The interplay between cognitive and motor functioning in healthy older adults: findings from dual-task studies and suggestions for intervention

Reaching late adulthood is accompanied by losses in physical and mental resources, but lifestyle choices seem to have a considerable influence on the aging trajectory. This review deals with the interplay between cognitive and motor functioning in old age, focusing on two different lines of research, namely (a) dual-task studies requiring participants to perform a cognitive and a motor task simultaneously, and (b) intervention studies investigating whether increases in physical fitness also lead to improvements in cognitive performance. Dual-task studies indicate that healthy older adults show greater performance reductions in both domains than young adults when performing a cognitive and a motor task simultaneously. In addition, older adults often tend to protect their motor functioning at the expense of the cognitive task when the situation involves a threat to balance. This can be considered an adaptive behavior since fall-related injuries can have severe consequences. Fitness intervention studies which increased the aerobic fitness of previously sedentary older adults have demonstrated impressive performance improvements in the cognitive domain, especially for tasks involving executive control processes. These findings are interesting in light of cognitive intervention studies, which often fail to find significant transfer effects to tasks that have not been trained directly. The authors argue that future research should compare the effects of cognitive and aerobic fitness interventions in older adults, and they present a study design in which cognition and fitness are trained sequentially as well as simultaneously. Finally, methodological issues involved in this type of research and potential applications to applied settings are discussed.     

Multiple roads lead to Rome: combined high-intensity aerobic and strength training vs. gross motor activities leads to equivalent improvement in executive functions in a cohort of healthy older adults

The effects of physical activity on cognition in older adults have been extensively investigated in the last decade. Different interventions such as aerobic, strength, and gross motor training programs have resulted in improvements in cognitive functions. However, the mechanisms underlying the relationship between physical activity and cognition are still poorly understood. Recently, it was shown that acute bouts of exercise resulted in reduced executive control at higher relative exercise intensities. Considering that aging is characterized by a reduction in potential energy (V·O2 max − energy cost of walking), which leads to higher relative walking intensity for the same absolute speed, it could be argued that any intervention aimed at reducing the relative intensity of the locomotive task would improve executive control while walking. The objective of the present study was to determine the effects of a short-term (8 weeks) high-intensity strength and aerobic training program on executive functions (single and dual task) in a cohort of healthy older adults. Fifty-one participants were included and 47 (age, 70.7 ± 5.6) completed the study which compared the effects of three interventions: lower body strength + aerobic training (LBS-A), upper body strength + aerobic training (UBS-A), and gross motor activities (GMA). Training sessions were held 3 times every week. Both physical fitness (aerobic, neuromuscular, and body composition) and cognitive functions (RNG) during a dual task were assessed before and after the intervention. Even though the LBS-A and UBS-A interventions increased potential energy to a higher level (Effect size: LBS-A—moderate, UBS-A—small, GMA—trivial), all groups showed equivalent improvement in cognitive function, with inhibition being more sensitive to the intervention. These findings suggest that different exercise programs targeting physical fitness and/or gross motor skills may lead to equivalent improvement in cognition in healthy older adults. Such results call for further investigation of the multiple physiological pathways by which physical exercise can impact cognition in older adults.     

Aging and everyday memory: the beneficial effect of memory training

The authors investigated elderly people's ability to benefit from specific memory training. Empirical evidence of cognitive aging shows a deterioration in working memory ability but also suggests that elderly people maintain the ability to acquire new information and strategies. The aim of the present study was to investigate the effects of two different mnemonic strategies (Loci mnemonic vs. Strategic training) in young and older adults and to evaluate the ability of the older groups to improve performance. Participants received extensive practice in the use of a specific strategy. Three groups of participants (20 adult, 20 younger elderly, and 20 older elderly) were tested in the laboratory, as well as in ecological conditions using a battery of cognitive tests. Questionnaires were also administrated to explore cognitive, metacognitive and emotive motivational aspects of working memory performance. The results show the efficacy of both trainings in improving performances in different tasks, particularly the ecological. The elderly benefit from strategies as much as younger people; nevertheless, the memory performances of the latter are higher. Differences between the two trainings are found only in the task evaluating ability to re-use learnt strategies in other unfamiliar situations. Improvement in performance was more pronounced for the strategic training.     

Predictors of transitions in vitality: the italian longitudinal study on aging

It is widely acknowledged that there is a strong need to identify which modifiable risk factors predict healthy aging to use this information as the scientific basis for systematic interventions. Data from a 4-year longitudinal study on aging among 5632 older Italians were used. The definition of vitality was based on both cognitive and physical status, and the envisaged transitions were: positive or nonpositive stable, positive or negative transition, lost, and deceased. Predictors associated with different vitality trajectories were investigated by multinomial logistic analysis with a six-level outcome. Age and educational level were predictors of being "positive stable," whereas the other factors behaved differently according to comparison group. For example, being overweight is a common predictor except when compared to the deceased group, as is depressive symptomatology except when compared to the "positive transition" group. Interventions are warranted to reduce social inequalities, promote adequate body weight, and prevent and treat depressive symptoms.     

Factors associated with low levels of physical activity among elderly residents in a small urban area in the interior of the Brazilian Amazon

The aim of the present study was to investigate levels of physical activity and risk factors for inactivity in older adults living in an urban area in the interior of the Amazonas state, Brazil. Data were collected between 2013 and 2015 from 274 individuals 60 years of age or older who resided in the interior of the Brazilian Amazon. Sociodemographic, general health, functional capacity and physical performance were associated with self-referred physical activity level. A multivariate analysis, after adjustment, showed that being a man, having a body mass index above 27 kg/m², never having lived in riverside communities and having less than three associated chronic diseases were independent risk factors for low levels of physical activity among elderly residing in the interior of the Brazilian Amazon. Few studies have been conducted about the characteristics that are singular to this population. Our results suggest that the physical activity level and, consequently, the aging process of the elderly is influenced by where they have resided throughout their lives. Additionally, the results showed particular risk factors associated with low physical activity level among older adults residing in the interior of the state of Amazonas.     

No time to look back: approaching the finish line of life's course

Gerontologists have labelled individuals who do not follow the normal aging pattern of reduced physical activity and declining health as "successfully aging" adults. Competitive and sport-involved elder persons represent a kind of elderly elite who may exhibit special psychological characteristics that help to explain their active approach to late life. As part of a larger study on the physical fitness and body composition of participants at seniors' games, a qualitative exploration of personal life philosophy was undertaken in order to initiate understanding about the cognitive make-up of competitive older men and women. Content analysis of open-ended survey questions about life in review and future goals permitted insight into life orientation differences between men and women. The responses provided evidence that sport and physical recreation may be an important type of coping strategy for some elderly adults who find life meaning and a sense of achievement in challenging themselves physically. Beyond a general optimism in life orientation, uncertainties about the nature of the future left many with a sense of urgency combined with specific short-term goal setting.     

A Comparison of Self-Rated and Objectively Measured Successful Aging Constructs in an Urban Sample of African American Older Adults

Sixty-seven (N = 67) urban African American older adults were divided into successful and nonsuccessful aging groups based on objective MacArthur (i.e., physical and cognitive functioning) and on self-rated health criteria. Only 30% of the sample met objective MacArthur criteria for successful aging compared to 63% who rated themselves as successful. Self-rated successful aging was best predicted by regular exercise, whereas objective successful aging was best predicted by demographic characteristics and cognition. Reading ability mediated the relationship between both education and cognition to objectively defined success. Finally, objective successful aging was related to quantity and quality of education, whereas self-rated successful aging was related to a wider variety of variables. Defining successful aging on objective factors alone may limit our understanding of successful aging in urban African American older adults.     

Constructing an index of physical fitness age for Japanese elderly based on 7-year longitudinal data: sex differences in estimated physical fitness age

A standardized method for assessing the physical fitness of elderly adults has not yet been established. In this study, we developed an index of physical fitness age (fitness age score, FAS) for older Japanese adults and investigated sex differences based on the estimated FAS. Healthy elderly adults (52 men, 70 women) who underwent physical fitness tests once yearly for 7 years between 2002 and 2008 were included in this study. The age of the participants at the beginning of this study ranged from 60.0 to 83.0 years. The physical fitness tests consisted of 13 items to measure balance, agility, flexibility, muscle strength, and endurance. Three criteria were used to evaluate fitness markers of aging: (1) significant cross-sectional correlation with age; (2) significant longitudinal change with age consistent with the cross-sectional correlation; and (3) significant stability of individual differences. We developed an equation to assess individual FAS values using the first principal component derived from principal component analysis. Five candidate fitness markers of aging (10-m walking time, functional reach, one leg stand with eyes open, vertical jump and grip strength) were selected from the 13 physical fitness tests. Individual FAS was predicted from these five fitness markers using a principal component model. Individual FAS showed high longitudinal stability for age-related changes. This investigation of the longitudinal changes of individual FAS revealed that women had relatively lower physical fitness compared with men, but their rate of physical fitness aging was slower than that of men.     

Promoting Healthy Aging During COVID-19

Older adults have been markedly impacted by the coronavirus disease 19 (COVID-19) pandemic. The American Geriatrics Society previously published a White Paper on Healthy Aging in 2018 that focused on a number of domains that are core to healthy aging in older adults: health promotion, injury prevention, and managing chronic conditions; cognitive health; physical health; mental health; and social health. The potentially devastating consequences of COVID-19 on health promotion are recognized. The purpose of this article is multifold. First, members of the Healthy Aging Special Interest Group will present the significant difficulties and obstacles faced by older adults during this unprecedented time. Second, we provide guidance to practicing geriatrics healthcare professionals overseeing the care of older adults. We provide a framework for clinical evaluation and screening related to the five aforementioned domains that uniquely impact older adults. Last, we provide strategies that could enhance healthy aging in the era of COVID-19.     

The influence of winter and summer seasons on physical fitness in aged population

Epidemiological studies have described the association between physical fitness and health. Few have reported the impact of seasonal variation on fitness determinants, in elderly. We investigated the effects of summer and winter environmental conditions on physical fitness, in both exercise and non-exercise elders. 371 non-institutionalized older adults (74.1% female; 78.4 ± 5.3 years) randomly recruited from a total sample of 1338 subjects from north of Portugal, were prospectively followed during 1 year and 3 assessments were performed – April (baseline), October (summer season) and April (winter season). Four groups were defined, according to reported habits of exercising: Exercise (EG); Winter Exercise (WG); and Summer Exercise (SG); non-Exercise (nEG). Muscle strength was assessed with handgrip and isometric knee extension test, and aerobic capacity with the 6 min walking test. Repeated measures ANOVA with two between-subjects factors were run for independent variables, considering a three Time points. Significance set at p < .05. Findings show that: (1) men were fitter than women; (2) EG showed better results than nEG (p = .000), but not different than WG or SG, (3) nEG physical fitness was not significantly different from WG and SG; (4) SG and WG showed similar results; (5) there was significant group-by-time interaction for all variables in study. Among elderly, the regular physical exercise determined better cardiorespiratory fitness and levels of strength compared to individuals that were not exercising, however, no season impact was observed. Independently of exercising mode, regular, seasonal or not exercising, the pattern of changes in physical fitness throughout the year was similar.     

A Comparison of Self-Rated and Objectively Measured Successful Aging Constructs in an Urban Sample of African American Older Adults

Sixty-seven (N = 67) urban African American older adults were divided into successful and nonsuccessful aging groups based on objective MacArthur (i.e., physical and cognitive functioning) and on self-rated health criteria. Only 30% of the sample met objective MacArthur criteria for successful aging compared to 63% who rated themselves as successful. Self-rated successful aging was best predicted by regular exercise, whereas objective successful aging was best predicted by demographic characteristics and cognition. Reading ability mediated the relationship between both education and cognition to objectively defined success. Finally, objective successful aging was related to quantity and quality of education, whereas self-rated successful aging was related to a wider variety of variables. Defining successful aging on objective factors alone may limit our understanding of successful aging in urban African American older adults.     

Brain imaging and age-related changes in cognition

—Although there is currently some debate as to the degree of structural changes in the brain that occur with age, there is little doubt that such changes occur. There also are physiological changes in many areas that could have implications for cognitive function in the elderly. One way to study the impact of these age-related changes in the brain on cognition is to use neuroimaging techniques to examine brain activity during the performance of various tasks, and determine how this activity differs between young and older individuals. This approach has been used to study functions such as memory, perception, and attention, and it has generally been found that older individuals utilize different areas of the brain than do young subjects when carrying out the same cognitive task. This has led some researchers to suggest that older persons utilize different functional brain networks, perhaps to compensate for reductions of efficiency in some brain areas. The areas of the brain most often found to be more active during cognitive tasks in the elderly are the frontal lobes. Studies that have directly examined the functional networks utilized during cognition have found that older people do indeed have different functional interactions involving the frontal lobes, and therefore, utilize different functional networks. In some cases this differential activity has been accompanied by cognitive performance in the older participants that is equivalent to that seen in the young, suggesting that greater reliance on this brain region is related in some way to the maintained ability of the older individuals to perform the task. However, data collected to date on this issue are still limited, so although the evidence is intriguing, the definitive interpretation of these findings must await further experiments.     

The association between routinization and cognitive resources in later life

The aim of this study was to investigate the association between routinization of daily life activities and cognitive resources during aging. Routinization could increase excessively during aging and become maladaptative in reducing individual resources. Fifty-two young participants (M = 20.8 years) and 62 older participants (M = 66.9 years) underwent a routinization scale and cognitive tasks of working memory, speed of processing, and attention. Results revealed that older adults presented a decrease on the three cognitive measures but no change on the routinization score. While no association was observed between routinization and cognitive measures for the young adults, a high routinization was associated with lower cognitive flexibility in the older adults. These findings are interpreted in the light of theories about the positive impact of variety in daily life environment on cognitive functions.     

The effects of color and preretinal aging on embedded figures test performance: a failure to replicate

This study examined the hypothesis that preretinal aging may adversely affect performance in older adults. The relationship between preretinal aging and a perceptual variable (i.e., color) was also explored. Under standard testing procedures, the (a) normal, (b) light-attenuated, and (c) simulated aged performance of 90 young women was compared to the performance of 30 elderly women, using two forms (colored or noncolored) of the Embedded Figures Test (EFT). Results revealed that young women performed significantly better than elderly women on all measures, suggesting that neither the simulation of preretinal aging nor color was a significant factor in EFT performance. Inasmuch as the present study failed to replicate Ball and Pollack (1989), the critical age-related factors in cognitive/perceptual performance have yet to be identified.     

Obstructive Sleep Apnea in the Elderly: Extent of the Problem and Therapeutic Options

Obstructive Sleep Apnea (OSA) is an underdiagnosed and potentially serious disorder that is more common but less well characterized in older adults than in the middle-aged. With aging, anatomic and physiologic changes to the upper airway make it prone to collapse. Except in female nursing home residents and older adults with excessive daytime sleepiness, there is no association between OSA and mortality in the elderly. In comparison to the middle-aged, cardiovascular consequences also are substantially attenuated in the elderly; however, the limited existing evidence supports a relationship between OSA and arrhythmia, heart failure, stroke, and cognitive dysfunction. Currently, the diagnosis of clinically significant OSA in the elderly is similar to that of the general population. Special care to a patient’s physical and cognitive impairments is critical to consider when administering CPAP, oral appliances, and surgery in older adults.     

Association between physical activity and cognition in Mexican and Korean older adults

IntroductionAs the world's population ages, the prevalence of cognitive impairment associated with age increases. This increase is particularly pronounced in Asia and South-America. The objective of this study was to investigate separately the longitudinal association of physical activity and cognitive function in; older adults in Mexico and South Korea.Materials and MethodsThis is a secondary analysis of two surveys, The Mexican Health and aging Study (MHAS) (n = 5853) and Korean Longitudinal Study of aging (KLoSA) (n = 5188), designed to study the aging process of older adults living in Mexico and South Korea. Participants older than 50 years were selected from rural and urban areas achieving a representative sample. Physical activity was assessed using self-report. Cognition was assessed using Cross-Cultural Cognitive Examination (CCCE) and Minimental state examination (MMSE) in Mexico and South Korea respectively. Here we investigate the longitudinal association between physical activity and cognition during 3 years for MHAS and 4 years for KLoSA using multiple linear regression analyses.ResultsThe prevalence of physical activity was 40.68 % in MHAS and 35.57 % in KLoSA. In the adjusted longitudinal multivariate analysis, an independent association was found between physical activity and MMSE score OR 0.0866 (CI 0.0266-0.1467 p-value 0.0047) in the Korean older adults, while there was no significant association in MHAS.ConclusionsPhysical activity could have a protective effect on the cognitive decline associated with aging in the Korean population.     

Strategies for improving cognition with aging: insights from a longitudinal study of antioxidant and behavioral enrichment in canines

Studies in humans suggest that lifestyle factors can have a beneficial impact on the risk for developing cognitive decline and dementia with age. There is growing evidence that maintaining a physically and intellectually active lifestyle can positively impact cognitive ability in older individuals. Dietary factors, such as the intake of antioxidants, may also prevent age-related cognitive decline. However, studies in humans are challenging; many variables cannot be controlled, making it difficult for researchers to determine the exact types and quantities of enrichment and dietary factors necessary for positive effects on cognition. Studies in animal models of human aging allow researchers to precisely control such variables, and can be used to assess the mechanisms and molecular pathways underlying any positive effects. Here we review the results of an intervention study using a canine model of human aging. The study was unique in that it compared the effects of dietary antioxidant supplementation alone and in combination with behavioral enrichment. We found that both interventions lead to improvements in cognitive ability in aged dogs; however, combining the treatments preserved cognition to a greater extent than either treatment alone. Overall, the results suggest that antioxidant supplementation and behavioral enrichment target separate yet complementary molecular pathways to improve cognition, and support the idea that combinations of treatments to improve cognition and slow brain aging will produce greater benefits than single interventions.     

A 5-year retrospective examination of cognitive screening test stages in normal older adults and patients with Alzheimer's disease: the Tajiri project

One conception of aging and cognitive deterioration is that cognitive decline becomes common with age, and dementia may be regarded as one extreme of the continuum. An alternative conception is that the cognitive process is spared by the aging process itself and that cognitive functioning of normal older adults and those with slight cognitive impairment, a CDR (Clinical Dementia Rating) score of 0.5 (suspected dementia), should be different. We examined changes in the screening test performances of 170 older adults over a 5-year period and found the following: (a) The CDR 0 (normal) participants did not show remarkable changes even in the older groups and (b) the subitems of orientation, memory, and so forth were useful for distinguishing normal older adults from early Alzheimer's disease patients. The results support the idea that dementia is better conceptualized as an age-related than as an "aging-related" disorder and that a CDR score of 0.5 should be considered very mild Alzheimer's disease.     

Aerobic exercise training increases brain volume in aging humans

BACKGROUND: The present study examined whether aerobic fitness training of older humans can increase brain volume in regions associated with age-related decline in both brain structure and cognition. METHODS: Fifty-nine healthy but sedentary community-dwelling volunteers, aged 60-79 years, participated in the 6-month randomized clinical trial. Half of the older adults served in the aerobic training group, the other half of the older adults participated in the toning and stretching control group. Twenty young adults served as controls for the magnetic resonance imaging (MRI), and did not participate in the exercise intervention. High spatial resolution estimates of gray and white matter volume, derived from 3D spoiled gradient recalled acquisition MRI images, were collected before and after the 6-month fitness intervention. Estimates of maximal oxygen uptake (VO2) were also obtained. RESULTS: Significant increases in brain volume, in both gray and white matter regions, were found as a function of fitness training for the older adults who participated in the aerobic fitness training but not for the older adults who participated in the stretching and toning (nonaerobic) control group. As predicted, no significant changes in either gray or white matter volume were detected for our younger participants. CONCLUSIONS: These results suggest that cardiovascular fitness is associated with the sparing of brain tissue in aging humans. Furthermore, these results suggest a strong biological basis for the role of aerobic fitness in maintaining and enhancing central nervous system health and cognitive functioning in older adults.     

Effect of exercise on cognitive performance in community-dwelling older adults: review of intervention trials and recommendations for public health practice and research

There is evidence from observational studies that increasing physical activity may reduce the risk of cognitive decline in older adults. Exercise intervention trials have found conflicting results. A systematic review of physical activity and exercise intervention trials on cognition in older adults was conducted. Six scientific databases and reference lists of previous reviews were searched. Thirty studies were eligible for inclusion. Articles were grouped into intervention-outcome pairings. Interventions were grouped as cardiorespiratory, strength, and multicomponent exercises. Cognitive outcomes were general cognition, executive function, memory, reaction time, attention, cognitive processing, visuospatial, and language. An eight-member multidisciplinary panel rated the quality and effectiveness of each pairing. Although there were some positive studies, the panel did not find sufficient evidence that physical activity or exercise improved cognition in older adults. Future research should report exercise adherence, use longer study durations, and determine the clinical relevance of measures used.