Decomposing the within-person and between-person sources of variation in physical activity-cognition associations for low-active older adults

Abstract

Objectives: To examine within-person and between-person sources of variation in the relationship between physical activity and cognition in older adults participating in a walking program. To explore whether demographic, health and fitness variables, and their interactions with activity, are significant predictors of cognition.

Design: Brief longitudinal burst design.

Participants: 118 participants (91 females, mean age?=?72.81?+ 5.24 years).

Main Outcome Measures: Cognition, self-reported moderate-to-vigorous walking and self-reported moderate-to-vigorous physical activity were assessed at baseline and 6, 9, 12 and 16 weeks follow-up. Attendance at weekly walks was also recorded.

Results: Within-persons, changes in physical activity were related to select measures of executive functioning, with increased activity predictive of better cognition (three of four cognitive functions, p<.05). Between-persons, activity was also associated with cognition (two of four cognitive functions, p<.05). Younger age and higher education were related to better cognition. Interactions of demographic, health, and fitness variables with changes in within-person activity were generally non-significant.

Conclusion: The results highlight the importance of distinguishing within- from between-person effects in longitudinal analyses of the association between physical activity and cognition. This stringent within-person test of association underscores the potential value of simple physical activity interventions for improving cognitive function.     

Expansion of Genetic Services Utilizing a General Genetic Counseling Clinic

We established a general genetic counseling clinic (GCC) to help reduce long wait times for new patient appointments and to enhance services for a subset of patients. Genetic counselors, who are licensed in Tennessee, were the primary providers and MD geneticists served as medical advisors. This article describes the clinic referral sources, reasons for referral and patient dispositions following their GCC visit(s). We obtained patients by triaging referrals made to our medical genetics division. Over 24 months, our GCC provided timely visits for 321 patients, allowing the MD geneticists to focus on patients needing a clinical exam and/or complex medical management. Following their GCC visit(s), over 80 % of patients did not need additional appointments with an MD geneticist. The GCC allowed the genetic counselor to spend more time with patients than is possible in our traditional medical genetics clinic. Patient satisfaction surveys (n?=?30) were very positive overall concerning the care provided. Added benefits for the genetic counselors were increased professional responsibility, autonomy and visibility as health care providers. We conclude that genetic counselors are accepted as health care providers by patients and referring providers for a subset of clinical genetics cases. A GCC can expand genetic services, complement more traditional genetic clinic models and utilize the strengths of the genetic counselor health care provider.     

The next generation of psychological autopsy studies: part 2. Interview procedures

The psychological autopsy (PA) is a systematic method of assessing the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of suicide decedents. Procedural challenges that need to be addressed to conduct PA interviews are described in this article and recommendations for meeting these challenges in future PA investigations are made. Procedures addressed include determining the timing of PA interviews after suicide, designing the structure and flow of interviews, selection of proxy respondents, integrating interview data with information gathered from records, and selecting and training interviewers. This methodological article is the second in a two-part series-the first article focused on interview content.