Older versus middle-aged adults with schizophrenia: Executive functioning and community outcomes.
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ABSTRACT:
SUBMITTER: Muralidharan A
PROVIDER: S-EPMC7239713 | biostudies-literature | 2020 Feb
REPOSITORIES: biostudies-literature
Publications
Older versus middle-aged adults with schizophrenia: Executive functioning and community outcomes.
Muralidharan Anjana A Finch Anastasia A Bowie Christopher R CR Harvey Philip D PD
Schizophrenia research 20191202
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Project description:ObjectiveGender differences in neurocognition, social skills, and negative symptoms, favoring women, have been documented among young/middle-aged adults with schizophrenia. However, gender differences have rarely been examined among older adults with schizophrenia, when decreases in circulating estrogens may impact outcomes among women.MethodsCommunity-dwelling adults (N = 242, ages 40-85) with schizophrenia/schizoaffective disorder completed assessments of negative symptoms (expressive and experiential deficits), neurocognition, and social skills. Mann-Whitney U tests examined gender differences; a regression-based bootstrapped approach to moderation examined gender by age interactions.ResultsFemale participants had better neurocognition (U = 6,814.00, p = 0.011) and less severe experiential deficits (U = 4,130.50, p = 0.022). There was no gender difference in social skills (U = 5,920.50, p = 0.150). Older age was associated with greater expressive deficits among men but not women (b = -0.04; 95% confidence interval -0.0780, -0.0114; bootstrap p = 0.009).ConclusionGender differences among adults with schizophrenia may vary depending on age; gender differences in negative symptoms may vary by symptom subgroup.
| S-EPMC6537109 | biostudies-literature
Project description:ObjectivesTo describe aerobic physical activity among middle-aged and older adults by their self-reported cognitive decline and their receipt of informal care for declines in cognitive functioning and most common type of physical activity.DesignCross-sectional study using data from the 2011 Behavioral Risk Factor Surveillance System.SettingLandline and cellular telephone survey.Participants93,082 respondents aged 45 years and older from 21 US states in 2011.MeasurementsSubjective cognitive decline (SCD) was defined as experiencing confusion or memory loss that was happening more often or getting worse during the past 12 months. Regular care was defined as always, usually, or sometimes receiving care from family or friends because of SCD. Using the 2008 Physical Activity Guidelines for Americans, respondents were classified as being inactive, insufficiently active, or sufficiently active based on their reported aerobic exercise. We calculated weighted proportions and used chi-square tests for differences across categories by SCD status and receipt of care. We estimated the prevalence ratio (PR) for being inactive, insufficiently active, and sufficiently active using separate log-binomial regression models, adjusting for covariates.Results12.3% of respondents reported SCD and 23.1% of those with SCD received regular care. 29.6% (95%CI: 28.9-30.4) of respondents without SCD were inactive compared to 37.1% (95%CI: 34.7-39.5) of those with SCD who did not receive regular care and 50.2% (95%CI: 45.2-55.1) of those with SCD who received regular care. 52.4% (95%CI: 51.6-53.2) of respondents without SCD were sufficiently active compared to 46.4% (95%CI: 43.8-49.0) of respondents with SCD and received no regular care and 30.6% (95%CI: 26.1-35.6) of respondents with SCD who received regular care. After adjusting for demographic and health status differences, people receiving regular care for SCD had a significantly lower prevalence of meeting aerobic guidelines compared to people without SCD (PR=0.80, 95%CI: 0.69-0.93, p=0.005). The most prevalent physical activity was walking for adults aged ≥ 45 years old (41-52%) regardless of SCD status or receipt of care.ConclusionOverall, the prevalence of inactivity was high, especially among people with SCD. These findings suggest a need to increase activity among middle-aged and older adults, particularly those with SCD who receive care. Examining ways to increase walking, potentially by involving informal caregivers, could be a promising way for people with SCD to reduce inactivity and gain the health benefits associated with meeting physical activity guidelines.
| S-EPMC6149221 | biostudies-literature
Project description:Common scales for physical functioning are not directly comparable without harmonization techniques, complicating attempts to pool data across studies. Our aim was to provide a standardized metric for physical functioning in adults based on basic and instrumental activities of daily living scaled to NIH PROMIS norms. We provide an item bank to compare the difficulty of various physical functioning activities. We used item response theory methods to place 232 basic and instrumental activities of daily living questions, administered across eight intervention studies of middle-aged and older adults (N = 2,556), on a common metric. We compared the scale's precision to an average z-score of items and evaluated criterion validity based on objective measures of physical functioning and Fried's frailty criteria. Model-estimated item thresholds were widely distributed across the range of physical functioning. From test information plots, the lowest precision in each dataset was 0.80. Using power calculations, the sample size needed to detect 25% physical functional decline with 80% power based on the physical functioning factor was less than half of what would be needed using an average z-score. The physical functioning factor correlated in expected directions with objective measurements from the Timed Up and Go task, tandem balance, gait speed, chair stands, grip strength, and frailty status. Item-level harmonization enables direct comparison of physical functioning measures across existing and potentially future studies and across levels of function using a nationally representative metric. We identified key thresholds of physical functioning items in an item bank to facilitate clinical and epidemiologic decision-making.
| S-EPMC5533461 | biostudies-literature
Project description:Frontal lobe structures decline faster than most other brain regions in older adults. Age-related change in the frontal lobe is associated with poorer executive function (e.g., working memory, switching/set-shifting, and inhibitory control). The effects and presence of frontal lobe white matter hyperintensities (WMH) on executive function in normal aging is relatively unknown. The current study assessed relationships between region-specific frontal WMH load and cognitive performance in healthy older adults using three executive function tasks from the NIH Toolbox (NIHTB) Cognition Battery. A cohort of 279 healthy older adults ages 65-88 completed NIHTB and 3T T1-weighted and FLAIR MRI. Lesion Segmentation Toolbox quantified WMH volume and generated lesion probability maps. Individual lesion maps were registered to the Desikan-Killiany atlas in FreeSurfer 6.0 to define regions of interest (ROI). Independent linear regressions assessed relationships between executive function performance and region-specific WMH in frontal lobe ROIs. All models included age, sex, education, estimated total intracranial volume, multi-site scanner differences, and cardiovascular disease risk using Framingham criteria as covariates. Poorer set-shifting performance was associated with greater WMH load in three frontal ROIs including bilateral superior frontal (left β = -0.18, FDR-p = 0.02; right β = -0.20, FDR-p = 0.01) and right medial orbitofrontal (β = -0.17, FDR-p = 0.02). Poorer inhibitory performance associated with higher WMH load in one frontal ROI, the right superior frontal (right β = -0.21, FDR-p = 0.01). There were no significant associations between working memory and WMH in frontal ROIs. Our study demonstrates that location and pattern of frontal WMH may be important to assess when examining age-related differences in cognitive functions involving switching/set-shifting and inhibition. On the other hand, working memory performance was not related to presence of frontal WMH in this sample. These data suggest that WMH may contribute selectively to age-related declines in executive function. Findings emerged beyond predictors known to be associated with WMH presence, including age and cardiovascular disease risk. The spread of WMH within the frontal lobes may play a key role in the neuropsychological profile of cognitive aging. Further research should explore whether early intervention on modifiable vascular factors or cognitive interventions targeted for executive abilities may help mitigate the effect of frontal WMH on executive function.
| S-EPMC8273864 | biostudies-literature
Project description:BackgroundMultimorbidity (≥ 2 chronic diseases) is associated with greater disability and higher treatment burden, as well as difficulty coordinating self-management tasks for adults with complex multimorbidity patterns. Comparatively little work has focused on assessing multimorbidity patterns among patients seeking care in community health centers (CHCs).ObjectiveTo identify and characterize prevalent multimorbidity patterns in a multi-state network of CHCs over a 5-year period.DesignA cohort study of the 2014-2019 ADVANCE multi-state CHC clinical data network. We identified the most prevalent multimorbidity combination patterns and assessed the frequency of patterns throughout a 5-year period as well as the demographic characteristics of patient panels by prevalent patterns.ParticipantsThe study included data from 838,642 patients aged ≥ 45 years who were seen in 337 CHCs across 22 states between 2014 and 2019.Main measuresPrevalent multimorbidity patterns of somatic, mental health, and mental-somatic combinations of 22 chronic diseases based on the U.S. Department of Health and Human Services Multiple Chronic Conditions framework: anxiety, arthritis, asthma, autism, cancer, cardiac arrhythmia, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), congestive heart failure, coronary artery disease, dementia, depression, diabetes, hepatitis, human immunodeficiency virus (HIV), hyperlipidemia, hypertension, osteoporosis, post-traumatic stress disorder (PTSD), schizophrenia, substance use disorder, and stroke.Key resultsMultimorbidity is common among middle-aged and older patients seen in CHCs: 40% have somatic, 6% have mental health, and 24% have mental-somatic multimorbidity patterns. The most frequently occurring pattern across all years is hyperlipidemia-hypertension. The three most frequent patterns are various iterations of hyperlipidemia, hypertension, and diabetes and are consistent in rank of occurrence across all years. CKD-hyperlipidemia-hypertension and anxiety-depression are both more frequent in later study years.ConclusionsCHCs are increasingly seeing more complex multimorbidity patterns over time; these most often involve mental health morbidity and advanced cardiometabolic-renal morbidity.
| S-EPMC9585110 | biostudies-literature
Project description:Beyond mere prognostication, optimal biomarkers of aging provide insights into qualitative and quantitative features of biological aging and might, therefore, offer useful information for the testing and, ultimately, clinical use of gerotherapeutics. We aimed to develop a proteomic aging clock (PAC) for all-cause mortality risk as a proxy of biological age. Data were from the UK Biobank Pharma Proteomics Project, including 53,021 participants aged between 39 and 70 years and 2923 plasma proteins assessed using the Olink Explore 3072 assay®. 10.9% of the participants died during a mean follow-up of 13.3 years, with the mean age at death of 70.1 years. The Spearman correlation between PAC proteomic age and chronological age was 0.77. PAC showed robust age-adjusted associations and predictions for all-cause mortality and the onset of various diseases in general and disease-free participants. The proteins associated with PAC proteomic age deviation were enriched in several processes related to the hallmarks of biological aging. Our results expand previous findings by showing that biological age acceleration, based on PAC, strongly predicts all-cause mortality and several incident disease outcomes. Particularly, it facilitates the evaluation of risk for multiple conditions in a disease-free population, thereby, contributing to the prevention of initial diseases, which vary among individuals and may subsequently lead to additional comorbidities.
| S-EPMC11320350 | biostudies-literature
Project description:BackgroundBeyond mere prognostication, optimal biomarkers of aging provide insights into qualitative and quantitative features of biological aging and might therefore offer useful information for the testing and ultimately clinical use of gerotherapeutics. Using a large proteomic cohort in the UK Biobank (UKB), we aimed to develop a proteomic aging clock for all-cause mortality risk as a proxy of biological age (BA).MethodsParticipants in the UK Biobank Pharma Proteomics Project (UKB PPP) were included with ages between 39 and 70 years (n=53,021). Data were split into a training (70%, n=37,115) and a test set (30%, n=15,906), including 2,923 plasma proteins assessed using the Olink Explore 3072 assay®. We developed a proteomic aging clock (PAC) for all-cause mortality risk as a surrogate of BA using a combination of Least Absolute Shrinkage and Selection Operator (LASSO) penalized Cox regression and Gompertz proportional hazards models. The validation for PAC included assessing its age-adjusted associations with, and predictions for all-cause mortality and 18 incident diseases, and head-to-head comparisons with two biological age measures (PhenoAge and BioAge) and leukocyte telomere length (LTL). Additionally, a functional analysis was performed to identify gene sets and tissues enriched with genes associated with BA deviation, based on different BA measures.FindingsThe Spearman correlation between PAC proteomic age and chronological age was 0.76. 10.9% of the combined training and test samples died during a mean follow-up of 13.3 years (SD=2.2), with the mean age at death 70.1 years (SD=8.1). PAC proteomic age, after controlling for age and other covariates, showed stronger associations than PhenoAge, BioAge, and LTL, with mortality and multiple incident diseases in the test set sample and in disease-free participants, such as mortality, heart failure, pneumonia, delirium, Chronic Obstructive Pulmonary Disease (COPD), and dementia. Additionally, PAC proteomic age showed higher predictive power for the conditions above compared to chronological age, PhenoAge, and BioAge, based on Harrell's C-statistics. Proteins associated with PAC proteomic age deviation (from chronological age) are enriched in various hallmarks of biological aging, including immunoinflammatory responses, cellular senescence, extracellular matrix remodeling, cellular response to stressors, and vascular biology.InterpretationPAC showed robust age-adjusted associations and predictions for all-cause mortality and the onset of various diseases. The diverse hallmark gene sets linked with PAC proteomic age deviation highlight the potential efficacy of geroscience-guided interventions. Further validation is essential to ascertain the use of PAC across different settings.
| S-EPMC10775323 | biostudies-literature
Project description:ObjectivesMaintaining cognitive function is an important component of healthy aging. There is increasing recognition that extraneous factors expedite the typical cognitive aging process. Risk factors for cognitive decline cluster around inequalities and disproportionally affect minority and vulnerable groups. Taking a minority stress approach, we examined the relationship between proxy measures of minority stress and cognitive health in a large sample of Canadians aged 45-85 years.MethodsData were drawn from the baseline of the Canadian Longitudinal Study on Aging, a prospective cohort study. Memory (n = 36,849) and executive function (n = 36,266) were assessed using standardized assessment tools. We ran multiple linear regression models with memory and executive function as the outcomes. Explanatory variables included known correlates of cognitive health (i.e., demographic, health, and cognitive reserve) and proxy measures of minority stress (i.e., sexual orientation, race, and perceived social standing).ResultsResults were consistent with existing evidence showing that demographic and health variables were associated with cognitive performance. Modifiable health variables, walking, and fruit/vegetable consumption were associated with better cognitive performance, as were cognitive reserve and social support measures. Within the models, racial minority status was consistently associated with lower cognitive performance. As one's perceived social standing within their own community increased, so too did cognitive function.DiscussionThese findings identify factors that may put people at risk for cognitive decline. There is a need to support the cognitive health of racialized Canadians and members of other disadvantaged groups, while promoting health equity.
| S-EPMC9159064 | biostudies-literature
Project description:Phishing is the spoofing of Internet websites or emails aimed at tricking users into entering sensitive information, with such goals as financial or identity theft. The current study sought to determine whether age is associated with increased susceptibility to phishing and whether tests of executive functioning can predict phishing susceptibility. A total of 193 cognitively intact participants, 91 younger adults and 102 older adults, were primarily recruited through a Psychology department undergraduate subject pool and a gerontology research registry, respectively. The Executive Functions Module from the Neuropsychological Assessment Battery and the Iowa Gambling Task were the primary cognitive predictors of reported phishing suspiciousness. Other predictors included age group (older vs. younger), sex, education, race, ethnicity, prior knowledge of phishing, prior susceptibility to phishing, and whether or not browsing behaviors were reportedly different in the laboratory setting versus at home. A logistic regression, which accounted for a 22.7% reduction in error variance compared to the null model and predicted phishing suspiciousness with 73.1% (95% CI [66.0, 80.3]) accuracy, revealed three statistically significant predictors: the main effect of education (b = 0.58, SE = 0.27) and the interactions of age group with prior awareness of phishing (b = 2.31, SE = 1.12) and performance on the Neuropsychological Assessment Battery Mazes test (b = 0.16, SE = 0.07). Whether or not older adults reported being suspicious of the phishing attacks used in this study was partially explained by educational history and prior phishing knowledge. This suggests that simple educational interventions may be effective in reducing phishing vulnerability. Although one test of executive functioning was found useful for identifying those at risk of phishing susceptibility, four tests were not found to be useful; these results speak to the need for more ecologically valid tools in clinical neuropsychology.
| S-EPMC5291531 | biostudies-literature
Project description:Two competing hypotheses, cumulative advantage/disadvantage and age-as-leveller, have been proposed to explain the contradictory findings on socioeconomic differences in health over the lifespan. To test these hypotheses, this investigation examined the influence of educational attainment and material condition on individual trajectories of physical functioning (PF) in unexplored ageing populations in Central and Eastern Europe.28 783 men and women aged 45-69 years selected from populations in seven Czech towns, Krakow (Poland) and Novosibirsk (Russia). PF was measured by the Physical Functioning Subscale (PF-10) of the Short-Form-36 questionnaire (SF-36) at baseline and three subsequent occasions. The highest educational attainment was self-reported at baseline, and material condition was captured by the sum score of 12 household amenities and assets.In all cohorts, participants with a university degree had the highest PF-10 score at baseline and slowest rate of decline in the score during follow-up, while the lowest baseline scores and fastest decline rate were found in participants with less than secondary education in all cohorts and in Russians with secondary education. Similar disparities in the baseline PF-10 score and decline rate were observed across tertiles of material condition, but differences in decline rates across the three tertiles among Czechs or between the lower two tertiles among Russians were not statistically significant.Disparities in PF by educational attainment and material condition among middle-aged and older adults in Central and Eastern Europe existed at baseline and widened during ∼10 years of follow-up, supporting the cumulative advantage/disadvantage hypothesis.
| S-EPMC5541176 | biostudies-other