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Background: We investigated a potential sex difference in the relationship between alcohol consumption, brain age gap and cognitive function in older adults without cognitive impairment from the population-based Mayo Clinic Study of Aging., Methods: Self-reported alcohol consumption was collected using the food-frequency questionnaire. A battery of cognitive testing assessed performance in four different domains: attention, memory, language, and visuospatial. Brain magnetic resonance imaging (MRI) was conducted using 3-T scanners (Signa; GE Healthcare). Brain age was estimated using the Brain-Age Regression Analysis and Computational Utility Software (BARACUS). We calculated the brain age gap as the difference between predicted brain age and chronological age., Results: The sample consisted of 269 participants [55% men (n=148) and 45% women (n=121) with a mean age of 79.2 ± 4.6 and 79.5 ± 4.7 years respectively]. Women had significantly better performance compared to men in memory, (1.12 ± 0.87 vs 0.57 ± 0.89, P<0.0001) language (0.66 ± 0.8 vs 0.33 ± 0.72, P=0.0006) and attention (0.79 ± 0.87 vs 0.39 ± 0.83, P=0.0002) z-scores. Men scored higher in visuospatial skills (0.71 ± 0.91 vs 0.44 ± 0.90, P=0.016). Compared to participants who reported zero alcohol drinking (n=121), those who reported alcohol consumption over the year prior to study enrollment (n=148) scored significantly higher in all four cognitive domains [memory: F 3,268  = 5.257, P=0.002, Language: F 3,258  = 12.047, P<0.001, Attention: F 3,260  = 22.036, P<0.001, and Visuospatial: F 3,261  = 9.326, P<0.001] after correcting for age and years of education. In addition, we found a significant positive correlation between alcohol consumption and the brain age gap (P=0.03). Post hoc regression analysis for each sex with language z-score revealed a significant negative correlation between brain age gap and language z-scores in women only (P=0.008)., Conclusion: Among older adults who report alcohol drinking, there is a positive association between higher average daily alcohol consumption and accelerated brain aging despite the fact that drinkers had better cognitive performance compared to zero drinkers. In women only, accelerated brain aging is associated with worse performance in language cognitive domain. Older adult women seem to be vulnerable to the negative effects of alcohol on brain structure and on certain cognitive functions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Abulseoud, Caparelli, Krell‐Roesch, Geda, Ross and Yang.)

Objectives: To examine the longitudinal associations between fitness and metabolic syndrome (MetS) in community-dwelling adults over 29 years of follow-up., Design: Ongoing, population-based cohort study of adults aged ≥ 33 years at baseline residing in the city of Bad Schönborn, Germany., Methods: The sample comprised 89 persons (41 females; mean age 40.1 years at baseline) who participated at baseline (in the year 1992) and 29-years follow-up (in the year 2021). Fitness (predictor variable) was assessed using 15 standardized and validated tests that measured strength, gross motor coordination, mobility/ flexibility and cardiorespiratory fitness/ endurance, and a z-transformed fitness score was calculated for analysis. MetS (outcome of interest) was assessed through five criteria related to waist circumference, blood glucose, HDL cholesterol, triglycerides, and blood pressure, and a sum score was created for analysis. We ran partial correlations to examine the association between fitness score at baseline and MetS score at 29-years follow-up, adjusted for age, sex, socio-economic status, smoking status, sleep quality, and physical activity engagement in minutes/ week., Results: A higher fitness score at baseline was significantly associated with a lower MetS score indicative of better metabolic health at 29-years follow-up (r=-0.29; p = 0.011). These associations were present in participants aged ≤ 40 years (r=-0.33; p = 0.025) as well as those aged > 40 years (r=-0.43; p = 0.045)., Conclusions: Fitness may be a predictor of longitudinal metabolic health, and potentially also mediates previously reported longitudinal associations between physical activity and metabolic health. More research is needed to confirm these observations, and to also explore underlying mechanisms., (© 2024. The Author(s).)

Background: Studies that assess cognition prospectively and study in detail anxiety history in the participants' medical records within the context of brain aging and Alzheimer's disease are limited., Objective: To examine the associations of anxiety and unspecified emotional distress (UED) acquired throughout a person's life with prospectively collected cognitive outcomes., Methods: Mayo Clinic Study of Aging participants who were cognitively unimpaired at baseline were included. Anxiety and UED data were abstracted from the medical record using the Rochester Epidemiology Project (REP) resources and were run separately as predictors in our models. The data were analyzed using Cox proportional hazards models for the outcomes of incident mild cognitive impairment (MCI) and dementia and using linear mixed effects models for the outcomes of global and domain specific cognitive z-scores and included key covariates., Results: The study sample (n = 1,808) had a mean (standard deviation) age of 74.5 (7.3) years and 51.4% were male. Anxiety was associated with increased risk of MCI and dementia and was associated with lower baseline cognitive z-scores and accelerated decline over time in the global, memory, and attention domains. UED was associated with faster decline in all domains except visuospatial but did not show evidence of association with incident cognitive outcomes. These results varied by medication use and timing of anxiety., Conclusions: Anxiety and UED both showed inverse associations with cognition. Utilization of anxiety and UED data from across the life course, as available, from the REP system adds robustness to our results.

Background: Population-based research on the prevalence and determinants of dementia, Alzheimer's disease, and cognitive impairment is scarce in East Africa., Objective: To provide an overview of community- and population-based studies among older adults on the prevalence of dementia and cognitive impairment in East Africa, and identify research gaps., Methods: We carried out a literature search using three electronic databases (PubMed, Scopus, Google Scholar) using pertinent search terms., Results: After screening 445 publications, we identified four publications on the population-based prevalence of dementia, and three on cognitive impairment. Prevalence rates varied from 6- 23% for dementia, and 7- 44% for cognitive impairment, among participants aged≥50-70 years. Old age and a lower education level were risk factors for dementia and cognitive impairment. Physical inactivity, lack of a ventilated kitchen, and history of central nervous system infections and chronic headache were associated with increased odds of dementia. Female sex, depression, having no spouse, increased lifetime alcohol consumption, low income, rural residence, and low family support were associated with increased odds of cognitive impairment. Potential misclassification and non-standardized data collection methods are research gaps that should be addressed in future studies., Conclusions: Establishing collaborative networks and partnering with international research institutions may enhance the capacity for conducting population-based studies on dementia and cognitive impairment in East Africa. Longitudinal studies may provide valuable insights on incidence, as well as potential risk and protective factors of dementia and cognitive impairment, and may inform the development of targeted interventions including preventive strategies in the region.

The study included 1,738 Mayo Clinic Study of Aging participants (≥50 years old; 1,460 cognitively unimpaired and 278 with mild cognitive impairment (MCI)) and examined the cross-sectional association between cerebrovascular (CVD) imaging biomarkers (e.g., white matter hyperintensities (WMH), infarctions) and Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) scores, as well as their association with MCI. High (abnormal) WMH burden was significantly associated with having BDI-II>13 and BAI > 7 scores, and both (CVD imaging biomarkers and depression/anxiety) were significantly associated with MCI when included simultaneously in the model, suggesting that both were independently associated with the odds of MCI., Competing Interests: Maria Vassilaki has received research funding from F. Hoffmann-La Roche Ltd and Biogen and consulted for F. Hoffmann-La Roche Ltd; currently, she receives research funding from NIH; she has equity ownership in Johnson and Johnson, Medtronic, Merck, and Amgen. Jonathan Graff-Radford receives support from the NIH, serves on the DSMB for StrokeNET, and is an investigator in clinical trials sponsored by Esai and the Alzheimer’s Treatment and Research Institute at USC. Prashanthi Vemuri receives NIH funding. Eugene L Scharf is a consultant for Boston Scientific but receives no compensation. Mary M. Machulda receives NIH funding. Julie A. Fields serves as a consultant for Medtronic, Inc. and receives research support from the NIH. Walter K. Kremers receives research support from the NIH. Val J. Lowe serves as a consultant for Bayer Schering Pharma, Piramal Life Sciences, Life Molecular Imaging, Eisai Inc., AVID Radiopharmaceuticals, and Merck Research, and receives research support from GE Healthcare, Siemens Molecular Imaging, AVID Radiopharmaceuticals, and the NIH (NIA, NCI). Clifford R. Jack Jr. has no financial conflicts to disclose; he receives research support from NIH and the Alexander Family Alzheimer’s Disease Research Professorship of the Mayo Clinic. David S. Knopman serves on a Data Safety Monitoring Board for the Dominantly Inherited Alzheimer Network Treatment Unit study. He served on a Data Safety monitoring Board for a tau therapeutic for Biogen (until 2021) but received no personal compensation. He is an investigator in clinical trials sponsored by Biogen, Lilly Pharmaceuticals and the University of Southern California. He has served as a consultant for Roche, Samus Therapeutics, Magellan Health, Biovie and Alzeca Biosciences but receives no personal compensation. He attended an Eisai advisory board meeting for lecanemab on December 2, 2022, but received no compensation. He receives funding from the NIH. Ronald C. Petersen serves as a consultant for Roche, Inc., Eisai, Inc., Genentech, Inc. Eli Lilly, Inc., and Nestle, Inc., served on a DSMB for Genentech, receives royalties from Oxford University Press and UpToDate, and receives NIH funding. Yonas E. Geda receives funding from NIH and the BARROW Neurological Foundation. All other authors have no conflict of interest to report., (© 2023 – The authors. Published by IOS Press.)

Background and Purpose: Physical activity (PA) can have a beneficial effect on cognitive and physical performance in individuals with dementia (IWD), including those residing in nursing homes. However, PA interventions in nursing homes are usually delivered using a group setting, which may limit the effectiveness of the intervention due to the heterogenous nature of IWD. Therefore, the purpose of this study was to identify clusters based on cognitive and physical performance values, which could be used to improve individualization of PA interventions., Methods: Based on the cognitive and physical performance variables of 230 IWD, a cluster analysis was conducted. Global cognition (Mini-Mental State Examination), mobility (6-Meter Walking Test), balance (Frailty and Injuries: Cooperative Studies of Intervention Techniques-subtest-4), and strength and function of lower extremities (30-Second Chair-Stand Test) were assessed, and values were used to perform a hierarchical cluster analysis with Ward's method. Differences in physical and cognitive performance as well as other secondary outcomes (age, sex, body mass index, use of walking aids, diagnosis and etiology of dementia, number of medications, and Cumulative Illness Rating Scale) were tested using 1-factorial analyses of variance., Results and Discussion: Out of 230 data sets, 3-cluster solutions were identified with similar cluster sizes of 73 to 79. The silhouette coefficients for all calculated clusters ranged between 0.15 and 0.34. The cluster solutions were discussed in the context of cognitive and physical functions as well as training modalities and opportunities. The 4-cluster solution appears to be best suited for providing or developing an individualized PA intervention., Conclusions: The identified clusters of the 4-cluster solution may be used in future research to improve individualization of dementia-specific PA interventions. By assigning IWD to these clusters, more homogenous groups with regard to cognitive and physical performance can be formed. This allows for more individualized PA interventions and may result in a higher effectiveness, particularly in nursing homes. Our findings are relevant for therapists and nursing staff who design or deliver PA interventions in nursing homes or similar settings., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 APTA Geriatrics, An Academy of the American Physical Therapy Association.)

Introduction: We examined the association between cerebrospinal fluid (CSF)-derived biomarkers of Alzheimer's disease and neuropsychiatric symptoms (NPS) in older non-demented adults., Methods: We included 784 persons (699 cognitively unimpaired, 85 with mild cognitive impairment) aged ≥ 50 years who underwent CSF amyloid beta (Aβ42), hyperphosphorylated tau 181 (p-tau), and total tau (t-tau) as well as NPS assessment using Beck Depression and Anxiety Inventories (BDI-II, BAI), and Neuropsychiatric Inventory Questionnaire (NPI-Q)., Results: Lower CSF Aβ42, and higher t-tau/Aβ42 and p-tau/Aβ42 ratios were associated with BDI-II and BAI total scores, clinical depression (BDI-II ≥ 13), and clinical anxiety (BAI ≥ 10), as well as NPI-Q-assessed anxiety, apathy, and nighttime behavior., Discussion: CSF Aβ42, t-tau/Aβ42, and p-tau/Aβ42 ratios were associated with NPS in community-dwelling individuals free of dementia. If confirmed by a longitudinal cohort study, the findings have clinical relevance of taking into account the NPS status of individuals with abnormal CSF biomarkers., (© 2021 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia., Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach., Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively., Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as "good." The main usability issues concerned navigation logic and comprehensibility of app content., Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ≥50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study., (©Jelena Krafft, Bettina Barisch-Fritz, Janina Krell-Roesch, Sandra Trautwein, Andrea Scharpf, Alexander Woll. Originally published in JMIR Aging (https://aging.jmir.org), 22.08.2023.)

Introduction: We examined associations between plasma-derived biomarkers of Alzheimer's disease (AD) and neuropsychiatric symptoms (NPS) in community-dwelling older adults., Methods: Cross-sectional study involving 1005 persons ≥50 years of age (mean 74 years, 564 male, 118 cognitively impaired), who completed plasma-derived biomarker (amyloid beta 42 [Aβ42]/Aβ40, phosphorylated tau 181 [p-tau181], p-tau217, total tau [t-tau], neurofilament light [NfL]), and NPS assessment., Results: P-tau181 (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.41-3.00, p  < 0.001), p-tau217 (OR 1.70, 95% CI 1.10-2.61, p  = 0.016), and t-tau (OR 1.44, 95% CI 1.08-1.92, p  = 0.012) were associated with appetite change. We also found that p-tau181 and p-tau217 were associated with increased symptoms of agitation (OR 1.93, 95% CI 1.20-3.11, p  = 0.007 and OR 2.04, 95% CI 1.21-3.42, p  = 0.007, respectively), and disinhibition (OR 2.39, 95% CI 1.45-3.93, p  = 0.001 and OR 2.30, 95% CI 1.33-3.98, p  = 0.003, respectively). Aβ42/Aβ40 and NfL were not associated with NPS., Conclusion: Higher plasma-derived p-tau181 and p-tau217 levels are associated with increased symptoms of appetite change, agitation, and disinhibition. These findings may support the validity of plasma tau biomarkers for predicting behavioral symptoms that often accompany cognitive impairment., Highlights: We studied 1005 community-dwelling persons aged ≥ 50 yearsHigher plasma tau levels are associated with increased neuropsychiatric symptomsAβ42/Aβ40 and NfL are not associated with neuropsychiatric symptomsClinicians should treat neuropsychiatric symptoms in persons with high plasma-derived tau., Competing Interests: Walter K. Kremers receives research funding from the Department of Defense, the National Institutes of Health (NIH), Astra Zeneca, Biogen, and Roche. Alicia Algeciras‐Schimnich serves on advisory boards for Roche Diagnostics and Fujirebio Diagnostics. Jeffrey L. Dage is an inventor on patents or patent applications of Eli Lilly and Company relating to the assays, methods, reagents, and/or compositions of matter related to measurement of p‐tau217. Jeffrey L. Dage has served as a consultant for Genotix Biotechnologies Inc, Gates Ventures, Karuna Therapeutics, AlzPath Inc, Cognito Therapeutics, Inc., and received research support from ADx Neurosciences, AlzPath, Roche Diagnostics, and Eli Lilly and Company in the past 2 years. Jeffrey L. Dage has received speaker fees from Eli Lilly and Company. Argonde C. van Harten served as a consultant for Roche Diagnostics. Julie A. Fields receives research funding from the NIH. David S. Knopman serves on a Data Safety Monitoring Board for the Dominantly Inherited Alzheimer Network (DIAN) study and is an investigator in clinical trials sponsored by Biogen, Lilly Pharmaceuticals, and the University of Southern California. Clifford R. Jack Jr. serves on an independent data monitoring board for Roche, has served as a speaker for Eisai, and consulted for Biogen, but he receives no personal compensation from any commercial entity. He receives research support from NIH and the Alexander Family Alzheimer's Disease Research Professorship of the Mayo Clinic. Ronald C. Petersen consults for Roche, Merck, Genentech, and Biogen, and GE Healthcare and receives royalties from Oxford University Press for the publication of Mild Cognitive Impairment. Maria Vassilaki has received in the past research funding from Roche and Biogen; she currently consults for Roche; receives research funding from NIH; and has equity ownership in Abbott Laboratories, Johnson and Johnson, Medtronic, and Amgen. Yonas E. Geda receives funding from the NIH and Roche and served on the Lundbeck Advisory Board. No other disclosures were reported. Author disclosures are available in the supporting information.All participants gave their written informed consent to participate in the Mayo Clinic Study of Aging, in accordance with the ethical standards set by the Mayo Clinic and Olmsted Medical Center institutional review boards., (© 2023 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.)

Background: Fitness has important implications for physical activity behavior and is associated with various health-related outcomes. It can be assessed through a test battery or a self-reported questionnaire. One example is the FFB-Mot (Funktionsfragebogen Motorik; engl. functional fitness questionnaire) which consist of 28 items to assess four components of fitness in adults: cardiorespiratory fitness/ endurance, muscular strength, gross motor coordination, and flexibility. The aims of this manuscript were to (1) provide an English-version of the FFB-Mot questionnaire (developed from the German-version using translation and back-translation) to the international community of researchers in the areas of physical activity, fitness and health in adults, and (2) examine the predictive validity of the FFB-Mot questionnaire in a large sample of community-dwelling adults., Methods: We used data from a longitudinal study in Germany with four measurement waves over a period of 18 years, with samples ranging between 310 and 437 participants (1572 adults in total, mean ages 46-58 years). To assess predictive validity, we calculated Pearson correlations between FFB-Mot data collected in 1997 and external health-related criteria (i.e., subjective health status, physician-rated health status, back pain, physical complaints and physical activity in minutes per week) collected in 2002, 2010, and 2015, and separately for males and females., Results: We observed correlations between higher FFB-Mot scores with better subjective health status (in 2002: males, r = 0.25; females, r = 0.18; in 2010: males, r = 0.29; females, r = 0.28; in 2015: males, r = 0.40), and higher physical activity (in 2002: males, r = 0.24; females, r = 0.25; in 2010: males, r = 0.30; females, r = 0.38; in 2015: females, r = 0.27). Higher FFB-Mot scores were also correlated with lower back pain (in 2002: males, r = -0.23; females, r = -0.25; in 2010: females, r = -0.22), less physical complaints (in 2002: males, r = -0.36; females, r = -0.24), and better physician-rated health status (in 2002: males, r = -0.41; females, r = -0.29, 2010: males, r = -0.38; females, r = -0.44; in 2015: males, r = -0.47)., Conclusions: Our results suggest that the FFB-Mot to assess fitness in adults has predictive validity for health-related outcomes as indicated by significant correlations, albeit some effect sizes are small. The FFB-Mot may be used as one-time assessment of self-reported fitness, or for repeated testing to assess change of self-reported fitness over time and in different settings (e.g., public health research)., (© 2023. The Author(s).)

Background: We examined the longitudinal association between (change in) physical activity (PA) with new onset of five risk factors of metabolic syndrome among 657 middle-aged adults (mean age 44.1 (standard deviation (SD) 8.6) years) who were free of the respective outcome at baseline, in a longitudinal cohort study spanning over 29 years., Methods: Levels of habitual PA and sports-related PA were assessed by a self-reported questionnaire. Incident elevated waist circumference (WC), elevated triglycerides (TG), reduced high-density lipoprotein cholesterols (HDL), elevated blood pressure (BP), and elevated blood-glucose (BG) were assessed by physicians and by self-reported questionnaires. We calculated Cox proportional hazard ratio regressions and 95% confidence intervals., Results: Over time, participants developed (cases of incident risk factor; mean (SD) follow-up time) elevated WC (234 cases; 12.3 (8.2) years), elevated TG (292 cases; 11.1 (7.8) years), reduced HDL (139 cases; 12.4 (8.1) years), elevated BP (185 cases; 11.4 (7.5) years), or elevated BG (47 cases; 14.2 (8.5) years). For PA variables at baseline, risk reductions ranging between 37 and 42% for reduced HDL levels were detected. Furthermore, higher levels of PA (≥ 16.6 METh per week) were associated with a 49% elevated risk for incident elevated BP. Participants who increased PA levels over time, had risk reductions ranging between 38 and 57% for elevated WC, elevated TG and reduced HDL. Participants with stable high amounts of PA from baseline to follow-up had risk reductions ranging between 45 and 87% for incident reduced HDL and elevated BG., Conclusions: PA at baseline, starting PA engagement, maintaining and increasing PA level over time are associated with favorable metabolic health outcomes., (© 2023. The Author(s).)

Exoskeletons are a promising tool to support individuals with a decreased level of motor performance. Due to their built-in sensors, exoskeletons offer the possibility of continuously recording and assessing user data, for example, related to motor performance. The aim of this article is to provide an overview of studies that rely on using exoskeletons to measure motor performance. Therefore, we conducted a systematic literature review, following the PRISMA Statement guidelines. A total of 49 studies using lower limb exoskeletons for the assessment of human motor performance were included. Of these, 19 studies were validity studies, and six were reliability studies. We found 33 different exoskeletons; seven can be considered stationary, and 26 were mobile exoskeletons. The majority of the studies measured parameters such as range of motion, muscle strength, gait parameters, spasticity, and proprioception. We conclude that exoskeletons can be used to measure a wide range of motor performance parameters through built-in sensors, and seem to be more objective and specific than manual test procedures. However, since these parameters are usually estimated from built-in sensor data, the quality and specificity of an exoskeleton to assess certain motor performance parameters must be examined before an exoskeleton can be used, for example, in a research or clinical setting.

Objective: This study examined associations between physical activity (PA) and neuropsychiatric symptoms (NPS) in older adults free of dementia., Methods: This cross-sectional study included 3,222 individuals ≥70 years of age (1,655 men; mean±SD age=79.2±5.6; cognitively unimpaired, N=2,723; mild cognitive impairment, N=499) from the population-based Mayo Clinic Study of Aging. PA (taken as a presumed predictor) in midlife (i.e., when participants were 50-65 years of age) and late life (i.e., the year prior to assessment) was assessed with a self-reported, validated questionnaire; PA intensity and frequency were used to calculate composite scores. NPS (taken as presumed outcomes) were assessed with the Neuropsychiatric Inventory Questionnaire, Beck Depression Inventory (BDI-II), and Beck Anxiety Inventory (BAI). Regression analyses included midlife and late-life PA in each model, which were adjusted for age, sex, education, apolipoprotein E ɛ4 status, and medical comorbidity., Results: Higher late-life PA was associated with lower odds of having apathy (OR=0.89, 95% CI=0.84-0.93), appetite changes (OR=0.92, 95% CI=0.87-0.98), nighttime disturbances (OR=0.95, 95% CI=0.91-0.99), depression (OR=0.94, 95% CI=0.90-0.97), irritability (OR=0.93, 95% CI=0.89-0.97), clinical depression (OR=0.92, 95% CI=0.88-0.97), and clinical anxiety (OR=0.90, 95% CI=0.86-0.94), as well as lower BDI-II (β estimate=-0.042, 95% CI=-0.051 to -0.033) and BAI (β estimate=-0.030, 95% CI=-0.040 to -0.021) scores. Higher midlife PA was associated only with higher BDI-II scores (β estimate=0.011, 95% CI=0.004 to 0.019). Sex modified the associations between PA and NPS., Conclusions: Late-life PA was associated with a lower likelihood of clinical depression or anxiety and subclinical NPS. These findings need to be confirmed in a cohort study.

Background: In middle-aged and particularly older adults, body mass index (BMI) is associated with various health outcomes. We examined associations between physical activity (PA) and longitudinal BMI change in persons aged ≥ 50 years., Methods: The sample included 5159 community-dwelling individuals aged ≥ 50 years (50.5% males, mean (SD) age 73.0 (10.2) years at baseline) who were enrolled in the Mayo Clinic Study of Aging (MCSA). Participants had information on PA within one year of baseline assessment, BMI at baseline, and potential follow-up assessments (mean (SD) follow-up 4.6 (3.7) years). Linear mixed-effect models were used to calculate the association between PA (moderate-vigorous physical activity, MVPA; and all PA composite score) and the longitudinal change in BMI, adjusted for baseline age, sex, education and medical comorbidities. In addition to interactions between years since baseline and PA, we also included 2- and 3-way interactions with baseline age to further assess whether age modifies the trajectory of BMI over time., Results: We observed a decrease in BMI among participants engaging at a mean amount of PA (i.e., , Mvpa: 2.7; all PA: 6.8) and with a mean age (i.e., 73 years) at baseline (MVPA: estimate = -0.047, 95% CI -0.059, -0.034; all PA: estimate = -0.047, 95% CI -0.060, -0.035), and this decline is accelerated with increasing age. Participants with a mean age (i.e., 73 years) that engage at an increased amount of MVPA or all PA at baseline (i.e., one SD above the mean) do not decrease as fast with regard to BMI (MVPA: estimate = -0.006; all PA: estimate = -0.016), and higher levels of MVPA or all PA at baseline (i.e., two SD above the mean) were even associated with an increase in BMI (MVPA: estimate = 0.035; all PA: estimate = 0.015). Finally, MVPA but not all PA is beneficial at slowing BMI decline with increasing age., Conclusion: PA, particularly at moderate-vigorous intensity, is associated with slower decline in longitudinal BMI trajectories. This implies that engaging in PA may be beneficial for healthy body weight regulation in middle and late adulthood., (© 2023. The Author(s).)

Objective: To examine interactions between Neuropsychiatric symptoms (NPS) with Pittsburgh Compound B (PiB) and fluorodeoxyglucose positron emission tomography (FDG-PET) in predicting cognitive trajectories., Methods: We conducted a longitudinal study in the setting of the population-based Mayo Clinic Study of Aging in Olmsted County, MN, involving 1581 cognitively unimpaired (CU) persons aged ≥50 years (median age 71.83 years, 54.0% males, 27.5% APOE ɛ4 carriers). NPS at baseline were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Brain glucose hypometabolism was defined as a SUVR ≤ 1.47 (measured by FDG-PET) in regions typically affected in Alzheimer's disease. Abnormal cortical amyloid deposition was measured using PiB-PET (SUVR ≥ 1.48). Neuropsychological testing was done approximately every 15 months, and we calculated global and domain-specific (memory, language, attention, and visuospatial skills) cognitive z-scores. We ran linear mixed-effect models to examine the associations and interactions between NPS at baseline and z-scored PiB- and FDG-PET SUVRs in predicting cognitive z-scores adjusted for age, sex, education, and previous cognitive testing., Results: Individuals at the average PiB and without NPS at baseline declined over time on cognitive z-scores. Those with increased PiB at baseline declined faster (two-way interaction), and those with increased PiB and NPS declined even faster (three-way interaction). We observed interactions between time, increased PiB and anxiety or irritability indicating accelerated decline on global z-scores, and between time, increased PiB and several NPS (e.g., agitation) showing faster domain-specific decline, especially on the attention domain., Conclusions: NPS and increased brain amyloid deposition synergistically interact in accelerating global and domain-specific cognitive decline among CU persons at baseline., (© 2023 The Authors. Psychiatric Research and Clinical Practice published by Wiley Periodicals LLC on behalf of American Psychiatric Association.)

There is a growing interest in the application of machine learning (ML) in Alzheimer's disease (AD) research. However, neuropsychiatric symptoms (NPS), frequent in subjects with AD, mild cognitive impairment (MCI), and other related dementias have not been analyzed sufficiently using ML methods. To portray the landscape and potential of ML research in AD and NPS studies, we present a comprehensive literature review of existing ML approaches and commonly studied AD biomarkers. We conducted PubMed searches with keywords related to NPS, AD biomarkers, machine learning, and cognition. We included a total of 38 articles in this review after excluding some irrelevant studies from the search results and including 6 articles based on a snowball search from the bibliography of the relevant studies. We found a limited number of studies focused on NPS with or without AD biomarkers. In contrast, multiple statistical machine learning and deep learning methods have been used to build predictive diagnostic models using commonly known AD biomarkers. These mainly included multiple imaging biomarkers, cognitive scores, and various omics biomarkers. Deep learning approaches that combine these biomarkers or multi-modality datasets typically outperform single-modality datasets. We conclude ML may be leveraged to untangle the complex relationships of NPS and AD biomarkers with cognition. This may potentially help to predict the progression of MCI or dementia and develop more targeted early intervention approaches based on NPS.

We examined the longitudinal association between physical activity (PA) and the risk of incident metabolic syndrome (MetS) among middle-aged, community-dwelling adults, including 591 individuals (314 females; mean (SD) age, 43.8 (8.5) years) who were free of MetS at baseline. Habitual and sports-related PA was assessed by a self-reported questionnaire. MetS was defined based on HDL-cholesterols, triglycerides, glucose or HbA1c, blood pressure, and waist circumference. We calculated Cox proportional hazard ratios (HR) and 95% confidence intervals (CI) using regression analyses. Over a mean follow-up of 12.5 years, 205 participants developed incident MetS. Four different sports-related PA measures were associated with a decreased risk of incident MetS: (1) Engaging in ≥ 75 min/week (HR 0.71, 95% CI 0.53-0.94), (2) maintaining a continuously high amount from baseline to follow-up of ≥ 75 min/week (HR 0.66, 95% CI 0.46-0.94), (3) starting from < 150 min/week at baseline to ≥ 150 min/week at follow-up (HR 0.65, 95% CI 0.45-0.94), and (4) increasing from < 16.6 MET-hours/week at baseline to ≥ 16.6 MET-hours/week at follow-up (HR 0.47, 95% CI 0.31-0.71). Thus, maintaining, starting or increasing sports-related PA is associated with a lower risk of incident MetS., (© 2022. The Author(s).)

Introduction: We investigated the longitudinal relationship between cortical amyloid deposition, anxiety, and depression and the risk of incident mild cognitive impairment (MCI)., Methods: We followed 1440 community-dwelling, cognitively unimpaired individuals aged ≥ 50 years for a median of 5.5 years. Clinical anxiety and depression were assessed using Beck Anxiety and Depression Inventories (BAI, BDI-II). Cortical amyloid beta (Aβ) was measured by Pittsburgh compound B positron emission tomography (PiB-PET) and elevated deposition (PiB+) was defined as standardized uptake value ratio ≥ 1.48. We calculated Cox proportional hazards models with age as the time scale, adjusted for sex, education, and medical comorbidity., Results: Cortical Aβ deposition (PiB+) independent of anxiety (BAI ≥ 10) or depression (BDI-II ≥ 13) increased the risk of MCI. There was a significant additive interaction between PiB+ and anxiety (joint effect hazard ratio 6.77; 95% confidence interval 3.58-12.79; P = .031) that is, being PiB+ and having anxiety further amplified the risk of MCI., Discussion: Anxiety modified the association between PiB+ and incident MCI., (© 2021 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: The COVID-19 pandemic has had drastic consequences on everyday life in nursing homes. Limited personnel resources and modified hygiene and safety measures (eg, no external exercise instructors, no group settings) have often led to interrupted physical exercise treatments. As a consequence, people with dementia benefiting from individualized exercise programs are affected by the pandemic's impact., Objective: Our goal is to develop an easily applicable mobile application (Individualized Cognitive and Physical Exercise [InCoPE] app) allowing nursing assistants to test cognitive function and physical performance and subsequently train people with dementia through a multidomain, individualized exercise program., Methods: We will evaluate the usability and effectiveness of the InCoPE-App by applying a mixed method design. Nursing assistants will use the InCoPE-App for 18 weeks to assess the cognitive function and physical performance of 44 people with dementia every 3 weeks and apply the individualized exercise program. We will record overall usability using questionnaires (eg, Post-Study System Usability and ISONORM 9241/10), log events, and interviews. Perceived hedonic and pragmatic quality will be assessed using the AttrakDiff questionnaire. Effectiveness will be evaluated by considering changes in quality of life as well as cognitive function and physical performance between before and after the program., Results: Enrollment into the study will be completed in the first half of 2022. We expect an improvement in the quality of life of people with dementia accompanied by improvements in cognitive function and physical performance. The usability of the InCoPE-App is expected to be rated well by nursing assistants., Conclusions: To date, there is no scientifically evaluated app available that enables nursing assistants without expertise in sports science to deliver an individualized exercise program among people with dementia. A highly usable and effective InCoPE-App allows nursing assistants to test cognitive function and physical performance of people with dementia and, based thereon, select and deliver an appropriate individualized exercise program based on the cognitive and physical status of an individual, even in times of a pandemic., Trial Registration: German Register of Clinical Trials DRKS00024069; https://www.drks.de/drks&#95;web/navigate.do?navigationId=trial.HTML&TRIAL&#95;ID=DRKS00024069., International Registered Report Identifier (irrid): DERR1-10.2196/36247., (©Bettina Barisch-Fritz, Jelena Bezold, Andrea Scharpf, Sandra Trautwein, Janina Krell-Roesch, Alexander Woll. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 26.09.2022.)

Physical activity interventions can alleviate the course of disease for individuals with dementia (IWD) who have been extraordinarily affected by the COVID-19 pandemic. Information and Communication Technology (ICT) provides new opportunities not only to mitigate negative effects of the pandemic but also to sustainably improve everyday life of IWD in nursing homes. The aim of the present study was to evaluate the ICT-based InCoPE-App, which was used to assess physical and cognitive performance and deliver individualized exercise for IWD, with regard to 1) user experience of nursing assistants, and 2) trends toward the effectiveness of the intervention on physical and cognitive performance of IWD. An 18-week individualized multidomain intervention (2 × 60 min/session) was delivered to an intervention group (IG; n = 10, mean age 88.4 ± 5.6, 70% female) by nursing assistants ( n = 10, mean age 56.1 ± 10.4, 90% female) using the InCoPE-App. A control group (CG; n = 3, mean age 87.3 ± 3.5, 100% female) received conventional treatment. User experience was assessed among nursing assistants by different questionnaires, i.e., PSSUQ and ISONORM 9241/110-S for usability, and AttrakDiff2 for pragmatic (PQ), hedonic quality-identity and stimulation (HQI and HQS), and attractiveness (ATT). Trends toward the effectiveness of the intervention were assessed using MMSE (global cognitive function), FICSIT-4 (balance), 6MWT and TUG (mobility), and m30CST (function of lower limbs). Usability of the InCoPE-App was rated as high by nursing assistants (mean ± SD; overall PSSUQ 2.11 ± 0.75; overall ISONORM 9241/110-S 1.90 ± 0.88; ATT 1.86 ± 1.01; PQ 1.79 ± 1.03; HQI 1.8 ± 0.79; and HQS 1.37 ± 0.69). Dropout was high in the total sample (36.7%). Trends toward the effectiveness were observed within IG in nine IWD who showed positive or neutral trends in at least two physical performance outcomes. Seven participants had positive or neutral trends in the FICSIT-4, seven participants in m30CST, and four and seven participants in 6MWT and TUG, respectively. In conclusion, the InCoPE-App has good nursing assistant-rated usability, whereas training effects and intervention adherence were rather low most likely due to COVID-19 restrictions. Single-subject research revealed more positive than negative trends in IG of IWD. Further research is needed to evaluate feasibility, suitability, and effectiveness of the InCoPE-App., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Barisch-Fritz, Bezold, Scharpf, Trautwein, Krell-Roesch and Woll.)

Introduction: Many employees report high physical strain from overhead work and resulting musculoskeletal disorders. The consequences of these conditions extend far beyond everyday working life and can severely limit the quality of life of those affected. One solution to this problem may be the use of upper-limb exoskeletons, which are supposed to relieve the shoulder joint in particular. The aim of this literature review was to provide an overview of the use and efficacy of exoskeletons for upper extremities in the working environment. Methods: A literature review was conducted using the PICO scheme and the PRISMA statement. To this end, a systematic search was performed in the PubMed, Web of Science and Scopus databases in May 2020 and updated in February 2022. The obtained studies were screened using previously defined inclusion and exclusion criteria and assessed for quality. Pertinent data were then extracted from the publications and analyzed with regard to type of exoskeleton used as well as efficacy of exoskeleton use. Results: 35 suitable studies were included in the review. 18 different exoskeletons were examined. The majority of the exoskeletons only supported the shoulder joint and were used to assist individuals working at or above shoulder level. The main focus of the studies was the reduction of muscle activity in the shoulder area. Indeed, 16 studies showed a reduced activity in the deltoid and trapezius muscles after exoskeleton use. Kinematically, a deviation of the movement behavior could be determined in some models. In addition, study participants reported perceived reduction in exertion and discomfort. Discussion: Exoskeletons for upper extremities may generate significant relief for the intended tasks, but the effects in the field (i.e., working environment) are less pronounced than in the laboratory setting. This may be due to the fact that not only overhead tasks but also secondary tasks have to be performed in the field. In addition, currently available exoskeletons do not seem to be suitable for all overhead workplaces and should always be assessed in the human-workplace context. Further studies in various settings are required that should also include more females and older people., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Moeller, Krell-Roesch, Woll and Stein.)

This study examined the development of muscular fitness and coordination in children and adolescents with and without attention deficit hyperactivity disorder (ADHD) over a period of 11 years. Data was collected in three measurement waves as part of the longitudinal, representative Motorik-Modul (MoMo) study in Germany (2003-2006, 2009-2012, 2014-2017). The overall sample comprised 2988 participants (253 with ADHD, 65% males; 2735 non-ADHD, 47% males; mean age 9 years). Structural equation modeling was conducted, and the estimated models had a good fit. No differences in muscular fitness were observed between participants with and without ADHD. Participants with ADHD had a lower coordinative performance at first measurement than those without ADHD. The difference in coordinative performance persisted throughout the study period., (© 2022. The Author(s).)

Background and Purpose: Dementia affects physical as well as cognitive performance. In individuals with dementia (IWD), decline in physical performance increases with disease progression and is associated with higher functional dependence and decreased quality of life. It is paramount to examine factors that potentially preserve physical performance in IWD, particularly in light of conflicting findings on the effectiveness of physical activity interventions on physical performance of IWD, mainly due to limited number of high-quality studies, large heterogeneity in methods used, or insufficient reporting of methods. The aim of this study was to investigate the effects of a 16-week multimodal exercise program (MEP) combining physical and cognitive tasks on physical performance in IWD, and to identify individual characteristics of MEP responders., Methods: A multicenter randomized controlled trial with assessment methods identified by an expert panel was conducted. We included 319 IWD of mild to moderate severity, older than 65 years, who underwent a standardized MEP specifically designed for IWD. At baseline and immediately after the MEP, we assessed physical performance (ie, mobility, balance, and strength) and function of lower extremities (primary outcomes). Potential effects of the MEP on physical performance were identified using 2-factor analyses of variance with repeated measurements within 2 samples (ie, intention-to-treat and per-protocol sample). Additionally, we compared characteristics related to physical performance between positive, non-, and negative responders., Results and Discussion: Neither analysis procedure revealed statistically significant time×group effects. However, 28% to 40% of participants were positive responders with regard to balance, and strength and function of lower extremities; and these persons had statistically significant lower baseline performance in the corresponding assessments., Conclusions: This randomized controlled trial revealed no overall effects of the MEP on physical performance, probably due to high heterogeneity of the study sample. Findings in responder analysis showed that IWD with lower physical performance at baseline tended to benefit more than those with higher baseline performance. Thus, a higher degree of individualization of the MEP depending on baseline performance on IWD may improve overall MEP effectiveness., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 APTA Geriatrics, An Academy of the American Physical Therapy Association.)

Background: Considering the world's rapidly increasing life expectancy, with people working and maintaining active lifestyles longer than ever before, addressing the effects of aging on cognition is of utmost importance. A greater understanding of cognitive aging may also be critical in distinguishing natural cognitive aging from pre-clinical stages of Alzheimer's disease and related cognitive disorders., Objective: To systematically examine the association between aging and cognitive performance in a cognitively and otherwise healthy probability population-based sample using a computer-based method., Methods: This cross-sectional study enrolled 673 cognitively and otherwise healthy participants aged 25-89 years (mean age 52.3±14.2 years, 52.5% of whom were female) from the Kardiovize study cohort. Mild cognitive impairment and dementia cases were excluded, followed by measurement of cognitive performance with the computer-administered Cogstate Brief Battery. We used ANCOVA and Modified Signed-Likelihood Ratio tests to examine patterns of cognition across age groups., Results: We found a gradual decrease in cognitive performance across the lifespan, which required two decades to demonstrate significant changes. In contrast to attention and learning, psychomotor speed and working memory showed the most significant age-related decrease and variability in performance. The established pattern of cognitive aging was not altered by sex or education., Conclusion: These findings corroborate, validate, and extend the current understanding of natural cognitive aging and pinpoint specific cognitive domains with the most extensive age-related interindividual differences. This will contribute to the development of strategies to preserve cognition with aging and may also serve to improve early diagnostics of cognitive disorders using computer-based methods.

Until recently, emotional processes have played little role in personality psychology. Based on neuroscientific findings, Davidson and colleagues proposed a theory of emotional styles, postulating six dimensions of emotional life: outlook, resilience, social intuition, self-awareness, sensitivity to context, and attention. Recently, an English version of the Emotional Style Questionnaire (ESQ) was developed and tested for reliability and validity. The aim of the present work was to test the test-retest reliability, internal consistency, construct validity, and criterion validity of the German version of the ESQ. Two separate samples consisting of 365 and 344 subjects took part in an online survey. The results of the two studies indicated satisfactory test-retest reliability and internal consistency. Regarding the construct validity, the results from Study 1 to Study 2 indicate good model fit indices. Although there was a high correlation between the subscales outlook and resilience, the analyses supported the six-factor structure postulated by Davidson and colleagues. Substantial correlations were found between the dimensions of the ESQ and other validated scales, confirming the criterion validity of the questionnaire. Our results suggest that the German version of the ESQ is a reliable and valid measurement of emotional styles. It is a feasible and economical questionnaire that can be applied in various psychology disciplines, such as personality psychology, clinical psychology, industrial psychology or sport and exercise psychology., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Jekauc, Mülberger, Weyland, Ennigkeit, Wunsch, Krell-Roesch and Fritsch.)

Background: The sense of coherence (SOC) is reported to influence health, but health may also have an impact on SOC. The objective of this study was to examine the longitudinal associations between SOC and selected self-reported and physician-assessed health outcomes over a period of 10 and 20 years and to determine the predominant direction of the associations. Methods: We conducted a population-based, longitudinal study, involving 392 participants (188 females and 204 males; mean age 43.01 years) who were followed for a median of 10 and 18 years. Analyses of variance were carried out to examine the longitudinal associations between SOC at baseline and health outcomes (i.e., self-rated health status, SHS; physical health status assessed by a physician, PHS; self-reported satisfaction with life, SWL) at follow-ups. The direction of associations was examined using a cross-lagged model on correlation coefficients. Results: There were significant group effects for SOC at baseline on SHS at 20-year follow-up ( F = 4.09, p = 0.018, η p 2 = 0.041), as well as on SWL at 10-year ( F = 12.67, p < 0.01, η p 2 = 0.072) and at 20-year follow-up ( F = 8.09, p < 0.1, η p 2 = 0.069). SHS ( r = 0.238, p < 0.01), PHS ( r = -0.140, p < 0.05) and SWL ( r = 0.400, p < 0.01) predicted SOC at 10-year follow-up stronger than vice versa. The direction of associations between SOC and health parameters at 20-year follow-up was less consistent. Conclusions: The long-term associations between SOC and self-reported and physician-assessed health may be reciprocal in community-dwelling adults. More research is needed to examine the predictive power of health on SOC and whether interventions targeted at improving health parameters, may impact SOC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dziuba, Krell-Roesch, Schmidt, Bös and Woll.)

Objective: The purpose of this study was to test the hypothesis that subcortical β-amyloid (Aβ) deposition was associated with elevated scores on standardized measures of depressive and anxiety symptoms when compared with cortical (Aβ) deposition in persons without dementia., Methods: The authors performed a cross-sectional study, derived from the population-based Mayo Clinic Study of Aging, comprising participants aged ≥70 years (N=1,022; 55% males; 28% apolipoprotein E [APOE] ε4 carriers; without cognitive impairment, N=842; mild cognitive impairment; N=180). To assess Aβ deposition in cortical and subcortical (the amygdala, striatum, and thalamus) regions, participants underwent Pittsburgh Compound B positron emission tomography (PiB-PET) and completed the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). The investigators ran linear regression models to examine the association between PiB-PET standardized uptake value ratios (SUVRs) in the neocortex and subcortical regions and depressive and anxiety symptoms (BDI-II and BAI total scores). Models were adjusted for age, sex, education level, and APOE ε4 carrier status and stratified by cognitive status (without cognitive impairment, mild cognitive impairment)., Results: Cortical PiB-PET SUVRs were associated with depressive symptoms (β=0.57 [SE=0.13], p<0.001) and anxiety symptoms (β=0.34 [SE=0.13], p=0.011). PiB-PET SUVRs in the amygdala were associated only with depressive symptoms (β=0.80 [SE=0.26], p=0.002). PiB-PET SUVRs in the striatum and thalamus were associated with depressive symptoms (striatum: β=0.69 [SE=0.18], p<0.001; thalamus: β=0.61 [SE=0.24], p=0.011) and anxiety symptoms (striatum: β=0.56 [SE=0.18], p=0.002; thalamus: β=0.65 [SE=0.24], p=0.008). In the mild cognitive impairment subsample, Aβ deposition, regardless of neuroanatomic location, was associated with depressive symptoms but not anxiety symptoms., Conclusions: Elevated amyloid deposition in cortical and subcortical brain regions was associated with higher depressive and anxiety symptoms, although these findings did not significantly differ by cortical versus subcortical Aβ deposition. This cross-sectional observation needs to be confirmed by a longitudinal study.

A worsening trend of critical shortages in senior health care workers across low- and middle-income countries (LMICs) in sub-Saharan Africa has been documented for decades. This is especially the case in Ethiopia that has severe shortage of mental health professionals. Consistent with the WHO recommended approach of task sharing for mental health care in LMICs, Acceptance and Commitment Therapy (ACT), which is an empirically validated psychological intervention aimed at increasing psychological flexibility, may be delivered by trained laypersons who have a grassroots presence. In this paper, we discuss the need for and potential role of ACT to be delivered by health extension workers (HEWs) to address mental health care needs across Ethiopia. To this end, we also reviewed previous studies that have examined the effectiveness of ACT-based interventions in African countries including in Nigeria, Sierra Leone, Uganda, and South Africa. All studies revealed significant improvements of various mental health-related outcome measures such as decreased psychological distress and depressive symptoms, or increased subjective wellbeing and life satisfaction in the groups that received an ACT-based intervention. However, to date, there is no study that applied ACT in Ethiopia. Thus, more research is warranted to examine the effectiveness and, if proven successful, to scale up a task sharing approach of an ACT-based intervention being delivered by trained HEWs at a grassroots level, possibly paving the way for an innovative, sustainable mental health service in Ethiopia as well as other African LMICs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Geda, Krell-Roesch, Fisseha, Tefera, Beyero, Rosenbaum, Szabo, Araya and Hayes.)

Objective: Neuropsychiatric symptoms (NPS) are associated with the risk of incident mild cognitive impairment (MCI) and dementia. We examined associations between NPS and the outcomes of global and domain-specific cognitive trajectories., Methods: In this longitudinal study conducted in the setting of the population-based Mayo Clinic Study of Aging, 5081 community-dwelling, nondemented individuals aged ≥50 years (51% males) underwent NPS assessment using Neuropsychiatric Inventory Questionnaire (NPI-Q), and Beck Depression and Anxiety Inventories (BDI-II, BAI). Global and domain-specific (memory, language, attention, and visuospatial skills) cognitive performance was assessed through neuropsychological testing every 15 months. Associations between baseline NPS and trajectories for individual yearly change in cognitive z-scores were calculated using linear mixed-effect models., Results: Cognition declined regardless of NPS status over the median follow-up of 4.5 years. Presence of NPS was associated with increased cognitive decline. Differences in annualized change in global cognition z-scores for participants with NPS compared to without NPS ranged from -0.018 (95% CI -0.032, -0.004; p = 0.011) for irritability to -0.159 (-0.254, -0.065; p = 0.001) for hallucinations. Associations between NPS and annual decline in global cognition were significant for most NPI-Q-assessed NPS and clinical depression (BDI-II≥13). Participants with NPI-Q-assessed depression, apathy, nighttime behavior, and clinical depression had greater decline in all domain-specific z-scores; presence of delusions and anxiety was associated with more pronounced decline in language, attention and visuospatial skills., Conclusion: NPS were associated with a more accelerated cognitive decline. Clinical assessment and potential treatment of NPS is warranted even in a community setting as NPS may impact cognitive decline in nondemented individuals., (© 2021 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Background: Higher age and cognitive impairment are associated with a higher risk of falling. Wearable sensor technology may be useful in objectively assessing motor fall risk factors to improve physical exercise interventions for fall prevention. This systematic review aims at providing an updated overview of the current research on wearable sensors for fall risk assessment in older adults with or without cognitive impairment. Therefore, we addressed two specific research questions: 1) Can wearable sensors provide accurate data on motor performance that may be used to assess risk of falling, e.g., by distinguishing between faller and non-faller in a sample of older adults with or without cognitive impairment?; and 2) Which practical recommendations can be given for the application of sensor-based fall risk assessment in individuals with CI? A systematic literature search (July 2019, update July 2020) was conducted using PubMed, Scopus and Web of Science databases. Community-based studies or studies conducted in a geriatric setting that examine fall risk factors in older adults (aged ≥60 years) with or without cognitive impairment were included. Predefined inclusion criteria yielded 16 cross-sectional, 10 prospective and 2 studies with a mixed design., Results: Overall, sensor-based data was mainly collected during walking tests in a lab setting. The main sensor location was the lower back to provide wearing comfort and avoid disturbance of participants. The most accurate fall risk classification model included data from sit-to-walk and walk-to-sit transitions collected over three days of daily life (mean accuracy = 88.0%). Nine out of 28 included studies revealed information about sensor use in older adults with possible cognitive impairment, but classification models performed slightly worse than those for older adults without cognitive impairment (mean accuracy = 79.0%)., Conclusion: Fall risk assessment using wearable sensors is feasible in older adults regardless of their cognitive status. Accuracy may vary depending on sensor location, sensor attachment and type of assessment chosen for the recording of sensor data. More research on the use of sensors for objective fall risk assessment in older adults is needed, particularly in older adults with cognitive impairment., Trial Registration: This systematic review is registered in PROSPERO ( CRD42020171118 )., (© 2021. The Author(s).)

Objective: The authors conducted a prospective cohort study to examine the risk of incident mild cognitive impairment (MCI) as predicted by baseline neuropsychiatric symptoms (NPS) and brain regional glucose metabolic dysfunction., Methods: About 1,363 cognitively unimpaired individuals (52.8% males) aged ≥50 years were followed for a median of 4.8 years to the outcome of incident MCI. NPS were assessed using Beck Depression and Anxiety Inventories and Neuropsychiatric Inventory Questionnaire. Glucose hypometabolism was measured by fluorodeoxyglucose positron emission tomography and defined as standardized uptake value ratio ≤ 1.47 in regions typically affected in Alzheimer disease. Cox proportional hazards models were adjusted for age, sex, education, and APOE ε4 status., Results: Participants with regional glucose hypometabolism and depression (Beck Depression Inventory-II ≥13) had a more than threefold increased risk of incident MCI (hazard ratio [95% confidence interval], 3.66 [1.75, 7.65], p <0.001, χ 2  = 11.83, degree of freedom [df] = 1) as compared to the reference group (normal regional glucose metabolism and no depression), and the risk was also significantly elevated (7.21 [3.54, 14.7], p <0.001, χ 2  = 29.68, df = 1) for participants with glucose hypometabolism and anxiety (Beck Anxiety Inventory ≥10). Having glucose hypometabolism and ≥1 NPS (3.74 [2.40, 5.82], p <0.001, χ 2  = 34.13, df = 1) or ≥2 NPS (3.89 [2.20, 6.86], p <0.001, χ 2  = 21.92, df = 1) increased the risk of incident MCI by more than three times, and having ≥3 NPS increased the risk by more than four times (4.12 [2.03, 8.37], p <0.001, χ 2  = 15.39, df = 1)., Conclusion: Combined presence of NPS with regional glucose hypometabolism is associated with an increased risk of incident MCI, with fluorodeoxyglucose positron emission tomography appearing to be a stronger driving force of cognitive decline than NPS., (Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: There are conflicting reports about the fitness status of European adults, partly due to the lack of a standardized fitness test battery used across Europe. The European Fitness Badge (EFB) was developed in 2017 as an online-based tool to assess the health-related fitness of persons aged ≥ 18 years residing in European countries. We examined the demographic characteristics and fitness status of persons who completed the EFB between June 2017 and May 2019., Methods: We conducted a multinational study in eight European countries. Participants completed the EFB which includes 11 validated motor tests to measure endurance, strength, coordination, and flexibility performance, under the supervision of an EFB instructor in different settings (e.g., sports club sessions, public events). Two different test batteries [test profiles (TPs)] are available to distinguish between less active (TP1) and active individuals (TP2). We calculated descriptive statistics and conducted analyses of variance to examine sample characteristics and a potential impact of sex, age, body mass index (BMI), physical activity, and posture on fitness as assessed by the EFB., Results: The sample included 6,019 adults (68.7% females; mean age 52.7 years; age range 18-89 years). Participants who completed TP1 were older (TP1: 61.4 years; TP2: 44.2 years; p = 0.00), reported a lower level of physical activity (TP1: 3.8; TP2: 4.0; p = 0.00), had a higher BMI (TP1: 25.7; TP2: 24.3; p = 0.00) and a higher frequency of postural abnormalities (TP1: 43%; TP2: 33%; p = 0.00) than TP2 participants. Among 3,034 participants who completed TP2, males had higher performance in endurance, strength, and overall fitness, whereas females performed better in coordination and flexibility tests. In addition, younger age, lower BMI, and higher level of physical activity engagement were associated with better EFB test performance., Conclusion: The EFB can be used to assess the health-related fitness status of individuals aged ≥ 18 years. Our results show that TP1 and TP2 were completed by persons from the respective target groups (i.e., less active vs. active), and also confirm findings from previous studies on potential determinants of fitness such as sex or age., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Klemm, Krell-Roesch, De Clerck, Brehm and Boes.)

Background: Little is known about the association between physical activity (PA) and cognitive trajectories in older adults., Objective: To examine the association between PA and change in memory, language, attention, visuospatial skills, and global cognition, and a potential impact of sex or Apolipoprotein E (APOE) ɛ4 status., Methods: Longitudinal study derived from the population-based Mayo Clinic Study of Aging, including 2,060 cognitively unimpaired males and females aged ≥70 years. Engagement in midlife (ages 50-65) and late-life (last year) PA was assessed using a questionnaire. Neuropsychological testing was done every 15 months (mean follow-up 5.8 years). We ran linear mixed-effect models to examine whether mid- or late-life PA at three intensities (mild, moderate, vigorous) was associated with cognitive z-scores., Results: Light intensity midlife PA was associated with less decline in memory function compared to the no-PA reference group (time x light PA; estimate [standard error] 0.047 [0.016], p = 0.004). Vigorous late-life PA was associated with less decline in language (0.033 [0.015], p = 0.030), attention (0.032 [0.017], p = 0.050), and global cognition (0.039 [0.016], p = 0.012). Females who were physically inactive in midlife experienced more pronounced cognitive decline than females physically active in midlife and males regardless of PA (p-values for time interaction terms with midlife PA levels and sex were all p < 0.05 for global cognition). APOE ɛ4 carriership did not moderate the association between PA and cognition., Conclusion: Engaging in PA, particularly of vigorous intensity in late-life, was associated with less pronounced decline in global and domain-specific cognition. This association may differ by sex.

The physical activity enjoyment scale (PACES) is a measurement instrument that is commonly used in monitoring and intervention research to assess how much people enjoy being physically active, as this has been related to physical activity adherence. However, while the measurement properties of PACES are well-researched in the English language, there is a gap of research in the German language, especially when looking at adults. Thus, the purpose of this work was to examine reliability, factorial validity, criterion-related validity, and measurement invariance across sex, age groups and time of the PACES for German-speaking adults. Data was obtained from the Motorik-Modul-Study (MoMo) in which 863 adults (53.5% female; mean age = 20.9 years) were examined. To investigate measurement invariance across age groups, data from 2,274 adolescents (50.5% female; mean age = 14.4 years) was obtained additionally. The study provided a nationwide representative sample for Germany. Results showed high internal consistency of PACES in adults (Cronbach's α = .94). Confirmatory factor analyses confirmed the invariance of the measure across age groups, time, and sex. Criterion-related validity could be shown as the global factor significantly correlated with overall physical activity, physical activity in sports clubs, and leisure-time physical activity. The analyses of factorial structure indicated a method effect for positively and negatively worded items. Correlated uniqueness, latent method factor and a hybrid model were applied to analyze the method effect and results indicated that the method effect of positively worded items was predictive of physical activity independently of the global factor. Overall, it can be concluded that PACES is reliable, valid and invariant measure of physical activity enjoyment to be used in German-speaking adults. Further studies are warranted to examine the factorial structure of the PACES and the consequences of the method effect., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Habitually instigated exercise is thought to increase health behavior maintenance. Previous research has explored several aspects of habit formation. However, there is a lack of longitudinal research investigating affective determinants, especially post-exercise affective states. Therefore, the present study aimed to investigate (a) if behavior frequency will enhance automaticity, (b) if positive affect will enhance automaticity, and (c) if positive affect will moderate the relationship between behavior frequency and automaticity. Methods: 226 participants (64% females, mean age 24 years) who attended weekly sports and gym classes at two universities were followed for 13 weeks. Class attendance was documented on a weekly basis (behavior frequency) during the semester. Before, during and immediately after each class, participants filled in the Feeling Scale (affective valence). Furthermore, at the beginning of each class, they answered a question about their automaticity in arriving at the decision to attend the class (instigation habit). We used a two-level modeling approach to predict subsequent automaticity by the different constructs at the previous attendance. Results: The cumulative frequency of prior class attendance did not significantly enhance the automaticity of the decision to re-attend the class. There were significant effects of valence on automaticity on the between-subject level, i.e., a one-point higher mean valence score was associated with a 0.62 point increase in automaticity ( p = 0.001). No moderation effects of affect on the association between behavior frequency and automaticity were observed. Conclusion: Behavior repetition, albeit not significant, and positive affective states at the end of an exercise class may be beneficial in building exercise instigation habits. Practitioners and researchers alike may thus want to emphasize the importance of behavior repetition and affective response for health behavior maintenance., (Copyright © 2020 Weyland, Finne, Krell-Roesch and Jekauc.)

Background: There is a high prevalence of gait impairments in individuals with dementia (IWD). Gait impairments are associated with increased risk of falls, disability, and economic burden for health care systems. Only few studies have investigated the effectiveness of physical activity on gait performance in IWD, reporting promising but inconsistent results. Thus, this study aimed to investigate the effectiveness of a multimodal exercise program (MEP) on gait performance in IWD., Methods: In this parallel-group randomized controlled trial, we enrolled 319 IWD of mild to moderate severity, living in care facilities, aged ≥ 65 years, and being able to walk at least 10 m. The control group (n = 118) received conventional treatment, whereas the intervention group (n = 201) additionally participated in a 16-week MEP specifically tailored to IWD. We examined the effects of the MEP on spatiotemporal gait parameters and dual task costs by using the gait analysis system GAITRite. Additionally, we compared characteristics between positive, non-, and negative responders, and investigated the impact of changes in underlying motor and cognitive performance in the intervention group by conducting multiple regression analyses., Results: Two-factor analyses of variance with repeated measurements did not reveal any statistically significant time*group effects on either spatiotemporal gait parameters or dual task costs. Differences in baseline gait performance, mobility, lower limb strength, and severity of cognitive impairments were observed between positive, non-, and negative responders. Positive responders were characterized by lower motor performance compared to negative and non-responders, while non-responders showed better cognitive performance than negative responders. Changes in lower limb strength and function, mobility, executive function, attention, and working memory explained up to 39.4% of the variance of changes in gait performance., Conclusions: The effectiveness of a standardized MEP on gait performance in IWD was limited, probably due to insufficient intensity and amount of specific walking tasks as well as the large heterogeneity of the sample. However, additional analyses revealed prerequisites of individual characteristics and impacts of changes in underlying motor and cognitive performance. Considering such factors may improve the effectiveness of a physical activity intervention among IWD., Trial Registration: DRKS00010538 (German Clinical Trial Register, date of registration: 01 June 2016, retrospectively registered, https://www.drks.de/drks&#95;web/setLocale&#95;EN.do ).

Background: A growing body of studies that investigated the longitudinal association between physical activity (PA) and the outcome of incident obesity, coronary heart disease (CHD), diabetes and hypertension has become available in recent years. Thus, the purpose of this systematic review was to provide an update on the association between PA and onset of obesity, CHD, diabetes and hypertension in individuals aged ≥18 years who were free of the respective conditions at baseline., Methods: We systematically searched OVID, Pubmed, and Web of Science databases for pertinent literature published between January of 2012 and February of 2019. To ensure that conclusions are based on high quality evidence, we only included longitudinal studies conducted in samples of ≥500 participants and with ≥5 years of follow-up., Result: The search yielded 8929 records of which 26 were included in this review. Three studies were conducted on the outcome of incident obesity, eight on incident CHD, nine on incident diabetes, four on incident hypertension, one on the outcome of both diabetes and hypertension, and one on the outcome of CHD, diabetes and hypertension. Overall, there was an association between PA and lower risk of incident obesity, CHD and diabetes, but not hypertension. Higher levels or amount of PA were associated with a reduced risk of new onset of the respective diseases in 20 studies (77%). Whereas four studies reported an elevated risk of incidence of diseases with lower PA levels (15%). PA was not associated with incidence of diseases in two studies (8%)., Conclusion: Higher levels of PA are likely associated with a lower risk of becoming obese, develop CHD or diabetes. These findings replicate and strengthen conclusions from earlier reviews underlining the importance of promoting PA in adults. The associations between PA and incident hypertension were less consistent. More research, particularly using prospective cohort designs in large population-based samples, is needed to further untangle the association between PA and incident hypertension., Trail Registration: CRD42019124474 (PROSPERO Protocol registration). Date of registration in PROSPERO 27 February 2019.

Objective: To investigate the association of a 6-month Zumba intervention with cognition and quality of life among older cognitively unimpaired apolipoprotein ∊4 (APOE4) carrier and noncarrier women., Methods: Fifty-three women were randomly assigned to either twice-weekly Zumba group classes or maintenance of habitual exercise (control group) for 6 months. At baseline, 3, and 6 months, all participants underwent neuropsychological, physical activity, and quality-of-life assessments., Results: Overall, neuropsychological test scores and level of physical activity did not differ between intervention and control groups at any time. However, compared to the control group, quality of life was higher at 3 months, and visuospatial working memory and response inhibition improved more in the intervention group by 6 months. Apolipoprotein ∊4 status did not affect the results., Discussion: Zumba may strengthen performance on visuospatial working memory among cognitively unimpaired older women but this needs to be tested in a larger clinical trial.

Background: Several theories have been established to explain physical activity (PA) participation. However, many of these theories might not be applicable to adolescent PA behavior as they require a high level of cognitive reflection. Weiss suggests a model for youth which is based on the theoretical concept of Harter, focusing on self-esteem within social, emotional, and developmental aspects to explain behavior. The aim of this study was to test the original and a social support focused alternative version of the Weiss-Harter-model, and to cross-validate the findings in two separate studies., Methods: Data from two cross-sectional studies was retrieved and the models tested using structural equation modeling. Participants aged 11-17 years were recruited from a school (Study 1: N = 182) and from the German MoMo study (Study 2: N = 2,274). They filled in questionnaires about perceived competence, social support, self-esteem, PA enjoyment, and minutes of moderate-vigorous PA (MVPA)., Results: None of the studies showed a good model fit for the original model [Study 1: CFI = 0.870, RMSEA 0.118 (90% CI 0.081-0.158), χ 2 = 38.7, p < 0.01; Study 2: CFI = 0.871, RMSEA 0.148 (90% CI 0.140-0.155), χ 2 = 1112.6, p < 0.01], explaining only 12% and 17% of MVPA variance, respectively. The alternative model which added the direct paths of social support to MVPA and PA enjoyment had a very good model fit for both Study 1 [CFI = 1.000, RMSEA 0.000 (90% CI 0.000-0.031), χ 2 = 4.8, p > 0.05] and Study 2 [CFI = 0.990, RMSEA 0.043 (90% CI 0.035-0.051), χ 2 = 103.7, p < 0.01]. The addition of these paths led to changes in effect size and directions of other path coefficients, with self-esteem having a small to meaningless impact on MVPA. The revised models accounted for 38% and 42% explained variance in MVPA, respectively., Discussion: The prominent role of self-esteem in the original model could not be confirmed. Instead, the results emphasize the role of social support for PA and PA enjoyment, which is in line with current research. Interventions to increase adolescent PA levels should thus focus more on components of social support instead of self-esteem. Future studies are needed to examine the interplay between social support, PA enjoyment and perceived competence as PA determinants., (Copyright © 2019 Jekauc, Mnich, Niessner, Wunsch, Nigg, Krell-Roesch and Woll.)

Objective: To investigate whether timing, number, and frequency of mentally stimulating activities in midlife and late life are associated with the risk of incident mild cognitive impairment (MCI)., Methods: We conducted a prospective cohort study in the setting of the population-based Mayo Clinic Study of Aging in Olmsted County, Minnesota, including 2,000 individuals aged ≥70 years who were cognitively unimpaired at baseline and were followed for a median of 5.0 years. Participants completed a self-reported survey on timing, number, and frequency of engagement in 5 mentally stimulating activities (reading books, computer use, social activities, playing games, craft activities) at baseline., Results: The risk of incident MCI was significantly reduced for participants who engaged in social activities (hazard ratio [95% confidence interval] 0.80 [0.64-0.99]) and playing games (0.80 [0.66-0.98]) in both late life and midlife combined. Using a computer was associated with a decreased risk regardless of timing (not late life but midlife: 0.52 [0.31-0.88]; late life but not midlife: 0.70 [0.56-0.88]; late life and midlife: 0.63 [0.51-0.79]). Craft activities were associated with a reduced risk of incident MCI only when carried out in late life but not midlife (0.58 [0.34-0.97]). Furthermore, engaging in a higher number of activities in late life was associated with a significantly reduced risk of incident MCI (any 2 activities: 0.72 [0.53-0.99], any 3: 0.55 [0.40-0.77], any 4: 0.44 [0.30-0.65], all 5: 0.57 [0.34-0.96])., Conclusion: Engaging in a higher number of mentally stimulating activities, particularly in late life, is associated with a decreased risk of MCI among community-dwelling older persons., (Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Objective: Deep brain stimulation (DBS) is an effective treatment for motor symptoms of Parkinson's disease; however, there is conflicting literature about the effect of DBS on cognitive function. The authors conducted a historical cohort study involving patients with Parkinson's disease who underwent DBS of the globus pallidus pars interna (GPi; N=12) or subthalamic nucleus (STN; N=17)., Methods: The authors investigated differences in four neuropsychological test scores at 6 months post-DBS (follow-up) as compared with baseline (i.e., Boston Naming Test, WAIS Verbal Comprehension Index [WAIS-VCI], Working Memory Index [WAIS-WMI], and Processing Speed Index [WAIS-PSI])., Results: GPi DBS patients showed no difference between baseline and follow-up on any neuropsychological test. STN DBS patients had lower scores indicating decreased performance at follow-up as compared with baseline on WAIS-PSI (mean [SD], 91.47 [10.42] versus 81.65 [12.03]; p=0.03). There was a significant (p=0.008) difference between the change in baseline to follow-up scores on the WAIS-VCI for the STN DBS and GPi DBS groups (i.e., STN DBS patients scored lower at the 6-month follow-up compared with baseline, whereas GPi DBS patients scored higher)., Conclusions: GPi may be a preferred target for DBS in patients with Parkinson's disease when considering cognitive outcomes.

In this study derived from the population-based Mayo Clinic Study of Aging, we investigated whether non-exercise physical activity (PA) was associated with global and domain-specific cognitive trajectories (memory, language, visuospatial skills, attention) and whether the association differed by apolipoprotein E (APOE) ε4 genotype status. We included 2061 community-dwelling individuals aged ≥ 70 years (50.5% males, 26.7% APOE ε4 carriers) who were cognitively unimpaired at baseline and on whom serial cognitive data and self-reported information on non-exercise PA were available. We specifically inquired about non-exercise PA carried out at two time points, i.e., midlife (between 50 and 65 years of age) and late-life (within 1 year prior to assessment) and three intensity levels, i.e., light (e.g., laundry), moderate (e.g., scrubbing floors) and heavy (e.g., hard manual labor). Linear mixed-effect models revealed that engaging in midlife PA of moderate or heavy intensity was associated with significantly less-pronounced decline of z -scores in all cognitive domains. Similarly, participants that engaged in late-life moderate or heavy PA had less decline in visuospatial, attention and global z -scores than non-active peers. These associations varied depending on APOE ε4 carrier status, i.e., APOE ε4 non-carriers but not APOE ε4 carriers that engaged in late-life PA had less decline in cognitive z -scores. In contrast, engaging in midlife PA, irrespective of intensity, was significantly associated with less decline in memory function only among APOE ε4 carriers., Competing Interests: Conflict of interestThe authors declare no conflict of interest related to this manuscript., (© The Author(s) 2019.)