Puzzling with online games (BAM-COG): reliability, validity, and feasibility of an online self-monitor for cognitive performance in aging adults.

BACKGROUND: Online interventions are aiming increasingly at cognitive outcome measures but so far no easy and fast self-monitors for cognition have been validated or proven reliable and feasible. OBJECTIVE: This study examines a new instrument called the Brain Aging Monitor-Cognitive Assessment Battery (BAM-COG) for its alternate forms reliability, face and content validity, and convergent and divergent validity. Also, reference values are provided. METHODS: The BAM-COG consists of four easily accessible, short, yet challenging puzzle games that have been developed to measure working memory ("Conveyer Belt"), visuospatial short-term memory ("Sunshine"), episodic recognition memory ("Viewpoint"), and planning ("Papyrinth"). A total of 641 participants were recruited for this study. Of these, 397 adults, 40 years and older (mean 54.9, SD 9.6), were eligible for analysis. Study participants played all games three times with 14 days in between sets. Face and content validity were based on expert opinion. Alternate forms reliability (AFR) was measured by comparing scores on different versions of the BAM-COG and expressed with an intraclass correlation (ICC: two-way mixed; consistency at 95%). Convergent validity (CV) was provided by comparing BAM-COG scores to gold-standard paper-and-pencil and computer-assisted cognitive assessment. Divergent validity (DV) was measured by comparing BAM-COG scores to the National Adult Reading Test IQ (NART-IQ) estimate. Both CV and DV are expressed as Spearman rho correlation coefficients. RESULTS: Three out of four games showed adequate results on AFR, CV, and DV measures. The games Conveyer Belt, Sunshine, and Papyrinth have AFR ICCs of .420, .426, and .645 respectively. Also, these games had good to very good CV correlations: rho=.577 (P=.001), rho=.669 (P<.001), and rho=.400 (P=.04), respectively. Last, as expected, DV correlations were low: rho=-.029 (P=.44), rho=-.029 (P=.45), and rho=-.134 (P=.28) respectively. The game Viewpoint provided less desirable results with an AFR ICC of .167, CV rho=.202 (P=.15), and DV rho=-.162 (P=.21). CONCLUSIONS: This study provides evidence for the use of the BAM-COG test battery as a feasible, reliable, and valid tool to monitor cognitive performance in healthy adults in an online setting. Three out of four games have good psychometric characteristics to measure working memory, visuospatial short-term memory, and planning capacity.

Migraine does not affect cognitive decline: results from the Maastricht aging study.

OBJECTIVE: To investigate the effects of migraine and related pharmacotherapy on cognitive performance and cognitive change over time in a longitudinal population-based study. METHODS: Migraineurs (n = 99) and healthy controls (n = 1724) participating in the Maastricht Aging Study were cognitively tested at baseline and after 6 years. Scores on Mini Mental State Examination, immediate and delayed recall tests, and tests for simple and complex speed were compared for both groups. Generalized Estimating Equations analyses were performed to test the longitudinal effects of migraines on cognition. Effects of migraine medication use were also tested. RESULTS: Migraine headaches were found to have no effect on any of the cognitive measures. Medication use also had no effect on all cognitive measures. CONCLUSIONS: No evidence was found that migraine headaches or migraine-related medication use are risk or protective factors for cognitive dysfunction or cognitive deterioration over time.

Self-report measures of executive functioning are a determinant of academic performance in first-year students at a university of applied sciences.

Recent studies in late adolescents (age 17+) show that brain development may proceed till around the 25th year of age. This implies that study performance in higher education could be dependent upon the stage of brain maturation and neuropsychological development. Individual differences in development of neuropsychological skills may thus have a substantial influence on the outcome of the educational process. This hypothesis was evaluated in a large survey of 1760 first-year students at a University of Applied Sciences, of which 1332 are included in the current analyses. This was because of their fit within the age range we pre-set (17-20 years' old at start of studies). Student characteristics and three behavioral ratings of executive functioning (EF) were evaluated with regard to their influence on academic performance. Self-report measures were used: self-reported attention, planning, and self-control and self-monitoring. Results showed that students with better self-reported EF at the start of the first year of their studies obtained more study credits at the end of that year than students with a lower EF self-rating. The correlation between self-control and self-monitoring on the one hand, and study progress on the other, appeared to differ for male and female students and to be influenced by the level of prior education. The results of this large-scale study could have practical relevance. The profound individual differences between students may at least partly be a consequence of their stage of development as an adolescent. Students who show lower levels of attention control, planning, and self-control/self-monitoring can be expected to have a problem in study planning and study progress monitoring and hence study progress. The findings imply that interventions directed at the training of these (executive) functions should be developed and used in higher education in order to improve academic achievement, learning attitude, and motivation.

Temporal evolution of cognitive changes in incident hypertension: prospective cohort study across the adult age span.

Midlife hypertension is a risk factor for dementia, but little is known about the cognitive trajectories of individuals with incident hypertension. This study follows the cognitive functioning in prevalent and incident hypertension for 12 years and in relation to age and treatment status. Cognitively intact adults aged 25 to 84 years (n=1805) were serially assessed at baseline, 6 years, and 12 years. Hypertension was defined by sphygmomanometry or antihypertensive medication use, and its association with cognitive decline was tested in random-effects models. At baseline, 638 (35.3%) participants had hypertension. They showed faster decline in memory (χ(2) test for homogeneity=35.75; df=2; P<0.001), executive functions (χ(2)=21.68; df=2; P<0.001), and information processing speed (χ(2)=81.96; df= 2; P<0.001) than baseline normotensive participants. At follow-up, 352 individuals (30.2%) developed incident hypertension. They showed faster decline in memory (χ(2)=7.88; df=2; P=0.019) and information processing speed (χ(2)= 18.06; df=2; P<0.001), especially from 6- to 12-year follow-up. Effects were most pronounced and widespread in midlife for both prevalent and incident hypertension and in those with untreated and uncontrolled hypertension. This study shows that incident hypertension predicts cognitive decline in middle-aged individuals, and those with poorly controlled blood pressure are most at risk. In newly diagnosed individuals, decline evolves gradually, possibly opening a window for early intervention.

[Frailty, disability and multi-morbidity: the relationship with quality of life and healthcare costs in elderly people]. / Kwetsbaarheid, dagelijkse beperkingen en ziektelast: samenhang met kwaliteit van leven en zorggebruik bij ouderen.

OBJECTIVE: To assess the independent and combined impact of frailty, multi-morbidity, and activities of daily living (ADL) limitations on self-reported quality of life and healthcare costs in elderly people. DESIGN: Cross-sectional, descriptive study. METHOD: Data came from The Older Persons and Informal Caregivers Minimum DataSet (TOPICS-MDS), a pooled dataset with information from 41 projects across the Netherlands from the Dutch national care for the Elderly programme. Frailty, multi-morbidity and ADL limitations, and the interactions between these domains, were used as predictors in regression analyses with quality of life and healthcare costs as outcome measures. Analyses were stratified by living situation (independent or care home). Directionality and magnitude of associations were assessed using linear mixed models. RESULTS: A total of 11,093 elderly people were interviewed. A substantial proportion of elderly people living independently reported frailty, multi-morbidity, and/or ADL limitations (56.4%, 88.3% and 41.4%, respectively), as did elderly people living in a care home (88.7%, 89.2% and 77,3%, respectively). One-third of elderly people living at home (31.9%) reported all three conditions compared with two-thirds of elderly people living in a care home (68.3%). In the multivariable analysis, frailty had a strong impact on outcomes independently of multi-morbidity and ADL limitations. Elderly people experiencing problems across all three domains reported the poorest quality-of-life scores and the highest healthcare costs, irrespective of their living situation. CONCLUSION: Frailty, multi-morbidity and ADL limitations are complementary measurements, which together provide a more holistic understanding of health status in elderly people. A multi-dimensional approach is important in mapping the complex relationships between these measurements on the one hand and the quality of life and healthcare costs on the other.

The development of the Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS): a large-scale data sharing initiative.

INTRODUCTION: In 2008, the Ministry of Health, Welfare and Sport commissioned the National Care for the Elderly Programme. While numerous research projects in older persons' health care were to be conducted under this national agenda, the Programme further advocated the development of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) which would be integrated into all funded research protocols. In this context, we describe TOPICS data sharing initiative (www.topics-mds.eu). MATERIALS AND METHODS: A working group drafted TOPICS-MDS prototype, which was subsequently approved by a multidisciplinary panel. Using instruments validated for older populations, information was collected on demographics, morbidity, quality of life, functional limitations, mental health, social functioning and health service utilisation. For informal caregivers, information was collected on demographics, hours of informal care and quality of life (including subjective care-related burden). RESULTS: Between 2010 and 2013, a total of 41 research projects contributed data to TOPICS-MDS, resulting in preliminary data available for 32,310 older persons and 3,940 informal caregivers. The majority of studies sampled were from primary care settings and inclusion criteria differed across studies. DISCUSSION: TOPICS-MDS is a public data repository which contains essential data to better understand health challenges experienced by older persons and informal caregivers. Such findings are relevant for countries where increasing health-related expenditure has necessitated the evaluation of contemporary health care delivery. Although open sharing of data can be difficult to achieve in practice, proactively addressing issues of data protection, conflicting data analysis requests and funding limitations during TOPICS-MDS developmental phase has fostered a data sharing culture. To date, TOPICS-MDS has been successfully incorporated into 41 research projects, thus supporting the feasibility of constructing a large (>30,000 observations), standardised dataset pooled from various study protocols with different sampling frameworks. This unique implementation strategy improves efficiency and facilitates individual-level data meta-analysis.