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1.
Gerontology ; : 1-11, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882498

RESUMO

INTRODUCTION: Evidence suggests that older Black adults are frequent victims of financial fraud and exploitation. This study aims to identify the factors associated with scam susceptibility in older Black adults. METHODS: Participants were 383 older Black adults living in the Chicago metropolitan area (mean age = 78 years and 82% female). A scam susceptibility measure assessed perceptions and behaviors that predispose older adults to fraud and scams. Categories of age-associated factors, including cognition, physical health, psychosocial factors, personality, and behavioral economics, were measured using uniform systematic assessments. For each category separately, measures associated with scam susceptibility were identified via stepwise variable selection. RESULTS: Older age was associated with greater scam susceptibility. Further, the analysis revealed a robust association of cognitive health with scam susceptibility, particularly the domains of semantic and working memory. Psychological well-being was associated with susceptibility, as was neuroticism. Behavioral economic measures including financial and health literacy and financial and health decision-making ability were also implicated. In a final model that included all the measures initially retained by variable selection, semantic memory, psychological well-being, and financial and health literacy were independently associated with scam susceptibility. Moreover, the association of age was attenuated and no longer significant after adjusting for these correlates. DISCUSSION: Age-associated vulnerabilities, rather than age itself, predispose older Black adults to financial fraud and scams. The correlates of scam susceptibility in community-living older Black adults primarily involve cognitive health, psychological, and behavioral economic factors.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33676832

RESUMO

OBJECTIVES: Inadequate financial and health literacy presents a formidable public health and economic challenge in old age. This study investigated declining financial and health literacy in relation to decision making performance, scam susceptibility and psychological wellbeing. DESIGN: Longitudinal study. SETTING: A community-based cohort in Northeastern Illinois, USA. PARTICIPANTS: One thousand fourty-six older adults who were free of dementia at baseline and underwent annual clinical and literacy assessments. MEASUREMENTS: Financial and health literacy, decision making, scam susceptibility, and psychological wellbeing were assessed using validated instruments. Linear mixed effects models estimated person-specific rates of change in financial and health literacy, and multivariable regression analyses examined the associations of declining literacy with subsequent levels of decision making, scam susceptibility, and psychological wellbeing. RESULTS: The mean age was 81 years and 76% were female. Over up to 10 years of annual follow-ups, the average financial and health literacy score dropped 1 percentage point a year. Substantial variability in decline was observed between participants. Faster decline in financial and health literacy was associated with poorer decision making, higher scam susceptibility, and lower psychological wellbeing. Notably, these associations were above and beyond the baseline literacy level and persisted even after controlling for cognition. CONCLUSIONS: Most community-dwelling older adults experience decline in financial and health literacy over time, but decline is not inevitable. Declining literacy is related to poorer decision making, greater scam susceptibility and lower wellbeing. These findings suggest that efforts to mitigate declining financial and health literacy may promote independence and wellbeing in old age.

3.
Brain ; 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33742668

RESUMO

The aging brain is vulnerable to a wide array of neuropathologies. Prior work estimated that the three most studied of these, Alzheimer's disease (AD), infarcts, and Lewy bodies, account for about 40% of the variation in late life cognitive decline. However, that estimate did not incorporate many other diseases that are now recognized as potent drivers of cognitive decline (e.g. limbic predominant age-related TDP-43 encephalopathy [LATE-NC], hippocampal sclerosis, other cerebrovascular conditions). We examined the degree to which person-specific cognitive decline in old age is driven by a wide array of neuropathologies. 1,164 deceased participants from two longitudinal clinical-pathologic studies, the Rush Memory and Aging Project and Religious Orders Study, completed up to 24 annual evaluations including 17 cognitive performance tests and underwent brain autopsy. Neuropathologic examinations provided 11 pathologic indices, including markers of AD, non-AD neurodegenerative diseases (i.e. LATE-NC, hippocampal sclerosis, Lewy bodies), and cerebrovascular conditions (i.e. macroscopic infarcts, microinfarcts, cerebral amyloid angiopathy, atherosclerosis, and arteriolosclerosis). Mixed effects models examined the linear relation of pathologic indices with global cognitive decline, and random change point models examined the relation of the pathologic indices with the onset of terminal decline and rates of preterminal and terminal decline. Cognition declined an average of about 0.10 unit per year (estimate = -0.101, SE = 0.003, p < 0.001) with considerable heterogeneity in rates of decline (variance estimate for the person-specific slope of decline was 0.0094, p < 0.001). When considered separately, 10 of the 11 pathologic indices were associated with faster decline and accounted for between 2 and 34% of the variation in decline, respectively. When considered simultaneously, the 11 pathologic indices together accounted for a total of 43% of the variation in decline; AD-related indices accounted for 30-36% of the variation, non-AD neurodegenerative indices 4-10%, and cerebrovascular indices 3-8%. Finally, the 11 pathologic indices combined accounted for less than a third of the variation in the onset of terminal decline (28%) and rates of preterminal (32%) and terminal decline (19%). Although age-related neuropathologies account for a large proportion of the variation in late life cognitive decline, considerable variation remains unexplained even after considering a wide array of neuropathologies. These findings highlight the complexity of cognitive aging and have important implications for the ongoing effort to develop effective therapeutics and identify novel treatment targets.

4.
Front Aging Neurosci ; 12: 583433, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33304266

RESUMO

Financial exploitation (FE) in old age is devastating and common; however, the neural correlates of FE are poorly understood. Previous studies of FE in older adults have implicated declines in decision making and social cognition as two risk factors for FE in later life. Here we examined whether functional connectivity among brain regions implicated in decision making and social cognition differed for those with an experience of FE vs. those without. Participants included 16 older adults without cognitive impairment who reported FE (Mean age = 70.5, 62.5% female, Mean education = 16.0 years) and 16 demographically and cognitively matched adults who denied a history of FE (Mean age = 65.1, 37.5% female, Mean education = 15.1 years). Measures of whole-brain resting-state functional connectivity in the hippocampus, insula, and medial frontal cortex were derived for each group. Compared to the non-FE group, FE was associated with greater functional connectivity between the right hippocampus and bilateral temporal regions, and less functional connectivity between the right hippocampus and the right cerebellum and bilateral lingual gyri. The FE group showed less connectivity between the right and left insula and cingulate cortex, and between the right insula and regions of the left lateral temporal gyrus and dorsolateral prefrontal cortex. Finally, the FE group showed greater functional connectivity between the medial frontal cortex and the right lateral temporal gyrus and orbitofrontal cortex, and less functional connectivity with the right pre- and postcentral gyri. Results suggest that perceived FE in old age is associated with whole-brain functional connectivity differences involving the hippocampus, insula, and medial frontal cortex, consistent with models implicating age-associated changes in decision making and social cognition in FE.

5.
Neurology ; 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33144516

RESUMO

OBJECTIVE: To determine whether serial position scores in verbal memory differentiate hippocampal-related neuropathologic outcomes, we examined these associations in a sample of nondemented older adults who underwent autopsy. METHODS: We used data from the Rush Memory and Aging Project; a longitudinal clinical-pathologic cohort study of community-dwelling adults. Seven hundred one participants (mean age = 82.7, 71.2% female) completed baseline cognitive evaluations and underwent brain autopsy to identify pathologic AD, TDP-43 inclusions (defining limbic-predominant age-related TDP-43 encephalopathy [LATE]), and hippocampal sclerosis. The CERAD Word List Memory test immediate recall trials provided serial position scores, which index the proportion of words recalled from the beginning (primacy scores) and end (recency scores) of a word list. Binary and ordinal logistic regressions examined associations between serial position scores and neuropathologic outcomes. Secondary outcomes included Alzheimer's dementia and mild cognitive impairment proximate to death. RESULTS: Primacy and recency scores were uncorrelated (r = 0.07). Each standard deviation of better primacy score was associated with lower likelihood of neuropathologic changes (24% lower LATE, 31% lower pathologic AD, 37% lower hippocampal sclerosis). For pathologic AD, better baseline primacy scores were associated with a 36% lower likelihood of comorbidity with LATE or hippocampal sclerosis. Primacy scores better discriminated between clinical diagnoses proximate to death, including those with mild cognitive impairment compared to no impairment. Recency scores showed weaker or no associations. CONCLUSIONS: Primacy scores may be particularly sensitive markers of AD and related hippocampal neuropathologies. The differential predictive value of serial position scores suggests they offer complementary information about disease outcomes in addition to the routinely used total recall scores.

6.
Gerontol Geriatr Med ; 6: 2333721420971073, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33225020

RESUMO

Objective: Many older adults who are cognitively intact experience financial exploitation (FE), and the reasons for this are poorly understood. Methods: Data were gathered from 37 older adults (M age = 69.51, M education = 15.89, 62% female) from the Finance, Cognition, and Health in Elders Study (FINCHES). Twenty-four older adults who self-reported FE were demographically-matched according to age, education, race, and MoCA performance to thirteen older adults who denied experiencing FE. Participants completed the Tilburg Frailty Inventory. Results: FE participants reported greater total frailty (t = 2.06, p = .04) when compared to non-FE participants. Post-hoc analyses revealed that FE participants endorsed greater physical frailty (U = 89, p = .03), specifically poorer sensory functioning (hearing and vision). Discussion: Findings suggest frailty is associated with FE in old age and may represent a target for intervention programs for the financial wellbeing of older adults.

7.
Artigo em Inglês | MEDLINE | ID: mdl-33046355

RESUMO

OBJECTIVE: A wealth of evidence has linked purpose in life (PiL) to better mental and physical health and healthy aging. Here, the authors aimed to determine important correlates of PiL using a machine learning approach. METHODS: Participants were recruited from retirement communities by the Rush Memory and Aging Project and assessed for childhood experience, adulthood sociodemographic factors (e.g., education, income, marital status), lifestyle and health behavior (e.g., cognitively stimulating activities, exercise, social activities, social network size), psychological factors (e.g., depression, loneliness, perceived discrimination, perceived social support), personality traits (e.g., PiL, harm avoidance), and medical conditions. Elastic Net was implemented to identify important correlates of PiL. RESULTS: A total of 1,839 participants were included in our analysis. Among the 23 variables provided to Elastic Net, 10 were identified as important correlates of PiL. In order of decreasing effect size, factors associated with lower PiL were loneliness, harm avoidance, older age, and depressive symptoms, while those associated with greater PiL were perceived social support, more social activities, more years of education, higher income, intact late-life cognitive performance, and more middle-age cognitive activities. CONCLUSION: Our findings identify potentially important modifiable factors as targets for intervention strategies to enhance PiL.

8.
Neurology ; 95(14): e1951-e1962, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-32753441

RESUMO

OBJECTIVE: To examine the impact of 3 pathologic groups, pure limbic-predominant age-related transactive response DNA-binding protein 43 encephalopathy (LATE) neuropathologic changes (NC), pure Alzheimer disease neuropathologic change (ADNC), and mixed ADNC with LATE-NC, on late-life cognitive decline. METHODS: Data came from 1,356 community-based older persons who completed detailed annual cognitive testing and systematic neuropathologic examination at autopsy to identify LATE-NC, ADNC, and other age-related pathologies. Persons were categorized into (0) a group without a pathologic diagnosis of LATE or ADNC (n = 378), (1) LATE-NC without ADNC (n = 91), (2) ADNC without LATE-NC (n = 535), and (3) mixed ADNC with LATE-NC (n = 352). We used mixed-effect models to examine the group associations with rate of decline in global cognition and 5 cognitive domains and then examined whether age modified associations. RESULTS: Compared to those without LATE-NC or ADNC, those with pure LATE-NC had a faster decline in global cognition (p = 0.025) and episodic memory (p = 0.002); however, compared to persons with pure ADNC, those with pure LATE-NC showed a slower decline. Those with mixed ADNC with LATE-NC showed the fastest decline compared to those with either pathology alone. Persons ≥90 years of age with mixed ADNC with LATE-NC had slower cognitive decline compared to those ≤89 years of age. CONCLUSION: Persons with pure LATE-NC follow a slower trajectory compared to those with pure ADNC. Those with mixed LATE/ADNC have a steeper decline than individuals with either pathology alone. In addition, age may modify the effect of pathology on cognitive decline. These findings have important implications for the development of biomarkers and prognosis for late-life cognitive decline. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that LATE-NC and Alzheimer disease pathologic changes are associated with different trajectories of late-life cognitive decline.


Assuntos
Envelhecimento/patologia , Doença de Alzheimer/patologia , Disfunção Cognitiva/patologia , Proteinopatias TDP-43/patologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Disfunção Cognitiva/etiologia , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Proteinopatias TDP-43/complicações
9.
Artigo em Inglês | MEDLINE | ID: mdl-32646635

RESUMO

OBJECTIVE: The purpose of this study was to test the hypothesis that late life cognitive activity is associated with decision-making in older adults and to examine whether this association varies by level of cognitive function. DESIGN: This study employed a cross-sectional design. SETTING: All data were collected in participants' community-based residences. PARTICIPANTS: Participants were 1,084 older adults (mean age = 81.05 years, standard deviation = 7.53) without dementia (median Mini-Mental State Examination score = 29, interquartile range = 27.86-30.00). MEASUREMENTS: Participants completed assessments of late life cognitive activity, cognitive function, and decision-making. We used linear regression models to examine the associations of late life cognitive activity and cognitive function with decision-making. RESULTS: In a regression model adjusted for age, gender, and education, more frequent late life cognitive activity was associated with better decision-making, as was higher cognitive function. Furthermore, in an additional model that included the interaction of late life cognitive activity and cognitive function, the interaction was significant, such that late life cognitive activity was most strongly associated with decision-making among participants with lower levels of cognitive function. CONCLUSION: Frequent engagement in late life cognitive activity may help maintain decision-making among older persons, particularly among those with lower levels of cognitive function.

10.
Gerontologist ; 60(8): 1476-1484, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-32574350

RESUMO

BACKGROUND AND OBJECTIVES: Cognition is a known determinant of healthcare and financial decision making in old age. Social vulnerabilities also might play a role in such decisions; however, the evidence for this is less clear. Here, we examined the association of loneliness with decision making and tested the hypothesis that loneliness is associated with decision making via its interaction with global cognition. RESEARCH DESIGN AND METHODS: Participants were 1,121 nondemented older adults from the Rush Memory and Aging Project. Healthcare and financial decision making was assessed via a performance-based measure; loneliness was assessed via the De Jong Gierveld Loneliness Scale; and cognition was assessed via a 19-test neuropsychological battery. RESULTS: In a regression model adjusted for age, sex, and education, global cognition was associated with decision making (B = 2.43, SE = 0.14, p < .001) but loneliness was not (B = -0.04, SE = 0.11, p = .72). However, in a model including the interaction of loneliness with global cognition, the interaction was significant (B = 0.44, SE = 0.20, p = .03), such that the detrimental effect of loneliness on decision making was stronger when cognition was low. In secondary analyses examining the interaction of loneliness with 5 specific cognitive domains, the interaction between loneliness and working memory with decision making was significant (B = 0.35, SE = 0.15, p = .02). DISCUSSION AND IMPLICATIONS: Our results suggest that loneliness compromises healthcare and financial decision making among older adults with lower global cognition and, more specifically, lower working memory.

11.
Alzheimer Dis Assoc Disord ; 34(4): 299-305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32452861

RESUMO

PURPOSE: Emerging evidence suggests that limbic-predominant age-related TAR DNA-binding protein-43 (TDP-43) encephalopathy impacts domain-specific literacy, a complex ability not assessed in traditional cognitive evaluations. We examined longitudinal profiles of financial and health literacy in relation to limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC). PARTICIPANTS: A total of 275 community-dwelling older persons who had completed annual literacy assessments, died and undergone brain autopsy. METHODS: Financial and health literacy was assessed using a 32-item instrument. Latent class mixed effects models identified groups of individuals with distinct longitudinal literacy profiles. Regression models examined group differences in 9 common age-related neuropathologies assessed via uniform structured neuropathologic evaluations. RESULTS: Two distinct literacy profiles emerged. The first group (N=121, 44%) had higher level of literacy at baseline, slower decline and less variabilities over time. The second group (N=154, 56%) had lower level of literacy at baseline, faster decline, and greater variabilities. Individuals from the latter group were older, with fewer years of education and more female. They also had higher burdens of Alzheimer disease and LATE-NC. The group association with Alzheimer disease was attenuated and no longer significant after controlling for cognition. By contrast, the association with LATE-NC persisted. CONCLUSION: Limbic-predominant age-related TDP-43 encephalopathy is uniquely associated with distinct longitudinal profiles of financial and health literacy in old age.

12.
Ann Neurol ; 87(6): 816-829, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32144793

RESUMO

OBJECTIVE: To characterize trajectories of normative cognitive aging. METHODS: Older persons without dementia at study enrollment (n = 1,010) had annual cognitive testing for up to 24 years (mean = 9.9 years, standard deviation = 5.0), died, and underwent a neuropathologic examination to quantify 9 postmortem markers of common neurodegenerative and cerebrovascular conditions. To accommodate the heterogeneity in cognitive trajectories, we used functional mixed effects models, which allow individuals to have different patterns of cognitive decline under a unified model structure. RESULTS: In a functional mixed effects model, postmortem markers (Alzheimer disease pathology, Lewy bodies, transactive response DNA-binding protein 43 pathology, hippocampal sclerosis, atherosclerosis, gross infarcts) were associated with global cognitive decline. Residual global cognitive decline after adjustment for neuropathologic burden was weakly related to age at death; it occurred in only about one-third of participants, mostly proximate to death. Results were comparable after eliminating the initial cognitive assessments to minimize retest learning or controlling for frailty proximate to death. Analyses were also conducted with composite measures of episodic memory and perceptual speed. Residual decline not attributable to neuropathologic burden was confined to a subset for each outcome and was most evident proximate to death. Age at death was unrelated to residual decline in episodic memory but was related to residual decline in perceptual speed. INTERPRETATION: Late life cognitive loss mainly reflects non-normative pathologic and mortality-related processes rather than normative age-related processes. ANN NEUROL 2020;87:816-829.


Assuntos
Envelhecimento/psicologia , Disfunção Cognitiva/psicologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/psicologia , Morte , Escolaridade , Feminino , Fragilidade/psicologia , Humanos , Estudos Longitudinais , Masculino , Memória Episódica , Doenças Neurodegenerativas/patologia , Doenças Neurodegenerativas/psicologia , Exame Neurológico , Testes Neuropsicológicos , Tempo de Reação , Valores de Referência
14.
J Am Geriatr Soc ; 68(6): 1279-1285, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32092157

RESUMO

BACKGROUND/OBJECTIVES: Decision making in financial and healthcare matters is of critical importance for well-being in old age. Preliminary work suggests racial differences in decision making; however, the factors that drive racial differences in decision making remain unclear. We hypothesized literacy, particularly financial and health literacy, mediates racial differences in decision making. DESIGN: Community-based epidemiologic cohort study. SETTING: Communities in northeastern Illinois. PARTICIPANTS: Nondemented Black participants (N = 138) of the Rush Alzheimer's Disease Center Minority Aging Research Study and the Rush Memory and Aging Project who completed decision-making and literacy measures were matched to White participants (N = 138) according to age, education, sex, and global cognition using Mahalanobis distance (total N = 276). MEASUREMENTS: All participants completed clinical assessments, a decision-making measure that resembles real-world materials relevant to finance and healthcare, and a financial and health literacy measure. Regression models were used to examine racial differences in decision making and test the hypothesis that literacy mediates this association. In secondary analyses, we examined the impact of literacy in specific domains of decision making (financial and healthcare). RESULTS: In models adjusted for age, education, sex, and global cognition, older Black adults performed lower than older White adults on literacy (ß = -8.20; SE = 1.34; 95% CI = -10.82 to -5.57; P < .01) and separately on decision making (ß = -.80; SE = .23; 95% CI = -1.25 to -.34; P < .01). However, when decision making was regressed on both race and literacy, the association of race was attenuated and became nonsignificant (ß = -.45; SE = .24; 95% CI = -.93 to .02; P = .06), but literacy remained significantly associated with decision making (ß = .04; SE = .01; 95% CI = .02-.06; P < .01). In secondary models, a similar pattern was observed for both financial and healthcare decision making. CONCLUSIONS: Racial differences in decision making are largely mediated by literacy. These findings suggest that efforts to improve literacy may help reduce racial differences in decision making and improve health and well-being for diverse populations. J Am Geriatr Soc 68:1279-1285, 2020.

15.
NPJ Genom Med ; 5: 6, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32047652

RESUMO

Late-life depression is associated with an increased risk for dementia but we have limited knowledge of the molecular mechanisms underlying this association. Here we investigated whether brain microRNAs, important posttranscriptional regulators of gene expression, contribute to this association. Late-life depressive symptoms were assessed annually in 300 participants of the Religious Orders Study and Rush Memory and Aging Project for a mean of 7 years. Participants underwent annual cognitive testing, clinical assessment of cognitive status, and uniform neuropathologic examination after death. microRNAs were profiled from the prefrontal cortex using NanoString platform in the discovery cohort and small RNA sequencing in the replication cohort. A global microRNA association study of late-life depressive symptoms was performed using linear mixed model adjusting for the potential confounding factors. Four brain microRNAs were associated with late-life depressive symptoms at adjusted p < 0.05: miR-484, miR-26b-5p, miR-30d-5p, and miR-197-3p. Lower expression levels of these miRNAs were associated having greater depressive symptoms. Furthermore, lower levels of miR-484 and miR-197-3p were associated with faster decline of cognition over time. Moreover, lower miR-484 level was associated with higher probability of having Alzheimer's dementia. Importantly, the associations between miR-484 and depressive symptoms and Alzheimer's dementia, respectively, were replicated in an independent cohort. Lastly, the predicted targets of miR-484 were enriched in a brain protein co-expression module involving synaptic transmission and regulation of synaptic plasticity. This study identified four brain microRNAs associated with late-life depressive symptoms assessed longitudinally. In addition, we found a molecular connection between late-life depression and dementia through miR-484.

16.
Alzheimers Dement ; 16(1): 209-218, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31914231

RESUMO

INTRODUCTION: Reduced hippocampal volume is associated with late-life cognitive decline, but prior studies have not determined whether this association persists after accounting for Alzheimer's disease (AD) and other neuropathologies. METHODS: Participants were 531 deceased older adults from community-based cohort studies of aging who had undergone annual cognitive evaluations. At death, brain tissue underwent neuropathologic examination and magnetic resonance imaging (MRI). Linear mixed models examined whether hippocampal volume measured via MRI accounted for variation in decline rate of global cognition and five cognitive domains, above and beyond neuropathologic indices. RESULTS: Demographics and indices of AD, cerebrovascular disease, Lewy body disease, hippocampal sclerosis, TDP-43, and atherosclerosis accounted for 42.6% of the variation in global cognitive decline. Hippocampal volume accounted for an additional 5.4% of this variation and made similar contributions in four of the five cognitive domains. DISCUSSION: Hippocampal volume is associated with late-life cognitive decline, above and beyond contributions from common neuropathologic indices.


Assuntos
Envelhecimento , Disfunção Cognitiva/patologia , Hipocampo/patologia , Neuropatologia , Idoso , Envelhecimento/patologia , Encéfalo/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Lobo Temporal/patologia
17.
Neurology ; 94(1): e42-e50, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-31792096

RESUMO

OBJECTIVE: To estimate the proportion of late-life cognitive loss attributable to impending death. METHODS: Older persons (n = 1,071) in a longitudinal cohort study without dementia at enrollment underwent annual cognitive assessments (mean 10.6 years, SD 4.6, range 4-24) prior to death. We estimated the onset of terminal acceleration in cognitive decline and rates of decline before and after this point in change point models that allowed calculation of the percent of cognitive loss attributable to terminal decline. Outcomes were composite measures of global and specific cognitive functions. We also estimated dementia and mild cognitive impairment (MCI) incidence before and during the terminal period. RESULTS: A mean of 3.7 years before death (95% credible interval [CI] -3.8 to -3.5), the rate of global cognitive decline accelerated to -0.313 unit per year (95% CI -0.337 to -0.290), a more than 7-fold increase indicative of terminal decline. The mean global cognitive score dropped 0.377 unit (SD 0.516) assuming no terminal decline and 1.192 units (SD 1.080) with terminal decline. As a result, 71% (95% bootstrapped CI 0.70, 0.73) of overall global cognitive loss was terminal. In subsequent analyses, terminal decline accounted for 70% of episodic memory loss, 65% of semantic memory loss, 57% of working memory loss, 52% of perceptual speed loss, and 53% of visuospatial loss. MCI incidence in the preterminal and terminal periods was similar, but dementia incidence was more than 6-fold higher in the terminal period than preterminal. CONCLUSION: Most late-life cognitive loss is driven by terminal decline.


Assuntos
Transtornos Cognitivos/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/psicologia , Disfunção Cognitiva/patologia , Disfunção Cognitiva/psicologia , Estudos de Coortes , Morte , Demência/patologia , Demência/psicologia , Escolaridade , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos da Memória/etiologia , Transtornos da Memória/psicologia , Memória de Curto Prazo , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Desempenho Psicomotor , Percepção Espacial
18.
Neurology ; 94(2): e142-e152, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31757868

RESUMO

OBJECTIVE: To investigate the contribution of Alzheimer disease (AD) vs non-AD neuropathologies to hippocampal atrophy. METHODS: The Religious Orders Study and Rush Memory and Aging Project are clinicopathologic cohort studies of aging. The current study included 547 participants who had undergone brain autopsy and postmortem hippocampal volume measurement by November 1, 2018. Hippocampal volume was measured with postmortem MRI via a 3D region of interest applied to the hippocampal formation. Neuropathologies were measured via uniform structured evaluations. Linear regression analyses estimated the proportion of variance of hippocampal volume attributable to AD and non-AD neuropathologies. RESULTS: The average age at death was 90 years, and the average hippocampal volume was 2.1 mL. AD, transactive response DNA-binding protein 43 (TDP), hippocampal sclerosis (HS), and atherosclerosis were associated with hippocampal volume. After demographics and total hemisphere volume were controlled for, 7.0% of the variance (95% bootstrapped confidence interval [CI] 4.3%-10.5%) of hippocampal volume was attributable to AD pathology. TDP/HS explained an additional 4.5% (95% CI 2.2%-7.6%). Among individuals with Alzheimer dementia (n = 232), 3.1% (95% CI 0.6%-7.7%) of the variance was attributable to AD pathology, and TDP/HS explained an additional 6.1% (95% CI 2.2%-11.6%). Among those without Alzheimer dementia (n = 307), 3.2% (95% CI 0.9%-7.3%) of the variance was attributable to AD pathology, and TDP/HS explained an additional 1.1%, which did not reach statistical significance. Lewy bodies and vascular diseases had modest contribution to the variance of hippocampal volume. CONCLUSIONS: Both AD and TDP/HS contribute to hippocampal volume loss in older-old persons, with TDP/HS more strongly associated with hippocampal volume than AD in Alzheimer dementia.


Assuntos
Doença de Alzheimer/patologia , Hipocampo/patologia , Proteinopatias TDP-43/patologia , Idoso de 80 Anos ou mais , Atrofia , Feminino , Humanos , Masculino , Esclerose
19.
Brain Imaging Behav ; 14(5): 1521-1530, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30895444

RESUMO

Scam susceptibility places older adults - even those with intact cognition - at great risk. Lower grey matter volumes, particularly within right medial temporal regions, are associated with higher scam susceptibility; however, very little is known about white matter associates. We investigated associations between white matter integrity measured using diffusion tensor imaging (DTI) and scam susceptibility in 302 non-demented older adults (75% female; mean years: age = 81.3 + 7.5, education = 15.7 + 2.9). Participants completed comprehensive neuroimaging (including DTI, T1- and T2-weighted imaging), a self-report measure of scam susceptibility, and neuropsychological testing. Tract-Based Spatial Statistics (TBSS) investigated associations of DTI-derived measures of fractional anisotropy (FA), trace of the diffusion tensor, axial and radial diffusivity (separately) with scam susceptibility adjusting for age, sex, education, and white matter hyperintensities (WMH; total volume and voxelwise separately). Statistical significance was determined at p < 0.05, Family Wise Error corrected. TBSS revealed significant negative associations between FA in tracts connecting a number of right hemisphere white matter regions and scam susceptibility, particularly after additional adjustment for global cognitive functioning. The pathways implicated were mainly in right temporal-parietal and temporal-occipital regions. Association of trace, axial, and radial diffusivity with scam susceptibility were not significant in fully-adjusted models. Lower white matter integrity within right hemisphere tracts was associated with higher scam susceptibility independent of relevant confounds including global cognition. Thus, a right hemisphere brain network that includes key structures implicated in multi-sensory processing of immediate and future consequences may serve as a neurobiologic substrate of scam susceptibility in vulnerable older adults.

20.
Aging Clin Exp Res ; 32(5): 951-957, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31273677

RESUMO

BACKGROUND: Health and financial literacy are central to older adults' well-being and financial standing, but the relation of literacy with mortality in advanced age remains unclear. AIMS: To determine whether lower literacy, as reflected in measures of total literacy and subscales of health and financial literacy, was associated with an increased risk of mortality. METHODS: Participants were 931 community-based older adults from the Rush Memory and Aging Project [age: mean (SD) = 80.9 (7.6), range 58.8-100.8], an ongoing, prospective observational cohort study of aging. Participants were without dementia at the time literacy was assessed. Proportional hazards models were used to determine whether literacy measures were associated with mortality. RESULTS: During up to 8 years of follow-up, 224 (24.1% of 931) participants died. In models that adjusted for age, sex, and education, lower total, health, and financial literacy were each associated with an increased risk of mortality (total literacy: HR = 1.020, 95% CI 1.010-1.031, p < 0.001; health literacy: HR = 1.015, 95% CI 1.008-1.023, p < 0.001; financial literacy: HR = 1.013, 95% CI 1.003-1.023, p = 0.014). These associations persisted after additionally adjusting for income and indices of health status; however, only the association of lower health literacy with mortality persisted after further adjusting for a robust measure of global cognition. DISCUSSION: We suspect that the current associations of lower literacy with mortality reflect the detrimental effect of early pathologic brain aging on literacy. CONCLUSIONS: Lower literacy, particularly lower health literacy, is associated with mortality in advanced age.


Assuntos
Letramento em Saúde , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Cognição , Demência , Feminino , Letramento em Saúde/economia , Nível de Saúde , Humanos , Renda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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