Attention/Concentration: This domain deals with the ability to focus awareness on a given stimulus or task, to concentrate on that stimulus or task long enough to accomplish a goal, and to shift awareness if appropriate.

Language: Language is a complex cognitive domain composed of both crystallized and fluid cognitive abilities. They are typically associated with the left (dominant) cerebral hemisphere. Both oral, written, they consist of one’s abilities to comprehend repeat and express in these modes, in addition to finding words and names quickly by category or sound. Problems in this area can make communication difficult in therapy.

Visuospatial Skills: This group of cognitive functions involves the ability to understand space in two and three dimensions.Visual construction skills, which involves the ability to put together individual parts to make a coherent whole.

Motor Skills: Gross, manual fine-motor, and facial fine-motor abilities are covered here. Difficulties can make one’s facial expressions or gestures difficult to read, or affect one’s self-esteem.

Memory: Visual, verbal, and motor memory are the usual foci here, with olfactory and gustatory memory usually not having strong psychological implications (although they may be associated with dementia). Memory can be very brief, short-term, or long-term.

Executive functioning: This refers to capacities that allow a person to successfully engage in independent, appropriate, purposive, and self-serving behaviour. This includes a wide range of cognitive abilities such as the ability to self-monitor, plan, organize, reason, be mentally flexible, and problem-solve. largely concerned with the working of the frontal lobes.

The purpose of this study is as cognitive impairment is now a significant health concern as the individuals with cognitive impairments may experience loss of self-confidence and esteem and can increase dependence on family and may be left out of decision making in the family.

Hence punctual screening of cognitive impairment may be helpful in early detection and timely treatment. So that the quality of life can be improved as a future concern.

Thus, this study is being carried out to assess mild cognitive deficits in subjects in advancing age through an application as well as a questionnaire.

A cross-sectional study, on 75 participants of geriatric population were chosen and divided into three age groups 60-69 = young old ,70-79= middle old, 80 plus very old. With the inclusion criteria being atleast 60 years of age and no known history of any kind of cognitive deficit with a MMSE score of minimum 23. For those who consented to devote uninterrupted 20 minutes for performing the test and exclusion criteria being a disturbance in intellectual functioning or any symptom that indicates the lack of understanding of the questions, having a verbal audio /visual impairment or any psychological issues.

With the aim being to study the effect of advancing age on cognitive function in geriatric subjects. The objective of this study is to assess mild cognitive deficit in older adults using pre validated questionnaires and android based assessment application and to compare mild cognitive deficit in young old, mid old and old-old adults using above mentioned measures.

With an inclusion criteria of at least 60 years of age and no known history of any kind of cognitive deficit with a MMSE score of minimum 23 and those who consented to devote uninterrupted 20 minutes for performing the test, with the exclusion criteria being disturbance in intellectual functioning or any symptom that indicates the lack of understanding of the questions, having a verbal audio /visual impairment or any psychological issues.

The procedure is an interviewer-administered questionnaire was conducted to collect socio-demographic and health-related data including name, gender, age, education, dominance, height, weight, family type, current work status, and type of work involved. Self-reported medical conditions were recorded including diabetes, hypertension/hypotension, heart conditions, and thyroid respectively. Weight and height were measured and Body Mass Index (BMI) was calculated as weight in kilograms divided by height in meters squared (kg/m²); BMI <24 and ≥24 kg/m² were categorized as normal and overweight, respectively.

Cognitive function was examined by using a validated memory questionnaire and MIDLAND’S application. The assessments were conducted strictly following the guidelines and protocols of the application and the questionnaire.

The memory questionnaire comprises 20 questions that help to analyse the memory related to daily life activities. The total scoring of it is 100, where scores lying between 0-40 are considered to be of (most concern),40-80 (moderate concern, and 80-100 (low concern). Face-to-face interviews and cognitive assessments were both performed on the same day.

The assessments were conducted strictly following the guidelines and protocols of the application and the questionnaire.

Unfortunately, midland application hasn’t been used in any researches. Although it has been validated by a neurosurgeon and a neurophysician. The midlands app consists of a test called Mica which consists of a variety of cognitive tests under the main domains of cognition which are language, attention and concentration, memory, praxis, gnosis and executive functions respectively. Each domain has different tests the tests and scoring as follows: The scoring is divided into normal, equivocal and impaired respectively.

Face-to-face interview and cognitive assessment were both performed on the same day.

The ethics approval for research was taken from institutional ethics committee after submitting a detailed synopsis and methodology of the study. Written informed consent was taken from all study subjects.

The Midland cognitive application and the memory questionnaire was validated by two experts in the field since no evidence is present in of these questions being used in any published literature.

The software used in this study were Microsoft Word, Power-point and Excel. The data was analysed through Microsoft Excel and the results were expressed in mean and percentage.

Figure 1

Data analysis according to the midland application:

N - Normal

E - Equivocal

I – Impaired

Table 3

Domain	P value
Attention	0.1
Language comprehension	0.406
Anomia	0.754
Spoken language	0.406
Mvt2	.000*
Mvt3	.001*
STMVDR	.000*
STMVR	0.105
STMVR-orientation	0.111
Line drawing	.003*
Praxis FHD -R FHD -L	0.085 0.138
V&P(LDC)	.003*
Agnosia	0.71
Visuospatial & praxis	.001*
Executive functions ANT DF LURIA	0.965 0.038* .026*

According to the results of Table 3 the domain of attention and concentration dint have any severe impairment but a mild impairment of 8 % was seen in 60-69yrs (group 1), 4% in 70-79 yrs. (group 2) with mildly increasing to 16% in 80 yrs. and above (group 3). The language domain consists of three tests which are language comprehension, anomia and spoken language. The language domain is comparatively less affected than other domains. With increasing age also language is not much affected according to the results collected. Anomia, this test consists of tasks where some pictures had to be identified and named correctly a significant increase in the impairment was seen with aging in 60 -69 yr. (group 1) – 4% of mild impairment was noticed progressing to 8%, in 70-79 yrs. (group 2) - where as in the (group 3)-80 years and above the impairment was observed to increase, ranging from moderate to severe where 20% was moderately affected and 8 % was severely affected. Spoken language in this particular test no significant decrease or impairment was noticed with aging.

In this following test 10 words are given and the subject has to recall as many as possible. There are 3 trials later followed by a delayed recall. The results based on trial 1 are, where moderate impairment of 44% was seen in group 1 (60-69), 48% in group 2(70-79) and 12% in group 3 (80 yrs and above) followed by severe impairment of 20% in group 1, 48 % in group 2 and 84% in group 3. The results of trial 2 show a moderate impairment of 44% in group 1 (60-69) yrs, 48% in group 2(70-79) and 12% in group 3 (80 yrs and above) followed by a severe impairment of 20% in group 1 (60-69yrs),48%in group 2 (70-79yrs) progressing to 84 % in group 3 (80 yrs and above). The results of trial 3 shows a moderate impairment of 56% in group 1 (60-69yrs),56% in group 2(70-79 yrs) and 16% in group 3 (80 yrs and above) followed by a severe impairment of 24% in group 1, 40%in group 2 progressing to 84%in group 3. Results based on delayed recall showed that a moderate impairment of 20% was seen in group 1 (60-69yrs), 40%in group 2(70-79yrs) and 12% in group 3 (80 yrs and above) with a severe impairment of 8% seen in group 1 followed by 56%in group 2 with a progression of 88 % in group 3. In Short term memory verbal recognition in group 1 (60-69yrs) only 4% was severely affected ,whereas in group 2(70-79 yrs) a moderate impairment was seen in 4% and also 4% of severe impairment was noticed followed by a moderate to severe impairment of 24 % was seen. Thus this domain was comparatively mildly affected. In brief this domain was affected moderate-severely.

In short term memory drawing recall, a mild impairment was seen in 12% population in group 1 (60-69 yrs), 4% in group 2 (70-79yrs) and 12%in group 3 (80 yrs and above) followed by a moderate impairment of 24%in group 1, 44% in group 2 and 80 % in group 3. This suggests that there is mild to moderate impairment seen as a whole.

In the praxis domain there was a moderate to severe impairment observed as shown in the graphs.

Figure 0

Figure 0

In visuospatial and praxis there was an in increase in the severity of the impairment seen as shown in the graph where the severity increased from 12 %in group 1 to 16%in group 2 progressing to 72%in group 3.

Figure 0

The tasks of line drawings were impaired from a range of moderate to severe as shown in the graph above where a moderate impairment of 12 % in group 1, 36%in group 2 and 16 % in group 3 progressing to a severe impairment of 24 % in group 1, 28 % in group 2 and 72 % in group 3.

In design fluency task there was a severe impairment seen as age increases in group 1 the impairment was 32 %, 44% in group 2 progressing to 84 % in group 3 respectively.

The goal of the current study was to identify Mild cognitive deficits in elderly population. According to the demographic data collected in our study subjects the working population was 40% in group 1(60-69 yrs.),28%in group 2 (70-79yrs) and 12%in group 3(80yrs and above) as observed on the basis of the study the working population had a better memory than the retired population. As seen with increase in age the working population decreases and also a notable decrease in their memory is observed. Several experimental studies carried out by AndelR, FinkelD, Pederseren NL -Effects of preretirement work complexity 5 Dingemans, Henkens K-Involuntary retirement a longitudinal investigation and several other studies stated that lack of activity in old age may have negative consequences on health status and on personal well-being 6. The cognitive decline seen more in retired population is because cognitive aging is defined by a progressive reduction in brains weight and volume this loss is not homogenous indeed it is greater in temporal lobes hence memory is affected. Thus, there is a notable decrease in memory in the retired population.

The existence of co morbid factors (hypertension, diabetes, and obesity) in our study subjects were seen in 72%in group 1 (60-69 yrs.), 80%in group 2(70-79 yrs.) and 72% in group 3 (80 yrs. and above) these factors are found to have a significant role in decrease in the cognitive factors too. A study by Roland Devere, MD – the cognitive consequences of obesity7, stated that obesity had increased the concentration of hippocampal markers associated with Alzheimer’s disease and decreased hippocampal volume. BMI Alone is a predictor of atrophy and there is evidence that obesity increases the risk of mild cognitive impairment 7. Using diffusion tensor imaging to measure Gray and white matter volume of elderly subjects with normal cognition showed that those with increased BMI, hyperinsulinemia, and type 2 diabetes had more atrophy in the frontal, temporal and subcortical brain regions, areas that are known to be involved in learning and memory ^8.

Our study unravelled subtle impairments in Geriatric age group. These included in domains of memory, attention, praxis, gnosis and other executive tasks.

As observed in our study subjects the average memory score was 87/100 in the age of 60-69 yrs where as in the age group of 70-79 and 80 yrs and above it was 78 and 68 respectively, there are several theories about what's behind this deterioration, but according to Michael E Hasselmo s study -The role of Acetylcholine in learning and memory stated that aging causes major cell loss in a tiny region in the front of the brain that leads to a drop in the production of a neurotransmitter called acetylcholine 9. Acetylcholine is vital to learning and memory ^{10 .} In addition, some parts of the brain that are essential to memory are highly vulnerable to aging^{. 10}

Also according to a study by Richard c Mos it was seen that, The hippocampal area, loses 5 percent of its nerve cells with each passing decade for a total loss of 20 percent by the time the person reaches 80s 11^. In addition, the brain itself shrinks and becomes less efficient as you age. Thus, a decrease in memory is seen with increase in age.

Language comprehension and spoken language in our study had a positive finding of 96-100% in the study subjects. This particular domain of cognition is seen to be affected in western population but in our study was found to be intact with advancing age ^12. Is because India is a diverse country in terms or languages and its varied culture. more than 21 languages are present in our country apart from them English is the main language used in schools and colleges. Thus, almost every Indian is familiar with more than one language. A study called -How aging and bilingualism influence language processing, carried out by Eleonora Rossi stated that Bilingualism has a huge influence on language processing 13. As bilinguals would exhibit greater volume of the frontal lobe and temporal lobe (grey and white matter), given the importance of these regions in executive and language functions, respectively ^13.

According to another study carried by Lily Tao, Gongting Wang and Qing Cai on Bilingualism and domain-general cognitive functions from a neural perspective: A systematic review, stated that functional and structural neuroplasticity associated with bilingualism will contribute to some neural reserves which helps to have a better language comprehension ^14.

In our study subjects the working verbal memory was affected with about 20%impairment in group 1 (60-69 yrs), with a significant increase seen in group 2(70-79yrs) of about 48% and 84%in group 3(80 yrs and above. Along with working verbal memory there was significant decrease in short term as well. On the basis of the neuroanatomical changes, it is stated that although the hippocampus undergoes structural and biochemical changes with normal aging process, these changes may represent an important component of age-related deterioration in hippocampus-dependent cognition. The effects are regionally distributed in the brain especially in the regions of the neocortex and the hippocampal dentate gyrus. Due to this decline is further observed. Another theory by Ebere C. Anyanwu on Neurochemical Changes in the Aging Process: Implications in Medication in the Elderly stated that short term memory and working verbal memory is the decline of neurotransmitter production ^15. Neurotransmitters are the brain chemicals that allows brain cells to communicate and perform their various functions. As one ages the problem can be twofold. The first being that one can produce less of these chemicals with increase in age and the second being the body’s natural process of breaking down excess neurotransmitters which begin to malfunction and work to excess causing a lack of supply for the brain 16. Without proper supply of these chemicals the brain cannot perform correctly. Hence a decrease is seen as the person ages.

In our study the praxis domain was affected severely in about 16%in group 1(60-69yrs) with an increase of about 20%in group 2 (70-79yrs) increasing to 36% in group 3. A person’s ability to copy a simple figure declines with age. On standard iq measures such as block design and object assembly much of declines with age are due to time but some researches show decline in when the time is factored out researches state that ageing produces loss of photoreceptor, bipolar or ganglion cells and changes in their connections that could account for visual acuity loses 17 also memory has to be intact to complete such tasks as we have seen in the above results that memory decreases with increase in age thus that also results in difficulty in performing visuospatial tasks.

There are age related declines in aspects of constructional praxis were Visual recognition of objects, shapes, gestures and conventional signs remain stable into advanced age according to the researches. As observed in our results also the tasks where they had to identify objects a positive result was found ^18.

On the basis of our study the executive functions were found to be normal in various aspects but moderate to severe impairment was observed in the design fluency activities with an impairment of 32 % seen in group 1(60-69 yrs), 44%in group 2 and 84%in group 3 respectively. The neuroanatomical changes like the frontal-striatal systems are preferentially vulnerable to white matter change, atrophy, and certain forms of neurotransmitter depletion. Frontal-striatal change may underlie mild executive functions difficulties in aging that are most apparent on tasks demanding high levels of controlled processing. The change in the frontal striatal circuits is the most likely significant cause of reduced executive function in non-demented older adults. A research called White and Gray matter contributions to executive functions by Irene Cristofori and Jordan stated that have shown that damage of white matter results in considerable loss of the executive functions as it detoriates signal transmission between cortical areas within a functional network.