Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults.

Purpose: The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults. Patients and Methods: This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests. Results: The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%. Conclusion: The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.

Fall risk assessments are crucial for preventative care in older adults. However, the demands of clinical practice require an accurate and time-efficient method. The U.S Centers for Disease Control and Prevention (CDC) has implemented a fall risk checklist through the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. However, the STEADI checklist might cost clinicians more time than expected, as some patients initially classified as high risk for falling may not actually be at high risk. This leads to unnecessary follow-up assessments. In this study, we compared the STEADI checklist to direct measures of postural sway (balance) using the BTrackS system and fear of falling using the Short FES-I survey to determine how they differed in classifying community-dwelling older adults as high versus low fall risk. Our results show that the STEADI checklist classifies older adults as high risk more frequently than the BTrackS and Short FES-I. Considering that the follow-up assessments for a high-risk classification by the STEADI checklist include a balance test, we suggest that combining a balance test such as the BTrackS with a questionnaire or checklist may yield better screening outcomes and accurately identify high-risk individuals in a timely manner. Further research is needed to determine the effectiveness of this combination and to establish a true gold standard method for fall risk appraisal.

Age-group differences in trust-related decision-making and learning.

Facial impressions contribute to evaluations of trustworthiness. Older adults are especially vulnerable to trust violations, incurring risks for deception and exploitation. Using the newly developed social Iowa Gambling Task (S-IGT), we examined age-group differences in the impact of facial trustworthiness on decision-making and learning. In the congruent condition (CS-IGT), advantageous decks were paired with trustworthy faces and disadvantageous decks with untrustworthy faces. In the incongruent condition (IS-IGT), this pairing was reversed. Younger (n = 143) and older (n = 129) participants completed either the standard Iowa Gambling Task (IGT), CS-IGT, or IS-IGT. Both age groups preferred trustworthy faces in their initial choices. Older adults performed worse than younger adults across all tasks over time. Further, compared to younger adults, older adults performed worse on the IS-IGT, suggesting that incongruent facial cues interfered with older adults' performance, which aligns with reduced sensitivity to negative social reputations in aging. Multilevel modeling also indicated that age-group differences were most pronounced across all tasks in the last 40 trials. Together these findings suggest that differences between younger and older adults in experience-dependent decision-making are magnified in social contexts that involve a "wolf in sheep's clothing," which may reflect age-related difficulties in integrating incongruent information.

Impact of amputation of the upper limb and prostheses on perceptions of competence, warmth, and functional abilities.

PURPOSE/OBJECTIVES: This study investigated attitudes that young adults have toward individuals with amputation of the upper limb (AUL). Previous studies have found that people tend to feel sympathy toward these individuals, but they are also perceived as less competent in various situations. However, it is unclear if these perceptions are influenced by factors such as the cause of amputation, the gender of the amputee, whether they use a prosthesis or not, or the type of prosthesis. RESEARCH METHOD/DESIGN: The survey included 469 participants from a university in the Southeastern United States. Participants rated pictures of individuals with or without amputation, and with and without prostheses after reading a brief background scenario. Images were rated using a semantic differential for competence and warmth, and a scale of functional ability. RESULTS: Factorial analysis of variances produced significant main effects indicating individuals with AULs who used prostheses were rated with higher competence and ability than individuals with AULs who did not use prostheses. Females were rated with lower competence and ability, and higher warmth regardless of AULs status. Higher ability ratings were obtained for individuals with advanced technology prostheses as compared to body-powered prostheses. CONCLUSIONS/IMPLICATIONS: Our research shows that people generally hold positive attitudes toward individuals with AUL when they use prostheses. However, traditional stereotypes persist for those who do not. Negative biases toward women should be accounted for in disability stigma studies. The cause of amputation did not influence ratings. Prostheses that appear to be advanced technology positively influenced ratings of functional ability when compared to traditional body-powered types. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social cognitive neuroscience in the digital age.

Human interactions are increasingly taking place from a distance through methods of remote interpersonal communication like video chatting and social media. While remote interpersonal communication has existed for millennia-with the first postal system arising in ∼2400 B.C.-accelerated advances in technology and the recent global COVID-19 pandemic have led to a dramatic increase in remote interpersonal communication use in daily life. Remote interpersonal communication presents a challenge to the field of social-cognitive neuroscience, as researchers seek to understand the implications of various types of remote interpersonal communication for the "social brain." The present paper reviews our current understanding of the social-cognitive neural network and summarizes critical differences between the neural correlates of social cognition in remote vs. face-to-face interactions. In particular, empirical and theoretical work is reviewed that highlight disparities in the neural mechanisms of social perception, evaluation of social stimuli, human motivation, evaluation of social reward, and theory of mind. Potential impacts of remote interpersonal communication on the development of the brain's social-cognitive network are also discussed. Finally, this review closes with future directions for research on social-cognitive neuroscience in our digital technology-connected world and outlines a neural model for social cognition in the context of remote interpersonal communication. For the field of social-cognitive neuroscience to advance alongside of the ever-evolving society, it is crucial for researchers to acknowledge the implications and concepts suggested for future research in this review.

Primary Scientific Literature Is Not Just for Students and Academics: a Study of Primary Source Modalities and Predictors of Learning across Adulthood.

The 2019 coronavirus disease pandemic and distrust for popular media have highlighted the need for effective methods of direct communication of biomedical science to the public. It is presently unclear how well nonexperts can learn from primary scientific sources and what factors predict such learning in the general public. The present study examined three modalities for learning about biomedical science directly from study investigators: primary scientific articles, annotated primary scientific articles presented online with interactive learning features, and TEDTalks about scientific studies presented by a study investigator. Each modality presented the same study, "Sleep Drives Metabolite Clearance from the Adult Brain" (L. Xie, H. Kang, Q. Chen, Y. Liao, et al., Science 342:373-377, 2013, https://doi.org/10.1126/science.1241224). Knowledge about the study's scientific content was assessed before and after the randomly assigned learning modality using multiple-choice questions. Participants included a sample of college psychology students and a sample of community-dwelling older adults. Cognitive tests were used to assess individual differences in working memory, processing speed, science literacy, and semantic knowledge. Surveys were used to assess trust in science and scientists, attitudes toward science, and attitudes toward cognitive tasks. Results indicated that both younger and older adults can learn basic biomedical science from a primary source. Knowledge gains were observed in all three learning modalities with no evidence of age group differences. Notably, the largest learning gains for undergraduates and older adults were observed in the primary scientific article condition, followed by the TEDTalk, and the annotated paper. Baseline knowledge about the science study topic and adoption of "scientific attitudes" (e.g., open-mindedness) predicted learning across age groups and learning modalities. These findings suggest that science educators, communicators, and outreach professionals should consider methods of promoting science literacy in the general public through direct access to primary scientific sources.

Facial Trustworthiness Perception Across the Adult Life Span.

OBJECTIVES: Trust is crucial for successful social interaction across the life span. Perceiver age, facial age, and facial emotion have been shown to influence trustworthiness perception, but the complex interplay between these perceiver and facial characteristics has not been examined. METHOD: Adopting an adult life-span developmental approach, 199 adults (aged 22-78 years) rated the trustworthiness of faces that systematically varied in age (young, middle-aged, and older) and emotion (neutral, happy, sad, fearful, angry, and disgusted) from the FACES Lifespan Database. RESULTS: The study yielded three key results. First, on an aggregated level, facial trustworthiness perception did not differ by perceiver age. Second, all perceivers rated young faces as the most trustworthy, and middle-aged and older (but not young) perceivers rated older faces as least trustworthy. Third, facial emotions signaling threat (fear, anger, and disgust) relative to neutral, happy, and sad expressions moderated age effects on facial trustworthiness perception. DISCUSSION: Findings from this study highlight the impact of perceiver and facial characteristics on facial trustworthiness perception in adulthood and aging and have potential to inform first impression formation, with effects on trait attributions and behavior. This publication also provides normative data on perceived facial trustworthiness for the FACES Lifespan Database.

Aging in an "infodemic": The role of analytical reasoning, affect, and news consumption frequency on news veracity detection.

Increasing misinformation spread poses a threat to older adults but there is little research on older adults within the fake news literature. Embedded in the Changes in Integration for Social Decisions in Aging (CISDA) model, this study examined the role of (a) analytical reasoning; (b) affect; (c) news consumption frequency, and their interplay with (d) news content on news veracity detection in aging. Conducted during the early phase of the COVID-19 pandemic, the present study asked participants to view and evaluate COVID or non-COVID (i.e., everyday) news articles, followed by measures of analytical reasoning, affect, and news consumption frequency. News veracity detection was comparable between young and older adults. Additionally, fake news detection for non-COVID news was predicted by individual differences in analytic reasoning for both age groups. However, chronological age effects in fake news detection emerged within the older adult sample and interacted with the CISDA-derived components of analytical reasoning, affect, and news consumption frequency by news content. Collectively, these findings suggest that age-related vulnerabilities to deceptive news are only apparent in very old age. Our findings advance understanding of psychological mechanisms in news veracity detection in aging. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Value network engagement and effects of memory-related processing during encoding and retrieval of value.

Decision makers rely on episodic memory to calculate choice values in everyday life, yet it is unclear how neural mechanisms of valuation differ when value-related information is encoded versus retrieved from episodic memory. The current fMRI study compared neural correlates of value while information was encoded versus retrieved from memory. Scanned tasks were followed by a behavioral episodic memory test for item-attribute associations. Our analyses sought to (i) identify neural correlates of value that were distinct and common across encoding and retrieval, and (ii) determine whether neural mechanisms of valuation and episodic memory interact. The study yielded three primary findings. First, value-related activation in the fronto-striatal reward circuit and posterior parietal cortex was comparable across valuation phases. Second, value-related activation in select fronto-parietal and salience regions was significantly greater at value retrieval than encoding. Third, there was no interaction between neural correlates of valuation and episodic memory. Taken with prior research, the present study indicates that fronto-parietal and salience regions play a key role in retrieval-dependent valuation and context-specific effects likely determine whether neural correlates of value interact with episodic memory.

Neural mechanisms of decision-making in aging.

The present review synthesizes findings on decision neuroscience and aging by focusing on decision processes that have been extensively studied in neuroeconomics and critically assessing the driving mechanisms of age-related change. The paper first highlights age-related changes to key brain structures that have been implicated in decision-making, then, reviews specific decision components and discusses investigations of age-related changes to their neural mechanisms. The review also weighs evidence for organic brain aging versus age-related changes to social and psychological factors in mediating age effects. Reviewed findings are discussed in the context of theories and frameworks that have been used to explain trajectories of change in decision-making across adulthood. This article is categorized under: Psychology > Development and Aging Psychology > Reasoning and Decision-Making Neuroscience > Cognition.

Reward Responsiveness and Inhibition Traits Differentially Predict Economic Biases in Gain and Loss Contexts.

Research on economic decision making has revealed specific biases in gain versus loss domains such that risky choice options are overvalued in gain conditions, implying optimism, but undervalued in loss conditions, implying pessimism. Individual differences in motivational traits and affective states have been shown to predict beliefs and behavior in risky decision making, but it is presently unclear which personal characteristics are most predictive of domain-specific biases. To address this gap in the literature, we investigated the relative influence of positive and negative motivational traits (general sensitivity to rewards and punishments) versus affective states (current levels of positive and negative emotions) on beliefs and choice behavior during a risky economic decision task. We also expanded on previous research by examining how the valence of one's judgment context (positive context tested in Experiment 1, negative context tested in Experiment 2) may determine whether risky choice behavior is more strongly influenced by positive versus negative characteristics. Biases in belief were calculated using an economic decision task that involved estimating the value of risky "stocks" relative to safe "bonds" from experienced outcomes. Experiment 1 used a positive judgment context (likelihood of a "good stock") while Experiment 2 used a negative judgment context (likelihood of a "bad stock"). Consistent with previous findings, we observed a domain-based bias in beliefs about stock values across experiments, such that participants exhibited optimism in gain domain and pessimism in the loss domain. Experiment 1 further revealed that domain-based bias and suboptimal choice behavior was predicted by trait-level reward sensitivity, while positive affective state (PAS) had a more limited influence on belief bias alone. Under the negative judgment context of Experiment 2, there was a similar relationship between reward sensitivity and choice behavior; however, results revealed a slightly stronger influence of negative affective state (NAS). A subsequent cross-study analysis found sensitivity to rewards was most predictive of domain-based biases. These results suggest that motivational traits - particularly those relating to reward sensitivity - are more consistent predictors of domain-based biases and risky choice behavior than affective states, but their predictive power depends the valence of the decision context.

Application of Graph Theory for Identifying Connectivity Patterns in Human Brain Networks: A Systematic Review.

Background: Analysis of the human connectome using functional magnetic resonance imaging (fMRI) started in the mid-1990s and attracted increasing attention in attempts to discover the neural underpinnings of human cognition and neurological disorders. In general, brain connectivity patterns from fMRI data are classified as statistical dependencies (functional connectivity) or causal interactions (effective connectivity) among various neural units. Computational methods, especially graph theory-based methods, have recently played a significant role in understanding brain connectivity architecture. Objectives: Thanks to the emergence of graph theoretical analysis, the main purpose of the current paper is to systematically review how brain properties can emerge through the interactions of distinct neuronal units in various cognitive and neurological applications using fMRI. Moreover, this article provides an overview of the existing functional and effective connectivity methods used to construct the brain network, along with their advantages and pitfalls. Methods: In this systematic review, the databases Science Direct, Scopus, arXiv, Google Scholar, IEEE Xplore, PsycINFO, PubMed, and SpringerLink are employed for exploring the evolution of computational methods in human brain connectivity from 1990 to the present, focusing on graph theory. The Cochrane Collaboration's tool was used to assess the risk of bias in individual studies. Results: Our results show that graph theory and its implications in cognitive neuroscience have attracted the attention of researchers since 2009 (as the Human Connectome Project launched), because of their prominent capability in characterizing the behavior of complex brain systems. Although graph theoretical approach can be generally applied to either functional or effective connectivity patterns during rest or task performance, to date, most articles have focused on the resting-state functional connectivity. Conclusions: This review provides an insight into how to utilize graph theoretical measures to make neurobiological inferences regarding the mechanisms underlying human cognition and behavior as well as different brain disorders.

CISDA: Changes in Integration for Social Decisions in Aging.

The aging of our population has been accompanied by increasing concerns about older adults' vulnerability to violations of trust and a growing interest in normative age-related changes to decision making involving social partners. This intersection has spurred research on age-related neurocognitive and affective changes underlying social decision making. Based on our review and synthesis of this literature, we propose a specification that targets social decision making in aging to the recently proposed Affect-Integration-Motivation (AIM) framework. Our framework specification, Changes in Integration for Social Decisions in Aging (CISDA), emphasizes three key components of value integration with particular relevance for social decisions in aging: theory of mind, emotion regulation, and memory for past experience. CISDA builds on converging research from economic decision making, cognitive neuroscience, and lifespan development to outline how age-related changes to neurocognition and behavior impact social decision making. We conclude with recommendations for future research based on CISDA's predictions, including implications for the development of interventions to enhance social decision outcomes in older adults. This article is categorized under: Economics > Individual Decision Making Psychology > Reasoning and Decision Making Psychology > Development and Aging Neuroscience > Cognition.

Feedback-Based Learning in Aging: Contributions and Trajectories of Change in Striatal and Hippocampal Systems.

The striatum supports learning from immediate feedback by coding prediction errors (PEs), whereas the hippocampus (HC) plays a parallel role in learning from delayed feedback. Both regions show evidence of decline in human aging, but behavioral research suggests greater decline in HC versus striatal functions. The present study included male and female humans and used fMRI to examine younger and older adults' brain activation patterns during a learning task with choice feedback presented immediately or after a brief delay. Participants then completed a surprise memory task that tested their recognition of trial-unique feedback stimuli, followed by assessments of postlearning cue preference, outcome probability awareness, and willingness to pay. The study yielded three main findings. First, behavioral measures indicated similar rates of learning in younger and older adults across conditions, but postlearning measures indicated impairment in older adults' ability to subsequently apply learning to discriminate between cues. Second, PE signals in the striatum were greater for immediate versus delayed feedback in both age groups, but PE signals in the HC were greater for delayed versus immediate feedback only in younger adults. Third, unlike younger adults, older adults failed to exhibit enhanced episodic memory for outcome stimuli in the delayed-feedback condition. Together, these findings indicate that HC circuits supporting learning and memory decline more than striatal circuits in healthy aging, which suggests that declines in HC learning signals may be an important predictor of deficits in learning-dependent economic decisions among older adults.SIGNIFICANCE STATEMENT The hippocampus (HC) and striatum play distinct and critical roles in learning. Substantial research suggests that age-related decline in learning supported by the HC outpaces decline in learning supported by the striatum; however, such inferences have been drawn by comparing performance in tasks with fundamentally different structures. The present study overcomes this obstacle by implementing a single fMRI-learning paradigm with a subtle variation in feedback timing to examine differential age effects on memory supported by the HC and striatum. Our results provide converging behavioral and brain-imaging evidence showing that HC circuits supporting learning and memory decline more than striatal circuits in healthy aging and that declines in HC learning signals may predict early deficits in learning-dependent decisions among older adults.

Functional compensation in the ventromedial prefrontal cortex improves memory-dependent decisions in older adults.

Everyday consumer choices frequently involve memory, as when we retrieve information about consumer products when making purchasing decisions. In this context, poor memory may affect decision quality, particularly in individuals with memory decline, such as older adults. However, age differences in choice behavior may be reduced if older adults can recruit additional neural resources that support task performance. Although such functional compensation is well documented in other cognitive domains, it is presently unclear whether it can support memory-guided decision making and, if so, which brain regions play a role in compensation. The current study engaged younger and older humans in a memory-dependent choice task in which pairs of consumer products from a popular online-shopping site were evaluated with different delays between the first and second product. Using functional imaging (fMRI), we found that the ventromedial prefrontal cortex (vmPFC) supports compensation as defined by three a priori criteria: (1) increased vmPFC activation was observed in older versus younger adults; (2) age-related increases in vmPFC activity were associated with increased retrieval demands; and (3) increased vmPFC activity was positively associated with performance in older adults-evidence of successful compensation. Extending these results, we observed evidence for compensation in connectivity between vmPFC and the dorsolateral PFC during memory-dependent choice. In contrast, we found no evidence for age differences in value-related processing or age-related compensation for choices without delayed retrieval. Together, these results converge on the conclusion that age-related decline in memory-dependent choice performance can be minimized via functional compensation in vmPFC.

Stress modulates reinforcement learning in younger and older adults.

Animal research and human neuroimaging studies indicate that stress increases dopamine levels in brain regions involved in reward processing, and stress also appears to increase the attractiveness of addictive drugs. The current study tested the hypothesis that stress increases reward salience, leading to more effective learning about positive than negative outcomes in a probabilistic selection task. Changes to dopamine pathways with age raise the question of whether stress effects on incentive-based learning differ by age. Thus, the present study also examined whether effects of stress on reinforcement learning differed for younger (age 18-34) and older participants (age 65-85). Cold pressor stress was administered to half of the participants in each age group, and salivary cortisol levels were used to confirm biophysiological response to cold stress. After the manipulation, participants completed a probabilistic learning task involving positive and negative feedback. In both younger and older adults, stress enhanced learning about cues that predicted positive outcomes. In addition, during the initial learning phase, stress diminished sensitivity to recent feedback across age groups. These results indicate that stress affects reinforcement learning in both younger and older adults and suggests that stress exerts different effects on specific components of reinforcement learning depending on their neural underpinnings.

Risk preferences and aging: the "certainty effect" in older adults' decision making.

A prevalent stereotype is that people become less risk taking and more cautious as they get older. However, in laboratory studies, findings are mixed and often reveal no age differences. In the current series of experiments, we examined whether age differences in risk seeking are more likely to emerge when choices include a certain option (a sure gain or a sure loss). In four experiments, we found that age differences in risk preferences only emerged when participants were offered a choice between a risky and a certain gamble but not when offered two risky gambles. In particular, Experiments 1 and 2 included only gambles about potential gains. Here, compared with younger adults, older adults preferred a certain gain over a chance to win a larger gain and thus, exhibited more risk aversion in the domain of gains. But in Experiments 3 and 4, when offered the chance to take a small sure loss rather than risking a larger loss, older adults exhibited more risk seeking in the domain of losses than younger adults. Both their greater preference for sure gains and greater avoidance of sure losses suggest that older adults weigh certainty more heavily than younger adults. Experiment 4 also indicates that older adults focus more on positive emotions than younger adults do when considering their options, and that this emotional shift can at least partially account for age differences in how much people are swayed by certainty in their choices.

Both Risk and Reward are Processed Differently in Decisions Made Under Stress.

Years of research show that stress influences cognition. Most of this research has focused on how stress affects memory and the hippocampus. However, stress impacts other regions involved in cognitive and emotional processing, including the prefrontal cortex, striatum, and insula. New research examining how stress affects decision processes reveals two consistent findings. First, acute stress enhances selection of previously rewarding outcomes but impairs selection of previously negative outcomes, possibly due to stress-induced changes in dopamine in reward-processing brain regions. Second, stress amplifies gender differences in strategies during risky decisions, with males taking more risk and females less risk under stress. These gender differences in behavior are associated with differences in activity in the insula and dorsal striatum, brain regions involved in computing risk and preparing to take action.

Gender differences in reward-related decision processing under stress.

Recent research indicates gender differences in the impact of stress on decision behavior, but little is known about the brain mechanisms involved in these gender-specific stress effects. The current study used functional magnetic resonance imaging (fMRI) to determine whether induced stress resulted in gender-specific patterns of brain activation during a decision task involving monetary reward. Specifically, we manipulated physiological stress levels using a cold pressor task, prior to a risky decision making task. Healthy men (n = 24, 12 stressed) and women (n = 23, 11 stressed) completed the decision task after either cold pressor stress or a control task during the period of cortisol response to the cold pressor. Gender differences in behavior were present in stressed participants but not controls, such that stress led to greater reward collection and faster decision speed in males but less reward collection and slower decision speed in females. A gender-by-stress interaction was observed for the dorsal striatum and anterior insula. With cold stress, activation in these regions was increased in males but decreased in females. The findings of this study indicate that the impact of stress on reward-related decision processing differs depending on gender.

Sex differences in how stress affects brain activity during face viewing.

Under stress, men tend to withdraw socially whereas women seek social support. This functional magnetic resonance imaging study indicates that stress also affects brain activity while viewing emotional faces differently for men and women. Fusiform face area response to faces was diminished by acute stress in men but increased by stress in women. Furthermore, among stressed men viewing angry faces, brain regions involved in interpreting and understanding others' emotions (the insula, temporal pole, and inferior frontal gyrus) showed reduced coordination with the fusiform face area and the amygdala, whereas the functional connectivity among these regions increased with stress for women. These findings suggest that stress influences emotional perception differently for men and women.