Identifying elderly people at risk for cognitive decline by using the 2-step test

In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness-Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression

BACKGROUND

Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial.

METHODS

We recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could 'enrol' a family member/ 'other' to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement.

RESULTS

Study 1 Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention. Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2 Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention. Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward.

Association of psychological factors with advanced-level functional competency: Findings from the Aichi workers' cohort study, 2002-2019

Objective

This study examined the longitudinal association of perceived stress, ikigai, and having someone one can count on in middle age with the advanced-level functional competency in older age, which is crucial for the maintenance of independent life among older adults. The issue is especially relevant in super-aged countries like contemporary Japan, where more and more older people live in a household consisting only of older people.

Methods

Data were collected in 2019 from a total of 1692 retirees of the Aichi Workers' Cohort Study participants in which baseline survey including psychological factors was conducted during their employment in 2002. Japan Science and Technology Agency Index of Competence (JST-IC) was used to measure the advanced-level functional competency. Multivariable-adjusted odds ratios (ORs) were obtained for having low JST-IC in later life by the degrees of psychological factors reported in the middle age adjusting for the presence of depressive mood in 2019.

Results

Those who were not sure about ikigai (OR: 2.02, 95 % CI: 1.33 to 3.08) and who have no one to count on (OR: 2.19, 95 % CI: 1.52 to 3.16) in the middle age were significantly associated with low JST-IC after retirement. Having much stress was significantly inversely associated with a low JST-IC (OR: 0.69, 95 % CI: 0.50 to 0.97).

Conclusion

Having ikigai and someone reliable, and stress during middle age might play a role in preventing impaired advanced-level functional competency. Improved ikigai and increased social interaction and support might improve functional competency. Further research might explore avenues for improving ikigai.

Factors affecting executive function performance of Brazilian elderly in the Stroop test

Aging is related to a decrease in physiological abilities, especially cognitive functions. To unravel further evidence of age-related cognitive decline, we analyzed which physical and functional variables are predictors of cognitive performance in a sample of 498 Brazilian elderly (67.26% women). To do so, we used the Stroop test as a tool to evaluate executive functions and the General functional fitness index (GFFI) to evaluate the functional fitness of the participants. A linear regression analysis revealed that female sex (β=-0.097; t=-2.286; P=0.023), younger age (β=0.205; t=4.606; P<0.0001), more years of education (β=-0.280; t=-6.358; P<0.0001), and higher GFFI (β=-0.101; t=-2.347; P<0.02) were predictors of better cognitive performance. Body mass index (kg/m²) and nutritional status (underweight, eutrophic, overweight, or obese) were not predictors of cognitive performance. Interestingly, among the GFFI tasks, muscle strength influenced the test execution time, both in upper and lower limbs (elbow flexion: β=-0.201; t=-4.672; P<0.0001; sit-to-stand: β=-0.125; t=-2.580; P<0.01). Our findings showed that: 1) women performed the Stroop test faster than men; 2) the older the person, the lower was the cognitive performance; 3) the higher the education, the better the test execution time; and 4) higher scores in the GFFI were associated with a better performance in the Stroop test. Therefore, gender, age, education, and functional fitness and capacity were predictors of cognitive performance in the elderly.

The beneficial effect of physical activity on cognitive function in community-dwelling older persons with locomotive syndrome

Background

Cognitive decline is closely related to motor decline. Locomotive syndrome (LS) is defined as a state associated with a high risk of requiring support because of locomotive organ disorders, and can be evaluated using a questionnaire. This study aimed to clarify the effectiveness of daily goal-targeted exercise on cognitive function in two different populations classified by scores on the Locomo 25 questionnaire.

Methods

Seventy community-dwelling older people who participated in a 13-week health class were divided into two populations based on Locomo 25 scores: <7 (non-LS) and ≥7 (LS). Participants were presented with a daily target steps and worked towards that goal. Cognitive function was evaluated using the Japanese version of Addenbrooke’s Cognitive Examination-Revised (ACE-R). Average daily physical activity (exercise [Ex]) for 13 weeks was measured using a portable activity meter. Depression status was assessed using the Geriatric Depression Scale (GDS-15).

Results

No significant differences were observed in age, years of education, body mass index, smooth muscle mass index, GDS-15 scores, or ACE-R scores between the non-LS and LS populations. Multiple logistic regression analysis showed that Ex (odds ratio = 5.01, p = 0.002) for 13 weeks was significantly associated with increased cognitive function in the LS population. The Ex threshold for the increase in cognitive function based on receiver operating curve analysis was 2.29 metabolic equivalents of task (METs) × h (METs · h/day) (p = 0.047) in the LS population. After 13 weeks, ACE-R scores were significantly higher in the Ex ≥ 2.29 than in the Ex < 2.29 METs · h/day group (p = 0.024, η_p² = 0.241) in the LS population based on two-way analysis of covariance. Furthermore, a significant increase in the ACE-R memory domain was seen in the Ex ≥ 2.29 group (p = 0.035, η_p² = 0.213).

Conclusions

These results suggest that Ex ≥ 2.29 METs · h/day is important for improving cognitive function in LS populations.

Brain Activity in the Prefrontal Cortex during Cognitive Tasks and Dual Tasks in Community-Dwelling Elderly People with Pre-Frailty: A Pilot Study for Early Detection of Cognitive Decline

We aimed to detect brain abnormalities during cognitive and motor tasks in older individuals with pre-frailty, as this could prevent dementia. Sixty elderly participants (mean age: 76.3 years; 27 healthy and 33 with pre-frailty) were included, and their motor function, cognitive function, and dual-task abilities (gait with calculation and while carrying a ball) were evaluated. Total hemoglobin (t-Hb) was measured using functional near-infrared spectroscopy (fNIRS) during tasks and resting periods. The pre-frailty group had a slightly lower gait speed than the healthy group, but there was no significant difference in cognitive function. In the pre-frailty group, the t-Hb values during the normal gait and cognitive tasks were higher than the resting value in the right prefrontal cortex, while in the healthy group, only the word frequency task (WFT) was higher. Furthermore, in the WFT, the t-Hb values were significantly lower in the pre-frailty group than in the healthy group. The results showed that pre-frail subjects had lower brain activation during the WFT in the right prefrontal cortex and excessive activity during walking, even without a noticeable cognitive decline. The differences in cerebral blood flow under the pre-frailty conditions may be a clue to detecting cognitive decline earlier.

Assessment of locomotive syndrome among older individuals: a confirmatory factor analysis of the 25-question Geriatric Locomotive Function Scale

Background

The 25-question Geriatric Locomotive Function Scale (GLFS-25) is widely used in daily clinical practice in evaluating locomotive syndrome (LS). The questionnaire contains 25 questions aiming to describe 6 aspects, including body pain, movement-related difficulty, usual care, social activities, cognitive status, and daily activities. However, its potential underlying latent factor structure of the questionnaire has not been fully examined so far.

Methods

Five hundred participants who were 60 years or older and were able to walk independently with or without a cane but had complaints of musculoskeletal disorders were recruited face to face at the out-patient ward of Aichi Medical University Hospital between April 2018 and June 2019. All participants completed the GLFS-25. Confirmatory factor analysis (CFA) models (single-factor model, 6-factor model as designed by the developers of the GLFS-25) were fitted and compared using Mplus 8.3 with a maximum likelihood minimization function. Modification indices, standardized expected parameter change were used, a standard strategy for scale development was followed in the search for an alternative and simpler model that could well fit the collected data. Cronbach’s α and its 95% confidence interval (CI) were also calculated.

Results

Mean (standard deviation) participants age was 72.6 (7.4) years old; 63.6% of them were women. Under the current criteria, 132 (26.4%) and 262 (52.4%) of the study subjects would be classified as LS stage 1 and stage 2, respectively. Overall, the Cronbach’s α (95% CI) for GLFS-25 evaluated using these data was 0.959 (0.953, 0.964). The single- and 6-factor models were rejected due to poor fit. The alternative models with either full 25 questions or a shortened GLFS-16 were found to fit the data better. These alternative models included three latent factors (body pain, movement-related difficulty, and psycho-social complication) and allowed for cross-loading and residual correlations.

Discussion

The findings of the CFA models provided evidence that the factor structure of the GLFS-25 might be simpler than the 6-factor model as suggested by the designers. The complex relationships between the latent factors and the observed items may also indicate that individual sub-scale use or simply combining the raw scores for evaluation is likely to be inadequate or unsatisfactory. Thus, future revisions of the scoring algorithm or questions of the GLFS-25 may be required.

Effect of home-based high-intensity interval training and behavioural modification using information and communication technology on cardiorespiratory fitness and exercise habits among sedentary breast cancer survivors: habit-B study protocol for a randomised controlled trial

INTRODUCTION

Maintaining high levels of physical activity helps to maintain and improve physical health and quality of life, and plays a role in reducing adverse effects due to cancer treatments. Moreover, a greater degree of cardiorespiratory fitness is associated with reduced risk of all-cause mortality. However, there are no home-based programme for improving cardiorespiratory fitness using body weight exercises for breast cancer survivors. This study will assess the efficacy of the newly developed habit-B programme on maximum oxygen uptake compared with treatment as usual with wearable device. The effects of this programme on exercise habits, level of physical activity, physical fitness and subjective indices will also be investigated.

METHODS AND ANALYSIS

This is a 12-week, parallel-group, single-blind, randomised controlled trial. Allocation will be managed by a central server using a computer-generated random allocation sequence provided by an independent data centre. Participants will be assigned to the habit-B programme (high-intensity interval training, exercise counselling + guidance, home-based exercise support using information and communication technology, and a wearable device) or treatment as usual with a wearable device. Subjects will be sedentary women aged 20-59 years who have received breast surgery in the past 2-13 months after the diagnosis of invasive breast cancer (stages I-IIa) and have never received chemotherapy except for hormone therapy. The primary endpoint is the change in peak oxygen uptake (VO_2peak; mL/kg/min) between the groups after 12 weeks of intervention.

ETHICS AND DISSEMINATION

The study protocol was approved by the Institutional Review Board of the National Cancer Center Japan on 28 February 2019 (ID: 2018-347). The findings will be disseminated through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

UMIN000036400.

Improvement of Attention, Executive Functions, and Processing Speed in Elderly Women as a Result of Involvement in the Nordic Walking Training Program and Vitamin D Supplementation

Research indicates that life satisfaction declines with age, and cognitive abilities are gradually reduced—mainly attentional functioning and cognitive processing speed. Therefore, scientists seek to find protective factors and test possible intervention programs; moderately intensive physical activity stands out as particularly promising. In this context, we evaluated the influence of Nordic Walking training supported by vitamin D supplementation (as this nutrient is especially deficient in older people in Poland) on the cognitive and psychological functioning of elderly women. A total of 52 healthy elderly women took part in a Nordic Walking training program complemented by vitamin D supplementation. Cognitive functioning was assessed with the Trail Making Test and the D2 Test of Attention. Quality of life and severity of depressive symptoms were measured with the Short Form Health Survey and the Beck Depression Inventory 2. Significant improvements in all aspects of cognitive functioning was observed (p = 0.01–0.47). The study also showed a decrease in depressive symptoms (p = 0.026). Physical activity and adequate levels of vitamin D can be the key factors in maintaining self-reliance in old age. Involvement in Nordic Walking training, supported by vitamin D supplementation, can strengthen the cognitive functioning of older people—reflected in higher attentional capabilities, better executive functions, and improved cognitive processing speed.