Normative data for older adults may be tainted by inadvertent inclusion of undiagnosed individuals at the very early stage of a neurodegenerative process. To avoid this pitfall, we developed norms for a cohort of older adults without MCI/dementia at 3-year follow-up.

A randomly selected sample of 1041 community-dwelling individuals (age ≥ 65) received a full neurological and neuropsychological examination on two occasions [mean interval = 3.1 (SD = 0.9) years].

Of these, 492 participants (Group 1; 65–87 years old) were without dementia on both evaluations (CDR=0 and MMSE ≥ 26); their baseline data were used for norms development. Group 2 (n = 202) met the aforementioned criteria only at baseline, but not at follow-up. Multiple linear regressions included demographic predictors for regression-based normative formulae and raw test scores as dependent variables for each test variable separately. Standardized scaled scores and stratified discrete norms were also calculated. Group 2 performed worse than Group 1 on most tests (p-values < .001–.021). Education was associated with all test scores, age with most, and sex effects were consistent with the literature.

We provide a model for developing sound normative data for widely used neuropsychological tests among older adults, untainted by potential early, undiagnosed cognitive impairment, reporting regression-based, scaled, and discrete norms for use in clinical settings to identify cognitive decline in older adults. Additionally, our co-norming of a variety of tests may enable intra-individual comparisons for diagnostic purposes. The present work addresses the challenge of developing robust normative data for neuropsychological tests in older adults.

Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer’s disease (AD).

We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of AD on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube.

While healthy participants tended to outperform the AD group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates respectively) when using established clinical cutoff scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with AD. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube.

Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in low education older cohorts.

This study aimed to compare Greek Australian and English language normative data with regard to impairment rates yielded within a healthy Greek Australian older adult sample. We also examined whether optimal cut scores could be identified and capable of sensitively and specifically distinguishing between healthy Greek Australians from those with a diagnosis of Alzheimer’s disease (AD).

Ninety healthy Greek Australian older adults and 20 demographically matched individuals with a diagnosis of AD completed a range of neuropsychological measures, including the Wechsler Adult Intelligence Scale-Fourth Edition, Greek Adaptation (WAIS-IV GR), verbal and visual memory, language and naming, and executive functions. Impairment rates derived from the use of either Greek Australian or English language normative data were calculated and compared, using a 1.5 standard deviation criterion to denote impairment. Receiver operating characteristics curve analysis was used to investigate the sensitivity and specificity of alternate cut scores.

Impairment rates derived from the Greek Australian normative data showed that rates of impairment generally fell within the expected 7% range. In contrast, impairment rates for all tests derived using English language normative data were significantly higher and ranged from 11%–66%. Comparisons between healthy and AD participants with moderate dementia showed significant differences across all measures. Area under the curve results ranged from .721 to .999 across all measures, with most tests displaying excellent sensitivity and specificity.

English language normative data were found to be inappropriate for use with Greek Australian elders, potentially leading to erroneous diagnostic outcomes. The use of minority group specific normative data and associated cut points appear to partially ameliorate this issue. Clinical implications are discussed alongside future research directions.

There is limited research on the prognostic value of language tasks regarding mild cognitive impairment (MCI) and Alzheimer’s clinical syndrome (ACS) development in the cognitively normal (CN) elderly, as well as MCI to ACS conversion.

Participants were drawn from the population-based Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) cohort. Language performance was evaluated via verbal fluency [semantic (SVF) and phonemic (PVF)], confrontation naming [Boston Naming Test short form (BNTsf)], verbal comprehension, and repetition tasks. An additional language index was estimated using both verbal fluency tasks: SVF-PVF discrepancy. Cox proportional hazards analyses adjusted for important sociodemographic parameters (age, sex, education, main occupation, and socioeconomic status) and global cognitive status [Mini Mental State Examination score (MMSE)] were performed.

A total of 959 CN and 118 MCI older (>64 years) individuals had follow-up investigations after a mean of ∼3 years. Regarding the CN group, each standard deviation increase in the composite language score reduced the risk of ACS and MCI by 49% (8–72%) and 32% (8–50%), respectively; better SVF and BNTsf performance were also independently associated with reduced risk of ACS and MCI. On the other hand, using the smaller MCI participant set, no language measurement was related to the risk of MCI to ACS conversion.

Impaired language performance is associated with elevated risk of ACS and MCI development. Better SVF and BNTsf performance are associated with reduced risk of ACS and MCI in CN individuals, independent of age, sex, education, main occupation, socioeconomic status, and MMSE scores at baseline.

We investigated the utility of traditional neuropsychological tests in older uneducated/illiterate individuals without dementia to determine the possibility that they are likely not appropriate for this group.

We assessed the neuropsychological performance of 1122 older adults [≥65 years old; mean age: 74.03 (SD = 5.46); mean education: 4.76 (SD = 2.5) years; women: n = 714], in the context of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population-based study conducted in Greece.

We based our analyses on three groups: high-functioning/cognitively healthy (i.e., without dementia) uneducated/illiterate individuals (n = 80), high-functioning/cognitively healthy educated/literate individuals (n = 932), and low-functioning/cognitively impaired educated/literate individuals (presumably with dementia; n = 110). We used binary regression analyses with Bonferroni correction to investigate whether test performance differentiated uneducated/illiterate from educated/literate individuals. Models were adjusted for age and sex; raw test scores were the predictor variables. The uneducated/illiterate cohort was at a disadvantage relative to the healthy educated/literate group on all variables but verbal memory recognition and consolidation, congruent motor responses, and phonological fluency clustering (p > .002). Moreover, only word list learning immediate and delayed free recall and delayed cued recall differentiated the high-functioning/cognitively healthy uneducated/illiterate from the low-functioning/cognitively impaired educated/literate group, favoring the former (p’s < .002).

Our findings suggest that only particular verbal memory test variables are fair in determining whether older uneducated/illiterate individuals have functional/cognitive impairment suggestive of a neurodegenerative process. On all other neuropsychological variables, this cohort was at a disadvantage. Therefore, we highlight the need for identifying appropriate methods of assessment for older uneducated/illiterate individuals.

The prevalence and associated factors related to psychotic symptoms in older adults are understudied. The objectives were to assess the prevalence, incidence and factors associated with psychotic symptoms in a representative Greek sample of community living older adults.

This study includes older adults aged ≥ 65 years participating in the Hellenic Longitudinal Investigation of Aging and Diet. The analysis is based on n=1,904 participants with available data at baseline and n=947 participants at the 3-year follow-up. The presence of delusions and hallucinations in the past month was assessed on the grounds of the 17 symptoms of the Columbia University Scale for Psychopathology in Alzheimer's Disease and of the 14 symptoms of the Neuropsychiatric Inventory Questionnaire. An affirmative answer to any of these 31 symptoms defined the presence of psychotic symptoms. A comprehensive neuropsychological assessment for probable diagnosis of dementia and physical comorbidity was carried out by neurologists. Study factors included age, education, marital status, widowed in the past year, occupation, hearing impairment and number of chronic comorbidities. Penalized logistic regression analyses were carried out to assess the socio-demographic and clinical factors associated with the prevalence and incidence of psychotic symptoms.

The past-month prevalence of any psychotic symptom was 1.9% and 1.0% when excluding cases of dementia. The prevalence of any delusion and hallucination was 1.5% and 0.7%, and 0.8% and 0.3% when excluding cases with dementia. Paranoid delusions were the most prevalent. The incidence at the follow-up of any psychotic symptom was 2.1% and 1.3% when excluding dementia. Individuals not married had twice the odds and, farmers/breeders had three times the odds than public servants/teachers/executives of experiencing psychotic symptoms. Hearing impairment and the number of comorbidities increased the odds of the presence of psychotic symptoms. In addition to age and recent widowhood, these factors remained significantly associated with the presence of psychotic symptoms in cases without dementia.

Dementia was not related to over half of the cases observed with psychotic symptoms. Paranoid delusions were the most prevalent. Socio-economic and health status factors are significant predictors of psychotic symptoms.

Life expectancy has increased leading to a concomitant increase in the population of older people. Malnutrition, a major problem in this age group, deteriorates their health and quality of life. The association between risk of malnutrition and dietary intake has not been investigated sufficiently. The aim of this study was to examine potential associations between risk of malnutrition and dietary intake in a representative cohort of adults ≥ 65 years old.

1,831 older people (mean age 73.1 ± 5.9 years old) from the HELIAD study were included in the analyses. Risk of malnutrition was assessed with the “Determine your Nutritional Health” checklist. Total score of the questionnaire ranges from 1–21, with 0–2 indicating good nutritional status, 3–5 moderate nutritional risk and ≥ 6 high nutritional risk. Dietary intake was evaluated with a semi-quantitative food frequency questionnaire, validated for the Greek population, from which consumption of specific food groups (non-refined cereals, fruits, vegetables, legumes, fish, red meat, poultry, fish, dairy products, alcohol and sweets in servings/day) was estimated, as well as adherence to the Mediterranean diet, using a relevant a priori score.

35.8% of the participants were well-nourished, 34.8% were at moderate nutritional risk and 29.4% were at high nutritional risk. Total energy intake did not differ between the groups (1,984 ± 500 kcal/day for those well-nourished, 1,995 ± 537 kcal/day for those at moderate nutritional risk and 1,934 ± 566 kcal/day for those at high nutritional risk, p = 0.140). Well-nourished older people consumed per day more portions of vegetables, fruits, legumes, poultry, sweets and fewer portions of alcohol compared to those at moderate and high risk (all p < 0.05). Furthermore, adherence to the Mediterranean diet differed significantly between the groups, i.e. those well-nourished had greater adherence to the Mediterranean Diet compared to the other groups (p < 0.001).

Although energy intake did not differ between the groups, there were significant differences in quality of their diet, as this was depicted in specific food group intake and adherence to a healthy dietary pattern. Thus, health experts should also consider diet quality when screening malnutrition in this vulnerable age group.

The present study aimed to explore the associations between social life and adherence to a healthy dietary pattern, the Mediterranean diet (MD), in a population-representative cohort of older people.

Cross-sectional study. Adherence to the MD was evaluated by an a priori score; tertiles of the score, indicating low, medium and high adherence, were used in the analyses. Social life was assessed by a questionnaire evaluating participation in leisure-time activities and the number of social contacts; primary occupation was also recorded and job characteristics were further explored.

Community-dwelling older adults.

Adults from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study (n 1933; age range 65–99 years).

Each unit increase in the number of social contacts/month and in the frequency score of intellectual, social and physical activities was associated with a 1·6, 6·8, 4·8 and 13·7 % increase in the likelihood of a participant being in the high MD adherence group, respectively. The analysis by age group revealed that younger elderly participants had a 1·4, 8·4 and 11·3 % higher likelihood to be in the high adherence group for each unit increase in the number of social contacts/month and in the frequency score of engagement in intellectual and physical activities, respectively. Similar associations were found for older elderly participants with high compared with low MD adherence, except for the intellectual activities.

The present results suggest that high MD adherence is associated with good social life, suggesting a clustering of health-promoting lifestyle factors in older adults.

To investigate whether amnestic mild cognitive impairment (aMCI) identified with visual memory tests conveys an increased risk of Alzheimer’s disease (risk-AD) and if the risk-AD differs from that associated with aMCI based on verbal memory tests.

4,771 participants aged 70.76 (SD = 6.74, 45.4% females) from five community-based studies, each a member of the international COSMIC consortium and from a different country, were classified as having normal cognition (NC) or one of visual, verbal, or combined (visual and verbal) aMCI using international criteria and followed for an average of 2.48 years. Hazard ratios (HR) and individual patient data (IPD) meta-analysis analyzed the risk-AD with age, sex, education, single/multiple domain aMCI, and Mini-Mental State Examination (MMSE) scores as covariates.

All aMCI groups (n = 760) had a greater risk-AD than NC (n = 4,011; HR range = 3.66 – 9.25). The risk-AD was not different between visual (n = 208, 17 converters) and verbal aMCI (n = 449, 29 converters, HR = 1.70, 95%CI: 0.88, 3.27, p = 0.111). Combined aMCI (n = 103, 12 converters, HR = 2.34, 95%CI: 1.13, 4.84, p = 0.023) had a higher risk-AD than verbal aMCI. Age and MMSE scores were related to the risk-AD. The IPD meta-analyses replicated these results, though with slightly lower HR estimates (HR range = 3.68, 7.43) for aMCI vs. NC.

Although verbal aMCI was most common, a significant proportion of participants had visual-only or combined visual and verbal aMCI. Compared with verbal aMCI, the risk-AD was the same for visual aMCI and higher for combined aMCI. Our results highlight the importance of including both verbal and visual memory tests in neuropsychological assessments to more reliably identify aMCI.