Interventions to reduce the adverse psychosocial impact of driving cessation on older adults

As a result of our aging population, the coming years will see increasing numbers of older adults faced with the prospect of giving up driving due to poor health or functional limitations. Driving cessation has been associated with negative psychosocial outcomes for older adults including restricted mobility and depression. While several studies report evaluations of interventions designed to help older adults to drive safely for longer, there is a paucity of published research concerned with the design or implementation of intervention programs intended to reduce the negative consequences of driving cessation. This paper reviews cognitive and educational interventions designed to promote older driver safety, and discusses possible approaches to the design and implementation of clinical interventions for older adults who have ceased driving. A broad framework for adaptable interventions based on the theoretical tenets of social cognitive theory, with an emphasis on planning for cessation, problem-solving and the involvement of friends and family members is proposed

White matter hyperintensities and within-person variability in community-dwelling adults aged 60–64 years

Estimates of white matter hyperintensities (WMH) derived from T2-weighted MRI were investigated in relation to cognitive performance in 469 healthy community-dwelling adults aged 60–64 years. Frontal lobe WMH but not WMH from other brain regions (temporal, parietal, and occipital lobes, anterior and posterior horn, periventricular body) were associated with elevated within-person reaction time (RT) variability (trial to trial fluctuations in RT performance) but not performance on several other cognitive tasks including psychomotor speed, memory, and global cognition. The findings are consistent with the view that elevated within-person variability is related to neurobiological disturbance, and that attentional mechanisms supported by the frontal cortex play a key role in this type of variability

APOE genotype and entorhinal cortex volume in non-demented community-dwelling adults in midlife and early old age

Copyright © 2012 IOS PressThis article has been made available through the Brunel Open Access Publishing Fund.The apolipoprotein E (APOE) ε4 allele is a risk factor for the neuropathological decline accompanying Alzheimer's disease (AD) while, conversely, the ε2 allele offers protection. One of the brain structures exhibiting the earliest changes associated with the disease is the entorhinal cortex. We therefore investigated the volumes of the entorhinal cortex and other structures in the medial temporal lobe including the parahippocampal gyrus, temporal pole, and inferior, middle, and superior temporal cortices, in relation to APOE genotype. Our main objectives were to determine if (a) volumes systematically varied according to allele in a stepwise fashion, ε2 > ε3 > ε4, and (b) associations varied according to age. We investigate this association in 627 non-demented community-dwelling adults in middle age (44 to 48 years; n = 314) and older age (64 to 68 years; n = 313) who underwent structural MRI scans. We found no evidence of APOE-related variation in brain volumes in the age groups examined. We conclude that if a ε2 > ε3 > ε4 pattern in brain volumes does emerge in non-demented adults living in the community in old age, it is not until after the age of 68 years.This study was funded by the UK Leverhulme Trust, the British Academy, the NHMRC Research Fellowship No. 471501, the NHMRC Research Fellowship No.#1002560, the National Health and Medical Research Council of Australia Unit Grant No. 973302, Program Grant No. 179805, Project grant No. 157125; Program grant no. 350833, and the National Computational Infrastructure. This article is made available through the Brunel Open Access Publishing Fund

Deriving prevalence estimates of depressive symptoms throughout middle and old age in those living in the community

BACKGROUND: There is considerable debate about the prevalence of depression in old age. Epidemiological surveys and clinical studies indicate mixed evidence for the association between depression and increasing age. We examined the prevalence of probable depression in the middle aged to the oldest old in a project designed specifically to investigate the aging process. METHODS: Community-living participants were drawn from several Australian longitudinal studies of aging that contributed to the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. Different depression scales from the contributing studies were harmonized to create a binary variable that reflected "probable depression" based on existing cut-points for each harmonized scale. Weighted prevalence was benchmarked to the Australian population which could be compared with findings from the 1997 and 2007 National Surveys of Mental Health and Well-Being (NSMHWB). RESULTS: In the DYNOPTA project, females were more likely to report probable depression. This was consistent across age levels. Both NSMHWB surveys and DYNOPTA did not report a decline in the likelihood of reporting probable depression for the oldest old in comparison with mid-life. CONCLUSIONS: Inconsistency in the reports of late-life depression prevalence in previous epidemiological studies may be explained by either the exclusion and/or limited sampling of the oldest old. DYNOPTA addresses these limitations and the results indicated no change in the likelihood of reporting depression with increasing age. Further research should extend these findings to examine within-person change in a longitudinal context and control for health covariates.NHMRC (National Health and Medical Research Council of Australia

Towards More Data-Aware Application Integration (extended version)

Although most business application data is stored in relational databases, programming languages and wire formats in integration middleware systems are not table-centric. Due to costly format conversions, data-shipments and faster computation, the trend is to "push-down" the integration operations closer to the storage representation. We address the alternative case of defining declarative, table-centric integration semantics within standard integration systems. For that, we replace the current operator implementations for the well-known Enterprise Integration Patterns by equivalent "in-memory" table processing, and show a practical realization in a conventional integration system for a non-reliable, "data-intensive" messaging example. The results of the runtime analysis show that table-centric processing is promising already in standard, "single-record" message routing and transformations, and can potentially excel the message throughput for "multi-record" table messages.Comment: 18 Pages, extended version of the contribution to British International Conference on Databases (BICOD), 2015, Edinburgh, Scotlan

Cognitive benefits of social dancing and walking in old age: the Dancing Mind randomized controlled trial

Background: A physically active lifestyle has the potential to prevent cognitive decline and dementia, yet the optimal type of physical activity/exercise remains unclear. Dance is of special interest as it complex sensorimotor rhythmic activity with additional cognitive, social, and affective dimensions. Objectives: To determine whether dance benefits executive function more than walking, an activity that is simple and functional. Methods: Two-arm randomized controlled trial among community-dwelling older adults. The intervention group received 1 h of ballroom dancing twice weekly over 8 months (~69 sessions) in local community dance studios. The control group received a combination of a home walking program with a pedometer and optional biweekly group-based walking in local community park to facilitate socialization. Main outcomes: Executive function tests: processing speed and task shift by the Trail Making Tests, response inhibition by the Stroop Color-Word Test, working memory by the Digit Span Backwards test, immediate and delayed verbal recall by the Rey Auditory Verbal Learning Test, and visuospatial recall by the Brief Visuospatial Memory Test (BVST). Results: One hundred and fifteen adults (mean 69.5 years, SD 6.4) completed baseline and delayed baseline (3 weeks apart) before being randomized to either dance (n = 60) or walking (n = 55). Of those randomized, 79 (68%) completed the follow-up measurements (32 weeks from baseline). In the dance group only, “non-completers” had significantly lower baseline scores on all executive function tests than those who completed the full program. Intention-to-treat analyses showed no group effect. In a random effects model including participants who completed all measurements, adjusted for baseline score and covariates (age, education, estimated verbal intelligence, and community), a between-group effect in favor of dance was noted only for BVST total learning (Cohen’s D Effect size 0.29, p = 0.07) and delayed recall (Cohen’s D Effect size = 0.34, p = 0.06). Conclusion: The superior potential of dance over walking on executive functions of cognitively healthy and active older adults was not supported. Dance improved one of the cognitive domains (spatial memory) important for learning dance. Controlled trials targeting inactive older adults and of a higher dose may produce stronger effects, particularly for novice dancers. Trial registration: Australian and New Zealand Clinical Trials Register (ACTRN12613000782730)

Body, brain, life for cognitive decline (BBL-CD): Protocol for a multidomain dementia risk reduction randomized controlled trial for subjective cognitive decline and mild cognitive impairment

This is the final version. Available from Dove Medical Press via the DOI in this record. Background: With no cure for dementia and the number of people living with the condition predicted to rapidly rise, there is an urgent need for dementia risk reduction and prevention interventions. Modifiable lifestyle risk factors have been identified as playing a major role in the development of dementia; hence, interventions addressing these risk factors represent a significant opportunity to reduce the number of people developing dementia. Relatively few interventions have been trialed in older participants with cognitive decline (secondary prevention). Objectives: This study evaluates the efficacy and feasibility of a multidomain lifestyle risk reduction intervention for people with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). Methods: This study is an 8-week, two-arm, single-blind, randomized controlled trial (RCT) of a lifestyle modification program to reduce dementia risk. The active control group receives the following four online educational modules: dementia literacy and lifestyle risk, Mediterranean diet (MeDi), cognitive engagement and physical activity. The intervention group also completes the same educational modules but receives additional practical components including sessions with a dietitian, online brain training and sessions with an exercise physiologist to assist with lifestyle modification. Results: Primary outcome measures are cognition (The Alzheimer’s Disease Assessment Scale-Cognitive-Plus [ADAS-Cog-Plus]) and a composite lifestyle risk factor score for Alzheimer’s disease (Australian National University – Alzheimer’s Disease Risk Index [ANU-ADRI]). Secondary outcome measures are motivation to change lifestyle (Motivation to Change Lifestyle and Health Behaviour for Dementia Risk Reduction [MCLHB-DRR]) and health-related quality of life (36-item Short Form Health Survey [SF-36]). Feasibility will be determined through adherence to diet (Mediterranean Diet Adherence Screener [MEDAS] and Australian Recommended Food Score [ARFS]), cognitive engagement (BrainHQ-derived statistics) and physical activity interventions (physical activity calendars). Outcomes are measured at baseline, immediately post-intervention and at 3-and 6-month follow-up by researchers blind to group allocation. Discussion: If successful and feasible, secondary prevention lifestyle interventions could provide a targeted, cost-effective way to reduce the number of people with cognitive decline going on to develop Alzheimer’s disease (AD) and other dementias.Dementia Australia Research FoundationAustralian National UniversityDementia Collaborative Research CentreNHMRC Centre for Research Excellence in Cognitive Health, the Australian National UniversityNeuroscience Research Australia, University of New South WalesRoyal Commonwealth Societ

The role of demographic change in explaining the growth of Australia's older migrant population living with dementia, 2016–2051

Objective: To examine the demographic drivers contributing to the future growth in the population of older migrants in Australia living with dementia. Methods: Using birthplace-specific cohort-component projection models, we projected the number of older migrants living with dementia. ABS data on births, deaths, migration and birthplace were used, alongside Australian Institute of Health and Welfare (AIHW) estimates of dementia prevalence with birthplace dementia weights calculated from administrative data. Results: The number of older migrants living with dementia is projected to increase from about 134,423 in 2016 to 378,724 by 2051. Increases in populations with dementia varied considerably, from a slight decrease for those born in Southern & Eastern Europe to over 600% increases amongst the South-East Asia, Southern & Central Asia, and Sub-Saharan Africa-born populations. Conclusions: Cohort flow is the primary driver increasing the number of older migrants living with dementia. This growth is largely inevitable because the cohorts are already living in Australia as part of the migrant population, but currently at ages below 60 years. Implications for public health: High relative growth and shifting birthplace composition in the number of migrants living with dementia poses implications for culturally appropriate care, health care access and workforce needs to support migrant families, carers and their communities

Burying the hatchet? Britain and France in the Democratic Republic of Congo

Against the background of conflict in the Great Lakes Region, the UK and France promised, at their 1998 Saint-Malo summit, to set aside rivalries and cooperate on Africa. In subsequent Anglo-French gatherings, they singled out the DRC and pledged to work together there to promote peace and tackle poverty. This article asks whether this coordination took place and whether it involved a ‘deconflictualisation’ of approaches, ‘coincidental’ cooperation, or ‘sustained and reciprocal’ collaboration. It looks for evidence of institutionalisation of UK-French ties and policy cooperation in the fields of peacebuilding and poverty reduction. It then identifies the pressures for, and barriers to, collaboration, focusing particularly on the role of interests, foreign policy norms, institutional factors and resource constraints. It concludes by setting out the wider implications of UK-French cooperation and the limited prospects of closer future collaboration