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
The relationship between habitual sleep and cognition in older adults with sleep complaints is poorly understood, because research has focused on younger adults, used experimental or retrospective quasi-experimental designs, and generally produced equivocal results. Prospective studies using sleep diaries are rare, but may provide important insights into this relationship as they offer greater ecological validity and allow for examination of the impact of night-to-night variability in sleep (an often overlooked aspect of sleep) on cognitive performance. Seventy-two older adults (Mage = 70.18 years, SDage = 7.09 years) completed fourteen consecutive days of sleep diaries and paper/pencil self-administered cognitive tasks, including measures of processing speed (Symbol Digit) and reasoning (Letter Series). Regression analyses revealed increased average total wake time (TWT) during the night was associated with higher Symbol Digit scores, β = 0.45, P < 0.05. Night-to-night variability in either total sleep time (TST) or TWT was not associated with either cognitive measure. Implications and potential explanations for these initially counterintuitive findings are discussed.
Older adults; Sleep complaints; Cognitive performance; Variability; Reasoning; Processing speed
Rates of mild cognitive impairment (MCI) have varied substantially, depending on the criteria used and the samples surveyed. The present investigation used a psychometric algorithm for identifying MCI and its’ stability to determine if low cognitive functioning was related to poorer longitudinal outcomes. The Advanced Cognitive Training of Independent and Vital Elders (ACTIVE) study is a multi-site longitudinal investigation of long-term effects of cognitive training with older adults. ACTIVE exclusion criteria eliminated participants at highest risk for dementia (i.e., MMSE<23). Using composite normative for sample- and training- corrected psychometric data, 8.07% of the sample had amnestic impairment, while 25.09% had a non-amnestic impairment at baseline. Poorer baseline functional scores were observed in those with impairment at the first visit, including a higher rate of attrition, depressive symptoms, and self-reported physical functioning. Participants were then classified based upon the stability of their classification. Those who were stably impaired over the five-year interval had the worst functional outcomes (e.g., IADL performance), and inconsistency in classification over time also appeared to be associated increased risk. These findings suggest that there is prognostic value in assessing and tracking cognition to assist in identifying the critical baseline features associated with poorer outcomes.
cognitive impairment; research classification; cognitive aging; longitudinal follow-up
Apathy is a common feature of Parkinson's disease (PD) that can manifest independently of depression, but little is known about its natural progression in medically-managed patients. The present study sought to characterize and compare trajectories of apathy, depression, and motor symptoms in PD over 18 months.
Data from a sample of 186 PD patients (mean disease duration of 8.2 years) followed by the University of Florida Movement Disorders Center were obtained from a clinical research database. Scores on the Unified Parkinson's Disease Rating Scale (motor portion), Apathy Scale, and Beck Depression Inventory at three time-points (baseline, 6 months, 18 months) were analyzed in a structural equation modeling framework.
A multivariate growth model controlling for age, sex, education, and disease duration identified linear worsening of both apathy (slope estimate = 0.73; p <.001) and motor symptoms (slope estimate = 1.51; p <.001), and quadratic changes in depression (slope estimate = 1.18; p = .07). All symptoms were positively correlated. Higher education was associated with lower apathy, depression, and motor severity. Advanced age was associated with greater motor and apathy severity. Female sex and longer disease duration were associated with attenuated motor worsening. Antidepressant use was associated only with depression scores.
These longitudinal results support the differentiation of apathy and depression in PD. Like motor progression, apathy progression may be linked at least partially to dopaminergic neurodegeneration. Empirically-supported treatments for apathy in PD are needed.
Apathy; depression; antidepressants; structural equation modeling; neurodegeneration
Low neighborhood-level socioeconomic status has been associated with poorer health, reduced physical activity, increased psychological stress, and less neighborhood-based social support. These outcomes are correlates of late life cognition, but few studies have specifically investigated the neighborhood as a unique source of explanatory variance in cognitive aging. This study supplemented baseline cognitive data from the ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) study with neighborhood-level data to investigate (1) whether neighborhood socioeconomic position (SEP) predicts cognitive level, and if so, whether it differentially predicts performance in general and specific domains of cognition and (2) whether neighborhood SEP predicts differences in response to short-term cognitive intervention for memory, reasoning, or processing speed. Neighborhood SEP positively predicted vocabulary, but did not predict other general or specific measures of cognitive level, and did not predict individual differences in response to cognitive intervention.
This article presents the results of an empirical test of a literature-based Patient-Centered Culturally Sensitive Health Care Model. The model was developed to explain and improve health care for ethnically diverse patients seen in community-based primary care clinics.
Samples of predominantly low-income African American (N = 110) and non-Hispanic White American (N = 119) patients were recruited to complete questionnaires about their perceived health care provider cultural sensitivity and adherence to their provider's treatment regimen recommendations.
Main Outcome Measures
Patients completed written measures of their perceived provider cultural sensitivity, trust in provider, interpersonal control, satisfaction with their health care provider, physical stress and adherence to provider recommended treatment regimen variables (i.e., engagement in a health promoting lifestyle, and dietary and medication adherence).
Two-group path analyses revealed significant links between patient-perceived provider cultural sensitivity and adherence to provider treatment regimen recommendations, with some differences in associations emerging by race/ethnicity.
The findings provide empirical support for the potential usefulness of the Patient-Centered Culturally Sensitive Health Care Model for explaining the linkage between the provision of patient-centered, culturally-sensitive health care, and the health behaviors and outcomes of patients who experience such care.
patient-centered culturally sensitive health care; interpersonal control; health promoting lifestyle; patient satisfaction; treatment adherence
The objective of this study was to test the hypothesis that apathy and depression are dissociable in Parkinson disease (PD) by conducting a confirmatory factor analysis (CFA) of items from two commonly used mood scales. A total of 161 non-demented PD patients (age = 64.1; ± 8.4 years) were administered the Apathy Scale and the Beck Depression Inventory-II. Items were hypothesized to load onto four factors: (1) an apathy factor representing loss of motivation, (2) dysphoric mood factor representing sadness and negativity, (3) loss of interest/pleasure factor representing the features common to both apathy and depression, and (4) a somatic factor representing bodily complaints. Results indicated a good fit for the overall CFA model, χ2 (128, N = 146) = 194.9; p<.01. RMSEA was .060 (p = .16). The four-factor model was significantly better than all alternative nested models at p < .001, including an overarching single factor model, representing “depression.” Results support the concept that apathy and depression are discrete constructs. We suggest a “factor based” scoring of the Apathy Scale and Beck Depression Inventory-II that disentangles symptoms related to apathy, depression, overlapping symptoms, and somatic complaints. Such scoring may be important in providing useful information regarding differential treatment options.
Parkinson’s disease; Apathy; Depression; Confirmatory factor analysis; Apathy Scale
Preclinical studies strongly suggest that accelerated apoptosis in skeletal myocytes may be involved in the pathogenesis of sarcopenia. However, evidence in humans is sparse. In the present study, we investigated whether apoptotic signaling in the skeletal muscle was associated with indices of muscle mass and function in older persons.
Community-dwelling older adults were categorized into high-functioning (HF) or low-functioning (LF) groups according to their short physical performance battery (SPPB) summary score. Participants underwent an isokinetic knee extensor strength test and 3-dimensional magnetic resonance imaging of the thigh. Vastus lateralis muscle samples were obtained by percutaneous needle biopsy and assayed for the expression of a set of apoptotic signaling proteins. Age, sex, number of comorbid conditions and medications as well as knee extensor strength were not different between groups. HF participants displayed greater thigh muscle volume compared with LF persons. Multivariate partial least squares (PLS) regressions showed significant correlations between caspase-dependent apoptotic signaling proteins and the muscular percentage of thigh volume (R2 = 0.78; Q2 = 0.61) as well as gait speed (R2 = 0.81; Q2 = 0.56). Significant variables in the PLS model of percent muscle volume were active caspase-8, cleaved caspase-3, cytosolic cytochrome c and mitochondrial Bak. The regression model of gait speed was mainly described by cleaved caspase-3 and mitochondrial Bax and Bak. PLS predictive apoptotic variables did not differ between functional groups. No correlation was determined between apoptotic signaling proteins and muscle strength or quality (strength per unit volume).
Data from this exploratory study show for the first time that apoptotic signaling is correlated with indices of muscle mass and function in a cohort of community-dwelling older persons. Future larger-scale studies are needed to corroborate these preliminary findings and determine if down-regulation of apoptotic signaling in skeletal myocytes will provide improvements in the muscle mass and functional status of older persons.
We evaluated the effect of cognitive training among 1,534 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial (RCT) on 5-year improvements in 3 cognitive-specific measures of locus of control—internal, chance, and powerful others.
ACTIVE was a multisite RCT (age ≥ 65), with 4 groups (memory, reasoning, speed of processing, and no-contact control). Complete 5-year follow-up data were available for 1,534 (55%) of the 2,802 participants. A propensity score model was used to adjust for potential attrition bias. Clinically important improvements (and decrements) in the cognitive-specific locus of control scale scores were defined as greater than or equal to 0.5 SD (medium) and greater than or equal to 1.0 SD (large). Multinomial logistic regression was used to simultaneously contrast those who improved and those who declined with those whose locus of control scale score was unchanged.
Statistically significant effects reflecting medium-sized (≥0.5 SD) improvements in internal locus of control between baseline and the 5-year follow-up were found for the reasoning and speed of processing intervention groups who were 76% (p < .01) and 68% (p < .05) more likely, respectively, to improve than the no-contact control group. No improvement effects were found on the chance or powerful others locus of control measures or for the memory intervention group.
Cognitive training that targets reasoning and speed of processing can improve the cognitive-specific sense of personal control over one’s life in older adults.
cognitive status; personal control; randomized controlled trial; speed of processing
Obesity and a sedentary lifestyle are associated with physical impairments and biologic changes in older adults. Weight loss combined with exercise may reduce inflammation and improve physical functioning in overweight, sedentary, older adults. This study tested whether a weight loss program combined with moderate exercise could improve physical function in obese, older adult women.
Participants (N = 34) were generally healthy, obese, older adult women (age range 55–79 years) with mild to moderate physical impairments (ie, functional limitations). Participants were randomly assigned to one of two groups for 24 weeks: (i) weight loss plus exercise (WL+E; n = 17; mean age = 63.7 years [4.5]) or (ii) educational control (n = 17; mean age = 63.7 [6.7]). In the WL+E group, participants attended a group-based weight management session plus three supervised exercise sessions within their community each week. During exercise sessions, participants engaged in brisk walking and lower-body resistance training of moderate intensity. Participants in the educational control group attended monthly health education lectures on topics relevant to older adults. Outcomes were: (i) body weight, (ii) walking speed (assessed by 400-meter walk test), (iii) the Short Physical Performance Battery (SPPB), and (iv) knee extension isokinetic strength.
Participants randomized to the WL+E group lost significantly more weight than participants in the educational control group (5.95 [0.992] vs 0.23 [0.99] kg; P < 0.01). Additionally, the walking speed of participants in the WL+E group significantly increased compared with that of the control group (reduction in time on the 400-meter walk test = 44 seconds; P < 0.05). Scores on the SPPB improved in both the intervention and educational control groups from pre- to post-test (P < 0.05), with significant differences between groups (P = 0.02). Knee extension strength was maintained in both groups.
Our findings suggest that a lifestyle-based weight loss program consisting of moderate caloric restriction plus moderate exercise can produce significant weight loss and improve physical function while maintaining muscle strength in obese, older adult women with mild to moderate physical impairments.
obesity; weight loss; physical function; oxidative stress; inflammation; walking speed
To examine the relationship between objectively measured nocturnal sleep and subjective report of morning pain in older adults with insomnia. The goal of the paper was to not only examine the sleep-pain association between-persons (mean-level over 14 days), but also to investigate the within-person, day-to-day association.
Fifty community-dwelling older adults (Mage = 69.10 years, SDage = 7.02 years, range = 60 – 90 years) with insomnia participated in the study.
This study employed daily home-based assessment utilizing nightly actigraphic measurement of sleep and daily self-report of pain. Measures were completed over fourteen consecutive days.
Between persons, average sleep over 14 days was not associated with average levels of rated pain. However, following a night in which an older adult with insomnia experienced above-average total sleep time s/he subsequently reported below-average pain ratings. The model explained approximately 24% of the within-person and 8% of the between-person variance in pain ratings.
Sleep and pain show day-to-day associations (i.e., covary over time) in older adults with insomnia. Such associations may suggest that common physiological systems underlie both the experience of insomnia and pain. Future research should examine the crossover effects of sleep treatment on pain and of pain treatment on sleep.
Sleep; Pain; Older Adults; Multilevel Modeling; Daily Associations
The triadic model of human infant temperament, involving Negative Affectivity, Orienting/Regulation, and Surgency/Extraversion factors, was applied to the rhesus neonate using exploratory factor analysis (EFA). Replicating and expanding earlier work in rhesus monkeys, the three factor solution produced latent constructs comparable to human neonatal temperament.
Infancy; temperament structure; rhesus macaques; factors analysis
The present study investigated evidence for race-related test bias in cognitive measures used in the baseline assessment of the ACTIVE clinical trial. Test bias against African Americans has been documented in both cognitive aging and early lifespan studies. Despite significant mean performance differences, Multiple Indicators Multiple Causes (MIMIC) models suggested most differences were at the construct level. There was little evidence that specific measures put either group at particular advantage or disadvantage and little evidence of cognitive test bias in this sample. Small group differences in education, cognitive status, and health suggest positive selection may have attenuated possible biases.
This study investigated individual differences in older adults' everyday problem-solving performance using 3 instruments. Past research, typically using only single measures, has yielded a multitude of findings regarding age effects in everyday problem solving. The present sample consisted of 111 older adults (44 men, 67 women) who ranged in age from 68 to 94 years. Confirmatory factor analyses revealed that, within each of the 3 instruments, subscales representing particular content domains could be reliably identified. There was, however, little relation between the different instruments, and the measures also differed in their relation with chronological age. These results support the view that everyday problem-solving competence is a multidimensional construct, of which previous investigations may only have studied particular dimensions.
Dual tasking can interfere with activity after stroke.
The authors examined the interactions between 3 different cognitive tasks and the swing and double-limb support (DLS) components of the gait cycle in community-dwelling individuals poststroke.
Acquisition of cognitive and gait data were synchronized to study the cognitive–motor interference effects during the different phases of the gait cycle. Participants performed 3 different cognitive tasks in isolation and in combination with walking as well as a single walking task. Tasks were performed continuously for 3 minutes, generating 131 ± 39 gait cycles per person for analysis for each walking trial. Data were analyzed for 8 participants 7.6 ± 4.2 months poststroke.
A significant increase was found in the proportion of the gait cycle spent in DLS in dual-task walking because of an increased duration of the DLS phase associated with paretic weight acceptance. There was a significant dual-task effect on nonparetic swing duration: participants reduced the amount of time in paretic single-limb stance in the 3 dual-task conditions. Temporal asymmetry of gait did not increase significantly under dual-task conditions. Reaction times were not affected by whether the stimuli were present during the swing or DLS phase of the gait cycle.
The findings from this pilot study provide evidence that cognitive–motor interference during gait may be influenced by the phase of the gait cycle, especially DLS involving paretic weight acceptance, which may affect community ambulators with hemiparetic stroke.
dual task; gait; stroke
The main objective of the present study was to examine daily associations (intraindividual variability or IIV) between sleep and affect in older adults. Greater understanding of these associations is important, because both sleep and affect represent modifiable behaviors that can have a major influence on older adults’ health and well-being. We collected sleep diaries, actigraphy, and affect data concurrently for 14 days in 103 community-dwelling older adults. Multilevel modeling was used to assess the sleep–affect relationship at both the group (between-persons) and individual (within-person or IIV) levels. We hypothesized that nights characterized by better sleep would be associated with days characterized by higher positive affect and lower negative affect, and that the inverse would be true for poor sleep. Daily associations were found between affect and subjective sleep, only and were in the hypothesized direction. Specifically, nights with greater reported awake time or lower sleep quality ratings were associated with days characterized by less positive affect and more negative affect. Gender was not a significant main effect in the present study, despite previous research suggesting gender differences in the sleep–affect relationship. The fact that self-ratings of sleep emerged as the best predictors of affect may suggest that perceived sleep is a particularly important predictor. Finally, our results suggest exploration of affect as a potential intervention target in late-life insomnia is warranted.
affect; daily variability; intraindividual variability; mood; older adults; sleep
The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a randomized, controlled, single-masked trial designed to determine whether cognitive training interventions (memory, reasoning, and speed of information processing), which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions, can affect cognitively based measures of daily functioning. Enrollment began during 1998; 2-year follow-up will be completed by January 2002. Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization. Trial participants (n = 2832) are aged 65 and over, and at entry into the trial, did not have significant cognitive, physical, or functional decline. Because of its size and the carefully developed rigor, ACTIVE may serve as a guide for future behavioral medicine trials of this nature.
Cognitive decline; activities of daily living; behavioral intervention
Cognitive function in older adults is related to independent living and need for care. However, few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently.
To evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older, independent-living adults.
Randomized, controlled, single-blind trial with recruitment conducted from March 1998 to October 1999 and 2-year follow-up through December 2001.
Setting and Participants
Volunteer sample of 2832 persons aged 65 to 94 years recruited from senior housing, community centers, and hospital/clinics in 6 metropolitan areas in the United States.
Participants were randomly assigned to 1 of 4 groups: 10-session group training for memory (verbal episodic memory; n=711), or reasoning (ability to solve problems that follow a serial pattern; n=705), or speed of processing (visual search and identification; n=712); or a no-contact control group (n=704). For the 3 treatment groups, 4-session booster training was offered to a 60% random sample 11 months later.
Main Outcome Measures
Cognitive function and cognitively demanding everyday functioning.
Thirty participants were incorrectly randomized and were excluded from the analysis. Each intervention improved the targeted cognitive ability compared with baseline, durable to 2 years (P<.001 for all). Eighty-seven percent of speed-, 74% of reasoning-, and 26% of memory-trained participants demonstrated reliable cognitive improvement immediately after the intervention period. Booster training enhanced training gains in speed (P<.001) and reasoning (P<.001) interventions (speed booster, 92%; no booster, 68%; reasoning booster, 72%; no booster, 49%), which were maintained at 2-year follow-up (P<.001 for both). No training effects on everyday functioning were detected at 2 years.
Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities. Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals. Because of minimal functional decline across all groups, longer follow-up is likely required to observe training effects on everyday function.
This study investigated the interactions between gait and three different cognitive tasks in people after stroke. Thirteen people post-stroke who were living in the community, were able to walk 10 m without physical assistance, and could respond verbally to auditory stimuli participated. Participants performed a walking task alone, three different cognitive tasks while seated, and each cognitive task in combination with walking. Gait data were acquired continuously for approximately 3 min. Reaction time and accuracy were recorded for two of the cognitive tasks (visuospatial task, working memory task). Speech samples from the spontaneous speech task were analyzed on several dimensions of language. Significant dual task effects were observed for gait speed, stride time, average stride length, and cadence, but not for stride time variability. Speech produced more gait interference than memory and visuospatial tasks. Interference effects on cognition were minimal; only speech was significantly affected by concurrent walking. Narratives in the dual task condition had more pauses, shorter sentences, but more utterances with new information. Even though participants in this study were mobility-impaired, they prioritized the cognitive tasks. Future research should determine whether dual task training can reduce gait decrements in dual task situations in people after stroke.
Cerebrovascular accident; Gait; Cognition; Rehabilitation; Dual task
Several researchers have suggested that the maintenance of global coherence (topic maintenance) and local coherence (maintenance between utterances) in discourse requires cognitive resources. This study directly tests this hypothesis by examining the relationship between cognitive variables and coherence in narrative discourse produced by mobility-impaired stroke survivors under single (talking) and dual (talking and walking) task conditions. Although there were no effects of the dual task on coherence, global coherence was significantly disrupted regardless of the single or dual task condition. Moreover, global coherence strongly correlated with cognitive function measures, whereas local coherence did not. Findings are consistent with two interpretations: (1) that global and local coherence may be subserved by different cognitive processes or (2) that maintaining global coherence is a more difficult task and thus will show effects of cognitive impairment before local coherence is impaired. These are both testable hypotheses for future research.
After reading the manuscript, the reader will be able to: (1) understand and differentiate between local and global measures of coherence; (2) discuss the effects of a dual task, walking and talking, on global coherence in a gait-impaired group of stroke survivors; (3) understand why the maintenance of global coherence in discourse might be more cognitively demanding than the maintenance of local coherence.
This paper is based on a presentation made during the Indiana Alzheimer Disease Center’s Symposium on Mild Cognitive Impairment on April 19, 2008. The results of the ACTIVE study (Advanced Cognitive Training for Independent and Vital Elderly) were presented at the symposium including review of previously published study findings. The ACTIVE study is a multicenter, randomized, controlled clinical trial that has been examining the long-term effectiveness of cognitive training on enhancing mental abilities (memory, reasoning, and attention) and preserving activities of daily living (managing finances, taking medication, using the telephone, and driving) in older adults. Six centers across the eastern United States enrolled nearly 3000 people initially. Participants underwent detailed assessments of mental and functional ability on multiple occasions over several years of follow-up. ACTIVE has shown positive effects of cognitive training at 5 years post-intervention for basic mental abilities, health-related quality of life, and improved ability to perform instrumental activities of daily living (IADL). A subgroup analysis through 2 years of follow-up suggested that subjects with mild cognitive impairment (MCI) did not benefit from memory training; however, they did benefit, to the same degree as cognitively normal participants, from training in reasoning and speed of processing. This finding suggests that MCI may interfere with a person’s ability to benefit from some forms of cognitive enhancement. Limitations of ACTIVE and directions for future research are reviewed.