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Background and Objectives: Lipid metabolism in older adults is affected by various factors including biological aging, functional decline, reduced physiologic reserve, and nutrient intake. The dysregulation of lipid metabolism could adversely affect brain health. This study investigated the association between year-to-year intraindividual lipid variability and subsequent risk of cognitive decline and dementia in community-dwelling older adults., Methods: ASPirin in Reducing Events in the Elderly (ASPREE) was a randomized trial of aspirin, involving 19,114 participants aged 65 years and older from Australia and the United States who were free of dementia and major cognitive impairment. ASPREE-eXTension is the post-trial observational follow-up of participants, currently to a maximum of 11 years. This post hoc analysis included participants who had lipid levels measured at baseline and in years 1, 2, and 3. Year-to-year variability in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and triglycerides over the first 3 years was quantified using variability independent of the mean. Individuals who initiated or discontinued lipid-lowering therapy during this period were excluded. Multivariable Cox proportional hazards regression was used to analyze associations with incident dementia, adjudicated by expert panels, and cognitive impairment with no dementia (CIND) confirmed by a battery of cognitive tests, occurring after year 3. A linear mixed model was used for assessing the association with changes in 4 cognitive function domains, including global, memory, processing speed, verbal fluency, and a composite score from baseline to the end of follow-up., Results: The analysis included 9,846 individuals (median [interquartile range] age: 73.9 [71.7-77.3] years, 54.9% female). 509 incident dementia and 1,760 CIND events were recorded over a median follow-up of 5.8 and 5.4 years after variability assessment. The hazard ratios (95% CI) comparing the highest and lowest quartiles of TC and LDL-c variability were 1.60 (1.23-2.08) and 1.48 (1.15-1.91) for dementia and 1.23 (1.08-1.41) and 1.27 (1.11-1.46) for CIND. Higher TC and LDL-c variability was also associated with a faster decline in global cognition, episodic memory, psychomotor speed, and the composite score (all p < 0.001). No strong evidence was found for an association of HDL-c and triglyceride variability with dementia and cognitive change., Discussion: Tracking variability of TC and LDL-c may serve as a novel biomarker of incident dementia and cognitive decline in older adults.

Background: The relationship between depression and cognition in middle-aged adults is a topic of interest. Whether poor cognitive function exacerbates depression remains controversial. We clarified the association between cognitive decline and depression based on six nationwide cohorts., Methods: 89,056 participants were retrieved from six cohorts in Europe, North America, Asia and Africa. Each two consecutive interviews were collected as a sample set with a total of twenty-eight sample sets to assess changes in depression and cognitive function. Multiple linear regression was conducted within each sample set to evaluate the association between cognitive decline and depression. A two-stage meta-analysis was performed to obtain the average effect within each cohort and the overall effect excluding population and regional heterogeneity. Meta-regression and subgroup analysis were used to explore heterogeneity and potential effect modifiers., Results: Almost all sample sets indicated negative association between changes in cognitive function and depression scores. The average effects varied across regions: Korea (-0.150 [-0.175, -0.126]), Europe (-0.130 [-0.149, -0.112]), South Africa (-0.090 [-0.129, -0.060]), China (-0.083 [-0.137, -0.030]), Mexico (-0.063 [-0.084, -0.042]), and North America (-0.048 [-0.056, -0.040]). The overall effect excluding population and regional heterogeneity was -0.094 [-0.129, -0.060], and was robust across populations of different age, sex, alcohol consumption, daily living activities and marital status., Limitations: The cross-sectional design limited our ability to determine causal relationships., Conclusion: Cognitive decline was associated with the exacerbation of depression status in middle-aged and older adults worldwide. Country-level factors, rather than individual-level factors, are more likely to modify this effect., 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 Elsevier B.V. All rights reserved.)

Background: Cognitive impairment, including dementia, and hip fracture are both common among older patients. Both conditions are associated with increased morbidity and mortality. Cognitive impairment is often underdiagnosed and may remain undetected in hip fracture patients. Little is known about the prevalence, specific characteristics, and outcomes of hip fracture patients with cognitive impairment. This analysis aimed to compare hip fracture patients with and without cognitive impairments regarding their health conditions, hospital care, and the risk of complications and mortality., Methods: This study used data derived from the EMAAge project, a prospective multi-center cohort study conducted in Berlin, Germany. Patients aged 40 years and older with hip fracture were stratified into three cognitive status groups: no cognitive impairment (NCI), moderate cognitive impairment (MCI), and severe cognitive impairment (SCI). Categorization was based on patients' ability to engage in interviews and their performance on the 6-item Cognitive Impairment Test (6-CIT). Standardized mean differences were used to compare various health-related parameters and health care utilization measures. Regression models, both adjusted and unadjusted, were calculated for the number of complications and the mortality rate., Results: Cognitive impairment was present in 37% of the 310 hip fracture patients in the study cohort. Patients with cognitive impairment had a worse baseline health profile, delayed admission to the emergency department, a longer time to surgery, and were less likely to be referred to a rehabilitation program. In the adjusted regression model for the number of complications, the incidence rate ratio was 1.237 (p = 0.292) for MCI patients and 2.065 (p < 0.001) for SCI patients compared with NCI patients. The adjusted odds ratio for mortality was 1.046 (p = 0.942) for MCI patients and 2.875 (p = 0.060) for SCI patients., Conclusions: Hip fracture patients with cognitive impairment, particularly severe impairment, arrive at the ED in a considerably poorer state of health and are at a higher risk of adverse outcomes, including complications and mortality. Timely identification of this at-risk group upon arrival appears to be essential to providing adequate care. This study highlights the need for interventions and research aimed at improving prevention, emergency care and outcomes for this vulnerable group, addressing their specific risk factors, and promoting the quality of care in hospital and after discharge., Competing Interests: Declarations. Ethics approval and consent to participate: The study has been conducted in adherence with the Declaration of Helsinki. Informed consent was obtained from all participants. The study was approved by the local ethics committee of the Charité-Universitätsmedizin Berlin (EA1/362/16) and registered in the German Clinical Trials Register (DRKS00014273). Consent for publication: All participants provided written consent to the publication of the study results. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Cognitive impairment (CI) is a common complication in patients with type 2 diabetes mellitus (T2DM), but its relationship with long-term glycemic control remains unclear. This study aimed to investigate the associations between mean hemoglobin A1c (HbA1c) levels, HbA1c control status, HbA1c fluctuations, and CI in Chinese adults aged 45 years and older with T2DM using data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 797 participants with HbA1c measurements from 2011 to 2015 and cognitive function assessments in 2018 were included. Logistic regression models and restricted cubic spline (RCS) analysis were applied, adjusting for potential confounders. Higher mean HbA1c levels (≥ 9%) were significantly associated with an increased risk of CI, particularly in global cognition and episodic memory (OR 4.03 (1.45-11.20) for global cognition; OR 2.92 (1.02-8.38) for episodic memory). RCS analysis revealed a U-shaped relationship between mean HbA1c and CI, indicating that both excessively low and high HbA1c levels elevate CI risk. Uncontrolled HbA1c levels (≥ 8%) were also linked to higher CI risk compared to stable HbA1c levels. Maintaining HbA1c levels below 8% may significantly reduce CI risk in T2DM patients, highlighting the importance of personalized glycemic management., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background and Objectives: The Systolic Blood Pressure Intervention Trial suggested that intensive lowering of systolic blood pressure (SBP) decreases the risk of developing dementia. However, an insufficient number of probable dementia cases stemming from the trial's early termination made results inconclusive. The goal of this study was to estimate the effect of intensive vs standard SBP lowering on the longer term incidence of cognitive impairment leveraging extended follow-up for cognitive status., Methods: This is a prespecified secondary analysis of a randomized clinical trial. Between 2010 and 2013, patients aged 50 years and older with hypertension and increased cardiovascular risk excluding those with diabetes mellitus or history of stroke were recruited from 102 clinics in the United States and Puerto Rico. Participants were randomized to a SBP goal of <120 mm Hg (intensive treatment) or <140 mm Hg (standard treatment) and received treatment for 3.3 years. In-person cognitive assessment follow-up occurred through July 2018. Continued ascertainment of cognitive status by telephone began in December 2019 for participants who had not withdrawn consent or been previously adjudicated with probable dementia, but provided consent for future research. Data were analyzed using survival analyses., Results: Of 9,361 randomized participants, 7,221 (77%) were eligible to be re-contacted. Cognitive status of 4,232 (59%) was ascertained (mean age 67 years, 36% female). We accrued a total of 216 new cases of probable dementia, less than our target of 326. Over a median follow-up of 7 years, 248 participants of the intensive treatment group (8.5 per 1,000 person-years) were adjudicated with probable dementia, compared with 293 participants (10.2 per 1,000 person-years) in the standard treatment group (hazard ratio [HR], 0.86; 95% CI, 0.72-1.02). Consistent with earlier results from the trial, the rate of both mild cognitive impairment (MCI; HR, 0.87 95% CI, 0.76-1.00) and a composite of MCI or probable dementia was lower with intensive treatment (HR, 0.89; 95% CI, 0.79, 0.99)., Discussion: Among ambulatory adults with hypertension and high cardiovascular risk, intensive treatment vs standard treatment of SBP for 3.3 years resulted in a lower risk of MCI and cognitive impairment including MCI or probable dementia, but not for probable dementia alone., Classification of Evidence: This study provides Class II evidence that intensively reducing SBP (target <120 mm Hg) decreases the risk of cognitive impairment in individuals aged 50 years and older with hypertension., Clinical Trial Information: Clinical trial number NCT01206062.

Background and Objective: It is unclear whether variation in covert cerebrovascular disease prevalence is attributable to ethnic differences or to other factors. We aimed to examine the associations of country of residence with covert vascular brain injury (VBI) and cognitive dysfunction among Chinese adults residing in Canada and China., Methods: This was a multisite cross-sectional study of Chinese adults aged 40-80 years in the Canadian Alliance for Healthy Hearts and Healthy Minds (CAHHM; January 1, 2014, to December 31, 2018) and Prospective Urban Rural Epidemiological-Mind (PURE-MIND; November 1, 2010, to July 31, 2015) cohorts living in Canada and China. The exposure was country of residence. The co-primary outcomes were covert VBI (defined as MRI findings of high white matter hyperintensities or covert brain infarct) and cognitive dysfunction (defined as a Montreal Cognitive Assessment [MoCA] score <26). We used generalized linear models to describe the association between country of residence and each outcome, adjusting for selected covariates., Results: We included 884 adults living in Canada (mean age 57.3 years, 55.4% female) and 473 living in China (mean age 56.8 years, 60.3% female). Participants in Canada had a lower prevalence of covert VBI (age 65-79 years: male, 11.5%; female, 12.2%) than those living in China (age 65-79 years: male, 62.9%; female, 52.1%). Prevalence of MoCA score <26 was lower among men and women in Canada (age 65-79 years: 40.2% and 30.0%, respectively) than among men and women in China (age 65-79 years: 74.3% and 79.2%). Living in China was associated with a 6-fold increase in the odds of covert VBI (5.85, 4.06-8.45), which remained significant after covariate adjustment. Living in China was associated with a 7-fold increase in the odds of MoCA score <26 (6.98, 5.38-9.04), which was no longer significant after covariate adjustment., Discussion: Despite sharing a similar ethnicity, the prevalence of covert VBI and cognitive dysfunction varied substantially by country of residence. Disparities in cognitive dysfunction were completely explained by differences in education and traditional cerebrovascular risk factors, whereas disparities in covert VBI prevalence were only partially explained by differences in such factors, suggesting a role for other environmental factors.

Background and Objectives: Fatigue is a common and disabling symptom in cerebrovascular disease and has been associated with white matter damage, but the underlying disease mechanisms are poorly understood. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common genetic form of stroke and causes a cerebral small vessel disease arteriopathy with white matter ischemia. We determined the prevalence of fatigue in CADASIL, the factors associated with it, and its relationship with both depression and cognitive impairment., Methods: Prospectively recruited genetically confirmed patients with CADASIL were assessed using the Fatigue Severity Scale. The prevalence of fatigue in CADASIL was compared with that of healthy controls from the community. We determined associations between fatigue and clinical features, cardiovascular risk factors, MRI parameters, cognition, and depression. Cognition was measured using the Brief Memory and Executive Test (BMET) and depression using the Geriatric Depression Scale (GDS). Mediation and path analyses were performed to determine relationships between fatigue, depression, and cognitive impairment., Results: One hundred seventy-four patients with CADASIL (mean age [SD] of 51.3 [12.30] years, 59.66% female) and 50 healthy controls were included in the analysis (mean age [SD] of 51.42 [12.58] years, 38.0% female). Fatigue was present in 51.7% of patients with CADASIL and was almost 5 times more common than in controls (OR: 4.99, 95% CI [2.28-10.95], p < 0.001). There was no association of fatigue with history of stroke or MRI parameters including white matter hyperintensity lesion volume. Logistic regression showed both GDS total score (OR: 1.11 [1.05-1.17], p = 0.0002) and BMET total score (OR: 0.86 [0.75-0.98], p = 0.02) to be predictors of fatigue. Fatigue, depression, and cognition were frequently comorbid. Mediation analysis showed depression to have a greater effect on fatigue prevalence than cognitive impairment. Path analysis confirmed depression to be the largest predictor of fatigue and found this relationship to be bidirectional., Discussion: Fatigue was present in over half of the patients with CADASIL. Depression and cognition were the main predictors of fatigue, and all 3 symptoms were frequently comorbid. The relationship between depression and fatigue was the strongest and was bidirectional. This suggests targeting depressive symptoms may have benefit in fatigue management.

Background: Frailty is a state of vulnerability to poor homeostatic resolution of after a stressful event. The prevalence of frailty in patients with chronic kidney disease (CKD) is more common than in the general population. Frailty is associated with a poor clinical prognosis, malnutrition, and cognitive impairment; however, studies on these factors in patients with CKD are lacking. Therefore, we aimed to evaluate the relationship between CKD and frailty, nutritional status, and cognitive impairment and their influence on clinical outcomes., Methods: We prospectively enrolled participants from June 2019 to December 2020 and divided them into three CKD groups according to kidney function (CKD G1-2, CKD G3-4, and CKD G5D). Clinical outcomes were defined as the composite outcomes of all-cause death, hospitalization, and cardiovascular outcomes, including nonfatal myocardial infarction, revascularization, or stroke. To calculate the relative risk of frailty, cognitive impairment, nutritional status, and clinical outcome, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression analysis., Result: A total of 83 patients were included, of whom 31.3% had frailty and 18.1% had cognitive impairment. In the CKD G5D group, the prevalence of frailty (56.7%, n = 17) was significantly higher, and the nutritional quotient score was lower in the other groups. The Korean-Montreal Cognitive Assessment score was significantly lower in the CKD G5D group; however, cognitive impairment did not differ among the three groups. Frailty was significantly associated with cognitive impairment and CKD G5D group. Cognitive impairment was significantly associated with older age and higher BMI. Well-nourished status was significantly associated with BMI and CKD G5D group. Patients in the CKD G5D group were significantly more likely to have adverse clinical outcomes., Conclusions: The prevalence of frailty increased significantly as the CKD stage progressed. Particularly, CKD G5D group correlated with frailty and nutritional status, leading to poor clinical outcomes., Competing Interests: Declarations. Ethics approval and consent to participate: This study involved human participants who gave informed consent to participate in the study before participation and all research procedures were conducted in accordance with relevant guidelines and regulations, was approved by the Institutional Review Board of Gyeongsang National University Hospital (IRB No. 2019–03-014–001). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The present study was aimed to cluster sub-groups of patients with varying degrees of cognitive impairment (Subjective Cognitive Decline, mild or Major Neurocognitive Disorder) based on their modifiable risk factors and cognitive reserve with k-means analysis. As a secondary analysis, we described the identified clusters from different perspectives, i.e., socio-demographic characteristics, cognitive functioning, and mental health. The analysis revealed two clusters, which were composed by 27 and 43 patients characterized by protective (Cluster 1) and unprotective (Cluster 2) everyday life habits, respectively. The two groups showed significant differences across all examined dimensions, with Cluster 1 demonstrating a more favourable profile compared to Cluster 2. Specifically, Cluster 1 exhibited advantages in: (1) sociodemographic (education, technological skills, and occupation), (2) cognitive (global cognitive functioning, executive functioning, and working memory), and (3) mental health (mood state and quality of life) characteristics. Such a finding is representative of a more positive individual wellbeing for people who adopt protective behaviours. In the field of dementia prevention, these results support the importance to intervene proactively and simultaneously in the management of multiple risk factors during the entire lifespan., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval: The study was performed in accordance with the guidelines of the Declaration of Helsinki. The study was approved by local ethics committee of San Matteo Hospital, Pavia, Italy (protocol number: P-20210032883, date of approval: May 2021) and all participants signed an informed consent., (© 2025. The Author(s).)

Hypertension is closely related to cognitive impairment; however, the correlation between blood pressure control and cognitive impairment in the hypertensive population is unclear. We aimed to explore the relationship between blood pressure control and cognitive impairment in older adults with hypertension. Using the cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, 5,860 people with self-reported history of hypertension were divided into the hypotension, intermediate blood pressure, and hypertension groups. Cognitive impairment was defined as a score of < 18 on the Chinese version of the Mini-Mental State Examination. Demographics of the population were also collected. Bivariate Logistic regression analysis and restricted cubic spline (RCS) model were used to analyze the relationship between blood pressure control and cognitive impairment. After adjusting for confounding factors, binary logistic regression analysis showed that the intermediate group was significantly associated with an increased risk of cognitive impairment than the hypotension group, whereas the hypertension group was significantly correlated with a reduced risk of cognitive impairment. No significant correlation was found between blood pressure control and cognitive impairment in patients aged <80 years, with hearing impairment, or with cerebrovascular diseases, whether in the hypotension or hypertension groups. There was a significant correlation between hypotension and cognitive impairment, and no correlation between hypertension and cognitive impairment in people aged ≥ 80 years, Han ethnicity and those who used antihypertensive drugs. Furthermore, RCS model analysis showed that there was a non-linear relationship between systolic blood pressure and cognitive impairment in individuals aged ≥ 80 years and those using antihypertensive drugs. There was a linear relationship between diastolic blood pressure and cognitive impairment. Blood pressure control in the hypertensive group was significantly associated with a lower risk of cognitive impairment., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Yao 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: Existing studies have indicated the potential role of non-invasive physical health indicators as an early detector of mild cognitive impairment (MCI) in older adults. However, evidence is lacking in determining the appropriate physical health indicators for early screening of cognitive decline in each domain. Therefore, the current study aimed to establish a comprehensive physical health indicators profile in association with cognitive performance., Methods: The present study utilized a three-year longitudinal cohort design, with data from the China Health and Retirement Longitudinal Study (CHARLS). 4,869 participants aged 60-97 years from CHARLS wave 2015 and 2018 who were cognitively and physically healthy were included in analysis. Physical functions (BMI, grip strength, blood pressure, balance tests, course walking time, repeated chair stands, and pulmonary function) were objectively measured by physical tasks. Cognitive performance domains (general cognition, episodic memory, executive function, verbal fluency, orientation, and language-and-praxis) were measured through standardised interviews and cognitive tasks. Multiple linear regression models were conducted to explore the association between physical health indicators and cognitive performance. Subgroup analysis was conducted to identify sex-specific factors., Results: Pulmonary function was identified as associated with all domains of cognitive performance in older adults (β ranged between 0.05 and 0.08). Right grip strength was also identified as an important factor associated with all cognitive domains except general cognition (β ranged between 0.04 and 0.12). Subgroup analysis revealed that the association between physical health indicators and cognitive performance is more pronounced in males than in females., Conclusions: A profile of non-invasive physical health indicators associated with cognitive performance was established, which warrants future incorporation of non-invasive physical health indicators in early risk screening systems for MCI, enabling timely intervention and prevention in older adults. Future studies can delve deeper into the mechanisms underlying this full-dimensional relationship between physical and cognitive domains., Competing Interests: Declarations. Ethics approval and consent to participate: The institutional review board at Peking University granted the CHARLS ethical approval. Written informed consent was given by each participate who agreed to take part in the study. Consent for publication: The present study contains no identifiable individual personal data. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The evidence on the association between lifetime traumatic events (LTE) and the occurrence of cognitive changes and dementia is heterogeneous and often based on studies in high-risk populations. Using data from a German population-based study, this study examines whether there is a connection between LTE and experiences of abuse (CA) and neglect (CN) in childhood with mild Neurocognitive Disorder (miNCD) in old age.889 participants were included in the analysis. The trauma list of the PTSD module of the Structured Clinical Interview for DSM-IV (SKID-I) and the Childhood Trauma Screener (CTS) were used to record LTE. miNCD was diagnosed using a neurocognitive test battery according to DSM-5 criteria. Binary logistic regression analyses were used to examine the extent to which the presence LTE is related to the presence of miNCD.In the sample 31.0% reported at least one LTE, 30.3% reported CN and 13.2% reported CA. 19.1% met the criteria for miNCD. Four models were tested, including age, gender and educational level as possible confounding variables. Model 1 examined whether LTE (yes/no) was associated with miNCD in old age. Model 2 tested whether the number of LTE was related to miNCD. Model 3 tested whether CN was related to miNCD, and model 4 tested whether CA was related to miNCD. None of the models showed a significant effect of the investigated variables on the occurrence of miNCD.International studies show indications of a correlation between TLE, CN, CA and miNCD, but there is a lack of corresponding studies in Germany. Despite methodological strengths (standardized recording of all variables, population-based study), our analysis found no correlations. Maybe study requirements led to a positive selection of healthy older people. Nevertheless, LTE, CA and CN were not underrepresented. The results contradict those in high-risk populations, but are consistent with more recent population-based studies that find no associations.In the wider population, the investigated link does not appear to be as clearly demonstrable as in populations with high traumatic burden, such as veterans, which seems reassuring news given that LTE are risk factors for numerous comorbidities that could then play a role in the development of the cognitive changes., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Chinese women experience higher dementia rates than men, yet sex-specific risk factors are understudied. We examined how menopause age affects cognitive function and decline in aging Chinese women., Methods: Data were from 7419 postmenopausal women 45-101 years of age at baseline in the China Health and Retirement Longitudinal Study (CHARLS; 2011-2018). Menopause age was categorized using clinical cutoffs (<40, 40-44, 45-49, 50-55, >55 years). Cognitive function was assessed with neuropsychological tests up to four times over 7 years, and associations were analyzed using multivariable-adjusted linear mixed-effects regression., Results: Compared to menopause at 50-55 years (3661/7419; 49.3%), premature (<40; 235/7419; 3.2%), early (40-44; 623/7419; 8.4%), and late menopause (>55; 366/7419; 4.9%) were associated with lower baseline cognitive scores. Although the rate of cognitive decline did not differ significantly across menopause age groups, late menopause showed a trend toward faster decline., Discussion: Cognitive health interventions should consider extreme menopausal age as a risk factor., Highlights: Extreme menopausal ages-premature (<40), early (40-44), and late (>55)-are linked to lower baseline cognition versus menopause ages 50-55, persisting over 7 years. Cognitive disadvantage for late menopause (>55) versus 50-55 tends to increase over time. Health interventions should consider extreme menopause ages in women's cognitive health., (© 2025 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Introduction: Previous observational studies have implied a correlation between cognitive impairment and dysphagia, but some have indicated no correlation between the two. Such contradictory findings may have been influenced by small sample sizes and potential confounders. In this Mendelian randomization (MR) analysis, we genetically estimated a causal relationship between cognitive impairment and dysphagia., Methods: The study included a large meta-analysis of genome-wide association studies (GWAS) of cognitive impairment in 269,867 individuals of European ancestry and pooled data from a GWAS of dysphagia in 165,765 individuals of European ancestry (cases 3497, controls 161,968). We then used five different complementary MR methods, including IVW, MR-Egger, MR-RAPS, weighted median, and weighted mean, to estimate causality between cognitive impairment and dysphagia and finally also assessed heterogeneity and horizontal pleiotropy by extensive sensitivity tests., Results: No evidence of heterogeneity in the effect of instrumental variables was found in Cochran's Q test; therefore, a fixed effects model was used. IVW analysis (OR: 1.206, 95% CI: [1.041, 1.371], p = 0.00508) found that cognitive impairment was associated with an increased risk of dysphagia and that there was a causal association between the two. Also, the weighted median (OR: 1.248, 95% CI: [1.012, 1.484], p = 0.0253), weighted mode (OR: 1.216, 95% CI: [1.043, 1.389], p = 0.0412), and MR-RAPS (OR: 1.225, 95% CI: [1.069, 1.381], p = 0.00627) validated the conclusions. Furthermore, extensive sensitivity analyses found no evidence of heterogeneity or horizontal pleiotropy, confirming the reliability of this MR result., Conclusion: Our MR study demonstrated a causal effect of cognitive impairment on dysphagia from a genetic perspective, suggesting that individuals with a history of cognitive impairment require specific clinical attention to prevent the development of dysphagia., (© 2025 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Background: People with chronic kidney disease (CKD) have an elevated risk of cognitive impairment (CI). Medications with anticholinergic activity are recognized for their adverse reactions on central nervous system. The putative association between the anticholinergic burden and CI has not previously been evaluated in patients with CKD. The study aimed to (i) describe prescriptions of medications with anticholinergic activity, (ii) analyze factors associated with these prescriptions, and (iii) evaluate the anticholinergic burden's association with cognitive performance., Methods: CKD-REIN, a prospective cohort study, enrolled nephrology outpatients with a confirmed diagnosis of CKD (eGFR <60 mL/min/1.73m 2 ). Drug prescriptions were recorded prospectively during the 5-year follow-up. Mini Mental State Examination (MMSE) was assessed at baseline and CI was defined as an MMSE score <24/30. For each patient, the anticholinergic burden was determined by summing the Anticholinergic Cognitive Burden (ACB) scores of all prescription drugs at baseline. Multinomial logistic regression was used to analyze factors associated with the ACB score. Logistic regression was used to evaluate the association between the cognitive impairment and the anticholinergic burden at baseline., Results: At baseline, 3007 patients (median age [IQR], 69[60-76]; 65% men) had MMSE data and were included. 1549 (52%) of these patients were taking at least one drug with anticholinergic properties. Most (1092; 70%) had a low anticholinergic burden, 294 (19%) had a moderate anticholinergic burden, and 163 (11%) had a high anticholinergic burden. A history of neurological/psychiatric disorders and a higher number of daily drugs were associated with a greater probability of having a high anticholinergic burden (odds ratio (OR) [95% confidence interval (95% CI)] = 1.88[1.29;2.74] and 1.53[1.45;1.61], respectively). Patients with a high anticholinergic burden had a significantly higher probability of presenting cognitive impairment, compared with patients without an anticholinergic burden (OR[95% CI] = 1.76[1.12;2.75]) after adjustment for sociodemographic factors, comorbidities, laboratory data, and the number of medications taken daily., Conclusions: The results of our study emphasize the need for caution in the prescription of drugs with anticholinergic properties to patients with CKD., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Objectives: Cognitive frailty refers to the co-occurrence of cognitive impairment and frailty without concurrent Alzheimer's disease or dementia. Studies of cognitive frailty and mortality have been limited to single country or older people. However, frailty and cognitive decline may occur much earlier. We aimed to examine the association between different cognitive frailty status and subsequent all-cause mortality among middle-aged and older people in 17 countries., Methods: Participants aged 50 and over were drawn from six prospective cohorts of aging. We classified participants according to their cognitive impairment and frailty status into the following groups: none, only cognitive impairment, only frailty and cognitive frailty. Competing-risks regression models were used to evaluate the association of different cognitive frailty status at baseline with subsequent all-cause mortality., Results: The cognitive frailty group had a higher mortality risk compared to those without cognitive impairment and frailty groups. Meta-analysis results showed participants with cognitive frailty (pooled subhazard ratio [SHR] = 2.34, 95% confidence interval [CI]: 2.01-2.72, I 2 = 68.0%) had a higher mortality risk compared with those with only cognitive impairment status (pooled SHR = 1.36, 95% CI: 1.25-1.48, I 2 = 3.0%) or only frailty status (pooled SHR = 1.83, 95% CI: 1.72-1.95, I 2 = 31.0%). The association between cognitive frailty and mortality were stronger among those who were aged 70 years and older, males, single and nonconsumers of alcohol., Conclusions: Cognitive frailty, frailty or cognitive impairment alone, is associated with an increased risk of all-cause mortality in Asian, European and American countries. Physical and cognitive function screening should be conducted as early as possible in middle-aged and older people, and targeted intervention approaches should be developed to reduce the incidence of adverse health outcomes., Competing Interests: DISCLOSURES The authors report no conflicts with any product mentioned or concept discussed in this article. This research was supported by a grant from the Postdoctoral Fellowship Program of CPSF (grant number: GZB20230037, GZC20230131), and The Major Project of National Social Science Fund of China (grant number: 21&ZD187). The funders had no role in the study design; data collection, analysis, or interpretation; in the writing of the report; or in the decision to submit the article for publication., (Copyright © 2024 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

In this study, we evaluated birth cohort (i.e., generational) differences in the onset and rate of acceleration in cognitive decline prior to death (i.e., terminal decline [TD]). We obtained data from two cohorts, born in 1901-1902 ( n = 755, 64% females) and 1930 ( n = 347, 48% females), identified and sampled at age 70 from the same city population and assessed on the same cognitive tests at ages 70, 75, 79, 85, and 88. The 1901-1902 cohort was additionally assessed at ages 90, 92, 95, 97, 99, and 100. The outcome was defined at each measurement occasion by a composite score of three cognitive tests assessing spatial ability, perceptual and motor speed, and reasoning. Date of death was obtained from population register, with the last update in April 2023, covering over 99% and 38% of the cohort members, respectively. We fitted a random TD change point model to the data while accounting for sex and education. Findings revealed expected TD onset (as conditioned on male with formal education) 5.17 (95% highest density interval [2.54, 8.05]) years prior to death in the 1901-1902 cohort, with an acceleration in rate of decline by a factor of 4.43 within the TD phase. This estimate was delayed by 2.53 (95% highest density interval [5.68, 0.10]) years in the 1930 cohort, with an acceleration by a factor of 5.16 within the TD phase. To the best of our knowledge, this is the first study to present evidence indicating that today's birth cohort experience, on average, a shorter TD phase in comparison to earlier born cohorts. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Smoking and obesity interact to exacerbate the risk of hypertension, diabetes, and cardiovascular disease, but their potential synergistic effects on outcomes in multiple sclerosis (MS) have not been well studied. We aimed to study whether smoking and obesity interact to affect disease progression and cognitive function in patients with MS., Methods: Incident cases from the population-based case-control study Epidemiological Investigation of MS (EIMS) were categorized by smoking and obesity status at diagnosis and followed up to 15 years postdiagnosis through the Swedish MS registry (n = 3336). Cox regression was used to analyze outcomes, including clinical disease worsening (CDW), progression to Expanded Disability Status Scale (EDSS) levels 3 and 4, physical worsening as measured by a 7.5-point increase in the MS Impact Scale (MSIS) physical score, and cognitive decline, defined as an 8-point or greater reduction on the Symbol Digit Modalities Test (SDMT). Interaction effects on the additive scale were assessed by combining dichotomous variables for smoking (nonsmoker = 0, smoker = 1) and obesity (nonobese = 0, obese = 1), yielding four categories: 0/0 (reference category), 0/1, 1/0, and 1/1., Results: Additive interactions between smoking and obesity were identified for CDW (attributable proportion due to interaction [AP] 0.18, 95% CI 0.03-0.30), progression to EDSS 4 (AP 0.18, 95% CI 0.08-0.26), MSIS-Physical score worsening (AP 0.32, 95% CI 0.21-0.42), and cognitive decline (AP 0.27, 95% CI 0.19-0.35)., Conclusions: Smoking and obesity appear to synergistically worsen MS progression and cognitive functioning, with the observed additive interactions across most outcomes suggesting that these factors partly share common biological pathways contributing to disease progression., (© 2025 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Objectives: Investigate whether the coexistence of pain and depressive symptoms is a risk factor for cognitive decline in individuals aged 50 or older., Method: Longitudinal trajectory study involving 4,718 participants from the English Longitudinal Study of Ageing (ELSA). Joint pain was self-reported, and intensity was classified as mild, moderate/intense. Depressive symptoms were investigated using the Centre for Epidemiologic Studies Depression Scale ( CES-D-8  ≥ 4). The sample was divided into six groups: no pain and no depression (NP/NDe), mild pain and no depression (MP/NDe), moderate/intense pain and no depression (M-IP/NDe), no pain and depression (NP/De), mild pain and depression (MP/De), and moderate/intense pain and depression (M-IP/De). The outcome of interest was performance in memory, executive function, and global cognition. Generalised linear mixed models were used to analyse performance in the cognitive domains and global cognition score as a function of pain and depressive symptoms during 12 years of follow-up., Results: Over time, individuals with M-IP/De had a greater memory decline (-0.038 SD/year, 95%CI: -0.068 to -0.007) and the global cognition score (-0.033 SD/year, 95%CI: -0.063 to -0.002) than those with NP/NDe., Conclusion: The coexistence of moderate/intense pain and depressive symptoms is a risk factor for the decline of global cognition and memory.

Background: The Italian Interceptor project is aimed at identifying a prodromal dementia phase and developing a nationwide organizational model. This study compares the sociodemographic and neuropsychological characteristics of mild cognitive impairment non-converters (MCI-NC) and MCI-converters (MCI-C) to dementia, including Alzheimer's disease (AD), enrolled during the Interceptor project., Methods: Sociodemographic, clinical, and neuropsychological data of MCI individuals were collected at baseline (December 2018 to October 2020) and every six-month follow-up visit for 3 years. Logistic regression and Random Forest classifier were used to describe the study population., Results: From 356 participants, 104 were MCI-C, whereas 252 were MCI-NC. Compared to MCI-NC, MCI-C were predominantly female (p = 0.020), older (p < 0.001), and more cognitively impaired (p < 0.001). Higher physical activity was protective for progression (p < 0.001), but no difference was observed for smoking exposure (p = 0.312) between the two groups. Similar results were found for AD individuals compared to MCI-C/non-AD. The ROC curve based on a Random Forest classifier distinguishing MCI-C from MCI-NC showed an area under the curve (AUC) of 0.7347., Conclusions: Our findings confirm previous evidence in literature and may increase the insight on dementia pathology and help in defining intervention strategies to prevent or slow down disease progression., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Objective: The objective was to evaluate the longitudinal patterns of central and general obesity, identify their genetic and behavioral risk determinants, and investigate the association of distinct obesity trajectories beyond middle age with subsequent cognitive decline and the risk of developing dementia in late life., Methods: Using a nationally representative, longitudinal, community-based cohort, we examined trajectory patterns of obesity over a 14-year span beyond middle age employing latent mixture modeling. We then evaluated their relationship with subsequent cognitive decline through linear mixed models and with the risk of developing dementia using Cox models, adjusting for confounding variables., Results: Among the 4751 eligible participants (mean age, 58.7 [SD 8.1] years; 57% female), our analysis identified five distinct BMI trajectories and four WC trajectories spanning a 14-year period. In comparison with individuals in the low-stable BMI group, characterized by a consistent and healthy body weight (range, 22.8-22.9 kg/m 2 ), those in the high-stable group, maintaining a stable obesity status (range, 34.3-35.4 kg/m 2 ), exhibited an elevated risk of developing dementia (odds ratio [OR], 1.43; 95% CI: 1.02 to 2.00) and experienced a more accelerated cognitive decline over 6 years (difference in 6-year decline, -0.11 SD [95% CI: -0.18 to -0.03]). Similarly, when compared with participants in the low-stable WC group, indicating a stable and healthy WC (range, 76-79 cm), those in the high-increasing WC group, showing an increasing trend (range, 115-122 cm), demonstrated an increased risk of developing dementia (OR, 1.57, 95% CI: 1.01 to 2.49) and experienced a swifter cognitive decline (OR: -0.18 [95% CI: -0.28 to -0.07])., Conclusions: General and central obesity trajectories beyond midlife with persistently high or increasing patterns were significantly associated with an increased risk of developing cognitive decline and dementia in late life. Longitudinal obesity patterns may assist in precise identification of older adults at risk of developing cognitive impairment for targeted intervention., (© 2025 The Author(s). Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Background: Overall life satisfaction among older adults is associated with cognitive impairment. However, little is known regarding its influence on satisfaction with specific domains of life, such as health, income status, and marital relationship. This study aims to analyze the relationship between cognitive impairment and satisfaction with specific domains of life in older Koreans., Methods: This study used data from the Korean National Longitudinal Study on Aging from 2014 to 2020. Cognitive function was measured with the Mini-Mental State Examination. Four different models are used to assess the effect of cognitive impairment on four different measures of life satisfaction. The dependent variable in each model was overall life satisfaction, satisfaction with health status, satisfaction with economic status, and satisfaction with marital relationship, respectively. A generalized estimating equation modeling approach was used to take advantage of panel data., Results: In the weighted sample, 54.1% of the participants were women. The mean (± standard error) age of all participants was 68.9 (±0.1) years old. A total of 1671 participants (24.8%) had cognitive impairment. After adjustment of other variables, individuals without cognitive impairment were more satisfied with overall life (B = 2.75, P < 0.001), health status (B = 4.31, P < 0.001), economic status (B = 2.83, P < 0.001) and marital relationship (B = 3.36, P < 0.001) than impaired individuals., Conclusion: Cognitive impairment in old age is significantly associated with overall life satisfaction as well as satisfaction with several domains of life, such as health, income status, and marital relationship. Cognitive impairment is more strongly associated with satisfaction with health status and marital relationship than on satisfaction with economic status. Geriatr Gerontol Int 2025; 25: 182-189., (© 2025 Japan Geriatrics Society.)

Purpose: To investigate the proportion of patients with lymphoma with persistent clinically relevant cognitive impairment, and its relation to  treatment, fatigue, and psychological distress., Methods: Patients with diffuse-large-B-cell-lymphoma (DLBCL), follicular-lymphoma (FL), and chronic-lymphocytic-leukemia (CLL)/small-lymphocytic-lymphoma (SLL), diagnosed between 2004-2010 or 2015-2019, were followed up to 8 years post-diagnosis. Sociodemographic and clinical data were obtained from the Netherlands Cancer Registry and the Population-based HAematological Registry for Observational Studies. The EORTC QLQ-C30 was used to assess cognitive functioning and fatigue, and the HADS to assess psychological distress. Individual growth curve models were performed. Results were compared with an age- and sex-matched normative population., Results: A total of 924 patients were included (70% response rate). Persistent cognitive impairment was twice as high in patients (30%) compared to the normative population (15%). Additionally, 74% of patients reported co-occurring symptoms of persistent fatigue and/or psychological distress. Patients with FL (- 23 points, p < 0.001) and CLL/SLL (- 10 points, p < 0.05) reported clinically relevant deterioration of cognitive functioning, as did the normative population (FLnorm - 5 points, DLBCLnorm - 4 points, both p < 0.05). Younger age, higher fatigue, and/or psychological distress at inclusion were associated with worse cognitive functioning (all p's < 0.01). Treatment appeared less relevant., Conclusion: Almost one-third of patients with lymphoma report persistent cognitive impairment, remaining present up to 8 years post-diagnosis. Early onset and co-occurrence of symptoms highlight the need for clinicians to discuss symptoms with patients early., Implications for Cancer Survivors: Early recognition of cognitive impairment could increase timely referral to suitable supportive care (i.e., lifestyle interventions) and reduce (long-term) symptom burden., Competing Interests: Declarations. Ethics approval: Ethical approval for the study was obtained from a certified Medical Ethics Committee (Maxima Medical Centre in Veldhoven, the Netherlands; 0734). Competing interests: The authors declare no competing interests., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: Dietary inflammatory potential, measured by the dietary inflammatory index (DII) has been linked to cognitive impairment. However, evidence was mostly driven by cross-sectional studies. This meta-analysis of prospective cohort studies aims to evaluate the relationship between DII and the risk of cognitive impairment, including mild cognitive impairment (MCI) and dementia., Methods: We conducted a systematic search of PubMed, Web of Science, and Embase for studies published up to July 25, 2024. Prospective cohort studies with adults aged 18 years or older, without dementia at baseline, and reporting the incidence of cognitive impairment by DII category were included. Data were analyzed using a random-effects model to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs)., Results: Nine prospective cohort studies with 266,169 participants were included. A high DII at baseline was associated with an increased risk of cognitive impairment during follow-up (RR: 1.34, 95% CI: 1.15-1.55, p < 0.001) with moderate heterogeneity (I² = 56%). Subgroup analyses revealed consistent associations across types of cognitive impairment (MCI, overall dementia, Alzheimer's disease) and study characteristics (p for subgroup difference all >0.05). Sensitivity analyses confirmed the robustness of the results., Conclusions: This meta-analysis suggests that a higher dietary inflammatory potential is independently associated with an increased risk of cognitive impairment. These findings underscore the potential impact of dietary inflammation on cognitive health and highlight the need for dietary strategies to mitigate cognitive decline risk., Competing Interests: Declaration of competing interest The authors declared no conflicts of interest., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Patients' capacities to understand and act upon healthcare information is crucial to decision-making and high-quality care. Cognitive impairment (CI) has been associated with adverse outcomes across a range of diseases and surgeries. Despite the importance of CI, there is little to no information on its prevalence and severity in vascular surgery patients in the United States. We therefore conducted a prospective observational study to better characterize the prevalence and severity of CI in a contemporary vascular surgery practice., Methods: We enrolled 111 outpatients attending a vascular surgery clinic using pragmatic consecutive sampling. Patients were excluded if they had a previous diagnosis of blindness, deafness, or dementia. Subjects completed a demographic survey and the Montreal Cognitive Assessment (MoCA), which was administered by a trained proctor. Chart review was used to assess comorbidities. The MoCA is a validated tool consisting of tasks such as clock drawing for assessing CI. It has a lower educational bias and higher sensitivity for detecting mild impairment compared to other examinations. The MoCA is scored from 0-30 based on an objective grading system. Scores between 0-9, 10-17, 18-25, and 26-30 indicate severe, moderate, mild, and no CI, respectively. Statistical analysis, including multivariable modeling, was performed using SAS (SAS Institute, Cary, NC)., Results: Of 163 patients, our analysis included 111 consecutive vascular patients who completed the MoCA. The average age of the entire cohort was 64.1 years, and 58.6% were male. The majority of the patients in the study were White (80.1%). The mean MoCA score of the entire cohort was 22.6 (mild CI). Of all subjects, 77% had CI: 68% with mild and 9% with moderate CI. Hypertension (P = 0.024), congestive heart failure (CHF) (P = 0.028), fewer years of education (P = 0.032), and Medicaid enrollment (P = 0.046) all had significant univariate associations with CI. There was no statistically significant difference between age (P = 0.11) or the primary vascular diagnosis disease for which the patient sought treatment and CI (P = 0.49). Multivariable models demonstrated that only CHF (odds ratio 3.8, P = 0.046) was statistically significantly associated with risk of CI., Conclusions: In this first-time prospective study of the entire spectrum of vascular patients in the United States, we found that nearly 4 of every 5 vascular surgery patients have undiagnosed CI. Furthermore, we found that having CHF was associated with a higher likelihood of CI. Given the implications on consent, decision-making, and postoperative care, future work should focus on enrollment of a larger cohort along with an examination of the impact of CI on mortality, length of stay, and other outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Examine whether physical activity (PA) changes during the COVID-19 pandemic were related to subjective cognitive decline (SCD), depression, and anxiety in older adults and whether these varied by sociodemographic variables. Methods: 301 older adults completed an online survey between May and October 2020 and 3 months later, including self-report questionnaires of SCD, depression, and anxiety. PA changes were determined with a question. Results: 60% of participants reported decreased PA. Those who reduced their PA were more likely to be from low to middle income and younger. PA increase was related to less SCD and depressive symptoms compared to those who decreased it. Participants who maintained their PA had fewer SCD concerns, depressive, and anxiety symptoms than those who decreased it. Discussion: Reducing PA was associated with worse neuropsychiatric and cognitive symptoms. Encouraging older adults to increase PA may help mitigate some of the pandemic's adverse effects on psychological well-being., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Yakeel Quiroz serves as a consultant for Biogen. All other co-authors have no conflicting interests to disclose.

Background: The emergency personnel who responded to the World Trade Center (WTC) attacks endured severe occupational exposures, yet the prevalence of cognitive impairment remains unknown among WTC-exposed-FDNY-responders. The present study screened for mild and severe cognitive impairment in WTC-exposed FDNY responders using objective tests, compared prevalence rates to a cohort of non-FDNY WTC-exposed responders, and descriptively to meta-analytic estimates of MCI from global, community, and clinical populations., Methods: A sample of WTC-exposed-FDNY responders (n = 343) was recruited to complete an extensive battery of cognitive, psychological, and physical tests. The prevalences of domain-specific impairments were estimated based on the results of norm-referenced tests, and the Montreal Cognitive Assessment (MoCA), Jak/Bondi criteria, Petersen criteria, and the National Institute on Aging and Alzheimer's Association (NIA-AA) criteria were used to diagnose MCI. NIA-AA criteria were also used to diagnose severe cognitive impairment. Generalized linear models and propensity score matching were used to compare prevalence estimates of cognitive impairment to a large sample of WTC-exposed-non-FDNY responders from the General Responder Cohort (GRC; n = 7102) who completed the MoCA during a similar time frame., Result: Among FDNY responders under 65 years, the unadjusted prevalence of MCI varied from 52.57% to 60.32% depending on the operational definition of MCI, apart from using a conservative cut-off applied to MoCA total scores (18 < MoCA < 23), which yielded a markedly lower crude prevalence (24.31%) compared to alternative criteria. Using propensity score matching, the prevalence of MCI was significantly higher among WTC-exposed FDNY responders, compared to WTC-exposed GRC responders (adjusted RR = 1.13 (CI 95% = 1.07-1.20, p < 0.001), and descriptively higher than meta-analytic estimates from different global, community, and clinical populations. Following NIA-AA diagnostic guidelines, 4.96% of WTC-exposed-FDNY-responders met the criteria for severe impairments (95% CI = 2.91-7.82), a prevalence that remained largely unchanged after excluding responders over the age of 65 years., Discussion: There is a high prevalence of mild and severe cognitive impairment among WTC-responders, highlighting the putative role of occupational, environmental, and disaster-related exposures in the etiology of accelerated cognitive decline., (© 2024 Wiley Periodicals LLC.)

Objective: Cognitive impairment (CI) in systemic lupus erythematosus (SLE) is quite common and is an important prognostic factor due to its severity. The aim of our study was to determine the proportion and type of CI in SLE and to identify associated risk factors., Methods: We performed a cross-sectional study (January - March 2022). Participants included SLE patients and controls (No-SLE). SLE patients were subdivided into those with and those without CI to identify associated risk factors. CI was defined based on the results of eight specific tests assessing various cognitive functions, with MMSE used for overall cognitive assessment. Impairment was indicated by abnormalities in at least five of these eight functions., Results: Our study included 60 lupus and 40 non-lupus participants. The median disease duration of patients in the SLE group was 72 months (interquartile range: 24 - 150 months). The proportion of cognitive impairment in SLE was 31.7%. The comparative study of cognitive functions between the two groups of participants with and without SLE concluded that executive functions and verbal fluency were more impaired in the lupus group compared to the non-lupus group. It also concluded that there were no statistically significant differences in attention and concentration, episodic memory, working memory, calculation, visuospatial and visuoconstructive activity, or judgement. In the multivariate analysis, patients with SLE have a significantly higher risk of CI (Adjusted OR 3.76, 95% CI: 1.217 - 11.621) compared to non-SLE individuals. Each additional year of age increases the risk by 4.4% (Adjusted OR 1.044, 95% CI: 1.008 - 1.082). For factors associated with CI in SLE, the multivariate analysis concluded that the duration of corticosteroid therapy, by months, had an adjusted OR equal to 1.009 (CI (95%): 1.000-1.018), and the duration of education, by years, had an adjusted OR equal to 0.857 (CI (95%): 0.736-0.999)., Conclusion: Screening for CI in lupus patients is important, especially for those with factors associated with these disorders such as prolonged duration of corticosteroid therapy and shortened schooling., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The associations between community-wide social determinants of health and mild cognitive impairment (MCI) among individuals warrant investigation., Methods: Among 2830 dementia-free individuals aged 65+ years in a community-based US study, we examined cross-sectional associations of MCI (Clinical Dementia Rating = 0.5) with the following potential social determinants of health: at the census tract or block group level obtained from public sources: neighborhood disadvantage (Area Deprivation Index, ADI), air pollution with fine particulate matter (PM 2.5 ), greenspace, Walkability Index, ambulatory healthcare availability per square mile, homicide rate; and at the individual participant level, birth/schooling in a southern US state., Results: Unadjusted logistic regression models found higher odds ratios (OR, 95% CI) for MCI with higher ADI (1.01, 1.003-1.02), higher PM 2.5 (1.16, 1.07-1.26), higher homicide rate (1.007, 1.001-1.012), lesser greenspace (0.99, 0.90-0.99), and southern schooling (2.06, 1.6-3.54). Adjusting for age, race, sex, and educational level, ADI remained statistically significant (1.04, 1.01-1.06), while PM 2.5 and Southern state schooling interacted significantly with race and were more strongly affected in Black participants than in White participants., Conclusions: In this cohort, several community-wide social/environmental factors were associated with MCI. While clinicians should continue to encourage older adults to modify their individual risk factors, policy changes are needed to mitigate social determinants of health in the community., (© 2024 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

Background: Modifiable lifestyle behaviors significantly influence the risk of cognitive impairment. However, the cumulative effects of multidimensional lifestyle profiles on cognitive function remain poorly understood, as most studies examine individual lifestyle behaviors in isolation. This study aimed to identify distinct profiles of individuals based on healthy lifestyle behaviors and to examine associations between these profiles and cognitive function in older Chinese adults., Methods: We used a prospective cohort, including 5381 participants of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2008 and 2018, aged 65 years and older with normal cognition at baseline. Questionnaires were used to collect self-reported data on healthy diet, sleep quality, physical activities, cognitive activities, and social activities. Repeated measures of the Mini-Mental State Examination (MMSE) were utilized to assess cognitive function. Latent Profile Analysis (LPA) was conducted to identify profiles characterized by similar characteristics of lifestyle behaviors. The resultant profiles, were then used to further explore associations with cognitive function using cox proportional hazard regression and linear mixed models., Results: During a 10-year follow-up period, 2017 (37.5%) out of 5381 participants developed cognitive impairment. Three latent profiles were identified: (1) "active engagement" (n = 347, 6.4%); (2) "moderate engagement" (n = 627, 11.7%); and (3) "negative engagement" (n = 4407, 81.9%). Compared to negative engagement, the active profile had the lower risk of cognitive impairment (HR = 0.693, 95% CI: 0.553-0.868), longer years to develop cognitive impairment (mean = 7.818, range: 6.701, 8.935) and slower rate of annual cognitive decline (0.407 points per year). Similarly, the moderate engagement profile had the lower risk of cognitive impairment (HR = 0.781, 95% CI: 0.664-0.919), longer years to develop cognitive impairment (mean = 7.541, 95%CI: 6.464, 8.619) and slower rate of annual cognitive decline (0.297 points per year) compared to negative profile. Subgroup analysis revealed that there were no significant differences observed across any of the subgroups, including age, gender, year of schooling, marital status, residence, live alone, family economic status., Conclusions: These findings imply the likelihood of an inverse correlation between the levels of engagement in healthy lifestyle behavior and the risk of cognitive impairment. Even adopting a few healthy lifestyle habits is superior to none at all, underscoring the value of lifestyle modifications for cognitive health., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interests., (Copyright © 2025 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Background: Schizophrenia (SCZ) shortens life expectancy, with cardiovascular disease (CVD) as the leading cause of death. The links between psychiatric symptoms, cognitive function and CVD are unclear, and sex differences in this relationship are understudied. This study examined the relationship between clinical characteristics and 10-year cardiovascular risk in males and females with SCZ., Methods: This study included 802 patients with chronic SCZ. Fasting venous blood samples were collected from all patients to measure relevant glycolipid metabolic indices. The Positive and Negative Syndrome Scale (PANSS) was used to assess psychiatric symptoms. Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The Framingham risk score (FRS) was used to estimate the 10-year CVD risk., Results: The mean 10-year cardiovascular risk for all patients was 11.76 ± 8.99%. Among patients with SCZ, 52.8% exhibited an intermediate-high 10-year cardiovascular risk. Multivariate linear regression analysis showed that FRS increased with higher body mass index, blood pressure, glucose, total cholesterol and triglyceride levels, while it was inversely related to high density lipoprotein levels. The general psychopathological scores were negatively associated with FRS (male: B = - 0.086, P = 0.013; female: B = - 0.056, P = 0.039). Negative symptom (B = - 0.088, P = 0.024) and total PANSS scores (B = - 0.042, P = 0.013) showed a negative association with FRS only in males. Additionally, in patients over 60 years old, general psychopathology (B = - 0.168, P = 0.001) and PANSS total scores (B = - 0.057, P = 0.041) were associated with reduced FRS, while immediate memory (B = 0.073, P = 0.025) was associated with higher FRS., Conclusion: Patients with SCZ have an elevated risk of developing CVD, with males showing a higher 10-year cardiovascular risk than females. Significant sex differences exist in the relationship between the FRS and psychiatric symptoms, with negative symptoms being negatively related to FRS only in males., Competing Interests: Declarations. Conflict of interest: All the authors declared that there is no conflict of interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Objective: Previous studies have linked sleep problems to subjective cognitive decline (SCD) using a variable-centered approach (e.g., adding sleep symptoms to form a score); however, sleep problems may cluster differently between individuals. Thus, employing a person-centered approach, we aimed to: 1) identify profiles of self-reported sleep problems among U.S. middle-aged and older adults; 2) examine the cross-sectional association between these classes and SCD., Methods: We studied 33,922 adults aged 45+ years from the 2017 U.S. Behavioral Risk Factor Surveillance System (BRFSS) with data on sleep problems, including short or long sleep duration, trouble falling or staying asleep, unintentionally falling asleep, snoring loudly, and observed apneas. Latent class analysis classified participants based on their responses to sleep items. We then used a subsample from Oregon, the only state that administered both sleep and SCD modules (n = 2,747), to examine the association between class membership and SCD using logistic regression, adjusting for sociodemographic and health-related characteristics., Results: We identified and labeled four classes: "Healthy Sleep" (48.0 %); "Primarily Apnea" (25.8 %); "Primarily Insomnia" (17.6 %); and "Comorbid Insomnia and Sleep Apnea (COMISA)" (8.6 %). In adjusted models, individuals in the "COMISA" class had almost twice the odds of SCD, compared to those in the "Healthy Sleep" class (OR=1.91, 95 % CI =1.15-3.15)., Conclusions: Compared to U.S. middle-aged and older adults with healthy sleep, those with COMISA were significantly more likely to report SCD, which is a risk factor for dementia. Studies are needed investigating whether sleep interventions delay cognitive decline in these individuals., Competing Interests: Declaration of competing interest Adam Spira received payment for serving as a consultant for Merck, received honoraria from Springer Nature Switzerland AG for guest editing special issues of Current Sleep Medicine Reports, and is a paid consultant to Sequoia Neurovitality, BellSant, Inc., and Amissa, Inc. The remaining authors have no conflicts of interest to declare, (Copyright © 2024 Elsevier B.V. All rights reserved.)

The study aims to develop and validate an effective model for predicting frailty risk in individuals with mild cognitive impairment (MCI). The cross-sectional analysis employed nationally representative data from CHARLS 2013-2015. The sample was randomly divided into training (70%) and validation sets (30%). The least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression model were used to identify independent predictors and establish a nomogram to predict the occurrence of frailty. The receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve analysis (DCA) were used to evaluate the performance of the nomogram. A total of 3,196 MCI patients were analyzed, and 803 (25.1%) exhibited symptoms of frailty. Multivariate logistic regression analysis revealed that age, activities of daily living (ADL) score, depression score, grip strength, cardiovascular disease (CVD), liver disease, pain, hearing, and vision were associated factors for frailty in MCI patients. The nomogram based on these factors achieved AUC values of 0.810 (95% CI 0.780, 0.840) in the training set and 0.791 (95% CI 0.760, 0.820) in the validation set. Calibration curves showed good agreement between the nomogram and the observed values. The Hosmer-Lemeshow test results for the training and validation sets were P = 0.396 and P = 0.518, respectively. The ROC curve and decision curve analysis further validated the robust predictive ability of the nomogram. The application of this model may facilitate early clinical interventions, thereby potentially reducing the incidence of frailty among patients with MCI and significantly enhancing their long-term health outcomes., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Overactive bladder (OAB) is a prevalent condition among older adults and may be linked to cognitive health. This study explored a relationship between OAB and cognitive health among adults aged 60 ≥ years in the United States, using NHANES 2011-2014. A cross-sectional analysis was conducted using a nationally representative sample of 2,324 (45.95% male, 54.05% female), within 755 individuals have OAB. Cognitive health was assessed using the Consortium to Establish a Registry for Alzheimer's Disease-Word Learning (CERAD W-L), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). OAB was defined by a score more than 3 on the Overactive Bladder Syndrome Symptom Score (OABSS). Depression incidence was also recorded. Weighted linear regression models adjusted for demographic, behavioral factors, and comorbidities (e.g., diabetes, kidney disease etc.), were employed to examine the independent association between cognitive health and OAB. The results indicated that cognitive scores were significantly lower in the OAB group compared to the non-OAB group across all cognitive tests (p<0.001). The incidence of depression was significantly higher in the OAB group (15%) compared to the non-OAB group (6.05%) (p<0.001). Regression analysis revealed that a 14% decrease in cognitive health z-scores in patients with OAB (β=-0.14, CI (95%) [-0.22, -0.06]). Furthermore, depression was found to mediate 34.56% of the association between OAB and cognitive health relationship [CI (95%): 0.20, 0.69]. This negative association was robust in subgroups by demographics, behavioral factors, and comorbidities. This study's findings, supported by mediation analysis, smoothed curve analysis, and sensitivity analysis, suggest that lower cognitive health is significantly associated with OAB, and depression plays an important mediating role in this association., Competing Interests: Declarations. 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).)

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).)

Objective: This study aims to assess the relationship between modifiable dementia risk factors and both dementia and cognitive decline., Methods: Data were obtained from the Health and Retirement Study (HRS) [2008-2020], the China Health and Retirement Longitudinal Study (CHARLS) [2011-2020], and the English Longitudinal Study of Ageing (ELSA) [2010-2020]. After adjusting for confounding factors, multivariable logistic regression was utilized to analyze the relationship between modifiable dementia risk factors and dementia, while multivariable linear regression was employed to examine the relationship between these risk factors and cognitive decline. Additionally, the Cox proportional hazards model was used to assess the relationship between the number of risk factor events, clusters, and dementia risk., Results: A total of 30,113 participants from HRS, CHARLS, and ELSA were included (44.6% male, mean age 66.04 years), with an average follow-up period of 7.29 years. A low education level was significantly associated with an increased risk of dementia and accelerated cognitive decline (Overall, OR = 2.93, 95% CI: 2.70-3.18; Overall, β  = -0.25, 95% CI: -0.60 to-0.55). The presence of multiple dementia risk factors correlated with a higher dementia risk; Specifically, compared with more than 5 risk factor events, both having no dementia risk factors and having only one dementia risk factor were associated with a significantly lower risk of dementia (Overall, HR = 0.15, 95% CI: 0.11-0.22, HR = 0.22, 95% CI: 0.18-0.25). Compared to the group with no coexistence of risk factors, the clusters of excessive alcohol, diabetes, vision loss, and hearing loss (HR = 4.11; 95% CI = 3.42-4.95; p  < 0.001); excessive alcohol, vision loss, smoking, and hearing loss (HR = 5.18; 95% CI = 4.30-6.23; p  < 0.001); and excessive alcohol, obesity, diabetes, and smoking (HR = 5.96; 95% CI = 5.11-6.95; p < 0.001) were most strongly associated with dementia risk., Conclusion: Among the 11 risk factors, educational attainment has the greatest impact on dementia risk and cognitive decline. A dose-response relationship exists between the number of modifiable risk factor events and dementia risk. The coexistence of multiple risk factors is associated with dementia risk, and these associations vary by risk factor cluster., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Wang, Fan, Han, Wang, Cai, Zhong, Yang, Wang, Wang and Han.)

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: Dementia is a growing global health challenge with significant economic and social implications. Underdiagnosis of dementia is prevalent due to a lack of knowledge and understanding among the general population. Enhancing dementia literacy through improved health information-seeking behavior is crucial for the self-determined management of the disease by those affected. Understanding the relationship between dementia literacy, health information-seeking behavior, and the use of various information sources among individuals with cognitive impairment is of high importance in this context., Objective: The aim of this study was to analyze the relevance of different sources of health information from the perspective of people with cognitive impairment, while also evaluating differences based on age, gender, and disease progression., Methods: This study is part of the ongoing project "Digital Dementia Registry Bavaria - digiDEM Bayern." The Digital Dementia Registry Bavaria is a multicenter, prospective, longitudinal register study in Bavaria, Germany. People with cognitive impairment rated several information sources by using Likert scales with the values unimportant (1) to very important (5). Data were analyzed descriptively, and multiple 2-sample, 2-tailed t tests were used to evaluate differences by cognitive status and gender and using multiple one-way ANOVA to evaluate differences by age group., Results: Data of 924 people with cognitive impairment (531 with dementia, 393 with mild cognitive impairment) were evaluated. The most relevant health information sources were "Personal visit to a medical professional" (mean 3.9, SD 1.1) and "Family / Friends" (mean 3.9, SD 1.2). "Internet" was 1 of the 2 lowest-rated information sources by people with cognitive impairment (mean 1.6, SD 1.1), with nearly three-quarters (684/924, 74%) of the participants rating the source as unimportant. The age-specific analyses showed significant differences for the sources "Internet" (F2,921=61.23; P<.001), "Courses / Lectures" (F2,921=18.88; P<.001), and "Family / Friends" (F2,921=6.27; P=.002) for the 3 defined age groups. There were several significant differences between people with mild cognitive impairment and dementia whereby the first group evaluated most sources higher, such as "Internet" (mean difference=0.6; t640=7.52; P<.001). The only sources rated higher by the dementia group were "TV / Radio" and "Family / Friends," with none of them showing significant differences. Gender-specific analyses showed women with cognitive impairment valuing every evaluated source higher than men apart from "Internet" (mean difference=0.4; t685=4.97; P<.001)., Conclusions: To enhance health and dementia literacy, the best way to communicate health information to people with cognitive impairment is through interpersonal contact with medical professionals and their friends and family. Slight changes in valuation should be considered as the medical condition progresses, along with variations by age and gender. In particular, the evaluation and use of the internet are dependent on these factors. Further research is needed to capture potential changes in the valuation of the internet as a health information source., (© Florian Weidinger, Nikolas Dietzel, Elmar Graessel, Hans-Ulrich Prokosch, Peter Kolominsky-Rabas. Originally published in JMIR Formative Research (https://formative.jmir.org).)

Vascular cognitive impairment (VCI) stresses the vascular contributions to cognitive decline, ranging from mild to major forms. Except for symptomatic treatment for relevant vascular diseases, the other recommended strategy is to intervene in key vascular risk factors (VRFs) as early as possible. A considerable amount of previous research delineated the association of a specific factor with dementia, involving each risk factor discussed in the present review. However, due to the heterogeneity and complexity of VCI, managing a single factor is insufficient to reduce its incidence and prevalence. Ongoing studies suggest differences in the impact of various combinations of risk factors on dementia. Here in this review, we aimed to provide an updated overview of clinical evidence and implications of complex interactions among various risk factors of VCI, including common VRFs and modifiable dementia-related risk factors. Understating the effect of comorbid risk factors on VCI and underlying mechanisms of them during VCI progression is essential for identifying high-risk population and developing preventive strategies. Furthermore, we summarized common composite risk scores and models used for risk evaluation and prediction of VCI, involving conventional risk scores, subclinical vascular composites, and novel risk models driven by intelligent algorithms. Lastly, we discussed potential gaps and research directions on searching specific clinical risk profiles, constructing effective risk scores, and implementing targeted risk interventions., Competing Interests: Declaration of competing interest The authors have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

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.)

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 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/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: With the aging of society, cognitive impairment in elderly people is becoming increasingly common and has caused major public health problems. The screening of cognitive impairment in elderly people and its related influencing factors can aid in the development of relevant intervention and improvement strategies., Methods: In this study, stratified random cluster sampling was used to conduct a cross-sectional survey of elderly individuals aged 65 years in Chengdu, Sichuan Province, through an electronic questionnaire from November 2022 to November 2023. Descriptive analysis and logistic regression analysis were used to investigate cognitive impairment and its relevant influencing factors., Results: Among the 16,609 elderly people, 7524 (45.3%) were males and 9085 (54.7%) were females, with an average age of 73.6 ± 6.5 years (age range 65-101 years). The average years of education was 5.9 ± 6.2 years, and the proportion of individuals with cognitive impairment was 13.1%. With increasing age, the risk of cognitive impairment increased significantly. The risk factors for cognitive impairment in elderly individuals included advanced age, hypertension, heart disease, diabetes, cerebrovascular disease, depressive symptoms, and anxiety symptoms, while the protective factors included higher education level, married status, and greater life satisfaction., Conclusion: Cognitive impairment in elderly individuals in Chengdu is serious. We can intervene in and improve cognitive impairment in elderly people by controlling blood pressure and blood sugar, treating depressive and anxiety symptoms and developing community colleges for elderly people and increasing satisfaction with life., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Ethical Review Committee of Chronic Disease Center, China CDC, which was affiliated with the Chronic Disease Center of China CDC and was conducted in accordance with the principles outlined in the Declaration of Helsinki. All participants provided informed consent statement for this study. Consent for publication: The results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher. All authors agreed to publish this article in BMC Geriatrics. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

It remains unclear whether the benefits of adhering to a healthy lifestyle outweigh the effects of high genetic risk on cognitive decline. We examined the association of combined lifestyle factors and genetic risk with changes in cognitive function and six specific dimensions of cognition among older adults from the Chinese Longitudinal Healthy Longevity Survey (1998-2018, n = 18,811, a subset of 6301 participants with genetic information). Compared to participants with an unfavorable lifestyle, those with a favorable lifestyle showed a 46.81% slower rate of cognitive decline, with similar results across most cognitive domains. High genetic risk was associated with a 12.5% faster rate of cognitive decline. Individuals with a high genetic risk and a favorable lifestyle have slower cognitive decline than those with a low genetic risk and an unfavorable lifestyle. These data suggest that the benefits of a favorable lifestyle outweigh genetic factors, and therefore that adhering to a favorable lifestyle may offset the genetic risk for accelerated cognitive decline., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

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).)

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.