Gender differences in the link between excessive drinking and domain-specific cognitive functioning among older adults

Alcohol consumption and cognitive function in elderly Japanese men

Although heavy alcohol consumption has been identified as a risk factor for adverse cognitive functioning, it currently remains unclear whether moderate alcohol consumption exerts similar effects. Observational studies previously reported the potential benefits of moderate alcohol consumption on cognition, particularly in the elderly; however, these effects have not yet been demonstrated in Asian populations. The aim of the present study was to investigate the relationship between alcohol consumption levels and global and domain-specific cognitive functions in cognitively intact elderly Japanese men. Cross-sectional data from the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA), an ongoing prospective, population-based study in Shiga, Japan, were used to examine the relationship between alcohol consumption and cognitive function. Men (n = 585) aged ≥65 years provided information on their weekly consumption of alcohol, and the data obtained were used to construct categories of never, ex- (quit before interview), very light (<14 g/day), light (14-23 g/day), moderate (>23-46 g/day), and heavy (>46 g/day) drinkers. Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI). A fractional logistic regression model adjusted for age, education, body mass index, smoking, exercise, hypertension, diabetes, and dyslipidemia showed that the CASI scores for global and domain-specific cognitive functions were not significantly different between all subgroups of current drinkers and never-drinkers. However, the CASI score of ex-drinkers (multivariable adjusted mean CASI score [SD]) was significantly lower than that of never-drinkers in the global [never vs. ex: 90.16 (2.21) vs. 88.26 (2.58)] and abstraction and judgment domain [never vs. ex: 9.48 (0.46) vs. 8.61 (0.57)]). The present results do not suggest any beneficial or adverse relationship between current alcohol consumption levels and cognitive functioning (both global and domain specific) in elderly Japanese men; however, low cognitive function among ex-drinkers warrants future investigations to identify the factors causing drinkers to quit.

The effect of legal mandates on substance use disorder treatment completion among older adults

Objective: This study seeks to determine the relationship between referral type (legally mandated versus non-mandated) and substance use disorder (SUD) treatment completion among older adults and by primary substance used.Method: We used data from the Treatment Episode Data Set - Discharges (TEDS-D) from 2011. Using data for persons age 55 and over (n = 104,747), we used propensity score matching (PSM) to address selection bias and attenuate the likelihood of a type I error. Logistic regression models estimated the effect of referral type on treatment completion based on treatment for a primary substance for five categories of substances.Results: In the matched sample, those who faced treatment mandates had 71% greater odds of completing treatment compared with those who entered treatment voluntarily (OR =1.71, 95% CI [1.64, 1.79]). Based on the primary drug used, odds of treatment completion were highest for alcohol, with 86% greater treatment completion for the mandated individuals compared with those entering treatment without a legal mandate (OR =1.86, 95% CI [1.75, 1.97]).Conclusion: These findings suggest that the motivating influence of treatment mandates may encourage completion of SUD treatment among older adults. Although the legal mandates for treatment are punitive, they may act to keep older adults with SUD engaged in treatment, an important factor as treatment completion is inversely related to relapse of a SUD.

Widowhood, leisure activity engagement, and cognitive function among older adults

OBJECTIVES

Maintaining cognitive function is an essential aspect of successful aging. Widowhood is a salient life transition that can affect older adults' cognitive function. Leisure engagement has received increasing attention because it is still modifiable in later life to help prevent cognitive decline. Nonetheless, limited longitudinal studies have examined how widowhood influences cognitive function, and even fewer studies have tested the role of leisure activities in this relationship.

METHOD

This study delineated the mechanism of widowhood, leisure activity engagement, and cognitive function among older adults using a national longitudinal dataset, the Health and Retirement Study, and its supplementary dataset, the Consumption and Activities Mail Survey, which repeatedly measured individuals' leisure activity engagement.

RESULTS

Findings showed no significant association between widowhood and cognitive function during a 4-year period. However, engagement in mental activities moderated the impact of widowhood on cognitive function. Specifically, the benefit of mental activity engagement on cognition was more pronounced among individuals who were recently widowed compared to those who were married. This implies a protective role of mental activities in the relationship between widowhood and cognitive function.

CONCLUSION

Interventions with mentally stimulating activities at the community level to retain cognition among individuals in early phase widowhoodare suggested. Future studies are necessary to explore whether other factors such as changes in physical and mental health and intergenerational support from adult children during widowhood may further influence this mechanism among widowhood, leisure activities, and cognitive function.

Retirement, Leisure Activity Engagement, and Cognition Among Older Adults in the United States

Objective: Retirement is a salient later-life transition that may influence cognition. Leisure activities can help individuals better adjust to life after significant life transitions. This study examined the role of leisure activity engagement in the relationship between retirement and cognition. Method: A path analysis (N = 2,827) was conducted using three waves of the Health and Retirement Study (2004, 2006, 2008) and its supplementary Consumption and Activities Mail Survey, to test the association between retirement (categorized as remained working, transitioned to retirement, remained retired) and cognition (memory, working memory, attention, and processing speed) via leisure (mental, physical, social, household) activity engagement. Results: Older adults who remained retired showed significantly lower cognition than those who remained working. Moreover, this negative association between retirement and cognition was attenuated by greater engagement mental activities. Discussion: Interventions that encourage mental activities among retired individuals are strongly suggested to help maintain cognitive function.

Associations between blood cadmium levels and cognitive function in a cross-sectional study of US adults aged 60 years or older

OBJECTIVES

The relationship between cadmium exposure and cognition has been well studied in children. However, the association between environmental cadmium exposure and cognitive function has not been researched extensively in older adults. Our goal was to evaluate the association between cognitive function and blood cadmium levels in US adults aged 60 years or older.

DESIGN

A cross-sectional study.

SETTING

The US National Health and Nutrition Examination Survey (NHANES).

PARTICIPANTS

A total of 2068 adults aged 60 years or older who completed four cognitive assessment tests and blood cadmium detection in two waves of NHANES (2011-2014).

MAIN OUTCOME MEASURES

Cognitive assessment was conducted by household interview or at a Mobile Examination Center (MEC) using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word List Learning Test, the CERAD Word List Recall Test, the Animal Fluency Test and the Digit Symbol Substitution Test (DSST). We created a composite cognitive z-score to represent global cognitive function.

RESULTS

The median blood cadmium concentration in the study participants was 0.35 µg/L, and the IQR was 0.24-0.56 µg/L. In linear regression analyses, adjusting for demographics, behaviour and medical history, blood cadmium as a continuous variable was inversely associated with the composite z-score (μg/L, β=-0.11, 95% CI -0.20 to -0.03). Similarly, there was a significant association between quartiles of blood cadmium and composite z-score, with somewhat lower scores in the upper quartile of exposure (blood cadmium ≥0.63 µg/L) compared with those in the lower quartile of exposure (blood cadmium <0.25 µg/L) (μg/L, β=-0.14, 95% CI -0.25 to -0.03), and there was a trend by quartiles of blood cadmium (P<0.0001).

CONCLUSIONS

Our findings suggest that increased blood cadmium is associated with worse cognitive function in adults aged 60 years or older in the USA.

Binge drinking and insomnia in middle-aged and older adults: the Health and Retirement Study

OBJECTIVE

Alcohol use in later life has been linked to poor sleep. However, the association between binge drinking, which is common among middle-aged and older adults, and insomnia has not been previously assessed.

METHODS

We studied participants aged 50 years and older (n = 6027) from the 2004 Health and Retirement Study who reported the number of days they had ≥4 drinks on one occasion in the prior 3 months. Participants also reported the frequency of four insomnia symptoms. Logistic regression analyses assessed the association between binge drinking frequency and insomnia.

RESULTS

Overall, 32.5% of participants had >0 to ≤2 binge drinking days/week; and 3.6% had >2 binge drinking days/week. After adjusting for demographic variables, medical conditions, body mass index, and elevated depressive symptoms, participants who binged >2 days/week had a 64% greater odds of insomnia than non-binge drinkers (adjusted odds ratio [aOR] = 1.64, 95% confidence interval [CI] = 1.09-2.47, p = 0.017). Participants reporting >0 to ≤2 binge days/week also had a 35% greater odds of insomnia than non-binge drinkers (aOR = 1.35, 95% CI = 1.15-1.59, p = 0.001). When smoking was added to the regression model, these associations fell just below the level of significance.

CONCLUSIONS

Results suggest that binge drinking is associated with a greater risk of insomnia among adults aged 50 years and older, although this relationship may be driven in part by current smoking behavior. The relatively high prevalence of both binge drinking and sleep complaints among middle-aged and older populations warrants further investigation into binge drinking as a potential cause of late-life insomnia.

White matter changes in breast cancer brain metastases patients who undergo radiosurgery alone compared to whole brain radiation therapy plus radiosurgery

Delayed toxicity after whole brain radiation therapy (WBRT) is of increasing concern in patients who survive more than one year with brain metastases from breast cancer. Radiation-related white matter toxicity is detected by magnetic resonance imaging (MRI) and has been correlated with neurocognitive dysfunction. This study assessed the risk of developing white matter changes (WMC) in breast cancer patients who underwent either WBRT plus stereotactic radiosurgery (SRS) or SRS alone. We retrospectively compared 35 patients with breast cancer brain metastases who received WBRT and SRS to 30 patients who only received SRS. All patients had evaluable imaging at a median of one year after their initial management. The development of white matter T2 prolongation as detected by T2 or FLAIR imaging was graded: grade 1 = little or no white matter T2 hyperintensity; grade 2 = limited periventricular hyperintensity; and grade 3 = diffuse white matter hyperintensity. After WBRT plus SRS, patients demonstrated a significantly higher incidence of WMC (p < 0.0001). After one year, 71.5 % of patients whose treatment included WBRT demonstrated WMC (42.9 % grade 2; 28.6 % grade 3). Only one patient receiving only SRS developed WMC. In long-term survivors of breast cancer, the risk of WMC was significantly reduced when SRS alone was used for management. Further prospective studies are necessary to determine how these findings correlate with neurocognitive toxicity. WBRT usage as initial management of limited brain disease should be replaced by SRS alone to reduce the risk of delayed white matter toxicity.

Risk Factors Related to Cognitive Functioning: A Cross-National Comparison of U.S. and Korean Older Adults

The purpose of this study was to conduct a cross-national comparison of factors related to cognitive functioning in later life in a U.S. and Korean sample. The study sample was comprised of subjects from the HRS ( N = 10,175) and the KLoSA ( N = 3,550). Separate multivariate regression models were employed to examine the impact of socio-demographic, health, and health behaviors on cognitive functioning among older adults. Regression results showed that age, gender, education, wealth, self-rated health, ADL, IADL, stroke, and poor eyesight were significantly associated with cognitive functioning in both countries. However, depression, high blood pressure, diabetes, and drinking were significantly associated with cognition only among Americans, while marital status and poor hearing were significantly associated with cognition only among Koreans. In addition, gender-specific models suggested several socio-economic and health factors had significantly different effects by gender in both countries. Cross-national comparative research identified similar risk factors, suggesting robust associations. Unique factors related to cognitive functioning in U.S. and Korean older adults highlight the important role of societal influences on cognitive outcomes.

Alcohol consumption and cognitive impairment among Korean older adults: does gender matter?

BACKGROUND

This study investigated gender differences in the relationship between alcohol consumption and cognitive impairment among older adults in South Korea.

METHODS

Using data from the Korean Longitudinal Study of Ageing, 2,471 females and 1,657 males were analyzed separately. Cognitive impairment was measured based on the Korean version of the Mini-Mental State Exam score. Logistic regression was conducted to examine the relationship between alcohol consumption and cognitive impairment among Korean older adults.

RESULTS

Multivariate analysis showed that compared to moderate drinkers, past drinkers were more likely to be cognitively impaired for women, while heavy drinkers were more likely to be cognitively impaired for men.

CONCLUSIONS

Findings suggest that the relationship between alcohol consumption and cognition varies with gender. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

A role for cognitive rehabilitation in increasing the effectiveness of treatment for alcohol use disorders

Neurocognitive impairments are prevalent in persons seeking treatment for alcohol use disorders (AUDs). These impairments and their physical, social, psychological and occupational consequences vary in severity across persons, much like those resulting from traumatic brain injury; however, due to their slower course of onset, alcohol-related cognitive impairments are often overlooked both within and outside of the treatment setting. Evidence suggests that cognitive impairments can impede treatment goals through their effects on treatment processes. Although some recovery of alcohol-related cognitive impairments often occurs after cessation of drinking (time-dependent recovery), the rate and extent of recovery is variable across cognitive domains and individuals. Following a long hiatus in scientific interest, a new generation of research aims to facilitate treatment process and improve AUD treatment outcomes by directly promoting cognitive recovery (experience-dependent recovery). This review updates knowledge about the nature and course of cognitive and brain impairments associated with AUD, including cognitive effects of adolescent AUD. We summarize current evidence for indirect and moderating relationships of cognitive impairment to treatment outcome, and discuss how advances in conceptual frameworks of brain-behavior relationships are fueling the development of novel AUD interventions that include techniques for cognitive remediation. Emerging evidence suggests that such interventions can be effective in promoting cognitive recovery in persons with AUD and other substance use disorders, and potentially increasing the efficacy of AUD treatments. Finally, translational approaches based on cognitive science, neurophysiology, and neuroscience research are considered as promising future directions for effective treatment development that includes cognitive rehabilitation.