Reversion to Normal Cognition and Its Correlates among the Community-dwelling Elderly with Mild Cognitive Impairment: the Longitudinal Cohort Study

Younhee Kang; Sun A Whang; Kuemju Park

doi:10.7469/kjan.2015.27.6.656

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Kang, Whang, and Park: Reversion to Normal Cognition and Its Correlates among the Community-dwelling Elderly with Mild Cognitive Impairment: the Longitudinal Cohort Study

Original Article

Korean J Adult Nurs 2015;27(6):656-664.

Published online: December 2015

DOI: https://doi.org/10.7469/kjan.2015.27.6.656

Reversion to Normal Cognition and Its Correlates among the Community-dwelling Elderly with Mild Cognitive Impairment: the Longitudinal Cohort Study

Younhee Kang^1,, Sun A Whang², Kuemju Park³

^¹Division of Nursing, College of Health Sciences, Ewha Womans University, Seoul

^²Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul

^³Department of Nursing Science, The University of Suwon, Suwon, Korea

Corresponding author: Kang, Younhee Division of Nursing, College of Health Sciences, Ewha Womans University, 11-1 Daehyun-dong, Seodaemun-gu, Seoul 120-750, Korea. Tel: +82-2-3277-4483, Fax: +82-2-3277-2850, E-mail: yxk12@ewha.ac.kr

Received 31 August 201511 December 2015 Accepted 12 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purposes of this study were to identify the rate of reversion from mild cognitive impairment (MCI) to normal cognition (NC) among the community-dwelling elderly and to determine if there were differences in cognitive function, leisure activities, and exercises between the group with MCI-maintained and the group with reversion to NC.

Methods

This study utilized a longitudinal descriptive comparative design. A total of 346 subjects over age 65 was recruited from public health center at baseline. Finally 152 elderly were enrolled at 1 year follow-up. Data were collected through MoCA-K, K-MMSE, KDSQ-C5 and questionnaires on leisure activities and exercises. Data were analyzed by IBM SPSS Statistics 21.0 using descriptive statistics, x² test, and t-test.

Results

The rate of reversion from MCI to NC among the subjects was 44.1%. At baseline, the group with MCI-maintained had lower cognitive function than the group with reversion to NC. At 1 year follow-up, the group with reversion to NC had higher subjective cognitive function than the group with MCI-maintained. Regarding leisure activities, there were differences between the groups at baseline and 1 year follow-up.

Conclusion

It is suggested that age, education year, subjective cognitive function, and leisure activities should be considered at planning a nursing intervention for MCI.

Keywords: Mild cognitive impairment, Leisure activity, Exercise

REFERENCES

1.Ministry of Health& Welfare. Nationwide study on the prevalence of dementia in Korean elders [Internet]. Seoul: Ministry of Health& Welfare;2013. [cited 2014 April 26]. Available from:. http://www.mw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=286138&page=1.

2.Health Insurance Review and Assessment Service. 2014 medical expenses review [Internet]. Seoul: Health Insurance Review and Assessment Service;2015. [cited 2015 April 26]. Available from:. http://www.hira.or.kr/dummy.do?pgmid=HIRAA020041000000&cmsurl=/cms/notice/02/1332409_24959.html&subject.

3.Mariani E., Monastero R., Mecocci P. Mild cognitive impairment: a systemic review. Journal of Alzheimer's Disease. 2007. 12(1):23–35.

4.Artero S., Ancelin ML., Portet F., Dupuy A., Berr C., Dartigues JF, et al. Risk profiles for mild cognitive impairment and progression to dementia are gender specific. Journal of Neurology & Neurosurgery Psychiatry. 2008. 79(9):979–84. http://dx.doi.org/10.1136/jnnp.2007.136903.

5.Plassman BL., Langa KM., Fisher GG., Heeringa SG., Weir DR., Ofstedal MB, et al. Prevalence of cognitive impairment without dementia in the United States. Annals of Internal Medicine. 2008. 148(6):427–34.

6.Shin KR., Kang Y., Jung D., Kim M., Kim J., Kim M. Prevalence and characteristics of mild cognitive impairment in the community-dwelling elderly compared to elderly with normal cognitive function. The Journal of Korean Academic Society of Adult Nursing. 2011. 23(1):40–9.

7.Manly JJ., Tang MX., Schupf N., Stern Y., Vonsattel JP., Mayeux R. Frequency and course of mild cognitive impairment in a multiethnic community. Annals of Neurology. 2008. 63(4):494–506. http://dx.doi.org/10.1002/ana.21326.

8.Ganguli M., Chang CC., Snitz BE., Saxton JA., Vanderbilt J., Lee CW. Prevalence of mild cognitive impairment by multiple classifications: the MYHAT project. American Journal of Geriatric Psychiatry. 2010. 18(8):674–83. http://dx.doi.org/10.1097/JGP.0b013e3181cdee4f.

9.Luck T., Riedel-Heller SG., Luppa M., Wiese B., Wollny A., Wagner M, et al. Risk factors for incident mild cognitive impairment-results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients(AgeCoDe). Acta Psychiat-rica Scandinavica. 2010. 121(4):260–72. http://dx.doi.org/10.1111/j.1600-0447.2009.01481.x.

10.Grande G., Vanacore N., Maggiore L., Cucumo V., Ghiretti R., Galimberti D, et al. Physical activity reduces the risk of dementia in mild cognitive impairment subjects: a cohort study. Journal of Alzheimer's Disease. 2014. 39(4):833–983.

11.Roberts RO., Knopman DS., Mielke MM., Cha RH., Pankratz VS., Christianson TJ, et al. Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal. Neurology. 2014. 82(4):317–25. http://dx.doi.org/10.1212/WNL.0000000000000055.

12.Olazarán J., Torrero P., Cruz I., Aparicio E., Sanz A., Mula N, et al. Mild cognitive impairment and dementia in primary care: the value of medical history. Family Practice. 2011. 28(4):385–92. http://dx.doi.org/10.1093/fampra/cmr005.

13.Park M., Sung MR., Kim SK., Lee DY. Comparison of demographic characteristics, comorbidity, and health habits of older adults with mild cognitive impairment and older adults with normal cognitive function. Journal of Korean Academy of Nursing. 2014. 44(4):351–60. http://dx.doi.org/10.4040/jkan.2014.44.4.351.

14.Luck T., Luppa M., Briel S., Riedel-Heller SG. Incidence of mild cognitive impairment: a systematic review. Dementia and Geriatric Cognitive Disorders. 2010. 29(2):164–75. http://dx.doi.org/10.1159/000272424.

15.Schlosser Covell GE., Hoffman-Snyder CR., Wellik KE., Woodruff BK., Geda YE., Caselli RJ, et al. Physical activity level and future risk of mild cognitive impairment or dementia: a critically appraised topic. The Neurologist. 2015. 19(3):89–91. http://dx.doi.org/10.1097/NRL.0000000000000013.

16.Etgen T., Sander D., Bickel H., Fὅrstl H. Mild cognitive impairment and dementia. Deutsches Ärzteblatt International. 2011. 108944:743–50.

17.Plassman BL., Williams JW Jr., Burke JR., Holsinger T., Benjamin S. Systematic review: factors associated with risk for and possible prevention of cognitive decline in later life. Annals of Internal Medicine. 2010. 153(3):182–93.

18.Yang YJ., Yoon YS., Oh SW., Lee ES. The amount of physical activity of Korean adults measured from the 2001 Korean National Health and Nutrition Survey. The Journal of the Korean Academy of Family Medicine. 2005. 26(1):22–30.

19.Chun MY. Validity and reliability of korean version of international physical activity questionnaire short form in the elderly. Korean Journal of Family Medicine. 2012. 33(3):144–51. http://dx.doi.org/10.4082/kjfm.2012.33.3.144.

20.Baker LD., Frank LL., Foster-Schubert K., Green PS., Wilkinson CW., McTiernan A, et al. Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Archives of Neurology. 2010. 67(1):71–9. http://dx.doi.org/10.1001/archneurol.2009.307.

21.Hong IS., Kim DA., Kim JS., Yoo YJ., Park S. The study of senior-aerobic exercise on mild cognitive impairment evaluation indicator relation in elderly women with mild cognitive impairment. The Korean Journal of Measurement and Evaluation in Physical Education and Sport Science. 2011. 13(1):23–31.

22.Blondell SJ., Hammersley-Mather R., Veerman JL. Does physical activity prevent cognitive decline and dementia?: a systematic review and meta-analysis of longitudinal studies. BMC Public Health. 2014. 14:510. http://www.biomedcentral.com/1471-2458/14/510.

23.Nasreddine ZS., Phillips NA., Bédirian V., Charbonneau S., Whitehead V., Collin I. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society. 2005. 53(4):695–9.

24.Lee JY., Lee DW., Cho SJ., Na DL., Hong JJ., Kim SK, et al. Brief screening for mild cognitive impairment in elderly outpatient clinic: validation of the Korean version of the Montreal Cognitive Assessment. Journal of Geriatric Psychiatry and Neurology. 2008. 21(2):104–10. http://dx.doi.org/10.1177/0891988708316855.

25.Folstein MF., Folstein SE., McHugh PR. "Mini-mental state". a practicalmethod for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research. 1975. 12(3):189–98.

26.Kang Y., Na DL., Hahn S. A validity study on the Korean Mini-Mental State Examination (K-MMSE) in dementia patients. Journal of the Korean Neurological Association. 1997. 15(2):300–8.

27.Yang DW., Cho BL., Chey JY., Kim SY., Kim BS. The development and validation of Korean Dementia Screening Questionnaire (KDSQ). Journal of the Korean Neurological Association. 2002. 20(2):1–8.

28.Kang Y., Kim M., Jung D., Cha C., Kim M. Factors associatedwith cognition recovery among elders with mild cognitive impair-mentin Korea. InternationalNursing Review. 2014. 61(3):318–26. http://dx.doi.org/10.1111/inr.12116.

29.Lee SA., Lee WH., Song JY., Paik JW. Association between subjective memory complaints and objective cognitive functions in the elderly. The Korean Journal of Clinical Psychology. 2011. 30(1):247–61.

30.Mitchell AJ. The clinical significance of subjective memory complaints in the diagnosis of mild cognitive impairment and dementia: a meta-analysis. International Journal of Geriatric Psychiatry. 2008. 23(11):1191–202. http://dx.doi.org/10.1002/gps.2053.

Table 1.

MET (Metabolic Equivalent)

METs	Types of exercise
2.5	Billiards
3	Bowling, gate ball, dumbbell
3.5	Hang glider
4	Walking, golf, yoga, hypogastric breathing
4.5	Weight lifting, table tennis, canoe, badminton, volleyball, horse-riding
5	Basketball, survival game, headstand, dodge ball, baseball, horizontal bar exercise, dancing, freehand exercise
5.5	Bicycle riding, calisthenics, fitness, foot volleyball, aerobics
6	Kendo, swimming, fencing, water-skiing, hula hoop
7	Football, tennis, ice skating, running, jogging, soccer, roller skating
8	Push-up, boxing, judo, teukgongmoosool, hiking, handball, karate, sit-up, ssireum, kung fu, wrestling, climbing stairs, hapkido
10	Kickboxing, martial arts, jump rope, taekwondo
12	Squash

Table2.

RateofNCGroupwith Reversionto NC, Groupwith MCI Maintained and Group with Progress to Dementia (N=152)

Groups	n(%)
Group with reversion to NC	67(44.1)
Group with MCI maintained	81(53.3)
Group with progress to dementia	4(2.6)

NC=normal cognition; MCI=mild cognitive impairment.

Table3.

Comparisonsof General CharacteristicsbetweenGroupwith Reversionto NCandGroupwith MCI Maintainedat Base (N=148)

Characteristics	Categories	Group with reversion to NC (n=67)	Group with MCI maintained (n=81)	x² or t	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	18 (26.9)	21 (25.9)	0.02	.522
Gender	Female	49 (73.1)	60 (74.1)	0.02	.522
Age (year)		71.9±5.5	74.9±5.7	-3.31	.001
	65~74	48 (71.6)	38 (46.9)	-	-
	75~84	19 (28.4)	37 (45.7)
	85 ≥		6 (7.4)
Education years		8.70±4.71	5.02±4.74	4.71	.001 ＜
	0~5	11 (16.4)	41 (50.6)	18.94	.001 ＜
	6~8	22 (32.8)	17 (21.0)
	9~11	14 (20.9)	9 (11.1)
	12 ≥	20 (29.9)	14 (17.3)
Marital status	With spouse	40 (59.7)	36 (44.4)	3.42	.071
Marital status	Without spouse	27 (40.3)	45 (55.6)	3.42	.071

NC=normal cognition; MCI=mild cognitive impairment.

Table 4.

Comparison of Cognitive Function, Leisure Activity and Exercise between the Group with Reversion to NC and the Group with MCI Maintained (N=148)

Characteristics	Categories	Group with reversion to NC (n=67)	Group with MCI maintained (n=81)	t	p
Characteristics	Categories	M±SD	M±SD	t	p
Objective cognitive function (MoCA-K)	Baseline	20.60±1.61	17.65±3.41	6.89	.001 ＜
Objective cognitive function (MoCA-K)	1 year F/U	25.12±1.68	18.60±3.32	15.43	.001 ＜
Subjective cognitive function (KDSQ-C5)	Baseline	2.78±2.04	3.46±2.55	-1.77	.080
Subjective cognitive function (KDSQ-C5)	1 year F/U	2.01±1.94	2.96±2.30	-2.72	.007
Leisure activity (times/year)	Baseline	793.67±372.41	666.91±343.35	2.15	.033
	Watching TV	329.57±103.29	334.73±97.78
	Listening radio	105.57±160.74	75.44±136.46
	Reading newspapers	165.75±165.91	101.24±152.98
	Reading books	138.58±157.71	95.10±143.13
	Playing games	30.31±69.71	38.65±101.37
	Participating cultural class	14.57±33.58	15.24±43.53
	Others	9.33±50.24	6.5±42.13
	1 year F/U	812.04±319.38	678.80±271.21	2.75	.007
	Watching TV	357.99±41.30	362.74±20.33
	Listening radio	97.57±154.95	51.09±125.60
	Reading newspapers	149.52±170.19	100.94±156.65
	Reading books	116.80±156.34	117.49±160.78
	Playing games	30.86±87.44	33.44±95.99
	Participating cultural class	29.10±75.53	6.81±20.72
	Others	30.21±94.80	6.30±20.93
Exercise (Kcal/week)	Baseline	926.20±1,230.57	889.90±1,253.03	0.18	.860
	3 MET 5 ≤ ＜	1,037.63±725.72	1,058.97±605.02
	5 MET 7 ≤ ＜	1,257.30±809.61	1,288.14±738.98
	7 MET ≤	1,598.29±1,009.36	2,601.46±2,148.50
	1 year F/U	925.64±1,186.95	815.00±1,284.12	0.54	.590
	3 MET 5 ≤ ＜	1,104.29±675.55	1,032.27±594.38
	5 MET 7 ≤ ＜	916.14±785.60	1,167.92±836.62
	7 MET ≤	2,000.40±1028.63	3,941.33±2,505.23

NC=normal cognition; MCI=mild cognitive impairment; MET=metabolic equivalent.

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