Different Levels Of Cognitive Functioning Research Articles

Cognitive function in older adults with stroke: A latent profile analysis

BackgroundPost-stroke cognitive impairment (PSCI) is one of the major complications after a stroke. Therefore, it is necessary to identify different categories of cognitive function in older adults with stroke and to explore factors associated with different levels of cognitive function in older adults after stroke. MethodsA cross-sectional survey was conducted using convenience sampling to collect data from 1076 older adults with stroke from 5 hospitals in Lanzhou City, Gansu Province, China, from June 2022 to August 2023. Latent Profile Analysis (LPA) was used to identify cognitive function subgroups among older adults with stroke, and multinomial logistic regression was used to analyze the related factors. Results1076 older adults with stroke were identified and classified as class-1: cognitive impairment, class-2: mild cognitive impairment, class-3: normal cognitive function. Age, gender, education level, hemorrhagic stroke, cerebrovascular disease are associated with different levels of cognitive function in older adults after stroke. ConclusionsThese findings highlight the heterogeneity of cognitive function in older adults with stroke. Our research could assist healthcare professionals in China to identify older adults with a high risk of cognitive impairment and to develop individualized interventions based on their characteristics.

Validation of the Chinese Version of Quality of Life Instrument (QUALIDEM-C) for People With Dementia in Long-Term Care Home.

To validate and examine the psychometric properties of the Chinese version of QUALIDEM (QUALIDEM-C). The psychometric properties of the Chinese QUALIDEM were tested in a sample of 150 residents in long-term care homes. Concurrent validity, internal consistency, inter-rater reliability, test-retest reliability and factor structure were determined. QUALIDEM-C demonstrated good semantic equivalence with original version and good content validity. QUALIDEM-C showed satisfactory internal consistency (Cronbachs' alpha=0.895), inter-rater reliability (ICC=0.970) and test-retest reliability (ICC=0.942). Acceptable concurrent validity was showed by consistently moderate correlations of QUALIDEM-C with generic and disease specific quality of life measures. QUALIDEM-C is reliable and valid scales to measure quality of life of residents in long-term care home. Its applicability across residents with different levels of cognitive function favors its use over other measures in this context. It is potentially an effective tool, rather by multiple measures, to evaluate quality of life in future long-term care home research.

Distinctive subgingival microbial signatures in older adults with different levels of cognitive function.

To examine association between subgingival microbial signatures and levels of cognitive impairment in older adults. We analysed subgingival plaque samples and 16S ribosomal RNA sequences for microbiota among 165 participants (normal controls [NCs]: 40, subjective cognitive decline [SCD]: 40, mild cognitive impairment [MCI]: 49 and dementia: 36). The bacterial richness was lower among individuals with worse cognitive function, and subgingival microbial communities differed significantly among the four groups. Declining cognitive function was associated with decreasing relative abundance of genera Capnocytophaga, Saccharibacteria_genera_incertae_sedis, Lautropia and Granulicatella, and increasing abundance of genus Porphyromonas. Moreover, there were differentially abundant genera among the groups. Random forest model based on subgingival microbiota could distinguish between cognitive impairment and NC (AUC = 0.933, 95% confidence interval 0.873-0.992). Significant correlations were observed between oral microbiota and sex, Montreal Cognitive Assessment (MoCA) score and Mini-Mental State Examination score. Partial correlation analysis showed that Leptotrichia and Burkholderia were closely negatively associated with the MoCA score after adjusting for multiple covariates. Gene function was not significantly different between SCD and NC groups, whereas three homozygous genes were altered in MCI patients and two in dementia patients. This is the first study to demonstrate an association between the composition, function and metabolic pathways of subgingival microbiota and different levels of cognitive function among older individuals. Future cohort studies should assess its diagnostic usefulness for cognitive impairment.

Aging gene signature of memory CD8+ T cells is associated with neurocognitive functioning in Alzheimer’s disease

BackgroundMemory CD8+ T cells expand with age. We previously demonstrated an age-associated expansion of effector memory (EM) CD8+ T cells expressing low levels of IL-7 receptor alpha (IL-7Rαlow) and the presence of its gene signature (i.e., IL-7Rαlow aging genes) in peripheral blood of older adults without Alzheimer’s disease (AD). Considering age as the strongest risk factor for AD and the recent finding of EM CD8+ T cell expansion, mostly IL-7Rαlow cells, in AD, we investigated whether subjects with AD have alterations in IL-7Rαlow aging gene signature, especially in relation to genes possibly associated with AD and disease severity.ResultsWe identified a set of 29 candidate genes (i.e., putative AD genes) which could be differentially expressed in peripheral blood of patients with AD through the systematic search of publicly available datasets. Of the 29 putative AD genes, 9 genes (31%) were IL-7Rαlow aging genes (P < 0.001), suggesting the possible implication of IL-7Rαlow aging genes in AD. These findings were validated by RT-qPCR analysis of 40 genes, including 29 putative AD genes, additional 9 top IL-7R⍺low aging but not the putative AD genes, and 2 inflammatory control genes in peripheral blood of cognitively normal persons (CN, 38 subjects) and patients with AD (40 mild cognitive impairment and 43 dementia subjects). The RT-qPCR results showed 8 differentially expressed genes between AD and CN groups; five (62.5%) of which were top IL-7Rαlow aging genes (FGFBP2, GZMH, NUAK1, PRSS23, TGFBR3) not previously reported to be altered in AD. Unbiased clustering analysis revealed 3 clusters of dementia patients with distinct expression levels of the 40 analyzed genes, including IL-7Rαlow aging genes, which were associated with neurocognitive function as determined by MoCA, CDRsob and neuropsychological testing.ConclusionsWe report differential expression of “normal” aging genes associated with IL‐7Rαlow EM CD8+ T cells in peripheral blood of patients with AD, and the significance of such gene expression in clustering subjects with dementia due to AD into groups with different levels of cognitive functioning. These results provide a platform for studies investigating the possible implications of age-related immune changes, including those associated with CD8+ T cells, in AD.

Feasibility and Acceptability of a Group Music Creativity Intervention for Adults with Varying Cognitive Function

ABSTRACT Maintaining healthy cognitive functioning and delaying cognitive decline in cognitively intact and cognitively impaired adults are major research initiatives for addressing dementia disease burden. Music interventions are promising, non-pharmaceutical treatment options for preserving cognitive function and psychological health in older adults with varying levels of cognitive function. While passive, music interventions have attracted considerable attention in the abnormal cognitive aging literature, active, music interventions such as music creativity are less well-studied. Among 58 older adults with different levels of cognitive function (cognitively healthy to mild cognitive impairment), we examined the feasibility and acceptability of Project CHROMA, a Stage 1 clinical trial developed to assess the effects of a novel, music creativity curriculum on various health outcomes. Music intervention participation (93%), overall study retention (78%), and intervention satisfaction (100%) rates were comparable to other similarly designed clinical trials. Exploratory analyses using mixed-level modeling tested the efficacy of the intervention on cognitive and psychological outcomes. Compared to those in the control condition, participants in the music condition showed some improvements in cognitive functioning and socioemotional well-being. Findings suggest that a 6-week music creativity clinical trial with several multi-modal health assessments can be feasibly implemented within a sample of varying cognitive ability.

Investigating the effectiveness of Socially Assistive Robot on Depression and Cognitive Functions of Community Dwelling Older Adults with Cognitive Impairments

ABSTRACT We evaluated a socially assistive robot (SAR) named Hyodol during a six-week intervention. This study enrolled 69 older adults with cognitive decline. To screen the eligibility, we have used the following three criteria, namely Korean-Mini-Mental Status Exam score ≤ 26). Clinical Dementia Rating 0.5–2), and Diagnostics and Statistical Manual V. Participants were divided into three groups based on their cognitive function (i.e. very mild cognitive impairment (vMCI), mild cognitive impairment (MCI), and moderate cognitive impairment (MOCI). The groups were instructed to use Hyodol at home for a six-week period. Baseline and post-intervention surveys were performed after six weeks to examine the changes in perceived health, depression, and cognitive function. The vMCI group showed a reduction in the depression score after the intervention (t = −2.447, p = 0.040), in comparison to their peers in the control group. Further, the MCI group showed an improvement in the cognitive function score after the intervention (t = 2.690, p = 0.021). No significant improvement was found among MOCI participants who used the SARs. The significance of this study was to examine whether participants with different levels of cognitive functioning would diverge after a period of intervention using the Hyodol SARs. Moreover, it presented preliminary data for services and policies for home care treatment targeted to cognitive decline in older adults.

Soluble TREM2 and Alzheimer-related biomarker trajectories in the blood of patients with diabetes based on their cognitive status

AimWe aimed to elucidate the dynamics of blood biomarkers according to the severity of cognitive impairment in patients with type 2 diabetes mellitus (DM) and to identify useful biomarkers for diabetes-related dementia. MethodsThis was a cross-sectional, nested case-control study of 121 Japanese DM and non-DM patients with different levels of cognitive functioning. We evaluated participants’ cognitive functions, blood biomarkers related to Alzheimer’s disease, and soluble triggering receptors expressed on myeloid cells 2 (sTREM2). We then compared these biomarkers between the DM and non-DM and across the different cognitive strata. ResultsIn all cognitive strata, significantly lower levels of serum sTREM2 were observed in the DM than in the non-DM. We also found that plasma levels of phosphorylated tau (p-tau) increased with increasing levels of cognitive decline in both the DM and non-DM. However, this was accompanied by a decrease in plasma amyloid-β(Aβ42/Aβ40 ratios in non-DM only. ConclusionThis study revealed novel characteristic trajectories of dementia-related blood biomarkers in diabetes-related dementia, suggesting the pathological involvement of molecular cascades initiated by impaired microglial activation. This results in decreased serum sTREM2, followed by tauopathy without substantial amyloid plaques, reflected by plasma p-tau elevation with no decrease in the Aβ42/Aβ40 ratio.Clinical trials (the unique trial number and the name of the registry): UMIN000048032, https://www.umin.ac.jp.

Cognitive impairment as a determinant of response to management plans after heart failure admission.

Cognitive impairment (CI) is highly prevalent in heart failure (HF), and increases patients' risks of readmission. This study sought to determine whether the presence and degree of CI could identify patients most likely to benefit from a HF disease management programme (DMP) to reduce readmissions. A total of 1152 consecutive Australian patients admitted with HF (2014-2017) were prospectively followed up for 12 months. Of these, 324 patients who received DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review) were matched (1:2 ratio) with 648 usual care patients. Cognitive function was assessed either on the day of or one day before discharge using the Montreal Cognitive Assessment (MoCA). Outcomes included readmission or death at 1, 3 and 12 months, and days at home within 12 months of discharge. Poorer cognitive function was associated with all adverse outcomes. Compared with usual care, DMP was associated with lower odds of 30-day [odds ratio (OR) 0.60, 95% confidence interval 0.40, 0.91] and 90-day (OR 0.53, 95% confidence interval 0.36, 0.77) readmission or death, and with 19 more days at home within 12 months, independent of HF therapy. The effect sizes of these associations were greater for patients with diminished cognition than those with normal cognition (interaction P=0.036), and might have been more pronounced among those with mild CI compared with those with more severe CI (MoCA score 17-22; OR 0.42, 95% confidence interval 0.21, 0.87) at 30 days (OR 0.31, 95% confidence interval 0.16, 0.60 at 90 days). Patients with normal cognition had fewer events, irrespective of DMP. Cognitive function may determine how HF patients respond to a DMP. Cognitive screening before implementation of a DMP may allow personalized plans for patients with different levels of cognitive function.

The comparative effects of intensive glucose lowering in diabetes patients aged below or above 65 years: Results from the ADVANCE trial.

For relatively old patients with diabetes, current guidelines recommend adjustment of glycaemic goals based on patients' cognitive function, or coexisting chronic illnesses. However, the evidence which supports the efficacy and safety of intensive glucose lowering in older patients with diabetes is scarce. The objective of the present study was to compare the efficacy and safety of intensive glucose lowering in patients with type 2 diabetes stratified by age (<65 and ≥ 65 years), and examine whether the effects differ according to patients' characteristics in the older patient group. The effects of intensive glucose lowering (to a target glycated haemoglobin [HbA1c] concentration of ≤48 mmol/mol [6.5%]) on major clinical outcomes were evaluated by Cox regression models according to subgroups defined by baseline age of <65 or ≥ 65 years in the ADVANCE trial (n = 11 140). Over a median follow-up of 5 years, intensive glucose lowering significantly decreased the risk of the composite of major macrovascular and microvascular events (hazard ratio 0.90, 95% confidence interval 0.82-0.98), with no heterogeneity in the effects across age subgroups (p for heterogeneity = 0.44). Relative effects on all-cause death, cardiovascular death, and components of major vascular events were also similar (P for heterogeneity ≥0.06), except for severe hypoglycaemia, which was of greater risk for patients aged <65 years. Absolute benefits and harms were broadly consistent across subgroups. Among patients aged ≥65 years, randomized treatment effects did not differ significantly across different levels of cognitive function or coexisting chronic illnesses. Our results suggest that an intensive glycaemic control strategy to reduce HbA1c to 48 mmol/mol (6.5%) provided broadly similar benefits and harms and may be recommended for older, as well as younger, patients.

Changes in the Cellular Composition of the Cerebral Cortex in Rats with Different Levels of Cognitive Function in Cerebral Hypoperfusion Combined with Short-Term Physical Activity

The aim of the study was to detect the features of neurodystrophic changes in neurons and glia of the motor cortex of the brain in rats with different levels of cognitive functions and stress resistance with bilateral ligation of the common carotid arteries combined with short-term physical activity.Material and methods. The study included 136 Wistar rats. All animals were divided into two subgroups depending on the results of testing in the Morris water maze: with a high and a low level of abilities for spatial environment learning. Animals of the experimental group were exposed to daily free swimming for 15 minutes, starting on the 7th and ending on the 35th days of the study. The rats were withdrawn from the experiment in 8, 14, 21, 35, 60, and 90 days after bilateral ligation of both carotid arteries. Histological sections of the precentral gyrus of the brain were stained according to Nissl and hematoxylin-eosin.Results. On the 8th day of the experiment (1 day of short-term physical activity), the hemomicrocirculatory bed of the cerebral cortex was characterized by a decrease in venous hyperemia, and a decrease of tissue edema signs around the hemocapillaries, a characteristic feature of isolated cerebral hypoperfusion. Neurons with signs of hyperfunction and rod-shaped inclusions in the nuclei (Roncoronni bodies) were detected on the 14th, 21st, 28th days. Hemocapillaries formed compact groups of cells. Further, neurodystrophic changes were less pronounced in comparison with isolated cerebral hypoperfusion, this was accompanied by a decrease in venous hyperemia, preservation of perivasal cell groups up to the 60th day of the experiment. Roncoroni bodies disappeared on the 90th day of observation.Conclusion. The effect of short-term physical activity on the development of cerebral hypoperfusion resulted in an increase in the number of neurons without irreversible changes, a decrease in neurodegenerative changes, and also reduced the severity of gliosis. The adaptive effect of short-term physical activity was more pronounced in animals with a high level of cognitive abilities, which was accompanied by a more significant decrease in the number of dead cells of the cerebral cortex. Day 28 was a critical point when gliosis and neuronal death were combined with the appearance of Roncoronni bodies and perikarion hypertrophy of some pyramidal neurons, as well as the concentration of gliocytes around hemocapillaries. The latter appears to be a sort of adaptation, since it is accompanied by a decrease in mortality in animals with a high level of cognitive abilities.

Interindividual Differences in Cognitive Functioning Are Associated with Autobiographical Memory Retrieval Specificity in Older Adults

Abstract. We examined whether interindividual differences in cognitive functioning among older adults are related to episodic memory engagement during autobiographical memory retrieval. Older adults ( n = 49, 24 males; mean age = 69.93; mean education = 15.45) with different levels of cognitive functioning, estimated using the Montreal Cognitive Assessment (MoCA), retrieved multiple memories (generation task) and the details of a single memory (elaboration task) to cues representing thematic or event-specific autobiographical knowledge. We found that the MoCA score positively predicted the proportion of specific memories for generation and episodic details for elaboration, but only to cues that represented event-specific information. The results demonstrate that individuals with healthy, but not unhealthy, cognitive status can leverage contextual support from retrieval cues to improve autobiographical specificity.

Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden

PurposeThe aim of this study was to describe changes in the pattern of cardiovascular agents used in elderly people living in nursing homes between 2007 and 2013. Further, the aim was to analyse the use of cardiovascular drugs in relation to cognitive impairment and associated factors within the same population, where prescription of loop diuretics was used as a proxy for heart failure.MethodsTwo questionnaire surveys were performed including 2494 people in 2007 and 1654 people in 2013 living in nursing homes in northern Sweden. Data were collected concerning drug use, functioning in activities of daily living (ADL) and cognition, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). The use of different drugs and drug classes among people at four different levels of cognitive function in 2007 and 2013 were compared.ResultsThe proportion of people prescribed ASA and diuretics was significantly lower at all four levels of cognitive function in 2013 compared to 2007. Among people prescribed loop diuretics, the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs) increased from 37.8 to 45.6%, β-blockers from 36.0 to 41.8% and warfarin from 4.4 to 11.4%. The use of warfarin, ACEI/ARBs, β-blockers and mineralocorticoid receptor antagonists (MRAs) were less common among individuals with more severe cognitive impairment.ConclusionThe results indicate that cardiovascular drug treatment has improved between 2007 and 2013, but there is room for further improvement, especially regarding adherence to guidelines for heart failure. Increasing cognitive impairment had an effect on treatment patterns for heart failure and atrial fibrillation.

Memory for familiar locations: The impact of age, education and cognitive efficiency on two neuropsychological allocentric tasks.

This research aims to reconsider and support the use of spatial tasks based on familiar geographical information in the neuropsychological assessment of topographical (dis)orientation. Performance on two spatial tasks based on familiar information -l andmark positioning on a map and map of Italy - were compared in two studies assessing allocentric orientation among young and healthy elderly with different levels of education (Study 1) and elderly with and without probable cognitive impairment (Study 2). Results from Study 1 showed that the map of Italy task was affected by education, while the landmark positioning on a map was not. Results of Study 2 showed that both tasks were sensitive to different levels of cognitive functioning in a sample of community-dwelling seniors. Overall, spatial tasks based on mental representation of the hometown environment may be an important supplement in the assessment of allocentric topographical disorientation, discriminating typical from atypical aging.

Effectiveness of executive function training on mental set shifting, working memory and inhibition in healthy older adults: A double-blind randomized controlled trials.

The aim of this study was to evaluate the effectiveness of executive function training on mental set shifting, working memory and inhibition for healthy older adults. Executive functions control and guide individuals' behaviours through a top-down cognitive model and have been regarded as the exhibition and integration of various high-level cognitive functions. However, prior studies have rarely focused on the subcomponent indicators of executive function, such as mental set shifting, working memory and inhibition in healthy older adults. Randomized controlled trial. A total of 62 participants were recruited between January 2015 - March 2017, with both groups attending a 30-min training session three times per week for 8weeks. Executive function training group received the training content that focused on the mental set shifting, working memory and inhibition. Active control group engaged in passive information activities. The primary outcome was mental set shifting, measured by the Wisconsin card sort test. The secondary outcomes were working memory measured by digit span and inhibition measured by the Stroop color word test. The executive function training group had statistically significant higher scores of mental set shifting and working memory at immediate follow-up and that its effect on mental set shifting could be maintained for 3-6months. However, this training did not have any statistically significant results on inhibition. The executive function training may be an effective preventive intervention for healthy older adults. Future studies are recommended to include a broader range of participants with different levels of cognitive function.

Educational level influenced the gold standard diagnosis of late-life depression in the GreatAGE study

IntroductionThe validity of the 30-item Geriatric Depression Scale (GDS-30) in detecting late-life depression (LLD) requires a certain level of cognitive functioning. Further research is needed in population-based setting on other socio-demographic and cognitive variables that could potentially influence the accuracy of clinician rated depression.ObjectiveTo compare the diagnostic accuracy of two instruments used to assess depressive disorders [(GDS-30) and the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID)] among three groups with different levels of cognitive functioning (normal, Mild Cognitive Impairment – MCI, Subjective Memory Complain – SMC) in a random sampling of the general population 65+ years.MethodsThe sample, collected in a population-based study (GreatAGE Study) among the older residents of Castellana Grotte, South-East Italy, included 844 subjects (54.50% males). A standardized neuropsychological battery was used to assess MCI, SMC and depressive symptoms (GDS-30). Depressive syndromes were diagnosed through the SCID IV-TR. Socio-demographic and cognitive variables were taken into account in influencing SCID performance.ResultsAccording to the SCID, the rate of depressive disorders was 12.56%. At the optimal cut-off score (≥ 4), GDS-30 had 65.1% sensitivity and 68.4% specificity in diagnosing depressive symptoms. Using a more conservative cut-off (≥ 10), the GDS-30 specificity reached 91.1% while sensitivity dropped to 37,7%. The three cognitive subgroups did not differ in the rate of depression diagnosis. Educational level is the only variable associated to the SCID diagnostic performance (P = 0.015).ConclusionsAt the optimal cut-off, GDS-30 identified lower levels of screening accuracy for subjects with normal cognition rather than for SMC (AUC 0.792 vs. 0.692); educational attainment possibly may modulate diagnostic clinician performance.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Associations of fat and muscle tissue with cognitive status in older adults: the AGES-Reykjavik Study.

studies on the association of dementia with specific body composition (BC) components are scarce. Our aim was to investigate associations of BC measures with different levels of cognitive function in late-life. we studied 5,169 participants (mean age 76 years, 42.9% men) in the AGES-Reykjavik Study of whom 485 (9.4%) were diagnosed with mild cognitive impairment (MCI) and 307 (5.9%) with dementia. Visceral fat, abdominal and thigh subcutaneous fat, and thigh muscle were assessed by computed tomography. MCI and dementia were based on clinical assessment and a consensus meeting; those without MCI or dementia were categorised as normal. Multinomial regression models assessed the associations stratified by sex and in additional analyses by midlife body mass index (BMI). among women, there was a decreased likelihood of dementia per SD increase in abdominal subcutaneous fat (OR 0.72; 95% CI: 0.59-0.88), thigh subcutaneous fat (0.81; 0.67-0.98) and thigh muscle (0.63; 0.52-0.76), but not visceral fat, adjusting for demographics, vascular risk factors, stroke and depression. Inverse associations of fat with dementia were attenuated by weight change from midlife and were strongest in women with midlife BMI <25. In men, one SD increase in thigh muscle was associated with a decreased likelihood of dementia (0.75; 0.61-0.92). BC was not associated with MCI in men or women. a higher amount of abdominal and thigh subcutaneous fat were associated with a lower likelihood of dementia in women only, while more thigh muscle was associated with a lower likelihood of dementia in men and women.

Visual and analytical strategies in spatial visualisation: perspectives from bilateral symmetry and reflection

This inquiry presents two fine-grained case studies of students demonstrating different levels of cognitive functioning in relation to bilateral symmetry and reflection. The two students were asked to solve four sets of tasks and articulate their reasoning in task-based interviews. The first participant, Brittany, focused essentially on three criteria, namely (1) equidistance, (2) congruence of sides and (3) ‘exactly opposite’ as the intuitive counterpart of perpendicularity for performing reflection. On the other hand, the second participant, Sara, focused on perpendicularity and equidistance, as is the normative procedure. Brittany’s inadequate knowledge of reflection shaped her actions and served as a validation for her solutions. Intuitively, her visual strategies took over as a fallback measure to maintain congruence of sides in the absence of a formal notion of perpendicularity. In this paper, we address some of the well-known constraints that students encounter in dealing with bilateral symmetry and reflection, particularly situations involving inclined line of symmetry. Importantly, we make an attempt to show how visual and analytical strategies interact in the production of a reflected image. Our findings highlight the necessity to give more explicit attention to the notion of perpendicularity in bilateral symmetry and reflection tasks.

Validation of the Iconographical Falls Efficacy Scale in Cognitively Impaired Older People

This study evaluated psychometric properties of the Iconographical Falls Efficacy Scale (Icon-FES) to measure fear of falling in cognitively impaired older people. Icon-FES uses pictures as visual cues to prompt responses. A total of 50 community-dwelling older people with moderate cognitive impairment were assessed on Icon-FES, Falls Efficacy Scale-International, and various physical and cognitive measures. Overall structure and measurement properties of Icon-FES, as evaluated with item response theory, were good. Internal consistency was high (Cronbach's alpha = 0.97). Distribution was near normal, indicating absence of floor and ceiling effects. Icon-FES construct validity was supported by its relation with Falls Efficacy Scale-International (r = .68, p < .001) and its ability to discriminate between groups relating to fall risk factors (gender, balance, falls). Scores were not affected by different levels of cognitive functioning, as assessed with the Mini-Mental State Examination and Trail Making Test. Icon-FES is the first measure of fear of falling that compensates for reduced abstract abilities by using pictures to match the verbal descriptions. This study supports its feasibility, reliability, and validity to assess fear of falling in people with moderate cognitive impairment or dementia living in the community. Compared with Falls Efficacy Scale-International, Icon-FES was better at identifying participants with higher fall risk and did not show a floor effect likely due to a greater range of physically challenging activities.

The Impact of Stimuli on Affect in Persons With Dementia

To examine how presentation of different stimuli impacts affect in nursing home residents with dementia. Participants were 193 residents aged 60 to 101 years from 7 Maryland nursing homes who had a diagnosis of dementia (derived from the medical chart or obtained from the attending physician). Cognitive functioning was assessed via the Mini-Mental State Examination (MMSE), and data pertaining to activities of daily living were obtained through the Minimum Data Set. Affect was assessed using observations of the 5 moods from Lawton's Modified Behavior Stream. Baseline observations of affect were performed for comparisons. During the study, each participant was presented with 25 predetermined engagement stimuli in random order over a period of 3 weeks. Stimuli were categorized as live social, simulated social, manipulative, work/task-related, music, reading, or individualized to the participant's self-identity. The dates of data collection were 2005-2007. Differences between stimulus categories were significant for pleasure (F(6,144) = 25.137, P < .001) and interest (F(6,144) = 18.792, P < .001) but not for negative affect. Pleasure and interest were highest for the live social category, followed by self-identity and simulated social stimuli for pleasure, and for manipulative stimuli in terms of the effect on interest. The lowest levels of pleasure and interest were observed for music. Participants with higher cognitive function had significantly higher pleasure (F(1,97) = 6.27, P < .05). Although the general trend of the impact of the different categories was similar for different levels of cognitive function, there were significant differences in pleasure in response to specific stimuli (interaction effect: F(6,92) = 2.31, P < .05). Overall, social stimuli have the highest impact on affect in persons with dementia. The findings of the present study are important, as affect is a major indicator of quality of life and this study is the first to systematically examine the impact of specific types of stimuli on affect. As live social stimuli are not always readily available, particularly in busy nursing home environments, simulated social stimuli can serve as an effective substitute, and other stimuli should have a role in the activity tool kit in the nursing home. The relative ranking of stimuli was different for interest and pleasure. The findings demonstrate the differential effect of presentation of different types of stimuli on the affect of persons with dementia, and that, while the impact is greater on persons with higher levels of cognitive function, there is a different effect of varying stimuli even in persons with MMSE scores of 3 or lower. Future research should attempt to ascertain a person's degree of interest in stimuli prior to developing an intervention.

What can we learn about the mobility of the elderly in the GPS era?

Until recently, the assessment of outdoor mobility of the elderly relied mainly on self-administered time–space diaries or on reports of family caregivers and institutional staff, using observational approaches, activity monitoring, or behavioral checklists. In recent years, however, the rapid development and availability of small, inexpensive, and reliable tracking devices has led to a growing volume of research that uses this technology as a tool for data collection in various disciplines. This paper presents new insights that are now available regarding the outdoor mobility of the elderly due to the analysis of GPS data with automatic scripts and GIS platforms. The data presented are based on the activity of 49 elderly people from the Tel-Aviv Metropolitan area (Israel), who took part in an interdisciplinary project, involving researchers in geography, social work, gerontology, psychology and medicine, that studies the outdoor activities of elderly people in time and space using advanced tracking technologies. Participants were tracked for an average of 28 consecutive days using a location kit that combined GPS with RFID technology. Differences were found in various walking and driving parameters, such as speed, length, timing, and frequency of participants with different levels of cognitive function. The trends present a general decline in out-of-home mobility of elderly people with cognitive impairment and illuminates as well the important role that additional factors as age, gender, and the accessibility to a private car play in determining levels of out-of-home mobility.