Concurrent Validity of Performance-Based Measures of Daily Functioning with Cognitive Measures and Informant Reported Everyday Functioning.

Functional ability and intrinsic capacity (IC) have been proposed as determinants of healthy aging, but the extent to which these indicators are affected by biological aging remains unknown. We explored the association of biological age acceleration (BAA) with functional ability and IC in older adults with physical and cognitive impairments. This cross-sectional study used data from 163 individuals (84.0 ± 5.2years [range 72-99], 61.8% women) of the COGFRAIL cohort. Functional ability on basic (BADL-Katz Index) and instrumental activities of daily living (IADL-Lawton Index) was assessed. IC was measured as a composite score (0-100, higher is better) including the locomotion, cognition, psychology, sensory, and vitality domains. BAA was assessed by Horvath's, Hannum's, PhenoAge, and GrimAge epigenetic clocks. In the fully adjusted model, higher BAAPhenoAGe was associated to lower functional ability in BADLs (β = - 0.021, 95% confidence interval = - 0.038 to - 0.003, p = 0.022), with no significant results observed for the remaining clocks. No significant association was found between BAA and IC, but some associations were found with specific IC domains. Particularly, BAAGrimAge was associated with lower locomotion scores (β = - 1.179, 2.286 to - 0.072, p = 0.037), while BAAPhenoAge tended to be associated with lower scores in vitality (β = - 0.257, - 0.539 to 0.025, p = 0.073). Higher BAAPhenoage was associated with lower functional ability in very old adults with frailty and cognitive impairment. Although no biological clock was associated with a composite IC score, some associations were found between second-generation epigenetic clocks and specific IC domains.

Predicting the value of the Mini Nutritional Assessment (MNA) as an indicator of functional ability in older Iranian adults (Kahrizak elderly study).

A-17 * Delay and Probability Discounting are Markers of Functional Ability in Community-Dwelling Older Adults

BackgroundEfficient identification of older adults with Mild Cognitive Impairment (MCI), including MCI due to AD, is a pressing challenge. Remote methods to accurately identify older adults with MCI are a promising approach. Subjective cognitive decline (SCD), reported by individuals and their study partners, can be efficiently collected remotely.MethodsIn 1286 older adults in the Brain Health Registry (BHR, Table 1), using logistic regression, we determined the accuracy of online self‐report mood (Geriatric Depression Scale Short Form, GDS), family history of AD, Everyday Cognition Scale (ECog) as a measure of SCD, and Cogstate Brief Battery one card learning (OCL) accuray to distinguish (1) Cognitively‐unimpaired (CU) from MCI, and (2) CU from b‐amyloid (Ab)+ MCI. In a subset of 289 participants with enrolled study partners, we measured the contribution of study partner‐report SCD to predicting diagnostic category, and the correlation between self‐ and study partner‐report SCD. Models covaried for age, gender, and education level.ResultsSelf‐ and study partner‐report SCD scores were moderately correlated (r=0.44); associations between the two measures were significantly lower in participants with higher GDS scores, indicating more depressive symptoms (p=0.03). Models including self‐ and study partner‐report SCD and Cogstate OCL scores had the highest accuracy for distinguishing CU from all MCI, as well as CU from Ab+ MCI (AUC=0.90 for CU vs MCI; AUC=0.93 for CU vs Ab+ MCI). Models excluding study partner‐report SCD had moderate accuracy at diagnostic classification (AUC=0.81 for CU vs MCI; AUC=0.83 for CU vs Ab+ MCI). Models excluding all SCD measures, and instead relying on OCL accuracy scores, had lower accuracy (AUC=0.73 for CU vs MCI; AUC=0.76 for CU vs Ab+ MCI). Model outputs are summarized in Table 2.ConclusionsRemotely‐collected self‐ and study partner‐report SCD accurately distinguish CU from MCI, as well as CU from biomarker positive MCI. SCD measures perform well in identifying MCI, even in the absence of objective cognitive measures. Results support utilization of remote SCD measures to identify older adults for prodromal AD clinical trials, and who are suitable candidates to receive future anti‐amyloid therapeutics.

Measures of complex functional decision-making capacity can greatly aid in assessing mild cognitive impairment (MCI) and facilitating early intervention in dementia care. We examined the ability of the Assessment of Functional Capacity Interview (AFCI) to detect functional differences among older adults who were cognitively unimpaired (CU), or who presented with subjective cognitive decline (SCD) or MCI. A sample of 97 older adults (CU; n = 30, Mage = 74.64 ± 7.42 years; SCD; n = 34, Mage = 72.56 ± 6.43 years; MCI; n = 33, Mage = 78.28 ± 7.55 years) underwent neuropsychological testing and responded to the Financial Capacity Instrument (FCI-SF). Informants completed the Assessment of Functional Capacity (AFCI), an instrument of functional decision-making capacity, and responded to the Social Vulnerability Scale (SVS15) and Amsterdam Instrumental Activity of Daily Living (A-IADL-Q-SV), a measure of functional status, for comparison. According to informant-reported responses, the CU group had significantly lower AFCI total (and domain) scores, H(2) = 27.59, p<.001, relative to MCI. Additionally, the CU group had significantly lower AFCI scores in the Home and Personal Safety domain relative to the SCD group, H(2) = 14.06, p<.05. In the overall sample, AFCI total scores were associated with FCI-SF, SVS15, and A-IADL-Q-SV scores and cognitive measures. Our results demonstrate that the AFCI is sensitive to impairment in safety, social, financial, and medical functioning in MCI and is associated with measures of cognitive functioning and social vulnerability in older adults. Incorporating this instrument as a supplement to cognitive screening instruments may aid in the prevention of hazardous decision-making in older adults.

Determine whether levels of anxiety and depression, cognitive ability, and self-quarantining during and prior to the pandemic predict decreases in perceived functional ability. Longitudinal data collected from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (2020) and core CLSA study (Follow-Up 1; 2014-2018). 17541 CLSA participants. Self-quarantining behaviours from questionnaires administered at Baseline (April 2020), Monthly, and Exit (December 2020) time points of the CLSA COVID-19 Questionnaire Study, levels of anxiety and depression at Baseline, perceived change in functional ability at Exit, and performance on neuropsychological tests (Rey Auditory Verbal Learning Task, Mental Alternation Task, Animal Fluency Test) and functional ability (Older Americans Resources and Services [OARS] Multidimensional Assessment Questionnaire) from the core CLSA study. Greater cognitive ability pre-pandemic (B = -.003, P < .01), higher levels of anxiety (B = -.024, P < .01) and depressive symptoms (B = -.110, P < .01) at Baseline, and higher frequency of engaging in self-quarantining throughout the COVID-19 survey period (B = -.098, P < .01) were associated with perceived loss in functional ability at Exit. Self-quarantining behaviour was associated with perceived loss in functional ability only at average and high levels of depressive symptoms (B = -.013, P < .01). Older adults with higher cognitive and lower functional ability prior to the pandemic were at greater risk of decreased perceived functional ability during the first year of the pandemic, as were those who experienced greater levels of anxiety and depressive symptoms during the pandemic. Strategies/interventions to preserve functional ability in older adults with cognitive independence prior to future pandemics are warranted.

Objective:Subjective cognitive decline (SCD), the self-reported experience of worsening cognitive abilities (Jessen et al., 2014), is associated with increased risk of developing Alzheimer’s disease and Mild Cognitive Impairment. Modifiable factors such as purpose in life (PiL), the experience of living a meaningful life where one’s life goals are attainable or being achieved (Boyle et al., 2009), and loneliness, an individual’s perceived social isolation (Luhmann &amp; Hawkley, 2016), are known to be associated with SCD. These relationships are understudied among ethnically diverse groups. Using an online survey, we examined associations between PiL, loneliness and SCD in older ethnically diverse individuals living in the US.Participants and Methods:870 older adults (126 Latino, 74 Black, 33 Asian, and 637 White; average age=67.0 [7.6]) completed an online survey including the Life Purpose Questionnaire, the Gierveld Loneliness Scale, and the Everyday Cognition scale (ECog), which measures subjective cognitive concerns in memory, language, executive function, and divided attention. Chi-square tests and analyses of variance were conducted to assess group differences in SCD and demographic/lifestyle predictors. Multiple regressions and correlations were conducted to assess the relationships between ethnicity and PiL with SCD, and the moderating effect of race/ethnicity. Multiple regressions and correlations were conducted to identify sociodemographic and lifestyle predictors of SCD in each study group.Results:White participants were older (p&lt;.001), and White and Asian groups had higher levels of education (p=.009) compared to Latinos. The White group had a higher proportion of female (p=.016) and middle-income (p=.019) respondents. Black participants had higher PiL (p=.035) and lower loneliness (p=.047) compared to White participants; there were no group differences in ECog ratings (p=.143). Regression results indicated that higher PiL associated with lower SCD in the whole sample (β=-.435, p&lt;.001). The interaction between PiL and ethnic group was significant (β=.078, p=.025), suggesting the relationship between PiL and SCD was strongest in White participants, followed by Asian, then Latino, and finally Black participants. In Latinos, female sex (β=-.281, p=.004) and higher PiL (β=-.240, p=.034) predicted lower SCD ratings. In White participants, higher PiL (β = -.394, p &lt; .001), and lower loneliness (β = .128, p = .003) predicted lower SCD ratings. Correlation analyses revealed no significant associations with SCD in the Black group, although the correlation between loneliness and SCD was trending (r=.222, p=.063). In the Asian group, greater PiL was associated with lower SCD ratings (r=-.439, p=.011).Conclusions:Our findings suggest that PiL may be protective against SCD, particularly in Latino, Asian, and White adults. Differential predictive factors of SCD were also identified for our study groups, suggesting certain groups may benefit from specific targeted interventions. Overall, findings suggest that interventions geared toward increasing PiL and/or mitigating loneliness may help reduce SCD and the risk of cognitive decline in older adults in the US. As the current study was cross-sectional and faced sample size limitations in Asian and Black groups, future studies should include longitudinal assessment of these associations with larger and more representative samples to confirm our findings.

BackgroundNeuropsychologically intact older adults who report experiencing subjective cognitive decline (SCD) likely draw on daily experiences of cognitive difficulties as an indicator of worsening cognitive functioning. Specifically, the frequency of problems (e.g., memory lapses, difficulty planning) and/or the degree that these problems interfere with their daily activities may play a role in their perception of cognitive changes. The current study examined differences in daily cognitive difficulties in older adults without SCD compared to those with SCD or MCI.MethodParticipants (n=212, Mage=76.97 years, range: 70‐90, 65% female, 50% White) completed a battery of objective cognitive performance tasks, psychosocial questionnaires, and they self‐reported experience of and interference from cognitive difficulties each day for 14 days (via smartphones). Fifty‐seven participants were classified as having mild cognitive impairment (MCI) using the Jak, Bondi (2009) criteria. One hundred and three participants not classified as MCI were classified as SCD as they reported their memory functioning worsening in the past 5 years. The remaining 52 participants with no SCD were normal controls. Generalized linear modeling was used to predict total number of and average interference from memory lapses and general thinking problems from daily reports.ResultAfter accounting for age, sex, race/ethnicity, education, and depressive symptoms, cognitively normal participants with SCD and those with MCI reported significantly more everyday cognitive difficulties compared to cognitively normal participants without SCD (Figures 1‐3). The MCI and SCD groups did not differ from each other (p’s&gt;.07). For retrospective memory lapses and general thinking problems, normal controls reported significantly lower interference than participants with SCD and those with MCI (p’s&gt;.02; Figures 5 and 6). For prospective memory lapses, only participants with MCI reported significantly higher interference than normal controls (p=.01; Figure 4).ConclusionCompared to participants without SCD, participants with SCD and those with MCI reported more frequent everyday cognitive problems and that problems were more likely to interfere in daily activities. Everyday cognitive difficulties may differentiate those individuals more likely to develop functional impairments related to declining cognition. Difficulties meeting daily cognitive demands has the potential to interfere with the ability of older adults to safely live independently.

Subjective cognitive decline (SCD) is defined as self-experienced cognitive decline without objective impairment on standardised tests. Research suggests SCD may show subtle impairment on detailed neuropsychological assessment and might therefore indicate the earliest stage of neurodegeneration. This review (PROSPERO: CRD42023382096) seeks to determine whether group differences in memory task performance between people with and without SCD exist. The review included studies since 2014 comparing episodic memory performance between people with and without SCD; where people with SCD were recruited exclusively from community or medical settings. Studies providing data for people with mild cognitive impairment (MCI) were included in a separate meta-analysis comparing SCD and MCI. A systematic search was conducted (PsycINFO, Web of Science, MEDLINE, CINAHL, PubMed on 11th August 2023). Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. 1,815 records were identified, of which 45 met inclusion criteria and were included in a random-effects meta-analysis (SCD N = 5,948, Non-SCD N = 8,468). Twenty-one studies additionally provided data for an MCI group (SCD N = 1,034, MCI N = 2,119). Results indicated people with SCD performed significantly worse than people without SCD (Hedges' g = -0.19, 95% CI = -0.26, -0.11) and significantly better than MCI participants (Hedges' g = 1.20, 95% CI = 0.94, 1.46). For both meta-analyses there was significant between-study heterogeneity. There was a significant risk of publication bias for the meta-analysis comparing SCD to Non-SCD. These results suggest detailed memory assessment may be sensitive to reduced objective memory performance in SCD. However, it is unclear whether the small effect size has clinical significance. Higher quality and larger studies are needed to rule out the influence of moderating factors on memory performance.

ABSTRACTIntroduction: Previous studies performed neuropsychological tests in non-demented patients, especially those with mild cognitive impairment (MCI), to predict dementia. Few recent studies reported that subjective cognitive decline (SCD) itself predicts dementia conversion. We evaluated certain characteristics and neuropsychological tests to predict cognitive deterioration in non-demented individuals.Methods: This study included 106 participants with subjective cognitive complaints (SCCs) classified as non-demented (90 MCI and 16 SCD). Data were collected at baseline and follow-up, wherein participants completed a comprehensive neuropsychological assessment to assess their cognitive and daily functions.Results: During the follow-up of all participants, 52 converted to dementia, while 54 did not. There were significant differences in age and education years, as well as language, memory, frontal lobe function, and Barthel’s Activities of Daily Living Index between the groups. Correlation analysis showed a significant correlation between the deterioration of the Clinical Dementia Rating scores and baseline language, memory, and frontal lobe function scores.Conclusion(s): SCDs consistently worrying about their SCCs and those identified with SCD by their caregivers were prone to cognitive function deterioration over time. Changes in language, memory, and frontal lobe function in neurocognitive tests were significantly different between the dementia converters and non dementia converters group. Particularly, SCD and MCI individuals with significantly poor initial executive function and memory abilities should be closely monitored for future cognitive decline.

Objective: To analyze the association between multimorbidity and low functional ability in older adults in southern Brazil. Methods: In a cross-sectional population-based study, we analyzed a sample of 435 persons aged 60–79 years old. Functional ability was estimated using a scale 0 to 100, stratified into quartiles, and the presence of diseases was self-reported. The association between multimorbidity and low functional ability (lowest quartile or less) was estimated by logistic regression. Results: The frequency of multimorbidity was 85.5% and the median functional ability score was 70. There was an inverse correlation between functional ability score and the number of chronic diseases (rho= -0.48; p&lt;0.0001). Low functional ability was associated with multimorbidity (OR 3.1; 95%CI 1.7–5.5; p&lt;0.001) and remained so after adjustment for sex, age, health service utilization, hospitalizations, health insurance status, and self-perceived health status (OR 2.0; 95%CI 1.07–3.73; p=0.029). Identifying the most vulnerable older adults and providing them with appropriate health care could help prevent loss of functional ability.

BackgroundThe recruitment of participants with a high risk of decline is crucial for the success of clinical trials in the earliest phases of Alzheimer´s Disease (AD), where treatment benefits could be the largest. Subjective cognitive decline (SCD) and minor neuropsychological deficits (MNPD) are associated with an increased risk of cognitive decline, making them promising predictors for this risk stratification. However, the prognostic value of their interplay is understudied.MethodWe pooled and analyzed data from cognitively unimpaired participants from the Alzheimer´s Disease Neuroimaging Initiative (N = 599), DZNE Longitudinal Cognitive Impairment and Dementia study (N = 618), and National Alzheimer's Coordinating Center (N = 11,975). SCD was measured using questionnaires or anamnestic data. MNPD was defined as a median neuropsychological test performance of z≤‐0.5. We assessed the association of MNPD and SCD with the conversion to mild cognitive impairment (MCI) and dementia (cox regression) and baseline amyloid and tau positivity – measured by PET/CSF (logistic regression). We adjusted these models for the study cohorts and demographic covariates. Using power analyses, we calculated the sample sizes necessary to detect a 30% reduction in the risk of progressing to MCI over 4.5 years in amyloid positive participants.ResultIn the overall sample (N = 13,192), the SCD‐/MNPD+ (+:present, ‐:absent; HR=3.13[2.68‐3.66]), SCD+/MNPD‐ (HR=1.97[1.76‐2.20]), and SCD+/MNPD+ (HR=6.23[5.23‐7.42]) groups had an increased risk of MCI compared to the SCD‐/MNPD‐ group. These groups also had an increased risk of dementia. In amyloid positive participants (n = 497), this pattern persisted for the progression to MCI, while only the SCD+/MNPD+ group had an increased risk for dementia. In participants with biomarker data (n = 2,616), the SCD+/MNPD‐ (OR=1.47[1.20‐1.81]) and SCD+/MNPD+ (OR=1.64[1.04‐2.59]) groups had an increased risk of amyloid positivity. The risk of tau positivity was increased in the SCD+/MNPD+ group (OR=2.10[1.13‐3.90]). In the power analyses, the required clinical trial size was reduced by approximately one third after excluding SCD‐/MNPD‐ individuals and approximately two thirds by focusing only on SCD+/MNPD+ individuals (Figure).ConclusionSCD and MNPD have a complementary prognostic value. SCD+/MNPD+ individuals are at particularly high risk of pathology and decline. These clinical symptoms should be taken into account in the recruitment for clinical trials in preclinical AD.

BackgroundEarly identification of individuals at risk for dementia is crucial for timely diagnosis and intervention. Visual rating scales (VRS) for atrophy on MRI are established tools in clinical practice for assessing dementia‐related brain changes and have predictive value for progression to dementia in mild cognitive impairment (MCI). However, the coarseness of VRS limits predictive value earlier in the disease. Alternatively, brain age gap (BAG), the difference between chronological and age estimated from MRI using AI, shows promise in detecting dementia‐related brain changes. In this study we assess whether BAG can predict progression to dementia in those with subjective cognitive decline (SCD) and MCI.MethodWe included subjects from the Amsterdam Dementia Cohort with a diagnosis of SCD (n = 391) or MCI (n = 366), baseline MRI, and at least 2 years of prospective clinical follow‐up (Table 1). T1 MR images were processed with SPM12 followed by BrainageR to derive BAG, which were adjusted for age, sex, and MRI scanner. Cox regression was used to model the risk of clinical progression to dementia. These models included age, sex, MMSE, and BAG, and hazard ratios (HR) were calculated to assess predictive value of BAG. To assess the added value of BAG over traditional radiological assessment, we repeated the analysis adding VRS of medial temporal lobe atrophy, global atrophy and parietal atrophy to the model. Analyses were performed in the whole sample and stratified per disease stage (SCD/MCI).Result224 subjects progressed to dementia (SCD=38 (9.72%), MCI=186 (50.8%)). On average, a dementia diagnosis was given 3.09 years (SD=1.95) after baseline. BAG predicted progression to dementia, with added value beyond VRS (Table 2). The predictive value of BAG was strongest in SCD, where VRS provided no added value. In MCI, the predictive value of BAG was lower and insignificant when VRS were included (Table 3).ConclusionBAG is predictive of progression to dementia in SCD and MCI and has added value over VRS in SCD. This highlights the potential of BAG as a predictor of progression to dementia, especially in early disease stages, when traditional VRS are insensitive.

The Memory Alteration Test (M@T) is a verbal episodic and semantic memory screening test able to detect subjective cognitive decline (SCD) and Mild Cognitive Impairment (MCI). To adapt M@T, creating a Greek version of the Memory Alteration Test (M@T-GR), and to validate M@T-GR compared to the Mini-Mental State Examination (MMSE), and Subjective Cognitive Decline- Questionnaire (SCD-Q) MyCog and TheirCog. 232 people over 55 years old participated in the study and they were classified as healthy controls (HC, n = 65), SCD (n = 78), or MCI (n = 89). The ANCOVA showed that the M@T-GR's total score was significantly different in HC and SCD (I-J = 2.26, p = 0.032), HC and MCI (I-J = 6.16, p < 0.0001), and SCD compared to MCI (I-J = 3.90, p < 0.0001). In particular, a cut-off score of 46.50 points had an 81%sensitivity and 61%specificity for discriminating HC from SCD (AUC = 0.76, p < 0.0001), while a cut-off score of 45.50 had a sensitivity of 92%and a specificity of 73%for discriminating MCI (AUC = 0.88, p < 0.0001), and a cut-off score of 45.50 points had a sensitivity of 63%and a specificity of 73%for discriminating SCD from those with MCI (AUC = 0.69, p < 0.0021). Exploratory factor analysis indicated that there was one factor explaining 38.46%of the total variance. Internal consistency was adequate (α= 0.75), while convergent validity was found between M@T-GR and MMSE (r = 0.37, p < 0.0001) and SCD-Q TheirCog (r = -0.32, p < 0.0001). The M@T-GR is a good to fair screening tool with adequate discriminant validity for administration in people with SCD and MCI in Greece.

Sleep problems are very prevalent in older adults, especially in those at risk for dementia. But the relationships between sleep parameters and subjective or objective cognitive decline are still inconclusive. The study aimed to investigate the self-reported and objectively measured sleep characteristics in older adults with mild cognitive impairment (MCI) and subjective cognitive decline (SCD). This study adopted a cross-sectional design. We included older adults with SCD or MCI. Sleep quality was measured separately by the Pittsburgh sleep quality index (PSQI) and ActiGraph. Participants with SCD were divided into low, moderate, and high levels of SCD groups. Independent samples T-tests, one-way ANOVA, or nonparametric tests were used to compare the sleep parameters across groups. Covariance analyses were also performed to control the covariates. Around half of the participants (45.9%) reported poor sleep quality (PSQI＜7), and 71.3% of participants slept less than 7 hours per night, as measured by ActiGraph. Participants with MCI showed shorter time in bed (TIB) (p＜0.05), a tendency of shorter total sleep time (TST) at night (p = 0.074) and for each 24-hour cycle (p = 0.069), compared to those with SCD. The high SCD group reported the highest PSQI total score and longest sleep latency than all the other three groups (p＜0.05). Both the MCI and high SCD groups had shorter TIB and TST for each 24-hour cycle than the low or moderate SCD groups. Besides, participants with multiple-domain SCD reported poorer sleep quality than those with single-domain SCD (p＜0.05). Sleep dysregulation is prevalent in older adults with a risk for dementia. Our findings revealed that objectively measured sleep duration might be an early sign of MCI. Individuals with high levels of SCD demonstrated poorerself-perceived sleep quality and deserved more attention. Improving sleep quality might be a potential target to prevent cognitive decline for people with a risk for dementia.