Effects of Playback Theatre on cognitive function and quality of life in older adults in Singapore: A preliminary study.

OBJECTIVE: This study investigated the effects of Playback Theatre on older adults' cognitive function and well-being, specifically in the Singapore context. METHODS: Eighteen healthy older adults, older than 50 years of age, participated in the study. Due to practical limitations, a single-group pre-post study design was adopted. Participants completed the outcome measures before and after the training program. There were six weekly sessions in total (about 1.5 hours, once weekly). RESULTS: Participants experienced a significant improvement in their emotional well-being after training. However, there were no significant changes in participants' cognitive function or health-related quality of life. CONCLUSION: Our results suggest that Playback Theatre as a community program has potential to improve the mental and emotional well-being of older people.

Longitudinal brain structure and cognitive changes over 8 years in an East Asian cohort.

Although East Asia harbors the largest number of aging adults in the world, there is currently little data clarifying the longitudinal brain-cognition relationships in this group. Here, we report structural MRI and neuropsychological findings from relatively healthy Chinese older adults of the Singapore-Longitudinal Aging Brain Study cohort over 8 years of follow up (n=111, mean age=67.1 years, range=56.1-83.1 years at baseline). Aging-related change in structural volume was observed, with total cerebral atrophy at -0.56%/year, hippocampal atrophy at -0.94%/year and ventricular expansion at 3.56%/year. Only speed of processing showed an aging-related decline, while other cognitive domains were relatively maintained. Faster decline in global cognition was associated with total cerebral, hippocampal and gray matter volume losses over time. Faster total cerebral atrophy and white matter atrophy (frontal and parietal regions) was associated with faster decline in verbal memory. Hippocampal atrophy and ventricular expansion were both associated with greater decline in verbal memory and executive function. Our findings provide a benchmark for research on brain structural and cognitive changes with aging in East Asians.

Developing and validating a localised, self-training mindfulness programme for older Singaporean adults: effects on cognitive functioning and implications for healthcare.

There is a paucity of research available on the effect of mindfulness on cognitive function. However, the topic has recently gained more attention due to the ageing population in Singapore, catalysed by recent findings on brain function and cellular ageing. Recognising the potential benefits of practising mindfulness, we aimed to develop a localised, self-training mindfulness programme, guided by expert practitioners and usability testing, for older Singaporean adults. This was followed by a pilot study to examine the potential cognitive benefits and feasibility of this self-training programme for the cognitive function of older adults in Singapore. We found that the results from the pilot study were suggestive but inconclusive, and thus, merit further investigation.

Differential age-dependent associations of gray matter volume and white matter integrity with processing speed in healthy older adults.

Slower processing speed (PS), a highly robust feature of cognitive aging, is associated with white matter (WM) deterioration and gray matter volume (GMV) loss. Traditional linear regression models assume a constant relationship between brain structure and cognition over time. To probe for variation in the association between WM and GMV and PS over time, we used a novel sparse varying coefficient model on data collected from 126 relatively healthy older adults (67 females, aged 58-85years) evaluated with MRI and a standardized neuropsychological test-battery. We found that WM microstructural differences indexed by fractional anisotropy values in the fronto-striatal tracts (internal and external capsule) showed a stronger association with PS before the age of 70years. Contrastingly, GMV values of the left putamen and middle occipital gyrus were more strongly correlated with PS after 70years. Additionally, within GM and WM compartments, there was heterogeneity in the temporal sequence in which different cortical and subcortical elements were most strongly associated with PS. Together, these observations provide a more nuanced account of the relationships between different structural components of the aging brain and processing speed, a key cognitive domain affected in relatively healthy older adults.

Aging and loss decision making: increased risk aversion and decreased use of maximizing information, with correlated rationality and value maximization.

We investigated how adult aging specifically alters economic decision-making, focusing on examining alterations in uncertainty preferences (willingness to gamble) and choice strategies (what gamble information influences choices) within both the gains and losses domains. Within each domain, participants chose between certain monetary outcomes and gambles with uncertain outcomes. We examined preferences by quantifying how uncertainty modulates choice behavior as if altering the subjective valuation of gambles. We explored age-related preferences for two types of uncertainty, risk, and ambiguity. Additionally, we explored how aging may alter what information participants utilize to make their choices by comparing the relative utilization of maximizing and satisficing information types through a choice strategy metric. Maximizing information was the ratio of the expected value of the two options, while satisficing information was the probability of winning. We found age-related alterations of economic preferences within the losses domain, but no alterations within the gains domain. Older adults (OA; 61-80 years old) were significantly more uncertainty averse for both risky and ambiguous choices. OA also exhibited choice strategies with decreased use of maximizing information. Within OA, we found a significant correlation between risk preferences and choice strategy. This linkage between preferences and strategy appears to derive from a convergence to risk neutrality driven by greater use of the effortful maximizing strategy. As utility maximization and value maximization intersect at risk neutrality, this result suggests that OA are exhibiting a relationship between enhanced rationality and enhanced value maximization. While there was variability in economic decision-making measures within OA, these individual differences were unrelated to variability within examined measures of cognitive ability. Our results demonstrate that aging alters economic decision-making for losses through changes in both individual preferences and the strategies individuals employ.

Sleep duration and age-related changes in brain structure and cognitive performance.

STUDY OBJECTIVES: To investigate the contribution of sleep duration and quality to age-related changes in brain structure and cognitive performance in relatively healthy older adults. DESIGN: Community-based longitudinal brain and cognitive aging study using a convenience sample. SETTING: Participants were studied in a research laboratory. PARTICIPANTS: Relatively healthy adults aged 55 y and older at study commencement. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Participants underwent magnetic resonance imaging and neuropsychological assessment every 2 y. Subjective assessments of sleep duration and quality and blood samples were obtained. Each hour of reduced sleep duration at baseline augmented the annual expansion rate of the ventricles by 0.59% (P = 0.007) and the annual decline rate in global cognitive performance by 0.67% (P = 0.050) in the subsequent 2 y after controlling for the effects of age, sex, education, and body mass index. In contrast, global sleep quality at baseline did not modulate either brain or cognitive aging. High-sensitivity C-reactive protein, a marker of systemic inflammation, showed no correlation with baseline sleep duration, brain structure, or cognitive performance. CONCLUSIONS: In healthy older adults, short sleep duration is associated with greater age-related brain atrophy and cognitive decline. These associations are not associated with elevated inflammatory responses among short sleepers. CITATION: Lo JC, Loh KK, Zheng H, Sim SK, Chee MW. Sleep duration and age-related changes in brain structure and cognitive performance.

Sleep reduces false memory in healthy older adults.

STUDY OBJECTIVES: To investigate the effects of post-learning sleep and sleep architecture on false memory in healthy older adults. DESIGN: Balanced, crossover design. False memory was induced using the Deese-Roediger-McDermott (DRM) paradigm and assessed following nocturnal sleep and following a period of daytime wakefulness. Post-learning sleep structure was evaluated using polysomnography (PSG). SETTING: Sleep research laboratory. PARTICIPANTS: Fourteen healthy older adults from the Singapore-Longitudinal Aging Brain Study (mean age ± standard deviation = 66.6 ± 4.1 y; 7 males). MEASUREMENTS AND RESULTS: At encoding, participants studied lists of words that were semantically related to non-presented critical lures. At retrieval, they made "remember"/"know" and "new" judgments. Compared to wakefulness, post-learning sleep was associated with reduced "remember" responses, but not "know" responses to critical lures. In contrast, there were no significant differences in the veridical recognition of studied words, false recognition of unrelated distractors, discriminability, or response bias between the sleep and the wake conditions. More post-learning slow wave sleep was associated with greater reduction in false memory. CONCLUSIONS: In healthy older adults, sleep facilitates the reduction in false memory without affecting veridical memory. This benefit correlates with the amount of slow wave sleep in the post-learning sleep episode.

Associations between elevated homocysteine, cognitive impairment, and reduced white matter volume in healthy old adults.

OBJECTIVES: Elevated homocysteine has emerged as a risk factor for cognitive impairment even in healthy elderly persons. Reduced brain volume and white matter hyperintensities also occur in healthy elderly as well, but the interrelationships between these have not been well studied. We report these interrelationships in non demented, relatively healthy, community-dwelling older adults from a single East Asian population. METHODS: Two hundred twenty-eight right-handed participants age 55 years and above were evaluated. Persons with medical conditions or neurological diseases other than well-controlled diabetes mellitus and hypertension were excluded. Participants underwent quantitative magnetic resonance imaging of the brain using a standardized protocol and neuropsychological evaluation. Plasma homocysteine, folate, vitamin B(12), and markers for cardiovascular risk: blood pressure, body mass index, fasting blood glucose, and lipid profile were measured. RESULTS: Elevated homocysteine was associated with reduced global cerebral volume, larger ventricles, reduced cerebral white matter volume, and lower cognitive performance in several domains. Elevated homocysteine was associated with reduced white matter volume (ß = -20.80, t = -2.9, df = 223, p = 0.004) and lower speed of processing (ß = -0.38, t = -2.1, df = 223, p = 0.03), even after controlling for age, gender, and education. However, the association between homocysteine and lower speed of processing disappeared after controlling for white matter volume. Elevated homocysteine was not associated with white matter hyperintensity volume or with hippocampal volume. Although homocysteine and folate levels were correlated, their effects on white matter volume were dissociated. CONCLUSION: In non demented, relatively healthy adults, elevated homocysteine is associated with lower cognitive scores and reduced cerebral white matter volume. These effects can be dissociated from those related to white matter hyperintensities or reduced folate level.

Culture-related differences in default network activity during visuo-spatial judgments.

Studies on culture-related differences in cognition have shown that Westerners attend more to object-related information, whereas East Asians attend more to contextual information. Neural correlates of these different culture-related visual processing styles have been reported in the ventral-visual and fronto-parietal regions. We conducted an fMRI study of East Asians and Westerners on a visuospatial judgment task that involved relative, contextual judgments, which are typically more challenging for Westerners. Participants judged the relative distances between a dot and a line in visual stimuli during task blocks and alternated finger presses during control blocks. Behaviorally, East Asians responded faster than Westerners, reflecting greater ease of the task for East Asians. In response to the greater task difficulty, Westerners showed greater neural engagement compared to East Asians in frontal, parietal, and occipital areas. Moreover, Westerners also showed greater suppression of the default network-a brain network that is suppressed under condition of high cognitive challenge. This study demonstrates for the first time that cultural differences in visual attention during a cognitive task are manifested both by differences in activation in fronto-parietal regions as well as suppression in default regions.

Adverse Associations between Visceral Adiposity, Brain Structure, and Cognitive Performance in Healthy Elderly.

UNLABELLED: The link between central adiposity and cognition has been established by indirect measures such as body mass index (BMI) or waist-hip ratio. Magnetic resonance imaging (MRI) quantification of central abdominal fat has been linked to elevated risk of cardiovascular and cerebro-vascular disease. However it is not known how quantification of visceral fat correlates with cognitive performance and measures of brain structure. We filled this gap by characterizing the relationships between MRI measures of abdominal adiposity, brain morphometry, and cognition, in healthy elderly. METHODS: A total of 184 healthy community dwelling elderly subjects without cognitive impairment participated in this study. Anthropometric and biochemical markers of cardiovascular risk, neuropsychological measurements as well as MRI of the brain and abdomen fat were obtained. Abdominal images were segmented into subcutaneous adipose tissue and visceral adipose tissue (VAT) adipose tissue compartments. Brain MRI measures were analyzed quantitatively to determine total brain volume, hippocampal volume, ventricular volume, and cortical thickness. RESULTS: VAT showed negative association with verbal memory (r = 0.21, p = 0.005) and attention (r = 0.18, p = 0.01). Higher VAT was associated with lower hippocampal volume (F = 5.39, p = 0.02) and larger ventricular volume (F = 6.07, p = 0.02). The participants in the upper quartile of VAT had the lowest hippocampal volume even after adjusting for age, gender, hypertension, and BMI (b = -0.28, p = 0.005). There was a significant age by VAT interaction for cortical thickness in the left prefrontal region. CONCLUSION: In healthy older adults, elevated VAT is associated with negative effects on cognition, and brain morphometry.

Culture differences in neural processing of faces and houses in the ventral visual cortex.

Behavioral and eye-tracking studies on cultural differences have found that while Westerners have a bias for analytic processing and attend more to face features, East Asians are more holistic and attend more to contextual scenes. In this neuroimaging study, we hypothesized that these culturally different visual processing styles would be associated with cultural differences in the selective activity of the fusiform regions for faces, and the parahippocampal and lingual regions for contextual stimuli. East Asians and Westerners passively viewed face and house stimuli during an functional magnetic resonance imaging experiment. As expected, we observed more selectivity for faces in Westerners in the left fusiform face area (FFA) reflecting a more analytic processing style. Additionally, Westerners showed bilateral activity to faces in the FFA whereas East Asians showed more right lateralization. In contrast, no cultural differences were detected in the parahippocampal place area (PPA), although there was a trend for East Asians to show greater house selectivity than Westerners in the lingual landmark area, consistent with more holistic processing in East Asians. These findings demonstrate group biases in Westerners and East Asians that operate on perceptual processing in the brain and are consistent with previous eye-tracking data that show cultural biases to faces.

Hippocampal region-specific contributions to memory performance in normal elderly.

To investigate the relationship between regional hippocampal volume and memory in healthy elderly, 147 community-based volunteers, aged 55-83years, were evaluated using magnetic resonance imaging, the Groton Maze Learning Test, Visual Reproduction and the Rey Auditory Verbal Learning Test. Hippocampal volumes were determined by interactive volumetry. We found greater age-related reduction in the volume of the hippocampal head relative to the tail. Right hippocampal tail volume correlated with spatial memory on the Groton Maze Learning Test while left hippocampal body volume was associated with delayed verbal memory. These associations were independent of age, sex, education and speed of processing and support the notion of functional differentiation along the long axis of the hippocampus.

Cognitive function and brain structure correlations in healthy elderly East Asians.

We investigated the effect of age and health variables known to modulate cognitive aging on several measures of cognitive performance and brain volume in a cohort of healthy, non-demented persons of Chinese descent aged between 55 and 86 years. 248 subjects contributed combined neuropsychological, MR imaging, health and socio-demographic information. Speed of processing showed the largest age-related decline. Education and plasma homocysteine levels modulated age-related decline in cognitive performance. Total cerebral volume declined at an annual rate of 0.4%/yr. Gray and white matter volume loss was comparable in magnitude. Regionally, there was relatively greater volume loss in the lateral prefrontal cortex bilaterally, around the primary visual cortex as well as bilateral superior parietal cortices. Speed of processing showed significant positive correlation with gray matter volume in several frontal, parietal and midline occipital regions bilaterally. In spite of differences in diet, lifestyle and culture, these findings are broadly comparable to studies conducted in Caucasian populations and suggest generalizability of processes involved in age-related decline in cognition and brain volume.