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Chimsuwan P, Aniwattanapong D, Petchlorlian A, Suriyaamarit D. Biomechanics of sit-to-stand with dual tasks in older adults with and without mild cognitive impairment. Gait Posture 2024; 111:169-175. [PMID: 38705034 DOI: 10.1016/j.gaitpost.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The decline in cognitive function in older adults with mild cognitive impairment (MCI) may contribute to a change in movement pattern during sit-to-stand transitions (STS). However, when comparing older adults with MCI to older adults without MCI, there is a lack of evidence of kinematic and kinetic data during STS. Furthermore, while significant cognitive dual-task interference has been demonstrated in older adults with MCI, studies on the effects of dual motor tasks in MCI, particularly during STS, have not been reported. RESEARCH QUESTION Are there any differences in the movement time, joint angles, and maximum joint moments while performing STS under single- and dual-task conditions in older adults with and without MCI? METHODS In a cross-sectional study, 70 participants were divided into two groups: older adults with MCI and without MCI. Motion analysis and a force plate system were used to collect and analyze the STS movement. All participants were asked to do the STS movement alone and the STS with a dual motor task with the self-selected pattern on an adjustable bench. RESULTS Older adults with MCI had greater maximum trunk flexion during STS with a dual task than older adults without MCI and greater than STS alone. Furthermore, older adults with MCI had a greater ankle plantar flexion moment during STS with a dual task than during STS alone. SIGNIFICANCE Even though the STS task is one of the simplest functional activities, different strategies to achieve the STS action with dual tasks were found among older adults with and without MCI in terms of joint angle and joint moments.
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Affiliation(s)
- Perayut Chimsuwan
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Thailand
| | - Daruj Aniwattanapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Thailand; Chulalongkorn Cognitive, Clinical & Computational Neuroscience Lab, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thailand
| | - Aisawan Petchlorlian
- Geriatric Excellence Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Thailand
| | - Duangporn Suriyaamarit
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Thailand.
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Zhou N, Huang CM, Cai Q, Tzeng OJL, Huang HW. The effects of aging and perceived loneliness on lexical ambiguity resolution. Front Psychol 2022; 13:978616. [PMID: 36337565 PMCID: PMC9633133 DOI: 10.3389/fpsyg.2022.978616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022] Open
Abstract
Language is central to the interactional nature of the social life within which it is situated. To react or respond in a particular situation, we must be able to recognize the social situation. Growing evidence has demonstrated the negative impact of perceived loneliness on late-life executive functions. Yet little is known about how social factors impact language processing for older people. The current study aims to fill this gap, first by assessing age-related changes in lexical processing during Chinese word reading, second, by examining whether older adults’ individual differences, such as processing speed and verbal abilities, modulate meaning retrieval and, third, by investigating whether perceived loneliness can hinder word reading. The use of compound words in Chinese enables significant sublexical ambiguity, requiring varying executive load during word recognition: when a word’s constituent characters carry multiple meanings, readers must consider the meaning contributions of both constituent characters and use top-down word information to determine the most accurate meaning of the ambiguous character, a process termed “sublexical ambiguity resolution.” In this study, adults read real Chinese words (including both sublexically ambiguous and unambiguous words) and pseudowords, and they were asked to make lexical decisions. Older adults exhibited greater lexicality effects (i.e., real words were easier to be identified than pseudowords) and similar sublexical ambiguity effects compared with young adults. Among older participants, processing speed could account for their ability to differentiate between words and pseudowords. In contrast, the level of perceived loneliness modulated the efficacy of sublexical ambiguity resolution: the participants with higher perceived loneliness displayed a greater sublexical ambiguity disadvantage effect. These results indicate that perceived loneliness may affect the use of contextual information in meaning retrieval during reading. The findings provide an important link between social connections and language processing.
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Affiliation(s)
- Nannan Zhou
- Institute of Brain and Education Innovation, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Qing Cai
- Institute of Brain and Education Innovation, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Shanghai Center for Brain Science and Brain-Inspired Technology, Shanghai, China
| | - Ovid J L Tzeng
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Cognitive Neuroscience Laboratory Institute of Linguistics, Academia Sinica, Taipei, Taiwan
- College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei, Taiwan
- Hong Kong Institute for Advanced Study, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Hsu-Wen Huang
- Department of Linguistics and Translation, City University of Hong Kong, Kowloon, Hong Kong SAR, China
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Zipperer MB, Churilla JR, Stapleton JN, Richardson MR. Joint Effect of Cognitive Function and C-Reactive Protein on All-Cause Mortality Risk: 1999-2002 NHANES. Ann Epidemiol 2022; 74:111-117. [PMID: 35868614 DOI: 10.1016/j.annepidem.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Examine the joint effect of cognitive function and C-reactive protein (CRP) on all-cause mortality risk in older U.S. adults. METHODS Sample included 1,335 older adult (≥ 60 years of age) participants in the 1999-2002 National Health and Nutrition Examination Survey. A four-level variable was created using cognitive function and CRP concentration. Mortality was assessed using National Center for Health Statistics linked death records from the National Death Index. RESULTS Increased risk of all-cause mortality was revealed in adults with high CRP and low cognitive function and in those with low to average CRP and low cognitive function (P < 0.0001 for both). The joint effect of cognitive function and CRP on all-cause mortality risk differed according to sex. CONCLUSION Low cognitive function was associated with increased all-cause mortality risk independent of CRP concentration. Sex-stratified analyses revealed increased all-cause mortality risk in males with low cognitive function, independent of CRP concentration. However, in females, a significant increase in all-cause mortality risk was only observed in those with low to average CRP and low cognitive function.
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Affiliation(s)
- Madeline B Zipperer
- University of North Florida, Department of Clinical and Applied Movement Sciences, Jacksonville, FL 32224.
| | - James R Churilla
- University of North Florida, Department of Clinical and Applied Movement Sciences, Jacksonville, FL 32224
| | - Jessica N Stapleton
- University of North Florida, Department of Clinical and Applied Movement Sciences, Jacksonville, FL 32224
| | - Michael R Richardson
- University of North Florida, Department of Clinical and Applied Movement Sciences, Jacksonville, FL 32224
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Stine-Morrow EAL, McCall GS, Manavbasi I, Ng S, Llano DA, Barbey AK. The Effects of Sustained Literacy Engagement on Cognition and Sentence Processing Among Older Adults. Front Psychol 2022; 13:923795. [PMID: 35898978 PMCID: PMC9309613 DOI: 10.3389/fpsyg.2022.923795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/16/2022] [Indexed: 11/22/2022] Open
Abstract
Considerable evidence suggests that language processing depends on memory processes, which are vulnerable to declines with aging. Yet little is known about the effects of language processing in the form of sustained literacy engagement on memory and other aspects of cognition. In the current study, adults (60-79 years of age) were randomly assigned to an 8-week program of leisure reading (n = 38) or to an active puzzle control (n = 38). Relative to the control, the experimental group showed differential improvement in verbal working memory and episodic memory. The experimental group also showed evidence of enhanced conceptual integration in sentence processing. These effects did not vary as a function of personality characteristics (e.g., openness) hypothesized to be compatible with literacy engagement. These findings support the idea that the exercise of cognitive capacities in the context of everyday life may offset age-related impairment in areas of cognition engaged by the activity, regardless of dispositional fit.
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Affiliation(s)
- Elizabeth A. L. Stine-Morrow
- Beckman Institute, University of Illinois, Urbana, IL, United States
- Department of Educational Psychology, University of Illinois, Champaign, IL, United States
| | - Giavanna S. McCall
- Beckman Institute, University of Illinois, Urbana, IL, United States
- Department of Educational Psychology, University of Illinois, Champaign, IL, United States
| | - Ilber Manavbasi
- Beckman Institute, University of Illinois, Urbana, IL, United States
| | - Shukhan Ng
- Beckman Institute, University of Illinois, Urbana, IL, United States
| | - Daniel A. Llano
- Beckman Institute, University of Illinois, Urbana, IL, United States
| | - Aron K. Barbey
- Beckman Institute, University of Illinois, Urbana, IL, United States
- Department of Psychology, University of Illinois, Champaign, IL, United States
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Dąbrowska E, Pascual E, Macías Gómez-Estern B. Literacy improves the comprehension of object relatives. Cognition 2022; 224:104958. [PMID: 35339943 DOI: 10.1016/j.cognition.2021.104958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 09/21/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022]
Abstract
While there is a considerable body of research indicating that the acquisition of literacy has profound effects on many aspects of language and cognition, to our knowledge, very little is known about its effects on morphosyntax. In this paper, we explore the effects of literacy on the comprehension of Spanish object relative clauses, a structure which is typically acquired by literate children about the age of 10, i.e., after a considerable amount of exposure to written language. We tested three groups of native Spanish speakers (semi-literates, late-literates and high-literates) using a picture selection task. Subject relatives were used as a control condition. All three groups performed at ceiling on subject relatives (group means of 95% or above). In contrast, we observed very large differences in performance on object relatives, with the semi-literate group performing at chance (51% correct) and the late-literate group slightly above chance (65% correct). Performance in the high-literate group was much better, although not quite at ceiling (82% correct). The results appear to support the hypothesis that literacy helps in the acquisition of some aspects of grammar. This could be partly due to differences in IQ, metalinguistic awareness, working memory and/or executive functioning. The results are also consistent with the 'training wheels' hypothesis (Dąbrowska, 2020), according to which the availability of written representations facilitates the acquisition of difficult structures by easing memory load and enabling speakers to process sentences at their own pace.
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Affiliation(s)
- Ewa Dąbrowska
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany, and University of Birmingham, United Kingdom
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MEDEIROS NMD, ORTIZ KZ. Formal language assessment in low-educated persons with aphasia: can the lesion effect be distinguished from the education effect? ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:125-128. [DOI: 10.1590/0004-282x-anp-2020-0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Background: Language tests are important in the assessment and follow up of people with aphasia (PWA). However, language assessment in the low literacy population is still a challenge. Objective: To investigate whether a formal evaluation of aphasia is able to distinguish the neurological effect from the effect of low educational level in people with post-stroke aphasia. Methods: The sample consisted of a group of 30 aphasic subjects (AG) and a control group (CG) of 36 individuals, both with an educational level of 1-4 years. The Brazilian Montreal-Toulouse Language Assessment battery was applied to all subjects. Results: There were statistically significant differences between the groups in 19 out of the 20 tasks analyzed. Conclusions: These results suggest that formal evaluation procedures are able to detect language disorders resulting from stroke, even in subjects with low educational level.
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Wen M, Ren Q. Cognitive and psychological health implications of living alone among middle-aged and older adults in China. ASIAN POPULATION STUDIES 2021. [DOI: 10.1080/17441730.2021.1886715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Qiang Ren
- Centre for Social Research and Guanghua School of Management, Peking University, Beijing, People’s Republic of China
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Alirezaei M, Forouzannia SM, Yarahmadi P, Sahraian MA, Owji M, Bidadian M, Ghadiri F, Naser Moghadasi A. Demographic features, behavioral measures, and clinical factors as predictors of cognitive function in patients with multiple sclerosis. Mult Scler Relat Disord 2021; 49:102758. [PMID: 33567391 DOI: 10.1016/j.msard.2021.102758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND One of the most concerning features that involves 40-70% of patients with multiple sclerosis (MS) is cognitive impairment. Moreover, it affects various aspects of patients' life. In this regard, this study was conducted to find independent predictors of cognitive function. METHOD We performed a cross-sectional analysis on 92 patients chosen from MS clinic of Sina hospital, Iran. After completing a general questionnaire of demographic and various clinical features, the included participants (patients with RRMS) underwent neuropsychological assessment using Minimal Assessment of Cognitive function in Multiple Sclerosis (MACFIMS), Expanded disability Status Scale (EDSS), Beck Depression Inventory II (BDI-II), and National American Adult Reading Test (NAART). An un-weighted average of MACFIMS subscales z-scores was reported as cognitive index. In order to find the association between CI and different factors, each variable was entered in a simple regression model first. Then, a univariate multiple regression model was invoked to evaluate the predictors of cognitive index in patients. RESULTS Simple regression for cognitive index of 92 patients (86% female) with a mean age of 33.4±7.6 years old suffering of RRMS for 6.8±4.8 years revealed patients with history of former smoking (p=0.001), sole visual symptoms as the presentation sign of the study (β=-0.341, p=0.001), lower EDSS score (β=-0.299, p=0.005), higher NAART score (β=0.416, p≤0.0001), and college education (p=0.001), had better cognitive function in our study population. Such factors including age, educational status, BDI-II score, EDSS score, and disease duration were fixed and the other significant factors entered once separately and then simultaneously in the univariate multiple linear regression model. It was revealed that former smoking (β=-0.372, p≤0.0001), NAART (β=0.304, p=0.002), and EDSS (β= -0.185, P=0.045) are associated significantly with the cognitive function of patients with multiple sclerosis. CONCLUSION This study demonstrated NAART, as a proxy of premorbid intelligence, history of former smoking, and EDSS score may have effects on cognitive function in MS. Future studies need to be invoked for the evaluation of the causality relation of these factors.
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Affiliation(s)
- Mohammad Alirezaei
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Seyed Mohammad Forouzannia
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Pourya Yarahmadi
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Mahsa Owji
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Maryam Bidadian
- Department of psychology, School of humanities, Tarbiat Modares University, Tehran, Iran
| | - Fereshteh Ghadiri
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran.
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Ghose S, Dasgupta A, Paul B, Bandyopadhyay L, Ghosh P, Yadav A. Cognitive impairment and its predictors: A cross-sectional study among the elderly in a rural community of West Bengal. J Family Med Prim Care 2020; 9:4603-4612. [PMID: 33209770 PMCID: PMC7652164 DOI: 10.4103/jfmpc.jfmpc_604_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/10/2020] [Accepted: 07/02/2020] [Indexed: 11/21/2022] Open
Abstract
Context: With the aging of Indian society, maintaining salubrious cognitive health in late life is a public health priority. Early detection and possible prevention of cognitive impairment (CI), thus, will help in increasing the quality of life of elderly people and decreasing the social, psychological, and economic burden of their families and caregivers. Aims: The study aimed to assess proportion of CI and its predictors. Settings and Design: This community-based cross-sectional study was conducted among 135 elderly people selected from 15 villages out of a total 64 villages in rural field practice area Singur of AIIH&PH, Kolkata. Methods and Material: Cluster sampling technique was used and villages were selected according to probability proportional to size method. Data was collected using a predesigned, pretested structured schedule, which included sociodemographic and behavioral variables, Montreal cognitive assessment tool, Geriatric depression scale short form (GDS 15), and mini nutritional assessment tool. Statistical Analysis Used: Predictors of CI were assessed by univariate and multivariable logistic regression using MS-Excel 2016 and SPSS version 16 software. Results: Mean age of the study participants was 67.03 ± 6.7 years with 51.9% of them being females. Proportion of CI was observed to be 48.1% which was significantly associated with increasing age [AOR = 1.1 (1.02–1.13)], decreasing years of schooling [AOR = 1.1 (1.01–1.2)], depression [AOR = 2.7 (1.3–5.8)], and malnourished group [AOR = 4.5 (1.01–20.3)] Conclusion: The burden of CI among the study population was found to be quite high. It is an alarming situation which needs improved screening facility for early detection. Nutritional upliftment and screening for depression should also be done on a regular basis.
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Marsh JE, Hansson P, Sörman DE, Ljungberg JK. Executive Processes Underpin the Bilingual Advantage on Phonemic Fluency: Evidence From Analyses of Switching and Clustering. Front Psychol 2019; 10:1355. [PMID: 31244740 PMCID: PMC6581746 DOI: 10.3389/fpsyg.2019.01355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
Bilinguals often show a disadvantage in lexical access on verbal fluency tasks wherein the criteria require the production of words from semantic categories. However, the pattern is more heterogeneous for letter (phonemic) fluency wherein the task is to produce words beginning with a given letter. Here, bilinguals often outperform monolinguals. One explanation for this is that phonemic fluency, as compared with semantic fluency, is more greatly underpinned by executive processes and that bilinguals exhibit better performance on phonemic fluency due to better executive functions. In this study, we re-analyzed phonemic fluency data from the Betula study, scoring outputs according to two measures that purportedly reflect executive processes: clustering and switching. Consistent with the notion that bilinguals have superior executive processes and that these can be used to offset a bilingual disadvantage in verbal fluency, bilinguals (35-65 years at baseline) demonstrated greater switching and clustering throughout the 15-year study period.
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Affiliation(s)
- John E. Marsh
- Department of Environmental Psychology, University of Gävle, Gävle, Sweden
- School of Psychology, University of Central Lancashire, Preston, United Kingdom
| | | | | | - Jessica Körning Ljungberg
- Department of Psychology, Umeå University, Umeå, Sweden
- Division of Human Work Science, Luleå University of Technology, Luleå, Sweden
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Abstract
OBJECTIVE Health literacy (HL) is the degree to which an individual can obtain, process, and communicate basic health information to make appropriate health decisions. Understanding HL of patients can improve outcomes. Thus, we evaluated HL in women with pelvic floor disorders and investigated its relationship to patient demographics, reading level, and cognition. METHODS We conducted a cross-sectional study with a convenience sample of English-speaking women 18 years or older, recruited from female pelvic medicine and reconstructive surgery clinics from July 2016 to January 1, 2017. Patients with severe visual impairment or severe cognitive impairment were excluded. We used the reading comprehension passages of the short form of Test of Functional Health Literacy in Adults to assess HL, the reading subscale of the Wide Range Achievement Test 3 for reading level, and the Self-administered Gerocognitive Exam for cognition. RESULTS Among 196 participants, the mean age was 61.1 ± 13.3 years, 84.7% were white, and 54.1% were college educated. Most participants (95.4%) demonstrated adequate HL. Those with adequate HL were younger (60.5 ± 13.2 vs 71.8 ± 10.7, P = 0.01), had less cognitive impairment (12.5% vs 77.8%, P < 0.001), and more frequently had post-high school reading levels (70.1% vs 33.3%, P < 0.001). CONCLUSIONS Overall HL in the pelvic floor disorder population is high, but older patients with cognitive impairment and lower reading levels are at risk of inadequate HL. Lowering reading levels of educational materials and screening for cognitive impairment may be beneficial to patient understanding and health outcomes.
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Choi SK, Rose ID, Friedman DB. How Is Literacy Being Defined and Measured in Dementia Research? A Scoping Review. Gerontol Geriatr Med 2018; 4:2333721418812246. [PMID: 30505890 PMCID: PMC6256312 DOI: 10.1177/2333721418812246] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 01/22/2023] Open
Abstract
Literacy plays an important role in Alzheimer's disease and related dementias (ADRD); however, less is known about how literacy is being used and defined in ADRD studies. This study reviewed terminology being used to describe types and definitions of literacy and instruments used to assess literacy in ADRD research. Among the 219 studies retrieved from 3 databases, 50 met our inclusion criteria. Literacy terms used in ADRD studies varied: literacy (n = 28), health literacy (n = 9), and dementia literacy (n = 7) were the most often used terms, followed by financial literacy (n = 4), dementia knowledge (n = 3), AD knowledge (n = 2), mental health literacy (n = 2), AD literacy, digital literacy, health literacy about incontinence, and financial knowledge (n = 1 each). Thirty studies did not define literacy terms used. Among the 20 studies defining literacy, definitions were inconsistent across studies even when they used the same term. Surveys (n = 30), open-ended questions, vignettes, or focus groups (n = 10), self-perceived (n = 3) or interviewer assessed (n = 1) literacy levels were used to assess literacy. Ten studies did not specify literacy measurement. Various literacies have been examined in ADRD research with unclear definitions and some inadequate measures. Well-defined terms with valid measures are needed to better understand the role of literacies in ADRD research.
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Affiliation(s)
| | - India D Rose
- Health Research Informatics and Technology Division, Atlanta, GA, USA
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Rogers-Soeder TS, Blackwell T, Yaffe K, Ancoli-Israel S, Redline S, Cauley JA, Ensrud KE, Paudel M, Barrett-Connor E, LeBlanc E, Stone K, Lane NE, Tranah G. Rest-Activity Rhythms and Cognitive Decline in Older Men: The Osteoporotic Fractures in Men Sleep Study. J Am Geriatr Soc 2018; 66:2136-2143. [PMID: 30136716 PMCID: PMC6235690 DOI: 10.1111/jgs.15555] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine rest-activity circadian rhythm (RAR) and cognitive decline in older men. DESIGN Longitudinal. SETTING Osteoporotic Fractures in Men (MrOS) and ancillary Outcomes of Sleep Disorders in Men (MrOS Sleep) studies. PARTICIPANTS MrOS and MrOS Sleep participants (N=2,754; mean age 76.0 ± 5.3). MEASUREMENTS The Modified Mini-Mental State examination (3MS) was used to assess cognition at baseline (2003-05) and follow-up examinations (2005-06 and 2007-09). Wrist actigraphy was used to measure 24-hour activity counts at baseline. RAR variables included amplitude (strength of activity rhythm), mesor (mean activity level), pseudo F-statistic (overall circadian rhythm robustness), and acrophase (time of daily peak activity). RESULTS After an average of 3.4 ± 0.5 years, men with lower amplitudes, mesors, and pseudo F-statistics had greater decline in 3MS performance (amplitude: -0.7 points Q1 vs -0.5 points Q4, p<.001; mesor: -0.5 points Q1 vs -0.2 points Q4, p=.01; pseudo F-statistic: -0.5 points Q1 vs -0.3 points Q4, p<.001). Lower amplitudes and pseudo-F statistics were associated with greater odds of clinically significant cognitive decline (≥5-point decrease) (amplitude Q1 vs. Q4: odds ratio (OR)=1.4, 95% confidence interval (CI)=1.0-1.9; pseudo-F statistic Q1 vs Q4: OR=1.4, 95% CI=1.0-1.9). Men with phase-advanced acrophase had greater odds of clinically significant cognitive decline (OR=1.8, 95% CI=1.2-2.8). Results were adjusted for multiple confounders. CONCLUSION Several parameters of disrupted RAR (lower amplitude, pseudo F-statistic, mesor, phase-advanced acrophase) were associated with greater cognitive decline in older community-dwelling men. These findings contribute to a growing body of evidence suggesting that altered RARs are associated with cognitive decline in older adults. J Am Geriatr Soc 66:2136-2143, 2018.
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Affiliation(s)
- Tara S. Rogers-Soeder
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California, Davis, Sacramento, CA
| | - Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Sonia Ancoli-Israel
- Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, CA
| | - Susan Redline
- Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Kristine E. Ensrud
- Department of Medicine and Division of EpiCH, University of Minnesota AND Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN
| | - Misti Paudel
- Health Economics and Outcomes Research, Optum Life Sciences, Inc., Eden Prairie, MN
| | - Elizabeth Barrett-Connor
- Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, #0607, La Jolla, CA
| | - Erin LeBlanc
- Center for Health Research Northwest, Kaiser Permanente, Portland OR
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Nancy E. Lane
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California, Davis, Sacramento, CA
| | - Greg Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA
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14
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Suh SW, Han JW, Park JY, Hong JW, Kim K, Kim T, Lee KH, Han G, Jeong H, Seo J, Kim TH, Lee DY, Lee DW, Ryu SH, Kim SG, Youn JC, Jhoo JH, Kim JL, Lee SB, Lee JJ, Kwak KP, Kim BJ, Moon SW, Park JH, Kim KW. Impacts of Illiteracy on the Risk of Dementia: A Global Health Perspective. J Alzheimers Dis 2018; 53:731-41. [PMID: 27232216 DOI: 10.3233/jad-160108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite its significance as a contributing factor for late-life dementia risk, illiteracy is frequently underappreciated in the management of dementia. In this study, we estimated the proportion of dementia cases attributable to illiteracy using the population attributable fraction (PAF), and calculated to what extent the monetary cost of dementia could be saved in the future by reducing illiteracy from the South Korean, Latin American, South Asian/Middle Eastern, and African populations. We collected necessary data from the 2011 United Nations Human Development Report and prevalence studies conducted in these regions. Additional variables not included in the above sources were estimated using a logit model under a "trend scenario"-based assumption. Around 16% of the total number of dementia cases in South Korea in 2015 can be attributed to illiteracy, with this figure predicted to decline to around 2% by 2050. This translates to a saving in dementia care costs of approximately 52 billion USD, providing we are successful in theoretically eradicating illiteracy as of 2015, in the population aged 65 years or under. Likewise, reducing illiteracy to 50% in Latin America, South Asia/The Middle East, and Africa by 2050 could generate further cost savings of between 71 and 244 billion, 13 and 94 billion, and 17 and 78 billion USD, respectively. Even public policies aimed solely at reducing illiteracy in the childhood, adolescent, or middle-aged population could potentially have a role in the primary prevention of dementia. Moving forward, governments will need to address this issue in a purposeful and systematic manner.
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Affiliation(s)
- Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Young Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Woo Hong
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kayoung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taehyun Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Hwan Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Guehee Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyeon Jeong
- Department of Psychiatry, Woori-Seongsim Psychiatric Clinic, Siheung, Korea
| | - Jiyeong Seo
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Korea
| | - Shin-Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jong Chul Youn
- Department of Neuropsychiatry, Gyeonggi Provincial Hospital for the Elderly, Yongin, Korea
| | - Jin Hyeong Jhoo
- Department of Neuropsychiatry, Kangwon National University Hospital, Chuncheon, Korea
| | - Jeong Lan Kim
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Bong-Jo Kim
- Department of Psychiatry, Gyeongsang National University, School of Medicine, Jinju, Korea
| | - Seok Woo Moon
- Department of Psychiatry, Konkuk University, School of Medicine, Chungju, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University, College of Natural Sciences, Seoul, Korea
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15
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Abstract
There is a consistent association between education and depressive symptoms, but research on the mechanisms to explain this association remains limited. No study has formally evaluated the extent to which the association between education and depressive symptoms is mediated through a foundational skill such as literacy. Inverse odds ratio weighting (IORW) was used to estimate total, natural direct, and natural indirect effects in examining literacy as a mediator of the association between education and depressive symptoms. Health and Retirement Study participants born in the U.S. between 1900 and 1947 were interviewed biennially for up to 12 years (N = 16,718). Literacy was assessed with a brief vocabulary measure. Depressive symptoms were measured using the 8-item Centers for Epidemiologic Studies-Depression (CES-D) scale. Decomposition estimates were derived using regression analyses of repeated measures of depressive symptoms. Standard errors were obtained using a nonparametric bootstrap with the individual as the independent unit to account for dependence of observations within an individual. In a large cohort of older Americans, a one standard deviation difference in educational attainment (~ 3 years) was associated with a 0.35-point decrement in CES-D score (95% CI: -0.38, -0.32). This decrement represents a 0.22 standard deviation difference in depressive symptoms. Using IORW, the estimated effect of education on depressive symptoms mediated through literacy was -0.10 (95% CI: -0.18, -0.01), which represents 28% of the total effect. Education confers many benefits; as demonstrated by this study for depressive symptoms, one important benefit is literacy.
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Richards A, Inslicht SS, Metzler TJ, Mohlenhoff BS, Rao MN, O'Donovan A, Neylan TC. Sleep and Cognitive Performance From Teens To Old Age: More Is Not Better. Sleep 2017; 40:2972132. [PMID: 28364476 DOI: 10.1093/sleep/zsw029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives To determine the interaction of age and habitual sleep duration in predicting cognitive performance in a large sample of participants aged 15 to 89 years. Methods This study is a cross-sectional analysis of performance data gathered between January 2012 and September 2013. First-time players (N = 512823) of three internet cognitive training games measuring processing speed, working memory, visuospatial memory, and arithmetic participated in the study. Results Performance was based on a measure of speed and accuracy for each game. The relationship between performance and self-reported habitual sleep duration was examined in the sample as a whole and across 10-year age groups starting at age 15 and ending at 75 and older. Performance peaked at 7 h of sleep duration for all three games in the sample as a whole, and the decrements in performance for sleep durations greater than 7 h were either comparable or greater in the youngest as compared to the oldest age groups. Conclusions These findings challenge the hypothesis that deteriorating cognitive performance with long sleep duration is driven by medical comorbidities associated with aging. Further, these data are consistent with an optimal dose model of sleep and suggest that the model for the homeostatic recovery of cognitive function as a function of sleep duration should incorporate a curvilinear decline with longer duration sleep, indicating that there may be a cost to increased sleep. Replication and further research is essential for clarifying the sleep duration-cognition relationship in youth and adults of all ages.
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Affiliation(s)
- Anne Richards
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | - Sabra S Inslicht
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | | | - Brian S Mohlenhoff
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | | | - Aoife O'Donovan
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | - Thomas C Neylan
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
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17
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Hahn EA, Magasi SR, Carlozzi NE, Tulsky DS, Wong A, Garcia SF, Lai JS, Hammel J, Miskovic A, Jerousek S, Goldsmith A, Nitsch K, Heinemann AW. Health and Functional Literacy in Physical Rehabilitation Patients. Health Lit Res Pract 2017; 1:e71-e85. [PMID: 31294252 PMCID: PMC6607848 DOI: 10.3928/24748307-20170427-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/05/2017] [Indexed: 11/20/2022] Open
Abstract
Background People with disabilities, who face multiple barriers to care, experience health disparities, yet few studies have measured health literacy in this population. Objective This study evaluated functional literacy, health literacy, fluid cognitive function, and self-reported health in people who live in community dwellings with spinal cord injury, stroke, or traumatic brain injury. Methods Participants with a traumatic spinal cord injury, stroke, or traumatic brain injury, one-year postinjury, and age 18 to 85 years, completed a battery of instruments at three medical centers in the Midwestern U.S.: functional literacy (word recognition, vocabulary knowledge), health literacy (comprehension of prose, document, and quantitative health information), fluid cognitive function (memory, executive function, and processing speed), and patient-reported outcomes (mobility, fatigue, sadness, anxiety, social function, and overall health). Key Results There were strong correlations between functional literacy, health literacy, and fluid cognitive function. After adjustment for sociodemographic and clinical characteristics, higher health literacy was associated with better mobility, less anxiety, and better overall health; higher functional literacy was associated with less anxiety and better overall health; and higher fluid cognitive function was associated with better mobility, less sadness, better social function, and better overall health. Conclusions To effectively address limited health literacy among people with spinal cord injury, stroke, and traumatic brain injury, and ensure that they are able to be informed partners in their health care, intervention is required at the level of patients, providers, and health care delivery systems. A special consideration is to ensure that health information is both well-targeted to people's health literacy levels and accessible for people with a range of physical, cognitive, and sensory limitations. The multimedia self-administered health literacy measure used in this study could be useful to rehabilitation providers and designers of health information and interfaces. [Health Literacy Research and Practice. 2017;1(2):e71-e85.]. Plain Language Summary Health literacy represents people's abilities to obtain, understand, and use health information to make informed decisions about their health and health care. People with disabilities face physical, attitudinal, economic, and structural barriers to care. Consideration of health literacy in rehabilitation practice can enhance the effectiveness of the patient-clinician relationship and help address the needs of this population.
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Affiliation(s)
- Elizabeth A. Hahn
- Address correspondence to Elizabeth A. Hahn, MA, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. Saint Clair Street, Suite 1900, Chicago, IL 60611;
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18
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Huang SW, Chi WC, Yen CF, Chang KH, Liao HF, Escorpizo R, Chang FH, Liou TH. Does more education mean less disability in people with dementia? A large cross-sectional study in Taiwan. BMJ Open 2017; 7:e013841. [PMID: 28473510 PMCID: PMC5566594 DOI: 10.1136/bmjopen-2016-013841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) is a feasible tool for assessing functional disability and analysing the risk of institutionalisation among elderly patients with dementia. However, the data for the effect of education on disability status in patients with dementia is lacking. The aim of this large-scale, population-based study was to analyse the effect of education on the disability status of elderly Taiwanese patients with dementia by using WHODAS 2.0. METHODS From the Taiwan Data Bank of Persons with Disability, we enrolled 7698 disabled elderly (older than 65 years) patients diagnosed with dementia between July 2012 and January 2014. According to their education status, we categorised these patients with and without formal education (3849 patients each). We controlled for the demographic variables through propensity score matching. The standardised scores of these patients in the six domains of WHODAS 2.0 were evaluated by certified interviewers. Student's t-test was used for comparing the WHODAS 2.0 scores of patients with dementia in the two aforementioned groups. Poisson regression was applied for analysing the association among all the investigated variables. RESULTS Patients with formal education had low disability status in the domains of getting along and social participation than did patients without formal education. Poisson regression revealed that standardised scores in all domains of WHODAS 2.0-except self-care-were associated with education status. CONCLUSIONS This study revealed lower disability status in the WHODAS 2.0 domains of getting along and social participation for patients with dementia with formal education compared with those without formal education. For patients with disability and dementia without formal education, community intervention of social participation should be implemented to maintain better social interaction ability.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chou Chi
- School of Occupational Therapy, College of Medicine, Chungshan Medical University, Taichung, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hua-Fang Liao
- Chinese Association of Early Intervention Profession for Children with Developmental Delays, Hualien City, Taipei, Taiwan
- School and Graduate Institute of Physical Therapy, College of Medicine, Chungshan Medical University, Taipei, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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19
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Mwamburi M, Qiu WQ. Different associations of premorbid intelligence vs. current cognition with BMI, insulin and diabetes in the homebound elderly. ACTA ACUST UNITED AC 2016; 3:547-552. [PMID: 27642517 PMCID: PMC5026314 DOI: 10.15761/imm.1000202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Premorbid intelligence does not decline through life even at the early stages of Alzheimer’s disease (AD). However, other cognitive measures such as Mini Mental State Examination (MMSE) decline with aging and severely with dementia. In this study, we examine the associations of premorbid intelligence vs. current cognition with body mass index (BMI), insulin and diabetes in elderly adults. Using a cross-sectional, population-based study, we assessed BMI, plasma insulin and the evidence of diabetes in homebound elders. The North American Adult Reading Test (NAART) and MMSE were conducted. Associations were assessed by T-test, linear correlation and multivariate regression analysis. Subjects were divided into four subgroups: 1) BMI <25; 2) 25 < BMI <30; 3) 30 < BMI <35 and 4) BMI >35. Lower verbal IQ, assessed by NAART, was associated with higher BMI (β=−0.28; P<0.01), elevated insulin (β= −0.02, P=0.02), and diabetes (β=− 3.18, P<0.01). Multivariate regression analyses showed that all three clinical conditions – obesity, hyperinsulinaemia and diabetes – were associated with lower premorbid intelligence assessed by verbal IQ, but only diabetes was associated with current cognitive impairment assessed by MMSE. These relationships persisted after adjustment for education. Premorbid intelligence is associated with diabetes precursors – obesity and high insulin – and diabetes itself, but cognitive impairment is related to diabetes only. Understanding the mechanisms that link verbal IQ to diabetes precursors might suggest targeted interventions for the prevention of diabetes and cognitive decline caused by diabetes.
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Affiliation(s)
- Mkaya Mwamburi
- Departments of Psychiatry, Boston University School of Medicine, Boston, US A
| | - Wei Qiao Qiu
- Departments of Psychiatry, Boston University School of Medicine, Boston, US A; Pharmacology, Boston University School of Medicine, Boston, USA; Alzheimer's Disease Center, Boston University School of Medicine, Boston, USA
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20
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Nguyen TT, Tchetgen Tchetgen EJ, Kawachi I, Gilman SE, Walter S, Liu SY, Manly JJ, Glymour MM. Instrumental variable approaches to identifying the causal effect of educational attainment on dementia risk. Ann Epidemiol 2015; 26:71-6.e1-3. [PMID: 26633592 DOI: 10.1016/j.annepidem.2015.10.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 09/17/2015] [Accepted: 10/18/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE Education is an established correlate of cognitive status in older adulthood, but whether expanding educational opportunities would improve cognitive functioning remains unclear given limitations of prior studies for causal inference. Therefore, we conducted instrumental variable (IV) analyses of the association between education and dementia risk, using for the first time in this area, genetic variants as instruments as well as state-level school policies. METHODS IV analyses in the Health and Retirement Study cohort (1998-2010) used two sets of instruments: (1) a genetic risk score constructed from three single-nucleotide polymorphisms (SNPs; n = 7981); and (2) compulsory schooling laws (CSLs) and state school characteristics (term length, student teacher ratios, and expenditures; n = 10,955). RESULTS Using the genetic risk score as an IV, there was a 1.1% reduction in dementia risk per year of schooling (95% confidence interval, -2.4 to 0.02). Leveraging compulsory schooling laws and state school characteristics as IVs, there was a substantially larger protective effect (-9.5%; 95% confidence interval, -14.8 to -4.2). Analyses evaluating the plausibility of the IV assumptions indicated estimates derived from analyses relying on CSLs provide the best estimates of the causal effect of education. CONCLUSIONS IV analyses suggest education is protective against risk of dementia in older adulthood.
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Affiliation(s)
- Thu T Nguyen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco.
| | - Eric J Tchetgen Tchetgen
- Department of Biostatistics, Harvard School of Public Health, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Stephen E Gilman
- Department of Epidemiology, Harvard School of Public Health, Boston, MA; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA; Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Stefan Walter
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco
| | - Sze Y Liu
- Harvard Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA
| | - Jennifer J Manly
- Department of Neurology, Sergievsky Center and the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY
| | - M Maria Glymour
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco
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21
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Stine-Morrow EAL, Hussey EK, Ng S. The Potential for Literacy to Shape Lifelong Cognitive Health. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/2372732215600889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In light of population aging, an understanding of factors that promote lifelong cognitive resilience is urgent. There is considerable evidence that education early in the life span, which promotes the development of literacy skills, leads to cognitive health and longevity, but the ways in which activity engagement in later adulthood affects long-term cognitive health is not well understood. The literature on cognitive training focusing on ability and skill training has not only demonstrated the existence of plasticity into late life but also shows that improvements are very tightly tied to the abilities trained. The rush to apply ability training to promote cognitive health has produced a vibrant “brain training” industry that neglects the very limited evidence for transfer to significant functional outcomes. Recent evidence on the neural substrates of reading, language comprehension, and discourse processing, as well as on the lifelong effects of literacy engagement in special populations, hints that reading may well be a “whole-brain exercise” with the potential to promote cognitive health. Such findings suggest promise for education-based approaches to promote lifelong cognitive health, calling for (a) societal investment in science at the interface of education and health, in particular to understand the mechanisms through which literacy engagement affects mind, brain, and physical health through the life span, and (b) innovation in developing models of life span education.
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22
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Opdebeeck C, Martyr A, Clare L. Cognitive reserve and cognitive function in healthy older people: a meta-analysis. AGING NEUROPSYCHOLOGY AND COGNITION 2015; 23:40-60. [PMID: 25929288 DOI: 10.1080/13825585.2015.1041450] [Citation(s) in RCA: 257] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The associations between proxy measures of cognitive reserve (CR) and cognition vary across studies and cognitive domains. This meta-analysis aimed to assess the relationship between CR and cognition in multiple domains (memory, executive function, visuospatial ability, and language). CR was considered in terms of three key proxy measures - educational level, occupational status, and engagement in cognitively stimulating activities - individually and in combination. One-hundred and thirty-five studies representing 128,328 participants were included. Of these, 109 used a measure of education, 19 used a measure of occupation, 31 used a measure of participation in cognitively stimulating activities, and 6 used a combination of these. All three proxy measures had a modest positive association with cognition; occupational status and cognitive activities showed the most variation across cognitive domains. This supports the view that the commonly used proxy measures of CR share an underlying process but that each additionally provides a unique contribution to CR.
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Affiliation(s)
- Carol Opdebeeck
- a Research in Ageing and Cognitive Health, School of Psychology , Bangor University , Bangor , UK
| | - Anthony Martyr
- b Centre for Research in Ageing and Cognitive Health, School of Psychology , University of Exeter , Exeter EX4 4QG , UK
| | - Linda Clare
- b Centre for Research in Ageing and Cognitive Health, School of Psychology , University of Exeter , Exeter EX4 4QG , UK
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23
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Correia R, Nieto A, Ferreira D, Sabucedo M, Barroso J. Fund of Information is More Strongly Associated with Neuropsychological Functioning Than Education in Older Spanish Adults. Arch Clin Neuropsychol 2015; 30:310-21. [PMID: 25762800 DOI: 10.1093/arclin/acv011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/15/2022] Open
Abstract
Educational influence on cognitive performance has been extensively agreed in Neuropsychology. Nonetheless, recent studies highlighted the need of better measurements to assess benefit from the schooling experience in order to further understand schooling influence on cognition. The WAIS-III Information subtest is proposed here to measure this influence at old age. Ninety-five older adults were divided according to their educational attainment and their Information subtest score, and completed extensive neuropsychological assessment. Performance on the Information subtest had a significant effect on all same cognitive functions as educational attainment, but also on additional domains. Moreover, cognitive performance on several tasks can be classified in three levels as a function of Information score. The WAIS-III Information subtest could be of special interest as a measurement of the benefit from educational experience not only to study cognition in Spanish older populations but also heterogeneous samples in terms of educational experiences and environments.
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Affiliation(s)
- Rut Correia
- Facultad de Educación, Universidad Diego Portales, Santiago 8370076, Chile
| | - Antonieta Nieto
- Facultad de Psicología, Universidad de La Laguna, Tenerife 38205, Spain
| | - Daniel Ferreira
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm 171 77, Sweden
| | - María Sabucedo
- Centro Geriatros de Ribeira, Santiago de Compostela 15960, Spain
| | - Jose Barroso
- Facultad de Psicología, Universidad de La Laguna, Tenerife 38205, Spain
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24
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Stolwyk R, Bannirchelvam B, Kraan C, Simpson K. The cognitive abilities associated with verbal fluency task performance differ across fluency variants and age groups in healthy young and old adults. J Clin Exp Neuropsychol 2015; 37:70-83. [DOI: 10.1080/13803395.2014.988125] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Kaup AR, Simonsick EM, Harris TB, Satterfield S, Metti AL, Ayonayon HN, Rubin SM, Yaffe K. Older adults with limited literacy are at increased risk for likely dementia. J Gerontol A Biol Sci Med Sci 2014; 69:900-6. [PMID: 24158765 PMCID: PMC4067115 DOI: 10.1093/gerona/glt176] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/06/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low literacy is common among the elderly and possibly more reflective of educational attainment than years of school completed. We examined the association between literacy and risk of likely dementia in older adults. METHODS Participants were 2,458 black and white elders (aged 71-82) from the Health, Aging and Body Composition study, who completed the Rapid Estimate of Adult Literacy in Medicine and were followed for 8 years. Participants were free of dementia at baseline; incidence of likely dementia was defined by hospital records, prescription for dementia medication, or decline in Modified Mini-Mental State Examination score. We conducted Cox proportional hazard models to evaluate the association between literacy and incidence of likely dementia. Demographics, education, income, comorbidities, lifestyle variables, and apolipoprotein E (APOE) ε4 status were included in adjusted analyses. RESULTS Twenty-three percent of participants had limited literacy (<9th-grade level). Limited literacy, as opposed to adequate literacy (≥9th-grade level), was associated with greater incidence of likely dementia (25.5% vs17.0%; unadjusted hazard ratio [HR] = 1.75, 95% confidence interval 1.44-2.13); this association remained significant after adjustment. There was a trend for an interaction between literacy and APOE ε4 status (p = .07); the association between limited literacy and greater incidence of likely dementia was strong among ε4 noncarriers (unadjusted HR = 1.85) but nonsignificant among ε4 carriers (unadjusted HR = 1.25). CONCLUSIONS Limited literacy is an important risk factor for likely dementia, especially among APOE ε4-negative older adults, and may prove fruitful to target in interventions aimed at reducing dementia risk.
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Affiliation(s)
- Allison R Kaup
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Medical Center, California. Department of Psychiatry, University of California San Francisco.
| | - Eleanor M Simonsick
- National Institute on Aging, Translational Gerontology Branch, Harbor Hospital, Baltimore, Maryland
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | | | | | - Kristine Yaffe
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Medical Center, California. Department of Psychiatry, University of California San Francisco. Department of Epidemiology and Biostatistics and Department of Neurology, University of California San Francisco
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26
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Yost KJ, DeWalt DA, Lindquist LA, Hahn EA. The association between health literacy and indicators of cognitive impairment in a diverse sample of primary care patients. PATIENT EDUCATION AND COUNSELING 2013; 93:319-26. [PMID: 23932515 PMCID: PMC3802526 DOI: 10.1016/j.pec.2013.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 07/01/2013] [Accepted: 07/08/2013] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To confirm the association of health literacy scores as measured by Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) with cognitive ability and education. To determine whether this association differs by cognitive task. METHODS Cognitive impairment was measured using the Mini-Cog, which combines a delayed word recall task (WRT) and a clock drawing task (CDT) to yield an overall classification of normal versus cognitively impaired. Participants were recruited from primary care clinics that provide care to underserved patients. RESULTS Participants (n=574) were predominantly non-Hispanic black (67%) with a mean age of 46 years, 50% did not have health insurance, 56% had a high school education or less and 21% screened positive for cognitive impairment. Overall cognitive ability and education were significantly associated with health literacy after adjusting for other variables, including race/ethnicity and physical health. We observed a stronger association between the CDT and health literacy than between the WRT and health literacy. CONCLUSION By confirming hypothesized associations, this study provides additional support of the validity of Health LiTT. PRACTICE IMPLICATIONS Health LiTT is a reliable and valid tool that researchers and clinicians can use to identify individuals who might have difficulty understanding health information.
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Affiliation(s)
- Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
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Ferreira D, Molina Y, Machado A, Westman E, Wahlund LO, Nieto A, Correia R, Junqué C, Díaz-Flores L, Barroso J. Cognitive decline is mediated by gray matter changes during middle age. Neurobiol Aging 2013; 35:1086-94. [PMID: 24239436 DOI: 10.1016/j.neurobiolaging.2013.10.095] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/22/2013] [Accepted: 10/26/2013] [Indexed: 01/09/2023]
Abstract
The present theoretical framework of Alzheimer's disease proposes that pathophysiological changes occur 10-20 years before the diagnosis of dementia. We addressed the question of how age-related changes in gray matter mediate the cognitive performance during middle age. Eighty-two participants (40-50 years, ±2) were assessed with a comprehensive neuropsychological battery covering a broad spectrum of cognitive domains and components. Mediation effects were studied with hierarchical regression and bootstrapping analysis. Results showed that more vulnerable cognitive components were related to executive functioning and in a lesser degree to processing speed. Age-related differences in gray matter mainly involved the frontal lobes. Moreover, age-related differences in visuoconstructive, visuospatial functions, reaction time, and mental flexibility and executive control were mediated by several gray matter regions. It is important to increase the knowledge of the impact of brain changes on cognitive function during middle age. To define the early stages of the aging process may allow early detection of pathologic changes and therapeutic interventions.
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Affiliation(s)
- Daniel Ferreira
- Faculty of Psychology, University of La Laguna, La Laguna, Tenerife, Spain; Department of Neurobiology, Care Sciences and Society, Section of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Yaiza Molina
- Faculty of Psychology, University of La Laguna, La Laguna, Tenerife, Spain
| | - Alejandra Machado
- Faculty of Psychology, University of La Laguna, La Laguna, Tenerife, Spain
| | - Eric Westman
- Department of Neurobiology, Care Sciences and Society, Section of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Section of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Antonieta Nieto
- Faculty of Psychology, University of La Laguna, La Laguna, Tenerife, Spain
| | - Rut Correia
- Faculty of Psychology, University of La Laguna, La Laguna, Tenerife, Spain
| | - Carme Junqué
- Departament de Psiquiatria i Psicobiologia Clínica, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - José Barroso
- Faculty of Psychology, University of La Laguna, La Laguna, Tenerife, Spain.
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Sung K, Gordon B, Yang S, Schretlen DJ. Evidence of semantic clustering in letter-cued word retrieval. J Clin Exp Neuropsychol 2013; 35:1015-23. [PMID: 24134125 DOI: 10.1080/13803395.2013.845141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Letter-cued word fluency is conceptualized as a phonemically guided word retrieval process. Accordingly, word clusters typically are defined solely by their phonemic similarity. We investigated semantic clustering in two letter-cued (P and S) word fluency task performances by 315 healthy adults, each for 1 min. Singular value decomposition (SVD) and generalized topological overlap measure (GTOM) were applied to verbal outputs to conservatively extract clusters of high-frequency words. The results generally confirmed phonemic clustering. However, we also found considerable semantic/associative clusters of words (e.g., pen, pencil, and paper), and some words showed both phonemic and semantic associations within a single cluster (e.g., pair, pear, peach). We conclude that letter-cued fluency is not necessarily a purely phonemic word retrieval process. Strong automatic semantic activation mechanisms play an important role in letter-cued lexical retrieval. Theoretical conceptualizations of the word retrieval process with phonemic cues may also need to be reexamined in light of these analyses.
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Affiliation(s)
- Kyongje Sung
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Apolinario D, Brucki SMD, Ferretti REDL, Farfel JM, Magaldi RM, Busse AL, Jacob-Filho W. Estimating premorbid cognitive abilities in low-educated populations. PLoS One 2013; 8:e60084. [PMID: 23555894 PMCID: PMC3605367 DOI: 10.1371/journal.pone.0060084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/24/2013] [Indexed: 11/30/2022] Open
Abstract
Objective To develop an informant-based instrument that would provide a valid estimate of premorbid cognitive abilities in low-educated populations. Methods A questionnaire was drafted by focusing on the premorbid period with a 10-year time frame. The initial pool of items was submitted to classical test theory and a factorial analysis. The resulting instrument, named the Premorbid Cognitive Abilities Scale (PCAS), is composed of questions addressing educational attainment, major lifetime occupation, reading abilities, reading habits, writing abilities, calculation abilities, use of widely available technology, and the ability to search for specific information. The validation sample was composed of 132 older Brazilian adults from the following three demographically matched groups: normal cognitive aging (n = 72), mild cognitive impairment (n = 33), and mild dementia (n = 27). The scores of a reading test and a neuropsychological battery were adopted as construct criteria. Post-mortem inter-informant reliability was tested in a sub-study with two relatives from each deceased individual. Results All items presented good discriminative power, with corrected item-total correlation varying from 0.35 to 0.74. The summed score of the instrument presented high correlation coefficients with global cognitive function (r = 0.73) and reading skills (r = 0.82). Cronbach's alpha was 0.90, showing optimal internal consistency without redundancy. The scores did not decrease across the progressive levels of cognitive impairment, suggesting that the goal of evaluating the premorbid state was achieved. The intraclass correlation coefficient was 0.96, indicating excellent inter-informant reliability. Conclusion The instrument developed in this study has shown good properties and can be used as a valid estimate of premorbid cognitive abilities in low-educated populations. The applicability of the PCAS, both as an estimate of premorbid intelligence and cognitive reserve, is discussed.
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Affiliation(s)
- Daniel Apolinario
- Geriatrics Division, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
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Coleman EA, Chugh A, Williams MV, Grigsby J, Glasheen JJ, McKenzie M, Min SJ. Understanding and Execution of Discharge Instructions. Am J Med Qual 2013; 28:383-91. [DOI: 10.1177/1062860612472931] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Amita Chugh
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Jim Grigsby
- University of Colorado Anschutz Medical Campus, Aurora, CO
- University of Colorado Denver, Denver, CO
| | | | | | - Sung-Joon Min
- University of Colorado Anschutz Medical Campus, Aurora, CO
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Schapira MM, Walker CM, Cappaert KJ, Ganschow PS, Fletcher KE, McGinley EL, Del Pozo S, Schauer C, Tarima S, Jacobs EA. The numeracy understanding in medicine instrument: a measure of health numeracy developed using item response theory. Med Decis Making 2012; 32:851-65. [PMID: 22635285 DOI: 10.1177/0272989x12447239] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health numeracy can be defined as the ability to understand and apply information conveyed with numbers, tables and graphs, probabilities, and statistics to effectively communicate with health care providers, take care of one's health, and participate in medical decisions. OBJECTIVE To develop the Numeracy Understanding in Medicine Instrument (NUMi) using item response theory scaling methods. DESIGN A 20-item test was formed drawing from an item bank of numeracy questions. Items were calibrated using responses from 1000 participants and a 2-parameter item response theory model. Construct validity was assessed by comparing scores on the NUMi to established measures of print and numeric health literacy, mathematic achievement, and cognitive aptitude. PARTICIPANTS Community and clinical populations in the Milwaukee and Chicago metropolitan areas. RESULTS Twenty-nine percent of the 1000 respondents were Hispanic, 24% were non-Hispanic white, and 42% were non-Hispanic black. Forty-one percent had no more than a high school education. The mean score on the NUMi was 13.2 (s = 4.6) with a Cronbach α of 0.86. Difficulty and discrimination item response theory parameters of the 20 items ranged from -1.70 to 1.45 and 0.39 to 1.98, respectively. Performance on the NUMi was strongly correlated with the Wide Range Achievement Test-Arithmetic (0.73, P < 0.001), the Lipkus Expanded Numeracy Scale (0.69, P < 0.001), the Medical Data Interpretation Test (0.75, P < 0.001), and the Wonderlic Cognitive Ability Test (0.82, P < 0.001). Performance was moderately correlated to the Short Test of Functional Health Literacy (0.43, P < 0.001). LIMITATIONS The NUMi was found to be most discriminating among respondents with a lower-than-average level of health numeracy. CONCLUSIONS The NUMi can be applied in research and clinical settings as a robust measure of the health numeracy construct.
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Affiliation(s)
- Marilyn M Schapira
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (MMS)
| | - Cindy M Walker
- Department of Educational Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin (CMW, KJC)
| | - Kevin J Cappaert
- Department of Educational Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin (CMW, KJC)
| | - Pamela S Ganschow
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County and Rush University Medical Center, Chicago, Illinois (PSG, SDP)
| | - Kathlyn E Fletcher
- Department of Medicine, Clement J. Zablocki VA Medical Center, and Medical College of Wisconsin, Milwaukee, Wisconsin (KEF)
| | - Emily L McGinley
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin (ELM, CS)
| | - Sam Del Pozo
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County and Rush University Medical Center, Chicago, Illinois (PSG, SDP)
| | - Carrie Schauer
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin (ELM, CS)
| | - Sergey Tarima
- Institute of Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin (ST)
| | - Elizabeth A Jacobs
- Department of Medicine, University of Wisconsin, Madison, Wisconsin (EAJ)
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Kavé G, Shrira A, Palgi Y, Spalter T, Ben-Ezra M, Shmotkin D. Formal education level versus self-rated literacy as predictors of cognitive aging. J Gerontol B Psychol Sci Soc Sci 2012; 67:697-704. [PMID: 22421808 DOI: 10.1093/geronb/gbs031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To compare the prediction of cognitive functioning by formal education and self-rated literacy and the differences in prediction across younger and older cohorts. METHOD Data on 28,535 respondents were drawn from a cross-sectional representative sample of community-dwelling older individuals (≥50), participating in the Survey of Health, Ageing, and Retirement in Europe. Education level was classified according to the International Standard Classification of Education 1997 (ISCED-1997) self-rated literacy was determined by having respondents rate their reading and writing on 1-5 scales. Cognitive functioning was measured by verbal recall, word fluency, and arithmetic ability. RESULTS Structural equation modeling demonstrated that self-rated literacy was more strongly associated with cognitive functioning than was education level, with or without additional exogenous variables (age, sex, household income, medical conditions, activities of daily living, reading eyesight, and country). The association between education level and cognitive functioning was weaker in older than in younger age groups, whereas the association between self-rated literacy and cognitive functioning showed the opposite trend. DISCUSSION Self-rated literacy was found to be a better predictor of late-life cognitive functioning than was the level of formal education. The results have implications for studies of age-related differences in which education level is taken into account.
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Affiliation(s)
- Gitit Kavé
- Department of Education and Psychology, The Open University, Ra'anana 43107, Israel.
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Memory performance, health literacy, and instrumental activities of daily living of community residing older adults. Nurs Res 2012; 61:70-5. [PMID: 22166912 DOI: 10.1097/nnr.0b013e31823b18f4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health literacy is associated with cognitive function across multiple domains in older adults, and these older adults may face special memory and cognitive challenges that can limit their health literacy and, in turn, their ability to live independently. OBJECTIVES The aim of this study was to evaluate if an association existed among health literacy, memory performance, and performance-based functional ability in community-residing older adults. METHODS Forty-five adults participated in this study. Designed to reflect everyday memory, the Rivermead Behavioral Memory Test (RBMT) bridges laboratory-based measures of memory and assessments obtained by self-report and observation. The RBMT classifies individuals into four categories of memory performance: normal, poor, mildly impaired, and severely impaired. The participants were recruited in the two categories of normal (≥22) or impaired (≤16) category on the RBMT. The sample consisted of 14 who were in the impaired category and 31 in the normal group. Their average age was 77.11 years, and their average number of years of education was 15.33 years. Health literacy scores measured with the Rapid Estimate of Adult Literacy in Medicine. RESULTS Health literacy scores were high (M = 65.09, SD = 2.80). Thirty-four participants or 76% of the sample scored a 66 out of a possible score of 80. Pearson correlations were calculated for the study variables. Health literacy scores with education and cognition (.30), memory performance groups (normal vs. poor; .25), and performance-based instrumental activities (.50) were associated significantly. DISCUSSION The development of a broader assortment of health literacy instruments would improve the ability of researchers to both compare studies and build on the knowledge and results of others.
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Abstract
Many aspects of patients’ experiences with illness, medication, and health care are best captured from patient-reported outcomes (PROs). In this article, we describe the process for constructing quality PRO instruments, from conceptual model development through instrument validation. We also discuss PROs as clinical trial end points and the potential of PRO data for aiding clinicians and patients in choosing from among multiple therapeutic options. Finally, we provide an overview of some existing PRO instruments.
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Affiliation(s)
- N E Rothrock
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Lowe DA, Rogers SA. Estimating Premorbid Intelligence among Older Adults: The Utility of the AMNART. J Aging Res 2011; 2011:428132. [PMID: 21629758 PMCID: PMC3100635 DOI: 10.4061/2011/428132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 01/07/2011] [Accepted: 02/24/2011] [Indexed: 11/20/2022] Open
Abstract
This study examines the utility of the American version of the National Adult Reading Test (AMNART) as a measure of premorbid intelligence for older adults. In a sample of 130 older adults, aged 56 to 104, the AMNART was compared to other tests of premorbid intelligence. The results revealed that AMNART-estimated IQ was significantly higher than other premorbid estimates. Across specific educational groups (i.e., 0–12, 13–16, and 17 or more years of education), AMNART-estimated IQ was inflated relative to all other premorbid estimates. The AMNART also declined as cognitive impairment increased, and there was a significant interaction between aging-related diagnostic group and premorbid estimate. The AMNART may therefore overestimate premorbid ability relative to other premorbid measures, particularly among those with greater cognitive impairment and lower levels of education. These results suggest that the AMNART should be used cautiously among older adults and in conjunction with other estimates of premorbid ability.
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Affiliation(s)
- Deborah A Lowe
- Department of Psychology, Westmont College, 955 La Paz Road, Santa Barbara, CA 93108, USA
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Chin J, Morrow DG, Stine-Morrow EAL, Conner-Garcia T, Graumlich JF, Murray MD. The process-knowledge model of health literacy: evidence from a componential analysis of two commonly used measures. JOURNAL OF HEALTH COMMUNICATION 2011; 16 Suppl 3:222-41. [PMID: 21951254 PMCID: PMC3310366 DOI: 10.1080/10810730.2011.604702] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We investigated the effects of domain-general processing capacity (fluid ability such as working memory), domain-general knowledge (crystallized ability such as vocabulary), and domain-specific health knowledge for two of the most commonly used measures of health literacy (S-TOFHLA and REALM). One hundred forty six community-dwelling older adults participated; 103 had been diagnosed with hypertension. The results showed that older adults who had higher levels of processing capacity or knowledge (domain-general or health) performed better on both of the health literacy measures. Processing capacity interacted with knowledge: Processing capacity had a lower level of association with health literacy for participants with more knowledge than for those with lower levels of knowledge, suggesting that knowledge may offset the effects of processing capacity limitations on health literacy. Furthermore, performance on the two health literacy measures appeared to reflect a different weighting for the three types of abilities. S-TOFHLA performance reflected processing capacity as well as general knowledge, whereas performance on the REALM depended more on general and health knowledge than on processing capacity. The findings support a process-knowledge model of health literacy among older adults, and have implications for selecting health literacy measures in various health care contexts.
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Affiliation(s)
- Jessie Chin
- Department of Educational Psychology, University of Illinois, Urbana-Champaign, Urbana, Illinois 61801, USA.
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Cavanaugh KL, Wingard RL, Hakim RM, Eden S, Shintani A, Wallston KA, Huizinga MM, Elasy TA, Rothman RL, Ikizler TA. Low health literacy associates with increased mortality in ESRD. J Am Soc Nephrol 2010; 21:1979-85. [PMID: 20671215 PMCID: PMC3014012 DOI: 10.1681/asn.2009111163] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 05/25/2010] [Indexed: 12/28/2022] Open
Abstract
Limited health literacy is common in the United States and associates with poor clinical outcomes. Little is known about the effect of health literacy in patients with advanced kidney disease. In this prospective cohort study we describe the prevalence of limited health literacy and examine its association with the risk for mortality in hemodialysis patients. We enrolled 480 incident chronic hemodialysis patients from 77 dialysis clinics between 2005 and 2007 and followed them until April 2008. Measured using the Rapid Estimate of Adult Literacy in Medicine, 32% of patients had limited (<9th grade reading level) and 68% had adequate health literacy (≥9th grade reading level). Limited health literacy was more likely in patients who were male and non-white and who had fewer years of education. Compared with adequate literacy, limited health literacy associated with a higher risk for death (HR 1.54; 95% CI 1.01 to 2.36) even after adjustment for age, sex, race, and diabetes. In summary, limited health literacy is common and associates with higher mortality in chronic hemodialysis patients. Addressing health literacy may improve survival for these patients.
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Affiliation(s)
- Kerri L Cavanaugh
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-2372, USA.
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Federman AD, Cole H, Sano M. Cognitive performance in community-dwelling English- and Spanish-speaking seniors. Age Ageing 2009; 38:669-75. [PMID: 19651699 DOI: 10.1093/ageing/afp127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES to examine the association of language (English vs Spanish), and commonly used measures of memory and word fluency among older adults. DESIGN cross-sectional. SETTING community-based settings in New York City, including senior centres and residential complexes. SUBJECTS four hundred and twenty independently living adults aged 60 or older (mean 73.8 years). METHODS participants completed the Mini-Mental State Exam (MMSE), animal naming test (ANT) and Wechsler Memory Scale III (WMS) Story A immediate and delayed subtests. Scores were examined by strata of language, age or education and for different thresholds of the MMSE. We tested the association of language and cognitive test performance using multivariable linear regression. RESULTS twenty-one per cent of subjects were interviewed in Spanish and 16.2% reported poor-fair English proficiency. The mean WMS scores were not statistically different between English and Spanish groups (immediate recall, 9.9 vs 9.5, P = 0.44; delayed recall, 8.0 vs 7.6, P = 0.36, respectively), whereas ANT scores did differ (16.6 vs 14.3, P < 0.0001). These associations were consistent across MMSE thresholds. The association of language and ANT score was not significant after accounting for education. CONCLUSIONS we found little difference in performance on the Story A subtests from the WMS suggesting that this test may be used for both English- and Spanish-speaking populations. Results suggest that variations in ANT performance may be accounted for by adjusting for the level of education. These results have important implications for the generalisability of test scores among diverse older populations.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Mehta KM, Stewart AL, Langa KM, Yaffe K, Moody-Ayers S, Williams BA, Covinsky KE. "Below average" self-assessed school performance and Alzheimer's disease in the Aging, Demographics, and Memory Study. Alzheimers Dement 2009; 5:380-7. [PMID: 19751917 DOI: 10.1016/j.jalz.2009.07.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 07/10/2009] [Accepted: 07/20/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND A low level of formal education is becoming accepted as a risk factor for Alzheimer's disease (AD). Although increasing attention has been paid to differences in educational quality, no previous studies addressed participants' own characterizations of their overall performance in school. We examined whether self-assessed school performance is associated with AD beyond the effects of educational level alone. METHODS Participants were drawn from the population-representative Aging, Demographics, and Memory Study (ADAMS, 2000-2002). The ADAMS participants were asked about their performance in school. Possible response options included "above average," "average," or "below average." The ADAMS participants also underwent a full neuropsychological battery, and received a research diagnosis of possible or probable AD. RESULTS The 725 participants (mean age, 81.8 years; 59% female; 16% African-American) varied in self-assessed educational performance: 29% reported "above average," 64% reported "average," and 7% reported "below average" school performance. Participants with a lower self-assessed school performance had higher proportions of AD: 11% of participants with "above average" self-assessed performance had AD, as opposed to 12% of participants with "average" performance and 26% of participants with "below average" performance (P < 0.001). After controlling for subjects' years in school, a literacy test score (Wide-Range Achievement Test), age, sex, race/ethnicity, apolipoprotein E-epsilon4 status, socioeconomic status, and self-reported comorbidities, respondents with "below average" self-assessed school performance were four times more likely to have AD compared with those of "average" performance (odds ratio, 4.0; 95% confidence interval, 1.2-14). "Above average" and "average" self-assessed school performance did not increase or decrease the odds of having AD (odds ratio, 0.9; 95% confidence interval, 0.5-1.7). CONCLUSIONS We suggest an association between "below average" self-assessed school performance and AD beyond the known association with formal education. Efforts to increase cognitive reserve through better school performance, in addition to increasing the number of years of formal education in early life, may be important in reducing vulnerability throughout the life course.
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Affiliation(s)
- Kala M Mehta
- Division of Geriatric Medicine, University of California at San Francisco, San Francisco, CA, USA.
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Bostrom N, Sandberg A. Cognitive enhancement: methods, ethics, regulatory challenges. SCIENCE AND ENGINEERING ETHICS 2009; 15:311-341. [PMID: 19543814 DOI: 10.1007/s11948-009-9142-5] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Accepted: 03/25/2009] [Indexed: 05/27/2023]
Abstract
Cognitive enhancement takes many and diverse forms. Various methods of cognitive enhancement have implications for the near future. At the same time, these technologies raise a range of ethical issues. For example, they interact with notions of authenticity, the good life, and the role of medicine in our lives. Present and anticipated methods for cognitive enhancement also create challenges for public policy and regulation.
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Affiliation(s)
- Nick Bostrom
- Future of Humanity Institute, Faculty of Philosophy & James Martin 21st Century School, Oxford University, Littlegate House, Oxford OX1 1PT, UK.
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Fichman HC, Fernandes CS, Nitrini R, Lourenço RA, Paradela EMDP, Carthery-Goulart MT, Caramelli P. Age and educational level effects on the performance of normal elderly on category verbal fluency tasks. Dement Neuropsychol 2009; 3:49-54. [PMID: 29213610 PMCID: PMC5619032 DOI: 10.1590/s1980-57642009dn30100010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cognitive decline, particularly executive dysfunction, is observed in normal aging. In Brazil, the elderly population presents broad educational diversity. Category verbal fluency tests are frequently used to detect cognitive impairment, assessing executive function, language and semantic memory. Objective To investigate the effects of age and education on category animal fluency task (CAF) in healthy elderly. Methods We evaluated 319 healthy elderly from outpatient care units of two university reference centers of Rio de Janeiro and São Paulo. The sample was divided into two age, and five schooling subgroups. To be included participants had to demonstrate preservation of global cognitive functioning, independence for activities of daily living and not fulfill diagnostic criteria for dementia. All participants were submitted to neurological and neuropsychological evaluations. Results There was a correlation between age and CAF performance (r= -0.26, p<0.01), which was not confirmed when years of education were included as a covariant in univariate ANCOVA. Significant differences were found in CAF performance among the different educational level groups on correlation analysis (r=0.42, p<0.01) and ANCOVA analysis (F=18.8, p<0.05). Illiteracy was associated with worst CAF performance, while university level was associated with best performance. Conclusion The best CAF performance was found in the first years of schooling (literacy learning process) compared to illiteracy, and when finishing high school and starting university courses compared to all other educational levels. These stages are associated with significant gains in semantic memory and executive function which are critical for verbal fluency performance.
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Affiliation(s)
- Helenice Charchat Fichman
- Departamento de Psicologia, Pontíficia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Departamento de Neurologia, Universidade de São Paulo, São Paulo, SP, Brazil.,Laboratório de Pesquisa em Envelhecimento Humano - GeronLab, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Departamento de Neurologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Conceição Santos Fernandes
- Laboratório de Pesquisa em Envelhecimento Humano - GeronLab, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Roberto Alves Lourenço
- Laboratório de Pesquisa em Envelhecimento Humano - GeronLab, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Departamento de Medicina Interna, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Paulo Caramelli
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Baker DW, Wolf MS, Feinglass J, Thompson JA. Health literacy, cognitive abilities, and mortality among elderly persons. J Gen Intern Med 2008; 23:723-6. [PMID: 18330654 PMCID: PMC2517873 DOI: 10.1007/s11606-008-0566-4] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 01/22/2008] [Accepted: 01/30/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low health literacy and low cognitive abilities both predict mortality, but no study has jointly examined these relationships. METHODS We conducted a prospective cohort study of 3,260 community-dwelling adults age 65 and older. Participants were interviewed in 1997 and administered the Short Test of Functional Health Literacy in Adults and the Mini Mental Status Examination. Mortality was determined using the National Death Index through 2003. MEASUREMENTS AND MAIN RESULTS In multivariate models with only literacy (not cognition), the adjusted hazard ratio was 1.50 (95% confidence of interval [CI] 1.24-1.81) for inadequate versus adequate literacy. In multivariate models without literacy, delayed recall of 3 items and the ability to serial subtract numbers were associated with higher mortality (e.g., adjusted hazard ratios [AHR] 1.74 [95% CI 1.30-2.34] for recall of zero versus 3 items, and 1.32 [95% CI 1.09-1.60] for 0-2 vs 5 correct subtractions). In multivariate analysis with both literacy and cognition, the AHRs for the cognition items were similar, but the AHR for inadequate literacy decreased to 1.27 (95% CI 1.03 - 1.57). CONCLUSIONS Both health literacy and cognitive abilities independently predict mortality. Interventions to improve patient knowledge and self-management skills should consider both the reading level and cognitive demands of the materials.
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Affiliation(s)
- David W Baker
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Evanston, IL, USA.
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Morrow D, Clark D, Tu W, Wu J, Weiner M, Steinley D, Murray MD. Correlates of health literacy in patients with chronic heart failure. THE GERONTOLOGIST 2007; 46:669-76. [PMID: 17050758 DOI: 10.1093/geront/46.5.669] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Many older adults have inadequate health-related literacy, which is associated with poor health outcomes. Thus, it is important to identify determinants of health literacy. We investigated relationships between health literacy and general cognitive and sensory abilities, as well as education, health, and demographic variables, in a community sample of middle-aged and older adults. DESIGN AND METHODS Participants were 314 community-dwelling adults (67% female, 48% African American) diagnosed with chronic heart failure recruited for a pharmacist-based intervention study to improve adherence to chronic heart failure medications. We adminstered demographic, health, education, cognitive (e.g., processing speed, working memory), and sensory measures, and the Short Test of Functional Health Literacy in Adults (STOFHLA), as part of the baseline condition of this study. RESULTS STOFHLA scores were lower for participants who were older, less educated, male, African American, had more comorbidities, or scored lower on all cognitive ability measures. Hierarchical linear regression analyses showed that education and cognitive ability were independently associated with the STOFHLA measure and explained age differences in health literacy. IMPLICATIONS The association of cognitive abilities and literacy has important implications for health literacy models and for interventions to reduce the impact of low health literacy on health outcomes. For example, medication instructions should be designed to reduce comprehension demands on general cognitive abilities as well as literacy skills.
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Affiliation(s)
- Dan Morrow
- Beckman Institute of Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Abstract
Cognitive enhancement, the amplification or extension of core capacities of the mind, has become a major topic in bioethics. But cognitive enhancement is a prime example of a converging technology where individual disciplines merge and issues transcend particular local discourses. This article reviews currently available methods of cognitive enhancement and their likely near-term prospects for convergence.
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Affiliation(s)
- Anders Sandberg
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, Oxford University, Littlegate House, 16/17 St. Ebbe's St. Oxford, OX1 1PT, United Kingdom.
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Lessov-Schlaggar CN, Swan GE, Reed T, Wolf PA, Carmelli D. Longitudinal genetic analysis of executive function in elderly men. Neurobiol Aging 2006; 28:1759-68. [PMID: 16965841 DOI: 10.1016/j.neurobiolaging.2006.07.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2006] [Revised: 07/24/2006] [Accepted: 07/28/2006] [Indexed: 11/24/2022]
Abstract
The objective of this study was to characterize the relative contribution of genetic and environmental influences to individual differences in longitudinal performance and decline of executive function (EF) using a population-based prospective study of male, WWII veteran twins (NHLBI twin study). Three tests of EF were administered when the twins were 59-70 years old, with 9- and 13-year follow-up. APOE epsilon4 allele status was incorporated in the genetic models to determine its contribution to longitudinal genetic variability. Mean EF performance significantly worsened over time. EF performance was highly genetically correlated across repeat assessment. There were significant genetic influences on 9- and 13-year decline in digit symbol performance. For all tasks decline over the last 4-year follow-up was influenced by individual-specific environmental effects. Controlling for APOE epsilon4 allele presence did not appreciably change the magnitude of genetic effects. These results suggest that common genetic factors underlie longitudinal EF task performance. Genetic influences on EF decline, however, appear to be evident at longer time intervals between assessments.
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Rodríguez-Aranda C, Waterloo K, Sparr S, Sundet K. Age-related psychomotor slowing as an important component of verbal fluency. J Neurol 2006; 253:1414-27. [PMID: 16773271 DOI: 10.1007/s00415-006-0225-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Accepted: 03/10/2006] [Indexed: 10/24/2022]
Abstract
Generalized psychomotor slowing is a characteristic of normal aging, and there is evidence suggesting that this feature is also central in dementia. The present article aims to evaluate the importance of psychomotor slowing as a factor underlying changes in the performance of verbal fluency tasks in normal and pathological aging. In study 1 reading and handwriting speed were used to predict performance on written and oral verbal fluency tasks (VFTs) in healthy elderly subjects (n = 20) and in patients of the Alzheimer type disease (n = 20). In study 2, spectrographic techniques were used to obtain reaction times, average of voice intensity and duration of single word production in young individuals (n = 20), healthy elderly subjects (n = 20), and in patients of the Alzheimer type disease (n = 7). Additionally, duration of single word production were also obtained. The results suggest that age-related psychomotor decline in word production speed is an important determinant of VFT.
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