Sex-related differences in the associations between diurnal cortisol pattern and social and emotional loneliness in older adults

Introduction

Loneliness is a distressful feeling that can affect mental and physical health, particularly among older adults. Cortisol, the primary hormone of the Hypothalamic-Pituitary-Adrenal axis (HPA-axis), may act as a biological transducer through which loneliness affects health. While most previous studies have evaluated the association between loneliness, as a unidimensional construct, and diurnal cortisol pattern, no research has examined this relationship discriminating between social and emotional loneliness in older adults. As sex differences in the negative mental health outcomes of loneliness have been reported, we also investigated whether diurnal cortisol indices and loneliness associations occur in a sex-specific manner.

Methods

We analyzed the diurnal cortisol- pattern in 142 community-dwelling, non-depressed, Caucasian older adults (55,6% female) aged 60-90. Social and emotional (family and romantic) loneliness scores were assessed using the Spanish version of the Social and Emotional Loneliness Scale for Adults (SELSA). Five salivary cortisol samples were used to capture key features of the diurnal cortisol pattern, including: awakening and bedtime cortisol levels, awakening response (CAR), post-awakening cortisol output (post-awakening cortisol [i.e., the area under the curve with reference to the ground: AUCG]), total diurnal cortisol release (AUCG), and diurnal cortisol slope (DCS).

Results

After controlling for sociodemographic variables, the hierarchical linear multiple regression analyses revealed that in male older adults, higher scores on social and family loneliness were associated with elevated awakening cortisol levels, total diurnal cortisol output, and a steeper diurnal cortisol slope (DCS). However, these associations were not observed in female older adults. In addition, feelings of romantic loneliness were positively associated with bedtime cortisol levels and AUCG in older males. Multilevel growth curve modeling showed that experiencing more social and emotional loneliness predicted higher diurnal cortisol output throughout the day in older male adults.

Discussion

The presence of sex differences in the relationship between cortisol indices and loneliness among older adults holds particular significance for diagnostic and screening procedures. Combining loneliness scales as screening tools with diurnal cortisol measures has the potential to be an effective and cost-efficient approach in identifying higher-risk individuals at early stages.

Acquisition and consolidation of verbal learning and episodic memory as predictors of the conversion from mild cognitive impairment to probable Alzheimer's disease

Verbal episodic memory tests assess memory performance using total learning scores. The analysis of inter-trial indices such as gained (GA) and lost (LA) access can provide additional information on the acquisition and consolidation processes. The main objetive was to determine whether the GA and LA indices, derived from a word-list verbal episodic memory test are useful for predicting cognitive impairment in aging. 60 older people aged was divided into 3 groups: cognitively healthy, stable Mild Cognitive Impairment (MCI) and MCI converting to probable Alzheimer's disease (MCI-conv). The results showed that GA and LA measures are independent from the traditional measures -total score of correct answers-. Logistic regression showed that these values are predictive of the conversion over time and could be a cognitive marker of conversion from MCI to AD. This suggests that the GA index, which shows acquisition processes in word-list tests, may be a marker of cognitive impairment.

Validation of the Spanish version of the Memory Failures of Everyday questionnaire in older adults using Rasch analysis

AIM

The Memory Failures of Everyday (MFE) is a widely used instrument for assessing memory failure. The aim of the study was to analyze the MFE items using the Rasch model in a sample of cognitively older adults in Spain.

METHODS

A cross-sectional validation study in a sample of 214 healthy people aged ≥60 years who used centers for older people in Madrid (Spain). The MFE for the assessment of memory complaints was used. The following properties of the Rasch model were assessed: data fit, reliability, unidimensionality, local dependence and lack of differential item functioning by gender, age and marital status.

RESULTS

The MFE showed a good fit to the Rasch model (χ² (140) = 160.2; P = 0.116) and high reliability (person separation index = 0.808). The questionnaire was unidimensional (6.54% t-test; IC binomial = 0.036-0.095). The items showed lack of local dependence between them and differential item functioning. The MFE scores were transformed into linear interval scores with a median of 44.31 and an observed range of 17.9-89.2 (theoretical range: 0-100).

CONCLUSIONS

The MFE is a unidimensional, reliable instrument to assess memory complaints in cognitively healthy older adults in Spain, with usefulness in clinical research and practice. The construct validity of the MFE linear score could not be fully confirmed and this deserves further investigation. Geriatr Gerontol Int 2022; 22: 332-337.

Normative Data for Verbal Fluency, Trail Making, and Rey-Osterrieth Complex Figure Tests on Monolingual Spanish-Speaking Older Adults

OBJECTIVE

This study aimed to generate updated normative data for commonly used tests in neuropsychological assessment applied to older monolingual Spanish-speaking adults: Verbal fluency tests, the Trail Making Test (TMT), and the Rey-Osterrieth complex figure test (ROCF).

METHOD

To obtain normative data, 382 cognitively healthy 60- to 90-year-old Spanish monolingual participants from the Autonomous Community of Madrid (Spain) with 0-22 years education were assessed using an overlapping interval strategy that involved cell and midpoint techniques, and that assessed the influence of age, education, and sex.

RESULTS

Age and education were associated with the scores in the verbal fluency tests, TMT, and ROCF, whereas sex only significantly affected the TMT results. Age-adjusted scaled scores (SSA) based on percentile ranks were also converted into age-education scaled scores (SSAE) using a linear regression model. In addition, tables with the relevant adjustments for sex are provided for TMT-A and TMT-B.

CONCLUSIONS

Thus, this study provides updated, uniform normative data for widely used neuropsychological tests on older Spanish adults. The normative procedure followed helps to make consistent comparisons when using these neuropsychological tests, which will improve the interpretation of the data obtained when these tools are employed, reducing the risk of misdiagnosing cognitive impairment in older adults.

Normative data for the Spanish version of the California Verbal Learning Test (TAVEC) from older adults

The aim of this study was to establish normative data for the Spanish version of the California Verbal Learning Test, the Test de Aprendizaje Verbal España-Complutense (TAVEC). Through different subtests, the TAVEC allows verbal learning and episodic memory to be evaluated, an assessment that was carried out on a sample of 382 cognitive healthy Spanish individuals aged 60-90 years old. Unlike the participant's educational level, their age and sex significantly influenced performance in the TAVEC. We provide tables that allow the scaled scores obtained with this test to be adjusted for age and other tables with the relevant adjustments for sex. The normative data obtained in this study will help more precisely interpret the performance of older Spanish adults in the TAVEC, enhancing the utility of this neuropsychological test to evaluate verbal learning and episodic memory in clinical settings and in relation to healthy aging. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Accuracy of verbal fluency tests in the discrimination of mild cognitive impairment and probable Alzheimer's disease in older Spanish monolingual individuals

The main objetive was to analyze the accuracy of different verbal fluency tests (VFTs) in discriminating cognitively healthy subjects from individuals with mild cognitive impairment (MCI) and probable Alzheimer's disease (AD) in a cohort of older Spanish speaking adults. As a result, we aimed to identify the VFT that best predicts conversion from MCI to probable AD. 287 subjects: 170 controls (HC), 90 stable MCI and 27 patients with MCI that evolved into probable AD (MCI-AD) were assessed with a neuropsychological battery test and five VFTs. The animal fluency test produced the best differentiation of HC from MCI (p < .001), of HC from MCI-AD (p < .001) and of MCI from MCI-AD converters (p < .001), with sensitivities 98.8%, 98.8% and 75.6%, respectively. Logistic regression showed that the animal fluency test (p < 0.001) appears to be the most useful and neuropsychological VFT to predict conversion to probable dementia.

Problems in Classifying Mild Cognitive Impairment (MCI): One or Multiple Syndromes?

As the conceptual, methodological, and technological advances applied to dementias have evolved the construct of mild cognitive impairment (MCI), one problem encountered has been its classification into subtypes. Here, we aim to revise the concept of MCI and its subtypes, addressing the problems of classification not only from the psychometric point of view or by using alternative methods, such as latent class analysis, but also considering the absence of normative data. In addition to the well-known influence of certain factors on cognitive function, such as educational level and cultural traits, recent studies highlight the relevance of other factors that may significantly affect the genesis and evolution of MCI: subjective memory complaints, loneliness, social isolation, etc. The present work will contemplate the most relevant attempts to clarify the issue of MCI categorization and classification, combining our own data with that from recent studies which suggest the role of relevant psychosocial factors in MCI.

Neuropsychological predictors of conversion to probable Alzheimer disease in elderly with mild cognitive impairment

In the field of neuropsychology, it is essential to determine which neuropsychological tests predict Alzheimer's disease (AD) in people with mild cognitive impairment (MCI) and which cut-off points should be used to identify people at greater risk for converting to dementia. The aim of the present study was to analyse the predictive value of the cognitive tests included in a neuropsychological battery for conversion to AD among MCI participants and to analyse the influence of some sociodemographic variables - sex, age, schooling - and others, such as follow-up time and emotional state. A total of 105 participants were assessed with a neuropsychological battery at baseline and during a 3-year follow-up period. For the present study, the data were analysed at baseline. During the follow-up period, 24 participants (22.85%) converted to dementia (2.79 ± 1.14 years) and 81 (77.14%) remained as MCI. The logistic regression analysis determined that the long delay cued recall and the performance time of the Rey figure test were the best predictive tests of conversion to dementia after an MCI diagnosis. Concerning the sociodemographic factors, sex had the highest predictive power. The results reveal the relevance of the neuropsychological data obtained in the first assessment. Specifically, the data obtained in the episodic verbal memory tests and tests that assess visuospatial and executive components may help to identify people with MCI who may develop AD in an interval not longer than 4 years, with the masculine gender being an added risk factor.

Increased morning salivary cortisol levels in older adults with nonamnestic and multidomain mild cognitive impairment

Exposure to elevated glucocorticoid levels has a detrimental impact on cognitive function. In the present study, elderly individuals were classified according to their cognitive status to (i) cognitively healthy; (ii) amnestic; (iii) nonamnestic; or (iv) multidomain, with an extensive cognitive profiling. Salivary cortisol samples were taken at awakening, evening and night. We report that, compared to cognitively normal control individuals, subjects with nonamnestic or multidomain mild cognitive impairment profiles show increased salivary cortisol levels, immediately after awakening, but not in the evening or at night. Importantly, individuals with amnestic mild cognitive impairment did not show this increase in salivary cortisol levels. We also found that higher morning cortisol levels were associated with a lower global cognitive state, as well as poorer score in executive function and visuoconstructive praxes, verbal fluency, and a worse free immediate recall of items from a word list. These findings open new avenues to the use of salivary cortisol levels as a possible biomarker for nonamnestic and multidomain mild cognitive impairment in elderly subjects.

Evolution of specific cognitive subprofiles of mild cognitive impairment in a three-year longitudinal study

The present work addresses one of the currently most controversial aspects of early detection of Alzheimer's disease (AD) and other dementias; that is, the identification of the Mild Cognitive Impairment (MCI) syndrome-in some cases, prior to AD-in a sample of older subjects who are healthy from the cognitive viewpoint. In a three-year longitudinal study, we classified the participants between 58 and 90 years of age in different cognitive profiles: healthy and MCI (amnestic MCI, non-amnestic MCI, and multi-domain MCI). We followed the evolution of each one by means of the administration on three occasions of an extensive battery of neuropsychological tests. We have found a high percentage of MCI in our sample. Although some of them were amnestic MCIs, this group was not the most frequent. The multi-domain MCI is the one that evolves directly into AD, not the amnestic MCIs. We have found diverse evolutional trajectories over the past three years, some expected, others somewhat unexpected. We also point out the methodological difficulties posed by the administration of certain episodic memory tests, which is not the most appropriate to detect subclinical MCI, due to the effect of practice.