Towards ambient assisted cities using linked data and data analysis

We investigated the effect of lifespan cognitive reserve and its components on cognitive frailty among older adults. A total of 4922 participants aged ≥65 years were recruited in 2008 and were followed up in 2011 from the Chinese Longitudinal Healthy Longevity Survey. Cognitive frailty was determined through the simultaneous presence of physical frailty (pre-frailty or frailty) and mild cognitive impairment, excluding concurrent dementia. The assessment of physical frailty and mild cognitive impairment was based on the Fatigue, Resistence, Ambulation, Illness, Loss of weight (FRAIL) (Fatigue, Resistence, Ambulation, Illness, Loss) and Mini-Mental State Examination scale, respectively. The lifespan cognitive reserve consisted of education attainment, occupational complexity and later-life leisure activities. We used logistic regression models to estimate the risk of cognitive frailty associated with the lifespan cognitive reserve and its components. A higher level of lifespan cognitive reserve, higher educational attainment or leisure activities engagement, but not occupational complexity, were associated with lower risk of incident cognitive frailty. Furthermore, cognitive, social and physical activities were associated with lower risk of incident cognitive frailty. Cognitive reserve, particularly educational attainment and leisure activities, can protect from cognitive frailty. This implicates that individuals should accumulate cognitive reserve in their lifespan, and older adults should actively participate in leisure activities to prevent cognitive frailty. Geriatr Gerontol Int 2024; 24: 398-403.

Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population.

BackgroundWhether physical activity can reduce cognitive frailty—a relatively new “compound” phenotype proposed in 2013—and whether the effect of physical activity differs based on levels of inflammation are unknown. Therefore, this study aimed to evaluate the effect of physical activity on cognitive frailty and whether baseline interleukin-6 (IL-6) levels modified this effect.MethodsWe used data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter, single-blinded randomized trial conducted at eight US field centers between February 2010 and December 2013. The main outcome was cognitive frailty at 24 months, expressed as an ordinal variable based on the six combinations of its two components: frailty (non-frail, pre-frail, and frail) and mild cognitive impairment (yes, no). Frailty and cognition were assessed by the Study of Osteoporotic Fractures (SOF) index and the Modified Mini-Mental State Examination (3MSE) scale, respectively. Plasma IL-6 was measured at baseline. Of the 1635 original randomized sedentary participants (70–89 years), this study included 1298 participants with data on both cognitive frailty and IL-6 assessments at baseline.ResultsAfter adjusting for field center, sex, and baseline levels of cognitive frailty, the ordinal logistic regression model revealed that participants in the physical activity group had 21% lower odds (odds ratio, 0.79; 95% confidence interval, 0.64–0.98) of worsening cognitive frailty over 24 months than those in the health education group. The effect of physical activity on cognitive frailty did not differ according to baseline IL-6 levels (P for interaction = 0.919). The results did not change after additional adjustment for IL-6 subgroups and the inverse probability of remaining in the study. Comparable results were observed according to age, sex, ethnicity/race, and short physical performance battery score (P for interaction = 0.835, 0.536, 0.934, and 0.458, respectively).ConclusionsA 24-month structured, moderate-intensity physical activity program reduced cognitive frailty compared with a health education program in sedentary older persons, and this beneficial effect did not differ according to baseline levels of inflammatory biomarker IL-6. These findings suggest that the new cognitive frailty construct is modifiable and highlight the potential of targeting cognitive frailty for promoting healthy aging.Trial registrationClinicaltrials.gov, NCT01072500

Plain Language SummaryCognitive frailty is a condition where older adults experience both mild cognitive impairment (MCI) and physical frailty, increasing their risk of poor health outcomes. Traditional tests for identifying this condition are often time-consuming and require specialized equipment, making them unsuitable for routine use or remote settings. This study explored a simple 20-s video-based Upper Frailty Meter (vFM) test as an alternative way to identify cognitive frailty, even from a distance. The study included 413 participants aged 50–79 years. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and physical frailty was measured through the vFM test. During the test, participants repeatedly bent and straightened their elbows for 20 s under two conditions: a physical task alone (single task) and a physical task combined with a mental exercise (dual task). Using video analysis powered by artificial intelligence, researchers evaluated physical frailty phenotypes like slowness, weakness, and exhaustion. The results showed that individuals classified as cognitively frail (12.8% of participants) had higher frailty index compared to those without the condition. The dual-task slowness measure was the most effective individual marker for identifying cognitive frailty. Combining single-task and dual-task results improved accuracy, achieving sensitivity and specificity rates exceeding 85%. The 20-s vFM test is practical, easy to use, and suitable for telehealth. It could help identify individuals at risk of cognitive frailty early, enabling timely interventions to support healthy aging. Future research will explore its long-term effectiveness.

Based on the complex aging background, more and more older people have to live in an institution in later life in China. The prevalence of cognitive frailty (CF) is more higher in institutions than in communities. Rarely studies were conducted on the relationship between institutional residence and CF. Hence, this study were performed to determine the relationship between institutional residence (living in a nursing home) and CF in older adults. A total of 1004 older community residents and 111 older nursing home residents over 50 years of age from Hefei, Anhui Province, China were recruited. CF included physical frailty (PF) and mild cognitive impairment (MCI). PF was assessed using the Chinese version of the Fried frailty scale, MCI was assessed using the Montreal Cognitive Assessment, and the common associated factors including sedentary behavior, exercise, intellectual activity, comorbidity, medication, chronic pain, sleep disorders, nutritional status and loneliness were analyzed using regression logistic models. Multivariate regression logistic analysis showed that exercise (P = .019, odds ratio [OR] = 0.494, 95% confidence interval [CI]: 0.274-0.891), intellectual activity (P = .019, OR = 0.595, 95% CI: 0.380-0.932), medication use (P = .003, OR = 2.388, 95% CI: 1.339-4.258), chronic pain (P = .003, OR = 1.580, 95% CI: 1.013-2.465) and loneliness (P = .000, OR = 2.991, 95% CI: 1.728-5.175) were significantly associated with CF in community residents; however, only sedentary behavior (P = .013, OR = 3.851, 95% CI: 1.328-11.170) was significantly associated with CF in nursing home residents. Our findings suggest that nursing homes can effectively address many common risk factors for CF, including lack of exercise and intellectual activity, medication use, chronic pain, and loneliness, better than the community setting. Thus, residing in a nursing home is conducive to the intervention of CF.

Background and objectives: Mild cognitive impairment (MCI) is an intermediate state between normal aging and dementia, and can be divided into amnestic and non-amnestic types. Patients with amnestic MCI present with memory impairments that are often considered as the early manifestation of Alzheimer’s disease. Patients with amnestic MCI are more likely to progress to Alzheimer’s disease than patients with non-amnestic MCI. The U.S. Food and Drug Administration has not yet approved any drug that can treat amnestic MCI. Moxibustion is a common noninvasive traditional oriental intervention, which uses mainly the heat generated by burning herbal preparations containing moxa and mugwort (Artemisia vulgaris) to simulate acupoints for alleviating the symptoms. To date, many clinical studies have investigated the clinical use of moxibustion to improve memory impairments of Alzheimer’s disease, but these have failed to make a distinction between amnestic and non-amnestic MCI. Therefore, this trial has been designed to assess the effectiveness of moxibustion on amnestic MCI using the Montreal Cognitive Assessment Scale. We will also assess the safety of moxibustion in healthy controls, and analyze the variation of brain functional connectivity and effective brain networks in patients with amnestic MCI undergoing moxibustion using function magnetic resonance imaging. Design: This is a prospective, single-center, randomized controlled clinical trial. Methods: This study will enroll 64 patients with amnestic MCI and 48 healthy controls at Baoan People’s Hospital, Shenzhen, China. The first 64 recruited patients with amnestic MCI will be randomly divided into moxibustion, placebo moxibustion, drug, and control groups (n = 16 per group). In the moxibustion group, patients will be given moxa-wool moxibustion for 12 consecutive weeks. The placebo moxibustion group will receive placebo moxibustion on the same acupoints. Patients in the drug group will be given oral administration of donepezil hydrochloride tablets, 5 mg daily, for 12 consecutive weeks. The control group will receive no intervention. Forty-eight healthy controls will also be randomly assigned into moxibustion, placebo moxibustion, and control groups (n = 16 per group). Interventions will be the same as those received by the patients with amnestic MCI. Evaluators will be blind to group allocation. Outcome measures and preliminary results: The primary outcome measure will be the improvement in cognitive function 12 months after treatment. Secondary outcome measures will be the scores on the Montreal Cognitive Assessment Scale, Clinical Dementia Rating Scale, Mini-Mental State Examination Scale, and Activity of Daily Living Scale before treatment, after 12 weeks of treatment, and 6 months after the end of treatment, as well as brain function analysis before treatment and after 12 weeks of treatment and adverse events during treatment and follow-up. A correlation analysis between cognitive function scores and brain function results will be performed. Results of our preliminary study involving 60 patients with amnestic MCI who experienced moxibustion or received no treatment showed that moxibustion on acupoints significantly improved cognitive ability and quality of sleep in patients relative to the baseline and compared with the control group. Moreover, the scores on attention and delayed recall in the moxibustion group after treatment were significantly higher than those at base line. In the control group the scores on visual space, execution, and delayed recall were significantly lower than those at baseline. These findings indicate that moxibustion improves patient’s attention and delayed recall. If not, visual space, execution, and delayed recall in MCI patients tend to be declined over time. No obvious adverse responses to moxibustion treatment occurred in the preliminary study. Discussion: This proposed trial has the potential to uncover that moxibustion will enhance cognitive-related brain function connections and effector brain networks, which is not yet known. If moxibustion is shown to be an effective and safe treatment strategy in patients with amnestic MCI, then this may pave the way for use of this treatment in clinic amnestic MCI. Ethics and dissemination: This study was approved by the Medical Ethics Committee of the Chinese Clinical Trial Registry (approval No. ChiECRCT-2017018) in October 2016, and registered on April 2017. The study was designed in June 2016. Patient recruitment was initialized in October 2016. Data analysis will be completed in December 2019. Results will be disseminated through publication in a peer-reviewed journal. Protocol version: 1.0. Trial registration: This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR-POC-17011162).

Utilising a sequential mixed-method design to investigate the relationship between planning and smart city development; this thesis aims to work toward an integrated response to these challenges through the provision of an evaluative framework for planning smart cities. Such a framework would act as a medium in recommending a future role and direction for the sector of planning and would aim to build upon the opportunities of technology found in smart cities. Such opportunities include improving the weaknesses of traditional-delivery-methods of development in what the thesis broadly views as an analogue approach to the future of cities challenge in a digital world. The thesis employs a grounded-theory approach to data analysis in phase one, before quantitatively analysing planning policy in phase two and comparing these measurements to questionnaire data in phase three to produce an evaluative framework for the role of planning in smart cities. This linkage via sequential steps for data collection and analysis is reflective of the holistic approach of planning as a profession, whereby a consultative process for expertise in the fields of transport, the environment, heritage and infrastructure combine to form a cohesive system of the built environment; leading this thesis to advocate for an introduction of a digital peer if cities are to be smart about their transformation. In being knowledgeable about this transformation the study’s main findings break down the cycle of data in smart cities to data capture, data communication, data processing and data production; before relating these to smart city development principles that combine with the project phases of planning developments to form quadrants, or areas of opportunity, for planning smart cities – building upon the strengths of planning to improve the capacity of cities in operating throughout the new environment of the digital world.

ADAM10: Biomarker of mild cognitive impairment but not of cognitive frailty.

In recent years, the problem of cognitive impairment in the elderly has become increasingly prominent. Understanding the research trend of influencing factors of mild cognitive impairment, and provide reference for medical staff to early screening of the elderly with mild cognitive impairment. Through the visual analysis of the influence factors of the elderly with mild cognitive impairment, the current research status was discussed. The relevant literature in the field of influencing factors of mild cognitive impairment in the elderly included in the Web of Science core collection database from 2013 to 2022 was searched. Using software such as Cite Space and VOS viewer to visually analyze literature citations, country, keywords, and development trends. A total of 547 relevant literatures were included, and the number of publications showed an increasing trend in the past ten years. The United States ranked first in both the number of published papers (157) and centrality (0.34), and the United States and China had a greater influence on the influencing factors of mild cognitive impairment. Alzheimer's disease, cognitive decline, the elderly, risk factors, are the research hotspot in this field. Cognitive decline will affect the autonomy of the elderly. Cognitive frailty, MRI is the forefront of MCI research, to understand the research hotspots and frontiers in this field, to conduct early screening and intervention guidance for people with mild cognitive impairment, so as to delay the occurrence of Alzheimer's disease, and reduce the pressure on family caregivers and society.

Chapter 40 - Cognitive frailty: definitions, components, and impact on disability and mortality

Cognitive frailty (CF) is defined by the coexistence of physical frailty and mild cognitive impairment. Malnutrition is an underlying factor of age-related conditions including physical frailty. However, the evidence associating malnutrition and cognitive frailty is limited. This cross-sectional study aimed to determine the association between malnutrition and CF in the elderly. A total of 373 participants aged 65–84 years were enrolled after excluding those who were suspected to have dementia and depression. Then, 61 CF and 45 normal participants were randomly selected to measure serum prealbumin level. Cognitive function was assessed using the Montreal Cognitive Assessment-Basic (MoCA-B). Modified Fried’s criteria were used to define physical frailty. Nutritional status was evaluated by the Mini Nutritional Assessment–short form (MNA-SF), serum prealbumin, and anthropometric measurements. The prevalence of CF was 28.72%. Malnourished status by MNA-SF category (aOR = 2.81, 95%CI: 1.18–6.67) and MNA-SF score (aOR = 0.84, 95%CI = 0.74–0.94) were independently associated with CF. However, there was no correlation between CF and malnutrition assessed by serum prealbumin level and anthropometric measurements. Other independent risk factors of CF were advanced age (aOR = 1.06, 95%CI: 1.02–1.11) and educational level below high school (aOR = 6.77, 95%CI: 1.99–23.01). Malnutrition was associated with CF among Thai elderly. High-risk groups who are old and poorly educated should receive early screening and nutritional interventions.

(1) Objectives: We aimed to identify clusters of physical frailty and cognitive impairment in a population of older primary care patients and correlate these clusters with their associated comorbidities. (2) Methods: We used a latent class analysis (LCA) as the clustering technique to separate different stages of mild cognitive impairment (MCI) and physical frailty into clusters; the differences were assessed by using a multinomial logistic regression model. (3) Results: Four clusters (latent classes) were identified: (1) highly functional (the mean and SD of the “frailty” test 0.58 ± 0.72 and the Mini-Mental State Examination (MMSE) test 27.42 ± 1.5), (2) cognitive impairment (0.97 ± 0.78 and 21.94 ± 1.95), (3) cognitive frailty (3.48 ± 1.12 and 19.14 ± 2.30), and (4) physical frailty (3.61 ± 0.77 and 24.89 ± 1.81). (4) Discussion: The comorbidity patterns distinguishing the clusters depend on the degree of development of cardiometabolic disorders in combination with advancing age. The physical frailty phenotype is likely to exist separately from the cognitive frailty phenotype and includes common musculoskeletal diseases.

BackgroundAs a novel intervention method that combines exercise and games, exergames have demonstrated a positive impact on enhancing the cognitive and physical functions of older adults with mild cognitive impairment (MCI). However, there remains a dearth of knowledge and evidence regarding the experiences and needs of the older adult population in China with MCI about exergames.ObjectiveThis qualitative study aimed to investigate the experience of and needs for exergames among older adults with MCI.MethodsWe adopted a phenomenological methodology for this study, and conducted it at a community and nursing home in Changsha, Hunan Province, from June to August 2023. We used the purpose sampling method to conduct semistructured interviews with 21 older people with MCI. Older people with MCI were allowed to experience exergames using our preselected exergame device, the Nintendo Switch, and they were interviewed to understand their experience and needs for exergames. The interviews were recorded and transcribed verbatim, and the data were uploaded to NVivo 12 software for encoding. The corresponding text was then reviewed for data analysis. Data analysis was guided by the methodology proposed by Giorgi and was carried out simultaneously with data collection. This study’s trustworthiness was evaluated according to credibility, dependability, confirmability, and transferability criteria.ResultsOverall, 21 participants (mean age 70.2, SD 7.6 y; n=17, 81% women; mean Montreal Cognitive Assessment score 18.8, SD 3.6) were interviewed. Moreover, 21 interviews were conducted. By the 18th interview, the data were saturated, and to make sure no new topics came up, we conducted 3 more interviews. The experience of older people with MCI with exergames includes five parts: their attitudes toward exergames vary, they are both entertaining and interesting, they promote physical activity and exercise, they pass the time and relieve loneliness, and their conditions of use are not restricted. The needs of older people with MCI for exergames include the desire to design older people–friendly exergames, ensure scientific validity and safety in the process of sports, provide a good gaming experience, exercise physical and cognitive function, and provide support and training.ConclusionsThis study provides an interpretative understanding of the experiences and needs associated with exergames in older people with MCI, which could inform exergame development appropriate for this population and guide the implementation of exergame interventions in this population. Most older people with MCI expressed a positive attitude toward exergames, but not all were interested in them. Older people with MCI viewed exergames as both entertaining and fun, promoting physical activity and exercise, passing the time, relieving loneliness, and the conditions of use were not restricted. Exergames for older people with MCI should be older people–friendly, scientific, safe, provide a good play experience, exercise physical and cognitive function, and provide training and support. In the future, exergames should be tailored to meet the unique needs of older people with MCI, which is critical to improving their well-being.

Mild cognitive impairment frequently represents a predementia stage of Alzheimer's disease. Although obstructive sleep apnea is increasingly recognized as a common comorbidity of mild cognitive impairment, most apnea research has focused on middle-aged adults with moderate-to-severe obstructive sleep apnea. Mild obstructive sleep apnea, defined as 5-14 apneas or hypopneas per hour slept, is common in older adults. Little is known about the effect on cognition of adherence to continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea in older adults with mild obstructive sleep apnea and mild cognitive impairment. The objective of this study was to explore the effect of CPAP adherence on cognition in older adults with mild obstructive sleep apnea and mild cognitive impairment. We conducted a secondary analysis of data from Memories 1, a 1-year quasiexperimental clinical trial on the effect of CPAP adherence in older adults with mild cognitive impairment and obstructive sleep apnea. Those with mild obstructive sleep apnea were divided into two groups based on their CPAP adherence over 1 year: (a) CPAP adherent group (mild cognitive impairment + CPAP) with an average CPAP use of ≥4 hours per night and (b) CPAP nonadherent group (mild cognitive impairment - CPAP) with an average CPAP use of <4 hours per night. Individuals currently using CPAP were not eligible. A CPAP adherence intervention was provided for all participants, and an attention control intervention was provided for participants who chose to discontinue CPAP use during the 1-year follow-up. Descriptive baseline analyses, paired t tests for within-group changes, and general linear and logistic regression models for between-group changes were conducted. Those in the mild cognitive impairment + CPAP group compared to the mild cognitive impairment - CPAP group demonstrated a significant improvement in psychomotor/cognitive processing speed, measured by the Digit Symbol Coding Test. Eight participants improved on the Clinical Dementia Rating Scale, whereas six worsened or were unchanged. Twelve participants rated themselves as improved on the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, whereas three reported their status as worsened or unchanged. The mild cognitive impairment + CPAP group had greater than an eightfold increased odds of improving on the Clinical Dementia Rating and greater than a ninefold increased odds of improving on the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, compared to the mild cognitive impairment - CPAP group. CPAP adherence may be a promising intervention for slowing cognitive decline in older adults with mild obstructive sleep apnea and mild cognitive impairment. A larger, adequately powered study is needed.

With rampant urbanization and industrialization, the quest to become a Smart City is in vogue. Elaborate designs, ideas, and solutions to existing problems are being devised. However, in this race, city planners often neglect the most critical factor related to one&#x2019;s existence on the Earth, i.e., Sustainability. Designing smart and sustainable cities is a challenge whose solutions are not easy. Also, developing a proposed smart city is a time-consuming process as it involves its foundations, analyzing the needs, latest technology, infrastructure, and topography. This paper aims to analyze the patterns followed by cities worldwide in the quest to make smart cities. This shall also show how newer cities can become innovative based on the work already done by the existing cities through the concept of Inheritance. In order to do this, a dataset comprising 102 cities is analyzed based on six metrics. A combination of the Principal Component Analysis and K-means Clustering technique is used to assist with the analysis of this unlabeled dataset. It is thereby shown that these 102 cities can be identified as belonging to 4 clusters and the cluster properties can then be inherited by any new city poised to become a future smart city.