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Social vulnerability and prefrontal cortical function in elderly people: a report from the Canadian Study of Health and Aging

Published online by Cambridge University Press:  11 August 2010

Melissa K. Andrew ,
John D. Fisk  and
Kenneth Rockwood
Melissa K. Andrew*
Affiliation:
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
John D. Fisk
Affiliation:
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Kenneth Rockwood
Affiliation:
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
*
Correspondence should be addressed to: Melissa K. Andrew, Division of Geriatric Medicine, Dalhousie University, 5955 Veterans' Memorial Lane, Halifax NS, B3H 2E1, Canada. Phone: +1 (902) 473–2378; Fax: +1 (902) 473–1050. Email: mandrew@dal.ca.
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Abstract

Background: Prefrontal cortical lobe function is related to social behavior in humans. We investigated whether performance on tests of prefrontal cortical function was associated with social vulnerability. Associations with non-frontal cognitive function were investigated for comparison.

Methods: 1216 participants aged 70+ of the Canadian Study of Health and Aging-2 screening examination, who also underwent detailed neuropsychological testing, comprised the study sample. Performance on WAIS-R abstraction, WAIS-R comprehension, Trails B, FAS and category verbal fluency, Block construction, Token Test and Wechsler Memory Scale Information Subset was tested in relation to the participant's level of social vulnerability using regression models adjusted for age, education, sex, frailty, MMSE score, diagnosis of depression, and use of psychoactive medications. Social vulnerability was measured by an index comprising many social problems or “deficits”.

Results: The most socially vulnerable group had worse performance on FAS verbal fluency, generating 4.1 fewer words (95% CI: 1.8–6.4, p<0.001) than those in the least socially vulnerable group; those with intermediate social vulnerability generated 2.6 fewer words (95% CI: 0.4–4.8, p = 0.02). Social vulnerability was also associated, though less strongly, with category verbal fluency. The most socially vulnerable people had impaired performance on the Trails B, taking 37 seconds longer (95% CI: 11–63, p = 0.005). These results were independent of age, education, sex, frailty, MMSE score, depression, and psychoactive medications. Social vulnerability was not associated with performance on WAIS-R abstraction, WAIS-R comprehension, Block Design, Token Test or Wechsler Memory Scale tests

Conclusions: High social vulnerability was associated with impaired performance on verbal fluency and set shifting but not with common sense judgment, abstraction, long-term memory, constructional ability, or language comprehension. The association between social functioning and the cognitive functions subserved by prefrontal cortex warrants further study.

Keywords

social vulnerabilitysocialfrailtyprefrontal cortexcognitionaged
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 3 , April 2011 , pp. 450 - 458
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Andrew, M. K. (2005). Le capital social et la santé des personnes âgées. Retraite et Société, 46, 129–143.Google Scholar
Andrew, M. K. (2010). Social vulnerability in old age. In Fillit, H., Rockwood, K. and Woodhouse, K. (eds.), Brocklehurst's Textbook of Geriatrics and Clinical Gerontology, 7th edn (pp. 198–204). Philadelphia: Saunders Elsevier.CrossRefGoogle Scholar
Andrew, M. K. and Rockwood, K. (2010). Social vulnerability predicts cognitive decline in a prospective cohort of older Canadians. Alzheimer's and Dementia, 6, 319–325.CrossRefGoogle Scholar
Andrew, M. K., Mitnitski, A. and Rockwood, K. (2008). Social vulnerability, frailty, and mortality in elderly people. PLoS One, 3, e2232.CrossRefGoogle ScholarPubMed
Atchley, R. C. (1989). A continuity theory of normal aging. The Gerontologist, 29, 183–190.CrossRefGoogle ScholarPubMed
Baldo, J. V. and Shimamura, A. P. (1998). Letter and category fluency in patients with frontal lobe lesions. Neuropsychology, 12, 259–267.CrossRefGoogle ScholarPubMed
Benton, A. L. and Hamsher, K. (1989). Multilingual Aphasia Examination, Manual of Instructions. 2nd edn. Iowa City: AJA Associates.Google Scholar
Deckel, A. W. (1999). Tests of executive functioning predict scores on the MacAndrew Alcoholism Scale. Progress in Neuro-Psychopharmacology and Biolological Psychiatry, 23, 209–223.CrossRefGoogle ScholarPubMed
Delis, D. C., Kaplan, E. and Kramer, J. H. (2001). Delis Kaplan Executive Function System Examiner's Manual, San Antonio, TX: The Psychological Corporation.Google Scholar
Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000). The FAB: a Frontal Assessment Battery at bedside. Neurology, 55, 1621–1626.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Goggins, W. B., Woo, J., Sham, A. and Ho, S. C. (2005). Frailty index as a measure of biological age in a Chinese population. Journal of Gerontology: Medical Sciences, 60, 1046–1051.Google ScholarPubMed
Gu, D., Dupre, M. E., Sautter, J., Zhu, H., Liu, Y. and Yi, Z. (2009). Frailty and mortality among Chinese at advanced ages. Journal of Gerontology: Social Sciences, 64, 279–289.CrossRefGoogle ScholarPubMed
Hastings, S. N., Purser, J. L., Johnson, K. S., Sloane, R. J. and Whitson, H. E. (2008). Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department. Journal of the American Geriatrics Society, 56, 1651–1657.CrossRefGoogle Scholar
Kramer, J. H. and Quitania, L. (2007). Bedside frontal lobe testing. In Miller, B. L. and Cummings, J. L. (eds.), The Human Frontal Lobes: Functions and Disorders. 2nd edn. New York: The Guilford Press.Google Scholar
Kulminski, A. M., Ukraintseva, S. V., Kulminskaya, I. V., Arbeev, K. G., Land, K. and Yashin, A. I. (2008). Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. Journal of the American Geriatrics Society, 56, 898–903.CrossRefGoogle ScholarPubMed
Legendre Ropacki, S. A. and Perry, W. (2007). Frontal lobe functioning in schizophrenia: evidence from neuropsychology, cognitive neuroscience, and psychophysiology. In Miller, B. L. and Cummings, J. L. (eds.), The Human Frontal Lobes: Functions and Disorders. 2nd edn. New York: The Guilford Press.Google Scholar
Lezak, M. D., Howieaon, D. B., Loring, D. W., Hannay, H. J. and Fischer, J. S. (2004). Neuropsychological Assessment, New York: Oxford University Press.Google Scholar
Mitnitski, A. B., Song, X. and Rockwood, K. (2004). The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. Journal of Gerontology: Medical Sciences, 59, M627–M632.Google ScholarPubMed
Mitnitski, A. et al. (2005). Relative fitness and frailty of elderly men and women in developed countries, in relation to mortality. Journal of the American Geriatrics Society, 53, 2184–2189.CrossRefGoogle ScholarPubMed
Reitan, R. M. (1992). Trail Making Test: Manual for Administration and Scoring. Arizona: Reitan Neuropsychology Laboratory.Google Scholar
Rockwood, K., McDowell, I. and Wolfson, C. (2001). Canadian Study of Health and Aging. International Psychogeriatrics, 13 (Suppl. 1), 1–237.Google ScholarPubMed
Rockwood, K., Andrew, M. and Mitnitski, A. (2007). A comparison of two approaches to measuring frailty in elderly people. Journal of Gerontology: Medical Sciences, 62, 738–743.Google ScholarPubMed
Sachdev, P. S. et al. (2004). The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology, 62, 912–919.CrossRefGoogle ScholarPubMed
Spreen, O. and Benton, A. L. (1977). Manual of Instructions: Neurosensory Centre Comprehensive Examination for Aphasia. Victoria, BC: University of Victoria.Google Scholar
Strauss, E., Sherman, E. M. S. and Spreen, O. (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary, New York: Oxford University Press.Google Scholar
Stuss, D. T. (2007). New approaches to frontal lobe testing. In Miller, B. L. and Cummings, J. L. (eds.), The Human Frontal Lobes: Functions and Disorders. 2nd edn. New York: The Guilford Press.Google Scholar
Stuss, D. T. and Benson, D. F. (1984). Neuropsychological studies of the frontal lobes. Psychological Bulletin, 95, 3–28.CrossRefGoogle ScholarPubMed
Stuss, D. T. et al. (1998). The effects of focal anterior and posterior brain lesions on verbal fluency. Journal of the International Neuropsychological Society, 4, 265–278.CrossRefGoogle ScholarPubMed
Stuss, D. T., Bisschop, S. M., Alexander, M. P., Levine, B., Katz, D. and Izukawa, D. (2001). The Trail Making Test: a study in focal lesion patients. Psychological Assessment, 13, 230–239.CrossRefGoogle ScholarPubMed
Teng, E. L. and Chui, H. C. (1987). The Modified Mini-mental State (3MS). examination. Journal of Clinical Psychiatry, 48, 314–318.Google ScholarPubMed
Tuokko, H., Kristjansson, E. and Miller, J. (1995). Neuropsychological detection of dementia: an overview of the neuropsychological component of the Canadian Study of Health and Aging. Journal of Clinical and Experimental Neuropsychology, 17, 352–373.CrossRefGoogle ScholarPubMed
Wechsler, D. (1974). Wechsler Memory Scale. New York: Psychological Corporation.Google Scholar
Wechsler, D. (1981). Wechsler Adult Intelligence Scale-Revised Manual. New York: Psychological Corporation.Google Scholar