TICS-M scores in an oldest-old normative cohort identified by computable phenotype.

Objective: To (1) examine the distribution of Telephone Interview for Cognitive Status modified (TICS-m) scores in oldest-old individuals (age 85 and above) identified as cognitively healthy by a previously validated electronic health records-based computable phenotype (CP) and (2) to compare different cutoff scores for cognitive impairment in this population. Method: CP identified 24,024 persons, 470 were contacted and 252 consented and completed the assessment. Associations of TICS-m score with age, sex, and educational categories (<10 years, 11-15 years, and >16 years) were examined. The number of participants perceived as impaired was studied with commonly used cutoff scores (27-31). Results: TICS-m score ranged from 18 to 44 with a mean of 32.6 (SD = 4.7) in older adults aged 85-99 years old. A linear regression model including (range-restricted) age, education, and sex, showed beta estimates comparable to previous findings. Different cutoff scores (27 to 31) generated slightly lower MCI and dementia prevalence rates of participants meeting the criteria for the impairments than studies of younger elderly using traditional recruitment methods. Conclusions: The use of validated computable phenotype to identify a normative cohort generated a normative distribution for the TICS-m consistent with prior findings from more effortful approaches to cohort identification and established expected TICS-m performance in the oldest-old population.

Multimodal cognitive and behavioral interventions for patients with MCI: a systematic review and meta-analysis on cognition and mood.

Background: Research has increasingly suggested a benefit to combining multiple cognitive or behavioral strategies in a single treatment program for cognitively impaired older adults. Therefore, this systematic review and meta-analysis aimed to summarize results on the effects of multimodal cognitive and behavioral interventions versus control conditions on changes in cognition and mood in patients with mild cognitive impairment (pwMCI). Methods: The review followed a general PRISMA guideline for systematic literature review with a format consisting of participants, interventions, comparators, and outcomes (PICO). Multilevel meta-analyses of aggregated efficacy were performed to assess the pooled effect sizes for cognitive and mood outcomes. Risk-of-bias, heterogeneity across studies, and publication bias were assessed for each outcome. Results: After primary and reference searches, 18 studies with low or some concerns of risk of bias were included. Low heterogeneity was found for mood and cognition. Funnel plots did not indicate publication bias. All the studies assessed changes in cognition (n = 1,555) while seven studies with mood outcomes (n = 343) were included. Multilevel meta-analyses demonstrated moderate effect (Hedge's g = 0.44, 95% CI = [0.21-0.67]) in cognitive outcomes and large effect in mood (g = 0.65, 95% CI = [0.37-0.93]). Subdomain analyses found low-moderate effects in global cognition, verbal and non-verbal memory, executive function, visuospatial abilities, and semantic fluency (0.20 < g < 0.50). Conclusion: These findings showed comparable to larger effects of multimodal cognitive and behavioral interventions on cognition than pharmacological treatment. Future studies should focus on the longitudinal effects of multimodal interventions in delaying dementia.Systematic review registration: PROSEPRO, CRD42022349297.