Category: Neuropsychology

Aging and Lifestyle

There is an increasing amount of evidence that a person’s lifestyle is critical to successful aging.  It is hypothesized that ongoing participation in lifestyle activities may confer some resistance to cognitive decline in the older adult.  A longitudinal study was recently performed that appeared to consolidate this hypothesis.  Small et al. (2011) used data from the Victoria Longitudinal Study that followed approximately five hundred subjects for twelve years.  The study authors compared three lifestyle factors with three neuropsychological factors across this time period.  The three lifestyle factors were comprised of fitness, cognitive activities and social activities that require “complex cognitive functioning.”  The three neuropsychological factors were verbal speed and two types of verbal memory.  The study participants varied in age from fifty-five to ninety-four.  While the neuropsychological measures were administered by professionals, the lifestyle and health questionnaires depended on the subject’s self-report.  This is important to note, since the study lacked an objective assessment of lifestyle or health.  Ninety year old test subjects were asked to recall detailed aspects of their health and lifestyle, and the power of the study depended on the accuracy of their self-report.

The study found that preserved verbal speed was associated with preserved physical, cognitive and social activity.  The authors discovered that cognition and lifestyle activity were dual coupled.  This means that the factors worked both ways.  Verbal speed predicted lifestyle activities, and lifestyle activities predicted verbal speed.  The results of the memory measures were less coupled than verbal speed.  Memory for stories was dual coupled with physical activity, but not cognitive or social activity.  For example, increased cognitive activity predicted increased story recall, but the reverse did not hold true.  Conversely, better story recall predicted increased social activity, but increased social activity was not associated with better story recall.  Memory for word lists was not correlated with physical activity, whatsoever.  Increased cognitive activity was predictive of better word list recall, and proficient word recall was predictive of increased social activity, but the reverse did not hold true for either.  Generally, the study authors discovered that a decline in cognitive ability preceded a decrease in social activity.  This artifact is the opposite of many studies that have demonstrated increased levels of lifestyle activity improving overall cognitive performance.  The current authors suggest that impaired cognition causes decreased lifestyle activity, rather than decreased lifestyle activity producing the decline in mental functioning.

As mentioned, it is important to consider the affect of self-report in this study.  Both health and overall activity level were measured by self-report of the participants. According to the findings, watermelons contain a natural cure ingredient called citrulline that can trigger production of a compound that helps relax the body’s blood vessels, similar to what happens when a man takes cheapest viagra tablets . The dose is meant to be taken roughly an hour before they make love. slovak-republic.org acquisition de viagra This is buy cialis a famous blue tablet. Also early sexual trauma causing sexual dysfunction needed to slovak-republic.org levitra 10 mg be address changing their treatment methods to include bibliotherapy, group therapy and medication for sexual issues.  It is also important to consider that most older adults are not proficient at reciting their medical history, and very few can list their medications accurately.  Do not forget the natural tendency for people to please the examiner.  Questionnaires completed by test subjects invariably reveal the nature of the study; at the very least there are clues to the desired response.  Additionally, accurate self-appraisal declines over time.  The self-awareness of a fifty-five year old person is generally greater than an eighty year old.  For example, an eighty year old test subject is more apt to make temporal errors than a fifty-five year old subject.  Combined with the natural tendency to please the examiner, the eighty year old is likely to report more social and physical activity than they actually experience.  The current study may actually have measured the change in self-awareness with age, rather than the influence of lifestyle activity levels on cognitive performance.  Since the variable of self-awareness was not controlled in the study, the ability to draw a conclusion was tarnished.

The reader needs to be rather sophisticated and thorough when interpreting scientific articles.  The objections to the current study do not invalidate the results.   The reliance on self-report reduces the study’s power to predict whether lifestyle affects cognition or cognition influences lifestyle.  As with most psychological phenomenon, there is a dynamic interplay between overall lifestyle activity and cognitive functioning.  The early onset of Alzheimer’s Disease directly lowers the social interest of the afflicted.  Reducing environmental stimulation, at any age, will have negative affects on cognition.  It is not surprising that isolating one component of the interaction collapses the dynamic interplay.  Statistics is limited in this way, as one variable is examined while others are considered invariable, or held as invariable for purpose(s) of the study.  Lifestyle and cognition possess so many variables that an immense effort must be made to reduce the uncontrolled factors.  If the study authors used an informant to crosscheck health and lifestyle data, the predictive power of the study would be much greater.  Commonly, the cost in money and time becomes prohibitive.  The current study used data obtained over a twelve year period, such that informants had to be utilized at the inception of the research.  To add the use of informants later in the study would produce two studies, and the data cannot be compared once the methodology is changed.  Keep in mind that there is no such thing as the perfect study.  The most important part of a research article is not the results, but the limitations that influence the results.

Growing Older, Not Bolder

There was an initial shock in providing psychological services to nursing homes.  It was less from the environment than the unexpected nature of the patient’s comments.  Bed-ridden patients warned staff to make travel arrangements as soon as possible; do not wait until they are too old and sick.  Most believed the whole notion of the “golden years” to be a cruel myth.  The very mention of “golden years” often forced an eye roll-even overt anger.  Story after story related a lifetime of work and sacrifice, with the view of saving money to effect a pleasant retirement.  The climax of so many stories was that a serious medical problem interrupted their plans.  Despite time and money, the retiree was not going beyond their front door.

Another unexpected facet of nursing home culture was the perception of children.  So many had come to believe that their offspring were downright traitors.  The truth is that responsible children are often required to liquidate their parent’s assets to pay for medical care.  This rarely sits well with the parents.  It is especially bothersome to those with dementia, since they are unable to understand the rationale for the actions of their children.  Often such demented patients only retain the emotionally charged aspects of the message, which is typically that their home was sold beneath them.  The logical conclusion, based on the few facts they retain, is that the children want to grab their money before they die.  This is rarely the case.  It is heartbreaking for the children to perform so much work for their parent, only to be regarded as little better than a criminal.

The brooding disappointment of extreme old age is not just relegated to the depressed individuals.  The loss of independence rarely sits well with Americans.  Many cultures appear to accept this as unavoidable, but Americans do not like the word “unavoidable.”  To work and plan for decades, only to be thwarted at the last moment, strikes Americans as horribly unfair.  The experience of other cultures is that life is often unfair, and this fact does not improve with age.  The American perspective on fairness is less prevalent with the older generations.  Two world wars and a depression impacted them in a way that is foreign to baby-boomers and beyond.  It is likely that the reaction of subsequent generations to nursing home placement will be increasingly negative.  While the WWII generation is less apt to gripe about fairness, they remain extremely adverse to depending on others.

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A change in perspective would also alleviate rancor between the patient and responsible children.  In order to liquidate assets to pay for medical care, children are  often forced to seek the paid assistance of consultants.  It would simply the process to have disinterested third parties perform this action, as part of the government benefit.  Strangely, even demented nursing home patients rarely become agitated over this process if performed by an attorney.  While the author has listened to thousands of complaints regarding the motives of the children, even one such complaint directed at an attorney cannot be recalled.  This should not be taken as an endorsement of attorneys, rather it speaks to the reduced agitation inherent in having a third party manage the assets.  Since most people cannot afford attorneys, it is necessary to make the service part of the Medicare or Medicaid benefit.

Growing older is not a right, but the benefit of a life well-lived.  Even though fifty percent of nursing home patients return home, the typical belief is that nursing homes only function as a place to die.  Often, the staff and doctors do not know who will improve, such that the patient is held in a state of suspense.  Placement within a nursing home may be the final hurdle; a concrete message that one’s life is limited and will soon be over.  How well we accept this message says not only a lot about ourselves, but also the culture that has influenced our values and expectations.  Still, all in all…it’s probably better to take that world cruise now.