Interoception, Affect, and Cognition in Older Adults.

Interoception is the detection of signals that arise from within the body. Interoceptive sensitivity has been found to be associated with affect and cognition among younger adults, and examination of these relationships in older adult samples is beginning to emerge. Here, we take an exploratory approach to determine how demographic, affective, and cognitive variables relate to interoceptive sensitivity in neurologically normal older adults, aged 60-91 years old. Ninety-one participants completed a comprehensive neuropsychological battery, self-report questionnaires, and a heartbeat counting task to measure interoceptive sensitivity. Our findings revealed several relationships: 1) interoceptive sensitivity was inversely correlated with measures of positive emotionality: participants with higher interoceptive sensitivity tended to have lower levels of positive affect and trait extraversion; 2) interoceptive sensitivity was found to positively correlate with cognition: participants who performed better on the heartbeat-counting task also tended to perform better on a measure of delayed verbal memory; and 3) when examining the predictors of interoceptive sensitivity in a single hierarchical regression model, higher interoceptive sensitivity was related to: higher time estimation, lower positive affect, lower extraversion, and higher verbal memory. In total, the model accounted for 38% of the variability in interoceptive sensitivity (R2 = .38). These results suggest that, among older adults, interoceptive sensitivity is facilitative for aspects of cognition but perhaps disruptive for certain aspects of emotional experience.

Adolescent predictors of psychiatric disorders in adulthood: The role of emotional distress and problem drinking in emerging adulthood.

The current study evaluated risk factors in adolescence on problem drinking and emotional distress in late adolescence and emerging adulthood, and meeting criteria for diagnosed disorders in adulthood. The study included 501 parents and their adolescent who participated from middle adolescence to adulthood. Risk factors in middle adolescence (age 18) included parent alcohol use, adolescent alcohol use, and parent and adolescent emotional distress. In late adolescence (age 18), binge drinking and emotional distress were assessed, and in emerging adulthood (age 25), alcohol problems and emotional distress were examined. Meeting criteria for substance use, behavioral, affective, or anxiety disorders were examined between the ages of 26 and 31. Results showed parent alcohol use predicted substance use disorder through late adolescent binge drinking and emerging adulthood alcohol problems. Behavioral disorders were indirectly predicted by adolescent and emerging adult emotional distress. Affective disorders were indirectly predicted by parent emotional distress through adolescent emotional distress. Finally, anxiety disorders were predicted by parent alcohol use via adolescent drinking; parent emotional distress via adolescent emotional distress, and through adolescent alcohol use and emotional distress. Results provided support for the intergenerational transmission of problem drinking and emotional distress on meeting criteria for diagnosed psychiatric disorders in adulthood.

A Preliminary Investigation into the Factor Structure of Two Psychological Flexibility Measures in a Sample of Community-Dwelling Older Adults.

OBJECTIVES: Acceptance and Commitment Therapy (ACT) targets psychological flexibility and the ability to identify behavioral function in context. Properly measuring these constructs is imperative to understanding whether these processes are mechanisms of change in treatment. The current study examined the factor structure of the Comprehensive Assessment of ACT processes (CompACT) and Tacting of Function scale (TOF) in community-dwelling older adults. METHODS: Factor structure was examined with CFA. Eighty community-dwelling older adults completed questionnaires prior to an intervention. RESULTS: While the original 23-item, 3-factor structure of the CompACT demonstrated inadequate fit, a modified 15-item, 3-factor structure demonstrated adequate fit. The original 1-factor structure of the TOF demonstrated inadequate fit. A modified 2-factor structure of the TOF fit significantly better than the original 1-factor structure; however, this model also demonstrated inadequate fit. CONCLUSIONS: Examining the factor structure of the CompACT and TOF in an older adult sample contributes to the field's understanding of the constructs of psychological flexibility and tacting ability and to the clinical utility of these measures in an understudied sample. CLINICAL IMPLICATIONS: These findings provide preliminary support for the use of a short-form version of the CompACT to measure therapeutic processes of change in community-dwelling older adults.

Emotion regulation in older adulthood: roles of executive functioning and social relationships.

Although emotion regulation (ER) is often maintained or even enhanced in older adulthood, resources used to promote ER in later life are not well understood. The current study examined how executive functioning (EF) and social relationships are related to ER in older adults (N=90; Age: M=74.98, SD=5.41). Results showed associations between higher shifting performance (a behavioral index of EF) and higher use of cognitive reappraisal, an ER strategy. This effect was moderated by social relationships, such that those with lower shifting performance reported higher levels of reappraisal in the presence of positive social relationships. Positive social relationships were also associated with lower use of expressive suppression, another ER strategy. Additional analyses did not reveal associations between ER and other cognitive domains. These findings contribute to current understandings of how cognitive and social resources contribute to ER in older adulthood and provide important potential future research and intervention targets.

Enhancing older adult financial decision making through the use of self-evaluation worksheets.

Financial products and options are frequently complex and difficult for consumers to understand, which, alongside positively oriented sales pitches and predatory practices, may lead to uninformed and hazardous financial decisions. While several legal reforms have been implemented to improve consumers' understanding of financial products, these modifications have only achieved mixed results. An ongoing challenge is the passive nature of such modifications, giving rise to confirmation bias-noticing the information which confirms one's belief about a product, while ignoring or not paying enough attention to the potential risks. The aim of this study was to test an implementable form of public policy to help older adults successfully navigate these financial decisions. We tested whether a self-evaluation worksheet (in conjunction with a written disclosure), involving an active manipulation of financial content, would significantly impact older adult participants' responses in an experimental reverse mortgage scenario. Forty community-dwelling, healthy older adults were randomized to one of two conditions: Control Condition (passive manipulation of financial content) and Manipulation Condition (active manipulation of financial content). In addition to completing a comprehensive neuropsychological examination, participants were administered the Reverse Mortgage Task (RM Task). Results indicated that a simple yet active manipulation-imparting accurate and understandable information regarding a complex financial product that must be further manipulated-led to the following among participants in the Manipulation Condition: (1) declines in mood; (2) superior understanding of the financial product; and (3) reduced intention of purchasing the financial product. In order for older adults to be well informed about reverse mortgages, policies must be put in place to ensure that adequate and accurate information has been not only provided but also actively processed by the individual.

The influence of social support on cognitive health in older women: a Women's Health Initiative study.

Social support is associated prospectively with cognitive decline and dementia among the elderly; however, little is known about the impact of social support on healthy neurological aging. The current study investigates whether perceived social support has an influence on neurological health among a large sample of healthy postmenopausal women. Social support and neuropsychological outcomes were measured annually for six years through the Women's Health Initiative Study of Cognitive Aging. In postmenopausal women, higher perceived social support was associated with significantly better overall neuropsychological functioning at baseline, especially in the domains of short-delay figural memory, short-delay verbal memory, and semantic fluency. No significant associations were found between social support and longitudinal changes in neuropsychological function over a median follow-up period of six years. Additionally, there was no significant relationship between social support and regional brain volumes. These findings suggest that social support is related to performance in a subset of neuropsychological domains and contributes to the existing literature that points to the importance of social support as a modifiable lifestyle factor that has the potential to help protect against the decline of cognitive aging, specifically among older adult women.

A Comprehensive Approach to Assessment of Testamentary Capacity.

The growing aging population raises important implications for legal and clinical systems, including testamentary capacity (TC) assessment. Yet, there are limited comprehensive and standardized assessment measures for TC readily available for clinical use. A review of current assessment methods and standardized approaches for TC assessment is provided. Although several guidelines regarding TC assessment have been proposed in prior literature, existing standardized approaches do not appear to meet full criteria for TC. A comprehensive approach to assessment of testamentary capacity is proposed.

Neural correlates of cognitive reappraisal of positive and negative affect in older adults.

OBJECTIVES: Compromised regulation of negative and positive emotions is a common feature of psychopathology. Healthy aging relates to changes in affective processing, but older adults' regulation of positive affect is less well understood than regulation of negative affect. We examined the cognitive reappraisal of positive and negative affect in healthy younger and older adults, and the neural correlates of reappraisal among older adults. METHOD: Participants viewed negative, positive, and neutral IAPS images and were instructed to attend or reappraise their affective response. Younger and older adults (N = 31) in the behavioral pilot were asked to report on their affect after each image. Another group of older adults (N = 19) completed the same task while undergoing functional magnetic resonance imaging. RESULTS: Behaviorally, older adults were less effective than young adults at downregulating negative and positive affect. Older adults showed engagement of cognitive control regions when regulating negative affect, but not positive affect. Older adults showed increased, rather than decreased, activation in emotion appraisal regions when reappraising negative affect. DISCUSSION: These results may suggest that older adults are less engaged with negative stimuli ; however, future work is needed to address several limitations such as a limited sample size. In addition, we recommend future researchers expand on this work examining regulation of both positive and negative affect among older adults.

The Role of Emotional vs. Cognitive Intelligence in Economic Decision-Making Amongst Older Adults.

The links between emotions, bio-regulatory processes, and economic decision-making are well-established in the context of age-related changes in fluid, real-time, decision competency. The objective of the research reported here is to assess the relative contributions, interactions, and impacts of affective and cognitive intelligence in economic, value-based decision-making amongst older adults. Additionally, we explored this decision-making competency in the context of the neurobiology of aging by examining the neuroanatomical correlates of intelligence and decision-making in an aging cohort. Thirty-nine, healthy, community dwelling older adults were administered the Iowa Gambling Task (IGT), an ecologically valid laboratory measure of complex, economic decision-making; along with standardized, performance-based measures of cognitive and emotional intelligence (EI). A smaller subset of this group underwent structural brain scans from which thicknesses of the frontal, parietal, temporal, occipital, cingulate cortices and their sub-sections, were computed. Fluid (online processing) aspects of Perceptual Reasoning cognitive intelligence predicted superior choices on the IGT. However, older adults with higher overall emotional intelligence (EI) and higher Experiential EI area/sub-scores learned faster to make better choices on the IGT, even after controlling for cognitive intelligence and its area scores. Thickness of the left rostral anterior cingulate (associated with fluid affective, processing) mediated the relationship between age and Experiential EI. Thickness of the right transverse temporal gyrus moderated the rate of learning on the IGT. In conclusion, our data suggest that fluid processing, which involves "online," bottom-up, cognitive processing, predicts value-based decision-making amongst older adults, while crystallized intelligence, which relies on "offline" previously acquired knowledge, does not. However, only emotional intelligence, especially its fluid "online" aspects of affective processing predicts the rate of learning in situations of complex choice, especially when there is a paucity of cues/information available to guide decision-making. Age-related effects on these cognitive, affective and decision mechanisms may have neuroanatomical correlates, especially in regions that form a subset of the human mirror-neuron and mentalizing systems. While superior decision-making may be stereotypically associated with "smarter people" (i.e., higher cognitive intelligence), our data indicate that emotional intelligence has a significant role to play in the economic decisions of older adults.

Reduced Retinal Thickness Predicts Age-Related Changes in Cognitive Function.

Currently, there is a lack of biomarkers to identify individuals in the early stages of Alzheimer's disease (AD). A preponderance of evidence suggests that neurodegenerative processes that affect the brain, may also affect the retina. Using optical coherence tomography (OCT), a non-invasive approach, many have shown thinning of the retina in AD and the developmental precursor to AD, mild cognitive impairment (MCI). However, the relationship between retinal thickness and cognitive function is not entirely clear. This is likely due to the disparity in diagnostic criteria used to determine MCI that does not fully probe the cognitive domains that are particularly vulnerable to aging. This study used a comprehensive neuropsychological assessment involving multiple domains of cognition to determine if retinal thickness correlates with cognitive performance in a normal aged population. In this study, 20 healthy individuals between 60 and 90 years of age were administered neuropsychological assessments probing various domains of cognitive function, and OCT to measure peripapillary retinal nerve fiber layer (RNFL) thickness. We found that RNFL thickness is correlated with neuropsychological performance in multiple cognitive domains (e.g., working memory, psychomotor speed, and executive function). Our work demonstrates a positive correlation between RNFL thickness and several, but not all, domains of cognitive function in a normative aging population. By determining which cognitive domains retinal thickness can predict, this work can help identify individuals at risk or in preclinical stages of AD and other neurodegenerative diseases.

Information use in risky decision making: Do age differences depend on affective context?

The current study focused on the degree to which decision context (deliberative vs. affective) differentially impacted the use of available information about uncertainty (i.e., probability, positive and negative outcome magnitudes, expected value, and variance/risk) when older adults were faced with decisions under risk. In addition, we examined whether individual differences in general mental ability and executive function moderated the associations between age and information use. Participants (N = 96) completed a neuropsychological assessment and the hot (affective) and cold (deliberative) versions of an explicit risk task. Our results did not find a significant Age × Hot/Cold Condition interaction on overall risk-taking. However, we found that older adults were less likely to use the full decision information available regardless of the decision context. This finding suggested more global age differences in information use. Moreover, older adults were less likely to make expected-value sensitive decisions, regardless of the hot/cold context. Finally, we found that low performance on measures of executive functioning, but not general mental ability, appears to be a risk factor for lower information use. This pattern appears in middle age and progressively becomes stronger in older age. The current work provides evidence that common underlying decision processes may operate in risk tasks deemed either affective or deliberative. It further suggests that underlying mechanisms such as information use may be paramount, relative to differences in the affective context. Additionally, individual differences in neuropsychological function may act as a moderator in the tendency to use available information across affective context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Soft on crime: Patients with ventromedial prefrontal cortex damage allocate reduced third-party punishment to violent criminals.

The human impulse to punish those who have unjustly harmed others (i.e., third-party punishment) is critical for stable, cooperative societies. Punishment selection is influenced by both harm outcome and the intent of the moral agent (i.e., the offender's knowledge of wrongdoing and desire that the prohibited consequence occur). We allocate severe punishments to those who commit violent crimes and milder punishments to those who commit non-violent crimes; and we allocate severe punishments to criminals who have malicious intent and milder punishments to criminals who lack malicious intent. Prior research has indicated that aversive, emotional responses of third-party judges may influence punishment allocation, as increased negative emotion correlates with more punitive punishments. Here, we show that patients with damage to the ventromedial prefrontal cortex (vmPFC; a region necessary for the normal generation of emotion), compared to other neurological patients and healthy adult participants, allocate more lenient third-party punishment to criminals who commit emotionally-evocative, violent crimes. By contrast, patients with vmPFC damage did not differ from comparison participants on punishment allocation for non-emotional, non-violent crimes. These results demonstrate the necessity of the vmPFC for the integration of emotion into third-party punishment decisions, and indicate that negative emotion influences third-party punishment allocation particularly for scenarios involving physical harm to another.

Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women's Health Initiative Observational Study.

OBJECTIVE: Previous studies have shown social support to be inversely associated with cardiovascular disease (CVD) in men, whereas fewer studies have assessed the relationship in women. The purpose of this study was to evaluate the relationship between perceived social support and cardiovascular outcomes among postmenopausal women enrolled in the Women's Health Initiative Observational Study. METHODS: We examined the relationships between perceived social support and (1) incident coronary heart disease (CHD), (2) total CVD, and (3) all-cause mortality. Participants were Women's Health Initiative Observational Study women, ages 50 to 79 years, enrolled between 1993 and 1998 and followed for up to 10.8 years. Social support was ascertained at baseline via nine questions measuring the following functional support components: emotional/informational, tangible, positive social interaction, and affectionate support. RESULTS: Among women with prior CVD (n = 17,351) and no prior CVD (n = 73,421), unadjusted hazard ratios ranged from 0.83 to 0.93 per standard deviation increment of social support. Adjustment for potential confounders, such as smoking and physical activity levels, eliminated the statistical significance of the associations with CHD and CVD. However, for all-cause mortality and among women free of baseline CVD, the association was modest but remained statistically significant after this adjustment (hazard ratio = 0.95 [95% confidence interval, 0.91-0.98]). No statistically significant association was observed among women with a history of CVD. CONCLUSIONS: After controlling for potential confounding variables, higher perceived social support is not associated with incident CHD or CVD. However, among women free of CVD at baseline, perceived social support is associated with a slightly lower risk of all-cause mortality.

Mindfulness, Experiential Avoidance, and Affective Experience in Older Adults.

Subjective well-being is comprised of two components: affective experience and life satisfaction. Older adulthood is marked by changes and challenges that have the potential to diminish well-being. As the proportion of older adults in the population rises, it is becoming increasingly important to identify factors that may be protective against these potentially detrimental events. Mindfulness and acceptance constructs have been shown to be associated with affective experience across the lifespan. However, little work has examined which facets of mindfulness drive these associations. The current study aimed to explore the associations between acceptance and mindfulness processes and positive and negative affect in older adults. Eighty-five healthy older adults completed self-report measures of mindfulness, experiential avoidance, and positive and negative affect. Results from linear regression analyses indicated that the act with awareness and nonreactivity facets of mindfulness were particularly important in their contribution to positive affect. Additionally, higher levels of experiential avoidance accounted for significant variance in negative affect. These findings help to elucidate how mindfulness and acceptance processes play a role in affective experience in older adults. Future studies should explore these facets in clinical populations to help create more targeted clinical goals.

Acceptance- and Mindfulness-Based Interventions for Health Behavior Change: Systematic Reviews and Meta-Analyses.

Behavioral health issues such as smoking and overweight are risk factors for a variety of adverse health outcomes, including mortality. Over the past decade, a growing number of randomized controlled trials have examined the efficacy of acceptance- and mindfulness-based interventions for smoking cessation and weight loss. The purpose of the current meta-analytic reviews was to quantitatively synthesize the existing literature comparing these interventions to controls for a) smoking cessation and b) weight loss outcomes. Searches identified 17 smoking cessation studies and 31 weight loss studies eligible for inclusion. Meta-analytic results indicated a non-significant effect favoring acceptance- and mindfulness-based interventions over controls for smoking cessation (OR = 1.13) and a small, significant effect favoring these interventions over controls for weight loss outcomes (Hedge's g = 0.30). Statistical heterogeneity and risk of bias were assessed. Subgroup and meta-regression analyses were conducted to examine moderating variables (e.g., sample and intervention characteristics). The findings indicated that acceptance- and mindfulness-based interventions were at least as efficacious as active control conditions. Given the significant health risks associated with smoking and overweight, these findings have important clinical and public health implications. Limitations (e.g., relative infancy of the literature; lack of diversity in sample demographics) and future directions (e.g., further exploration of mediators and moderators of change) are discussed.

The Use of Problem-Solving Therapy for Primary Care to Enhance Complex Decision-Making in Healthy Community-Dwelling Older Adults.

Some older adults who are cognitively healthy have been found to make poor decisions. The vulnerability of such older adults has been postulated to be the result of disproportionate aging of the frontal lobes that contributes to a decline in executive functioning abilities among some older adults. The purpose of this study was to investigate whether decision-making performance in older adults can be enhanced by a psychoeducational intervention. Twenty cognitively and emotionally intact persons aged 65 years and older were recruited and randomized into two conditions: psychoeducational condition [Problem-Solving Therapy for Primary Care (PST-PC)] and no-treatment Control group. Participants in the psychoeducational condition each received four 45-min sessions of PST-PC across a 2-week period. The Iowa Gambling Task (IGT) was administered as the outcome measure to the treatment group, while participants in the Control group completed the IGT without intervention. A significant interaction effect was observed between group status and the trajectory of score differences across trials on the IGT. Particularly, as the task progressed to the last 20% of trials, participants in the PST-PC group significantly outperformed participants in the Control group in terms of making more advantageous decisions. These findings demonstrated that a four-session problem-solving therapy can reinforce aspects of executive functioning (that may have declined as a part of healthy aging), thereby enhancing complex decision-making in healthy older adults.

Parkinson's Disease Dementia and Dementia with Lewy Bodies Have Similar Neuropsychological Profiles.

Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are common causes of dementia worldwide. Although considered separate entities based on the relative temporal onset of motor symptoms vs. diagnosis of dementia, it is unknown if these diseases truly have distinct cognitive profiles. We hypothesized that patients divided into PDD and DLB categories strictly by temporal criteria would have different neuropsychological profiles. We investigated this question via neuropsychological testing of PDD and DLB patients at the University of Iowa. We performed retrospective chart analysis and review of neuropsychological testing of clinically diagnosed patients with PDD or DLB, who had presented to University of Iowa's dementia and movement disorder clinics. Forty-seven patients diagnosed by the treating neurologist as PDD or DLB were included. Neuropsychological performance was compared between groups, and as a function of the relative timing of the motor diagnosis vs. diagnosis of dementia. We found that both PDD and DLB patients showed severe deficits in executive function, visual-spatial processing, and verbal learning. However, we found no significant differences in neuropsychological performance between groups, and neuropsychological performance could not reliably account for the relative timing of motor diagnosis vs. diagnosis of dementia. Our data support the idea that DLB and PDD are on a neuropsychological spectrum.

Increased perceived stress is related to decreased prefrontal cortex volumes among older adults.

INTRODUCTION: Several of the brain regions vulnerable to increased levels of stress (i.e., hippocampus and prefrontal cortex) are also known to undergo disproportionate decline during normal aging. To date, surprisingly little research has examined the effects of stress on the brain among healthy human populations, much less in the elderly. The aim of the current study was to investigate the relationship between chronic stress and brain morphometry in regions known for their involvement in the stress response, namely the prefrontal cortex, hippocampus, and amygdala, in a sample of healthy older adults. METHOD: The Perceived Stress Scale and structural magnetic resonance imaging (MRI) were collected in 28 older adult individuals aged 65 to 90 years. Gray and white matter volumes in various regions of interest in the prefrontal cortex and medial temporal lobes were calculated using semiautomated segmentation tools. RESULTS: Perceived stress was negatively correlated with overall prefrontal cortex (PFC) volume, specifically in overall white matter volume of the PFC. Additionally, perceived stress was negatively correlated with gray and white matter volumes in lateral regions of the PFC, specifically, in the ventrolateral and dorsolateral PFC. Perceived stress was not significantly related to medial temporal lobe volumes. CONCLUSIONS: These findings suggest that among healthy older adults, there is a salient relationship between prefrontal cortex volumes and levels of perceived stress. This research fills a critical gap in the current literature and provides initial groundwork for future studies investigating the relationship between perceived stress and the prefrontal cortex in the context of healthy aging.

Brain Network Theory Can Predict Whether Neuropsychological Outcomes Will Differ from Clinical Expectations.

OBJECTIVE: Theories of brain-network organization based on neuroimaging data have burgeoned in recent years, but the predictive power of such theories for cognition and behavior has only rarely been examined. Here, predictions from clinical neuropsychologists about the cognitive profiles of patients with focal brain lesions were used to evaluate a brain-network theory (Warren et al., 2014). METHOD: Neuropsychologists made predictions regarding the neuropsychological profiles of a neurological patient sample (N = 30) based on lesion location. The neuropsychologists then rated the congruence of their predictions with observed neuropsychological outcomes, in regard to the "severity" of neuropsychological deficits and the "focality" of neuropsychological deficits. Based on the network theory, two types of lesion locations were identified: "target" locations (putative hubs in a brain-wide network) and "control" locations (hypothesized to play limited roles in network function). RESULTS: We found that patients with lesions of target locations (N = 19) had deficits of greater than expected severity that were more widespread than expected, whereas patients with lesions of control locations (N = 11) showed milder, circumscribed deficits that were more congruent with expectations. CONCLUSIONS: The findings for the target brain locations suggest that prevailing views of brain-behavior relationships may be sharpened and refined by integrating recently proposed network-oriented perspectives.