Performance In Elderly Persons Research Articles

Iowa Gambling Task Performance in Elderly Persons with a Lifetime History of Suicidal Acts

Suicide in the elderly is a major public health problem. In the present study, we aimed to further understand the mechanisms of suicidal vulnerability in the elderly, focusing on high-risk decision-making. This trait-like impairment has been extensively studied in adolescent and middle-aged suicide attempters, but less often in older persons. Case-control study. Community and university hospital. All participants were aged 65 and older. Thirty-five persons with a lifetime history of suicide attempts and depressive disorder were compared with 52 individuals with a past history of depressive disorder but no history suicidal acts, and 43 healthy comparison subjects. The Iowa Gambling Task was used as a measure of value-based decision-making. Taking into account age, sex, and Beck depression scores, no difference in decision-making performance was found between the three groups. The group of suicide attempters exhibited a significant heterogeneity, however, with those using violent means performing worse than non-violent attempters. This study does not confirm the hypothesis of a significant role for poor Iowa Gambling Task performance as a general marker of suicidal behavior among the elderly but highlights its association with the specific subtype of violent suicidal attempters. Combined with previous findings among other age groups, it suggests that Iowa Gambling Task impairment may be a risk marker of vulnerability to violent suicidal acts. Future prospective studies should assess if this may represent a risk marker for suicide completion.

Associations between White Matter Microstructure and Cognitive Performance in Old and Very Old Age

Increasing age is associated with deficits in a wide range of cognitive domains as well as with structural brain changes. Recent studies using diffusion tensor imaging (DTI) have shown that microstructural integrity of white matter is associated with cognitive performance in elderly persons, especially on tests that rely on perceptual speed. We used structural equation modeling to investigate associations between white matter microstructure and cognitive functions in a population-based sample of elderly persons (age ≥ 60 years), free of dementia, stroke, and neurological disorders (n = 253). Participants underwent a magnetic resonance imaging scan, from which mean fractional anisotropy (FA) and mean diffusivity (MD) of seven white matter tracts were quantified. Cognitive functioning was analyzed according to performance in five task domains (perceptual speed, episodic memory, semantic memory, letter fluency, and category fluency). After controlling for age, FA and MD were exclusively related to perceptual speed. When further stratifying the sample into two age groups, the associations were reliable in the old-old (≥78 years) only. This relationship between white matter microstructure and perceptual speed remained significant after excluding persons in a preclinical dementia phase. The observed pattern of results suggests that microstructural white matter integrity may be especially important to perceptual speed among very old adults.

Bright-light effects on cognitive performance in elderly persons working simulated night shifts: psychological well-being as a mediator?

The present study examined whether the relationship between light exposure and cognitive functioning is mediated by psychological well-being in elderly persons working night shifts. The role of psychological well-being has been neglected so far in the relationship between bright light and cognitive performance. Sleepiness and mood were applied as indicators of psychological well-being. Cognitive functioning was examined in terms of concentration, working memory, and divided attention. A total of thirty-two test persons worked in three consecutive simulated night shifts, 16 under bright light (3,000 lux) and 16 under room light (300 lux). Concentration, working memory, and divided attention were measured by computerised tasks. The hypothesised mediators were recorded by questionnaires. Mediation analyses were conducted for estimating direct, total, and indirect effects in simple mediation models. Results indicate that sleepiness and mood did not function as mediators in the prediction of concentration, working memory, and/or divided attention by light exposure. Sleepiness led to an underestimation of the positive bright-light effect on concentration performance. Mood showed only a random effect due to the positive bright-light effect on working memory. Sleepiness and mood could completely be excluded as mediators in the relationship between light exposure and cognitive functioning. This study underlines that psychological well-being of elderly persons is not a critical component in the treatment of bright light on cognitive performance in the night shift workplace. In summary, it becomes evident that bright light has a strong direct and independent effect on cognitive performance, particularly on working memory and concentration.

The relationship between visceral adiposity and cognitive performance in older adults

a direct association between visceral adiposity on abdominal computed tomography (CT) and cognitive performance has not been reported. to investigate the associations between total and regional adiposity measured with abdominal CT, and cognitive performance in elderly persons and to explore their modification by age. cross-sectional study. a health promotion centre of a tertiary university hospital. two-hundred and fifty individuals aged 60 years and above who underwent anthropometric measurements, abdominal CT and cognitive testing. adiposity measures included body mass index (BMI), waist circumference and visceral and subcutaneous adiposity by abdominal CT. Poor cognitive performance was defined as Mini-Mental State Examination score being at or below 1 SD of age, sex and education-normative values. in multivariate logistic regression analyses obesity [odds ratio (OR) 2.61, 95% confidence interval (CI)=1.21-6.01, P=0.015] and being in the top tertile of the visceral adiposity area (OR: 2.58, 95% CI=1.001-6.62, P=0.045) were associated with poor cognitive performance in subjects younger than 70 years, but not in those 70 years and older. high adiposity, particularly visceral adiposity, was associated with poor cognitive functioning in younger elderly persons.

The cross-sectional relationship between total and visceral adiposity and cognitive performance in elderly persons

The cross-sectional relationship between total and visceral adiposity and cognitive performance in elderly persons

The effects of an active-assisted stretching program on functional performance in elderly persons: A pilot study

This study examined the impact of an eight-week active-assisted (AA) stretching program on functionality, mobility, power, and range of motion (ROM) in elderly residents of a residential retirement community. Seventeen volunteers (4 male, 13 female; 88.8 +/- 5.36 years) were randomly assigned to an AA or control group. The AA group performed 10 different AA stretches targeting the major joints of the body twice weekly for eight weeks. Controls attended classes requiring limited physical activity. All participants were assessed using four flexibility and six functional tests, one week before and after the eight-week training period. A fully randomized repeated-measures ANCOVA with pretest scores as a covariate was used to detect differences between groups across time. The AA group demonstrated significant increases in ROM for most of the joints evaluated (p < 0.05) and significant increases in all performance measures (p < 0.05). Controls showed no improvements in functional or ROM measures (alpha = 0.05). Additionally, the AA group showed significantly better performance outcomes across the training period than controls. We conclude that our eight-week flexibility program effectively reduces age-related losses in ROM and improves functional performance in elderly persons with insufficient physical reserves to perform higher-intensity exercises.

Albumin, hemoglobin, body mass index, cognitive and functional performance in elderly persons living in nursing homes

The aim of this study is to produce the relation between cognitive and functional performance and some biochemical parameters in elderly population. So, we searched for the correlation between the activities of daily living (ADL), mini-mental state examination (MMSE) and body weight, age, hemoglobin, albumin, serum sodium level of 180 elderly people in five nursing homes. Face-to-face interviews and questionnaires were applied to evaluate ADL. To evaluate the cognitive function we used the MMSE. The average age of 180 people contacted was 71.5 ± 5.1 (±S.D.), ranging 65–91 years; 112 of them were women (62.2%), 68 were men (37.8%). Of these elderly people, 25% had no medically diagnosed illnesses, whereas 17 of them (9.4%) were bedridden. There was a positive correlation between ADL and hemoglobin, albumin, body weight, cognitive function parameters and a negative one with age and serum sodium. There was a positive correlation between cognitive functions and hemoglobin, body weight, ADL and a negative one with serum sodium. Hemoglobin concentrations indicating anemia were observed in 30% of subjects, 3.9% of them had hyponatremia and 26.7% displayed a hypernatremia. There was a positive correlation between cognitive and physical function scores and hemoglobin, albumin levels in elderly patients. These results suggest that restoration of hemoglobin and albumin levels could improve cognitive and physical functional status in the elderly population.

Subtle Neurological Abnormalities as Risk Factors for Cognitive and Functional Decline, Cerebrovascular Events, and Mortality in Older Community-Dwelling Adults

Subtle, but clinically detectable, neurological abnormalities (SNAs) are associated with impaired physical performance in elderly persons without overt neurological diseases. We investigated whether SNAs were prospectively associated with cognitive and functional status, death, and cerebrovascular events (CVEs) in older community-dwelling individuals. In participants without history of stroke, parkinsonism and dementia, or cognitive impairment, a score (N(SNA)) was obtained by summing SNAs detected with a simple neurological examination. Cognitive status and disability were reassessed 4 years later, and deaths and CVEs were documented over 8 years. Of 506 participants free of neurological diseases (mean [SEM] age, 71.9 [0.3] years; 42% were men), 59% had an N(SNA) of 1 or more (mean [SEM], 1.1 [0.06]; range, 0-8). At baseline, the N(SNA) increased with age and with declining cognitive and physical performance, depressive symptoms, and disability, after adjusting for several covariates, but did not increase with falls and urinary incontinence. The N(SNA) prospectively predicted worsening cognitive status and disability, adjusting for demographics and for baseline comorbidity and cognitive and physical performance. The mortality rates were 22.6, 23.3, 23.9, 58.6, and 91.9 per 1000 person-years in participants with an N(SNA) of 0, 1, 2, 3, and 4 or higher, respectively. Compared with an N(SNA) of less than 3, having an N(SNA) of 3 or higher was associated with an increased adjusted risk of death (hazard ratio, 1.77; 95% confidence interval [CI], 1.25-2.74) and of CVE (hazard ratio, 1.94; 95% CI, 1.07-3.54) over 8 years. In this sample of older community-dwelling persons without overt neurological diseases, multiple SNAs were associated with cognitive and functional decline and independently predicted mortality and CVEs.

The effect of chronic benzodiazepine use on cognitive functioning in older persons: good, bad or indifferent?

This study investigates the effects of benzodiazepine (BZ) use on cognitive performance in elderly persons in a longitudinal design. Data were obtained from the Longitudinal Aging Study Amsterdam (LASA), in the Netherlands. 2,105 respondents (>/=62 years of age) were included and had repeated measurements over a period of 9 years. For all BZs the type, dosage, frequency and duration of use was measured. The equivalent of a dose of diazepam was determined with regard to type and dosage and a cumulative dosage was calculated. General cognitive functioning was measured with the Mini-Mental State Examination, information processing speed was measured with the coding task, fluid intelligence with Raven's Coloured Progressive Matrices and episodic memory with the Auditory Verbal Learning Test. Multilevel analyses were used to investigate the relationship between BZ use and cognitive decline. A negative effect of BZ use on cognitive performance was found. However, the effect sizes were very small. This study suggests that both duration and cumulative exposure to BZ has a small negative effect on the long-term cognitive functioning of elderly people in the community.

Serum Anticholinergic Activity and Motor Performance in Elderly Persons

Medications prescribed to elderly persons often have an anticholinergic effect, as do many commonly used over-the-counter drugs. Anticholinergic medications are known to produce psychomotor slowing, especially in older persons. The present study examined whether the cumulative anticholinergic load present in the serum of community volunteers was associated with decrements on tests of psychomotor performance (gait speed and simple manual response time) known to predict falls in elderly persons. Serum anticholinergic activity (SAA) was relatively low in this group; however, an elevated SAA was associated with a significant slowing in both gait speed and simple response time. Cumulative anticholinergic burden may be one of the factors contributing to an increased risk of falls in the older population.

Stroke and Memory Performance in Elderly Persons Without Dementia

There are conflicting data showing that stroke is associated with a higher risk of dementia and a more severe decline in persons with cognitive impairment. However, it remains unclear if cerebrovascular disease is directly related to cognitive decline in the absence of cognitive impairment or dementia. To examine the association between stroke and changes in cognitive function over time in elderly persons without dementia at baseline. The results of neuropsychological tests from several intervals over a 5-year period were clustered into domains of memory, abstract/visuospatial, and language in 1271 elderly persons without dementia or cognitive decline. Stroke was related to the slope of performance in each cognitive domain using generalized estimating equations. Memory performance declined over time, while abstract/visuospatial and language performance remained stable during the study period. Stroke was associated with a more rapid decline in memory performance, while there was no association between stroke and decline in abstract/visuospatial or language performance. The association between stroke and decline in memory performance was strongest for men and for persons without an APOEepsilon4 allele. A significant association between stroke and decline in abstract/visuospatial performance was also observed for persons without the APOEepsilon4 allele. A history of stroke is related to a progressive decline in memory and abstract/visuospatial performance, especially among men and those without an APOEepsilon4 allele.

Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study

Muscle strength and physical performance in old age might be related to the oxidative damage caused by free radicals. The objective was to assess the correlation of plasma concentrations and daily dietary intakes of antioxidants with skeletal muscle strength and physical performance in elderly persons. This study is part of the Invecchiare in Chianti (InCHIANTI) study, which was conducted in 986 Italians aged > or = 65 y. Physical performance was assessed on the basis of walking speed, ability to rise from a chair, and standing balance. Knee extension strength was assessed with a hand-held dynamometer. The European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire was used to evaluate the daily dietary intakes of vitamin C, vitamin E, beta-carotene, and retinol. Plasma alpha- and gamma-tocopherol concentrations were measured. Adjusted linear regression analyses were used to calculate regression coefficients per SD increase in plasma concentrations and daily dietary intakes. In adjusted analyses, plasma alpha-tocopherol was significantly correlated with knee extension (beta = 0.566, P = 0.003) and the summary physical performance score (beta = 0.044, P = 0.008). Plasma gamma-tocopherol was associated only with knee extension strength (beta = 0.327, P = 0.04). Of the daily dietary intake measures, vitamin C and beta-carotene were significantly correlated with knee extension strength, and vitamin C was significantly associated with physical performance (beta = 0.029, P = 0.04). Plasma antioxidant concentrations correlate positively with physical performance and strength. Higher dietary intakes of most antioxidants, especially vitamin C, appear to be associated with higher skeletal muscular strength in elderly persons.

Cross-sectional and prospective relationships of interleukin-6 and C-reactive protein with physical performance in elderly persons: MacArthur studies of successful aging.

Chronic inflammation has been proposed as a biological mechanism underlying the decline in physical function that occurs with aging. The purpose of this investigation was to examine the cross-sectional and prospective relationships between markers of inflammation, interleukin-6 (IL-6) and C-reactive protein (CRP), with several measures of physical performance in older persons aged 70 to 79 years. Subjects were 880 high-functioning men and women participating in the MacArthur Study of Successful Aging (n = 1189), a subset of the Established Populations for Epidemiologic Studies of the Elderly (n = 4030). Plasma IL-6 and CRP levels were determined by enzyme-linked immunosorbent assay and log transformed to normalize the distributions. Physical function measures included handgrip strength, signature time, chair stands (time to complete five repetitions), and 6-m walk time. Women had lower (p < .05) IL-6 levels than men, but there was no significant difference between blacks and whites. IL-6 and CRP levels were higher (p < .05) in current smokers than in nonsmokers and in those with a greater body mass index (BMI). Hours per year undertaking moderate and strenuous physical activity were also related to inflammatory markers with higher (p < .001) IL-6 and CRP levels in less active individuals. After adjusting for age, sex, race, BMI, smoking status, use of nonsteroidal anti-inflammatory drugs, and prevalence of morbidity, those in the top two quartiles for walking speed had lower (p = .012) IL-6 levels than those in the bottom quartile. In addition, there was a trend (p = .038) for lower CRP levels in those with higher walking speed. CRP levels were also lower (p = .04) in individuals in the top quartile for grip strength. No significant differences were noted for chair stands or signature time performance. Repeat performance measures obtained on 405 subjects (67% of those eligible at baseline) obtained 7 years later had declined significantly (grip strength, 18%; signature time, 21%; walking speed, 31%; p < .001), except for the chair rise; however, baseline IL-6 and CRP were not associated with a change in performance. However, those who died or who were unable to undergo testing had higher baseline IL-6 and CRP levels (p < .01) and slower walking speed (p < .05). Although IL-6 has been shown to predict onset of disability in older persons and both IL-6 and CRP are associated with mortality risk, these markers of inflammation have only limited associations with physical performance, except for walking measures and grip strength at baseline, and do not predict change in performance 7 years later in a high-functioning subset of older adults.

Staff views on the Resident Assessment Instrument, RAI/MDS, in nursing homes, and the use of the Cognitive Performance Scale, CPS, in different levels of care in Stockholm, Sweden.

Multidimensional functional assessment is the basis of individualized care. It is especially important in the care of elderly, with the complexity of symptomatology and often with cognitive impairment present. An assessment instrument for elderly persons, used in this study, is the Resident Assessment Instrument/Minimum Data Set (RAI/MDS) and its incorporated MDS Cognitive Performance Scale (CPS). The purposes of the study were to demonstrate the cognitive performance in elderly persons in different levels of care by using the CPS and to elicit the views of staff on use of the RAI/MDS. Cognitive impairment was found in 1276 elderly persons in six levels of care studied, an important factor to consider when organizing care of elderly. An intervention study was carried out for 1 year in three nursing home wards, with training and supervision in implementation of the RAI/MDS including individualized and documented care. Part of a questionnaire was used to evaluate staff (n = 50) views on using the instrument. A majority of the staff thought that the RAI/MDS could contribute to the improvement of quality of care, documentation in nursing records, and in co-operation and engagement. Further research is necessary to elicit more knowledge on the usefulness and benefits of the instrument.

Personality structure of elderly drivers.

This paper reports the factor structure of a 37-item personality questionnaire intended to be predictive of driving performance in elderly persons. Subjects were 191 persons 63 years of age of older, about half of whom also were given perceptual/cognitive tasks and drove on a closed driving course. Although the personality questionnaire did not predict driving skill, the factor structure of the questionnaire is of interest. Of several factor analyses, the most satisfactory was a 2-factor solution. We interpreted the approximately orthogonal factors as measuring what we labeled Competence and Emotionality.

Motor function in 90-year olds measured by optoelectronic kinesiology and activities of daily living.

Computer-assisted optoelectronic movement analysis using a Posturo-Locomotor-Manual (PLM) test, and assessment with an ADL (Activities of Daily Living) scale were performed in 36 (18 women and 18 men) 90-year-old subjects as part of a larger study. In the PLM test, the subjects were asked to pick up an object placed on the floor, and carry it to a shelf at the height of their chin and at a distance of 150 cm from the starting position. In the ADL assessment, the subjects were classified as ADL-dependent or independent in each of 4 instrumental (cleaning, shopping, transport and cooking) and 5 personal activities (bathing, dressing, going to the toilet, transfer and feeding). ADL independence was defined as being able to perform ADL activities without assistance from another person. In this study, ADL-dependent subjects performed the PLM test considerably more slowly than the ADL-independent group. A correlation was found in females between poorer ADL performance and slower and less co-ordinated PLM test results. Particularly, the Postural and Locomotor phases representing lower limb mobility correlated to the ADL steps. In males, no such correlation was found, indicating that factors other than mobility were important for ADL performance in this group, e.g., cooking skills. The relationships between the PLM test and the ADL assessment estimating practical motor function could be an indication that the PLM test is not only a strict laboratory method, but also measures components of everyday motor activities. Combined use of optoelectronic measurements and ADL scales will improve measurements of motor performance in elderly persons.