Kristin R. Krueger

Early and late life cognitive activity and cognitive systems in old age.

Little is known about the relative benefits of cognitively stimulating activities at different points in the lifespan. In a cohort of 576 older persons without dementia, we assessed current and past (childhood, young adulthood, middle age) frequency of cognitive activity; availability of cognitively stimulating resources in the home in childhood and middle age; and 5 domains of cognitive function. Past cognitive activity and cognitive resources were positively correlated with both current cognitive activity and current cognitive function. The association with cognitive function was reduced after controlling for current cognitive activity, however. Current cognitive activity was associated with better cognitive function, especially semantic memory and perceptual speed, even after controlling for past activity. The results suggest that past cognitive activity contributes to current cognition principally through its association with cognitive activity in old age.

Neuroticism, extraversion, and mortality in a defined population of older persons

Objective: The objective of this study was to test the association of the personality traits of neuroticism and extraversion with risk of death in old age. Methods: A census was taken of a geographically defined urban community in Chicago, and those aged 65 years or older were invited to participate in an in-home interview; 6158 (79% of those eligible) did so. The interview included brief measures of neuroticism and extraversion, medical history, and questions about current participation in cognitive, social, and physical activities. Vital status was subsequently monitored. The association of each trait with risk of death was examined in a series of accelerated failure-time models that controlled for age, sex, race, and education. Results: During a mean of more than 6 years of observation, 2430 persons (39.5%) died. A high level of neuroticism (score = 27; 90th percentile) was associated with a 33% increase in risk of death compared with a low level of neuroticism (score = 9; 10th percentile). A high level of extraversion (score = 33; 90th percentile) was associated with a 21% decrease in risk of death compared with a low level (score = 18; 10th percentile). Adjustment for medical conditions and health-related variables did not substantially affect results, but adjusting for baseline levels of cognitive, social, and physical activity reduced the association of both traits with mortality. Conclusions: The results suggest that higher extraversion and lower neuroticism are associated with reduced risk of mortality in old age and that these associations are mediated in part by personality-related patterns of cognitive, social, and physical activity. SD = standard deviation; SE = standard error; RR = relative risk; CI = confidence interval.

Social engagement and cognitive function in old age.

We examined the association of diverse measures of social engagement with level of function in multiple cognitive domains in 838 persons without dementia who had a mean age of 80.2 (SD = 7.5). Social network size, frequency of social activity, and level of perceived social support were assessed in linear regression models adjusted for age, sex, education, and other covariates. Social activity and social support were related to better cognitive function, whereas social network size was not strongly related to global cognition. The results confirm that higher level of social engagement in old age is associated with better cognitive function but the association varies across domains of social engagement.

Hallucinations and mortality in Alzheimer disease.

OBJECTIVE The authors tested the relationship of hallucinations and delusions to mortality in Alzheimer disease (AD). METHODS A group of 407 persons with clinically diagnosed AD completed a uniform clinical evaluation, after which vital status was monitored for a mean of 3.7 years. At the initial evaluation, a previously established, structured, informant interview was used to ascertain the presence of hallucinations and delusional thinking. The evaluation also included a structured medical history, inspection of all medications, and detailed assessment of cognitive functioning and parkinsonian signs. RESULTS At study onset, hallucinations were present in 41.0% of participants and delusions in 54.4%. During follow-up, 146 deaths occurred. In a proportional-hazards model adjusted for age, sex, race, and education, hallucinations were associated with a 78% increase in risk of death. The association was not substantially altered in subsequent analyses that controlled for level of cognitive impairment, severity of parkinsonism, use of antipsychotic medications, and the presence of chronic medical conditions. Risk of death was more than doubled in those with both auditory and visual hallucinations. By contrast, we did not find evidence of an association of delusions with mortality. CONCLUSION Hallucinations are associated with an increased risk of death in AD.

The Spanish Translation And Adaptation Of The Uniform Data Set Of The National Institute on Aging Alzheimer’s Disease Centers

Researchers from Alzheimers Disease Centers (ADCs) across the United States with expertise in the assessment of Spanish-speaking elderly collaborated to create the official Spanish version of measures in the Uniform Data Set of the National Institute on Aging Alzheimers Disease Center Program. The present article describes this project, whose primary goal was to create Spanish instruments with cultural and linguistic equivalence to the English versions. The resulting Spanish versions make provisions for variations among Spanish-speaking groups in the United States of different nationalities, socio-cultural, linguistic, and educational backgrounds. A consensus-based translation and adaptation approach was used, and guiding principles and specific components of this process are summarized. The Spanish translation and adaptation of the Uniform Data Set measures became available online to ADCs in April 2007. Its creation is important, as the resulting effort provides standardized measures for the collection of cross-sectional and longitudinal data on a large cohort of Spanish-speaking elders across the country and facilitates collaborative research among ADCs.

The evaluation of a Latino community health worker HIV prevention program

This study evaluated the effectiveness of a community health promotion project to increase HIV knowledge in an urban, immigrant Latino community in Chicago. Latino participants (N = 704) answered questions on HIV before and after an education intervention given by community health workers. Outcomes included changes in knowledge and self-perceived risk. Increases in knowledge scores were greatest for Central/South Americans (p = .038), women (p = .027), and those with an education level less than 7 years (p = .001). Significant changes in self-perceived risk resulted from the intervention (p < .001), and the odds ratio for a change in self-perceived risk when the knowledge score increased by 10% was 1.225. The Centro San Bonifacio HIV Prevention Program successfully reached a Latino community, increased HIV knowledge, and changed self-perceptions of HIV risk.

A battery of tests for assessing cognitive function in older Latino persons.

With the proportion of older Latinos in the United States rapidly growing, dementia is expected to be an increasing public health problem in this segment of the population. Yet relatively few cognitive test batteries have been developed for evaluating older Spanish-speaking persons. We selected a battery of cognitive tests used in cognitive aging studies of English speakers, adapted it for Spanish speakers, and administered it to 66 older Latinos (mean age=71.1, SD=8.1). The results of a factor analysis supported grouping the tests into the same 5 functional domains identified for English speakers. Composite measures of performance in each domain were positively related to education and, with some exceptions, inversely related to age. The results suggest that this battery may be useful in epidemiologic research on cognition in older Latinos.

The Word Accentuation Test – Chicago

A reading test for Spanish speakers in the United States was developed called the Word Accentuation Test-Chicago. The construction and validation of this 40 item test was modeled after reading tests developed in Spain and Argentina, and is based on irregular accentuation of words. The Word Accentuation Test-Chicago was validated on 45 community participants using the Wechsler Adult Intelligence Scale-III in Spanish. Better reading performance was associated with higher intelligence test performance, with an additional 5% of the variation in intelligence score accounted for by reading performance after controlling for age and education. These results indicate that the Word Accentuation Test-Chicago is a psychometrically sound measure of Spanish reading ability that is robustly related to general cognitive ability.

Loss of basic lexical knowledge in old age

Background Basic lexical skills are hypothesised to be relatively preserved in mild dementia, but clinical studies have reported inconsistent results. Methods More than 400 older Catholic nuns, priests and brothers recruited from groups across the USA completed annual evaluations for up to 15 years, died and underwent brain autopsy. Each clinical evaluation included administration of a 20-item word reading test and a 15-item vocabulary test, which were combined to form a composite measure of word knowledge. In a uniform neuropathological examination, Alzheimers disease pathology was quantified with a composite index of plaques and tangles, and the presence of gross and microscopic cerebral infarctions and Lewy bodies was recorded. Results The post-mortem level of Alzheimers disease neuropathology was linearly related to rate of decline in word knowledge. Decline was nearly fourfold faster at a relatively high level of pathology (75th percentile) compared with a relatively low level (25th percentile). Neocortical (but not nigral or limbic) Lewy bodies and gross (but not microscopic) cerebral infarction were also associated with a more rapid decline in word knowledge. Effects for word reading and vocabulary were similar, except that gross cerebral infarction was associated with accelerated decline in vocabulary, but not in word reading. Conclusion Common neuropathological changes associated with late-life dementia impair word knowledge in old age, calling into question the use of word knowledge tests to estimate premorbid cognitive ability.

Association of cognitive activity and neurocognitive function in blacks and whites with HIV

Objective: Older persons with HIV are at risk for impaired cognition, yet there is limited information on modifiable factors associated with neurocognitive function in this group. Design: This is a cross-sectional observational study of cognitive activities and neurocognitive function. Methods: We examined the relation between frequency of cognitive activity and current neurocognitive performance in 176 older persons with HIV [70% African American, 76% men; mean age = 58.7 (SD = 5.5); mean education = 13.2 (SD = 2.8)]. Results: In linear regression models adjusted for demographic variables, we found that higher frequency of cognitive activity was associated with better cognition in global cognition, semantic memory, and perceptual speed. Subsequent models that examined the role of race demonstrated that the association was significant only among Blacks for global cognition, episodic memory, working memory, and perceptual speed (interaction of cognitive activity by race: Estimate range = 0.38–0.55; all P < 0.05). Conclusion: Greater frequency of cognitive activity is associated with better neurocognitive function in older persons with HIV, particularly older Blacks. Longitudinal studies are needed to assess the relation of cognitive activity to change in neurocognitive function in older persons with HIV.