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Article ; Online: Reply - Letter to the editor: Longitudinal trajectories of dietary quality and cognitive performance in older adults: Results from a 6-year cohort study.

Chen, Ling-Wei / Chen, Yen-Ching

Clinical nutrition (Edinburgh, Scotland)

2023 Volume 42, Issue 8, Page(s) 1535–1536

MeSH term(s)	Humans ; Aged ; Cohort Studies ; Diet ; Longitudinal Studies ; Cognition
Language	English
Publishing date	2023-06-07
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2023.06.006
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Article ; Online: Association Between Olfactory Dysfunction and Cognitive Impairment in Dementia-Free Older Adults: A Prospective Cohort Study in Taiwan.

Wang, Mu-Cyun / Chiou, Jeng-Min / Chen, Yen-Ching / Chen, Jen-Hau

Journal of Alzheimer's disease : JAD

2023 Volume 96, Issue 4, Page(s) 1477–1488

Abstract: Background: Previous studies assessing olfactory function and cognition have mostly been cross-sectional, and few have investigated the Asian geriatric population.: Objective: To examine the relationships of olfaction with global or domain-specific ... ...

Abstract	Background: Previous studies assessing olfactory function and cognition have mostly been cross-sectional, and few have investigated the Asian geriatric population. Objective: To examine the relationships of olfaction with global or domain-specific cognitive function in Taiwanese community-dwelling older adults. Methods: This cohort study (2015-2019) is part of the Taiwan Initiative for Geriatric Epidemiological Research. The Taiwanese version of the Montreal Cognitive Assessment (MoCA-T) and a battery of neuropsychological tests were assessed at baseline and at a two-year follow-up. The cross-culture modified Sniffin' Sticks Identification Test (SSIT) was utilized to measure olfactory function. Generalized linear mixed models were used to examine the association of olfaction with cognitive performance over two years. Results: Data were collected from 376 participants (55.1% women), with a mean age of 75.6 years. A one-point decrease in the SSIT score (worsening of olfaction) was associated with worse global cognition (MoCA-T: βˆ= -0.13), memory (βˆ= -0.08 to -0.06), and verbal fluency (βˆ= -0.07). Compared with an SSIT score ≥ 11 (normosmia), an SSIT score < 8 (anosmia) was associated with worse global cognition (MoCA-T: βˆ= -0.99), memory (βˆ= -0.48 to -0.42), executive function (Trail Making Test A: βˆ= -0.36), attention (digit span backward: βˆ= -0.34), and verbal fluency (βˆ= -0.45). After stratified analyses, the associations remained in older adults ≥ 75 years, males, and non-carriers of apolipoprotein E ɛ4 in terms of global cognition, memory, and verbal fluency. Conclusions: Odor identification deficits were associated with poor global or domain-specific cognitive function in a four-year cohort of community-dwelling older adults. Cognitive assessments should be conducted in dementia-free elderly individuals with impaired odor identification.
MeSH term(s)	Male ; Humans ; Female ; Aged ; Smell ; Cohort Studies ; Prospective Studies ; Cross-Sectional Studies ; Taiwan/epidemiology ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/complications ; Cognition ; Neuropsychological Tests ; Apolipoprotein E4 ; Olfaction Disorders/epidemiology ; Olfaction Disorders/complications
Chemical Substances	Apolipoprotein E4
Language	English
Publishing date	2023-11-18
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-230319
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Article ; Online: Handgrip strength asymmetry and cognitive impairment risk: Insights from a seven-year prospective cohort study.

Peng, Tao-Chun / Chiou, Jeng-Min / Chen, Yen-Ching / Chen, Jen-Hau

The journal of nutrition, health & aging

2023 Volume 28, Issue 1, Page(s) 100004

Abstract: Objectives: This study aimed to explore the links of handgrip strength and asymmetry with cognitive impairment.: Design: This was a seven-year prospective cohort study.: Setting and participants: We used data from wave 3 (2015-2017) to wave 5 ( ... ...

Abstract	Objectives: This study aimed to explore the links of handgrip strength and asymmetry with cognitive impairment. Design: This was a seven-year prospective cohort study. Setting and participants: We used data from wave 3 (2015-2017) to wave 5 (2019-2022) from the ongoing Taiwan Initiative of Geriatric Epidemiological Research (TIGER), with wave 3 as the baseline (n = 446). The study included community-dwelling participants aged 65 years or older. Measurements: Handgrip strength was measured, and abnormalities were determined based on handgrip strength weakness and asymmetry. Handgrip strength asymmetry was categorized into three groups at baseline based on the handgrip strength ratio (left handgrip strength/right handgrip strength). Cognitive tests evaluating global and specific cognitive domains were conducted at baseline and two biennial follow-ups. Generalized linear mixed models were utilized to assess the associations of abnormal handgrip strength with global cognition and multiple cognitive domain progression over time. Results: This study included 392 dementia-free participants, with an average age of 75.8 years and 179 (45.7%) males. Mild handgrip strength asymmetry was present in 88 participants (22.4%), while 53 (13.5%) exhibited moderate asymmetry. In men, the coexistence of low handgrip strength and handgrip strength asymmetry was linked to cognitive impairment over time. These associations were observed in global cognition (β^ = -1.76, 95% CI: -2.79 to -0.74), memory (immediate free recall: β^ = -0.67, 95% CI: -1.17 to -0.17), executive function (Trail Making Test-A: β^ = -0.54, 95% CI: -0.94 to -0.13), and attention (Digit span-forward: β^ = -1.00, 95% CI: -1.46 to -0.54). Conclusions: This study found that individuals with reduced handgrip strength and handgrip strength asymmetry had an increased risk of cognitive impairment across various domains. Moreover, this association appears to be more pronounced among men than women. Incorporating these simple assessments into regular clinical practice improves the allocation of limited screening resources and timely clinical interventions in older adults.
MeSH term(s)	Male ; Humans ; Female ; Aged ; Hand Strength ; Prospective Studies ; Cognitive Dysfunction ; Cognition ; Executive Function
Language	English
Publishing date	2023-12-06
Publishing country	France
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2081921-3
ISSN	1760-4788 ; 1279-7707
ISSN (online)	1760-4788
ISSN	1279-7707
DOI	10.1016/j.jnha.2023.100004
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Article ; Online: Caregiver Burden and Dementia: A Systematic Review of Self-Report Instruments.

Tu, Jennifer Young / Jin, Grace / Chen, Jen-Hau / Chen, Yen-Ching

Journal of Alzheimer's disease : JAD

2022 Volume 86, Issue 4, Page(s) 1527–1543

Abstract: Background: As the demand for dementia care grows rapidly worldwide, heavy "caregiver burden" has been associated with stress and depression. Even so, standard metrics for interdisciplinary research of caregiver burden are limited.: Objective: The ... ...

Abstract	Background: As the demand for dementia care grows rapidly worldwide, heavy "caregiver burden" has been associated with stress and depression. Even so, standard metrics for interdisciplinary research of caregiver burden are limited. Objective: The objective of the present review is to recommend valid, reliable, and comprehensive self-report instruments of caregiver burden. Methods: A systematic review was performed using four databases, searched in April 2021. Articles that established or evaluated self-report instruments for dementia caregiver burden were included, while studies that involved non-dementia caregivers or did not clearly define caregiver burden were excluded. Established guidelines for reliability and agreement studies were used to assess quality and risk of bias. Assessments of self-report instruments were made based on reliability, validity, feasibility, and quality of psychometric evaluations, and comparative evaluations were presented in visual form using radar graphs. Results: Search terms yielded 1,720 articles, and 40 were included in the systematic review after excluding those of low quality. Based on the results of these studies, we recommend the Zarit Burden Interview, Screen for Caregiver Burden, Caregiver Burden Interview, and Burden Scale for Family Caregivers, due to their validity, reliability, and inclusion of multiple subjective and objective dimensions of burden. Conclusion: Targeting specific sources of caregiver burden can help prevent negative outcomes for both dementia patients and caregivers. Future studies should apply self-report instruments to measure and address caregiver burden longitudinally.
MeSH term(s)	Caregiver Burden ; Cost of Illness ; Dementia/therapy ; Humans ; Reproducibility of Results ; Self Report
Language	English
Publishing date	2022-03-07
Publishing country	Netherlands
Document type	Systematic Review ; Journal Article
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-215082
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Article ; Online: Multimorbid Patterns and Cognitive Performance in the Presence of Informative Dropout Among Community-Dwelling Taiwanese Older Adults.

Hsieh, Pei-Iun / Chen, Yen-Ching / Chen, Ta-Fu / Chiou, Jeng-Min / Chen, Jen-Hau

Innovation in aging

2023 Volume 7, Issue 2, Page(s) igad012

Abstract: Background and objectives: Longitudinal studies among older adults often feature elevated dropout rates and multiple chronic conditions. How Taiwanese multimorbid patterns relate to different cognitive domains remains unclear. This study aims to ... ...

Abstract	Background and objectives: Longitudinal studies among older adults often feature elevated dropout rates and multiple chronic conditions. How Taiwanese multimorbid patterns relate to different cognitive domains remains unclear. This study aims to identify sex-specific multimorbid patterns and associate them with cognitive performance while modeling the risk for dropout. Research design and methods: A prospective cohort study (2011-19) in Taiwan recruited 449 Taiwanese older adults without dementia. Global and domain-specific cognition were assessed biennially. We used exploratory factor analysis to identify baseline sex-specific multimorbid patterns of 19 self-reported chronic conditions. We utilized a joint model incorporating longitudinal and time-to-dropout data to examine the association between multimorbid patterns and cognitive performance accounting for the informative dropout via the shared random effect. Results: At the end of the study, 324 participants (72.1%) remained in the cohort, with an average annual attrition rate of 5.5%. We found that advanced age, low levels of physical activities, and poor cognition at baseline were associated with increased dropout risks. Besides, 6 multimorbid patterns were identified, labeled Discussion and implications: Sex-specific multimorbid patterns identified in the Taiwanese older population showed differences (notably
Language	English
Publishing date	2023-02-08
Publishing country	England
Document type	Journal Article
ISSN	2399-5300
ISSN (online)	2399-5300
DOI	10.1093/geroni/igad012
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Article: Association of subclinical depressive symptoms and sleep with cognition in the community-dwelling older adults.

Hsieh, Ching-Jow / Chiou, Jeng-Min / Chen, Ta-Fu / Chen, Yen-Ching / Chen, Jen-Hau

Journal of the Formosan Medical Association = Taiwan yi zhi

2023 Volume 122, Issue 8, Page(s) 790–799

Abstract: Background: /Purpose: This study aimed to explore the association of subclinical depressive symptoms and sleep with cognition in community-dwelling Taiwanese older adults.: Methods: This four-year prospective cohort study (2015-2019) included 379 ... ...

Abstract	Background: /Purpose: This study aimed to explore the association of subclinical depressive symptoms and sleep with cognition in community-dwelling Taiwanese older adults. Methods: This four-year prospective cohort study (2015-2019) included 379 participants aged 65 years or older from the annual senior health checkup program at National Taiwan University Hospital who were followed up two years later. Global and domain cognitive functions were assessed using validated neuropsychological tests. Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression (CES-D) Scale. Sleep quality was evaluated using the Pittsburg Sleep Quality Index (PSQI). Excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Generalized linear mixed models were used to explore the associations of subclinical depressive symptoms and sleep variables with cognition, adjusting for important covariates. Stratification analyses were performed using the sleep variables. Results: Over time, depressive symptoms were associated with poor performance of memory (βˆ = 0.24, P = 0.04) and executive function (βˆ = -0.24, P = 0.03). Poor sleep quality (elevated PSQI score) was associated with poor memory performance (βˆ = -0.04 to -0.03, P < 0.05). Excessive daytime sleepiness (elevated ESS score) was associated with poor performance of memory (βˆ = -0.02, P < 0.05) and executive function (βˆ = -0.02, P = 0.001). At baseline, better sleep quality and no excessive daytime sleepiness were associated with better memory performance over time. Conclusion: Subclinical depressive symptoms, worse sleep quality, and excessive daytime sleepiness were differentially associated with impairment of cognitive domains (mainly memory and executive function).
MeSH term(s)	Humans ; Aged ; Depression/diagnosis ; Independent Living ; Prospective Studies ; Sleep ; Cognition ; Disorders of Excessive Somnolence ; Sleep Wake Disorders/epidemiology ; Sleep Wake Disorders/diagnosis
Language	English
Publishing date	2023-03-22
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	2096659-3
ISSN	1876-0821 ; 0929-6646
ISSN (online)	1876-0821
ISSN	0929-6646
DOI	10.1016/j.jfma.2023.03.005
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Article ; Online: Longitudinal trajectories of dietary quality and cognitive performance in older adults: Results from a 6-year cohort study

Chen, Ling-Wei / Chou, Yi-Chun / Lee, Meei-Shyuan / Chiou, Jeng-Min / Chen, Jen-Hau / Chen, Yen-Ching

Clinical Nutrition. 2023 June, v. 42, no. 6 p.879-886

2023

Abstract: Diet affects cognitive performance, but most previous studies only assessed diet once. Trajectory analysis of diet measured at multiple timepoints can identify subpopulations requiring more interventional efforts. We thus assessed associations between ... ...

Abstract	Diet affects cognitive performance, but most previous studies only assessed diet once. Trajectory analysis of diet measured at multiple timepoints can identify subpopulations requiring more interventional efforts. We thus assessed associations between dietary trajectories and cognitive performance in older adults. This was a 6-year prospective cohort study involving 356 ethnically Chinese, non-demented, community-dwelling older adults recruited between 2011 and 2013. At baseline and at 4th- and 6th-year follow-ups, dietary intakes of the participants were assessed using food frequency questionnaires. Dietary quality was graded using the modified Alternative Healthy Eating Index (mAHEI) with seven components; longitudinal trajectories of dietary quality were derived using latent growth mixture modelling. Outcomes were global- and domain-specific cognitive performance (attention, memory, executive functions, and verbal fluency). Multivariable regressions adjusting for important covariates (sex, age, energy intake, APOE risk alleles, depressive symptoms, and body mass index (BMI)) assessed associations between the dietary trajectories and cognitive outcomes. Included participants had a mean age of 71.6 years and a mean BMI of 23.8 kg/m². Three mutually exclusive dietary quality trajectories, namely “deteriorating”, “improving”, and “stable-high”, were derived. Compared with the stable-high trajectory, the improving trajectory was associated with a lower z-score for the memory domain (β: −0.403; 95% CI: −0.656, −0.151; P = 0.002), which was consistently observed for the four individual tests of the domain (β range: −0.324 to −0.448; all P < 0.05). In unadjusted analysis, the deteriorating trajectory was associated with a 0.369 lower z-score for the verbal fluency domain (95% CI: −0.700, −0.039 P = 0.028), though attenuated to borderline significance with adjustment for covariates. Sex and BMI modified some of these associations. No other associations were observed for global cognition or other cognitive domains. In Taiwanese older adults, consistently high dietary quality is associated with better cognitive performance. Interventions to promote and sustain better dietary quality over time can have substantial impacts on cognitive function.
Keywords	body mass index ; clinical nutrition ; cognition ; cohort studies ; diet ; energy intake ; food quality ; memory ; risk ; Older adults ; Cognitive performance ; Dietary quality ; Trajectory ; mAHEI
Language	English
Dates of publication	2023-06
Size	p. 879-886.
Publishing place	Elsevier Ltd
Document type	Article ; Online
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2023.04.002
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Grip Strength and Sarcopenia Predict 2-Year Cognitive Impairment in Community-Dwelling Older Adults.

Peng, Tao-Chun / Chiou, Jeng-Min / Chen, Ta-Fu / Chen, Yen-Ching / Chen, Jen-Hau

Journal of the American Medical Directors Association

2022 Volume 24, Issue 3, Page(s) 292–298.e1

Abstract: Objectives: Using the Asian Working Group for Sarcopenia (AWGS2019) and the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, this study examined associations of sarcopenia and its components with specific domains of cognitive ... ...

Abstract	Objectives: Using the Asian Working Group for Sarcopenia (AWGS2019) and the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, this study examined associations of sarcopenia and its components with specific domains of cognitive impairment over time. Design: A prospective cohort study with a 2-year follow-up. Setting and participants: This study is part of the Taiwan Initiatives for Geriatric Epidemiological Research (TIGER), which recruited participants aged 65 years old who attended the senior health checkup program at National Taiwan University Hospital (NTUH). Methods: Grip strength was measured using a handgrip dynamometer. Walking speed (m/s) was measured as the time required to walk 8 feet. Muscle mass was measured by performing a bioelectrical impedance analysis. Global cognition (assessed using the Taiwanese version of the Montreal Cognitive Assessment) and 4 cognitive domains (memory, executive function, verbal fluency, and attention) were assessed over time. Associations of sarcopenia and its components with cognitive impairment were evaluated after stratification by sex using generalized linear mixed models adjusted for essential covariates for cognitive impairment. Results: Compared with robust women, those with severe sarcopenia were more likely to have a global cognitive impairment over time (β = -0.87, P = .03 based on AWGS2019 criteria and β = -1.07, P = .02 based on the EWGSOP2 criteria). Among men, low grip strength was associated with poor scores on measures of global cognition (β = -0.80, P = .03), executive function (β = -0.35, P = .001), verbal fluency (β = -0.31, P = .02), and attention (β = -0.34, P = .008) over time. Conclusions and implications: Severe sarcopenia predicted global and specific domains of cognitive impairment in older adults. Poor grip strength predicted cognitive impairment in men but not in women. A screen for sarcopenia severity and low muscle strength may be used to identify the risk of cognitive impairment.
MeSH term(s)	Male ; Humans ; Female ; Aged ; Sarcopenia ; Hand Strength/physiology ; Independent Living ; Prospective Studies ; Muscle Strength/physiology ; Cognitive Dysfunction ; Geriatric Assessment ; Prevalence
Language	English
Publishing date	2022-11-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2022.10.015
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Article: The association between retinal vascular fractal dimension and cognitive function in the community-dwelling older adults cohort TIGER.

Wu, Ting-Yu / Hsieh, Yi-Ting / Wang, Yu-Hsin / Chiou, Jeng-Min / Chen, Ta-Fu / Lai, Liang-Chuan / Chen, Jen-Hau / Chen, Yen-Ching

Journal of the Formosan Medical Association = Taiwan yi zhi

2023 Volume 122, Issue 10, Page(s) 1050–1060

Abstract: Background/purpose: The small retinal vessels reflect cerebral microcirculation and its fractal dimension (D: Methods: This four-year prospective cohort study (2015-2019) is part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research ...

Abstract	Background/purpose: The small retinal vessels reflect cerebral microcirculation and its fractal dimension (D Methods: This four-year prospective cohort study (2015-2019) is part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research (TIGER, 2011 to present). Of the 434 older adults (age >65) recruited, 207 participants were included for analysis. The retinal vascular D Results: Decreased left retinal vascular complexity was associated with poor attention performance (β = -0.40). As follow-up time increased, decreased vascular complexity was associated with poor memory performance (right: β = -0.25; left: β = -0.19), and decreased right vascular complexity was associated with poor attention performance (β = -0.18). Conclusion: Low retinal vascular complexity of the right or left eye may be differentially associated with cognitive domains in community-dwelling older adults over two years. The retinal vascular D
MeSH term(s)	Humans ; Aged ; Prospective Studies ; Fractals ; Independent Living ; Cognition ; Cognitive Dysfunction/epidemiology
Language	English
Publishing date	2023-04-19
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	2096659-3
ISSN	1876-0821 ; 0929-6646
ISSN (online)	1876-0821
ISSN	0929-6646
DOI	10.1016/j.jfma.2023.04.001
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Article ; Online: Effect of indoor air quality on the association of long-term exposure to low-level air pollutants with cognition in older adults.

Chen, Yen-Ching / Hsieh, Pei-Iun / Chen, Jia-Kun / Kuo, Emily / Yu, Hwa-Lung / Chiou, Jeng-Min / Chen, Jen-Hau

Environmental research

2023 Volume 233, Page(s) 115483

Abstract: Background: How indoor air quality affects the temporal associations of long-term exposure to low-level air pollutants with cognition remains unclear.: Methods: This cohort study (2011-2019) included 517 non-demented older adults at baseline with ... ...

Abstract	Background: How indoor air quality affects the temporal associations of long-term exposure to low-level air pollutants with cognition remains unclear. Methods: This cohort study (2011-2019) included 517 non-demented older adults at baseline with four repeated cognitive assessments. The time-varying exposure to PM Results: Over time, per 2.97 μg/m Conclusion: This study demonstrated how indoor air quality in areas using clean fuels differentially affected the associations of long-term exposure to low-level air pollutants with cognition. Tightening air quality standards may help prevent dementia.
MeSH term(s)	Humans ; Aged ; Air Pollutants/analysis ; Air Pollution, Indoor/adverse effects ; Cohort Studies ; Air Pollution/analysis ; Cognition ; Particulate Matter/analysis ; Environmental Exposure/analysis ; Nitrogen Dioxide/analysis
Chemical Substances	Air Pollutants ; Particulate Matter ; Nitrogen Dioxide (S7G510RUBH)
Language	English
Publishing date	2023-02-13
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	205699-9
ISSN	1096-0953 ; 0013-9351
ISSN (online)	1096-0953
ISSN	0013-9351
DOI	10.1016/j.envres.2023.115483
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