Design and evaluation of a cognitive health education pilot program according to the RE-AIM framework

Objective Most formats of currently used community-based health education for cognitive impairment prevention are limited to one-way communication, such as distributing leaflets, pasting posters, or holding a lecture, and they lack comprehensive evaluation. Here we aim to design, test, and evaluate a novel pilot cognitive health education program combined with psychosocial interventions (CHECPI). Methods We designed the CHECPI program and tested it among adults aged 60 and over in an aging-friendly community in 2018. Multidimensional cognitive functions were measured by the Montreal Cognitive Assessment (MoCA) before and three months after the CHECPI program. Quantitative and qualitative analyses were performed based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the program. Wilcoxon signed-rank tests were used to assess changes in multidimensional cognitive functions. Results The CHECPI program was comprised of 12 courses and introduced 5 kinds of psychosocial interventions. Reach: 28 older adults participated in the program, of whom most were female (n = 22) and younger elderly with an average age of 65.32 years. Effectiveness: 19 participants finished≥6 courses as well as the follow-up survey. Although their MoCA scores did not improve significantly, they had increased their visuospatial ability significantly (with the average score increasing by 0.42). Adoption: the community officers, lecturers, and participants highly recommended the program, but they agreed that the lack of professional instructors may hinder its popularization. Implementation: the program was implemented in full accordance with the pre-program design. Maintenance: three months after the program, 17 participants had maintained at least one of the seven healthy behaviors that were introduced in the program. Conclusions Younger female elderly were more willing to participate in the program. It enhanced participants’ visuospatial ability, but a sufficient number of professional instructors are crucial for large-scale promotion.

Circadian Rest and Activity Rhythms and Cognitive Change in the Baltimore Longitudinal Study of Aging

Alterations in 24-hour movement patterns, or circadian rest/activity rhythms (RARs), commonly occur with aging. Using linear mixed effects (LME) modeling, we examined associations of baseline RARs with longitudinal change in cognition. Participants (N=424; 47% male, baseline age 72.8±10.1 years) were from the Baltimore Longitudinal Study of Aging and completed 5.6±0.8 nights of wrist actigraphy at baseline. Tests of memory, executive function, attention, language, and visuospatial ability were administered at baseline and subsequent visits (3.7±1.7 years of follow-up in those with >1 visit (n=295)). In unadjusted random intercept and slope LME models, greater RAR stability predicted slower memory decline, and higher activity during participants’ least active 5 hours (L5) predicted slower decline in visuospatial ability. After covariate adjustment, higher activity in participants’ most active 10 hours (M10) and higher L5 predicted slower decline in visuospatial ability (p<.05). Further research is needed on RARs as risk factors for later-life cognitive decline.

Apolipoprotein E Genetic Variation and Its Association With Cognitive Function in Rural-Dwelling Older South Africans

Apolipoprotein E (APOE) 𝜀4 allele carrier status is well known for its association with an increased likelihood of developing Alzheimer’s disease, but its independent role in cognitive function is unclear. APOE genetic variation is understudied in African populations; hence, this cross-sectional study in a rural South African community examined allele and genotype frequencies, and their associations with cognitive function. Cognitive function was assessed using two different screening methods to produce a total cognition score and four domain-specific cognition scores for verbal episodic memory, executive function, language, and visuospatial ability. Cognitive phenotype and APOE genotype data were used to determine whether APOE variation was significantly associated with cognitive function in this population. Observed allele frequencies for 1776 participants from the HAALSI study [age 40–80years (mean=56.19); 58.2% female] were 58.1% (𝜀3), 25.4% (𝜀4) and 16.5% (𝜀2). Allele distributions were similar to the African super population, but different from all non-African super populations from the 1,000 Genomes Project. The 𝜀3 homozygous genotype was most common (34.9%) and used as the base genotype for comparison in regression models. Four models were tested for each of the five cognitive phenotypes to explore association of APOE variation with cognitive function. In the first model assessing association with all genotypes for all individuals, marginally significant associations were observed for 𝜀2 homozygotes where executive function scored higher by ~0.5 standard deviations (p=0.037, SE=0.23), and for 𝜀3/𝜀4 heterozygotes where visuospatial ability scores were lower (p=0.046, SE=0.14). These did not survive correction for multiple testing. Regional African population differences were observed at the APOE locus. Marginally, significant associations between APOE genotype, and executive function and visuospatial ability indicate the need for larger studies to better examine these associations in African populations. Furthermore, longitudinal data could shed light on APOE genetic association with rate of change, or decline, in cognitive function.

Trends in Cognitive Function Pre- and Post- Stroke among Chinese Population

Introduction: To learn the trajectories of cognitive function before and after stroke among Chinese participants. Method: During the seven-year follow-up, 401 participants survived incident stroke and 7551 remained stroke free. Cognitive function was assessed by a global cognition score, which included episodic memory, visuospatial abilities, and executive function. A linear mixed model was developed to explore the repeated measurements. Result: There was no significant difference between the rate of pre-stroke cognitive decline and the decline rate of cognition among stroke-free participants. Among the stroke survivors, the acute decline was -0.123 and -0.187 SD/y in cognitive domains of episodic memory and visuospatial ability, respectively. Executive function did not decline acutely after stroke. In the years after stroke, the decline rate of global cognition was 0.074 SD/y faster than the rate before stroke. The additional decline rate of episodic memory and executive function was 0.043 and 0.061 SD/y, respectively. The rate of visuospatial ability did not change after stroke. Conclusion: Among Chinese stroke survivors, incident stroke was associated with acute decline in episodic memory and visuospatial abilities, and accelerated decline in episodic memory, orientation, attention, and calculation. Cognitive training may help alleviate post-stroke cognitive impairment.

Longitudinal effects of using and discontinuing CNS medications on cognitive functioning

BackgroundMedications acting on the central nervous system (CNS) have been associated with accelerated cognitive decline and increased risk of dementia. However, results are inconsistent and the longitudinal effects of CNS medications on cognitive performance are still not known.MethodsUsing longitudinal cognitive data from healthy adults aged 25-100 years (N = 2,475) from four test waves five years apart, we investigated both the link between use of CNS medications (opioids, antidepressants, anxiolytics, hypnotics and sedatives) on cognitive task performance (episodic memory, semantic memory, visuospatial ability) across 15 years, and the effect of discontinuing these medications in linear mixed effects models.ResultsWe found that opioid use was associated with decline in visuospatial ability, whereas antidepressant use was associated with decline in semantic memory over 15 years. A link between drug discontinuation and cognitive improvement was seen for opioids, antidepressants as well as for anxiolytics, hypnotics and sedatives.ConclusionsAlthough our results may be confounded by subjacent conditions, they suggest that long-term use of CNS medications may have domain-specific negative effects on cognitive performance over time, whereas the discontinuation of these medications may partly reverse these effects. These results open up for future studies that address subjacent conditions on cognition to develop a more complete understanding of the cognitive effects of CNS medications.

Neuropsychological Profiles of Patients with Progressive Apraxia of Speech and Aphasia

Objective: To characterize and compare the neuropsychological profiles of patients with primary progressive apraxia of speech (PPAOS) and apraxia of speech with progressive agrammatic aphasia (AOS-PAA). Method: Thirty-nine patients with PPAOS and 49 patients with AOS-PAA underwent formal neurological, speech, language, and neuropsychological evaluations. Cognitive domains assessed included immediate and delayed episodic memory (Wechsler Memory Scale-Third edition; Logical Memory; Visual Reproduction; Rey Auditory Verbal Learning Test), processing speed (Trail Making Test A), executive functioning (Trail Making Test B; Delis-Kaplan Executive Functioning Scale – Sorting), and visuospatial ability (Rey-Osterrieth Complex Figure copy). Results: The PPAOS patients were cognitively average or higher in the domains of immediate and delayed episodic memory, processing speed, executive functioning, and visuospatial ability. Patients with AOS-PAA performed more poorly on tests of immediate and delayed episodic memory and executive functioning compared to those with PPAOS. For every 1 unit increase in aphasia severity (e.g. mild to moderate), performance declined by 1/3 to 1/2 a standard deviation depending on cognitive domain. The degree of decline was stronger within the more verbally mediated domains, but was also notable in less verbally mediated domains. Conclusion: The study provides neuropsychological evidence further supporting the distinction of PPAOS from primary progressive aphasia and should be used to inform future diagnostic criteria. More immediately, it informs prognostication and treatment planning.

159 The Role of Education on the Association between OSA and Cognitive Functions in Middle-age and Older Adults

Introduction A weak relation between an increase in education and improved health knowledge was observed among those who attended college, but not among those whose highest educational level attainment was high school (Altindag, Cannonier, & Mocan, 2014). Alachantis and colleagues (2005) had applied cognitive reserve theory (Stern, 2002) to help explain why OSA patients with higher intelligence scores perform well on cognitive tasks. The resource substitution theory (RST; Ross & Mirowsky, 2006) posits that higher education compensates for background disadvantages rather than magnifying background advantages. The goals of the current study were to examine the interaction between educational level and obstructive sleep apnea (OSA) on cognitive functions such as verbal fluency, psychomotor vigilance, executive functions, visuospatial ability, and attention span and to determine whether the results would support the RST. Methods One hundred and nine participants (47 ApneaLinkTM -screened controls and 62 untreated OSA patients) participated in the study and completed the Wisconsin Card Sorting Test, WAIS-III digit span and block design, semantic and phonemic fluency tests, and a psychomotor vigilance task. Subjective sleep (PSQI and ESS) and health measures (depression, anxiety, mood disturbance, diabetes, hypertension) were assessed. A hierarchical regression was conducted to test for the additional variance explained by the interaction term even after accounting for the covariates. Results In semantic fluency and visuospatial ability tasks, patients with higher education performed better than patients with high school or less education. This moderation effect of education was not observed for the control group. A significant interaction effect was not observed for vigilance, phonemic fluency, attention span, or executive functions although education was a significant predictor for all cognitive tasks. Conclusion The resource substitution theory was supported as the benefit of education seemed more crucial for OSA patients than for controls, specifically in semantic fluency and visuospatial ability. This benefit of higher education contributing to larger cognitive reserves in patients with OSA helped buffer some cognitive deficits but not for others, but this buffer no longer works when the cognitive demand gets larger. Support (if any) A grant from the Center for Integrative Research on Cognitive Neural Science, Southern Illinois University Carbondale was received.