Differences in cognitive performance,level of dependency and quality of life (QoL), related to age and cognitive status in a sample of Spanish old adults under and over 80 years of age

The main objective of this study was to analyze the similarities and differences in cognitive performance, level of dependency, cognitive plasticity and QoL in a sample of young–old adults and old–old adults, bearing in mind both the age-group (under or over 80 years) and the cognitive status of the participants. The study population consisted of 220 people living in sheltered accommodation for elderly people in the South of Spain, with an average age of 80.75 years. Participants were evaluated by means of cognitive performance tests, a QoL questionnaire, a depression scale and a dependency assessment scale. The results indicate that the main differences in the variables analyzed are due to the cognitive status of the sample and not to the fact that the participants are under or over 80 years of age. The findings show that major inter-individual differences in this stage of life depend not only on age but also on cognitive status, which is thus an important factor to take into account when working with this sector of the population.     

Comparison of cognitive performance in mild cognitive impairment and dementia patients with that in normal children and adults

Background: It is well known that there is rapid cognitive development in childhood and cognitive decline during aging, but the volume of these changes using the same clinical tool is not well documented in the literature. The aim of our study was to investigate and compare the cognitive performance of mild cognitive impairment (MCI) and dementia patients with that of children, adolescents and adults, using a worldwide screening tool, the Mini Mental State Examination (MMSE), and considering the age, educational level and mental status of the participants. Methods: Our sample included 1364 Greek participants and consisted of normal children, adolescents, adults and non‐demented, MCI and demented elderly participants. Results: The variables of age, education and mental status influenced the participant's performance in the MMSE, but sex did not. The smallest variance of the MMSE score was found in 16–18‐year‐old adolescents, a big variance was found in 7–8‐year‐old children, while the biggest was in 71–90‐year‐olds. Alzheimer's disease (AD) participants performed poorer than the 7–8 years old children, though MCI participants showed similar cognitive performance to that age‐group. The participants with 7–9 years of schooling and those with more than 9 years had no significant difference in their MMSE performance. Conclusion: Comparing cognitive performance between subgroups, our results indicated that MCI patients have a similar cognitive performance to that of 7–8‐year‐old children and AD patients' a poorer one than that group. The significant years of cognitive decline in aging are the 56^th year, the 66 quinquennium, and the 7^th and 8^th decades. Geriatr Gerontol Int 2012; 12: 336–344.     

Subjective cognitive dysfunctions in the elderly: a change-oriented viewpoint

The relation between subjective cognitive complaints and the actual level of cognitive performance in the elderly is of interest in both basic and applied cognitive research. However, most studies suggest a small to moderate correlation between complaints and actual performance. In contrast to previous studies, we examined the relation between changes in fluid and crystallized intelligence, changes in memory performance, and changes in subjective cognitive complaints in a sample of 465 older adults (M = 62.9 years) at two measurement occasions four years apart. The results indicate significant relationships between changes in subjective complaints and changes in memory performance and changes in fluid intelligence. The discussion focuses on the importance of a change-oriented view in examining subjective cognitive complaints from an applied perspective.     

Social disengagement and incident cognitive decline in community-dwelling elderly persons.

BACKGROUND: Social engagement, which is defined as the maintenance of many social connections and a high level of participation in social activities, has been thought to prevent cognitive decline in elderly persons. However, few longitudinal studies of this relation have been done. OBJECTIVE: To determine the relation between social disengagement and incident cognitive decline in community-dwelling elderly persons. DESIGN: Cohort study. SETTING: New Haven, Connecticut. PARTICIPANTS: 2812 noninstitutionalized elderly persons (65 years of age or older) who were interviewed in their homes in 1982, 1985, 1988, and 1994. MEASUREMENTS: A global social disengagement scale was constructed from the following indicators: presence of a spouse, monthly visual contact with three or more relatives or friends, yearly nonvisual contact with 10 or more relatives or friends, attendance at religious services, group membership, and regular social activities. Cognitive function was assessed with the Short Portable Mental Status Questionnaire. Response to the questionnaire was scored as high, medium, or low. Cognitive decline was defined as a transition to a lower category. RESULTS: Compared with persons who had five or six social ties, those who had no social ties were at increased risk for incident cognitive decline after adjustment for age, initial cognitive performance, sex, ethnicity, education, income, housing type, physical disability, cardiovascular profile, sensory impairment, symptoms of depression, smoking, alcohol use, and level of physical activity. The 3-year odds ratio was 2.24 (95% CI, 1.40 to 3.58; P < 0.001), the 6-year odds ratio was 1.91 (CI, 1.14 to 3.18; P = 0.01), and the 12-year odds ratio was 2.37 (CI, 1.07 to 4.88; P = 0.03). CONCLUSION: Social disengagement is a risk factor for cognitive impairment among elderly persons.     

Differences in cognitive performance, level of dependency and quality of life (QoL), related to age and cognitive status in a sample of Spanish old adults under and over 80 years of age

The main objective of this study was to analyze the similarities and differences in cognitive performance, level of dependency, cognitive plasticity and QoL in a sample of young-old adults and old-old adults, bearing in mind both the age-group (under or over 80 years) and the cognitive status of the participants. The study population consisted of 220 people living in sheltered accommodation for elderly people in the South of Spain, with an average age of 80.75 years. Participants were evaluated by means of cognitive performance tests, a QoL questionnaire, a depression scale and a dependency assessment scale. The results indicate that the main differences in the variables analyzed are due to the cognitive status of the sample and not to the fact that the participants are under or over 80 years of age. The findings show that major inter-individual differences in this stage of life depend not only on age but also on cognitive status, which is thus an important factor to take into account when working with this sector of the population.     

Trajectories of cognitive decline and social relations

We assessed conjoint trajectories of cognitive decline and social relations over 7 years on a representative sample of community-dwelling elderly persons. We analyzed data using repeated measurement models. Social integration, family ties, and engagement with family were associated with cognitive function at advanced ages, controlling for education and introducing depressive symptoms, functional limitations, and chronic conditions as intervening variables. Association of social integration, through participation in community activities, with change in cognitive decline was more significant at advanced ages. Having friends was significantly associated with change in cognitive function in women only. Our findings have important implications for clinical medicine and public health because associations of social relations with cognitive function suggests that they may help to maintain cognitive function in old age.     

老年高血压患者身体活动能力对认知功能的影响

目的探讨老年高血压患者身体活动能力对认知功能的影响。方法 2015年8月至2016年5月从武汉市28个社区卫生服务中心/乡镇卫生院分层随机抽取年龄≥65岁的高血压患者1 508人,患者的身体活动状况采用老年人身体活动量表(PASE)评估,其中身体活动包括休闲身体活动、家务活动、职业身体活动;认知功能采用简易精神状态量表(MMSE)评估。结果多因素非条件Logistic回归分析结果显示,较多身体活动、受教育程度高、运动习惯好是认知功能的保护性因素,而高龄是认知功能的危险因素;认知功能与性别有关,女性较男性认知功能差;认知功能与高血压患者吸烟、体质量指数、腰围身高比、血压水平分级、高血压合并糖尿病、冠心病、高血脂症未见显著相关性(P>0.05);多元线性回归分析结果显示,将身体活动细化分类后,认知功能与休闲身体活动中坐着的运动、外出散步或步行、中度身体活动、费力身体活动以及职业身体活动呈正相关,且与坐着的运动、外出散步或步行相关性最明显(β值分别为0.185,0.191;均P<0.05)。认知功能与轻度身体活动、增加肌肉力量的活动、家务活动不相关(P>0.05)。结论老年高血压患者较多身体活动是认知功能的保护性因素,认知功能与休闲身体活动中坐着的运动、外出散步或步行相关性最明显。     

Biomedical and social determinants of cognitive impairment in the elderly

Studies in age-related cognitive changes do not necessarily take into account the clinical and social phenomena associated with age that may have more effect on cognition than does psychologic senescence. Clinically inapparent biologic deterioration, drugs, mild dementia, and atypically presenting depression may influence cognition. Selection bias may skew the results of studies on the elderly when control groups are made up of undergraduates or of "normal" elderly whose normality is taken for granted rather than verified. The epiphenomena of aging, such as retirement, social isolation, and bereavement, which are not inherent in the aging process, influence cognition, as do labeling and learned helplessness. Laboratory-based tests of cognition may not sufficiently resemble real-life conditions to have validity. Future research will be shaped by how we conceptualize the relation between aging and intellectual function.     

Age-related changes of postural control: effect of cognitive tasks.

BACKGROUND: Postural control and falls in the elderly constitute a major health problem. The interest in balance deficits is growing, as concern about the rising costs of health care increases. This issue is particularly relevant to the elderly population in which falls occur most frequently. Postural control in the elderly was studied using a cognitive approach. OBJECTIVE: The purpose of this study was to study the characteristics of central processing of postural control while performing cognitive tasks. METHODS: A dual-task procedure was developed to estimate the level of automaticity of a quiet upright standing task. The effect of a concurrent attention-demanding task (modified Stroop test) on the efficiency of balance control in the elderly was determined using force platform and electromyography measurements. RESULTS: It was found that there is an increase in postural sway in old subjects compared with young subjects when performing single tasks and dual-task tests. The results of the study demonstrate that postural adjustments require cognitive processing; young and old subjects showed similar interference effects on postural steadiness (postural sway) caused by the concurrent attention-demanding task. The results are corroborated by the hypothesis that a dual task gives information on the restoration of automaticity of postural control in old age by a central reorganization process. When performing a dual task tested on a narrow base of support, the old subjects decreased their body sway, while the younger did not. According to electromyography measurements, the older subjects increased their muscle activity in the tibialis anterior and soleus muscles, using slow-twitch motor units compared with the younger subjects. CONCLUSIONS: Both alterations (cognitive and base of support) have a substantially greater effect on the elderly than on the young. The older subjects decreased their body sway by activating a cocontraction strategy of postural control around the ankle joint, probably because of the danger to their postural stability.     

Memory Age Identity as a predictor of cognitive function in the elderly: A 2-year follow-up study

BackgroundThere is a growing interest in finding psychosocial predictors related to cognitive function. In our previous research, we conducted a cross-sectional study on memory age identity (MAI) and found that MAI might be associated with objective cognitive performance in non-cognitively impaired elderly. A longitudinal study was conducted to better understand the importance of MAI as a psychosocial predictor related to objective cognitive function.MethodsData obtained from 1345 Korean subjects aged 60 years and above were analyzed. During the two-year follow-up, subjective memory age was assessed on three occasions using the following question: How old do you feel based on your memory? Discrepancy between subjective memory age and chronological age was then calculated. We defined this value as ‘memory age identity (MAI)’. A generalized estimating equation (GEE) was then obtained to demonstrate the relationship between MAI and Korean version-Mini Mental State Examination (K-MMSE) score over the 2 years of study.ResultsMAI was found to significantly (β = −0.03, p< 0.0001) predict objective cognitive performance in the non-cognitively impaired elderly.ConclusionMAI may be a potential psychosocial predictor related to objective cognitive performance in the non-cognitively impaired elderly.     

The influence of a cognitive stimulation program on the quality of life perception among the elderly

There is an undeniable concern among the elderly about the mental changes they experience as they grow older. In general, the elderly tend to regard mental deterioration as a pathological condition, however these changes should be considered inherent in the aging process and in the last few years cognitive stimulation programs have been developed in order to address these concerns among the elderly. The purpose of this study is to analyze the influence of a cognitive training program on 53 subjects with age-related memory loss. The results of cognitive performance have been compared with a control group consisting of 51 subjects with no cognitive training. Moreover, this research analyses the relationship between cognitive changes and the variation in the perceived quality of life of the elderly people in both groups. The results show significant changes in the test group, demonstrating improved cognitive performance and quality of life perception.     

White matter lesions as a feature of cognitive impairment, low vitality and other symptoms of geriatric syndrome in the elderly

Aim:   White matter lesions (WML) are common findings on magnetic resonance imaging (MRI) in elderly persons. In this study, we analyzed the relation of WML with global cognitive function, depression, vitality/volition, and 19 symptoms of geriatric syndrome in Japanese elderly patients who attended three university geriatric outpatient clinics.
Methods:   Two hundred and eighty-six subjects (103 men and 183 women; mean ± standard deviation age, 74.5 ± 7.8 years) were included in this study. MRI scans were performed for the diagnosis of WML, and the severity of periventricular and deep white matter hyperintensities (PVH and DWMH) was rated semiquantitatively. Concurrently, all subjects underwent tests of cognitive function, depressive state and vitality, and were examined for 19 symptoms of geriatric syndrome.
Results:   The study subjects showed cognitive decline, depression and low vitality, all to a mild extent. Univariate linear regression analysis showed a negative correlation between the severity of WML and cognitive function or vitality. Multiple logistic analysis revealed that the severity of WML was a significant determinant of cognitive impairment and low vitality, after adjustment for confounding factors such as age, sex and concomitant diseases. PVH and/or DWMH score was significantly greater in subjects who exhibited 13 out of 19 symptoms of geriatric syndrome. Logistic regression analysis indicated that WML were associated with psychological disorders, gait disturbance, urinary problems and parkinsonism.
Conclusion:   WML were associated with various symptoms of functional decline in older persons. Evaluating WML in relation to functional decline would be important for preventing disability in elderly people.     

College students' perceptions of job demands, recommended retirement ages, and age of optimal performance in selected occupations

Two studies were conducted. In study one 100 participants rated 60 occupations on the amount of cognitive/intellectual, physical, sensory-perceptual, and perceptual-motor demands they perceived as required for successful performance in that particular occupation. Results of a cluster analysis determined four clusters of occupations on the basis of the four demands. These clusters were described as High Risk, Professions, Skilled Trades, and White Collar. Further, for each of the four demands/dimensions, the cognitive/intellectual, physical, sensory-perceptual, and perceptual motor demands were significantly different both between and within clusters. In study two, 100 participants rated the perceived retirement age, and 99 different participants rated the perceived optimal performance age for the 60 occupations employed in study one. Results indicated that age norms for perceived recommended retirement and perceived optimal performance age were differentially correlated across the four clusters of occupations. Perceived retirement age and optimal performance age varied discriminably between occupational clusters.     

Late-life alcohol consumption and cognitive function in elderly men

Moderate alcohol consumption (one to two drinks per day) has been associated with better cognitive function and lower risk of developing dementia in the elderly. In light of alcohol’s well-known neurotoxic properties, more evidence from well-controlled population-based studies is required. The objective of this study was to examine whether self-reported alcohol intake at age 70 is linked to cognitive function (assessed by trail making tests (TMTs) A and B, which are measures of attention, mental speed, and flexibility) in a population-based cohort consisting of 652 cognitively healthy elderly men. Linear regression models were used to assess both cross-sectional (i.e., age 70) and prospective (i.e., age 77) associations between alcohol intake and cognitive function. The analyses were adjusted for education, body mass index, energy intake, self-reported physical activity, smoking, a history of hypertension or diabetes, apolipoprotein E ε4 status, and cholesterol levels at the age of 70. Baseline data were obtained from 1990 to 1996. Self-reported alcohol intake (mean 6.9 ± 7.1 g/day) was associated with better performance on TMT-B at ages 70 and 77 (β = −0.87, p < 0.001). In contrast, alcohol intake was not predictive of the difference in performance on these tests between ages 70 and 77. Despite cross-sectional associations with performance in a test of executive functioning, moderate intake of alcohol was not linked to differences in cognitive performance between ages 70 and 77 in the present study. Thus, our findings do not support the view that daily moderate alcohol consumption is a recommendable strategy to slow cognitive aging in elderly populations.     

Impact of age, gender and cognitive functioning on pain perception

BACKGROUND: Experimental data on nociception in the elderly have so far been contradictory and most of these have been obtained using psychophysical methods with little attention paid simultaneously to the state of cognition and the psychometric performance of the subjects. OBJECTIVE: The aim of this study was twofold: (1) to evaluate the impact of age on experimental nociception thresholds, and (2) to investigate the interactions of age, sex, cognition and psychometric performance with nociception thresholds. METHODOLOGY: (1) Two groups, one young and one elderly, of 42 healthy participants each, 21 males and 21 females, were compared as regards nociception thresholds with thermal and mechanical stimuli (heat and pressure detection and tolerance thresholds). (2) The elderly group took cognitive (mini-mental test), psychometric (choice reaction time) and psychophysical tests in auditory (sensibility, tolerance, discrimination) and nociceptive fields. Results: This study shows that (1) pressure nociception decreases with age especially in males, while thermal thresholds are not modified, and (2) correlations exist between cognitive function, psychometric performance, tolerance to loud sounds and tolerance to mechanical noxious stimuli. CONCLUSION: Our results suggest that cognitive and psychomotor parameters have to be taken into account when assessing experimental nociception in the elderly. Further studies are needed to evaluate possible report biases and to assess these interactions in old patients with pain and in mildly sensory, cognitive or motor impaired elderly subjects.     

Evaluation of cognitive functions and the related factors in 50–80 year type 2 diabetic subjects

To study cognitive functions in 50–80 year aged type 2 diabetic patients. Cognitive performance was evaluated through a mini mental test (MMT) in 131 patients between 50 and 80 years (100 type 2 diabetics and 31 non-diabetics). Relation analysis were carried out for different parameters. Scores in registration and recall were significantly lower in diabetic group. The effect of HbA1c, body mass index (BMI) and age variables on MMT score was statistically significant. A negative linear correlation was estimated between MMT score and age, HbA1c level and BMI value. HbA1c, age and BMI were inversely related to cognitive functions. MMT scores were 24.98?±?3.10 in diabetic group and 25.35?±?3.22 in control group and statistically no significant difference was found. No significant difference was between type 2 diabetics and non-diabetics in terms of cognitive functions. But performance of diabetic patients in relation to the registration and recall was lower. Poor glycemic control and obesity in diabetics negatively affect cognitive performance.     

Plasma homocysteine and cognitive function in elderly patients with diabetes mellitus

Background: The purpose of the present paper was to investigate a possible contribution of plasma homocysteine to cognitive impairment. To this end the relationship between plasma homocysteine levels and cognitive performance test results were investigated in elderly patients with diabetes. Methods: A total of 144 elderly patients (39 men and 105 women) with diabetes mellitus, who were free of clinical stroke, were studied. Plasma levels of homocysteine, folate, vitamin B12, vitamin B6, and the C677T polymorphism of methylene tetrahydrofolate reductase were determined. Cognitive function was assessed with the Wechsler Adult Intelligence Scale, Revised (digit symbol substitution, backward digit span, similarities, picture arrangement), Stroop test, Benton Visual Retention Test, and Mini‐Mental State Examination (MMSE). Results: In elderly women with diabetes, elevated homocysteine levels in the plasma were significantly associated with impairment of cognitive performance assessed with the MMSE, digit symbol substitution test, similarities, Stroop test, and Benton visual retention test, but not the backward digit span test. Multiple logistic regression analyses revealed that the associations between the log‐transformed plasma homocysteine level and low scores of the MMSE and digit symbol substitution test remained significant after adjustment for age, education, hemoglobin (Hb)A1c, systolic blood pressures, insulin treatment, serum levels of folate, vitamin B12, and vitamin B6, and the presence of asymptomatic cerebral infarction on brain magnetic resonance images. Conclusions: Elevated plasma homocysteine level was independently associated with cognitive impairment in elderly diabetic women. Because the cause of the association between homocysteine and cognitive impairment remains unclear, future intervention studies are necessary to examine whether reducing plasma homocysteine levels prevents cognitive decline in elderly patients with diabetes mellitus.     

Influence of cognitive status on the sexual life of 352 elderly Italians aged 65-105 years

BACKGROUND: Various factors are considered to influence sexual behavior in the elderly, but the role played by preservation of adequate cognitive functioning has not been adequately explored. OBJECTIVE: The aim of this research, conducted on 352 older adults aged between 65 and 105 years, was to identify the specific role played by cognitive functioning in sexual activity and sexual interest in the elderly. METHODS: The data were collected from elderly people attending the surgeries of 21 general practitioners in the city of Padua (Italy). Analysis of sexual functioning was based on two items, from the LEIPAD questionnaire: 'Are you interested in sex?' and 'Do you have sexual relations?'. Subjects cognitive status was assessed objectively through the Mini Mental State Examination (MMSE) and subjectively by the LEIPAD subscale on cognitive functioning. RESULTS: Subjects who were sexually active and interested in sex were more highly represented among the married elderly. The elderly who reported being active and interested in sex were significantly younger and had a significantly superior educational level and MMSE score. Mean scores for cognitive functioning and all quality-of-life indicators were in general significantly better for the active and interested. Univariate logistic regression analysis indicated that a higher MMSE score and cognitive functioning score influenced the maintenance of sexual interest. CONCLUSIONS: One third of the subjects reported being still sexually active and 40% being still interested in sex. This study seems to suggest that a significant role may be played by cognitive functioning in the maintenance of sexual interest in the elderly, especially older females in whom this dimension is evidently linked to far more diversified experiences than their male peers.     

老年人轻度认知损害危险因素的调查分析

目的 调查北京老年人轻度认知损害(MCD)与年龄、性别、体质指数等的关系.方法 应用简易精神状态检查,对北京东直门社区招募的129例老年人进行认知功能评估.结果 检出记忆型轻度认知损害(aMCI)37例(28.7%),阿尔茨海默病(AD)36例(27.9%),认知正常者56例(43.4%).aMCI和AD患者年龄高于认知正常者,分别为(67.6±7.5)岁、(66.6±8.2)岁和(62.5±7.9)岁,两两比较差异均有统计学意义(t值分别为2.847、-1.747和-2.429,P>0.05、P<0.01和P<0.01);aMCI和AD患者受教育年限低(P<0.05);aMCI和AD患者的血压较认知正常者高(P<0.05);aMCI体质指数高于其他两组(P<0.05),不同性别老年人aMCI和AD患病率差异无统计学意义(P>0.05);不同月份出生aMCI和AD患病率差异无统计学意义(P>0.05).结论 aMCI患病率与年龄、教育程度、高血压和体质指数等因素有关,与性别、出生月份无关.     

Cardiovascular disease and cognitive performance in middle-aged and elderly men

BACKGROUND: Decline of cognitive function with age may be due, in part, to atherosclerotic changes. The aim of the present study was to determine the relative contribution of cardiovascular disease (CVD) to cognitive functioning in middle-aged and elderly men. METHODS: In a cross-sectional study, cognitive tests were administered to 400 independently living men aged 40-80 years. Compound scores were calculated for memory function, processing capacity/speed, and executive function. The MMSE was used as a measure of global cognitive function. Carotid intima-media thickness, pulse wave velocity and ankle brachial blood pressure index were assessed as measures of sub-clinical CVD. The adjusted association of sub-clinical and prevalent CVD with neuropsychological test scores in the total group and in subgroups was assessed by linear regression analysis. RESULTS: Increased IMT was associated with lower scores on memory performance, and increased PWV was associated with lower scores on processing capacity and executive functioning. Compared with subjects with no CVD, both sub-clinical and prevalent cardiovascular diseases were related to a lower memory performance, beta's (95% CI) were -0.45 (-0.83, -0.07) and -0.45 (-0.84, 0.01), respectively. These associations were present in both middle-aged and elderly men. Furthermore, we observed that for subjects who had sub-clinical or prevalent cardiovascular disease the distribution of MMSE-scores was shifted toward lower values; the distributions were statistically different (p=0.003). CONCLUSIONS: The results of this study support a relation of sub-clinical CVD with cognitive functioning in middle-aged and elderly men. These results suggest that actions to prevent cognitive decline by preventing atherosclerosis should be taken before middle age.