Association Between Diet And Cognitive Performance In Adults Aged 60 And Over: NHANES, 2011–2014

There is limited evidence examining associations between diet and cognitive performance (CP) in older adults. We used the 2011-2014 National Health and Nutrition Examination Survey to determine if meeting dietary recommendations was associated with CP in adults 60+ years of age. Diet was based on the healthy eating index (HEI) 2015 and categorized into quintiles (higher quintiles indicating healthier diet). CP was based on word list learning, animal naming, and digit symbol substitution test, with scores above 25th percentile indicating adequate performance. Multivariate logistic regression modeling was conducted and adjusted for potential cofounders. A total of 3,068 participants completed the CP tests. A slightly higher percentage of participants were female (54.0%), predominantly White (80.5%) and the largest percentage (54.7%) was 60 to 69 years of age. The mean HEI-2015 score (0-100) was 54.89 (SE = 0.56). High CP scores increased with healthier dietary quintiles. However, results were only significant (p for trend <0.05) for digit symbol substitution test when comparing those in the highest quintile (82.53%) to those in the lowest (70.23%). Compared with participants in the lowest quintile of HEI-2015, participants in the highest quintile had a two-fold increased odds of better digit symbol substitution test scores, after adjusting for confounders (Odds Ratio [OR]: 1.96, 95% Confidence Interval [CI]: 1.28-3.01). Results showed that meeting healthy diet recommendations is associated with improved digit symbol substitution test, a marker of attention, processing speed and executive function. Future research should consider the role of diet in older adults to improve cognitive performance.

Discriminant Validity of the WAIS-R Digit Symbol Substitution Test in Subjective Cognitive Decline, Mild Cognitive Impairment (Amnestic Subtype) and Alzheimer’s Disease Dementia (ADD) in Greece

Objective: The aim of the current study was to estimate the discriminant potential and validity of the Digit Symbol Substitution Test (DSST) of the WAIS-R in the Greek elderly population meeting criteria for subjective cognitive decline (SCD), mild cognitive impairment (aMCI; amnestic subtype), or Alzheimer’s disease dementia (ADD). Method: Four hundred eighty-eight community-dwelling older adults, visitors of the Day Center of Alzheimer Hellas, participated in the study. Two hundred forty-three of them met the criteria for ADD, one hundred eighty-two for aMCI and sixty-three for SCD. Results: Path analysis indicated that the DSST score is affected by age group, educational level, and diagnostic category, but is not affected by gender. The ROC curve analysis showed that the DSST sum score could perfectly differentiate SCD from ADD patients, whereas test’s discriminant potential between aMCI and dementia ADD’s subtype was satisfactory. However, DSST was unable to separate the SCD from the aMCI group. Conclusion: It appears that the DSST is unable to separate the SCD from aMCI population. Therefore, the test in question may be insensitive to incipient cognitive decline. On the contrary, the discriminant potential of the DSST as regards SCD and ADD is excellent, while discrimination between aMCI and ADD is good.

KŪRYBINIŲ VEIKLŲ POVEIKIS PACIENTŲ DĖMESIO KONCENTRACIJOS KAITAI PO GALVOS SMEGENŲ INSULTO

Tyrimo tikslas – išsiaiškinti kūrybinės veiklos poveikį pacientų dėmesio koncentracijai po galvos smegenų insulto. Tyrimo metodai. Tyrimas atliktas Vilniaus universiteto ligoninės Santaros klinikų Reabilitacijos, fizinės ir sporto medicinos centro I stacionarinės reabilitacijos skyriuje. Tyrimo laikotarpis 2017 m. spalis – 2018 m. kovas. Tyrime dalyvavo 30 pacientų, po galvos smegenų insulto atvykusių į stacionarinę reabilitaciją ir turinčių dėmesio koncentracijos problemų. Tiriamieji, atitikę įtraukimo į tyrimą kriterijus, atsitiktinės atrankos būdu suskirstyti į dvi grupes: tiriamąją ir kontrolinę po 15 asmenų. Tyrimui taikytas anketinis testavimas: sociodemografinių duomenų anketa, Trumpas protinės būklės vertinimo testas (Mini Mental), Monrealio kognityvinis testas (MOCA) bei Skaičių pakeitimo simboliais testas (Digit-Symbol substitution test, DSST), kurie padėjo įvertinti tiriamųjų dėmesio sutelktumą, apimtį ir perkėlimą. Taikyti įprastinės ergoterapijos užsiėmimai, kūrybinės veiklos ir gautų duomenų statistinė analizė. Rezultatai: kūrybinės veiklos terapija daro teigiamą įtaką pacientų po galvos smegenų insulto dėmesio sutelktumui. Visiems tiriamosios grupės pacientams dėmesio sutelktumas pagerėjo 30 procentų. Apskaičiavus taikyto poveikio reikšmingumą, skirtumas tarp I ir II tyrimo rezultatų laikomas statistiškai patikimu (p<0,05). Dėmesio apimties sutrikimų po taikytos kūrybinės veiklos neturėjo 67 proc. pacientų. Apskaičiavus taikyto poveikio reikšmingumą, skirtumas tarp I ir II tyrimo laikomas statistiškai nepatikimu (p>0,05). Pacientų, kuriems buvo taikoma kūrybinės veiklos terapija, dėmesio perkėlimas pagerėjo vidutiniškai 3,6 balo. Apskaičiavus taikyto poveikio reikšmingumą, skirtumas tarp I ir II tyrimo rezultatų laikomas statistiškai patikimu (p<0,05).

Longitudinal Associations of Midlife Accelerometer Determined Sedentary Behavior and Physical Activity With Cognitive Function: The CARDIA Study

Background To determine if accelerometer measured sedentary behavior (SED), light‐intensity physical activity (LPA), and moderate‐to‐vigorous–intensity physical activity (MVPA) in midlife is prospectively associated with cognitive function. Methods and Results Participants were 1970 adults enrolled in the CARDIA (Coronary Artery Risk Development in Young Adults) study who wore an accelerometer in 2005 to 2006 (ages 38–50 years) and had cognitive function assessments completed 5 and/or 10 years later. SED, LPA, and MVPA were measured by an ActiGraph 7164 accelerometer. Cognitive function tests included the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop Test. Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA with repeated measures of the cognitive function standardized scores. In men, statistical reallocation of 30 minutes of LPA with 30 minutes of MVPA resulted in an estimated difference of SD 0.07 (95% CI, 0.01–0.14), SD 0.09 (95% CI, 0.02–0.17), and SD −0.11 (95% CI, −0.19 to −0.04) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating better performance. Associations were similar when reallocating time in SED with MVPA, but results were less robust. Reallocation of time in SED with LPA resulted in an estimated difference of SD −0.05 (95% CI, −0.06 to −0.03), SD −0.03 (95% CI, −0.05 to −0.01), and SD 0.05 (95% CI, 0.03– 0.07) in the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop scores, respectively, indicating worse performance. Associations were largely nonsignificant among women. Conclusions Our findings support the idea that for men, higher‐intensity activities (MVPA) may be necessary in midlife to observe beneficial associations with cognition.

How Does Dementia Begin to Manifest in Bipolar Disorder? A Description of Prodromal Clinical and Cognitive Changes.

BackgroundThis study aims to identify longitudinal cognitive changes that may signal early dementia in bipolar disorder.MethodsParticipants were 114 adults with bipolar disorder, all initially non-demented, who underwent annual neuropsychological assessment up to ten years (47.3 months average follow-up). A small subset (n=12) also had available structural neuroimaging data. Longitudinal features associated with future dementia status were examined with linear mixed-effects models, and yearly differences between incident dementia and controls cases were examined in the six years prior to diagnosis.ResultsTwenty-six participants (22.8%) developed dementia over the follow-up period (‘incident cases’), and the remaining 88 (77.2%) remained dementia-free (‘controls’). Alzheimer’s disease was the most common presumed etiology in the incident cases, and this aligned with findings of smaller hippocampal volumes relative to controls. The incident cases showed clearly declining trajectories in episodic memory, verbal fluency and attention. Story recall and digit symbol substitution showed the earliest decline, four and five years before diagnosis respectively. Digit symbol substitution was most accurate at distinguishing cases from controls: impaired performance (<-1.5 SD) at any time during the follow-up period was associated with 54% sensitivity and 87% specificity of future dementia.ConclusionsProdromal dementia in bipolar disorder can be detected up to five years before onset using the same cognitive tests used in psychiatrically-healthy older adults. Cognition in the natural course of bipolar disorder is generally stable, and impairment or marked decline on measures of memory, fluency or attention may indicate an early neurodegenerative process.

A social dancing pilot intervention for older adults at high risk for Alzheimer's disease and related dementias

Close to 6 million older US adults have Alzheimer's disease or related dementias, yet there is currently no cure or effective treatment. This single-blind randomized controlled trial (clinicaltrials.gov: NCT03475316) aims to establish feasibility, and explore the relative efficacy, of a 6-month social ballroom dancing intervention versus a 6-month active control intervention (treadmill walking) for improving executive function in 32 older adults at increased risk for Alzheimer's disease or related dementias. Dementia-at-risk status is determined with cut-scores on the memory impairment screen (≥3 to ≤6) and/or the AD8 Dementia Screening Interview (≥1). The primary outcome is a composite executive function score from digit-symbol substitution, flanker interference and walking-while-talking tasks. The secondary outcome is functional neuroplasticity during fMRI-adapted versions of digit-symbol substitution, flanker interference and walking-while-talking.

Peripheral Insulin Resistance in Cognitively Normal Older Adults Relates to Poorer Performance on a Test for Speed of Processing

Objectives Peripheral insulin resistance (IR) and impaired glucose metabolism increases the risk for cognitive decline. However, data looking at peripheral IR's relationship with cognition in cognitively normal adults is limited. This study aimed to assess the relationship between peripheral IR and tests of speed of processing (SOP) in cognitively normal older adults using a novel IR measure. Methods Baseline data from 56 cognitively normal older adults participating in a nutrition intervention study (Nutrition Interventions for Cognitive Enhancement study; NICE study) were analyzed. Fasting blood draws were attained, and peripheral IR was measured using Quest Diagnostics’ Cardio IQ Insulin Resistance Panel (Test Code: 36,509). A cognitive battery was conducted by a trained psychometrician. Z-Scores of the Digit Symbol Substitution Test, Stroop Color, Stroop Word, Stroop Interference, and Stroop Letter Number Sequencing and Crossing-Off tests were combined to give a global SOP score. We constructed ordinary least squares regression models to assess IR's relationships with individual SOP tests and global SOP, including age and education as covariates. Statistical analyses were performed using R (v. 3.6.2; R Foundation, Vienna, Austria). Statistical significance was set at P &lt; 0.05. Results Participants were 77% female and had a mean age of 72.1 ± 4.9 years. Higher IR scores were related to poorer performance on the Digit Symbol Substitution Test (β = −0.26, P = 0.04). IR scores were not related to other individual cognitive tests: Stroop Color (β = −0.17, P = 0.20), Stroop Word (β = −0.19, P = 0.11), Stroop Interference (β = −0.14, P = 0.28), Stroop Letter Number Sequencing (β = 0.03, P = 0.83), Crossing-Off (β = −0.18, P = 0.15), or Global SOP (β = −0.20, P = 0.11). Conclusions There was a relationship between higher IR scores and poorer performance on the Digit Symbol Substitution Test. Although other SOP tests were not significantly correlated with IR scores, directionality of the relationships indicated trend for higher IR being related to lower SOP. Consequently, maintaining insulin sensitivity with healthy lifestyle choices may be important for healthy aging. Future analyses with a larger sample size will be more informative for understanding the relationship between IR and SOP. Funding Sources National Institute on Aging.

Utilization of Medications With Cognitive Impairment Side Effects and the Implications for Older Adults’ Cognitive Function

Objectives: Many medications have cognitive impairment, memory loss, amnesia, or dementia as side effects (“cognitive side effects” hereafter), but little is known about trends in the prevalence of these medications or their implications for population-level cognitive impairment. Method: We use data from the National Health and Nutrition Examination Survey (1999–2016) to describe trends in the use of medications with cognitive side effects among adults aged 60+ ( N = 16,937) and their implications for cognitive functioning (measured using word learning and recall, animal fluency, and digit symbol substitution assessments). Results: Between 1999 to 2000 and 2015 to 2016, the prevalence of older adults taking one, two, and at least three medications with cognitive side effects increased by 10.2%, 57.3%, and 298.7%, respectively. Compared to non-users, respondents who simultaneously used three or more medications with cognitive side effects scored 0.22 to 0.27 standard deviations lower in word learning and recall ( p = .02), digit symbol substitution ( p < .01), and the average standardized score of the three assessments ( p < .001). Limitation: Dosage of medications associated with cognitive side effects was not measured. Discussion: Concurrent use of medications with cognitive side effects among older adults has increased dramatically over the past two decades. The use of such medications is associated with cognitive impairment and may explain for disparities in cognitive function across subgroups. These findings highlight the need for cognitive screenings among patients who consume medications with cognitive side effects. They also highlight the synergic effects of polypharmacy and potential drug-drug interactions that result in cognitive deficits.