Transcranial Brain Stimulation Improves Cognition in Older Adults With Depression and Anxiety

Abstract Older adults admitted to hospital for rehabilitation often have some degree of concomitant cognitive impairment, which may be a barrier to optimizing rehabilitation approaches. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, delivers a low electrical current across the brain. The neuromodulatory effects of tDCS can be of therapeutic benefit and has been shown to augment cognitive functions in both healthy and clinical populations. This study investigated the effects of tDCS on cognition in older adult inpatients with depression or anxiety. It was hypothesized that anodal tDCS over the left dorsolateral prefrontal cortex would increase cognitive performance compared to a placebo group. Twenty adults between 65 to 86 years of age admitted to the Glenrose Rehabilitation Hospital with underlying depression or anxiety were recruited. Anodal (n=10) or sham (n=10) tDCS stimulation was administered at 1.5mA over 20 minutes, for 10-15 sessions based on participant availability. Cognitive assessments were administered before and after the tDCS protocol. Anodal tDCS stimulation resulted in significant gains on the Symbol Digit Modality Test, Trail Making Test Part A, and Forward Digit Span. This study demonstrated a tDCS-invoked cognitive enhancement in the domains of attention, information processing speed, and short-term memory processes. With the rapidly ageing population, tDCS may be a potential therapeutic option for cognitive enhancement and may be beneficial in ageing-related cognitive-disorders including mild cognitive impairment and dementia.

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Can noninvasive brain stimulation enhance function in the ageing brain?

Journal of Neurophysiology ◽

10.1152/jn.00088.2013 ◽

2014 ◽

Vol 111 (1) ◽

pp. 1-3 ◽

Cited By ~ 9

Author(s):

Ann-Maree Vallence ◽

Mitchell R. Goldsworthy

Keyword(s):

Older Adults ◽

Health Systems ◽

Brain Stimulation ◽

Motor Performance ◽

Clinical Importance ◽

Ageing Population ◽

Motor Sequence ◽

Noninvasive Brain Stimulation ◽

Performance Deficits ◽

Ageing Brain

Advancing age is associated with cognitive and motor performance deficits and a reduced capacity for plasticity. Zimerman and colleagues (Zimerman M, Nitsch M, Giraux P, Gerloff C, Cohen LG, Hummel FC. Ann Neurol 73: 10–15, 2013) have recently shown that noninvasive brain stimulation can enhance behavioral improvements following training on a motor sequence task in older adults. The work is of high clinical importance given the rapidly growing ageing population and the accompanying costs to health systems globally.

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Intermittent Hypoxia Training for Treating Mild Cognitive Impairment: A Pilot Study

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/1533317519896725 ◽

2020 ◽

Vol 35 ◽

pp. 153331751989672 ◽

Cited By ~ 3

Author(s):

Hong Wang ◽

Xiangrong Shi ◽

Hannah Schenck ◽

James R. Hall ◽

Sarah E. Ross ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Pilot Study ◽

Elderly Patients ◽

Intermittent Hypoxia ◽

Short Term Memory ◽

Cerebral Oxygenation ◽

Word Association ◽

Digit Span ◽

Verbal Learning

Although intermittent hypoxia training (IHT) has proven effective against various clinical disorders, its impact on mild cognitive impairment (MCI) is unknown. This pilot study examined IHT’s safety and therapeutic efficacy in elderly patients with amnestic MCI (aMCI). Seven patients with aMCI (age 69 ± 3 years) alternately breathed 10% O2 and room-air, each 5 minutes, for 8 cycles/session, 3 sessions/wk for 8 weeks. The patients’ resting arterial pressures fell by 5 to 7 mm Hg ( P < .05) and cerebral tissue oxygenation increased ( P < .05) following IHT. Intermittent hypoxia training enhanced hypoxemia-induced cerebral vasodilation ( P < .05) and improved mini-mental state examination and digit span scores from 25.7 ± 0.4 to 27.7 ± 0.6 ( P = .038) and from 24.7 ± 1.2 to 26.1 ± 1.3 ( P = .047), respectively. California verbal learning test score tended to increase ( P = .102), but trail making test-B and controlled oral word association test scores were unchanged. Adaptation to moderate IHT may enhance cerebral oxygenation and hypoxia-induced cerebrovasodilation while improving short-term memory and attention in elderly patients with aMCI.

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Effect of Berry-Based Supplements and Foods on cognitive function: A Systematic Review

10.21203/rs.3.rs-571401/v1 ◽

2021 ◽

Author(s):

Negar Bonyadi ◽

Neda Dolatkhah ◽

Yaghoub Salekzamani ◽

Maryam Hashemian

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Cognitive Function ◽

Short Term Memory ◽

Brain Perfusion ◽

Controlled Trials ◽

Ageing Population ◽

Cochrane Central Register ◽

Eligibility Criteria ◽

Freeze Dried

Abstract In the current decade, a growing body of evidence proposes the correlation between diet and cognitive function or dementia in the ageing population. This study was designed to appraise discoveries from the randomized controlled trials (RCTs) to confirm the effects of Berry-Based supplements or foods on cognitive function in older adults. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, EMBASE, Google Scholar, and ProQuest as well as SID, Magiran, and Iranmedex electronic databases were explored for human interventional studies up to March 2021. A total of 259 studies were recognized from the primary database searches, and after eliminating the duplicates, 225 studies remained. Of these, 102 were disqualified after screening the title and abstracts of studies. The lasting 17 studies were evaluated in full text and 10 studies (which include 583 participants) encountered the eligibility criteria. Of the included studies, seven were randomized parallel-group (n = 7), two were crossover (n = 2) and one was the pilot study (n = 1). In total, ten articles were identified using freeze-dried blueberries (n = 3 studies), blueberry concentrate (n = 2), beverage (n = 3), capsule (n = 1), extract and powder (n = 1). These studies were directed in older people with no recognized cognitive impairment or mild cognitive impairment (MCI). The primary outcomes included episodic memory, long-term and short-term memory, working memory, executive function, psychomotor reaction time and attention. To our knowledge, this is the first systematic review of available clinical trials on the effects of berry-based supplements and foods on cognitive performances and brain perfusion parameters in elderlies with normal cognition or MCI. Existing evidence concludes that berry-based supplements and foods have beneficial effects on resting brain perfusion, cognitive function, memory performance, executive functioning, processing speed, and attention indices.

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Exposure to Ambient Air Pollution and Cognitive Impairment in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193767 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3767 ◽

Cited By ~ 14

Author(s):

Shin ◽

Han ◽

Choi

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Air Pollutants ◽

Meteorological Data ◽

Digit Span ◽

Multiple Logistic Regression Analysis ◽

Ambient Air ◽

Community Dwelling ◽

Ambient Air Pollution ◽

Global Cognition

The aim of this study was to investigate the associations between ambient air pollutants and cognitive impairment in Korean older adults. The cognitive function of 2,896 participants aged 70 to 84 years was measured using the Korean version of the mini-mental state examination, the digit span test, the word list learning test, and the frontal assessment battery. After matching the average concentrations of particulate matter (PM) <10 μm in size (PM10) and <2.5 μm (PM2.5), NO2, CO, SO2, and O3 between 2013 and 2017, the association between air pollutants and cognitive scales was analyzed using a linear mixed regression and a multiple logistic regression analysis (after adjusting for age, sex, health related behaviors, socioeconomic status, comorbidity, and meteorological data). Exposure to PM2.5, PM10, NO2, SO2, and CO was associated with cognitive impairment above and beyond age or education level effects. Specifically, PM2.5 was negatively associated with most components of the cognitive scales (interquartile range for PM2.5: 2.0 μg/m3, odds ratio for poor global cognition: 2.28, 95% confidence interval: 1.60–3.26). These associations may be affected by sex, residence area, or alcohol intake. Conclusively, air pollutants, especially PM2.5, were associated with cognitive impairment, including global cognition, attention, memory, and executive function in Korean older adults aged ≥70 years.

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A-197 Utility of the Addenbrooke’s Cognitive Examination—Third Edition (ACE-III) to Predict Neuropsychological Test Performance in Older Adults Referred for Neurocognitive Evaluation

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.197 ◽

2020 ◽

Vol 35 (6) ◽

pp. 992-992

Author(s):

Zarrella G ◽

Kay C ◽

Gettens K ◽

Sherman J ◽

Colvin M

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Test Performance ◽

Word Association ◽

Digit Span ◽

Block Design ◽

Group Differences ◽

Neuropsychological Evaluation ◽

Adult Intelligence Scale ◽

Category Fluency

Abstract Objective The ACE-III is a brief cognitive screener with high sensitivity and specificity in detecting neurocognitive disorders. We examined the utility of ACE-III subscale scores (Attention/Orientation, Memory, Fluency, Language, Visuospatial) to predict performance on expanded neuropsychological evaluation and detect diagnostic group differences. Data Selection 217 patients (Mag = 74.0, Medu = 15.78) with neurocognitive concerns completed the ACE-III followed by a comprehensive neuropsychological evaluation, including Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span Backward (DSB), Trail Making Test Part B (TMT B), Boston Naming Test (BNT), Controlled Oral Word Association Test (COWAT), Category Fluency (Vegetables), Wechsler Memory Scale-IV (WMS-IV) Logical Memory (LM), and WAIS-IV Block Design (BD). Patients were diagnosed as having Normal Cognition (NC), Mild Cognitive Impairment (MCI), or Major Neurocognitive Disorder (MND) from clinical history and overall performance (67-NC, 105-MCI, 45-MND). Within-construct performances on comprehensive testing were regressed on ACE-III subscales. Group differences in ACE-III subscales and total scores were also examined. Data Synthesis Each ACE-III subscale score predicted within-construct performance on expanded testing with moderate-strong effects (p’s < .001): Attention/Orientation predictive of WAIS-IV DSB and TMT B; Memory predictive of WMS-IV LM immediate and delayed; Fluency predictive of COWAT and Category Fluency; Language predictive of BNT; Visuospatial predictive of WAIS-IV BD. ACE-III subscale and total scores also distinguished between groups (NC > MCI > MND; p’s < .001). Conclusions Across severity of cognitive impairment, ACE-III subscales are predictive of within-construct performance on expanded testing. The ACE-III may be a useful proxy for a comprehensive neuropsychological evaluation and demonstrates diagnostic utility in distinguishing different levels of cognitive impairment in older adults referred for neurocognitive concerns.

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Comparison of cognitive functions among frail and prefrail older adults: a clinical perspective

International Psychogeriatrics ◽

10.1017/s1041610218000765 ◽

2018 ◽

Vol 31 (2) ◽

pp. 297-301 ◽

Cited By ~ 1

Author(s):

Bárbara Bispo da Silva Alves ◽

Elizabete de Oliveira Barbosa ◽

Daniel de Moraes Pimentel ◽

Lara S. F. Carneiro ◽

Ana Carolina M. A. Rodrigues ◽

...

Keyword(s):

Older Adults ◽

Cognitive Functions ◽

Short Term Memory ◽

Digit Span ◽

Statistical Significance ◽

P Value ◽

Older Individuals ◽

Short Term ◽

Term Memory ◽

Global Cognition

ABSTRACTObjective:To compare cognitive function among frail and prefrail older adults.Design:Cross-sectional clinical study.Participants:Fifty-one non-institutionalized older individuals participated in this study.Measurements:Cognitive functions were evaluated through Mini-Mental State Examination (Global Cognition), Digit Span Forward (short-term memory), Digit Span Backward (working memory), Verbal Fluency Test (semantic memory/executive function). Data were compared using parametric and non-parametric bivariate tests. Binary logistic regression was used to test a frailty prediction model. Statistical significance was defined as p ≤ 0.01 to compare groups. In the regression model, the p value was set to be ≤0.05.Results:Statistically significant differences were observed in global cognition, and short-term memory between frail and prefrail individuals (p ≤ 0.01). Global cognition explained 14–19% of frailty's model.Conclusion:According to our findings, the evaluation of cognitive functions among older persons with frailty and prefrailty provides important complementary information to better manage frailty and its progression.

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Identification of Neuroprotective Factors Associated with Successful Ageing and Risk of Cognitive Impairment among Malaysia Older Adults

Current Gerontology and Geriatrics Research ◽

10.1155/2017/4218756 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Huijin Lau ◽

Arimi Fitri Mat Ludin ◽

Nor Fadilah Rajab ◽

Suzana Shahar

Keyword(s):

Older Adults ◽

Vitamin D ◽

Cognitive Impairment ◽

Telomere Length ◽

Serum Vitamin ◽

Dietary Vitamin ◽

Ageing Population ◽

Successful Ageing ◽

Bdnf Level ◽

Serum Vitamin D

The increase of ageing population has raised public attention on the concept of successful ageing. Studies have shown that vitamin D, telomere length, and brain-derived neurotrophic factor (BDNF) have been associated with cognitive function. Therefore, this study aimed to identify neuroprotective factors for cognitive decline in different ageing groups. A total of 300 older adults aged 60 years and above were recruited in this population based cross-sectional study. Participants were categorized into three groups: mild cognitive impairment (MCI) (n=100), usual ageing (UA) (n=100), and successful ageing (SA) (n=100). Dietary vitamin D intake was assessed through Diet History Questionnaire (DHQ). Out of the 300 participants, only 150 were subjected to fasting blood sample collection. These samples were used for serum vitamin D and plasma BDNF measurements. Whole blood telomere length was measured using RT-PCR method. The results show that the reduction of the risk of MCI was achieved by higher serum vitamin D level (OR: 0.96, 95% CI: 0.92–0.99, p<0.05), higher plasma BDNF level (OR: 0.51, 95% CI: 0.30–0.88, p<0.05), and longer telomere (OR: 0.97, 95% CI: 0.95–0.99, p<0.001). In conclusion, participants with higher vitamin D level, higher BDNF level, and longer telomere length were more likely to age successfully.

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Transcranial magnetic stimulation reveals diminished homoeostatic metaplasticity in cognitively impaired adults

Brain Communications ◽

10.1093/braincomms/fcaa203 ◽

2020 ◽

Vol 2 (2) ◽

Author(s):

Mark H Sundman ◽

Koeun Lim ◽

Viet Ton That ◽

Jack-Morgan Mizell ◽

Chidi Ugonna ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Transcranial Magnetic Stimulation ◽

Brain Stimulation ◽

Magnetic Stimulation ◽

Cognitive Status ◽

Synaptic Activity ◽

Cognitively Impaired ◽

Non Invasive ◽

Potential Value

Abstract Homoeostatic metaplasticity is a neuroprotective physiological feature that counterbalances Hebbian forms of plasticity to prevent network destabilization and hyperexcitability. Recent animal models highlight dysfunctional homoeostatic metaplasticity in the pathogenesis of Alzheimer’s disease. However, the association between homoeostatic metaplasticity and cognitive status has not been systematically characterized in either demented or non-demented human populations, and the potential value of homoeostatic metaplasticity as an early biomarker of cognitive impairment has not been explored in humans. Here, we report that, through pre-conditioning the synaptic activity prior to non-invasive brain stimulation, the association between homoeostatic metaplasticity and cognitive status could be established in a population of non-demented human subjects (older adults across cognitive spectrums; all within the non-demented range). All participants (n = 40; age range, 65–74, 47.5% female) underwent a standardized neuropsychological battery, magnetic resonance imaging and a transcranial magnetic stimulation protocol. Specifically, we sampled motor-evoked potentials with an input/output curve immediately before and after repetitive transcranial magnetic stimulation to assess neural plasticity with two experimental paradigms: one with voluntary muscle contraction (i.e. modulated synaptic activity history) to deliberately introduce homoeostatic interference, and one without to serve as a control condition. From comparing neuroplastic responses across these experimental paradigms and across cohorts grouped by cognitive status, we found that (i) homoeostatic metaplasticity is diminished in our cohort of cognitively impaired older adults and (ii) this neuroprotective feature remains intact in cognitively normal participants. This novel finding suggests that (i) future studies should expand their scope beyond just Hebbian forms of plasticity that are traditionally assessed when using non-invasive brain stimulation to investigate cognitive ageing and (ii) the potential value of homoeostatic metaplasticity in serving as a biomarker for cognitive impairment should be further explored.

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Effect of Tai Chi on Cognitive Function among Older Adults with Cognitive Impairment: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/6679153 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Renjun Gu ◽

Yujia Gao ◽

Chunbing Zhang ◽

Xiaojuan Liu ◽

Zhiguang Sun

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cognitive Impairment ◽

Cognitive Function ◽

Cognitive Decline ◽

Tai Chi ◽

Digit Span ◽

Meta Analysis ◽

Control Group ◽

Clinical Dementia Rating

Background. Cognitive decline occurs in all persons during the aging process and drugs can only alleviate symptoms and are expensive. Some researches demonstrated that Tai Chi had potential in preventing cognitive decline while others’ results showed Tai Chi had no influence on cognitive impairment. Therefore, we conduct a systematic review and meta-analysis to assess the efficacy and safety of cognitive impairment patients practicing Tai Chi. Methods. A comprehensive literature search was carried out in multiple databases, including PubMed, Cochrane, MEDLINE (Ovid), Web of Science, Embase, Scopus, PsycInfo (Ovid), CKNI, Wan Fang, VIP, SinoMed, and ClinicalTrails, from their inception to 1 July 2020 to collect randomized controlled trials about practicing Tai Chi for patients with cognitive impairment. Primary outcomes included changes of cognitive function and secondary outcomes included changes of memory functions. Data were extracted by two independent individuals and Cochrane Risk of Bias tool version 2.0 was applied for the included studies. Systematic review and meta-analysis were performed by RevMan 5.3 software. Results. The results included 827 cases in 9 studies, of which 375 were in the experimental group and 452 were in the control group. Meta-analysis showed that Mini-Mental State Examination WMD = 1.52, 95% CI [0.90, 2.14]; Montreal Cognitive Assessment WMD = 3.5, 95% CI [0.76, 6.24]; Clinical Dementia Rating WMD = −0.55, 95% CI [−0.80, −0.29]; logical memory delayed recall WMD = 1.1, 95% CI [0.04, 2.16]; digit span forward WMD = 0.53, 95% CI [−0.65, 1.71]; and digit span backward WMD = −0.1, 95% CI [−0.38, 0.19]. No adverse events were reported in the included articles. Conclusion. There is limited evidence to support that practicing Tai Chi is effective for older adults with cognitive impairment. Tai Chi seems to be a safe exercise, which can bring better changes in cognitive function score.

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Evaluation of Bedside Tests of Attention and Arousal Assessing Delirium in Parkinson’s Disease, Dementia, and Older Adults

Journal of Parkinson s Disease ◽

10.3233/jpd-212849 ◽

2021 ◽

pp. 1-11

Author(s):

Rachael A. Lawson ◽

Sarah J. Richardson ◽

Daisy Kershaw ◽

Daniel Davis ◽

Blossom C.M. Stephan ◽

...

Keyword(s):

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Digit Span ◽

Lewy Bodies ◽

Area Under The Curve ◽

Optimal Tests ◽

Bedside Tests ◽

Simple Bedside

Background: Delirium is a serious acute neuropsychiatric condition associated with altered attention and arousal. Objective: To evaluate simple bedside tests for attention and arousal to detect delirium in those with and without Parkinson’s disease (PD) and dementia. Methods: Participants from two prospective delirium studies were pooled comprising 30 with PD without cognitive impairment, 24 with Lewy body cognitive impairment (PD dementia or dementia with Lewy bodies), 16 with another dementia and 179 PD and dementia-free older adults. Participants completed standardised delirium assessments including tests of attention: digit span, Memorial Delirium Assessment Scale (MDAS) attention and months of the year backwards; and arousal: Glasgow Coma Scale (GSC), Observational Scale of Level of Arousal (OSLA), Modified Richmond Agitation Scale and MDAS consciousness. Delirium was diagnosed using the DSM-5 criteria. Results: On their first admission, 21.7%participants had prevalent delirium. Arousal measures accurately detected delirium in all participants (p < 0.01 for all), but only selected attention measures detected delirium in PD and dementia. In PD and dementia-free older adults, impaired digit span and OSLA were the optimal tests to detect delirium (area under the curve [AUC] = 0.838, p < 0.001) while in PD and dementia the optimal tests were MDAS attention and GCS LB. Conclusion: Simple bedside tests of attention and arousal at a single visit could accurately detect delirium in PD, dementia and PD and dementia-free older adults; however, the optimal tests differed between groups. Combined attention and arousal scores increased accuracy, which could have clinical utility to aid the identification of delirium neurodegenerative disorders.

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