Informant-Reported Cognitive Decline and Activity Engagement across Four Years in a Community Sample.

BACKGROUND: Subtle age-related cognitive decline may be associated with the capacity to remain engaged in mental, physical, and social activities. Informant reports of cognitive decline potentially provide additional information to psychometric tests on change in everyday cognitive function relevant to activity engagement. OBJECTIVE: To investigate relations between decline in everyday cognitive function as assessed by informant report and activity engagement in community-dwelling older adults. METHODS: A sample of cognitively normal older adults was drawn from the 2 latest waves of the PATH Through Life Study (n = 1,391; mean age 74.5 ± 1.5, 48.4% female). PATH is a 16-year longitudinal cohort study set in the Canberra/Queanbeyan district, Australia. Assessments were carried out at baseline, and at 3 subsequent time-points 4 years apart. At wave-4, the IQCODE, an informant measure of 4-year cognitive decline was provided by a spouse, family member, or friend of each participant. Activity engagement was assessed by the abbreviated RIASEC Mental Activity List, self-reported frequency and duration of physical activity (Whitehall Questionnaire) and the Lubben Social Network Scale that assessed interaction with family/friends. Participants provided demographic information, self-reported health status (SF-12), and responses to the Goldberg Depression Scale. The Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test (CVLT) were used to measure objective 4-year cognitive change. Those with MMSE score of ≤27 were excluded. RESULTS: IQCODE score predicted disengagement from mental activities over 4 years in cognitively healthy adults (ß = -0.056, standard error [SE] = 0.019, p = 0.004). This association was robust to covariate control and change on the SDMT which was also significantly related to mental activity disengagement. In models adjusted for change scores on the SDMT and the CVLT, the IQCODE was associated with less physical (ß = -0.692, SE = 0.24, p = 0.004) and social engagement (ß -0.046, SE = 0.021, p = 0.032), but relationships were attenuated with the inclusion of covariates. CONCLUSION: Informant-reported cognitive decline in a non-clinical sample was linked to activities that support cognitive health. Associations were robust to adjustment for cognitive change scores. Utilising informant reports prior to the manifestation of clinically relevant decline may identify those who would benefit most from personalised activity interventions.

Ageism: we are our own worst enemy.

In 1969, Butler (1969) first coined the term "ageism" to confront "prejudice by one age group toward other age groups" (pp. 243). As with other "isms," such as racism and sexism, ageism leads to bigotry and discrimination, though it is a very distinct beast in that, for the most part, other "isms" refer to those different from ourselves: distinct, mutually exclusive, and impervious groups. Conversely, age is a fluid social construct in which we are all intimately bound as we move through the lifespan, transitioning in and out of different age-groups. Unlike other "isms," individuals negotiate shifts from the "in-group" of youth to the "out-group" of old age. Yet we are all immersed, largely unconsciously, in this ubiquitous but too often unrecognized "ism" that needs to be named and challenged.

Concurrent lifestyle risk factors: Clusters and determinants in an Australian sample.

OBJECTIVE: To examine clustering among three major lifestyle risk factors for chronic disease (smoking, alcohol, and physical inactivity) and define sociodemographic subgroups with elevated risks of multiple lifestyle risk factors. METHOD: Data on 6052 adults aged 28-32, 48-52, and 68-72 from wave 3 (2007-2010) of the PATH Through Life Cohort Study, Australia, were used to estimate prevalence of individual and combinations of risk factors, and multinomial regression analysis undertaken to examine demographic factors associated with number of risks. RESULTS: Clustering of risks varied by age and gender, with more people than expected having none or all of the risk factors. Smoking clustered with harmful alcohol use, as well as physical inactivity. No relationship was observed between physical inactivity and alcohol use. Several sociodemographic characteristics were associated with the number of lifestyle risk factors including partner status, gender, age, education, and physical and mental health related quality of life. CONCLUSIONS: The tendency for lifestyle risk factors to aggregate in different subgroups has meaningful implications for health promotion strategies. Better insight in the more vulnerable subpopulations that are at higher risk of displaying multiple lifestyle risk factors is of importance if we wish to reduce the population propensity for chronic disease.

The Impact of Age Stereotypes on Older Adults' Hazard Perception Performance and Driving Confidence.

This study examined the effect of age-stereotype threat on older adults' performance on a task measuring hazard perception performance in driving. The impact of age-stereotype threat in relation to the value participants placed on driving and pre- and post-task confidence in driving ability was also investigated. Eighty-six adults aged from 65 years of age completed a questionnaire measuring demographic information, driving experience, self-rated health, driving importance, and driving confidence. Prior to undertaking a timed hazard perception task, participants were exposed to either negative or positive age stereotypes. Results showed that age-stereotype threats, while not influencing hazard perception performance, significantly reduced post-driving confidence compared with pre-driving confidence for those in the negative prime condition. This finding builds on the literature that has found that stereotype-based influences cannot simply be understood in terms of performance outcomes alone and may be relevant to factors affected by confidence such as driving cessation decisions.

Association of cognitive function with glucose tolerance and trajectories of glucose tolerance over 12 years in the AusDiab study.

INTRODUCTION: We investigated the association between glucose tolerance status and trajectories of change in blood glucose, and cognitive function in adults aged 25 to 85. METHODS: The sample (n = 4547) was drawn from a national, population-based cohort study in Australia (AusDiab). Fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) and general health were assessed at 0, 5 and 12 years. Covariates included age, education, body mass index, blood pressure and physical activity. At 12 years, participants completed assessments of memory, processing speed and verbal ability. RESULTS: Known diabetes at baseline was associated with slower processing speed at 12 years in both younger (25-59 years) and older (>60 years) age-groups. After 12 years of follow-up, adults aged < 60 with diabetes at baseline had a mean speed score of 49.17 (SE = 1.09) compared with 52.39 (SE = 0.20) in normals. Among younger males without diagnosed diabetes, reduced memory at 12 years was associated with higher HbA1c at 5 years (ß = -0.91, SE = 0.26, p < 0.001). No effects were apparent for females or older males. Adjusting for insulin sensitivity (HOMA-%S) and hs-C reactive protein attenuated these associations, but depression and CVD risk did not. Latent class analysis was used to analyse the associations between trajectories of HbA1C and glucose over 12 years, and cognition. Identified classes were described as 1) normal and stable blood glucose over time (reference), 2) high intercept but stable blood glucose over time, and 3) increasing blood glucose over time. In both young males and females, high stable glucose measures were associated with poorer cognitive function after 12 years. CONCLUSION: Those with type 2 diabetes, younger males with high non-diabetic HbA1c, and adults with high stable blood glucose are at increased risk of poorer cognition. The findings reinforce the need for management of diabetes risk factors in midlife.

A qualitative study of older and middle-aged adults' perception and attitudes towards dementia and dementia risk reduction.

AIM: To investigate perceptions of dementia and dementia risk reduction held by people without dementia. BACKGROUND: Dementia does not only affect individuals with dementia, but also has an impact on family and friends, society and healthcare professionals. Recent research has identified modifiable risk and protective factors for dementia. However, it is unclear what knowledge people without dementia have about these risk factors and their attitudes towards addressing these risk factors to achieve dementia risk reduction are not known. DESIGN: Qualitative descriptive study using focus group methodology. METHOD: A focus group study was conducted in February 2011 with 34 older adults aged between 52-90 years. The long-table approach was used to identify themes and categorize data on dementia knowledge, risk and attitudes. FINDINGS: Participants correctly identified dementia risk factors as a group. Participants' responses about their perceived likelihood of developing dementia could be classified into three distinctive themes; fear, rational and cynical perceptions. Both fear of developing dementia and the need to improve dementia knowledge were considered major motivators towards adopting healthier lifestyle and health behaviours. Lack of knowledge on risk factors for dementia was identified as a major barrier for behavioural and lifestyle change. CONCLUSION: These findings can be used to develop effective and personalized interventions that increase motivators and reduce barriers by tailoring interventions to individual's dementia risk reduction literacy and motivations to change behaviours. Greater public-health promotion and education about risk and protective factors for dementia are also necessary to increase dementia health literacy and to reduce overall dementia prevalence.

An Australian survey of cognitive health beliefs, intentions, and behaviours through the adult life course.

OBJECTIVE: Information is required regarding cognitive health beliefs and behaviours from across the life in order to inform the design of interventions to optimise cognitive health and reduce the risk of cognitive impairment. METHODS: A survey of Australian adults aged 20-89 was administered via Computer Assisted Telephone Interviewing (CATI) software to respondents recruited by random digit dialling (N = 900). Socio-demographic and self-reported health information was collected to investigate associations with cognitive health responses. RESULTS: Alcohol abuse was nominated by the highest proportion of respondents (34.3%) as detrimental for brain health. Fewer than 5% nominated elevated cholesterol, blood pressure, obesity, poor education, or ageing. The most frequently endorsed protective activity was socialising (70%). Socio-demographic factors predicted responses. Age-group differences were apparent in the proportions nominating alcohol (X(2) = 24.2; p < .001), drugs (X(2) = 56.8; p < .001), smoking (X(2) = 13.1; p = .001), nutrition (X(2) = 20.4; p < .001), and mental activity (X(2) = 12.8; p = .002) as relevant to brain health. Activities undertaken for cognitive benefit also differed by age. Across all ages the perceived benefit of activities was not supported by intentions to undertake activities. CONCLUSIONS: Interventions are needed to inform and motivate people across the life-course to undertake behaviours specifically to optimise their cognitive health.

The relationship between age-stereotypes and health locus of control across adult age-groups.

OBJECTIVE: This study integrates healthy ageing and health psychology theories to explore the mechanisms underlying the relationship between health control expectancies and age-attitudes on the process of ageing well. Specifically, the aim of this study is to investigate the relationship between age-stereotypes and health locus of control. DESIGN: A population-based survey of 739 adults aged 20-97 years (mean = 57.3 years, SD = 13.66; 42% female) explored attitudes towards ageing and health attitudes. A path-analytical approach was used to investigate moderating effects of age and gender. RESULTS: Higher age-stereotype endorsement was associated with higher chance (ß = 2.91, p < .001) and powerful other (ß = 1.07, p = .012) health expectancies, after controlling for age, gender, education and self-rated health. Significant age and gender interactions were found to influence the relationship between age-stereotypes and internal health locus of control. CONCLUSION: Our findings suggest that the relationship between age-stereotypes and health locus of control dimensions must be considered within the context of age and gender. The findings point to the importance of targeting health promotion and interventions through addressing negative age-attitudes.

Hippocampal atrophy is associated with subjective memory decline: The PATH Through Life study.

OBJECTIVE: To investigate whether subjective memory decline (SMD) in cognitively healthy individuals is associated with hippocampal atrophy. METHODS: Multiple regression analyses assessing the relationship between hippocampal atrophy over 4 years and SMD at baseline and follow-up in 305 cognitively healthy individuals aged 60-64 years free from dementia, mild cognitive impairment, and other neurological disorders. RESULTS: SMD at baseline was not a significant predictor of hippocampal atrophy. However, SMD at follow-up was associated with greater hippocampal atrophy. Associations were reduced but remained significant after controlling for anxiety and depression symptomatology. CONCLUSION: Hippocampal atrophy was associated with incident/persisting SMD and this association was not, or only partly, explained by anxiety and depression symptomatology. These results are consistent with a biological origin to subjective memory decline. SMD should be included in screening and neuropsychological batteries.

Self-Reported History of Chemotherapy and Cognitive Decline in Adults Aged 60 and Older: The PATH Through Life Project.

BACKGROUND: There is a lack of data from cohort studies assessing cognitive function prior to and after chemotherapy. We evaluated the effect of self-reported cancer chemotherapy on cognitive function in a cohort assessed at baseline, 4 and 8 years. METHODS: Participants were from the population-based PATH Through Life Study. Of the 2,551 participants aged 60-64 at baseline without cognitive impairment, 1,949 completed wave 3 and had data on cancer and chemotherapy and cognitive function. Linear mixed models were used to analyze the data. RESULTS: At wave 3, participants reporting history of chemotherapy (n = 76) had lower scores on memory, processing speed, and executive function compared with those reporting cancer without chemotherapy (n = 289) and no cancer history (n = 1508). After adjustment for depression and disability, effects remained for processing speed and memory. Chemotherapy prior to the study commencement (n = 24), but not between waves 1 and 3 (n = 81), was associated with greater decline in delayed recall (ß = -.21 [95% CI -0.38, -.03], p = .02) and digits backwards ß = -.05 [95% CI -0.09, -.01], p = .02) over 8 years compared with those with no cancer history (n = 1562). Women reporting chemotherapy for breast cancer after wave 1 (n = 26) had slower choice reaction time (-0.81 (95% CI -1.28, -0.34), p = .001) but did not decline faster on this measure compared with those reporting no breast cancer history (n = 818). CONCLUSIONS: Results suggest chemotherapy prior to old age is associated with faster decline in memory in late life but that it does not affect decline in other domains of cognitive function.

Role of physical activity in the relationship between mastery and functional health.

PURPOSE OF THE STUDY: To examine the influence of mastery, physical activity levels, and subsequent trajectories of domains of functional health across the adult life course. DESIGN AND METHODS: We examined 8-year trajectories of physical functioning (handgrip strength) and functional health (physical [RAND PHC12], psychological [RAND MHC12], and cognitive [processing speed]) in a large Australian sample (n = 7,485 at baseline) of 3 cohorts (20-24, 40-44, and 60-64 years). Within- and between-person indirect effects of physical activity on the relationship between mastery and health were examined using multilevel structural equation models. RESULTS: Mastery was positively related to within-person change in physical and psychological health for all cohorts, and processing speed for the 60s. Between-person mastery was positively associated with all health domains across all cohorts. Physical activity indirectly influenced the between-person relationships between mastery and handgrip strength, physical health, and psychological health in all cohorts, and between mastery and processing speed for the 60s. IMPLICATIONS: Psychological resources are important mechanisms for functional health as they may drive adaptive behaviors such as physical activity. The within-person association connecting mastery with physical and psychological health trajectories provides promise for interventions that foster or improve a sense of mastery. The findings contribute to the understanding of complex relationships between personal resources and behaviors that aid in successful aging across the life span.

Development of the motivation to change lifestyle and health behaviours for dementia risk reduction scale.

BACKGROUND AND AIMS: It is not yet understood how attitudes concerning dementia risk may affect motivation to change health behaviours and lifestyle. This study was designed to develop a reliable and valid theory-based measure to understand beliefs underpinning the lifestyle and health behavioural changes needed for dementia risk reduction. METHODS: 617 participants aged ≥50 years completed a theory-based questionnaire, namely, the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale. The MCLHB-DRR consists of 53 items, reflecting seven subscales of the Health Belief Model. RESULTS: Confirmatory factor analysis was performed and revealed that a seven-factor solution with 27 items fitted the data (comparative fit index = 0.920, root-mean-square error of approximation = 0.047) better than the original 53 items. Internal reliability (α = 0.608-0.864) and test-retest reliability (α = 0.552-0.776) were moderate to high. Measurement of invariance across gender and age was also demonstrated. CONCLUSIONS: These results propose that the MCLHB-DRR is a useful tool in assessing the beliefs and attitudes of males and females aged ≥50 years towards dementia risk reduction. This measure can be used in the development and evaluation of interventions aimed at dementia prevention.

Gender differences in alcohol consumption among middle-aged and older adults in Australia, the United States and Korea.

OBJECTIVES: To compare gender differences in alcohol use and the socioeconomic correlates of at-risk drinking among middle-aged and older adults in Australia, the United States (US) and South Korea. METHOD: Data were drawn from large nationally representative surveys of people aged 45 years and older, collected in 2006. RESULTS: Rates of any drinking and at-risk drinking (>14 US standard drinks/week) were higher for males than females in all countries and these gender differences were largest in Korea. Socioeconomic differentials for at-risk drinking varied by country and gender. In the US, at-risk drinking was associated with lower educational levels among men, but higher educational levels among women; in Korea, it was associated with being unpartnered, particularly for women; and in Australia, at-risk drinking was associated with higher income. CONCLUSIONS: Gender-role expectations differ between countries and may influence both the levels at which older adults consume alcohol and the ways in which at-risk drinking is associated with socioeconomic factors. IMPLICATIONS: Heavy alcohol use in middle-aged and older adults is a cause for concern. Health promotion strategies should target older age groups and consider the ways in which gender, marital status and education influence norms and opportunities for risky alcohol use.

An examination of the effects of intra and inter-individual changes in wellbeing and mental health on self-rated health in a population study of middle and older-aged adults.

PURPOSE: Self-rated health is frequently used as an indicator of health and quality of life in epidemiological studies. While the association between self-rated health and negative mental health is well established, associations with indictors of positive wellbeing are less clear. Data from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project were used to compare the effects of vitality and mental health on self-rated health. METHODS: Participants (n = 40,712) provided information on vitality, mental health and self-rated health, were aged 45-95 years at baseline, and were followed between 1 and 10 years (M = 5.6; SD = 2.9). RESULTS: In comparison with mental health, multi-level modelling indicated between- and within-person change in vitality was more strongly associated with self-rated health. Bivariate dual change score modelling of the cross-lagged associations between vitality and self-rated health indicated vitality to be a stronger predictor of change in self-rated health. Self-rated health was unrelated to change in vitality. CONCLUSION: Vitality accounted for most of the mental health effect on self-rated health and was identified as a significant predictor of change in self-rated health over a 10-year period. Promoting wellbeing and psychological functioning may have significant protective effects on negative health outcomes throughout the adult lifespan and into late life.

Cognitive development over 8 years in midlife and its association with cardiovascular risk factors.

OBJECTIVE: We describe population-level cognitive development in early middle-age and evaluate whether cardiovascular risk factors for late-onset dementia influence cognitive change in midlife. METHOD: The sample from the PATH Through Life (PATH) Project (N = 2,530; 40-44 years of age at baseline) was drawn randomly from the community, followed for 8 years, and assessed on cognitive function, health, and lifestyle risk factors at 4 yearly intervals. A summary risk score (PATHrisk) was computed for presence of smoking, hypertension, depression, high body mass index, diabetes, and insufficient physical activity. RESULTS: Decline in processing speed and reaction time (RT) and improvement in memory and verbal ability were observed. Higher PATHrisk score was associated with poorer performance on all cognitive tests, except for RT. Participants with higher PATHrisk scores had greater slowing on choice RT over 8 years. Education was associated with cognitive test performance and was weakly protective against slowing of RT. Individual risk factors, primarily diabetes, smoking, and depression, were associated with cognitive function, and smoking was associated with decline in simple RT. CONCLUSION: Reliable change in cognitive function was detected in midlife, and decline occurred primarily in measures of cognitive speed. It appears that in midlife, the overall burden of cardiovascular risk factors is more important than individual risk factors. Midlife is a critical period for identifying modifiable risk factors for dementia in late-life, and evaluation of burden of risk factors is indicated for developing strategies to prevent cognitive decline in ageing.

The effect of health behavior change on self-rated health across the adult life course: a longitudinal cohort study.

OBJECTIVE: While it is clear that health behaviors are related to self-rated health (SRH), it is less clear if maintaining positive behaviors, or improving, can protect SRH over time. METHOD: SRH trajectories were modeled in a large representative Australian sample (n=7485 at baseline), of three age cohorts (20-24, 40-44 and 60-64 years at baseline; 1999, 2000 & 2001 respectively), over an 8 year period. Change in smoking, alcohol consumption and physical activity on SRH trajectories were examined, controlling for demographic, physical and mental health factors. RESULTS: SRH became poorer over time across the sample. Being a non-smoker was associated with more positive SRH levels across all groups. Maintaining or increasing moderate physical activity was associated with less decline in SRH. CONCLUSIONS: Findings highlight the benefits of positive health behaviors, particularly performing regular physical activity over time, for reducing the risk of subjective health becoming poorer across the adult life course.

Longitudinal change of self-perceptions of aging and mortality.

OBJECTIVE: To understand the association between self-perceptions of aging (SPA) and mortality in late life. Method. The sample (n = 1,507) was drawn from the Australian Longitudinal Study of Aging (baseline age = 65-103 years). We used joint growth curve and survival models on 5 waves of data for a period of 16 years to investigate the random intercept and slope of SPA for predicting all-cause mortality. RESULTS: The unadjusted model revealed that poor SPA at baseline, as well as decline in SPA, increased the risk of mortality (SPA intercept hazard ratio [HR] = 1.21, 95% confidence interval [CI] = 1.13, 1.31; SPA slope HR = 1.17, 95% CI = 1.02, 1.33). This relationship remained significant for the SPA intercept after adjusting for other risk factors including demographics, physical health, cognitive functioning, and well-being. CONCLUSION: These findings suggest that a single measurement of SPA in late life may be very informative of future long-term vulnerability to health decline and mortality. Furthermore, a dynamic measure of SPA may be indicative of adaptation to age-related changes. This supports a "self-fulfilling" hypothesis, whereby SPA is a lens through which age-related changes are interpreted, and these interpretations can affect future health and health behaviors.

Measuring anxiety about aging across the adult lifespan.

BACKGROUND: The development of instruments to measure aging attitudes is an essential part of research into the role of individual differences in the aging process, giving clarification to the relationship between attitudes and behavior across the lifespan. Here we test the structural validity of Lasher and Faulkender's (1993) Anxiety about Aging Scale (AAS), and explore measurement invariance across age and gender. METHODS: A sample of 783 adults (42% females) age ranging from 20 to 97 years (M = 57.3, SD = 13.66) participated. RESULTS: The first-order four-factor AAS model reflecting the original Lasher and Faulkender (1993) structure showed a better fit to the data than the second-order model. Measurement invariance for both gender and age groups (young adults 20-44 years; mid-aged adults 45-64 years, older adults 65+ years old) was found for three of the factors, but not for all items in the Fear of Losses factor. Structural covariance inequality between the Fear of Losses and Physical Appearance factors was shown between males and females. CONCLUSIONS: Findings indicate that the original AAS measures four distinct dimensions of anxiety about aging. These dimensions were shown to be generally comparable across age and gender, indicating that the AAS is a suitable measure for providing meaningful comparison of anxiety about aging across the lifespan. The exception is the Fear of Losses factor, where items may have differential meanings across groups based on cultural and social attitudes regarding aging and gender.

Characterizing mild cognitive disorders in the young-old over 8 years: prevalence, estimated incidence, stability of diagnosis, and impact on IADLs.

OBJECTIVES: Few studies report incidence of mild cognitive impairment (MCI) and other mild cognitive disorders (MCD) in cohorts in their 60s, at an age when diagnoses are less stable. The authors' goal was to estimate the incidence and prevalence of MCI and MCD, characterize subgroups with stable vs nonstable diagnoses, and evaluate the impact of diagnosis on daily life in a young-old cohort. METHODS: A community-based cohort age 60 to 64 years in 1999 (n = 2551) was monitored for 8 years and assessed every 4 years. A two-stage sampling design was used to identify MCI and MCD through a neuropsychological and neurological assessment. A panel of physicians blind to previous diagnoses reviewed each case using published criteria. RESULTS: The prevalence of MCDs in the cohort aged 68 to 72 years at the last follow-up was approximately 10%. An estimated 141 subjects (7.7%) progressed to MCI and 183 subjects (10.0%) progressed to MCD between years 4 and 8. Only eight participants received a dementia diagnosis at any wave, five of whom progressed from MCDs. More than 45% of diagnoses were unstable during the 8 years of follow-up. Stable diagnoses were associated with lower Mini-Mental State Examination scores, history of neurological disorder, higher cardiovascular risk, and depression at baseline. MCDs were associated with impairments in instrumental activities of daily living and higher rates of reporting memory problems prior to diagnosis. CONCLUSIONS: MCDs in individuals in their 60s occur in at least 10% of the population and are likely to be heterogeneous in terms of their etiology and long-term prognosis, but may cause a significant impact in everyday life.