Carrie Brumback Peltz

Objective: To examine the incidence of dementia among the oldest-old people with normal cognition and different types of cognitive impairment. Methods: This study included 395 participants without dementia (mean age 93.3 years) from The 90+ Study, a prospective, population-based study of aging and dementia in people aged 90 years and older. The participants had evaluations for dementia every 6 months, and their average follow-up was 2.5 years. We examined the incidence of all-cause dementia in participants stratified into 4 cognitive groups: normal, amnestic mild cognitive impairment (aMCI), nonamnestic mild cognitive impairment (naMCI), and other cognitive impairment (OCI). Results: Dementia incidence was highest for participants with aMCI (31.4% per year) and OCI (39.9% per year). Participants with naMCI had an incidence of 14.1% per year, and participants with normal cognition had an incidence of 8.4% per year. Dementia incidence was associated with increasing age in both normal and cognitively impaired participants; however, an APOE4 allele was associated with a higher dementia incidence only in participants with baseline cognitive impairment. Conclusions: The risk of developing dementia in the oldest-old is high and increases to higher rates when cognitive impairment is present. Similar to results of studies in younger elderly individuals, cognitive impairment and increasing age were related to increased dementia incidence. High dementia incidence rates in the oldest-old individuals, particularly when cognitively impaired, emphasize the need to further study cognitive impairment and dementia in this rapidly expanding age group.

Objective: To determine the prevalence and types of cognitive impairment in a sample of nondemented participants aged ≥90 (the oldest‐old) and to examine the relationships between cognitive impairment and cardiovascular risk factors.Participants: The participants were 420 nondemented individuals from The 90+ Study, a study of aging and dementia in the oldest‐old. These participants were categorized into four nonoverlapping groups: normal cognition, amnestic mild cognitive impairment (aMCI), nonamnestic MCI (naMCI), and other cognitive impairment (OCI). History of cardiovascular risk factors was assessed through self‐report.Results: The overall prevalence of cognitive impairment in nondemented participants was 34.0% (95% CI: 29.5–38.5). The prevalence of OCI was highest (17.4%; 95% CI: 13.9–21.4), followed by aMCI (8.3%; 95% CI: 5.9–11.4) and naMCI (8.3%; 95% CI: 5.9–11.4). Normal cognition was present in 66.0% (95% CI: 61.2–70.5) of participants. History of hypertension and stroke were the only risk factors that varied between the groups, occurring more frequently in participants with naMCI (χ² = 3.82; P < .05) and OCI (χ² = 5.51; P < .05).Conclusions: This study found a high prevalence of cognitive impairment in a sample of nondemented oldest‐old. We did not find a strong relationship between cardiovascular risk factors and the cognitive impairment groups, other than between hypertension and naMCI and stroke and OCI. Future studies comparing the incidence of dementia in these groups will ultimately determine their predictive utility in the oldest‐old.

Older adults exhibit great variability in their cognitive abilities, with some maintaining high levels of performance on executive control tasks and others showing significant deficits. Previous event-related potential (ERP) work has shown that some of these performance differences are correlated with persistence of the novelty/frontal P3 in older adults elicited by task-relevant events, presumably reflecting variability in the capacity to suppress orienting to unexpected but no longer novel events. In recent ERP work in young adults, we showed that the operation-span (OSPAN) task (a measure of attention control) is predictive of the ability of individuals to keep track of stimulus sequencing and to maintain running mental representations of task stimuli, as indexed by the parietally distributed P300 (or P3b). Both of these phenomena reflect aspects of frontal function (cognitive flexibility and attention control, respectively). To investigate these phenomena we sorted both younger and older adults into low- and high-working memory spans and low- and high-cognitive flexibility subgroups, and examined ERPs during an equal-probability choice reaction time task. For both age groups (a) participants with high OSPAN scores were better able to keep track of stimulus sequencing, as indicated by their smaller P3b to sequential changes; and (b) participants with lower cognitive flexibility had larger P3a than their high-scoring counterparts. However, these two phenomena did not interact suggesting that they manifest dissociable control mechanisms. Further, the fact that both effects are already visible in younger adults suggests that at least some of the brain mechanisms underlying individual differences in cognitive aging may already operate early in life.

People aged 90 years and older (oldest old), the fastest growing segment of the United States population, are known to have high rates of spells of all types, including strokes, transient ischemic attacks, and seizures. This study examined the prevalence of EEG abnormalities in 12 physically and cognitively healthy oldest old (mean age = 94 years) with no history of seizures or spells. Abnormalities were found in 83% of participants: temporal intermittent polymorphic slowing was seen in 67%, background slowing (alpha rhythm <8 Hz) was present in 33%, and temporal intermittent rhythmic delta was found in 17%. The high rates of EEG abnormalities found in these physically and cognitively healthy participants prompt reappraisal of pathologic significance in this unique population.