Prospective associations of plasma growth differentiation factor 15 with physical performance and cognitive functions in older adults

Background Growth differentiation factor 15 (GDF15) has been associated with several age-related disorders, but its associations with functional abilities in community-dwelling older adults are not well studied. Methods The study was a secondary analysis on 1096 community-dwelling older adults (aged 69 to 94 years) recruited from the Multidomain Alzheimer’s Preventive Trial. Plasma GDF15 was measured one year after participants’ enrolment. Annual data of physical performance (grip strength and short physical performance battery [SPPB]) and global cognitive functions (mini-mental state examination [MMSE] and a composite cognitive score) were measured for four years. Adjusted mixed-effects linear models were performed for cross-sectional and longitudinal association analyses. Results A higher GDF15 was cross-sectionally associated with a weaker grip strength (β = -1.1E-03, 95%CI [-2.0E-03, -1.5E-04]), a lower SPPB score (β = -3.1E-04, 95%CI [-5.4E-04, -9.0E-05]) and worse cognitive functions (β = -2.4E-04, 95%CI [-3.3E-04, -1.6E-04] for composite cognitive score; β = -4.0E-04, 95%CI [-6.4E-04, -1.6E-04] for MMSE). Participants with higher GDF15 demonstrated greater longitudinal declines in SPPB (β = -1.0E-04, 95%CI [-1.7E-04, -2.0E-05]) and composite cognitive score (β = -2.0E-05, 95%CI [-4.0E-05, -3.6E-06]). The optimal initial GDF15 cutoff values for identifying participants with minimal clinically significant decline after one year were 2189 pg/mL for SPPB (AUC: 0.580) and 2330 pg/mL for composite cognitive score (AUC: 0.587). Conclusions Plasma GDF15 is cross-sectionally and longitudinally associated with lower-limb physical performance and global cognitive function in older adults. Circulating GDF15 alone has limited capacity of discriminating older adults who will develop clinically significant functional declines.

Analysis the Safety and Efficacy at Different Types of Anesthesiological Support During Aesthetic Interventions on the Breast Glands in Ukraine

The aim is to learn the features of aesthetic and reduction surgical interventions on the mammary glands in Ukraine. Materials and methods. The study was conducted by analyzing the inpatient ambulatory cards of 320 patients. Anesthesia was provided by propofol (n=130), sevoflurane (n=140) and combined use of sevoflurane and nalbuphine (n=50). The results of the study. It was found that usage of combined inhalation analgesia of sevoflurane with opioids was characterized by 41.9% less recovery time. It was found that 8 hours after surgery, the individual assessment of pain was lower in the group of combined analgesia with opioids relative to intravenous anesthesia with propofol (87.5%, p<0.05) and inhalation anesthesia with sevoflurane (71, 3%, p<0.05). After 24 hours all patients reported about pain below 1.0 point, however, in groups where sevoflurane and nalbuphine were used, the level of pain self-esteem was 2.61 and 3 times lower than after intravenous propofol. It was found that within 1 hour after surgery, the average cognitive score on the Montreal scale decreased in the group of intravenous propofol by 5.0% (p<0.05) and by 1.7% under inhalation anesthesia with sevoflurane. Under combined anesthesia the cognitive score remained at 12.0 points. The frequency of postoperative nausea was the highest level in the group of inhalation anesthesia - 16.7%. The addition of nalbuphine to sevoflurane significantly reduced the risk of postoperative nausea (χ2=7.250; p=0.007). Conclusions. Combined anesthesia with opioids is a highly effective anesthetic choice for aesthetic and reconstructive interventions on the mammary glands.

Association Between Occupational Exposure to Formaldehyde and Cognitive Impairment

Objective:To our knowledge, no study has investigated the effect of exposure to formaldehyde on cognition in the general population. Our objective was to examine the association between occupational exposure to formaldehyde and cognitive impairment in middle-aged and young- old adults (≥45 years).Methods:In the French CONSTANCES cohort, cognitive function was assessed with a standardized battery of seven cognitive tests to evaluate global cognitive function, episodic verbal memory, language abilities and executive functions (e.g., Digit Symbol Substitution Test, DSST). A global cognitive score was created using principal component analysis. Cognitive impairment was assessed in reference to norms of neuropsychological battery according to age, sex and education. Lifetime exposure to formaldehyde was assessed using a French job-exposure matrix created in the framework of the Matgéné project. After performing multiple imputation, separate modified Poisson regression models were used to evaluate the association between cognitive impairment (<25th percentile) and formaldehyde exposure (exposed/never exposed), exposure duration, cumulative exposure index (CEI), and combination of CEI and time of last exposure.Results:Among 75 322 participants (median age: 57.5 years, women: 53%), 8% were exposed to formaldehyde during their professional life. These participants were at higher risk of global cognitive impairment (for global cognitive score: adjusted relative risk, aRR, 1.17, 95% confidence interval, CI: 1.11-1.23), after adjusting for confounders (age, sex, education, income, solvent exposure, Effort–Reward Imbalance, night-shift, repetitive, and noisy work). They were at higher risk of cognitive impairment for all cognitive domains explored. Longer exposure duration and high CEI were associated with cognitive impairment, with a dose-effect relationship for exposure duration. Recent exposure was associated with impairment in all cognitive domains. Time did not fully attenuate formaldehyde-associated cognitive deficits especially in highly exposed individuals (for DSST: high past exposure aRR 1.23, 95%CI: 1.11-1.36; high recent exposure: aRR 1.24, 95%CI: 1.13-1.35).Conclusion:Our findings highlight the long-term detrimental effect of formaldehyde exposure on cognitive health in a relatively young population.

The Correlation between a New Online Cognitive Test (the Brain Assessment) and Widely Used In-Person Neuropsychological Tests

<b><i>Introduction:</i></b> There are several problems with standard in-person neuropsychological assessments, such as habituation, necessity of human resources, and difficulty of in-person assessment under societal conditions during the outbreak of coronavirus disease 2019. Thus, we developed an online cognitive test (the Brain Assessment [BA]). In this study, we investigated the correlation between the results of the BA and those of established neuropsychological tests. <b><i>Participants and Methods:</i></b> Seventy-seven elderly persons (mean 71.3 ± 5.1 years old; range 65–86; male:female = 45:32) were recruited through the internet. Correlations were evaluated between the BA and the following widely used neuropsychological tests: the mini-mental state examination (MMSE), the Raven’s colored progressive matrices (RCPM), the logical memory I and II of the Rivermead Behavioral Memory Test, the word fluency (WF) test, and the Trail-Making TestA/B. <b><i>Results:</i></b> We found moderate correlations between the total cognitive score of the BA and the total score of the MMSE (<i>r</i> = 0.433, <i>p</i> &#x3c; 0.001), as well as between the total BA score and the total RCPM score (<i>r</i> = 0.582, <i>p</i> &#x3c; 0.001) and time to complete the RCPM (<i>r</i> = 0.455, <i>p</i> &#x3c; 0.001). Moderate correlations were also observed between the cognitive score of the memory of words BA subtest and the LM-I (<i>r</i> = 0.518, <i>p</i> &#x3c; 0.001), the mental rotation subtest and figure drawing (<i>r</i> = 0.404, <i>p</i> &#x3c; 0.001), the logical reasoning subtest and total RCPM score (<i>r</i> = 0.491, <i>p</i> &#x3c; 0.001), and the memory of numbers and words subtests and WF (memory of numbers and total WF: <i>r</i> = 0.456, <i>p</i> &#x3c; 0.001; memory of words and total WF: <i>r</i> = 0.571, <i>p</i> &#x3c; 0.001). <b><i>Discussion:</i></b> We found that the BA showed moderate correlations between established neuropsychological tests for intellect, memory, visuospatial function, and frontal function. The MMSE and the RCPM reflect Spearman’s s-factor and g-factor, respectively, and thus the BA also covered both factors. <b><i>Conclusion:</i></b> The BA is a useful tool for assessing the cognitive function of generally healthy elderly persons.

Early-Life Circumstances and Racial Disparities in Cognition among US Older Adults

ImportanceExisting studies concentrate on exploring mid-life to late-life risk factors on racial disparities in cognition. Given the critical role of neurocognitive development in early life, understanding contributions of early-life circumstances has important implications for early-stage interventions.ObjectiveTo evaluate the association between early-life circumstances and racial disparities in cognition, and to determine their overall and respective contributions.Design, Setting, and ParticipantsWe assembled three analytic samples from the Health and Retirement Study (HRS) (1995-2018), a nationally representative longitudinal survey of Americans 50 years or older. 17,092 participants, with 13,907 identifying as non-Hispanic White (White) and 3,185 as non-Hispanic Black (Black), were included in the Core sample. The Trauma and PGS samples respectively included 6,533 participants (5,696 White, 837 Black) and 5,532 participants (4,893 White, 639 Black).Main Outcomes and MeasuresThe main outcomes were cognitive score and cognitive impairment, as assessed by the Telephone Interview for Cognitive Status (TICS). We used the Blinder-Oaxaca Decomposition (BOD) to evaluate disparities in cognitive outcomes between White and Black participants attributable to differences in early-life circumstances.ResultsAmong all White and Black participants at initial survey, their respective average age were 58.1 (95% CI, 58.0-58.3) years and 55.8 (95% CI, 55.5-56.0) years; their respective average cognitive score were 17.3 (95% CI, 17.2-17.3) points and 14.6 (95% CI, 14.4-14.7) points; and their respective proportion with cognitive impairment were 7.2 (95% CI, 6.8-7.6) percentage points (pp) and 22.9 (95% CI, 21.5-24.4) pp. Across three analytic samples, overall differences in early-life circumstances respectively explained 23.5%–40.4% and 33.8%–65.3% of the racial gaps in cognitive score and proportion of cognitive impairment between White and Black participants. Difference in educational attainment contributed the most. In the Trauma sample, for example, years of education explained 3.1 (95% CI, 1.9-4.3) pp or 18.6% of the racial gap in proportion of cognitive impairment using the baseline assessment, and 3.3 (95% CI, 2.0-4.5) pp or 26.9% using the latest assessment. Additional early-life contributors included educational environments (e.g., ownership of books, parental education, time spent with mothers) and socioeconomic status (e.g., financial difficulty). However, childhood trauma and selected genetic factors were not significant contributors.Conclusions and RelevanceLess favorable early-life circumstances are associated with clinically meaningful and statistically significant racial gaps in cognition.Key PointsQuestionsHow much do differences in early-life circumstances explain late-life disparities in cognitive outcomes between non-Hispanic Black (Black) and non-Hispanic White (White) older adults? What are the key early-life contributors to these racial disparities?FindingsEarly-life circumstances contribute substantially to racial disparities in cognitive outcomes over age 50. Educational attainment and early-life educational environment are the most important contributors, even after accounting for a rich set of other early-life socioeconomic, demographic, health, traumatic, and genetic factors.MeaningExposure to less favorable early-life circumstances for Black than White adults was associated with large racial gaps in cognitive outcomes.

Subjective social position and cognitive function in a longitudinal cohort of older, rural South African adults, 2014–2019

BackgroundThe relationship between subjective social position (SSP) and cognitive ageing unclear, especially in low-income settings. We aimed to investigate the relationship between SSP and cognitive function over time among older adults in rural South Africa.MethodsData were from 3771 adults aged ≥40 in the population-representative ‘Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa’ from 2014/2015 (baseline) to 2018/2019 (follow-up). SSP was assessed at baseline with the 10-rung MacArthur Network social position ladder. Outcomes were composite orientation and episodic memory scores at baseline and follow-up (range: 0–24). Mortality- and attrition-weighted linear regression estimated the associations between baseline SSP with cognitive scores at each of the baseline and follow-up. Models were adjusted for age, age2, sex, country of birth, father’s occupation, education, employment, household assets, literacy, marital status and health-related covariates.ResultsSSP responses ranged from 0 (bottom ladder rung/lowest social position) to 10 (top ladder rung/highest social position), with a mean of 6.6 (SD: 2.3). SSP was positively associated with baseline cognitive score (adjusted β=0.198 points per ladder rung increase; 95% CI 0.145 to 0.253) and follow-up cognitive score (adjusted β=0.078 points per ladder rung increase; 95% CI 0.021 to 0.136).ConclusionIndependent of objective socioeconomic position measures, SSP is associated with orientation and episodic memory scores over two time points approximately 3 years apart among older rural South Africans. Future research is needed to establish the causality of the observed relationships, whether they persist over longer follow-up periods and their consistency in other populations.

Does Quantitative Electroencephalography Refine Preoperative Cognitive Assessment in Parkinson’s Disease Patients Treated with Deep Brain Stimulation? A Follow-Up Study

<b><i>Objective:</i></b> Deep brain stimulation (DBS) in Parkinson’s disease (PD) is associated with an increased risk of post-operative cognitive deterioration. Preoperative neuropsychological testing can be affected and limited by the patient’s collaboration in advanced disease. The purpose of this study was to determine whether preoperative quantitative electroencephalography (qEEG) may be a useful complementary examination technique during preoperative assessment to predict cognitive changes in PD patients treated with DBS. <b><i>Methods:</i></b> We compared the cognitive performance of 16 PD patients who underwent bilateral subthalamic nucleus DBS to the performance of 15 PD controls (matched for age, sex, and education) at baseline and at 24 months. Cognitive scores were calculated for all patients across 5 domains. A preoperative 256-channel resting EEG was recorded from each patient. We computed the global relative power spectra. Correlation and linear regression models were used to assess associations of preoperative EEG measures with post-operative cognitive scores. <b><i>Results:</i></b> Slow waves (relative delta and theta band power) were negatively correlated with post-operative cognitive performance, while faster waves (alpha 1) were strongly positively correlated with the same scores (the overall cognitive score, attention, and executive function). Linear models revealed an association of delta power with the overall cognitive score (<i>p</i> = 0.00409, adjusted <i>R</i>² = 0.6341). Verbal fluency (VF) showed a significant decline after DBS surgery, which was correlated with qEEG measures. <b><i>Conclusions:</i></b> To analyse the side effects after DBS in PD patients, the most important parameter is verbal fluency capacity. In addition, correlation with EEG frequency bands might be useful to detect particularly vulnerable patients for cognitive impairment and be supportive in the selection process of patients considered for DBS.

Association Between Urate-Lowering Therapies and Cognitive Decline in Community-Dwelling Older Adults: A Post-Hoc Analysis of the MAPT Study.

Introduction Long-term use of urate-lowering therapies (ULT) may reduce inflammaging and thus prevent cognitive decline during aging. This article examined the association between long-term use of ULT and cognitive decline among community-dwelling older adults with spontaneous memory complaints. Material and methods We performed a secondary observational analysis using data of 1,673 participants ≥ 70 years old from the Multidomain Alzheimer Preventive Trial (MAPT Study), a randomized controlled trial assessing the effect of a multidomain intervention, the administration of polyunsaturated fatty acids (PUFA), both, or placebo on cognitive decline. We compared cognitive decline during the 5-year follow-up between three groups according to ULT use: participants treated with ULT during at least 75% of the study period (PT ≥ 75; n = 51), less than 75% (PT < 75; n = 31), and non-treated participants (PNT; n = 1,591). Cognitive function (measured by a composite score) was assessed at baseline, 6 months and every year for 5 years. Linear mixed models were performed and adjusted for age, sex, body mass index (BMI), diagnosis of arterial hypertension or diabetes, baseline composite cognitive score, and MAPT intervention groups. Results After the 5-year follow-up, only non-treated participants presented a significant decline in the cognitive composite score (mean change − 0.173, 95%CI -0.212 to -0.135; p < 0.0001). However, there were no differences in change of the composite cognitive score between groups (adjusted between-group difference for PNT vs. PT < 75: 0.089, 95%CI -0.160 to 0.338, p = 0.484; PNT vs. PT ≥ 75: 0.174, 95%CI -0.042 to 0.391, p = 0.115). Conclusion Use of ULT was not associated with reduced cognitive decline over a 5-year follow-up among community-dwelling older adults at risk of dementia.

Factors Associated with Cognitive Score in People with Schizophrenia at Prof. Dr. M. Ildrem Mental Hospital Medan

BACKGROUND: Schizophrenia is characterized by being a condition with complex symptomatic dimensions. Its prognosis is poor due to the impairment of multiple cognitive functions, which handicaps the adequate social, academic, or employment reintegration of the patient. Cognitive impairment refers to the loss of cognitive functions, specifically memory, attention, and speed of information processing. A wide range of cognitive functions is affected, particularly memory, attention, motor skills, executive function, and intelligence. METHODS: This study is a multivariate predictive conceptual framework study with a cross-sectional approach to 120 subjects at the Prof. Dr. M Ildrem Mental Hospital Medan in May 2020–July 2020 using a sample that is a consecutive sampling. The test conducted in this study consisted of a bivariate test and a multivariate linear regression test to determine the factors that were associated with the cognitive score. The measuring instrument used is the Montreal Cognitive Assessment (MoCA) Ina. RESULTS: In the bivariate test, in gender variable (p = 0.644) and age variable (p = 0.255) were not statistically significant, so the variables were not included in the multivariate test. In marital status variable (p = 0.0001), type of antipsychotic (p = 0.193), income/month (p = 0.0001), length of education (p = 0.0001), length of illness (p = 0.0001), frequency hospital admission (p = 0.0001), duration of untreated psychosis (DUP) (p = 0.0001), positive and negative syndrome scale (PANSS) scale (p = 0.141), and negative PANSS scale (p = 0.0001) were found statistically significant for the total MoCA Ina score on the bivariate test. After multivariate linear regression testing, the statistically significant variables on the total MoCA Ina score were negative PANSS scale (p = 0.001), income/month (p = 0.0001), length of education (p = 0.001), length of illness (p = 0.0001), DUP (p = 0.028), and marital status (p = 0.0001). CONCLUSION: By knowing the factors related to the total score of MoCA Ina, it is expected that clinicians can be more careful in giving treatment interventions for people with schizophrenia who are at risk for cognitive impairment.

Does Acute Exercise Stress Affect Postural Stability and Cognitive Function in Subjects with Chronic Ankle Instability?

Altered postural control in people with chronic ankle instability (CAI) may be attributed to deficits that are associated with neurocognitive function. Acute training is another factor that may negatively affect postural control and increase the risk of ankle sprain. The purpose of this investigation was to determine the effect of acute exercise on postural stability and cognitive function among patients with CAI. Fifteen patients with CAI (aged 21.5 ± 2.0 years) and 15 healthy controls (aged 20.3 ± 1.7 years) completed a single-limb stance postural control test and a battery of computer-based cognitive tests before and after acute exercise. The overall stability index (OSI) was used as a measure of postural stability. The cognitive domains tested were global cognitive score, executive function, attention, visual-spatial perception, information processing, and fine motor control. Subjects in both groups had similar OSI scores, with a trend for reduced stability in the CAI after the exercise protocol (p = 0.053). There were no differences between the groups in all cognitive domains before or after exercise. Following exercise, the domains of overall cognitive score, visual-spatial perception, and information processing speed improved in both groups (p = 0.003, p = 0.033, p = 0.001; respectively). These findings should be considered with caution due to the heterogeneity of the CAI population.