The development of photodynamic therapy and anti-vascular endothelial growth factor agents have revolutionized the treatment of retinal diseases, transforming the retina subspecialty by ushering in an age of pharmacological treatments for a wide range of diseases, including age-related macular degeneration.

PurposeTo use the power of knowledge acquisition and machine learning in the development of a collaborative computer classification system based on the features of age-related macular degeneration (AMD).MethodsA vocabulary was acquired from four AMD experts who examined 100 ophthalmoscopic images. The vocabulary was analyzed, hierarchically structured, and incorporated into a collaborative computer classification system called IDOCS. Using this system, three of the experts examined images from a second set of digital images compiled from more than 1000 patients with (...) AMD. Images were annotated, and features were identified and defined. Decision trees, a machine learning method, were trained on the data collected and used to extract patterns. Interrelationships between the data from the different clinicians were investigated.ResultsSix drusen classes in the structured vocabulary were largely sufficient to describe all the identified features. The decision trees classified the data with 76.86% to 88.5% accuracy and distilled patterns in the form of hierarchical trees composed of 5 to 15 nodes. Experts were largely consistent in their characterization of soft, and to a lesser extent, hard drusen, but diverge in definition of other drusen. Size and crystalline morphology were the main determinants of drusen type across all experts.ConclusionsMachine learning is a powerful tool for the characterization of disease phenotypes. The creation of a defined feature set for AMD will facilitate the development of an IDOCS-based classification system. (shrink)

PURPOSE:To report the localization of a gene causing drusen and macular degeneration in a previously undescribed North American family. METHODS:Genetic mapping studies were performed using linkage analysis in a single family with drusen and atrophic macular degeneration. RESULTS:The clinical manifestations in this family ranged from fine macular drusen in asymptomatic middle-aged individuals to atrophic macular lesions in two children and two elderly patients. We mapped the gene to chromosome 6q14 between markers D6S2258 and D6S1644. (...) CONCLUSIONS:In a family with autosomal dominant drusen and atrophic macular degeneration, the gene maps to a 3.2-cM region on chromosome 6q14. This locus appears to be distinct from, but adjacent to, the loci for cone-rod dystrophy 7 (CORD7) and North Carolina macular dystrophy (MCDR1). Future identification of the gene responsible for the disease in this family will provide a better understanding of macular degeneration. (shrink)

IntroductionCognition generally declines gradually over time due to progressive degeneration of the brain, leading to dementia and eventual loss of independent functions. The rate of regression varies among the six cognitive domains. Current modality of cognitive assessment using neuropsychological paper-and-pencil screening tools for cognitive impairment such as the Montreal Cognitive Assessment has limitations and is influenced by age. Virtual reality is considered as a potential alternative tool to assess cognition. A novel, fully immersive automated VR system has been developed (...) to assess the six cognitive domains. As cognition is associated with age, VR performance is postulated to vary with age using this system.AimsThis is a feasibility study to evaluate the VR performance of cognitively healthy adults aged between 35 and 74 years old, based on the performance score and completion time using the CAVIRE system.MethodsConducted in a public primary care clinic in Singapore, 25 multi-ethnic Asian adults were recruited in each of the four age groups in years: 35–44; 45–54; 55–64, and 65–74. The eligibility criteria included a MoCA score of 26 or higher to reflect normal cognition and understanding English instructions. They completed common daily activities ranging from brushing teething to shopping, across 13 VR segments. Their performances scores and completion time were automatically computed by the CAVIRE system. These VR performance indices were compared across the four age groups using one-way ANOVA, F-test of the hypothesis, followed by pair-wise comparisons in the event of a significant F-test.ResultsOne participant dropped out from Group 1. The demographic characteristics of 99 participants were similar across the 4 age groups. Overall, younger participants in Groups 1 and 2 attained higher VR performance scores and shorter completion time, compared to those in Groups 3 and 4, in all six cognitive domains.ConclusionThe CAVIRE VR performance scores and completion time significantly differ between the younger and older Asian participants with normal cognition. Enhancements to the system are needed to establish the age-group specific normal performance indices. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:DisaffiliationsBeauvoir and Gorz on Masculinity as AgingPenelope DeutscherThe same drama of flesh and spirit, and of finitude and transcendence, plays itself out in both sexes; both are eaten away by time, stalked by death.The Second Sex, 763Simone de Beauvoir wrote her second large theoretical work in 1970, La Vieillesse (V), some nine years after André Gorz published a two-part article, “Le Vieillissement,” in Les Temps Modernes, in 1961 and (...) 1962. These were essays in which Gorz did not hesitate to refer to the “conflict between generations.” He found unremarkable the constant transitions involved in what he saw as a combat between younger and older age groups, unremarkable that the young would resent the domination of the aged and find themselves resented in turn. The aged would bear heavily on the young, but eventually find themselves demeaned if not subordinated by them.Since Gorz was one of the many references in La Vieillesse, Beauvoir was using resources that could have prompted her to think of youth and aging as a further domain of group-based conflict and hostility. Instead, she preferred a different language. Stories that might have seemed to be those of inter-generational conflict were present in her work—she mentions a story from the Brothers Grimm of three generations: son, father, and grandfather. The father treats the grandfather abusively until he learns that his son accordingly anticipates repeating the same treatment toward him. But Beauvoir does not narrate the story as one of conflict between groups who should be understood as “generations.”1 For Gorz, by contrast, such relations seem inevitable. He writes [End Page 88] of young men frustrated by their disenfranchisement by older men, who are in turn disenfranchised as young men eventually manage to usurp them.Just as the language of group-based conflict seems to Gorz obvious to describe such relations, so does the tacit (though not overtly noted) masculinity of their experience. But because he does not directly note that the conflict, on his own account, occurs between the younger and older generations of males, it is not clear how a vision of generational conflict might be inflected by a sense that such relations are also those of sexual difference. How might that affect relations between the sexes or relations among women of different ages?For her part, Beauvoir did refer to tensions between younger and older women, both in The Second Sex (SS) and Old Age(OA), but these were largely references to relations between mothers and daughters. They were familial stories. Certainly, they were refracted through structure and social context: It is the impoverished status and history of women that, in Beauvoir’s view, inhibits their lives to the point that mothers and daughters resent each other. But describing such tensions, Beauvoir does not present them as competition between groups. Her visions are those of individual experiences occurring in family contexts, not those of a generation of women of a particular age group, understanding each other as engaged in some kind of potentially conflictual group relations with a group of women understood as generationally younger or older. This is not to say that Beauvoir ought to have preferred the language of generational conflict in considering aging. But in understanding that she turned away, without saying so, from a model that might well have seemed most plausible, we can think further about the interpretation that did seem more plausible to her.How, then, do aging and sex interact for Beauvoir? Her presentation of aging in The Second Sex is characteristically ambivalent. She describes middle-aged women who have bet on the norms of femininity—“She has counted on her sexual attributes far more than man has” (SS, 620)—only to be confronted with the dilemmas of the transformation brought by time. Beauvoir takes this transformation to be largely negative—comprehended in terms of loss rather than possible gain. She describes the physical transformation of aging in terms of degeneration and the passing of youth, beauty, health, innovation, capacity. She also claims, albeit with an important exception, that it is experienced by the woman negatively, with accompanying effects of shock, discontinuity, crisis, anxious concern, denial... (shrink)

Information on age-related differences in affective meanings of words is widely used by researchers to study emotions, word recognition, attention, memory, and text-based sentiment analysis. To date, no Chinese affective norms for older adults are available although Chinese as a spoken language has the largest population in the world. This article presents the first large-scale age-related affective norms for 2,061 four-character Chinese words (AANC). Each word in this database has rating values in the four dimensions, namely, valence, arousal, dominance, and (...) familiarity. We found that older adults tended to perceive positive words as more arousing and less controllable and evaluate negative words as less arousing and more controllable than younger adults did. This indicates that the positivity effect is reliable for older adults who show a processing bias toward positive vs. negative words. Our AANC database supplies valuable information for researchers to study how emotional characteristics of words influence the cognitive processes and how this influence evolves with age. This age-related difference study on affective norms not only provides a tool for cognitive science, gerontology, and psychology in experimental studies but also serves as a valuable resource for affective analysis in various natural language processing applications. (shrink)

By age 85, most adults manifest some degree of motor impairment. However, in most individuals a specific etiology for motor decline and treatment to modify its inexorable progression cannot be identified. Recent clinical-pathologic studies provide evidence that mixed-brain pathologies are commonly associated with late-life motor impairment. Yet, while nearly all older adults show some degree of accumulation of Alzheimer’s disease and related dementias pathologies, the extent to which these pathologies contribute to motor decline varies widely from person to person. Slower (...) or faster than expected motor decline in the presence of brain injury and/or pathology has been conceptualized as more or less “resilience” relative to the average person This suggests that other factors, such as lifestyles or other neurobiologic indices may offset or exacerbate the negative effects of pathologies via other molecular pathways. The mechanisms underlying neural motor resilience are just beginning to be illuminated. Unlike its cousin, cognitive resilience which is restricted to neural mechanisms above the neck, the motor system extends the total length of the CNS and beyond the CNS to reach muscle and musculoskeletal structures, all of which are crucial for motor function. Building on prior work, we propose that by isolating motor decline unrelated to neuropathologies and degeneration, investigators can identify genes and proteins that may provide neural motor resilience. Elucidating these molecular mechanisms will advance our understanding of the heterogeneity of late-life motor impairment. This approach will also provide high value therapeutic targets for drug discovery of therapies that may offset the negative motor consequences of CNS pathologies that are currently untreatable. (shrink)

About thirty years ago, when the Internet started to be commercialised, access to the medium became a topic of research and debate. Up-to-date evidence about key predictors, such as age, is crucial because of the Internet's ever-changing nature and the challenges associated with gaining access to it. This paper aims to give an overview of New Zealand's Internet access trends and how they relate to age. It is based on secondary analysis of data from a larger online panel survey with (...) 1,001 adult respondents. The Chi-square test of independence and Cramer's V were used in the analysis. The study provides new evidence to understand the digital divide. Specifically, it uncovers a growing disparity in the quality of Internet connectivity. Even though fibre is the most common type of broadband connection at home, older adults are less likely to have it and more likely to use wireless broadband, which is a slower connection type. Additionally, a sizable majority of people in all age categories have favourable opinions on the Internet. Interestingly, this was more prevalent among older people, although they report an increased concern about the security of their personal information online. The implications of the results are discussed and some directions for future research are proposed. (shrink)

Older adults process emotional speech differently than young adults, relying less on prosody (tone) relative to semantics (words). This study aimed to elucidate the mechanisms underlying these age-related differences via an emotional speech-in-noise test. A sample of 51 young and 47 older adults rated spoken sentences with emotional content on both prosody and semantics, presented on the background of wideband speech-spectrum noise (sensory interference) or on the background of multi-talker babble (sensory/cognitive interference). The presence of wideband noise eliminated age-related differences (...) in semantics but not in prosody when processing emotional speech. Conversely, the presence of babble resulted in the elimination of age-related differences across all measures. The results suggest that both sensory and cognitive-linguistic factors contribute to age-related changes in emotional speech processing. Because real world conditions typically involve noisy background, our results highlight the importance of testing under such conditions. (shrink)

Previous studies found similarities in adults’ disgust responses to benign (e.g. obesity) and actual disease signs (e.g. influenza). However, limited research has compared visual (i.e. benign and actual) to cognitive (i.e. disease label) disease cues in different age groups. The current study investigated disgust responses across middle childhood (7–9 years), late childhood (10–12 years), adolescence (13–17 years), and adulthood (18+ years). Participants viewed individuals representing a benign visual disease (obese), sick-looking (staphylococcus), sick-label (cold/flu), and healthy condition. Disgust-related outcomes were: (1) (...) avoidance, or contact level with apparel the individual was said to have worn, (2) disgust facial reactions, and (3) a combination of (1) and (2). Avoidance was greater for the sick-looking and sick-label than the healthy and obese conditions. For facial reaction and combination outcomes, middle childhood participants responded with greater disgust to the sick-looking than the healthy condition, while late childhood participants expressed stronger disgust towards the sick-looking and obese conditions than the healthy condition. Adolescents and adults exhibited stronger disgust towards sick-label and sick-looking than obese and healthy conditions. Results suggest visual cues are central to children’s disgust responses whereas adolescents and adult responses considered cognitive cues. (shrink)

How should healthcare systems prepare to care for growing numbers and proportions of older people? Older people generally suffer worse health than younger people do. Should societies take steps to reduce age-related health inequalities? Some express concern that doing so would increase age-related inequalities in healthcare. This paper addresses this debate by presenting an argument in support of three principles for distributing scarce resources between age groups; framing these principles of age group justice in terms of life stages; and indicating (...) policy implications that merit further attention in light of rapidly aging societies. (shrink)

Ageist attitudes have been discovered in children as early as 3 years. However, so far very few studies, especially during the last decade, have examined age-related stereotypes in preschool children. Available questionnaires adapted to this population are scarce. Our study was designed to probe old age-related views in 3- to 6-year-old children ( n = 126) using both an open-ended Image-of-Aging question and a new pilot tool, called Young Children’s Views of Older People (YCVOP), based on a visual analog scale (...) illustrated by cartoons. Parental views of older people were also collected. The YCVOP was easy to use and internally consistent. Both that scale and the Image-of-Aging question showed globally favorable views of older people in preschool children, especially regarding warmth and smartness traits. However, assessment of physical capacity and independence tended to be negative. The overall results were in line with the low-competence, high-warmth stereotype of older people that is common in young adults and school-age children and was found in parents in the current study (Stereotype Content Model). Strikingly, children’s views did not correlate with those of their parents’: The children’s responses appeared more personal and emotional, while the parents tended to adopt global stereotypes. The preschoolers’ views of older people were much more positive in those who spontaneously evoked their grandparents when asked to think of an old person. In conclusion, this study, introducing a new visual tool to assess age-related stereotypes, suggests ambivalent views of older adults start in preschool children and are influenced by grandparents relationships. (shrink)

Vocabulary size has been suggested as a useful measure of “verbal abilities” that correlates with speech recognition scores. Knowing more words is linked to better speech recognition. How vocabulary knowledge translates to general speech recognition mechanisms, how these mechanisms relate to offline speech recognition scores, and how they may be modulated by acoustical distortion or age, is less clear. Age-related differences in linguistic measures may predict age-related differences in speech recognition in noise performance. We hypothesized that speech recognition performance can (...) be predicted by the efficiency of lexical access, which refers to the speed with which a given word can be searched and accessed relative to the size of the mental lexicon. We tested speech recognition in a clinical German sentence-in-noise test at two signal-to-noise ratios (SNRs), in 22 younger (18–35 years) and 22 older (60–78 years) listeners with normal hearing. We also assessed receptive vocabulary, lexical access time, verbal working memory, and hearing thresholds as measures of individual differences. Age group, SNR level, vocabulary size, and lexical access time were significant predictors of individual speech recognition scores, but working memory and hearing threshold were not. Interestingly, longer accessing times were correlated with better speech recognition scores. Hierarchical regression models for each subset of age group and SNR showed very similar patterns: the combination of vocabulary size and lexical access time contributed most to speech recognition performance; only for the younger group at the better SNR (yielding about 85% correct speech recognition) did vocabulary size alone predict performance. Our data suggest that successful speech recognition in noise is mainly modulated by the efficiency of lexical access. This suggests that older adults’ poorer performance in the speech recognition task may have arisen from reduced efficiency in lexical access; with an average vocabulary size similar to that of younger adults, they were still slower in lexical access. (shrink)

Previous studies have highlighted that temporal source memory can be influenced by factors such as the individual’s age and the emotional valence of the event to be remembered. In this study, we investigated how the different points of view (POVs) from which an event is presented could interact with the relationship between age-related differences and emotional valence on temporal source memory. One hundred and forty-one younger adults (aged 18–30) and 90 older adults (aged 65–74) were presented with a series of (...) emotional videos shot from different POVs (first vs. third-person) in three sessions. In the fourth session, participants were asked to indicate in which session (1, 2, or 3) they viewed each video. The results indicated that the first-person POV amplified the effects of the emotional valence on temporal source memory. Only in this experimental condition, older adults “pushed away” negative stimuli by perceiving them as more distant in time, and “kept closer” positive stimuli by perceiving them as more recent. In comparison, younger adults “kept closer” positive stimuli. These findings add to the existing literature on the positivity effect on temporal source memory and highlighted the importance of considering the POV in relation to the emotional valence. (shrink)

Research suggests that moral evaluations change during adulthood. Older adults (75+) tend to judge accidentally harmful acts more severely than younger adults do, and this age‐related difference is in part due to the greater negligence older adults attribute to the accidental harmdoers. Across two studies (N = 254), we find support for this claim and report the novel discovery that older adults’ increased attribution of negligence, in turn, is associated with a higher perceived likelihood that the accident would occur. (...) We propose that, because older adults perceive accidents as more likely than younger adults do, they condemn the agents and their actions more and even infer that the agents’ omission to exercise due care is intentional. These findings refine our understanding of the cognitive processes underpinning moral judgment in older adulthood and highlight the role of subjective probability judgments in negligence attribution. (shrink)

The mental lexicon changes across the lifespan. Prior work, aggregating data among individuals of similar ages, found that the aging lexicon, represented as a network of free associations, becomes more sparse with age: degree and clustering coefficient decrease and average shortest path length increases. However, because this work is based on aggregated data, it remains to be seen whether or not individuals show a similar pattern of age-related lexical change. Here, we demonstrate how an individual-level approach can be used to (...) reveal differences that vary systematically with age. We also directly compare this approach with an aggregate-level approach, to show how these approaches differ. Our individual-level approach follows the logic of many past approaches by comparing individual data as they are situated within population-level data. To do this, we produce a conglomerate network from population-level data and then identify how data from individuals of different ages are situated within that network. Though we find most qualitative patterns are preserved, individuals produce associates that have a higher clustering coefficient in the conglomerate network as they age. Alongside a reduction in degree, this suggests more specialized but clustered knowledge with age. Older individuals also reveal a pattern of increasing distance among the associates they produce in response to a single cue, indicating a more diverse range of associations. We demonstrate these results for three different languages: English, Spanish, and Dutch, which all show the same qualitative patterns of differences between aggregate and individual network approaches. These results reveal how individual-level approaches can be taken with aggregate data and demonstrate new insights into understanding the aging lexicon. (shrink)

Traditional measurement of multisensory facilitation in tasks such as speeded motor reaction tasks (MRT) consistently show age-related improvement during early childhood. However, the extent to which motor function increases with age and hence contribute to multisensory motor reaction times in young children has seldom been examined. Thus, we aimed to investigate the contribution of motor development to measures of multisensory (auditory, visual, and audiovisual) and visuomotor processing tasks in three young school age groups of children (n = 69) aged (5−6, (...) n = 21; 7−8, n = 25.; 9−10 n = 18 years). We also aimed to determine whether age-related sensory threshold times for purely visual inspection time (IT) tasks improved significantly with age. Bayesian results showed decisive evidence for age-group differences in multisensory MRT and visuo-motor processing tasks, though the evidence showed that threshold time for visual identification IT performance was only slower in the youngest age group children (5−6) compared to older groups. Bayesian correlations between performance on the multisensory MRT and visuo-motor processing tasks indicated moderate to decisive evidence in favor of the alternative hypothesis (BF10 = 4.71 to 91.346), though not with the threshold IT (BF10 < 1.35). This suggests that visual sensory system development in children older than 6 years makes a less significant contribution to the measure of multisensory facilitation, compared to motor development. In addition to this main finding, multisensory facilitation of MRT within race-model predictions was only found in the oldest group of children (9−10), supporting previous suggestions that multisensory integration is likely to continue into late childhood/early adolescence at least. (shrink)

Rapid advances in digital hearing technologies, also known as hearables, are expected to disrupt the direct‐to‐consumer health market. For older adults with higher incidence of hearing loss, such disruption could reduce hearing problems, increase accessibility to hearing aids, and mitigate related stigmas. This paper delves into the intersection of disruptive innovation and hearables within the realm of biomedical ethics. Through a comprehensive exploration, we shed light on the ethical implications surrounding hearables. By critically evaluating the key ethical advantages and drawbacks, (...) we find that no single concern presents an insurmountable a priori objection to hearables. We conclude with some ideas to maximize the benefits of hearables and further promote opportunities for equitable hearing health. (shrink)

(1982). Sex‐ and Age‐Related Differences in the Musical Behaviour, Interests and Attitudes Towards Music of 232 Secondary School Students. Educational Studies: Vol. 8, No. 2, pp. 131-139.

Researchers consistently report that individuals see themselves acting far more ethically than comparable others when confronted with ethically uncertain work-related behaviors. They suggest that this belief encourages unethical conduct and contributes to the degeneration of business ethics; however, they have not specifically investigated the consequences of this belief. If undesirable work behaviors actually do occur, educators and other ethics advocates would be strongly encouraged to dispel this widely held notion.In the present study, data was collected from college students and (...) practicing accountants regarding how they and others would respond to ten ethical scenarios. Participants' perceptions were calculated and correlated to their decision in a hypothetical business case. Analysis indicated that individuals, regardless of age, gender, or work status, see themselves acting far more ethically than others. It also disclosed significant association between participants' own attitudes and the case response, but no significant association between the response and their attitudes relative to those perceived to be held by others. Believing that everyone else is less ethical, therefore, appears to have little impact on work behavior. (shrink)

Word in noise identification is facilitated by acoustic differences between target and competing sounds and temporal separation between the onset of the masker and that of the target. Younger and older adults are able to take advantage of onset delay when the masker is dissimilar to the target word, but only younger adults are able to do so when the masker is similar. We examined the neural underpinning of this age difference using cortical evoked responses to words masked by either (...) Babble or Noise when the masker preceded the target word by 100 or 600 ms in younger and older adults, after adjusting the signal-to-noise ratios to equate behavioural performance across age groups and conditions. For the 100 ms onset delay, the word in noise elicited an acoustic change complex response that was comparable in younger and older adults. For the 600 ms onset delay, the ACC was modulated by both masker type and age. In older adults, the ACC to a word in babble was not affected by the increase in onset delay whereas younger adults showed a benefit from longer delays. Hence, the age difference in sensitivity to temporal delay is indexed by early activity in the auditory cortex. These results are consistent with the hypothesis that an increase in onset delay improves stream segregation in younger adults in both noise and babble, but only in noise for older adults and that this change in stream segregation is evident in early cortical processes. (shrink)

BackgroundCerebral Visual Impairment is a very common finding in children affected by Cerebral Palsy. In this paper we studied the characteristics of CVI of a large group of children with CP and CVI, describing their neurovisual profiles according to three different age subgroups.MethodsWe enrolled 180 subjects with CP and CVI for the study. We carried out a demographic and clinical data collection, neurological examination, developmental or cognitive assessment, and a video-recorded visual function assessment including an evaluation of ophthalmological characteristics, oculomotor (...) functions, and basic visual functions. In school-aged children, we also performed an evaluation of their cognitive-visual profiles.ResultsThere were signs of CVI in all the three subgroups. Subgroup 1 and subgroup 2 were different for fixation, visual acuity and contrast sensitivity, being more frequently impaired in younger children. Comparing subgroup 2 with subgroup 3, the older children presented more frequently myopia while the younger ones esotropia and alteration in smooth pursuit and saccades. Furthermore, fixation, smooth pursuit, visual acuity, contrast sensitivity and visual filed were more frequently impaired in younger children compared to the older ones. Multiple correspondence analysis confirmed the different neurovisual profiles according to age: younger children with CP showed more signs of CVI compared to the older ones. 34 out of 68 children belonging to subgroup 3 underwent the cognitive visual evaluation; an impairment of cognitive visual skills was detected in 21 subjects.ConclusionYounger children with CP showed more signs of CVI compared to the older ones, likely for the physiological maturation of visual system and mechanisms of neuroplasticity. In this direction, we suggest an early neurovisual evaluation to detect any weak visual functions. (shrink)

Mental imagery of movement is a potentially valuable rehabilitation task, but its therapeutic efficacy may depend on the specific cognitive strategy employed. Individuals use two main strategies to perform the hand mental rotation task, which involves determining whether a visual image depicts a left or right hand. One is the motor imagery strategy, which involves mentally simulating one’s own hand movements. In this case, task performance as measured by response time is subject to a medial–lateral effect wherein the RT is (...) reduced when the fingertips are directed medially, presumably as the actual motion would be easier. The other strategy is to employ visual imagery, which involves mentally rotating the picture and is not subject to this medial–lateral effect. The rehabilitative benefits of the HMRT are thought to depend on the MI strategy, so it is essential to examine the effects of individual factors such as age, image perspective, and innate ability on the strategy adopted. When presented with pictures of the palm, all subjects in the current study used the MI strategy, regardless of age and ability. In contrast, when subjects were presented with pictures of the back of the hand, the VI strategy predominated among the young age group regardless of performance, while the strategy used by middle-age and elderly groups depended on performance ability. In the middle-age and elderly groups, the VI approach predominated in those with high performance skill, whereas the MI strategy predominated among those with low performance skill. Thus, higher-skill middle-aged and elderly individuals may not necessarily form a motion image during the HMRT, potentially limiting rehabilitation efficacy. (shrink)