The Role of Cognitive Reserve in Protecting Cerebellar Volumes of Older Adults with mild Cognitive Impairment.

The present study aims to investigate the relationship between cerebellar volumes and cognitive reserve in individuals with Mild Cognitive Impairment (MCI). A description of proxies of cerebellar cognitive reserve in terms of different volumes across lobules is also provided. 36 individuals with MCI underwent neuropsychological (MoCA, MMSE, Clock test, CRIq) assessment and neuroimaging acquisition with magnetic resonance imaging at 3 T. Simple linear correlations were applied between cerebellar volumes and cognitive measures. Multiple linear regression models were then used to estimate standardized regression coefficients and 95% confidence intervals. Simple linear correlations between cerebellar lobules volumes and cognitive features highlighted a significant association between CRIq_Working activity and specific motor cerebellar volumes: Left_V (ρ = 0.40, p = 0.02), Right_V (r = 0.42, p = 0.002), Vermis_VIIIb (ρ = 0.47, p = 0.003), Left_X (ρ = -0.46, p = 0.002) and Vermis_X (r = 0.35, p = 0.03). Furthermore, CRIq_Working activity scores correlated with certain cerebellar lobules implicated in cognition: Left_Crus_II, Vermis VIIb, Left_IX. MMSE was associated only with the Right_VIIB volume (r = 0.35, p = 0.02), while Clock Drawing Test scores correlated with both Left_Crus_I and Right_Crus_I (r = -0.42 and r = 0.42, p = 0.02, respectively). This study suggests that a higher cognitive reserve is associated with specific cerebellar lobule volumes and that Working activity may play a predominant role in this association. These findings contribute to the understanding of the relationship between cerebellar volumes and cognitive reserve, highlighting the potential modulatory role of Working activity on cerebellum response to cognitive decline.

Social interaction level modulates the impact of frailty on cognitive decline: a longitudinal study.

OBJECTIVES: This study evaluates whether social interaction level modifies the association between frailty and cognitive decline in older adults. METHODS: A total of 2701 adults aged ≥65 years enrolled in the Progetto Veneto Anziani (Pro.V.A.), participated in the study. At baseline, participants were classified as having low, moderate, or high social interactions based on: cohabiting status, frequency of contacts with relatives/friends or involvement in childcare activities, and frequency of participation in social or community activities. Baseline frailty was defined as the presence of ≥3 criteria among: weight loss, weakness, slowness, low physical activity, and exhaustion. Cognitive function was assessed through the Mini-Mental State Examination (MMSE) at baseline and after 4.4 and 7 years. The association between frailty and MMSE changes over time was evaluated through linear mixed models. Interaction and subgroup analyses explored the modifying effect of social interaction level on the above association. RESULTS: The mean age of participants was 76.1 years, and 59.1% were women. Frail individuals had a steeper annual MMSE decline than their non-frail counterparts (ß=-0.40, 95%CI: -0.59, -0.20). When stratifying participants by social interaction level, we found that the association between frailty and MMSE changes over time was stronger in those with low social interactions (ß=-0.74, 95%CI: -1.33, -0.15) while attenuated in those with moderate (ß=-0.42, 95%CI: -0.74, -0.11) or high social interaction level (ß=-0.29, 95%CI: -0.58, 0.01). CONCLUSION: Maintaining frequent social interactions might mitigate the negative impact of frailty on older people's cognitive functions.

Fibrinogen Levels and the Risk of Cerebrovascular Events in Older Adults With Both Depressive Symptoms and Cognitive Impairment: A Prospective Study.

Depression and cognitive impairment have been identified as risk factors for cerebrovascular events (CVE), and one of their potential etiological pathways is inflammatory status. This prospective study aims to investigate the association between inflammatory markers and the risk of CVE in a population of 2659 older adults, enrolled in the Progetto Veneto Anziani (Pro.V.A.), with depressive symptoms, cognitive impairment, or both conditions. For each individual, we assessed at baseline the presence of depressive symptoms (defined as a Geriatric Depression Scale ≥11), cognitive impairment (defined as a Mini-Mental State Examination <24), and serum levels of fibrinogen, white blood cells (WBC), and erythrocyte sedimentation rate (ESR). During a 4.4-year follow-up, 188 (7.1%) participants had CVE. Among the inflammatory markers, high fibrinogen values were associated with a 50% higher risk of CVE in the whole sample, and with a 4-fold higher risk in individuals with both depressive symptoms and cognitive impairment (hazard ratio = 4.04, 95% confidence interval: 1.45-11.23). Elevated WBC were associated with a 5% higher risk of CVE in the whole sample and in those with both conditions. No significant association was observed with the ESR. In conclusion, our study found that high fibrinogen levels may predict the risk of CVE in older people with concomitant depressive symptoms and cognitive impairment. Therefore, fibrinogen could be considered as an easily accessible aging biomarker, which might estimate the chronic inflammatory status and its potential detrimental effects on the most vulnerable older adults.

Dietary inflammatory index is associated with lung function in healthy older adults.

OBJECTIVES: Aging is associated with low-grade chronic inflammation contributing to a decline in lung performance. The Dietary Inflammatory Index (DII) has been introduced to evaluate the inflammatory potential of different diets, which may further affect individuals' respiratory function. This study investigates the association between DII and lung performance in older adults. METHODS: This cross-sectional study included 155 adults aged ≥65 y recruited at public gyms in Padua, Italy. Participants were assessed on medical history, biochemical parameters, body composition (through dual energy x-ray absorptiometry), anthropometry, and lung function (by spirometry). Based on individuals' dietary habits, we computed their DII and categorized participants in the lower DII (comprising those in the lowest DII tertile) or the higher DII (comprising those in the highest DII tertiles) groups. The association of DII with forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) was tested through multivariable linear regression analyses in the total sample and stratified by body mass index (<25 kg/m2 versus ≥25 kg/m2). RESULTS: The mean age of the sample was 71.2 y and 80% were women. Individuals in the higher DII group had FEV1 and FVC values reduced by 0.15 L (95% CI, -0.29 to -0.01 L) and 0.25 L (95% CI, -0.43 to -0.07 L), respectively, as compared with those in the lower DII group. Results seemed to be more marked among participants with excess weight conditions. CONCLUSIONS: Pro-inflammatory diets may affect lung function in fit older people, and this effect may be exacerbated in overweight or obese individuals.

Longitudinal investigation of the role of cognitive reserve in the evolution of dementia in outpatients prescribed AChEI.

Aim: The role of cognitive reserve (CR) in modulating dementia has been broadly investigated. We aimed to evaluate the long-term effects of CR on cognitive functions in outpatients newly treated with acetylcholinesterase inhibitors.Method: Fifty older adults with dementia (age 80 ± 6.4 years) were followed up over 27 months. CR was assessed with the Cognitive Reserve Index questionnaire (CRIq), which provides a Total CR index and three proxy measures: Education, Working Activity and Leisure Time. The association between CR and cognition, evaluated by the Mini-Mental State Examination (MMSE), was tested through linear mixed models.Results: The cognitive profile of High CR individuals (n = 16) was more fluctuating than that of patients with Low CR (n = 34) up to 15 months of treatment, showingan alternation of improvements and worsening. At linear mixed models, CRIq Total score was significantly associated with MMSE over the follow-up either when considered as continuous (ß = 0.13 [95%CI:0.07-0.19], p < .001, per each 1-unit increase) orcategorical variable (ß = 3.62 [95%CI:1.77-5.47], p = .002, High vs Low CR). Among the CR domains, higher CRIq Leisure-time scores were significantly associated with higher MMSE during the follow-up (ß = 0.05 [95%CI:0.02-0.09], p = .009, per each 1-unit increase).Conclusion: The study indicates that higher CR, and especially Leisure Time-related CR, was associated with better cognitive performance in older outpatients with dementia treated with AChEI for 27 months. These findings suggest that Leisure Time-related CR could influence the evolution of dementia, and support the need of further investigations to verify the potential usefulness of interventions enhancing such domain even in advanced age.

Efficacy of an interdisciplinary pathway in a first level trauma center orthopaedic unit: A prospective study of a cohort of elderly patients with hip fractures.

BACKGROUND: hip fracture has negative consequences for elderly people. Alternative models of care, with respect to traditional model, were developed to minimize complications and improve functional outcomes. The interdisciplinary model in orthopaedic wards has less evidence of efficacy compared to orthogeriatric units. OBJECTIVE: to compare the efficacy (in-hospital outcomes, mortality, functional status at 6 months after discharge) of an interdisciplinary pathway, based on comprehensive geriatric assessment, compared to a traditional model of care, in hip-fractured elderly patients. DESIGN: prospective study with retrospective control group conducted in a first-level trauma center Orthopaedic Unit. SUBJECTS: 97 patients treated with the traditional model and 127 with an interdisciplinary pathway (mean age 83.9 ±â€¯7.4 vs 84 ±â€¯6.7 years, p = 0.89). METHODS: in all participants we assessed: clinical history, functional pre-fracture status utilising Activities of Daily Living (ADL), in-hospital details. At 6 months after discharge, we evaluated functional status, place of residence, hospital readmissions, mortality. RESULTS: during hospital stay, significant differences emerged in mortality and in external visits. A higher proportion of patients of the orthogeriatric group lived alone at home at 6 months and showed a lower functional decline. Comprehensive geriatric assessment was associated with the ADL score (partial R2: 0.08, p < 0.001) and with a higher probability of independent walking ability ([OR] 3.89 95% [CI] 1.73-8.74, p = 0.001). CONCLUSIONS: an interdisciplinary pathway in hip-fractured elderly patients, could reduce in-hospital mortality, improve functional recovery and increase the probability of living alone at home, at 6 months.