Function In Old Age Research Articles

Caregivers in geriatrics: burnout and loss of meaning

The burnout of caregivers in geriatrics reveals a serious loss of meaning: that of 'ageing', of the status and the function of old age in the process and orientation of life. Faced with this challenge, the key is to find meaning in one's work. In geriatrics in particular, caregivers play a valuable role of 'conveyor'.

Geriatric intensive care patients : Perspectives and limits of geriatric intensive care medicine

Critically ill geriatric patients are vitally endangered due to the aging processes of organs, the frequently existing multimorbidity with subsequent polypharmacy and the typical geriatric syndrome of functional impairments. Aging processes in organs lower the clinical threshold for organ dysfunction and organ failure. Physiological organ aging processes with practical consequences for intensive care medicine are atypical manifestion of sepsis in immunosenescence, altered pharmacokinetics, reduced tolerance to hypovolemia due to proportionally reduced water compartment of the body in old age, the frequently only apparently normal function of the kidneys and the continuous reduction in pulmonary function in old age. The main reasons for changes in therapeutic targets are the will of the patient and risk-benefit considerations. The guidelines of the ethics section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) provide assistance and suggestions for a structured decision-making process.

Physical Activity Throughout the Adult Life Span and Domain-Specific Cognitive Function in Old Age: A Systematic Review of Cross-Sectional and Longitudinal Data.

A growing body of literature suggests that physical activity might alleviate the age-related neurodegeneration and decline of cognitive function. However, most of this evidence is based on data investigating the association of exercise interventions or current physical activity behavior with cognitive function in elderly subjects. We performed a systematic review and hypothesize that physical activity during the adult life span is connected with maintained domain-specific cognitive functions during late adulthood defined as age 60+ years. We performed a systematic literature search up to November 2017 in PubMed, Web of Science, and Google Scholar without language limitations for studies analyzing the association of leisure physical activity during the adult life span (age 18+years) and domain-specific cognitive functions in older adults (age 60+years). The literature review yielded 14,294 articles and after applying inclusion and exclusion criteria, nine cross-sectional and 14 longitudinal studies were included. Moderate- and vigorous-intensity leisure physical activity was associated with global cognitive function and specific cognitive domains including executive functions and memory but not attention or working memory. Most studies assessed mid- to late-adulthood physical activity, thus information concerning the influence of young adult life-span physical activity is currently lacking. Observational evidence that moderate- and vigorous-intensity leisure physical activity is beneficially associated with maintained cognitive functions during old age is accumulating. Further studies are necessary to confirm a causal link by assessing objective physical activity data and the decline of cognitive functions at multiple time points during old age.

Effects of Daily L-Dopa Administration on Learning and Brain Structure in Older Adults Undergoing Four Weeks of Cognitive Training: A Randomised, Parallel-Group, Double-Blind, Placebo-Controlled Trial

Background: Cognitive aging creates major individual and societal burden, motivating search for treatment and preventive care strategies. Behavioural interventions can improve cognitive performance in older age, but effects are small. Basic research has implicated dopaminergic signaling in plasticity. We investigated whether transient enhancement of dopaminergic neurotransmission via administration of L-dopa improves effects of cognitive training on performance. Methods: Participants for this randomised, parallel-group, double-blind, placebo-controlled trial were recruited via newspaper advertisements. Inclusion criteria were: age of 65-75 years, Mini-Mental State Examination score >25, absence of serious medical conditions. Eligible subjects were randomly allocated to either receive 100/25mg L-dopa/benserazide or placebo prior to each of twenty cognitive training sessions administered during a four-week period. Participants and staff were masked to group assignment. Primary outcomes were latent variables of spatial and verbal fluid intelligence. This trial was preregistered at the European Clinical Trial Registry, EudraCT#2016-000891-54. Findings: Between January 1st and October 10th 2017, we screened 235 people from the population in Stockholm, Sweden and randomly assigned 63 eligible subjects to receive L-dopa (n=32) or placebo (n=31) during cognitive training. Compared to the placebo group, subjects receiving L-dopa improved less in spatial intelligence (-0·267 SDs; 95% CI [-0·498, -0·036]; p=0·024). Change in verbal intelligence did not significantly differ between the groups (-0·081 SDs, 95% CI [-0·242, 0·080]; p=0·323). Adverse events occurred for 10 subjects (31%) in the active and for 7 participants (23%) in the control groups. Interpretation: The results speak against early pharmacological interventions in older healthy adults to improve cognitive functions by targeting the dopaminergic system and provide no support for learning-enhancing properties of L-dopa supplements. The findings warrant closer investigation about the cognitive effects of early dopamine-replacement therapy in neurological disorders. Trial Registration Number: This trial was preregistered at the European Clinical Trial Registry, EudraCT#2016-000891-54. Funding: European Research Council (ERC Grant agreement #617280-REBOOT), Wallenberg Clinical Scholars, and Stiftelse Stockholms Sjukhem. Declaration of Interest: We declare no competing interests. Ethical Approval: The study protocol was approved by the regional ethics review board in Stockholm (2016-1897-31/1) and the Swedish medical product agency (20016000891-54). Participants provided written informed consent before enrolment.

Change in Engagement in Cognitive Activity and Risk for Mild Cognitive Impairment in a Cohort of Older Adults: The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) Study.

Engagement in cognitively stimulating activities is gaining prominence as a potential strategy to maintain cognitive functioning in old age. In a population-based cohort of individuals aged 65+ years, we examined patterns of change in frequency of engagement in total cognitive activity (TCA), higher cognitive activity (HCA), and frequent cognitive activity (FCA) based on the Florida Cognitive Activities Scale over an average of 3.62 years, and whether these patterns were associated with incident mild cognitive impairment (MCI) during this same period. Among 867 cognitively normal participants, 129 (15%) progressed to MCI. Latent class trajectory modeling identified high and stable, slowly, and quickly declining patterns for TCA; high and stable, slowly declining, and slowing increasing patterns for FCA; and high and stable, and slowly declining patterns for HCA. Separate, adjusted Cox proportional hazard models, revealed that compared with the high, stable pattern, both slow decline [hazard ratio (HR), 2.5; 95% confidence interval (CI), 1.5-4.0] and quick decline (HR, 11.0; 95% CI, 6.3-19.2) in TCA, and slow decline in the FCA (HR, 8.7; 95% CI, 5.3-14.3) and HCA (HR, 3.4; 95% CI, 2.0-5.6) subscales increased risk for incident MCI. Maintaining engagement in cognitive activities may be protective against progression to MCI, alternatively, declining engagement may be a marker for impending cognitive impairment.

Light Alcohol Consumption Does Not Protect Cognitive Function: A Longitudinal Prospective Study

Studies show that light to moderate alcohol consumption is related to better health and higher cognitive performance. However, it has been suggested that this association is caused by a systematic bias in the control group as many people abstain from drinking or quit because of health issues. Therefore, the group of non-drinkers is biased towards poor health and may not be suitable as a control group. The present study examined the effect of alcohol on cognitive performance while addressing this bias by excluding the non-drinkers. Thus, instead of comparing different levels of alcohol consumption to a non-drinking control group, a dose-response association was calculated between all levels of alcohol intake and cognitive performance. The study used information from a sample of people in the Swedish Twin Registry, who in their midlife (1967) participated in a survey on alcohol intake and 25 years later participated in a longitudinal study on cognitive aging (N = 486). The cognitive aging study took place on five occasions, at 2-year intervals, and included the Mini Mental State Examination (MMSE), tests of episodic memory, semantic memory and spatial ability. The association between midlife alcohol consumption and later cognitive performance was analyzed using growth curve models, adjusting for background variables. The findings showed that there was a significant negative dose-response association between alcohol intake in midlife and the MMSE, and the tests of episodic memory, such that higher intake in midlife was related to lower performance in old age. The associations between alcohol and semantic memory, and spatial ability respectively, were not significant. In contrast to findings from other studies, which show that low to moderate alcohol intake promotes cognitive function, the current study showed that alcohol intake was related to lower cognitive performance in a dose-response manner, even at low levels. The results from this study indicate that the observed benefits of moderate alcohol intake for cognitive function reported by others might be solely due to comparisons to an inappropriate control group, a group that is biased towards poor health. Hence, it is concluded that light alcohol intake may not protect cognitive function.

Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study

ObjectiveTo assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning...

Compromised Grid-Cell-like Representations in Old Age as a Key Mechanism to Explain Age-Related Navigational Deficits

SummaryA progressive loss of navigational abilities in old age has been observed in numerous studies, but we have only limited understanding of the neural mechanisms underlying this decline [1]. A central component of the brain’s navigation circuit are grid cells in entorhinal cortex [2], largely thought to support intrinsic self-motion-related computations, such as path integration (i.e., keeping track of one’s position by integrating self-motion cues) [3, 4, 5, 6]. Given that entorhinal cortex is particularly vulnerable to neurodegenerative processes during aging and Alzheimer’s disease [7, 8, 9, 10, 11, 12, 13, 14], deficits in grid cell function could be a key mechanism to explain age-related navigational decline. To test this hypothesis, we conducted two experiments in healthy young and older adults. First, in an fMRI experiment, we found significantly reduced grid-cell-like representations in entorhinal cortex of older adults. Second, in a behavioral path integration experiment, older adults showed deficits in computations of self-position during path integration based on body-based or visual self-motion cues. Most strikingly, we found that these path integration deficits in older adults could be explained by their individual magnitudes of grid-cell-like representations, as reduced grid-cell-like representations were associated with larger path integration errors. Together, these results show that grid-cell-like representations in entorhinal cortex are compromised in healthy aging. Furthermore, the association between grid-cell-like representations and path integration performance in old age supports the notion that grid cells underlie path integration processes. We therefore conclude that impaired grid cell function may play a key role in age-related decline of specific higher-order cognitive functions, such as spatial navigation.

Thalamic functional connectivity and its association with behavioral performance in older age.

IntroductionDespite the thalamus’ dense connectivity with both cortical and subcortical structures, few studies have specifically investigated how thalamic connectivity changes with age and how such changes are associated with behavior. This study investigated the effect of age on thalamo‐cortical and thalamo‐hippocampal functional connectivity (FC) and the association between thalamic FC and visual–spatial memory and reaction time (RT) performance in older adults.MethodsResting‐state functional magnetic resonance images were obtained from younger (n = 20) and older (n = 20) adults. A seed‐based approach was used to assess the FC between the thalamus and (1) sensory resting‐state networks; (2) the hippocampus. Participants also completed visual–spatial memory and RT tasks, from the Cambridge Neuropsychological Test Automated Battery (CANTAB).ResultsOlder adults exhibited a loss of specificity in the FC between sensory thalamic subregions and corresponding sensory cortex. Greater thalamo‐motor FC in older adults was associated with faster RTs. Furthermore, older adults exhibited greater thalamo‐hippocampal FC compared to younger adults, which was greatest for those with the poorest visual–spatial memory performance.ConclusionAlthough older adults exhibited poorer visual–spatial memory and slower reaction times compared to younger adults, “good” and “poorer” older performers exhibited different patterns of thalamo‐cortical and thalamo‐hippocampal FC. These results highlight the potential role of thalamic connectivity in supporting reaction times and memory in aging. Furthermore, these results highlight the importance of including the thalamus in studies of aging to fully understand how brain changes with age may be associated with behavior.

Lifespan leisure physical activity profile, brain plasticity and cognitive function in old age

ABSTRACTObjectives: Despite the evidence suggesting physical activity (PA) as a major factor for the prevention of age-related cognitive decline, only a few studies have systematically investigated the impact of leisure PA during the lifespan (LLPA). This study investigates the effects of LLPA on cognitive function (CF) and brain plasticity (BP) in old age.Method: Participants’ (n = 50, 72 ± 5 yrs, 27 females) LLPA energy expenditure and volume was assessed via a validated questionnaire investigating five epochs (14–80 yrs). Using current WHO PA recommendations as reference, participants were stratified into energy expenditure and volume groups. CF outcomes were attention, executive functions, working memory and memory. BP was assessed using magnetic resonance spectroscopy (MRSI) and brain derived neurotropic factor (BDNF).Results: Correlation analysis revealed associations of mean LLPA energy expenditure with attention (CF) and N-acetylaspartate to choline ratios (NAA/Cho) (MRSI). ANOVA revealed higher interference control performance (CF) and NAA/Cho in participants complying with current PA recommendations (2-3 h per week) compared to non-compliers. Further CF and BP outcomes including BDNF were not associated with LLPA.Conclusion: Lifelong adherence to minimum recommended PA seems to be associated with markers of cognitive function and neuronal integrity in old age.

Erratum.

Nilsen, C., Agahi, N., & Kåreholt, I. (2017): Work stressors in late midlife and physical functioning in old age. Journal of Aging and Health, 29, 893-911. DOI: 10.1177/0898264316654673 In the above article, on page 903, the following paragraph has been placed incorrectly "example, passive jobs have been associated with an inactive lifestyle in men but not women (Gimeno et al., 2009). However, the association remained after controlling for lifestyle factors (physical activity and smoking), although the results regarding mobility problems and limited physical performance were slightly attenuated (Table 4, Model II). Another possibility is that other activities outside work that help people cope with work stressors differed for women and men. It is also possible that passive jobs are as stressful for men as high-strain jobs are for women. Perhaps men with passive jobs did not live up to ideas of hegemonic masculinity, and this, in turn, might have resulted in stress. The general pattern we observed-that in men, high job demands were somewhat protective of physical functioning, whereas in women, high job demands decreased physical functioning-has been noted in earlier studies (Karlqvist et al., 2002; Nilsen et al., 2014). Job demands may be viewed differently by men than women; alternatively, in men in these birth cohorts, job demands may have been an indicator of intellectual engagement at work." This paragraph should appear on page 906 after the following sentence "The sex differences in the associations between work stressors and physical functioning in old age may have been due to differences in lifestyle; for".

Working memory training in older adults: Bayesian evidence supporting the absence of transfer.

The question of whether working memory training leads to generalized improvements in untrained cognitive abilities is a longstanding and heatedly debated one. Previous research provides mostly ambiguous evidence regarding the presence or absence of transfer effects in older adults. Thus, to draw decisive conclusions regarding the effectiveness of working memory training interventions, methodologically sound studies with larger sample sizes are needed. In this study, we investigated whether or not a computer-based working memory training intervention induced near and far transfer in a large sample of 142 healthy older adults (65 to 80 years). Therefore, we randomly assigned participants to either the experimental group, which completed 25 sessions of adaptive, process-based working memory training, or to the active, adaptive visual search control group. Bayesian linear mixed-effects models were used to estimate performance improvements on the level of abilities, using multiple indicator tasks for near (working memory) and far transfer (fluid intelligence, shifting, and inhibition). Our data provided consistent evidence supporting the absence of near transfer to untrained working memory tasks and the absence of far transfer effects to all of the assessed abilities. Our results suggest that working memory training is not an effective way to improve general cognitive functioning in old age. (PsycINFO Database Record

Healthy heart, healthy brain: Hypertension affects cognitive functioning in older age.

Healthy heart, healthy brain: Hypertension affects cognitive functioning in older age.

Adult Lifetime Diet Quality and Physical Performance in Older Age: Findings From a British Birth Cohort.

BackgroundCurrent evidence that links “healthier” dietary patterns to better measured physical performance is mainly from older populations; little is known about the role of earlier diet. We examined adult diet quality in relation to physical performance at age 60–64 years.MethodsDiet quality was defined using principal component analysis of dietary data collected at age 36, 43, 53, and 60–64. Throughout adulthood, diets of higher quality were characterized by higher consumption of fruit, vegetables, and wholegrain bread. Diet quality scores calculated at each age indicated compliance with this pattern. Physical performance was assessed using chair rise, timed-up-and-go, and standing balance tests at age 60–64. The analysis sample included 969 men and women.ResultsIn gender-adjusted analyses, higher diet quality at each age was associated with better measured physical performance (all p < .01 for each test), although some associations were attenuated after adjustment for covariates. Diet quality scores were highly correlated in adulthood (0.44 ≤ r ≤ 0.67). However, conditional models showed that higher diet quality at age 60–64 (than expected from scores at younger ages), was associated with faster chair rise speed and with longer standing balance time (adjusted: 0.08 [95% CI: 0.02, 0.15] and 0.07 [0.01, 0.14] SD increase in chair rise speed and balance time, respectively, per SD increase in conditional diet quality; both p < .05).ConclusionsHigher diet quality across adulthood is associated with better physical performance in older age. Current diet quality may be particularly important for physical performance, suggesting potential for improvements in diet in early older age.

The relation of education and cognitive activity to mini-mental state in old age: the role of functional fitness status.

It remains unclear so far whether the role of cognitive reserve for cognitive functioning in old age may differ between individuals with low, compared to those with high functional fitness status. Therefore, the present study set out to investigate the relation of education and cognitive leisure activity as key markers of cognitive reserve to mini-mental state in old age (as an indicator of the extent of cognitive impairment) and its interplay with functional fitness status in a large sample of older adults. We assessed MMSE in 701 older adults (M=70.4years, SD=6.9, range: 60-91). We measured functional fitness status using the Senior Fitness Test battery and interviewed individuals on their education and cognitive leisure activity. Results showed that better functional fitness status, longer education, and greater engagement in cognitive leisure activity were significantly related to higher MMSE scores. Moderation analyses showed that the relations of education and cognitive leisure activity to MMSE scores were significantly larger in individuals with low, compared to those with high functional fitness status. In conclusion, cognitive functioning in old age may more strongly depend on cognitive reserve accumulated during the life course in older adults with low, compared to those with high functional fitness status. These findings may be explained by cross-domain compensation effects in vulnerable individuals and may (at least partly) account for the large variability in cognitive reserve-cognition relations debated in the literature.

Gender Differences in the Association Between Leisure Activity in Adulthood and Cognitive Function in Old Age: A Prospective Longitudinal Population-Based Study.

ObjectivesTo examine the long-term association between leisure activities in adulthood and cognitive function in old age while recognizing gender differences in activity profiles.MethodsThe sample included 340 cognitively healthy twins enrolled in the OCTO-Twin Study, a longitudinal study on cognitive aging. Leisure activity was measured in midlife and cognitive function in old age (mean age 83). Leisure activities covered the domains of domestic, intellectual–cultural, and self-improvement activities. The cognitive assessments comprised 5 measurement occasions (2-year intervals) covering verbal ability, spatial ability, memory, and speed. The association between leisure activity and cognitive function was estimated separately for the genders using growth curve models, adjusting for age and education.ResultsMen and women had the same level of total leisure activity but differed in activity profiles and in the associations between activity and cognitive function. Higher engagement in self-improvement among men was related to higher level of cognitive functioning. Among women, intellectual–cultural activity was related to better verbal ability and memory. Concerning trajectories of cognitive function, domestic activity among men was related to less decline in speed, whereas for women it was related to steeper decline in spatial ability and memory. Further, higher intellectual–cultural activity among women was related to steeper decline in memory.DiscussionCognitively stimulating activities (i.e., self-improvement and intellectual–cultural), might increase cognitive reserve whereas less cognitively stimulating activities (i.e., domestic) do not. Gender differences should be considered when examining lifestyle factors in relation to cognitive aging.

The impact of physical activity and sex differences on intraindividual variability in inhibitory performance in older adults

ABSTRACTIt is well-known that processing speed and executive functions decline with advancing age. However, physical activity (PA) has a positive impact on cognitive performances in aging, specifically for inhibition. Less is known concerning intraindividual variability (iiV) in reaction times. This study aims to investigate the influence of PA and sex differences on iiV in inhibitory performance during aging. Healthy adults were divided into active and sedentary groups according to PA level. To analyse iiV in reaction times, individual mean, standard deviation and the ex-Gaussian parameters were considered. An interaction between activity level and sex was revealed, sedentary females being slower and more variable than sedentary men. No sex differences were found in the active groups. These results indicate that the negative impact of sedentariness on cognitive performance in older age is stronger for females. The present findings underline the need to consider sex differences in active aging approaches.

Sex Differences in the Associations between L-Arginine Pathway Metabolites, Skeletal Muscle Mass and Function, and their Responses to Resistance Exercise, in Old Age.

The current study was designed to explore the associations between L-arginine metabolites and muscle mass and function in old age, which are largely unknown. The study used a randomised, double-blind, placebo-controlled design. The study was carried out in a laboratory setting. 50 healthy older adults [median age 70 years (IQR 67-73); 27 males]. Participants undertook an 18-week resistance exercise program, and a nutritional intervention (fish oil vs. placebo). Serum homoarginine, ornithine, citrulline, asymmetric dimethylarginine (ADMA), NG-monomethyl-L-arginine (L-NMMA), and symmetric dimethylarginine (SDMA), maximal voluntary contraction (MVC) and isokinetic torque of the knee extensors at 30° s-1 (MIT), muscle cross sectional area (MCSA) and quality (MQ) were measured at baseline and after the intervention. No significant exercise-induced changes were observed in metabolite concentrations. There were significant sex differences in the associations between metabolites and muscle parameters. After adjusting for age, glomerular filtration rate and fish oil intervention, citrulline (P=0.002) and ornithine (P=0.022) were negatively associated with MCSA at baseline in males but not females. However, baseline citrulline was negatively correlated with exercise-induced changes in MVC (P=0.043) and MQ (P=0.026) amongst females. Furthermore, amongst males, baseline homoarginine was positively associated with exercise-induced changes in MVC (P=0.026), ADMA was negatively associated with changes in MIT (P=0.026), L-NMMA (p=0.048) and ornithine (P<0.001) were both positively associated with changes in MCSA, and ornithine was negatively associated with changes in MQ (P=0.039). Therefore, barring citrulline, there are significant sex differences in the associations between L-arginine metabolites and muscle mass and function in healthy older adults. These metabolites might enhance sarcopenia risk stratification, and the success of exercise programs, in old age.

Ketogenic Diet Reduces Midlife Mortality and Improves Memory in Aging Mice

Ketogenic diets recapitulate certain metabolic aspects of dietary restriction such as reliance on fattyacid metabolism and production of ketone bodies. We investigated whether an isoprotein ketogenic diet (KD) might, like dietary restriction, affect longevity and healthspan in C57BL/6 male mice. We find that Cyclic KD, KD alternated weekly with the Control diet to prevent obesity, reduces midlife mortality but does not affect maximum lifespan. A non-ketogenic high-fat diet (HF) fed similarly may have an intermediate effect on mortality. Cyclic KD improves memory performance in old age, while modestly improving composite healthspan measures. Gene expression analysis identifies downregulation of insulin, protein synthesis, and fatty acid synthesis pathways as mechanisms common to KD and HF. However, upregulation of PPARα target genes is unique to KD, consistent across tissues, and preserved in old age. In all, we show that a non-obesogenic ketogenic diet improves survival, memory, and healthspan in aging mice.

The Joint Associations of Sedentary Time and Physical Activity With Mobility Disability in Older People: The NIH-AARP Diet and Health Study.

The purpose of this study was to determine the joint associations of sedentary time and physical activity with mobility disability in older age. We analyzed prospective data from 134,269 participants in the National Institutes of Health (NIH)-American Association of Retired Persons (NIH-AARP) Diet and Health Study between 1995-1996 and 2004-2005. Total sitting time (h/d), TV viewing time (h/d) and light- and moderate-to-vigorous-intensity physical activity (h/wk) were self-reported at baseline, and mobility disability at follow-up was defined as being "unable to walk" or having an "easy usual walking pace (<2 mph)." Multivariable logistic regression determined the independent and joint associations of sedentary time and total physical activity with the odds of disability. Among the most active participants (>7 h/wk), sitting <6 h/d was not related to excess disability at follow-up, and those in the most active group reporting the highest level of sitting time (≥7 h/d) still had a significantly lower odds (odds ratios = 1.11; 95% confidence interval = 1.02, 1.20) compared with those reporting the lowest level of sitting (<3 h/d) in the least active group (≤3 h/wk; odds ratios = 2.07; 95% confidence interval = 1.92, 2.23). Greater TV time was significantly related to increased disability within all levels of physical activity. Reduction of sedentary time, combined with increased physical activity may be necessary to maintain function in older age.