The Interaction of Cognitive and Emotional Status on Subsequent Physical Functioning in Older Mexican Americans: Findings From the Hispanic Established Population for the Epidemiologic Study of the Elderly

Association Between Depressive Symptoms, Cognitive Status, and the Dual-Task Performance Index in Older Adults: A Cross-Sectional Study

The Performance Index (P-Index) is a measure for evaluating mobility-related dual-task performance in older adults. The identification of specific clinicodemographic factors predictive of P-Index scores, however, remains unclear. This cross-sectional study analyzed data from 120 community-dwelling older adults (average age 71.3 ± 11.23 years) to explore clinicodemographic variables that influence P-Index scores during the instrumented timed up and go test. Unadjusted analyses suggested several factors, including age, gender, body mass index, Mini-Mental Status Examination scores, functional reach test performance, history of falls, ethnicity, Geriatric Depression Scale scores, alcohol consumption, and educational levels, as potential predictors of P-Index. However, adjusted multinomial multiple regression analysis revealed Geriatric Depression Scale and Mini-Mental Status Examination scores as the exclusive independent predictors of P-Index classifications, segmented into high, intermediate, or low (percentiles ≤ 25, 26-74, or ≥ 75, respectively). A significant association was observed between the manifestation of depressive symptoms, lower Mini-Mental Status Examination scores, and reduced cognitive-motor performance. The findings implicate depressive symptoms and low cognitive performance as substantial impediments to optimal dual-task mobility within this cohort. Further studies are warranted to examine the efficacy of cognitive stimulation and antidepressant therapy, in augmenting mobility-related dual-task performance among older adults.

Moving towards the detection of frailty with biomarkers: A population health study

Aging adults experience increased health vulnerability and compromised abilities to cope with stressors, which are the clinical manifestations of frailty. Frailty is complex, and efforts to identify biomarkers to detect frailty and pre-frailty in the clinical setting are rarely reproduced across cohorts. We developed a predictive model incorporating biological and clinical frailty measures to identify robust biomarkers across data sets. Data were from two large cohorts of older adults: "Invecchiare in Chianti (Aging in Chianti, InCHIANTI Study") (n = 1453) from two small towns in Tuscany, Italy, and replicated in the Atherosclerosis Risk in Communities Study (ARIC) (n = 6508) from four U.S. communities. A complex systems approach to biomarker selection with a tree-boosting machine learning (ML) technique for supervised learning analysis was used to examine biomarker population differences across both datasets. Our approach compared predictors with robust, pre-frail, and frail participants and examined the ability to detect frailty status by race. Unique biomarker features identified in the InCHIANTI study allowed us to predict frailty with a model accuracy of 0.72 (95% confidence interval (CI) 0.66-0.80). Replication models in ARIC maintained a model accuracy of 0.64 (95% CI 0.66-0.72). Frail and pre-frail Black participant models maintained a lower model accuracy. The predictive panel of biomarkers identified in this study may improve the ability to detect frailty as a complex aging syndrome in the clinical setting. We propose several concrete next steps to keep research moving toward detecting frailty with biomarker-based detection methods.

Doing housework and having regular daily routine standing out as factors associate with physical function in the older people

Background and objectives

Nationwide data were used to explore factors associated with physical function in order to identify interventions that could improve and maintain physical function in the older people.

Methods

The physical function was assessed by gait speed (GS). We selected 2,677 male and 2,668 female older adults (aged ≥60) who could perform the GS test as study subjects. GS was measured by having subjects walk across and back a 10-m course. A gait speed less than 20% that of a reference population (<0.7 m/s) was used as the definition of slow gait speed (SGS). Co-morbidity, polypharmacy, medical expenses, need for care, and hospitalization were used to evaluate health status. A stepwise logistic regression model was used to determine factors associated with SGS.

Results

SGS was associated with poorer health status, higher medical cost, lower ranking on the Geriatric Depression Scale (GDS) and decreased Mini-mental State Examination (MMSE). Co-morbidity (OR = 1.81, 1.58-2.07), polypharmacy (OR = 1.47, 1.25-1.74), MMSE <24 (OR = 1.85, 1.54-2.22), and GDS ≥ 11 (OR = 1.40, 1.18-1.65) were associated with SGS. In contrast, doing housework (DHW, OR = 0.43, 0.38-0.49), having a regular daily routine (RDR, OR = 0.64, 0.45-0.91), and current alcohol consumption (OR = 0.74, 0.62-0.90) were inversely associated with SGS. DHW plus having RDR could greatly reduce the risk of SGS (OR = 0.29, 0.19-0.43).

Conclusion

Poor physical function is associated with poorer health status in Chinese older people. Maintaining a regular daily routine and doing some housework may be important factors that can help older people preserve their physical function.

Cognitive and physical impairment in spinal cord injury: A scoping review and call for new understanding

Study Design: Scoping review.Objective: To examine potential underlying mechanisms of cognitive and physical impairment in patients with spinal cord injury and identify current research gaps.Methods: A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews to identify primary studies that explored mechanisms of cognitive and/or physical impairment after spinal cord injury. The databases searched were PubMed/MEDLINE, EMBASE (OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO), Web of Science, Scopus, and PsycInfo. These databases were searched from inception through December 20, 2021.Results: Accumulating research suggests that neuroinflammation and neurodegeneration after a traumatic event may be possible mechanisms for cognitive impairment among patients with SCI. In addition, lack of physical activity due to impaired mobility is associated with an increased risk of cognitive impairment.Conclusion: While the results establish a foundation for understanding how cognitive impairment, mental health, and physical function independently affect patients with SCI, further research is warranted to understand how these factors systemically impact the patient and discover refined targets for future rehabilitation therapies. Studies should also explore potential predisposing factors for the relationship between cognitive and physical impairment among patients with SCI.

The combined associations of depression and cognitive impairment with functional disability and mortality in older adults: a population-based study from the NHANES 2011-2014

Objective

The present study aimed to explore the combined associations of depression and cognitive impairment with functional disability and mortality, and whether the joint effects of depression and cognitive impairment on mortality were influenced by functional disability.

Methods

A total of 2,345 participants aged 60 and above from the 2011-2014 cycle of the National Health and Nutrition Examination Survey (NHANES) were included in the analyses. Questionnaires were used to evaluated depression, global cognitive function and functional disability (including disability in activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activity (GPA)). Mortality status was ascertained up to December 31, 2019. Multivariable logistic regression was performed to investigate the associations of depression and low global cognition with functional disability. Cox proportional hazards regression models were conducted to evaluate the effect of depression and low global cognition on mortality.

Results

Interactions between depression and low global cognition were observed when exploring associations of depression and low global cognition with IADLs disability, LEM disability, and cardiovascular mortality. Compared with normal participants, participants with both depression and low global cognition had the highest odds ratios of disability in ADLs, IADLs, LSA, LEM, and GPA. Besides, participants with both depression and low global cognition also had the highest hazard ratios of all-cause mortality and cardiovascular mortality, and these associations remained after adjusting for disability in ADLs, IADLs, LSA, LEM, and GPA.

Conclusion

Older adults with both depression and low global cognition were more likely to have functional disability, and had the highest risk of all-cause mortality and cardiovascular mortality.

Trajectories of Concurrent Depressive Symptoms and Cognitive Function on Health Outcomes and Mortality among Older Mexican Americans

BACKGROUND

We sought to identify distinctive concurrent trajectory classes of depressive symptoms (DS) and cognitive function (CF) in Mexican Americans aged 75+ years, and to examine whether these trajectories were associated with an increased risk of adverse outcomes.

METHODS

We used 4 waves of Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) data from 2004 to 5 to 2013. Latent growth curve analysis was used to identify distinctive concurrent trajectory classes of DS and CF. Generalized linear mixed models were further used to examine the association between the concurrent trajectories and health outcomes. Cox proportional hazards regression model was used to examine the risk of mortality as a function of the concurrent trajectories.

RESULTS

1,302 older adults followed-up approximately 9-years were successfully classified into 6 distinct concurrent trajectory classes of DS (low-increasing, high) and CF (high, high-declining, medium-declining). Compared to the co-occurrence of low DS and high CF trajectories, those with the high DS and declining CF trajectories were at greater risk of ADL and IADL functional limitations (1.6 - 2.9 times), more medical visits (1.3 - 1.4 times), hospital admissions (1.6 - 1.9 times), and mortality (1.7 - 2.6 times).

CONCLUSIONS

Differences in adverse health outcomes across concurrent trajectory classes of DS and CF suggest that differences in underlying co-occurrence and progression have important implications for public health interventions as well as development of aging social and health policies.

Differences in the Level of Functional Fitness and Precise Hand Movements of People with and without Cognitive Disorders

OBJECTIVES

to assess and compare the gross and fine motor skills in people with identified cognitive impairment and in people from the control group.

METHOD

The research was conducted at the Center of Dementia-Related Diseases, involved participants with (n = 39) and without (n = 29) cognitive disorders. Fast, precise hand movements were measured via Vienna System Test. The up-and-go, chair-stand, 6-minute walk tests were used to assess functional fitness. The results for participants with and without cognitive disorders were compared.

RESULTS

People from both groups do not differ significantly in terms of the level of condition-based functional fitness. Participants with cognitive disorders achieve worse results in hand coordination tests which are more complex and require both speed and accuracy of hand movements.

DISCUSSION

The deterioration of precise hand movements with the correct functional efficiency may indicate degenerative changes in brain areas associated with complex thought processes, conceptual thinking, and may lead to dementia.

The clinical correlates of the chair sit to stand performance in people with multiple sclerosis

Objective: This study aimed to evaluate the motor and non-motor factors associated with sit-to-stand performance in people with Multiple Sclerosis (PwMS). Design: Observational cross-sectional study. Subjects: A total of 88 individuals with MS participated in this study. Main Measures: Standing performance was measured using the five-times-sit-to-stand test (FTSTS). The Berg Balance Scale to assess balance, the 10-Meter Walking Test (10-MWT) was used to assess walking speed; the Patient Determined Disease Steps (PDDS) was used to assess disability level. Furthermore, Brief International Cognitive Assessment for MS (BICAMS) was used to assess cognitive status, Hospital Anxiety and Depression scale (HADS) to assess depression and anxiety, and the Modified Fatigue Impact scale (MFIS) to evaluate fatigue. Spearman correlation coefficient was used to determine the relationship between all these variables and the FTSTS. Furthermore, multiple linear regression was conducted to determine predictive factors of the FTSTS. Results: FTSTS score was correlated significantly with BBS, PDDS, BICAMS, 10-MWT and MFIS (r ranged from 0.3 to 0.52; P < .05). However, there was no significant correlation observed between the FTSTS and HADS-depression or HADS-anxiety. Considering the multiple regression analysis, the following factors were significantly predictive of the FTSTS: 10-MWT, MFIS and the BICAMS-z score (R²: 0.433, P < .0001). Conclusion: The study concludes that sit to stand is multifactorial and is potentially associated with walking speed, cognitive function and fatigue. These factors should be considered by healthcare professionals in interpreting the sit-to-stand performance of PwMS and in designing rehabilitation interventions.

Peer-to-Peer Support and Changes in Health and Well-being in Older Adults Over Time

IMPORTANCE

Literature on peer-to-peer (P2P) programs suggests they improve health and well-being of older adults. Analysis from a previous study showed P2P to be associated with higher rates of hospitalization and no significant differences in rates of emergency department or urgent care visits; however, it is not known whether measures of health and well-being varied by group over time.

OBJECTIVE

To compare the association between receiving P2P support and secondary outcomes (ie, health status, quality of life, and depressive and anxiety symptoms) with receiving standard community services (SCS) over time.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study was conducted among a volunteer sample of older adults (≥65 years) who were new to P2P or were already receiving P2P and a corresponding control group. Participants were matched between groups on age, sex, and race/ethnicity. The study was conducted from March 2015 to December 2017 at 3 community-based organizations that delivered P2P in California, Florida, and New York. Data analysis was performed from October 2018 through May 2020.

EXPOSURES

P2P support, provided by trained older adult volunteers.

MAIN OUTCOMES AND MEASURES

Mental and physical components of the health status and quality of life measure and depressive and anxiety symptoms were collected over 12 months. The hypothesis was that older adults receiving P2P support would maintain higher health status and quality of life than the SCS group.

RESULTS

A total of 503 participants were screened, 456 participants were enrolled and had baseline data, and 8 participants only had baseline information with no follow-up data, leaving 448 participants (231 [52%] in the SCS group; 217 [48%] in the P2P group; 363 [81%] women; mean [SD] age, 80 [9] years). The P2P group had improvements in mental health (change at 12 months, 1.1 points; 95% CI, -0.8 to 3.0 points) and physical health (change at 12 months, 1.0 points; 95% CI, -0.7 to 2.8 points). However, the difference of differences between the 2 groups did not differ significantly from baseline to 12 months (mental health: 0.2 points; 95% CI -2.3 to 2.7 points; physical health: 1.7 points; 95% CI, -0.6 to 3.9 points). The P2P and SCS groups had a statistically significant difference of differences in anxiety symptoms of 0.36 points (95% CI, 0.04 to 0.61 points). There were no significant differences in depressive symptoms or mental and physical components of the health status and quality of life.

CONCLUSIONS AND RELEVANCE

These findings suggest that receiving P2P support did not slow the decline of health and well-being in older adults compared with those who received SCS. Baseline imbalance in key characteristics, even after adjusting for the imbalance using the propensity score method, may explain the results. Randomized trials are needed.

Mobility but Not Balance Limitations Are Associated With Cognitive Decline among Older Hispanics

Aging is associated with changes in lower-body functioning. The extent to which lower-body function is associated with cognitive changes over time is unclear, especially among older Hispanics, a high-risk population for declines in physical and cognitive functioning. We sought to determine if the association between lower-body functioning and cognitive decline over 9-years differentially varied with respect to balance, gait speed, lower-body strength (chair stands), or a summary score of the three measures. This retrospective cohort study used clinical performance data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE). Cognitive function was measured using the Mini-Mental Status Exam. Linear mixed modeling was used to investigate the association between lower-body function and cognitive decline, controlling for patients' demographic and health characteristics. We found that gait speed and timed chair stands but not balance were associated with accelerated cognitive decline in Mexican-Americans age 75 years and older. These parameters of lower-body function can be feasibly measured in any clinic. As limitations in lower-body functioning may be an early marker of cognitive decline, this suggests an opportunity for the development of interventions to slow cognitive and physical disablement and promote successful aging among persons older than 75 years.

The modifying effect of positive emotion on the relationship between cognitive impairment and disability among older Mexican Americans: a cohort study

OBJECTIVE

To determine if positive emotion modifies the relationship between cognitive impairment and activities of daily living disability status over 10 years in Mexican American adults aged 75 years and older.

METHODS

A retrospective cohort design using data from the Hispanic established populations for the epidemiologic studies of the elderly. About 2674 participants aged 75 years and older were included and followed over 10 years. Cognition was measured using the mini-mental state examination, positive emotion was measured using four questions from the Center for Epidemiologic Studies Depression Scale, and disability was measured using seven activities of daily living items. A series of generalized estimating equations models were used, with the initial analysis including those with disability at baseline and subsequent analyses excluding disability at baseline.

RESULTS

Positive emotion and cognitive impairment consistently decreased and increased risk for activities of daily living disability, respectively. Positive emotion was a significant modifier in the cross-sectional analysis, and was not a statistically significant modifier in the longitudinal or predictive series analysis.

CONCLUSIONS

Positive emotion and cognitive impairment differentially affect the risk of developing activities of daily living disability. Further research is needed to explore the interaction of positive emotion and cognitive impairment, and to identify appropriate interventions that address the specific cognitive and emotional needs of older Mexican Americans. Implications for rehabilitation Promoting emotional well-being may be protective against incident disability for older adults. Cognitive impairment significantly predicts incident disability in activities of daily living and should be considered an early indicator of impending disability for older adults.

Correlates and Predictors of Mobility Limitation in Community-Dwelling Hispanic Older Adults in the United States: A Systematic Review

This article presents a systematic review of the literature on correlates/predictors of mobility limitation among community-dwelling U.S. Hispanic older adults. A search of scientific databases (PubMed, CINAHL, and PsycINFO) was conducted. After abstract and full text review, 20 epidemiologic studies that met all eligibility criteria were included. The theoretical framework of mobility was used to categorize factors related to mobility limitation. The majority of the studies reviewed (n = 17) examined some aspect of physical factors in relation to mobility limitation. Several factors emerged as important influences on mobility outcomes: diabetes mellitus, stroke, obesity, arthritis, and depression. None examined the influence of built environment. This review suggests that multilevel factors can impact both mobility limitations and disability among U.S. Hispanic older adults. However, the study findings were inconsistent, with some studies showing significant relationships or effects and others demonstrating no associations or mixed findings.

Motoric Cognitive Risk Syndrome: Could It Be Defined Through Increased Five-Times-Sit-to-Stand Test Time, Rather Than Slow Walking Speed?

Background: Slow walking speed, time to perform the five-times-sit-to-stand (FTSS) test and motoric cognitive risk syndrome (MCR; defined as slow gait speed combined with subjective cognitive complaint) have been separately used to screen older individuals at risk of cognitive decline. This study seeks to (1) compare the characteristics of older individuals with MCR, as defined through slow walking speed and/or increased FTSS time; and (2) examine the relationship between MCR and its motor components as well as amnestic (a-MCI) and non-amnestic (na-MCI) Mild Cognitive Impairment.

Methods: A total of 633, individuals free of dementia, were selected from the cross-sectional “Gait and Alzheimer Interactions Tracking” study. Slow gait speed and increased FTSS time were used as criteria for the definition of MCR. Participants were separated into five groups, according to MCR status: MCR as defined by (1) slow gait speed exclusively (MCRs); (2) increased FTSS time exclusively (MCRf); (3) slow gait speed and increased FTSS time (MCRsaf); (4) MCR; irrespective of the mobility test used (MCRsof); and (5) the absence of MCR. Cognitive status (i.e., a-MCI, na-MCI, cognitively healthy) was also determined.

Results: The prevalence of MCRs was higher, when compared to the prevalence of MCRf (12.0% versus 6.2% with P ≤ 0.001). There existed infrequent overlap (2.4%) between individuals exhibiting MCRs and MCRf, and frequent overlap between individuals exhibiting MCRs and na-MCI (up to 50%). a-MCI and na-MCI were negatively [odd ratios (OR) ≤ 0.17 with P ≤ 0.019] and positively (OR ≥ 2.41 with P ≤ 0.019) related to MCRs, respectively.

Conclusion: Individuals with MCRf are distinct from those with MCRs. MCRf status does not relate to MCI status in the same way that MCRs does. MCRs is related negatively to a-MCI and positively to na-MCI. These results suggest that FTTS cannot be used to define MCR when the goal is to predict the risk of cognitive decline, such as future dementia.

Factors Associated With Physical Performance Measures in a Multiethnic Cohort of Older Adults

Objective: To explore the association between ethnicity, sociodemographic, health, and lifestyle factors, and physical performance (PP) in ethnically diverse community-dwelling older adults from one geographic area. Method: We used multivariable linear regression to identify factors associated with upper (grip strength [GS], arm curls [AC]) and lower (chair stands [CS]) body strength and mobility (gait speed [GSp]) in 577 older adults (mean age 74 ± 8; 104 African American, 142 Afro-Caribbean, 123 Hispanic, and 208 European American) from South Florida. Results: Worse mental health was negatively associated with CS in African Americans and AC in Hispanics. Older age and higher body mass index (BMI) was associated with slower GSp in all except in Hispanics. Higher physical activity was associated with higher upper body strength in Hispanics and better mobility in African Americans and Afro-Caribbeans, but not in European Americans. Conclusion: Studies with large multiethnic cohorts are needed to further our understanding of ethnic differences in PP, which will help in tailoring interventions and recognizing unmet needs for health and social services.

Frailty and diabetes among Mexican American older adults

PURPOSE

Progressive physical frailty in older adults is associated with increased risk of falls, disability, institutionalization, and mortality. Although associations between diabetes and frailty have been observed, the impact of diabetes on frailty in older Hispanics is largely unexplored. We examine the association of diabetes on the odds of frailty among older Mexican Americans.

METHODS

Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly from 1995 until 2012, frailty was assessed by slow gait, weak hand grip strength, exhaustion, and unexplained weight loss (n = 1327).

RESULTS

Logistic regression showed a large magnitude of effect of diabetes on the odds of frailty (odds ratio 1.47, 95% confidence interval 1.14-1.90). Other contributors to frailty included arthritis, heart attack, and hip fracture. Positive and negative effects had significant and opposing associations. Ordinal logit models assessed the odds of frail compared to nonfrail and prefrail. In these models, diabetes was associated with a 32% increase in the odds of a higher level of frailty.

CONCLUSIONS

Diabetes is a significant contributor to increased frailty in older Mexican Americans. Interventions to reduce frailty rates should focus on mitigating the effects of diabetes and shifting away from negative and toward positive effect.

A New Approach to Improve Cognition, Muscle Strength, and Postural Balance in Community-Dwelling Elderly with a 3-D Virtual Reality Kayak Program

Aging is usually accompanied with deterioration of physical abilities, such as muscular strength, sensory sensitivity, and functional capacity. Recently, intervention methods with virtual reality have been introduced, providing an enjoyable therapy for elderly. The aim of this study was to investigate whether a 3-D virtual reality kayak program could improve the cognitive function, muscle strength, and balance of community-dwelling elderly. Importantly, kayaking involves most of the upper body musculature and needs the balance control. Seventy-two participants were randomly allocated into the kayak program group (n = 36) and the control group (n = 36). The two groups were well matched with respect to general characteristics at baseline. The participants in both groups performed a conventional exercise program for 30 min, and then the 3-D virtual reality kayak program was performed in the kayak program group for 20 min, two times a week for 6 weeks. Cognitive function was measured using the Montreal Cognitive Assessment. Muscle strength was measured using the arm curl and handgrip strength tests. Standing and sitting balance was measured using the Good Balance system. The post-test was performed in the same manner as the pre-test; the overall outcomes such as cognitive function (p < 0.05), muscle strength (p < 0.05), and balance (standing and sitting balance, p < 0.05) were significantly improved in kayak program group compared to the control group. We propose that the 3-D virtual reality kayak program is a promising intervention method for improving the cognitive function, muscle strength, and balance of elderly.

The Intersection of Mental and Physical Health in Older Mexican Americans

The incidence of chronic diseases is highest among the elderly in general; compared to Anglo-Americans, Mexican Americans have lower rates of cancer and cardiovascular disease and higher rates of depression and diabetes. Using baseline data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE) study, weighted hierarchical logistic regression analyses showed that sociodemographic, cultural, and psychosocial profiles of respondents varied in the context of cancer and cardiovascular disease (CVD). More depressive symptoms were associated with both diseases, as were lower levels of self-esteem, life satisfaction, and perceived health. Higher socioeconomic status, greater assimilation, divorced marital status, and adverse life events/changes involving significant personal losses, trauma, and family events increased cancer risk. People who were lower in socioeconomic status, were less assimilated into the host culture, were divorced, and had experienced the illness of a close family member were more likely to have CVD.

Stability and Change in Activities of Daily Living Among Older Mexican Americans

BACKGROUND

Longitudinal studies of activities of daily living (ADL) in older adults have identified numerous factors associated with declining ability. Analyses based on population averages may not observe distinct subgroups whose ADL trajectories differ.

METHODS

We used latent class models to identify subgroups of trajectories in a sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of noninstitutionalized Mexican Americans aged 65 and older from five Southwestern states (n = 2584).

RESULTS

Three distinct trajectories of ADL limitations were identified and characterized as stable, delayed, and rapid ADL increase. Sex (female), diabetes, and arthritis were associated with increased odds of membership in the delayed and rapid groups compared with the stable group. Stroke had a differential magnitude of effect on ADL limitations across the stable (β = 1.11, p < .001), delayed (β = 0.52, p < .001), and rapid groups (β = 0.12, p < .05). Hip fracture was associated with increased limitations in the stable group (β = 1.27, p < .001) but not in the rapid group. Church attendance was associated with fewer limitations in all groups with a larger effect in the stable group (β = -0.87, p < .001) compared with the rapid group (β = -0.10, p < .05).

CONCLUSIONS

Substantial heterogeneity exists in changes in ADL disability over time among older Mexican Americans. Attempts at maintaining function may benefit from targeting reductions in comorbidities and acute health events associated with disability.

The joint association of depression and cognitive function with severe disability among community-dwelling older adults in Finland, Poland and Spain

OBJECTIVES

To explore the joint association of depression and cognitive function with severe disability in nationally-representative samples of community-dwelling adults aged 50 years and older from Finland, Poland and Spain.

DESIGN

Cross-sectional.

SETTING

Community-based.

PARTICIPANTS

Population-based sample of 7987 non-institutionalized adults aged 50 and older.

MEASUREMENTS

The outcome was severe disability, defined as ≥ 90th percentile of the 12-item version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Past 12-month DSM-IV major depressive disorder was assessed with the depression module of the WHO Composite International Diagnostic Interview (CIDI). A global cognitive function score was obtained through neuropsychological tests. Product terms between depression and cognition were introduced in multivariable logistic regression models to test for interaction.

RESULTS

Lower cognitive function and depression were both significantly associated with severe disability in all countries. A significant interaction was only found in Finland where the ORs (95% CIs) of depression for severe disability at the 25th (worse), 50th, and 75th (better) percentiles of cognitive function were 7.26 (4.28-12.32), 11.1 (6.7-18.38), and 17.56 (9.29-33.2), respectively.

CONCLUSION

People with depression and cognitive decline are likely to benefit from the usual evidence-based treatments to reduce the burden of disability. However, in Finland, those with better cognitive function may benefit from more aggressive depression treatment. Future research is warranted to assess whether our results may be replicated.

An Examination of the Disablement Process Among Older American Indians: The Native Elder Care Study

PURPOSE OF THE STUDY

Older American Indians disproportionately suffer from poorer physical and mental health and have greater disability compared to their racial and ethnic counterparts. The purpose of this study was to examine the disablement process among older American Indians.

DESIGN AND METHODS

Data analyzed were from the Native Elder Care Study, which included in-person interviews with 505 community-dwelling American Indians aged ≥55 years. We used structural equation modeling to examine the contributive direct and indirect effects of health, demographic, and psychosocial risk factors on disability.

RESULTS

Pathology had direct and indirect effects through social support and depressive symptoms on chronic pain intensity. Pathology also had direct and indirect effects on disability. Chronic pain intensity was a significant mediator between pathology and functional limitations. With contributive effects of older age and female sex, greater functional limitations were associated with increased disability.

IMPLICATIONS

Our results support the theorized main pathway of the Disablement Process Model with our sample of older American Indians. Our findings support the importance of taking into account intra and extraindividual factors in assessing the prevalence and incidence of disability for older American Indians.

Stability in Cognitive Function Over 18 Years: Prevalence and Predictors among Older Mexican Americans

PURPOSE

Numerous studies have examined the association of physical, behavioral and social factors with cognitive decline in older adults. Less attention has been placed on factors associated with long-term maintenance of intact cognition even into very old age. A greater understanding of those factors can inform the development of activities for maintaining cognitive strength.

METHODS

Using a sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of non-institutionalized Mexican Americans aged 65 and older from five Southwestern states (N = 2767), latent class mixture models were developed to identify subgroups of cognitive change over time.

RESULTS

Three distinct trajectories of cognitive change were identified and characterized as stable, slow decline and rapid decline. Compared to the rapid decline group, a higher proportion of the stable cognition group were women, had high school education, were married and attended church one or more times per week. Regular church attendance had a significant positive impact in the stable group (β = 0.64, p <0.01), the slow decline group (β = 0.84, p <0.001) and the rapid decline group (β = 2.50, p <0.001). Activity limitations had a consistently negative association with cognition in the stable, slow decline and rapid decline groups (β = -0.37, p <0.001; β = -0.85, p <0.001; and β = -1.58, p <0.001 respectively).

CONCLUSION

Substantial heterogeneity exists in rates of cognitive decline among older Mexican Americans. Interventions targeting cognitive maintenance may benefit from increased focus on factors associated with continued social engagement.

Falls and cognitive decline in Mexican Americans 75 years and older

Background

Little is known about long-term emotional and cognitive consequences of falls. We examined the association between falls and subsequent cognitive decline, and tested the hypothesis that depression would mediate any falls–cognition association among cognitively intact Hispanic Elders.

Methods

We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine change in Mini Mental State Examination (MMSE) scores over the 6-year period according to number of falls. All participants (N=1,119) had MMSE scores ≥21 and complete data on Center for Epidemiologic Studies of Depression Scale, social and demographic factors, medical conditions (diabetes, heart attack, stroke, and hypertension), and hand grip muscle strength.

Results

At baseline, participants’ mean age was 80.8 years (range, 74–109), mean education was 6.3 years (range, 0–17), and mean MMSE was 25.2 (range, 21–30). Of the 1,119 participants, 15.8% experienced one fall and 14.4% had two or more falls. In mixed model analyses, having two or more falls was associated with greater decline in MMSE score (estimate =−0.81, standard error =0.19, P<0.0001) compared to having no fall, after adjusting for age, sex, marital status, and education. The magnitude of the association decreased (estimate =−0.65, standard error =0.19, P=0.0007) when adjustment was made for high depressive symptoms, suggesting a possible mediating effect of depression on the falls–cognition association. Female sex, high level of education, and high performance in hand grip muscle strength were associated with a slower decline in MMSE scores.

Conclusion

Having two or more falls was independently associated with steeper decline in cognition over 6 years, with a possible mediating effect of depression on the falls–cognition association.

Life-Space Assessment scale to assess mobility: validation in Latin American older women and men

BACKGROUND

The Life-Space Assessment (LSA) instrument of the University of Alabama and Birmingham study is a useful and innovative measure of mobility in older populations. The purpose of this article was to assess the reliability, construct and convergent validity of the LSA in Latin American older populations.

METHODS

In a cross-sectional study, a total of 150 women and 150 men, aged 65-74 years, were recruited from seniors' community centers in Manizales, Colombia and Natal, Brazil. The LSA questionnaire summarizes where people travel (5 levels from room to places outside of town), how often and any assistance needed. Four LSA variables were obtained according to the maximum life space achieved and the level of independence. As correlates of LSA, education, perception of income sufficiency, depression, cognitive function, and functional measures (objective and subjectively measured) were explored. The possible modifying effect of the city on correlates of LSA was examined.

RESULTS

Reliability for the composite LSA score was substantial (ICC = 0.70; 95 % CI 0.49-0.83) in Manizales. Average levels of LSA scores were higher in those with better functional performance and those who reported less mobility difficulties. Low levels of education, insufficient income, depressive symptoms, and low scores of cognitive function were all significantly related to lower LSA scores. Women in both cities were more likely to be restricted to their neighborhood and had lower LSA scores.

CONCLUSION

This study provides evidence for the validity of LSA in two Latin American populations. Our results suggest that LSA is a good measure of mobility that reflects the interplay of physical functioning with gender and the social and physical environment.

The dynamic relationship between physical function and cognition in longitudinal aging cohorts

On average, older people remember less and walk more slowly than do younger persons. Some researchers argue that this is due in part to a common biologic process underlying age-related declines in both physical and cognitive functioning. Only recently have longitudinal data become available for analyzing this claim. We conducted a systematic review of English-language research published between 2000 and 2011 to evaluate the relations between rates of change in physical and cognitive functioning in older cohorts. Physical functioning was assessed using objective measures: walking speed, grip strength, chair rise time, flamingo stand time, and summary measures of physical functioning. Cognition was measured using mental state examinations, fluid cognition, and diagnosis of impairment. Results depended on measurement type: Change in grip strength was more strongly correlated with mental state, while change in walking speed was more strongly correlated with change in fluid cognition. Examining physical and cognitive functioning can help clinicians and researchers to better identify individuals and groups that are aging differently and at different rates. In future research, investigators should consider the importance of identifying different patterns and rates of decline, examine relations between more diverse types of measures, and analyze the order in which age-related declines occur.

Life-space mobility in Mexican Americans aged 75 and older

OBJECTIVES

To examine the factors associated with life-space mobility in older Mexican Americans.

DESIGN

Cross-sectional study involving a population-based survey.

SETTING

Hispanic Established Population for the Epidemiologic Study of the Elderly survey conducted in the southwestern of United States (Texas, Colorado, Arizona, New Mexico, and California).

PARTICIPANTS

Seven hundred twenty-eight Mexican-American men and women aged 75 and older.

MEASUREMENTS

Sociodemographic factors, self-reported physician diagnoses of medical conditions (arthritis, diabetes mellitus, heart attack, stroke, hip fracture, and cancer), depressive symptoms, cognitive function, body mass index (BMI), upper and lower extremity muscle strength, Short Physical Performance Battery (SPPB), activities of daily living (ADLs), and the life-space assessment (LSA) were assessed in in-home interviews.

RESULTS

The mean age of participants was 84.2 ± 4.2. Sixty-five percent were female. Mean LSA score was 41.7 ± 20.9. Multiple regression analysis showed that older age, being female, limitation in ADLs, stroke, high depressive symptoms, and a BMI index of 35 kg/m(2) and greater were significantly associated with lower LSA scores. Education and better lower extremity function and muscle strength were factors significantly associated with higher LSA scores.

CONCLUSION

Older Mexican Americans had restricted life-space, with approximately 80% limited to their home or neighborhood. Older age, female sex, stroke, high depressive symptoms, BMI of 35 kg/m(2) or greater, and ADL disability were related to less life-space. Future studies are needed to examine the association between life-space and health outcomes and to characterize the trajectory of life-space over time in this population.

Rastreamento da função cognitiva de idosos não-institucionalizados

O objetivo deste trabalho foi avaliar a função cognitiva dos idosos e determinar a frequência do déficit cognitivo, estratificando-os por idade, escolaridade, passatempo, relação social, doenças crônicas informadas e depressão. A uma amostra aleatória de 394 idosos com idade igual ou maior que 60 anos do município de Batatais (SP) foi aplicado questionário sobre condições socioeconômicas, saúde e Escala de Depressão Geriátrica (EDG). Para rastrear o déficit cognitivo, foi utilizado o MEEM - Mini-Exame do Estado Mental modificado. Na avaliação do desempenho cognitivo, usou-se ponto de corte 23. Observou-se que 81,7% dos idosos ficaram acima desse ponto e 18,3% ficaram abaixo. Os idosos que tiveram os escores mais elevados foram associados a fatores como idade (60-69 anos), nível de escolaridade, hábito de leitura, boa relação social, principalmente com familiares, e não ter hipertensão arterial, diabete, incontinência urinária, catarata e ou sintomas depressivos. O desempenho cognitivo global dos idosos avaliado pelo instrumento baseado no MEEM revelou que aqueles com escores abaixo do ponto de corte tiveram proporção semelhante à encontrada em outros estudos.

The effect of cognitive impairment on the predictive value of multimorbidity for the increase in disability in the oldest old: the Leiden 85-plus Study

Background: prevention of disability is an important aim of healthcare for older persons. Selection of persons at risk is a first crucial step in this process.

Objectives: this study investigates the predictive value of multimorbidity for the development of disability in the general population of very old people and the role of cognitive impairment in this association.

Design: the Leiden 85-plus Study (1997–2004) is an observational prospective cohort study with 5 years of follow-up.

Setting: general population of the city of Leiden, the Netherlands.

Subjects: population based sample of 594 participants aged 85 years.

Methods: disability in activities of daily living (ADL) was measured annually for 5 years with the Groningen Activity Restriction Scale (range 9–36, 9 = optimal). Multimorbidity is defined as the presence of two or more chronic diseases at age 85 years. Cognitive function was measured at baseline with the mini-mental state examination (MMSE).

Results: at baseline participants with multimorbidity had higher ADL disability scores compared with those without [median 11 inter-quartile range (IQR 9–16) versus 9 (IQR 9–13) ADL points, Mann–Whitney U test P < 0.001]. Stratified into four MMSE groups, ADL disability increased over time in all groups, even in participants without multimorbidity (P trend <0.001). Multimorbidity predicted accelerated increase in ADL disability in participants with MMSE of 28–30 points (n = 205, 0.67 points/year, P < 0.001), but not in participants with lower MMSE scores (all P > 0.100).

Conclusion: the predictive value of multimorbidity for the increase in ADL disability varies with cognitive function in very old people. In very old people with good cognitive function, multimorbidity predicts accelerated increase in ADL disability. This relation is absent in very old people with cognitive impairment.

The Five-Times-Sit-to-Stand test, a marker of global cognitive functioning among community-dwelling older women

OBJECTIVE

To determine whether there was an association between the Five-Times-Sit-to-Stand test (FTSS) and the global cognitive function assessed with Short-Portable-Mental-State-Questionnaire (SPMSQ) among the EPIDOS cohort.

DESIGN

Cross-sectional study corresponding to the baseline assessment of the EPIDOS study.

SETTING

Five French cities including Amiens, Lyon, Montpellier, Paris and Toulouse.

PARTICIPANTS

7421 community-dwelling older women (mean age 80.41 ± 0.04 years).

MEASUREMENTS

Time to achieve FTSS, and SPMSQ score. Age, body mass index, high number of comorbidities, cardiovascular risk factors, depression, regular physical activity, joint pain, quadriceps strength, visual acuity, use of psychoactive drugs, serum albumin, vitamin D deficiency (i.e., serum concentration < 10 ng/mL), and the influence of seasons and study centers were used as covariables. Subjects were divided into 2 groups according to SPMSQ score (either impaired < 8/10 or normal ≥ 8/10).

RESULTS

Compared to their counterparts, the women with cognitive impairment (n=1190, mean 81.51 ± 0.45 years) took more time in performing FTSS (17.8± 0.9 seconds versus 16.1 ± 0.3 seconds, P < 0.001). There was a significant negative association of SPMSQ score with FTSS (Unadjusted β=-0.02(95%CI -0.03;-0.01), P< 0.001; Fully Adjusted β=-0.03(95%CI -0.05;-0.01), P=0.003; Stepwise Backward Adjusted β=-0.02(95%CI -0.04;-0.01), P=0.005), as well as with advance in age (β=-0.04, P=0.006) and vitamin D deficiency (β=-0.34, P=0.011). The FTSS limit value in predicting moderate cognitive impairment was set at 15 seconds by a sensitivity analysis (negative predictive value=86%).

CONCLUSION

We found a negative association of FTSS with global cognitive performance. Achieving FTSS in less than 15 seconds made unlikely the existence of a moderate cognitive impairment. FTSS could be used as a tool in primary care medicine to exclude moderate cognitive decline.

Association between executive function and physical performance in older Korean adults: findings from the Korean Longitudinal Study on Health and Aging (KLoSHA)

Reduced executive function and physical performance are common age-related conditions. This study evaluated the associations between executive function and physical performance in a representative sample of older adults. Cross-sectional data were analyzed from a population-based sample of 629 men and women aged 65 or older and living in one typical city in Korea. Specific aspects of executive function were assessed using the trail making test, digit span test, and lexical fluency test to measure set shifting, working memory and cognitive flexibility functions. Physical performance was measured using performance-oriented mobility assessment (POMA) scores and isokinetic muscle strength. Subjects' self-efficacy was also assessed using the activities-specific balance confidence (ABC) scale. Results of the lexical fluency test were associated with POMA scores and muscle strength, independent of age, gender, education, comorbidity, physical activity status, depression, and global cognition, suggesting that reduced cognitive flexibility is associated with reduced physical performance and muscle strength. Self-efficacy was also independently associated with physical performance and muscle strength. Clinicians need to consider the association between executive function and physical performance when working to improve physical functioning in an aged population.

Trends in diabetes medication use and prevalence of geriatric syndromes in older Mexican Americans from 1993/1994 to 2004/2005

BACKGROUND

New diabetes medications introduced over the last decade have led to changes in diabetes treatment recommendations for the increasing number of elderly patients with diabetes. It is, however, not clear whether these changes are accompanied by changes in prevalence of comorbid geriatric syndromes.

OBJECTIVE

To determine whether changes in diabetes treatment between 1993/1994 and 2004/2005 were accompanied by changes in prevalence of geriatric syndromes in Mexican Americans aged 75 years and older.

METHODS

Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly were used. Participants aged 75 years and older with diabetes in 1993/1994 (n = 284) and in 2004/2005 (n = 324; new cohort added in 2004/2005) were included in the analyses. Medication use and geriatric syndromes prevalence rates were estimated and compared using descriptive and univariate statistics for continuous variables and contingency tables (chi(2)) for categorical variables.

RESULTS

Older Mexican Americans with diabetes in 2004/2005 were more likely to be taking 2 or more oral diabetes medications than were those in the 1993/1994 cohort; most of the drugs taken by the 2004/2005 cohort were the newly introduced oral diabetes medications. Use of insulin as sole diabetes therapy decreased from 20.3% in the 1993/1994 cohort to 7.5% in the 2004/2005 cohort. The 2004/2005 cohort reported longer diabetes duration and higher prevalence of obesity and hypertension; they were also more likely than the 1993/1994 cohort to have more geriatric syndromes: pain, arthritis, incontinence, and self-reported activities of daily living disability. No significant differences exist between the 2 cohorts in objective measures of cognitive and physical function.

CONCLUSIONS

Older Mexican Americans with diabetes in 2004/2005 used more of the newer diabetes medications and less insulin compared to the 1993/1994 cohort. The prevalence rates of geriatric syndromes were higher in the 2004/2005 cohort. Our findings suggest that screening for and treating comorbid geriatric syndromes is increasingly important for optimal geriatric diabetes care.

Cognitive status and future risk of frailty in older Mexican Americans

BACKGROUND

Because cognitive impairment and frailty share common risk factors (eg, high proinflammatory cytokines), we examined whether poor cognition predicts subsequent risk of frailty in initially nonfrail Mexican Americans aged 67 years and older.

METHODS

Frailty was defined as meeting one or more of the following components: (a) unintentional weight loss of >10 pounds, (b) weakness, (c) self-reported exhaustion, and (d) slow walking speed. Sociodemographic factors, Mini-Mental State Examination, medical conditions (stroke, heart attack, diabetes, arthritis, cancer, and hypertension), and depressive symptoms were obtained. Main outcome measure was risk of becoming frail over 10 years.

RESULTS

Out of 942 participants who were nonfrail at baseline (1995-1996), 57.8% were women and the mean age was 73.7 years (SD = 5.3). In general estimation equation models testing the relationship between Mini-Mental State Examination (<21 vs. ≥21) and the risk of becoming frail over a 10-year period, there was a significant association (odds ratio = 1.09, 95% confidence interval = 1.00-1.19; p = .0310)] between the cognition-by-time interaction and odds of becoming prefrail or frail over time. This association was independent of age, sex, marital status, education, time, and medical conditions, indicating that nonfrail participants with poor cognition had a 9% odds per year of becoming frail over time compared with those with good cognition.

CONCLUSION

Low Mini-Mental State Examination score was independently associated with increased risk of frailty over a 10-year period in older Mexican Americans. Low Mini-Mental State Examination score may be an early marker for future risk of frailty.

Is the emergence of functional ability decline in early old age related to change in speed of cognitive processing and also to change in personality?

OBJECTIVE

To test whether the onset of functional ability decline in early old age is related to change in speed of cognitive processing and personality characteristics.

METHOD

Among 500 randomly sampled participants, the 230 cases that did not show impairment in functional ability were selected. Mean age at Time 1 was 62.4 years. For this subsample, the emergence of functional ability decline was tracked across a 12-year observation period.

RESULTS

The emergence of functional ability decline was related to change in speed of cognitive processing. Decline in functional ability was also related to increased neuroticism and external control, whereas this was not the case regarding extraversion and internal control.

DISCUSSION

Cognitive processing speed was shown to be a predictor of functional disability decline; in addition, the results provided initial evidence that functional ability decline in the early aging phase could be accompanied by changes in personality, particularly neuroticism and external control.

Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women

PURPOSE

to investigate if the increased risk of disability onset among older people who live alone could possibly be moderated by either high social participation or by being satisfied with the social relations.

DESIGN AND METHODS

logistic regression models were tested using two waves in a study population of 2,697 non-disabled older men and women from The Danish Longitudinal Study on Preventive Home Visits.

RESULTS

living alone and low social participation were significant risk factors for later male disability onset. Not being satisfied with the social relations was significantly associated with onset of disability for both genders. Among men who lived alone low social participation was a significant predictor of disability onset [odds ratio, OR = 2.30 (1.00-5.29)]; for cohabiting men social participation was not associated with disability onset, [adjusted OR = 0.91 (0.49-1.71)]. Similar results were present concerning satisfaction with the social relations among men. There was no significant interaction for women.

CONCLUSIONS

the study suggests that men who live alone can possibly alleviate their risk of disability onset by being socially active and by having access to satisfactory social relations. Women do not seem to benefit as much from cohabitation as men, although women who live alone and who are not satisfied with their social relations also constitute a significant risk category.

The relationship between cognitive function and physical performance in older women: results from the women's health initiative memory study

BACKGROUND

Cognitive function and physical performance are associated, but the common sequence of cognitive and physical decline remains unclear.

METHODS

In the Women's Health Initiative Memory Study (WHIMS) clinical trial, we examined associations at baseline and over a 6-year follow-up period between the Modified Mini-Mental State (3MS) Examination and three physical performance measures (PPMs): gait speed (meters/second), chair stands (number of stands in 15 seconds), and grip strength (kilograms). Using mixed models, we examined the baseline 3MS as predictor of change in PPM, change in the 3MS as predictor of change in PPM, and baseline PPM as predictors of 3MS change.

RESULTS

Among 1,793 women (mean age = 70.3 years, 89% white, and mean 3MS score = 95.1), PPM were weakly correlated with 3MS-gait speed: r = .06, p = .02; chair stands: r = .09, p < .001; and grip strength: r = .10, p < .001. Baseline 3MS score was associated with subsequent PPM decline after adjustment for demographics, comorbid conditions, medications, and lifestyle factors. For every SD (4.2 points) higher 3MS score, 0.04 SD (0.04 m/s) less gait speed and 0.05 SD (0.29 kg) less grip strength decline is expected over 6 years (p </= .01 both). Changes in 3MS and PPM were associated, particularly with chair stands and grip strength (p < .003 both). Baseline PPMs were not associated with subsequent 3MS change.

CONCLUSIONS

Baseline global cognitive function and change in global cognitive function were associated with physical performance change, but baseline physical performance was not associated with cognitive change in this cohort. These analyses support the hypothesis that cognitive decline on average precedes or co-occurs with physical performance decline.

Profiles of functioning as predictors of mortality in old age: the advantage of a configurative approach

This study proposes the concept of functioning profile, by which one's status is summarized across essential functioning domains, and validates its efficiency in predicting mortality. The study analyzed data of two cohorts of community-dwelling Israelis aged 75 and over, nationally sampled in 1989 (N=1200) and 1999 (N=421), respectively. Eight groups with differential profiles reflected higher versus lower levels of functioning in three domains: physical (activities of daily living), cognitive (Orientation-Memory-Concentration test=OMC) and affective (depressive symptoms). The analyses predicted mortality within 4 years, adjusting for sociodemographic and health variables. Relative to the optimal profile, most functioning profiles represented groups having elevated mortality risks of considerable consistency across cohorts. Physical functioning was the most predictive component in the profiles, but its combinations with cognitive and affective functioning produced unique contributions to mortality prediction. The study suggests that the functioning profile, representing a person-centered configurative approach (i.e., one that considers the person's combined standing on key factors), is a useful concept for delineating risk groups in late life and evaluating risk factors in predicting mortality.

A novel aging phenotype of slow gait, impaired executive function, and depressive symptoms: relationship to blood pressure and other cardiovascular risks

BACKGROUND

Our objectives were to investigate the existence of a group of nondemented elderly individuals who simultaneously have impairments in cognition, mobility, and mood, and to examine the association between being a member of this group and elevated blood pressure and other cardiovascular conditions.

METHODS

The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston study is an ongoing prospective observational study of community-dwelling individuals. We analyzed the cross-sectional data collected at baseline (N=580, mean age=77.8 years, 64% women, 14% African American, mean Mini-Mental State Examination=27.2). Using latent profile analysis, we investigated the existence of a group of elderly participants with impairments in executive function (Trail Making Test Part B [TMT-B]), gait speed (two 4-m walk tests), and depressive symptoms (Center for Epidemiological Studies-Depression scale [CES-D]).

RESULTS

We identified a group (n=99 [17%]) with prolonged TMT-B, slow gait speed, and high CES-D scores. This group did not exist when we used a memory measure. Hypertension (p=.001), diabetes (p=.0002), congestive heart failure (p=.006), stroke (p=.005), and higher Framingham cardiovascular risk score (p=.0001) were associated with an increased likelihood of being a member in this group. This association with elevated systolic and pulse pressure, and stroke remained significant after multiple covariate adjustments.

CONCLUSIONS

There exists a group of elderly individuals in whom poor executive function, slow gait speed, and depressive symptoms occur simultaneously. Memory measures did not identify such a grouping. Elevated blood pressure and other cardiovascular diseases are independently associated with being a member of this group. Assessing these domains is an important part of the evaluation of the elderly patients with high vascular risk.

Physical function trajectories, depressive symptoms, and life satisfaction among the elderly in Taiwan

OBJECTIVE

The purpose of this study was to examine the effect of physical function trajectories on emotional health and subjective well-being among the elderly in Taiwan.

METHODS

Data was from a 6-year nation-representative panel for analysis. Physical function trajectories were categorized as independent, declined, disabled, improved, fluctuating, died well and died disabled. The effects of physical function trajectories on depressive symptoms and life satisfaction were examined by controlling for demographics, chronic disease, cognitive function and social support. Mixed linear modeling was used for analysis.

RESULTS

Among the physical trajectory groups, differences were shown between depressive symptoms and life satisfaction. An increase in the difficulty of physical function also increases depressive symptoms and reduces life satisfaction. The died-well group showed a difference from the independent group in depressive symptoms and life satisfaction, but these who died without disability did have better emotional health and subjective well-being than the disabled survivors.

CONCLUSION

Coping strategies and supporting resources to help the disabled elderly to improve their successful aging is suggested in future research and health policies.

Early parental depression and child language development

OBJECTIVE

To examine the effects of early maternal and paternal depression on child expressive language at age 24 months and the role that parent-to-child reading may play in this pathway.

PARTICIPANTS AND METHODS

The 9-month and 24-month waves from a national prospective study of children and their families, the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B), provided data on 4,109 two-parent families. Depressive symptoms were measured with a short form of the Center for Epidemiologic Studies Depression Scale (CES-D). Parents reported on positive parent-infant interactions, child expressive vocabulary, and demographic and health information at child age 9 and 24 months. Linear regression was used to estimate associations between depression, parenting, and child vocabulary. Structural equation modeling was used to test the hypothesis that parent reading behavior mediates the parent depression to child vocabulary pathway. These models were adjusted for demographic indicators.

RESULTS

As previously reported from this national sample, 14% of mothers and 10% of fathers exhibited elevated levels of depressive symptoms at 9 months. For both mothers and fathers, depression at 9 months was negatively associated with contemporaneous parent-to-child reading. Only for fathers, however, was earlier depression associated with later reading to child and related child expressive vocabulary development. A model describing this pathway demonstrated a significant indirect pathway from depression to vocabulary via parent reading to child.

CONCLUSIONS

Depression is a significant problem among both mothers and fathers of young children, but has a more marked impact on the father's reading to his child and, subsequently, the child's language development.

Effects of changes in depressive symptoms and cognitive functioning on physical disability in home care elders

BACKGROUND

This study sought to investigate the effect of changes in depression status on physical disability in older persons receiving home care, examine whether the effect is due to concomitant changes in cognitive status, and test whether affective state and cognitive ability interact to influence physical disability.

METHODS

Multilevel analyses were conducted using longitudinal data collected about every 3 months from older participants in Michigan's community-based long-term care programs (N = 13,129). The data set provided an average of nine repeated measures of depressive symptoms, cognitive functioning, and physical disability. We estimated the lag effects of within-person changes in depression and cognitive status, and their interaction, on physical disability measured by activities of daily living (ADL) and instrumental activities of daily living (IADL), controlling for health-related events that occurred in the interim.

RESULTS

Changes between not having and having depressive symptoms, including subsyndromal symptoms, are critical to physical disability for home care elders. The effects are independent of concomitant changes in cognitive status, which also have significant adverse effects on physical disability. There is some evidence that improvement of depression buffers the adverse effect of cognitive decline on IADL disability.

CONCLUSIONS

Providers should monitor changes in depression and cognitive status in home care elders. Early detection and treatment of subthreshold depression, as well as efforts to prevent worsening of cognitive status in home care elders, may have a meaningful impact on their ability to live at home.

Cognitive status and physical function in older african americans

OBJECTIVES

To investigate the relationship between global cognition, three specific domains of cognition, and lower extremity function in community-dwelling elderly African Americans (AAs) from two community settings.

DESIGN

Cross-sectional study.

SETTING

Community.

PARTICIPANTS

Ninety-six AA men and women aged 60 and older from two community settings, enrolled in the Boosting Minority Involvement (BMI) study, a community-based cohort study designed to increase research participation of older low-income AAs.

MEASUREMENTS

Physical performance was assessed using Short Physical Performance Battery score, which is composed of three timed tests: a 4-m walking task, static balance assessment, and a chair stand test. The Bushke Memory Impairment Screen (MIS) and Mini-Mental State Examination were used to assess global memory and global cognition, respectively. For domain-specific performance, three z-score composite scores (attention, verbal memory, and executive function) were developed using the Computer-based Assessment of Mild Cognitive Impairment.

RESULTS

All domains of cognition were significant predictors of lower extremity function except for verbal memory. Executive function and MIS were the best predictors of lower extremity function in adjusted models. Participants with poor executive function were more than four times as likely to have poorer lower extremity function (odds ratio=4.96, 95% confidence interval=1.07-23.0).

CONCLUSION

Global memory and executive function were the best predictors of lower extremity function in a sample of community-dwelling AA adults. Deficits in lower extremity function may depend on multifaceted higher executive function control processes.

The mini-mental state examination: age and education distribution for a Latin American population

The Mini Mental State Examination (MMSE) is used widely internationally. Data on population age and gender distribution of MMSE scores outside of the US is rare. The Composite International Diagnostic Interview (CIDI), which incorporates the MMSE, was administered to a household sample of 2978 individuals age 15 and older in Chile. DSM-III-R lifetime prevalence rates were estimated. The average MMSE score ranged from 16-29 depending on the level of educational attainment. Sociodemographic variables, including age marital status, urban-rural and income, impacted MMSE scores. When the MMSE scores were controlled for sociodemographic variables, those with any psychiatric disorder had significantly lower scores; however, specific diagnoses did not affect MMSE scores.

Neuropsychiatric symptoms are associated with disability in cognitively impaired Latino elderly with and without dementia: results from the Sacramento Area Latino study on Aging

OBJECTIVE

To examine the relationship between neuropsychiatric symptoms burden and disability in cognitively impaired older Latinos.

METHODS

Subjects in the cross-sectional study were 95 cognitively impaired (both demented and non-demented) non-institutionalized Latino elderly participating in an epidemiological cohort study and their family caregivers. Care recipient neuropsychiatric symptoms (Neuropsychiatric Inventory) and level of functional impairment (i.e. impairment in activities of daily living and instrumental activities of daily living) were assessed through interviews with family caregivers.

RESULTS

Both NPI total score and NPI depression subscale score were significantly associated with disability before and after controlling for potential confounding variables. The strength of the association between higher neuropsychiatric symptom levels and higher disability was similar for both the cognitively impaired not demented and demented groups.

CONCLUSIONS

Neuropsychiatric symptoms are associated with increased disability in a community sample of cognitively impaired Latino elderly. More effective identification and treatment of neuropsychiatric symptoms may improve functioning in older Latinos and reduce health disparities for this population.

Depressive symptoms and cognitive change in older Mexican Americans

To examine the association between presence of clinically relevant depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D] score >or= 16) and subsequent cognitive function (Mini-Mental State Examination [MMSE]) over a 7-year period in older Mexican Americans, a prospective cohort study was performed. Five south-western states contributed data to the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Participants included 2812 noninstitutionalized Mexican Americans aged 65 and older followed from 1993-1994 until 2000-2001. Cognitive change was assessed using the MMSE at baseline and at 2, 5, and 7 years of follow-up. Independent variables were sociodemographics, CES-D >or= 16, medical conditions (hypertension, diabetes, coronary artery disease, and stroke), and activities of daily living (ADL) status. A general linear mixed model was used to estimate cognitive change. There was a cross-sectional association between CES-D >or= 16 and lower MMSE score (estimate = -0.48; standard error [SE] = 0.15; P < .01), independent of age, gender, education, marital status, time of interview, ADL limitations, vision impairment, and medical conditions. In the fully adjusted longitudinal model, subjects with clinically relevant depressive symptoms had a greater decline in MMSE score over 7 years than those without clinically relevant depressive symptoms (estimate = -0.17; SE = 0.05; P < .001), adjusting for sociodemographics, ADL and medical conditions. Each point increase in the CES-D score was associated with a decline of 0.010 point in MMSE score per year (SE = 0.002; P < 0.0001), adjusting for relevant confounders. Presence of clinically relevant depressive symptoms was associated with subsequent decline in cognitive function over 7 years in older Mexican Americans, independent of demographic and health factors.

Influence of sociodemographic variables on neuropsychological test performance in Spanish-speaking older adults

There is limited information regarding the impact of sociodemographic variables on the neuropsychological test performance of the Spanish-speaking older adult residing in the United States (US). This study examines the influence of age, education, gender, age of arrival in the US, percentage of lifetime in the US, acculturation, and reported depressive symptoms on neuropsychological test performance in a group of cognitively normal Spanish-speaking elders, the majority of whom were Cuban born. Educational attainment had a broad effect on test scores, with the other variables having only limited effects. These results underscore the impact of educational attainment on neuropsychological test performance among the cognitively normal Spanish-speaking older adult.

Cognitive Function, Gait Speed Decline, and Comorbidities: The Health, Aging and Body Composition Study

BACKGROUND

Emerging evidence indicates an association between cognitive function and physical performance in late life. This study examines the relationship between cognitive function and subsequent gait speed decline among high-functioning older adults.

METHODS

Measures of global cognitive function (Modified Mini Mental State Examination [3MS]) and executive control function (ECF) (a clock drawing task [CLOX 1] and the 15-item Executive Interview [EXIT 15]) were obtained in the Health, Aging, and Body Composition Study in 1999-2000. Gait-speed (meters/second) was assessed over 20 meters at usual pace. Using a mixed model, we assessed the relationship between baseline cognitive function and gait-speed change over 3 years.

RESULTS

Two thousand, three hundred forty-nine older adults (mean age 75.6 +/- 2.9 years) completed the assessments. After adjustment for baseline gait speed, a 1-standard-deviation (SD) lower performance on each cognitive test was associated with greater gait-speed decline over 3 years: 0.016 m/s for the 3MS (SD = 8.1), 0.009 m/s for CLOX 1 (SD = 2.4), and 0.012 m/s for EXIT 15 (SD = 4.1) (p <.0005 for all). After adjustment for comorbidities, the effect size was attenuated for 3MS and CLOX 1, and the association for EXIT 15 was no longer significant. Depression score was most strongly associated with the EXIT 15 effect reduction.

CONCLUSION

Global and executive cognitive functions predict declines in gait speed. The association of ECF with gait speed decline is attenuated by comorbid conditions, particularly depression. Elucidation of the mechanisms underlying these associations may point to new pathways for the treatment of physical decline associated with diminished cognitive function.