To compare the trajectory of motor decline, as measured by gait speed and finger-tapping speed, between elderly people who developed mild cognitive impairment (MCI) and those who remained cognitively intact. We also sought to determine the approximate time at which the decline in motor function accelerated in persons who developed MCI.

Background Early detection of cognitive decline in the elderly has become of heightened importance in parallel with the recent advances in therapeutics. Computerized assessment may be uniquely suited to early detection of changes in cognition in the elderly. We present here a systematic review of the status of computer-based cognitive testing focusing on detection of cognitive decline in the aging population. Methods All studies purporting to assess or detect age-related changes in cognition or early dementia/mild cognitive impairment (MCI) by means of computerized testing were included. Each test battery was rated on availability of normative data, level of evidence for test validity and reliability, comprehensiveness, and usability. All published studies relevant to a particular computerized test were read by a minimum of two reviewers, who completed rating forms containing the above-mentioned criteria. Results Of the 18 test batteries identified from the initial search, eleven were appropriate to cognitive testing in the elderly and were subjected to systematic review. Of those 11, five were either developed specifically for application with the elderly or have been used extensively with that population. Even within the computerized testing genre, great variability existed in manner of administration, ranging from fully examiner administered to fully self-administered. All tests had at least minimal reliability and validity data, commonly reported in peer-reviewed articles. However, level of rigor of validity testing varied widely. Conclusion All test batteries exhibited some of the strengths of computerized cognitive testing: standardization of administration and stimulus presentation, accurate measures of response latencies, automated comparison in real-time with an individual’s prior performance as well as with age-related norms, and efficiencies of staffing and cost. Some, such as the MCIS, adapted complicated scoring algorithms to enhance the information gathered from already existing tests. Others, such as CogState, used unique interfaces and subtests. We found that while basic indices of psychometric properties were typically addressed, sufficient variability exists that currently available computerized test batteries must be judged on a case by case basis.

Models combining multiple risk factors should refine the prediction of questionable dementia and persistent cognitive impairment, harbingers of dementia. Individuals at risk for cognitive impairment may represent a high-risk group for intervention.

Background: White matter hyperintensity (WMH) change on brain MRI is observed with increased

Hippocampal and parahippocampal atrophy occurs at a similar rate regardless of diagnostic group. Those who develop dementia may have smaller hippocampi to begin with, but become symptomatic because of accelerated loss of temporal lobe volume. Temporal lobe volume loss may mark the beginning of the disease process within six years prior to dementia onset.

We determined the effects of distraction on gait in healthy elderly subjects and Alzheimer's disease (AD) patients. The effects of simultaneous performance of a verbal fluency task (effect of reciting male or female names) on the time and number of steps taken to walk 30 feet were compared using a repeated-measures design with between-group comparison between community-dwelling healthy old old (oOld; n = 20; mean age +/- SD, 86 +/- 4.4), healthy young old (yOld; n = 23; mean age +/- SD, 72 +/- 3.6), and probable AD subjects without parkinsonism (n = 15; mean age +/- SD, 74 +/- 13). AD patients slowed more than the yOld (p = 0.005) and the oOld (p = 0.002). The yOld and oOld did not differ from each other (p = 0.68). Mean (+/-SD) differences in time were as follows: yOld, -2.2 +/- 1.9; oOld, -1.6 +/- 2.0; AD, -7.1 +/- 9.2 seconds. The change in steps did not differ between groups. Walking speed of AD patients slowed more than that of elderly subjects during the dual task. This may contribute to the risk of falls in AD.

Eighty-five healthy elderly subjects were prospectively evaluated for 3 years to determine motor differences between those who remain cognitively intact and those who developed cognitive impairment during prospective follow-up. The 18 subjects who developed cognitive impairment had slower finger tapping and took longer to walk 30 feet before or at the time of cognitive impairment. Coordination was more impaired and steps, but not balance, deteriorated more rapidly, independent of other variables.

Objective: To examine the cross-sectional relationship between nutrient status and psychometric and imaging indices of brain health in dementia-free elders.Methods: Thirty plasma biomarkers of diet were assayed in the Oregon Brain Aging Study cohort (n ϭ 104). Principal component analysis constructed nutrient biomarker patterns (NBPs) and regression models assessed the relationship of these with cognitive and MRI outcomes.Results: Mean age was 87 Ϯ 10 years and 62% of subjects were female. Two NBPs associated with more favorable cognitive and MRI measures: one high in plasma vitamins B (B1, B2, B6, folate, and B12), C, D, and E, and another high in plasma marine -3 fatty acids. A third pattern characterized by high trans fat was associated with less favorable cognitive function and less total cerebral brain volume. Depression attenuated the relationship between the marine -3 pattern and white matter hyperintensity volume. Conclusion:Distinct nutrient biomarker patterns detected in plasma are interpretable and account for a significant degree of variance in both cognitive function and brain volume. Objective and multivariate approaches to the study of nutrition in brain health warrant further study. These findings should be confirmed in a separate population. Neurology The epidemiology of Alzheimer disease (AD) suggests a role for nutrition. [1][2][3][4][5][6][7] Despite studies in favor of a single or a few nutrients in the prevention of AD, the translation to formal clinical trials testing vitamin E, B vitamins, or docosahexaenoic acid have been disappointing. [8][9][10][11][12] Given the interactive nature of nutrient action and metabolism, it is not surprising that a single or few nutrient approaches for neurodegenerative disease are tenuous. [13][14][15] These results impart the rationale for novel methodologic approaches that appreciate the interactive features of nutrients and model their collective influence in the promotion of brain health.Food frequency questionnaires (FFQ) have traditionally been used to construct dietary patterns.16 FFQ is relatively inexpensive and fairly comprehensive, but this method is subject to faulty recall of dietary intake and does not account for variability in nutrient absorption, both of which are issues in the elderly. 17,18 We have recently reported a reliable blood test that assesses nutritional status in people at risk for dementia. 19 In the current study, we examine the relationship of nutrient biomarkers with cognitive function and MRI.To capture the effect of nutrients in combination, we construct nutrient biomarker patterns using principal component analysis (PCA). Cluster analysis, 20 index scores, 21 and reduced rankFrom the