Questionnaire-based evaluation of everyday competence in older adults

Effects of Physical Activity on Cognitive Functioning: The Role of Cognitive Reserve and Active Aging

BACKGROUND

The increase in average life expectancy necessitates the identification of possible mechanisms capable of promoting "active aging" to ensure adequate levels of global functioning. Numerous studies show that regular physical activity promotes, even in the elderly, a state of functional psychophysical well-being capable of slowing down age-related cognitive decline. This study aimed to clarify whether, and how, the intensity of physical activity can modulate cognitive and executive skills by influencing specific psychological variables.

METHODS

Our sample consisted of 151 senior subjects divided into hikers (HIK), gentle gymnastics (GYM), and sedentary (SED), who practice intense, moderate, and reduced physical activity, respectively. A battery of psychological questionnaires was administrated to evaluate attentional skills, decision-making, the ability to implement targeted behaviors, perceived self-efficacy, and psychophysical well-being. We included: the Mini-Mental State Examination, Cognitive Reserve Index Questionnaire, General Self-Efficacy Scale, Letter Cancellation Test, Everyday Competence Questionnaire, and Geriatric Depression Scale (GDS).

RESULTS

Comparisons between the scores reported by the three groups showed that the HIK group differs from the others with respect to most of the measurements, presenting better mood and cognitive performance, and a specific psychological profile. On the contrary, the GYM group appeared to have a greater affinity with the SED group than with the HIK group, both cognitively and psychologically.

CONCLUSIONS

Types of physical activity, as well as the intensity and frequency with which they are practiced, are factors that promote an active aging process, protecting the psychophysical well-being and overall cognitive functioning of the elderly.

Functional Ability in Everyday Life: Are Associations With an Engaged Lifestyle Mediated by Working Memory?

OBJECTIVES

An engaged lifestyle has been linked to measures of functional ability in everyday life. However, the underlying mechanism of this link is still understudied. We propose working memory as a potential mediator of this relation.

METHODS

Modeling data of 158 older adults with a latent-variables approach, we examined whether working memory mediated the relation between an engaged lifestyle, that is, intellectual, social, and physical activities, and functional ability, that is, self-reported everyday failures and test-based everyday performance.

RESULTS

Working memory was found to fully mediate the relation between gaming activities and test-based everyday performance. Furthermore, we found a negative association between sports activities and self-reported everyday failures not mediated through working memory, indicating that individuals who reported high levels of sports activities reported fewer everyday cognitive failures. All other lifestyle activities were, however, neither directly nor indirectly associated with functional ability.

DISCUSSION

Working memory is one pathway by which gaming activities are related to test-based measures of functional ability in everyday life. Given the overlapping cognitive demands of working memory, gaming activities, and the test-based measure of functional ability, the findings suggest that while an engaged lifestyle can benefit functional ability, those benefits may be limited to highly similar domains.

The interactive Physical and Cognitive Exercise System (iPACES™): effects of a 3-month in-home pilot clinical trial for mild cognitive impairment and caregivers

Background

Alzheimer’s and related dementias are on the rise, and older adults and their families are seeking accessible and effective ways to stave off or ameliorate mild cognitive impairment (MCI).

Aim

This pilot clinical trial (ClinicalTrials.gov Identifier: 03069391) examined neuropsychological and neurobiological outcomes of interactive physical and mental exercise.

Participants and methods

Older adults (MCI and caregivers) were enrolled in a 3-month, in-home trial of a portable neuro-exergame (the interactive Physical and Cognitive Exercise System [iPACES™]), in which they pedaled and steered along a virtual bike path to complete a list of errands (Memory Lane™). Neuropsychological function and salivary biomarkers were measured at pre-, mid-, and posttrial. Ten older adults complied with the recommended use of iPACES (complete dose; ≥2×/wk, 67% of the 15 who also had pre- and postevaluation data). Statistical analyses compared change over time and also change among those with a complete dose vs inadequate dose. Correlations between change in neuropsychological and biomarker measures were also examined.

Results

Executive function and verbal memory increased after 3 months (p = 0.01; no significant change was found with an inadequate dose). Change in salivary biomarkers was moderately associated with increasing cognition (cortisol, r = 0.68; IGF-1, r = 0.37).

Conclusion

Further research is needed, but these pilot data provide preliminary indications to suggest neuro-exergaming can impact cognitive function, perhaps via neurobiological mechanisms, and as such may provide an effective and practical way to promote healthy aging.

Geriatrics in medical students' curricula: questionnaire-based analysis

BACKGROUND

Demographic development is accompanied by an increasingly aging society. Concerning medical education, the treatment of older people as well as the scientific research and exploration of ageing aspects in the coming years need to be considered. Aim of the study was to ascertain medical students' knowledge, interest, and attitudes regarding older patients and geriatric medicine.

METHODS

Each participant completed a self-designed questionnaire. This questionnaire was based on three validated internationally recognised questionnaires ("Facts on Aging Quiz--FAQ", "Expectations Regarding Aging--ERA" and the "Aging Semantic Differential--ASD"). The inquiry and survey were performed at the beginning of the summer term in 2012 at the University of Regensburg Medical School.

RESULTS

A total of n = 184/253 (72.7%) students participated in this survey. The results of the FAQ 25+ showed that respondents were able to answer an average of M = 20.4 of 36 questions (56.7%) correctly (Median, Md = 21; SD ±6.1). The personal attitudes and expectations of ageing averaged M = 41.2 points on the Likert-scale that ranged from 0 to 100 (Md = 40.4; SD ±13.7). Respondents' attitudes towards the elderly (ASD 24) averaged M = 3.5 points on the Likert-scale (range 1-7, Md 3.6, SD ±0.8).

CONCLUSIONS

In our investigation, medical students' knowledge of ageing was comparable to previous surveys. Attitudes and expectations of ageing were more positive compared to previous studies. Overall, medical students expect markedly high cognitive capacities towards older people that can actively prevent cognitive impairment. However, medical students' personal interest in medicine of ageing and older people seems to be rather slight.

Six months of dance intervention enhances postural, sensorimotor, and cognitive performance in elderly without affecting cardio-respiratory functions

During aging, sensorimotor, cognitive and physical performance decline, but can improve by training and exercise indicating that age-related changes are treatable. Dancing is increasingly used as an intervention because it combines many diverse features making it a promising neuroplasticity-inducing tool. We here investigated the effects of a 6-month dance class (1 h/week) on a group of healthy elderly individuals compared to a matched control group (CG). We performed a broad assessment covering cognition, intelligence, attention, reaction time, motor, tactile, and postural performance, as well as subjective well-being and cardio-respiratory performance. After 6 months, in the CG no changes, or further degradation of performance was found. In the dance group, beneficial effects were found for dance-related parameters such as posture and reaction times, but also for cognitive, tactile, motor performance, and subjective well-being. These effects developed without alterations in the cardio-respiratory performance. Correlation of baseline performance with the improvement following intervention revealed that those individuals, who benefitted most from the intervention, were those who showed the lowest performance prior to the intervention. Our findings corroborate previous observations that dancing evokes widespread positive effects. The pre-post design used in the present study implies that the efficacy of dance is most likely not based on a selection bias of particularly gifted individuals. The lack of changes of cardio-respiratory fitness indicates that even moderate levels of physical activity can in combination with rich sensorimotor, cognitive, social, and emotional challenges act to ameliorate a wide spectrum of age-related decline.

Promoting healthy ageing: development of the Healthy Ageing Quiz

AIM

The aim of this study was to develop the evidence-based Healthy Ageing Quiz (HAQ).

METHODS

Phase 1 activities (focus groups with 33 older adults, literature review and discussion with an advisory panel) informed the development of a draft HAQ. Phase 2 involved assessing the quiz's psychometric properties and collecting respondent feedback.

RESULTS

Phase 1 provided broad topics for formulating quiz questions. In Phase 2, 297 and 122 respondents returned a quiz for validity and reliability testing respectively (over 70% response rate). The HAQ was found to be both valid (r =-0.7 to 0.6) and reliable (r = 0.8).

CONCLUSIONS

The development of the HAQ was guided by the literature and input from older people and experts in healthy ageing. The quiz showed good psychometric properties and was acceptable to respondents. It allows older adults and people approaching old age to evaluate their current lifestyle in order to maximise their chances of ageing well.

Protocol for a randomized controlled trial evaluating the effect of physical activity on delaying the progression of white matter changes on MRI in older adults with memory complaints and mild cognitive impairment: the AIBL Active trial

BACKGROUND

Older adults free of dementia but with subjective memory complaints (SMC) or mild cognitive impairment (MCI) are considered at increased risk of cognitive decline. Vascular risk factors (VRF), including hypertension, heart disease, smoking, hypercholesterolemia and lack of physical activity (PA) have been identified as modifiable risk factors contributing to cognitive decline, and white matter hyperintensities (WMH) are associated with VRF, SMC and cognitive impairment. Findings from a growing number of clinical trials with older adults are providing strong evidence for the benefits of physical activity for maintaining cognitive function, but few studies are investigating these benefits in high-risk populations. The aim of AIBL Active is to determine whether a 24-month physical activity program can delay the progression of white matter changes on magnetic resonance imaging (MRI).

METHODS/DESIGN

This single-blind randomized controlled trial (RCT) is offered to 156 participants, aged 60 and older, in the Melbourne arm of the Australian Imaging Biomarkers and Lifestyle Flagship Study of Aging (AIBL). Participants must have SMC with or without MCI and at least one VRF. The PA intervention is a modification of the intervention previously trialed in older adults with SMC and MCI (Fitness for the Ageing Brain Study). It comprises 24 months of moderate, home-based PA (150 minutes per week) and a behavioral intervention package. The primary outcome measure will be change in WMH after 24 months on MRI. Cognition, quality of life, functional fitness, level of physical activity, plasma biomarkers for cerebrovascular disease and amyloid positron emission tomography (PET) imaging comprise secondary measures.

DISCUSSION

Currently, there is no effective pharmacological treatment available to delay cognitive decline and dementia in older adults at risk. Should our findings show that physical activity can slow down the progression of WMH, this RCT would provide an important proof of concept. Since imbedded in AIBL this RCT will also be able to investigate the interaction between vascular and Alzheimer's disease pathologies.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry ACTRN12611000612910.

Long-term sensory stimulation therapy improves hand function and restores cortical responsiveness in patients with chronic cerebral lesions. Three single case studies

Rehabilitation of sensorimotor impairment resulting from cerebral lesion (CL) utilizes task specific training and massed practice to drive reorganization and sensorimotor improvement due to induction of neuroplasticity mechanisms. Loss of sensory abilities often complicates recovery, and thus the individual's ability to use the affected body part for functional tasks. Therefore, the development of additional and alternative approaches that supplement, enhance, or even replace conventional training procedures would be advantageous. Repetitive sensory stimulation protocols (rSS) have been shown to evoke sensorimotor improvements of the affected limb in patients with chronic stroke. However, the possible impact of long-term rSS on sensorimotor performance of patients with CL, where the incident dated back many years remains unclear. The particular advantage of rSS is its passive nature, which does not require active participation of the subjects. Therefore, rSS can be applied in parallel to other occupations, making the intervention easier to implement and more acceptable to the individual. Here we report the effects of applying rSS for 8, 36, and 76 weeks to the paretic hand of three long-term patients with different types of CL. Different behavioral tests were used to assess sensory and/or sensorimotor performance of the upper extremities prior, after, and during the intervention. In one patient, the impact of long-term rSS on restoration of cortical activation was investigated by recording somatosensory evoked potentials (SEP). After long-term rSS all three patients showed considerable improvements of their sensory and motor abilities. In addition, almost normal evoked potentials could be recorded after rSS in one patient. Our data show that long-term rSS applied to patients with chronic CL can improve tactile and sensorimotor functions, which, however, developed in some cases only after many weeks of stimulation, and continued to further improve on a time scale of months.

Balance, sensorimotor, and cognitive performance in long-year expert senior ballroom dancers

Physical fitness is considered a major factor contributing to the maintenance of independent living and everyday competence. In line with this notion, it has been shown that several years of amateur dancing experience can exert beneficial effects not only on balance and posture but also on tactile, motor, and cognitive functions in older people. This raises the question of whether an even more extensive schedule of dancing, including competitive tournaments, would further enhance these positive effects. We therefore assessed posture, balance, and reaction times, as well as motor, tactile, and cognitive performance in older expert ballroom dancers with several years of competitive experience. We found substantially better performance in the expert group than in the controls in terms of expertise-related domains like posture, balance, and reaction times. However, there was no generalization of positive effects to those domains that were found to be improved in amateur dancers, such as tactile and cognitive performance, suggesting that there might be an optimal range of intervention intensity to maintain health and independence throughout the human lifespan.

Rapid assessment of age-related differences in standing balance

As life expectancy continues to rise, in the future there will be an increasing number of older people prone to falling. Accordingly, there is an urgent need for comprehensive testing of older individuals to collect data and to identify possible risk factors for falling. Here we use a low-cost force platform to rapidly assess deficits in balance under various conditions. We tested 21 healthy older adults and 24 young adults during static stance, unidirectional and rotational displacement of their centre of pressure (COP). We found an age-related increase in postural sway during quiet standing and a reduction of maximal COP displacement in unidirectional and rotational displacement tests. Our data show that even low-cost computerized assessment tools allow for the comprehensive testing of balance performance in older subjects.