Publication Database
Below is a compilation of research by EdDem members and affiliates who have published work examining at least one of our three key areas using a network-supported dataset.
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| Title | Author | Year | Abstract | Dataset | Critical Area | Keywords | Link to Access | Citation | Journal |
|---|---|---|---|---|---|---|---|---|---|
| The role of educational attainment and quality in U.S. regional variation in prevalence of dementia and CIND | Ailshire JA, Farina MP, Jackson H, Walsemann KM. | 2025 | There are striking disparities in dementia prevalence across regions of the U.S. Education is one of the most important risk factors for dementia. Level and quality of education varied geographically for older cohorts of U.S. adults, potentially contributing to regional differences in dementia prevalence. This study links historical state education quality data to respondents ages 65 and older in the Health and Retirement Study to determine the extent to which geographic disparities in dementia and cognitive impairment with no dementia (CIND) can be attributed to state-level measures of education quality. Older adults educated in states with better resourced education systems had lower prevalence of dementia (Relative risk ratio (RRR): 0.81; CI: 0.75, 0.87) and CIND (RRR: 0.89; CI: 0.84, 0.93), while those educated in states where more school funding came from state rather than local sources had higher prevalence of dementia (RRR: 1.12; CI: 1.01, 1.23) and CIND (RRR: 1.10; CI: 1.03, 1.16). Educational attainment does not explain the higher prevalence of dementia or CIND in the US South, but state-level education quality fully accounted for higher prevalence of dementia and CIND in the South. Finally, state-level education quality indicators were more strongly associated with dementia and CIND among those with less education These findings suggest education does in fact explain regional disparities in dementia and cognitive impairment, particularly between the South and other regions, but that it is the educational environment that matters more for geographic differences than educational attainment in these cohorts. | Health and Retirement Study (HRS) | Early Life | Cognitive function, Dementia, Educational attainment, Geographic disparities, Neighborhoods, School quality, Structural inequality | Link | Ailshire, J. A., Farina, M. P., Jackson, H., & Walsemann, K. M. (2025). The role of educational attainment and quality in US regional variation in prevalence of dementia and CIND. PLoS One, 20(9), e0332410. | PLoS One |
| Associations between anxious-depression and cognitive change and mild cognitive impairment: HCHS/SOL Study of Latinos-Investigation of Neurocognitive Aging | Anita NZ, Gonzalez-Prado R, Paredes AM, Tarraf W, Kuwayama S, Stickel AM, Sotres-Alvarez D, Gallo LC, Pendedo FJ, Daviglus M, Testai FD, González HM. | 2025 | Objectives: This study examined the associations between anxious-depression symptoms with cognitive change and prevalent mild cognitive impairment (MCI) in middle-aged and older Hispanics/Latinos. Methods: Participants were enrolled in the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) and the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Anxiety and depression were measured at Visit 1 using the 10-item Spielberger State-Trait Anxiety Inventory and the 10-item Center for Epidemiologic Studies Depression Scale, with latent class analysis applied to derive anxious-depression phenotypes based on items from both scales. Cognitive tests were completed at Visits 1 and 2 (average 7-years follow-up), where change was assessed using a change index between Visit 1 and 2, and function was assessed at Visit 2. Prevalent MCI was assessed using National Institute on Aging diagnostic criteria. Regression models were used to investigate the association of anxious-depression phenotypes with cognitive function, change, and MCI. Results: In 6140 participants (mean age = 56.5 ± 8.1-years), three anxious-depression profiles were identified: low (62 %), moderate (30 %), and high (8 %). All three profiles were associated with cognitive function at Visit 2, where high and moderate phenotypes were associated with lower cognitive scores compared to low. Moderate and high anxious-depression phenotypes were associated with greater prevalence of MCI compared to low (OR [95 % CI] = 1.64 [1.25; 2.16] and OR = 1.62 [1.12; 2.33], respectively). We found no associations between cognitive change and anxious-depression phenotype. Discussion: Co-occurring elevated anxiety and depression symptoms were associated with lower cognitive function and increased prevalence MCI 7-years later, but not overall changes in cognitive function between Visit 1 and Visit 2. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Mid-Life Factors | Cognitive function, Hispanics/Latinos, Mental health | Link | Anita, N. Z., Gonzalez-Prado, R., Paredes, A. M., Tarraf, W., Kuwayama, S., Stickel, A. M., ... & González, H. M. (2025). Associations between anxious-depression and cognitive change and mild cognitive impairment: HCHS/SOL Study of Latinos-Investigation of Neurocognitive Aging. International Psychogeriatrics, 100058. | International Psychogeriatrics |
| Kidney function is associated with plasma ATN biomarkers among Hispanics/Latinos: SOL-INCA and HCHS/SOL results | Anita NZ, Tarraf W, Kuwayama S, Márquez F, DeCarli C, Thyagarajan B, Franceschini N, Lash JP, Johns T, González KA, Daviglus M, Zhou H, Stickel AM, Penedo FJ, Rundek T, Galasko D, González HM. | 2025 | Background: Plasma amyloid-tau-neurodegeneration (ATN) biomarker levels may be influenced by non-brain systems, such as kidney function, which could impact the interpretation of ATN biomarker results, particularly in groups like Hispanic/Latino individuals with higher rates of cardiometabolic health issues. Here, we examine the association between kidney function and plasma ATN markers among a diverse sample of Hispanic/Latino individuals living in the U.S. Methods: Data was collected from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL, Visit 1, 2008–2011), the largest prospective cohort study of noninstitutionalized Hispanic/Latino adults in the U.S., and its ancillary study, the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) which was conducted during the second visit of the parent HCHS/SOL study (Visit 2, 2015–2018). SOL-INCA aimed to examine the neurocognitive decline of middle-aged and older Hispanic/Latino adults, and the inclusion criteria were the age of 50-years and older by Visit 2 and completion of battery of neurocognitive tests at Visit 1. Survey linear regression models were used to examine associations between CKD status (estimated glomerular filtration rate [eGFR] = 30 mg/g) and the plasma ATN biomarkers (β-amyloid 42/40 ratio [Aβ42/40 ratio], phosphorylated-tau181 [p-Tau181], neurofilament light [NfL], and glial fibrillary associated protein [GFAP]), independently. All models adjusted for sociodemographic and cardiometabolic factors (BMI, diabetes, and hypertension). Results: 5,968 participants were included in the study (mean age 63.4 ± 8.1, 54% women). CKD was associated with higher p-Tau181 (b = 0.82), NfL (b = 11.60) and GFAP levels (b = 31.41), and lower Aβ42/Aβ40 ratio (b=-0.004). Lower eGFR (i.e., reduced kidney function) was associated with higher p-Tau181, NfL, and GFAP levels (b ranges [-0.87 - -0.03]), and lower Aβ42/Aβ40 ratio (b = 0.000). Higher (natural log) uACR was associated with lower Aβ42/Aβ40 ratio and higher levels of all other biomarkers (b ranges [0.24–5.49]). Additionally, CKD, eGFR, and uACR were associated with ATN biomarkers in models adjusted for cardiometabolic risk factors, diabetes and hypertension. Conclusions: CKD status, kidney function and urinary markers of kidney damage are significant confounders in the interpretation of plasma ATN biomarker levels. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cardiometabolic health, Cardiometabolic outcomes, Cognitive function, Hispanics/Latinos | Link | Anita, N. Z., Tarraf, W., Kuwayama, S., Márquez, F., DeCarli, C., Thyagarajan, B., ... & González, H. M. (2025). Kidney function is associated with plasma ATN biomarkers among Hispanics/Latinos: SOL-INCA and HCHS/SOL results. Alzheimer's research & therapy, 17(1), 137. | Alzheimer's Research & Therapy |
| Changes in marital and health status as risk factors for a subsequent negative wealth shock: A population-based longitudinal study in the United States, 1995-2020 | Cho TC, Yu X, Adar SD, Choi H, Langa KM, Kobayashi LC. | 2025 | Objectives: A negative wealth shock, defined as a loss of ≥75% in equivalized household total wealth over a short period, may cause adverse health outcomes for older adults. The individual-level risk factors for experiencing a negative wealth shock in later adulthood are unclear. Methods: Data were from 25,072 adults aged ≥55 in the longitudinal, population-based US Health and Retirement Study from 1995 to 2020 (n = 123,651 observations across all study respondents). We performed multivariable-adjusted Poisson mixed effects models to examine the association of each of the four risk factors, 1) separation from or loss of a spouse/partner; 2) transition from better to worse self-reported general health; 3) transition from low to high depressive symptoms; and 4) transition from normal cognition to cognitive impairment without dementia (CIND) or dementia, with the subsequent experience of a negative wealth shock in mid-to-later life. Results: All four risk factors increased the likelihood of newly experiencing a negative wealth shock: separation from or loss of a spouse/partner (incidence rate ratio (IRR) = 1.59; 95% CI: 1.41, 1.78), transition from excellent/good to fair/poor self-reported general health (IRR = 1.14; 95% CI: 1.06, 1.23), transition from low to high depressive symptoms (IRR = 1.10; 95% CI: 1.02, 1.19), and transition from normal to CIND or dementia (IRR = 1.14; 95% CI: 1.06, 1.22). Discussion: This long-timespan, population-based study suggests that adverse changes in marital or health status in mid-to-later life may signal risks for a future negative wealth shock. Public policy interventions to support aging adults at risk of a negative wealth shock may be warranted. | Health and Retirement Study (HRS) | Mid-Life Factors | Bereavement, Cognitive function, Dementia, Family, Mental health, Socioeconomic status | Link | Cho, T. C., Yu, X., Adar, S. D., Choi, H., Langa, K. M., & Kobayashi, L. C. (2025). Changes in marital and health status as risk factors for a subsequent negative wealth shock: A population-based longitudinal study in the United States, 1995–2020. Social Science & Medicine, 371, 117905. | Social Science & Medicine |
| Family availability and memory function and decline among adults aged ≥51 in England and the United States, 2004-2019 | Cho TC, Yu X, Kobayashi LC. | 2025 | Objectives: We investigated whether spousal and child availability may jointly impact memory aging among middle-aged and older adults, and if their joint impact varies between the US and England, two high-income countries with dissimilar social safety nets. Methods: We examined the associations of joint family availability with subsequent memory function and decline among adults aged ≥51 in the US Health and Retirement Study (HRS; n = 4612) and English Longitudinal Study of Aging (ELSA; n = 3502) from 2004 to 2019. Joint family availability was assessed on a 6-point index incorporating the presence and disability status of a spouse, any coresident child, and any child with frequent social contact. Memory was assessed biennially using a harmonized 20-point word recall scale. Results: A moderate level of joint family availability (vs. no spouse or children) was associated with better memory function in both countries. Yet, it was associated with faster memory decline in the US, but not in England (e.g., 4-point family availability score in the US: β = −0.18; 95 % CI: −0.31, −0.06; P-value for the cross-national difference: 0.01). No dose-response relationship was observed for either outcome. Discussion: Among aging US adults, joint spousal and child availability may support better later-life memory function, yet faster memory decline, consistent with a cognitive reserve mechanism. The lack of dose-response relationships suggests diminishing returns with increasing levels of family availability beyond the presence of a spouse or child. Cross-national heterogeneity in these associations between the US and England may imply effect modification by social safety net contexts, although further investigation is needed. | Health and Retirement Study (HRS) | Mid-Life Factors | Cross-national comparison, Family, Memory, Social well-being | Link | Cho, T. C., Yu, X., & Kobayashi, L. C. (2025). Family availability and memory function and decline among adults aged≥ 51 in England and the United States, 2004-2019. SSM-Population Health, 101824. | SSM - Population Health |
| Living in Historically Redlined Neighborhoods and the Cognitive Function of Black and White Adults | Fisk CE, Ailshire JA, Walsemann KM. | 2025 | Objectives: We determined if living in historically redlined neighborhoods was associated with level and change in cognitive functioning and if this association differed for Black and White older adults. Methods: We linked the Health and Retirement Study 1998–2018 data to redlining scores from the Historic Redlining Indicator data. Our sample included adults aged 50 years and older (24,230 respondents, 129,618 person-period observations). Using three-level linear mixed models, we estimated the relationship between living in historically redlined neighborhoods on level and change in cognitive functioning for pooled and race-stratified samples. Results: Residents of historically redlined “Declining” and “Hazardous” neighborhoods had lower cognitive functioning scores compared to residents of “Best/Desirable” neighborhoods. Among Black adults, living in “Hazardous” neighborhoods was associated with slower declines in cognitive functioning compared to living in “Best/Desirable” neighborhoods. Discussion: Historical redlining is associated with older adults’ cognitive functioning, underscoring the importance of sociohistorical context for the neighborhood–cognition relationship. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Neighborhoods, Racial-ethnic disparities, Structural inequality | Link | Fisk, C. E., Ailshire, J. A., & Walsemann, K. M. (2025). Living in Historically Redlined Neighborhoods and the Cognitive Function of Black and White Adults. Journal of Aging and Health, 08982643251315020. | Journal of Aging and Health |
| Association of epigenetic aging with plasma biomarkers of amyloid, tau, neurodegeneration, and neuroinflammation in Hispanic/Latino adults | Fornage M, Tarraf W, Daviglus ML, DeCarli C, Gonzalez KA, Isasi CR, Kuwayama S, Lamar M, Levin BE, Parada H Jr, Ramos AR, Rundek T, Thyagarajan B, González HM. | 2025 | Background: Blood-based biomarkers hold significant promise for the early detection and diagnosis of Alzheimer’s disease (AD) and other dementias. Age-related changes in blood levels of AD biomarkers are well-documented but poorly understood. Epigenetic clocks are mathematical models based on DNA methylation patterns that reflect various aspects of the multidimensional aging process. We investigated the associations of epigenetic aging with five blood-based AD biomarkers in 2656 Hispanic/Latino adults (mean age 62.5 years; 65% females) from the Hispanic Community Health Study/Study of Latinos. We used multivariable linear regression models to estimate the associations of acceleration in each of five epigenetic clocks with each biomarker in the total sample and in sex-specific strata, controlling for chronological age, sex (except in sex-stratified analyses), Hispanic/Latino background, recruitment site, risk factors, and comorbid medical conditions. Results: There were varying strengths of association between acceleration of the clocks and the plasma biomarkers. There were significant associations of acceleration in all epigenetic clocks with higher plasma levels of neurofilament light chain (NfL) (Beta = 0.0045 to 0.0193; P = 0.022 to 4.9 × 10–15). There were significant associations of acceleration in all epigenetic clocks except DunedinPACE with higher plasma levels of amyloid beta (Aβ)40 (Beta = 0.0033 to 0.0049; P = 0.024 to 1.7 × 10–5). PC-PhenoAge acceleration was associated with all circulating biomarkers but its associations with Aβ42, Aβ42/40 ratio, and phosphorylated Tau 181 (p-Tau181) showed heterogeneity by sex. Specifically, PC-PhenoAge acceleration was associated with higher Aβ42 and p-Tau181 levels in males (Beta = 0.0066, P = 0.002 and Beta = 0.0158, P = 2 × 10–4, respectively) but not females, while it was associated with lower Aβ42/40 ratio in females (Beta = − 0.0032, P = 0.012) but not males. Conclusions: Epigenetic age acceleration is associated with circulating biomarkers of AD in Hispanic/Latino adults. The second‐generation clock PC-PhenoAge showed strong and consistent associations across all biomarkers, and thus may reflect biological processes most relevant to age-related changes in AD biomarkers. Considering sex differences in the relationship between biological aging and circulating AD biomarkers is paramount. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cognitive function, Gender/Sex, Genetics, Hispanics/Latinos | Link | Fornage, M., Tarraf, W., Daviglus, M. L., DeCarli, C., Gonzalez, K. A., Isasi, C. R., ... & González, H. M. (2025). Association of epigenetic aging with plasma biomarkers of amyloid, tau, neurodegeneration, and neuroinflammation in Hispanic/Latino adults. Clinical epigenetics, 17(1), 136. | Clincal Epigenetics |
| Longitudinal associations of epigenetic aging with cognitive aging in Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos | Fornage M, Tarraf W, Xia R, Ordonez A, Sofer T, Márquez F, Thyagarajan B, Talavera GA, Gallo LC, DeCarli C, González HM. | 2025 | Due to the paucity of longitudinal DNA methylation data (DNAm), especially among Hispanic/Latino adults, the association between changes in epigenetic clocks over time and cognitive aging phenotypes has not been investigated. This longitudinal study included 2671 Hispanic/Latino adults (57 years; 66% women) with blood DNAm data and neurocognitive function assessed at two visits ~7 years apart. We evaluated the associations of 5 epigenetic clocks and their between-visit change with multiple measures of cognitive aging that included a global and domain-specific cognitive function score at each visit, between-visit change in global and domain-specific cognitive function score, and MCI diagnosis at visit 2 (V2). There were significant associations between greater acceleration of all clocks and lower cognitive function at each visit and MCI at V2. The strongest associations were observed for GrimAge and DunedinPACE. There were significant associations of between-visit increase in PhenoAge and GrimAge acceleration with decline in cognitive function and greater risk of MCI diagnosis at V2. Epigenetic aging is associated with lower global and domain-specific cognitive function, greater cognitive decline, and greater risk of MCI in Hispanic/Latino adults. Longitudinal assessment of change in age acceleration for second-generation clocks, GrimAge and PhenoAge may provide additional value in predicting cognitive aging beyond a single time point assessment. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cognitive function, Genetics, Hispanics/Latinos | Link | Fornage M, Tarraf W, Xia R, Ordonez A, Sofer T, Márquez F, Thyagarajan B, Talavera GA, Gallo LC, DeCarli C, González HM. Longitudinal associations of epigenetic aging with cognitive aging in Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos. Aging (Albany NY). 2025 Sep 10; . https://doi.org/10.18632/aging.206317 | Aging |
| Perceptions matter: Physical neighborhood disadvantage and older adults’ emotional health | Frazier, Cleothia | 2025 | For adults aged 65 and older, the neighborhood environment can be a haven for successful aging or a source of chronic stress, especially if the neighborhood is perceived as disadvantaged. Consequently, neighborhood stressors can negatively affect older adults’ emotional health and wellbeing, particularly with regards to anxiety and anger. Utilizing the stress process model this study examines whether perceptions of neighborhood disadvantage affect older adults’ emotional health (i.e., anxiety and anger). In addition, this study tests whether mastery is a viable psychosocial resource that helps moderate and/or mediate the effects of perceived neighborhood disadvantage. Finally, drawing from intersectionality and socialization theories, I also investigate whether these relationships vary by race-gender group status. Data for this study are from the Health and Retirement Study (HRS; N = 7106). Structural equation modeling (i.e., path analysis) was utilized to answer the research questions in the study. Results from the path analysis reveal that perceived neighborhood disadvantage is associated with increased anxiety and externalized anger (i.e., anger-out). Moreover, reduced mastery explains part of the effect of neighborhood disadvantage on anxiety and anger-out, respectively. There is also evidence of moderation by race-gender group status. The findings from this study demonstrate that older adults’ perceptions of physical neighborhood stressors matter in ways that can have a deleterious impact on their emotional health. | Health and Retirement Study (HRS) | Biological Mechanisms | Mental health, Neighborhoods, Stress, Structural inequality | Link | Frazier, C. (2025). Perceptions matter: Physical neighborhood disadvantage and older adults’ emotional health. Wellbeing, Space and Society. 8, 100266. | Wellbeing, Space and Society |
| Sustained Purpose in Life is Associated With Slower Cognitive Decline in Older Adults: A Longitudinal Analysis With a Diverse National Sample | Friedman EM, Thomas PA, Sauerteig-Rolston MR, Barnes LL, Ferraro KF. | 2025 | Objectives: Purpose in life is positively associated with cognitive function and better maintenance of cognitive function over time in aging adults. However, purpose in life itself declines over time, and we examined whether such changes are related to changes in cognition and whether this varied by race and ethnicity. Method: The current study used 3 waves of data from the nationally representative survey, Health and Retirement Study (HRS; N = 9,808), to examine the longitudinal associations between purpose in life and cognitive function in White, Black, and Hispanic adults age 65 and older. Purpose in life was measured using the 7-item version of the Ryff Psychological Well-Being scale. Cognitive function was assessed using a modified version of the TICS (Telephone Interview for Cognitive Status). Results: Growth curve models showed that purpose in life and cognitive function both declined over time, initial levels of purpose and cognitive function were positively associated, and less decline in purpose was associated with less decline in cognitive function. Addition of interaction terms for race and ethnicity showed that the positive association between initial levels of purpose in life and cognitive function was stronger in Black participants than in White or Hispanic participants; there were no racial or ethnic differences in the longitudinal associations. Discussion: These results show that maintaining higher levels of purpose in life may protect cognitive abilities in older adults from diverse racial and ethnic groups. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Mental health, Racial-ethnic disparities | Link | Friedman, E. M., Thomas, P. A., Sauerteig-Rolston, M. R., Barnes, L. L., & Ferraro, K. F. (2025). Sustained purpose in life is associated with slower cognitive decline in older adults: A longitudinal analysis with a diverse national sample. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 80(6), gbaf021. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Kidney function and cognitive aging and impairment among diverse Hispanic/Latino individuals: Study of Latinos-Investigation of Neurocognitive Aging (HCHS/SOL) | González HM, Kuwayama S, Anita N, Galasko D, Márquez F, Stickel AM, Daviglus M, Elfassy T, Johns T, Lash J, Franceschini N, Tarraf W. | 2025 | Introduction: The purpose of this study is to examine associations between kidney disease and cognitive impairment among diverse middle-aged and older Hispanic/Latino individuals. Methods: Between 2016 and 2018, the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) enrolled diverse Hispanic/Latino individuals ages 50 years and older (n = 6377). Cognitive function, cognitive change, and mild cognitive impairment (MCI) were the primary outcomes. Chronic kidney disease (CKD, defined as estimated glomerular filtration rate [eGFR] < 60 mL/min per 1.73 m2 or urine albumin-creatinine ratio [uACR] ≥ 30 mg/g) and two independent secondary exposures (i.e., eGFR and uACR) were examined. Results: CKD was associated with lower cognitive function and 7-year cognitive decline independent of diabetes and hypertension. CKD was associated with MCI, but the effect attenuated by adjustments for CVD risk factors. More albuminuria was associated with lower cognitive function, cognitive decline, independent of CVD risk factors. Discussion: CKD and higher albuminuria were linked to lower cognitive function, cognitive decline, and elevated risk for MCI among diverse middle-aged and older Hispanic/Latino individuals. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cardiometabolic outcomes, Cognitive function, Hispanics/Latinos | Link | González, H. M., Kuwayama, S., Anita, N., Galasko, D., Márquez, F., Stickel, A. M., ... & Tarraf, W. (2025). Kidney function and cognitive aging and impairment among diverse Hispanic/Latino individuals: Study of Latinos‐Investigation of Neurocognitive Aging (HCHS/SOL). Alzheimer's & Dementia, 21(5), e70301. | Alzheimer's & Dementia |
| Associations between depressive symptoms and subjective cognitive decline among diverse hispanics/latinos: Results from the study of Latinos-investigation of Neurocognitive Aging (SOL-INCA) | Guareña LA, Morlett-Paredes A, Tarraf W, Kuwayama S, González-Prado R, Zlatar ZZ, Stickel AM, Perreira KM, Wassertheil-Smoller S, Zeng D, Gallo LC, Daviglus ML, Isasi CR, González HM. | 2025 | Introduction: Depressive symptoms and subjective cognitive decline (SCD) are commonly reported prior to cognitive impairment. We examined associations between depressive symptoms and SCD among diverse Hispanic/Latino adults to better understand how depressive symptoms should be considered when interpreting SCD. Methods: This cross-sectional study utilized data from Hispanic/Latino adults [n = 6189; Age: M= 63.4 years, SD= 8.2; 55 % female; 40.5 % reported more than high school education] from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). Results: Higher depressive symptoms were associated with worse global (β=0.37, SE=0.02) and domain-specific SCD (Memory: β=0.32, SE=0.02; Visual-Spatial Planning: β=0.27, SE=0.02; Executive Function: β=0.34, SE=0.02; ps < 0.001). These associations were significantly stronger for individuals with low cognitive status and current cognitive worry. Discussion: These findings underscore the importance of assessing depressive symptoms in relation to SCD among diverse Hispanics/Latinos, especially among individuals with current cognitive worry and suspected cognitive impairment. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Mid-Life Factors | Cognitive function, Hispanics/Latinos, Memory, Mental health, Methodology | Link | Guareña, L. A., Morlett-Paredes, A., Tarraf, W., Kuwayama, S., González-Prado, R., Zlatar, Z. Z., ... & González, H. M. (2025). Associations between depressive symptoms and subjective cognitive decline among diverse Hispanics/Latinos: Results from the study of Latinos-investigation of Neurocognitive Aging (SOL-INCA). International Psychogeriatrics, 100135. | International Psychogeriatrics |
| Sex variation in the relationship between APOE ε4, cognitive decline, and dementia | Kerr EM, Ailshire JA, Crimmins E, Walsemann KM. | 2025 | Introduction: We examine if the relationship between apolipoprotein E (APOE) ε4 and cognitive decline and dementia onset differs by sex in non-Hispanic White and Black respondents from the Health and Retirement Study. Methods: We used race-stratified linear mixed models to estimate cognitive decline and Cox proportional hazards models to estimate time to dementia onset. Sex differences were estimated using interaction terms. Results: APOE ε4 was associated with cognitive decline (b = −0.4) and dementia onset (hazard ratio [HR] = 1.48) in White adults, and cognitive decline (b = −0.5) in Black adults. The relationship between APOE ε4 and cognitive decline or dementia onset did not differ by sex in either group. Discussion: Our findings question a key hypothesis in the field—that female APOE ε4 carriers experience faster cognitive decline and earlier dementia onset than their male counterparts—and highlight the importance of using probability samples to reduce survivor and participation bias commonly found in genetics research. | Health and Retirement Study (HRS) | Biological Mechanisms | APOE, Cognitive function, Dementia, Gender/Sex, Genetics, Racial-ethnic disparities | Link | Kerr, E. M., Ailshire, J. A., Crimmins, E., & Walsemann, K. M. (2025). Sex variation in the relationship between APOE ε4, cognitive decline, and dementia. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 17(2), e70053. | Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring |
| Association of Blood-based Neurodegenerative Biomarkers with cognitive functioning and dementia in India (LASI-DAD) and the United States (HRS) | Kim JK, Anwar M, Gupta A, Thyagarajan B, Hu P, Faul JD, Weir DR, Langa KM, Lee J, Dey S, Crimmins EM. | 2025 | This study examines associations between blood-based neurodegenerative biomarkers and cognitive functioning in nationally representative samples of older adults in India and the United States. Using data from the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) and the Health and Retirement Study (HRS), we analyzed 4 biomarkers—the ratio of Amyloid beta 42-40 (Aβ42/Aβ40), Glial Fibrillary Acidic Protein (GFAP), Neurofilament Light Chain (NfL), and Phosphorylated Tau at Threonine 181 (pTau181)—in relation to cognitive outcomes. Higher levels of GFAP and NfL were associated with worse cognitive function and a greater likelihood of dementia in both populations. GFAP and NfL were also associated with cognitive decline in the HRS, but not in LASI-DAD. Higher Aβ42/Aβ40 ratio was associated with worse cognitive functioning and more dementia in HRS; on the other hand, higher levels of the Aβ42/Aβ40 ratio were significantly linked with better cognitive functioning in LASI-DAD. pTau181 was generally not associated with cognitive functioning in either country. The associations of the whole set of markers with subsequent mortality suggest they may serve as markers for general aging. | Health and Retirement Study (HRS) | Biological Mechanisms | Biomarkers, Cardiometabolic outcomes, Cognitive function, Cross-national comparison, Mortality | Link | Kim, J. K., Anwar, M., Gupta, A., Thyagarajan, B., Hu, P., Faul, J. D., ... & Crimmins, E. M. (2025). Association of blood-based neurodegenerative biomarkers with cognitive functioning and dementia in India (LASI-DAD) and the United States (HRS). American journal of epidemiology, kwaf179. | American Journal of Epidemiology |
| How much can biomarkers explain sociodemographic inequalities in cognitive dysfunction and cognitive impairment? Results from a machine learning model in the Health and Retirement Study | Klopack ET, Farina MP, Thyagarajan B, Faul JD, Crimmins EM. | 2025 | Background: Biomarkers may be pathways by which social adversity affects cognitive aging and Alzheimer's disease and related dementias (ADRD) risk. Objective: How much variance in cognitive dysfunction and cognitive impairment onset do blood-based and physiological biomarkers provide above and beyond easily attainable sociodemographic variables, and how much can biomarkers explain differences in cognitive functioning and ADRD by sociodemographic variables? Methods: We utilize machine learning to generate measures of predicted cognitive dysfunction and cognitive impairment incidence based on 91 biomarkers, identify the relative importance of each biomarker, and examine how much these biomarkers mediate sociodemographic differences. Results: Markers related to cellular aging, neurodegeneration, diet and nutrition, immune functioning, and lung function were identified as important. Biomarkers mediated 47.2–77.3% of the variance associated with age, 22.7–35.2% of racial/ethnic differences in cognitive dysfunction, and 12.5–17.6% of educational differences. Conclusions: Biomarkers provide the potential to understand pathways linking sociodemographic characteristics to cognitive functioning and health. Future research should consider additional biomarkers and evaluate the specific systems that put people at risk for cognitive impairment. | Health and Retirement Study (HRS) | Biological Mechanisms | Biomarkers, Cognitive function, Immune function, Socioeconomic status | Link | Klopack, E. T., Farina, M. P., Thyagarajan, B., Faul, J. D., & Crimmins, E. M. (2025). How much can biomarkers explain sociodemographic inequalities in cognitive dysfunction and cognitive impairment? Results from a machine learning model in the Health and Retirement Study. Journal of Alzheimer’s Disease, 13872877251338063. | Journal of Alzheimer's Disease |
| Development of a novel transcriptomic measure of aging: Transcriptomic Mortality-risk Age (TraMA) | Klopack ET, Seshadri G, Arpawong TE, Cole S, Thyagarajan B, Crimmins EM. | 2025 | Increasingly, research suggests that aging is a coordinated multi-system decline in functioning that occurs at multiple biological levels. We developed and validated a transcriptomic (RNA-based) aging measure we call Transcriptomic Mortality-risk Age (TraMA) using RNA-seq data from the 2016 Health and Retirement Study using elastic net Cox regression analyses to predict 4-year mortality hazard. In a holdout test sample, TraMA was associated with earlier mortality, more chronic conditions, poorer cognitive functioning, and more limitations in activities of daily living. TraMA was also externally validated in the Long Life Family Study and several publicly available datasets. Results suggest that TraMA is a robust, portable RNAseq-based aging measure that is comparable, but independent from past biological aging measures (e.g., GrimAge). TraMA is likely to be of particular value to researchers interested in understanding the biological processes underlying health and aging, and for social, psychological, epidemiological, and demographic studies of health and aging. | Health and Retirement Study (HRS) | Biological Mechanisms | Biomarkers, Methodology, Mortality | Link | Klopack, E. T., Seshadri, G., Arpawong, T. E., Cole, S., Thyagarajan, B., & Crimmins, E. M. (2025). Development of a novel transcriptomic measure of aging: Transcriptomic Mortality-risk Age (TraMA). Aging (Albany NY), 17(6), 1521. | Aging |
| Influence of Birthplace and Age at Migration on Cognitive Aging Among Hispanic/Latino Populations in the United States: Study of Latinos-Investigation of Neurocognitive Aging | Liu MM, Stickel AM, Tarraf W, Li L, Perreira KM, Riosmena F, Lamar M, Testai FD, Gallo LC, Garcia TP, Llibre-Guerra JJ, Isasi CR, Lipton RB, Daviglus M, Dow WH, González HM. | 2025 | Background and Objectives: Although Hispanic/Latino populations in the United States are remarkably diverse in terms of birthplace and age at migration, we poorly understand how these factors are associated with cognitive aging. Our research seeks to operationalize a life course perspective of migration and health and contribute new understanding of Alzheimer’s disease/Alzheimer’s disease-related dementias among U.S.-based Hispanic/Latino older adults. Research Design and Methods: Harnessing the Hispanic Community Health Study/Study of Latinos (n = 16,415) and the Study of Latinos-Investigation of Neurocognitive Aging (n = 6,377) data, we compare baseline cognition and 7-year cognitive change among U.S./mainland-born Hispanic/Latino adults relative to foreign/island-born immigrants by age of migration (4 groups: born in mainland United States, immigrated 34 years). Global cognition was calculated as a composite measure, and domain-specific measures were considered in secondary analyses. We employed linear regressions, ANOVA contrasts, and Blinder–Oaxaca decomposition techniques. Results: All Hispanic/Latino immigrant adults, regardless of age at migration, have a cognitive health disadvantage (at each visit and over time) relative to U.S./mainland-born Hispanic/Latino individuals. Differences did not endure the inclusion of covariates and were explained predominantly by first socioeconomic and then acculturative factors, and far less by health and health behaviors. Acculturative factors are particularly important for individuals who migrated after childhood. Discussion and Implications: Socioeconomic and acculturation factors have outsized roles in explaining gaps in cognitive aging among U.S.-born and migrant Hispanic/Latino adults. It is then vital to examine whether disrupting socioeconomic and acculturation inequalities closes such gaps in cognitive aging. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Early Life | Cognitive function, Hispanics/Latinos, Migration, Racial-ethnic disparities | Link | Liu, M. M., Stickel, A. M., Tarraf, W., Li, L., Perreira, K. M., Riosmena, F., ... & González, H. M. (2025). Influence of birthplace and age at migration on cognitive aging among Hispanic/Latino populations in the US: Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). The Gerontologist, gnaf009. | The Gerontologist |
| Alzheimer Disease Biomarkers and Subjective Cognitive Decline Among Hispanic and/or Latino Adults | Márquez F, Tarraf W, Gonzalez K, Valencia DF, Stickel AM, Anita NZ, Sotres-Alvarez D, Levin BE, Yassa MA, Zhou H, Daviglus M, Pirzada A, Goodman ZT, Thyagarajan B, Gallo LC, González HM. | 2025 | Importance Subjective cognitive decline (SCD) may be an early indicator of Alzheimer disease and related dementias (ADRD), yet its association with plasma biomarkers remains unclear among middle-aged and older adults (aged 50-86 years). Objective To examine associations between plasma biomarkers of amyloid, tau, neuroaxonal damage, and glial activation with SCD in a heterogeneous cohort of Hispanic and/or Latino adults. Design, Setting, and Participants This cross-sectional study used survey-weighted data from the Study of Latinos–Investigation of Neurocognitive Aging, an ancillary study of the Hispanic Community Health Study/Study of Latinos. Participants were aged 50 to 86 years and resided in 4 major US cities. Data were collected from 2016 to 2018 and analyzed between December 2024 and June 2025. Exposure Plasma biomarkers included amyloid-beta (Aβ42/40), phosphorylated tau-181 (ptau-181), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP), quantified using Simoa (Quanterix HD-X) and log-transformed (ln) to reduce skewness. Main Outcomes and Measures SCD was assessed using the short-form Everyday Cognition Scale (ECog-12), evaluating global-, executive-, and memory-related SCD, and a single-item cognitive concerns question. Survey-weighted linear and logistic regression models tested associations between biomarkers and SCD, adjusting for demographic, cardiovascular, kidney, and APOE genotype covariates. Results Among 5712 adults (mean [SD] age, 63.47 (8.15) years; unweighted 3663 [53.92%] female), higher ln(ptau-181) was associated with ECog-12 memory (unstandardized β = 0.088; 95% CI, 0.005-0.170). Higher ln(NfL) levels were associated with greater ECog-12 global (unstandardized β = 0.169; 95% CI, 0.074-0.265), executive (unstandardized β = 0.182; 95% CI, 0.087-0.277), and memory (unstandardized β = 0.156; 95% CI, 0.065-0.248) domains. Higher ln(GFAP) levels were associated with greater ECog-12 global (unstandardized β = 0.109; 95% CI, 0.019-0.198) and executive (unstandardized β = 0.121; 95% CI, 0.031-0.211) domains. Ln(Aβ42/40) was not associated with SCD domains. Cognitive concerns significantly modified the associations between ln(NfL) and ECog-12 domains, with more pronounced associations among those reporting cognitive concerns. No biomarkers were associated with the single-item cognitive concerns score. Conclusions and Relevance In this study of middle-aged and older Hispanic and/or Latino adults, plasma biomarkers of p-tau181, NfL, and GFAP, but not Aβ42/40, were associated with greater SCD. These findings underscore their potential utility in early ADRD detection strategies. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | APOE, Biomarkers, Cognitive function, Genetics, Hispanics/Latinos, Memory | Link | Márquez, F., Tarraf, W., Gonzalez, K., Valencia, D. F., Stickel, A. M., Anita, N. Z., ... & González, H. M. (2025). Alzheimer Disease Biomarkers and Subjective Cognitive Decline Among Hispanic and/or Latino Adults. JAMA network open, 8(9), e2531038-e2531038. | JAMA Netw Open |
| Offspring education and cognitive health: A comparison between Hispanic and White older adults in the United States | Meza E, Romero KRF, Allen IE, González HM, Glymour MM, Torres JM. | 2025 | Introduction: We compared the relationship between offspring education and cognitive health outcomes among Hispanic and White adults. Methods: We used data from Hispanic and White (1998–2018) United States (US) Health and Retirement Study (HRS) participants (n = 17,484). We assessed cognitive function and decline using episodic memory scores in linear mixed models and incident cognitive impairment with no dementia (CIND) or probable dementia using the Langa-Weir 27-point-scale in Cox proportional hazards models. Results: Higher offspring education (> 12 years) was associated with higher baseline cognitive scores and faster cognitive decline. Higher offspring education was also linked to a reduced risk of CIND or probable dementia, particularly among Hispanic participants. Among Hispanic participants, associations with cognitive decline but not incident CIND or probable dementia were of larger magnitude for foreign-born versus US-born participants. Discussion: We found limited evidence of heterogeneity in the association between offspring education and cognitive aging by Hispanic ethnicity and nativity. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Educational attainment, Family, Generational effects, Hispanics/Latinos, Memory | Link | Meza, E., Romero, K. R. F., Allen, I. E., González, H. M., Glymour, M. M., & Torres, J. M. (2025). Offspring education and cognitive health: A comparison between Hispanic and White older adults in the United States. Alzheimer's & Dementia, 21(2), e14523. | Alzheimer's & Dementia |
| Intergenerational upward educational mobility and cognitive performance: results from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Meza E, Tarraf W, Gallo LC, Isasi CR, Perreira KM, Lamar M, Estrella ML, Daviglus M, Allen IE, Glymour MM, Torres JM, González HM. | 2025 | Introduction: Upward educational attainment is associated with better cognitive function; differences by Hispanic/Latino heritage are unclear. Methods: We analyzed data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and its ancillary study SOL-Investigation of Neurocognitive Aging (SOL-INCA; n = 3300) to compare cognitive function and 7-year cognitive change between first-generation and multigenerational high school (HS) graduates (i.e., neither parent vs 1+ parent graduated HS) using survey-linear regression models, and assessing for heterogeneity by heritage and nativity. Results: First-generation Cuban, Mexican, and Puerto Rican HS graduates had significantly lower baseline cognitive scores than multigenerational graduates, while Dominican, Central, and South American graduates had similar cognitive scores. We found some evidence of heterogeneity by nativity. Cognitive change was similar across groups. Discussion: More studies of Latinos across the life course are needed to disentangle the role of educational mobility and cognitive health, particularly among US-born Hispanic/Latino adults. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Early Life | Cognitive function, Educational attainment, Family, Generational effects, Hispanics/Latinos, Socioeconomic status | Link | Meza, E., Tarraf, W., Gallo, L. C., Isasi, C. R., Perreira, K. M., Lamar, M., ... & González, H. M. (2025). Intergenerational upward educational mobility and cognitive performance: results from the Study of Latinos‐Investigation of Neurocognitive Aging (SOL‐INCA). Alzheimer's & Dementia, 21(5), e70214. | Alzheimer's & Dementia |
| Education and midlife cognitive functioning: Evidence from the High School and Beyond cohort | Muller C, Grodsky E, Brickman AM, Manly JJ, Hung K, Culbertson MJ, Warren JR. | 2025 | Introduction: Educational attainment is associated with midlife cognitive functioning. However, degree attainment is the culmination of complex and unequal processes involving students’ backgrounds, the opportunities that schools provide them, and their performance within those schools─all of which may also shape midlife cognition. What do educational gradients in midlife cognition look like using a richer conceptualization and measures of “education?”. Methods: We use data from High School and Beyond (HS&B:80)─a large, nationally representative sample of Americans followed from high school through age ∼60─to assess the role of education in stratifying midlife cognition. Results: High schools’ academic and socioeconomic environments predict midlife cognition primarily through their associations with their students’ academic performance. Student academic performance strongly predicts midlife cognition, partially through its association with degree attainment. Discussion: Inequalities in educational opportunities and in students’ performance in schools shape midlife cognition─even among students with the same attained degrees. | EdShare: High School and Beyond (HSB) | Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Educational attainment, School quality | Link | Muller, C., Grodsky, E., Brickman, A. M., Manly, J. J., Hung, K., Culbertson, M. J., & Warren, J. R. (2025). Education and midlife cognitive functioning: Evidence from the High School and Beyond cohort. Alzheimer's & Dementia, 21(2), e70015. | Alzheimer's & Dementia |
| Sleep Disordered Breathing and Subsequent Neuroimaging Markers of Brain Health in Hispanic/Latino Adults | Ramos AR, Agudelo C, Gonzalez KA, Tarraf W, Daviglus M, Gallo LC, Isasi CI, Kaur S, Lipton RB, Patel SR, Redline S, Sostres-Alvarez D, Stickel AM, Testai FD, Talavera GA, Gonzalez HM, Decarli CS. | 2025 | Background and Objectives: Sleep disordered breathing (SDB) is a risk factor of stroke and Alzheimer disease and related dementias (ADRDs). Hispanic/Latino adults have higher risk of SDB and ADRDs, which emphasizes the need to better understand the association between SDB and brain health. Furthermore, results on SDB and brain aging are mixed, and there are limited data for Hispanic/Latino adults. The main goal of this study is to assess the association between SDB and brain MRI measures in a diverse Hispanic/Latino population. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a community-based prospective cohort multisite (Bronx, Chicago, Miami, San Diego) study of diverse Hispanic/Latino adults in the United States. Participants underwent 1 night of unsupervised home testing with a sleep apnea test device at baseline. The SOL-Investigation of Neurocognitive Aging MRI, an ancillary study, recruited 2,667 HCHS/SOL participants (35–85 years) who underwent neuroimaging approximately 10 years after baseline sleep assessment. The main exposure was the respiratory event index (REI, 3% desaturation). Secondary exposures encompassed measures of oxygen saturation. Main outcomes included total brain, gray matter, white matter hyperintensity (WMH), and hippocampal volumes. Survey linear regression models were used to determine associations between SDB and brain MRI measures. Results: The mean age was 67.6 years, with a body mass index of 29.7, and 58.3% were female. We found that increased REI was associated with larger hippocampal volumes (bhippocampus = 0.006 [0.001–0.012]). These results were consistent with oxygen levels (minimum SpO2%) during sleep (bhippocampus = −0.013 [−0.021 to −0.004]). Lower oxygen levels (mean SpO2) during sleep were associated with enlarged WMH volumes (bWMH = −0.095 [−0.164 to −0.025]). Discussion: We found that SDB and worse oxygenation during sleep were linked to larger hippocampal volumes. These results underscore the complex relationships between sleep health and brain aging and warrant longitudinal follow-up, starting in middle age or earlier. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Alzheimer's disease, Dementia, Health behavior, Hispanics/Latinos, Neuroimaging | Link | Ramos, A. R., Agudelo, C., Gonzalez, K. A., Tarraf, W., Daviglus, M., Gallo, L. C., ... & Decarli, C. S. (2025). Sleep disordered breathing and subsequent neuroimaging markers of brain health in Hispanic/Latino adults. Neurology, 104(1), e210183. | Neurology |
| Multimodal Associations of Modifiable Risk Factors on White Matter Injury: The SOL-INCA-MRI Study (HCHS/SOL) | Sapkota S, Maillard P, Stickel AM, Tarraf W, González KA, Ivanovic V, Morlett-Paredes A, Cai J, Isasi CR, Lipton RB, Daviglus M, Testai FD, Lamar M, Gallo LC, Talavera GA, Agudelo C, Ramos AR, González HM, DeCarli C. | 2025 | Background: Modifiable risk factors play a central role in the development and course of neurodegenerative disorders of later life, including dementias. Although past research has focused on independent associations of modifiable risk factors, including cardiovascular disease risk factors using Framingham cardiovascular risk score, physical activity, dietary quality, body mass index, and sleep, on neurodegeneration, the impact of all 5 factors simultaneously in a multimodal model has not been studied. We examined independent associations and an overall combined model with 5 modifiable risk factors with white matter injury, a recognized risk factor for dementia, ≈10 years later in a diverse Hispanic/Latino population. Methods: Participants were from the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) Investigation of Nerocognitive Aging-Magnetic Resonance Imaging longitudinal study (n=2667; clinical visit 1 mean age, 52.01 [8.90] years). We conducted path and mediation analyses across 5 modifiable risk factors obtained at clinical visit 1 (2008–2011) and 2 measures of white matter injury (free water and white matter hyperintensity volume) obtained at the magnetic resonance imaging visit (2018–2022; mean age, 62.37 [9.23] years). We controlled for age at the time of the dependent variable, sex, education, Hispanic/Latino heritage, overall cognitive status, and b-value when free water was included. Results: We observed 11 significant independent associations across modifiable risk factors and white matter injury measures. The association of Framingham cardiovascular risk score to white matter hyperintensity volume was mediated by free water (indirect mediation: β=2.473; SE=0.207; P<0.001), and the association of physical activity to body mass index was mediated by sleep duration (indirect mediation: β=−0.038; SE=0.019; P=0.050). We combined the 2 mediational pathways and added diet associated with white matter hyperintensity volume (β=0.008; SE=0.007; P=0.004) and physical activity associated with Framingham cardiovascular risk score (β=−0.007; SE=0.002; P=0.001) in the overall model. Conclusions: Our findings identified how modifiable risk factors synergistically influence future white matter injury in Hispanic/Latino populations. Such multimodal models may lead to the development of novel and personalized lifestyle clinical interventions for adults at risk for dementia due to elevated white matter hyperintensity volume. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cognitive function, Hispanics/Latinos, Neuroimaging | Link | Sapkota, S., Maillard, P., Stickel, A. M., Tarraf, W., González, K. A., Ivanovic, V., ... & DeCarli, C. (2025). Multimodal Associations of Modifiable Risk Factors on White Matter Injury: The SOL-INCA-MRI Study (HCHS/SOL). Stroke, 56(5), 1138-1148. | Stroke |
| Religious Involvement and Cognitive Function Among White, Black, and Hispanic Older Adults | Sauerteig-Rolston MR, Barnes LL, Thomas PA, Angel JL, Ferraro KF. | 2025 | We examined whether religious involvement was associated with cognitive function among older adults in the 2006–2020 waves of the Health and Retirement Study. Using growth curve analysis, we found the association between religious involvement and cognition varied by facet of religious involvement and race and Hispanic ethnicity. Attending religious services with friends was associated with higher initial levels of cognitive function (b = 0.22, p < .05). For Hispanic older adults, frequent attendance at religious services was associated with a slower rate of cognitive decline (b = 0.16, p < .01). Stratified models by race and Hispanic ethnicity demonstrated that religious salience was associated with lower initial levels of cognitive function among non-Hispanic White adults (b = -0.19, p < .01). We found no association between religious involvement and cognitive function among non-Hispanic Black respondents. In sum, elements of religious involvement are positively or negatively related to cognitive function in later life and vary by race and ethnicity. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Racial-ethnic disparities, Religion and spirituality | Link | Sauerteig-Rolston, M. R., Barnes, L. L., Thomas, P. A., Angel, J. L., & Ferraro, K. F. (2025). Religious Involvement and Cognitive Function Among White, Black, and Hispanic Older Adults. Research on aging, 47(2), 116-127. | Research on Aging |
| Association of Cardiovascular Health With Brain Volume and White Matter Integrity: Results of the SOL-INCA MRI Study | Trifan G, Stickel AM, Cai J, Daviglus M, Estrella M, Garcia-Bedoya O, Gallo LC, Isasi CR, Kaplan R, Lamar M, Talavera GA, Tarraf W, Gonzalez HM, Maillard P, Decarli CS, Testai FD. | 2025 | Background and Objectives: Better cardiovascular health (CVH), measured using the Life's Simple 7 (LS7) score, is associated with improved cognitive function. However, its effect on brain imaging in Hispanics/Latinos has not been reported. We investigated the association of LS7 score with brain MRI outcomes in a diverse Hispanic/Latino population. Methods: Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is the largest prospective cohort study of diverse Hispanic/Latino adults in the United States. LS7 score was assessed at baseline (2008–2011). The SOL-Investigation of Neurocognitive Aging (SOL-INCA) MRI ancillary study recruited HCHS/SOL participants who underwent neuroimaging approximately 10 years (2017–2022) later. Main outcomes include standardized residuals for total brain, total and lobar gray matter (frontal, temporal, parietal, and occipital), total white matter, total CSF, lateral ventricle (LV), and white matter hyperintensity (WMH) volumes and diffusion tensor imaging (mean free water fraction, peak width skeletonized mean diffusivity, and mean fractional anisotropy). MRI outcomes across continuous LS7 scores were investigated using adjusted linear regression models. We performed an interaction analysis by age and sex. All analyses accounted for complex sample design. Results: The study included 2,659 participants (weighted %female = 56%). The mean age (95% CI) was 54 (53–55) years, and the mean LS7 score was 7.2 (7.1–7.3). In the fully adjusted model, higher LS7 scores were associated with larger total and lobar brain volumes (βTotal Brain = 0.03 [0.002 to 0.06], βTotal White = 0.05 [0.03 to 0.08], βTotal Gray = 0.04 [0.01 to 0.06], βFrontal Gray = 0.04 [0.02 to 0.07]); smaller total CSF (β = −0.06 [-0.08 to −0.03]), LV (β = −0.03 [-0.06 to −0.004]), and WMH (β = −0.05 [-0.07 to −0.03]) volumes; and better measures of microstructural integrity (βFW = −0.002 [-0.003 to −0.001], βPSMD = −0.01 [-0.01 to −0.003], and βFA = 0.001 [0.001 to 0.002]). In interaction analysis by age, the benefits of CVH on magnetic resonance volumes and microstructural integrity were more pronounced in older patients. No interaction was observed by sex. Discussion: We found that better CVH is associated with better brain-based volumes and microstructural integrity and that the effects of LS7 score on brain health are age dependent. Additional studies are needed to assess the longitudinal effect of CVH on MR-based brain health outcomes. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cardiometabolic health, Hispanics/Latinos, Neuroimaging | Link | Trifan, G., Stickel, A. M., Cai, J., Daviglus, M., Estrella, M., Garcia-Bedoya, O., ... & Testai, F. D. (2025). Association of Cardiovascular Health With Brain Volume and White Matter Integrity: Results of the SOL-INCA MRI Study. Neurology, 104(8), e213404. | Neurology |
| Changes in Long-term Services and Supports Among Adults With and Without Dementia During the First Year of the COVID-19 Pandemic | Truskinovsky Y, Freedman VA, Hoffman GJ, Leggett AN, Wiemers E. | 2025 | Background and Objectives: This study draws upon local coronavirus disease 2019 (COVID-19) mortality rates as a proxy for pandemic severity to determine if the COVID-19 pandemic disrupted long-term services and supports (LTSS) for adults with dementia, relative to adults with care needs unrelated to dementia. Research Design and Methods: We used the Health and Retirement Study to estimate associations between local COVID-19 mortality rates from March 2020 through April 2021 and LTSS outcomes (receiving paid and unpaid help, monthly hours of paid and unpaid help, number of paid and unpaid helpers, living in a residential care setting, or living with adult children). We compared 2 groups of adults ages 51 and older: those with dementia (n = 522) and those without dementia but having difficulty with at least one activity of daily living (n = 2,036). Results: We found that higher local COVID-19 mortality rates were associated with a reduction in paid care and living in residential care settings for both groups of adults with care needs. In addition, higher local COVID-19 mortality rates were associated with a greater likelihood of living with adult children among those without dementia and greater hours of unpaid help among those with dementia. Discussion and Implications: Although we did not find differences in disruptions of LTSS between persons with and without dementia, observed declines in paid LTSS and increases in unpaid care in the first year of the pandemic may nevertheless have different implications for persons with dementia. Future research should investigate if COVID-19 related disruptions in LTSS led to differential changes in health and unmet needs among adults with dementia, increased strain for their caregivers, and the equitable availability of high-quality paid care. | Health and Retirement Study (HRS) | Mid-Life Factors | Dementia, Healthcare, Mortality | Link | Truskinovsky, Y., Freedman, V. A., Hoffman, G. J., Leggett, A. N., & Wiemers, E. (2025). Changes in Long-term Services and Supports Among Adults With and Without Dementia During the First Year of the COVID-19 Pandemic. Innovation in Aging, 9(2), igaf003. | Innovation in Aging |
| APOE genotype and cognitive decline: educational context as a moderator of genetic risk | Walsemann KM, Jackson HM, Boardman JD, Herd P. | 2025 | Objectives: The apolipoprotein E (APOE) ε4 allele is linked to increased risk of Alzheimer’s disease and cognitive decline. While educational attainment appears to mitigate this risk, it is not a direct measure of the early-life environment. This study examined whether childhood exposure to well- versus poorly resourced educational contexts modified the association between APOE ε4 and cognitive decline, independent of parent and respondent educational attainment. Methods: We used data from the Health and Retirement Study (2006–2018) linked with state-level data on public education systems. The sample included U.S.-born respondents who participated in the 2006–2012 genetic data collection, lived in one of the 48 contiguous states at age 10, and were born between 1914 and 1959 (n = 14,817 respondents, 76,806 person–period observations). To measure educational context, we created a standardized factor score representing state education resources, derived from indicators such as per-pupil spending, pupil–teacher ratios, and teacher salary. We used mixed effects models to estimate the interaction between APOE ε4 and state education resources, adjusting for parent and respondent education (measured in years of schooling). Results: APOE ε4 carriers who grew up in states with low education resources experienced an accelerated rate of cognitive decline compared to carriers from states with high education resources. For noncarriers, the rate of cognitive decline was not statistically different across educational contexts. Discussion: Ensuring access to high-quality education may serve as an effective social policy to slow cognitive decline among future cohorts of older adults at high genetic risk of dementia. | Health and Retirement Study (HRS) | Biological Mechanisms | APOE, Cognitive function, Dementia, Educational attainment, Educational attainment, Genetics, School quality, Structural inequality | Link | Walsemann, K. M., Jackson, H., Boardman, J. D., & Herd, P. (2025). APOE genotype and cognitive decline: Educational context as a moderator of genetic risk. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, gbaf110. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Associations of Perceived Neighborhood Factors and Alzheimer's Disease Polygenic Score with Cognition: Evidence from the Health and Retirement Study | Ware EB, Zhu P, Noppert G, Fu M, Benbow M, Kobayashi LC, Ryan LH, Bakulski KM. | 2025 | We examined the relationships between neighborhood characteristics, cumulative genetic risk for Alzheimer’s disease (polygenic scores for Alzheimer’s disease), and cognitive function using data from the Health and Retirement Study (2008-2020, age>50). Baseline perceived neighborhood characteristics were combined into a subjective neighborhood disadvantage index. Cognitive function was assessed at baseline and measured biennially over a 10-year follow-up period. Analyses were stratified by genetic ancestry. Cox proportional hazard models analyzed associations between neighborhood characteristics, Alzheimer’s disease polygenic scores, and their interactions on cognitive impairment. In the European ancestries sample, a one standard deviation higher score on the subjective neighborhood disadvantage index was associated with a higher hazard of any cognitive impairment (HR:1.09; CI:1.03-1.15). Similarly, a one standard deviation increase in Alzheimer’s disease polygenic score was associated with a higher risk of cognitive impairment (HR:1.10; CI:1.05-1.16). Similar effect sizes were observed when examining cognitive impairment without dementia and dementia separately. No significant interactions were found. Comparable but nonsignificant trends were noted in the African ancestries sample. Subjective neighborhood disadvantage index and Alzheimer’s disease polygenic score were independently associated with incident cognitive impairment. Preventing dementia by addressing modifiable risk factors is essential. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Alzheimer's disease, Cognitive function, Genetics, Neighborhoods, Racial-ethnic disparities, Socioeconomic status | Link | Ware, E. B., Zhu, P., Noppert, G., Fu, M., Benbow, M., Kobayashi, L. C., ... & Bakulski, K. M. (2025). Associations of Perceived Neighborhood Factors and Alzheimer’s Disease Polygenic Score with Cognition: Evidence from the Health and Retirement Study. medRxiv. | MedRxiv |
| Assessing Metabolic Ageing via DNA Methylation Surrogate Markers: A Multicohort Study in Britain, Ireland and the USA | Xu K, Hernández B, Arpawong TE, Camuzeaux S, Chekmeneva E, Crimmins EM, Elliott P, Fiorito G, Jiménez B, Kenny RA, McCrory C, McLoughlin S, Pinto R, Sands C, Vineis P, Lau CE, Robinson O. | 2025 | Metabolomics and epigenomics have been used to develop ‘ageing clocks’ that assess biological age and identify ‘accelerated ageing’. While metabolites are subject to short-term variation, DNA methylation (DNAm) may capture longer-term metabolic changes. We aimed to develop a hybrid DNAm-metabolic clock using DNAm as metabolite surrogates (‘DNAm-metabolites’) for age prediction. Within the UK Airwave cohort (n = 820), we developed DNAm metabolites by regressing 594 metabolites on DNAm and selected 177 DNAm metabolites and 193 metabolites to construct ‘DNAm-metabolic’ and ‘metabolic’ clocks. We evaluated clocks in their age prediction and association with noncommunicable disease risk factors. We additionally validated the DNAm-metabolic clock for the prediction of age and health outcomes in The Irish Longitudinal Study of Ageing (TILDA, n = 488) and the Health and Retirement Study (HRS, n = 4018). Around 70% of DNAm metabolites showed significant metabolite correlations (Pearson's r: > 0.30, p < 10−4) in the Airwave test set and overall stronger age associations than metabolites. The DNAm-metabolic clock was enriched for metabolic traits and was associated (p < 0.05) with male sex, heavy drinking, anxiety, depression and trauma. In TILDA and HRS, the DNAm-metabolic clock predicted age (r = 0.73 and 0.69), disability and gait speed (p < 0.05). In HRS, it additionally predicted time to death, diabetes, cardiovascular disease, frailty and grip strength. DNAm metabolite surrogates may facilitate metabolic studies using only DNAm data. Clocks built from DNAm metabolites provided a novel approach to assess metabolic ageing, potentially enabling early detection of metabolic-related diseases for personalised medicine. | Health and Retirement Study (HRS) | Biological Mechanisms | Biomarkers, Cardiometabolic health, Cognitive function, Health behavior, Mental health, Methodology, Trauma | Link | Xu, K., Hernández, B., Arpawong, T. E., Camuzeaux, S., Chekmeneva, E., Crimmins, E. M., ... & Robinson, O. (2025). Assessing Metabolic Ageing via DNA Methylation Surrogate Markers: A Multicohort Study in Britain, Ireland and the USA. Aging Cell, 24(5), e14484. | Aging Cell |
| Offspring Educational Disadvantage and Parents' Dementia Onset: Does the Educational Success of One Child Moderate the Educational Disadvantage of Another? | Yahirun JJ, Applegate JS, Mossakowski KN, Hayward MD. | 2025 | Objectives: A growing body of research examines how adult children’s education influences older parents’ cognitive health. Whereas prior studies tend to focus on educational advantage, this study seeks to understand how various measures of educational disadvantage are associated with parents’ dementia likelihood. In addition, we ask how the risks associated with one child’s educational disadvantage are shaped by a sibling’s educational success. Methods: Using data from the U.S. Health and Retirement Study (2000–2018) and event history analyses, comparisons are made between measures of offspring educational disadvantage and their relationships with parents’ risk of dementia onset. In addition, analyses are conducted to understand whether the link between one child’s educational disadvantage and parental dementia onset is influenced by a sibling’s educational advantage. Results: Educational disadvantage is associated with an increased risk of parental dementia onset, with a threshold measure for whether a parent had at least one child without a high school education providing the best model fit for the data. Moreover, the heightened risks associated with one child’s educational disadvantage are not offset by another sibling’s educational success. Discussion: Children’s educational deficits are a hidden source of health disparities among older parents. Although scholars in recent years have rightly focused on the importance of offspring education, more attention should be paid to conceptualizing how educational disadvantage matters for parents and how the educational attainment of each child shapes parents’ cognitive health. | Health and Retirement Study (HRS) | Mid-Life Factors | Dementia, Educational attainment, Family, Generational effects | Link | Yahirun, J. J., Applegate, J. S., Mossakowski, K. N., & Hayward, M. D. (2025). Offspring Educational Disadvantage and Parents’ Dementia Onset: Does the Educational Success of One Child Moderate the Educational Disadvantage of Another?. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 80(6), gbaf033. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos | Elfassy T, Kulandavelu S, Dodds L, Mesa RA, Rundek T, Sharashidze V, Paidas M, Daviglus ML, Kominiarek MA, Stickel AM, Perreira KM, Kobayashi MA, Garcia TP, Isasi CR, Lipton RB, González HM. | 2024 | Objective: To evaluate whether hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are associated with cognitive decline later in life among U.S. Hispanic/Latina individuals. Methods: The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) is a prospective population-based study of Hispanic/Latino individuals aged 18–74 years from four U.S. communities. This analysis included parous individuals aged 45 years or older who participated in the HCHS/SOL clinic study visit 1 (2008–2011) neurocognitive assessment and subsequently completed a repeat neurocognitive assessment as part of the Study of Latinos–Investigation of Neurocognitive Aging ancillary study visit 2 (2015–2018). Hypertensive disorders of pregnancy were assessed retrospectively by self-report of any gestational hypertension, preeclampsia, or eclampsia. Cognitive functioning was measured at both study visits with the Brief Spanish-English Verbal Learning Test, Digit Symbol Substitution, and Word Fluency. A regression-based approach was used to define cognitive decline at visit 2 as a function of cognition at visit 1 after adjustment for age, education, and follow-up time. Linear regression models were used to determine whether hypertensive disorders of pregnancy or their component diagnoses were associated with standardized cognitive decline after adjustment for sociodemographic characteristics, clinical and behavioral risk factors, and follow-up time. Results: Among 3,554 individuals included in analysis, the mean age was 56.2 years, and 467 of individuals (13.4%) reported at least one hypertensive disorder of pregnancy. Individuals with hypertensive disorders of pregnancy compared with those without were more likely to have higher mean systolic blood pressure, fasting glucose, and body mass index. After an average of 7 years of follow-up, in fully adjusted models, gestational hypertension was associated with a 0.17-SD relative decline in Digit Symbol Substitution scores (95% CI, −0.31 to −0.04) but not other cognitive domains (Brief Spanish-English Verbal Learning Test or Word Fluency). Neither preeclampsia nor eclampsia was associated with neurocognitive differences. Conclusion: The presence of preeclampsia or eclampsia was not associated with interval neurocognitive decline. In this cohort of U.S. Hispanic/Latina individuals, gestational hypertension alone was associated with decreased processing speed and executive functioning later in life. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cardiometabolic outcomes, Cognitive function, Hispanics/Latinos, Reproductive health | Link | Elfassy, T., Kulandavelu, S., Dodds, L., Mesa, R. A., Rundek, T., Sharashidze, V., ... & González, H. M. (2024). Association between hypertensive disorders of pregnancy and interval neurocognitive decline: an analysis of the Hispanic Community Health Study/Study of Latinos. Obstetrics & Gynecology, 143(6), 785-793. | Obstetrics & Gynecology |
| Psychosocial factors associated with 7-year change in cognition among middle-aged and older Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) and Sociocultural ancillary studies | Estrella ML, Tarraf W, Kuwayama S, Gallo LC, Wu B, Marquine MJ, Perreira KM, Vasquez PM, Isasi CR, Lipton RB, Mattei J, González HM, Daviglus ML, Lamar M. | 2024 | Introduction: Few studies have examined the associations of psychosocial factors with cognitive change in Hispanics/Latinos. Methods: Data from the Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging (HCHS/SOL INCA) and Sociocultural studies were used (n = 2,155; ages ≥45 years). Psychosocial exposures included intrapersonal (ethnic identity, optimism, purpose in life), interpersonal (family cohesion, familism, social networks, social support), and social factors (ethnic discrimination, loneliness, subjective social status). Survey-linear regression models examined associations between psychosocial exposures and 7-year cognitive change (global cognition [GC], verbal learning, memory, word fluency [WF], and digit symbol substitution [DSS]). Results: Familism predicted decline in GC, verbal learning, and memory; family cohesion predicted DSS decline; and loneliness predicted memory decline. Ethnic identity was protective against decline in GC and memory, optimism and social support were protective against decline in memory, and purpose in life was protective against WF decline. Discussion: Psychosocial factors are differentially related to cognitive changes. Culturally relevant factors should be explored in Hispanic/Latino cognitive aging research. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Mid-Life Factors | Cardiometabolic outcomes, Cognitive function, Cultural factors, Family, Hispanics/Latinos, Loneliness, Memory, Racial-ethnic disparities, Social cohesion, Social well-being | Link | Estrella, M. L., Tarraf, W., Kuwayama, S., Gallo, L. C., Wu, B., Marquine, M. J., ... & Lamar, M. (2024). Psychosocial factors associated with 7‐year change in cognition among middle‐aged and older Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos‐Investigation of Neurocognitive Aging (SOL‐INCA) and Sociocultural ancillary studies. Alzheimer's & Dementia, 20(2), 1137-1148. | Alzheimer's & Dementia |
| Psychosocial factors associated with 7-year change in cognition among middle-aged and older Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) and Sociocultural ancillary studies. | Estrella, Mayra L; Tarraf, Wassim; Kuwayama, Sayaka; Gallo, Linda C; Wu, Benson; Marquine, María J; Perreira, Krista M; Vasquez, Priscilla M; Isasi, Carmen R; Lipton, Richard B; Mattei, Josiemer; González, Hector M; Daviglus, Martha L; Lamar, Melissa | 2024 | Introduction: Few studies have examined the associations of psychosocial factors with cognitive change in Hispanics/Latinos.; Methods: Data from the Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging (HCHS/SOL INCA) and Sociocultural studies were used (n = 2,155; ages ≥45 years). Psychosocial exposures included intrapersonal (ethnic identity, optimism, purpose in life), interpersonal (family cohesion, familism, social networks, social support), and social factors (ethnic discrimination, loneliness, subjective social status). Survey-linear regression models examined associations between psychosocial exposures and 7-year cognitive change (global cognition [GC], verbal learning, memory, word fluency [WF], and digit symbol substitution [DSS]).; Results: Familism predicted decline in GC, verbal learning, and memory; family cohesion predicted DSS decline; and loneliness predicted memory decline. Ethnic identity was protective against decline in GC and memory, optimism and social support were protective against decline in memory, and purpose in life was protective against WF decline.; Discussion: Psychosocial factors are differentially related to cognitive changes. Culturally relevant factors should be explored in Hispanic/Latino cognitive aging research.; Highlights: Psychosocial factors are differentially related to cognitive changes in Latinos. Role of culturally relevant factors on cognition should be further explored. Familism predicted decline in global cognition, verbal learning, and memory. Ethnic identity predicted increase in global cognition and memory. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Mid-Life Factors | Cognitive function, Cultural factors, Family, Hispanics/Latinos, Loneliness, Memory, Racial-ethnic disparities, Structural inequality | Link | Estrella, M. L., Tarraf, W., Kuwayama, S., Gallo, L. C., Wu, B., Marquine, M. J., Perreira, K. M., Vasquez, P. M., Isasi, C. R., Lipton, R. B., Mattei, J., González, H. M., Daviglus, M. L., & Lamar, M. (2024). Psychosocial factors associated with 7-year change in cognition among middle-aged and older Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) and Sociocultural ancillary studies. Alzheimer's & dementia : the journal of the Alzheimer's Association, 20(2), 1137–1148. | Alzheimer's & Dementia |
| The role of Southern context in shaping life course exposures linked to dementia incidence for Black and White older adults in the United States | Farina MP, Crimmins EM, Hayward MD. | 2024 | While racial inequities in dementia risk are well-documented in the United States, research has paid less attention to role of US Southern context in shaping dementia risk through life course exposures. In this study, we examine how Southern birth and Southern residence in adulthood are linked to dementia incidence for Black and White older adults in the United States. Using the Health and Retirement Study (N = 15,613), we estimate a series of hazard models to evaluate how life course risk factors such as childhood health and social disadvantage, education, adult socioeconomic status, health behaviors, and cardiometabolic conditions impact the association between Southern life course residency and dementia risk. We find different patterns in how Southern life course context shapes dementia risk among Black and White adults, with dementia risk among Blacks especially sensitive to combinations of Southern life course context. These findings demonstrate the importance of considering potential heterogenous life course pathways to cognitive aging and health that may be shaped by larger socio-historical experiences. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Cardiometabolic outcomes, Childhood/Adolescence, Cognitive function, Educational attainment, Geographic disparities, Health behavior, Socioeconomic status, Structural inequality | Link | Farina, M. P., Crimmins, E. M., & Hayward, M. D. (2024). The role of Southern context in shaping life course exposures linked to dementia incidence for Black and White older adults in the United States. BMC geriatrics, 24(1), 927. | BMC Geriatrics |
| Heritage, Birthplace, Age at Migration, and Education as Life Course Mechanisms Influencing Cognitive Aging Among Latinos | Garcia, C; Garcia, MA; Sheftel, M; Adorno, DS | 2024 | Latinos are the fastest-growing segment of older adults in the United States and are at high risk for cognitive impairment (CI). Although research on factors that affect the prevention, diagnosis, and care of Latinos with CI has been increasing, less explored are reconstitutive aspects of Latinidad (i.e., the intersection of heritage, birthplace, and age at migration) that function as life course mechanisms influencing cognitive health across the life course. Therefore, this study investigates how intersectional Latinidades influence self-reported cognitive impairment (SRCI), a precursor to CI. Data from the 2015–2019 American Community Survey were used to examine SRCI among Latinos aged 45+ from the 10 largest U.S. Latino heritage population groups originating from the following places: Colombia, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Peru, and Puerto Rico. A set of nested binary logistic regression models, stratified by gender, were estimated to model SRCI as a function of Latino heritage, birthplace, age at migration, and educational attainment. Our findings indicate that when solely considering Latino heritage, Puerto Ricans had the highest probabilities of SRCI at all ages, followed by Dominicans, Cubans, and Mexicans. When birthplace or nativity status is combined with Latino heritage, some Latino heritage groups displayed an immigrant advantage, which further widened with age. Additional consideration of age at migration revealed that the immigrant advantage does not extend to Latino immigrants who arrived in the United States at ages 50 or older, particularly for Cuban, Dominican, and Puerto Rican women. Last, we find that higher educational attainment is associated with lower probabilities of SRCI for many Latino groups. As the Latino population ages, comprehensive, multidisciplinary, and multilevel efforts are needed across disciplines along with authentic community-based and participant engagement to develop actionable and culturally appropriate health policies aimed at ameliorating the burden of CI. | American Community Survey (ACS) | Early Life, Mid-Life Factors | Cognitive function, Cultural factors, Educational attainment, Hispanics/Latinos, Migration | Link | García, C., Garcia, M. A., Sheftel, M. G., & Adorno, D. L. S. (2024). Heritage, Birthplace, Age at Migration, and Education as Life Course Mechanisms Influencing Cognitive Aging Among Latinos. In Older Mexicans and Latinos in the United States: Where Worlds Meet (pp. 119-150). Cham: Springer International Publishing. | In book: Older Mexicans and Latinos in the United States |
| Glycemic Control, Cognitive Aging, and Impairment Among Diverse Hispanic/Latino Individuals: Study of Latinos- Investigation of Neurocognitive Aging (Hispanic Community Health Study/Study of Latinos) | González HM, Tarraf W, Stickel AM, Morlett A, González KA, Ramos AR, Rundek T, Gallo LC, Talavera GA, Daviglus ML, Lipton RB, Isasi C, Lamar M, Zeng D, DeCarli C. | 2024 | Objective: Hispanic/Latino individuals in the U.S. have the highest prevalence of undiagnosed and untreated diabetes and are at increased risk for cognitive impairment. In this study, we examine glycemic control in relation to cognitive aging and impairment in a large prospective cohort of middle-aged and older Hispanic/Latino individuals of diverse heritages. Research Design and Methods: Study of Latinos–Investigation of Neurocognitive Aging (SOL-INCA) is a Hispanic Community Health Study/Study of Latinos (HCHS/SOL) ancillary study. HCHS/SOL is a multisite (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA), probability sampled prospective cohort study. SOL-INCA enrolled 6,377 diverse Hispanic/Latino individuals aged 50 years and older (2016–2018). The primary outcomes were cognitive function, 7-year cognitive decline, and mild cognitive impairment (MCI). The primary glycemia exposure variables were measured from fasting blood samples collected at HCHS/SOL visit 1 (2008–2011). Results: Visit 1 mean age was 56.5 years ± 8.2 SD, and the average glycosylated hemoglobin A1C (HbA1c) was 6.12% (43.5 ± 14.6 mmol/mol). After covariate adjustment, higher HbA1c was associated with accelerated 7-year global (b = −0.045; 95% CI −0.070; −0.021; in z score units) and executive cognitive decline and a higher prevalence of MCI (odds ratio 1.20; 95% CI 1.11; 1.29). Conclusions: Elevated HbA1c levels were associated with 7-year executive cognitive decline and increased MCI risk among diverse middle-aged and older Hispanic/Latino individuals. Our findings indicate that poor glycemic control in midlife may pose significant risks for cognitive decline and MCI later in life among Hispanic/Latino individuals of diverse heritages. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cardiometabolic outcomes, Cognitive function | Link | González, H. M., Tarraf, W., Stickel, A. M., Morlett, A., González, K. A., Ramos, A. R., ... & DeCarli, C. (2024). Glycemic Control, Cognitive Aging, and Impairment Among Diverse Hispanic/Latino Individuals: Study of Latinos–Investigation of Neurocognitive Aging (Hispanic Community Health Study/Study of Latinos). Diabetes care, 47(7), 1152-1161. | Diabetes Care |
| Sleep duration and brain MRI measures: Results from the SOL-INCA MRI study. | González, Kevin A; Tarraf, Wassim; Stickel, Ariana M; Kaur, Sonya; Agudelo, Christian; Redline, Susan; Gallo, Linda C; Isasi, Carmen R; Cai, Jianwen; Daviglus, Martha L; Testai, Fernando D; DeCarli, Charles; González, Hector M; Ramos, Alberto R | 2024 | Introduction: Sleep duration has been associated with dementia and stroke. Few studies have evaluated sleep pattern-related outcomes of brain disease in diverse Hispanics/Latinos.; Methods: The SOL-INCA (Study of Latinos-Investigation of Neurocognitive Aging) magnetic resonance imaging (MRI) study recruited diverse Hispanics/Latinos (35-85 years) who underwent neuroimaging. The main exposure was self-reported sleep duration. Our main outcomes were total and regional brain volumes.; Results: The final analytic sample included n = 2334 participants. Increased sleep was associated with smaller brain volume (β total_brain = -0.05, p 9 hours was associated with smaller gray (β combined_gray = -0.17, p < 0.05) and occipital matter volumes (β occipital_gray = -0.18, p < 0.05).; Discussion: We found that longer sleep duration was associated with lower total brain and gray matter volume among diverse Hispanics/Latinos across sex and background. These results reinforce the importance of sleep on brain aging in this understudied population.; Highlights: Longer sleep was linked to smaller total brain and gray matter volumes. Longer sleep duration was linked to larger white matter hyperintensities (WMHs) and smaller hippocampal volume in an obstructive sleep apnea (OSA) risk group. These associations were consistent across sex and Hispanic/Latino heritage groups. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms, Mid-Life Factors | Alzheimer's disease, Health behavior, Neuroimaging | Link | González, K. A., Tarraf, W., Stickel, A. M., Kaur, S., Agudelo, C., Redline, S., Gallo, L. C., Isasi, C. R., Cai, J., Daviglus, M. L., Testai, F. D., DeCarli, C., González, H. M., & Ramos, A. R. (2024). Sleep duration and brain MRI measures: Results from the SOL-INCA MRI study. Alzheimer's & dementia : the journal of the Alzheimer's Association, 20(1), 641–651. | Alzheimer's & Dementia |
| Underestimating the Relationship: Unpacking Both Socioeconomic Resources and Cognitive Function and Decline in Midlife to Later Life | Herd, Pamela; Walsemann, Katrina M. | 2024 | Although there is robust evidence that socioeconomic position influences later-life cognitive function, two issues limit knowledge regarding the nature and magnitude of these relationships and potential policy interventions. First, most social science research tends to treat cognition as a unitary concept despite evidence that cognitive outcomes are not interchangeable. Second, most biomedical research focuses exclusively on education, with limited attention to economic resources despite robust social science theoretical and empirical rationales for their role. Relatedly, there has been limited attention to how these relationships may vary across cohorts, even as educational and economic contexts have changed. Using the Health and Retirement Study (N = 36,494), we show that failing to attend to different facets of cognition, socioeconomic resources, and cohort differences leads to underestimates in the magnitude of educational and economic disparities in cognitive function and decline. This has important implications for appropriate policy interventions to address these disparities. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Cognitive decline, Cognitive function, Socioeconomic status | Link | Herd, P., & Walsemann, K. M. (2024). Underestimating the Relationship: Unpacking Both Socioeconomic Resources and Cognitive Function and Decline in Midlife to Later Life. Journal of Health and Social Behavior. | Journal of Health and Social Behavior. |
| Associations of Everyday and Lifetime Experiences of Discrimination With Willingness to Undergo Alzheimer Disease Predictive Testing. | Hill-Jarrett, Tanisha G; Choi, Minhyuk; Buto, Peter T; Miramontes, Silvia; Thomas, Marilyn D; Yang, Yulin; Kim, Min Hee; Sims, Kendra D; Glymour, M Maria | 2024 | Background and Objectives: Rapid developments in Alzheimer disease (AD) biomarker research suggest that predictive testing may become widely available. To ensure equal access to AD predictive testing, it is important to understand factors that affect testing interest. Discrimination may influence attitudes toward AD testing, particularly among racially and ethnically minoritized populations, because of structural racism in health care systems. This study examined whether everyday or lifetime discrimination experiences shape interest in AD predictive testing.; Methods: In the 2010 and 2012 biennial Health and Retirement Study waves, respondents were randomly selected to complete questions on interest in receiving free testing that could determine whether they would develop AD in the future. The exposures were everyday discrimination (6 items) and lifetime discrimination (7 items); both were transformed into a binary variable. Logistic regression models predicting interest in AD testing were controlled for deciles of propensity scores for each discrimination measure. Odds ratios were re-expressed as risk differences (RDs).; Results: Our analytic sample included 1,499 respondents. The mean age was 67 (SD = 10.2) years, 57.4% were women, 65.7% were White, and 80% endorsed interest in AD predictive testing. Most of the participants (54.7%) experienced everyday discrimination in at least one domain; 24.1% experienced major lifetime discrimination in at least one domain. Those interested in predictive testing were younger (66 vs 70 years) and more likely to be Black (20% vs 15%) or Latinx (14% vs 8%) than participants uninterested in testing. The probability of wanting an AD test was not associated with discrimination for Black (RD everyday discrimination = -0.026; 95% CI [-0.081 to 0.029]; RD lifetime discrimination = -0.012; 95% CI [-0.085 to 0.063]) or Latinx (RD everyday discrimination = -0.023, 95% CI [-0.082 to 0.039]; RD lifetime discrimination = -0.011; 95% CI [-0.087 to 0.064]) participants.; Discussion: Despite historical and contemporary experiences of discrimination, Black and Latinx individuals express interest in AD testing. However, Black and Latinx individuals remain underrepresented in AD research, including research on AD testing. Interest in personalized information about dementia risk may be a pathway to enhance their inclusion in research and clinical trials. | Health and Retirement Study (HRS) | Mid-Life Factors | Alzheimer's disease, Biomarkers, Cognitive function, Dementia, Gender/Sex, Healthcare, Racial-ethnic disparities, Structural inequality | Link | Hill-Jarrett, T. G., Choi, M., Buto, P. T., Miramontes, S., Thomas, M. D., Yang, Y., ... & Glymour, M. M. (2024). Associations of Everyday and Lifetime Experiences of Discrimination With Willingness to Undergo Alzheimer Disease Predictive Testing. Neurology, 102(4), e208005. | Neurology |
| Foreclosure, memory decline, and dementia probability: A longitudinal cohort study | Kim MH, Schwartz GL. | 2024 | Introduction: Housing insecurity is rising among older adults; health researchers know little about how this may impact their cognitive health. We investigated links between foreclosure and older adults’ memory and probability of dementia. Methods: Using the Health and Retirement Study (2008 to 2018), we fit mixed models comparing the memory and dementia probability scores of 249 older adults who experienced foreclosure (treated) with 15,645 who did not. Baseline covariates included sociodemographics and health. Models were stratified by age group. Results: Foreclosure was associated with faster memory decline among middle-aged (50 to 64) older adults (−0.007 standard deviations/year, 95% confidence interval: −0.13, −0.001). Compared to average memory decline among middle-aged older adults who were stably housed, foreclosure equated to 3.7 additional years of aging over 10 years. Among those 65+, differences between those who were and were not foreclosed upon were short-lived and less clear, potentially driven by depletion-of-susceptibles bias. Discussion: Foreclosure may endanger older adults’ memory. | Health and Retirement Study (HRS) | Mid-Life Factors | Dementia, Memory, Socioeconomic status, Structural inequality | Link | Kim, M. H., & Schwartz, G. L. (2024). Foreclosure, memory decline, and dementia probability: A longitudinal cohort study. Alzheimer's & dementia, 20(9), 6517-6526. | Alzheimer's & Dementia |
| Life-Course Multidisciplinary Psychosocial Predictors of Dementia Among Older Adults: Results From the Health and Retirement Study | Kuwayama S, Tarraf W, González KA, Márquez F, González HM. | 2024 | Background and Objectives: Identifying predictors of dementia may help improve risk assessments, increase awareness for risk reduction, and identify potential targets for interventions. We use a life-course psychosocial multidisciplinary modeling framework to examine leading predictors of dementia incidence. Research Design and Methods: We use data from the Health and Retirement Study to measure 57 psychosocial factors across 7 different domains: (i) demographics, (ii) childhood experiences, (iii) socioeconomic conditions, (iv) health behaviors, (v) social connections, (vi) psychological characteristics, and (vii) adverse adulthood experiences. Our outcome is dementia incidence (over 8 years) operationalized using Langa–Weir classification for adults aged 65+ years who meet criteria for normal cognition at the baseline when all psychosocial factors are measured (N = 1 784 in training set and N = 1 611 in testing set). We compare the standard statistical method (Logistic regression) with machine learning (ML) method (Random Forest) in identifying predictors across the disciplines of interest. Results: Standard and ML methods identified predictors that spanned multiple disciplines. The standard statistical methods identified lower education and childhood financial duress as among the leading predictors of dementia incidence. The ML method differed in their identification of predictors. Discussion and Implications: The findings emphasize the importance of upstream risk and protective factors and the long-reaching impact of childhood experiences on cognitive health. The ML approach highlights the importance of life-course multidisciplinary frameworks for improving evidence-based interventions for dementia. Further investigations are needed to identify how complex interactions of life-course factors can be addressed through interventions. | Health and Retirement Study (HRS) | Mid-Life Factors | Childhood/Adolescence, Educational attainment, Gender/Sex, Health behavior, Mental health, Retirement, Social well-being, Socioeconomic status, Trauma | Link | Kuwayama, S., Tarraf, W., González, K. A., Márquez, F., & González, H. M. (2024). Life-Course Multidisciplinary Psychosocial Predictors of Dementia Among Older Adults: Results From the Health and Retirement Study. Innovation in Aging, 8(11), igae092. | Innovation in Aging |
| Loneliness, cerebrovascular and Alzheimer's disease pathology, and cognition | Lao P, Young CB, Ezeh C, Lacayo B, Seblova D, Andrews RM, Gibbons L, Kraal AZ, Turney I, Deters KD, Dotson V, Manly JJ, Barnes LL, Zahodne LB. | 2024 | Introduction: Loneliness has a rising public health impact, but research involving neuropathology and representative cohorts has been limited. Methods: Inverse odds of selection weights were generalized from the autopsy sample of Rush Alzheimer's Disease Center cohorts (N = 680; 89 ± 9 years old; 25% dementia) to the US-representative Health and Retirement Study (N = 8469; 76 ± 7 years old; 5% dementia) to extend external validity. Regressions tested cross-sectional associations between loneliness and (1) Alzheimer's disease (AD) and cerebrovascular pathology; (2) five cognitive domains; and (3) relationships between pathology and cognition, adjusting for depression. Results: In weighted models, greater loneliness was associated with microinfarcts, lower episodic and working memory in the absence of AD pathology, lower working memory in the absence of infarcts, a stronger association of infarcts with lower episodic memory, and a stronger association of microinfarcts with lower working and semantic memory. Discussion: Loneliness may relate to AD through multiple pathways involving cerebrovascular pathology and cognitive reserve. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Cognitive function, Dementia, Loneliness, Memory, Neuroimaging, Social well-being | Link | Lao, P., Young, C. B., Ezeh, C., Lacayo, B., Seblova, D., Andrews, R. M., ... & Zahodne, L. B. (2024). Loneliness, cerebrovascular and Alzheimer's disease pathology, and cognition. Alzheimer's & Dementia, 20(10), 7113-7123. | Alzheimer's & Dementia |
| Hypertension, Cognitive Decline, and Mild Cognitive Impairment Among Diverse Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging Results (SOL-INCA). | Márquez, Freddie; Tarraf, Wassim; Stickel, Ariana M; González, Kevin A; Testai, Fernando D; Cai, Jianwen; Gallo, Linda C; Talavera, Gregory A; Daviglus, Martha L; Wassertheil-Smoller, Sylvia; DeCarli, Charles; Schneiderman, Neil; González, Hector M | 2024 | Background: Hypertension can have deleterious effects on cognitive function; however, few studies have examined its effects on cognition among Hispanics/Latinos.; Objective: To assess associations between hypertension status with 1) change in cognitive performance, and 2) having mild cognitive impairment (MCI) among diverse Hispanics/Latinos.; Methods: This population-based, prospective cohort, multisite study included Hispanic/Latino adults aged 45 to 72 years in enrolled in the Hispanic Community Health Study/Study of Latinos at Visit 1 (2008-2011; mean age of 63.40±8.24 years), and the Study of Latinos-Investigation of Neurocognitive Aging at Visit 2 (2016-2018), with a mean follow-up duration of 7 years (n = 6,173). Hypertension status was assessed at both visits: normotension (no hypertension), incident hypertension (only at Visit 2), and persistent hypertension (at both visits). We examined change in cognitive performance and having MCI (only assessed at Visit 2) relative to hypertension status and adjusted for demographics and cardiovascular disease risk factors.; Results: Compared to normotension, persistent hypertension was associated with significantly increased decline in verbal fluency (β= -0.08; CI = [-0.16;-0.01]; p < 0.05), and processing speed (β= -0.11; CI = [-0.20;-0.02]; p < 0.05). Incident hypertension was not associated with significant change in cognitive performance. Both incident (OR = 1.70; CI = [1.16;2.50]; p < 0.01) and persistent hypertension (OR = 2.13; CI = [1.57;2.88]; p < 0.001) were associated with significantly higher odds ratios of having MCI.; Conclusions: These findings indicate that persistent hypertension is associated with clinical impairment and domain-specific cognitive decline in middle-aged and older Hispanics/Latinos. It underscores the importance of monitoring blood pressure in routine healthcare visits beginning at midlife in this population to reduce the burden of cognitive decline. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms, Mid-Life Factors | Alzheimer's disease, Cardiometabolic health, Cognitive function, Dementia, Hispanics/Latinos | Link | Márquez, F., Tarraf, W., Stickel, A. M., González, K. A., Testai, F. D., Cai, J., Gallo, L. C., Talavera, G. A., Daviglus, M. L., Wassertheil-Smoller, S., DeCarli, C., Schneiderman, N., & González, H. M. (2024). Hypertension, Cognitive Decline, and Mild Cognitive Impairment Among Diverse Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging Results (SOL-INCA). Journal of Alzheimer's disease : JAD, 97(3), 1449–1461. | Journal of Alzheimer's Disease |
| Social Support From Family and Friends, Educational Attainment, and Cognitive Function | Moorman SM, Pai M. | 2024 | This study assessed the extent to which associations between perceived and received social support from family and friends and changes in older adults’ cognitive function were moderated by educational attainment. Sibling pairs in the Wisconsin Longitudinal Study (WLS) (N = 4,297) completed a survey about social support in 2011 and a cognitive battery in 2011 and 2020. Participants’ mean age in 2020 was 80.2 years old. Multilevel linear regressions indicated that perceived, but not received, support from friends was associated with better cognitive function 9 years later. Perceived family support was cognitively advantageous for older adults at most levels of educational attainment. However, among postgraduates, perceived family support was unrelated to cognitive function. That the association between perceived support and cognitive function differs based on educational attainment gives interventionists additional information needed to identify groups of older adults most susceptible to cognitive impairment. | Wisconsin Longitudinal Study (WLS) | Mid-Life Factors | Cognitive function, Educational attainment, Family, Social well-being | Link | Moorman, S. M., & Pai, M. (2024). Social support from family and friends, educational attainment, and cognitive function. Journal of Applied Gerontology, 43(4), 396-401. | Journal of Applied Gerontology |
| High School Curricular Rigor and Cognitive Function among White Older Adults | Moorman, Sara M; Kong, Jooyoung | 2024 | Most research on the strong relationship between education and cognitive aging has focused on years of schooling. Using data from the Wisconsin Longitudinal Study-a sample of White persons born in 1939-we explored whether greater curricular rigor in high school was also associated with better cognitive function in later life. We estimated multilevel structural equation models in data from 2,749 participants who attended 308 Wisconsin high schools, graduating in 1957. Independent of academic ability and performance and school-level financial and material resources, a more rigorous high school curriculum was associated with significantly better global cognitive functioning in 2020, when most participants were 81 years old. There was also a significant mediation via eventual degree attainment. The mediation was moderated such that men and participants from high socioeconomic status families benefited most from a rigorous curriculum. We discuss implications for modern educational policy. | Wisconsin Longitudinal Study (WLS) | Early Life | Childhood/Adolescence, Cognitive function, Educational attainment, School quality, Socioeconomic status | Link | Moorman, S. M., & Kong, J. (2024). High school curricular rigor and cognitive function among White older adults. Journal of Health and Social Behavior, 00221465241283745. | Journal of Health and Social Behavior |
| Interpersonal, Community, and Societal Stressors Mediate Black-White Memory Disparities | Morris EP, Palms JD, Scambray K, Lee JH, Sol K, Jones LM, Smith J, Kobayashi LC, Zahodne LB. | 2024 | Objectives: Structural racism creates contextual stressors that disproportionately affect Black, relative to White, older adults in the United States and may contribute to worse cognitive health. We examined the extent to which interpersonal, community, and societal stressors uniquely explain Black–White disparities in initial memory and memory change. Methods: The sample included 14,199 non-Latino Black and White older adults (Mage = 68.32, 19.8% Black) from the U.S. Health and Retirement Study who completed psychosocial questionnaires at baseline and a word list memory task every 2 years over an 8-year period. Interpersonal, community, and societal stressors were operationalized as self-reported everyday discrimination, neighborhood physical disorder, and subjective societal status, respectively. Latent growth curves modeled longitudinal memory performance. Stressors were modeled simultaneously and allowed to correlate. Covariates included age, sex, education, wealth, parental education, and Southern residence. Results: Compared to White participants, Black participants experienced more discrimination (β = −0.004, standard error [SE] = 0.001, p < .001), more neighborhood physical disorder (β = −0.009, SE = 0.002, p < .001), and lower perceived societal status (β = −0.002, SE = 0.001, p = .001), each of which uniquely mediated the racial disparity in initial memory. Sensitivity analyses utilizing proxy-imputed memory scores revealed an additional racial disparity in memory change, wherein Black participants evidenced a faster decline than White participants. This disparity in memory change was only uniquely mediated by more everyday discrimination among Black participants. Discussion: Elements of structural racism may contribute to cognitive disparities via disproportionate stress experiences at multiple contextual levels among Black older adults. Future research should consider multilevel protective factors that buffer against negative impacts of racism on health. | Health and Retirement Study (HRS) | Mid-Life Factors | Geographic disparities, Memory, Neighborhoods, Racial-ethnic disparities, Socioeconomic status, Structural inequality, Stress | Link | Morris, E. P., Palms, J. D., Scambray, K., Lee, J. H., Sol, K., Jones, L. M., ... & Zahodne, L. B. (2024). Interpersonal, community, and societal stressors mediate Black–White memory disparities. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 79(11), gbae163. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Persistent organic pollutants and cognitive decline among middle-aged or older adults in the Hispanic Community Health Study/Study of Latinos | Parada H Jr, Hyde ET, Turyk ME, Persky V, López-Gálvez N, Gallo LC, Talavera GA, Sjodin A, González HM. | 2024 | Persistent organic pollutants may negatively impact cognition; however, associations between persistent organic pollutants and changes in cognition among United States Hispanic/Latino adults have not been investigated. Herein, we examined the associations between 33 persistent organic pollutants and cognitive changes among 1837 Hispanic/Latino adults. At baseline (2008–2011; Visit 1), participants provided biospecimens in which we measured levels of 5 persistent pesticides or pesticide metabolites, 4 polybrominated diphenyl ethers and 2,2’,4,4’,5,5’-hexabromobiphenyl, and 24 polychlorinated biphenyls. At Visit 1 and again at Visit 2 (2015–2018), a battery of neurocognitive tests was administered which included the Brief-Spanish English Verbal Learning Test, Word Fluency Test, and Digit Symbol Substitution Test. To estimate the adjusted associations between changes in cognition and each POP, we used linear regression for survey data. Each doubling in plasma levels of polychlorinated biphenyls 146, 178, 194, 199/206, and 209 was associated with steeper declines in global cognition (βs range:-0.053 to −0.061) with stronger associations for the Brief-Spanish English Verbal Learning Test. Persistent organic pollutants, in particular polychlorinated biphenyls, were associated with declines in cognition over 7 years and may be a concern for Hispanic/Latino adults. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cardiometabolic health, Cognitive function, Environmental exposure, Hispanics/Latinos | Link | Parada Jr, H., Hyde, E. T., Turyk, M. E., Persky, V., López-Gálvez, N., Gallo, L. C., ... & Gonzalez, H. M. (2024). Persistent organic pollutants and cognitive decline among middle-aged or older adults in the Hispanic Community Health Study/Study of Latinos. Ecotoxicology and environmental safety, 282, 116697. | Ecotoxicology and Environmental Safety |
| Sleep-wake behaviors associated with cognitive performance in middle-aged participants of the Hispanic Community Health Study/Study of Latinos | Smagula SF, Zhang G, Krafty RT, Ramos A, Sotres-Alvarez D, Rodakowski J, Gallo LC, Lamar M, Gujral S, Fischer D, Tarraf W, Mossavar-Rahmani Y, Redline S, Stone KL, Gonzalez HM, Patel SR. | 2024 | Objectives: Many sleep-wake behaviors have been associated with cognition. We examined a panel of sleep-wake/activity characteristics to determine which are most robustly related to having low cognitive performance in midlife. Secondarily, we evaluate the predictive utility of sleep-wake measures to screen for low cognitive performance. Methods: The outcome was low cognitive performance defined as being >1 standard deviation below average age/sex/education internally normalized composite cognitive performance levels assessed in the Hispanic Community Health Study/Study of Latinos. Analyses included 1006 individuals who had sufficient sleep-wake measurements about 2 years later (mean age = 54.9, standard deviation = 5.1; 68.82% female). We evaluated associations of 31 sleep-wake variables with low cognitive performance using separate logistic regressions. Results: In individual models, the strongest sleep-wake correlates of low cognitive performance were measures of weaker and unstable 24-hour rhythms; greater 24-hour fragmentation; longer time-in-bed; and lower rhythm amplitude. One standard deviation worse on these sleep-wake factors was associated with ∼20%-30% greater odds of having low cognitive performance. In an internally cross-validated prediction model, the independent correlates of low cognitive performance were: lower Sleep Regularity Index scores; lower pseudo-F statistics (modellability of 24-hour rhythms); lower activity rhythm amplitude; and greater time in bed. Area under the curve was low/moderate (64%) indicating poor predictive utility. Conclusion: The strongest sleep-wake behavioral correlates of low cognitive performance were measures of longer time-in-bed and irregular/weak rhythms. These sleep-wake assessments were not useful to identify previous low cognitive performance. Given their potential modifiability, experimental trials could test if targeting midlife time-in-bed and/or irregular rhythms influences cognition. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Cognitive function, Health behavior, Hispanics/Latinos | Link | Smagula, S. F., Zhang, G., Krafty, R. T., Ramos, A., Sotres-Alvarez, D., Rodakowski, J., ... & Patel, S. R. (2024). Sleep-wake behaviors associated with cognitive performance in middle-aged participants of the Hispanic Community Health Study/Study of Latinos. Sleep health, 10(4), 500-507. | Sleep Health |
| Cardiovascular disease risk exacerbates brain aging among Hispanic/Latino adults in the SOL-INCA-MRI Study | Stickel AM, Tarraf W, Gonzalez KA, Paredes AM, Zeng D, Cai J, Isasi CR, Kaplan R, Lipton RB, Daviglus ML, Testai FD, Lamar M, Gallo LC, Talavera GA, Gellman MD, Ramos AR, Ivanovic V, Seiler S, González HM, DeCarli C. | 2024 | Background: Cardiovascular disease (CVD) risk factors are highly prevalent among Hispanic/Latino adults, while the prevalence of MRI infarcts is not well-documented. We, therefore, sought to examine the relationships between CVD risk factors and infarcts with brain structure among Hispanic/Latino individuals. Methods: Participants included 1,886 Hispanic/Latino adults (50–85 years) who underwent magnetic resonance imaging (MRI) as part of the Study of Latinos—Investigation of Neurocognitive Aging-MRI (SOL-INCA-MRI) study. CVD risk was measured approximately 10.5 years before MRI using the Framingham cardiovascular risk score, a measure of 10-year CVD risk (low (<10%), medium (10- < 20%), and high (≥20%)). MR infarcts were determined as present or absent. Outcomes included total brain, cerebral and lobar cortical gray matter, hippocampal, lateral ventricle, and total white matter hyperintensity (WMH) volumes. Linear regression models tested associations between CVD risk and infarct with MRI outcomes and for modifications by age and sex. Results: Sixty percent of participants were at medium or high CVD risk. Medium and high CVD risk were associated with lower total brain and frontal gray matter and higher WMH volumes compared to those with low CVD risk. High CVD risk was additionally associated with lower total cortical gray matter and parietal volumes and larger lateral ventricle volumes. Men tended to have greater CVDRF-related differences in total brain volumes than women. The association of CVD risk factors on total brain volumes increased with age, equal to an approximate 7-year increase in total brain aging among the high-CVD-risk group compared to the low-risk group. The presence of infarct(s) was associated with lower total brain volumes, which was equal to an approximate 5-year increase in brain aging compared to individuals without infarcts. Infarcts were also associated with smaller total cortical gray matter, frontal and parietal volumes, and larger lateral ventricle and WMH volumes. Conclusion: The high prevalence of CVD risk among Hispanic/Latino adults may be associated with accelerated brain aging. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Biomarkers, Cardiometabolic outcomes, Hispanics/Latinos, Neuroimaging | Link | Stickel, A. M., Tarraf, W., Gonzalez, K. A., Paredes, A. M., Zeng, D., Cai, J., ... & DeCarli, C. (2024). Cardiovascular disease risk exacerbates brain aging among Hispanic/Latino adults in the SOL-INCA-MRI Study. Frontiers in aging neuroscience, 16, 1390200. | Frontiers in Aging Neuroscience |
| Connections between reproductive health and cognitive aging among women enrolled in the HCHS/SOL and SOL-INCA | Stickel AM, Tarraf W, Kuwayama S, Wu B, Sundermann EE, Gallo LC, Lamar M, Daviglus M, Zeng D, Thyagarajan B, Isasi CR, Lipton RB, Cordero C, Perreira KM, Gonzalez HM, Banks SJ. | 2024 | Introduction: Reproductive health history may contribute to cognitive aging and risk for Alzheimer's disease, but this is understudied among Hispanic/Latina women. Methods: Participants included 2126 Hispanic/Latina postmenopausal women (44 to 75 years) from the Study of Latinos-Investigation of Neurocognitive Aging. Survey linear regressions separately modeled the associations between reproductive health measures (age at menarche, history of oral contraceptive use, number of pregnancies, number of live births, age at menopause, female hormone use at Visit 1, and reproductive span) with cognitive outcomes at Visit 2 (performance, 7-year change, and mild cognitive impairment [MCI] prevalence). Results: Younger age at menarche, oral contraceptive use, lower pregnancies, lower live births, and older age at menopause were associated with better cognitive performance. Older age at menarche was protective against cognitive change. Hormone use was linked to lower MCI prevalence. Discussion: Several aspects of reproductive health appear to impact cognitive aging among Hispanic/Latina women. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Cognitive function, Hispanics/Latinos, Reproductive health | Link | Stickel, A. M., Tarraf, W., Kuwayama, S., Wu, B., Sundermann, E. E., Gallo, L. C., ... & Banks, S. J. (2024). Connections between reproductive health and cognitive aging among women enrolled in the HCHS/SOL and SOL‐INCA. Alzheimer's & Dementia, 20(3), 1944-1957. | Alzheimer's & Dementia |
| DNA Methylation at C-Reactive Protein-Associated CpG Sites May Mediate the Pathway Between Educational Attainment and Cognition | Stoldt M, Ammous F, Lin L, Ratliff SM, Ware EB, Faul JD, Zhao W, Kardia SLR, Smith JA. | 2024 | Growing evidence has linked inflammatory processes to cognitive decline and dementia. This work examines whether an epigenetic marker of C-reactive protein (CRP), a common clinical inflammatory biomarker, may mediate the relationship between educational attainment and cognition. We first evaluated whether 53 previously reported CRP-associated DNA methylation sites (CpGs) are associated with CRP, both individually and aggregated into a methylation risk score (MRSCRP), in 3 298 participants from the Health and Retirement Study (HRS, mean age = 69.7 years). Forty-nine CpGs (92%) were associated with the natural logarithm of CRP in HRS after adjusting for age, sex, smoking, BMI, genetic ancestry, and white blood cell counts (p < .05), and each standard deviation increase in MRSCRP was associated with a 0.38 unit increase in lnCRP (p = 4.02E-99). In cross-sectional analysis, for each standard deviation increase in MRSCRP, total memory score and total cognitive score decreased, on average, by 0.28 words and 0.43 items, respectively (p < .001). Further, MRSCRP mediated 6.9% of the relationship between high school education and total memory score in a model adjusting for age, sex, and genetic ancestry (p < .05); this was attenuated to 2.4% with additional adjustment for marital status, APOE ε4 status, health behaviors, and comorbidities (p < .05). Thus, CRP-associated methylation may partially mediate the relationship between education and cognition at older ages. Further research is warranted to determine whether DNA methylation at these sites may improve current prediction models for cognitive impairment in older adults. | Health and Retirement Study (HRS) | Biological Mechanisms | APOE, Biomarkers, Educational attainment, Genetics, Inflammation, Memory | Link | Stoldt, M., Ammous, F., Lin, L., Ratliff, S. M., Ware, E. B., Faul, J. D., ... & Smith, J. A. (2024). DNA methylation at C-reactive protein-associated CpG sites may mediate the pathway between educational attainment and cognition. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 79(8), glae159. | The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences |
| Early-Life Parental Affection, Social Relationships in Adulthood, and Later-Life Cognitive Function | Thomas PA, Teas E, Friedman E, Barnes LL, Sauerteig-Rolston MR, Ferraro KF. | 2024 | Objective: Although research has demonstrated the long-term health consequences of childhood adversities, less is known about the long-term impact of positive childhood experiences, such as parental affection. Method: Using longitudinal data (1995–2014) from the Midlife in the United States (MIDUS) study, we analyze structural equation models estimating direct and indirect pathways from early-life parental affection to changes in later-life cognitive function through relationship quality in adulthood among Black and White older adults (N = 1983). Results: Analyses revealed significant indirect effects of parental affection on better cognitive function through higher levels of social support (both average social support and family social support) in adulthood in the full sample and among Black respondents. Indirect pathways through relationship strain and through friend support were not significant. Discussion: This work elevates the importance of promoting positive parental relationships during childhood, with implications for better social relationships in adulthood and cognitive function in later life. | Midlife in the U.S. (MIDUS) | Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Family, Racial-ethnic disparities, Social well-being | Link | Thomas, P. A., Teas, E., Friedman, E., Barnes, L. L., Sauerteig-Rolston, M. R., & Ferraro, K. F. (2024). Early-life parental affection, social relationships in adulthood, and later-life cognitive function. Journal of Aging and Health, 08982643241303589. | Journal of Aging and Health |
| Childbearing Histories and Midlife Cognition: Accounting for Early Life Factors | Thomeer, Mieke Beth; Wolfe, Joseph D; Ferguson, Dee; Reczek, Rin; Cao, Rui | 2024 | Objectives: Childbearing histories—for example, parity and age at first birth—matter for the health outcomes of mid- and later-life women. There is growing evidence that childbearing may shape cognitive outcomes. However, previous research is not definitive due to its inability to account for selection. Selection is critical to address given that multiple factors, including socioeconomic background and cognition in adolescence, place women at risk for both specific childbearing experiences and poor cognitive functioning. Methods: We analyze the 1979 National Longitudinal Survey of Youth (NLSY79) (N=3,668), a longitudinal nationally representative dataset from the US that began collecting data during respondents’ late teens and early 20s. We estimate the average treatment effects (ATEs) of childbearing histories on midlife memory and cognition using propensity-score matching techniques that incorporate an expansive set of early-life factors. Results: In models adjusting for early life covariates, we find that any births, high parity, and early first birth are associated with worse self-reported memory, but not cognitive functioning scores. After addressing the influence of early life factors through matching techniques, the only robust differences relate to any births and early first births with self-reported memory. Discussion: Selection into specific childbearing experiences partially drives the link between childbearing and cognition at mid-life, with cascading implications into later life. We suggest incorporating childbearing and early life factors into models to identify social determinants of memory and cognitive functioning. | 1979 National Longitudinal Survey of Youth (NLSY79) | Biological Mechanisms, Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Memory, Reproductive health | Link | Thomeer, M.B., Wolfe, J.D., Ferguson, Dee, Reczek, R., & Cao, R. Childbearing Histories and Midlife Cognition: Accounting for Early Life Factors, The Journals of Gerontology: Series B, 2024 | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| State-Level Education Quality and Trajectories of Cognitive Function by Race and Educational Attainment | Walsemann, Katrina M.; Jackson, Heide; Abbruzzi, Emily; Ailshire, Jennifer A. | 2024 | Context: Although educational attainment is consistently associated with better cognitive function among older adults, we know little about how education quality is related to cognitive function. This is a key gap in the literature given that the quality of US education improved considerably during the early to mid-20th century as state and federal investment increased. We posit that growing up in states with higher-quality education systems may protect against poor cognitive function, particularly among Black adults and adults who completed fewer years of school. Methods:We used prospective data on cognitive function from the Health and Retirement Study linked to historical data on state investment in public schools, restricting our sample to non-Hispanic White and Black adults born between 1914 and 1959 (19,096 White adults and 4,625 Black adults). Using race-stratified linear mixed models, we considered if state-level education quality was associated with level and decline in cognitive function and if these patterns differed by years of schooling and race.Findings: Residing in states with higher-resourced education systems during childhood was associated with better cognitive function, particularly among those who completed less than 12 years of schooling, regardless of race. For White adults, higher-resourced state education systems were associated with higher scores of total cognitive function and episodic memory, but there were diminishing returns as resources increased to very high levels. For Black adults, the relationship between state education resources and cognitive function varied by age with positive associations in midlife and generally null or negative associations at the oldest ages. Conclusions: Federal and state investment in public schools may provide students with opportunities to develop important cognitive resources during schooling that translate into better cognitive function in later life, especially among marginalized populations. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Educational attainment, Memory, Race, School quality | Link | Walsemann, K. M., Jackson, H., Abbruzzi, E., & Ailshire, J. A. (2024). State‐Level Education Quality and Trajectories of Cognitive Function by Race and Educational Attainment. The Milbank Quarterly. | The Milbank Quarterly. |
| Cognition and Wealth Changes in Mid-to-later Life: A Latent Class Trajectories Approach Using the Health and Retirement Study | Westrick AC, Esiaka DK, Meier HCS, Rooks RN, Manning M, Tarraf W. | 2024 | To assess how cognitive trajectories from mid-to-later life relate to wealth change, overall and by mid-life income. Methods: Data were from participants (51–64 years) in the 2000–2018 U.S. Health and Retirement Study who were cognitively healthy at baseline (year 2000; unweighted n = 3821). Longitudinal latent class analyses generated cognitive and wealth trajectories, independently, and multinomial logistic regressions estimated the association between cognitive trajectories and wealth profiles, overall and by median income. Results: We identified three cognitive: cognitively healthy (CH), increasing cognitive impairment (ICI), and increasing dementia (ID) and four wealth profiles: stable wealth loss (SWL), delayed gradual wealth loss (DGWL), stable wealth gain (SWG), and gradual wealth gain (GWG). The ID group had higher probability of being in the SWL group and lower probability of SWG, which was more pronounced in respondents with greater median income. Discussion: Individuals with ID may be vulnerable to wealth loss, particularly for middle-class households. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Socioeconomic status | Link | Westrick, A. C., Esiaka, D. K., Meier, H. C., Rooks, R. N., Manning, M., & Tarraf, W. (2024). Cognition and wealth changes in mid-to-later life: A latent class trajectories approach using the health and retirement study. Journal of aging and health, 36(9), 510-522. | Journal of Aging and Health |
| Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India. | Westrick, Ashly C; Avila-Rieger, Justina; Gross, Alden L; Hohman, Timothy; Vonk, Jet M J; Zahodne, Laura B; Kobayashi, Lindsay C | 2024 | Introduction: We compared gender disparities in later-life memory, overall and by education, in India and the United States (US).; Methods: Data (N = 7443) were from harmonized cognitive assessment protocols (HCAPs) in the Longitudinal Aging Study of India-Diagnostic Assessment of Dementia (LASI-DAD; N = 4096; 2017-19) and US Health and Retirement Study HCAP (HRS-HCAP; N = 3347; 2016-17). We derived harmonized memory factors from each study using confirmatory factor analysis. We used multivariable-adjusted linear regression to compare gender disparities in memory function between countries, overall and by education.; Results: In the United States, older women had better memory than older men (0.28 SD-unit difference; 95% CI: 0.22, 0.35). In India, older women had worse memory than older men (-0.15 SD-unit difference; 95% CI: -0.20, -0.10), which attenuated with increasing education and literacy.; Conclusion: We observed gender disparities in memory in India that were not present in the United States, and which dissipated with education and literacy. | Health and Retirement Study (HRS) | Mid-Life Factors | Cross-national comparison, Educational attainment, Gender/Sex, Memory | Link | Westrick, A. C., Avila-Rieger, J., Gross, A. L., Hohman, T., Vonk, J. M. J., Zahodne, L. B., & Kobayashi, L. C. (2024). Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India. Alzheimer's & dementia : the journal of the Alzheimer's Association, 20(1), 16–24. | Alzheimer's & Dementia |
| Midlife and late-life environmental exposures on dementia risk in the Wisconsin Longitudinal Study: The modifying effects of ApoE | Williams VJ, Trane R, Sicinski K, Herd P, Engelman M, Asthana S. | 2024 | Introduction: Late-life air pollution exposure is associated with an increased risk for dementia, with this effect exacerbated among apolipoprotein E-4 (ApoE-4) carriers. However, whether midlife occupational exposures likewise influence dementia outcomes, and varies as a function of ApoE-4 status is unknown. Methods: Using data from 3814 participants in the Wisconsin Longitudinal Study (WLS), we employed weighted logistic regression to evaluate associations between midlife occupational respiratory exposures and late-life air pollution on all-cause dementia risk, stratified by ApoE-4 status. Results: Midlife occupational exposure was associated with increased odds of all-cause dementia preferentially among ApoE-4 noncarriers (odds ratio [OR] = 1.59, p = 0.01), whereas higher late-life urban air pollution exposure was associated with increased dementia risk among ApoE-4 carriers (OR = 1.258, p = 0.029). Discussion: Associations between environmental exposures and dementia risk vary based on the timing of exposure and ApoE-4 status. While late-life environmental exposures are associated with dementia among ApoE-4 carriers, for noncarriers midlife environmental exposure confers the greatest risk. | Wisconsin Longitudinal Study (WLS) | Biological Mechanisms | APOE, Cognitive function, Dementia, Environmental exposure, Occupation | Link | Williams, V. J., Trane, R., Sicinski, K., Herd, P., Engelman, M., & Asthana, S. (2024). Midlife and late‐life environmental exposures on dementia risk in the Wisconsin Longitudinal Study: The modifying effects of ApoE. Alzheimer's & Dementia, 20(12), 8263-8278. | Alzheimer's & Dementia |
| Anemia, hemoglobin concentration and cognitive function in the Longitudinal Ageing Study in India-Harmonized Diagnostic Assessment of Dementia (LASI-DAD) and the Health and Retirement Study. | Winchester, Laura M; Newby, Danielle; Ghose, Upamanyu; Hu, Peifeng; Green, Hunter; Chien, Sandy; Ranson, Janice; Faul, Jessica; Llewellyn, David; Lee, Jinkook; Bauermeister, Sarah; Nevado-Holgado, Alejo | 2024 | Background: In India, anemia is widely researched in children and women of reproductive age, however, studies in older populations are lacking. Given the adverse effect of anemia on cognitive function and dementia this older population group warrants further study. The Longitudinal Ageing Study in India - Harmonized Diagnostic Assessment of Dementia (LASI-DAD) dataset contains detailed measures to allow a better understanding of anaemia as a potential risk factor for dementia.; Method: 2,758 respondents from the LASI-DAD cohort, aged 60 or older, had a complete blood count measured from venous blood as well as cognitive function tests including episodic memory, executive function and verbal fluency. Linear regression was used to test the associations between blood measures (including anemia and hemoglobin concentration (g/dL)) with 11 cognitive domains. All models were adjusted for age and gender with the full model containing adjustments for rural location, years of education, smoking, region, BMI and population weights.Results from LASI-DAD were validated using the USA-based Health and Retirement Study (HRS) cohort (n=5720) to replicate associations between blood cell measures and global cognition.; Results: In LASI-DAD, we showed an association between anemia and poor memory (p=0.0054). We found a positive association between hemoglobin concentration and ten cognitive domains tested (β=0.041-0.071, p<0.05). The strongest association with hemoglobin was identified for memory-based tests (immediate episodic, delayed episodic and broad domain memory, β=0.061-0.071, p<0.005). Positive associations were also shown between the general cognitive score and the other red blood count tests including mean corpuscular hemoglobin concentration (MCHC, β=0.06, p=0.0001) and red cell distribution width (RDW, β =-0.11, p<0.0001). In the HRS cohort, positive associations were replicated between general cognitive score and other blood count tests (Red Blood Cell, MCHC and RDW, p<0.05).; Conclusion: We have established in a large South Asian population that low hemoglobin and anaemia are associated with low cognitive function, therefore indicating that anaemia could be an important modifiable risk factor. We have validated this result in an external cohort demonstrating both the variability of this risk factor cross-nationally and its generalizable association with cognitive outcomes. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Biomarkers, Cardiometabolic outcomes, Cognitive function, Cross-national comparison, Dementia, Memory, Racial-ethnic disparities | Link | Winchester, L. M., Newby, D., Ghose, U., Hu, P., Green, H., Chien, S., Ranson, J., Faul, J., Llewellyn, D., Lee, J., Bauermeister, S., & Nevado-Holgado, A. (2024). Anemia, hemoglobin concentration and cognitive function in the Longitudinal Ageing Study in India-Harmonized Diagnostic Assessment of Dementia (LASI-DAD) and the Health and Retirement Study. medRxiv : the preprint server for health sciences, 2024.01.22.24301583. | MedRxiv |
| Admixture mapping of cognitive function in diverse Hispanic and Latino adults: Results from the Hispanic Community Health Study/Study of Latinos | Xia R, Jian X, Rodrigue AL, Bressler J, Boerwinkle E, Cui B, Daviglus ML, DeCarli C, Gallo LC, Glahn DC, Knowles EEM, Moon JY, Mosley TH, Satizabal CL, Sofer T, Tarraf W, Testai F, Blangero J, Seshadri S, González HM, Fornage M. | 2024 | Introduction: We conducted admixture mapping and fine-mapping analyses to identify ancestry-of-origin loci influencing cognitive abilities. Methods: We estimated the association of local ancestry intervals across the genome with five neurocognitive measures in 7140 diverse Hispanic and Latino adults (mean age 55 years). We prioritized genetic variants in associated loci and tested them for replication in four independent cohorts. Results: We identified nine local ancestry–associated regions for the five neurocognitive measures. There was strong biological support for the observed associations to cognitive function at all loci and there was statistical evidence of independent replication at 4q12, 9p22.1, and 13q12.13. Discussion: Our study identified multiple novel loci harboring genes implicated in cognitive functioning and dementia, and uncovered ancestry-relevant genetic variants. It adds to our understanding of the genetic architecture of cognitive function in Hispanic and Latino adults and demonstrates the power of admixture mapping to discover unique haplotypes influencing cognitive function, complementing genome-wide association studies. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Cognitive function, Genetics, Methodology, Racial-ethnic disparities | Link | Xia, R., Jian, X., Rodrigue, A. L., Bressler, J., Boerwinkle, E., Cui, B., ... & Fornage, M. (2024). Admixture mapping of cognitive function in diverse Hispanic and Latino adults: Results from the Hispanic Community Health Study/Study of Latinos. Alzheimer's & Dementia, 20(9), 6070-6081. | Alzheimer's & Dementia |
| Educational Attainment and Later-life Cognitive Function in High- and Middle-income Countries: Evidence from the Harmonized Cognitive Assessment Protocol. | Zhang, Yuan S; O'Shea, Brendan; Yu, Xuexin; Cho, Tsai-Chin; Zhang, Kelvin Pengyuan; Kler, Jasdeep; Langa, Kenneth M; Weir, David R; Gross, Alden L; Kobayashi, Lindsay C | 2024 | Objective: Identifying social policies that can promote cognitive health is crucial for reducing the global burden of dementia. We evaluated the importance of educational attainment for later-life cognitive function in various social and geographic settings.; Methods: Using harmonized data for individuals aged ≥65 years from the United States Health and Retirement Study (HRS) and its international partner studies in England, Mexico, China, and India, and each study's respective Harmonized Cognitive Assessment Protocol (HCAP), we conducted a cross-national comparative study to examine the role of educational attainment in later-life cognitive function across countries (n = 14,980, 2016-2019). We used multivariable-adjusted regression to estimate associations between educational attainment and harmonized global cognitive function scores.; Results: In Mexico, China, and India, the general cognitive function scores on average is approximately one standard deviation of the HRS-HCAP cognitive function score distribution lower compared to the United States and England, paralleling patterns of educational attainment across countries. In all countries, higher educational attainment was associated with progressively higher later-life cognitive function scores. Population-level differences in educational attainment explained about 50%-90% of the observed differences in cognitive function scores across countries.; Discussion: The relationship between education and later-life cognitive function across social and geographic contexts underscores the crucial role of education to promote cognitive health and reduce dementia risk. Continual improvement of educational attainment in low- and middle-income settings may yield a significant pay-off in later-life cognitive health. | Health and Retirement Study (HRS) | Mid-Life Factors | Cross-national comparison, Educational attainment, Geographic disparities, Socioeconomic status | Link | Zhang, Y. S., O'Shea, B., Yu, X., Cho, T. C., Zhang, K. P., Kler, J., Langa, K. M., Weir, D. R., Gross, A. L., & Kobayashi, L. C. (2024). Educational Attainment and Later-life Cognitive Function in High- and Middle-income Countries: Evidence from the Harmonized Cognitive Assessment Protocol. The journals of gerontology. Series B, Psychological sciences and social sciences, gbae005. Advance online publication. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Memory and language cognitive data harmonization across the United States and Mexico. | Arce Rentería, Miguel; Briceño, Emily M; Chen, Diefei; Saenz, Joseph; Kobayashi, Lindsay C; Gonzalez, Christopher; Vonk, Jet M J; Jones, Richard N; Manly, Jennifer J; Wong, Rebeca; Weir, David; Langa, Kenneth M; Gross, Alden L | 2023 | Introduction: We used cultural neuropsychology-informed procedures to derive and validate harmonized scores representing memory and language across population-based studies in the United States and Mexico.; Methods: Data were from the Health and Retirement Study Harmonized Cognitive Assessment Protocol (HRS-HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex-Cog). We statistically co-calibrated memory and language domains and performed differential item functioning (DIF) analysis using a cultural neuropsychological approach. We examined relationships among harmonized scores, age, and education.; Results: We included 3170 participants from the HRS-HCAP ( M age = 76.6 [standard deviation (SD): 7.5], 60% female) and 2042 participants from the Mex-Cog ( M age = 68.1 [SD: 9.0], 59% female). Five of seven memory items and one of twelve language items demonstrated DIF by study. Harmonized memory and language scores showed expected associations with age and education.; Discussion: A cultural neuropsychological approach to harmonization facilitates the generation of harmonized measures of memory and language function in cross-national studies.; Highlights: We harmonized memory and language scores across studies in the United States and Mexico.A cultural neuropsychological approach to data harmonization was used.Harmonized scores showed minimal measurement differences between cohorts.Future work can use these harmonized scores for cross-national studies of Alzheimer's disease and related dementias. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Cross-national comparison, Cultural factors, Memory, Methodology | Link | Arce Rentería, M., Briceño, E. M., Chen, D., Saenz, J., Kobayashi, L. C., Gonzalez, C., Vonk, J. M. J., Jones, R. N., Manly, J. J., Wong, R., Weir, D., Langa, K. M., & Gross, A. L. (2023). Memory and language cognitive data harmonization across the United States and Mexico. Alzheimer's & dementia (Amsterdam, Netherlands), 15(3), e12478. | Alzheimer's & Dementia |
| Association of Religious Service Attendance and Neuropsychiatric Symptoms, Cognitive Function, and Sleep Disturbances in All-Cause Dementia. | Britt, Katherine Carroll; Richards, Kathy C; Acton, Gayle; Hamilton, Jill; Radhakrishnan, Kavita | 2023 | Commonly reported in dementia, neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances indicate dementia progression. With the growing dementia burden, identifying protective factors that may slow dementia progression is increasingly essential. Religion and spirituality are associated with better mental and physical health, yet few studies have been reported in older adults with dementia. This study examines associations between religious service attendance and symptoms of dementia progression. Using data from the Health and Retirement Study in 2000, 2006, and 2008 and the sub-study, Aging, Demographics, and Memory Study in 2001-2003, 2006-2007, and 2008-2009, we examined the association of religious attendance with neuropsychiatric symptoms, cognitive function, and sleep disturbances among U.S. older adults aged 70 years and older with all-cause dementia ( N = 72) using Spearman's partial Rho correlation controlling for social interaction. Significant associations were identified for religious attendance and NPS (r s (97) = -0.124, 95% CI [-0.129, -0.119], p < 0.0005); cognitive function, r s (97) = -0.018, 95% CI [-0.023, -0.013], p < 0.001); and sleep disturbances, r s (97) = -0.275, 95% CI [-0.280, -0.271], p < 0.0005). Beyond adjusting for social interaction, increased religious attendance was associated with lower NPS, better cognitive function, and fewer sleep disturbances. Clinical trials and longitudinal studies with a larger sample size examining religion and spirituality factors with dementia progression are warranted. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Alzheimer's disease, Cognitive function, Health behavior, Mental health, Memory, Religion and spirituality | Link | Britt, K. C., Richards, K. C., Acton, G., Hamilton, J., & Radhakrishnan, K. (2023). Association of Religious Service Attendance and Neuropsychiatric Symptoms, Cognitive Function, and Sleep Disturbances in All-Cause Dementia. International journal of environmental research and public health, 20(5), 4300. | International Journal of Environmental Research and Public Health |
| Negative wealth shocks in later life and subsequent cognitive function in older adults in China, England, Mexico, and the USA, 2012-18: a population-based, cross-nationally harmonised, longitudinal study. | Cho, Tsai-Chin; Yu, Xuexin; Gross, Alden L; Zhang, Yuan S; Lee, Jinkook; Langa, Kenneth M; Kobayashi, Lindsay C | 2023 | Background: Household wealth is positively related to cognitive health outcomes in later life. However, the association between negative wealth shocks and cognitive function in later life, and whether this association might differ across countries at different levels of economic development, is unclear. We aimed to investigate whether negative wealth shocks in later life are associated with cognitive function in older adults in China, England, Mexico, and the USA, and whether this association is modified by country income level.; Methods: For this population-based, cross-nationally harmonised, longitudinal study, data were analysed from core interviews of the population-based US Health and Retirement Study (2012 and 2016) and its partner studies in China (the China Health and Retirement Longitudinal Study; 2015 and 2018), England (the English Longitudinal Study of Ageing; 2012 and 2016), and Mexico (Mexican Health and Aging Study; 2012 and 2015-16), and their respective Harmonized Cognitive Assessment Protocols (HCAPs). Negative wealth shocks over the follow-up periods of the respective cohorts were defined in two ways: an extreme loss of 75% or greater from the baseline amount of wealth, and a decline in within-population wealth quintile rank. The primary outcome was the harmonised general cognitive function (GCF) factor score, which was constructed with factor analysis on the HCAP neuropsychological assessments of memory, orientation, attention, executive function, and verbal fluency performance (mean 0; SD 1). We used sampling-weighted, multivariable-adjusted linear models to examine associations.; Findings: Data from 9465 participants were included in this analysis: 3796 from China, 1184 from England, 1193 from Mexico, and 3292 from the USA. The mean baseline age of participants was 68·5 (SD 5·4) years in China (49·8% women), 72·0 (7·0) years in England (54·6% women), 70·6 (6·8) years in Mexico (55·1% women), and 72·7 (7·5) years in the USA (60·4% women). A wealth loss of 75% or greater was negatively associated with subsequent cognitive function in the USA (β -0·16 SD units; 95% CI -0·29 to -0·04) and China (-0·14; -0·21 to -0·07), but not in England (-0·01; -0·24 to 0·22) or Mexico (-0·11; -0·24 to 0·03). Similarly, within-population wealth quintile rank declines were negatively associated with subsequent cognitive function in the USA (β -0·07 per quintile rank decline; 95% CI -0·11 to -0·03) and China (β -0·07; -0·09 to -0·04), but not in England (-0·05; -0·11 to 0·01) or Mexico (-0·03; -0·07 to 0·01).; Interpretation: The impact of wealth shocks in later life on subsequent lower level of cognitive function of older adults in China, England, Mexico, and the USA differed across macro-level socioeconomic structures. These findings suggest that government policies and social safety nets in countries with different levels of economic development might have a role in protecting older adults from adverse health effects of wealth losses in later life. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Cross-national comparison, Memory, Socioeconomic status | Link | Cho, T. C., Yu, X., Gross, A. L., Zhang, Y. S., Lee, J., Langa, K. M., & Kobayashi, L. C. (2023). Negative wealth shocks in later life and subsequent cognitive function in older adults in China, England, Mexico, and the USA, 2012-18: a population-based, cross-nationally harmonised, longitudinal study. The lancet. Healthy longevity, 4(9), e461–e469. | The Lancet Healthy Longevity |
| The Mode Effect of Web-Based Surveying on the 2018 U.S. Health and Retirement Study Measure of Cognitive Functioning. | Domingue, Benjamin W; McCammon, Ryan J; West, Brady T; Langa, Kenneth M; Weir, David R; Faul, Jessica | 2023 | Objectives: Measuring cognition in an aging populabtion is a public health priority. A move towards survey measurement via the web (as opposed to phone or in-person) is cost-effective but challenging as it may induce bias in cognitive measures. We examine this possibility using an experiment embedded in the 2018 wave of data collection for the U.S. Health and Retirement Study (HRS).; Methods: We utilize techniques from multiple group item response theory to assess the effect of survey mode on performance on the HRS cognitive measure. We also study the problem of attrition by attempting to predict dropout and via approaches meant to minimize bias in subsequent inferences due to attrition.; Results: We find evidence of an increase in scores for HRS respondents who are randomly assigned to the web-based mode of data collection in 2018. Web-based respondents score higher in 2018 than experimentally matched phone-based respondents, and they show much larger gains relative to 2016 performance and subsequently larger declines in 2020. The differential in favor of web-based responding is observed across all items, but is most pronounced for the Serial 7 task and numeracy items. Due to the relative ease of the web-based mode, we suggest a cutscore of 12 being used to indicate CIND (cognitively impaired but not demented) status when using the web-based version rather than 11.; Discussion: The difference in mode may be nonignorable for many uses of the HRS cognitive measure. In particular, it may require reconsideration of some cutscore-based approaches to identify impairment. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Methodology | Link | Domingue, B. W., McCammon, R. J., West, B. T., Langa, K. M., Weir, D. R., & Faul, J. (2023). The Mode Effect of Web-Based Surveying on the 2018 US Health and Retirement Study Measure of Cognitive Functioning. The Journals of Gerontology: Series B, 78(9), 1466-1473. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Subjective Memory Decline Predicts Incident Cognitive Impairment Among White-But Not Black or Hispanic-Older Adults | Ferraro, Kenneth F; Sauerteig-Rolston, Madison R; Barnes, Lisa L; Friedman, Elliot; Sands, Laura P; Thomas, Patricia A | 2023 | Background and Objectives: This study investigates whether subjective memory decline (SMD) in a racially diverse sample of older adults without cognitive impairment at baseline is associated with incident cognitive impairment during a 12-year follow-up period. Research Design and Methods: With panel data from a national sample (N = 9,244) of cognitively intact Black, White, and Hispanic Americans 65 years or older in 2004, we examine if SMD is associated with the loss of normal cognition by 2016. Cognitive status was assessed every 2 years with a modified version of the Telephone Interview for Cognitive Status to identify the transition from normal cognition to cognitive impairment. Results: Estimates from Weibull accelerated failure-time models reveal that SMD is associated with earlier incident cognitive impairment (time ratio = 0.96, p < .05). In subsequent models stratified by race-ethnicity, this association was evident among White respondents (time ratio = 0.95, p < .01) but not among Black, U.S.-born Hispanic, or foreign-born Hispanic respondents. Discussion and Implications: Given that the prognostic validity of SMD differs by race and ethnicity, caution is warranted when using it as a screening or clinical tool in diverse populations. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Memory, Racial-ethnic disparities | Link | Ferraro, K. F., Sauerteig-Rolston, M. R., Barnes, L. L., Friedman, E., Sands, L. P., & Thomas, P. A. (2023). Subjective memory decline predicts incident cognitive impairment among White—but not Black or Hispanic—older adults. The Gerontologist, 63(4), 690-699. | The Gerontologist |
| Interaction analysis of ancestry-enriched variants with APOE-ɛ4 on MCI in the Study of Latinos-Investigation of Neurocognitive Aging. | Granot-Hershkovitz, Einat; Xia, Rui; Yang, Yunju; Spitzer, Brian; Tarraf, Wassim; Vásquez, Priscilla M; Lipton, Richard B; Daviglus, Martha; Argos, Maria; Cai, Jianwen; Kaplan, Robert; Fornage, Myriam; DeCarli, Charles; Gonzalez, Hector M; Sofer, Tamar | 2023 | APOE-ɛ4 risk on Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD) differs between race/ethnic groups, presumably due to ancestral genomic background surrounding the APOE locus. We studied whether African and Amerindian ancestry-enriched genetic variants in the APOE region modify the effect of the APOE-ɛ4 alleles on Mild Cognitive Impairment (MCI) in Hispanics/Latinos. We defined African and Amerindian ancestry-enriched variants as those common in one Hispanic/Latino parental ancestry and rare in the other two. We identified such variants in the APOE region with a predicted moderate impact based on the SnpEff tool. We tested their interaction with APOE-ɛ4 on MCI in the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) population and African Americans from the Atherosclerosis Risk In Communities (ARIC) study. We identified 5 Amerindian and 14 African enriched variants with an expected moderate effect. A suggestive significant interaction (p-value = 0.01) was found for one African-enriched variant, rs8112679, located in the ZNF222 gene fourth exon. Our results suggest there are no ancestry-enriched variants with large effect sizes of interaction effects with APOE-ɛ4 on MCI in the APOE region in the Hispanic/Latino population. Further studies are needed in larger datasets to identify potential interactions with smaller effect sizes. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | APOE, Cognitive function, Genetics, Hispanic/Latino, Racial-ethnic disparities | Link | Granot-Hershkovitz, E., Xia, R., Yang, Y., Spitzer, B., Tarraf, W., Vásquez, P. M., Lipton, R. B., Daviglus, M., Argos, M., Cai, J., Kaplan, R., Fornage, M., DeCarli, C., Gonzalez, H. M., & Sofer, T. (2023). Interaction analysis of ancestry-enriched variants with APOE-ɛ4 on MCI in the Study of Latinos-Investigation of Neurocognitive Aging. Scientific reports, 13(1), 5114. | Scientific Reports |
| Decomposing interaction and mediating effects of race/ethnicity and circulating blood levels of cystatin C on cognitive status in the United States health and retirement study. | Higgins Tejera, César; Ware, Erin B; Kobayashi, Lindsay C; Fu, Mingzhou; Hicken, Margaret; Zawistowski, Matthew; Mukherjee, Bhramar; Bakulski, Kelly M | 2023 | Background and Objectives: Elevated circulating cystatin C is associated with cognitive impairment in non-Hispanic Whites, but its role in racial disparities in dementia is understudied. In a nationally representative sample of older non-Hispanic White, non-Hispanic Black, and Hispanic adults in the United States, we use mediation-interaction analysis to understand how racial disparities in the cystatin C physiological pathway may contribute to racial disparities in prevalent dementia.; Methods: In a pooled cross-sectional sample of the Health and Retirement Study ( n = 9,923), we employed Poisson regression to estimate prevalence ratios and to test the relationship between elevated cystatin C (>1.24 vs. ≤1.24 mg/L) and impaired cognition, adjusted for demographics, behavioral risk factors, other biomarkers, and chronic conditions. Self-reported racialized social categories were a proxy measure for exposure to racism. We calculated additive interaction measures and conducted four-way mediation-interaction decomposition analysis to test the moderating effect of race/ethnicity and mediating effect of cystatin C on the racial disparity.; Results: Overall, elevated cystatin C was associated with dementia (prevalence ratio [PR] = 1.2; 95% CI: 1.0, 1.5). Among non-Hispanic Black relative to non-Hispanic White participants, the relative excess risk due to interaction was 0.7 (95% CI: -0.1, 2.4), the attributable proportion was 0.1 (95% CI: -0.2, 0.4), and the synergy index was 1.1 (95% CI: 0.8, 1.8) in a fully adjusted model. Elevated cystatin C was estimated to account for 2% (95% CI: -0, 4%) for the racial disparity in prevalent dementia, and the interaction accounted for 8% (95% CI: -5, 22%). Analyses for Hispanic relative to non-white participants suggested moderation by race/ethnicity, but not mediation.; Discussion: Elevated cystatin C was associated with dementia prevalence. Our mediation-interaction decomposition analysis suggested that the effect of elevated cystatin C on the racial disparity might be moderated by race/ethnicity, which indicates that the racialization process affects not only the distribution of circulating cystatin C across minoritized racial groups, but also the strength of association between the biomarker and dementia prevalence. These results provide evidence that cystatin C is associated with adverse brain health and this effect is larger than expected for individuals racialized as minorities had they been racialized and treated as non-Hispanic White. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Biomarkers, Cardiometabolic health, Racial-ethnic disparities, Structural inequality | Link | Higgins Tejera, C., Ware, E. B., Kobayashi, L. C., Fu, M., Hicken, M., Zawistowski, M., Mukherjee, B., & Bakulski, K. M. (2023). Decomposing interaction and mediating effects of race/ethnicity and circulating blood levels of cystatin C on cognitive status in the United States health and retirement study. Frontiers in human neuroscience, 17, 1052435. | Frontiers in Human Neuroscience |
| In sickness and in health: Loneliness, depression, and the role of marital quality among spouses of persons with dementia. | Hsu, Kristie Y; Cenzer, Irena; Harrison, Krista L; Ritchie, Christine S; Waite, Linda; Kotwal, Ashwin | 2023 | Background: Older adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and the role of marital quality in mediating these outcomes.; Methods: We used a US population-based sample of 4071 couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PLwD (N = 227), married to persons with CIND (N = 885), or married to persons with no cognitive impairment (NCI) (N = 2959). We determined the prevalence of loneliness (UCLA 3-item scale), depressive symptoms (CESD-8 scale), and both, using multivariable logistic regression adjusting for sociodemographic and health-related characteristics. We then tested for interaction terms between marital quality (4-item scale) and degree of spousal cognitive impairment for each outcome of loneliness and depressive symptoms.; Results: The sample was 55% women and on average 67-years-old (range: 50-97). After adjustment, spouses of persons with cognitive impairment were more likely to be lonely (NCI: 20%, CIND: 23%, PLwD: 29%; p = 0.04), depressed (NCI: 8%, CIND: 15%, PLwD: 14%; p < 0.01), and both (NCI: 4%, CIND: 9%, PLwD: 7%; p < 0.01). The association between cognition and loneliness, but not depression, differed by marital quality (interaction p-value = 0.03). Among couples with high marital quality, spousal cognitive impairment was associated with higher likelihood of loneliness (p < 0.05). In contrast, no association existed between spousal cognition and loneliness among couples with lower marital quality (p = 0.37).; Conclusions: One in six spouses of persons with CIND or more advanced disease (PLwD) experienced depressive symptoms, and loneliness among spouses of PLwD was experienced at a twofold rate. By identifying and managing both, and facilitating interventions that promote high-quality social connection, clinical teams might improve the lives of older couples facing dementia. | Health and Retirement Study (HRS) | Mid-Life Factors | Dementia, Family, Loneliness, Mental health | Link | Hsu, K. Y., Cenzer, I., Harrison, K. L., Ritchie, C. S., Waite, L., & Kotwal, A. (2023). In sickness and in health: Loneliness, depression, and the role of marital quality among spouses of persons with dementia. Journal of the American Geriatrics Society, 71(11), 3538–3545. | Journal of the American Geriatrics Society |
| Impact of educational attainment on time to cognitive decline among marginalized older adults: Cohort study of 20,311 adults. | Jester, Dylan J; Palmer, Barton W; Thomas, Michael L; Brown, Lauren L; Tibiriçá, Lize; Jeste, Dilip V; Gilmer, Todd | 2023 | Background: The effect of years of education on the maintenance of healthy cognitive functioning may differ by race and ethnicity given historical and ongoing inequities in educational quality.; Methods: We examined 20,311 Black, Latinx, and White adults aged 51-100 from the Health and Retirement Study (2008-2016). Telephone Interview for Cognitive Status-27 data was used to measure cognitive functioning. Generalized additive mixed models were stratified by race and ethnicity and educational attainment (≥12 vs. <12 years). Selected social determinants of health, all-cause mortality, time-varying health and healthcare utilization characteristics, and study wave were included as covariates.; Results: On average, Black and Latinx adults scored lower at baseline compared to White adults regardless of educational attainment (p < 0.001), with a significant overlap in the distributions of scores. The rate of cognitive decline was non-linear for Black, Latinx, and White adults (p < 0.001), and a period of stability was witnessed for those with higher educational attainment irrespective of race and ethnicity. Compared to Black, Latinx, and White adults with lower educational attainment, higher-educated White adults received the greatest protection from cognitive decline (13 years; 64 vs. 51), followed by Latinx (12 years; 67 vs. 55), and Black adults (10 years; 61 vs. 51). Latinx adults experienced cognitive decline beginning at a later age.; Conclusions: The extent to which higher educational attainment protects adults from cognitive decline differs by race and ethnicity, such that higher-educated White adults received a greater benefit than higher-educated Black or Latinx adults. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Educational attainment, Mortality, Racial-ethnic disparities | Link | Jester, D. J., Palmer, B. W., Thomas, M. L., Brown, L. L., Tibiriçá, L., Jeste, D. V., & Gilmer, T. (2023). Impact of educational attainment on time to cognitive decline among marginalized older adults: Cohort study of 20,311 adults. Journal of the American Geriatrics Society, 71(9), 2913–2923. | Journal of the American Geriatrics Society |
| Wisconsin Longitudinal Study (WLS), the Initial Lifetime’s Impact on Alzheimer’s Disease (WLS-ILIAD): A Novel Opportunity to Study the Influence of Education on ADRD | Lange, Kate; Williams, Victoria J; Strait, Brittani J; Fischer, Anne M; Herd, Pamela; Asthana, Sanjay | 2023 | Background: The importance of education in shaping brain health and dementia risk are increasingly supported, although the mechanisms by which these life course factors impact late life cognition remain elusive due to a scarcity of full life-course longitudinal studies. A new data collection wave of the Wisconsin Longitudinal Study (WLS), the Initial Lifetime’s Impact on Alzheimer’s Disease (WLS-ILIAD), stands to address this gap. The WLS cohort is a randomly selected community sample that’s been followed since 1957, offering a wealth of prospectively collected lifespan data to pull from. Now that this cohort has reached their 80’s, the ILIAD study aims to detect dementia prevalence in this sample, and when combined with prior data waves, offers an unparalleled opportunity to explore how full life-course and sociodemographic factors shape the relationship between education and dementia risk and resilience. Method: WLS-ILIAD employs a multi-phasic study design. In Phase 1, the modified Telephone Interview for Cognitive Status (TICS-m) was administered to all eligible participants to screen for dementia risk. Those performing below cutoff (TICS-m≤28) were selected for Phase 2 to complete more robust cognitive assessment and to obtain comprehensive health history. Cognitive diagnoses were determined by multidisciplinary consensus panel. Proxy assessments were employed for participants who were deceased or unable to complete the assessment. Result: Preliminary results indicate a response rate of ∼78%. Approximately 4,800 participants completed Phase 1, with 1,227 (26%) falling below cutoff for dementia risk (TICS-m≤28). Of those completing Phase 2, 460 participants were classified as normal cognition, 443 mild cognitive impairment (MCI), and 197 dementia. Another 300 dementia cases were identified via proxy. Participants diagnosed with MCI or dementia tended to be older, ApoeE-4 allele carriers, and had a lower high school IQ. Of those diagnosed with dementia, 88% reported no prior clinical workup or existing cognitive diagnosis. Conclusion: Results of the WLS-ILIAD study yields detailed cognitive diagnostic classifications for this sample. When combined with prospectively collected life course data, the WLS cohort offers a unique opportunity to explore the impact of education on risk and resilience factors for dementia outcomes, leading to important public policy and public health implications. | Wisconsin Longitudinal Study (WLS) | Early Life | Alzheimer's disease, APOE, Cognitive function, Dementia, Educational attainment, Methodology | Link | Lange, K., Williams, V. J., Strait, B. J., Fischer, A. M., Herd, P., & Asthana, S. (2023). Wisconsin Longitudinal Study (WLS), the Initial Lifetime’s Impact on Alzheimer’s Disease (WLS‐ILIAD): A Novel Opportunity to Study the Influence of Education on ADRD. Alzheimer's & Dementia, 19, e074822. | Alzheimer's & Dementia |
| The Effects of Midlife Acute and Chronic Stressors on Black-White Differences in Cognitive Decline. | Mitchell, Uchechi A; Shaw, Benjamin A; Torres, Jacqueline M; Brown, Lauren L; Barnes, Lisa L | 2023 | Objectives: Midlife stressors may be particularly consequential for cognitive performance and disparities in cognitive decline. This study examined Black-White differences in trajectories of cognition among middle-aged adults and the effects of acute and chronic stressors on these trajectories.; Methods: Data come from 4,011 cognitively healthy individuals aged 51-64 (620 Black and 3,391 White) who participated in the 2006-2018 waves of the Health and Retirement Study. Stressors included a count of recent life events and measures of financial strain and everyday discrimination. Global cognition was assessed using a modified version of the Telephone Interview for Cognitive Status. Linear mixed models with random slopes and intercepts assessed change in cognition over time. Race-by-time, race-by-stressor, time-by-stressor, and race-by-stressor-by-time interactions were assessed as were quadratic terms for time and each stressor.; Results: After adjusting for sociodemographic, health behaviors, and health-related factors, Black respondents had lower initial cognitive performance scores (b = -1.75, p < .001) but experienced earlier but slower decline in cognitive performance over time (Black × Time2 interaction: b = 0.02, p < .01). Financial strain, discrimination, and recent life events each had distinct associations with cognitive performance but did not influence racial differences in levels of or change in cognition over time.; Discussion: Middle-aged Black adults have lower initial cognition levels and experience earlier but less accelerated cognitive decline compared to White middle-aged adults. Midlife acute and chronic stressors influence baseline cognition but do so in different ways. Future research should examine the influence of other stressors on racial differences in cognitive decline at other points in the life course. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Memory, Racial-ethnic disparities, Stress | Link | Mitchell, U. A., Shaw, B. A., Torres, J. M., Brown, L. L., & Barnes, L. L. (2023). The Effects of Midlife Acute and Chronic Stressors on Black–White Differences in Cognitive Decline. The Journals of Gerontology: Series B, 78(12), 2147-2155. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Body Mass Index and Memory Across 18 Years in the Wisconsin Longitudinal Study. | Moorman, Sara M; Kobielski, Sara | 2023 | Background: Body weight is a modifiable risk factor for dementia, but results have been mixed as to the ages at which normal body weight is markedly preferable to overweight or obesity. This study assessed the association between change in body mass index (BMI) over 2 periods of the life course with change in memory between the ages of 65 and 72 for males and females.; Methods: Participants were 3 637 White high school graduates, born in 1939, from the Wisconsin Longitudinal Study. The statistical analyses were fixed-effects regression models, with moderation terms to test for sex differences. One set of models examined change in BMI between ages 54 and 65, and the other set examined change in BMI between ages 65 and 72. In both cases, cognitive change occurred between ages 65 and 72.; Results: Greater increases in BMI were associated with a greater decline in immediate recall for females only, both contemporaneously and following a lag. Increases in BMI were associated with greater contemporaneous-but not lagged-declines in both delayed recall and digit ordering for both males and females.; Conclusions: The present study adds to the evidence that for White, high school educated Americans, weight gain in midlife and young-old age is a risk factor for memory decline. Results vary according to the timing of the weight gain, the aspect of memory measured, and participant sex. | Wisconsin Longitudinal Study (WLS) | Biological Mechanisms, Mid-Life Factors | Memory, Obesity | Link | Moorman, S. M., & Kobielski, S. (2023). Body Mass Index and Memory Across 18 Years in the Wisconsin Longitudinal Study. The journals of gerontology. Series A, Biological sciences and medical sciences, 78(1), 129–133. | The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences |
| Alzheimer's disease medication use and adherence patterns by race and ethnicity. | Olchanski, Natalia; Daly, Allan T; Zhu, Yingying; Breslau, Rachel; Cohen, Joshua T; Neumann, Peter J; Faul, Jessica D; Fillit, Howard M; Freund, Karen M; Lin, Pei-Jung | 2023 | Background: We examined racial and ethnic differences in medication use for a representative US population of patients with Alzheimer's disease and related dementias (ADRD).; Methods: We examined cholinesterase inhibitors and memantine initiation, non-adherence, and discontinuation by race and ethnicity, using data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims.; Results: Among newly diagnosed ADRD patients (n = 1299), 26% filled an ADRD prescription ≤90 days and 36% ≤365 days after diagnosis. Among individuals initiating ADRD-targeted treatment (n = 1343), 44% were non-adherent and 24% discontinued the medication during the year after treatment initiation. Non-Hispanic Blacks were more likely than Whites to not adhere to ADRD medication therapy (odds ratio: 1.50 [95% confidence interval: 1.07-2.09]).; Discussion: Initiation of ADRD-targeted medications did not vary by ethnoracial group, but non-Hispanic Blacks had lower adherence than Whites. ADRD medication non-adherence and discontinuation were substantial and may relate to cost and access to care.; Highlights: Initiation of anti-dementia medications among newly diagnosed Alzheimer's disease and related dementias (ADRD) patients was low in all ethnoracial groups. ADRD medication non-adherence and discontinuation were substantial and may relate to cost and access to care. Compared to Whites, Blacks and Hispanics had lower use, poorer treatment adherence, and more frequent discontinuation of ADRD medication, but when controlling for disease severity and socioeconomic factors, racial disparities diminish. Our findings demonstrate the importance of adjusting for socioeconomic characteristics and disease severity when studying medication use and adherence in ADRD patients. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Alzheimer's disease, Cognitive function, Dementia, Healthcare, Racial-ethnic disparities | Link | Olchanski, N., Daly, A. T., Zhu, Y., Breslau, R., Cohen, J. T., Neumann, P. J., Faul, J. D., Fillit, H. M., Freund, K. M., & Lin, P. J. (2023). Alzheimer's disease medication use and adherence patterns by race and ethnicity. Alzheimer's & dementia : the journal of the Alzheimer's Association, 19(4), 1184–1193. | Alzheimer's & Dementia |
| Neurocognitive test performance following cancer among middle-aged and older adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and the SOL-Investigation of Neurocognitive Aging Ancillary Study. | Parada, Humberto, Jr; Pichardo, Margaret S; Gallo, Linda C; Talavera, Gregory A; McDaniels-Davidson, Corinne; Penedo, Frank J; Lee, David J; Tarraf, Wassim; Garcia, Tayna P; Daviglus, Martha L; González, Hector M | 2023 | Background: Cancer patients and survivors often experience acute cognitive impairments; however, the long-term cognitive impact remains unclear particularly among Hispanics/Latinos. We examined the association between cancer history and neurocognitive test performance among middle-aged and older Hispanic/Latinos.; Methods: Participants included 9639 Hispanic/Latino adults from the community-based and prospective Hispanic Community Health Study/Study of Latinos. At baseline (2008-2011; V1), participants self-reported their cancer history. At V1 and again at a 7-year follow-up (2015-2018; V2), trained technicians administered neurocognitive tests including the Brief-Spanish English Verbal Learning Test (B-SEVLT), Word Fluency Test (WF), and Digit Symbol Substitution Test (DSS). We used survey linear regression to estimate the overall, sex-specific, and cancer site-specific [i.e., cervix, breast, uterus, and prostate] adjusted associations between cancer history and neurocognitive test performance at V1 and changes from V1 to V2.; Results: At V1, a history of cancer (6.4%) versus no history of cancer (93.6%) was associated with higher WF scores (β = 0.14, SE = 0.06; p = 0.03) and global cognition (β = 0.09, SE = 0.04; p = 0.04). Among women, a history of cervical cancer predicted decreases in SEVLT-Recall scores (β = -0.31, SE = 0.13; p = 0.02) from V1 to V2, and among men, a history of prostate cancer was associated with higher V1 WF scores (β = 0.29, SE = 0.12; p = 0.02) and predicted increases in SEVLT-Sum (β = 0.46, SE = 0.22; p = 0.04) from V1 to V2.; Conclusion: Among women, a history of cervical cancer was associated with 7-year memory decline, which may reflect the impacts of systemic cancer therapies. Among men, however, a history of prostate cancer was associated with improvements in cognitive performance, perhaps due in part to engaging in health promoting behaviors following cancer. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms, Mid-Life Factors | Cognitive function, Gender/Sex, Memory | Link | Parada, H., Jr, Pichardo, M. S., Gallo, L. C., Talavera, G. A., McDaniels-Davidson, C., Penedo, F. J., Lee, D. J., Tarraf, W., Garcia, T. P., Daviglus, M. L., & González, H. M. (2023). Neurocognitive test performance following cancer among middle-aged and older adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and the SOL-Investigation of Neurocognitive Aging Ancillary Study. Cancer medicine, 12(10), 11860–11870. | Cancer Medicine |
| Depressive Symptoms Partially Mediate the Association of Frailty Phenotype Symptoms and Cognition for Females but Not Males. | Resciniti, Nicholas V; Farina, Mateo P; Merchant, Anwar T; Lohman, Matthew C | 2023 | Objectives: We aimed to evaluate whether depressive symptoms mediated the relationship between frailty phenotype and cognitive function by sex.; Methods: Data came from the Health and Retirement Study from 2012-2016. The outcome was measured by Fried's frailty criteria, our outcome was continuous global cognition, and mediator was depressive symptoms. We used mediation analysis, stratified by sex, to estimate the direct and indirect effects of frailty symptoms on cognition mediated by depressive symptoms.; Results: Males had a larger total effect (β= -0.43; 95% CI: -0.66, -0.02) for lower cognitive score for each increase in frailty symptom compared to females (β= -0.28; 95% CI: -0.47, -0.08). A significant indirect effect from frailty phenotype to cognition was found through depressive symptoms for females but not males.; Conclusion: These results highlight the importance of identifying individuals with frailty and depressive symptoms to monitor and provide interventions to preserve cognitive function. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Cognitive function, Gender/Sex, Mental health | Link | Resciniti, N. V., Farina, M. P., Merchant, A. T., & Lohman, M. C. (2023). Depressive Symptoms Partially Mediate the Association of Frailty Phenotype Symptoms and Cognition for Females but Not Males. Journal of aging and health, 35(1-2), 42–49. | Journal of Aging and Health |
| Development of a latent dementia index in the aging, demographics, and memory study: Validation and measurement invariance by sex. | Saenz, Joseph; Beam, Christopher R; Kim, Alice J | 2023 | Latent variable models can create a latent dementia index (LDI) using cognitive and functional ability to approximate dementia likelihood. The LDI approach has been applied across diverse cohorts. It is unclear whether sex affects its measurement properties. We use Wave A (2001-2003) of the Demographics, and Memory Study ( n = 856). Multiple group confirmatory factor analysis (CFA) was used to test measurement invariance (MI) using informant-reported functional ability and cognitive performance tasks, which we group into verbal, nonverbal, and memory. Partial scalar invariance was found, allowing for testing sex differences in LDI means ( M Diff = 0.38). The LDI correlated with consensus panel dementia diagnosis, Mini-Mental State Examination (MMSE), and dementia risk factors (low education, advanced age, and apolipoprotein ε4 [APOE-ε4] status) for men and women. The LDI validly captures dementia likelihood to permit estimation of sex differences. LDI sex differences indicate higher dementia likelihood in women, potentially due to social, environmental, and biological factors. | Health and Retirement Study (HRS) | Mid-Life Factors | APOE, Dementia, Gender/Sex, Memory, Methodology | Link | Saenz, J., Beam, C. R., & Kim, A. J. (2023). Development of a latent dementia index in the aging, demographics, and memory study: Validation and measurement invariance by sex. Alzheimer's & dementia (Amsterdam, Netherlands), 15(2), e12433. | Alzheimer's & Dementia |
| A polygenic risk score for Alzheimer's disease constructed using APOE-region variants has stronger association than APOE alleles with mild cognitive impairment in Hispanic/Latino adults in the U.S. | Sofer, Tamar; Kurniansyah, Nuzulul; Granot-Hershkovitz, Einat; Goodman, Matthew O; Tarraf, Wassim; Broce, Iris; Lipton, Richard B; Daviglus, Martha; Lamar, Melissa; Wassertheil-Smoller, Sylvia; Cai, Jianwen; DeCarli, Charles S; Gonzalez, Hector M; Fornage, Myriam | 2023 | Introduction: Polygenic Risk Scores (PRSs) are summaries of genetic risk alleles for an outcome.; Methods: We used summary statistics from five GWASs of AD to construct PRSs in 4,189 diverse Hispanics/Latinos (mean age 63 years) from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). We assessed the PRS associations with MCI in the combined set of people and in diverse subgroups, and when including and excluding the APOE gene region. We also assessed PRS associations with MCI in an independent dataset from the Mass General Brigham Biobank.; Results: A simple sum of 5 PRSs ("PRSsum"), each constructed based on a different AD GWAS, was associated with MCI (OR = 1.28, 95% CI [1.14, 1.41]) in a model adjusted for counts of the APOE-[Formula: see text] and APOE-[Formula: see text] alleles. Associations of single-GWAS PRSs were weaker. When removing SNPs from the APOE region from the PRSs, the association of PRSsum with MCI was weaker (OR = 1.17, 95% CI [1.04,1.31] with adjustment for APOE alleles). In all association analyses, APOE-[Formula: see text] and APOE-[Formula: see text] alleles were not associated with MCI.; Discussion: A sum of AD PRSs is associated with MCI in Hispanic/Latino older adults. Despite no association of APOE-[Formula: see text] and APOE-[Formula: see text] alleles with MCI, the association of the AD PRS with MCI is stronger when including the APOE region. Thus, APOE variants different than the classic APOE alleles may be important predictors of MCI in Hispanic/Latino adults. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms, Mid-Life Factors | APOE, Cognitive function, Genetics, Hispanic/Latino | Link | Sofer, T., Kurniansyah, N., Granot-Hershkovitz, E., Goodman, M. O., Tarraf, W., Broce, I., Lipton, R. B., Daviglus, M., Lamar, M., Wassertheil-Smoller, S., Cai, J., DeCarli, C. S., Gonzalez, H. M., & Fornage, M. (2023). A polygenic risk score for Alzheimer's disease constructed using APOE-region variants has stronger association than APOE alleles with mild cognitive impairment in Hispanic/Latino adults in the U.S. Alzheimer's research & therapy, 15(1), 146. | Alzheimer's Research & Therapy |
| Characterizing age- and sex-related differences in brain structure among middle-aged and older Hispanic/Latino adults in the study of Latinos- investigation of neurocognitive aging magnetic resonance imaging (SOL-INCA MRI). | Stickel, Ariana M; Tarraf, Wassim; González, Kevin A; Ivanovic, Vladamir; Morlett Paredes, Alejandra; Zeng, Donglin; Cai, Jianwen; Isasi, Carmen R; Kaplan, Robert; Lipton, Richard B; Daviglus, Martha; Testai, Fernando D; Lamar, Melissa; Gallo, Linda C; Talavera, Gregory A; Gellman, Marc D; Ramos, Alberto R; González, Hector M; DeCarli, Charles | 2023 | Hispanic/Latino adults are a growing segment of the older U.S. population yet are underrepresented in brain aging research. We aimed to characterize brain aging among diverse Hispanic/Latino individuals. Hispanic/Latino individuals (unweighted n = 2273 ages 35-85 years; 56% female) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) population-based study underwent magnetic resonance imaging (MRI) as part of the SOL- Investigation of Neurocognitive Aging MRI (SOL-INCA-MRI) ancillary study (2018-2022). We performed linear regressions to calculate age associations with brain volumes for each outcome (total (global) brain, hippocampal, lateral ventricle, total white matter hyperintensity (WMH), individual cortical lobar, and total cortical gray matter) and tested modification by sex. Older age was associated with smaller gray matter volumes and larger lateral ventricle and WMH volumes. Age-related differences in global brain volumes and gray matter volumes in specific regions (i.e., the hippocampus and temporal and occipital lobes) were less pronounced among women. Our findings warrant further investigation into sex-specific mechanisms of brain aging using longitudinal studies. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms, Mid-Life Factors | Gender/Sex, Neuroimaging | Link | Stickel, A. M., Tarraf, W., González, K. A., Ivanovic, V., Morlett Paredes, A., Zeng, D., Cai, J., Isasi, C. R., Kaplan, R., Lipton, R. B., Daviglus, M., Testai, F. D., Lamar, M., Gallo, L. C., Talavera, G. A., Gellman, M. D., Ramos, A. R., González, H. M., & DeCarli, C. (2023). Characterizing age- and sex-related differences in brain structure among middle-aged and older Hispanic/Latino adults in the study of Latinos- investigation of neurocognitive aging magnetic resonance imaging (SOL-INCA MRI). Neurobiology of aging, 126, 58–66. | Neurobiology of Aging |
| Connections between reproductive health and cognitive aging among women enrolled in the HCHS/SOL and SOL-INCA. | Stickel, Ariana M; Tarraf, Wassim; Kuwayama, Sayaka; Wu, Benson; Sundermann, Erin E; Gallo, Linda C; Lamar, Melissa; Daviglus, Martha; Zeng, Donglin; Thyagarajan, Bharat; Isasi, Carmen R; Lipton, Richard B; Cordero, Christina; Perreira, Krista M; Gonzalez, Hector M; Banks, Sarah J | 2023 | Introduction: Reproductive health history may contribute to cognitive aging and risk for Alzheimer's disease, but this is understudied among Hispanic/Latina women.; Methods: Participants included 2126 Hispanic/Latina postmenopausal women (44 to 75 years) from the Study of Latinos-Investigation of Neurocognitive Aging. Survey linear regressions separately modeled the associations between reproductive health measures (age at menarche, history of oral contraceptive use, number of pregnancies, number of live births, age at menopause, female hormone use at Visit 1, and reproductive span) with cognitive outcomes at Visit 2 (performance, 7-year change, and mild cognitive impairment [MCI] prevalence).; Results: Younger age at menarche, oral contraceptive use, lower pregnancies, lower live births, and older age at menopause were associated with better cognitive performance. Older age at menarche was protective against cognitive change. Hormone use was linked to lower MCI prevalence.; Discussion: Several aspects of reproductive health appear to impact cognitive aging among Hispanic/Latina women. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms, Mid-Life Factors | Cognitive function, Dementia, Gender/Sex, Hispanics/Latinos, Reproductive health | Link | Stickel, A. M., Tarraf, W., Kuwayama, S., Wu, B., Sundermann, E. E., Gallo, L. C., Lamar, M., Daviglus, M., Zeng, D., Thyagarajan, B., Isasi, C. R., Lipton, R. B., Cordero, C., Perreira, K. M., Gonzalez, H. M., & Banks, S. J. (2023). Connections between reproductive health and cognitive aging among women enrolled in the HCHS/SOL and SOL-INCA. Alzheimer's & dementia : the journal of the Alzheimer's Association, 10.1002/alz.13575. Advance online publication. | Alzheimer's & Dementia |
| The Mediating Role of Systemic Inflammation and Moderating Role of Race/Ethnicity in Racialized Disparities in Incident Dementia: A Decomposition Analysis. | Tejera, César Higgins; Ware, Erin B; Hicken, Margaret T; Kobayashi, Lindsay C; Wang, Herong; Adkins-Jackson, Paris B; Blostein, Freida; Zawistowski, Matthew; Mukherjee, Bhramar; Bakulski, Kelly M | 2023 | Background: Exposure to systemic racism is linked to increased dementia burden. To assess systemic inflammation as a potential pathway linking exposure to racism and dementia disparities, we investigated the mediating role of C-reactive protein (CRP), a systemic inflammation marker, and the moderating role of race/ethnicity on racialized disparities in incident dementia.; Methods: In the US Health and Retirement Study (n=5,143), serum CRP was measured at baseline (2006, 2008 waves). Incident dementia was classified by cognitive tests over a six-year follow-up. Self-reported racialized categories were a proxy for exposure to the racialization process. We decomposed racialized disparities in dementia incidence (non-Hispanic Black and/or Hispanic vs. non-Hispanic White) into 1) the mediated effect of CRP, 2) the moderated portion attributable to the interaction between racialized group membership and CRP, and 3) the controlled direct effect (other pathways through which racism operates).; Results: The 6-year cumulative incidence of dementia was 15.5%. Among minoritized participants (i.e., non-Hispanic Black and/or Hispanic), high CRP levels (> 75 th percentile or 4.57μg/mL) was associated with 1.27 (95%CI: 1.01,1.59) times greater risk of incident dementia than low CRP (≤4.57μg/mL). Decomposition analysis comparing minoritized versus non-Hispanic White participants showed that the mediating effect of CRP accounted for 2% (95% CI: 0%, 6%) of the racial disparity, while the interaction effect between minoritized group status and high CRP accounted for 12% (95% CI: 2%, 22%) of the disparity. Findings were robust to potential violations of causal mediation assumptions.; Conclusions: Systemic inflammation mediates racialized disparities in incident dementia. | Health and Retirement Study (HRS) | Biological Mechanisms | Biomarkers, Dementia, Inflammation, Inflammation, Racial-ethnic disparities | Link | Tejera, C. H., Ware, E. B., Hicken, M. T., Kobayashi, L. C., Wang, H., Adkins-Jackson, P. B., Blostein, F., Zawistowski, M., Mukherjee, B., & Bakulski, K. M. (2023). The Mediating Role of Systemic Inflammation and Moderating Role of Race/Ethnicity in Racialized Disparities in Incident Dementia: A Decomposition Analysis. medRxiv : the preprint server for health sciences, 2023.03.22.23287593. | MedRxiv |
| Perceived discrimination and nativity status: risk of cognitive impairment among Latin American older adults. | Tibiriçá, Lize; Jester, Dylan J; Kohn, Jordan N; Williams, Allison P; McEvoy, Linda K; Palmer, Barton W | 2023 | Objectives: We examined the association between perceived discrimination and the risk of cognitive impairment with no dementia (CIND) and Alzheimer's disease and related dementias (ADRD) while considering the potential effects of nativity status.; Design: A prospective analysis of discrimination and nativity status with dementia and cognitive impairment was conducted among Latinx adults aged 51 years and older who participated in the Health and Retirement Study.; Setting: A national representative sample.; Participants: A sample of 1,175 Latinx adults aged 51 years and older.; Measurements: Demographics, cognitive functioning, perceived discrimination, and nativity status (US-born vs. non-US born) were assessed. Traditional survival analysis methods (Fine and gray models) were used to account for the semi-competing risk of death with up to 10 years of follow-up.; Results: According to our results, neither everyday discrimination nor nativity status on their own had a statistically significant association with CIND/ADRD; however, non-US-born Latinx adults who reported no discrimination had a 42% lower risk of CIND/ADRD (SHR = 0.58 [0.41, 0.83], p = .003) than US-born adults.; Conclusions: These results highlight the need for healthcare providers to assess for discrimination and provide support and resources for those experiencing discrimination. It also highlights the need for better policies that address discrimination and reduce health disparities. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Hispanics/Latinos, Migration, Structural inequality | Link | Tibiriçá, L., Jester, D. J., Kohn, J. N., Williams, A. P., McEvoy, L. K., & Palmer, B. W. (2023). Perceived discrimination and nativity status: risk of cognitive impairment among Latin American older adults. International psychogeriatrics, 1–13. Advance online publication. | International Psychogeriatrics |
| Explainable variational autoencoder (E-VAE) model using genome-wide SNPs to predict dementia. | Vivek, Sithara; Faul, Jessica; Thyagarajan, Bharat; Guan, Weihua | 2023 | Objective: Alzheimer's disease (AD) and AD related dementias (ADRD) are complex multifactorial neurodegenerative diseases. The associations between genetic variants obtained from genome wide association studies (GWAS) are the most widely available and well documented variants associated with ADRD. Application of deep learning methods to analyze large scale GWAS data may be a powerful approach to elucidate the biological mechanisms in ADRD compared to penalized regression models that may lead to over-fitting.; Methods: We developed a deep learning frame work explainable variational autoencoder (E-VAE) classifier model using genotype (GWAS SNPs = 5474) data from 2714 study participants in the Health and Retirement Study (HRS) to classify ADRD. We validated the generalizability of this model among 234 participants in the Religious Orders Study and Memory and Aging Project (ROSMAP). Utilizing a linear decoder approach we have extracted the weights associated with latent features for biological interpretation.; Results: We obtained a predictive accuracy of 0.71 (95 % CI [0.59, 0.84]) with an AUC of 0.69 in the HRS test dataset and got an accuracy of 0.62 (95 % CI [0.56, 0.68]) with an AUC of 0.63 in the ROSMAP dataset.; Conclusion: This is the first study showing the generalizability of a deep learning prediction model for dementia using genetic variants in an independent cohort. The latent features identified using E-VAE can help us understand the biology of AD/ ADRD and better characterize disease status. | Health and Retirement Study (HRS) | Biological Mechanisms | Dementia, Genetics, Memory, Methodology | Link | Vivek, S., Faul, J., Thyagarajan, B., & Guan, W. (2023). Explainable variational autoencoder (E-VAE) model using genome-wide SNPs to predict dementia. Journal of biomedical informatics, 148, 104536. | Journal of Biomedical Informatics |
| Race, gender, and cohort differences in the educational experiences of Black and White Americans | Walsemann, Katrina M; Fisk, Calley E; Farina, Mateo P; Abbruzzi, Emily; Ailshire, Jennifer A | 2023 | Federal legislation and judicial intervention led to significant transformation in the U.S. education system during the early to mid-twentieth century. These changes may differentiate older adults in their experiences of aging, particularly at the intersection of race, gender, and cohort, but are not well documented among current cohorts of older adults. Our study addresses this gap by providing rich, descriptive information on the educational experiences of U.S. adults who attended primary or secondary school between 1915 and 1977. We used data from the Health and Retirement Study (HRS), a nationally representative, prospective study of U.S. adults over age 50 years. The HRS collected information on respondents’ schooling history and experiences through a Life History Mail Survey (LHMS). We restricted our sample to age-eligible HRS-LHMS respondents who self-identified as non-Hispanic White or non-Hispanic Black and completed at least 75% of their primary or secondary schooling in the U.S. (n = 10,632). Educational experiences, defined as pre-k to post-secondary education, varied across cohort, regardless of race or gender. Greater course offerings, improvements in learning support, and increasing exposure to integrated schools occurred across successive cohorts. We found the highest rates of enrollment in college preparatory curriculum and foreign-language courses as well as diagnosed learning differences in cohorts born after 1948. Among White adults, many of the gender differences in educational experiences documented in the oldest cohort were still found among the most recent cohort. Few gender differences, however, were found for Black adults regardless of cohort. Conversely, most race inequities in educational experiences persisted. Such inequities may be an important source of continued differences in experiences of aging observed across demographic groups. | Health and Retirement Study (HRS) | Early Life | APOE, Childhood/Adolescence, Cognitive function, Educational attainment, Gender/Sex, Genetics, Racial-ethnic disparities, School quality, School segregation | Link | Walsemann, K. M., Fisk, C. E., Farina, M. P., Abbruzzi, E., & Ailshire, J. A. (2023). Race, gender, and cohort differences in the educational experiences of Black and White Americans. Population Research and Policy Review, 42(6), 86. | Population Research and Policy Review |
| State-level desegregation in the U.S. South and mid-life cognitive function among Black and White adults | Walsemann, Katrina M; Hair, Nicole L; Farina, Mateo P; Tyagi, Pallavi; Jackson, Heide; Ailshire, Jennifer A | 2023 | Rationale: Black adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s–1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function. Objective: We determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents’ educational attainment. Methods: We linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects. Results: Greater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment. Conclusions: Our findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Childhood/Adolescence, Dementia, Memory, Mortality, Racial-ethnic disparities, School segregation, Socioeconomic status, Structural inequality | Link | Walsemann, K. M., Hair, N. L., Farina, M. P., Tyagi, P., Jackson, H., & Ailshire, J. A. (2023). State-level desegregation in the U.S. South and mid-life cognitive function among Black and White adults. Social Science & Medicine, 338, 116319. | SSM - Population Health |
| Associations Between Midlife Menopausal Hormone Therapy Use, Incident Diabetes, and Late Life Memory in the Wisconsin Longitudinal Study. | Williams, Victoria J; Koscik, Rebecca; Sicinski, Kamil; Johnson, Sterling C; Herd, Pamela; Asthana, Sanjay | 2023 | Background: Prior research suggests a link between menopausal hormone therapy (MHT) use, memory function, and diabetes risk. The menopausal transition is a modifiable period to enhance long-term health and cognitive outcomes, although studies have been limited by short follow-up periods precluding a solid understanding of the lasting effects of MHT use on cognition.; Objective: We examined the effects of midlife MHT use on subsequent diabetes incidence and late life memory performance in a large, same-aged, population-based cohort. We hypothesized that the beneficial effects of MHT use on late life cognition would be partially mediated by reduced diabetes risk.; Methods: 1,792 women from the Wisconsin Longitudinal Study (WLS) were included in analysis. We employed hierarchical linear regression, Cox regression, and causal mediation models to test the associations between MHT history, diabetes incidence, and late life cognitive performance.; Results: 1,088/1,792 women (60.7%) reported a history of midlife MHT use and 220/1,792 (12.3%) reported a history of diabetes. MHT use history was associated with better late life immediate recall (but not delayed recall), as well as a reduced risk of diabetes with protracted time to onset. Causal mediation models suggest that the beneficial effect of midlife MHT use on late life immediate recall were at least partially mediated by diabetes risk.; Conclusion: Our data support a beneficial effect of MHT use on late life immediate recall (learning) that was partially mediated by protection against diabetes risk, supporting MHT use in midlife as protective against late life cognitive decline and adverse health outcomes. | Wisconsin Longitudinal Study (WLS) | Biological Mechanisms, Mid-Life Factors | Alzheimer's disease, Health behavior, Memory, Reproductive health | Link | Williams, V. J., Koscik, R., Sicinski, K., Johnson, S. C., Herd, P., & Asthana, S. (2023). Associations Between Midlife Menopausal Hormone Therapy Use, Incident Diabetes, and Late Life Memory in the Wisconsin Longitudinal Study. Journal of Alzheimer's disease : JAD, 93(2), 727–741. | Journal of Alzheimer's Disease |
| Urban but not rural patterns of ambient air pollution exposure is associated with an accelerated rate of late life memory decline in the Wisconsin Longitudinal Study. | Williams, Victoria J; Sicinski, Kamil; Herd, Pamela; Asthana, Sanjay | 2023 | Background: Exposure to ambient air pollution is an emerging risk factor for dementia, yet air pollution levels are found to vary by neighborhood affluence and across rural/urban settings. In this study, we leverage data from the Wisconsin Longitudinal Study (WLS) to evaluate the effects of ambient air pollution exposure on the rate of memory decline in late life, while accounting for both local (neighborhood) and regional (urbanization) residency characteristics. Method: Annualized rate of change for both immediate and delayed recall trials of a 10-item word list were calculated between 2010-1 (baseline) and 2021-2 (follow-up) data collection waves. Yearly averages of geocoded regional air pollution data were obtained for 5 pollutants at baseline: particulate matter > 2.5um (PM2.5), ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO). Principal component analysis was performed to reduce multicollinearity among the 5 pollutants in subsequent analyses. Annualized rate of change in memory measures were regressed on resultant pollutant factor scores, additionally controlling for baseline age, adolescent IQ, education, health conditions (heart disease, stroke, hypertension, diabetes), neighborhood-level deprivation, ApolipoproteinE-4 (ApoE-4) status, and sex. Result: 3,601 WLS participants were included in analyses, with a mean age of 70.4±3.4 years at baseline and 80.1±3.4 years at follow-up. PCA yielded a 2-factor solution classifying air pollutants into distinct urban (PM2.5, NO2, and CO2) versus rural (SO2 and O3) composites. Linear regression analysis revealed that greater annualized decline in delayed recall was predicted by higher exposure to urban air pollutants (but not rural), adolescent IQ, older age at baseline, and a history of heart disease. Air pollution exposure did not predict annualized change in immediate recall. Conclusion: Using longitudinal data from the WLS cohort, we find that higher levels of urban ambient air pollutant exposure predicted a more precipitous decline in delayed memory across late life. This finding remained significant after controlling for relevant confounders including neighborhood disadvantage, adolescent IQ, and ApoE-4 status. Although the effect size of pollution exposure on the rate of memory decline was small, it remains a modifiable risk factor and stands to inform public policies to optimize late life cognition. | Wisconsin Longitudinal Study (WLS) | Early Life, Mid-Life Factors | APOE, Cognitive function, Environmental exposure, Geographic disparities, Memory, Neighborhoods, Structural inequality | Link | Williams, V. J., Sicinski, K., Herd, P., & Asthana, S. (2023). Urban but not rural patterns of ambient air pollution exposure is associated with an accelerated rate of late life memory decline in the Wisconsin Longitudinal Study. Alzheimer's & Dementia, 19, e080470. | Alzheimer's & Dementia |
| Black-White Differences in Offspring Educational Attainment and Older Parents' Dementia. | Yahirun, Jenjira J; Vasireddy, Sindhu; Hayward, Mark D | 2023 | Emerging research documents the health benefits of having highly educated adult offspring. Yet less is known about whether those advantages vary across racial groups. This study examines how offspring education is tied to parents' dementia risk for Black and White parents in the United States. Using data from the Health and Retirement Study, findings suggest that children's education does not account for the Black-White gap in dementia risk. However, results confirm that parental race moderates the relationship between children's education and dementia risk and that the association between children's education and parents' dementia risk is strongest among less-educated parents. Among less-educated parents, higher levels of children's attainment prevent the risk of dementia onset for Black parents, but low levels of offspring schooling increase dementia risk among White parents. The study highlights how offspring education shapes the cognitive health of social groups differently and points to new avenues for future research. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Cognitive function, Dementia, Educational attainment, Racial-ethnic disparities | Link | Yahirun, J. J., Vasireddy, S., & Hayward, M. D. (2023). Black-White Differences in Offspring Educational Attainment and Older Parents' Dementia. Journal of health and social behavior, 64(4), 503–519. | Journal of Health and Social Behavior |
| Cumulative loneliness and subsequent memory function and rate of decline among adults aged ≥50 in the United States, 1996 to 2016 | Yu, Xuexin; Westrick, Ashly C; Kobayashi, Lindsay C | 2023 | Introduction: The study objective was to investigate the association between loneliness duration and memory function over a 20-year period.; Methods: Data were from 9032 adults aged ≥50 in the Health and Retirement Study. Loneliness status (yes vs. no) was assessed biennially from 1996 to 2004 and its duration was categorized as never, 1 time point, 2 time points, and ≥3 time points. Episodic memory was assessed from 2004 to 2016 as a composite of immediate and delayed recall trials combined with proxy-reported memory. Mixed-effects linear regression models were fitted.; Results: A longer duration of loneliness was associated with lower memory scores (P < 0.001) and a faster rate of decline (P < 0.001). The association was stronger among adults aged ≥65 than those aged <65 (three-way interaction P = 0.013) and was stronger among women than men (three-way interaction P = 0.002).; Discussion: Cumulative loneliness may be a salient risk factor for accelerated memory aging, especially among women aged ≥65.; Highlight: A longer duration of loneliness was associated with accelerated memory aging. The association was stronger among women than men and among older adults than the younger. Reducing loneliness in mid- to late life may help maintain memory function. | Health and Retirement Study (HRS) | Mid-Life Factors | Loneliness, Memory | Link | Yu, X., Westrick, A. C., & Kobayashi, L. C. (2023). Cumulative loneliness and subsequent memory function and rate of decline among adults aged ≥50 in the United States, 1996 to 2016. Alzheimer's & dementia : the journal of the Alzheimer's Association, 19(2), 578–588. | Alzheimer's & Dementia |
| Geographic Patterns of Dementia in the United States: Variation by Place of Residence, Place of Birth, and Subpopulation. | Zacher, Meghan; Brady, Samantha; Short, Susan E | 2023 | Objectives: The prevalence of dementia varies geographically in the United States. However, the extent to which this variation reflects contemporary place-based experiences versus embodied exposures from earlier in the life course remains unclear, and little is known regarding the intersection of place and subpopulation. This study, therefore, evaluates whether and how risk for assessed dementia varies by place of residence and birth, overall and by race/ethnicity and education.; Methods: We pool data from the 2000 to 2016 waves of the Health and Retirement Study, a nationally representative panel survey of older U.S. adults (n = 96,848 observations). We estimate the standardized prevalence of dementia by Census division of residence and birth. We then fit logistic regression models of dementia on region of residence and birth, adjusting for sociodemographic characteristics, and examine interactions between region and subpopulation.; Results: The standardized prevalence of dementia ranges from 7.1% to 13.6% by division of residence and from 6.6% to 14.7% by division of birth, with rates highest throughout the South and lowest in the Northeast and Midwest. In models accounting for region of residence, region of birth, and sociodemographic covariates, Southern birth remains significantly associated with dementia. Adverse relationships between Southern residence or birth and dementia are generally largest for Black and less-educated older adults. As a result, sociodemographic disparities in predicted probabilities of dementia are largest for those residing or born in the South.; Discussion: The sociospatial patterning of dementia suggests its development is a lifelong process involving cumulated and heterogeneous lived experiences embedded in place. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Cognitive function, Educational attainment, Geographic disparities, Racial-ethnic disparities | Link | Zacher, M., Brady, S., & Short, S. E. (2023). Geographic Patterns of Dementia in the United States: Variation by Place of Residence, Place of Birth, and Subpopulation. The journals of gerontology. Series B, Psychological sciences and social sciences, 78(7), 1192–1203. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Hypertension and Stroke as Mediators of Air Pollution Exposure and Incident Dementia. | Zhang, Boya; Langa, Kenneth M; Weuve, Jennifer; D'Souza, Jennifer; Szpiro, Adam; Faul, Jessica; Mendes de Leon, Carlos; Kaufman, Joel D; Lisabeth, Lynda; Hirth, Richard A; Adar, Sara D | 2023 | Importance: Fine particulate matter air pollution (PM2.5) has been consistently associated with cardiovascular disease, which, in turn, is associated with an increased risk of dementia. As such, vascular dysfunction might be a mechanism by which PM2.5 mediates dementia risk, yet few prior epidemiological studies have examined this potential mechanism.; Objective: To investigate whether hypertension and stroke serve as mediators and modifiers of the association of PM2.5 with incident dementia.; Design, Setting, and Participants: As part of the Environmental Predictors of Cognitive Health and Aging (EPOCH) Project, this cohort study used biennial survey data collected between 1998 and 2016 from respondents of the Health and Retirement Study (HRS), a nationally representative, population-based, cohort in the US. Eligible participants were those over 50 years of age who were free of dementia at baseline and had complete exposure, mediator, outcome, and demographic data from the HRS. Data analysis was conducted from August to November 2022.; Exposures: Exposure to PM2.5, calculated for the 10 years preceding each person's baseline examination according to residential histories and spatiotemporal models.; Main Outcomes and Measures: Incident dementia was identified using a validated algorithm based on cognitive testing and informant reports. The 4-way decomposition causal mediation analysis method was used to quantify the degree to which hypertension and stroke mediated or modified the association of PM2.5 with incident dementia after adjustment for individual-level and area-level covariates.; Results: Among 27 857 participants (mean [SD] age at baseline, 61 [10] years; 15 747 female participants [56.5%]; 19 249 non-Hispanic White participants [69.1%]), 4105 (14.7%) developed dementia during the follow-up period (mean [SD], 10.2 [5.6] years). Among participants with dementia, 2204 (53.7%) had a history of hypertension at baseline and 386 (9.4%) received a diagnosis of hypertension during the follow up. A total of 378 participants (9.2%) had a history of stroke at baseline and 673 (16.4%) developed stroke over the follow-up period. The IQR of baseline PM2.5 concentrations was 10.9 to 14.9 μg/m3. In fully adjusted models, higher levels of PM2.5 (per IQR) were not associated with increased risk of incident dementia (HR, 1.04; 95% CI, 0.98 to 1.11). Although there were positive associations of prevalent stroke (HR, 1.67; 95% CI, 1.48 to 1.88) and hypertension (HR, 1.15; 95% CI, 1.08 to 1.23) with incident dementia compared with those free of stroke and hypertension during follow-up, there was no statistically significant association of PM2.5 with stroke (odds ratio per IQR increment in PM2.5, 1.08; 95%CI, 0.91 to 1.29) and no evidence of an association of PM2.5 with hypertension (odds ratio per IQR increment in PM2.5, 0.99; 95%CI, 0.92 to 1.07). Concordantly, there was no evidence that hypertension or stroke acted as mediators or modifiers of the association of PM2.5 with incident dementia. Although the nonmediated interaction between PM2.5 and hypertension accounted for 39.2% of the total excess association (95% CI, -138.5% to 216.9%), the findings were not statistically significant.; Conclusions and Relevance: These findings suggest that although hypertension may enhance the susceptibility of individuals to air pollution, hypertension and stroke do not significantly mediate or modify the association of PM2.5 with dementia, indicating the need to investigate other pathways and potential mediators of risk. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Cardiometabolic health, Cognitive function, Dementia, Environmental exposure | Link | Zhang, B., Langa, K. M., Weuve, J., D'Souza, J., Szpiro, A., Faul, J., Mendes de Leon, C., Kaufman, J. D., Lisabeth, L., Hirth, R. A., & Adar, S. D. (2023). Hypertension and Stroke as Mediators of Air Pollution Exposure and Incident Dementia. JAMA network open, 6(9), e2333470. | JAMA Network Open |
| Comparison of Particulate Air Pollution From Different Emission Sources and Incident Dementia in the US. | Zhang, Boya; Weuve, Jennifer; Langa, Kenneth M; D'Souza, Jennifer; Szpiro, Adam; Faul, Jessica; Mendes de Leon, Carlos; Gao, Jiaqi; Kaufman, Joel D; Sheppard, Lianne; Lee, Jinkook; Kobayashi, Lindsay C; Hirth, Richard; Adar, Sara D | 2023 | Importance: Emerging evidence indicates that exposure to fine particulate matter (PM2.5) air pollution may increase dementia risk in older adults. Although this evidence suggests opportunities for intervention, little is known about the relative importance of PM2.5 from different emission sources.; Objective: To examine associations of long-term exposure of total and source-specific PM2.5 with incident dementia in older adults.; Design, Setting, and Participants: The Environmental Predictors of Cognitive Health and Aging study used biennial survey data from January 1, 1998, to December 31, 2016, for participants in the Health and Retirement Study, which is a nationally representative, population-based cohort study in the US. The present cohort study included all participants older than 50 years who were without dementia at baseline and had available exposure, outcome, and demographic data between 1998 and 2016 (N = 27 857). Analyses were performed from January 31 to May 1, 2022.; Exposures: The 10-year mean total PM2.5 and PM2.5 from 9 emission sources at participant residences for each month during follow-up using spatiotemporal and chemical transport models.; Main Outcomes and Measures: The main outcome was incident dementia as classified by a validated algorithm incorporating respondent-based cognitive testing and proxy respondent reports. Adjusted hazard ratios (HRs) were estimated for incident dementia per IQR of residential PM2.5 concentrations using time-varying, weighted Cox proportional hazards regression models with adjustment for the individual- and area-level risk factors.; Results: Among 27 857 participants (mean [SD] age, 61 [10] years; 15 747 [56.5%] female), 4105 (15%) developed dementia during a mean (SD) follow-up of 10.2 [5.6] years. Higher concentrations of total PM2.5 were associated with greater rates of incident dementia (HR, 1.08 per IQR; 95% CI, 1.01-1.17). In single pollutant models, PM2.5 from all sources, except dust, were associated with increased rates of dementia, with the strongest associations for agriculture, traffic, coal combustion, and wildfires. After control for PM2.5 from all other sources and copollutants, only PM2.5 from agriculture (HR, 1.13; 95% CI, 1.01-1.27) and wildfires (HR, 1.05; 95% CI, 1.02-1.08) were robustly associated with greater rates of dementia.; Conclusion and Relevance: In this cohort study, higher residential PM2.5 levels, especially from agriculture and wildfires, were associated with higher rates of incident dementia, providing further evidence supporting PM2.5 reduction as a population-based approach to promote healthy cognitive aging. These findings also indicate that intervening on key emission sources might have value, although more research is needed to confirm these findings. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Dementia, Environmental exposure, Structural inequality | Link | Zhang, B., Weuve, J., Langa, K. M., D'Souza, J., Szpiro, A., Faul, J., Mendes de Leon, C., Gao, J., Kaufman, J. D., Sheppard, L., Lee, J., Kobayashi, L. C., Hirth, R., & Adar, S. D. (2023). Comparison of Particulate Air Pollution From Different Emission Sources and Incident Dementia in the US. JAMA internal medicine, 183(10), 1080–1089. | JAMA Internal Medicine |
| Predictors of cognitive functioning trajectories among older Americans: A new investigation covering 20 years of age- and non-age-related cognitive change. | Zheng, Hui; Cagney, Kathleen; Choi, Yoonyoung | 2023 | Despite the extensive study of predictors of cognitive decline in older age, a key uncertainty is how much these predictors explain both the intercept and age- and non-age-related change in cognitive functioning (CF). We examined the contribution of a broad range of life course determinants to CF trajectories. Data came from 7,068 participants in the 1996-2016 Health and Retirement Study. CF was measured as a summary score on a 27-point cognitive battery of items. We estimated multilevel growth curve models to examine the CF trajectories in individuals ages 54-85. We found that the variation in CF level at age 54 was three times as much as the variation in age slope. All the observed individual predictors explained 38% of the variation in CF at age 54. Personal education was the most important predictor (25%), followed by race, household wealth and income, parental education, occupation, and depression. The contributions of activity limitations, chronic diseases, health behaviors (obesity, smoking, vigorous activity), childhood conditions (childhood health, nutrition, financial situation), gender, marital status, and religion were rather small (<5%). Even though the age slope varied with many adulthood factors, they only explained 5.6% of the between-person variation in age slope. Moreover, age explained 23% of within-person variation in CF from age 54 to 85. The rest non-age-related within-person variation could not be explained by the observed time-varying factors. These findings suggest that future research is urgently needed to discover the main determinants of the slope of cognitive decline to slow down the progression of cognitive impairment and dementia. | Health and Retirement Study (HRS) | Mid-Life Factors | Childhood/Adolescence, Cognitive function, Educational attainment, Health behavior, Mental health, Socioeconomic status | Link | Zheng, H., Cagney, K., & Choi, Y. (2023). Predictors of cognitive functioning trajectories among older Americans: A new investigation covering 20 years of age- and non-age-related cognitive change. PloS one, 18(2), e0281139. | PloS One |
| Childhood and Adulthood Trauma Associate With Cognitive Aging Among Black and White Older Adults. | Zuelsdorff, Megan; Sonnega, Amanda; Barnes, Lisa L; Byrd, DeAnnah R; Rose, Deborah K; Cox, Robynn; Norton, Derek; Turner, Robert W | 2023 | Sociocontextual factors powerfully shape risk for age-related cognitive impairment, including excess risk burdening medically underserved populations. Lifecourse adversity associates with cognitive aging, but harms are likely mitigable. Understanding population-salient relationships and sensitive periods for exposure is crucial for targeting clinical interventions.; Objective: The authors examined childhood and adulthood traumatic events in relation to cognition among Black and White older adults in the Health and Retirement Study (HRS).; Participants: Participants (N = 13,952) aged 55+ had complete lifetime trauma and cognitive testing data at the 2006/08, 2010/12, and/or 2014/16 waves.; Measures: Trauma indices comprised childhood and adulthood event counts. Outcomes included baseline performance and trajectories on the Telephone Interview for Cognitive Status.; Design: Main and nonlinear trauma effects were modeled via linear regression, and overall contributions assessed with omnibus likelihood ratio tests.; Results: Black participants (N = 2,345) reported marginally lower adulthood trauma exposure than White participants (N = 11,607) with no other exposure differentials observed. In White participants only, greater childhood trauma exposure predicted worse baseline cognition but slower change over time. Across race, adulthood trauma robustly associated with baseline cognition. Relationships were frequently nonlinear: low but nonzero trauma predicted highest cognitive scores, with much poorer cognition observed as trauma exposure increased. Relationships between adulthood trauma and trajectory were limited to the White sample.; Conclusion: Traumatic experiences, particularly in adulthood, may impact late-life cognitive health if not addressed. Findings highlight foci for clinical researchers and providers: adverse life events as a source of cognitive risk, and identification of community-specific resources that buffer behavioral, physical, and mental health sequelae of previous and incident trauma. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Mental health, Racial-ethnic disparities, Stress, Trauma | Link | Zuelsdorff, M., Sonnega, A., Barnes, L. L., Byrd, D. R., Rose, D. K., Cox, R., ... & Turner, R. W. (2023). Childhood and Adulthood Trauma Associate With Cognitive Aging Among Black and White Older Adults. The American Journal of Geriatric Psychiatry. | The American Journal of Geriatric Psychiatry |
| Regional variation in U.S dementia trends from 2000-2012. | Ailshire, Jennifer A; Walsemann, Katrina M; Fisk, Calley E | 2022 | Although recent studies report a decline in dementia prevalence among U.S. older adults, national trends may mask subnational variation, particularly given large health and social inequalities linked to geography. To address this gap, we determined if there was subnational variation in reported national dementia trends and if region-specific trends were explained by sociodemographic and health characteristics. Data come from the 2000 (n = 10,447) and 2012 (10,426) waves of the Health and Retirement Study. We used validated methods for dementia classification using proxy and self-respondents. Logistic regression models, adjusted for within-person clustering over time, estimated trends in dementia prevalence by region and census division. We found subnational variation in dementia prevalence in both 2000 and 2012, as well as in change in dementia prevalence during this period. In 2000, dementia prevalence was lowest in the West (8.6%), higher in the Midwest (10.0%) and Northeast (11.1%), and highest in the South (14.6%). Dementia prevalence declined over time across all regions of the U.S. from 2000 to 2012 but remained highest in the South (10.7%) compared to the other regions (7.0-7.8%). Despite downward trends in dementia across the U.S., the prevalence of dementia in the South in 2012 approximated levels found in other regions in 2000. There was relatively less change over time in the West compared to other regions, but dementia prevalence was already quite low in the West in 2000. Within region, trends in dementia prevalence between 2000 and 2012 also varied slightly across census divisions. Subnational variation in changes in dementia prevalence were largely explained by education and health status. Variation in baseline prevalence, as well as differential rates of change, highlight the importance of examining subnational variation in dementia trends. | Health and Retirement Study (HRS) | Mid-Life Factors | Dementia, Geographic disparities, Structural inequality | Link | Ailshire, J. A., Walsemann, K. M., & Fisk, C. E. (2022). Regional variation in U.S dementia trends from 2000-2012. SSM - population health, 19, 101164. https://doi.org/10.1016/j.ssmph.2022.101164 | SSM - Population Health |
| Older Adults with Dementia: Association of Prayer with Neuropsychiatric Symptoms, Cognitive Function, and Sleep Disturbances. | Britt, Katherine Carroll; Richards, Kathy C; Acton, Gayle; Hamilton, Jill; Radhakrishnan, Kavita | 2022 | Protective factors that slow dementia progression and improve quality of life are needed. Neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances are commonly found in dementia, indicate progression, and increase caregiver distress. The purpose of this study was to examine the association of private prayer with NPS, cognitive function, and sleep disturbances in older adults with dementia. We analyzed data from the Health and Retirement Study in 2000, 2006, and 2008 and Aging, Demographics, and Memory Sub study in 2001-2003, 2006-2007, and 2008-2009 among 40 older adults (age 70-100 years, mean age = 84.67, 29 females and 11 males, 73.9% non-Hispanic White, and 19.2% Non-Hispanic Black, and 3% Hispanic, cognitive function = 1.169 indicating mild cognitive impairment) using correlational analysis. The results indicated that increased frequency of private prayer was significantly associated with lower NPS, better cognitive function, and lower sleep disturbances. In total, 100% of Non-Hispanic Black and Hispanic participants reported praying at least once per week. Findings could be due to use of cognitive processes used in prayer during supplication, requesting aid, and through communication with the divine, reducing loneliness. Longitudinal studies including historically underrepresented populations are needed to examine these associations over time. | Health and Retirement Study (HRS) | Mid-Life Factors | Alzheimer's disease, Health behavior, Loneliness, Memory, Mental health, Religion and spirituality, Stress | Link | Britt, K. C., Richards, K. C., Acton, G., Hamilton, J., & Radhakrishnan, K. (2022). Older Adults with Dementia: Association of Prayer with Neuropsychiatric Symptoms, Cognitive Function, and Sleep Disturbances. Religions, 13(10), 973. | Religions |
| Sibling Deaths, Racial/Ethnic Disadvantage, and Dementia in Later Life. | Cha, Hyungmin; Thomas, Patricia A; Umberson, Debra | 2022 | Objectives: Sibling loss is understudied in the bereavement and health literature. The present study considers whether experiencing the death of siblings in mid-to-late life is associated with subsequent dementia risk and how differential exposure to sibling losses by race/ethnicity may contribute to racial/ethnic disparities in dementia risk.; Methods: We use discrete-time hazard regression models, a formal mediation test, and a counterfactual simulation to reveal how sibling loss in mid-to-late life affects dementia incidence and whether unequal exposures by race/ethnicity mediate the racial/ethnic disparities in dementia. We analyze data from the Health and Retirement Study (2000-2016). The sample includes 13,589 respondents (10,670 non-Hispanic White, 1,761 non-Hispanic Black, and 1,158 Hispanic adults) aged 65 years and older in 2000 who show no evidence of dementia at baseline.; Results: Discrete-time hazard regression results show that sibling loss in mid-to-late life is associated with up to 54% higher risk for dementia. Sibling loss contributes to Black-White disparities in dementia risk. In addition, a simulation analysis shows that dementia rates would be 14% lower for Black adults if they experienced the lower rates of sibling loss experienced by White adults. This pattern was not observed among Hispanic adults.; Discussion: The death of a sibling in mid-to-late life is a stressor that is associated with increased dementia risk. Black adults are disadvantaged in that they are more likely than Whites to experience the death of siblings, and such losses contribute to the already substantial racial/ethnic disadvantage in dementia. | Health and Retirement Study (HRS) | Mid-Life Factors | Bereavement, Dementia, Family, Racial-ethnic disparities, Stress | Link | Cha, H., Thomas, P. A., & Umberson, D. (2022). Sibling Deaths, Racial/Ethnic Disadvantage, and Dementia in Later Life. The journals of gerontology. Series B, Psychological sciences and social sciences, 77(8), 1539–1549. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Does a Cancer Diagnosis in Mid-to-Later Life Modify Racial Disparities in Memory Aging? | Eastman, Marisa R; Ospina-Romero, Monica; Westrick, Ashly C; Kler, Jasdeep S; Glymour, Medellena Maria; Abdiwahab, Ekland; Kobayashi, Lindsay C | 2022 | Background: It is unknown whether an incident cancer diagnosis differentially impacts acute and long-term memory aging between older White and Black Americans.; Methods: Incident cancer diagnoses and memory (immediate and delayed recall, combined with proxy-reported memory) were assessed at biennial study interviews in the US Health and Retirement Study (N=14,235, 1998-2016). We used multivariable segmented linear mixed-effects models to evaluate the rate of change in standardized memory score (SD/decade) in the years before, acutely at the time of, and in the years following an incident cancer diagnosis, compared to cancer-free adults, by race.; Results: Black participants experienced faster memory decline than White participants (cancer-free group: -1.211 vs. -1.077; P<0.0001). An incident cancer diagnosis was associated with an acute memory drop in White, but not Black participants (-0.065 vs. 0.024; P<0.0001). However, White cancer survivors experienced slower memory decline than cancer-free White adults before and after diagnosis, but this memory advantage was not observed among Black cancer survivors.; Conclusions: Racial disparities in memory aging are not modified by an incident cancer diagnosis. The acute cancer-related memory decline and long-term memory advantage experienced by White, but not Black, cancer survivors relative to cancer-free older adults, requires further investigation. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Memory, Racial-ethnic disparities | Link | Eastman, M. R., Ospina-Romero, M., Westrick, A. C., Kler, J. S., Glymour, M. M., Abdiwahab, E., & Kobayashi, L. C. (2022). Does a Cancer Diagnosis in Mid-to-Later Life Modify Racial Disparities in Memory Aging?. Alzheimer disease and associated disorders, 36(2), 140–147. | Alzheimer Disease and Associated Disorders |
| Links between inflammation and immune functioning with cognitive status among older Americans in the Health and Retirement Study. | Farina, Mateo P; Kim, Jung Ki; Hayward, Mark D; Crimmins, Eileen M | 2022 | Elevated inflammation and poor immune functioning are tied to worse cognitive health. Both processes are fundamental to aging and are strongly implicated in the development of age-related health outcomes, including cognitive status. However, results from prior studies evaluating links between indicators of inflammation and immune function and cognitive impairment have been inconsistent due to biomarker selection, sample selection, and cognitive outcome. Using the Health and Retirement Study (HRS), a nationally representative study of older adults in the United States, we assessed how indicators of inflammation (neutrophil-lymphocyte ratio (NLR), albumin, CRP, IL6, IL10, IL-1Ra, sTNFR1, and TGFβ1) and immune functioning (CMV, CD4 + T N /T M, and CD8 + T N /T M ) are associated with cognitive status. First, to examine the association between each biomarker and cognitive status, we tested whether markers of inflammation and immune functioning varied across cognitive status categories. We found that dementia and cognitive impairment without dementia (CIND) were associated with elevated inflammation and poorer immune functioning across biomarkers except for CD4 + T N /T M . Next, we estimated multinomial logistic regression models to assess which biomarkers would continue to be associated with dementia and CIND, net of each other. In these models, albumin, cytokines, CMV, CD4 + T N /T M, and CD8 + T N /T M are associated with cognitive status. Because poor immune functioning and increased inflammation are associated with cognitive impairment, improving immune functioning and reducing inflammation may provide a mechanism for reducing ADRD risk in the population. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Biomarkers, Dementia, Immune function, Inflammation | Link | Farina, M. P., Kim, J. K., Hayward, M. D., & Crimmins, E. M. (2022). Links between inflammation and immune functioning with cognitive status among older Americans in the Health and Retirement Study. Brain, behavior, & immunity - health, 26, 100559. | Brain, Behavior, & Immunity - Health |
| Trans-Ethnic Meta-Analysis of Interactions Between Genetics and Early-Life Socioeconomic Context on Memory Performance and Decline in Older Americans. | Faul, Jessica D; Kho, Minjung; Zhao, Wei; Rumfelt, Kalee E; Yu, Miao; Mitchell, Colter; Smith, Jennifer A | 2022 | Background: Later-life cognitive function is influenced by genetics as well as early- and later-life socioeconomic context. However, few studies have examined the interaction between genetics and early childhood factors.; Methods: Using gene-based tests (interaction sequence kernel association test [iSKAT]/iSKAT optimal unified test), we examined whether common and/or rare exonic variants in 39 gene regions previously associated with cognitive performance, dementia, and related traits had an interaction with childhood socioeconomic context (parental education and financial strain) on memory performance or decline in European ancestry (EA, N = 10 468) and African ancestry (AA, N = 2 252) participants from the Health and Retirement Study.; Results: Of the 39 genes, 22 in EA and 19 in AA had nominally significant interactions with at least one childhood socioeconomic measure on memory performance and/or decline; however, all but one (father's education by solute carrier family 24 member 4 [SLC24A4] in AA) were not significant after multiple testing correction (false discovery rate [FDR] < .05). In trans-ethnic meta-analysis, 2 genes interacted with childhood socioeconomic context (FDR < .05): mother's education by membrane-spanning 4-domains A4A (MS4A4A) on memory performance, and father's education by SLC24A4 on memory decline. Both interactions remained significant (p < .05) after adjusting for respondent's own educational attainment, apolipoprotein-ε4 allele (APOE ε4) status, lifestyle factors, body mass index, and comorbidities. For both interactions in EA and AA, the genetic effect was stronger in participants with low parental education.; Conclusions: Examination of common and rare variants in genes discovered through genome-wide association studies shows that childhood context may interact with key gene regions to jointly impact later-life memory function and decline. Genetic effects may be more salient for those with lower childhood socioeconomic status. | Health and Retirement Study (HRS) | Biological Mechanisms, Early Life, Mid-Life Factors | APOE, Childhood/Adolescence, Cognitive function, Genetics, Memory, Socioeconomic status | Link | Faul, J. D., Kho, M., Zhao, W., Rumfelt, K. E., Yu, M., Mitchell, C., & Smith, J. A. (2022). Trans-Ethnic Meta-Analysis of Interactions Between Genetics and Early-Life Socioeconomic Context on Memory Performance and Decline in Older Americans. The journals of gerontology. Series A, Biological sciences and medical sciences, 77(11), 2248–2256. | The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences |
| Life course linkages between enriching early-life activities and later life cognition: Evidence from the Wisconsin Longitudinal Study. | Greenfield, Emily A; Reynolds, Addam; Moorman, Sara M | 2022 | Prior research suggests that participation in enriching early-life activities (EELAs) has long-term benefits for cognitive health and aging. This study aims to examine the life course processes underlying these associations by drawing on theoretical models from life course epidemiology. Specifically, we tested sensitive-period effects, social pathways, and selection effects as potential explanations for linkages between greater participation in EELAs and better later life cognition. We drew on data from the Wisconsin Longitudinal Study (WLS), which is among the longest-running cohort studies in the U.S. that has followed graduates (all identified as non-Hispanic White) from Wisconsin high schools since 1957. We used prospective measures of key variables, including information from high school yearbooks, with assessments of cognitive performance at ages 65 and 72. Results from multilevel modeling indicated that greater participation in cognitively oriented extracurricular activities (but not physically nor socially oriented activities) was associated with both better language/executive functioning and memory at age 65. Although the size of these associations was reduced when accounting for other cognitive resources in adolescence (childhood socioeconomic status and adolescent cognitive ability) and in midlife (adult socioeconomic status and formal group participation), there remained small, yet statistically robust, associations. We did not find robust associations between greater EELA engagement and slower rates of decline in cognition between ages 65 and 72, nor did we find evidence of gender differences. Results suggest that for this cohort of older adults, EELA participation is part of life course "protective chains," whereby exposures to assets at one point in the life course increase the likelihood of subsequent exposures, each sequentially and in their own right, toward better later life cognition. We discuss how results support the importance of policies and practices to promote healthy cognitive development among youth for the long-term cognitive health of a rapidly aging U.S. population. | Wisconsin Longitudinal Study (WLS) | Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Memory, School quality | Link | Greenfield, E. A., Reynolds, A., & Moorman, S. M. (2022). Life course linkages between enriching early-life activities and later life cognition: Evidence from the Wisconsin Longitudinal Study. Social science & medicine (1982), 294, 114673. | SSM - Population Health |
| Out-of-Pocket Health Expenditures and Health Care Services Use Among Older Americans With Cognitive Impairment: Results From the 2008-2016 Health and Retirement Study. | Jenkins, Derek; Stickel, Ariana; González, Hector M; Tarraf, Wassim | 2022 | Background and Objectives: The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out-of-pocket (OOP) expenditures.; Research Design and Methods: We use prospective data from the Health and Retirement Study (2007/2008-2015/2016) on adults 70 years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (unweighted n = 1,692) to fit 2-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing home use, hospitalizations, and OOP expenditures.; Results: Over 8 years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use which were particularly pronounced among those who transitioned or died during follow-up and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval = 832-1,479]), maintainers ($1,145 [993-1,296]), and transitioners ($1,385 [1,041-1,730]). Individuals who died during follow-up spent $2,529 (2,101-2,957). By the eighth year of follow-up, spending among reverters increased to $1,402 (869-1,934) and $2,188 (1,402-2,974) and $8,988 (5,820-12,157) for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 (4,345-11,094). Estimates were only partly attenuated through adjustment to covariables.; Discussion and Implications: A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Dementia, Healthcare | Link | Jenkins, D., Stickel, A., González, H. M., & Tarraf, W. (2022). Out-of-Pocket Health Expenditures and Health Care Services Use Among Older Americans With Cognitive Impairment: Results From the 2008-2016 Health and Retirement Study. The Gerontologist, 62(6), 911–922. | The Gerontologist |
| Effect of childhood proximity to lead mining on late life cognition. | Lee, Mark; Lee, Haena; Warren, John Robert; Herd, Pamela | 2022 | Introduction: Lead exposure negatively affects cognitive functioning among children. However, there is limited evidence about whether exposure to lead in early life impairs later life cognitive functioning.; Methods: Participants in the prospective Wisconsin Longitudinal Study cohort (N = 8583) were linked to the 1940 Census, which was taken when they were young children. We estimated the effect of living near a lead mine in childhood on late life memory/attention and language/executive function in 2004 (mean age 64) and 2011 (mean age 71).; Results: Lead-exposed children had significantly steeper memory/attention decline between 2004 and 2011 and worse language/executive function at baseline in late life. These long-term effects of lead were not mediated through adolescent IQ or late life SES and health factors.; Discussion: Proximity to lead mining in childhood had long-term effects on late life memory/attention decline and language/executive function, reflecting a possible latent influence of lead exposure. More research is needed to understand behavioral and biological pathways underlying this relationship. | Wisconsin Longitudinal Study (WLS) | Early Life | Childhood/Adolescence, Cognitive function, Environmental exposure, Memory, Socioeconomic status | Link | Lee, M., Lee, H., Warren, J. R., & Herd, P. (2022). Effect of childhood proximity to lead mining on late life cognition. SSM - population health, 17, 101037. | SSM - Population Health |
| Anticholinergic Drug Burden and Neurocognitive Performance in the Study of Latinos-Investigation of Neurocognitive Aging. | Posis, Alexander Ivan B; Tarraf, Wassim; Gonzalez, Kevin A; Soria-Lopez, Jose A; Léger, Gabriel C; Stickel, Ariana M; Daviglus, Martha L; Lamar, Melissa; Zeng, Donglin; González, Hector M | 2022 | Background: Studies of cumulative anticholinergic drug burden on cognitive function and impairment are emerging, yet few for Hispanics/Latinos.; Objective: To examine associations between anticholinergic use and neurocognitive performance outcomes among diverse Hispanics/Latinos.; Methods: This prospective cohort study included diverse Hispanic/Latino participants, enrolled in the Study of Latinos-Investigation of Neurocognitive, from New York, Chicago, Miami, and San Diego (n = 6,249). Survey linear regression examined associations between anticholinergic use (measured during baseline [Visit 1] and average 7-year follow up [Visit 2]) with global cognition, episodic learning, memory, phonemic fluency, processing speed, executive functioning, and average 7-year change.; Results: Anticholinergic use was associated with lower cognitive global cognition (β= -0.21; 95% CI [-0.36; -0.05]), learning (β= -0.27; 95% CI [-0.47; -0.07]), memory (β= -0.22; 95% CI [-0.41; -0.03]), and executive functioning (β= -0.22; 95% CI [-0.40; -0.03]) scores, particularly among those who took anticholinergics at both visits. Anticholinergic use was associated with faster decline in global cognition, learning, and verbal fluency (β: -0.28 [95% CI: -0.55, -0.01]; β: -0.28 [95% CI: -0.55, -0.01]; β: -0.25, [95% CI -0.47, -0.04], respectively). Sex modified associations between anticholinergic use with global cognition, learning, and executive functioning (F3 = 3.59, F3 = 2.84, F3 = 3.88, respectively).; Conclusion: Anticholinergic use was associated with lower neurocognitive performance, especially among those who used anticholinergics at both visits, among a study population of diverse Hispanics/Latinos. Findings will support evidence-based decisions regarding anticholinergic prescriptions and efforts to minimize cognitive impact. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms | Cognitive function, Memory | Link | Posis, A. I. B., Tarraf, W., Gonzalez, K. A., Soria-Lopez, J. A., Léger, G. C., Stickel, A. M., Daviglus, M. L., Lamar, M., Zeng, D., & González, H. M. (2022). Anticholinergic Drug Burden and Neurocognitive Performance in the Study of Latinos-Investigation of Neurocognitive Aging. Journal of Alzheimer's disease : JAD, 86(1), 53–65. | Journal of Alzheimer's Disease |
| Race, Childhood Socioeconomic Status, and Region of Childhood Residence as Intersectional Life-Course Predictors of Cognitive Aging in the United States. | Reynolds, Addam; Greenfield, Emily A; Moorman, Sara; Reyes, Laurent | 2022 | Background and Objectives: Race, childhood socioeconomic status (cSES), and region of childhood residence are each associated with later-life cognition, but no studies have examined how the confluence of these factors influences later-life cognitive performance. Guided by intersectionality theory, we examined individuals' social positionality across these dimensions as a predictor of cognitive performance in later life among non-Hispanic White (NHW) and non-Hispanic Black (NHB) older adults.; Research Design and Methods: We used data from the 2010-2016 waves of the Health and Retirement Study with participants aged 65 and older in 2010. We employed growth curve modeling to estimate associations among race, cSES, and region of childhood residence, as well as their interactions, and cognitive performance at baseline and over time.; Results: Identifying as NHB, residing in the South, and having lower cSES each were associated with poorer later-life cognition at baseline. Childhood residence in the South was an especially strong risk factor for poorer cognition among NHBs. Among NHWs, higher cSES was associated with better baseline cognitive performance, especially among those from the South. NHBs from the South demonstrated a small advantage of higher cSES, but regardless of cSES, NHBs from the South had lower levels of baseline cognitive scores compared to all other subgroups. We observed steeper declines in cognitive performance over the 6-year study period among participants who lived in the South as children.; Discussion and Implications: Our findings suggest that intersectional social positions across race, cSES, and region of childhood residence primarily influence baseline cognition in later life. Results implicate the importance of attention to multiple life-course social positions in the context of racism within social policies and other initiatives to promote equity in later-life brain health. | Health and Retirement Study (HRS) | Early Life | Childhood/Adolescence, Cognitive function, Racial-ethnic disparities, Socioeconomic status, Structural inequality | Link | Reynolds, A., Greenfield, E. A., Moorman, S., & Reyes, L. (2022). Race, Childhood Socioeconomic Status, and Region of Childhood Residence as Intersectional Life-Course Predictors of Cognitive Aging in the United States. Innovation in aging, 6(3), igac020. | Innovation in Aging |
| Religion and Trajectories of Cognitive Function Among White, Black, and Hispanic Older Adults. | Sauerteig-Rolson, Madison; Barnes, Lisa; Thomas, Patricia; Ferraro, Kenneth | 2022 | Most prior research on the relationship between religious involvement and cognition among older adults is based on cross-sectional data and yields inconsistent results. We use longitudinal data from 14,161 older adults in the Health and Retirement study (HRS) to investigate whether religious involvement, measured by attendance, integration, and religiosity (i.e., beliefs, meanings, and values) is associated with trajectories of cognitive function from 2006 to 2016 among a diverse sample of respondents. We find that religiosity is associated with lower levels of cognition at baseline among White adults (b=-0.12, p < 0.001), but higher levels of cognition among Black adults (b=0.18, p < 0.05). In addition, growth curve analysis reveals that religious attendance is associated with higher cognition over time for Hispanic respondents (b=0.07, p < 0.001). Religious involvement is associated with later-life cognition, but this relationship differs for White, Black, and Hispanic older adults. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Racial-ethnic disparities, Religion and spirituality | Link | Sauerteig-Rolston, M., Barnes, L., Thomas, P., & Ferraro, K. (2022). Religion and Trajectories of Cognitive Function Among White, Black, and Hispanic Older Adults. Innovation in Aging, 6(Suppl 1), 550. | Innovation in Aging |
| Concordance Between Self-Reported Medical Diagnosis of Mild Cognitive Impairment/Dementia and Neurocognitive Function Among Middle-Aged and Older Hispanic/Latino Adults: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). | Vásquez, Priscilla M; Tarraf, Wassim; Li, Yuyi; Jenkins, Derek; Soria-Lopez, Jose A; Zlatar, Zvinka Z; Marquine, Maria J; Stickel, Ariana M; Estrella, Mayra L; Gallo, Linda C; Lipton, Richard B; Isasi, Carmen R; Cai, Jianwen; Zeng, Donglin; Daviglus, Martha L; Schneiderman, Neil; González, Hector M | 2022 | Background: Population-based studies typically rely on self-reported medical diagnosis (SRMD) of mild cognitive impairment (MCI)/dementia; however, links to objective neurocognitive function have not been established.; Objective: Examine the association between SRMD of MCI/dementia and objective neurocognitive function among Hispanic/Latino adults.; Methods: We conducted a case-control study using the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) baseline data and its ancillary SOL-Investigation of Neurocognitive Aging (SOL-INCA) at visit 2. Hispanic/Latino adults aged 50 years and older (n = 593) were administered neurocognitive tests: the Six-Item Screener (SIS), Brief-Spanish English Verbal Learning Test (B-SVELT Sum), B-SVELT Recall, Word Fluency Test (WF), Digit Symbol Substitution Test (DSS), and Trail Making Test A and B. Individual and global neurocognitive function scores were used for analyses. Propensity matching techniques and survey generalized linear regression models were used to compare SRMD of MCI/dementia with demographic, psychological, and cardiovascular risk matched controls. Complex survey design methods were applied.; Results: There were 121 cases of SRMD of MCI/dementia and 472 propensity matched controls. At baseline, compared to matched controls, cases showed no differences in neurocognitive function (p > 0.05). At SOL-INCA visit 2, cases had poorer scores in global neurocognitive function (p < 0.05), B-SEVLT Sum, B-SEVLT Recall, WF, DSS, and Trail A (p < 0.01).; Conclusion: Observed differences in neurocognitive test scores between SRMD of MCI/dementia cases and matched controls were present at visit 2, but not at baseline in middle-aged and older Hispanic/Latino adults. These findings present initial evidence of the potential utility of SRMD of MCI/dementia in epidemiologic studies, where obtaining confirmation of diagnosis may not be feasible. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms, Mid-Life Factors | Cardiometabolic outcomes, Cognitive function, Dementia, Hispanics/Latinos | Link | Vásquez, P. M., Tarraf, W., Li, Y., Jenkins, D., Soria-Lopez, J. A., Zlatar, Z. Z., Marquine, M. J., Stickel, A. M., Estrella, M. L., Gallo, L. C., Lipton, R. B., Isasi, C. R., Cai, J., Zeng, D., Daviglus, M. L., Schneiderman, N., & González, H. M. (2022). Concordance Between Self-Reported Medical Diagnosis of Mild Cognitive Impairment/Dementia and Neurocognitive Function Among Middle-Aged and Older Hispanic/Latino Adults: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). Journal of Alzheimer's disease : JAD, 88(1), 45–55. | Journal of Alzheimer's Disease |
| Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors. | Vivek, Sithara; Nelson, Heather Hammond; Prizment, Anna E; Faul, Jessica; Crimmins, Eileen M; Thyagarajan, Bharat | 2022 | Purpose: The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia.; Methods: Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters.; Results: CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95% CI [6.1, 56.1]).; Conclusion: The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors. | Health and Retirement Study (HRS) | Biological Mechanisms | Biomarkers, Cognitive function, Dementia, Inflammation | Link | Vivek, S., Nelson, H. H., Prizment, A. E., Faul, J., Crimmins, E. M., & Thyagarajan, B. (2022). Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors. Cancer causes & control : CCC, 33(1), 81–90. | Cancer Causes & Control |
| Takes Two to Tango: Cognitive Impairment and Sexual Activity in Older Individuals and Dyads. | Waite, Linda J; Iveniuk, James; Kotwal, Ashwin | 2022 | Objectives: This article examines the association between cognitive impairment, including mild cognitive impairment (MCI) and early dementia (ED), and sexual activity in a large, longitudinal sample of community-dwelling older adults. We focus here on sexual activity, which includes both sexual activity with a partner and masturbation.; Methods: We analyzed 3,777 older individuals and members of 955 intimate dyads using the National Social Life, Health, and Aging Project (2010 and 2015). We used ordered probit regression, cross-lagged panels models, and probit regression.; Results: We find that older adults with cognitive limitations, either MCI or ED, are about as likely to be sexually active with a partner as those with normal cognitive function. This is the case both in the cross-section and longitudinally. Both men and women with ED are less likely to have masturbated, however. Among married and cohabiting couples, we find no association between cognitive impairment in either the husband, the wife, or in both partners and their joint sexual activity. Women whose measured cognitive function is lower than their husbands are less likely to report any masturbation.; Discussion: Sex with a partner, a fundamentally social activity, seems to be conserved in the face of cognitive limitation but masturbation, a solitary activity, does not. We argue that the intimate dyad plays an important role in conserving partnered sexual activity. Results can inform strategies to maintain the sexual well-being of older adults with cognitive impairment and their partners as part of overall strategies to improve quality of life. | National Social Life, Health & Aging Project (NSHAP) | Mid-Life Factors | Cognitive function, Family, Health behavior | Link | Waite, L. J., Iveniuk, J., & Kotwal, A. (2022). Takes Two to Tango: Cognitive Impairment and Sexual Activity in Older Individuals and Dyads. The journals of gerontology. Series B, Psychological sciences and social sciences, 77(5), 992–1003. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Black-White variation in the relationship between early educational experiences and trajectories of cognitive function among US-born older adults. | Walsemann, Katrina M; Kerr, Eleanor M; Ailshire, Jennifer A; Herd, Pamela | 2022 | Black adults face a substantially higher risk for dementia in later life compared to their White peers. Given the critical role of educational attainment and cognitive function in later life dementia risk, this paper aims to determine if early educational experiences and educational attainment are differentially related to trajectories of cognitive status across race and if this further varies by education cohort. We use data from the Life History Mail Survey (LHMS) and prospective data on cognition from the Health and Retirement Study (HRS). We restrict our sample to Black and White US-born adults who provided at least one measure of cognitive status from 1995/6-2016. We find evidence of Black-White differences in the association between educational experiences and level of cognitive function, episodic memory, and working memory, but little evidence of Black-White differences in these associations with decline. Having a learning problem was associated with lower levels of cognitive function, episodic memory, and working memory for White and Black older adults, but was more strongly related to these outcomes among Black older adults. Further, the Black-White difference in this association was generally found in older cohorts that completed schooling after enactment of federal policies that improved educational resources for children with learning disabilities. Attending racially discordant schools was positively associated with level of these cognitive outcomes for Black older adults but not for White older adults. We also find that the educational gradient in level of cognitive function was larger for Black compared to White older adults in older cohorts not benefiting from the Brown v Board of Education decision but was similar for Black and White older adults attending school in the post- Brown era. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Dementia, Memory, Racial-ethnic disparities, School segregation | Link | Walsemann, K. M., Kerr, E. M., Ailshire, J. A., & Herd, P. (2022). Black-White variation in the relationship between early educational experiences and trajectories of cognitive function among US-born older adults. SSM - population health, 19, 101184. | SSM - Population Health |
| Education in the Jim Crow South and Black-White inequities in allostatic load among older adults | Walsemann, Katrina M; Pearson, Jay; Abbruzzi, Emily | 2022 | In the U.S., Black adults consistently have higher allostatic load – an indicator of physiological dysregulation – than White adults. Education is considered a likely mechanism given racial differences in attainment, but evidence is mixed. This may be due, in part, to data limitations that have made it difficult for scholars to account for the structurally rooted systemic racism that shaped the U.S. education system and led to large racial inequities in school term length and school attendance among older adults who grew up in the Jim Crow South. Our study addresses this limitation by linking historical data on Black and White segregated school systems in the U.S. South from 1919 to 1954 to the Health and Retirement Study (HRS) to determine if a new measure of educational attainment that accounts for structural racism that led to differences in the number of school days attended by Black and White students across years and states better explains Black-White inequities in allostatic load among older adults who attended school during Jim Crow. We restrict our sample to HRS respondents racialized as White or Black, who resided in the South when they were school-aged, completed primary/secondary school between 1919 and 1954, and provided a measure of allostatic load (n = 1932). We find that our new measure of schooling – duration in school – reduced the Black-White inequity in allostatic load more so than self-reported years of schooling whether we measured allostatic load continuously (34% vs 16%) or categorically (45% vs 20%). Our findings highlight the importance of identifying and using historically informed measures of schooling that account for structurally rooted systemic racism when trying to understand how education shapes the health of individuals racialized as Black in the United States. | Health and Retirement Study (HRS) | Biological Mechanisms, Early Life, Mid-Life Factors | Childhood/Adolescence, Racial-ethnic disparities, School quality, School segregation, Stress, Structural inequality | Link | Walsemann, K. M., Pearson, J., & Abbruzzi, E. (2022). Education in the Jim Crow South and Black-White inequities in allostatic load among older adults. SSM - Population Health, 19, 101224. | SSM - Population Health |
| Race Inequity in School Attendance Across the Jim Crow South and Its Implications for Black-White Disparities in Trajectories of Cognitive Function Among Older Adults | Walsemann, Katrina M; Urena, Stephanie; Farina, Mateo P; Ailshire, Jennifer A | 2022 | Objectives: Although education is a key determinant of cognitive function, its role in determining Black–White disparities in cognitive function is unclear. This may be due, in part, to data limitations that have made it difficult to account for systemic educational inequities in the Jim Crow South experienced by older cohorts, including differences in the number of days Black students attended school compared to their White counterparts or Black peers in better-funded southern states. We determine if accounting for differential rates of school attendance across race, years, and states in the Jim Crow South better illuminates Black–White disparities in trajectories of cognitive function. Methods: We linked historical state-level data on school attendance from the 1919/1920 to 1953/1954 Biennial Surveys of Education to the Health and Retirement Study, a nationally representative, longitudinal study of U.S. adults older than age 50. We restricted our sample to Black and White older adults who attended school in the Jim Crow South and began primary school in/after 1919/1920 and completed primary/secondary school by 1953/1954 (n = 4,343). We used linear mixed models to estimate trajectories of total cognitive function, episodic memory, and working memory. Results: Self-reported years of schooling explained 28%–33% of the Black–White disparity in level of cognitive function, episodic memory, and working memory. Duration of school, a measure that accounted for differential rates of school attendance, explained 41%–55% of the Black–White disparity in these outcomes. Discussion: Our study highlights the importance of using a more refined measure of schooling for understanding the education–cognitive health relationship. | Health and Retirement Study (HRS) | Early Life | Childhood/Adolescence, Cognitive function, Memory, School quality, Structural inequality | Link | Walsemann, K. M., Ureña, S., Farina, M. P., & Ailshire, J. A. (2022). Race Inequity in School Attendance Across the Jim Crow South and Its Implications for Black–White Disparities in Trajectories of Cognitive Function Among Older Adults. The Journals of Gerontology: Series B, 77(8), 1467–1477. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study. | Wu, Benson; Toseef, Mohammad Usama; Stickel, Ariana M; González, Hector M; Tarraf, Wassim | 2022 | Background: Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging.; Objective: We examined how midlife self-rated physical functioning and health may predict cognitive health in older age.; Methods: We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications.; Results: After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment.; Conclusion: Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Cognitive function, Dementia, Health behavior | Link | Wu, B., Toseef, M. U., Stickel, A. M., González, H. M., & Tarraf, W. (2022). Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study. Journal of Alzheimer's disease : JAD, 85(4), 1621–1637. | Journal of Alzheimer's Disease |
| Subjective cognitive decline and objective cognition among diverse U.S. Hispanics/Latinos: Results from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). | Zlatar, Zvinka Z; Tarraf, Wassim; González, Kevin A; Vásquez, Priscilla M; Marquine, María J; Lipton, Richard B; Gallo, Linda C; Khambaty, Tasneem; Zeng, Donglin; Youngblood, Marston E; Estrella, Mayra L; Isasi, Carmen R; Daviglus, Martha; González, Hector M | 2022 | Introduction: Despite increased risk of cognitive decline in Hispanics/Latinos, research on early risk markers of Alzheimer's disease in this group is lacking. Subjective cognitive decline (SCD) may be an early risk marker of pathological aging. We investigated associations of SCD with objective cognition among a diverse sample of Hispanics/Latinos living in the United States.; Methods: SCD was measured with the Everyday Cognition Short Form (ECog-12) and cognitive performance with a standardized battery in 6125 adults aged ≥ 50 years without mild cognitive impairment or dementia (x̄ age = 63.2 years, 54.5% women). Regression models interrogated associations of SCD with objective global, memory, and executive function scores.; Results: Higher SCD was associated with lower objective global (B = -0.16, SE = 0.01), memory (B = -0.13, SE = 0.02), and executive (B = -0.13, SE = 0.02, p's < .001) function composite scores in fully adjusted models.; Discussion: Self-reported SCD, using the ECog-12, may be an indicator of concurrent objective cognition in diverse middle-aged and older community-dwelling Hispanics/Latinos. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Mid-Life Factors | Cognitive function, Hispanics/Latinos, Mental health, Memory | Link | Zlatar, Z. Z., Tarraf, W., González, K. A., Vásquez, P. M., Marquine, M. J., Lipton, R. B., Gallo, L. C., Khambaty, T., Zeng, D., Youngblood, M. E., Estrella, M. L., Isasi, C. R., Daviglus, M., & González, H. M. (2022). Subjective cognitive decline and objective cognition among diverse U.S. Hispanics/Latinos: Results from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). Alzheimer's & dementia : the journal of the Alzheimer's Association, 18(1), 43–52. | Alzheimer's & Dementia |
| Education Differences in the Adverse Impact of PM2.5 on Incident Cognitive Impairment Among U.S. Older Adults. | Ailshire, Jennifer; Walsemann, Katrina M | 2021 | Background: Air pollution is linked to worse cognitive function in older adults, but whether differences in this relationship exist by education, a key risk factor for cognitive decline, remains unknown.; Objective: To determine if the association between fine particulate matter air pollution (PM2.5) and incident cognitive impairment varies by level of education in two cohorts assessed a decade apart.; Methods: We used data on adults ages 60 and older from the nationally representative Health and Retirement Study (HRS) linked with tract-level annual average PM2.5. We used mixed-effects logistic regression models to examine education differences in the association between PM2.5 and incident cognitive impairment in two cohorts: 2004 (n = 9,970) and 2014 (n = 9,185). Cognitive impairment was determined with tests of memory and processing speed for self-respondents and proxy and interviewer assessments of cognitive functioning in non-self-respondents.; Results: PM2.5 was unrelated to incident cognitive impairment among those with 13 or more years of education, but the probability of impairment increased with greater concentrations of PM2.5 among those with 8 or fewer years of education. The interaction between education and PM2.5 was only found in 2004, possibly because PM2.5 concentrations were much lower in 2014.; Conclusion: Education is a key determinant of cognitive decline and impairment, and in higher pollution contexts may serve as a protective factor against the harms of air pollution on the aging brain. Additionally, because air pollution is ubiquitous, and particularly harmful to vulnerable populations, even small improvements in air quality may have large impacts on population health. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Cognitive function, Dementia, Educational attainment, Environmental exposure, Memory | Link | Ailshire, J., & Walsemann, K. M. (2021). Education Differences in the Adverse Impact of PM2.5 on Incident Cognitive Impairment Among U.S. Older Adults. Journal of Alzheimer's disease : JAD, 79(2), 615–625. | Journal of Alzheimer's Disease |
| Cumulative Genetic Risk and APOE ε4 Are Independently Associated With Dementia Status in a Multiethnic, Population-Based Cohort. | Bakulski, Kelly M; Vadari, Harita S; Faul, Jessica D; Heeringa, Steven G; Kardia, Sharon L R; Langa, Kenneth M; Smith, Jennifer A; Manly, Jennifer J; Mitchell, Colter M; Benke, Kelly S; Ware, Erin B | 2021 | Objective: Alzheimer disease (AD) is a common and costly neurodegenerative disorder. A large proportion of AD risk is heritable, and many genetic risk factors have been identified. The objective of this study was to test the hypothesis that cumulative genetic risk of known AD markers contributed to odds of dementia in a population-based sample.; Methods: In the US population-based Health and Retirement Study (waves 1995-2014), we evaluated the role of cumulative genetic risk of AD, with and without the APOE ε4 alleles, on dementia status (dementia, cognitive impairment without dementia, borderline cognitive impairment without dementia, and cognitively normal). We used logistic regression, accounting for demographic covariates and genetic principal components, and analyses were stratified by European and African genetic ancestry.; Results: In the European ancestry sample (n = 8,399), both AD polygenic score excluding the APOE genetic region (odds ratio [OR] = 1.10; 95% confidence interval [CI]: 1.00-1.20) and the presence of any APOE ε4 alleles (OR = 2.42; 95% CI: 1.99-2.95) were associated with the odds of dementia relative to normal cognition in a mutually adjusted model. In the African ancestry sample (n = 1,605), the presence of any APOE ε4 alleles was associated with 1.77 (95% CI: 1.20-2.61) times higher odds of dementia, whereas the AD polygenic score excluding the APOE genetic region was not significantly associated with the odds of dementia relative to normal cognition 1.06 (95% CI: 0.97-1.30).; Conclusions: Cumulative genetic risk of AD and APOE ε4 are both independent predictors of dementia in European ancestry. This study provides important insight into the polygenic nature of dementia and demonstrates the utility of polygenic scores in dementia research. | Health and Retirement Study (HRS) | Biological Mechanisms | Alzheimer's disease, APOE, Cognitive function, Dementia, Genetics | Link | Bakulski, K. M., Vadari, H. S., Faul, J. D., Heeringa, S. G., Kardia, S. L. R., Langa, K. M., Smith, J. A., Manly, J. J., Mitchell, C. M., Benke, K. S., & Ware, E. B. (2021). Cumulative Genetic Risk and APOE ε4 Are Independently Associated With Dementia Status in a Multiethnic, Population-Based Cohort. Neurology. Genetics, 7(2), e576. | Neurology Genetics |
| No increased risk of Alzheimer's disease among people with immune-mediated inflammatory diseases: findings from a longitudinal cohort study of U.S. older adults. | Booth, Michael J; Kobayashi, Lindsay C; Janevic, Mary R; Clauw, Daniel; Piette, John D | 2021 | Objective: Immune-mediated inflammatory diseases (IMID) are characterized by systemic inflammation affecting the joints and bodily organs. Studies examining the association between individual IMIDs and the risk of Alzheimer's disease (AD) have yielded inconsistent findings. This study examines AD risk across a group of IMIDs in a large population-based sample of older adults.; Methods: Data on a national sample of US adults over age 50 was drawn from the Health and Retirement Study (HRS) and linked Medicare claims from 2006 to 2014. IMIDs include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, and related conditions. We identified IMIDs from 2006 to 2009 Medicare claims using International Classification of Diseases (ICD9-CM) codes. The date of incident AD was derived from Chronic Conditions Warehouse (CCW) identifiers. We examined the risk of AD from 2009 to 2014 using Cox proportional hazards models, both unadjusted and adjusted for age, gender, education, race, and the genetic risk factor APOE-e4.; Results: One hundred seventy-one (6.02%) of the 2842 total HRS respondents with Medicare coverage and genetic data were classified with IMIDs. Over the subsequent 6 years, 9.36% of IMID patients developed AD compared to 8.57% of controls (unadjusted hazard ratio (HR): 1.09, 95% CI .66-1.81, p = 0.74). Adjusted HR 1.27 (95% CI 0.76-2.12, p = 0.35). Age (HR for 10-year increment 3.56, p < .001), less than high school education (HR 1.70, p = .007), and APOE-e4 (HR 2.61, p < .001 for one or two copies), were also statistically significant predictors of AD.; Conclusion: HRS respondents with common IMIDs do not have increased risk of Alzheimer's disease over a 6-year period. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Alzheimer's disease, APOE, Immune function, Inflammation | Link | Booth, M. J., Kobayashi, L. C., Janevic, M. R., Clauw, D., & Piette, J. D. (2021). No increased risk of Alzheimer's disease among people with immune-mediated inflammatory diseases: findings from a longitudinal cohort study of U.S. older adults. BMC rheumatology, 5(1), 48. | BMC Rheumatology |
| Socioeconomic status across the life course and dementia-status life expectancy among older Americans. | Cha, Hyungmin; Farina, Mateo P; Hayward, Mark D | 2021 | This study examines how socioeconomic status (SES) across the life course is associated with individuals' lifetime dementia experience - the years of life persons can expect to live and without with dementia. Conceptually, dementia-free life expectancy reflects the ability to postpone dementia onset while dementia life expectancy reflects the average lifetime period with the condition. How SES across the life course contributes to dementia-status life expectancy is the focus of this study. We assess whether persons who are advantaged in their lifetime SES live the most years without dementia and the fewest years with dementia compared to less advantaged persons. Using the Health and Retirement Study (2000-2016), we examine these questions for U.S. adults aged 65 and older using multistate life tables and a microsimulation approach. The results show that higher SES persons can expect to live significantly more years of life without dementia and that the period of life with dementia is compressed compared to less advantaged persons. The results also underscore that importance of cumulative exposure, showing that adults from disadvantaged childhoods who achieve high education levels often have dementia experiences that are similar to or better than those of adults from advantaged childhoods who achieved low education levels. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Dementia, Mortality, Socioeconomic status | Link | Cha, H., Farina, M. P., & Hayward, M. D. (2021). Socioeconomic status across the life course and dementia-status life expectancy among older Americans. SSM - population health, 15, 100921. | SSM - Population Health |
| The Effect of Childhood Socioeconomic Position and Social Mobility on Cognitive Function and Change Among Older Adults: A Comparison Between the United States and England. | Faul, Jessica D; Ware, Erin B; Kabeto, Mohammed U; Fisher, Jonah; Langa, Ken M | 2021 | Objectives: This study aims to examine the relationship between childhood socioeconomic position (SEP) and cognitive function in later life within nationally representative samples of older adults in the United States and England, investigate whether these effects are mediated by later-life SEP, and determine whether social mobility from childhood to adulthood affects cognitive function and decline.; Method: Using data from the Health and Retirement Study (HRS) and the English Longitudinal Survey of Ageing (ELSA), we examined the relationships between measures of SEP, cognitive performance and decline using individual growth curve models.; Results: High childhood SEP was associated with higher cognitive performance at baseline in both cohorts and did not affect the rate of decline. This benefit dissipated after adjusting for education and adult wealth in the United States. Respondents with low childhood SEP, above median education, and high adult SEP had better cognitive performance at baseline than respondents with a similar childhood background and less upward mobility in both countries.; Discussion: These findings emphasize the impact of childhood SEP on cognitive trajectories among older adults. Upward mobility may partially compensate for disadvantage early in life but does not protect against cognitive decline. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Cross-national comparison, Educational attainment, Socioeconomic status | Link | Faul, J. D., Ware, E. B., Kabeto, M. U., Fisher, J., & Langa, K. M. (2021). The effect of childhood socioeconomic position and social mobility on cognitive function and change among older adults: a comparison between the United States and England. The Journals of Gerontology: Series B, 76(Supplement_1), S51-S63. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults. | Friedman, Esther M; Houle, Jason N; Cagney, Kathleen A; Slaughter, Mary E; Shih, Regina A | 2021 | Objectives: While home foreclosures are often thought of as a household-level event, the consequences may be far-reaching, and spill over to the broader community. Older adults, in particular, could be affected by the spiral of community changes that result from foreclosures, but we know very little about how the foreclosure crisis is related to older adult health, in particular cognition.; Method: This article uses growth curve models and data from the Health and Retirement Study matched to Census and county-level foreclosure data to examine whether community foreclosures are related to older adults' cognitive health and the mechanisms responsible.; Results: We find that higher rates of county-level foreclosures are associated with a faster decline in individual cognition at older ages. Although we examined an extensive number of individual and community mechanisms, including individual housing wealth and depressive symptoms, community structural factors, social factors, and perceptions of physical disorder and cohesion, none of the mechanisms examined here explained this relationship.; Discussion: This study shows that the adverse consequences of home foreclosures spill over to the local community, with implications for the cognitive health of older adults. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Mental health, Neighborhoods, Social cohesion, Structural inequality | Link | Friedman, E. M., Houle, J. N., Cagney, K. A., Slaughter, M. E., & Shih, R. A. (2021). The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults. The journals of gerontology. Series B, Psychological sciences and social sciences, 76(5), 956–967. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Educational Benefits and Cognitive Health Life Expectancies: Racial/Ethnic, Nativity, and Gender Disparities. | Garcia, Marc A; Downer, Brian; Chiu, Chi-Tsun; Saenz, Joseph L; Ortiz, Kasim; Wong, Rebeca | 2021 | Background and Objectives: To examine racial/ethnic, nativity, and gender differences in the benefits of educational attainment on cognitive health life expectancies among older adults in the United States.; Research Design and Methods: We used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively healthy, cognitively impaired/no dementia, and dementia life expectancies by gender for older White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults with less than high school, high school, and some college or more.; Results: White respondents lived a greater percentage of their remaining lives cognitively healthy than their minority Black or Hispanic counterparts, regardless of level of education. Among respondents with some college or more, versus less than high school, Black and U.S.-born Hispanic women exhibited the greatest increase (both 37 percentage points higher) in the proportion of total life expectancy spent cognitively healthy; whereas White women had the smallest increase (17 percentage points higher). For men, the difference between respondents with some college or more, versus less than high school, was greatest for Black men (35 percentage points higher) and was lowest for U.S.-born Hispanic men (21 percentage points higher).; Discussion and Implications: Our results provide evidence that the benefits of education on cognitive health life expectancies are largest for Black men and women and U.S.-born Hispanic women. The combination of extended longevity and rising prevalence of Alzheimer's disease points to the need for understanding why certain individuals spend an extended period of their lives with poor cognitive health. | Health and Retirement Study (HRS) | Mid-Life Factors | Dementia, Migration, Mortality, Racial-ethnic disparities | Link | Garcia, M. A., Downer, B., Chiu, C. T., Saenz, J. L., Ortiz, K., & Wong, R. (2021). Educational Benefits and Cognitive Health Life Expectancies: Racial/Ethnic, Nativity, and Gender Disparities. The Gerontologist, 61(3), 330–340. | The Gerontologist |
| The Importance of Improving Educational Attainment for Dementia Prevalence Trends From 2000 to 2014, Among Older Non-Hispanic Black and White Americans. | Hayward, Mark D; Farina, Mateo P; Zhang, Yuan S; Kim, Jung Ki; Crimmins, Eileen M | 2021 | Objectives: While a number of studies have documented a notable decline in age-standardized prevalence in dementia in the U.S. population, relatively little is known about how dementia has declined for specific age and race groups, and the importance of changing educational attainment on the downward trend. We assess (a) how the trends in dementia prevalence may have differed across age and race groups and (b) the role of changing educational attainment in understanding these trends.; Methods: This article estimates a series of logistic regression models using data from the Health and Retirement Study (2000-2014) to assess the relative annual decline in dementia prevalence and the importance of improving educational attainment for non-Hispanic Whites and non-Hispanic Blacks.; Results: Consistent with other studies, we found significant declines in dementia for non-Hispanic Blacks and non-Hispanic Whites across this period. Nonetheless, these declines were not uniform across age and race groups. Non-Hispanic Blacks aged 65-74 years had the steepest decline in this period. We also found that improved educational attainment in the population was fundamentally important in understanding declining dementia prevalence in the United States.; Discussion: This study shows the importance of improvement in educational attainment in the early part of the twentieth century to understand the downward trend in dementia prevalence in the United States from 2000 to 2014. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Educational attainment, Racial-ethnic disparities | Link | Hayward, M. D., Farina, M. P., Zhang, Y. S., Kim, J. K., & Crimmins, E. M. (2021). The Importance of Improving Educational Attainment for Dementia Prevalence Trends From 2000 to 2014, Among Older Non-Hispanic Black and White Americans. The journals of gerontology. Series B, Psychological sciences and social sciences, 76(9), 1870–1879. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Using sibling models to unpack the relationship between education and cognitive functioning in later life. | Herd, Pamela; Sicinski, Kamil | 2021 | As the population ages and the prevalence of dementia increases, unpacking robust and persistent associations between educational attainment and later life cognitive functioning is increasingly important. We do know, from studies with robust causal designs, that policies that increase years of schooling improve later life cognitive functioning. Yet these studies don't illuminate why older adults with greater educational attainment have relatively preserved cognitive functioning. Studies focused on why , however , have been hampered by methodological limitations and inattention to some key explanations for this relationship. Consequently, we test explanations encompassing antecedent factors, specifically family environments, adolescent IQ, and genetic factors, as well as adult mediating mechanisms, specifically health behaviors and health. We employ the Wisconsin Longitudinal Study, which includes 80 years of prospectively collected data on a sample of 1 in every 3 high school graduates, and a selected sibling, from the class of 1957. Sibling models, and the inclusion of prospectively collected early and midlife covariates, allows us to address the explanatory and methodological limitations of the prior literature to better unpack the relationship between education and later life cognitive functioning. We find little evidence that early life genetic endowments and environments, or midlife health and health behaviors, explain the relationship. Adolescent cognition, however, does matter; higher educational attainment, linked to antecedent adolescent cognitive functioning, helps protect against lower levels of cognitive functioning in later life. Both adolescent cognition and education, however, independently associate with later life cognitive functioning at relatively similar magnitudes. Educational attainment's relationship to later life cognitive functioning is not simply a function of adolescent cognitive functioning. | Wisconsin Longitudinal Study (WLS) | Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Educational attainment, Family, Genetics, Health behavior | Link | Herd, P., & Sicinski, K. (2021). Using sibling models to unpack the relationship between education and cognitive functioning in later life. SSM - population health, 17, 100960. | SSM - Population Health |
| Does Rural Living in Early Life Increase the Risk for Reduced Cognitive Functioning in Later Life? | Herd, Pamela; Sicinski, Kamil; Asthana, Sanjay | 2021 | Background: There is a robust consensus, most recently articulated in the 2020 Lancet Commission, that the roots of dementia can be traced to early life, and that the path to prevention may start there as well. Indeed, a growing body of research demonstrates that early life disadvantage may influence the risk for later life dementia and cognitive decline. A still understudied risk, however, is early life rural residence, a plausible pathway given related economic and educational disadvantages, as well as associations between later life rural living and lower levels of cognitive functioning.; Objective: We aim to examine whether living in rural environments during early life has long term implications for cognitive health in later life.; Methods: We employed the Wisconsin Longitudinal Study, which tracked 1 in every 3 high school graduates from the class of 1957, from infancy to ∼age 72. The data include a rich array of prospectively collected early life data, unique among existing studies, as well as later life measures of cognitive functioning.; Results: We found a robust relationship between early life rural residence, especially living on a farm, and long-term risk for reduced cognitive performance on recall and fluency tasks. Controls for adolescent cognitive functioning, APOEɛ2 and APOEɛ4, as well as childhood and adult factors, ranging from early life socioeconomic conditions to later life health and rural and farm residency, did not alter the findings.; Conclusion: Rural living in early life is an independent risk for lower levels of cognitive functioning in later life. | Wisconsin Longitudinal Study (WLS) | Early Life, Mid-Life Factors | APOE, Childhood/Adolescence, Cognitive function, Geographic disparities, Socioeconomic status | Link | Herd, P., Sicinski, K., & Asthana, S. (2021). Does Rural Living in Early Life Increase the Risk for Reduced Cognitive Functioning in Later Life?. Journal of Alzheimer's disease : JAD, 82(3), 1171–1182. | Journal of Alzheimer's Disease |
| Trajectories of multiple behavioral risk factors and their associations with cognitive function trajectories among older African Americans and White Americans. | Li, Chien-Ching; Chen, Yi-Fan; Liang, Jersey; Matthews, Alicia K; Barnes, Lisa L | 2021 | Objectives: This study examined the joint trajectories of behavioral risk factors (smoking, alcohol drinking, and body mass index) and their associations with cognitive function trajectories among older African Americans and white Americans. Methods: Data from the Health and Retirement Study (1998–2014) were used. Group-based mixture modeling and multinomial logistic regression analysis were performed. Results: Three joint trajectories of behavioral risk factors (overweight, smoking and drinking, and drinking and overweight) and three cognitive function trajectories (low, moderate, and high) were identified. A significantly higher percentage of African Americans were in the “overweight,” “smoking and drinking,” and “low” cognitive functioning groups as measured by the total cognition composite score compared to white Americans. After accounting for covariates, the “drinking and overweight” group was associated with the “moderate” or “high” cognitive functioning group. Discussion: Future interventions targeting the combinations of behavioral risk factors are needed to promote healthy aging among high-risk populations. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Health behavior, Obesity, Racial-ethnic disparities | Link | Li, C. C., Chen, Y. F., Liang, J., Matthews, A. K., & Barnes, L. L. (2021). Trajectories of multiple behavioral risk factors and their associations with cognitive function trajectories among older African Americans and White Americans. Journal of aging and health, 33(9), 674-684. | Journal of Aging and Health |
| Using Mixture Modeling to Construct Subgroups of Cognitive Aging in the Wisconsin Longitudinal Study. | Moorman, Sara M; Greenfield, Emily A; Carr, Kyle | 2021 | Objectives: Longitudinal surveys of older adults increasingly incorporate assessments of cognitive performance. However, very few studies have used mixture modeling techniques to describe cognitive aging, identifying subgroups of people who display similar patterns of performance across discrete cognitive functions. We employ this approach to advance empirical evidence concerning interindividual variability and intraindividual change in patterns of cognitive aging.; Method: We drew upon data from 3,713 participants in the Wisconsin Longitudinal Study (WLS). We used latent class analysis to generate subgroups of cognitive aging based on assessments of verbal fluency and episodic memory at ages 65 and 72. We also employed latent transition analysis to identify how individual participants moved between subgroups over the 7-year period.; Results: There were 4 subgroups at each point in time. Approximately 3 quarters of the sample demonstrated continuity in the qualitative type of profile between ages 65 and 72, with 17.9% of the sample in a profile with sustained overall low performance at both ages 65 and 72. An additional 18.7% of participants made subgroup transitions indicating marked decline in episodic memory.; Discussion: Results demonstrate the utility of using mixture modeling to identify qualitatively and quantitatively distinct subgroups of cognitive aging among older adults. We discuss the implications of these results for the continued use of population health data to advance research on cognitive aging. | Wisconsin Longitudinal Study (WLS) | Mid-Life Factors | Alzheimer's disease, Memory, Methodology | Link | Moorman, S. M., Greenfield, E. A., & Carr, K. (2021). Using Mixture Modeling to Construct Subgroups of Cognitive Aging in the Wisconsin Longitudinal Study. The journals of gerontology. Series B, Psychological sciences and social sciences, 76(8), 1512–1522. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Genetic effects and gene-by-education interactions on episodic memory performance and decline in an aging population. | Smith, Jennifer A; Kho, Minjung; Zhao, Wei; Yu, Miao; Mitchell, Colter; Faul, Jessica D | 2021 | Both social and genetic factors contribute to cognitive impairment and decline, yet genetic factors identified through genome-wide association studies (GWAS) explain only a small portion of trait variability. This "missing heritability" may be due to rare, potentially functional, genetic variants not assessed by GWAS, as well as gene-by-social factor interactions not explicitly modeled. Gene-by-social factor interactions may also operate differently across race/ethnic groups. We selected 39 genes that had significant, replicated associations with cognition, dementia, and related traits in published GWAS. Using gene-based analysis (SKAT/iSKAT), we tested whether common and/or rare variants were associated with episodic memory performance and decline either alone or through interaction with education in >10,000 European ancestry (EA) and >2200 African ancestry (AA) respondents from the Health and Retirement Study (HRS). Nine genes in EA and five genes in AA were associated with memory performance or decline (p < 0.05), and these effects did not attenuate after adjusting for education. Interaction between education and CLPTM1 on memory performance was significant in AA (p = 0.003; FDR-adjusted p = 0.038) and nominally significant in EA (p = 0.026). In both ethnicities, low memory performance was associated with CLPTM1 genotype (rs10416261) only for those with less than high school education, and effects persisted after adjusting for APOE ε4. For over 70% of gene-by-education interactions across the genome that were at least nominally significant in either ethnic group (p < 0.05), genetic effects were only observed for those with less than high school education. These results suggest that genetic effects on memory identified in this study are not mediated by education, but there may be important gene-by-education interactions across the genome, including in the broader APOE genomic region, which operate independently of APOE ε4. This work illustrates the importance of developing theoretical frameworks and methodological approaches for integrating social and genomic data to study cognition across ethnic groups. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | APOE, Cognitive function, Educational attainment, Genetics, Memory | Link | Smith, J. A., Kho, M., Zhao, W., Yu, M., Mitchell, C., & Faul, J. D. (2021). Genetic effects and gene-by-education interactions on episodic memory performance and decline in an aging population. Social science & medicine (1982), 271, 112039. | SSM - Population Health |
| Area‐level deprivation is associated with rate of memory decline in late life within a community‐based cohort. | Williams, Victoria J; Herd, Pamela; Sicinski, K; Johnson, Sterling C; Asthana, Sanjay | 2021 | Background: Residing in a disadvantaged neighborhood is associated with adverse health outcomes, as well as increased risk for dementia. However, it remains unclear whether area-level deprivation impacts the rate of age-related memory decline, especially in community-based populations. Method: We quantified late life neighborhood level disadvantage using the 2013 Area Deprivation Index (ADI) for 2,554 participants with complete data of interest within the Wisconsin Longitudinal Study – a same-aged, community-based cohort of randomly selected 1957 Wisconsin high school graduates. Delayed recall for a 10-item word list was assessed at two timepoints in mid to late life (Time 1 (∼2004): age 64.39 + 0.74 years; and Time 2 (∼2011): age 71.28 + 0.97 years). We used multivariate linear regression models to evaluate whether ADI was associated with memory performance at each time point, and with the annualized rate of change in memory performance over time. Result: Increasing ADI was significantly correlated with lower adolescent IQ, less educational attainment, lower net worth, higher vascular risk scores, elevated depression metrics, and increasing age (all p<0.001). Mean ADI did not differ by sex, but was significantly higher in ApoE-4 positive carriers (t(2552) =2.257, p=0.024). Results of multivariate regression indicated that greater area-level deprivation (higher ADI) was not associated with delayed recall performance at Time 1 (b = 0.001; 95% CI: -0.003 to 0.005, P=0.790), but was associated with poorer delayed recall performance at Time 2 (B = -0.004; 95% CI: -0.007 to -0.001, P=0.019). Higher ADI also predicted greater annualized rate of decline in delayed recall between timepoints (B = -0.001; 95% CI: -0.001 to -9.9^10-5, P=0.025). These findings held after controlling for individual-level demographic and socioeconomic variables (age, sex, adolescent IQ, years of education, net worth), genetic risk (ApoE-4 carrier status), depression, hearing loss, and a modified CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) risk score calculated at Time 1. Conclusion: Even after accounting for established individual-level demographic, socioeconomic, health, and genetic risk factors for cognitive decline, greater neighborhood disadvantage is associated with an accelerated rate of annualized decline in delayed recall performance across mid to late life in a community sample. | Wisconsin Longitudinal Study (WLS) | Early Life, Mid-Life Factors | APOE, Biomarkers, Cardiometabolic outcomes, Cognitive function, Genetics, Mental health, Memory, Neighborhoods, Structural inequality | Link | Williams, V. J., Herd, P., Sicinski, K., Johnson, S. C., & Asthana, S. (2021). Area‐level deprivation is associated with rate of memory decline in late life within a community‐based cohort. Alzheimer's & Dementia, 17, e056608. | Alzheimer's & Dementia |
| A New Look at Cohort Trend and Underlying Mechanisms in Cognitive Functioning. | Zheng, Hui | 2021 | Objectives: The prevalence of dementia in the United States seems to have declined over the last few decades. We investigate trends and their underlying mechanisms in cognitive functioning (CF) across 7 decades of birth cohorts from the Greatest Generation to Baby Boomers.; Methods: Data come from 30,191 participants of the 1996-2014 Health and Retirement Study. CF is measured as a summary score on a 35-point cognitive battery of items. We use generalized linear models to examine the trends in CF and explanatory variables across birth cohorts. Then, Karlson-Holm-Breen decomposition method is used to evaluate the contribution of each explanatory variable to the trend of CF.; Results: CF has been improving from the Greatest Generation to Late Children of Depression and War Babies, but then significantly declines since the Early-Baby Boomers and continues into Mid-Baby Boomers. This pattern is observed universally across genders, race/ethnicities, education groups, occupations, income, and wealth quartiles. The worsening CF among Baby Boomers does not originate from childhood conditions, adult education, or occupation. It can be attributed to lower household wealth, lower likelihood of marriage, higher levels of loneliness, depression and psychiatric problems, and more cardiovascular risk factors (e.g., obesity, physical inactivity, hypertension, stroke, diabetes, and heart disease).; Discussion: The worsening CF among Baby Boomers may potentially reverse past favorable trends in dementia as they reach older ages and cognitive impairment becomes more common if no effective interventions and policy responses are in place. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Cardiometabolic outcomes, Cognitive function, Dementia, Gender/Sex, Generational effects, Loneliness, Mental health, Socioeconomic status | Link | Zheng H. (2021). A New Look at Cohort Trend and Underlying Mechanisms in Cognitive Functioning. The journals of gerontology. Series B, Psychological sciences and social sciences, 76(8), 1652–1663. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Racial and Educational Disparities in Dementia and Dementia-Free Life Expectancy. | Farina, Mateo P; Hayward, Mark D; Kim, Jung Ki; Crimmins, Eileen M | 2020 | Objectives: We estimate life expectancy with and without dementia for Americans 65 years and older by education and race to examine how these stratification systems combine to shape disparities in later-life cognitive health.; Method: Based on the Health and Retirement Study (2000-2014), we use a multivariate, incidence-based life table approach to estimate life expectancy by cognitive health status for race-education groups. The models also simulate group differences in the prevalence of dementia implied by these rates.; Results: The life table results document notable race-education differences in dementia and dementia-free life expectancy, as well as stark differences in implied dementia prevalence. At each education level, blacks can expect to live more years with dementia and they have significantly higher rates of dementia prevalence. This distribution of disparities in the older population is anchored by 2 groups-blacks without a high school diploma and whites with some college or more.; Discussion: Dementia experience and dementia burden differ dramatically along race-education lines. Race and education combine to exaggerate disparities and they both have enduring effects. Future research should explicitly consider how race and education combine to influence dementia in the older American population. | Health and Retirement Study (HRS) | Mid-Life Factors | Dementia, Educational attainment, Mortality, Racial-ethnic disparities | Link | Farina, M. P., Hayward, M. D., Kim, J. K., & Crimmins, E. M. (2020). Racial and Educational Disparities in Dementia and Dementia-Free Life Expectancy. The journals of gerontology. Series B, Psychological sciences and social sciences, 75(7), e105–e112. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Cognitive Function and Cardiometabolic-Inflammatory Risk Factors Among Older Indians and Americans. | Hu, Peifeng; Lee, Jinkook; Beaumaster, Sidney; Kim, Jung Ki; Dey, Sharmistha; Weir, David; Crimmins, Eileen M | 2020 | Objectives: To investigate how cardiometabolic-inflammatory risk factors are related to cognition among older adults in India and the United States.; Design: The Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) and the Harmonized Cognitive Assessment Protocol of the Health and Retirement Study (HRS-HCAP) in the United States conducted an in-depth assessment of cognition, using protocols designed for international comparison.; Setting: Cognitive tests were conducted in hospital or household settings in India and in household settings in the United States.; Participants: Respondents aged 60 years and older from LASI-DAD (N = 1,865) and respondents aged 65 years and older from HRS-HCAP (N = 2,111) who provided venous blood specimen.; Measurements: We used total composite scores from the common cognitive tests administered. Cardiovascular risk was indicated by systolic and diastolic blood pressure, pulse rate, pro-B-type natriuretic peptide (proBNP), and homocysteine. Metabolic risk was measured by body mass index, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, and lipoprotein (a) (only in India). Inflammatory risk was indicted by white blood cell count, C-reactive protein, albumin, and uric acid (only in India).; Results: The distribution of both total cognition scores and of cardiometabolic risk factors differed significantly between India and the United States. In both countries, lower cognition was associated with older age, lower education, elevated homocysteine, elevated proBNP, and lower albumin levels. The associations between HbA1c levels and cognitive measures were statistically significant in both countries, but in the opposite direction, with a coefficient of 1.5 (P < .001) in India and -2.4 (P < .001) in the United States for one percentage increase in absolute HbA1c value.; Conclusion: Cardiometabolic-inflammatory biomarkers are associated with cognitive functional levels in each country, but the relationships may vary across countries. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Biomarkers, Cardiometabolic health, Cognitive function, Cross-national comparison, Dementia, Inflammation, Racial-ethnic disparities | Link | Hu, P., Lee, J., Beaumaster, S., Kim, J. K., Dey, S., Weir, D., & Crimmins, E. M. (2020). Cognitive Function and Cardiometabolic-Inflammatory Risk Factors Among Older Indians and Americans. Journal of the American Geriatrics Society, 68 Suppl 3(Suppl 3), S36–S44. | Journal of the American Geriatrics Society |
| More Than Selection Effects: Volunteering Is Associated With Benefits in Cognitive Functioning. | Kail, Ben Lennox; Carr, Dawn C | 2020 | Objectives: Volunteering is a lifestyle behavior that bolsters cognitive resilience. However, previous studies have not assessed the degree to which cognitive functioning is predictive of becoming a volunteer (i.e., selection into volunteering), and how this might contribute to the superior cognitive performance observed among volunteers. The purpose of this brief report is to address the role of cognition-related selection into becoming a volunteer in the association between formal volunteering and two cognitive measures: (a) overall cognitive function and (b) self-rated memory.; Method: The Health and Retirement Study was used to assess whether, net of cognitive selection into volunteering, formal volunteering is associated with cognitive function.; Results: Selection explained between 4.9% and 29% of the effect of volunteering on cognitive function (depending on the cognitive outcome and the level of volunteering). However, net of cognitive selection into volunteering, among all cognitive measures there are beneficial effects of formal volunteering on cognitive function.; Discussion: These findings suggest a proportion of the positive association between volunteering and cognitive function is explained by selection. However, net of selection, formal volunteering is associated with benefits to cognitive function. These findings offer promise for the development of volunteer-based interventions designed to bolster cognitive functioning. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Health behaviors, Memory | Link | Kail, B. L., & Carr, D. C. (2020). More Than Selection Effects: Volunteering Is Associated With Benefits in Cognitive Functioning. The journals of gerontology. Series B, Psychological sciences and social sciences, 75(8), 1741–1746. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Cognition and Daily Functioning: Results from the Hispanic Community Health Study/Study of Latinos (SOL) and Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). | Stickel, Ariana M; Tarraf, Wassim; Wu, Benson; Marquine, Maria J; Vásquez, Priscilla M; Daviglus, Martha; Estrella, Mayra L; Perreira, Krista M; Gallo, Linda C; Lipton, Richard B; Isasi, Carmen R; Kaplan, Robert; Zeng, Donglin; Schneiderman, Neil; González, Hector M | 2020 | Background: Among older adults, poorer cognitive functioning has been associated with impairments in instrumental activities of daily living (IADLs). However, IADL impairments among older Hispanics/Latinos is poorly understood.; Objective: To characterize the relationships between cognition and risk for IADL impairment among diverse Hispanics/Latinos.; Methods: Participants included 6,292 community-dwelling adults from the Study of Latinos - Investigation of Neurocognitive Aging, an ancillary study of 45+ year-olds in the Hispanic Community Health Study/Study of Latinos. Cognitive data (learning, memory, executive functioning, processing speed, and a Global cognitive composite) were collected at Visit 1. IADL functioning was self-reported 7 years later, and treated as a categorical (i.e., risk) and continuous (i.e., degree) measures of impairment. Survey two-part models (mixture of logit and generalized linear model with Gaussian distribution) and ordered logistic regression tested the associations of cognitive performance (individual tests and composite z-score) with IADL impairment. Additionally, we investigated the moderating role of age, sex, and Hispanic/Latino background on the association between cognition and IADL impairment.; Results: Across all cognitive measures, poorer performance was associated with higher odds of IADL impairment 7 years later. Associations were generally stronger for the oldest group (70+ years) relative to the youngest group (50-59 years). Sex and Hispanic/Latino background did not modify the associations. Across the full sample, lower scores on learning, memory, and the Global cognitive composite were also associated with higher degree of IADL impairment.; Conclusion: Across diverse Hispanics/Latinos, cognitive health is an important predictor of everyday functioning 7 years later, especially in older adulthood. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Mid-Life Factors | Cognitive function, Health behavior, Hispanics/Latinos, Memory | Link | Stickel, A. M., Tarraf, W., Wu, B., Marquine, M. J., Vásquez, P. M., Daviglus, M., Estrella, M. L., Perreira, K. M., Gallo, L. C., Lipton, R. B., Isasi, C. R., Kaplan, R., Zeng, D., Schneiderman, N., & González, H. M. (2020). Cognition and Daily Functioning: Results from the Hispanic Community Health Study/Study of Latinos (SOL) and Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA). Journal of Alzheimer's disease : JAD, 77(3), 1267–1278. | Journal of Alzheimer's Disease |
| Death of a Child Prior to Midlife, Dementia Risk, and Racial Disparities. | Umberson, Debra; Donnelly, Rachel; Xu, Minle; Farina, Matthew; Garcia, Michael A | 2020 | Objectives: This study considers whether experiencing the death of a child prior to midlife (by parental age 40) is associated with subsequent dementia risk, and how such losses, which are more common for black than for white parents, may add to racial disparities in dementia risk.; Methods: We use discrete-time event history models to predict dementia incidence among 9,276 non-Hispanic white and 2,182 non-Hispanic black respondents from the Health and Retirement Study, 2000-2014.; Results: Losing a child prior to midlife is associated with increased risk for later dementia, and adds to disparities in dementia risk associated with race. The death of a child is associated with a number of biosocial variables that contribute to subsequent dementia risk, helping to explain how the death of child may increase risk over time.; Discussion: The death of a child prior to midlife is a traumatic life course stressor with consequences that appear to increase dementia risk for both black and white parents, and this increased risk is explained by biosocial processes likely activated by bereavement. However, black parents are further disadvantaged in that they are more likely than white parents to experience the death of a child, and such losses add to the already substantial racial disadvantage in dementia risk. | Health and Retirement Study (HRS) | Mid-Life Factors | Bereavement, Dementia, Family, Racial-ethnic disparities, Structural inequality, Stress | Link | Umberson, D., Donnelly, R., Xu, M., Farina, M., & Garcia, M. A. (2020). Death of a Child Prior to Midlife, Dementia Risk, and Racial Disparities. The journals of gerontology. Series B, Psychological sciences and social sciences, 75(9), 1983–1995. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Early Educational Experiences and Trajectories of Cognitive Functioning Among US Adults in Midlife and Later. | Walsemann, Katrina M; Ailshire, Jennifer A | 2020 | Educational attainment is often considered the most important protective factor against cognitive impairment and dementia, yet significant variation in early educational experiences exists among midlife and older US adults. We used prospective data from the Health and Retirement Study (HRS) along with information on respondents' early educational experiences collected in the 2015 and 2017 HRS Life History Mail Survey to examine whether school context, educational content, and academic ability were associated with trajectories of cognitive functioning and whether educational attainment explains this relationship. We restricted our sample to age-eligible HRS Life History Mail Survey respondents who provided data on cognitive functioning at least once during 1998-2014 and attended primary school or higher (n = 9,565 respondents providing 62,037 person-period observations). Estimates from linear mixed models revealed that school context, educational content, and academic ability were significantly associated with level of cognitive functioning but not rate of cognitive decline. Educational attainment explained 9%-55% of the association between these early educational experiences and level of cognitive functioning; however, all relationships remained statistically significant. Our results suggest that educational experiences that span childhood and adolescence are independently related to level of cognitive functioning decades later. | Health and Retirement Study (HRS) | Early Life | Childhood/Adolescence, Cognitive function, School quality, School segregation | Link | Walsemann, K. M., & Ailshire, J. A. (2020). Early educational experiences and trajectories of cognitive functioning among mid-life and older U.S. adults. American Journal of Epidemiology, 189(5), 403–411. | American Journal of Epidemiology |
| Considering the APOE locus in Alzheimer's disease polygenic scores in the Health and Retirement Study: a longitudinal panel study. | Ware, Erin B; Faul, Jessica D; Mitchell, Colter M; Bakulski, Kelly M | 2020 | Background: Polygenic scores are a strategy to aggregate the small, additive effects of single nucleotide polymorphisms across the genome. With phenotypes like Alzheimer's disease, which have a strong and well-established genomic locus (APOE), the cumulative effect of genetic variants outside of this area has not been well established in a population-representative sample.; Methods: Here we examine the association between polygenic scores for Alzheimer's disease both with and without the APOE region (chr19: 45,384,477 to 45,432,606, build 37/hg 19) at different P value thresholds and dementia. We also investigate the addition of APOE-ε4 carrier status and its effect on the polygenic score-dementia association in the Health and Retirement Study using generalized linear models accounting for repeated measures by individual and use a binomial distribution, logit link, and unstructured correlation structure.; Results: In a large sample of European ancestry participants of the Health and Retirement Study (n = 9872) with an average of 5.2 (standard deviation 1.8) visit spaced two years apart, we found that including the APOE region through weighted variants in a polygenic score was insufficient to capture the large amount of risk attributed to this region. We also found that a polygenic score with a P value threshold of 0.01 had the strongest association with the odds of dementia in this sample (odds ratio = 1.10 95%CI 1.0 to 1.2).; Conclusion: We recommend removing the APOE region from polygenic score calculation and treating the APOE locus as an independent covariate when modeling dementia. We also recommend using a moderately conservative P value threshold (e.g. 0.01) when creating polygenic scores for Alzheimer's disease on dementia. These recommendations may help elucidate relationships between polygenic scores and regions of strong significance for phenotypes similar to Alzheimer's disease. | Health and Retirement Study (HRS) | Biological Mechanisms | Alzheimer's disease, APOE, Demenia, Genetics | Link | Ware, E. B., Faul, J. D., Mitchell, C. M., & Bakulski, K. M. (2020). Considering the APOE locus in Alzheimer's disease polygenic scores in the Health and Retirement Study: a longitudinal panel study. BMC medical genomics, 13(1), 164. | BMC Medical Genomics |
| Prevalence and correlates of mild cognitive impairment among diverse Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging results. | González, Hector M; Tarraf, Wassim; Schneiderman, Neil; Fornage, Myriam; Vásquez, Priscilla M; Zeng, Donglin; Youngblood, Marston; Gallo, Linda C; Daviglus, Martha L; Lipton, Richard B; Kaplan, Robert; Ramos, Alberto R; Lamar, Melissa; Thomas, Sonia; Chai, Albert; DeCarli, Charles | 2019 | Introduction: We estimated the prevalence and correlates of mild cognitive impairment (MCI) among middle-aged and older diverse Hispanics/Latinos.; Methods: Middle-aged and older diverse Hispanics/Latinos enrolled (n = 6377; 50-86 years) in this multisite prospective cohort study were evaluated for MCI using the National Institute on Aging-Alzheimer's Association diagnostic criteria.; Results: The overall MCI prevalence was 9.8%, which varied between Hispanic/Latino groups. Older age, high cardiovascular disease (CVD) risk, and elevated depressive symptoms were significant correlates of MCI prevalence. Apolipoprotein E4 (APOE) and APOE2 were not significantly associated with MCI.; Discussion: MCI prevalence varied among Hispanic/Latino backgrounds, but not as widely as reported in the previous studies. CVD risk and depressive symptoms were associated with increased MCI, whereas APOE4 was not, suggesting alternative etiologies for MCI among diverse Hispanics/Latinos. Our findings suggest that mitigating CVD risk factors may offer important pathways to understanding and reducing MCI and possibly dementia among diverse Hispanics/Latinos. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms, Mid-Life Factors | Alzheimer's disease, APOE, Cardiovascular Disease, Cognitive function, Dementia, Hispanics/Latinos, Mental health | Link | González, H. M., Tarraf, W., Schneiderman, N., Fornage, M., Vásquez, P. M., Zeng, D., Youngblood, M., Gallo, L. C., Daviglus, M. L., Lipton, R. B., Kaplan, R., Ramos, A. R., Lamar, M., Thomas, S., Chai, A., & DeCarli, C. (2019). Prevalence and correlates of mild cognitive impairment among diverse Hispanics/Latinos: Study of Latinos-Investigation of Neurocognitive Aging results. Alzheimer's & dementia : the journal of the Alzheimer's Association, 15(12), 1507–1515. | Alzheimer's & Dementia |
| Growing up on a farm and cognitive functioning in later life. | Herd, Pamela; Asthana, Sanjay; Sicinski, Kamil | 2019 | There is growing interest in rural disadvantage and the implications for health and well-being in later life. We examine the relationship between living in rural areas in childhood and cognitive outcomes later in life using the Wisconsin Longitudinal Study. The WLS has prospective childhood measures of geographic status, adolescent IQ, and detailed measures of socioeconomic status, combined with later life measures of health and cognitive functioning. We find a robust relationship between rurality and lower levels of cognitive functioning, but it is explained by growing up on a farm. | Wisconsin Longitudinal Study (WLS) | Early Life | Childhood/Adolescence, Cognitive function, Geographic disparities, Neighborhoods, Socioeconomic status | Link | Herd, P., Asthana, S., & Sicinski, K. (2019). Growing up on a farm and cognitive functioning in later life. Innovation in Aging, 3(Suppl 1), S57. | Innovation in Aging |
| School context in adolescence and cognitive functioning 50 years later. | Moorman, Sara M; Greenfield, Emily A; Garcia, Sarah | 2019 | To advance understanding of how social inequalities from childhood might contribute to cognitive aging, we examined the extent to which school context in adolescence was associated with individuals’ cognitive performance more than 50 years later. Using data from 3,012 participants in the Wisconsin Longitudinal Study (WLS), we created an aggregate measure of school-level structural advantage, with indicators such as the proportion of teachers who had at least five years of teaching experience and spending per pupil. Multilevel models indicated that secondary school advantage was associated with small benefits in language/executive function at age 65 among older adults who had lower academic achievement in secondary school. Findings suggest that school advantage is a developmental context of adolescence that has modest implications for intracohort differences in aspects of later life cognition. | Wisconsin Longitudinal Study (WLS) | Early Life | Childhood/Adolescence, Cognitive function, Educational attainment, School quality, Structural inequality | Link | Moorman, S. M., Greenfield, E. A., & Garcia, S. (2019). School context in adolescence and cognitive functioning 50 years later. Journal of Health and Social Behavior, 60(4), 493-508. | Journal of Health and Social Behavior |
| Educational Differences in the Prevalence of Dementia and Life Expectancy with Dementia: Changes from 2000 to 2010. | Crimmins, Eileen M; Saito, Yasuhiko; Kim, Jung Ki; Zhang, Yuan S; Sasson, Isaac; Hayward, Mark D | 2018 | Objectives: This article provides the first estimates of educational differences in age-specific prevalence, and changes in prevalence over time, of dementia by education levels in the United States. It also provides information on life expectancy, and changes in life expectancy, with dementia and cognitively healthy life for educational groups. Method: Data on cognition from the 2000 and 2010 Health and Retirement Study are used to classify respondents as having dementia, cognitive impairment without dementia (CIND), or being cognitively intact. Vital statistics data are used to estimate life tables for education groups and the Sullivan method is used to estimate life expectancy by cognitive state. Results: People with more education have lower prevalence of dementia, more years of cognitively healthy life, and fewer years with dementia. Years spent in good cognition increased for most sex-education groups and, conversely, years spent with dementia decreased for some. Mortality reduction was the most important factor in increasing cognitively healthy life. Change in the distribution of educational attainment has played a major role in the reduction of life with dementia in the overall population. Discussion: Differences in the burden of cognitive loss by education point to the significant cost of low social status both to individuals and to society. | Health and Retirement Study (HRS) | Mid-Life Factors | Dementia, Educational attainment, Mortality | Link | Crimmins, E. M., Saito, Y., Kim, J. K., Zhang, Y. S., Sasson, I., & Hayward, M. D. (2018). Educational Differences in the Prevalence of Dementia and Life Expectancy with Dementia: Changes from 2000 to 2010. The journals of gerontology. Series B, Psychological sciences and social sciences, 73(suppl_1), S20–S28. | The Journals of Gerontology. Series B, Psychological sciences and social sciences |
| Cognitive Function and its Risk Factors Among Older US Adults Living at Home. | Dale, William; Kotwal, Ashwin A; Shega, Joseph W; Schumm, L Philip; Kern, David W; Pinto, Jayant M; Pudelek, Kelly M; Waite, Linda J; McClintock, Martha K | 2018 | Background: The Montreal Cognitive Assessment (MoCA) has not been administered to a representative national sample, precluding comparison of patient scores to the general population and for risk factor identification. Methods: A validated survey-based adaptation of the MoCA (MoCA-SA) was administered to a probability sample of home-dwelling US adults aged 62 to 90, using the National Social Life, Health, and Aging Project (n=3129), yielding estimates of prevalence in the United States. The association between MoCA-SA scores and sociodemographic and health-related risk factors were determined. Results: MoCA-SA scores decreased with age, and there were substantial differences among sex, education, and race/ethnicity groups. Poor physical health, functional status, and depression were also associated with lower cognitive performance; current health behaviors were not. Using the recommended MoCA cut-point score for Mild Cognitive Impairment (MoCA score <26; MoCA-SA score <17), 72% (95% confidence interval, 69% to 74%) of older US adults would be classified as having some degree of cognitive impairment. Conclusions: Our results provide an important national estimate for interpreting MoCA scores from individual patients, and establish wide variability in cognition among older home-dwelling US adults. Care should be taken in applying previously-established MoCA cut-points to the general population, especially when evaluating individuals from educationally and ethnically diverse groups. | National Social Life, Health & Aging Project (NSHAP) | Mid-Life Factors | Cognitive function, Dementia, Health behavior, Mental health | Link | Dale, W., Kotwal, A. A., Shega, J. W., Schumm, L. P., Kern, D. W., Pinto, J. M., Pudelek, K. M., Waite, L. J., & McClintock, M. K. (2018). Cognitive Function and its Risk Factors Among Older US Adults Living at Home. Alzheimer disease and associated disorders, 32(3), 207–213. | Alzheimer Disease and Associated Disorders |
| The role of education in the association between race/ethnicity/nativity, cognitive impairment, and dementia among older adults in the United States. | Garcia, Marc A; Saenz, Joseph; Downer, Brian; Wong, Rebeca | 2018 | Background: Older Black and Hispanic adults are more likely to be cognitively impaired than older White adults. Disadvantages in educational achievement for minority and immigrant populations may contribute to disparities in cognitive impairment. Objective: Examine the role of education in racial/ethnic and nativity differences in cognitive impairment/no dementia (CIND) and dementia among older US adults. Methods: Data comes from the 2012 Health and Retirement Study. A total of 19,099 participants aged >50 were included in the analysis. Participants were categorized as having normal cognition, CIND, or dementia based on the Telephone Interview for Cognitive Status (TICS) or questions from a proxy interview. We document age and educational differences in cognitive status among White, Black, US-born Hispanic, and foreign-born Hispanic adults by sex. Logistic regression is used to quantify the association between race/ethnicity/nativity, education, and cognitive status by sex. Results: Among women, foreign-born Hispanics have higher odds of CIND and dementia than Whites. For men, Blacks have higher odds for CIND and dementia compared to Whites. The higher odds for CIND and dementia across race/ethnic and nativity groups was reduced after controlling for years of education but remained statistically significant for older Black and US-born Hispanic adults. Controlling for education reduces the odds for CIND (women and men) and dementia (men) among foreign-born Hispanics to nonsignificance. Contribution: These results highlight the importance of education in CIND and dementia, particularly among foreign-born Hispanics. Addressing inequalities in education can contribute to reducing racial/ethnic/nativity disparities in CIND and dementia for older adults. | Health and Retirement Study (HRS) | Mid-Life Factors | Dementia, Educational attainment, Migration, Racial-ethnic disparities | Link | Garcia, M. A., Saenz, J., Downer, B., & Wong, R. (2018). The role of education in the association between race/ethnicity/nativity, cognitive impairment, and dementia among older adults in the United States. Demographic research, 38, 155–168. | Demographic Research |
| Apolipoprotein E genotypes among diverse middle-aged and older Latinos: Study of Latinos-Investigation of Neurocognitive Aging results (HCHS/SOL). | González, Hector M; Tarraf, Wassim; Jian, Xueqiu; Vásquez, Priscilla M; Kaplan, Robert; Thyagarajan, Bharat; Daviglus, Martha; Lamar, Melissa; Gallo, Linda C; Zeng, Donglin; Fornage, Myriam | 2018 | The apoE4 isoform is associated with increased cholesterol, cardiovascular risk, and Alzheimer's Disease risk, however, its distribution is not well-understood among US Latinos. Latinos living in the US are highly Amerindian, European and African admixed, which varies by region and country of origin. However, Latino genetic diversity is understudied and consequently poorly understood, which has significant implications for understanding disease risk in nearly one-fifth of the US population. In this report we describe apoE distributions in a large and representative sample of diverse, genetically determined US Latinos. | Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) | Biological Mechanisms, Mid-Life Factors | Alzheimer's disease, APOE, Cardiovascular Disease, Genetics | Link | González, H. M., Tarraf, W., Jian, X., Vásquez, P. M., Kaplan, R., Thyagarajan, B., Daviglus, M., Lamar, M., Gallo, L. C., Zeng, D., & Fornage, M. (2018). Apolipoprotein E genotypes among diverse middle-aged and older Latinos: Study of Latinos-Investigation of Neurocognitive Aging results (HCHS/SOL). Scientific reports, 8(1), 17578. | Scientific Reports |
| Predictors and Implications of Accelerated Cognitive Aging. | Levine, Morgan E; Harrati, Amal; Crimmins, Eileen M | 2018 | Aging is a major risk factor for both normal and pathological cognitive decline. However, individuals vary in their rate of age-related decline. We developed an easily interpretable composite measure of cognitive age, and related both the level of cognitive age and cognitive slope to sociodemographic, genetic, and disease indicators and examined its prediction of dementia transition. Using a sample of 19,594 participants from the Health and Retirement Study, cognitive age was derived from a set of performance tests administered at each wave. Our findings reveal different conclusions as they relate to levels versus slopes of cognitive age, with more pronounced differences by sex and race/ethnicity for absolute levels of cognitive decline rather than for rates of declines. We also find that both level and slope of cognitive age are inversely related to education, as well as increased for persons with APOE Ɛ4 and/or diabetes. Finally, results show that the slope in cognitive age predicts subsequent dementia among non-demented older adults. Overall, our study suggests that this measure is applicable to cross-sectional and longitudinal studies on cognitive aging, decline, and dementia with the goal of better understanding individual differences in cognitive decline. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | APOE, Cognitive function, Dementia, Educational attainment, Genetics | Link | Levine, M. E., Harrati, A., & Crimmins, E. M. (2018). Predictors and Implications of Accelerated Cognitive Aging. Biodemography and social biology, 64(2), 83–101. | Biodemography and Social Biology |
| Racial Differences in the Relationship of Physical Activity Trajectories on Cognitive Function Trajectories. | Li, Chien-Ching; Chen, Yi-Fan; Liang, Jersey; Barnes, Lisa L; Matthews, Alicia K | 2018 | Prior observational studies have shown that physical activity reduces the risk of cognitive decline. Furthermore racial disparities in cognitive health have been found that older African Americans (AAs) have poor cognitive function than older White Americans. However, no studies have examined the association between trajectory patterns of physical activity and cognitive function trajectories among older Americans and whether the association differs between older AAs and Whites. This study used a group-based mixture model to identify distinct physical activity and cognitive function trajectory groups by analyzing a 16-year longitudinal data obtained from the Health and Retirement Study (1998–2014). Three distinct cognitive function trajectory groups (C1=high, C2=moderate, C3=low cognitive function) and five distinct physical activity trajectory groups (P1=active, P2=active-decreased to moderate, P3=moderate, P4=moderate-decreased to inactive, P5=inactive) were identified. Significant interaction effects between race and physical activity trajectories (i.e., P1xAAs, P2xAAs) on cognitive function trajectories were found. Stratified analyses was conducted to examine how the association differed by racial groups. Results showed that people who were active (P1) compared to inactive people were more likely to be in high cognitive function group (C1). The magnitude of the association was found to be greater in AAs (OR=6.11) than in Whites (OR=5.11). However, P2 group (active-decreased to moderate) was associated with high cognitive function (C1) only in Whites (OR=2.20). In conclusion, the trajectory patterns of physical activity were associated with cognitive function trajectories. The associations were moderated by racial groups. Future studies can further examine other behavioral risk factors trajectories and associations with cognitive function | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Health behavior, Racial-ethnic disparities | Link | Li, C., Chen, Y., Liang, J., Barnes, L., & Matthews, A. (2018). Racial Differences in the Relationship of Physical Activity Trajectories on Cognitive Function Trajectories. Innovation in Aging, 2(suppl_1), 978-978. | Innovation in Aging |
| Childhood socioeconomic status and genetic risk for poorer cognition in later life. | Moorman, Sara M; Carr, Kyle; Greenfield, Emily A | 2018 | The ε4 allele of the APOE gene is associated with poorer cognition in later life. This study aimed to advance understanding of how environments potentially moderate this genetic risk by focusing on childhood socioeconomic status (SES). Previous research across diverse national contexts has found that older adults from higher-SES families in childhood demonstrate better cognitive functioning than their lower-SES counterparts. Nevertheless, few studies have examined whether higher childhood SES might also promote later life cognition by mitigating the effects of ε4 carrier status. To address this gap, we used data from 3017 participants in the Wisconsin Longitudinal Study, which has followed a random sample of people who graduated from Wisconsin high schools in 1957. Childhood SES included parents' educational attainment, father's occupational status, and household income in adolescence. We constructed measures of memory and of language/executive functioning using scores from neurocognitive tests administered when participants were approximately ages 65 and 72. APOE ε4 status was measured through saliva samples. Results from cross-controlled multilevel models indicated that APOE ε4 status—and not childhood SES—independently predicted memory, whereas childhood SES—and not APOE ε4 status—independently predicted language/executive functioning. Moreover, a statistical interaction between APOE ε4 status and childhood SES for memory indicated that at baseline, higher childhood SES protected against the risk of APOE ε4 status, whereas lower childhood SES exacerbated the risk of APOE ε4 status. However, by follow-up, these moderating effects dissipated, and APOE ε4 status alone was associated with memory. We interpret these results in light of theorizing on differential susceptibility for poorer cognition across the life course. | Wisconsin Longitudinal Study (WLS) | Biological Mechanisms, Early Life, Mid-Life Factors | APOE, Childhood/Adolescence, Genetics, Memory, Socioeconomic status, Structural inequality | Link | Moorman, S. M., Carr, K., & Greenfield, E. A. (2018). Childhood socioeconomic status and genetic risk for poorer cognition in later life. Social Science & Medicine, 212, 219-226. | SSM - Population Health |
| Does Caring for a Spouse With Dementia Accelerate Cognitive Decline? Findings From the Health and Retirement Study. | Dassel, Kara Bottiggi; Carr, Dawn C; Vitaliano, Peter | 2017 | Purpose of the Study: The purpose of this study is to expand our recent work, which showed that spousal dementia caregivers compared to spousal nondementia caregivers experience an accelerated rate of frailty over time, by exploring cognitive health outcomes between dementia and nondementia caregivers. Design and Methods: Using 8 biannual waves of the Health and Retirement Study data and performance on the modified Telephone Interview for Cognitive Status, we examined changes in cognitive health among surviving spousal caregivers (N = 1,255) of individuals with dementia (n = 192) and without dementia (n = 1,063), 2 waves prior and 2 waves following the death of the care recipient. Results: Controlling for baseline health and contextual factors (e.g., frailty status, age, education), results revealed that dementia caregivers had significantly greater cognitive decline (p < .01) compared to nondementia caregivers. Relative to 2 waves prior to the death of their spouse, dementia caregivers declined by 1.77 points relative to nondementia caregivers (0.87 points) at the time their spouses’ deaths were reported and 1.89 relative to the 1.18 points at the wave following these deaths, respectively. Implications: The findings from this study show that spousal caregivers of persons with dementia experience accelerated cognitive decline themselves compared to nondementia caregivers. These results, along with our previous study findings, suggest that this vulnerable group could benefit from early cognitive screening and psychosocial interventions designed to help dementia caregivers better maintain their cognitive and physical health during and following their intensive caregiving responsibilities. | Health and Retirement Study (HRS) | Mid-Life Factors | Bereavement, Cognitive function, Dementia, Family | Link | Dassel, K. B., Carr, D. C., & Vitaliano, P. (2017). Does Caring for a Spouse With Dementia Accelerate Cognitive Decline? Findings From the Health and Retirement Study. The Gerontologist, 57(2), 319–328. | The Gerontologist |
| Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S. | Friedman, Esther M; Shih, Regina A; Slaughter, Mary E; Weden, Margaret M; Cagney, Kathleen A | 2017 | Recent evidence suggests that living in a neighborhood with a greater percentage of older adults is associated with better individual health, including lower depression, better self-rated health, and a decreased risk of overall mortality. However, much of the work to date suffers from four limitations. First, none of the U.S.-based studies examine the association at the national level. Second, no studies have examined three important hypothesized mechanisms - neighborhood socioeconomic status and neighborhood social and physical characteristics - which are significantly correlated with both neighborhood age structure and health. Third, no U.S. study has longitudinally examined cognitive health trajectories. We build on this literature by examining nine years of nationally-representative data from the Health and Retirement Study (2002–2010) on men and women aged 51 and over linked with Census data to examine the relationship between the percentage of adults 65 and older in a neighborhood and individual cognitive health trajectories. Our results indicate that living in a neighborhood with a greater percentage of older adults is related to better individual cognition at baseline but we did not find any significant association with cognitive decline. We also explored potential mediators including neighborhood socioeconomic status, perceived neighborhood cohesion and perceived neighborhood physical disorder. We did not find evidence that neighborhood socioeconomic status explains this relationship; however, there is suggestive evidence that perceived cohesion and disorder may explain some of the association between age structure and cognition. Although more work is needed to identify the precise mechanisms, this work may suggest a potential contextual target for public health interventions to prevent cognitive impairment. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Dementia, Mental health, Mortality, Neighborhoods, Social cohesion, Socioeconomic status | Link | Friedman, E. M., Shih, R. A., Slaughter, M. E., Weden, M. M., & Cagney, K. A. (2017). Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S. Social science & medicine (1982), 174, 149–158. | SSM - Population Health |
| Social Function and Cognitive Status: Results from a US Nationally Representative Survey of Older Adults. | Kotwal, Ashwin A; Kim, Juyeon; Waite, Linda; Dale, William | 2016 | Background: An early sign of cognitive decline in older adults is often a disruption in social function, but our understanding of this association is limited. Objective: We aimed to determine whether those screening positive for early stages of cognitive impairment have differences across multiple dimensions of social function and whether associations differ by gender. DESIGN: United States nationally representative cohort (2010), the National Social life, Health, and Aging Project (NSHAP). PARTICIPANTS: Community-dwelling adults aged 62–90 years (N = 3,310) with a response rate of 76.9 %. MAIN MEASURES: Cognition was measured using a survey adaptation of the Montreal Cognitive Assessment categorized into three groups: normal, mild cognitive impairment (MCI), and dementia. We measured three domains of social relationships, each comprised of two scales: network structure (size and density), social resources (social support and social strain), and social engagement (community involvement and socializing). We used multiple linear regression to characterize the relationship of each social relationship measure to cognition. KEY Results: Individuals screened as at risk for MCI and early dementia had smaller network sizes by 0.3 and 0.6 individuals (p < 0.001), and a 10 % and 25 % increase in network density (p < 0.001), respectively. For social resources, individuals at risk for MCI and dementia had 4 % and 14 % less social strain (p = 0.01), but only women had 3 % and 6 % less perceived social support (p = 0.013), respectively. For social engagement, individuals screened positive for MCI and dementia had 8 % and 19 % less community involvement (p = 0.01), but only men had 8 % and 13 % increased social involvement with neighbors and family members (p < 0.001), respectively. Conclusion: Changes in social functioning provide an early indication to screen for cognitive loss. Recognition that early cognitive loss is associated with differences in social function can guide counseling efforts and help identify social vulnerabilities to ease the transition to overt dementia for both patients and caregivers. | National Social Life, Health & Aging Project (NSHAP) | Mid-Life Factors | Cognitive function, Dementia, Family, Loneliness, Neighborhoods, Social cohesion, Social well-being | Link | Kotwal, A. A., Kim, J., Waite, L., & Dale, W. (2016). Social Function and Cognitive Status: Results from a US Nationally Representative Survey of Older Adults. Journal of general internal medicine, 31(8), 854–862. | Journal of General Internal Medicine |
| Life Course Pathways to Racial Disparities in Cognitive Impairment among Older Americans. | Zhang, Zhenmei; Hayward, Mark D; Yu, Yan-Liang | 2016 | Blacks are especially hard hit by cognitive impairment at older ages compared to whites. Here, we take advantage of the Health and Retirement Study (1998–2010) to assess how this racial divide in cognitive impairment is associated with the racial stratification of life course exposures and resources over a 12-year period among 8,946 non-Hispanic whites and blacks ages 65 and older in 1998. We find that blacks suffer from a higher risk of moderate/severe cognitive impairment at baseline and during the follow-up. Blacks are also more likely to report childhood adversity and to have grown up in the segregated South, and these early-life adversities put blacks at a significantly higher risk of cognitive impairment. Adulthood socioeconomic status is strongly associated with the risk of cognitive impairment, net of childhood conditions. However, racial disparities in cognitive impairment, though substantially reduced, are not eliminated when controlling for these life course factors. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Cognitive function, Dementia, Geographic disparities, Racial-ethnic disparities, Socioeconomic status, Trauma | Link | Zhang, Z., Hayward, M. D., & Yu, Y. L. (2016). Life Course Pathways to Racial Disparities in Cognitive Impairment among Older Americans. Journal of health and social behavior, 57(2), 184–199. | Journal of Health and Social Behavior |
| Neighbourhood racial/ethnic composition and segregation and trajectories of cognitive decline among US older adults. | Kovalchik, Stephanie A; Slaughter, Mary E; Miles, Jeremy; Friedman, Esther M; Shih, Regina A | 2015 | Background The influence of the sociodemographic context of one's environment on cognitive ageing is not well understood. Methods We examined differences in cognitive trajectories according to the racial/ethnic characteristics of the residential environment. On the basis of 63 996 person-years of data from a nationally representative cohort of 6150 adults over the age of 50 years from the Health and Retirement Study, we used multivariate linear mixed models to determine the effect of neighbourhood racial/ethnic composition and county-level segregation on cognitive function and cognitive decline over a 10-year period. Results In models adjusting for individual demographic and health characteristics, Hispanic composition had a significant positive association with cognitive function (standardised β=0.136, p<0.05) and moderate evidence of an association with greater cognitive decline (standardised β=−0.014, p=0.09). Greater Hispanic-white segregation was associated with statistically significant higher cognitive function at baseline (standardised β=0.099, p<0.001) and greater cognitive decline (standardised β=−0.011, p<0.01). For a 20 percentage-point increase in Hispanic composition and segregation, the observed associations implied 1 and 1.25 additional years of cognitive ageing over 10 years, respectively. These effects did not differ by individual race/ethnicity and were not explained by neighbourhood socioeconomic status or neighbourhood selection. Black composition and black-white segregation did not have a significant influence on cognitive ageing. Discussion This study demonstrates disparities in the progression of cognitive ageing according to racial/ethnic characteristics of the neighbourhood environment. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Neighborhoods, Racial-ethnic disparities, Structural inequality | Link | Kovalchik, S. A., Slaughter, M. E., Miles, J., Friedman, E. M., & Shih, R. A. (2015). Neighbourhood racial/ethnic composition and segregation and trajectories of cognitive decline among US older adults. Journal of epidemiology and community health, 69(10), 978–984. | Journal of Epidemiology and Community Health |
| Fine particulate matter air pollution and cognitive function among older US adults. | Ailshire, Jennifer A; Crimmins, Eileen M | 2014 | Existing research on the adverse health effects of exposure to pollution has devoted relatively little attention to the potential impact of ambient air pollution on cognitive function in older adults. We examined the cross-sectional association between residential concentrations of particulate matter with aerodynamic diameter of 2.5 μm or less (PM2.5) and cognitive function in older adults. Using hierarchical linear modeling, we analyzed data from the 2004 Health and Retirement Study, a large, nationally representative sample of US adults aged 50 years or older. We linked participant data with 2000 US Census tract data and 2004 census tract–level annual average PM2.5 concentrations. Older adults living in areas with higher PM2.5 concentrations had worse cognitive function (β = −0.26, 95% confidence interval: −0.47, −0.05) even after adjustment for community- and individual-level social and economic characteristics. Results suggest that the association is strongest for the episodic memory component of cognitive function. This study adds to a growing body of research highlighting the importance of air pollution to cognitive function in older adults. Improving air quality in large metropolitan areas, where much of the aging US population resides, may be an important mechanism for reducing age-related cognitive decline. | Health and Retirement Study (HRS) | Biological Mechanisms, Mid-Life Factors | Cognitive function, Environmental exposure, Memory, Socioeconomic status, Structural inequality | Link | Ailshire, J. A., & Crimmins, E. M. (2014). Fine particulate matter air pollution and cognitive function among older US adults. American journal of epidemiology, 180(4), 359–366. | American Journal of Epidemiology |
| Mental work demands, retirement, and longitudinal trajectories of cognitive functioning. | Fisher, Gwenith G; Stachowski, Alicia; Infurna, Frank J; Faul, Jessica D; Grosch, James; Tetrick, Lois E | 2014 | Age-related changes in cognitive abilities are well-documented, and a very important indicator of health, functioning, and decline in later life. However, less is known about the course of cognitive functioning before and after retirement and specifically whether job characteristics during one’s time of employment (i.e., higher vs. lower levels of mental work demands) moderate how cognition changes both before and after the transition to retirement. We used data from n = 4,182 (50% women) individuals in the Health and Retirement Study, a nationally representative panel study in the United States, across an 18 year time span (1992–2010). Data were linked to the O*NET occupation codes to gather information about mental job demands to examine whether job characteristics during one’s time of employment moderates level and rate of change in cognitive functioning (episodic memory and mental status) both before and after retirement. Results indicated that working in an occupation characterized by higher levels of mental demands was associated with higher levels of cognitive functioning before retirement, and a slower rate of cognitive decline after retirement. We controlled for a number of important covariates, including socioeconomic (education and income), demographic, and health variables. Our discussion focuses on pathways through which job characteristics may be associated with the course of cognitive functioning in relation to the important transition of retirement. Implications for job design as well as retirement are offered. | Health and Retirement Study (HRS) | Mid-Life Factors | Cognitive function, Memory, Occupation, Retirement | Link | Fisher, G. G., Stachowski, A., Infurna, F. J., Faul, J. D., Grosch, J., & Tetrick, L. E. (2014). Mental work demands, retirement, and longitudinal trajectories of cognitive functioning. Journal of occupational health psychology, 19(2), 231–242. | Journal of Occupational Health Psychology |
| What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline. | González, Hector M; Tarraf, Wassim; Bowen, Mary E; Johnson-Jennings, Michelle D; Fisher, Gwenith G | 2013 | Background/Aims: To examine the cognitive reserve hypothesis by comparing the contribution of early childhood and life course factors related to cognitive functioning in a nationally representative sample of older Americans. Methods: We examined a prospective, national probability cohort study (Health and Retirement Study; 1998-2010) of older adults (n = 8,833) in the contiguous 48 United States. The main cognitive functioning outcome was a 35-point composite of memory (recall), mental status, and working memory tests. The main predictors were childhood socioeconomic position (SEP) and health, and individual-level adult achievement and health. Results: Individual-level achievement indicators (i.e., education, income, and wealth) were positively and significantly associated with baseline cognitive function, while adult health was negatively associated with cognitive function. Controlling for individual-level adult achievement and other model covariates, childhood health presented a relatively small negative, but statistically significant association with initial cognitive function. Neither individual achievement nor childhood SEP was statistically linked to decline over time. Conclusions: Cognitive reserve purportedly acquired through learning and mental stimulation across the life course was associated with higher initial global cognitive functioning over the 12-year period in this nationally representative study of older Americans. We found little supporting evidence that childhood economic conditions were negatively associated with cognitive function and change, particularly when individual-level achievement is considered. | Health and Retirement Study (HRS) | Early Life, Mid-Life Factors | Childhood/Adolescence, Cognitive function, Educational attainment, Memory, Socioeconomic status | Link | González, H. M., Tarraf, W., Bowen, M. E., Johnson-Jennings, M. D., & Fisher, G. G. (2013). What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline. Neuroepidemiology, 41(2), 101–109. | Neuroepidemiology |
| Social strain and cortisol regulation in midlife in the US. | Friedman, Esther M; Karlamangla, Arun S; Almeida, David M; Seeman, Teresa E | 2012 | Chronic stress has been implicated in a variety of adverse health outcomes, from compromised immunity to cardiovascular disease to cognitive decline. The hypothalamic pituitary adrenal (HPA) axis has been postulated to play the primary biological role in translating chronic stress into ill health. Stressful stimuli activate the HPA-axis and cause an increase in circulating levels of cortisol. Frequent and long-lasting activation of the HPA-axis, as occurs in recurrently stressful environments, can in the long run compromise HPA-axis functioning and ultimately affect health. Negative social interactions with family and friends may be a significant source of stress in daily life, constituting the type of recurrently stressful environment that could lead to compromised HPA functioning and altered diurnal cortisol rhythms. We use data from two waves (1995 and 2004–2005) of the Midlife in the U.S. (MIDUS) study and from the National Study of Daily Experiences (NSDE) and piecewise growth curve models to investigate relationships between histories of social strain and patterns of diurnal cortisol rhythms. We find that reported levels of social strain were significantly associated with their diurnal cortisol rhythm. These effects were more pronounced for individuals with a history of greater reported strain across a ten-year period. | Midlife in the U.S. (MIDUS) | Biological Mechanisms, Mid-Life Factors | Cardiometabolic health, Family, Immune function, Social cohesion, Stress | Link | Friedman, E. M., Karlamangla, A. S., Almeida, D. M., & Seeman, T. E. (2012). Social strain and cortisol regulation in midlife in the US. Social science & medicine (1982), 74(4), 607–615. | SSM - Population Health |