The association between change in cognitive ability and cause-specific mortality in a community sample of older adults

While there is consistent evidence that initial levels of cognitive ability predict mortality, there is mixed evidence for a relationship between changes in cognition and mortality. There have been few studies that have examined whether the level and slope of cognitive performance is predictive of subsequent mortality from all causes or from cardiovascular disease, stroke, heart disease, respiratory disease, or cancer. This study aimed to assess whether the level and slope of cognitive ability were associated with all-cause or cause-specific mortality. A cohort of 896 community-based elderly people in Australia was interviewed four times over 12 years, with vital status followed for up to 17 years. Of these, 592 participants completed two or more interviews and were included in survival models of six mortality outcomes. Cognitive change in five domains of ability was estimated using latent growth models. Poorer initial processing speed or verbal fluency was significantly associated with greater all-cause and/or cardiovascular mortality. In addition, declines in global ability were associated with greater all-cause, cardiovascular, and heart disease mortality. Vocabulary and episodic memory were not associated with mortality, and none of the cognitive tests significantly predicted respiratory or cancer mortality. Initial levels of cognitive ability tended to be better predictors of subsequent mortality than were changes in ability. The results suggest that vascular events may be largely responsible for the overall relationship between cognition and mortality.     

The Association Between Health and Cognitive Performance in a Population-Based Study of Older Adults: The Charlotte County Healthy Aging Study (CCHAS)

In the present study, the relationship between self-reports and objective measures of health status and measures of cognitive performance was examined. Participants consisted of 437 persons (M =72.91 years) from the Charlotte County Healthy Aging Study, a population-based sample of older adults. Cognitive performance was assessed by tests of episodic memory, perceptual speed, and attention. Health status was indexed by subjective ratings, self-reports, and objective measures. The health measures accounted for significant variance on both the Trailmaking A and B tests, accounting for a modest amount of variance (4.4% and 1.1%, respectively). The health measures were not significantly associated with performance on the measures of attention or episodic memory. The results suggest that health status is associated with processing speed to a greater degree than higher order cognitive processes.     

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.     

Fluency does not express implicit knowledge of artificial grammars

It is commonly held that implicit knowledge expresses itself as fluency. A perceptual clarification task was used to examine the relationship between perceptual processing fluency, subjective familiarity, and grammaticality judgments in a task frequently used to produce implicit knowledge, artificial grammar learning (AGL). Four experiments examined the effects of naturally occurring differences and manipulated differences in perceptual fluency, where decisions were based on a brief exposure to test-strings (during the clarification task only) or normal exposure. When perceptual fluency was not manipulated, it was weakly related to familiarity and grammaticality judgments, but unrelated to grammatical status and hence not a source of accuracy. Counterbalanced grammatical and ungrammatical strings did not differ in perceptual fluency but differed substantially in subjective familiarity. When fluency was manipulated, faster clarifying strings were rated as more familiar and were more often endorsed as grammatical but only where exposure was brief. Results indicate that subjective familiarity derived from a source other than perceptual fluency, is the primary basis for accuracy in AGL. Perceptual fluency is found to be a dumb heuristic influencing responding only in the absence of actual implicit knowledge.     

Activity engagement is related to level, but not change in cognitive ability across adulthood

It is unclear whether the longitudinal relation between activity participation and cognitive ability is due to preserved differentiation (active individuals have higher initial levels of cognitive ability), or differential preservation (active individuals show less negative change across time). This distinction has never been evaluated after dividing time-varying activity into its two sources of variation: between-person and within-person variability. Further, few studies have investigated how the association between activity participation and cognitive ability may differ from early to older adulthood. Using the PATH Through Life Project, we evaluated whether between- and within-person variation in activity participation was associated with cognitive ability and change within cohorts aged 20-24 years, 40-44 years, and 60-64 years at baseline (n = 7,152) assessed on three occasions over an 8-year interval. Multilevel models indicated that between-person differences in activity significantly predicted baseline cognitive ability for all age cohorts and for each assessed cognitive domain (perceptual speed, short-term memory, working memory, episodic memory, and vocabulary), even after accounting for sex, education, occupational status, and physical and mental health. In each case, greater average participation was associated with higher baseline cognitive ability. However, the size of the relationship involving average activity participation and baseline cognitive ability did not differ across adulthood. Between-person activity and within-person variation in activity level were both not significantly associated with change in cognitive test performance. Results suggest that activity participation is indeed related to cognitive ability across adulthood, but only in relation to the starting value of cognitive ability, and not change over time.     

Bias in self-motion perceived speed can enhance episodic memory

Prior experiences of a stimulus facilitate reprocessing of that stimulus on a subsequent occasion. This relative ease and speed with which information is processed is defined as fluency and can constitute a basis for memory judgment. Fluency can also be manipulated on line by perceptual bias (e.g., levels of noise), leading to an increase in recognition for items processed more fluently (e.g., items with less noise). Previous experiments using Remember-Know paradigm have shown an impact of perceptual fluency only on familiarity and not on recollection. Recent episodic memory models have postulated a strong link between episodic memory and spatial processes, especially with egocentric updating (Gomez et al. in Acta Psychol 132(3):221-227, 2009). The present experiment was conducted to determine whether self-motion fluency affects recognition performance and particularly has an impact on "Remember" responses. Thirty participants learned a 4-min path movie and then had to recognize among short paths if they were part of the learned path, followed by a Remember-Know procedure for recognized items. Self-motion fluency was manipulated with the presence of nimble acceleration applied on a small part of the recognition paths. Results show that the presence of a self-motion fluency increases significantly the proportion of remember responses solely on learned paths. This study spotlights for the first time a specific fluency effect on recollection and indicates an implication of egocentric-updating processing in episodic memory retrieval.     

Developmental change in the relation between executive functions and symptoms of ADHD and co‐occurring behaviour problems

In a sample of 92 children aged 6–13 years this study investigates the normal developmental change in the relation between executive functioning (EF) and the core behavioural symptoms associated with attention deficit hyperactivity disorder (ADHD) (hyperactivity/impulsivity and inattention) as well as symptoms often co‐occurring with childhood hyperactivity (conduct‐ and internalizing problems). EF was assessed by using multiple tests grouped through prior factor analysis, resulting in cognitive measures relating to disinhibition, speed/arousal, verbal working memory, non‐verbal working memory, and fluency. The results showed that although disinhibition was positively related to hyperactivity/impulsivity and inattention mainly for the youngest age group, there were no significant age effects for these relations. Instead, age effects were found for the relations between speed/arousal and inattention as well as for the relations between verbal working memory/fluency and inattention. In the oldest age group poor performance on these cognitive measures was associated with high ratings of inattention. For the total sample a relation was obtained between disinhibition and hyperactivity/impulsivity as well as between both working memory measures and internalizing problems. In conclusion, the results from this study suggest that poor inhibition is most clearly associated with ADHD symptoms for younger children, whereas poor functioning with regard to later developing and more complex executive functions such as working memory and fluency is associated with ADHD symptoms for older children. Copyright © 2006 John Wiley & Sons, Ltd.     

Contributions of processing ability and knowledge to verbal memory tasks across the adult life-span

This study investigated the relationships of processing capacity and knowledge to memory measures that varied in retrieval difficulty and reliance on verbal knowledge in an adult life-span sample (N = 341). It was hypothesized that processing ability (speed and working memory) would have the strongest relationship to tasks requiring active retrieval and that knowledge (vocabulary ability) would be related to verbal fluency and cued recall, as participants relied upon verbal knowledge to retrieve category items (fluency) or develop associations (cued recall). Measurement and structural equation models were developed for the entire sample and separately for younger (aged 20-54 years, n = 168) and older (aged 55-92 years, n = 173) subgroups. In accordance with the hypotheses, processing ability was found to be most highly related to free recall, with additional significant relationships to cued recall, verbal fluency, and recognition. Knowledge was found to be significantly related only to verbal fluency and to cued recall. Moreover, knowledge was more important for older than for younger adults in mediating variance in cued recall, suggesting that older adults may use age-related increases in knowledge to partially compensate for processing declines when environmental support is available in memory tasks.     

Enhanced processing fluency leads to biases in source memory

The present experiments were conducted to determine whether processing fluency affects source memory decisions. In the first three experiments, participants decided whether test items appeared in the same sensory modality (Experiments 1A, 1B) or perceptual form (font type, Experiment 2) at study and test. The results were consistent across the three studies and showed that perceptual priming leads to an increase in reports that stimuli were presented in the same sensory or perceptual form during the study and test phase. Experiment 3 showed that conceptual fluency affects source attributions in much the same way as perceptual fluency, and Experiment 4 showed that fluency is associated with a subjective experience of familiarity even when it might serve as a basis for source inference. These results are consistent with recent neuropsychological and neuroimaging evidence that familiarity-based processes contribute to source memory decisions under some circumstances, such as when items and contexts are unitized rather than merely bound together at encoding.     

Enhanced processing fluency leads to biases in source memory

The present experiments were conducted to determine whether processing fluency affects source memory decisions. In the first three experiments, participants decided whether test items appeared in the same sensory modality (Experiments 1A, 1B) or perceptual form (font type, Experiment 2) at study and test. The results were consistent across the three studies and showed that perceptual priming leads to an increase in reports that stimuli were presented in the same sensory or perceptual form during the study and test phase. Experiment 3 showed that conceptual fluency affects source attributions in much the same way as perceptual fluency, and Experiment 4 showed that fluency is associated with a subjective experience of familiarity even when it might serve as a basis for source inference. These results are consistent with recent neuropsychological and neuroimaging evidence that familiarity-based processes contribute to source memory decisions under some circumstances, such as when items and contexts are unitized rather than merely bound together at encoding.     

The fate of cognition in very old age: six-year longitudinal findings in the Berlin Aging Study (BASE)

The authors report full-information longitudinal age gradients in 4 intellectual abilities on the basis of 6-year longitudinal changes in 132 individuals (mean age at T1 = 78.27, age range = 70-100) from the Berlin Aging Study. Relative to the cross-sectional parent sample (N = 516, mean age at T1 = 84.92 years), this sample was positively selected because of differential mortality and experimental attrition. Perceptual speed, memory, and fluency declined with age. In contrast, knowledge remained stable up to age 90, with evidence for decline thereafter. Age gradients were more negative in old old (n = 66, mean age at T1 = 83.04) than in old (n = 66, mean age at T1 = 73.77) participants. Rates of decline did not differ reliably between men and women or between participants with high versus low life-history status. They conclude that intellectual development after age 70 varies by distance to death, age, and intellectual ability domain.     

On the contribution of perceptual fluency and priming to recognition memory

Repetition priming has been shown to be independent of recognition memory. Thus, the severely amnesic patient E.P. has demonstrated intact stem completion priming and perceptual identification priming, despite at-chance performance on recognition memory tasks. It has also been shown that perceptual fluency can influence feelings of familiarity, in the sense that items perceived more quickly tend to be identified as familiar. If studied items are identified more fluently, due to perceptual priming, and fluency leads to familiarity, why do severely amnesic patients perform no better than chance on recognition memory tasks? One possibility is that severely amnesic patients do not exhibit normal fluency. Another possibility is that fluency is not a sufficiently strong cue for familiarity. In two experiments, 2 severely amnesic patients, 3 moderately amnesic patients, and 8 controls saw words slowly clearing from a mask. The participants identified each word as quickly as possible and then made a recognition (old/new) judgment. All the participants exhibited fluency, in that old responses were associated with shorter identification times than new responses were. In addition, for the severely amnesic patients, priming was intact, and recognition memory performance was at chance. We next calculated how much priming and fluency should elevate the probability of accurate recognition. The tendency to identify studied words rapidly (.6) and the tendency to label these rapidly identified words old (.6) would result in 36% of the studied words being labeled old. Other studied words were identified slowly (.4) but were still labeled old (.4), resulting in an additional 16% of studied words labeled old. Thus, the presence of fluency increases the probability of accurate recognition judgments to only 52% (chance = 50%). This finding explains why amnesic patients can exhibit both priming and fluency yet still perform at chance on recognition tests.     

Plasticity of memory for new learning in very old age: a story of major loss?

Longitudinal survivors of the Berlin Aging Study (N = 96, mean age = 84 years, range 75-101 years) were instructed and trained in a mnemonic skill to examine plasticity of episodic memory performance in very old age. Performance gains after mnemonic instruction were modest, and most individuals were unable to further enhance their performance during 4 sessions of mnemonic practice. Whereas the proportion of variance explained by measures from the broad fluid-ability domain (e.g., perceptual speed) increased with training, the proportion of variance explained by crystallized-ability domain (e.g., word knowledge) and sociobiographical variables decreased. Furthermore, prior 6-year longitudinal changes (loss) in perceptual speed predicted individual differences in plasticity. Results suggest that aging-induced biological factors are a prominent source of individual differences in cognitive plasticity in very old age.     

The contributions of memory and attention processes to cognitive abilities

In two experiments, the contributions of memory and attention processes to the cognitive abilities of reasoning and perceptual speed were investigated. Two measures of speed of information retrieval from long-term and short-term memory (Posner paradigm, Sternberg paradigm) and two attention measures (continuous attention test, attention switching test) were included in the first experiment (N = 220). The memory tests led to correlations with the measures of cognitive abilities, whereas the attention test did not. The same tests as well as one additional memory test and one attention test (working memory test, test of covert orientation) were administered in the second experiment (N = 116). Again, the memory tests led to the larger correlations with the measures of cognitive abilities. Two components were obtained in components analysis, of which the first was characterized by high loadings of the memory tests and the second by high loadings of the attention tests. Only the memory component contributed to the prediction of cognitive abilities.     

Bias in self-motion perceived speed can enhance episodic memory

Prior experiences of a stimulus facilitate reprocessing of that stimulus on a subsequent occasion. This relative ease and speed with which information is processed is defined as fluency and can constitute a basis for memory judgment. Fluency can also be manipulated on line by perceptual bias (e.g., levels of noise), leading to an increase in recognition for items processed more fluently (e.g., items with less noise). Previous experiments using Remember–Know paradigm have shown an impact of perceptual fluency only on familiarity and not on recollection. Recent episodic memory models have postulated a strong link between episodic memory and spatial processes, especially with egocentric updating (Gomez et al. in Acta Psychol 132(3):221–227, 2009). The present experiment was conducted to determine whether self-motion fluency affects recognition performance and particularly has an impact on “Remember” responses. Thirty participants learned a 4-min path movie and then had to recognize among short paths if they were part of the learned path, followed by a Remember–Know procedure for recognized items. Self-motion fluency was manipulated with the presence of nimble acceleration applied on a small part of the recognition paths. Results show that the presence of a self-motion fluency increases significantly the proportion of remember responses solely on learned paths. This study spotlights for the first time a specific fluency effect on recollection and indicates an implication of egocentric-updating processing in episodic memory retrieval.     

Change in perceptual form attenuates the use of the fluency heuristic in recognition

Four experiments (total N=295) were conducted to determine whether within-modality changes in perceptual form between the study and the test phases of an experiment would moderate the role of the fluency heuristic in recognition memory. Experiment 1 showed that a change from pictures to words reduced the role of fluency in recognition memory. In Experiment 2, the same result was found using counterfeit study lists that supposedly consisted of pictures or words. Experiments 3 and 4 showed that changes in the font used to present the study and test words also attenuated the contribution of fluency to the recognition decision when font change was manipulated between subjects, but not within subjects. Results suggest that the fluency heuristic is subject to metacognitive control, since participants' attributions of perceptual fluency depend on the perceived usefulness of fluency as a cue to recognition.     

Contribution of perceptual fluency to recognition judgments.

Following a shallow (count vowels) or deep (read) study task, old and new words were tested for both fluency of perception and recognition memory. Subjects first identified a test word as it came gradually into view and then judged it as old or new. Old words were identified faster than new words, indicating implicit, perceptual memory for old words. Independently of this effect, words judged old were identified faster than words judged new, especially after shallow study. Eight experiments examined the possible causal relationship between perceptual fluency and recognition judgements. Experiments 1 to 4 showed that fast identifications per se do not promote old judgments. Accelerating the identification of test items by semantically priming them or making them come more quickly into view did not affect recognition judgments. Experiment 5 showed that the usual association of fast identifications with old judgments is not an artifact of item selection because the association disappeared when the identifications and judgements were segregated into different phases of the test task. Experiments 6 and 7 showed tha the likelihood of old judgments increases directly with the pretested perceptibility of test words, but only after shallow study. Experiment 8 showed that the dependency of recognition judgments on perceptual fluency continues to hold when the requirement to identify the words before judging them is eliminated. We conclude that fluency of perception contributes to recognition judgments, but only when the fluency is produced naturally (e.g., through perceptual memory) and explicit memory is minimal.     

Cytokines and memory across the mature life span of women

Increasing evidence suggests a role of the immune system in modulation of cognition, but details on affected memory systems are largely lacking. We therefore aimed to study the relation between selected cytokines and subsets of memory, and the impact of age in these relations. From a random population-based sample (the Betula Prospective Cohort Study), 298 women (age 45-90) were studied in terms of episodic recall and recognition, semantic fluency and knowledge, and prospective memory. Circulating cytokines of relevance for cognition and aging were measured with ELISA. Levels of interleukin (IL)-6 and sIL-2R were significantly and negatively associated with most cognitive variables, while the opposite was true for IL-1β. Age shared substantial variance with both cytokines and memory, and turned most correlations non-significant when controlled for together with education, BMI and presence of disease. Interactions between age and cytokines were further analyzed in multiple regressions. For IL-6, significant negative interactions with age were found for semantic fluency (p<0.05) and prospective memory (p<0.01), and for sIL-2R in predicting semantic knowledge (p<0.05), indicating an increased negative impact of these cytokines on memory with increasing age. In conclusion, the study indicates a relation between cytokines and memory that appears to be largely mediated by age, and supports the suggestion that cytokine dysregulation with higher age may interact with cognitive aging.     

Neuropsychological function and apolipoprotein E genotype in the preclinical detection of Alzheimer's disease.

Nondemented older adults genotyped for the Apolipoprotein E (ApoE) epsilon4 allele (n = 43) were neuropsychologically compared to participants without a copy of the epsilon4 allele (n = 90). At baseline, the groups did not differ on age, education, gender, or global cognitive status. ApoE-epsilon4 participants demonstrated significantly poorer mean performances on delayed recall, but no significant group differences emerged on attention, language, constructional skills, psychomotor speed, or executive function. Significantly more ApoE-epsilon4 participants developed probable or questionable Alzheimer's disease (AD) compared with non-epsilon4 participants, suggesting that the group differences resulted from a preponderance of preclinical AD cases within the epsilon4 group and not from a direct influence of ApoE genotype on cognition. Cox proportional hazards analysis, adjusting for age, years of education, and global cognitive status, revealed that ApoE-epsilon4 allele status and measures of recall performance were significant and independent predictors of conversion to AD. Results support the importance of specific episodic memory changes and possession of the ApoE-epsilon4 allele in the preclinical detection of AD.     

Cognitive and attentional functioning in adolescents and young adults with Tetralogy of Fallot and d-transposition of the great arteries

The objective of this study is to investigate cognitive and attentional function in adolescents and young adults with operated congenital heart disease. Previous research has indicated that children with congenital heart disease have deficits in broad areas of cognitive function. However, less attention has been given to survivors as they grow into adolescence and early adulthood. The participants were 18 non-syndromic adolescents and young adults with tetralogy of Fallot and d-transposition of the great arteries that required cardiac surgery before the age of 5 years, and 18 healthy, unaffected siblings (11–22 years of age for both groups). Cases with congenital heart disease and their siblings were administered Wechsler Intelligence scales and reported attention problems using the Achenbach System of Empirically Based Assessments. Cases were compared to both healthy siblings and established norms. Cases performed significantly lower than siblings on full scale IQ and processing speed, and significantly lower than norms on perceptual reasoning. Cases also reported more attention problems compared to both siblings and norms. Effect sizes varied with medium-to-large effects for processing speed, perceptual reasoning, working memory, and attention problems. Findings suggest that neurocognitive function may continue to be affected for congenital heart disease survivors in adolescence and young adulthood, and that comparisons to established norms may underestimate neurocognitive vulnerabilities.