To clarify the characteristic of impaired and unimpaired Instrumental Activities of daily living (IADL) processes with the severity of cognitive impairment in community-dwelling older adults with Alzheimer’s disease (AD) using the Process Analysis of Daily Activity for Dementia (PADA-D).

Cross-sectional study.

13 medical and care centers in Japan.

115 community-dwelling older adults with AD.

The severity of cognitive impairment was classified by Mini-Mental State Examination (20 ≥ mild group, 20 < moderate group ≥ 10, 10 < severe group), and IADL scores and eight IADL items in PADA-D were compared among three groups after adjusting for covariates. Rate of five feasible processes included in each IADL of PADA-D was compared.

IADL score showed a decrease in independence with the severity of AD except for Use modes of transportation and Managing finances, which was especially pronounced in Shopping (F = 25.58), Ability to use the telephone (F = 16.75), and Managing medication (F = 13.1). However, when the PADA-D was examined by process, some processes that were impaired and unimpaired with the severity of cognitive impairment were clear. For example, Plan a meal was impaired (ES = 0.29) with the severity, but Prepare the food was not in Cooking performance.

We suggested that detailed process analysis in IADLs can clarify the characteristic of processes that are impaired and unimpaired with the severity of cognitive impairment in older adults with AD living in the community. Our findings may be useful for rehabilitation and care in IADL to continue living at home.

Previous studies have demonstrated structural and functional changes of the hippocampus in patients with major depressive disorder (MDD). However, no studies have analyzed the dynamic functional connectivity (dFC) of hippocampal subregions in melancholic MDD. We aimed to reveal the patterns for dFC variability in hippocampus subregions – including the bilateral rostral and caudal areas and its associations with cognitive impairment in melancholic MDD.

Forty-two treatment-naive MDD patients with melancholic features and 55 demographically matched healthy controls were included. The sliding-window analysis was used to evaluate whole-brain dFC for each hippocampal subregions seed. We assessed between-group differences in the dFC variability values of each hippocampal subregion in the whole brain and cognitive performance on the MATRICS Consensus Cognitive Battery (MCCB). Finally, association analysis was conducted to investigate their relationships.

Patients with melancholic MDD showed decreased dFC variability between the left rostral hippocampus and left anterior lobe of cerebellum compared with healthy controls (voxel p < 0.005, cluster p < 0.0125, GRF corrected), and poorer cognitive scores in working memory, verbal learning, visual learning, and social cognition (all p < 0.05). Association analysis showed that working memory was positively correlated with the dFC variability values of the left rostral hippocampus-left anterior lobe of the cerebellum (r = 0.338, p = 0.029) in melancholic MDD.

These findings confirmed the distinct dynamic functional pathway of hippocampal subregions in patients with melancholic MDD, and suggested that the dysfunction of hippocampus-cerebellum connectivity may be underlying the neural substrate of working memory impairment in melancholic MDD.

We examined whether preadmission history of depression is associated with less delirium/coma-free (DCF) days, worse 1-year depression severity and cognitive impairment.

A health proxy reported history of depression. Separate models examined the effect of preadmission history of depression on: (a) intensive care unit (ICU) course, measured as DCF days; (b) depression symptom severity at 3 and 12 months, measured by the Beck Depression Inventory-II (BDI-II); and (c) cognitive performance at 3 and 12 months, measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) global score.

Patients admitted to the medical/surgical ICU services were eligible.

Of 821 subjects eligible at enrollment, 261 (33%) had preadmission history of depression. After adjusting for covariates, preadmission history of depression was not associated with less DCF days (OR 0.78, 95% CI, 0.59–1.03 p = 0.077). A prior history of depression was associated with higher BDI-II scores at 3 and 12 months (3 months OR 2.15, 95% CI, 1.42–3.24 p = <0.001; 12 months OR 1.89, 95% CI, 1.24–2.87 p = 0.003). We did not observe an association between preadmission history of depression and cognitive performance at either 3 or 12 months (3 months beta coefficient −0.04, 95% CI, −2.70–2.62 p = 0.97; 12 months 1.5, 95% CI, −1.26–4.26 p = 0.28).

Patients with a depression history prior to ICU stay exhibit a greater severity of depressive symptoms in the year after hospitalization.

To investigate the association between serum vitamin D (25-hydroxy-cholecalciferol) (25(OH)D) concentrations and cognitive impairment in older adults living in Southern Brazil.

Cross-sectional analysis using data from the second follow-up wave of the populational-based EpiFloripa Aging Cohort Study was collected in 2013–2014.

Cognitive impairment was evaluated using the Mini-Mental State Examination (MMSE). Blood samples were collected to measure serum vitamin D concentrations using a chemiluminescent microparticle immunoassay. Vitamin D concentrations were distributed in quartiles (Q1: 4·0–20·7 ng/ml; Q2: 20·8–26·6 ng/ml; Q3: 26·7–32·0 ng/ml and Q4: 32·1–60·1 ng/ml), and its association with cognitive impairment was tested by crude and adjusted logistic regression (sociodemographic, behavioural and health aspects) using Q4 as a reference group.

200 men and 371 women aged 60 years or older participated in this study.

The prevalence of probable cognitive impairment was 21·7 %. Those without cognitive impairment had a higher mean of vitamin D serum concentrations (26·8 v. 24·6, P = 0·014). In the crude analysis, only individuals in Q2 of vitamin D presented an increased risk for probable cognitive impairment compared with Q4 (highest quartile) (OR 2·65, 95 % CI 1·46, 4·81), remaining significant in the adjusted analysis (OR 6·04, 95 % CI 2·78, 13·13). While Q1 (lowest quartile) was not associated in the crude analysis, but when adjusted, an increased risk of cognitive impairment was observed.

The lowest quartile of vitamin D was directly associated with probable cognitive impairment in older adults in Southern Brazil. More studies are needed to investigate whether maintaining adequate serum levels may represent a significant factor in preventing age-related neurological disorders as well as to verify the need for new cutoff points for this age group.

It´s been proved that cognitive stimulation (CS) has direct effects over the improvement of general cognitive functions in people with cognitive impairment (PCI). The restrictions in daily life associated to COVID-19 pandemic had an impact in the quality of life of PCI and it might have affected the efficacy of the CS programs targeting this population.

To analyse if there was a moderating effect of the pandemic on the efficacy of CS programs.

Participants were enrolled in a public memory clinic; 213 PCI were assigned to two groups: 173 received CS treatment before the pandemic (PRECOVID) and 40 received CS during the pandemic (COVID). Pre and post assessments were carried out with the Mini Mental State Exam (MMSE), the clock-test and the brief Geriatric Depression Scale. The treatment consisted of 32 sessions of CS held twice a week during 4 months. No significant differences (p<.05) were found between groups at baseline in age (74.46±7.80 years), cognitive function (MMSE=23.43±3.30), gender (58% women) and the remaining variables.

After treatment, both samples improved in depression (t = 4.56, p < .05), the COVID group improved in MMSE (t = -3.40, p < .05) and clock-test (t= -3.78, p < .05), the rest of the changes were not significant. Between group effect sizes favoured the COVID group intervention for MMSE (dc = 0.74) and the clock test (dc = 0.48). No between group differences were found for depression (dc = -0.48).

Older people participating of CS during the pandemic benefited more from the treatment than those participating before the pandemic. This apparently contradictory result might be explained by the context of lack of social, emotional and cognitive stimulation associated to the restrictions inherent to social confinement. The continuity of CS care to PCI is essential in the context of generalised restrictions in daily life associated to COVID-19 pandemic and might play an important role in preventing cognitive loss and associated disabilities.

Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive test, appropriate for people with minimum completed level of education and sensitive to multicultural contexts. It could be a good instrument for cognitive impairment (CI) screening in Primary Health Care (PHC). It comprises the following areas: recent memory, body orientation, praxis, executive functions and language.

The objective of this study is to assess the construct validity of RUDAS analysing its internal consistency and factorial structure.

Internal consistency will be calculated using ordinal Cronbach’s α, which reflects the average inter-item correlation score and, as such, will increase when correlations between the items increase. Exploratory Factor Analysis will be used to arrange the variables in domains using principal components extraction. The factorial analysis will include the extraction of five factors reflecting the neuropsychological areas assessed by the test. The result will be rotated under Varimax procedure to ease interpretation.

Exploratory factor analysis will be used to arrange the variables in domains using principal components extraction. The analysis will include Kaiser–Meyer–Olkin measure of sampling adequacy and Bartlett’s test of sphericity. Estimations will be based based on Pearson’s correlations between indicators using a principal component analysis and later replicated with a tetrachoric correlation matrix. The variance in the tetrachoric model will be analysed to indentify convergent iterations and their explicative power.

RUDAS is being administered to 321 participants older than 65 years, from seven PHC physicians’ consultations in O Grove Health Center. The data collection will be finished by August 2021 and in this poster we will present the final results of the exploratory factor analysis.

We expect that the results of the exploratory factor analysis will replicate the results of previous studies of construct validity of the test in which explanatory factor weights were between 0.57 and 0.82, and all were above 40%. Confirming that RUDAS has a strong factor construct with high factor weights and variance ratio, and 6-item model is appropriate for measurement will support its recommendation as a valid screening instrument for PHC.

Previous work using a US sample has shown that an index of social deprivation (SoDep Index) is associated with cognitive functioning and decline in older adults. This study aimed to replicate these findings using a European sample (Survey of Health, Ageing and Retirement in Europe, SHARE).

We analyzed data of 51,630 respondents aged 50 years and older (M: 63.5 years, standard deviation [SD]: 9.1) with at least two cognitive assessments (follow-up M: 6.06 years, SD: 3.86). Cognitive scores were transformed to Z-scores. Multiple growth curve modeling was used to model cognitive status and decline as predicted by the SoDep Index. In a sensitivity analysis, we constructed a new SoDep Index (SoDep Indexnew) including further social deprivation domains.

Adjusting for covariates, a unit increase in SoDep Index was associated with a cognitive score of 0.037 SDs smaller (p < .001) and a decline 0.003 SDs per year faster (p < .001). Of the covariates, depressive symptoms, chronic disease burden, male gender, and widowhood were also associated with poorer cognition. Being divorced was associated with better cognition. Sensitivity analysis confirmed findings. Compared to the SoDep Index, the SoDep Indexnew showed a more pronounced association with both cognition and cognitive decline.

We were able to replicate results showing an association between SoDep Index and cognitive function and decline. The sensitivity analysis further emphasizes the relevance of financial security. This strengthens the implication that preventing social deprivation can contribute to reducing the dementia burden by raising cognitive functioning in the older population. The findings are relevant to policy-makers and health care practitioners.

Diagnosis of patients suspected of mild dementia (MD) is a challenge and patient numbers continue to rise. A short test triaging patients in need of a neuropsychological assessment (NPA) is welcome. The Montreal cognitive assessment (MoCA) has high sensitivity at the original cutoff <26 for MD, but results in too many false-positive (FP) referrals in clinical practice (low specificity). A cutoff that finds all patients at high risk of MD without referring to many patients not (yet) in need of an NPA is needed. A difficulty is who is to be considered at risk, as definitions for disease (e.g. MD) do not always define health at the same time and thereby create subthreshold disorders.

In this study, we compared different selection strategies to efficiently identify patients in need of an NPA. Using the MoCA with a double threshold tackles the dilemma of increasing the specificity without decreasing the sensitivity and creates the opportunity to distinguish the clinical (MD) and subclinical (MCI) state and hence to get their appropriate policy.

Patients referred to old-age psychiatry suspected of cognitive impairment that could benefit from an NPA (n = 693).

The optimal strategy was a two-stage selection process using the MoCA with a double threshold as an add-on after initial assessment. By selecting who is likely to have dementia and should be assessed further (MoCA<21), who should be discharged (≥26), and who’s course should be monitored actively as they are at increased risk (21<26).

By using two cutoffs, the clinical value of the MoCA improved for triaging. A double-threshold MoCA not only gave the best results; accuracy, PPV, NPV, and reducing FP referrals by 65%, still correctly triaging most MD patients. It also identified most MCIs whose intermediate state justifies active monitoring.

Even when sharing etiologic factors, the incidence of DM-1 is low in patients with schizophrenia. Both diseases can lead to cognitive impairment, but its difficult to define its origin. 33 years old male, with DM-1 and schizophrenia referred to Therapeutic Community for psychotic symptomatology control, cannabis consumption withdrawal, improvement of self-care and hipoglycemia control reach

Nowadays toxic abstinent and adequate consciousness of disorder. Remarkable persistence of hallucinations both auditive and visual, mostly shown as delirium, pharmacologic treatment-refractary. During last months, he shows excessive absent-mindedness, recent memory failure and verbal declarative memory and psychomotor slowdown Analysis: unbalance glycosylated hemoglobin. MR: cortical-subcortical atrophy, very shocking his age. Endocrinology follow up it was decided to stablish an insulin pump, so metrics were regulated.

Neurological profile of the patient (deficit and slowdown attention capability) aggravation of symptoms according to glycaemia and disturbances in image test could lead to vascular origin. Attention deficit and excessive focus are symptoms of schizophrenia, but they are shown in the beginning, they tend to stabilize during years. Verbal declarative memory disruptions can be produced in both disorders

Better glycemic control and changed to Lurasidone 37mg and Cariprazine 3mg objecting higher reactivity and less absent-mindednes

Cognitive impairment in DM is frequent in adults with severe and long evolving hypoglycemic episodes Regardless of its origin, the cognitive impairment in schizophrenia leads to serious impact in functional and pragmatic areas Further investigation will allow us to quantify the magnitude of cognitive effect in metabolic control so according strategies could be developed

Schizophrenia it’s a deteriorating illness, where the cognitive impairment it’s one of the predominant components in this process. Theory of neurodevelopment, the most widely recognized, explains that cognition will depend most of it, on premorbid development. However, other factors explain this impairment, such as the cardiovascular risk factors (CVRF).

The purpose of this study is to determine cognitive impairment and the domains affected in a sample of patients who suffered schizophrenia and almost one CVRF.

Cross-sectional study. Patients diagnosed with schizophrenia and at least one poorly controlled CVRF (diabetes, hypercholesterolemia, arterial hypertension or active smoking) were selected. Screen for Cognitive Impairment in Psychiatry (SCIP) scale was used to evaluate cognitive impairment and the domains affected.

Preliminary data of twenty patients were included (60% men, mean age: 50 years). At CVRF in the sample, no diabetes was found, 75% had hypercholesterolemia, 15% arterial hypertension and 20% active smoking. SCIP scale showed deficits in word learning and delayed learning in 95% of the sample (n=19). The domain less affected was verbal fluency, affected in 55% of the sample (n=11). Additionally, moderate to severe cognitive impairment was observed in 65% of the sample (n=13).

More than half of the patients with schizophrenia and CVRF have a moderate to severe cognitive impairment. Intervention at CVRF could reduce the severity of cognitive impairment, improving functionality in these patients.

The Cognitive Disorders Unit carries out sessions of Psychoeducational Groups (PG) for caregivers of patients diagnosed with cognitive impairment (CI). The aim is to educate about the disease, improve the caregiver’s self-care and learn how to take better care of the sick.

Analyze the profile of the caregivers that participate in PG and assess changes in their psychological state.

Subjects: 110 caregivers of patients diagnosed with mild-moderate CI who have participated in PG. Methodology: sociodemographic data of the caregiver and patient are collected. The following scales are passed: General-Health-Questionnaire (GHQ-12), Global-Deterioration-Scale, Barthel-Index. 5 sessions of 90 minutes are carried out every fortnight. An opinion questionnaire and the GHQ-12 are administered at the end of the sessions.

86% of caregivers are women: 37% spouses and 55% daughters; mean age 57; 92% of patients live with the caregiver. 62% of caregivers present some kind of psychological disorder that is significantly reduced (p=0,0003) after some sessions. After PG: 65% of caregivers are able to further enjoy their daily activities 46% improve concentration capacity 42% improve sleeping and mood. Opinion Questionnaire Results: 98% of caregivers are satisfied with the activities, the topics addressed and their applicability.

The participants in PG were mostly daughters of patients, with average age 57, and living in the same household. Participation in PG improves the information and skills of caregivers, and reduces psychological disorders by improving their mood, their ability to concentrate, their quality of sleep and enjoyment of daily activities.

It remains difficult to predict which individuals will develop cognitive impairment and progress to major neurocognitive disorders. Prevention studies suffer from the long time frames and the manner in which this topic does not lend itself to randomized, double-blinded controlled trials.

We aimed to construct a computer simulation model that would accurate portray the time course for a series of individuals to develop cognitive impairment and to progress to major neurocognitive disorder.

We built a computer simulation model that incorporated the role of exercise, genetic load, age, quality of diet, presence of diabetes and level of hemoglobin A1C, ongoing levels of cognitive stimulation, presence or absence of micronutrients, presence or absence of other co-morbidities, an overall general health index, levels of smoking and other substance use, and family history. We modeled the life course of 10 individuals, adjusting parameters to make correct predictions for all 10 people. Then we entered the data from another 10 people to determine how accurate the model would be with ten new individuals for whom it had not been developed.

We defined success as a prediction of onset within 10% of the actual date and a prediction of the slope of the trend within 20%. We had 7 successes. We were able to engage 6 of the 10 in interacting with the model to change health behaviors.

Computer simulation modeling may provide an opportunity to study the long-term effects of health behaviors and to engage people in interacting with the program to change behavior.

No significant relationships.

Сognitive deficit significantly affects the quality of life of patients. Aims of research was detection of cognitive impairments of varying degrees in epilepsy, and as well as studying the results of complex treatment in conditions of University clinic, physical and psychological rehabilitation, cognitive training and VNS included.

We studied the features of clinical and psychopathological manifestations of cognitive impairments in patients suffering from epilepsy.

The study was attended by 100 patients (35 men and 65 women) who were inpatient care. The following psychodiagnostic techniques were used: the Toronto Cognitive Assessment TorCA, the test of 10 words of Luria, the MOCA test, the Münsterberg test, the quality of life scale, the Hamilton scale of depression and anxiety.

MCI was observed in 88 % patients, dementia in 12 % (50 % - mild dementia, in 24 % - moderate dementia and in 16% - severe dementia). We used non-pharmacological rehabilitation methods for correction of cognitive impairment in epileptic patients with MCI and mild dementia during 3 mounth.. Improving of cognitive function was observed in 48 % patients, stable level of cognitive function - in 36 %, progressing of cognitive imparment - in 16 % patiens with epilepsy.

The results of the conducted research indicate the need for further study of the features of cognitive disorders in pharmacologically treatment resistant epilepsy and implementation of training aimed at improving cognitive function and preventing the progression of cognitive impairment in complex treatment of those patients.

Delirium affects a significant proportion of hospitalized older patients with acute infections. There is growing evidence that delirium accelerates the cognitive decline at long term.

We aimed to determine if delirium during hospitalization was independently associated with cognitive deterioration at one-year.

From a total of 22 patients (12 C, 4 Dem, 2 D, and 4 DD) delirium (D and DD groups) was associated with a worse score in MOCA of 3-points (p<.02) and 2.5-points (p<.03), respectively, at one year, follow up. Dementia patients without delirium had a decrease of 2-point (p=.04) while cognitively healthy patients had a decrease in 1.08 points (p=.05) (Graph1). MOCA and NPI scores during hospitalization correlated significantly with cognitive decline in the four groups (r=.658, p<.01 and r=.439, p=.02, respectively.)

From a total of 22 patients (12 C, 4 Dem, 2 D and 4 DD) delirium (D and DD groups) was associated with a worse score in MOCA of 3-points (p<.02) and 2.5-points (p<.03), respectively, at one year follow up. Dementia patients without delirium had a of 2-point (p=.04) while cognitively healthy patients had a decrease in 1.08 points (p=.05) (Graph1). MOCA and NPI scores during hospitalization correlated significantly with cognitive decline in the four groups (r=.658, p<.01 and r=.439, p=.02, respectively.)

Individuals developing delirium while recovering from infection have higher rates of cognitive decline after one year, but the cognitive decline is also present to a lower extent for individuals with infections that did not develop delirium.

No significant relationships.

Cognitive depressive disorder (or depressive pseudodementia) is a condition defined by functional impairment, similar to dementias or other neurodegenerative disorders, in the context of psychiatric patients. It is important to consider a differential diagnosis in patients with cognitive impairment.

Presentation of a clinical case of a patient with depression with psychotic symptoms who presents cognitive impairment.

Bibliographic review of the differential diagnosis between cognitive depressive disorder and real dementia by searching for articles in PubMed.

We present a 51-year-old woman, previously diagnosed with adjustment disorder (with mixed anxiety and depressed mood) and unspecific anxiety disorder, who was admitted to the hospital due to delusional ideation of harm and Capgras syndrome, ensuring that her relatives had been replaced and the rest of the patients were not real patients, but actors who conspired against her. The MRI (Magnetic Resonance Imaging) was strictly normal (tumors or acute injuries as stroke or hemorrhage were discarded), and a MoCA (Montreal Cognitive Assesment) test was performed to screen any cognitive impairments (obtaining a score of 19/30, with language fluency and abstraction particularly affected). It would be convenient to repeat the test when this episode and the psychotic symptoms are resolved or improved.

1. Some patients may have cognitive impairment in the context of a mood disorder. 2. A differential diagnosis and follow-up of these patients should be performed to assess prognosis, reversibility and treatment. 3. Depressive cognitive impairment may precede the development and establishment of a dementia or neurodegenerative picture.

No significant relationships.