Mobility and Depressive Symptoms in Persons With Mild Cognitive Impairment and Alzheimer Dementia.

BACKGROUND AND PURPOSE: Persons with mild cognitive impairment (MCI) and Alzheimer dementia (AD) often experience gait and balance disturbances and depressive symptoms alongside their cognitive impairment. The aim of this study was to explore the relationship between mobility and depressive symptoms in community-dwelling persons with MCI and mild to moderate AD. METHODS: Ninety-nine participants with MCI and AD from the memory clinic at Oslo University Hospital, Ullevål, Norway, were included. The Balance Evaluation Systems Test (BESTest), 10-m walk test regular (gait speed), and dual task (naming animals, dual-task cost in percent) were used to assess mobility. The Cornell Scale for Depression in Dementia, with validated cut-off 5/6 points, was used to assess presence of depressive symptoms. Multiple regression analysis was used to explore the relationship between mobility (3 separate models) and depressive symptoms, controlled for demographic factors, comorbidity, and Mini-Mental State Examination. RESULTS: One-third of the participants had depressive symptoms, mean (SD) gait speed was 1.09 (0.3) m/s, and median (interquartile range) BESTest percent score was 81.5 (17.6). No statistically significant associations were found between depression and BESTest, gait speed or dual-task cost, neither in the simple models (P = 0.15-0.85), nor in the 3 multivariate models (P = 0.57-0.69). DISCUSSION AND CONCLUSIONS: In this study, we found no associations between mobility and depressive symptoms in persons with MCI and AD recruited at a memory clinic. Few participants had major symptoms of depression, which may have influenced the results. Longitudinal studies are needed to explore the long-time associations between mobility and depression.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A366).

Fun and a meaningful routine: the experience of physical activity in people with dementia.

BACKGROUND: Physical activity is important to health and wellbeing. People with dementia are less physically active than their cognitively healthy counterparts. Reasons for this are multifaceted, and are thought to be social, psychological, and physiological. People with dementia often use services such as home care, day care centres and nursing home, and according to the stage of disease they are less or more dependent on other people to take part in activities. To develop appropriate services to this patient group, their needs and preferences regarding physical activity must be recognized. The aim of the study was therefore to provide insight into experiences with physical activity in people with dementia. METHODS: The current study is part of a larger research project on needs in people with dementia. The main project included qualitative semi-structured interviews with 35 persons with dementia. 27 of the participants talked about their experience with physical activity. In the current study, the relevant findings on this theme were analysed separately. A phenomenological hermeneutic research design was applied. RESULTS: The analysis revealed three main categories regarding experiences with physical activity. To be physically active provided positive experiences such as feelings of mastering and post-exercise euphoria. To be physically active was meaningful. The daily walk was an important routine to many, and it gave meaningful content to the day. Keeping up with activities confirmed identity. Lastly, to be active was perceived as challenging. Participants described different barriers to being physically active such as a decline of physical function, lack of motivation and being dependent on others to go out. CONCLUSIONS: Many of the participants expressed that being physically active was important to them. It is essential that informal and formal carers are aware of the role physical activity plays in the lives of many people with dementia, so that appropriate measures can be taken to assure continued active living in order to preserve health and quality of life.

Sex Differences on Montreal Cognitive Assessment and Mini-Mental State Examination Scores and the Value of Self-Report of Memory Problems among Community Dwelling People 70 Years and above: The HUNT Study.

INTRODUCTION: The aims were to examine if the total and item scores on the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) and self-reported memory problems differed between older women and men, and if self-reported memory problems were associated with scores on the 2 tests. METHODS: We included 309 home-dwelling people aged 70 years and older, 155 women, mean age 75.6 (SD 4.1) years, and 154 men, mean age 76.0 (SD 4.6) years. They were examined with MoCA and MMSE, and they answered 2 questions: "have you experienced any memory problems" and "have you experienced significant memory problems the last 5 years?" RESULTS: The participants scored significantly higher on the MMSE (women 28.0 [1.8], men 28.4 [1.4]) than on MoCA (women 24.6 [3.3], men 24.3 [3.1]). Spearman's rho was 0.36 between the tests. Women scored significantly higher than men on delayed recall of MoCA (3.0 [1.6] vs. 2.4 [1.6]), whereas men scored significantly higher on visuoconstruction (3.8 [1.2] vs. 3.5 [1.0]) and serial subtraction on MoCA (2.7 [0.6] vs. 2.5 [0.8]) and serial sevens on MMSE (4.5 [0.8] vs. 4.1 [1.1]). Multivariate linear regression analyses revealed that female sex, younger age, and higher education were associated with a higher score on MoCA, whereas age and education were associated with a higher score on MMSE. About half of the participants (no sex difference) had experienced significant memory problems the last 5 years, and they had significantly lower scores on both tests. CONCLUSIONS: The MoCA score was associated with sex, age, and education, whereas sex did not influence the MMSE score. The question "have you experienced significant memory problems the last 5 years?" may be useful to evaluate older people's cognition.

Exploring life-space in the nursing home. An observational longitudinal study.

BACKGROUND: Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time. METHODS: In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time. RESULTS: We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period. CONCLUSION: From NH admission most NH residents' LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.

Factors Associated with Level of Physical Activity After Minor Stroke.

OBJECTIVES: To explore factors from the acute phase, and after three and 12 months, associated with level of self-reported physical activity 12 months after a minor ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 in persons 70 years or younger. MATERIALS AND METHOD: In this longitudinal cohort study patients were recruited consecutively from two stroke units. Activity level were measured with three sets of questions addressing the average number of frequency (times exercising each week), the average intensity, and duration (the average time), and a sum score was constructed. The association between physical activity 12 months after stroke and sociodemographic factors, NIHSS, body mass index, balance, and neuropsychiatric symptoms were explored using multiple linear regression. RESULTS: This study included 101 patients, with mean age (SD) 55.5 (11.4) years, NIHSS median (Q1, Q3) 0.0 (0.0, 1.0), and 20 % were female. Multiple linear regression analyses showed sick leave status at stroke onset, balance at three and 12 months, and anxiety, depression, apathy, and fatigue at 12 months to be factors associated with physical activity at 12 months after stroke. CONCLUSION: We found that pre-stroke sick leave, post-stroke balance, and neuropsychiatric symptoms were associated with the level of physical activity one year after minor stroke. This might be of importance when giving information about physical activity and deciding about post-stroke follow-up.

Subjective memory impairment, instrumental activities of daily living and longitudinal effect on mortality among older adults in a population-based cohort study: The HUNT Study.

Background: Subjective impairment in memory and instrumental activities in daily living (IADL) are associated with future cognitive decline and poorer mental health in older adults, but their association with mortality is uncertain. Our aim was to examine the associations between subjective memory and IADL impairments and all-cause mortality, as well as the mortality risk for reporting both memory and IADL impairments. Methods: Data from the 70-year-old and older cohort in the third survey of a population-based study, the Nord-Trøndelag Health Study (HUNT3), were linked to the Norwegian Causes of Death Registry. A total of 5802 older adults had complete data from HUNT3 (70.8% of the 70+ cohort). The mean follow-up time was 8.0 years, and 1870 respondents had died. Associations between subjective memory and ADL impairments with mortality were analysed in Cox regression models adjusted for covariates with attained age as the timescale. Analyses were performed separately for two age groups - 70-79 and 80+ years - to fulfil the proportional hazards assumption. Results: Subjective impairments in short-term memory and IADL were significantly associated with mortality both separately and combined. These associations were strongest in the 70- to 79-year-old group, where reporting impairment on one short-term memory item increased the mortality risk by 51% (hazard ratio=1.51; 95% confidence interval 1.20-1.91). Long-term memory impairments were not associated with mortality in the adjusted models. Conclusions: Subjective short-term memory impairments and IADL impairments are associated with increased mortality risk. Neither of these symptoms should be regarded as benign aspects of ageing, and concerns should be properly addressed.

Measuring physical performance in highly active older adults: associations with age and gender?

BACKGROUND: Higher age is associated with reduced physical capability in the general population. The role of age and gender for physical performance in older adults who exercises regularly is, however, not clear, and there is also a lack of recommendations for outcomes to address physical performance for this population. AIMS: To explore the associations between physical performance, age and gender, and to examine the suitability and feasibility of clinical field tests for physical performance in active older adults. METHODS: In this cross-sectional study we included 105 persons, 70-90 years of age, who had exercised regularly for ≥ 12 months. The field tests were Short Physical Performance Battery (SPPB), Timed Up and Go and gait speed for mobility; One-leg standing (OLS) test and Mini-BESTest for balance; Stair test for endurance, 30 s sit-to-stand, and grip strength for muscle strength. RESULTS: We found associations between age and physical performance, and the associations were slightly stronger for women. Men performed better on tests of muscle strength, balance and endurance, while no gender differences were found in mobility. Grip strength was not associated with mobility tests for men. All tests were feasible, while SPPB and OLS had ceiling and floor effects that limit their suitability in this population. CONCLUSIONS: Both age and gender were associated with physical performance. We recommend using the gait speed, Mini-BESTest, 30 s sit-to-stand, grip strength and stair tests to assess physical performance in physically active older adults.

Correction to: Measuring physical performance in highly active older adults: associations with age and gender?

In the published article, the Table 2 was published incorrectly. The correct Table 2 is given below.

Mobility and cognition at admission to the nursing home - a cross-sectional study.

BACKGROUND: Earlier studies show that the main reasons for admission to long-term nursing home care are cognitive impairment and functional impairments of activities of daily life. However, descriptive evidence of mobility is scant. The aims of this study were to describe mobility at admission to nursing homes and to assess the association between mobility and degree of dementia. METHODS: We included 696 residents at admission to 47 nursing homes in Norway. Inclusion criteria were expected stay for more than 4 weeks and 65 years or older. In addition, younger residents with dementia were included. Residents with life expectancy shorter than six weeks were excluded. Mobility was assessed using the Short Physical Performance Battery (SPPB) and the Nursing Home Life Space Diameter (NHLSD). The Clinical Dementia Rating Scale (CDR) was used to describe the degree of dementia. The associations between mobility and degree of dementia was analysed using the Chi-square and the Kruskal-Wallis test (KW-test). When the KW-test indicated a statistical significant difference, we proceeded with planned group comparisons with the Mann-Whitney U-test. In addition, we performed multiple linear regression analyses to control for potential confounders. RESULTS: Forty-three percent of the residents were not able to perform the balance test in SPPB. Twenty-four percent of the residents were not able to walk four meters, while only 17.6% had a walking speed of 0.83 m/s or higher. Sixty-two percent of the residents were not able to rise from a chair or spent more than 60 s doing it. The median score on NHLSD area was 22 (IQR 17) and the median score on NHLSD dependency was 36 (IQR 26). Residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia. Cognitive function was associated with SPPB and NHLSD dependency in the adjusted models. CONCLUSION: Nursing home residents form a frail, but heterogeneous group both in terms of cognition and mobility at admission. Mobility was negatively associated with cognitive function, and residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia.

Interrater and test-retest reliability and validity of the Norwegian version of the BESTest and mini-BESTest in people with increased risk of falling.

BACKGROUND: The Balance Evaluation Systems Test (BESTest) was developed to assess underlying systems for balance control in order to be able to individually tailor rehabilitation interventions to people with balance disorders. A short form, the Mini-BESTest, was developed as a screening test. The study aimed to assess interrater and test-retest reliability of the Norwegian version of the BESTest and the Mini-BESTest in community-dwelling people with increased risk of falling and to assess concurrent validity with the Fall Efficacy Scale-International (FES-I), and it was an observational study with a cross-sectional design. METHODS: Forty-two persons with increased risk of falling (elderly over 65 years of age, persons with a history of stroke or Multiple Sclerosis) were assessed twice by two raters. Relative reliability was analysed with Intraclass Correlation Coefficient (ICC), and absolute reliability with standard error of measurement (SEM) and smallest detectable change (SDC). Concurrent validity was assessed against the FES-I using Spearman's rho. RESULTS: The BESTest showed very good interrater reliability (ICC = 0.98, SEM = 1.79, SDC95 = 5.0) and test-retest reliability (rater A/rater B = ICC = 0.89/0.89, SEM = 3.9/4.3, SDC95 = 10.8/11.8). The Mini-BESTest also showed very good interrater reliability (ICC = 0.95, SEM = 1.19, SDC95 = 3.3) and test-retest reliability (rater A/rater B = ICC = 0.85/0.84, SEM = 1.8/1.9, SDC95 = 4.9/5.2). The correlations were moderate between the FES-I and both the BESTest and the Mini-BESTest (Spearman's rho -0.51 and-0.50, p < 0.01). CONCLUSION: The BESTest and its short form, the Mini-BESTest, showed very good interrater and test-retest reliability when assessed in a heterogeneous sample of people with increased risk of falling. The concurrent validity measured against the FES-I showed moderate correlation. The results are comparable with earlier studies and indicate that the Norwegian versions can be used in daily clinic and in research.

Spatial navigation measured by the Floor Maze Test in patients with subjective cognitive impairment, mild cognitive impairment, and mild Alzheimer's disease.

BACKGROUND: Impaired spatial navigation is an early sign of Alzheimer's disease (AD), but this can be difficult to assess in clinical practice. We examined how the performance on the Floor Maze Test (FMT), which combines navigation with walking, differed between patients with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and mild AD. We also explored if there was a significant relationship between the FMT and the cognitive tests or sociodemographic factors. METHODS: The study included 128 patients from a memory clinic classified as having SCI (n = 19), MCI (n = 20), and mild AD (n = 89). Spatial navigation was assessed by having the patients walk through the FMT, a two-dimensional maze. Both timed measures and number of errors were recorded. Cognitive function was assessed by the Word List Memory test, the Clock Drawing test, the Trail Making tests (TMT) A and B, and the Mini Mental Status Examination (MMSE). RESULTS: The patients with MCI were slower than those with SCI, while the patients with mild AD more frequently completed the FMT with errors or gave up than the patients with MCI. Performance on the FMT was significantly associated with executive function (measured by TMT-B). CONCLUSIONS: The performances on the FMT worsened with increasing severity of cognitive impairment, and the FMT was primarily associated with executive function. The explained variance was relatively low, which may indicate that the standard cognitive test battery does not capture impairments of spatial navigation.

Daily physical activity in older adults across levels of care: the HUNT Trondheim 70 + study.

BACKGROUND: Physical activity (PA) is imperative for healthy ageing and is a modifiable lifestyle factor. Accurate, clinically meaningful estimates of daily PA among older adults can inform targeted interventions to maintain function and independence. This study describes daily PA in older adults across levels of care as a first step contributing to the limited evidence on potential associations between PA and the use of care services. METHODS: This study used data from the Trondheim 70 + cohort in the population-based Norwegian HUNT Study. In total, 1042 participants aged 70 years or older with valid activity data were included. PA was assessed using two accelerometers over 7 consecutive days and was classified into PA (walking, standing, running, and cycling) and sedentary behavior (sitting and lying). Data on received care services were retrieved from municipal registers and participants were classified into four levels of care: 1) independently living (81.9%), 2) independently living with low-level home care services (6.5%), 3) recipients of home care services (6.0%), and 4) nursing home residents (5.7%). Time spent in the activity types and duration of bouts are presented across levels of care. RESULTS: Participants mean age was 77.5 years (range: 70.1-105.4, 55% female) and PA was lower with higher age. Across levels of care, significant group differences were found in the total time spent in PA, particularly in walking and standing. Daily PA, duration of active bouts, and number of daily walking bouts were lower for participants receiving higher levels of care. Standing was the dominant type of PA and walking appeared predominantly in short bouts at all care levels. CONCLUSIONS: This is the first population-based study using device-measured PA to describe daily PA across levels of care. The results showed that low-intensity activities constitute the primary component of everyday PA, advocating for placing greater emphasis on the significant role these activities play in maintaining daily PA at older age. Furthermore, the study demonstrated that activity types and bout durations are related to the ability to live independently among older adults. Overall, these findings can contribute to better target interventions to maintain function and independence in older adults.

Regional MRI volumetry using NeuroQuant versus visual rating scales in patients with cognitive impairment and dementia.

BACKGROUND AND PURPOSE: The aims were to compare the novel regional brain volumetric measures derived by the automatic software NeuroQuant (NQ) with clinically used visual rating scales of medial temporal lobe atrophy (MTA), global cortical atrophy-frontal (GCA-f), and posterior atrophy (PA) brain regions, assessing their diagnostic validity, and to explore if combining automatic and visual methods would increase diagnostic prediction accuracy. METHODS: Brain magnetic resonance imaging (MRI) examinations from 86 patients with subjective and mild cognitive impairment (i.e., non-dementia, n = 41) and dementia (n = 45) from the Memory Clinic at Oslo University Hospital were assessed using NQ volumetry and with visual rating scales. Correlations, receiver operating characteristic analyses calculating area under the curves (AUCs) for diagnostic accuracy, and logistic regression analyses were performed. RESULTS: The correlations between NQ volumetrics and visual ratings of corresponding regions were generally high between NQ hippocampi/temporal volumes and MTA (r = -0.72/-0.65) and between NQ frontal volume and GCA-f (r = -0.62) but lower between NQ parietal/occipital volumes and PA (r = -0.49/-0.37). AUCs of each region, separating non-dementia from dementia, were generally comparable between the two methods, except that NQ hippocampi volume did substantially better than visual MTA (AUC = 0.80 vs. 0.69). Combining both MRI methods increased only the explained variance of the diagnostic prediction substantially regarding the posterior brain region. CONCLUSIONS: The findings of this study encourage the use of regional automatic volumetry in locations lacking neuroradiologists with experience in the rating of atrophy typical of neurodegenerative diseases, and in primary care settings.

Mobility and associations with levels of cerebrospinal fluid amyloid ß and tau in a memory clinic cohort.

Background: Mobility impairments, in terms of gait and balance, are common in persons with dementia. To explore this relationship further, we examined the associations between mobility and cerebrospinal fluid (CSF) core biomarkers for Alzheimer's disease (AD). Methods: In this cross-sectional study, we included 64 participants [two with subjective cognitive decline (SCD), 13 with mild cognitive impairment (MCI) and 49 with dementia] from a memory clinic. Mobility was examined using gait speed, Mini-Balance Evaluation Systems test (Mini-BESTest), Timed Up and Go (TUG), and TUG dual-task cost (TUG DTC). The CSF biomarkers included were amyloid-ß 42 (Aß42), total-tau (t-tau), and phospho tau (p-tau181). Associations between mobility and biomarkers were analyzed through correlations and multiple linear regression analyses adjusted for (1) age, sex, and comorbidity, and (2) SCD/MCI vs. dementia. Results: Aß42 was significantly correlated with each of the mobility outcomes. In the adjusted multiple regression analyses, Aß42 was significantly associated with Mini-BESTest and TUG in the fully adjusted model and with TUG DTC in step 1 of the adjusted model (adjusting for age, sex, and comorbidity). T-tau was only associated with TUG DTC in step 1 of the adjusted model. P-tau181 was not associated with any of the mobility outcomes in any of the analyses. Conclusion: Better performance on mobility outcomes were associated with higher levels of CSF Aß42. The association was strongest between Aß42 and Mini-BESTest, suggesting that dynamic balance might be closely related with AD-specific pathology.

Diagnostic accuracy of brain age prediction in a memory clinic population and comparison with clinically available volumetric measures.

The aim of this study was to assess the diagnostic validity of a deep learning-based method estimating brain age based on magnetic resonance imaging (MRI) and to compare it with volumetrics obtained using NeuroQuant (NQ) in a clinical cohort. Brain age prediction was performed on minimally processed MRI data using deep convolutional neural networks and an independent training set. The brain age gap (difference between chronological and biological age) was calculated, and volumetrics were performed in 110 patients with dementia (Alzheimer's disease, frontotemporal dementia (FTD), and dementia with Lewy bodies), and 122 with non-dementia (subjective and mild cognitive impairment). Area-under-the-curve (AUC) based on receiver operating characteristics and logistic regression analyses were performed. The mean age was 67.1 (9.5) years and 48.7% (113) were females. The dementia versus non-dementia sensitivity and specificity of the volumetric measures exceeded 80% and yielded higher AUCs compared to BAG. The explained variance of the prediction of diagnostic stage increased when BAG was added to the volumetrics. Further, BAG separated patients with FTD from other dementia etiologies with > 80% sensitivity and specificity. NQ volumetrics outperformed BAG in terms of diagnostic discriminatory power but the two methods provided complementary information, and BAG discriminated FTD from other dementia etiologies.

Increased mortality risk for adults aged 25-44 years with long-term disability: A prospective cohort study with a 35-year follow-up of 30,080 individuals from 1984-2019 in the population-based HUNT study.

Background: Differences in survival between groups may reflect avoidable and modifiable inequalities. This study examines the 35-year mortality risk for adults aged 25-44 years in the mid-1980s with disability due to vision, hearing, or motor impairment; physical illness; or mental health problems. Methods: This Norwegian study was based on data from the Trøndelag Health Study (HUNT1, 1984-86, and HUNT2, 1995-97) linked to tax-registry data for deaths before 15 November 2019. Mortality risk was estimated by Cox regression analysis adjusted for age and sex. Sensitivity analysis included the following possible mediators: education, work, living situation, body mass index, systolic blood pressure and smoking. Findings: Of the 30,080 HUNT1 participants aged 25-44 years, 5071 (16.9%) reported having disability. During the 35 years of follow-up, 1069 (21.1%) participants with disability and 3107 (12.4%) without disability died. Individuals with any type of disability had 62% higher mortality risk compared to those without a disability, adjusted by age and sex. The highest mortality risks were observed for disability due to severe motor impairment (HR=3.67, 95%CI=2.89-4.67) and severe mental health problems (HR=3.40, 95%CI=2.75-4.23) compared to those without these disabilities. Increased mortality risk was found for all the included disability types. The associations were somewhat mediated, especially by education, work and living situation. Interpretation: This study shows that among adults aged 25-44 years, the risk of death increases with disability of different types and severity levels, particularly for disability related to mental health problems or motor impairment. Funding: None.

Spatial Navigation and Its Association With Biomarkers and Future Dementia in Memory Clinic Patients Without Dementia.

BACKGROUND AND OBJECTIVES: Impaired spatial navigation is considered an early sign in many neurodegenerative diseases. We aimed to determine whether spatial navigation was associated with future dementia in patients with subjective cognitive decline (SCD) or mild cognitive impairment (MCI) and to explore associations between spatial navigation and biomarkers of Alzheimer disease (AD) and neurodegeneration. METHODS: This study included memory clinic patients without dementia in the longitudinal BioFINDER cohort. The Floor Maze Test (FMT) was used to assess spatial navigation at baseline. Conversion to dementia was evaluated at 2-year and 4-year follow-ups. At baseline, amyloid-ß 42/40 ratio, phosphorylated-tau (P-tau), and neurofilament light (NfL) were analyzed in CSF. Cortical thickness and volume of regions relevant for navigation and white matter lesion volume were quantified from MRI. The predictive role of the FMT for conversion to all-cause dementia was analyzed using logistic regression analyses in 2 models: (1) controlled for age, sex, and education and (2) adding baseline cognitive status and MMSE. Associations between FMT and biomarkers were adjusted for age, sex, and cognitive status (SCD or MCI). RESULTS: One hundred fifty-six patients with SCD and 176 patients with MCI were included. FMT total time was associated with progression to all-cause dementia in model 2 at 2-year (OR 1.10, 95% CI 1.04-1.16) and at 4-year follow-up (OR 1.10, 95% CI 1.04-1.16), i.e., a 10% increase in odds of developing dementia per every 10 seconds increase in FMT. In the adjusted analyses, P-tau and NfL were associated with FMT total time, as well as hippocampal volume, parahippocampal, and inferior parietal cortical thickness. Amyloid-ß 42/40 ratio was not associated with FMT total time. DISCUSSION: Impaired spatial navigation was associated with conversion to dementia within 2 and 4 years and with key CSF and MRI biomarkers for AD and neurodegeneration in patients with SCD and MCI. This supports its use in early cognitive assessments, but the predictive accuracy should be validated in other cohorts. CLASSIFICATION OF EVIDENCE: This is a Class I prospective cohort study demonstrating association of baseline markers of spatial recognition with development of dementia in patients with SCD or MCI at baseline.

Spatial navigation in older adults with mild cognitive impairment and dementia: A systematic review and meta-analysis.

In this systematic review and meta-analysis, we compared the spatial navigation performance of older adults with mild cognitive impairment (MCI), Alzheimer's Disease (AD), and other dementias, using healthy older adults as controls. In addition, we evaluated the possible influence of the environment type (virtual and real), protocol (object- or environment-based), and the navigation mode (active and passive navigation) on spatial navigation task performance. In total, 1372 articles were identified and 24 studies were included in the meta-analysis. We found a large effect size on the spatial navigation performance of patients with cognitive decline (standardized mean difference (SMD) = 0.87, confidence interval (CI95%) = 0.62-1.09, p < 0.001), especially amnestic MCI (SMD = 1.10, CI95% = 0.71-1.49, p < 0.001) and patients with AD (SMD = 1.60, CI95% = 1.25-1.95, p < 0.001). However, the tasks did not identify mixed and vascular dementia (SMD = 0.92, CI95% = -0.33-2.18, p = 0.15 and SMD = 0.65, CI95% = -0.67-1.97, p = 0.33, respectively). Spatial navigation ability assessed using the Floor Maze Test showed the largest effect size in differentiating healthy older adults and patients with cognitive decline (SMD = 1.98,CI95% = 1.00-2.97, p < 0.001). In addition, tasks that require walking showed the greatest differences between the two groups. These results suggest that spatial navigation impairment is important, but disease-specific behavioral biomarker of the dementia pathology process that can be identified even in the early stages.

Malnutrition Is Associated With Impaired Functional Status in Older People Receiving Home Care Nursing Service.

Objective: This study aimed to explore the magnitude and significance of associations among nutritional status, functional status, comorbidities, age, and gender in older adults receiving assistance from the in-home nursing care service. Method: In this cross-sectional study, 210 home-dwelling persons 65 years or older who received in-home nursing care service were evaluated. Demographic variables, nutritional status, comorbidities, and the dependency levels of activities of daily living were analyzed. To assess the correlation among the factors that influence nutritional status, a theoretical model was developed and adjusted using the path analysis model. Results: The primary finding is that functional status is directly associated with nutritional status (ß = 0.32; p < 0.001) and severity of comorbidities is indirectly associated with nutritional status (ß = -0.07; p < 0.017). Conclusion: The elicited outcomes in this study reinforce the concept that nutritional status is linked with functional status in older adults receiving in-home care nursing service.

Physical performance across the cognitive spectrum and between dementia subtypes in a population-based sample of older adults: The HUNT study.

BACKGROUND: Literature on physical performance in older adults across the cognitive spectrum remains inconclusive, and knowledge on differences between dementia subtypes is lacking. We aim to identify distinct physical-performance deficits across the cognitive spectrum and between dementia subtypes. METHODS: 11,466 persons were included from the 70-year-and-older cohort in the fourth wave of the Trøndelag Health Study (HUNT4 70+). Physical performance was assessed with the Short Physical Performance Battery (SPPB), 4-meter gait speed, five-times-sit-to-stand (FTSS), grip strength and one-leg-standing (OLS). Clinical experts diagnosed dementia per DSM-5 criteria. Multiple linear and logistic regression were performed to analyze differences between groups. Age, sex, education, somatic comorbidity, physical activity and smoking status were used as covariates. RESULTS: Gait speed declined across the cognitive spectrum, beginning in people with subjective cognitive decline (SCD). Participants with mild cognitive impairment (MCI) additionally showed reduced lower-limb muscle strength, balance and grip strength. Those with dementia scored lowest on all physical-performance measures. Participants with Alzheimer's disease (AD) had a higher SPPB sum score and faster gait speed than participants with vascular dementia (VaD) and Lewy body dementia (LBD); participants with VaD and LBD had lower odds of being able to perform FTSS and OLS than participants with AD. CONCLUSIONS: Physical performance declined across the spectrum from cognitively healthy to SCD to MCI and to dementia. Participants with AD performed better on all assessments except grip strength than participants with VaD and LBD. Stage of cognitive impairment and dementia subtype should guide exercise interventions to prevent mobility decline and dependency.