Cognitive Functioning and the Quality of Survey Responses: An Individual Participant Data Meta-Analysis of 10 Epidemiological Studies of Aging

OBJECTIVES

Self-reported survey data are essential for monitoring the health and well-being of the population as it ages. For studies of aging to provide precise and unbiased results, it is necessary that the self-reported information meets high psychometric standards. In this study, we examined whether the quality of survey responses in panel studies of aging depends on respondents' cognitive abilities.

METHODS

Over 17 million survey responses from 157,844 participants aged 50 years and older in 10 epidemiological studies of aging were analyzed. We derived 6 common statistical indicators of response quality from each participant's data and estimated the correlations with participants' cognitive test scores at each study wave. Effect sizes (correlations) were synthesized across studies, cognitive tests, and waves using individual participant data meta-analysis methods.

RESULTS

Respondents with lower cognitive scores showed significantly more missing item responses (overall effect size ρ^ = -0.144), random measurement error (ρ^ = -0.192), Guttman errors (ρ^ = -0.233), multivariate outliers (ρ^ = -0.254), and acquiescent responses (ρ^ = -0.078); the overall effect for extreme responses (ρ^ = -0.045) was not significant. Effect sizes were consistent across studies, modes of survey administsration, and different cognitive functioning domains, although some cognitive domain specificity was also observed.

DISCUSSION

Lower-quality responses among respondents with lower cognitive abilities add random and systematic errors to survey measures, reducing the reliability, validity, and reproducibility of survey study results in aging research.

Attrition from longitudinal ageing studies and performance across domains of cognitive functioning: an individual participant data meta-analysis

OBJECTIVES

This paper examined the magnitude of differences in performance across domains of cognitive functioning between participants who attrited from studies and those who did not, using data from longitudinal ageing studies where multiple cognitive tests were administered.

DESIGN

Individual participant data meta-analysis.

PARTICIPANTS

Data are from 10 epidemiological longitudinal studies on ageing (total n=209 518) from several Western countries (UK, USA, Mexico, etc). Each study had multiple waves of data (range of 2-17 waves), with multiple cognitive tests administered at each wave (range of 4-17 tests). Only waves with cognitive tests and information on participant dropout at the immediate next wave for adults aged 50 years or older were used in the meta-analysis.

MEASURES

For each pair of consecutive study waves, we compared the difference in cognitive scores (Cohen's d) between participants who dropped out at the next study wave and those who remained. Note that our operationalisation of dropout was inclusive of all causes (eg, mortality). The proportion of participant dropout at each wave was also computed.

RESULTS

The average proportion of dropouts between consecutive study waves was 0.26 (0.18 to 0.34). People who attrited were found to have significantly lower levels of cognitive functioning in all domains (at the wave 2-3 years before attrition) compared with those who did not attrit, with small-to-medium effect sizes (overall d=0.37 (0.30 to 0.43)).

CONCLUSIONS

Older adults who attrited from longitudinal ageing studies had lower cognitive functioning (assessed at the timepoint before attrition) across all domains as compared with individuals who remained. Cognitive functioning differences may contribute to selection bias in longitudinal ageing studies, impeding accurate conclusions in developmental research. In addition, examining the functional capabilities of attriters may be valuable for determining whether attriters experience functional limitations requiring healthcare attention.

Using Item Response Times in Online Questionnaires to Detect Mild Cognitive Impairment

OBJECTIVES

With the increase in web-based data collection, response times (RTs) for survey items have become a readily available byproduct in most online studies. We examined whether RTs in online questionnaires can prospectively discriminate between cognitively normal respondents and those with cognitive impairment, no dementia (CIND).

METHOD

Participants were 943 members of a nationally representative internet panel, aged 50 and older. We analyzed RTs that were passively recorded as paradata for 37 surveys (1,053 items) administered online over 6.5 years. A multilevel location-scale model derived 3 RT parameters for each survey: (1) a respondent's average RT and 2 components of intraindividual RT variability addressing (2) systematic RT adjustments and (3) unsystematic RT fluctuations. CIND status was determined at the end of the 6.5-year period.

RESULTS

All 3 RT parameters were significantly associated with CIND, with a combined predictive accuracy of area under the receiver-operating characteristic curve = 0.74. Slower average RTs, smaller systematic RT adjustments, and greater unsystematic RT fluctuations prospectively predicted a greater likelihood of CIND over periods of up to 6.5, 4.5, and 1.5 years, respectively.

DISCUSSION

RTs for survey items are a potential early indicator of CIND, which may enhance analyses of predictors, correlates, and consequences of cognitive impairment in online survey research.

Neighborhood Social Environment and Self-Perceptions of Aging

Background and Objectives

Self-perceptions of aging (SPA) are associated with health and well-being later in life. Although prior studies have identified individual-level predictors of SPA, the role of neighborhood social context in SPA remains largely unexplored. A neighborhood social environment may act as a critical avenue for older adults to remain healthy and socially active, contributing to their evaluations of how they grow old. The present study aims to fill the previous research gap by examining the relationship between neighborhood social environment and SPA, and how age may moderate this relationship. This study is guided by Bronfenbrenner's Ecology of Human Development theory and Lawton's Ecological Model of Aging, positing that an individual's aging experience is deeply rooted in their residential environment.

Research Design and Methods

Our sample includes 11,145 adults aged 50+ from the 2014 and 2016 waves of the Health and Retirement Study. We included 4 social and economic aspects of neighborhoods: (1) neighborhood poverty; (2) percentage of older adults; (3) perceived social cohesion; and (4) perceived disorder.

Results

Multilevel linear regression models showed that respondents in neighborhoods with higher percentages of the older population and with perceptions of high neighborhood disorder reported more negative SPA. Those who perceived their neighborhoods as more socially cohesive reported more positive SPA. Controlling for individual socioeconomic and health status, only neighborhood social cohesion remained significant. We also found significant interaction effects between neighborhood social cohesion and age: The effects of neighborhood cohesion on SPA were stronger in middle age than in old age.

Discussion and Implications

Our findings provide insights into how neighborhood social context is associated with SPA, suggesting that a socially cohesive neighborhood may be important to promote more favorable perceptions of aging, particularly for middle-aged residents.

Quality of survey responses at older ages predicts cognitive decline and mortality risk

Background and Objectives

It is widely recognized that survey satisficing, inattentive, or careless responding in questionnaires reduces the quality of self-report data. In this study, we propose that such low-quality responding (LQR) can carry substantive meaning at older ages. Completing questionnaires is a cognitively demanding task and LQR among older adults may reflect early signals of cognitive deficits and pathological aging. We hypothesized that older people displaying greater LQR would show faster cognitive decline and greater mortality risk.

Research Design and Methods

We analyzed data from 9,288 adults 65 years or older in the Health and Retirement Study. Indicators of LQR were derived from participants’ response patterns in 102 psychosocial questionnaire items administered in 2006-2008. Latent growth models examined whether LQR predicted initial status and change in cognitive functioning, assessed with the modified Telephone Interview for Cognitive Status, over the subsequent 10 years. Discrete-time survival models examined whether LQR was associated with mortality risk over the 10 years. We also examined evidence for indirect (mediated) effects in which LQR predicts mortality via cognitive trajectories.

Results

After adjusting for age, gender, race, marital status, education, health conditions, smoking status, physical activity, and depressive symptoms, greater LQR was cross-sectionally associated with poorer cognitive functioning, and prospectively associated with faster cognitive decline over the follow-up period. Furthermore, greater LQR was associated with increased mortality risk during follow-up, and this effect was partially accounted for by the associations between LQR and cognitive functioning.

Discussion and Implications

Self-report questionnaires are not formally designed as cognitive tasks but this study shows that LQR indicators derived from self-report measures provide objective, performance-based information about individuals’ cognitive functioning and survival. Self-report surveys are ubiquitous in social science, and indicators of LQR may be of broad relevance as predictors of cognitive and health trajectories in older people.

Subtle mistakes in self-report surveys predict future transition to dementia

INTRODUCTION

We investigate whether indices of subtle reporting mistakes derived from responses in self-report surveys are associated with dementia risk.

METHODS

We examined 13,831 participants without dementia from the prospective, population-based Health and Retirement Study (mean age 69 ± 10 years, 59% women). Participants' response patterns in 21 questionnaires were analyzed to identify implausible responses (multivariate outliers), incompatible responses (Guttman errors), acquiescent responses, random errors, and the proportion of skipped questions. Subsequent incident dementia was determined over up to 10 years of follow-up.

RESULTS

During follow-up, 2074 participants developed dementia and 3717 died. Each of the survey response indices was associated with future dementia risk controlling for confounders and accounting for death as a competing risk. Stronger associations were evident for participants who were younger and cognitively normal at baseline.

DISCUSSION

Mistakes in the completion of self-report surveys in longitudinal studies may be early indicators of dementia among middle-aged and older adults.

Personality predictors of cognitive dispersion: A coordinated analysis of data from seven international studies of older adults

OBJECTIVES

Dispersion in cognitive test performance within a single testing session is proposed as an early marker of poor brain health. Existing research, however, has not investigated factors that may explain individual differences in cognitive dispersion. We investigate the extent to which the Big Five personality traits are associated with cognitive dispersion in older adulthood.

METHOD

To promote transparency and reliability, we applied preregistration and conceptual replication via coordinated analysis. Drawing data from seven longitudinal studies of aging (N_total = 33,581; M_age range = 56.4-71.2), cognitive dispersion scores were derived from cognitive test results. Independent linear regression models were fit in each study to examine personality traits as predictors of dispersion scores, adjusting for mean cognitive performance and sociodemographics (age, sex, education). Results from individual studies were synthesized using random effects meta-analyses.

RESULTS

Synthesized results revealed that openness was positively associated with cognitive dispersion, 0.028, 95% CI [0.003, 0.054]. There was minimal evidence for associations between cognitive dispersion and the other personality traits in independent analyses or meta-analyses. Mean cognitive scores were negatively associated with cognitive dispersion across the majority of studies, while sociodemographic variables were not consistently associated with cognitive dispersion.

CONCLUSION

Higher levels of openness were associated with greater cognitive dispersion across seven independent samples, indicating that individuals higher in openness had more dispersion across cognitive tests. Further research is needed to investigate mechanisms that may help to explain the link between openness and cognitive dispersion, as well as to identify additional individual factors, beyond personality traits, that may be associated with cognitive dispersion. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Information and Communication Technology Use in Older Adults: A Unidirectional or Bi-directional Association with Cognitive Function?

Previous research on older adults' information and communication technology (ICT) use has shown that cognitive function is linked with ICT use; however, the direction of influence has been yet to be determined. The current study examined the temporal sequence of ICT use and cognitive performance. Using three waves (2013, 2015, and 2017) from the National Health and Aging Trends Study, a total of 3,904 community-dwelling older adults aged 65 and above were selected for the analysis. Two cognitive domains were considered: episodic memory and executive function. Reciprocal 4-year lagged associations between ICT use and each cognitive domain were examined, controlling for covariates (age, gender, education, race/ethnicity, and depression). Greater use of ICT was significantly associated with memory performance, B (SE) = .19 (.01), p < .001, and executive function, B (SE) = .26 (.01), p < .001, in following years. Reciprocally, episodic memory predicted ICT use, B (SE) = .02 (.01), p < .001, 2 years later. However, the cross-lagged effect of executive functioning on ICT use was not significant, B (SE) = .00 (.01), p = .14. These results suggest the direction of the association between ICT use and cognitive performance might vary depending on the cognitive domain.

The Association Between Spousal Education and Cognitive Ability Among Older Mexican Adults

OBJECTIVES

Education and cognition are closely associated, yet the role of spousal education is not well understood. We estimate the independent effects of own and spousal education on cognitive ability in late-life in Mexico, a developing country experiencing rapid aging.

METHOD

We analyzed 4,017 married dyads (age 50+) from the 2012 Mexican Health and Aging Study. Cognitive ability for married adults was a factor score from a single factor model. Using seemingly unrelated regression, we test whether spousal education influences older adults' cognitive ability, whether associations are explained by couple-level socioeconomic position, health and health behaviors, and social support, and whether associations differed by gender.

RESULTS

Education and cognitive ability were correlated within couples. Higher spousal education was associated with better cognitive ability. Associations between spousal education and cognitive ability were independent of own education, did not differ by gender, and remained significant even after adjustment for couple-level socioeconomic position, health and health behaviors, and perceived social support.

DISCUSSION

In addition to own education, spousal education was associated with better cognitive ability, even at relatively low levels of education. We discuss the possibility that spousal education may improve cognition via transmission of knowledge and mutually reinforcing cognitively stimulating environments.

Is Healthy Neuroticism Associated with Chronic Conditions? A Coordinated Integrative Data Analysis

Early investigations of the neuroticism by conscientiousness interaction with regards to health have been promising, but to date, there have been no systematic investigations of this interaction that account for the various personality measurement instruments, varying populations, or aspects of health. The current study - the second of three - uses a coordinated analysis approach to test the impact of the neuroticism by conscientiousness interaction on the prevalence and incidence of chronic conditions. Using 15 pre-existing longitudinal studies (N > 49,375), we found that conscientiousness did not moderate the relationship between neuroticism and having hypertension (OR = 1.00,95%CI[0.98,1.02]), diabetes (OR = 1.02[0.99,1.04]), or heart disease (OR = 0.99[0.97,1.01]). Similarly, we found that conscientiousness did not moderate the prospective relationship between neuroticism and onset of hypertension (OR = 0.98,[0.95,1.01]), diabetes (OR = 0.99[0.94,1.05]), or heart disease (OR = 0.98[0.94,1.03]). Heterogeneity of effect sizes was largely nonsignificant, with one exception, indicating that the effects are consistent between datasets. Overall, we conclude that there is no evidence that healthy neuroticism, operationalized as the conscientiousness by neuroticism interaction, buffers against chronic conditions.

Is Healthy Neuroticism Associated with Longevity? A Coordinated Integrative Data Analysis

Individual differences in the Big Five personality traits have emerged as predictors of health and longevity. Although there are robust protective effects for higher levels of conscientiousness, results are mixed for other personality traits. In particular, higher levels of neuroticism have significantly predicted an increased risk of mortality, no-risk at all, and even a reduced risk of dying. The current study hypothesizes that one potential reason for the discrepancy in these findings for neuroticism is that interactions among neuroticism and other key personality traits have largely been ignored. Thus, in the current study we focus on testing whether the personality traits neuroticism and conscientiousness interact to predict mortality. Specifically, we borrow from recent evidence of "healthy neuroticism" to explore whether higher levels of neuroticism are only a risk factor for increased mortality risk when conscientiousness levels are low. We conducted a pre-registered integrative data analysis using 12 different cohort studies (total N = 44,702). Although a consistent pattern emerged of higher levels of conscientiousness predicting a reduced hazard of dying, neuroticism did not show a consistent pattern of prediction. Moreover, no study provided statistical evidence of a neuroticism by conscientiousness interaction. The current findings do not support the idea that the combination of high conscientiousness and high neuroticism can be protective for longevity. Future work is needed to explore different protective factors that may buffer the negative effects of higher levels of neuroticism on health, as well as other behaviors and outcomes that may support the construct of healthy neuroticism.

Is Healthy Neuroticism Associated with Health Behaviors? A Coordinated Integrative Data Analysis

Current literature suggests that neuroticism is positively associated with maladaptive life choices, likelihood of disease, and mortality. However, recent research has identified circumstances under which neuroticism is associated with positive outcomes. The current project examined whether "healthy neuroticism", defined as the interaction of neuroticism and conscientiousness, was associated with the following health behaviors: smoking, alcohol consumption, and physical activity. Using a pre-registered multi-study coordinated integrative data analysis (IDA) approach, we investigated whether "healthy neuroticism" predicted the odds of engaging in each of the aforementioned activities. Each study estimated identical models, using the same covariates and data transformations, enabling optimal comparability of results. These results were then meta-analyzed in order to estimate an average (N-weighted) effect and to ascertain the extent of heterogeneity in the effects. Overall, these results suggest that neuroticism alone was not related to health behaviors, while individuals higher in conscientiousness were less likely to be smokers or drinkers, and more likely to engage in physical activity. In terms of the healthy neuroticism interaction of neuroticism and conscientiousness, significant interactions for smoking and physical activity suggest that the association between neuroticism and health behaviors was smaller among those high in conscientiousness. These findings lend credence to the idea that healthy neuroticism may be linked to certain health behaviors and that these effects are generalizable across several heterogeneous samples.

HEALTH BEHAVIORS ASSOCIATED WITH SUBJECTIVE COGNITIVE DECLINE IN OLDER ADULTS

Participation in risky health behaviors can increase the potential for cognitive decline. Smoking, alcohol consumption, and minimal physical activity are modifiable risk factors associated with worse performance on cognitive assessments; however, the relationship between subjective cognitive decline (SCD) and risky practices has not been assessed. As a potential early indicator of cognitive impairment, SCD may serve as a screening measure for dementia. The Behavioral Risk Factor Surveillance System is an annual, self-reported telephone survey of Americans that includes fifteen core and twenty-five optional sections. The present study included Behavioral Risk Factor Surveillance System participants age 45 or older who completed the core and cognitive decline modules in 2015 (n=147,243). Roughly 11% of participants endorsed worsening memory in the previous year. Logistic regression examined the impact of smoking, drinking, and inactivity on self-reported cognitive decline. Current or former smokers had greater odds of endorsing cognitive decline compared to those who never smoked (OR=1.4; 95% CI: 1.27-1.52). Individuals who consumed at least one alcoholic beverage in the previous month had lower SCD odds compared to non-drinkers (OR=0.8; 95% CI: 0.72-0.87). Respondents who engaged in little to no physical activity had greater odds of endorsing cognitive decline compared to active respondents (OR=1.4; 95% CI: 1.31-1.57). Individuals who endorsed cognitive decline engaged in unhealthy habits such as smoking or inactive lifestyles; however, low to moderate alcohol consumption may be beneficial for cognitive functioning.

USE OF INFORMATION AND COMMUNICATION TECHNOLOGY AND MEMORY PERFORMANCE IN OLDER ADULTS: WHICH COMES FIRST?

The topic of older adults’ information and communication technology (ICT) use looms large because of the beneficial effects of ICT use on physical health, emotional well-being, and social engagement. Previous research has shown that memory performance is also linked with ICT use, but the direction of influence is yet to be determined. Individuals with higher levels of memory function are more likely to use ICT devices, but ICT use may have protective effects on maintaining memory because using technologies includes mental exercises. The current study examined the temporal sequence of ICT use and memory performance, which can provide insight into the causation. Using three waves (2013, 2015, and 2017) from the National Health and Aging Trends Study (NHATS), a total of 4,048 community-dwelling older adults aged 65 and above were selected for the analysis. Memory performance was measured by summing scores of immediate and delayed word recall. Reciprocal 5-year lagged associations between ICT use and memory were examined, while controlling for age, gender, education, racial/ethnic minority status, and depressive symptoms. The final model showed adequate fit indices (CFI = .979 and RMSEA = .038). Word recall significantly predicted ICT use in later years. Reciprocally, greater use of ICT was significantly associated with better memory performance in following years. The effect of ICT use on memory performance was of greater magnitude in comparison with memory as a predictor for ICT use. These results suggest that ICT can have potential benefits for maintaining memory in old age.

PRESENCE AND PREDICTORS OF FAMILIAL AND NON-FAMILIAL AGE-INTEGRATED SOCIAL NETWORKS

A growing older adult population living longer provides opportunities for greater age-integration, which includes reducing age-related structural barriers and increasing cross-age interactions (Riley & Riley, 2000). While research on the theoretical construct of age-integration is prevalent, empirical evidence of age-integration in older adults’ social networks is lacking (Hagestad & Uhlenburg, 2005). This study uses the National Health and Aging Trends Study to quantify and characterize age-integrated social networks in the United States, and to understand the sociodemographic predictors of these age-integrated relationships. Participants’ social networks, comprised of respondents’ spouses, household members, children, helpers, care recipients, and up to five individuals they share important things with were considered age-integrated if individuals were at least 10 years younger than the respondent. About 96% of respondents reported at least one person 10+ years younger than them. Further, these relationships were coded as familial (i.e., spouse, children, grandchildren, parents, siblings, and other relatives) and non-familial relationships (i.e., other non-relatives) and analyses predicting age-integrated relationships as a function of sociodemographic characteristics were stratified by relationship type. Weighted multilevel logistic regression analyses suggest that females have lower odds of familial and non-familial age-integration than males; compared to white and married individuals, Black and Hispanic individuals have greater odds of familial and non-familial age-integration; compared to married individuals, separated, divorced, and widowed individuals have greater odds of familial age-integration, and those who were never married have greater odds of non-familial age-integration. This foundational study reveals that sociodemographic factors differentially predict familial and non-familial age-integrated social networks.

Mobile Apps for Caregivers of Older Adults: Quantitative Content Analysis

Background

Informal caregivers of older adults provide critical support for their loved ones but are subject to negative health outcomes because of burden and stress. Interventions to provide information and resources as well as social and emotional support reduce burden. Mobile apps featuring access to information, assistance with scheduling, and other features can automate support functions inexpensively and conveniently and reach a greater proportion of caregivers than otherwise possible.

Objective

The aim of this study was to identify mobile apps geared towards caregivers of older adults, catalog features, and suggest best practices for adoption based on empirical findings of beneficial interventions in the caregiving literature.

Methods

Search for apps focused on ones catered for caregivers of older adults in Google Play and iTunes, compiling their features, and identifying features reflecting categories of support identified in successful intervention studies to negative caregiver outcomes. Intervention research indicates that provision of information and resources, assistance in practical problem solving, coordinating care among multiple caregivers, and emotional support reduce caregiver burden.

Results

Despite approximately over 200,000 mobile health–related apps, the availability of mobile apps for caregivers is relatively sparse (n=44 apps) as of October 2017. Apps generally addressed specific categories of support, including information and resources, family communication, and caregiver-recipient interactions. Few apps were comprehensive. Only 8 out of 44 (18%) had features that addressed three or more categories. Few apps provided specific stress reduction exercises for caregivers, which is important for reducing burden.

Conclusions

Mobile apps have the potential to provide resources, just­-in­-time information for problem-solving, and stress reduction strategies for caregivers. Many apps offer functions that have been shown to reduce burden and improve health outcomes in caregivers, but few provide emotional support. Using an evidence­-based practice approach, mobile apps for caregivers can provide multiple beneficial support functions. Apps can serve a much larger proportion of this highly underserved population in their mobile form than more traditional means, improving their health and quality of life.

Cognitive activity mediates the association between social activity and cognitive performance: A longitudinal study

Social activity is 1 aspect of an active lifestyle and some evidence indicates it is related to preserved cognitive function in older adulthood. However, the potential mechanisms underlying this association remain unclear. We investigate 4 potential mediational pathways through which social activity may relate to cognitive performance. A multilevel structural equation modeling approach to mediation was used to investigate whether cognitive activity, physical activity, depressive symptoms, and vascular health conditions mediate the association between social activity and cognitive function in older adults. Using data from the Victoria Longitudinal Study, we tested 4 cognitive outcomes: fluency, episodic memory, reasoning, and vocabulary. Three important findings emerged. First, the association between social activity and all 4 domains of cognitive function was significantly mediated by cognitive activity at the within-person level. Second, we observed a significant indirect effect of social activity on all domains of cognitive function through cognitive activity at the between-person level. Third, we found a within-person indirect relationship of social activity with episodic memory performance through physical activity. For these older adults, engagement in social activities was related to participation in everyday cognitive activities and in turn to better cognitive performance. This pattern is consistent with the interpretation that a lifestyle of social engagement may benefit cognitive performance by providing opportunities or motivation to participate in supportive cognitively stimulating activities. (PsycINFO Database Record

Personality Predicts Mortality Risk: An Integrative Data Analysis of 15 International Longitudinal Studies

This study examined the Big Five personality traits as predictors of mortality risk, and smoking as a mediator of that association. Replication was built into the fabric of our design: we used a Coordinated Analysis with 15 international datasets, representing 44,094 participants. We found that high neuroticism and low conscientiousness, extraversion, and agreeableness were consistent predictors of mortality across studies. Smoking had a small mediating effect for neuroticism. Country and baseline age explained variation in effects: studies with older baseline age showed a pattern of protective effects (HR<1.00) for openness, and U.S. studies showed a pattern of protective effects for extraversion. This study demonstrated coordinated analysis as a powerful approach to enhance replicability and reproducibility, especially for aging-related longitudinal research.

Context-Dependent Learning in People With Parkinson's Disease

Context-dependent learning is a phenomenon in which people demonstrate superior performance in the context in which they originally learned a skill but perform less well in a novel context. This study investigated context-dependent learning in people with Parkinson's disease (PD) and age-matched nondisabled adults. All participants practiced 3 finger sequences, each embedded within a unique context (colors and locations on a computer screen). One day after practice, the participants were tested either under the sequence-context associations remained the same as during practice, or the sequence-context associations were changed (SWITCH). Compared with nondisabled adults, people with PD demonstrated significantly greater decrement in performance (especially movement time) under the SWITCH condition, suggesting that individuals with PD are more context dependent than nondisabled adults.

Evaluating the relationship between change in performance on training tasks and on untrained outcomes

Training interventions for older adults are designed to remediate performance on trained tasks and to generalize, or transfer, to untrained tasks. Evidence for transfer is typically based on the trained group showing greater improvement than controls on untrained tasks, or on a correlation between gains in training and in transfer tasks. However, this ignores potential correlational relationships between trained and untrained tasks that exist before training. By accounting for crossed (trained and untrained) and lagged (pre-training and post-training) and cross-lagged relationships between trained and untrained scores in structural equation models, the training-transfer gain relationship can be independently estimated. Transfer is confirmed if only the trained but not control participants' gain correlation is significant. Modeling data from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study (Smith et al., 2009), transfer from speeded auditory discrimination and syllable span to list and text memory and to working memory was demonstrated in 487 adults aged 65-93. Evaluation of age, sex, and education on pretest scores and on change did not alter this. The overlap of the training with transfer measures was also investigated to evaluate the hypothesis that performance gains in a non-verbal speeded auditory discrimination task may be associated with gains on fewer tasks than gains in a verbal working memory task. Gains in speeded processing were associated with gains on one list memory measure. Syllable span gains were associated with improvement in difficult list recall, story recall, and working memory factor scores. Findings confirmed that more overlap with task demands was associated with gains to more of the tasks assessed, suggesting that transfer effects are related to task overlap in multimodal training.

How Interventions Might Improve Cognition in Healthy Older Adults

Many of the cognitive declines in healthy aging are moderated by experience, suggesting that interventions may be beneficial. Goals for aging outcomes include improving performance on untrained tasks, remediating observed cognitive declines, and ensuring preservation of functional ability. This selective review evaluates current progress towards these goals. Most research focuses on untrained tasks. Interventions associated with this outcome include games and exercises practicing specific cognitive skills, as well as aerobic exercise, and modestly benefit a relatively narrow range of cognitive tasks. Few studies have directly tested improvements in tasks on which individuals have been shown to experience longitudinal decline, so this goal has not been realized, though remediation can be examined rather easily. Little work has been done to develop psychometrically strong functional outcomes that could be used to test preservation of independence in everyday activities. Virtual reality approaches to functional assessment show promise for achieving the third goal.

A transformative subfield in rehabilitation science at the nexus of new technologies, aging, and disability

We argue that a silo research and training approach is no longer sufficient to provide real solutions to the complex humanitarian, social, and financial problems brought about by global trends in aging and the increased prevalence of multiple chronic conditions that limit independence and activities of daily living. This perspective highlights the opportunities for collaborative research and training in a new multidisciplinary science of rehabilitation enabled by growing knowledge and information along scientifically and clinically meaningful lines. The recent proliferation of eHealth technologies offers opportunities for development of low-cost, simple, interactive media prevention, health maintenance, and continued functional recovery programs using a chronic care model designed to promote engagement and participation. With two examples - long-term disability consequential to (1) hip fracture and (2) manual wheelchair use - we outline the developing science for a collaborative and transformative nexus team capable of accelerating an understanding of ways to restore independence and improve quality of life, in the long-term. We conclude with a set of recommendations for the design of interactive media systems to both increase acceptability and stimulate research.

Extended practice and aerobic exercise interventions benefit untrained cognitive outcomes in older adults: a meta-analysis

OBJECTIVES

To examine whether therapeutic interventions of extended practice of cognitive tasks or aerobic exercise have led to significant improvement in untrained cognitive tasks.

DESIGN

The PSYCINFO, MEDLINE, and Abstracts in Social Gerontology databases were searched for English-language studies of cognitive interventions of exercise or extended cognitive practice between 1966 and 2010. The final search was in January 2011. Studies included were experimental interventions hypothesizing improvement on untrained cognitive outcomes with pre- and posttests. Studies of varying quality were included and compared.

SETTING

Interventions generally took place in laboratories, in gymnasium facilities, in the home, and outdoors. Experimenters administered testing.

PARTICIPANTS

Forty-two studies with 3,781 healthy older adults aged 55 and older were analyzed.

MEASUREMENTS

Between-group effect sizes (ESs), which account for practice effects on outcome measures, and within-experimental group ESs were computed from untrained cognitive outcome domains, including choice reaction time, memory, and executive function, and compared. ESs were also coded for training type and study quality. Multilevel mixed-effect analyses accommodated multiple outcomes from individual studies.

RESULTS

Extended practice (estimated ES = 0.33, 95% confidence interval (CI) = 0.13-0.52) and aerobic fitness (estimated ES = 0.33, 95% CI = 0.10-0.55) training produced significant between-group ESs, but they did not differ in magnitude. Better study quality was associated with larger ESs.

CONCLUSION

Findings indicate that aerobic and extended cognitive practice training interventions for healthy older adults improve performance on untrained cognitive tasks.

Improvement in memory with plasticity-based adaptive cognitive training: results of the 3-month follow-up

OBJECTIVES

To investigate maintenance of training effects of a novel brain plasticity-based computerized cognitive training program in older adults after a 3-month no-contact period.

DESIGN

Multisite, randomized, controlled, double-blind trial with two treatment groups.

SETTING

Communities in northern and southern California and Minnesota.

PARTICIPANTS

Four hundred eighty-seven community-dwelling adults aged 65 and older without diagnosis of clinically significant cognitive impairment.

INTERVENTION

Random assignment into a broadly available brain plasticity-based computerized cognitive training program experimental group or a novelty- and intensity-matched cognitive stimulation active control. Assessments at baseline, after training, and at 3 months.

MEASUREMENTS

The primary outcome was a composite of auditory subtests of the Repeatable Battery for the Assessment of Neuropsychological Status. Secondary measures included trained task performance, standardized neuropsychological assessments of overall memory and attention, and participant-reported outcomes (PROs).

RESULTS

A significant difference in improvement from baseline to 3-month follow-up was seen between the experimental training and control groups on the secondary composite of overall memory and attention, (P=.01, d=0.25), the trained processing-speed measure (P<.001, d=0.80), word list total recall (P=.004, d=0.28), letter-number sequencing (P=.003, d=0.29), and the cognitive subscale of PRO (P=.006, d=0.27). Previously significant improvements became nonsignificant at the 3-month follow-up for the primary outcome, two secondary measures of attention and memory, and several PROs. Narrative memory continued to show no advantage for the experimental group. Effect sizes from baseline to follow-up were generally smaller than effect sizes from baseline to posttraining.

CONCLUSION

Training effects were maintained but waned over the 3-month no-contact period.

List and text recall differ in their predictors: replication over samples and time

This study tested the hypothesis that latent list and text recall invoke somewhat different processes. A bivariate outcome path model of latent list and text recall evaluated the effects of age, latent speed, working memory, and vocabulary as their predictors. Independent of age, working memory reliably predicted both recall variables, whereas speed reliably predicted list recall only. The relationship between vocabulary and recall was mediated by age, working memory, and speed. The generalizability of this model, based on data from the 1994 testing of the Long Beach Longitudinal Study, was evaluated across samples by testing its invariance on baseline data from an additional panel and for eventual attrition at baseline and at a subsequent testing of retested participants and dropouts. Results showed that the model was invariant over all groups, supporting a replicable distinction between list and text recall.

Cognitive benefits of computer games for older adults

The purpose of this paper is to develop a basis for the hypothesis that digital action games may produce cognitive benefits for older adults. First, a discussion of the relationship between cognitive and physical health shows the increasing weight given to the role of declines in cognition in the development of dependency in older adult population studies. Second, evidence that cognitive training produces 'far transfer' in elders is presented. The key issue is that one approach, known as extended practice training, has been successful in producing far transfer to memory and other processes. Its principles, which are consistent with those associated with positive brain plasticity effects, are identified. Those principles are then related to the mechanics of digital action games, which also have the important added feature of producing the experiences of presence, engagement, and flow, the subjective elements of game play that are likely to sustain interest and emotional investment in the skills practiced so that the play produces cognitive benefits. The specific cognitive abilities proposed to be improved by different types of game genres are outlined, and recent developments in game and interface design that may affect the willingness of older adults to play are described.

A cognitive training program based on principles of brain plasticity: results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study

OBJECTIVES

To investigate the efficacy of a novel brain plasticity-based computerized cognitive training program in older adults and to evaluate the effect on untrained measures of memory and attention and participant-reported outcomes.

DESIGN

Multisite randomized controlled double-blind trial with two treatment groups.

SETTING

Communities in northern and southern California and Minnesota.

PARTICIPANTS

Community-dwelling adults aged 65 and older (N=487) without a diagnosis of clinically significant cognitive impairment.

INTERVENTION

Participants were randomized to receive a broadly-available brain plasticity-based computerized cognitive training program (intervention) or a novelty- and intensity-matched general cognitive stimulation program modeling treatment as usual (active control). Duration of training was 1 hour per day, 5 days per week, for 8 weeks, for a total of 40 hours.

MEASUREMENTS

The primary outcome was a composite score calculated from six subtests of the Repeatable Battery for the Assessment of Neuropsychological Status that use the auditory modality (RBANS Auditory Memory/Attention). Secondary measures were derived from performance on the experimental program, standardized neuropsychological assessments of memory and attention, and participant-reported outcomes.

RESULTS

RBANS Auditory Memory/Attention improvement was significantly greater (P=.02) in the experimental group (3.9 points, 95% confidence interval (CI)=2.7-5.1) than in the control group (1.8 points, 95% CI=0.6-3.0). Multiple secondary measures of memory and attention showed significantly greater improvements in the experimental group (word list total score, word list delayed recall, digits backwards, letter-number sequencing; P<.05), as did the participant-reported outcome measure (P=.001). No advantage for the experimental group was seen in narrative memory.

CONCLUSION

The experimental program improved generalized measures of memory and attention more than an active control program.

Far transfer in cognitive training of older adults

PURPOSE

This article reviews the literature on far transfer effects in training of older adults.

METHODS

Adapting a taxonomy of transfer developed by Barnett and Ceci (2002), to rehabilitation or enhancement of existing cognitive skills; results of studies assessing transfer effects from training of memory, reasoning, UFOV, dual task performance, and complex training are classified.

RESULTS

Comparisons of the transfer outcomes of both strategy training and extended practice approaches suggest that far transfer has been observed.

CONCLUSIONS

Outcomes for strategy studies training memory have had less success than extended practice studies in obtaining far transfer. Reasons for this are discussed, as are suggestions for improved assessment of transfer outcomes.

Not your parents' test scores: cohort reduces psychometric aging effects

Increases over birth cohorts in psychometric abilities may impact effects of aging. Data from 2 cohorts of the Long Beach Longitudinal Study, matched on age but tested 16 years apart, were modeled over ages 55-87 to test the hypothesis that the more fluid abilities of reasoning, list and text recall, and space would show larger cohort differences than vocabulary. This hypothesis was confirmed. At age 74, average performance estimates for people from the more recently born cohort were equivalent to those of people from the older cohort when they were up to 15 years younger. This finding suggests that older adults may perform like much younger ones from the previous generation on fluid measures, indicating higher levels of abilities than expected. This result could have major implications for the expected productivity of an aging workforce as well as for the quality of life of future generations. However, cohort improvements did not mitigate age declines.

Estimating age change in list recall in asset and health dynamics of the oldest-old: the effects of attrition bias and missing data treatment

Average change in list recall was evaluated as a function of missing data treatment (Study 1) and dropout status (Study 2) over ages 70 to 105 in Asset and Health Dynamics of the Oldest-Old data. In Study 1 the authors compared results of full-information maximum likelihood (FIML) and the multiple imputation (MI) missing-data treatments with and without independent predictors of missingness. Results showed declines in all treatments, but declines were larger for FIML and MI treatments when predictors were included in the treatment of missing data, indicating that attrition bias was reduced. In Study 2, models that included dropout status had better fits and reduced random variance compared with models without dropout status. The authors conclude that change estimates are most accurate when independent predictors of missingness are included in the treatment of missing data with either MI or FIML and when dropout effects are modeled.

A 10-item Rasch modeled memory self-efficacy scale

A 10-item scale to measure memory self-efficacy was developed from responses to the 33-item Frequency of Forgetting scale of the Memory Functioning Questionnaire (MFQ). Responses to the MFQ from 565 participants in the 1994-1995 wave of the Long Beach Longitudinal Study were analyzed. Rasch scaling procedures were used to select items that discriminated individuals' scoring patterns and that provided non-redundant information about responses. A set of 10 items provided a scale that was reliable across items and persons. Female gender, conscientiousness score, depression score, and list recall predicted individual differences in participants' scores on the scale. Age, education, neuroticism, and text recall were also reliably correlated with scores but were suppressed by the other covariates. The shortened test is predicted by the same covariates as the long version, indicating that it has similar construct validity.

Adult age differences in multiple cognitive functions: differentiation, dedifferentiation, or process-specific change?

Adult age differences in covariance structures of latent variables of vocabulary, list recall, speed, working memory, and text recall, were analyzed to test hypotheses of structural changes with age. There were baseline data from 613 men and women aged 30-97, data from a second wave of testing from 322 people, and complete longitudinal data from 289 people. There were age differences in the size but not configuration of factor loadings cross-sectionally but not longitudinally. There were no changes in factor standard deviations or covariances. Findings did not support models of dedifferentiation with age.

Effects of demographic and health variables on Rasch scaled cognitive scores

OBJECTIVES

To determine whether demographic and health variables interact to predict cognitive scores in Asset and Health Dynamics of the Oldest-Old (AHEAD), a representative survey of older Americans, as a test of the developmental discontinuity hypothesis.

METHODS

Rasch modeling procedures were used to rescale cognitive measures into interval scores, equating scales across measures, making it possible to compare predictor effects directly. Rasch scaling also reduces the likelihood of obtaining spurious interactions. Tasks included combined immediate and delayed recall, the Telephone Interview for Cognitive Status (TICS), Series 7, and an overall cognitive score.

RESULTS

Demographic variables most strongly predicted performance on all scores, with health variables having smaller effects. Age interacted with both demographic and health variables, but patterns of effects varied.

DISCUSSION

Demographic variables have strong effects on cognition. The developmental discontinuity hypothesis that health variables have stronger effects than demographic ones on cognition in older adults was not supported.

Longitudinal hierarchical linear models of the memory functioning questionnaire

Three hypotheses about the nature of self-rated memory as measured by the Memory Functioning Questionnaire (MFQ; M. J. Gilewski, E. M. Zelinski, & K. W. Schaie, 1990) were tested: that ratings reflect memory performance, that personality traits underlie ratings, and that ratings reflect implicit theories of memory change. Baseline scores and 19 year change slopes for the 4 MFQ factor ratings of a sample of 97 participants aged 30-81 were investigated. There were significant mean declines for all MFQ ratings except Frequency of Forgetting and significant individual differences in slopes for Frequency, Retrospective Functioning, and Mnemonics. Personality predicted baseline Frequency and Seriousness ratings and list and text recall slopes predicted Mnemonics slopes. Different mechanisms may underlie baseline ratings and changes in ratings for different factors.

Understanding unfamiliar words in young, young-old, and old-old adults: Inferential processing and the abstraction-deficit hypothesis

Previous research suggests that older adults derive interpretations of unfamiliar words that are less precise than those of young adults (D. McGinnis & E. M. Zelinski, 2000). Thirty-one adults aged 18-37, 27 aged 65-74, and 28 aged 75-87 read passages containing unfamiliar words (1 per passage) and were asked to think aloud during reading. After reading each passage, participants selected meaning-relevant cues and rated the quality of 4 definition options. Compared with the 2 younger groups, the oldest group rated thematic and irrelevant definitions significantly higher, and their think-aloud protocols included more generalized inferences. Results pertaining to cue selection were not significant. Taken together, these results suggest that age differences in meaning derivation may be related to inferential processing that is overgeneralized, providing support for the abstraction-deficit hypothesis.

The Long Beach Longitudinal Study: evaluation of longitudinal effects of aging on memory and cognition

This article outlines the purposes, design, and findings of the Long Beach Longitudinal Study, a multipanel study of adults aged 28 through the upper reaches of the life span. The goal of the study is to identify normal short- and long-term longitudinal changes in memory and cognition across adulthood, and to develop models to explain cognitive changes. Descriptive findings of 3- and 16-year longitudinal change patterns are identified, as well as results suggesting the role of cognitive processing resources and intellectual ability in memory change. Change patterns of the oldest-old, who differ from less elderly adults, are discussed.

The relationship between subjective and objective memory in the oldest old: comparisons of findings from a representative and a convenience sample

OBJECTIVES

To evaluate the hypotheses that subjective memory ratings are more accurate in the oldest old than in the young old and more accurate in a representative sample than in a convenience sample.

METHODS

Outcomes of hierarchical regressions of subjective ratings and participant characteristics on recall were compared between a nationally representative sample of 6,446 adults ages 70 to 103 and a convenience sample of 326 adults ages 70 to 97.

RESULTS

Education interacted with memory ratings in the prediction of performance in the representative sample, with better prediction for more highly educated participants than for participants with lower levels of education.

DISCUSSION

The general pattern of findings was consistent across both samples and neither hypothesis was supported. Possible explanations for the similarity of results across samples are considered.

Age, medical conditions, and gender as interactive predictors of cognitive performance: the effects of selective survival

The interaction of age, medical conditions, and gender on free-recall and mental status test performance was analyzed in two large survey samples of older adults. Age, gender, and the presence of medical conditions interacted with recall and mental status in Study 1 (n = 2,695) and mental status in Study 2 (n = 6,299). For men, those with one or more medical conditions declined more steeply with age than those with no conditions. For women, this relationship was reversed. The findings suggest survival effects, whereby those who lived to old age with medical conditions and were selected into the sample had high levels of cognitive functioning. The age at which these effects are seen vary with gender because women survive longer than men.

Understanding unfamiliar words: the influence of processing resources, vocabulary knowledge, and age

In a 2-experiment design, the authors assessed the role of age and ability in defining unfamiliar words from context. In Experiment 1, 60 adults aged 18-33 and 60 adults aged 61-96 read passages with cues to the meaning of rare words, then defined them. Older adults produced fewer components of the words' meanings and were more likely to produce generalized interpretations of the precise meaning. In Experiment 2, 726 adults aged 30-97 selected definitions from 4 choices: the exact definition, a generalized interpretation of the exact definition, a generalized interpretation of the story, and definition-irrelevant information from the story. Adults over age 75 selected fewer precise definitions and more generalized interpretations of the story than younger ones. Findings suggest that older adults may have special difficulties in deriving the meaning of unfamiliar words from context.

Understanding unfamiliar words: the influence of processing resources, vocabulary knowledge, and age

In a 2-experiment design, the authors assessed the role of age and ability in defining unfamiliar words from context. In Experiment 1, 60 adults aged 18-33 and 60 adults aged 61-96 read passages with cues to the meaning of rare words, then defined them. Older adults produced fewer components of the words' meanings and were more likely to produce generalized interpretations of the precise meaning. In Experiment 2, 726 adults aged 30-97 selected definitions from 4 choices: the exact definition, a generalized interpretation of the exact definition, a generalized interpretation of the story, and definition-irrelevant information from the story. Adults over age 75 selected fewer precise definitions and more generalized interpretations of the story than younger ones. Findings suggest that older adults may have special difficulties in deriving the meaning of unfamiliar words from context.

Individual differences in 16-year memory changes

The authors analyzed the role of individual differences in age, gender, and 16-year declines in reasoning and vocabulary as predictors of 16-year changes in text and list recall and recognition in 82 adults aged 55-81 years at baseline. Declines in reasoning as well as being older at baseline predicted declines in text recall. Male gender and declining in vocabulary predicted declines in list recall. There were no reliable predictors of declines in recognition. The findings suggest that changes in abilities, as well as age and gender, predict declines on memory tasks. However, the specific predictors varied across tasks.