The evolution of mild parkinsonian signs in aging

The progression of mild parkinsonian signs in the absence of idiopathic Parkinson's disease in aging is unclear. This study aims to identify predictors of the evolution of mild parkinsonian signs in non-dementedolder adults. Two hundred ten participants (76.25±7.10years, 57% women) were assessed at baseline and 1-year follow-up. Mild parkinsonian signs were defined as the presence of bradykinesia, rigidity and/or rest tremor. Depending upon the presence of these features at baseline and follow-up, participants were divided into one of four groups (no, transient, persistent or new-onset mild parkinsonian signs). Physical function was assessed using gait velocity. Ninety-five participants presented with mild parkinsonian signs at baseline. At 1-year follow-up, 59 demonstrated persistent mild parkinsonian signs, while 36 recovered (i.e., transient). Participants with persistent mild parkinsonian signs were older (79.66±7.15 vs. 75.81±7.37years, p=0.01) and evidenced slower gait velocity (90.41±21.46 vs. 109.92±24.32cm/s, p<0.01) compared to those with transient mild parkinsonian signs. Gait velocity predicted persistence of mild parkinsonian signs, even after adjustments (OR: 0.96, 95% CI: 0.94-0.98). Fifty-five participants demonstrated new-onset of mild parkinsonian signs. In comparison to participants without mild parkinsonian signs, presence of cardiovascular but not cerebrovascular disease at baseline was associated with new-onset mild parkinsonian signs. Our study reveals that gait velocity was the main predictor of persistent mild parkinsonian signs, whereas cardiovascular disease was associated with new-onset mild parkinsonian signs. These findings suggest a vascular mechanism for the onset of mild parkinsonian signs and a different mechanism, possibly neurodegenerative, for the persistence of mild parkinsonian signs

Age Effects on Load-Dependent Brain Activations in Working Memory for Novel Material

Three competing models of cognitive aging (neural compensation, capacity limitations, neural inefficiency) were examined in relation to working memory for novel non-verbal material. To accomplish this goal young (n = 25) and old (n = 25) participants performed a delayed item recognition (DIR) task while being scanned with bold fMRI. The stimuli in the DIR task consisted of computer-generated closed-curve shapes with each shape presented only once in the testing conditions of each participant. This ensured that both the novelty and appearance of the shapes maximized visual demands and limited the extent of phonologic processing. Behaviorally, as expected, the old participants were slower and less accurate compared to the young participants. Spatial patterns of brain activation that corresponded to load-dependent (stimulus set size ranged from 1 to 3) fMRI signal during the three phases of the DIR task (memory set presentation, retention delay, probe presentation) were evaluated in both age groups. Support for neural compensation and capacity limitation was evident in retention delay and the probe phase, respectively. Data were inconsistent with the neural inefficiency model. The process specific support for the theories we examined is consistent with a large corpus of research showing that the substrates underlying the encoding, retention and probe phases are different. That is, cognitive aging theories can be specific to the neural networks/regions underlying the different phases of working memory. Delineating how these theories work in concert can increase knowledge of age-related effects on working memory

A Common Neural Network for Cognitive Reserve in Verbal and Object Working Memory in Young but Not Old

Epidemiologic evidence suggests that cognitive reserve (CR) mitigates the effects of aging on cognitive function. The goal of this study was to see whether a common neural mechanism for CR could be demonstrated in brain imaging data acquired during the performance of 2 tasks with differing cognitive processing demands. Young and elder subjects were scanned with functional magnetic resonance imaging (fMRI) while performing a delayed item response task that used either letters (40 young, 18 old) or shapes (24 young, 21 old). Difficulty or load was manipulated by varying the number of stimuli that were presented for encoding. Load-dependent fMRI signal corresponding to each trial component (stimulus presentation, retention delay, and probe) and task (letter or shape) was regressed onto 2 putative CR variables. Canonical variates analysis was applied to the resulting maps of regression coefficients, separately for each trial component, to summarize the imaging data--CR relationships. There was a latent brain pattern noted in the stimulus presentation phase that manifested similar relationships between load-related encoding activation and CR variables across the letter and shape tasks in the young but not the elder age group. This spatial pattern could represent a general neural instantiation of CR that is affected by the aging process

Psychopathological Features in Alzheimer's Disease: Course and Relationship with Cognitive Status

OBJECTIVES: To examine the course, clinical correlates, and relationship between cognitive status and psychopathological features in patients with probable Alzheimer's disease (AD) followed over a 5-year period. DESIGN: Cohort study with follow-up of 5 years. SETTING: Patients were recruited at three sites: 91 patients at Columbia Medical Center, 84 at Johns Hopkins School of Medicine, and 61 at Massachusetts General Hospital. PARTICIPANTS: Patients diagnosed with probable AD (n = 236) enrolled in a longitudinal study (Predictors study). MEASUREMENTS: Wandering/agitation, physical aggression, hallucinations, and delusions were evaluated at 6-month intervals using the Columbia Scale for Psychopathology in Alzheimer's Disease. Descriptive analyses were used to provide estimates of prevalence and course of psychopathological features. General estimating equations determined the odds of having any of the four psychopathological behaviors as a function of cognitive status. Markov analyses provided 6-month transition probabilities for psychopathological behaviors given patients' cognitive status and the presence or absence of such behaviors in the previous evaluation. RESULTS: For wandering/agitation, prevalence (39-57%) and persistence increased as a function of time and decrement in cognitive status. Physical aggression was less prevalent (6-22%) and increased as a function of cognitive decline but tended to persist only in the more severely impaired patients. Delusions (34-49%) reached a peak at the second year and then declined. The odds of delusions were maximal with intermediate decline but remained persistent regardless of cognitive status. Hallucinations, despite some fluctuations, were relatively stable during the follow-up period (8-17%) and moderately persistent. CONCLUSION: Psychopathological features, particularly wandering/agitation and delusions, in AD were common throughout the disease course. The natural history and persistence of the four psychopathological features varied. These findings provide important information to clinicians and caregivers regarding the course, predictability, and possible treatment of psychopathological behaviors in patients with probable AD

Motoric Cognitive Risk Syndrome: Multicountry Prevalence and Dementia Risk

OBJECTIVES: Our objective is to report prevalence of motoric cognitive risk syndrome (MCR), a newly described predementia syndrome characterized by slow gait and cognitive complaints, in multiple countries, and its association with dementia risk. METHODS: Pooled MCR prevalence analysis of individual data from 26,802 adults without dementia and disability aged 60 years and older from 22 cohorts from 17 countries. We also examined risk of incident cognitive impairment (Mini-Mental State Examination decline ≥4 points) and dementia associated with MCR in 4,812 individuals without dementia with baseline Mini-Mental State Examination scores ≥25 from 4 prospective cohort studies using Cox models adjusted for potential confounders. RESULTS: At baseline, 2,808 of the 26,802 participants met MCR criteria. Pooled MCR prevalence was 9.7% (95% confidence interval [CI] 8.2%-11.2%). MCR prevalence was higher with older age but there were no sex differences. MCR predicted risk of developing incident cognitive impairment in the pooled sample (adjusted hazard ratio [aHR] 2.0, 95% CI 1.7-2.4); aHRs were 1.5 to 2.7 in the individual cohorts. MCR also predicted dementia in the pooled sample (aHR 1.9, 95% CI 1.5-2.3). The results persisted even after excluding participants with possible cognitive impairment, accounting for early dementia, and diagnostic overlap with other predementia syndromes. CONCLUSION: MCR is common in older adults, and is a strong and early risk factor for cognitive decline. This clinical approach can be easily applied to identify high-risk seniors in a wide variety of settings

A consensus guide to using functional near-infrared spectroscopy in posture and gait research

BACKGROUND: Functional near-infrared spectroscopy (fNIRS) is increasingly used in the field of posture and gait to investigate patterns of cortical brain activation while people move freely. fNIRS methods, analysis and reporting of data vary greatly across studies which in turn can limit the replication of research, interpretation of findings and comparison across works. RESEARCH QUESTION AND METHODS: Considering these issues, we propose a set of practical recommendations for the conduct and reporting of fNIRS studies in posture and gait, acknowledging specific challenges related to clinical groups with posture and gait disorders. RESULTS: Our paper is organized around three main sections: 1) hardware set up and study protocols, 2) artefact removal and data processing and, 3) outcome measures, validity and reliability; it is supplemented with a detailed checklist. SIGNIFICANCE: This paper was written by a core group of members of the International Society for Posture and Gait Research and posture and gait researchers, all experienced in fNIRS research, with the intent of assisting the research community to lead innovative and impactful fNIRS studies in the field of posture and gait, whilst ensuring standardization of research

Predicting Age-Related Dual-Task Effects With Individual Differences on Neuropsychological Tests.

This study examined the relation of dual-task performance to individual differences on neuropsychological tests. Neuropsychological test scores from 16 young and 16 older participants were simultaneously submitted to a factor analysis that yielded 2 factors (Attention/Executive and Memory) that differed by age and 2 (Motor Speed and Cognitive Status) that did not. Regression analyses revealed that these factors were significant predictors of performance on a delayed visual recognition task, but the relationship varied as a function of task condition. The Memory and Motor Speed factors were the strongest predictors of single-task performance, but the Attention/Executive factor was the most important predictor of dual-task performance. The authors conclude that compromised central executive may underlie age-related decline in dual-task performance

Age-related differences in executive control of working memory

In two experiments, we used dual-task methodology to assess the effect of aging on executive control of working memory. We hypothesized that (1) age-related dual-task costs would be observed even when individual tasks represent different perceptual modalities; (2) age would modulate the effect of increased temporal overlap on dual-task performance; and (3) the vulnerability of specific memory mechanisms to interference would be age related. We found that aging was associated with disproportionate dual-task costs that increased when extending the overlap between individual tasks. The effect of interference with encoding, and arguably output, was disproportionately larger in old than in young individuals. Ensuring that individual tasks represent different perceptual modalities is important but insufficient when using dual-task methodology to assess the effect of aging on executive function. The degree of temporal overlap between individual tasks and the sensitivity of specific memory operations to interference should be considered, as well