Academic journal article East Asian Archives of Psychiatry

Modulating Factors That Preserve Cognitive Function in Healthy Ageing

Academic journal article East Asian Archives of Psychiatry

Modulating Factors That Preserve Cognitive Function in Healthy Ageing

Article excerpt

Introduction

Successful ageing is a concept that has received increasing attention. Paradoxical to the convention of ageing which signifies process of degeneration and loss of function, successful ageing embraces the need for physical, mental, and cognitive well-being, as well as active engagement in life. While the studies of risk factors for cognitive impairment and dementia are extremely important, it is apparent that identification of protective factors for good cognition offers insights for the prevention of disability. Recent research suggested that certain lifestyle factors, such as physical exercise, cognitively stimulating activities, and participation in leisure activities may facilitate cognitive preservation. (1-10)

The main objective of this study was to explore factors that may modulate cognitive function in healthy non-demented Chinese elders in Hong Kong. We assumed that there was a difference in lifestyle, emotional status, and physical health in elderly persons with different levels of cognitive function. We also hypothesised that older people with better cognitive function were more active when it came to participating in leisure activities, and that they had a lower level of loneliness and less physical illnesses than those with lower levels of cognitive function.

Methods

Participants

This study was the secondary analyses from a follow-up study (11) on the prevalence of cognitive impairment in community-dwelling elders in Hong Kong. A total of 788 participants aged [greater than or equal to] 60 years were recruited at baseline. At follow-up, 515 (65%) subjects were followed up at 22 months, 251 (32%) refused interview or were not contacted, 21 (3%) had passed away, and 1 had deteriorated due to physical illness and was unable to complete the cognitive assessment.

In this analysis, subjects diagnosed with dementia (n = 29) or having a Cantonese-version Mini-Mental State Examination (CMMSE) score of < 20 (n = 9) were excluded from the analyses. The severity of dementia was based on the Clinical Dementia Rating (CDR). (12) On completion of each assessment, participants were assigned with a CDR by trained raters. This indicated the severity of their cognitive impairment as: (i) non-demented (score 0); (ii) very mild dementia (score 0.5); (iii) mild dementia (score 1); (iv) moderate dementia (score 2); and (v) severe dementia (score 3). One subject with a baseline age of 57 years was also excluded from analysis. As a result, information from 476 cognitively normal healthy subjects was analysed.

Procedure

Potential subjects were invited by telephone to participate in follow-up interviews, conducted either at their home or at the nearest elderly centre. Informed consent and information regarding socio-demographic data, history of physical health and psychiatric illness, as well as mood were also collected by the team psychiatrist. A battery of cognitive assessment tests was administered by a trained research assistant.

Assessment

Socio-demographic data regarding age, gender, education, marital and socio-economic status, self-rated health, and medication were obtained. The severity of physical or psychiatric illnesses, cardiovascular and cerebrovascular risk factors were assessed using the Cumulative Illness Rating Scale. (13)

Lifestyle and psychosocial factors regarding smoking, drinking, social networks and supports, leisure activity and loneliness were collected. The level of leisure activity engaged was measured using a specifically designed questionnaire delving into the variety and frequency of leisure activities usually undertaken. Leisure activity was divided into 4 types: cognitive, social, recreational, and physical. The follow-up study also employed a Chinese version of the 6-item De Jong Gierveld Loneliness Scale (14) to measure the level of social, emotional, and overall loneliness.

Cognitive functional assessment was based on the Cantonese version of Alzheimer's Disease Assessment Scale--cognitive subscale, (15) the 10-minute delay recall, the category verbal fluency test, (16) the digit and visual span tests, and the abstract thinking test (similarities and differences). …

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