Sensory and cognitive association in older persons: findings from an older Australian population

BACKGROUND: Explanations for associations found between sensory and cognitive function remain unclear. OBJECTIVE: To assess in an older Australian population: (1) the correlation between sensory and cognitive function across groups with a narrow age range; (2) any independent association between sensory and cognitive impairment. METHODS: We examined 3,509 non-institutionalised residents aged 50+ years in the second cross-sectional survey of the Blue Mountains Eye Study (1997-2000). Visual impairment was defined for best-corrected visual acuity (VA) < 6/12 in the better eye, moderate to severe hearing loss for hearing threshold > 40 dB (better ear), and likely cognitive impairment for Mini-Mental State Examination (MMSE) < 24 points. RESULTS: We found likely cognitive impairment in 3.3%, vision impairment in 2.7% and moderate to severe hearing loss in 10.5% of this population. Correlation between VA or hearing threshold and MMSE score increased with age. After adjusting for age, weak but significant correlation was evident in the normal ageing sample between vision and MMSE (r = 0.12 with vision items included and r = 0.11 with vision items excluded, both p < 0.0001), and between hearing thresholds and MMSE (r = -0.12, p < 0.0001). After adjusting for age, sex, education and history of stroke, persons with vision impairment had a lower mean MMSE score than those with normal vision, regardless of whether vision-related items were included (27.1 vs. 28.6, p < 0.001) or excluded (19.8 vs. 21.0, p < 0.001). Similarly, persons with moderate to severe hearing loss had a lower mean MMSE score than those without hearing loss (28.1 vs. 28.7, p < 0.001). Persons with likely cognitive impairment also had lower mean VA and higher mean hearing threshold than those without, after adjustment. CONCLUSIONS: We have documented an age-related correlation between sensory and cognitive function in a normal ageing sample. The association between sensory impairment and likely cognitive impairment remained significant after excluding vision-related MMSE items and adjusting for confounding factors. Our data suggest that age-related decline and the effect of visual impairment on the measurement of cognition only partly explain the association between sensory and cognitive impairments in older persons.     

Age modify the associations of obesity,physical activity,vision and grip strength with functional mobility in Irish aged 50 and older

ObjectiveTo estimate whether the associations of obesity, physical activity, vision and grip strength with functional mobility were modified by age.MethodsData from The Irish Longitudinal Study on Ageing (2009–2012) were analyzed and 5001 individuals were included in this study. Mobility was assessed by the timed up and go test (TUG-test). Main exposure variables were obesity, physical activity, visual acuity and grip strength at baseline. Multiple linear regression models were fitted to assess the associations of baseline main exposure variables with 2-year follow-up functional mobility and potential confounders were adjusted. Stratified analyses by age were used to assess the interaction between main exposures and age on functional mobility.ResultsMultiple linear regression models identified significant interactions of obesity (P < 0.001), vigorous physical activity (P = 0.001), vision (P < 0.001) and grip strength (P < 0.001) with age on functional mobility. Stratified analyses suggested that the risk effect of obesity on functional mobility was greater in middle-aged group (β = 0.025, P < 0.001) than in older group (β = 0.016, P = 0.017). The protective effects of high level of physical activity and grip strength on functional mobility were stronger in older group (β = −0.023, P = 0.004 for physical activity; β = −0.002, P < 0.001 for grip strength) than in middle-aged group (β = −0.012, P = 0.008 for physical activity; β = −0.0015, P < 0.001 for grip strength). The benefit of better vision on functional mobility was observed in middle-aged group only (β = −0.032, P = 0.002).ConclusionNon-obesity, higher level of physical activity, vision and grip strength at baseline were associated with better mobility performance among middle-aged and older Irish. And these associations were modified by age.     

Pulmonary Function and Cognitive Decline in an Older Chinese Population in Singapore

Abstract

Introduction: Various cognitive deficits associated with reduced pulmonary function are reported in different studies, but the pattern of cognitive deficits across multiple domains and its associated everyday functional disability remain unclear. Methods: We analyzed neuropsychological functioning, cognitive impairment and accompanying disability in instrumental activities of daily living (IADL) associated with reduced pulmonary function in community-living middle-aged and older adults in Singapore. Performance on a comprehensive battery of neuropsychological tests, spirometry and cognitively demanding IADLs were assessed in the population-based Singapore Longitudinal Ageing Studies. Results: Consecutive 10% increase in forced expiratory volume in 1 s (FEV1) as percent of predicted was positively associated with 0.18 points increase in Mini-mental state examination (MMSE) and 0.04 points increase in executive function, independent of age, education and other variables. Subjects with moderate-to-severe airway obstruction showed significantly poorer MMSE score (p for linear trend = 0.001), and information processing speed (p for linear trend < 0.001). FEV1 (per 10% of predicted) was significantly associated with lower risk of cognitive impairment (OR = 0.92, 95% CI: 0.87-0.98, P = 0.005) and cognitive IADL disability (OR = 0.86,95% CI:0.79–0.93, P < 0.001). Pulmonary restriction was associated with greater risk of cognitive impairment (OR = 1.98, 95% CI: 1.26-3.11, P = 0.003) and cognitive IADL disability (OR = 2.43, 95% CI: 1.31-4.53, P = 0.005). Moderate-to-severe airway obstruction (OR = 2.04, 95% CI: 1.11–3.74, P = 0.022) was positively associated with cognitive IADL disability. Conclusion: The findings suggest a measurable but modest cognitive effect of low pulmonary function that was accompanied by corresponding disability in living activities. The effect on executive functioning should be further investigated in longitudinal studies.     

Incidence and predictors of vision loss complicating type 2 diabetes: The Fremantle Diabetes Study Phase II

Background and purposeAlthough diabetes is associated with multiple ocular complications, there are limited data on the incidence and predictors of visual acuity (VA) loss in type 2 diabetes. The aim of this study was to determine the 4-year cumulative incidence of visual impairment and blindness, and the predictors of vision loss, in a representative community-based cohort.MethodsThe longitudinal Fremantle Diabetes Study Phase II recruited 1551 participants with type 2 diabetes between 2008 and 2011. Participants attended biennial face-to-face assessments including VA measurement. Multivariable logistic regression was used to determine the predictors of vision loss (defined as a decrease in VA by >10 letters at the Year 4 assessment), excluding those with visual impairment (VA >6/19 and ≤6/48) and blindness (VA >6/48) at baseline.Results882 participants with normal/near normal vision at baseline had VA data at Year 4 available. During a median [interquartile range] 4.1 [4.0–4.4] years of follow-up, the cumulative incidences of visual impairment and vision loss were 0.9% (n = 8) and 2.9% (n = 26), respectively. No participants developed blindness and 1.9% (n = 17) improved their VA. Multivariable logistic regression showed baseline smoking (OR: 3.17 (95% CI: 1.15–8.76)), prior severe hypoglycemia (5.59 (1.32–23.61)) and urinary albumin:creatinine ratio (uACR) (1.42 (1.09–1.84) for an increase of 1 in ln(uACR)) had higher odds of vision loss during follow-up.ConclusionsSmoking cessation and management strategies that avoid severe hypoglycemia and preserve kidney function may potentially prevent vision loss in people with type 2 diabetes.     

Association of cognitive impairment with sleep quality,depression and cardiometabolic risk factors in individuals with type 2 diabetes mellitus: A cross sectional study

AimThe aim of this study was to evaluate the association of cognitive impairment with sleep quality, depression, and cardiometabolic risk factors among participants with type 2 diabetes mellitus.MethodsSubjects underwent clinical interview to capture socio-demographic details, medical history, sleep quality, presence of depression, along with anthropometric and biochemical measurements. A detailed neuropsychological assessment [Montreal cognitive assessment scale (MoCA), Trail making A and B, Digit span, Spatial span, Letter Number Sequencing] was done. Cognitive impairment was defined as MoCA score of <23.ResultsParticipants (n = 250, 50% women, 63.6% middle-age) had a mean (±SD) age of 53.6 (±9.1) years and HbA1c of 55.1 ± 6.8 mmol/mol (7.2 ± 0.6%). Cognitive impairment was present in 57 (22.8%) participants. In the middle-age subgroup, cognitive impairment was higher (23.9%) than those in the fourth decade (6.3%), but comparable (24.0%) to the older age (60–70 years) individuals. Diabetes-related vascular complications [Odds ratio (95% CI) 2.03 (1.05, 3.94)]; hypertension [2.00 (1.04, 3.84)], depression [2.37 (1.24, 4.55)] and lower education [2.73 (1.42, 5.23)] had a significant association with cognitive impairment on multivariate logistic regression analysis.ConclusionThe high burden of cognitive impairment calls for an urgent need to establish longitudinal cohorts in midlife to understand this population's cognitive trajectories and see the influence of various bio-psychosocial variables.     

Which factors contribute to loneliness among older Europeans? Findings from the Survey of Health,Ageing and Retirement in Europe: Determinants of loneliness

BackgroundWhile previous studies have examined the determinants of loneliness (i) using a longitudinal approach and (ii) using data from nationally representative samples, only few studies have done both at once. Hence, the purpose of our study was to clarify which factors are associated with loneliness longitudinally based on nationally representative data.MethodsData were taken from wave 5 to 7 of the “Survey of Health Ageing, and Retirement in Europe “(SHARE; covering 27 European countries and Israel in total) (in our analytical sample, n = 101,909 observations). Loneliness was assessed using the three-item loneliness scale. As explanatory variables, we included age, marital status, income, self-rated health, depressive symptoms, functional decline, cognitive functioning and chronic diseases. Exploiting the features of panel data and mitigating the problem of unobserved heterogeneity, linear FE regressions were used.ResultsFE regressions showed that loneliness increased with increasing age (β = .02, p < .001), changes from married and living together with spouse/registered partnership to another marital status (β=-.71, p < .001), decreases in log income (β=-.01, p < .05), worsening self-rated health (β = .04, p < .001), functional decline (β = .09, p < .001), increases in depressive symptoms (β = .13, p < .001) and decreases in cognitive functioning (β=-.01, p < .001), whereas it was not associated with changes in chronic diseases.ConclusionOur longitudinal study based on nationally representative SHARE data contributed to identify the determinants of loneliness among older Europeans using panel data methods. Tackling the identified risk factors may assist in avoiding loneliness in older adults living in Europe.     

Reductions in cognitive functioning are associated with decreases in satisfaction with aging. Longitudinal findings based on a nationally representative sample

ObjectiveThe objective of this study was to investigate the link between cognitive functioning and satisfaction with aging.MethodsData were drawn from a population-based sample, the German Ageing Survey (wave 5 and wave 6 with n = 6,384 in the analytical sample). The validated Philadelphia Geriatric Center Morale Scale was used to quantify satisfaction with aging. Cognitive functioning was measured using the digit symbol test. Linear fixed effects regressions were used.ResultsAdjusting for socioeconomics and various health-related covariates, regressions showed that decreases in cognitive functioning were associated with decreases in satisfaction with aging (β = .002, p = .02). Furthermore, regressions showed that decreases in satisfaction with aging were associated with increases in age (β=-.01, p < .001), decreases in physical functioning (β = .002, p < .01), worsening self-rated health (β=-.12, p < .001) and they were inversely associated with changes from employment to retirement (β = .11, p < .001).ConclusionStudy findings stress the importance of maintaining cognitive functioning for sustaining satisfaction with ageing. Strategies to postpone cognitive decline among middle-aged and older adults may contribute to aging satisfaction and ultimately to successful aging.     

Effects of vildagliptin,a DPP-4 inhibitor,in elderly diabetic patients with mild cognitive impairment

IntroductionThere is an unclear association between type 2 diabetes and mild cognitive impairment in the elderly. Both diseases are more prevalent in the older adults compared to the younger counterpart. Some anti-diabetic drugs seem to influence positively the evolution of mild cognitive impairment. This retrospective study investigated the effect of vildagliptin, an inhibitor of the enzyme dipeptidyl peptidase-4 (DPP-4), on the cognitive functioning of elderly diabetic patients with mild cognitive impairment (MCI) documented at mini mental state examination (MMSE).MethodsWe included 60 diabetic elderly people which were divided in 2 groups: Group A, 30 patients with HbA₁c (glycated hemoglobin) ≤7.5% and treated with metformin, and Group B, 30 patients with HbA₁c >7.5%, and treated with metformin plus vildagliptin. We collected data on MMSE, fasting plasma glucose (FPG) and HbA₁c at baseline and after 180 ± 10 days from the beginning of treatment.ResultsThe two groups exhibited significantly different values in FPG (P < 0.05) and HbA₁c (P < 0.01) at baseline, and in MMSE score (P < 0.001) after treatment. The intragroup comparison showed a significant (P < 0.05) reduction in MMSE score in group A, and in HbA1c (P = 0.01) in group B.ConclusionVildagliptin in addition to metformin resulted in the maintenance of MMSE score, showing a protecting role on cognitive functioning compared to the metformin only group.     

The association of cognitive impairment as screened by the Mini-Cog with long term post-hospitalization outcomes

BackgroundPrior studies have suggested that patients with cognitive impairment are at increased risk for adverse post-hospitalization outcomes. We aimed to determine if cognitive status assessed by the Mini-Cog, a quick bedside screening test, is associated with long-term outcomes.MethodsIn this secondary analysis of data from a prospective cohort study, 668 patients >65 years of age admitted to a tertiary care academic hospital over a two-year period were screened for cognitive impairment with the Mini-Cog within 24 h of admission. We performed multivariable regression adjusting for demographics, comorbidities, principal diagnoses and functional status to determine association between cognitive impairment and discharge to post-acute care, 90-day readmission and one-year mortality.ResultsOverall 35% screened positive for cognitive impairment. Those with impairment were older (median age 83 versus 78), less likely to be admitted from home and had lower functional independence and self-reported performance scores (p < 0.001 for all). Patients with cognitive impairment were more likely to be discharged to post-acute care facilities (54% versus 39%, p < 0.001). 90-day readmission rate of patients with and without cognitive impairment was 35% versus 27%; one-year survival 77% versus 84% and median length-of-stay was 4 days for both groups. Differences in readmission and mortality were not statistically significant after adjusting for covariates.ConclusionCognitive impairment as screened for by the Mini-Cog was not associated with readmission, length-of-stay, or 1-year mortality but was associated with discharge to post-acute care. Other tools such as frailty assessment may be more useful in predicting these outcomes in hospitalized older adults.     

Feeling too old? Consequences for subjective well-being. Longitudinal findings from the German Ageing Survey

ObjectivesA lack of longitudinal studies exists where the difference between chronological age and perceived age (feeling older/feeling younger) and its association with subjective well-being (SWB) is examined. Therefore, the purpose of this study was to investigate whether these differences are associated with SWB.MethodLongitudinal data (year 2002–2017; n = 18,373 observations in the analytical sample) were taken from the nationally representative German Ageing Survey. To capture SWB comprehensively, positive and negative affect as well as life satisfaction was considered. The Positive and Negative Affect Schedule was used to assess positive and negative affect. Life satisfaction was quantified using the Satisfaction with Life Scale. The difference between chronological age and perceived age was used to quantify our main independent variable. More specifically, asymmetric effects were used, i.e. we tested whether changes in negative (chronological age was lower than perceived age, “feeling older”) and positive age comparisons (otherwise, “feeling younger”) are associated with changes in SWB differently.ResultsFixed effects regressions showed that feeling younger was associated with a slight increase in life satisfaction (β = .15, p < .001) and positive affect (β = .15, p < .001). Moreover, feeling younger was associated with a slight decrease in negative affect (β=-.07, p < .05). Feeling older was associated with a considerable decrease in life satisfaction (β=-.65, p < .01) and positive affect (β=-.45, p < .01), was well as a considerable increase in negative affect (β = .49, p < .01).ConclusionsFindings highlight the importance of negative age comparisons (feeling older) for SWB. Strategies to shift age perceptions may be beneficial for SWB in older individuals.     

Social and lifestyle characteristics and burden of ill-health associated with self-reported hearing and vision impairments in older men in the British community: a cross-sectional study

BackgroundSensory impairment is common in older adults and we need to understand more about its association with other health conditions. We explored sensory impairment in relation to demographic, lifestyle factors, and health conditions in older men.MethodsIn a cross-sectional study, 3981 men aged 63–85 years (82% of participants recruited to the British Regional Heart Study cohort in 1978–80 and still alive in 2003) were selected from general practices in 24 British towns. Data on hearing aid use and ability to follow television at a volume others find acceptable allowed for four categories of hearing: can hear (n=2851), can hear with an aid (n=482), cannot hear and no aid (n=424), and cannot hear despite an aid (n=168). Vision impairment was defined as not being able to recognise a friend across a road (n=124). Logistic regression was used to investigate associations of hearing impairment and vision impairment with self-reported doctor-diagnosed coronary heart disease, disability (difficulty taking the stairs, difficulty keeping balance), social interaction (attending few social activities), and quality of life (experiencing pain, feeling anxious or depressed).Findings1074 men (27%) reported hearing impairment and 124 (3%) reported vision impairment. Compared with those reporting no hearing problem, hearing impairment was associated with disability, poor social interaction, and poor quality of life. Poor quality of life remained significant after having adjusted for social class, smoking, obesity, and physical activity. Only men who could not hear despite having a hearing aid were more likely to report coronary heart disease (age-adjusted odds ratio 1·89, 95% CI 1·36–2·63) and falls (1·62, 1·05–2·48). Vision impairment was associated with symptoms of coronary heart disease including chest pain (1·58, 1·07–2·40) and breathlessness (2·06, 1·38–3·06), but not with diagnosed coronary heart disease (1·39, 0·93–2·07). Vision impairment was also significantly associated with falls, poor quality of life, poor social interaction, and disability, which remained significant after adjusting for social class, smoking, obesity, and physical activity. Men with a sensory impairment were more likely to be physically inactive, obese (hearing impairment only), and in a manual social class.InterpretationOlder men with hearing impairment and vision impairment have a high risk of disability, poor health, and poor social interaction. Policy efforts for early detection and treatment of sensory impairment could be crucial for independent living in old age.FundingThe British Regional Heart Study is funded by the British Heart Foundation. AEML is funded by the National Institute for Health Research School for Public Health Research. SER is funded by a UK Medical Research Council Fellowship.     

Chronic Kidney Disease and Cognitive Function in Older Adults: Findings from the Chronic Renal Insufficiency Cohort Cognitive Study

OBJECTIVES: To investigate cognitive impairment in older, ethnically diverse individuals with a broad range of kidney function, to evaluate a spectrum of cognitive domains, and to determine whether the relationship between chronic kidney disease (CKD) and cognitive function is independent of demographic and clinical factors. DESIGN: Cross‐sectional. SETTING: Chronic Renal Insufficiency Cohort Study. PARTICIPANTS: Eight hundred twenty‐five adults aged 55 and older with CKD. MEASUREMENTS: Estimated glomerular filtration rate (eGFR, mL/min per 1.73 m²) was estimated using the four‐variable Modification of Diet in Renal Disease equation. Cognitive scores on six cognitive tests were compared across eGFR strata using linear regression; multivariable logistic regression was used to examine level of CKD and clinically significant cognitive impairment (score ≤1 standard deviations from the mean). RESULTS: Mean age of the participants was 64.9, 50.4% were male, and 44.5% were black. After multivariable adjustment, participants with lower eGFR had lower cognitive scores on most cognitive domains (P<.05). In addition, participants with advanced CKD (eGFR<30) were more likely to have clinically significant cognitive impairment on global cognition (adjusted odds ratio (AOR) 2.0, 95% CI=1.1–3.9), naming (AOR=1.9, 95% CI=1.0–3.3), attention (AOR=2.4, 95% CI=1.3–4.5), executive function (AOR=2.5, 95% CI=1.9–4.4), and delayed memory (AOR=1.5, 95% CI=0.9–2.6) but not on category fluency (AOR=1.1, 95% CI=0.6–2.0) than those with mild to moderate CKD (eGFR 45–59). CONCLUSION: In older adults with CKD, lower level of kidney function was associated with lower cognitive function on most domains. These results suggest that older patients with advanced CKD should be screened for cognitive impairment.     

Depressive symptoms in the oldest-old: The role of sensory impairments

BackgroundWhile a fair amount of research has investigated the impact of sensory impairments on the mental health of young older adults (65–79 years of age), only a few studies have focused on the associations of sensory impairments with mental health outcomes in the oldest-old (80 years and older). To close this gap, this study examined the separate and combined effects of self-reported vision and hearing impairment for depressive symptoms in a sample of oldest-old individuals, controlling for other mental health risks (e.g., functional disability, health interference, and loneliness).MethodsCentenarians and near-centenarians (N = 119; average age = 99) were recruited from the community and geriatric healthcare organizations. In-person interviews were conducted at participants’ place of residence.ResultsVision impairment and its interaction with hearing impairment as well as functional disability, health interference with desired activities, and loneliness were significant predictors of depressive symptoms in hierarchical regression analyses. Hearing impairment alone was not associated with depressive symptoms, but follow-up analyses clarifying the interaction effect showed that individuals with poor vision had the highest levels of depressive symptoms, if they had a concurrent hearing impairment. Thus, a concurrent presence of poor vision and poor hearing resulted in an increased vulnerability for depressive symptoms.ConclusionsGiven that a majority of oldest-old has sensory impairments which can result in mental health issues, it is important to facilitate this population’s access to vision and audiological treatment and rehabilitation.     

Association of impairments of older persons with caregiver burden among family caregivers: Findings from rural South India

AimIn India, owing to cultural norms and a lack of formal long-term care facilities, responsibility for care of the older person falls primarily on the family. Based on the stress process model, we assessed the association of type and number of impairments of older persons (∼primary stressors) with caregiver burden among their family caregivers in rural South India.MethodsAll impaired older persons (aged ≥60, with impairment in activities of daily living (ADL) or cognition or vision or hearing) residing in 8 villages in Bangalore district, Karnataka, India, and their primary informal caregivers were interviewed. Caregiver burden was measured using the Zarit Burden Interview (ZBI; higher score indicating greater perceived burden). Linear regression models, adjusting for background characteristics of older persons and caregivers, assessed the association of type of impairment (physical [Yes/No], cognitive [Yes/No], vision [Yes/No] and hearing [Yes/No]) and number (1 or 2 or 3 or 4) of older person impairments with caregiver burden.ResultsA total of 140 caregivers, caring for 149 older persons, were interviewed. The mean (standard deviation) ZBI score was 21.2 (12.9). Of the various older person impairments, ZBI score was associated only with physical impairment (β = 6.6; 95% CI: 2.1–11.1). Relative to caregivers of older person with one impairment, those caring for an older person with all 4 impairments had significantly higher ZBI score (β = 13.9; CI: 2.5–25.4).ConclusionCaregivers of older persons with multiple impairments, especially physical impairment, are vulnerable.     

Cognitive and functional impairment in an older community population from Brazil: The intriguing association with frequent pain

ObjectiveThis cross-sectional community-based epidemiologic survey aimed to investigate the prevalence of cognitive and functional impairment (CFI) and its distribution in relation to socio-demographic and clinical factors in an older community sample in Florianópolis, Brazil.Materials and methodsThe population was a representative sample aged 60 and older; the cluster sample strategy was performed. CFI, a syndromic category that does not exclude dementia, was defined according to the combination of low MMSE (Mini-Mental State Examination) score and moderate/severe dependence in a scale that measured activities of daily living. The data were submitted to multiple regression analysis using the Poisson regression method.ResultsA sample of 1705 subjects was interviewed; the mean age was 70.6 years (60–104 years; SD: 8.0); 63.9% were female and 43.7% had up to 4 years of schooling. CFI was detected in 325 subjects, resulting in a raw prevalence of 19.2% (95% CI: 17.3–21.0). Older age, presence of diabetes, heart disease, stroke, urinary incontinence, arthritis, frequent pain and depression were significantly associated with CFI (p < 0.05).ConclusionIn addition to the diversity of factors associated with CFI, the present study indicated the need to investigate the role of frequent pain in the development and progression of cognitive impairment and dementia.     

The association between earlobe crease (Frank’s sign) and cognitive performance is related to age. Results from the Atahualpa Project

BackgroundEarlobe crease (ELC) has been linked to cardiovascular diseases, but information on its association with cognitive decline is limited. We aimed to assess the association between ELC and cognitive performance in community-dwelling adults living in rural Ecuador.MethodsOf 863 individuals aged ≥40 years enrolled in the Atahualpa Project, 629 (73%) were included. ELC were visually identified by two independent raters, and cognitive performance was measured by the Montreal Cognitive Assessment (MoCA). Using generalized linear and interaction models, adjusted for demographics, cardiovascular risk factors and edentulism, we assessed the association between ELC and cognitive performance, as well as the influence of age in this association.ResultsELC was present in 246 (39%) individuals, and the mean MoCA score in the entire population was 21.9 ± 4.7 points. A generalized linear model showed no relationship between ELC presence and the MoCA score (p = 0.449). In this model, covariates remaining significant were age (p < 0.001), physical activity (p = 0.014) and edentulism (p < 0.001). When participants were stratified according of quartiles of age, the MoCA score did not differ according to the presence or absence of ELC. Weighted exposure-effect models – using ELC and the MoCA score as the exposure and outcome (respectively) – revealed no association between both variables.ConclusionsThe association between ELC and the MoCA score is mainly related to age. These findings might be explained by the high prevalence of ELC and cognitive decline in older adults.     

Poor vision accompanied with other sensory impairments as a predictor of falls in older women

Objectives: we studied visual acuity (VA) and co-existing hearingimpairment and poor standing balance as predictors of falls. Design: prospective study with 1-year follow-up. Setting: research laboratory and residential environment. Participants: 428 women aged 63–76 years from the FinnishTwin Study on Aging. Measurements: participants were followed up for incidence offalls over 1 year. VA, hearing ability and standing balancewere assessed at the baseline. The incidence rate ratios (IRR)for falls were computed using the negative binomial regressionmodel. Results: during the follow-up, 47% of participants experienceda fall. After adjusting for age and interdependence of twinsisters, participants with vision impairment (VA of <1.0)but no other sensory impairments had a higher, but non-significant,risk for falls compared to persons with normal vision (IRR 1.5,95% CI 0.6–4.2). Co-existing vision impairment and impairedbalance increased the risk (IRR 2.7, 95% CI 0.9–8.0),as also did co-existing vision and hearing impairment (IRR 4.2,95% CI 1.5–11.3), compared to those with normal vision.Among persons with all three impairments, the IRR for fallsincreased to 29.4 (95% CI 5.8–148.3) compared to participantswith good vision. Conclusion: the impact of vision impairment on fall risk washigher when accompanied with other sensory and balance impairments,probably because the presence of other impairments preventedthe reception of compensatory information about body postureand environment being received from other sensory sources. Whenaiming to prevent falls and their consequences in older people,it is important to check whether poor vision is accompaniedwith other impairments.     

Presentation,Treatment, and Outcomes of Older Adults Hospitalized for Acute Myocardial Infarction According to Cognitive Status: The SILVER-AMI Study

BackgroundWhile survival after acute myocardial infarction has improved substantially, older adults remain at heightened risk for hospital readmissions and death. Evidence for the role of cognitive impairment in older myocardial infarction survivors’ risk for these outcomes is limited.Methods3041 patients aged ≥75 years hospitalized with acute myocardial infarction (mean age 82 ± 5 years, 56% male) recruited from 94 US hospitals. Cognition was assessed using the Telephone Interview for Cognitive Status; scores of <27 and <22 indicated mild and moderate/severe impairment, respectively. Readmissions and death at 6 months post-discharge were ascertained via participant report and medical record review. Associations between cognition and outcomes were evaluated with multivariable-adjusted logistic regression.ResultsMild and moderate/severe cognitive impairment were present in 11% and 6% of the cohort, respectively. Readmission and death at 6 months occurred in 41% and 9% of participants, respectively. Mild and moderate/severe cognitive impairment were associated with increased risk of readmission (odds ratio [OR] 1.36; 95% confidence interval [CI], 1.08-1.72 and OR 1.58; 95% CI, 1.18-2.12, respectively) and death (OR 2.19; 95% CI, 1.54-3.11 and OR 3.82; 95% CI, 2.63-5.56, respectively) in unadjusted analyses. Significant associations between moderate/severe cognitive impairment and death (OR 1.69; 95% CI, 1.10-2.59) persisted after adjustment for demographics, myocardial infarction characteristics, comorbidity burden, functional status, and depression, but not for readmissions.ConclusionsModerate-to-severe cognitive impairment is associated with heightened risk of death in older acute myocardial infarction patients in the months after hospitalization, but not with readmission. Routine cognitive screening may identify older myocardial infarction survivors at risk for poor outcomes who may benefit from closer oversight and support in the post-discharge period.     

Montreal Cognitive Assessment Performance in Patients with Parkinson's Disease with "Normal" Global Cognition According to Mini-Mental State Examination Score

OBJECTIVES: To examine Montreal Cognitive Assessment (MoCA) performance in patients with Parkinson's disease (PD) with "normal" global cognition according to Mini-Mental State Examination (MMSE) score.
DESIGN: A cross-sectional comparison of the MoCA and the MMSE.
SETTING: Two movement disorders centers at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center.
PARTICIPANTS: A convenience sample of 131 patients with idiopathic PD who were screened for cognitive and psychiatric complications.
MEASUREMENTS: Subjects were administered the MoCA and MMSE, and only subjects defined as having a normal age- and education-adjusted MMSE score were included in the analyses (N=100). As previously recommended in patients without PD, a MoCA score less than 26 was used to indicate the presence of at least mild cognitive impairment (MCI).
RESULTS: Mean MMSE and MoCA scores±standard deviation were 28.8±1.1 and 24.9±3.1, respectively. More than half (52.0%) of subjects with normal MMSE scores had cognitive impairment according to their MoCA score. Impairments were seen in numerous cognitive domains, including memory, visuospatial and executive abilities, attention, and language. Predictors of cognitive impairment on the MoCA using univariate analyses were male sex, older age, lower educational level, and greater disease severity; older age was the only predictor in a multivariate model.
CONCLUSION: Approximately half of patients with PD with a normal MMSE score have cognitive impairment based on the recommended MoCA cutoff score. These results suggest that MCI is common in PD and that the MoCA is a more sensitive instrument than the MMSE for its detection.     

Hearing impairment is associated with cognitive function in community-dwelling older adults: A cross-sectional study

BackgroundHearing impairment (HI) is associated with dementia. However, the cognitive screening tasks effective in older community dwellers presenting with HI are unclear.MethodsWe retrospectively and cross-sectionally investigated the associations between HI and cognitive function assessed with screening tasks using data from two healthcare check-up programs for community dwellers ≥65 years old in 2018. We examined demographics, risk factors, cognitive function, hearing condition, lifestyles, and self-care levels. Cognitive function was assessed using the clock drawing task and the delayed three words recall task. Hearing condition was assessed using questionnaires on the use of hearing aids and HI during conversation situations. Multivariate analysis was used to identify independent associations between HI and cognitive assessment tasks.ResultsWe analyzed 1602 eligible participants (61.9% women; 74.3 ± 6.5 years old). Hearing aid users (n = 90) were older (80 vs. 73 years, respectively; p < 0.001) and less likely to draw the clock correctly (71.1% vs. 80.1% years, respectively; p = 0.044) than non-hearing aid users. Multivariate logistic regression analysis showed that HI was associated with inability to draw the clock correctly (odds ratio 1.60, 95% confidence interval 1.12–2.26; p = 0.011), independent of age, living alone, memory impairment, and impaired self-care levels.ConclusionHearing impairment is independently associated with cognitive decline assessed by the clock drawing task. The clock drawing task may be useful for identifying an increased risk of dementia in older subjects presenting with HI.