HIV-associated dementia in older adults: clinical and tomographic aspects

ABSTRACTBackground: Elderly adults with human immunodeficiency virus (HIV) are at greater risk of developing cognitive impairment. The purpose of this study was to describe clinical and tomographic characteristics of HIV-1 associated dementia (HIVD) in older adults.Methods: A descriptive study was carried out involving eight HIVD patients. Seven tests were employed for cognitive assessment and transformed to whole number z-scores using appropriate normative sets.Results: The average age of the patients was 71 years; seven cases described the route of HIV infection as being heterosexual; and mean schooling was 6.5 years. Six subjects were using highly active anti-retroviral therapy (HAART), with an average CD4 count of 407.8 cells/mm3. Mild dementia was detected in most cases (87.5%). Deficits on neuropsychological tests showed results similar to multi-center transversal studies on HIVD. The classic HIVD triad observed in younger adults was also seen in this population: i.e. cognitive changes, psychiatric changes and motor impairment. Cortical injury shown by dyscalculia, visual-spatial change and language deficits were frequent. Brain images showed cortical atrophy in all patients but was restricted to frontal lobes in five cases.Conclusion: The findings on brain imaging were non-specific, revealing images similar to those of the elderly brain and to HIVD in younger adults. HIVD in the elderly is a challenge and become an increasingly significant differential diagnosis for cognitive loss in old age. This dementia must be clinically suspected and image exams are useful in excluding other central disorders. Prospective studies of HIV-positive elderly people are warranted to better understand HIVD.

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Should the family or the state provide support for the elderly people? Findings from a two-generational Finnish study

International Journal of Sociology and Social Policy ◽

10.1108/ijssp-06-2018-0102 ◽

2019 ◽

Vol 39 (1/2) ◽

pp. 138-155 ◽

Cited By ~ 1

Author(s):

Antti O. Tanskanen ◽

Johanna Kallio ◽

Mirkka Danielsbacka

Keyword(s):

Older Adults ◽

Elderly People ◽

Elderly Care ◽

The Elderly ◽

The State ◽

Younger Adults ◽

Content Type ◽

Public Opinions ◽

The Family ◽

Nationally Representative

Purpose The purpose of this paper is to investigate public opinions towards elderly care. The authors analysed respondents’ opinions towards financial support, practical help and care for elderly people. Design/methodology/approach The authors used nationally representative data collected in Finland in 2012. Respondents represent an older generation (born between 1945 and 1950, n=1,959) and their adult children (born between 1962 and 1993, n=1,652). Findings First, the authors compared the opinions of older and younger Finns but did not find that older adults were more likely than younger adults support the state responsibility, or vice versa. It was also when only actual parent-child dyads (n=779) from same families were included. Next, the authors found that several socioeconomic and family-related variables were associated with public opinions of elderly care in both generations. For instance, in both generations lower-income individuals supported the state’s responsibility more compared to their better-off counterparts. Originality/value The study provides important knowledge on attitudes towards elderly care using unique two-generational data of younger and older adults.

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Biomechanical constraints to stair negotiation

The New Dynamics of Ageing Volume 1 ◽

10.1332/policypress/9781447314721.003.0014 ◽

2018 ◽

Author(s):

Constantinos Maganaris ◽

Vasilios Baltzopoulos ◽

David Jones ◽

Irene Di Giulio ◽

Neil Reeves ◽

...

Keyword(s):

Older Adults ◽

Dynamic Stability ◽

Ankle Joint ◽

The Elderly ◽

The Body ◽

Centre Of Mass ◽

Centre Of Pressure ◽

Younger Adults ◽

Stair Negotiation ◽

Biomechanical Constraints

This chapter discusses strategies that older and younger people employ to negotiate stairs based on experiments performed on an instrumented staircase in lab environment aiming at identifying ways to reduce stair fall risk for the elderly. Stair negotiation was found to be more demanding for the knee and ankle joint muscles in older than younger adults, with the demand increasing further when the step-rise was higher. During descent of stairs with higher step-rises, older adults shifted the centre of mass (COM) posteriorly, behind the centre of pressure (COP) to prevent forward falling. A decreased step-going resulted in a slower descent of the centre of mass in the older adults and standing on a single leg for longer than younger adults. A greater reliance on the handrails and rotation of the body in the direction of the handrail was also observed when the step-going was decreased during descent, which allowed this task to be performed with better dynamic stability, by maintaining the COM closer to the COP. These findings have important implications for stair design and exercise programs aiming at improving safety on stairs for the elderly.

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The Association between Age-Related Cognitive Changes and Obstacle Avoidance: Focusing on Memory-Guided Limb Movements

10.21203/rs.3.rs-205844/v1 ◽

2021 ◽

Author(s):

Ryota Sakurai ◽

Kentaro Kodama ◽

Yu Ozawa ◽

Frederico Pieruccini-Faria ◽

Kimi Estela Kobayashi-Cuya ◽

...

Keyword(s):

Older Adults ◽

Obstacle Avoidance ◽

Safety Margin ◽

Cognitive Test ◽

Limb Movements ◽

Cognitive Changes ◽

Younger Adults ◽

Foot Kinematics ◽

Age Related ◽

The Difference

Abstract An association between cognitive impairment and tripping over obstacles during locomotion in older adults has been suggested. However, owing to its memory-guided movement, whether this is more pronounced in the trailing limb is poorly known. We examined the age-related changes in stepping-over, focusing on trailing limb movements, and their association with cognitive performance. Age-related change in obstacle avoidance was examined by comparing the foot kinematics of 105 older and 103 younger adults when stepping over an obstacle. The difference in clearance between the leading limb and trailing limb (Δ clearance) was calculated to determine the degree of decrement in the clearance of the trailing limb. A cognitive test battery was used to evaluate cognitive function among older adults for assessing their association with Δ clearance. Older adults showed a significantly lower clearance of the trailing limb than younger adults, resulting in a greater Δ clearance. The significant correlations between greater Δ clearance and scores of Montreal Cognitive Assessment and delayed recall of the Wechsler Memory Scale-Revised Logical Memory. Our results suggest that memory functions may contribute to the control of trailing limb movements, which can secure a safety margin to avoid stumbling on an obstacle, during obstacle avoidance locomotion.

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Role of positive pressure therapy on sleep disordered breathing and cognition in the elderly

10.1093/med/9780199682003.003.0037 ◽

2017 ◽

Author(s):

Molly E. Zimmerman ◽

Mark S. Aloia

Keyword(s):

Older Adults ◽

Sleep Disordered Breathing ◽

Randomized Clinical Trials ◽

The Elderly ◽

Positive Pressure ◽

Cognitive Changes ◽

Pressure Therapy ◽

Age Related ◽

Disordered Breathing

Efforts aimed toward alleviating senescence have intensified as older adults occupy an increasing proportion of the population. Cognitive abilities become compromised with advancing age, with a vast heterogeneity of presentations, ranging from occasional word-finding difficulties to dementia. The role of sleep disordered breathing (SDB) in moderating or mediating age-related cognitive decline is particularly relevant given its potential reversibility in response to positive airway pressure (PAP) therapies. Establishment of SDB as a significant contributor to the development of dementia and cognitive dysfunction among the elderly has immense public health relevance, underscoring the importance of its early identification and treatment. Although several studies have examined the effect of PAP on cognitive function in older adults with SDB, additional prospective randomized clinical trials are needed. This chapter reviews the literature on SDB and cognition among the elderly as well as cognitive changes in response to PAP. Considerations for future research are also discussed.

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Effects of Working Memory Load and Age on the Comprehension of Passive Sentences

International Journal of Psychological Studies ◽

10.5539/ijps.v10n3p13 ◽

2018 ◽

Vol 10 (3) ◽

pp. 13

Author(s):

Xinmiao Liu

Keyword(s):

Older Adults ◽

Working Memory ◽

Sentence Comprehension ◽

Memory Load ◽

Matching Task ◽

Age Difference ◽

Working Memory Load ◽

Cognitive Changes ◽

Younger Adults ◽

Passive Sentence

The ability of older adults to comprehend sentences may decline due to the cognitive changes in working memory. Therefore, an increase in working memory demands during sentence comprehension would result in poorer performance among older adults. To test this hypothesis, the present study explored sentence comprehension as a result of manipulations of age and working memory loads using a sentence-picture matching task. 35 older adults and 35 younger adults were required to match Mandarin passive sentences (high working memory load) and active sentences (low working memory load) with pictures. Passive sentences were found to be more difficult than active sentences for all participants. Older adults responded to passive sentences more slowly than younger adults. However, no significant age difference was found in accuracy of responses. Accuracy on passive sentence comprehension was marginally correlated with syntactic complexity effect among older adults. Compared with younger adults, older adults seem to be more disrupted by the increased WM load in passive sentence comprehension, but they can compensate for the decline in the accuracy of comprehension by spending extra time on sentences with high WM load.

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Older and Younger Adults Perform Similarly in an Iterated Trust Game

Frontiers in Psychology ◽

10.3389/fpsyg.2021.747187 ◽

2021 ◽

Vol 12 ◽

Author(s):

Maïka Telga ◽

Juan Lupiáñez

Keyword(s):

Older Adults ◽

Impression Formation ◽

The Elderly ◽

Social Contexts ◽

Trust Game ◽

Social Categories ◽

Younger Adults ◽

Categorical Information ◽

The Individual ◽

The Impact

In social contexts, aging is typically associated with a greater reliance on heuristics, such as categorical information and stereotypes. The present research examines younger and older adults’ use of individuating and age-based categorical information when gauging whether or not to trust unfamiliar targets. In an adaptation of the iterated Trust Game, participants had to predict the cooperative tendencies of their partners to earn economic rewards in first encounters – in a context in which they knew nothing about their partners, and across repeated interactions – in a context in which they could learn the individual cooperative tendency of each partner. In line with previous research, we expected all participants to rely on stereotypes in first encounters, and progressively learn to disregard stereotypes to focus on individuating behavioral cues across repeated interactions. Moreover, we expected older participants to rely more on social categories than younger participants. Our results indicate that overall, both the elderly and the young adopted an individuating approach to predict the cooperative behaviors of their partners across trials. However, older adults more consistently relied on gender (but not age) stereotypes to make cooperation decisions at zero acquaintance. The impact of context, motivation, and relevance of categorical information in impression formation is discussed.

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Auditory and Visual Integration for Emotion Recognition and Compensation for Degraded Signals are Preserved With Age

Trends in Hearing ◽

10.1177/23312165211045306 ◽

2021 ◽

Vol 25 ◽

pp. 233121652110453

Author(s):

Minke J. de Boer ◽

Tim Jürgens ◽

Deniz Başkent ◽

Frans W. Cornelissen

Keyword(s):

Older Adults ◽

Emotion Recognition ◽

Visual Information ◽

Elderly Population ◽

Recognition Accuracy ◽

The Elderly ◽

The Other ◽

Younger Adults ◽

Visual Integration ◽

Sensory Impairments

Since emotion recognition involves integration of the visual and auditory signals, it is likely that sensory impairments worsen emotion recognition. In emotion recognition, young adults can compensate for unimodal sensory degradations if the other modality is intact. However, most sensory impairments occur in the elderly population and it is unknown whether older adults are similarly capable of compensating for signal degradations. As a step towards studying potential effects of real sensory impairments, this study examined how degraded signals affect emotion recognition in older adults with normal hearing and vision. The degradations were designed to approximate some aspects of sensory impairments. Besides emotion recognition accuracy, we recorded eye movements to capture perceptual strategies for emotion recognition. Overall, older adults were as good as younger adults at integrating auditory and visual information and at compensating for degraded signals. However, accuracy was lower overall for older adults, indicating that aging leads to a general decrease in emotion recognition. In addition to decreased accuracy, older adults showed smaller adaptations of perceptual strategies in response to video degradations. Concluding, this study showed that emotion recognition declines with age, but that integration and compensation abilities are retained. In addition, we speculate that the reduced ability of older adults to adapt their perceptual strategies may be related to the increased time it takes them to direct their attention to scene aspects that are relatively far away from fixation.

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Elderly Care Law

A Medic's Guide to Essential Legal Matters ◽

10.1093/med/9780198749851.003.0008 ◽

2018 ◽

pp. 99-112

Author(s):

Richard Biram

Keyword(s):

Older Adults ◽

Elder Abuse ◽

Elderly Care ◽

Geriatric Medicine ◽

General Medicine ◽

The Elderly ◽

Medical Problems ◽

Younger Adults ◽

Assessment And Treatment ◽

Vulnerable Adults

The Royal College of Physicians describes geriatric medicine as a branch of general medicine that is concerned with the clinical, preventative, remedial, and social aspects of illness in older age. The constellation of medical problems encountered by the elderly patient requires a holistic, team-based approach to care, utilizing a process known as the ‘comprehensive geriatric assessment’. This is an evidence-based approach to the assessment and treatment of older adults, which returns more patients to their own homes, and reduces inpatient mortality compared with standard ward care. Legal issues in the care of older adults are essentially the same as in younger adults. However, some areas that feature more frequently in the care of the elderly, which are considered further in this chapter, are age discrimination, elder abuse, safeguarding of vulnerable adults, deprivation of liberty, and the regulations related to driving in the elderly population.

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Pain and Addiction in Older Adults (DRAFT)

10.1093/med/9780190265366.003.0031 ◽

2018 ◽

Author(s):

Nelly A. Buckalew

Keyword(s):

Older Adults ◽

Physical Examination ◽

Geriatric Patients ◽

Substance Misuse ◽

The Elderly ◽

Opioid Misuse ◽

Patient History ◽

Geriatric Population ◽

Younger Adults ◽

Tabular Format

Addressing unique effects of both addiction and analgesia on older adults, this chapter defines the geriatric population and proceeds to discuss the recognition of addiction or substance misuse in it. There is little argument that the elderly have special diagnostic concerns and management needs that are imposed upon those of younger adults. The concept of the pain signature is introduced as a measure of the functions with which the individual’s pain interferes. Four instruments serving as diagnostic aids are included in tabular format: the pain signature elements; a list of recommended patient history queries; suggested components of the review of systems; and special components of the physical examination. The tables are geared specifically toward geriatric patients. The two central themes of the chapter are treatment of pain, and the treatment of opioid misuse and addiction.

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Subjective memory complaint and its relationship with cognitive changes and physical vulnerability of community-dwelling older adults

Dementia & Neuropsychologia ◽

10.1590/1980-57642018dn13-030012 ◽

2019 ◽

Vol 13 (3) ◽

pp. 343-349

Author(s):

Daniela Dalpubel ◽

Paulo Giusti Rossi ◽

Mariana Luciano de Almeida ◽

Estela Barbosa Ribeiro ◽

Renata Araújo ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Community Dwelling ◽

Physical Vulnerability ◽

Cognitive Changes ◽

Cross Sectional ◽

Memory Complaint ◽

Visual Spatial

ABSTRACT Memory complaint (MC) is common in older adults and can be confirmed by people close to them, such as family members and caregivers. Studies show an association between MC and cognitive impairment and, hence, physical vulnerability may exacerbate MC. However, the relationship between MC and physical vulnerability is not yet clear in the literature.\ Objective: to investigate the association between MC, cognitive impairment, and physical vulnerability. Methods: this is a cross-sectional study. We evaluated 100 older adults with a mean age of 65 years or over. The Memory Complaint Scale (MCS), Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Vulnerable Elderly Research-13 (VES-13), Geriatric Depression Scale and a sociodemographic questionnaire were applied. Results: participants were divided into two groups according to results on the MCS-A (elderly) and MCS-B (informant). Correlations were found between the MCS-A and the MMSE (p=.045/ρ=.201), ACE-R/Visual-Spatial (p=.048/ρ=.199), and ACE-R/Attention-Orientation (p=.026/ρ=.223). For the MCS-B, correlations were found with total score on the ACE-R (p=.044/ρ=-.202) and the ACE-R/Visual-Spatial (p=0.003/ρ=-.291). Conclusion: MC reported by the informant indicate the need to assess, in more depth, the cognition of the older adult. Thus, for clinical practice, screening of MC through an informant is advised.

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