Michael Marsiske

Ten-Year Effects of the Advanced Cognitive Training for Independent and Vital Elderly Cognitive Training Trial on Cognition and Everyday Functioning in Older Adults

To determine the effects of cognitive training on cognitive abilities and everyday function over 10 years.

ACTIVE: a cognitive intervention trial to promote independence in older adults.

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a randomized, controlled, single-masked trial designed to determine whether cognitive training interventions (memory, reasoning, and speed of information processing), which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions, can affect cognitively based measures of daily functioning. Enrollment began during 1998; 2-year follow-up will be completed by January 2002. Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization. Trial participants (n = 2832) are aged 65 and over, and at entry into the trial, did not have significant cognitive, physical, or functional decline. Because of its size and the carefully developed rigor, ACTIVE may serve as a guide for future behavioral medicine trials of this nature.

Dissociating apathy and depression in Parkinson disease

Objective: To examine the hypothesis that apathy is a core feature of Parkinson disease (PD) and that apathy can be dissociated from depression. Methods: Eighty patients with PD and 20 patients with dystonia completed depression and apathy measures including the Marin Apathy Evaluation Scale (AES), Beck Depression Inventory (BDI), and Centers for Epidemiologic Studies–Depression Scale (CES-D). Results: There was a significantly higher severity and frequency of apathy in PD (frequency = 51%, 41/80) than in dystonia (frequency = 20%, 4/20). Apathy in the absence of depression was frequent in PD and did not occur in dystonia (PD = 28.8%, dystonia = 0%). Conclusions: Patients with Parkinson disease (PD) experienced significantly higher frequency and severity of apathy when compared with patients with dystonia. Apathy may be a “core” feature of PD and occurs in the absence of depression.

Everyday cognition: age and intellectual ability correlates.

The primary aim of this study was to examine the relationship between a new battery of everyday cognition measures, which assessed 4 cognitive abilities within 3 familiar real-world domains, and traditional psychometric tests of the same basic cognitive abilities. Several theoreticians have argued that everyday cognition measures are somewhat distinct from traditional cognitive assessment approaches, and the authors investigated this assertion correlationally in the present study. The sample consisted of 174 community-dwelling older adults from the Detroit metropolitan area, who had an average age of 73 years. Major results of the study showed that (a) each everyday cognitive test was strongly correlated with the basic cognitive abilities; (b) several basic abilities, as well as measures of domain-specific knowledge, predicted everyday cognitive performance; and (c) everyday and basic measures were similarly related to age. The results suggest that everyday cognition is not unrelated to traditional measures, nor is it less sensitive to age-related differences.

Resilience and levels of reserve capacity in later adulthood: Perspectives from life-span theory

The goal of this article is to explore the utility of integrating two lines of research on questions of modifiability or plasticity of human development. The first line, dealing with the notion of resilience, originated within the field of clinical developmental research. The second line, concerned with developmental reserve capacity, evolved primarily within the field of life-span developmental psychology. Resilience addresses questions of maintenance and recovery of adaptation in the face of stress. In addition, ideas about levels of reserve capacity, rooted in life-span developmental psychology, emphasize the potential for growth. A review of research in the areas of cognitive and self-related functioning provides evidence for resilience as well as developmental reserve capacity in adulthood and old age. It is argued that across the life span reserve capacity is increasingly allocated to resilience-related processes (maintenance of functioning and recovery from dysfunction) rather than growth. A model of successful aging is discussed which suggests that, by means of selective optimization with compensation, old age nevertheless continues to hold the potential for selective growth.

Longitudinal change and prediction of everyday task competence in the elderly

The present study examined longitudinal change in everyday task competence in a sample of 102 community-dwelling older adults from central Pennsylvania. Subjects were assessed on cognitive abilities, intellectual control beliefs, and everyday task competence in 1979 and 1986. The results indicated significant mean level decline on everyday task competence. However, wide individual differences were apparent in the timing and rate of decline; 62% of the sample remained stable or improved in competence over this seven-year period. Structural equation analyses were conducted to examine lagged relationships among the ability, intellectual control, and everyday task competence constructs. Fluid reasoning ability was a significant longitudinal predictor of subsequent everyday task competence. Everyday task competence was a significant longitudinal predictor of subsequent self-efficacy beliefs regarding intellectual aging. The results suggest that mean level decline in everyday task competence may not represent the intraindividual developmental trajectory of many subjects. Prior level of fluid ability influences subsequent everyday task competence, and prior level of everyday task competence influences levels of self-efficacy beliefs.

Pain Assessment in Persons with Dementia: Relationship Between Self‐Report and Behavioral Observation

OBJECTIVES: To investigate the relationship between self‐report and behavioral indicators of pain in cognitively impaired and intact older adults.

Effect of memory impairment on training outcomes in ACTIVE

Cognitive training improves mental abilities in older adults, but the trainability of persons with memory impairment is unclear. We conducted a subgroup analysis of subjects in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial to examine this issue. ACTIVE enrolled 2802 non-demented, community-dwelling adults aged 65 years and older and randomly assigned them to one of four groups: Memory training, reasoning training, speed-of-processing training, or no-contact control. For this study, participants were defined as memory-impaired if baseline Rey Auditory Verbal Learning Test (AVLT) sum recall score was 1.5 SD or more below predicted AVLT sum recall score from a regression-derived formula using age, education, ethnicity, and vocabulary from all subjects at baseline. Assessments were taken at baseline (BL), post-test, first annual (A1), and second annual (A2) follow-up. One hundred and ninety-three subjects were defined as memory-impaired and 2580 were memory-normal. Training gain as a function memory status (impaired vs. normal) was compared in a mixed effects model. Results indicated that memory-impaired participants failed to benefit from Memory training but did show normal training gains after reasoning and speed training. Memory function appears to mediate response to structured cognitive interventions in older adults.

Sleep and affect in older adults: using multilevel modeling to examine daily associations

The main objective of the present study was to examine daily associations (intraindividual variability or IIV) between sleep and affect in older adults. Greater understanding of these associations is important, because both sleep and affect represent modifiable behaviors that can have a major influence on older adults’ health and well‐being. We collected sleep diaries, actigraphy, and affect data concurrently for 14 days in 103 community‐dwelling older adults. Multilevel modeling was used to assess the sleep–affect relationship at both the group (between‐persons) and individual (within‐person or IIV) levels. We hypothesized that nights characterized by better sleep would be associated with days characterized by higher positive affect and lower negative affect, and that the inverse would be true for poor sleep. Daily associations were found between affect and subjective sleep, only and were in the hypothesized direction. Specifically, nights with greater reported awake time or lower sleep quality ratings were associated with days characterized by less positive affect and more negative affect. Gender was not a significant main effect in the present study, despite previous research suggesting gender differences in the sleep–affect relationship. The fact that self‐ratings of sleep emerged as the best predictors of affect may suggest that perceived sleep is a particularly important predictor. Finally, our results suggest exploration of affect as a potential intervention target in late‐life insomnia is warranted.

The Revised Observed Tasks of Daily Living: A Performance-Based Assessment of Everyday Problem Solving in Older Adults

The Revised Observed Tasks of Daily Living (OTDL-R), a performance-based test of everyday problem solving, was administered to a sample of community-dwelling older adults. The OTDLR included nine tasks, representing medication use, telephone use, and financial management. The OTDL-R had a desirable range of difficulty and satisfactory internal consistency and showed a relatively invariant pattern of relations between measured tasks and the underlying latent dimensions they represent across White and non-White subsamples. The OTDL-R also correlated significantly with age, education, self-rated health, a paper-and-pencil measure of everyday problem solving, and measures of basic cognitive functioning. Thus, the OTDL-R is a reliable and valid objective measure of everyday problem solving that has great practical utility for assessing performance in diverse populations.