Age trajectories of everyday cognition in African American and White older adults under prompted and unprompted conditions

Associations between social determinants of health and 10-year change in everyday functioning within Black/African American and White older adults enrolled in ACTIVE

Introduction

Given prior work showing racial differences on baseline social determinants of health (SDoH) and 10-year trajectories of everyday functioning, we examined associations between SDoH and longitudinal everyday functioning performance in Black/African American and White older adults.

Methods

Participants were 2505 older adults (M_age = 73.5; 28% Black/African American) without dementia. SDoH included economic stability/status, education access/quality, health-care access, neighborhood/built environment, and social/community contexts. The Observed Tasks of Daily Living (OTDL) measured everyday functioning and was administered at baseline and 1-, 2-, 3-, 5-, and 10-year visits.

Results

Across the sample, social and community context and economic stability/status were associated with steeper age-related OTDL declines (βs = 0.05 to 0.07, Ps < 0.001). Lower levels of social and community context (β = 0.08, P = 0.002) and economic stability/status (β = 0.07, P = 0.04) were associated with OTDL linear age declines in Black/African American participants, but not in White participants (Ps > 0.30).

Discussion

Inequities across SDoH accelerate age-related declines in everyday functioning among Black/African American older adults.

Augmenting cognitive training in older adults (The ACT Study): Design and Methods of a Phase III tDCS and cognitive training trial

BACKGROUND

Adults over age 65 represent the fastest growing population in the US. Decline in cognitive abilities is a hallmark of advanced age and is associated with loss of independence and dementia risk. There is a pressing need to develop effective interventions for slowing or reversing the cognitive aging process. While certain forms of cognitive training have shown promise in this area, effects only sometimes transfer to neuropsychological tests within or outside the trained domain. This paper describes a NIA-funded Phase III adaptive multisite randomized clinical trial, examining whether transcranial direct current stimulation (tDCS) of frontal cortices enhances neurocognitive outcomes achieved from cognitive training in older adults experiencing age-related cognitive decline: the Augmenting Cognitive Training in Older Adults study (ACT).

METHODS

ACT will enroll 360 participants aged 65 to 89 with age-related cognitive decline, but not dementia. Participants will undergo cognitive training intervention or education training-control combined with tDCS or sham tDCS control. Cognitive training employs a suite of eight adaptive training tasks focused on attention/speed of processing and working memory from Posit Science BrainHQ. Training control involves exposure to educational nature/history videos and related content questions of the same interval/duration as the cognitive training. Participants are assessed at baseline, after training (12weeks), and 12-month follow-up on our primary outcome measure, NIH Toolbox Fluid Cognition Composite Score, as well as a comprehensive neurocognitive, functional, clinical and multimodal neuroimaging battery.

SIGNIFICANCE

The findings from this study have the potential to significantly enhance efforts to ameliorate cognitive aging and slow dementia.