the mood profile in men seeking treatment for infertility and also to investigate if aetiological factors of infertility have any impact on mood. This was a prospective questionnaire study and the setting was the Human Assisted Reproduction Ireland (H.A.R.I.) unit in the Rotunda Hospital. Fifty men participated in the study and were required to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire. The results were analysed using an ordered logit regression analysis on the statistical software package DATA DESK 5.0.1. There were no cases of depression in the study population. However, detectable anxiety levels were displayed in 31.9% of men. Those with severe oligospermia had a higher mean anxiety score (8.5) compared with other patient subgroups. Clinically significant anxiety was found in 8.5%; all of these men had a male-factor problem. The study population was relatively small but some interesting trends were observed. A larger trial is warranted to assess if genuine at-risk groups exist.     

Poor sleep quality impairs cognitive performance in older adults

The prevalence of insomnia increases with age. Short sleep duration is associated with deficits in cognitive performance. We hypothesized that short sleep duration and sleep quality influence cognitive performance in older adults. The study included 78 adults aged 60 years and over (72.2 ± 5.9 years). Total sleep time and sleep efficiency (total sleep time/time in bed × 100) were calculated using actigraphy. We evaluated cognitive performance with the continuous performance test‐identical pairs and the number‐back test. Sleep apnea was evaluated overnight with a portable home monitoring system. The accuracy of the 0‐back test significantly decreased in participants with total sleep time less than 5 h compared with those with total sleep time greater than 7 h, but there was no significant difference in continuous performance test‐identical pairs between the two groups. Participants with sleep efficiency <85% showed a significant decrease in 0‐ and 1‐back test accuracy compared with those with sleep efficiency ≥85%. There were no significant differences in the accuracy of number‐back tests and continuous performance test‐identical pairs between apnea–hypopnea index ≥15 h^?1 and apnea–hypopnea index <15 h^?1 groups, or among lowest SpO₂ ≥ 90%, lowest 80–90%, and lowest SpO₂ < 80% groups. Age, total sleep time and sleep efficiency were significantly correlated with accuracy on the 0‐back test. Age and sleep efficiency were significantly correlated with accuracy on the 1‐back test. Multiple regression analysis revealed that total sleep time was independently correlated with accuracy on the 0‐back test, while age was independently correlated with accuracy on the 1‐back test. Our findings suggest that sleep duration and sleep quality may play a role in cognitive performance in older adults.     

Chronic insomnia and cognitive functioning among older adults

Chronic insomnia and cognitive impairment are both common complaints among older adults. This study explores the association between chronic insomnia and changes in cognitive functioning among older adults. The study population comprised two groups: 64 older adults without insomnia and 35 older adult insomniacs. The cognitive capacity of each participant was tested at the participant's home using the computerized “MindFit” test (CogniFit, Inc.). In five categories of cognitive functioning, older adult insomniacs displayed impaired performance compared to older adult good sleepers. Specifically, significant differences were found between insomniacs and good sleepers on memory span, allocating attention to a target, time estimation, executive functioning, and integration of two dimensions (visual and semantic) tests. The findings imply that insomnia may have detrimental effects on some cognitive functions in healthy older adults.     

A comparison of methods for measuring cognitive change in older adults.

Well-researched statistical methods are required to guide clinicians in determining the significance of test score changes in serial neuropsychological assessment of older adults. The following six change score methods were examined using five-year test-retest data from the Canadian Study of Health and Aging: the standard deviation method, three reliable change indices (RCIs), and two standardized regression-based methods. Changes in scores on four memory measures were examined in cognitively healthy older adults, and the RCI with a correction for practice/aging effects most accurately classified this normal variability. Diagnostic change (i.e., developing dementia versus remaining cognitive healthy) was also examined in relation to memory test score changes. All change score methods were significantly associated with diagnostic change, though the strength of association varied by measure and method. In contrast to some previous research, RCIs were found to be useful when making diagnostic discriminations in older adults.