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Cognitive functioning from normal to dementia

Cognitive functioning refers to higher order brain functions involved in memory and thinking, abilities that are at high risk for compromised functioning in later life. Although normal aging does not produce cognitive disability, the aging nervous system becomes more vulnerable for various disease processes and especially for the prevalent co-morbidity observed in late life. This work-area, directed by Boo Johansson, studies inter-relationships among genetic, biological, and psychosocial risk factors for cognitive decline and dementia (e.g. Alzheimer´s disease and vascular dementia), life satisfaction, and decision making in the elderly and whether and how the influence of various risk factors and their interactions change with age. Another primary focus is to identify predictors and preclinical symptoms of cognitive decline and dementia, as well as conditions and factors that may protect cognitive functioning, whether individuals with dementia are recognized by the health care system and if they are properly treated, and to study long-term prognosis of dementia and cognitive decline in relation to institutionalization and mortality. The analyses employ data from neuropsychological, psychiatric, genetic, somatic and psychosocial examinations, as well as data from brain imaging, cerebrospinal fluid analysis, and personality inventories. The overall aim of the cognition work-area is to address questions about the interrelationships between health and cognitive functioning, across the entire spectrum from normal to impaired cognition using various population studies conducted at the University of Gothenburg. The work plan consists primarily of several related projects as described below, which employ identical or similar measures of cognitive function and dementia.

Determinants of cognitive decline in old age

Aims of this project are to improve understanding of factors that contribute to cognitive decline and functional disabilities among healthy elderly and individuals in the face of pre-clinical dementia. Better understanding of interaction of life-style factors, physical conditions, biomarkers, and genetic markers and their associated effects with cognitive functioning and decline will improve guidance for general public health recommendations and interventions aiming to minimize and prevent cognitive impairment, disabilities, and dependence in old age. Over the last decades, there has been extensive development and improvement in statistical theory and computational power that now allow us to use analytical techniques appropriate for longitudinal studies and a continuing discussion concerning validity threats in longitudinal cognitive aging studies. Results from our previous studies have shown that there is a substantial variability in level of cognitive performance, time of onset of decline, and rate of decline in the general population. A logical next step is to improve our understanding of this variability by identification of interactions of genetic factors, life-style factors, functional biomarkers and neurobiological markers. One lifestyle factor that we have examined with respect to cognitive health is physical activity. We have shown that regular physical activity is positively related to better cognitive status and lower depression and that change in physical activity are associated with changes in depression and cognition in older adults.

In accordance with the aims we apply integrated data analysis using complementary major Swedish longitudinal aging studies, including the large scale epidemiological studies (the Gerontological and Geriatric Population Studies H70, Origins of Variance in Oldest-Old, and the Lund 80 study) and one memory clinic study (the Gothenburg MCI study in which patients identified with mild cognitive impairment are followed longitudinally). In these projects we use “state of the art” methodological approaches including latent growth curve modeling within multilevel modeling (MLM) and structural equation modeling (SEM) frameworks with specific emphasis on identification and proper hypothesis testing of determinant of within-person (e.g., longitudinal) sources of variability.

Cohort differences in cognitive function

The observation that cognitive performance typically is better in younger as compared with older birth cohorts is a challenging finding for aging research. In these studies we analyze cohort differences across multiple cognitive variables in the context of physical and mental health, social, and demographic variables to better understand the role of contributing factors. Access to data from population-based samples, aged 70 and older, recruited from Swedish birth cohorts born in between 1900-1930, are used in these analyses. The main data base is the longitudinal H 70 Study in Gothenburg. Data are also available from the longitudinal 80 studies conducted in Lund. Knowledge about factors that contribute to observed cohort differences is valuable in the prediction of the magnitude of age related changes in future cohorts and in the clinical context where an evaluation typically is based on a distinction between what is considered 'normal cognitive aging' and cognitive impairment or dementia.

Protective factors for normal cognitive function in late-life

Alike many non-researchers we wonder why some maintain good cognitive function while others endure significant cognitive decline and dementia. We examine this question by comparing individuals characterized by stable cognitive function with those of experiencing cognitive decline regarding the role of protective factors. Our hypothesis is that preserved cognitive function is dependent not only on the absence of risk factors but also on the presence of protective factors. Research has mainly focused on detecting risk factors and many have been discovered. Knowledge concerning protective factors is currently lacking. The project is based on data from the OCTO-Twin study and the Swedish Twin Registry. We use survey data collected in the sixties and seventies (midlife data), as well as in-person-testing data from two longitudinal studies that started in the eighties and the nineties (old age data) that used the same participants as the earlier surveys.

Resilience and conversion from MCI to dementia

Mild Cognitive Impairment (MCI) is defined as cognitive dysfunction but not meeting the criteria of dementia. MCI-patients are expected to develop dementia within a limited time period, but studies show that only 5-10 % convert to dementia every year. A central research challenge in aging- and dementia research is to identify factors that are related to non-convertion into dementia. Previous studies have identified neuropathological and cognitive predictors of conversion, but also found that psycho-social variables such as social network, personal control, stress, and life events are important. The aim of the present project is to identify relationships among psychosocial and neuropathological processes and cognitive functioning. The project consists of two main parts where the first part is an in-depth interview study with individuals who had been evaluated for dementia but found not to meet the criteria and who remain as MCI-cases for a longer period. The purpose of this study is to improve our understanding of how individuals experience, create meaning and cope with imbalance when their own cognitive capacity doesn’t meet the demands from the environment. In other studies we focus specifically on associations between AD neuropathology and cognition.

In a related project we examine the effect of resilience in aging and more specifically a socio-emotional reserve model. The model is an extension of the cognitive reserve paradigm. Individuals who experience social and psychological well-being have been found to tolerate more neuropathology before cognitive symptoms become manifest. We propose that resilience in terms of a socio-emotional reserve could complement the hypothesis of cognitive reserve. We investigate the protective effects of psychological well-being and social support on cognitive functioning in the presence of abnormal CSF-biomarkers of AD neuropathology in the longitudinal ongoing Gothenburg MCI-study and in a control group of cognitively healthy individuals; all examined by neurological, psychiatric, and cognitive/neuropsychological methods and sampled for blood and CSF-analyses. The role of socio-emotional factors is related to outcomes on an extensive neuropsychological battery and CSF-biomarker.

Cognition in everyday life - decision making in old age

Elderly are currently expected to make more decisions about their own service and care and they are now confronted with more options and situations where they are expected to make decisions that significantly affect their own well-being. A core focus of the project is directed towards personal control and autonomy and the actual prerequisites and possibilities for decision-making in these situations. The overall aim of the project is to identify challenges in decision-making in old age care and to develop systems that can improve control and autonomy. The project is based on collaboration between psychology (decision-research) and social work (old age care) in which we integrate knowledge of decision-making in older individuals within the old age care context.

Geriatric psychology

Adult Development and Aging

Page Manager: Katarina Englund|Last update: 1/13/2014

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