What Is Normal Cognitive Aging A Provisional Definition

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What Is Normal Cognitive Aging? A Provisional
Definition

• Normal cognitive aging is continuing to function
  at a level characteristic of our age group as
  influenced by relevant demographic factors
• Memory within normal limits
• Overall cognitive functioning is no lower than
  the bottom 7 of age group, with no more than
  one aptitude below than that level
• (such as attention, spatial, calculation
  skills)

PSYC S-1293, 2004
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What Is Normal Cognitive Aging? A Provisional
Definition (Contd)

• Normal cognitive aging is also being inattentive
  to potential problems associated with normal
  age-related cognitive decline
• Assuming that one functions as well cognitively
  in the Third Age (60-80) as in the prime of
  life, ignoring evidence to the contrary
• Being unaware, as opposed to being aware, of
  activities that are associated with optimal
  cognitive aging

PSYC S-1293, 2004
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Average WAIS Full Scale IQ Scores for Age Groups
25-34 to 75Normal Subjects
Kaufman, 1990
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Difference in Decline Rate With
AgingCrystallized Fluid Abilities

• Crystallized slower
• Less time pressure
• More education related
• Single task attention
• Vocabulary
• Information
• Calculation

• Fluid faster decline
• More time pressure
• Less education related
• Dual task attention
• Working memory
• Spatial abilities
• Reasoning
• Memory after delay

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Change in WAIS-R Verbal IQs Across the 20- to
74-year Range
Kaufman, 1990
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What Explains Age-Related Decline Rate in
Cognitive Abilities?

• Slowing of processing spend
• Shrinking of working memory
• Growing cognitive disinhibition

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Response Time and Aging Research Studies
Salthouse, 1991
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Working Memory

• Working Memory The ability to retain
  information in memory while simultaneously
  using this and other information to solve a
  problem
• Analogous to your desktop when writing term
  paper
• Or, RAM (random access memory)

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Working Memory and Age Performance on Analogies
Salthouse, 1992
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Growing Age Related Cognitive DisinhibitionResult
s

• Major impact of age-related cognitive
  disinhibition is upon tasks requiring
  concentration and working memory
• Disinhibition grows with age, especially in the
  tendency to have past methods of problem solving
  persist in new settings
• Processing speed does decline with age
• But declining inhibition had greater negative
  impact
• Vocabulary doesnt decline with age
• Gender differences Men read faster, but women
  remember verbal content better

Persad, et al., 2002
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Verbal Fluency Write Down All Words Beginning
With C, F, or L

• Average in one minute
• 60-65 13.80
• 71-75 12.25 11 decline from 60-65
• 81-85 10.16 26 decline from 60-65

Persad, et al., 2002
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Use It or Lose ItHow Much Does Experience Count?
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Test Scores of Older Faculty Compared to Younger
Colleagues
Sward,1945
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The Immeasurable Dimensions of Experience

• Self Knowledge
• Store of accumulated information
• Discriminating important from unimportant
• Knowing how to proceed with complex tasks
• Understanding the rhythm of things
• Considering possible problem solving scenarios
• Accessing resources

Salthouse Mitchell, 1990
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Do Men and Women Differ in Aptitudes?
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Gender Differences on Cognitive Tests

• With high aptitude groups (Terman, Project
  Talent) males are more numerous among the high
  scorers
• Not unusual to have more males among the
  graduating Summas in sciences and math
• But more at bottom of class, too
• May have to do with variability

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The Bell Curve of Normal Distribution of Test
Scores
Lots
Few
IQ
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Hypothetical Distribution of Group As Scores on
a Cognitive Test
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Hypothetical Distribution of Group Bs Scores on
a Cognitive Test
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Hypothetical Differences in the Distribution of
Scores of Groups A B on a Cognitive Test
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Gender Differences on Cognitive Tests

• A consistent finding has been that M W do not
  differ much on cognitive test averages
• Especially when the testing is of large numbers
  of diverse Ss
• Elite groups show greater gender differences in
  spatial/math scores

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Gender Differences in Reading Test Scores100
Studies
Hyde, et al., 1990
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Gender Differences

• Bottom line is that few differences in aptitude
  have emerged, and those were small
• Most differences at extremes or tails of bell
  curve
• For instance, older men were often stronger on
  tests of number memory and spatial tasks
• Older women stronger on verbal memory tasks
• Gender differences on tests are much smaller than
  the impact of energy, diligence, social skills,
  etc.
• Could the differences between the sexes be more a
  function of generation than gender?

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Class 5 Optimal Cognitive Aging

• Optimal cognitive aging
• Variability as evidence for OCA
• Moderate exercise
• Diurnal variation
• Glucose level
• Blood pressure control
• Cognitive training
• Diverse challenging intellectual activities
• Selection, optimization compensation

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What Is Optimal Cognitive Aging?

• Optimal cognitive aging is continuing to function
  at the highest possible level in the context of
  the inevitable limitations that growing older
  places upon us
• It is being aware, as opposed to being unaware,
  of the beneficial effects of certain physical,
  intellectual, and psychosocial activities on
  cognition

PSYC S-1293, 2004
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What Is Optimal Cognitive Aging? (Cont)

• Optimal cognitive aging is also doing, as
  opposed to not doing, things that are known to
  maintain and enhance intellectual functioning
• It is regularly appraising cognitive status, and
  making adjustments as needed
• Optimal cognitive aging is getting the best out
  of what is possible for as long as possible

PSYC S-1293, 2004
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Standards for OCAPreliminary Conclusions

• Standards for OCA are relative and subjective,
  based on self judgments, and confirmed by
  objective observer
• Criteria usually relative to age group peers and
  self 5 years earlier
• Standards involve overall HRQOL
• Evidence of recognition of age imposed
  limitations and making adjustments

PSYC S-1293, 2006
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Standards for OCA Characteristics of ACAgers
from Interviews

• Hi energy
• Engaged in satisfying activities
• Efforts to maintain mental acuity
• Active social networks
• Recognize/accept decline in cognitive abilities
• Selection, optimization compensation

PSYC S-1293, 2006
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Optimal Aging Rectangular Model
Rabbitt, 1990
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More Realistic Rectangular Model of Optimal
Aging Intellectual Ability
Territory to be gained
Powell, 1994
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Chronological vs. Functional Age

• Chronological age Calendar years
• Functional age Objective physical and mental
  state and performance
• Why important Demographic, phys/psych,
  economic, legislative changes

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What Percentage of Older Adults Could Be Said to
Meet Criteria for OCA?
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of Optimal Cognitive AgersTest Scores Higher
Than ½ of Those Age 45-54
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Powell,1994
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of Optimal Cognitive AgersTest Scores Higher
Than Lowest 7 of Those Age 45-54
Powell,1994
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Aerobic Fitness Cognition in Older Ss SLC
Prospective Study

• In Salt Lake City investigators looked at link
  between exercise and cognition
• Their question was whether exercise would
  improve cognition of previously sedentary men
  women
• Divided Ss into 3 groups Exercise,
  Flexibility/Strength, No-Exercise

Dustman et al, 1984
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Aerobic Fitness Cognition in Older Ss SLC
Prospective Study

• Exercise 3 X 1-hour sessions per week for 4
  months. Aerobic exercise was fast walking, slow
  jogging (70-80 max heart rate)
• Flexibility/Strength Participated in strength
  flexibility exercises but not aerobic training
• Non-Exercise ControlParticipated in neither
  aerobic or strength/flex exercises
• All three groups tested with cognitive tests
  before after the fitness training

Dustman et al, 1984
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Aerobic Fitness Cognition in Older Ss SLC
Prospective Study
Dustman, et al, 1983
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Effects of Fitness Training on Cognition of Older
Adults Meta-analyses

• Q These authors ask is Does fitness training
  enhance cognitive vitality of older people?
• Meta-analysis of 18 studies from 1966-2001
• Excluded many others for shoddy design
• 197 Ss 55-80 higher of females
• 101 exercisers, 97 control Ss
• Ages of Ss young-old (55-65) mid-old (66-70)
  old-old (71-80)

Colcombe Kramer, 2003
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Effects of Fitness Training on Cognition of Older
Adults Meta-analyses

• Program duration
• Short (1-3 months)
• Medium (4-6 months)
• Long (6 months)
• Session duration
• Short (15-30 minutes)
• Medium (31-45 minutes)
• Long (46-60 minutes)

Colcombe Kramer, 2003
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Effects of Fitness Training on Cognition of Older
Adults Meta-analyses

• Cognitive abilities measured
• Executive Planning, reasoning, multi-tasking
• Control Inhibition
• Speed Response or reaction time
• Spatial Recall, rotate, or transform forms
• Types of training
• Aerobic, emphasizing cardiovascular training
• Combination, aerobic strength

Colcombe Kramer, 2003
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Effect Size (ES) Statistic

• Often used in meta-analyses
• Effect size useful when estimating influence of
  one variable (exercise) on another (cognition)
• Virtue is they are independent of sample size
  and significance (p) values
• Most effect sizes are under 1.00
• When judging importance of effect sizes, I think
  of them this way .90 (very large influence)
  .60- .80 (large) .30-.50 (medium) lt.20 (small
  influence)

Cohen, 1988
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Results of Meta-Analysis Forms of Exercise
Cognitive Benefits

• Training Cardio only-ES of .41 Combined-.59
• Duration 1-3 mos (.52) 4-6 mos (.27)
• 6 mos (.67)
• Session length 15-30 min (.18) 31-45 min
  (.61) 46-60 min (.47)
• Ss age 55-65 (.30) 66-70 (.69)
• 71-80 (.55)

Colcombe Kramer, 2003
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Effect Sizes for All Fitness Training on
Cognition of Older Adults
Colcombe Kramer, 2003
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Impact of Activity on Cerebral Blood Flow
Cognition After 65

• Texas researchers followed 3 groups of Ss
  beginning just before age 65
• Groups were working (active), retired (active)
  retired (inactive)
• Activity calculated on calories expended per
  week
• Looked at impact of activity on cerebral blood
  flow (CBF) cognition

Rogers et al, 1990
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Activity and Cerebral Blood Flow Four Years
After Retirement at 65
Rogers et al, 1990
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Can Aerobic Fitness Reduce Brain Tissue Loss in
Elders?

• From 30 to 90 humans lose 25 of brain tissue
  density due to aging
• Studies show exercise associated with higher
  levels of cognition
• Investigated whether exercise associated with
  less age-related loss of brain tissue

Colcombe, et al., 2003
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Can Aerobic Fitness Reduce Brain Tissue Loss in
Elders?

• 55 Ss (55-77, ave. 67) were tested for aerobic
  fitness, based on VO2max
• Each S received MRI brain scan
• Fitness and brain density compared
• Fitter Ss had less loss of brain tissue
• Effects were in frontal, parietal, and temporal
  areas
• Study not been replicated

Colcombe, et al., 2003
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Diurnal Variation When Are Younger Older
People at Their Best?

• Two studies comparing older younger Ss on
  optimal time of day
• 1st asked about optimal time of day morning,
  evening or neutral
• 2nd tested recognition memory for passages they
  had read

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Diurnal Variation When Are Younger Older
People at Their Best?
May, et al., 1993
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Diurnal Variation When Are Young Old People at
Their Best?
May, et al., 1993
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Glucose Effects on Cognition In Older Folks

• Would older Ss perform better on cognitive tests
  after drinking glucose?
• Recruited Ss(62-84,M73) to drink either glucose
  or saccharin and take cognitive tests after each

Manning, et al., 1990
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Glucose Effects on Cognition in Older Folks

• Significant differences for glucose on
• Recall of story after 5 delay
• Recall of story after 40 delay
• Recall of wordlist (no delay)
• These abilities often decline with age

Manning, et al., 1990
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Blood Pressure and Cognition

• Data from the Framingham (Heart) Study compared
  cognitive test scores and blood pressure (BP)
• 506 normal and hypertensive Ss compared on
  Speed, Executive Function, Episodic Memory,
  Attention, Memory
• Found correlation between elevated BP and
  diminished cognition above 160/90

Saxby, et al, 2003
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Blood Pressure and Cognition

• Found correlation between elevated BP and
  diminished cognition above 160/90
• Specifically, hypertensive group had relative
  deficits in Speed, Episodic Working Memory,
  and Executive Function

Saxby, et al, 2003
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Blood Pressure and Cognition

• Data from the Framingham (Heart) Study compared
  cognitive test scores and blood pressure (BP)
• Found correlation between elevated BP and
  diminished cognition above 140/90
• Negative effects of elevated BP on cognition far
  greater for younger adults

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Blood Pressure and CognitionNormal
Hypertensive Adults

• Q Is higher BP (blood pressure) correlated with
  lower scores on cognitive tests?
• Controlled for age, education, and gender
• 301 Ss (20 to 75, Mean44) had BP taken and were
  given cognitive tests
• Ss divided into 2 groups
• Normotensive (lt140/90)
• Hypertensive (gt140/90)

Elias, et al. 1990
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Blood Pressure and Cognition Findings

• Linear relationship between hypertension and
  cognition for all ages
• Diastolic blood pressure more negatively
  correlated with overall cognition than Systolic
  blood pressure
• Lower test scores were on Overall Score, as well
  as reasoning, memory, and spatial recall
• Negative effects of elevated Diastolic BP on
  cognition greater for younger Ss

Elias, et al. 1990
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Blood Pressure and CognitionNormal
Hypertensive Adults

• Q Why do they say effects of hypertension
  greater for younger adults? Two reasons
• (1)Healthy survivor effect
• (2) Probably because younger Ss are mostly in
  very good health and so do well on NP tests
• Therefore, small differences are significant
• Oldsters in poorer health, so even larger test
  differences are obscured by more variability

Elias, et al. 1990
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Ideas for Remaining an Optimal Cognitive Ager

• Seek new learning experiences
• Challenge yourself
• Engage the new technology
• Improve declining skills through training

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Role of Diverse Challenging Intellectual
Activities in OCA

• A consensus of numerous experts, i.e., Marian
  Diamond Werner Schaie supports this idea
• Involvement in complex, intellectually
  stimulating activities
• Seeking challenges, intellectual and other
• Spending time with interesting people, with a
  variety of interests/talents
• Being in a relationship where activities/interest
  s are shared

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Study of Differences Between OCA and NCA MDs in
Florida

• Questions thought to be correlated with OCA were
  asked
• 20 OCA males 20 NCA males completed
  questionnaire and were interviewed
• Domains were physical, intellectual, social and
  psychological
• Several significant findings emerged

Anderson, 1992
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Physical Variables Correlating With OCA Among
Physicians

• Age -.34
• Exercise Correlation
• Hours NS
• Purpose NS
• Feel afterglow NS
• Vigorous NS
• Moderate .31
• Sexual Energy
• At 45 NS
• At 55 .56
• At 65 .42

Anderson, 1992
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Reading Activities Correlating With OCA Among
Physicians

• Age -.34
• Hours NS
• Newspapers NS
• Prof Journals NS
• Challenging mags .62
• Magazines for fun .36
• Books for fun .41

Anderson, 1992
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Social Variables Correlating With OCA Among
Physicians

• Age -.34
• Social Relationships Correlation
• In primary rel/ship NS
• Comfort from rel/ship NS
• Duration .36
• Contact with children/ .41
• younger generation

Anderson, 1992
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Psychological Variables Correlating With OCA
Among Physicians

• Age -.34
• Feel Joy .42
• Responses to Stress
• Think about future consequences .39
• Find humor .42
• Feel initially intimidated .41

Anderson, 1992
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Cognitive Training Nearly Everything Works
PSYC S-1293, 2005
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Approaches to Cognitive Training of Older People
Examples

• Ss in rural PA were given 2 hours of classroom
  training in reasoning, spatial abilities, and
  verbal memory results were improvement in
  pre/post test scores
• Ss in Germany divided into three groups 1 given
  5 hours of group tutoring to improve performance
  on mazes and vocabulary 2 studied for same
  amount of time with self-guided manual 3
  nothing both Tutored and Self-Study groups
  improved at post-test, but stronger performance
  by Tutored Ss on spatial ability

PSYC S-1293, 2005
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Mnemonic Training10 Item Grocery List to
Memorize

• Celery Onions
• Bagels Cream cheese
• Orange Juice Coffee
• Soup Pasta Sauce
• Post-Its Rug Cleaner

PSYC S-1293, 2005
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Mnemonic Training What Strategies Did You Use?
PSYC S-1293, 2005
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What Mnemonic Strategies Did You Use? Some
Possibilities

• Straight memorization
• Cued recall
• BCCCOOPPRS
• Clustering (breakfast, vegetables, drinks, cans,
  other)
• Method of loci (associating item to be recalled
  with rooms in a house or subway stops)

PSYC S-1293, 2005
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Cognitive TrainingIndirect Approaches Work, Too
PSYC S-1293, 2005
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Indirect Approaches Does Playing Bridge Improve
Cognition?

• Compared older bridge players to non-card playing
  controls. Higher Scores by bridge players
• In working memory
• Backward digit span
• Letter sets
• In reasoning
• Matrices
• Letter series
• Not in
• Response time
• Vocabulary

PSYC S-1293, 2005
73
Transcendental Meditationand Cognition

• Anxiety impedes the capacity to focus attention,
  anything that lowers anxiety improves mental
  function
• Psychologists at Harvard and Maharishi
  International University taught a group of 80
  year olds transcendental meditation (TM)
• Those receiving TM improved on memory, word
  fluency, and reasoning
• At follow-up three years later, all of those
  receiving TM were still alive. This compares
  with an overall survival rate of for this age
  group of 63.

Alexander, et al, 1989
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Enhancing Cognitive Vitality in Older Adults

• Authors review impact of training on reducing
  the magnitude of age- related cognitive decline
• Examines impact of experience
• Reviews fitness and cognitive sparing
• Discusses laboratory-based training

Kramer Willis, 2002
75
Enhancing Cognitive Vitality in Older Adults

• Role of experience
• Some studies show less decline among experienced
  typists pianists
• But they practiced longer and harder than younger
  Ss
• Role of fitness
• Some, but not all, studies show positive effects
• Greatest impact could be on executive
  functions planning, inhibition, working memory,
  multi-tasking

Kramer Willis, 2002
76
Enhancing Cognitive Vitality in Older Adults

• Looking at laboratory training authors conclude
• Training can improve cognition of old young
• Can improve targeted skills, and not others
• Especially when the task involves accuracy
  alone, not speed accuracy

Kramer Willis, 2002
77
Enhancing Cognitive Vitality in Older Adults

• Older (64-95) Ss from the Seattle Longitudinal
  Study were tested about every 7 years
• Ss were divided into 2 groups (1) those whose
  scores in reasoning spatial skills remained
  stable over the previous 14 years and (2) those
  whose scores had declined
• With 5 hours of training Ss whose scores had
  declined improved to the level 14 years earlier

Kramer Willis, 2002
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Stable Ss Effect of Training on Spatial Ability
by Gender
Willis Schaie, 1988
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Decline Ss Effect of Training on Spatial Ability
by Gender
Willis Schaie, 1988
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Limitations of Cognitive Training Studies

• Some cautions are warranted
• Not all studies produce positive results
• Effects seem narrow, only on the specific
  aptitude being trained
• No studies have as yet looked at whether
  the improved test performance generalizes to the
  real world

Kramer Willis, 2002
81
Selective Optimization With Compensation

• 3 interactive elements
• l Selection
• l Optimization
• l Compensation

Baltes, 1997
82
Selective Optimization With Compensation

• Selection
• l Concentration on fewer things
• l Where opportunities, abilities and
• motivation converge
• l Give up something where satisfaction less
  possible now or would interfere
• l Allows more satisfaction, personal
  control
• Examples?

Baltes, 1997
83
Selective Optimization With Compensation

• Optimization
• l Focus on selected activities that
• are most satisfying
• l Work to improve or maintain skills
• l Means letting other activities
• decline
• Examples?

Baltes, 1997
84
Selective Optimization With Compensation

• Compensation
• l Maximizing ability to continue to perform
• or participate in activities
• l In context of reduced capacities
• l By
• More thorough preparation
• Training
• Technology
• Examples?

Baltes, 1997