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95 Fear of Falling Associated with Decreased Attention and Executive Functioning in Caregivers
- Sheila M Thompson, Eliza Morgan, J Kaci Fairchild
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 395-396
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Objective:
Fear of falling is an anxiety-related phenomenon that is associated with increased risk of morbidity and mortality in older adults. Furthermore, a growing body of research has established the relationship between fear of falling and decreased cognitive functioning within various populations (i.e., older adult, multiple sclerosis, stroke survivors). Yet there is little information on the relationship between fear of falling and cognition outside of a geriatric context, with no publications investigating this relationship within informal caregivers. It is important to understand this relationship within caregiver populations because fear of falling may negatively impact caregivers’ ability to take care of themselves and their care recipients. The present study examines the relationship between fear of falling and cognitive function in informal caregivers.
Participants and Methods:Fifty informal caregivers (86% female; 58% White; 10% Hispanic or Latino; 82% married; 53% with at least a bachelor’s degree; mean age = 57.76 ± 16.60 years) were assessed at the VA Palo Alto Health Care System in Palo Alto, CA. Fear of falling was measured via the Short Falls Efficacy Scale. Areas of cognitive functioning included verbal attention (Rey Auditory Verbal Learning Task [RAVLT] Trial 1), learning and memory (RAVLT Trials 1-5), delayed memory (RAVLT Delayed Recall), visual attention (Stroop Color, Stroop Word), and executive function (Stroop Color Word). Analyses included linear regressions with age as a covariate in all models.
Results:Analyses revealed that fear of falling was significantly associated with decreased verbal attention (RAVLT Trial 1: ß=-0.34, p = 0.02, t = -2.35, CI = [-0.659, -0.051]) and with decreased executive functioning (Stroop Color Word: ß = -0.35, p < 0.001, t = -3.10, CI = [-4.097, -0.874]). Fear of falling was not significantly associated with learning and memory or visual attention.
Conclusions:Fear of falling negatively impacts verbal attention and executive functioning, regardless of age. To our knowledge, this is the first study to examine the relationship between fear of falling and cognition outside of a geriatric population and within a caregiver sample. Findings suggest a need for additional assessment, research, and treatment of fear of falling within informal caregivers. Caregivers may need to be assessed for anxiety-related symptoms such as fear of falling on a more regular basis. A caregiver experiencing fear of falling, as well as difficulties with attention and executive functioning, can result in increased risk of functional and cognitive decline for both the caregiver and their care recipient. It is integral that future research investigates this relationship longitudinally to identify if the negative impact of fear of falling on cognition is reversible.
2 Water-Based Exercise Improves Cognition and Reduces Neurological-Related Plasma Proteins in Older Adults.
- Adriana A Savettiere, Peter Louras, J. Kaci Fairchild, M. Windy McNerney
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 318-319
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Objective:
In the United States, Alzheimer’s disease (AD) is the most common cause of dementia and the seventh leading cause of death. Exercise has demonstrated health benefits in older adults and reduces the risk of developing AD. Exploring underlying biological mechanisms of exercise could aid in identifying therapeutic targets to prevent AD progression, especially for high-risk individuals such as those with Mild Cognitive Impairment (MCI). Many studies of dementia focus on memory; however, executive function and processing speed are also vulnerable to the neuropathology that causes AD. This exploratory study aimed to identify potential mechanisms by which physical activity can facilitate change in cognitive functioning in older adults. This was accomplished by investigating correlations between changes in neurology-related plasma proteins and changes in measures of executive function and processing speed after participation in a water-based exercise intervention.
Participants and Methods:The sample included 20 older adults with amnestic MCI, ages 55-82 years (mean 68.15 ±7.75). Participants were predominately male (90%), White (70%), and non-Hispanic (85%), with more than high school education (95%). Participants engaged in supervised high-intensity water-based exercise three times per week for six months. Neuropsychological assessments and blood samples were assessed at baseline and after completion of the exercise intervention. Cognitive measures included: the Digit Span subtests from the Wechsler Adult Intelligence Scale, 4th Edition, Trail-Making Test (TMT), Stroop Color Word Test (SCWT), and the Symbol Digit Modalities Test (SDMT). Plasma protein levels were analyzed using the Olink Target 96 Neurology assay (Uppsala, Sweden), selected a priori for the established markers linked to neurobiological processes and diseases. Changes in cognitive measures and protein levels were assessed using paired-sample t-tests, and Pearson’s correlations were calculated for significant findings.
Results:Participants’ cognitive performance significantly improved on the SCWT color trial (t = -2.19, p = 0.042) and SDMT (t = -2.17, p = .043). Significant decreases in plasma proteins levels were found for GDNF family receptor alpha-1 ([GFRA1]: t =2.05, p = 0.055), neuroblastoma suppressor tumorigenicity-1 ([NBL1]: t = 2.13, p= .046), and neuropilin-2 ([NRP2]: t = 2.61 p= 0.017). Correlational analyses showed reductions in NBL1 were significantly associated with changes in both SDMT (r = -.61, p = 0.006) and the color trial of SCWT (r = .48, p = .038), and NRP2 was significantly associated with improvement on the SDMT (r = -.46, p = 0.045). GFRA1 was not significantly associated with change on any cognitive measure.
Conclusions:In a sample of older adults with MCI, participation in high-intensity water-based exercise led to significant improvements in cognitive function as well as changes in neurological plasma proteome. Improved outcomes in processing speed, attention, visuospatial scanning, and working memory were associated with changes in specific plasma protein concentrations. This highlights potential activity-dependent neurobiological mechanisms that may underlie the cognitive benefits derived from physical activity. Future studies should explore these findings in Randomized Control Trials with a comparative condition and larger sample size.
14 The Impact of Visual Attention and Impulsivity on Disinhibited Eating Behaviors in Older Adults
- Eliza Morgan, Nesha Harper, Adriana Savettiere, Sheila Mae Thompson, J. Kaci Fairchild
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 328
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Objective:
Although the relationship between visual attention, impulsivity, and cognitively restrained eating patterns has been established in previous research, less is known about the relationship of cognitive processes and disinhibited eating patterns in older adults. Research postulates that disinhibited eating behaviors may be associated with stress, limited emotional capacity, anxiety, and impulsivity. The current study investigated impulsivity as a potential mediator of the relationship between visual attention and disinhibited eating in older veterans.
Participants and Methods:This study included 101 Veterans who were screened as part of a larger study assessing the impact of multi-modal activity-based interventions on brain health in older adulthood. The sample included largely White (76%), male (94%) Veterans aged 54 to 88 (M = 70.1, SD 8.9). The Three-Factor Eating Questionnaire was used to assess daily disinhibited eating patterns, and attentional impulsivity was assessed with the Barratt Impulsiveness Scale. Visual attention was evaluated using the Stroop Color Word Test (Color Trial). Mediation analyses were conducted using the SPSS PROCESS Macro. The outcome variable for analysis was disinhibited eating. The predictor variable was visual attention. The mediator variable was impulsivity. Body mass index (BMI) was included as a covariate as it was significantly associated with the predictor and outcome variables.
Results:The indirect effect of visual attention on disinhibited eating was found to be statistically significant (effect = 0.06, 95%: 0.02, 0.12)
Conclusions:Attentional impulsivity appears to mediate the relationship between visual attention and disinhibited eating behaviors. This finding extends the current literature about the relationship between visual attention, impulsivity, and other eating patterns (e.g., cognitively restrained eating) in older adults. Exploring this relationship helps us better understand the impact of eating habits through the aging process. Caregivers and older adults should be informed about the impact of increased impulsivity on disinhibited eating behaviors, especially in those with limited visual attention processes. Further understanding of the neurobiological impact of eating behaviors on cognition in older adulthood may assist in developing awareness about the importance of healthy eating patterns when considering brain health in the aging process.
Sleep-wake disorders in Alzheimer’s disease: further genetic analyses in relation to objective sleep measures
- Jerome A. Yesavage, Art Noda, Alesha Heath, M. Windy McNerney, Benjamin W. Domingue, Yozen Hernandez, Gary Benson, Joachim Hallmayer, Ruth O’Hara, Leanne M. Williams, Andrea N. Goldstein-Piekarski, Jamie M. Zeitzer, J. Kaci Fairchild
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- Journal:
- International Psychogeriatrics / Volume 32 / Issue 7 / July 2020
- Published online by Cambridge University Press:
- 19 November 2019, pp. 807-813
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This paper presents updated analyses on the genetic associations of sleep disruption in individuals with Alzheimer’s disease (AD). We published previously a study of the association between single nucleotide polymorphisms (SNPs) found in eight genes related to circadian rhythms and objective measures of sleep-wake disturbances in 124 individuals with AD. Here, we present new relevant analyses using polygenic risk scores (PRS) and variable number tandem repeats (VNTRs) enumerations. PRS were calculated using the genetic data from the original participants and relevant genome wide association studies (GWAS). VNTRs for the same circadian rhythm genes studied with SNPs were obtained from a separate cohort of participants using whole genome sequencing (WGS). Objectively (wrist actigraphy) determined wake after sleep onset (WASO) was used as a measure of sleep disruption. None of the PRS were associated with sleep disturbance. Computer analyses using VNTRseek software generated a total of 30 VNTRs for the circadian-related genes but none appear relevant to our objective sleep measure. In addition, of 71 neurotransmitter function-related genes, 29 genes had VNTRs that differed from the reference VNTR, but it was not clear if any of these might affect circadian function in AD patients. Although we have not found in either the current analyses or in our previous published analyses of SNPs any direct linkages between identified genetic factors and WASO, research in this area remains in its infancy.
Verbal Naming Test for Use with Older Adults: Development and Initial Validation
- Brian P. Yochim, Sherry A. Beaudreau, J. Kaci Fairchild, Maya V. Yutsis, Neda Raymond, Leah Friedman, Jerome Yesavage
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- Journal:
- Journal of the International Neuropsychological Society / Volume 21 / Issue 3 / March 2015
- Published online by Cambridge University Press:
- 24 March 2015, pp. 239-248
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Naming or word-finding tasks are a mainstay of the typical neuropsychological evaluation, particularly with older adults. However, many older adults have significant visual impairment and there are currently no such word-finding tasks developed for use with older visually impaired populations. This study presents a verbal, non-visual measure of word-finding for use in the evaluation of older adults with possible dysnomia. Stimuli were chosen based on their frequency of usage in everyday spoken language. A 60-item scale was created and given to 131 older Veterans. Rasch analyses were conducted and differential item functioning assessed to eliminate poorly-performing items. The final 55-item scale had a coefficient alpha of 0.84 and correlated with the Neuropsychological Assessment Battery Naming test, r=0.84, p<.01, Delis-Kaplan Executive Function System (D-KEFS) Category Fluency, r=0.45, p<.01, and the D-KEFS Letter Fluency, r=0.40, p<.01. ROC analyses found the measure to have sensitivity of 79% and specificity of 85% for detecting dysnomia. Patients with dysnomia performed worse on the measure than patients with intact word-finding, t(84)=8.2, p<.001. Patients with no cognitive impairment performed significantly better than patients with mild cognitive impairment, who performed significantly better than patients with dementia. This new measure shows promise in the neuropsychological evaluation of word-finding ability in older adults with or without visual impairment. Future directions include the development of a shorter version and the generation of additional normative data. (JINS, 2015, 21, 1–10)