International psychogeriatrics最新文献

Background: The SUPERA® Cognitive Stimulation program was tested in a randomized, single-blinded, controlled clinical trial to investigate its effectiveness in older adults without cognitive impairment or dementia.

Methods: A total of 207 participants were randomly assigned to three groups: Training Group (TG), Active Control Group (ACG), and Passive Control Group (PCG). The TG (n = 65) received the SUPERA® Cognitive Stimulation program in 72 weekly cognitive stimulation sessions over 18 months; the ACG (n = 63) received health and lifestyle education; and the PCG (n = 79) received no intervention. Participants were assessed at baseline (T0), 6 (T1), 12 (T2), 18 (T3), and 24 (T4) months (six-month follow-up). Main outcomes included a battery of cognitive performance tests. Additional outcomes included psychological symptoms, quality of life, and self-perceived cognitive functioning. Intention-to-treat (ITT) analyses using Linear Mixed Models were conducted.

Results: Main outcomes showed significant improvement in Phonemic Verbal Fluency (FAS) in the TG, with evidence of maintenance of effects at the twenty-four-month follow-up. The post-hoc analysis of the composite scores revealed significant time-group interactions favoring the TG for memory, executive function, and global cognition. Specifically, a marked time-group interaction was observed on the FAS in favor of the TG, an effect that was sustained at the six-month follow-up (T4). Furthermore, robust effects were found for subjective cognitive functioning. In this domain, the time-group interaction analysis was consistently favorable for the TG, which reported sustained gains across all follow-up assessments. These findings demonstrate the positive impact of the intervention on objective cognitive performance, and particularly on participants´ self-perceived functioning.

Conclusions: These findings suggest that an 18-month-long multicomponent SUPERA® Cognitive Stimulation program may represent an effective preventive strategy against cognitive decline among healthy older adults. However, further studies are needed to confirm long-term benefits and to explore the mechanisms underlying the reported improvements.

Background and aims: Associations of Subjective Memory Complaints (SMC) with cognition and future dementia are poorly understood in the oldest old (age 90 +), who have high incidence and prevalence of cognitive impairment. This study aims to (1) report SMC frequency, (2) assess cross-sectional associations between SMC and cognitive test scores, and (3) compare the abilities of SMC, Mini-mental state examination (MMSE), and cognitive diagnosis to predict dementia in the oldest old.

Method: The 90 + Study participants without baseline dementia and with baseline SMC, MMSE, at least one other cognitive test, and cognitive diagnosis were included in cross-sectional analysis. A subset of this group with follow-up cognitive diagnosis was included in longitudinal analysis. Cross-sectional association between SMC and cognitive test scores was explored using linear regression. Risk of incident dementia in relation to baseline SMC, MMSE, and cognitive diagnosis was explored using three Cox regression models. Concordance Index (C-index) was used to compare model performance.

Results: In 893 participants with average age 93 years (range 90-102), 43 % had SMC. Cross-sectionally, SMC were associated with lower scores on memory, language, executive function. After 3.5 years of follow-up (range 0.4-16), 325 of 789 participants developed dementia. SMC, compared with no SMC, was associated with twice the risk of incident dementia (HR=2.16, 95 %CI, 1.72-2.72; p < 0.01). SMC predicted incident dementia as well as MMSE (p = 0.12), but not as well as cognitive diagnosis (p < 0.01).

Conclusions: Single SMC question might be useful to identify oldest old with cognitive impairment or at risk of dementia.

Objective: Studies of dementia involving the oldest old are few in Sub-Saharan Africa. Survivors of the Ibadan arm of the Indianapolis-Ibadan Dementia Project who were enrolled in 1992 or 2001 were re-examined between 2021 and 2022.

Aim: To revisit these subjects and evaluate them for the presence of cognitive and functional impairment and assign diagnoses as relevant as well as determine factors that mitigate development of dementia and cognitive impairment and thus promote healthy aging.

Design: Evaluation consisted of the CERAD neuropsychological battery, an informant interview, and a clinical examination by physicians with expertise in cognitive disorders of aging. Diagnoses were adjudicated by consensus between psychiatrists and neurologists using ICD-10 and DSM-IV criteria and diagnosis of Mild Cognitive Impairment based on the National Institute of Aging- criteria RESULT: One hundred and thirty-five of the original 4425 persons ever recruited were re-evaluated. Mean age was 93·0±2·8 years (range 89-106 years); 103 (76 %) were females, 29 (21 %) were diagnosed dementia, 25 (18 %) had AD, 44 (32·6 %) had diagnosis of Mild Cognitive Impairment (MCI) and 62 (45·9 %) were cognitively normal. Using logistic regression model for the combined dementia and MCI group with predictor variables collected during the 2001 evaluation wave, we found that cognitive score (Odds Ratio (OR)= 0·94, p = 0·024 (95 % CI:0.09-0.99), diastolic blood pressure (OR=1·04, p = 0·015 (95 % CI:1.01-1.07) and regular alcohol use (OR=0·42, p = 0·041(95 % CI:0.18-0.96) were associated with 20-year prevalence of cognitive impairment after adjusting for age, sex, and education. ApoE4 allele was neither a risk factor for dementia nor Cognitive Impairment in this cohort.

Conclusion: Prevalence of cognitive impairment in this oldest old survivor cohort was associated with cognitive performance, diastolic blood pressure and regular use of alcohol 20 years before.

Objectives: Social relationships are well-researched as protective factors against cognitive impairment, but their role for individuals experiencing cognitive impairment is less clear. The present study examined the associations between cognitive impairment, social relationships, and well-being in very old adults (80 + years), a high-risk group for cognitive impairment.

Design: Using representative data from the Study on Quality of Life and Well-Being in North-Rhine Westphalia (NRW80+ Study), we analyzed three social factors (close network, leisure activity, loneliness) and two well-being measures (depressiveness, positive affect) across very old individuals with and without cognitive impairment. We also investigated whether cognitive impairment affected the associations between social factors and well-being.

Setting: Computer-assisted interviews were conducted with target persons or proxies in private housing and care facilities.

Participants: The final sample included 1516 participants: 66.80 % without cognitive impairment, 15.00 % with mild impairment, and 18.20 % with major impairment.

Measurements: Social and well-being measures were assessed through standardized interviews.

Results: Cognitive impairment was associated with poorer social outcomes and lower well-being. Meanwhile, stronger social connections were linked to higher well-being. The associations were partially influenced by cognitive impairment. Notably, low leisure engagement was more strongly associated with increased depressiveness in individuals with major cognitive impairment than in those without (B = -0.53 [-0.83, -0.23], p < .001).

Conclusions: Our findings emphasize the importance of social integration in preserving well-being for individuals with cognitive impairment. As the incidence of cognitive impairment rises, future research should not only focus on prevention but also on improving the situation for those affected.

Background: This study intends to assess to what extent instruments commonly used in clinical practice, as well as plasma p-tau-181, can predict the progression from MCI to dementia. The usefulness of a disease progression model (DPM) is also explored.

Methods: A longitudinal, prospective nested case-control study was conducted with patients from the Geriatrics outpatient clinics who met the MCI International Working Group criteria. The patients had a first clinical interview and two follow-ups after 12 and 24 months. Validated Spanish instruments were used for assessment, including the Mini-Mental State Examination (MMSE), the clock test, verbal fluency, the EURO-D depression scale, Barthel's Index, and Lawton's Index. P-tau-181 analysis was performed with SIMOA (Single MOlecule Array). A robust parametric disease progression model (RPDPM) was developed.

Results: Fifty-nine patients fulfilled the inclusion criteria. The median age was 82.7 + /-8.7 years, 93 % had amnestic MCI and 45.8 % progressed to dementia (ICD-11 criteria) in two years. P-tau-181 was not prognostic. An RPDPM with the MMSE, clock test, and Lawton's Index could predict progression to dementia with an AUC of 0.945.

Conclusion: A combination of the MMSE, clock test, and Lawton's Index in a DPM model predicted progression from MCI to dementia best. P-tau and other blood biomarkers did not predict progression. Our results highlight the strength of clinical variables to predict the progression of MCI.

Introduction: Depressive symptoms and subjective cognitive decline (SCD) are commonly reported prior to cognitive impairment. We examined associations between depressive symptoms and SCD among diverse Hispanic/Latino adults to better understand how depressive symptoms should be considered when interpreting SCD.

Methods: This cross-sectional study utilized data from Hispanic/Latino adults [n = 6189; Age: M= 63.4 years, SD= 8.2; 55 % female; 40.5 % reported more than high school education] from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA).

Results: Higher depressive symptoms were associated with worse global (β=0.37, SE=0.02) and domain-specific SCD (Memory: β=0.32, SE=0.02; Visual-Spatial Planning: β=0.27, SE=0.02; Executive Function: β=0.34, SE=0.02; ps < 0.001). These associations were significantly stronger for individuals with low cognitive status and current cognitive worry.

Discussion: These findings underscore the importance of assessing depressive symptoms in relation to SCD among diverse Hispanics/Latinos, especially among individuals with current cognitive worry and suspected cognitive impairment.

Objectives: Positive psychological characteristics may help to bolster daily functioning in older adults even in the presence of subjective or subtle objective cognitive weaknesses. The purpose of the present study was to examine which specific psychological characteristics may contribute to better functional abilities, independent of cognitive performance, among a sample of older adults with subjective cognitive decline (SCD).

Design, setting, and participants: Participants included 277 older adults recruited from the community who were enrolled in a randomized controlled trial examining the impact of training in memory support strategies and healthy lifestyle behaviors. The current study was based on baseline data prior to intervention randomization.

Measurements: Linear regression was used to assess associations between positive psychological characteristics (positive affect, life satisfaction, purpose in life, resiliency, self-management of health, and perceived competence), one negative psychological characteristic (negative affect), and functional abilities controlling for demographic variables. A final model assessed for associations between functional abilities and any of the significant characteristics identified in the linear regressions while controlling for global cognition (measured with the Modified Neuropsychological Test Battery composite score), depression, and demographic variables.

Results: In the individual regressions, most of the psychological characteristics were significantly associated with functional abilities. In the final model, positive and negative affect remained significantly associated with functional abilities.

Conclusions: This is one of the first studies to show that greater positive affect is associated with better functional abilities, even after controlling for objective cognitive performance. Positive affect in older adults may represent a modifiable target for intervention.

Objectives: The aim of this study was to determine whether individuals with Subjective Cognitive Decline (SCD), particularly those with a neurostructural marker of risk for AD (SCD+), exhibit differences in the functional connectivity of the Default-Mode Network (DMN) relative to controls, as this network is known to be altered in the AD continuum.

Design: Cross-sectional study.

Setting: Galicia, Northwest Spain.

Participants: The sample compromised 133 participants: 69 controls, 51 SCD and 13 SCD+.

Measurements: Seed-to-voxel analysis was conducted using four DMN ROIs. Dynamic independent component analysis of the DMN was also performed.

Results: The SCD and SCD+ groups exhibited DMN hyperconnectivity, which was more extensive in the SCD+ group. Increased anti-correlations between DMN and task-positive parietal regions were related to poorer executive scores in SCD+ and a tendency for higher DMN recurrence in SCD+.

Conclusions: Hippocampal atrophy as a SCD+ biomarker is associated with extensive DMN hyperconnectivity and increased anti-correlations between DMN and task-positive network regions.