Adam Davey

Background/Study Context: We demonstrate that observer-rated factor structure of personality in centenarians is congruent with the normative structure. Prevalence of cognitive impairment, which has previously been linked to changes in personality in younger samples, is high in this age group, requiring observer ratings to obtain valid data in a population-based context. Likewise, the broad range of cognitive functioning necessitates synthesis of results across multiple measures of cognitive performance. Methods and Results: Data from 161 participants in the Georgia Centenarian Study (GCS; M_Age = 100.3 years, 84% women, 20% African American, 40% community-dwelling, 30% low cognitive functioning) support strong overall correspondence with reference structure (full sample: .94; higher cognitive functioning: .94; lower cognitive functioning: .90). Centenarians with lower cognitive functioning are higher on neuroticism and lower on openness to experience, agreeableness, and conscientiousness. Facet-level differences (higher N1–N6: anxiety, hostility, depression, self-consciousness, impulsiveness, vulnerability to stress; lower E1: warmth; lower O4–O6: actions, ideas, values; lower A1, A3, A4: trust, altruism, compliance; C1, C5: competence, self-discipline) are also observed. Multivariate factor-level models indicate only neuroticism of the five broad factors predicts membership in cognitively impaired group; facet-level models showed that lower-order scales from three of the five domains were significant. Centenarians with higher self-consciousness (N4), impulsiveness (N5), and deliberation (C6) but lower ideas (O5), compliance (A4), and self-discipline (C5) were more likely to be in the lower cognitive functioning category. Conclusion: Results present first normative population-based data for personality structure in centenarians and offer intriguing possibilities for the role of personality in cognitive impairment centered on neuroticism.

Objective: This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings. Design: Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators. Main outcome measures: Primary outcomes were depressive symptoms, sleep problems and quality of life indicators. Results: Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes. Conclusions: Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.

Chronic bronchitis (CB) has been related to poor outcomes in Chronic Obstructive Pulmonary Disease (COPD). From a clinical standpoint, we have shown that subjects with CB in a group with moderate to severe airflow obstruction were younger, more likely to be current smokers, male, Caucasian, had worse health related quality of life, more dyspnea, and increased exacerbation history compared to those without CB. We sought to further refine our clinical characterization of chronic bronchitics in a larger cohort and analyze the CT correlates of CB in COPD subjects. We hypothesized that COPD patients with CB would have thicker airways and a greater history of smoking, acute bronchitis, allergic rhinitis, and occupational exposures compared to those without CB.

Secondhand smoke exposure (SHSe) harms children’s health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice. A multilevel intervention combining pediatric healthcare providers’ advice with behavioral counseling and navigation to pharmacological cessation aids may improve SHSe control in pediatric populations.

Centenarians represent a rare but rapidly growing segment of the oldest‐old. This study presents item‐level data from the M ini‐ M ental S tate E xamination ( MMSE ) in a cross‐sectional, population‐based sample of 244 centenarians and near‐centenarians (aged 98–108, 16% men, 21% African‐American, 38% community dwelling) from the Georgia Centenarian Study (2001–2008) according to age, education, sex, race, and residential status. Multiple‐ I ndicator M ultiple‐ C ause ( MIMIC ) models were used to identify systematic domain‐level differences in MMSE scores according to demographic characteristics in this age group. Indirect effects of age, educational attainment, race, and residential status were found on MMSE scores. Direct effects were limited to concentration for education and race and orientation for residential status. Mean levels of cognitive functioning in centenarians were low, with mean values below most commonly‐used cutoffs. Overall scores on the MMSE differed as a function of age, education, race, and residential status, with differences in scale performance limited primarily to concentration and orientation and no evidence of interactions between centenarian characteristics. Adjusting for education was not sufficient to account for differences according to race, and adjusting for residential status was not sufficient to account for differences according to age.

Background/Study Context: The goal of the study was to identify and characterize latent profiles (clusters) of cognitive functioning in centenarians and the psychometric properties of cognitive measures within them. Methods: Data were collected from cross-sectional, population-based sample of 244 centenarians (aged 98 to 108, 15.8% men, 20.5% African American, 38.0% community-dwelling) from 44 counties in northern Georgia participating in the Georgia Centenarian Study (2001–2008). Measures included the Mini-Mental State Examination (MMSE), Severe Impairment Battery (SIB), Wechsler Adult Intelligence Scale-III Similarities subtest (WAIS), Hand Tapping, Behavioral Dyscontrol Scale (BDS), Controlled Oral Word Association Test (COWAT), and Fuld Object Memory Evaluation (FOME). The Global Deterioration Rating Scale (GDRS) was used to independently evaluate criterion-related validity for distinguishing cognitively normal and impaired groups. Relevant covariates included directly assessed functional status for basic and instrumental activities of daily living (DAFS), race, gender, educational attainment, Geriatric Depression Scale Short Form (GDS), and vision and hearing problems. Results: Results suggest two distinct classes of cognitive performance in this centenarian sample. Approximately one third of the centenarians show a pattern of markedly lower cognitive performance on most measures. Group membership is independently well predicted (area under the curve [AUC] = .83) by GDRS scores (sensitivity 67.7%, specificity 82.4%). Membership in the lower cognitive performance group was more likely for individuals who were older, African Americans, had more depressive symptoms, lower plasma folate, carriers of the apolipoprotein E (APOE) ε4 allele, facility residents, and individuals who died in the 2 years following interview. Conclusions: In a population expected to have high prevalence of dementia, latent subtypes can be distinguished via factor mixture analysis that provide normative values for cognitive functioning. The present study allows estimates for normative cognitive performance in this age group.

Decreased estimated glomerular filtration rate (eGFR) and higher serum creatinine (sCR) levels have been associated with longitudinal decline in global mental status measures. Longitudinal data describing change in multiple domains of cognitive functioning are needed in order to determine which specific abilities are most affected in individuals with impaired renal function. We conducted a 5-year longitudinal study with 590 community-living individuals (mean age 62.1 years, 60.2% female, 93.2% white, 11.4% with diabetes mellitus, mean eGFR 78.4 mL/min/1.73 m²) free from dementia, acute stroke and end-stage renal disease. To measure longitudinal change-over-time, cognitive performance measures were regressed on eGFR adjusting for baseline eGFR and cognitive performance, comorbidity and vascular risk factors. Outcome measures were scores from 17 separate tests of cognitive abilities that were used to index 5 theoretically relevant domains: verbal episodic memory, visual-spatial organization and memory, scanning and tracking, working memory and similarities (abstract reasoning). Declines in eGFR values were associated with cognitive declines, when adjusted for eGFR and cognitive function scores at baseline. Change in renal functioning over time was related to change observed in global cognitive ability [b = 0.21SD decline per unit ln(eGFR), 95% CI: 0.04–0.38, P = .018], verbal episodic memory [b = 0.28 SD decline per unit ln(eGFR), 95% CI: 0.02–0.54, P = 0.038] and abstract reasoning [b = 0.36 SD decline per unit ln(eGFR), 95% CI: 0.04–0.67, P = 0.025]. Decline in cognitive functioning in association with declining renal functioning was observed despite statistical adjustment for demographic variables and CVD risk factors and the exclusion of persons with dementia or a history of acute stroke. Early detection of mild to moderate kidney disease is an important public health concern with regard to cognitive decline.

Objectives: To describe the prevalence of diabetes mellitus ( DM ) in centenarians. Design: Cross‐sectional, population‐based. Setting: Forty‐four counties in northern Georgia. Participants: Two hundred forty‐four centenarians (aged 98–108, 15.8% male, 20.5% African American, 38.0% community dwelling) from the G eorgia C entenarian S tudy (2001–2009). Measurements: Nonfasting blood samples assessed glycosylated hemoglobin ( HbA _1c ) and relevant clinical parameters. Demographic, diagnosis, and DM complication covariates were assessed. Results: 12.5% of centenarians were known to have DM . DM was more prevalent in African Americans (27.7%) than whites (8.6%, P  < .001). There were no differences between men (16.7%) and women (11.7%, P  = .41) or between centenarians living in the community (10.2%) and in facilities (13.9%, P  = .54). DM was more prevalent in overweight and obese (23.1%) than nonoverweight (7.1%, P  = .002) centenarians. Anemia (78.6% vs 48.3%, P  = .004) and hypertension (79.3% vs 58.6%, P  = .04) were more prevalent in centenarians with DM than in those without, and centenarians with DM took more nonhypoglycemic medications (8.6 vs 7.0, P  = .02). No centenarians with HbA _1c of less than 6.5% had random serum glucose levels greater than 200 mg/dL. DM was not associated with 12‐month all‐cause mortality, visual impairment, amputations, cardiovascular disease, or neuropathy. Thirty‐seven percent of centenarians reported onset before age 80 (survivors), 47% between age 80 and 97 (delayers), and 15% aged 98 and older (escapers). Conclusion: Diabetes mellitus is a risk factor for cardiovascular disease and mortality but is seen in persons who live into very old age. Aside from higher rates of anemia and use of more medications, few clinical correlates of DM were observed in centenarians.