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An extensive body of research has investigated the association between cognition and blood pressure (BP). Limited research, however, has examined the association at the daily within-person level. No study has yet applied an intensive measurement design utilizing the convenience and objectivity of mobile devices for cognitive assessments and automated BP monitors. To address this gap in the literature, we recruited community-residing healthy adults (N=64; Mage=70.6, SD=3.5; 76.6% female), who recorded their BP and completed a battery of brief cognitive tasks twice daily for 14 days. Multi-level models estimated associations between systolic/diastolic BP (sBP/dBP) and cognitive functioning, adjusting for time-varying self-reported effort, stressors, and physical activity, as well as time-invariant variables (age, sex, education, and anti-hypertensive medication). At the interindividual level, results suggest that individuals with higher overall sBP and dBP relative to others performed worse on delayed-reproduction and visual short-term memory tasks. At the intraindividual level, on occasions when individuals had higher sBP compared to their personal average, they performed relatively worse on delayed-reproduction tasks. Mean sBP was also significant within these models, suggesting that this coupled relationship is stronger for individuals with higher sBP on average. Analyses did not indicate significant associations for working memory, reaction time, or cognitive interference assessments, which may have been due to relatively limited power for between-person analyses. Use of such digital health technology is critical for detecting the complex nature of and interplay between physiological and cognitive processes. Further, research based on intraindividual associations may contribute to strategies aiming to promote lifestyle modifications.

Background Given increasing incidence of cognitive impairment and dementia, further understanding of modifiable factors contributing to increased healthspan is crucial. Extensive literature provides evidence that physical activity (PA) delays the onset of cognitive impairment; however, it is unclear whether engaging in PA in older adulthood is sufficient to influence progression through cognitive status categories. Method Applying a coordinated analysis approach, this project independently analyzed 14 longitudinal studies (NTotal = 52 039; mean baseline age across studies = 69.9–81.73) from North America and Europe using multistate survival models to estimate the impact of engaging in PA on cognitive status transitions (nonimpaired, mildly impaired, severely impaired) and death. Multinomial regression models were fit to estimate life expectancy (LE) based on American PA recommendations. Meta-analyses provided the pooled effect sizes for the role of PA on each transition and estimated LEs. Results Controlling for baseline age, sex, education, and chronic conditions, analyses revealed that more PA is significantly associated with decreased risk of transitioning from nonimpaired to mildly impaired cognitive functioning and death, as well as substantially longer LE. Results also provided evidence for a protective effect of PA after onset of cognitive impairment (eg, decreased risk of transitioning from mild-to-severe cognitive impairment; increased likelihood of transitioning backward from severe-to-mild cognitive impairment), though between-study heterogeneity suggests a less robust association. Conclusions These results yield evidence for the importance of engaging in PA in older adulthood for cognitive health, and a rationale for motivating older adults to engage consistently in PA.

Background:There is a pressing need for assessment approaches that can be deployed remotely to measure cognitive outcomes in clinical trials and longitudinal aging cohorts. We evaluated the utility of a mobile phone-based intensive measurement study for this purpose. Method:A small cohort of healthy older adults (N = 17, mean age = 73) completed five assessment "bursts" over 12 months, with each measurement burst involving two assessments daily for five consecutive days. Each assessment included brief tests of visual short-term memory and information processing speed, as well as surveys measuring state factors that can affect cognition. Results:At study endpoint we had 94% retention, 97% compliance, and high participant satisfaction. Mobile cognitive test scores demonstrated good reliability, moderate correlations with in-person baseline neuropsychological testing, and significant associations with participant age and education level. Conclusions: Mobile phone-based intensive measurement designs represent a promising assessment approach for measuring cognition longitudinally in older adults.

Previous cross-sectional research suggests that age-related decreases in Rapid-Eye Movement (REM) sleep may contribute to poorer cognitive functioning (CF); however, few studies have examined the relationship at the intraindividual level by measuring habitual sleep over multiple days. Applying a 14-day daily diary design, the current study examines the dynamic relationship between REM sleep and CF in 69 healthy older adults (M age=70.8 years, SD=3.37; 73.9% female; 66.6% completed at least an undergraduate degree). A Fitbit device provided actigraphy indices of REM sleep (minutes and percentage of total sleep time), while CF was measured four times daily on a smartphone via ambulatory cognitive tests that captured processing speed and working memory. This research addressed the following questions: At the within-person level, are fluctuations in quantity of REM sleep associated with fluctuations in next day cognitive measures across days? Do individuals who spend more time in REM sleep on average, perform better on cognitive tests than adults who spend less time in REM sleep? A series of multilevel models were fit to examine the extent to which each index of sleep accounted for daily fluctuations in performance on next day cognitive tests. Results indicated that during nights when individuals had more REM sleep minutes than was typical, they performed better on the working memory task the next morning (estimate = -.003, SE = .002, p = .02). These results highlight the impact of REM sleep on CF, and further research may allow for targeted interventions for earlier treatment of sleep-related cognitive impairment.

Measures of clinical significance offer important information about psychological interventions that cannot be garnered from tests of the statistical significance of the change from pretest to posttest. For example, post-intervention comparisons to a nonclinical group often offer valuable information about the practical value of the change that occurred. This study explored the manner in which researchers conduct clinical significance analyses in an effort to summarize the effectiveness of an intervention at the group level. The focus was on the use of the original Jacobson and Truax (Journal of Consulting and Clinical Psychology, 59, 12–19, 1991) method and the normative comparisons method due to Kendall et al. (Journal of Consulting and Clinical Psychology, 67, 285–299, 1999). The results highlight that although the Jacobson and Truax method is routinely adopted for summarizing group-level clinical significance, advanced strategies for summarizing the results are very infrequently applied. Further, the Kendall et al. method, which provides valuable and distinct information regarding how the treated group is performing relative to a normal comparison group, is rarely adopted and even when it is it is often not conducted appropriately. Recommendations are provided for conducting group-level clinical significance analyses.