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1.  Association of Social Engagement with Brain Volumes Assessed by Structural MRI 
Journal of Aging Research  2012;2012:512714.
We tested the hypothesis that social engagement is associated with larger brain volumes in a cohort study of 348 older male former lead manufacturing workers (n = 305) and population-based controls (n = 43), age 48 to 82. Social engagement was measured using a summary scale derived from confirmatory factor analysis. The volumes of 20 regions of interest (ROIs), including total brain, total gray matter (GM), total white matter (WM), each of the four lobar GM and WM, and 9 smaller structures were derived from T1-weighted structural magnetic resonance images. Linear regression models adjusted for age, education, race/ethnicity, intracranial volume, hypertension, diabetes, and control (versus lead worker) status. Higher social engagement was associated with larger total brain and GM volumes, specifically temporal and occipital GM, but was not associated with WM volumes except for corpus callosum. A voxel-wise analysis supported an association in temporal lobe GM. Using longitudinal data to discern temporal relations, change in ROI volumes over five years showed null associations with current social engagement. Findings are consistent with the hypothesis that social engagement preserves brain tissue, and not consistent with the alternate hypothesis that persons with smaller or shrinking volumes become less socially engaged, though this scenario cannot be ruled out.
doi:10.1155/2012/512714
PMCID: PMC3446736  PMID: 22997582
2.  Internet use and decision making in community-based older adults 
Use of the internet may provide tools and resources for better decision making, yet little is known about the association of internet use with decision making in older persons. We examined this relationship in 661 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Participants were asked to report if they had access to the internet and how frequently they used the internet and email. A 12-item instrument was used to assess financial and healthcare decision making using materials designed to approximate those used in real world settings. Items were summed to yield a total decision making score. Associations were tested via linear regression models adjusted for age, sex, race, education, and a measure of global cognitive function. Secondary models further adjusted for income, depression, loneliness, social networks, social support, chronic medical conditions, instrumental activities of daily living (IADLs), life space size, and health and financial literacy. Interaction terms were used to test for effect modification. Almost 70% of participants had access to the internet, and of those with access, 55% used the internet at least several times a week. Higher frequency of internet use was associated with better financial and healthcare decision making (β = 0.11, p = 0.002). The association persisted in a fully adjusted model (β = 0.08, p = 0.024). Interaction models indicated that higher frequency of internet use attenuated the relationships of older age, poorer cognitive function, and lower levels of health and financial literacy with poorer healthcare and financial decision making. These findings indicate that internet use is associated with better health and financial decision making in older persons. Future research is required to understand whether promoting the use of the internet can produce improvements in healthcare and financial decision making.
doi:10.3389/fpsyg.2013.00605
PMCID: PMC3936138  PMID: 24578696
internet; decision making; older adults; aging; cohort study
3.  Total Daily Activity Measured With Actigraphy and Motor Function in Community-Dwelling Older Persons With and Without Dementia 
Actigraphic measures of physical activity do not rely on participant self-report and may be of particular importance for efforts to examine the health benefits of physical activity across the full spectrum of older individuals especially those with dementia, a group in which loss of motor function is particularly salient. We tested whether actigraphy could be employed to examine the relationship between total daily physical activity and motor function in community-dwelling older persons both with (n=70) and without clinical dementia (n=624). Total daily activity was measured with actigraphy for a median of 9 (range 2–16) days. All participants also underwent a structured examination including 9 muscle strength and 9 motor performance measures summarized as a composite measure. In linear regression models controlling for age, sex, and education, total daily activity was associated with global motor scores (β=0.13, SD=0.01, p<0.001). This association remained significant after adjusting for body composition, cognition, depressive symptoms, disability, vascular risk factors and diseases (β=0.07, SD=0.01, p < 0.001). The association did not vary by dementia status (interaction p=0.53). In persons without dementia, the association was independent of self-reported physical activity. Total daily activity was associated with both muscle strength (β=0.10, SD=0.02, p<0.001) and motor performance (β=0.16, SD=0.02, p<0.001). Actigraphy can be employed in the community-setting to provide objective measures of total daily activity that are associated with a broad range of motor performances and these associations did not vary by dementia status. Actigraphy may provide a means to more fully explicate the nature and course of motor impairment in old age.
doi:10.1097/WAD.0b013e31822fc3cb
PMCID: PMC3251727  PMID: 21946015
actigraphy; physical activity; motor function
4.  The Impact of Health and Financial Literacy on Decision Making in Community-Based Older Adults 
Gerontology  2012;58(6):531-539.
Background
Health and financial literacy have been linked to the health and well-being of older adults, yet there are few data on how health and financial literacy actually impact decision making regarding healthcare and economic choices in advanced age.
Objective
To examine the association of health and financial literacy with decision making in older adults.
Method
Data came from 525 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal study of aging. Health and financial literacy were assessed via a series of questions designed to measure comprehension of health and financial information and concepts. The two scores were averaged to yield a total literacy score. A modified, 12-item version of the Decision-Making Competence Assessment Tool was used to measure financial and healthcare decision making (6 items each), using materials designed to approximate those used in real world settings. All 12 items were summed to yield a total decision-making score. Associations were tested via linear regression models adjusted for age, sex and education. Secondary models adjusted for global cognitive function, income, depression and chronic medical conditions.
Results
On average, participants correctly answered 67% of the literacy questions (health literacy = 61.6%, SD = 18.8% and financial literacy = 72.5%, SD = 16.0%). After adjustment for cognitive function, the total literacy score was positively associated with the decision-making total score (estimate = 0.64, SE = 0.08, p < 0.001), as well as healthcare (estimate = 0.37, SE = 0.5, p < 0.001) and financial decision making (estimate = 0.28, SE = 0.05, p < 0.001). Further, total literacy, health and financial literacy all were independently associated with decision making in models adjusted for covariates including income, depression, and chronic medical conditions (all p values < 0.001). Finally, there was evidence of effect modification such that the beneficial association between literacy and healthcare decision making was stronger among older persons, poorer persons and persons at the lower ranges of cognitive ability.
Conclusion
Among community based older persons without dementia, higher levels of health and financial literacy were associated with better decision making, suggesting that improvements in literacy could facilitate better decision making and lead to better health and quality of life in later years.
doi:10.1159/000339094
PMCID: PMC3491105  PMID: 22739454
Financial literacy; Health literacy; Decision making
5.  Genetic Risk Factors for Longitudinal Changes in Structural MRI in Former Organolead Workers 
Journal of Aging Research  2011;2011:362189.
This study examined associations between polymorphisms in three genes, apolipoprotein E (APOE), angiotensin converting enzyme (ACE), and vitamin D receptor (VDR), and longitudinal change in brain volumes and white matter lesions (WML) as well as effect modification by cardiovascular factors and tibia lead concentrations. Two MRIs, an average of 5 years apart, were obtained for 317 former organolead workers and 45 population-based controls. Both regions-of-interest and voxel-wise analyses were conducted. APOE ε3/ε4 and ε4/ε4 genotypes were associated with less decline in white matter volumes. There was some evidence of interaction between genetic polymorphisms and cardiovascular risk factors (ACE and high-density lipoprotein; VDR and diabetes) on brain volume decline. The VDR FokI ff genotype was associated with an increase in WML (no association for APOE or ACE). This study expands our understanding of how genetic precursors of dementia and cardiovascular diseases are related to changes in brain structure.
doi:10.4061/2011/362189
PMCID: PMC3199062  PMID: 22028967
6.  Interpreting the Clinical Significance of Capacity Scores for Informed Consent in Alzheimer Disease Clinical Trials 
Objective
Among Alzheimer disease (AD) patients enrolled in a clinical trial, the authors assessed the ability of a standardized capacity assessment procedure to identify persons who are capable of giving their own informed consent.
Design
Cross-sectional interview.
Setting
Thirteen sites participating in a randomized and placebo controlled study of simvastatin for the treatment of mild to moderate AD.
Participants
Persons with mild to moderate AD and their study partners enrolled in the simvastatin clinical trial.
Measurements
Interviews to assess decision-making capacity using the MacArthur Competency Assessment Tool for Clinical Research (MacCAT-CR).
Results
Judges blinded to the subject’s clinical status had a high rate of agreement on patients capable of giving their own informed consent (κ = 0.73). The understanding subscale had the best receiver operator characteristic and an analysis of positive and negative predictive values over a range of hypothetical prevalences of incapacity to consent demonstrated the value of a range of understanding cut-points.
Conclusion
Among mild to moderate AD patients, enrolled in an actual clinical trial, these results suggest evidence based guidelines for using the MacCAT-CR understanding subscale to help guide judgments about whether a patient has the capacity to consent.
doi:10.1097/JGP.0b013e318172b406
PMCID: PMC3936673  PMID: 18556397
Informed consent; decision making capacity; Alzheimer disease
7.  Life Space and Risk of Alzheimer Disease, Mild Cognitive Impairment, and Cognitive Decline in Old Age 
Objective
To test the hypothesis that a constricted life space, the extent of movement through the environment covered during daily functioning, is associated with increased risk of incident Alzheimer disease (AD), increased risk of mild cognitive impairment (MCI), and more rapid cognitive decline in older adults.
Design
Two prospective cohort studies.
Setting
Retirement communities, community-based organizations, churches, and senior subsidized housing facilities across the Chicago metropolitan area.
Participants
A total of 1,294 community-dwelling elders without baseline clinical dementia.
Main Outcome Measures
Detailed annual clinical evaluation to diagnose incident AD and MCI, and document change in cognitive function.
Results
During a mean (SD) follow-up of 4.4 (1.7) years, 180 persons developed AD. In a proportional hazards model controlling for age, sex, race, and education, a more constricted life space was associated with an increased risk of AD (hazard ratio = 1.21, confidence interval: 1.08--1.36). A person with a life space constricted to their home was almost twice as likely to develop AD than a person with the largest life space (out of town). The association did not vary along demographic lines and persisted after the addition of terms for performance-based physical function, disability, depressive symptoms, social network size, vascular disease burden, and vascular risk factors. The association remained consistent after excluding persons with MCI at baseline and who developed AD in the first 2 years of observation. A constricted life space was also associated with an increased risk of MCI (hazard ratio = 1.17, confidence interval: 1.06--1.28), and a more rapid rate of global cognitive decline (estimate: –0.012, standard error: 0.003, t[5033] = –3.58, p <0.001).
Conclusions
A constricted life space is associated with increased risk of AD, MCI, and cognitive decline among older persons.
doi:10.1097/JGP.0b013e318211c219
PMCID: PMC3123692  PMID: 21430509
Alzheimer disease; cognition; dementia; epidemiology; life space; mild cognitive impairment (MCI)
8.  Relation of Late-Life Social Activity With Incident Disability Among Community-Dwelling Older Adults 
Background.
We tested the hypothesis that a higher level of social activity was associated with decreased risk of incident disability in older adults.
Methods.
Data came from older adults in the Rush Memory and Aging Project, an ongoing longitudinal cohort study of aging. Analyses were restricted to persons without clinical dementia and reporting no need for help performing any task in the particular functional domain assessed. Participants were followed for an average of 5.1 years (SD = 2.5). Social activity, based on 6 items (visiting friends or relatives; going to restaurants, sporting events, or playing games; group meetings; church/religious services; day or overnight trips; unpaid community/volunteer work), was assessed at baseline. Disability in basic activities of daily living, mobility disability, and instrumental activities of daily living was assessed annually. Proportional hazard models adjusted for age, sex, and education were used to examine the association between social activity and incident disability. Fully adjusted models included terms for depression, vascular diseases and risk factors, body mass index, social networks, and self-reported physical activity.
Results.
In fully adjusted models, among 954 persons without baseline disability, the risk of developing disability in activities of daily living decreased by 43% (hazard ratio = 0.57, 95% confidence interval = 0.46, 0.71) for each additional unit of social activity. Social activity was also associated with decreased risk of developing mobility disability (hazard ratio = 0.69, 95% confidence interval = 0.54, 0.88) and disability in instrumental activities of daily living (hazard ratio = 0.71, 95% confidence interval = 0.55, 0.93).
Conclusions.
Social activity is associated with a decreased risk of incident disability in activities of daily living, mobility, and instrumental activities of daily living, among community-dwelling older adults.
doi:10.1093/gerona/glq231
PMCID: PMC3055280  PMID: 21300745
Disability; Longitudinal; Social activity
9.  Late-Life Social Activity and Cognitive Decline in Old Age 
We examined the association of social activity with cognitive decline in 1138 persons without dementia at baseline with a mean age of 79.6 (SD = 7.5) who were followed for up to 12 years (mean = 5.2; SD = 2.8). Using mixed models adjusted for age, sex, education, race, social network size, depression, chronic conditions, disability, neuroticism, extraversion, cognitive activity, and physical activity, more social activity was associated with less cognitive decline during average follow-up of 5.2 years (SD = 2.7). A one point increase in social activity score (range = 1–4.2; mean = 2.6; SD = 0.6) was associated with a 47% decrease in the rate of decline in global cognitive function (p < .001). The rate of global cognitive decline was reduced by an average of 70% in persons who were frequently socially active (score = 3.33, 90th percentile) compared to persons who were infrequently socially active (score = 1.83, 10th percentile). This association was similar across five domains of cognitive function. Sensitivity analyses revealed that individuals with the lowest levels of cognition or with mild cognitive impairment at baseline did not drive this relationship. These results confirm that more socially active older adults experience less cognitive decline in old age.
doi:10.1017/S1355617711000531
PMCID: PMC3206295  PMID: 22040898
Cognition; Cognitive reserve; Aging; Social behavior; Life Style; Risk reduction behavior; Longitudinal studies; Epidemiology
10.  Relation of Driving Status to Incident Life Space Constriction in Community-Dwelling Older Persons: A Prospective Cohort Study 
Background.
Maintaining spatial movement through the environment is an important feature of healthy aging. We examined whether being licensed to drive is associated with maintaining spatial movement in older persons initially reporting maximum spatial mobility.
Methods.
From the Rush Memory and Aging Project, 571 nondemented, community-dwelling older persons were identified with (i) baseline data on driving status, (ii) baseline report of spatial mobility to the largest life space zone, and (iii) at least one annual follow-up evaluation. Incident constriction of life space was the primary outcome of interest.
Results.
Over an average follow-up of 4.3 years, 303 participants reported incident constriction of life space. In a proportional hazards model adjusted for age, sex, and education, having a valid driver's license at baseline was associated with a decreased hazard of reporting a life space constriction (hazard ratio = 0.39; 95% confidence interval = 0.29–0.54). Results were unchanged after controlling for number of vascular risk factors and vascular diseases, low visual acuity, social isolation, and gait speed. Of participants reporting incident life space constriction, 188 subsequently reported reexpansion of spatial mobility to the largest zone of life space. Having a valid driver's license was associated with a greater likelihood of life space recovery (hazard ratio = 2.00; 95% confidence interval = 1.27–3.17).
Conclusion.
In older persons, having a valid driving license was associated with reduced hazard of reporting life space constriction and a greater likelihood of life space recovery if incident life space constriction occurred.
doi:10.1093/gerona/gls133
PMCID: PMC3436089  PMID: 22546958
Driving; Life space; Spatial mobility; Elderly; Prospective cohort study
11.  Correlates of health and financial literacy in older adults without dementia 
BMC Geriatrics  2012;12:30.
Background
Recent research has begun to recognize the important influence of literacy levels and how they affect health and wellbeing, especially in older adults. Our study focuses on health and financial literacy, two domains of literacy which previous research has suggested may be significantly related to health and wellbeing. Our study examines the relation of health and financial literacy with health promoting behaviors and health status among community-based older persons.
Methods
We conducted a cross-sectional study using data from the Rush Memory and Aging Project, a community-based cohort study of aging in northeastern Illinois. The study consisted of 556 older persons without dementia, each determined by a clinical evaluation. Health and financial literacy were measured using a series of questions designed to assess the ability to understand and process health and financial information, concepts, and numeracy; the two scores were averaged to yield a total literacy score. Health promoting behaviors, including engagement in cognitive, physical, and social activities, were assessed using self report measures. Indicators of heath status, including cognition (global cognition and five specific cognitive abilities), functional status (basic and instrumental activities of daily living, mobility disability), and mental health (depressive symptoms, loneliness) were assessed.
Results
In a series of regression models adjusted for age, sex, and education, higher total literacy scores were associated with more frequent participation in health promoting behaviors, including cognitive, physical and social activities (all p values <0.05). Higher total literacy scores were associated with higher cognitive function, less disability, and better mental health (all p values < 0.05). Literacy remained associated with health promoting behaviors and health status in fully adjusted models that also controlled for income and the number of chronic medical conditions. Most of the findings were similar for health and financial literacy except that health literacy was more strongly associated with health promoting behaviors whereas financial literacy was more strongly associated with mental health.
Conclusions
Health and financial literacy are associated with more frequent engagement in health promoting behaviors and better health status in older persons without dementia.
doi:10.1186/1471-2318-12-30
PMCID: PMC3459814  PMID: 22691341
Health literacy; Financial literacy; Older adults; Dementia
12.  Dementia From Alzheimer Disease and Mixed Pathologies in the Oldest Old 
Jama  2012;307(17):1798-1800.
doi:10.1001/jama.2012.3556
PMCID: PMC3368581  PMID: 22550192
13.  Neighborhood psychosocial environment, apolipoprotein E genotype, and cognitive function in older adults 
Archives of General Psychiatry  2011;68(3):314-321.
Context
The social environment may influence cognitive function in aging. However, to our knowledge, no studies have investigated whether specific genes modify this association.
Objective
To examine whether the apolipoprotein E (APOE) epsilon-4 allele modified the associations of neighborhood psychosocial hazards and cognitive function.
Design
A cross-sectional analysis.
Setting
The Baltimore Memory Study, a population-based sample of older urban residents. The 65 study neighborhoods in Baltimore city were characterized using the Neighborhood Psychosocial Hazards scale, designed to assess social disorganization, physical disorder, public safety, and economic deprivation.
Participants
One thousand one hundred forty urban residents aged 50 to 70 years at baseline.
Main Outcome Measures
Cognitive performance on 20 standard tests was measured and combined to form 7 summary domain scores (language, processing speed, eye-hand coordination, executive functioning, verbal memory and learning, visual memory, and visuoconstruction).
Results
In analyses fully adjusted for individual covariates, we found that high (i.e., worse) neighborhood psychosocial hazards were not consistently associated with worse cognitive performance. However, the interaction of high neighborhood psychosocial hazards and APOE ε4 genotype was found to be associated with worse cognitive domain scores, with evidence of associations in the domains of processing speed (p = 0.02) and executive functioning (p < 0.001). Suggestive evidence was also found for eye-hand coordination (p = 0.05).
Conclusion
Living in a psychosocially hazardous neighborhood was associated with worse cognitive function in persons with the APOE ε4 allele, evidence of a novel gene x environment interaction.
doi:10.1001/archgenpsychiatry.2011.6
PMCID: PMC3328419  PMID: 21383266
residential characteristics; psychosocial factors; apolipoprotein E; cognitive function; gene-environment interaction
14.  Altered NEP2 Expression and Activity in Mild Cognitive Impairment and Alzheimer’s Disease 
Journal of Alzheimer's Disease  2012;28(2):433-441.
Neprilysin-2 (NEP2), a close homolog of neprilysin (NEP), degrades amyloid-β (Aβ) and serves an important role in clearing Aβ in vivo. We measured NEP2 and NEP mRNA levels from non-impaired (NI), mild cognitive impaired (MCI), and clinical Alzheimer’s disease (AD) subjects in the mid-temporal gyrus, mid-frontal gyrus, caudate, and cerebellum. NEP2 activity levels were also determined. Our results indicate that NEP2 and NEP mRNA expression is altered in MCI subjects relative to NI subjects in AD-susceptible regions. NEP2 enzymatic activity was lowered in association with MCI and AD and was positively associated with level of cognitive function, independent of diagnostic category. Our finding that NEP2 expression and activity are altered in MCI is significant as these changes may potentially serve as preclinical markers for AD and reduced NEP2 activity may be associated with the development of AD.
doi:10.3233/JAD-2011-111307
PMCID: PMC3320721  PMID: 22008264
Alzheimer’s disease; amyloid-β peptide; biomarker; human brain; neprilysin; neprilysin-2
15.  Association Between Life Space and Risk of Mortality in Advanced Age 
OBJECTIVES
To examine the association between life space, a measure of functional status that describes the range of movement through the environment covered during daily functioning, and the risk of mortality in older community-based persons.
DESIGN
Two ongoing, prospective observational cohort studies of aging.
SETTING
Greater metropolitan Chicago area.
PARTICIPANTS
One thousand four hundred forty-five community-based older persons without dementia.
MEASUREMENTS
Life space was measured at baseline using a series of questions designed to measure the extent of participants’ movement throughout their environment, ranging from the bedroom to out of town. The association between life space and mortality was examined using proportional hazards models adjusted for age, sex, race, and education.
RESULTS
Over up to 8 years of follow-up (mean 4.1 years), 329 of 1,445 (22.8%) participants died. In a proportional hazards model adjusted for age, sex, race, and education, a more-constricted life space was associated with a greater risk of death (hazard ratio = 1.18, 95% confidence interval = 1.09–1.27, P < .001), such that people with life spaces constricted to their immediate home environment (score = 3) were approximately 1.6 times as likely to die as those whose life spaces included trips out of town (score = 0). This association persisted after the addition of terms for several potential confounders, including physical activity, performance-based physical function, disability, depressive symptoms, social networks, body mass index, and number of chronic medical conditions.
CONCLUSION
Constricted life space is associated with greater risk of death in older community-based persons.
doi:10.1111/j.1532-5415.2010.03058.x
PMCID: PMC3286640  PMID: 20831722
life space; functional status; death; daily living; disability
16.  Lasagna plots: A saucy alternative to spaghetti plots 
Epidemiology (Cambridge, Mass.)  2010;21(5):621-625.
Longitudinal repeated-measures data often have been visualized with spaghetti plots for continuous outcomes. For large datasets, the use of spaghetti plots often leads to the over-plotting and consequential obscuring of trends in the data. This obscuring of trends is primarily due to the overlapping of trajectories. Here, we suggest a framework called lasagna plotting that constrains the subject-specific trajectories to prevent overlapping and utilizes gradients of color to depict the outcome. Dynamic sorting and visualization is demonstrated as an exploratory data analysis tool.
doi:10.1097/EDE.0b013e3181e5b06a
PMCID: PMC2937254  PMID: 20699681
17.  Increasing incidence of dementia in the oldest old: evidence and implications 
The oldest old are the fastest growing segment of the US population but accurate estimates of the incidence of dementia in this age group have been elusive. Corrada and colleagues present data on the 5-year age-specific rates of dementia incidence in persons 90 years and older from The 90+ Study. Their findings show a continued exponential increase in dementia incidence after age 90 that mirrors the increase observed in persons aged 65 to 90, with a doubling every 5.5 years. This contrasts with previous smaller studies reporting a slowing of the increase in incidence after age 90. If confirmed, the continued increase, rather than a plateau, in the incidence of dementia in the oldest old has implications for proper healthcare planning. Strategies for prevention and treatment will require more information regarding risk factors and the etiopathogenesis of dementia in the oldest old.
doi:10.1186/alzrt32
PMCID: PMC2919692  PMID: 20497589
18.  Evaluation of cumulative lead dose and longitudinal changes in structural MRI in former organolead workers 
Objective
We evaluated whether tibia lead was associated with longitudinal change in brain volumes and white matter lesions in male former lead workers and population-based controls in whom we have previously reported on the cognitive and structural consequences of cumulative lead dose.
Methods
We used linear regression to identify predictors of change in brain volumes and white matter lesion grade scores, using two MRIs an average of five years apart.
Results
On average, total brain volume declined almost 30 cm3, predominantly in gray matter. Increasing age at the first MRI was strongly associated with larger declines in volumes and greater increases in white matter lesion scores. Tibia lead was not associated with change in brain volumes or white matter lesion scores.
Conclusions
In former lead workers in whom cumulative lead dose was associated with progressive declines in cognitive function decades after occupational exposure had ended, cumulative lead dose was associated with earlier persistent effects on brain structure, but not with additional worsening over five years.
doi:10.1097/JOM.0b013e3181d5e386
PMCID: PMC2869464  PMID: 20357679
19.  Loneliness and the rate of motor decline in old age: the rush memory and aging project, a community-based cohort study 
BMC Geriatrics  2010;10:77.
Background
Being alone, as measured by less frequent social interactions, has been reported to be associated with a more rapid rate of motor decline in older persons. We tested the hypothesis that feeling alone is associated with the rate of motor decline in community-dwelling older persons.
Methods
At baseline, loneliness was assessed with a 5-item scale in 985 persons without dementia participating in the Rush Memory and Aging Project, a longitudinal community-based cohort study. Annual detailed assessment of 9 measures of muscle strength and 9 motor performances were summarized in a composite measure of global motor function.
Results
Linear mixed-effects models which controlled for age, sex and education, showed that the level of loneliness at baseline was associated with the rate of motor decline (Estimate, -0.016; S.E. 0.006, p = 0.005). For each 1-point higher level of loneliness at baseline, motor decline was 40% more rapid; this effect was similar to the rate of motor decline observed in an average participant 4 years older at baseline. Furthermore, this amount of motor decline per year was associated with about a 50% increased risk of death. When terms for both feeling alone (loneliness) and being alone were considered together in a single model, both were relatively independent predictors of motor decline. The association between loneliness and motor decline persisted even after controlling for depressive symptoms, cognition, physical and cognitive activities, chronic conditions, as well as baseline disability or a history of stroke or Parkinson's disease.
Conclusions
Among community-dwelling older persons, both feeling alone and being alone are associated with more rapid motor decline, underscoring the importance of psychosocial factors and motor decline in old age.
doi:10.1186/1471-2318-10-77
PMCID: PMC2975650  PMID: 20969786

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