The current knowledge of internet-based cognitive behavior therapy (ICBT) implemented in primary care settings is sparse. Our objective was to explore primary care therapists' experiences and ...attitudes of ICBT, the opportunities and conditions for research in primary care, and to identify potential barriers to the implementation of ICBT treatment in primary care.
Eleven therapists (of 14) participating in the research and implementation project PRIM-NET completed a survey. Four of them were selected also for a detailed semi-structured interview. Data from the interviews were analyzed qualitatively and according to methods used in implementation science.
Six general themes were identified in which the therapists considered ICBT as a good treatment that ought to be introduced in primary care. To optimize procedure in primary care settings, several adaptations of ICBT were suggested. Integrating and blending ICBT and face-to-face therapies, for example, would render primary care psychology more efficient. The PRIM-NET study and research within primary care was seen as rewarding and necessary, but challenging. To a large extent primary care still revolves around the general practitioner, with a focus on production, finances, and a somatic aspect of the patients. Five possible barriers to implementation of ICBT were identified which perhaps explains why psychological procedures are not fully integrated into primary care.
Although the implementation of new methods and routines is typically accompanied by challenges, the overall experience of the therapists supports the implementation of ICBT as an additional treatment in primary care.
•Therapistssee ICBT as a good treatment that should be introduced in primary care.•Adaptations of ICBT to the primary care context could improve usability.•Barriers to implementation, and perhaps integration of psychology were identified.•The experience of the therapists supports the implementation of ICBT in primary care.
The primary aim of the present study was to examine whether there is an association between blood pressure and the risk of subsequent cognitive decline in the oldest old. Various factors associated ...with blood pressure and cognitive function were considered.
The study comprised 599 individuals of a population-based sample, 199 men (mean age at baseline 82.8 years, range 80-95) and 400 women (mean age at baseline 83.3 years, range 80-100). Cognitive function was evaluated by the Mini Mental State Examination (MMSE). For a subgroup of 385 subjects (130 men, 255 women), data were available on blood pressure and MMSE at baseline and two followups at two-year intervals. Baseline blood pressure was studied in one group with reduced cognition and in another group with intact cognition across the following four years. The association of systolic blood pressure (SBP) with the MMSE score through the follow-up period was analysed controlling for frailty (time to death), age, gender, apoprotein E, homocysteine, hypertension, congestive heart failure, and stroke.
A medical history of arterial hypertension was associated with lower MMSE scores and a higher prevalence of dementia and cognitive decline at baseline. However, intact cognition through the observation period was associated with higher baseline SBP. This relationship also remained when the frailty of aging subjects, indicated by remaining time to death, was taken into account.
Lower SBP in the oldest old is associated with an increased risk of cognitive impairment even after adjustment for compromised vitality. In late life, the risk of cognitive decline needs to be considered in clinical practice.
The present longitudinal study investigates continuity and change in the personality dimensions of extraversion and neuroticism among the oldest‐old. Overall disease load, self‐rated health, ...functional capacity, impaired vision and hearing, self‐reported cognitive impairment, and measured cognitive status were tested for their role as potentially relevant late‐life predictors of personality change. The sample consists of 408 individuals aged 80–98 in the Swedish OCTO‐Twin Study who completed the Eysenck Personality Inventory at four measurement occasions during a 6‐year period. Growth curve analyses revealed an age‐related linear decrease in extraversion and stability in neuroticism. More extraverted individuals were more educated and perceived their health and cognition as better. Notably, only hearing impairment was found to be related to a steeper age‐related decline in extraversion. A life span developmental model focusing on health‐related changes can improve our understanding of personality change in late life.
Previous studies suggest that cholesterol metabolic dysregulation, characterized by abnormally low or high serum total cholesterol (TC) values, constitutes a risk for pronounced cognitive decline in ...old age. We tested this prediction using a population-based representative Swedish sample (N = 382), born in 1901-1902, and subsequently assessed on TC and 3 cognitive outcomes (verbal ability, spatial ability, and perceptual-motor-speed) at ages 70, 75, 79, 85, 88, and 90. None of the participants were on lipid-lowering medication, as prescription availability for these medications were not initiated in Sweden until the mid-1990s. We used a 3-level hierarchical model, with cognitive tests nested within time, nested within individuals. Estimates from this model revealed a nonlinear between-person association between TC and cognition, indicating that low, and to some degree high, TC values were associated with poorer cognition. This association was stronger among nondementia-cases (n = 255). Among subsequent dementia cases (n = 127), the data suggested a linear trend, indicating that lower TC values were associated with poorer cognition. TC levels declined over time in the vast majority (96%), and the steepness of this decline was associated with the rate of cognitive decline. This within-person association was particularly strong among incident dementia cases with low TC values. Our findings indicate an optimal range of TC values associated with better cognition in old age and that the within-person association between TC and cognition is related to dementia pathologies. Further, our findings demonstrate the need to separate between-person from within-person associations when evaluating the relation between TC and cognition in old age.
Little is known about birth cohort differences in the impact of stroke on cognitive aging. Given improved poststroke rehabilitation and better treatments for vascular health risk, we may expect a ...reduction in the stroke impact in later-born cohorts. We tested this prediction using data from two cohorts, born in 1901-1907 (n = 1,155) and 1930 (n = 919), identified from the same city population at the same age of 70 and subsequently measured on the same cognitive outcomes (i.e., spatial ability, perceptual-motor speed, and reasoning) at ages 70, 75, 79, and 85. We fitted multiple-group second-order latent growth curve models to the data, regressing the first-order cognitive factor on the time-varying stroke variable and controlling for relevant covariates. Findings revealed moderate to large average cognitive decline (d = −.45) following stroke, and the impact was relatively similar across cohorts (1901-1907: d = −.52; 1930: d = −.39). However, there was a stroke by age by cohort interaction, implying that the stroke impact increased with age in the 1901-1907 cohort (dage≤75 = −.42; dage≥79 = −.70) but decreased in the 1930 cohort (dage≤75 = −.53; dage≥79 = −.17). We found no evidence for lagged effect of stroke beyond the impact on measures following the incidence. Our hypothesis was only partially supported, as the impact of stroke was reduced in the later-born cohort but solely at higher ages.
Public Significance Statement
This study suggests that cognitive decline following a stroke is considerable and relatively similar across birth cohorts. However, with age, there is an increase in the impact among members of earlier-born cohorts but a decrease among members of later-born cohorts. The findings may have implications for predictions of future health care challenges.
Abstract
Objective: The aim of the present study was to calculate the overall heritability of some routine biochemical analyses. Furthermore, as genetic and environmental influences might differ ...across various segments, genetic impact in the highest and lowest thirds of the distributions was estimated. Methods: Ninety-six monozygotic and 120 dizygotic same-sex twin pairs aged 82 and older were tested. Structural equation modelling was used to estimate the genetic and environmental influences on serum levels of albumin, calcium, total cholesterol, HDL-cholesterol, GGT, potassium, sodium, creatinine, urea, urate, cobalamin, folate, homocysteine, free thyroxine and thyroid stimulating hormone (TSH). Results: Additive genetic influence of between 66% and 28% of the variance was accounted for all values except creatinine, for which the genetic influence was marginal. The highest influence was found for homocysteine, cobalamin, folate and HDL- cholesterol. Genetic influence for the tests was mainly in congruence with previous findings in younger samples. When limited to the highest and lowest thirds of distribution, there were substantial differences in the proportion of genetic influence for some tests. Conclusion: For the majority of biochemical tests, the magnitude of genetic influence is considerable. Heritability estimates, however, should be considered in a broad context, with age, gender, morbidity and medication taken into account. Notably, for many test values, the genetic impact may differ considerably between the highest and the lowest range of the distribution.
The Interplay of Genes and Environment across Multiple Studies (IGEMS) group is a consortium of eight longitudinal twin studies established to explore the nature of social context effects and ...gene-environment interplay in late-life functioning. The resulting analysis of the combined data from over 17,500 participants aged 25-102 at baseline (including nearly 2,600 monogygotic and 4,300 dizygotic twin pairs and over 1,700 family members) aims to understand why early life adversity, and social factors such as isolation and loneliness, are associated with diverse outcomes including mortality, physical functioning (health, functional ability), and psychological functioning (well-being, cognition), particularly in later life.
Abstract Background Education, a marker for cognitive reserve, is thought to be associated with low risks of dementia, but less is known about its association with cognitive decline in preclinical ...stages of dementia. This study aimed to see whether higher education level could have a protective effect against faster cognitive decline in preclinical stages of dementia and whether this protection is consistent across six different studies around the world. Methods We assessed the association between education and change in mini-mental state examination (MMSE) in people who developed dementia during the study period before the time of dementia diagnosis in six international studies of ageing: Newcastle 85+, UK; Three-City (3C), France; Leiden 85+ and Longitudinal Aging Study Amsterdam (LASA), the Netherlands; Octogenarian Twins (OCTO-Twin), Sweden; and Memory and Ageing Study (MAS), Australia. Using a coordinated analysis approach, we used multilevel models to investigate the role of education in the change in MMSE independently within each cohort, while controlling for common covariates such as age at baseline, sex, and time to dementia diagnosis from study entry within each cohort. Each individual's cognitive scores were aligned according to distance (years) to dementia diagnosis. Findings High levels of education (>12 years) were associated with steeper linear rates of decline in MMSE scores from study entry to time of dementia diagnosis in most cohorts—3C, Leiden 85+, LASA, OCTO-Twin, and MAS. However, in one cohort (Newcastle 85+), higher education was associated with a slow rate of decline in the preclinical stages of dementia (β=0·93, 95% CI 0·09–1·77) compared with lower education, suggesting perhaps a difference in the educational system between the UK and the rest of Europe or Australia during the early 1990s. A random-effects meta-analysis across data from all six studies showed a non-significant steeper cognitive decline with time for those with higher education (β=–0·08, 95% CI –0·17 to 0·003; see appendix for forest plot). Interpretation This coordinated approach analysis revealed no consistent protection for people with higher education in terms of lowering the rate of cognitive decline in the preclinical stages of dementia, which is a major public health burden. This work only partly supports the cognitive reserve hypothesis—ie, the clinical manifestation of dementia is delayed in people with higher education but that a steeper decline occurs once a certain threshold has been reached. Funding The funding sources of this work were the Alzheimer's Society (grant number 144) and the Medical Research Council (unit programme number MC_UU_12019/1).
Engagement in cognitively stimulating activities has been considered to maintain or strengthen cognitive skills, thereby minimizing age-related cognitive decline. While the idea that there may be a ...modifiable behavior that could lower risk for cognitive decline is appealing and potentially empowering for older adults, research findings have not consistently supported the beneficial effects of engaging in cognitively stimulating tasks. Using observational studies of naturalistic cognitive activities, we report a series of mixed effects models that include baseline and change in cognitive activity predicting cognitive outcomes over up to 21 years in four longitudinal studies of aging. Consistent evidence was found for cross-sectional relationships between level of cognitive activity and cognitive test performance. Baseline activity at an earlier age did not, however, predict rate of decline later in life, thus not supporting the concept that engaging in cognitive activity at an earlier point in time increases one's ability to mitigate future age-related cognitive decline. In contrast, change in activity was associated with relative change in cognitive performance. Results therefore suggest that change in cognitive activity from one's previous level has at least a transitory association with cognitive performance measured at the same point in time.
Background and aims:
Life satisfaction in the elderly has usually been found to be closely related to self-rated health, and less to diagnoses and more objective measures of health status. However, ...few studies have examined the relative importance of various specific diagnoses in population-based samples.
Methods:
In this study, we investigate the relationship between life satisfaction and medical diagnoses in a non-demented sample of 392 participants aged 80 and older.
Results:
Among 25 common diagnoses, only sleeping problems, urinary incontinence and stroke were significantly related to life satisfaction. Men with angina pectoris and eczema were less satisfied with life compared with men without these diagnoses, whereas women with peptic ulcer were less satisfied with life compared with women without this diagnosis.
Conclusions:
Our results confirm previous findings of a weak relationship between medically based measures of health and life satisfaction. However, health care and future studies of health and quality of life need to focus on the fact that meaning and consequences of various diseases differ among individuals and that gender may partially account for variability.
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