Cognitive performance in older adults across Europe based on the SHARE database

The effect of frailty on the relationship between cognition and depression symptoms in older people. A differential analysis by European regions

This study aimed to investigate the moderating effect of frailty on the relationship between cognition and symptoms of depression in individuals aged ≥65 and to explore differences between four European regions (West, North, South, and East). A cross-sectional analysis was conducted with 29,094 participants (16,365 women) from 27 countries, aged ≥65 years, who responded to wave 8 of the SHARE project. The variables analysed were depression (12-item EURO-D scale), frailty, and a general cognition index (CogId). A higher CogId was associated with less depression. Western and Northern European countries indicated better cognitive performance, lower depression symptomology, and frailty scores than those in the South and East. A pre-frail and frail status was a significant moderator, increasing the association between depression and cognition in the East, South, North, and West regions, respectively. The interaction effects between CogId and frailty were found in the West and East regions. Comparatively, the moderating role of frailty in countries in the Western region differed significantly from those in the North. In turn, countries in the South and East differed from those in the North region. Frailty was a moderator of depression symptoms, increasing its association with cognition. Strategies to prevent frailty are important to reduce the burden of depression and cognitive deficits in Europe.

Sensory impairments and the risk of cognitive decline and dementia across sex, age, and regions: Longitudinal insights from Europe

BACKGROUND

In aging populations, understanding predictors of cognitive decline is essential. We aimed to investigate the risk of cognitive decline and dementia by sensory impairments across sex, age, and European regions, and examined the mediating role of activities of daily living (ADL), physical activity, and depressive symptoms.

METHODS

A cohort study of 72,287 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe. We employed mixed-effects and time-to-event models, incorporating sex interactions, and adjusting for socio-demographic factors and medical history.

RESULTS

Compared to individuals with good vision and hearing, lower cognitive function was found for people with vision impairment (VI) (males: coef. -0.70, 95 % CI -0.95; -0.46; females: coef. -1.12, 95 % CI -1.33; -0.92), hearing impairment (HI) (males: coef. -0.64, 95 % CI -0.93; -0.35; females: coef. -0.96, 95 % CI -1.27; -0.65) and dual sensory impairment (DSI, i.e. VI and HI) (males: coef. -1.81, 95 % CI -2.16; -1.46; females: coef. -2.71, 95 % CI -3.05; -2.38), particularly among females. Moreover, higher dementia risk was observed among participants with VI (hazard ratio (HR) 1.29, 95 % CI 1.17; 1.43), HI (HR 1.18, 95 % CI 1.05; 1.34), and DSI (HR 1.62, 95 % CI 1.45; 1.81) with no sex-interactions. Findings were overall consistent across age and European regions.

CONCLUSION

The results suggest the necessity of preventing sensory impairments to maintain good cognitive function. Mitigating depressive symptoms, ADL limitations, and physical inactivity could potentially reduce a significant portion of the total effect of sensory impairments on cognitive decline.

Normative study of SATURN: a digital, self-administered, open-source cognitive assessment tool for Italians aged 50-80

Introduction

This study aimed to establish normative data for the Self-Administered Tasks Uncovering Risk of Neurodegeneration (SATURN), a brief computer-based test for global cognitive assessment through accuracy and response times on tasks related to memory, attention, temporal orientation, visuo-constructional abilities, math (calculation), executive functions, and reading speed.

Methods

A sample of 323 Italian individuals with Montreal Cognitive Assessment (MoCA) equivalent score ≥1 (180 females; average age: 61.33 years; average education: 11.32 years), stratified by age, education, and sex, completed SATURN using PsychoPy, and a paper-and-pencil protocol consisting of Mini-Mental State Examination (MMSE) and MoCA. Data analyses included: (i) correlations between the total accuracy scores of SATURN and those of MMSE and MoCA; (ii) multiple regressions to determine the impact of sex, age, and education, along with the computation of adjusted scores; (iii) the calculation of inner and outer tolerance limits, equivalent scores, and the development of correction grids.

Results

The mean total time on tasks was 6.72 ± 3.24 min. Age and education significantly influence the SATURN total accuracy, while sex influences the total time on tasks. Specific sociodemographic characteristics influence subdomain accuracies and times on task differently. For the adjusted SATURN total score, the outer limit corresponds to 16.56 out of 29.00 (cut-off), while the inner limit is 18.57. SATURN significantly correlates with MMSE and MoCA.

Discussion

In conclusion, SATURN is the first open-source digital tool for initial cognitive assessment in Italy, showing potential for self-administration in primary care, and remote administration. Future studies need to assess its sensitivity and specificity in detecting pathological cognitive decline.

Effect of emotional stimulus on response inhibition in people with mild cognitive impairment: an event-related potential study

Background

A few studies are emerging to explore the issue of how aging promotes emotional response inhibition. However, there is a lack of empirical study concerning the impact of pathological cognitive impairment on emotional response inhibition. The present study investigated the effect of emotion on response inhibition in people with mild cognitive impairment, the stage of cognitive impairment before dementia.

Methods

We used two emotional stop-signal tasks to explore whether the dual competition framework considering limited cognitive resources could explain the relationship between emotion and response inhibition in mild cognitive impairment.

Results

The results showed that negative emotions prolonged N2 latency. The Go trial accuracy was reduced in the high-arousal negative conditions and the stop-signal reaction time was prolonged under high-arousal conditions. This study also verified impaired response inhibition in mild cognitive impairment and found that negative emotions prolonged P3 latency in mild cognitive impairment.

Conclusion

Emotional information interferes with response inhibition in mild cognitive impairment populations, possibly because emotional information captures more attentional resources, thus interfering with response inhibition that relies on common-pool resources.

Palliative Care in the Ageing European Population: A Cross-Country Comparison

With Europe's ageing population and rising demand for palliative care, it is crucial to examine the use of palliative care among older adults during their last years of life and understand the factors influencing their access and end-of-life circumstances. This study employed a cohort of SHARE participants aged 65 years or older who had passed away between Wave 6 (2015) and Wave 7 (2017). Information on death circumstances, palliative care utilization, and associated variables were analysed. The study revealed that nearly 13.0% of individuals across these countries died under palliative care, with Slovenia having the lowest rate (0.3%) and France the highest (30.4%). Palliative care utilization in the last 30 days before death was observed in over 24.0% of participants, with the Czech Republic having the lowest rate (5.0%) and Greece the highest (48.8%). A higher risk of using or dying in palliative care was significantly associated with cognitive impairment (low verbal fluency), physical inactivity, and good to excellent self-perceived health. This work highlights the urgent need for enhanced global access to palliative care and advocates for the cross-country comparison of effective practices within Europe, tailored to the unique healthcare needs of older adults.

Validation of a Harmonised, Three-Item Cognitive Screening Instrument for the Survey of Health, Ageing and Retirement in Europe (SHARE-Cog)

More accurate and standardised screening and assessment instruments are needed for studies to better understand the epidemiology of mild cognitive impairment (MCI) and dementia in Europe. The Survey of Health, Ageing and Retirement in Europe (SHARE) does not have a harmonised multi-domain cognitive test available. The current study proposes and validates a new instrument, the SHARE cognitive instrument (SHARE-Cog), for this large European longitudinal cohort. Three cognitive domains/sub-tests were available across all main waves of the SHARE and incorporated into SHARE-Cog; these included 10-word registration, verbal fluency (animal naming) and 10-word recall. Subtests were weighted using regression analysis. Diagnostic accuracy was assessed from the area under the curve (AUC) of receiver operating characteristic curves. Diagnostic categories included normal cognition (NC), subjective memory complaints (SMC), MCI and dementia. A total of 20,752 participants were included from wave 8, with a mean age of 75 years; 55% were female. A 45-point SHARE-Cog was developed and validated and had excellent diagnostic accuracy for identifying dementia (AUC = 0.91); very good diagnostic accuracy for cognitive impairment (MCI + dementia), (AUC = 0.81); and good diagnostic accuracy for distinguishing MCI from dementia (AUC = 0.76) and MCI from SMC + NC (AUC = 0.77). SHARE-Cog is a new, short cognitive screening instrument developed and validated to assess cognition in the SHARE. In this cross-sectional analysis, it has good-excellent diagnostic accuracy for identifying cognitive impairment in this wave of SHARE, but further study is required to confirm this in previous waves and over time.

Exploring the Impact of Age of Onset of Mild Cognitive Impairment on the Profile of Cognitive and Psychiatric Symptoms

The present study aims to explore the differences in the manifestation of cognitive decline and psychiatric symptoms across the different ages of MCI onset: early onset (EOMCI: <65 years old), middle onset (MOMCI: 65-75 years old), and late onset (LOMCI: >75 years old). It was hypothesized that individuals with EOMCI will preserve their cognitive functions to a greater extent as compared to individuals with LOMCI, even after adjusting the cognitive performance for age and education through the use of published Greek norms. The level of cognitive decline concerning MOMCI was evaluated for extracting more precise conclusions regarding the impact of the age of onset on the patterns of MCI symptomatology. The analyses of data were conducted in a Greek population of individuals with MCI, who were consecutive visitors of the Outpatient Memory Clinic of Nestor Alzheimer's Centre in Athens, Greece. The sample consisted of 297 participants who fulfilled the following inclusion criteria: MCI diagnosis based on Petersen's criteria, Greek mother language, and absence of a psychiatric history or chronic and incurable organic disease. The overall results support the presence of a cognitive advantage of the EOMCI group compared to the LOMCI group. In the MOMCI group, cognitive performance displayed a tendency to remain intermediate compared to the other two groups. Nonetheless, significant differences were observed when this group was compared with the LOMCI group. The current findings indicate that the age of onset should be taken under consideration in the neuropsychological assessment of individuals with MCI. The specific parameters could have implications in terms of prognosis as well as the design and implementation of tailored interventions.

Adversity specificity and life period exposure on cognitive aging

This study set out to examine the role of different adversities experienced at different life course stages on cognitive aging (i.e., level and change). Data from the longitudinal study: Survey of Health, Ageing, and Retirement in Europe (SHARE) with the selection of participants over 60 years were used (N = 2662, Mdnage = 68, SDage = 5.39) in a Structural Equation Modeling. In early life, the experience of hunger predicted lower delayed recall (β = - 0.10, p < 0.001) and verbal fluency (β = - 0.06, p = 0.001) performance in older age, whereas financial hardship predicted lower verbal fluency (β = - 0.06, p = 0.005) performance and steeper decline in delayed recall (β = - 0.11, p < 0.001). In early adulthood, financial hardship and stress predicted better delayed recall (financial hardship: β = 0.08, p = 0.001; stress: β = 0.07, p = 0.003) and verbal fluency performance (financial hardship: β = 0.08, p = 0.001; stress β = 0.10, p < 0.001), but no adversities were associated with a change in cognitive performance. In middle adulthood, no adversities were associated with the level of cognitive performance, but financial hardship predicted lower decline in delayed recall (β = 0.07, p = 0.048). This study highlights the importance of disentangling the period effect from the specific effect of the adversity experienced in the association between adversity and cognition in older age. Moreover, differential results for delayed recall and verbal fluency measures suggest that it is also important to consider the cognitive outcome domains examined.

Coenzyme Q10 Levels Associated With Cognitive Functioning and Executive Function in Older Adults

Brain deterioration with age is associated with inflammation and oxidative stress that result in structural and functional changes. Recent studies have indicated that coenzyme Q10 (CoQ10) is associated with neurological oxidative stress and cognitive impairment. Studies with older people have shown a relationship between neurodegenerative diseases and CoQ10 levels. However, no studies have analyzed the relationship between CoQ10 and cognitive functioning in older adults. The aim of this study was to analyze the association between CoQ10 and cognitive functioning in an older adult sample, controlling for other factors that may influence aging, such as the level of physical activity and nutritional status. The sample consisted of 64 older adults aged 65-99 years (76.67 ± 8.16 years), among whom 48 were women (75%). The participants were recruited among those who attended community centers to voluntarily participate in leisure activities. According to previous studies, physical activity and nutritional status are positively associated with cognitive functioning. However, the main finding of this study was that plasma CoQ10, controlling for other measures, was significantly associated with cognitive functioning and executive function. The current findings suggest that a decline in cognitive capacities may be related to reduced antioxidant defenses, as reflected by low CoQ10 levels in older adults.

The CERAD Word List Memory Test: Normative Data Based on a Norwegian Population-Based Sample of Healthy Older Adults 70 Years and Above. The HUNT Study

BACKGROUND

The CERAD Word List Memory Test (WLMT) is widely used in the assessment of older adults with suspected dementia. Although normative data of the WLMT exist in many different regions of the world, normative data based on large population-based cohorts from the Scandinavian countries are lacking.

OBJECTIVE

To develop normative data for the WLMT based on a large population-based Norwegian sample of healthy older adults aged 70 years and above, stratified by age, gender, and education.

METHODS

A total of 6,356 older adults from two population-based studies in Norway, HUNT4 70 + and HUNT4 Trondheim 70+, were administered the WLMT. Only persons with normal cognitive function were included. We excluded persons with a diagnosis of mild cognitive impairment (MCI) and dementia, and persons with a history of stroke and/or depression. This resulted in 3,951 persons aged between 70 and 90 years, of whom 56.2% were females. Regression-based normative data were developed for this sample.

RESULTS

Age, gender, and education were significant predictors of performance on the WLMT list-learning subtests and the delayed recall subtest, i.e., participants of younger age, female sex, and higher education level attained higher scores compared to participants of older age, male sex, and lower level of education.

CONCLUSION

Regression-based normative data from the WMLT, stratified by age, gender, and education from a large population-based Norwegian sample of cognitively healthy older adults aged 70 to 90 years are presented. An online norm calculator is available to facilitate scoring of the subtests (in percentiles and z-scores).

Determinants of Self-Perceived Health: The Importance of Physical Well-Being but Also of Mental Health and Cognitive Functioning

With life expectancy increasing for the general population, public health promotion activities should be a priority to aim at a reduction of the burden and costs of hospitalization, disability, and lifelong treatment. This study aimed to explore the influence of parameters pertaining to different aspects of well-being, including physical and mental health and cognitive functioning, on self-perceived health, a predictor of chronic disease prevalence and mortality. We used data from the Survey of Health, Aging and Retirement in Europe (SHARE) project gathered between 2013 and 2017, obtaining a sample of 96,902 participants (63.23 ± 6.77 years). We found a strong association between the self-perceived health rating and not only physical health aspects but also mental health and cognitive functioning. In particular, BMI, chronic diseases and medications, muscle strength, and mobility issues had a strong effect on self-perceived health, as also did the quality of life, depression, and verbal fluency, while other aspects, such as individual characteristics, limitations in daily activities, and pain, among others only had a small effect. These results show that public health and prevention interventions should prioritize the targeting of all aspects of well-being and not only of physical health, acknowledging self-perceived health rating as a simple tool that could help provide a complete overview of psycho-physical well-being and functional status.

Does emotional dysregulation mediate the relationship between disability and depressive symptoms in older people?

BACKGROUND

Emotion dysregulation has been consistently linked to psychopathology, and the relationship between disability and depressive symptomatology in old age is well-known.

OBJECTIVE

To examine the mediational role of emotional dysregulation in the relationship between perceived disability and depressive symptomatology in older adults.

METHODS

Two hundred eighty-three participants, aged 60-96 years (M±SD=74.22±8.69; 62.9% women; 29.0% with long-term care support [LTC-S] and 71.0% community residents without LTC-S), were assessed with the Geriatric Depression Scale-8 (GDS-8), the World Health Organization Disability Assessment Schedule-2 (WHODAS-2), and the Difficulties in Emotion Regulation Scale-16 (DERS-16).

RESULTS

A mediation model was established, which revealed: (1) a moderate association between WHODAS-2 and GDS-8 (β=0.20; p<.001); (2) DERS-16 partially and weakly mediated the relationship between WHODAS-2 and GDS-8 (β=0.003; p<.01). The model explained 31.9% of the variance of depressive symptoms. An inconsistent mediation model was obtained in the LTC-S group.

CONCLUSIONS

Globally, our findings indicate that disability has an indirect relationship with depressive symptomatology through emotional dysregulation (except for those in the LTC-S). Accordingly, we present suggestions for the treatment of depressive symptoms and for the inclusion of other emotion regulation variables in the study of the disability-depressive symptom link in future studies with older people in the LTC-S.

Functional Capacity and Difficulties in Activities of Daily Living From a Cross-National Perspective

Objectives: This study investigated whether physical and cognitive functioning predicts developing difficulties in basic or instrumental activities of daily living (ADL/IADL), and whether country-level factors moderated the associations. Methods: 69,227 adults aged 50+ from 19 countries were followed for up to 14 years. Cox regression and meta-regression analyses were used. Results: Higher grip strength was associated with a 45% lower risk of developing ADL limitations and a 47% lower risk of IADL limitations. The corresponding values were 22% and 23% for peak flow, 20% and 23% for word recall, and 20% and 24% for temporal orientation. The associations were similar and statistically significant in most countries, but some associations were weaker in countries with lower GDP and lower service coverage. Discussion: Good physical and cognitive functional capacity protects from ADL and IADL limitations consistently across Western countries. The associations may be stronger in countries with more resources.

Assessment of dual-tasking during a dynamic balance task using a smartphone app: a pilot study

[Purpose] To assess if the instrumented Timed Up and Go (iTUG) task score calculated with an iPhone application can detect gait changes under dual-tasking conditions. [Participants and Methods] Twenty participants (age 38.30 ± 12.54, 12 females) were asked to complete the TUG as a single task and under two dual-tasking conditions: 1) verbal fluency and 2) mental calculation. We used a smartphone, stopwatch, digital camera, and wearable sensor to calculate the dependent variables which included time, step count, gait speed, and iTUG score and, the dual-tasking cost (DTC) of those variables. We used Friedman analyses of variance and Wilcoxon tests for statistical analyses. [Results] the iTUG score, step count, gait speed, and the time measured by the stopwatch and wearable sensor differed significantly for all tasks, but the smartphone time did not. [Conclusion] We conclude that the iTUG score could be used as a sensitive measure for identifying gait changes under dual-tasking conditions. With the growing demands of telehealth, using technology as an objective tool for movement analysis is needed for clinicians and payers. Our findings demonstrate the potential value of the iTUG score to assess and track patient’s progress.

Lower social participation partly explains the association between perceived neighbourhood crime and depressive symptoms in European adults aged 50 years or older: A longitudinal mediation analysis

Neighbourhood crime likely increases the risk of developing depression among older adults. However, little is known about the underlying behavioural and social pathways. We examined the association between perceived neighbourhood crime and depressive symptoms and whether this relationship was mediated by health behaviours (physical activity, smoking, and alcohol consumption) and social participation. Furthermore, we explored differential vulnerability across age, gender, education and household wealth. Data were drawn from six waves of longitudinal data (from 2004/2005 to 2017) of approximately 15,000 adults aged 50 years and older, derived from the multi-national Survey of Health, Ageing and Retirement in Europe. Perceived neighbourhood crime and covariates were measured at baseline, time-variant mediators and depressive symptoms across all waves. Confounder-adjusted mediator and outcome models were fitted with mixed-effects models. Total association was decomposed into direct and indirect pathways applying causal mediation analyses with Monte-Carlo simulations. Perceived crime was associated with higher risk of depressive symptoms; 4.6% of the effect was mediated via lower engagement in social activities (b = 0.005; 95% CI: 0.001-0.009). No mediation was detected through physical activity, smoking or alcohol consumption. Exploratory analyses revealed that the mediating role of social participation was more pronounced among participants with low household wealth (b = 0.012; 95% CI: 0.004-0.023; 7.3% mediated). Lower engagement in social activities partly explained the association between perceived neighbourhood crime and depressive symptoms in adults aged 50 years or older. Policies targeting disadvantaged communities to prevent crime and support social participation might be beneficial for population mental health, especially among financially vulnerable older residents.

How Welfare Regimes Moderate the Associations Between Cognitive Aging, Education, and Occupation

OBJECTIVES

Previous studies have shown the importance of individual markers of cognitive reserve, such as education and occupation, for cognitive health in old age. However, there has been only little investigation so far on how this relationship varies across contexts.

METHODS

We analyzed data from the Survey of Health, Ageing, and Retirement in Europe, using second-order latent growth models, to assess the moderating role of welfare regimes on the relationship between education and occupation skill level in explaining overall cognitive functioning and decline in old age. Our sample includes 13 European countries using data from 5 regular waves of the survey (2004-2007 and 2011-2015) and 2 retrospective ones (2008-2009 and 2017). Cognitive functioning was modeled as a latent variable measured by immediate and delayed recall, verbal fluency, and numeracy.

RESULTS

74,193 participants were included from the survey. Our analysis showed that the association of education with cognition was weaker overall in Scandinavian countries, but stronger in Southern European countries, relative to Bismarckian ones. However, educational differences in the decline of cognition were more pronounced only in Scandinavian compared to Bismarckian countries. Additionally, higher-skilled occupations in Scandinavian countries had better overall functioning compared to the same occupations in Bismarckian countries, but there was no difference in the decline in cognitive functioning.

DISCUSSION

Our findings indicate that the associations of cognitive functioning and its decline with individuals' cognitive reserve markers (education and occupational skill level) vary according to welfare regimes, showing the importance of contextual factors in cognitive aging processes.

Numeracy Skills, Cognitive Reserve, and Psychological Well-Being: What Relationship in Late Adult Lifespan?

BACKGROUND

The capacity of understanding and manipulating numerical stimuli (i.e., numeracy) can impact decision making. This investigation was conducted to examine whether number comprehension and mental calculation predict hedonic (i.e., Scale of Positive and Negative Experience, SPANE) and eudaimonic (i.e., Flourishing Scale) well-being in late adulthood, and whether cognitive reserve (i.e., education, time spent for gardening, and time spent for leisure activities) and non-verbal reasoning predict numeracy skills of old adults. Additionally, the effect of age on numeracy was examined, controlling for the effect of education and cognitive efficiency.

METHODS

One hundred and fifty-eight (i.e., 65-94 years old) community-dwellers completed a battery of tools assessing numeracy, cognitive and metacognitive efficiency, and psychological well-being.

RESULTS

Number comprehension, metacognition, time spent for leisure, and perceived physical health accounted for 23% of the variance in the SPANE condition, whereas metacognition, perceived physical health, time for leisure, and education explained 15% of the variance in the Flourishing condition. Moreover, cognitive reserve assessed in terms of vocabulary and education predicted mental calculation. Finally, aging significantly impacted the mental calculation performance of older participants.

CONCLUSIONS

These findings suggest that numeracy skills can selectively impact the mental health and daily life of older adults.

Instrumental Activities of Daily Living (iADL) Limitations in Europe: An Assessment of SHARE Data

This study aims to evaluate the instrumental activities of daily living (iADLs) limitations in Europe and its association with socio-demographic characteristics, economic parameters and physical and mental health status. We used data from the wave 6 of SHARE database. Individuals were classified as having either none or one or more limitations on iADLs. Participants aged 65 or more years who answered all questions for the variables included in this work were selected. A total of 54.8% of participants were female and had a mean age of 74.37 (SD = 7.08) years. A global prevalence of 1 or more iADLs in Europe was shown to be 23.8% and more prevalent in women than in men (27.1% vs. 17.6%) and in people aged 85 years or more (51.5%). Older age, female gender, lower education, physical inactivity, frailty, having two or more chronic diseases, presence of depression, polypharmacy, poor self-perception of health and lower network satisfaction were found to be factors associated with the presence of 1 or more iADLs limitation. This study highlights the burden of iADLs limitations at the European level. These are based on a multidimensional biopsychosocial model and are associated with both health conditions and environmental factors. This intersection between the physical and social world underscores its potential as a health indicator and can, to some extent, explain some of the pronounced differences seen among European countries. Different inter-tasks can also stress different dimensions of health indicators in distinct and specific groups of individuals. Minimizing the impact of iADL limitations can improve the quality and sustainability of public health systems.