Dietary Lutein and Cognitive Function in Adults: A Meta-Analysis of Randomized Controlled Trials

Emerging literature suggests that dietary lutein may have important functions in cognitive health, but there is not enough data to substantiate its effects in human cognition. The current study was intended to determine the overall effect of lutein on the main domains of cognition in the adult population based on available placebo randomized-controlled trials. Literature searches were conducted in PubMed, AGRICOLA, Scopus, MEDLINE, and EMBASE on 14 November 2020. The effect of lutein on complex attention, executive function and memory domains of cognition were assessed by using an inverse-variance meta-analysis of standardized mean differences (SMD) (Hedge’s g method). Dietary lutein was associated with slight improvements in cognitive performance in complex attention (SMD 0.02, 95% CI −0.27 to 0.31), executive function (SMD 0.13, 95% CI −0.26 to 0.51) and memory (SMD 0.03, 95% CI −0.26 to 0.32), but its effect was not significant. Change-from-baseline analysis revealed that lutein consumption could have a role in maintaining cognitive performance in memory and executive function. Although dietary lutein did not significantly improve cognitive performance, the evidence across multiple studies suggests that lutein may nonetheless prevent cognitive decline, especially executive function. More intervention studies are needed to validate the role of lutein in preventing cognitive decline and in promoting brain health.

Neurocognitive Outcome Following Recovery from Severe Acute Respiratory Syndrome – Coronavirus-1 (SARS-CoV-1)

Objective: Severe acute respiratory syndrome (SARS) is a highly contagious viral respiratory illness associated with hypoxia and dyspnea. Many of those who contracted and recovered from SARS during the 2002–2003 outbreak reported persistent physical, psychological, and cognitive difficulties. Here, we investigated the residual influences of SARS on cognition for a subset of healthcare professionals who recovered and were referred for neuropsychological evaluation through their workplace insurance. Method: Twenty-eight healthcare professionals were evaluated on neuropsychological and mood functioning approximately 1.5 years post-recovery from a severe respiratory illness. Test scores were compared with age-matched normative data, and correlations were examined between mood, self-report memory scales, subjective complaints (e.g., poor concentration, pain, fatigue), illness severity (i.e., length of hospitalization, oxygen use during hospital stay), and cognitive performance. Results: Participants performed within age expectations on the majority of cognitive measures including overall memory ability. Although processing speed was generally within normal limits, 43% showed significant speed–accuracy trade-offs favoring accuracy over maintaining speed. Deficits were observed on measures of complex attention, such as working memory and the ability to sustain attention under conditions of distraction. Participants endorsed poorer memory ability than same-age peers on a meta-memory measure and mild to moderate depression and anxiety symptoms. Objective test performance was largely uncorrelated with self-reports, mood, or illness severity, except for moderate correlations between complex attention and participants’ subjective ratings of Everyday Task-Oriented Memory. Conclusions: These findings demonstrate specific long-term cognitive deficits associated with SARS and provide further evidence of the cognitive effects of hypoxic illnesses.

A-72 Neuropsychological Functioning in Primary Dystonia: A Multi-Domain Meta-Analysis

Objective Primary dystonia is conventionally seen as a motor disorder, though growing literature indicates cognitive dysfunction among persons with primary dystonia (PWD). Here, we completed a meta-analysis comparing cognition on clinical measures between PWD and normal controls. Method We searched PubMed, Embase, Cochrane Library, Scopus, and PsycINFO using a uniform search-strategy to locate original research comparing cognition between PWD and control samples. All analyses were modeled under random-effects. We used Hedge’s g as a bias-corrected estimate of effect size. Between-study heterogeneity was assessed using Cochran’s Q and I2. Results The initial search strategy yielded 866 results. Twenty studies were analyzed (PWD n = 739, control n = 865; 254 effect sizes extracted). Meta-analysis showed a significant combined effect size of primary dystonia across all studies (g = −0.55, p < 0.001), with low heterogeneity (Q = 23.60, p = 0.21, I2 = 19.49). Trim-and-fill procedure estimated 6 studies missing due to publication bias (adjusted g = −0.47, Q = 44.58). Within-domain effects of primary dystonia were: Motor/Non-Motor Speed = −0.76, Global Cognition/Orientation = −0.65, Language = −0.62, Executive Functioning = −0.50, Learning/Memory = −0.46, Visuospatial/Construction = −0.44, and Simple/Complex Attention = −0.36. Heterogeneity was generally low within domains. Effects were comparable between Speed tasks with (g = −0.85) and without (g = −0.80) a motor component. Meta-regressions indicated age, education, gender, and disease duration were not related to effect sizes. Conclusions PWD consistently demonstrated lower performances on neuropsychological tests compared to controls. Effect sizes were generally moderate in strength, with smallest effects in Simple/Complex Attention, and largest in Motor/Non-Motor Speed. Within the Speed domain, results suggested cognitive slowing beyond effects from motor symptoms. This quantitative summary indicates that PWD experience difficulties in multiple aspects of cognition, as detected by neuropsychological tests.

POS0714 WHITE MATTER HYPERINTENSITIES LEAD TO REDUCED PSYCHOMOTOR SPEED IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND NEUROPSYCHIATRIC SYMPTOMS

Background:Cognitive impairment is common in patients with systemic lupus erythematosus (SLE) and neuropsychiatric (NP) symptoms, but the exact underlying structural brain correlates are unknown.Objectives:We aimed to compare cognitive function between groups of patients with different phenotypes of (NP)SLE and assessed the association between brain volumes, white matter hyperintensity (WMH) volume and cognitive function.Methods:Patients who visited the NPSLE clinic of the Leiden University Medical Center between 2007-2015 were included in this study (n=151; 42 ± 13 years, 91% female). In a multidisciplinary consensus meeting, phenotypes were established and neuropsychiatric symptoms were attributed to SLE (NPSLE, inflammatory (n=24) or ischemic (n=12)) or to minor involvement of SLE or other causes (minor/non-NPSLE (n=115)). All patients underwent standardized cognitive assessment of the four cognitive domains: global cognitive functioning (GCF), learning and memory (LM), executive functioning and complex attention (EFCA) and psychomotor speed (PS)). Cognitive dysfunction was defined as a T-score <40, with age, sex, gender and education matched individuals of the Dutch population as reference. In addition, automated volume measurements on brain MRI (white matter, grey matter, white matter hyperintensities (WMH) and total brain volume (TBV)) were performed. Patients with brain infarcts >1.5 cm were excluded. Cognitive function (Z-score) was compared between different NPSLE phenotypes using multiple regression analyses corrected for age, sex and education. Associations between brain volumes, WMH and cognitive function were assessed per phenotype using multiple regression analyses corrected for age, sex and intracranial volume.Results:Global cognitive functioning was impaired in 5%, learning & memory in 46%, and executive functioning & complex attention in 39% and psychomotor speed in 46% of all patients. Patients with inflammatory NPSLE showed the most cognitive impairment and reduced cognitive function compared to ischemic NPSLE (all domains) and minor/non-NPSLE (EFCA) (p <0.05).Lower total brain volume and grey matter volume were associated with lower cognitive functioning in all domains (β: 0.00/0.01 (0.00; 0.01)) and lower white matter volume associated with lower LM, EFCA and PS (β: 0.00/0.01 (0.00; 0.01)) in all patients. Higher WMH volume associated with lower psychomotor speed (β: -0.14 (-0.32; -0.02)), especially in patients with inflammatory NPSLE (β: -0.36 (-0.60; -0.12).Conclusion:Reduced brain volume leads to reduced cognitive function in multiple cognitive domains in all patients with SLE and neuropsychiatric symptoms. Increased WMH volume leads to reduced psychomotor speed, especially in patients with inflammatory NPSLE.Table 1.Prevalence of cognitive impairment in patients with minor/non-NPSLE, inflammatory NPSLE and ischemic NPSLEGlobal cognitive functioningLearning &memoryExecutive functioning & complex attentionPsychomotor speedAll patients(n = 151)8 (5)70 (46)57 (39)69 (46)Inflammatory NPSLE(n = 24) 3 (13) 14 (58) 12 (50) 12 (50)Ischemic NPSLE(n = 12) 0 (0) 6 (50) 2 (17) 2 (17)Minor/non-NPSLE(n = 115) 5 (4) 50 (44) 43 (38) 55 (49)NPSLE = neuropsychiatric systemic lupus erythematosus.Data represent n (%) of patients with cognitive impairment in the mentioned cognitive domain. Cognitive impairment was defined as cognitive function at least 1SD lower than the mean of an age, sex and education matched general Dutch population. The percentages were calculated from total number of patients with available scores: Global functioning: 23/24 inflammatory NPSLE and 113/115 minor/non-NPSLE; psychomotor speed 113/115 minor/non-NPSLE, executive function & complex attention: also 113/115. All tests were available for ischemic NPSLE.Disclosure of Interests:None declared

Age-related performance in using a fully-immersive and automated virtual reality system to assess cognitive function (Preprint)

BACKGROUND Cognition generally declines gradually over time due to progressive degeneration of the brain, leading to dementia and eventual loss of independent functions. Cognition in the six domains (perceptual motor, executive function, complex attention, learning and memory, social cognition and language) varies in their rate of regression. Current modality of cognitive assessment using neuropsychological, questionnaire-based such as the Montreal Cognitive Assessment (MoCA) has its limitations and is influenced by age. Virtual reality (VR) has been introduced as a potential alternative tool to assess cognition. A novel fully immersive automated VR system (CAVIRE) has been developed to assess the six cognitive domains. As cognition is associated with age, VR performance is postulated to vary with age using this system. OBJECTIVE This study aimed to evaluate the VR performance of cognitively healthy adults using the CAVIRE system based on its automated scoring matrix and completion time. METHODS Conducted in a public primary care clinic in Singapore, the study recruited 25 multi-ethnic Asian adults in each of the age groups in years: (1) 35-44; (2) 45-54; (3) 55-64 and (4) 65-74. Their eligibility included a MoCA score of 26 or higher to reflect normal cognition and understanding the automated English instructions in the CAVIRE system. They completed common daily activities from brushing teething to shopping across 13 virtual segments. Their performances were automatically evaluated and computed using cognitive domain score matrix and completion time of the VR tasks. These VR performance indices were compared across the age groups using a one-way ANOVA, F-test of the hypothesis, followed by pair-wise comparisons in the event of a significant F-test (p<0.05). RESULTS One participant dropped out from Group (1). The demographic characteristics of 99 participants were similar across the 4 age groups. Overall, younger participants in Groups (1) and (2) attained higher VR performance scores and shorter completion time using the CAVIRE system, compared to those in Groups (3] and (4) in every cognitive domain (all p<0.05). Significant differences in performance scores are noted in sequential age groups from (1) to (3) in “Executive Functions”; Group (1) and those in Groups (3) and (4) in “perceptual motor; Group (1) and those in Groups (2), (3) and (4) in “complex attention” and “social cognition”; Group (1) and (4) In “learning and memory”; Groups (1) and (2) and those in Groups (3) and (4) in language. Significant differences in completion time are noted between Groups (1) and (3) except for “social cognition”; and between Groups (2) and (3), except for “learning and memory”. CONCLUSIONS The CAVIRE VR performance scores and completion time significantly differ between the younger and older Asian participants with normal cognition. Enhancements to the system are needed to establish the age-group specific normal performance indices.

Cognitive Improvement and Safety Assessment of a Dietary Supplement Containing Propolis Extract in Elderly Japanese: A Placebo-Controlled, Randomized, Parallel-Group, Double-Blind Human Clinical Study

Objectives. This study aimed to evaluate the effect of propolis on cognitive function in elderly Japanese with a placebo-controlled design. Material and Methods. This study was performed on 79 elderly Japanese. Participants orally received either a placebo or dietary supplement containing propolis extract for 24 weeks. Cognitive function assessed by Cognitrax and various blood or urine markers were measured at pre- and postadministration. Results and Conclusion. Eligible data from 68 subjects (placebo: 33, propolis: 35) who completed the study were analyzed. Compared to the placebo group, the propolis group showed significant improvement in verbal memory in Cognitrax ( P = 0.028 ). Total cholesterol, LDL cholesterol, urea nitrogen, creatinine, and uric acid were significantly improved in the propolis group compared to the placebo group ( P = 0.011 , P = 0.004 , P = 0.048 , P = 0.045 , and P = 0.005 , respectively). However, urea nitrogen, creatinine, and uric acid fluctuated within the normal level. Furthermore, a subgroup analysis was performed on those with higher than 100 of the standardized score of the neurocognitive index indicated by the overall Cognitrax score. Significant improvements in the propolis group compared to placebo were confirmed in verbal memory ( P = 0.007 ) and processing speed as indications for information processing ability, complex attention, and concentration ( P = 0.029 ). No side effects were observed in any of the groups. This study demonstrates that propolis is effective in improving cognitive functions such as memory, information processing, complex attention, and concentration in elderly Japanese.

Effects of dance on cognitive function in older adults: a systematic review and meta-analysis

Background dance is a mind–body activity that stimulates neuroplasticity. We explored the effect of dance on cognitive function in older adults. Methods we searched MEDLINE, EMBASE, CENTRAL and PsycInfo databases from inception to August 2020 (PROSPERO:CRD42017057138). Inclusion criteria were (i) randomised controlled trials (ii) older adults (aged ≥ 55 years), (iii) intervention—dance and (iv) outcome—cognitive function. Cognitive domains were classified with the Diagnostic and Statistical Manual of Mental Disorders-5 Neurocognitive Framework. Meta-analyses were performed in RevMan5.3 and certainty of evidence with GradePro. Results we reviewed 3,997 records and included 11 studies (N = 1,412 participants). Seven studies included only healthy older adults and four included those with mild cognitive impairment (MCI). Dance interventions varied in frequency (1–3×/week), time (35–60 minutes), duration (3–12 months) and type. We found a mean difference (MD) = 1.58 (95% confidence interval [CI) = 0.21–2.95) on the Mini Mental State Examination for global cognitive function (moderate-certainty evidence), and the Wechsler Memory Test for learning and memory had an MD = 3.02 (95% CI = 1.38–4.65; low-certainty evidence). On the Trail Making Test-A for complex attention, MD = 3.07 (95% CI = −0.81 to 6.95; high-certainty evidence) and on the Trail Making Test-B for executive function, MD = −4.12 (95% CI = −21.28 to 13.03; moderate-certainty evidence). Subgroup analyses did not suggest consistently greater effects in older adults with MCI. Evidence is uncertain for language, and no studies evaluated social cognition or perceptual–motor function. Conclusions dance probably improves global cognitive function and executive function. However, there is little difference in complex attention, and evidence also suggests little effect on learning and memory. Future research is needed to determine the optimal dose and if dance results in greater cognitive benefits than other types of physical activity and exercise.

Neuropsychological and Emotional Functioning in Patients with Cushing’s Syndrome

Patients with Cushing’s syndrome (CS) frequently report impairments in cognitive and emotional functioning. Given neuroimaging research that implicates alterations in structure and function in the brain in this population, goals of this study were to investigate neuropsychological and emotional functioning, with particular emphasis on complex attention and memory. In a clinical sample of 18 adults with CS referred for neuropsychological evaluation (age 41.6±10.6, 72% Caucasian), patients’ most common subjective complaints were in attention and increased irritability. On objective testing, patients exhibited significant declines in the consistency of their sustained attention and visual-spatial functioning compared to normative peers. Patients exhibited on average significantly reduced initial learning following first exposure to visual and verbal stimuli but intact retention of information learned. Patients with CS endorsed highly elevated levels of somatization, depression, and anxiety, and 59% of them scored in the clinically elevated range for somatization and depressive symptomatology. Exploratory analyses suggested that the 11 patients with active Cushing’s exhibited lower processing speed, poorer sustained attention, naming, and cognitive flexibility compared to the 7 patients who achieved biochemical remission. Patients with active Cushing’s also reported higher levels of somatization and anxiety compared to patients in biochemical remission. Overall, this study provides new insights into complex attention and memory deficits in patients with CS and concern regarding cognitive and emotional issues despite resolution of hypercortisolism. Our study opens several avenues for further exploration.

Atomoxetine Does Not Improve Complex Attention in Idiopathic Parkinson’s Disease Patients with Cognitive Deficits: A Meta-Analysis

Objectives. To evaluate the effects of atomoxetine on complex attention and other neurocognitive domains in idiopathic Parkinson’s disease (PD). Methods. Interventional trials reporting changes in complex attention and other neurocognitive functions (Diagnostic and Statistical Manual of Mental Disorders-5) following administration of atomoxetine for at least 8 weeks in adults with idiopathic PD were included. Effect sizes (Cohen’s d), the standardized mean difference in the scores of each cognitive domain, were compared using a random-effects model (MetaXL version 5.3). Results. Three studies were included in the final analysis. For a change in complex attention in PD with mild cognitive impairment (MCI), the estimated effect size was small and nonsignificant (0.16 (95% CI: −0.09, 0.42), n = 42). For changes in executive function, perceptual-motor function, language, social cognition, and learning and memory, the estimated effect sizes were small and medium, but nonsignificant. A deteriorative trend in executive function was observed after atomoxetine treatment in PD with MCI. For a change in global cognitive function in PD without MCI, the estimated effect size was large and significant. Conclusion. In idiopathic PD with MCI, atomoxetine does not improve complex attention. Also, a deteriorative trend in the executive function was noted.