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.

Developing context and background underlying cognitive intervention/training studies in older populations.

Underlying the attempt to change behavior or improve performance by virtue of intervention or training is the notion that change is possible and that plasticity, life-course malleability, and compensation are well-recognized concepts of life-span development. The cognition and aging literature reveals that there are a growing number of context and background variables against which the effectiveness of intervention/training can be judged beyond the intrinsic motivations for change. In this introductory article to a special issue on cognitive intervention and training, we briefly discuss several of these background variables.

Enhancing measurement in health outcomes research supported by Agencies within the US Department of Health and Human Services.

Many of the Institutes, Agencies and Centers that make up the US Department of Health and Human Services (DHHS) have recognized the need for better instrumentation in health outcomes research, and provide support, both internally and externally, for research utilizing advances in measurement theory and computer technology (informatics). In this paper, representatives from several DHHS agencies and institutes will discuss their need for better instruments within their discipline and describe current or future initiatives for exploring the benefits of these technologies. Together, the perspectives underscore the importance of developing valid, precise, and efficient measures to capture the full burden of disease and treatment on patients. Initiatives, like the Patient-Reported Outcomes Measurement Information System (PROMIS) to create health-related quality of life item banks, represent a trans-DHHS effort to develop a standard set of measures for informing decision making in clinical research, practice, and health policy.

Oxidation of serum low-density lipoprotein (LDL) and antioxidant status in young and elderly humans.

The incidence of atherosclerosis increases with age, as do various indices of free-radical mediated damage, e.g., lipid peroxidation. Because lipid peroxidation plays a prominent role in lipoprotein oxidation, likely a prelude to atherosclerosis, we compared the susceptibility of lipoproteins to oxidation in young (19-30 years) and elderly (59-86 years) groups. Although we found no significant differences in serum malondialdehyde (MDA) or oxidized LDL antibodies (OLAB) between young and elderly lipoproteins, MDA was directly related to OLAB regardless of age (r = 0.322, p = 0.005) and there was a trend for lower OLAB levels (30.5%, p = 0.079) in the elderly compared to the young population. Overall, serum antioxidant status was either similar or greater in the elderly group compared to the young group, likely reflecting antioxidant supplementation by the elderly group. OLAB was inversely related to Vitamin C (r = -0.310, p = 0.008) and Vitamin E intake (r = -0.277, p = 0.018) from foods and supplements. Serum levels of Vitamin C and Vitamin E were significantly higher (18.5%, p = 0.021 and 58.1 %, p < 0.001, respectively) in the elderly group compared to the young group and the ratio of Vitamin E to Vitamin C was significantly higher (30.4%, p = 0.042) in the serum of the elderly group. Oxidation of serum LDL and antioxidant status were not affected by age; however, the ratio of serum Vitamin E to Vitamin C was higher in the elderly group which may affect Vitamin E recycling.

Preliminary examination of cognitive reserve theory in closed head injury.

This investigation was designed to provide preliminary support for cognitive reserve theory in closed head injury (CHI), and demonstrate the effectiveness of using the Oklahoma premorbid intelligence estimate (OPIE) in research and clinical activities. Out of a possible 124 consecutive referrals, 26 patients (N=26) who underwent neuropsychological assessment following brain injury met study inclusion/exclusion criteria. Participants were included if they had exited post-traumatic amnesia (PTA), demonstrated uncompromised upper extremity use, displayed adequate verbal communication, and were judged capable of completing a full neuropsychological evaluation. Participants were divided into a closed head injury-negative premorbid history (CHI-) or closed head injury-positive premorbid history (CHI+) group based upon premorbid variables (e.g., history of alcoholism). Groups did not differ in terms of demographic variables or premorbid IQ. Despite having less severe head injuries, the CHI+ group had a greater pre-post difference for PIQ, and a significantly larger VIQ/PIQ discrepancy than the CHI- group. In conclusion, these findings suggest that the CHI+ group had diminished cognitive reserve secondary to the aggregate effects of premorbid insult, which resulted in greater cognitive decline following an additional stressor (i.e., CHI) than what might otherwise be expected from the head injury alone.

The influence of commercial-grade carpet on postural sway and balance strategy among older adults.

PURPOSE: The purpose of this research study was to examine the effect of a selected commercial-grade carpet on the static balance of healthy, older adults who had not fallen more than twice in the last 6 months. DESIGN AND METHODS: We tested a total of 45 participants. Each participant stood on a computerized balance machine and was subjected to a carpeted versus a noncarpeted condition while exposed to various sensory limitations. We measured both postural sway and balance strategy. RESULTS: The selected commercial-grade carpet did not affect postural sway. The participants were able to adapt to the sensory limitations regardless of whether they were standing on the carpet. Although balance strategy scores were significantly lower during the carpeted conditions, the clinical significance was questionable as the difference between the means was small for practical purposes. IMPLICATIONS: Healthy, older adults did not have difficulty maintaining static balance on the carpeted surface; however, the results could be different if participants who had a history of falling had been included. The results from this study are important and provide a basis of comparison for those individuals who have experienced more than two falls in the last 6 months or who have a history of falling.