A Study on the Relationship between Cognitive Performance, Hearing Impairment, and Frailty in Older Adults.

INTRODUCTION: As the human lifespan rises, older people are increasingly affected by multimorbidity, including hearing impairment (HI), frailty, and cognitive decline. OBJECTIVE: We studied the effect of HI on the cognitive performance of older patients with mild cognitive impairment and mild dementia and how this effect is altered when HI and frailty coexist. METHODS: The sample comprised 172 outpatients (age ≥65 years) with a Clinical Dementia Rating of 0.5-1 and a Mini-Mental State Examination score ≥20. Cognitive, neuropsychological, physical function tests, and body measurements were performed. The participants' comorbidity indices were calculated, and they were asked to report their hearing condition. Finally, the participants were divided into 4 groups based on the presence of frailty, HI, both conditions, or neither. RESULTS: The presence of HI was significantly associated with a lower Digit Symbol Substitution Test (DSST) score (unadjusted model: p = 0.003; adjusted: p = 0.012). Moreover, people with both HI and frailty were more likely to have a low DSST score than those in the other groups (unadjusted model: OR: 3.741, 95% CI: 1.374-10.183, p = 0.010; adjusted model: OR: 4.192, 95% CI: 1.026-17.136, p = 0.046). CONCLUSIONS: This study highlights the negative relationship between cognitive performance scored on the DSST and the presence of HI. Furthermore, the presence of both frailty and HI is associated with a worse cognitive score than HI alone.

Association Between Sarcopenia and Quality of Life in Patients with Early Dementia and Mild Cognitive Impairment.

BACKGROUND: Cognitive impairment is linked to decreased quality of life (QOL), but few studies have investigated the impact of comorbid sarcopenia. OBJECTIVE: The aim of this study was to elucidate the association of sarcopenia with QOL in patients with early dementia and mild cognitive impairment. METHODS: Individuals with a Clinical Dementia Rating of 0.5 or 1 and a Mini-Mental State Examination score of 20-30 underwent a battery of neuropsychological assessments administered by a group of well-trained clinical psychologists. The EQ-5D was completed by both the patients and their main caregivers. EQ-5D utility and visual analog scale scores were measured. Sarcopenia was defined according to the criteria published in the 2019 consensus update by the Asian Working Group for Sarcopenia. RESULTS: Patients with sarcopenia had significantly lower scores on the Digit Symbol Substitution Test and Trail Making Test Part A. There was a significant negative association between sarcopenia and both self- and proxy-rated EQ-5D utility scores independent of potential confounding factors. However, there was no association between QOL visual analog scale scores and sarcopenia. CONCLUSION: Given that sarcopenia is often found in individuals with cognitive impairment, early detection by timely screening and effective intervention may help to maintain or improve QOL in this population. However, this study could not determine whether reduced QOL is a direct consequence of sarcopenia.

Potentially Inappropriate Medications and Polypharmacy: A Study of Older People with Mild Cognitive Impairment and Mild Dementia.

BACKGROUND: With multimorbidity increasing among older people, polypharmacy and the use of potentially inappropriate medications (PIMs) are assuming a prominent role in the life of the geriatric population. OBJECTIVE: To investigate the association of polypharmacy and PIM use with a wide range of factors in older people with mild cognitive impairment (MCI) to mild dementia. METHODS: The study population comprised 160 outpatients with a Clinical Dementia Rating of 0.5-1 and a Mini-Mental State Examination score of 20-30. Patients were classified as receiving polypharmacy when they took ≥5 different medications at the same time. PIMs were identified using the STOPP-J criteria. Cognitive, neuropsychological, nutritional, and physical function tests were performed and body measurements taken. Quality of life (QOL) was assessed using both components of the EQ-5D scale, the index score and the visual analogue scale (QOL VAS). A comorbidity index was calculated for all participants. RESULTS: PIM use was significantly associated with lower scores on the verbal fluency (initial letters) test and QOL index. Participants receiving polypharmacy showed an increased likelihood of worse frailty status and lower QOL VAS score. The number of medications was significantly associated with a worse frailty status. CONCLUSION: In a geriatric population with MCI to mild dementia, PIM use was associated with lower verbal fluency (initial letters) score and lower QOL, while the presence of polypharmacy was correlated with a worse frailty status and lower QOL. The number of medicines, instead, was correlated with a worse frailty status only.

Quality of life in cognitively impaired older adults.

AIM: Quality of life (QOL) in older adults can be affected by many factors, such as dementia, sarcopenia and frailty. This study sought to identify factors that can lead to global deterioration in QOL among older outpatients, including factors stated in caregiver reports. This study also evaluated the discrepancy between QOL ratings reported by the patients and those by their family or professional caregivers. METHODS: The sample comprised 141 patients with a Mini-Mental State Examination score ≥20 and a Clinical Dementia Rating of 0.5-1, indicating mild cognitive impairment to mild dementia. QOL was assessed using both components of the EQ-5D scale, namely, the index score and visual analog scale. In addition, cognitive, neuropsychological, nutritional and physical function tests were carried out, and body measurements were taken. RESULTS: Patients' self-reported QOL was significantly associated with basic activities of daily living, Mini Nutritional Assessment score and Geriatric Depression Scale-15. QOL rated by caregivers was significantly associated with basic activities of daily living. EQ-5D index scores reported by caregivers were lower than those reported by patients. Furthermore, patients achieved a better score for self-care, usual activities, pain/discomfort and anxiety/depression than those assigned by caregivers. CONCLUSIONS: As far as the patient's ratings are concerned, the presence of depressive symptoms and a worse nutritional status were indicative of lower QOL, whereas a better functional status was associated with a higher QOL. For caregivers, however, the most relevant factor negatively affecting QOL was basic activities of daily living. Geriatr Gerontol Int 2019; 19: 999-1005.