Association of Behavioral Self-Regulation with Concurrent Functional Capacity Among Stroke Rehabilitation Patients

The purpose of this study was to test the hypothesis that the Behavioral Dyscontrol Scale (BDS), a measure of the executive cognitive capacity to use an intention to guide purposeful, goal-directed activity would be strongly associated with concurrent functional status after controlling for age, sex, education, severity of pain, medical comorbidity, depression, and general mental status, in a sample of 246 elderly inpatients receiving rehabilitation services following hospitalization for stroke. Functional status was assessed by rehabilitation nurses' ratings of patients on 11 ADL items and on the Barthel Index. The BDS was the strongest predictor for 11 of the 12 dependent variables. Although it correlated significantly with all outcomes, the MMSE entered only one of the regression models. Of the other covariates, only age and severity of pain made an additional contribution to the prediction of functional ability for more than 1 dependent variable. Consistent with prior results in several other samples, the ability to use intentions to guide purposeful behavior appears to be an important contributor to everyday functioning among older adults.     

Post-stroke depression: Main phenomenological clusters and their relationships with clinical measures

Objectives: To investigate the principal psychopathological dimensions of post-stroke depression (PSD) through the assessment of the factorial structure of the Post-Stroke Depression Rating Scale (PSDRS). Methods: We enrolled ninety-eight subjects with PSD, who underwent the PSDRS, MMSE and Barthel Index. Information about demographic, clinical, and neuroanatomical factors was collected. Results: The factor analysis extracted three factors accounting for 63.4% of the total variance, and identified as: 1) "Depressive and Anxious Symptoms" (DAS); 2) "Lack of Emotional Control" (LEC); 3) "Reduced Motivation" (RM). On multivariate statistics, DAS severity was predicted by previous history of mood disorders and Barthel Index; LEC severity was predicted by Barthel Index; RM severity was predicted by age. Conclusions: The PSDRS displayed a reliable factor structure that agreed with previous interpretation of PSD. In particular, core depressive symptoms seem to be related to premorbid personality and functional status, whereas apathy/anhedonia may be connected to brain aging.     

Expanding the ecological validity of WAIS-IV and WMS-IV with the Texas functional living scale

Assessment of functional status is an important aspect of clinical evaluation. As part of the standardization of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV), participants completed the Texas Functional Living Scale (TFLS), a measure of Instrumental Activities of Daily Living. The relationships between TFLS and WAIS-IV and WMS-IV were examined in both normally developing and clinical samples. In general, the highest correlations were between TFLS and measures of general cognitive ability (WAIS-IV FSIQ [Full Scale IQ] and GAI [General Ability Index]) and working memory (WAIS-IV WMI [Working Memory Index] and WMS-IV VWMI [Visual Working Memory Index]). Across the clinical populations, working memory subtests were generally strongly related to TFLS performance, although this relationship was more consistent with WAIS-IV than WMS-IV. Contrast scaled scores are presented for the TFLS based on WAIS-IV or WMS-IV performance. These scores allow the evaluation of functional abilities within the context of cognitive and memory ability, enhancing and expanding the utility of the WAIS-IV and WMS-IV.     

Development and Validation of a Short Health Behaviors Index for Use with Low Socioeconomic Status (SES) Older Adults

This study reports on the development and validation of a health behavior index in predominantly low socioeconomic status (SES) older adults. In order to develop and validate the index for use in low SES older adults, the 24-item Health and Human Services HealthStyle Self-Test was used for item generation. It was reduced to a relatively brief instrument, the Short HealthStyle (SHS) Index with 13 items that measures four major content areas of lifestyle behaviors among low SES older adults. The SHS Index was administered to a sample of 350 low SES older individuals. Principal component model factor analysis indicated a four-factor structure. Items loading on the first factor appeared to assess fitness and leisure activities, whereas those loading on the second and third factor assessed nutrition practices and stress control, respectively. A fourth factor assessed drinking/eating behaviors. Discriminant validity of the SHS was confirmed using the Instrumental Activities of Daily Living, and other health measures that indicated distinct constructs. Internal consistency for the SHS was .72 using Chronbach's alpha. Overall, the SHS Index displayed good psychometric properties in this sample, suggesting the appropriateness of using it to measure selected health behaviors with low SES older adults.     

Aging and the Ranschburg effect: no evidence of reduced response suppression in old age

Two experiments tested 1 aspect of L. Hasher and R. T. Zacks's (1988) reduced inhibition hypothesis, namely, that old age impairs the ability to suppress information in working memory that is no longer relevant. In Experiment 1, young and older adults were asked to recall lists of letters in the correct order. Half of the lists contained repeated items while half were control lists. Recall of nonadjacent repeated items was worse than that of control items. This Ramschburg effect was larger (i.e., greater response suppression) in older than in young adults. In Experiment 2, young and older adults were required either to recall the list or to report if there was a repeated item. Repetition detection was high and similar in the 2 age groups. When age differences in overall performance were taken into account, there was evidence of increased repetition inhibition with age in both experiments. Thus, contrary to the general reduced inhibition hypothesis, the specific process of response suppression during serial recall is not reduced by aging.     

Neural correlates of age-related declines in the formation and realization of delayed intentions

Neural correlates of age-related declines in prospective memory were studied by using event-related brain potentials (ERPs) in a task in which individuals formed and later realized simple intentions. The behavioral data revealed that prospective responding was less accurate and slower in older than in younger adults. The electrophysiological data revealed age-related differences in the amplitude of modulations of the ERPs associated with the encoding of intentions, the detection of cues, and disengagement from the ongoing activity. These findings support the hypothesis that age-related declines in prospective memory result from a reduction in the efficiency with which older adults encode intentions and detect cues.     

Cognitive and functional deterioration in patients with severe COPD

The objective of this study was to examine the association among the duration of COPD, degree of hypoxemia, and neurological abnormalities including cognitive functioning. Fifty-four patients with severe COPD and 24 age- and sex-matched controls, were included in the study. All patients and controls were administered pulmonary function tests, standardized Mini-mental State Examination (MMSE), Blessed Dementia Scale (BDS), Physical Self-maintenance Scale (PSMS), Modified Activities of Daily Living scale (MADL), Instrumental Activities of Daily Living scale (IADL), Cornell Scale for Depression in Dementia (CSDD), Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR). In addition, detailed physical and neurological examinations were performed. Sixty-four percent of patients with COPD showed abnormalities in MMSE, predominantly in recent memory, construction, attention, language, and orientation domains. Functional abnormalities were correlated with cognitive abnormalities. Although COPD patients did not show significant depression compared to controls, 77.7%. of the patients showed subjective and objective cognitive disturbance and 72.2% of the patients were classified as questionable or mild dementia. In conclusion, patients with COPD show significant cognitive and functional impairments that cannot be explained just by coincidence or by depression.     

The intention‐superiority effect for naturally occurring activities: The role of intention accessibility in everyday prospective remembering in young and older adults

This study examined age differences in the accessibility of a single pool of naturally occurring intentions both before and after completion. Following Maylor, Darby, and Della Sala (2000), accessibility was measured in terms of the number of activities generated in a 4‐minute activity fluency task. Each participant undertook two such tasks. A prospective task in which they generated activities intended for completion during the following week and a retrospective task, 1 week later, in which they generated activities carried out over the previous week. In a partial replication of Maylor et al.'s findings, young, but not healthy older, adults generated more to‐be‐completed intentions than completed ones, demonstrating an intention‐superiority effect (ISE) for everyday activities. The absence of an ISE for older adults appeared to reflect the reduced accessibility of intentions prior to completion, rather than the impaired inhibition of fulfilled intentions. Moreover, both groups showed greater inaccessibility of completed than intended activities, thus demonstrating an intention‐completion effect for naturally occurring intentions that is preserved in healthy ageing (cf. Marsh, Hicks, & Bink, 1998). Despite showing a reduced accessibility of intended activities, older adults reported having completed a greater proportion of their intentions during the week than young adults. Moreover, there was a correlation between the ability to access intentions and the proportion of intentions completed only for young adults. These observations suggest that older adults' everyday prospective memory performance may be relatively less dependent on intention accessibility and more dependent on other factors. While there was no age difference in the reported use and effectiveness of external retrieval aids, older adults demonstrated a greater level of temporal organization in the production of their intentions in the fluency task. This is consistent with the possibility that older adults may have more structured daily lives and may be able to use information about the sequence of ongoing events to support superior everyday prospective remembering.     

Age-related differences in the von restorff isolation effect

When one item is made distinct from the other items in a list, memory for the distinctive item is improved, a finding known as the isolation or von Restorff effect (after von Restorff, 1933). Although demonstrated numerous times with younger adults and children, this effect has not been found with older adults (Cimbalo & Brink, 1982). In contrast to the earlier study, we obtained a significant von Restorff effect for both younger and older adults using a physical manipulation of font colour. The effect size for older adults was smaller than that obtained for younger adults, confirming a prediction of Naveh-Benjamin's (2000) associative deficit hypothesis, which attributes age-related differences in memory performance to older adults' reduced ability to form associations. The findings are consistent with related research in which older adults demonstrate similar—but smaller—benefits for distinctive information to those for younger adults.     

Meaning in Life and Volunteerism in Older Adults

Researchers explored predictors of meaning in life such as physical and mental health and volunteerism in a representative sample of older adults. Measures included the Geriatric Depression Scale and the Life Regard Index. Implications for counseling older adults are discussed.     

Prospective memory and aging: preserved spontaneous retrieval,but impaired deactivation,in older adults

Prospective remembering is partially supported by cue-driven spontaneous retrieval processes. We investigated spontaneous retrieval processes in younger and older adults by presenting prospective memory target cues during a lexical decision task following instructions that the prospective memory task was finished. Spontaneous retrieval was inferred from slowed lexical decision responses to target cues (i.e., intention interference). When the intention was finished, younger adults efficiently deactivated their intention, but the older adults continued to retrieve their intentions. Levels of inhibitory functioning were negatively associated with intention interference in the older adult group, but not in the younger adult group. These results indicate that normal aging might not compromise spontaneous retrieval processes but that the ability to deactivate completed intentions is impaired.     

Loneliness, depression, social support, and quality of life in older chronically ill Appalachians

This study's purpose was to describe loneliness and to examine the relationships between loneliness, depression, social support, and QOL in chronically ill, older Appalachians. In-person interviews were conducted with a convenience sample of 60 older, chronically ill, community-dwelling, and rural adults. Those with dementia or active grief were excluded. The UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1985), Geriatric Depression Scale (Shiekh & Yesavage, 1986), Katz ADL scale (Katz, Down, & Cash, 1970), MOS Social Support Scale (Sherbourne & Stewart, 1991), and a visual analog scale for Quality of Life (Spitzer et al., 1981) scale were used. Diagnoses were obtained through chart reviews. SPSS was used for data analyses. The majority of the 65% female sample (M age = 75 years) were married and impoverished. Participants' number of chronic illnesses averaged more than 3. Over 88% of participants reported at least 1 area of functional impairment. Loneliness was prevalent with UCLA loneliness scores indicating moderate to high loneliness, ranging from 39 to 62 (possible scores were 20-80). Higher loneliness scores correlated with depression, lower Qol, and lower social support, particularly lower emotional support. This study provides evidence that loneliness is a significant problem for older chronically ill Appalachian adults and that it may be related to low emotional support. Further, it provides evidence that this population may be significantly lonely and may not self-identify as lonely. Screening for loneliness and designing interventions that target the emotional aspects of loneliness could be important in this population.     

Age-related differences in the von Restorff isolation effect

When one item is made distinct from the other items in a list, memory for the distinctive item is improved, a finding known as the isolation or von Restorff effect (after von Restorff, 1933). Although demonstrated numerous times with younger adults and children, this effect has not been found with older adults (Cimbalo & Brink, 1982). In contrast to the earlier study, we obtained a significant von Restorff effect for both younger and older adults using a physical manipulation of font colour. The effect size for older adults was smaller than that obtained for younger adults, confirming a prediction of Naveh-Benjamin's (2000) associative deficit hypothesis, which attributes age-related differences in memory performance to older adults' reduced ability to form associations. The findings are consistent with related research in which older adults demonstrate similar—but smaller—benefits for distinctive information to those for younger adults.     

Managing daily life with age-related sensory loss: cognitive resources gain in importance

This paper investigates the role of cognitive resources in everyday functioning, comparing visually impaired, hearing impaired, and sensory unimpaired older adults. According to arguments that cognitive resources are of increased importance and a greater awareness of cognitive restrictions exists among sensory impaired individuals, in particular among visually impaired individuals, we hypothesized differential relationships between resources and outcomes when comparing sensory impaired and sensory unimpaired older adults. Findings are based on samples of 121 visually impaired, 116 hearing impaired, and 150 sensory unimpaired older adults (M = 82 years). Results from a sample of 43 dual sensory impaired older adults are reported for comparison. Assessment relied on established instruments (e.g., WAIS-R, ADL/IADL). Structural equation modeling showed that cognitive resources and behavior-related everyday functioning were more strongly related in the sensory impaired groups as compared to the sensory unimpaired group. Cognitive resources and evaluation of everyday functioning were significantly linked only among the sensory impaired groups. When medical condition was controlled for, these effects persisted. It is concluded that both cognitive training as well as psychosocial support may serve as important additions to classic vision and hearing loss rehabilitation.     

Comparison of Privacy Consciousness Between Younger and Older Adults

The degree of being conscious about privacy for the self and others is known as privacy consciousness. This study aimed to compare privacy consciousness between younger and older adults. Japanese younger (n = 166) and older (n = 145) adults were requested to rate all items in the Privacy Consciousness Scale, which assessed their degree of consciousness about privacy for the self and others and behaviors for maintaining privacy based on this consciousness. Results indicated that older adults scored lower on Consciousness Regarding Privacy of Others and higher on Behaviors Regarding Privacy of Others than younger adults. However, no significant difference was found in Consciousness and Behaviors Regarding Privacy of the Self between younger and older adults.     

Age-Related Influences on Repetition Priming in the Verb Generation Task: Examining the Role of Response Competition

ABSTRACT

The identification-production framework suggests that aging is associated with a decline in production forms of repetition priming, particularly under test conditions that maximize response competition. The present study examined this prediction by testing young and healthy older adults in a single-encoding version of the verb generation task in which some items had one dominant verb response (low competition) or had no such dominant response (high competition). Further analyses examined whether priming and error rates were related to performance on neuropsychological tests purported to measure frontal lobe functioning. Priming was invariant across age groups and was not related to frontal lobe status in older adults, but frontal lobe status did predict task performance: low-frontal older adults made more errors than high-frontal older adults, particularly for high-competition items and items with high association strength. These results are not consistent with the identification-production framework, but are consistent with the conclusions that (a) aging is associated with invariance in the processes that support repetition priming in the verb generation task and (b) frontal lobe status in aging is related to verb generation performance.     

Correlates of level and change in the Mini-Mental State Examination

The goal of the current project was to determine (a) the cognitive abilities assessed by the Mini Mental State Examination (MMSE; M. F. Folstein, S. E. Folstein, & P. R. McHugh, 1975), (b) whether the same abilities are associated with MMSE performance among people of different ages, and (c) whether the same abilities are involved in changes within the same people over time. The authors therefore examined whether the initial levels of 5 cognitive ability constructs (vocabulary, reasoning, memory, space, and speed) predicted initial levels of MMSE performance and whether the initial levels or the changes in these 5 cognitive abilities predicted change in the MMSE performance. The major findings were that 3 cognitive constructs (vocabulary, reasoning, and memory) contribute to performance in the MMSE but that their respective contributions to the MMSE vary as a function of age and time. In particular, individual differences and change in the MMSE are primarily related to individual differences in reasoning among adults younger than about 70 years, whereas both initial level of MMSE performance and longitudinal change in MMSE performance primarily related to initial level and change in memory ability among adults older than 70 years. The results therefore imply that both the level of performance on the MMSE at a single point in time and the change in MMSE over time may represent somewhat different cognitive abilities at different ages.     

Sex Differences in Cognitive Performance Among the Very Old--Mini-Mental State Examination in a Population Aged 85 Years and Over

We examined 553 persons aged 85 years or more, who comprised 92% of all 601 citizens of a Finnish city Vantaa. The Mini-Mental State Examination (MMSE), Index of Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) scale were completed. Diagnoses of dementia and depression were made according to the DSM-III-R criteria. Mean MMSE score for men was 20.1 and for women was 16.8 (difference = 3.3 points). When demented subjects (N = 210) were excluded, the difference reduced to 2.2 points. When depressed subjects were also excluded, the difference further reduced to 1.9 points. Education and institutionalization explained some of this difference, but sex also had an independent effect on the MMSE score. The home-dwelling women had lower functional capacity compared with respective men, as measured by the ADL scale. No differences were found in the IADL scale. It seems that men over 85 years of age represent a very select population. Men probably die earlier in the course of any deteriorating illness. It is also possible that our measurements of cognitive capacity favor men among very old people.     

Aging and attentional guidance during visual search: functional neuroanatomy by positron emission tomography

Positron emission tomography (PET) was used to examine adult age differences in neural activation during visual search. Target detection was less accurate for older adults than for younger adults, but both age groups were successful in using color to guide attention to a subset of display items. Increasing perceptual difficulty led to greater activation of occipitotemporal cortex for younger adults than for older adults, apparently as the result of older adults maintaining higher levels of activation within the easier task conditions. The results suggest that compensation for age-related decline in the efficiency of occipitotemporal cortical functioning was implemented by changes in the relative level of activation within this visual processing pathway, rather than by the recruitment of other cortical regions.     

What underlies the deficit in reported recollective experience in old age?

In recognition memory, older adults report fewer occasions on which recognition is accompanied by recollection of the original encoding context. This study asks why this occurs. Two main hypotheses were tested: (1) Older adults fail to encode the items sufficiently when first they experience them. (2) Older adults have a retrieval deficit that prevents efficient reintegration of target and context. In addition, the hypothesis that frontal lobe integrity is essential for recollective experience was examined. Twenty older (mean age 70.7 years) and 20 younger (mean age 22.9 years) adults were asked to study a list of items and to verbalize the strategies they were using to remember. A further 20 older adults (mean age 70.0 years) were tested without the think-aloud protocol. Subsequently, subjects completed a battery of psychometric tests before completing a recognition test. As expected, older adults showed less recollective experience. They differed from the young in how they encoded the material, and once this difference was accounted for, no age differences in recollective experience remained. There was little evidence to support the hypothesis that frontal lobe integrity plays a role in the reduction of recollective experience with age.