scholarly journals Daily Activities Related to Mobile Cognitive Performance in Middle-Aged and Older Adults: An Ecological Momentary Cognitive Assessment Study

10.2196/19579 ◽  
2020 ◽  
Vol 8 (9) ◽  
pp. e19579 ◽  
Author(s):  
Laura M Campbell ◽  
Emily W Paolillo ◽  
Anne Heaton ◽  
Bin Tang ◽  
Colin A Depp ◽  
...  
Keyword(s):  
Older Adults ◽  
Real Time ◽  
Cognitive Assessment ◽  
Verbal Learning ◽  
Leisure Activities ◽  
Daily Activities ◽  
Neurocognitive Performance ◽  
Middle Aged ◽  
And Behavior ◽  
Ecological Momentary

Background Daily activities have been associated with neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a laboratory or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real world and neurocognitive functioning to improve tracking of symptoms or disease states and aid in the early identification of neurocognitive deficits among at-risk individuals. Objective We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning and verbal learning) in the everyday environment of middle-aged and older adults with and without HIV. Methods A total of 103 adults aged 50-74 years (67 persons with HIV; mean age 59 years, SD 6.4) were recruited from the University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities 4 times per day; following 2 of the 4 daily ecological momentary assessment (EMA) surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT), each once per day. Activities were categorized into cognitively stimulating activities, passive leisure activities, and instrumental activities of daily living (IADLs). We used multilevel modeling to examine the same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance. Results On average, participants completed 91% of the EMA surveys, 85% of the mCWIT trials, and 80% of the mVLT trials, and they reported engaging in cognitively stimulating activities on 17% of surveys, passive leisure activities on 33% of surveys, and IADLs on 20% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance (β=−1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (β=.94; P=.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance (β=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (β=−.07; P=.01). IADLs were not associated with mCWIT or mVLT performance. Conclusions Smartphones present unique opportunities for assessing neurocognitive performance and behavior in middle-aged and older adults’ own environment. Measurement of cognition and daily functioning outside of clinical settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance and may add new dimensions to understanding the complexity of human behavior.

scholarly journals Daily Activities Related to Mobile Cognitive Performance in Middle-Aged and Older Adults: An Ecological Momentary Cognitive Assessment Study (Preprint)

2020 ◽  
Author(s):  
Laura M Campbell ◽  
Emily W Paolillo ◽  
Anne Heaton ◽  
Bin Tang ◽  
Colin A Depp ◽  
...  
Keyword(s):  
Older Adults ◽  
Real Time ◽  
Cognitive Assessment ◽  
Verbal Learning ◽  
Leisure Activities ◽  
Daily Activities ◽  
Neurocognitive Performance ◽  
Middle Aged ◽  
And Behavior ◽  
Ecological Momentary

BACKGROUND Daily activities have been associated with neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a laboratory or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real world and neurocognitive functioning to improve tracking of symptoms or disease states and aid in the early identification of neurocognitive deficits among at-risk individuals. OBJECTIVE We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning and verbal learning) in the everyday environment of middle-aged and older adults with and without HIV. METHODS A total of 103 adults aged 50-74 years (67 persons with HIV; mean age 59 years, SD 6.4) were recruited from the University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities 4 times per day; following 2 of the 4 daily ecological momentary assessment (EMA) surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT), each once per day. Activities were categorized into cognitively stimulating activities, passive leisure activities, and instrumental activities of daily living (IADLs). We used multilevel modeling to examine the same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance. RESULTS On average, participants completed 91% of the EMA surveys, 85% of the mCWIT trials, and 80% of the mVLT trials, and they reported engaging in cognitively stimulating activities on 17% of surveys, passive leisure activities on 33% of surveys, and IADLs on 20% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance (β=−1.12; <i>P</i>=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance (β=.94; <i>P=</i>.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance (β=.07; <i>P=</i>.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance (β=−.07; <i>P=</i>.01). IADLs were not associated with mCWIT or mVLT performance. CONCLUSIONS Smartphones present unique opportunities for assessing neurocognitive performance and behavior in middle-aged and older adults’ own environment. Measurement of cognition and daily functioning outside of clinical settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance and may add new dimensions to understanding the complexity of human behavior.

Is the Cutoff of the MoCA too High? Longitudinal Data From Highly Educated Older Adults

2019 ◽  
Vol 33 (3) ◽  
pp. 155-160 ◽  
Author(s):  
Odelia Elkana ◽  
Noy Tal ◽  
Noga Oren ◽  
Shani Soffer ◽  
Elissa L. Ash
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Repeated Measures ◽  
Cognitive Assessment ◽  
Digit Span ◽  
Verbal Learning ◽  
Cutoff Score ◽  
Adult Intelligence Scale ◽  
Cognitively Normal ◽  
Highly Educated

Background: The Montreal Cognitive Assessment (MoCA) is widely used to evaluate cognitive decline in older individuals. Although, age and education-related norms have been published, the vast majority of diagnostic clinicians use the MoCA cutoff score to identify patients with cognitive impairment. Aim: To identify whether the MoCA cutoff is too stringent for cognitively normal older adults. Methods: Twenty-seven participants aged 68 to 83 (mean = 75.07, standard deviation [SD] = 4.62), with high education level (mean = 17.14 years, SD = 3.21) underwent cognitive assessment once a year for 5 consecutive years. The cognitive assessment included MoCA; Rey Auditory Verbal Learning Test; Rey Osterrieth Complex Figure test; Wechsler Adult Intelligence Scale Information and Digit Span Subtest; Trail Making Test; Verbal Fluency Test; and Beck Depression Inventory questionnaire. Repeated measures analysis of variance (ANOVA) was used to analyze all standardized scores as well as MoCA standardized and raw scores across all years. Results: Repeated-measures ANOVA for MoCA raw scores yielded significant decline across the years ( P < .05). From the second year and forward, the average MoCA total score was below the cutoff of 26/30. However, in substantial contrast, all other neuropsychological scores and the MoCA standardized scores were within the normal range and even above in all years. Conclusion: Our study demonstrates that the currently used MoCA cutoff is too high even for highly educated, cognitively normal older adults. Therefore, it is crucial to use the age- and education-related norms for the MoCA in order to avoid misdiagnosis of cognitive decline.

A-54 Greater Time Spent Watching TV is Related to Worse Real-Time Neurocognitive Performance in Older Adults With and Without HIV

2019 ◽  
Vol 34 (6) ◽  
pp. 914-914
Author(s):  
S Kamarsu ◽  
L Campbell ◽  
E paolillo ◽  
T Filip ◽  
J Swendsen ◽  
...  
Keyword(s):  
Real Time ◽  
Daily Life ◽  
Leisure Activity ◽  
Cognitive Testing ◽  
Daily Activities ◽  
Hiv Status ◽  
Neurocognitive Performance ◽  
Daily Life Activities ◽  
Persons Living With Hiv ◽  
Watching Tv

Abstract Objective There is a need to identify determinants of neurocognitive impairment among older persons living with HIV (PLHIV). Utilizing smartphone-based Ecological Momentary Assessment (EMA) and mobile cognitive testing, we examined the relationships between daily life activities and real-world neurocognitive performance among older PLHIV and HIV-uninfected adults. Method Ninety-one participants (58 PLHIV; Mage = 59.4, SD = 6.4), 70.3% male, 65.9% non-Hispanic white, completed four smartphone-based EMA surveys of daily activities and one mobile color-word interference test (mCWIT) per day for 14 days. Daily activities were grouped into five categories: activities of daily living (ADLs, IADLs), cognitively demanding activities, socially-engaging activities, physical activity (PA), and passive leisure activity (watching TV). Data was collapsed across the 14 days to examine between-person effects of the proportion of time reportedly spent on each activity on neurocognitive outcomes (the average correct responses and completion time for the mCWIT). Results No effect was found for engaging in activities by HIV status; however, PLHIV had significantly longer times on the mCWIT compared to persons without HIV (t = 2.49; 95% CI: 0.60, 5.37; p = 0.02). In a multivariable regression model accounting for HIV status, a greater proportion of time spent watching TV was associated with slower average mCWIT performance (beta = 9.41; 95% CI: 1.88,17.0; p = 0.01). There were no relationships between other domains of daily life activities and mCWIT performance. Conclusion Our findings provide evidence that more time spent watching TV is associated with slower mCWIT performance. Future work examining the time-lagged relationships between these variables is needed to understand whether watching TV decreases real-time neurocognitive performance.

scholarly journals Leisure Activity and Caregiver Involvement in Middle-Aged and Older Adults With Down Syndrome

2017 ◽  
Vol 55 (2) ◽  
pp. 97-109 ◽  
Author(s):  
Iulia Mihaila ◽  
Sigan L. Hartley ◽  
Benjamin L. Handen ◽  
Peter D. Bulova ◽  
Rameshwari V. Tumuluru ◽  
...  
Keyword(s):  
Older Adults ◽  
Down Syndrome ◽  
Support Services ◽  
Leisure Activities ◽  
Primary Caregivers ◽  
Leisure Activity ◽  
Primary Caregiver ◽  
Middle Aged ◽  
Need For Support ◽  
Caregiver Involvement

Abstract The present study examined leisure activity and its association with caregiver involvement (i.e., residence and time spent with primary caregiver) in 62 middle-aged and older adults with Down syndrome (aged 30–53 years). Findings indicated that middle-aged and older adults with Down syndrome frequently participated in social and passive leisure activities, with low participation in physical and mentally stimulating leisure activities. Residence and time spent with primary caregiver were associated with participation in physical leisure activity. The findings suggest a need for support services aimed at increasing opportunities for participating in physical and mentally stimulating leisure activity by middle-aged and older adults with Down syndrome. These support services should partner with primary caregivers in order to best foster participation in physical leisure activity.

scholarly journals Possible Application of Ecological Momentary Assessment to Older Adults’ Daily Depressive Mood: Integrative Literature Review

10.2196/13247 ◽  
2020 ◽  
Vol 7 (6) ◽  
pp. e13247
Author(s):  
Heejung Kim ◽  
Sunah Kim ◽  
Seong Sook Kong ◽  
Yi-Rang Jeong ◽  
Hyein Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Literature Review ◽  
Real Time ◽  
Ecological Momentary Assessment ◽  
Compliance Rate ◽  
Depressive Mood ◽  
Age Difference ◽  
Technical Problems ◽  
Ecological Momentary ◽  
Momentary Assessment

Background Ecological momentary assessment is a method of investigating individuals’ real-time experiences, behaviors, and moods in their natural environment over time. Despite its general usability and clinical value for evaluating daily depressive mood, there are several methodological challenges when applying ecological momentary assessment to older adults. Objective The aims of this integrative literature review were to examine possible uses of the ecological momentary assessment methodology with older adults and to suggest strategies to increase the feasibility of its application in geriatric depression research and practice. Methods We searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and EMBASE) and gray literature; we also hand searched the retrieved articles’ references. We limited all database searches to articles published in peer-reviewed journals from 2009 to 2019. Search terms were “ecological momentary assessment,” “smartphone assessment,” “real time assessment,” “electronic daily diary,” “mHealth momentary assessment,” “mobile-based app,” and “experience sampling method,” combined with the relevant terms of depression. We included any studies that enrolled older adults even as a subgroup and that reported depressive mood at least once a day for more than 2 days. Results Of the 38 studies that met the inclusion criteria, only 1 study enrolled adults aged 65 years or older as the entire sample; the remainder of the reviewed studies used mixed samples of both younger and older adults. Most of the analyzed studies (18/38, 47%) were quantitative, exploratory (descriptive, correlational, and predictive), and cohort in design. Ecological momentary assessment was used to describe the fluctuating pattern of participants’ depressive moods primarily and to examine the correlation between mood patterns and other health outcomes as a concurrent symptom. We found 3 key methodological issues: (1) heterogeneity in study design and protocol, (2) issues with definitions of dropout and adherence, and (3) variation in how depressive symptoms were measured with ecological momentary assessment. Some studies (8/38, 21%) examined the age difference of participants with respect to dropout or poor compliance rate. Detailed participant burden was reported, such as technical problems, aging-related health problems, or discomfort while using the device. Conclusions Ecological momentary assessment has been used for comprehensive assessment of multiple mental health indicators in relation to depressive mood. Our findings provide methodological considerations for further studies that may be implemented using ecological momentary assessment to assess daily depressive mood in older adults. Conducting more feasibility studies focusing on older adults with standardized data collection protocols and mixed-methods research is required to reflect users’ experiences. Further telepsychiatric evaluation and diagnosis based on ecological momentary assessment data should involve standardized and sophisticated strategies to maximize the potential of ecological momentary assessment for older adults with depression in the community setting.

Neighborhood Disorder and Distress in Real Time: Evidence from a Smartphone-Based Study of Older Adults

2020 ◽  
Vol 61 (4) ◽  
pp. 523-541
Author(s):  
Erin York Cornwell ◽  
Alyssa W. Goldman
Keyword(s):  
Older Adults ◽  
New York ◽  
Real Time ◽  
Cumulative Exposure ◽  
Neighborhood Disorder ◽  
Activity Spaces ◽  
Residential Neighborhood ◽  
Short And Long Term ◽  
Ecological Momentary

Socioeconomic disadvantage and disorder in the residential neighborhood have been linked to multiple health risks, but less is known about the relevance of other spaces of daily life. This article considers whether disadvantage and disorder in the immediate context—within or outside of the residential neighborhood—is associated with physiological symptoms indicative of stress and strain. We use data from a study of 61 older adults in four New York City neighborhoods. Participants carried smartphones to capture GPS locations and ecological momentary assessments during the study week. We find that instantaneous exposure to disorder is associated with momentary spikes in pain and fatigue. This is not explained by cumulative exposure to disorder or concurrent stress or fear. Rather, disordered spaces may be physically and cognitively taxing for older adults in real time. We urge further research on short- and long-term health consequences of activity spaces.

scholarly journals Effects of Urban Park Quality, Environmental Perception, and Leisure Activity on Well-Being among the Older Population

2021 ◽  
Vol 18 (21) ◽  
pp. 11402
Author(s):  
Yu-Ting Chu ◽  
Dongying Li ◽  
Po-Ju Chang
Keyword(s):  
Older Adults ◽  
Leisure Activities ◽  
Leisure Activity ◽  
Well Being ◽  
Environmental Perception ◽  
Urban Park ◽  
Environmental Perceptions ◽  
Middle Aged ◽  
Park Quality

Previous studies have shown that natural environments and leisure activities can reduce depression and increase well-being. Urban parks are important for the psychological well-being of middle-aged and older adults. However, it remains unknown whether the relationship between environmental perceptions, leisure activity, and well-being is affected by the quality of park environments. This study uses a cross-level framework to examine the effects of urban park quality on middle-aged and older adults’ environmental perceptions, leisure activity, and well-being. The Neighborhood Green Space Tool was used to assess the environmental quality of 19 parks, and 380 individuals aged 55 years and older were interviewed in each park using an on-site questionnaire. The results reveal that the associations between environmental perception and well-being were moderated by the quality of park accessibility, amenities, and incivilities; the effect of environmental perception on depression was moderated by the quality of incivilities in parks; and the effect of frequency of leisure activities on depression was moderated by the quality of park accessibility.

scholarly journals Possible Application of Ecological Momentary Assessment to Older Adults’ Daily Depressive Mood: Integrative Literature Review (Preprint)

2019 ◽  
Author(s):  
Heejung Kim ◽  
Sunah Kim ◽  
Seong Sook Kong ◽  
Yi-Rang Jeong ◽  
Hyein Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Literature Review ◽  
Real Time ◽  
Ecological Momentary Assessment ◽  
Compliance Rate ◽  
Depressive Mood ◽  
Age Difference ◽  
Technical Problems ◽  
Ecological Momentary ◽  
Momentary Assessment

BACKGROUND Ecological momentary assessment is a method of investigating individuals’ real-time experiences, behaviors, and moods in their natural environment over time. Despite its general usability and clinical value for evaluating daily depressive mood, there are several methodological challenges when applying ecological momentary assessment to older adults. OBJECTIVE The aims of this integrative literature review were to examine possible uses of the ecological momentary assessment methodology with older adults and to suggest strategies to increase the feasibility of its application in geriatric depression research and practice. METHODS We searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and EMBASE) and gray literature; we also hand searched the retrieved articles’ references. We limited all database searches to articles published in peer-reviewed journals from 2009 to 2019. Search terms were “ecological momentary assessment,” “smartphone assessment,” “real time assessment,” “electronic daily diary,” “mHealth momentary assessment,” “mobile-based app,” and “experience sampling method,” combined with the relevant terms of depression. We included any studies that enrolled older adults even as a subgroup and that reported depressive mood at least once a day for more than 2 days. RESULTS Of the 38 studies that met the inclusion criteria, only 1 study enrolled adults aged 65 years or older as the entire sample; the remainder of the reviewed studies used mixed samples of both younger and older adults. Most of the analyzed studies (18/38, 47%) were quantitative, exploratory (descriptive, correlational, and predictive), and cohort in design. Ecological momentary assessment was used to describe the fluctuating pattern of participants’ depressive moods primarily and to examine the correlation between mood patterns and other health outcomes as a concurrent symptom. We found 3 key methodological issues: (1) heterogeneity in study design and protocol, (2) issues with definitions of dropout and adherence, and (3) variation in how depressive symptoms were measured with ecological momentary assessment. Some studies (8/38, 21%) examined the age difference of participants with respect to dropout or poor compliance rate. Detailed participant burden was reported, such as technical problems, aging-related health problems, or discomfort while using the device. CONCLUSIONS Ecological momentary assessment has been used for comprehensive assessment of multiple mental health indicators in relation to depressive mood. Our findings provide methodological considerations for further studies that may be implemented using ecological momentary assessment to assess daily depressive mood in older adults. Conducting more feasibility studies focusing on older adults with standardized data collection protocols and mixed-methods research is required to reflect users’ experiences. Further telepsychiatric evaluation and diagnosis based on ecological momentary assessment data should involve standardized and sophisticated strategies to maximize the potential of ecological momentary assessment for older adults with depression in the community setting.

scholarly journals When home becomes a cage: Daily activities, space-time constraints, isolation and the loneliness of older adults in urban environments

2020 ◽  
Vol 28 (4) ◽  
pp. 322-337
Author(s):  
Bohumil Frantál ◽  
Pavel Klapka ◽  
Eva Nováková
Keyword(s):  
Older Adults ◽  
Leisure Activities ◽  
Urban Environments ◽  
Daily Activities ◽  
Cultural Events ◽  
Time Space ◽  
Age Related ◽  
Sport Activities ◽  
Spatial Isolation ◽  
Positive Effect

AbstractThe geography of ageing is addressed in this article by providing new empirical evidence about the significant role of daily activities on the perceptions of isolation and loneliness. The developed model of socio-spatial isolation is based on data from time-space diaries and questionnaires completed by older adults living in three cities in the Czech Republic. The study suggests that socio-spatial isolation is a multicomponent (consisting of passivity, isolation and loneliness components), place-dependent and gendered issue. The passivity is significantly associated with the income and leisure sport activities. The isolation can be well predicted by the age, gender and education, and the frequency of work and specific leisure activities, which are constrained by health conditions, financial opportunities and spatial mobility. Particularly trips to nature, sport activities, cultural events, get together with friends, and visits to restaurants have a positive effect on reducing isolation. Women, particularly those who raised more children, more likely feel lonely in old age when family contacts are reduced. Visits to restaurants, shopping malls and cultural events have a positive effect on reducing loneliness. A constrained mobility and higher time consumption for necessary activities also proved to be an age-related and gendered problem. In this respect, policy interventions should seek to improve flexible work opportunities, the digital skills of older people, and the accessibility and safety of public transport with regard to perceived constraints, which is gaining in importance in the Covid-19 era.

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