Developmental Patterns of Cognitive Function and Associated Factors among the Elderly in Taiwan

Physical activity modifies cognitive impairment-associated mortality risks among chronic kidney disease

BACKGROUND

Older chronic kidney disease (CKD) patients frequently face unrecognized cognitive impairment and excess mortality. Physical activity (PA) reduces cognitive decline but whether PA modifies cognitive impairment-associated mortality remains unknown.

METHODS

From 2005 to 2011, 30,561 older Taiwanese CKD patients were enrolled. Patients were divided into intact cognition (≥8 scores), mild (6-7 scores), and severe (≤5 scores) cognitive impairment groups by the Short Portable Mental Status Questionnaire (SPMSQ), and were also categorized into high-PA (≥60 min/week of moderate-intensity PA), low-PA (20-60 min/week) or inactive (<20 min/week) groups. Cox regression was conducted to evaluate the individual and joint associations of cognitive impairment and PA on all-cause and cardiovascular mortality.

RESULTS

After a median follow-up of 4.52 years, the all-cause mortality were higher in CKD patients with severe (multivariable-adjusted hazard ratio [aHR] 2.31; 95% confidence interval [CI] 2.05-2.60) and mild (aHR 1.74; CI 1.51-1.99) cognitive impairment than cognitively intact ones. Remarkably, decreased PA amount interacted and amplified the cognitive impairment-associated mortality risks. Notably, the high-PA status linked to lower overall mortality risks both in mild (aHR 0.65; CI 0.45-0.93) and severe (aHR 0.73; CI 0.54-0.99) cognitively-impaired patients as compared to inactivity. Survival tree analysis indicated the least mortality in those with high PA and >8 SPMSQ scores. Similar associations were found in the cardiovascular mortality.

LIMITATIONS

Residual confounding and single ethnicity.

CONCLUSIONS

Cognitive impairment defined by SPMSQ was progressively associated with higher mortality among elderly CKD. Higher PA linked to lower cognitive impairment-associated death risks, and could be promoted for longevity benefits.

Trajectories and influencing factors of cognitive function and physical disability in Chinese older people

Introduction

Dementia and physical disability are serious problems faced by the aging population, and their occurrence and development interact.

Methods

Based on data from a national cohort of Chinese people aged 60 years and above from the China Health and Retirement Longitudinal Survey from 2011 to 2018, we applied the group-based trajectory model to identify the heterogeneous trajectories of cognitive function and physical disability in participants with different physical disability levels. Next, multinomial logistic regression models were used to explore the factors affecting these trajectories.

Results

The cognitive function trajectories of the Chinese older people could be divided into three characteristic groups: those who maintained the highest baseline level of cognitive function, those with a moderate baseline cognitive function and dramatic progression, and those with the worst baseline cognitive function and rapid-slow-rapid progression. The disability trajectories also fell into three characteristic groups: a consistently low baseline disability level, a low initial disability level with rapid development, and a high baseline disability level with rapid development. Compared with those free of physical disability at baseline, a greater proportion of participants who had physical disability at baseline experienced rapid cognitive deterioration. Education, income, type of medical insurance, gender, and marital status were instrumental in the progression of disability and cognitive decline in the participants.

Discussion

We suggest that the Chinese government, focusing on the central and western regions and rural areas, should develop education for the older people and increase their level of economic security to slow the rate of cognitive decline and disability among this age group. These could become important measures to cope with population aging.

Trajectories of cognitive function among people aged 45 years and older living with diabetes in China: Results from a nationally representative longitudinal study (2011~2018)

OBJECTIVES

Diabetes is associated with decline of cognitive function. Exploring different trajectories of cognitive function occurring in people with diabetes is important to improved prognosis. This study aimed to investigate differential patterns of trajectories of cognitive function and baseline determinants of trajectory group membership utilizing data from middle-aged and older Chinese adults with diabetes.

METHODS

Participants of the Chinese Health And Retirement Longitudinal Study (CHARLS) aged 45 years and above received biennial assessments between 2011 and 2018. The primary outcome was overall cognitive function score operationalized as sum of mental intactness and episodic memory scores derived from the Telephone Interview of Cognitive Status (TICS). A weighted growth mixture model was used to estimate cognitive function trajectories of CHARLS participants with diabetes, and baseline factors associated with trajectory group membership were investigated with weighted multinomial logistic regression.

RESULTS

Data from 1,463 participants with diabetes aged 45 years and above were analyzed, a three-group trajectory model showed the best fit for overall cognitive scores: low baseline, linear declining (22.1%); moderate baseline, linear declining (37.5%) and high-stable (40.3%). Older participants, females, participants with low education, with nighttime sleep <6 h, without daytime napping habits, and with depressive symptoms were at a higher risk of unfavorable cognitive function trajectories.

CONCLUSIONS

We identified heterogeneous trajectories of cognitive function among middle-aged and older people living with diabetes in China. Socially vulnerable groups including females, rural residents, and those with low education were at a higher risk for unfavorable trajectories. In health programs aimed at preventing and mitigating cognitive decline in individuals with diabetes more attention should be given to vulnerable groups. Reduced nighttime sleep, lack of daytime napping, and depressive symptoms appear to be modifiable risk factors.

Physical Activity and Cognitive Decline Among Older Adults: A Systematic Review and Meta-Analysis

Importance

Physical activity is associated with the risk for cognitive decline, but much of the evidence in this domain comes from studies with short follow-ups, which is prone to reverse causation bias.

Objective

To examine how length of follow-up, baseline age, physical activity amount, and study quality modify the longitudinal associations of physical activity with cognition.

Data Sources

Observational studies of adults with a prospective follow-up of at least 1 year, a valid baseline cognitive measure or midlife cohort, and an estimate of the association of baseline physical activity and follow-up cognition were sought from PsycInfo, Scopus, CINAHL, Web of Science, SPORTDiscus, and PubMed, with the final search conducted on November 2, 2022.

Study Selection

Two independent researchers screened titles with abstracts and full-text reports.

Data Extraction and Synthesis

Two reviewers independently assessed study quality and extracted data. Pooled estimates of association were calculated with random-effects meta-analyses. An extensive set of moderators, funnel plots, and scatter plots of physical activity amount were examined. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Main Outcomes and Measures

Pooled estimates of the associations between physical activity and global cognition, as well as specific cognitive domains, were examined.

Results

A total of 104 studies with 341 471 participants were assessed. Analysis of binary outcomes included 45 studies with 102 452 individuals, analysis of follow-up global cognition included 14 studies with 41 045 individuals, and analysis of change in global cognition included 25 studies with 67 463 individuals. Physical activity was associated with a decreased incidence of cognitive impairment or decline after correction for funnel plot asymmetry (pooled risk ratio, 0.97; 95% CI, 0.97-0.99), but there was no significant association in follow-ups longer than 10 years. Physical activity was associated with follow-up global cognition (standardized regression coefficient, 0.03; 95% CI, 0.02-0.03) and change in global cognition (standardized regression coefficient, 0.01; 95% CI, 0.01 to 0.02) from trim-and-fill analyses, with no clear dose-response or moderation by follow-up length, baseline age, study quality or adjustment for baseline cognition. The specific cognitive domains associated with physical activity were episodic memory (standardized regression coefficient, 0.03; 95% CI, 0.02-0.04) and verbal fluency (standardized regression coefficient, 0.05; 95% CI, 0.03-0.08).

Conclusions and Relevance

In this meta-analysis of the association of physical activity with cognitive decline, physical activity was associated with better late-life cognition, but the association was weak. However, even a weak association is important from a population health perspective.

Eight-year trajectories and predictors of cognitive function in community-dwelling Korean older adults with cardiovascular diseases

PURPOSE

This study aims to identify longitudinal patterns and predictors of cognitive function trajectories among Korean older adults with cardiovascular diseases.

DESIGN

This study is a longitudinal panel analysis based on secondary data. Data from the the Korean Longitudinal Study of Ageing (KLoSA) were used for analysis.

METHODS

The KLoSA is a representative panel survey of older Koreans. We analyzed responses from 301 participants aged ≥65 years who completed the same survey more than three times out of five waves between 2012 and 2020.

FINDINGS

Latent class growth modeling identified two trajectories of cognitive function in older people with cardiovascular diseases: "low and declining" (n = 81, 26.9%) and "high and declining" (n = 220, 73.1%). Participants in "the low and declining trajectory group" were more likely to have a low educational level, weak handgrip strength, depression, and low social participation at baseline than those in "the high and declining trajectory group."

CONCLUSIONS

Our results indicate a need to develop community-based tailored interventions for improving handgrip strength, mental health, and social participation in delaying cognitive decline in older people with cardiovascular diseases considering their educational level.

CLINICAL RELEVANCE

Healthcare providers should be more concerned about older people with a weaker handgrip, depression, and low social activities as a high-risk group for cognitive decline over time in cardiovascular care. Therefore, it is necessary to evaluate them early with standardized tools and make subsequent strategies for the older population with cardiovascular diseases.

The mediating effect of leisure activities in the relationship between depression and cognitive decline in middle age and older adults in Taiwan

BACKGROUND

Depression can affect the development of cognitive functions, and there are many people with depressive symptoms and cognitive decline in the aging population. The role of mediators between depressive symptoms and the subsequent cognitive decline remains unclear. We aimed to investigate whether depressive symptoms can slow down cognitive decline through a mediator.

METHODS

A total of 3,135 samples were collected in 2003, 2007, and 2011. This study used the CES-D10 and SPMSQ (Short Portable Mental State Questionnaire) to measure depression and cognitive functions. The effect of depression trajectory on the subsequent cognitive dysfunction was analyzed using multivariable logistic regression, and the mediating effect was analyzed using the Sobel test.

RESULTS

The results of the multivariable linear regression analysis showed that after including different variables in each model, such as leisure activities and mobility in 2003 and 2007, women had a higher percentage of depressive symptoms in each model, compared to men. The effect of depression in 2003 on cognitive decline in 2011 was mediated by intellectual leisure activities in 2007 in men (Z=-2.01) and physical activity limitation in 2007 in women (Z=-3.02).

CONCLUSIONS

The mediation effect of this study shows that people with depressive symptoms will reduce their participation in leisure activities, which will lead to the degeneration of cognitive function. We suggest that if depressive symptoms are addressed as early as possible, people will have the ability and motivation to delay the decline of cognitive function through participation in leisure activities.

Functional social support and cognitive function in middle- and older-aged adults: a systematic review of cross-sectional and cohort studies

BACKGROUND

Intact cognitive function is crucial for healthy aging. Functional social support is thought to protect against cognitive decline. We conducted a systematic review to investigate the association between functional social support and cognitive function in middle- and older-aged adults.

METHODS

Articles were obtained from PubMed, PsycINFO, Sociological Abstracts, CINAHL, and Scopus. Eligible articles considered any form of functional social support and cognitive outcome. We narratively synthesized extracted data by following the Synthesis Without Meta-Analysis (SWiM) guidelines and assessed risk of bias using the Newcastle-Ottawa Scale (NOS).

RESULTS

Eighty-five articles with mostly low risk-of-bias were included in the review. In general, functional social support-particularly overall and emotional support-was associated with higher cognitive function in middle- and older-aged adults. However, these associations were not all statistically significant. Substantial heterogeneity existed in the types of exposures and outcomes evaluated in the articles, as well as in the specific tools used to measure exposures and outcomes.

CONCLUSIONS

Our review highlights the role of functional social support in the preservation of healthy cognition in aging populations. This finding underscores the importance of maintaining substantive social connections in middle and later life.

SYSTEMATIC REVIEW REGISTRATION

Rutter EC, Tyas SL, Maxwell CJ, Law J, O'Connell ME, Konnert CA, Oremus M. Association between functional social support and cognitive function in middle-aged and older adults: a protocol for a systematic review. BMJ Open;10(4):e037301. https://doi.org/10.1136/bmjopen-2020-037301.

Effects of cognitive ageing trajectories on multiple adverse outcomes among Chinese community-dwelling elderly population

BACKGROUND

Whether cognitive ageing trajectory is related to common functional deficits independent of initial cognitive function remains inconclusive. We aimed to explore the adverse health effect and potential predictive factors of distinct cognitive trajectories among Chinese older adults.

METHODS

Three thousand five hundred eighty-one community-dwelling older adults who completed three consecutive cognitive function examinations with the Mini-Mental State Examination (MMSE) over 5 years and were without cognitive impairment at enrollment were included. A group-based trajectory model was used to estimate cognitive ageing trajectories. Multivariable-adjusted odds ratio (OR) and 95% confidence intervals (CI) were computed with logistic regression models to identify potential baseline determinants and health effect of cognitive trajectories on various adverse outcomes.

RESULTS

Two distinct cognitive ageing trajectories were identified with about 5.3% of the study participants ascribed to the rapidly decreasing group. Subjects with rapidly decreasing cognition showed significantly higher odds (OR, 95%CI) of experiencing frailty (4.04, 2.77-5.86), falls (2.01, 1.05-3.70), balance impairment (4.20, 2.75-6.38), high fall risk (5.66, 2.67-11.77) based on the Tinetti total score, disability in activities of daily living (1.76, 1.19-2.56), disability in instrumental activities of daily living (1.52, 1.05-2.19), and motor cognitive risk syndrome (2.24, 1.23-3.98) compared with their steadily decreasing counterparts. Individuals with older age, low education level, no marriage, high score of rapid eye movement behavior disorders, poor physical and cognitive function at baseline were more predisposed to an accelerated cognitive decline.

CONCLUSIONS

Faster cognitive decline was independently associated with higher risk of multiple adverse events. Our findings put more emphasis on a routine and constant surveillance of cognitive function among community-dwelling older adults.

Associations Between Symptoms of Depression and Air Pollutant Exposure Among Older Adults: Results From the Taiwan Longitudinal Study on Aging (TLSA)

Background: Little epidemiological research has investigated the associations of air pollutant exposure over various time windows with older adults' symptoms of depression. This study aimed to analyze the relationships of long- and short-term ambient air pollution exposure (to coarse particulate matter, O₃, SO₂, CO, and NO_x) with depressive symptoms in a sample of community-dwelling older adults.

Methods: A sample of older adults (n = 1,956) was recruited from a nationally representative multiple-wave study (Taiwan Longitudinal Study on Aging). Between 1996 and 2007, four waves of surveys investigated depressive symptoms by using the 10-item Center for Epidemiologic Studies Depression questionnaire. We approximated air pollutant concentrations from 1995 to 2007 by using daily concentration data for five air pollutants at air quality monitoring stations in the administrative zone of participants' residences. after adjusting for covariates, we applied generalized linear mixed models to analyze associations for different exposure windows (7-, 14-, 21-, 30-, 60-, 90-, and 180-day and 1-year moving averages).

Results: In a one-pollutant model, long- and short-term exposure to CO and NO_x was associated with heightened risks of depressive symptoms; the odds ratio and corresponding 95% confidence interval for each interquartile range (IQR) increment in CO at 7-, 14-, 21-, 30-, 60-, 90-, and 180-day and 1-year moving averages were 1.232 (1.116, 1.361), 1.237 (1.136, 1.348), 1.216 (1.128, 1.311), 1.231 (1.133, 1.338), 1.224 (1.124, 1.332), 1.192 (1.106, 1.285), 1.228 (1.122, 1.344), and 1.180 (1.102, 1.265), respectively. Those for each IQR increment in NO_x were 1.312 (1.158, 1.488), 1.274 (1.162, 1.398), 1.295 (1.178, 1.432), 1.310 (1.186, 1.447), 1.345 (1.209, 1.496), 1.348 (1.210, 1.501), 1.324 (1.192, 1.471), and 1.219 (1.130, 1.314), respectively. The exposure to PM₁₀, O₃, and SO₂ over various windows were not significant. In the two-pollutant model, only the associations of NO_x exposure with depressive symptoms remained robust after adjustment for any other pollutant.

Conclusions: Exposure to traffic-associated air pollutants could increase depression risks among older adults.

The effect of social relationships on cognitive decline in older adults: an updated systematic review and meta-analysis of longitudinal cohort studies

Background

A previous meta-analysis (Kuiper et al., 2016) has shown that multiple aspects of social relationships are associated with cognitive decline in older adults. Yet, results indicated possible bias in estimations of statistical effects due to the heterogeneity of study design and measurements. We have updated this meta-analysis adding all relevant publications from 2012 to 2020 and performed a cumulative meta-analysis to map the evolution of this growing field of research (+80% of studies from 2012-2020 compared to the period considered in the previous meta-analysis).

Methods

Scopus and Web of Science were searched for longitudinal cohort studies examining structural, functional and combined effects of social relationships. We combined Odds Ratios (OR) with 95% confidence intervals (CI) using random effects meta-analysis and assessed sources of heterogeneity and the likelihood of publication bias. The risk of bias was evaluated with the Quality of Prognosis Studies in Systematic Reviews (QUIPS) tool.

Results

The review was prospectively registered on PROSPERO (ID: CRD42019130667). We identified 34 new articles published in 2012-2020. Poor social relationships were associated with cognitive decline with increasing precision of estimates compared to previously reviewed studies [(for structural, 17 articles, OR: 1.11; 95% CI: 1.08; 1.14) (for functional, 16 articles, OR: 1.12; 95% CI: 1.05; 1.20) (for combined, 5 articles, OR: 1.15; 95% CI: 1.06; 1.24)]. Meta-regression, risk and subgroup analyses showed that the precision of estimations improved in recent studies mostly due to increased sample sizes.

Conclusions

Our cumulative meta-analysis would confirm that multiple aspects of social relationships are associated with cognitive decline. Yet, there is still evidence of publication bias and relevant information on study design is often missing, which could lead to an over-estimation of their statistical effects.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12889-022-12567-5).

Relationship Between Depression After Hemorrhagic Stroke and Auditory Event-Related Potentials in a Chinese Patient Group

PURPOSE

Post-stroke depression (PSD) is the most common psychiatric sequelae of stroke. Numerous studies revealed that event-related potentials (ERP) can reflect depression severity to a certain extent, while there is almost no research on depression after hemorrhagic stroke. Therefore, we employed a prospective cross-sectional study to explore the relationship between ERP and depression after hemorrhagic stroke.

METHODS

A total of 74 patients with intracranial hemorrhage were included in this study. Neurological deficits were evaluated using the National Institutes of Health Stroke Scale (NIHSS) on admission. Depression severity and cognitive impairment were measured using the 17-item Hamilton Depression Scale (HAMD-17) and the Chinese version of the Montreal Cognitive Assessment (MoCA) after two weeks of treatment. All patients were conducted auditory Oddball paradigm for event-related potential mismatch negativity (MMN) and P300.

RESULTS

In total, 36 patients were diagnosed with PSD at the two weeks of treatment, for a percentage of 48.6%. Depression severity of ICH patients correlated positively with both the latency of MMN (r = 0.376, P = 0.001) and P300 (r = 0.325, P = 0.005), and correlated negatively with both the amplitude of MMN (r=-0.385, P = 0.001) and P300 (r=-0.311, P = 0.007). Depression severity was negatively correlated with cognitive function after hemorrhagic stroke (r=-0.347, P = 0.002).

CONCLUSION

The latency and amplitude of MMN and P300 can well reflect the degree of depression after hemorrhagic stroke, which may help in the early diagnosis and effective treatment of PSD.

Trends in Cognitive Function Among Chinese Elderly From 1998 to 2018: An Age-Period-Cohort Analysis

Objectives: To investigate the effects of age, period, and cohort (APC) on trends in cognitive function among the Chinese elderly, and to explore how gender gaps in cognitive function change with age, period, and cohort. Methods: This study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, and included 90,432 participants aged above 65 years old. The measurement of cognitive function was the score of the Mini-Mental State Examination (MMSE). Cross-classified random-effect models were used to investigate age, period, and cohort trends in cognitive function. Results: Mini-Mental State Examination scores decreased with age at an increasing rate. While the cohort effect was nearly stable, the period effect demonstrated a downward trend from 1998 to 2002 followed by a nearly flat line. Females were associated with lower MMSE scores than males. When age increased, the gender gaps in MMSE scores further increased. The period-based gender gaps in MMSE scores diverged throughout the 20 years, while the cohort-based gender disparities in MMSE scores converged with successive cohorts. Conclusions: Age, period, and cohort had different and independent effects on cognitive function among the Chinese elderly. The effect of age was stronger than that of period and cohort. Gender disparities in cognitive function increased with age and period, and decreased with successive cohorts.

Association between ambient temperature and cognitive function in a community-dwelling elderly population: a repeated measurement study

OBJECTIVES

Evidence on the associations between short-term and long-term air temperature exposure and cognitive function in older adults, particularly those in Asia, is limited. We explored the relationships of short-term and long-term air temperature exposure with cognitive function in Taiwanese older adults through a repeated measures survey.

DESIGN AND SETTING

We used data the ongoing Taiwan Longitudinal Study on Aging, a multiple-wave nationwide survey.

PARTICIPANTS

We identified 1956, 1700, 1248 and 876 older adults in 1996, 1999, 2003 and 2007, respectively.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants' cognitive function assessment was based on the Short Portable Mental Status Questionnaire. We calculated the temperature moving average (TMA) for temperature exposure windows between 1993 and 2007 using data from air quality monitoring stations, depending on the administrative zone of each participant's residence. Generalised linear mixed models were used to examine the effects of short-term and long-term temperature changes on cognitive function.

RESULTS

Short-term and long-term temperature exposure was significantly and positively associated with moderate-to-severe cognitive impairment, with the greatest increase in ORs found for 3-year TMAs (OR 1.247; 95% CI 1.107 to 1.404). The higher the quintiles of temperature exposure were, the higher were the ORs. The strongest association found was in long-term TMA exposure (OR 3.674; 95% CI 2.103 to 6.417) after covariates were controlled for.

CONCLUSIONS

The risk of mild cognitive impairment increased with ambient temperature in community-dwelling older adults in Taiwan.

Differences in Trajectories and Predictive Factors of Cognition over Time in a Sample of Cognitively Healthy Adults, in Zaragoza, Spain

Great inter-individual variability has been reported in the maintenance of cognitive function in aging. We examined this heterogeneity by modeling cognitive trajectories in a population-based longitudinal study of adults aged 55+ years. We hypothesized that (1) distinct classes of cognitive trajectories would be found, and (2) between-class differences in associated factors would be observed. The sample comprised 2403 cognitively healthy individuals from the Zaragoza Dementia and Depression (ZARADEMP) project, who had at least three measurements of the Mini-Mental State Examination (MMSE) in a 12-year follow-up. Longitudinal changes in cognitive functioning were modeled using growth mixture models (GMM) in the data. The best-fitting age-adjusted model showed 3 distinct trajectories, with 1-high-to-moderate (21.2% of participants), 2-moderate-stable (67.5%) and, 3-low-and-declining (9.9%) cognitive function over time, respectively. Compared with the reference 2-trajectory, the association of education and depression was significantly different in trajectories 1 and 3. Instrumental activities of daily living (iADLs) were only associated with the declining trajectory. This suggests that intervention strategies should be tailored specifically to individuals with different trajectories of cognitive aging, and intervention strategies designed to maintain cognitive function might be different from those to prevent decline. A stable cognitive performance ('successful cognitive aging') rather than a mild decline, might be more 'normal' than generally expected.

Trajectories of Multiple Behavioral Risk Factors and Their Associations With Cognitive Function Trajectories Among Older African Americans and White Americans

Objectives: This study examined the joint trajectories of behavioral risk factors (smoking, alcohol drinking, and body mass index) and their associations with cognitive function trajectories among older African Americans and white Americans. Methods: Data from the Health and Retirement Study (1998-2014) were used. Group-based mixture modeling and multinomial logistic regression analysis were performed. Results: Three joint trajectories of behavioral risk factors (overweight, smoking and drinking, and drinking and overweight) and three cognitive function trajectories (low, moderate, and high) were identified. A significantly higher percentage of African Americans were in the "overweight," "smoking and drinking," and "low" cognitive functioning groups as measured by the total cognition composite score compared to white Americans. After accounting for covariates, the "drinking and overweight" group was associated with the "moderate" or "high" cognitive functioning group. Discussion: Future interventions targeting the combinations of behavioral risk factors are needed to promote healthy aging among high-risk populations.

Hippocampus Mediates the Effect of Emotional Support on Cognitive Function in Older Adults

BACKGROUND

Despite strong evidence that emotional support has a protective effect on cognitive decline, the neural basis for how an individual's emotional support is associated with cognition is unknown. We investigated if the hippocampus mediates the relationship between emotional support and cognition in older adults.

METHOD

Four hundred and ten nondemented Korean older adults were classified into two groups according to their Medical Outcomes Study-Social Support Survey emotional support scores: the poor emotional support (score ≤ 25th percentile of entire sample) and normal emotional support (score > 25th percentile of entire sample) groups. Cognitive function was assessed using the Verbal Memory Score and Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet Neuropsychological Assessment Battery total score (CERAD-TS). Left and right hippocampal volume were obtained using 3T T1-weighted magnetic resonance images. Mediation analyses were conducted.

RESULTS

In the association of emotional support with Verbal Memory Score, left hippocampal volume played a mediating role (indirect effect = 0.40, SE = 0.21, bias-corrected 95% confidence interval = 0.04, 0.86). In the association of emotional support with CERAD-TS, both left (indirect effect = 0.82, SE = 0.45, bias-corrected 95% confidence interval = 0.09, 1.83) and right (indirect effect = 0.51, SE = 0.32, bias-corrected 95% confidence interval = 0.02, 1.24) HPVs played mediating roles.

CONCLUSIONS

The hippocampus may mediate the association between emotional support and cognition. Higher levels of emotional support may be associated with better verbal memory and global cognition via larger HPV.

The Mediating Effect of Physical Function Decline on the Association Between Social Activity and Cognitive Function in Middle and Older Korean Adults: Analyzing Ten Years of Data Through Multivariate Latent Growth Modeling

Purpose

This study aimed to examine the long-term association between social activity, physical function decline and cognitive function, as well as verify the long-term mediating effect of physical function decline on the relationship between social activity and cognitive function.

Methods

Data from the Korean Longitudinal Study of Aging (KLoSA) that was collected over 10 years was analyzed. The sample included 10,240 adults aged 45–93 years (Mean age = 61.66 [SD = 11.061]). Multivariate latent growth modeling (LGM) was applied to verify the long-term effect of social activity and physical function on cognitive function.

Results

The results revealed that social activity had a positive impact on cognitive function and negative impact on physical function decline after controlling for age and education level. Additionally, physical function decline negatively influenced cognitive function. Finally, social activity indirectly affected cognitive function through physical function decline.

Conclusion

The contribution of this study was to test the long-term effect social activity on physical and cognitive function.

Distinct Cognitive Trajectories in Late Life and Associated Predictors and Outcomes: A Systematic Review

Background

Cognitive aging is a dynamic process in late life with significant heterogeneity across individuals.

Objective

To review the evidence for latent classes of cognitive trajectories and to identify the associated predictors and outcomes.

Methods

A systematic search was performed in MEDLINE and EMBASE for articles that identified two or more cognitive trajectories in adults. The study was conducted following the PRISMA statement.

Results

Thirty-seven studies were included, ranging from 219 to 9,704 participants, with a mean age of 60 to 93.4 years. Most studies (n = 30) identified distinct cognitive trajectories using latent class growth analysis. The trajectory profile commonly consisted of three to four classes with progressively decreasing baseline and increasing rate of decline-a 'stable-high' class characterized as maintenance of cognitive function at high level, a 'minor-decline' class or 'stable-medium' class that declines gradually over time, and a 'rapid-decline' class with the steepest downward slope. Generally, membership of better classes was predicted by younger age, being female, more years of education, better health, healthier lifestyle, higher social engagement and lack of genetic risk variants. Some factors (e.g., education) were found to be associated with cognitive function over time only within individual classes.

Conclusion

Cognitive aging in late life is a dynamic process with significant inter-individual variability. However, it remains unclear whether similar patterns of cognitive aging are observed across all cognitive domains. Further research into unique factors which promote the maintenance of high-cognitive function is needed to help inform public policy.

Association of Chinese drifting elderly's intergenerational support satisfaction with expectation: A mixed method study in Shanghai

OBJECTIVE

In China's drifting elderly explosive growth context, in spite the importance of intergenerational support for drifting elderly is well recognised, but the association of related satisfaction with expectation is neglected. So current study was designed to explore this.

METHODS

A mixed study with two-stage survey was undertaken involving 136 drifting elderly in Shanghai from June to September in 2019, among which 17 patriciates were involved in the in-depth interviews in stage 2. The intergenerational support in two directions, which were support drifting elderly provided and received, and in three dimensions, which were material, service and emotional, were analysed.

RESULTS

The intergenerational support relationship of drifting elderly and their adult children were strengthened by the unsatisfied social support context. A stronger satisfaction with service support and material support was associated with weaker related expectation, and weaker satisfaction with emotional support was associated with a stronger related expectation.

CONCLUSION

A stronger satisfaction of drifting elderly with intergenerational material and service support can result in a weaker related expectation. While a weaker satisfaction intergenerational emotional support can result in a stronger related expectation. Thus, strengthen drifting elderly's emotional support as they expected is necessary for satisfying their old-ageing pension in urban.

The association between health-related factors, physical and mental diseases, social activities, and cognitive function in elderly Koreans: a population-based cross-sectional study

AIM

The purpose of this study was to verify the association of cognitive function with health-related variables, diseases, and social activities.

METHODS

Data from the 2016 Korean Longitudinal Study of Aging were analyzed. The participants of that study were 5678 adults aged 60 years or older living in 17 major Korean regions nationwide.

RESULTS

Hierarchical multiple regression analyses indicated that gender, age, education, marital status, depressive symptoms, body mass index, regular exercise, activities of daily living, instrumental activities of daily living, hand grip strength, and social activities were all significantly associated with cognitive function in elderly Koreans. However, socioeconomic status, diabetes, smoking, alcohol consumption, attendance at school reunions, volunteer work, and participation in political or civic organizations had no impact on cognitive function. First, the results indicated that men had better cognitive function than women; likewise, married individuals and those with a higher level of education also had better cognitive function. As age increased, cognitive function declined. Second, higher body mass index was related to poorer cognitive function, whereas regular exercise was positively associated with better cognitive function. In addition, higher activities of daily living and instrumental activities of daily living scores were associated with poorer cognitive function. Third, depressive symptoms were negatively associated with cognitive function. Finally, religious activities, social activities, and participation in leisure activities, cultural events, and sports were associated with better cognitive functioning. The possibility of reverse association exists between some of the variables (e.g. religious activity and cognitive function), and it is necessary to verify this possibility through a longitudinal study. The biggest limitation is that this is a cross-sectional study, which made it unfeasible to investigate the causal pathways.

CONCLUSIONS

This study suggests that regularly exercising and attending social activities each help to improve cognitive function in the elderly.

Association of depressive symptoms with decline of cognitive function-Rugao longevity and ageing study

Cognitive decline is a central feature in the aging process. Previous studies have indicated an association between depressive symptoms and cognitive decline in Caucasian populations. However, few studies have examined the effect of changes in depression on the trajectory of cognitive decline. Here, we included 580 participants with normal cognitive ability and complete cognitive and depression data from the Rugao Longevity and Ageing Study (RuLAS). We explored the relationship between depressive symptoms and cognitive decline in these participants. We examined how the change in depressive symptoms affected the trajectory in the HDS-R (the Revised Hasegawa Dementia Scale) scores by comparing cognition function in both the depression deterioration group and the depression steady group by using a linear mixed model. The results indicated that those with deteriorating depression tended to have faster cognitive declines than those with steady depression, indicated by the significance of the interaction term of GDS (Geriatric Depression Scale) groups and time (unadjusted model, β = - 0.673, p < 0.001). The results remained significant after adding demographic covariates. Moreover, we found that those with the worst depressive symptoms at baseline had the worst cognition in subsequent years (GDS = 0 group vs. GDS ≥ group in the unadjusted model: β = - 1.522, p < 0.003), while the slope of change was not significantly different among groups (GDS = 0 group × time vs. GDS > =4 group × time in the unadjusted model: β = - 0.045, p = 0.857). Therefore, we found that depressive symptom deterioration was significantly associated with faster cognitive decline. Medical interventions for depression may decrease the number of older Chinese individuals who experience early-stage cognitive decline.

Emotional support (giving or receiving) and risk of incident dementia: The Ohsaki Cohort 2006 Study

Previous studies have suggested that emotional support may promote cognition; however, the effects of giving or receiving emotional support on incident dementia remain unclear. Therefore, we sought to investigate the relationship between emotional support (giving or receiving) and incident dementia. In December 2006, we conducted a prospective cohort study of 31,694 Japanese individuals aged ≥65 years who lived in Ohsaki City, Miyagi Prefecture, Japan. A self-reported questionnaire including items on emotional support and lifestyle factors was distributed. After excluding those who did not provide consent or responses to all items, 13,636 eligible responses were analyzed for this study. According to responses of "yes" or "no" for emotional support, we made two categories for both giving (gave or did not give) and receiving (received or did not receive) emotional support. Furthermore, we combined giving and receiving emotional support into four categories ("giving = no & receiving = no", "giving = no & receiving = yes", "giving = yes & receiving = no", "giving = yes & receiving = yes"). Data on incident dementia were retrieved from the Long-term Care Insurance Database in which participants were followed up for 5.7 years. Using multivariate Cox proportional hazards models, we found that compared with participants who did not give emotional support to others, those who did give had a lower risk of dementia (multivariate-adjusted hazard ratio [HR]: 0.61 (95% confidence interval [CI]: 0.52, 0.71)). However, a nonsignificant relationship was observed for receiving emotional support. Additionally, compared to "giving = no & receiving = no" for emotional support, "giving = no & receiving = yes" showed a higher risk of dementia (multivariate-adjusted HR: 1.51 [95% CI: 1.07, 2.14]).

The Association between Social Support Sources and Cognitive Function among Community-Dwelling Older Adults: A One-Year Prospective Study

There is evidence that social relationships may modify cognitive decline in older people. We examined the prospective association between social support and cognitive function among community-dwelling older people. Japanese adults recruited at health checkups in suburban towns were surveyed at baseline and one-year follow-up. Cognitive function was assessed using the Montreal Cognitive Assessment, Japanese version (MoCA-J). Social support from coresiding family, non-coresiding family, and neighbors/friends was assessed using self-administered questionnaires. Multivariable linear regression analysis was conducted to examine the effects of social support on MoCA-J scores at follow-up. Data were analyzed from 121 older people (mean age (standard deviation): 73.86 (4.95) years). There was a positive association between social support exchanges with neighbors and friends and MoCA-J scores at follow-up after covariate adjustment (unstandardized β = 1.23, p = 0.006). Social support exchanges with coresiding family and non-coresiding family and relatives were not associated with MoCA-J scores at follow-up (coresiding family: Unstandardized β = 0.28, p = 0.813, non-coresiding family and relatives: Unstandardized β = 0.51, p = 0.238). The provision of emotional support to neighbors and friends had the largest effect on MoCA-J scores. Our findings suggest that social support exchanges with neighbors and friends are protective against cognitive decline.

Air Pollution Exposure and Cognitive Function in Taiwanese Older Adults: A Repeated Measurement Study

Studies related to air pollution exposure and neurocognitive disorders, specifically cognitive impairment, among older adults are limited. We investigated the association between short-term and long-term exposure to ambient air pollution (i.e., particulate matter with an aerodynamic diameter of <10 μm and ozone) and the effects of their interaction on cognitive function in a community-dwelling, free-living elderly population. Study participants were in a multiple-wave representative sample, namely the Taiwan Longitudinal Study on Aging (n = 2241). In four surveys between 1996 and 2007, their cognitive function was assessed using the Short Portable Mental Status Questionnaire (SPMSQ). We estimated air pollution from 1993 to 2007, including daily concentrations of PM₁₀ and O₃ from air quality monitoring stations, based on the administrative zone of each participant’s residence. Generalized linear mixed models were used to examine these associations after adjusting for covariates. We found that long-term exposure to PM₁₀ and O₃ was significantly associated with cognitive impairment (OR = 1.094, 95% CI: 1.020, 1.174 for PM₁₀; OR = 1.878, 95% CI: 1.363, 2.560 for O₃). The joint effect of exposure to PM₁₀ and O₃ was associated with cognitive impairment (p < 0.001). Co-exposure to ambient PM₁₀ and O₃ may deteriorate cognitive function in older adults.

Trajectories of functional impairment in homeless older adults: Results from the HOPE HOME study

Difficulty performing activities of daily living ("functional impairment") is common in homeless adults aged 50 and older. However, little is known about the trajectory of these impairments, nor the extent to which these trajectories are similar to those of older adults in the general population. We identified trajectories of functional impairment in homeless adults aged 50 and older, and risk factors for differing trajectories. We conducted a prospective cohort study of 350 homeless adults, aged 50 and older, recruited via population-based sampling in Oakland, California and interviewed at 6-month intervals for up to 3 years. We assessed functional trajectories based on self-reported difficulty performing 5 activities of daily living. We used multivariable multinomial logistic regression to identify baseline risk factors for each trajectory. At baseline, participants' mean age was 58 years (SD, 5.3), 24.1% were women, 80.9% were African American, and 38.6% had difficulty performing 1 or more activities of daily living. We identified 4 distinct functional trajectories: minimal impairment in 136 participants (41.1%); persistent impairment in 81 (25.4%); partial improvement in 74 (23.5%); and decline in 28 (10.0%). Risk factors for persistent impairment included falls in the 6 months before baseline, depressive symptoms, and low physical performance. Although functional impairment improved in some homeless adults, it persisted or worsened in many others. These findings suggest that, similar to older adults in the general population, functional impairment among older homeless persons is not a transient phenomenon, but instead a chronic issue requiring long-term solutions.

Cognitive ageing trajectories and mortality of Chinese oldest-old

OBJECTIVE

This study aims to identify distinctive cognitive trajectories jointly with mortality probabilities and to explore factors related to the particular trajectories of cognitive ageing in China.

METHOD

6842 individuals aged 80 years and above from 7 waves of the Chinese Longitudinal Healthy Longevity Survey were assessed with the Mini-Mental State Examination for up to 16 years. A group-based trajectory model was used to jointly estimate cognitive ageing and mortality trajectories; and to explore the factors related to membership of the trajectory groups.

RESULTS

A four-group model best fit the data. For all groups, the cognitive function declined with age according to different rates. Group 4, 3, 2, and 1 showed slow (prevalence 52.8%), moderate (31.1%), progressive (12.6%) and rapid (3.5%) cognitive decline, respectively. Mortality probability trajectories followed a hierarchy in consistence with cognitive trajectories approximately. Females, illiteracy, and those born in rural areas were less likely to belong to the most favorable trajectory group.

CONCLUSIONS

The heterogeneity of cognitive ageing was identified among Chinese oldest-old. Childhood socioeconomic status, especially education, was associated with the rate of cognitive decline.

Does social capital and a healthier lifestyle increase mental health resilience to disability acquisition? Group-based discrete trajectory mixture models of pre-post longitudinal data

Poor mental health is strongly associated with disability acquisition. Social capital and healthier lifestyles pre-disability onset may help promote mental health resilience (i.e. a state of seemingly being unaffected by the event), or the capacity to 'bounce back', post-acquisition. This paper used a novel methodology (discrete trajectory mixture models) to examine discrete trajectories in mental health before and after disability acquisition in the Household Income Labour Dynamics in Australia (HILDA) survey. Group membership in association with pre-onset social capital and healthy lifestyles were then examined using multinomial logistic regressions. Four discrete trajectory groups were identified in 2904 Australians reporting onset of ongoing disability, with about 28.4% demonstrating mental health resilience. Three other groups were identified, each demonstrating increasingly severe reductions in mental health. No clear 'bounce back' group was observed. Group membership was associated with participants who felt they had 'no-help from others' prior to disability acquisition. Pre-disability acquisition measures of social capital and unhealthy behaviours moderated the association between disability acquisition and mental health trajectories. Social capital was protective only for the respondents who had poorer mental health before disability onset and had less resilience after onset, and long working hours and less resilience were positively associated. Public policies that help to enhance levels of social capital and reduce unhealthy behaviours at a population level may help to promote mental health resilience to adversities such as the acquisition of disability.

Affective problems and decline in cognitive state in older adults: a systematic review and meta-analysis

Evidence suggests that affective problems, such as depression and anxiety, increase risk for late-life dementia. However, the extent to which affective problems influence cognitive decline, even many years prior to clinical diagnosis of dementia, is not clear. The present study systematically reviews and synthesises the evidence for the association between affective problems and decline in cognitive state (i.e., decline in non-specific cognitive function) in older adults. An electronic search of PubMed, PsycInfo, Cochrane, and ScienceDirect was conducted to identify studies of the association between depression and anxiety separately and decline in cognitive state. Key inclusion criteria were prospective, longitudinal designs with a minimum follow-up period of 1 year. Data extraction and methodological quality assessment using the STROBE checklist were conducted independently by two raters. A total of 34 studies (n = 71 244) met eligibility criteria, with 32 studies measuring depression (n = 68 793), and five measuring anxiety (n = 4698). A multi-level meta-analysis revealed that depression assessed as a binary predictor (OR 1.36, 95% CI 1.05-1.76, p = 0.02) or a continuous predictor (B = -0.008, 95% CI -0.015 to -0.002, p = 0.012; OR 0.992, 95% CI 0.985-0.998) was significantly associated with decline in cognitive state. The number of anxiety studies was insufficient for meta-analysis, and they are described in a narrative review. Results of the present study improve current understanding of the temporal nature of the association between affective problems and decline in cognitive state. They also suggest that cognitive function may need to be monitored closely in individuals with affective disorders, as these individuals may be at particular risk of greater cognitive decline.

The Association between Social Support and Incident Dementia: A 10-Year Follow-Up Study in Japan

Social support is important for the health of elderly populations. However, its longitudinal effect on incident dementia is unclear. We used the Aichi Gerontological Evaluation Study (AGES) project data to investigate the longitudinal effect of social support on dementia onset. Functionally independent older people at baseline (n = 14,088) in 10 municipalities were followed from 2003 to 2013 using National Long-term Care Insurance System data. Social support was assessed by the following support sources: co-residing family, family or relatives living apart, and friends or neighbors. Cumulative incidence of dementia was 14.6% and 18.7% for men and women, respectively. Cox proportional hazard models were employed by gender to investigate the association between social support and dementia onset adjusting for age, health status, health behaviors, subjective cognitive complaints, depression, and other socioeconomic factors. Gender differences were observed in the association between social support and incident dementia. Support from co-residing family members was protective among men, whereas among women, no effect of social support on dementia was observed. Among other social factors, community engagement was protective for women, while for men, being married was associated with lower incidence of dementia. The association between social support and dementia seems to differ by gender. When we design programs to promote social interactions among the elderly, we need to take into account such gender differences.

Postural control and balance in a cohort of healthy people living in Europe: An observational study

In the past 20 years, posturography has been widely used in the medical field. This observational study aimed to report the values derived from posturography of a wide set of healthy subjects from various European countries using a plantar pressure platform and a standardized method of measurement.A random cluster sampling of 914 healthy subjects aged between 7.0 and 85.99 years, stratified by age, was carried out. To provide percentile values of our cohort, data were processed to obtain 3 curves corresponding to the following percentiles: 25th, 50th, 75th, and the interquartile range. Distance-weighted least squares method was used to represent the percentile on appropriate graphs.In our sample, the balance to improve with age, up to approximately 45 years, but the trend to reverse with older age. The data show that the oscillations on the sagittal plane (y-mean) change with advancing age. Young people had more retro-podalic support than older people; the balance shifted forward in elderly people.As the study included a relatively large quantity of data collected using a standardized protocol, these results could be used as normative values of posturography for similar populations. On the basis of this data, correct diagnostic clues will be available to clinicians and professionals in the field. However, further studies are needed to confirm our findings.

The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review

BACKGROUND

Social relationships, which are contingent on access to social networks, promote engagement in social activities and provide access to social support. These social factors have been shown to positively impact health outcomes. In the current systematic review, we offer a comprehensive overview of the impact of social activities, social networks and social support on the cognitive functioning of healthy older adults (50+) and examine the differential effects of aspects of social relationships on various cognitive domains.

METHODS

We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and collated data from randomised controlled trials (RCTs), genetic and observational studies. Independent variables of interest included subjective measures of social activities, social networks, and social support, and composite measures of social relationships (CMSR). The primary outcome of interest was cognitive function divided into domains of episodic memory, semantic memory, overall memory ability, working memory, verbal fluency, reasoning, attention, processing speed, visuospatial abilities, overall executive functioning and global cognition.

RESULTS

Thirty-nine studies were included in the review; three RCTs, 34 observational studies, and two genetic studies. Evidence suggests a relationship between (1) social activity and global cognition and overall executive functioning, working memory, visuospatial abilities and processing speed but not episodic memory, verbal fluency, reasoning or attention; (2) social networks and global cognition but not episodic memory, attention or processing speed; (3) social support and global cognition and episodic memory but not attention or processing speed; and (4) CMSR and episodic memory and verbal fluency but not global cognition.

CONCLUSIONS

The results support prior conclusions that there is an association between social relationships and cognitive function but the exact nature of this association remains unclear. Implications of the findings are discussed and suggestions for future research provided.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2012: CRD42012003248 .