Contemporary review 2009: cognitive aging

Age differences in speech motor performance on a novel speech task

PURPOSE

The study was aimed at characterizing age-related changes in speech motor performance on a nonword repetition task as a function of practice and nonword length and complexity.

METHOD

Nonword repetition accuracy, lip aperture coordination, and nonword production durations were assessed on 2 consecutive days for 16 young and 16 elderly participants for the production of 6 novel nonwords increasing in length and complexity.

RESULTS

The effect of age on the ability to accurately and rapidly repeat long, complex nonwords was significant. However, the authors found no differences between the speech motor coordinative patterns of young and elderly adults. Further, the authors demonstrated age- and nonword-specific within- and between-session gains in speech motor performance.

CONCLUSIONS

The authors speculate that cognitive, sensory, and motor factors interact in complex ways in elderly individuals to produce individual differences in nonword repetition ability at the levels of both behavioral and speech motor performance.

ω-3 fatty acids and domain-specific cognitive aging: secondary analyses of data from WHISCA

OBJECTIVE

To test the hypothesis that higher levels of red blood cell (RBC) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have a protective association with domain-specific cognitive function in women aged 65 years and older.

METHODS

A total of 2,157 women with normal cognition enrolled in a clinical trial of postmenopausal hormone therapy were followed with annual cognitive testing for a median of 5.9 years. In this retrospective cohort study, we assessed the relationship between prerandomization RBC DHA + EPA levels and a) cognitive measures at baseline, and b) cognitive change over time. Endpoints were composite cognitive function and performance in 7 cognitive domains: fine motor speed, verbal memory, visual memory, spatial ability, verbal knowledge, verbal fluency, and working memory.

RESULTS

After adjustment for demographic, clinical, and behavioral characteristics, no significant (p < 0.01) cross-sectional cognitive differences were found between women in the high and low DHA + EPA tertiles at the time of the first annual cognitive battery. In addition, no significant (p < 0.01) differences were found between the high and low DHA + EPA tertiles in the rate of cognitive change over time.

CONCLUSIONS

We did not find an association between RBC DHA + EPA levels and age-associated cognitive decline in a cohort of older, dementia-free women.

Magnetic resonance imaging and neuropsychological testing in the spectrum of normal aging

OBJECTIVE

To understand the relationships between brain structures and function (behavior and cognition) in healthy aging.

METHOD

The study group was composed of 56 healthy elderly subjects who underwent neuropsychological assessment and quantitative magnetic resonance imaging. Cluster analysis classified the cohort into two groups, one (cluster 1) in which the magnetic resonance imaging metrics were more preserved (mean age: 66.4 years) and another (cluster 2) with less preserved markers of healthy brain tissue (mean age: 75.4 years).

RESULTS

The subjects in cluster 2 (older group) had worse indices of interference in the Stroop test compared with the subjects in cluster 1 (younger group). Therefore, a simple test such as the Stroop test could differentiate groups of younger and older subjects based on magnetic resonance imaging metrics.

CONCLUSION

These results are in agreement with the inhibitory control hypotheses regarding cognitive aging and may also be important in the interpretation of studies with other clinical groups, such as patients with dementia and mild cognitive impairment.

Cognitive decline and oral health in middle-aged adults in the ARIC study

Even before dementia becomes apparent, cognitive decline may contribute to deterioration in oral health. This cohort study of middle-aged adults evaluated associations of six-year change in cognitive function with oral health behaviors and conditions in the Atherosclerosis Risk in Communities (ARIC) study. Cognitive function was measured at study visits in 1990-1992 and 1996-1998 with three tests: (a) Delayed Word Recall (DWR), (b) Digit Symbol Substitution (DSS), and (c) Word Fluency (WF). Cognitive decline scores were computed as 'studentized' residuals of 1996-1998 scores regressed against 1990-1992 scores. In 1996-1998, 10,050 participants answered dental screening questions, and 5,878 of 8,782 dentate participants received a comprehensive oral examination. Multiple regression models used cognitive change to predict oral health behaviors and conditions with adjustment for covariates. In the fully adjusted models, greater decline in all three measures of cognitive function was associated with increased odds of complete tooth loss. Greater decline in DSS and WF scores was associated with infrequent toothbrushing. Decline in WF scores was also associated with higher plaque levels. In these middle-aged adults, six-year cognitive decline was modestly associated with less frequent toothbrushing, plaque deposit, and greater odds of edentulism, but not with other oral behaviors or diseases.

Reduced frontal cortex efficiency is associated with lower white matter integrity in aging

Increased frontal cortex activation during cognitive task performance is common in aging but remains poorly understood. Here we explored patterns of age-related frontal brain activations under multiple task performance conditions and their relationship to white matter (WM) microstructure. Groups of younger (N = 28) and older (N = 33) participants completed a task-switching paradigm while functional magnetic resonance imaging (fMRI) was performed, and rested while diffusion tensor imaging was performed. Results from fMRI analyses indicated age-related increases in frontal brain activations under conditions of poorer performance in the older group (the nonswitch and switch conditions) and for a contrast in which behavioral performance was equated (older group nonswitch condition vs. younger group switch condition). Within the older adult group, higher frontal activation was associated with poorer behavioral performance under all task conditions. In 2 regions in right frontal cortex, blood oxygen level-dependent (BOLD) magnitudes were negatively correlated with WM integrity in tracts connecting these structures with other task-relevant frontoparietal and striatal regions. Our results link age-related declines in the efficiency of frontal cortex functioning with lower WM integrity in aging.

Hyperthermia does not alter the increase in cerebral perfusion during cognitive activation

This study tested the hypothesis that hyperthermia attenuates the increase in cerebral perfusion during cognitive activation. Mean middle cerebral artery blood velocity (MCAV(mean)) served as an index of cerebral perfusion, while the nBack test (a test of working memory) was the cognitive task. Hyperthermia was characterized by elevations (P < 0.001) in skin (by 5.0 ± 0.8 °C) and intestinal temperatures (by 1.3 ± 0.1 °C) and reductions (P < 0.020) in mean arterial pressure (by 11 ± 10 mmHg), end-tidal CO2 tension (by 3 ± 6 mmHg) and MCAV(mean) (by 10 ± 9 cm s(-1)). Hyperthermia had no influence on nBack test performance (mean difference from normothermia to hyperthermia, -1 ± 11%; P = 0.276) or, counter to the hypothesis, the increase in MCAV(mean) during nBack testing (mean difference from normothermia to hyperthermia: 0 ± 16 cm s(-1); P = 0.608). These findings indicate that the capacity to increase cerebral perfusion during cognitive activation is unaffected by hyperthermia.

Neurophysiological correlates of moderate alcohol consumption in older and younger social drinkers

BACKGROUND

Nearly 40% of adults aged 65 and older in the United States consume alcohol. Research in older adults has largely examined potential health effects of a moderate drinking lifestyle. Examination of acute effects in this population is generally lacking. To investigate alcohol-induced alteration of electrophysiological correlates of attention in this population, we employed a covert attentional task. We hypothesized that moderate alcohol administration as well as older age would reduce P3 amplitude and increase latency. We anticipated an interaction such that, relative to their age-matched controls, older adults receiving alcohol would be more affected than their younger counterparts.

METHODS

Participants included healthy older (aged 50 to 67; n = 20; 9 men) and younger (aged 25 to 35; n = 12; 5 men) moderate drinkers. Participants received either a moderate dose of alcohol (breath alcohol concentration ~50 mg/dl) or a placebo beverage. Following absorption, the task was administered and neurophysiological measures were obtained. P3 amplitude and latency were separately subjected to ANOVA across cue conditions using age and dose as independent variables.

RESULTS

As predicted, P3 amplitude in older adults was significantly lower than in younger adults across cue conditions. An age by alcohol interaction was detected, revealing that older adults receiving alcohol showed lower P3 amplitudes than any other group. An age effect for P3 latency was found, with older adults having longer latencies than their younger counterparts. A significant age by alcohol interaction for P3 latency was detected, revealing that older adults receiving alcohol displayed delayed P3 latencies relative to older adults receiving placebo. In contrast, younger adults receiving alcohol had reduced latency compared to those receiving placebo, although this effect did not reach significance.

CONCLUSIONS

Results suggest that older adults demonstrated alcohol-related shifts in P3 characteristics during an intentional attention task, whereas younger adults failed to demonstrate this pattern.

A profile for predicting attrition from exercise in older adults

The purpose of this study was to determine a profile for predicting attrition among older adults involved in a 12-month exercise program. The parent study was a single-blinded randomized controlled trial. The study took place between 2006 and 2009 within a university setting. Older adults (N = 179) completed baseline assessments of functional performance and psychosocial measures. Participants who were randomized, elected to receive treatment, and did not complete the exercise program were considered "dropouts" (n = 35). Those who completed the program (n = 144) were classified as "completers." A latent profile analysis revealed two distinct patterns of memory complaints, self-efficacy to overcome barriers to exercise, balance performance, and stair performance. Dropouts were nearly twice as likely to be members of the profile that exhibited a higher degree of memory complaints, lower self-efficacy for overcoming exercise barriers, poorer single leg balance, and longer times to walk down stairs. The results provide an initial validation of a profile for discriminating between "dropouts" and "completers," one that may have considerable utility for screening older adults prior to study entry.

The Iowa Gambling Task (IGT) in Brazil: a systematic review

Background: Decision-making is a complex, multidimensional cognitive function that requires the choice between two or more options and also the predictive analysis of its consequences. One of the tools most widely used to assess decision-making in neuropsychological research is the Iowa Gambling Task (IGT). Objective: To conduct a systematic review of articles reporting empirical IGT studies based in Brazil. Method: Articles were obtained from multiple journal databases including ISI Web of Knowledge, Scopus, SciELO, LILACS, and Scholar Google. Results: Thirty-six studies were included in this review and divided into four categories according to main subject matter (psychiatry & personality; demographic & cultural variables; medical/clinic; and psychometric properties & test administration standardization). In general, there was a significant growth in research employing IGT (Χ² = 17.6, df = 5, p = 0.0003), but this growth was restricted to a few geographic areas of Brazil. The psychiatry & personality subject matter was the most abundant, accounting for 14 publications (39% of the total sample). Conclusion: Since its first adaptation to Brazilian Portuguese in 2006, a growing interest in decision-making as measured by the IGT can be observed, with psychiatry & personality topics representing a large portion of the scientific inquiry to date. Nevertheless, in order to extend the initial results of Brazilian IGT decision-making research, more studies are necessary - across a more diverse range of topics, including demographic & cultural variables, and psychometric properties & test administration standardization, the areas least studied -, as is the dissemination of the IGT to more regions of the country.

Predictors of successful communication with interactive voice response systems in older people

OBJECTIVES

Interactive voice response (IVR) systems are computer programs that can interact with people to provide a number of services from business to health care. However, surveys examining people's attitudes toward these systems have consistently found that people in general and older people in particular strongly dislike these systems. We wanted to determine the memory and cognitive abilities that predict successful IVR interactions for older people.

METHOD

We compared the performance of 185 older adults (aged 65 and older) on normed cognitive tests (the Wechsler Adult Intelligence Scale fourth edition and the Wechsler Memory Scale fourth edition) with their performance on 4 real-life IVR systems that included fact-finding at governmental agencies and plane ticket reservation.

RESULTS

The results indicated that adults aged 65 and older experience significant difficulties in interacting with IVR systems. A significant number of people (20.5%) could not complete any of the tasks. Participants who could not complete any task were older and had the lowest full-scale IQ. However, there was little difference between the age of participants who completed 1, 2, 3, or 4 tasks. Rather, auditory memory and working memory were the best overall predictors for success in IVR tasks.

DISCUSSION

The impact of poorer auditory memory and working memory is compounded by programming practices that increase the demand on these abilities and create unnecessary difficulties. Successful use of IVR systems could eventually complement in person health services.

The effects of age and education on executive functioning and oral naming performance in greek cypriot adults: the neurocognitive study for the aging

BACKGROUND/AIMS

Age, educational experiences, language and culture can affect linguistic-cognitive performance. This is the first systematic study investigating linguistic-cognitive aging in Greek Cypriot adults focusing on executive functioning (EF) and oral naming performance.

METHOD

Three hundred and fifty-nine participants were included, a group of young-old, aged 60-75 years (n = 231), and a group of old-old participants, aged 76 years and older (n = 128). Participants in each age group were divided into three education groups: 0-4 years (n = 50), 5-9 years (n = 198), and 10 years of education and higher (n = 111). Participants were administered 5 measures of EF along with measures of receptive vocabulary and confrontational naming.

RESULTS

There was a significant relationship between the EF composite score and all language measures. MANOVA (α = 0.05) indicated significant age and education effects on most measures of EF and language. Performance on receptive vocabulary and cognitive shift remained stable across age groups, but was mediated by education.

CONCLUSION

Education plays a significant role on all measures requiring semantic organization, speed of information processing, cognitive shift, mental flexibility, receptive vocabulary and confrontational naming. Furthermore, strategic thinking has a role in semantic knowledge, word retrieval and semantic access in healthy aging. We conclude with clinical implications and assessment considerations in aphasia.

Cusp catastrophe models for cognitive workload and fatigue in a verbally cued pictorial memory task

OBJECTIVE

The aim of this study was to evaluate two cusp catastrophe models for cognitive workload and fatigue. They share similar cubic polynomial structures but derive from different underlying processes and contain variables that contribute to flexibility with respect to load and the ability to compensate for fatigue.

BACKGROUND

Cognitive workload and fatigue both have a negative impact on performance and have been difficult to separate. Extended time on task can produce fatigue, but it can also produce a positive effect from learning or automaticity.

METHOD

In this two-part experiment, 129 undergraduates performed tasks involving spelling, arithmetic, memory, and visual search.

RESULTS

The fatigue cusp for the central memory task was supported with the quantity of work performed and performance on an episodic memory task acting as the control parameters. There was a strong linear effect, however. The load manipulations for the central task were competition with another participant for rewards, incentive conditions, and time pressure. Results supported the workload cusp in which trait anxiety and the incentive manipulation acted as the control parameters.

CONCLUSION

The cusps are generally better than linear models for analyzing workload and fatigue phenomena; practice effects can override fatigue. Future research should investigate multitasking and task sequencing issues, physical-cognitive task combinations, and a broader range of variables that contribute to flexibility with respect to load or compensate for fatigue.

APPLICATIONS

The new experimental medium and analytic strategy can be generalized to virtually any real-world cognitively demanding tasks. The particular results are generalizable to tasks involving visual search.

Age differences of multivariate network expressions during task-switching and their associations with behavior

The effect of aging on functional network activation associated with task-switching was examined in 24 young (age=25.2±2.73 years) and 23 older adults (age=65.2±2.65 years) using functional magnetic resonance imaging (fMRI). The study goals were to (1) identify a network shared by both young and older adults, (2) identify additional networks in each age group, and (3) examine the relationship between the networks identified and behavioral performance in task-switching. Ordinal trend covariance analysis was used to identify the networks, which takes advantage of increasing activation with greater task demand to isolate the network of regions recruited by task-switching. Two task-related networks were found: a shared network that was strongly expressed by both young and older adults and a second network identified in the young data that was residualized from the shared network. Both networks consisted of regions associated with task-switching in previous studies including the middle frontal gyrus, the precentral gyrus, the anterior cingulate, and the superior parietal lobule. Not only was pattern expression of the shared network associated with reaction time in both age groups, the difference in the pattern expression across task conditions (task-switch minus single-task) was also correlated with the difference in RT across task conditions. On the contrary, expression of the young-residual network showed a large age effect such that older adults do not increase expression of the network with greater task demand as young adults do and correlation between expression and accuracy was significant only for young adults. Thus, while a network related to RT is preserved in older adults, a different network related to accuracy is disrupted.

Hormonal environment affects cognition independent of age during the menopause transition

CONTEXT

Cognitive decline is prevalent in aging populations, and cognitive complaints are common during menopause. However, the extent of hormonal influence is unclear, particularly when considered independent of the aging process.

OBJECTIVE

We sought to determine differences in cognitive function attributable to menopause, hypothesizing that differences would be associated with reproductive rather than chronological age.

DESIGN AND SETTING

In this cross-sectional study at a university hospital, we combined neuropsychological measures with functional magnetic resonance imaging to comprehensively assess cognitive function.

PARTICIPANTS

Sixty-seven menopausal women, aged 42-61 yr, recruited from a population-based menopause study, grouped into menopause stages based on hormonal and cycle criteria (premenopause, perimenopause, and postmenopause), participated in the study.

MAIN OUTCOME MEASURES

Neuropsychological and functional magnetic resonance imaging measures of verbal, visual, and executive cognitive function.

RESULTS

We found age-independent menopause effects on verbal function. Menopause groups differed in phonemic verbal fluency (F = 3.58, P < 0.019) and regional brain activation (inferior frontal cortex: corrected P < 0.000 right, P < 0.036 left; left prefrontal cortex: P < 0.012); left temporal pole: P < 0.001). Verbal measures correlated with estradiol and FSH (phonemic fluency: R = 0.249, P < 0.047 estradiol, R = -0.275, P < 0.029 FSH; semantic fluency: R = 0.318, P < 0.011 estradiol, R = -0.321, P < 0.010 FSH; right inferior frontal cortex: R = 0.364, P < 0.008 FSH; left inferior frontal cortex: R = -0.431, P < 0.001 estradiol, left prefrontal cortex: R = 0.279, P < 0.045 FSH; left temporal pole: R = -0.310, P < 0.024 estradiol, R = 0.451, P < 0.001 FSH; left parahippocampal gyrus: R = -0.278, P < 0.044 estradiol; left parietal cortex: R = -0.326, P < 0.017 estradiol).

CONCLUSIONS

Results suggest that verbal fluency mechanisms are vulnerable during the menopausal transition. Targeted intervention may preserve function of this critical cognitive domain.

Figural memory performance and functional magnetic resonance imaging activity across the adult lifespan

We examined performance and functional magnetic resonance imaging activity in participants (n = 235) aged 17-81 years on a nonverbal recognition memory task, figural memory. Reaction time, error rate, and response bias measures indicated that the youngest and oldest participants were faster, made fewer errors, and showed a more conservative response bias than participants in the median age ranges. Encoding and Recognition phases activated a distributed bilateral network encompassing prefrontal, subcortical, lateral, and medial temporal and occipital regions. Activation during Encoding phase did not correlate with age. During Recognition, task-related activation for correctly identified targets (Hit-Targets) correlated linearly positively with age; nontask related activity correlated negative quadratically with age. During correctly identified distractors (Hit-Distractors) activity in task-related regions correlated positive linearly with age, nontask activity showed positive and negative quadratic relationships with age. Missed-Targets activity did not correlate with age. We concluded that figural memory performance and functional magnetic resonance imaging activity during Recognition but not Encoding was affected both by continued maturation of the brain in the early 20s and compensatory recruitment of additional brain regions during recognition memory in old age.

Testing the white matter retrogenesis hypothesis of cognitive aging

The retrogenesis hypothesis postulates that late-myelinated white matter fibers are most vulnerable to age- and disease-related degeneration, which in turn mediate cognitive decline. While recent evidence supports this hypothesis in the context of Alzheimer's disease, it has not been tested systematically in normal cognitive aging. In the current study, we examined the retrogenesis hypothesis in a group (n = 282) of cognitively normal individuals, ranging in age from 7 to 87 years, from the Brain Resource International Database. Participants were evaluated with a comprehensive neuropsychological battery and were imaged with diffusion tensor imaging. Fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (DA), measures of white matter coherence, were computed in 2 prototypical early-myelinated fiber tracts (posterior limb of the internal capsule, cerebral peduncles) and 2 prototypical late-myelinated fiber tracts (superior longitudinal fasciculus, inferior longitudinal fasciculus) chosen to parallel previous studies; mean summary values were also computed for other early- and late-myelinated fiber tracts. We examined age-associated differences in FA, RD, and DA in the developmental trajectory (ages 7-30 years) and degenerative trajectory (ages 31-87 years), and tested whether the measures of white matter coherence mediated age-related cognitive decline in the older group. FA and DA values were greater for early-myelinated fibers than for late-myelinated fibers, and RD values were lower for early-myelinated than late-myelinated fibers. There were age-associated differences in FA, RD, and DA across early- and late-myelinated fiber tracts in the younger group, but the magnitude of differences did not vary as a function of early or late myelinating status. FA and RD in most fiber tracts showed reliable age-associated differences in the older age group, but the magnitudes were greatest for the late-myelinated tract summary measure, inferior longitudinal fasciculus (late fiber tract), and cerebral peduncles (early fiber tract). Finally, FA in the inferior longitudinal fasciculus and cerebral peduncles and RD in the cerebral peduncles mediated age-associated differences in an executive functioning factor. Taken together, the findings highlight the importance of white matter coherence in cognitive aging and provide some, but not complete, support for the white matter retrogenesis hypothesis in normal cognitive aging.

Associations between a neurophysiological marker of central cholinergic activity and cognitive functions in young and older adults

Background

The deterioration of the central cholinergic system in aging is hypothesized to underlie declines in several cognitive domains, including memory and executive functions. However, there is surprisingly little direct evidence regarding acetylcholine’s specific role(s) in normal human cognitive aging.

Methods

We used short-latency afferent inhibition (SAI) with transcranial magnetic stimulation (TMS) as a putative marker of cholinergic activity in vivo in young (n = 24) and older adults (n = 31).

Results

We found a significant age difference in SAI, concordant with other evidence of cholinergic decline in normal aging. We also found clear age differences on several of the memory and one of the executive function measures. Individual differences in SAI levels predicted memory but not executive functions.

Conclusion

Individual differences in SAI levels were better predictors of memory than executive functions. We discuss cases in which the relations between SAI and cognition might be even stronger, and refer to other age-related biological changes that may interact with cholinergic activity in cognitive aging.

Normal aging and cognition: the unacknowledged contribution of cerebrovascular risk factors

Despite the widespread assumption that cognitive decline is an inherent part of the normal aging process, research suggests that part of the variance in age-related cognitive decline is attributable to modifiable factors common in geriatric populations such as cerebrovascular risk factors. We completed a literature search using Science Citation Index and evaluated the most cited articles from the last 10 years to determine the extent to which investigations of normal aging and cognition account for the influence of cerebrovascular risk factors. We found that the majority of the most frequently cited literature does not adequately account for the contribution of cerebrovascular risk factors and therefore, it is possible that many conclusions about normal aging and cognition are flawed or incomplete. Further investigation of the role of cerebrovascular risk factors in age-related cognitive decline is imperative to more accurately understand the effect of aging on cognition.

Impaired spatial working memory learning and performance in normal aged rhesus monkeys

Aged non-human primates may have deficits in a variety of cognitive functions. However, it is possible that at least some age-related performance deficits relate to a deficit in initial task learning. To assess this, aged rhesus monkeys were trained to perform a Self-Ordered Spatial Search (SOSS) task using the same training and testing parameters used previously with normal young animals. Aged animals failed to reach criterion at the easiest task level. In an attempt to improve learning, a group of aged animals were first trained on SOSS using a standard 5s ITI, followed by trials with low inter-trial interference (e.g., a stimulus used in a trial would not be used again for the next 2 trials) or with trials in which the spatial distance between the stimuli on the screen was maximized. Because performance improved but failed to reach criterion, this was followed by sessions with increasing ITIs (from 5 s to 10 or 15 s). Only increasing the ITI improved the performance of the aged animals enough to allow them to learn the task to criterion. Once the criterion was reached, memory was taxed by increasing the delay between stimulus presentations and increasing the number of spatial positions to be remembered. Performance declined for young animals, but even more so for aged animals. The results of the present study suggests that aged primates have difficulty initially learning a complex working memory task, and that the ITI may be an important parameter to manipulate to improve learning. However, once the task is learned, performance of aged animals is inferior to that of young animals, particularly when memory demands are increased.

From Neuroplasticity to Scaffolding

This paper is a review of cognitive aging research centred on the Scaffolding Theory of Aging and Cognition (STAC), a theory which brings together much of the previous research into cognitive aging over the past century and suggests directions for future work. From Santiago Ramon y Cajal, with his microscope and talented drawings, to today’s researchers with psychological and neurobiological methods and technology, particularly neuroimaging techniques, such as fMRI, sMRI, PET, etc., enormous progress has been made, through cognitive reserve, dedifferentiation, compensation, hemispherical asymmetry, inhibition and neurotransmission, to the Scaffolding theory of aging and cognition and beyond. Prior to 1990, research was almost entirely behavioural, but the advent of neuroimaging has boosted research and given rise to a new domain known as cognitive neuroscience, combining behavioural and neurobiological approaches to investigate structural and functional changes in the aging brain. Having reviewed the existing literature on cognitive aging research, the author concludes that although the scaffolding theory brings together a significant body of work and ideas, it is not yet the single, unifying theory for researchers. However, it does represent a giant step toward that theory.

Design principles to accommodate older adults

The global population is aging. In many industrial countries, almost one in five people are over age 65. As people age, gradual changes ensue in vision, hearing, balance, coordination, and memory. Products, communication materials, and the physical environment must be thoughtfully designed to meet the needs of people of all ages. This article summarizes normal changes in sensory function, mobility, balance, memory, and attention that occur with age. It presents practical guidelines that allow design professionals to accommodate these changes and better meet the needs of older adults. Designing for older adults is inclusive design: it accommodates a range of physical and cognitive abilities and promotes simplicity, flexibility, and ease of use for people of any age.

Deterministic learning and attempted suicide among older depressed individuals: cognitive assessment using the Wisconsin Card Sorting Task

BACKGROUND

Late-life suicide is an under-investigated public health problem. Among the putative vulnerabilities for this complex multifactorial behaviour are deficits in cognitive control, an ability to integrate and prioritize multiple cognitive processes in order to flexibly adapt behaviour and meet situational demands. We investigated cognitive control during rule learning in a complex and changing environment in older individuals with suicide attempts of varying lethality.

METHOD

Ninety-three participants over the age of 60 (30 healthy controls, 29 depressed never suicidal, 20 low-lethality suicide attempters, 14 high-lethality suicide attempters) underwent structured clinical and cognitive assessments. Participants then completed the Wisconsin Card Sorting Test (WCST), a well-studied task of cognitive control during rule learning.

RESULTS

High-lethality attempters demonstrated a pattern of deficits involving poor conceptual reasoning, perseverative errors and total errors. Compared to low-lethality attempters and healthy controls, high-lethality attempters demonstrated poor conceptual reasoning, as well as increased rates of perseverative errors and total errors. Compared to non-suicidal depressed participants, high-lethality attempters also made more conceptual errors.

CONCLUSION

High-lethality suicide attempts among older people are associated with impaired cognitive control during rule learning as detected by the WCST. Our data suggest that impairment in cognitive control during rule learning may represent a vulnerability distinct from the impulsive diathesis, typically manifesting in young, low-lethality attempters. This vulnerability may contribute to the high incidence of serious or, often, fatal suicidal acts in old age.

Aging microglia: relevance to cognition and neural plasticity

Over the years it has become evident that the immune system can affect the function of the central nervous system (CNS), including altering cognitive processes. The impact of immune activation on the CNS is particularly important for aged individuals, as the brain's resident immune cells, microglia, acquire a pro-inflammatory profile. The low-grade chronic neuroinflammation that develops with normal aging likely contributes to the susceptibility to cognitive deficits and a host of age-related pathologies. Understanding why microglia show increased inflammatory activity (i.e., neuroinflammation) and identifying effective treatments to reduce microglia activation is expected to have beneficial effects on cognitive performance and measures of neural plasticity. However, microglia also promote regeneration after injury. Therefore, effective treatments must dampen inflammatory activity while preserving microglia's neuroprotective function. Discovering factors that induce neuroinflammation and investigating potential preventative therapies is expected to uncover the ways of maintaining normal microglia activity in the aged brain.

Age-related changes in orienting attention in time

Temporal cues guide attentional resources toward relevant points in time, resulting in optimized behavioral performance. Although deficits in aspects of attention have been documented in older adults, it remains unknown whether the critical ability to orient attention in time is affected by normal aging. To address this, younger and older adults participated in a temporally cued target-response experiment while electroencephalographic data were recorded. Three conditions (one detection and two discrimination tasks) were used to manipulate task complexity. Response times show that younger adults, but not older adults, used temporal cues to enhance performance regardless of task complexity. Similarly, alpha band activity (8-12 Hz) and the contingent negative variation preceding targets indicated that only younger adults engaged prestimulus, anticipatory neural mechanisms associated with temporal cues. Overall, these results provide novel evidence that older adults do not use temporal cues to orient attention in time and support an expectation deficit in normal aging.

Cognitive health in older adults

This article addresses both the theoretical and practical issues associated with cognitive aging, including the implications of neurophysiological changes in the brain as well as practical ways of screening for changes that may be problematic or may actually enhance healthy cognitive adaptations.

Age-related changes in the cognitive function of sleep

Healthy aging is characterized by a diminished quality of sleep with decreased sleep duration and increased time awake after sleep onset. Older adults awaken more frequently and tend to awaken less from rapid eye movement (REM) sleep and more from non-REM (nREM) sleep than young adults. Sleep architecture also begins changing in middle age leading to a dramatic decrease in the deepest stage of nREM-slow wave sleep (SWS)-as aging progresses. Other less marked nREM changes include reduced numbers of sleep spindles and K-complexes. In contrast, the amount of REM diminishes only slightly. Both circadian and homeostatic sleep-regulatory processes are affected by aging. Circadian rhythms of temperature, melatonin, and cortisol are phase advanced and their amplitude diminished. An increased number of nocturnal awakenings and diminished daytime sleepiness suggest diminished homeostatic sleep pressure. A variety of endocrine and neuromodulatory changes (e.g., reduced growth hormone and dopamine levels) also accompany healthy aging. Healthy aging is characterized by declines in working memory and new episodic memory performance with relative sparing of semantic memory, recognition memory, and priming. Memory systems impacted by aging are associated with volumetric and functional changes in fronto-striatal circuits along with more limited changes in medial temporal structures (in which larger aging-related changes suggest neuropathology). Cross-sectional studies generally associate poorer sleep quality with poorer neuropsychological functioning. However, paradoxically, older adults appear to be more resistant to the cognitive effects of sleep deprivation, restriction, and fragmentation than younger adults. A new and expanding field examines the interaction between aging and sleep-dependent memory consolidation. Among forms of learning displaying prominent sleep-dependent consolidation in young adults, motor-sequence learning displays loss of sleep-dependent consolidation with aging whereas sleep-dependent consolidation of verbal declarative memory appears spared. Findings suggest that improving sleep through behavioral or pharmacological treatments may enhance cognition and performance in older adults.

Lead, manganese, and methylmercury as risk factors for neurobehavioral impairment in advanced age

Contamination of the environment by metals is recognized as a threat to health. One of their targets is the brain, and the adverse functional effects they induce are reflected by neurobehavioral assessments. Lead, manganese, and methylmercury are the metal contaminants linked most comprehensively to such disorders. Because many of these adverse effects can appear later in life, clues to the role of metals as risk factors for neurodegenerative disorders should be sought in the exposure histories of aging populations. A review of the available literature offers evidence that all three metals can produce, in advanced age, manifestations of neurobehavioral dysfunction associated with neurodegenerative disease. Among the critical unresolved questions is timing; that is, during which periods of the lifespan, including early development, do environmental exposures lay the foundations for their ultimate effects?

Attention, executive functioning and memory in normal aged rhesus monkeys

Understanding how cognition declines in normal aging is vital in order to distinguish between normal cognitive decline due to aging and cognitive decline due to an age-related pathological process such as Parkinson's disease (PD). Several cognitive domains including memory, executive functioning and attention are all adversely affected with age in humans, as well as by PD, yet less is known about how these processes are affected by aging in non-human primates. Thus, in order to characterize baseline performance in aged primates prior to inducing Parkinson-like pathology, male rhesus macaques aged 15-22 years were tested on several tasks analogous to those used in cognitive aging studies in humans. The tasks included simple visual discrimination to assess learning and reference memory, discrimination reversal to assess cognitive flexibility and response inhibition, continuous performance to assess sustained visual attention, and attention set shifting to assess cognitive flexibility and set-shifting ability. Deficits were detected in some aspects of learning, cognitive flexibility, response inhibition and sustained visual attention, whereas reference memory and set-shifting did not appear to be affected. Additionally, there was a greater amount of variability in cognitive abilities across the aged animals than observed previously in young adult animals. These findings will form an important baseline for comparison with cognitive performance after PD-like pathology is superimposed on the normal aging process.

Exercising the brain to avoid cognitive decline: examining the evidence

Dementias and related cognitive disorders of the brain are strongly age-associated and prevalence is expected to rise dramatically with a rapidly aging population. As a result, there has been increasing attention on the prevention and treatment of cognitive decline associated with these conditions. A number of approaches have been designed to maintain and strengthen the cognitive capacity of the healthy, as well as the pathologically damaged brain. Evidence suggests that despite advancing age, our brains, and thus our cognitive functions, retain the ability to be maintained and strengthened through the biological process of neuroplasticity. With this opportunity, a new commercial field of ‘brain fitness’ has been launched to bring to the market training exercises and games that maintain and strengthen cognitive abilities in adulthood. However, the majority of brain fitness methods and products now marketed and sold to consumers have scant scientific evidence to support their effectiveness.

How treatment affects cognitive deficits in patients with sleep disorders: methodological issues and results

Sleep disorders are frequently associated with impaired performance although the type and extent of cognitive deficits varies widely between different types of sleep disorders. Treatment is expected to ameliorate these deficits. However, cognitive functioning and its change with treatment depend on numerous factors. In this chapter we discuss methodological issues, including test selection, and person-specific, task-specific and environmental factors that influence cognitive functioning. In addition, features of study design and sampling strategies are discussed. The chapter ends with a short overview of routes by which treatment may affect cognition in sleep-disordered patients.