The Effect of Sociodemographics, Physical Function, and Mood on Dementia Screening in a Multicultural Cohort

To assess age, sex, race and ethnicity disparities in cognitive function in community-dwelling older adults and identify factors that contribute to these disparities. Cognitive performance (global and domain-specific) and self-reported cognitive function were compared among Black (N=57), Hispanic (N=139), and White (N=108) older adults. The impact of socioeconomic status (SES), physical functionality, and mood indicators was assessed with a combination of hierarchical general linear models and mediation analysis. Poorer cognitive performance and higher levels of impairment were found in older adults from racial and ethnic backgrounds. The contribution of lower SES to the observed racial and ethnic disparities in objective cognitive performance was 33% in Hispanics and about 20% in Blacks, while poorer physical functionality explained over half of the differences between Black and White participants. Higher self-reported cognitive impairment in minorities was explained by lower SES and higher depressive symptoms in Hispanics but not in Blacks. Performance on objective memory testing and self-reported cognition are greatly influenced by relevant biological, sociodemographic and medical variables. Dementia screening programs should be tailored to individual sociodemographic groups based on contributors that are specific to each group

What older adults do with results from a community‐based dementia screening program

Background Alzheimer’s disease and related dementias (ADRD), and mild cognitive impairment (MCI) are often under‐recognized in the community. Primary care providers are often responsible for the detection, diagnosis, and treatment of ADRD as the number of dementia specialists are not sufficient to meet the growing demands. MCI/ADRD screening could offer benefits such as early treatment, research participation, lifestyle modification, and advanced care planning. To date, there are no clear guidelines regarding the benefits vs. harms of dementia screening or what individuals who completed screening will do with their results. Methods A community‐based study was conducted to evaluate acceptability of MCI/ADRD screening, and how older adults would make use of the results and information provided to them. Measures of cognition, physical health, functionality, and mood were collected. Participants met with a health professional, were given screening results with recommendations, and then contacted 60 days later to determine what was done with the results. Results Participants (n=288) had a mean age 71.5+8.3y, mean education 13.3+4.8y, and were 70% female, 67% White, 26% Black, 48% Hispanic. After 60 days, 75% of participants were contacted; 54% shared results with family, 32% shared results with health care providers (HCPs), and 52% initiated behavioral change. Among participants sharing results, 51% reported HCPs did not follow‐up on the results, and 18% HCPs did not show any interest in the screening. Behavioral changes included lifestyle modification (58%), social engagement (10%), cognitive stimulation (5%) and advanced care planning (4%). Predictors of behavioral change were lower comorbidities (OR=0.62, 95%CI:0.39‐0.96), higher A1C (OR=3.24, 95%CI:1.32‐7.95), poorer self‐perceived emotional health (OR=4.67, 95%CI:1.17‐18.67) and increased age (OR=1.14, 95%CI:1.01‐1.29). Conclusion MCI/ADRD screening was well‐accepted in a diverse community sample. Participants showed interest in sharing the results with their family and HCPs and many attempted behavioral change. While HCPs did always not act on screening results, 25% ordered further testing and evaluation. Future efforts are needed to (1) increase self‐efficacy of older adults to discuss screening results with their HCPs, and (2) educate HCPs on the value of early detection of MCI/ADRD. Community dementia screening programs can increase MCI/ADRD detection, improving patient‐centered outcomes and medical decision‐making

What older adults do with the results of dementia screening programs.

IntroductionAlzheimer's disease and related dementias (ADRD) and mild cognitive impairment (MCI) are often under-recognized in the community. MCI/ADRD screening could offer benefits such as early treatment, research participation, lifestyle modification, and advanced care planning. To date, there are no clear guidelines regarding the benefits vs. harms of dementia screening or whether a dementia screening program could be successful.MethodsA community-based study was conducted to evaluate an MCI/ADRD screening program and determine what older adults would do with the information. Measures of cognition, physical health, functionality, and mood were collected. Participants met with a health professional, were given screening results with recommendations, and then contacted 60 days later to determine what was done with the results. Logistic regression models were used to build predictive models.ResultsParticipants (n = 288) had a mean age of 71.5±8.3y, mean education of 13.3±4.8y, and were 70% female, 67% White, 26% African American, and 48% Hispanic. After 60 days, 75% of participants were re-contacted; 54% shared results with family, 33% shared results with health care providers (HCPs), and 52% initiated behavioral change. Among participants sharing results with HCPs, 51% reported HCPs did not follow-up on the results, and 18% that HCPs did not show any interest in the screening visit or its results. Predictors of sharing results with HCPs were elevated hemoglobin A1C (OR = 1.85;95%CI:1.19-2.88), uncontrolled hypertension (OR = 2.73;95%CI:1.09-6.83), and mobility issues (OR = 2.43;95%CI: 1.93-5.54). Participant behavioral changes included lifestyle modification (58%), social engagement (10%), cognitive stimulation (5%), and advanced care planning (4%). The most significant predictors of sharing with family were better overall mental health (OR = 0.19; 95%CI: 0.06-0.59) and better physical function (OR = 0.38; 95%CI: 0.17-0.81).DiscussionMCI/ADRD screening was well-received by a diverse community sample. Participants showed interest in sharing the results with their family and HCPs and many attempted behavioral change. While HCPs did not always act on screening results, 25% ordered further testing and evaluation. Efforts need to be directed toward (1) increasing self-efficacy of older adults to discuss screening results with their HCPs, and (2) educating HCPs on the value of early detection of MCI/ADRD. Community dementia screening programs can increase MCI/ADRD detection and improve patient-centered outcomes and medical decision-making

Sarcopenic obesity and cognitive performance

Sarcopenia and obesity both negatively impact health including cognitive function. Their coexistence, however, can pose an even higher threat likely surpassing their individual effects. We assessed the relationship of sarcopenic obesity with performance on global- and subdomain-specific tests of cognition. The study was a cross-sectional analysis of data from a series of community-based aging and memory studies. The sample consisted of a total of 353 participants with an average age of 69 years with a clinic visit and valid cognitive (eg, Montreal Cognitive Assessment, animal naming), functional (eg, grip strength, chair stands), and body composition (eg, muscle mass, body mass index, percent body fat) measurements. Sarcopenic obesity was associated with the lowest performance on global cognition (Est. =-2.85±1.38, =0.039), followed by sarcopenia (Est. =-1.88±0.79, =0.017) and obesity (Est. =-1.10±0.81, =0.175) adjusted for sociodemographic factors. The latter, however, did not differ significantly from the comparison group consisting of older adults with neither sarcopenia nor obesity. Subdomain-specific analyses revealed executive function (Est. =-1.22±0.46 for sarcopenic obesity; Est. =-0.76±0.26 for sarcopenia; Est. =-0.52±0.27 for obesity all at <0.05) and orientation (Est. =0.59±0.26 for sarcopenic obesity; Est. =-0.36±0.15 for sarcopenia; Est. =-0.29±0.15 all but obesity significant at <0.05) as the individual cognitive skills likely to be impacted. Potential age-specific and depression effects are discussed. Sarcopenia alone and in combination with sarcopenic obesity can be used in clinical practice as indicators of probable cognitive impairment. At-risk older adults may benefit from programs addressing loss of cognitive function by maintaining/improving strength and preventing obesity

Using a patient-reported outcome to improve detection of cognitive impairment and dementia: The patient version of the Quick Dementia Rating System (QDRS).

IntroductionCommunity detection of mild cognitive impairment (MCI) and Alzheimer's disease and related disorders (ADRD) is a challenge. While Gold Standard assessments are commonly used in research centers, these methods are time consuming, require extensive training, and are not practical in most clinical settings or in community-based research projects. Many of these methods require an informant (e.g., spouse, adult child) to provide ratings of the patients' cognitive and functional abilities. A patient-reported outcome that captures the presence of cognitive impairment and corresponds to Gold Standard assessments could improve case ascertainment, clinical care, and recruitment into clinical research. We tested the patient version of the Quick Dementia Rating System (QDRS) as a patient-reported outcome to detect MCI and ADRD.MethodsThe patient QDRS was validated in a sample of 261 consecutive patient-caregiver dyads compared with the informant version of the QDRS, the Clinical Dementia Rating (CDR), neuropsychological tests, and Gold Standard measures of function, behavior, and mood. Psychometric properties including item variability, floor and ceiling effects, construct, concurrent, and known-groups validity, and internal consistency were determined.ResultsThe patient QDRS strongly correlated with Gold Standard measures of cognition, function, mood, behavior, and global staging methods (p-values DiscussionThe patient QDRS validly and reliably differentiates individuals with and without cognitive impairment and can be completed by patients through all stages of dementia. The patient QDRS is highly correlated with Gold Standard measures of cognitive, function, behavior, and global staging. The patient QDRS provides a rapid method to screen patients for MCI and ADRD in clinical practice, determine study eligibility, improve case ascertainment in community studies

The Cognitive & Leisure Activity Scale (CLAS): A new measure to quantify cognitive activities in older adults with and without cognitive impairment

Potentially modifiable dementia risk factors include diet and physical and cognitive activity. However, there is a paucity of scales to quantify cognitive activities. To address this, we developed the Cognitive & Leisure Activity Scale (CLAS). The CLAS was validated in 318 consecutive individuals with and without cognitive impairment. Psychometric properties were compared with sample characteristics, disease stage, and etiology. The CLAS has very good data quality (Cronbach alpha: 0.731; 95% confidence interval: 0.67-0.78). CLAS scores correlated with gold standard measures of cognition, function, physical functionality, behavior, and caregiver burden. CLAS scores were positively correlated with other resilience factors (eg, diet, physical activity) and negatively correlated with vulnerability factors (eg, older age, frailty). The CLAS is a brief inventory to estimate dosage of participation in cognitive activities. The CLAS could be used in clinical care to enhance cognitive activity or in research to estimate dosage of activities prior to an intervention

The Effect of Baseline Patient and Caregiver Mindfulness on Dementia Outcomes

Background: Mindfulness is the practice of awareness and living in the present moment without judgment. Mindfulness-based interventions may improve dementia-related outcomes. Before initiating interventions, it would be beneficial to measure baseline mindfulness to understand targets for therapy and its influence on dementia outcomes. Objective: This cross-sectional study examined patient and caregiver mindfulness with patient and caregiver rating scales and patient cognitive performance and determined whether dyadic pairing of mindfulness influences patient outcomes. Methods: Individuals (N = 291) underwent comprehensive evaluations, with baseline mindfulness assessed using the 15-item Applied Mindfulness Process Scale (AMPS). Correlation, regression, and mediation models tested relationships between patient and caregiver mindfulness and outcomes. Results: Patients had a mean AMPS score of 38.0±11.9 and caregivers had a mean AMPS score of 38.9±11.5. Patient mindfulness correlated with activities of daily living, behavior and mood, health-related quality of life, subjective cognitive complaints, and performance on episodic memory and attention tasks. Caregiver mindfulness correlated with preparedness, care confidence, depression, and better patient cognitive performance. Patients in dyads with higher mindfulness had better cognitive performance, less subjective complaints, and higher health-related quality of life (all p-values<0.001). Mindfulness effects on cognition were mediated by physical activity, social engagement, frailty, and vascular risk factors. Conclusion: Higher baseline mindfulness was associated with better patient and caregiver outcomes, particularly when both patients and caregivers had high baseline mindfulness. Understanding the baseline influence of mindfulness on the completion of rating scales and neuropsychological test performance can help develop targeted interventions to improve well-being in patients and their caregivers

Longitudinal associations between physical and cognitive performance among community-dwelling older adults.

To assess the directionality of the association between physical and cognitive decline in later life, we compared patterns of decline in performance across groups defined by baseline presence of cognitive and/or physical impairment [none (n = 217); physical only (n = 169); cognitive only (n = 158), or both (n = 220)] in a large sample of participants in a cognitive aging study at the Knight Alzheimer's Disease Research Center at Washington University in St. Louis who were followed for up to 8 years (3,079 observations). Rates of decline reached 20% for physical performance and varied across cognitive tests (global, memory, speed, executive function, and visuospatial skills). We found that physical decline was better predicted by baseline cognitive impairment (slope = -1.22, p<0.001), with baseline physical impairment not contributing to further decline in physical performance (slope = -0.25, p = 0.294). In turn, baseline physical impairment was only marginally associated with rate of cognitive decline across various cognitive domains. The cognitive-functional association is likely to operate in the direction of cognitive impairment to physical decline although physical impairment may also play a role in cognitive decline/dementia. Interventions to prevent further functional decline and development of disability and complete dependence may benefit if targeted to individuals with cognitive impairment who are at increased risk