Impairment In Old Age Research Articles

Physical Activity Over the Life Course and Its Association with Cognitive Performance and Impairment in Old Age

To determine how physical activity at various ages over the life course is associated with cognitive impairment in late life. Cross-sectional study. Four U.S. sites. Nine thousand three hundred forty-four women aged 65 and older (mean 71.6) who self-reported teenage, age 30, age 50, and late-life physical activity. Logistic regression was used to determine the association between physical activity status at each age and likelihood of cognitive impairment (modified Mini-Mental State Examination (mMMSE) score >1.5 standard deviations below the mean, mMMSE score</=22). Models were adjusted for age, education, marital status, diabetes mellitus, hypertension, depressive symptoms, smoking, and body mass index. Women who reported being physically active had a lower prevalence of cognitive impairment in late life than women who were inactive at each time (teenage: 8.5% vs 16.7%, adjusted odds ratio (AOR)=0.65, 95% confidence interval (CI)=0.53-0.80; age 30: 8.9% vs 12.0%, AOR=0.80, 95% CI=0.67-0.96); age 50: 8.5% vs 13.1%, AOR=0.71, 95% CI=0.59-0.85; old age: 8.2% vs 15.9%, AOR=0.74, 95% CI=0.61-0.91). When the four times were analyzed together, teenage physical activity was most strongly associated with lower odds of late-life cognitive impairment (OR=0.73, 95% CI=0.58-0.92). However, women who were physically inactive as teenagers and became active in later life had lower risk than those who remained inactive. Women who reported being physically active at any point over the life course, especially as teenagers, had a lower likelihood of cognitive impairment in late life. Interventions should promote physical activity early in life and throughout the life course.

Education and physical activity mediate the relationship between ethnicity and cognitive function in late middle-aged adults

Objective. Minority status has been implicated as a risk factor for disparate scores on cognitive function tests in older adults. Research on ethnicity and cognitive function has yielded socioeconomic status, particularly education, as a primary reason for the discrepancy. Other factors, such as physical activity may provide insight into the relationship. Despite this knowledge, few studies have thoroughly examined the mediating characteristics of education or physical activity in the relationship between ethnicity and cognitive function in younger aged groups. Most research conducted focuses only on older adults during a time when degeneration of brain tissue may complicate the exploration of the relationships among ethnicity and cognitive function. The current research will expand existing knowledge about education, physical activity, and cognitive function in minority groups. Design. The study presents data from the Health and Retirement Study, a nationally representative sample of late middle-aged White, Black, and Hispanic adults (n=9204, mean age±SD = 55.8±3.1). Regression and mediation testing determined the mediating effects of education and physical activity in the relationship between ethnicity and cognitive function. Results. Significant association between White ethnicity and higher scores on cognitive tests was evident as early as late middle age. The magnitude of the association significantly diminished on adjusting for education and leisure time physical activity. Conclusion. Our data suggest a potential mediating role of education and physical activity on the ethnic differences in cognitive tests in late middle-aged White, Black, and Hispanic adults. Our findings suggest a need for studies to understand if adult education and culturally appropriate physical activity interventions in middle age influence ethnic disparities in prevalence of cognitive impairment in old age.

A Prospective Analysis of Elevated Fasting Glucose Levels and Cognitive Function in Older People

OBJECTIVETo investigate the relationship between fasting glucose levels, insulin resistance, and cognitive impairment in old age. Diabetes is associated with cognitive impairment in older people. However, the link between elevated fasting glucose levels and insulin resistance in nondiabetic individuals, and the risk of cognitive impairment is unclear.RESEARCH DESIGN AND METHODSWe analyzed data from, in total, 8,447 participants in two independent prospective studies: the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), 5,019 participants, aged 69–84 years, and the Rotterdam Study, 3,428 participants, aged 61–97 years. Fasting glucose levels were assessed at baseline in both studies; fasting insulin levels were assessed in the Rotterdam Study only. Cognitive function was assessed in both studies at baseline and during follow-up.RESULTSSubjects with diabetes had impaired cognitive function at baseline. In contrast, in people without a history of diabetes, there was no clear association between baseline fasting glucose levels and executive function and memory, nor was there a consistent relationship between elevated baseline fasting glucose levels and the rate of cognitive decline in either cohort. Insulin resistance (homeostasis model assessment index) was also unrelated to cognitive function and decline.CONCLUSIONSElevated fasting glucose levels and insulin resistance are not associated with worse cognitive function in older people without a history of diabetes. These data suggest either that there is a threshold for effects of dysglycemia on cognitive function or that factors other than hyperglycemia contribute to cognitive impairment in individuals with frank diabetes.

A high-fat diet induces lower expression of retinoid receptors and their target genes GAP-43/neuromodulin and RC3/neurogranin in the rat brain

Numerous studies have reported an association between cognitive impairment in old age and nutritional factors, including dietary fat. Retinoic acid (RA) plays a central role in the maintenance of cognitive processes via its nuclear receptors (NR), retinoic acid receptor (RAR) and retinoid X receptor (RXR), and the control of target genes, e.g. the synaptic plasticity markers GAP-43/neuromodulin and RC3/neurogranin. Given the relationship between RA and the fatty acid signalling pathways mediated by their respective NR (RAR/RXR and PPAR), we investigated the effect of a high-fat diet (HFD) on (1) PUFA status in the plasma and brain, and (2) the expression of RA and fatty acid NR (RARbeta, RXRbetagamma and PPARdelta), and synaptic plasticity genes (GAP-43 and RC3), in young male Wistar rats. In the striatum of rats given a HFD for 8 weeks, real-time PCR (RT-PCR) revealed a decrease in mRNA levels of RARbeta ( - 14 %) and PPARdelta ( - 13 %) along with an increase in RXRbetagamma (+52 %). Concomitantly, RT-PCR and Western blot analysis revealed (1) a clear reduction in striatal mRNA and protein levels of RC3 ( - 24 and - 26 %, respectively) and GAP-43 ( - 10 and - 42 %, respectively), which was confirmed by in situ hybridisation, and (2) decreased hippocampal RC3 and GAP-43 protein levels (approximately 25 %). Additionally, HFD rats exhibited a significant decrease in plasma ( - 59 %) and brain ( - 6 %) n-3 PUFA content, mainly due to the loss of DHA. These results suggest that dietary fat induces neurobiological alterations by modulating the brain RA signalling pathway and n-3 PUFA content, which have been previously correlated with cognitive impairment.

Vision and hearing impairment in old age

Vision and hearing impairment in old age

Vision and hearing impairment in old age

Vision and hearing impairment in old age

Cardio-Ankle Vascular Index as a Predictor of Cognitive Impairment in Community-Dwelling Elderly People: Four-Year Follow-Up

Background/Aim: The relation between markers of generalized atherosclerosis and cognitive impairment in old age is controversial. The aim of the study was to evaluate the cardio-ankle vascular index (CAVI) as a predictor of longitudinal changes in cognitive function in older individuals. Methods: We evaluated the cognitive function in elderly people with high (AS(+)) and low (AS(–)) values of CAVI each year over 4 years. Results: The changes in the Hasegawa Dementia Scale Revised (HDS-R) and the mini-mental state examination (MMSE) at 4 years were significantly larger in the AS(+) group (AS(+) vs. AS(–) = –1.8 ± 4.4 vs. 0.3 ± 2.8 points and –1.1 ± 3.0 vs. 0.1 ± 2.3 points, p = 0.008 and 0.03, respectively). The annual changes in the HDS-R were significantly decreased from baseline at 1 year later to 4 years later in AS(+) (baseline vs. 1, 2, 3, 4 years = 26.5 vs. 25.0, 25.5, 25.7, 24.8 points, p < 0.001); in comparison, the annual changes in MMSE significantly decreased from the baseline over the 4 years in AS (+) (baseline vs. 1, 2, 3, 4 years = 26.8 vs. 26.2, 25.8, 26.4, 25.7 points, p = 0.002). Conclusion: The results of this study suggest that elderly people with a high CAVI value are at a greater risk of cognitive decline.

Die Reservekapazität des Gehirns beeinflusst die kognitive Funktion im Alter: Motivationale, kognitive und körperliche Facetten

Die Reservekapazität des Gehirns ist seine Fähigkeit, neuropathologische Veränderungen so zu tolerieren, dass ihre klinische Manifestation hinausgezögert wird. Diese Studie untersucht, inwiefern frühere motivationale („motivationale Reserve“), kognitive und körperliche Fähigkeiten bzw. Aktivitäten unabhängige Prädiktoren einer leichten kognitiven Beeinträchtigung im Alter sind. Eine Stichprobe von 147 nicht-dementen Personen zwischen 60 und 94 Jahren absolvierte kognitive Tests und Fragebogen zur Berufsbiographie sowie früheren körperlichen Aktivitäten. Frühere motivationale und kognitive Fähigkeiten wurden auf der Basis des Hauptberufs unter Anwendung der Datenbank des Occupational Information Networks (O*NET) geschätzt. Die früheren motivationalen Fähigkeiten und die kristallisierte Intelligenz sagten ein reduziertes Risiko einer leichten kognitiven Beeinträchtigung voraus, nicht aber frühere körperliche Aktivitäten. Die Ergebnisse legen nahe, dass insbesondere die motivationale Reservekapazität als protektiver Faktor gegen kognitive Beeinträchtigung im Alter wirkt.

A Population-Based Study of the Association between Trypanosoma cruzi Infection and Cognitive Impairment in Old Age (The Bambuí Study)

Background: Limited clinical data suggest that chronic Trypanosoma cruzi infection, which causes Chagas’ disease (ChD), is associated with cognitive impairment. This study investigated this association in a large population-based sample of older adults. Methods: Participants in this cross-sectional study comprised 1,449 persons aged ≥60 years from a Brazilian endemic area (Bambuí). Cognitive functioning was ascertained by the Mini-Mental State Examination (MMSE), considering its score in percentiles [≤14 (<5th percentile), 15–22 (5th to <25th) and ≥23]. Hypothesized risk factors were T. cruzi infection, ChD-related electrocardiographic (ECG) abnormalities and use of digoxin medication. Potential confounders included depressive symptoms, smoking, stroke, hemoglobin, HDL cholesterol, blood glucose, systolic blood pressure, and use of psychoactive medication. Results: The prevalence of T. cruzi infection was 37.6%. There was a graded and independent association between infection and the MMSE score (adjusted odds ratios estimated by ordinal logistic regression = 1.99; 95% CI 1.43–2.76). No significant associations between the MMSE score and ECG abnormalities or digoxin medication use were found. Conclusions: This study provides for the first time epidemiological evidence of an association between T. cruzi infection and cognitive impairment which was not mediated by either ChD-related ECG abnormalities or digoxin medication use.

S4-03-01: Personality and risk of cognitive impairment in old age

Recent epidemiologic research suggests that selected dimensions of personality may affect risk of mild cognitive impairment (MCI) and Alzheimer's disease (AD) in old age. This presentation will consider two triats: neuroticism, which refers to the tendency to experience psychological distress, and conscientiousness, which refers to the tendency to control impulses and be goal-directed. Review of recent data from epidemiologic and clinical-pathologic studies. High neuroticism/distress predicts loss of cognition in the form of increased incidence of MCI and AD and more rapid cognitive decline. Level of distress does not appear to increase during the prodromal phase of AD, however, or to be correlated with the neuropathologic lesions most commonly seen in persons with AD and other forms of dementia (ie, amyloid plaques, neurofibrillary tangles, Lewy bodies, cerebral infarctions). The applicability of animal models of chronic stress to these observations will be discussed. In addition, data will be presented showing lower level of conscientiousness to be associated with increased loss of cognition, even after controlling for neuroticism, despite a lack of association with common age-related neuropathologic lesions. Personality contributes to risk of MCI and dementia in old age but does not appear to be related to the neuropathologic lesions traditionally associated with these conditions. Understanding the neurobiologic mechanisms through which personality affects cognition in late life may suggest novel strategies for delaying the onset of dementia in old age.

Early Life Influences on Cognitive Impairment Among Oldest Old Chinese

This article examines the effects of early life socioeconomic conditions on the risk of cognitive impairment among oldest old persons in China. We also examine whether adult socioeconomic status mediates the association between early life socioeconomic status and cognitive impairment in old age. Data derived from two waves (1998-2000) of the Chinese Longitudinal Healthy Longevity Survey. We estimated logistic and multinomial regression models of cognitive impairment for a nationwide sample of people aged 80 to 105 (N = 8,444). Among both men and women, urban residence in early life as well as education was associated with lower odds of cognitive impairment at baseline. We found modest support for a protective effect of advantaged childhood background on the odds of cognitive impairment onset during the 2-year follow-up, especially among women. Our findings suggest that socioeconomic environment throughout the life course, early life in particular, can influence the risk of cognitive impairment in old age. Not only can public policy that targets illiteracy, hunger, and poverty improve the lives of tens of thousands of children, but ultimately such investments will pay significant dividends many decades later in enhancing the cognitive well-being of older persons.

Olfactory Identification and Incidence of Mild Cognitive Impairment in Older Age

Mild cognitive impairment (MCI) is often a precursor to Alzheimer disease, but knowledge about factors that predict its development is limited. To test the hypothesis that impaired odor identification is related to increased risk of incident MCI. Longitudinal cohort study. Academic research. Subjects were 589 community-dwelling older persons without cognitive impairment at study baseline, at which time odor identification was assessed using the 12-item Brief Smell Identification Test (mean +/- SD score, 9.3 +/- 1.9). Incidence of MCI and rate of decline in cognitive function. During annual observation of up to 5 years, 177 subjects developed MCI. In a proportional hazards model adjusted for age, sex, and education, odor identification score predicted development of MCI (relative risk, 1.15; 95% confidence interval, 1.07-1.23), with risk increased by 50% in persons with below-average (score of 8 [25th percentile]) compared with above-average (score of 11 [75th percentile]) odor identification scores. Results were not substantially changed in subsequent analyses that controlled for level of cognitive function or disability, presence of stroke, or smoking status at baseline or that required MCI to persist for at least 1 year. Impaired odor identification was also associated with a lower level of global cognition at baseline and with more rapid decline in episodic memory, semantic memory, and perceptual speed. Among older persons without manifest cognitive impairment, difficulty in identifying odors predicts subsequent development of MCI.

The effect of social networks on the relation between Alzheimer's disease pathology and level of cognitive function in old people: a longitudinal cohort study

Few data are available about how social networks reduce the risk of cognitive impairment in old age. We aimed to measure this effect using data from a large, longitudinal, epidemiological clinicopathological study. 89 elderly people without known dementia participating in the Rush Memory and Aging Project underwent annual clinical evaluation. Brain autopsy was done at the time of death. Social network data were obtained by structured interview. Cognitive function tests were Z scored and averaged to yield a global and specific measure of cognitive function. Alzheimer's disease pathology was quantified as a global measure based on modified Bielschowsky silver stain. Amyloid load and the density of paired helical filament tau tangles were also quantified with antibody-specific immunostains. We used linear regression to examine the relation of disease pathology scores and social networks to level of cognitive function. Cognitive function was inversely related to all measures of disease pathology, indicating lower function at more severe levels of pathology. Social network size modified the association between pathology and cognitive function (parameter estimate 0.097, SE 0.039, p=0.016, R(2)=0.295). Even at more severe levels of global disease pathology, cognitive function remained higher for participants with larger network sizes. A similar modifying association was observed with tangles (parameter estimate 0.011, SE 0.003, p=0.001, R(2)=0.454). These modifying effects were most pronounced for semantic memory and working memory. Amyloid load did not modify the relation between pathology and network size. The results were unchanged after controlling for cognitive, physical, and social activities, depressive symptoms, or number of chronic diseases. These findings suggest that social networks modify the relation of some measures of Alzheimer's disease pathology to level of cognitive function.

Contrasting cognitive trajectories of impending death and preclinical dementia in the very old

Both impending death and preclinical dementia are associated with cognitive impairment in old age, although their effects on cognitive functioning have rarely been examined within the same study. Participants (n = 1,200, aged 75+ years) from a community-based study completed a measure of global cognitive performance (the Mini-Mental State Examination [MMSE]) at 3-year intervals over an 11-year period. Level and change of MMSE performance were compared for three groups: persons in close proximity to death, persons in a preclinical phase of dementia, and persons who remained alive and nondemented throughout the study. There were significant group differences in MMSE performance 3 years before each outcome (death, dementia, or end of study). Those with preclinical dementia performed the poorest and declined twice as fast on the MMSE relative to the other groups. Although persons in close proximity to death declined faster in general, no accelerated decline was observed for the impending death group after persons with dementia or preclinical dementia had been excluded. Group differences were attenuated for the oldest-old (81+ years) compared to the old-old (75 to 80 years). The lack of accelerated decline in proximity to death after excluding persons with dementia or preclinical dementia suggests that part of the terminal decline effect demonstrated in previous investigations may reflect preclinical dementia deficits. Further, accelerated cognitive decline might be a more reliable indicator of preclinical dementia than a low cognitive score due to confounds associated with cross-sectional cognitive performance.

Gender Differentials in Cognitive Impairment and Decline of the Oldest Old in China

Research in China has shown that women are significantly disadvantaged in cognitive functioning in old age. This article adds to this line of inquiry by examining gender differentials in the odds of having cognitive impairment at baseline and during follow-up among the Chinese oldest old, as well as the potential pathways linking gender and the likelihood of having cognitive impairment. Using two waves (1998 and 2000) of the Chinese Longitudinal Healthy Longevity Survey, the researcher estimated logistic and multinomial regression models of cognitive impairment for a nationwide sample of people aged 80-105 years old (N = 8,291). Among the Chinese oldest old, women were at higher risk than men for having cognitive impairment both at baseline and during 2-year follow-up, controlling for age, activities of daily living disability, and rural residence. Women's disadvantages in socioeconomic status, social network, and participation in leisure activities partially accounted for the gender differentials in cognitive impairment. The findings suggest that oldest old Chinese women are a vulnerable group at higher risk for cognitive impairment than oldest old men. Closing gender disparities in formal education will significantly reduce the gender gap in cognitive impairment in old age.

The Fischer 344/NNiaHSd X Brown Norway/BiNia is a Better Model of Sarcopenia than the Fischer 344/NNiaHSd: a Comparative Analysis of Muscle Mass and Contractile Properties in Aging Male Rat Models

Sarcopenia, characterized by profound muscle atrophy and the loss of contractile function, contributes significantly to the development of frailty and functional impairment in older age. Although present in aging humans, rat models have failed to clearly demonstrate a similar degree of this age-associated loss of muscle mass and function. This investigation compared two models of rats raised specifically for aging studies, the Fischer 344/NNiaHSd (F344/N) and the Fischer 344/NNiaHSd X Brown Norway/BiNia (F344/NXBN), and sought to determine which model provides the most accurate representation of human sarcopenia. We found that aging had no effect on F344/N muscle mass or contractile function in the extensor digitorum longus (EDL) and soleus (SOL). Conversely, in the F344/NXBN model, aging was found to decrease EDL and SOL mass and contractile function. These changes were sufficient to satisfy the proposed criteria for the diagnosis of human sarcopenia based upon muscle mass and contractile function. Results indicate that the F344/NXBN provides a better model of the alterations seen in aging human muscle than the F344/N rat model.

Homocysteine, vitamin B-12, and folic acid and the risk of cognitive decline in old age: the Leiden 85-Plus Study

High concentrations of homocysteine and low concentrations of vitamin B-12 and folic acid are frequently observed in subjects with dementia. We assessed whether serum concentrations of homocysteine, vitamin B-12, or folic acid predict cognitive decline in old age. This was a prospective, population-based, longitudinal study of 599 subjects (Leiden 85-Plus Study, Netherlands). The subjects were administered a battery of cognitive tests (including the Mini Mental State Examination, the Stroop test, a letter digit coding test, and a word recall test) at 85 y of age and yearly thereafter until 89 y of age. Serum concentrations of homocysteine, vitamin B-12, and folic acid were measured at 85 and 89 y of age. Cross-sectional associations between serum concentrations and cognition were assessed at 85 and 89 y of age. The association between baseline serum concentrations and subsequent longitudinal cognitive decline was assessed with the use of mixed linear models. In the cross-sectional analyses, serum concentrations of homocysteine and folic acid were significantly associated with cognitive performance, but serum concentrations of vitamin B-12 were not. In the longitudinal analyses, there were no significant associations of serum concentrations of homocysteine, vitamin B-12, or folic acid with rate of cognitive decline. Elevated serum concentrations of homocysteine and reduced folic acid are associated with cognitive impairment in elderly persons but do not predict an increased rate of cognitive decline. The association of high serum concentrations of homocysteine and low folic acid with cognitive impairment in old age is likely to be a consequence of disease and not a contributory cause.

No Old Man Ever Forgot Where He Buried His Treasure: Concepts of Cognitive Impairment in Old Age Circa 1700

Cognitive impairment in old age is one of the most important topics in modern geriatrics. This article discusses the historical dimensions of this phenomenon. To this end, a number of primary sources ranging from antiquity to the modern era are evaluated. Although a physiology and pathology of old age were conceptualized in Greco-Roman times, cognitive impairment in old age remained a marginal issue until the 17th century. Alternatively, after 1500, medicine boasted detailed theories on the physiology and pathology of old age. There are several possible explanations for this unusual situation. Underlying conflict between idealistic and materialistic views of man played a decisive role, for these concepts differed considerably regarding the intellectual and mental functioning of the soul as well as the effects of the passage of time. After Cartesianism and Iatromechanism had pushed these traditional boundaries back, the problem of cognitive impairment in old age was increasingly regarded as a physical illness and began to receive more attention. Just as its philosophical and theological context shaped early modern medicine, contemporary nonmedical disciplines such as genetics, (neuro-)biology, and the information sciences influence modern research.

Normal Aging of Brain Structure and Cognition: Evolutionary Perspectives

Many aging changes in the brain are separate from clinical disease and show evidence of adaptive compensation. The many levels of compensation are illustrated with age-related changes in dopamine neurotransmitter systems, myelination, gross structure, processing speed, and performance on neuropsychological and psychometric tests in middle and older ages. Major declines in very low-level processes that are not simultaneously paralleled by performance declines may indicate compensatory mechanisms that mask prodromal dementia. These patterns of change follow a model of biologically (genetically) programmed adaptive responses to aging in brain cells. Moreover, adaptive mechanisms also interact with the individual's environment, as suggested by the role of socioeconomic status and childhood experience in risk of cognitive impairment in old age. These findings support evolutionary mechanisms of natural selection along with extensive social support in brain aging that may be unique to humans.

Relationship between Dementia and Nutrition-Related Factors and Disorders: An Overview

This review gives a brief overview of the main types of dementia and summarizes current thinking on the relationship between nutritional-related factors and disorders, and dementia. Dementia is a multi-factor pathological condition, and nutrition is one factor that may play a role on its onset and progression. An optimal intake of nutrients doesn't protect people from dementia. However, studies in this area show that inadequate dietary habits, which are of particular concern in elderly populations, may increase the risk of developing a number of age-related diseases, including disorders of impaired cognitive function. They show that a deficiency in essential nutrients, such as certain B complex vitamins, can result in hyperhomocysteinemia, a well-known risk factor for atherosclerosis and recently associated with cognitive impairment in old age. A deficiency of antioxidants such as vitamins C and E, and beta-carotene, as well as nutrition-related disorders like hypercholesterolemia, hypertension, and diabetes, may also have some role in cognitive impairment. These factors can be present for a long time before cognitive impairment becomes evident, therefore they could be potentially detected and corrected in a timely manner.