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INTRODUCTION: Clinical understanding of primary progressive aphasia (PPA) has been primarily derived from Indo‐European languages. Generalizing certain linguistic findings across languages is unfitting due to contrasting linguistic structures. While PPA patients showed noun classes impairments, Chinese languages lack noun classes. Instead, Chinese languages are classifier language, and how PPA patients manipulate classifiers is unknown. METHODS: We included 74 native Chinese speakers (22 controls, 52 PPA). For classifier production task, participants were asked to produce the classifiers of high‐frequency items. In a classifier recognition task, participants were asked to choose the correct classifier. RESULTS: Both semantic variant (sv) PPA and logopenic variant (lv) PPA scored significantly lower in classifier production task. In classifier recognition task, lvPPA patients outperformed svPPA patients. The classifier production scores were correlated to cortical volume over left temporal and visual association cortices. DISCUSSION: This study highlights noun classifiers as linguistic markers to discriminate PPA syndromes in Chinese speakers. Highlights: Noun classifier processing varies in the different primary progressive aphasia (PPA) variants. Specifically, semantic variant PPA (svPPA) and logopenic variant PPA (lvPPA) patients showed significantly lower ability in producing specific classifiers. Compared to lvPPA, svPPA patients were less able to choose the accurate classifiers when presented with choices.In svPPA, classifier production score was positively correlated with gray matter volume over bilateral temporal and left visual association cortices in svPPA. Conversely, classifier production performance was correlated with volumetric changes over left ventral temporal and bilateral frontal regions in lvPPA.Comparable performance of mass and count classifier were noted in Chinese PPA patients, suggesting a common cognitive process between mass and count classifiers in Chinese languages. [ABSTRACT FROM AUTHOR]

Background: Coffee and tea consumption has been shown to associate with the risk of dementia. However, little is known about how sex and vascular comorbidities (type 2 diabetes, hypertension, and hypercholesterolemia) modify this association. Method: This is a multi‐center case‐control study. We recruited 278 Alzheimer's disease (AD) and 102 small‐vessel vascular dementia (VaD) patients aged 60 or older from three teaching hospitals in Taiwan from 2007 to 2010; controls (n = 468) were recruited from the health checkup program during the same period of time. The outcomes of this study are clinically diagnosed AD and VaD. Information on coffee and tea consumption and the history of type 2 diabetes, hypertension, and hypercholesterolemia were collected based on questionnaires and medical charts. A multinomial logistic regression model was utilized to evaluate 1) the association of coffee and tea consumption with dementia risk, and 2) how sex and vascular risk factors modified these associations. Result: Different combinations and quantities of coffee and tea consumption protected against AD and VaD. Our analyses demonstrated consumption of three or more cups of coffee or tea per day was associated with a decreased risk of AD [adjusted odds ratio (aOR) = 0.42; 95% confidence interval (CI) = 0.22‐0.78)] and VaD (aOR = 0.42; 95% CI = 0.19‐0.94). After stratification, these associations became more evident in females for AD (aOR = 0.15; 95% CI = 0.05‐0.46) and in males for VaD (aOR = 0.06; 95% CI = 0.01‐0.50). Similarly, hypertensive participants consuming higher quantities of coffee and tea had a decreased risk of AD (aOR = 0.30; 95% CI = 0.11‐0.78). Moreover, hypercholesterolemia significantly modified the association of coffee or tea consumption with the risk of dementia (Pinteraction < 0.001). Conclusion: Coffee and tea consumption was associated with a decreased risk of AD and VaD. Sex and vascular comorbidities differentially modified the association of coffee and tea consumption with the risk of dementia. [ABSTRACT FROM AUTHOR]

Background: Diet quality is an essential modifiable factor that has been associated with cognitive performance and physical function. However, few studies investigated the association of diet quality trajectories with "cognitive frailty." This study aimed to identify specific diet quality trajectories and explore their relationship with cognitive frailty in Taiwanese community‐dwelling older adults. Method: This 11‐year cohort study (2011‐2022) recruited 520 non‐demented older adults at baseline (2011‐2013). The global and domain‐specific cognition was assessed by the Taiwanese version of the Montreal Cognitive Assessment and a battery of neuropsychological tests. Physical frailty was assessed by a modified version of the criteria of Fried et al. The presence of both physical frailty and MCI was defined as cognitive frailty. Diet quality was assessed by the modified Alternative Healthy Eating Index, which includes seven components obtained from a semi‐quantitative food frequency questionnaire. Growth mixture modeling was used to identify diet quality trajectories over 11 years. The generalized linear mixed model was used to explore the association of energy‐adjusted diet quality trajectories with cognitive frailty over time adjusting for important covariates. Result: This study identified four diet quality trajectories: 1) worsening, 2) low‐moderate‐low, 3) moderate‐low‐moderate, and 4) still low. Compared to trajectory 4, trajectory 3 had lower odds of worsening frailty [adjusted odds ratio (aOR) = 0.48; 95% confidence interval (CI): 0.27, 0.85], worsening cognitive‐frailty (aOR = 0.52; 95% CI: 0.30, 0.92), and impaired logical memory‐frailty (aOR = 0.42‐0.53). In addition, trajectory 1 had lower odds of worsening impaired logical memory‐physical frailty (aOR = 0.53; 95% CI: 0.32, 0.86) compared with trajectory 4. No association was found for trajectory 2. Conclusion: We found that the moderate‐low‐moderate diet quality trajectory lowers the odds of worsening frailty and cognitive frailty. Further studies on different ethnic groups will help researchers to clarify the temporal relationship between diet quality and cognitive frailty. [ABSTRACT FROM AUTHOR]

Background: Diabetes was considered one of the risk factors for dementia. However, one‐third of diabetic patients also suffer from kidney disease. It remains unclear the intercorrelation between blood sugar and kidney function that affects the occurrence of mild cognitive impairment for people with normal blood sugar levels. This study aimed to explore the relationship between hyperglycemia and kidney dysfunction (KD) on cognitive impairment in older adults. Method: This is an eight‐year cohort study (2011‐2019). A total of 509 non‐demented older adults were recruited from the elderly health checkup program at baseline (2011‐2013) with three biannual follow‐ups. Global and domain‐specific (memory, attention, executive function, and language) cognition were assessed by the Taiwanese version of Montreal Cognitive Assessment (MoCA‐T) and a battery of neuropsychological tests, respectively. MCI was defined as a MoCA‐T score of 22 or 23. Hyperglycemia was defined as fasting blood glucose greater than 100 mg/dL. KD was defined as having either glomerular filtration rate < 60 ml/min/1.73 m2 or proteinuria. The generalized linear mixed model was utilized to examine the effects of hyperglycemia and KD on cognitive performance. Result: The prevalence of MCI was 9.4% at baseline. Hyperglycemia [adjusted odds ratio (aOR) = 1.91] and KD (aOR = 1.98) were significantly associated with the risk of MCI over eight years after adjusting for covariates, respectively. In addition, hyperglycemia and KD were significantly associated with poor performance of logical memory (β:‐0.51 to ‐0.01), executive function (β:‐0.25 to ‐0.003), attention (β:‐0.07 to ‐0.03), and verbal fluency (β:‐0.08 to ‐0.005). Hyperglycemia and KD was associated with an increased risk of MCI participants aged less than 75 years (aOR = 2.19–2.21) and in APOE ε4 non‐carriers (aOR = 2.02–2.15). Conclusion: Our finding indicated that poor glycemic control and kidney function were associated with an increased risk of MCI or poor performance of cognitive domains in older adults. Cognitive impairment may be reversible through optimal management of glycemia and kidney disease; interventions (e.g., self‐management education, dietary restriction, and sufficient physical activity, etc.) at the early stage will be helpful to prevent dementia. [ABSTRACT FROM AUTHOR]

Background: There are more than 7,000 living languages worldwide with wide heterogeneities in their linguistic features. Varying dementia symptomatology has been noted across speakers of different languages. Chinese languages adopt logographic scripts that contrast greatly from Indo‐European languages with alphabetic writing systems. For instance, Chinese characters have weak grapheme‐phoneme correspondence, with only 19‐ 39% pronounced per their phonetic components. Chinese characters also have 20 different spatial configurations with varying visuospatial complexity and abundant heteronyms. Past literature has focused on the reading presentations of primary progressive aphasia (PPA) patients that adopt Indo‐European languages. This study outlined the reading presentations of Chinese‐speaking PPA patients. Method: The CLAP (Chinese Language Assessment for PPA) battery is designed to characterize the neurolinguistics features of Chinese‐speaking PPA individuals. In CLAP character reading test, participants are tasked to read aloud 50 Chinese characters that vary in lexicality (pictographic, regular compound, and irregular compound characters), character frequency and concreteness. Voxel‐based morphometry(VBM) was performed to examine the neural basis of reading performance. Participants are also tasked with reading pairs of compound words with heteronyms (e.g., "bow tie" vs "bow down). Results: A total of 15 Mandarin‐speaking controls and 38 PPA individuals [6 nonfluent variant (nfv) PPA, 9 semantic variant (sv) PPA and 23 logopenic variant (lv) PPA] completed CLAP reading task. In character reading test, svPPA scored significantly lower than controls and nfvPPA (pictographic: p = 0.026; regular compound: p = 0.007; irregular compound characters: p<0.001). Regardless of lexicality, the reading score significantly correlated with volumetric changes over left temporal pole. While over‐regularization errors/surface dyslexia was the most common reading error across control and PPA groups, it was not specific to svPPA (p = 0.109). Conversely, on heteronym word reading test, svPPA and lvPPA scored significantly lower in accuracy, with over‐regularization errors more frequently noted in svPPA group. Conclusion: Contrary to English svPPA patients that struggled specifically with irregular word reading and showed frequent surface dyslexia, Chinese PPA patients showed no variant‐specific differences across lexicality, and svPPA‐specific over‐regularization phenomenon were found at the lexical (i.e., heteronym‐reading) and not sub‐lexical reading. Diagnostic criteria for PPA syndrome vary with languages and should ideally be tailored linguistically. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) has known to be associated with disability1, 2, cognitive impairment3 and depression4 in the older adults. However, the association between MetS and successful aging, an overall assessment of elders' status, is unknown. Method: This study is part of an ongoing prospective cohort study: Taiwan Initiatives for Geriatric Epidemiological Research (TIGER). A total of 605 participants (age 65+) were recruited at baseline (2011‐2013) with 4‐year and 6‐year follow‐ups. After exclusion of participants with missing data of successful aging and metabolic syndrome as well as loss to follow‐up, a total of 202 participants were included for statistical analysis. MetS was assessed at baseline (2011‐2013). Successful aging was evaluated at baseline, 4‐year and 6‐year follow ups. Successful aging was defined by the following variables: cognitive function, numbers of chronic disease, activity of daily living (ADL), instrumental activities of daily living (IADL), gait speed, depression, self‐rated health, the frequency of participating in social and leisure activities, the family support and annual disposable income. Generalized linear mixed‐effects models with random intercept were utilized to assess the association between MetS and successful aging adjusting for time (follow‐up years), age, sex, years of education, smoking, alcohol consumption and the interaction terms with time. A p value of <0.05 (two‐tailed) for individual covariate and <0.1 for interaction with time was considered statistically significant. Results: At baseline, 33.7% (n=68) older adults had MetS. Compared with older adults without MetS, those with MetS had lower diet quality (the modified Alternative Healthy Eating Index: 34.8 vs. 38.2), higher body mass index (25.7 vs. 22.9 kg/m2), higher mean serum C‐reactive protein level (0.26 vs. 0.17 mg/dL), and more chronic diseases [e.g., hypertension (70.6% vs. 30.6%), diabetes mellitus (27.9% vs. 2.2%), hyperlipidemia (70.6% vs. 35.1%) and cardiac disease (29.4% vs. 15.7%)]. The baseline MetS had a negative effect on the probability of successful aging, and the effect increased as time elapsed [MetS×time interaction: odds ratio=0.87, 90% confidence interval=0.76‐0.98, p‐value=0.06]. Conclusion: MetS is a risk factor of successful aging for community‐dwelling older adults. Prevention of MetS in earlier life will be beneficial to successful aging in their later life. [ABSTRACT FROM AUTHOR]

Background: Elders' mobility and social activities are closely related to their living environments and cognitive function. Built environments and social activities tend to vary across populations and geographic regions. Therefore, this study aims to explore the association between late‐life neighborhood built environment and cognitive function in community‐dwelling older adults. Methods: This prospective cohort study recruited 605 participants aged 65 or older from senior health checkup program at a tertiary medical center at baseline (2011‐2013) with three biennial follow‐ups. After excluding participants with suspected dementia, stroke, brain tumor, incomplete or changing residential address between 2005 and 2011, 465 participants remained for analyses. Global and domain‐specific cognition (memory, attention, executive function, and language) were assessed at baseline and each follow‐up. Built environment data was obtained from 2005 land use survey in Taiwan. Two buffer zones (500 m and 1000 m) centering at each participant's residential address were created to assess built environment by the following indices: (1) the percentage of public open space, (2) the number of cultural resources, and (3) sports venue. Generalized linear mixed models were used to explore the association between built environment and global or domain‐specific cognitive function adjusting for age, sex, socioeconomic status, apolipoprotein E e4 status, physical activity, physical function and chronic conditions. Results: Over six years, more public open space was associated with better logical memory delaying theme recall (within a 1000‐m buffer: β=2.17), more cultural resources were associated with poor executive function (Trail Making Test A, within a 500‐m buffer: β=‐0.078). For every 1 year increment, more public open space was associated with poor executive function (Trail Making Test B, within a 1000‐m buffer: β=‐0.52), more cultural resources was associated with better executive function (within a 1000‐m buffer: β=0.006) and poor logical memory delayed theme recall (within a 500‐m buffer: β=‐0.019). No significant association was found for sports venues in relation to cognition. Conclusion: We found that different neighborhood built environment was associated with the performance of specific cognitive domains. Findings from this study indicate that choosing proper neighborhood environment may prevent cognitive impairment in the preclinical stage of dementia. [ABSTRACT FROM AUTHOR]

Background: The anatomical structure is close between retina and brain. Our team for the first time found a nonlinear relationship between retinal markers and cognition (Liu et al. 2019). Exposure to ambient air pollution was also known to affect cognition. However, the relationship between long‐term air pollution, retina markers and cognition remains unclear. Therefore, we aimed to clarify this association in a community‐based prospective cohort study. Method: Participants of this study (2015‐2019) were part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research. A total of 232 older adults (≥ 65 years old) were enrolled at baseline (2015‐2017) with a two‐year follow up. Ganglion cell‐inner plexiform layer (GC‐IPL) and retinal nerve fiber layer (RNFL) thickness were measured by Cirrus High‐Definition Optical Coherence Tomography at baseline. Data of air pollutants were obtained from monitors of Taiwan Environmental Protection Administration between 1993 and 2010. Global cognition and domain‐specific cognition were assessed by a battery of neuropsychological test. Generalized linear mixed model were utilized to assess the association of retinal markers and air pollution with cognition adjusted for important covariates. Result: We found a nonlinear association between GC‐IPL and poor logical memory over 2 years (immediate theme recall: β=‐0.30×10‐2; immediate free recall: β=‐0.22×10‐2; delayed free recall: β=‐0.17×10‐2). No association was not found between RNFL and cognition. High‐level NO2 (≥ 27.23 ppb) exposure was associated with poor logical memory (immediate theme recall: β=‐0.56; immediate free recall: β=‐0.71; delayed free recall: β=‐0.67). Similarly, high‐level O3 (≥ 41.75 ppb) exposure was associated with poor logical memory (immediate free recall: β=‐0.32). No significant association was found for other air pollutants. After stratification by levels of air pollutants, association remain non‐significant. Conclusion: Thinning and thickening of GC‐IPL was associated with cognitive impairment over two years. Long‐term high‐level exposure to NO2 or O3 was associated with poor logical memory over the same duration. More studies are need to clarify the association between retinal markers and air pollution on the performance of cognition. [ABSTRACT FROM AUTHOR]

Background: To date, most literature on Primary Progressive Aphasia (PPA) has been based on English language users. Yet, there are more than 7,000 living languages worldwide with vast heterogeneities in their linguistic features. Contrary to English language, Chinese language is a classifier language in which it is grammatically mandatory to have classifiers present between numerals and nouns. In addition, Chinese characters typically have an abundance of homophones (i.e., words with same pronunciation but vary in orthography and meaning) and heteronyms (i.e., words with same orthography but vary in meaning and pronunciation). Chinese language users rely on semantic knowledge to identify the accurate classifiers, homophones, and heteronym pronunciations. Thus, we hypothesize that Chinese‐speaking semantic variant (sv) PPA patients have difficulties producing classifiers, homophones, and heteronyms. Method: To assess classifier production, participants are presented with pictures of nouns. Participants are first tasked with producing noun‐specific classifiers spontaneously. If failed, they are presented with four classifiers to select. To evaluate homophone selection skills, participants are shown short sentences with one character/word removed. They are then tasked to complete the sentences by choosing one of the four homophones presented. For heteronym reading, participants are asked to read out loud Chinese compound words with heteronyms (e.g., "windmill" and "wind up"). Result: We recruited 22 controls and 47 PPA individuals (12 svPPA, 10 nonfluent variant (nfv) PPA and 25 logopenic variant (lv) PPA). In classifier production test, svPPA and lvPPA patients produce fewer accurate classifiers (p<0.0001, p = 0.001), with svPPA showing least improvement when presented with multiple choices (p = 0.003). In homophone selection test, svPPA and lvPPA scored lower than controls (p<0.0001 and p = 0.007). For heteronym reading test, svPPA showed the lowest performance when tasked with reading heteronym characters (p = 0.001). Using voxel‐based morphometry, we noted that the ability to produce classifiers, read heteronyms and identify heteronyms are correlated with grey matter volumetric changes over the anterior portion of the left temporal lobe and fusiform gyri, brain regions associated with language semantic functions. Conclusion: PPA symptomatology may vary across languages. Thus, studying PPA symptoms via a linguistically diverse approach potentially provides a more comprehensive understanding to the syndrome. [ABSTRACT FROM AUTHOR]

Background: The olfactory impairment could be one of the earliest signs of cognitive impairment. However, limited studies have evaluated olfactory function and cognitive domains in Asian older adults. This study aimed to relate olfaction with global and domain‐specific cognition in Taiwan's community‐dwelling, non‐demented older adults. Method: This cohort study is part of the Taiwan Initiative for Geriatric Epidemiological Research, including 310 non‐demented older adults between 2015‐2019 with two repeated measures on cognitive function. Global and domain‐specific (memory, executive function, attention, and language) cognition were assessed by the Taiwanese version of Montreal Cognitive Assessment (MoCA‐T) and a battery of neuropsychological tests, respectively. The Sniffin' Sticks‐Odor Identification Test (SS‐OIT) was utilized to identify impaired olfaction. The generalized linear mixed model was used to examine the association of SS‐OIT with cognitive function over time, after adjustment for age, sex, years of education, apolipoprotein E ε4 status, presence of depression, sleep quality, chronic respiratory diseases, smoking, practice effect and follow‐up time. Subgroup analyses were also conducted. Result: Better olfactory identification ability (i.e., increased SS‐OIT score) was associated with better performance of global cognition (MoCA‐T: β = 0.14, 95% confidence interval = 0.05‐0.24), memory (logical memory ‐ immediate and delayed theme and free recall: β = 0.06 to 0.09), executive function (trail making test‐A: β = 0.05 for baseline, ‐0.03 for interaction with follow‐up years), and verbal fluency (β = 0.08). Anosmia (SS‐OIT score ≦8) was associated with impaired memory [the lowest tertile (T1) vs. higher tertiles (T2+T3), adjusted odds ratio (aOR): 2.40 to 3.06], and verbal fluency (T1 vs. T2+T3, aOR = 2.39). After stratified analyses, the associations above remained significant in apolipoprotein E ε4 non‐carriers (MoCA‐T: β = 0.19; memory: β = 0.08 to 0.11; verbal fluency: β = 0.08), older adults without respiratory diseases (MoCA‐T: β = 0.14; memory: β = 0.06 to 0.10; verbal fluency: β = 0.10), and older adults without depression (MoCA‐T: β = 0.14; memory: β = 0.06 to 0.09; trail making test‐A: β = 0.04 for baseline, ‐0.02 for interaction with follow‐up years; verbal fluency: β = 0.09). Conclusion: Impaired olfactory identification is associated with poor global or domain‐specific cognition in non‐demented older adults. Further research is required to validate our findings and clarify the underlying mechanism between anosmia and cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Dietary factors influence cognitive functions, but most previous studies were conducted in Western settings and assessed diet only once. Trajectory analysis of diet measured at multiple timepoints can track changes in diet and identify subpopulations requiring more intervention efforts. We thus assessed associations between dietary trajectories and cognitive functions in an understudied Asian elderly population. Method: The TIGER study involves non‐demented community‐dwelling participants aged ≥65 years recruited between 2011‐2013. Dietary intakes were assessed using a food frequency questionnaire during baseline and 4th‐ and 6th‐year follow‐ups. Modified Alternative Healthy Eating Index (mAHEI) scores (energy‐adjusted using the residual method) were generated at each timepoint to reflect diet quality. Longitudinal trajectories of dietary quality were derived using latent growth mixture modelling. The Montreal Cognitive Assessment—Taiwanese version was used to assess global cognition for outcomes. Cognitive functions (baseline‐normalized z‐scores) of four cognitive domains, i.e., memory, attention, executive function, and verbal fluency, were also assessed. Associations between trajectories of dietary quality and cognitive functions were assessed using linear regressions, adjusting for important covariates including sex, apolipoprotein (APOE) e4 status, baseline age, body mass index (BMI), and depressive symptoms. Result: Included participants (n = 356) were 54.2% female, had a mean age of 71.6 years, and a mean BMI of 23.8 kg/m2 at baseline. The overall mean mAHEI scores were close to 37 (out of 70 possible) at all three time points. Three trajectories of dietary quality, namely 1) 'increasing', 2) 'decreasing', and 3) 'stable‐high' were identified and deemed optimal considering fit indices and interpretability. Compared with 'stable‐high' dietary quality trajectory, the 'increasing' trajectory was associated with worse memory performance (adjusted‐β = ‐0.424; 95% CI: ‐0.679, ‐0.169; P = 0.001) whereas the 'decreasing' trajectory was associated with worse performance for the verbal fluency domain (adjusted‐β = ‐0.342; 95% CI: ‐0.653, ‐0.030; P = 0.031). No other significant associations were observed. Conclusion: Maintaining a stable‐high dietary quality trajectory over time is associated with better cognitive functions among Taiwanese older adults. Since there is much room for dietary improvement in this Taiwanese population, interventions to promote and sustain better dietary quality over time can have substantial impacts on their cognitive functions. [ABSTRACT FROM AUTHOR]

Background: Tooth loss, periodontal disease, dementia, and Alzheimer's disease share several risk factors in older adults. Several previous studies have reported positive associations between these dental problems and global cognitive defects. However, limited is known about the relationships among multiple dental/periodontal statuses and different cognitive domains. Method: This six‐year (2011‐2017) cohort study includes 515 older adults (65+). Global cognition was assessed by Montreal cognitive assessment‐Taiwan version (MoCA‐T). For cognitive domains, we used logical memory tests (immediate and delayed theme and free recall) in Wechsler Memory Scale‐Third Edition (WMS‐III) to assess memory. Trail Making Test A and B was used to assess attention and executive function, respectively. Digit span‐forward and backward was used to evaluate attention and working memory/short‐term memory, respectively. Verbal fluency tests were used to assess category/semantic fluency. A Z‐score was calculated for each cognitive domain‐specific test according to baseline mean and standard deviation. Oral health status includes tooth defect (dental caries, tooth wear, cervical abrasion, retained root or crown fracture), periodontal health (disease severity from healthy periodontal status, gingivitis to periodontitis), and arch integrity (no tooth loss nor retained root or crown fracture). Generalized linear mixed models were used to assess the associations above adjust important covariates. Result: At baseline, periodontitis was associated with poor performance in executive function [Trail Making Test A: b = ‐0.14, 95% confidence interval (CI) = ‐0.27 to ‐0.01]. The association between baseline severity of tooth defect and poor memory decreased (logical memory‐immediate theme recall: b = ‐0.05, 95% CI = ‐0.10 to ‐0.01); similarly finding was found for attention domain (digit span‐forward: b = ‐0.04, 95% CI = ‐0.07 to ‐0.001). At baseline, loss of arch integrity was associated with a better working memory/short‐term memory (digit span‐backward: β = 0.18, 95% CI = 0.01 to 0.36); as follow‐up time increased, this association decreased over six years (β = ‐0.04, 95% CI = ‐0.07 to ‐0.003). Conclusion: Periodontitis, tooth defects, or arch integrity was associated with poor performance of cognitive domains (memory, attention, and executive function) over time. A oral health evaluation may serve as predictors of the preclinical phase of dementia in its upcoming years. [ABSTRACT FROM AUTHOR]

Background: Past research on Primary Progressive Aphasia(PPA) has been centered around English language, thus there is limited knowledge to the presentations of linguistic features that differ from the English language. Chinese language possesses numerous linguistic features that contrast significantly from the English language. Chinese language is a tonal and numeral classifier language; hence tones are lexically contrastive and numeral cannot quantify a noun without classifiers. As more than 40% and 20% of living languages worldwide are tonal and numeral classifier languages, investigating these idiosyncratic neurolinguistics features in non‐English speaking PPA individuals may refine the clinical practice paradigm to be more adaptable worldwide. Method: The CLAP (Chinese Language Assessment for PPA) project aims to investigate the neurolinguistics features of Chinese speaking PPA individuals. The CLAP battery consists of fourteen speech and language tasks and this presentation focuses on the tonal and numeral classifier performances as they are idiosyncratic traits of the Chinese language. The tonal perception function is assessed via tonal identification, tonal discrimination, tone‐picture matching, and tone‐word matching tasks. The tonal production performance is evaluated through serial tone reading, repetition of tonal tongue‐twisters, and multi‐tone multi‐repetition tasks. To illustrate classifier function, participants are tasked with producing the accurate classifiers after visual and auditory stimuli of the nouns. Result: The CLAP project recruited 13 healthy controls and 20 PPA individuals (5 nfvPPA, 6 svPPA, and 9 lvPPA) that are native Chinese speakers. Individuals with svPPA were noted to perform significantly lower in the tone‐picture matching task (p=0.024) and classifier task (p<0.0001). Volumes in left inferior temporal and bilateral temporal poles were significantly correlated with the performance in the tone‐picture matching and classifier task respectively. Conversely, individuals with nfvPPA scored substantially lower than healthy controls in all three tone production tasks (p<0.0001, p=0.024, p<0.0001) and lower than other PPA variants in tonal tongue‐twisters tasks. Performance in tonal tongue‐twister tasks was found to correlate with the degree of atrophy in left inferior and superior frontal regions. Conclusion: Tone and classifier tasks can potentially serve as diagnostic and classification tools for PPA individuals that speaks Chinese language and other tonal and numeral classifier languages. [ABSTRACT FROM AUTHOR]

Background: Long‐term ambient air pollution has known to affect cognitive function. However, limited studies investigated the relationship between co‐exposure to ambient air pollutants and cognitive functions in non‐demented older adults. Therefore, this study aimed to explore this association in a community‐based prospective cohort study. Method: This four‐year prospective cohort study is part of the ongoing Taiwan Initiative Geriatric Epidemiological Research (TIGER, 2011‐present) and included 286 non‐demented older adults between 2015‐2019. Ambient air pollution data were collected from 29 monitoring stations from Taiwan Environmental Protection Administration (TEPA) between 1994 and 2019. Global and domain‐specific (memory, attention, executive function, and language) cognitive functions were assessed using the Taiwanese version of Montreal Cognitive Assessment (MoCA‐T) and a battery of neuropsychological tests. The generalized linear mixed models were used to evaluate the association of co‐exposure to air pollutants with cognitive function adjusting for important covariates. Furthermore, we conducted stratified analyses by olfaction, known as an early marker of dementia. Result: Except for PM2.5, the annual average exposure of the other five pollutants was below the TEPA standards. A 25‐year high‐level exposure of NO2 (≥ 27.7 ppb) was associated with good performance executive function (β = 0.25) over four years. For joint effect, high‐level (the highest tertile) PM2.5 with low to medium concentration level of NO2, CO, or SO2 were significantly associated with the poor performance of memory (β = ‐0.39 to ‐0.35). Similarly, high‐level PM2.5 with low to medium concentration level of NO2, PM10 with O3 were significantly associated with poor executive function (β = ‐0.28 to ‐0.19). In participants with normal olfaction, high co‐exposure level to PM2.5 and PM10, with CO, SO2, O3, and NO2 was significantly associated with poor memory and executive function (β = ‐0.55 to ‐0.30). No significant associations were found in participants with abnormal olfaction. Conclusion: Long‐term low to medium‐level co‐exposure to NO2, CO, or SO2 and high‐level PM2.5 was associated with poor memory; co‐exposure to O3 with PM10 and co‐exposure to NO2 with PM2.5 was associated with poor executive function. A revision on exposure standards shall be considered to protect older adults at the preclinical phase of dementia. [ABSTRACT FROM AUTHOR]

Background: Sleep has been related to cognition and frailty, respectively. Cognitive frailty, the co‐existence of mild cognitive impairment (MCI) and physical frailty, has been proposed in 2013 and its relation with sleep remains unclear. To predict cognitive frailty in the preclinical stage, this study aimed to explore the relationship between sleep and cognitive pre‐frailty in non‐demented older adults. Method: This study is part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research. After exclusion of participants with specific conditions and loss to follow‐up, 324 older adults from the senior health checkup program of National Taiwan University Hospital were included at baseline (2015‐2017). Outcome of this study was the coexistence of MCI and pre‐frailty (cognitive pre‐frailty) and were assessed at baseline and two‐year follow‐up (2017‐2019). Global and domain‐specific cognition were assessed by Taiwanese version of Montreal Cognitive Assessment and a battery of neuropsychological tests, respectively. Pre‐frailty was defined as the existence of one or two out of five conditions using modified Fried's frailty phenotype. Sleep variables was available at baseline, which included global sleep quality [assessed by Pittsburgh Sleep Quality Index (PSQI), score range: 0‐21)], sleep duration (in hours), and daytime sleepiness (assessed by Epworth Sleepiness Scale, ESS, score range: 0‐24). Generalized linear mixed model was utilized to assess the association between sleep and cognitive pre‐frailty over 2 years adjusting for age, sex, years of education and other important covariates. Result: Participants' mean age was 75.2 years at baseline. Prevalence of cognitive pre‐frailty was 1.85% at baseline and 2.55% at two‐year follow‐up. Instead of a linear relationship, we found a non‐linear association between sleep and cognition. When mean PSQI score and mean sleep duration deviated from the corresponding sample mean (PSQI score: 6.3; sleep duration: 6.2 hours), the severity of cognitive pre‐frailty increased [quadratic PSQI score: adjusted odds ratio (aOR)=1.02, 95% confidence interval (CI)=0.01‐0.04; quadratic sleep duration: aOR=1.15, 95% CI=0.04‐0.23]. No significant association was found between daytime sleepiness and cognitive pre‐frailty. Conclusion: This study found a nonlinear association of global sleep quality and sleep duration with cognitive pre‐frailty over two years in the community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

Background: Exposure to air pollutants have known to increase the risk of cognitive impairment. Some older adults spend a long time indoors. However, limited studies have evaluated the effect of time staying indoors on the association between exposure to ambient air pollutants and cognitive function in older adults. Method: This cohort study is part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research (2011‐present). A total of 605 older adults were recruited at baseline (2011‐2013) with three biennial follow‐ups, and 496 participants were included after exclusion. The data of six air pollutants including sulphur dioxide, nitrogen dioxide, particulate matter in diameter ≤ 2.5µm (PM2.5) and 2.5‐10µm (PMcoarse), carbon monoxide, and ozone were obtained from 26 monitor stations of Taiwan Environmental Protection Administration (TEPA) between 1993 and 2019. Spatial‐Time Analysis Rendering with Bayesian Maximum Entropy was utilized to estimate the individual air pollutants' exposure. Hours staying indoors were collected across four seasons. Generalized linear mixed model was utilized to explore the association between long‐term exposure to air pollutants and global or domain‐specific cognitive function (memory, attention, executive function, and language) over 6 years adjusted for some covariates. Stratified analyses were performed by median hours staying indoors every day. Result: The mean age of the study participants were 72.4 years at baseline. PM2.5 was the only pollutant with a 14‐year average level (29.0 µm/m3) higher than the TEPA air quality standards. An interquartile range (IQR) increase in PM2.5 was associated with poor global cognition (β=‐0.19) and executive function (β=‐0.08), and the former effect became more evident in those with hours staying indoors < 13 hours/day (β=‐0.31). An IQR increase in PMcoarse was associated with poor global cognition (β=‐0.21) and verbal fluency (β=‐0.10), which became more evident in those stayed indoors ≥13 hours/day (β=‐0.32 and ‐0.13, respectively). Exposure to PMcoarse was associated with poor attention (β=‐0.15). No significant association was observed between other air pollutants and the performance of logical memory. Conclusion: Long‐term exposure to PM2.5 or PMcoarse showed detrimental effect on cognitive function in community‐dwelling older adults and indoor air quality may play a role on these associations. [ABSTRACT FROM AUTHOR]

Background: Previous studies mainly explored the effect of single chronic disease on cognition. However, limited focuses have been put on the co‐existence of diseases, symptoms, and functional impairments and how their combinations affect older adults. This study aimed to identify sex‐specific patterns of multiple chronic conditions (MCC) and to relate them with cognitive impairment in a six‐year cohort study. Method: We included 516 non‐demented older adults at baseline (2011‐2013) from the ongoing Taiwan Initiative for Geriatric Epidemiological Research, with three biennially follow‐ups. The global and domain‐specific (memory, attention, executive function, and language) cognition were assessed using the Taiwanese version of Montreal Cognitive Assessment and a battery of neuropsychological tests. Exploratory factor analysis was utilized to identify patterns of 33 self‐reported chronic conditions. For each pattern, the factor score of each participant was calculated by summing up the product of the status of a specific condition and its corresponding factor loadings. The generalized linear mixed model was utilized to examine the association between MCC patterns and cognitive performance adjusted for age, years of education, apolipoprotein E ε4 status, cigarette smoking, alcohol consumption, and years of follow‐up. Result: Three MCC patterns were identified for each sex, which included (1) Mental‐Exhaustion, (2) Cancer‐Thyroid, and (3) Frailty‐Cardiometabolic patterns in females; and (1) Mental‐Skeletal, (2) Cardiometabolic‐Renal, and (3) Thyroid‐Prostate patterns in males. Among females, higher factor scores of the Mental‐Exhaustion and Frailty‐Cardiometabolic patterns were significantly associated with poor performance of global cognition (β: ‐0.16), logical memory (β:‐0.11 to ‐0.07) and executive function (β:‐0.32). Among males, higher factor scores of the Mental‐Skeletal and Thyroid‐Prostate patterns were significantly associated with poor performance of memory (β:‐0.11) and attention (β:‐0.13). In contrast, a protective effect was observed between Cancer‐Thyroid pattern and memory (β:0.12 to 0.13) or attention (β:0.16), as well as between Cardiometabolic‐Renal pattern and verbal fluency (β:0.15). Conclusion: MCC patterns identified in this Asian population were different from those observed in western countries, and these patterns were associated with poor global or domain‐specific cognition. Further research was required to validate our findings and to clarify the underlying mechanism between MCC and cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Primary Progressive Aphasia (PPA) is a neurodegenerative syndrome that presents with speech and language impairments and is generally classified into three variants: semantic (svPPA), nonfluent/ agrammatic (nfvPPA), and logopenic variants (lvPPA). Current understanding of PPA has been mostly derived from English language patients. Expanding PPA research into non‐English languages encourages language‐specific linguistic‐adapted assessments and enriches our knowledge in linguistic features distinct from English language. This presentation focuses on three Chinese linguistic features that differ from English language: lexical tones, classifier, and logographic script. Chinese is a tonal and classifier language in which tones are lexically contrastive, and classifiers are obligatory to quantify nouns numerally. It also adopts logographic script that has complex visuospatial configurations and weak grapheme‐phoneme correspondence. Method: The CLAP (Chinese LanguageAssessment for PPA) battery is designed to characterize the neurolinguistics features of Chinese speaking PPA individuals. In CLAP classifier task, participants are asked to spontaneously produce classifiers specific to numerous nouns and presented with multiple choices when failed. To evaluate Chinese writing skills, participants are tasked with dictating 60 Chinese characters of varying lexicality, character frequency, and stroke number. The motor speech function is assessed by multiple repetitions of Chinese characters that differ in articulation places, manners, and tones. Results: The CLAP project enrolled 20 controls and 33 PPA individuals (7 nfvPPA, 10 svPPA, and 16 lvPPA). In classifier task, svPPA and lvPPA scored lower (p<0.01), though lvPPA were more responsive to choices than svPPA (p<0.001). The classifier score significantly correlated with volumetric changes over the left middle, inferior temporal, and fusiform gyri, brain regions typically associated with semantic functions. For orthographic dictation task, all three PPA variants performed worse than controls (p<0.001), and distinctive dysgraphia phenotypes were noted in each variant (svPPA: phonological plausible and perseveration errors; nfvPPA: motoric, radical and morphemic errors; lvPPA: visual and stroke errors, P<0.001). In motor speech task, nfvPPA showed lower performance when tasked with repeating characters that vary in articulation places and tones (p=0.018, p<0.001) but not in articulation manners (p=0.076). Conclusion: The clinical features and assessment strategies for PPA syndrome may vary across languages and should ideally be tailored linguistically. [ABSTRACT FROM AUTHOR]