Project description:Background/objectivesObstructive sleep apnea (OSA) has been linked to an increased risk for Alzheimer's disease (AD), but little prospective evidence exists on the effects of OSA treatment in preclinical AD. The objective was to determine if continuous positive airway pressure (CPAP) treatment adherence, controlling for baseline differences, predicts cognitive and everyday function after 1 year in older adults with mild cognitive impairment (MCI) and to determine effect sizes for a larger trial.DesignQuasi-experimental pilot clinical trial with CPAP adherence defined as CPAP use 4 hours or more per night over 1 year.SettingSleep and geriatric clinics and community.ParticipantsOlder adults, aged 55 to 89 years, with an apnea-hypopnea index of 10 or higher participated: (1) MCI, OSA, and CPAP adherent (MCI +CPAP), n = 29; and (2) MCI, OSA, CPAP nonadherent (MCI -CPAP), n = 25.InterventionCPAP.MeasurementsThe primary cognitive outcome was memory (Hopkins Verbal Learning Test-Revised), and the secondary cognitive outcome was psychomotor/cognitive processing speed (Digit Symbol subtest from the Wechsler Adult Intelligence Scale Substitution Test). Secondary function and progression measures were the Everyday Cognition, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, and Clinical Dementia Rating.ResultsStatistically significant improvements in psychomotor/cognitive processing speed in the MCI +CPAP group vs the MCI -CPAP group were observed at 1 year after adjustment for age, race, and marital status (parameter estimate = 1.68; standard error = 0.47; 95% confidence interval = 0.73-2.62), with a 6-month effect size (ES) of 0.46 and a 1-year ES of 1.25. There were small to moderate ESs for memory (ES 0.20, 6 mo), attention (ES 0.25, 1 y), daytime sleepiness (ES 0.33, 6 mo and ES 0.22, 1 y), and everyday function (ES 0.50, 6 mo) favoring the MCI +CPAP group vs the MCI -CPAP group.ConclusionControlling for baseline differences, 1 year of CPAP adherence in MCI +OSA significantly improved cognition, compared with a nonadherent control group, and may slow the trajectory of cognitive decline.Trial registration numberMemories; NCT01482351; https://clinicaltrials.gov/ct2/show/NCT01482351?cond=MCI+and+OSA&rank=1 J Am Geriatr Soc 67:558-564, 2019.
Project description:. In this study we identify a unique signature protein and metabolic biomarker panel for those who improve in cognition and those who decline, assessed by the Montreal Cognitive Assessment (MoCA). We investigate a discovery cohort of Brain in Motion participants involving a quasi-experimental aerobic exercise intervention study and analyze blood plasma before and after a six-month aerobic exercise intervention and 5 years later. We relate the differentially expressed proteins and metabolites to subjective sleep quality measures and fitness level. This study informs on the differences in the plasma of those who decline and those who improve in cognition, identifying pathways that are of importance for preventing cognitive decline.
Project description:IntroductionThe striatum and frontal lobes have been shown to have early Alzheimer's disease (AD) neuropathology and are critical for motor and cognitive function. We hypothesized gait would be associated with early-stage dementia in Down syndrome (DS), a cohort at risk for AD.MethodsTwenty-eight participants with DS were enrolled in the study. Participants walked at their self-selected pace and while completing a dual task (counting, obstacle, or counting+obstacle).ResultsAll participants were able to complete the self-paced condition and 78.57-96.42% completed the dual-task conditions. There was a trend for greater dual-task effects on gait velocity based on dementia diagnosis. Gait velocity had stronger associations with clinical dementia assessments than age or diagnosis.DiscussionA dual-task gait paradigm is feasible to conduct with adults with DS and is associated with age and cognitive impairment. Dual-task gait may serve as an indicator of early stage dementia in DS.
Project description:We evaluated the effect of Acetyl-cholinesterase-inhibitors (AChEIs) on cognitive decline and overall survival in a large sample of older patients with late onset Alzheimer’s disease (LOAD), vascular dementia (VD) or Lewy body disease (LBD) from a real world setting. Patients with dementia enrolled between 2005 and 2020 by the "Alzheimer's Disease Research Centers" were analysed; the mean follow-up period was 7.9 years. A 1:1 propensity score matching was performed generating a cohort of 1.572 patients (786 treated [AChEIs +] and 786 not treated [AChEIs-] with AChEIs. The MMSE score was almost stable during the first 6 years of follow up in AChEIs + and then declined, while in AChEIs− it progressively declined so that at the end of follow-up (13.6 years) the average decrease in MMSE was 10.8 points in AChEIs- compared with 5.4 points in AChEIs + (p < 0.001). This trend was driven by LOAD (Δ-MMSE:−10.8 vs. −5.7 points; p < 0.001), although a similar effect was observed in VD (Δ-MMSE:−11.6 vs. −8.8; p < 0.001). No effect on cognitive status was found in LBD. At multivariate Cox regression analysis (adjusted for age, gender, dependency level and depression) a strong association between AChEIs therapy and lower all-cause mortality was observed (H.R.:0.59; 95%CI: 0.53–0.66); this was confirmed also in analyses separately conducted in LOAD, VD and LBD. Among older people with dementia, treatment with AChEIs was associated with a slower cognitive decline and with reduced mortality, after a mean follow-up of almost eight years. Our data support the effectiveness of AChEIs in older patients affected by these types of dementia.
Project description:Type 2 diabetes (T2D) is consistently associated with an elevated risk of cognitive decline and dementia. The underlying molecular mechanisms relating T2D to cognitive decline remain unclear, impeding the ability to detect the earliest stages of cognitive decline in older adults with T2D, consequently hindering advancement of preventive interventions. This study compared quantitative alterations in glycoproteoforms, represented by tryptic glycopeptiforms—specific glycan compositions on amino acid sites of proteins—in older T2D adults. We utilized label free, mass spectrometry-based glycoproteomics to analyze protein N-glycosylation and glycation patterns in serum samples, collected at two time points (T1 and T2), an average 52 months apart, from two initially cognitively healthy T2D groups. One group was comprised of individuals who experienced cognitive decline (“decliners”; N=8), and the other, of individuals who maintained normal cognition (“non-decliners”; N=14) over time. Comparison of these two groups revealed distinct patterns for glycosylation and glycation. Glycosylation primarily affected platelet function pathways. Glycation was also involved in immune system and platelet function along with various metabolic pathways. These findings suggest that aberrant glycoproteomic modifications may contribute to the development of cognitive impairment in T2D and may serve as potential early biomarkers. Further research is warranted to elucidate the functional implications of glycopeptiform modifications in T2D-related cognitive decline.
Project description:Background: Dementia is the one of the most common and prominent disease in the elderly person that results in the Cognitive interventions. In this study, we aim to conceptualize the cognitive intervention for older adults with and without cognitive dysfunction and to clarify the heterogeneity existing in this literature field by determining the main variables implicated. Methods: We conducted a study analysis using previous literature highlighting the significant data reporting empirical results from cognitive intervention for healthy older adults and other seniors with different types of dementia. Each paper was reviewed in terms of compensatory cognitive training, cognitive remediation, enrichment, cognitive activation, brain training, cognitive stimulation, cognitive training, and cognitive rehabilitation. The research analysis was performed following rigorous inclusion and exclusion criteria with the purpose of collecting relevant answers to our research questions. Results: We included a total of 168 studies in our review. Our findings indicated heterogeneity regarding methods, concepts, and procedures. Additionally, the values were integrated using different information existing in this field. Conclusion: In conclusion, we highlighted that this is the first review that clarify the discrepancy of various existing definitions, methods, and procedures, as well as the overlapping information in the cognitive interventions.
Project description:The primary purpose of this study is to determine the effectiveness of a multi-media presentation and survey to increase screening for colorectal cancer. Content of this presentation is based on the concept of "implementation intentions," an advanced planning model taken from the Theory of Planned Behavior. The multi-media presentation is delivered in a touch-screen computer format and contains messages about colorectal cancer that are tailored to each participant based on individual survey responses. It is hypothesized that tailored messages and defining implementation intentions may have a relationship with completion of colorectal cancer screening.
Project description:IntroductionPrevious longitudinal studies indicate that hearing loss and cognitive impairment are associated in non-tonal language-speaking older adults. This study aimed to investigate whether there is a longitudinal association between hearing loss and cognitive decline in older adults who speak a tonal language.MethodsChinese-speaking older adults aged 60 years and above were recruited for baseline and 12 month follow-up measurements. All participants completed a pure tone audiometric hearing test, Hearing Impaired-Montreal Cognitive Assessment Test (HI-MoCA), and a Computerized Neuropsychological Test Battery (CANTAB). The De Jong Gierveld Loneliness Scale was used to measure loneliness, and the 21-item Depression Anxiety Stress Scale (DASS-21) was used to measure aspects of mental health. Associations between baseline hearing loss and various cognitive, mental and psychosocial measures were evaluated using logistic regression.ResultsA total of 71 (29.6%) of the participants had normal hearing, 70 (29.2%) had mild hearing loss, and 99 (41.2%) had moderate or severe hearing loss at baseline, based on mean hearing thresholds in the better ear. After adjusting for demographic and other factors, baseline moderate/severe audiometric hearing loss was associated with an increased risk of cognitive impairment at follow-up (OR: 2.20, 95% CI: 1.06, 4.50). When pure-tone average (PTA) was modeled continuously, an average difference of 0.24 in HI-MoCA scores for every 10 dB increase in BE4FA existed, and an average difference of 0.07 in the change of HI-MoCA scores in a 12 month period.DiscussionThe results revealed a significant longitudinal relationship between age-related hearing loss and cognitive decline in this cohort of tonal language-speaking older adults. Steps should also be taken to incorporate hearing assessment and cognitive screening in clinical protocols for older adults 60 years and above in both hearing and memory clinics.
Project description:BackgroundDementia is a growing public health issue. Non-drug interventions targeting individuals before the onset of overt cognitive decline may be effective. Subjective cognitive decline (SCD) is present in > 50% of older adults and associated with progression to dementia. Here, we tested the compliance and effectiveness of a Multidomain Lifestyle Intervention Program using the mini-program, Cognitive Evergreenland, (MLIP-CE), based on the Health Action Process Approach model to support home-based intervention in older adults with SCD.MethodsCognitive Evergreenland was designed to improve cognitive reserve and maintain brain function in people at high risk of dementia and included: cognitive stimulation, cognitive training, health education, vascular risk monitoring, social support, and functional assessment, among other features. This was an exploratory trial designed to examine participant compliance with the mobile lifestyle intervention and its effectiveness, as well as changes in health-related indicators and cognitive function of older adults with SCD from baseline to 12 and 24 weeks post-intervention.ResultsThe retention rate for MLIP-CE was 90.2% (37/41). Mean participant age was 70.93 ± 6.91 years, 73.2% of participants were female, and mean Montreal Cognitive Assessment score was 24.51 ± 2.87. Throughout the 24 weeks of the prescribed intervention, app usage remained consistently high, with over 92% of participants using the mini-program at least once a week and successfully completing corresponding health management tasks. In terms of average usage, cognitive training emerged as the most frequently used functional module (95.73%), closely followed by health education (95.02%). The health behavior levels of older adults with SCD, measured in terms of ability, opportunity, and motivation, were significantly increased relative to baseline (p < 0.001). Regarding cognitive function, Mini-Mental State Examination scores were significantly improved post-intervention, with a moderate effect size (Hedges' g = 0.60).ConclusionsThese findings suggest that MLIP-CE, which was designed based on a theoretical framework, has potential for implementation, and support ongoing research into use of MLIP-CE for individuals at high risk of SCD or other dementia conditions.Trial registrationThe trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR2200058665 on 13 April 2022.
Project description:Down syndrome (DS) is associated with intellectual disability and an ultra-high risk of developing dementia. Informant ratings are invaluable to assess abilities and related changes in adults with DS, particularly for those with more severe intellectual disabilities and/or cognitive decline. We previously developed the informant rated Cognitive Scale for Down Syndrome (CS-DS) to measure everyday cognitive abilities across memory, executive function, and language domains in adults with DS, finding CS-DS scores are a valid measure of general abilities, and are significantly lower for those with noticeable cognitive decline compared to those without decline. To further test the validity of the CS-DS in detecting changes associated with cognitive decline we collected longitudinal data across two time points, approximately 1.5-2 years apart, for 48 adults with DS aged 36 years and over. CS-DS total scores (78.83 ± 23.85 vs. 73.83 ± 25.35, p = 0.042) and executive function scores (46.40 ± 13.59 vs. 43.54 ± 13.60, p = 0.048) significantly decreased between the two time points, with scores in the memory domain trending towards a significant decrease (22.19 ± 8.03 vs. 20.81 ± 8.63, p = 0.064). Adults with noticeable cognitive decline at follow-up showed a trend to significantly greater change in total scores (7.81 ± 16.41 vs. 3.59 ± 16.79, p = 0.067) and significantly greater change in executive function scores (5.13 ± 9.22 vs. 1.72 ± 9.97, p = 0.028) compared to those without decline. Change in total scores showed significant correlations with change in scores from other informant measures of everyday adaptive abilities and symptoms associated with dementia, and participant assessment of general cognitive abilities (all p < 0.005), while change in memory scores (R 2 = 0.28, p = 0.001) better predicted change in participant cognitive assessment scores than change in executive function (R 2 = 0.15, p = 0.016) or language (R 2 = 0.15, p = 0.018) scores. These results suggest informants may better detect changes in the executive function domain, while change in informant rated memory scores best predicts change in assessed cognitive ability. Alternatively, memory domain scores may be sensitive to changes across both early and late cognitive decline, whereas executive function domain scores are more sensitive to changes associated with later noticeable cognitive decline. Our results provide further support for the validity of the CS-DS to assess everyday cognitive abilities and to detect associated longitudinal changes in individuals with DS.