Nondemented Adults Research Articles

Metabolic Syndrome and Cognitive Impairment among High Socioeconomic, Nondemented Older US Adults.

Nondemented cognitive impairment (CI) presents opportunities for early interventions among individuals at risk for dementia. Identification of modifiable determinants is paramount to the development of effective clinical interventions. Metabolic syndrome (MetS) was theorized as a risk factor, but current research yields inconsistent findings. Few studies have examined the association between MetS and CI among US populations, and global results may be ungeneralizable. We investigated the MetS-CI association among high socioeconomic, nondemented older US adults, examining the roles of sociodemographic, clinical, behavioral, and genetic factors. Cross-sectional. Cooper Clinic of Dallas, Texas: Cooper Center Longitudinal Study (2009-2017). A total of 5200 dementia-free older adult Cooper Clinic patients. CI was detected with a Montreal Cognitive Assessment (MoCA) score lower than 26. MetS was established based on National Cholesterol Education Program Adult Treatment Panel guidelines. Unadjusted and multivariable log-binomial regression were used to assess the MetS-CI association, with modification assessment by age, sex, education, cardiorespiratory fitness (CRF), and apolipoprotein-ε4 carrier status (APOE-ε4). MetS was not associated with CI when adjusting for age, sex, minority status, education, and marital status (prevalence ratio [PR] = 1.09; 95% confidence interval = .97-1.23) or when additionally adjusting for body mass index, CRF, alcohol consumption, current smoking status, and APOE-ε4 (PR = 1.07; 95% confidence interval = .80-1.45). The association was not modified by age, sex, CRF, or APOE-ε4 (P for interaction >.05). In contrast with some global and US studies, MetS and CI were not associated among our study population of nondemented older US adults. MetS may not be a suitable intervention target for poor cognitive outcomes among high socioeconomic older US adults, although separate MetS components may have different recommendations. Future studies should explore more diverse older US populations. If replicated, these findings would inform clinical efforts to reduce the burden of poor cognitive outcomes in the United States.

COGNITIVE VARIABILITY AND BRAIN AGING IN LATE-LIFE DEPRESSION

Introduction Dispersion across cognitive test scores, a measure of variability in cognitive performance, may be an indication of pathological aging. The aim of the current study was to investigate the association of test dispersion with structural brain variables and cognitive decline in non-demented older adults with major depression (MD) and healthy controls (HC). We hypothesized that those with greater dispersion would have lower hippocampal volumes (HPC) and higher white matter hypointensities (WMH) and that dispersion would predict cognitive decline at one-year follow-up. Methods Subjects included 121 MD and 39 HC subjects who participated in the NBOLD study at UConn Health. Inclusion criteria were age 60+ and a psychiatrist's diagnosis of MD for the patient group. Dementia and other major neuropsychiatric illnesses were exclusion criteria. Dispersion was calculated as the standard deviation of z-scores divided by group mean z-scores of a demographically adjusted neuropsychological test performance across a comprehensive battery. Results Dispersion positively correlated with WMH in both HC (r=0.386; p =.001) and MD (r=0.318; p=0.001), and negatively correlated with left HPC volume in MD (r=-0.191; p=0.034). Linear regression analyses accounting for baseline cognitive performance, demographics, and depression found that dispersion predicted cognitive tasks performed at a year follow up. For older adults with MD word list (WL) 1-3 (p=.038), WL delayed recall (DR) (p=.020) and symbol digit modality test (SDMT) (p=.035) were predictors. For HC dispersion was predicted for logical memory (LM) DR (p=.004) and Benton test (p=.003). Conclusions Dispersion is correlated with evidence of brain aging in older adults with MD. Future studies may look at ways to reduce dispersion in older adults and help prevent cognitive decline. This research was funded by Research reported in this poster was supported by the National Institute of General Medical Sciences of the National Institutes of Health under linked Award Numbers RL5GM118969, TL4GM118971, and UL1GM118970. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Educational and research grant from the Leo and Anne Albert Charitable Trust.

ANXIETY, NEUROTICISM AND LATE-LIFE DEPRESSION

Introduction Late-life depression (LLD) is associated with psychiatric comorbidities that may worsen mood outcomes in older adults, yet these comorbid conditions remain underdiagnosed and understudied in LLD. Anxiety and neuroticism have been independently associated with depression, but the interplay between these traits in older adults is uncertain and may be key to understanding the development and important mood and cognitive outcomes of LLD. In this study, we analyzed the relationship between neuroticism, anxiety and depression in older adults and hypothesized that higher anxiety measures would be associated with: (1) higher depression severity, (2) higher neuroticism, (3) lower cognitive scores at baseline, and (4) cognitive decline. Methods Older non-demented adults who were either depressed or never depressed (controls) were recruited. Anxiety, neuroticism, depression and cognition were assessed using the State-Trait Anxiety Inventory (STAI), NEO Personality Inventory (NEO PI), Montgomery-Asberg Depression Rating Scale (MADRS) and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) cognitive battery, respectively. A study psychiatrist confirmed or ruled out diagnosis of depression for depressed and control subjects. The psychiatrist followed a guided treatment algorithm in which sertraline was initially offered to all subjects at baseline. A sub-group analysis was performed on sertraline intention to treat (ITT) subjects. Subjects in the depression group were followed every two weeks by the psychiatrist, who made dosing adjustments and administered the MADRS. Results Baseline study results were obtained from a sample of 121 older depressed subjects and 39 never depressed controls. Longitudinal results were obtained from a sample of 93 depressed subjects for 3-month outcomes (3M), and 57 subjects for 12-month outcomes (12M). The sub-group sertraline-ITT analysis was performed for 51 subjects for 3M and 36 subjects for 12M. At baseline, state and trait anxiety scores were highly associated with depression scores in both study groups. Higher state and trait anxiety scores were associated with lower baseline cognition scores in the control group, and significantly less so in the depressed group. Baseline total neuroticism was associated with higher state and trait anxiety, and with higher depression scores in both groups. At baseline, total neuroticism was not significantly associated with lower cognition scores. For longitudinal results, we found that baseline trait anxiety was a predictor of 3M and 12M depression scores in the depressed group, but not a predictor of change from baseline. Trait anxiety and total neuroticism were predictors of 3M depression scores in the ITT sub-group. We also found that the anxiety, depression and stress vulnerability domains of neuroticism were predictors of 3M depression scores, for both the depressed group and the ITT sub-group. The impulsiveness facet of neuroticism was a predictor of 12M depression in both group and sub-group analyses. The only significant predictor of 12M cognitive score was baseline state anxiety. Conclusions Anxiety and neuroticism in late life are highly prevalent among older depressed individuals. We found that anxiety measures correlated with depression measures in older adults, regardless of clinical diagnosis as depressed or non-depressed. Interestingly, anxiety correlated with lower cognitive performance only in the non-depressed individuals. These results highlight a differential effect of anxiety on cognition between non-depressed older adults and those adults suffering from LLD. Several baseline neuroticism and anxiety traits were found to predict depression scores, but none was found to correlate with significant changes in depression and cognition in this 12-month analysis. There is a complex interplay between mood and personality traits in older adults, and studies that include a longer follow-up are needed to identify important predictors of mood and cognitive outcomes in LLD. This research was funded by The Leo and Anne Albert Charitable Trust National Institute of Mental Health Grant R01 MH108578

Characterization of normative angular joint kinematics during two functional upper limb tasks

BackgroundOptical motion capture is a powerful tool for assessing upper body kinematics, including compensatory movements, in different populations. However, the lack of a standardized protocol with clear functional relevance hinders its clinical acceptance. Research questionThe objective of this study was to use motion capture to: (1) characterize angular joint kinematics in a normative population performing two complex, yet standardized upper limb tasks with clear functional relevance; and (2) assess the protocol’s intra-rater reliability. MethodsTwenty non-disabled adults performed the previously developed Pasta Box Task and Cup Transfer Task. The kinematics of the upper body were captured using an optoelectronic motion capture system and rigid plates with reflective markers. Angular joint trajectories, peak angle, range of motion (RoM), and peak angular velocity were extracted for the trunk, shoulder, elbow, forearm, and wrist. Intra-class correlation was used to assess the intra-rater reliability of the kinematic measures. ResultsBoth tasks required minimal trunk motion. Cross-body movements required greater RoM at the trunk, shoulder, and elbow joints compared to movements in front of the body. Reaches to objects further away from the body required greater trunk and elbow joint RoM compared to reaches to objects closer to the body. Transporting the box of pasta required the wrist to maintain an extended position. The two different grasp patterns in the Cup Transfer Task forced the wrist into a flexed and ulnar-deviated position for the near cup, and an extended and radial-deviated position for the far cup. For both tasks, the majority of measures displayed intra-class correlation values above 0.75, indicating good reliability. SignificanceOur protocol and functional tasks elicit a degree of movement sensitivity that is not available in current clinical assessments. Our study also provides a comprehensive dataset that can serve as a normative benchmark for quantifying movement compensations following impairment.

A tale of two stories: Validity of an alternative story memory test in a sample of older adults

Objective: Many patients require repeat neuropsychological evaluations to determine change over time. Repeat evaluations lead to practice effects, which can impact the validity of the assessment. The current study assessed, in older adults, the validity of an alternative set of verbal memory stories created by Newcomer and colleagues.Method: A total 154 of non-demented adults, ages 60–92, completed the WMS-III logical memory (LM) stories and two Newcomer stories (Carson–Jones) as part of a larger battery of neurocognitive tests. The Carson–Jones stories were scored for: (1) verbatim (traditional) and (2) thematic (developed for this study) accuracy. Story memory variables were compared to each other and additional neurocognitive measures using bivariate correlations. A subset of participants (n = 133) completed magnetic resonance imaging (MRI) and various structural regions (e.g. thickness and volume of medial temporal lobe structures) were used to assess external validity of Carson–Jones stories with hierarchical multiple regression analyses.Results: There was a strong positive correlation between WMS-III LM and Carson–Jones stories for both verbatim and thematic scoring. Both scoring types showed convergent validity with other verbal memory measures (e.g. WMS-III LM and HVLT-R Delay/Learning) and divergent validity with Stroop Word Reading and JOLO. Regarding neuroimaging correlates, Carson–Jones verbatim scoring was significantly associated with left subiculum and left whole hippocampal volume whereas thematic scoring was significantly associated only with left subiculum.Conclusions: Newcomer stories appear to be a valid alternative to WMS-III LM stories in terms of assessing verbal memory in healthy older adults.

Supplemental Material for Cognitive Dispersion Is a Sensitive Marker for Early Neurodegenerative Changes and Functional Decline in Nondemented Older Adults

Supplemental Material for Cognitive Dispersion Is a Sensitive Marker for Early Neurodegenerative Changes and Functional Decline in Nondemented Older Adults

Effects of a Group-Based 8-Week Multicomponent Cognitive Training on Cognition, Mood and Activities of Daily Living among Healthy Older Adults: A One-Year Follow-Up of a Randomized Controlled Trial.

Cognitive interventions have the potential to enhance cognition among healthy older adults. However, little attention has been paid to the effect of cognitive training (CT) on mood and activities of daily living (ADL). To assess the effectiveness of a multicomponent CT using a training program of executive functions, attention, memory and visuospatial functions (TEAM-V Program) on cognition, mood and instrumental ADL. A randomized, single-blinded, treatment-as-usual controlled trial. Geriatric clinic in Bangkok, Thailand. 77 nondemented community-dwelling older adults (mean age 65.7±4.3 years). The CT (TEAM-V) program or the treatment-as-usual controlled group. The TEAM-V intervention was conducted over 5 sessions, with a 2-week interval between each session. Of 77 participants randomized (n=40 the TEAM-V program; n=37 the control group). The Thai version of Montreal Cognitive Assessment (MoCA), The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Thai version of Hospital Anxiety and Depression Scale (HADS) and The Chula ADL were used to assess at baseline, 6 months and 1 year. Compared with the control arm, the TEAM-V Program was associated with reducing anxiety (P = 0.004). Compared with the baseline, participants receiving the TEAM-V Program were associated with significantly improved general cognition (MoCA, P < 0.001), immediate recall (word recall task, P = 0.01), retrieval and retention of memory process (word recognition task, P = 0.01), attention (number cancellation part A, P < 0.001) and executive function (maze test, P = 0.02) at 1 year. No training effects on depression (P = 0.097) and IADL (P = 0.27) were detected. The TEAM-V Program was effective in reducing anxiety. Even though, the program did not significantly improve cognition, depression and ADL compared with the control group, global cognition, memory, attention and executive function improved in the intervention group compared with baseline. Further studies incorporating a larger sample size, longitudinal follow-up and higher-intensity CT should be conducted.

Combinations of gait speed testing protocols (automatic vs manual timer, dynamic vs static start) can significantly influence the prevalence of slowness: Results from the Korean Frailty and Aging Cohort Study

AimThis study aimed to compare 4-m usual gait speed obtained with different protocols and to determine the prevalence of slowness using different diagnostic criteria in a large cohort of community-dwelling older adults. MethodsA total of 1177 non-disabled community-dwelling older adults aged 70–84 years were assessed for 4-m usual gait speed using four different testing protocols: (1) automatic timer (ultrasonic sensor), dynamic start; (2) manual timer (stopwatch), dynamic start; (3) automatic timer, static start; and (4) manual timer, static start. To assess agreement between usual gait speed and the testing protocols, linear regression and Bland-Altman analyses were performed. ResultsThere was systematic bias (i.e., difference between automatic timer and manual timer methods), with underestimation of usual gait speed (bias 0.0695 m/s for dynamic start; bias 0.0702 m/s for static start) by the manual timer. There was systematic bias in start conditions, with underestimation of usual gait speed with a static start using both timer methods, compared with that in dynamic start assessment (P < 0.001). The prevalence of slowness ranged from 2.3 to 4.7% in men and 5.9–11.1% in women for <0.80 m/s, and from 17.1 to 30.5% in men and 26.3–45.9% in women for <1.00 m/s. ConclusionsThe findings of this study indicated that 4-m usual gait speed measured under different testing protocols was able to determine different prevalence rates of slowness among non-disabled community-dwelling older adults. An automatic timer may be useful for measuring gait speed changes in individuals likely to have faster gait speed in community-based research settings.

Associations of literacy with diabetes indicators in older adults

BackgroundLiteracy, the ability to access, understand and utilise information and concepts from diverse sources in ways that promote good outcomes is key to successful ageing. Domain-specific health and financial literacy...

Longer TOMM40 poly-T variants associated with higher FDDNP-PET medial temporal tau and amyloid binding.

BackgroundThe translocase of outer mitochondrial membrane 40 (TOMM40), which lies in linkage disequilibrium with the apolipoprotein E (APOE) gene, has been implicated in Alzheimer’s disease (AD). TOMM40 influences AD pathology through mitochondrial neurotoxicity, and the medial temporal lobe (MTL) is the most likely brain region for identifying early manifestations of AD-related morphology changes. While early reports indicated that the longer length poly-T allele of TOMM40 increases risk for AD, these findings have not been consistently replicated in further studies. We examined the effect of TOMM40 and APOE on regional brain positron emission tomography (PET) 2-(1-{6-[(2 [F18]fluoroethyl) (methyl) amino]-2-naphthyl}ethylidene)malononitrile (FDDNP) binding values in MTL.MethodsA total of 73 non-demented older adults (42 females; mean age: 62.9(10.9) completed genotyping for both APOE and TOMM40 and received FDDNP-PET scans. For TOMM40, the lengths of the poly-T sequence were classified as short (14–20 repeats; S), long (21–29 repeats, L) or very long (>29 repeats, VL). Using general linear models, we examined medial temporal lobe FDDNP binding and cognitive functioning between TOMM40 and APOE-4 groups, with age, sex, and education as covariates.ResultsData from 30 individuals with APOE-4 and L TOMM40 poly-T length, 11 non E4 TOMM40 S/S, 14 non E4 TOMM40 S/VL and 13 non E4 TOMM40 VL/VL were analyzed. Medial temporal FDDNP binding differed significantly between TOMM40/APOE groups (F(3,62) = 3.3,p = .03). Participants with TOMM40 S/S exhibited significantly lower binding compared to TOMM40 S/VL and APOE-4 carriers. We did not find a significant relationship between TOMM40 poly-T lengths/APOE risk groups and cognitive functioning.ConclusionsThis is the first report to demonstrate a significant association between longer TOMM40 poly-T lengths and higher medial temporal plaque and tangle burden in non-demented older adults. Identifying biomarkers that are risk factors for AD will enhance our ability to identify subjects likely to benefit from novel AD treatments.

The Association of Mid- and Late-Life Systemic Inflammation with Brain Amyloid Deposition: The ARIC-PET Study.

Although inflammation has been implicated in the pathogenesis of Alzheimer's disease, the effects of systemic inflammation on brain amyloid deposition remain unclear. We examined the association of midlife and late-life systemic inflammation with late-life brain amyloid levels in a community sample of non-demented older adults from the Atherosclerosis Risk in Communities (ARIC) - PET Study. 339 non-demented participants (age: 75 [SD 5]) were recruited from the ARIC Study to undergo florbetapir PET (amyloid) imaging. Blood levels of high sensitivity C-reactive protein (CRP), a marker of systemic inflammation, were measured 22 years (Visit 2), 16 years (Visit 4), and up to 2 years before PET imaging (Visit 5). Elevated brain amyloid deposition (standardized uptake value ratio >1.2) was the primary outcome. Our primary analyses found no association of midlife and late-life CRP with late-life brain amyloid levels. However, in secondary stratified analyses, we found that higher midlife (Visit 2) CRP was associated with elevated amyloid among males (OR 1.65, 95% CI: 1.13-2.42), and among white (OR 1.33, 95% CI: 1.02-1.75), but not African American, participants (p-interactions<0.05). Among male participants, those who maintained high CRP levels (≥3 mg/L) throughout mid- and late-life were most likely to have elevated brain amyloid (OR, 8.81; 95% CI: 1.23, 62.91). Although our primary analysis does not support an association between systemic inflammation and brain amyloid deposition, we found evidence for sex- and race-dependent associations. However, findings from subgroup analyses should be interpreted with caution.

Deleterious Impact of Expressive Suppression on Test Performance Persists at One-Year Follow-Up in Community-Dwelling Older Adults.

Expressive suppression (ES) is an emotion-regulation strategy that is associated with poorer performance on subsequently administered tests of executive functioning (EF). It is not known, however, how far into the future ES interferes with EF. This study examined whether (a) ES negatively affects performance on EF tests repeated 1 year after the initial administration (presumably through interference with learning, leading to a reduced practice effect), and (b) whether such an effect, if seen, is unique to EF or whether it also affects lower-order cognitive processes needed for EF test performance. Sixty-six non-demented community-dwelling older adults were randomly assigned to either an ES group or control group. Executive and non-executive tests were administered before and immediately following the exposure to an emotionally evocative video, and then again at 1-year follow-up. Groups were compared at 1-year follow-up on tests of EF and lower-order processes, to examine whether the previously demonstrated impact of ES on EF is evident only immediately following the experimental manipulation (Franchow &amp; Suchy, 2017), or also at 1-year follow-up. The results showed that participants who engaged in ES continued to exhibit poorer performance on EF tests 1 year later. This effect was not present for performance on tests of lower-order processes. These results suggest that the use of ES before an EF task can interfere with the ability to benefit from exposure to that task, thereby negatively affecting future performance. (JINS, 2019, 25, 29-38).

Development of the GeriatrICS, an ICF-based and person-centred assessment tool for evaluation of health-related problems in community-living older adults

Introduction: Ideally, older adults should receive person-centred care and support that meets their individual needs and wishes, taking all relevant health-related problems into account. The International Classification of Functioning, Disability and Health ICF might offer a basis for identification of these problems as it provides a unified language for evaluation of functioning and disability associated with someone’s health status. ICF Core Sets have been developed to describe the spectrum of disabilities of specific patient populations. Therefore, aim of this study was to develop a valid Geriatric ICF Core Set GeriatrICS reflecting all relevant health-related problems of community-living older adults without dementia. Methods: This study consisted of two sub-studies: 1 a written Delphi study to select ICF categories, and 2 assessing content validity in a cross-sectional study. For the Delphi study, a representative panel of experts older adults and non-medical experts on health-related problems due to ageing was constituted. Panel members had to select second-level categories from the ICF-classification relevant to community-living, non-demented older adults 75+, and had to reach consensus on this selection. For the validation study, older adults frail or with complex care needs were visited by a case manager district nurse or social worker who used the initial GeriatrICS as an assessment tool. Older adults had to rate all categories on a scale ranging from 0 no problem to 10 complete problem. Content validity of a category was guaranteed if ≥10% indicated a problem with that category. Results: 41 Delphi panel members obtained consensus in two rounds on 30 ICF-categories. Next, 267 older adults participated in the validation study. All categories met the criterion for content validity except for d530 Toileting. The final GeriatrICS consists of 29 categories: fourteen Body Functions categories, nine Activities and Participation categories and six Environmental Factors categories. Discussions and conclusions: This study resulted in a valid ICF Core Set GeriatrICS including 29 ICF categories representing the most relevant health-related problems among community-living older adults without the diagnosis of dementia. The GeriatrICS included categories from all ICF components, showing that older people’s health is a multidimensional construct. Compared to commonly used, profession-based tools, the GeriatrICS is unique as it is a population-based, cross-domain tool. Therefore, the GeriatrICS is a good starting point for the delivery of person-centred and integrated care. Lessons learned: The GeriatrICS may be used in person-centred and integrated care practice as an assessment tool, in order to tailor care and support to the needs of older adults. Analysis and interpretation of an older adult’s outcomes, and translation into an appropriate care plan, requires highly competent and experienced professionals. Limitations: Older adults with dementia or cognitive impairments may have been included in the validation study since dementia was not an exclusion criterion. Impact on the results is expected to be trivial as case managers were experienced interviewers and a partner or family member participated in the assessment in case of cognitive problems. Suggestions for future research: Future research should investigate the health-related problems of older adults with dementia and robust older adults.

Gender-stratified analyses reveal longitudinal associations between social support and cognitive decline in older men

Objectives: Research has extensively examined the relationship between social support and health outcomes in older adults. Little is known, however, about the longitudinal associations between distinct dimensions of perceived social support and incident cognitive decline. The current longitudinal study examined whether dimensions of perceived social support were associated with increased risk of cognitive decline, and if the relationship differed by gender.Methods: 493 community-residing non-demented older adults were assessed for baseline social support via the Medical Outcomes Study-Social Support Survey (MOS-SSS). Incident cognitive impairment was determined using a 1 standard deviation below age and education adjusted total score on the Repeatable Battery for the Assessment of Neuropsychological Status Cox proportional-hazard models were used to analyze incident risk of cognitive impairment.Results: Higher perceived support, overall and in specific domains, at baseline was associated with increased risk of incident cognitive impairment. Further gender-stratified analyses revealed that higher perceived support at baseline was associated with increased risk of incident cognitive impairment only among males.Conclusion: Contrary to previous research, results from this longitudinal study suggest that perceived support might be an important risk factor for cognitive decline, notably in males, and should be integrated into multifactorial risk assessment and intervention procedures.

Aortic Stiffness is Associated with Increased Risk of Incident Dementia in Older Adults.

Cardiovascular disease risk factors, including age, hypertension, and diabetes, contribute to aortic stiffness and subclinical cardiovascular and brain disease, increasing dementia risk. Aortic stiffness, measured by carotid-femoral pulse wave velocity (cfPWV), reduces the buffering of pulsatile blood flow, exposing cerebral small arteries to microvascular damage. High cfPWV is related to white matter hyperintensities and brain amyloid deposition, and to cognitive decline, but it is unclear whether cfPWV independently predicts incident dementia. Therefore, we tested the hypothesis that cfPWV predicts incident dementia in older adults, independent of potential confounders. The Cardiovascular Health Study Cognition Study followed 532 non-demented older adults with annual cognitive exams from 1998-99 through 2013. CfPWV was measured on 356 (mean age = 78, 59% women) between 1996-2000. Over 15 years, 212 (59.6%) developed dementia (median time from cfPWV measurement = 4 years). In age and sex-adjusted Cox models, cfPWV was significantly associated with increased risk of dementia, but systolic blood pressure, mean arterial pressure and pulse pressure were not. CfPWV (transformed as - 1/cfPWV) remained significantly associated with dementia risk when further adjusted for education, race, APOEɛ4, diabetes, body mass index, mean arterial pressure, and anti-hypertensive medication (hazard ratio = 1.60, 95% CI = 1.02, 2.51). Results were similar when further adjusted for baseline global cognition, subclinical brain measures, and coronary artery calcification. Finally, higher cfPWV was related to lower physical activity intensity and higher systolic blood pressure, heart rate, and waist circumference measured 5 years prior. An important unanswered question is whether interventions to slow arterial stiffening can reduce the risk of dementia.

Participant satisfaction with dementia prevention research: Results from Home-Based Assessment trial

IntroductionLittle is known about factors affecting motivation and satisfaction of participants in dementia prevention trials. MethodsA Research Satisfaction Survey was administered to 422 nondemented older adults who participated in the Home-Based Assessment trial. ResultsOverall satisfaction was high, with means of all individual items near to above a value of 3 on a scale from 1 (worst) to 4 (best). Greater satisfaction was associated with staff-administered interviews versus automated technologies. The most liked aspects of research participation were volunteerism, opportunity to challenge and improve mental function, and positive interactions with staff. The least liked aspect was repetitiveness of the assessments. Participants requested more contact with staff and other older adults and more feedback on performance. DiscussionOlder adults' participation in research was primarily motivated by altruism. Methodologies that facilitate human contact, encourage feedback and novelty of tasks should be incorporated into future trial design.

The Use of the Incremental Shuttle Walk Test to Identify Instrumental Activity Daily Living Disability and to Predict Peak Oxygen Consumption in Older Adults

Aerobic capacity is essential for physical function. The aims of this study were to identify the peak oxygen consumption ( JOURNAL/tgere/04.03/00013614-201810000-00002/2FSM1/v/2023-10-01T043932Z/r/image-gif o 2 peak) and the incremental shuttle walk test (ISWT) distance associated with disability and to develop an equation to predict JOURNAL/tgere/04.03/00013614-201810000-00002/2FSM1/v/2023-10-01T043932Z/r/image-gif o 2 peak, based on the ISWT distance. Fifteen disabled and 13 nondisabled older adults performed the ISWT using a portable telemetric gas analyzer. The JOURNAL/tgere/04.03/00013614-201810000-00002/2FSM1/v/2023-10-01T043932Z/r/image-gif o 2 peak and the distance associated with disability were 15.8 mL/kg/min or less and 230 m or less, respectively. The coefficient of determination from the predictive model was 0.54. The ISWT might be considered to assess aerobic capacity in older adults.

Alzheimer's disease and late-onset epilepsy of unknown origin: two faces of beta amyloid pathology.

Although amyloid pathology plays a role in epilepsy, little is known about the relationship between beta amyloid and progression to Alzheimer's disease (AD) among patients with late-onset epilepsy of unknown origin (LOEU). This multicenter, observational, prospective study enrolled 40 consecutive nondemented adults diagnosed with LOEU, together with 43 age- and sex-matched healthy controls. All patients completed neuropsychological tests, core CSF AD biomarkers assessment (Aβ1-42, total tau, and phosphorylated tau), and follow-up for a mean of 3years to verify cognitive decline. Despite age and baseline cognitive performance were similar to healthy controls, patients with LOEU had significant prevalence of CSF pathological Aβ1-42 (<500 pg/mL; 37.5%), 7.5% displaying an AD-like CSF pattern. Moreover, 17.5% of patients with LOEU converted to AD dementia, versus none among healthy controls (p < 0.005). Patients with LOEU with pathological Aβ1-42 had a hazard ratio 3.4 (CI 0.665-17.73) for progression to AD dementia at follow-up. Patients with LOEU have a high prevalence of abnormal CSF Aβ1-42 and progression to AD dementia compared with healthy controls, and therefore should be monitored for cognitive decline.

Reduced Regional Cerebral Blood Flow Relates to Poorer Cognition in Older Adults With Type 2 Diabetes.

Type 2 diabetes mellitus (T2DM) increases risk for dementia, including Alzheimer’s disease (AD). Many previous studies of brain changes underlying cognitive impairment in T2DM have applied conventional structural magnetic resonance imaging (MRI) to detect macrostructural changes associated with cerebrovascular disease such as white matter hyperintensities or infarcts. However, such pathology likely reflects end-stage manifestations of chronic decrements in cerebral blood flow (CBF). MRI techniques that measure CBF may (1) elucidate mechanisms that precede irreversible parenchymal damage and (2) serve as a marker of risk for cognitive decline. CBF measured with arterial spin labeling (ASL) MRI may be a useful marker of perfusion deficits in T2DM and related conditions. We examined associations among T2DM, CBF, and cognition in a sample of 49 well-characterized nondemented older adults. Along with a standard T1-weighted scan, a pseudocontinuous ASL sequence optimized for older adults (by increasing post-labeling delays to allow more time for the blood to reach brain tissue) was obtained on a 3T GE scanner to measure regional CBF in FreeSurfer derived regions of interest. Participants also completed a neuropsychological assessment. Results showed no significant differences between individuals with and without T2DM in terms of cortical thickness or regional brain volume. However, adjusting for age, sex, comorbid vascular risk factors, and reference CBF (postcentral gyrus) older adults with T2DM demonstrated reduced CBF in the hippocampus, and inferior temporal, inferior parietal, and frontal cortices. Lower CBF was associated with poorer memory and executive function/processing speed. When adjusting for diabetes, the significant associations between lower regional CBF and poorer executive function/processing speed remained. Results demonstrate that CBF is reduced in older adults with T2DM, and suggest that CBF alterations likely precede volumetric changes. Notably, relative to nondiabetic control participants, those with T2DM showed lower CBF in predilection sites for AD pathology (medial temporal lobe and inferior parietal regions). Findings augment recent research suggesting that perfusion deficits may underlie cognitive decrements frequently observed among older adults with T2DM. Results also suggest that CBF measured with ASL MRI may reflect an early and important marker of risk of cognitive impairment in T2DM and related conditions.

Short-term repeat cognitive testing and its relationship to hippocampal volumes in older adults

BackgroundPractice effects are improvements in cognitive test scores due to repeated exposure to testing materials. If practice effects provide information about Alzheimer’s disease pathology, then they could be useful for clinical trials enrichment. The current study sought to add to the limited literature on short-term practice effects on cognitive tests and their relationship to neuroimaging biomarkers. MethodsTwenty-five, non-demented older adults (8 cognitively intact, 17 with mild cognitive impairment) received magnetic resonance imaging and two testing sessions across one week to determine practice effects on seven neuropsychological test scores. A series of correlations examined if hippocampal volume was associated with baseline, one-week, or practice effects scores on these tests. Next, a series of stepwise multiple regression models examined which of the three test scores best predicted hippocampal volumes ResultsIn the correlation analysis, baseline scores on 5 of the 7 tests were significantly associated with hippocampal volumes, one week scores were significantly related for 7 of the 7 tests, and practice effects scores were significantly correlated for 4 of the 7 tests. In the stepwise regression models, 5 of the 7 tests indicated that one-week scores best predicted hippocampal volumes. For the other models, baseline score and practice effects score each best predicted hippocampal volume. ConclusionsThese results add to the growing body of evidence suggesting that diminished practice effects on short-term repeat testing is related to neuroimaging biomarkers of Alzheimer’s disease and may serve as a screening tool for clinical practice and to enrich samples for research trials.