This study investigated the effect of verbal prompting on elders’ 10-year longitudinal change in everyday cognition. Differential effects of prompting associated with impaired cognitive status were also examined.
At baseline, 2,802 participants (mean age=73.6 years, mean education=13.5 years) from the ACTIVE clinical trial were classified as unimpaired, having amnestic mild cognitive impairment (MCI) or non-amnestic MCI based on psychometric algorithm. Participants were given the Observed Tasks of Daily Living (OTDL; a behavioral measure with tasks involving medication management/finances/telephone use) at baseline and at 1-, 2-, 3-, 5-, and 10-year follow-ups. When participants said “I don’t know” or did not respond to an item, they received a standardized verbal prompt. At each occasion, Unprompted (sum of items correct without prompting) and Prompted (sum of items correct including both prompted and unprompted) scores were derived for each participant. Multi-level modeling, adjusting for demographics/health/training group, was used to determine the trajectories of OTDL performance.
In general, persons with MCI performed at lower levels than those who were unimpaired (amnestic
Very simple prompting appears to enhance and maintain performance on a task of everyday cognition over 10 years for both unimpaired and mildly-impaired older adults.
everyday cognition; verbal prompting; cognitive impairment; cognitive aging; longitudinal follow-up
The method of loci (MoL) is a complex visuospatial mnemonic strategy. Previous research suggests older adults could potentially benefit from using the MoL, but that it is too attentionally demanding for them to use in practice. We evaluated the hypotheses that training can increase the use of MoL, and that MoL use is associated with better memory.
We analyzed skip patterns on response forms for the Auditory Verbal Learning Test (AVLT) in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE, n=1,401) trial using 5 years of longitudinal follow-up.
At baseline, 2% of participants skipped spaces. Fewer than 2% of control participants skipped spaces at any visit across 5 years, but 25% of memory-trained participants, taught the MoL, did so. Participants who skipped spaces used more serial clustering, a hallmark of the MoL (p<0.001). Trained participants who skipped spaces showed greater memory improvement after training than memory-trained participants who did not skip spaces (Cohen's d=0.84, P=0.007), and did not differ in the subsequent rate of long-term memory decline through up to 5 years of follow-up.
Despite being attentionally demanding, this study suggests that after training, the MoL is used by up to 25% of older adults, and that its use is associated with immediate memory improvement that was sustained through the course of follow-up. Findings are consistent with the notion that older adults balance complexity with novelty in strategy selection, and that changes in strategies used following memory training result in observable qualitative and quantitative differences in memory performance.
Method of loci; strategy use; memory training; gerontology; older adults
The purpose of this study was to determine the factor structure, internal consistency reliability, and validity of the Tucker Culturally Sensitive Health Care Clinic Environment Inventory–Patient Form (T-CSHCCEI-PF), a novel instrument designed to assess an aspect of health care often ignored in health care quality research: the cultural sensitivity of health care center policies and environment as perceived by adult, racially/ethnically diverse patients. Using ratings on this inventory by a culturally diverse national sample of adult patients (N = 1,639) from 67 health care sites across the United States, a confirmatory factor analysis of the T-CSHCCEI-PF was conducted, and its reliability and validity were determined. The T-CSHCCEI-PF was shown to be a reliable and valid inventory for culturally diverse patients to provide feedback to the administrators at their health care centers regarding the degree to which these centers have characteristics that are reflective of patient-centered culturally sensitive health care.
patient-centered care; clinic environment cultural sensitivity; patient satisfaction; patient evaluation of clinic environment; Tucker Culturally Sensitive Health Care Clinic Environment Inventory-Patient Form (T-CSHCCEI-PF)
Computer-administered assessment of cognitive function is being increasingly incorporated in clinical trials, however its performance in these settings has not been systematically evaluated.
The Seniors Health and Activity Research Program (SHARP) pilot trial (N=73) developed a computer-based tool for assessing memory performance and executive functioning. The Lifestyle Interventions and Independence for Seniors (LIFE) investigators incorporated this battery in a full scale multicenter clinical trial (N=1635). We describe relationships that test scores have with those from interviewer-administered cognitive function tests and risk factors for cognitive deficits and describe performance measures (completeness, intra-class correlations).
Computer-based assessments of cognitive function had consistent relationships across the pilot and full scale trial cohorts with interviewer-administered assessments of cognitive function, age, and a measure of physical function. In the LIFE cohort, their external validity was further demonstrated by associations with other risk factors for cognitive dysfunction: education, hypertension, diabetes, and physical function. Acceptable levels of data completeness (>83%) were achieved on all computer-based measures, however rates of missing data were higher among older participants (odds ratio=1.06 for each additional year; p<0.001) and those who reported no current computer use (odds ratio=2.71; p<0.001). Intra-class correlations among clinics were at least as low (ICC≤0.013) as for interviewer measures (ICC≤0.023), reflecting good standardization. All cognitive measures loaded onto the first principal component (global cognitive function), which accounted for 40% of the overall variance.
Our results support the use of computer-based tools for assessing cognitive function in multicenter clinical trials of older individuals.
Cognitive function; Clinical trial; Performance measures
Recruitment of older adults into long-term clinical trials involving behavioral interventions is a significant challenge. The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled multisite trial, designed to compare the effects of a moderate-intensity physical activity program with a successful aging health education program on the incidence of major mobility disability (the inability to walk 400 m) in sedentary adults aged 70–89 years, who were at high risk for mobility disability (scoring ≤9 on the Short Physical Performance Battery) at baseline.
Recruitment methods, yields, efficiency, and costs are described together with a summary of participant baseline characteristics. Yields were examined across levels of sex, race and ethnicity, and Short Physical Performance Battery, as well as by site.
The 21-month recruiting period resulted in 14,812 telephone screens; 1,635 participants were randomized (67.2% women, 21.0% minorities, 44.7% with Short Physical Performance Battery scores ≤7). Of the telephone-screened participants, 37.6% were excluded primarily because of regular participation in physical activity, health exclusions, or self-reported mobility disability. Direct mailing was the most productive recruitment strategy (59.5% of randomized participants). Recruitment costs were $840 per randomized participant. Yields differed by sex and Short Physical Performance Battery. We accrued 11% more participant follow-up time than expected during the recruitment period as a result of the accelerated recruitment rate.
The LIFE Study achieved all recruitment benchmarks. Bulk mailing is an efficient method for recruiting high-risk community-dwelling older persons (including minorities), from diverse geographic areas for this long-term behavioral trial.
Mobile disability; Older adults; Physical activity; Minority recruitment; Randomized controlled trial.
Salthouse (2006) illustrated that among Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial participants, the pace of cognitive change over time accelerated for persons who had participated in training. Our goal was to determine if the pace of cognitive aging, net of effects due to practice, training, and loss of training gains, differed for persons who received training.
We evaluated change in cognitive performance over five years following brief cognitive training among older adults (N=1,659, age 65-94) in ACTIVE using a latent growth curve model.
Reasoning training, but not memory or speed, attenuated aging-related change. But this model modification produced instability and was not statistically significant. Memory gains were maintained throughout follow-up. About half of reasoning and speed gains were lost, however all trained groups performed better than controls at 5 years. Performance differences at the end of the follow-up were equivalent to about 6, 4, and 8 years of aging for memory, reasoning and speed training, respectively.
Training can appear to accelerate age-related change, because change over time is coupled with loss of training gains. Of the three training interventions, only reasoning training appeared to attenuate the pace of normative decline. However, our analysis is limited by follow-up that is short for precisely characterizing aging-related change.
Cognitive training interventions; Advanced Cognitive Training for Independent and Vital Elderly; training outcomes; growth curve modeling; older adults
The current study examined five-year cognitive change in untrained African American and White participants from the ACTIVE study
Five year trajectories of memory, reasoning, visual processing speed/useful field of view, digit symbol substitution, and vocabulary were investigated. Education, health, gender, age and retest/practice effects were controlled for, and a missing data pattern mixture approach was used to adjust for dropout effects.
After considering age, education health and gender, being African American uniquely explained 2% to 7% of the variance in cognitive performance. There were virtually no significant race differences in rates of change.
Race-related results in the current study are consistent with previous research suggesting that social advantage factors like education have a stronger influence on level of performance than rate of change. The small remaining effects of being African American on performance levels likely reflect uncontrolled variation in factors like literacy and financial advantage.
Aging; Cognition; Race/Ethnicity; Memory; Reasoning; UFOV; Vocabulary
To examine basic and everyday cognitive predictors of older adults’ self-reported instrumental activities of daily living (IADL).
Basic and everyday cognitive predictors of self-reported IADL were examined in a sample of healthy, community-dwelling older adults (n = 698) assessed over five years of measurement.
Multilevel longitudinal analyses revealed linear and quadratic change trends for self-reported IADL function, with steeper declines at higher ages. Within-person, when participants exhibited lower cognitive performance, they also reported more IADL impairment. Everyday cognition remained a significant unique predictor of self-reported IADL after controlling for attrition, re-sampling effects, temporal gradients, and baseline levels and changes in demographic, sensory, functional, and basic cognitive measures.
By itself, everyday cognition appears to be an important predictor of self-reported IADL, and maintains a unique predictive contribution after many covariates are controlled. Future research should consider the inclusion of everyday cognitive measures in functional assessment batteries.
aging; everyday cognition; IADL
Psychological symptoms are common in Parkinson’s disease (PD). Psychological symptoms do not respond to psychotropic medications as well in patients with PD as in patients with psychiatric illnesses who do not have PD. Evidence that PD patients can be classified into distinct psychological symptom subgroups is conflicting. This study sought to examine potential psychological heterogeneity in PD with a broader range of instruments than has been used in previous studies.
A comprehensive battery of psychological measures assessing dysphoria, apathy, anhedonia, anxiety, and negative affect was administered to 95 PD patients without global cognitive impairment. Latent class analysis was used to identify subgroups of patients based on continuous variables derived from the psychological battery. Multinomial regression was used to examine predictors of classification.
The latent class analysis identified three subgroups with incremental levels of psychopathology across most symptom domains. One exception was a greater level of affective flattening in the “psychologically healthy” group compared to the “moderate symptoms” group. Greater motor dysfunction and less education were associated with greater severity of psychological symptoms.
These results support high psychological co-morbidity in PD, which complicates the treatment of individual symptoms. In addition, emotional blunting and anhedonia may be less indicative of widespread psychological distress than anxiety, dysphoria, and cognitive aspects of apathy. Clinicians should be aware that PD patients with greater motor dysfunction and less education are at greater risk not only for depression, but also for a variety of other psychological symptoms that may not be routinely assessed.
Depression; anxiety; apathy; anhedonia; dysphoria
Efficacious interventions to promote long-term maintenance of physical activity are not well understood. Engineers have developed methods to create dynamical system models for modeling idiographic (i.e., within-person) relationships within systems. In behavioral research, dynamical systems modeling may assist in decomposing intervention effects and identifying key behavioral patterns that may foster behavioral maintenance. The Active Adult Mentoring Program (AAMP) was a 16-week randomized controlled trial of a group-based, peer-delivered physical activity intervention targeting older adults. Time intensive (i.e., daily) physical activity reports were collected throughout the intervention. We explored differential patterns of behavior among participants who received the active intervention (N=34; 88% women, 64.1±8.3 years of age) and either maintained 150 minutes/week of moderate to vigorous intensity physical activity (MVPA; n=10) or did not (n=24) at 18 months following the intervention period. We used dynamical systems modeling to explore whether key intervention components (i.e., self-monitoring, access to an exercise facility, behavioral initiation training, behavioral maintenance training) and theoretically plausible behavioral covariates (i.e., indoor vs. outdoor activity) predicted differential patterns of behavior among maintainers and non-maintainers. We found that maintainers took longer to reach a steady-state of MVPA. At week 10 of the intervention, non-maintainers began to drop whereas maintainers increased MVPA. Self-monitoring, behavioral initiation training, % outdoor activity, and behavioral maintenance training, but not access to an exercise facility, were key variables that explained patterns of change among maintainers. Future studies should be conducted to systematically explore these concepts within a priori idiographic (i.e., N-of-1) experimental designs.
physical activity; maintenance; dynamical systems; system identification
The current study examined predictors of individual differences in the magnitude of practice-related improvements achieved by 87 older adults (meanage 63.52 years) over 18-weeks of cognitive practice. Cognitive inconsistency in both baseline trial-to-trial reaction times and week-to-week accuracy scores was included as predictors of practice-related gains in two measures of processing speed. Conditional growth models revealed that both reaction time and accuracy level and rate-of-change in functioning were related to inconsistency, even after controlling for mean-level, but that increased inconsistency was negatively associated with accuracy versus positively associated with reaction time improvement. Cognitive inconsistency may signal dysregulation in the ability to control cognitive performance or may be indicative of adaptive attempts at functioning.
Older adults; Cognitive Inconsistency; Intraindividual Variability; Practice Learning; Growth Curves
Previous research employing short-term practice and long-term training have been successful in reducing cognitive control deficits in the elderly. The goal of this study was to examine the effect of practice within session on a demanding cognitive control task. Nineteen older adults and 16 young adults performed 720 trials of a cued version of the Stroop task, in which an instructional cue is presented before each individually presented Stroop stimulus. Statistical analyses focused on the most difficult color-naming condition in task-switching blocks. Overall, participants showed faster reaction times and decreased errors with practice, particularly on incongruent trials. Older adults showed a greater reduction in errors with practice than young adults. Moreover, older adults, but not young adults, showed a reduction in errors and reaction times with practice on incongruent trials. Findings further suggest that practice reduces age-related differences in cognitive control. Improvements in cognitive control functioning has implications for treating functional deficits in older adults.
Aging; Cognitive Control; Practice; Stroop task
To investigate the ability of the Timed Up & Go test to identify patients with Parkinson's disease at risk for a fall.
Cross-sectional cohort study.
Sixteen participating National Parkinson's Foundation Centers of Excellence.
A query yielded a total of 2985 records (1828 men and 1157 women). From these, 884 were excluded because of a lack of crucial information (age, diagnosis, presence of deep brain stimulation, disease duration, inability of performing the Timed Up & Go test without assistance) at the time of testing, leaving 2097 patients included in the analysis.
Main Outcome Measures
The primary outcome measure for this study was falls. The chief independent variable was the Timed Up & Go test.
The initial model examined the prediction of falls from the Timed Up & Go test, adjusting for all study covariates. The estimated models in the imputed data sets represented a significant improvement above chance (χ2 range [df=17], 531.29–542.39, P<.001), suggesting that 74% of participants were accurately classified as a faller or nonfaller. The secondary model in which the question of whether the effect of Timed Up & Go test was invariant across disease severity demonstrated 75% of participants were accurately classified as a faller or nonfaller. Additional analysis revealed a proposed cut score of 11.5 seconds for discrimination of those who did or did not fall.
The findings suggest that the Timed Up & Go test may be an accurate assessment tool to identify those at risk for falls.
Accidental falls; Gait; Nervous system diseases; Rehabilitation
Examine the relationship of demographics and health conditions, alone and in combination, on objective measures of cognitive function in a large sample of community-dwelling older adults.
Baseline data from 2782 participants in the ACTIVE study were used to examine relationships of demographics and health conditions with composite scores of memory, reasoning, and speed of processing.
Younger age, increased education, and white race were independently associated with better performance in each cognitive domain after adjusting for gender and health conditions. Male gender, diabetes, and suspected clinical depression were associated with poorer cognitive functioning; suspected clinical depression was associated with lower reasoning and diabetes and history of stroke with slower speed of processing.
Age, education, and race are consistently associated with cognitive performance in this sample of older community-dwelling adults. Diabetes, stroke, and suspected clinical depression had independent but weaker affects on cognition.
Cognitive functioning; Older adults; Cognitive aging; Memory; Reasoning; Speed
Functional magnetic resonance imaging (fMRI) studies have identified consistent age-related changes during various cognitive tasks, such that older individuals display more positive and less negative task-related activity than young adults. Recently, evidence shows that chronic physical exercise may alter aging-related changes in brain activity; however, the effect of exercise has not been studied for the neural substrates of language function. Additionally, the potential mechanisms by which aging alters neural recruitment remain understudied. To address these points, the present study enrolled elderly adults who were either sedentary or physically active to characterize the neural correlates of language function during semantic fluency between these groups in comparison to a young adult sample. Participants underwent fMRI during semantic fluency and transcranial magnetic stimulation to collect the ipsilateral silent period, a measure of interhemispheric inhibition. Results indicated that sedentary older adults displayed reductions in negative task-related activity compared to the active old group in areas of the attention network. Longer interhemispheric inhibition was associated with more negative task-related activity in the right and left posterior perisylvian cortex, suggesting that sedentary aging may result in losses in task facilitatory cortical inhibition. However, these losses may be mitigated by regular engagement in physical exercise.
Cognitive aging; Physical activity; Functional magnetic resonance imaging; Semantic fluency; Attention network; Transcranial magnetic stimulation
The current study investigated the effect of video game training on older adult’s useful field of view performance (the UFOV® test). Fifty-eight older adult participants were randomized to receive practice with the target action game (Medal of Honor), a placebo control arcade game (Tetris), a clinically validated UFOV training program, or into a no contact control group. Examining pretest–posttest change in selective visual attention, the UFOV improved significantly more than the game groups; all three intervention groups improved significantly more than no-contact controls. There was a lack of difference between the two game conditions, differing from findings with younger adults. Discussion considers whether games posing less challenge might still be effective interventions for elders, and whether optimal training dosages should be higher.
Aging; Visual attention; Training; Videogames; Older adults
To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years.
Design, Setting, and Participants
Ten-year follow-up of a randomized, controlled single-blind trial with 3 intervention groups and a no-contact control group. A volunteer sample of 2832 persons (mean baseline age, 73.6 years; 26% African American) living independently in 6 US cities.
Ten-session training for memory, reasoning, or speed-of-processing.; 4-session booster training at 11 and at 35 months after training.
Objectively measured cognitive abilities and self-reported and performance-based measures of everyday function.
Participants in each intervention group reported less difficulty with instrumental activities of daily living (IADL) (memory: effect size, 0.48 [99% CI, 0.12-0.84]; reasoning: effect size, 0.38 [99% CI, 0.02-0.74]; speed-of-processing: effect size, 0.36 [99% CI, 0.01-0.72]). At mean age of 82 years, about 60% of trained participants compared to 50% of controls (p<.05) were at or above their baseline level of self-reported IADL function at 10 years. The reasoning and speed-of-processing interventions maintained their effects on their targeted cognitive abilities at 10 years (reasoning: effect size, 0.23 [99% CI, 0.09-0.38]; speed-of-processing: effect size, 0.66 [99% CI, 0.43-0.88]). Memory training effects were no longer maintained for memory performance. Booster training produced additional and durable improvement for the reasoning intervention for reasoning performance (effect size, 0.21 [99% CI, 0.01-0.41]) and the speed-of-processing intervention for speed-of-processing performance (effect size, 0.62 [99% CI, 0.31-0.93]).
Each ACTIVE cognitive intervention resulted in less decline in self-reported IADL compared with the control group. Reasoning and speed, but not memory, training resulted in improved targeted cognitive abilities for 10 years.
cognitive training; elderly; cognitive abilities; everyday function; training maintenance
The Tucker-Culturally Sensitive Health Care Provider Inventory – Patient Form (T-CSHCPI-PF) is an inventory for culturally diverse patients to evaluate provider cultural sensitivity in the health care process. The T-CSHCPI-PF is novel in that it assesses provider cultural sensitivity as defined by culturally diverse patients. The purpose of the present study was to determine the factor structure and internal consistency reliability of the T-CSHCPI-PF.
A sample of 1648 adult patients was recruited by staff at 67 health care sites across the United States. These patients anonymously completed the T-CSHCPI-PF, a demographic data questionnaire, and a patient satisfaction questionnaire.
Confirmatory factor analyses of the TCSHCPI-PF revealed that it has three factors with high internal consistency and validity.
It is concluded that the T-CSHCPI-PF is a psychometrically strong and useful inventory for assessing the cultural sensitivity of health care providers. Practical implications: The T-CSHCPI-PF may be a useful inventory for obtaining patients’ feedback on their providers’ cultural sensitivity and for assessing the effectiveness of trainings to promote patient centered cultural sensitivity among providers.
While driving is a complex task, it becomes relatively automatic over time although unfamiliar situations require increased cognitive effort. Much research has examined driving risk in cognitively impaired elders and found little effect. This study assessed whether mildly memory impaired elders made disproportionate errors in driving or story recall, under simultaneous simulated driving and story recall. Forty-six healthy (61% women; mean age = 76.4) and 15 memory impaired (66% women, mean age = 79.4) elders participated. Cognitive status was determined by neuropsychological performance. Results showed that during dual-task conditions, participants stayed in lane more, and recalled stories more poorly, than when they did the tasks separately. Follow-up analysis revealed that verbatim recall, in particular, was reduced while driving for healthy participants. While memory impaired participants performed more poorly than healthy controls on both tasks, cognitive status was not associated with greater dual-task costs when driving and story recall were combined.
Older adults; Dual-task; Divided attention; Memory impairment; Driving
To investigate the influence of memory training on initial recall and learning.
The Advanced Cognitive Training for Independent and Vital Elderly study of community-dwelling adults older than age 65 (n = 1,401). We decomposed trial-level recall in the Auditory Verbal Learning Test (AVLT) and Hopkins Verbal Learning Test (HVLT) into initial recall and learning across trials using latent growth models.
Trial-level increases in words recalled in the AVLT and HVLT at each follow-up visit followed an approximately logarithmic shape. Over the 5-year study period, memory training was associated with slower decline in Trial 1 AVLT recall (Cohen’s d = 0.35, p = .03) and steep pre- and posttraining acceleration in learning (d = 1.56, p < .001). Findings were replicated using the HVLT (decline in initial recall, d = 0.60, p = .01; pre- and posttraining acceleration in learning, d = 3.10, p < .001). Because of the immediate training boost, the memory-trained group had a higher level of recall than the control group through the end of the 5-year study period despite faster decline in learning.
This study contributes to the understanding of the mechanisms by which training benefits memory and expands current knowledge by reporting long-term changes in initial recall and learning, as measured from growth models and by characterization of the impact of memory training on these components. Results reveal that memory training delays the worsening of memory span and boosts learning.
AVLT; Growth modeling; HVLT; Memory training; Older adults
Endometrial cancer (EC) is the most common type of gynecologic cancer affecting women; however, very little research has examined relationships between psychological factors and hypothalamic-pituitary-adrenal (HPA) axis dysregulation in this population. The current study examined relations between depressive/anxious symptoms and salivary cortisol diurnal rhythm and variability in women undergoing surgery for suspected endometrial cancer. Depressive and anxious symptoms were measured prior to surgery using the Structured Interview Guide for the Hamilton Depression Inventory (SIGH-AD). Saliva was collected four times a day for the three days prior to surgery and then assayed by ELISA to obtain cortisol concentrations. Cortisol slopes and intraindividual variability were then calculated across subjects. Relations between depressive/anxious symptoms and cortisol indices were examined using multilevel modeling and linear regression analyses. Participants were 82 women with nonmetastatic endometrial cancer. Anxious symptoms were not associated with either cortisol slope or intraindividual variability, and depressive symptoms were unrelated to cortisol slope. However, after controlling for presence of poorer prognosis cancer subtypes, greater depressive symptoms (excluding symptoms possibly/definitely due to health/treatment factors) in the week preceding surgery were significantly related to greater cortisol intraindividual variability (β=.214; p<.05). These results suggest that depressive symptoms prior to surgery for suspected endometrial cancer are related to greater cortisol intraindividual variability, which is suggestive of more erratic HPA axis arousal. Future research should examine whether mood symptoms may be associated with compromised health outcomes via erratic HPA axis arousal in this population.
Endometrial Cancer; Cortisol; Intraindividual variability; Anxiety; Depression
The current study investigated older adults’ level of engagement with a video game training program. Engagement was measured using the concept of Flow (Csikszentmihalyi, 1975).
Forty-five older adults were randomized to receive practice with an action game (Medal of Honor), a puzzle-like game (Tetris), or a gold-standard Useful Field of View (UFOV) training program.
Both Medal of Honor and Tetris participants reported significantly higher Flow ratings at the conclusion, relative to the onset of training.
Participants are more engaged in games that can be adjusted to their skill levels and that provide incremental levels of difficulty. This finding was consistent with the Flow theory (Csikszentmihalyi, 1975)
aging; flow; engagement; videogames; older adults
Classic developmental theory suggests that aging is associated with using compensatory strategies to prolong independence. While compensatory strategies are typically considered positive adaptations, they also signify an early phase in the disablement process — commonly known as pre-clinical disability. To build a better understanding of psychological constructs related to these early signs of disability, we examined the contribution of self-efficacy and state anxiety on using compensatory strategies among pre-clinically disabled older adults. Compensatory strategies were observed during performance of daily activities in 257 pre-clinically disabled older adults (67.6 ± 7.04), and self-efficacy and state anxiety were evaluated prior to performing each task. In univariate models, lower self-efficacy and higher anxiety were associated with more compensation (Spearman correlations: 0.15-0.48, p < 0.05). Multivariate logistic regression indicated that low self-efficacy [Odds Ratio (OR): 1.70; 95% Confidence Interval (CI): 1.40-2.08) and high anxiety (OR: 1.34; 95% CI: 1.10-1.63) were positively associated with using ≥ 6 compensatory strategies – a level signifying substantial compensation. When considered jointly with self-efficacy, the association with anxiety was reversed— higher anxiety demonstrated a lower likelihood of using compensation (OR: 0.70-0.73; 95% CI: 0.50-0.99). The addition of self-efficacy might remove the self-defeating cognitions characterizing anxiety allowing the remaining arousal component to appear beneficial. In conclusion, lower self-efficacy and higher anxiety are associated with using compensation to complete daily tasks among pre-clinically disabled older adults. Such psychological constructs may contribute to the use of compensatory strategies and represent future intervention targets to help reduce early signs of disability.
disablement; confidence; state anxiety; functional task modification
Depression is a clinically heterogeneous disorder common in Parkinson disease (PD). The goal of this study was to characterize PD depression in terms of components, including negative affect, apathy, and anhedonia. Ninety-five, nondemented individuals with idiopathic PD underwent a diagnostic interview and psychological battery. Twenty-seven patients (28%) met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition [DSM-IV]) criteria for a current depressive episode. The best-fitting confirmatory factor analysis model had 3 factors (negative affect, apathy, and anhedonia). Apathy loaded most strongly onto a second-order factor representing global psychological disturbance. All factors are uniquely associated with depression status. Negative affect exhibited the strongest relationship. Psychological disturbance in PD is heterogeneous and can produce symptoms of apathy, anhedonia, and negative affect. Apathy appears to be the core neuropsychiatric feature of PD, whereas negative affect (eg, dysphoria) seems to be most pathognomonic of depression. Future studies should examine the specific neural correlates and treatment response patterns unique to these 3 components.
apathy; anhedonia; negative affect; dysphoria; anxiety; confirmatory factor analysis
Systematic cognitive training produces long-term improvement in cognitive function and less difficulty in performing activities of daily living. We examined whether cognitive training was associated with reduced rate of incident dementia. Participants were from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (n=2,802). Incident dementia was defined using a combination of interview- and performance-based methods. Survival analysis was used to determine if ACTIVE treatment affected the rate of incident dementia during 5 years of follow-up. A total of 189 participants met criteria for incident dementia. Baseline factors predictive of incident dementia were older age, male gender, African American race, fewer years of education, relationship other than married, no alcohol use, worse MMSE< worse SF-36 physical functioning, higher depressive symptomatology, diabetes, and stroke (all p<.05). A multivariable model with significant predictors of incident dementia and training group revealed that cognitive training was not associated with a lower rate of incident dementia. Cognitive training did not affect rates of incident dementia after 5 years of follow-up. Longer follow-up or enhanced training may be needed to fully explore the preventive capacity of cognitive training in forestalling onset of dementia.
Cognitive training; Intervention; Aging; Dementia; Prevention; Cognition