Predictors of perceived health status of tuberculosis-infected homeless

This study examines the predictors of perceived health status among homeless adults with latent tuberculosis (TB) in Los Angeles, especially in relation to gender differences. Total, 415 men and women enrolled in a TB-adherence trial completed baseline assessments concerning health status. Results indicated that women were more likely than men to report being in fair or poor health and to have experienced health problems. More women than men self-reported daily drug use and poor mental health. Homeless women were also more likely than their male counterparts to receive support from non-drug-users. Homeless adults who reported fair or poor health were also more likely than those who reported better health to have used injection drugs, to report experiencing depressive symptoms and poor mental health, and to have been homeless more than 3 years. Predictors of fair or poor health included being female and experiencing more depressive symptoms.     

Self-reported Exhaustion is Associated with Small Life Space in Older Adults with Mild Cognitive Impairment

[Purpose] Older adults experience exhaustion-induced health problems, such as poor physical function and low physical activity levels. The associations between self-reported exhaustion and physical function and activity are not clear in older adults with mild cognitive impairment (MCI). The aim of this study was to investigate the relationships between self-reported exhaustion and physical function and activity in older adults with mild cognitive impairment. [Subjects] A total of 356 older adults with mild cognitive impairment (mean age = 71.6 ± 0.3 years, 50.8% women) were included in this study. [Methods] Self-reported exhaustion was identified by one item from the Study of Osteoporotic Fractures index. Gait speed, gait endurance, and life space were also assessed. [Results] Sixty-two participants reported having exhaustion, giving a 17.4% prevalence of self-reported exhaustion among these individuals. Logistic regression analysis showed that the Life-Space Assessment score was the only parameter significantly independently associated with exhaustion status (adjusted odds ratio 0.97, 95% confidence interval 0.95–0.99). [Conclusion] These results suggest that self-reported exhaustion is associated with life space. Future research is needed to identify ways for older people with MCI to improve their exhaustion status.Key words: Mild cognitive impairment, Self-reported exhaustion, Life space     

Older adults in the SeniorWISE study at risk for mild cognitive impairment

As part of a larger clinical trial, SeniorWISE (Wisdom Is Simply Exploration), this study provides baseline affective, cognitive, and functional ability data and reports on the likely incidence of mild cognitive impairment (MCI) in a tri-ethnic community sample of older adults (N = 265). Seventy-eight individuals had memory complaints, whereas 105 had none. Of the complainants, 32 had normal memory function and 46 had poor memory performance. Among those without memory complaints, 42 had no memory impairment and 63 had poor memory performance. Forty-six individuals (17%) met the criteria of poor everyday memory functioning and memory complaints whereas 81 (31%) would be considered to be at risk based on other MCI criteria. This pattern of results suggests that those with declining memory are less aware of their deficits in activities of daily living that their actual performance would suggest are occurring.     

Visual cognitive function: changes associated with chronic insomnia in older adults

Older adults typically exhibit poor sleep efficiency as well as a decline in visual perception. In this study, the authors investigated whether late-life insomnia is associated with age-related changes in visual processing of global and local aspects of hierarchical figures. The study findings suggest that late-life insomnia may be one of the most important factors contributing to the decline of visual processing in older adults. The findings offer hope that treatment of insomnia in older adults could have beneficial effects on improving visual processing in this population.     

Can computerized cognitive training reverse the diagnosis of HIV‐associated neurocognitive disorder? A research protocol

Nearly 50% of adults with HIV have some form of HIV‐associated neurocognitive disorder (HAND), ranging from subtle to symptoms that interfere with everyday functioning and quality of life. HAND is diagnosed when a person performs more than 1 standard deviation below his or her normative mean on standardized measures in two or more cognitive domains (e.g., attention, speed of processing, verbal memory, executive functioning). As adults age with HIV, they are more likely to develop comorbidities such as cardiovascular disease, hypertension, and insulin resistance that may further contribute to poorer cognitive functioning and HAND. Certain computerized cognitive training programs may be able to improve specific cognitive domains in those with HIV. Such programs may be effective in changing the diagnosis of HAND in cognitively vulnerable adults. In this article, we describe the design and methods of TOPS—the Training On Purpose Study. In this on‐going experimental study, 146 older adults (50+) with HAND are randomized to either: (i) an Individualized‐Targeted Cognitive Training group, or (ii) a no‐contact control group. This study targets those cognitive domains in which participants experience a deficit and trains participants with the corresponding computerized cognitive training program for that domain. An Individualized Targeted Cognitive Training approach using cognitive‐domain‐specific cognitive training programs may offer symptom relief to those individuals diagnosed with HAND, which may actually reverse this diagnosis. Given that these cognitive training programs are commercially available, this approach represents a potential paradigm shift in how HAND is considered and treated.     

Combined Tai Chi and cognitive interventions for older adults with or without cognitive impairment: A meta-analysis and systematic review

Background and purposeEvidence from the field of cognitive interventions indicates that nonpharmaceutical interventions seem more promising in enhancing cognition. The number of clinical trials that examine the cognitive benefits of combined physical exercise with cognitive intervention on older adults has recently increased. Tai Chi (TC) has been recommended as an effective and safe exercise for older adults aged 60 and over. However, there is a lack of conclusion about whether combined TC with cognitive interventions can show more benefits than a single intervention for older adults. Thus, this review aimed to evaluate the effects of combined TC and cognitive interventions on older adults.MethodsPubMed, Embase, PsycINFO, and Web of Science were searched for English peer-reviewed papers from inception until November 12, 2021. Data were extracted by two independent reviewers.ResultsA total of 1524 records were generated and nine studies were included. The pooled results showed that combined TC and cognitive interventions showed significantly large gains on memory [standardised mean difference (SMD) = 0.87, 95% confidence interval (CI): (0.01, 1.74), P 0.05], moderate gains on cognition [SMD = 0.74, 95% CI:(0.19, 1.29), P 0.05], and small size effects on balance. No statistically significant difference was found in executive function, depression, risk of falls, or well-being.ConclusionCombined TC and cognitive interventions have positive effects on improving cognition and balance in older adults, but their superiority over the single intervention, as well as their additional effects on the physical and psychological function, are required further investigation.     

First year after stroke: tracking cognitive and affective deficits

A total of 58 cerebrovascular accident (CVA) rehabilitation inpatients with lateralized brain damage were assessed at two time points (T1 = admission to rehabilitation facility, about 7 weeks post-CVA, and T2 = 10 months post-CVA) in the following domains: hemispatial neglect, reaction time, depression, and affect comprehension. Performance was compared with 22 age-matched control subjects. Repeated measures ANOVAs were performed with patients subdivided into groups by laterality of lesion and visual field status (a strong predictor of psychometric performance, particularly in the hemispatial-neglect domain). During this initial year after stroke onset, significant improvements were observed in hemispatial neglect and affect comprehension in the two right-brain-damaged groups, but not the left-brain-damaged group. There was also a trend for improvement in observer rating of depression in all three groups. However, there was poor resolution of reaction time and self-reported depression in all three groups. These findings suggest that these latter domains should be targeted for more aggressive therapeutic intervention. An important component of such intervention, in addition to direct treatment of deficits, should be education of both patient and family as to the nature of deficits, expectations regarding resolution, and appropriate attributions of changed behavior after stroke.     

Assessing the clinical value of cognitive appraisal in adults aging with HIV

HIV and normal aging can each negatively affect executive functioning, attention, memory, and, ultimately, metacognitive abilities, which are important for internally monitoring neuropsychological performance. Some individuals who are aging with HIV may experience severe changes in their metacognitive abilities. They may be unaware of their neuropsychological functioning and may not be accurately monitoring their cognitive abilities. Nurses who rely on patients' self-reports of cognitive status should exercise caution regarding the accuracy of these reports and consider confirming and validating such responses when impairments are suspected. A flowchart for monitoring patients with suspected metacognitive impairments is provided.     

An exploratory study of depression among older African American users of an academic outpatient rehabilitation program

Variation in the presentation of depressive illness among older African Americans may complicate assessment of depression, especially among those with multiple medical comorbidities and functional disabilities. The purpose of this study was to explore the prevalence of depression among older poor African Americans attending an academic outpatient rehabilitation program, using a depression measure with low somatic item content. Correlates of depression in this population also were explored. Health-care records of 150 older African Americans seen over a 2-year period were examined. Depression was assessed on admission using the 30-item Geriatric Depression Scale (GDS). Using a GDS cutoff score for depression of 11 or higher, 30% of the sample (age 75.5 +/- 7.16 years, range 65-95, 75% women) scored positive for depression. Nine percent also reported having suicidal thoughts within the previous week. Consistent with existing literature, depressed patients, as compared to nondepressed patients, were significantly younger, more suicidal, more likely to rate their general health as poor, had higher mean ratings of pain, and more often limited their social activities. Six GDS items were found to have little ability to discriminate between depressed and nondepressed patients: satisfaction with life, getting bored easily, prefer staying at home, find life exciting, getting started on new projects, and full of energy. The authors recommend further testing of the GDS with similar populations of older, poor, medically ill, and functionally disabled older adults.     

Prevalence,Factors, and Health Impacts of Chronic Pain Among Community-Dwelling Older Adults in China

BackgroundChronic pain (CP) is prevalent among older adults in many Western countries and its prevalence, factors, and self-reported or objective measured health impacts have been well documented. However, there is limited information on these aspects among Chinese community-dwelling older adults.AimsOur aim was to assess the prevalence of CP and identify its associated factors as well as health impacts among older adults in China.DesignCross-sectional design.SettingsCommunity settings.Participants/SubjectsA total of 1219 community-dwelling adults aged 60 years or older.MethodsData on CP, sociodemographic characteristics, comorbidity, cognitive function, and physical activity, as well as self-reported outcomes (functional disability, depression, quality of sleep, and undernutrition) and objective measured physical function, were obtained.ResultsAmong 1,219 participants, 41.1% reported CP, of whom 16.6% experienced moderate to severe pain. The risk of CP was higher among older women with comorbidity and with depression and lower among older adults with higher educational level as well as with adequate physical activity. CP had significant associations with inadequate physical activity, functional disability, depression, poorer quality of sleep, and undernutrition, as well as worsening physical performance, poorer standing balance, and chair stands.ConclusionsCP is a common problem among Chinese community-dwelling older adults, particularly among the most vulnerable subgroups, and has substantial impacts on self-reported functional disability, depression, poor quality of sleep, and undernutrition, as well as objective measured physical function. Therefore it is relevant for older adults to develop effective CP management programs.     

Global self-rated mental health: associations with other mental health measures and with role functioning

BACKGROUND: A large body of research shows that global self-rated health is related to important outcome variables. Increasingly, studies also obtain a single global self-rating of mental health, but understanding of what this item measures is limited. OBJECTIVE: To clarify interpretation of self-reported mental health, we examine its associations with other validated measures of mental health and role functioning. RESEARCH DESIGN: We conducted cross-sectional analyses of nationally representative data from the Medical Expenditure Panel Survey. MEASURES: In-person household interviews obtained data on global self-reported mental health and any limitations in work, school, or housekeeping activities. Adult respondents (N = 11,109) completed the SF-12 health status survey, the K6 scale of nonspecific psychologic distress, and the Patient Health Questionnaire (PHQ-2) depression screener in a self-administered questionnaire. We used the SF-12 Mental Component Summary and the mental health subscale. Analyses examined associations among mental health measures and regressed activity limitations, and the SF-12 physical and emotional role functioning scales on mental health measures, controlling for demographics and selected chronic conditions. RESULTS: The 4 multi-item mental health measures were strongly correlated with each other (r > 0.69), but correlated less strongly with the self-reported mental health item (r approximately 0.4). In an exploratory factor analysis, self-reported mental health loaded on both mental and physical health factors. In multivariate analyses, each mental health variable was significantly associated with activity limitations and with role functioning, but the association of self-reported mental health with emotional role functioning was relatively weak. CONCLUSIONS: Although global self-rated mental health is related to symptoms of psychologic distress, it cannot be considered to be a substitute for them.     

Specific Dimensions of Depression Have Different Associations With Cognitive Decline in Older Adults With Type 2 Diabetes

OBJECTIVEDepression is highly frequent in older adults with type 2 diabetes and is associated with cognitive impairment, yet little is known about how various depression dimensions differentially affect cognition. We investigated longitudinal associations of specific depression dimensions with cognitive decline.RESEARCH DESIGN AND METHODSParticipants (N = 1,002) were from the Israel Diabetes and Cognitive Decline study, were ≥65 years of age, had type 2 diabetes, and were not experiencing dementia at baseline. Participants underwent a comprehensive neuropsychological battery at baseline and every 18 months thereafter, including domains of episodic memory, attention/working memory, semantic categorization/language, and executive function, and Z-scores of each domain were averaged and further normalized to calculate global cognition. Depression items from the 15-item Geriatric Depression Scale were measured at each visit and subcategorized into five dimensions: dysphoric mood, withdrawal-apathy-vigor (entitled apathy), anxiety, hopelessness, and memory complaint. Random coefficients models examined the association of depression dimensions with baseline and longitudinal cognitive functioning, adjusting for sociodemographics and baseline characteristics, including cardiovascular risk factors, physical activity, and use of diabetes medications.RESULTSIn the fully adjusted model at baseline, all dimensions of depression, except for anxiety, were associated with some aspect of cognition (P values from 0.01 to <0.001). Longitudinally, greater apathy scores were associated with faster decline in executive function (P = 0.004), a result that withstood adjustment for multiple comparisons. Associations of other depression dimensions with cognitive decline were not significant (P > 0.01).CONCLUSIONSApathy was associated with a faster cognitive decline in executive function. These findings highlight the heterogeneity of depression as a clinical construct rather than as a single entity and point to apathy as a specific risk factor for cognitive decline among older adults with type 2 diabetes.     

社区可逆认知衰弱老年人运动联合认知干预方案的构建

目的 针对社区可逆认知衰弱老年人,构建运动联合认知干预方案。 方法 采用文献分析法,结合运动和认知干预相关指南、专家共识等制订方案初稿,并通过德尔菲专家咨询形成干预方案。 结果 纳入专家10名,2轮问卷回收率分别为80%和100%;运动干预方案、认知干预方案的专家权威系数分别为0.90和0.99;各条目重要性评分均数为4.25~5.00分,满分率为0.25~1.00;2轮专家意见的肯德尔和谐系数分别为0.429（P=0.002）、0.545（P=0.031）;各条目变异系数为0~0.133。 干预方案包括一级指标10个,二级指标24个,三级指标23个。 结论 社区可逆认知衰弱老年人运动联合认知干预方案科学可靠,可以用于社区可逆认知衰弱老年人,为改善其身体功能和认知功能,延缓不良结局的发生提供参考。     

The relationship of pain and depression to cognitive function in rheumatoid arthritis patients

The purpose of this study was to assess the hypothesis that pain and depression negatively impact the cognitive functioning of individuals with rheumatoid arthritis (RA). One hundred twenty-one community-dwelling RA patients (ages 34-84) completed a battery of cognitive tasks and multiple measures of pain and depression. Structural equation modeling techniques were used to assess the relative contributions of pain, depression, and age to cognitive performance. Individuals who performed poorly on cognitive tasks reported more pain and depression and were older than those individuals who performed well on cognitive tasks. Moreover, high levels of pain were associated with depression. Further analyses revealed that depression mediated the relationship between pain and cognition. That is, when depression was entered into the analyses, the previously significant effects of pain on cognition were no longer found. Interestingly, depression still mediated the pain-cognition relationship even after controlling for age. These findings suggest the importance of both pain and depression for understanding cognitive function in RA and may have important implications for treating this disease.