Cognitive decline after elective and nonelective hospitalizations in older adults

ObjectiveTo determine whether emergent and urgent (nonelective) hospitalizations are associated with faster acceleration of cognitive decline compared to elective hospitalizations, accounting for prehospital decline.MethodsData came from the Rush Memory and Aging Project, a prospective cohort study of community-dwelling older persons without baseline dementia. Annual measures of cognition via a battery of 19 tests were linked to 1999 to 2010 Medicare claims records.ResultsOf 777 participants, 460 (59.2%) were hospitalized over a mean of 5.0 (SD = 2.6) years; 222 (28.6%) had at least one elective and 418 (53.8%) at least one nonelective hospitalization. Mixed-effects regression models estimated change in global cognition before and after each type of hospitalization compared to no hospitalization, adjusted for age, sex, education, medical conditions, length of stay, surgery, intensive care unit, and comorbidities. Persons who were not hospitalized had a mean loss of 0.051 unit global cognition per year. In comparison, there was no significant difference in rate of decline before (0.044 unit per year) or after (0.048 unit per year) elective hospitalizations. In contrast, decline before nonelective hospitalization was faster (0.076 unit per year; estimate = −0.024, SE = 0.011, p = 0.032), and accelerated by 0.036 unit (SE = 0.005, p < 0.001) to mean loss of 0.112 unit per year after nonelective hospitalizations, more than doubling the rate in those not hospitalized.ConclusionsNonelective hospitalizations are related to more dramatic acceleration in cognitive decline compared to elective hospitalizations, even after accounting for prehospital decline. These findings may inform which hospital admissions pose the greatest risk to the cognitive health of older adults.

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SAT-LB115 Metformin-Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes Mellitus: The Sydney Memory and Ageing Study

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2055 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Katherine Samaras ◽

Steve Makkar ◽

John D Crawford ◽

Nicole A Kochan ◽

Wei Wen ◽

...

Keyword(s):

Older Adults ◽

Heart Disease ◽

Executive Function ◽

Older People ◽

Cognitive Decline ◽

Community Dwelling ◽

Incident Dementia ◽

Ageing Study ◽

Global Cognition ◽

Rate Of Decline

Abstract Background Metformin use in diabetes has been associated with both increased and decreased dementia rates in observational studies of people with diabetes. Objective: To examine changes in global cognition and specific cognitive domains over 6 years in older adults with diabetes treated with metformin, compared to other glucose lowering medications, and to people without diabetes. Methods Data were examined from the Sydney Memory and Ageing Study, a prospective observational study of 6 years duration of 1037 non-demented community-dwelling elderly aged 70-90 at baseline, derived from a compulsory electoral roll. Neuropsychological testing was performed every 2 years with domain measures of memory, executive function, language, visuospatial function, attention and processing speed and a composite of global cognition. Data were analysed by linear mixed modelling, including age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking and apolipoprotein E ε4 carriage as covariates. Results: At baseline, 123 participants had diabetes (DM) with 67 receiving metformin (DM+MF) who were similar in demographics to those not receiving metformin (DM-noMF) and those without diabetes (no-DM). Participants with diabetes had higher BMI, lower HDL- and LDL-cholesterol and more prevalent heart disease, hypertension and smoking, compared to no-DM. Over 6-years, DM+MF participants had significantly slower rates of decline in global cognition and executive function, compared to DM-noMF, adjusted for covariates. The rate of decline for each cognitive domain was similar between DM+MF and controls. No impact was found in analyses examining interactions with sex, ApoEε4 carriage or hyperlipidemia. No difference was found in the rate of decline in brain volumes between the groups over 2 years. Incident dementia was significantly higher in DM-noMF, compared to DM+MF (adjusted OR 5.29 [95% CI 1.17-23.88], p,0.05), whereas risk of incident dementia was similar between DM+MF and participants without diabetes. Conclusions: In older people with diabetes receiving metformin, rates of cognitive decline and dementia were similar to that found in people without diabetes and significantly less than that found in people with diabetes not receiving metformin. Large randomized studies in people with and without diabetes are required to determine whether these associations can be attributed to metformin alone or if other factors explain these observations. Future studies will clarify if this cheap and safe medication can be repurposed for prevention of cognitive decline in older people.

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Dual-task gait speed and mobility are positively associated with declarative memory

Innovation in Aging ◽

10.1093/geroni/igab046.3175 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 879-879

Author(s):

Michelle Gray ◽

Sally Paulson ◽

Joshua Gills ◽

Erica Madero ◽

Jennifer Myers ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Physical Function ◽

Sex Education ◽

Dual Task ◽

Declarative Memory ◽

Peak Velocity ◽

Paired Comparison ◽

Community Dwelling ◽

Cognitive Testing

Abstract In the US, it is not recommended to perform routine screening assessments for cognitive function or impairment among older adults, due to the lack of effective pharmacological treatments. These common practices result in delayed identification and treatments for slowing cognitive decline progression. Thus, the purpose of the present investigation was to determine the ability to predict cognition from common measures of physical function. Seventy-five community-dwelling older adults (80.7±5.4 years) completed physical function and cognitive assessments. Physical function was assessed using the Short Physical Performance Battery (SPPB), peak velocity during a power sit-to-stand task, and dual-task walking test. Cognition (declarative memory) was assessed using a validated Visual Paired Comparison test. 38% of the variance in cognition was accounted for by the predictor variables (age, sex, education, SPPB, dual-task, peak velocity). Significant predictors included dual-task walking (p = .03), SPPB (p = .02), and education (p = .02). For each 1 second faster during the dual-task performance, cognition increased by 4 percentile units. Likewise, each 1 unit increase in SPPB resulted in an increase of 4 percentile points in cognition. The results indicate more than a third of the variance in declarative memory can be predicted by commonly assessed measures of physical function. This information is useful when identifying older adults that may have cognitive impairment before overt signs are realized. With the lack of recommended cognitive testing, using physical function declines to identify possible cognitive decline is promising. These results are preliminary in nature and longitudinal determination is warranted.

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Abstract MP88: Fetuin-A, a Vascular Biomarker of Cognitive Decline in Older Adults

Circulation ◽

10.1161/circ.129.suppl_1.mp88 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Gail A Laughlin ◽

Linda K McEvoy ◽

Elizabeth Barrett-Connor ◽

Lori B Daniels ◽

Joachim H Ix

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Vascular Disease ◽

Sex Education ◽

Cognitive Aging ◽

Community Dwelling ◽

Fetuin A ◽

High Functioning ◽

Age Related

Objectives: The contribution of vascular disease to neurocognitive decline is now widely recognized. Fetuin-A is an abundant plasma protein known to predict vascular disease. Prior studies have shown that fetuin-A levels are lower in patients with Alzheimer’s disease in direct proportion to the severity of cognitive impairment; however, their association with normal cognitive aging is unknown. We evaluated the association of serum fetuin-A levels with cognitive function in relatively high-functioning, community-dwelling older adults from the Rancho Bernardo Study. Methods: This is a population-based study of 1382 older adults (median age 75) who had plasma fetuin-A levels and cognitive function evaluated in 1992-96; 855 had repeat cognitive function assessment a median of 4 years later. Results: Adjusting for age, sex, education, and depression, higher levels of fetuin-A were associated with better baseline performance on the Mini-Mental Status Exam (MMSE) (P=0.012) and a tendency for better Trails Making B scores (P=0.066). In longitudinal analyses, the likelihood of a major decline (highest decile of change) in Trails B was 29% lower (P=0.010) for each SD higher baseline fetuin-A level; odds of major decline in MMSE was 42% lower (P=0.005) per SD higher fetuin-A for individuals with no known CVD, but were not related to fetuin-A in those with CVD (P=0.33). Fetuin-A was not related to Category Fluency performance. Results did not vary by sex and were not explained by numerous vascular risk factors and comorbidities. Conclusions: Higher plasma fetuin-A concentrations are associated with better performance on tests of global cognitive function and executive function and with reduced likelihood of major decline in these cognitive abilities over a 4-year period. These observations are consistent with the hypothesis that higher fetuin-A protects against cognitive decline in relatively high functioning older adults, although this may be less apparent in those with established vascular disease. Fetuin-A may serve as a biological link between vascular disease and normal age-related cognitive decline.

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Development of a Compensation-aware Virtual Rehabilitation System for Upper Extremity Rehabilitation in Community-Dwelling Older Adults with Stroke

10.21203/rs.3.rs-511925/v1 ◽

2021 ◽

Author(s):

Zhiqiang Luo ◽

Audrey Ei-Ping Lim ◽

Ponraj Durairaj ◽

Kim Kiow Tan ◽

Verawaty Verawaty

Keyword(s):

Older Adults ◽

Upper Extremity ◽

Community Dwelling ◽

Virtual Rehabilitation ◽

Motor Practice ◽

Significant Difference ◽

Rehabilitation System ◽

Before And After ◽

Upper Extremity Rehabilitation ◽

Community Dwelling Older Adults

Abstract Background: Compensatory movements are commonly observed in older adults with stroke when they take motor practice for rehabilitation, which could limit their motor recovery.Aim: This study aims to develop one virtual rehabilitation system (VRS) that can detect and reduce compensatory movements to improve the quality of upper extremity (UE) movements and hence the outcome of rehabilitation in community-dwelling older adults with stroke. Method: To design and validate the algorithm of compensation detection equipped in VRS, a study was first conducted to recruit 17 healthy and 6 stroke participants to identify and quantify compensatory movements when they played rehabilitation games provided by the VRS. Then a pilot study was conducted to test the feasibility and efficacy of the VRS deployed in community, where 18 stroke participants were assigned to either virtual reality (VR) group or conventional treatment (CT) group, and each participant underwent 10 sessions of an additional 6 minutes of VR games or CT respectively, on top of their usual rehabilitation programme. Participants were assessed before and after interventions using Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Wolf Motor Function Test(WMFT), Stroke Rehabilitation Motivation Scale (SRMS), Range of Motion (ROM) measurements and the number of compensatory movements.Results: VR group demonstrated a trend in reduction of trunk and upper-extremity compensations, increased intrinsic motivation scores, and statistically significant improvements in FMA-UE (p=0.045) and WMFT (p=0.009, p=0.0355) scores. There was, however, no significant difference in all outcome measures between two groups. Conclusion: The compensation-aware VRS demonstrates a trend towards reduced compensation and higher motivation level, which could be an effective adjunct to the conventional therapy with less supervision from a therapist as well as be potentially deployed in a community center or at an elder adult’s home.

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Abstract P402: Aortic Stiffness and 5-year Cognitive Decline Among Community-dwelling Older Adults: The Atherosclerosis Risk in Communities Neurocognitive Study (aric-ncs)

Circulation ◽

10.1161/circ.141.suppl_1.p402 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Jingkai Wei ◽

Priya Palta ◽

Aozhou Wu ◽

Michelle Meyer ◽

A. Richey Sharret ◽

...

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Aortic Stiffness ◽

Community Dwelling ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Rate Of Decline ◽

Community Dwelling Older Adults ◽

Annual Decline

Background: Vascular aging is associated with cognitive decline. Aortic stiffness is a hallmark of vascular aging. We tested the hypothesis that greater aortic stiffness is associated with a faster rate of cognitive decline over 5 years among older adults. Methods: A prospective cohort study at the 5th (2011-2013) and 6th (2016-2017) examinations of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) was conducted to quantify the association between baseline aortic stiffness and cognitive decline over 5 years. A total of 4639 participants (mean age: 75 years, 41% men, 22% Black) with baseline measures of aortic stiffness and cognitive function were included in the analysis. Aortic stiffness was measured as carotid-femoral pulse wave velocity (cfPWV) using the Omron VP-1000 Plus device and analyzed continuously per 1 standard deviation meter/second (3.20 m/s). Elevated aortic stiffness was defined as the upper 25th percentile of cfPWV (13.39 m/s). Cognitive function was based on ten neuropsychological tests across multiple domains of cognition, including memory, executive function/processing speed, and language. A global cognitive performance factor score was estimated based on all cognitive tests at both visits. Multivariable linear regression was used to examine the associations of each standard deviation (SD) increment in cfPWV and elevated cfPWV with annual cognitive decline over 5 years. Interactions with baseline cognitive status were assessed. To account for attrition (35% over 5 years), multiple imputation by chained equations was used to impute missing global cognitive performance factor scores at visit 6. Results: Each 1 SD increase in cfPWV was associated with 0.008 SD (Beta (β)=-0.008, 95% confidence interval (CI): -0.010, -0.003) annual rate of decline in cognitive function after adjustment for age, sex, education, race-center and ApoE4. With additional adjustment for ever smoking, total weekly physical activity time, mean arterial pressure, diabetes, and body mass index, each SD higher cfPWV was associated with 0.005 SD (β=-0.005, 95% CI: -0.010, -0.001) annual rate of decline in cognitive function. Elevated cfPWV was associated with 0.015 SD (β=-0.015, 95% CI: -0.024, -0.005) annual decline in cognitive function, and with 0.010 SD (β=-0.010, 95% CI: -0.020, 0.0001) annual decline after additional adjustment. Conclusion: Higher aortic stiffness is associated with the rate of decline in global cognitive function among community-dwelling older adults. The hemodynamic sequelae of aortic stiffening may contribute to cognitive decline among older adults.

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Examination of the cognitive function of Japanese community-dwelling older adults in a class for preventing cognitive decline during the COVID-19 pandemic

PLoS ONE ◽

10.1371/journal.pone.0248446 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0248446

Author(s):

Minoru Kouzuki ◽

Shota Furukawa ◽

Keisuke Mitani ◽

Katsuya Urakami

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Daily Life ◽

Community Dwelling ◽

Retrospective Case ◽

Function Test ◽

Before And After ◽

Community Dwelling Older Adults ◽

Cognitive Function Test

We examined the changes in cognitive function due to restrictions in daily life during the coronavirus disease 2019 (COVID-19) pandemic in community-dwelling older adults with mild cognitive decline. This was a retrospective, case-control study. The participants include 88 older adults with mild cognitive decline (mean age = 81.0 [standard deviation = 6.5] years) who participated in a class designed to help prevent cognitive decline. This class was suspended from early-March to end of May 2020 to prevent the spread of COVID-19, and resumed in June 2020. We collected demographic and cognitive function test data (Touch Panel-type Dementia Assessment Scale [TDAS]) before and after class suspension and questionnaire data on their lifestyle and thoughts during the suspension. Change in TDAS scores from before and after the suspension was used to divide the participants into decline (2 or more points worsening) and non-decline (all other participants) groups, with 16 (18.2%) and 72 (81.8%) participants in each group, respectively. A logistic regression model showed that the odds ratio (OR) for cognitive decline was lower in participants whose responses were “engaged in hobbies” (OR = 0.07, p = 0.015), “worked on a worksheet about cognitive training provided by the town hall” (OR = 0.19, p = 0.026), and “had conversations over the phone” (OR = 0.28, p = 0.0495). There was a significant improvement in TDAS scores after class was resumed (p < 0.01). A proactive approach to intellectual activities and social ties may be important for the prevention of cognitive decline during periods of restrictions due to COVID-19. We found that cognitive function test scores before class suspension significantly improved after resuming classes. We speculate that continued participation in this class led to positive behavioral changes in daily life during periods of restriction due to COVID-19.

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Midlife Marital Status and Subsequent Cognitive Decline over 20 Years: Discovery from ARIC

10.31237/osf.io/wfgr7 ◽

2019 ◽

Author(s):

Simo Du

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Marital Status ◽

Community Dwelling ◽

Cognitive Domain ◽

Mixed Effect ◽

Cognitive Domains ◽

Never Married ◽

Domain Specific ◽

Significant Difference

Background — Recent studies show that marriage is associated with a protective effect against cognitive decline among older adults. However, definite evidence from large prospective cohorts is lacking. Even less is known about the association between marital status during midlife and domain-specific cognitive decline in later life. Objective — To investigate the effect of midlife marital status on subsequent domain specific cognitive decline over 20 years among community dwelling older adults. Methods — Prospective cohort study of a biracial population of 14148 participants in the Artherosclerosis Risk in Communities (ARIC) study. Participants were followed from 1990-1992 through 2011-2013 and underwent three cognitive assessments at visit 2 (1990-1992), visit 4 (2004-2006) and visit 5 (2011-2013). Factor scores of cognitive functions were developed from neurocognitive tests during three visits and harmonized into three cognitive domains including executive, memory and language as well as general cognitive performance. Marital status was collected at visit 2 and categorized into four groups: married, divorced or separated, widowed, and never married. Multiple imputation using chained equations (MICE) was applied to address the challenge of informative attrition. Multivariable mixed effect linear models were applied after imputation with a spline term at year six to represent non-linear cognitive decline and a random slope to allow individual variations in cognitive decline after year six. Models were adjusted for age, sex, race, education, hypertension, diabetes, alcohol consumption, smoking status, and BMI measured at baseline. Results — The median age of 14148 participants was 56.8; 24.2% of participants were black and 55.6% were female. Median follow-up time was 20.78 years. For the first six years, there was no statistically significant cognitive decline difference comparing groups without partners at baseline to the married group. After year six, models suggested that being widowed at baseline was associated with greater cognitive decline compared to the married group across all cognitive domains. In the general cognitive domain, the difference in annual cognitive decline comparing the widowed group to the married group was -0.019 standard deviation (SD) units [95%CI (-0.023, -0.015)] (p < 0.001). Similarly, the corresponding difference in cognitive decline in the memory domain was -0.017 [95%CI (-0.023, -0.012), p< 0.001] unit, and for language was -0.028 [ 95%CI (-0.032, -0.024) , p<0.001 ]. For participants who were divorced or separated, annual cognitive decline only presented statistically significant difference in language domain with -0.006 [95%CI (-0.010, -0.003) , p=0.001] unit greater decline but not in other cognitive domains. There was no difference in the rate of cognitive decline between the married and never-married group.Conclusion — Widowhood by midlife may increase the risk of cognitive decline across all cognitive domains, while being divorced or separated in midlife was associated with greater annual cognitive decline in language domain. Being never married is not associated with greater cognitive decline.

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Impact of Driving Cessation on Trajectories of Life-Space Scores Among Community-Dwelling Older Adults

Journal of Applied Gerontology ◽

10.1177/0733464816630637 ◽

2016 ◽

Vol 36 (12) ◽

pp. 1433-1452 ◽

Cited By ~ 6

Author(s):

Carrie Huisingh ◽

Emily B. Levitan ◽

Patricia Sawyer ◽

Richard Kennedy ◽

Cynthia J. Brown ◽

...

Keyword(s):

Older Adults ◽

Community Dwelling ◽

Life Space ◽

Driving Cessation ◽

Random Intercept ◽

Before And After ◽

Precipitous Decline ◽

Rate Of Decline ◽

The University ◽

Community Dwelling Older Adults

The purpose of this study was to examine the trajectories of life-space before and after the transition to driving cessation among a diverse sample of community-dwelling older adults. Life-space scores and self-reported driving cessation were assessed at annual visits from baseline through Year 6 among participants in the University of Alabama at Birmingham Study of Aging. Approximately 58% of older adults reported having stopped driving during the 6 years of follow-up. After adjusting for potential confounders, results from a random intercept model indicate that mean life-space scores decreased about 1 to 2 points every year ( p = .0011) and approximately 28 points at the time of driving cessation ( p < .0001). The rate of life-space decline post driving cessation was not significantly different from the rate of decline prior to driving cessation. Driving cessation was associated with a precipitous decline in life-space score; however, the driving cessation event did not accelerate the rate of life-space decline.

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DETERIORATION IN MOTOR FUNCTION OVER TIME IN OLDER ADULTS WITH TYPE 2 DIABETES IS ASSOCIATED WITH ACCELERATED COGNITIVE DECLINE

Endocrine Practice ◽

10.4158/ep-2020-0289 ◽

2020 ◽

Vol 26 (10) ◽

pp. 1143-1152

Author(s):

Ithamar Ganmore ◽

Isak Elkayam ◽

Ramit Ravona-Springer ◽

Hung-Mo Lin ◽

Xiaoyu Liu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Cognitive Decline ◽

Motor Function ◽

Gait Speed ◽

Semantic Categorization ◽

Z Scores ◽

Global Cognition ◽

Rate Of Decline

Objective: Type 2 diabetes (T2D) is associated with motor impairments and a higher dementia risk. The relationships of motor decline with cognitive decline in T2D older adults has rarely been studied. Using data from the Israel Diabetes and Cognitive Decline study (N = 892), we examined associations of decline in motor function with cognitive decline over a 54-month period. Methods: Motor function measures were strength (handgrip) and gait speed (time to walk 3 m). Participants completed a neuropsychologic battery of 13 tests transformed into z-scores, summarized into 4 cognitive domains: episodic memory, attention/working memory, executive functions, and language/semantic categorization. The average of the 4 domains’ z-scores defined global cognition. Motor and cognitive functions were assessed in 18-months intervals. A random coefficients model delineated longitudinal relationships of cognitive decline with baseline and change from baseline in motor function, adjusting for sociodemographic, cardiovascular, and T2D-related covariates. Results: Slower baseline gait speed levels were significantly associated with more rapid decline in global cognition ( P = .004), language/semantic categorization ( P = .006) and episodic memory ( P = .029). Greater decline over time in gait speed was associated with an accelerated rate of decline in global cognition ( P = .050), attention/working memory ( P = .047) and language/semantic categorization ( P<.001). Baseline strength levels were not associated with cognitive decline but the rate of declining strength was associated with an accelerated decline in executive functions ( P = .025) and language/semantic categorization ( P = .006). Conclusion: In T2D older adults, the rate of decline in motor function, beyond baseline levels, was associated with accelerated cognitive decline, suggesting that cognitive and motor decline share common neuropathologic mechanisms in T2D. Abbreviations: HbA1c = hemoglobin A1c; IDCD = Israel Diabetes and Cognitive Decline; T2D = type 2 diabetes

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Impact of the COVID-19 pandemic on cognitive function in Japanese community-dwelling older adults in a class for preventing cognitive decline

10.1101/2021.02.26.21252497 ◽

2021 ◽

Author(s):

Minoru Kouzuki ◽

Shota Furukawa ◽

Keisuke Mitani ◽

Katsuya Urakami

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Daily Life ◽

Community Dwelling ◽

Retrospective Case ◽

Function Test ◽

Before And After ◽

Community Dwelling Older Adults ◽

Cognitive Function Test

We examined the effects of lifestyle and thoughts on cognitive function and change in cognitive function due to restrictions in daily life during the coronavirus disease 2019 (COVID-19) pandemic in community-dwelling older adults with mild cognitive decline. This was a retrospective case-control study. The participants were 88 older adults with mild cognitive decline who participated in a class designed to help prevent cognitive decline. The class was suspended from early-March to end of May 2020 to prevent the spread of COVID-19, and resumed in June 2020. We collected demographic and cognitive function test data (Touch Panel-type Dementia Assessment Scale [TDAS]) before and after class suspension and questionnaire data on their lifestyle and thoughts during the suspension. Change in TDAS scores from before and after the suspension was used to divide the participants into decline (2 or more points worsening) and non-decline (all other participants) groups, with 16 (18.2%) and 72 (81.8%) participants in each group, respectively. A logistic regression model showed that the odds ratio (OR) for cognitive decline was lower in participants whose responses were "engaged in hobbies" (OR = 0.07, p = 0.015), "worked on a worksheet about cognitive training provided by the town hall" (OR = 0.19, p = 0.026), and "had conversations over the phone" (OR = 0.28, p = 0.0495). There was a significant improvement in TDAS scores after class was resumed (p < 0.01). A proactive approach to intellectual activities and social ties may be important for the prevention of cognitive decline during periods of restrictions due to COVID-19. We found that cognitive function test scores before class suspension significantly improved after resuming classes. We speculate that continued participation in the class led to positive behavioral changes in daily life during periods of restriction due to COVID-19.

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