Patient activation, the perceived capacity to manage one’s health, is positively associated with better health outcomes and lower costs. Underlying characteristics influencing patient activation are not completely understood leading to gaps in intervention strategies designed to improve patient activation. We suggest that variability in executive functioning influences patient activation and ultimately has an impact on health outcomes. To examine this hypothesis, 440 chronically ill Medicaid enrollees completed measures of executive functioning, patient activation, and health-related quality of life. Mediation analyses revealed that executive functioning: (a) directly affected patient activation and mental health-related quality of life, (b) indirectly affected mental health-related quality of life through patient activation, and (c) was unrelated to physical health-related quality of life. These data indicate that further study of the relationships among neurocognitive processes, patient activation, and health-related quality of life is needed and reinforces previous work demonstrating the association between patient activation and self-reported outcomes.

We developed an Observer-Reported Outcome (ObsRO) survey instrument to be applied in a multicenter, placebo-controlled, crossover randomized controlled trial of dichloroacetate in children with pyruvate dehydrogenase complex deficiency. The instrument quantifies a subject's at-home level of functionality, as reported by a parent/caregiver, who were instrumental in providing the clinical descriptors and domains that formed the instrument's content. Feasibility testing of the ObsRO tool showed it to be easy to use and comprehensive in capturing the major clinical functional limitations of affected children and requires less than 5min for a parent/caregiver to complete daily.

UNLABELLEDABSTRACT.OBJECTIVEDespite substantial attention being paid to the health benefits of moderate alcohol intake as a lifestyle, the acute effects of alcohol on psychomotor and working memory function in older adults are poorly understood.METHODThe effects of low to moderate doses of alcohol on neurobehavioral function were investigated in 39 older (55-70 years; 15 men) and 51 younger (25-35 years; 31 men) social drinkers. Subjects received one of three randomly assigned doses (placebo, .04 g/dl, or .065 g/dl target breath alcohol concentration). After beverage consumption, they completed the Trail Making Test Parts A and B and a working memory task requiring participants to determine whether probe stimuli were novel or had been presented in a preceding set of cue stimuli. Efficiency of working memory task performance was derived from accuracy and reaction time measures.RESULTSAlcohol was associated with poorer Trail Making Test Part B performance for older subjects. Working memory task results suggested an Age × Dose interaction for performance efficiency, with older but not younger adults demonstrating alcohol-related change. Directionality of change and whether effects on accuracy or reaction time drove the change depended on the novelty of probe stimuli.CONCLUSIONSThis study replicates previous research indicating increased susceptibility of older adults to moderate alcohol-induced psychomotor and set-shifting impairment and suggests such susceptibility extends to working memory performance. Further research using additional tasks and assessing other neuropsychological domains is needed. (J. Stud. Alcohol Drugs, 75, 870-879, 2014).

In this chapter, we review existing research regarding sex differences in alcohol's effects on neurobehavioral functions/processes. Drawn largely from laboratory studies, literature regarding acute alcohol administration and chronic alcohol misuse is explored focusing on commonly employed neuropsychologic domains (e.g., executive function, visuospatial skills, learning and memory, gait and balance), neurophysiologic measures (e.g., electroencephalography and event-related potentials), and structural and functional neuroimaging (e.g., magnetic resonance imaging (MRI), functional MRI, diffusion tensor imaging, positron emission tomography, and magnetic resonance spectroscopy). To provide a historical perspective on the development of these questions, we have included reference to early and more recent research. Additionally, specific biases, knowledge gaps, and continuing controversies are noted.

BACKGROUND:Studies exploring differential effects of acute alcohol consumption on younger and older adults are lacking within the field of alcohol research, especially those using moderate doses. Previous studies addressing this question have tended to use complex behavioral tasks too broad to isolate specific neurocognitive processes affected by both alcohol and aging. Compromises in cognitive efficiency (i.e., the ability to respond both quickly and accurately) have previously been identified in both elderly and acutely intoxicated individuals. METHODS:The present study employed a visual-spatial, 2-choice reaction time (RT) task to evaluate the interactive effects of aging and alcohol on cognitive efficiency. Our primary outcome measure was an efficiency ratio derived from each participant's response accuracy (ACC) and mean RT (%correct/RT). Younger (25 to 35; n = 22) and older (55 to 74; n = 37) participants were randomly assigned to receive either a placebo or moderate alcohol dose intended to produce a peak breath alcohol concentration of 0.04%. Participants performed the task at peak alcohol levels. RESULTS:A significant interaction between age group and dose assignment was observed, F(3, 55) = 4.86, p = 0.03, for the efficiency ratio. Younger participants who received alcohol performed significantly better than did their older counterparts regardless of alcohol condition and despite no differences in performance between the 2 age groups in the placebo condition. Additional correlation analyses between ACC and RT suggested that moderately intoxicated older adults become more accurate as response times increase. This relationship was not observed in older adults in the placebo condition. CONCLUSIONS:These data suggest that healthy individuals exhibit a differential susceptibility to the effects of alcohol depending on their age. Unfortunately, because of the presumed safety of moderate alcohol doses and a lack of studies investigating the interactive effects of acute alcohol consumption and aging, most individuals are unlikely to be aware of this relationship between alcohol consumption and age.

BACKGROUND Nearly 40% of adults aged 65 and older in the United States consume alcohol. Research in older adults has largely examined potential health effects of a moderate drinking lifestyle. Examination of acute effects in this population is generally lacking. To investigate alcohol-induced alteration of electrophysiological correlates of attention in this population, we employed a covert attentional task. We hypothesized that moderate alcohol administration as well as older age would reduce P3 amplitude and increase latency. We anticipated an interaction such that, relative to their age-matched controls, older adults receiving alcohol would be more affected than their younger counterparts. METHODS Participants included healthy older (aged 50 to 67; n = 20; 9 men) and younger (aged 25 to 35; n = 12; 5 men) moderate drinkers. Participants received either a moderate dose of alcohol (breath alcohol concentration ~50 mg/dl) or a placebo beverage. Following absorption, the task was administered and neurophysiological measures were obtained. P3 amplitude and latency were separately subjected to ANOVA across cue conditions using age and dose as independent variables. RESULTS As predicted, P3 amplitude in older adults was significantly lower than in younger adults across cue conditions. An age by alcohol interaction was detected, revealing that older adults receiving alcohol showed lower P3 amplitudes than any other group. An age effect for P3 latency was found, with older adults having longer latencies than their younger counterparts. A significant age by alcohol interaction for P3 latency was detected, revealing that older adults receiving alcohol displayed delayed P3 latencies relative to older adults receiving placebo. In contrast, younger adults receiving alcohol had reduced latency compared to those receiving placebo, although this effect did not reach significance. CONCLUSIONS Results suggest that older adults demonstrated alcohol-related shifts in P3 characteristics during an intentional attention task, whereas younger adults failed to demonstrate this pattern.