Because the pathologic processes that underlie Alzheimer's disease (AD) appear to start 10 to 20 years before symptoms develop, there is currently intense interest in developing techniques to accurately predict which individuals are most likely to become symptomatic. Several AD risk prediction strategies - including identification of biomarkers and neuroimaging techniques and development of risk indices that combine traditional and non-traditional risk factors - are being explored. Most AD risk prediction strategies developed to date have had moderate prognostic accuracy but are limited by two key issues. First, they do not explicitly model mortality along with AD risk and, therefore, do not differentiate individuals who are likely to develop symptomatic AD prior to death from those who are likely to die of other causes. This is critically important so that any preventive treatments can be targeted to maximize the potential benefit and minimize the potential harm. Second, AD risk prediction strategies developed to date have not explored the full range of predictive variables (biomarkers, imaging, and traditional and non-traditional risk factors) over the full preclinical period (10 to 20 years). Sophisticated modeling techniques such as hidden Markov models may enable the development of a more comprehensive AD risk prediction algorithm by combining data from multiple cohorts. As the field moves forward, it will be critically important to develop techniques that simultaneously model the risk of mortality as well as the risk of AD over the full preclinical spectrum and to consider the potential harm as well as the benefit of identifying and treating high-risk older patients.

Objectives

Physical activity may reduce the risk of cognitive decline in the elderly, but its effects among the oldest-old (i.e., those aged 85 years and older) are not well known. Our study assessed the association between very late-life physical activity and 5-year risk of mild cognitive impairment (MCI) or dementia and neuropsychological test performance among oldest-old women.

Methods

This prospective study was conducted at three sites. Participants included 1,249 women (mean [standard deviation] age: 83.3 [2.8] years). Baseline physical activity was measured by self-reported blocks walked per week and analyzed according to tertile. Five years later, surviving participants who were 85 years and older (oldest-old) completed neuropsychological testing and underwent adjudication of clinical cognitive status (normal, MCI, or dementia). All analyses were adjusted for baseline age, education, cognition, depression, body mass index, hypertension, smoking, and coronary artery disease.

Results

Compared with women in the lowest tertile, women in the highest tertile were less likely to develop dementia (13.0% versus 23.2%; multivariate adjusted odds ratio: 0.54 [95% confidence interval: 0.36-0.82]). However, risk of MCI was not associated with physical activity. Physical activity was also associated with higher performance 5 years later on tests of global cognition, category fluency, and executive function but not phonemic fluency, memory, or attention.

Conclusions

Higher level of very late-life physical activity was associated with a lower risk of subsequent dementia in oldest-old women. These findings support future studies for late-life physical activity interventions for the prevention of dementia among oldest-old women.

OBJECTIVE: To determine whether less severe depression spectrum diagnoses such as dysthymia, as well as depression, are associated with risk of developing dementia and mortality in a real-world setting. DESIGN: Retrospective cohort study conducted using the Department of Veterans Affairs (VA) National Patient Care Database (1997-2007). SETTING: VA medical centers in the United States. PARTICIPANTS: A total of 281,540 veterans aged 55 years and older without dementia at study baseline (1997-2000). MEASUREMENTS: Depression status and incident dementia were ascertained from International Classification of Diseases, Ninth Revision codes during study baseline (1997-2000) and follow-up (2001-2007), respectively. Mortality was ascertained by time of death dates in the VA Vital Status File. RESULTS: Ten percent of veterans had baseline diagnosis of depression and nearly 1% had dysthymia. The unadjusted incidence of dementia was 11.2% in veterans with depression, 10.2% with dysthymia and 6.4% with neither. After adjusting for demographics and comorbidities, patients diagnosed with dysthymia or depression were twice as likely to develop incident dementia compared with those with no dysthymia/depression (adjusted dysthymia hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.71-2.25; and depression HR: 2.18, 95% CI: 2.08-2.28). Dysthymia and depression also were associated with increased risk of death (31.6% dysthymia and 32.9% depression versus 28.5% neither; adjusted dysthymia HR: 1.41, 95% CI: 1.31-1.53; and depression HR: 1.47, 95% CI: 1.43-1.51). CONCLUSIONS: Findings suggest that older adults with dysthymia or depression need to be monitored closely for adverse outcomes. Future studies should determine whether treatment of depression spectrum disorders may reduce risk of these outcomes.

Substance use is an important clinical issue in the older adult population. As older adults are susceptible to cognitive disorders, the intersection of the fields of substance use and cognitive neuroscience is an active area of research. Prior studies of alcohol use and cognitive performance are mixed, and inconsistencies may be due to under- or over-adjustment for confounders. This article adds to this literature by conducting a secondary analysis of self-reported lifetime history of alcohol use and cognitive performance in older adults (n = 133). It was hypothesized that current alcohol users would have poorer cognitive performance compared to never/minimal and former alcohol users. Older adult participants were classified into never/minimal alcohol users, former alcohol users, and current alcohol users. A neurocognitive battery included a global cognitive measure and individual measures of attention, memory, fluency, and executive function. A directed acyclic graph-based approach was used to select variables to be included in the multiple linear regression models. Though unadjusted analyses showed some significant associations between alcohol use and cognitive performance, all associations between alcohol use and cognitive performance were eliminated after adjusting for age, education, sex, race, and smoking pack years. Alcohol drink years were not significantly associated with cognitive performance among current and former alcohol users. These results suggest that lifetime alcohol use is not significantly associated with cognitive performance in older adults after adjustment for key confounders. Inconsistencies in prior studies may be due to uncontrolled confounding and/or unnecessary adjustment of mediators and/or colliders.

OBJECTIVE: To compare characteristics between middle-aged and older prosthesis users with and without cognitive impairment and determine whether cognitive impairment contributes to variability in perceived physical function. DESIGN: Cross-sectional, observational study SETTING: General community. PARTICIPANTS: Adults 45 years or older, at least 1-year post lower limb amputation (LLA) who were walking independently with a prosthesis (N=119). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: We identified cognitive impairment using an education-adjusted Telephone Interview for Cognitive Status-modified score. Perceived physical function was measured using the Prosthesis Mobility Questionnaire. RESULTS: Of 119 participants (mean age, 62.6±8.2 years; male: 89.1%; vascular etiology: 82.4%; years since amputation: 4.9±4.7 years), 28 (23.5%) had cognitive impairment. Compared with participants without cognitive impairment, those with cognitive impairment were more likely to use an assistive device (60.7% vs 25.3%, P=.002); were older (66.3±7.3 vs 61.5±8.1 years, P=.006) and had more chronic conditions (7.1±3.4 vs 5.4±2.5, P=.004), more depressive symptoms (6.6±5.1 vs 4.2±3.8, P=.008), and worse perceived physical function (2.0±0.6 vs 2.6±0.7, P<.001). Using backward stepwise linear regression, we found that participants with cognitive impairment had worse perceived physical function (standardized parameter estimate [β]=-0.15, P=.02), even after adjusting for depressive symptoms (β=-0.31, P<.001), prosthesis satisfaction (β=0.34, P<.001), number of chronic conditions (β=-0.19, P=.006), and assistive device use (βcane=0.01, P=.93; βother=-0.20, P=.003). Together, these variables explained 59% of perceived physical function variability. CONCLUSIONS: Cognitive impairment is common and associated with worse perceived physical function post LLA, even after controlling for physical and mental health differences. Tailored rehabilitation interventions may be needed to improve perceived physical function in prosthesis users with cognitive impairment.

Prior studies have described positive behavioral, emotional, and social responses to dolls in persons with dementia (PWD), but most have examined formal doll therapy in institutional settings and primarily included women. This study describes two cases of spontaneous doll interactions in male veterans who were participating in a research study of a gentle group movement program at an adult day center. A doll was present at the study site, and two participants chose to interact with it. Researchers analyzed class videos and thematically coded behavioral, emotional, and social responses to the doll. Mr. B was a 90-year-old World War II-era veteran with moderate Alzheimers disease. Behavioral responses (n = 83) toward the doll included gazing, holding, and caressing. Emotional responses (n = 46) included chuckles, smiles, and laughter. Social responses (n = 59) involved conversations about the doll in which his ability to communicate verbally was markedly improved. Mr. C was a 68-year-old Vietnam veteran with mild Lewy body dementia. He also exhibited frequent behavioral (n = 10), social (n = 11) and emotional (n = 8) responses toward the doll. In addition, he reported having an intense, cathartic dream about the doll, crying it brings me back to holding my son or my daughter. These case studies add to the literature supporting the benefits of doll use by PWD by describing the effects of spontaneous doll use in two male veterans. Results suggest that having dolls available and providing a nonjudgmental environment where doll use is encouraged and supported may have profound beneficial effects to diverse populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background

Indigenous peoples in Canada have higher prevalence of modifiable risk factors for Alzheimer's disease (AD). The relative importance of these risk factors on AD risk management is poorly understood.

Methods

Relative risks from literature and prevalence of risk factors from Statistics Canada or the First Nations Regional Health Survey were used to determine projected population attributable risk (PAR) associated with modifiable risk factors for AD (low education and vascular risk factors) among on- and off-reserve Indigenous and non-Indigenous people in Canada using the Levin formula.

Results

Physical inactivity had the highest PAR for AD among Indigenous and non-Indigenous peoples in Canada (32.5% [10.1%-51.1%] and 30.5% [9.2%-48.8%] respectively). The PAR for most modifiable risk factors was higher among Indigenous peoples in Canada, particularly among on-reserve groups. The greatest differences in PAR were for low educational attainment and smoking, which were approximately 10% higher among Indigenous peoples in Canada. The combined PAR for AD for all six modifiable risk factors was 79.6% among on-reserve Indigenous, 74.9% among off-reserve Indigenous, and 67.1% among non-Indigenous peoples in Canada. (All differences significant to p < .001.).

Conclusions

Modifiable risk factors are responsible for the most AD cases among Indigenous peoples in Canada. Further research is necessary to determine the prevalence of AD and the impact of risk factor modification among Indigenous peoples in Canada.

Objectives

To examine post-traumatic stress disorder (PTSD) symptoms in older jail inmates, and to determine whether adverse social and health-related characteristics were associated with having PTSD symptoms.

Method

We performed an exploratory cross-sectional study of 238 older (age ≥55 years) jail inmates from a county jail. PTSD symptoms were determined using the Primary Care PTSD (PC-PTSD) screen. Reporting three or more PTSD symptoms was defined as a positive screen. Descriptive statistics and multiple regression analyses were used to examine the prevalence of a positive PTSD screen and associations with social and health-related characteristics.

Results

The mean age was 59 years, 64% were Black, and 82% reported an annual income ≤$15,000. Nearly 40% of older jail inmates had a positive PTSD screen and 10% reported a prior PTSD diagnosis by a physician. Older jail inmates with a positive PTSD screen were significantly more likely than those with a negative PTSD screen to report medication insecurity in the past year, impairment in two or more activities of daily living, traumatic brain injury, pain in the past week, and poor self-rated health.

Conclusion

Over one in three of the older jail inmates in this study had a positive PTSD screen, though only one in five of those with a positive screen reported a prior PTSD diagnosis. Screening for PTSD in jails may help identify older inmates who would benefit from additional mental health treatment and reentry planning to improve health in this population.