Early detection of cognitive impairment by natural language among outpatients and community dwellers

Abstract Background: Although early detection of cognitive decline has a significant relation to improving the quality of life of dementia patients, this early detection has been difficult due to requires of neuropsychological tests which people generally take when they notice their cognitive impairment. The timing of patients’ notice was reported to be worse cognitive decline already, thus, we aimed to determine if cognitive impairment from a short interview by using Natural Language Processing approach. Methods: The present study used cross-sectional analysis among elderly outpatients and community-dwelling elderly from Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. Cognitive decline was assessed by Telephone Interview of Cognitive Status for Japanese (TICS-J) and modeled as a binary outcome (cut-off <33 points). Natural language data was collected by semistructured interviews about health conditions and cognitive orientation in space, time, and place. We used an open-source text segmentation library to parse natural language text into bag-of-words and term frequency-inverse document frequency (TF-IDF) representations. Results: There were 38 (19.9%) outpatients and 153 (80.1%) community dwellers, and 60 (31.4%) participants were defined as cognitive impairment. The maximized TF-IDF score was 0.49 in cognitive orientation in time questions. In this question, participants without cognitive impairment could not calculate the score. There were no significant differences in TF-IDF scores between participants with and without cognitive impairment. Conclusions: Elderly without cognitive impairment might not have an episode about cognitive orientation in time, and this may help for early detection of cognitive impairment

between device-based or technologically measured LPA and cognition among healthy older adults, identify trends in the literature, and pinpoint future areas of research.Six electronic databases were searched between January and August 2020.Eighteen published studies met the inclusion criteria: one acute exercise study, two randomized control trials (RCTs), twelve cross-sectional studies, and three longitudinal studies.Overall, n=9 studies (n=1 RCT, n=7 cross-sectional, and n=1 longitudinal) reported a significant, positive relationship between LPA and one or more cognitive outcomes including memory, attention, executive function and global cognition (MMSE/MOCA).These heterogeneous findings can largely be attributed to the diverse study designs, inconsistent definitions of LPA and numerous assessments used to test the cognitive domains.Collectively, these findings suggest LPA may be a potential lifestyle intervention to improve cognition among healthy older adults.However, the inconsistent approaches used among these studies suggests a more concerted, unified scientific approach and rigorous methodology are needed to further understand the LPA-cognition relationship.

DAILY STRESSORS DEGRADE PERCEIVED COGNITIVE ABILITIES IN HEALTHCARE PROFESSIONALS
Rhitik Joshi Taylor Drury, and Soomi Lee, University of South Florida, Tampa, Florida, United States Stress negatively impacts cognitive functioning.Less is known about whether daily stress is associated with perceived cognitive abilities in healthcare workers who require mental sharpness and attention to provide high-quality patient care.We examined daily associations between stressors and perceived cognitive abilities in nurses and whether the associations differed between workday vs. non-workday.Using 14-day smartphone-based ecological momentary assessment, 61 inpatient nurses at a U.S. cancer hospital reported the frequency and severity of daily stressors (e.g., arguments, accidents).Each day, participants subjectively evaluated their mental focus, memory, and attention.Multilevel modeling examined the within-and betweenperson associations of daily stressors with cognitive abilities adjusting for sociodemographics, work shift, and workday.Nurses reported experiencing stressors once every other day.More stressors were associated with poorer cognitive abilities.At the between-person level, those with more frequent or severe stressors reported poorer mental focus (B=-22.4, p<.01; B=-0.35, p<.01, respectively), worse memory (B=-24.35,p<.01; B=-0.37, p<.01, respectively), and lower attention (B=-25.47, p<.05; B=-0.40, p<.01, respectively).At the within-person level, on days with more frequent or severe stressors, participants reported poorer mental focus (B=-2.05,p<.05; B=-.03, p<.05, respectively) and lower attention (B=-1.95, p<.05; B=-.04, p<.01, respectively).Some of the between-person associations were more apparent on workdays; those with more stressors reported poorer mental focus and lower attention on workdays than on non-workdays.Nurses' perceived cognitive abilities at work vary by daily stressors.Disconnecting the linkage between stressors and perceived cognition may help improve work performance in nurses who may encounter frequent stressors at work.

DEPRESSION COMPLICATES THE RELATIONSHIP BETWEEN SUBJECTIVE MEMORY COMPLAINTS AND MEMORY IN OLDER ADULTS Kristi Wisniewski, Eun Young Choi, Christopher Beam, and Elizabeth Zelinski, University of Southern California, Los Angeles, California, United States
Subjective memory complaints (SMCs) are self-reported changes in memory performance and may indicate prospective dementia.Cognitive function and depressive symptoms are negatively correlated; however, depression's influence on the relationship between SMCs and cognition is unclear.Data were drawn from the Long Beach Longitudinal Study, a three-panel study of community-dwelling older adults from southern California who were assessed every three years.The present study included participants ages 54-89 who completed a 20-item immediate recall task at each wave and the Memory Functioning Questionnaire Frequency of Forgetting (FOF) subscale, a measure of SMC, on 2+ occasions from 1994-2014 (n=788; Mage=73 years at baseline, Meduc=15 years).Higher FOF scores indicated fewer memory complaints.Depression was measured as the average Geriatric Depression Scale score across occasions.Bivariate linear latent growth models over age adjusted for age, sex, and education (covariates associated with cognition).The SMC and recall slopes were positively correlated (parameter estimate=1.40;p<0.05).After controlling for depression, the slope-slope correlation was not significant (parameter esti-mate=0.83;p=0.127).However, after removing cognitivelyrelevant items from the Geriatric Depression Scale then adjusting for depression, the SMC slope-recall slope correlation trended toward significance (parameter estimate=0.99;p=0.070) suggesting that the cognitively relevant items were confounding the slope-slope correlation.These findings indicate that depression impacts the relationship between SMC and objective memory over age; therefore, depression may limit the clinical utility of SMCs as a cognitive screening measure.Future studies should assess depression using scales devoid of cognitive items to differentiate its influence on subjective and objective memory performance.

EARLY DETECTION OF COGNITIVE IMPAIRMENT BY NATURAL LANGUAGE AMONG OUTPATIENTS AND COMMUNITY DWELLERS
Eri Kiyoshige, 1 Mai Kabayama, 1 Yasushi Takeya, 1 Yoichi Takami, 1 Shuko Takeda, 1 Yasuyuki Gondo, 2 Hiromi Rakugi, 1 and Kei Kamide, 1 1.Osaka University Graduate School of Medicine, Suita, Osaka, Japan, 2. Osaka University, Suita, Osaka, Japan Background: Although early detection of cognitive decline has a significant relation to improving the quality of life of dementia patients, this early detection has been difficult due to requires of neuropsychological tests which people generally take when they notice their cognitive impairment.The timing of patients' notice was reported to be worse cognitive decline already, thus, we aimed to determine if cognitive impairment from a short interview by using Natural Language Processing approach.Methods: The present study used cross-sectional analysis among elderly outpatients and community-dwelling elderly from Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study.Cognitive decline was assessed by Telephone Interview of Cognitive Status for Japanese (TICS-J) and modeled as a binary outcome (cut-off <33 points).Natural language data was collected by semistructured interviews about health conditions and cognitive orientation in space, time, and place.We used an open-source text segmentation library to parse natural language text into bag-of-words and term frequency-inverse document frequency (TF-IDF) representations.Results: There were 38 (19.9%) outpatients and 153 (80.1%) community dwellers, and 60 (31.4%) participants were defined as cognitive impairment.The maximized TF-IDF score was 0.49 in cognitive orientation in time questions.In this question, participants without cognitive impairment could not calculate the score.There were no significant differences in TF-IDF scores between participants with and without cognitive impairment.Conclusions: Elderly without cognitive impairment might not have an episode about cognitive orientation in time, and this may help for early detection of cognitive impairment

EXAMINING COGNITIVE FUNCTION AND SELF-ESTEEM OF MIDDLE AGED AND OLDER ADULTS Daniela Catarino, and Colin Adams, University of Colorado Colorado Springs, Colorado Springs, Colorado, United States
Research shows that self-esteem and well-being have strong correlations to cognitive abilities.People with high self-esteem, compared to those with a low self-esteem, tend to evaluate themselves as more favorable after both high and low performance.However, less research has been conducted on self confidence among the older population and how this can potentially negatively or positively influence the aging process.The purpose of the study was to see if there is an effect of age on cognitive function.The second aim was to see if there is an effect of cognitive function on self-esteem.The first hypothesis was that middle-aged adults would exhibit higher cognitive functioning than older adults.The second hypothesis was that those with lower cognition would exhibit lower self-esteem.A secondary analysis of data from the National Social Life, Health, and Aging Project (NSHAP) was performed on 60 randomly selected individuals from a total of 3,005 participants.A 2 x 2 chi square test revealed that the younger group (63%) compared to the older group (37%) were significantly more likely to exhibit perfect cognitive functions (versus not), χ² (1) = 4.27, p < .05.A One-Way ANOVA revealed no significant main effect of cognitive function on self-esteem, F(1, 58) = 2.97, p = .09.This suggests that cognitive functions are more likely to decline as one ages but cognitive function alone might not strongly influence self-esteem.Future research should aim to understand under what conditions confidence influences cognitive function to promote healthy interventions for successful aging.

NEUROPSYCHIATRIC SYMPTOMS BY COGNITIVE STATUS FOR MEXICAN-AMERICANS AGED 85 AND OLDER Lan Vu, University of Texas Medical Branch at Galveston, Galveston, Texas, United States
Older adults with dementia and cognitive impairment often experience neuropsychiatric symptoms (NPS).Few studies have investigated the presence of NPS among older Mexican-American adults.Our objective was to describe the NPS of Mexican-Americans 85 years and older according to cognitive status.Data came from wave 9 (conducted in 2016) of the Hispanic Established Populations for the Epidemiological Study of the Elderly.The final sample consisted of 381 care recipients aged 85 years and older, along with their caregivers.The 12-item Neuropsychiatric Inventory (NPI-12) was administered to measure behavioral and psychiatric symptoms among the care recipients.Cognitive impairment was defined as a score of 18 or less on the Mini Mental Status Exam (MMSE).Care recipients with a diagnosis of dementia as reported by the caregiver were also classified as cognitively impaired.Overall, 259 (68.0%) participants had one or more NPS.Logistic regression models were used to estimate the average marginal effect (range = -1 to 1) of cognitive impairment on NPS, controlling for care-recipient characteristics.Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment (p<0.01).The predicted probability of having one or more NPI symptoms was 0.25 percentage points (95% CI=0.14-0.35)higher for participants with cognitive impairment than those without.NPS are present in the majority of older Mexican American adults, particularly in those with cognitive impairment.Future research could also investigate sociodemographic correlates of NPS.

OLDER AND YOUNGER ADULTS REAPPRAISE NEGATIVE LIFE EVENTS IN DIFFERENT WAYS Lucas Hamilton, and Eric Allard, Cleveland State University, Cleveland, Ohio, United States
Past reappraisal studies have been equivocal regarding age and reappraisal efficacy potentially due to the use of laboratory-generated stimuli.We examined reappraisal in a more self-relevant context: negative autobiographical events.49 younger adults (YA) and 47 older adults (OA) generated 50 negative memories and provided negativity, positivity, and vividness ratings.One to two weeks later, participants underwent the reappraisal task during which physiological data were collected.Participants implemented one of three instructions for 30 seconds: remember naturally, increase negative reactions, or decrease negative reactions via a "positivizing" tactic.Each instruction was provided for 10 unique memories with negativity, positivity, and vividness ratings collected after each trial. 2 (Age; YA, OA) × 3 (Instruction; Remember, Increase, Decrease) mixed ANOVAs uncovered no differences in negativity or vividness ratings before reappraisal.However, OAs rated all memories more positively than YAs.This age difference persisted after reappraisal; however, OAs rated all memories more negatively and vividly than YAs, although both decreased compared to pre-reappraisal levels.Cardiorespiratory data were tested via 2 × 3 mixed ANOVAs, uncovering only a main effect of age on average heart rate.A multilevel model revealed significant variability in the time-course of pupillary responses.2 × 3 mixed ANOVAs illustrated that reappraisal brought about faster and more frequent spikes in pupil diameter, particularly for OAs.We conclude that OAs and YAs may achieve reappraisal in different ways.Contrary to strict hedonic orientations, OAs simultaneously maintain higher negativity and positivity than YAs challenging existing propositions regarding age-related prioritization of hedonic goals.