Population Normative Data for the CERAD Word List and Victoria Stroop Test in Younger- and Middle-Aged Adults: Cross-Sectional Analyses from the Framingham Heart Study

Background/Study Context: To provide baseline normative data on tests of verbal memory and executive function for nondemented younger- and middle-aged adults.

Methods: The Consortium to Establish a Registry for Alzheimer’s Disease word list memory task (CERAD-WL) and Victoria Stroop Test (VST) were administered to 3362 Framingham Heart Study (FHS) volunteer participants aged 24–78 years. Analyses of the effects of age, gender, and education were conducted. Normative data on traditional measures and error responses are reported for each test.

Results: Traditional measures were significantly associated with both age and education in this cohort. Error responses also evidenced significant age and education effects.

Conclusion: These data provide a normative comparison for assessment of verbal memory and executive functioning capabilities in younger- and middle-aged adults and may be utilized as a tool for preclinical studies of disease in this population.     

Normative Data for the Cognitively Intact Oldest-Old: The Framingham Heart Study

Background/Study Context: The number of individuals who reach extreme age is quickly increasing. Much of the current literature focuses on impaired cognition in extreme age, and debate continues regarding what constitutes “normal” cognition in extreme age. This study aimed to provide oldest-old normative data and to compare cognitive performances of cognitively intact elderly individuals from the Framingham Heart Study.

Methods: A total of 1302 individuals aged 65+ years from the Framingham Heart Study were separated into 5-year age bands and compared on cognitive tests. Multivariate linear regression analyses were conducted, adjusting for gender, the Wide Range Achievement Test—Third Edition (WRAT-III) Reading score, and cohort. Analyses also included comparisons between 418 individuals aged 80+ and 884 individuals aged 65–79, and comparisons within oldest-old age bands.

Results: Normative data for all participants are presented. Significant differences were found on most tests between age groups in the overall analysis between young-old and oldest-old, and analysis of oldest-old age bands also revealed select significant differences (all ps <.05).

Conclusion: As aging increases, significant cognitive differences and increased variability in performances are evident. These results support the use of age-appropriate normative data for oldest-old individuals.     

Cognitive Reserve and Emotional Stimuli in Older Individuals: Level of Education Moderates the Age-Related Positivity Effect

Background/Study Context: A frequently observed age-related effect is a preference in older individuals for positive stimuli. The cognitive control model proposes that this positivity effect may be mediated by executive functions. We propose that cognitive reserve, operationally defined as years of education, which tempers cognitive decline and has been linked to executive functions, should also influence the age-related positivity effect, especially as age advances.

Methods: An emotional free recall test was administered to a group of 84 cognitively intact individuals aged 60 to 88, who varied in years of education. As part of a larger test battery, data were obtained on measures of executive functioning and depression.

Results: Multiple regression and moderation analyses were performed, controlling for general cognitive function, severity of depressive symptoms, and executive function. In our data, years of education appeared to moderate the effect of age on the positivity effect; age was negatively associated with recall of positive words in participants with fewer years of education, whereas a nonsignificant positive correlation was observed between age and positivity in participants with more education.

Conclusion: Cognitive reserve appears to play a role in explaining individual differences in the positivity effect in healthy older individuals. Future studies should investigate whether cognitive reserve is also implicated in the ability to process a wide range of emotional stimuli and whether greater reserve is reflected in improved emotional regulation.     

Personality Structure Among Centenarians: The Georgia Centenarian Study

Background/Study Context: We demonstrate that observer-rated factor structure of personality in centenarians is congruent with the normative structure. Prevalence of cognitive impairment, which has previously been linked to changes in personality in younger samples, is high in this age group, requiring observer ratings to obtain valid data in a population-based context. Likewise, the broad range of cognitive functioning necessitates synthesis of results across multiple measures of cognitive performance.

Methods and Results: Data from 161 participants in the Georgia Centenarian Study (GCS; M_Age = 100.3 years, 84% women, 20% African American, 40% community-dwelling, 30% low cognitive functioning) support strong overall correspondence with reference structure (full sample: .94; higher cognitive functioning: .94; lower cognitive functioning: .90). Centenarians with lower cognitive functioning are higher on neuroticism and lower on openness to experience, agreeableness, and conscientiousness. Facet-level differences (higher N1–N6: anxiety, hostility, depression, self-consciousness, impulsiveness, vulnerability to stress; lower E1: warmth; lower O4–O6: actions, ideas, values; lower A1, A3, A4: trust, altruism, compliance; C1, C5: competence, self-discipline) are also observed. Multivariate factor-level models indicate only neuroticism of the five broad factors predicts membership in cognitively impaired group; facet-level models showed that lower-order scales from three of the five domains were significant. Centenarians with higher self-consciousness (N4), impulsiveness (N5), and deliberation (C6) but lower ideas (O5), compliance (A4), and self-discipline (C5) were more likely to be in the lower cognitive functioning category.

Conclusion: Results present first normative population-based data for personality structure in centenarians and offer intriguing possibilities for the role of personality in cognitive impairment centered on neuroticism.     

Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer's disease

OBJECTIVE: To examine changes in equilibrium and limb coordination in normal aging, mild cognitive impairment, and moderate cognitive impairment associated with early probable Alzheimer's disease (AD), by means of parametric clinical measures. DESIGN: Case series SETTING: Out-patient clinic. PARTICIPANTS: A consecutive sample of 365 community-residing ambulatory volunteers (137 men, 228 women; mean age 70.4 +/- 9.4 years; mean educational attainment 14.6 +/- 3.1 years), who were followed in an ongoing longitudinal study of aging and AD, comprising cognitively intact individuals, persons with mild cognitive impairment, and patients with mild AD. MEASUREMENTS: For general magnitude of cognitive function, the Global Deterioration Scale (GDS). For cognition, the Mini-Mental State Examination (MMSE). Equilibrium was assessed with parametric measurements of single leg stance (SLS) and tandem walking (TW). Limb coordination was assessed with parametric measurements of foot tapping (FT), alternating pronation and supination (PS), and sequential finger to thumb tapping (FTH). MAIN RESULTS: After adjustment for age, persons with mild cognitive impairment or mild AD had significantly poorer performance on parametric clinical tests of equilibrium and limb coordination compared with cognitively intact individuals (P < .05). CONCLUSIONS: Changes in equilibrium and limb coordination are clinically demonstrable in persons with mild cognitive impairment and mild AD using simple parametric tests. Such tests could potentially identify individuals with increased risk of falling. Early diagnosis and treatment of conditions that can jeopardize equilibrium and limb coordination, as well as balance and coordination training, might help cognitively impaired older people to maintain optimal function and may decrease the risk of falls and injuries.     

Physical Activity and Depressive Symptoms Interact to Predict Executive Functioning Among Community-Dwelling Older Adults

Background/Study Context: Physical activity is beneficial for the executive functioning (EF) of older adults, but may be particularly protective of EF when they are cognitively vulnerable, such as during depressive episodes. Intervention studies support more potent effects of physical activity on EF among clinically depressed older adults, although these results may have limited generalizability to the daily mood and physical activity of healthy, community-dwelling older adults.

Methods: The current study aimed to test whether physical activity among older adults was more protective of EF during periods of cognitive vulnerability due to mildly elevated depressive symptoms. Longitudinal data from 150 generally healthy, community-dwelling older adults were collected semiannually and analyzed with multilevel modeling.

Results: Physical activity was more protective of EF within individuals during periods of relatively elevated depressive symptoms.

Conclusions: The power of physical activity to protect EF during periods of cognitive vulnerability may extend to community-dwelling older adults with nonclinical levels of depressive symptoms.     

Pulmonary Function and Cognitive Decline in an Older Chinese Population in Singapore

Abstract

Introduction: Various cognitive deficits associated with reduced pulmonary function are reported in different studies, but the pattern of cognitive deficits across multiple domains and its associated everyday functional disability remain unclear. Methods: We analyzed neuropsychological functioning, cognitive impairment and accompanying disability in instrumental activities of daily living (IADL) associated with reduced pulmonary function in community-living middle-aged and older adults in Singapore. Performance on a comprehensive battery of neuropsychological tests, spirometry and cognitively demanding IADLs were assessed in the population-based Singapore Longitudinal Ageing Studies. Results: Consecutive 10% increase in forced expiratory volume in 1 s (FEV1) as percent of predicted was positively associated with 0.18 points increase in Mini-mental state examination (MMSE) and 0.04 points increase in executive function, independent of age, education and other variables. Subjects with moderate-to-severe airway obstruction showed significantly poorer MMSE score (p for linear trend = 0.001), and information processing speed (p for linear trend < 0.001). FEV1 (per 10% of predicted) was significantly associated with lower risk of cognitive impairment (OR = 0.92, 95% CI: 0.87-0.98, P = 0.005) and cognitive IADL disability (OR = 0.86,95% CI:0.79–0.93, P < 0.001). Pulmonary restriction was associated with greater risk of cognitive impairment (OR = 1.98, 95% CI: 1.26-3.11, P = 0.003) and cognitive IADL disability (OR = 2.43, 95% CI: 1.31-4.53, P = 0.005). Moderate-to-severe airway obstruction (OR = 2.04, 95% CI: 1.11–3.74, P = 0.022) was positively associated with cognitive IADL disability. Conclusion: The findings suggest a measurable but modest cognitive effect of low pulmonary function that was accompanied by corresponding disability in living activities. The effect on executive functioning should be further investigated in longitudinal studies.     

The Interaction Between Memory Trace and Memory Judgment in Age-Related Decline

Background/Study Context: Associative memory deficit and executive functioning deficit are two alternative—but nonexclusive—accounts of the episodic memory deficit observed in aging. The first explain the episodic memory decline generally observed in aging by an associative memory deficit (memory decline per se), whereas the second explains it by an executive functioning deficit. This distinction could be critical in early discrimination between healthy aging and very mild Alzheimer’s-type dementia.

Methods: Memory performance was measured in older adults (n = 20) and paired younger participants (n = 20), whereas the facial expression and auditory context (spoken voice) associated with the face were manipulated between study and test. Recollection and familiarity were estimated using a remember/know judgment, and source memory performance was obtained depending on the information to retrieve.

Results: Although no between-group difference was observed for correctly recognized old faces, older participants made more false alarms than younger ones, thus revealing lower discriminability (d’). Facial expression change decreased recognition for all participants, whereas auditory context change decreased recognition only for younger participants. Remember/know judgments revealed age-related deficits in both recollection and familiarity, the relative decrease in familiarity reported by older adults was particularly large in the expression change conditions, and a disadvantage in source memory performance was particularly pronounced when the task was to retrieve auditory context associated with the face at study.

Conclusions: The present findings show that age-related associative memory differences occur with familiarity as well as recollection and are observed in situations that do not necessarily require conscious retrieval. This age-related decline is more prominent for multimodal (face–auditory context) than for intraitem (face-expression) associations. The value of exploring both memory trace and memory judgment was discussed, and potential applications for the development of neuropsychological tools for memory assessment in aging were highlighted.     

Age Effect in Recall Performance According to the Levels of Processing,Elaboration, and Retrieval Cues

Background/Study Context: The variability associated with reaction time (RT) is sometimes considered as a proxy for inefficient neural processing, particularly in old age and complex situations relying upon executive control functions. Here, it is examined whether the amount of variability exhibited early in practice can predict the amount of improvement with later practice in dual-task performance, and whether the predictive power of variability varies between younger and older adults.

Methods: To investigate the relationship between variability and practice-related improvement, RT mean and variability data are used, obtained from an experiment in which younger and older adults performed two tasks in single-task and dual-task conditions across seven practice sessions. These RT and variability data were related to the single-task and dual-task practice benefits. These benefits were computed as follows: dual-task/single-task RTs at the beginning of practice minus dual-task/single-task RTs at the end of practice.

Results: In both age groups, dual-task processing was speeded up with practice and variability associated with the means was reduced. Most important, independent of mean RTs, variability allowed predicting dual-task practice benefit in both age groups under specific conditions.

Conclusion: These findings suggest that the relationship between performance variability and executive control functions under some specific conditions. Implications of these results for models of practiced dual tasks are discussed.     

Practice of Aerobic Sports is Associated with Better Spatial Memory in Adults and Older Men

Background/Study Context: Cognitive abilities experience diverse age-related changes. Memory complaints are common in aging. The practice of sports is known to benefit brain functioning, improving memory among other abilities. Introduction of virtual reality tasks makes it possible to easily assess cognitive functions such as spatial memory, a hippocampus-dependent cognitive ability.

Methods: In this study, the authors applied a virtual reality–based task to study spatial reference memory in two groups of men, sportsmen (n = 28) and sedentary (n = 28), across three different age groups: 50–59, 60–69, and 70–77 years.

Results: The data showed that sportsmen outperformed sedentary participants. In addition, there was also a significant effect of the factor age. Hence, older men (70–77 years old) displayed a poorer performance in comparison with the other age groups.

Conclusions: These results support the beneficial effect of habitual physical activity in spatial memory.     

Perceptions of Competence: Age Moderates Views of Healthy Aging and Alzheimer’s Disease

Background/Study Context: Older adults have more complex and differentiated views of aging than do younger adults, but less is known about age-related perceptions of Alzheimer’s disease. This study investigated age-related perceptions of competence of an older adult labeled as “in good health” (healthy) or “has Alzheimer’s disease” (AD), using a person-perception paradigm. It was predicted that older adults would provide more differentiated assessments of the two targets than would younger adults.

Methods: Younger (n = 86; 18–36 years) and older (n = 66; 61–95 years) adults rated activities of daily living (ADL), instrumental activities of daily living (IADL), and memory abilities of a female target aged 75 years, described as healthy or with AD. Data on anxiety about aging, knowledge of and experience with aging and AD, knowledge of memory aging, and positive and negative biases toward aging and AD were also collected.

Results: Older adults perceived the healthy target as more capable of cognitively effortful activities (e.g., managing finances) and as possessing better memory abilities than the AD target. As predicted, these differences were greater than differences between targets perceived by younger adults. The interaction effect remained significant after statistically controlling for relevant variables, including education and gender. Additionally, exploratory analyses revealed that older adults held less positively biased views of AD than younger adults, but negatively biased views were equivalent between age groups.

Conclusion: The results demonstrate that mere labels of “healthy” and “Alzheimer’s disease” produce significant and subtle age differences in perceived competencies of older adults, and that biases towards AD vary by age group and valence. Our findings extend the person-perception paradigm to an integrative analysis of aging and AD, are consistent with models of adult development, and complement current research and theory on stereotypes of aging. Future directions for research on perceptions of aging are suggested.     

Longitudinal association of executive function and structural network controllability in the aging brain

Executive function encompasses effortful cognitive processes that are particularly susceptible to aging. Functional brain networks supporting executive function—such as the frontoparietal control network and the multiple demand system—have been extensively investigated. However, it remains unclear how structural networks facilitate and constrain the dynamics of functional networks to contribute to aging-related executive function declines. We examined whether changes in structural network modal controllability—a network’s ability to facilitate effortful brain state transitions that support cognitive functions—are associated with changes in executive function cross-sectionally and longitudinally. Diffusion-weighted imaging and neuropsychological testing were conducted at two time points (Time 1: ages 56 to 66, N?=?172; Time 2: ages 61 to 70, N?=?267) in community-dwelling men from the Vietnam Era Twin Study of Aging. An executive function factor score was computed from six neuropsychological tasks. Structural networks constructed from white matter connectivity were used to estimate modal controllability in control network and multiple demand system. We showed that higher modal controllability in control network and multiple demand system was associated with better executive function at Time 2, after controlling for age, young adult general cognitive ability, and physical health status. Moreover, changes in executive function over a period of 5 to 6 years (Time 1-Time 2, N?=?105) were associated with changes in modal controllability of the multiple demand system and weakly in the control network over the same time period. These findings suggest that changes in the ability of structural brain networks in facilitating effortful brain state transitions may be a key neural mechanism underlying aging-related executive function declines and cognitive aging.

     

Interlimb Practice and Aging: Coding a Simple Movement Sequence

Background/Study Context: The purpose was to determine if aging interacts with the coding of a simple spatial-temporal movement sequence.

Methods: An interlimb practice paradigm (24 participants; 12 young adults [age: 23–29]; 12 old adults [age: 65–78]) was designed to determine the coordinate system (visual-spatial/motor) that is used to code the movement sequence. Practice was scheduled over 2 days involving either the same visual-spatial or the same motor coordinates. On Day 3, two retention tests (Day 1/Day 2) were conducted.

Results: Keeping the motor coordinates the same during acquisition resulted in superior retention only for younger adults.

Conclusion: The data provide strong evidence that the motor code plays a dominant role in acquiring simple movement sequences for younger adults, but not for older adults.     

Memory Self-Efficacy and Beliefs about Memory and Aging in Oldest-Old Adults in the Louisiana Healthy Aging Study (LHAS)

Background/Study Context. Adaptation to normative age-related declines in memory is an important but understudied aspect of successful aging. The purpose of the present study was to shed new light on memory self-efficacy and beliefs about memory and aging as two integral aspects of adult cognition with relevance to successful aging.

Methods. Young (19 to 27 years) and community-dwelling older adults (60 to 94 years) from the Louisiana Healthy Aging Study (LHAS) completed an adapted Memory Functioning Questionnaire (MFQ) which includes a memory self-efficacy subscale, the Memory Controllability Inventory (MCI), and the Aging Concerns Scale (ACS).

Results. Nonagenarians’ self-reported memory and beliefs about memory and aging were of central interest. We compared their responses to three younger reference groups to examine hypothesized differences in self-reported memory and beliefs about memory and aging in very late life. Results yielded age effects for most of the MFQ and MCI subscales demonstrating more positive subjective views about memory functioning and control over memory for the young adults. Correlation and regression analyses were conducted to isolate factors that may be associated with memory self-efficacy. Age, symptoms of depression, and memory control beliefs accounted for approximately half of the variance in memory self-efficacy ratings.

Conclusion. These data indicate that although memory self-efficacy may be age sensitive, we detected no differences in subjective views across the three older groups. Implications for cognitive adaptability and successful aging are considered.     

An adaptation of the Korean mini-mental state examination (K-MMSE) in elderly Koreans: demographic influence and population-based norms (the AGE study)

The mini-mental state examination (MMSE) is a brief global instrument used to assess cognitive abilities, and has been translated into the K-MMSE. The clinical value of the K-MMSE is restricted by the small amount of normative data available, especially for the elderly population. We investigated the population-based data of K-MMSE scores to obtain the norms specific for the sociodemographic characteristics of elderly Koreans. The K-MMSE was applied to a cognitively normal sample of 977 subjects aged 60-84 years in Ansan, South Korea. We determined whether the sociodemographic characteristics were related to the K-MMSE scores and calculated the norms. The K-MMSE score was significantly associated with age, gender, and level of education, and this result was used to develop normative data with age, gender, and educational strata. The normative data based on age, gender, and level of education presented here are suitable for clinical use.     

An adaptation of the Korean mini-mental state examination (K-MMSE) in elderly Koreans: Demographic influence and population-based norms (the AGE study)

The mini-mental state examination (MMSE) is a brief global instrument used to assess cognitive abilities, and has been translated into the K-MMSE. The clinical value of the K-MMSE is restricted by the small amount of normative data available, especially for the elderly population. We investigated the population-based data of K-MMSE scores to obtain the norms specific for the sociodemographic characteristics of elderly Koreans. The K-MMSE was applied to a cognitively normal sample of 977 subjects aged 60–84 years in Ansan, South Korea. We determined whether the sociodemographic characteristics were related to the K-MMSE scores and calculated the norms. The K-MMSE score was significantly associated with age, gender, and level of education, and this result was used to develop normative data with age, gender, and educational strata. The normative data based on age, gender, and level of education presented here are suitable for clinical use.     

Microstructural Change of the Brain in Chronic Obstructive Pulmonary Disease: A Voxel-Based Investigation by MRI

Abstract

Background: Cognitive deficit is a common problem in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to prospectively evaluate if MRI can demonstrate microstructural volume loss and the diffusion anisotropic change in subjects with COPD, compared with cognitively normal (CN) subjects. Methods: Six subjects with severe COPD, 13 with moderate COPD, and 12 CN subjects underwent isotropic volumetric T1-weighted imaging and diffusion tensor imaging (DTI). Voxel-based statistical analyses among groups were performed on brain volumes, fractional anisotropy (FA) and trace. Cognitive function tests were performed in all subjects, and the Cognitive function tests (CFT) scores were compared among the three groups. Results: No significant regional difference in volume was found in both the severe and moderate COPD groups relative to the CN group. Comparing between severe COPD and CN, FA was reduced in both the cerebral cortices, and in frontoparietal periventricular white matter. The trace value of the severe COPD group was significantly higher in the cerebral cortices, and in frontoparietal periventricular white matter, than that of the CN group. The severe COPD group showed significantly lower scores in the language-related, visuospatial, and frontal executive functions compared to those of the CN and moderate COPD group. Conclusion: This study demonstrated that COPD could affect the axonal integrity in multiple brain regions, and change in DTI might be related with the severity of the COPD.     

Normal values of balance tests in women aged 20-80

OBJECTIVES: To determine normal values for four commonly used clinical functional balance tests from community-dwelling women aged 20 to 80 and to identify any significant decline due to aging. DESIGN: A cross-sectional study was undertaken to provide normative values for four clinical balance tests across 6 decade cohorts. SETTING: The Betty Byrne-Henderson Center for Women and Aging, Royal Womens' Hospital, Brisbane, Australia. PARTICIPANTS: Four hundred fifty-six community-dwelling, independently ambulant women with no obvious neurological or musculoskeletal-related disability, aged 20 to 80, were randomly recruited from a large metropolitan region. MEASUREMENTS: The clinical balance measures/tests were the Timed Up and Go test, step test, Functional Reach test, and lateral reach test. Multivariate analysis was used to test the effect for age, height, and activity level. RESULTS: Normal data were produced for each test across each decade cohort. Gradual decline in balance performance was confirmed, with significant effect for age demonstrated. CONCLUSION: New normative data across the adult age decades are available for these clinical tests. Use of clinical balance tests could complement other balance tests and be used to screen women aged 40 to 60 whose performance is outside the normal values for age and to decrease later falls risk.     

Exploring the intersection of executive function and medication adherence in school-age children with asthma

Asthma is one of the most common chronic diseases of childhood. For children with persistent asthma, asthma control is largely related to controller medication adherence. With increasing calls for children to be involved in their own asthma management, there is a gap in our knowledge about the executive functioning of children with asthma. Objective: The purpose of this study was to explore the relationship between executive function, asthma, and medication adherence among school-age children with asthma. Methods: Thirty-one children ages 7 to 11 years (M = 8.9 ± 1.51) and one of their parents were enrolled in this study. Parents reported on asthma control while children reported on asthma control, medication beliefs, medication adherence, and completed an executive function battery that assessed inhibition, updating, shifting and planning. Results: Compared to the reference sample, children in this study had significantly lower composite scores in inhibition, t (31) = ?3.84, p =. 001, and shifting, t (30) = ?3.73, p =. 001. Controlling for age and asthma control, hierarchical regression analyses revealed that shifting accounted for 16% of the variance in child-reported medication adherence. Conclusions: This study revealed lowered executive functioning scores among school-age children with persistent asthma. Furthermore, it appears executive functioning and controller medication adherence are intertwined and warrant future exploration.     

Understanding Within-Group Variability of Everyday Cognition in Aging Black/African American Adults: A Mimic (Multiple Indicators,Multiple Causes) Model Approach

Background/Study Context: Everyday cognition represents the ability to solve problems within domains that are representative of issues faced by adults on a daily basis. The current study examined individual differences in everyday cognitive ability among aging Black/African American adults.

Methods: Demographic data on age, gender, education, physical functioning, chronic illnesses, self-reported health, and depression were collected from 248 African American adults (mean age = 67.8 years, standard deviation = 8.47 years). A multiple indicators, multiple causes (MIMIC) modeling approach was used to examine the associations of individual characteristics with latent everyday cognitive ability and composite score indicators.

Results: Age, depressive symptoms, and number of chronic illnesses were negatively related to latent everyday cognition. The individual characteristics of age, depressive symptoms, self-rated health, and education were directly associated with composite indicators of latent everyday cognition. This suggests that within this sample of older Black/African American adults that certain composite scores (i.e., telephone use, food preparation, and finances) may be particularly sensitive to these individual characteristics.

Conclusion: These results identify specific sources of variability in everyday cognitive ability among aging Blacks/African Americans. These individual differences should be accounted for when studying everyday cognition among Blacks/African Americans and when comparing the everyday cognitive ability of Blacks/African Americans with other groups.