BackgroundCognitive impairment is highly prevalent in COPD and is associated with a sedentary lifestyle, unhealthy diet and increased cognitive stress susceptibility. Enhancement of cognitive performance by working memory training (WMT) may reverse these effects. Therefore, this study aimed to investigate the efficacy of WMT in COPD on cognitive performance, healthy lifestyle behaviours and cognitive stress susceptibility.MethodsThe double-blind randomised, placebo-controlled Cogtrain trial consisted of a 12-week training phase comprising 30 active or sham WMT sessions, followed by a second 12-week maintenance phase with 12 sessions. Measurements took place at baseline and after the first and second phases. The primary outcome was cognitive performance. Secondary outcomes were the recall of prespecified healthy lifestyle goals, physical capacity and activity, dietary quality and cognitive stress susceptibility. Motivation towards exercising and healthy eating and psychological wellbeing were exploratory outcomes.ResultsSixty-four patients with moderate COPD (45% male, aged 66.2±7.2 years, median forced expiratory volume in 1 s 60.6% predicted) were randomised. WMT significantly increased patients’ performance on the trained tasks in the first phase, which remained stable in the second phase. Of the 17 cognitive outcome measures, only one measure of memory improved after the first phase and one measure of reaction time after the second phase. This intervention did not influence physical capacity and activity, recall of prespecified healthy lifestyle goals, psychological wellbeing or cognitive stress susceptibility.ConclusionWMT improved performance on the trained tasks but not overall cognitive performance, healthy lifestyle behaviours or cognitive stress susceptibility in patients with COPD.
Advocating continued health into old age, so called successful aging, is a growing public health goal. However, the development of tools to measure aging is limited by the lack of appropriate outcome measures, and operational definitions of successful aging. Using exploratory factor analysis, we attempted to identify distinguishable health domains with representative variables of physical function, cognitive status, social interactions, psychological status, blood biomarkers, disease history, and socioeconomic status from the InCHIANTI study. We then used logistic and mixed effect regression models to determine whether the resulting domains predicted outcomes of successful aging over a nine-year follow-up. A four-domain health model was identified: neuro-sensory function, muscle function, cardio-metabolic function and adiposity. After adjustment for age and gender, all domains contributed to the prediction of walking speed (R 2 =0.73). Only the muscle function domain predicted dependency (R 2 =0.50). None of the domains were a strong, significant predictor of self-rated health (R 2 =0.18) and emotional vitality (R 2 =0.23). Cross-sectional findings were essentially replicated in the longitudinal analysis extended to nine-year follow-up. Our results suggest a multi-domain health model can predict objective but not subjective measures of successful aging.
Purpose of Review: There is great interest in developing tools to measure healthy ageing and to identify early stages of health impairment which may guide the implementation of interventions to prevent or delay the development of disease, disability and mortality. Here we review the most recent developments directed to operationalise, and test, definitions of healthy ageing. Recent Findings:There is lack of consensus about how to define healthy ageing and, unsurprisingly, diversity in the instruments for its measurement. However, progress is being made in describing and in devising tools to capture the healthy ageing phenotype. Attempts to measure healthy ageing have relied primarily on cross-sectional data collected in older people. More recent studies have assessed the healthy ageing phenotype using markers of multiple functional domains and have used longitudinal data to model the dynamics and trajectories of healthy ageing. Summary:Given the complexity of the ageing process, no single measure is able to predict the ageing trajectory. Current attempts to operationalise the healthy ageing phenotype have relied on markers and data from earlier cohort studies and are limited by the tools used to collect data in those studies. Such data are often unsuitable to detect early subtle declines in function and/ or are inappropriate for use in younger old-adults. Future studies employing more objective and novel markers of healthy ageing are likely to offer opportunities to define and operationalise the healthy ageing phenotype.
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