We examined longitudinal changes in cognitive and physical function and associations between change in function and falls in people with and without mild cognitive impairment (MCI).

Prospective cohort study with assessments every 2 years (for up to 6 years).

Community, Sydney, Australia.

Four hundred and eighty one people were classified into three groups: those with MCI at baseline and MCI or dementia at follow-up assessments (n = 92); those who fluctuated between cognitively normal and MCI throughout follow-up (cognitively fluctuating) (n = 157), and those who were cognitively normal at baseline and all reassessments (n = 232).

Cognitive and physical function measured over 2–6 years follow-up. Falls in the year following participants’ final assessment.

In summary, 27.4%, 38.5%, and 34.1% of participants completed 2, 4, and 6 years follow-up of cognitive and physical performance, respectively. The MCI and cognitive fluctuating groups demonstrated cognitive decline, whereas the cognitively normal group did not. The MCI group had worse physical function than the cognitively normal group at baseline but decline over time in physical performance was similar across all groups. Decline in global cognitive function and sensorimotor performance were associated with multiple falls in the cognitively normal group and decline in mobility (timed-up-and-go test) was associated with multiple falls across the whole sample.

Cognitive declines were not associated with falls in people with MCI and fluctuating cognition. Declines in physical function were similar between groups and decline in mobility was associated with falls in the whole sample. As exercise has multiple health benefits including maintaining physical function, it should be recommended for all older people. Programs aimed at mitigating cognitive decline should be encouraged in people with MCI.

Computerised neuropsychological assessments (CNAs) are proposed as an alternative method of assessing cognition to traditional pencil-and-paper assessment (PnPA), which are considered the “gold standard” for diagnosing dementia. However, limited research has been conducted with culturally and linguistically diverse (CALD) individuals. This study investigated the suitability of PnPAs and CNAs for measuring cognitive performance in a heterogenous sample of older, Australian CALD English-speakers compared to a native English-speaking background (ESB) sample.

Participants were 1037 community-dwelling individuals aged 70–90 years without a dementia diagnosis from the Sydney Memory and Ageing Study (873 ESB, 164 CALD). Differences in the level and pattern of cognitive performance in the CALD group were compared to the ESB group on a newly developed CNA and a comprehensive PnPA in English, controlling for covariates. Multiple hierarchical regression was used to identify the extent to which linguistic and acculturation variables explained performance variance.

CALD participants’ performance was consistently poorer than ESB participants on both PnPA and CNA, and more so on PnPA than CNA, controlling for socio-demographic and health factors. Linguistic and acculturation variables together explained approximately 20% and 25% of CALD performance on PnPA and CNA respectively, above demographics and self-reported computer use.

Performances of CALD and ESB groups differed more on PnPAs than CNAs, but caution is needed in concluding that CNAs are more culturally-appropriate for assessing cognitive decline in older CALD individuals. Our findings extend current literature by confirming the influence of linguistic and acculturation variables on cognitive assessment outcomes for older CALD Australians.

This study aimed to investigate psychometric properties and enhance precision of the 16-item Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-16) up to interval-level scale using Rasch methodology.

Partial Credit Rasch model was applied to the IQCODE-16 scores using longitudinal data spanning 10 years of biennial follow-up.

Community-dwelling older adults aged 70–90 years and their informants, living in Sydney, Australia, participated in the longitudinal Sydney Memory and Ageing Study (MAS).

The sample included 400 participants of the MAS aged 70 years and older, 109 out of those were diagnosed with dementia 10 years after the baseline assessment.

The IQCODE-16.

Initial analysis indicated excellent reliability of the IQCODE-16, Person Separation Index (PSI) = 0.92, but there were four misfitting items and local dependency issues. Combining locally dependent items into four super-items resulted in the best Rasch model fit with no misfitting or locally dependent items, strict unidimensionality, strong reliability, and invariance across person factors such as participants’ diagnosis and relationship to their informants, as well as informants’ age and sex. This permitted the generation of conversion algorithms to transform ordinal scores into interval data to enhance precision of measurement.

The IQCODE-16 demonstrated strong reliability and satisfied expectations of the unidimensional Rasch model after minor modifications. Ordinal-to-interval transformation tables published here can be used to increase accuracy of the IQCODE-16 without altering its current format. These findings could contribute to enhancement of precision in assessing clinical conditions such as cognitive decline in older people.

Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD).

We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle–Ottawa Scale.

The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen’s d = −0.25, 95% CI [−0.02, −0.49] I2 35%).

There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.

To investigate whether amnestic mild cognitive impairment (aMCI) identified with visual memory tests conveys an increased risk of Alzheimer’s disease (risk-AD) and if the risk-AD differs from that associated with aMCI based on verbal memory tests.

4,771 participants aged 70.76 (SD = 6.74, 45.4% females) from five community-based studies, each a member of the international COSMIC consortium and from a different country, were classified as having normal cognition (NC) or one of visual, verbal, or combined (visual and verbal) aMCI using international criteria and followed for an average of 2.48 years. Hazard ratios (HR) and individual patient data (IPD) meta-analysis analyzed the risk-AD with age, sex, education, single/multiple domain aMCI, and Mini-Mental State Examination (MMSE) scores as covariates.

All aMCI groups (n = 760) had a greater risk-AD than NC (n = 4,011; HR range = 3.66 – 9.25). The risk-AD was not different between visual (n = 208, 17 converters) and verbal aMCI (n = 449, 29 converters, HR = 1.70, 95%CI: 0.88, 3.27, p = 0.111). Combined aMCI (n = 103, 12 converters, HR = 2.34, 95%CI: 1.13, 4.84, p = 0.023) had a higher risk-AD than verbal aMCI. Age and MMSE scores were related to the risk-AD. The IPD meta-analyses replicated these results, though with slightly lower HR estimates (HR range = 3.68, 7.43) for aMCI vs. NC.

Although verbal aMCI was most common, a significant proportion of participants had visual-only or combined visual and verbal aMCI. Compared with verbal aMCI, the risk-AD was the same for visual aMCI and higher for combined aMCI. Our results highlight the importance of including both verbal and visual memory tests in neuropsychological assessments to more reliably identify aMCI.

Late-life depression has been associated with white matter changes in studies using the regions of interest approach.

To investigate the cross-sectional and longitudinal relationship between white matter integrity and depression in community-dwelling individuals using diffusion tensor imaging with tract-based spatial statistics.

The sample comprised 381 participants aged between 72 and 92 years who were assessed twice within 2 years. Depressive symptoms were measured with the Geriatric Depression Scale. Tract-based spatial statistics were applied to investigate white matter integrity in currently depressed v. non-depressed elderly people and in those with a history of depression v. no history of depression. The relationship between white matter integrity and development of depressive symptoms after 2 years were analysed with logistic regression.

Individuals with current depression had widespread white matter integrity reduction compared with non-depressed elderly people. Significant fractional anisotropy reductions were found in 45 brain areas with the most notable findings in the frontal lobe, association and projection fibres. A history of depression was not associated with reduced fractional anisotropy. White matter changes in the superior frontal gyrus, posterior thalamic radiation, superior longitudinal fasciculus and in the body of corpus callosum predicted depression at follow-up.

Reduced white matter integrity is associated with late-life depression and predicts future depressive symptoms whereas a history of depression is not related to white matter changes. Disruption to white matter integrity may be a biomarker to predict late-life depression.

There have been limited data available on the prevalence of structural brain abnormalities in asymptomatic individuals and a growing interest in the various ethical issues related to reporting of such findings. This study evaluated the prevalence of incidental abnormalities on brain magnetic resonance imaging (MRI) in a random sample of 60- to 64-year-old community-dwelling individuals as well as successfully followed a referral pathway taking into account of the various ethical issues related to the referral process. The Personality and Total Health (PATH) Project was designed to study the risk and protection factors of normal ageing, dementia and other neuropsychiatric disorders.

MRI scans were performed in randomly selected 478 healthy, community-dwelling 60- to 64-year-old individuals. All scans were reported for abnormalities by a radiologist.

Abnormalities were detected in 22 (4.8%) subjects, comprising 10 tumours (pituitary adenoma 4, meningioma 3, suprasellar tumour 1, cavernous haemangioma 1, subarachnoid lipoma 1), 6 infarct-like lesions, 2 arachnoid cysts, 1 possible normal pressure hydrocephalus, and 1 each of unconfirmed aneurysm and mesial temporal sclerosis. Further evaluation led to novel intervention in one case of pituitary adenoma, and adjustment of drug treatment to modify risk factors in two cases with subclinical infarction.

While no case required immediate referral or urgent surgical intervention, the change in the outcome of treatment of some cases suggests that appropriate referral process should be in place when researchers study large number of subjects in the community using MRI of the brain.