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Cognitive reserve has shown evidence of mitigating HIV-related effects on cognition in people living with HIV (PWH). In a sample of adults residing in the Deep South, an underrepresented subgroup in the neuroAIDS literature, we assessed the association between HIV serostatus and age on processing speed, visual attention, executive function, and episodic memory and the attenuating effect of cognitive reserve. Adults ( n  = 138; 72 PWH; M age = 58.7 years, SD  = 7.9 years; 75% nonwhite race) were recruited from a university clinic and the community. Verbal abilities served as a proxy for cognitive reserve. Regressions accounting for race, alcohol usage, and depressive symptoms were conducted for each cognitive outcome. Indirect effects were tested using the PROCESS macro. Being HIV seropositive was associated with worse executive function ( b  = -1.04, SE = 0.38, p  = .007) and episodic memory ( b  = -39.94, SE = 12.54, p  = .002) performance. Every year of age above the mean and nonwhite race was associated with worse cognitive performance ( p s < .05). The addition of cognitive reserve to the model attenuated the HIV serostatus associations with executive function (BC 95% CI -0.770, -0.001) along with most associations between race and cognitive outcomes. Age associations remained for all cognitive outcomes ( p s < .05). Findings highlight the importance of including verbal ability proxies of cognitive reserve when assessing cognition in PWH. Highlighting modifiable cognitive processes, such as cognitive reserve, will further the development of targeted cognitive interventions in this at-risk population.

Abstract: HIV-associated neurocognitive disorder (HAND) is experienced by 30% to 50% of people living with HIV (PLWH), potentially affecting their quality of life (QoL). In the Training on Purpose Study, we investigated whether targeted cognitive training can improve QoL in PLWH with HAND. Using a two-group experimental design, we randomized 109 adults with HAND to either (a) the Individualized-Targeted Cognitive Training group or (b) a no-contact control group. Those in the training group were assigned 10 hr of cognitive training per two selected cognitive domains (20 hr total) for which impairment was observed. Overall, two patterns emerged. First, significant improvements in measures of everyday cognitive complaints, depression, and mental health were consistently observed after the completion of many cognitive training protocols. Second, immediate and delayed spatial learning and memory training resulted in more significant indicators of QoL improvements compared with the other cognitive domain trainings. The findings suggest that some types of cognitive training may have advantages over others in improving aspects of QoL., (Copyright © 2021 Association of Nurses in AIDS Care.)

Half of people with HIV (PWH) have HIV-associated neurocognitive disorder (HAND). This study examined whether cognition can be improved using a framework targeting impaired individual cognitive domains in PWH with HAND. In this two-group pre-post experimental design study, 88 adults with HAND were randomized to either: (1) a no-contact control group (n = 40) or (2) the Individualized-Targeted Cognitive Training group (n = 48). Baseline cognitive performance was assessed on eight cognitive domains. A theoretical framework was used to determine the two cognitive domains selected for training. With priority on speed of processing (SOP) and attention impairments, participants received SOP and/or attention training if such impairments were detected; if not, participants were assigned to cognitive training in one/two of the least impaired cognitive domains contributing to their HAND diagnosis. Global cognitive score was slightly improved following training (p = 0.256; d = - 0.21), but it was not significant. Significant improvements were observed on SOP following training in that domain (SOP; d = - 0.88; p = 0.011). SOP training also improved functioning in other cognitive domains. This individualized cognitive intervention did not change HAND status, but it did result in improved SOP, in turn yielding improvement in other cognitive domains., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To examine in a population-based sample of 2000 drivers aged 70 years and older, the independent association between higher order visual processing impairment and motor vehicle collision (MVC) rate during the prior 5 years., Methods: Three higher order visual processing screening tests were administered since previous research found associations between impaired performance on these screens and MVC involvement. They included an estimate of visual processing speed under divided attention conditions (useful field of view [UFOV] subset 2); Trails B, a paper and pencil test of visual processing speed also involving problem solving, executive function, and working memory; and the visual closure subtest of the Motor Free Visual Perception Test (MVPT) examining the ability to recognize objects only partially visible. Potentially confounding variables were also assessed including demographics, general cognitive status, visual acuity, and contrast sensitivity. MVC involvement was determined by accident reports from the Alabama Department of Public Safety, and driving exposure was estimated from the Driving Habits Questionnaire., Results: MVC rates (for at fault and all MVCs) were significantly higher for those older drivers with impairments in any of the three visual processing screening tests. After adjustment for potentially confounding influences, the association between MVC rate and Trails B remained significant, whereas the association with MVPT and UFOV did not., Conclusions: This population-based study of drivers aged 70 years and older suggests that a paper and pencil test assessing higher order visual processing skills is independently associated with a recent history of MVC involvement.

Mild Cognitive Impairment (MCI) involves subtle functional losses that may include decrements in driving skills. We compared 46 participants with MCI to 59 cognitively normal controls on a driving evaluation conducted by a driving rehabilitation specialist who was blinded to participants' MCI classification. Participants with MCI demonstrated significantly lower performance than controls on ratings of global and discrete driving maneuvers, but these differences were not at the level of frank impairments. Rather, performance was simply less than optimal, which to a lesser degree was also characteristic of a subset of the cognitively normal control group. The finding of significantly lower global driving ratings, coupled with the increased incidence of dementia among people with MCI and the known impact of dementia on driving safety, suggests the need for increased vigilance among clinicians, family members, and individuals with MCI for initially benign changes in driving that may become increasingly problematic over time.

Objective: To evaluate the relationship between sensory and cognitive decline, particularly with respect to speed of processing, memory span, and fluid intelligence. In addition, the common cause, sensory degradation and speed of processing hypotheses were compared., Method: Structural equation modeling was used to investigate the complex relationships among age-related decrements in these areas., Results: Cross-sectional data analyses included 842 older adult participants (M = 73 years). After accounting for age-related declines in vision and processing speed, the direct associations between age and memory span and between age and fluid intelligence were nonsignificant. Older age was associated with visual decline, which was associated with slower speed of processing, which in turn was associated with greater cognitive deficits., Discussion: The findings support both the sensory degradation and speed of processing accounts of age-related, cognitive decline. Furthermore, the findings highlight positive aspects of normal cognitive aging in that older age may not be associated with a loss of fluid intelligence if visual sensory functioning and processing speed can be maintained.

Objectives: To determine whether patients with mild cognitive impairment (MCI) are fully aware of and provide reliable estimates of their functional status., Design: Controlled, matched-samples, cross-sectional study., Setting: University medical and research centers., Participants: Fifty-seven persons with amnestic MCI and 68 normal controls., Measurements: The study examined accuracy of self-report in MCI across five functional domains (driving, financial abilities, medication management, grocery shopping, and telephone use) by comparing patients' report of functioning with their performance on laboratory-based measures of function., Results: The discrepancy between self-report and objective performance was significantly higher in patients with MCI than in their cognitively normal peers only on financial abilities. Patients with MCI overestimated their abilities on this functional domain. Patients with MCI also tended to overestimate their driving abilities, although this was not statistically significant., Conclusion: These findings provide evidence that awareness of functional difficulties is not a unitary construct; rather, it varies across functional domains. They also suggest that self-report of functional abilities in MCI may be, on the whole, as accurate as in cognitively intact older adults. Even so, the self-objective discrepancies noted for both study groups suggest that supplementing self-reported information with objective functional assessment might improve detection of older adults who have begun to experience more functional restriction than is normal for age. In turn, timely identification would permit the targeted implementation of interventions that delay or forestall further deterioration in function.

We examined the physical, visual, health, and cognitive abilities of 1,656 older adults as prospective predictors of self-reported driving cessation over a 5-year period. We examined the time to driving cessation across 5 years after we controlled for days driven per week at baseline and any cognitive intervention participation. Older age, congestive heart failure, and poorer physical performance (according to the Turn 360 Test) were statistically significant risk factors for driving cessation. Slower speed of processing (according to the Digit Symbol Substitution and Useful Field of View tests) was a significant risk factor even after we took baseline driving, age, health, vision, and physical performance into consideration. Implications are that assessments of cognitive speed of processing can provide valuable information about the subsequent risk of driving cessation.

Among older adults, 20%-56% report having cognitive problems, and such cognitive complaints frequently correspond to actual neuropsychological impairment. The loss of cognitive abilities can be frustrating and frightening and can have a negative impact on instrumental activities of daily living and quality of life. Cognitive remediation interventions have been shown to be successful in improving mental function in older adults in many situations and may increase the number of everyday activities they are able to carry out. Nurses, given their direct contact with older adult patients, are able to inquire about or observe cognitive loss, make appropriate referrals, and emphasize steps such as cognitive remediation and other interventions that promote successful cognitive aging.

Physical activity has been shown to be positively associated with cognitive health, but the mechanisms underlying the benefits of physical activity on cognitive health are unclear. The present study simultaneously examined two hypotheses using structural equation modeling (SEM). The depression-reduction hypothesis states that depression suppresses cognitive ability and that physical activity alleviates dysphoric mood and thereby improves cognitive ability. The social-stimulation hypothesis posits that social contact, which is often facilitated by socially laden physical activities, improves cognitive functioning by stimulating the nervous system. Sedentary behavior in the absence of physical activity is expected to exert an inverse relationship on cognitive health through each of these hypotheses. Community-dwelling elders (N = 158) were administered a variety of measures of cognition, depression, social support, and physical activity. SEM techniques provided partial support for the social-stimulation hypothesis and depression-reduction hypothesis. Implications for treating depression and improving cognitive functioning are discussed.

Background: Age-related sensory and cognitive impairments have been related to functional performance in older adults. With regard to cognitive abilities, processing speed in particular may be strongly related to older adults' abilities to perform everyday tasks. Identifying and comparing cognitive correlates of functional performance is particularly important in order to design interventions to promote independence and prevent functional disability., Objective: The present study examined the relative importance of cognitive (specifically, speeded and nonspeeded) and sensory factors in relation to older adults' functional abilities. Functional abilities included measures of mobility and performance of everyday activities., Methods: A cross-sectional study design was employed. Five hundred and thirty adults between the ages of 62 and 94 completed measures of sensory, cognitive (including processing speed, attention, memory, intelligence) and functional abilities., Results: Overall, functional performance was most strongly associated with cognitive speed performance, but nonspeeded cognitive and sensory abilities also accounted for significant amounts of variance in functional performance. Age explained a small but statistically significant amount of additional variance in some functional abilities, but no additional variance in self-reported mobility measures., Conclusion: These findings point to the potential impact of multifaceted training programs, targeting both sensory and cognitive abilities for maintaining functional abilities., (Copyright (c) 2005 S. Karger AG, Basel.)

Background: Evidence establishing the potential for modification of cognitive functioning in later adulthood has begun to accumulate.Objective: The primary goal of the current study was to evaluate, among older adults, the extent to which standardized speed of processing training transfers to similar and dissimilar speeded cognitive measures as well as to other domains of cognitive functioning.Methods: Ninety-seven older adults (mean age 73.71 years) were administered a battery of cognitive tests assessing intelligence, memory, attention, verbal fluency, visual-perceptual ability, speed of processing, and functional abilities. Forty-four of the participants received ten 1-hour sessions of speed of processing training. The remainder of participants were in a no-contact control group. Approximately 6 weeks after the pretraining assessment, all participants repeated the same battery of tests.Results: The results revealed training effects for some speed of processing measures, including performance of instrumental activities of daily living, but no transfer to other domains of cognitive functioning.Conclusion: Speed of processing training may enhance the speed at which older adults can perform instrumental activities of daily living. [ABSTRACT FROM AUTHOR]