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BACKGROUND: The Rotterdam Elderly Pain Observation Scale (REPOS) has not yet been validated for institutionalised cognitively impaired adults. To fill this gap of knowledge, we tested psychometric properties of the REPOS when used for pain assessment in this population.METHODS: In this multicentre observational study, residents were filmed during a possibly painful moment and at rest. Healthcare professionals were asked to rate residents' pain by means of a Numeric Rating Scale (NRS)-proxy. Two researchers assessed pain with the REPOS and the Chronic Pain Scale for Non Verbal Adults with Intellectual Disabilities (CPS-NAID) from video-recordings.RESULTS: In total, 168 observations from 84 residents were assessed. Inter-observer reliability between the two researchers was good, with Cohen's kappa 0.72 [95% confidence interval (CI) 0.64 to 0.79]. Correlation between the REPOS and CPS-NAID for a possibly painful moment was 0.73 (95% CI 0.65 to 0.79). Sensitivity (85%) and specificity (61%) for the detection of pain were calculated with REPOS ≥ 3 and NRS ≥ 4 as a reference value. Item response theory analysis shows that the item grimace displayed perfect discrimination between residents with and without pain.CONCLUSION: The REPOS is a reliable and valid instrument to assess pain in cognitively impaired individuals.

Background Despite experimental evidence suggesting that pain sensitivity is not impaired by cognitive impairment, observational studies in nursing home residents have observed an inverse association between cognitive impairment and resident-reported or staff-assessed pain. Under the hypothesis that the inverse association may be partially attributable to differential misclassification due to recall and communication limitations, this study implemented a missing data approach to quantify the absolute magnitude of misclassification of pain, pain frequency, and pain intensity by level of cognitive impairment. Methods Using the 2016 Minimum Data Set 3.0, we conducted a cross-sectional study among newly admitted US nursing home residents. Pain presence, severity, and frequency is assessed via resident-reported measures. For residents unable to communicate their pain, nursing home staff document pain based on direct resident observation and record review. We estimate a counterfactual expected level of pain in the absence of cognitive impairment by multiply imputing modified pain indicators for which the values were retained for residents with no/mild cognitive impairment and set to missing for residents with moderate/severe cognitive impairment. Absolute differences (∆) in the presence and magnitude of pain were calculated as the difference between documented pain and the expected level of pain. Results The difference between observed and expected resident reported pain was greater in residents with severe cognitive impairment (∆ = -10.2%, 95% Confidence Interval (CI): -10.9% to -9.4%) than those with moderate cognitive impairment (∆ = -4.5%, 95% CI: -5.4% to -3.6%). For staff-assessed pain, the magnitude of apparent underreporting was similar between residents with moderate impairment (∆ = -7.2%, 95% CI: -8.3% to -6.0%) and residents with severe impairment (∆ = -7.2%, 95% CI: -8.0% to -6.3%). Pain characterized as “mild” had the highest magnitude of apparent underreporting. Conclusions In residents with moderate to severe cognitive impairment, documentation of any pain was lower than expected in the absence of cognitive impairment. This finding supports the hypothesis that an inverse association between pain and cognitive impairment may be explained by differential misclassification. This study highlights the need to develop analytic and/or procedural solutions to correct for recall/reporter bias resulting from cognitive impairment.

Background Task-based functional MRI (tb-fMRI) is a well-established technique used to identify eloquent cortex, but has limitations, particularly in cognitively impaired patients who cannot perform language paradigms. Resting-state functional MRI (rs-fMRI) is a potential alternative modality for presurgical mapping of language networks that does not require task performance. The purpose of our study is to determine the utility of rs-fMRI for clinical preoperative language mapping when tb-fMRI is limited. Methods We retrospectively reviewed 134 brain tumor patients who underwent preoperative fMRI language mapping. rs-fMRI was post-processed with seed-based correlation (SBC) analysis, when language tb-fMRI was limited. Two neuroradiologists reviewed both the tb-fMRI and rs-fMRI results. Six neurosurgeons retrospectively rated the usefulness of rs-fMRI for language mapping in their patients. Results Of the 134 patients, 49 cases had limited tb-fMRI and rs-fMRI was post-processed. Two neuroradiologists found rs-fMRI beneficial for functional language mapping in 41(84%) and 43 (88%) cases respectively; Cohen’s kappa is 0.83, with a 95% confidence interval (0.61, 1.00). The neurosurgeons found rs-fMRI “definitely” useful in 26 cases (60%) and “somewhat” useful in 13 cases (30%) in locating potential eloquent language centers of clinical interest. Six unsuccessful rs-fMRI cases were due to: head motion (2 cases), nonspecific functionality connectivity outside the posterior language network (1 case), and an unknown system instability (3 cases). Conclusions This study is a proof of concept that shows SBC rs-fMRI may be a viable alternative for clinical language mapping when tb-fMRI is limited.

Ching-Ju Chiu,1 Min-Chia Yang,2 Chi-Chang Huang,3 Chia-Ming Chang1,3 1Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan; 2Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan; 3Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, TaiwanCorrespondence: Min-Chia YangDepartment of Medicine, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 70101, TaiwanTel +886-6-2353535 ext. 5739Fax +886-6-3028175Email kh9531023@gmail.comBackground: In this study, factors associated with the duration of a disability before death in older adults who are moderately to severely disabled in Taiwan are investigated.Methods: A nationally representative sample of older adults (65+) in 1996 who died before 2016 (n = 1139) were analyzed to calculate their disability status and the length of time they were disabled before death.Results: The mean period during which the participants experienced moderate to severe disability before death for older adults in Taiwan was 5.53 years (SD = 3.15). Men who were overweight had an average of 1.17 more survival years (βoverweight = 1.17, p < 0.05) as compared to those who were normal weight, and in the case of those who were cognitively impaired (SPMSQ ≤ 7), years of survival were decreased by an average of 1.70 years as compared to those who were cognitively intact before death (βcognition = − 1.70, p < 0.01). The aforementioned effects were independent of age. In women, the number of diseases was the most dominant independent correlate for survival years (βdisease = − 0.34, p < 0.05).Conclusion: Disability distribution at various time points before death among the elderly in Taiwan was revealed in the study. At 10 years before death, 93% of the elderly were free from any ADL disabilities, and only 4% reported more than three ADL disabilities. At 6 years before death, an average of 10% of the participants had more than three ADL disabilities, and at one year before death, moderate to severe disability increased to 38%. Factors associated with the survival years among those who were moderately to severely disabled showed distinct gender differences.Keywords: disability, duration before death, elderly, risk factor

Introduction This study investigates the relationship between retinal image features and β-amyloid (Aβ) burden in the brain with the aim of developing a noninvasive method to predict the deposition of Aβ in the brain of patients with Alzheimer's disease. Methods Retinal images from 20 cognitively impaired and 26 cognitively unimpaired cases were acquired (3 images per subject) using a hyperspectral retinal camera. The cerebral amyloid status was determined from binary reads by a panel of 3 expert raters on 18F-florbetaben positron-emission tomography (PET) studies. Image features from the hyperspectral retinal images were calculated, including vessels tortuosity and diameter and spatial-spectral texture measures in different retinal anatomical regions. Results Retinal venules of amyloid-positive subjects (Aβ+) showed a higher mean tortuosity compared with the amyloid-negative (Aβ−) subjects. Arteriolar diameter of Aβ+ subjects was found to be higher than the Aβ− subjects in a zone adjacent to the optical nerve head. Furthermore, a significant difference between texture measures built over retinal arterioles and their adjacent regions were observed in Aβ+ subjects when compared with the Aβ−. A classifier was trained to automatically discriminate subjects combining the extracted features. The classifier could discern Aβ+ subjects from Aβ− subjects with an accuracy of 85%. Discussion Significant differences in texture measures were observed in the spectral range 450 to 550 nm which is known as the spectral region known to be affected by scattering from amyloid aggregates in the retina. This study suggests that the inclusion of metrics related to the retinal vasculature and tissue-related textures extracted from vessels and surrounding regions could improve the discrimination performance of the cerebral amyloid status.

[Purpose] The aim of this study was to determine whether there are differences in postural stability control while leaning forward and backward between healthy elderly participants and elderly participants with cognitive impairment. [Participants and Methods] Postural stability was analyzed in 36 participants. According to the Mini-Mental State Examination results, participants were divided into the cognitive impairment group and the control group. A force plate was used to register the center of pressure in the sagittal and frontal plane, during two trials of maximum forward and backward body leaning. [Results] Significant differences were shown in both forward and backward leaning between the control and cognitive impairment groups. [Conclusion] The control of stability in the sagittal plane during maximum forward and backward lean of the body in cognitively impaired patients is similar to the results obtained by their healthy peers. However, individuals with cognitive impairment demonstrated larger lateral oscillations, which may be the reason for postural instability in this group, leading to an increased occurrence of falls.

Alzheimer’s disease biomarkers are primarily evaluated through MRI, PET and CSF methods in order to diagnose and monitor disease. Recently, advances in the assessment of blood-based biomarkers have shown promise for simple, inexpensive, accessible and minimally invasive tools with diagnostic and prognostic value for Alzheimer’s disease. Most recently, plasma phosphorylated tau181 has shown excellent performance. The relationship between plasma phosphorylated tau181 and cerebral metabolic dysfunction assessed by [18F]fluorodeoxyglucose PET in Alzheimer’s disease is still unknown. This study was performed on 892 older individuals (297 cognitively unimpaired; 595 cognitively impaired) from the Alzheimer’s Disease Neuroimaging Initiative cohort. Plasma phosphorylated tau181 was assessed using single molecular array technology and metabolic dysfunction was indexed by [18F]fluorodeoxyglucose PET. Cross-sectional associations between plasma and CSF phosphorylated tau181 and [18F]fluorodeoxyglucose were assessed using voxelwise linear regression models, with individuals stratified by diagnostic group and by β-amyloid status. Associations between baseline plasma phosphorylated tau181 and longitudinal (24 months) rate of brain metabolic decline were also assessed in 389 individuals with available data using correlations and voxelwise regression models. Plasma phosphorylated tau181 was elevated in β-amyloid positive and cognitively impaired individuals as well as in apolipoprotein E ε4 carriers and was significantly associated with age, worse cognitive performance and CSF phosphorylated tau181. Cross-sectional analyses showed strong associations between plasma phosphorylated tau181 and [18F]fluorodeoxyglucose PET in cognitively impaired and β-amyloid positive individuals. Voxelwise longitudinal analyses showed that baseline plasma phosphorylated tau181 concentrations were significantly associated with annual rates of metabolic decline in cognitively impaired individuals, bilaterally in the medial and lateral temporal lobes. The associations between plasma phosphorylated tau181 and reduced brain metabolism, primarily in cognitively impaired and in β-amyloid positive individuals, supports the use of plasma phosphorylated tau181 as a simple, low-cost, minimally invasive and accessible tool to both assess current and predict future metabolic dysfunction associated with Alzheimer’s disease, comparatively to PET, MRI and CSF methods., Graphical Abstract Graphical Abstract, Lussier et al. report that plasma phosphorylated tau181 is associated cross-sectionally with CSF phosphorylated tau181 and [18F]fluorodeoxyglucose PET in 823 individuals from the Alzheimer’s Disease Neuroimaging Initiative cohort. The authors also report a significant association between baseline plasma p-tau181 and longitudinal change in brain glucose metabolism indexed by [18F]fluorodeoxyglucose PET.

Introduction This clinical trial aimed to determine whether in‐car video feedback about unsafe driving events (UDE) to cognitively impaired older drivers and family members leads to a reduction in such driving behaviors. Methods We randomized 51 cognitively impaired older drivers to receive either (1) a weekly progress report with recommendations and access to their videos, or (2) video monitoring alone without feedback over 3 months. Results UDE frequency/1000 miles was reduced by 12% in feedback (rate ratio [RR] = 0.88, 95% confidence interval [CI] = .58–1.34), while remaining constant with only monitoring (RR = 1.01, 95% CI = .68–1.51). UDE severity/1000 miles was reduced by 37% in feedback (RR = 0.63, 95% CI = .31–1.27), but increased by 40% in monitoring (RR = 1.40, 95% CI = .68–2.90). Cognitive impairment moderated intervention effects (P = .03) on UDE frequency. Discussion Results suggest the potential to improve driving safety among mild cognitively impaired older drivers using a behavior modification approach aimed at problem behaviors detected in their natural driving environment.

The care of dementia patients presents a large challenge for caregivers and family members. Whether it is at home or in institutional care, patients have problems with spatial and environmental cognition. It often leads to abnormal behaviors such as a route recognition problem, wandering, or even getting lost. These behaviors require caregivers to keep an eye on the movement of the cognitively impaired elderly and the safety of these movement processes, to avoid them approaching dangerous areas or leaving the care environment. This paper used qualitative research methods (i.e., participatory interviews, case studies, and contextual observation methods) in the demand exploration phase and quantitative research methods in the product&rsquo, s technological verification phase. In this study, we implemented a three-stage service design process&mdash, demand exploration, demand definition, and design execution&mdash, to analyze the care status and route recognition obstacles of elders with dementia, to identify hidden needs as a turning point for new product innovations in care management and guidance security. This study summarizes six service needs for care management and guides the surveillance and safety of elders with dementia: (1) offering indoor user-centered guidance, (2) providing the instant location information of elders with dementia to caregivers, (3) landmarks setting, (4) assistance notification, (5) environmental route planning, (6) use of a wearable device as a guide for indoor route guidance. Based on the potential deficiencies and demands of observation, the care management and guidance security system (CMGSS) was designed. The experimental results show that the use of ultra-wide band positioning technology used in the indoor guiding system can accurately guide the behavior of patients to the right position, provide accurate information for caregivers, and record their daily behavior. The error range of this technology was not only within 42.42 cm in indoor static positioning but also within 55 cm in dynamic positioning, even where wall thickness was 18 cm. Although the device was designed for institutional care, it can also be applied to the management and care of general home-based patients.

The robustness of brain structural networks, estimated from diffusion MRI data, may be relevant to cognition. We investigate whether measures of network robustness, such as Ollivier-Ricci curvature, can explain cognitive impairment in multiple sclerosis (MS). We assessed whether local (i.e., cortical area) and/or global (i.e., whole brain) robustness, differs between cognitively impaired (MSCI) and non-impaired (MSNI) MS patients. Fifty patients, with Expanded Disability Status Scale mean (m): 3.2, disease duration m: 12 years, and age m: 40 years, were enrolled. Cognitive impairment scores were estimated from the Minimal Assessment of Cognitive Function in Multiple Sclerosis. Images were obtained in a 3T MRI using a diffusion protocol with a 2 min acquisition time. Brain structural networks were created using 333 cortical areas. Local and global robustness was estimated for each individual, and comparisons were performed between MSCI and MSNI patients. 31 MSCI and 10 MSNI patients were included in the analyses. Brain structural network robustness and centrality showed significant correlations with cognitive impairment. Measures of network robustness and centrality identified specific cortical areas relevant to MS-related cognitive impairment. These measures can be obtained on clinical scanners and are succinct yet accurate potential biomarkers of cognitive impairment.

Longevity-associated neurological disorders have been observed across human and canine aging populations. Alzheimer’s disease (AD) and canine cognitive dysfunction syndrome (CDS) represent comparable diseases affecting both species as they age. Translational diagnostic and therapeutic research is needed for these incurable diseases. The amyloid β (Aβ) peptide family are AD-associated peptides with identical amino acid sequences between dogs and humans. Plasma Aβ42 concentration increases with age and decreases with AD in humans, and cerebrospinal fluid (CSF) concentration decreases in AD and correlates inversely with the amyloid load within the brain. Similarly, CSF Aβ42 concentrations decrease in dogs with CDS but there is limited and conflicting information on plasma Aβ42 concentrations in aging dogs and dogs with CDS. We measured plasma concentrations of Aβ42 and Aβ40 with an ultrasensitive single-molecule array assay (SIMOA) in a population of healthy aging dogs of different life stages (n = 36) and dogs affected with CDS (n = 11). In addition, the ratio of Aβ42/β40 was calculated. The mean plasma concentrations of Aβ42 and Aβ40 increased significantly with age (r2 = 0.27, p = 0.001; and r2 = 0.42, p < 0.001, respectively) and with life stage: puppy/junior group (0.43–2 years): 1.23 ± 0.95 and 38.26 ± 49.43 pg/mL; adult/mature group (2.1–9 years): 10.99 ± 5.45 and 131.05 ± 80.17 pg/mL; geriatric/senior group (9.3–14.5 years): 18.65 ± 16.65 and 192.88 ± 146.38 pg/mL, respectively. Concentrations of Aβ42 and Aβ40 in dogs with CDS (11.0–15.6 years) were significantly lower than age-matched healthy dogs at 11.61 ± 6.39 and 150.23 ± 98.2 pg/mL (p = 0.0048 and p = 0.001), respectively. Our findings suggest the dynamics of canine plasma amyloid concentrations are analogous to that found in aging humans with and without AD.

The main purpose of the present study was to compare the smoothness of gait in older adults with and without cognitive impairments, using the harmonic ratio (HR), a metric derived from trunk accelerations. Ninety older adults aged over 65 (age: 78.9 &plusmn, 4.8 years, 62% female) underwent instrumental gait analysis, performed using a wearable inertial sensor and cognitive assessment with the Mini Mental State Examination (MMSE) and Addenbrooke&rsquo, s Cognitive Examination Revised (ACE-R). They were stratified into three groups based on their MMSE performance: healthy controls (HC), early and advanced cognitive decline (ECD, ACD). The spatio-temporal and smoothness of gait parameters, the latter expressed through HR in anteroposterior (AP), vertical (V) and mediolateral (ML) directions, were derived from trunk acceleration data. The existence of a relationship between gait parameters and degree of cognitive impairment was also explored. The results show that individuals with ECD and ACD exhibited significantly slower speed and shorter stride length, as well as reduced values of HR in the AP and V directions compared to HC, while no significant differences were found between ECD and ACD in any of the investigated parameters. Gait speed, stride length and HR in all directions were found to be moderately correlated with both MMSE and ACE-R scores. Such findings suggest that, in addition to the known changes in gait speed and stride length, important reductions in smoothness of gait are likely to occur in older adults, owing to early/prodromal stages of cognitive impairment. Given the peculiar nature of these metrics, which refers to overall body stability during gait, the calculation of HR may result in being useful in improving the characterization of gait patterns in older adults with cognitive impairments.

Objective: We examined whether older adults' health and well-being during their final year of life predicts end-of-life (EOL) quality of life (QOL) and quality of care (QOC). Methods: Using data from deceased participants (n = 1125) in the 2011-2015 National Health and Aging Trends Study, we performed latent class analysis to identify profiles of health and well-being, and we examined the association between these classes and EOL QOL and QOC. Results: Four classes were identified: healthy/happy (20%), frail/happy (37%), cognitively impaired/moderately distressed (27%), and highly impaired/highly distressed (16%). Persons in the highly impaired/highly distressed class showed a poorer QOL at the EOL, whereas those in the healthy/happy class reported a lower level of QOC at the EOL. Discussion: The benefits of maintaining health and well-being often carry forward to EOL. Older adults with high impairment and distress merit greater attention such as assuring care and advance care plans. Nanyang Technological University The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Nanyang Technological University (Start-Up Grant/No. M4082337).

Background Health, as defined by the WHO, is a multidimensional concept that includes different aspects. Interest in the health conditions of the oldest-old has increased as a consequence of the phenomenon of population aging. This study investigates whether (1) it is possible to identify health profiles among the oldest-old, taking into account physical, emotional and psychological information about health, and (2) there are demographic and socioeconomic differences among the health profiles. Methods Latent Class Analysis with covariates was applied to the Mugello Study data to identify health profiles among the 504 nonagenarians residing in the Mugello district (Tuscany, Italy) and to evaluate the association between socioeconomic characteristics and the health profiles resulting from the analysis. Results This study highlights four groups labeled according to the posterior probability of determining a certain health characteristic: “healthy”, “physically healthy with cognitive impairment”, “unhealthy”, and “severely unhealthy”. Some demographic and socioeconomic characteristics were found to be associated with the final groups: older nonagenarians are more likely to be in worse health conditions; men are in general healthier than women; more educated individuals are less likely to be in extremely poor health conditions, while the lowest-educated are more likely to be cognitively impaired; and office or intellectual workers are less likely to be in poor health conditions than are farmers. Conclusions Considering multiple dimensions of health to determine health profiles among the oldest-old could help to better evaluate their care needs according to their health status.

Fluorodeoxyglucose (FDG) positron emission tomography-magnetic resonance (PET/MR) is useful for the evaluation of cognitively-impaired patients. This study aims to assess two different attenuation correction (AC) methods (Dixon-MR and atlas-based) versus index-standard computed tomography (CT) AC for the visual interpretation of regional hypometabolism in patients with cognitive impairment. Two board-certified nuclear medicine physicians blindly scored brain region FDG hypometabolism as normal versus hypometabolic using two-dimensional (2D) and 3D FDG PET/MR images generated by MIM software. Regions were quantitatively assessed as normal versus mildly, moderately, or severely hypometabolic. Hypometabolism scores obtained using the different methods of AC were compared, and interreader, as well as intra-reader agreement, was assessed. Regional hypometabolism versus normal metabolism was correctly classified in 16 patients on atlas-based and Dixon-based AC map PET reconstructions (vs. CT reference AC) for 94% (90%–96% confidence interval [CI]) and 93% (89%–96% CI) of scored regions, respectively. The averaged sensitivity/specificity for detection of any regional hypometabolism was 95%/94% (P = 0.669) and 90%/91% (P = 0.937) for atlas-based and Dixon-based AC maps. Interreader agreement for detection of regional hypometabolism was high, with similar outcome assessments when using atlas- and Dixon-corrected PET data in 93% (Κ =0.82) and 93% (Κ =0.84) of regions, respectively. Intrareader agreement for detection of regional hypometabolism was high, with concordant outcome assessments when using atlas- and Dixon-corrected data in 93%/92% (Κ =0.79) and 92/93% (Κ =0.78). Despite the quantitative advantages of atlas-based AC in brain PET/MR, routine clinical Dixon AC yields comparable visual ratings of regional hypometabolism in the evaluation of cognitively impaired patients undergoing brain PET/MR and is similar in performance to CT-based AC. Therefore, Dixon AC is acceptable for the routine clinical evaluation of dementia syndromes.

Background/Aims: Clinicians are increasingly being asked to provide their opinion on the decision-making capacity of older adults, while validated and widely available tools are lacking. We sought to identify an online cognitive screening tool for assessing mental capacity through the measurement of executive function. Methods: A mixed elderly sample of 45 individuals, aged 65 years and older, were screened with the Montreal Cognitive Assessment (MoCA) and the modified Cambridge Brain Sciences Battery. Results: Two computerized tests from the Cambridge Brain Sciences Battery were shown to provide information over and above that obtained with a standard cognitive screening tool, correctly sorting the majority of individuals with borderline MoCA scores. Conclusions: The brief computerized battery should be used in conjunction with standard tests such as the MoCA in order to differentiate cognitively intact from cognitively impaired older adults.

Accurate activity recognition plays a major role in smart homes to provide assistance and support for users, especially elderly and cognitively impaired people. To realize this task, knowledge-driven approaches are one of the emerging research areas that have shown interesting advantages and features. However, several limitations have been associated with these approaches. The produced models are usually incomplete to capture all types of human activities. This resulted in the limited ability to accurately infer users’ activities. This paper presents an alternative approach by combining knowledge-driven with data-driven reasoning to allow activity models to evolve and adapt automatically based on users’ particularities. Firstly, a knowledge-driven reasoning is presented for inferring an initial activity model. The model is then trained using data-driven techniques to produce a dynamic activity model that learns users’ varying action. This approach has been evaluated using a publicly available dataset and the experimental results show the learned activity model yields significantly higher recognition rates compared to the initial activity model.

We discuss a case of circumferential ulceration of the lower leg in a cognitively impaired elderly man with poor tissue integrity. Thorough clinical examination eventually determined the cause as being a circumferentially placed, forgotten elastic band causing ulceration via sustained tension around the limb. Circumferential application of an elastic band to an extremity is an exceedingly rare but serious cause of lower leg ulceration.

Background: Neuropsychological comparisons between patients with mild cognitive impairment due to Parkinson’s disease (MCI-PD) and Alzheimer’s disease (MCI-AD) is mostly based on indirect comparison of patients with these disorders and normal controls (NC). Objective: The focus of this study was to make a direct comparison between patients with these diseases. Methods: The study compared 13 patients with MCI-PD and 19 patients with MCI-AD with similar age, education and gender. The participants were recruited and assessed at the same university clinic with equal methods. Results: The main finding was that on group level, MCI-AD scored significantly poorer on learning and memory tests than MCI-PD, whereas MCI-PD were impaired on 1 of 3 measures of executive functioning. Conclusion: MCI-AD performed poorer learning and memory tests, whereas MCI-PD only scored below the employed cut-off on one single executive test. In general, MCI-PD was noticeably less cognitively impaired than MCI-AD.

As the population ages, increased prevalence of cognitive and sensory impairments may pose growing public health challenges. Among the nine modifiable risk factors for dementia, the highest percentage (9%) of dementia cases are attributed to hearing impairment. While much research has examined the relationship between hearing impairment and cognition, almost none has translated these relationships into a meaningful, life course metric: how many years of life individuals can expect to live with both impairments and how hearing impairment affects years lived with cognitive impairment. Our study fills this gap by using Bayesian multistate life table methods applied to nine waves of the Health and Retirement Study (1998-2014) to estimate years of life to be spent (1) with/without hearing and cognitive impairment, and (2) with/without cognitive impairment, conditional on having versus not having hearing impairment. Preliminary results for aim 1 reveal that at age 50, individuals will live 18.9 (18.7-19.2) years healthy, 4.3 (4.2-4.5) years hearing impaired but cognitively intact, 4.2 (4.0-4.3) years hearing unimpaired but cognitively impaired, and 2.3 (2.2-2.6) years with both impairments. Women will spend more years healthy, hearing unimpaired but cognitively impaired, or with both impairments; men will spend more years hearing impaired but cognitively intact. People with more education will spend more years hearing impaired but cognitively intact; people with less education will spend more years hearing unimpaired but cognitively impaired or with both impairments. Our study is one of the first to investigate the implications of hearing impairment for years of cognitively impaired life.

Sometimes care is provided to a cognitively impaired person against the person’s will, referred to as involuntary treatment. An intervention (PRITAH) was developed to prevent and reduce involuntary treatment comprising 4 components: client-centered care policy, workshops, coaching on the job by a specialized nurse and the use of alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group. ispartof: Innovation in Aging vol:4 issue:Issue Supplement_1 pages:665-665 status: published

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The aim of the study was to investigate the biometrical quality of a newly developed activity monitor (uSense) to document established physical activity (PA) parameters as well as innovative qualitative and quantitative gait characteristics for habitual activity behavior in multi-morbid, older adults. Validity, test-retest reliability, and feasibility of established (including activity counts, MET-Intensities, number/duration of gait episodes/steps) as well as newly developed gait characteristics, which have not been documented before for habitual assessment (including number, velocity, duration of turnings, various parameters for gait symmetry/ regularity), have been analyzed for multimorbid, geriatric patients with cognitive impairment (n=110) discharged from ward-based rehabilitation. On average, Spearman correlations of established and innovative uSense parameters with clinically relevant parameters were high for motor performances (range for rhos: 0.02 – 0.63) and life space (0.01 – 0.59) and low to moderate for cognitive status (0.01 – 0.25), and age (0.01 – 0.30), indicating moderate to good construct validity. Concurrent validity was high as PA parameters measured by the U-Sense monitor showed consistently high correlation with equivalent parameters measured by another well-established ambulatory motion sensor (PAMSysTM) (0.59 – 0.91). Moderate to excellent test-retest reliability was shown for all uSense parameters (ICC: 0.68–0.97) and good feasibility could be shown, as 85.5% of all measurements were completed without failure. The uSense monitor allows documentation of established and innovative qualitative-quantitative parameters for habitual PA behavior which have so far only been assessed in laboratory settings in multi-morbid, cognitively impaired, older adults with moderate to good validity and high test-retest reliability.

AIMS: To examine concurrent validity of inertial sensor (APDM ISway) versus force plate center of pressure (COP) measures of postural sway in cognitively impaired older adults. METHODS: Participants, mean age 85.6 (SD 4.8), were tested in 4 static standing conditions: (1) eyes open/normal base, (2) eyes open/narrow base, (3) eyes closed/normal base, and (4) eyes closed/narrow base. ISway and COP measures were collected. RESULTS: Strong correlations between ISway trunk sway smoothness [ISway JERK, (m(2)/s(5))] and COP path length (r = 0.67–0.85) and COP mean velocity (r = 0.77–0.87); also ISway total sway acceleration path length/trail duration [ISway PATH, (m(2)/s(2))] and COP path length (r = 0.77–0.87) and COP mean velocity (r = 0.77–0.91). Increased sway was detected in narrow versus normal base and eyes closed versus open conditions (P = .001). CONCLUSIONS: APDM ISway demonstrated concurrent validity to force-plate COP and changes in postural sway were detected between conditions.

Commentary on: Dolansky MA, Hawkins MA, Schaefer JT, et al . Cognitive function predicts risk for clinically significant weight gain in adults with heart failure. J Cardiovasc Nurs 2016. doi: 10.1097/JCN.0000000000000376. [Epub ahead of print: 2 Nov 2016]. HF has a prevalence between 0.5% and 2% in the general population and is associated with poor quality of life, increased hospitalisations and high care costs.1 To counteract the impact of HF, patients need to perform self-care, including daily weighing, as recommended by international guidelines.1 Daily weighing allows for detection of fluid retention that can cause HF decompensation. When the patient has a weight gain ≥2 kg …

This presentation addresses conceptual and clinical issues concerning the senior attorney with cognitive impairment and diminished vocational capacity (DVC). Increasingly attorneys are choosing not to retire at the traditional age of age 65 and instead are working past age 70 and beyond. As a consequence, the legal profession is aging and is vulnerable to cognitive declines related to cognitive aging and dementias of aging. Assessment and appropriate management of the senior attorney with cognitive impairment and DVC represents a growing national problem faced by lawyer assistance programs and state legal disciplinary commissions. Clinicians with knowledge of capacity assessment can play a valuable role in helping these agencies accurately assess and obtain successful disposition in often challenging cases. This presentation will discuss the senior attorney with cognitive impairment, the role of the clinician, conceptual and clinical aspects of such assessments, and will include an instructive case study.

Objective:To investigate how changes in functional network hierarchy determine cognitive impairment in multiple sclerosis (MS).Methods:A cohort consisting of 332 patients with MS (age 48.1 ± 11.0 years, symptom duration 14.6 ± 8.4 years) and 96 healthy controls (HCs; age 45.9 ± 10.4 years) underwent structural MRI, fMRI, and extensive neuropsychological testing. Patients were divided into 3 groups: cognitively impaired (CI; n = 87), mildly cognitively impaired (MCI; n = 65), and cognitively preserved (CP; n = 180). The functional importance of brain regions was quantified with degree centrality, the average strength of the functional connections of a brain region with the rest of the brain, and eigenvector centrality, which adds to this concept by adding additional weight to connections with brain hubs because these are known to be especially important. Centrality values were calculated for each gray matter voxel based on resting-state fMRI data, registered to standard space. Group differences were assessed with a cluster-wise permutation-based method corrected for age, sex, and education.Results:CI patients demonstrated widespread centrality increases compared to both HCs and CP patients, mainly in regions making up the default-mode network. Centrality decreases were similar in all patient groups compared to HCs, mainly in occipital and sensorimotor areas. Results were robust across centrality measures.Conclusions:Patients with MS with cognitive impairment show hallmark alterations in functional network hierarchy with increased relative importance (centrality) of the default-mode network.

Cognitive decline is one of the major causes of disability among the aging population. The aim of this study was to explore the relationship between oral health parameters (number of teeth, chewing ability, and presence of a denture) and cognitive function in the elderly across the UAE. Fifty persons (age ≥ 60; 71.26 ± 10.23) were enrolled in the study. Cognitive status was assessed using the standardized mini-mental state examination (SMMSE) and accordingly, cognitively normal subjects scoring ≥24 were considered as the control group and cognitively impaired individuals scoring ≤23 were considered as the low scoring group. Chewing ability was examined, number of teeth was noted, and demographical data was collected. The results of this pilot study showed that individuals with low SMMSE scores were significantly less educated (P<0.01) and had fewer number of remaining teeth (P<0.05) and impaired chewing ability (P<0.05). These results demonstrate a significant link between the number of teeth, chewing ability, and cognitive function. However, this pilot study had its limitations and was the first of its kind in the UAE and Gulf region; therefore, future research addressing the limitations is needed to further explore this association.