[Show abstract][Hide abstract] ABSTRACT: While a training model of cognitive intervention targets the improvement of particular skills through instruction and practice, an engagement model is based on the idea that being embedded in an intellectually and socially complex environment can impact cognition, perhaps even broadly, without explicit instruction. We contrasted these 2 models of cognitive enrichment by randomly assigning healthy older adults to a home-based inductive reasoning training program, a team-based competitive program in creative problem solving, or a wait-list control. As predicted, those in the training condition showed selective improvement in inductive reasoning. Those in the engagement condition, on the other hand, showed selective improvement in divergent thinking, a key ability exercised in creative problem solving. On average, then, both groups appeared to show ability-specific effects. However, moderators of change differed somewhat for those in the engagement and training interventions. Generally, those who started either intervention with a more positive cognitive profile showed more cognitive growth, suggesting that cognitive resources enabled individuals to take advantage of environmental enrichment. Only in the engagement condition did initial levels of openness and social network size moderate intervention effects on cognition, suggesting that comfort with novelty and an ability to manage social resources may be additional factors contributing to the capacity to take advantage of the environmental complexity associated with engagement. Collectively, these findings suggest that training and engagement models may offer alternative routes to cognitive resilience in late life. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Psychology and Aging 11/2014; · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Experience Corps® (EC) was designed to simultaneously increase cognitive, social, and physical activity through high-intensity volunteerism in elementary school classrooms. It is, therefore, highly likely that EC participation may alter pre-existing patterns of lifestyle activity. This study examined the impact of "real-world" volunteer engagement on the frequency of participation in various lifestyle activities over a 2-year period. Specifically, we examined intervention-related changes on reported activity levels at 12 and 24 months post-baseline using Intention-to-Treat (ITT) and Complier Average Causal Effect (CACE) analyses, which account for the amount of program exposure. ITT analyses indicated that, compared to the control group, EC participants reported modest increases (approximately half a day/month) in overall activity level, especially in intellectual and physical activities 12 months post-baseline. Increases in activity were not found at the 24-month assessment. CACE models revealed similar findings for overall activity as well as for intellectual and physical activities at 12 months. Additionally, CACE findings suggested modest increases in social activity at 12 months and in intellectual and passive activities at 24 months post-baseline. This community-based, health promotion intervention has the potential to impact lifestyle activity, which may lead to long-term increases in activity and to other positive cognitive, physical, and psychosocial health outcomes.
Journal of Urban Health 11/2014; · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: We studied the association between insomnia symptoms and late-life functioning, including physical capacity, limitations in household activities, and participation in valued activities.
METHODS: Participants were 6,050 adults independent in self-care activities from a representative sample of older Medicare beneficiaries. They completed objective measures of physical capacity and self-report measures of insomnia symptoms, help and difficulty with household activities, and participation in valued activities.
RESULTS: After adjustment, insomnia symptoms were associated with a greater odds of receiving help or having difficulty with selected household activities (laundry, shopping), greater odds of help or difficulty with ≥1 household activity [1 symptom vs. 0, odds ratio (OR)=1.27, p < .05; 2 symptoms vs. 0, OR = 1.35, p < .01), and of restricted participation in specific valued activities (attending religious services, going out for enjoyment) and in ≥1 valued activity (1 symptom vs. 0, OR = 1.29, p < .05; 2 symptoms vs. 0, OR = 1.50, p < .01). There was no independent association between insomnia symptoms and physical capacity.
DISCUSSION: Among older adults, insomnia symptoms are associated with a greater odds of limitation in household activities and of restricted participation in valued activities. Insomnia interventions may improve functioning and quality of life among elders.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences 11/2014; 69(Suppl 1):S35-41. · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Within the context of the Advanced Cognitive Training for Independent and Vital Elderly study (ACTIVE; Ball et al., 2002; Jobe et al., 2001; Willis et al., 2006), we examined the longitudinal association of baseline depressive symptoms on inductive reasoning performance over a 10-year period between the reasoning training and control conditions (N = 1,375). At baseline, 322 participants (23%) reported elevated depressive symptoms, defined by a score ≥9 on the 12-item version of the Center for Epidemiological Studies Depression Scale (CES-D; Mirowsky & Ross, 2003; Radloff, 1977). Differences in baseline depressive status were not associated with immediate posttraining gains or with subsequent annual change in reasoning performance, suggesting that the presence of elevated baseline depressive symptoms does not impact the ability to benefit from reasoning training. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Psychology and Aging 09/2014; · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT Background: We determined the association between neighborhood socio-environmental factors and insomnia symptoms in a nationally representative sample of US adults aged >50 years. Methods: Data were analyzed from two waves (2006 and 2010) of the Health and Retirement Study using 7,231 community-dwelling participants (3,054 men and 4,177 women) in the United States. Primary predictors were neighborhood physical disorder (e.g. vandalism/graffiti, feeling safe alone after dark, and cleanliness) and social cohesion (e.g. friendliness of people, availability of help when needed, etc.); outcomes were insomnia symptoms (trouble falling asleep, night awakenings, waking too early, and feeling unrested). Results: After adjustment for age, income, race, education, sex, chronic diseases, body mass index, depressive symptoms, smoking, and alcohol consumption, each one-unit increase in neighborhood physical disorder was associated with a greater odds of trouble falling asleep (odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.04-1.14), waking too early (OR = 1.05, 95% CI: 1.00-1.10), and, in adults aged ≥69 years (adjusting for all variables above except age), feeling unrested in the morning (OR = 1.11, 95% CI: 1.02-1.22 in 2006). Each one-unit increase in lower social cohesion was associated with a greater odds of trouble falling asleep (OR = 1.06, 95% CI: 1.01-1.11) and feeling unrested (OR = 1.09, 95% CI: 1.04-1.15). Conclusions: Neighborhood-level factors of physical disorder and social cohesion are associated with insomnia symptoms in middle-aged and older adults. Neighborhood-level factors may affect sleep, and consequently health, in our aging population.
International Psychogeriatrics 09/2014; · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The association between lifestyle activities and incident depressive symptoms was examined within the Women's Health and Aging Study II. Measures of activity and depressive symptoms were collected on four occasions, spanning six-years. Discrete-time Cox proportional hazards models were employed to examine the effects of baseline activity on depressive symptoms over time. Overall, activity was not associated with incident depressive symptoms. When specific activity domains were examined, greater participation in creative activities was associated with a reduced risk of depressive symptoms (hazard ratio = 0.92; CI 95% 0.87, 0.98). Further longitudinal research between diverse activities and incident depressive symptoms is warranted.
[Show abstract][Hide abstract] ABSTRACT: Experience Corps (EC) represents a high-intensity, intergenerational civic engagement activity where older adults serve as mentors and tutors in elementary schools. Although high-intensity volunteer opportunities are designed to enhance the health and well being of older adult volunteers, little is known about the negative and positive aspects of volunteering unique to intergenerational programs from the volunteer's perspective.
Stressors and rewards associated with volunteering in EC were explored in 8 focus group discussions with 46 volunteers from EC Baltimore. Transcripts were coded for frequently expressed themes.
Participants reported stressors and rewards within 5 key domains: intergenerational (children's problem behavior, working with and helping children, observing/facilitating improvement or transformation in a child, and developing a special connection with a child); external to EC (poor parenting and children's social stressors); interpersonal (challenges in working with teachers and bonding/making social connections); personal (enjoyment, self-enhancement/achievement, and being/feeling more active); and structural (satisfaction with the structural elements of the EC program).
Volunteers experienced unique intergenerational stressors related to children's problem behavior and societal factors external to the EC program. Overall, intergenerational, interpersonal, and personal rewards from volunteering, as well as program structure may have balanced the stress associated with volunteering. A better understanding of stressors and rewards from high-intensity volunteer programs may enhance our understanding of how intergenerational civic engagement volunteering affects well being in later life and may inform project modifications to maximize such benefits for future volunteers and those they serve.
[Show abstract][Hide abstract] ABSTRACT: Episodic memory shows substantial declines with advancing age, but research on longitudinal trajectories of spoken discourse memory (SDM) in older adulthood is limited. Using parallel process latent growth curve models, we examined 10 years of longitudinal data from the no-contact control group (N = 698) of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomised controlled trial in order to test (1) the degree to which SDM declines with advancing age, (2) the predictors of these age-related declines and (3) the within-person relationship between longitudinal changes in SDM and longitudinal changes in fluid reasoning and verbal ability over 10 years, independent of age. Individuals who were younger, were White, had more years of formal education, were male and had better global cognitive function and episodic memory performance at baseline demonstrated greater levels of SDM on average. However, only age at baseline uniquely predicted longitudinal changes in SDM, such that declines accelerated with greater age. Independent of age, within-person decline in reasoning ability over the 10-year study period was substantially correlated with decline in SDM (r = .87). An analogous association with SDM did not hold for verbal ability. The findings suggest that longitudinal declines in fluid cognition are associated with reduced spoken language comprehension. Unlike findings from memory for written prose, preserved verbal ability may not protect against developmental declines in memory for speech.
[Show abstract][Hide abstract] ABSTRACT: Objective. Marriage is associated with better physical and mental health, but less is known about its effects on cognitive health. We investigated the association between marital status and both cognitive and functional performance in older adults. Methods. We analyzed baseline data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE; n=2,802) study, a multi-site randomized controlled trial of cognitive training to improve or maintain cognitive function and daily living skills. We examined cross-sectional associations between marital status (i.e., married, widowed, divorced, single) and cognitive measures (i.e., memory, reasoning, and processing speed) and functional performance (activities of daily living (ADLs) and instrumental activities of daily living (IADLs)) using multiple linear regressions. The standardized effect sizes were calculated based on the standard deviation of the married individuals (reference group). Results. After accounting for demographic characteristics, depressive symptoms, and cardiovascular risk factors, married individuals had significantly better performance than non-married individuals (i.e., divorced, widowed, single) on measures of memory and functional ability. On tests of memory, effect sizes ranged from 0.08-0.18 for episodic memory and 0.10-0.15 for prose memory. Further, the significant association between marital status and everyday functioning was driven by differences in IADLs (effect sizes ranged from 0.72 0.74). However, marital status was not associated with measures of reasoning or processing speed. Conclusion. Marriage may protect against cognitive and functional impairment in later life. Research is needed to clarify the mechanisms underlying the observed associations.
141st APHA Annual Meeting and Exposition 2013; 11/2013
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To determine the association between personality domains and 11-year cognitive decline in a sample from a population-based study. METHOD: Data from Waves 3 (1993-1996) and 4 (2003-2004) of the Baltimore cohort of the Epidemiologic Catchment Area (ECA) study were used for analyses. The sample included 561 adults (mean age ± SD: 45.2 ± 10.78 years) who completed the NEO Personality Inventory-Revised prior to Wave 4. Participants also completed the Mini-Mental State Examination (MMSE) and immediate and delayed word recall tests at Wave 3, and at Wave 4, 10.9 ± 0.6 years later. RESULTS: In models adjusted for baseline cognitive performance, demographic characteristics, medical conditions, depressive symptoms, and psychotropic medication use, each 10-point increase in Neuroticism T-scores was associated with a 0.15-point decrease in MMSE scores (B = -0.15, 95% confidence interval [CI]: -0.30, -0.01), whereas each 10-point increase in Conscientiousness T-scores was associated with a 0.18-point increase on the MMSE (B = 0.18, 95% CI: 0.04, 0.32) and a 0.21-point increase in immediate recall (B = 0.21, 95% CI: 0.003, 0.41) between baseline and follow-up. CONCLUSION: Findings suggest that greater Neuroticism is associated with decline, and greater Conscientiousness is associated with improvement in performance on measures of general cognitive function and memory in adults. Further studies are needed to determine the extent to which personality traits in midlife are associated with clinically significant cognitive outcomes in older adults, such as mild cognitive impairment and dementia, and to identify potential mediators of the association between personality and cognitive trajectories.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 06/2013; · 3.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: Data from the memory training arm (n = 629) of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial were examined to characterize change in memory performance through 5 years of follow-up as a function of memory training, booster training, adherence to training, and other characteristics. RESULTS: Latent growth model analyses revealed that memory training was associated with improved memory performance through Year 5 but that neither booster training nor training adherence significantly influenced this effect. Baseline age was associated with change in memory performance attributable to the passage of time alone (i.e., to aging). Higher education and better self-rated health were associated with greater change in memory performance after training. DISCUSSION: These findings confirm that memory training can aid in maintaining long-term improvements in memory performance. Booster training and adherence to training do not appear to attenuate rates of normal age-related memory decline.
Journal of Aging and Health 10/2012; · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Experience Corps(®) places teams of trained volunteers in elementary school classrooms to promote academic achievement in children, and serve as a health promotion intervention for older adults. Prior to randomization, individuals reported participation in several activities of varying cognitive, physical, and social demands. Maintaining an active lifestyle, particularly in intellectually demanding activities, was associated with physical, mental, and cognitive health in adulthood. Establishing how individuals allocated their time before randomization to this program provides insight to prevalent health behaviors for at-risk older adults, and can provide the basis for examining intervention-related changes in lifestyle as a result of volunteer participation.
[Show abstract][Hide abstract] ABSTRACT: Analyses of individual differences in change may be unintentionally biased when versions of a neuropsychological test used at different follow-ups are not of equivalent difficulty. This study's objective was to compare mean, linear, and equipercentile equating methods and demonstrate their utility in longitudinal research.
The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE, N = 1,401) study is a longitudinal randomized trial of cognitive training. The Alzheimer's Disease Neuroimaging Initiative (ADNI, n = 819) is an observational cohort study. Nonequivalent alternate versions of the Auditory Verbal Learning Test (AVLT) were administered in both studies.
Using visual displays, raw and mean-equated AVLT scores in both studies showed obvious nonlinear trajectories in reference groups that should show minimal change and poor equivalence over time (ps ≤ .001), and raw scores demonstrated poor fits in models of within-person change (root mean square errors of approximation, RMSEAs > 0.12). Linear and equipercentile equating produced more similar means in reference groups (ps ≥ .09) and performed better in growth models (RMSEAs < 0.05).
Equipercentile equating is the preferred equating method because it accommodates tests more difficult than a reference test at different percentiles of performance and performs well in models of within-person trajectory. The method has broad applications in both clinical and research settings to enhance the ability to use nonequivalent test forms.
Journal of Clinical and Experimental Neuropsychology 04/2012; 34(7):758-72. · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A systematic review and meta-analysis of memory training research was conducted to characterize the effect of memory strategies on memory performance among cognitively intact, community-dwelling older adults, and to identify characteristics of individuals and of programs associated with improved memory. The review identified 402 publications, of which 35 studies met criteria for inclusion. The overall effect size estimate, representing the mean standardized difference in pre-post change between memory-trained and control groups, was 0.31 standard deviations (SD; 95% confidence interval (CI): 0.22, 0.39). The pre-post training effect for memory-trained interventions was 0.43 SD (95% CI: 0.29, 0.57) and the practice effect for control groups was 0.06 SD (95% CI: 0.05, 0.16). Among 10 distinct memory strategies identified in studies, meta-analytic methods revealed that training multiple strategies was associated with larger training gains (p=0.04), although this association did not reach statistical significance after adjusting for multiple comparisons. Treatment gains among memory-trained individuals were not better after training in any particular strategy, or by the average age of participants, session length, or type of control condition. These findings can inform the design of future memory training programs for older adults.
Aging and Mental Health 03/2012; 16(6):722-34. · 1.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Cognitive performance benefits from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study may differ for individuals who exhibit a greater number of depressive symptoms. METHOD: Using data from ACTIVE memory training and control conditions, we evaluated the effect of depressive symptomatology on memory scores across a 5-year period. Of 1,401 participants, 210 had elevated depressive symptoms at baseline, as measured by a 12-item version of the Center for Epidemiological Studies-Depression Scale (CES-D). RESULTS: Participants with elevated depressive symptoms scored significantly lower at baseline and had faster decline in memory performance than those exhibiting fewer depressive symptoms. Memory score differences among depressive symptom categories did not differ between training conditions. DISCUSSION: Findings suggest that elevated depressive symptoms may predict declines in memory ability over time, but do not attenuate gains from training. Training provides a potential method of improving memory which is robust to effects of depression.
Journal of Aging and Health 01/2012; · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A systematic review to examine the efficacy of computer-based cognitive interventions for cognitively healthy older adults was conducted. Studies were included if they met the following criteria: average sample age of at least 55 years at time of training; participants did not have Alzheimer's disease or mild cognitive impairment; and the study measured cognitive outcomes as a result of training. Theoretical articles, review articles, and book chapters that did not include original data were excluded. We identified 151 studies published between 1984 and 2011, of which 38 met inclusion criteria and were further classified into three groups by the type of computerized program used: classic cognitive training tasks, neuropsychological software, and video games. Reported pre-post training effect sizes for intervention groups ranged from 0.06 to 6.32 for classic cognitive training interventions, 0.19 to 7.14 for neuropsychological software interventions, and 0.09 to 1.70 for video game interventions. Most studies reported older adults did not need to be technologically savvy in order to successfully complete or benefit from training. Overall, findings are comparable or better than those from reviews of more traditional, paper-and-pencil cognitive training approaches suggesting that computerized training is an effective, less labor intensive alternative.
PLoS ONE 01/2012; 7(7):e40588. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although educational attainment has been consistently related to cognition in adulthood, the mechanisms are still unclear. Early education, and other social learning experiences, may provide the skills, knowledge, and interest to pursue intellectual challenges across the life course. Therefore, cognition in adulthood might reflect continued engagement with cognitively complex environments. Using baseline data from the Baltimore Experience Corps Trial, multiple mediation models were applied to examine the combined and unique contributions of intellectual, social, physical, creative, and passive lifestyle activities on the relationship between education and cognition. Separate models were tested for each cognitive outcome (i.e., reading ability, processing speed, memory). With the exception of memory tasks, findings suggest that education-cognition relations are partially explained by frequent participation in intellectual activities. The association between education and cognition was not completely eliminated, however, suggesting that other factors may drive these associations.
[Show abstract][Hide abstract] ABSTRACT: This study examined whether participation in a variety of lifestyle activities was comparable to frequent participation in cognitively challenging activities in mitigating impairments in cognitive abilities susceptible to aging in healthy, community-dwelling older women. Frequencies of participation in various lifestyle activities on the Lifestyle Activities Questionnaire (LAQ) were divided according to high (e.g., reading), moderate (e.g., discussing politics), and low (e.g., watching television) cognitive demand. We also considered the utility of participation in a variety of lifestyle activities regardless of cognitive challenge. Immediate and delayed verbal recall, psychomotor speed, and executive function were each measured at baseline and at five successive exams, spanning a 9.5-year interval. Greater variety of participation in activities, regardless of cognitive challenge, was associated with an 8 to 11% reduction in the risk of impairment in verbal memory and global cognitive outcomes. Participation in a variety of lifestyle activities was more predictive than frequency or level of cognitive challenge for significant reductions in risk of incident impairment on measures sensitive to cognitive aging and risk for dementia. Our findings offer new perspectives in promoting a diverse repertoire of activities to mitigate age-related cognitive declines.
Journal of the International Neuropsychological Society 12/2011; 18(2):286-94. · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We examined the relationship of cognitive and functional measures with life space (a measure of spatial mobility examining extent of movement within a person's environment) in older adults, and investigated the potential moderating role of personal control beliefs. Internal control beliefs reflect feelings of competence and personal agency, while attributions of external control imply a more dependent or passive point of view. Participants were 2,737 adults from the ACTIVE study, with a mean age of 74 years. Females comprised 76% of the sample, with good minority representation (27% African American). In multiple regression models controlling for demographic factors, cognitive domains of memory, reasoning, and processing speed were significantly associated with life space (p < .001 for each), and reasoning ability appeared most predictive (B = .117). Measures of everyday function also showed significant associations with life space, independent from the traditional cognitive measures. Interactions between cognitive function and control beliefs were tested, and external control beliefs moderated the relationship between memory and life space, with the combination of high objective memory and low external control beliefs yielding the highest life space (t = -2.07; p = .039). In conclusion, older adults with better cognitive function have a larger overall life space. Performance-based measures of everyday function may also be useful in assessing the functional outcome of life space. Additionally, subjective external control beliefs may moderate the relationship between objective cognitive function and life space. Future studies examining the relationships between these factors longitudinally appear worthwhile to further elucidate the interrelationships of cognitive function, control beliefs, and life space.
Psychology and Aging 08/2011; 27(2):364-74. · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Low socioeconomic status (SES) is associated with increased risk for adverse health outcomes; those with low SES are thought to experience greater environmental disadvantage and exposure to chronic stress over the life course. The effects of chronic stress on health have been measured by cortisol levels and variations in their diurnal pattern. However, the patterns of association between SES and cortisol have been equivocal in older adults. This paper examined in 98 older adults participating in the Brain Health Substudy of the Baltimore Experience Corps Trial baseline patterns of diurnal variation in salivary cortisol associated with lower versus higher SES using total income and perceived SES relative to others. For each measure, participants stratified into lower versus higher SES showed a more blunted rate of decline in diurnal salivary cortisol over the day in adjusted models (P values ≤ 0.05). There were no SES-related differences in awakening cortisol, cortisol-awakening response, or area under the curve. These findings confirm prior evidence of a biologic pathway through which socioeconomic disadvantage is linked to biologic vulnerability, and through which the impact of volunteer service in Experience Corps may be measured.
Annals of the New York Academy of Sciences 08/2011; 1231:56-64. · 4.38 Impact Factor