Utility of olfactory identification test for screening of cognitive dysfunction in community-dwelling older adults

Background There is a need for a large-scale screening test that can be used to detect dementia in older individuals at an early stage. Olfactory identification deficits have been shown to occur in the early stages of dementia, indicating their usefulness in screening tests. This study investigated the utility of an olfactory identification test as a screening test for mild cognitive dysfunction in community-dwelling older people. Methods The subjects were city-dwelling individuals aged over 65 years but under 85 years who had not been diagnosed with dementia or mild cognitive impairment. The Japanese version of the Mild Cognitive Impairment Screen was used to evaluate cognitive function. Based on the results, the subjects were divided into two groups: healthy group and cognitively impaired group. Olfactory identification abilities based on the Japanese version of the University of Pennsylvania Smell Identification Test were compared between the groups. Results There were 182 participants in total: 77 in the healthy group and 105 in the cognitively impaired group. The mean olfactory identification test score of the cognitively impaired group was significantly lower than that of the healthy group. The cognitive impairment test score was significantly correlated with the olfactory identification test score. Conclusions Cross-sectional olfactory identification deficits at baseline in community-dwelling older adults reflected cognitive dysfunction. Assessing olfactory identification ability might be useful as a screening test for mild cognitive dysfunction in community-dwelling older people.

Development and validation of Dementia Solat Score for detecting cognitive impairment among Muslim patients: A pilot study

Background & Objective: Low education and simplicity of lifestyle of Malaysian older adults may mask the early signs of dementia and lead to late presentation with various complications and neglect. From clinical observation, decline in prayer performance in older Muslims might be a sign of cognitive impairment. This study aim to develop and validate an objective assessment tool for dementia based on Muslim routine prayer performance status. Methods: This was a pilot study which involved Muslim participants aged 50 and above. They were divided into normal cognitive control group and cognitive impaired group. Clinical Dementia Rating (CDR) was done on all participants upon recruitment, and Dementia Solat Score (DSS) was done by another group of assessors which were blinded to CDR findings. All the statistical analyses was performed using R statistical software, Version 3.5.2. Results: There were total of 36 participants, 16 from normal cognitive control group and 20 from cognitive impaired group. DSS score was significantly lower in cognitive normal control (median=0, IQR=0) compared to cognitive impaired group (median=4, IQR=9.0), Z=-4.54, p<0.001. Spearman’s rank-order correlation test between CDR and DSS revealed a positive correlation between the two assessment tools, r= 0.920, p<0.001. The cut-off point of 1 and above in DSS showed a sensitivity of 85.0%, specificity of 93.8%, positive predictive value of 94.4% and negative predictive value of 83.3%. Conclusions: This pilot study showed that DSS has high sensitivity and specificity in detecting cognitive impairment among Muslim patients. A higher score in DSS may indicate more severe stage of disease.

A-12 Racial Differences in Performance Validity Test Failure Rates

Objective Embedded performance validity tests (PVTs) may show increased false positive rates in racially diverse examinees. This study examined false positive rates by race in an older adult sample. Method The project involved secondary analysis of a deidentified dataset (N = 22,688) from the National Alzheimer’s Coordinating Center (NACC). Participants were included if their identified race was African American or white. Exclusion criteria included diagnosis of mild cognitive impairment (MCI; n = 5160) or dementia (n = 5550). The initial sample included 11,114 participants grouped as cognitively normal (89.9%) or impaired but not MCI of whom 16.4% identified as African American. Propensity score matching was conducted by diagnostic group to match African American and white participants on age, education, gender, and MMSE score. The final sample included 3024 and 482 participants in normal and impaired groups, respectively, with 50% of participants identifying as African American in each group. Failure rates on five embedded PVTs in the NACC cognitive test battery were examined by race and by diagnosis. Results Age, education, gender, and MMSE score were not significantly different by race in either diagnostic group. In the normal group, 4.7% of African American and 1.9% of white participants failed two or more PVTs (p &lt; 0.001). In the impaired group, 9.5% of African American and 5.8% of white participants failed two or more PVTs (n.s.). Conclusions PVT failure rates were significantly higher among African American participants in the normal group but not in the impaired group. Failure rates remained below a common false positive threshold of 10%.

A-184 Performance Validity Test Failure Rates in Bilingual Individuals Evaluated in English

Objective Classification accuracy of embedded performance validity tests (PVTs) is unknown in cases involving bilingual examinees evaluated in English. This study examined false positive rates in bilingual individuals in an older adult sample. Method The project involved secondary analysis of a deidentified dataset (N = 22,688) from the National Alzheimer’s Coordinating Center (NACC). Exclusion criteria were diagnosis of mild cognitive impairment (MCI; n = 5160) or dementia (n = 5550). The initial sample included 11,513 participants grouped as cognitively normal (89.6%) or impaired but not MCI. A subset of 275 participants was identified with a primary language other than English who were evaluated in English. Propensity score matching was conducted by diagnostic group to match bilingual to monolingual participants on age, education, gender, and MMSE score. The final sample included 450 and 100 participants in normal and impaired groups, respectively. Failure rates on five embedded PVTs in the NACC cognitive test battery were examined by language and by diagnosis. Results Age, education, gender, and MMSE score were not significantly different by language in either diagnostic group. In the normal group, 4.9% of bilingual and 2.2% of monolingual participants failed two or more PVTs (n.s.). In the impaired group, 12% of bilingual and 6% of monolingual participants failed two or more PVTs (n.s.). Conclusions PVT failure rates were not significantly different between bilingual participants evaluated in English and monolingual participants in either diagnostic group. Failure rates, however, increased slightly above a common false positive threshold of 10% in bilingual participants in the impaired group.

Is preoperative bone conduction shape a prognostic factor in otosclerosis surgery?

1. We focused on 175 patients operated on for otosclerosis. There were 89 in group 1 (preoperative 4000 Hz BC threshold better than 2000 Hz) and 86 in group 2 (preoperative 2000 Hz BC threshold better than 4000 Hz). 2. Preoperatively, there was no significant difference in terms of average bone conduction (BC) thresholds, average air conduction (AC) thresholds and air-bone gap (ABG) between the two groups. 3. Three months and 1 year after surgery, group 1 had better audiometric outcomes than group 2 in terms of average AC and BC thresholds and ABG. 4. Postoperative BC gain was better in group 1 than group 2, particularly at 500 Hz, 1000 Hz and 2000 Hz. 5. When the 4000 Hz BC threshold was preoperatively impaired (group 2), it was not worsened after stapes surgery. This was not the case in group 1.

Model Selection Reveals the Butyrate-Producing Gut Bacterium Coprococcus eutactus as Predictor for Language Development in 3-Year-Old Rural Ugandan Children

IntroductionThe metabolic activity of the gut microbiota plays a pivotal role in the gut-brain axis through the effects of bacterial metabolites on brain function and development. In this study we investigated the association of gut microbiota composition with language development of 3-year-old rural Ugandan children.MethodsWe studied the language ability in 139 children of 36 months in our controlled maternal education intervention trial to stimulate children’s growth and development. The dataset includes 1170 potential predictors, including anthropometric and cognitive parameters at 24 months, 542 composition parameters of the children’s gut microbiota at 24 months and 621 of these parameters at 36 months. We applied a novel computationally efficient version of the all-subsets regression methodology and identified predictors of language ability of 36-months-old children scored according to the Bayley Scales of Infant and Toddler Development (BSID-III).ResultsThe best three-term model, selected from more than 266 million models, includes the predictors Coprococcus eutactus at 24 months of age, Bifidobacterium at 36 months of age, and language development at 24 months. The top 20 four-term models, selected from more than 77 billion models, consistently include C. eutactus abundance at 24 months, while 14 of these models include the other two predictors as well. Mann–Whitney U tests suggest that the abundance of gut bacteria in language non-impaired children (n = 78) differs from that in language impaired children (n = 61). While anaerobic butyrate-producers, including C. eutactus, Faecalibacterium prausnitzii, Holdemanella biformis, Roseburia hominis are less abundant, facultative anaerobic bacteria, including Granulicatella elegans, Escherichia/Shigella and Campylobacter coli, are more abundant in language impaired children. The overall predominance of oxygen tolerant species in the gut microbiota was slightly higher in the language impaired group than in the non-impaired group (P = 0.09).ConclusionApplication of the all-subsets regression methodology to microbiota data established a correlation between the relative abundance of the anaerobic butyrate-producing gut bacterium C. eutactus and language development in Ugandan children. We propose that the gut redox potential and the overall bacterial butyrate-producing capacity in the gut are important factors for language development.

MO990THE RELATIONSHIP BETWEEN T-CELL INFILTRATION IN BIOPSY PROVEN ACUTE T-CELL MEDIATED REJECTION WITH ALLOGRAFT FUNCTION

Background and Aims Todays increasing effort are made to detect non-invasive and reliable methods for prediction of organ rejection. In the current study, we evaluated the degree of CD3, CD20, Th17 and Tregs infiltration in kidney biopsy of the patients with acute cellular rejection and the possible relation with graft outcome. Method From 70 biopsy proven ATCMR according to Banff criteria in whom kidney biopsy were done based on acute creatinine rise, 50 patients were selected. 20 patients excluded because of insufficient specimen or clinical data. All of recruited patients experienced their first episode of ATCMR. 21 patients had deceased donors and 29 had living ones. Paraffin sections were deparaffinized then dehydrated using alcohols. The tissues were incubated with Antibodies in two stages. First, they were incubated with antihuman IL-17 monoclonal antibody and polyclonal antibody against FOXP3. The results analyzed with SPSS version 20. P value less than 0.05 was considered as significant. Results FOXP3 mean cell count in stable graft function group was 7.88 but in impaired graft group was 8.02, which was not statistically significant (P-value :0. 96). Th17 mean cell count in stable group was 5.0 but in impaired group was 10.1, which was not significant too (P-value: 0.24). FOXP3/Th17 ratio was higher in stable group (1.4 versus 1.12) but without any statistically important value (P-value: 0.22) .CD3 count was higher in impaired group (29.8 versus 27.7) and CD20 count was more in stable group (8.8 versus 7.8) without any significant values (P-value: 0.7 and 0.62) respectively. FOXP3 positive cell count was higher in failure to response group (9.95 vs. 6.63) but with non-significant P-value of 0.1. Th17 count was higher also in this group (11.3 vs. 8.3) but with non-significant value .The FOXP3/Th17 ratio was higher in appropriate response group (1.19 vs. 1.15) with P-value 0.8 .CD3 count was higher in response group and CD20 in failure group vice versa (31.2 vs. 27.3 and 7.96 vs. 8.06) also with nonsignificant values Conclusion We observed that allografts with higher Th17 at biopsy had lower levels of GFR in the next 12 months. One conclusion can be that assessing the Th17 infiltration is more effective than FOXP3 Tregs in predicting the prognosis of renal transplant .

Protective factors for cognitive decline: Trajectories and changes in a longitudinal study with Italian elderly

This retrospective study quantifies the relative contribution of age and sex as demographic factors, comorbidity, education and occupation as cognitive reserve (CR) proxies in accounting for cognitive aging. Participants underwent three neuropsychological evaluations, with their cognitive profiles being classified as unimpaired, mildly or severely impaired. For all 3,081 participants, in addition to age, education was the best predictor of performance followed by occupation. From the original sample, 543 participants were reassessed a second time, and 125 a third time. Depending on whether they maintained or worsened their profile based on their initial performance, participants were classified as resistant or declining. Results showed that, across assessments, the resistant had higher levels of education and occupation than the declining. Education and occupation modulated cognitive performance also in the more severely impaired group. This study confirms that the trajectories of changes of performance in ageing are consistently predicted by high levels of CR.

Model selection reveals the butyrate-producing gut bacterium Coprococcus eutactus as predictor for language development in three-year-old rural Ugandan children

ABSTRACTIntroductionThe metabolic activity of the gut microbiota plays a pivotal role in the gut-brain axis through the effects of bacterial metabolites on brain function and development. In this study we investigated the association of gut microbiota composition with language development of three-year-old rural Ugandan children.MethodsWe studied the language ability in 139 children of 36 months in our controlled maternal education intervention trial to stimulate children’s growth and development. The dataset includes 1170 potential predictors, including anthropometric and cognitive parameters at 24 months, 542 composition parameters of the children’s gut microbiota at 24 months and 621 of these parameters at 36 months. We applied a novel computationally efficient version of the all-subsets regression methodology and identified predictors of language ability of 36-months-old children scored according to the Bayley Scales of Infant and Toddler Development (BSID-III).ResultsThe best three-term model, selected from more than 266 million models, includes the predictors Coprococcus eutactus at 24 months of age, Bifidobacterium at 36 months of age, and language development at 24 months. The top 20 four-term models, selected from more than 77 billion models, consistently include Coprococcus eutactus abundance at 24 months, while 14 of these models include the other two predictors as well. Mann-Whitney U tests further suggest that the abundance of gut bacteria in language non-impaired children (n = 78) differs from that in language impaired children (n = 61) at 24 months. While obligate anaerobic butyrate-producers, including Coprococcus eutactus, Faecalibacterium prausnitzii, Holdemanella biformis, Roseburia hominis are less abundant, facultative anaerobic bacteria, including Granulicatella elegans, Escherichia/Shigella and Campylobacter coli, are more abundant in language impaired children. The overall predominance of oxygen tolerant species in the gut microbiota of Ugandan children at the age 24 months, expressed as the Metagenomic Aerotolerant Predominance Index (MAPI), was slightly higher in the language impaired group than in the non-impaired group (P = 0.09).ConclusionsApplication of the all-subsets regression methodology to microbiota data established a correlation between the relative abundance of the anaerobic butyrate-producing gut bacterium Coprococcus eutactus and language development in Ugandan children. We propose that the gut redox potential and the overall bacterial butyrate-producing capacity could be factors of importance as gut microbiota members with a positive correlation to language development are mostly strictly anaerobic butyrate-producers, while microbiota members that correlate negatively, are predominantly oxygen tolerant with a variety of known adverse effects.

Socioeconomic and physical health status changes after visual impairment in Korea using difference-in-difference estimations

This study analyzed the impact of visual impairment on socioeconomic and physical health status and its heterogeneity by severity of visual impairment. We used nationally representative cohort data based on Korean national health insurance claims (2002–2013), which were extracted for 11,030 persons (2206 visually impaired, 8824 control). This was restructured as monthly data for each person (person-month). Multivariate and ordered logistic regressions were conducted, and the pre-impairment status between the visually impaired and non-visually impaired people was adjusted by difference-in-difference (DiD) estimation. Focusing on medical aid (a public healthcare service assistance program for people who cannot afford health insurance premiums), the DiD estimate showed that the likelihood of receiving aid was higher among visually impaired compared with non-impaired people. Mildly and severely visually impaired people were more likely to be medical aid recipients than their counterparts. The severely visually impaired group was more likely to be unemployed. The visually impaired group were less likely to have no comorbidity. Our findings show that the socioeconomic and physical health status of visually impaired people is more likely to deteriorate than that of their non-visually impaired counterparts following onset of impairment.