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Objective To determine whether the burden of the family caregiver is related to cognitive status and dependence on the activities of daily living (ADL) of the stroke patient under their care. Methods A cross-sectional study was carried out. The Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Barthel index were used to assess, respectively, the patient’s cognitive status and ADL. The Zarit scale was applied to assess the burden on caregivers. A Spearman correlation was used assuming data abnormality on the Zarit scale and considering a significance of P Results 28 patients and 28 caregivers were evaluated. The Zarit scale showed correlations with the MMSE (Rho = −.48) and MoCA (Rho = −.43), as well as in the cognitive domains associated with temporo-spatial orientation (Rho = −.45) and reading (Rho = −.45) of the MMSE and language (Rho = −.41), memory (Rho = −.40) and temporo-spatial orientation (Rho = −.46) of the MoCA. On the other hand, the Zarit scale was correlated with the Barthel index (Rho = −.56) and the ADLs relating to dressing and undressing (Rho = −.45), bathing (Rho = −.38) and transferring from the chair to the bed (Rho = −.41). Conclusions The caregiver burden was correlated with impaired cognitive status and dependence on ADL in stroke patients.

Objective To analyse cognitive status in relation to activities of daily living (ADL) dependency in stroke patients. Methods A cross-sectional study was carried out. The Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and the Barthel index were used to assess cognitive status and ADL, respectively. A Pearson and Spearman correlation was used considering the normality of the data in cognitive status. Results 62 patients were evaluated. The most impaired domains were associated with writing and drawing in the MMSE (mean = 24.9 ± 4.1) and language, visuospatial/executive function, and memory in the MoCA (mean = 18.3 ± 5.6). The ADLs with most dependency on the Barthel index (mean = 78.1 ± 14.0) were eating, dressing/undressing, bathing, and going up and down stairs. On the other hand, the ADL dependency showed a correlation with the MMSE (Rho = 0.3) and the MoCA (r = 0.2). In addition, MMSE was correlated with activities including dressing/undressing (Rho = 0.3) and bathing (Rho = 0.3) and MoCA with transfer from chair to bed (r = 0.2). Conclusions The domains with the highest cognitive impairment were related to memory and visuospatial/executive function. The correlations reflect that stroke survivors with greater cognitive impairment show greater ADL dependency.

© 2022 Taylor & Francis Group, LLC., The Mini-Mental State Examination (MMSE) is a long-established test to screen for dementia, estimate the severity and monitor the progression of cognitive impairment. The MMSE total score is dependent upon demographic factors, particularly education, but little is known about how education influences the 6 distinct MMSE cognitive domains. The present study aims to understand how the performances in the MMSE cognitive domains reflect clinical diagnosis and educational level. The study recruited 1043 participants, comprising 388 healthy controls, 360 patients with Mild Cognitive Impairment (MCI) and 295 patients with dementia. The association of the MMSE cognitive domains scores with clinical diagnosis (healthy, MCI, dementia) and educational level (primary education, middle school, high school and university/college) was analyzed with a multivariate ordinal regression model. The scores in all MMSE domains were generally higher in healthy controls as compared to patients with MCI, and higher in these as compared to patients with dementia. The MMSE domain Constructional ability was associated to the education level, the domains Orientation, Recall and Language were associated to diagnosis, Attention and calculation was associated to both education level and diagnosis, and Registration was not associated to either education or diagnosis. In conclusion, impairment in specific MMSE domains pinpoints cognitive decline, probably indicating brain areas affected by neurodegeneration, and impairment in others reflects lower education levels and the lack of acquisition of relevant schooling abilities.

Background. The Motoric Cognitive Risk (MCR) syndrome is defined in non-demented older adults by cognitive complaints and slow gait. Individuals with MCR are at higher risk of dementia and other poor clinical outcomes, such as falls. However, no data are available as regards functional mobility alterations associated with MCR. The main purpose of the present study is to quantitatively investigate such an aspect using the instrumented Timed-Up-and-Go (iTUG) test carried out using a wearable inertial measurement unit (IMU). Methods. Fifty-one women aged over 65 years underwent a geriatric and neuropsychologic assessment (which included the Mini Mental State Examination, MMSE and Addenbrooke’s Cognitive Examination Revised, ACE-R), instrumented gait analysis and iTUG performed using an IMU located on the lower back. Based on subjective cognitive complaints and slow gait, they were assigned either to the MCR (n = 24) or non-MCR (n = 27) group. IMU data allowed calculation of overall and sub-phases iTUG times.Results. Women with MCR were characterized by a significantly higher body mass and body mass index, lower normalized handgrip strength, and similar values of MMSE compared to non-MCRs. A trend was observed in terms of lower overall and sub-domain ACE-R score. They also performed iTUG at a significantly slower speed (22.4 s vs 14.1 of the non-MCR group, p < 0.001) and exhibited increased sub-phase times (29 to 31% higher with respect to non-MCRs).Conclusions. The findings of the present study suggest that the MCR syndrome impairs functional mobility, probably due reduced muscular strength and coordination, fear of falling and increased instability. The instrumental evaluation of functional mobility appears useful in the management of women with MCR, particularly in monitoring the progression of the motor impairments, verifying the effectiveness of interventions targeted in alleviating the impact on daily life of mobility limitations associated with MCR and in defining tailored rehabilitation programs.

Rationale and Objectives To investigate the diagnostic performance of histogram analysis combined with quantitative susceptibility mapping (QSM) for differentiating Parkinson's disease (PD) patients from healthy controls. Methods We included 35 patients with PD diagnosed by two neurologists from August 2019 to January 2020 in our hospital in this prospective study. The clinical diagnosis was based on the Movement Disorder Society Clinical Diagnostic Criteria for PD. At the same time, 23 healthy volunteers matched for age and sex were recruited as controls. The Mini Mental State Examination, the third part of the Parkinson's Disease Rating Scale, the Hoehn & Yahr stages, and disease duration (year) were used to assess the PD patients. QSM was performed using a 3T MR scanner. The regions of interest were depicted according to the head of the caudate nucleus(CN), globus pallidus(GP), putamina (PUT), thalmus(TH), substantia nigra (SN), red nucleus(RN), and dentate nucleus. Then the corresponding histogram features were extracted. The Mann–Whitney U test was used to identify significant histogram features for differentiating PD patients from healthy controls. Area under the receiver operating characteristics curve (AUC) analysis was conducted to evaluate the diagnostic performance of all significant histogram features. Multivariate logistic regression analysis was performed to identify the best combined model for all seven nuclei. Differences among the AUCs were compared pairwise. Results Histogram features in all nuclei except TH showed significant differences between the groups. Among the single features, the 10th percentile of SN (SNP10) yielded the highest AUC of 0.894, with the highest specificity of 86.86% for differentiating PD patients from healthy controls. The 75th percentile of PUT (PUTP75) yielded the highest sensitivity of 97.14%. In the multivariate logistic regression analysis, SNP10 combined with PUTP75 yielded the highest diagnostic performance with the highest AUC of 0.911, the highest specificity of 91.30% and an excellent sensitivity of 92.40%. Conclusion QSM combined with histogram analysis successfully distinguished PD patients from healthy controls, and the result was notably superior to the mean value.

Background The Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses. Methods Five-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18–96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically. Results With respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability. Discussion The Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-02041-4.

Background: With the global increase in cognitive impairment and dementia, the need to investigate into the possible ways that can be used to prevent or delay such occurrence has been growing. Maintenance of dental care and oral hygiene has been promoted as one such aspect. Aims and Objectives: To study the association between cognitive impairment in patients without registered diagnosis of dementia with tooth loss and chewing ability. Materials and Methods: It was a cross-sectional hospital-based study where consenting elderly persons attending Dental outpatient department over 1½ years were included. Data obtained on socio-demographic details, number of tooth loss, number of remaining teeth, subjective chewing ability, cognitive assessment as per mini-mental state examination (MMSE), and Clock Drawing Test were analyzed statistically to check correlational association. Results: In this study 96 eligible elderly persons of mean age of 68.30±6.28 years showed increased cognitive impairment among females (P=0.003), increased age (P=0.009), rural background (P=0.033) and low income groups (P=0.001). Positive correlation was found between chewing capacity (P=0.348), number of remaining teeth (r=0.418) with MMSE scores. Conclusion: Our study population showed positive correlation between impaired cognition and the number of extracted tooth and chewing capacity. With further study on wider and representative population, we hope to project the role of maintaining good oral hygiene and dental care as a possible preventive strategy among many others to combat the increased burden of cognitive impairment.

Assessment of neurocognitive function (NCF) is important in brain tumor clinical trials, however there are varying methodologies available. We used the Cogstate computerized NCF testing battery and the mini-mental state examination (MMSE) to prospectively assess cognition in adult patients with recurrent glioblastoma (GBM) enrolled in the CABARET randomized phase II clinical trial of bevacizumab versus bevacizumab plus carboplatin chemotherapy. We determined completion rates; compared NCF results between trial arms; and assessed baseline NCF as a predictor of survival outcome. 93 of 103 eligible patients completed baseline Cogstate NCF testing. Completion rates were between 60 and 100% across each timepoint, and 38% at disease progression. There was no evidence of difference between arms in time to deterioration in NCF using either test. Prior to disease progression, deterioration on the Cogstate tests was substantially more common (90%) than deterioration on the MMSE (37%), and decline in the Cogstate composite score within the first 8 weeks was associated with shorter overall survival. This testing methodology may be useful when determining net clinical benefit for therapies in patients with recurrent GBM.

Background: Obesity has become one of the common problems encountered by people of the present day. This condition is often accompanied by cardiovascular problems like hypertension, hyperlipidemia, is chemic heart disease. Also, that the relationship between obesity and cognitive impairment plays an important role in the development of neurodegenerative disorders. But reports on the association between obesity and working memory lack scientific evidence. So, the present study planned to assess the influence of obesity on cognitive functions and compare among obese and non - obese individuals. Objective: This study evaluated the changes in cognitive functions comparative between samples of obese and non-obese individuals from India. Methods: Based on the Body Mass Index (BMI), the participants were classified into 2 groups. Cognitive screening was done using MINI MENTAL STATE EXAMINATION and the parameters like level of orientation, registration, recall, language, copy art skills were analyzed and scores were calculated. The data was statistically analyzed using SPSS version 23 and the independent sample t test was used to analyze the differences in cognitive functions. Results: The study reported that there was statistically significant decline in language, recall and copy art skills in obese individuals compared to non-obese group. Conclusion: The study concluded an innovative finding that obesity is associated with impaired cognitive performance pertaining to recall, language and copy art and overall decreased MMSE scores indicating that accelerated cognitive decline and neurodegenerative pathologies such as dementia in later life is influenced by changes in body weight. Interventions that target mid-life obesity may be helpful in reducing the cognitive risks associated with obesity.

BACKGROUND: Although electroconvulsive therapy (ECT) is a safe and effective treatment for patients with severe late life depression (LLD), transient cognitive impairment can be a reason to discontinue the treatment. The aim of the current study was to evaluate the association between structural brain characteristics and general cognitive function during and after ECT. METHODS: A total of 80 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electroconvulsive Therapy study were examined. Magnetic resonance imaging scans were acquired before ECT. Overall brain morphology (white and grey matter) was evaluated using visual rating scales. Cognitive functioning before, during, and after ECT was measured using the Mini Mental State Examination (MMSE). A linear mixed-model analysis was performed to analyze the association between structural brain alterations and cognitive functioning over time. RESULTS: Patients with moderate to severe white matter hyperintensities (WMH) showed significantly lower MMSE scores than patients without severe WMH (F(1,75.54) = 5.42, p = 0.02) before, during, and post-ECT, however their trajectory of cognitive functioning was similar as no time × WMH interaction effect was observed (F(4,65.85) = 1.9, p = 0.25). Transient cognitive impairment was not associated with medial temporal or global cortical atrophy (MTA, GCA). CONCLUSION: All patients showed a significant drop in cognitive functioning during ECT, which however recovered above baseline levels post-ECT and remained stable until at least 6 months post-ECT, independently of severity of WMH, GCA, or MTA. Therefore, clinicians should not be reluctant to start or continue ECT in patients with severe structural brain alterations. ispartof: American Journal Of Geriatric Psychiatry vol:29 issue:11 pages:1117-1128 ispartof: location:England status: accepted

Background The main mode of transportation in Ireland remains travel by car. Transport mobility is important for older adults in accessing shops, healthcare, services, community and in maintaining relationships. Cessation of driving is associated with negative effects on mental health, loneliness and physical health. We aimed to explore factors associated with driving status in older adults living in an urban environment. Methods Study included adults aged greater than 65 years attending a geriatric outpatient service in an urban environment and recruited as part of the TUDA (Trinity Ulster, Department of Agriculture) study. We excluded those with a MMSE (Mini-Mental State Exam) less than 24 as we aimed to include only non-dementia patients. Physical frailty was measured with the Timed Up and Go (TUG) and depression with the Center for Epidemiological Studies Depression scale (CES-D). Factors associated with driving status were explored in multinomial regression models. Results 1978 adults, mean age 77.7 ± 7.1 years, 76.0% were female. 35.5% were current drivers but this differed by age category 45.9% (65–75 years), 25% (75–85 years) and 12.5% (85+ years). 28.1% were past drivers. Positive independent predictors of current driving were younger age (P Conclusion One third of patients attending a geriatric outpatients in an urban environment were currently driving which is much lower than in the general older Irish population. However, our study included frail adults living in more deprived socioeconomic areas and had a high proportion of females who had never learned to drive. Furthermore, access to urban public transport may be a factor. Non-drivers were more likely to have depression and report loneliness independent of other factors highlighting its negative impact.

Background and Aims This study aimed atinvestigating the relationship between speech-frequency hearing loss (SFHL), high-frequency hearing loss (HFHL), and cognitive impairment (CI) and then to determine whether there are any differences in gender among older community dwellers in China. Methods 1012 adults aged ≥ 60 years (428 males; average age, 72.61 ± 5.51 years) and living in Chongming District, Shanghai were enrolled in the study. We used the audiometric definition of hearing loss (HL) adopted by the World Health Organization (WHO). Speech-frequencies were measured at 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz; high-frequencies were measured at 4 kHz and 8 kHz. Pure tone average (PTA) was measured as hearing sensitivity. Cognitive performance was measured using the mini mental state examination (MMSE). Results Our studies demonstrated a 37.6% prevalence of HL in males and a 36.0% prevalence of HL in females. Adjusted for confounding variables, the results from a multivariate analysis showed that SFHL was associated with CI in females (OR = 2.922, 95% Confidence Interval = 1.666–5.124) and males (OR = 2.559, 95% Confidence Interval = 1.252–5.232). However, HFHL was associated with CI only in females (OR = 3.490, 95% Confidence Interval = 1.834–6.643). HL was associated with poorer cognitive scores (P P Conclusions The associations between HL and CI varied according to gender in older community-dwellers, suggesting that different mechanisms are involved in the etiology of HL. Moreover, hearing sensitivity was negatively associated with cognition scores; therefore, early screening for HL and CI among older community-dwelling adults is advised.

Background Cognitive impairment is an aging-related disease that can result in a variety of health problems as disability and death. Cognitive impairment was reported to be more than 40% among elderly individuals. Aim To predict cognitive impairment among geriatric patients at Asir central hospital, Saudi Arabia and its relationship to health status. Study design A descriptive correlational study design was used to conduct this study. The study included a convenient sample of all geriatric patients (130) attending outpatient clinics of Asir central hospital in Abha city from the first of February to the mid of March 2020. Three tools were utilized to collect data pertinent to this study; Tool (I): structured geriatric patient’s sociodemographic and clinical data interview questionnaire, Tool II: Geriatric Depression Scale Short-Form (GDS-SF) and Tool III: Mini Mental State Examination (MMSE) Scale. Results The majority of the studied sample was in the age group between 60 and 69 years, and female, having a chronic disease, (31.6%) were having a mild cognitive impairment and (17%) were having severe cognitive impairment and there was an association between cognitive impairment levels and health status of the studied patients with no statistically significant difference. Conclusion Nearly one third were having a mild cognitive impairment and about one fifth were having severe cognitive impairment. There was a correlation between levels of cognitive impairment and health status of the studied patients. Recommendations Health education programs to increase the awareness of the Saudi community about cognitive impairment and its risk factors are needed. Elderly cognitive screening services must be readily available for early diagnosis and early treatment of cognitive impairment.

Project to be completed as part of a PhD PGR degree, Department of Psychology, University of Sheffield. Worldwide, more than 55 million people are living with dementia, and this is projected to increase drastically over the next 20-30 years, with cases estimated to reach more than 150 million by 2050 (Patterson, 2018). Social isolation (an objective measure of social connection) is a modifiable risk factor for dementia (Livingston et al., 2021), and its impact on cognition in healthy older adults and on dementia risk is well documented (Evans et al., 2018; Kelley et al., 2017; Penninkilampi et al., 2018), however its impact on the rate of cognitive decline of patients with an existing dementia diagnosis is less well understood. Similarly, the impact of loneliness (a subjective measure of social connection) on patients with an existing dementia diagnosis is unclear. The aim of this study is to investigate the modifying effect of marital status, as a proxy of social isolation, on the cognitive changes in dementia patients. Marital status is associated with level of social isolation (Wenger et al., 1996) and has been found to be a subcomponent of social isolation that predicts dementia risk (Sommerlad et al., 2018). The study will utilise data from Electronic health records that contain clinical information from patient diagnosis through the course of the disease, including measures of cognitive assessment (such as Mini-Mental State Examination), marital status, diagnosis type (e.g. Alzheimer’s disease), prescription/medication, diagnosis duration and demographics. In the first step, a systematic review will be conducted of the current state of knowledge of the prognostic effects of social connection on the cognitive changes in dementia patients (the systematic review has been registered on PROSPERO and details can be found by searching for the record ID 'CRD42022352273'). In the second step, data from patients' records will be analysed using multilevel models to investigate the modifying effect of social isolation (marital status) on cognitive changes across the development of the dementia diseases.

Objective: To verify the influence of physical performance and handgrip strength on the quality of life of the elderly. Method: Quantitative, longitudinal, household survey type survey conducted with 322 elderly people living in the interior of Minas Gerais. Data were collected in 2014 and 2017/2018 using the instruments: Mini Mental State Examination; questionnaires with sociodemographic/economic and clinical data; Short Physical Performance Battery, dynamometry, World Health Organization Quality of Life-Bref and World Health Organization Quality of Life-Olders. Descriptive, bivariate analysis and multiple linear regression (p≤0.05) were performed. Results: Between the two collections there was a change in the highest percentage of marital status, with husband or partner in the baseline for widowers at follow-up, in addition to the percentage increase of 5 or more morbidities. The lowest physical performance was a predictor of worse quality of life scores in the domains: physical (p

В этом исследовании рассматривалось влияние выбранного метода анестезии на когнитивные функции в послеоперационном периоде. Анализ когнитивного статуса проведен при помощи нейропсихологического тестирования: шкала лобных дисфункций (Frontal Assessment Battery, FAB), краткая шкала оценки психического статуса (Mini-Mental State Examination, MMSE). Оценивание проводилось в три этапа: накануне оперативного вмешательства, через 6 часов после него и на 21-й день послеоперационного периода. Пациенты были распределены на две группы: больные группы d получали общую анестезию с применением дексмедетомидина за 40 минут до операции, поддержание анестезии — севофлурано-кислородная смесь на малом потоке газа; в группе b общая анестезия была дополнена блокадой крылонебной ямки за 20 минут до вмешательства. Группы были статистически сопоставимы по возрасту и полу. Оценка глубины анальгезии контролировалась при помощи показателя индекса анальгезии при ноцицептивном воздействии (Аnalgesia Nociception Index, ANI), оценка глубины анестезии — по биспектральному индексу (Bispectral index, BIS). Результаты проведенного исследования показали, что согласно данным нейропсихологического тестирования по шкалам MMSE и FAB показатели были более низкими в послеоперационном периоде в группе с использованием общего обезболивания в комбинации с блокадой крылонебной ямки, чем в группе с использованием дексмедетомидина как компонента мультимодального обезболивания (p 0,05).

There is an increased prevalence of cognitive impairment (CI) in patients with type 2 diabetes; thus, there is a need for a sensitive and a convenient screening tool for its detection. While Mini-Mental State Examination (MMSE) is a widely used tool for the assessment of cognition, it is not available for free for research. Hindi version of Addenbrooke’s Cognitive Examination III is a freely available cognition assessment tool that has been widely used on diverse group of diseases including diabetes. To assess cognitive function in patients with type 2 diabetes using Hindi version of ACE-III and compare its performance with MMSE. Cognition was assessed using validated Hindi version of ACE-III and MMSE among 54 participants with type 2 diabetes and similar number of age, sex, and educational status matched healthy controls. The cut-off for CI was taken at 82/100 for ACE-III, and for MMSE, education level–based cut-offs were used: 21 for the illiterate group, 22 for the low education group, 23 for the middle education group, and 24 for the high education group. Mean age of the study population was 64.5 ± 5.3 years. The average duration of diabetes was 8.5 ± 6.0 years with mean HbA1C of 8.8 ± 2.5%. Both the tools showed high prevalence of CI among cases, but ACE-III was more sensitive in detection of CI when compared to MMSE (64.8% vs. 55.6%). There was a good agreement between ACE-III and MMSE outcomes (Cohen’s kappa = 0.732). Type 2 diabetes mellitus is an independent risk factor for cognitive decline in elderly patients. ACE-III is an easy to use, sensitive, and freely available screening tool for cognition assessment in diabetes population.

Background: Studies have suggested a connection between a decrease in the levels of polyunsaturated fatty acids (PUFAs) and Alzheimer’s disease (AD). We aimed to assess the effect of supplementation with omega-3 fatty acids (n-3 FAs) on biomarkers analyzed in the cerebrospinal fluid (CSF) of patients diagnosed with AD. Objective: To investigate the effects of daily supplementation with 2.3 g of PUFAs in AD patients on the biomarkers in CSF described below. We also explored the possible correlation between these biomarkers and the performance in the cognitive test Mini-Mental State Examination (MMSE). Methods: Thirty-three patients diagnosed with AD were randomized to either treatment with a daily intake of 2.3 g of n-3 FAs (n = 18) or placebo (n = 15). CSF samples were collected at baseline and after six months of treatment, and the following biomarkers were analyzed: Aβ 38, Aβ 40, Aβ 42, t-tau, p-tau, neurofilament light (NfL), chitinase-3-like protein 1 (YKL-40), acetylcholinesterase (AChE), butyrylcholinesterase (BuChE), soluble IL-1 receptor type II (sIL-1RII), and IL-6. Results: There were no significant differences between the groups concerning the level of the different biomarkers in the CSF at baseline. Within the treatment group, there was a small but significant increase in both YKL-40 (p = 0.04) and NfL (p = 0.03), while the other CSF biomarkers remained stable. Conclusion: Supplementation with n-3 FAs had a statistically significant effect on NfL and YKL-40, resulting in an increase of both biomarkers, indicating a possible increase of inflammatory response and axonal damage. This increase in biomarkers did not correlate with MMSE score.

Objective: To analyze the application of the Mini-Mental State Examination (MMSE) scale in cognitive assessment of elderly patients in a general ward. Methods: Elderly patients who underwent nephrosurgery and thoracic surgery between July 2015 to June 2019 were eligible for the study. A total of 713 patients enrolled and data were collected for the assessment of cognitive status. We analyzed the relationship between cognitive impairment, degree of cognitive impairment, age, and gender. Result: In the 713 cases of cognitive ability assessment by the MMSE, there was cognitive impairment in 21 (4.04%) male patients, and 10 (5.18%) female patients. In addition, the analysis of the correlation between cognitive impairment and gender showed a P value of 0.51, which was not statistically significant. In the participants age research, the average age of the patients in the cognitive normal group was 72.30±6.50 years old, and the average age of the patients in the cognitive impairment group was 78.61±6.90 years old. Their p value was

Objective. To study the opportunities to increase the efficiency of pathogenetic therapy in patients with chronic cerebrovascular diseases (CVD) (discirculatory encephalopathy, DE) on the background of metabolic syndrome (MS) using the drug Vitaxon®. The feature of the work was to identify strategic areas of the brain in cognitive and emotional disorders in patients with MS and its absence. Materials and methods. We observed 49 patients with DE II degree aged 37 to 73 years against the background of MS. The main group — 30 patients — received Vitaxon® as a part of treatment. The control group consisted of 19 patients with DE degree II following MS, comparable in the age and stage of the disease, who were not taking Vitaxon®. Patients were observed for 12 weeks. In addition to neurological, general clinical examinations, detection of MS signs, we have used neuropsychological tests by Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (МоСА), Spielberger anxiety scale; Beck depression scale; study of attention: search of numbers by Schulte tables with the assessment of task-performance time. The brain and its liquor system in 41 patients (27 patients with MS — the first group and 14 patients without MS — the second group) were evaluated using the method of volumetry (measuring the volume of certain brain regions), on the magnetic resonance imaging scanner Toshiba Vantage Titan 1.5. Results. Cognitive impairment in both groups manifested by the loss of memory, attention disorders, slowing of mental processes. After 12 weeks, the median by the MMSE significantly increased by 3.3 % (p < 0.05 compared with the first test) in patients who received Vitaxon®. By МоСА, which is more sensitive when determining the mild cognitive impairment, in a group of Vitaxon® cognitive functions improved by 5 %, while in the control group — by 1.66 %. By Spielberger scale, state anxiety indicators improved more in the group of patients who received study drug: at baseline — 42.4 ± 3.4 points and 24.6 ± 2.8 points at week 12 (p < 0.05). It was determined that cognitive performance by МоСА scale was inversely dependent on the parameters of glycated hemoglobin. Results of volumetric studies showed significant (p < 0.05) reduction in the volume of the brain substance, cortex and the volume of white matter of the cerebral hemispheres, temporal lobe in patients with CVD on the background of MS compared with those of similar age with no signs of MS. In addition, patients with MS had the likely decrease in the area of the corpus callosum (p < 0.05) compared to patients without MS. Conclusions. During the treatment of patients with CVD following MS, it is necessary to consider anxiety-asthenic conditions and cognitive disorders that often occur at this pathology. Addition of Vitaxon® to the generally accepted drug therapy helps to eliminate psycho-emotional disorders. In patients with chronic CVD on the background of MS, the degree of the atrophy of the cortex and white matter of the cerebral hemispheres, the frontal and temporal lobes, as well as the corpus callosum, was significantly higher (p < 0.05) compared to patients without MS.

Background: Pneumonia is a common complication of ischemic stroke that may worsens brain injury, leading to cognitive impairment as well as patient outcome. The aim of this study was to compare cognitive function in ischemic stroke patients with and without pneumonia. Methods: This study was a comparative numerical analytic retrospective cross-sectional study that was conducted from September 2020 to February 2021. This study used data from ischemic stroke patients treated at Dr. Hasan Sadikin General Hospital in 2019 with the total sampling method. Data were stratified into patients with pneumonia and without pneumonia. The mini mental state examination (MMSE) was used to measure cognitive function in both groups and scores were compared using the Mann-Whitney Test. Result: Of the 164 data, 25 were patients with pneumonia and 139 without pneumonia. Male patients were predominantly prevalent in the pneumonia and non-pneumonia groups. Hemiparesis was the most common neurological deficit. The MMSE score was significantly lower in the pneumonia group (22.6 ± 5.4 vs. 24.7 ± 4.8, respectively; p- value=0.032). Conclusion: Cognitive function is more prevalent in ischemic stroke patient with pneumonia compared to non-pneumonia. However, other factors such as recurrent stroke and possible vascular risk factors should be considered for future studies to better identify the relationship between ischemic stroke and pneumonia.

Tetsumasa Kamei,1 Hiroyuki Kobayashi,2,3 Maika Nishida,2 Kenzo Muramoto,2 Shohei Nishimoto2 1Shonan Fujisawa Tokushukai Hospital, Kanagawa, Japan; 2Eisai Co., Ltd., Medical Headquarters, Tokyo, Japan; 3Department of Neuropsychiatry, School of Medicine, Toho University, Tokyo, JapanCorrespondence: Shohei NishimotoEisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo, 112-8088, JapanTel +81-3-3817-3700Fax +81-3-5229-0705Email s-nishimoto@hhc.eisai.co.jpPurpose: Medication discontinuation for patients with Alzheimer’s dementia (AD) influences treatment efficacy. This study aimed to evaluate the effect of psychoeducational intervention (PI) on donepezil retention rates and identify the factors associated with donepezil continuation in patients with AD.Patients and Methods: One hundred and seventeen patients with AD were randomly allocated to the PI (n = 58) or standard care (SC; n = 59) groups. All patients were prescribed donepezil for 48 weeks. Primary endpoints were the 48-week donepezil retention rate and the reasons for donepezil discontinuation in the PI and SC groups. The secondary endpoint was the predictive factors, among the baseline clinical variables, for donepezil continuation in all patients.Results: The donepezil retention rate was 62.1% (36/58) in the PI group and 66.1% (39/59) in the SC group. The most common reason for discontinuation in both groups was adverse events (PI, 12.1%; SC, 10.2%). Logistic regression analysis revealed that the results of the pentagon copying test in the Mini-Mental State Examination administered at baseline was a significant predictor of donepezil continuation for all patients in both the groups (odds ratio: 0.359; 95% confidence interval: 0.154– 0.839).Conclusion: There was no significant difference between the PI and SC groups concerning donepezil retention rate in patients with AD. Our results demonstrate that the pentagon copying test can significantly predict donepezil continuation in patients with AD, indicating that impaired visuospatial and executive functions may reflect medication discontinuation.Trial Registration: UMIN-CTR:UMIN000012617.Keywords: adherence, cholinesterase inhibitors, medication discontinuation, Mini-Mental State Examination, pentagon copying task

Many medicines have anticholinergic properties, which have previously been correlated with a range of adverse effects, including cognitive impairment, hallucinations and delirium. These effects are potentially of concern for people with dementia. This systematic review investigated the effect of anticholinergic medicines on the health outcomes of people with pre-existing dementia. Embase, Medline and the Cochrane Library were searched from January 2000 to January 2021. Studies were included if they matched the following criteria: (1) the intervention involved anticholinergic medications; (2) the study was conducted in people with pre-existing dementia; (3) there was at least one comparator group; and (4) the outcome of interest was clinically measurable. A total of 14 studies met the inclusion criteria. Most studies used an anticholinergic burden scale to measure anticholinergic exposure. Five high-quality studies consistently identified a strong association between anticholinergic medications and all-cause mortality. Anticholinergics were also found to be associated with longer hospital length of stay in three studies. Inconsistent findings were reported for cognitive function (in 4 studies) and neuropsychiatric functions (in 2 studies). In single studies, anticholinergic medications were associated with the composite outcome of stroke and mortality, pneumonia, delirium, poor physical performance, reduced health-related quality of life and treatment modifications due to reduced treatment response or symptom exacerbation. While the evidence suggests that anticholinergic medication use for people with dementia has a strong association with all-cause mortality, the association with cognitive and other clinical outcomes remains uncertain. Hence, further studies are needed to substantiate the evidence for other outcomes.

Objective The purpose of this study is to investigate the safety, tolerability and efficacy of titrating dose of rivastigmine oral solution in patients with mild to moderate Alzheimer's disease (AD) in Taiwan. Methods We recruited 108 mild to moderate AD patients with RivastⓇ (rivastigmine oral solution 2 mg/ml) treatment for 52 weeks. We recorded the demographic characteristics, initial cognition by mini-mental state examination (MMSE), initial global status by clinical dementia rating (CDR) with CDR-Sum of Boxes (CDR-SB), initial dose, and titrating dose at each visit. We investigated the adherence, proportion of possible side effects, optimal dose, and time to optimal dose. We demonstrated the proportion of cognitive decline and its possible risk factors. Results During the course, 9 patients discontinued the rivastigmine oral solution due to poor compliance or preference. Twelve out of 99 patients (12.1%) reported possible side effects. Among 87 patients, the mean age was 77.2 ± 9.0 years ago with female predominant (65.2%). The optimal dose was 3.6 ± 1.4 ml in average and 4 ml (n = 31, 35.6%) in mode. The duration to optimal dose was 12.5 ± 10.2 weeks and 24 weeks (n = 35, 40.2%) in mode. It presented 25% with cognitive decline in MMSE, 27% with global function decline in CDR and 63% with global function decline in CDR-SB. Conclusion We demonstrated the clinical experience of rivastigmine oral solution in mild to moderate AD patients. It suggested rivastigmine oral solution 4ml is the optimal dose with 24 weeks to the optimal dose for at least one third of patients.

BACKGROUND: Cognitive impairment is correlated with left calf circumference (LCC) which corresponds to an indirect marker of sarcopenia. LCC is a simple and quick measure to be collected in outpatient clinics. However, the magnitude of this correlation seems to be different between the different degrees of frailty in the elderly. OBJECTIVE: Verify the correlation between LCC and cognitive impairment at different levels of frailty in the elderly. MATERIALS AND METHODS: Cross-sectional study with secondary data from medical records of elderly people diagnosed with dementia registered at the State Reference Center for Health Care for the Elderly (CREASI). Data were collected from the Mini Mental State Examination (MMSE) and the left calf circumference (LCC) obtained from the comprehensive geriatric assessment carried out on admission of the elderly to CREASI. The elderly's sociodemographic data were recorded to characterize the sample, divided according to gender and degree of frailty. In each group, Pearson's test was applied to verify the correlation between MMSE and LCC considering p value of 0.05. RESULTS: 470 medical records were evaluated, 342 women and 128 men. The frail elderly showed a weak correlation between the sexes. CONCLUSION: Cognitive impairment and LCC are only weakly correlated in frail older adults. Gender did not modify the correlation between cognitive impairment and LCC.

Background Cognitive dysfunctions are increasing alarmingly around the world, and researchers are exploring preventive measures for improving brain performance. Pyrroloquinoline quinone (PQQ), a naturally occurring coenzyme in foods, exhibits potent antioxidant activity, and improves diverse functions which include mitochondrial activation, growth, repair, protection of nerve cells by increased expression of nerve growth factor (NGF) and NGF receptors; and suppression of fibril formation and aggregation of amyloid β. Objective This randomized, double-blind, placebo-controlled, parallel-group clinical investigation (RCT) evaluated the efficacy and safety of PQQ disodium salt powder (mnemoPQQ®) for improved cognitive function after 12 weeks of supplementation in healthy Japanese male and female (age 40 to Methods 64 healthy subjects were randomly assigned to receive either mnemoPQQ® (PQQ disodium salt: 21.5 mg/day) or a placebo over a period of 12 weeks. The efficacy of mnemoPQQ® on cognitive performance (memory, attention, judgment, and cognitive flexibility) was examined using Cognitrax as the primary outcome (primary endpoint), and forgetfulness questionnaire (DECO: Deterioration Cognitive Observee) and Mini-Mental State Examination-Japanese (MMSE-J) as the secondary outcome (secondary endpoint). Results A total of 58 subjects (placebo = 31; Age = 70.91 ± 3.06 Y; mnemoPQQ® group = 27; Age = 72.10 ± 3.77 Y) completed the study over a period of 12 weeks of supplementation. Significant improvements were observed on the Cognitrax's cognitive function domain score on "composite memory", "verbal memory", "reaction time", "complex attention", "cognitive flexibility", "executive function", and "motor speed" in the mnemoPQQ® group as compared to the placebo group. The DECO and the MMSE-J scores were also significantly improved in the mnemoPQQ® group. No adverse events were observed. Conclusions Study demonstrates that supplementation of PQQ disodium salt is useful in improving memory, attention, judgment, and cognitive function, in middle-aged to elderly population, who feel they have become more forgetful because of aging.

BACKGROUND: Dementia with Lewy bodies (DLB) is one of the most common degenerative dementias. Clinical trials for individuals with DLB are increasing. We aimed to identify commonly used outcome measures for trials in DLB. METHODS: A pragmatic literature search of PubMed and clinicaltrials.gov identified interventional studies including populations with DLB. Studies were included if they enrolled participants with DLB and met the National Institutes of Health criteria for a clinical trial. Data were collected using standardized forms. Outcome measures were categorized according to core and supportive features of DLB. RESULTS: After de-duplication, 58 trials were identified. The most common cognitive outcome measures were the Mini Mental State Examination (n=24) and Cognitive Drug Research computerized Assessment System (n=5). The Clinician’s Assessment of Fluctuations was the most commonly employed measure for fluctuations (n=4). Over half of studies used the Neuropsychiatric Inventory to assess behavioral symptoms (n=31). The Unified Parkinson’s Disease Rating Scale was frequently used for motor assessment (n=23). CONCLUSIONS AND RELEVANCE: Clinical trial outcomes used in DLB are rarely validated in this population and some lack face validity. There is a need to validate existing scales in DLB and develop DLB-specific outcome measures.

Introduction. In chronic cerebrovascular diseases (CVD), neuroprotective medications, the effectiveness of which requires further study, are widely used. The effectiveness of Cytoflavinum in patients with chronic CVD was evaluated.Material and methods. The data of 60 patients (35 women and 25 men) with chronic CVD were analyzed. 30 patients, included in the main group (mean age 61 ± 5.87 years old), in addition to basic therapy (antihypertensive, antithrombotic drugs, statins), received Cytoflavinum according to the following scheme: 1 time a day in the morning intravenously 10.0 ml for 10 days, then 2 tablets 2 times a day for 30 days. 30 patients in the comparison group (mean age 59.8 ± 8.7 years old) received only basic therapy. An analysis of patient complaints, neurological status was carried out. Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) were used.Results. In the group of patients taking Cytoflavinum, there was a decrease in the frequency and intensity of headache, dizziness, an increase in MMSE score from 26.32 ± 0.86 to 28.05 ± 1.36 (p ≤ 0.05), in MoCA score from 25.35 ± 0.96 to 27.88 ± 1.13 (p ≤ 0.05), decrease in anxiety score from 8.82 ± 1.31 to 5.2 ± 2.82 (p ≤ 0.05) and decrease in HADS depression score from 8.31 ± 1.85 to 4.6 ± 3.15 (p ≤ 0.05).Conclusion. The inclusion of Cytoflavinum in the treatment regimen for patients with chronic CVD helps to reduce the frequency and intensity of headaches and dizziness, improve cognitive functions, and reduce the level of anxiety and depression.

Menopausal transition among midlife women is accompanied by the issues of hot flushes, mood swings as well as sleep disturbances, night sweats, urogenital diminution and cognitive changes. The present cross-sectional study is an attempt to recognize the cognitive differences associated with various stages of reproductive aging.The study included women (The results of the present study exhibited a decline in cognitive scores across successive menopausal transitional stages in most of the cognitive domains except registration. The results of multivariate regression analysis demonstrated that illiteracy, vegetarian diet, perimenopause and late postmenopause phase were significantly associated with lower global cognitive scores.With increased longevity, early identification of potential risk factors associated with cognitive decline among women during their midlife can be beneficial in improving the mental health of postmenopausal women.

To discover common biomarkers correlating with the Mini-Mental State Examination (MMSE) scores from multi-country MRI datasets. The first dataset comprised 112 subjects (49 men, 63 women; range, 46–94 years) at the National Hospital Organization Kyushu Medical Center. A second dataset comprised 300 subjects from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (177 men, 123 women; range, 57–91 years). Three-dimensional T1-weighted MR images were collected from both datasets. In total, 14 deep gray matter volumes and 70 cortical thicknesses were obtained from MR images using FreeSurfer software. Total hippocampal volume and the ratio of hippocampus to cerebral volume were also calculated. Correlations between each variable and MMSE scores were assessed using Pearson’s correlation coefficient. Parameters with moderate correlation coefficients (r > 0.3) from each dataset were determined as independent variables and evaluated using general linear model (GLM) analyses. In Pearson’s correlation coefficient, total and bilateral hippocampal volumes, right amygdala volume, and right entorhinal cortex (ERC) thickness showed moderate correlation coefficients (r > 0.3) with MMSE scores from the first dataset. The ADNI dataset showed moderate correlations with MMSE scores in more variables, including bilateral ERC thickness and hippocampal volume. GLM analysis revealed that right ERC thickness correlated significantly with MMSE score in both datasets. Cortical thicknesses of the left parahippocampal gyrus, left inferior parietal lobe, and right fusiform gyrus also significantly correlated with MMSE score in the ADNI dataset (p < 0.05). A positive correlation between right ERC thickness and MMSE score was identified from multi-country datasets.

Background: Vascular dementia is a cognitive decline with functional deterioration caused by cerebrovascular disease. It is the second leading cause of dementia. A number of screening questionnaires and models have been developed to help in assessing cognitive function and activity daily living (ADL) in patients with dementia. Mini Mental State Examination (MMSE), Clock Drawing Test (CDT) and Barthel Index are instruments to evaluate cognitive function and ADL of vascular dementia patients. Objective: To determine the role of achetylcholine-esterase inhibitor therapy on cognitive function and ADL in patients with vascular dementia in Saiful Anwar General Hospital. Methods: This study is an analytical study assessing the improvement of cognitive function and ADL of patients with vascular dementia after administration of acethylcholine-esterase inhibitor by assessing the MMSE, CDT and Barthel Index scoring in 1, 3, 6 and 12 month period consecutively. Results: From 15 study subjects, individuals who have been given treatment for 12 months consecutively have the highest increase in MMSE and CDT whilst for Barthel Index has shown highest improvement in one month period. Conclusion: The administration of acetylcholine-esterase inhibitor drugs has the potential to improve and maintain cognitive function and improve ADL. The limited number of study subjects and the many confounding factors that we did not evaluate were the drawbacks of this study. The results of this study cannot be generalized to all patients with vascular dementia and only apply to 15 patients who were the subjects of this study.

Background: People living with inflammatory bowel disease (IBD) are exposed to multiple risk factors for cognitive impairment and frequently report cognitive difficulties. However, the presence of cognitive impairment in IBD has not been systematically reviewed. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic multidatabase search for cross-sectional and longitudinal studies comparing adults with IBD versus healthy controls for domain-specific cognitive function or scores on multidomain cognitive screening tools. For any domain reported by 3 or more studies, we conducted random-effects meta-analysis to calculate the standardized mean difference between groups; lower scores reflected poorer performance. Between-study heterogeneity was assessed using the I 2 statistic and study quality assessed using an IBD-modified Newcastle-Ottawa scale. Results: Of 8302 articles screened, 12 studies (n = 687) were included in the qualitative synthesis and 11 in meta-analyses. All studies were cross-sectional. Studies generally excluded people with active IBD and older adults. Despite no significant differences on multidomain screening tools such as the Mini Mental State Examination (−0.27 [95% confidence interval −0.68, 0.08], P = 0.14), people with IBD showed significant deficits compared with healthy controls in attention (standardized mean difference −0.36 [−0.60, −0.12], P = 0.003, I 2 = 0%), executive function (standardized mean difference −0.45 [−0.77, −0.13, P = 0.005, I 2 = 42.5%), and specifically in working memory (standardized mean difference −0.58 [−0.85, −0.30], P < 0.001, I 2 = 0%). Deficits in learning and recall were nonsignificant (P = 0.089) and other domains insufficient for meta-analysis. Conclusions: People with IBD show deficits in attention and executive function, particularly in working memory, suggesting that cognitive impairment is a potential extraintestinal manifestation of IBD.

Background With the aging of society, the incidence of diseases increases. And along with the increase of surgery rate, the number of elderly patients with postoperative cognitive dysfunction (POCD) is also increasing. POCD seriously affects the mental state and quality of life of patients and their families. Clinical studies have shown that POCD is closely related to inflammatory reaction, and Ulinastatin can inhibit the inflammatory reaction and reduce the incidence of POCD in elderly patients under general anesthesia. However. the effect of Ulinastatin on POCD in elderly patients under general anesthesia has not been systematically evaluated. Objective Meta analysis will be used to evaluate the efficacy and safety of Ulinastatin in elderly patients with general anesthesia POCD during perioperative period. Methods We will search China Science and Technology Journal Database Chinese database, China National Knowledge Infrastructure, Wanfang, China biomedical database, PubMed, EMBASE, Cochrane Library and web of science for randomized controlled trials of the effect of Ulinastatin on POCD of elderly patients with general anesthesia from the establishment of the database to November 2020. The 2 researchers will independently screen the literature and conducted quality assessment and data extraction for the included studies, Revman5.3 software will be used for risk assessment and meta analysis. Results In this study, the efficacy and safety of Ulinastatin in elderly patients with general anesthesia POCD will be evaluated by the incidence of postoperative cognitive impairment, mini mental state examination (Mini-Mental State Examination [MMSE]), visual regeneration, associative memory score, S100 β protein, tumor necrosis factor α (TNF- α), interleukin 6 (IL-6), IL- 10 inflammatory factors and the incidence of adverse reactions. Conclusion The use of Ulinastatin in perioperative period can significantly reduce the inflammatory level of elderly patients after general anesthesia, effectively prevent the occurrence of POCD and reduce its incidence. Ethics and dissemination The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. Osf registration number DOI 10.17605/OSF.IO/GY3V7.

Background: Geriatric Depression Scale (GDS) has been widely used in assessing depression in elderly population. Using the Ministry of Health Malaysia definition for elderly, this study aimed to examine the construct validity and reliability of the GDS (Malay version) in elderly with cognitive impairment in Malaysia. Methods: A cross-sectional validation study involving 219 elderlies with cognitive impairment was conducted using universal sampling method. Participants aged 60 years old and above, scored less than 11 for the short mini mental state examination (SMMSE), have sufficient command of the Malay or English language, residing in the government nursing homes and attending memory clinics in government hospitals in Klang Valley were sampled. The GDS-15 English version underwent adaptation, translation, face validation and field testing to produce the Malay version. Psychometric analysis was performed using the exploratory factor analysis and its internal consistency was examined. Results: Mean age of participants were 72.61 ± 7.79. Majority were male (50.7%), Malay (50.2%), studied at least until primary school (71.7%) and stayed at nursing homes (50.2%). Construct validity showed significant Bartlett’s test of sphericity (Chi-square = 1,340.058, P < 0.001) and Kaiser-Meyer-Olkin (KMO) test of 0.90. Factor loadings for each item in the depression domain were satisfactory ranging from 0.42 to 0.83. Factor loadings for each item in the psychosocial activities’ domain were satisfactory ranging from 0.53 to 0.76. For the questionnaire reliability analysis, the total Cronbach’s alpha for the final model was satisfactory, with and overall Cronbach’s alpha of 0.89. Cronbach’s alpha value for the depression and psychosocial activities domain was 0.861 and 0.80, respectively. Conclusion: The GDS (Malay version) is a valid and reliable tool to screen for depression in elderly with cognitive impairment.

BACKGROUND: Cervical dystonia (CD) involves clinical and motor manifestations, and visual and cognitive dysfunctions may also be frequent. OBJECTIVE: To evaluate functional vision, visual attention, and cognitive aspects in patients with CD compared with a control group. METHODS: Fifty patients with CD were assessed using the Useful Field of View Test (UFOV), the Mini Mental State Examination (MMSE), and the Trail Making Tests (TMT‐A and TMT‐B), and compared with an identical number of health controls matched by sex, age, and educational level. RESULTS: No differences were seen between the groups in terms of MMSE score (P = 0.481), but the CD patient group had poorer scores for the TMA‐A (P = 0.004) and TMT‐B (P = 0.004). For the UFOV subtests, a decrease was found for visual processing speed (P

Purpose To evaluate the changes in fundus parameters in patients with Alzheimer’s type dementia (ATD) using optical coherence tomography angiography (OCTA), to record flash electroretinograms using the RETeval system and to explore changes in retinal function.Methods Twenty-nine patients with ATD and 26 age-matched normal subjects were enrolled. All subjects underwent OCTA scans to analyse the superficial retinal vessel parameters in the macular area, including the vascular length density, the vascular width density and the area of foveal avascular zone (FAZ), as well as the choroidal thickness. The differences between the patients with ATD and the normal control group were compared and explored the relevant factors affecting vessel parameters. We also recorded the flash electroretinograms (ERG) using the RETeval system and intended to explore changes in retinal function by analysing the ERG image amplitude in patients with ATD.Results The vessel parameters and average choroid thickness in the macular area of the ATD group was less than the control group, The FAZ area was statistically significantly enlarged in the ATD group. These parameters were correlated with the Mini-Mental State Examination (MMSE) score and the Montreal Cognitive Assessment (MoCA).Conclusions Patients with Alzheimer’s type dementia exhibit decreases in the parameters associated with fundus. In addition, these indicators significantly correlated with the MMSE score and the MoCA score. OCTA may be an adjunct tool with strong potential to track changes in the diagnosis and monitoring the progression of the disease.

Aim. To study the influence of the trained environment of geriatric onco-surgical patients on the quality of the interventions in the complex of early postoperative rehabilitation in the Intensive Care Unit (ICU). Methods. The 96 patients aged 73.37.1 years operated on in the emergency onco-surgery clinic of the Tatarstan Cancer Center of the Ministry of Health of the Republic of Tatarstan between 2016 and 2020. Patients, similar in age and condition (American Society of Anaesthesiologists Physical Status category IIIE) were divided into three equal groups: the first group generally accepted measures for early rehabilitation were carried out by medical staff; the second group the prepared relatives of the patient was additionally involved in rehabilitation; the control group early rehabilitation was not carried out. The quality of nutritional support and measures to prevent pressure ulcers, cognitive function were assessed. Statistical processing was performed by using Microsoft Excel 2007 and IBM SPSS Statistics version 20 software. The statistical significance of data was determined by using the chi-square test at p 0.05. Results. The involvement of previously trained relatives made it possible to reduce the incidence of pressure ulcers grade IV to 0%. There was a significant difference in the volume of assimilated enteral oral feeding (180.620.8; 240.620.8; 80.510.2; p 0.05) and the serum albumin level by 11 days after surgery (26.81.5; 28.91.2; 24.21.1 g/L, respectively; p 0.05). Assimilation of enteral oral feeding improved 3 times compared with the control group and 1.5 times compared with the first group (p 0.05). Indicators of cognitive status by the Mini Mental State Examination (MMSE) on the 6th day were 23.31.1; 25.31.1; 21.21.2 (p 0.05), respectively. Conclusion. A rationally organized preparation of the patient's environment for the implementation of care, participation in rehabilitation measures and the prevention of complications can improve outcomes of medical intervention and reduce the incidence of postoperative complications.

Objective To examine political participation after traumatic brain injury (TBI). Design Qualitative, participatory research via interviews and observations. Each participant was interviewed to discuss their experience of voting in 2007 or 2008. Data were coded using Grounded Theory to develop themes, metacodes, and theories. Setting Community. Participants A total of 57 individuals with history of TBI and 28 family members (N=85). Main Outcome Measures Not applicable. Results Four themes emerged from the data: (1) people with TBI have barriers to voting; (2) the voting process can be improved for people with TBI; (3) voting is the responsibility of members of society; and (4) voting is one way we have a voice in society. Conclusions The data support the importance of voting as an American right regardless of the presence of disability. While persons with TBI report voting represents their freedom and voice, there may be barriers that can threaten or limit their voice.

Background: Spatial navigation and dual-task (DT) performance may represent a low-cost approach to the identification of the cognitive decline in older adults and may support the clinical diagnosis of mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Objective: To assess the accuracy of different types of motor tasks in differentiating older persons with MCI and AD from healthy peers. Methods: Older adults aged 60 years or over (n = 105; healthy = 39; MCI = 23; AD = 43) were evaluated by the floor maze test (FMT), the senior fitness test, and DT performance. Receiver operating characteristic curve (ROC) analysis was used to evaluate the accuracy of the tests. We also performed principal component analysis (PCA) and logistic regression analysis to explore the variance and possible associations of the variables within the sample. Results: FMT (AUC = 0.84, sensitivity = 75.7%, specificity = 76.1%, p

Introduction Chronic kidney disease (CKD) is a recognized risk factor for cognitive impairment. Identification of those at greatest risk of cognitive impairment may facilitate earlier therapeutic intervention. This study evaluated associations between estimated glomerular filtration rate (eGFR) and cognitive function in the Northern Ireland Cohort for the Longitudinal Study of Ageing. Methods Data were available for 3412 participants ≥50 years of age living in non-institutionalized settings who attended a health assessment between February 2014 and March 2016. Measures of serum creatinine (SCr) and cystatin C (cys-C) were used for eGFR. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). Results Following adjustment for potential confounders, a single unit decrease in eGFR was significantly associated with reduced cognitive function defined by an MMSE ≤24/30 {eGFR calculated using serum cys-C [eGFRcys]: β = −0.01 [95% confidence interval (CI) −0.001 to −0.01], P = 0.01} and MoCA Conclusions Decreased eGFRcys was associated with a significantly increased risk of cognitive impairment in a population-based cohort of older adults. However, there was no evidence of an association between cognitive impairment and the more commonly used eGFR calculated using SCr. eGFRcys may offer improved sensitivity over eGFRcr in the determination of renal function and associated risk of cognitive impairment.

Study aim was to determine whether Late Life Depression (LLD) is associated with Mitral Valve Syndrome (MVS) presence, and to assess direct proportionality between MVS and LLD severity. A total of 504 consecutive patients (M=260, F=244; Mean Age 79.74±7.83, range=60-98) were included and divided in 2 groups: 1) 360 patients with LLD and MVS (Group 1), and 2) 144 patients without LLD and with MVS (Group 2). All patients were assessed by Doppler echocardiography, complete standardized Comprehensive Geriatric Assessment (CGA) [including basal/instrumental Activities of Daily Living (ADL/IADL), Short Portable Mental Status Questionnaire (SPMSQ), Cumulative Illness Rating Scale Comorbidity Index (CIRS-CI), Mini Nutritional Assessment (MNA), Exton-Smith Scale (ESS), medication use and social aspects], Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), and Frontal Assessment Battery (FAB). Group 1 were more females (p

Background: Neuroinflammation and excitotoxicity play a key role as triggers and support for neurodegenerative processes, increase levels of TNF-α have been found in schizophrenic patients. Improved inflammatory processes have been demonstrated in acute and chronic schizophrenia. In schizophrenia is characterized by a collection of core symptoms that trigger individuals experiencing several cognitive disorders. Objective: To investigate the relationship of serum TNF-α levels to impaired cognitive function in schizophrenic patients in Medan, Indonesia. Method: This research is cross sectional analytical correlative study involving 40 male schizophrenic patients at Prof. Dr. M. Ildrem Mental Hospital through July to September 2019 that fulfilled our inclusion and exclusion criteria. Serum TNF-α levels were analyzed using Quantikine HS Human TNF-α Assay with a minimum detection limit of 0.1062 pg/ml while in the other hand, cognitive function test was carried out by using the Mini Mental State Examination. Results: Serum TNF-α levels with a mean of 25.1216 with a standard deviation of 1.7629. There is a positive correlation with moderate correlation (r = 0.4

NT-proB-type natriuretic peptide (NT-proBNP) serum concentration can be transformed by simple formulas into proBNPage, a surrogate of biological age strongly associated with chronological age, all-cause mortality, and disease count. This cross-sectional study aimed to assess whether proBNPage is also associated with other manifestations of the aging process in comparison with other variables. The study included 1117 noninstitutionalized older adults (73.1 ± 5.6 years, 537 men). Baseline measurements of serum NT-proBNP, erythrocyte sedimentation rate, hemoglobin, lymphocytes, and creatinine, which have previously been shown to be highly associated with both age and all-cause mortality, were performed. These variables were compared between subjects with and without manifestations of cardiovascular impairment (myocardial infarction (MI), stroke, peripheral artery disease (PAD), arterial revascularizations (AR)), physical impairment (long step test duration (LSTD), walking problems, falls, deficit in one or more activities of daily living), and psychological impairment (poor self-rating of health (PSRH), anxiety/depression, Mini Mental State Examination (MMSE) score

Background:: Citicoline is a drug used both in degenerative and in vascular cognitive decline; memantine is a drug used for the treatment of mild to moderate Alzheimer’s disease (AD). Our hypothesis is that their combined use could have enhanced action in patients having AD and mixed dementia (MD). We report the main tips from a recent study on the use of these drugs, the CITIMEM study. Methods:: The study was retrospective and was performed on 126 patients aged 65 years old or older affected with AD or MD (mean age 80.7 ± 5.2 years old) who had been visited between 2015 and 2017 in four different centers for dementia all over Italy. Neuropsychological and functional tests were administered at baseline (T0), after 6 (T1), and 12 months (T2). The effects of combined treatment versus memantine alone on cognitive functions assessed by Mini Mental State Examination (MMSE) and the possible onset of side effects or adverse events, as well as the influence on daily life functions and behavioral symptoms were investigated. Results:: Patients undergoing combined treatment showed a significant increase in MMSE vs memantine alone, both at T1 (p=0.003) and T2 (p =0.000). Conclusions:: The CITIMEM study confirms our hypothesis that combined administration of memantine plus citicoline is safe and more effective than memantine alone on cognition in patients suffering from AD or MD.

This non-randomized clinical trial aimed to analyze the impact of the Brazilian samba training protocol on the balance and quality of life of people with Parkinson’s disease. Forty-seven individuals participated, with a mean age of 68 ± 9.3 years-old, 24 from the control group (CG) and 23 from the experimental group (EG). The CG was formed by those who did not participate in the intervention, and the EG by individuals who participated in the Brazilian samba dance protocol. This study was divided into pre-intervention (before 12 weeks) and post-intervention (after 12 weeks) with a questionnaire consisting of: Mini Mental State Examination (MMSE); Unified Parkinson’s Disease Rating Scale (UPDRS); Quality of life (PDQ-39); Berg’s Balance Scale; Perception of perceived changes. The results point to a significant improvement after the intervention in the UPDRS (p < 0.001) and balance (p = 0.006) of the EG; in the quality of life of the EG after intervention in the mobility (p = 0.009) and total (p = 0.034) domains; and in the post-intervention period in the cognitive (p = 0.025) and communication (p = 0.032) domains of the EG and CG. Thus, it is concluded that the Brazilian samba rhythm has been shown to be effective in improving the total UPDRS, balance and quality of life, as well as in mobility, cognition and communication.

Objective. To assess the efficacy of memantine hydrochloride in correcting gait disturbances in patients with Parkinson’s disease (PD). Materials and methods. The study group consisted of 30 patients with PD in whom standard antiparkinsonism therapy was supplemented with memantine hydrochloride (Akatinol Memantine) at dose of 20 mg/day for three months; the reference group consisted of 25 PD patients who received only antiparkinsonism therapy. Both groups of patients were investigated using clinical scales to detect cognitive deficit and with a computerized protocol for assessment of gait parameters; subjects were investigated twice with an interval of three months. Results. During treatment with memantine, patients of the study group showed an increase in the total score on the Mini Mental State Examination (MMSE), while digital gait analysis demonstrated improvements in the ratio of stride phases and an increase in gait rhythm as compared with the group of patients not receiving memantine. Conclusions. Thus, the gait improvements obtained in this study confirm that correction of cortical gait disturbances in PD patients using memantine hydrochloride is a potential therapeutic approach.

Physicians performing impairment evaluations on patients with cognitive complaints and possible central nervous system disorders should perform a clinical mental status assessment. Assessing cognitive complaints efficiently, in a systematic and supportable way, can be challenging. The AMA Guides to the Evaluation of Permanent Impairment specifies that objective criteria are important to consider when assessing impairment. Physicians may choose to use standardized cognitive screening tests (cognitive screeners) as a relatively quick, practical tool to initially assess patients and aid in decision making. Several cognitive screeners will be discussed in detail below. A patient's performance on such tests may indicate that more comprehensive testing is needed. Cognitive screeners have limitations and are not designed to assess symptom validity or the extent to which psychological factors may contribute to cognitive complaints. Comprehensive neuropsychological assessment may be indicated in these situations and when the screeners demonstrate findings of potential concern help define MMI.

Background Cognitive dysfunction is a functional disorder that occurs after brain tissue damage, which can be classified as mild, moderate, or severe according to the degree of illness, especially in the elderly. Mild cognitive impairment (MCI) has many causes and is difficult to treat. It has been reported that biopsychosocial holistic care models can achieve good results in treating MCI. This study aimed to explore the application effect of biopsychosocial holistic care models on elderly patients with MCI. Methods A total of 140 patients with MCI diagnosed in Nantong People's Hospital (Nantong, China) from March 2019 to March 2020 were selected as the research cohort. Using a computer-generated randomization list, the participants were randomly allocated to either the observation group or control group, with 70 cases in each group. We compared the cognitive function and quality of life scores of the 2 groups before treatment, 1 month after treatment, and 3 months after treatment. Results In the first and third months after the intervention, the mini mental state examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score of the observation group were higher than those of the control group, and activities of daily living (ADL) score was lower than that of the control group. The difference between MMSE and MoCA scores between the 2 groups of participants at the third month of treatment was statistically significant (P=0.000). Conclusions Biopsychosocial holistic care models can improve the cognitive function and quality of life of elderly MCI patients. Trial registration Chinese Clinical Trial Registry ChiCTR2100046021.

Andreas Zenthöfer,1 Judith Ehret,1 Melania Zajac,1 Samuel Kilian,2 Jana Kostunov,1 Peter Rammelsberg,1 Anna-Luisa Klotz1 1University of Heidelberg, Dental School, Department of Prosthodontics, Heidelberg, 69120, Germany; 2University of Heidelberg, Institute of Medical Biometry and Informatics, Heidelberg, 69120, GermanyCorrespondence: Anna-Luisa KlotzUniversity of Heidelberg, Dental School, Department of Prosthodontics, INF 400, Heidelberg, 69120, GermanyTel +49 6221 56-8799Fax +49 6221 56-5371Email anna-luisa.klotz@med.uni-heidelberg.deObjective: To evaluate how changes in oral health and chewing efficiency affect the changes in oral-health-related quality of life (OHRQoL) of nursing-home residents over six months.Methods: The study was conducted in nine nursing homes. Sociodemographic and general data were collected for all eligible individuals (n = 150). Of these, 114 participants (mean age 82.0 [± 9.5] years, 77.2% women) were available for the following tests at baseline and six months later: a comprehensive examination of dental and general health, a two-colour mixing-ability test (to assess chewing efficiency), the Geriatric Oral Health Assessment Index (GOHAI; to evaluate the OHRQoL), and the Mini Mental State Examination (MMSE; to diagnose the presence and severity of dementia). Univariate and multivariate linear regression models were compiled to analyse possible factors affecting OHRQoL.Results: For the final analysis, 108 participants were available. For the study cohort as a whole, a decrease in the number of functional occluding pairs (C: 0.195; p = 0.034) and an increase in dental-treatment needs (C: − 1.968; p = 0.056) had the greatest negative effects on OHRQoL as expressed by the GOHAI score. For denture wearers, a deterioration of denture condition (C: − 2.946; p = 0.003) was the most important predictor for a decline in OHRQoL.Conclusion: A short-term decline in oral health and function affects the OHRQoL of nursing-home residents. The most important dental variables in this regard are the number of functional occluding pairs and dental and denture-related treatment needs.Keywords: chewing-efficiency test, nursing home, OHRQoL, oral health

Sedentary behavior is associated with cardiovascular disease, loss of autonomy and functional independence,worse quality of life and increased mortality. Preliminary evidence supports that sedentary behavior is associated with cognitive decline, however the magnitude and direction of these associations are not completely understood. The aim of this study was to verify the association between sedentary behavior and cognitive decline community-dwelling older adults. Cross-sectional study with a probabilistic and home-based sample of older adults registered in Primary Care in the municipality of Balneario Arroio do Silva, Santa Catarina, Brazil. Sedentary behavior was assessed by the question “time spent sitting” in the International Physical Activity Questionnaire and categorized into: 0 to 3 hours; 4 to 7 hours; 8 to 10 hours; and 11 or more hours a day. Cognitive decline was assessed by the Mini Mental State Examination, considering the cutoff points recommended by Brucki et al.14. Crude and adjusted Multivariate Logistic Regression models were performed, presenting the odds ratio and 95% CI values. A total of 308 older adults were evaluated, 57.8% of whom were female and with a mean age of 60.8 years (SD = 7.06 years). The prevalence of cognitive decline was 57.7%, with a predominance of women, with a lower age range and worse health behaviors. The final regression model pointed out that the older adults who remained seated 11 or more hours/day were five times more likely to have cognitive decline (OR = 5.03; 95% CI: 1.07; 23.61) when compared to those who remained for up to 3 hours/day sitting. In conclusion, there was a positive and significate association between greater sedentary behavior and cognitive decline in the elderly evaluated.