Factors associated with hospitalization risk among community living middle aged and older persons: Results from the Swedish Adoption/Twin Study of Aging (SATSA)

The aims of the present study were to: (1) describe and compare individual characteristics of hospitalized and not hospitalized community living persons, and (2) to determine factors that are associated with hospitalization risk over time. We conducted a prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). A total of 772 Swedes (mean age at baseline 69.7 years, range 46-103, 59.8% females) answered a postal questionnaire about physical and psychological health, personality and socioeconomic factors. During nine years of follow-up, information on hospitalizations and associated diagnoses were obtained from national registers. Results show that 484 persons (63%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases (25%) and tumors (22%). Cox proportional hazard regression models controlling for age, sex and dependency within twin pairs, showed that higher age (HR=1.02, p<0.001) and more support from relatives (HR=1.09, p=0.028) were associated with increased risk of hospitalization, while marital status (unmarried (HR=0.75, p=0.033) and widow/widower (HR=0.69, p<0.001)) and support from friends (HR=0.93, p=0.029) were associated with lower risk of hospitalization. Social factors were important for hospitalization risk even when medical factors were controlled for in the analyses. Number of diseases was not a risk in the final regression model. Hospitalization risk was also different for women and men and within different age groups. We believe that these results might be used in future interventions targeting health care utilization.

Widowhood and the Stability of Late Life Depressive Symptomatology in the Swedish Adoption Twin Study of Aging

Although the Swedish Adoption Twin of Aging (SATSA) has been used to investigate phenotypic stability of late life depressive symptoms, the biometric processes underlying this stability have not been studied. Under a reciprocal effects modeling framework, we used SATSA twins' Center for Epidemiologic Studies Depression (CES-D) Scale data across 5 waves (from 1987-2007) to test whether the reciprocal exchange between twins within a family and their nonshared environments (P<=>E) promote the accumulation of gene-environment correlation (rGE) over time. The model generates increasing rGE that produces subsequent stable environmental differences between twins within a family-a process hypothesized to explain stability in chronic late life depressive symptoms. Widowhood is included as a stressful life experience that may introduce an additional nonshared source of variability in CES-D scores. Genetic effects and nonshared environmental effects are primary sources of stability of late life depressive symptoms without evidence of underlying rGE processes. Additionally, widowhood explained stable differences in CES-D scores between twins within a family up to 3 years after spousal loss.

Gene-Environment Interplay in Physical, Psychological, and Cognitive Domains in Mid to Late Adulthood: Is APOE a Variability Gene?

Despite emerging interest in gene-environment interaction (GxE) effects, there is a dearth of studies evaluating its potential relevance apart from specific hypothesized environments and biometrical variance trends. Using a monozygotic within-pair approach, we evaluated evidence of G×E for body mass index (BMI), depressive symptoms, and cognition (verbal, spatial, attention, working memory, perceptual speed) in twin studies from four countries. We also evaluated whether APOE is a 'variability gene' across these measures and whether it partly represents the 'G' in G×E effects. In all three domains, G×E effects were pervasive across country and gender, with small-to-moderate effects. Age-cohort trends were generally stable for BMI and depressive symptoms; however, they were variable-with both increasing and decreasing age-cohort trends-for different cognitive measures. Results also suggested that APOE may represent a 'variability gene' for depressive symptoms and spatial reasoning, but not for BMI or other cognitive measures. Hence, additional genes are salient beyond APOE.

Anxiety is associated with increased risk of dementia in older Swedish twins

INTRODUCTION

We asked whether anxiety is associated with prospective risk of dementia, and the extent to which genetic influences mediate this association.

METHODS

Nondemented twins (n = 1082) from the Swedish Adoption Twin Study of Aging completed an assessment of anxiety symptoms in 1984 and were followed for 28 years.

RESULTS

Baseline anxiety score, independent of depressive symptoms, was significantly associated with incident dementia over follow-up (hazard ratio [HR] = 1.04; 95% confidence interval [CI] = 1.01-1.06). There was 48% increased risk of becoming demented for those who had experienced high anxiety at any time compared with those who had not. In co-twin analyses, the association between anxiety symptoms and dementia was greater for dizygotic (HR = 1.11; 95% CI = 1.02-1.20) compared with monozygotic twins (HR = 1.06; 95% CI = 0.95-1.20), indicating genetic mediation.

DISCUSSION

Anxiety symptoms were associated with increased risk of dementia. Genetic factors common to dementia and anxiety partially mediated this association.

Getting personal with blood donors - the rationale for, methodology of and an overview of participants in the UK blood donor survey

OBJECTIVE

To design and pilot a survey of UK blood donors to assess, on a large scale, their understanding of and compliance with the donor selection guidelines (DSG).

BACKGROUND

Compliance with the DSG is important for maintaining blood safety, however, little is currently known about the extent of this among UK donors.

MATERIALS AND METHODS

The online, unlinked survey was based on the donor health check form with a focus on behaviours associated with blood borne infections, sexual contact, drug use and travel. The survey materials were reviewed by a donor focus group and the survey was piloted among 2982 UK donors. Percentage responses were calculated, complaints monitored and answers to questions reviewed. The survey went live in 2013; 225 091 donors were invited via email to participate followed by two reminders.

RESULTS

The survey was well received by the focus group, with little concern about the sensitive and personal questions. Their feedback led to important refinement in the survey materials. In the pilots, 21·0% (627/2982) responded, a reminder was necessary to achieve this. Among responders, there was evidence of non-compliance and test seeking behaviour, and no evidence that intention to donate again was affected. In the live survey, 29% (65 439) responded; responders were generally representative of donors overall.

CONCLUSION

A large scale survey of donor compliances is feasible, acceptable and effective in ascertaining appropriate information; involving donors and the blood services in the development stages through a focus group and pilots was important to achieve this.

The association between intelligence and lifespan is mostly genetic

Background: Several studies in the new field of cognitive epidemiology have shown that higher intelligence predicts longer lifespan. This positive correlation might arise from socioeconomic status influencing both intelligence and health; intelligence leading to better health behaviours; and/or some shared genetic factors influencing both intelligence and health. Distinguishing among these hypotheses is crucial for medicine and public health, but can only be accomplished by studying a genetically informative sample.

Methods: We analysed data from three genetically informative samples containing information on intelligence and mortality: Sample 1, 377 pairs of male veterans from the NAS-NRC US World War II Twin Registry; Sample 2, 246 pairs of twins from the Swedish Twin Registry; and Sample 3, 784 pairs of twins from the Danish Twin Registry. The age at which intelligence was measured differed between the samples. We used three methods of genetic analysis to examine the relationship between intelligence and lifespan: we calculated the proportion of the more intelligent twins who outlived their co-twin; we regressed within-twin-pair lifespan differences on within-twin-pair intelligence differences; and we used the resulting regression coefficients to model the additive genetic covariance. We conducted a meta-analysis of the regression coefficients across the three samples.

Results: The combined (and all three individual samples) showed a small positive phenotypic correlation between intelligence and lifespan. In the combined sample observed r  = .12 (95% confidence interval .06 to .18). The additive genetic covariance model supported a genetic relationship between intelligence and lifespan. In the combined sample the genetic contribution to the covariance was 95%; in the US study, 84%; in the Swedish study, 86%, and in the Danish study, 85%.

Conclusions: The finding of common genetic effects between lifespan and intelligence has important implications for public health, and for those interested in the genetics of intelligence, lifespan or inequalities in health outcomes including lifespan.

A meta-analysis of heritability of cognitive aging: minding the "missing heritability" gap

The etiologies underlying variation in adult cognitive performance and cognitive aging have enjoyed much attention in the literature, but much of that attention has focused on broad factors, principally general cognitive ability. The current review provides meta-analyses of age trends in heritability of specific cognitive abilities and considers the profile of genetic and environmental factors contributing to cognitive aging to address the 'missing heritability' issue. Our findings, based upon evaluating 27 reports in the literature, indicate that verbal ability demonstrated declining heritability, after about age 60, as did spatial ability and perceptual speed more modestly. Trends for general memory, working memory, and spatial ability generally indicated stability, or small increases in heritability in mid-life. Equivocal results were found for executive function. A second meta-analysis then considered the gap between twin-based versus SNP-based heritability derived from population-based GWAS studies. Specifically, we considered twin correlation ratios to agnostically re-evaluate biometrical models across age and by cognitive domain. Results modestly suggest that nonadditive genetic variance may become increasingly important with age, especially for verbal ability. If so, this would support arguments that lower SNP-based heritability estimates result in part from uncaptured non-additive influences (e.g., dominance, gene-gene interactions), and possibly gene-environment (GE) correlations. Moreover, consistent with longitudinal twin studies of aging, as rearing environment becomes a distal factor, increasing genetic variance may result in part from nonadditive genetic influences or possible GE correlations. Sensitivity to life course dynamics is crucial to understanding etiological contributions to adult cognitive performance and cognitive aging.

Understanding Associations among Family Support, Friend Support, and Psychological Distress

Emotional support from family and friends is associated with lower psychological distress. This study examined whether genetic and environmental influences explain associations among family support, friend support, and psychological distress. Data were drawn from the Midlife Development in the United States (MIDUS) study and included 947 pairs of MZ, same-sex DZ, and opposite-sex DZ twins. Results showed that a genetic factor explains the relationship between friend support and psychological distress, independent of family support. Alternatively, a nonshared environmental factor accounts for an association among family support, friend support, and psychological distress. Thus, heritable factors shape a distinct relationship between friend support and psychological distress, but unique experiences contribute to a link among family support, friend support, and psychological distress.

Factors associated with grip strength decline in older adults

BACKGROUND

Few studies have examined associations of multi-faceted demographic, health and lifestyle factors with long-term change in grip strength performance across the adult lifespan. The aim of this study was to examine the associations of risk factors in specific parts of the adult lifespan (e.g. in early midlife, in late midlife and in old adulthood) separately for women and men.

METHODS

Data came from the longitudinal Swedish Adoption/Twin Study of Aging (SATSA). Grip strength performance was followed in 849 participants who were 50-88 years of age at baseline. The follow-up period with seven waves of data of grip strength was 22 years, and the risk factors were measured up to 20 years before the assessment of grip strength. Latent growth modelling was used for the longitudinal analyses.

RESULTS

A gender difference in the type of factors associated with grip strength performance and development across the adult lifespan was found. Significant factors for the age slopes for women were stress, smoking and dementia. For men, marital status, mean arterial pressure, physical activity at work and having a chronic disorder were of importance. These factors varied in their associations with grip strength across the adult lifespan.

CONCLUSION

Factors measured earlier in adulthood were associated with grip strength decline in late midlife and old adulthood. Gender-specific patterns of risk factors suggest that it may be worthwhile to conduct research on grip and muscle strength (and biological vitality) separately for men and women.

Apolipoprotein E ε4 genotype and the temporal relationship between depression and dementia

To investigate how apolipoprotein E (APOE) affects the temporal relationship between depression and dementia, we conducted a nested case-control study with longitudinal depression and dementia evaluations from several population studies by using 804 dementia cases and 1600 matched controls, totaling 1519 unique individuals. Depression within 10 years of onset of dementia was strongly associated with dementia diagnosis regardless of APOE status (incidence rate ratio [IRR] 5.25, 95% confidence interval [95% CI] 3.32-8.31 for ε4 carriers, IRR 4.40, 95%CI 3.23-5.99 for noncarriers). However, we found a significant interaction between depression more than 10 years before the onset of dementia and APOE (p = 0.01), with depression more distal to dementia being a risk factor only in ε4 carriers (IRR 3.39, 95% CI 1.69-6.78 for carriers, IRR 1.01, 95% CI 0.60-1.70 for noncarriers). Thus, depression with onset close in time to dementia onset is associated with disease irrespective of APOE genotype, whereas depression more distal to dementia onset is a risk factor only in ε4-carriers. This is the first study to show the interaction between APOE and depression to be dependent on timing of depression onset.

Age differences and longitudinal change in the effects of data collection mode on self-reports of psychosocial functioning

The current study investigated age differences and longitudinal change in mode effects, wherein individuals report less negative and more positive psychosocial functioning with data collection modes that have greater (vs. less) direct contact with interviewers (e.g., in-person interviews vs. telephone interviews). Using 2 longitudinal datasets, the Later Life Study of Social Exchanges (LLSSE) and Swedish Adoption/Twin Study of Aging (SATSA), we tested how mode effects may vary with cohort (baseline age differences) and maturational development (longitudinal change). In Study 1, LLSSE participants (65-90 years old) completed in-person and telephone interviews assessing negative and positive aspects of psychosocial functioning across 2 years. The data collection mode with greater direct contact with interviewers (in-person interviews) was associated with reporting less negative and more positive psychosocial functioning compared to the mode with less direct contact (telephone interviews). These mode effects were more pronounced with older baseline age, but only for the negative psychosocial measures. Mode effects also became stronger over time for reports of negative affect. In Study 2, SATSA participants (38-86 years old) completed mailed questionnaires and questionnaires collected in-person that assessed depressive symptoms and positive affect across 18 years. Consistent with Study 1, participants reported fewer depressive symptoms and more positive affect with greater (vs. less) direct contact with interviewers (questionnaires collected in-person vs. mailed questionnaires). For reports of depressive symptoms, but not positive affect, mode effects were more pronounced with age and time. Together, the results underscore how mode effects may contribute to inconsistent findings in the socioemotional aging literature.

Serotonin concentrations in platelets, plasma, mitral valve leaflet, and left ventricular myocardial tissue in dogs with myxomatous mitral valve disease

HYPOTHESIS/OBJECTIVES

Altered serotonin (5-hydroxytryptamine, 5HT) signaling is postulated in development and progression of canine myxomatous mitral valve disease (MMVD). Little is known regarding platelet, plasma, valvular, or myocardial 5HT concentration ([5HT]) in affected dogs. We quantified [5HT] in platelet-rich plasma (PRP), platelet-poor plasma (PPP), mitral valve leaflets (MV), and left ventricular myocardium (LV).

ANIMALS

Forty-five dogs comprised 4 plasma groups of Cavalier King Charles Spaniels (CKCS) or non-CKCS, either healthy (CON) or MMVD affected: CKCS CON (n = 12); non-CKCS CON (n = 8); CKCS MMVD (n = 14); non-CKCS MMVD (n = 11). Twenty-four dogs comprised 3 tissue groups: MMVD (n = 8); other-HD (heart disease) (n = 7); non-HD, extracardiac disease (n = 9).

METHODS

High-performance liquid chromatography measured PRP, PPP, MV, and LV [5HT].

RESULTS

Platelet-rich plasma platelet [5HT] was greater in CKCS CON (1.83 femtograms/platelet [fg/plt]; range, 0.20-4.76; P = .002), CKCS MMVD (1.58 fg/plt; range, 0.70-4.03; P = .005), and non-CKCS MMVD (1.72 fg/plt; range, 0.85-4.44; P = .003) versus non-CKCS CON (0.92 fg/plt; range, 0.63-1.30). There was no group difference in PPP [5HT]. MV [5HT] was significantly higher in MMVD (32.4 ng/mg; range, 8.4-106.7) versus non-HD (3.6 ng/mg; range, 0-28.3; P = .01) and LV [5HT] was significantly higher in MMVD (11.9 ng/mg; range, 4.0-104.8) versus other-HD (0.9 ng/mg; range, 0-10.1; P = .011) and non-HD (2.5 ng/mg; range, 0-6.9; P = .001).

CONCLUSIONS AND CLINICAL IMPORTANCE

Platelet [5HT] was highest in healthy CKCS and both MMVD groups, but plasma [5HT] showed no group differences. Tissue [5HT] was highest in MV and LV of MMVD-affected dogs, suggesting altered 5HT signaling as a potential feature of MMVD. Interactions of platelet, valvular, and myocardial 5HT signaling warrant further investigation.

Childhood sleep duration and lifelong mortality risk

OBJECTIVE

Sleep duration is known to significantly affect health in adults and children, but little is understood about long-term associations. This prospective cohort study is the first to examine whether childhood sleep duration is associated with lifelong mortality risk.

METHOD

Data from childhood were refined and mortality data collected for 1,145 participants from the Terman Life Cycle Study. Participants were born between 1904 and 1915, lived to at least 1940, and had complete age, bedtime, and waketime data at initial data collection (1917-1926). Homogeneity of the cohort sample (intelligent, mostly White) limits generality but provides natural control of common confounds. Through 2009, 1,039 participants had confirmed deaths. Sleep duration was calculated as the difference between each child's bed and wake times. Age-adjusted sleep (deviation from that predicted by age) was computed. Cox proportional hazards survival models evaluated childhood sleep duration as a predictor of mortality separately by sex, controlling for baseline age.

RESULTS

For males, a quadratic relation emerged: Male children who underslept or overslept compared with peers were at increased risk of lifelong all-cause mortality (HR = 1.15, CIs [1.05, 1.27]). Effect sizes were smaller and nonsignificant in females (HR = 1.02, CIs [0.91, 1.14]).

CONCLUSIONS

Male children with shorter or longer sleep durations than expected for their age were at increased risk of death at any given age in adulthood. The findings suggest that sleep may be a core biobehavioral trait, with implications for new models of sleep and health throughout the entire life span.

A genome-wide association study implicates the APOE locus in nonpathological cognitive ageing

Cognitive decline is a feared aspect of growing old. It is a major contributor to lower quality of life and loss of independence in old age. We investigated the genetic contribution to individual differences in nonpathological cognitive ageing in five cohorts of older adults. We undertook a genome-wide association analysis using 549 692 single-nucleotide polymorphisms (SNPs) in 3511 unrelated adults in the Cognitive Ageing Genetics in England and Scotland (CAGES) project. These individuals have detailed longitudinal cognitive data from which phenotypes measuring each individual's cognitive changes were constructed. One SNP--rs2075650, located in TOMM40 (translocase of the outer mitochondrial membrane 40 homolog)--had a genome-wide significant association with cognitive ageing (P=2.5 × 10(-8)). This result was replicated in a meta-analysis of three independent Swedish cohorts (P=2.41 × 10(-6)). An Apolipoprotein E (APOE) haplotype (adjacent to TOMM40), previously associated with cognitive ageing, had a significant effect on cognitive ageing in the CAGES sample (P=2.18 × 10(-8); females, P=1.66 × 10(-11); males, P=0.01). Fine SNP mapping of the TOMM40/APOE region identified both APOE (rs429358; P=3.66 × 10(-11)) and TOMM40 (rs11556505; P=2.45 × 10(-8)) as loci that were associated with cognitive ageing. Imputation and conditional analyses in the discovery and replication cohorts strongly suggest that this effect is due to APOE (rs429358). Functional genomic analysis indicated that SNPs in the TOMM40/APOE region have a functional, regulatory non-protein-coding effect. The APOE region is significantly associated with nonpathological cognitive ageing. The identity and mechanism of one or multiple causal variants remain unclear.

Genetic and environmental variation in lung function drives subsequent variation in aging of fluid intelligence

Longitudinal studies document an association of pulmonary function with cognitive function in middle-aged and older adults. Previous analyses have identified a genetic contribution to the relationship between pulmonary function with fluid intelligence. The goal of the current analysis was to apply the biometric dual change score model to consider the possibility of temporal dynamics underlying the genetic covariance between aging trajectories for pulmonary function and fluid intelligence. Longitudinal data from the Swedish Adoption/Twin Study of Aging were available from 808 twins ranging in age from 50 to 88 years at the first wave. Participants completed up to six assessments covering a 19-year period. Measures at each assessment included spatial and speed factors and pulmonary function. Model-fitting indicated that genetic variance for FEV1 was a leading indicator of variation in age changes for spatial and speed factors. Thus, these data indicate a genetic component to the directional relationship from decreased pulmonary function to decreased function of fluid intelligence.

Accuracy of recalled body weight--a study with 20-years of follow-up

OBJECTIVE

Weight changes may be an important indicator of an ongoing pathological process. Retrospective self-report might be the only possibility to capture prior weight. The objective of the study was to evaluate the accuracy of retrospective recall of body weight in old age and factors that might predict accuracy.

DESIGN AND METHODS

In 2007, 646 participants (mean age, 71.6 years) of the Swedish Adoption/Twin Study of Aging (SATSA) answered questions about their present weight and how much they weighed 20-years ago. Of these, 436 had self-reported their weight twenty years earlier and among these 134 had also had their weight assessed at this time point.

RESULTS

Twenty year retrospectively recalled weight underestimated the prior assessed weight by -1.89 ± 5.9 kg and underestimated prior self-reported weight by -0.55 ± 5.2 kg. Moreover, 82.4% of the sample were accurate within 10%, and 45.8% were accurate within 5% of their prior assessed weights; similarly, 84.2% and 58.0% were accurate within 10% and 5% respectively, for prior self-reported weight. Current higher body mass index and preferences of reporting weights ending with zero or five was associated with an underestimation of prior weight, while greater weight change over 20 years, and low Mini-Mental State Scores (MMSE) (<25) led to an overestimation of prior weight.

CONCLUSIONS

Recalled weight comes close to the assessed population mean, but at the individual level there is a large variation. The accuracy is affected by current BMI, changes in weight, end-digit preferences, and current cognitive ability. Recalled weight should be used with caution.

Coordinated analysis of age, sex, and education effects on change in MMSE scores

OBJECTIVES

We describe and compare the expected performance trajectories of older adults on the Mini-Mental Status Examination (MMSE) across six independent studies from four countries in the context of a collaborative network of longitudinal studies of aging. A coordinated analysis approach is used to compare patterns of change conditional on sample composition differences related to age, sex, and education. Such coordination accelerates evaluation of particular hypotheses. In particular, we focus on the effect of educational attainment on cognitive decline.

METHOD

Regular and Tobit mixed models were fit to MMSE scores from each study separately. The effects of age, sex, and education were examined based on more than one centering point.

RESULTS

Findings were relatively consistent across studies. On average, MMSE scores were lower for older individuals and declined over time. Education predicted MMSE score, but, with two exceptions, was not associated with decline in MMSE over time.

CONCLUSION

A straightforward association between educational attainment and rate of cognitive decline was not supported. Thoughtful consideration is needed when synthesizing evidence across studies, as methodologies adopted and sample characteristics, such as educational attainment, invariably differ.

Shared and unique genetic and environmental influences on aging-related changes in multiple cognitive abilities

Aging-related declines occur in many different domains of cognitive function during middle and late adulthood. However, whether a global dimension underlies individual differences in changes in different domains of cognition and whether global genetic influences on cognitive changes exist is less clear. We addressed these issues by applying multivariate growth curve models to longitudinal data from 857 individuals from the Swedish Adoption/Twin Study of Aging, who had been measured on 11 cognitive variables representative of verbal, spatial, memory, and processing speed abilities up to 5 times over up to 16 years between ages 50 and 96 years. Between ages 50 and 65 years scores on different tests changed relatively independently of one another, and there was little evidence for strong underlying dimensions of change. In contrast, over the period between 65 and 96 years of age, there were strong interrelations among rates of change both within and across domains. During this age period, variability in rates of change were, on average, 52% domain-general, 8% domain-specific, and 39% test-specific. Quantitative genetic decomposition indicated that 29% of individual differences in a global domain-general dimension of cognitive changes during this age period were attributable to genetic influences, but some domain-specific genetic influences were also evident, even after accounting for domain-general contributions. These findings are consistent with a balanced global and domain-specific account of the genetics of cognitive aging.

Genetic variants from lipid-related pathways and risk for incident myocardial infarction

BACKGROUND

Circulating lipids levels, as well as several familial lipid metabolism disorders, are strongly associated with initiation and progression of atherosclerosis and incidence of myocardial infarction (MI).

OBJECTIVES

We hypothesized that genetic variants associated with circulating lipid levels would also be associated with MI incidence, and have tested this in three independent samples.

SETTING AND SUBJECTS

Using age- and sex-adjusted additive genetic models, we analyzed 554 single nucleotide polymorphisms (SNPs) in 41 candidate gene regions proposed to be involved in lipid-related pathways potentially predisposing to incidence of MI in 2,602 participants of the Swedish Twin Register (STR; 57% women). All associations with nominal P<0.01 were further investigated in the Uppsala Longitudinal Study of Adult Men (ULSAM; N = 1,142).

RESULTS

In the present study, we report associations of lipid-related SNPs with incident MI in two community-based longitudinal studies with in silico replication in a meta-analysis of genome-wide association studies. Overall, there were 9 SNPs in STR with nominal P-value <0.01 that were successfully genotyped in ULSAM. rs4149313 located in ABCA1 was associated with MI incidence in both longitudinal study samples with nominal significance (hazard ratio, 1.36 and 1.40; P-value, 0.004 and 0.015 in STR and ULSAM, respectively). In silico replication supported the association of rs4149313 with coronary artery disease in an independent meta-analysis including 173,975 individuals of European descent from the CARDIoGRAMplusC4D consortium (odds ratio, 1.03; P-value, 0.048).

CONCLUSIONS

rs4149313 is one of the few amino acid changing variants in ABCA1 known to associate with reduced cholesterol efflux. Our results are suggestive of a weak association between this variant and the development of atherosclerosis and MI.

IGEMS: the consortium on Interplay of Genes and Environment across Multiple Studies

The Interplay of Genes and Environment across Multiple Studies (IGEMS) group is a consortium of eight longitudinal twin studies established to explore the nature of social context effects and gene-environment interplay in late-life functioning. The resulting analysis of the combined data from over 17,500 participants aged 25-102 at baseline (including nearly 2,600 monogygotic and 4,300 dizygotic twin pairs and over 1,700 family members) aims to understand why early life adversity, and social factors such as isolation and loneliness, are associated with diverse outcomes including mortality, physical functioning (health, functional ability), and psychological functioning (well-being, cognition), particularly in later life.

Heritability of an Age-Dependent Categorical Phenotype: Cognitive Dysfunction

We investigated the extent to which cognitive dysfunction is shaped by genetic or environmental influences, and whether these factors differ in women and men. All members of the Swedish Twin Registry aged 65 and older were screened by telephone using the TELE, a brief cognitive assessment instrument (Gatz et al., 2002), and the Blessed Dementia Rating Scale (Blessed et al., 1968) from relatives of those who scored poorly on the TELE. Data were available for 4308 pairs where both members responded and 5070 pairs where only one member was alive and participated. To analyze all available data, we used a raw data method extended to ordinal data. As the prevalence of cognitive dysfunction increases with age, we incorporated age-adjusted thresholds. The best fitting model from biometric analyses indicated 35% of the variation in liability to cognitive dysfunction could be explained by heritable influences and the remaining 65% by nonfamilial environmental influences. Differences by gender were not significant. As this is a normative population including cognitively intact individuals, preclinical dementia cases and demented individuals, the relative magnitude of genetic and environmental effects is of particular interest in light of high heritabilities found for dementias such as Alzheimer's disease. The findings emphasize the extent to which research is needed to uncover nonfamilial environmental influences on cognitive dysfunction in later life.

Genotype–Environment Interactions: Cognitive Aging and Social Factors

The possibility of genotype–environment interaction for memory performance and change was examined in 150 monozygotic (MZ) twin pairs from the Swedish Adoption Twin Study of Aging (SATSA). We used an MZ twin pair difference approach to examine the possibility that genotype was associated with intrapair variability and thus suggestive of genotype–nonshared environment interactions. Multiple ‘variability genes’ were found for longitudinal change in a semantic memory task including candidates coding for apolipoprotein E (APOE) and estrogen receptor alpha (ESR1) as well as serotonin candidates (HTR2Aand5HTT). One candidate also related to variability in change in episodic memory (5HTT). Of the significant associations observed, generally results indicated that MZ pairs who carry putative risk alleles were less variable than noncarriers, suggesting that noncarriers may be more sensitive to environmental contexts. We sought to ‘contextualize’ the possible nonshared environmental influences for found gene–environment (G × E) effects by considering intrapair differences in measured social and stress factors, including social support, life events and depressive symptoms. Results suggested that nonshared environmental influences associated with depressive symptoms may moderate the G × E relationship observed forESR1andAPOEand longitudinal semantic memory change whereby noncarriers of putative risk alleles may be relatively more sensitive to depressionevoking environmental contexts than carriers of the risk allele. Thus, the contexts that facilitate or reduce depressive symptoms may affect semantic memory resiliency dependent on genotype. Further work ought to consider larger sample sizes as well as consider additional social and contextual factors.