Cognitive Reserve and the Prevention of Dementia: the Role of Physical and Cognitive Activities

The Chinese Translation Study of the Cognitive Reserve Index Questionnaire

Purpose

The purpose of this study was to perform the translation and adaption of the Cognitive Reserve Index questionnaire into Chinese and assess the reliability of the Chinese version.

Materials and Methods

The Chinese version of the Cognitive Reserve Index questionnaire was created from a standard forward-backward translation. A total of 371 volunteers, aged between 20 and 89 years, participated in this survey. Participants were divided into three age-groups (Young, Middle-aged, and Elderly), and subgroup differences were examined by independent samples t-tests, ANOVA analysis as well as post-hoc analysis. Pearson correlation analysis was applied to test the association between the total scores and each subscore (CRI-Education, CRI-WorkingActivity, and CRI-LeisureTime). The internal consistency and test-retest reliability of the Cognitive Reserve Index questionnaire were assessed. The test-retest reliability was measured among 40 participants with a 2-week interval using intraclass correlation coefficient.

Results

Strong correlations were observed between the total scores and each subscore (CRI-Education, CRI-WorkingActivity, and CRI-LeisureTime: r = 0.65, 0.79, and 0.70, respectively). In contrast, it was found low to moderate correlations among three subscores. The internal consistency was acceptable (Cronbach's alpha coefficient = 0.68). The intraclass correlation coefficient for total scores of the Chinese version of the Cognitive Reserve Index questionnaire was 0.87 (95% CI 0.74–0.93).

Conclusion

The Chinese version of the Cognitive Reserve Index questionnaire was a potentially reliable and practical tool for evaluating cognitive reserve accumulated through a person's life span.

Longitudinal Cognitive and Physical Training Effectiveness in MCI, Based on the Experience of the Alzheimer's Hellas Day Care Centre

This study assesses the effectiveness of a multicomponent Longitudinal Cognitive Training (CT) program plus physical exercise (PE) for people with Mild Cognitive Impairment (MCI). 155 people with MCI, completed a 3 years (3Y) CT+PE, whilst 133 were control. Neuropsychological assessment was performed at baseline and 3 years later, whilst CT+PE had additional annual assessments. According to the results, the 3Y CT+PE outperformed control in cognitive abilities (p < 0.002), and Activities of Daily Living (ADL) (p < 0.001), stabilized their functional performances between 1st and 2nd year, but worsened in working and verbal memory between 2nd and 3 rd year (p < 0.002). Control deteriorated in cognitive functions (p < 0.001) and ADL (p < 0.001) after 3 years, whilst 1.33% of the experimental and 13.53% of the control group progressed to dementia (p < 0.001). Longitudinal CT+PE improves cognitive performance and ADL in MCI and delay the progression to dementia.

Dietary Intervention in Infancy and Cognitive Function in Young Adulthood: The Special Turku Coronary Risk Factor Intervention Project

OBJECTIVE

Consumption of saturated fatty acids (SAFAs), polyunsaturated fatty acids (PUFAs), cholesterol, and fiber have been linked with cognitive function in adults. We evaluated these associations from childhood by leveraging data from the Special Turku Coronary Risk Factor Intervention Project (STRIP).

STUDY DESIGN

STRIP recruited children aged 5 months and randomly assigned them into intervention/control groups. The intervention introduced a heart-healthy diet, characterized mainly by low consumption of SAFAs and cholesterol, through counseling at least biannually between age 7 months and 20 years. Diet was assessed repeatedly using food diaries. Six years after the end of the intervention phase, at age 26 years, the participants were invited to the first postintervention follow-up, which included cognitive testing that covered learning and memory, verbal memory, short-term working memory, reaction time, information processing, and cognitive flexibility and inhibitory control. We studied the associations of the STRIP intervention and the consumptions of SAFAs, PUFAs, cholesterol, and fiber within these cognitive domains.

RESULTS

Participants in the STRIP intervention group had better cognitive flexibility and inhibitory control and were better able to manage conflicting information and ignore task-irrelevant information (0.18 SD higher in the intervention group, adjusted for sex and socioeconomic status). No associations were observed with the dietary components studied.

CONCLUSIONS

The infancy-onset STRIP intervention, which promoted a heart-healthy diet, was favorably associated with cognitive flexibility and inhibitory control at age 26 years. No associations were found for the intervention targets studied, indicating that these specific dietary components did not underlie the observed effect of the intervention.

The combined effect of physical activity and fruit and vegetable intake on decreasing cognitive decline in older Taiwanese adults

The factors associated with cognitive decline among older adults include physical activity and fruit and vegetable intake. However, the long-term effects of concomitant physical activity and fruit and vegetable intake are unknown. This 16-year longitudinal study explored the joint effect of mitigating cognitive decline in a cohort of older Taiwanese individuals. Five population-based surveys (Taiwan Longitudinal Survey on Aging [1999–2015]) involving 4440 respondents over 53 years old in 1999 were conducted. Cognitive function was assessed using the Short Portable Mental Status Questionnaire (SPMSQ). The demographic, socioeconomic, health-related, behavioral, and disease status covariates were adjusted in the regression analysis. Trends in cognitive decline were observed over 16 years. The risk of cognitive decline decreased by 63% when high physical activity and high fruit and vegetable intake were combined (odds ratio 0.37; 95% confidence interval 0.23–0.59), indicating a potential combined effect of physical activity and fruit and vegetable intake on mitigating cognitive decline. These personal actions are safe, effective, and economical approaches to health promotion and disease prevention.

Is the Sardinian Blue Zone the New Shangri-La for mental health? Evidence on depressive symptoms and its correlates in late adult life span

Background

An area of extraordinary longevity (i.e., Sardinian Blue Zone) characterized by a very high prevalence of long-lived successful agers has been validated in Sardinia, an Italian island located in the Mediterranean Sea.

Aims

This study was primarily aimed at examining whether dietary habits (intake of vegetables and fruit, animal-derived proteins, and carbohydrates-rich food), time spent on hobbies, subjective physical health, and socio-cultural context (Sardinian Blue Zone vs. another Sardinian rural area) predicted self-reported depressive symptoms in older adults recruited in the Sardinian Blue Zone and another Sardinian rural area not being characterized by a higher prevalence of long-lived individuals.

Methods

Three hundred and eighteen community-dwellers, age 65 years and older, 188 females and 130 males (M_age = 79.1 years, SD = 6.9 years) were recruited from the Sardinian Blue Zone and another Sardinian rural area. Each participant individually completed a battery of instruments to assess lifestyle, food habits, perceived physical health, and depressive symptoms through the CES-D inventory.

Results

Significant associations were found between depressive signs, perceived physical health, time spent gardening, proteins, and carbohydrates intake, respectively. Approximately 17% of the variance in the CES-D condition was predicted by socio-cultural context, perceived physical health, and gardening. Participants recruited in the Sardinian Blue Zone spent more time gardening and self-reported better physical health.

Conclusions

current results suggest that a socio-cultural context where people age well (i.e., the Sardinian Blue Zone), and a healthy and physically active lifestyle are crucial for promoting well-being in late adulthood.

The Relationship Between Prior Cancer Diagnosis and All-Cause Dementia Progression Among US Adults

BACKGROUND

Cancer-related cognitive impairment (CRCI), a frequent effect of cancer and its treatments, shares common cognitive symptoms with dementia syndromes. Cross-sectional studies demonstrate an inverse relationship between cancer and dementia. However, the longitudinal relationship between dementia decline and cancer has not been investigated.

OBJECTIVE

To evaluate the association between cancer and longitudinal progression of dementia.

METHODS

We extracted electronic health record data from July 2003 to February 2020 from a single academic medical center. We identified dementia and cancer history prior to dementia using ICD-9/10 codes. We measured cognitive decline with the Alabama Brief Cognitive Screener (ABCs). We used adjusted linear mixed models to estimate baseline cognition and rate of progression by cancer history, including differences by race.

RESULTS

The study included 3,809 participants with dementia, of which 672 (17.6%) had cancer history. Those with cancer history had higher baseline cognition (β: 0.62, 95% CI: -0.02-1.25), but similar rate of decline. Non-Hispanic Blacks had lower cognitive scores at baseline and throughout follow-up regardless of cancer status compared to non-Hispanic Whites and other races/ethnicities with and without cancer history.

CONCLUSION

In this longitudinal retrospective study, participants with cancer history demonstrate better cognition at dementia diagnosis and no difference in cognitive decline than those without cancer history. Smoking and comorbidities attenuate this association and results indicate non-Hispanic Blacks have worse cognitive outcomes in dementia regardless of cancer history than other race/ethnicity groups. Further exploration of the role of smoking, comorbidities, and race/ethnicity on cancer and dementia-related cognitive decline is needed.

Lifestyle affects amyloid burden and cognition differently in men and women

Objective

Evidence on associations of lifestyle factors with Alzheimer's pathology and cognition are ambiguous, potentially because they rarely addressed inter‐relationships of factors and sex effects. While considering these aspects, we examined the relationships of lifestyle factors with brain amyloid burden and cognition.

Methods

We studied 178 cognitively normal individuals (women, 49%; 65.0 [7.6] years) and 54 individuals with mild cognitive impairment (women, 35%; 71.3 [8.3] years) enrolled in a prospective study of volunteers who completed ¹⁸F‐Flutemetamol amyloid positron emission tomography. Using structural equation modeling, we examined associations between latent constructs representing metabolic/vascular risk, physical activity, and cognitive activity with global amyloid burden and cognitive performance. Furthermore, we investigated the influence of sex in this model.

Results

Overall, higher cognitive activity was associated with better cognitive performance and higher physical activity was associated with lower amyloid burden. The latter association was weakened to a nonsignificant level after excluding multivariate outliers. Examination of the moderating effect of sex in the model revealed an inverse association of metabolic/vascular risk with cognition in men, whereas in women metabolic/vascular risk trended toward increased amyloid burden. Furthermore, a significant inverse association between physical activity and amyloid burden was found only in men. Inheritance of an APOE4 allele was associated with higher amyloid burden only in women.

Interpretation

Sex modifies effects of certain lifestyle‐related factors on amyloid burden and cognition. Notably, our results suggest that the negative impact of metabolic/vascular risk influences the risk of cognitive decline and Alzheimer's disease through distinct paths in women and men. ANN NEUROL 2022;92:451–463

Effects of Two Short-Term Aerobic Exercises on Cognitive Function in Healthy Older Adults during COVID-19 Confinement in Japan: A Pilot Randomized Controlled Trial

Aerobic exercise improves executive function-which tends to decline with age-and dual-task training with aerobic exercise improves the global cognitive function. However, home-based older adults could not follow these programs due to social isolation during the coronavirus disease 2019 pandemic. Therefore, we conducted a single-blind randomized controlled trial with 88 healthy older adults without dementia or sarcopenia who were randomly assigned into the Nordic walking (aerobic exercise), dance (dual-task training with aerobic exercise), or control group. The participants in both exercise intervention groups trained for 30 min, three times per week, for 4 weeks. All groups consumed amino acid-containing foods three times per week. We found that both exercise intervention groups showed improvements in executive function, while the dance group showed additional improvement in global cognitive function. The dance group showed a higher maximum gait speed, greater improvement in imitation ability, and improved executive function and cognitive function than the Nordic walking group. The intervention programs did not significantly affect the muscle mass or muscle output than the control group; however, both programs improved the participant neurological functions such as the heel lift, with dance training being the most effective intervention. In conclusion, dance training effectively improves cognitive function.

Do the impacts of mentally active and passive sedentary behavior on dementia incidence differ by physical activity level? A 5-year longitudinal study

BACKGROUND

It has not been determined whether mentally active sedentary behavior (MASB) and passive sedentary behavior (PSB) differentially affect cognitive function, and whether these associations differ according to physical activity (PA) level. We examined the comparative impacts of MASB and PSB on dementia onset and aimed to understand whether the associations differed by PA level.

METHODS

A 5-year longitudinal study involving all community-dwelling older adults in a rural area in Japan (n = 5,323). Dementia onset was examined using long-term care insurance data. PA was evaluated using the International Physical Activity Questionnaire and categorized as low (<2.5 MET-h/week), moderate (<16.0 MET-h/week), or high (≥16.0 MET-h/week). We also assessed PSB (TV-watching time; <1 h/day, <3 h/day, ≥3 h/day) and MASB (Book-reading time; <10 min/day, <30 min/day, ≥30 min/day). To examine the associations of MASB and PSB with dementia onset, we performed the Fine-Gray models accounting for competing risk of death.

RESULTS

During the follow-up period, 606 (11.4%) participants developed dementia. MASB was independently associated with a lower risk of dementia; the magnitude of the impact was significant at higher PA levels. There was no association between PSB and developing dementia across all PA levels. Furthermore, dementia risk for individuals with high PA levels and moderate or high MASB levels was approximately 60% lower than those with low PA levels and low MASB.

CONCLUSIONS

Providing interventions to promote MASB, which reduces dementia risk, and PA, which increases MASB's effect on dementia incidence, can be beneficial in delaying or preventing dementia onset.

Individualised computerised cognitive training for community-dwelling people with mild cognitive impairment: study protocol of a completely virtual, randomised, controlled trial

Background

People with mild cognitive impairment (MCI) are at increased risk of converting to dementia. Cognitive training can improve the cognitive abilities of people with MCI. Computerised cognitive training (CCT) offers several advantages over traditional paper-and-pencil cognitive training and has the potential to be more individualised by matching task difficulty with individual performance. Recent systematic reviews have reported promising effects of CCT on improving the cognitive capacities of people with MCI. However, the quality of existing studies has been limited, and it is still unclear whether CCT can influence the progression to dementia. We developed an ‘individualised’ CCT (MAKSCog) specialised for people with MCI that automatically matches task difficulty with individual performance and an active control training (‘basic’ CCT). The aims of the present study are (a) to evaluate MAKSCog and (b) to investigate whether it can be applied to maintain the cognitive abilities of people with MCI.

Methods

The present study investigates the effects of CCT on cognition in a randomised controlled intervention study in Germany. Participants are community-dwelling people with a psychometric diagnosis of MCI based on the Montreal Cognitive Assessment (MoCA) and Mini-Mental Status Test (MMSE). Screening and baseline testing are conducted via a videoconferencing assessment and telephone. Participants are randomly allocated. The treatment phase is 6 months with an open phase in which participants can freely decide to continue to use the CCTs. Additionally, both CCTs contain a monthly computerised cognitive assessment that measures different cognitive abilities: information processing speed, memory span, short term memory, and logical reasoning.

Discussion

This is the first study to investigate the effect of MAKSCog, an individualised CCT, specifically developed for people with different subtypes of MCI. A methodological strength is the double-blind, randomised, controlled design and the use of basic CCT as an active control group. The study is conducted entirely virtually with valid telehealth assessments for cognitive function. Methodological limitations might include a restriction to participants who feel comfortable with the use of technology and who own a computer, laptop, or tablet.

Trial registration

ISRCTN ISRCTN14437015. Prospectively registered on 27 February 2020.

Creativity, leisure activities, social engagement and cognitive impairment: the AGES-Reykjavík study

BACKGROUND

Participation in leisure activities and extensive social network have been associated with lower risk of cognitive impairment (CI) and dementia.

AIMS

We examined whether leisure activities (cognitive solitary, cognitive group, social, physical, or creative activities) and social involvement are associated with less incidence of CI or dementia.

METHODS

Analyses were performed from data of 2933 cognitively intact individuals at baseline included in the AGES-REYKJAVIK study. Odds ratios (OR) were calculated for incident CI and dementia in relation to cognitive individual, cognitive group, social, physical, and creative leisure activities as well as social networks. Models were adjusted for a number of known risk factors for cognitive decline.

RESULTS

In 5 years, 12% of the cohort were diagnosed with CI or dementia. All leisure activities were associated with reduced likelihood of cognitive decline in the raw model, but in adjusted models, cognitive solitary [OR 0.49 (Confidence Interval (CI) 0.38-0.64)], cognitive group [OR 0.50 (CI 0.30-0.82)], and creative activities [OR 0.53 (CI 0.35-0.83)] were significantly associated with less cognitive decline. Analyses examining creative leisure activities independently, controlling for all other activities, suggested individuals participating in creative activities exhibited less CI [OR 0.64 (CI 0.41-0.98)]. Among social networks variables, frequency of meeting with friends and relatives was associated with reduced likelihood of CI [OR 0.49 (CI 0.31-0.75)].

DISCUSSION

Cognitive and creative leisure activities and frequent gatherings with friends and relatives are associated with reduced incidence of CI in this older cohort.

CONCLUSION

Creative leisure activities might have special benefit for cognitive ability.

Neuropsychological functioning in post-ICU patients after severe COVID-19 infection: The role of cognitive reserve

Background

Cognitive manifestations associated with Severe Acute Respiratory Syndrome by Coronavirus 2 (SARS-CoV-2) are yet to be described in the existing literature. The aim of this exploratory study is to analyze the impact of severe SARS-CoV-2 infection on neuropsychological performance 6 months following hospital discharge, and to identify which medical variables predict worse outcome. In this context, we study if cognitive reserve (CR) may play a protective role on cognitive impairment.

Methods

We enrolled a cohort of 102 severe SARS-CoV-2 survivors who had been admitted to the Intensive Care Unit (ICU) and were contacted 6-months post discharge. A total of 58 agreed to participate in this 6-month follow-up study. Patients with previously known cognitive impairment were excluded. Demographic, clinical and laboratory data were collected. Firstly, to test the magnitude of neurocognitive sequalae two standard deviations below normative group were considered. Secondly, to analyze the main effects of medical variables on cognition and the interaction with cognitive reserve, ANCOVA analyses were performed.

Results

53.4% obtained a score below the cutoff point (<26) in the screening test MOCA. ICU variables including mechanical ventilation, days of sedation or high CRP days were related with cognition. Cognitive Reserve (CR) interacted with delirium (F ​= ​6.8, p ​= ​0.01) and sedation days (F ​= ​9.40, p ​= ​0.003) to predict verbal memory and interacted with high CRP to predict phonemic fluency (F ​= ​6.47, p ​= ​0.01). Finally, no differences in neuropsychological performance were found depending on subjective cognitive impairment (SCI). However, patients with SCI had a higher score in the HAD anxiety subscale (t ​= ​−2.2; p ​< ​0.05).

Conclusions

In our cohort, cognitive dysfunction was related with ICU variables such as delirium, mechanical ventilation, and inflammation. CR modulated the impact of these variables on cognition. Cognitive complaints were related with anxiety but not with cognitive performance. Despite some limitations, including the need of replication of the findings with larger samples and control groups, our study suggests that high CR may be protective for severe COVID-19-related cognitive impairment.

The influence of adiposity on the interactions between strength, physical function and cognition among older adults in the Australian Diabetes, Obesity and Lifestyle (AusDiab) study

Background

Being overweight or obese may be associated with lower physical and cognitive function, but in late-adulthood (≥ 65 years) evidence is mixed. This study aimed to investigate how being overweight or obese affected interactions between muscle strength, function and cognition in Australians aged ≥ 50 years, and whether interactions varied according to age (i.e. ≥ 50–65 vs > 65 years).

Methods

This study included 2368 adults [mean (standard deviation) age: 63 (7) years; 56% female] from the 2011/2012 Australian Diabetes, Obesity and Lifestyle (AusDiab) follow-up. Physical function was assessed via timed up-and-go (TUG) and muscle strength from knee extensor strength (KES). Cognition was assessed using Mini-Mental-State Exam (MMSE), Spot-the-Word (STW), California Verbal Learning Test (CVLT) and Symbol–Digit-Modalities Test (SDMT). Beta binomial regression was used to evaluate how being overweight or obese influenced strength, physical and cognitive function associations.

Results

Being overweight or obese did not affect strength-cognition associations regardless of sex or age. With slower physical function; obese females showed better STW (odds ratio [OR] 95% CI]: 1.070 [1.016, 1.127], P = 0.011); obese men better MMSE (OR [95% CI]: 1.157 [1.012, 1.322], P = 0.033); and obese men aged > 65 better CVLT (OR [95% CI]: 1.122 [1.035, 1.217], P = 0.019) and MMSE (OR [95% CI]: 1.233 [1.049, 1.449], P = 0.017) compared to normal weight participants.

Conclusion

Slower physical function was associated with better performance in some cognitive domains in obese, but not in non-obese adults aged ≥ 50 years. These findings suggest some benefits of obesity to aspects of cognition when physical function is slower, but longitudinal follow-up studies are needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03033-3.

Increasing participation in habitual intellectual activities on modulating functional connectivity of default mode network among older adults at risk of dementia: study protocol of a randomized controlled trial

BACKGROUND

Active participation in intellectual leisure activities such as calligraphy helps prevent cognitive decline and dementia, but the underlying mechanisms are not fully understood. With disrupted functional connectivity (FC) of default mode network (DMN) associated with cognitive decline, we speculate that intellectual activities might optimize cognitive function through modulating FC of DMN. This two-arm single-blind randomized controlled trial aims to identify the effects of increasing practice of calligraphy on cognitive function and FC of DMN in people with subjective cognitive decline (SCD).

METHODS

One hundred twelve community-living Chinese aged 55 to 75 years old with SCD but without mild cognitive impairment or dementia and with prior practice of calligraphy as defined by 1 h of calligraphy per week will be recruited through elderly social centres in Hong Kong and randomized into either control or intervention group. The control group will continue with their usual practice of calligraphy, whereas the intervention group will double their practice of calligraphy. Measurement of cognitive outcomes and neuroimaging on resting-state FC will be performed at baseline and in 6 months. Repeated measures analysis of variance will be used to assess cognitive and FC changes, with time being the within-group factor, control/intervention as the between-group measure, and important covariates (age, sex, educational and occupational attainment, health, and other lifestyle factors) controlled for.

DISCUSSION

This study will shed light on the underlying neurocognitive mechanisms of how intellectual activities promotes cognitive maintenance. Our anticipated findings will provide evidence that reversing or slowing FC disruption by actively participating in intellectual activities is still possible for the at-risk individuals.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900024433 . Registered on 11 July 2019.

Are subjective cognitive complaints associated with executive functions and mental health of older adults?

Subjective cognitive complaints are used to detect detrimental age-related variations in cognitive efficiency before cognitive decline occurs in late adulthood. Despite this, there is controversial evidence on the relationship between the aforementioned metacognitive measure and the actual cognitive efficiency of older individuals. Instead, subjective cognitive complaints seem to be related to perceived mental health. This study aimed to investigate the nature of the relationships between subjective cognitive failures, mental health, and executive functioning. An additional goal was to examine whether there were significant differences in perceived mental health and executive functions efficiency by comparing older people who exhibited fewer subjective cognitive complaints with a group who reported more cognitive complaints. Eighty-nine community-dwellers (M_age = 78.6 years, SD = 6.5 years; age range = 66-95 years), 42 males and 47 females, were recruited and completed a battery of tools assessing cognitive failures, depressive symptoms, psychological well-being, optimism, global cognitive functioning, vocabulary, and several executive functions. Significant relationships were only found between self-reported cognitive failures, depressive symptoms, optimism, and psychological well-being. Moreover, participants who reported more cognitive failures also exhibited less optimism and psychological well-being and showed more depressive symptoms than older respondents who exhibited fewer cognitive complaints. Finally, no differences in the measures of executive functioning were found between groups exhibiting low vs. high levels of subjective cognitive complaints. In conclusion, the concurrent objective assessment of cognitive functioning and self-reported evaluation of cognitive processes and mental health of older people should be encouraged, to detect possible threats to their well-being.

Development and Validation of a Cognitive Reserve Index in HIV

OBJECTIVES

In the neuroHIV literature, cognitive reserve has most often been operationalized using education, occupation, and IQ. The effects of other cognitively stimulating activities that might be more amenable to interventions have been little studied. The purpose of this study was to develop an index of cognitive reserve in people with HIV, combining multiple indicators of cognitively stimulating lifetime experiences into a single value.

METHODS

The data set was obtained from a Canadian longitudinal study (N = 856). Potential indicators of cognitive reserve captured at the study entry included education, occupation, engagement in six cognitively stimulating activities, number of languages spoken, and social resources. Cognitive performance was measured using a computerized test battery. A cognitive reserve index was formulated using logistic regression weights. For the evidence on concurrent and predictive validity of the index, the measures of cognition and self-reported everyday functioning were each regressed on the index scores at study entry and at the last follow-up [mean duration: 25.9 months (SD 7.2)], respectively. Corresponding regression coefficients and 95% confidence intervals (CIs) were computed.

RESULTS

Professional sports [odds ratio (OR): 2.9; 95% CI 0.59-14.7], visual and performance arts (any level of engagement), professional/amateur music, complex video gaming and competitive games, and travel outside North America were associated with higher cognitive functioning. The effects of cognitive reserve on the outcomes at the last follow-up visit were closely similar to those at study entry.

CONCLUSION

This work contributes evidence toward the relative benefit of engaging in specific cognitively stimulating life experiences in HIV.

Cognitive reserve and its correlates in child and adolescent offspring of patients diagnosed with schizophrenia or bipolar disorder

AIM

To analyze cognitive reserve (CR) in child and adolescent offspring of patients diagnosed with schizophrenia (SZ-off) or bipolar disorder (BD-off) and compare them with a group of community controls (CC-off). We also aimed to investigate whether there was an association between CR and clinical and neuropsychological variables according to group.

METHODS

The study included 46 SZ-off, 105 BD-off and 102 CC-off. All participants completed assessments regarding CR and clinical, neuropsychological and psychosocial functioning. CR was measured with a proxy based on premorbid intelligence, parental occupational level, educational attainment, developmental milestones and sociability. The clinical assessment included the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime, the Semi-structured Interview for Prodromal Syndromes, and the Global Assessment Functioning scale. The neuropsychological assessment included measures of executive functioning, attention, verbal memory, working memory and processing speed.

RESULTS

SZ-off showed a lower level of CR compared to BD-off and CC-off, while BD-off showed an intermediate level of CR between SZ-off and CC-off. Moreover, an association between higher CR and less lifetime psychopathology, fewer prodromal psychotic symptoms, higher psychosocial functioning, and a higher working memory score was observed in all groups, but it was stronger in SZ-off.

CONCLUSIONS

CR seemed to be associated with psychopathology, clinical symptoms, psychosocial functioning, and some cognitive functions. SZ-off appeared to benefit more from a higher CR, therefore it could be considered a protective factor against the development of clinical symptomatology and cognitive impairment.

Bilingualism and Aging: Implications for (Delaying) Neurocognitive Decline

As a result of advances in healthcare, the worldwide average life expectancy is steadily increasing. However, this positive trend has societal and individual costs, not least because greater life expectancy is linked to higher incidence of age-related diseases, such as dementia. Over the past few decades, research has isolated various protective "healthy lifestyle" factors argued to contribute positively to cognitive aging, e.g., healthy diet, physical exercise and occupational attainment. The present article critically reviews neuroscientific evidence for another such factor, i.e., speaking multiple languages. Moreover, with multiple societal stakeholders in mind, we contextualize and stress the importance of the research program that seeks to uncover and understand potential connections between bilingual language experience and cognitive aging trajectories, inclusive of the socio-economic impact it can have. If on the right track, this is an important line of research because bilingualism has the potential to cross-over socio-economic divides to a degree other healthy lifestyle factors currently do not and likely cannot.

Add Bilingualism to the Mix: L2 Proficiency Modulates the Effect of Cognitive Reserve Proxies on Executive Performance in Healthy Aging

We investigated the contribution of bilingual experience to the development of cognitive reserve (CR) when compared with other, traditionally more researched, CR proxies, in a sample of cognitively healthy senior (60 +) bilingual speakers. Participants performed in an online study where, in addition to a wide inventory of factors known to promote CR, we assessed several factors related to their second language (L2) use. In addition, participants’ inhibitory executive control was measured via the Flanker Task. We used Structural Equation Modeling to derive a latent composite measure of CR informed by traditional CR proxies (i.e., occupational complexity, marital status, current and retrospective socio-economic status, physical exercise, perceived positive support, maximal educational attainment, frequency of leisure activities and extent of social network). We examined whether bilingualism may act as a mediator of the effects of such proxies on cognitive performance therefore assessing the unique contribution of dual language use to CR. First, our analyses revealed facilitatory effects of both L2 age of acquisition and L2 proficiency on the executive performance. Second, our analyses confirmed the moderating role of bilingual experience on the relationship between other factors known to promote CR and cognitive integrity, revealing a strong contribution by bilingualism to CR development. Our findings provide further support to the notion that bilingualism plays an important role in mitigating cognitive decline and promoting successful aging.

Neural Advantages of Older Musicians Involve the Cerebellum: Implications for Healthy Aging Through Lifelong Musical Instrument Training

This study compared 30 older musicians and 30 age-matched non-musicians to investigate the association between lifelong musical instrument training and age-related cognitive decline and brain atrophy (musicians: mean age 70.8 years, musical experience 52.7 years; non-musicians: mean age 71.4 years, no or less than 3 years of musical experience). Although previous research has demonstrated that young musicians have larger gray matter volume (GMV) in the auditory-motor cortices and cerebellum than non-musicians, little is known about older musicians. Music imagery in young musicians is also known to share a neural underpinning [the supramarginal gyrus (SMG) and cerebellum] with music performance. Thus, we hypothesized that older musicians would show superiority to non-musicians in some of the abovementioned brain regions. Behavioral performance, GMV, and brain activity, including functional connectivity (FC) during melodic working memory (MWM) tasks, were evaluated in both groups. Behaviorally, musicians exhibited a much higher tapping speed than non-musicians, and tapping speed was correlated with executive function in musicians. Structural analyses revealed larger GMVs in both sides of the cerebellum of musicians, and importantly, this was maintained until very old age. Task-related FC analyses revealed that musicians possessed greater cerebellar-hippocampal FC, which was correlated with tapping speed. Furthermore, musicians showed higher activation in the SMG during MWM tasks; this was correlated with earlier commencement of instrumental training. These results indicate advantages or heightened coupling in brain regions associated with music performance and imagery in musicians. We suggest that lifelong instrumental training highly predicts the structural maintenance of the cerebellum and related cognitive maintenance in old age.

Cognitive Health Worries, Reduced Physical Activity and Fewer Social Interactions Negatively Impact Psychological Wellbeing in Older Adults During the COVID-19 Pandemic

The Coronavirus pandemic has significantly affected psychological wellbeing in older adults, with cases of depression, anxiety and loneliness rising in the general population. Cognitive health has also potentially been affected, as social isolation can lead to cognitive decline. Worrying about cognitive health can be damaging to psychological wellbeing and is especially relevant to explore in the context of the Coronavirus pandemic. The objective of the present study was to explore the associations between cognitive health worries and wellbeing, and to investigate whether physical activity and social contact can mitigate negative effects of the pandemic on psychological wellbeing. Older adults (N = 191) completed an online survey which included measures of cognitive health worries, depression, anxiety, loneliness, social isolation, fatigue, impact of the Coronavirus pandemic, quality of life, subjective vitality, and physical activity. Analyses indicated that cognitive health worries, lower levels of physical activity and smaller amounts of social interaction were associated with poorer psychological and physical wellbeing. Results showed that worrying about cognitive health is associated with poorer wellbeing, and so interventions are needed to encourage positive cognitive functioning in times of social isolation. Promoting physical activity and social interaction is also beneficial, as results show that exercise and social contact are linked with improved wellbeing.

Exploring the Recent Trends in Management of Dementia and Frailty: Focus on Diagnosis and Treatment

Dementia and frailty increase health adversities in older adults, which are topics of growing research interest. Frailty is considered to correspond to a biological syndrome associated with age. Frail patients may ultimately develop multiple dysfunctions across several systems, including stroke, transient ischemic attack, vascular dementia, Parkinson's disease, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, cortico-basal degeneration, multiple system atrophy, amyotrophic lateral sclerosis, and Creutzfeldt-Jakob disease. Patients with dementia and frailty often develop malnutrition and weight loss. Rigorous nutritional, pharmacological, and non-pharmacological interventions generally are required for these patients, which is a challenging issue for healthcare providers. A healthy diet and lifestyle instigated at an early age can reduce the risk of frailty and dementia. For optimal treatment, accurate diagnosis involving clinical evaluation, cognitive screening, essential laboratory evaluation, structural imaging, functional neuroimaging, and neuropsychological testing is necessary. Diagnosis procedures best apply the clinical diagnosis, identifying the cause(s) and the condition(s) appropriate for treatment. The patient's history, caregiver's interview, physical examination, cognitive evaluation, laboratory tests, and structural imaging should best be involved in the diagnostic process. Varying types of physical exercise can aid the treatment of these disorders. Nutrition maintenance is a particularly significant factor, such as exceptionally high-calorie dietary supplements and a Mediterranean diet to support weight gain. The core purpose of this article is to investigate trends in the management of dementia and frailty, focusing on improving diagnosis and treatment. Substantial evidence builds the consensus that a combination of balanced nutrition and good physical activity is an integral part of treatment. Notably, more evidence-based medicine knowledge is required.

The Lifetime of Experiences Questionnaire: Psychometric Properties and Relationships With Memory Function in an Iranian Elderly Sample

This study aimed to validate the Persian version of the Lifetime of Experiences Questionnaire (LEQ) and examine the relationship between life experience and memory function. To this end, two studies were conducted. Study one examined the factor structure, internal consistency, and convergent and discriminant validity of the Persian version of LEQ with 247 healthy elderly individuals (M age = 70.17, SD = 4.42; 55.9% women). The exploratory factor analysis yielded a five-factor solution, including Knowledge, Physical, Socialization, Artistic, and Leisure dimensions, which accounted for 42.42% of the explained variance. The internal consistency of the LEQ was in the acceptable range (α = 0.703). Also, the LEQ and its subscales (except the Artistic subscale) had a negative relationship with geriatric depression and a positive relationship with a healthy lifestyle, supporting the measure's convergent and discriminant validity. In the second study, we examined the relationship between LEQ (total and subscales score) and memory function using Pearson correlation and moderating analysis with 149 participants (M age = 70.37, SD = 4.29; 55.03% women). The results demonstrated that the LEQ total and subscales scores correlated positively with episodic memory. In the same vein, LEQ total score and Knowledge subscale showed a positive correlation with semantic memory. The results of moderation analysis showed that LEQ subscales have a different role in memory decline. The knowledge subscale as a content component moderates the effect of age on semantic memory (B = 0.005, t = 2.021, p = 0.045), while the mid-life non-specific activities, which are based on life stages, moderate the effect of age on episodic memory (B = 0.007, t = 3.348, p = 0.001). In conclusion, our results indicated that the Persian version of the LEQ is a valid and reliable instrument for measuring experiences and activities throughout life, which can be used in professional clinical and research settings in the aging context with Iranian elderly samples. Furthermore, our findings suggest that various life experiences can be considered cognitive reserves in old age.

The effect of a multimodal dementia prevention program involving community-dwelling elderly

BACKGROUND

With the rapid increase in the average age of society, the number of people with dementia has increased in Japan. Thus, the need to prevent dementia is greater, and prevention programs have been implemented throughout Japan. This study aims to evaluate both the short-term and the long-term effects of a dementia prevention program on physical and cognitive function in community-dwelling elderly.

METHODS

Cognitive and physical assessments were carried out at baseline for a sample including 57 elderly participants. The participants underwent an intensive training program lasting for 2 h per week for 10 days. After the last period of training, the assessment performed was reapplied. The outcome measures used to establish effectiveness were a Mini-Mental State Examination, Five Cognitive Tests, a Cognitive Function Instrument, a Timed Up & Go Test, a grip strength evaluation, a Geriatric Depression Scale, an EQ-5D and a Physical Activity Scale for the Elderly. Participants were then divided randomly into two groups: a booster group and a non-booster group. The booster group received booster training every 3 months after the intensive training period, whereas the non-booster group did not. Both groups were monitored every 6 months for approximately two and a half years after baseline assessment.

RESULTS

The Mini-Mental State Examination, the subtests of the Five Cognitive Tests (attention, memory, language and reasoning) and the Timed Up & Go Test revealed a significant improvement after intensive training. For most of the outcome measures, the booster training showed no additional significant improvements.

CONCLUSIONS

In this study, intensive training had a short-term positive effect. Although the effect of the booster training was not clear, the functions of the elderly participants were found to be maintained during a follow-up assessment. The study findings recommend conducting intensive training for the community-dwelling elderly without follow-up training.

Effect of Paprika Xanthophyll Supplementation on Cognitive Improvement in a Multitasking Exercise: A Pilot Study for Middle-Aged and Older Adults

Ingestion of paprika xanthophyll supplement (PX), which has antioxidant effects, has been recently reported to maintain red blood cell deformability and improve oxygen delivery efficiency. Therefore, we hypothesized that the brain activation induced by multitasking exercise in middle-aged and older participants along with the improved erythrocyte oxygen-carrying efficiency induced by PX supplementation would show a synergistic effect, increasing oxygen supply to the brain and improving cognitive function more effectively. In study 1, cerebral blood flow measurements were conducted during the multitasking exercise and cognitive function tests to verify their effect on cognitive function. The results confirmed that cerebral blood flow increased during the exercise and cognitive function improved after the exercise. In study 2, we compared the effects of the multitasking exercise on cognitive function before and after PX supplementation in middle-aged and older participants to evaluate the effects of PX supplementation. The results suggested that PX supplementation enhanced the effects of active multitasking exercise on cognitive function. We speculate that the improvement of oxygen transport efficiency by PX resulted in more effective oxygen supply, allowing the multitasking exercise to occur more effectively, which was reflected as an improvement in the cognitive function.

Book-Oriented Environment in Childhood and Current Cognitive Performance among Old-Aged Europeans

INTRODUCTION

Identifying early-life factors that protect against compromised late-life cognition is of great public health interest. We aimed to explore the associations between book-oriented environment in childhood and late-life cognitive performance in the Survey of Health, Ageing and Retirement in Europe (SHARE).

METHODS

The sample included 8,239 individuals aged ≥65 years (N = 8,239) free of stroke, Parkinson's disease, or Alzheimer's disease, who participated in both waves 4 (2011) and 5 (2013) of SHARE. Book-oriented environment was assessed by the self-reported home library size during childhood. Cognitive performance was assessed using tests of memory and verbal fluency. Covariates included education and measures of current health, lifestyle, and financial status. Additionally, interactions with age and education were assessed.

RESULTS

After controlling for potential confounders, having large home libraries was related to better performance on the immediate and delayed memory (β = 0.11 ± 0.02, p < 0.001; β = 0.13 ± 0.02, p < 0.001) and the verbal fluency tests (β = 0.14 ± 0.06, p < 0.001) and to a lesser decline in these domains (β = 0.08 ± 0.01, p < 0.001; β = 0.09 ± 0.02, p < 0.001; and β = 0.09 ± 0.06, p < 0.001, respectively). Significant interactions were observed between library size and age such that larger home library was more strongly associated with improved immediate memory (p = 0.016), delayed memory (p < 0.001), and verbal fluency (p = 0.003) and with less cognitive decline (p = 0.013, p < 0.001, and p = 0.095, respectively) among the younger-old (<80 years) compared to the oldest-old (≥80 years) participants. No effect modification by education was observed.

CONCLUSIONS

These findings suggest that early-life book-oriented environment may be important in shaping cognitive aging.

Design and evaluation of a cognitive health education pilot program according to the RE-AIM framework

OBJECTIVE

Most formats of currently used community-based health education for cognitive impairment prevention are limited to one-way communication, such as distributing leaflets, pasting posters, or holding a lecture, and they lack comprehensive evaluation. Here we aim to design, test, and evaluate a novel pilot cognitive health education program combined with psychosocial interventions (CHECPI).

METHODS

We designed the CHECPI program and tested it among adults aged 60 and over in an aging-friendly community in 2018. Multidimensional cognitive functions were measured by the Montreal Cognitive Assessment (MoCA) before and three months after the CHECPI program. Quantitative and qualitative analyses were performed based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the program. Wilcoxon signed-rank tests were used to assess changes in multidimensional cognitive functions.

RESULTS

The CHECPI program was comprised of 12 courses and introduced 5 kinds of psychosocial interventions. Reach: 28 older adults participated in the program, of whom most were female (n = 22) and younger elderly with an average age of 65.32 years. Effectiveness: 19 participants finished≥6 courses as well as the follow-up survey. Although their MoCA scores did not improve significantly, they had increased their visuospatial ability significantly (with the average score increasing by 0.42). Adoption: the community officers, lecturers, and participants highly recommended the program, but they agreed that the lack of professional instructors may hinder its popularization. Implementation: the program was implemented in full accordance with the pre-program design. Maintenance: three months after the program, 17 participants had maintained at least one of the seven healthy behaviors that were introduced in the program.

CONCLUSIONS

Younger female elderly were more willing to participate in the program. It enhanced participants' visuospatial ability, but a sufficient number of professional instructors are crucial for large-scale promotion.

Cognitive reserve, modifiable-risk-factor profile and incidence of dementia: results from a longitudinal study of CFAS Wales

OBJECTIVES

Both cognitive reserve and modifiable-risk-factor profiles play a role in dementia incidence. We investigated whether cognitive reserve moderates the risk of dementia attributable to the modifiable-risk-factor profile.

METHOD

We followed 2102 older individuals aged 65+ years recruited from the population-based longitudinal cohort CFAS Wales study, begun in 2011, and the follow-up wave completed in early 2016. Cognitive reserve was measured by combining educational level, occupation complexity, and engagement in social and cognitive activities in later life. Modifiable-risk-factor profile scores were based on depression, diabetes, smoking, physical activity, healthy diet, and drinking. The interactions between cognitive reserve indicators and modifiable-risk-factor profiles were assessed on multiplicative and additive scales.

RESULTS

There is an additive interaction between the composite effect of cognitive reserve indicator and modifiable-risk-factor profile on dementia. In those with low cognitive reserve, the risk of dementia in participants with a favorable profile was significantly lower than in those with an unfavorable one (OR = 0.08, 95% CI = 0.02-0.27).

CONCLUSION

Cognitive reserve significantly moderates the association between modifiable-risk-factor profiles and dementia.

Cognitive reserve in patients with first-episode psychosis as outcome predictor at 5-year follow-up

Cognitive reserve (CR) is the premorbid brain capacity to cope with neural damage. People with good CR can tolerate higher levels of pathological brain injuries before displaying clinical symptoms than others. This study aimed to analyze CR in a sample of patients diagnosed with first-episode psychosis (FEP) during childhood or adolescence, comparing them to a community control group (CC) and assessing the predictive value of CR regarding psychosocial functioning, clinical symptoms and neuropsychological variables at the 5-year follow-up. 57 patients diagnosed with FEP during childhood or adolescence and 37 controls completed clinical, neuropsychological, and psychosocial functioning assessments at baseline and 5-year follow-up. CR was assessed in both groups at baseline. The FEP group showed lower CR scores than the CC group. Higher CR in the FEP group was associated with fewer psychotic negative symptoms, total psychotic symptoms and depressive symptoms, higher psychosocial functioning, and less impaired memory and attention at the 5-year follow-up. CR is associated with long-term clinical, neuropsychological and psychosocial functioning outcomes in patients diagnosed with FEP during childhood or adolescence.

Comparison of the effects of open vs. closed skill exercise on the acute and chronic BDNF, IGF-1 and IL-6 response in older healthy adults

BACKGROUND

Accumulating evidence shows that physical exercise has a positive effect on the release of neurotrophic factors and myokines. However, evidence regarding the optimal type of physical exercise for these release is still lacking. The aim of this study was to assess the acute and chronic effects of open-skill exercise (OSE) compared to closed-skill exercise (CSE) on serum and plasma levels of brain derived neurotrophic factor (BDNFS, BDNFP), and serum levels of insulin like growth factor 1 (IGF-1), and interleukin 6 (IL-6) in healthy older adults.

METHODS

To investigate acute effects, thirty-eight participants were randomly assigned to either an intervention (badminton (aOSE) and bicycling (aCSE), n  = 24, 65.83 ± 5.98 years) or control group (reading (CG), n  = 14, 67.07 ± 2.37 years). Blood samples were taken immediately before and 5 min after each condition. During each condition, heart rate was monitored. The mean heart rate of aOSE and aCSE were equivalent (65 ± 5% of heart rate reserve). In a subsequent 12-week training-intervention, twenty-two participants were randomly assigned to either a sport-games (cOSE, n  = 6, 64.50 ± 6.32) or a strength-endurance training (cCSE, n  = 9, 64.89 ± 3.51) group to assess for chronic effects. Training intensity for both groups was adjusted to a subjective perceived exertion using the CR-10 scale (value 7). Blood samples were taken within one day after the training-intervention.

RESULTS

BDNFS, BDNFP, IGF-1, and IL-6 levels increased after a single exercise session of 30 min. After 12 weeks of training BDNFS and IL-6 levels were elevated, whereas IGF-1 levels were reduced in both groups. However, only in the cOSE group these changes were significant. We could not find any significant differences between the exercise types.

CONCLUSION

Our results indicate that both exercise types are efficient to acutely increase BDNFS, BDNFP, IGF-1 and IL-6 serum levels in healthy older adults. Additionally, our results tend to support that OSE is more effective for improving basal BDNFS levels after 12 weeks of training.

Prevalence, risk and protective factors for mild cognitive impairment in a population-based study of Singaporean elderly

The prevalence of dementia has been widely reported, and its potential risk and protective factors are well-characterized. However, there is a scarcity of related information regarding mild cognitive impairment (MCI). Thus this population-based study aimed to determine the prevalences of MCI and its subtypes, as well as to identify the risk and protective factors for MCI in the Chinese elderly population of Singapore. Results showed that the overall prevalence of MCI was 12.5%, while the gender-adjusted prevalence of MCI was 12.3%. Gender was found to be significantly associated with the subtypes of MCI, with males more likely to have amnestic MCI and females more likely to have non-amnestic MCI. Older age, lower educational levels, lower social activity levels, depression, hypertension, hyperlipidemia, diabetes and stroke were found to be risk factors for MCI in univariate analysis. However, multivariable analysis showed that only hypertension and stroke were the significant risk factors for MCI. Higher educational levels and active social engagements were significant protective factors for MCI in multivariable analysis. Age and depression had boundary significant associations with the prevalence of MCI. After adjusting for gender, the influence of hypertension, stroke, social engagement, age and depression on MCI remained unchanged, except that education became a boundary significant lower risk factor of MCI development. In conclusion, this study presented the prevalence, risk and protective factors for MCI among Singaporean Chinese older adults, which facilitates the screening of vulnerable groups for MCI.

Leisure Activities and Their Relationship With MRI Measures of Brain Structure, Functional Connectivity, and Cognition in the UK Biobank Cohort

Introduction: This study aimed to evaluate whether engagement in leisure activities is linked to measures of brain structure, functional connectivity, and cognition in early old age. Methods: We examined data collected from 7,152 participants of the United Kingdom Biobank (UK Biobank) study. Weekly participation in six leisure activities was assessed twice and a cognitive battery and 3T MRI brain scan were administered at the second visit. Based on responses collected at two time points, individuals were split into one of four trajectory groups: (1) stable low engagement, (2) stable weekly engagement, (3) low to weekly engagement, and (4) weekly to low engagement. Results: Consistent weekly attendance at a sports club or gym was associated with connectivity of the sensorimotor functional network with the lateral visual (β = 0.12, 95%CI = [0.07, 0.18], FDR q = 2.48 × 10-3) and cerebellar (β = 0.12, 95%CI = [0.07, 0.18], FDR q = 1.23 × 10-4) networks. Visiting friends and family across the two timepoints was also associated with larger volumes of the occipital lobe (β = 0.15, 95%CI = [0.08, 0.21], FDR q = 0.03). Additionally, stable and weekly computer use was associated with global cognition (β = 0.62, 95%CI = [0.35, 0.89], FDR q = 1.16 × 10-4). No other associations were significant (FDR q > 0.05). Discussion: This study demonstrates that not all leisure activities contribute to cognitive health equally, nor is there one unifying neural signature across diverse leisure activities.

Does Second Language Learning Promote Neuroplasticity in Aging? A Systematic Review of Cognitive and Neuroimaging Studies

As the population ages, understanding how to maintain older adults' cognitive abilities is essential. Bilingualism has been linked to higher cognitive reserve, better performance in executive control, changes in brain structure and function relative to monolinguals, and delay in dementia onset. Learning a second language thus seems a promising avenue for cognitive enhancement in older adults. Our review aims to determine whether learning a foreign language in later life improves cognition and promotes neuroplasticity. We screened articles from the Pubmed, Scopus, and Science Direct databases to identify interventional studies using second language training in senior participants, including either cognition or neuroimaging as outcome measures. A total of nine articles were found, with only one neuroimaging study. Results from these studies are inconsistent, but tend to suggest that second language learning is associated with improvement in attentional switching, inhibition, working memory, and increased functional connectivity. We discuss the implications of these results, and suggest new directions and methodological recommendations for future research.

Data-driven approaches to executive function performance and structure in aging: Integrating person-centered analyses and machine learning risk prediction

Objective: Executive function (EF) performance and structure in nondemented aging are frequently examined with variable-centered approaches. Person-centered analytics can contribute unique information about classes of persons by simultaneously considering EF performance and structure. The risk predictors of these classes can then be determined by machine learning technology. Using data from the Victoria Longitudinal Study we examined two goals: (a) detect different underlying subgroups (or classes) of EF performance and structure and (b) test multiple risk predictors for best discrimination of these detected subgroups. Method: We used a classification sample (n = 778; M_age = 71.42) for the first goal and a prediction subsample (n = 570; M_age = 70.10) for the second goal. Eight neuropsychological measures represented three EF dimensions (inhibition, updating, shifting). Fifteen predictors represented five domains (genetic, functional, lifestyle, mobility, demographic). Results: First, we observed two distinct classes: (a) lower EF performance and unidimensional structure (Class 1) and (b) higher EF performance and multidimensional structure (Class 2). Second, Class 2 was predicted by younger age, more novel cognitive activity, more education, lower body mass index, lower pulse pressure, female sex, faster balance, and more physical activity. Conclusions: Data-driven modeling approaches tested the possibility of an EF aging class that displayed both preserved EF performance levels and sustained multidimensional structure. The two observed classes differed in both performance level (lower, higher) and structure (unidimensional, multidimensional). Machine learning prediction analyses showed that the higher performing and multidimensional class was associated with multiple brain health-related protective factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Risk of Dementia in Posttraumatic Stress Disorder

Several studies have investigated the risk of dementia in posttraumatic stress disorder (PTSD) using a varying methodology. Epidemiological studies have found an increased risk of dementia with PTSD in Vietnam veterans as well as the general population. Laboratory studies reported the accelerated formation of β-amyloid and tau, which represent the primary pathology of Alzheimer's dementia in animal models of PTSD. These investigations were conducted against a background of cognitive impairment and atrophy of the hippocampus and certain cortical areas in patients with PTSD. Very few studies have investigated the pathological basis in humans for the reported association of PTSD with dementia. This important gap in the literature has recently been partly addressed by very few studies that estimated the burden of β-amyloid and tau. The PET studies did not show an association between PTSD and the specific pathology of Alzheimer's disease or signs of neurodegenerative diseases underlying other dementia syndromes. Another study demonstrated decreased plasma β-amyloid load and increased plasma β-amyloid 42/40 ratio in PTSD without PET evaluation. While PTSD is associated with an increased risk of dementia syndrome in general, there is no convincing evidence that it causes or accelerates the pathology of Alzheimer's disease, which causes the most common type of dementia. Factors that may account for the association between PTSD and a clinical diagnosis of dementia are discussed in this review.

Acquired Brain Injury Survivor Long-Term Cognitive Exercise Engagement Post-Speech Therapy Discharge

Purpose The purpose of this article is to promote the viewpoint that speech-language pathologists (SLPs) are well positioned to actively encourage individuals with cognitive-communication disorders following acquired brain injury (ABI) to engage in ongoing, long-term, cognitive exercise post-therapy discharge. Method This viewpoint article draws on evidence from the well-researched area of physical exercise, reports findings of early-stage research in the much less studied area of cognitive exercise, and highlights relevant aspects of motivational theory informing exercise participation. Informed by these, an evidence-supported model of cognitive exercise engagement is offered to inform ABI-targeted cognitive wellness empowerment efforts, and a case study illustrates clinical application of the model. Conclusions Exercise provides an opportunity to sustain or improve long-term health, function, and quality of life outcomes. It is within SLP scope of practice to collaborate with family members and other caregivers to empower individuals post-ABI, especially those with decreased self-management skills, to engage in long-term computerized and noncomputerized cognitive exercise following SLP therapy discharge. Ongoing research will further inform the evidence supporting the scholarly opinion presented in this viewpoint.

Cognitive Reserve and Anxiety Interactions Play a Fundamental Role in the Response to the Stress

The aims of the present study were to assess the possible interaction between Cognitive Reserve (CR) and State Anxiety (SA) on adrenocortical and physiological responses in coping situations. Forty healthy, middle-aged men completed the Cognitive Reserve Scale and the State-Trait Anxiety Inventory. We used an Observational Fear Conditioning (OFC) paradigm in order to assess emotional learning and to induce stress. Electrodermal activity (EDA) and salivary cortisol concentrations were measured throughout the conditions. Our results indicate that those who indicated having higher state anxiety showed a lower capacity for learning the contingency, along with presenting higher salivary cortisol peak response following the observational fear-conditioning paradigm. The most prominent finding was the interaction between cognitive reserve and state anxiety on cortisol response to the post observational fear-conditioning paradigm. Thus, those who showed a high anxiety-state and, at the same time, a high cognitive reserve did not present an increased salivary cortisol response following the observational fear-conditioning paradigm. Given these results, we postulate that the state anxiety reported by participants, reflects emotional activation that hinders the attention needed to process and associate emotional stimuli. However, cognitive reserve has an indirect relation with conditioning, enabling better emotional learning. In this context, cognitive reserve demonstrated a protective effect on hormonal response in coping situations, when reported anxiety or emotional activation were high. These findings suggest that cognitive reserve could be used as a tool to deal with the effects of stressors in life situations, limiting development of the allostatic load.

Moderate-Intensity Physical Activity, Music and Art Activities Preserved Cognitive Health in Older Adults: An Argument for Social Prescribing Solution

Introduction: Rates of dementia are projected to increase over the coming years as global populations age. Without a treatment to slow the progression of dementia, many health policies are focusing on preventing dementia by slowing the rate of cognitive decline with age. However, it is unclear which lifestyle changes in old age meaningfully reduce the rate of cognitive decline associated with aging. Objectives: Use existing, multi-year longitudinal health data to determine if engagement in a variety of different lifestyle activities can slow the rate of cognitive decline as older adults age. Method: Data from the English Longitudinal Study of Aging was analyzed using a quasi-experimental, efficient matched-pair design inspired by the clinical trial methodology. Changes in short-term memory scores were assessed over a multi-year interval for groups who undertook one of 11 different lifestyle activities, compared to control groups matched across confounding socioeconomic and lifestyle factors. Results: Two factors, moderate-intensity physical activity and learning activities, resulted in significant positive impact on cognitive function. Conclusion: Our analysis brings cognitive benefit arguments in favor of two lifestyle activities, moderate-intensity physical activity and learning activities, while rejecting other factors advanced by the literature such as vigorous-intensity physical activity. Those findings justify and encourage the development of new lifestyle health programs by health authorities and bring forward the new health system solution, social prescribing.

Association of bilateral oophorectomy and menopause hormone therapy with mild cognitive impairment: the REDLINC X study

BACKGROUND

Dementia is a major public health problem. Estrogen is a regulator of the central nervous system and its deficit could be involved in cognitive decline in older women.

OBJECTIVE

This study aimed to evaluate the association of bilateral oophorectomy, menopause hormone therapy (MHT) and other factors on mild cognitive impairment (MCI).

METHOD

The case-control study included 941 otherwise healthy postmenopausal women aged 60 years and over from six Latin American countries. Personal and family data were recorded and MCI was assessed using the Montreal Cognitive Assessment test (MoCA).

RESULTS

Average age, years of education and body mass index were 66.1 ± 5.8 years, 12.4 ± 5.0 years and 26.0 ± 4.3 kg/m², respectively. A total of 30.2% had undergone bilateral oophorectomy and 40.3% had used MHT. A total of 232 women (24.7%) had MCI. The prevalence of MCI was higher in women with intact ovaries and non-MHT users as compared to MHT users (29.3% vs. 11.7% [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.20-0.51]). Among oophorectomized women, MCI prevalence was higher among non-MHT users as compared to MHT users (45.2% vs. 12.8% [OR 0.18; 95% CI 0.10-0.32]). Logistic regression analysis determined that the variables associated with MCI were age >65 years (OR 1.69; 95% CI 1.20-2.38), parity (having >2 children; OR 1.69; 95% CI 1.21-2.37), bilateral oophorectomy (OR 1.56; 95% CI 1.09-2.24), hypertension (OR 1.41; 95% CI 1.01-1.96), being sexually active (OR 0.56; 95% CI 0.40-0.79), education >12 years (OR 0.46; 95% CI 0.32-0.65) and MHT use (OR 0.31; 95% CI 0.21-0.46).

CONCLUSION

Age, parity, bilateral oophorectomy and hypertension are independent factors associated with MCI; contrary to this, higher educational level, maintaining sexual activity and using MHT are protective factors.

Interaction between cognitive leisure activity and long-chain polyunsaturated fatty acid intake on global cognitive decline in a Japanese longitudinal cohort study: National Institute for Longevity Sciences-Longitudinal Study of Aging

Background

There is a growing interest in the significance of adopting a variety of lifestyle habits for maintaining cognitive function among older adults. A lifestyle that is easy to modify, simple, and less burdensome for older people is ideal. We investigated the longitudinal association between global cognitive decline and cognitive leisure activities (CLAs) combined with long-chain polyunsaturated fatty acids (LCPUFAs) intake.

Methods

The National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) enrolled community-dwelling middle-aged and older men and women who were randomly selected from Obu-City and Higashiura Town, Aichi, Japan. Baseline data (2006–2008), including CLAs and dietary intake, were obtained from 517 participants (aged 60–84 years) with normal cognition. Global cognitive decline, defined as the Mini-Mental State Examination (MMSE) score ≤ 27, was assessed at baseline and four years later. Interaction between CLAs and LCPUFAs on cognitive decline was investigated using a multiple logistic analysis with adjustment for confounders. CLA engagement and LCPUFA intake were divided into high and low groups according to the frequency at which each participant engaged in the activity and the median intake level according to sex, respectively.

Results

A significant interaction was detected for the combination of CLA engagement and LCPUFA intake. Logistic regression coefficients revealed significant interactions when participants engaged in more than five CLA varieties. One of the CLAs, art appreciation, produced a significant main effect against cognitive decline and a significant interaction in combination with LCPUFA intake. The major LCPUFAs—docosahexaenoic acid and arachidonic acid—also exhibited a significant interaction. The combination of high LCPUFA intake and high art appreciation frequency yielded a lower adjusted odds ratio for cognitive decline than the combination of low LCPUFA and low art appreciation [0.25 (95 % confidence intervals, 0.11–0.56)].

Conclusions

Preserving cognitive function might be associated with a combination of varied and high-frequency engagement in CLAs combined with high LCPUFA intake.

Verbal intelligence is a more robust cross-sectional measure of cognitive reserve than level of education in healthy older adults

BACKGROUND

Cognitive reserve is most commonly measured using socio-behavioural proxy variables. These variables are easy to collect, have a straightforward interpretation, and are widely associated with reduced risk of dementia and cognitive decline in epidemiological studies. However, the specific proxies vary across studies and have rarely been assessed in complete models of cognitive reserve (i.e. alongside both a measure of cognitive outcome and a measure of brain structure). Complete models can test independent associations between proxies and cognitive function in addition to the moderation effect of proxies on the brain-cognition relationship. Consequently, there is insufficient empirical evidence guiding the choice of proxy measures of cognitive reserve and poor comparability across studies.

METHOD

In a cross-sectional study, we assessed the validity of 5 common proxies (education, occupational complexity, verbal intelligence, leisure activities, and exercise) and all possible combinations of these proxies in 2 separate community-dwelling older adult cohorts: The Irish Longitudinal Study on Ageing (TILDA; N = 313, mean age = 68.9 years, range = 54-88) and the Cognitive Reserve/Reference Ability Neural Network Study (CR/RANN; N = 234, mean age = 64.49 years, range = 50-80). Fifteen models were created with 3 brain structure variables (grey matter volume, hippocampal volume, and mean cortical thickness) and 5 cognitive variables (verbal fluency, processing speed, executive function, episodic memory, and global cognition).

RESULTS

No moderation effects were observed. There were robust positive associations with cognitive function, independent of brain structure, for 2 individual proxies (verbal intelligence and education) and 16 composites (i.e. combinations of proxies). Verbal intelligence was statistically significant in all models. Education was significant only in models with executive function as the cognitive outcome variable. Three robust composites were observed in more than two-thirds of brain-cognition models: the composites of (1) occupational complexity and verbal intelligence, (2) education and verbal intelligence, and (3) education, occupational complexity, and verbal intelligence. However, no composite had larger average effects nor was more robust than verbal intelligence alone.

CONCLUSION

These results support the use of verbal intelligence as a proxy measure of CR in cross-sectional studies of cognitively healthy older adults.

Association of lewy bodies, hippocampal sclerosis and amyloid angiopathy with dementia in community-dwelling elderly: A systematic review and meta-analysis

INTRODUCTION

We measured the proportion of Lewy body pathology (LB), hippocampal sclerosis (HS), and cerebral amyloid angiopathy (CAA) among community-dwelling people with and without dementia.

METHODS

We searched for community-based cohorts with postmortem brain autopsy until 1 January 2020. We calculated the summary risk difference and 95% confidence interval (95% CI) using a random-effects model in R.

RESULTS

We found 12 articles, comprising 2197 demented and 2104 non-demented participants. LB, HS, CAA were prevalent lesions among community-dwelling elderly (15%, 10%, and 24%, respectively). These significantly increased the risk of dementia (LB: risk difference 38%, 95% CI 20-56%, HS: 34%, 24-44%, CAA: 19%, 3-34%). 20% of cases with neocortical LB, 17% with bilateral HS, and 42% with moderate/severe CAA pathology remained non-demented by death.

DISCUSSION

LB or HS or CAA are common neuropathologies among community-dwelling elderly. Although these lesions independently are associated with dementia, many remain non-demented, by death.

APOE ε4 and cognitive reserve effects on the functional network in the Alzheimer's disease spectrum

The apolipoprotein E (APOE) ε4 allele is a genetic risk factor for Alzheimer's disease, whereas educational attainments have protective effects against cognitive decline in aging and patients with Alzheimer's disease. We examined the possible effects of years of education and APOE genotype on the topological properties of the functional network in normal aging, mild cognitive impairment and Alzheimer's disease. The years of education showed a significant, negative association with the local efficiency, clustering coefficient and small-worldness of functional networks in APOE ε4 noncarriers but not in ε4 carriers. These associations were mainly observed in normal aging and were reduced in mild cognitive impairment and Alzheimer's disease. Moreover, regions of the inferior frontal gyrus, temporal pole, and cuneus also showed correlations between education and nodal degree. Our findings demonstrated that the protective effects of education persist in APOE ε4 noncarriers but diminish in ε4 carriers. In addition, the protective effects of education were attenuated or reduced in the progression of Alzheimer's disease.

Bilingualism: A Global Public Health Strategy for Healthy Cognitive Aging

Dementia is a global public health priority which cost global societies $818 billion in 2015 and is disproportionately impacting low and middle-income countries (LMICs). With limited availability of disease modifying drugs to treat Alzheimer's disease (AD), researchers have increasingly focused on preventative strategies which may promote healthy cognitive aging and mitigate the risk of cognitive impairment in aging. Lifelong bilingualism has been presented as both a highly debated and promising cognitive reserve factor which has been associated with better cognitive outcomes in aging. A recent metanalysis has suggested that bilingual individuals present on average 4.05 years later with the clinical features of AD than monolinguals. Bilinguals are also diagnosed with AD ~2.0 years later than monolingual counterparts. In this perspective piece we critically evaluate the findings of this metanalysis and consider the specific implications of these findings to LMICs. Furthermore, we appraise the major epidemiological studies conducted globally on bilingualism and the onset of dementia. We consider how both impactful and robust studies of bilingualism and cognition in older age may be conducted in LMICs. Given the limited expenditure and resources available in LMICs and minimal successes of clinical trials of disease modifying drugs we propose that bilingualism should be positioned as an important and specific public health strategy for maintaining healthy cognitive aging in LMICs. Finally, we reflect upon the scope of implementing bilingualism within the education systems of LMICs and the promotion of bilingualism as a healthy cognitive aging initiative within government policy.

Making the Case for Age-Diverse Universities

Life expectancy has increased substantially; yet universities remain age-segregated and fail to educate people across the longer life course. Demographic shifts call for universities to change their orientation toward age and life course. Arguments as to why universities should serve students of all ages and operate as age-diverse communities include: ensuring the capacity of individual workers and the labor force; educating people to succeed in age-diverse settings; producing innovation in an aging society; supporting meaningful engagement, social connection, and cognitive health into later life; and ensuring the supply of students. Conceptual foundations for these arguments derive from ideas about age stratification, where chronological age is used as a criterion for inclusion or exclusion from social expectations, roles, and privileges and where age integration is viewed as a positive alternative. In response to population aging and the constraints associated with age segregation in higher education, the Age-Friendly University Global Network was formed to increase the inclusion of older learners in all aspects of university life. The challenge is to create conditions where nontraditionally aged students expect to engage fully in educational activities, where students of all ages are valued and supported, and where age diversity is a common feature of campus life. The transformation of our universities must be done for the sake of society, for younger and older people, and for the self-interest of institutions themselves.

The Cognitive & Leisure Activity Scale (CLAS): A new measure to quantify cognitive activities in older adults with and without cognitive impairment

INTRODUCTION

Potentially modifiable dementia risk factors include diet and physical and cognitive activity. However, there is a paucity of scales to quantify cognitive activities. To address this, we developed the Cognitive & Leisure Activity Scale (CLAS).

METHODS

The CLAS was validated in 318 consecutive individuals with and without cognitive impairment. Psychometric properties were compared with sample characteristics, disease stage, and etiology.

RESULTS

The CLAS has very good data quality (Cronbach alpha: 0.731; 95% confidence interval: 0.67-0.78). CLAS scores correlated with gold standard measures of cognition, function, physical functionality, behavior, and caregiver burden. CLAS scores were positively correlated with other resilience factors (eg, diet, physical activity) and negatively correlated with vulnerability factors (eg, older age, frailty).

DISCUSSION

The CLAS is a brief inventory to estimate dosage of participation in cognitive activities. The CLAS could be used in clinical care to enhance cognitive activity or in research to estimate dosage of activities prior to an intervention.

Development of a Neuropsychological Test to Evaluate Cognitive Flexibility

Background

Cognitive flexibility is also referred to as set-shifting and is considered to be an important activity of the frontal lobe. The objective of this study was to produce a Cognitive Flexibility Test (CFT) that can evaluate cognitive flexibility in a short time and in a simple manner and to verify the usefulness of the test.

Methods

The CFT, Mini Mental State Examination (MMSE), Verbal Fluency Test (VFT), and Geriatric Depression Scale 15 (GDS-15) were implemented among a total of 94 elderly people who live at home. An "A" version of CFT (CFT-A), which asked about the possible uses of a plastic bottle other than drinking and a "B" version (CFT-B), which asked about the possible uses of a ballpoint pen other than writing, were produced.

Results

In the case of CFT-A, after adjusting the number of years of education, a significant correlation was found between CFT-A and the variables age, VFT, and MMSE. As for CFT-B, after adjusting the number of years of education, it was found to have a significant correlation with age and VFT. The number of responses for CFT-A and CFT-B were significantly lower than that of VFT. The number of responses for CFT-B was significantly lower than that of CFT-A.

Conclusion

The CFT-A may be useful as a neuropsychological test to evaluate cognitive flexibility among elderly people that can be implemented easily in a short time.