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OBJECTIVE: Loneliness is linked to interleukin 6 (IL-6), a marker of systemic inflammation, which chronically has deleterious effects on physical and mental health across the adult life span. This study investigated cross-sectional relationships among loneliness, IL-6, demographics, multimorbidity, depression, obesity, friendship quantity, and slowed gait. METHODS: Data from the Midlife Development in the United States Biomarker Project, a national adult sample ( N = 822; age range, 26-78 years) was used for this study. The PROCESS macro tested the hypothesis that IL-6 would mediate the relationship between loneliness and gait, after adjusting for demographic and health risk factors. RESULTS: Age ( ß = 0.292, p < .001), sex ( ß = 0.197, p < .001), body mass index (BMI, ß = 0.374, p < .001), waist-hip ratio ( ß = 0.242, p < .001), and loneliness ( ß = 0.089, p = .025) but not multimorbidity ( ß = 0.043, p = .20), depression history ( ß = 0.022, p = .47), depression symptoms ( ß = 0.036, p = .28), and number of friends ( ß = 0.022, p = .46) contributed to the variance in IL-6. Serial mediation analyses supported the chained effect of loneliness on walking time through BMI and IL-6. Results also showed specific indirect effects of BMI and IL-6 on walking time, suggesting more than one pathway by which loneliness influences health. CONCLUSIONS: These results suggest that loneliness may increase the risk of systemic inflammation, leading to slowed gait and adverse health outcomes. Psychosocial interventions that address loneliness may provide an optimal treatment target for reducing inflammation and preventing declines in health.
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Solidão , Velocidade de Caminhada , Adulto , Humanos , Pessoa de Meia-Idade , Idoso , Solidão/psicologia , Interleucina-6 , Inflamação , Fatores de Risco , Depressão/psicologiaRESUMO
OBJECTIVES: Age-related variations in emotional, physical, and cognitive health are poorly understood. This multimethod study extends previous work by investigating mechanistic models by which trait mindfulness, perceived stress, and negative affect (NA) influence health outcomes in adults aged 57-87 years old. METHOD: In this cross-sectional study, 119 adults completed clinical interviews, cognitive and gait assessments, the Mindful Attention and Awareness Scale, Positive and Negative Affect Schedule, and Perceived Stress Scale. Gait velocity and executive function (Flanker test of inhibitory control), which are important predictors of global health and functioning in older adults, served as objective health outcome measures. RESULTS: Correlational analyses found that trait mindfulness is positively associated with age, gait velocity, and inhibitory control and negatively associated with NA and perceived stress. NA but not perceived stress was associated with slower gait velocity. PROCESS mediation analyses suggested that those higher in trait mindfulness showed lower NA as a result of less perceived stress, while moderation analyses indicated the relationship between gait velocity and age varied by levels of trait mindfulness. CONCLUSION: Our findings are consistent with a mindfulness stress-buffering model of health. It is plausible that trait mindfulness, which has both mediating and moderating effects on health, might help to promote more successful aging and provide resilience to age-related declines in physical health.
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OBJECTIVES: Adverse childhood experiences (ACE) are associated with an increased risk for dementia, but this relationship and modifying factors are poorly understood. This study is the first to our knowledge to comprehensively examine the effect of ACE on specific cognitive functions and measures associated with greater risk and resiliency to cognitive decline in independent community-dwelling older adults. METHODS: Verbal/nonverbal intelligence, verbal memory, visual memory, and executive attention were assessed. Self-report measures examined depression, self-efficacy, and subjective cognitive concerns (SCC). The ACE questionnaire measured childhood experiences of abuse, neglect, and household dysfunction. RESULTS: Over 56% of older adults reported an adverse childhood event. ACE scores were negatively associated with income and years of education and positively associated with depressive symptoms and SCC. ACE scores were a significant predictor of intellectual function and executive attention; however, these relationships were no longer significant after adjusting for education. Follow-up analyses using the PROCESS macro revealed that relationships among higher ACE scores with intellectual function and executive attention were mediated by education. CONCLUSIONS: Greater childhood adversity may increase vulnerability for cognitive impairment by impacting early education, socioeconomic status, and mental health. These findings have clinical implications for enhancing levels of cognitive reserve and addressing modifiable risk factors to prevent or attenuate cognitive decline in older adults.
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Experiências Adversas da Infância , Disfunção Cognitiva , Criança , Humanos , Idoso , Cognição , Disfunção Cognitiva/etiologia , Autorrelato , Fatores de RiscoRESUMO
OBJECTIVES: Sleep health and executive function are multifaceted constructs that decline with age. Some evidence suggests that poor sleep health may underlie declines in executive function, but this relationship is not consistently found in cognitively normal older adults. The authors systematically investigated distinct sleep health domain associations with specific aspects of executive function. METHODS: Community-dwelling older adults completed clinical interviews, comprehensive neuropsychological assessments, and subjective sleep measures. Four sleep health domains were investigated: satisfaction/quality, sleep efficiency, sleep duration, and daytime sleepiness/fatigue. Hierarchical multiple regression analyses, adjusting for significant covariates, examined whether the sleep health domains differentially predicted executive function. RESULTS: Separate analyses found that greater sleep efficiency was associated with better response inhibition, while greater daytime sleepiness/fatigue was associated with worse cognitive flexibility. Categorical differences in sleep duration indicated that average durations, compared with short and long durations, had better executive function performance across measures. Sleep satisfaction/quality was not statistically associated with executive function. CONCLUSIONS: These findings have implications for sleep assessment and its intervention. Routine screening of sleep duration, efficiency, and daytime fatigue may be particularly useful in identifying those at greater risk of executive dysfunction. Targeting specific problems in sleep may serve to improve cognitive control and efficiency in older adults. Future research is warranted to establish the optimal hours of sleep duration for cognitive health.
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Distúrbios do Sono por Sonolência Excessiva , Transtornos do Sono-Vigília , Idoso , Distúrbios do Sono por Sonolência Excessiva/complicações , Função Executiva , Fadiga , Humanos , Sono/fisiologia , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologiaRESUMO
OBJECTIVES: The current study investigated trait mindfulness associations with distinct aspects of executive function. We also aimed to characterize relationships between trait mindfulness with measures of psychological risk and resilience within adults aged 55-87 years. METHOD: In this cross-sectional study, 121 adults completed neuropsychological measures of working memory, mental set-shifting, and inhibition, as well as a battery of well-validated psychological self-report measures. The Mindful Attention Awareness Scale (MAAS) measured trait mindfulness. RESULTS: Trait mindfulness was associated with greater age, years of education and self-efficacy, and less perceived stress, depression, anxiety, and subjective cognitive concerns. Hierarchal multiple regression analyses showed that trait mindfulness was a significant predictor of inhibitory control, even after adjusting for age, education, and global cognition in the model. Trait mindfulness was not significantly associated with working memory or mental set-shifting. Follow-up analyses using the PROCESS macro revealed that trait mindfulness mediated the relationship between perceived stress and inhibitory control. CONCLUSION: Trait mindfulness was associated with measures of greater well-being and mental health. Our results also indicate that trait mindfulness may provide psychological resilience by attenuating perceived stress and enhancing the capacity to intentionally suppress irrelevant information and automatic responses.
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Função Executiva , Atenção Plena , Humanos , Idoso , Estresse Psicológico/psicologia , Estudos Transversais , Atenção Plena/métodos , Cognição/fisiologiaRESUMO
Slowed gait is one of the strongest predictors of fall risk in older adults. The present study investigated whether gait speed mediated the relationship between depression and fall history in 147 older adults presenting to a memory clinic for cognitive complaints. Depression, cognitive status, gait speed, and number of falls within the last year were the primary measures. Results revealed fallers, relative to non-fallers, had slower gait speed and higher depression scores. As hypothesized, analyses using the PROCESS macro found that gait mediated the relationship between depression and fall history. Additionally, the combination of depression and mild cognitive impairments (MCI) associated with a significantly greater likelihood of falling. Our findings indicate that combined depression and MCI have additive effects on fall risk, likely through the destabilizing effect of slowed gait on balance. Better understanding the underlying pathophysiology involved in MCI and depression-related gait disturbances may lead to improved intervention targets for fall risk prevention.
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Acidentes por Quedas , Velocidade de Caminhada , Idoso , Cognição/fisiologia , Depressão/epidemiologia , Marcha/fisiologia , Humanos , Velocidade de Caminhada/fisiologiaRESUMO
BACKGROUND: Gait-related changes in older adulthood may be related to changes in cognition (e.g., executive functioning), and recent work suggests that different self-reported measures of sleep may be tied to contrasting aspects of executive functioning. However, the relationship between these self-reported sleep measures and gait domains has not been explored. Such an investigation would be useful in helping to determine which older adults might exhibit changes in gait as well as experience other gait-associated changes (e.g., increased fall risk). OBJECTIVE: To examine associations between different aspects of self-reported sleep and gait domains in a sample of cognitively healthy older adults. METHOD: A total of 423 older adults (mean age 69.9 years, range 50-92) completed self-report measures of sleep quality, daytime sleepiness, and sleep-related distress. The participants also completed an objective, electronic measure of both single-task and dual-task gait (i.e., GAITRite). Principal component analyses were used to elucidate the solution for each gait condition, and multiple linear regression was used to examine the contributions of sleep measures to variability in gait performance. RESULTS: A 5-component solution of the single-task condition and a 4-component solution of the dual-task condition were identified. Multiple linear regressions revealed that a poorer sleep quality was associated with greater single-task and dual-task asymmetry. Greater daytime sleepiness was associated with increased dual-task gait variability and postural control. After controlling for the effects of other facets of sleep, sleep-related distress was not associated with any gait domain. CONCLUSIONS: Among cognitively healthy older adults,sleep quality and daytime sleepiness, but not sleep-related distress, are associated with aspects of gait. Patients who report these symptoms should be assessed and monitored for possible changes in gait.
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Cognição/fisiologia , Marcha/fisiologia , Sono/fisiologia , Idoso , Idoso de 80 Anos ou mais , Função Executiva , Feminino , Humanos , Louisiana , Masculino , Pessoa de Meia-Idade , Autorrelato , Distúrbios do Início e da Manutenção do Sono/complicaçõesRESUMO
OBJECTIVES: Longitudinal research indicates that cognitive load dual-task gait assessment is predictive of cognitive decline and thus might provide a sensitive measure to screen for mild cognitive impairment (MCI). However, research among older adults being clinically evaluated for cognitive concerns, a defining feature of MCI, is lacking. The present study investigated the effect of performing a cognitive task on normal walking speed in patients presenting to a memory clinic with cognitive complaints. METHODS: Sixty-one patients with a mean age of 68 years underwent comprehensive neuropsychological testing, clinical interview, and gait speed (simple- and dual-task conditions) assessments. Thirty-four of the 61 patients met criteria for MCI. RESULTS: Repeated measure analyses of covariance revealed that greater age and MCI both significantly associated with slower gait speed, ps<.05. Follow-up analysis indicated that the MCI group had significantly slower dual-task gait speed but did not differ in simple-gait speed. Multivariate linear regression across groups found that executive attention performance accounted for 27.4% of the variance in dual-task gait speed beyond relevant demographic and health risk factors. CONCLUSIONS: The present study increases the external validity of dual-task gait assessment of MCI. Differences in dual-task gait speed appears to be largely attributable to executive attention processes. These findings have clinical implications as they demonstrate expected patterns of gait-brain behavior relationships in response to a cognitive dual task within a clinically representative population. Cognitive load dual-task gait assessment may provide a cost efficient and sensitive measure to detect older adults at high risk of a dementia disorder. (JINS, 2017, 23, 493-501).
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Disfunção Cognitiva/fisiopatologia , Função Executiva/fisiologia , Marcha/fisiologia , Desempenho Psicomotor/fisiologia , Idoso , Humanos , Pessoa de Meia-IdadeRESUMO
Ambivalence is an important facet of pathology that has received limited attention despite its importance in understanding negative emotionality within schizophrenia spectrum disorders. Central to understanding the role of ambivalence in schizophrenia is characterizing its manifestation within schizotypal individuals-those with the purported genetic liability for schizophrenia. The present study used the Schizotypal Ambivalence Scale (SAS) to examine the nature of ambivalence. An exploratory factor analysis of SAS scores revealed three factors: interpersonal, indecision, and contradictory feelings of ambivalence. Group differences in SAS scores were found such that psychometrically defined schizotypal individuals reported higher levels of ambivalence than controls, and different schizotypy traits exhibited different relationships with SAS factors and quality of life. The inclusion of implicit and explicit measures of positive and negative attitudes revealed that individuals with schizotypy might lack insight into their affective experiences as suggested by the incongruence between our explicit and implicit measures of social attitudes. As hypothesized, the Schizotypal Personality Questionnaire trait dimensions associated with greater SAS ambivalence and the different trait dimensions of schizotypy showed both common and disparate relationships with the ambivalence factors. The current results support the notion that schizotypal ambivalence is a multifaceted construct that not only is affective but also reflects broader processes that dynamically interact with one another to influence functional outcomes.
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Testes de Personalidade , Testes Psicológicos , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/psicologia , Feminino , Humanos , Masculino , Testes de Personalidade/normas , Testes Psicológicos/normas , Qualidade de Vida/psicologia , Autorrelato/normas , Adulto JovemRESUMO
OBJECTIVES: Contextually driven decision making is multidimensional, as individuals need to contend with prioritizing both competing and complementary demands. However, data is limited as to whether temporal discounting rates vary as a function of framing (gains vs loss) and domain (monetary vs social) in middle-to-older aged adults. It is also unclear whether socioaffective characteristics like social isolation and loneliness are associated with temporal discounting. METHODS: Temporal discounting rates were examined across monetary gain, monetary loss, social gain, and social loss conditions in 140 adults aged 50-90 during the Omicron stage of the pandemic. Self-report measures assessed loneliness and social isolation levels. RESULTS: Results found evidence of steeper temporal discounting rates for gains as compared to losses in both domains. Social outcomes were also more steeply discounted than monetary outcomes, without evidence of an interaction with the framing condition. Socioeconomic and socioaffective factors were unexpectedly not associated with temporal discounting rates. DISCUSSION: Community-dwelling middle-to-older aged adults showed a preference for immediate rewards and devalued social outcomes more than monetary outcomes. These findings have implications for tailoring social and financial incentive programs for middle to later adulthood.
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COVID-19 , Desvalorização pelo Atraso , Solidão , Humanos , Idoso , Masculino , Feminino , Idoso de 80 Anos ou mais , Solidão/psicologia , Pessoa de Meia-Idade , COVID-19/psicologia , Isolamento Social/psicologia , Tomada de Decisões , RecompensaRESUMO
BACKGROUND: Student burnout can be defined as the negative reactions that occur because of prolonged academic stress, which can result in emotional exhaustion/exhaustion (EE/EX), depersonalization/cynicism, and diminished personal accomplishment/reduced academic efficacy (DPA/RAE). OBJECTIVE: The purpose of this scoping review is to determine if burnout is prevalent in oral health students (OHS); identify the factors that are shown to be predicators of burnout in OHS; determine the preventive and coping strategies OHS used to mitigate the effects of burnout; and identify gaps in the literature on burnout in OHS. METHODS: A systematic search was completed using the following databases: PubMed, CINAHL, EBSCO, and ERIC. The returns were screened by all members of the team using inclusion and exclusion criteria, and the studies that met the criteria were appraised. RESULTS AND DISCUSSION: Eighteen studies assessed burnout in OHS, 15 studied dental students, 2 studied dental hygiene students, and 1 studied both. Findings concerning the prevalence of burnout varied greatly across the literature with anywhere between 7% and 70.4% of OHS reporting suffering from burnout syndrome. The most prevalent scale of burnout in OHS was EE/EX with 10%-66.2% of OHS reporting high levels. Stressors for OHS were years of study, clinical components, and demanding academic courses. Early identification and interventions are keys to prevent the negative consequences of burnout. CONCLUSION: Burnout in OHS can affect their mental health, empathy toward patients, and professional conduct. Therefore, educating students and faculty on the signs and symptoms of burnout is key in preventing detrimental effects that may inhibit their academic success.
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Esgotamento Profissional , Estudantes de Odontologia , Humanos , Esgotamento Profissional/epidemiologia , Inquéritos e Questionários , Estudantes de Odontologia/psicologiaRESUMO
OBJECTIVES: Research has longitudinally linked dual-task gait dysfunction to mild cognitive impairment (MCI) and dementia risk. Our group previously demonstrated that dual-task gait speed assessment distinguished between subjective cognitive complaints (SCC) and MCI in a memory clinic setting, and also found that differences in dual-task gait speed were largely attributable to executive attention processes. This study aimed to reproduce these findings in a larger diverse sample and to extend them by examining whether there were group differences in single- versus dual-task cognitive performance (number of letters correctly sequenced backward). METHOD: Two-hundred fifty-two patients (M age = 66.01 years, SD = 10.46; 119 MCI, 133 SCC) presenting with cognitive complaints in an academic medical setting underwent comprehensive neuropsychological and gait assessment (single- and dual-task conditions). RESULTS: Patients with MCI walked slower and showed greater decrement in cognitive performance than those with SCC during dual-task conditions. Neuropsychological measures of executive attention accounted for significant variance in dual-task gait performance across diagnostic groups beyond demographic and health risk factors. DISCUSSION: Reproduction of our results within a sample over four times the previous size provides support for the use of dual-task gait assessment as a marker of MCI risk in clinical settings.
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Disfunção Cognitiva/diagnóstico , Análise da Marcha/métodos , Idoso , Atenção , Disfunção Cognitiva/fisiopatologia , Função Executiva , Feminino , Marcha , Humanos , Masculino , Testes Neuropsicológicos , Análise e Desempenho de Tarefas , Velocidade de CaminhadaRESUMO
OBJECTIVE: Mild cognitive impairment and dementia are clinically heterogeneous disorders influenced by diverse risk factors. Improved characterization of the effect of multiple risk factors influence on specific cognitive functions may improve understanding of mechanisms in early cognitive change and lead to more effective interventions. METHODS: Structural equation modeling (SEM) simultaneously examined the effects of modifiable (education, depression, and metabolic/vascular risk) and nonmodifiable risk factors (age, sex, and apolipoprotein E-É4 allele [APOE-e4] status) on specific cognitive domains in 461 cognitively normal older adults. RESULTS: The hypothesized model(s) provided an adequate fit for the data. Sex differences in cognition, depression, and vascular risk were found. On average, men were higher in vascular risk with generally lower cognitive performance than women; women were more likely to have depression. APOE-e4 associated with depression but not age, sex, or metabolic/vascular risk. Depression associated with lower executive attention, memory, and language performance, whereas metabolic/vascular risk associated with lower executive attention, memory, and working memory. Older age and lower education are associated with worse performance across the cognitive domains. The combined risk factors accounted for 16%-47% of the variance in the cognitive domains. CONCLUSIONS: Results highlight the combined effect of risk factors on cognitive function. Future research is needed to determine whether the multifactorial risk effects on cognition vary by sex. Precision medicine approaches that integrate neuropsychological services may improve diagnostic accuracy and earlier identification of those at risk of cognitive decline.
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Apolipoproteína E4 , Cognição , Depressão , Doenças Vasculares , Idoso , Apolipoproteína E4/genética , Apolipoproteínas E/genética , Depressão/genética , Feminino , Humanos , Masculino , Memória , Testes Neuropsicológicos , Risco , Doenças Vasculares/genéticaRESUMO
BACKGROUND: Clarifying relationships between specific neurocognitive functions in cognitively intact older adults can improve our understanding of mechanisms involved in cognitive decline, which may allow identification of new opportunities for intervention and earlier detection of those at increased risk of dementia. METHOD: The present study employed latent growth curve modeling to longitudinally examine the relationship between executive attention/processing speed, episodic memory, language, and working memory functioning utilizing the neuropsychological test battery from the National Alzheimer's Disease Coordinating Center. A total of 691 relatively healthy older adults (Mage = 69.07, SD = 6.49) were assessed at baseline, and 553 individuals completed three visits spanning a two-year period. RESULTS: Better cognitive performance was concomitantly associated with better functioning across domains. Subtle declines in executive attention/processing speed processes were found, while, on average, memory and language performance improved with repeated testing. Lower executive attention/processing speed performance at baseline predicted less incremental growth rate in memory. In turn, higher initial memory functioning was associated with incremental improvements in language performance. CONCLUSIONS: These results are consistent with the notion that intact executive function and attention processes are important to preserving memory functioning with advanced age, but are also the functions most susceptible to decline with age. These findings also provide further insight into the critical role of practice effects in clinical assessment practice and have implications for pharmaceutical trials. Practice effects should be routinely considered as they may give the appearance of retention of function within the cognitive domains considered to be a hallmark of Alzheimer's disease pathology.
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Doença de Alzheimer/diagnóstico , Atenção/fisiologia , Cognição/fisiologia , Disfunção Cognitiva/diagnóstico , Função Executiva/fisiologia , Idioma , Idoso , Doença de Alzheimer/psicologia , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/psicologia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Memória de Curto Prazo/fisiologia , Pessoa de Meia-Idade , Testes NeuropsicológicosRESUMO
A growing body of research suggests that traumatic events lead to persisting personality change characterized by increased neuroticism. Relevantly, enduring improvements in Post-Traumatic Stress Disorder (PTSD) symptoms have been found in response to 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. There is evidence that lasting changes in the personality feature of "openness" occur in response to hallucinogens, and that this may potentially act as a therapeutic mechanism of change. The present study investigated whether heightened Openness and decreased Neuroticism served as a mechanism of change within a randomized trial of MDMA-assisted psychotherapy for chronic, treatment-resistant PTSD. The Clinician-Administered PTSD Scale (CAPS) Global Scores and NEO PI-R Personality Inventory (NEO) Openness and Neuroticism Scales served as outcome measures. Results indicated that changes in Openness but not Neuroticism played a moderating role in the relationship between reduced PTSD symptoms and MDMA treatment. Following MDMA-assisted psychotherapy, increased Openness and decreased Neuroticism when comparing baseline personality traits with long-term follow-up traits also were found. These preliminary findings suggest that the effect of MDMA-assisted psychotherapy extends beyond specific PTSD symptomatology and fundamentally alters personality structure, resulting in long-term persisting personality change. Results are discussed in terms of possible mechanisms of psychotherapeutic change.
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Terapia Combinada/métodos , N-Metil-3,4-Metilenodioxianfetamina/uso terapêutico , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Adulto , Feminino , Alucinógenos/uso terapêutico , Humanos , Masculino , Neuroticismo/efeitos dos fármacos , Inventário de Personalidade , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Developing measures to detect preclinical Alzheimer's Disease is vital, as prodromal stage interventions may prove more efficacious in altering the disease's trajectory. Gait changes may serve as a useful clinical heuristic that precedes cognitive decline. This study provides the first systematic investigation of gait characteristics relationship with relevant demographic, physical, genetic (Apolipoprotein E genotype), and health risk factors in non-demented older adults during a cognitive-load dual task walking condition. METHODS: The GAITRite system provided objective measurement of gait characteristics in APOE-e4 "carriers" (n = 75) and "non-carriers" (n = 224). Analyses examined stride length and step time gait characteristics during simple and dual-task (spelling five-letter words backwards) conditions in relation to demographic, physical, genetic, and health risk factors. RESULTS: Slower step time and shorter stride length associated with older age, greater health risk, and worse physical performance (ps < .05). Men and women differed in height, gait characteristics, health risk factors and global cognition (ps < .05). APOE-e4 associated with a higher likelihood of hypercholesterolemia and overall illness index scores (ps < .05). No genotype-sex interactions on gait were found. APOE-e4 was linked to shorter stride length and greater dual-task related disturbances in stride length. CONCLUSIONS: Stride length has been linked to heightened fall risk, attention decrements and structural brain changes in older adults. Our results indicate that stride length is a useful behavioral marker of cognitive change that is associated with genetic risk for AD. Sex disparities in motor decline may be a function of health risk factors.
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Doença de Alzheimer/genética , Apolipoproteínas E/genética , Transtornos Neurológicos da Marcha/fisiopatologia , Marcha/genética , Hipercolesterolemia/epidemiologia , Fatores Etários , Idoso , Doença de Alzheimer/fisiopatologia , Feminino , Transtornos Neurológicos da Marcha/genética , Predisposição Genética para Doença , Variação Genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Caracteres SexuaisRESUMO
Gait abnormalities are linked to cognitive decline and an increased fall risk within older adults. The present study addressed gaps from cross-sectional studies in the literature by longitudinally examining the interplay between temporal and spatial aspects of gait, cognitive function, age, and lower-extremity strength in elderly "fallers" and "non-fallers". Gait characteristics, neuropsychological and physical test performance were examined at two time points spaced a year apart in cognitively intact individuals aged 60 and older (N = 416). Mixed-model repeated-measure ANCOVAs examined temporal (step time) and spatial (stride length) gait characteristics during a simple and cognitive-load walking task in fallers as compared to non-fallers. Fallers consistently demonstrated significant alterations in spatial, but not temporal, aspects of gait as compared to non-fallers during both walking tasks. Step time became slower as stride length shortened amongst all participants during the dual task. Shorter strides and slower step times during the dual task were both predicted by worse executive attention/processing speed performance. In summary, divided attention significantly impacts spatial aspects of gait in "fallers", suggesting stride length changes may precede declines in other neuropsychological and gait characteristics, thereby selectively increasing fall risk. Our results indicate that multimodal intervention approaches that integrate physical and cognitive remediation strategies may increase the effectiveness of fall risk interventions.
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Patients with severe mental illnesses (SMI) often experience dysfunction in their ability to efficiently carry out everyday roles and/or skills. These deficits are seen across many domains of daily functioning. We suggest that the "self-conscious emotions" of pride and shame play a role in these functional outcomes. Pride and shame appear to facilitate individuals׳ ability to evaluate their group status, detect social threats, and to adjust their behaviors accordingly. This study utilized an objective performance measure of functional capacity and a self-report of quality of life (QoL) to examine the respective roles of pride and shame in functional outcomes within two SMI patient groups (schizophrenia and affective disorder) and a community control group. The influence of neurocognition, affect and symptomatology on functional outcomes was also assessed. The patient groups did not differ in cognitive functioning, QoL, or shame. The schizophrenia group reported significantly higher pride and displayed worse objective performance than the other groups. Within each of the groups, shame had an inverse relationship with QoL, while pride positively associated with QoL. Shame associated with worse functional capacity in the schizophrenia group. Shame associated with better functional capacity, while pride associated with worse functional capacity within the affective disorder group.
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Transtornos do Humor/psicologia , Qualidade de Vida , Psicologia do Esquizofrênico , Autoimagem , Vergonha , Ajustamento Social , Adulto , Estudos de Casos e Controles , Cognição , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , AutorrelatoRESUMO
Neuropsychological abilities have found to explain a large proportion of variance in objective measures of walking gait that predict both dementia and falling within the elderly. However, to this date there has been little research on the interplay between changes in these neuropsychological processes and walking gait overtime. To our knowledge, the present study is the first to investigate intra-individual changes in neurocognitive test performance and gait step time at two-time points across a one-year span. Neuropsychological test scores from 440 elderly individuals deemed cognitively normal at Year One were analyzed via repeated measures t-tests to assess for decline in cognitive performance at Year Two. 34 of these 440 individuals neuropsychological test performance significantly declined at Year Two; whereas the "non-decliners" displayed improved memory, working memory, attention/processing speed test performance. Neuropsychological test scores were also submitted to factor analysis at both time points for data reduction purposes and to assess the factor stability overtime. Results at Year One yielded a three-factor solution: Language/Memory, Executive Attention/Processing Speed, and Working Memory. Year Two's test scores also generated a three-factor solution (Working Memory, Language/Executive Attention/Processing Speed, and Memory). Notably, language measures loaded on Executive Attention/Processing Speed rather than on the Memory factor at Year Two. Hierarchal multiple regression revealed that both Executive Attention/Processing Speed and sex significantly predicted variance in dual task step time at both time points. Remarkably, in the "decliners", the magnitude of the contribution of the neuropsychological characteristics to gait variance significantly increased at Year Two. In summary, this study provides longitudinal evidence of the dynamic relationship between intra-individual cognitive change and its influence on dual task gait step time. These results also indicate that the failure to show improved test performance (particularly, on memory tests) with repeated administrations might prove to be useful of indicator of early cognitive decline.
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Envelhecimento , Transtornos Cognitivos/fisiopatologia , Cognição , Marcha , Memória de Curto Prazo , Caminhada , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Longitudinais , MasculinoRESUMO
Speech deficits are thought to be an important feature of schizotypy--defined as the personality organization reflecting a putative liability for schizophrenia. There is reason to suspect that these deficits manifest as a function of limited cognitive resources. To evaluate this idea, we examined speech from individuals with psychometrically-defined schizotypy during a low cognitively-demanding task versus a relatively high cognitively-demanding task. A range of objective, computer-based measures of speech tapping speech production (silence, number and length of pauses, number and length of utterances), speech variability (global and local intonation and emphasis) and speech content (word fillers, idea density) were employed. Data for control (n=37) and schizotypy (n=39) groups were examined. Results did not confirm our hypotheses. While the cognitive-load task reduced speech expressivity for subjects as a group for most variables, the schizotypy group was not more pathological in speech characteristics compared to the control group. Interestingly, some aspects of speech in schizotypal versus control subjects were healthier under high cognitive load. Moreover, schizotypal subjects performed better, at a trend level, than controls on the cognitively demanding task. These findings hold important implications for our understanding of the neurocognitive architecture associated with the schizophrenia-spectrum. Of particular note concerns the apparent mismatch between self-reported schizotypal traits and objective performance, and the resiliency of speech under cognitive stress in persons with high levels of schizotypy.