Brain health correlates of mobility-related confidence

Or is it better executive function that gives you greater gait confidence? I have both. And since this was tested in cognitively unimpaired older adults it doesn't apply to us.

Brain health correlates of mobility-related confidence

Author links open overlay panelC. ElizabethShaaban^a

EricaFan^aBrooke N.Klatt^bAnn D.Cohen^cBeth E.Snitz^dZhemingYu^eBrian J.Lopresti^eVictor L.Villemagne^cWilliam E.Klunk^cHoward J.Aizenstein^cAndrea L.Rosso^a

https://doi.org/10.1016/j.exger.2022.111776Get rights and content

Highlights

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Subjective measures of mobility and neuroimaging/cognition assessed in older adults

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Greater gait confidence associated with better attention and executive function

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Greater balance confidence associated with better global cognition and attention

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Greater gait and balance confidence associated with lower brain amyloid levels

Abstract

Background

Mobility is important for independence in older age. While brain health correlates of objectively measured mobility-related features like gait and balance have been reported, we aimed to test neuroimaging and cognitive correlates of subjective measures of mobility-related confidence.

Methods

We carried out a cross-sectional observational study comprised of N = 29 cognitively unimpaired older adult participants, mean age 75.8 ± 5.8, 52% female, 24% non-white. We measured cognition, hippocampal volume, white matter hyperintensities, cerebral amyloid-β (Aβ), and gait and balance confidence. We tested associations using unadjusted Spearman correlations and correlations partialling out covariates of interest one at a time.

Results

Greater gait confidence was associated with better attention (unadjusted ρ = 0.37, p = 0.05; partially attenuated by adjustment for age, APOE4, anxiety, motivation, gait speed, and Aβ); executive performance (unadjusted ρ = 0.35, p = 0.06; partially attenuated by adjustment for age, APOE4, gait speed, or Aβ); and lower Aβ levels (unadjusted ρ = −0.40, p = 0.04; partially attenuated by adjustment for age, depressive symptoms, motivation, or gait speed). Greater balance confidence was associated with better global cognition (unadjusted ρ = 0.41, p = 0.03; partially attenuated by adjustment for APOE4, gait speed, or Aβ); attention (unadjusted ρ = 0.46, p = 0.01; robust to adjustment); and lower Aβ levels (unadjusted ρ = −0.35, p = 0.07; partially attenuated by adjustment for age, education, APOE4, depressive symptoms, anxiety, motivation, or gait speed).

Conclusions

Self-reported mobility-related confidence is associated with neuroimaging and cognitive measures and would be easy for providers to use in clinical evaluations. These associations should be further evaluated in larger samples, and longitudinal studies can help determine temporality of declines.

 

New BP guidelines reclassify 1 in 6 older adults as achieving targets

Still no really useful and clear numbers that laypersons can understand in an easily understood table. Once again forcing us to go through our doctor gatekeepers. And with the lack of confidence I have in my stroke doctors why should I listen to any doctor at all?
jnc 7 blood pressure guidelines 2012 here
 JNC8P blood pressure guidelines - See the box partway down the article.


http://www.healio.com/cardiology/vascular-medicine/news/online/%7B226c7a00-d2a5-4451-9321-6ff2f077037a%7D/new-bp-guidelines-reclassify-1-in-6-older-adults-as-achieving-targets?utm_source=maestro&
Under the guidelines developed by members appointed to the Eighth Joint National Committee Guidelines for the management of high BP in aging adults, 1 in 6 patients in a U.S. cohort of representative individuals were reclassified as having BP at goal, according to recent findings.

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Researchers evaluated 6,088 participants in the longitudinal Atherosclerosis Risk in Communities (ARIC) study of CVD conducted at four centers in the United States. Participants were interviewed in their homes and received baseline clinical examinations between 1987 and 1989, then underwent four follow-up exams, with the most recent occurring between 2011 and 2013. The mean age of the study participants at the most recent exam was 75.6 years (range, 66-90 years; 58.4% women; 23.2% black).
BP was measured at the 2011-2013 follow-up exam and use of antihypertensive medication was determined for each patient. For this analysis, researchers assessed BP control according to the guidelines set forth by the Seventh Joint National Committee (JNC7) and the panel appointed to the Eighth Joint National Committee (JNC8P). JNC7 guidelines advise a target BP of 130/80 mm Hg for individuals without diabetes or chronic kidney disease (CKD). JNC8P guidelines target a BP of less than 150/90 mm Hg for individuals aged older than 60 years and a goal of 140/90 mm Hg for those with diabetes or CKD.
According to the JNC7 guidelines, 81.9% of the participants had hypertension and 62.8% had achieved their target BP. Of those with BP at-goal according to JNC7 guidelines, 71.2% were taking antihypertensive medications. Based on the JNC8P guidelines, 79.4% of the total study population had achieved their target BP, and 72.7% of these participants were taking antihypertensive drugs. The researchers noted that 16.6%, or approximately 1 in 6 of the participants, were recategorized according to the JNC8P guidelines as having achieved BP control.
Among patients without diabetes or CKD, 11.6% of patients had achieved their target BP according to the JNC8P criteria, but not JNC7. The reclassification rate was higher among patients with diabetes or CKD, with 20.6% of patients identified as at their BP goal according to JNC8P but not JNC7.
“The less stringent BP goals will increase the number who are ‘at goal,’ indicating to the patient and their primary care provider that treatment is not indicated, when in fact treatment of their mildly elevated BP may reduce their risk for a heart attack and stroke,” researcher Michael Miedema, MD, of the Minneapolis Heart Institute Foundation, said in a press release.
Miedema also expressed concern that over 20% of the population had BP above the goals for both JNC7 and JNC8P. “Regardless of what the exact BP goal should be, we clearly need to continue efforts at improving the detection and control of hypertension,” he said in the release

Neural Basis of Confidence Uncovered in Mice

Do you still have this confidence  region in your brain post-stroke? If not, what the hell is your doctor doing to recover it?  You are going to need massive amounts of confidence that you will recover even though your doctor knows nothing about how to get you back to 100% recovery. I must still have it because even though 8 years later I still have quite a few deficits I know I will eventually recover. As compared to my doctor who told me nothing about my recovery prospects. He must have been confident that he was right. In my opinion he knew nothing and I'm confident in that opinion. I'm confident in my confidence, must be my arrogance showing. 

Neural Basis of Confidence Uncovered in Mice

Life is a series of decisions, ranging from the mundane to the monumental. And each decision is a gamble, carrying with it the chance to second-guess. Did I make the right turn at that light? Did I choose the right college? Was this the right job for me?

Our desire to persist along a chosen path is almost entirely determined by our confidence in the decision: when you are confident that your choice is correct, you are willing to stick it out for a lot longer. 

Confidence determines much of our path through life, but what is it? Most people would describe it as an emotion or a feeling. In contrast, scientists at Cold Spring Harbor Laboratory (CSHL) have found that confidence is actually a measureable quantity, and not reserved just for humans. The team, led by CSHL Associate Professor Adam Kepecs, has identified a brain region in rats whose function is required for the animals to express confidence in their decisions. 

How do we know when a rat is exhibiting confidence? The researchers devised a method to study decision making in these animals. The rats were offered an odor that they were trained to associate with one of two doors. When they chose the correct door, they were rewarded. This part was easy for the animals: their selections were almost always correct.­­ Things got trickier when Kepecs and his team offered a mixture of the two scents, with one dominating over the other by only a very small percentage. The rats now needed to choose the door representing the dominant odor in order to get their reward– a choice that reflects their best guess.

In work published today in Neuron, the team describes how confidence can be measured simply by challenging a rat to wait for the reward to be revealed behind the door. The time they are willing wait serves as a measure of the confidence in their original decision. “We found that the rats are willing to ‘gamble’ with their time,” Kepecs explains, sometimes waiting as much as 15 seconds, which is an eternity for these animals. “This is something that we can measure and create mathematical models to explain,” said Kepecs. “The time rats are willing to wait predicts the likelihood of correct decisions and provides an objective measure to track the feeling of confidence.”

The researchers hypothesized that a distinct region of the brain might control confidence. Previous work has suggested that the orbitofrontal cortex (OFC), a part of the brain involved in making predictions, might have a role in decision confidence. Kepecs and his team specifically shut off neurons in the OFC, inactivating it, and found that rats no longer exhibited appropriate levels of confidence in their decisions. 

“With an inactive OFC, the rats retained the ability to make decisions– their accuracy did not change,” said Kepecs. “And they spent the same amount of time waiting for a reward on average. The only difference is that animals’ willingness to wait for a reward was no longer guided by confidence. They would often wait a long time even when they were wrong.” 

The discovery offers a rare glimpse into the neuronal basis of a higher-level cognitive process, and is likely to have implications in human decision-making as well. As Kepecs describes, “we now know that the OFC is critical for making on-the-fly predictions in rats. The human OFC is just a more sophisticated version of the rodent counterpart.” The team is expanding their research to explore how the elusive feelings of confidence are based on objective predictions that influence human decisions as well. 

The study appeared online in Neuron.