PRogram to Improve Stress-levels and Enhance Memory

The questions in the PSS ask about feelings and thoughts during the last month. In each case, respondents are asked how often they felt a certain way. PSS scores are obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1 \& 4 = 0) to the four positively stated items (items 4, 5, 7, \& 8) and then summing across all 10 scale items. Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress.

The SF-12 QoL uses two items each to estimate scores for four to eight health concepts (physical functioning, role-physical, role-emotional, and mental health). Scores for the remaining four health concepts (bodily, pain, general health, vitality, and social functioning) are estimated using one item each. The lower the score the more disability.

Self-reported weight (Kg) will be collected at each study time point

Body Mass Index (BMI) is a person's weight in kilograms divided by the square of height in meters. BMI will be calculated at each study time point.

Systolic and diastolic blood pressure (SBP and DBP)will be measured at each time point. BP (mmHg) will be assessed by utilizing an automatic sphygmomanometer in which a cuff will be placed on the participant's forearm.

Heart rate variability (HRV) will be measured with an ECG monitor. A validated signal processing code will be used to evaluate these signals for noise and detect the necessary ECG component measures, and when outliers are suspected, a visual inspection will be performed. If any episodes of Atrial fibrillation are detected by the program, they will be confirmed by the study team and excluded. HRV will be examined in 5-minute sliding windows, and the median, 10th percentile, and minimum values will be calculated.

Indices of arterial stiffness and wave reflections will be estimated in the supine position using the Sphygmocor device (Atcor Medical, Australia), which records sequential high-quality pressure waveforms at peripheral pulse sites using a high-fidelity tonometer. Pulse-wave velocity (PWV) measured between carotid and femoral arteries is a regional assessment of aortic stiffness and is the gold standard index of arterial stiffness.

The TMT is a measure of attention, speed, and mental flexibility. It also tests spatial organization, visual pursuits, recall, and recognition. Part A requires the individual to draw lines to connect 25 encircled numbers distributed on a page. Part A tests visual scanning, numeric sequencing, and visuomotor speed. A score over 78 seconds may indicate a deficit in visual perception. The average time is around 29 seconds.

Trail Making Test (TMT) Part B is scored based on the time in seconds it takes to complete the task, which involves alternating between connecting numbered and lettered circles in ascending order (1-A-2-B-3-C). Part B assesses cognitive flexibility and executive function, and is scored separately from Part A. A higher score indicates greater cognitive impairment.

The Flanker test measures inhibitory control and attention by having participants identify a central stimulus (fish or arrows) while ignoring flanking stimuli. Scoring is based on both accuracy and reaction time. If a participant's accuracy is below 80% correct, the score is based solely on accuracy. If accuracy is 80% or higher, both accuracy and reaction time are used to calculate the score. This ensures participants who are accurate but slow, or fast but inaccurate, are scored accordingly. The final computed score is converted to an age-adjusted scale score. A score of 100 represents the national average for a given age, with 115 being one standard deviation above average and 85 being one standard deviation below average.

PCPST is an assessment of processing speed. Participants are asked to quickly determine whether two stimuli are the same or not the same. It measures how quickly a person can decide if two visual patterns are identical, scoring how many correct comparisons are made in a set time. Scores are converted to normative scores that compare performance to a representative sample, with a higher score indicating better processing speed. A mean of 100 with a standard deviation of 15 is considered average, with scores indicating the test-taker's performance relative to their age group or the general population.

The Picture Sequence Memory (PSM) test, specifically the NIH Toolbox version, is scored by counting the number of adjacent pairs of pictures correctly placed in the sequence across three learning trials. The meaning of the score is that it provides a measure of episodic memory, which is the ability to recall and place in order a series of events or images. A higher score indicates better episodic memory performance, while lower scores suggest memory impairments.

The List Sorting Working Memory Test scores are calculated based on the number of stimuli correctly recalled and sequenced in order of size. The test has two phases: a one-dimensional phase (1-List) and a two-dimensional phase (2-List). A higher score indicates better working memory, meaning an individual can better register, maintain, and manipulate visual and auditory information.

The Dimensional Change Card Sort (DCCS) measures cognitive flexibility by assessing how well a person can switch between different sorting rules. It typically involves sorting cards by one rule (e.g., color) and then switching to a new rule (e.g., shape). The test records how many cards are correctly sorted and how long it takes to respond. Pass/Fail: The primary scoring method is a pass/fail based on performance after the rule-switching "switch" trials.

The PASE score (Physical Activity Scale for the Elderly) is a numerical value derived from a 12-item questionnaire that measures the physical activity level of older adults over the past week. Meaning is determined by the score, with higher scores indicating greater physical activity. Scores are calculated by multiplying the frequency, duration, and intensity of various activities (leisure, household, occupational) by pre-determined weights and summing them up, resulting in a score that can range from 0 to 400 or more.

Interpreting scores: Sedentary: 0-40; Light Physical Activity: 41-90; Moderate to Intense Activity: 91+

The MIND diet quiz is a 15-point assessment of how closely participants' diet aligns with the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) eating plan. The final score, which ranges from 0 to 15, indicates their level of adherence and is associated with their potential for better cognitive health. Higher scores (above 9): Indicate they are following the MIND diet closely.

Moderate scores (7 and 8): Suggest a moderate alignment with the MIND diet. Even moderate adherence has been shown to provide a reduced risk of Alzheimer's compared to the lowest scores.

Lower scores (below 6): Indicate that their diet is less aligned with the brain-healthy principles of the MIND diet.