A Remote Intervention to Prevent or Delay Cognitive Impairment in Older Adults: Design, Recruitment, and Baseline Characteristics of the Virtual Cognitive Health (VC Health) Study

BACKGROUND A growing body of evidence supports the use of lifestyle interventions for preventing or delaying the onset of Alzheimer’s disease (AD) and other forms of dementia in at-risk individuals. The development of virtually delivered programs would increase the scalability and reach of these interventions, but requires validation to ensure similar efficacy to brick and mortar options. OBJECTIVE The aims of this study are to describe the study design, recruitment process, and baseline participant characteristics of the sample in the virtual cognitive health (VC Health) study. Future analyses will assess the impact of the remotely delivered lifestyle intervention on (1) cognitive function, (2) depression and anxiety, and (3) various lifestyle behaviors, including diet, exercise, and sleep in a cohort of older adults with subjective memory decline. Additional analyses will explore feasibility outcomes, as well as the participants’ engagement patterns with the program. METHODS Older adults (age 60-75) with subjective memory decline as measured by the Subjective Cognitive Decline (SCD-9) questionnaire, and who reported feeling worried about their memory decline, were eligible to participate in this single-arm pre-post study. All participants enrolled in the year-long virtual intervention, which consists of health coach-guided lifestyle change for improving diet, exercise, sleep, stress, and cognition. All components of this study were conducted virtually, including the collection of data and the administration of the intervention. Participants were assessed at baseline, 12 weeks, 24 weeks, and 52 weeks with online surveys and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test. Intention-to-treat analysis will be conducted on all outcomes. RESULTS A total of 85 participants enrolled in the intervention and 82 are included in the study sample (3 participants withdrew). The study cohort is 74% female, 88% Caucasian, 78% overweight or obese, and 67% have at least a college degree. The average baseline RBANS score was 95.9±11.1, which is within age-adjusted norms. The average SCD-9 score was 6.0±2.0, indicating minor subjective cognitive impairment at the beginning of the study. Average baseline Generalized Anxiety Disorder (GAD-7) scores were 6.2±4.5 and Patient Health Questionnaire (PHQ-9) scores were 8.5±4.9, indicating mild levels of anxiety and depression at baseline. CONCLUSIONS Virtually delivered lifestyle interventions may represent a scalable solution for the prevention or delay of AD. The results of this study will provide the first evidence for the efficacy of a fully remote intervention and lay the groundwork for future investigations. CLINICALTRIAL NCT02969460

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Kidney Function and Cognitive Health in Older Adults: The Cardiovascular Health Study

American Journal of Epidemiology ◽

10.1093/aje/kwu102 ◽

2014 ◽

Vol 180 (1) ◽

pp. 68-75 ◽

Cited By ~ 20

Author(s):

B. Darsie ◽

M. G. Shlipak ◽

M. J. Sarnak ◽

R. Katz ◽

A. L. Fitzpatrick ◽

...

Keyword(s):

Older Adults ◽

Kidney Function ◽

Cardiovascular Health ◽

Health Study ◽

Cardiovascular Health Study ◽

Cognitive Health

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Factors Associated With Social Isolation Among Older Adults: The Singapore Chinese Health Study

Innovation in Aging ◽

10.1093/geroni/igaa057.543 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 168-168

Author(s):

Jon Barrenetxea ◽

Yang Yi ◽

Woon Puay Koh ◽

Feng Qiushi

Keyword(s):

Social Support ◽

Older Adults ◽

Cognitive Impairment ◽

Social Isolation ◽

Well Being ◽

Population Based ◽

Living Alone ◽

Health Study ◽

Factors Associated ◽

Singapore Chinese

Abstract Social isolation is a determinant of mortality and well-being among older people. Factors associated with isolation could be different in societies where older adults live mainly with family, as individuals might feel isolated despite living with others. We studied the factors associated with isolation among 16,948 older adults from follow-up 3 of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age of 73, range: 61-96 years). We defined social isolation as having “zero hour per week” of participation in social activities involving 3 or more people and scoring the lowest decile on the Duke Social Support Scale of perceived social support. We used multivariable logistic regressions to compute odds ratio (OR) and 95% confidence interval (CI) for factors associated with likelihood of social isolation. Although only 14.4% of isolated participants lived alone, living alone remained a significant factor associated with isolation (OR 1.93, 95% CI 1.58-2.35), together with cognitive impairment (OR 1.73, 95% CI 1.46-2.04) and depression (OR 2.44, 95% CI 2.12-2.80). Higher education level was inversely associated with isolation (p for trend<0.001). In stratified analysis, among those living alone, compared to women, men had higher odds of social isolation (OR 2.18, 95% CI 1.43-3.32) than among those not living alone (OR 0.99, 95% CI 0.84-1.17) (p for interaction<0.001). Our results showed that living alone, cognitive impairment and depression were indicators of isolation among older Singaporeans. In addition, among those living alone, men were more likely to experience social isolation than women.

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Association between cognitive impairment and criteria for frailty syndrome among older adults

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190138 ◽

2020 ◽

Vol 78 (1) ◽

pp. 2-8 ◽

Cited By ~ 1

Author(s):

Allan Gustavo BRIGOLA ◽

Ana Carolina OTTAVIANI ◽

Danilo Henrique Trevisan CARVALHO ◽

Nathalia Alves OLIVEIRA ◽

Érica Nestor SOUZA ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Cardiovascular Health ◽

Functional Dependence ◽

Health Study ◽

Cardiovascular Health Study ◽

Multinomial Regression ◽

Cognitive Frailty ◽

Elderly Caregivers ◽

State Examination

Abstract The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. Objective: To analyze the association between cognitive impairment and the criteria for frailty. Methods: We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled ‘Variables associated to cognition in elderly caregivers’ involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. Results: Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. Conclusion: Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.

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The Education of Multiple Family Members and the Life-Course Pathways to Cognitive Impairment

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa039 ◽

2020 ◽

Vol 75 (7) ◽

pp. e113-e128 ◽

Cited By ~ 1

Author(s):

Jenjira J Yahirun ◽

Sindhu Vasireddy ◽

Mark D Hayward

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Parental Education ◽

Life Stage ◽

Family Members ◽

Later Life ◽

The United States ◽

Cognitively Impaired ◽

Cognitive Health ◽

Educational Attainments

Abstract Objectives This article asks how the educational attainments of multiple family members, including parents and offspring, are associated with the cognitive health of older adults in the United States. Methods We use panel data from the U.S. Health and Retirement Study (2000–2012) to examine how the education of an individual, their parent(s), and their offspring are associated with the prevalence of moderate/severe cognitive impairment and the onset of cognitive impairment among older adults using logistic regression and discrete-time event history analysis, respectively. Results We found that when combined, only the education of the individual is inversely associated with cognitive impairment at baseline. However, both the educational attainments of an individual and their offspring are negatively associated with the risk of becoming cognitively impaired, among individuals who were not already cognitively impaired. Conversely, parental education was not predictive of being cognitively impaired or the onset of impairment. Furthermore, we found that respondent gender did not moderate the relationship between a family member’s education and respondent cognitive health. Discussion This study adds to current research by asking how resources from earlier and subsequent generations matter for older adults’ cognitive health. Although we found little evidence that parental education matters at this life stage, results suggest that offspring education has a salient positive effect on later-life cognitive health. This finding underscores an overlooked source of health disparities—offspring resources—and highlights how a family perspective remains a powerful tool for understanding health inequalities in later life.

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Car Accidents Associated with Physical Frailty and Cognitive Impairment

Gerontology ◽

10.1159/000508823 ◽

2020 ◽

Vol 66 (6) ◽

pp. 624-630

Author(s):

Takehiko Doi ◽

Hideaki Ishii ◽

Kota Tsutsumimoto ◽

Sho Nakakubo ◽

Satoshi Kurita ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Cognitive Function ◽

Assessment Tool ◽

Health Study ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

Car Accidents ◽

Age Related ◽

Low Activity

Introduction: Age-related functional decline elevates the risk of car accidents. Whether specific cognitive impairments and physical frailty increase the risk of car accidents is still unclarified. Objective: This study examines the association between car accidents, frailty, and cognitive function, owing to an increase in car accidents related to older adults. Methods: Data were collected from 12,013 older adults (45.4% women, mean age: 71.7 years [min: 60, max: 96]) enrolled in the National Center for Geriatrics and Gerontology (NCGG) – Study of Geriatric Syndromes. A 2-year self-reported history of car accidents was assessed. The Japanese cardiovascular health study index was used as the criterion and included the following components of frailty: shrinking, weakness, exhaustion, low activity, and slowness. “Frailty” was assigned a value of 1 or more based on these components. Cognitive function was assessed using the NCGG Functional Assessment Tool, and cognitive impairment was assessed using a standardized value. Results: Of the participants, 1,117 (9.3%) had a car accident history. The proportions of the frailty components’ applicability were observed in the car accidents group compared to the non-car accidents group: shrinking (p = 0.006), exhaustion (p = 0.031), low activity (p = 0.034), and slowness (p = 0.030), but not weakness (p = 0.452). The proportion of cognitive impairment in executive function was also higher in the car accidents group (p = 0.011). A logistic regression analysis showed that both frailty (OR 1.26, 95% CI 1.11–1.43; p < 0.001) and cognitive impairment (OR 1.26, 95% CI 1.11–1.43, p < 0.001) are associated with car accidents. Discussion: This study’s findings contribute to enhancing the utility of risk assessments for older drivers. Further study is required to clarify the risk of car accidents.

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Supporting older adults’ engagement in health-care programs and policies: Findings from a rural cognitive health study

Home Health Care Services Quarterly ◽

10.1080/01621424.2019.1614505 ◽

2019 ◽

Vol 38 (3) ◽

pp. 209-223

Author(s):

Juanita Bacsu ◽

Thomas McIntosh ◽

Marc Viger ◽

Shanthi Johnson ◽

Bonnie Jeffery ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Health Study ◽

Cognitive Health

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Health Benefits of β-Hydroxy-β-Methylbutyrate (HMB) Supplementation in Addition to Physical Exercise in Older Adults: A Systematic Review with Meta-Analysis

Nutrients ◽

10.3390/nu11092082 ◽

2019 ◽

Vol 11 (9) ◽

pp. 2082 ◽

Cited By ~ 7

Author(s):

Courel-Ibáñez ◽

Vetrovsky ◽

Dadova ◽

Pallarés ◽

Steffl

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Physical Exercise ◽

Older People ◽

Meta Analysis ◽

Cognitive Health ◽

Limited Mobility ◽

Beneficial Effects ◽

Randomized Controlled ◽

Age Related

Both regular exercise training and beta-hydroxy-beta-methylbutyrate (HMB) supplementation are shown as effective treatments to delay or reverse frailty and reduce cognitive impairment in older people. However, there is very little evidence on the true benefits of combining both strategies. The aim of this meta-analysis was to quantify the effects of exercise in addition to HMB supplementation, on physical and cognitive health in older adults. Data from 10 randomized controlled trials (RCTs) investigating the effect of HMB supplementation and physical function in adults aged 50 years or older were analyzed, involving 384 participants. Results showed that HMB supplementation in addition to physical exercise has no or fairly low impact in improving body composition, muscle strength, or physical performance in adults aged 50 to 80 years, compared to exercise alone. There is a gap of knowledge on the beneficial effects of HMB combined with exercise to preserve cognitive functions in aging and age-related neurodegenerative diseases. Future RCTs are needed to refine treatment choices combining HMB and exercises for older people in particular populations, ages, and health status. Specifically, interventions in older adults aged 80 years or older, with cognitive impairment, frailty, or limited mobility are required.

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Severity of Cognitive Impairment Moderates the Effect of Depression on Motivation

Innovation in Aging ◽

10.1093/geroni/igaa057.946 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 295-295

Author(s):

Claire Growney ◽

Xianghe Zhu ◽

Julia Sorensen ◽

Emily Smith ◽

Shevaun Neupert

Keyword(s):

Mental Health ◽

Older Adults ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Cognitive Ability ◽

Well Being ◽

Critical Feature ◽

Cognitive Health ◽

Growing Body ◽

Cognitive Activities

Abstract Motivation to engage in cognitive activities is a critical feature of cognitive health, especially for older adults. A growing body of literature demonstrates that personal resources such as mental health contribute to older adults’ motivation. However, little is known about factors that contribute to motivation for cognitive engagement in older adults already experiencing significant decline, a population for whom engagement may be uniquely consequential. In the present study, older adults (age 61-85) with cognitive impairment (Short Blessed scores of 7+) and/or dementia diagnoses completed a series of assessments of cognitive ability, well-being, and motivation to engage in cognitively demanding activities as a part of a larger project. Linear regression analyses revealed that cognitive ability moderated the effect of depression on motivation to engage in cognitively demanding activities. For those with relatively mild levels of cognitive impairment, depression was associated with lower levels motivation, whereas depression was unrelated to motivation for those with more severe cognitive impairment. Notably, results were unchanged when controlling for physical health, suggesting that depression has unique effects on motivation for these individuals. Results contribute to a growing body of literature demonstrating that mental health is particularly consequential for individuals in earlier stages of cognitive decline. We suggest that interventions targeting mental health in individuals beginning to experience cognitive decline may be effective in increasing motivation to engage in activities that are beneficial for cognitive health and that such interventions may be most effective when implemented at the earliest stages of dementia.

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Cardiovascular and Cognitive Health Study in Middle-Aged and Elderly Residents of Beijing(CCHS-Beijing): Design and Rationale

Neuroepidemiology ◽

10.1159/000443707 ◽

2016 ◽

Vol 46 (3) ◽

pp. 182-190 ◽

Cited By ~ 4

Author(s):

Xianghua Fang ◽

Zhengwu Wang ◽

Chunxiu Wang ◽

Jian Wu ◽

Ya Yang ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

High Sensitivity ◽

Population Based ◽

Left Ventricular ◽

Health Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Cognitive Health

The Cardiovascular and Cognitive Health Study (CCHS-Beijing) is a population-based study of cardiovascular disease (CVD) and cognitive impairment in adults aged 55 and older in Beijing. The main aims of the study are to investigate the prevalence rates of CVD, asymptomatic atherosclerosis, and cognitive impairment, as well as validate the risk factors related to the onset and development of CVD, Alzheimer's disease (AD) and mild cognitive impairment (MCI). The study was designed to detect the traditional and new risk factors in this age group. Participants were recruited randomly from residential regions in the greater Beijing municipality area based on the average levels of development in Beijing, China in 2012 (based on socioeconomic, demographic, and geographical characteristics). Thorough physical and laboratory examination were performed at baseline (also the cross-sectional survey) to identify the risk factors such as hypertension, dyslipidemia, diabetes, as well as newly defined risk factors like elevated homocysteine, high sensitivity C-reactive protein, and urine micro-albumin. Subclinical disease of the cerebral vasculature included atherosclerosis of carotid arteries, intracranial arteries, and retinal vessels. Subclinical cardiac diseases included left ventricular enlargement, arrhythmias, chamber hypertrophy and myocardial ischemia. Blood pressure was documented using the ankle-arm method. In addition, neuropsychological assessments were performed for all subjects aged 65 and above. Baseline evaluation began during the period August 2013 to December 2014. Follow-up examination will occur in 5 years. The initial and recurrent CVD, AD and MCI events will be verified and validated during the follow-up period.

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