Executive function, working memory, and medication adherence among older adults

The purpose of this study was to investigate the association between cognitive processes and medication adherence among community-dwelling older adults. Ninety-five participants (M = 78 years) completed a battery of cognitive assessments including measures of executive function, working memory, cued recall, and recognition memory. Medication adherence was examined over 8 weeks for one prescribed medicine by use of an electronic medication-monitoring cap. In a simultaneous regression, the composite of executive function and working memory tasks was the only significant predictor (beta =.44, p <.01). Findings suggest that assessments of executive function and working memory can be used to identify community-dwelling older adults who may be at risk for failure to take medicines as prescribed.     

Short-term changes in general and memory-specific control beliefs and their relationship to cognition in younger and older adults

We examined short-term changes in younger and older adults' control beliefs. Participants completed measures of general and memory-specific competence and locus of control on 10 bi-monthly occasions. At each occasion, participants rated their control beliefs prior to and following completion of a battery of cognitive tasks. Exposure to the set of cognitively demanding tasks led to declines in older adults' ratings of both general and memory-specific competence compared to little change or increases in younger adults' ratings. Older adults were also more inconsistent in their reported locus of control beliefs across the 10 occasions. Analyses examining the relationship between control beliefs and actual cognitive performance revealed few significant effects, suggesting that short-term changes in perceived control are not driven by monitoring changes in actual performance. The results suggest the importance of assessing short-term as well as long-term changes in perceived control to obtain a complete picture of aging-related changes.     

Cognitive abilities that predict success in a computer-based training program

PURPOSE: The purposes of this study were (a) to identify cognitive abilities and other factors related to successful completion of training for computer-based tasks that simulated real jobs and (b) to create a brief assessment battery useful in assessing older adults for these kinds of jobs. DESIGN AND METHODS: Participants from three age groups (young, middle-aged, and older) completed a battery of cognitive measures. They then trained on one of three computer-based tasks that simulated actual jobs and were asked to perform the tasks for 3 days. We recorded whether they completed training and whether and how well they did the tasks. In a series of logistic regressions, we evaluated the ability of a subset of cognitive measures drawn from a larger battery to predict participants' ability to successfully complete training and go on to task performance. RESULTS: Results confirmed theory-based expectations that measures of domain knowledge, crystallized intelligence, memory, and psychomotor speed would predict success in computer-based activities. A brief battery was able to predict older adults' successful completion of training for one task but was less useful for another. IMPLICATIONS: A brief battery of cognitive measures may be useful in evaluating individuals for job selection. Different measures are related to job-related criteria depending on task and group evaluated, although it was not possible to identify a reduced battery for one task. The specific cognitive abilities related to participants' success have implications for task and interface design for the elderly population.     

The Granny-Nanny: A Guide for Parents and Grandparents Who Share Child Care,by Lee Edwards Benning

In recent years interest has increased toward mental exercise as a way to promote healthy cognitive aging. Consistent findings have shown that declines in working memory performance are associated with aging. Sudoku is a popular puzzle game that has task demands similar to working memory processes. Younger and older adults completed a battery of tests and solved Sudoku puzzles. The results showed that Sudoku performance had a significant relationship to working memory. This suggests that Sudoku has the potential to become a new focus in the study of mental exercise and cognitive aging.     

Cognitive efficiency declines over time in adults with Type 1 diabetes: effects of micro- and macrovascular complications

Aims/hypothesis Mild cognitive dysfunction is not uncommon in adults with Type 1 diabetes, but its pathogenesis remains unclear. Previous cross-sectional studies had suggested that microangiopathy might affect brain integrity and lead to 'central neuropathy.' To assess the relationship between changes in cognitive performance and the incidence of new micro- and macrovascular complications, 103 young and middle-aged adults (mean age: 40 yrs) with childhood-onset Type 1 diabetes were followed over a 7-year period, and were compared to 57 demographically-similar adults without diabetes.Methods All subjects completed a comprehensive battery of neurocognitive tests on two occasions. Diabetic subjects also received repeated medical assessments to diagnose the onset of clinically significant complications.Results Relative to control subjects, diabetic adults showed significant declines on measures of psychomotor efficiency; no between-group differences were evident on learning, memory, or problem-solving tasks. The development of proliferative retinopathy and autonomic neuropathy during the follow-up period predicted decline in psychomotor speed (p<0.01), as did incident macrovascular complications (p<0.05), systolic blood pressure at follow-up (p<0.01), and duration of diabetes (p<0.01).Conclusion/interpretation This study shows that cognitive efficiency may decline over time in diabetic adults, and that this neurocognitive change may be linked, at least in part, to the occurrence of complications like proliferative retinopathy and elevated blood pressure. Therapeutic interventions that reduce the risk of vascular complications may have a similarly beneficial effect on the brain and reduce the risk of neurocognitive dysfunction in diabetic patients.Abbreviations AN Autonomic neuropathy - BAEP brainstem auditory evoked potential - CNS central nervous system - CAD coronary artery disease - DSST digit symbol substitution test - DSP distal symmetrical polyneuropathy - EDC epidemiology of diabetes complications - MRI magnetic resonance imaging - ON overt nephropathy - PVD peripheral vascular disease - PDR proliferative diabetic retinopathy - rCBF regional cerebral blood flow - WAIS-R wechsler adult intelligence scale, revised     

Longitudinal associations of depressive symptoms,subjective memory decline,and cognitive functioning among Chinese older adults: Between-person and within-person perspective

ObjectivesWe examined between- and within-person associations between depressive symptoms and cognitive functioning among Chinese older adults (aged 60+) over time. Furthermore, we also investigated whether subjective memory decline (SMD) is uniquely associated with cognitive functioning above and beyond depressive symptoms for both between-person and within-person associations.MethodsAbout 7385 older adults from the China Health and Retirement Longitudinal Study reported their demographic and health status, and completed self-report measures of depressive symptoms and SMD, as well as a battery of cognitive tests, every two years at three times between 2011 and 2015.ResultsThere were significant between-person and within-person associations between depressive symptoms and cognitive functioning. Furthermore, SMD was uniquely associated with cognitive functioning for both within-person and between-person associations after controlling for depressive symptoms.ConclusionsThe results highlight the importance of careful screening and monitoring of depressive symptoms and SMD for the benefits of cognitive functioning among Chinese older adults. More importantly, SMD has practical implications for the care of Chinese older adults given significant cultural stigma attached to mental illness within Chinese culture.     

Cognitive Training Program to Improve Working Memory in Older Adults with MCI

ABSTRACT

Objectives: Deficits in working memory (WM) are associated with age-related decline. We report findings from a clinical trial that examined the effectiveness of Cogmed, a computerized program that trains WM. We compare this program to a Sham condition in older adults with Mild Cognitive Impairment (MCI). Methods: Older adults (N = 68) living in the community were assessed. Participants reported memory impairment and met criteria for MCI, either by poor delayed memory or poor performance in other cognitive areas. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS, Delayed Memory Index) and the Clinical Dementia Rating scale (CDR) were utilized. All presented with normal Mini Mental State Exams (MMSE) and activities of daily living (ADLs). Participants were randomized to Cogmed or a Sham computer program. Twenty-five sessions were completed over five to seven weeks. Pre, post, and follow-up measures included a battery of cognitive measures (three WM tests), a subjective memory scale, and a functional measure.Results: Both intervention groups improved over time. Cogmed significantly outperformed Sham on Span Board and exceeded in subjective memory reports at follow-up as assessed by the Cognitive Failures Questionnaire (CFQ). The Cogmed group demonstrated better performance on the Functional Activities Questionnaire (FAQ), a measure of adjustment and far transfer, at follow-up. Both groups, especially Cogmed, enjoyed the intervention.Conclusions: Results suggest that WM was enhanced in both groups of older adults with MCI. Cogmed was better on one core WM measure and had higher ratings of satisfaction. The Sham condition declined on adjustment.     

Transfer of a speed of processing intervention to near and far cognitive functions

BACKGROUND: Evidence establishing the potential for modification of cognitive functioning in later adulthood has begun to accumulate. OBJECTIVE: The primary goal of the current study was to evaluate, among older adults, the extent to which standardized speed of processing training transfers to similar and dissimilar speeded cognitive measures as well as to other domains of cognitive functioning. METHODS: Ninety-seven older adults (mean age 73.71 years) were administered a battery of cognitive tests assessing intelligence, memory, attention, verbal fluency, visual-perceptual ability, speed of processing, and functional abilities. Forty-four of the participants received ten 1-hour sessions of speed of processing training. The remainder of participants were in a no-contact control group. Approximately 6 weeks after the pretraining assessment, all participants repeated the same battery of tests. RESULTS: The results revealed training effects for some speed of processing measures, including performance of instrumental activities of daily living, but no transfer to other domains of cognitive functioning. CONCLUSION: Speed of processing training may enhance the speed at which older adults can perform instrumental activities of daily living.     

Attentional functioning is impaired during acute hypoglycaemia in people with Type 1 diabetes.

AIMS: To examine the effects of acute insulin-induced hypoglycaemia on different aspects of attention and on general non-verbal reasoning in people with Type 1 diabetes. METHODS: A hyperinsulinaemic glucose clamp was used to maintain euglycaemia (4.5 mmol/l) or induce hypoglycaemia (2.6 mmol/l) on separate occasions in 16 adults with Type 1 diabetes each of whom were studied on two occasions in a counterbalanced order. During each study condition, the subjects completed parallel tests of cognitive function assessed by the Test of Everyday Attention and the Raven's Progressive Matrices. RESULTS: Hypoglycaemia caused a significant deterioration in tests sensitive to visual and auditory selective attention. During hypoglycaemia, attentional flexibility deteriorated and speed of information processing was delayed. Sustained attention and intelligence scores were preserved during hypoglycaemia. CONCLUSIONS: In people with Type 1 diabetes, hypoglycaemia causes a significant deterioration in attentional abilities, while non-verbal reasoning is preserved. It is likely therefore that many complex cognitive tasks which involve attention will be impaired during moderate hypoglycaemia during everyday life.     

Cognitive performance by humans during a smoked cocaine binge-abstinence cycle

Five cocaine-dependent individuals completed a 22-day inpatient study of sleep and cognition. Following 3 days of drug-free baseline, participants underwent 3 days of twice-daily smoked cocaine base self-administration (6 50-mg doses, 14 minutes apart), followed by 15 days of abstinence. Each morning and afternoon, the CDR repeatable, multiple-version, computerized cognitive battery (whose stability following practice has been documented) was administered. During abstinence, performance deteriorated on vigilance tasks (especially reaction time) as well as on immediate and delayed verbal recognition tasks but not on working memory tasks. Declines were most evident in the afternoon. Data suggest that abstinence can unmask cognitive deficits induced by chronic cocaine use and circadian factors may mediate their severity.     

Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment(*)

Background

Existing tools for rapid cognitive assessment in HIV‐positive individuals with mild cognitive deficits lack sensitivity or do not meet psychometric requirements for tracking changes in cognitive ability over time.

Methods

Seventy‐five nondemented HIV‐positive patients were evaluated with the Montreal Cognitive Assessment (MoCA), a brief battery of standardized neuropsychological tests, and computerized tasks evaluating frontal‐executive function and processing speed. Rasch analyses were applied to the MoCA data set and subsequently to the full set of data from all tests.

Results

The MoCA was found to adequately measure cognitive ability as a single, global construct in this HIV‐positive cohort, although it showed poorer precision for measuring patients of higher ability. Combining the additional tests with the MoCA resulted in a battery with better psychometric properties that also better targeted the range of abilities in this cohort.

Conclusion

This application of modern test development techniques shows a path towards a quick, quantitative, global approach to cognitive assessment with promise both for initial detection and for longitudinal follow‐up of cognitive impairment in patients with HIV infection.     

A comparison of computerized and pencil-and-paper tasks in assessing cognitive function in community-dwelling older people in the Newcastle 85+ Pilot Study

OBJECTIVES: To compare the acceptability and feasibility of computerized and pencil-and-paper tests of cognitive function in 85-year-old people. DESIGN: Group comparison of participants randomly allocated to pencil-and-paper (Wechsler Adult Intelligence and Memory Scales) or computerized (Cognitive Drug Research) tests of verbal memory and attention. SETTING: The Newcastle 85+ Pilot Study was the precursor to the Newcastle 85+ Study a United Kingdom Medical Research Council/Biotechnology and Biological Sciences Research Council cohort study of health and aging in the oldest-old age group. PARTICIPANTS: Eighty-one community-dwelling individuals aged 85. MEASUREMENTS: Participant and researcher acceptability, completion rates, time taken, validity as cognitive measures, and psychometric utility. RESULTS: Participants randomized to computerized tests were less likely to rate the cognitive function tests as difficult (odds ratio (OR)=0.16, 95% confidence interval (CI)=0.07-0.39), stressful (OR=0.18, 95% CI=0.07-0.45), or unacceptable (OR=0.18, 95% CI=0.08-0.48) than those randomized to pencil-and-paper tests. Researchers were also less likely to rate participants as being distressed in the computer test group (OR=0.19, 95% CI=0.07-0.46). Pencil-and-paper tasks took participants less time to complete (mean+/-standard deviation 18+/-4 minutes vs 26+/-4 minutes) but had fewer participants who could complete all tasks (91% vs 100%). Both types of task were equally good measures of cognitive function. CONCLUSION: Computerized and pencil-and-paper tests are both feasible and useful means of assessing cognitive function in the oldest-old age group. Computerized tests are more acceptable to participants and administrators.     

A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults

OBJECTIVES: To determine whether cardiorespiratory fitness at baseline is associated with maintenance of cognitive function over 6 years or with level of cognitive function on tests performed 6 years later in a longitudinal study of healthy older people. DESIGN: Prospective cohort. SETTING: Community-based study of noninstitutionalized adults aged 55 and older living in Sonoma, California. PARTICIPANTS: Three hundred forty-nine cohort members without evidence of cardiovascular disease, musculoskeletal disability, or cognitive impairment at baseline. MEASUREMENTS: Cardiorespiratory fitness measures were based on a standard treadmill exercise test protocol and included peak oxygen consumption (peak VO2), treadmill exercise duration, and oxygen uptake efficiency slope (OUES). Cognitive function was evaluated at baseline with a modified Mini-Mental State Examination (mMMSE) and after 6 years of follow-up with a detailed cognitive test battery that included the full MMSE, three tests of attention/executive function, two measures of verbal memory, and two tests of verbal fluency. RESULTS: Participants with worse cardiorespiratory fitness at baseline experienced greater decline on the mMMSE over 6 years (mean mMMSE decline (95% confidence interval) by baseline peak VO2 tertile: lowest = -0.5 (-0.8 to -0.3), middle = -0.2 (-0.5-0.0), highest = 0.0 (-0.3-0.2), P =.002 for trend over tertiles). Participants with worse baseline cardiorespiratory fitness also performed worse on all cognitive tests conducted 6 years later. Results were similar for analyses based on peak VO2, treadmill exercise duration, and OUES. After adjustment for demographic and health-related covariates, measures of cardiorespiratory fitness were associated most strongly with measures of global cognitive function and attention/executive function. CONCLUSION: Baseline measures of cardiorespiratory fitness are positively associated with preservation of cognitive function over a 6-year period and with levels of performance on cognitive tests conducted 6 years later in healthy older adults. High cardiorespiratory fitness may protect against cognitive dysfunction in older people.     

Validity of divided attention tasks in predicting falls in older individuals: a preliminary study

OBJECTIVES: Although cognitive impairment is known to be a major risk factor for falls in older individuals, the role of cognitive tests in predicting falls has not been established. Limited attentional resources may increase the risk for falls in older individuals. We examined the reliability and validity of divided attention tasks, walking while talking (WWT), in predicting falls. DESIGN: A prospective cohort study of 12-months' duration. SETTING: Community-based longitudinal aging study, the Einstein Aging Study. PARTICIPANTS: Sixty nondemented community-living subjects, aged 65 to 98 (mean age +/- standard deviation = 79.6 +/- 6.3). MEASUREMENTS: Simple and complex versions of the WWT task in addition to standard balance and cognitive assessments. The primary outcome was cumulative incidence of falls at 12 months. RESULTS: Thirteen subjects fell over the 12 months, four of whom had major injuries. The WWT task had good interrater reliability (r = 0.602, P <.001). Poor performance on simple (odds ratio (OR) = 7.02, 95% confidence interval (CI) = 1.7-29.4) and complex WWT tasks (OR = 13.7, 95% CI = 2.3-83.6) was highly predictive of falls. The simple task had a sensitivity of 46% and specificity of 89%. For the complex task, sensitivity was 39%, and specificity was 96%. CONCLUSIONS: The WWT is a reliable and valid test to identify older individuals at high risk for falls. Future studies with larger sample sizes and in different settings are needed to confirm the findings of this study.     

Successful Cognitive Aging and Health-Related Quality of Life in Younger and Older Adults Infected with HIV

Neurocognitive impairments commonly occur and adversely impact everyday functioning in older adults infected with HIV, but little is known about successful cognitive aging (SCA) and its health-related quality of life (HRQoL) correlates. Seventy younger (≤40 years) and 107 older (≥50 years) HIV+ adults, as well as age-matched seronegative comparison groups of younger (N = 48) and older (N = 77) subjects completed a comprehensive battery of neuropsychological, psychiatric, medical, and HRQoL assessments. SCA was operationalized as the absence of both performance-based neurocognitive deficits and self-reported symptoms (SCA-ANDS) as determined by published normative standards. A stair-step decline in SCA-ANDS was observed in accordance with increasing age and HIV serostatus, with the lowest rates of SCA-ANDS found in the older HIV+ group (19 %). In both younger and older HIV+ adults, SCA-ANDS was strongly related to better mental HRQoL. HIV infection has additive adverse effects on SCA, which may play a unique role in mental well-being among HIV-infected persons across the lifespan.     

Differences between two types of dual tasks according to the educational level in older adults

IntroductionFor dual-task paradigms, the timed up and go (TUG) test along with other cognitive or motor tasks has been used to evaluate and predict the risk of falling in older adults. However, the interference between motor-cognitive tasks can differ by the cognitive task.ObjectiveTo evaluate the performance of the TUG test under a single task condition and two dual-task conditions in older adults and to explore the effect of educational level on task performance.MethodsA total of 418 older adults (328 females) voluntarily participated in this study. The TUG test was administered as a single task and a dual task with one secondary simultaneous task: counting aloud backward from 100 or naming animals. Comparisons were performed to determine the interference caused by each cognitive task on the motor task, and correlation analysis was performed to explore the role of educational level.ResultsThe animal task led to a poorer TUG performance and a higher dual-task cost than did the counting task. Furthermore, the motor task led to a higher percentage of errors and cognitive stops in the animal task. Educational level plays a significant role in the interaction between tasks.ConclusionsBetween-task interference differs by the type of cognitive task performed and the educational level of the participants. The results of the present study should be considered when dual-task assessments are planned for older adults.     

The health benefits following regular ongoing exercise lifestyle in independent community‐dwelling older Taiwanese adults

Aim: To examine the effect of regular ongoing exercise lifestyle on mental and physical health in a group of independent community‐dwelling Taiwanese older adults over a 2‐year period. Methods: 197 older adults (mean age 72.5 years; 106 men and 91 women) who were independent in walking, instrumental and basic activities of daily living completed the baseline and a 2‐year follow‐up assessment. Older adults regularly performing exercises during the 2‐year study period were grouped into regular exercise group; otherwise in the irregular exercise group. Baseline and follow‐up assessments included a face‐to‐face interview and a battery of performance tests. Results: The regular exercise group showed significantly less depression (P= 0.03) and tended to regress less on the performance tests (P= 0.025–0.410) across 2 years compared to the irregular exercise group. Conclusion: Regular exercise is important for maintaining or even improving mental and functional health, even for independent community‐dwelling older adults.     

Health status and assessed need for a cohort of older people admitted to nursing and residential homes

OBJECTIVE: to investigate dependency and health status of a cohort of older people admitted for long term nursing or residential care and to compare these findings with assessments conducted by social services departments prior to placement. DESIGN: retrospective cohort study. SETTING: residential, nursing and dual registered homes within Nottingham Health Authority boundaries. SUBJECTS: 205 residents placed over 3 months. MAIN OUTCOME MEASURES: levels of disability, cognitive impairment and behavioural disturbance identified by assessment before and after admission. RESULTS: cognitive impairment and physical disability were significantly higher in nursing homes, although a third of residents in residential care had substantial physical disability. In nursing homes, a quarter of residents had low dependency needs but these had greater cognitive impairment than those in residential homes with the same level of dependency. Most residents had some degree of behavioural disturbance (particularly in nursing homes) and more severe disturbance was associated with greater cognitive impairment and more depressed mood, but not physical disability. A moderate level of agreement was found between preadmission and follow-up assessments of health status. CONCLUSIONS: a case-mix which includes higher dependency residents in residential homes and lower dependency residents in nursing homes is likely to reflect changes in the health status of residents following placement but also suggests that a range of placement criteria were used together, rather than individual indicators of need. Although pre-placement measures of disability and dependency were supported by follow-up assessments, it is essential that the needs of residents in long-term care are adequately monitored and managed, in particular those in residential care with higher dependency needs.     

Cross-domain variability of cognitive performance in very old nursing home residents and community dwellers: relationship to functional status

BACKGROUND: Recent evidence suggests that cross-domain variability in cognition may be related to subsequent cognitive decline beyond mean performance levels in cognitive tasks. OBJECTIVES: To examine age-related changes in cross-domain variability across cognitive task performance in very old nursing home residents in contrast to community-dwelling older adults. To explore the relationship between cross-domain variability in cognition and functional disability in very old age. METHODS: 204 very old (82.00+/-8.51 years) residents from the Jewish Home and Hospital, Bronx, N.Y., and 376 community-dwelling older adults of similar age (86.75+/-5.84 years) were tested on a cognitive battery. Cross-domain variability scores were computed across the cognitive tasks. Functional disability measures were derived from the CDR (Clinical Dementia Rating) Scale. RESULTS: Whereas oldest old community-dwelling adults showed a decrease in variability across domains with age, variability increased with age in nursing home residents, irrespective of the level of cognitive performance. Cross-domain variability was associated with functional disability beyond the effects of age, gender, education, dementia status, residential status, and level of cognitive performance. CONCLUSION: Findings suggest that cross-domain variability in cognition is related to functional decline with age. Cross-domain variability in cognition may be a prominent predictor for the development of functional decline in very old adults.     

Aging and memory for self-performed tasks: effects of task difficulty and time pressure

An increase in task difficulty or time pressure during the performance of cognitive tasks decreased the ability of older adults to recall the tasks. In Experiments 1 and 2, adult age differences in recall of cognitive tasks were smaller for easier than for more difficult tasks, and, in Experiment 3, adult age differences were smaller for recall of cognitive tasks without time pressure than for recall of cognitive tasks with time pressure. During difficult or time-pressured cognitive tasks, older adults may become anxious about their performance, and they may have trouble inhibiting negative self-evaluative thoughts about their performance. Older adults may thus devote less attention to aspects of the cognitive tasks that would be beneficial for task recall.