Cognitive screening in a population-based sample of community-living elderly: Effects of age and education on the construct of cognitive status

This study examined the measurement properties of a cognitive screening test, the Halifax Mental Status Scale (HMSS), in a population-based sample of community-living elderly subjects (N = 361) and a clinic sample (N = 20) of patients with Alzheimer's disease. Receiver operating characteristic analyses yielded estimates of sensitivity and specificity of approximately 90% for this test. Factor analysis confirmed a three-factor solution for the HMSS. Although both age and education were correlated with the HMSS total score, their relationship to the factor scores differed. Our study shows that comprehensive cognitive status tests do not measure a unitary construct and that adjustment of summary scores for education is unlikely to optimize sensitivity and specificity. In population-based studies, only those components of a test that reflect education should be adjusted.     

Category fluency in a latino sample: associations with age, education, gender, and language

The authors know of no published studies that have evaluated the effect of Spanish- versus English-language on category fluency within a sample of United States Latinos only. As part of a pilot study for the institution of a cognitive screening program in a cohort of Latinos, we assessed category fluency (fruits, vegetables, and "other" supermarket items) in a sample of 90 self-identified Latino community residents (aged 52-84, 0-18 years of education). The primary demographic correlates of category fluency were age and education. The decrement in naming of fruits with age was limited to the older old subjects (>age 70). Relatively younger old subjects (aged 61-70) did not differ from middle-aged subjects on category fluency. Gender showed little relationship to category naming. Persons naming in Spanish named significantly fewer 'other supermarket' items, but did not differ from English speakers in the more common fluency categories of fruits and vegetables. This analysis of category fluency in an ethnically homogenous sample with a wide range of formal education provided an evaluation of the effects of chosen language free of possible confounding by cultural differences, and also provided a more complete evaluation of the influence of education on category fluency.     

Prevalence of dementia in rural China: impact of age, gender and education

OBJECTIVE: To determine the prevalence of dementia and Alzheimer's disease (AD) in rural China. METHODS: A cross-sectional study was conducted within a cohort of adults older than 50 years of age in Linxian County, China. A Chinese version of the Mini-Mental State Examination (CMMSE) was used to screen cases of possible dementia. Three different cutoff points on CMMSE were applied depending on the participant's level of education. The participants then were given psychiatric interviews, medical and neurological examinations, and psychometric tests to ascertain the clinical diagnoses of dementia and AD. RESULTS: Among the 16,095 participants, 5.26% were screened positive with 374 diagnosed as having dementia. Among them, AD accounted for 80.5%. The adjusted prevalence rates were 0.33%, 0.89%, 3.43%, and 8.19% in people in age groups 50-54, 55-64, 65-74, and 75 and above, respectively. The prevalence of AD correlated with the participant's level of education, and was 2.61%, 0.94%, and 0.56% in the illiterate group, in the primary school group, and in the middle school or higher group, respectively. Adjusted by education levels a higher prevalence in women was observed in the illiterate group. CONCLUSIONS: The prevalence of dementia in this population is similar to that reported from other areas in mainland China and Taiwan with aging being a significant risk factor. After controlling for age, being a female and having received less number of years of education were associated with an higher prevalence of AD.     

Effects of age, education and gender on verbal fluency

The objective was to study the effects of age, education and gender on verbal fluency in cognitively unimpaired, older individuals. The methods used were as follows: cognitively unimpaired elderly (55-84 years) subjects (n=153), were administered category (animal) (CF) and letter (/pa/) (LF) fluency tasks, in their native language of Malayalam. Results and conclusions were (1) Level of education, but not age or gender, significantly influence LF. (2) Level of education (directly) and in the elderly subjects, age (inversely) affect CF. (3) Age, but not education, has a differential effect on the tasks of verbal fluency, influencing CF more than LF.     

Effects of age,education, and gender on the Rey-osterrieth complex figure

The Rey-Osterrieth Complex Figure (copy and immediate recall) was given to 346 normal elderly subjects divided into groups according to three variables: (1) age (56–60, 61–65, 66–70, 71–75, 76 or more years old), (2) educational level (0–5, 6–12, and more than 12 years of schooling), and (3) sex. Taylor's (1959) system was used to score the figures. It was observed that scores varied as a function of all three selection variables, for both the copy and for the immediate reproduction of the figure.     

Prevalence of dementia in an elderly rural population: effects of age, sex, and education.

OBJECTIVES--To estimate the prevalence of dementia in an elderly rural population and to determine the effects of age, sex, and education. METHODS--To obtain prevalence estimates of both cognitive impairment and dementia a door to door two phase population survey was carried out in three rural villages in central Italy. Of 1147 inhabitants older than 64, 968 (84.4%) completed the protocol. RESULTS--The prevalence rates (cases per 100 population over 64) were 8.0 for dementia and 27.3 for cognitive impairment. The prevalence rate for dementia did not differ between men and women (7.9 v 8.2), but increased with age (from 1.1 at age 65-69 to 34.8 at age 90-96). Subjects with less than three years of schooling had a significantly higher prevalence of dementia (14.6; 95% confidence interval (95% CI) 10.2-19.1) than subjects with three or more years of schooling (5.9; 95% CI 4.2-7.7). At the multivariate logistic analysis, the risk related with a low level of education was still present after adjustment for age and sex (OR = 2.0; 95% CI 1.2-3.3). Alzheimer's disease was diagnosed in 64% of the 78 demented patients, vascular dementia in 27%, and other dementing diseases in 9%. CONCLUSIONS--In both Alzheimer and vascular dementia subtypes, the prevalence rates did not differ between men and women, but increased with age and were higher in subjects with a low level of education.     

Subsyndromal depression in old age: clinical significance and impact in a multi-ethnic community sample of elderly Singaporeans

OBJECTIVE: This cross-sectional study examined the clinical significance and impact of subsyndromal depression in a sample of elderly people living in the community in Singapore. METHOD: Data were analyzed from a population survey (the Singapore National Mental Health Survey of the Elderly). A total of 1092 respondents from a nationally representative multi-ethnic (Chinese, Malay and Indian) stratified random sample of older adults aged 60 and above were examined for depression using the Geriatric Mental State Examination (GMS). Diagnostic confidence levels of 3-5 indicated a DSM-IV diagnosis of syndromal depression, and 1-2 indicated subsyndromal depression. Other variables included sociodemographic characteristics, psychiatric and medical comorbidities, MMSE, health awareness, health and functional status. RESULTS: Subjects with subsyndromal depression were more likely to have poor socioeconomic status, cognitive impairment, anxiety, and measures of poor mental, physical and functional status compared with non-depressed subjects, and were similar to or worse than syndromal cases. In multivariate analyses that controlled for age, gender, ethnicity, education and several other sociodemographic factors, both subsyndromal and syndromal depression were significantly associated with higher numbers of medical comorbidities, diagnoses of comorbid dementia and anxiety, lower MMSE scores, self-reported mental health problem, functional disability and poor health status. CONCLUSION: In this Asian population, subsydromal depression had the same clinical significance and health impact as syndromal depression, similar to findings in the West.     

The combined effect of age, education, and stroke on dementia and cognitive impairment no dementia in the elderly

BACKGROUND: This study aims to detect the impact of stroke on the occurrence of dementia and cognitive impairment/no dementia (CIND) in different age, sex, and education groups. METHODS: Persons with dementia (DSM-III-R) or CIND were identified by a two-phase study design among 7,930 persons from the population-based Faenza Community Aging Study. RESULTS: Subjects with a history of stroke had increased risk of both dementia [risk ratio (RR) = 3.7; 95% confidence interval (CI) = 3.1-4.4] and CIND (RR = 1.7, 95% CI = 1.4-2.2). These associations were stronger in the younger-old (61-74 years) than in the older-old (75+ years), and among higher-educated (4+ years) than lower-educated (0-3 years of schooling) persons. Dementia and CIND prevalence among stroke subjects was similar to the prevalence detected among subjects 10 years older but without a history of stroke. In stroke subjects, dementia prevalence became higher than CIND prevalence 10 years earlier than in non-stroke subjects. A combined effect for dementia due to a history of stroke, increasing age, and decreasing years of schooling was detected. CONCLUSIONS: Stroke is a strong risk factor for dementia among younger-old and higher-educated subjects; in the presence of a stroke, dementia onset might occur about 10 years earlier, possibly by accelerating the progression from CIND to dementia.     

Cued and uncued memory tests: norms in elderly adults from the 3 Cities epidemiological study

INTRODUCTION: The free and cued reminding test is often considered to be essential in the neuropsychological examination of elderly people consulting Memory Clinics. One of the reasons is that this test maximizes learning by inducing deep semantic processing and by controlling encoding and retrieval conditions. The aim of this study was to produce age, sex and educational level-adjusted normative data for this test. METHODS: These data were collected as part of the Three-City (3C) Study, a French population-based study on aging. RESULTS: The subsample of subjects analysed for this study included 1 458 non-institutionalised and non-demented elderly adults aged 65 and over. Norms were calculated according to age (65-70, 70-74, 74-78, 78-90), sex and educational level of the subjects (primary level versus and secondary or university level). CONCLUSION: The interest of this work is to provide to clinicians normative scores on the free and cued reminding test which can be used as an aid to interpret a patient's performance on a test widely used to detect episodic memory deficits in aging.     

Separation anxiety and gender variance in a community sample of children

In clinical child and retrospective adult samples, childhood gender variance (GV; i.e., cross-gender behaviour) has been associated with separation anxiety (SA; i.e., distress related to separation from attachment figures) in males. This study examined GV and SA in a nonclinical sample of 892 boys and 933 girls aged 6–12 years via parent-reports. Parental factors (i.e., parenting style, parent–child relationship, willingness to serve as an attachment figure, attitudes towards gender stereotypes in children) were examined as potential moderators. GV predicted SA in boys, even when statistically controlling for general psychopathology and demographic variables. Authoritative parenting, closeness in the parent–child relationship, willingness to serve as an attachment figure, and liberal attitudes towards gender stereotypes in children moderated the association between GV and SA in both boys and girls. Thus, SA may be a unique internalizing problem related to GV in boys in nonclinical samples and influenced by a variety of parental factors.

     

Smoking and cognitive performance in the community elderly: a longitudinal study

This prospective study investigated the association between smoking and cognitive performance in a community of nondemented elderly subjects aged 65 or older. All subjects were categorized as current smokers, former smokers, or never smokers. The lifetime cigarette exposure was computed. At baseline, we found the abstainers from smoking had better cognitive performances; however, the differences were not significant after adjusting for age, education, hypertension, diabetes, and vascular events. The lifetime cigarette exposure was not predictive of the cognitive status. At a 3-year follow-up, neither the smoking status nor the lifetime cigarette exposure predicted the declination of cognition.     

兰州市社区老年人认知功能障碍调查

目的调查兰州市社区老年人的认知功能障碍情况,为有针对性地对认知障碍高危人群进行干预提供参考。方法采用分层随机抽样方法,抽取年龄≥65岁的兰州市社区居民,采用蒙特利尔认知评估量表(Mo CA)调查老年人的认知障碍情况。结果实际完成调查的社区老年人共723人,检出有认知功能障碍者490人(67.77%)。不同性别(t=6.64,P=0.025)、婚姻状态(t=6.97,P=0.037)、受教育程度(F=21.34,P0.01)、喝茶情况(t=0.18,P0.01)、运动情况(t=2.74,P0.01)、业余活动(t=0.66,P=0.041)、患病情况(t=-1.78,P=0.023)的社区老年人Mo CA评分比较,差异有统计学意义。结论兰州市社区老年人认知功能障碍检出率较高,男性、已婚、受教育程度在高中及以上、喝茶、运动及未患病者认知功能较好。     

Neuropsychological tests in the elderly: methods and sample characteristics of a GRECC study

This report describes the methods and sample characteristics of a neuropsychological study of the elderly conducted by the Geriatric Research, Education and Clinical Center of the Department of Veterans Affairs Medical Center in Minneapolis, Minnesota. The goal of the study was to provide normative data, internal consistency and 1-year reliability estimates, and validated methods of estimating expected performance level. Thirty-one cognitive measures and a demographic questionnaire were administered to an age-, education-, and gender-stratified sample ( N = 349) and a validation sample (N = 70). After 1 year, 104 of the participants were retested. Relative to published, nationally based normative data, the stratified sample showed performance levels that ranged from average to high average across the five tests examined.     

Prevalence of dissociative experiences in a community sample: relationship to gender,ethnicity, and substance use

This study examined the relationship between gender, ethnicity, substance use, and dissociation in a community sample of adults. Telephone interviews were conducted using, among others, measures of dissociation (Dissociative Experiences Scale-Taxon [DES-T]) and alcohol use (Alcohol Use Disorders Identification Test [AUDIT]) to screen a representative sample of 1007 adults in Memphis, Tennessee. Six percent of respondents endorsed four or more lifetime dissociative symptoms, whereas approximately one third of respondents endorsed at least one symptom. Only 2% were identified as having pathological dissociation on the DES-T. DES-T scores were significantly associated with gender (male), ethnicity (African-American), and harmful alcohol use. Dissociative symptoms appear to be relatively common in the population, but only a small proportion of individuals suffer from significant levels of dissociation. Further assessment of the link between demographic factors and the severity and expression of dissociative phenomena in nonclinical samples is warranted.     

Effects of varying diagnostic criteria on prevalence of mild cognitive impairment in a community based sample

Mild cognitive impairment (MCI) is proposed to be a prodrome to dementia in some older adults. However, the presentation of MCI in the community can differ substantially from clinic-based samples. The aim of the current study is to demonstrate the effects of different operational definitions of MCI on prevalence estimates in community-dwelling older adults. A consecutive series of 200 participants aged 65 and over from the Adult Changes in Thought (ACT) community-based cohort were approached to undergo comprehensive neuropsychological and medical evaluation; 159 were included in the final analyses. Nondemented subjects were categorized using various diagnostic criteria for MCI. In a novel approach, neuropsychological test scores were evaluated using an individualized benchmark as a point of test comparison, as well as traditional methods that entail comparison to age-based normative data. Diagnostic criteria were further subdivided by severity of impairment (1.0 vs. 1.5 standard deviations [sd] below the benchmark) and extent of impairment (based on a single test or an average of tests within a cognitive domain). MCI prevalence rates in the sample were highly dependent on these diagnostic factors, and varied from 11% to 92% of the sample. Older groups tended to show higher prevalence rates, although this was not the case across all diagnostic schemes. The use of an individualized benchmark, less severe impairment cutoff, and impairment on only a single test all produced higher rates of MCI. Longitudinal follow-up will determine whether varying diagnostic criteria improves sensitivity and specificity of the MCI diagnosis as a predictor for dementia.     

综合认知训练对社区老年人工作记忆事件相关电位的影响

目的 探索综合认知训练对社区老年人大脑认知功能的影响及其可能机制.方法 将上海市某街道社区49名老年人(年龄≥70岁)按配对原则分为认知训练干预组(以下简称干预组,27名)和非认知训练组(以下简称对照组,22名).对干预组进行12周(共24次)的认知训练.干预前后采用延迟样本匹配(delayed matching-to-sample,DMS)模式诱发工作记忆事件相关电位(ERPs),分析工作记忆相关ERPs P500的波幅和潜伏期变化.结果 (1)干预前两组间工作记忆ERPs主成分P500的波幅和潜伏期的差异均无统计学意义.(2)与干预前比较,干预组在匹配任务Fp2、F4、Fz、CPz、Pz导联处P500潜伏期缩短,对照组Fp1导联P500潜伏期延迟;干预组不匹配任务Fp2和F4导联P500潜伏期缩短;对照组CPz导联P500波幅降低;差异均有统计学意义(P均<0.05).(3)干预后干预组匹配任务Fpz处波幅高于对照组,差异有统计学意义(P<0.05).(4)干预组工作记忆ERPs P500改善的脑区相对集中于右侧额叶或前额叶.结论 综合认知训练可改善健康老年人大脑认知功能状态,改善的脑区相对集中于右侧额叶/前额叶;综合认知训练对老年人脑功能的可塑性有一定影响.     

Pulmonary function, cognitive impairment and brain atrophy in a middle-aged community sample

OBJECTIVE: To determine the relationship of lung function to brain anatomical parameters and cognitive function and to examine the mediating factors for any relationships. METHODS: A random sub-sample of 469 persons (men = 252) aged 60-64 years from a larger community sample underwent brain magnetic resonance imaging scans and pulmonary function tests (forced vital capacity, FVC, forced expiratory volume in the first second, FEV(1)). Subjects were assessed for global cognitive function, episodic memory, working memory, information processing speed, fine motor dexterity and grip strength. The magnetic resonance imaging scans were analysed for overall brain atrophy, subcortical atrophy (ventricle-to-brain ratio, VBR), hippocampal volume, and white matter hyperintensity (WMH) volume. RESULTS: FEV(1) had a significant negative correlation with overall brain atrophy and VBR in men. The FEV(1)/FVC ratio had a significant correlation with WMHs in both men and women. In regression models that controlled for sex, age, height, level of activity, smoking, chronic respiratory disease and education, FEV(1) and FVC were significant predictors of VBR but no other structural brain measure. Pulmonary function was also significantly related to information processing speed and fine motor dexterity. Male subjects with chronic respiratory disease had more deep WMHs. Path analyses to examine if structural measures mediated between lung function and cognition, and whether markers of inflammation and oxidative stress or cortisol mediated between lung function and brain measures were negative. CONCLUSIONS: Decreased lung function is related to poorer cognitive function and increased subcortical atrophy in mid-adult life. Presence of chronic respiratory disease may be related to deep WMHs in men.     

Effects of a cognitive stimulation program on psychological well-being in a sample of elderly long-term care hospital inpatients

Objectives: The primary objective of this work is to report the observed changes in psychological well-being in a sample of long-term medically hospitalized patients, after attending a cognitive stimulation program. The secondary aim is to determine if the observed changes were related to previous cognitive level.

Methods: Inclusion criteria for study participation were to be a long-term care hospital inpatient, to be 65 years old or older, and to be cognitively preserved or with mild cognitive impairment. A total of 176 participants were included and distributed in two groups: Cognitive Stimulation Group (N = 123) and Non-Cognitive Stimulation Group (N = 53). Measures were applied just before the beginning of the program and just when it finished, two months later. Participants of the Non-Cognitive Stimulation Group were re-assessed again after two months.

Results: No differences were found between the two groups in the measures assessed at baseline. After treatment, participants of the Cognitive Stimulation Group improved significantly more in psychological well-being (p < .001) than the ones of the Non-Cognitive Stimulation Group. When unimpaired and mild cognitively impaired participants of the Cognitive Stimulation Group were studied separately, both groups improved their psychological well-being, but the unimpaired experienced a greater effect.

Conclusion: Cognitive stimulation plays a role in the improvement of psychological well-being of elderly medically hospitalized patients unimpaired or with mild cognitive impairment. The improvements in psychological well-being were related to the previous cognitive status and to the number of sessions that had been attended.