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Longitudinal Analysis of Physical Performance, Functional Status, Physical Activity, and Mood in Relation to Executive Function in Older Adults Who Fall.

ABSTRACT: To examine whether good executive function (EF; the cognitive processes important for goal-oriented and controlled behavior) at baseline and maintenance of EF over time predict maintenance of physical performance, functional status, physical activity, and mood over a 1-year period, and conversely, to examine whether baseline functioning in these noncognitive domains predicts maintenance of EF over the same period of time.12-month prospective cohort study.Vancouver Falls Prevention Clinic.Community-dwelling older adults (N = 199; mean age 81.6 ± 6.5; 63% female) referred to the clinic after a fall.At each time point, structural equation modeling created a latent EF variable from performance on five EF tasks. Physical performance (physiological falls risk and gait speed), instrumental activities of daily living (IADLs), physical activity, and depressive symptoms were also assessed at each time point.Higher baseline EF predicted decreases in depressive symptoms (P = .005) and maintenance of IADLs (P = .006) from baseline to follow-up. Improvements in EF correlated with increases in gait speed (P = .005) and physical activity (P = .03) and with the maintenance of IADLs (P = .002) over follow-up. All effects were independent of demographic characteristics and global cognitive function. Baseline performance in the noncognitive domains did not predict changes in EF.In older fallers, EF is a marker of resiliency in several noncognitive domains and should therefore be assessed. Furthermore, interventions to improve EF should be tested in older fallers with EF deficits.

SUBMITTER: Best JR

PROVIDER: S-EPMC4911218 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Longitudinal Analysis of Physical Performance, Functional Status, Physical Activity, and Mood in Relation to Executive Function in Older Adults Who Fall.

Best John R JR Davis Jennifer C JC Liu-Ambrose Teresa T

Journal of the American Geriatrics Society 20150611 6

<h4>Objectives</h4>To examine whether good executive function (EF; the cognitive processes important for goal-oriented and controlled behavior) at baseline and maintenance of EF over time predict maintenance of physical performance, functional status, physical activity, and mood over a 1-year period, and conversely, to examine whether baseline functioning in these noncognitive domains predicts maintenance of EF over the same period of time.<h4>Design</h4>12-month prospective cohort study.<h4>Set ...[more]

PMID: 26096385

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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.

Dataset Information

Longitudinal Analysis of Physical Performance, Functional Status, Physical Activity, and Mood in Relation to Executive Function in Older Adults Who Fall.

Publications

Longitudinal Analysis of Physical Performance, Functional Status, Physical Activity, and Mood in Relation to Executive Function in Older Adults Who Fall.

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