Physical predictors of cognitive performance in healthy older adults: a cross-sectional analysis

Comparative study of machine learning methods for modeling associations between risk factors and future dementia cases

A substantial portion of dementia risk can be attributed to modifiable risk factors that can be affected by lifestyle changes. Identifying the contributors to dementia risk could prove valuable. Recently, machine learning methods have been increasingly applied to healthcare data. Several studies have attempted to predict dementia progression by using such techniques. This study aimed to compare the performance of different machine-learning methods in modeling associations between known cognitive risk factors and future dementia cases. A subset of the AGES-Reykjavik Study dataset was analyzed using three machine-learning methods: logistic regression, random forest, and neural networks. Data were collected twice, approximately five years apart. The dataset included information from 1,491 older adults who underwent a cognitive screening process and were considered to have healthy cognition at baseline. Cognitive risk factors included in the models were based on demographics, MRI data, and other health-related data. At follow-up, participants were re-evaluated for dementia using the same cognitive screening process. Various performance metrics for all three machine learning algorithms were assessed. The study results indicate that a random forest algorithm performed better than neural networks and logistic regression in predicting the association between cognitive risk factors and dementia. Compared to more traditional statistical analyses, machine-learning methods have the potential to provide more accurate predictions about which individuals are more likely to develop dementia than others.

Reciprocal associations of posttraumatic stress symptoms and cognitive decline in community-dwelling older adults: The mediating role of depression

BACKGROUND

People with posttraumatic stress disorder (PTSD) may have cognitive decline, a risk which can be particularly threatening at old age. However, it is yet unclear whether initial cognitive decline renders one more susceptible to subsequent PTSD following exposure to traumatic events, whether initial PTSD precedes cognitive decline or whether the effects are reciprocal.

OBJECTIVE

This study examined the bidirectional longitudinal associations between cognitive function and PTSD symptoms and whether this association is mediated by depressive symptoms.

METHOD

The study used data from two waves of the Israeli component of the Survey of Health, Ageing, and Retirement in Europe (SHARE), collected in 2013 and 2015. This study focused on adults aged 50 years and above (N = 567, mean age = 65.9 years). Each wave used three measures of cognition (recall, fluency, and numeracy) and PTSD symptoms following exposure to war-related events. Data were analyzed using mediation analysis with path analysis.

RESULTS

Initial PTSD symptoms predicted cognitive decline in recall and fluency two years later, while baseline cognitive function did not impact subsequent PTSD symptoms. Partial mediation showed that older adults with more PTSD symptoms had higher depressive symptoms, which in turn were linked to subsequent cognitive decline across all three measures.

CONCLUSIONS

This study reveals that PTSD symptoms are linked with subsequent cognitive decline, supporting approaches addressing this direction. It further indicates that part of this effect can be explained by increased depressive symptoms. Thus, treatment for depressive symptoms may help reduce cognitive decline due to PTSD.

Doing housework and having regular daily routine standing out as factors associate with physical function in the older people

Background and objectives

Nationwide data were used to explore factors associated with physical function in order to identify interventions that could improve and maintain physical function in the older people.

Methods

The physical function was assessed by gait speed (GS). We selected 2,677 male and 2,668 female older adults (aged ≥60) who could perform the GS test as study subjects. GS was measured by having subjects walk across and back a 10-m course. A gait speed less than 20% that of a reference population (<0.7 m/s) was used as the definition of slow gait speed (SGS). Co-morbidity, polypharmacy, medical expenses, need for care, and hospitalization were used to evaluate health status. A stepwise logistic regression model was used to determine factors associated with SGS.

Results

SGS was associated with poorer health status, higher medical cost, lower ranking on the Geriatric Depression Scale (GDS) and decreased Mini-mental State Examination (MMSE). Co-morbidity (OR = 1.81, 1.58-2.07), polypharmacy (OR = 1.47, 1.25-1.74), MMSE <24 (OR = 1.85, 1.54-2.22), and GDS ≥ 11 (OR = 1.40, 1.18-1.65) were associated with SGS. In contrast, doing housework (DHW, OR = 0.43, 0.38-0.49), having a regular daily routine (RDR, OR = 0.64, 0.45-0.91), and current alcohol consumption (OR = 0.74, 0.62-0.90) were inversely associated with SGS. DHW plus having RDR could greatly reduce the risk of SGS (OR = 0.29, 0.19-0.43).

Conclusion

Poor physical function is associated with poorer health status in Chinese older people. Maintaining a regular daily routine and doing some housework may be important factors that can help older people preserve their physical function.

Detrimental effects of effortful physical exertion on a working memory dual-task in older adults

Action and cognition often interact in everyday life and are both sensitive to the effects of aging. The present study tested the effects of a simple physical action, effortful handgrip exertion, on working memory (WM) and inhibitory control in younger and older adults. Using a novel dual-task paradigm, participants engaged in a WM task with 0 or 5-distractors under concurrent physical exertion (5% vs. 30% individual maximum voluntary contraction). Effortful physical exertion, although failing to effect WM accuracy in the distractor absent condition for both age groups, reduced WM accuracy for the older, but not young adults, in the distractor-present condition. Similarly, older adults experienced greater distractor interference in the distractor-present condition under high physical exertion, indexed by slower reaction time (RT), confirmed by hierarchical Bayesian modeling of RT distributions. Our finding that a simple but effortful physical task results in impaired cognitive control may be empirically important for understanding everyday functions of older adults. For example, the ability to ignore task-irrelevant items declines with age and this decline is greater when simultaneously performing a physical task, which is a frequent occurrence in daily life. The negative interactions between cognitive and motor tasks may further impair daily functions, beyond the negative consequences of reduced inhibitory control and physical abilities in older adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploratory and confirmatory factor analyses identify three structural dimensions for measuring physical function in community-dwelling older adults

Background

Physical function is a strong indicator of biological age and quality of life among older adults. However, the results from studies exploring the structural dimensions of physical function are inconsistent, and the measures assessed vary greatly, leading to a lack of comparability among them. This study aimed to construct a model to identify structural dimensions that are suitable and best assess physical function among community-dwelling adults 60-74 years of age in China.

Method

This study was conducted in 11 communities in Shanghai, China, from May to July 2021. A total of 381 adults 60-74 years of age were included in the study. Measured physical function data were used in factor analyses. Data collected from individuals were randomly assigned to either exploratory factor analysis (EFA) (n = 190) or confirmatory factor analysis (CFA) (n = 191). The statistical software used in the study was SPSS for EFA and AMOS for CFA. To test the properties of the structural dimension model of physical function, various fit indices, convergent validity, and discriminant validity were calculated.

Results

The EFA results derived seven indicators in three factors, with 58.548% of the total variance explained. The three factors were mobility function (three indicators), which explained 26.380% of the variance, handgrip strength and pulmonary function (two indicators), which explained 19.117% of the variance, and muscle strength (two indicators) which explained 13.050% of the variance. The CFA indicated that this model had an acceptable fit (χ2/df ratio, 2.102; GFI, 0.967; IFI, 0.960; CFI, 0.959; and RMSEA, 0.076), and the criteria for convergent validity and discriminability were also met by the model.

Conclusion

The constructed structural dimension model of physical function appeared to be a suitable and reliable tool to measure physical function in community-dwelling adults aged 60-74 years in China. The structural dimension indicators identified by this model may help sports medicine experts and healthcare providers offer more targeted interventions for older adults to reverse or slow the decline of physical function and to offer actionable targets for healthy aging in this population.

Mediating effect of gait speed on the relationship between ankle-brachial index and mild cognitive impairment in hemodialysis patients

BACKGROUND

Patients undergoing hemodialysis are highly predisposed to arterial disease, poor physical performance, and cognitive impairment. However, the connection between them is not yet known. We aimed to investigate the mediating effect of physical performance on the relationship between arterial stiffness and mild cognitive impairment (MCI).

METHODS

We conducted a multicenter cross-sectional study. The final analyzed hemodialysis patients comprised 616 subjects (men 391, women 225) from seven dialysis units in Shanghai, China. MCI was assessed by Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale. Arterial function was measured by ankle-brachial index (ABI) and branchial-ankle pulse-wave velocity (baPWV). Physical function was assessed by the Short Physical Performance Battery (SPPB). Logistic regression and mediation model were used to analysis.

RESULTS

The mean age of the final analysis sample (n = 616) was 59.0 ± 12.0 years. Hemodialysis patients with MCI were more likely to have lower ABI (p < 0.001) and higher baPWV (p < 0.01). After adjusting for covariates, lower ABI (abnormal ≤0.9 and borderline 0.91-0.99) were positively associated with MCI (OR = 4.43, 95% CI = 1.89-10.39; OR = 4.83, 95% CI = 1.61-14.46). SPPB total score and its components standing balance, gait speed score were negatively associated with MCI. In the mediational model, gait speed played a mediating role (indirect effect ab = -0.21; 95% CI = -0.58 to -0.03) in the association of ABI (≤0.9) and MMSE, while standing balance and chair stands did not.

CONCLUSIONS

Lower gait speed mediates a positive association between ABI and MCI in hemodialysis patients. Suitable interventions for physical performance, especially gait speed, may reduce the risk of MCI in hemodialysis patients.

Life-course social connectedness: Comparing data-driven and theoretical classifications as predictors of functional limitations in adulthood

A life course perspective on social relationships highlights the importance of specific relationships at specific times in life, but analyses that account for life course trajectories in social relationships are rare. This study compares theoretical and data-driven approaches to classifying life course relationships, including multiple dimensions of social connectedness at different time points across the life course. We examine each approach's ability to predict later-life functional limitations, given that functional impairment is prevalent among middle-aged and older adults. Data were from three waves of the Midlife in the United States (MIDUS) study (n = 6909). Relationship variables (parental affection, parental discipline, social support, social strain, and positive relations with others) were from wave 1 or wave 2. Functional limitations were measured at wave 3. Results showed that the data-driven approach had more predictive power than the theoretical approach. Additionally, results suggested that including only positive relationship features was nearly as robust as including both positive and negative relationship features. Overall, the data-driven approach outperformed the theoretical approach and revealed relationship trajectories consistent with life course cumulative processes.

Cognition and brain health among older adults in Iceland: the AGES-Reykjavik study

The paper aimed to compare how factors previously identified as predictive factors for cognitive decline and dementia related to cognitive performance on the one hand and brain health on the other. To that aim, multiple linear regression was applied to the AGES-Reykjavik study epidemiological data. Additionally, a regression analysis was performed for change in cognition over 5 years, using the same exposure factors. The study ran from 2002 to 2011, and the sample analyzed included 1707 participants between the ages of 66 and 90. The data contains MR imaging, cognitive testing, background data, and physiological measurements. Overall, we conclude that risk factors linked to dementia relate differently to cognition and brain health. Mobility, physical strength, alcohol consumption, coronary artery disease, and hypertension were associated with cognition and brain volume. Smoking, depression, diabetes, and body fat percentage were only associated with brain volume, not cognitive performance. Modifiable factors previously linked to cognitive reserve, such as educational attainment, participation in leisure activities, multilingualism and good self-reported health, were associated with cognitive function but did not relate to brain volume. These findings show that, within the same participant pool, cognitive reserve proxy variables have a relationship with cognitive performance but have no association with relative brain volume measured simultaneously.

Cognitive ability and motor performances in the elderly

Background/Aim. Aging entails a wide range of cognitive processes that are not independent of one another. It leads to changes in physical-motor characteristics and sometimes to disability. The aim of this study was to examine the association between multiple cognitive performances in elderly subjects and their physical-motor abilities. Method. The study included 98 elderly participants (60+) (16 males and 82 females). Cognitive abilities were assessed by the Montreal Cognitive Assessment (MoCA)/Serbian version, and physical measures were assessed by the Senior Fitness Test with its five subtests, supplemented by the Walking Speed Test. Results. Several MoCA items demonstrated relatively low variability, i.e., they proved to be too easy for most of the participants. The participants exhibited the lowest performance on the memory relating to other domains, followed by executive functions, visuospatial skills, attention, concentration, and working memory domains, with the highest performance on temporal and spatial orientation relating to other domains. Executive functions and language correlated most significantly with physical strength. Agility and dynamic balance, lower- and upper-body strength, and aerobic endurance correlated moderately and positively. Conclusion. This study underlines the positive correlation between physical fitness and cognitive level in the elderly and emphasizes the importance of physical fitness for cognitive functions, especially those of executive type in elderly subjects. Clinicians should consider the association between cognitive function and physical-motor performances when dealing with functioning improvement in the elderly. The importance of designing the most efficient exercise pro-grams to achieve maximal somatic and cognitive effects is emphasized.

Predictors of Future Walking Speed: A 12-Month Monitoring Program

The purpose of the current study was to identify significant predictors of walking speed (WS) among community-dwelling older adults, as it is one of the most representative measures of functioning in their daily lives. Seventy-seven (24 adult men, 26 adult women, and 27 older-adult women) community-dwelling older adults (73.7 ± 4.9 years) performed two assessments, over a 12-month period. Several physical, cognitive, and psychological tests were performed, as well as assessing the preferred WS. Multiple linear regression, stratified by gender, was used to identify significant predictors of future WS. For the adult men, walking and functional performances at the first assessment predicted 71.9%; for adult women, reaction time, walking, and balance performance predicted 64.4%; and, for the older-adult women, fast walking and reaction time predicted 48.2% of the variance of future WS. Clinicians should consider including different exercises for each group of older adults to evaluate and preserve functional abilities.

An Updated Narrative Review on Ergometric Systems Applied to Date in Assessing Divers' Fitness

Many recreational divers suffer medical conditions, potentially jeopardizing their safety. To scale down risks, medical examinations are mandatory and overwhelmingly performed using bicycle ergometry, which overlooks some important aspects of diving. Searching ergometric systems that better address the underwater environment, a systematic literature search was conducted using the keywords 'diving', 'fitness', 'ergometry', and 'exertion'. All presented alternative systems found convincingly describe a greatly reduced underwater physical performance. Thus, if a diver's workload in air should already be limited, he/she will suffer early from fatigue, risking a diving incident. How to assess fitness? Performance diagnostics in sports is always specific for a modality or movement. Therefore, professional scuba divers should be tested when fin-swimming underwater. For the vast number of recreational divers, the current screening can likely not be replaced. However, to prevent accidents, divers need to understand and be able to improve factors that limit their physical performance underwater. Other systems, presented here, will continue to be important tools in underwater research.

Poor Lower Extremity Functioning Is Associated with Modest Increased Incidence of Probable Dementia

Lower extremity functioning in older adults provides a measure of poor physical performance and can predict negative health outcomes. The consequences of reduced lower extremity functioning on cognitive decline, measured as time-varying variables, have not been well documented in previous studies. We aimed to evaluate whether lower extremity functioning is associated with an increased incidence rate of probable dementia among older adults using data from the National Health and Aging Trends Study (NHATS). Participants (n = 6457) were followed for 8 years to examine the relationship between lower extremity functioning, as measured by the Short Physical Performance Battery (SPPB), and incident probable dementia. Using weighted data, a multivariable Poisson regression with generalized estimating equations (GEE) was used to calculate incidence rate ratios (IRR), adjusting for covariates and clustering. Participants with low SPPB scores (0–5) had a 5% increase in incident probable dementia when compared with those who had good SPPB scores (10–12) in the adjusted model (IRR = 1.05; 95% CI = 1.04–1.07). Lower extremity functioning is associated with a modest increase in incident probable dementia. The SPPB score may be helpful in identifying subjects at risk of dementia. Efforts aimed at improving physical functioning may lead to better cognitive outcomes.

Social network type and subsequent cognitive health among older Europeans

OBJECTIVES

One's personal social network constitutes a contextual framing factor for late-life cognitive function. This study examined the association between network type at baseline and changes in three cognitive measures: immediate recall, delayed recall, and fluency, two years hence, among Europeans aged 50 and older.

PARTICIPANTS

Data were taken from Waves four and five of the Survey of Health, Ageing, and Retirement in Europe of adults aged 50 and above (N = 50,071).

MEASUREMENTS

The latent class analysis was applied to a set of criterion variables. The procedure yielded five distinct network types: multi-tie (6%), family-rich (23%), close-family (49%), family-poor (12%), and friend-enhanced (10%). The network types were then regressed on the cognition measures at follow-up, controlling for the respective baseline cognition scores, as well as for age, gender, education, self-rated health, mobility difficulty, and country.

RESULTS

Respondents in family-poor network types had poorer cognition scores at follow-up, compared to those in the modal close-family network, while those in multi-tie networks had consistently better scores. The family-rich network and the friend-enhanced network also had a somewhat better cognitive function.

CONCLUSIONS

Having varied sources of network ties, e.g. friendship ties and/or several types of family relationships, is beneficial to the cognitive health of older adults over time. Networks based mainly on ties with relatives other than spouse and children, on the other hand, have poorer cognitive outcomes. Older people in this latter group face an increased risk for cognitive decline and should receive assistance in enhancing their interpersonal environments.

Distinct Trajectories of Individual Physical Performance Measures Across 9 Years in 60- to 70-Year-Old Adults

Background

Physical performance is an important factor for successful aging. This study aimed to identify distinct trajectories of multiple physical performance measures over 9 years in individuals aged 60–70 years and to evaluate their characteristics and the overlap between measures.

Methods

Four physical performance measures were assessed in 440 participants of the Longitudinal Aging Study Amsterdam: tandem stand, gait speed, chair stand, and handgrip strength. Gender-specific latent class models were conducted to obtain distinct trajectories and their degree of overlap.

Results

Mean age at baseline was 67.9 (SD 1.7) years for males and 68.0 (SD 1.7) years for females. The optimal number of trajectories differed across measures. For tandem stand, no distinct trajectories were found (all 179 males, 198 females). For gait speed, three trajectories were identified, dependent on baseline speed: high-stable (47 males, 27 females), intermediate-stable (132 males, 130 females), and low-declining performance (6 males, 48 females). Two trajectories were identified for the chair stand: a stable (168 males, 150 females) and declining trajectory (10 males, 38 females). For handgrip strength, three declining trajectories were identified differing in baseline performance: high (55 males, 75 females), intermediate (111 males, 118 females), and low (17 males, 10 females). Overall, 11.9% of males and 5.7% of females were classified in similar trajectories across measures.

Conclusions

Trajectories of physical performance were heterogeneous, but showed similar patterns for males and females. Little overlap between measures was shown, suggesting different mechanisms for decline. This study emphasizes the use of multiple domains to assess physical performance.

Age-Varying Relationships Between Physical Function and Cognition in Older Adulthood

OBJECTIVES

There are positive relationships between physical and cognitive function in older adulthood; however, the strength of these relationships are inconsistent across studies. Although novel statistical tools provide flexibility to explore age-related differences in relationship magnitude, such methods have not been implemented in gerontological research. This study applied such methods to examine variations in relationship magnitude between physical function and cognition in healthy older adults (N = 2,783).

METHOD

Time-varying effects modeling (TVEM) is an extension of regression that models changes in relationships as a function of time-varying metrics like age. TVEM was used to examine if physical function (Turn 360, grip strength) predicted cognitive performance (memory, processing speed/attention, and reasoning) similarly across adults aged 65-90.

RESULTS

All associations between Turn 360 and all cognitive domains were significant and positive; however, speed of processing had significant magnitude variation across age such that the young-old and the old-old demonstrated the strongest relationships. Associations between grip strength and all cognitive domains significantly strengthened with increased age.

DISCUSSION

Results suggest that depending on the sample age, there may be inconsistencies in the relationships between physical and cognitive performance. Future research should explore these relationships longitudinally to better elucidate discrepant findings.

The Bidirectional in Bilingual: Cognitive, Social and Linguistic Effects of and on Third-Age Language Learning

Bilingualism has been put forward as a life experience that, similar to musical training or being physically active, may boost cognitive performance and slow down age-related cognitive decline. In more recent years, bilingualism has come to be acknowledged not as a trait but as a highly individual experience where the context of use strongly modulates any cognitive effect that ensues from it (cf. van den Noort et al., 2019). In addition, modulating factors have been shown to interact in intricate ways (Pot, Keijzer and de Bot, 2018). Adding to the complexity is the fact that control processes linked to bilingualism are bidirectional-just as language control can influence cognitive control, individual differences in cognitive functioning often predict language learning outcomes and control. Indeed, Hartsuiker (2015) posited the need for a better understanding of cognitive control, language control as well as the transfer process between them. In this paper, we aim to shed light on the bidirectional and individual cognitive, social and linguistic factors in relation to bilingualism and second language learning, with a special focus on older adulthood: (1) we first show the intricate clustering of modulating individual factors as deterministic of cognitive outcomes of bilingual experiences at the older end of the lifespan; (2) we then present a meta-study of work in the emergent field of third-age language learning, the results of which are related to lifelong bilingualism; (3) objectives (1) and (2) are then combined to result in a blueprint for future work relating cognitive and social individual differences to bilingual linguistic outcomes and vice versa in the context of third-age language learning.

Reliability, validity and minimal detectable change of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with dementia

BACKGROUND

Walk tests are commonly used to evaluate walking ability in frail older adults with dementia but their psychometric evidence in this population is lacking.

OBJECTIVES

1) To examine test-retest and inter-rater reliability, construct and known-group validity, and minimal detectable change at 95% level of confidence (MDC₉₅) of walk tests in frail older adults with dementia, and 2) to examine the feasibility and consistency of a cueing system in facilitating participants in completing walk tests.

DESIGN

Psychometric study with repeated measures.

SETTING

Day care and residential care facilities.

PARTICIPANTS

Thirty-nine frail older adults with a mean age 87.1 and a diagnosis of dementia or Alzheimer's disease who were able to walk independently for at least 15 m.

METHODS

The participants underwent a 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on 6 separate occasions under 2 independent assessors using a cueing system. Functional status was measured using the Elderly Mobility Scale (EMS), Berg Balance Scale (BBS) and Modified Barthel Index (MBI).

RESULTS

Excellent test-retest (ICC = 0.91-0.98) and inter-rater reliability (ICC = 0.86-0.96) were shown in the 2MWT, 6MWT and 10MeWT. The walk tests were strongly correlated with each other (ρ = 0.85-0.94). The correlations between the walk tests and the functional measures were moderate in general (ρ = 0.34-0.55). All the walk tests were able to distinguish between those who could walk outdoor and indoor only (p ≤ .036). The MDC₉₅ were 9.1 m in the 2MWT, 28.1 m in the 6MWT, and.16 m/s in the 10MeWT. The cues provided by the assessors in the walk tests were generally consistent (ICC = 0.62-0.89).

CONCLUSIONS

The 2MWT, 6MWT and 10MeWT are reliable and valid measures in evaluating walking ability in frail older adults with dementia. The MDC₉₅ of the walk tests has been established. The cueing system is feasible and reliable to facilitate the administration of the walk tests in this population group.

Postural control and posture-unrelated attention control in advanced age-An exploratory study

OBJECTIVES

The link between postural control and cognition is under-studied, especially in healthy older adults. In the present study, we examined the link between postural control and posture-unrelated attention control.

STUDY DESIGN AND OUTCOME MEASURES

Healthy individuals (n = 112) - men aged 77.2 ± 5.5, and two groups of women, aged 78.6 ± 3.5 and 68.9 ± 3.7 - participated in this cross-sectional study. Postural control was assessed by static balance (SB) posturography in eight standing positions, and by two measures of dynamic balance (DB): the Timed Up-and-Go (TUG) test, and the Functional Reach Test (FRT). Attention control (inhibition) was assessed by the Continuous Performance Test (CPT) measuring Go/NoGo tasks with and without visual and audio distractors.

RESULTS

Men tended to perform better on DB and women on SB. In the men, significant correlations were observed between Go/NoGo tasks and DB (r range: 0.373 to 0.653 for TUG, and -0.342 to -0.530 for FRT). In the younger women, Go/NoGo tasks were correlated with SB (r range: 0.323 to 0.572), and no correlations were observed in the older women. Go/NoGo tasks without distractions followed by tasks with audio distractors explained postural control measures.

CONCLUSIONS

Posture-unrelated attention inhibition was associated with SB in the women and with DB in the men. Tasks with no distractions explained the variability in postural control in both genders. It is recommended to examine the effect of balance exercises on postural control and posture-unrelated attention control in both genders, and the contribution of the relationship between postural control and posture-unrelated attention control to falls in old age.

Providers' competencies positively affect personal recovery of involuntarily admitted patients with severe mental illness: A prospective observational study

OBJECTIVE

There is limited research on the patient-provider relationship in inpatient settings. The purpose of this study was to measure the effect of mental healthcare providers' recovery-promoting competencies on personal recovery in involuntarily admitted psychiatric patients with severe mental illness.

METHODS

In all, 127 Dutch patients suffering from a severe mental illness residing in a high-secure psychiatric hospital reported the degree of their personal recovery (translated Questionnaire about Processes of Recovery questionnaire (QPR)) and the degree of mental healthcare providers' recovery-promoting competence (Recovery Promoting Relationship Scale (RPRS)) at two measurement points, 6 months apart.

ANALYSES

(Mixed-effects) linear regression analysis was used to test the effect of providers' recovery-promoting competence on personal recovery, while controlling for the following confounding variables: age, gender drug/alcohol problems, social relationships, activities of daily living, treatment motivation and medication adherence.

RESULTS

Analyses revealed a significant positive effect of providers' recovery-promoting competencies on the degree of personal recovery ( t = 8.4, p < .001) and on the degree of change in personal recovery over time ( ts > 4, p < .001).

CONCLUSION

This study shows that recovery-promoting competencies of mental healthcare providers are positively associated with (a change in) personal recovery of involuntarily admitted patients. Further research is necessary on how to organize recovery-oriented care in inpatient settings and how to enhance providers' competencies in a sustainable way.

Cognition, Health, and Well-Being in a Rural Sub-Saharan African Population

Cognitive health is an important dimension of well-being in older ages, but few studies have investigated the demography of cognitive health in sub-Saharan Africa's (SSA) growing population of mature adults (= persons age 45+). We use data from the Malawi Longitudinal Study of Families and Health (MLSFH) to document the age and gender patterns of cognitive health, the contextual and life-course correlates of poor cognitive health, and the understudied linkages between cognitive and physical/mental well-being. Surprisingly, the age-pattern of decline in cognitive health is broadly similar to that observed in the U.S. We also find that women have substantially worse cognitive health than men, and experience a steeper age-gradient in cognitive ability. Strong social ties and exposure to socially complex environments are associated with higher cognitive health, as is higher socioeconomic status. Poor cognitive health is associated with adverse social and economic well-being outcomes such as less nutrition intake, lower income, and reduced work efforts even in this subsistence agriculture context. Lower levels of cognitive health are also strongly associated with increased levels of depression and anxiety, and are associated with worse physical health measured through both self-reports and physical performance. Our findings suggest that cognition plays a key-but understudied-role in shaping late-life well-being in low-income populations.

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.

"Do it-yourself": Home blood pressure as a predictor of traditional and everyday cognition in older adults

BACKGROUND

Hypertension guidelines recommend home blood pressure (HBP) monitoring in adjunct to office blood pressure (OBP) for its greater reproducibility and prognostic utility in the prevention of cardiovascular outcomes, especially stroke. To date, the relationship between HBP and cognitive function remains unexplored.

METHODS

We examined HBP as a cognitive predictor in a multi-ethnic group of community-dwelling adults aged 60 and over (N = 133) using neuropsychological measures and analyzed the data using multiple regression analyses. We also employed "everyday cognition" measures that have been found to have higher prognostic utility for real-world functioning than traditional cognitive tasks.

RESULTS

Good to perfect HBP monitoring compliance over seven days was achieved by 88.7% of the participants with superior reliability (ICC≥.96) to office readings. Higher home systolic BP and pulse pressure predicted worse processing speed, executive function, and everyday cognitive function, whereas lower home diastolic BP predicted worse everyday cognition. Office readings were similarly associated with everyday cognitive function but with no other cognitive measures.

CONCLUSION

Our findings are the first to validate HBP as a predictor of neuropsychological function in older adults beyond cognitive screening. Differential relationships among blood pressure variables and specific cognitive domains were observed. With proper standardization and training, we demonstrated that HBP can be obtained in a multi-ethnic community-dwelling older adult cohort. Our findings emphasize the importance of employing blood pressure and cognitive measures that are adequately sensitive to detect vascular-related cognitive impairment in a relatively healthy population. Implications regarding proper HBP measurement for hypertension management, cognitive health, and everyday function are discussed.

Risk factors for cognitive decline associated with gait speed in community-dwelling elderly Koreans with MMSE scores of 30

BACKGROUND AND AIM

We aimed to investigate the association between lower gait speed and cognitive decline over a 3-year period in community-dwelling older people with mini-mental state examination (MMSE) scores of 30 at baseline.

METHODS

The study was based on data from 10,003 Koreans aged 60 years or older who completed the National Elderly Survey in both 2008 and 2011. Among them 620 subjects achieved MMSE scores of 30 in 2008. Over a 3-year period, preservation of MMSE score 28 or more was defined as preserved cognition and decrease of three or more points as cognitive decline. A 4-m gait speed was measured at baseline. Data on sociodemographic factors (age, number of schooling years, and household composition), alcohol drinking, current smokers, Korean version of Short form Geriatric Depression Scale score, and self-reported comorbid conditions, were collected.

RESULTS

Of 620 (weighted 884) respondents included in the analysis, 208 (52.3 %) of 398 males (weighted 567) and 152 (68.5 %) of 222 females (weighted 317) suffered cognitive decline over the 3-year period. After adjustment, lower gait speed was associated with cognitive decline in males (OR 2.29; 95 % CI 1.07-4.89, P = 0.032). Educational level was a significant risk factor for both men and women (OR 0.86; 95 % CI 0.79-0.93 in males, OR 0.75; 95 % CI 0.65-0.87 in females). Males diagnosed with hypertension (OR 0.44; 95 % CI 0.22-0.88) or male smokers (OR 0.38; 95 % CI 0.19-0.75) were significantly less likely to have cognitive decline. There was no significant association between cognitive decline and gait speed in females.

CONCLUSIONS

Higher 4-m gait speed is associated with preservation of cognitive function over time in men, but not in women.

The Impact of Three Cognitive Training Interventions on Older Adults' Physical Functioning Across 5 Years

OBJECTIVE

Physical functioning is closely associated with cognition. The current study assessed the impact of three cognitive training programs on objective measures of physical functioning across 5 years.

METHOD

Older adults randomized to a processing speed ( n = 702), reasoning ( n = 694), or memory ( n = 703) training intervention were compared with those randomized to a no-contact control condition ( n = 698). Intention-to-treat (ITT) and treatment-received/dosage (time-varying number of training sessions) analyses were conducted.

RESULTS

There were no transfer effects in the ITT analyses. Treatment-received models demonstrated that training sessions (i.e., higher dosage) across all intervention arms transferred to better maintained Digit Symbol Copy and Turn 360 performance relative to the control group. More reasoning training transferred to better grip strength.

DISCUSSION

This is the first study to demonstrate differential longitudinal cognitive training transfer effects to three performance-based physical functioning measures. Future research should investigate mechanisms of far-transfer effects.

[The association between cognition and handgrip strength among the elderly: an integrative review]

The objective of this study is to identify researches that associated cognition and handgrip strength among the elderly. This is a bibliographic review, based on an integrative approach of articles published in the last five years, indexed in the PubMed, Lilacs and Scopus databases. Inclusion criteria were: observational or experimental studies with a sample of elderly people (aged 60 years or more); assessment of muscular strength using a manual dynamometer; seniors who had at least one cognitive assessment instrument. At the end of the search 10 articles were selected to examine cognitive function and statistical results in the sample. It was observed that most of the research was conducted among the elderly aged over 75 and the Mini Mental State Examination (MMSE) was identified as the scale most commonly used for global cognitive assessment. A significant association was identified between alterations in cognition and reduction of handgrip strength (HGS) in 90% of the articles included in this study. Results of this review suggest the influence of cognitive impairment on the muscular strength of the elderly, which can affect aspects of their functional capacity and consequent dependence.

Effects of Three Types of Exercise Interventions on Healthy Old Adults' Gait Speed: A Systematic Review and Meta-Analysis

BACKGROUND

Habitual walking speed predicts many clinical conditions later in life, but it declines with age. However, which particular exercise intervention can minimize the age-related gait speed loss is unclear.

PURPOSE

Our objective was to determine the effects of strength, power, coordination, and multimodal exercise training on healthy old adults' habitual and fast gait speed.

METHODS

We performed a computerized systematic literature search in PubMed and Web of Knowledge from January 1984 up to December 2014. Search terms included 'Resistance training', 'power training', 'coordination training', 'multimodal training', and 'gait speed (outcome term). Inclusion criteria were articles available in full text, publication period over past 30 years, human species, journal articles, clinical trials, randomized controlled trials, English as publication language, and subject age ≥65 years. The methodological quality of all eligible intervention studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. We computed weighted average standardized mean differences of the intervention-induced adaptations in gait speed using a random-effects model and tested for overall and individual intervention effects relative to no-exercise controls.

RESULTS

A total of 42 studies (mean PEDro score of 5.0 ± 1.2) were included in the analyses (2495 healthy old adults; age 74.2 years [64.4-82.7]; body mass 69.9 ± 4.9 kg, height 1.64 ± 0.05 m, body mass index 26.4 ± 1.9 kg/m2, and gait speed 1.22 ± 0.18 m/s). The search identified only one power training study, therefore the subsequent analyses focused only on the effects of resistance, coordination, and multimodal training on gait speed. The three types of intervention improved gait speed in the three experimental groups combined (n = 1297) by 0.10 m/s (±0.12) or 8.4% (±9.7), with a large effect size (ES) of 0.84. Resistance (24 studies; n = 613; 0.11 m/s; 9.3%; ES: 0.84), coordination (eight studies, n = 198; 0.09 m/s; 7.6%; ES: 0.76), and multimodal training (19 studies; n = 486; 0.09 m/s; 8.4%, ES: 0.86) increased gait speed statistically and similarly.

CONCLUSIONS

Commonly used exercise interventions can functionally and clinically increase habitual and fast gait speed and help slow the loss of gait speed or delay its onset.

Physical Fitness and Serum Vitamin D and Cognition in Elderly Koreans

Poor physical fitness and low serum vitamin D are known to be modifiable risk factors for cognitive declines with normal aging. We investigated the association of physical fitness and serum vitamin D levels with global cognitive function in older adults. In this cross-sectional study, a total of 412 older Korean adults (108 men aged 74.4 ± 6.0 years and 304 women aged 73.1 ± 5.4 years) completed the Korean version of Mini-Mental State Examination (MMSE) to assess global cognitive performance and the senior fitness test to assess strength, flexibility, agility, and endurance domains of physical fitness. Body mass index, percent body fat, serum vitamin D, geriatric depression scale (GDS), level of education, smoking, and history of cardiovascular or cerebrovascular disease were also assessed as covariates. Age, sex, GDS, and body fatness were negatively associated with MMSE-based cognitive performance. Serum vitamin D and physical fitness were positively associated with MMSE-based cognitive performance. Multivariate linear regression showed that agility (partial R(2) = -0.184, p = 0.029) and endurance (partial R(2) = 0.191, p = 0.022) domains of physical fitness along with serum vitamin D (partial R(2) = 0.210, p = 0.012) were significant predictors for global cognitive performance after controlling for covariates (i.e., age, sex, education, GDS, body fatness, and comorbidity index). The current findings of the study suggest that promotion of physical fitness and vitamin D supplementation should be key components of interventions to prevent cognitive decline with normal aging. Key pointsCognitive declines are associated with normal aging as well as modifiable lifestyle risk factors, and there is an increasing need to identify the modifiable risk factors for the onset of cognitive declines and to provide evidence-based strategies for healthy and successful aging.In Korea, little is known about the relationships of physical fitness and serum vitamin D with cognitive function in older adults, and we determined the associations between a) serum vitamin D levels and cognitive function and b) physical fitness and cognitive function among community-dwelling elderly Koreans.The current findings of the study suggest that agility and endurance domains of physical fitness along with serum vitamin D were significant predictors for global cognitive performance after controlling for covariates.

Longitudinal associations between physical and cognitive performance among community-dwelling older adults

To assess the directionality of the association between physical and cognitive decline in later life, we compared patterns of decline in performance across groups defined by baseline presence of cognitive and/or physical impairment [none (n = 217); physical only (n = 169); cognitive only (n = 158), or both (n = 220)] in a large sample of participants in a cognitive aging study at the Knight Alzheimer's Disease Research Center at Washington University in St. Louis who were followed for up to 8 years (3,079 observations). Rates of decline reached 20% for physical performance and varied across cognitive tests (global, memory, speed, executive function, and visuospatial skills). We found that physical decline was better predicted by baseline cognitive impairment (slope = -1.22, p<0.001), with baseline physical impairment not contributing to further decline in physical performance (slope = -0.25, p = 0.294). In turn, baseline physical impairment was only marginally associated with rate of cognitive decline across various cognitive domains. The cognitive-functional association is likely to operate in the direction of cognitive impairment to physical decline although physical impairment may also play a role in cognitive decline/dementia. Interventions to prevent further functional decline and development of disability and complete dependence may benefit if targeted to individuals with cognitive impairment who are at increased risk.

Walking speed in elderly outpatients depends on the assessment method

Walking speed is shown to be an important indicator of the health status and function in older adults and part of the comprehensive geriatric assessment in clinical practice. The present study aimed to assess the influence of different assessment methods on walking speed and its association with the key aspects of poor health status, i.e., the presence of low cognitive performance and cardiopulmonary disease. In 288 community-dwelling elderly (mean age 82.2 ± 7.1 years) referred to a geriatric outpatient clinic, walking speed was assessed with the 4-m, 10-m, and 6-min walking tests. The mean walking speed assessed with the 10-m walking test was higher compared to the 4-m and 6-min walking tests (mean difference (95% CI) 0.11 m/s (0.10; 0.13) and 0.08 m/s (0.04; 0.13), respectively). No significant difference was found in the walking speed assessed with the 4-m compared to the 6-min walking test (mean difference (95% CI) -0.03 m/s (-0.08; 0.03)). ICCs showed excellent agreement of the 4-m with the 10-m walking test and fair to good agreement of the 6-min with the 4-m as well as 10-m walking test. The presence of low cognitive performance was negatively associated with walking speed, with the highest effect size for the 4-m walking test. The presence of cardiopulmonary disease was negatively associated with walking speed as well, with the highest effect size for the 6-min walking test. In conclusion, in the clinically relevant population of elderly outpatients, walking speed and its interpretation depends on the assessment method, which therefore cannot be used interchangeably in clinical practice.

Estimating the inbreeding depression on cognitive behavior: a population based study of child cohort

BACKGROUND

Cognitive ability tests are widely assumed to measure maximal intellectual performance and predictive associations between intelligence quotient (IQ) scores and later mental health problems. Very few epidemiologic studies have been done to demonstrate the relationship between familial inbreeding and modest cognitive impairments in children.

OBJECTIVE

We aimed to estimate the effect of inbreeding on children's cognitive behavior in comparison with non-inbred children.

METHODOLOGY

A cohort of 408 children (6 to 15 years of age) was selected from inbred and non-inbred families of five Muslim populations of Jammu region. The Wechsler Intelligence Scales for Children (WISC) was used to measure the verbal IQ (VIQ), performance IQ (PIQ) and full scale IQ (FSIQ). Family pedigrees were drawn to access the family history and children's inbred status in terms of coefficient of inbreeding (F).

RESULTS

We found significant decline in child cognitive abilities due to inbreeding and high frequency of mental retardation among offspring from inbred families. The mean differences (95% C.I.) were reported for the VIQ, being -22.00 (-24.82, -19.17), PIQ -26.92 (-29.96, -23.87) and FSIQ -24.47 (-27.35,-21.59) for inbred as compared to non-inbred children (p<0.001) [corrected].The higher risk of being mentally retarded was found to be more obvious among inbred categories corresponding to the degree of inbreeding and the same accounts least for non-inbred children (p<0.0001). We observed an increase in the difference in mean values for VIQ, PIQ and FSIQ with the increase of inbreeding coefficient and these were found to be statistically significant (p<0.05). The regression analysis showed a fitness decline (depression) for VIQ (R2 = 0.436), PIQ (R2 = 0.468) and FSIQ (R2 = 0.464) with increasing inbreeding coefficients (p<0.01).

CONCLUSIONS

Our comprehensive assessment provides the evidence for inbreeding depression on cognitive abilities among children.

Relationship between physical performance and cognitive performance measures among community-dwelling older adults

Purpose

Cognitive impairment is correlated with physical function. However, the results in the literature are inconsistent with cognitive and physical performance measures. Thus, the aim of this study was to determine the association between cognitive performance and physical function among older adults.

Methods

A total of 164 older adults aged ≥60 years and residing in low-cost housing areas in Kuala Lumpur, Malaysia participated in this study. Cognitive performance was measured using the Mini Mental State Examination, clock drawing test, Rey auditory verbal learning test, digit symbol test, digit span test, matrix reasoning test, and block design test. Physical performance measures were assessed using the ten step test for agility, short physical performance battery test for an overall physical function, static balance test using a Pro.Balance board, and dynamic balance using the functional reach test.

Results

There was a negative and significant correlation between agility and the digit symbol test (r=−0.355), clock drawing test (r=−0.441), matrix reasoning test (r=−0.315), and block design test (r=−0.045). A significant positive correlation was found between dynamic balance, digit symbol test (r=0.301), and matrix reasoning test (r=0.251). The agility test appeared as a significant (R²=0.183, R²=0.407, R²=0.299, P<0.05) predictor of some cognitive performance measures, including the digit span test, clock drawing test, and Mini Mental State Examination.

Conclusion

These results suggest that a decline in most cognitive performance measures can be predicted by poor execution of a more demanding physical performance measure such as the ten step test for agility. It is imperative to use a more complex and cognitively demanding physical performance measure to identify the presence of an overall cognitive impairment among community-dwelling older adults. It may also be beneficial to promote more complex and cognitively challenging exercises and activities among older adults for optimal physical and cognitive function.