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Search Results: 1 - 10 of 468647 matches for " Patricia A Boyle "
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Relation of neuropathology with cognitive decline among older persons without dementia
Patricia A. Boyle,Lei Yu,David A. Bennett
Frontiers in Aging Neuroscience , 2013, DOI: 10.3389/fnagi.2013.00050
Abstract: Objective: Although it is now widely accepted that dementia has a long preclinical phase during which neuropathology accumulates and cognition declines, little is known about the relation of neuropathology with the longitudinal rate of change in cognition among older persons without dementia. We quantified the burden of the neuropathologies of the three most common causes of dementia [i.e., Alzheimer’s disease (AD), cerebrovascular disease (CVD), and Lewy body disease (LBD)] and examined their relation with cognitive decline in a large cohort of persons without dementia proximate to death.
Risk Aversion is Associated with Decision Making among Community-Based Older Persons
Patricia A. Boyle,Aron S. Buchman,David A. Bennett
Frontiers in Psychology , 2012, DOI: 10.3389/fpsyg.2012.00205
Abstract: Background: Risk aversion is associated with many important decisions among younger and middle aged persons, but the association of risk aversion with decision making has not been well studied among older persons who face some of the most significant decisions of their lives. Method: Using data from 606 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal epidemiologic study of aging, we examined the association of risk aversion with decision making. Risk aversion was measured using standard behavioral economics questions in which participants were asked to choose between a certain monetary payment ($15) versus a gamble in which they could gain more than $15 or gain nothing; potential gamble gains ranged from $20 to $300 with the gain amounts varied randomly over questions. Decision making was measured using a 12 item version of the Decision Making Competence Assessment Tool. Findings: In a linear regression model adjusted for age, sex, education, and income, greater risk aversion was associated with poorer decision making [estimate = ?1.03, standard error (SE) = 0.35, p = 0.003]. Subsequent analyses showed that the association of risk aversion with decision making persisted after adjustment for global cognitive function as well as executive and non-executive cognitive abilities. Conclusion: Similar to findings from studies of younger persons, risk aversion is associated with poorer decision making among older persons who face a myriad of complex and influential decisions.
Association of cognition with temporal discounting in community based older persons
Boyle Patricia A,Yu Lei,Segawa Eisuke,Wilson Robert S
BMC Geriatrics , 2012, DOI: 10.1186/1471-2318-12-48
Abstract: Background The objective of this study was to test the hypothesis that cognitive function is negatively associated with temporal discounting in old age. Methods Participants were 388 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal epidemiologic study of aging in the Chicago metropolitan area. Temporal discounting was measured using standard questions in which participants were asked to choose between an immediate, smaller payment and a delayed, larger one. Cognition was measured using a detailed battery including 19 tests. The association between cognition and temporal discounting was examined via mixed models adjusted for age, sex, education, income, and the number of chronic medical conditions. Results Descriptive data revealed a consistent pattern whereby older persons with lower cognitive function were more likely to discount greater but delayed rewards compared to those with higher cognitive function. Further, in a mixed effect model adjusted for age, sex, education, income, and chronic medical conditions, global cognitive function was negatively associated with temporal discounting (estimate = 0.45, SE = 0.18, p = 0.015), such that a person with lower cognition exhibited greater discounting. Finally, in subsequent models examining domain specific associations, perceptual speed and visuospatial abilities were associated with temporal discounting, but episodic memory, semantic memory and working memory were not. Conclusion Among older persons without dementia, a lower level of cognitive function is associated with greater temporal discounting. These findings have implications regarding the ability of older persons to make decisions that involve delayed rewards but maximize well-being.
Faster cognitive decline in the years prior to MR imaging is associated with smaller hippocampal volumes in cognitively healthy older persons
Debra A. Fleischman,Lei Yu,Konstantinos Arfanakis,S. Duke Han,Patricia A. Boyle,David A. Bennett
Frontiers in Aging Neuroscience , 2013, DOI: 10.3389/fnagi.2013.00021
Abstract: Early identification of persons at risk for cognitive decline in aging is critical to optimizing treatment to delay or avoid a clinical diagnosis of mild cognitive impairment (MCI) or dementia due to Alzheimer's disease (AD). To accomplish early identification, it is essential that trajectories of cognitive change be characterized and associations with established biomarkers of MCI and AD be examined during the phase in which older persons are considered cognitively healthy. Here we examined the association of rate of cognitive decline in the years leading up to structural magnetic resonance imaging with an established biomarker, hippocampal volume. The sample comprised 211 participants of the Rush Memory and Aging Project who had an average of 5.5 years of cognitive data prior to structural scanning. Results showed that there was significant variability in the trajectories of cognitive change prior to imaging and that faster cognitive decline was associated with smaller hippocampal volumes. Domain-specific analyses suggested that this association was primarily driven by decline in working memory. The results emphasize the importance of closely examining cognitive change and its association with brain structure during the years in which older persons are considered cognitively healthy.
Poor Decision Making Is a Consequence of Cognitive Decline among Older Persons without Alzheimer’s Disease or Mild Cognitive Impairment
Patricia A. Boyle, Lei Yu, Robert S. Wilson, Keith Gamble, Aron S. Buchman, David A. Bennett
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0043647
Abstract: Objective Decision making is an important determinant of health and well-being across the lifespan but is critical in aging, when many influential decisions are made just as cognitive function declines. Increasing evidence suggests that older adults, even those without dementia, often make poor decisions and are selectively vulnerable to scams. To date, however, the factors associated with poor decision making in old age are unknown. The objective of this study was to test the hypothesis that poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment. Methods Participants were 420 non-demented persons from the Memory and Aging Project, a longitudinal, clinical-pathologic cohort study of aging in the Chicago metropolitan area. All underwent repeated cognitive evaluations and subsequently completed assessments of decision making and susceptibility to scams. Decision making was measured using 12 items from a previously established performance-based measure and a self-report measure of susceptibility to scams. Results Cognitive function data were collected over an average of 5.5 years prior to the decision making assessment. Regression analyses were used to examine whether the prior rate of cognitive decline predicted the level of decision making and susceptibility to scams; analyses controlled for age, sex, education, and starting level of cognition. Among 420 persons without dementia, more rapid cognitive decline predicted poorer decision making and increased susceptibility to scams (p’s<0.001). Further, the relations between cognitive decline, decision making and scams persisted in analyses restricted to persons without any cognitive impairment (i.e., no dementia or even mild cognitive impairment). Conclusions Poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment, those widely considered “cognitively healthy.” These findings suggest that even very subtle age-related changes in cognition have detrimental effects on judgment.
Cognitive function is associated with risk aversion in community-based older persons
Patricia A Boyle, Lei Yu, Aron S Buchman, David I Laibson, David A Bennett
BMC Geriatrics , 2011, DOI: 10.1186/1471-2318-11-53
Abstract: Using data from 369 community-dwelling older persons without dementia from the Rush Memory and Aging Project, an ongoing longitudinal epidemiologic study of aging, we examined the correlates of risk aversion and tested the hypothesis that cognition is negatively associated with risk aversion. Global cognition and five specific cognitive abilities were measured via detailed cognitive testing, and risk aversion was measured using standard behavioral economics questions in which participants were asked to choose between a certain monetary payment ($15) versus a gamble in which they could gain more than $15 or gain nothing; potential gamble gains ranged from $21.79 to $151.19 with the gain amounts varied randomly over questions. We first examined the bivariate associations of age, education, sex, income and cognition with risk aversion. Next, we examined the associations between cognition and risk aversion via mixed models adjusted for age, sex, education, and income. Finally, we conducted sensitivity analyses to ensure that our results were not driven by persons with preclinical cognitive impairment.In bivariate analyses, sex, education, income and global cognition were associated with risk aversion. However, in a mixed effect model, only sex (estimate = -1.49, standard error (SE) = 0.39, p < 0.001) and global cognitive function (estimate = -1.05, standard error (SE) = 0.34, p < 0.003) were significantly inversely associated with risk aversion. Thus, a lower level of global cognitive function and female sex were associated with greater risk aversion. Moreover, performance on four out of the five cognitive domains was negatively related to risk aversion (i.e., semantic memory, episodic memory, working memory, and perceptual speed); performance on visuospatial abilities was not.A lower level of cognitive ability and female sex are associated with greater risk aversion in advanced age.Compelling economics, behavioral economics, and neuroeconomics studies have shown that r
Correlates of health and financial literacy in older adults without dementia
Jarred S Bennett, Patricia A Boyle, Bryan D James, David A Bennett
BMC Geriatrics , 2012, DOI: 10.1186/1471-2318-12-30
Abstract: We conducted a cross-sectional study using data from the Rush Memory and Aging Project, a community-based cohort study of aging in northeastern Illinois. The study consisted of 556 older persons without dementia, each determined by a clinical evaluation. Health and financial literacy were measured using a series of questions designed to assess the ability to understand and process health and financial information, concepts, and numeracy; the two scores were averaged to yield a total literacy score. Health promoting behaviors, including engagement in cognitive, physical, and social activities, were assessed using self report measures. Indicators of heath status, including cognition (global cognition and five specific cognitive abilities), functional status (basic and instrumental activities of daily living, mobility disability), and mental health (depressive symptoms, loneliness) were assessed.In a series of regression models adjusted for age, sex, and education, higher total literacy scores were associated with more frequent participation in health promoting behaviors, including cognitive, physical and social activities (all p values <0.05). Higher total literacy scores were associated with higher cognitive function, less disability, and better mental health (all p values?<?0.05). Literacy remained associated with health promoting behaviors and health status in fully adjusted models that also controlled for income and the number of chronic medical conditions. Most of the findings were similar for health and financial literacy except that health literacy was more strongly associated with health promoting behaviors whereas financial literacy was more strongly associated with mental health.Health and financial literacy are associated with more frequent engagement in health promoting behaviors and better health status in older persons without dementia.
Temporal Discounting Is Associated with an Increased Risk of Mortality among Community-Based Older Persons without Dementia
Patricia A. Boyle, Lei Yu, Keith J. Gamble, David A. Bennett
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0067376
Abstract: Background Temporal discounting is an important determinant of many health and financial outcomes, but we are not aware of studies that have examined the association of temporal discounting with mortality. Methods Participants were 406 older persons without dementia from the Rush Memory and Aging Project, a longitudinal cohort study of aging. Temporal discounting was measured using standard preference elicitation questions. Individual discount rates were estimated using a well-established hyperbolic function and used to predict the risk of mortality during up to 5 years of follow-up. Results The mean estimate of discounting was 0.45 (SD = 0.33, range: 0.08–0.90), with higher scores indicating a greater propensity to prefer smaller immediate rewards over larger but delayed ones. During up to 5 years of follow-up (mean = 3.6 years), 62 (15% of 406) persons died. In a proportional hazards model adjusted for age, sex, and education, temporal discounting was associated with an increased risk of mortality (HR = 1.103, 95% CI 1.024, 1.190, p = 0.010). Thus, a person with the highest discount rate (score = 0.90) was about twice more likely to die over the study period compared to a person with the lowest discount rate (score = 0.08). Further, the association of discounting with mortality persisted after adjustment for the level of global cognitive function, the burden of vascular risk factors and diseases, and an indicator of psychological well being (i.e., purpose in life). Conclusion Temporal discounting is associated with an increased risk of mortality in old age after accounting for global cognitive function and indicators of physical and mental health.
Association of total daily physical activity with disability in community-dwelling older persons: a prospective cohort study
Shah Raj C,Buchman Aron S,Leurgans Sue,Boyle Patricia A
BMC Geriatrics , 2012, DOI: 10.1186/1471-2318-12-63
Abstract: Background Based on findings primarily using self-report measures, physical activity has been recommended to reduce disability in old age. Collecting objective measures of total daily physical activity in community-dwelling older adults is uncommon, but might enhance the understanding of the relationship of physical activity and disability. We examined whether greater total daily physical activity was associated with less report of disability in the elderly. Methods Data were from the Rush Memory and Aging Project, a longitudinal prospective cohort study of common, age-related, chronic conditions. Total daily physical activity was measured in community-dwelling participants with an average age of 82 using actigraphy for approximately 9 days. Disability was measured via self-reported basic activities of daily living (ADL). The odds ratio and 95% Confidence Interval (CI) were determined for the baseline association of total daily physical activity and ADL disability using a logistic regression model adjusted for age, education level, gender and self-report physical activity. In participants without initial report of ADL disability, the hazard ratio and 95% CI were determined for the relationship of baseline total daily physical activity and the development of ADL disability using a discrete time Cox proportional hazard model adjusted for demographics and self-report physical activity. Results In 870 participants, the mean total daily physical activity was 2. 9 × 105 counts/day (range in 105 counts/day = 0.16, 13. 6) and the mean hours/week of self-reported physical activity was 3.2 (SD = 3.6). At baseline, 718 (82.5%) participants reported being independent in all ADLs. At baseline, total daily physical activity was protective against disability (OR per 105 counts/day difference = 0.55; 95% CI = 0.47, 0.65). Of the participants without baseline disability, 584 were followed for 3.4 years on average. Each 105 counts/day additional total daily physical activity was associated with reduced hazard of developing disability by 25% (HR = 0.75, 95% CI = 0.66, 0.84). The results were unchanged after controlling for important covariates including cognition, depressive symptoms, and chronic health conditions. Conclusions Greater total daily physical activity is independently associated with less disability even after controlling for self-reported physical activity.
Combinations of motor measures more strongly predict adverse health outcomes in old age: the rush memory and aging project, a community-based cohort study
Aron S Buchman, Sue E Leurgans,, Patricia A Boyle,, Julie A Schneider,, Steven E Arnold, David A Bennett
BMC Medicine , 2011, DOI: 10.1186/1741-7015-9-42
Abstract: In total, 949 people without dementia, history of stroke or Parkinson's disease, who were participating in the Rush Memory and Aging Project (a longitudinal community-based cohort study), underwent assessment at study entry. From this, three constructs were derived: 1) physical frailty based on grip strength, timed walk, body mass index and fatigue; 2) Parkinsonian Signs Score based on the modified motor section of the Unified Parkinson's Disease Rating Scale; and 3) a motor construct, based on nine strength measures and nine motor performances. Disability and cognitive status were assessed annually. A series of Cox proportional-hazards models, controlling for age, sex and education, were used to examine the association of each of these three constructs alone and in various combinations with death, disability and Alzheimer's disease (AD).All three constructs were related (mean r = 0.50, all P < 0.001), and when considered individually in separate proportional-hazards models, were associated with risk of death, incident disability and AD. However, when considered together, combinations of these constructs more strongly predicted adverse health outcomes.Physical frailty, parkinsonian signs score and global motor score are related constructs that capture different aspects of motor function. Assessments using several motor constructs may more accurately identify people at the highest risk of adverse health consequences in old age.Loss of motor function is a common consequence of old age, and is associated with adverse health consequences [1-5]. The specific motor abilities impaired in old age vary, and encompass a wide spectrum, including reduced gait speed and loss of muscle strength and bulk, balance, and dexterity [6-8]. Thus, the growing public-health challenge of identifying motor impairment in old age is complicated by the variability of its clinical expression.Currently there is no single scale that can be used to assess motor impairments. Several constructs base
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