Effect of a Purpose in Life on Risk of Incident Alzheimer Disease and Mild Cognitive Impairment in Community-Dwelling Older Persons

ObjectiveTo investigate whether timing, number, and frequency of mentally stimulating activities in midlife and late life are associated with the risk of incident mild cognitive impairment (MCI).MethodsWe conducted a prospective cohort study in the setting of the population-based Mayo Clinic Study of Aging in Olmsted County, Minnesota, including 2,000 individuals aged ≥70 years who were cognitively unimpaired at baseline and were followed for a median of 5.0 years. Participants completed a self-reported survey on timing, number, and frequency of engagement in 5 mentally stimulating activities (reading books, computer use, social activities, playing games, craft activities) at baseline.ResultsThe risk of incident MCI was significantly reduced for participants who engaged in social activities (hazard ratio [95% confidence interval] 0.80 [0.64–0.99]) and playing games (0.80 [0.66–0.98]) in both late life and midlife combined. Using a computer was associated with a decreased risk regardless of timing (not late life but midlife: 0.52 [0.31–0.88]; late life but not midlife: 0.70 [0.56–0.88]; late life and midlife: 0.63 [0.51–0.79]). Craft activities were associated with a reduced risk of incident MCI only when carried out in late life but not midlife (0.58 [0.34–0.97]). Furthermore, engaging in a higher number of activities in late life was associated with a significantly reduced risk of incident MCI (any 2 activities: 0.72 [0.53–0.99], any 3: 0.55 [0.40–0.77], any 4: 0.44 [0.30–0.65], all 5: 0.57 [0.34–0.96]).ConclusionEngaging in a higher number of mentally stimulating activities, particularly in late life, is associated with a decreased risk of MCI among community-dwelling older persons.

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Effects of combined physical and cognitive training on fall prevention and risk reduction in older persons with mild cognitive impairment: a randomized controlled study

Clinical Rehabilitation ◽

10.1177/0269215520918352 ◽

2020 ◽

Vol 34 (6) ◽

pp. 773-782 ◽

Cited By ~ 1

Author(s):

Donald S Lipardo ◽

William WN Tsang

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Training ◽

Older Persons ◽

Dynamic Balance ◽

Community Dwelling ◽

Controlled Study ◽

Fall Rate ◽

Randomized Controlled ◽

Significant Difference

Objective: The aim of this study is to investigate the effects of combined physical and cognitive training on fall rate and risks of falling in older adults with mild cognitive impairment. Design: The design of this study was an assessor-blinded, randomized controlled trial. Setting: The setting for this study is the community from Manila, Philippines. Subjects: In total, 92 community-dwelling older persons with mild cognitive impairment (aged 60–83) were randomly allocated to three intervention groups and one waitlist control group. Interventions: The physical training, cognitive training, and combined physical and cognitive training intervention programs were delivered for 60 to 90 minutes, one to three times per week for 12 weeks with six-month follow-up. Main measures: Participants were assessed at baseline, 12 weeks after baseline, and 36 weeks after baseline for fall incidence, overall fall risk, dynamic balance, walking speed, and lower limb strength. Results: No significant difference was observed across time and groups on fall incidence rate at 12 weeks ( P = 0.152) and at 36 weeks ( P = 0.954). The groups did not statistically differ in other measures except for a significant improvement in dynamic balance based on Timed Up and Go Test in the combined physical and cognitive training group (9.0 seconds with P = 0.001) and in the cognitive training alone group (8.6 seconds with P = 0.012) compared to waitlist group (11.1 seconds) at 36 weeks. Conclusion: There was no significant difference among groups on fall rate and risks of falling post-intervention. Dynamic balance was improved with combined physical and cognitive training and cognitive training alone. Further research with a larger sample size is needed to establish whether or not the interventions are effective.

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Current State of Digital Biomarker Technologies for Real-Life, Home-Based Monitoring of Cognitive Function for Mild Cognitive Impairment to Mild Alzheimer Disease and Implications for Clinical Care: Systematic Review (Preprint)

10.2196/preprints.12785 ◽

2018 ◽

Author(s):

Antoine Piau ◽

Katherine Wild ◽

Nora Mattek ◽

Jeffrey Kaye

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Alzheimer Disease ◽

Alternative Assessment ◽

Real Life ◽

Community Dwelling ◽

Home Based ◽

Passive Sensors ◽

Digital Biomarkers

BACKGROUND Among areas that have challenged the progress of dementia care has been the assessment of change in symptoms over time. Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured by means of digital devices, such as embedded environmental sensors or wearables. Digital biomarkers provide an alternative assessment approach, as they allow objective, ecologically valid, and long-term follow-up with continuous assessment. Despite the promise of a multitude of sensors and devices that can be applied, there are no agreed-upon standards for digital biomarkers, nor are there comprehensive evidence-based results for which digital biomarkers may be demonstrated to be most effective. OBJECTIVE In this review, we seek to answer the following questions: (1) What is the evidence for real-life, home-based use of technologies for early detection and follow-up of mild cognitive impairment (MCI) or dementia? And (2) What transformation might clinicians expect in their everyday practices? METHODS A systematic search was conducted in PubMed, Cochrane, and Scopus databases for papers published from inception to July 2018. We searched for studies examining the implementation of digital biomarker technologies for mild cognitive impairment or mild Alzheimer disease follow-up and detection in nonclinic, home-based settings. All studies that included the following were examined: community-dwelling older adults (aged 65 years or older); cognitively healthy participants or those presenting with cognitive decline, from subjective cognitive complaints to early Alzheimer disease; a focus on home-based evaluation for noninterventional follow-up; and remote diagnosis of cognitive deterioration. RESULTS An initial sample of 4811 English-language papers were retrieved. After screening and review, 26 studies were eligible for inclusion in the review. These studies ranged from 12 to 279 participants and lasted between 3 days to 3.6 years. Most common reasons for exclusion were as follows: inappropriate setting (eg, hospital setting), intervention (eg, drugs and rehabilitation), or population (eg, psychiatry and Parkinson disease). We summarized these studies into four groups, accounting for overlap and based on the proposed technological solutions, to extract relevant data: (1) data from dedicated embedded or passive sensors, (2) data from dedicated wearable sensors, (3) data from dedicated or purposive technological solutions (eg, games or surveys), and (4) data derived from use of nondedicated technological solutions (eg, computer mouse movements). CONCLUSIONS Few publications dealt with home-based, real-life evaluations. Most technologies were far removed from everyday life experiences and were not mature enough for use under nonoptimal or uncontrolled conditions. Evidence available from embedded passive sensors represents the most relatively mature research area, suggesting that some of these solutions could be proposed to larger populations in the coming decade. The clinical and research communities would benefit from increasing attention to these technologies going forward.

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Capacity to make decisions on medication management in Chinese older persons with mild cognitive impairment and mild Alzheimer's disease

International Psychogeriatrics ◽

10.1017/s1041610212000129 ◽

2012 ◽

Vol 24 (7) ◽

pp. 1103-1111 ◽

Cited By ~ 10

Author(s):

Victor Wing-Cheong Lui ◽

Linda Chiu-Wa Lam ◽

Rachel Ching-Man Chau ◽

Ada Wai-Tung Fung ◽

Billy Mou-Lam Wong ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Decision Making ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Older Persons ◽

Medication Management ◽

Community Dwelling ◽

Decisional Capacity ◽

Cognitively Normal

ABSTRACTBackground: This study aimed to assess if decisional capacity and the four decision-making abilities related to decisions concerning medication management were impaired among community-dwelling Chinese older persons in Hong Kong with amnestic mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), as compared with cognitively normal older adults.Methods: Two hundred and ninety-one Chinese community-dwelling older adults were recruited. The four decision-making abilities and decisional capacity were assessed by using the Chinese version of the Assessment of Capacity for Everyday Decision-Making (ACED) and independent clinician ratings based on the definition in the UK Mental Capacity Act 2005, respectively.Results: Ninety-nine participants (34%) were diagnosed with MCI and ninety-five (33%) with mild AD. Although almost all (96%) of the participants in the MCI group were found to be mentally competent to make decisions on medication management in clinician ratings, their decision-making abilities as measured by the ACED were significantly lower than those of the cognitively normal controls.Conclusions: Results from this study suggest that abilities related to decisions on medication management are impaired before the clinical diagnosis of dementia is made. Use of specific and structured assessment of the relevant decisional abilities may enhance clinical judgment.

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Structured Assessment of Mental Capacity to Make Financial Decisions in Chinese Older Persons With Mild Cognitive Impairment and Mild Alzheimer Disease

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988713481268 ◽

2013 ◽

Vol 26 (2) ◽

pp. 69-77 ◽

Cited By ~ 11

Author(s):

Victor W. C. Lui ◽

Linda C. W. Lam ◽

Rachel C. M. Chau ◽

Ada W. T. Fung ◽

Billy M. L. Wong ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Alzheimer Disease ◽

Older Persons ◽

Mental Capacity ◽

Financial Decisions

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The APOE ε4 Allele Is Associated with Incident Mild Cognitive Impairment among Community-Dwelling Older Persons

Neuroepidemiology ◽

10.1159/000256662 ◽

2010 ◽

Vol 34 (1) ◽

pp. 43-49 ◽

Cited By ~ 49

Author(s):

Patricia A. Boyle ◽

Aron S. Buchman ◽

Robert S. Wilson ◽

Jeremiah F. Kelly ◽

David A. Bennett

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Older Persons ◽

Community Dwelling ◽

Apoe Ε4 ◽

Ε4 Allele

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Current State of Digital Biomarker Technologies for Real-Life, Home-Based Monitoring of Cognitive Function for Mild Cognitive Impairment to Mild Alzheimer Disease and Implications for Clinical Care: Systematic Review

Journal of Medical Internet Research ◽

10.2196/12785 ◽

2019 ◽

Vol 21 (8) ◽

pp. e12785 ◽

Cited By ~ 19

Author(s):

Antoine Piau ◽

Katherine Wild ◽

Nora Mattek ◽

Jeffrey Kaye

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Alzheimer Disease ◽

Alternative Assessment ◽

Real Life ◽

Community Dwelling ◽

Home Based ◽

Passive Sensors ◽

Digital Biomarkers

Background Among areas that have challenged the progress of dementia care has been the assessment of change in symptoms over time. Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured by means of digital devices, such as embedded environmental sensors or wearables. Digital biomarkers provide an alternative assessment approach, as they allow objective, ecologically valid, and long-term follow-up with continuous assessment. Despite the promise of a multitude of sensors and devices that can be applied, there are no agreed-upon standards for digital biomarkers, nor are there comprehensive evidence-based results for which digital biomarkers may be demonstrated to be most effective. Objective In this review, we seek to answer the following questions: (1) What is the evidence for real-life, home-based use of technologies for early detection and follow-up of mild cognitive impairment (MCI) or dementia? And (2) What transformation might clinicians expect in their everyday practices? Methods A systematic search was conducted in PubMed, Cochrane, and Scopus databases for papers published from inception to July 2018. We searched for studies examining the implementation of digital biomarker technologies for mild cognitive impairment or mild Alzheimer disease follow-up and detection in nonclinic, home-based settings. All studies that included the following were examined: community-dwelling older adults (aged 65 years or older); cognitively healthy participants or those presenting with cognitive decline, from subjective cognitive complaints to early Alzheimer disease; a focus on home-based evaluation for noninterventional follow-up; and remote diagnosis of cognitive deterioration. Results An initial sample of 4811 English-language papers were retrieved. After screening and review, 26 studies were eligible for inclusion in the review. These studies ranged from 12 to 279 participants and lasted between 3 days to 3.6 years. Most common reasons for exclusion were as follows: inappropriate setting (eg, hospital setting), intervention (eg, drugs and rehabilitation), or population (eg, psychiatry and Parkinson disease). We summarized these studies into four groups, accounting for overlap and based on the proposed technological solutions, to extract relevant data: (1) data from dedicated embedded or passive sensors, (2) data from dedicated wearable sensors, (3) data from dedicated or purposive technological solutions (eg, games or surveys), and (4) data derived from use of nondedicated technological solutions (eg, computer mouse movements). Conclusions Few publications dealt with home-based, real-life evaluations. Most technologies were far removed from everyday life experiences and were not mature enough for use under nonoptimal or uncontrolled conditions. Evidence available from embedded passive sensors represents the most relatively mature research area, suggesting that some of these solutions could be proposed to larger populations in the coming decade. The clinical and research communities would benefit from increasing attention to these technologies going forward.

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