Handwriting synthesis techniques have been extensively studied in the detection of cognitive impairment in dementia and Parkinson's disease. But handwriting characteristics in older adults with mild cognitive impairment (MCI) still need to be studied further.
To explore the differences between the handwriting characteristics of elderly patients with MCI and normal elderly people, and to assess the value of handwriting features in MCI screening.
By use of convenience sampling, 33 older adults with MCI were recruited from Huzhou communities from January to April 2022 (observation group), and were compared to age-, sex- and education level-matched 43 community-living older adults with normal cognitive function (control group). The General Information Questionnaire, the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment-Basic (MoCA-B), the Activity of Daily Living Scale (ADL), and the 15-item Geriatric Depression Scale (GDS-15) were used to survey subjects. Subjects were invited to complete six handwriting tasks (four are Chinese characters tasks and the other two are graphical drawing tasks) using a dot matrix digital pen to collect their kinematic parameters of handwriting. The classification accuracy, sensitivity and specificity of handwriting characteristics for the diagnosis of MCI were analyzed by discriminant analysis and receiver operating characteristic (ROC) curve, and predictive values of different schemes for MCI were analyzed.
Compared with the control group, the observation group had higher average pressure in writing (Z=-2.122, P=0.034), longer time in air (Z=-4.302, P<0.001), writing time (Z=-3.663, P<0.001) and total time (t'=-5.565, P<0.001), lower average writing velocity (Z=-2.458, P=0.014), horizontal (Z=-2.950, P=0.003) and vertical (Z=-2.094, P=0.040) average writing velocity and maximum horizontal writing velocity (Z=-2.206, P=0.027), lower average acceleration of writing in horizontal direction (Z=-2.667, P=0.008) and overall score for writing correctness (Z=-3.593, P<0.001) in completing graphical drawing tasks. The observation group had relatively longer time in air (Z=-3.464, P=0.001) and total time (Z=-2.940, P=0.003) in completing Chinese characters tasks. Compared with the total time for completing Chinese characters tasks, the total time for completing graphical drawing tasks had higher specificity (93.0% vs 55.8%) in differentiating between MCI and control groups, with an area under the curve (AUC) of 0.828. The summary of handwriting characteristics for graphical drawing tasks correctly classified 80.3% (61/76) of older adults with MCI, with 87.9% sensitivity and 79.1% specificity, and had higher diagnostic efficacy for those with MCI than the MMSE scale (Z=1.993, P=0.046) and the summary of handwriting characteristics for Chinese characters tasks (Z=2.408, P=0.016) .
Handwriting characteristics of graphical drawing tasks may have potential application in screening of older adults at risk for MCI, which can be used simultaneously or prior to sets of neuropsychological tests conducted for the diagnosis of MCI in community health care facilities.
COVID-19 may impair the central nervous system, but the prevalence and related factors of very early cognitive impairment in discharged COVID-19 convalescents are still unclear.
To assess the prevalence of very early cognitive impairment in discharged COVID-19 convalescents, and to identify its influencing factors.
This study included 574 COVID-19 convalescents from August 28 to September 30, 2020, including individuals who were discharged from designated hospitals for treating COVID-19 in Wuhan from December 2019 to April 2020 randomly selected from the hospital information system, and those with informed consent recruited through news media. According to the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) score, the subjects were divided into a very early cognitive impairment group (AD8≥2) and a non-very early cognitive impairment group (AD8<2). A questionnaire survey was conducted with the subjects by four investigators at Hubei Provincial Hospital of Traditional Chinese& Western Medicine, using the General Information Questionnaire to collect demographic information and past disease history of the patients (including gender, age, underlying disease, classification of COVID-19 on admission, interval between discharge and the current survey, and various symptoms present at the time of follow-up), using the Generalized Anxiety Disorder-7 (GAD-7), the PTSD Check List–Civilian Version (PCL-C), and the Short Form 36 Health Survey Questionnaire (SF-36) to assess patients' anxiety, post-traumatic stress disorder, and quality of life, respectively. Three hundred and eleven cases finally completed the cognitive function screening. Multiple Logistic regression was used to evaluate the effects of gender, age, underlying disease and admission classification of COVID-19 on very early cognitive impairment. A restricted cubic spline model was used to assess the quantitative relationship between anxiety level and very early cognitive impairment.
311 (54.18%) who effectively responded to the survey was finally enrolled, including 170 (54.7%) with very early cognitive impairment and 141 (45.3%) without. 230 (23.9%) had residual symptoms after discharge. Comparisons of gender, age, insomnia, fatigue, chest tightness, shortness of breath, loss of appetite, generalized anxiety disorder, PTSD positive, and the score of each SF-36 entry among COVID-19 convalescents with and without very early cognitive impairment were statistically significant (P<0.05). Multivariate Logistic regression analysis suggested that females〔OR (95%CI) =2.658 (1.528, 4.625) 〕, advanced age〔OR (95%CI) =3.736 (1.083, 12.890) 〕, and having generalised anxiety disorder〔OR (95%CI) =5.081 (1.229, 21.008) 〕were influential factors in increasing very early cognitive impairment (P<0.05). Restricted cubic spline models indicated a linear quantitative relationship between anxiety level and very early cognitive impairment, with higher levels of anxiety associated with a greater likelihood of very early cognitive impairment (P for non-linear test =0.132) .
The incidence of very early cognitive impairment is high in COVID-19 convalescents, and it may be higher in those who are older, female, or have generalized anxiety symptoms. Timely interventions for psychiatric problems and alleviation of anxiety symptoms in COVID-19 convalescents, especially in older women, may help to improve their cognitive function and Alzheimer's disease.
Subjective cognitive decline (SCD) is a target for early prevention of Alzheimer's disease (AD). AD is closely related to multimorbidity, but the correlation of SCD with multimorbidity has not been well defined.
To investigate the correlation between SCD and multimorbidity in the elderly, providing a theoretical basis for early prevention and intervention of AD.
From January 2021 to June 2022, 612 elderly people aged≥60 years were sampled by convenience sampling method in urban communities and elderly care institutions in Guangzhou. The objective cognitive function was assessed using the Chinese version of Montreal Cognitive Assessment-Basic (MoCA-BC), Chinese version of Clinical Dementia Rating Scale (CDR-C), and Chinese version of Hachinski Ischemic Scale (HIS-C). SCD was diagnosed using the conceptual framework proposed by the working group of the Subjective Cognitive Decline Initiative and Chinese version of Subjective Cognitive Decline-Questionnaire 9 (SCD-Q9-C). Then according to the assessment results, participants were divided into SCD group (having normal overall objective cognitive function, SCD and SCD-Q9-C score≥5) and normal cognitive (NC) group (having normal overall objective cognitive function, and SCD-Q9-C score<5). A general information questionnaire to collect socio-demographics〔gender, age, place of residence (community or elderly care institution), years of education, marital status, type of occupation before retirement, monthly income〕and health-related information〔body mass index, waist circumference, habits of smoking, alcohol consumption and drinking tea, exercise frequency, habit and average duration of siesta, sleep quality assessed using the Chinese version of Pittsburgh Sleep Quality Index (PSQI-C), depressive symptoms assessed using the Chinese version of Patient Health Questionnaire (PHQ-9-C), anxiety symptoms assessed using the Chinese version of Generalized Anxiety Disorder Scale-7 (GAD-7-C), and activities of daily living (ADLs) assessed using the ADL Scale for Chinese Adults〕. Besides, another questionnaire to collect the history of chronic illness. The level of multimorbidity was classified into three categories〔no multimorbidity (0-1), low multimorbidity (2-4) and high multimorbidity (≥5) 〕by the number of chronic conditions. A binary Logistic regression analysis was used to explore the effect of multimorbidity on the SCD.
The mean SCD-Q9-C score was (4.20±1.95) in 612 elderly people in this survey. Two hundred and fifty cases (40.8%) and 362 cases (59.2%) were assigned to the SCD group, and NC group, respectively. Univariate analysis showed statistically significant differences in gender, age, years of education, type of occupation before retirement, monthly income, tea drinking habits, sleep quality, depressive symptoms, anxiety symptoms and ADL scores between SCD and NC groups (P<0.05). Five hundred and seventy-four cases (93.8%) had chronic diseases, and 475 (77.6%) of them had multimorbidity, including 352 (57.5%) with low multimorbidity level and 123 (20.1%) with high multimorbidity level. The differences in multimorbidity prevalence, multimorbidity level, diabetes, arthritis and osteoporosis between SCD and NC groups were statistically significant (P<0.05). Binary Logistic regression analysis showed that older age, poor sleep quality, presence of anxiety symptoms, poor ADLs, and high level of multimorbidity were statistically significant risk factors for SCD (P<0.05), with the risk of SCD being 1.826〔95%CI (1.037, 3.216) 〕times higher for high multimorbidity level than for no multimorbidity (P<0.05). Longer years of education was a protective factor for SCD (P<0.05) .
High multimorbidity level is associated with increased risk of SCD. Community and elderly care providers can use multimorbidity as an assessment indicator of cognitive decline, and collaboratively implement management of multimorbidity and related factors to actively identify and intervene in SCD in order to delay the development of AD in older adults and promote healthy ageing.
With the rapid population aging in China, cognitive impairment in older adults has become a growing public health concern.
To examine the association between nighttime sleep duration and cognitive impairment among community-dwelling older adults.
Data were derived from the cohort of Older Adult Health and Modifiable Environmental Factors established in Fuyang City from July to September 2018, among whom a total of 4 837 older adults with complete data on cognitive function and sleep time were included in this study. General demographic characteristics〔gender, age, living area (urban or rural), education level, occupation, marital status〕, living habits, the history of chronic diseases, sleep duration, and overall cognitive function were extracted. Binary Logistic regression models were used to analyze the association between nighttime sleep duration and cognitive impairment. Restrictive cubic splines were used to further determine potential dose-response relationships between them.
The participants had a mean nighttime sleep duration of (6.95±1.75) hours, among whom 1 773 (36.65%) slept ≤6 hours per day, 2 088 (43.17%) slept >6-8 hours per day, and 976 (20.18%) slept >8 hours per day. The detection rate of cognitive impairment was 37.44% (1 811/4 837). After adjusting for gender, age, living area, education level and other confounding factors, the detection rate of cognitive impairment was 1.26〔95%CI (1.09, 1.46) 〕 times higher in older adults with nighttime sleep duration of ≤6 hours, and was 1.22〔95%CI (1.03, 1.46) 〕 times higher in older adults with nighttime sleep duration of >8 hours than in those with nighttime sleep duration of >6-8 hours (P<0.05). The detection rate of cognitive impairment in male older adults with nighttime sleep duration of >8 hours was 1.35〔 (95%CI (1.06, 1.72) 〕 times higher than in those with nighttime sleep duration of >6-8 hours (P<0.05). The detection rate of cognitive impairment in female older adults with nighttime sleep duration of≤6 hours was 1.29〔95%CI (1.06, 1.58) 〕 times higher than in those with nighttime sleep duration of >6-8 hours (P<0.05). The restriction cube spline curve showed an approximate U-shaped relationship between nighttime sleep duration and the risk for cognitive impairment, with the lowest risk at 7 hours.
Both shorter and longer nighttime sleep duration may be independent and dose-dependent risk factors for cognitive impairment in older adults. The optimal sleep time is about 7 hours. The association between longer sleep duration and cognitive impairment is pronounced in males, while the association between shorter sleep duration and cognitive impairment is pronounced in females.
