High performance older adults in a population-based sample with low education: Pietà study

Abstract

Background Healthy brain aging can be defined as aging without neurological or psychiatric disorders, sustaining functional independence. In addition to the absence of disease and preserved functionality, there are individuals who stand out for their superior performance to that considered normal for their age in cognitive tests. These individuals are called “high-performance older adults” (HPOA). Objectives To investigate the presence of HPOA in an oldest-old population with low education, and if present, to investigate associations with sociodemographic, clinical, and lifestyle variables. Methods We evaluated 132 cognitively healthy individuals from the Pietà Study, a population-based investigation with 639 participants. We used the delayed recall from the Rey Auditory-Verbal Learning Test to verify the existence of HPOA and to classify participants based on their performance. Sociodemographic, clinical, and lifestyle variables associated with HPOA were investigated. Results We identified 18 individuals fulfilling HPOA criteria (age: 77.4 ± 2.6 years old; 14 women; education: 4.6 ± 3.4 years). The other participants, 114 total (age: 79.8 ± 4.5 years old; 69 women; education: 3.0 ± 2.7 years) were classified as “standard performance older adults” (SPOA). In multivariate analysis, younger age (odds ratio [OR] = 0.672; 95% confidence interval [CI]: 0.462–0.979; p = 0.037) and lower scores on the Geriatric Depression Scale (OR = 0.831; 95%CI: 0.688–0.989; p = 0.038) were associated with HPOA. Conclusions The present study identifies for the first time HPOA with low educational level, thereby reinforcing the existence of biological substrates related to this condition. Furthermore, the data suggest an association between younger age and less depressive symptoms with HPOA.

Defining exceptional cognition in older adults: A systematic review of cognitive super‐ageing

“…Demographic and clinical characteristics of cases and controls differed markedly in nine studies. More females were included in cognitively high‐performing than control cohorts in six of these studies 11,18,19,28,49,53 while education levels were significantly higher in six cognitively high performing cohorts compared with controls 11–13,15,28,49 . Rates of hypertension and diabetes were higher in the cognitively average than the super‐ageing cohort in one study but not significantly so 43 .…”

“…Those aged 80 and above are more likely to manifest cognitive impairment than those in their 60s or 70s which is why many studies have restricted their samples to this group 5 . Individuals aged 75 and above have been selected in low‐ and middle‐income countries 15,26 . However, this approach may limit research into the longitudinal trajectories of cognition in super‐agers.…”

“…Cognitive super‐agers (henceforth ‘super‐agers’) have been shown to have higher occupational attainment, 11 a musical background, 12 lower rates of smoking and diabetes and exhibit higher levels of intellectual and social activity than their cognitively average peers 11,13,14 . The association between years of education and super‐ageing has not been consistent 11,12,15 . Super‐agers have been shown to be resilient to post‐operative delirium 16 .…”

Broadening the identification of superior cognition in older age

“…Likewise, studies focused on better-than-expected memory performance in older age provide important paradigms for informing mechanisms of reserve, resilience, resistance, and compensation (e.g.). 1 2 3 4 5 6 7 8 Carmona and colleagues 9 extend this work by drawing from the population-based Pietà Study in Brazil to explore whether “high-performance older adults (HPOA)” are present and to identify potential sociodemographic, clinical, and lifestyle features that set them apart from typical agers (called “standard performance older adults (SPOA).”…”

“…Which of these factors are modifiable? Carmona and colleagues 9 have embraced this approach and provided an initial indication that superior memory performance in older age is possible even with low education. This exciting prospect deserves further investigation to uncover significant biologic, psychosocial, genetic, and other contributors, and may benefit from prospectively designed collaborative science designs.…”