Neural signature of everyday function in older adults at-risk of cognitive impairment

Assessment of everyday activities are central to the diagnosis of pre-dementia and dementia. Yet, little is known about the brain substrates and processes that contribute to everyday functional impairment, particularly during early stages of cognitive decline. We investigated everyday function using a complex gait task in normal older adults stratified by risk of cognitive impairment. We applied a novel EEG approach, which combines electroencephalographic with 3D-body tracking technology to measure brain-gait dynamics with millisecond precision while participants are in motion. Twenty-six participants (mean age = 74.9 years) with cognitive and everyday functional profiles within the normal range for their age and sex were ranked for risk of cognitive impairment. We used the Montreal Cognitive Assessment battery, a global index of cognition with a range from 0 to 30, to classify individuals as being at higher (22-26) and lower risk (27+). Individuals walking on a treadmill were exposed to visual perturbation designed to destabilize gait. Assuming that brain changes precede behavioral decline, we predicted that older adults increase step width to gain stability, yet the underlying neural signatures would be different for lower versus higher risk individuals. When pooling across risk groups, we found that step width increased and fronto-parietal activation shifted from transient, during swing phases, to sustained across the gait cycle during visually perturbed input. As predicted, step width increased in both groups but underlying neural signatures were different. Fronto-medial theta (3-7Hz) power of gait-related brain oscillations were increased in higher risk individuals during both perturbed and unperturbed inputs. On the other hand, left central gyri beta (13-28Hz) power was decreased in lower risk individuals, specifically during visually perturbed input. Finally, relating MoCA scores to spectral power pooled across fronto-parietal regions, we found associations between increased theta power and worse MoCA scores and between decreased beta power and better MoCA scores. Able-bodied older adults at-risk of cognitive impairment are characterized by unique neural signatures of mobility. Stronger reliance on frontomedial theta activation in at-risk individuals may reflect higher-order compensatory responses for deterioration of basic sensorimotor processes. Region and spectral-specific signatures of mobility may provide brain targets for early intervention against everyday functional decline.

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Anticipatory Care Planning Intervention for Older Adults at Risk of Functional Decline: A Primary Care Feasibility Study

Case Medical Research ◽

10.31525/ct1-nct03902743 ◽

2019 ◽

Author(s):

Keyword(s):

Older Adults ◽

Primary Care ◽

At Risk ◽

Feasibility Study ◽

Functional Decline ◽

Care Planning ◽

Planning Intervention

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EEG Measures of Value-Directed Strategic Processing in Older Adults With and Without Mild Cognitive Impairment

Innovation in Aging ◽

10.1093/geroni/igaa057.937 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 292-293

Author(s):

Lydia Nguyen ◽

Shraddha Shende ◽

Daniel Llano ◽

Raksha Mudar

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Aging ◽

Spectral Power ◽

Group Differences ◽

Cognitive Resources ◽

Alpha Power ◽

Strategic Processing ◽

Unique Word

Abstract Value-directed strategic processing is important for daily functioning. It allows selective processing of important information and inhibition of irrelevant information. This ability is relatively preserved in normal cognitive aging, but it is unclear if mild cognitive impairment (MCI) affects strategic processing and its underlying neurophysiological mechanisms. The current study examined behavioral and EEG spectral power differences between 16 cognitively normal older adults (CNOA; mean age: 74.5 ± 4.0 years) and 16 individuals with MCI (mean age: 77.1 ± 4.3 years) linked to a value-directed strategic processing task. The task used five unique word lists where words were assigned high- or low-value based on letter case and were presented sequentially while EEG was recorded. Participants were instructed to recall as many words as possible after each list to maximize their score. Results revealed no group differences in recall of low-value words, but individuals with MCI recalled significantly fewer high-value words and total number of words relative to CNOA. Group differences were observed in theta and alpha bands for low-value words, with greater synchronized theta power for CNOA than MCI and greater desynchronized alpha power for MCI than CNOA. Collectively, these findings demonstrate that more effortful neural processing of low-value words in the MCI group, relative to the CNOA group, allowed them to match their behavioral performance to the CNOA group. Individuals with MCI appear to utilize more cognitive resources to inhibit low-value information and might show memory-related benefits if taught strategies to focus on high-value information processing.

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Implementation and effectiveness of a multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres

Scientific Reports ◽

10.1038/s41598-021-83408-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Pei Ern Mary Ng ◽

Sean Olivia Nicholas ◽

Shiou Liang Wee ◽

Teng Yan Yau ◽

Alvin Chan ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

At Risk ◽

Cognitive Impairment ◽

Mobile Application ◽

Intervention Group ◽

Blood Parameters ◽

Attrition Rate ◽

Control Group

AbstractTo address the paucity of research investigating the implementation of multi-domain dementia prevention interventions, we implemented and evaluated a 24-week, bi-weekly multi-domain program for older adults at risk of cognitive impairment at neighborhood senior centres (SCs). It comprised dual-task exercises, cognitive training, and mobile application-based nutritional guidance. An RCT design informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework was adopted. Outcome measures include cognition, quality of life, blood parameters, and physical performance. Implementation was evaluated through questionnaires administered to participants, implementers, SC managers, attendance lists, and observations. The program reached almost 50% of eligible participants, had an attrition rate of 22%, and was adopted by 8.7% of the SCs approached. It was implemented as intended; only the nutritional component was re-designed due to participants’ unfamiliarity with the mobile application. While there were no between-group differences in cognition, quality of life, and blood parameters, quality of life reduced in the control group and physical function improved in the intervention group after 24 weeks. The program was well-received by participants and SCs. Our findings show that a multi-domain program for at-risk older adults has benefits and can be implemented through neighborhood SCs. Areas of improvement are discussed.Trial registration: ClinicalTrials.gov NCT04440969 retrospectively registered on 22 June 2020.

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Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

10.21203/rs.3.rs-1182649/v1 ◽

2022 ◽

Author(s):

Laura Tay ◽

Melvin Chua ◽

Yew Yoong Ding

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Functional Decline ◽

Oral Intake ◽

Index Admission ◽

Geriatric Syndromes ◽

Poor Oral Intake ◽

Hospitalized Older Adults ◽

Minimal Adjustment

Abstract Background: Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods: Consecutive admissions of patients >65 years to a general medical department were recruited over 15 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for intermediary events including poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results: We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) patients. Depressive symptoms (OR 1.55, 95% CI 1.15-2.07), malnutrition (OR 1.59, 95% CI 1.14-2.23), higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P<0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR=1.62, 95% CI 1.22-2.16), had poor oral intake (OR=1.35, 95% CI 1.02-1.79) and functional decline during admission (OR=1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty, delirium, cognitive impairment and poor oral intake during hospitalization (P<0.05). In minimal adjustment set identified by DAG, depressive symptoms (OR=1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was attenuated after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR=1.40, 95% CI 0.99-1.98, P=0.06). Conclusion: The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

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Aspirin and statin therapy for primary prevention of cardiovascular disease in older adults

Heart ◽

10.1136/heartjnl-2021-320154 ◽

2021 ◽

pp. heartjnl-2021-320154

Author(s):

Sophie Montgomery ◽

Michael D Miedema ◽

John Dodson

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Decision Making ◽

Cognitive Impairment ◽

Primary Prevention ◽

Absolute Risk ◽

Functional Decline ◽

Calcium Score ◽

Risk Of Death ◽

Therapeutic Decisions

The value of primary preventative therapies for cardiovascular disease (CVD) in older adults (age ≥75 years) is less certain than in younger patients. There is a lack of quality evidence in older adults due to underenrolment in pivotal trials. While aspirin is no longer recommended for routine use in primary prevention of CVD in older adults, statins may be efficacious. However, it is unclear which patient subgroups may benefit most, and guidelines differ between expert panels. Three relevant geriatric conditions (cognitive impairment, functional impairment and polypharmacy) may influence therapeutic decision making; for example, baseline frailty may affect statin efficacy, and some have advocated for deprescription in this scenario. Evidence regarding statins and incident functional decline are mixed, and vigilance for adverse effects is important, especially in the setting of polypharmacy. However, aspirin has not been shown to affect incident cognitive or functional decline, and its lack of efficacy extends to patients with baseline cognitive impairment or frailty. Ultimately, the utility of primary preventative therapies for CVD in older adults depends on potential lifetime benefit. Rather than basing treatment decisions on absolute risk alone, consideration of comorbidities, polypharmacy and life expectancy should play a significant role in decision making. Coronary calcium score and new tools for risk stratification validated in older adults that account for the competing risk of death may aid in evaluating potential benefits. Given the complexity of therapeutic decisions in this context, shared decision making provides an important framework.

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Neuropsychological and Functional Impact of COVID-19 on Mild Cognitive Impairment

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/1533317520960875 ◽

2020 ◽

Vol 35 ◽

pp. 153331752096087

Author(s):

Kalpana P. Padala ◽

Christopher M. Parkes ◽

Prasad R. Padala

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Case Report ◽

Mild Cognitive Impairment ◽

Activities Of Daily Living ◽

Older Adult ◽

Daily Living ◽

Functional Decline ◽

Depression And Anxiety ◽

Physically Active

We present a case report to showcase that behavioral, cognitive, and functional decline may be associated with COVID-19 stay-home guidance among older adults with pre-existent cognitive impairment. In a functionally independent and physically active older adult with Mild Cognitive Impairment, there was worsening in depression and anxiety symptoms associated with the restrictions of COVID-19. Functional decline was also noted as assessed by Instrumental Activities of Daily Living. We discuss solutions to mitigate the effects of COVID-19 restrictions in this vulnerable population.

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