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

Carmona, Karoline Carvalho; Resende, Elisa de Paula França; Guimarães, Henrique Cerqueira; Machado, Thais Helena; Amaral-Carvalho, Viviane; Santos, Etelvina Lucas dos; Barbosa, Maira Tonidandel; Caramelli, Paulo

doi:10.1055/s-0042-1759760

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Original Article • Arq. Neuropsiquiatr. 81 (2) • 2023 • https://doi.org/10.1055/s-0042-1759760 linkcopy

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

Idosos de alta performance cognitiva em uma amostra de base populacional com baixa escolaridade: estudo Pietà

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Aging; Memory; Healthy Aging; Depression; Aged; Educational Status

Significant variables	Other variables included
Age	Marital status
Education	Profession
Retired	Present physical activity
Number of meals eaten out	Present reading habits
Past physical activity	Past reading habits
Number of falls in the last year	Participation in social meetings (present)
Weight	Participation in social meetings (past)
Systolic blood pressure	Alcohol consumption (present)
Cardiac rate	Alcohol consumption (past)
UPDRSm total score	Brachial ankle index
Bradykinesia (UPDRS subitem)	Body mass index
GDS total score	Diastolic blood pressure
Fear (GDS subitem)	The Other GDS sub-items
Feeling of empty life (GDS subitem)	Hours of sleep during night
Feeling of inferiority (GDS subitem)	Hours of sleep during day
Abandonment of interests (GDS subitem)	Sleep satisfaction
F26.1 (WHOQOL-OLD)
F27.3 (WHOQOL-OLD)
F29.3 (WHOQOL-OLD)

Variables	SPOA	HPOA	Total	p-value
n	114	18	132	@
Sex (Female/Male)	69F/45M	15F/3M	83F/49M	0.172
Age (years ± SD)	79.8 ± 4.5	77.4 ± 2.6	79.5 ± 4.4	0.039
Education (years ± SD)	3.0 ± 2.7	4.6 ± 3.4	3.3 ± 2.8	0.031
Hypertension (Frequency %)	88 (72.2)	16 (88.9)	104 (78.8)	0.212
Diabetes (Frequency%)	13 (11.4)	3 (16.7)	16 (12.1)	0.376
MMSE Median (1^st–3^rd quartile)	24.5 (22.0–26.0)	25.5 (22.8–28.0)	25.0 (22.0–26.8)	0.116
DRS Median (1^st–3^rd quartile)	123.5 (110.0–132.0)	135.0 (125.3–139.3)	124.5 (111.3–134.0)	0.004
RAVLT A1 Median (1^st–3^rd quartile)	4.0 (3.0–4.0)	5.0 (4.0–6.0)	4.0 (3.0–5.0)	0.001
RAVLT A2 Median (1^st–3^rd quartile)	6.0 (5.0–7.0)	7.0 (6.7–8.2)	5.0 (5.0–6.0)	< 0.001
RAVLT A3 Median (1^st–3^rd quartile)	7.0 (5.0–8.0)	9.0 (8.0–10.0)	6.0 (5.0–8.0)	< 0.001
RAVLT A4 Median (1^st–3^rd quartile)	7.0 (5.2–9.0)	10.5 (9.0–12.0)	7.0 (5.0–9.0)	< 0.001
RAVLT A5 Median (1^st–3^rd quartile)	8.0 (6.0–10.0)	11.5 (10.0–13.0)	8.0 (6.0–9.0)	< 0.001
RAVLT A7 Median ((1^st–3^rd quartile)	6.0 (3.0–7.7)	10.0 (9.0–10.0)	5.0 (2.0–6.0)	< 0.001
FAQ Median (1^st–3^rd quartile)	0.0 (0.0–1.0)	0.0 (0.0–0.0)	0.0 (0.0–1.0)	0.326
GDS Median (1^st–3^rd quartile)	2.0 (1.0–3.0)	1.0 (1.0–2.0)	2.0 (1.0–3.0)	0.030
UPDRSm Median (1^st–3^rd quartile)	2.0 (1.0–5.0)	0.0 (0.0–2.0)	2.0 (0.0–5.0)	0.008

Variable	Coefficient	OR (95%CI)	p-value
Age	–0.185	0.672 (0.462–0.979)	0.037
GDS-15 total score	–0.397	0.831 (0.698–0.989)	0.038

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[TFN1] Abbreviations: GDS, Geriatric Depression Scale; UPDRSm, United Parkinson’s Disease Ratio Scale (motor section); WHOQOL-OLD, World Health Organization Quality of Life – Old Module.