BackgroundSarcopenia and obesity both negatively impact health including cognitive function. Their coexistence, however, can pose an even higher threat likely surpassing their individual effects. We assessed the relationship of sarcopenic obesity with performance on global- and subdomain-specific tests of cognition.Patients and methodsThe study was a cross-sectional analysis of data from a series of community-based aging and memory studies. The sample consisted of a total of 353 participants with an average age of 69 years with a clinic visit and valid cognitive (eg, Montreal Cognitive Assessment, animal naming), functional (eg, grip strength, chair stands), and body composition (eg, muscle mass, body mass index, percent body fat) measurements.ResultsSarcopenic obesity was associated with the lowest performance on global cognition (Est.Definition1=−2.85±1.38, p=0.039), followed by sarcopenia (Est.Definition1=−1.88±0.79, p=0.017) and obesity (Est.Definition1=−1.10±0.81, p=0.175) adjusted for sociodemographic factors. The latter, however, did not differ significantly from the comparison group consisting of older adults with neither sarcopenia nor obesity. Subdomain-specific analyses revealed executive function (Est.Definition1=−1.22±0.46 for sarcopenic obesity; Est.Definition1=−0.76±0.26 for sarcopenia; Est.Definition1=−0.52±0.27 for obesity all at p<0.05) and orientation (Est.Definition1=0.59±0.26 for sarcopenic obesity; Est.Definition1=−0.36±0.15 for sarcopenia; Est.Definition1=−0.29±0.15 all but obesity significant at p<0.05) as the individual cognitive skills likely to be impacted. Potential age-specific and depression effects are discussed.ConclusionSarcopenia alone and in combination with sarcopenic obesity can be used in clinical practice as indicators of probable cognitive impairment. At-risk older adults may benefit from programs addressing loss of cognitive function by maintaining/improving strength and preventing obesity.

Introduction:The National Institute on Aging Alzheimer's Disease Research Center program added the Lewy body dementia module (LBD-MOD) to the Uniform Data Set to facilitate LBD characterization and distinguish dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). We tested the performance of the LBD-MOD.

Introduction Alzheimer's disease and related dementias (ADRD) and mild cognitive impairment (MCI) are often under-recognized in the community. MCI/ADRD screening could offer benefits such as early treatment, research participation, lifestyle modification, and advanced care planning. To date, there are no clear guidelines regarding the benefits vs. harms of dementia screening or whether a dementia screening program could be successful. Methods A community-based study was conducted to evaluate an MCI/ADRD screening program and determine what older adults would do with the information. Measures of cognition, physical health, functionality, and mood were collected. Participants met with a health professional, were given screening results with recommendations, and then contacted 60 days later to determine what was done with the results. Logistic regression models were used to build predictive models. Results Participants (n = 288) had a mean age of 71.5±8.3y, mean education of 13.3±4.8y, and were 70% female, 67% White, 26% African American, and 48% Hispanic. After 60 days, 75% of participants were re-contacted; 54% shared results with family, 33% shared results with health care providers (HCPs), and 52% initiated behavioral change. Among participants sharing results with HCPs, 51% reported HCPs did not follow-up on the results, and 18% that HCPs did not show any interest in the screening visit or its results. Predictors of sharing results with HCPs were elevated hemoglobin A1C (OR = 1.85;95%CI:1.19-2.88), uncontrolled hypertension (OR = 2.73;95%CI:1.09-6.83), and mobility issues (OR = 2.43;95%CI: 1.93-5.54). Participant behavioral changes included lifestyle modification (58%), social engagement (10%), cognitive stimulation (5%), and advanced care planning (4%). The most significant predictors of sharing with family were better overall mental health (OR = 0.19; 95%CI: 0.06-0.59) and better physical function (OR = 0.38; 95%CI: 0.17-0.81).

Introduction Alzheimer’s disease and related dementias (ADRD) affect over 5.7 million Americans and over 35 million people worldwide. Detection of mild cognitive impairment (MCI) and early ADRD is a challenge to clinicians and researchers. Brief assessment tools frequently emphasize memory impairment, however executive dysfunction may be one of the earliest signs of impairment. To address the need for a brief, easy-to-score, open-access test of executive function for use in clinical practice and research, we created the Number Symbol Coding Task (NSCT). Methods This study analyzed 320 consecutive patient-caregiver dyads who underwent a comprehensive evaluation including the Clinical Dementia Rating (CDR), patient and caregiver versions of the Quick Dementia Rating System (QDRS), caregiver ratings of behavior and function, and neuropsychological testing, with a subset undergoing volumetric magnetic resonance imaging (MRI). Estimates of cognitive reserve were calculated using education, combined indices of education and occupation, and verbal IQ. Psychometric properties of the NSCT including data quality, data distribution, floor and ceiling effects, construct and known-groups validity, discriminability, and clinical profiles were determined. Results The patients had a mean age of 75.3±9.2 years (range 38-98y) with a mean education of 15.7±2.8 years (range 6-26y) of education. The patients had a mean CDR-SB of 4.8±4.7 (range 0–18) and a mean MoCA score of 18.6±7.1 (range 1–30). The mean NSCT score was 30.1±13.8 and followed a normal distribution. All healthy controls and MCI cases were able to complete the NSCT. The NSCT showed moderate-to-strong correlations with clinical and neuropsychological measures with the strongest association (all p’s < .001) for measures with executive components (e.g., Judgement and Problem Solving box of the CDR, Decision Making and Problem Solving domain of the QDRS, Trailmaking B, and Cognigram Attention and Executive Composite Scores). Women slightly outperformed men, and individuals with lower educational attainment and lower education-occupation indices had lower NSCT scores. Decreasing NSCT scores corresponded to older age, worse cognitive scores, higher CDR sum of boxes scores, worse caregiver ratings of function and behavior, worse patient and informant QDRS ratings, and smaller hippocampal volumes and hippocampal occupancy scores. The NSCT provided excellent discrimination (AUC: .866; 95% CI: .82-.91) with a cut-off score of 36 providing the best combination of sensitivity (0.880) and specificity (0.759). Combining the NSCT with patient QDRS and caregiver QDRS ratings improved discrimination (AUC: .908; 95% CI: .87-.94). Discussion The NSCT is a brief, 90-second executive task that incorporates attention, planning and set-switching that can be completed by individuals into the moderate-to-severe stages of dementia. The NSCT may be a useful tool for dementia screening, case-ascertainment in epidemiological or community-based ADRD studies, and in busy primary care settings where time is limited. Combining the NSCT with a brief structured interview tool such as the QDRS may provide excellent power to detect cognitive impairment. The NSCT performed well in comparison to standardized scales of a comprehensive cognitive neurology evaluation across a wide array of sociodemographic variables in a brief fashion that could facilitate its use in clinical care and research.

Introduction Dementia caregiving is often examined as a monolithic experience describing the challenges caregivers face, exploring one construct at a time, with little research on the positive experiences of caregiving. To address this, we developed the Positive and Negative Appraisals of Caregiving (PANAC) scale. Methods PANAC was validated in 253 patient‐caregiver dyads. Factor analyses revealed a two‐factor solution: Positive Appraisals (PAs) and Negative Appraisals (NAs). Psychometric properties were compared with patient and caregiver characteristics and outcomes, disease stage, and etiology. Results Internal consistency was good with Cronbach's alpha: 0.82 NA and 0.80 PA ( P < 0.001). NA correlated with patient and caregiver characteristics, whereas PA correlated only with caregiver characteristics. The PA/NA ratio could be used to capture change due to an intervention. Discussion The PANAC scale is a useful measure of the overall caregiver experience accounting for negative and positive experiences and may be used to tailor support to individual caregivers.