The relationships between cognitive functioning and decision making under value-based conditions in older adults: Findings based on a psychometric network analysis

BackgroundCognitive decline is a typical aging‐related condition in older adults. Maintaining or improving the cognitive function of older adults has been a major focus of older adults’ welfare policy. Examining predictors of deteriorating older adults’ cognitive decline is critical to support healthcare policies. This study aims to identify predictors of cognitive function in community‐dwelling older adults using machine learning algorithms.MethodWe extracted 6,940 older adults’ demographic and clinical characteristics from the 2018 Korean Longitudinal Study of Aging (KLoSA). We utilized the final sample of 4,282 older adults by removing the missing observations in the study variables (n = 2,658, 38.3%). The dependent variable was the Mini‐Mental State Examination‐K (MMSE‐K), and the independent variables included demographic characteristics, grip strength, the Center for Epidemiologic Studies Depression Scale (CES‐D) score, life habit, presence of chronic disease, and social participations. We used two machine learning (ML) algorithms: random forest and classification and regression tree (CART) to predict older adults’ cognitive function. Mean absolute error (MAE) and root mean square error (RMSE) were used to compare the model accuracy of those machine learning algorithms.ResultThe mean age was 75.7 years (SD = 8.1) with more females in the sample (n = 2,376, 55.5%). The random forest model performed better than CART (MSE: 3.0 and 3.3 and RMSE: 4.0 and 4.4 for random forest and CART sequentially). The random forest model identified the CES‐D, age, grip strength, educational attainment, self‐reported health, residential area, and social participations as predictors of older adults’ cognitive function (the degrees of predictor importance were in order).ConclusionThis study presents a list of predictors for cognitive function in community‐dwelling older adults. Among various predictors, depression in older adults was the most influential variable in predicting older adults’ cognitive function.

Interface of Law and Psychiatric Problems in the Elderly.

Aims: Inhibition associated with perception has been implicated in sensory integration processes for balance when sensory conflict occurs. The current study examines the associations of three measures of inhibition (perceptual inhibition, motor inhibition, and Stroop interference) with standing balance under sensory conflict conditions in younger and older adults. Methods: Perceptual inhibition, motor inhibition, and Stroop interference were measured in younger and older subjects. Standing balance under conditions of sensory conflict was evaluated using a modified dynamic posturography protocol. Correlative analysis was performed to examine the associations between the inhibition measures and sway. Results: In older adults only, perceptual inhibition was correlated with sway when sensory conflict was present. Stroop interference and motor inhibition were not significantly correlated with sway under any posturography conditions. Conclusion: Measures of perceptual inhibition are associated with reduced sensory integration capability for balance during sensory conflict conditions in older adults.

BackgroundCognitive and gait speed decline are common conditions in older adults and are often associated with future adverse consequences. Although an association between cognitive function and gait speed has been demonstrated, its temporal sequence remains unclear, especially in older Chinese adults. Clarifying this could help identify interventions to improve public health in older adults.ObjectiveThis study aims to examine the longitudinal reciprocal association between gait speed and cognitive function and the possible temporal sequence of changes in both factors in a national longitudinal cohort.MethodsData were derived from 2 waves (2011 baseline and 2015 follow-up) of the China Health and Retirement Longitudinal Study (CHARLS). Participants 60 years or older, without dementia or Parkinson disease at baseline, and with completed data on gait speed and cognition at both baseline and follow-up were included. Usual gait speed was measured over two 2.5-m walks. Mental intactness and episodic memory were used to assess global cognitive function. Cross-lagged panel models and linear mixed-effects models were used to examine the association between cognition and gait speed over time. Standardized coefficients were reported.ResultsA total of 3009 participants (mean age 66.4 years, SD 5.4 years; 1422/3009, 47.26%, female participants) were eligible for inclusion in our analyses. Cross-lagged panel analyses revealed that after accounting for baseline gait speed, cognition, and potential confounders, baseline global cognition (β=.117, 95% CI 0.082-0.152; P<.001), mental intactness (β=.082, 95% CI 0.047-0.118; P<.001), and episodic memory (β=.102, 95% CI 0.067-0.137; P<.001) were associated with subsequent gait speed. Simultaneously, baseline gait speed was also associated with subsequent global cognition (β=.056, 95% CI 0.024-0.087; P=.001), mental intactness (β=.039, 95% CI 0.008-0.069; P=.01), and episodic memory (β=.057, 95% CI 0.023-0.092; P=.001). The comparison of standardized cross-lagged coefficients suggested that the effect size of baseline global cognition on subsequent gait speed was significantly larger than the reverse effect (χ12=6.50, P for difference=.01). However, the effects of both mental intactness and episodic memory on subsequent gait speed were not significantly stronger than those of the reverse pathway (χ12=3.33, P for difference=.07 and χ12=3.21, P for difference=.07). Linear mixed-effects analyses further supported these bidirectional relationships, revealing that lower baseline cognitive scores predicted steeper declines in gait speed trajectory, and slower baseline gait speed predicted more declines in cognitive trajectory over time.ConclusionsThere is a longitudinal bidirectional association between usual gait speed and both global cognitive function and specific domains of mental intactness and episodic memory among Chinese older adults. Baseline global cognition is likely to have a stronger association with subsequent gait speed than the reverse pathway. This interlinkage is noteworthy and may have implications for public health. Maintaining normal cognitive function may be an important interventional strategy for mitigating age-related gait speed reduction.

Read the full review for this Faculty Opinions recommended article: Effect of single dose methylphenidate on walking and postural stability under single- and dual-task conditions in older adults--a double-blind randomized control trial.

Chronic kidney disease (CKD) is a common chronic condition in older adults that is associated with cognitive decline. However, the exact prevalence of cognitive impairment in older adults with CKD is unclear likely due to the variety of methods utilized to assess cognitive function. The purpose of this integrative review is to determine how cognitive function is most frequently assessed in older adult patients with CKD. Five electronic databases were searched to explore relevant literature related to cognitive function assessment in older adult patients with CKD. Inclusion and exclusion criteria were created to focus the search to the assessment of cognitive function with standardized cognitive tests in older adults with CKD, not on renal replacement therapy. Through the search methods, 36 articles were found that fulfilled the purpose of the review. There were 36 different types of cognitive tests utilized in the included articles, with each study utilizing between one and 12 tests. The most commonly utilized cognitive test was the Mini Mental State Exam (MMSE), followed by tests of digit symbol substitution and verbal fluency. The most commonly assessed aspect of cognitive function was global cognition. The assessment of cognitive function in older adults with CKD with standardized tests is completed in various ways. Unfortunately, the common methods of assessment of cognitive function may not be fully examining the domains of impairment commonly found in older adults with CKD. Further research is needed to identify the ideal cognitive test to best assess older adults with CKD for cognitive impairment.

Difficulty performing concurrent tasks while walking, or dual-task walking, may have negative consequences for safe and independent functional mobility among older adults. Older adults with amnestic mild cognitive impairment (aMCI) may demonstrate slower gait and worse cognitive task speed or accuracy during dual-task conditions. However, prior research has not consistently quantified cognitive performance during dual-task walking, and it is unclear whether changes in dual-task performance are consistent across different task combinations. The purpose of this study was to compare cognitive and gait performance during dual-task conditions in older adults with aMCI and those with normal cognition (NC). An observational cross-sectional study was conducted with 40 community-dwelling older adults, aged 70-95years with aMCI (n=18) and NC (n=22). Gait (self-paced, fast-paced) and cognitive task performance (serial 3, serial 7 subtraction) were quantified during single-task and dual-task conditions. Linear mixed-effects models with a random effect for participants were used to quantify differences between groups (aMCI vs NC) and task conditions (single-task vs dual-task). Further analysis was performed to quantify cognitive performance and gait changes during more challenging dual-task combinations. Across task combinations, gait performance declined for both groups during dual-task conditions. Gait speed was slower during dual-task conditions than single-task conditions in both the NC and aMCI groups for all task combinations. Older adults with aMCI performed worse on cognitive tasks than those with NC during both single-task and dual-task conditions. Correct response rate was slower for people with aMCI than NC during both single-task and dual-task conditions. Dual-task activities, combining gait and cognitive processes, are associated with fall risk and are therefore commonly evaluated in physical therapy care for older adults. Both aMCI and NC groups walked slower during dual-task conditions, but the aMCI group experienced changes with a lower cognitive load. This highlights the importance of quantifying both cognitive and gait performance during dual-task assessments. Changes in cognitive task and gait performance were consistent across different dual-task combinations, which could inform dual-task interventions.

Several factors can impact food consumption in older adults, including those of sociodemographic, physiological, and chronic non-communicable diseases. This study aimed to evaluate the association of food consumption according to its degree of processing with sociodemographic conditions in community-dwelling older adults. Food intake was evaluated from 24-h recall data. All food items were classified according to the degree of processing into four groups as follows: in natura or minimally processed, culinary ingredients, processed, and ultra-processed foods. Food groups were considered dependent variables in a quantile regression model, adjusting for sex, age, schooling, ethnicity, and number of residents. Women and individuals with higher levels of education had lower consumption of in natura or minimally processed foods and higher consumption of ultra-processed foods. The yellow or indigenous ethnicity presented the lowest consumption of processed foods; older people who lived with three or more individuals had the highest consumption of culinary ingredients, whereas the older people who lived with one to two people had the highest consumption of processed foods and the lowest consumption of ultra-processed. These groups may be the target of educational and public policies to improve diet quality and contribute to quality of life in older ages.

Metacognitive dysfunctions have been implicated in several neuropsychiatric conditions, while cognitive performances have been evaluated by measuring cognitive domains in older adults. This study investigated a relationship between metacognitive processes and cognitive performances in older adults. A sociodemographic form, the Standardised Mini-Mental State Examination (SMMSE) and the Metacognitions Questionnaire-30 (MCQ-30) were applied to participants aged >65 years who had no significant cognitive decline defined as normal or with mild cognitive impairment. 'Negative beliefs about worry' and 'need to control thoughts' domains of MCQ-30 were related to cognitive performance measured with SMMSE. Increased negative beliefs about worry were a predicting factor for total cognitive performance as a means of contributing to cognitive impairment, whereas an increased need to control thoughts was related to having a less likely cognitive impairment. Metacognitive dysfunctional processes, in particular about worry, might contribute to determining more decent outcomes for cognitive conditions in older adults with no significant cognitive dysfunction.

A growing number of studies have revealed that higher aerobic fitness is associated with better working memory (WM) performance in older adults. However, the underlying functional neural mechanisms of this association remain under debate. It has been reported that aging increases recruitment of the prefrontal cortex (PFC) during cognitive tasks, and that this is associated with task performance in a compensatory manner. Therefore, this study aimed to clarify the prefrontal activation pattern that is associated with the relationship between aerobic fitness and WM performance in older adults, focusing on age-related extended prefrontal recruitment. Forty-seven older adults (65-74 years, 29 females) and 49 younger adults (18-24 years, 23 female) performed verbal and spatial n-back tasks, which included 0-, 1-, and 2-back conditions. Reaction time (RT) and accuracy (ACC) were assessed as indices of task performance. Prefrontal activation during the experimental tasks was monitored using functional near-infrared spectroscopy (fNIRS) and analyzed using an adaptive GLM method. We compared task performance and prefrontal activation between age groups to find age-related prefrontal activation patterns. Only older adults underwent a graded exercise test (GXT) to determine their ventilation thresholds (VT) as a measure of aerobic fitness, and, subsequently, the relationships among aerobic fitness, n-back task performance, and prefrontal activation in older adults were examined using correlation analysis and mediation analysis controlling for possible covariates. A comparison of task performance between groups revealed that older adults had slower RT and lower ACC than did younger adults, especially in the higher WM load 2-back condition. Group comparisons of prefrontal activation showed that older adults exhibited additional or greater activation than younger adults mainly in the ventrolateral PFC (VLPFC) and front polar area (FPA) in both the verbal and spatial 2-back conditions. Correlation analysis showed a relationship between higher VT, shorter RT for the verbal 2-back condition, and greater prefrontal activation of the bilateral FPA and right VLPFC during verbal 2-back conditions in older adults. In addition, mediation analyses indicated the possibility of a mediation effect of the prefrontal activation on the relationship between VT and RT for the verbal 2-back condition. These results suggest that older adults with higher aerobic fitness levels recruited more extended PFC regions, possibly for compensatory activation, to enhance their performance of the verbal n-back task. This study sheds light on the neural mechanisms underpinning the relationship between aerobic fitness and cognitive function in older adults.

Biomechanics of sit-to-stand with dual tasks in older adults with and without mild cognitive impairment

Introduction: Rapid urbanization in the 21st century has substantially increased air pollution levels, with more than 55% of the global population now residing in urban areas. Emerging evidence suggests that chronic exposure to urban air pollutants may contribute to neurodegeneration, particularly among older adults. However, limited data are available from developing countries such as India, where urban air pollution remains a major public health concern. Objectives: To investigate the association between chronic exposure to urban air pollution and cognitive decline among adults aged 45 years and above in selected urban centers of India. Methods: A mixed-methods study design was employed. Air quality data and health records were collected from three major urban centers in India. Cognitive performance was assessed using standardized cognitive assessment tools, and in-depth interviews were conducted among 300 participants aged ≥45 years. Quantitative data were analyzed using correlation and regression analyses to determine the relationship between air pollutant exposure and cognitive performance. Results: Findings revealed a significant inverse correlation between chronic exposure to urban air pollution and cognitive performance. Participants residing in high-pollution areas demonstrated significantly lower cognitive scores compared to those in lower-pollution areas. A moderate negative correlation was observed between PM2.5 concentrations and cognitive performance. Regression analysis identified PM2.5 and NO₂ as significant predictors of cognitive decline among older adults. Conclusions: The study demonstrates that chronic exposure to urban air pollution is significantly associated with cognitive decline and may contribute to the development of neurodegenerative conditions in older adults. These findings underscore the urgent need for policymakers, urban planners, and environmental regulators to implement effective air quality control measures to protect brain health, particularly among vulnerable populations such as the elderly and low-income communities. DOI: https://doi.org/10.52783/jchr.v16.i1.11800

Background: Bodily pain is a common condition in older adults and interferes with individuals’ cognitive functioning. We aimed to evaluate the association between bodily pain and related locations and cognitive impairment among community-dwelling older adults in Taiwan. Method: In this retrospective, cross-sectional study, we enrolled 2022 participants aged 60‒70 years, from the Taiwan Biobank. Mini-Mental State Examination was performed to assess cognitive impairment. Further, logistic regression analyses were performed to identify the relationship between bodily pain and cognitive impairment. Results: Overall, 161 participants had cognitive impairment. Multivariable analysis showed that older adults who reported bodily pain were more likely than those who did not have cognitive impairment (odds ratio 1.68). Moreover, the occurrence of cognitive impairment correlated with the presence of two or more pain locations and self-reported low back and waist pain or sciatica. Conclusion: Our study revealed that cognitive impairment was associated with bodily pain in community-dwelling older adults, particularly older adults with low back and waist pain or sciatica and those with two or more pain locations. To maintain the quality of older adults’ life, pain and cognitive decline need to be simultaneously assessed with considerably more precise and objective markers.

Psychometric network analysis (PNA) has been gaining great popularity over the past decade. As a promising dimensionality assessment method, existing research has shown that PNA is able to outperform traditional methods such as exploratory factor analysis in examining the internal structure of a latent construct, and various R packages have been developed to carry out PNA. Yet, PNA has not been widely used in various fields due to researchers’ lack of familiarization with this method and the available R packages. Therefore, this study aims to briefly review the PNA method, compare different R packages, and provide step-by-step guidance on how to use these R packages to conduct PNA using a personality dataset.

Age-related hearing loss is one of the most prevalent health conditions in older adults. Although hearing aid technology has advanced dramatically, a large percentage of older adults do not use hearing aids. This untreated hearing loss may accelerate declines in cognitive and neural function and dramatically affect the quality of life. Our previous findings have shown that the use of hearing aids improves cortical and cognitive function and offsets subcortical physiological decline. The current study tested the time course of neural adaptation to hearing aids over the course of 6 months and aimed to determine whether early measures of cortical processing predict the capacity for neural plasticity. Seventeen (9 females) older adults (mean age = 75 years) with age-related hearing loss with no history of hearing aid use were fit with bilateral hearing aids and tested in six testing sessions. Neural changes were observed as early as 2 weeks following the initial fitting of hearing aids. Increases in N1 amplitudes were observed as early as 2 weeks following the hearing aid fitting, whereas changes in P2 amplitudes were not observed until 12 weeks of hearing aid use. The findings suggest that increased audibility through hearing aids may facilitate rapid increases in cortical detection, but a longer time period of exposure to amplified sound may be required to integrate features of the signal and form auditory object representations. The results also showed a relationship between neural responses in earlier sessions and the change predicted after 6 months of the use of hearing aids. This study demonstrates rapid cortical adaptation to increased auditory input. Knowledge of the time course of neural adaptation may aid audiologists in counseling their patients, especially those who are struggling to adjust to amplification. A future comparison of a control group with no use of hearing aids that undergoes the same testing sessions as the study’s group will validate these findings.