Profiles of well-being in French older adults and associations with successful aging and personality: findings from the SHARE project

Maintaining the well-being of the older adults is a primary concern in gerontology. This study determined different profiles of well-being (WB) and compared the profiles in terms of successful aging (SA), personality, and sociodemographic variables. The study sample consisted of 856 adults aged 65-98 years. WB was taken into account in an eudemonic and hedonic approach. SA was measured by assessing the three distinct components of Rowe and Kahn's model (Successful aging. Gerontol 37(4):433-440. 10.1093/geront/37.4.433, 1997), personality by the Big Five Inventory, and sociodemographic variables. Latent class analyses (LCA) determined the number of WB profiles, and ANOVAs and Chi2 tests to compare them. The LCA revealed three WB profiles: Profile 1 (9.35%, n = 80), Profile 2 (37.38%, n = 320), and Profile 3 (53.27%, n = 456) in which participants reported lower, intermediate, and higher WB scores. Our results confirm that a high level of WB (Profile 3) can be linked to the components of SA and socio-demographic characteristics (age, marital status, level of education, income). This raises questions about the injunctions concerning healthy aging that older people integrate. It's also interesting to note that the intermediate profile (profile 2) can be either close to the "lower WB" profile (Profile 1) in terms of openness, conscientiousness, and agreeableness or to the "higher WB" profile (Profile 3) in terms of extraversion. However the three profiles do not have the same level of neuroticism. These results also showed the importance of adapting the support offered to older people according to their health status and/or individual characteristics.

Protective effects of physical activity on episodic memory during aging are explained by executive functioning

Aging is marked by a memory decline related to an executive function decline. Physical activity (PA) has beneficial effects on both executive functions and memory, especially in aging. The protective effects of PA on these two cognitive abilities have always been studied separately, despite the well-established relationship between memory and executive functions. Our objective was to explore whether the benefits of PA on memory could be explained by reduced age-related changes in executive functions.Nineteen young adults (27.16 years old) and 25 older adults (69.64 years old) performed a resource-dependent memory task, three executive tasks and completed a PA questionnaire (measuring sports and leisure PA). Age group and PA effects on memory and executive performance were analyzed with generalized linear models. Mediation analyses were calculated using method of causal steps approach with a non-parametric bootstrapping procedure.The results confirmed the effects of age and PA on memory and executive performance. A significant interaction confirmed the protective effect of PA on age-related cognitive performance. PA was positively correlated with performance in both memory and executive tasks, but only in the older adults. Although each predictor alone (age, executive functions and PA) significantly explained memory performance in older adults, only the effect of PA on memory performance remained significant when all the predictors were introduced in the analyses.PA mediates the effects of age and executive functions on memory performance. This suggests that PA protects older adults against memory decline by reducing the decline in executive functioning.

The PAPA Questionnaire: Assessment of Long-Term Engagement in Activities, with Separate Quantification of Their Physical, Cognitive, and Social Components

Purpose

Engagement in activities promotes healthy living. Evaluating it is a challenging issue. Assessing engagement in activities while differentiating the physical, cognitive, and social component of each activity and taking into account the intensity level involved in each of the three components would be very relevant. Since none of the currently available cognitive reserve and questionnaires on the activities practiced takes into consideration both points, the purpose of this new questionnaire, called Pertinent Activities Practice in Adults (PAPA) questionnaire, is to fill these gaps.

Patients and Methods

The questionnaire was developed through a literature review and interviews with older adults (n=177 ≥55 years). The intensity level of each item (none, light, moderate, or high) was determined by the compendium of physical activities for the physical component and consensus for the cognitive and social components, then validated by 56 professional experts (6 groups: physiotherapists, neuropsychologists, occupational therapists, geriatricians, etc.).

Results

The PAPA questionnaire includes 75 items that give rise to 4 scores (sedentary lifestyle and physical, cognitive, and social activity scores) weighted by the frequency, duration, and intensity level for each component. The weighted percentage of agreement of the expert groups for the intensity levels was never significantly lower than the minimum target threshold (80% of the hypothetical median) except in a single domain (cognitive) for an expert group non-specialized in cognition. Cronbach's alpha was ≥0.85.

Conclusion

This questionnaire, which assesses long-term engagement in activities, with separate quantification of the physical, cognitive, and social components of a wide range of activities, should help guide actions to promote healthy aging and reduce dementia risk.

Bridging the Gap between Research and the Community: Implementing Physical and Cognitive Interventions to Improve Spontaneous Walking Speed in Older Adults

The application of interventions to enhance mobility in ecological settings remain understudied. This study was developed to evaluate the feasibility of training methods in a community centre and to evaluate their impact on mobility outcomes. Fifty-four participants were randomized to one of three 12-week training programs (three times/week): aerobic (AE), gross motor abilities (GMA) or cognitive (COG). Feasibility was evaluated by calculating adherence, feedback from participants and long-term participation. The impact of these interventions on mobility was assessed by comparing pre- and post-program on Timed-up-and-go (TUG) and spontaneous walking speed (SWS) performances. Results showed relatively high rates of adherence (85.1%) and long-term participation (66.7%), along with favorable feedbacks. SWS significantly improved in COG (0.10 ± 0.11 m.s^-1; p = 0.004) and AE (0.06 ± 0.11 m.s^-1; p = 0.017) groups, and TUG performance was maintained in all groups. Results of this feasibility study demonstrated successful implementation of physical and cognitive training programs, encouraging the development of real-world applications.

Multiple routes to help you roam: A comparison of training interventions to improve cognitive-motor dual-tasking in healthy older adults

Cognitive-motor dual-tasking is a complex activity that predicts falls risk and cognitive impairment in older adults. Cognitive and physical training can both lead to improvements in dual-tasking; however, less is known about what mechanisms underlie these changes. To investigate this, 33 healthy older adults were randomized to one of three training arms: Executive function (EF; n = 10), Aerobic Exercise (AE; n = 10), Gross Motor Abilities (GMA; n = 13) over 12 weeks (1 h, 3×/week). Single and dual-task performance (gait speed, m/s; cognitive accuracy, %) was evaluated before and after training, using the 2-back as concurrent cognitive load. Training arms were designed to improve cognitive and motor functioning, through different mechanisms (i.e., executive functioning – EF, cardiorespiratory fitness – CRF, and energy cost of walking – ECW). Compared to baseline, we observed few changes in dual-task gait speed following training (small effect). However, dual-task cognitive accuracy improved significantly, becoming facilitated by walking (large effect). There were no differences in the magnitude of improvements across training arms. We also found that older adults with lower cognitive ability (i.e., MoCA score < 26; n = 14) improved more on the dual-task cognitive accuracy following training, compared to older adults with higher cognitive ability (i.e., MoCA ≥26; n = 18). Taken together, the results suggest that regardless of the type of intervention, training appears to strengthen cognitive efficiency during dual-tasking, particularly for older adults with lower baseline cognitive status. These gains appear to occur via different mechanisms depending on the form of intervention. Implications of this research are paramount, as we demonstrate multiple routes for improving cognitive-motor dual-tasking in older adults, which may help reduce risk of cognitive impairment.

Associations Between Frailty and Inflammation, Physical, and Psycho-Social Health in Older Adults: A Systematic Review

Frailty is a complex geriatric syndrome with multifactorial associated mechanisms that need to be examined more deeply to help reverse the adverse health-related outcomes. Specific inflammatory and physical health markers have been associated with the onset of frailty, but the associations between these factors and psycho-social health outcomes seem less studied. This systematic review aimed to identify, in the same study design, the potential associations between frailty and markers of inflammation, and physical or psycho-social health. A literature search was performed from inception until March 2021 using Medline, Psycinfo, and EMBASE. Three raters evaluated the articles and selected 22 studies, using inclusion and exclusion criteria (n = 17,373; 91.6% from community-dwelling samples). Regarding biomarkers, 95% of the included studies showed significant links between inflammation [especially the higher levels of C-reactive protein (CRP) and interleukin-6 (IL-6)], and frailty status. Approximately 86% of the included studies showed strong links between physical health decline (such as lower levels of hemoglobin, presence of comorbidities, or lower physical performance), and frailty status. At most, 13 studies among the 22 included ones evaluated psycho-social variables and mixed results were observed regarding the relationships with frailty. Results are discussed in terms of questioning the medical perception of global health, centering mostly on the physical dimension. Therefore, the development of future research studies involving a more exhaustive view of frailty and global (bio-psycho-social) health is strongly encouraged.

Episodic memory and aging: Benefits of physical activity depend on the executive resources required for the task

Physical activity has beneficial effects on executive functions and episodic memory, two processes affected by aging. These benefits seem to depend on the type of memory task, but only a few studies have evaluated them despite their importance in understanding aging. This study aimed to confirm that the benefits of physical activity on episodic memory in older adults vary according to the executive resources required by the memory task, comparing free recall and cued recall. Thirty-seven young adults and 37 older adults performed two memory tasks and an updating task. The two groups had a similar level of physical activity over the preceding 12 months, assessed by a questionnaire. Both the memory and the updating tasks were performed better by the younger than the older adults. A similar cueing effect was observed in the two groups. Physical activity was positively correlated with updating and free recall, but not with cued-recall, and only in older adults. Regression analyses indicated that physical activity accounted for 24% of the variance in free recall in older adults. Updating did not predict free recall (ns) when physical activity was entered in the analysis. The present results show that the benefits of physical activity vary with age and episodic memory task. Only free-recall performance, which relies on updating, seems to depend on physical activity, suggesting that the executive resources required for the task play an important role in the effect of physical activity on memory performance. This should be investigated in greater depth in subsequent studies.

A Comparison of the Effect of Physical Activity and Cognitive Training on Dual-Task Performance in Older Adults

OBJECTIVES

Studies suggest that cognitive training and physical activity can improve age-related deficits in dual-task performances. However, both of these interventions have never been compared in the same study. This article investigates the improvement in dual-task performance in 2 types of exercise training groups and a cognitive training group and explores if there are specific dual-task components that are more sensitive or more likely to improve following each type of training.

METHODS

Seventy-eight healthy inactive participants older than the age of 60 (M = 69.98, SD = 5.56) were randomized to one of three 12-week training programs: aerobic training (AET) = 26, gross motor abilities (GMA) = 27, and cognition (COG) = 25. Before and after the training program, the participants underwent physical fitness tests, and cognitive evaluations involving a computerized cognitive dual task. The AET consisted of high- and low-intensity aerobic training, the GMA of full-body exercises focusing on agility, balance, coordination, and stretching, and the COG of tablet-based exercises focusing on executive functions.

RESULTS

Repeated-measures analysis of variance on reaction time data revealed a group × time interaction (F(2,75) = 11.91, p < .01) with COG having the greatest improvement, followed by a significant improvement in the GMA group. Secondary analysis revealed the COG to also improve the intraindividual variability in reaction time (F(1,24) = 8.62, p < .01), while the GMA improved the dual-task cost (F(1,26) = 12.74, p < .01).

DISCUSSION

The results show that physical and cognitive training can help enhance dual-task performance by improving different aspects of the task, suggesting that different mechanisms are in play.

A comparison of physical exercise and cognitive training interventions to improve determinants of functional mobility in healthy older adults

OBJECTIVES

Mobility is a complex but crucial clinical outcome in older adults. Past observational studies have highlighted that cardiorespiratory fitness (CRF), energy cost of walking (ECW), and cognitive switching abilities are associated with mobility performance, making these key determinants of mobility intervention targets to enhance mobility in older adults. The objective of this study was to compare, in the same design, the impact of three training methods - each known to improve either CRF, ECW, or cognitive switching abilities - on mobility in healthy older adults.

METHODS

Seventy-eight participants (69.28 ± 4.85yo) were randomly assigned to one of three twelve-week interventions: Aerobic Exercise (AE; n = 26), Gross Motor Abilities (GMA; n = 27), or Cognitive (COG; n = 25) training. Each intervention was designed to improve one of the three key determinants of mobility (CRF, ECW, and cognitive switching). Primary outcomes (usual gait speed, and TUG performance) and the three mobility determinants were measured before and after the intervention.

RESULTS

Repeated-measures ANOVAs showed a time effect for TUG performance (F_(1,75) = 14.92, p < .001): all groups equally improved after the intervention (Δ_TUGpost-pre, in seconds, with 95% CI: AE = -0.44 [-0.81 to -0.08]; GMA = -0.60 [-1.10 to -0.10]; COG = -0.33 [-0.71 to 0.05]). No significant between group differences were observed. CRF was improved in the AE group only (Hedges' G = 0.27, small effect), ECW and cognitive switching improved the most in the GMA (Hedges' G = -0.78, moderate effect) and COG groups (Hedges' G = -1.93, large effect) respectively. Smaller improvements in ECW were observed following AE and COG trainings (Hedges' G: AE = -0.39, COG = -0.36, both small effects) as well as in cognitive switching following AE and GMA training (Hedges' G: AE = -0.42, GMA = -0.21, both small effects).

DISCUSSION

This study provides further support to the notion that multiple interventional approaches (aerobic, gross motor exercise, or cognitive training) can be employed to improve functional mobility in older adults, giving them, and professionals, more options to promote healthy ageing.

Statin use moderates the beneficial effects of aerobic exercise on older adults' performances on the Stroop test: A subanalysis

Aerobic training can lead to improved cognition in older adults and this effect can be explained by enhanced cardiorespiratory fitness. However, statins could limit the physical benefits of aerobic training by altering the mechanisms through which exercise improves cognition. Whether statins could have an effect on the cognitive benefits associated with aerobic training remains to be elucidated. The objective of this study was to determine whether the cognitive benefits of aerobic training were comparable in statin users and non-users. A total of 144 sedentary participants (>60 y.o.; 106 non-users, 38 statin users) were included. Participants were either part of an aerobic training group (n = 75) or a control group (n = 69). Cognition was assessed using the Stroop test. Analyses were performed on z-score changes from pre to post-intervention of Stroop reaction time (RT) and number of errors, using Two-factor ANCOVAs, while controlling for potential confounding factors (age, education, BMI, Charlson Comorbidity Index, sex, protocol and handgrip strength). The moderating effect of statins on the cognitive changes associated with aerobic training was determined through moderation analyses. An interaction effect on the Stroop switching condition was detected between intervention and statin intake (F [1, 140] = 5.659, P < 0.01). The intervention effect on switching RT was moderated by statin intake, where intervention improved switching RT only in non-users (Effect = 0.1678; P < 0.01). Statins could limit the cognitive benefits of aerobic training on switching capacities in some patients. Future randomized studies including a larger number of participants and looking at different types of statins should be conducted to confirm these results.

A Web-Based Multidomain Lifestyle Intervention for Older Adults: The eMIND Randomized Controlled Trial

Importance/Objective: To describe the feasibility and acceptability of a 6-month web-based multidomain lifestyle training intervention for community-dwelling older people and to test the effects of the intervention on both function- and lifestyle-related outcomes.

DESIGN

6-month, parallel-group, randomized controlled trial (RCT).

SETTING

Toulouse area, South-West, France.

PARTICIPANTS

Community-dwelling men and women, ≥ 65 years-old, presenting subjective memory complaint, without dementia.

INTERVENTION

The web-based multidomain intervention group (MIG) received a tablet to access the multidomain platform and a wrist-worn accelerometer measuring step counts; the control group (CG) received only the wrist-worn accelerometer. The multidomain platform was composed of nutritional advices, personalized exercise training, and cognitive training. Main outcomes and measures: Feasibility, defined as the proportion of people connecting to ≥75% of the prescribed sessions, and acceptability, investigated through content analysis from recorded semi-structured interviews. Secondary outcomes included clinical (eg, cognitive function, mobility, health-related quality of life (HRQOL)) and lifestyle (eg, step count, food intake) measurements.

RESULTS

Among the 120 subjects (74.2 ±5.6 years-old; 57.5% women), 109 completed the study (n=54, MIG; n=55, CG). 58 MIG subjects connected to the multidomain platform at least once; among them, adherers of ≥75% of sessions varied across multidomain components: 37 people (63.8% of 58 participants) for cognitive training, 35 (60.3%) for nutrition, and three (5.2%) for exercise; these three persons adhered to all multidomain components. Participants considered study procedures and multidomain content in a positive way; the most cited weaknesses were related to exercise: too easy, repetitive, and slow progression. Compared to controls, the intervention had a positive effect on HRQOL; no significant effects were observed across the other clinical and lifestyle outcomes.

CONCLUSIONS AND RELEVANCE

Providing multidomain lifestyle training through a web-platform is feasible and well-accepted, but the training should be challenging enough and adequately progress according to participants' capabilities to increase adherence. Recommendations for a larger on-line multidomain lifestyle training RCT are provided.

Change of depressive symptoms in a French nine-year longitudinal study of aging: Gender differences and relationships between social support, health status and depressive symptoms

OBJECTIVES

The aims of this study were to examine the trajectory of depressive symptoms among older French people, to investigate the role of gender in the developmental trajectory of depressive symptoms and to explore whether the linear increase in depressive symptoms might be accentuated or attenuated at time points during which the older adults' scores on social support and health satisfaction scales were higher than their individual averages.

METHODS/MATERIALS

Data were used from a subsample of older adults living at home who participated in a longitudinal study initiated by researchers from the University of Tours. They were collected at five time points over a 9-year period (T1: 2003; T2: 2005; T3: 2007; T4: 2009; T5: 2011). This study included 707 participants, and multilevel growth curve analysis was used on measures of depressive symptoms, gender differences, social support and health satisfaction.

RESULTS

Results indicated (1) a significant positive linear effect of age on depressive symptoms; (2) that women reported significantly higher scores of depressive symptoms than men at 63 years old (i.e., intercept) and that this gender difference remained constant across age; (3) that the slope of depressive symptoms appeared to increase at time points during which participants had higher levels of social support and to decrease when they had greater health satisfaction.

CONCLUSION

This study provides pertinent information about the change of depressive symptoms in older people living at home and particularly highlights the interest in studying gender, social support and health satisfaction.

Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility

Objectives

With their broad spectrum of action, psychotropic drugs are among the most common medications prescribed to the elderly. Consequently, the number of older adults taking multiple psychotropic drugs has more than doubled over the last decade. To improve knowledge about the deleterious effects of psychotropic polypharmacy, we investigated whether there is a threshold number of psychotropic molecules that could lead to impairment of global cognition, executive function, or mobility. Furthermore, relationships between the number of psychotropic molecules and cognitive and mobility impairment were examined.

Design

Cross-sectional study

Setting

University Hospital of Caen (France) and advertisements in medical offices

Participants

Community-dwelling older adults 55 years and older (n = 177; 69.8 ± 9.3 years; 81% women)

Measurements

Number of psychotropic molecules taken daily, global cognition assessed with the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), processing speed with the Trail Making Test (TMT) A, executive function with the TMT B and TMT B-A, and mobility with the Time Up and Go (TUG). The threshold numbers of psychotropic molecules were determined by ROC curves analysis. Based on these threshold values, multinomial logistic regression adjusting for covariates was then performed.

Results

Logistic regressions showed that the threshold of two daily psychotropic molecules, identified by the ROC curves analysis, increases the risk of impaired executive function (p = .05 and.005 for the TMT B and TMT B-A, respectively), global cognition (p = .006 and.001 for the MMSE and MoCA, respectively), and mobility (p = .005 for the TUG), independent of confounding factors, including comorbidities. Furthermore, psychotropic polypharmacy would affect mobility through executive functions.

Conclusion

Impairment of global cognition, executive function, and mobility when as few as two psychotropic molecules are consumed in relatively healthy young older adults should alert physicians when prescribing combinations of psychotropic medications.

Effects of a 3-Year Multi-Domain Intervention with or without Omega-3 Supplementation on Cognitive Functions in Older Subjects with Increased CAIDE Dementia Scores

Findings from recent Alzheimer's disease prevention trials have shown subjects with increased dementia score based upon mid-life cardiovascular risk factors, to benefit from multi-domain intervention strategies to some extent. The effects of such interventions on cognitive functions remains yet to be well-established. This study is a secondary analysis of the MAPT study, 1,293 older subjects (mean age 75 years) with high CAIDE score (i.e., ≥6) were classified according to the four intervention groups: 1) multi-domain intervention plus placebo, 2) isolated supplementation with Omega-3 polyunsaturated fatty acid (n-3 PUFA), 3) combination of the two interventions, and 4) placebo alone. Linear mixed-model repeated-measures analyses were used to assess the cognitive changes according to various neuropsychological test scores between intervention groups compared to the placebo at 36 months from baseline. Compared to the placebo, group with multi-domain intervention in combination withn-3PUFA was found to show significant improvement in the delayed total recall test of the free and cued selective reminding test (FCSRT) (mean±standard error(SE) = 0.20±0.10) and MMSE orientation test (mean±SE = 0.15±0.06) at 36 months. Isolated multi-domain intervention group showed significant less decline in the MMSE orientation test (mean±SE = 0.12±0.06) compared to the placebo. There was significant less improvement (mean±SE = - 1.01±0.46) in the FCSRT free recall test in the n-3 PUFA intervention group compared to the placebo at 36 months. Our findings show high-risk subjects for dementia screened with CAIDE dementia score might benefit from multi-domain intervention strategies as in the MAPT study, particularly in the orientation and delayed recall domain.

Lifestyle multidomain intervention, omega-3 supplementation, or both for reducing the risk of developing clinically relevant depressive symptoms in older adults with memory complaints? Secondary analysis from the MAPT trial

BACKGROUND

We tested the associations of a lifestyle multidomain intervention (MI), omega-3 supplementation (O3) or their combination with the change of clinically meaningful depressive symptoms in older adults.

METHODS

Secondary analysis of the 3-year Multidomain Alzheimer Preventive Trial (MAPT), in which 1679 people, ≥70 years with memory complaints were randomized into: MI, O3, MI + O3, or placebo. MI was composed of nutritional and physical activity counselling and cognitive training. O3 supplementation corresponded to a daily dose of 1000 mg of omega-3. Discrete-time cox regressions were performed for each outcome. Three binary variables of incidence of depressive symptoms were created from the 15-item geriatric depression scale (GDS-15): minimum clinically meaningful depressive symptoms (≥2-point increase in GDS-15), moderate depressive symptoms (GDS-15 ≥ 5), and severe depressive symptoms (GDS-15 ≥ 10) DS.

RESULTS

Discrete-time cox proportional hazards have found no associations for all of the analysis. The incidence of severe depressive symptoms across groups were, respectively: 1.1, 2.4, 2.3 and 2.5 per 100 person year for MI + O3, for O3, for MI, for placebo. There was a trend for a decreased risk of developing severe DS compared to placebo in the MI + O3 group (p = 0.085 after adjustment).

CONCLUSIONS

To conclude, we did not find any association of a lifestyle multidomain intervention with the onset of clinically depressive symptoms in older adults with memory complaints. A study with a more intensive multidomain intervention might bring further insights on this topic.

A web-based multidomain lifestyle intervention with connected devices for older adults: research protocol of the eMIND pilot randomized controlled trial

BACKGROUND

Multidomain interventions composed of nutritional counseling, exercise and cognitive trainings have shown encouraging results as effective preventive strategies delaying age-related declines. However, these interventions are time- and resource-consuming. The use of Information and Communication Technologies (ICT) might facilitate the translation from research into real-world practice and reach a massive number of people.

AIM

This article describes the protocol of the eMIND study, a randomized controlled trial (RCT) using a web-based multidomain intervention for older adults.

METHODS

One hundred and twenty older adults (≥ 65 years), with a spontaneous memory complaint, will be randomly assigned to a six-month web-based multidomain (nutritional counseling, physical and cognitive trainings) intervention group with a connected accelerometer (number of steps, energy expenditure), or to a control group with access to general information on healthy aging plus the accelerometer, but no access to the multidomain intervention. The main outcome is the feasibility/acceptability of the web-based intervention. Secondary clinical outcomes include: cognitive functions, physical performance, nutritional status and cost-effectiveness.

RESULTS

We expect a high amount of adherers (ie, > 75% compliance to the protocol) to reflect the feasibility. Acceptability, assessed through interviews, should allow us to understand motivators and barriers to this ICT intervention. We also expect to provide data on its effects on various clinical outcomes and efficiency.

CONCLUSION AND DISCUSSION

The eMIND study will provide crucial information to help developing a future and larger web-based multidomain lifestyle RCT, which should facilitate the translation of this ICT intervention from the research world into real-life clinical practice for the healthcare of older adults.

A comparison of the impact of physical exercise, cognitive training and combined intervention on spontaneous walking speed in older adults

BACKGROUND

Spontaneous walking speed (SWS) is one of the most important indicators of health in older adults. Studies have shown benefits of physical trainings on SWS in older adults but the impact of cognitive training and multidomain interventions remains understudied.

AIMS

This original study aimed at comparing the impact of aerobic/resistance exercise, computerized cognitive training and the combination of both interventions compared with active control conditions on SWS in healthy older adults.

METHODS

Ninety community-dwelling older adults were randomly assigned to four different combinations composed of two active interventions: physical aerobic/resistance and cognitive dual-task trainings, and two active control conditions: stretching exercises and computer lessons. The four combinations were the following: (1) aerobic/resistance and cognitive dual task (n = 28), (2) aerobic/resistance and computer lessons (n = 21), (3) stretching exercises and cognitive dual task and (n = 23), (4) stretching exercises and computer lessons (n = 18). Training sessions were held three times/week for three months. SWS for 30 s was assessed before and after the intervention.

RESULTS

Repeated-measures ANOVA showed a main effect of time and a significant three-way interaction suggesting differential improvement in SWS according to training combinations. A clinical meaningful improvement in SWS was observed in groups 1-3 (0.08-0.14 m/s; effect sizes: small to moderate) but not in the active control group 4.

DISCUSSION

Results of this study suggest that aerobic/resistance exercise and computerized dual-task training are two non-pharmacological interventions by which SWS, a functional vital sign, can be clinically improved in older adults.

CONCLUSION

This original study pointed out different tools to prevent functional decline in older people.

Shifting from Declines to Improvements: Associations between a Meaningful Walking Speed Change and Cognitive Evolution over Three Years in Older Adults

BACKGROUND

Although the close relationship between mobility and cognitive declines is well-known, literature has very little questioned whether improvement in walking speed over time could be associated with improvements in cognitive functions. The objective of this study was to examine the associations between a clinically meaningful improvement in walking speed and global and specific cognitive changes in older adults.

DESIGN

Prospective cohort study.

SETTING

Multidomain Alzheimer Preventive Trial (MAPT) study.

PARTICIPANTS

Three-hundred participants from the control group of the MAPT study (mean age 74.8 ± 4.2; 57% women).

MEASUREMENTS

The 4-m usual walking speed, global cognition, memory, executive functions, and processing speed measures were collected at baseline, and at 6, 12, 24 and 36 months. Participants were categorized into three groups according to their walking speed change over the three-year study: 1/ Non-Improvers (participants not presenting an increase ≥0.05m/sec on walking speed; n=138); 2/ Improvers (increase ≥0.05m/sec; n=40); Cyclic (≥0.05m/sec improvement at some time points without maintaining it through the whole period; n=122).

RESULTS

Adjusted mixed-effect linear regressions revealed that walking speed improvers did not significantly differ from participants who never or temporarily improved their walking speed on all of global and specific cognitive functions over three years. Nevertheless, a sensitivity analysis (excluding participants with a non-clinical walking speed improvement) indicated specific cognitive trajectories per group associated with better episodic memory scores for Improvers compared to non-improvers (β=2.41, 95% CI=.12 - 4.71; p=.039).

CONCLUSION

This study found that the overtime trajectories of cognitive functions did not differ as a function of clinically meaningful walking speed changes in older adults. Nevertheless, secondary analyses provided new insights on the relationship between walking speed and specific cognitive functions. The novelty of this approach (switching from declines to improvements) should be considered in future large-scale, observational longitudinal studies.

Polypharmacy Cut-Off for Gait and Cognitive Impairments

BACKGROUND

Polypharmacy is a well-established risk factor for falls, and these are one of the major health problems that affect the quality of life as people age. However, the risk of mobility and cognitive impairments consecutive to polypharmacy has been little addressed, despite the association between these adverse outcomes and falls. Moreover, the rare polypharmacy cut-offs were all but one arbitrarily determined.

OBJECTIVE

Studying relationships between polypharmacy and both mobility and cognitive impairments, and statistically determining a cut-off point in the number of medicinal molecule beyond which polypharmacy has deleterious consequences with respect to mobility and cognitive impairment.

METHODS

We enrolled 113 community-dwelling adults aged 55 years and older with a fall history, with or without injury, in the previous year. We carefully collected information about daily medicinal molecules taken. We assessed basic mobility and global cognition with the Time-Up-and-Go and the Montreal Cognitive Assessment (MoCA) test, respectively (clinicaltrials.gov NCT02292316).

RESULTS

Timed-Up and Go test and MoCA scores were both significantly correlated with the number of molecule, used. Receiver Operating Characteristic curves indicate, with high prediction (p < 0.002), that daily consumption of five or more molecules is associated with risk for both impaired mobility and global cognition. These relationships were independent of the number of comorbidities and of the pharmacological class.

CONCLUSION

Community-dwelling adults aged 55 years and older who take five or more daily medicinal molecules are at high risk for both mobility and cognitive impairments. Physicians and patients should be aware of these new findings, especially when there are multiple prescribers involved in the care of the patient.

Multiple Object Tracking While Walking: Similarities and Differences Between Young, Young-Old, and Old-Old Adults

OBJECTIVE

Walking while simultaneously engaged in another activity becomes more difficult as one grows older. Here, we address the issue of changes in dual-task behavior at different stages of life, particularly in the latter stages.

METHODS

We developed a dual task that combined walking along an 8-m walkway with a multiple object tracking (MOT) task of increasing difficulty. This secondary cognitive task imitates visuospatial daily activities and provides reliable quantitative measurements. Our dual-task paradigm was tested on 27 young adults (23.85 ± 2.09 years old) and two groups of older adults (18 young-old and 18 old-old adults, aged 63.89 ± 3.32 and 80.83 ± 3.84 years, respectively).

RESULTS

Significant decrease in tracking performance with increasing complexity of the MOT task was found in all three groups. An age-related decrease in MOT and gait performance was also found. However, young-old adults performed as well as young adults under low attentional load conditions (in the MOT task and simple walking), whereas their performance was as impaired as those of old-old adults under high attentional load conditions (in the MOT task and walking under dual-task condition).

DISCUSSION

These different profiles between the two groups of older participants could be explained in terms of compensation strategies and risk of falling.

Abstract P6-07-11: Health economic impact of breast cancer index (BCI) for late disease management in patients with estrogen receptor-positive, node-negative breast cancer

Background

Several recent randomized, prospective clinical trials (MA.17, ATLAS, aTTom) have demonstrated the clinical benefit of extending endocrine therapy beyond 5 years to address the persistent risk of recurrence in patients with ER+ breast cancer. Breast Cancer Index (BCI) is a gene expression-based test that predicts overall (10y) risk of recurrence in patients with ER+, LN- breast cancer, and also informs late (post-5 year) disease management by providing information on risk of late (≥5y) recurrence, and likelihood of benefit from extended (≥5y) endocrine therapy. Previously, BCI was shown to be cost saving across a 10-year disease horizon. The current study specifically assessed the health economic benefit of BCI for late disease management, evaluating the impact of identifying patients at risk of late recurrence and those that may benefit from extended endocrine therapy.

Methods

A fact-based economic model was developed which projected the cost and effectiveness of BCI from a US third-party payer perspective in a hypothetical population of patients with ER+, LN- breast cancer who are disease free at 5 years post-diagnosis compared to standard clinical practice. Patients flowed through the model based on patterns of care and BCI data. Costs associated with endocrine therapy, toxicity, follow-up, and recurrence were modeled over 5 yrs. Model inputs were based primarily on published literature, and supplemented by interviews with disease experts and payers. Sensitivity analyses were performed around key inputs to estimate effects on the model.

Results

Use of BCI is projected to be cost saving in this population of patients that are disease-free at 5 years post-diagnosis, with a net cost savings of $691 per patient tested after accounting for BCI cost. Gross cost savings were projected to be achieved through reduced recurrence in patients receiving extended endocrine therapy based on BCI ($4,102), and reduced recurrence in previously non-compliant patients ($39). BCI was cost saving for both pre- and post-menopausal women. Sensitivity analyses demonstrated that results were most sensitive to current use of extended endocrine therapy in postmenopausal patients, future use of extended endocrine therapy in BCI (H/I) high patients, and the percentage of patients characterized as BCI (H/I) high.

Conclusions

BCI is projected to be cost saving in a population of ER+, LN-, breast cancer patients who are recurrence free at 5 years post-diagnosis. Cost savings are achieved through projected impact on extended endocrine therapy use and endocrine therapy compliance, and provide additional cost savings beyond impact on chemotherapy utilization. These findings require validation in additional cohorts, including studies of real-world clinical practice.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-07-11.