Does Consumer Credit Precede or Follow Health Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial

Background and Objectives

Consumer credit has shown increasing relevance to the health of older adults; however, studies have not been able to assess the extent to which creditworthiness influences future health or health influences future creditworthiness. We assessed the relationships between 4-year pre and postmorbid consumer credit history and self-rated physical and mental health outcomes among older adults.

Research Design and Methods

Generalized estimating equations models assessed pre and postmorbid credit history (credit scores, derogatory accounts, and unpaid accounts in collections) and the onset of poor self-rated health (SF-36 score <50) among 1,740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly study from 2001 to 2017, linked to TransUnion consumer credit data.

Results

In any given year, up to 1/4 of participants had a major derogatory, unpaid, or collections account, and up to 13% of the sample had poor health. Each 50-point increase in credit score trended toward a 5% lower odds of poor health in the next 1 year, a 6% lower odds in the next 2 years, and a statistically significant finding of 13% lower odds by 3 years. A drop in credit score was associated with a 10% greater odds of poor health in the next year, and having a major derogatory account was associated with an 86% greater odds of poor health in the next 3 years. After poor health onset, credit scores continued to see significant losses up to the 3 years, with larger decrements over time.

Discussion and Implications

Having a major derogatory account or a sudden loss in credit may be a time to monitor older adults for changes in health. After a downturn in health, supporting older adults to manage their debt may help stabilize their credit.

Effects of Cognitive Training on Alzheimer's Disease and Related Dementias: The Moderating Role of Social Determinants of Health

Objective: We examined whether social determinants of health (SDoH) are associated with Alzheimer's disease and related dementias (ADRD) risk and the effects of cognitive training over a 20-year follow-up period. Methods: Data were obtained from 1605 participants in ACTIVE. SDoH measures were created using baseline data at the individual and neighborhood level. Incident ADRD was defined using administrative claims data (1999-2019). Cause-specific hazard models estimated associations between SDoH and claims-based diagnosed ADRD. Results: Higher scores on neighborhood and built environment were associated with lower ADRD risk. Trained participants obtained a greater degree of protection from ADRD when they had higher scores for SDoH domains associated with health care and education access. However, there were fewer significant SDoH moderation effects on cognitive training than expected. Discussion: Future work should continue to explore culturally tailored cognitive training interventions to reduce ADRD risk associated with SDoH that disproportionately affects racially diverse aging populations.

Beyond Big Five trait domains: Stability and change in personality facets across midlife and old age

OBJECTIVE

Accumulated evidence indicates both stable and malleable parts of inter-individual differences in the broad Big Five domains. Less is known, however, about stability and change at the more diversified facet level. With the current study, we fill this gap by investigating personality stability and change across midlife and old age.

METHOD

We apply local structural equation measurement models and second-order growth curve models to four waves of data obtained with the full NEO Personality Inventory (NEO-PI-R) collected over 11 years from 1667 adults (Mage  = 62.69 years, SDage  = 15.62, 55% female) who participated in the Seattle Longitudinal Study.

RESULTS

Measurement invariance analyses indicated that the psychometric properties of the NEO-PI-R facets are comparable across time and age. Results revealed substantial rank-order stabilities across all facets, yet the exact pattern varied strongly between facets of the same trait and across traits. Mean-level change of facets from midlife to old age largely mirrored the mean-level change observed for the broader traits.

CONCLUSION

We discuss conceptual implications and argue that in the face of overall stability across midlife and old age, changes in the rank-ordering of people reveals a much more complex and diverse pattern of development than analyses at the trait level suggest.

Does Consumer Credit Precede or Follow Changes in Cognitive Impairment Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial

OBJECTIVES

We assessed the relationships between pre- and post-morbid consumer credit history (credit scores, debts unpaid, or in collections) and classification of mild (or greater) cognitive impairment (MCI).

METHODS

Generalized Estimating Equation models assessed pre-and post-morbid credit history and MCI risk among 1740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, linked to TransUnion consumer credit data.

RESULTS

Each 50-point increase in credit score was associated with up to 8% lower odds of MCI in the next 3 years. In contrast, new unpaid collections over doubled the odds of having MCI in the next 3 years. MCI was associated with subsequent credit score declines and a 47%-71% greater risk of having a new unpaid collection in the next 4 years.

DISCUSSION

Credit declines may signal risk for future MCI. MCI may lead to financial challenges that warrant credit monitoring interventions for older adults.

Rural-Urban Differences in Cognition: Findings From the Advanced Cognitive Training for Independent and Vital Elderly Trial

ObjectivesWe examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures-memory (B = -1.17 (0.17)), reasoning (B = -1.55 (0.19)), and processing speed (B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.

The ACTIVE Study: Association of Race and Social Determinants of Health (SDoH) with Long-Term Outcomes and Cognitive Training Effects

Objective: The purpose of this article is to introduce a special issue on the ACTIVE project examining the association between race and social determinants of health (SDoH) and long-term participant outcomes and training effectiveness for older Black/African Americans and Whites in the ACTIVE (for Advanced Cognitive Training for Independent and Vital Elderly) Trial on cognitive abilities, everyday functioning, and incidence of dementia. The ACTIVE study is the largest randomized clinical trial (N = 2802) of the efficacy of three types of cognitive training (memory, reasoning, speed of processing) in improving cognitive and everyday functioning in normal older adults, with follow-ups extending through 5 and 10 years post-intervention. Method: We provide background and context for studying the multiple domains of SDoH in understanding long-term participant outcomes in the ACTIVE trial and racial disparities in the efficacy of cognitive training and summarize the 11 articles in this special issue. Results: Articles in this special issue address several cross-cutting themes. These include 1) a focus on SDoH and race in relation to three cognitive abilities and driving; 2) cognitive training outcomes in older Black/African Americans (B/AA); 3) race differences in everyday function; and 4) associations of various risk factors (e.g., cardiovascular disease, obesity, depression) and protective factors (e.g., occupational complexity) for cognitive decline with health disparities in incident dementia and mortality. Conclusion: In cognitive training studies with cognitively healthy older adults, it is important to consider how factors such as race and SDoH relate to long-term participant outcomes and how they moderate intervention effects.

Disparities in First Instrumental Activity of Daily Living Difficulty between Black and White Older Adults: Findings from the Advanced Cognitive Training in Independent and Vital Elderly Study

Objectives: Few studies have examined differences in age of onset of first self-reported instrumental activities of daily living difficulty, much less differences by race. Our objective was to determine whether there are differences in the first reported difficulty with IADLs between Black and white older adults. Methods: We analyzed data from N = 1168 participants in the Advanced Cognitive Training in Independent and Vital Elderly (ACTIVE) study. A multiple group discrete-time multiple-event process survival mixture (MEPSUM) model was used to estimate the hazard of incident IADL difficulty in seven IADL task groups. Results: No statistically significant differences were identified in the first reported IADL task group difficulty between Black and white older adults. Discussion: Our findings indicate similar patterns of early IADL difficulty in Black and white older adults, suggesting that previously reported racial disparities in ability to perform IADLs may be attributable to differences in absolute risk, not timing.

Evaluating Social Determinants of Health Domains and Their Predictive Validity Within Black/African American and White Older Adults From the ACTIVE Trial

OBJECTIVE

To assess domains of social determinants of health (SDoH) and their associations with cognition and quality of life.

METHOD

This investigation uses baseline data from individuals participating in the ACTIVE trial (n = 2505) to reproduce the SDoH domains described in Healthy People 2030 (economic stability, health care, education, neighborhood and built environment, and social and community context). Results: Results support using data from the ACTIVE trial to assess all five SDoH domains, and the ability of the composites to predict baseline performance on measures of cognition and self-reported quality of life within a sample of older adults. Additionally, higher SDoH domain scores were associated with better functioning on composite measures of cognition and higher scores for mental and general health-related quality of life with Access to Healthcare associated with all outcomes. Discussion: These findings can inform investigators interested in assessing multiple domains of SDoH and highlight the importance of access to health care within older Black/African American and White older adults.

Long-Term Effects of Cognitive Training on All-Cause Mortality in US Older Adults

Objectives: Cognitive abilities have been implicated as predictors of mortality in older adults. This study examines the effects of cognitive training on mortality 20 years post-intervention. Methods: Data come from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial (N = 2802). Participants were cognitively and physically healthy, community-dwelling adults aged 65 and older. Cox proportional hazard models were used to investigate (1) the association between baseline cognition and mortality risk and (2) the effect of ACTIVE cognitive training (memory, reasoning, and speed of processing) on mortality risk 20 years post-intervention. Results: Higher baseline cognition predicted lower mortality risk 20 years post-intervention. No significant effects of ACTIVE cognitive training in memory, reasoning, or speed of processing on mortality risk were observed. Discussion: More work is needed to identify cognitive training interventions that may lead to lower mortality risks in later adulthood.

Acting Like a Baby Boomer? Birth-Cohort Differences in Adults' Personality Trajectories During the Last Half a Century

Society and developmental theory generally assume that there are wide generational differences in personality. Yet evidence showing historical change in the levels of adult Big Five traits is scarce and particularly so for developmental change. We tracked adult trajectories of personality in 4,732 participants (age: M = 52.93 years, SD = 16.69; 53% female) from the Seattle Longitudinal Study (born 1883-1976) across 50 years. Multilevel models revealed evidence for historical change in personality: At age 56, later-born cohorts exhibited lower levels of maturity-related traits (agreeableness and neuroticism) and higher levels of agency-related traits (extraversion and openness) than earlier-born cohorts. Historical changes in agreeableness and neuroticism were more pronounced among young adults, but changes in openness were less pronounced. Cohort differences in change were rare and were observed only for agreeableness; within-person increases were more pronounced among later-born cohorts. Our results yield the first evidence for historical change in the Big Five across adulthood and point to the roles of delayed social-investment and maturity effects.

Adult development and aging in historical context

Human functioning and development are shaped by sociocultural contexts and by the historical changes that occur in these contexts. Over the last century, sociocultural changes such as increases in early life education have profoundly reshaped normative developmental sequences. In this article, we first briefly review how history-graded changes have influenced levels of objective performance and subjective evaluations among older adults and conclude that old age in countries such as the United States and Germany is getting younger, both on behavioral measures and in people's own perception. Second, we put these findings in a larger perspective and note some of the "presumed" causes driving historical change. Third, we identify key aspects of change that need to be further described, including history-graded change in (a) the formative role of experiences made across adulthood; (b) within-person trajectories of adult development and aging, including rates of change, patterns of variation, and causal influence; (c) the structure of very old age and the end of life; and (d) what may be expected in the forthcoming decades. We suggest a number of reasons why the rosy picture of historical change obtained for older adults over the last century may not necessarily continue in the future. In a final step, we outline promising methods that might be used to discover and test mechanisms driving history-graded changes, and to inform projection and optimization of functioning and development in future generations of older adults. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Application of neuropsychological criteria to classify mild cognitive impairment in the active study

Objective: Comprehensive neuropsychological criteria (NP criteria) for mild cognitive impairment (MCI) has reduced diagnostic errors and better predicted progression to dementia than conventional MCI criteria that rely on a single impaired score and/or subjective report. This study aimed to implement an actuarial approach to classifying MCI in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. Method: ACTIVE study participants (N = 2,755) were classified as cognitively normal (CN) or as having MCI using NP criteria. Estimated proportion of MCI participants and reversion rates were examined as well as baseline characteristics by MCI subtype. Mixed effect models examined associations of MCI subtype with 10-year trajectories of self-reported independence and difficulty performing instrumental activities of daily living (IADLs). Results: The proportion of MCI participants was estimated to be 18.8%. Of those with MCI at baseline, 19.2% reverted to CN status for all subsequent visits. At baseline, the multidomain-amnestic MCI group generally had the greatest breadth and depth of cognitive impairment and reported the most IADL difficulty. Longitudinally, MCI participants showed faster IADL decline than CN participants (multidomain-amnestic MCI > single domain-amnestic MCI > nonamnestic MCI). Conclusion: NP criteria identified a proportion of MCI and reversion rate within ACTIVE that is consistent with prior studies involving community-dwelling samples. The pattern of everyday functioning change suggests that being classified as MCI, particularly amnestic MCI, is predictive of future loss of independence. Future work will apply these classifications in ACTIVE to better understand the relationships between MCI and health, social, and cognitive intervention-related factors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Incident Instrumental Activities of Daily Living Difficulty in Older Adults: Which Comes First? Findings From the Advanced Cognitive Training for Independent and Vital Elderly Study

Introduction: Instrumental activities of daily living (IADLs) are complex daily tasks important for independent living. Many older adults experience difficulty with IADLs as their physical and/or cognitive function begins to decline. However, it is unknown in what order IADLs become difficult. Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who were free of IADL difficulty at baseline (N = 1,277) were followed up to 10 years until first reported IADL difficulty. A total of 19 IADL tasks were grouped into seven task categories. A discrete-time multiple-event process survival mixture model (MEPSUM) was used to generate hazard estimates of incident IADL difficulty in seven groups from ages 65 to 80. Hazard estimates were compared in the three intervention groups (memory, inductive reasoning, and speed of information processing) vs. the no-contact control group. Results: A total of 887 (69.5%) participants reported incident difficulty in at least one IADL task category. Compared to individuals who remained free of IADL difficulty, those who reported incident difficulty were more likely to be older, female, and have lower Short Form 36 general health scores. The IADL task categories to first become difficult were housework, managing health care, and phone use. There were no differences by intervention group in the hazard estimates of incident IADL difficulty. Conclusion: Managing health care and phone use are more cognitively demanding IADLs, and individuals who experience difficulty in these tasks first may be more likely to experience cognitive decline. Recognizing early difficulty in managing health care may allow for implementation of compensation strategies to minimize unintentional medication misuse, increased adverse medical events, and unnecessary hospitalization. Training of a specific cognitive domain may not influence ordering of IADL difficulty because IADL tasks require proficiency in, and integration of, multiple cognitive domains.

Cohort differences in cognitive aging: The role of perceived work environment

Studies of historical and societal influences on cognitive aging generally document that later-born cohorts outperform earlier-born cohorts on tests of fluid cognitive performance. It is often noted how advances in educational attainment in childhood and adolescence may contribute to these historical improvements in cognitive aging. Less is known about the role of work environment in adulthood. Over the last century, work demands and characteristics have been changing profoundly, particularly with shifts from a manufacturing to a service and technical economy. In this article, we used data from the Seattle Longitudinal Study to compare age-related trajectories of cognitive change in five primary mental abilities between earlier-born (1901-1938) and later-born cohorts (1939-1966). Cohorts were matched on an observation-by-observation basis using age and retest, and analyses controlled for participants' gender and number of data points provided. We found that (a) later-born cohorts had higher levels of performance on most cognitive tasks and exhibited less age-related declines in word fluency; (b) later-born cohorts had more enriched perceived work environments, as indicated by higher levels of worker control and innovation, with no cohort differences in work autonomy; (c) these experiences were associated with higher levels of cognitive performance at age 55 years; (d) the effects of perceived work environment were independent of education; and (e) the effects of perceived work environment were consistent across cohorts. The findings suggest that perceived work environment is associated with cognitive functioning independently of education and invariably across historical time. We discuss potential mechanisms underlying these associations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

COHORT DIFFERENCES IN COGNITIVE AGING: THE ROLE OF PERCEIVED WORK ENVIRONMENT

Studies of historical change on cognitive aging generally document that later-born cohorts outperform earlier-born cohorts on tests of fluid cognitive performance. It is often noted how advances in educational attainment contribute to this finding. Over the last century, work demands and characteristics have changed profoundly, with shifts from a manufacturing to service and technical economy. We used data from the Seattle Longitudinal Study to compare trajectories of cognitive change between earlier-born (1901-1938) and later-born cohorts (1939-1966). Our findings show that (a) later-born cohorts had higher levels of performance on most cognitive tasks and exhibited less decline in word fluency, (b) had more enriched perceived work environment as indicated by higher levels of worker control and innovation, with no cohort differences in work autonomy (c) these experiences were associated with higher levels of cognitive performance independent of education and consistently across cohorts. We discuss potential mechanisms underlying these associations.

APOEε4 Genotype and Hypertension Modify 8-year Cortical Thinning: Five Occasion Evidence from the Seattle Longitudinal Study

We investigated individual differences in longitudinal trajectories of brain aging in cognitively normal healthy adults from the Seattle Longitudinal Study covering 8 years of longitudinal change (across 5 occasions) in cortical thickness in 249 midlife and older adults (52-95 years old). We aimed to understand true brain change; examine the influence of salient risk factors that modify an individual's rate of cortical thinning; and compare cross-sectional age-related differences in cortical thickness to longitudinal within-person cortical thinning. We used Multivariate Multilevel Modeling to simultaneously model dependencies among 5 lobar composites (Frontal, Parietal, Temporal, Occipital, and Cingulate [CING]) and account for the longitudinal nature of the data. Results indicate (1) all 5 lobar composites significantly atrophied across 8 years, showing nonlinear longitudinal rate of cortical thinning decelerated over time, (2) longitudinal thinning was significantly altered by hypertension and Apolipoprotein-E ε4 (APOEε4), varying by location: Frontal and CING thinned more rapidly in APOEε4 carriers. Notably, thinning of parietal and occipital cortex showed synergistic effect of combined risk factors, where individuals who were both APOEε4 carriers and hypertensive had significantly greater 8-year thinning than those with either risk factor alone or neither risk factor, (3) longitudinal thinning was 3 times greater than cross-sectional estimates of age-related differences in thickness in parietal and occipital cortices.

Leptomeninges-Derived Induced Pluripotent Stem Cells and Directly Converted Neurons From Autopsy Cases With Varying Neuropathologic Backgrounds

Patient-specific stem cell technology from skin and other biopsy sources has transformed in vitro models of neurodegenerative disease, permitting interrogation of the effects of complex human genetics on neurotoxicity. However, the neuropathologic changes that underlie cognitive and behavioral phenotypes can only be determined at autopsy. To better correlate the biology of derived neurons with age-related and neurodegenerative changes, we generated leptomeningeal cell lines from well-characterized research subjects that have undergone comprehensive postmortem neuropathologic examinations. In a series of proof of principle experiments, we reprogrammed autopsy leptomeningeal cell lines to human-induced pluripotent stem cells (hiPSCs) and differentiated these into neurons. We show that leptomeningeal-derived hiPSC lines can be generated from fresh and frozen leptomeninges, are pluripotent, and retain the karyotype of the starting cell population. Additionally, neurons differentiated from these hiPSCs are functional and produce measurable Alzheimer disease-relevant analytes (Aβ and Tau). Finally, we used direct conversion protocols to transdifferentiate leptomeningeal cells to neurons. These resources allow the generation of in vitro models to test mechanistic hypotheses as well as diagnostic and therapeutic strategies in association with neuropathology, clinical and cognitive data, and biomarker studies, aiding in the study of late-onset Alzheimer disease and other age-related neurodegenerative diseases.

Is subjective memory specific for memory performance or general across cognitive domains? Findings from the Seattle Longitudinal Study

A growing body of research has examined whether people's judgments of their own memory functioning accurately reflect their memory performance at cross-section and over time. Relatively less is known about whether these judgments are specifically based on memory performance, or reflect general cognitive change. The aim of the present study was to examine longitudinal associations of subjective memory with performance in tests of episodic memory and a wide range of other cognitive tests, including the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Block Design, Comprehension, Digit Span, Digit Symbol, and Vocabulary subtests. We applied latent growth curve models to five occasions over up to 16 years of neuropsychological assessments from 956 participants of the Seattle Longitudinal Study (SLS; 57% women; age at baseline: M = 65.1, SD = 11.4, 38 - 96 years). Results revealed that lower self-reported Frequency of Forgetting was significantly associated with better performance in all cognitive domains at baseline. The baseline correlation of Frequency of Forgetting with memory performance was stronger than its correlations with performance in other cognitive tests. Furthermore, additional analyses with baseline data showed that a latent memory performance factor reliably predicted Frequency of Forgetting after controlling for a general cognitive factor. Over time, steeper increases in Frequency of Forgetting were associated with steeper declines in tests of memory performance and in the Block Design and Digit Symbol subtests. Taken together, these findings suggest that although self-reported Frequency of Forgetting reflects performance in a broad range of other cognitive domains, it also shows some specificity for memory performance. (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.

Control beliefs and cognition over a 10-year period: Findings from the ACTIVE trial

We examined two facets of control beliefs and cognition over 10 years within the Advanced Cognitive Training for Independent and Vital Elderly study. Intellectual Self-Efficacy decreased (β = -0.32 units/year; SE = 0.03) and Concern About Intellectual Aging increased (β = 0.26 units/year; SE = 0.02) over time, with older age being the only predictor of increases in Concern About Intellectual Aging. Although baseline cognitive performance was related to control beliefs over time, the reverse was not supported. Findings were not altered by participation in the ACTIVE training programs, suggesting the need for including intervention components that lead to long-term maintenance or improvements in such beliefs. (PsycINFO Database Record

Age and Distance to Death in the Seattle Longitudinal Study

A series of hierarchical regression models was used to determine if time to death was a significant independent variable for level and seven-year change in intellectual performance for 1,214 community-dwelling adults. Distance to death explained a significant amount of the variance of intellectual performance at individuals’last measurement but not of the decline in performance after controlling for age, education, gender, and survivorship. The inclusion of time to death improved the proportion of unique variance explained by about 1% to 3% and between 4% and 10.4% of the total variance explained. Decedents had lower levels of verbal meaning, spatial ability, reasoning ability, and psychomotor speed at last measurements and greater amounts of seven-year decline on verbal meaning and psychomotor speed. The inclusion of distance to death may help improve the explanation of variability in performance associated with increased age.

Cognitive Function and Medication Usage in Older Adults

Research is presented from three different cognitive aging laboratories that examines the relationship between cognitive function, age, and the ability to adhere to medication regimens. The first section focuses on the effectiveness of complete, explicit instructions that emphasize the importance of organization of medication information on adherence behaviors for both younger and older adults. The second section examines the role of literal versus inferential medication information in normal elderly and in Alzheimer's patients. This research demonstrates that traditional measures of cognitive functioning are correlated with the comprehension of medication information and medication adherence. Finally, the third section presents an overview of research issues m adherence, including the relative effectiveness of two adherence measurement techniques, as well as a discussion of the effects of illness beliefs on adherence and evidence that adherence is not a global behavior but may vary within the individual as a function of certain medications. Directions for future research are suggested.

Enhancing the Cognitive Vitality of Older Adults

Aging is associated with decline in a multitude of cognitive processes and brain functions. However, a growing body of literature suggests that age-related decline in cognition can sometimes be reduced through experience, cognitive training, and other interventions such as fitness training. Research on cognitive training and expertise has suggested that age-related cognitive sparing is often quite narrow, being observed only on tasks and skills similar to those on which individuals have been trained. Furthermore, training and expertise benefits are often realized only after extensive practice with specific training strategies. Like cognitive training, fitness training has narrow effects on cognitive processes, but in the case of fitness training, the most substantial effects are observed for executive-control processes.

External locus of control contributes to racial disparities in memory and reasoning training gains in ACTIVE

Racial disparities in cognitive outcomes may be partly explained by differences in locus of control. African Americans report more external locus of control than non-Hispanic Whites, and external locus of control is associated with poorer health and cognition. The aims of this study were to compare cognitive training gains between African American and non-Hispanic White participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study and determine whether racial differences in training gains are mediated by locus of control. The sample comprised 2,062 (26% African American) adults aged 65 and older who participated in memory, reasoning, or speed training. Latent growth curve models evaluated predictors of 10-year cognitive trajectories separately by training group. Multiple group modeling examined associations between training gains and locus of control across racial groups. Compared to non-Hispanic Whites, African Americans evidenced less improvement in memory and reasoning performance after training. These effects were partially mediated by locus of control, controlling for age, sex, education, health, depression, testing site, and initial cognitive ability. African Americans reported more external locus of control, which was associated with smaller training gains. External locus of control also had a stronger negative association with reasoning training gain for African Americans than for Whites. No racial difference in training gain was identified for speed training. Future intervention research with African Americans should test whether explicitly targeting external locus of control leads to greater cognitive improvement following cognitive training.

Hypertension moderates the effect of APOE on 21-year cognitive trajectories

We examined whether hypertension moderated the effects of apolipoprotein ε4 (APOE ε4) on individual differences in level and change in cognitive functions over a 21-year period using data from the Seattle Longitudinal Study (SLS). A total of 563 nondemented adults ages 32 to 74 years in 1984 (M = 51.06, SD = 12.03) were included in the study. Cognitive performance was assessed spanning 7 domains-verbal comprehension, numeric facility, episodic memory, spatial orientation, inductive reasoning, perceptual speed, and cognitive flexibility-over 4 occasions of measurement at 7-year intervals. Multilevel modeling was used to test the cross-sectional and longitudinal effects of hypertension, APOE, and their interaction, after adjusting for age, gender, and education. APOE and hypertension had additive and interactive effects on select cognitive functions. APOE ε4 carriers had a performance advantage at baseline on reasoning ability, relative to non-ε4 carriers. The additive effect of hypertension on level of cognitive flexibility (i.e., lower performance for hypertensives) was qualified by a significant APOE × Hypertension interaction on the slope. Hypertension moderated the effects of APOE ε4 on the rate of change for cognitive flexibility, such that the presence of the APOE ε4 allele and hypertension was associated with steeper cognitive decline over a 21-year period. A double dose of genetic vascular risk factors accounted for variation in the slope in normal cognitive aging, suggesting that clinical interventions aimed at lowering vascular risk may benefit cognitive health.

Depressive symptoms and inductive reasoning performance: findings from the ACTIVE reasoning training intervention

Within the context of the Advanced Cognitive Training for Independent and Vital Elderly study (ACTIVE; Ball et al., 2002; Jobe et al., 2001; Willis et al., 2006), we examined the longitudinal association of baseline depressive symptoms on inductive reasoning performance over a 10-year period between the reasoning training and control conditions (N = 1,375). At baseline, 322 participants (23%) reported elevated depressive symptoms, defined by a score ≥9 on the 12-item version of the Center for Epidemiological Studies Depression Scale (CES-D; Mirowsky & Ross, 2003; Radloff, 1977). Differences in baseline depressive status were not associated with immediate posttraining gains or with subsequent annual change in reasoning performance, suggesting that the presence of elevated baseline depressive symptoms does not impact the ability to benefit from reasoning training.

Reasoning training in the ACTIVE study: how much is needed and who benefits?

OBJECTIVE

To characterize change through 5-year follow-up, associated with training, booster, adherence, and other characteristics.

METHODS

Sample included all individuals randomly assigned to reasoning training (N = 699). Piecewise latent growth modeling was used to examine trajectory of performance on outcome measures.

RESULTS

Training resulted in improved reasoning performance through Year 5. A significant third annual booster effect was one-half the size of the training effect. Training adherence resulted in greater training effects. Higher education, Mini-Mental State Exam (MMSE), better health, and younger age related to higher baseline performance. Higher MMSE was related to larger training effects, larger linear slopes, and smaller booster effects. Significant functional outcomes included a training effect for complex reaction time (CRT), and first annual booster effects for the CRT and observed tasks of daily living.

DISCUSSION

Initial training gain was comparable with magnitude of age-related cognitive decline over 5 years with no training. Neither age nor gender predicted training or booster effects, indicating the generality of training effects across age (65-90 years).

Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults

OBJECTIVES

To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years.

DESIGN

Ten-year follow-up of a randomized, controlled single-blind trial (Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)) with three intervention groups and a no-contact control group.

SETTING

Six U.S. cities.

PARTICIPANTS

A volunteer sample of 2,832 persons (mean baseline age 73.6; 26% African American) living independently.

INTERVENTION

Ten training sessions for memory, reasoning, or speed of processing; four sessions of booster training 11 and 35 months after initial training.

MEASUREMENTS

Objectively measured cognitive abilities and self-reported and performance-based measures of everyday function.

RESULTS

Participants in each intervention group reported less difficulty with instrumental activities of daily living (IADLs) (memory: effect size = 0.48, 99% confidence interval (CI) = 0.12-0.84; reasoning: effect size = 0.38, 99% CI = 0.02-0.74; speed of processing: effect size = 0.36, 99% CI = 0.01-0.72). At a mean age of 82, approximately 60% of trained participants, versus 50% of controls (P < .05), were at or above their baseline level of self-reported IADL function at 10 years. The reasoning and speed-of-processing interventions maintained their effects on their targeted cognitive abilities at 10 years (reasoning: effect size = 0.23, 99% CI = 0.09-0.38; speed of processing: effect size = 0.66, 99% CI = 0.43-0.88). Memory training effects were no longer maintained for memory performance. Booster training produced additional and durable improvement for the reasoning intervention for reasoning performance (effect size = 0.21, 99% CI = 0.01-0.41) and the speed-of-processing intervention for speed-of-processing performance (effect size = 0.62, 99% CI = 0.31-0.93).

CONCLUSION

Each Advanced Cognitive Training for Independent and Vital Elderly cognitive intervention resulted in less decline in self-reported IADL compared with the control group. Reasoning and speed, but not memory, training resulted in improved targeted cognitive abilities for 10 years.

The ACTIVE cognitive training interventions and trajectories of performance among older adults

OBJECTIVES

Salthouse illustrated that among Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) participants, cognitive change accelerated following training. Our goal was to determine if this finding persists net of practice, training, and loss of training gains effects.

METHODS

We evaluated change over 5 years following cognitive training among older adults (N = 1,659, age 65 to 94).

RESULTS

Reasoning training, but not memory or speed, attenuated aging-related change. Memory gains were maintained, but about half of reasoning and speed gains were lost. Performance differences at the end of the follow-up were equivalent to about 6, 4, and 8 years of aging for memory, reasoning, and speed training, respectively.

DISCUSSION

Training can appear to accelerate age-related change, because change over time is coupled with loss of training gains. Our analysis is limited by follow-up that is short for precisely characterizing aging-related change.

The association between higher order abilities, processing speed, and age are variably mediated by white matter integrity during typical aging

Although aging is associated with changes in brain structure and cognition it remains unclear which specific structural changes mediate individual cognitive changes. Several studies have reported that white matter (WM) integrity, as assessed by diffusion tensor imaging (DTI), mediates, in part, age-related differences in processing speed (PS). There is less evidence for WM integrity mediating age-related differences in higher order abilities (e.g., memory and executive functions). In 165 typically aging adults (age range 54-89) we show that WM integrity in select cerebral regions is associated with higher cognitive abilities and accounts variance not accounted for by PS or age. Specifically, voxel-wise analyses using tract-based spatial statistics (TBSS) revealed that WM integrity was associated with reasoning, cognitive flexibility and PS, but not memory or word fluency, after accounting for age and gender. While cerebral fractional anisotropy (FA) was only associated with PS; mean (MD), axial (AD) and radial (RD) diffusivity were associated with reasoning and flexibility. Reasoning was selectively associated with left prefrontal AD, while cognitive flexibility was associated with MD, AD and RD throughout the cerebrum. Average WM metrics within select WM regions of interest accounted for 18% and 29% of the variance in reasoning and flexibility, respectively, similar to the amount of variance accounted for by age. WM metrics mediated ~50% of the age-related variance in reasoning and flexibility and different proportions, 11% for reasoning and 44% for flexibility, of the variance accounted for by PS. In sum, (i) WM integrity is significantly, but variably, related to specific higher cognitive abilities and can account for a similar proportion of variance as age, and (ii) while FA is selectively associated with PS; while MD, AD and RD are associated with reasoning, flexibility and PS. This illustrates both the anatomical and cognitive selectivity of structure-cognition relationships in the aging brain.

Alcohol effects on cognitive change in middle-aged and older adults

OBJECTIVES

This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups.

METHODS

Data (1998-2005) from n = 571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45-64, young-old: 65-75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities).

RESULTS

Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status.

DISCUSSION

In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.

Cohort differences in cognitive aging and terminal decline in the Seattle Longitudinal Study

Life span researchers have long been interested in how and why fundamental aspects of human ontogeny differ between cohorts of people who have lived through different historical epochs. When examined at the same age, later born cohorts are often cognitively and physically fitter than earlier born cohorts. Less is known, however, about cohort differences in the rate of cognitive aging and if, at the very end of life, pervasive mortality-related processes overshadow and minimize cohort differences. We used data on 5 primary mental abilities from the Seattle Longitudinal Study (Schaie, 2005) to compare both age-related and mortality-related changes between earlier born cohorts (1886-1913) and later born cohorts (1914-1948). Our models covary for several individual and cohort differences in central indicators of life expectancy, education, health, and gender. Age-related growth models corroborate and extend earlier findings by documenting level differences at age 70 of up to 0.50 SD and less steep rates of cognitive aging on all abilities between 50 and 80 years of age favoring the later born cohort. In contrast, mortality-related models provide limited support for positive cohort differences. The later born cohort showed steeper mortality-related declines. We discuss possible reasons why often reported positive secular trends in age-related processes may not generalize to the vulnerable segment of the population that is close to death and suggest routes for further inquiry.

Spousal interrelations in happiness in the Seattle Longitudinal Study: considerable similarities in levels and change over time

Development does not take place in isolation and is often interrelated with close others such as marital partners. To examine interrelations in spousal happiness across midlife and old age, we used 35-year longitudinal data from both members of 178 married couples in the Seattle Longitudinal Study. Latent growth curve models revealed sizeable spousal similarities not only in levels of happiness but also in how happiness changed over time. These spousal interrelations were considerably larger in size than those found among random pairs of women and men from the same sample. Results are in line with life-span theories emphasizing an interactive minds perspective by showing that adult happiness waxes and wanes in close association with the respective spouse. Our findings also complement previous individual-level work on age-related changes in well-being by pointing to the importance of using the couple as the unit of analysis.

Cognitive predictors of everyday functioning in older adults: results from the ACTIVE Cognitive Intervention Trial

OBJECTIVE

The present study sought to predict changes in everyday functioning using cognitive tests.

METHODS

Data from the Advanced Cognitive Training for Independent and Vital Elderly trial were used to examine the extent to which competence in different cognitive domains--memory, inductive reasoning, processing speed, and global mental status--predicts prospectively measured everyday functioning among older adults. Coefficients of determination for baseline levels and trajectories of everyday functioning were estimated using parallel process latent growth models.

RESULTS

Each cognitive domain independently predicts a significant proportion of the variance in baseline and trajectory change of everyday functioning, with inductive reasoning explaining the most variance (R2 = .175) in baseline functioning and memory explaining the most variance (R2 = .057) in changes in everyday functioning.

DISCUSSION

Inductive reasoning is an important determinant of current everyday functioning in community-dwelling older adults, suggesting that successful performance in daily tasks is critically dependent on executive cognitive function. On the other hand, baseline memory function is more important in determining change over time in everyday functioning, suggesting that some participants with low baseline memory function may reflect a subgroup with incipient progressive neurologic disease.

Midlife memory improvement predicts preservation of hippocampal volume in old age

This study examines whether midlife change in episodic memory predicts hippocampal volume in old age. From the Seattle Longitudinal Study we retrospectively identified 84 healthy, cognitively normal individuals, age 52 to 87, whose episodic memory had reliably declined (n = 33), improved (n = 28) or remained stable (n = 23) over a 14-year period in midlife (age 43-63). Midlife memory improvement was associated with 13% larger hippocampal volume (p < 0.01) in old age (age 66-87), compared with old age individuals whose midlife episodic memory had either declined or remained stable during midlife. Midlife memory change did not predict total hippocampal volume for those currently in late middle age (age 52-65). The pattern of findings was not modified by gender, apolipoprotein ε4 status, education or current memory performance. Change in midlife memory scores over 14 years, but not any single assessment, predicted hippocampal volumes in old age, emphasizing the importance of longitudinal data in examining brain-cognition relationships. These findings suggest that improvement in memory in midlife is associated with sparing of hippocampal volume in later life.

Word list memory predicts everyday function and problem-solving in the elderly: results from the ACTIVE cognitive intervention trial

Data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial (N = 2,802) were analyzed to examine whether word list learning predicts future everyday functioning. Using stepwise random effects modeling, measures from the modified administrations of the Hopkins Verbal Learning Test (HVLT) and the Auditory Verbal Learning Test (AVLT) were independently predictive of everyday IADL functioning, problem-solving, and psychomotor speed. Associations between memory scores and everyday functioning outcomes remained significant across follow-up intervals spanning 5 years. HVLT total recall score was consistently the strongest predictor of each functional outcome. Results suggest that verbal memory measures are uniquely associated with both current and future functioning and that specific verbal memory tests like the HVLT and AVLT have important clinical utility in predicting future functional ability among older adults.

Does cognitive training improve internal locus of control among older adults?

OBJECTIVES

We evaluated the effect of cognitive training among 1,534 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized controlled trial (RCT) on 5-year improvements in 3 cognitive-specific measures of locus of control-internal, chance, and powerful others.

METHODS

ACTIVE was a multisite RCT (age > or = 65), with 4 groups (memory, reasoning, speed of processing, and no-contact control). Complete 5-year follow-up data were available for 1,534 (55%) of the 2,802 participants. A propensity score model was used to adjust for potential attrition bias. Clinically important improvements (and decrements) in the cognitive-specific locus of control scale scores were defined as greater than or equal to 0.5 SD (medium) and greater than or equal to 1.0 SD (large). Multinomial logistic regression was used to simultaneously contrast those who improved and those who declined with those whose locus of control scale score was unchanged.

RESULTS

Statistically significant effects reflecting medium-sized (> or = 0.5 SD) improvements in internal locus of control between baseline and the 5-year follow-up were found for the reasoning and speed of processing intervention groups who were 76% (p < .01) and 68% (p < .05) more likely, respectively, to improve than the no-contact control group. No improvement effects were found on the chance or powerful others locus of control measures or for the memory intervention group.

CONCLUSION

Cognitive training that targets reasoning and speed of processing can improve the cognitive-specific sense of personal control over one's life in older adults.

Factors associated with cognition in adults: the Seattle Longitudinal Study

A better understanding of factors that affect cognition could lead to improved health and greater independence for older adults. We examined the association of four modifiable factors (leisure-time physical activity, leisure-time cognitive activity, self-directed work, and hypertension) with changes in two aspects of fluid intelligence (verbal memory and inductive reasoning). Data for 626 adults collected over 14 years (three time points) were analyzed by multi-level modeling. A component of self-directed work, higher work control, was associated with better verbal memory (p < .05) and inductive reasoning (p < .01). There were no significant interactions among these factors. The findings suggest that a strong sense of control at work may be protective for fluid intelligence in adults.

Health behavior risk factors across age as predictors of cardiovascular disease diagnosis

OBJECTIVE

The current study examines the prevalence of health risk behaviors and their cumulative effects on cardiovascular disease (CVD) among a sample of adults. Age cohort is also examined to determine the role of age in predicting CVD and risky health behaviors.

METHOD

Medical records of a sample of adults from the Seattle Longitudinal Study categorized into one of four age-group cohorts were examined. Data regarding participants' health risk behaviors were examined individually and cumulatively for predicting later CVD diagnosis.

RESULTS

The prevalence of CVD increases with age, obesity, and risky medical checkups. Female risky sleepers are more likely to receive a CVD diagnosis than men who report risky sleep patterns (p < .05).

DISCUSSION

A high risk of CVD appears to exist for adults across the life span, and several risky health behaviors also seem to place individuals more at risk for being diagnosed with CVD.

Factor structure and invariance of the Quality of Life in Alzheimer's Disease (QoL-AD) Scale

The factor structure and factorial invariance of the Quality of Life in Alzheimer's Disease (QoL-AD) Scale was investigated in a sample of 653 nondemented, community-dwelling older adults, ages 57 to 95 years (M = 71.62, SD = 8.86), from the Seattle Longitudinal Study. The total sample was split into two random halves to explore and confirm the structure of the QoL-AD. Confirmatory factor analyses indicated better fit for a three-factor solution than one- or two-factor solutions. Weak factorial invariance was found for the three-factor solution (Physical, Social, and Psychological Well-being) across age group and gender. These findings may help to establish a baseline quality of life before the onset of any noticeable AD symptoms.

Cognitive training and plasticity: theoretical perspective and methodological consequences

PURPOSE

To provide an overview of cognitive plasticity concepts and findings from a lifespan developmental perspective.

METHODS

After an evaluation of the general concept of cognitive plasticity, the most important approaches to study behavioral and brain plasticity are reviewed. This includes intervention studies, experimental approaches, cognitive trainings, the study of facilitating factors for strategy learning and strategy use, practice, and person-environment interactions. Transfer and durability of training-induced plasticity is discussed.

RESULTS

The review indicates that methodological and conceptual advances are needed to improve the match between levels of behavioral and brain plasticity targeted in current developmental research and study designs.

CONCLUSIONS

The results suggest that the emphasis of plasticity studies on treatment effectiveness needs to be complemented by a strong commitment to the grounding of the intervention in a conceptual framework.

The interface of medical devices and pharmaceuticals: Part II

The technical challenges of developing combination products were addressed in Part I of this two part article. Part II reviews the preclinical tests and shelf-life testing that are required using drug eluting stents and drug eluting beads as examples. Regulatory considerations and ways to simplify development are also examined.