Investigating the relationship between specific executive functions and functional decline among community-dwelling older adults: results from a prospective pilot study

Neuropsychology's Role in Assessment of Medical Decision-Making Capacity, Home Safety, and Driving Ability

Individuals with neurologic illness/injury often experience changes in their daily functioning. Clinical providers caring for these individuals are frequently called upon for input as patients and their families navigate challenging decisions to ensure safety. This article reviews 3 areas in which recommendations from clinicians are often requested: medical decision-making, home safety, and driving. Strategies for making recommendations in these areas is offered including discussion of how neuropsychology evaluations can provide useful information to aid in making recommendations.

The Effects of Simultaneous Aerobic Exercise and Video Game Training on Executive Functions and Brain Connectivity in Older Adults

OBJECTIVE

The study was designed to examine the effects of simultaneous combination of aerobic exercise and video game training on executive functions (EFs) and brain functional connectivity in older adults.

DESIGN

A four-armed, quasi-experimental study.

SETTING AND PARTICIPANTS

Community-dwelling adults aged 55 years and older.

METHODS

A total of 97 older adults were divided into one of four groups: aerobic exercise (AE), video game (VG), combined intervention (CI), and passive control (PC). Participants in intervention groups received 32 sessions of training over a 4-month period at a frequency of twice a week. EFs was evaluated using a composite score derived from a battery of neuropsychological tests. The Montreal Cognitive Assessment (MoCA) was employed to evaluate overall cognitive function, while the 6-Minute Walking Test (6MWT) was utilized to gauge physical function. Additionally, the functional connectivity (FC) of the frontal-parietal networks (FPN) was examined as a neural indicator of cognitive processing and connectivity changes.

RESULTS

In terms of EFs, both VG and CI groups demonstrated improvement following the intervention. This improvement was particularly pronounced in the CI group, with a large effect size (Hedge's g = 0.83), while the VG group showed a medium effect size (Hedge's g = 0.56). A significant increase in MoCA scores was also observed in both the VG and CI groups, whereas a significant increase in 6MWT scores was observed in the AE and CI groups. Although there were no group-level changes observed in FC of the FPN, we found that changes in FC was behaviorally relevant as increased FC was associated with greater improvement in EFs.

CONCLUSION

The study offers preliminary evidence that both video game training and combined intervention could enhance EFs in older adults. Simultaneous combined intervention may hold greater potential for facilitating EFs gains. The initial evidence for correlated changes in brain connectivity and EFs provides new insights into understanding the neural basis underlying the training gains.

Effects of aerobic exercise on executive function of healthy middle-aged and older adults: A systematic review and meta-analysis

BACKGROUND

The deterioration of executive function is a hallmark of cognitive aging. Reports indicate that signs of decline in executive function begin to emerge as early as middle age. Aerobic exercise improves executive function in healthy middle-aged and older adults, but the optimal exercise prescription variables are still unclear.

OBJECTIVE

To investigate the effects of aerobic exercise on executive function of healthy middle-aged and older adults and explore the dose-response relationship and moderators.

METHODS

We conducted comprehensive searches of PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, PsycINFO, and SPORTDiscus for English literature, and CNKI, WanFang, and VIP for Chinese literature, covering the period from inception until April 25, 2024. Randomized controlled trials examining the effect of aerobic exercise on executive function in healthy middle-aged and older adults aged 45 or older were included. The Cochrane Collaboration's RoB2 tool was used to assess the methodological quality of the included studies. And subgroup analyses and meta-regressions were conducted to elucidate the impact of aerobic exercise on executive function.

RESULTS

Forty-two eligible randomized controlled trials, involving a total of 2881 participants, met the inclusion criteria for the systematic review and meta-analysis. The pooled results showed that aerobic exercise had positive effects on improving cognitive flexibility (Hedge's g = 0.343, p < 0.001), working memory (Hedge's g = 0.392, p < 0.001), and inhibitory control (Hedge's g = 0.229, p < 0.001) in healthy middle-aged and older adults. However, it did not demonstrate an improvement in planning (Hedge's g = 0.094, p = 0.440). The dose-response relationships between different exercise parameters and subdomains of executive functions revealed that the largest effects on cognitive flexibility were observed after 13-24 weeks of progression-intensity mind-body exercise, 46-60 min per session, and 5-7 days per week. Regarding working memory, the largest effects were observed after 13-24 weeks of progression-intensity general aerobic exercise, 20-45 min per session, and 5-7 days per week. For inhibitory control, the greatest effects were noted after 13-24 weeks of low-intensity general aerobic exercise, 20-45 min per session, and 3-4 days per week.

CONCLUSION

Aerobic exercise can significantly improve cognitive flexibility, working memory, and inhibitory control in healthy middle-aged and older adults. The effect of aerobic exercise on different aspects of executive function is influenced by specific exercise parameters, suggesting that personalized aerobic exercise programs may be more effective for enhancing executive function of healthy middle-aged and older adults.

The impact of cognitive-motor interference on balance and gait in hearing-impaired older adults: a systematic review

BACKGROUND

Hearing impairments are a rising burden in our aging society. Hearing loss is associated with reduced cognitive performance as well as decrements in balance and gait. Therefore, impaired hearing affects also dual tasking (DT). The aim of this review is to summarize the evidence for DT performance decrements of older adults with hearing impairments during maintaining balance or walking.

METHODS

The systematic literature research according to PRISMA guidelines was conducted using MEDLINE, APA Psych-Info, and Web of Science. Inclusion criteria were: Independent living older people ≥ 60 years with hearing impairments, use of a DT paradigm to test hearing impaired older adults within a balance or walking condition.

RESULTS

N = 57 studies were found within the databases. Eight studies were included (N = 456 participants (58% women), including n = 200 older hearing-impaired persons with different levels of hearing loss). Most of the included studies oriented their inclusion criteria for hearing-impairments at thresholds for mild hearing loss with Pure Tone Average (0.5-4 kHz) ≥ 25 and < 40 dB. Three of the studies focused on DT balance performance and five used DT walking comparing participants with and without hearing loss. For DT balance and gait performance, higher decrements for the hearing-impaired group were observed compared to healthy older adults. Performance decrements were accompanied by reduced compensatory strategies in balance performance.

CONCLUSION

More pronounced decrements in DT performance were observed for participants with hearing impairments compared to those without. This implies that hearing-impaired older adults might need specific interventions to reduce the cognitive-motor interference (CMI) to maintain balance control or walking stability in daily situations that require managing of cognitive and motor tasks simultaneously. However, taking all results into account the underlying mechanisms of CMI for this target group needs to be further examined.

TRIAL REGISTRATION

This review was registered at Prospero with the ID CRD42022340232.

Cardiorespiratory fitness is associated with cognitive performance in 80 + -year-olds: Detangling processing levels

Cardiorespiratory fitness is known to protect against cognitive decline in older adults. Specifically, it has been shown that physical activity and fitness are beneficial for executive functions that are crucial for independent living up to old age. In this study, 115 individuals aged 80 years and older underwent a cardiorespiratory fitness assessment using the two-minute step test and had their electroencephalogram recorded during a colored flanker task in order to measure executive function performance. Cardiorespiratory fitness was related to quicker responses during the flanker task. A mediation analysis was carried out to determine whether these positive effects were mediated through event-related potentials (N1, N2, or P3) or motor-related cortical potentials (MRCP). Cardiorespiratory fitness was related to better visual discriminative processing as indicated by larger occipital N1 amplitudes. In addition, fitness was associated with larger MRCP amplitudes, which are a correlate of the response generation process. Fitness was not found to have a significant effect on fronto-central N2 or parietal P3, which are thought to capture cognitive control processes such as conflict detection and response inhibition. Moreover, all effects reported were present in all three flanker trial conditions (congruent, neutral, and incongruent). Thus, these results indicate that the quicker response times in fitter people were related to visual processing and motor response generation rather than cognitive control.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.