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Objective: To summarize the evidence for the associations between hearing loss and mental health and cognitive function in Africa., Methods: This systematic review was prepared following the PRISMA guidelines. Cohort, case‒control and cross-sectional studies were considered for inclusion if they reported the prevalence of any mental health conditions or levels of cognitive functioning among persons with hearing loss/deafness in comparison to those without hearing loss. No age restriction was applied. Articles not published in English or not from the African subcontinent were excluded. The initial search yielded a total of 2,822 articles from electronic databases. After title, abstract and full-text screening, seven articles were found to be eligible, with a total of 2,761 participants across Africa., Results: Five studies reported that hearing difficulties were significantly associated with an increased prevalence of poor mental health. Two studies reported on cognition, one on higher odds (2.22; 95%CI) of developing cognitive decline among persons with hearing difficulties than among those with normal hearing. The majority of studies were conducted among special populations (i.e., retirement homes and special schools), with most participants being female., Conclusion: This study revealed an increased risk of mental health disorders and/or cognitive decline for people with hearing impairment in African populations. However, the number of relevant studies is small, and more research is needed to provide evidence for public health interventions across the continent., Trial Registration: PROSPERO-CRD42024520957., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The association between social capital and trajectories of cognitive function (CF) is still unclear among older adults in mainland China. The present study aims to examine the association using a longitudinal cohort from the Ningxia Healthy Aging Cohort., Methods: Four waves of longitudinal data were abstracted to identify the CF trajectories using the conditional latent class growth model (LCGM). CF was measured using the Chinese version of the Mini-Mental State Examination (MMSE) from 2012 to 2023. Social capital, including social cohesion, social interaction, civic participation, and spiritual capital, was assessed using a series of standard instruments at baseline. Multinomial logistic regression was used to test the association between social capital and each trajectory class., Results: Three distinct CF trajectories were identified: Stable (72.5%), slow decline (25.8%), and deterioration (1.7%). High spiritual capital was associated with a decreased risk of developing a deterioration trajectory (OR = 0.36, 95% CI = 0.14-0.93), while high civic participation (OR = 0.61, 95% CI = 0.46-0.81) was associated with a decreased risk of developing a slow decline trajectory. Low CF at baseline was the first important risk factor, followed by age, civic participation, sex, monthly income, spiritual capital, and obesity., Conclusions: The CF trajectories are heterogeneous among older Chinese adults. Civic participation was associated with a lower risk of a slow decline trajectory, and spiritual capital was slightly associated with a lower risk of a deterioration trajectory. These findings support the development of social-integrated interventions for vulnerable groups., Competing Interests: Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Institutional Review Board of Ningxia Medical University (approval numbers 2015151 and 2018115). All participants provided written informed consent before enrollment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Older adults with cognitive impairment tend to experience deteriorating oral health and inadequate oral hygiene behaviors, but few studies have addressed interethnic variability. This study aimed to explore the associations between cognitive impairment and oral health or oral hygiene behaviors in multiethnic older adults in Western China., Methods: We conducted a cross-sectional multicenter study from four provinces of Western China, recruiting multiethnic older adults aged 50 years and older between July and December 2018. Oral health and oral hygiene behaviors were evaluated through an oral examination and a self-made questionnaire, whereas cognitive condition was assessed via the Chinese version of the Short Portable Mental Status Questionnaire (SPMSQ). Three multiple regression models were used to examine the associations between cognitive impairment and oral health or oral hygiene behaviors, with adjustments for relevant variables., Results: A total of 6529 participants with a median age (interquartile range) of 62.4 (55, 68) years were included. The prevalence of cognitive impairment was 15.4%, with the Yi group having the highest prevalence (28.9%), followed by the Tibetan (19.1%) and Qiang (15.4%) groups. Poorer self-rated oral health, fewer residual teeth, less frequent use of toothbrushes and toothpaste, and irregular dental care were associated with a risk of cognitive impairment (p < 0.05). The SPMSQ scores and correlations between cognitive impairment and oral health or oral hygiene behaviors were heterogeneous among the multiethnic groups., Conclusion: Inadequate oral hygiene behaviors and deteriorating oral health may be associated with a higher risk of cognitive impairment. Advancing oral health and oral hygiene behaviors is essential for preventing cognitive impairment among multiethnic older adults., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by The Ethical Review Committee of West China Hospital of Sichuan University (approval number 2017[445]). The study was conducted in accordance with ethical standards established in the 1964 Declaration of Helsinki and its later amendments. All participants provided written informed consent prior to participating in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: To assess the association between sodium-glucose co-transporter-2 inhibitor (SGLT-2i) use and the risk of incident dementia compared with dipeptidyl peptidase-4 inhibitors (DPP-4i) use among individuals with type 2 diabetes., Design: A population-based retrospective cohort study., Setting: The Clinical Practice Research Datalink (CPRD) Aurum database from the UK., Participants: Individuals with type 2 diabetes, aged 40 years or older, newly prescribed SGLT-2i or DPP-4i on or after 2013-2021, registered in the CPRD Aurum database., Main Outcome Measure: The primary outcome was incident dementia, and the secondary outcome was incident mild cognitive impairment (MCI). Cox proportional hazard models were used to estimate the HR and corresponding 95% CI for the primary and secondary outcomes. Propensity score fine stratification weights were used to adjust for confounding., Results: Among a cohort of 118 006 individuals, the incident rate (IR) of dementia was 0.56/1000 person-years over a median follow-up period of 1.54 years among SGLT-2i users compared with 2.67/1000 person-years in DPP-4i users, over a median follow-up period of 1.79 years. The adjusted HR for SGLT-2i use compared with DPP-4i use for dementia was 0.78 (95% CI 0.55 to 1.12), while for MCI was 0.86 (95% CI 0.80 to 0.92). The age-specific stratified analysis demonstrated the adjusted HR for SGLT-2i use compared with DPP-4i use for the risk of incident dementia among elderly, aged ≥65 years, was 0.50 (95% CI 0.31 to 0.80)., Conclusion: Primary findings did not yield conclusive evidence to infer an association between SGLT-2i use and the risk of incident dementia., Competing Interests: Competing interests: RWP has received consulting fees from Biogen, Boehringer Ingelheim, Merck, Nant Pharma, Pfizer and Vanda Pharmaceuticals for work unrelated to this project. OHYY received fees for participation in a Novo Nordisk Advisory Board in December 2021 for work unrelated to this project. The other authors have no conflicts of interest to disclose., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Ancient texts and archaeological evidence indicate substantial lead exposure during antiquity that potentially impacted human health. Although lead exposure routes were many and included the use of glazed tablewares, paints, cosmetics, and even intentional ingestion, the most significant for the nonelite, rural majority of the population may have been through background air pollution from mining and smelting of silver and lead ores that underpinned the Roman economy. Here, we determined potential health effects of this air pollution using Arctic ice core measurements of Roman-era lead pollution, atmospheric modeling, and modern epidemiology-based relationships between air concentrations, blood lead levels (BLLs), and cognitive decline. Findings suggest air lead concentrations exceeded 150 ng/m 3 near metallurgical emission sources, with average enhancements of >1.0 ng/m 3 over Europe during the Pax Romana apogee of the Roman Empire. The result was blood lead enhancements in young children of about 2.4 µg/dl above an estimated Neolithic background of 1.0 µg/dl, leading to widespread cognitive decline including a 2.5-to-3 point reduction in intelligence quotient throughout the Roman Empire., Competing Interests: Competing interests statement:The authors declare no competing interest.

Introduction: Long-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents' wishes and goals. Decision to transfer to hospital, when not aligned with the resident's wishes, can result in transfers that are harmful to residents, leaving residents in a state of disability that could be considered worse than death. We aim to examine whether transfer to an acute care hospital is associated with subsequent new onset of severe permanent physical and cognitive disability in LTC residents., Method and Analysis: We will conduct a retrospective cohort study of all LTC residents ≥65 admitted to LTC homes between 1 April 2013 and 31 March 2018 in Ontario, Canada. We will use health administrative data from the Continuing Care Reporting System (CCRS), National Ambulatory Care Reporting System (NACRS) and Registered Persons Databases (RPDB), which include data on emergency department visits, hospitalisations, demographic information and mortality. All participants will be followed until 31 March 2023. The exposure is any transfer from LTC to an emergency department or acute care hospital. The outcomes are (1) subsequent new permanent physical disability, (2) subsequent new permanent cognitive disability and (3) all-cause mortality. Due to the time-varying nature of the exposure and confounders, we will use an extended cause-specific Cox regression model to explore this relationship. We will fit marginal structural models (MSMs) to account for the known shortcomings of traditional regression modelling, such as collider bias. Lastly, we will use a preference-based instrumental variable approach to address unmeasured confounders., Ethics and Dissemination: Ethics approval was obtained through Bruyère Research Institute Ethics Committee (REB#M16-23-030). Study findings will be submitted for publication in a peer-reviewed journal. Findings will be disseminated in conferences and seminars., Trial Registration: Open Science Framework (https://doi.org/10.17605/OSF.IO/JCDEY)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: The impacts of early-life tobacco smoke exposure, including exposure during pregnancy and the initiation of smoking during childhood and adolescence, on cognitive decline and the risk of dementia in later life have not been investigated., Methods: We used data from the UK Biobank (UKB) to assess early-life tobacco exposure, including in utero exposure and the age at which smoking was initiated. Cox proportional-hazards regression models were employed to gauge the relationships between early-life tobacco smoke exposure and both the risk of cognitive decline and dementia in adulthood. We adjusted for potential confounding factors, including age, gender, race, household income, alcohol consumption status, physical activity, family history of dementia, education level, and other relevant variables., Results: This study of 291,113 UKB participants and 4,836 new dementia cases over a median 13.26-year follow-up found that in utero tobacco exposure led to significant cognitive decline in adulthood, but not a higher dementia risk. Those who began smoking in childhood or adolescence had significant cognitive decline and increased dementia risk. Early smoking was linked to various brain structure changes, including volumes of the hippocampus, lateral ventricles, white and gray matter., Conclusions: Early exposure to tobacco is associated with cognitive decline and an increased risk of dementia in adulthood. This underscores the significance of educational campaigns targeting the reduction of smoking among children, adolescents, and pregnant women as an effective strategy to mitigate cognitive decline and dementia in adulthood., Competing Interests: Declarations. Ethics approval and consent to participate: Not Applicable. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: This study examines the association between prior incarceration and cognition trajectories among older adults in the United States., Methods: Data are from the Health and Retirement Study (HRS), a nationally representative longitudinal survey of older adults in the United States. The analysis included respondents aged 55 and older who participated in the 2012-2020 HRS surveys and had valid responses on Langa-Weir cognition scores, incarceration history, and covariates (n = 5,663). Cognition trajectories were estimated using group-based trajectory modeling, and multinomial logistic regression was used to assess the relationship between prior incarceration and cognition trajectory group membership., Results: The study identified four distinct cognition trajectories. Formerly incarcerated individuals were significantly more likely to be in cognition trajectory groups defined by lower cognition scores and steeper declines in cognitive functioning over time. However, these associations were attenuated after accounting for sociodemographic and health-related characteristics, and all associations were rendered statistically nonsignificant after accounting for educational attainment., Discussion: These findings highlight poorer cognition among older formerly incarcerated individuals compared with their never incarcerated counterparts, as well as underscore the role of educational attainment in this relationship. Future research and data collection efforts are needed to further understand the nexus between incarceration and cognitive functioning and the mechanisms underpinning this association., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: This study is to develop and validate a robust risk prediction model for mild cognitive impairment (MCI) in patients with malignant haematological diseases after haematopoietic stem cell transplantation (HSCT)., Methods: In this study, we analysed the clinical data of the included patients. Logistic regression analysis was used to identify independent risk factors for cognitive impairment after HSCT in patients with malignant haematological diseases, and a risk prediction model was constructed. Multiple cohorts of patients with haematological malignancies after HSCT (282 cases) from the Affiliated Hospital of Xuzhou Medical University and the First People's Hospital of Yancheng City between April 2019 and February 2022, and patients from the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University between March 2022 and July 2023 were used for external validation. Logistic regression analysis was performed to develop the predictive model. The predictive value and consistency of the model were evaluated using the area under the curve (AUC) and calibration method, respectively. Decision curve analysis (DCA) was performed to access the utility of the model., Results: Approximately half (52.26%) of the patients in the study developed mild cognitive impairment (MCI). Older age, allogeneic HSCT, anxiety, graft-versus-host disease, and longer hospital stay were associated with a higher risk of developing MCI. ROC curve analysis confirmed the sound performance of the predictive model and external validation, with AUC of 0.897 and 0.789 respectively. The direction of the calibration curves of the training and validation sets is closer to the diagonal (ideal curve), indicating good model consistency; the DCA curves also show that the model has good predictive ability and stability., Conclusions: We conclude that it is possible to predict mild cognitive impairment with readily available, mostly pretransplant predictors. The accuracy of the risk prediction models can be improved for use in clinical practice, possibly by adding pretransplant patient-reported functioning and comorbidities., Competing Interests: Declarations. Competing interest:  The authors declare no competing interests., (© 2025. The Author(s).)

Lifestyle factors and ambient air pollution are linked to dementia and CMDs, yet few studies have investigated their impact on dementia risk in CMDs patients at the same time. The Cox proportional hazards model was used to evaluate the influence of lifestyle and ambient air pollution on the dementia risk of the CMDs population among 438,681 participants in the UK Biobank. It is found that the risk of developing mild cognitive impairment and dementia in the population seems to increase with the increase in the number of CMDs. There appears to be a statistically significant association between high levels of ambient air pollution, unhealthy lifestyles, and a higher risk of developing mild cognitive impairment and dementia in the CMDs population. It is found that a healthy lifestyle may have an effect modifier role in the association between ambient air pollution and the risk of mild cognitive impairment and the development of dementia in patients with CMDs. Therefore, maybe people with CMDs can lessen the impact of ambient air pollution on their risk of developing mild cognitive impairment and dementia by improving their lifestyle., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background and Purpose: Anxiety is frequent after stroke; however, little is known about its determinants. This study aims to assess the prevalence and correlates of post stroke anxiety (PSA) within 3-6 months following ischemic stroke., Methods: Three cohort studies from the STROKOG consortium were involved. Demographic and clinical data were standardized. PSA and PSD were assessed using inventories. The criteria for post-stroke cognitive impairment (PSCI) were at least one cognitive domain impaired if applicable, or a Montreal Cognitive Assessment (MoCA) score. Descriptive analyses were conducted to ascertain the prevalence of anxiety. Comparisons between anxious and non-anxious patients in the total sample were made using χ 2 and t-tests. A two-step individual participant data (IPD) meta-analysis was employed to identify factors associated with PSA., Results: 584 patients were included. The total prevalence of PSA was 35 % (95%CI = [31.23;38.97]) and ranged from 27 % to 45 % across cohorts. In the total sample, there was a higher proportion of females in the anxiety group than the non-anxiety group (χ 2  = 19.62; p < 0.001). Anxious patients had lower education, (χ 2  = 6.59; p = 0.03), higher stroke severity (t = 2.77; p = 0.002), and higher rates of PSD (χ 2  = 118.09; p < 0.001), and PSCI (χ 2  = 23.81, p < 0.001). The analysis demonstrates that the odds of presenting with PSA is larger in patients with PSCI (OR = 1.84, 95%CI = [1.14; 2.91])., Conclusions: Anxiety is frequent after stroke, especially in females, and is associated with depression and cognitive impairment., Competing Interests: Declaration of competing interest None of authors do not have any conflicts of interest to declare., (Copyright © 2024. Published by Elsevier B.V.)

Background: Globally, over 2.2 billion people have a vision impairment and over 1.5 billion live with hearing impairment, which are significant public health concerns given the meaningful impacts on individual and society. We aimed to investigate whether long-term average visual, hearing, and dual sensory impairment was independently associated with cognitive impairment, incident dementia, and incident depressive symptoms., Methods: We used data from the Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS), two nationally representative and prospective cohorts of community middle aged and older adults. Average sensory impairment was calculated using the area under the curve divided by follow-up time from wave 3 (1996) to wave 15 (2020) in HRS and wave 1 (2011) to wave 4 (2018) in CHARLS. Cox regression models adjusted for multiple covariates were used to estimate adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CIs)., Results: For each one standard deviation (SD) increment in average visual impairment, the risk of developing cognitive impairment, incident dementia, and incident depressive symptoms increased by 12 %, 34 %, and 39 % in CHARLS and 11 %, 14 % and 10 % in HRS. Similar results were found for each SD increment in average hearing impairment and dual sensory impairment. Nonlinear dose-response relationships were identified between visual impairment and dementia, as well as dual sensory impairment and dementia in both cohorts., Limitations: The diagnosis of cognitive impairment, dementia, and depression were based on subjective assessment., Conclusion: Multi-level approaches aimed at improving access to sensory care are needed to improve middle-aged and older adults' visual and auditory functions., Competing Interests: Declaration of competing interest All authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Objectives: Antibiotics rapidly reduce intestinal bacterial diversity, leading to dysbiosis that persists for months to years. Although emerging evidence from retrospective and claims-based studies has linked dysbiosis to cognitive function, prospective data are lacking. We aim to examine the prospective association of antibiotics with cognitive aging among initially healthy older adults., Methods: We leveraged data from prospective follow-up and observational extension of ASPirin in Reducing Events in the Elderly, a completed randomized trial of community-based Australian older adults. Among participants whose prescription records were available and without dementia during the first 2 years of follow-up, we identified any or repeated antibiotic use based on the Anatomical Therapeutic Chemical code (J01). We assessed the associations of antibiotic use during the first 2 years with longitudinal changes in standardized composite and domain-specific cognitive scores (global cognition, episodic memory, language and executive function, and psychomotor speed) using linear mixed models, and with incident, clinically adjudicated dementia ( Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria) and incident cognitive impairment, no dementia (CIND, without a dementia trigger but with significant, nontransient decline), using Cox proportional hazard models., Results: Over a median of 4.7 years after the second follow-up visit, we documented 461 dementia and 2,576 CIND cases among 13,571 participants (mean age ± SD 75.0 ± 4.1 years, 54.3% female). Compared with nonuse, antibiotic use was not associated with increased risks for dementia (hazard ratio [HR] 1.03; 95% CI 0.84-1.25), CIND (HR 1.02; 95% CI 0.94-1.11), or subsequent declines in cognitive scores, after adjusting for sociodemographic, lifestyle factors, family history of dementia, baseline cognitive function, and medications known to affect cognition. There were also no associations according to the cumulative frequency of antibiotic use, long-term use, specific antibiotic classes (e.g., beta-lactams, tetracyclines, and sulfonamides), and subgroups defined by risk factors., Discussion: Among initially healthy older adults, any or repeated antibiotic use was not associated with incident dementia, CIND, or accelerated cognitive decline. Although prescription data may not reflect the actual use, we examined the frequency of antibiotics within a defined period to capture the extent and duration of antibiotic exposure. Our results do not support an association between antibiotic-associated gut microbiome disruption and dementia risk.

Background: As the global population ages, there is an increasing prevalence of mild cognitive impairment and dementia. Protecting and preserving cognitive function in older adults has become a critical public health concern., Methods: This study utilized data from four phases of the Chinese Longitudinal Healthy Longevity Survey conducted from 2008 to 2018, encompassing a total of 2454 participants. Latent growth curve modeling was employed to analyze the trajectory and role of protein intake frequency and cognitive function., Results: The frequency of protein intake among older adults tends to rise, with individuals exhibiting higher initial levels experiencing smaller subsequent increases. Conversely, cognitive function generally declines, with those starting at higher levels experiencing more pronounced decreases. Notably, the initial frequency of protein intake is positively correlated with the initial level of cognitive function ( β = 0.227, 95% CI: 0.156 to 0.299, p < 0.001), but does not significantly influence the rate of change in cognitive function ( β = -0.030, 95% CI: -0.068 to 0.009, p = 0.128). The rate of change in protein intake frequency is positively associated with the rate of change in cognitive function ( β = 0.152, 95% CI: 0.023 to 0.280, p = 0.020)., Conclusions: The alterations in protein intake frequency are linked to alterations in cognitive function among older adults. Maintaining a stable high frequency of protein intake or increasing the frequency of protein intake may contribute to stabilizing cognitive function as well as reducing the risk of cognitive impairment and dementia in older adults.

Background: Ambient air pollution, detrimental built and social environments, social isolation (SI), low socioeconomic status (SES), and rural (versus urban) residence have been associated with cognitive decline and risk of Alzheimer's disease and related dementias (ADRD). Research is needed to investigate the influence of ambient air pollution and built and social environments on SI and cognitive decline among rural, disadvantaged, ethnic minority communities. To address this gap, this cohort study will recruit an ethnoracially diverse, rural Florida sample in geographic proximity to seasonal agricultural burning. We will (1) examine contributions of smoke-related fine particulate matter (PM2.5) exposures to SI and cognitive function; (2) determine effects of built and social environments on SI and cognitive function; and (3) contextualize SI and cognitive function among residents from different ethnoracial groups during burn and non-burn seasons., Methods: We will recruit 1,087 community-dwelling, dementia-free, ≥45-year-olds from five communities in Florida's Lake Okeechobee region. Over 36 months, participants will complete baseline visits to collect demographics, health history, and health measurements (e.g., blood pressure, body mass index) and 6-month follow-ups assessing cognitive function and social isolation at each visit. A subsample of 120 participants representative of each community will wear smartwatches to collect sensor data (e.g., heart rate) and daily routine and predefined activities (e.g., GPS-captured travel, frequent destinations) over two months. Ecological momentary assessments (EMA) (e.g., whether smoke has bothered participant in last 30 minutes) will occur over two months during agricultural burning and non-burning months. PurpleAir monitors (36 total) will be installed in each community to continuously monitor outdoor PM2.5 levels., Discussion: We expect to identify individual- and community-level factors that increase the risk for SI and cognitive decline in a vulnerable rural population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Besser et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Repetitive head impacts (RHI) in sports may represent a risk factor for long-term cognitive and neurological sequelae. Recent studies have identified an association between playing football at the top level and an elevated risk of cognitive impairment and neurodegenerative disease. However, these were conducted on men, and there is a knowledge gap regarding these risks in female athletes. This study aims to investigate the effect of head impacts on brain health in female former top-level football players., Methods and Analysis: This is a prospective cohort study, enroling female former football players and top-level athletes from sports without an inherent risk of RHI. All participants are born in 1980 or earlier. We plan to perform follow-up assessments at least three times over 20 years.The protocol includes neurocognitive assessments, self-reported neurocognitive outcomes, neurological examination, advanced brain MRI, and fluid biomarkers., Ethics and Dissemination: The study has been approved by the South-East Regional Ethics Committee for Medical Research in Norway (2023/178330) and the Norwegian Agency for Shared Services in Education and Research (SIKT). A Data Protection Impact Assessment was developed by the research group and approved by SIKT and the Norwegian School of Sport Sciences. We will disseminate the results through peer-reviewed publications, academic conference presentations and webinars. We will communicate with the public and key stakeholders in football worldwide to inform and promote the development and implementation of potential preventive measures based on our study findings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background/objectives: Sex differences in nutrition-related determinants of mild cognitive impairment (MCI) exist among the elderly. This study aimed to explore sex-specific influencing factors of MCI., Methods: A case-control study was conducted in 2020 involving 1086 elderly people aged 55 years and above from four sites in Zhejiang Province, China. Data on demographics, cognitive assessment, depression scale, daily food intake, and physical examinations were collected. The assessment of plant-based diet patterns depended on an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Multivariate logistic regression models were employed to assess the determinants of MCI in females and males., Results: Among 571 females, 141 (24.7%) had MCI, and 126 (24.5%) had MCI among 514 male participants. In females, the multivariate analysis revealed that being unmarried/divorced/widowed (OR = 1.95, 95% CI: 1.10-3.45), having depression (OR = 6.06, 95% CI: 1.87-19.66), and having a uPDI score ≥ 55 (OR = 2.41, 95% CI: 1.50-3.89) were associated with a significantly elevated risk of MCI. Conversely, a cereal consumption of ≥300 g/d (OR = 0.32, 95% CI: 0.19-0.53) was linked to a significantly reduced risk. In males, vegetable consumption ≥ 150 g/d (OR = 0.39, 95% CI: 0.23-0.66), vegetable oil consumption ≥ 22 g/d (OR = 0.502, 95% CI: 0.307-0.820), and cereal consumption ≥ 300 g/d (OR = 0.44, 95% CI: 0.27-0.71) were associated with a lower MCI risk. Meanwhile, rural residence (OR = 1.90, 95% CI: 1.12-3.25) and advanced age, especially 75 years old and above (OR = 4.71, 95% CI: 2.44-9.12), were also risk factors in males. Notably, the Restricted Cubic Spline (RCS) model showed that females with a uPDI score < 55 had a lower prevalence of MCI, while those with a score ≥ 55 faced a higher risk., Conclusions: This study indicates potential sex disparities in the risk factors for MCI. Future research should prospectively establish causal relationships. Additionally, precise intervention strategies are urgently needed.

Background: Evidence indicates that cognitive function is influenced by potential environmental factors. We aimed to determine the variables influencing cognitive function., Methods: Our study included 164,463 non-demented adults (89,644 [54.51%] female; mean [SD] age, 56.69 [8.14] years) from the UK Biobank who completed four cognitive assessments at baseline. 364 variables were finally extracted for analysis through a rigorous screening process. We performed univariate analyses to identify variables significantly associated with each cognitive function in two equal-sized split discovery and replication datasets. Subsequently, the identified variables in univariate analyses were further assessed in a multivariable model. Additionally, for the variables identified in multivariable model, we explored the associations with longitudinal cognitive decline. Moreover, one- and two- sample Mendelian randomization (MR) analyses were conducted to confirm the genetic associations. Finally, the quality of the pooled evidence for the associations between variables and cognitive function was evaluated., Results: 252 variables (69%) exhibited significant associations with at least one cognitive function in the discovery dataset. Of these, 231 (92%) were successfully replicated. Subsequently, our multivariable analyses identified 41 variables that were significantly associated with at least one cognitive function, spanning categories such as education, socioeconomic status, lifestyle factors, body measurements, mental health, medical conditions, early life factors, and household characteristics. Among these 41 variables, 12 were associated with more than one cognitive domain, and were further identified in all subgroup analyses. And LASSO, rigde, and principal component analysis indicated the robustness of the primary results. Moreover, among these 41 variables, 12 were significantly associated with a longitudinal cognitive decline. Furthermore, 22 were supported by one-sample MR analysis, and 5 were further confirmed by two-sample MR analysis. Additionally, the quality of the pooled evidence for the associations between 10 variables and cognitive function was rated as high. Based on these 10 identified variables, adopting a more favorable lifestyle was significantly associated with 38% and 34% decreased risks of dementia and Alzheimer's disease (AD)., Conclusion: Overall, our study constructed an evidence database of variables associated with cognitive function, which could contribute to the prevention of cognitive impairment and dementia., Competing Interests: Declarations. Ethics approval and consent to participants: UK Biobank has received ethical approval from the North West Multi-centre Research Ethics Committee (MREC, https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/about-us/ethics ), and informed consent through electronic signature was obtained from study participants in accordance with the Declaration of Helsinki. This study utilized the UK Biobank Resource under application number 19542. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Older individuals are at risk of malnutrition resulting from chronic diseases-related body and muscle mass reduction. In turn, nutritional deficiencies may enhance catabolic processes, leading to accelerated aging and comorbidity, thus creating a vicious cycle. Our study aimed to assess the prevalence of malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to determine the health correlates of malnutrition in a representative sample of community-dwelling older adults., Methods: We used the GLIM criteria to diagnose malnutrition in 5,614 participants of the PolSenior2 study. The PolSenior2 study was a population-based survey designed to assess the medical, psychological, social, and economic characteristics of community-dwelling older adults., Results: Malnutrition was diagnosed in 13.4% of the participants using the GLIM criteria. Results of multiple logistic regression showed that the risk of depression [OR 4.18, p<0.001], peptic ulcer disease [OR 2.73, p<0.001], past stroke [OR 1.71, p<0.001], cognitive impairment [OR 1.34, p = 0.015], and chronic pain [OR 1.23, p = 0.046] were independent correlates of malnutrition., Conclusion: Due to the high risk of malnutrition, special attention should be paid to individuals in late old age. Suspected malnutrition should also be considered in people at risk of depression, with peptic ulcer disease, past stroke, and cognitive impairment. Chronic pain should also prompt the diagnosis for malnutrition., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Kaluźniak-Szymanowska et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Atrial fibrillation is an independent risk factor for the development of cognitive impairments. Regular coffee consumption has shown cognitive benefits in healthy individuals. Whether regular consumption reduces cognitive decline in vulnerable patients is controversial. We investigated the association in elderly people with atrial fibrillation., Methods and Results: Daily coffee consumption was assessed using a structured nutrition questionnaire, and cognitive function was evaluated by a detailed neurocognitive-test-battery, including the Montreal Cognitive Assessment, Trail-Making Test, semantic fluency, and Digit-Symbol-Substitution Test. The cognitive construct score combines all neurocognitive tests mentioned and provides an overall cognitive performance indicator. Hs-CRP (high-sensitivity C-reactive protein) and IL-6 (interleukin-6) were measured to explore an association with inflammation. Results were estimated using linear mixed-effects-models with detailed adjustments for confounders. The <1 cup/day consumers (reference group) reached a cognitive construct score of -0.24 (95% CI, -0.27 to -0.16), and the group with the highest consumption (>5 cups/day) was at -0.10 (95% CI, -0.10 to 0.04; p =0.048). Montreal Cognitive Assessment score in the reference group was 24.58 (95% CI, 24.58-25.32); the group with the highest intake achieved 25.25 (95% CI, 24.98-26.85; p =0.163). Inflammatory markers decreased with higher coffee consumption (hs-CRP with 5 compared with <1 cup/day by factor 0.78 [95% CI, 0.54-1.13], p = 0.188, IL-6 significantly by factor 0.73 [95% CI, 0.57-0.95], p =0.017)., Conclusions: Coffee consumption in patients with atrial fibrillation may be associated with improved cognitive performance and reduced inflammatory markers. Further research is needed to confirm these findings and to consider implementation in dietary counseling for atrial fibrillation management., Registration: URL: https://www.clinicaltrials.gov; Identifier: NCT02105844.

Background: Adolescents living with HIV face unique challenges, including mental health issues such as depression and cognitive dysfunction. Despite this significant burden, there is a lack of evidence focusing on this population. This study therefore aims to examine the moderating effects of biopsychosocial factors on the bi-directional relationship between HIV-related depression and cognitive function among adolescents living with HIV in the Mbeya region, Tanzania., Methods: The analytical cross-sectional study will be conducted in public healthcare facilities in the Mbeya region, involving 207 adolescents living with HIV who will be selected using a systematic random sampling technique. Depression will be assessed using a standardized PHQ-9 tool, while cognitive functioning will be evaluated using a validated Montreal Cognitive Assessment Tool Version 8.3. A biopsychosocial model will be used to guide this study. Descriptive statistics will be used to describe the frequency distribution of the study variables, a chi-square test will be used to describe the relationship between the variables and a binary logistic regression model will be used to predict the moderating effects of biopsychosocial factors on the relationship between HIV-related depression and cognitive function. The odds ratio and a 95% confidence interval will be reported, and the p-value of 0.05 will be considered statistical significance. This study is expected to be conducted for three months. The high prevalence of mental health issues among HIV-positive adolescents, the detrimental effect of HIV on cognitive development, and the lack of studies focused on this population raised the need to conduct this study., Discussion: The findings of this study will inform the development of a comprehensive integrated care model that addresses both the mental and cognitive aspects of living with HIV during adolescence. Moreover, the identification of factors associated with depression and cognitive performance will help healthcare providers in identifying at-risk adolescents and proper management of the conditions. This study's results will also help reveal areas that need in-depth exploration that will lead to a better understanding of the responsible factors., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Kitoki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Dementia is the leading cause of disability and imposes a significant burden on society. Previous studies have suggested an association between metabolites and cognitive decline. Although the metabolite composition differs between Western and Asian populations, studies targeting Asian populations remain scarce., Methods: This cross-sectional study used data from a cohort survey of community-dwelling older adults aged ≥60 years living in Miyagi, Japan, conducted by Tohoku Medical Megabank Organization between 2013 and 2016. Forty-three metabolite variables quantified using nuclear magnetic resonance spectroscopy were used as explanatory variables. Dependent variable was the presence of cognitive decline (≤23 points), assessed by the Mini-Mental State Examination. Principal component (PC) analysis was performed to reduce the dimensionality of metabolite variables, followed by logistic regression analysis to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline., Results: A total of 2,940 participants were included (men: 49.0%, mean age: 67.6 years). Among them, 1.9% showed cognitive decline. The first 12 PC components (PC1-PC12) accounted for 71.7% of the total variance. Multivariate analysis showed that PC1, which mainly represented essential amino acids, was associated with lower odds of cognitive decline (OR 0.89; 95% CI, 0.80-0.98). PC2, which mainly included ketone bodies, was associated with cognitive decline (OR 1.29; 95% CI, 1.11-1.51). PC3, which included amino acids, was associated with lower odds of cognitive decline (OR 0.81; 95% CI, 0.66-0.99)., Conclusion: Amino acids are protectively associated with cognitive decline, whereas ketone metabolites are associated with higher odds of cognitive decline.

Background: Cognitive impairment is a common health problem among older adults. Previous studies have proven the association between sleep quality and cognitive impairment, but the specific underlying mechanisms need to be further explored. This study aimed to examine the relationship between sleep quality and cognitive impairment and the mediating effect of frailty in this relationship among the rural older adults., Methods: Data from a cross-sectional study conducted in rural areas of Shandong Province from September to December in 2023. A total of 695 rural older adults were included. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. Frailty was defined using the FRAIL scale. We assessed cognitive impairment using the Dementia Screening Interview (AD8). Logistic regression analyse was used to assess the relationship between sleep quality and cognitive impairment. And the Karlson-Holm-Breen (KHB) method was performed to test the mediating role of frailty in this relationship., Results: After adjusting for all covariates, sleep quality was significantly associated with cognitive impairment (OR = 1.047, 95% CI: 1.005-1.090). Frailty mediated the relationship between sleep quality and cognitive impairment, with a mediation effect value of 0.010 (95% CI: 0.001-0.020), accounting for 17.86% of the total effect., Conclusions: We found there was an association between sleep quality and cognitive impairment, and frailty mediated the above relationship. Comprehensive intervention measures should be taken to reduce the incidence of frailty in the older adults and to improve their sleep quality, thereby preventing and delaying the occurrence and development of cognitive impairment., Competing Interests: Declarations. Ethics approval and consent to participate: The study was performed in accordance with the Declaration of Helsinki, and approved by the Medical Ethics Committee of Weifang Medical University (2021YX-066). Written informed consent clarifying the study purposes, significance, methods and risks was obtained from each participant before the survey. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Importance: Disparities in cognition, including dementia occurrence, persist between non-Hispanic Black (hereinafter, Black) and non-Hispanic White (hereinafter, White) older adults, and are possibly influenced by early educational differences stemming from structural racism. However, the association between school racial segregation and later-life cognition remains underexplored., Objective: To investigate the association between childhood contextual exposure to school racial segregation and cognitive outcomes in later life., Design, Setting, and Participants: This cross-sectional study examined a nationally representative sample of US older adults from the Health and Retirement Study. Both restricted childhood residence data and publicly available cognitive assessment data (survey years 1995-2018) were used for Black and White participants aged 65 years and older. Data analyses were performed from March 2, 2023, to October 22, 2024., Exposures: State-level Black and White dissimilarity index for public elementary schools in the late 1960s (range, 0-100) was used to measure school segregation. States were categorized into high segregation (≥83.6) and low segregation (<83.6) based on the top quintile., Main Outcomes and Measures: Cognitive scores, cognitive impairment, and dementia were assessed using the Telephone Interview for Cognitive Status and proxy assessment. Multilevel regression analyses were conducted stratified by race and ethnicity, adjusting for sociodemographic covariates. Potential early-life and midlife mediators, including educational attainment, were assessed., Results: The study sample included 3566 Black (16 104 observations) and 17 555 White (90 874 observations) participants. The mean (SD) age of the sample was 75.6 (7.5) years, and 62 187 (58.1%) were female. Participants exposed to high vs low segregation exhibited lower cognitive scores (13.6 vs 14.5) and a higher prevalence of cognitive impairment (37.0% vs 28.0%) and dementia (14.1% vs 9.3%). Multilevel analyses revealed a significant negative association between school segregation and later-life cognitive outcomes among Black participants, but not among White participants, after adjusting for covariates. Potential mediators across the life course, including educational attainment, explained 57.6% to 72.6% of the association, yet the findings were significant among Black participants for all outcomes. In the model including all mediators and covariates, Black participants exposed to high segregation exhibited significantly lower cognitive scores (coefficient, -0.26; 95% CI, -0.43 to -0.09) and a higher likelihood of cognitive impairment (adjusted odds ratio [AOR], 1.35; 95% CI, 1.12-1.63) and dementia (AOR, 1.26; 95% CI, 1.03-1.54)., Conclusions and Relevance: This cross-sectional study of Black and White older individuals found that childhood exposure to school segregation was associated with late-life cognition among the Black population. Given the increasing amount of school segregation in the US, educational policies aimed at reducing segregation are needed to address health inequities. Clinicians may leverage patients' early-life educational circumstances to promote screening, prevention, and management of cognitive disorders.

Background: Cognitive impairment and limited health literacy are prevalent among patients with heart failure, particularly those residing in rural areas, and are linked to poor health outcomes. Little is known about the intricate relationships among cognitive function, health literacy, and rehospitalization and death in rural patients with heart failure., Objectives: To determine the relationships among cognitive function, health literacy, and cardiac event-free survival (ie, heart failure hospitalizations and cardiac mortality) in rural patients with heart failure., Methods: This was a secondary data analysis of a randomized controlled trial of 573 rural patients with heart failure. Cognitive function was measured using the Mini-Cog test. Health literacy was measured by the Short Test of Functional Health Literacy in Adults. Cardiac event-free survival was followed for 2 years. Survival analyses (ie, Kaplan-Meier plots with log-rank test and Cox regression) were used., Results: Cognitive impairment was associated with limited health literacy. Cognitive impairment and limited health literacy predicted worse cardiac event-free survival (P<.05). Patients with both cognitive impairment and limited health literacy had a 2.24 times higher risk of experiencing a cardiac event compared to those without cognitive impairment and with adequate health literacy (P<.001)., Conclusions: Patients with cognitive impairment and limited health literacy were at the highest risk of experiencing a cardiac event. It is important to screen rural patients with heart failure for cognitive impairment and limited health literacy. Interventions to improve outcomes need to be developed to target rural patients who have heart failure with cognitive impairment and limited health literacy., (© 2025 National Rural Health Association.)

Background: Apolipoprotein E (ApoE) ε4 genotype is a well-known risk factor for Alzheimer's disease (AD). However, its effect on predicting cognitive decline in individuals without dementia and its association with age are unclear., Objective: To investigate the relationship between ApoE polymorphism and risk of cognitive decline and dementia incidence in the elderly without dementia., Methods: This population-based prospective study was conducted between 2011 and 2016. The study involved 767 dementia-free individuals who had undergone ApoE genotype analysis, were aged ≥ 60 years, and lived in rural China. Participants were divided into three ApoE groups: E3 (genotype 3/3), E4 (genotypes 3/4 and 4/4), and E2 (genotype 2/3) groups., Results: After 5 years, 666 (86.8%) individuals were followed up. The rate of change in MMSE score was faster in the E4 group than in the E3 and E2 groups (5.0 ± 4.4 vs. 3.5 ± 3.8 vs. 3.9 ± 3.9, p = 0.001), after adjusting for age, sex, educational level and baseline MMSE scores, especially in the 70-79 years age group. In the same age group, the incidence rate of dementia was higher in the E4 group than in the E3 group (OR = 2.850; 95% CI: 1.146-7.090). After adjusting for age, sex, hypertensive status, educational level, marital status, engagement in social activities, and past history of stroke, the ApoE ε4 allele remained an independent risk factor for dementia incidence (OR = 3.070; 95% CI: 1.162-8.110) in individuals aged 70-79 years after follow-up., Conclusions: ApoE ε4 carriers with age ≥ 60 years had faster cognitive decline. The ApoE ε4 allele was an independent risk factor for dementia incidence in extremely old individuals., (© 2025 John Wiley & Sons Ltd.)

Introduction: Psoriasis is a chronic inflammatory skin condition often associated with comorbidities that may impact cognitive function. This study aims to determine if psoriasis is associated with the risk of cognitive impairment and to assess the relationship between cognitive impairment and various disease-related factors, including psoriasis severity, disease duration, and the presence of psoriatic arthropathy, using the Virtual Cognitive Assessment Tool (VCAT)., Materials and Methods: A total of 160 individuals were selected, comprising 80 psoriasis patients and 80 controls, matched for age, gender, ethnicity, marital status, education levels, and prevalence of comorbidities. Cognitive function was assessed using the VCAT. The relationship between cognitive impairment and various disease-related factors, including psoriasis severity measured using Psoriasis Area Severity Index (PASI scores), disease duration, and the presence of psoriatic arthropathy, was examined., Results: The mean VCAT scores for the psoriasis and control groups were 25.38 (SD = 3.18) and 25.94 (SD = 2.67), respectively, with no significant difference between the two groups (p = 0.227). While most cognitive domains showed no significant differences, the VCAT attention sub-score was significantly lower in psoriasis patients (p < 0.05). There was no significant association between psoriasis and cognitive impairment. No significant association was found between cognitive function and PASI scores nor psoriatic arthropathy. A negative association was found between disease duration and VCAT scores, suggesting longer disease duration correlates with lower cognitive function (p = 0.05)., Conclusions: This study did not find broad cognitive impairment in psoriasis patients compared to controls, the specific deficit in attention and its association with the duration of psoriasis warrants further investigation. Understanding and addressing the cognitive aspects of psoriasis could significantly improve the overall quality of life for these patients.

Background: In recent years, cognitive impairment has emerged as a pivotal symptom in elderly patients with depression, exerting a substantial impact on the course and prognosis of diseases. Moreover, it persists even following remission from depression during the rehabilitation period. However, there remains an incomplete understanding of the relevant influencing factors for cognitive impairment in elderly depressed patients, which seriously impedes the development of risk prediction models and the subsequent research on precision intervention programs., Objective: The purpose of this study is to examine the current state of negative influencing factors and assessment tools for cognitive impairment in patients with late-life depression (LLD), thereby providing a theoretical framework for the construction of subsequent targeted intervention programs., Methods: The search strategy employed in this study followed an evidence-based approach, utilizing a systematic scoping review to thoroughly explore six English and four Chinese databases up until November 2023. Two researchers independently conducted article screening and employed thematic analysis to categorize the results into themes., Results: Following two rounds of rigorous screening conducted by the evidence-based research team, data were meticulously extracted and succinctly summarized from five distinct themes encompassing socio-demographic, physiological, psychological, genetic, and other related factors. In addition, a comprehensive compilation of 19 diverse assessment tools was undertaken. Ultimately, a total of 22 articles met the eligibility criteria for inclusion in this study. These comprised five longitudinal studies, nine pathological controlled studies, five cross-sectional studies, two cohort studies, and one randomized controlled study., Conclusion: Cognitive dysfunction is an important symptom of LLD, which seriously affects the survival of patients. At present, the research on its influencing factors mainly includes socio-demographic, physiological, psychological, genetic, and other related factors. There have been existing cognitive function assessment tools specifically for those 18- to 65-year-old patients of major depressive disorder, but there is still a lack of reliability and validity tests in LLD., (© 2025 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Background: Atrial fibrillation (AF) is associated with an increased risk of cognitive impairment. Therefore, exploring factors which may be associated with cognitive impairment is important. Correspondingly, this study aimed to systematically evaluate factors associated with cognitive impairment in AF patients by synthesizing relevant evidence., Methods: A database search of the PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, Wanfang, and VIP databases was conducted from inception until December 21, 2023. The effect size was expressed as a combined odds ratio (OR) and 95 % confidence interval (95 % CI). The heterogeneity was qualitatively analyzed by Cochran's Q test and quantified by the I 2 statistic., Results: A total of 7,128 studies were identified from the 8 databases, and 39 studies of 3,491,423 participants were included. A meta-analysis was performed on 19 influencing factors. Advanced age (OR=1.38, 95 % CI: 1.11-1.71), female sex (OR=2.19, 95 % CI: 1.18-4.06), smoking (OR=2.44, 95 % CI: 1.24-4.80), hypertension (OR=1.61, 95 % CI: 1.27-2.03), diabetes (OR=1.42, 95 % CI: 1.20-1.67), and hearing impairment (OR=1.37, 95 % CI: 1.05-1.81) were risk factors for cognitive impairment. A higher education level (OR=0.57, 95 % CI: 0.46-0.72), oral anticoagulants (OR=0.61, 95 % CI: 0.48-0.78), novel oral anticoagulants (OR=0.63, 95 % CI: 0.54-0.73), warfarin (OR=0.55, 95 % CI: 0.39-0.79), novel oral anticoagulants relative to warfarin (OR=0.88, 95 % CI: 0.81-0.97), catheter ablation (OR=0.74, 95 % CI: 0.58-0.94) and exercise (OR=0.66, 95 % CI: 0.61-0.72) were protective factors for cognitive impairment., Conclusions: Age, sex, education level, smoking, exercise, hypertension, diabetes, hearing impairment, anticoagulation therapy, and catheter ablation were associated with cognitive impairment in AF patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Postoperative cognitive dysfunction (POCD) is a postoperative complication of the central nervous system, especially in elderly patients. Growing evidence shows a close relationship between the kidney and cognition. This study aimed to evaluate the relationship between the subsequent risk of POCD and indicators related to the kidney., Methods: A total of 93 eligible patients (≥65 years old) undergoing elective total hip replacement were enrolled. Before and 1 day after surgery, blood samples were collected from enrolled patients. Mini-Mental State Examination and Montreal Cognitive Assessment were conducted 1 day before surgery and 1 week after surgery or at discharge. The receiver operating characteristic curve was used to examine the predictive value of the estimated glomerular filtration rate (eGFR) for POCD. Univariate and multiple logistic regression models were used to analyze the risk factors of POCD., Results: Thirty patients (32.26%) were assessed for POCD 1 week after surgery. The preoperative eGFR level in the POCD group was significantly lower than in the non-POCD group (P < 0.001). The area under the curve of eGFR was 0.739 (95% CI, 0.630-0.848; P < 0.001). The multivariable logistic regression analysis results showed that preoperative eGFR was independently associated with POCD (odds ratio = 0.965, 95% CI = 0.935-0.996, P = 0.028) after adjustment for mixed factors., Conclusion: Low eGFR is associated with an increased risk of POCD in patients undergoing elective total hip replacement surgery. Low eGFR is an effective predictor of incident POCD., (© 2025 Japanese Psychogeriatric Society.)

Background: Atrial fibrillation (AF) is a common cardiac arrhythmia associated with significant cardiovascular morbidity and mortality, as well as cognitive impairment (CI). The interplay between AF and CI is complex, involving various pathophysiological changes and numerous risk factors. Among them, depression has emerged as a significant contributor to both AF and CI, further complicating the relationship between these conditions., Objectives: This systematic review and meta-analysis aimed to investigate the influence of depression on the development of cognitive impairment in AF patients and assess the predictive value of the CHA2DS2-VASc score for CI risk., Methods: We searched PubMed, Scopus, and Web of Science for relevant studies without language or date restrictions. Ten studies, comprising 1,605,577 participants, were included. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics. Funnel plots and Egger's test evaluated publication bias., Results: Depression significantly increased the risk of CI in AF patients (OR: 2.23, 95 % CI: 1.54-3.21, p < 0.01; I2=99 %). This association persisted in studies excluding baseline CI (OR: 1.95, 95 % CI: 1.33-2.85, p < 0.01; I2=88 %). Subgroup analysis confirmed these results for both prospective (OR: 1.78, 95 % CI: 0.92-3.44, p = 0.02; I2=65 %) and retrospective studies (OR: 2.63, 95 % CI: 1.75-3.93, p < 0.01; I2=100 %). Analysis of CHA2DS2-VASc risk factors showed associations with CI, particularly cerebrovascular disease (OR: 1.86, 95 % CI: 1.61-2.16)., Conclusions: Our findings support the association between depression and cognitive impairment in AF patients, demonstrating the importance of addressing mental health in cardiovascular care. Future research is necessary for a comprehensive understanding of this association., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Frailty has been conceptualized not only as a physical disease, but also as a multidomain entity that encompasses a multimorbid status, disability, cognitive impairment, psychosocial risk factors, and even geriatric syndromes. In addition to physical ailments and depending on the diagnostic model. Standardized neuropsychological tests can identify cognitive deficiencies along with mild cognitive impairment, a pre-dementia stage characterized by memory and/or other cognitive domain impairments with relatively preserved instrumental activities of daily living. Hence, the possibility of cognitive frailty (CF), a construct that refers to physical frailty in concurrence with non-dementia cognitive decline, is proposed. The estimated prevalence of CF ranges from 10.3 to 42.8%. It is likely that the pathway to overt cognitive impairment, which does not yet involve physical function, begins with the asymptomatic early accumulation of progressive brain damage. Thus, timely detection strategies that target the initial phases of CF are warranted. The pathophysiological components of CF include dysregulation of the hypothalamic-pituitary axis stress response, imbalance in energy metabolism, impaired cardiovascular function, mitochondrial deterioration, and vascular age-related arterial stiffness. Changes that contribute to this disease can also occur at the cellular level, including overexpression of the renin-angiotensin-aldosterone system, activation of proinflammatory pathways, endothelial dysfunction, reduced nitric oxide production, and increased oxidative stress. Non-pharmacological interventions, that range from dietary and nutritional counseling to psychosocial therapy, are currently the main approaches. Both cognitive and physical training programs are considered to be the best researched and most useful multidomain interventions. Clinicians recognize CF as a valid concept that warrants prevention and treatment strategies supported by current research., (Copyright © 2024. Published by Elsevier Inc.)

Background: Adverse childhood experiences (ACEs) are associated with later cognitive decline. However, the mechanisms underlying the effects of different types of ACEs are unclear. This study examined how ACEs impact cognitive function, specifically deprivation-related ACEs (DrACEs) and threat-related ACEs (TrACEs). Additionally, we explored the potential role of cognitive reserve (CR) and depression in these relationships., Methods: Data were taken from the China Health and Retirement Longitudinal Study (CHARLS) of 2014 and 2020. CR, depressive symptoms and cognitive function measures were collected from 2020. ACEs were assessed at the 2014 Life Course Survey. The main analyses included 7113 participants aged 45 years or older. To explore potential associations, linear regression and SPSS Macro PROCESS were employed., Results: Among middle-aged and older adults, only exposure to DrACEs was associated with cognitive function ((β = -0.101 [95%CI: -0.150, -0.052]) for DrACEs = 1; (β = -0.250 [95%CI: -0.333, -0.167]) for DrACEs ≥ 2). The indirect effects mediated by CR and depressive symptoms were statistically significant., Limitations: The use of retrospective self-reported data for ACEs may introduce recall bias., Conclusions: Chinese middle-aged and older adults who have experienced DrACEs exhibit poorer cognitive function, while the association between TrACEs and cognitive function was not significant. And the impact of DrACEs on cognitive function was mediated by CR and depressive symptoms. Further research is necessary to validate our findings, establish causal links, and uncover the underlying mechanisms involved., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024. Published by Elsevier B.V.)

This study aimed to investigate the association between global cognitive functioning (GCF) and fear of falling (FOF) in a large population-based sample of adults aged 45 years and older. A total of 2997 and 2012 participants from the original sample were included in the cross-sectional and prospective models, respectively. Participants were re-coded to 'no FOF' and 'FOF' based on their self-reported responses, and those who reported FOF at follow-up were defined as the newly-developed FOF group. GCF was evaluated at baseline and follow-up (2006 and 2020) using the Korean Mini-Mental State Examination (K-MMSE). Multivariable logistic regression models were used to examine the association between GCF at baseline and risk of FOF. In our study, 23.6% (706/2997) of the participants reported FOF at baseline, and 80.3% (1615/2012) reported newly-developed FOF in the follow-up cohort. Importantly, the negative association between GCF and FOF was observed not only in the cross-sectional analyses (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.96-0.99) but also in the prospective analyses (OR 0.93, 95% CI 0.87-0.99). Furthermore, GCF was associated with lower odds of recurrent newly-developed FOF in the stable group than in the original sample (OR 0.87, 95% CI 0.78-0.97 vs OR 0.92, 95% CI 0.86-0.98). Thus, GCF was negatively associated with FOF at baseline and newly-developed FOF in the long-term follow-up cohort, and persistent deficits in GCF may increase the risk of newly-developed FOF. Further research should explore the mechanisms underlying the longitudinal relationship between GCF and newly-developed FOF., Competing Interests: Declaration of Competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Although links between social networks and mild cognitive impairment (MCI) have been suggested. The pathway between social networks and MCI from the Person-Environment-Occupation (PEO) model perspective among older adults remains inconclusive., Objective: To examine the relationship between social networks and MCI, and further identify whether neuropsychological factors mediate the relationship., Methods: 1036 participants aged 55 to 75 years were recruited from two districts of Fuzhou, China, from December 2020 to December 2022. Data were obtained via a face-to-face neuropsychological scale assessment. Social networks and cognitive function were assessed by the Lubben Social Network Scale and the Montreal Cognitive Assessment, respectively. The mediation model and structural equation model (SEM) pathway analysis were used to examine the direct and indirect effects of social networks on MCI via neuropsychological factors., Results: Data from 580 participants were analyzed (year: 65.16 ± 5.38). Regression analysis indicated that higher levels of social networks and psychological resilience were positively correlated with improved cognitive function, even after adjusting for demographic data. Increased depressive symptoms and poor sleep quality were linked to cognitive decline. Support from family members had a greater impact than support from friends in reducing the risk of developing MCI. The SEM model supported the hypothesis that significant indirect effects of social networks on MCI via psychological resilience, depressive tendencies, and sleep quality., Conclusions: The effects of social networks on MCI are mediated by psychological resilience, depressive tendencies, and sleep quality., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Postoperative cognitive dysfunction (POCD) is a common complication in elderly patients, and cerebral small vessel disease (CSVD) has been suggested as a potential risk factor. This review examines the relationship between POCD and CSVD from epidemiological, pathophysiological, and clinical perspectives, while also considering the role of Alzheimer's disease (AD) pathology. We conducted a comprehensive literature search of major databases, supplemented by reference list checking, to ensure a thorough review of studies published between 2000 and 2023 on the relationship between POCD and CSVD. Epidemiological studies have shown that POCD and CSVD are associated in terms of common risk factors, including advanced age, vascular comorbidities, impaired baseline cognitive function, and certain population characteristics. Animal studies have revealed that CSVD and POCD share similar neuropathological changes, including abnormal cerebral hypoperfusion, inflammatory responses, and blood-brain barrier disruption. Furthermore, recent research suggests a complex interplay between CSVD, AD pathology, and POCD, with potential synergistic effects on cognitive decline. Neuroimaging studies have further demonstrated that preoperative CSVD burden and postoperative CSVD progression are associated with the development of POCD, and the presence of both CSVD and AD markers may increase the risk of cognitive decline. The association between CSVD and POCD has important implications for the perioperative management of elderly patients, including preoperative assessment, choice of anesthesia and surgical methods, intraoperative management, postoperative care, and long-term follow-up. A better understanding of the relationship between CSVD and POCD will guide evidence-based strategies to prevent and manage this debilitating complication in the aging population.

Objective: The incidence of mild cognitive impairment among the elderly in China was increasing. Widowhood, depression, and disability were significant factors that impacted cognitive function. Yet, there was currently no research, both domestically and internationally, that comprehensively examines all these factors together. Therefore, in order to achieve successful aging, the objective of this study is to investigate the impact and pathway of depression and disability on the association between widowhood and cognitive function in the elderly population of China, with the aim of establishing a robust foundation for developing evidence-based strategies to prevent and manage cognitive impairment among older adults in China., Methods: The 2018 Chinese Longitudinal Healthy Longevity Survey data was utilized to assess cognitive function, depression level, and disability status using the Mini-Mental State Examination, The Center for Epidemiological Studies Depression-10 scale, and the Katz scale. The mediating role of depression and disability in the association widowhood and cognitive function were tested by the bruceR package in R Studio., Results: A total of 7973 elderly individuals aged over 65 were included in the study, with nearly 50% being widowed. Widowhood was identified as a significant risk factor for cognitive impairment in the elderly population. The results from the analysis of mediating effects indicated that both depression and disability independently mediated this relationship, while also contributing to a chain-mediated effect on the association between widowhood and cognitive function in the population., Conclusion: We recommend that greater attention be dedicated to this population, and measures be implemented to enhance their mental well-being and disability management, thereby improving cognitive function., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Developing machine learning (ML) models to predict cognitive impairment among Medicare beneficiaries in the United States., Methods: This retrospective study used the 2016-2019 Medicare Current Beneficiary Survey Cost and Use and Survey Public Use Files. Medicare beneficiaries aged 65 and older (n=4,965) with at least two consecutive years' data were included. Cognitive impairment was categorized into three stages: severe, moderate, and none based on self-reported data. Baseline year's demographic, socioeconomic factors, self-reported functional limitations, health status and comorbidities, number of concurrent medications, level of social engagement, behavioral variables, and satisfaction of medical care's quality were features assessed in ML algorithms to predict next years' cognitive function. ML models in six major categories were developed, tested, and compared (accuracy, AUC, and F1 score) using Python version 3.11. The importance of features was evaluated using the total reduction of the Gini. A subgroup analysis was conducted among beneficiaries who were 80 years and older., Results: Approximately 11.1% of beneficiaries aged ≥ 65 had moderate or severe cognitive function impairment. Baseline cognitive function was the most significant predictor for next year's cognitive function impairment, followed by baseline IADL, level of social activities, ADL, general health status, income, age, education, region of residence, and body mass index. Beneficiaries 80 years and older had satisfaction of medical care's quality among the top 10 most significant predictors., Conclusions: Older adults' baseline cognitive function and IADL were top two predictors of cognitive function impairment. Clinicians should regularly screen and monitor older adults' cognitive and daily function., Competing Interests: Declaration of competing interest The authors have no conflicts to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty., Methods: Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0-2 (non-frail), 3-6 (frail) and 7-14 (most-frail). Data were analyzed using descriptive statistics., Results: Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %)., Conclusions: One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm., Competing Interests: Declaration of competing interest A.J.C. has received grant or consulting funds from the Medical Research Future Fund, Dementia Australia Research Foundation and the Pharmaceutical Society of Australia. All these funds were paid to the administering University. A.J.C. is also a national board director for the Pharmaceutical Society of Australia. S.H. belongs to an endowed chair funded by donations from Hakue technology, PROUMED, Japan Bio Products, Towa Pharmaceutical, Yellow Eight and Sugi Holdings and received research funding from SOMPO Care Inc. outside of this work. N.M.V. has received grant or consulting funds from UCB Biopharma, Nestlé and Vegenat. R.V. was previously on the board of Resthaven and the board governance committee. Visvanathan is co-founder and chair of the clinical advisory group for a wearable sensor technology start-up HealthVibes.ai. J.S.B. has received grant or consulting funds from the NHMRC, Medical Research Future Fund, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Australian Commission on Safety and Quality in Health Care, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organizations. All these funds were paid to the administering University. All other authors have no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier B.V.)

Background: Neurocognitive and neuropsychiatric symptoms are essential clinical manifestations of age-related cognitive impairment, yet their patterns of co-existence remain unclear through the cognitive continuum., Objective: To examine the associations of person-centered cluster-derived patterns, based on a comprehensive collection of domain-specific cognitive and neuropsychiatric assessments, with neuroimaging markers and dementia risk., Methods: 641 participants were included in the analysis from memory clinics in Singapore. Latent class analysis was applied to define clusters of individuals with different clinical patterns. The associations between identified clinical groups with neuroimaging markers of cerebrovascular diseases and neurodegeneration were analyzed using logistic regression models. Cox proportional hazard models were applied for incident dementia., Results: Three latent classes differing in neurocognitive and neuropsychiatric impairment were identified (Class 1 "memory impairment only"; Class 2 "global cognitive impairment"; Class 3 "global cognitive and neuropsychiatric impairment"). Compared with Class 1, Class 2 and 3 were associated with smaller brain volumes, moderate-to-severe cortical atrophy and medial temporal lobe atrophy, and the presence of all cerebrovascular lesions. Moreover, compared with Class 2, Class 3 had smaller brain volumes, moderate-to-severe cortical atrophy and presence of intracranial stenosis. Additionally, compared to Class 1, Class 2 (hazard ratio [HR] = 3.84, 95%CI 2.11-7.00), and Class 3 (HR = 6.92, 95%CI 2.84-16.83) showed an increased risk of incident dementia., Conclusions: Participants characterized by multi-domain cognitive impairment and co-occurrence of cognitive and neuropsychiatric impairment showed the highest risk of incident dementia, which may be attributed to both neurodegenerative and cerebrovascular pathologies., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To evaluate whether early age of first exposure to contact sports (AFE-CS) is associated with worse long-term brain health outcomes., Design: A cross-sectional, survey study of older men with a history of contact sport participation was completed., Setting: Tertiary care facility., Participants: A cohort of community-dwelling older men dichotomized by using AFE-CS (<12 years vs ≥12 years)., Interventions: Independent variables included a dichotomized group of AFE-CS (<12 years vs ≥12 years)., Main Outcome Measures: Brain health outcomes measured by depression, anxiety, cognitive difficulties, and neurobehavioral symptoms. Endorsements of general health problems, motor symptoms, and psychiatric history were also collected. Age of first exposure groups was compared using t tests, χ 2 tests, and multivariable linear regressions, which included the following covariates: age, number of prior concussions, and total years of contact sport., Results: Of 69 men aged 70.5 ± 8.0 years, approximately one-third of the sample (34.8%) reported AFE-CS before age 12 years. That group had more years of contact sports (10.8 ± 9.2 years) compared with those with AFE-CS ≥12 (5.6 ± 4.5 years; P = 0.02). No differences were found after univariate testing between AFE-CS groups on all outcomes ( P -values >0.05). Multivariable models suggest that AFE-CS is not a predictor of depression or anxiety. Those in the AFE-CS <12 group had fewer cognitive difficulties ( P = 0.03) and fewer neurobehavioral symptoms ( P = 0.03)., Conclusions: Those with AFE-CS <12 to contact sports did not have worse long-term brain health outcomes compared with those with AFE-CS ≥12. Individuals with AFE-CS <12 had significantly lower British Columbia Cognitive Complaints Inventory and Neurobehavioral Symptom Inventory scores compared with those with AFE-CS ≥12., Clinical Relevance: The benefits of earlier AFE-CS may outweigh the risks of head strikes and result in comparable long-term brain health outcomes., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To analyse the association between fruit consumption and cognitive performance in middle-aged and older adults in China., Methods: Participants were drawn from the Chinese Square Dance Cohort. The cross-sectional dataset included 4316 individuals, with their first visit from August 2020 to August 2023. The longitudinal dataset included 1465 participants, with their first visit from August 2020 to December 2021 and follow-up visits from August 2022 to December 2023. Fruit consumption was assessed using a food frequency questionnaire. Standardised neuropsychological assessments were used to measure composite z-scores of cognitive performance, and prevalent and incident mild cognitive impairment., Results: In the cross-sectional analysis, higher quartiles of citrus fruit, drupe, berry, and tropical fruit consumption were associated with higher composite z-scores for cognitive performance and lower odds of prevalent mild cognitive impairment. In the longitudinal analysis, there was a positive association between higher quartiles of citrus fruit intake and the annual rate of change in the composite z-scores for cognitive performance; standardised regression coefficient (95 % confidence interval) for the highest compared with the lowest quartile was 0.05 (0.02-0.08). Moreover, an association between higher quartiles of citrus fruit intake and a lower risk of incident mild cognitive impairment was detected; in the comparison of the highest with the lowest quartile, the risk ratio (95 % confidence interval) was 0.56 (0.36-0.88)., Conclusions: The relationship between fruit consumption and cognition varies across the different categories of fruit. Cognitive benefits of citrus fruit consumption were found for middle-aged and older adults. Ascertaining this association might enhance comprehensive dietary recommendations for fruit consumption., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Backgruound: The association of changes in metabolic syndrome (MetS) with cognitive function remains unclear. We explored this association using prospective and Mendelian randomization (MR) studies., Methods: MetS components including high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), waist circumference (WC), fasting plasma glucose (FPG), and triglycerides were measured at baseline and two follow-ups, constructing a MetS index. Immediate, delayed memory recall, and cognitive function along with its dimensions were assessed by immediate 10- word recall test (IWRT) and delayed 10-word recall test (DWRT), and mini-mental state examination (MMSE), respectively, at baseline and follow-ups. Linear mixed-effect model was used. Additionally, the genome-wide association study (GWAS) of MetS was conducted and one-sample MR was performed to assess the causality between MetS and cognitive function., Results: Elevated MetS index was associated with decreasing annual change rates (decrease) in DWRT and MMSE scores, and with decreases in attention, calculation and recall dimensions. HDL-C was positively associated with an increase in DWRT scores, while SBP and FPG were negatively associated. HDL-C showed a positive association, whereas WC was negatively associated with increases in MMSE scores, including attention, calculation and recall dimensions. Interaction analysis indicated that the association of MetS index on cognitive decline was predominantly observed in low family income group. The GWAS of MetS identified some genetic variants. MR results showed a non-significant causality between MetS and decrease in DWRT, IWRT, nor MMSE scores., Conclusion: Our study indicated a significant association of MetS and its components with declines in memory and cognitive function, especially in delayed memory recall.

Objectives: Research indicates adverse childhood experiences (ACEs) were associated with subjective cognitive decline (SCD), with higher ACEs reported by sexual minoritized individuals (i.e. lesbian, gay, and bisexual; LGB). This study aimed to explore the relationships between ACEs and SCD based on sexual orientation in middle-aged and older adults., Methods: The study included 76,592 participants from the 2019-2020 Behavioral Risk Factor Surveillance Survey (BRFSS). Multivariate logistic regressions analyzed ACEs status, score, and type associations with SCD., Results: 2.18% of the participants identified as sexual minoritized individuals. More sexual minoritized individuals reported SCD compared to heterosexual individuals (10.70% for heterosexuals; 17.27% for sexual minoritized individuals). Positive association between SCD and ACEs status (OR = 2.18, 95%CI: 1.09-4.40) was identified among sexual minoritized individuals., Conclusions: The association between ACEs and SCD was strong in both heterosexual and sexual minoritized populations. Given the higher experience of ACEs among sexual minoritized adults, the subsequent frequency of SCD among these adults also may be higher., Clinical Implications: Sexual minoritized older adults may have a history of numerous ACEs, which could contribute to a greater burden of SCD. Clinicians and other stakeholders may wish to consider relationships between ACEs and SCD based on sexual orientation.

Background and Purpose: Affective disturbances and cognitive impairment are common sequelae of intracerebral hemorrhage (ICH), yet predictive models for these outcomes remain limited, especially for spontaneous supratentorial ICH with small hematomas (<30 mL). The aim of this study was to investigate predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage., Methods: We retrospectively analyzed 1692 patients with spontaneous supratentorial ICH between January 2018 and December 2020 at the First Affiliated Hospital of Harbin Medical University. Of these, 1563 patients completed a median follow-up of 3.5 years. Cognitive function was evaluated using the modified Telephone Interview for Cognitive Status, and affective disturbances using the Hamilton Depression Scale and the Hamilton Anxiety Scale. Restricted cubic spline analyses were employed to examine the relationships between predictors and outcomes., Results: In this cohort, 58.5% had cognitive impairment, 52.8% reported depressive symptoms, and 39.4% exhibited anxiety symptoms. Logistic regression models using Boruta's algorithm demonstrated strong predictive capacity, with areas under the curve of 0.82 for cognitive impairment, 0.78 for depressive symptoms, and 0.73 for anxiety symptoms. Hematoma volume was significantly linked to depressive symptoms (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.38-1.76) and inversely to cognitive impairment (OR 0.67, 95% CI 0.59-0.77). Uric acid levels displayed a nonlinear relationship with cognitive impairment (OR 0.70, 95% CI 0.61-0.81). Hospitalization days significantly raised the risk of both depressive (OR 1.16, 95% CI 1.03-1.30) and anxiety symptoms (OR 1.17, 95% CI 1.04-1.31)., Conclusions: The logistic regression model, enhanced by Boruta's algorithm, provides a valuable tool for predicting affective disturbances and cognitive impairment after ICH. It facilitates early identification and improves risk assessment for these neuropsychiatric outcomes in patients with small hematomas., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Background: Cognitive impairment affects nearly half of vascular surgery patients, but its association with postoperative outcomes remains poorly understood. This study explores the link between preoperative cognitive performance and postoperative complications, including postoperative delirium, in vascular surgery patients., Methods: A prospective cohort study was conducted on vascular surgery patients aged ≥65. Preoperative cognitive performance was assessed using the Montreal Cognitive Assessment, and postoperative complications were evaluated using the Comprehensive Complication Index. The association was analyzed through multivariable logistic regression., Results: Among 110 patients (18.2 ​% female, mean age 73.8 ​± ​5.7 years), cognitive impairment was evident in 48.2 ​%. Of the participants, 29 (26.3 ​%) experienced postoperative complications, among which 11 (10 ​%) experienced postoperative delirium. The adjusted odds ratio for the association between cognitive performance and postoperative complications was 1.19 (95 ​% CI 1.02-1.38; p ​= ​0.02)., Conclusion: Worse preoperative cognitive performance correlated with increased odds of postoperative complications and postoperative delirium in vascular surgery patients., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

HIV stigma is associated with suboptimal clinical outcomes and has been cross-sectionally linked to cognitive deficits in people with HIV (PWH). However, it is unclear whether HIV stigma precedes cognitive decline or vice versa. We examined associations in 303 adult PWH (mean age 50.01 (11.91) years; 46% female; 67% non-Hispanic Black) between the abbreviated Berger Stigma Scale score and longitudinal change across the NIH Toolbox Cognition Battery measures. 89% of participants reported experiencing HIV stigma. In unadjusted analyses, greater HIV stigma was associated with worse attention performance at yearly follow-up visits (B = -0.07, 95% CI = -0.13 - -0.01, p = 0.025). When adjusting for clinicodemographic variables, HIV stigma was associated with worse processing speed and global cognition at yearly follow-up visits. This finding suggests that HIV stigma precedes subsequent cognitive decline and highlights the importance of reducing stigma to improve cognitive functioning among PWH., Competing Interests: Declarations. Competing Interests: The authors declare that they have no relevant competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To identify which cognitive functions and specific neuropsychological assessments predict falls in older people living in the community., Methods: Five electronic databases were searched until 30/08/2022 for studies assessing the association between specific cognitive functions and faller status (prospective and retrospective), in community-dwelling older people. Risk of bias was assessed with the Newcastle-Ottawa Scale. Meta-analyses synthesised the evidence regarding the associations between different neurocognitive subdomains and faller status., Results: Thirty-eight studies (20 retrospective, 18 prospective) involving 37,101 participants were included. All but one study was rated high or medium quality. Meta-analyses were performed with data from 28 studies across 11 neurocognitive subdomains and four specific neuropsychological tests. Poor cognitive flexibility, processing speed, free recall, working memory and sustained attention were significantly associated with faller status, but poor verbal fluency, visual perception, recognition memory, visuo-constructional reasoning and language were not. The Trail Making Test B was found to have the strongest association with faller status., Conclusion: Poor performance in neurocognitive subdomains spanning processing speed, attention, executive function and aspects of memory are associated with falls in older people, albeit with small effect sizes. The Trail Making Test, a free-to-use, simple assessment of processing speed and mental flexibility, is recommended as the cognitive screening test for fall risk in older people., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Stephen Lord reports financial support was provided by National Health and Medical Research Council. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Globally, loneliness is a growing public health concern associated with poor mental and physical health among older adults. Therefore, we performed a meta-analysis to explore the prevalence of loneliness and associated risk factors among older adults across six continents., Methods: Web of Science, PubMed, Embase, CINAHL, Cochrane Library, and references lists were comprehensively searched until April 2024. Data analysis was performed using Logit Transformation model in R-Software for pooled prevalence and DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis for associated factors of loneliness. Heterogeneity was quantified by I 2 and τ 2 statistics. The funnel plot and Egger's regression test assessed publication bias., Results: A total of 70 studies with 462,083 older adults were included. The pooled prevalence of loneliness was 26 % (95 %CI, 23 %-30 %) with 38 % for North America, 34 % for Africa, 32 % for Asia and South America, 23 % for Europe, and 13 % for Oceania. Cognitive impairment (2.98; 95 %CI, 1.30-6.81), poor health (2.35; 95 %CI, 1.59-3.45), female (1.92; 95 %CI, 1.53-2.41), depression (1.74; 95 %CI, 1.40-2.16), widowed (1.67; 95 %CI, 1.13-2.48), single (1.51; 95 %CI, 1.06-2.17), institutionalization (2.95; 95 %CI, 1.48-5.88), rural residency (1.18; 95 %CI, 1.04-1.34) were associated with increased risk of loneliness. Being married (0.51; 95 %CI, 0.31-0.82), male (0.55; 95 %CI, 0.43-0.70), and non-institutionalization (0.34; 95 %CI, 0.17-0.68) were associated with lower risk of loneliness., Conclusion: Approximately, three among ten older adults aged ≥ 60 years are lonely worldwide. Early detection, prevention, and management of loneliness among older adults should consider diverse needs using gender-specific approaches., Competing Interests: Declaration of competing interest Authors declare no conflict of interest., (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

Background: Choline, an essential nutrient, plays a critical role in cognition, and may help prevent dementia and mild cognitive impairment. However, studies on dietary choline and its derivatives for preventing these conditions are limited and inconsistent., Objective: The objective of this study was to explore the associations between dietary choline intake and the incidence of dementia, Alzheimer disease (AD), mild cognitive impairment (MCI), and current cognitive performance in the United Kingdom Biobank cohort., Methods: Dietary choline intake was categorized into quartiles of consumption based on 24-h dietary recalls, with units expressed as milligrams per day. Diagnoses of dementia, AD, and MCI were identified using the International Classification of Diseases (ICD-9/10) codes. Current cognitive performance was assessed via the computerized touchscreen interface. After adjusting for sociodemographic factors, dietary and lifestyle behaviors, and comorbid conditions, Cox proportional hazards regression, logistic regression, and restricted cubic splines were used to analyze the association between choline intake and dementia or cognitive performance., Results: Among 125,594 participants (55.8% female), with a mean age of 56.1 y (range: 40-70 years) at baseline and a median follow-up of 11.8 y, 1103 cases of dementia (including 385 AD and 87 cases of MCI) were recorded. U-shaped associations were observed between choline intake and dementia and AD. Participants in the 2nd quartile of total choline intake had lower risks than those in the lowest quartile, with HR of 0.80 (95% CI: 0.67, 0.96) for dementia and 0.76 (95% CI: 0.58, 1.00) for AD. Moderate intake of choline derivative, including free choline (HR, 0.77; 95%CI, 0.65, 0.92), phosphatidylcholine (HR 0.82; 95% CI: 0.68, 0.98), sphingomyelin (HR 0.82; 95% CI: 0.69, 0.98) and glycerophosphocholine (HR 0.83; 95% CI: 0.70, 1.00), were associated with a 17%-23% lower odds of dementia. Additionally, moderate total choline intake was associated with an 8%-13% lower odds of poor cognitive performance in visual attention (OR: 0.92; 95% CI: 0.86, 0.99), fluid intelligence (OR: 0.87; 95% CI: 0.82, 0.92), and complex processing speed (OR: 0.90; 95% CI: 0.84, 0.95)., Conclusions: In conclusion, our findings suggest that moderate dietary choline intake, ranging from 332.89 mg/d to 353.93 mg/d, is associated with lower odds of dementia and better cognitive performance., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)