Reaction to a Pandemic: Social Distancing and Driving Among Older Adults During COVID-19.

Coronavirus disease 2019 (COVID-19) has produced considerable morbidity and mortality worldwide, and older adults are at especially high risk for developing severe COVID-19. A cohort study of driving behavior from January 1, 2019, to April 25, 2019, and January 1, 2020, to April 25, 2020, was conducted. We hypothesized that older adults would reduce the number of days driving and number of trips/day they make after COVID-19 case acceleration. Data from 214 adults aged 66.5 to 92.8 years were used. Women comprised 47.6% of the sample and 15.4% were African American. Participants reduced the proportion of days driven during the pandemic (.673 vs. .382 [p < .001]) compared with same period the year before (.695 vs. .749). Trips/day showed a similar decline (p < .001). Participants also took shorter trips (p = .02), drove slower (p < .001), had fewer speeding incidents (p < .001), and had different trip destinations (p < .001). These results indicate that older adults reduce their driving behavior when faced with a pandemic.

Evaluation of Naturalistic Driving Behavior Using In-Vehicle Monitoring Technology in Preclinical and Early Alzheimer's Disease.

Cognitive impairment is a significant risk factor for hazardous driving among older drivers with Alzheimer's dementia, but little is known about how the driving behavior of mildly symptomatic compares with those in the preclinical, asymptomatic phase of Alzheimer's disease (AD). This study utilized two in-car technologies to characterize driving behavior in symptomatic and preclinical AD. The goals of this pilot study were to (1) describe unsafe driving behaviors in individuals with symptomatic early AD using G-force triggered video capture and (2) compare the driving habits of these symptomatic AD drivers to two groups of cognitively normal drivers, those with and those without evidence of cerebral amyloidosis (CN/A+ and CN/A-) using a global positioning system (GPS) datalogger. Thirty-three drivers (aged 60+ years) were studied over 3 months. G-force triggered video events captured instances of near-misses/collisions, traffic violations, risky driver conduct, and driving fundamentals. GPS data were sampled every 30 s and all instances of speeding, hard braking, and sudden acceleration were recorded. For the early AD participants, video capture identified driving unbelted, late response, driving too fast for conditions, traffic violations, poor judgment, and not scanning intersections as the most frequently occurring safety errors. When evaluating driving using the GPS datalogger, hard breaking events occurred most frequently on a per trip basis across all three groups. The CN/A+ group had the lowest event rate across all three event types with lower instances of speeding. Slower psychomotor speed (Trail Making Part A) was associated with fewer speeding events, more hard acceleration events, and more overall events. GPS tracked instances of speeding were correlated with total number of video-captured near-collisions/collisions and driving fundamentals. Results demonstrate the utility of electronic monitoring to identify potentially unsafe driving events in symptomatic and preclinical AD. Results suggest that drivers with preclinical AD may compensate for early, subtle cognitive changes by driving more slowly and cautiously than healthy older drivers or those with cognitive impairment. Self-regulatory changes in driving behavior appear to occur in the preclinical phase of AD, but safety concerns may not arise until symptoms of cognitive impairment emerge and the ability to self-monitor declines.

Cognitive-behavioral therapy augmentation of SSRI reduces cortisol levels in older adults with generalized anxiety disorder: A randomized clinical trial.

OBJECTIVES: Elevated cortisol in stress and aging, such as has been seen in late-life anxiety disorders, is postulated to accelerate cognitive and physiological decline in this large and increasing population. Selective serotonin-reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) are both effective treatments for generalized anxiety disorder (GAD) in older adults. On the other hand, there is very little research examining the effect of combining these therapies on peak cortisol levels. For the current analyses, we examined the effectiveness of CBT augmentation on peak cortisol levels in older adults diagnosed with GAD. METHODS: The sample consisted of 42 individuals with late-life GAD who received an acute course of the SSRI escitalopram and then entered a 16-week randomized phase. Twenty-one participants were randomized to receive 16 sessions of CBT in addition to continuing escitalopram and the remaining 21 participants continued on escitalopram without CBT. Generalized estimating equations were performed to assess the effectiveness of CBT augmentation on peak cortisol levels (30 min after waking). RESULTS: Older adults with GAD who received both escitalopram and CBT demonstrated a significant reduction in peak cortisol levels at posttreatment compared to the group who received escitalopram without CBT augmentation. CONCLUSIONS: CBT augmentation of SSRI treatment reduced peak cortisol levels for older adults with GAD. Since persistently high cortisol levels in aging are thought to increase age-related cognitive and medical problems, our findings suggest that there may be a benefit to health and cognition of CBT augmentation for late-life anxiety disorders.

Association of cortisol with neuropsychological assessment in older adults with generalized anxiety disorder.

OBJECTIVES: Older adults with generalized anxiety disorder (GAD) have elevated diurnal cortisol patterns and show an increased cortisol stress response, which may increase risk for cognitive dysfunction. The current secondary data analysis examined how neuropsychological assessment as a possible laboratory stressor affects cortisol levels in late-life GAD and, in turn, how cortisol levels affect cognitive performance. METHODS: The current sample consisted of 69 individuals with late-life GAD and 39 psychiatrically healthy group-matched comparison participants. Cognitive performance was measured with a neuropsychological battery and salivary cortisol was collected at several time points. Hierarchical regressions were performed to assess the moderating role of cortisol in the relationship between GAD status and cognitive performance. RESULTS: The results revealed that older adults with GAD showed significantly lower cortisol levels during neuropsychological assessment, compared to their baseline levels. Further, there was a significant interaction between post-neuropsychological assessment cortisol levels and GAD status on several measures of cognitive performance. The interaction indicated that there is a significant negative relationship between cortisol level and cognitive performance in the GAD participants and no such relationship in the comparison participants. CONCLUSIONS: Our results revealed that participating in a neuropsychological assessment was associated with reduced cortisol in GAD participants, suggesting that refocusing attention such as engaging in cognitive tasks had a cortisol-lowering effect. Further, a higher cortisol level appears to have a detrimental effect on cognitive performance for individuals with GAD, but not psychiatrically healthy comparison participants. The methodological and treatment implications of these findings are discussed.

Functional prediction of binding pockets.

Putative function for targets with no known ligands has typically been determined from liganded homologous proteins using sequence and structure comparisons. However, it is debatable what percentage of sequence identity implies similar function, whereas structural similarity is focused on global folds and could miss divergent structures and novel global folds. The present study describes an approach to classify a diverse set of proteins and predict their function. Descriptors corresponding to structural, physicochemical, and geometric properties of the ligand-binding cavities of a collection of 434 complexes (17 protein families) were calculated and analyzed by statistical methods. The best model using discriminant function analysis (DFA) consisted of 371 proteins (15 families) and had correct classification rates of 90% and cross-validation 86%. DFA with one protein and a random sample of the remaining proteins led to 100% correct prediction of putative protein function for 10 of the 15 protein families.

Associations between cognitive function and naturally occurring daily cortisol during middle adulthood: timing is everything.

OBJECTIVES: We examined associations between cognitive function (CF) and the naturally occurring daily cortisol levels using data from the Midlife in the United States survey and the National Study of Daily Experiences. METHODS: A national sample of 1,500 (mean age = 57 years; range = 33-84, 56% female) completed a phone-based battery of cognitive tasks and 3-6 months later provided saliva samples upon waking, 30 min after waking, at lunch time, and at bedtime on 4 consecutive days. RESULTS: Higher CF, particularly executive function, was associated with healthier daily cortisol profiles, including a steeper diurnal cortisol slope, higher morning cortisol levels, and lower afternoon and evening cortisol levels. DISCUSSION: The results indicate that better CF is associated with healthier profiles of naturally occurring cortisol and underscore the importance of the timing of cortisol sampling.

Fluid cognitive ability is associated with greater exposure and smaller reactions to daily stressors.

The authors of this study investigated whether fluid cognitive ability predicts exposure and emotional reactivity to daily stressors. A national sample of adults from the Midlife in the United States study and the National Study of Daily Experiences (N = 1,202) who had a mean age of 57 years (SD = 12; 56% women, 44% men) completed positive and negative mood reports as well as a stressor diary on 8 consecutive evenings via telephone. Participants also completed a telephone-based battery of tests measuring fluid cognitive ability. Higher levels of fluid cognitive ability were associated with greater exposure to work- and home-related overload stressors. Possessing higher levels of fluid cognitive ability was associated with smaller stressor-related increases in negative mood, primarily for interpersonal tensions and network stressors, and smaller stressor-related decreases in positive mood for interpersonal tensions. Furthermore, fluid cognitive ability was unrelated to subjective severity ratings of the stressors reported. Discussion focuses on the role of fluid cognitive ability in daily stress processes.

The effect of spousal bereavement on cognitive functioning in a sample of older adults.

OBJECTIVE: This study examined the association between bereavement and cross-sectional differences in cognitive performance in a sample of older adults. METHODS: Secondary cross-sectional data analysis was conducted on 211 participants from the MacArthur Battery dataset. Participants completed several cognitive tasks 6-months post-loss. RESULTS: Hierarchical multiple regression results suggested that bereavement status was not associated with cognitive performance. However, the effect of bereavement on memory (immediate and delayed story recall) performance was moderated by age and gender where the younger participants and men who were bereaved performed worse compared to their non-bereaved counterparts. DISCUSSION: Our results support the finding that bereavement is associated with poorer memory performance within certain subgroups (i.e., men and younger participants). We discuss findings in light of theories of stress and cognitive aging.

Negative life events and cognitive performance in a population of older adults.

OBJECTIVE: This study examined the association between negative life events in the past year and cognitive performance in a population of older adults. METHODS: Secondary data analysis was conducted on 428 participants from the Charlotte County Healthy Aging Study. Participants completed tests of episodic memory, attention, and psychomotor speed and endorsed the presence and severity of 24 life events. Life events were examined in the aggregate as well as individually. RESULTS: Hierarchical multiple regression results suggest no significant relationship between the aggregate frequency and severity measures of negative life events and cognitive performance. At the individual-event level, individuals who experienced the injury or illness of a friend during the past year and rated it as having more of an effect on their lives performed better on all three cognitive tasks. However, individuals who reported having less money to live on over the past year and rated the event as having more of an effect on their lives performed more poorly on the psychomotor speed tasks. DISCUSSION: The findings support previous research indicating that using estimates of individual stressors rather than aggregate stress measures increases the predictive validity of stress measurement. Furthermore, the individual negative life events can have both a positive and a negative effect, which nullify one another when using the sum score of events.

Apolipoprotein E and cognitive performance: a meta-analysis.

The epsilon4 allele of the apolipoprotein E (APOE) gene is a known risk factor for Alzheimer's disease and may also affect cognitive performance in normal aging. Evidence of the presence and magnitude of epsilon4-related cognitive deficits was examined with a meta-analysis of the available literature. Thirty-eight studies were included, and cognitive performance was collapsed into 8 domains. Results indicated significant APOE-epsilon4 group differences for global cognitive functioning, episodic memory, and executive functioning, in favor of non-epsilon4 carriers. In addition, older age and APOE-epsilon4 heterozygosity was associated with smaller epsilon4-related impairments. The meta-analysis results suggest that APOE-epsilon4 genotype does affect cognitive performance in healthy aging, although the influence is relatively small and specific to certain domains of cognitive performance.

Thinking ahead: factors associated with executing advance directives.

This article examines why older adults do or do not execute advance directives. METHODS. Secondary data analysis was conducted on data from the Charlotte County (Florida) Healthy Aging Study, on 451 adults who were relatively healthy and affluent. Exploratory logistic regressions were conducted on the probability that respondents had executed advance directives. RESULTS. Findings indicated that increasing age and higher income were the most consistent indicators of having executed an advance directive. Also, individuals reporting taking more prescription medications were more likely to have all the advance directives, except the durable power of attorney for health care. Reporting more negative life events was predictive of having executed the durable power of attorney for health care. DISCUSSION. These findings suggest that in addition to awareness of advance directives, demographic, health, and situational factors may affect the willingness of older adults to execute advance directives. Further research should examine other, more representative, samples to confirm these findings.