Association of Posture, Gait, and Auditory Functioning with Cognitive Status in a Cohort of Community−Dwelling Older Adults

Postural stability, hearing, and gait function deterioration are the risk factors associated with cognitive impairment. Although no method has been reported for treating severe cognitive impairment to date, developing an early detection model based on these risk factors could aid in slowing down or even reversing the deterioration process. In this study, the association between cognitive impairment and the combined predictive ability of sensory and gait features was assessed. Fifty−seven healthy community−dwelling men over the age of sixty−five participated in cognitive, postural stability, auditory, and level walking evaluations. They were divided into two groups: healthy control group (n = 39) and lower cognition group (n = 18), based on their Montreal cognitive assessment score. During gait, the center of mass of the cognitively impaired participants was confined to a smaller volume. Furthermore, the cognitively healthy participants were found to have better postural stability. Both groups possessed similar hearing ability; however, the cognitively impaired group made a significantly higher number of errors when repeating words or sentences. A logistic regression model utilizing each of these function quantifiers exhibited a high area under the receiver operating characteristic curve, suggesting excellent predictive ability. These models can be applied to smartphone or smart home healthcare technologies to detect the possibility of cognitive impairment, thus facilitating early detection.

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Early detection of cognitive impairment by natural language among outpatients and community dwellers

Innovation in Aging ◽

10.1093/geroni/igaa057.3291 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 892-893

Author(s):

Eri Kiyoshige ◽

Mai Kabayama ◽

Yasushi Takeya ◽

Yoichi Takami ◽

Shuko Takeda ◽

...

Keyword(s):

Cognitive Impairment ◽

Early Detection ◽

Natural Language ◽

Cognitive Decline ◽

Language Processing ◽

Cognitive Status ◽

Community Dwelling ◽

Cross Sectional ◽

Cognitive Orientation ◽

Community Dwellers

Abstract Background: Although early detection of cognitive decline has a significant relation to improving the quality of life of dementia patients, this early detection has been difficult due to requires of neuropsychological tests which people generally take when they notice their cognitive impairment. The timing of patients’ notice was reported to be worse cognitive decline already, thus, we aimed to determine if cognitive impairment from a short interview by using Natural Language Processing approach. Methods: The present study used cross-sectional analysis among elderly outpatients and community-dwelling elderly from Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. Cognitive decline was assessed by Telephone Interview of Cognitive Status for Japanese (TICS-J) and modeled as a binary outcome (cut-off <33 points). Natural language data was collected by semistructured interviews about health conditions and cognitive orientation in space, time, and place. We used an open-source text segmentation library to parse natural language text into bag-of-words and term frequency-inverse document frequency (TF-IDF) representations. Results: There were 38 (19.9%) outpatients and 153 (80.1%) community dwellers, and 60 (31.4%) participants were defined as cognitive impairment. The maximized TF-IDF score was 0.49 in cognitive orientation in time questions. In this question, participants without cognitive impairment could not calculate the score. There were no significant differences in TF-IDF scores between participants with and without cognitive impairment. Conclusions: Elderly without cognitive impairment might not have an episode about cognitive orientation in time, and this may help for early detection of cognitive impairment

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Abstract P237: Measuring Cognition in the Atherosclerosis Risk in Communities (ARIC) Study Cohort: An approach to Account for Informative Attrition

Circulation ◽

10.1161/circ.131.suppl_1.p237 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Lisa M Wruck ◽

Alvaro Alonso ◽

Marilyn Albert ◽

Josef Coresh ◽

David Couper ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Cognitive Status ◽

Data Management System ◽

Cognitively Impaired ◽

Study Cohort ◽

Supplementary Data ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Elderly Cohort

Introduction: Understanding the role of risk factors associated with accelerated cognitive decline has important public health relevance for the aging US population. To test hypotheses that mid-life cardiovascular (CV) risk factors increase risk of dementia in old age, the Atherosclerosis Risk in Communities (ARIC) cohort was evaluated for dementia in 2011-2013. Anticipating challenges of complete dementia ascertainment in an elderly population, supplementary data sources were collected to aid analysis accounting for potentially informative attrition. Methods: ARIC enrolled 15,792 participants 45-64 years old at baseline (1987-1989) from four US communities and collected baseline CV exposure data. A complete neurocognitive battery including informant interview was completed 2011-2013, yielding an algorithmic diagnosis of dementia, mild cognitive impairment (MCI) or normal cognition. Cognitively impaired and a random sample of cognitively normal were selected for further clinical evaluation. Syndromic diagnoses (dementia/MCI/normal) and etiologic diagnoses were made by a panel of experts using standardized criteria. Standardized protocols, timely reports of reviewer reliability, ongoing training of reviewers and a web-based data management system were developed to ensure reliability, consistency and efficiency of data collection and review. Living participants not attending the visit were asked to complete the Telephone Interview for Cognitive Status (TICS). Based on dementia discharge codes and death codes identified during cohort surveillance, interviewer impression of hearing loss or cognitive impairment or need for a proxy during semi-annual calls, or random sampling, participants refusing the TICS are eligible for proxy dementia interview. Medicare claims are being examined to identify missed dementia discharge codes. Results: Of 11,017 participants alive as of 2011, 6495 (59%) completed the neurocognitive battery; 2937 of these (45%) were selected for, and completed, additional clinical assessments and classification by committee (algorithmic or reviewer diagnosis: dementia 5%, MCI 21%). Of the 4522 participants who did not undergo the neurocognitive battery, 1463 (32%) completed the TICS (dementia 7%), while 1627 of the remaining participants were eligible for proxy calls (903 completed to date, dementia 58%). Conclusions: Participants who were not examined were more likely to be cognitively impaired, highlighting the importance of collecting supplementary data to support analyses of midlife CV risk factors accounting for informative attrition. Collection of exam data in an elderly cohort is difficult and requires a multi-pronged approach, especially for an outcome highly correlated with attrition. The strategy described here could be applied in other settings.

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Mini-Mental State Examination sentence writing among community-dwelling elderly adults in Brazil: text fluency and grammar complexity

International Psychogeriatrics ◽

10.1017/s104161021200097x ◽

2012 ◽

Vol 24 (11) ◽

pp. 1732-1737 ◽

Cited By ~ 9

Author(s):

Anita Liberalesso Neri ◽

Lia Lopes Ongaratto ◽

Mônica Sanches Yassuda

Keyword(s):

Cognitive Impairment ◽

Mental State ◽

Mini Mental State Examination ◽

Cognitive Status ◽

Community Dwelling ◽

Cognitively Impaired ◽

Simple Sentence ◽

Textual Production ◽

Probabilistic Sample ◽

State Examination

ABSTRACTBackground: In normal aging, the decrease in the syntactic complexity of written production is usually associated with cognitive deficits. This study was aimed to analyze the quality of older adults' textual production indicated by verbal fluency (number of words) and grammatical complexity (number of ideas) in relation to gender, age, schooling, and cognitive status.Methods: From a probabilistic sample of community-dwelling people aged 65 years and above (n = 900), 577 were selected on basis of their responses to the Mini-Mental State Examination (MMSE) sentence writing, which were submitted to content analysis; 323 were excluded as they left the item blank or performed illegible or not meaningful responses. Education adjusted cut-off scores for the MMSE were used to classify the participants as cognitively impaired or unimpaired. Total and subdomain MMSE scores were computed.Results: 40.56% of participants whose answers to the MMSE sentence were excluded from the analyses had cognitive impairment compared to 13.86% among those whose answers were included. The excluded participants were older and less educated. Women and those older than 80 years had the lowest scores in the MMSE. There was no statistically significant relationship between gender, age, schooling, and textual performance. There was a modest but significant correlation between number of words written and the scores in the Language subdomain.Conclusions: Results suggest the strong influence of schooling and age over MMSE sentence performance. Failing to write a sentence may suggest cognitive impairment, yet, instructions for the MMSE sentence, i.e. to produce a simple sentence, may limit its clinical interpretation.

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PREDICTORS OF GLOBAL COGNITIVE IMPAIRMENT 1 YEAR AFTER SUBARACHNOID HEMORRHAGE

Neurosurgery ◽

10.1227/01.neu.0000359317.15269.20 ◽

2009 ◽

Vol 65 (6) ◽

pp. 1043-1051 ◽

Cited By ~ 65

Author(s):

Mellanie V. Springer ◽

J. Michael Schmidt ◽

Katja E. Wartenberg ◽

Jennifer A. Frontera ◽

Neeraj Badjatia ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Activities Of Daily Living ◽

Daily Living ◽

Delayed Cerebral Ischemia ◽

Cognitive Status ◽

Cognitively Impaired

Abstract OBJECTIVE We sought to determine the frequency, risk factors, and impact on functional outcome and quality of life (QOL) of global cognitive impairment 1 year after subarachnoid hemorrhage. METHODS We prospectively evaluated global cognitive status 3 and 12 months after hospitalization with the Telephone Interview for Cognitive Status in 232 subarachnoid hemorrhage survivors. Cognitive impairment was defined as a score of 30 or less (scaled 0 = worst, 51 = best). Logistic regression was performed to calculate adjusted odds ratios (AORs) for impairment at 1 year. Basic activities of daily living were evaluated with the Barthel Index, instrumental activities of daily living were assessed with the Lawton scale, and QOL was evaluated with the Sickness Impact Profile. RESULTS The frequency of cognitive impairment was 27% at 3 months and 21% at 12 months. After the effects of age, education, and race/ethnicity were controlled for, risk factors for cognitive impairment at 12 months included anemia treated with transfusion (AOR, 3.4; P = 0.006), any temperature level higher than 38.6°C (AOR, 2.7; P = 0.016), and delayed cerebral ischemia (AOR, 3.6; P = 0.01). Among cognitively impaired patients at 3 months, improvement at 1 year occurred in 34% and was associated with more than 12 years of education and the absence of fever higher than 38.6°C during hospitalization (P = 0.015). Patients with cognitive impairment at 1 year had worse concurrent QOL and less ability to perform instrumental and basic activities of daily living (all P < 0.001). CONCLUSION Global cognitive impairment affects more than 20% of subarachnoid hemorrhage survivors at 1 year, is predicted by fever, anemia treated with transfusion, and delayed cerebral ischemia, and adversely affects functional recovery and QOL.

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Postural stability in the cognitively impaired elderly: A systematic review of the literature

Dementia ◽

10.1177/1471301216663012 ◽

2016 ◽

Vol 18 (1) ◽

pp. 178-189 ◽

Cited By ~ 3

Author(s):

Błażej Cieślik ◽

Lilianna Jaworska ◽

Joanna Szczepańska-Gieracha

Keyword(s):

Cognitive Impairment ◽

Postural Stability ◽

Mini Mental State Examination ◽

Berg Balance Scale ◽

Cognitive Status ◽

Cognitively Impaired ◽

Functional Tests ◽

Inclusion Criteria ◽

Evaluation Systems ◽

State Examination

Introduction The aim of this study was to review the literature and critically analyse publications connecting cognitive impairment with postural stability. Methods Four electronic databases were searched. The inclusion criteria comprised the relation between the process of maintaining balance and cognitive impairment. Results Of the 153 selected articles, 15 met the inclusion criteria. In 83% of publications, cognitive status was determined with the use of the Mini-Mental State Examination. In eight publications, postural stability was examined using force plates. Other methods used to test the balance were functional tests, i.e. the Berg Balance Scale or the Balance Evaluation Systems Test. Conclusion As the choice of methodology varies significantly, it is difficult to attempt an objective comparison between different studies. There is a clear need for the normalisation of methods used to assess the degree of dementia and to assess postural stability among this group of people.

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Cognitive Status and Risk Factors for Cognitive Impairment in Dialysis Patients

General Reanimatology ◽

10.15360/1813-9779-2020-4-21-31 ◽

2020 ◽

Vol 16 (4) ◽

pp. 21-31

Author(s):

A. Е. Khrulev ◽

D. D. Tolbuzova ◽

E. A. Plokhenko ◽

P. A. Egorova ◽

S. N. Sorokoumova ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Kidney Diseases ◽

Neuropsychological Test ◽

Cognitive Status ◽

Control Group ◽

Dialysis Patients ◽

Mathematical Methods ◽

Dialysis Adequacy ◽

The Mean

The number of dialysis patients is increasing every year and is estimated to be more than 2 million, with an annual increase of 6–12% in dialysis programs. There is a high correlation between cognitive impairment and mortality in dialysis patients, which suggests the relevance of screening cognitive functions in dialysis patients using diﬀerent neuropsychological scales.Aim of the study was to test the cognitive status and identify cognitive impairment in patients with terminal stage of chronic kidney disease treated using program hemodialysis, as well as to evaluate risk factors for cognitive impairment in this category of patients.Material and methods. 83 patients aged 28 to 78 years (mean age 56.7±13.7 years) were examined. The main group included 53 people who received program hemodialysis, of them 23 men and 30 women. The mean age of patients in this group was 58.3±13.3 years. The control group composed of 30 individuals without kidney diseases, including 13 men and 17 women. The mean age in the control group was 53.6±14.9 years. The MoCA and SLUMS scales were chosen for detecting cognitive impairment and assessment of neuropsychological status. We used mathematical methods of research data processing such as inductive statistics and correlation analysis.Results. Cognitive impairment was found to be signiﬁcantly more frequent in dialysis patients (75.5–81.1% of cases, P=0.05) compared to those without kidney pathology. The SLUMS scale was shown to be more sensitive than MoCA (P=0.05, CI 95.0%). The risk factors of cognitive impairment in dialysis patients included increased dialysis duration, age (rs=–0.298) and low estimated urea dialysis adequacy index (Kt/V less than 1.2).Conclusion. A high risk of cognitive impairment is common in dialysis patients. For its timely detection, the screening neuropsychological test are recommended to be used by clinicians. Cognitive impairment, diagnosed by the tests, is an indication for a specialist consultation.

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Increasing Life-Space Mobility in Community-Dwelling Older Persons With Cognitive Impairment Following Rehabilitation: A Randomized Controlled Trial

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa254 ◽

2020 ◽

Author(s):

Phoebe Ullrich ◽

Christian Werner ◽

Martin Bongartz ◽

Tobias Eckert ◽

Bastian Abel ◽

...

Keyword(s):

Cognitive Impairment ◽

Older Persons ◽

Controlled Trial ◽

Intervention Group ◽

Community Dwelling ◽

Control Group ◽

Life Space ◽

Home Based ◽

Independent Life

Abstract Background Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. Methods Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17–26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. Results One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89–13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00–0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. Conclusions The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.

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A Modified CAIDE Risk Score as a Screening Tool for Cognitive Impairment in Older Adults

Journal of Alzheimer s Disease ◽

10.3233/jad-210269 ◽

2021 ◽

pp. 1-14

Author(s):

Magdalena I. Tolea ◽

Jaeyeong Heo ◽

Stephanie Chrisphonte ◽

James E. Galvin

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Risk Score ◽

Clinical Sample ◽

Community Sample ◽

Community Dwelling ◽

Cognitive Testing ◽

Risk Scores ◽

Predictive Values

Background: Although an efficacious dementia-risk score system, Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) was derived using midlife risk factors in a population with low educational attainment that does not reflect today’s US population, and requires laboratory biomarkers, which are not always available. Objective: Develop and validate a modified CAIDE (mCAIDE) system and test its ability to predict presence, severity, and etiology of cognitive impairment in older adults. Methods: Population consisted of 449 participants in dementia research (N = 230; community sample; 67.9±10.0 years old, 29.6%male, 13.7±4.1 years education) or receiving dementia clinical services (N = 219; clinical sample; 74.3±9.8 years old, 50.2%male, 15.5±2.6 years education). The mCAIDE, which includes self-reported and performance-based rather than blood-derived measures, was developed in the community sample and tested in the independent clinical sample. Validity against Framingham, Hachinski, and CAIDE risk scores was assessed. Results: Higher mCAIDE quartiles were associated with lower performance on global and domain-specific cognitive tests. Each one-point increase in mCAIDE increased the odds of mild cognitive impairment (MCI) by up to 65%, those of AD by 69%, and those for non-AD dementia by > 85%, with highest scores in cases with vascular etiologies. Being in the highest mCAIDE risk group improved ability to discriminate dementia from MCI and controls and MCI from controls, with a cut-off of ≥7 points offering the highest sensitivity, specificity, and positive and negative predictive values. Conclusion: mCAIDE is a robust indicator of cognitive impairment in community-dwelling seniors, which can discriminate well between dementia severity including MCI versus controls. The mCAIDE may be a valuable tool for case ascertainment in research studies, helping flag primary care patients for cognitive testing, and identify those in need of lifestyle interventions for symptomatic control.

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The impact of cognitive impairment at admission on short-term functional outcome of elderly hip fracture patients

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1006319d ◽

2010 ◽

Vol 138 (5-6) ◽

pp. 319-322 ◽

Cited By ~ 4

Author(s):

Emilija Dubljanin-Raspopovic ◽

Dragana Matanovic ◽

Marko Bumbasirevic

Keyword(s):

Cognitive Impairment ◽

Hip Fracture ◽

Elderly Patients ◽

Functional Outcome ◽

Cognitive Status ◽

Cognitively Impaired ◽

Short Term ◽

Functional Gain ◽

The Impact ◽

Cognitively Intact

Introduction The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome. Objective To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients. Methods Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE) at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM) at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge - FIM admission). Absolute functional gain was analyzed in respect to cognitive status. Results Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p<0.01). Absolute functional gain, however, was higher in 1) cognitively intact compared to cognitively impaired patients (p<0.01), and 2) cognitively moderately impaired patients compared to severely cognitively impaired patients (p<0.01). No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p>0.05). Conclusion The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favorable short term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best achievable outcome to be reached.

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Aerobic or strength training and flexibility activities and mild cognitive impairment: CETI cohort

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.884 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Dupré ◽

B Bongue ◽

L Fruteau de Laclos ◽

J Blais ◽

M-J Sirois

Keyword(s):

Physical Activity ◽

Cognitive Impairment ◽

Neurodegenerative Diseases ◽

Cognitive Impairments ◽

Cognitive Status ◽

Physical Activities ◽

Community Dwelling ◽

Different Types ◽

Initiative Program ◽

The Impact

Abstract Background Previous studies have been notably criticized for not studying the different types of physical activity. The objective of this work was to examine the association between types of physical activity and cognitive decline in older people. Methods This is a sub-group analysis from the CETI cohort, a multicenter prospective study conducted by the Canadian Emergency Team Initiative Program (CETIE), between 2011 and 2016. Participants were community-dwelling seniors aged ≥ 65 years, consult emergency services for minor injuries with follow-up at 3 and 6 months. Physical activity was assessed by the RAPA (Rapid assessment of Physical activity), which describes the level of aerobic activities and the overall level of muscle strength and flexibility activities. The cognitive status was assessed with the Montreal Cognitive Assessment (MoCA) and the Telephone Interview for Cognitive Status (TICS), using their current cut-offs (MoCA <26/30 and TICS < = 35/50) for mild cognitive impairments (MCI). Logistic regression, COX models and splines were used to examine the association between the type of physical activities and the onset of cognitive impairment. Results At inclusion, 281 individuals were free of MCI, or 43.8% of the total sample, with an average age of 73 years. During follow-ups, MCI appeared in 31.7% of participants initially free of it. The risk of MCI was lower with higher muscular strength & flexibility physical activities (HR = 0.84 [0.70-0.99]), while the relationship with aerobic physical activities was not significant. Conclusions These results showed a potential link between strength & flexibility activities and cognitive impairments, but not with aerobic physical activities. Further analyses are needed to examine whether these relationships persist as a function of the adjustment variables, or statistical methods. This study contributes to the debate on the evaluation of physical activity in the elderly, and its link with neurodegenerative diseases. Key messages This study analyzed the link between types of physical activity and mild cognitive disorders. The aim is to put in place preventive policies of aging, specially in neurodegenerative diseases. The work allowed us to see the effect of the different types of physical activity and the impact of the statistical method on the results.

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