‘A little bit of empathy and compassion would go a long way’: emotional and psychosocial experiences of money management and cognitive decline in later life

Social connectedness and cognitive decline

Depressive symptoms and cognitive decline: A longitudinal analysis of potentially modifiable risk factors in community dwelling older adults

The ‘third wave’: impending cognitive and functional decline in COVID-19 survivors

With the rapid ageing of the world's population, investigating protective factors that may prevent or delay age-related disorders has become a new public health priority. Dementia is a common age-related disorder, affecting up to one in every two people reaching 80 years of age or above. Amongst the various potential 'protective factors' currently under investigation, physical activity seems to hold promise for the primary and the secondary prevention of dementia. This paper critically reviews the evidence in support of the association between exercise and cognitive decline/dementia, as reported by cohort studies or clinical trials. The results of cohort studies show that physical activity is associated with better cognitive function and less cognitive decline in later life although there is only scant evidence suggesting that physical activity may in fact reduce the risk of dementia and Alzheimer's disease. In addition, data to support the systematic introduction of physical activity programmes to reduce the risk of dementia in later life are not as yet available from randomized clinical trials. The results of observational studies are largely consistent with the hypothesis that physical activity reduces the risk of cognitive decline and dementia in later life. These findings are, however, not as yet adequately supported by data from randomized clinical trials.

Measures of cardiac ventricular electrophysiology have been associated with cognitive performance in cross-sectional studies. We sought to evaluate the association of worsening ventricular repolarization in midlife, as measured by incident prolonged QT interval, with cognitive decline in late life. Midlife QT interval was assessed by electrocardiography during three study visits from 1965/68 to 1971/74 in a cohort of Japanese American men aged 46-68 at Exam 1 from the Honolulu Heart Study. We defined incident prolonged QT as the QT interval in the upper quartile at Exam 2 or 3 after QT interval in lower three quartiles at Exam 1. Cognitive performance was assessed at least once using the Cognitive Abilities Screening Instrument (CASI), scored using item response theory (CASI-IRT), during four subsequent visits from 1991/93 to 1999/2000 among 2,511 of the 4,737 men in the Honolulu-Asia Aging Study otherwise eligible for inclusion in analyses. We used marginal structural modeling to determine the association of incident prolonged QT with cognitive decline, using weighting to account for confounding and attrition. Incident prolonged QT interval in midlife was not associated with late-life CASI-IRT at cognitive baseline (estimated difference in CASI-IRT: 0.04; 95% CI: -0.28, 0.35; p = 0.81), or change in CASI-IRT over time (estimated difference in annual change in CASI-IRT: -0.002; 95%CI: -0.013, 0.010; p = 0.79). Findings were consistent across sensitivity analyses. Although many midlife cardiovascular risk factors and cardiac structure and function measures are associated with late-life cognitive decline, incident prolonged QT interval in midlife was not associated with late-life cognitive performance or cognitive decline.

Smoke-free hospitality environments and cognitive health: A population-based study in the United States.

Late‐life social activity moderates the association between temporal lobe atrophy and episodic memory decline

BackgroundWhether history of adverse pregnancy outcomes (APOs) contributes to cognitive decline in later life is not understood because few cohorts have information on pregnancy history and later‐life cognition. We hypothesized that history of any APO would be related to lower global cognition and faster cognitive decline among older adults, compared to no APO history.MethodThe Adult Changes in Thought (ACT) Study is a prospective cohort study embedded in an integrated health care system of adults aged 65 and older without dementia at enrollment. Among ACT participants enrolled between 1994 and 2020 (n = 5,763, 58% women), women eligible for our study were born in 1940 or later, had evidence of ≥1 child or pregnancy, and had maternal or pregnancy information in their medical record (n = 444). APOs of interest were preterm birth, hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia), low birth weight, small for gestational age, and stillbirth. Cognition at ACT enrollment and every two years thereafter was assessed by the Cognitive Abilities Screening Instrument, a 40‐item instrument of global cognition, further processed using item‐response theory (CASI‐IRT); points are standard deviation units of CASI‐IRT in the study population. We fit linear models using generalized estimating equations to assess associations between history of any APO with (1) cognition score and (2) cognitive decline.ResultAmong eligible participants, 13% had a history of any APO. Among people of the same age, birth cohort, education, and marital status, CASI‐IRT scores were expected to be 0.23 point lower (95% CI: ‐0.54, 0.07) among people with a history of APOs than those without; this difference did not reach statistical significance. Expected 4‐year rates of cognitive change among people with a history of APOs [‐0.01; 95% CI ‐0.25, 0.23] was not found to differ significantly from those without [0.02; 95% CI ‐0.05, 0.09].ConclusionThere is some inconclusive evidence that history of any APO may be associated with lower cognition level in older adulthood. We failed to find any convincing evidence of the association between history of APOs and the rate of cognitive decline.

Mechanisms of Healthy Aging: An Integrated Neurobiological Perspective on Mood and Cognitive Function

Introduction Sleep disturbances are linked to suicidal ideation and depression in older adults. Depression is also linked to contemplation of suicide and suicidal behavior. While there are complex, bi-directional relationships between sleep, depression, and suicide risk, these relationships have yet to be measured in well-defined suicide risk groups in late life. This study explored the association between sleep and suicidal ideation using actigraphy and digital sleep diaries via a 3-week ecological momentary assessment protocol. Methods Participants included 72 older adults (M±SD=65.3± 6.5 years) with clinical depression, defined by a Hamilton Rating Scale for Depression (HRSD) score≥14. Forty-six percent (n=33) of participants had a lifetime suicide attempt. Actigraphic recordings of sleep including sleep duration and sleep efficiency were measured using Philips Spectrum Plus/ Pro actiwatches. Sleep diaries were completed in the morning, including sleep quality. Clinician-administered assessments of suicidal ideation (Scale for Suicidal ideation [SSI]) and depression (HRSD) were collected weekly, for 3 weeks. Mixed effect regression models were used to assess the associations between daily/weekly measures of sleep and suicidal ideation. Results Results: Thirty eight percent of participants reported experiencing suicidal ideation (SSI score ≥ 2) during the 3-week protocol. Presence of suicidal ideation was significantly associated with sleep duration. On the aggregate over 3 weeks, ideators had greater sleep duration (M±SD = 441.00±77.29) relative to non-ideators (M±SD=404.82±68.94); t = -2.071,df=70: p =.042. Among ideators, longer sleep duration was significantly associated with greater severity of suicidal ideation the next day (b=0.011, SE=0.004, t=2.54, df=80, p=0.013), Poor sleep quality the night prior to completing the SSI was also associated with the presence of suicidal ideation (OR=0.71, 95% CI: 0.51-0.99, z=-2.03, p=0.043). Conclusion Longer sleep duration was predictive of suicidal ideation in weekly and daily models. Long sleep is a symptom of atypical depression and associated with cardiovascular disease, cancer, and cognitive decline in late life, among others. Long sleep duration may compensate for poor sleep quality, which was associated with suicidal ideation in our sample of depressed older adults. Future research should replicate the above findings and verify mechanisms linking long sleep to suicidal ideation in older adults. Support (if any) R01 MH085651

Changes in cognitive function among older adults: A latent profile transition analysis

BackgroundVisual impairment has been associated with lower cognitive ability among older adults, yet little is known about whether improving visual function with cataract surgery would be associated with slower cognitive decline. This study aimed to assess whether trajectories of cognitive decline differed before and after cataract surgery and compare those trajectories between older adults with cataract surgery and without cataract.Methods and findingsData were drawn from the English Longitudinal Study of Ageing (ELSA) Wave 1 (2002/03) until Wave 7 (2014/15). The study population consisted of 2,068 individuals who underwent cataract surgery between Wave 2 and Wave 6 as the treatment group and 3,636 individuals with no cataract as the control group. We included only respondents who took part in a minimum three waves. Propensity score matching method was used to match the individuals in the treatment group with those in the control group. After we put an “artificial” intervention point for the individuals in the control group at the point that the matched person has cataract surgery, spline method was used to identify differences in cognitive trajectories pre- and post-cataract surgery. In the treatment group, we found that cataract surgery was positively associated with episodic memory scores after controlling for the potential covariates (β = 4.23, p<0.001). Episodic memory scores declined with older age, but the decline in episodic memory scores was slower after cataract surgery (β = -0.05, p<0.001) than before cataract surgery (β = -0.1, p<0.001). Although the episodic memory among respondents in the control group before intervention (β = -0.08, p<0.001) declined slower than those in the intervention group (β = -0.1, p<0.001), the declines in episodic memory scores were similar in both groups after the intervention (control: β = -0.05, p<0.001; intervention: β = -0.05, p<0.001).ConclusionsCataract surgery may have a positive impact on trajectories of cognitive decline in later life. Further research is required to identify the mechanism to explain the association between cataract surgery and cognitive ageing, and whether early intervention towards vision correction results in a reduction in dementia risk.

The growth in the aging population in the coming years represents a significant public health policy issue as more and more older adults wish to age in place. Additionally, as more older adults live longer, more older adults are living at home alone. Cognitive function and cognitive decline in later life represent additional challenges to the vulnerable elderly. As the health care system grapples to meet the needs of a growing aging population, the nursing profession can play an important role in health promotion and prevention efforts in cognition and aging. Given the need to advance more routine screening and assessment of cognition in later life, nurses are well poised to advance science and research and support recommendations for assessing cognitive function and cognitive decline in order to support safe and autonomous living in advanced age.

Aging has independently been associated with regional brain atrophy, reduced non-rapid eye movement (NREM) slow-wave activity (SWA), and impaired long-term retention of episodic memories. However, that the interaction of these factors represents a neuropatholgical pathway associated with cognitive decline in later life remains unknown. Here, we show that age-related medial prefrontal cortex (mPFC) grey-matter atrophy is associated with reduced NREM SWA activity in older adults, the extent to which statistically mediates the impairment of overnight sleep-dependent memory retention. Moreover, this memory impairment was further associated with persistent hippocampal activation and reduced task-related hippocampal-prefrontal cortex connectivity, potentially representing impoverished hippocampal-neocortical memory transformation. Together, these data support a model in which age-related mPFC atrophy diminishes SWA, the functional consequence of which is impaired long-term memory. Such findings suggest that sleep disruption in the elderly, mediated by structural brain changes, represent a novel contributing factor to age-related cognitive decline in later life.

The present study aimed to examine the current status and influencing mechanisms of different demographic factors associated with cognitive function in urban Chinese older adults. A total of 644 older adults from 14 communities in urban China (e.g., Shanghai, Beijing, and Wuxi) were investigated by using the Mini-Mental State Examination and the Repeatable Battery for the Assessment of Neuropsychological Status. The results indicated that the overall cognitive function of older adults in urban China was normal. We found an aging effect on cognitive level, and cognitive function declined more rapidly after age 80. Older age, unmarried status, and lower occupational cognitive requirements increased the likelihood of cognitive risk. Higher educational levels and active engagement in exercise may contribute to cognitive reserve and have a protective effect on cognitive decline in late life. Further study is needed to develop appropriate interventions to improve the mental health of older people.