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Maintenance of independence is a challenge for nursing home residents whose pain is often substantial. The objective of this study was to explore the relationship between pain perception and care dependency in a population of Dutch nursing home residents. Prospective cohort study. Dutch nursing home residents aged 65 or older, excluding residents with a severe cognitive impairment. The Numeric Rating Scale (NRS) was used to rate pain perception from 0 to 10 in half-point increments and the Care Dependency Scale (CDS) to measure care dependency, with scores ranging from 15 (completely care dependent) to 75 (fully independent). Both measurements were repeated after a 2-month follow-up. Multiple linear regression analysis was used to adjust for potential confounders. Missing data were dealt with by performing tenfold multiple imputation. A total of 1256 residents (65% women, mean age 83 years) were included. At baseline, the median NRS pain score was 3.0 (interquartile range 0.0–6.0) and the mean CDS score was 55.9 (SD 11.5). Cross-sectionally, for 1-point increase in pain score, care dependency increased 0.65 points [95% confidence interval (CI) 0.46–0.83]. More pain at baseline was associated with slightly lower care dependency after 2 months (beta 0.20, 95% CI 0.01–0.39). Compared with residents whose pain decreased over 2 months, residents with stable pain or increased pain had a 2.27-point (95% CI 0.83–3.70) and 2.39-point (95% CI 0.87–3.90) greater increase in care dependency, respectively. Pain perception and care dependency are associated in a population of older nursing home residents, and stable or increased pain is associated with increased care dependency progression. The findings of this study emphasize that pain and care dependency should not be assessed nor treated independently. [ABSTRACT FROM AUTHOR]

Although cognitive impairments are still prevalent in the current antiretroviral therapy era, limited investigations have compared the prevalence of cognitive disorder in people living with HIV (PLWH) and its determinants in different regions and ethnicities. We compared cognitive performance across six domains using comparable batteries in 134 PLWH aged ≥45 years from the COBRA study (Netherlands, UK), and 194 PLWH aged ≥18 years from the NeuroAIDS Project (South Korea). Cognitive scores were standardized and averaged to obtain domain and global T-scores. Associations with global T-scores were evaluated using multivariable regression and the ability of individual tests to detect cognitive impairment (global T-score ≤45) was assessed using the area-under-the-receiver-operating-characteristic curve (AUROC). The median (interquartile range) age of participants was 56 (51, 62) years in COBRA (88% white ethnicity, 93% male) and 45 (37, 52) years in NeuroAIDS (100% Korean ethnicity, 94% male). The rate of cognitive impairment was 18.8% and 18.0%, respectively (p = 0.86). In COBRA, Black-African ethnicity was the factor most strongly associated with cognitive function (11.1 [7.7, 14.5] lower scores vs. white ethnicity, p < 0.01), whereas in NeuroAIDS, age (0.6 [0.1, 1.3] per 10-year, p <0.01) and education (0.7 [0.5, 0.9] per year, p <0.01) were significantly associated with cognitive function with anemia showing only a weak association (−1.2 [−2.6, 0.3], p=0.12). Cognitive domains most associated with cognitive impairment were attention (AUROC = 0.86) and executive function (AUROC = 0.87) in COBRA and processing speed (AUROC = 0.80), motor function (AUROC = 0.78) and language (AUROC = 0.78) in NeuroAIDS. Two cohorts of PLWH from different geographical regions report similar rates of cognitive impairment but different risk factors and cognitive profiles of impairment. [ABSTRACT FROM AUTHOR]

Abstract Adherence to the Mediterranean Diet (MedDiet) has been suggested to reduce the risk of age-related cognitive decline. Therefore, we hypothesized that adults consuming a more Mediterranean-like diet were more likely to have better cognitive scores. We investigated cross-sectional associations between MedDiet adherence and cognitive performance using data of 1607 Dutch men and women aged 20–70 years. Dietary intake was assessed using a 183-item Food Frequency Questionnaire. MedDiet adherence was defined by a 0–9 point scale; which was based on intakes of vegetables, legumes, fruits/nuts, cereals, fish/seafood, meat/poultry, dairy, ethanol and the MUFA:SFA ratio. Cognitive function was assessed with a neuropsychological test battery. Linear regression analyses adjusted for relevant covariates showed a significant inverse association between MedDiet adherence and everyday memory: specifically β = −0.107 ± 0.046 points (P =.02) for the total population and β = −0.139 ± 0.055 points (P =.01) for those aged ≥50 years. Further exploration of the individual MedDiet food groups suggested that the association between MedDiet and every day memory was predominantly driven by the MUFA:SFA ratio. Moreover, associations were observed between higher ethanol intake with better semantic memory and language production (β = 0.016 ± 0.008 P =.05), higher vegetable intake with better processing speed (β = 0.005 ± 0.002, P =.02), and higher legumes intake with poorer processing speed (β = −0.014 ± 0.006, P =.03). Thus, in this Dutch cohort, higher MedDiet adherence was associated with poorer everyday memory. [ABSTRACT FROM AUTHOR]

Objectives:The ability to manage one's life with some degree of independence, to fulfill basic obligations, and to participate in social activities are social functions that delineate the core of ‘social health’. We examine to what extent clients of community care in Europe (n= 2884) complete such activities despite their cognitive problems. We focus on mildly and moderately impaired people, aged 65+ years. Methods:Data were collected using the interRAI HC-Assessment in IBenC-project. We tested the association between participants' capacity and performance in three LADLs (instrumental activities of daily living) and their cognitive performance and specific memory problems. Results:About 30% of home care clients in Europe suffer from mild-to-moderate cognitive impairment. Their relatively independent coping with requirements of routine activities is strongly determined by overall cognitive performance. Specific memory functions seem unimportant, except for procedural memory. It is striking that all clients, and particularly those with mild-to-moderate cognitive impairment, interact mostly with close relatives and friends. Mild-to-moderate cognitive limitations do not hinder clients from coping semi-independently with routine requirements. Discussion:When considering the influence of cognitive function on clients' capacity and performance in everyday activities and social relations, a comprehensive construct of cognitive function has to be applied. [ABSTRACT FROM PUBLISHER]

BackgroundSeveral psychosocial risk factors for complicated grief have been described. However, the association of complicated grief with cognitive and biological risk factors is unclear. The present study examined whether complicated grief and normal grief are related to cognitive performance or structural brain volumes in a large population-based study.MethodThe present research comprised cross-sectional analyses embedded in the Rotterdam Study. The study included 5501 non-demented persons. Participants were classified as experiencing no grief (n = 4731), normal grief (n = 615) or complicated grief (n = 155) as assessed with the Inventory of Complicated Grief. All persons underwent cognitive testing (Mini-Mental State Examination, Letter–Digit Substitution Test, Stroop Test, Word Fluency Task, word learning test – immediate and delayed recall), and magnetic resonance imaging to measure general brain parameters (white matter, gray matter), and white matter lesions. Total brain volume was defined as the sum of gray matter plus normal white matter and white matter lesion volume. Persons with depressive disorders were excluded and analyses were adjusted for depressive symptoms.ResultsCompared with no-grief participants, participants with complicated grief had lower scores for the Letter–Digit Substitution Test [Z-score −0.16 v. 0.04, 95% confidence interval (CI) −0.36 to −0.04, p = 0.01] and Word Fluency Task (Z-score −0.15 v. 0.03, 95% CI −0.35 to −0.02, p = 0.02) and smaller total volumes of brain matter (933.53 ml v. 952.42 ml, 95% CI −37.6 to −0.10, p = 0.04).ConclusionsParticipants with complicated grief performed poorly in cognitive tests and had a smaller total brain volume. Although the effect sizes were small, these findings suggest that there may be a neurological correlate of complicated grief, but not of normal grief, in the general population. [ABSTRACT FROM PUBLISHER]

Purpose: Maintenance of cognitive abilities is important for elderly to stay independent. With the aging of the population, the call for modifiable factors is emerging. Dietary protein might improve cognitive performance; however, this has hardly been studied. Therefore, we studied the impact of 24-week dietary protein supplementation on cognitive performance in pre-frail and frail elderly people. Methods: Pre-frail and frail elderly subjects, according to the Fried criteria, randomly received a protein drink containing 15 g protein or a placebo drink twice a day. Cognitive performance was measured at baseline and after 24 weeks by means of a sensitive neuropsychological test battery. In addition, reaction time was assessed after both 12 and 24 weeks of intervention. Domain scores were calculated for the domains episodic memory, attention and working memory, information processing speed, and executive functioning. Analyses of covariance were used to determine differences between groups. Linear mixed models were used to determine differences in reaction time over time and per treatment. Results: In total, 65 subjects (79 ± 8 years) with a median Mini-Mental State Examination score of 28 (interquartile range 26-30) were included. Reaction time improved more in the protein group (68 ms) than in the placebo group (18 ms, P = 0.03). Dietary protein had no significant effect on any of the cognitive domain scores. Conclusions: Protein supplementation might improve reaction time performance in pre-frail and frail elderly, but did not improve other cognitive functions. [ABSTRACT FROM AUTHOR]

Background: cognitive decline and muscle weakness are prevalent health conditions in elderly people. We hypothesised that cognitive decline precedes muscle weakness.Objective: to analyse the temporal relationship between cognitive performance and handgrip strength in oldest old people.Design: prospective population-based 4-year follow-up study.Subjects: a total of 555 subjects, all aged 85 years at baseline, were included into the study.Methods: handgrip strength measured at age 85 and 89 years. Neuropsychological test battery to assess global cognitive performance, attention, processing speed and memory at baseline and repeated at age 89 years. Associations between handgrip strength and cognitive performance were analysed by repeated linear regression analysis adjusted for common confounders.Results: at age 85 and 89 years, better cognitive performance was associated with higher handgrip strength (all, P < 0.03), except for attention. There was no longitudinal association between baseline handgrip strength and cognitive decline (all, P > 0.10), except for global cognitive performance (P = 0.007). Better cognitive performance at age 85 years was associated with slower decline in handgrip strength (all, P < 0.01) after adjustment for common confounders.Conclusion: baseline cognitive performance was associated with decline in handgrip strength, whereas baseline handgrip strength was not associated with cognitive decline. Our results suggest that cognitive decline precedes the onset of muscle weakness in oldest old people. [ABSTRACT FROM AUTHOR]

Long-term alcohol abuse is associated with poorer cognitive performance. However, the associations between light and moderate drinking and cognitive performance are less clear. We assessed this association via cross-sectional and longitudinal analyses in a sample of 702 Dutch students. At baseline, alcohol consumption was assessed using questionnaires and ecological momentary assessment (EMA) across four weeks ('Wave 1'). Subsequently, cognitive performance, including memory, planning, and reasoning, was assessed at home using six standard cognition tests presented through an online platform. A year later, 436 students completed the four weeks of EMA and online cognitive testing ('Wave 2'). In both waves, there was no association between alcohol consumption and cognitive performance. Further, alcohol consumption during Wave 1 was not related to cognitive performance at Wave 2. In addition, EMA-data-based drinking patterns, which varied widely between persons but were relatively consistent over time within persons, were also not associated with cognitive performance. Post-hoc analyses of cognitive performance revealed higher within-person variance scores (from Wave 1 to Wave 2) than between-person variance scores (both Wave 1 and Wave 2). In conclusion, no association was observed between alcohol consumption and cognitive performance in a large Dutch student sample. However, the online cognitive tests performed at home may not have been sensitive enough to pick up differences in cognitive performance associated with alcohol consumption.

Background: Poor cognitive performance is associated with high vascular risk. However, this association is only investigated in elderly. As neuropathological changes precede clinical symptoms of cognitive impairment by several decades, it is likely that cognitive performance is already associated with vascular risk at middle-age., Objectives: To investigate the association of cognitive performance with treatable vascular risk in middle-aged and old persons., Design: Longitudinal study with three measurements during follow-up period of 5.5 years., Setting: City of Groningen, the Netherlands., Participants: Cohort of 3,572 participants (age range, 35-82 years; mean age, 54 years; men, 52%)., Exposure: Treatable vascular risk as defined by treatable components of the Framingham Risk Score for Cardiovascular Disease at the first measurement (diabetes mellitus, smoking, hypercholesterolemia and hypertension)., Measurements: Change in cognitive performance during follow-up. Cognitive performance was measured with Ruff Figural Fluency Test (RFFT) and Visual Association Test (VAT), and calculated as the average of the standardized RFFT and VAT score per participant., Results: The mean (SD) cognitive performance changed from 0.00 (0.79) at the first measurement to 0.15 (0.83) at second measurement and to 0.39 (0.82) at the third measurement (Ptrend<0.001). This change was negatively associated with treatable vascular risk: the change in cognitive performance between two measurements decreased with 0.004 per one-point increment of treatable vascular risk (95%CI, -0.008 to 0.000; P=0.05) and with 0.006 per one-year increment of age (95%CI, -0.008 to -0.004; P<0.001)., Conclusions: Change in cognitive performance was associated with treatable vascular risk in persons aged 35 years or older., Competing Interests: There is no conflict of interest.

Attention-deficit/hyperactivity disorder (ADHD) in childhood is characterized by gray and white matter abnormalities in several brain areas. Considerably less is known about white matter microstructure in adults with ADHD and its relation with clinical symptoms and cognitive performance. In 107 adult ADHD patients and 109 gender-, age- and IQ-matched controls, we used diffusion tensor imaging (DTI) with tract-based spatial statistics (TBSS) to investigate whole-skeleton changes of fractional anisotropy (FA) and mean, axial, and radial diffusivity (MD, AD, RD). Additionally, we studied the relation of FA and MD values with symptom severity and cognitive performance on tasks measuring working memory, attention, inhibition, and delay discounting. In comparison to controls, participants with ADHD showed reduced FA in corpus callosum, bilateral corona radiata, and thalamic radiation. Higher MD and RD were found in overlapping and even more widespread areas in both hemispheres, also encompassing internal and external capsule, sagittal stratum, fornix, and superior lateral fasciculus. Values of FA and MD were not associated with symptom severity. However, within some white matter clusters that distinguished patients from controls, worse inhibition performance was associated with reduced FA and more impulsive decision making was associated with increased MD. This study shows widespread differences in white matter integrity between adults with persistent ADHD and healthy individuals. Changes in RD suggest aberrant myelination as a pathophysiological factor in persistent ADHD. The microstructural differences in adult ADHD may contribute to poor inhibition and greater impulsivity but appear to be independent of disease severity., (Copyright © 2015. Published by Elsevier Inc.)

Operational performance in military settings involves physical and mental skills that are generally investigated separately in lab settings, leading to reduced ecological validity. Therefore, we investigated the effects of anxiety and exercise-induced fatigue, separately and in combination, on cognitive and shooting performance of 22 soldiers in a real-world setting. Findings indicated that soldiers' shooting accuracy and decision-making and mathematical skills decreased significantly under anxiety. Whether exercise-induced fatigue was beneficial or detrimental to task performance depended on the task at hand. The increased arousal levels through exercise prevented shooting accuracy from deteriorating in the decision task. In contrast, cognitive performance suffered from the increased arousal: participants more often failed to shoot when being fired at by an opponent and also math performance seemed to decrease. We conclude that anxiety can deteriorate soldier performance and that exercise-induced fatigue may improve or deteriorate performance in combination with anxiety depending on the nature of the task., Practitioner Summary: Soldiers encounter anxiety and exercise-induced fatigue. We investigated to what degree these factors influence soldiers' shooting and cognitive performance. Experimental manipulation of anxiety and exercise during a representative field course indicated decreased performance under anxiety. Exercise prevented shooting accuracy from deteriorating under anxiety, although cognitive performance was negatively affected after exercise.