Five-year follow-up of cognitive impairment in older adults with bipolar disorder

Background: Mood disorders are often associated with persistent cognitive impairments. However, pro-cognitive treatments are essentially lacking. This is partially because of poor insight into the neurocircuitry abnormalities underlying these deficits and their change with illness progression. Aims: This functional magnetic resonance imaging (fMRI) study investigates the neuronal underpinnings of cognitive impairments and neuronal change after mood episodes in remitted patients with bipolar disorder (BD) using a hippocampus-based picture encoding paradigm. Methods: Remitted patients with BD ( n=153) and healthy controls ( n=52) were assessed with neuropsychological tests and underwent fMRI while performing a strategic picture encoding task. A subgroup of patients ( n=43) were rescanned after 16 months. We conducted data-driven hierarchical cluster analysis of patients’ neuropsychological data and compared encoding-related neuronal activity between the resulting neurocognitive subgroups. For patients with follow-up data, effects of mood episodes were assessed by comparing encoding-related neuronal activity change in BD patients with and without episode(s). Results: Two neurocognitive subgroups were revealed: 91 patients displayed cognitive impairments while 62 patients were cognitively normal. No neuronal activity differences were observed between neurocognitive subgroups within the dorsal cognitive control network or hippocampus. However, exploratory whole-brain analysis revealed lower activity within a small region of middle temporal gyrus in impaired patients, which significantly correlated with poorer neuropsychological performance. No changes were observed in encoding-related neuronal activity or picture recall accuracy with the occurrence of mood episode(s) during the follow-up period. Conclusion: Memory encoding fMRI paradigms may not capture the neuronal underpinnings of cognitive impairment or effects of mood episodes.

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Combined association of cognitive impairment and poor oral health on mortality risk in older adults: results from the NHANES with 15 years of follow‐up

Journal of Periodontology ◽

10.1002/jper.21-0292 ◽

2021 ◽

Author(s):

An Li ◽

Yuntao Chen ◽

Anita Visser ◽

Luc A.M. Marks ◽

Geerten‐Has E. Tjakkes

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Oral Health ◽

Mortality Risk

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Anticholinergics and Benzodiazepines on Cognitive Impairment among Elderly with Alzheimer’s Disease: a One year Follow-Up Study

10.21203/rs.2.17956/v1 ◽

2019 ◽

Author(s):

Rewadee Jenraumjit ◽

Surarong Chinwong ◽

Dujrudee Chinwong ◽

Tipaporn Kanjanarach ◽

Thanat Kshetradat ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Psychological Symptoms ◽

Esterase Inhibitors ◽

One Year ◽

State Examination ◽

Harmful Effects

Abstract Objective Age-associated decline in central cholinergic activity makes older adults susceptible to harmful effects of anticholinergics (ACs). Evidence exists of an association between effects of AC medications on cognition. This retrospective cohort study examines how ACs affect cognition among older adults with Alzheimer’s disease (AD) who received acetylcholine esterase inhibitors (AChEIs) over the course of 12 months. Results A total of 133 (80% women, mean age 78.38 years, SD 7.4) were recruited. No difference in sex, age and comorbid diseases was observed between participants who took ACs, Benzodiazepines (BZDs) and AChEIs. The most common prescribed ACs was quetiapine, being used for behavioral and psychological symptoms (BPSD). Multilevel analysis showed that the change of mental state examination scores were significantly predicted in the group using ACs (t (169), -2.52, p = .020) but not with the groups using BZD (t (162), 0.84, p = .440). Evidence showed that older adults with Alzheimer’s disease and exposed to ACs exhibited lower global cognitive scores than those without AC exposure. Using ACs could be a trade-off between controlling BPSD and aggravating cognitive impairment. Highlighting the awareness of the potential anticholinergic effect is important and may be the best policy.

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Nonimmersive Brain Gaming for Older Adults With Cognitive Impairment: A Scoping Review

The Gerontologist ◽

10.1093/geront/gny164 ◽

2019 ◽

Vol 59 (6) ◽

pp. e764-e781 ◽

Cited By ~ 5

Author(s):

Pallavi Sood ◽

Sandra L Kletzel ◽

Shilpa Krishnan ◽

Hannes Devos ◽

Ahmed Negm ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Scoping Review ◽

Research Field ◽

Cognitive Outcome ◽

Future Research ◽

Eligibility Criteria ◽

Technological Advances ◽

Design And Methods

Abstract Background Technological advances have allowed a variety of computerized cognitive training tools to be engineered in ways that are fun and entertaining yet challenging at a level that can maintain motivation and engagement. This revolution has created an opportunity for gerontological scientists to evaluate brain gaming approaches to improve cognitive and everyday function. The purpose of this scoping review is to provide a critical overview of the existing literature on nonimmersive, electronic brain gaming interventions in older adults with mild cognitive impairment or dementia. Research Design and Methods Systematic search was conducted using 7 electronic databases from inception through July 2017. A comprehensive 2-level eligibility process was used to identify studies for inclusion based on PRISMA guidelines. Results Seventeen studies met eligibility criteria. Majority of the studies were randomized controlled trials (n = 13) and incorporated an active control (n = 9). Intervention doses ranged from 4 to 24 weeks in duration with an average of 8.4 (±5.1 standard deviation [SD]) weeks. Session durations ranged from 30 to 100 min with an average of 54 (±25 SD) minutes. Nearly half of studies included a follow-up, ranging from 3 months to 5 years (n = 8). For most studies, brain gaming improved at least one cognitive outcome (n = 12); only one study reported improvement in activities of daily living. Discussion and Implications This scoping review conveys the breadth of an emerging research field, which will help guide future research to develop standards and recommendations for brain gaming interventions which are currently lacking.

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Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: A four-year follow-up study with older adults

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2019.104005 ◽

2020 ◽

Vol 87 ◽

pp. 104005

Author(s):

Allan Gustavo Brigola ◽

Ana Carolina Ottaviani ◽

Tiago da Silva Alexandre ◽

Bruna Moretti Luchesi ◽

Sofia Cristina Iost Pavarini

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Functional Decline ◽

Cumulative Effects ◽

Follow Up Study

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Two-year course of cognitive function and instrumental activities of daily living in older adults with bipolar disorder: evidence for neuroprogression?

Psychological Medicine ◽

10.1017/s0033291712001614 ◽

2012 ◽

Vol 43 (4) ◽

pp. 801-811 ◽

Cited By ~ 47

Author(s):

A. G. Gildengers ◽

D. Chisholm ◽

M. A. Butters ◽

S. J. Anderson ◽

A. Begley ◽

...

Keyword(s):

Older Adults ◽

Bipolar Disorder ◽

Cognitive Impairment ◽

Cognitive Function ◽

Activities Of Daily Living ◽

Cognitive Aging ◽

Repeated Measures ◽

Daily Living ◽

Time Points ◽

Instrumental Activities

BackgroundWhile bipolar disorder (BD) is a leading cause of disability, and an important contributor to disability in BD is cognitive impairment, there is little systematic research on the longitudinal course of cognitive function and instrumental activities of daily living (IADLs) in late-life. In this report, we characterize the 2-year course of cognitive function and IADLs in older adults with BD.MethodWe recruited non-demented individuals 50 years and older with BD I or BD II (n = 47) from out-patient clinics or treatment studies at the University of Pittsburgh. Comparator subjects (‘controls’) were 22 individuals of comparable age and education with no psychiatric or neurologic history, but similar levels of cardiovascular disease. We assessed cognitive function and IADLs at baseline, 1- and 2-year time-points. The neuropsychological evaluation comprised 21 well-established and validated tests assessing multiple cognitive domains. We assessed IADLs using a criterion-referenced, performance-based instrument. We employed repeated-measures mixed-effects linear models to examine trajectory of cognitive function. We employed non-parametric tests for analysis of IADLs.ResultsThe BD group displayed worse cognitive function in all domains and worse IADL performance than the comparator group at baseline and over follow-up. Global cognitive function and IADLs were correlated at all time-points. The BD group did not exhibit accelerated cognitive decline over 2 years.ConclusionsOver 2 years, cognitive impairment and associated functional disability of older adults with BD appear to be due to long-standing neuroprogressive processes compounded by normal cognitive aging rather than accelerated cognitive loss in old age.

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Mental Disorders, Cognitive Impairment and the Risk of Suicide in Older Adults

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.695286 ◽

2021 ◽

Vol 12 ◽

Author(s):

Agnieszka Kułak-Bejda ◽

Grzegorz Bejda ◽

Napoleon Waszkiewicz

Keyword(s):

Older Adults ◽

Bipolar Disorder ◽

Cognitive Impairment ◽

Mental Disorders ◽

Anxiety Disorders ◽

Older People ◽

Mood Disorders ◽

The Elderly ◽

Increased Risk ◽

The World

More than 600 million people are aged 60 years and over are living in the world. The World Health Organization estimates that this number will double by 2025 to 2 billion older people. Suicide among people over the age of 60 is one of the most acute problems. The factors strongly associated with suicide are mentioned: physical illnesses, such as cancer, neurologic disorder, pain, liver disease, genital disorders, or rheumatoid disorders. Moreover, neurologic conditions, especially stroke, may affect decision-making processes, cognitive capacity, and language deficit. In addition to dementia, the most common mental disorders are mood and anxiety disorders. A common symptom of these disorders in the elderly is cognitive impairment. This study aimed to present the relationship between cognitive impairment due to dementia, mood disorders and anxiety, and an increased risk of suicide among older people. Dementia is a disease where the risk of suicide is significant. Many studies demonstrated that older adults with dementia had an increased risk of suicide death than those without dementia. Similar conclusions apply to prodromal dementia Depression is also a disease with a high risk of suicide. Many researchers found that a higher level of depression was associated with suicide attempts and suicide ideation. Bipolar disorder is the second entity in mood disorders with an increased risk of suicide among the elderly. Apart from suicidal thoughts, bipolar disorder is characterized by high mortality. In the group of anxiety disorders, the most significant risk of suicide occurs when depression is present. In turn, suicide thoughts are more common in social phobia than in other anxiety disorders. Suicide among the elderly is a serious public health problem. There is a positive correlation between mental disorders such as dementia, depression, bipolar disorder, or anxiety and the prevalence of suicide in the elderly. Therefore, the elderly should be comprehensively provided with psychiatric and psychological support.

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Intermittent Fasting Enhanced the Cognitive Function in Older Adults with Mild Cognitive Impairment by Inducing Biochemical and Metabolic changes: A 3-Year Progressive Study

Nutrients ◽

10.3390/nu12092644 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2644 ◽

Cited By ~ 2

Author(s):

Theng Choon Ooi ◽

Asheila Meramat ◽

Nor Fadilah Rajab ◽

Suzana Shahar ◽

Intan Safinar Ismail ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Successful Aging ◽

Ketone Bodies ◽

Fasting Blood Glucose ◽

Elderly Subjects ◽

Intermittent Fasting

Intermittent fasting (IF) refers to various dietary regimens that cycle between a period of non-fasting and a period of total fasting. This study aimed to determine the effects of IF on cognitive function among elderly individuals who practice IF who have mild cognitive impairment (MCI). A total of 99 elderly subjects with MCI of Malay ethnicity without any terminal illness were recruited from a larger cohort study, LRGS TUA. The subjects were divided into three groups, comprising those who were regularly practicing IF (r-IF), irregularly practicing IF (i-IF), and non-fasters (n-IF). Upon 36 months of follow-up, more MCI subjects in the r-IF group reverted to successful aging with no cognitive impairment and diseases (24.3%) compared to those in i-IF (14.2%) and n-IF groups (3.7%). The r-IF group’s subjects exhibited significant increment in superoxide dismutase (SOD) activity and reduction in body weight, levels of insulin, fasting blood glucose, malondialdehyde (MDA), C-reactive protein (CRP), and DNA damage. Moreover, metabolomics analysis showed that IF may modulate cognitive function via various metabolite pathways, including the synthesis and degradation of ketone bodies, butanoate metabolism, pyruvate metabolism, and glycolysis and gluconeogenesis pathways. Overall, the MCI-afflicted older adults who practiced IF regularly had better cognitive scores and reverted to better cognitive function at 36 months follow-up.

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Physical Work and Exercise Reduce the Risk of Cognitive Impairment in Older Adults: A Population-based Longitudinal Study

Current Alzheimer Research ◽

10.2174/1567205018666211118100451 ◽

2021 ◽

Vol 18 ◽

Author(s):

Fan He ◽

Junfen Lin ◽

Fudong Li ◽

Yujia Zhai ◽

Tao Zhang ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Rural Areas ◽

Tai Chi ◽

Cox Regression ◽

Population Based ◽

Independent Effect ◽

Physical Work ◽

Protective Effects

Background: The independent effect of physical work on the risk of cognitive impairment in older Chinese adults living in rural areas remains to be elucidated. Objective: We aimed to determine whether physical work and physical exercise can reduce the risk of cognitive impairment. Methods: We collected data from 7,000 permanent residents without cognitive impairment (age ≥60 years) over a follow-up period of 2 years. We used the Chinese version of the Mini-Mental State Ex- amination (MMSE) to assess cognitive function. We performed multivariate Cox regression analyses to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (%95 CIs) as measures of the association between physical work/exercise and cognitive impairment while controlling for potential confounders. Results: Over a median follow-up period of 1.93 years, 1,224 (17.5%) of 7,000 participants developed cognitive impairment, with a total incidence of 97.69 per 1,000 person-years. After adjustment for potential confounders, participating in physical work (HR: 0.51; 95% CI: 0.43-0.60) or physical exer- cise (HR: 0.53; 95% CI: 0.44-0.65) was associated with a reduced risk of cognitive impairment. Strati- fied analyses suggested additive and multiplicative interactions between physical work and exercise. Agricultural work (HR: 0.46; 95% CI: 0.38-0.55), walking/tai chi (HR: 0.54; 95% CI: 0.44-0.67), and brisk walking/yangko (HR: 0.57; 95% CI: 0.33-0.97) exerted significant protective effects against cognitive impairment. Conclusion: Both physical work and exercise can reduce the risk of cognitive impairment in older adults. Reasonable types and appropriate intensities of physical activity are recommended to prevent or delay the progression of cognitive impairment.

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Degree of cognitive impairment and mortality: a 17-year follow-up in a community study

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796014000390 ◽

2014 ◽

Vol 24 (6) ◽

pp. 503-511 ◽

Cited By ~ 8

Author(s):

J. Santabárbara ◽

R. Lopez-Anton ◽

G. Marcos ◽

C. De-la-Cámara ◽

E. Lobo ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mortality Risk ◽

Community Sample ◽

Population Attributable Fraction ◽

Moderate Degree ◽

Mild Degree ◽

Mini Mental Status Examination ◽

Severe Degree

Background.To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment.Method.A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages.Results.Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the ‘mild’ degree of impairment; HR: 1.29 in the ‘moderate’ degree; and HR: 2.08 in the ‘severe’ degree). The PAF of mortality due to severe cognitive impairment was 3.49%.Conclusions.A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.

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