Hypovitaminosis D is associated with global cognitive impairment in adults. It remains unclear which domain-specific cognitive functions are affected with hypovitaminosis D.
To systematically review ...and quantitatively synthesize the association of serum 25-hydroxyvitamin D (25OHD) concentrations with episodic memory and executive functions in adults.
A Medline and PsycINFO libraries search was conducted on May 2012, with no limit of date, using the Medical Subject Headings (MeSH) terms "Vitamin D" OR "Hydroxycholecalciferols" combined with the MeSH terms "Memory" OR "Memory Disorders" OR "Executive Function" OR "Attention" OR "Cognition" OR "Cognition disorders" OR "Dementia" OR "Alzheimer disease" OR "Neuropsychological Tests". Fixed-effects meta-analysis was performed from 12 eligible studies using an inverse-variance method.
Of the 285 selected studies, 14 observational studies (including 3 prospective cohort studies) and 3 interventional studies met the selection criteria. All were of good quality. The number of participants ranged from 44-5,692 community-dwellers (0-100% women). In the pooled analysis, although episodic memory disorders showed only modest association with lower 25OHD concentrations (summary effect size of the difference (ES) = -0.09 95%CI:-0.16;-0.03), associations of greater magnitude were found with executive dysfunctions (processing speed: mean difference of Trail Making Test (TMT)-A score = 4.0 95% CI:1.20;6.83; mental shifting: mean difference of TMT-B score = 12.47 95% CI:6.78;18.16; information updating tests: ES = -0.31 95% CI:-0.5;-0.09). The pooled risk of incident decline of TMT-B score was OR = 1.25 95% CI:1.05;1.48 in case of initial lower 25OHD concentrations. Vitamin D repletion resulted in improved executive functions (ES = -0.50 95% CI:-0.69;-0.32 for before-and-after comparison), but exhibited no difference with control groups (ES = 0.14 95% CI:-0.04;0.32 for between-group comparison after intervention).
Lower serum 25OHD concentrations predict executive dysfunctions, especially on mental shifting, information updating and processing speed. The association with episodic memory remains uncertain.
BACKGROUND: The interpretation of the increase in stride-to-stride variability of stride time (STV) regarding the evolution of cognitive deficits across the dementia spectrum is matter of debate. ...OBJECTIVE: The aim of this study was to compare STV at usual and fast-pace walking speeds of MCI patients with that of cognitively healthy individuals (CHI) and Alzheimer’s disease (AD) patients with mild dementia, while considering the effects of potential confounders. METHODS: STV while walking at usual and fast-pace walking speeds was recorded with the GAITRite® system from 116 older adults (mean age 75.6±6.5 years; 55.2% female) divided into 3 groups according to their cognitive status (44 CHI, 39 MCI patients and 33 AD patients with mild dementia). RESULTS: The full adjusted multiple linear regression models showed that high STV was associated with slow gait speed at usual-pace walking speed (P=0.002) and with the MCI status at fast-pace walking speed (P=0.015). CONCLUSIONS: High STV at fast-pace walking speed was a specific gait disturbance of MCI patients in the sample of studied participants, and thus could be used in the future as a specific biomarker of MCI patients.
Highlights • We tested the effect of cognitive decline on postural control strategies. • Older adults without and with cognitive decline were compared. • The participants were asked to maintain quiet ...stance on force platform. • The analyses revealed an effect of cognitive status on COP velocity-based variables. • Results have implications for understanding clinical balance problems in older adults.
Gait characteristics measured at usual pace may allow profiling in patients with cognitive problems. The influence of age, gender, leg length, modified speed or dual tasking is unclear.
...Cross-sectional analysis was performed on a data registry containing demographic, physical and spatial-temporal gait parameters recorded in five walking conditions with a GAITRite® electronic carpet in community-dwelling older persons with memory complaints. Four cognitive stages were studied: cognitively healthy individuals, mild cognitive impaired patients, mild dementia patients and advanced dementia patients.
The association between spatial-temporal gait characteristics and cognitive stages was the most prominent: in the entire study population using gait speed, steps per meter (translation for mean step length), swing time variability, normalised gait speed (corrected for leg length) and normalised steps per meter at all five walking conditions; in the 50-to-70 years old participants applying step width at fast pace and steps per meter at usual pace; in the 70-to-80 years old persons using gait speed and normalised gait speed at usual pace, fast pace, animal walk and counting walk or steps per meter and normalised steps per meter at all five walking conditions; in over-80 years old participants using gait speed, normalised gait speed, steps per meter and normalised steps per meter at fast pace and animal dual-task walking. Multivariable logistic regression analysis adjusted for gender predicted in two compiled models the presence of dementia or cognitive impairment with acceptable accuracy in persons with memory complaints.
Gait parameters in multiple walking conditions adjusted for age, gender and leg length showed a significant association with cognitive impairment. This study suggested that multifactorial gait analysis could be more informative than using gait analysis with only one test or one variable. Using this type of gait analysis in clinical practice could facilitate screening for cognitive impairment.
This randomized controlled trial aims to compare changes in mental and physical health in older Japanese community-dwellers who participated in a productive art-based activity at the Tokyo Fuji Art ...Museum (intervention group) and in their counterparts, who did not participate in the intervention (control group).
A total of 73 older community-dwellers living in Tokyo participated in a single-blind RCT in two parallel groups (intervention group versus control group). The intervention was 2 h of productive art-based activities per week. The weekly sessions were carried out at the Tokyo Fuji Art Museum over a 12-week period. The control group did not participate in any productive art-based activity over the study period. Well-being, quality of life and frailty were assessed before the first, and after the last, art-based activity. These outcomes were assessed with the same schedule in both groups.
The intervention group saw a significant improvement in their quality of life (
< 0.044) and mixed results on their physical health (i.e., decreased frailty status) when compared to the control group. The comparison of changes in frailty scores between M0 and M3 showed improvement in the intervention group (
= 0.014), but when adjusted for baseline characteristics by linear regressions, revealed only a trend (
= 0.070). No conclusive effect was shown with well-being.
This RCT showed mixed health effects of productive art engagement in older Japanese community-dwellers in Tokyo. Benefits were reported for quality of life and mixed effects were observed for frailty, while no significant effect was found for well-being.
: Ethic committee of Shobi University, Tokyo (Japan), ref. A-2021-1; Clinical Trial Number NCT03679715.
Background
The “Program of Research on the Integration of Services for the Maintenance of Autonomy” (PRISMA-7) is the reference tool for the assessment of older patients visiting the emergency ...departments (EDs) in the province of Quebec (Canada). This study aimed to examine 1) whether the PRISMA-7 high-risk level for disabilities was associated with the length of stay in ED and in hospital, and hospital admission; and 2) performance criteria (i.e., sensitivity, specificity, positive predictive value PPV, negative predictive value NPV, likelihood ratios LR) of the PRISMA-7 high-risk level for the length of stay in ED and hospital, and hospital admission in older ED users.
Methods
A total of 12,983 older ED users of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited in this observational and prospective cohort study. All enrolled participants had a PRISMA-7 assessment upon their arrival at ED. The length of stay in ED and hospital, and hospital admission were used as outcomes.
Results
A PRISMA-7 high-risk level was associated with an increased length of stay in ED and hospital (β ≥2.1 with P≤0.001 and Hazard ratio (HR)= ≥1.2 with P≤0.001) as well as in hospital (HR=1.27 with P≤0.001) in patients on a stretcher. All performance criteria were low (i.e., <0.78). Patients with a PRISMA-7 high-risk level were discharged significantly later from ED and hospital compared to those with low-risk level (P=0.001).
Interpretation
A PRISMA-7 high-risk level was associated with a long length of stay in ED and hospital, and hospital admission in patients on a stretcher but had poor performance criteria for these adverse events, suggesting that it cannot be used as a prognostic tool in older ED users.
Preventing falls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and/or of calcium may reduce the fall ...and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting results as some studies failed to show any effect, while others reported a significant decrease of falls and fractures. Through a 15-year literature overview, and after a brief reminder on mechanism of falls in older adults, we reported evidences for a vitamin D action on postural adaptations - i.e., muscles and central nervous system - which may explain the decreased fall and bone fracture rates and we underlined the reasons for differences and controversies between published data. Vitamin D supplementation should thus be integrated into primary and secondary fall prevention strategies in older adults.
Cognitive impairment-related changes in postural sway increase fall risk among older adults. Better understanding this association could be helpful for fall prevention.
To examine the ...center-of-pressure (COP) velocity association with cognitive status and history of falls, in cognitively healthy individuals (CHI), patients with mild cognitive impairment (MCI), and with mild-to-moderate Alzheimer's disease (MMAD).
Six hundred and eleven older community-dwellers (77.2 ± 7.9 years; 51.8% men) were separated into CHI, MCI, and MMAD participants. By computing the average absolute maximal velocity (AAMV), the bounding limits of COP velocity dynamics were determined while participants were asked to maintain quiet stance on a force platform with eyes open or with eyes closed. Age, gender, history of falls, body mass index, medications, handgrip strength, Timed Up & Go score were used as covariates.
The multivariate ANCOVA, with AAMV in eyes open and eyes closed conditions as dependent variables, showed that the highest AAMVs that bound the COP velocity dynamics of postural sway were associated with cognitive impairment (p = 0.048) (i.e., lowest limits in CHI and MCI as compared with MMAD) and falls (p = 0.033) (i.e., highest limits in fallers).
These findings identified the bounding limits of COP velocity as a hallmark feature of cognitive impairment-related changes in postural sway, in particular for MMAD. This point is of special interest for clinical balance assessment and fall prevention in MMAD patients in order to plan long-term targeted fall-prevention programs.
Individuals with mild cognitive impairment (MCI) have worse gait performance compared to cognitive healthy individuals (CHI). The discrepancy between imagined and performed timed up and go test ...(TUG), known as the TUG delta time, is a marker of brain gait control impairment in individuals with MCI. The study aims to examine the association between the TUG delta time and brain gray matter (GM) volumes in CHI and individuals with MCI. A total of 326 participants, 156 CHI and 170 MCI, with TUG delta time and a brain T1-weighted magnetic resonance imaging (MRI) were selected in this cross-sectional study. Individuals with MCI were older and had greater (i.e., worst performance) performed TUG and TUG delta time compared to CHI. The GM volume association with TUG delta time was examined in CHI and MCI assuming that increased TUG delta time would be associated with locally decreased GM volumes. No significant association was found in CHI, whereas TUG delta time was negatively associated with the GM volume of the right medial temporal lobe in individuals with MCI.
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