The Association of Leisure Activities in Middle Adulthood with Cognitive Performance in Old Age: The Moderating Role of Educational Level

The Relationship Between Subjective Cognitive Decline and Cognitive Leisure Activity Engagement: A Systematic Review

BACKGROUND AND OBJECTIVES

Subjective cognitive decline (SCD) is a common experience of self-perceived decline without objective cognitive impairment. It has been theorized that SCD is associated with participation in cognitive leisure activities (CLAs), but the evidence base is multifarious and unclear. The purpose of this systematic review was to synthesize current evidence to determine the association between SCD and CLA engagement.

RESEARCH DESIGN AND METHODS

Systematic searches were conducted in EMBASE, MEDLINE, PsycINFO, and Web of Science (last searched April 2023). Data were extracted against a priori inclusion criteria and synthesized narratively using Synthesis without Meta-Analysis guidelines. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Mixed Methods Appraisal Tool (MMAT). Reporting follows PRISMA guidelines.

RESULTS

From 4,447 records, 11 articles were included. Due to study heterogeneity, evidence on SCD and CLA association is inconclusive. Although a modest correlation was found between greater engagement in CLA and fewer reports of SCD, the heterogeneity in study designs and outcomes, particularly in those addressing only perceived memory decline and CLA engagement, challenges definitive conclusions on this relationship. Evidence from mixed-method and qualitative studies indicated that perceived memory decline may cause negative feelings, such as shame and frustration, which may influence participating in CLA.

DISCUSSION AND IMPLICATIONS

These findings suggest that participation in CLA is moderately associated with, and may act protectively against, SCD. However, establishing a directional or causal relationship between CLA participation and SCD outcomes requires further investigation through longitudinal and/or interventional studies.

Associations between multiple metals exposure and cognitive function in the middle-aged and older adults from China: A cross-sectional study

The rapidly rising risk of cognitive decline is a serious challenge for the elderly. As the wide-distributed environmental chemicals, the effects of metals exposure on cognitive function have attracted much attention, but the results remain inclusive. This study aimed to investigate the roles of multiple metals co-exposure on cognition. We included a total of 6112 middle-aged and older participants, detected their plasma levels of 23 metals by using inductively coupled plasma mass spectrometry, and assessed their cognitive function by using the Mini-Mental State Examination (MMSE). The results showed that increased plasma levels of iron (Fe) and zinc (Zn) were positively associated with MMSE score, but the increased levels of nickel (Ni) and lead (Pb) were associated with decreased MMSE score (all FDR < 0.05). Subjects exposed to both high levels of Ni and Pb showed the lowest MMSE score [β (95% CI) = -0.310 (-0.519, -0.100)], suggesting that Ni and Pb had a synergistic toxic effect on cognitive function. In addition, the hazardous roles of Ni and Pb were mainly found among subjects with low plasma level of Zn, but were not significant among those with high-Zn level [Ni: β (95% CI) = -0.281 (-0.546, -0.015) vs. -0.146 (-0.351, 0.058); Pb: β (95% CI) = -0.410 (-0.651, -0.169) vs. -0.060 (-0.275, 0.155)], which suggested that Zn could attenuate the adverse effects of Pb and Ni on cognitive function. The cognitive function was gradually decreased among subjects with increased number of adverse exposures to the above four metals (Ptrend < 0.001). In conclusion, our findings revealed the individual, interactive, and combined effects of Fe, Ni, Pb, and Zn on cognitive function, which may provide new perspectives on cognitive protection, but further prospective cohort studies and biological researches are needed to validate these findings.

Impact of physical fitness and lifelong education on mild cognitive impairment in older adults

PURPOSE

The aim of this study was to explore the relationships among physical fitness, formal education levels, social educational experiences, and mild cognitive impairment in older adults.

METHODS

Using the Korean version of the mini-mental state examination, senior fitness tests, and questionnaires on social educational experiences and physical activity, the study assessed data on 148 Korean participants 65 years and above. Multiple linear regression analysis was conducted to examine the relationships among the factors.

RESULTS

The average age of the participants was 79.54 ± 0.55 years. Educational level showed a significant negative relationship with cognitive function scores, explaining 17.7% of the variance (R² = 0.177, p < 0.001). Current social educational experiences were significantly associated with a lower prevalence of mild cognitive impairment. Those without current social educational experiences were 1.946 times more likely to have MCI (p < 0.05) than those with such experiences. Physical fitness components, such as right upper body strength (OR = 1.171, 95% CI: 1.001-1.370), agility (OR = 1.246, 95% CI: 0.961-1.616), and cardiorespiratory fitness (OR = 0.975, 95% CI: 0.950-0.999), were also significantly associated with cognitive function. Additionally, older adult men had a higher likelihood of MCI than older adult women did (OR = 0.276, 95% CI: 0.097-0.782).

CONCLUSION

The findings highlight the importance of education, ongoing social educational experiences, and physical fitness in maintaining cognitive health in older adults. Thus, promoting lifelong education and physical fitness programs may help reduce the risk of mild cognitive impairment in older adults.

The effects of work on cognitive functions: a systematic review

Introduction

Cognitive functions play a crucial role in individual's life since they represent the mental abilities necessary to perform any activity. During working life, having healthy cognitive functioning is essential for the proper performance of work, but it is especially crucial for preserving cognitive abilities and thus ensuring healthy cognitive aging after retirement. The aim of this paper was to systematically review the scientific literature related to the effects of work on cognitive functions to assess which work-related factors most adversely affect them.

Method

We queried the PubMed and Scopus electronic databases, in February 2023, according to the PRISMA guidelines (PROSPERO ID number = CRD42023439172), and articles were included if they met all the inclusion criteria and survived a quality assessment. From an initial pool of 61,781 papers, we retained a final sample of 64 articles, which were divided into 5 categories based on work-related factors: shift work (n = 39), sedentary work (n = 7), occupational stress (n = 12), prolonged working hours (n = 3), and expertise (n = 3).

Results

The results showed that shift work, occupational stress, and, probably, prolonged working hours have detrimental effects on cognitive functioning; instead, results related to sedentary work and expertise on cognitive functions are inconclusive and extremely miscellaneous.

Discussion

Therefore, workplace health and well-being promotion should consider reducing or rescheduling night shift, the creation of less demanding and more resourceful work environments and the use of micro-breaks to preserve workers' cognitive functioning both before and after retirement.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023439172, identifier CRD42023439172.

Do executive functions explain older adults' health-related quality of life beyond event-based prospective memory?

Previous work has shown that event-based prospective memory (EBPM) predicted health-related quality of life (HrQoL). In the present study, we aimed to examine whether the relationship between EBPM and HrQoL extended to life satisfaction, and whether it persisted after controlling for other cognitive functions related to EBPM, namely executive functions and retrospective memory. We tested two models using structural equation modeling with latent variables in a sample of older adults. In the first model, we assessed whether EBPM predicted life satisfaction and HrQoL; in the second model, we controlled for retrospective memory and executive functions. The first model indicated that EBPM was related to HrQoL. However, in the second model, this relationship was eliminated by executive functions; life satisfaction was not related to any of the cognitive variables. Findings corroborated the link between HrQoL and EBPM, suggesting that such relationship stems from executive functions rather than retrospective memory.

Early- to late-life environmental factors and late-life global cognition in septuagenarian and octogenarians: The SONIC study

This study aimed to evaluate cognitively stimulating environments throughout life and to examine direct and indirect associations between these environments and late-life cognition. Early-life education, three domains of work complexity (data, people, and things) based on the longest-held occupation, and engagement in late-life leisure activities (LAs) were assessed. A structural equation model was developed using cross-sectional data of 1721 Japanese older adults in 70 ± 1 and 80 ± 1 years. The model confirmed significant direct effects of work complexity with data and late-life LAs on late-life cognitive performance. The associations of education and work complexity with late-life cognition were mediated through the subsequent environment(s). However, the total effects of work complexity with people and things on late-life cognition were insignificant. The findings suggest that cognitively stimulating activities in adulthood and beyond may lead to individual differences in late-life global cognition. In addition, antecedent complex environments might make subsequent life environments more cognitively stimulating. The results are discussed from the perspectives of cognitive plasticity and environmental complexity.

A Decade Later on How to "Use It" So We Don't "Lose It": An Update on the Unanswered Questions about the Influence of Activity Participation on Cognitive Performance in Older Age

Activity engagement is a modifiable factor that has been widely-cited as being good for the aging brain and cognition and represents a valuable target for reducing dementia risk. However, specific issues about activity engagement (mental, social, and physical) and cognition in older adulthood remain, and Bielak [Gerontology 2010;56: 507-519] reviewed seven major methodological and theoretical questions about this relationship. We present an updated reflection on these key questions, focusing on research published in the last 10 years. For some questions, a significant amount of work has been done and conclusions have become clearer; for others, there have been few additions to the literature and our knowledge remains much the same as it was a decade ago. We review the issues identified in the 2010 paper including the directionality and temporal nature of the relationship; whether specific activity domains offer different benefits to cognition and what domain(s) of cognition are affected; variation in the relation by age, gender, or education; potential mechanisms involved; and how activity engagement is assessed. For each, we present the most up-to-date research, discuss remaining challenges and possible future directions. This formal unifying of the information in the field is intended as a guide to support continued progress by spurring on studies addressing specific questions while reminding researchers of critical issues. We conclude with recommendations that future studies investigating the link between activity engagement and cognitive performance in adulthood should consider.

Effect of leisure activities on cognitive aging in older adults: A systematic review and meta-analysis

Abnormal cognitive aging in older adults is a growing public health problem. Previous studies showed inconsistent results pertaining to the effects of leisure activities on cognitive function in older adults. We conducted a systematic review and meta-analysis of published observational longitudinal studies to examine and synthesize the effects of leisure activities on cognitive function in older adults. MEDLINE, PubMed, EMBASE, PsycINFO (Ovid), CINAHL (EBSCO), and Web of Science databases were searched from January 2012 to January 2022. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using random-effects meta-analysis. Most studies found that leisure activities had a positive effect on cognitive function in older adults. The pooled RR for the effect of leisure activity on cognitive function was 0.77 (95% CI: 0.72-0.81, p < 0.01). The effects of leisure activities on cognitive function varied by different cognitive statuses in older adults, with RRs ranging from 0.55 (95% CI: 0.37-0.83) to 1.07 (95% CI: 0.95-1.22). Meta-regression analysis showed that compared with studies with percentage of female ≥50%, studies with female participant percentage <50% had significantly increased RR (p = 0.01). Moreover, studies conducted in European and American countries had significantly lower RR (p = 0.019), compared with those conducted in Asian countries. Our study revealed different effects of various types of leisure activities on different cognitive statuses in older adults. To make innovative recommendations for promoting cognitive function in older adults, more detailed observational longitudinal studies investigating the effects of different types of leisure activities on different cognitive statuses in older adults are needed.

The Relation of Having Experienced a Fall in the Past to Lower Cognitive Functioning in Old Age Is Mediated via Less Physical Activity Engagement as Cognitive Reserve Contributor

Physical activity and exercise contribute to the accumulation of cognitive reserve, which is instrumental for preserving cognitive health in old age. In a large sample of 701 older adults (mean age = 70.36 years), we investigated whether the relationship between having experienced a fall in the past and lower performance in cognitive functioning was mediated via less physical activity engagement as a cognitive reserve contributor. General cognition was assessed using the mini-mental state examination (MMSE), long-term memory using a word-pair delayed recall test and working memory using a backward digit-span test. In face-to-face interviews, individuals reported information on falls during the past 12 months and their habitual physical activity engagement. Our analyses demonstrated that the relationship between having experienced a fall in the past and lower performance in the cognitive functioning measures was partly mediated (by 16.3% for general cognition, 30.6% for long-term memory, and 33.1% for working memory, respectively) via less physical activity engagement. In conclusion, we suggest as a core bio-psychological mechanism that experiencing a fall at an older age is a critical life event that hinders sufficient physical activity engagement and thereby impedes cognitive reserve build-up, resulting in lower cognitive functioning outcomes.

Dementia Prevention in Clinical Practice

Over 55 million people globally are living with dementia and, by 2050, this number is projected to increase to 131 million. This poses immeasurable challenges for patients and their families and a significant threat to domestic and global economies. Given this public health crisis and disappointing results from disease-modifying trials, there has been a recent shift in focus toward primary and secondary prevention strategies. Approximately 40% of Alzheimer's disease (AD) cases, which is the most common form of dementia, may be prevented or at least delayed. Success of risk reduction studies through addressing modifiable risk factors, in addition to the failure of most drug trials, lends support for personalized multidomain interventions rather than a "one-size-fits-all" approach. Evolving evidence supports early intervention in at-risk patients using individualized interventions directed at modifiable risk factors. Comprehensive risk stratification can be informed by emerging principals of precision medicine, and include expanded clinical and family history, anthropometric measurements, blood biomarkers, neurocognitive evaluation, and genetic information. Risk stratification is key in differentiating subtypes of dementia and identifies targetable areas for intervention. This article reviews a clinical approach toward dementia risk stratification and evidence-based prevention strategies, with a primary focus on AD.

Leisure Activity Variety and Brain Volume Among Community-Dwelling Older Adults: Analysis of the Neuron to Environmental Impact Across Generations Study Data

Background: Recent findings indicate that leisure activity (LA) delays cognitive decline and reduces the risk of dementia. However, the association between LA and brain volume remains unclear. This study aimed to examine the association between LA variety and brain volume with a focus on the hippocampus and gray matter. Methods: Data were obtained from the baseline survey of the Neuron to Environmental Impact across Generations study, which had targeted community-dwelling older adults living in Niigata, Japan. We divided LAs into 10 categories, and counted the number of categories of activities in which the participants engaged. We classified them as follows: 0 (i.e., no activity), 1, 2, or ≥ 3 types. Brain volume was assessed through magnetic resonance imaging, and hippocampal and gray matter volumes were ascertained. Results: The sample size was 482. Multiple linear regression analysis showed that hippocampal and gray matter volumes were significantly greater among participants with ≥ 3 types of LAs than among their no-activity counterparts. Hippocampal volume was significantly greater among those who engaged in one type of LA than among those who engaged in no such activity. Sex-stratified analysis revealed that hippocampal volumes were significantly greater among males who engaged in ≥ 3 types of LAs and one type of LA. However, no such association was found among females. Conclusion: The present findings suggest that engaging in a wide range of LAs is related to hippocampal and gray matter volumes. Furthermore, there was a sex difference in the association between LA variety and brain volume.

Interactional Effects Between Relational and Cognitive Reserves on Decline in Executive Functioning

OBJECTIVES

The present study set out to investigate associations of cognitive reserve (as indicated by education) and relational reserve (as indicated by the family network size and indices of emotional support) to decline in executive functioning over 6 years as measured by changes in Trail Making Test (TMT) completion time in older adults and whether education and network size interacted with age and sex as covariates with respect to this longitudinal association.

METHOD

We analyzed data from 897 participants tested on TMT parts A and B in two waves 6 years apart. The mean age in the first wave was 74.33 years. Participants reported information on their family networks and their level of education.

RESULTS

Latent change score modeling testing for moderation effects revealed a significant interaction of network size in the first wave of data assessment with education. Specifically, for lower levels of cognitive reserve (-1 SD of education), the longitudinal association between relational reserve in the first wave and subsequent changes in executive functioning was not significant. In contrast, for higher levels of cognitive reserve (+1 SD of education), a higher relational reserve in the first wave significantly predicted a smaller subsequent increase in TMT completion time from the first to the second wave (i.e., a smaller decline in executive functioning).

DISCUSSION

The present longitudinal study provides evidence for the interaction between cognitive and relational reserves. This confirms the hypothesis that reserves from different domains are intertwined and their combined effects contribute to less cognitive decline in old age.

The relationship of obesity predicting decline in executive functioning is attenuated with greater leisure activities in old age

Objectives: We investigated the longitudinal relationship between obesity and subsequent decline in executive functioning over six years as measured through performance changes in the Trail Making Test (TMT). We also examined whether this longitudinal relationship differed by key markers of cognitive reserve (education, occupation, and leisure activities), taking into account age, sex, and chronic diseases as covariates.Method: We used latent change score modeling based on longitudinal data from 897 older adults tested on TMT parts A and B in two waves six years apart. Mean age in the first wave was 74.33 years. Participants reported their weight and height (to calculate BMI), education, occupation, leisure activities, and chronic diseases.Results: There was a significant interaction of obesity in the first wave of data collection with leisure activities in the first wave on subsequent latent change. Specifically, obesity in the first wave significantly predicted a steeper subsequent decline in executive functioning over six years in individuals with a low frequency of leisure activities in the first wave. In contrast, in individuals with a high frequency of leisure activities in the first wave, this longitudinal relationship between obesity and subsequent decline in executive functioning was not significant.Conclusion: The longitudinal relationship between obesity and subsequent decline in executive functioning may be attenuated in individuals who have accumulated greater cognitive reserve through an engaged lifestyle in old age. Implications for current cognitive reserve and gerontological research are discussed.

Motivation as a Mediator of the Relation Between Cognitive Reserve and Cognitive Performance

OBJECTIVES

Interindividual differences in cognitive aging may be explained by differences in cognitive reserve (CR) that are built up across the life span. A plausible but underresearched mechanism for these differences is that CR helps compensating cognitive decline by enhancing motivation to cope with challenging cognitive situations. Theories of motivation on cognition suggest that perceived capacity and intrinsic motivation may be key mediators in this respect.

METHOD

In 506 older adults, we assessed CR proxies (education, occupation, leisure activities), motivation (perceived capacity, intrinsic motivation), and a global measure of cognitive functioning.

RESULTS

Perceived capacity, but not intrinsic motivation, significantly mediated the relation between CR and cognitive performance.

DISCUSSION

Complementary with neurobiological and cognitive processes, our results suggest a more comprehensive view of the role of motivational aspects built up across the life span in determining differences in cognitive performance in old age.

Mitigating the negative impacts of aging on cognitive function; modifiable factors associated with increasing cognitive reserve

Research suggests that social, physical, and cognitively challenging activities during lifetime, could mitigate the negative effects of aging on cognitive function. This effect is explained by the increased cognitive reserve (CR) resulting from such factors; in fact, such activities, by altering structural and functional properties of the human brain, equip one with more effective compensatory mechanisms to resist brain damage before the presentation of severe clinical symptoms. Therefore, applying appropriate modifications in one's lifestyle and activities may be effective in lowering the risk of developing dementia and cognitive dysfunction in old age, especially in brain areas that are susceptible to aging. In this paper, we are going to review relevant studies discussing the association between important modifiable factors, known as CR proxies (i.e., educational attainment, occupational complexity, physical activity, social engagement, bilingualism, leisure activities, and Mediterranean diet), and different domains of cognitive function, which are affected either in the process of healthy aging or neurodegenerative diseases.

Specific Activities and the Trajectories of Cognitive Decline Among Middle-Aged and Older Adults: A Five-Year Longitudinal Cohort Study

BACKGROUND

How specific activities influence cognitive decline among different age groups, especially the late middle-aged and the early old, remains inadequately studied.

OBJECTIVE

To examine the association between specific activities with trajectories of cognitive functions in different age groups in China.

METHODS

A longitudinal cohort study was conducted based on data from the China Health and Retirement Longitudinal Study (CHARLS). Mixed effects growth models were applied to analyze the association between specific activities and cognitive functions.

RESULTS

Interacting with friends (infrequent: β= 0.13, confidence interval [CI] = 0.03 to 0.22; daily: β= 0.19, CI = 0.09 to 0.28), playing Mah-jong or other games (infrequent: β= 0.12, CI = 0.02 to 0.22; daily:β= 0.26, CI = 0.10 to 0.42), infrequent providing help to others (β= 0.24, CI = 0.11 to 0.37), and going to a sport (infrequent: β= 0.31, CI = 0.08 to 0.54); daily: β= 0.22, CI = 0.05 to 0.38) are significantly associated with participants' memory. Infrequently playing Mah-jong or other games (β= 0.30, CI = 0.17 to 0.43) and daily sports (β= 0.24, CI = 0.03 to 0.45) are significantly associated with better mental status. Effect of each activity varies among population of different age, education level, gender, and residence.

CONCLUSION

This study identifies four social activities that are associated with better cognitive functions, and provides a comprehensive, in-depth understanding on the specific protective effect of each activity among different subgroups.

Reserva cognitiva e os diferentes perfis de ganho cognitivo em idosos

O objetivo desse estudo foi verificar diferentes perfis de ganho cognitivo em idosos para a reserva cognitiva. Trata-se de uma scoping review, utilizando-se PubMed, Medline, Web of Science, Science Direct, Lilacs, SciELO, PsycInfo, PsycNet e AgeLine como base de dados; restringiu-se a busca entre o ano de 2008 e 2018. Identificou-se 2295 estudos e 51 foram elegíveis para a revisão. Dentre os 51 estudos selecionados, encontrou-se 9 perfis diferentes para manutenção cognitiva, sendo que 5 estudos não especificaram o perfil. Conclusão: Os perfis encontrados representaram relevância para a teoria de reserva cognitiva e forneceram esclarecimentos de como fatores individuais e de vida diária podem fazer o cérebro mais resiliente no envelhecimento e na velhice; no entanto, esses fatores individuais e o modo como eles contribuem para o desenvolvimento da reserva cognitiva e da manutenção da cognição ainda permanecem obscuras na literatura

Internet use in old age predicts smaller cognitive decline only in men

Internet use provides cognitive stimulation and thereby may contribute to the accumulation of cognitive reserve that is proposed to be instrumental for maintaining cognitive health in ageing. As the first study so far, we examined possible gender differences in the relationship between Internet use and subsequent cognitive decline over six years assessed through changes in Trail Making Test (TMT) accomplishment time in 897 older adults. Latent change score modelling (taking into account baseline cognitive level, chronic diseases, age, and central contributions to cognitive reserve through education, profession, and leisure engagement) revealed a significant interaction of frequency of Internet use and gender. More frequent Internet use in the first wave of data collection significantly predicted a smaller subsequent augmentation in TMT accomplishment time (i.e., a smaller subsequent cognitive decline) only in men, but not in women. In conclusion, frequent Internet use may contribute to the accumulation of cognitive reserve. The gender difference noted highlights an advantage for males. While this finding could be interpreted as gender-specific, it may be that the Internet activities males engage in differ from those of females, calling for a fine-grained investigation of Internet-based activities in future studies.

Relationship between education, leisure activities, and cognitive functions in older adults

This study aimed to reveal the relationship between life activities and cognitive function and to evaluate the interaction between education and various leisure activities in predicting cognitive function. Using a cross-sectional research design with retrospective data, a total of 210 healthy Korean older adults participated and reported their years of education, working, and lifelong leisure activities. Cognitive function was measured using the Mini Mental State Examination. A hierarchical multiple regression analysis showed that education was positively associated with cognitive function, whereas working activity was not. Craft activities positively predicted cognitive function. Furthermore, education moderated the relationship between leisure activities and cognitive function. Only low-educated participants showed a decrease in cognitive function as they performed domestic chores and an increase in cognitive function as they participated in social activities and volunteering. High-educated participants showed no relation between leisure activities and cognitive function. The results of the current study suggest that the relationship between various leisure activities and cognitive function can vary based on the nature of the leisure activity and educational level. Professionals examining older adults' cognitive function should pay closer attention to educational level, as well as life styles (i.e. leisure activities), to provide appropriate interventions.

Advantaged socioeconomic conditions in childhood are associated with higher cognitive functioning but stronger cognitive decline in older age

There is increasing evidence that socioeconomic conditions early in life have an impact on cognitive functioning in later life. Based on the large longitudinal sample from SHARE we find a clear pattern in cognitive functioning in old age, related to childhood socioeconomic conditions: Those from more affluent households show higher levels of fluid intelligence in old age and experience stronger decline over time in executive functions. The latter phenomenon is not often documented. Although modifications in cognitive functioning with aging are inevitable, life course socioeconomic circumstances impact the timing of this process. We conclude that the etiology of cognitive aging is the result of multiple social processes, defined by the socioeconomic conditions in childhood and all along the life course.

Cognitive aging is characterized by large heterogeneity, which may be due to variations in childhood socioeconomic conditions (CSC). Although there is substantial evidence for an effect of CSC on levels of cognitive functioning at older age, results on associations with cognitive decline are mixed. We examined by means of an accelerated longitudinal design the association between CSC and cognitive trajectories from 50 to 96 years. Cognition included two functions generally found to decline with aging: delayed recall and verbal fluency. Data are from six waves of the Survey of Health, Aging, and Retirement in Europe (SHARE), conducted between 2004 and 2015 (n = 24,066 at baseline; 56% female, age 50+). We found a consistent CSC pattern in levels of cognitive functioning in later life. Older people with disadvantaged CSC had lower levels of cognitive functioning than those with more advantaged CSC. We also find that decline is almost 1.6 times faster in the most advantaged group compared with the most disadvantaged group. The faster decline for people with more advantaged CSC becomes less pronounced when we additionally control for adulthood socioeconomic conditions and current levels of physical activity, depressive symptoms, and partner status. Our findings are in line with the latency, pathway, and cumulative model and lend support to theories of cognitive reserve, stating that neuronal loss can no longer be repaired in people with more cognitive reserve once the underlying pathology is substantial and speed of decline is accelerated.

The relation of close friends to cognitive performance in old age: the mediating role of leisure activities

ABSTRACTBackground:From a conceptual point of view, close friends are an important resource for promoting activity engagement in old age. Leisure activity engagement in turn is a key predictor of cognitive performance. Empirically, it remains unclear so far whether leisure activity engagement mediates between having close friends on the one hand and cognitive performance on the other, which we investigated in a large sample of older adults.

METHODS

We assessed cognitive performance (Mill Hill vocabulary scale and Trail Making Test (TMT) parts A and B) in 2,812 older adults. Participants reported information on leisure activity engagement and close friends.

RESULTS

A larger number of leisure activities and a larger number of close friends were significantly related to better cognitive performance in the Mill Hill vocabulary scale and TMT parts A and B. A larger number of close friends were significantly related to a larger number of leisure activities. The number of leisure activities mediated more than half of the relation of the number of close friends to performance in all three cognitive measures.

CONCLUSIONS

Having close friends may be helpful to stimulate and promote activity participation in old age. By enhancing individuals' cognitive reserve, this may finally preserve their cognitive performance level in old age.

Cognitive Reserve and Social Capital Accrued in Early and Midlife Moderate the Relation of Psychological Stress to Cognitive Performance in Old Age

AIMS

The present study set out to investigate the relation of psychological stress to cognitive performance and its interplay with key life course markers of cognitive reserve and social capital in a large sample of older adults.

METHODS

We assessed cognitive performance (verbal abilities and processing speed) and psychological stress in 2,812 older adults. The Participants reported information on education, occupation, leisure activities, family, and close friends.

RESULTS

Greater psychological stress was significantly related to lower performance in verbal abilities and processing speed. Moderation analyses suggested that the relations of psychological stress to cognitive performance were reduced in individuals with higher education, a higher cognitive level of the first profession practiced after education, a larger number of midlife leisure activities, a larger number of significant family members, and a larger number of close friends.

CONCLUSION

Cognitive reserve and social capital accrued in early and midlife may reduce the detrimental influences of psychological stress on cognitive functioning in old age.

The role of cognitive reserve accumulated in midlife for the relation between chronic diseases and cognitive decline in old age: A longitudinal follow-up across six years

OBJECTIVES

The present study set out to investigate relations of the number of chronic diseases (as a global indicator of individuals' multimorbidity) to cognitive status and cognitive decline over six years as measured by changes in Trail Making Test (TMT) completion time in old adults and whether those relations differed by key life course markers of cognitive reserve (education, occupation, and cognitively stimulating leisure activities).

METHOD

We analyzed data from 897 participants tested on TMT parts A and B in two waves six years apart. Mean age in the first wave was 74.33 years. Participants reported information on chronic diseases, education, occupation, and cognitively stimulating leisure activities.

RESULTS

Latent change score modeling testing for moderation effects revealed that a larger number of chronic diseases significantly predicted stronger increase in TMT completion time (i.e., steeper cognitive performance decline). Notably, the detrimental relation of the number of chronic diseases to stronger increase in TMT completion time (i.e., cognitive performance decline) was significantly stronger in individuals with less engagement in cognitively stimulating leisure activities in midlife.

DISCUSSION

Present data suggest that disease-related cognitive decline may be steeper in individuals who have accumulated less cognitive reserve in midlife. However, greater midlife activity engagement seemed to be associated with steeper cognitive decline in any case. Implications for current cognitive reserve and neuropsychological aging research are discussed.

APOE ε4 Genotype and Cognitive Reserve Effects on the Cognitive Functioning of Healthy Elders

AIM

To test the association between cognitive performance and APOE genotype, and to assess potential modifications of this association by sociodemographic and neuroanatomical factors in a sample of 74 healthy elders.

METHODS

Firstly, we explored the isolated role of the APOE ɛ4 genotype (i.e., APOE4) in different neuropsychological tests, and then the effects of its interaction with sociodemographic (i.e., age, gender, and educational level) and neuroanatomical (i.e., hippocampal volumes) variables. Subsequently, we performed the same analyses after dividing the sample into two subgroups according to their Mini-Mental State Examination scores (control-high group ≥29 and control-low group < 29).

RESULTS

In the whole group, APOE4 carriers exhibited a significantly poorer execution in several cognitive domains including global cognitive functioning, episodic memory, verbal fluency, and naming. This effect was more noticeable in older and less educated subjects. The separated analyses revealed that APOE4 carriers in the control-low group exhibited lower scores in global cognitive functioning and episodic memory, while no effects were observed in the control-high group. Neither gender nor hippocampal volumes showed a significant interaction effect with APOE genotype.

CONCLUSIONS

Current results point out that APOE4 genotype influences healthy aged cognition, although factors such age or educational attainment seem to modulate its effects.

Development of reserves over the life course and onset of vulnerability in later life

This Review develops a theoretical framework for the development and onset of vulnerability in later life based on the concept of reserves. We stress the advantages of using the concept of reserves in interdisciplinary life-course studies, compared with related concepts such as resources and capital. We enrich the definition of vulnerability as a lack of reserves and a reduced capacity of an individual to restore reserves. Two dimensions of reserves, originating from lifespan psychology and gerontology, are of particular importance: their constitution and sustainability by behaviours and interaction with the environment (the 'use it or lose it' paradigm) and the presence of thresholds, below which functioning becomes highly challenging. This heuristic approach reveals the potential for a conceptualization of reserves and is exemplified in an empirical illustration. Further interdisciplinary research based on the concept is needed.

High-Density Lipoprotein Cholesterol Level Relates to Working Memory, Immediate and Delayed Cued Recall in Brazilian Older Adults: The Role of Cognitive Reserve

AIMS

The present study set out to investigate the relation of the high-density lipoprotein cholesterol (HDL-C) level to cognitive performance and its interplay with key markers of cognitive reserve in a large sample of older adults.

METHODS

We assessed tests of working memory, immediate and delayed cued recall in 701 older adults from Amazonas, Brazil. The HDL-C level was derived from fasting blood samples. In addition, we interviewed individuals on their education, past occupation, and cognitive leisure activity.

RESULTS

A critically low HDL-C level (<40 mg/dL) was significantly related to lower performance in working memory, immediate and delayed cued recall. Moderation analyses suggested that the relations of the HDL-C level to working memory and delayed cued recall were negligible in individuals with longer education, a higher cognitive level of the job, and greater engagement in cognitive leisure activity.

CONCLUSION

Cognitive reserve accumulated during the life course may reduce the detrimental influences of a critically low HDL-C level on cognitive functioning in old age.

Cognitively Stimulating Leisure Activity and Subsequent Cognitive Function: A SHARE-based Analysis

Purpose of the Study

The aim of the inquiry was to examine whether cognitively stimulating leisure activity (CSLA) can delay or reduce cognitive decline in late life and whether its effect is moderated by education, age, or activity pattern.

Design and Methods

Employing secondary analysis of data on respondents aged 65 and older from the 4th and 5th waves of the Survey of Health, Ageing and Retirement in Europe (N = 16,572), the inquiry regressed cognitive function (memory, numeracy, and fluency) at Time 2 on frequency of engagement in CSLA at baseline, controlling for cognitive function scores at baseline and a range of confounders. The study also considered education by CSLA and age by CSLA interactions, as well as the effect of CSLA patterns.

Results

CSLA frequency was found to be positively related to subsequent cognitive functioning on all measures, 2 years later. The effect of CSLA on memory and fluency was stronger among those with lower education, whereas the age by CSLA interaction was not significant. Respondents who started CSLA after baseline showed better cognitive functioning at Time 2 than those who did not engage in CSLA at all and those who had engaged in such activity at baseline but stopped.

Implications

The study documents that CSLAs constitute a potential source for the delay or reduction of cognitive decline, regardless of one's age. As such, practitioners should recognize the value of this medium and encourage its greater use in appropriate settings.

Bells Test: Are there differences in performance between adult groups aged 40-59 and 60-75?

Objective

To verify whether differences exist between groups of Brazilian adults aged 40-59 and 60-75 in respective performance on the Bells Test, given the dearth of literature investigating the relationship between focused visual attention and the age factor.

Methods

Eighty-four neurologically healthy adults (half aged 40-59 and half 60-75) with high educational level (40-59 years group: M=17.75 years' education; SD=4.00; 60-75 years group: M=15.85 years education; SD=3.19) were assessed using the Bells Test. Data on accuracy and processing speed were compared between groups by ANCOVA, controlled for the covariates education and frequency of reading and writing habits.

Results

There were no significant differences between the age groups.

Conclusion

It is suggested that aging influences sustained and focused attention and speed processing after 75 years of age on visual cancellation paradigms, when executive and attentional changes tend to be more marked. Further studies should investigate healthy older and oldest-old adults, as well as groups with low and intermediate educational backgrounds. In addition, Brazilian clinical populations should also be characterized, particularly those with neurological disorders that might have visual hemineglect.

The impact of physical activity and sex differences on intraindividual variability in inhibitory performance in older adults

It is well-known that processing speed and executive functions decline with advancing age. However, physical activity (PA) has a positive impact on cognitive performances in aging, specifically for inhibition. Less is known concerning intraindividual variability (iiV) in reaction times. This study aims to investigate the influence of PA and sex differences on iiV in inhibitory performance during aging. Healthy adults were divided into active and sedentary groups according to PA level. To analyse iiV in reaction times, individual mean, standard deviation and the ex-Gaussian parameters were considered. An interaction between activity level and sex was revealed, sedentary females being slower and more variable than sedentary men. No sex differences were found in the active groups. These results indicate that the negative impact of sedentariness on cognitive performance in older age is stronger for females. The present findings underline the need to consider sex differences in active aging approaches.

The Relation of Hypertension to Performance in Immediate and Delayed Cued Recall and Working Memory in Old Age: The Role of Cognitive Reserve

OBJECTIVE

We investigated the relation of hypertension to cognitive performance and its interplay with key markers of cognitive reserve in a large sample of older adults.

METHOD

We assessed tests of immediate and delayed cued recall and working memory in 701 older adults. We measured systolic blood pressure and interviewed individuals on their education, past occupation, and cognitive leisure activity.

RESULTS

Hypertension (≥140 mmHg) was related to lower performance in all three cognitive measures. Moderation analyses suggested that these relations were reduced in individuals with greater engaging in cognitive leisure activity. Hierarchical regression analyses showed that hypertension was not related to any of the three investigated cognitive performance measures when education, cognitive level of job, and cognitive leisure activity were simultaneously taken into account.

DISCUSSION

The detrimental influences of hypertension on cognitive functioning in old age may be reduced in individuals with greater cognitive reserve accumulated during the life course.

The reciprocal relationship between participation in leisure activities and cognitive functioning: the moderating effect of self-rated literacy level

OBJECTIVE

Participation in leisure activities is beneficial for cognitive functioning of older adults, but it is less known whether it is also beneficial for those with low basic cognitive level. This study examined the reciprocal relationship between participating in leisure activities and cognitive functioning among low and higher literacy level older adults.

METHOD

Respondents aged 60 years and older who participated in both first waves (2005-2006 and 2009-2010) of the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) were divided into low (n = 139) and higher literacy level respondents (n = 714). They reported participation in leisure activities and completed measures of cognitive functioning at both waves.

RESULTS

Cross-lagged models showed that participation in leisure activities predicted higher cognitive functioning four years later only among older adults with low literacy level. On the other hand, cognitive functioning predicted more participation in leisure activities four years later only among higher literacy level older adults.

CONCLUSIONS

Participating in leisure activities may be especially beneficial to cognitive functioning among older adults with low literacy level, as their initial low cognitive level allows more room for cognitive improvement than among higher literacy level older adults. Public efforts aimed at increasing participation in leisure activities may therefore target particularly older adults with low basic cognitive level.

No cross-sectional evidence for an increased relation of cognitive and sensory abilities in old age

OBJECTIVES

A key question in gerontological research concerns whether good functioning can be maintained in some cognitive abilities in old age, even if deficits occur in other cognitive or sensory abilities. Our goals were to investigate relations of cognitive and sensory abilities in old age, whether these relations differed in size across old age, and whether this was affected by general cognitive ability (processing speed), educational level, and/or general health status.

METHODS

Two thousand eight hundred and twelve older adults (aged 65-101, M = 77.9 years) from the Vivre-Leben-Vivere survey served as cross-sectional sample for the present study. We administered psychometric tests on processing speed (the speed of cognitive processing), cognitive flexibility (the ability to alternate between cognitive operations), and verbal abilities (vocabulary). In addition, we interviewed individuals on their hearing, eyesight, educational level, and general health status. We regressed sizes of relations between abilities (calculated within each 1-year age tranche) on mean age within the corresponding age tranche, with the number of participants within the corresponding age tranche as case weights.

RESULTS

We observed a decrease in relations between processing speed and cognitive flexibility in old age that was particularly pronounced in individuals with high educational level (r = -.41). In contrast, we did not find differences in relations between other cognitive and sensory abilities across old age, which held for different levels of general cognitive ability, education, and general health status.

CONCLUSION

Present data do not support the view of a generally increased relation of cognitive and sensory abilities in old age.

The association of educational attainment, cognitive level of job, and leisure activities during the course of adulthood with cognitive performance in old age: the role of openness to experience

BACKGROUND

The relevance of mental health for everyday life functioning and well-being is crucial. In this context, higher educational attainment, higher cognitive level of one's occupation, and more engaging in stimulating leisure activities have been found to be associated with better cognitive functioning in old age. Yet, the detailed pattern of the potential interplay of such a cognitively engaged lifestyle with personality dimensions, such as openness to experience, in their relations to cognitive functioning remains unclear.

METHODS

Two thousand eight hundred and twelve older adults served as sample for the present study. Psychometric tests on verbal abilities and processing speed were administered. In addition, individuals were retrospectively interviewed on their educational attainment, occupation, and regarding 18 leisure activities that had been carried out in mid-life. Moreover, openness to experience was assessed.

RESULTS

We found that the effect of openness to experience on cognitive functioning was mediated by educational attainment, cognitive level of job, and engaging in different leisure activities. Data were not better described by alternative moderation models testing for interactive (i.e. dependent) effects of openness to experience and cognitively stimulating engagement.

CONCLUSIONS

To explain interindividual differences in cognitive functioning in old age, present data are in line with a mechanism in which individuals with high openness to experience may have been more engaged in stimulating activities in early and mid-life. Possibly by increasing their cognitive reserve throughout adulthood, this may finally enhance their cognitive performance level later in old age.

The Alzheimer's Prevention Clinic at Weill Cornell Medical College / New York - Presbyterian Hospital: Risk Stratification and Personalized Early Intervention

In July 2013, Weill Cornell Medical College founded the first Alzheimer's Prevention Clinic (APC) in the United States, providing direct clinical care to family members of patients with Alzheimer's disease (AD) as part of the Weill Cornell Memory Disorders Program. At the APC, patients seeking to lower their AD risk undergo a comprehensive assessment, receive a personalized plan based on rapidly evolving scientific evidence, and are followed over time using validated as well as emerging clinical and research technologies. The APC approach applies the principles of pharmacogenomics, nutrigenomics and clinical precision medicine, to tailor individualized therapies for patients. Longitudinal measures currently assessed in the clinic include anthropometrics, cognition, blood biomarkers (i.e., lipid, inflammatory, metabolic, nutritional) and genetics, as well as validated, self-reported measures that enable patients to track several aspects of health-related quality of life. Patients are educated on the fundamental concepts of AD prevention via an interactive online course hosted on Alzheimer's Universe (www.AlzU.org), which also contains several activities including validated computer-based cognitive testing. The primary goal of the APC is to employ preventative measures that lower modifiable AD risk, possibly leading to a delay in onset of future symptoms. Our secondary goal is to establish a cohort of at-risk individuals who will be primed to participate in future AD prevention trials as disease-modifying agents emerge for testing at earlier stages of the AD process. The clinical services are intended to lower concern for future disease by giving patients a greater sense of control over their brain health.

The role of cognitive resources for subjective work ability and health in nursing

Cognitive resources can be considered to be key variables in the context of work ability and health, particularly in the aging workforce. However, research on this issue is sparse, lacking a comprehensive examination of specific cognitive functions. Therefore, the aim of the present study was to examine the association of cognitive resources with subjective work ability and health in more detail. In 166 geriatric care workers (mean age 42.1 years, SD = 11.5, range 20-62), subjective work ability and health were assessed. Additionally, a comprehensive battery of cognitive tests measuring crystallized intelligence, cognitive speed, short-term memory, working memory, and inhibition was administered in a standardized procedure. Controlling for individual differences in age, education, depressive symptoms, self-regulation strategies (in terms of selective optimization with compensation), and cognitive resources (particularly better performance in short-term memory, working memory, and inhibition) were related to better subjective work ability and health. The present results demonstrate the relation of a variety of specific cognitive functions with subjective work ability and health over and above individual differences in age, education, depressive symptoms, and self-regulation strategies. Implications to explicitly consider a set of cognitive resources in models of work and organizational psychology, particularly with respect to the aging workforce, are discussed.