Decline In Visuospatial Ability Research Articles

Digital clock drawing test reflects visuospatial ability of older drivers.

To keep older drivers safe, it is necessary to assess their fitness to drive. We developed a touch screen-based digital Clock Drawing Test (dCDT) and examined the relationship between the dCDT scores and on-road driving performance of older drivers in a community-setting. One hundred and forty-one community-dwelling older drivers (range; 64-88 years old) who participated in this study were included in the analysis. Participants completed the dCDT, the Mini-Mental State Examination-Japanese (MMSE-J), and an on-road driving assessment. We examined the relationship between dCDT scores using the method by Rouleau et al. (maximum 10 points) and the on-road driving performance based on a driving assessment system originally developed by Nagoya University. Multiple regression analyses showed that errors in the driving test were associated with dCDT score for the items "confirmation," "turning left" and "maintains driving lane position". This study confirmed the relationship between the dCDT score and driving errors, such as confirmation, turning left and maintaining driving lane position. The increase in these errors indicates a decline in visuospatial ability while driving. The dCDT score may reflect older drivers' visuospatial abilities while driving.

Longitudinal effects of using and discontinuing central nervous system medications on cognitive functioning.

To investigate the longitudinal effect of using and discontinuing central nervous system (CNS) medications on cognitive performance. Using longitudinal cognitive data from population representative adults aged 25-100 years (N=2188) from four test waves 5 years apart, we investigated both the link between use of CNS medications (opioids, anxiolytics, hypnotics and sedatives) on cognitive task performance (episodic memory, semantic memory, visuospatial ability) across 15 years, and the effect of discontinuing these medications in linear mixed effects models. We found that opioid use was associated with decline in visuospatial ability whereas using anxiolytics, hypnotics and sedatives was not associated with cognitive decline over 15 years. A link between drug discontinuation and cognitive improvement was seen for opioids as well as for anxiolytics, hypnotics and sedatives. Although our results may be confounded by subjacent conditions, they suggest that long-term use of CNS medications may have domain-specific negative effects on cognitive performance over time, whereas the discontinuation of these medications may partly reverse these effects. These results open up for future studies that address subjacent conditions on cognition to develop a more complete understanding of the cognitive effects of CNS medications.

A case-control and seven-year longitudinal neurocognitive study of adults with sickle cell disease in Ghana.

Ageing in sickle cell disease (SCD) is associated with a myriad of end-organ complications, including cerebrovascular damage and cognitive impairment (CI). Although CI is very common in SCD, little is known about cognitive functioning and how it changes with age. This study examines cognitive patterns of 63 adults with SCD and 60 non-SCD, age- and education-matched controls in Ghana. Of those adults with SCD, 34 completed the neuropsychological battery at baseline and again seven years later. In cross-sectional data, adults with SCD performed worse than controls in all cognitive test domains (p< 0.01 for all). The seven-year follow-up data showed that the group exhibited a significant decline in visuospatial abilities (ranging from Cohen's d= 1.40 to 2.38), and to a lesser extent, in processing speed and executive functioning. Exploratory analyses showed a significant time-by-education interaction, indicating that education may be protective from decline in cognitive performance. These findings have implications for clinical practice. Early neuropsychological surveillance coupled with early assessment and remedial programmes will provide avenues for enhancing the quality of life of adults living with SCD in Ghana.

Circadian Rest and Activity Rhythms and Cognitive Change in the Baltimore Longitudinal Study of Aging

Alterations in 24-hour movement patterns, or circadian rest/activity rhythms (RARs), commonly occur with aging. Using linear mixed effects (LME) modeling, we examined associations of baseline RARs with longitudinal change in cognition. Participants (N=424; 47% male, baseline age 72.8±10.1 years) were from the Baltimore Longitudinal Study of Aging and completed 5.6±0.8 nights of wrist actigraphy at baseline. Tests of memory, executive function, attention, language, and visuospatial ability were administered at baseline and subsequent visits (3.7±1.7 years of follow-up in those with >1 visit (n=295)). In unadjusted random intercept and slope LME models, greater RAR stability predicted slower memory decline, and higher activity during participants’ least active 5 hours (L5) predicted slower decline in visuospatial ability. After covariate adjustment, higher activity in participants’ most active 10 hours (M10) and higher L5 predicted slower decline in visuospatial ability (p<.05). Further research is needed on RARs as risk factors for later-life cognitive decline.

Associations of automatically segmented, enlarged perivascular spaces with neuropathology and cognition in community‐based older adults

Previous studies on the associations between enlarged perivascular spaces (EPVS) and pathology have used manual assessment of EPVS burden, with limitations on cohorts and access to pathology. In this work, we first developed a deep learning model to automatically segment EPVS on MRI. We then combined total and regional EPVS measurements with detailed neuropathology and longitudinal cognitive assessment on 817 community-based older adults to investigate EPVS links to neuropathology and cognition (Fig. 1). Data: This work included 817 participants from three longitudinal cohort studies of aging. All participants underwent annual cognitive assessment, ex-vivo T2 -weighted imaging (0.6x0.6x1.5 mm) using clinical 3T MRI, and detailed neuropathologic examination by a board-certified neuropathologist blinded to all data (Fig. 2). Pathologies assessed: gross and microscopic infarcts, atherosclerosis, arteriolosclerosis, cerebral amyloid angiopathy (CAA), amyloid plaques, neurofibrillary tangles, Lewy bodies, and TDP-43. Segmentation: Data from 10 participants and manually segmented EPVS were used to train convolutional neural networks (Fig. 3) to automatically segment EPVS. The trained networks were used to segment and quantify total and regional EPVS clusters in the ex-vivo MRI data of all participants. Model performance validation: Using 100 randomly generated ROIs, EPVS were 1) identified by an expert neuroradiologist, and 2) manually segmented by an experienced observer. Neuroradiologist and observer were blind to each other. Model segmentation accuracy and sensitivity were evaluated. Associations with neuropathologies, controlling for demographics, were investigated using elastic-net regularized linear regression. Linear mixed-effects models were used to investigate independent association of EPVS with cognitive decline independent of neuropathologies and demographics. Model validation showed 68% average sensitivity, DSC=0.66 segmentation accuracy, and high correlation (Pearson, ρ=0.91) in segmentation volume per ROI (Fig. 4). EPVS number was associated with gross infarcts, microscopic infarcts, and diabetes in multiple brain regions, and with CAA in occipital and temporal lobes (Fig. 5). Total and frontal lobe EPVS were associated with faster decline in visuospatial ability, (-0.0079, p=0.036) and (-0.0071, p=0.018) respectively, independent of neuropathologies, diabetes and demographics. This is the largest investigation on neuropathologic and cognitive correlates of EPVS conducted to date, generating robust evidence on EPVS associations with infarcts, CAA and diabetes, and independent contributions on cognitive decline.

Acculturation in context: The relationship between acculturation and socioenvironmental factors with level of and change in cognition in older Latinos

AbstractBackgroundLatinos are 1.5 times as likely to develop Alzheimer’s dementia as non‐Latino Whites. This health disparity may arise from multiple influences with culturally‐relevant factors receiving increasing attention. Models of acculturation stress the importance of considering acculturation‐related factors within the context of socioenvironmental factors to better capture the Latino experience in the US.MethodWe measured 10 acculturation and contextually‐related variables in 199 Latinos (age∼69.7yrs) without dementia participating in Rush Alzheimer’s Disease Center studies. We subjected these variables to Principal Component Analysis (PCA) to study their interrelationships; then investigated how the resulting components associated with level of and longitudinal change in domain‐specific cognition using separate linear mixed effects models adjusted for relevant confounders and their interactions with time.ResultThe PCA revealed a 3‐factor unrotated solution (variance explained ∼70%). Factor 1, representing acculturation‐related aspects of nativity, language‐ and social‐based acculturation, was positively associated with level, but not change, in semantic memory and perceptual speed. Factor 2, representing contextually‐related socioenvironmental experiences of discrimination, social isolation, and social networks, was associated with lower levels of episodic memory and working memory and faster longitudinal decline in visuospatial ability (Figure 1). Factor 3 (familism only) did not associate with level or change in any cognitive outcome. We are actively investigating the role of cardiovascular health on these associations.ConclusionAcculturation‐ and contextually‐related factors differentiated from each other and differentially contributed to cognition and cognitive decline in older Latinos. Providers should query multiple social determinants of health when evaluating older Latinos including acculturation‐ and contextually‐related lived experiences.

Cognitive and Neuroimaging Profiles of Individuals With Dual Decline in Memory and Gait

Across 6 aging cohorts we showed that dual decline in memory and gait speed was associated with increased risk of dementia compared to memory or gait decline only. We now characterize dual decliners. Using longitudinal BLSA data, we examined associations of phenotypic groups with changes in cognition, depressive symptoms, and brain volumes in areas important for cognitive (dorsolateral prefrontal, medial temporal) and motor functions (precentral gyrus,striatum,thalamus,anterior cingulate cortex) using linear mixed effects models (usual agers=reference), adjusting for covariates. Compared to usual agers, dual decliners had faster decline in card rotation score, greater increase in CES-D, and greater atrophy in thalamus and anterior cingulate cortex. Rates of change in these parameters did not differ among the other three groups. Dual decliners experience faster decline in visuospatial ability, greater atrophy in selected motor areas, and greater increase in depressive symptoms, suggesting potential mechanisms underlying increased dementia risk in dual decliners.

Acculturation in Context: The Relationship Between Acculturation and Socioenvironmental Factors With Level of and Change in Cognition in Older Latinos.

Latinos are 1.5 times as likely to develop Alzheimer's dementia as non-Latino Whites. This health disparity may arise from multiple influences with culturally relevant factors receiving increasing attention. Models of acculturation stress the importance of considering acculturation-related factors within the context of socioenvironmental factors to better capture the Latino experience in the United States. We measured 10 acculturation and contextually-related variables in 199 Latinos (age 69.7 years) without dementia participating in Rush Alzheimer's Disease Center studies. We tested the relationship between these variables via Principal Component Analysis (PCA), then investigated how resulting components associated with level of and longitudinal change in global and domain-specific cognition using separate linear mixed-effects models adjusted for relevant confounders and their interactions with time. The PCA revealed a 3-factor unrotated solution (variance explained ~70%). Factor 1, representing acculturation-related aspects of nativity, language- and social-based acculturation, was positively associated with level, but not change, in global cognition, semantic memory, and perceptual speed. Factor 2, representing contextually-related socioenvironmental experiences of discrimination, social isolation, and social networks, was negatively associated with level of global cognition, episodic and working memory, and faster longitudinal decline in visuospatial ability. Factor 3 (familism only) did not associate with level or change in any cognitive outcome. Acculturation- and contextually-related factors differentiated from each other and differentially contributed to cognition and cognitive decline in older Latinos. Providers should query acculturation and lived experiences when evaluating cognition in older Latinos.

Associations between cognitive and brain volume changes in cognitively normal older adults

Investigation of relationships between age-related changes in regional brain volumes and changes in domain-specific cognition could provide insights into the neural underpinnings of individual differences in cognitive aging. Domain-specific cognition (memory, verbal fluency, visuospatial ability) and tests of executive function and attention (Trail-Making Test Part A and B) and 47 brain volumes of interest (VOIs) were assessed in 836 Baltimore Longitudinal Study of Aging participants with mean follow-up of 4.1 years (maximum 23.1 years). To examine the correlation between changes in domain-specific cognition and changes in brain volumes, we used bivariate linear mixed effects models with unstructured variance-covariance structure to estimate longitudinal trajectories for each variable of interest and correlations among the random effects of these measures. Higher annual rates of memory decline were associated with greater volume loss in 14 VOIs primarily within the temporal and occipital lobes. Verbal fluency decline was associated with greater ventricular enlargement and volume loss in 24 VOIs within the frontal, temporal, and parietal lobes. Decline in visuospatial ability was associated with volume loss in 3 temporal and parietal VOIs. Declines on the attentional test were associated with volume loss in 4 VOIs located within temporal and parietal lobes. Greater declines on the executive function test were associated with greater ventricular enlargement and volume loss in 10 frontal, parietal, and temporal VOIs. Our findings highlight domain-specific patterns of regional brain atrophy that may contribute to individual differences in cognitive aging.

Neuropathologic and Cognitive Correlates of Enlarged Perivascular Spaces in a Community-Based Cohort of Older Adults.

Enlarged perivascular spaces (EPVS) have been associated with aging, increased stroke risk, decreased cognitive function, and vascular dementia. However, the relationship of EPVS with age-related neuropathologies is not well understood. Therefore, the purpose of this study was to assess the neuropathologic correlates of EPVS in a large community-based cohort of older adults. The cognitive correlates of EPVS over and beyond those of other pathologies were also assessed. This study included 654 older deceased and autopsied participants of 3 longitudinal community-based studies of aging that had available data on cognition, ex vivo brain magnetic resonance imaging, and detailed neuropathologic examination. EPVS seen on ex vivo magnetic resonance imaging were histologically validated. Experienced observers rated EPVS burden in ex vivo magnetic resonance imaging using a semiquantitative 4-level scale. Elastic-net regularized ordinal logistic regression was used to investigate associations of EPVS burden with age-related neuropathologies. Mixed-effects models of cognition controlling for neuropathologies, demographics, and clinical factors, were used to determine whether EPVS burden has additional contributions to cognitive decline. EPVS burden in the whole group was associated with gross infarcts (odds ratio=1.67, P=0.0017) and diabetes mellitus (odds ratio=1.73, P=0.004). When considering only nondemented participants (with mild or no cognitive impairment), EPVS burden was associated with gross infarcts (odds ratio=1.74, P=0.016) and microscopic infarcts (odds ratio=1.79, P=0.013). EPVS burden was associated with faster decline in visuospatial abilities (estimate=-0.009, P=0.028), in the whole group, as well as lower levels of semantic memory (estimate=-0.13, P=0.048) and visuospatial abilities (estimate=-0.11, P=0.016) at the time of death. EPVS and infarcts may share similar neurobiological pathways regardless of dementia status. EPVS burden is linked to diabetes mellitus independently of neuropathologies, extending recent findings in animal studies implicating diabetes mellitus in impairment of the glymphatic system. Finally, EPVS burden may reflect additional brain tissue injury that may contribute to cognitive decline, not captured with traditional neuropathologic measures.

Associations Between Declining Physical and Cognitive Functions in the Lothian Birth Cohort 1936.

BackgroundThe ageing process is characterized by declines in physical and cognitive function. However, the relationship between these trajectories remains a topic of investigation.MethodsUsing four data waves collected triennially between ages 70 and 79, we tested for associations between multiple cognitive ability domains (verbal memory, processing speed, and visuospatial ability) and physical functions (walking speed, grip strength, and lung function). We first tested for associations between linear declines in physical and cognitive functions over the entire 9-year study period, and then, for lead-lag coupling effects between 3-year changes in cognitive and physical functions.ResultsSteeper linear decline in walking speed was moderately correlated with steeper linear declines in each cognitive domain. Steeper linear decline in grip strength was moderately correlated with steeper linear declines in verbal memory and processing speed. Lead-lag coupling models showed that decline in verbal memory was preceded by declines in walking speed and grip strength. By contrast, decline in grip strength was preceded by declines in processing speed and visuospatial ability, and decline in walking speed was preceded by decline in visuospatial ability. Following additional adjustment for covariates, only coupling effects from earlier decline in processing speed to later decline in grip strength remained significant (β = 0.545, p = .006).ConclusionOur findings provide further evidence of an association between cognitive and physical declines and point to the potential order in which these changes occur. Decline in processing speed in particular may serve as a unique early marker of declining upper body strength.

The relationship of cerebral microbleeds to cognition and incident dementia in non-demented older individuals.

Cerebral microbleeds (CMB), suspected markers of hemorrhage-prone microangiopathy, are common in patients with cerebrovascular disease and in those with cognitive impairment. Their longitudinal relationship with cognitive decline and incident dementia in non-demented community-dwelling older individuals has been insufficiently examined. 302 adults aged 70-90 participating in the population-based Sydney Memory and Ageing Study underwent a susceptibility-weighted imaging (SWI) MRI sequence. The relationship of CMB with performance on neuropsychological tests was examined both cross-sectionally and longitudinally, over a mean of 4years. The association with cases of incident dementia during this period was also examined. The prevalence of CMB was 20%. In cross-sectional analysis, after adjusting for demographics and vascular risk factors, there was a significant association between the presence of CMB and poorer executive function. CMB were not associated with global cognition or other cognitive domains. On longitudinal analysis, after adjusting for demographics and vascular risk factors, there was a greater decline in visuospatial ability in those with CMB compared to those without. The presence of CMB was not associated with increased progression to dementia. CMB are associated with impairments in specific cognitive domains: executive function and decline in visuospatial ability, independent of other markers of CVD including white matter hyperintensities. This suggests a direct contribution of CMB to cognitive impairment although no significant difference in incident dementia rates was observed.

A snapshot survey of perceptions of healthcare professionals on ageing surgeons

ObjectiveThe aim of this research was to understand healthcare professionals’ perception of the continued practice of ageing surgeons in Singapore.MethodologyA quantitative method was chosen for this research to determine healthcare...

Visual search and the aging brain: discerning the effects of age-related brain volume shrinkage on alertness, feature binding, and attentional control.

Decline in visuospatial abilities with advancing age has been attributed to a demise of bottom-up and top-down functions involving sensory processing, selective attention, and executive control. These functions may be differentially affected by age-related volume shrinkage of subcortical and cortical nodes subserving the dorsal and ventral processing streams and the corpus callosum mediating interhemispheric information exchange. Fifty-five healthy adults (25-84 years) underwent structural MRI and performed a visual search task to test perceptual and attentional demands by combining feature-conjunction searches with "gestalt" grouping and attentional cueing paradigms. Poorer conjunction, but not feature, search performance was related to older age and volume shrinkage of nodes in the dorsolateral processing stream. When displays allowed perceptual grouping through distractor homogeneity, poorer conjunction-search performance correlated with smaller ventrolateral prefrontal cortical and callosal volumes. An alerting cue attenuated age effects on conjunction search, and the alertness benefit was associated with thalamic, callosal, and temporal cortex volumes. Our results indicate that older adults can capitalize on early parallel stages of visual information processing, whereas age-related limitations arise at later serial processing stages requiring self-guided selective attention and executive control. These limitations are explained in part by age-related brain volume shrinkage and can be mitigated by external cues.

Longitudinal Changes in Cognition in Parkinson’s Disease with and without Dementia

Background: The longitudinal cognitive course in Parkinson’s disease (PD) with and without dementia remains undefined. We compared cross-sectional models of cognition in PD (both with and without dementia), Alzheimer’s disease (AD), and nondemented aging and followed the participants over time. Method: Previously validated models of cognitive performance in AD and nondemented aging were extended to individuals with PD (with dementia, n = 71; without dementia, n = 47). Confirmatory factor analysis and piecewise regression were used to compare the longitudinal course of participants with PD with 191 cognitively healthy subjects and 115 individuals with autopsy-confirmed AD. Results: A factor analytic model with one general factor and three specific factors (verbal memory, visuospatial memory, working memory) fit demented and nondemented PD. Longitudinal change indicated that individuals with PD with dementia declined significantly more rapidly on visuospatial and verbal memory tasks than AD alone. Cognitive declines across all factors in AD and PD dementia accelerated several years prior to clinical dementia diagnosis. Conclusion: Both specific and global cognitive changes are witnessed in PD and AD. Longitudinal profiles of cognitive decline in PD and AD differed. PD with or without dementia has a core feature of longitudinal decline in visuospatial abilities.

Visuospatial deficits in stroke patients and their relationship to dressing performance.

Three visuospatial tests (figure-ground, design copy and block design) were used to measure the visuospatial ability of stroke patients. The relationship between the visuospatial deficits and the potential of dressing performance was explored. In addition, age, sex, educational level, and recovery status were also analyzed to determine their influence on subjects' performance. A total of 30 stroke patients including 16 right hemiplegics and 14 left hemiplegics participated in this study. Twenty-five normal subjects were selected as a control group. Control subjects were comparable to the patient group with respect to age, ex, and educational level. The results are as follows: (1) The impairment of visuospatial ability was found in stroke patients and the visuospatial dysfunction was more prominent in the left hemiplegics. (2) Visuospatial deficits contributed to the failure of dressing performance, especially in the left hemiplegics. (3) The decline in visuospatial ability was more prominent in the left hemiplegics of older age. (4) Sex, educational level, and recovery status of the affected upper extremity did not affect the performance of visuospatial tests of dressing performance. (5) The patient's score on each visuospatial test is a significant predictor of dressing performance in the left hemiplegics, while in the right hemiplegics, the prediction of dressing performance is dependent on the total scores of three visuospatial tests. The findings of this study suggest that simple clinical tests can be used to predict the patient's potential of acquiring the dressing skill after stroke. It also indicates the importance of developing an effective treatment program aimed at compensating visuospatial deficits for stroke patients.