Mortality-Related Differences and Changes in Episodic Memory Among the Oldest Old: Evidence From a Population-Based Sample of Nonagenarians

We examined cross-sectional differences and longitudinal changes in episodic memory performance related to impending death among a group of very old people, aged 90–101 years. Participants were assessed at 3 measurement points across a 6-year interval. Three groups were identified: those who survived the entire follow-up period (n =40), those who died before the first follow-up (n =44), and those who died after the first follow-up (n =14). Participants completed a battery of episodic memory tasks consisting of face recognition, word recognition, word recall, and object recall with selective reminding. Those who survived performed better than those who were going to die in object recall at baseline. A Cox regression analysis, controlling age, revealed that object recall performance was significantly related to subsequent mortality status. Longitudinal analyses demonstrated significant 3-year decline for both face recognition and object recall, but no evidence of differential decline as a function of mortality group. Thus, longitudinal changes in memory preceding death were not as pronounced as the corresponding cross-sectional differences in this very old sample. In general, the results suggest that mortality-related memory deficits are present in extreme old age, although these deficits are relatively small and task-specific.     

Self-Reported Cognitive Inconsistency in Older Adults

ABSTRACT

Insight into one's own cognitive abilities, or metacognition, has been widely studied in developmental psychology. Relevance to the clinician is high, as memory complaints in older adults show an association with impending dementia, even after controlling for likely confounds. Another candidate marker of impending dementia under study is inconsistency in cognitive performance over short time intervals. Although there has been a recent proliferation of studies of cognitive inconsistency in older adults, to date, no one has examined adults' self-perceptions of cognitive inconsistency. Ninety-four community-dwelling older adults (aged 70–91) were randomly selected from a parent longitudinal study of short-term inconsistency and long-term cognitive change in aging. Participants completed a novel 40-item self-report measure of everyday cognitive inconsistency, including parallel scales indexing perceived inconsistency 5 years ago and at present, yielding measures of past, present, and 5-year change in inconsistency. The questionnaire showed acceptable psychometric characteristics. The sample reported an increase in perceived inconsistency over time. Higher reported present inconsistency and greater 5-year increase in inconsistency were associated with noncognitive (e.g., older age, poorer ADLs, poorer health, higher depression), metacognitive (e.g., poorer self-rated memory) and neuropsychological (e.g., poorer performance and greater 5-year decline in global cognitive status, vocabulary, and memory) measures. Correlations between self-reported inconsistency and neuropsychological performance were attenuated, but largely persisted when self-rated memory and age were controlled. Observed relationships between self-reported inconsistency and measures of neuropsychological (including memory) status and decline suggest that self-perceived inconsistency may be an area of relevance in evaluating older adults for memory disorders.     

Modeling memory decline in older adults: the importance of preclinical dementia, attrition, and chronological age

This longitudinal study examined memory loss in a sample of 391 initially nondemented older adults. Analyses decomposed observed memory loss into decline associated with preclinical dementia, study attrition, terminal decline, and chronological age. Measuring memory as a function of only chronological age failed to provide an adequate representation of cognitive change. Disease progression accounted for virtually all of the memory loss in the 25% of the sample that developed diagnosable dementia. In the remainder of the sample, both chronological age and study attrition contributed to observed memory loss. These results suggest that much of memory loss in aging adults may be attributable to the progression of preclinical dementia and other nonnormative aging processes that are not captured by chronological age.     

Predicting impending death: inconsistency in speed is a selective and early marker

Among older adults, deficits in both level and variability of speeded performance are linked to neurological impairment. This study examined whether and when speed (rate), speed (inconsistency), and traditional accuracy-based markers of cognitive performance foreshadow terminal decline and impending death. Victoria Longitudinal Study data spanning 12 years (5 waves) of measurement were assembled for 707 adults aged 59 to 95 years. Whereas 442 survivors completed all waves and relevant measures, 265 decedents participated on at least 1 occasion and subsequently died. Four main results were observed. First, Cox regressions evaluating the 3 cognitive predictors of mortality replicated previous results for cognitive accuracy predictors. Second, level (rate) of speeded performance predicted survival independent of demographic indicators, cardiovascular health, and cognitive performance level. Third, inconsistency in speed predicted survival independent of all influences combined. Fourth, follow-up random-effects models revealed increases in inconsistency in speed per year closer to death, with advancing age further moderating the accelerated growth. Hierarchical prediction patterns support the view that inconsistency in speed is an early behavioral marker of neurological dysfunction associated with impending death.     

Dispersion in Cognitive Ability as a Function of Age: A Longitudinal Study of an Elderly Community Sample

This longitudinal study investigated whether age is associated with increased dispersion among major domains of cognitive ability. Three samples were examined: the full sample of 760 elderly community dwellers aged 70 years and older who were tested in 1990; a subset of the original sample who died between testing occasions; and the sample of 426 who survived with full data sets in 1994 (followed up for a mean 3.5 years). Dispersion, as measured by the within-individual standard deviation of ability scores and by the within-individual deviations from crystallized intelligence for speed, memory and spatial functioning, was significantly correlated with age in all three samples at Wave 1 and at Wave 2 (for the longitudinal sample). The rate at which dispersion increased was not significantly correlated with age. In a more detailed analysis of the 426 survivors, dispersion as a function of age was similar for demented persons within this sample, those without dementia, those with poor and excellent educational levels, and those with a physical disability. Activities of daily living was a predictor of larger-than-average changes in dispersion – but not age, education, or activity. Greater dispersion was associated with faster deterioration in memory and speed performance. Contrary to some recent reports, there was evidence for greater within-individual variability among cognitive domains in older individuals.     

Studying individual aging in an interindividual context: typical paths of age-related, dementia-related, and mortality-related cognitive development in old age

This study has 2 objectives: (a) to explore typical paths of cognitive development associated with aging, terminal decline, and dementia and (b) to promote and illustrate an individual-oriented approach to the study of cognitive aging based on longitudinal panel data from a population-based sample (N = 500; age range-sub(T1)= 60-80, where T refers to time) tested at 3 occasions 5 years apart. Results document interindividual differences in multivariate patterns of change. Although cognitive changes generally covary, the present study indicates that subgroups of individuals develop along different paths characterized by selective changes in subsets of cognitive functions. Typical progression of dementia followed a developmental cascade from low declarative memory, via low functioning across all observed cognitive measures, to dementia diagnosis, and finally, death.     

Relations of Age to Cognitive and Motivational Elements of Impulse Control in Boys With and Without Externalizing Behavior Problems

In a cross-sectional study of 83 unmedicated boys, 6 to 16 years of age (M = 10.6, SD = 2.1), attending public (N = 48) and therapeutic schools for behaviorally disturbed children (N = 35), we examined relations of externalizing psychopathology to age-dependent change in performance on cognitive and motivational dimensions of impulse control assessed by laboratory tasks. When we controlled for internalizing symptoms and IQ or school achievement, all children showed improving competence with increasing age on both dimensions over the age range of the sample. Children with externalizing problems performed more poorly on both dimensions at all ages than children without such problems. Comparing age-dependent competence for the two groups, a model of convergent maturation in cognitive aspects of impulse control, and a model depicting a stable deficit in motivational aspects of impulse control in those children with externalizing behavior problems, relative to those without such problems, emerged. Studies of individual growth in impulse control, together with correlates of growth, are needed to validate these observations.Project on Human Development in Chicago Neighborhoods     

前临床期痴呆的认知特征：当前研究进展和未来研究展望

在这篇文章中, 我将讨论从正常老化到痴呆, 这一通常被称为痴呆前临床阶段的认知功能的转变。研究表明, 阿尔茨海默症和血管性痴呆病人在临床确诊之前的几年中, 会出现明显的认知损伤。早期最突出的损伤存在于情节记忆、加工速度以及执行功能。这些功能性损伤与神经生物学研究证实的边缘系统和新皮层区存在多重损伤是相一致的。虽然早在临床诊段之前, 病人组和控制组的平均成绩存在巨大差异, 但同时这两组测试成绩的分布在很大程度上是重叠的。寻求降低这种重叠度的方法是未来研究的一个重要任务。这有可能通过将认知的和其他指标(如基于脑的、基因的、临床的、社会的)相结合构建预测模型来实现。此外, 在未来研究中以下三方面也是急需考虑问题: (a) 找出在 前临床期间认知功能急速下降的时间点: (b) 评估从前临床到临床诊断变化速率中存在的个体差异; (c) 确定特定因素与随后发生的痴呆之间的关联强度是如何随时间向临床确诊推进而逐渐变化的。     

Type 2 Diabetes Mellitus and Cognitive Performance in a Population-Based Sample of the Oldest Old: Impact of Comorbid Dementia

We examined the relationship between type 2 diabetes mellitus and cognitive function in a population-based sample of very old people. The sample comprised 338 persons, aged 80-93 years (mean age 83.5 years), of whom 70 persons had type 2 diabetes mellitus. Measures of cognitive functioning included tests of perceptual speed, visuo-spatial ability, inductive reasoning, short-term memory, semantic memory, episodic memory, and the Mini-Mental State Examination. Regression analyses showed that type 2 diabetes mellitus duration was related to test performance across all cognitive domains, with the exception of short-term memory, such that longer duration was associated with lower test performance. When cases with dementia were excluded from the sample, further analyses showed that diabetes duration was not associated with cognitive test performance. This indicates that diabetes is not related to lower cognitive function in the general population of non-demented old people. Diabetes, however, increases the risk for cerebrovascular incidents, like stroke, that may contribute to vascular dementia.     

Aging and time-sharing aspects of executive control

A particularly important aspect of executive functioning involves the ability to coordinate two simultaneous activities. The role of this aspect of executive functioning in adult-age differences in cognitive performance was examined in a study involving 150 adults between 20 and 91 years of age who performed the same visual-motor tracking task with three different primary tasks. The participants also performed several additional cognitive tasks that allowed examination of the relation of time-sharing efficiency to other types of cognitive functioning The results were consistent with the existence of a distinct time-sharing ability because the time-sharing costs in the three dual-task combinations were significantly correlated with one another but only weakly correlated with other cognitive variables. Increased age was associated with reductions in time-sharing ability, and greater efficiency in performing two tasks at once was associated with better performance on tasks assessing spatial, reasoning, and memory abilities. Although this pattern is what one would expect if executive processes contribute to age differences in cognitive functioning, the effects were smaller than those associated with a perceptual speed construct.     

Recycling,evolution and the structure of human personality

Lower childhood cognitive ability may be a risk factor for greater cognitive decline in late life and progression to dementia. To assess variation in age-related cognitive change, it is helpful to have valid measures of cognitive ability from early life. Here, we examine the relation between childhood intelligence and cognitive change in later life in two samples, one born in 1921 and the other in 1936. All participants completed the same test of mental ability (one of the Moray House Test series) at age about 11 years, and were re-examined on Raven’s Progressive Matrices at age 77 (1921-born) or age 64 (1936-born). Where possible, the 1921 sample was re-tested at the age of about 80 years old and the 1936 sample re-tested at about 66 years. After taking into account various covariates, including sex, education and occupation, childhood intelligence was a significant predictor of cognitive change in later life. Results were in the direction that participants with lower childhood mental ability experienced relatively greater cognitive decline, whereas those of higher childhood mental ability showed improved performance. This result suggests that higher premorbid cognitive ability is protective of decline in later life.     

An analysis of diversity in the cognitive performance of elderly community dwellers: individual differences in change scores as a function of age.

This longitudinal study investigated whether age is associated with increases in interindividual variability across 4 ability domains using a sample of 426 elderly community dwellers followed over 3.5 years. Interindividual variability in change scores increased with age for memory, spatial functioning, and speed but not for crystallized intelligence for the full sample and in a subsample that excluded dementia or probable dementia cases. Hierarchical regression analyses indicated that being female, having weaker muscle strength, and having greater symptoms of illness and greater depression were associated with overall greater variability in cognitive scores. Having a higher level of education was associated with reduced variability. These findings are consistent with the view that there is a greater range of responses at older ages, that certain domains of intelligence are less susceptible to variation than others and that variables other than age affect cognitive performance in later life.     

Neuropsychological tools to predict conversion from amnestic mild cognitive impairment to dementia. The TREDEM Registry

Most of the studies about conversion from Mild cognitive impairment (MCI) to dementia have focused on amnestic MCI (aMCI) which is considered a preclinical phase of Alzheimer’s disease. The aim of the present study was to identify neuropsychological tools that would best predict conversion from aMCI to dementia. Fifty-five aMCI subjects on the Treviso Dementia Registry were investigated. They underwent a neuropsychological evaluation during their first assessment and again at follow-up. Cox proportional-hazard regression models were created to measure the association between the dependent variable (dementia diagnosis or MCI status maintenance) and the neuropsychological test scores at baseline. The sample (28 women and 27 men; mean age 76.82 ± 5.88 years; education 7.62 ± 3.99 years) was observed for an average time of 2.17 ± 1.25 years. A Cox backward stepwise regression showed that the Rey Auditory Verbal Learning Test, Delayed Recall (p = .041) and Semantic Verbal Fluency tests (p = .031) appear to be useful in predicting conversion to dementia.     

Visual function and cognitive aging: differential role of contrast sensitivity in verbal versus spatial tasks

Cognitive and sensory function are correlated in older adults. Sensory function may provide an index of neurological integrity (common-cause hypothesis). Declining sensory input may also directly impair cognition (direct-cause hypothesis). Accordingly, sensory function should more strongly predict cognitive performance and should account for more age-related variability in tasks with higher sensory demands. In a cross-sectional adult life span sample, visual contrast sensitivity was a better predictor and accounted for more of the age-related variability in high sensory-demand tasks, compared with low sensory-demand tasks, consistent with the direct-cause hypothesis. The results suggest a direct role for sensory function in cognitive aging when task conditions place heavy demands on sensory processing.     

Gender and education impact on brain aging: a general cognitive factor approach

In cognitive aging research, the study of a general cognitive factor has been shown to have a substantial explanatory power over the study of isolated tests. The authors aimed at differentiating the impact of gender and education on global cognitive change with age from their differential impact on 4 psychometric tests using a new latent process approach, which intermediates between a single-factor longitudinal model for sum scores and an item-response theory approach for longitudinal data. The analysis was conducted on a sample of 2,228 subjects from PAQUID, a population-based cohort of older adults followed for 13 years with repeated measures of cognition. Adjusted for vascular factors, the analysis confirmed that women performed better in tests involving verbal components, while men performed better in tests involving visuospatial skills. In addition, the model suggested that women had a slightly steeper global cognitive decline with oldest age than men, even after excluding incident dementia or death. Subjects with higher education exhibited a better mean score for the 4 tests, but this difference tended to attenuate with age for tests involving a speed component.     

Terminal decline and cognitive performance in very old age: does cause of death matter?

Cross-sectional differences and longitudinal changes in cognitive functioning in relation to mortality across a 7-year follow-up period, with 3 times of measurement, were examined in a population-based sample of very old adults. The authors also sought to determine whether cause of death (cerebro/cardiovascular disease [CVD]; non-CVD) modified the magnitude of mortality-related cognitive deficits. Cognitive performance was indexed by tests of general cognitive ability, episodic memory, primary memory, verbal fluency, and visuospatial ability. Results indicated cross-sectional differences on all domains of functioning, with persons who would die within 3 years after baseline testing performing more poorly. Longitudinally, greater decrements were observed on all domains for persons who would die after the first follow-up period, as compared with survivors. Cause of death failed to modify the magnitude of the cross-sectional and longitudinal deficits. The pattern of results point to the general nature of this phenomenon.     

Familiarity,Cued and Free Odor Identification and Their Association with Cognitive Functioning in Middle Aged and Older Adults

ABSTRACT

The aim of the present study was to examine the association between familiarity of odors, cued and free odor identification performance and cognitive function in elderly adults. It was further investigated how age affects performance on the various odor tasks. A third aim was to investigate the role of familiarity in explaining performance on the free identification task. One hundred and thirty-six participants (aged 45–79 years) with normal olfactory sensitivity were assessed with the Scandinavian Odor Identification Test (SOIT) and standardized tests of cognitive function. Familiarity did not correlate with any measure of cognitive function, while verbal identification performance was associated with several cognitive measures, although correlations were modest. In this sample, free odor identification was affected by increasing age to a marginally larger extent than cued identification performance and familiarity ratings. The results suggest that the different olfactory tasks involve different levels of cognitive processing.     

Individual Piagetian Epistemological Development of Children from Ages 6 to 11

This long-term study of children from ages 6 to 11 was undertaken to support the patterns of cognitive development inferred from Piaget's work and its short-term statistical replications. Several Piagetian tasks were used individually with 48 first graders, some of the same and new tasks with 43 of the same children as third graders, and two new tasks with 38 of the same children as fifth graders. Pearson product-moment coefficients indicated that uses of the clinical tasks in the study agreed significantly with those in the literature. In 33 individual line graphs, the average age (as indicated in the literature) for the most difficult task performed by a child at each level was compared with the actual age for the child's performance. Although individual aberrations in rates and patterns of cognitive development were observed, the graphic data supported the main hypothesis of the study.     

Differential trajectories of age-related changes in components of executive and memory processes

Several studies have demonstrated age-related declines in general executive function and memory. In this study, we examined cross-sectional and longitudinal age effects in more specific cognitive processes that constitute executive function and memory. We postulated that, whereas some components of executive and memory functions would show age differences and longitudinal declines, other specific abilities would be maintained or even improve with repeated testing. In a sample of individuals ≥55 years old from the Baltimore Longitudinal Study of Aging, we found longitudinal declines in inhibition, manipulation, semantic retrieval, phonological retrieval, switching, and long-term memory over a maximum of 14 years follow-up. In contrast, abstraction, capacity, chunking, discrimination, and short-term memory were maintained or even improved longitudinally, probably due in part to repeated testing. Moreover, whereas several different abilities were correlated across participants' cross-sectional performance, longitudinal changes in performance showed more heterogeneous trajectories. Finally, compared with cross-sectional performance, longitudinal trajectories showed better distinction between participants with and those without later cognitive impairment. These results show that longitudinal cognitive aging of executive and memory functions is not a uniform process but a heterogeneous one and suggest that certain executive and memory functions remain stable despite age-related declines in other component processes. (PsycINFO Database Record (c) 2012 APA, all rights reserved).