Motoric cognitive risk syndrome and incident hospitalization in Quebec's older population: Results of the NuAge cohort study.

Background: Screening older adults at risk of hospitalization is essential to prevention of this adverse event. Motoric cognitive risk syndrome (MCR) has been associated with incident dementia and falls, which are both risk factors of hospitalization. There is no information on the association of MCR with incident hospitalization in older adults. Objective: The study aims to examine the association of MCR with incident hospitalization in community-dwelling older adults. Design: Quebec older population-based observational cohort study with 3 years of follow-up. Setting: Community dwellings. Subjects: A subset of 999 participants recruited in the NuAge study. Methods: Participants with MCR (i.e., with slow gait and cognitive complaint without dementia or motor disability) were identified at baseline assessment. Incident hospitalization (i.e., ≥1) and its recurrence (i.e., ≥2) were collected annually over a 3 year follow-up period. Results: The prevalence of MCR was 5.0% at baseline. The overall incidence of hospitalization was 29.0% and its recurrence 4.8%. MCR was associated with incident recurrent hospitalization [adjusted Hazard Ratio (aHR) = 2.58 with 95% Confidence Interval (CI) = (1.09-6.09) and P = 0.031], but not with incident hospitalization [aHR = 1.48, with 95%CI = (0.95-2.28) and P = 0.081]. Conclusion: MCR is associated with incident recurrent hospitalization in NuAge participants, suggesting that MCR may be of clinical interest for screening individuals at risk for hospitalization in Quebec's older population.

Emergency Room Evaluation and Recommendations and Risk Screening of Incident Major Neurocognitive Disorders in Older Females: Results of an Observational Population-Based Cohort Study.

Background: "Emergency Room Evaluation and Recommendations" (ER2) risk levels (i.e., low, moderate and high) may be used to screen for major neurocognitive disorders (MNCD) in older emergency department users, as a high ER2 risk level is associated with MNCD diagnosis. This study aims to examine the association of ER2 risk levels with incident MNCD in community-dwelling older adults. Methods: A total of 709 participants of the EPIDémiologie de l'OStéoporose (EPIDOS) study-an observational population-based cohort study-were recruited in Toulouse (France). ER2 low, moderate and high risk levels were determined at baseline. Incident MNCD and their type (i.e., Alzheimer's disease (AD) vs. non-AD) were diagnosed after a 7-year follow-up period. Results: The overall incidence of MNCD was 29.1%. A low ER2 risk level was associated with low incidence of MNCD [Hazard ratio (HR) = 0.71 with P = 0.018] and AD (HR = 0.56 with P = 0.003), whereas a high risk level, both individually and when combined with a moderate risk level, was associated with high incidence of MNCD (HR ≥ 1.40 with P ≤0.018) and AD (HR ≥ 1.80 with P ≤ 0.003). No association was found with incident non-AD. Conclusion: ER2 risk levels were positively associated with incident MNCD in EPIDOS participants, suggesting that ER2 may be used for risk screening of MNCD in the older population.

"Emergency Room Evaluation and Recommendations" and Incident Hospital Admissions in Older People with Major Neurocognitive Disorders Visiting Emergency Department: Results of an Experimental Study.

INTRODUCTION: Older people with major neurocognitive disorders (MNCDs) visiting the emergency department (ED) are at high risk of hospital admissions. The "Emergency Room Evaluation and Recommendations" (ER2) tool decreases the length of stay (LOS) in the hospital when older people visiting ED are hospitalized after an index ED visit, regardless of their cognitive status. Its effect on hospital admissions has not yet been examined in older people with MNCD visiting ED. This study aimed to examine whether ER2 recommendations were associated with incident hospital admissions and LOS in ED in older people with MNCD visiting ED. METHODS: A total of 356 older people with MNCD visiting ED of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited in this non-randomized, pre-post-intervention, single arm, prospective and longitudinal open label trial. ED staff and patients were blinded of the ER2 score, and patients received usual ED care during the observation period, whereas ED staff were informed about the ER2 score, and patients had ER2 tailor-made recommendations in addition to usual care during the intervention period. Hospital admissions and the LOS in ED were the outcomes. RESULTS: There were less incident hospital admissions (odds ratio ≤ 0.61 with p ≤ 0.022) and longer LOS in ED (coefficient beta ≥4.28 with p ≤ 0.008) during the intervention period compared to the observation period. DISCUSSION/CONCLUSION: ER2 recommendations have mixed effects in people with MNCD visiting ED. They were associated with reduced incident hospital admissions and increased LOS in ED, suggesting that they may have benefits in addition to usual ED care.

CARE frailty e-health scale: Association with incident adverse health outcomes and comparison with the Cardiovascular Health Study frailty scale in the NuAge cohort.

BACKGROUND: This study examines and compares CARE and Cardiovascular Health Study (CHS) frailty states (i.e., robust, prefrail and frail) for their association with incident adverse health outcomes, including falls, depression, cognitive and functional decline, major neurocognitive disorders, hospitalization and mortality in community-dwelling older adults living in the province of Quebec (Canada). METHODS: A subset of individuals (n = 1098) who participated in "Nutrition as a determinant of successful aging: The Quebec longitudinal study" (NuAge), which is an elderly population-based observational cohort study with 3 years of follow-up, were selected. CARE and CHS frailty states were determined using the NuAge baseline assessment. Incident falls (i.e., ≥1, ≥2 and severe falls), depression (i.e., 30-item Geriatric Depression Scale score > 10/30), decline in cognition (i.e., Modified Mini Mental State (3MS) score < 79/100) and functionality (i.e., Activity Daily Living (ADL) score ≤ 3/4 and an Instrumental Activity Daily Living (IADL) score ≤ 6/8), major neurocognitive disorders (i.e., 3MS score < 79/100 and IADL score < 6/8), hospitalization and mortality were annually recorded over a 3-year follow-up period. RESULTS: 66.8% and 23.6% of participants were classified as pre-frail and frail with CARE respectively, whereas this distribution of frailty states differed with CHS (47.9% and 8.4%). There were significant associations of CARE pre-frail and frail states with all incident adverse health outcomes, the lowest odds ratio (OR) being reported with falls and the highest with cognitive decline (OR ranging from 1.63 to 12.85 with P ≤ 0.032). All ORs of the CARE frailty states were greater than those of the CHS, except for frail participants with IADL decline (OR = 4.92 for CARE versus OR = 9.62 for CHS). CONCLUSIONS: CARE frail states were associated with incident adverse health outcomes and these associations were greater than with CHS, suggesting that the CARE scale is of clinical interest when screening for frailty and related adverse health outcomes in the elderly population.

Improving the mental and physical health of older community-dwellers with a museum participatory art-based activity: results of a multicentre randomized controlled trial.

BACKGROUND: The aim of this randomized controlled trial (RCT) was to examine the mental and physical effects of a participatory art-based activity carried out at museums in older community-dwellers. METHODS: Based on a bicentre (the Montreal Museum of Fine Arts (MMFA), Montreal, Quebec, Canada; the Fuji Museum, Tokyo, Japan) single-blind RCT in two parallel groups (intervention group versus control group), 228 community-dwelling older adults (mean age 71.1 ± 5.4 years, 76.3% female) were enrolled. The intervention was a participatory art-based activity carried out at the MMFA and the Fuji Museum. The intervention group met weekly for 2 h over a 12-week period. The control group did not participate in any art-based intervention over the study period. Well-being was assessed before and after the first (M0) and the twelfth (M3) workshops, and quality of life and frailty before workshops at M0 and M3. These outcomes were assessed with standardized questionnaires with the same schedule in both groups. RESULTS: Well-being and quality of life improved significantly in the intervention group compared to the control group. Mixed results were observed with frailty. Although there were significantly more vigorous and fewer mildly frail participants by the end of the session when comparing intervention to control group participants, only a trend was observed in the decrease in mean value of the intervention group's frailty score. INTERPRETATION: This RCT confirmed that a participatory art-based activity performed weekly over a 3-month period may improve both mental and physical health in older community-dwellers. TRIAL REGISTRATION: NCT03679715; Title: A-Health RCT: Effects of Participatory Art-Based Activity on Health of Older Community Dwellers; First posted date: September 20, 2018; prospectively registered: https://clinicaltrials.gov/ct2/show/NCT03679715.

Late-Life Depressive Symptomatology, Motoric Cognitive Risk Syndrome, and Incident Dementia: The "NuAge" Study Results.

Background: Late-life depressive symptomatology and motoric cognitive risk syndrome (MCR) have independently been associated with an increased risk for incident dementia. This study aimed to examine the association of late-life depressive symptomatology, MCR, and their combination on incident dementia in community-dwelling older adults living in Quebec (Canada). Methods: The study was carried out in a subset of 1,098 community dwellers aged ≥65 years recruited in the "Nutrition as a determinant of successful aging: The Quebec longitudinal study" (NuAge), an observational prospective cohort study with 3 years follow-up. At baseline, MCR was defined by the association of subjective cognitive complaint with slow walking speed, and late-life depressive symptomatology with a 30-item Geriatric Depression Scale (GDS) score >5/30. Incident dementia, defined as a Modified Mini-Mental State score ≤79/100 test and Instrumental Activity Daily Living score <4/4, was assessed at each annual visit. Results: The prevalence of late-life depressive symptomatology only was 31.1%, of MCR only 1.8%, and the combination of late-life depressive symptomatology and MCR 2.4%. The combination of late-life depressive symptomatology and MCR at baseline was associated with significant overall incident dementia (odds ratio (OR) = 2.31 with P ≤ 0.001) but not for MCR only (OR = 3.75 with P = 0.186) or late-life depressive symptomatology only (OR = 1.29 with P = 0.276). Conclusions: The combination of late-life depressive symptomatology and MCR is associated with incident dementia in older community dwellers. The results suggested an interplay between late-life depressive symptomatology and MCR exposing them to an increased risk for dementia.

Health benefits of "Thursdays at the Montreal Museum of Fine Arts": Results of a randomized clinical trial.

OBJECTIVE: . This study aims to examine and compare changes in frailty status, well-being and quality of life in community-dwelling older adults living in Montreal (Quebec, Canada) participating in a 3-month session of weekly "Thursdays at the Museum" and in their control counterparts who did not participate in art-based activities. METHODS: . 165 older community dwellers were recruited to a randomized controlled trial with two parallel groups (intervention versus control). The intervention was weekly participatory art-based activities over a 3-month period carried out at the Montreal Museum of Fine Arts (MMFA, Montreal, Quebec, Canada). Frailty, well-being and quality of life were assessed using standardized questionnaires completed at baseline (M0) and before the fifth (M1), ninth (M2) and twelfth (M3) workshops in the intervention group. The control group completed these questionnaires according to the same schedule. The outcomes were mean values of frailty, well-being and quality of life scores, as well as the distribution of frailty categories (vigorous versus mild, moderate and severe frailty) at M0, M1, M2 and M3. RESULTS: . The intervention group showed significant improvements in frailty, well-being and quality of life scores (P≤0.004) when compared with the control group. CONCLUSION: . The results suggest that the 3-month session of weekly "Thursdays at the Museum" may improve both physical and mental health in Montreal community-dwelling older adults.

Risk for short-term undesirable outcomes in older emergency department users: Results of the ER2 observational cohort study.

BACKGROUND: The "Emergency Room Evaluation and Recommendations" (ER2) is a clinical tool designed to determine prognosis for the short-term Emergency Department (ED) undesirable outcomes including long length of stay (LOS) in ED and in hospital, as well as the likelihood of hospital admission during an index ED visit. It is also designed to guide appropriate and timely tailor-made geriatric interventions. This study aimed to examine whether ER2 assessment part was: 1) usable by ED healthcare workers (e.g. nurses) and 2) scoring system associated with long LOS in ED and in hospital, as well as hospital admission in older ED users on stretchers. METHODS: Based on an observational, prospective and longitudinal cohort study 1,800 participants visiting the ED of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited between September and December 2017. ER2 assessment determined three risk-levels (i.e., low, medium and high) for short-term ED undesirable outcomes. The rate of ER2 digital form completed, the time to fill ER2 items and obtain ER2 risk-levels, the LOS in ED and in hospital, and hospital admission were used as outcomes. RESULTS: ER2 was usable by ED nurses in charge of older ED users. High-risk group was associated with both increased ED stay (coefficient of regression ß = 3.81 with P≤0.001) and hospital stay (coefficient of regression ß = 4.60 with P = 0.002) as well as with hospital admission (HR = 1.32 with P≤0.001) when low ER2 risk level was used as referent level. Kaplan-Meier distributions showed that the three risk groups of participants differed significantly (P = 0.001). Those with high-risk level (P≤0.001) were discharged later from hospital to a non-hospital location compared to those with low risk. There was no significant difference between those classified in low-risk and in medium-risk groups (P = 0.985) and those in medium and high-risk groups (P = 0.096). CONCLUSION: The ER2 assessment part is usable in daily practice of ED care and its risk stratifications may be used to predict adverse outcomes including prolonged LOS in ED and in hospital as well as hospital admission. TRIAL REGISTRATION: NCT03964311.

Emergency room evaluation and recommendations for older emergency department users: results of the ER2 experimental study.

PURPOSE: The study aims to examine whether the use of "emergency room evaluation and recommendations" (ER2) tool in daily ED practice reduces the length of stay in ED and hospital, and hospital admission in older patients visiting ED on stretcher. METHODS: A total of 3931 older patients visiting ED of the Jewish General Hospital (Montreal, Quebec, Canada) on stretcher were recruited in this non-randomized, pre-post intervention, single arm, prospective and longitudinal open-label trial. ED staff and patients were blinded of the ER2 score and patients received usual ED care over the observational phase, whereas ED staff were informed about the ER2 score and patients had usual care plus interventions based on tailor-made geriatric recommendations during the interventional phase. The length of stay in ED and in hospital, and hospital admission were the outcomes. RESULTS: The ER2 recommendations were associated with increased length of stay in ED (ß = 2.94 with P ≤ 0.001) and decreased length of stay in hospital (ß = - 2.07 with P = 0.011). No effect was found for hospital admission (Odd Ratio (OR) = 0.92 with P = 0.182). CONCLUSION: Emergency room evaluation and recommendations (ER2) tool had mixed effects. Shorter hospital stay has been reported for older ED users hospitalized, but increased ED stay and no effects on hospital admission were found.

Pre-Dementia Stages and Incident Dementia in the NuAge Study.

BACKGROUND: Motoric cognitive risk syndrome (MCR) and mild cognitive impairment (MCI) are two pre-dementia stages with an overlap, which may influence the risk for dementia. OBJECTIVE: The study aims to examine the association of MCR, MCI, and their combination with incident dementia in Quebec community-dwelling older adults. METHODS: 1,063 older adults (i.e., ≥65) were selected from a population-based observational cohort study known as the "Nutrition as a determinant of successful aging: The Quebec longitudinal study" (NuAge). Participants were separated into four groups at the baseline assessment: those without MCR and MCI (i.e., cognitively healthy individual; CHI), those with MCR alone, those with MCI alone, and those with MCR plus MCI. Incident dementia was recorded at each annual visit during a 3-year follow-up. RESULTS: The prevalence of CHI was 87.2%, MCR 3.0%, MCI 8.8%, and MCR plus MCI 0.9%. The overall incidence of dementia was 2.4% and was significantly associated with MCR alone (Odd Ratio (OR) = 5.00 with 95% Confidence interval (CI) = [1.01;24.59] and p = 0.049), MCI alone (OR = 6.04 with 95% CI = [2.36;15.47] and p≤0.001), and the combination of MCR and MCI (OR = 25.75 with 95% CI = [5.32;124.66] and p≤0.001). CONCLUSION: Combining MCR and MCI increased the risk for incident dementia. These results also demonstrated that this combination is a better predictor of dementia than MCI or MCR alone.

Prognosis tools for short-term adverse events in older emergency department users: result of a Québec observational prospective cohort.

BACKGROUND: The "Program of Research on the Integration of Services for the Maintenance of Autonomy" (PRISMA-7) and "Emergency room evaluation and recommendations" (ER2) are both clinical tools used in Québec Emergency Departments (EDs) for screening of older ED users at higher risk of poor outcomes, such as prolonged length of stay (LOS) in EDs and in hospital. The study aimed to: 1) examine whether the PRISMA-7 and ER2 risk levels were associated with length of stays in ED and hospital, as well as hospital admission; and 2) compare the criteria performance (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under receiver operating characteristic curve) of the PRISMA-7 and ER2 high-risk levels for these three ED adverse events in Québec older patients visiting ED on a stretcher. METHODS: A total of 1905 older patients who visited the ED of the Jewish General Hospital (Montreal, Québec, Canada) on stretchers were recruited in this prospective observational cohort. Upon their ED arrival, PRISMA-7 and ER2 were performed. The outcomes were LOS in ED and in hospital, and hospital admission. RESULTS: The PRISMA-7 and ER2 risk levels were associated with length of stay in ED and hospital as well as with hospital admission. Prolonged stays and higher hospitalization rates were associated with high-risk levels, whereas those in low-risk level groups had significantly shorter LOS and a lower rate of hospital admission (P < 0.006). While performance measures were poor for both assessment tools, ER2 had a greater prognostic testing accuracy compared with PRISMA-7. CONCLUSION: PRISMA-7 and ER2 were both associated with incidental short-term ED adverse events but their overall prognostic testing accuracy was low, suggesting that they cannot be used as prognostic tools for this purpose.

"Emergency Room Evaluation and Recommendations" (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database.

Purpose: The Emergency Room Evaluation and Recommendation (ER2) is an application in the electronic medical file of patients visiting the Emergency Department (ED) of the Jewish General Hospital (JGH; Montreal, Quebec, Canada). It screens for older ED visitors at high risk of undesirable events. The aim of this study is to examine the performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive likelihood ratio [LR+], negative likelihood ratio [LR-] and area under the receiver operating characteristic curve [AUROC]) of the ER2 high-risk level and its "temporal disorientation" item alone to screen for major neurocognitive disorders in older ED visitors at the JGH. Methods: Based on a cross-sectional design, 999 older adults (age 84.9 ± 5.6, 65.1% female) visiting the ED of the JGH were selected from the ER2 database. ER2 was completed upon the patients' arrival at the ED. The outcomes were ER2's high-risk level, the answer to ER2's temporal disorientation item (present vs. absent), and the diagnosis of major neurocognitive disorders (yes vs. no) which was confirmed when it was present in a letter or other files signed by a physician. Results: The sensitivities of both ER2's high-risk level and temporal disorientation item were high (≥0.91). Specificity, the PPV, LR+, and AROC were higher for the temporal disorientation item compared to ER2's high-risk level, whereas a highest sensitivity, LR-, and NPV were obtained with the ER2 high-risk level. Both area under the receiver operating characteristic curves were high (0.71 for ER2's high-risk level and 0.82 for ER2 temporal disorientation item). The odds ratios (OR) of ER2's high-risk level and of temporal disorientation item for the diagnosis of major neurocognitive disorders were positive and significant with all OR above 18, the highest OR being reported for the temporal disorientation item in the unadjusted model [OR = 26.4 with 95% confidence interval (CI) = 17.7-39.3]. Conclusion: Our results suggest that ER2 and especially its temporal disorientation item may be used to screen for major neurocognitive disorders in older ED users.

Long-term effects of the Montreal museum of fine arts participatory activities on frailty in older community dwellers: results of the A-Health study.

PURPOSE: The study aims (1) to examine the long-term effects (i.e., at 12 months) of the Montreal museum of fine arts (MMFA) participatory art-based activities on frailty in a subset of participants of the Art and Health (A-Health) study and (2) to compare these long-term effects with short-term effects (i.e., at 3 months). METHODS: The A-Health study is a pre-post intervention, single arm, prospective and longitudinal study. A subset of 101 participants (67.3%) who completed the 12-month follow-up assessment was selected for this study. The intervention consisted in one weekly structured participatory art-based workshop over a 3-month period. Participants were separated according to their frailty status: vigorous (i.e., no frailty) versus mild frailty, moderate frailty and frailty merging mild and moderate frailty. Frailty was assessed before the intervention (M0), at the end of the 3-month intervention (M3) and 12 months (M15) after the end of the intervention. RESULTS: The mean value of frailty score was lower after the intervention compared to the beginning, regardless of the time of the assessments (i.e., M3 and M15). The proportion of vigorous participants increased and the proportion of mild frail participants decreased at the end of the intervention (i.e., M3) but no long-term effect was shown (i.e., M15) compared to M0. The proportion of moderate frail participants and frail participants at M15 were significantly lower compared to M0. CONCLUSION: The MMFA participatory art-based activities improved frailty at short and long terms, suggesting that it could be an effective way to promote an active and healthy aging. TRIAL REGISTRATION: NCT03557723; Title: Effect of Art Museum Activity Program for the Elderly on Health: A Pilot Study; First submission date: January 31, 2018; First posted date: June 15, 2018; prospectively registered.

Motoric cognitive risk syndrome and incident dementia in older adults from the Québec NuAge cohort.

BACKGROUND: The co-occurrence of slow walking speed and subjective cognitive complaint (SCC) in non-demented individuals defines motoric cognitive risk syndrome (MCR), which is a pre-dementia stage. There is no information on the association between MCR and incident dementia in Québec's older population. OBJECTIVE: The study aims to examine the association of MCR and its individual components (i.e. SCC and slow walking speed) with incident dementia in community-dwelling older adults living in the province of Québec (Canada). DESIGN: Québec older people population-based observational cohort study with 3 years of follow-up. SETTING: Community dwellings. SUBJECTS: A subset of participants (n = 1,098) in 'Nutrition as a determinant of successful aging: The Québec longitudinal study' (NuAge). METHODS: At baseline, participants with MCR were identified. Incident dementia was measured at annual follow-up visits using the Modified Mini-Mental State (≤79/100) test and Instrumental Activity Daily Living scale (≤6/8) score values. RESULTS: The prevalence of MCR was 4.2% at baseline and the overall incidence of dementia was 3.6%. MCR (Hazard Ratio (HR) = 5.18, with 95% confidence interval (CI) = [2.43-11.03] and P ≤ 0.001) and SCC alone (HR = 2.54, with 95% CI = [1.33-4.85] and P = 0.005) were associated with incident dementia, but slow walking speed was not (HR = 0.81, with 95%CI = [0.25-2.63] and P = 0.736). CONCLUSIONS: MCR and SCC are associated with incident dementia in NuAge study participants.

Telemedicine for housebound older persons during the Covid-19 pandemic.

Targeting older at-risk patients with decision-making algorithms is a priority at a time when hospitals are receiving an influx of Covid-19 patients that may exceed their capacity. Such screening could likely be extended to primary care settings in order to identify older community dwellers with Covid-19, but also those experiencing the adverse consequences of prolonged home confinement. The Centre of Excellence on Longevity of McGill University (Quebec, Canada) designed a short assessment for Montreal's housebound community-dwelling older adults. It acts as the first step in connecting older community dwellers who are housebound during the Covid-19 outbreak to telemedicine.

Effects of participatory art-based painting workshops in geriatric inpatients: results of a non-randomized open label trial.

BACKGROUND: Art-based activities like painting workshops demonstrated health benefits in older individuals living in home care facilities. Few studies examined the effects of painting workshops in geriatric inpatients. AIM: The study aims to examine whether the participation in painting workshops performed in patients admitted to a geriatric acute care ward reduced the number of medications taken daily, use of psychoactive medications, the length of stay and inhospital mortality. METHODS: Based on a non-randomized open label trial, 79 inpatients who participated in painting workshops and 79 control inpatients were recruited in the geriatric acute care ward of the Jewish general hospital (Montreal, Quebec, Canada). Four outcomes were used: the number of medications taken daily and use of psychoactive medications the day of discharge to geriatric acute care ward, the length of hospital stay and inhospital mortality. RESULTS: The participation in Painting workshops were associated with a lower number of medications taken daily at discharge (Coefficient of regression ß = - 1.35 with P = 0.001) and lower inhospital mortality (odd ratio (OR) = 0.09 with P = 0.031). No significant association was reported with use of psychoactive medications and length of stay. CONCLUSION: The participation in painting workshops reduced the number of medications taken daily and incident inhospital mortality in geriatric inpatients admitted to a geriatric acute care ward, suggested a positive effect on health condition of this participatory art-based activity.

Relationship between motoric cognitive risk syndrome, cardiovascular risk factors and diseases, and incident cognitive impairment: Results from the "NuAge" study.

BACKGROUND: Motoric Cognitive Risk syndrome (MCR), which combines Subjective Cognitive Complaint (SCC) and slow gait speed in individuals free of dementia and gait disability, is associated with cardiovascular risk factors and diseases as well as incident cognitive impairment. Little information on MCR exists in the Canadian population. This study aims to examine these associations in community-dwelling elderly people living in Quebec, which is a Canadian province. METHODS: Data was collected from the"Nutrition as a determinant of successful aging: The Quebec longitudinal study" (NuAge), which is a Quebec population-based observational cohort study with 3 years of follow-up. A subset of 1113 participants (age 73.8 ±â€¯4.1 and 51.9% female; 63.5% of the initial NuAge sample) was selected. MCR, cardiovascular risk factors and disease were recorded at baseline. Incident cognitive impairment was considered if the Modified Mini-Mental State Examination (3MS) score was ≤79/100 at subsequent annual visits. RESULTS: The prevalence of MCR was 4.2% at baseline and was significantly associated with diabetes (P < 0.032), cerebrovascular disease (P < 0.043) and incident cognitive impairment (P ≤ 0.001). The overall incidence of cognitive impairment during the 3-year follow-up period was 4.6%. A greater decrease of the 3MS score was observed in participants with MCR compared to those without MCR, at each annual assessment (P ≤ 0.001). CONCLUSION: MCR was associated with diabetes and cerebrovascular diseases at baseline, and incident cognitive impairment in NuAge study participants.

Effects of Vitamin D and Calcium Fortified Yogurts on Gait, Cognitive Performances, and Serum 25-Hydroxyvitamin D Concentrations in Older Community-Dwelling Females: Results from the GAit, MEmory, Dietary and Vitamin D (GAME-D2) Randomized Controlled Trial.

BACKGROUND: Vitamin D3 fortified food may improve serum vitamin D level, suggesting that the prevention of adverse consequences of hypovitaminosis D is possible with food fortification. The aim of this randomized controlled trial (RCT) was to examine the effects of vitamin D and calcium fortified yogurt on spatiotemporal gait parameters, cognitive performance, handgrip strength, and serum 25OHD levels in healthy older females. METHODS: Forty older community-dwelling females were recruited in a single-blind, randomized, controlled, superiority clinical trial in two parallel groups (20 participants in the intervention group and 20 in the control group) with intent-to-treat. The intervention group took fortified yogurts daily (i.e., 400 UI of vitamin D3 and 800 mg calcium) for 3 months. The non-fortified yogurts contained similar proteins, carbohydrates and lipids, as well as a lower dose of calcium (300 mg) and no vitamin D3 supplementation. Spatiotemporal gait parameters (mean value and coefficient of variation) were assessed using a computerized walkway. Handgrip strength was measured with hydraulic dynamometers. Cognitive performances, including global cognitive functioning assessed with the Mini Mental Status Examination (MMSE) were recorded. All the outcomes were assessed at baseline and at the end of follow-up. The primary outcome was the coefficient of variation of stride time. RESULTS: The intervention group maintained its global cognitive performance and serum 25OHD concentrations, whereas these outcomes decreased (i.e., worst performance) in the control group. The changes in the MMSE score (p = 0.022) and serum 25OHD concentrations were different (p ≤ 0.001) with better values reported in the intervention group compared to the control group. There was no significant change in gait parameters (p ≥ 0.518) and handgrip strength (p ≥ 0.600). CONCLUSIONS: Fortified yogurts with vitamin D (i.e., 200 IU) and calcium (i.e., 400 mg) twice a day maintained global cognitive performance and vitamin D status in older females, but not gait performances, signifying that they mainly prevent hypovitaminosis D-related extra-skeletal disorders.

Screening for older inpatients at risk for long length of stay: which clinical tool to use?

BACKGROUND: Screening for inpatients at risk for long length of stay (LOS) is the first step of an effective hospital care plan for older inpatients. This study aims, in older adults admitted to a geriatric acute care ward, to examine and compare the 6-item brief geriatric assessment (BGA) and the "Programme de Recherche sur l'Intégration des Services pour le Maintien de l'Autonomie" (PRISMA-7) risk levels with long LOS, and to establish their performance criteria (i.e., sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios) for LOS. METHODS: Based on an observational, retrospective, cohort design, 166 inpatients aged ≥75 admitted to a geriatric acute care ward of a McGill University-affiliated hospital (Montreal, Quebec, Canada) were recruited. The risk levels of the 6-item BGA (low, moderate and high) and the PRISMA-7 (low versus high) were calculated from a baseline assessment. The LOS was subsequently calculated in number of days. RESULTS: Only the 6-item BGA high risk level was associated with a long LOS (Odds ratio = 1.1 with P = 0.028 and Hazard ratio = 2.1 with P = 0.004). Kaplan-Meier distributions showed that there was no significant difference in the delay of hospital discharge between the low and high-risk level reported by the PRISMA-7 (P = 0.381), whereas the 6-item BGA three risk levels differed significantly (P = 0.008), with individuals at high risk levels being discharged later when compared to those with low (P = 0.001) and moderate (P = 0.019) risk levels. Both tools' performance criteria were poor (i.e., < 0.70), except for PRISMA-7's sensitivity which was 100%. CONCLUSION: The 6-item BGA risk levels were associated with LOS, low risk-level being associated with short LOS and high-risk level with long LOS, but no association was reported with the PRISMA-7 risk levels. Both tools had poor performance criteria for long LOS, suggesting that they cannot be used as prognostic tools with current scientific knowledge.

Motoric cognitive risk syndrome, incident cognitive impairment and morphological brain abnormalities: Systematic review and meta-analysis.

BACKGROUND: Motoric cognitive risk syndrome (MCR) is a pre-dementia stage, which associates slow walking speed with subjective cognitive impairment (SCI). MCR's clinical utility for the prediction of dementia and its pathophysiology are unclear. The aim of this systematic review and meta-analysis is to examine the association of MCR with incident cognitive impairment, cognitive performance and brain structures. METHODS: A systematic search was conducted using the Medical Subject Heading terms "Walking" and "Cognition disorders" combined with the terms "Subjective cognitive impairment", "Subjective cognitive decline" and "Motoric cognitive risk". A total of 11 studies were included in the systematic review and meta-analysis: 3 studies had dementia as the outcome, 3 studies had cognitive performance as the outcome, 4 studies had brain structures as the outcome and one study examined the incidence of both major neurocognitive disorders and cognitive impairment. RESULTS: MCR was found to be associated with incident cognitive impairment (pooled hazard ratio (HR) = 1.70, 95% CI, 1.46-1.98 with P-value <0.001) and dementia (pooled HR = 2.50, 95% CI, 1.75-2.39 with P-value <0.001). MCR was also found to be associated with low grey matter volume involving the premotor and the prefrontal cortex, and lacunar lesions in the frontal lobe. No significant association was found with white matter abnormalities. CONCLUSION: MCR predicts cognitive impairment and dementia, suggesting that it may be used as a screening syndrome for dementia in a primary care setting. Its significant association with both low grey matter volume and lacunar lesions makes its pathophysiology unclear and suggests multiple pathways.