Cognitive Benefit of a Multidomain Intervention for Older Adults at Risk of Cognitive Decline: A Cluster-Randomized Controlled Trial.

OBJECTIVE: We sought to assess cognitive benefits of a community-based multidomain intervention for improving cognition among older adults at risk of cognitive decline (COMBAT). DESIGN: A two-armed cluster-randomized controlled trial. SETTING AND PARTICIPANTS: Community-dwelling older adults aged 60 years or older and were at risk of cognitive decline (n = 209). INTERVENTION: In this 9-month intervention study, 10 community hospitals in Beijing, China, were randomized (1:1) to receive either a multidomain intervention of meditation, cognitive training, exercise, and nutrition counseling or usual care. The intervention was delivered with weekly 1-hour group training sessions and weekly home homework. MEASUREMENTS: Primary outcome was change in cognition as measured by a composite Z score of seven cognitive tests. Secondary outcomes included subjective cognitive abilities, positive and negative affective experiences, physical activity, and dietary habits. Assessments were administered at baseline, end of the intervention, and 1 year after completing the intervention (1-year follow-up). RESULTS: Immediately after the intervention, the intervention group showed significant enhancement in cognitive performance (p = 0.026). The between-group difference in the Z score of change of cognition was 0.20 (95% CI: 0.053, 0.35), with a Hedges' g of 0.40 (95% CI: 0.29, 0.50). However, this cognitive benefit was not significant at 1-year follow-up. CONCLUSION: This multidomain intervention was effective to improve cognition for at-risk individuals. Long-term effects on cognitive function and individual differences in response to the intervention deserve further investigation.

Emotional and Behavioral Changes in Older Adults With High Risk of Cognitive Impairment During the COVID-19 Pandemic.

COVID-19 is not only a threat to physical health but also a stressor to mental health, particularly for older adults. Previous studies have indicated that healthy older adults have resilience to cope with such stressful event through emotional and behavioral effort. However, very few have investigated the coping ability of older adults with High Risk of Cognitive Impairment (HRCI), as they are characterized with risk factors that can make them more vulnerable to COVID-19 in both physical and mental aspects. To examine whether older adults with HRCI were able to cope with and recover from the outbreak of COVID-19, we investigated the changes of their self-reported emotional states and intentions of taking protective behaviors between the outbreak period (data collected from February 17th to 24th, 2020) and the remission period (data collected from April 7th to 20th, 2020). The results showed that compared with the outbreak period, older adults with HRCI showed better emotional states and higher levels of intention to take more protective behaviors during the remission period. Subgroup analysis showed that even those who showed relatively poor coping abilities during the outbreak period could gradually improve their emotional states and intend to take more protective behaviors later on in the remission period. Therefore, these results suggested that older adults with HRCI were able to cope with and recover from the pandemic outbreak.

The Longitudinal Association Between Cardiovascular Risk and Cognitive Function in Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study.

Objective: China has the largest population living with dementia, causing a tremendous burden on the aging society. Cardiovascular disease (CVD) may trigger a cascade of pathologies associated with cognitive aging. We aim to investigate the association between cardiovascular risk (CVR) factors and cognitive function in the nationally representative cohort in China. Methods: Participants were recruited from 150 counties in 28 provinces via a four-stage sampling method. The outcomes included several cognitive tasks. The independent variable was a composite score of cardiovascular risk calculated from sex-specific equations. We fitted the time-lagged regression to model the association between CVR and cognition. Besides, we performed cross-group analyses to test for model invariance across sex and age. We thus constrained path coefficients to be equal across each grouping variable (e.g., sex) and compared the fit of this constrained model with an unconstrained model in which the path coefficients were allowed to vary by group. Results: A total of 3,799 participants were included in the final analyses. We found that the CVR had a negative linear association with global cognition (ß = -0.1, p < 0.01). Additionally, CVR had inverse linear associations with domain-specific measurements of memory and learning, calculation, orientation, and visual-spatial ability (all values of p < 0.01). Regarding sex and age moderation, males had a more pronounced association between higher CVR and worse general cognition, immediate recall, orientation, calculation, and visual-spatial ability (all values of p < 0.0001). In contrast, females exhibited a slightly larger negative association in delayed recall. Older participants (>65 years old) had a more pronounced association between higher CVR and worse calculation ability (p = 0.003). Conclusion: CVD are risk factors for lower global cognition and cognitive subdomains in middle-aged and older adults in China.

Posttraumatic Stress Disorder and Nonadherence to Treatment in People Living With HIV: A Systematic Review and Meta-analysis.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a commonly reported and serious complication among people living with HIV (PLWH). PTSD may significantly increase unintentional non-adherence to antiretroviral therapy. In this systematic review and meta-analysis, we aimed to pool the observational studies exploring the association between PTSD and medication adherence among PLWH. METHODS: Comprehensive searches were conducted in PubMed/Medline, Web of Science, PsycINFO, Google Scholar, and ProQuest to identify relevant articles and dissertations. A random effects meta-analysis with inverse variance weighting was used to summarize the odds ratio (OR) across studies. Meta-regression and subgroup analyses were also carried out to assess the moderation effects for potential factors. RESULTS: By synthesizing 12 studies comprising 2489 participants, the pooled odd ratio of non-adherence to antiretroviral therapy was 1.19 (95% confidential interval (CI), 1.03-1.37, p = 0.02). No significant publication bias was detected by Egger's test (Intercept = 0.842, p = 0.284). Factors moderating the association were mean age of participants, depression adjustment, and depression (all p < 0.05). CONCLUSIONS: This meta-analysis supports that PTSD is related to adherence in PLWH. The hypothesized mechanisms (avoidant behavior and cognitive impairment) underlying this association need further investigation. Overall, this study highlights that clinicians should thoughtfully integrate timely mental health intervention into routine care.

The Long-Term Efficacy of Working Memory Training in Healthy Older Adults: A Systematic Review and Meta-Analysis of 22 Randomized Controlled Trials.

OBJECTIVES: The long-lasting efficacy of working memory (WM) training has been a controversial and still ardently debated issue. In this meta-analysis, the authors explored the long-term effects of WM training in healthy older adults on WM subdomains and abilities outside the WM domain assessed in randomized controlled studies. METHOD: A systematic literature search of PubMed, Web of Science, PsycINFO, Cochrane Library, ProQuest, clinicaltrials.gov, and Google Scholar was conducted. Random-effects models were used to quantitatively synthesize the existing data. RESULTS: Twenty-two eligible studies were included in the meta-analysis. The mean participant age ranged from 63.77 to 80.1 years. The meta-synthesized long-term effects on updating were 0.45 (95% confidence interval = 0.253-0.648, <6 months: 0.395, 0.171-0.619, ≥6 months: 0.641, 0.223-1.058), on shifting, 0.447 (0.246-0.648, <6 months: 0.448, 0.146-0.75, ≥6 months: 0.446, 0.176-0.716); on inhibition, 0.387 (0.228-0.547, <6 months: 0.248, 0.013-0.484, ≥6 months: 0.504, 0.288-0.712); on maintenance, 0.486 (0.352-0.62, <6 months: 0.52, 0.279-0.761, ≥6 months: 0.471, 0.31-0.63). DISCUSSION: The results showed that WM training exerted robust long-term effects on enhancing the WM system and improving processing speed and reasoning in late adulthood. Future studies are needed to use different tasks of the same WM construct to evaluate the WM training benefits, to adopt more ecological tasks or tasks related to daily life, to improve the external validity of WM training, and to identify the optimal implementation strategy for WM training.

The ERP Effects of Combined Cognitive Training on Intention-Based and Stimulus-Based Actions in Older Chinese Adults.

Age-related decreases in action are caused by neuromuscular weakness and cognitive decline. Although physical interventions have been reported to have beneficial effects on cognitive function in older adults, whether cognitive training improves action-related function remains unclear. In this study, we investigated the effects of combined cognitive training on intention-based and stimulus-based actions in older adults using event-related potentials (ERPs). A total of 26 healthy older adults (16 in the training group and 10 in the control group) participated in the study. The training group received 16 sessions of cognitive training, including eight sessions of executive function training and eight sessions of memory strategy training. Before and after training, both groups of participants underwent cognitive assessments and ERP recordings during both the acquisition and test phases with a motor cognitive paradigm. During the acquisition phase, subjects were asked to press one of two keys, either using a self-selected (intention-based) method or based on the preceding stimulus (stimulus-based). During the test phase, subjects were asked to respond to the pre-cues with either congruent or incongruent tasks. Using ERP indices-including readiness potential, P3 and contingent negative variation to identify motor preparation, stimulus processing and interference effect, respectively-we revealed the effects of training on both intention-based and stimulus-based actions. The correlations were also computed between the improved cognitive performance and the ERP amplitudes. It was shown that the improved executive function might extend substantial benefits to both actions, whereas associative memory may be specifically related to the bidirectional action-effect association of intention-based action, although the training effect of memory was absent during the insufficient training hours. In sum, the present study provided empirical evidence demonstrating that action could benefit from cognitive training. CLINICAL TRIAL REGISTRATION: www.chictr.org.cn, identifier: ChiCTR-OON-16007793.