The Impact of Three Cognitive Training Interventions on Older Adults' Physical Functioning Across 5 Years.

OBJECTIVE: Physical functioning is closely associated with cognition. The current study assessed the impact of three cognitive training programs on objective measures of physical functioning across 5 years. METHOD: Older adults randomized to a processing speed ( n = 702), reasoning ( n = 694), or memory ( n = 703) training intervention were compared with those randomized to a no-contact control condition ( n = 698). Intention-to-treat (ITT) and treatment-received/dosage (time-varying number of training sessions) analyses were conducted. RESULTS: There were no transfer effects in the ITT analyses. Treatment-received models demonstrated that training sessions (i.e., higher dosage) across all intervention arms transferred to better maintained Digit Symbol Copy and Turn 360 performance relative to the control group. More reasoning training transferred to better grip strength. DISCUSSION: This is the first study to demonstrate differential longitudinal cognitive training transfer effects to three performance-based physical functioning measures. Future research should investigate mechanisms of far-transfer effects.

The synergistic effects of HIV, diabetes, and aging on cognition: implications for practice and research.

Thanks to highly active antiretroviral therapy, many people infected with HIV will likely live into old age. Although this is a welcome prognosis, new issues are emerging that may complicate the ability to successfully age in this clinical population. HIV and aging independently are related to cognitive impairments, so there are concerns that those aging with HIV may be more at risk of such cognitive impairments. Moreover, highly active antiretroviral therapy itself can create metabolic disorders, such as prediabetes and/or frank type 2 diabetes, which have also been linked to poorer cognitive functioning. Thus, concerns increase that, as people age with HIV and develop comorbid metabolic disorders that may lead to type 2 diabetes, they will be at triple risk of developing cognitive impairments that can impair everyday functioning and reduce quality of life. This article explores these issues and provides implications for practice and research.

Predictors of improvement following speed of processing training in middle-aged and older adults with HIV: a pilot study.

Speed of processing training has been shown to improve cognitive functioning in normal older adults. A recent study demonstrated that middle-aged and older adults with HIV also improved on a measure of speed of processing and a measure of everyday functioning after such training. The primary objective was to examine what predicts the speed of processing training gains observed in the previous study. Participants were administered an extensive battery of demographic, psychosocial, and neuropsychological measures at baseline. They were randomized either to the speed of processing training group (n = 22) or to a no-contact control group (n = 24). Participants received approximately 10 hours of computerized speed of processing training. Predictors of training gains on the Useful Field of View (UFOV) Test and the Timed Instrumental Activities of Daily Living (TIADL) Test were examined through correlational analyses. In general, those who performed worse on the UFOV and TIADL at baseline demonstrated significantly more training gains. Also, higher HIV viral load, poorer medication adherence, a higher number of years diagnosed with HIV, and lower baseline scores on the Wisconsin Card Sorting Test (an executive functioning measure) were correlated with better TIADL training gains. TIADL performance improved in those with higher HIV viral load, poorer medication adherence, and poor executive functioning. Speed of processing training may be a way to improve everyday functioning and therefore quality of life in more medically and cognitively vulnerable adults with HIV.

Neurological and psychiatric diseases and their unique cognitive profiles: implications for nursing practice and research.

To successfully negotiate and interact with one's environment, optimal cognitive functioning is needed. Unfortunately, many neurological and psychiatric diseases impede certain cognitive abilities such as executive functioning or speed of processing; this can produce a poor fit between the patient and the cognitive demands of his or her environment. Such nondementia diseases include bipolar disorder, schizophrenia, post-traumatic stress syndrome, depression, and anxiety disorders, just to name a few. Each of these diseases negatively affects particular areas of the brain, resulting in distinct cognitive profiles (e.g., deficits in executive functioning but normal speed of processing as seen in schizophrenia). In fact, it is from these cognitive deficits in which such behavioral and emotional symptoms may manifest (e.g., delusions, paranoia). This article highlights the distinct cognitive profiles of such common neurological and psychiatric diseases. An understanding of such disease-specific cognitive profiles can assist nurses in providing care to patients by knowing what cognitive deficits are associated with each disease and how these cognitive deficits impact everyday functioning and social interactions. Implications for nursing practice and research are posited within the framework of cognitive reserve and neuroplasticity.

Self-rated driving and driving safety in older adults.

Many U.S. states rely on older adults to self-regulate their driving and determine when driving is no longer a safe option. However, the relationship of older adults' self-rated driving in terms of actual driving competency outcomes is unclear. The current study investigates self-rated driving in terms of (1) systematic differences between older adults with high (good/excellent) versus low (poor/fair/average) self-ratings, and (2) the predictive nature of self-rated driving to adverse driving outcomes in older adults (n=350; mean age 73.9, SD=5.25, range 65-91). Adverse driving outcomes included self-reported incidences of (1) being pulled over by the police, (2) receiving a citation, (3) receiving a recommendation to cease or limit driving, (4) crashes, and (5) state-reported crashes. Results found that older drivers with low self-ratings reported more medical conditions, less driving frequency, and had been given more suggestions to stop/limit their driving; there were no other significant differences between low and high self-raters. Logistic regression revealed older drivers were more likely to have a state-reported crash and receive a suggestion to stop or limit driving. Men were more likely to report all adverse driving outcomes except for receiving a suggestion to stop or limit driving. Regarding self-rated driving, older adults with high ratings were 66% less likely (OR=0.34, 95% CI=0.14-0.85) to have received suggestions to limit or stop driving after accounting for demographics, health and driving frequency. Self-ratings were not predictive of other driving outcomes (being pulled over by the police, receiving a citation, self-reported crashes, or state-reported crashes, ps>0.05). Most older drivers (85.14%) rated themselves as either good or excellent drivers regardless of their actual previous citation or crash rates. Self-rated driving is likely not related to actual driving proficiency as indicated by previous crash involvement in older adults. Suggestions from other individuals to limit or cease driving may be more influential on self-ratings.

Longitudinal predictors of driving cessation among older adults from the ACTIVE clinical trial.

We examined the physical, visual, health, and cognitive abilities of 1,656 older adults as prospective predictors of self-reported driving cessation over a 5-year period. We examined the time to driving cessation across 5 years after we controlled for days driven per week at baseline and any cognitive intervention participation. Older age, congestive heart failure, and poorer physical performance (according to the Turn 360 Test) were statistically significant risk factors for driving cessation. Slower speed of processing (according to the Digit Symbol Substitution and Useful Field of View tests) was a significant risk factor even after we took baseline driving, age, health, vision, and physical performance into consideration. Implications are that assessments of cognitive speed of processing can provide valuable information about the subsequent risk of driving cessation.