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1.
Artigo em Inglês | MEDLINE | ID: mdl-32396611

RESUMO

We aimed to examine the relationship between APOE*4 carriage on cognitive decline, and whether these associations were moderated by sex, baseline age, ethnicity, and vascular risk factors. Participants were 19,225 individuals aged 54-103 years from 15 longitudinal cohort studies with a mean follow up duration ranging between 1.2 and 10.7 years. Two-step individual participant data (IPD) meta-analysis was used to pool results of study-wise analyses predicting memory and general cognitive decline from carriage of one or two APOE*4 alleles, and moderation of these associations by age, sex, vascular risk factors and ethnicity. Separate pooled estimates were calculated in both men and women who were younger (i.e., 62 years) and older (i.e., 80 years) at baseline. Results showed that APOE*4 carriage was related to faster general cognitive decline in women, and faster memory decline in men. A stronger dose-dependent effect was observed in older men, with faster general cognitive and memory decline in those carrying two versus one APOE*4 allele. Vascular risk factors were related to an increased effect of APOE*4 on memory decline in younger women, but a weaker effect of APOE*4 on general cognitive decline in older men. The relationship between APOE*4 carriage and memory decline was larger in older-aged Asians than Whites. In sum, APOE*4 is related to cognitive decline in men and women, although these effects are enhanced by age and carriage of two APOE*4 alleles in men, a higher numbers of vascular risk factors during the early stages of late adulthood in women, and Asian ethnicity.

2.
Exp Gerontol ; 137: 110948, 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32302664

RESUMO

BACKGROUND: Evidence suggests that better cognitive functioning is associated with better mobility in older age. It is unknown whether older adults with better cognitive function are more resilient to mobility decline after a fall. METHODS: Participants from the Monongahela Youghiogheny Healthy Aging Team (MYHAT) study were followed annually for up to 9 years for incident falls. We examined one-year (mean 1.0 year, SD 0.1) change in mobility pre- to post-fall using the Timed Up and Go (TUG) in relation to pre-fall cognition (executive function, attention, memory, and visuospatial function) among incident fallers (n = 598, mean age 79.1, SD = 7.0). Linear regression models tested the association of cognition with change in TUG. Interaction terms were tested to explore if age, sex, body mass index, physical activity, depressive symptoms, or visual acuity modified the associations of cognition and mobility among fallers. The association between cognition and one-year change in TUG was also tested in a comparison sample of non-fallers (n = 442, mean age 76.3, SD = 7.2). RESULTS: Overall, mobility decline was greater in fallers compared to non-fallers. In fully-adjusted models, higher executive function, but not attention, memory, or visuospatial function, was associated with less decline in mobility among incident fallers. The effect was significantly stronger for those who were older, sedentary, and had lower body mass index. Higher scores in memory tests, but not in other domains, was associated with less mobility decline among non-fallers. CONCLUSIONS: Higher executive function may offer resilience to mobility decline after a fall, especially among older adults with other risk factors for mobility decline. Future studies should assess whether executive function may be a helpful risk index of fall-related physical functional decline in geriatric settings.

3.
Alzheimer Dis Assoc Disord ; 33(4): 291-298, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31567145

RESUMO

BACKGROUND: Linear models cannot capture nonlinear associations when the relationships between cognition and risk factors vary across risk levels. We demonstrate a method of modelling nonlinear associations using the example of blood pressure (BP) and memory. METHODS: We measured memory and BP (in mm Hg) annually for 10 years in a population-based cohort (N=1982) aged 65+. We evaluated the relationship between BP and memory at the same time points using both linear mixed models and generalized additive mixed models with smoothing splines, adjusting for relevant covariates. RESULTS: Linear mixed models found no significant associations. Generalized additive mixed models detected different associations between BP and memory across baseline BP categories (normotensive, hypertensive, hypotensive). Among normotensives, systolic blood pressure (SBP)/diastolic blood pressure (DBP) around 140/80 was associated with the highest, while SBP/DBP around 110/60 was associated with the lowest, predicted memory scores. Among hypertensives, SBP/DBP around 130/85 was associated with the highest, while SBP/DBP around 150/65 was associated with the lowest, predicted memory scores. Among hypotensives, no significant association was found. Among both normotensives and hypertensives, a DBP >75 was associated with better memory. CONCLUSIONS: By modelling nonlinear associations, we showed that the relationship between BP and memory performance varied by baseline BP among normotensives and hypertensives.

4.
PLoS Med ; 16(7): e1002853, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31335910

RESUMO

BACKGROUND: With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. METHODS AND FINDINGS: We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. CONCLUSIONS: These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.


Assuntos
Cognição , Disfunção Cognitiva/etnologia , Grupos Étnicos/psicologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Comorbidade , Diabetes Mellitus/etnologia , Exercício Físico , Feminino , Educação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/etnologia , Acidente Vascular Cerebral/etnologia
5.
J Am Geriatr Soc ; 67(2): 232-238, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30444944

RESUMO

BACKGROUND/OBJECTIVE: In population studies, most individuals with mild cognitive impairment (MCI) do not progress to dementia in the near term, but rather remain stable MCI or revert to normal cognition. Here, we characterized MCI subgroups with different outcomes over 5 years. SETTING/PARTICIPANTS: A population-based cohort (N=1603). MEASUREMENTS: Clinical Dementia Rating (CDR); self-reported medical conditions, subjective cognitive concerns, self-rated health, depressive symptoms, blood pressure, medications, blood pressure, APOE genotype, cognitive domain composite scores. DESIGN: We compared 3 MCI subgroups who progressed to dementia (n=86), stabilized at MCI (n=384), or reverted to normal (n=252), to those who remained consistently normal (n=881), defining MCI as CDR = 0.5 and dementia as CDR≥1. Using multinomial logistic regression models adjusted for demographics, we examined the associations of each group with selected baseline characteristics. RESULTS: With the normal group for reference, worse subjective cognitive concerns, functional impairments, self-rated health, and depressive symptoms were associated with being in any MCI group. Taking more prescription medications was associated with being in the stable MCI and reverter groups; diabetes and low diastolic blood pressure were associated with stable MCI. The APOE4 genotype was associated with stable and progressive MCI; stroke was associated with progressive MCI. All MCI subgroups were likely to have lower mean composite scores in all cognitive domains and more operationally defined impairments in attention, language, and executive function; reverters were more likely to lack memory and visuospatial impairments. CONCLUSIONS: MCI subgroups with different 5-year outcomes had some distinct characteristics suggesting different underlying causes. The progressors, unlike the reverters, had a profile broadly typical of Alzheimer's disease; the stable MCIs had other, including vascular, morbidity. These data shed light on the heterogeneity of MCI in the population. J Am Geriatr Soc 67:232-238, 2019.


Assuntos
Cognição , Disfunção Cognitiva/psicologia , Demência/epidemiologia , Progressão da Doença , Idoso , Idoso de 80 Anos ou mais , Apolipoproteína E4/análise , Pressão Sanguínea , Disfunção Cognitiva/genética , Disfunção Cognitiva/fisiopatologia , Estudos de Coortes , Demência/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia
6.
J Gerontol A Biol Sci Med Sci ; 74(9): 1439-1445, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-30312371

RESUMO

BACKGROUND: Incidence rates of dementia appear to be declining in high-income countries according to several large epidemiological studies. We aimed to describe declining incident dementia rates across successive birth cohorts in a U.S. population-based sample and to explore the influences of sex and education on these trends. METHODS: We pooled data from two community-sampled prospective cohort studies with similar study aims and contiguous sampling regions: the Monongahela Valley Independent Elders Survey (1987-2001) and the Monongahela-Youghiogheny Healthy Aging Team (2006-Ongoing). We identified four decade-long birth cohorts spanning birth years 1902-1941. In an analysis sample of 3,010 participants (61% women, mean baseline age = 75.7 years, mean follow-up = 7.1 years), we identified 257 cases of incident dementia indicated by a Clinical Dementia Rating of 1.0 or higher. We used Poisson regression to model incident dementia rates by birth cohort, age, sex, education, and interactions of Sex × Cohort and Sex × Education. We further examined whether cohort effects varied by education, testing a Cohort × Education interaction and stratifying the models by education. RESULTS: Compared to the earliest birth cohort (1902-1911), each subsequent cohort had a significantly lower incident dementia rate (1912-1921: incidence rate ratio [IRR] = 0.655, 95% confidence interval [95% CI] = 0.477-0.899; 1922-1931: IRR = 0.387, 95% CI = 0.265-0.564; 1932-1941: IRR = 0.233, 95% CI = 0.121-0.449). We observed no significant interactions of either sex or education with birth cohort. CONCLUSIONS: A decline in incident dementia rates was observed across successive birth cohorts independent of sex, education, and age.

7.
Alzheimers Dement ; 14(6): 734-742, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29352855

RESUMO

INTRODUCTION: We compared risk of progression from subjective cognitive decline (SCD) to mild cognitive impairment (MCI) in an academic memory clinic versus a population-based study. METHODS: Older adults presenting at a memory clinic were classified as SCD (n = 113) or as noncomplainers (n = 82). Participants from a population study were classified as SCD (n = 592) and noncomplainers (n = 589) based on a memory complaint score. Annual follow-up performed for a mean of 3 years. RESULTS: The adjusted hazard ratio for SCD was 15.97 (95% confidence interval: 6.08-42.02, P < .001) in the memory clinic versus 1.18 (95% confidence interval: 1.00-1.40, P = .047) in the population study, where reported "worry" about memory further increased SCD-associated risk for MCI. DISCUSSION: SCD is more likely to progress to MCI in a memory clinic than the general population; participants' characteristics vary across settings. Study setting should be considered when evaluating SCD as a risk state for MCI and dementia.


Assuntos
Disfunção Cognitiva/classificação , Progressão da Doença , Transtornos da Memória/classificação , Idoso , Instituições de Assistência Ambulatorial , Disfunção Cognitiva/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Fatores de Risco , Estados Unidos/epidemiologia
8.
Alzheimer Dis Assoc Disord ; 32(2): 137-144, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29028647

RESUMO

Engagement in cognitively stimulating activities is gaining prominence as a potential strategy to maintain cognitive functioning in old age. In a population-based cohort of individuals aged 65+ years, we examined patterns of change in frequency of engagement in total cognitive activity (TCA), higher cognitive activity (HCA), and frequent cognitive activity (FCA) based on the Florida Cognitive Activities Scale over an average of 3.62 years, and whether these patterns were associated with incident mild cognitive impairment (MCI) during this same period. Among 867 cognitively normal participants, 129 (15%) progressed to MCI. Latent class trajectory modeling identified high and stable, slowly, and quickly declining patterns for TCA; high and stable, slowly declining, and slowing increasing patterns for FCA; and high and stable, and slowly declining patterns for HCA. Separate, adjusted Cox proportional hazard models, revealed that compared with the high, stable pattern, both slow decline [hazard ratio (HR), 2.5; 95% confidence interval (CI), 1.5-4.0] and quick decline (HR, 11.0; 95% CI, 6.3-19.2) in TCA, and slow decline in the FCA (HR, 8.7; 95% CI, 5.3-14.3) and HCA (HR, 3.4; 95% CI, 2.0-5.6) subscales increased risk for incident MCI. Maintaining engagement in cognitive activities may be protective against progression to MCI, alternatively, declining engagement may be a marker for impending cognitive impairment.


Assuntos
Cognição/fisiologia , Disfunção Cognitiva/prevenção & controle , Disfunção Cognitiva/psicologia , Envelhecimento Saudável/fisiologia , Testes Neuropsicológicos/estatística & dados numéricos , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pennsylvania , Estudos Prospectivos , Fatores de Risco
9.
Int Psychogeriatr ; 29(1): 137-148, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27725002

RESUMO

BACKGROUND: In many developed countries, cognitive functioning (as measured by neuropsychological tests) appears to be improving over time in the population at large, in parallel with the declining age-specific incidence of dementia. Here, we investigated cohort effects in the age-associated trajectories of verbal memory function in older adults. We sought to determine whether they varied by decade of birth and, if so, whether the change would be explained by increasing educational attainment. METHODS: Pooling data from two prospective US population-based studies between 1987 and 2015, we identified four birth cohorts born 1902-1911, 1912-1921, 1922-1931, and 1932-1943. Among these cohorts, we compared age-associated trajectories both of performance and of practice effects on immediate and delayed recall of a 10-item Word List. We used mixed effects models, first including birth cohorts and cohort X age interaction terms, and then controlling for education and education X age interaction. RESULTS: We observed significant cohort effects in performance (baseline and age-associated trajectories) in both immediate recall and delayed recall, with function improving between the earliest- and latest-born cohorts. For both tests, we also observed cohort effects on practice effects with the highest levels in the latest-born cohorts. Including education in the models did not attenuate these effects. CONCLUSIONS: In this longitudinal population study, across four decade-long birth cohorts, there were significant improvements in test performance and practice effects in verbal memory tests, not explained by education. Whether this reflects declining disease incidence or other secular trends awaits further investigation.


Assuntos
Envelhecimento/psicologia , Cognição/fisiologia , Efeito de Coortes , Memória de Curto Prazo/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Pennsylvania , Estudos Prospectivos , Inquéritos e Questionários
10.
J Int Neuropsychol Soc ; 21(9): 732-42, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26477680

RESUMO

The relationship between subjective memory complaints (SM) and objective memory (OM) performance in aging has been variably characterized in a substantial literature, to date. In particular, cross-sectional studies often observe weak or no associations. We investigated whether subjective memory complaints and objectively measured cognition influence each other over time, and if so, which is the stronger pathway of change-objective to subjective, or subjective to objective-or whether they are both important. Using bivariate latent change score modeling in data from a population study (N=1980) over 5 annual assessment cycles, we tested four corresponding hypotheses: (1) no coupling between SM and OM over time; (2) SM as leading indicator of change in OM; (3) OM as leading indicator of change in SM; (4) dual coupling over time, with both SM and OM leading subsequent change in the other. We also extended objective cognition to two other domains, language and executive functions. The dual-coupling models best fit the data for all three objective cognitive domains. The SM-OM temporal dynamics differ qualitatively compared to other domains, potentially reflecting changes in insight and self-awareness specific to memory impairment. Subjective memory and objective cognition reciprocally influence each other over time. The temporal dynamics between subjective and objective cognition in aging are nuanced, and must be carefully disentangled to shed light on the underlying processes.


Assuntos
Transtornos Cognitivos/complicações , Transtornos da Memória/complicações , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Função Executiva , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Fatores de Tempo
11.
Alzheimers Dement ; 11(11): 1377-84, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25684687

RESUMO

INTRODUCTION: The objective of this study was to examine the independent and combined influences of late-life cognitive activity (CA) and physical activity (PA) on the risk of incident mild cognitive impairment (MCI). METHODS: We used interval censored survival modeling to examine the risk of incident MCI (Clinical Dementia Rating [CDR] = 0.5) as a function of CA (high vs. low) and at least moderate intensity PA (any vs. none) among 864 cognitively normal (CDR = 0) older adults. RESULTS: During three annual follow-up waves, 72 participants developed MCI. Compared with low CA with no PA, significant reductions in risk for MCI were observed for high CA with any PA (hazards ratio (HR) = 0.20, 95% confidence interval (CI) 0.07-0.52) and low CA with any PA (HR = 0.52, 95% CI 0.29-0.93), but not for high CA without PA (HR = 0.94, 95% CI 0.45-1.95). DISCUSSION: These findings suggest that a combination of CA and PA may be most efficacious at reducing the risk for cognitive impairment.


Assuntos
Cognição , Disfunção Cognitiva/epidemiologia , Atividade Motora , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Entrevista Psiquiátrica Padronizada , Pennsylvania/epidemiologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida
12.
Act Adapt Aging ; 39(2): 109-132, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26823639

RESUMO

This qualitative study examines older adults' subjective views on the types and purposes of social activities. In-depth interviews were conducted with a purposive sample of 20 older adults, with low (n = 10) and high (n = 10) memory performance. We used grounded theory methods to analyze the narrative data. Four types of social activities-Altruism, Creativity, Game, and Motion-were identified. The purpose of social activities included enjoyment, relaxation, stimulation, and belongingness. Those in the low memory group seemed to face more barriers to participation. Different types of social activities may be important for cognitive health and well-being.

13.
Neurology ; 84(1): 72-80, 2015 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-25471390

RESUMO

OBJECTIVE: To estimate rate of progression from normal cognition or mild impairment to dementia, and to identify potential risk and protective factors for incident dementia, based on age at dementia onset in a prospective study of a population-based cohort (n = 1,982) aged 65 years and older. METHODS: Following the cohort annually for up to 5 years, we estimated incidence of dementia (Clinical Dementia Rating ≥1) among individuals previously normal or mildly impaired (Clinical Dementia Rating 0 or 0.5). In the whole cohort, and also stratified by median onset age, we examined several vascular, metabolic, and inflammatory variables as potential risk factors for developing dementia, using interval-censored survival models. RESULTS: Based on 67 incident cases of dementia, incidence rate (per 1,000 person-years) was 10.0 overall, 5.8 in those with median onset age of 87 years or younger, and 31.5 in those with onset age after 87 years. Adjusting for demographics, the risk of incident dementia with onset age of 87 years or younger (n = 33) was significantly increased by baseline smoking, stroke, low systolic blood pressure, and APOE*4 genotype, and reduced by current alcohol use. Among those with dementia with onset after 87 years (n = 34), no risk or protective factor was significant. CONCLUSION: Risk and protective factors were only found for incident dementia with onset before the median onset age of 87 years, and not for those with later onset. Either unexplored risk factors explain the continued increase in incidence with age, or unknown protective factors are allowing some individuals to delay onset into very old age.


Assuntos
Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Fatores Etários , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Apolipoproteína E4/genética , Pressão Sanguínea , Estudos de Coortes , Demência/genética , Progressão da Doença , Feminino , Predisposição Genética para Doença , Humanos , Hipotensão/epidemiologia , Masculino , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia
14.
Alzheimer Dis Assoc Disord ; 28(2): 113-21, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24521821

RESUMO

BACKGROUND: The International Working Group (IWG) criteria for mild cognitive impairment have variable utility in predicting progression to dementia, partly depending on the setting. We explored an empiric approach to optimize the criteria and cutoff points in a population study. METHODS: In a cohort of adults aged 65 years or older, we identified 1129 individuals with normal or only mildly impaired cognition by cognitive classification, and 1146 individuals without dementia (Clinical Dementia Rating <1). Operationally defining the IWG criterion set, we examined its sensitivity and specificity for the development of severe cognitive impairment and dementia (Clinical Dementia Rating ≥1) over 4 years. We then disaggregated the criteria and used Classification and Regression Tree analyses to identify the optimal predictive model. RESULTS: The operational IWG criteria had 49% sensitivity and 86% specificity for the outcome of severe cognitive impairment, and 40% sensitivity and 84% specificity for the outcome of dementia. Classification and Regression Tree modeling improved sensitivity to 82% for the cognitive outcome and 76% for the dementia outcome; specificity remained high. Memory scores were the most important predictors for both outcomes. The optimal cutoff points were around 1.0 SD below the age-education mean. The best fit was observed when prediction was modeled separately for each age-education group. CONCLUSIONS: Objective cognitive measurements contributed more to the prediction of dementia than subjective and functional measures. Those with less education only required memory testing, whereas those with more education required assessment of several cognitive domains. In cases in which only overall norms are available, the appropriate threshold will vary according to the individual's age and education.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Valor Preditivo dos Testes , Análise de Regressão , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade
15.
Int J Geriatr Psychiatry ; 29(9): 890-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24452845

RESUMO

OBJECTIVE: We evaluated the feasibility of a trial of Wii interactive video gaming, and its potential efficacy at improving cognitive functioning compared with health education, in a community sample of older adults with neuropsychologically defined mild cognitive impairment. METHODS: Twenty older adults were equally randomized to either group-based interactive video gaming or health education for 90 min each week for 24 weeks. Although the primary outcomes were related to study feasibility, we also explored the effect of the intervention on neuropsychological performance and other secondary outcomes. RESULTS: All 20 participants completed the intervention, and 18 attended at least 80% of the sessions. The majority (80%) of participants were "very much" satisfied with the intervention. Bowling was enjoyed by the most participants and was also rated the highest among the games for mental, social, and physical stimulation. We observed medium effect sizes for cognitive and physical functioning in favor of the interactive video gaming condition, but these effects were not statistically significant in this small sample. CONCLUSION: Interactive video gaming is feasible for older adults with mild cognitive impairment, and medium effect sizes in favor of the Wii group warrant a larger efficacy trial.


Assuntos
Disfunção Cognitiva/reabilitação , Educação em Saúde , Jogos de Vídeo , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Disfunção Cognitiva/fisiopatologia , Estudos de Viabilidade , Feminino , Marcha , Educação em Saúde/métodos , Humanos , Masculino , Satisfação do Paciente , Comportamento Social
16.
Am J Geriatr Psychiatry ; 22(3): 274-84, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23759435

RESUMO

OBJECTIVE: To disentangle the complex associations of depression and anxiety with mild cognitive impairment (MCI) at the population level. We examined subgroups of anxiety symptoms and depression symptom profiles in relation to MCI, which we defined using both cognitive and functional approaches. METHODS: We used an epidemiologic, cross-sectional study with an age-stratified, random, population-based sample of 1,982 individuals aged 65 years and over. Three definitions of MCI were used: 1) a purely cognitive classification into amnestic and nonamnestic MCI, 2) a combined cognitive-functional definition by International Working Group (IWG) criteria, and 3) a purely functional definition by the Clinical Dementia Rating (CDR) of 0.5. Three depression profiles were identified by factor analysis of the modified Center for Epidemiological Studies-Depression Scale: core mood, self-esteem/interpersonal, and apathy/neurovegetative profiles. Three anxiety groups, chronic mild worry, chronic severe anxiety, and recent-onset anxiety, were based on screening questions. RESULTS: Recent-onset anxiety was associated with MCI by nonamnestic and IWG criteria, chronic severe anxiety was associated with MCI by all definitions, and chronic mild worry was associated with none. Of the depression profiles, the core mood profile was associated with CDR-defined MCI, the apathy/neurovegetative profile was associated with MCI by amnestic, IWG, and CDR definitions, and the self-esteem/interpersonal profile was associated with none. CONCLUSION: In this population-based sample, subgroups with different anxiety and depression profiles had different relationships with cognitive and functional definitions of MCI. Anxiety, depression, and MCI are all multidimensional entities, interacting in complex ways that may shed light on underlying neural mechanisms.


Assuntos
Ansiedade/diagnóstico , Disfunção Cognitiva/diagnóstico , Depressão/diagnóstico , Avaliação de Sintomas/psicologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Ansiedade/complicações , Disfunção Cognitiva/complicações , Estudos Transversais , Depressão/complicações , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica
17.
Alzheimer Dis Assoc Disord ; 28(1): 9-15, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24126216

RESUMO

We examined several vascular factors in relation to the rates of decline in 5 cognitive domains in a population-based cohort. In an age-stratified random sample (N=1982) aged 65+ years, we assessed at baseline the cognitive domains of attention, executive function, memory, language, and visuospatial function, and also vascular, inflammatory, and metabolic indices. Random effects models generated slopes of cognitive decline over the next 4 years; linear models identified vascular factors associated with these slopes, adjusting for demographics, baseline cognition, and potential interactions. Several vascular risk factors (history of stroke, diabetes, central obesity, C-reactive protein), although associated with lower baseline cognitive performance, did not predict rate of subsequent decline. APOE*4 genotype was associated with accelerated decline in language, memory, and executive functions. Homocysteine elevation was associated with faster decline in executive function. Hypertension (history or systolic blood pressure >140 mm Hg) was associated with slower decline in memory. Baseline alcohol consumption was associated with slower decline in attention, language, and memory. Different indices of vascular risk are associated with low performance and with rates of decline in different cognitive domains. Cardiovascular mechanisms explain at least some of the variance in cognitive decline. Selective survival may also play a role.


Assuntos
Doenças Cardiovasculares/epidemiologia , Transtornos Cognitivos/epidemiologia , Cognição , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/complicações , Transtornos Cognitivos/etiologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Fatores de Risco
18.
Neurology ; 80(23): 2112-20, 2013 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-23658380

RESUMO

OBJECTIVE: We examined the incidence of mild cognitive impairment (MCI) and its potential vascular risk factors in a prospective population-based study. METHODS: An age-stratified random population-based cohort (baseline n = 1,982), followed for up to 4 years, was annually assessed for cognitive and everyday functioning. Incidence rates were calculated for both cognitive (neuropsychological [NP]-MCI) and functional (Clinical Dementia Rating [CDR] = 0.5) definitions of MCI. Several measures of vascular, metabolic, and inflammatory risk were assessed at baseline. Risk factor analyses used interval censoring survival models, followed by joint modeling of both MCI and attrition due to mortality and illness. RESULTS: Incidence rates for NP-MCI and CDR = 0.5 were 95 and 55 per 1,000 person-years. In individual joint models, risk factors for NP-MCI were diabetes and adiposity (waist: hip ratio), while APOE ε4 genotype and heart failure increased risk of attrition. Adiposity, stroke, heart failure, and diabetes were risk factors for nonamnestic MCI. For CDR = 0.5, risk factors were stroke and heart failure; heart failure and adiposity increased risk of attrition. In multivariable joint models combining all risk factors, adiposity increased risk of NP-MCI, while stroke and heart failure increased risk for CDR = 0.5. Current alcohol use appeared protective against all subtypes. CONCLUSION: Incidence of MCI increased with age regardless of definition and did not vary by sex or education. Several vascular risk factors elevated the risk of incident MCI, whether defined cognitively or functionally, but most were associated with nonamnestic MCI and CDR = 0.5. Controlling vascular risk may potentially reduce risk of MCI.


Assuntos
Disfunção Cognitiva/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/mortalidade , Disfunção Cognitiva/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Modelos Estatísticos , Testes Neuropsicológicos , Pennsylvania/epidemiologia , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fatores de Tempo
19.
Int Psychogeriatr ; 25(4): 587-95, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23257280

RESUMO

BACKGROUND: It is of considerable public health importance to prevent or delay the progression of mild cognitive impairment (MCI) to more severely impaired cognitive states. This study examines the risk of progression from mild to severe cognitive impairment in relation to engagement in social activities while mildly impaired and the concurrence of subsequent change in engagement with MCI progression. METHODS: Participants were 816 older adults with cognitively defined MCI (mean age 78.0 (standard deviation or SD = 7.4) years) from the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) Study--a prospective cohort study of MCI in the community. Over three years of follow-up, 78 individuals progressed from MCI to severe cognitive impairment, while 738 did not progress. Risk of progression was estimated using discrete time survival analyses. The main predictors were standardized composite measures of the variety and frequency of engagement in social activities. RESULTS: Lower risk of progression from mild to severe cognitive impairment was associated with both a greater level of frequency of engagement in social activities while mildly impaired (OR = 0.72, 95% CI: 0.55-0.93, p = 0.01) and also with a slower rate of decline in the variety of activities over time (OR = 0.01, 95% CI: <0.001-0.38, p = 0.02). CONCLUSIONS: Greater engagement in social activities may potentially be beneficial for preventing or delaying further cognitive decline among older adults with MCI. Alternatively, lesser engagement in social activities may be a marker of impending cognitive decline in MCI.


Assuntos
Transtornos Cognitivos/prevenção & controle , Transtornos Cognitivos/psicologia , Disfunção Cognitiva/psicologia , Relações Interpessoais , Participação Social/psicologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Depressão/diagnóstico , Depressão/psicologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Testes Neuropsicológicos , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Comportamento Social , Apoio Social , Fatores Socioeconômicos
20.
Am J Geriatr Psychiatry ; 20(10): 836-44, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22337146

RESUMO

OBJECTIVE: : A key component of successful aging is the ability to independently perform instrumental activities of daily living (IADL). We examined the ability to perform multiple IADL tasks in relation to mild cognitive impairment (MCI) defined on purely neuropsychological grounds. DESIGN: : Cross-sectional study. SETTING: : Population-based cohort in southwestern Pennsylvania. PARTICIPANTS: : One thousand seven hundred thirty-seven community-dwelling adults age 65 years and older. MEASUREMENTS: : Classification of MCI based on performance with reference to norms in the cognitive domains of memory, language, attention, executive, and visuospatial functions. The ability to perform seven IADL tasks (traveling, shopping, preparing meals, doing housework, taking medications, handling personal finances, and using the telephone) as assessed by the Older Americans Resources and Services scale. RESULTS: : Those with cognitively defined MCI were more likely to be dependent in at least one IADL task, as well as in each individual IADL task, than cognitively normal participants. Better memory and executive functioning were associated with lower odds of IADL dependence in MCI. Across the subtypes of MCI, those with the multiple-domain amnestic subtype were most likely to be dependent in all IADL tasks, with better executive functioning associated with lower risk of dependence in select IADL tasks in this group. CONCLUSIONS: : Mild impairment in cognition is associated with difficulty performing IADL tasks at the population level. Understanding these associations may help improve prediction of the outcomes of MCI. It may also allow appropriate targeting of cognitive interventions in MCI to potentially help preserve functional independence.


Assuntos
Atividades Cotidianas/psicologia , Disfunção Cognitiva/psicologia , Características de Residência , Idoso , Idoso de 80 Anos ou mais , Amnésia/complicações , Amnésia/psicologia , Cognição , Disfunção Cognitiva/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Testes Neuropsicológicos/estatística & dados numéricos , Pennsylvania , Desempenho Psicomotor
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