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L5, the most electronegative subfraction of low-density lipoprotein cholesterol (LDL-C), may play a role in the pathogenesis of cerebrovascular dysfunction and neurodegeneration. We hypothesized that serum L5 is associated with cognitive impairment and investigated the association between serum L5 levels and cognitive performance in patients with mild cognitive impairment (MCI). This cross-sectional study conducted in Taiwan included 22 patients with MCI and 40 older people with normal cognition (healthy controls). All participants were assessed with the Cognitive Abilities Screening Instrument (CASI) and a CASI-estimated Mini-Mental State Examination (MMSE-CE). We compared the serum total cholesterol (TC), LDL-C, and L5 levels between the MCI and control groups and examined the association between lipid profiles and cognitive performance in these groups. The serum L5 concentration and total CASI scores were significantly negatively correlated in the MCI group. Serum L5% was negatively correlated with MMSE-CE and total CASI scores, particularly in the orientation and language subdomains. No significant correlation between the serum L5 level and cognitive performance was noted in the control group. Conclusions: Serum L5, instead of TC or total LDL-C, could be associated with cognitive impairment through a disease stage-dependent mode that occurs during neurodegeneration.

Background The rate of undetected dementia is high in China. However, the performance of dementia screening tools may differ in the Chinese population due to the lower education level and cultural diversity. This study aimed to evaluate the diagnostic accuracy of dementia screening tools in the Chinese population. Methods Eleven electronic databases were searched for studies evaluating the diagnostic accuracy of dementia screening tools in older Chinese adults. The overall diagnostic accuracy was estimated using bivariate random-effects models, and the area under the summary receiver operating characteristic curve was presented. Results One hundred sixty-seven studies including 81 screening tools were identified. Only 134 studies qualified for the meta-analysis. The Mini-Mental State Examination (MMSE) was the most commonly studied tool, with a combined sensitivity (SENS) and specificity (SPEC) of 0.87 (95%CI 0.85–0.90) and 0.89 (95%CI 0.86–0.91), respectively. The Addenbrooke’s Cognitive Examination-Revised (ACE-R) (SENS: 0.96, 95%CI 0.89–0.99; SPEC: 0.96, 95%CI 0.89–0.98) and Montreal Cognitive Assessment (MoCA) (SENS: 0.93, 95%CI 0.88–0.96; SPEC: 0.90, 95%CI 0.86–0.93) showed the highest performance. The General Practitioner Assessment of Cognition (GPCOG), Hasegawa’s Dementia Scale and Cognitive Abilities Screening Instrument had performances comparable to that of the MMSE. The cut-off scores ranged widely across studies, especially for the MMSE (range: 15–27) and MoCA (range: 14–26). Conclusions A number of dementia screening tools were validated in the Chinese population after cultural and linguistical adaptations. The ACE-R and MoCA had the best diagnostic accuracy, whereas the GPCOG, with an administration time

Objective:The Cognitive Abilities Screening Instrument (CASI) is a screening test of global cognitive function used in research and clinical settings. However, the CASI was developed using face validity and has not been investigated via empirical tests such as factor analyses. Thus, we aimed to develop and test a parsimonious conceptualization of the CASI rooted in cognitive aging literature reflective of crystallized and fluid abilities.Design:Secondary data analysis implementing confirmatory factor analyses where we tested the proposed two-factor solution, an alternate one-factor solution, and conducted a χ2 difference test to determine which model had a significantly better fit.Setting:N/A.Participants:Data came from 3,491 men from the Kuakini Honolulu-Asia Aging Study.Measurements:The Cognitive Abilities Screening Instrument.Results:Findings demonstrated that both models fit the data; however, the two-factor model had a significantly better fit than the one-factor model. Criterion validity tests indicated that participant age was negatively associated with both factors and that education was positively associated with both factors. Further tests demonstrated that fluid abilities were significantly and negatively associated with a later-life dementia diagnosis.Conclusions:We encourage investigators to use the two-factor model of the CASI as it could shed light on underlying cognitive processes, which may be more informative than using a global measure of cognition.

Although heavy alcohol consumption has been identified as a risk factor for adverse cognitive functioning, it currently remains unclear whether moderate alcohol consumption exerts similar effects. Observational studies previously reported the potential benefits of moderate alcohol consumption on cognition, particularly in the elderly; however, these effects have not yet been demonstrated in Asian populations. The aim of the present study was to investigate the relationship between alcohol consumption levels and global and domain-specific cognitive functions in cognitively intact elderly Japanese men. Cross-sectional data from the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA), an ongoing prospective, population-based study in Shiga, Japan, were used to examine the relationship between alcohol consumption and cognitive function. Men (n = 585) aged ≥65 years provided information on their weekly consumption of alcohol, and the data obtained were used to construct categories of never, ex- (quit before interview), very light (14 g/day), light (14-23 g/day), moderate (23-46 g/day), and heavy (46 g/day) drinkers. Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI). A fractional logistic regression model adjusted for age, education, body mass index, smoking, exercise, hypertension, diabetes, and dyslipidemia showed that the CASI scores for global and domain-specific cognitive functions were not significantly different between all subgroups of current drinkers and never-drinkers. However, the CASI score of ex-drinkers (multivariable adjusted mean CASI score [SD]) was significantly lower than that of never-drinkers in the global [never vs. ex: 90.16 (2.21) vs. 88.26 (2.58)] and abstraction and judgment domain [never vs. ex: 9.48 (0.46) vs. 8.61 (0.57)]). The present results do not suggest any beneficial or adverse relationship between current alcohol consumption levels and cognitive functioning (both global and domain specific) in elderly Japanese men; however, low cognitive function among ex-drinkers warrants future investigations to identify the factors causing drinkers to quit.

Background Cognitive impairment is a public health burden. Our objective was to investigate associations between work hours and cognitive function. Methods Multi-Ethnic Study of Atherosclerosis (MESA) participants (n = 2,497; 50.7% men; age range 44–84 years) reported hours per week worked in all jobs in Exams 1 (2000–2002), 2 (2002–2004), 3 (2004–2005), and 5 (2010–2011). Cognitive function was assessed (Exam 5) using the Cognitive Abilities Screening Instrument (version 2), a measure of global cognitive functioning; the Digit Symbol Coding, a measure of processing speed; and the Digit Span test, a measure of attention and working memory. We used a prospective approach and linear regression to assess associations for every 10 hours of work. Results Among all participants, associations of hours worked with cognitive function of any type were not statistically significant. In occupation-stratified analyses (interaction p = 0.051), longer work hours were associated with poorer global cognitive function among Sales/Office and blue-collar workers, after adjustment for age, sex, physical activity, body mass index, race/ethnicity, educational level, annual income, history of heart attack, diabetes, apolipoprotein E-epsilon 4 allele (ApoE4) status, birth-place, number of years in the United States, language spoken at MESA Exam 1, and work hours at Exam 5 (β = –0.55, 95% CI = –0.99, –0.09) and (β = –0.80, –1.51, –0.09), respectively. In occupation-stratified analyses (interaction p = 0.040), we also observed an inverse association with processing speed among blue-collar workers (adjusted β = –0.80, –1.52, –0.07). Sex, race/ethnicity, and ApoE4 did not significantly modify associations between work hours and cognitive function. Conclusion Weak inverse associations were observed between work hours and cognitive function among Sales/Office and blue-collar workers.

Objectives: The Clinical Dementia Rating (CDR) Scale is the gold standard for the staging of dementia due to Alzheimer's disease (AD). However, the application of CDR for the staging of subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in AD remains controversial. This study aimed to use the sum of boxes of the CDR (CDR-SB) plus an SCD single questionnaire to operationally determine the different stages of cognitive impairment (CI) due to AD and non-AD.Methods: This was a two-phase study, and we retrospectively analyzed the Show Chwan Dementia registry database using the data selected from 2015 to 2020. Individuals with normal cognition (NC), SCD, MCI, and mild dementia (MD) due to AD or non-AD with a CDR < 2 were included in the analysis.Results: A total of 6,946 individuals were studied, including 875, 1,009, 1,585, and 3,447 with NC, SCD, MCI, and MD, respectively. The cutoff scores of CDR-SB for NC/SCD, SCD/MCI, and MCI/dementia were 0/0.5, 0.5/1.0, and 2.5/3.0, respectively. The receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) values of the test groups were 0.85, 0.90, and 0.92 for discriminating NC from SCD, SCD from MCI, and MCI from dementia, respectively. Compared with the Cognitive Abilities Screening Instrument or the Montreal Cognitive Assessment, the use of CDR-SB is less influenced by age and education.Conclusion: Our study showed that the operational determination of SCD, MCI, and dementia using the CDR-SB is practical and can be applied in clinical settings and research on CI or dementia.

Few studies have examined associations between neighborhood built environments (BE) and longitudinally measured cognition. We examined whether four BE characteristics were associated with six-year change in global cognition and processing speed. We obtained data on 1816 participants without dementia from the Multi-Ethnic Study of Atherosclerosis. BE measures included social destination density, walking destination density, proportion of land dedicated to retail, and network ratio (street connectivity). Global cognition was measured with the Cognitive Abilities Screening Instrument (CASI) and processing speed with the Digit Symbol Coding test (DSC). Multivariable random intercept logistic models tested associations between neighborhood BE at 2010–2012 and maintained/improved cognition (versus decline) from 2010–2018, and mediation by minutes of physical activity (PA)/week. The sample was an average of 67 years old (standard deviation = 8.2) (first cognitive measurement) and racially/ethnically diverse (29% African American, 11% Chinese, 17% Hispanic, 44% White). Compared to individuals with no walking destinations in the 1-mile surrounding their residence, those with 716 walking destinations (maximum observed) were 1.24 times more likely to have maintain/improved DSC score (Odds ratio: 1.24, 95% confidence interval: 1.03–1.45). No other associations were observed between BE and cognition, and PA minutes/week did not mediate the association between walking destination density and DSC change. This study provides limited evidence for an association between greater neighborhood walking destinations and maintained/improved processing speed in older age and no evidence for associations between the other BE characteristics and cognition. Future studies with finer grained BE and cognitive measures and longer-term follow up may be required.

Background/Aims: To detect cognitive decline in older adults, measures of verbal fluency and verbal memory are widely used. Less is known about performance in these measures in younger persons or according to education level and gender. We investigated cognitive performance according to age, education and gender among cognitively healthy adults aged 30–100 years. Methods: The study population comprised 4,174 cognitively healthy persons participating in the nationally representative Finnish Health 2011 survey. Cognitive assessment included verbal fluency, word list memory, word list recall and word list savings from the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery. Results: Total variance in the cognitive test performance explained by age, education and gender varied from 12.3 to 31.2%. A decreasing trend in cognitive performance existed in all subtests by advancing age, with differences appearing between 50 and 55 years. Persons with the highest-education level performed best for all measures. For the participants < 55 years, education explained part of the variance, while age and gender did not. Conclusions: When assessing cognition, age and education should be accounted for in more detail in research and clinical practice. Additionally, the cohort effect and its potential impact on the renewal cycle of future normative values for cognitive tests should be considered.

Background: The aim of this study is to investigate the validity of the coin-in-the-hand (CIH) test with other neuropsychological tests for the detection of malingering in the memory. Materials and Methods: A simulated scenario design was developed to investigate the validity of the CIH test, entitled the Test of Memory Malingering (TOMM), associated with the Clinical Dementia Rating, the cognitive abilities screening instrument, the Mini-Mental Status Examination, and the WHO Quality of Life-BREF. The performances of the patients with dementia (n = 25) were compared with one group of normal controls (n = 9), and another group instructed to simulate malingering dementia (n = 19). Results: The CIH test demonstrated good validity and displayed a better sensitivity and a positive likelihood ratio than the TOMM, while patients with dementia could provide, on average, more than nine correct answers, in comparison to only more than six correct answers in the simulated malingering group. The optimal cutoff score of the CIH test is ≤8. Conclusions: This pilot study showed that the CIH test is a quick and practical test for detecting malingering in the memory.

Background: The Cognitive Abilities Screening Instrument (CASI) is increasingly used to assess general cognitive function in people with dementia. The Mini-Mental State Examination (MMSE) score can be converted from the CASI (i.e., the estimated MMSE). Recognizing that measurement equivalence is critical to meaningfully representing one with the other, we aimed to determine whether the estimated MMSE score obtained from the CASI was equivalent to the original MMSE in people with dementia. Methods: We obtained 110 data points for the MMSE and CASI scores in people with dementia. The intraclass correlation coefficient (ICC), Pearson’s r, percent of standard error of measurement (SEM%), paired t-test, and effect size (Cohen’s d) were used to investigate the equivalence. Results: To examine the equivalence between the original and estimated MMSE score, the ICC and Pearson’s r of the total score and six domains were 0.62–0.95 and 0.62–0.96, respectively. The SEM% of the total score and six domains were 0.6–8.9%. The paired t-test results showed a significant difference (p &lt, 0.05) between the total score and the three domains. The Cohen’s d of the total score and six domains were 0.06–0.27. Conclusions: The estimated MMSE score was found to have moderate to excellent equivalence to the original MMSE score. The three domains (i.e., registration, attention and calculation, and visual-constructional ability) with moderate equivalence should be used cautiously to interchange with the original MMSE in people with dementia.

Introduction As the number of U.S. veterans over age 65 has increased, interest in whether military service affects late-life health outcomes has grown. Whether military employment is associated with increased risk of cognitive decline and dementia remains unclear. Materials and Methods We used data from 4,370 participants of the longitudinal Adult Changes in Thought (ACT) cohort study, enrolled at age 65 or older, to examine whether military employment was associated with greater cognitive decline or higher risk of incident dementia in late life. We classified persons as having military employment if their first or second-longest occupation was with the military. Cognitive status was assessed at each biennial Adult Changes in Thought study visit using the Cognitive Abilities Screening Instrument, scored using item response theory (CASI-IRT). Participants meeting screening criteria were referred for dementia ascertainment involving clinical examination and additional cognitive testing. Primary analyses were adjusted for sociodemographic characteristics and APOE genotype. Secondary analyses additionally adjusted for indicators of early-life socioeconomic status and considered effect modification by age, gender, and prior traumatic brain injury with loss of consciousness TBI with LOC. Results Overall, 6% of participants had military employment; of these, 76% were males. Military employment was not significantly associated with cognitive change (difference in modeled 10-year cognitive change in CASI-IRT scores in SD units (95% confidence interval [CI]): −0.042 (−0.19, 0.11), risk of dementia (hazard ratio [HR] [95% CI]: 0.92 [0.71, 1.18]), or risk of Alzheimer’s disease dementia (HR [95% CI]: 0.93 [0.70, 1.23]). These results were robust to additional adjustment and sensitivity analyses. There was no evidence of effect modification by age, gender, or traumatic brain injury with loss of consciousness. Conclusions Among members of the Adult Changes in Thought cohort, military employment was not associated with increased risk of cognitive decline or dementia. Nevertheless, military veterans face the same high risks for cognitive decline and dementia as other aging adults.

Wafaa M Farghaly,1 Hamdy N El Tallawy,1 Heba Mohamed,1 Sara H El Tallawy,2 Mohamed A Abdelhamed1 1Department of Neuropsychiatry, and Neuroepidemiology Lab, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Psychology, Faculty of Arts, Assiut University, Assiut, EgyptCorrespondence: Mohamed A AbdelhamedDepartment of Neuropsychiatry, and Neuroepidemiology research center, Faculty of medicine, Assiut University, 7th Floor, Assiut, 71926, EgyptTel +00201002629734Fax +20 88 2333327Email moh78_abdelhamed@aun.edu.egPurpose: Validated diagnostic scales for dementia in Arabic are still scarce. The aim of this study is to construct a standardized dementia scale for dementia diagnosis among the Arabic-speaking population.Patients and Methods: Construction of the Dementia Arabic Scale (DAS) was done, followed by evaluation of content validity. A pilot study was done to ascertain feasibility and language clarity used in the scale. Patients diagnosed to have major neurocognitive disorder according to DSM-V criteria and control group were subjected to DAS, mini-mental state examination (MMSE) and Cognitive Abilities Screening Instrument (CASI). Finally, standardization of the scale and estimation of cutoff point, sensitivity, specificity, positive predictive value and negative predictive value of the newly constructed scale (DAS) were done.Results: There is significant correlation between DAS and both MMSE and CASI on Pearson’s correlation study. The internal consistency of the DAS scale was good, with Cronbach’s alpha correlation coefficient of 0.88. At cut-off ≤ 95 for literate, and ≤ 68 for illiterate, the sensitivity of the DAS scale was 100%, 87% for literate and illiterate, respectively, while specificity was 84%, 96% respectively, with an area under the receiver operating characteristic curve of (AUC) 0.96.Conclusion: The DAS scale is an acceptable, reliable and valid scale for the diagnosis of dementia in Arabic-speaking countries.Keywords: dementia, cognitive screening test, standardization, validity

Background A cohort of children prenatally exposed to the 1945 atomic bombings in Japan revealed harmful effects of ionizing radiation in a variety of measures of cognitive function, including mental retardation. Here we examined cognitive function in the non-affected, now elderly, cohort. Methods From 2011-2015, using the Cognitive Abilities Screening Instrument and a maternal uterine radiation dose estimated with the 2002 dosimetry system, we evaluated 303 prenatally exposed subjects and their non-exposed controls from the Adult Health Study of the Radiation Effects Research Foundation, excluding those who had shown marked cognitive effects earlier. About 11% of the subjects were exposed to more than 250 mGy. We examined a self-reported disease history and, using regression analysis, evaluated the relationship between cognitive function and radiation exposures, adjusting for demographic factors. Results None of the subjects reported a history of dementia. We also did not find a significant radiation effect on cognitive function overall or in any gestational-week group. Education was associated with a significant effect, but educational level was not associated with radiation dose. Conclusion We found no significant radiation effect on cognitive function among 65- to 70-year-old subjects who were prenatally exposed to the bombings and did not have marked childhood cognitive function deterioration. The limitations of this study include a small sample size and potential bias pertaining to non-participation in the Adult Health Study or refusal of Cognitive Abilities Screening Instrument evaluation. Further investigations using various endpoints in other populations prenatally exposed to radiation are warranted.

OBJECTIVE To determine whether cerebral small vessel disease or disability modify the effect of SBP treatment on cognitive and vascular outcomes in older patients with recent lacunar stroke. METHODS Participants aged at least 65 years of the Secondary Prevention of Small Subcortical Strokes Trial were randomized to a higher (130-149 mmHg) or lower (

Background. Patients undergoing hemodialysis experience a greater risk of cognitive impairment than the general population, but limited data elucidates the biomarkers on this. We evaluated the association of bone turnover markers on cognitive function among 251 prevalent hemodialysis enrollees in a cross-sectional study. Methods. 251 hemodialysis patients (median age=57.8, 55% men) and 37 control subjects (mean age=61.2, 56% men) without a prior stroke or dementia diagnosis were enrolled. Serum concentrations of 8 bone markers were analyzed as the association of cognitive function (Montreal Cognitive Assessment (MoCA) and Cognitive Abilities Screening Instrument (CASI)) using linear regression analysis. Results. A lower cognitive function was noted in hemodialysis patients compared to control subjects. The receptor activator of nuclear factor kappa-B ligand (RANKL) was the only bone marker found to be associated with cognitive function (MoCA and CASI tests) in hemodialysis patients without a prior stroke or dementia diagnosis. In stepwise multiple linear regression analysis, the association remained significant in MoCA (β=1.14, 95% CI 0.17 to 2.11) and CASI (β=3.06, 95% CI 0.24 to 5.88). Short-term memory (β=0.52, 95% CI 0.01 to 1.02), mental manipulation (β=0.51, 95% CI 0.05 to 0.96), and abstract thinking (β=0.57, 95% CI 0.06 to 1.09) were the significant subdomains in the CASI score related to RANKL. Conclusions. Serum RANKL levels were potentially associated with better cognitive function in hemodialysis patients. Further large-scale and prospective studies are needed to confirm our findings.

Introduction We modeled associations between glycated hemoglobin (HbA1c) levels (8%) and cognitive and physical function among adults 80+ years of age with diabetes and determined whether associations differ by frailty, multimorbidity, and disability. Methods A total of 316, adults with diabetes, 80+ years of age, were from the Adult Changes in Thought Study. The Cognitive Abilities Screening Instrument Item Response Theory (CASI‐IRT) measured cognition. Short performance‐based physical function (sPPF) and gait speed measured physical function. Glycosylated hemoglobin (HbA1c) levels were from clinical measurements. Analyses estimated associations between average HbA1c levels (8%) and functional outcomes using linear regressions estimated with generalized estimating equations. Results sPPF scores did not differ significantly by HbA1c levels. Gait speed did, but only for non‐frail individuals; those with HbA1c >8% were slower (‐0.10 m/s [95% CI, −0.16 to −0.04]) compared to those with HbA1c 7% to 8%. The association between HbA1c and CASI‐IRT varied with age (interaction P = 0.04). At age 80, for example, relative to people with HbA1c levels of 7% to 8%, CASI‐IRT scores were, on average, 0.18 points lower (95% CI, −0.35 to −0.02) for people with HbA1c 8%. At older ages, these estimated differences were attenuated. Estimated associations were not modified by multimorbidity or disability. Discussion Moderate HbA1c levels of 7% to 8% were associated with better cognition in early but not late octogenarians with diabetes. Furthermore, HbA1c >8% was associated with slower gait speed among those without frailty. These results add to an evidence base for determining glucose targets for very old adults with diabetes.

IMPORTANCE: Age-related hearing difficulties can include problems with signal audibility and central auditory processing. Studies have demonstrated associations between audibility and dementia risk. To our knowledge, limited data exist to determine whether audibility, central processing, or both drive these associations. OBJECTIVE: To determine the associations between signal sensitivity, central auditory processing, and dementia and Alzheimer dementia (AD) risk. DESIGN, SETTING, AND PARTICIPANTS: This follow-up observational study of a sample from the prospective Adult Changes in Thought study of dementia risk was conducted at Kaiser Permanente Washington, a western Washington health care delivery system, and included 280 volunteer participants without dementia who were evaluated from October 2003 to February 2006 with follow-up through September 2018. Analyses began in 2019 and continued through 2021. EXPOSURES: Hearing tests included pure tone signal audibility, a monaural word recognition test, and 2 dichotic tests: the Dichotic Sentence Identification (DSI) test and the Dichotic Digits test (DDT). MAIN OUTCOMES AND MEASURES: Cognition was assessed biennially with the Cognitive Abilities Screening Instrument (range, 1-100; higher scores are better), and scores of less than 86 prompted clinical and neuropsychological evaluations. All data were reviewed at multidisciplinary consensus conferences, and standardized criteria were used to define incident cases of dementia and probable or possible AD. Cox proportional hazard models were used to determine associations with hearing test performance. RESULTS: A total of 280 participants (177 women [63%]; mean [SD] age, 79.5 [5.2] years). As of September 2018, there were 2196 person-years of follow-up (mean, 7.8 years) and 89 incident cases of dementia (66 not previously analyzed), of which 84 (94.4%) were AD (63 not previously analyzed). Compared with people with DSI scores of more than 80, the dementia adjusted hazard ratio (aHR) for DSI scores of less than 50 was 4.18 (95% CI, 2.37-7.38; P

Studies on the relationship of cholesterol concentrations and lipid-lowering medications with dementia risk have yielded inconsistent findings. Therefore, we investigated the association of lipid concentrations and lipid-lowering medications with cognitive function in the Multi-Ethnic Study of Atherosclerosis across 3 different cognitive domains assessed by means of the Cognitive Abilities Screening Instrument (CASI; version 2), the Digit Symbol Coding (DSC) Test, and the Digit Span (DS) Test in 2010-2012. After adjustment for sociodemographic and confounding factors, including concentrations of other lipids and use of lipid-lowering medication, higher total cholesterol, low-density lipoprotein cholesterol, and non-high-density-lipoprotein cholesterol concentrations were modestly associated with higher DS Test scores. None of the lipid parameters were associated with CASI or DSC Test scores. Similarly, changes in lipid concentrations were not associated with any cognitive function test score. Using treatment effects model analysis and after adjusting for confounding factors, including lipid concentrations, the use of any lipid-lowering medication, especially statins, was associated with higher scores on the CASI and backward DS tests but not on the DSC and forward DS tests. Our study does not support a robust association between lipid concentrations and cognitive function or between the use of lipid-lowering medication, especially statins, and worse cognitive function.

Background/Objectives Longitudinal studies have shown an increase in cognitive decline many years before clinical diagnosis of dementia. We sought to estimate changes, relative to “normal” aging, in the trajectory of scores on a global cognitive function test—the Cognitive Abilities Screening Instrument (CASI). Design A prospective cohort study. Setting Community-dwelling members of a U.S. health maintenance organization. Participants Individuals aged 65 and older who had no dementia diagnosis at baseline and had at least two visits with valid CASI test score (N = 4,315). Measurements Average longitudinal trajectories, including changes in trajectory before clinical diagnosis in those who would be diagnosed with dementia, were estimated for CASI item response theory (IRT) scores. The impact of sex, education level, and APOE genotype on cognitive trajectories was assessed. Results Increased cognitive decline relative to “normal” aging was evident in CASI IRT at least 10 years before clinical diagnosis. Male gender, lower education, and presence of ≥1 APOE e4 alleles were associated with lower average IRT scores. In those who would be diagnosed with dementia, a trajectory change point was estimated at an average of 3.1 years (95% confidence interval 3.0-3.2) before clinical diagnosis, after which cognitive decline appeared to accelerate. The change point did not differ by sex, education level, or APOE e4 genotype. There were subtle differences in trajectory slopes by sex and APOE e4 genotype, but not by education. Conclusion Decline in average global cognitive function was evident at least 10 years before clinical diagnosis of dementia. The decline accelerated about 3 years before clinical diagnosis.

Background We examined whether changes in metabolic factors over 10 years were associated with cognitive performance. Methods Participants from the Multi-Ethnic Study of Atherosclerosis were followed since baseline (2000–2002) with five clinical examinations. At exam 5 (2010–2012), they received a short cognitive battery (Cognitive Abilities Screening Instrument [CASI], Digit Symbol Coding [DSC], and Digit Span [DS]). We examined associations between baseline metabolic factors and their changes over time before cognitive testing. Results Among 4392 participants, baseline metabolic disorders (fasting glucose, systolic and diastolic blood pressures) were significantly associated with poorer CASI, DSC, and DS scores measured 10 years later. Increases in blood pressure were associated with lower cognitive performance. Results did not differ by race/ethnicity and were stronger among those without the APOE e4 allele. Conclusions Cognitive performance was associated with antecedent abnormalities in glucose metabolism and blood pressure increases. Findings appeared stronger among APOE e4-negative participants.

Background Findings are inconsistent regarding the role of traumatic head injury in the subsequent development of neurologic outcomes. Objective Examine the relationship between head injury and later cognitive impairment. Methods A sample of 3,123 Japanese-American men was assessed for history of head injury and evaluated for cognitive impairment using the Cognitive Abilities Screening Instrument (CASI). For a subsample of 676 respondents, neuropathologic results from those with and without head injury were compared. Results Although the crude model showed an association between history of head injury and later severe cognitive impairment, the relationship lost significance in the adjusted model (OR = 1.320, CI: 0.90-1.93), regardless of time between injury and impairment. Similar to cognitive impairment, hippocampal sclerosis was observed significantly more in the brains of respondents with a history of head injury in the crude model, but the relationship weakened in the adjusted model (OR = 1.462, CI: 0.68-3.12). After adjustment, decedents with a head injury demonstrated marginally higher brain weight (OR = 1.003, CI: 1.00-1.01). Conclusion We did not find a relationship between head injury and subsequent cognitive decline in this cohort. The neuropathology results also displayed no strong association between history of head injury and specific brain lesions and characteristics. These results support other findings in prospective cohorts. However, they could be influenced by the demographic make-up of the sample (male Japanese-Americans) or by the observation that the majority reported only a single head injury.

Objectives Visuospatial dysfunction (VSD) is one of the most important symptoms for the diagnosis of dementia with Lewy bodies (DLB). The aim of this study was to validate a novel VSD questionnaire and determine the cutoff score for the screening for VSD in DLB. Methods This is a retrospective analysis of data from a project of the History-based Artificial Intelligent Clinical Dementia Diagnostic System (HAICDDS). VSD of non-demented control (NDC), Alzheimer's disease (AD), and DLB participants were analyzed and compared using the visuospatial questionnaire in the HAICDDS (HAI-VSQ), the Draw subscale in the Cognitive Abilities Screening Instrument (CASI-Draw), and the visuospatial subscale in Montreal Cognitive Assessment (MoCA-VS). Results A total of 440 individuals were studied, including 154 NDC, 229 AD, and 57 DLB participants. Compared to NDC or AD participants, DLB participants showed a higher total score on HAI-VSQ after adjustment for age. Using HAI-VSQ, a cutoff score ≥ 2 was useful for the screening for VSD in DLB with a sensitivity of 0.77 and a specificity of 0.94. Compared with CASI-Draw or MoCA-VS, HAI-VSQ was least influenced by gender, age, and education and had the highest correlation with the sum of boxes of the Clinical Dementia Rating scale. After adjustment for age, education, gender, and global cognitive function, HAI-VSQ significantly discriminated DLB from AD and NDC whereas MoCA-VS or CASI-Draw did not. Conclusion Our study showed that the newly designed simple questionnaire was a practical screening tool for VSD in DLB that can be applied in clinical practice as well as on a registration platform.

Patients with chronic kidney disease have a greater risk of cognitive impairment. Cerebral uremic solute accumulation causes uremic encephalopathy; however, the association of protein-bound uremic toxins on cognitive function remains unclear. The present study aimed to investigate the association of two protein-bound uremic toxins, namely indoxyl sulfate (IS) and p-cresyl sulfate (PCS), on cognitive function in patients receiving hemodialysis (HD) for at least 90 days. Circulating free form IS and PCS were quantified by liquid chromatography/mass spectrometry. Mini-Mental State Examination (MMSE) and Cognitive Abilities Screening Instrument (CASI) were used to evaluate cognitive function. In total, 260 HD patients were recruited with a mean age of 58.1 ± 11.3 years, of which, 53.8% were men, 40% had diabetes, and 75.4% had hypertension. The analysis revealed that both free IS and free PCS were negatively associated with the CASI score and MMSE. After controlling for confounders, circulating free IS levels persisted to be negatively associated with MMSE scores [β = −0.62, 95% confidence interval (CI): −1.16 to −0.08] and CASI scores (β = −1.97, 95% CI: −3.78 to −0.16), mainly in the CASI domains of long-term memory, mental manipulation, language ability, and spatial construction. However, there was no correlation between free PCS and total MMSE or total CASI scores after controlling for confounders. In conclusion, circulating free form IS, but not PCS is associated with lower cognitive function test scores in HD patients. Thus, a further study is needed to evaluate whether a decrease in free IS levels can slow down cognitive decline in HD patients.

Background Past research has focused on risk factors for developing dementia, with increasing recognition of "resilient" people who live to old age with intact cognitive function despite pathological features of Alzheimer's disease (AD). Objective To evaluate demographic factors, mid-life characteristics, and non-AD neuropathology findings that may be associated with cognitive resilience to AD pathology. Methods We analyzed data from 276 autopsy cases with intermediate or high levels of AD pathology from the Adult Changes in Thought study. We defined cognitive resilience as having Cognitive Abilities Screening Instrument scores ≥86 within two years of death and no clinical dementia diagnosis; non-resilient people had dementia diagnoses from AD or other causes before death. We compared mid-life characteristics, demographics, and additional neuropathology findings between resilient and non-resilient people. We used multivariable logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for being resilient compared to not being resilient adjusting for demographic and neuropathology factors. Results We classified 68 (25%) people as resilient and 208 (75%) as not resilient. A greater proportion of resilient people had a college degree (50%) compared with non-resilient (32%, p = 0.01). The odds of being resilient were significantly increased among people with a college education (OR = 2.01, 95% CI = 1.01-3.99) and significantly reduced among people with additional non-AD neuropathology findings such as hippocampal sclerosis (OR = 0.28, 95% CI = 0.09-0.89) and microinfarcts (OR = 0.34, 95% CI = 0.15-0.78). Conclusion Increased education and absence of non-AD pathology may be independently associated with cognitive resilience, highlighting the importance of evaluating co-morbid factors in future research on mechanisms of cognitive resilience.

Background: The Cognitive Abilities Screening Instrument (CASI) assesses global cognitive function in people with dementia with 9 domains (i.e., long-term memory, short-term memory, concentration, orientation, attention, abstraction and judgment, language abilities, visual construction, and category fluency). However, the ecological, convergent, and discriminant validities of the CASI have not yet been examined. Purpose: This study designed to investigate these 3 validities of the CASI in people with dementia. Methods: Fifty-eight participants underwent assessments with the CASI, 3 functional measures, and 3 cognitive measures. Pearson's r was used to estimate correlations among the CASI and 3 functional measures for examining ecological validity. We computed correlations (r) among the CASI and 3 functional measures for examining convergent validity. An independent t-test was applied to compare the levels of disability, and ceiling/floor effects were analyzed for examining discriminative validity. Results: The CASI total score and domains had moderate to high correlations with 3 functional measures (r = 0.42–0.80), except in 2 CASI domains (i.e., attention and language). The CASI total score and domains showed moderate to high correlations with 3 cognitive measures (r = 0.45–0.93). The t-test results revealed significant differences (P

Introduction: A positive association between physical activity and cognition has been reported. However, very few pertinent studies have evaluated physical activity by objective measures. Hypothesis: In a community-based sample of non-demented men, objectively measured step count was positively associated with higher cognitive function. Methods: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) randomly recruited community-dwelling apparently healthy men aged 40-79 years from Shiga, Japan, and measured their step counts over 7 consecutive days using a pedometer (DIGI-Walker, DW-200) at baseline (2006-08). Among 853 mem who returned for follow-up (2010-12), we assessed their cognition using Cognitive Abilities Screening Instrument (CASI) score. The score can range from 0 to 100, and higher score indicates better cognition. We restricted our analyses to those with a valid 7-day average step count at baseline and who remained free of stroke (N=678). We calculated crude and adjusted mean CASI score according to quartile of average step count using linear regression models. All adjusting covariates used in models were asssessed at baseline including age, educational attainment, smoking, and drinking. Results: The mean [standard deviation] of age and unadjusted score were 63.8 [9.1] years and 90.8 [5.8]. Mean CASI score was higher in higher quartile of average step: 90.2, 90.4, 90.6, and 91.8 from the lowest to the highest quartile of average step ( P for trend =0.004) in a model adjusted for age and education. Further adjustment for smoking, drinking and other cardiovascular risk factors resulted in similar pattern of association (Table 1). Conclusions: Apparently healthy Japanese men with greater 7-day average step count at baseline measured with pedometer was associated with a small but significantly higher CASI score than those with fewer step count. The finding is consistent with the hypothesis that physical activity is protective for cognition in non-demented individuals.

Objective: To compare daily functional performance and potential predictiv e factors in pa tients withAlzheimer’s disease (AD) and subcortical ischemic vascular disease (SIVD). Methods: Sixty-eight community patients with AD and 39 with SIVD were eva luated using t h e informantbasedBarthel Index of Activities of Daily Living (B-ADL) and Instrumental Activities of DailyLiving (IADL). Motor function, cognition, and white matter hyperintensities (WMHs) wereassessed using the modified Rankin Scale (mRS), Cognitive Abilities Screening Instrument(CASI)/Clinical Dementia Rating (CDR), and Scheltens scale, respectively. Results: After controlling for systemic diseases and medications, toilet use was the o nly B -ADL subset inwhich the patients with SIVD performed worse than those with AD in overall c omparisons andCDR0.5-1. Additionally, the SIVD group with CDR0.5-1 performed worse in bathing, mobility,and climbing stairs. Regarding IADL performance, the SIVD group had worse performancesthan the AD group in mode of transportation during CDR2. In WMHs analysis, periventricularWMHs (PWMHs) was the only factor showing significant inverse correlations with both CASI andB-ADL/IADL. Hierarchical regression of all patients suggested that the best models incl uding age,education, PWMHs, CASI, and mRS accounted for 71% and 78% of the variances in B-ADL andIADL, respectively. While mRS accounted for a significant effect in both B-ADL and IADL, CASIaccounted for a significant effect only in IADL. Subgroup analysis suggested that the effects ofCASI and PWMHs were confined within B-ADL/IADL and IADL in the AD group, respectively. Conclusions: Motor function was the major factor in both B-ADL and IADL, and cognition ha d a significanteffect on IADL. Although PWMH load had inverse associations with both motor and cognitivefunctions, this radiological marker better predicted IADL in AD than in SIVD. The variationin daily functional profiles with dementia s tage and subtypes highlights the need to assessmotor function for preventive interventions.

There are conflicting findings regarding the link between sleep apnea and cognitive dysfunction.Investigate associations between indicators of sleep-disordered breathing (SDB) and cognitive function in the Multi-Ethnic Study of Atherosclerosis and assess effect modification by the apolipoprotein ε-4 (APOE-ε4) allele.A diverse population (N = 1,752) underwent type 2 in-home polysomnography, which included measurement of percentage sleep time less than 90% oxyhemoglobin saturation (%Sat 90%) and apnea-hypopnea index (AHI). Epworth Sleepiness Scale score (ESS) and sleep apnea syndrome (SAS; AHI ≥ 5 and ESS 10) were also analyzed. Cognitive outcomes included the Cognitive Abilities Screening Instrument; Digit Symbol Coding (DSC) test; and Digit Span Tests (DST) Forward and Backward.Participants were 45.4% men, aged 68.1 years (SD, 9.1 yr) with a median AHI of 9.0 and mean ESS of 6.0. Approximately 9.7% had SAS, and 26.8% had at least one copy of the APOE-ε4 allele. In adjusted analyses, a 1-SD increase in %Sat 90% and ESS score were associated with a poorer attention and memory assessed by the DST Forward score (β = -0.12 [SE, 0.06] and β = -0.13 [SE, 0.06], respectively; P ≤ 0.05). SAS and higher ESS scores were also associated with poorer attention and processing speed as measured by the DSC (β = -0.69 [SE, 0.35] and β = -1.42 [SE, 0.35], respectively; P 0.05). The presence of APOE-ε4 allele modified the associations of %Sat 90% with DST forward and of ESS with DSC (POvernight hypoxemia and sleepiness were associated with cognition. The average effect estimates were small, similar to effect estimates for several other individual dementia risk factors. Associations were strongest in APOE-ε4 risk allele carriers. Our results (1) suggest that SDB be considered among a group of modifiable dementia risk factors, and (2) highlight the potential vulnerability of APOE-ε4 risk allele carriers with SDB.

With the rapid growth of the global aging population, especially the oldest old, cognitive impairment has become a pervasive public health issue. In the United States, population-based studies suggest that age-related cognitive impairment affects 17%–34% of community-dwelling older adults (1). The demographic shift will likely increase the prevalence of age-related cognitive impairment, place considerable demands on the U.S. health care system, and impose physical, psychological, and financial stress on patients, their caregivers, and family members (2). U.S. Chinese aging population is one of the fastest growing subpopulations of older adults in the country. The life expectancy of U.S. Chinese older adults is in the mid 80s (3). Given the prevalence of cognitive impairment increasing with age, we can expect a growing demand for geriatric care in Chinese Americans. However, the prevalence of cognitive impairment is relatively underresearched among U.S. Chinese older adults due to the lack of large scale population-based studies examining the prevalence of cognitive impairment and related clinical diagnosis including dementia or Alzheimer’s disease. Despite the data gap, research suggests that there is evidence to believe that Asian Americans should have the same rates or even higher than that of Caucasian older adults (4,5). In addition, some methodological challenges may have dampened our systematic assessment of cognitive function among Chinese older adults and to make sensible comparisons with other racial/ethnic populations. First, there was a lack of population-based studies which administered a cognitive battery of tests to measure cognitive function and change in different cognitive abilities among Chinese older adults. Cognitive impairment of older adults is not limited to memory, but reflects a host of different definitions, including impairments in language, visual, or spatial awareness, and attention. Multiple measures of each ability may be valuable in reporting different cognitive abilities. Second, since individual differences found at baseline are likely to become more pronounced over time, forming composite cognitive measures allows researchers to combine tests of various difficulty levels to reflect a wider range of cognitive performance (6,7). The use of standard score, or z score, has the statistical advantage of increasing power by reducing random variability present within different tests that accommodate a wide range of cognitive function performance, and has been widely reported in population-based epidemiological studies of U.S. older adults (6,8). Whereas recent studies have further identified the use of composite scores to better demonstrate performance characteristics in studies of cognitive impairment compared with other scoring methods (9), such reports remain scare among Chinese American older adults. Third, the paucity of data on cognitive impairment can largely be attributed to the absence of culturally and linguistically sensitive instruments to screen and diagnose cognitive impairment among this population (10). There existed a number of measure developed and adapted for use in different cultures and for multiple languages, such as the Cognitive Abilities Screening Instrument (11) or the Cross-Cultural Neuropsychological Battery (12). Despite these tests have been piloted among groups of Chinese Americans, the sample size was small, and the majority of items were taken from a few screening scale which may be limited to measure a wide range of cognitive performances. Apart from existing methodological challenges, culturally specific perceptions, beliefs, and negative affects relating to cognitive impairment further present challenges to engaging Chinese American older adults to research studies (13), leaving Chinese older adults underrepresented in clinical studies, especially studies of cognitive impairment (14). As a result, we have incomplete knowledge on the scope of cognitive impairment and the effect of sociodemographic characteristics on the cognitive function among community-dwelling U.S. Chinese older adults, which is critical in informing culturally sensitive prevention strategies in the aging population. To fill in the knowledge void, in the current study, we adapted a battery of five tests for use with Chinese American older adults. These tests, including the Chinese Mini-Mental State Exam (C-MMSE), East Boston Memory Test (EBMT)-Immediate Recall, EBMT-Delayed Recall, Digit Span Backwards assessment, and Symbol Digit Modalities Test, have been validated and widely used among English-speaking and Spanish-speaking older adults in the United States (6,15). The objectives of this report is to: (i) describe cognitive function in an older U.S. Chinese populations using five cognitive function tests, (ii) explore the sociodemographic and self-reported health correlates of cognitive function, and (iii) describe the effect of key sociodemographic variables including age, sex, education on cognitive function.

BackgroundThe Cognitive Abilities Screening Instrument (CASI) is widely used to assess global cognitive function in patients with dementia. It contains nine cognitive domains, namely long-term memory, short-term memory, attention, mental manipulation, orientation, abstraction and judgment, language, visual construction, and list-generating fluency. However, test-retest reliability and minimal detectable change (MDC) of the CASI are largely unknown in patients with dementia, which limits its utility and the explanation of a score change.PurposeThe purpose of this study was to examine test-retest reliability and calculate MDC of the CASI in patients with dementia.MethodsFifty-two patients with dementia completed the CASI twice with a two-week interval. The frequencies of the scores in the Clinical Dementia Rating (0.5, 1, and ≥ 2) were 38.5, 36.5, and 25.0, respectively. Test-retest reliability was examined using intraclass correlation coefficient (ICC) for the total score and nine domains of the CASI. The MDC was calculated based on standard error of measurement.ResultsThe ICC value of the CASI total score was 0.97 while the ICC value for the nine domains were 0.65-0.92. The MDC values (MDC%) were 11.6 (12.9%), 2.8 (23.2%), 4.5 (41.2%), 3.4 (42.1%), 4.9 (49.2%), 5.3 (29.2%), 3.4 (28.8%), 2.2 (22.3%), 3.2 (32.1%), and 3.1 (30.7%) for CASI total score, long-term memory, short-term memory, attention, mental manipulation, orientation, abstraction and judgment, language, visual construction, and list-generating fluency, respectively.ConclusionOur results revealed that the CASI has sufficient test-retest reliability. The MDC values are useful in determining a real change (i.e., improvement or deterioration) between two assessments of an individual patient. However, four domains (i.e., short-term memory, attention, mental manipulation, and list-generating fluency) demonstrated lower ICC values and substantial random measurement errors. Clinicians and researchers should be cautious while using these four domains to explain score changes between repeated assessments of patients with dementia.

Aim The aim of this study was to investigate the clinical utility of the Functional Independence Measure (FIM), and especially FIM-Cognition (FIM-C) scores, in patients with Alzheimer's disease (AD) and vascular dementia (VaD), and to determine the influence of behavioural and psychological symptoms of dementia (BPSD) on FIM-C scores. Methods This was a cross-sectional survey of 37 AD and 40 VaD patients. Cognitive function was assessed with the Cognitive Abilities Screening Instrument. Activities of daily living were evaluated with the FIM and the Barthel Index. BPSD were assessed with the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale. Results For both groups, Spearman's correlations were found between FIM-Motor and Barthel Index scores and between FIM-C and Mini Mental State Examination scores. Each FIM-C subscore was correlated with Cognitive Abilities Screening Instrument scores in both groups, except for the FIM-C Social interaction subscore in VaD. VaD patients showing Activity Disturbance and Aggressiveness on the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale had significantly lower FIM-C Memory and Social interaction subscores than those without BPSD. Conclusion The results suggest that the FIM-Motor and FIM-C scales are useful measures of physical and cognitive disabilities in patients with AD and VaD. The FIM-C profile of AD may reflect global cognitive function, while that of VaD may be more influenced by BPSD.

To determine the associations between classes of antihypertensive medication use and the risk of cognitive impairment among elderly hypertensive men.The Honolulu-Asia Aging Study is a prospective, community-based cohort study of Japanese American men conducted in Honolulu, Hawaii. We examined 2,197 participants (mean age 77 years at cohort entry, 1991-1993, followed through September 2010) with hypertension and without dementia or cognitive impairment at baseline, who provided information on medication use. Cognitive function was assessed at 7 standardized examinations using the Cognitive Abilities Screening Instrument (CASI). Cognitive impairment was defined as a CASI score74.A total of 854 men developed cognitive impairment (median follow-up, 5.8 years). β-Blocker use as the sole antihypertensive drug at baseline was consistently associated with a lower risk of cognitive impairment (incidence rate ratio [IRR] 0.69; 95% confidence interval [CI] 0.50-0.94), as compared with men not taking any antihypertensive medications, adjusting for multiple potential confounders. The use of diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or vasodilators alone was not significantly associated with cognitive impairment. Results were similar excluding those with cardiovascular disease or1 year of follow-up, and additionally adjusting for pulse pressure, heart rate, baseline and midlife systolic blood pressure, and midlife antihypertensive treatment (IRR 0.65; 95% CI 0.45-0.94). The association between β-blocker use and cognitive impairment was stronger among men with diabetes, men aged75 years, and those with pulse pressure ≥70 mm Hg.β-blocker use is associated with a lower risk of developing cognitive impairment in elderly Japanese American men.

Background As cognitive decline mostly occurs in late life, where typically it co-exists with many other ailments, it is important to consider frailty in understanding cognitive change. Objective Here, we examined the association of change in frailty status with cognitive trajectories in a well-studied cohort of older Japanese-American men. Methods Using the prospective Honolulu-Asia Aging Study (HAAS), 2,817 men of Japanese descent were followed (aged 71-93 at baseline). Starting in 1991 with follow-up health assessments every two to three years, cognition was measured using the Cognitive Abilities Screening Instrument (CASI). For this study, health data was used to construct an accumulation of deficits frailty index (FI). Using six waves of data, multilevel growth curve analyses were constructed to examine simultaneous changes in cognition in relation to changes in FI, controlling for baseline frailty, age, education, and APOE-ɛ4 status. Results On average, CASI scores declined by 2.0 points per year (95% confidence interval 1.9-2.1). Across six waves, each 10% within-person increase in frailty from baseline was associated with a 5.0 point reduction in CASI scores (95% confidence interval 4.7-5.2). Baseline frailty and age were associated both with lower initial CASI scores and with greater decline across the five follow-up assessments (p Discussion Cognition is adversely affected by impaired health status in old age. Using a multidimensional measure of frailty, both baseline status and within-person changes in frailty were predictive of cognitive trajectories.

Background: Handling errors with household flammables, such as pan burning, may result in serious accidents. In the previous study, we surveyed an actual status of handling errors with household flammables in the 590 older residents in Kurihara, northern Japan. The accidents were caused by a decrease in attention/executive function and the ability to predict risks. Methods: According to results of a questionnaire regarding the “frequency of small fire accidents at home” and “the presence or absence of pan burning”, 592 elderly people were divided into 2 groups, the “low-risk group” (no small fire accident, or

This study verifies the environmental effects on agraphia in mild cognitive impairment and dementia. We compared elderly Japanese subjects living in Japan and Brazil. Methods: We retrospectively analyzed the database of the Prevalence Study 1998 in Tajiri (n=497, Miyagi, Japan) and the Prevalence Study 1997 of elderly Japanese immigrants living in Brazil (n=166, migrated from Japan and living in the São Paulo Metropolitan Area). In three Clinical Dementia Rating (CDR) groups, i.e., CDR 0 (healthy), CDR 0.5 (questionable dementia), and CDR 1+ (dementia) , the Mini-Mental State Examination (MMSE) item of spontaneous writing and the Cognitive Abilities Screening Instrument (CASI) domain of dictation were analyzed with regard to the number of Kanji and Kana characters. Formal errors in characters and pragmatic errors were also analyzed. Results: The immigrants in Brazil wrote similar numbers of Kanji or Kana characters compared to the residents of Japan. In spontaneous writing, the formal Kanji errors were greater in the CDR 1+ group of immigrants. In writing from dictation, all the immigrant CDR groups made more formal errors in Kana than the Japan residents. No significant differences in pragmatic errors were detected between the two groups. Conclusions: Subjects living in Japan use Kanji frequently, and thus the form of written characters was simplified, which might be assessed as mild formal errors. In immigrants, the deterioration in Kanji and Kana writing was partly due to decreased daily usage of the characters. Lower levels of education of immigrants might also be related to the number of Kanji errors. Resumo Este estudo verifica os efeitos do meio ambiente sobre a agrafia em comprometimento cognitivo leve e demência. Nós comparamos indivíduos idosos vivendo no Japão e Brasil. Métodos: Nós, retrospectivamente, analisamos a base de dados do Estudo de Prevalência 1998 em Tajiri (n=497, Miyagi, Japão) e do Estudo de Prevalência 1997 de imigrantes idosos japoneses vivendo no Brasil (n=166, imigrados do Japão e residindo na área metropolitana da cidade de São Paulo). Em três grupos de CDR (Clinical Dementia Rating), isto é, CDR 0 (saudáveis), CDR 0.5 (demência questionável) e CDR1+ (demência), o item de escrita espontânea do Mini-Exame do Estado Mental (MEEM) e o domínio de ditado do Cognitive Abilities Screening Instrument (CASI) foram analisados em relação ao número de caracteres em Kanji e Kana. Erros formais nos caracteres e erros pragmáticos foram também analisados. Resultados: Os imigrantes no Brasil escreveram número similar de caracteres de Kanji e Kana comparados aos residentes no Japão. Na escrita espontânea, os erros formais de Kanji foram maiores no grupo de CDR1+ em imigrantes. Na escrita sob ditado, todos os grupos de CDR de imigrantes fizeram mais erros formais em Kana do que os residentes no Japão. Nenhuma diferença foi encontrada em erros pragmáticos entre os grupos. Conclusões: Sujeitos vivendo no Japão usam Kanji freqüentemente, e então, a forma de caracteres escritos foi simplificada, o que pode ser avaliado como discretos erros formais. Em imigrantes, a deterioração na escrita em Kanji e Kana foi parcialmente devida ao uso diário restrito dos caracteres. Baixos níveis educacionais dos imigrantes podem estar relacionados ao número de erros em Kanji.

Introduction Subjective chronic tinnitus is a common medical syndrome with a high frequency of cognitive impairment; however, the characteristics of cognitive impairment in chronic tinnitus are poorly understood. Investigating the scope of cognitive impairment across the severity spectrum of tinnitus patients may shed light on the issue. Methods A consecutive series of 207 subjective chronic tinnitus patients were classified into mild tinnitus group (n = 95) and severe tinnitus group (n = 112) by THI score (the cutoff THI scores were 37/38). These patients were assessed using the Cognitive Abilities Screening Instrument (CASI) and P300 event‐related potential. Results Although pure tone averages were not different between mild or severe tinnitus patients, severe tinnitus patients scored lower on the CASI assessment as well as almost all subdomains of CASI, particularly in items such as “short‐term memory,” “concentration or mental manipulation,” “orientation,” “abstraction and judgment,” “language abilities,” and “visual construction.” Furthermore, compared to mild tinnitus patients, severe tinnitus patients exhibited longer N2 and P3 latencies. Finally, a correlation analysis revealed that tinnitus severity was negatively correlated with CASI score and positively correlated with N2 and P3 latencies. Conclusions This study reveals that tinnitus patients on the severe end of the spectrum may be at risk for serious cognitive deficits, which may not be a secondary response to disease manifestations but a primary feature of the underlying disease.

There is evidence for a relationship between raised inflammatory markers, including high sensitivity C-reactive protein (hs-CRP), measured late in life, and an increased risk of cognitive decline and dementia. This study evaluates the association of midlife hs-CRP concentrations with late-life longitudinal trends in cognitive function. Data are from the Honolulu-Asia Aging Study (HAAS), a longitudinal community-based study of Japanese American men. hs-CRP levels were measured on average 25 years before cognitive testing began in 1991. Subjects were followed from up to three follow-up examinations (mean of 6.1 years). At each exam, cognitive function was measured with the Cognitive Abilities Screening Instrument (CASI). This analysis includes a sub-sample of 691 subjects dementia-free in 1991. With incident dementia cases included, those with the highest quartile of hs-CRP had significantly more cognitive decline than those in the lowest quartile, after adjustment for baseline CASI score, demographic and cardiovascular risk factors. When cases were removed, there was no difference in cognitive decline by CRP quartile. This relationship was not modified by the presence of apolipoprotein E varepsilon4. These findings suggest that inflammatory mechanisms during midlife may reflect underlying processes contributing to dementia-related cognitive decline late in life.

The objective of this study was to investigate radiation effects on longitudinal pre-dementia cognitive decline among participants who developed dementia as well as on those who did not develop dementia during follow-up.Measuring cognitive function with the Cognitive Abilities Screening Instrument approximately every 2 years, we followed 1844 atomic bomb survivors participating in the Adult Health Study of the Radiation Effects Research Foundation from 1992 to 2011. Participants were adolescents or older when exposed to between 0 and 4 Gy. Approximately 15% and 40% of participants were exposed to ≥1 Gy and5 mGy, respectively. At study start, participants were dementia-free and between 60 and 80 years old. Three-quarters of the participants returned after baseline, averaging 8.4 years of follow-up. During follow-up, 313 developed dementia. We used cognitive scores before dementia onset for analysis and a mixed-effects model to estimate radiation effects on longitudinal change of cognition, adjusting for dementia occurrence, age, sex, and education.Cognition level was significantly associated with age, education, and dementia occurrence but not with radiation dose or sex. Cognitive decline accelerated with increasing age, especially among participants who developed dementia. Neither radiation nor education was significantly associated with the degree of deterioration with age. Radiation did not modify the different cognitive decline by dementia occurrence.Radiation did not significantly affect cognition among atomic bomb survivors exposed at or after adolescence.