BackgroundMild cognitive impairment (MCI) represents a critical window to intervene against dementia. Exercise training is a promising intervention strategy, but the efficiency (i.e., relationship of costs and consequences) of such types of training remains unknown. Thus, we estimated the incremental cost-effectiveness of resistance training or aerobic training compared with balance and tone exercises in terms of changes in executive cognitive function among senior women with probable MCI.MethodsEconomic evaluation conducted concurrently with a six-month three arm randomized controlled trial including eighty-six community dwelling women aged 70 to 80 years living in Vancouver, Canada. Participants received twice-weekly resistance training (n = 28), twice weekly aerobic training (n = 30) or twice-weekly balance and tone (control group) classes (n = 28) for 6 months. The primary outcome measure of the Exercise for Cognition and Everyday Living (EXCEL) study assessed executive cognitive function, a test of selective attention and conflict resolution (i.e., Stroop Test). We collected healthcare resource utilization costs over six months.ResultsBased on the bootstrapped estimates from our base case analysis, we found that both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes. Compared with the balance and tone group, the resistance-training group had significantly improved performance on the Stroop Test (p = 0.04).ConclusionsResistance training and aerobic training result in health care cost saving and are more effective than balance and tone classes after only 6 months of intervention. Resistance training is a promising strategy to alter the trajectory of cognitive decline in seniors with MCI.Trial RegistrationClinicalTrials.gov NCT00958867.

Cognitive impairment and impaired mobility are major public health concerns. There is growing recognition that impaired mobility is an early biomarker of cognitive impairment and dementia. The neural basis for this association is currently unclear. We propose disrupted functional connectivity as a potential mechanism. In this 12-month prospective exploratory study, we compared functional connectivity of four brain networks– the default mode network (DMN), fronto-executive network (FEN), fronto-parietal network (FPN), and the primary motor sensory network (SMN) – between community-dwelling older adults with ≥ two falls in the last 12 months and their non-falling counterparts (≤ one fall in the last 12 months). Functional connectivity was examined both at rest and during a simple motor tapping task. Compared with non-fallers, fallers showed more connectivity between the DMN and FPN during right finger tapping (p = 0.04), and significantly less functional connectivity between the SMN and FPN during rest (p≤0.05). Less connectivity between the SMN and FPN during rest was significantly associated with greater decline in both cognitive function and mobility over the12-month period (r = −0.32 and 0.33 respectively; p≤0.04). Thus, a recent history of multiple falls among older adults without a diagnosis of dementia may indicate sub-clinical changes in brain function and increased risk for subsequent decline.

Background Cardiovascular disease is the leading cause of mortality and disability worldwide. A noninvasive test that can detect underlying cardiovascular disease has the potential to identify patients at risk prior to the occurrence of adverse cardiovascular events. We sought to determine whether an easily observed imaging finding indicative of retinal ischemia, which we term ‘ retinal ischemic perivascular lesions’ (RIPLs), could serve as a biomarker for cardiovascular disease. Methods We reviewed optical coherence tomography (OCT) scans of individuals, with no underlying retinal pathology, obtained at UC San Diego Health from July 2014 to July 2019. We identified 84 patients with documented cardiovascular disease and 76 healthy controls. OCT scans were assessed for evidence of RIPLs. In addition, the 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator was used to risk-stratify the subjects into four different categories. Findings Patients with documented cardiovascular disease had higher number of RIPLs compared to healthy controls (2.8 vs 0.8, p < 0.001). After adjusting for age, sex, smoking history, systolic blood pressure and triglycerides, cholesterol and hemoglobin A1C levels, each RIPL was associated with an odds ratio of having cardiovascular disease of 1·60 (1.09–2>37). The number of RIPLs in individuals with intermediate and high 10-year ASCVD risk scores was higher than in those with low ASCVD risk scores (1.7 vs 0.64, p = 0.02 and 2.9 vs 0.64, p 0.002, respectively). Interpretation The presence of RIPLs, which are anatomical markers of prior retinal ischemic infarcts, is suggestive of coexisting cardiovascular disease. RIPLs detection, obtained from routine retinal scans, may thus provide an additional biomarker to identify patients at risk of developing adverse cardiovascular events. Funding None.

While mind-wandering is common, engaging in task-irrelevant thoughts can have negative functional consequences. We examined whether mind-wandering frequency may be related to falls -a major health care problem. Seniors completed a sustained attention task and self-reported their current attentional states. Monthly falls reports were collected over 12 months. Falls were associated with an increased frequency of mind-wandering. Additionally, poorer performance on the sustained attention task was associated with more falls over 12 months. Given that fallers are known to have impaired executive cognitive functioning, our results are consistent with the current theory that poor attentional control may contribute to the occurrence of mind-wandering. KeywordsAging; Mind-wandering; FallsThe natural tendency for our thoughts to drift off task -known as mind-wandering -has become an increasingly popular topic of research in neuroscience (e.g., Smallwood, in press). Although it is a ubiquitous phenomenon, with up to 50% of our waking time spent creating and maintaining an inner dialogue secondary to current behavioural goals (Smallwood, in press), variations in mind-wandering are associated with neurocognitive pathologies (e.g., Shaw & Giambra, 1993; Smallwood, O'Connor, Sudbery, & Obonsawin, 2007). Furthermore, mind-wandering frequency is modulated as a function of age -with older adults spending significantly less time engaging in task-unrelated thoughts (e.g., Giambra, 1989;Jackson & Balota, 2012). Given what we now understand about how mindwandering impacts neurocognitive functioning, the aim of our study was to establish whether alterations in mind-wandering may be also contributing to one of the primary health risks of aging --namely, falling.Corresponding Author: Lindsay S. Nagamatsu, 2136 West Mall, Vancouver, BC, Canada, V6T 1Z4, Tel: 604-822-3120, Fax: 604-822-6923, lindsay@psych.ubc CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptEvidence that mind-wandering may be a heretofore unrecognized risk factor of falling in older adults stems from three core findings regarding the transient effects of mind-wandering on neurocognitive function. First, mind-wandering directly alters how we perceive, analyze, and respond to the external environment. This statement is substantiated by neuroimaging evidence using event-related potentials (ERPs). In a study examining the effects of mindwandering on sensory gain control, Kam and colleagues (2011) found that during off-task periods, sensory processing was attenuated. Specifically, sensory-evoked responses to stimuli presented in both visual and auditory modalities were reduced during periods of mind-wandering, relative to "on-task" states. In addition, Smallwood et al. (2008) reported decreased cognitive processing of visual stimuli during mind-wandering. Together, these studies converge on the idea that there is a systematic reduction in the depth of stimulus processing at both the sensory/perceptual and cognitive levels. Likewise, behavioral co...

IntroductionCurrent research suggests that the neuropathology of dementia—including brain changes leading to memory impairment and cognitive decline—is evident years before the onset of this disease. Older adults with cognitive decline have reduced functional independence and quality of life, and are at greater risk for developing dementia. Therefore, identifying biomarkers that can be easily assessed within the clinical setting and predict cognitive decline is important. Early recognition of cognitive decline could promote timely implementation of preventive strategies.MethodsWe included 89 community-dwelling adults aged 70 years and older in our study, and collected 32 measures of physical function, health status and cognitive function at baseline. We utilized an L1–L2 regularized regression model (elastic net) to identify which of the 32 baseline measures were strongly predictive of cognitive function after one year. We built three linear regression models: 1) based on baseline cognitive function, 2) based on variables consistently selected in every cross-validation loop, and 3) a full model based on all the 32 variables. Each of these models was carefully tested with nested cross-validation.ResultsOur model with the six variables consistently selected in every cross-validation loop had a mean squared prediction error of 7.47. This number was smaller than that of the full model (115.33) and the model with baseline cognitive function (7.98). Our model explained 47% of the variance in cognitive function after one year.DiscussionWe built a parsimonious model based on a selected set of six physical function and health status measures strongly predictive of cognitive function after one year. In addition to reducing the complexity of the model without changing the model significantly, our model with the top variables improved the mean prediction error and R-squared. These six physical function and health status measures can be easily implemented in a clinical setting.

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A prospective study of 135 controls, 286 non-insulin-dependent diabetic patients, and 31 subjects with an elevated fasting plasma glucose was performed to assess the prevalence of high-grade carotid artery stenosis. The carotid artery evaluation was performed using an ultrasonic duplex scanner. When those patients with an elevated fasting plasma glucose and non-insulin-dependent diabetes were considered together, the prevalence was 8.2% as compared with 0.7% for the controls (P = 0.0007). Those risk factors found to be significantly related to the higher prevalence of carotid disease in the combined groups of patients included age, ratio of systolic blood pressure to diastolic blood pressure, plasma cholesterol, and cigarette smoking. These findings may be an explanation for the greater incidence of stroke in patients with diabetes mellitus.

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