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Reyes A, Prabhakaran D, Banegas MP, Shih JJ, Iragui-Madoz VJ, Almane DN, Ferguson L, Jones JE, Busch RM, Hermann BP, McDonald CR. Individual- and community-level social determinants of health are associated with cognition in older adults with focal epilepsy. Epilepsy Behav 2024; 158:109927. [PMID: 38970893 DOI: 10.1016/j.yebeh.2024.109927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Epilepsy is associated with significant health disparities, including access to specialized care and adverse outcomes that have been associated with several social determinants of health (SDOH). We sought to examine the relationship between individual- and community-level SDOH and cognitive outcomes in older adults with epilepsy. MATERIALS AND METHODS We collected clinical, SDOH, and neuropsychological data in 57 older adults with epilepsy. Individual-level SDOH included patient factors (quality of education, income, insurance, marital status) and early-life environmental factors (parental education and occupation, childhood employment). Neighborhood deprivation was measured with the Area Deprivation Index (ADI). Stepwise regressions were conducted to examine the independent contribution of individual-level SDOH to cognitive performance, and Spearman rho correlations were conducted to examine the relationship between ADI and cognitive performance. The SDOH profiles of patients who met the criteria for cognitive impairment were examined. RESULTS After controlling for clinical variables, patient factors (public health insurance, poorer quality of education) and early-life environmental factors (lower mother's education, lower father's and mother's occupational complexity, history of childhood employment) were significant predictors of lower performance on measures of global cognition, verbal learning and memory, processing speed, and executive function. Higher ADI values (greater disadvantage) were associated with lower scores on global cognitive measures, verbal learning and memory, and executive function. Patients who met criteria for cognitive impairment had, on average, a greater number of adverse SDOH, including lower household incomes and father's education, and higher ADI values compared to those who were cognitively intact. CONCLUSION We provide new evidence of the role of individual- and community-level SDOH on cognitive outcomes in older adults with epilepsy. This emerging literature highlights the need to examine SDOH beyond epilepsy-related clinical factors. These data could inform the development of interventions focused on increasing access to epilepsy care, education, and resources and promoting brain and cognitive health within the most at-risk communities.
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Affiliation(s)
- Anny Reyes
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA.
| | - Divya Prabhakaran
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA
| | - Matthew P Banegas
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA
| | - Jerry J Shih
- Department of Neuroscience, University of California, San Diego, San Diego, CA, USA
| | | | - Dace N Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, USA
| | - Carrie R McDonald
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
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Westrick AC, Ospina-Romero M, Clarke P, Langa KM, Kobayashi LC. Does Neighborhood Socioeconomic Status Alter Memory Change Associated with a Cancer Diagnosis? Preliminary Evidence from the US Health and Retirement Study. Cancer Epidemiol Biomarkers Prev 2024; 33:953-960. [PMID: 38639923 PMCID: PMC11216856 DOI: 10.1158/1055-9965.epi-23-1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/13/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Neighborhood disadvantage has been linked to cognitive impairment, but little is known about the effect of neighborhood disadvantage on long-term cancer-related memory decline. METHODS Incident cancer diagnosis and memory (immediate and delayed recall, combined with proxy-reported memory) were assessed at biennial interviews in the US Health and Retirement Study (N = 13,293, 1998-2016). Neighborhood disadvantage was measured using the National Neighborhood Data Archive disadvantage index, categorized into tertiles (T1: least disadvantaged-T3: most disadvantaged). Linear mixed-effects models estimated the standardized memory trajectories in participants with or without cancer, by neighborhood disadvantage. RESULTS Living in more disadvantaged neighborhoods was associated with worse mean memory function and steeper memory declines, regardless of cancer status. An incident cancer diagnosis was associated with an acute memory drop for those living in least disadvantaged neighborhoods but not more disadvantaged neighborhoods [T1: -0.05, 95% confidence interval (CI): -0.08, -0.01; T3: -0.13, 95% CI: -0.06, 0.03]. Cancer survivors in the least disadvantaged neighborhoods had a slight memory advantage in the years prior to diagnosis (T1: 0.09, 95% CI: 0.04, 0.13) and after diagnosis (T1: 0.07, 95% CI: 0.01, 0.13). CONCLUSIONS An incident cancer diagnosis among those living in the least disadvantaged neighborhoods was associated with an acute memory drop at the time of diagnosis and a long-term memory advantage before and after diagnosis compared with cancer-free individuals in similar neighborhoods. IMPACT These findings could inform interventions to promote cancer survivor's long-term aging. Future studies should investigate the social and biological pathways through which neighborhood socioeconomic status could influence cancer-related memory changes.
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Affiliation(s)
- Ashly C. Westrick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Monica Ospina-Romero
- University of Wisconsin School of Medicine and Public Health, Department of Pathology and Laboratory Medicine, Madison, WI, USA
| | - Philippa Clarke
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Social Environment and Health Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M. Langa
- Department of Internal Medicine and Cognitive Health Services Research Program, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Lindsay C. Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Lane JM, Zimmer A, Quiñones-Cordero MM, Sörensen S. Racial differences in the effect of verbal and nonverbal memory on concrete planning for future care needs among older adults: a multi-group structural equation modeling approach. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2024; 31:587-604. [PMID: 37317954 PMCID: PMC10721738 DOI: 10.1080/13825585.2023.2223902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
Concrete planning for future care needs may positively impact older adults' subsequent mental health and quality of life. However, the cognitive factors that facilitate concrete planning among Black and White older adults are still poorly understood. We investigated whether there are significant differences between Black (n = 159) and White (n = 262) older adults in concrete planning and explored racial differences in the relationship between verbal and nonverbal episodic memory and concrete planning. Results revealed that Blacks showed lower engagement in concrete planning and lower scores than Whites on each verbal and nonverbal memory task. For Blacks, but not Whites, verbal memory and nonverbal memory performance predicted concrete planning with higher nonverbal memory relating to less concrete planning and higher verbal memory associated with more concrete planning. Our findings suggest racial differences exist in how episodic verbal and nonverbal memory affect concrete planning, a crucial factor for older adults' preparation for future care.
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Affiliation(s)
- Jamil M Lane
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alexis Zimmer
- Department of Counseling and Human Development, University of Rochester, Rochester, USA
| | - Maria M Quiñones-Cordero
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester School of Nursing, Rochester, NY, USA
| | - Silvia Sörensen
- Department of Counseling and Human Development, University of Rochester, Rochester, USA
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Grasset L, Zeki Al Hazzouri A, Milazzo F, Lu P, Elfassy T, Elbejjani M, Vittinghoff E, Yaffe K. Long-Term Depressive Symptom Trajectories and Midlife Cognition: The CARDIA Study. Neurology 2024; 103:e209510. [PMID: 38865677 DOI: 10.1212/wnl.0000000000209510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The nature of associations between depressive symptoms and cognition early in the life course remains unclear, and racial differences in these associations are not well characterized. The aim of this study was to examine the relationship between trajectories of depressive symptom over 20 years, beginning in young adulthood, and cognitive functions in middle-age among Black and White adults. METHODS We used prospective data from participants of the Coronary Artery Risk Development in Young Adults Study. Depressive symptoms were measured at 5 study visits between 1990 and 2010 using the Center for Epidemiologic Studies Depression scale. We used latent class group-based modeling to identify 4 trajectories: "persistently low," "persistently medium," "medium decreasing," and "high increasing" depressive symptoms. In 2015, cognitive function was measured using the Digit Symbol Substitution Test (DSST), Stroop test (reverse coded), and Rey Auditory-Verbal Learning Test (RAVLT).We excluded participants who missed the cognitive battery or had no depressive symptoms measurements, resulting in a total of 3,117 participants. All cognitive tests were standardized, and linear regression was used to relate depressive trajectories with 2015 cognitive functions. RESULTS The mean [SD] baseline age was 30.1 [3.6] years, and 57% were female. The associations between depressive symptoms and cognition significantly differed by race (p < 0.05). Among Black individuals, compared with having "persistently low," having "medium decreasing," "persistently medium," or "high increasing" depressive symptoms were associated with worse verbal memory, processing speed, and executive function scores (RAVLT persistently medium vs low: β = -0.30, 95% CI -0.48 to -0.12; and high increasing vs low: β = -0.49, 95% CI -0.70 to -0.27; DSST persistently medium vs low: β = -0.28, 95% CI -0.47 to -0.09; and high increasing vs low: β = -0.64, 95% CI -0.87 to -0.42; Stroop persistently medium vs low: β = -0.46, 95% CI -0.70 to -0.23; and high increasing vs low: β = -0.76, 95% CI -1.04 to -0.47). Associations were slightly weaker among White individuals, but we still found that having 'high increasing' depressive symptoms was associated with worse verbal memory and processing speed scores (high increasing vs low: β = -0.38, 95% CI -0.61 to -0.15; and β = -0.40, 95% CI -0.63 to -0.18, respectively). DISCUSSION Prolonged exposure to elevated depressive symptoms beginning in young adulthood may result in worse cognitive function over midlife. This association was stronger among Black adults.
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Affiliation(s)
- Leslie Grasset
- From the Univ. Bordeaux (L.G.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219; Inserm, CIC1401-EC, Bordeaux, France; Department of Epidemiology (A.Z.A.H., F.M., P.L.), Mailman School of Public Health, Columbia University, NY; Division of Medicine (T.E.), Miller School of Medicine, University of Miami, FL; Clinical Research Institute (M.E.), Department of Internal Medicine, American University of Beirut, Lebanon; and Departments of Psychiatry (E.V., K.Y.), Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
| | - Adina Zeki Al Hazzouri
- From the Univ. Bordeaux (L.G.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219; Inserm, CIC1401-EC, Bordeaux, France; Department of Epidemiology (A.Z.A.H., F.M., P.L.), Mailman School of Public Health, Columbia University, NY; Division of Medicine (T.E.), Miller School of Medicine, University of Miami, FL; Clinical Research Institute (M.E.), Department of Internal Medicine, American University of Beirut, Lebanon; and Departments of Psychiatry (E.V., K.Y.), Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
| | - Floriana Milazzo
- From the Univ. Bordeaux (L.G.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219; Inserm, CIC1401-EC, Bordeaux, France; Department of Epidemiology (A.Z.A.H., F.M., P.L.), Mailman School of Public Health, Columbia University, NY; Division of Medicine (T.E.), Miller School of Medicine, University of Miami, FL; Clinical Research Institute (M.E.), Department of Internal Medicine, American University of Beirut, Lebanon; and Departments of Psychiatry (E.V., K.Y.), Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
| | - Peiyi Lu
- From the Univ. Bordeaux (L.G.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219; Inserm, CIC1401-EC, Bordeaux, France; Department of Epidemiology (A.Z.A.H., F.M., P.L.), Mailman School of Public Health, Columbia University, NY; Division of Medicine (T.E.), Miller School of Medicine, University of Miami, FL; Clinical Research Institute (M.E.), Department of Internal Medicine, American University of Beirut, Lebanon; and Departments of Psychiatry (E.V., K.Y.), Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
| | - Tali Elfassy
- From the Univ. Bordeaux (L.G.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219; Inserm, CIC1401-EC, Bordeaux, France; Department of Epidemiology (A.Z.A.H., F.M., P.L.), Mailman School of Public Health, Columbia University, NY; Division of Medicine (T.E.), Miller School of Medicine, University of Miami, FL; Clinical Research Institute (M.E.), Department of Internal Medicine, American University of Beirut, Lebanon; and Departments of Psychiatry (E.V., K.Y.), Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
| | - Martine Elbejjani
- From the Univ. Bordeaux (L.G.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219; Inserm, CIC1401-EC, Bordeaux, France; Department of Epidemiology (A.Z.A.H., F.M., P.L.), Mailman School of Public Health, Columbia University, NY; Division of Medicine (T.E.), Miller School of Medicine, University of Miami, FL; Clinical Research Institute (M.E.), Department of Internal Medicine, American University of Beirut, Lebanon; and Departments of Psychiatry (E.V., K.Y.), Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
| | - Eric Vittinghoff
- From the Univ. Bordeaux (L.G.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219; Inserm, CIC1401-EC, Bordeaux, France; Department of Epidemiology (A.Z.A.H., F.M., P.L.), Mailman School of Public Health, Columbia University, NY; Division of Medicine (T.E.), Miller School of Medicine, University of Miami, FL; Clinical Research Institute (M.E.), Department of Internal Medicine, American University of Beirut, Lebanon; and Departments of Psychiatry (E.V., K.Y.), Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
| | - Kristine Yaffe
- From the Univ. Bordeaux (L.G.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219; Inserm, CIC1401-EC, Bordeaux, France; Department of Epidemiology (A.Z.A.H., F.M., P.L.), Mailman School of Public Health, Columbia University, NY; Division of Medicine (T.E.), Miller School of Medicine, University of Miami, FL; Clinical Research Institute (M.E.), Department of Internal Medicine, American University of Beirut, Lebanon; and Departments of Psychiatry (E.V., K.Y.), Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
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Kim J, Hwang S. Separating the Effects of Transitions Into and Out of Social Isolation and Loneliness on Cognitive Function in Later Life. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae082. [PMID: 38742600 DOI: 10.1093/geronb/gbae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES This study investigates the effects of social isolation and loneliness on cognitive function, distinguishing between the effects of transitioning into and out of these states. METHODS This study analyzed data from 6,663 adults aged 65 or older collected over the course of 7 waves (12 years) of the Korean Longitudinal Study of Aging from 2006 to 2018. A novel asymmetric fixed effects model was utilized to separately estimate the effects of transitions into and out of social isolation or loneliness. RESULTS The association of transitions into social isolation due to a lack of informal social contact or loneliness with cognitive function (b = -1.387, p < .001 and b = -0.601, p < .001, respectively) was stronger than the association of transitions out of these states (b = 0.345, p < .05 and b = 0.353, p < .001, respectively). The magnitude of the negative and positive coefficients was statistically different (F-statistic = 45.29, p < .001 and F-statistic = 5.12, p < .05, respectively). In contrast, no such asymmetric effects were observed for social isolation due to a lack of formal activity (F-statistic = 0.06, p = .800). DISCUSSION The detrimental effects of transitioning into social isolation due to a lack of informal social contact (but not formal activity) or loneliness on cognitive function outweigh the beneficial effects of transitioning out of these states. Preventing the onset of social disconnection should be prioritized as an intervention to improve the cognitive function of older adults.
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Affiliation(s)
- Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
| | - Sungsik Hwang
- Department of Sociology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Neale ZE, Fonda JR, Miller MW, Wolf EJ, Zhang R, Sherva R, Harrington KM, Merritt V, Panizzon MS, Hauger RL, Gaziano JM, Logue MW. Subjective cognitive concerns, APOE ε4, PTSD symptoms, and risk for dementia among older veterans. Alzheimers Res Ther 2024; 16:143. [PMID: 38951900 PMCID: PMC11218206 DOI: 10.1186/s13195-024-01512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are associated with self-reported problems with cognition as well as risk for Alzheimer's disease and related dementias (ADRD). Overlapping symptom profiles observed in cognitive disorders, psychiatric disorders, and environmental exposures (e.g., head injury) can complicate the detection of early signs of ADRD. The interplay between PTSD, head injury, subjective (self-reported) cognitive concerns and genetic risk for ADRD is also not well understood, particularly in diverse ancestry groups. METHODS Using data from the U.S. Department of Veterans Affairs (VA) Million Veteran Program (MVP), we examined the relationship between dementia risk factors (APOE ε4, PTSD, TBI) and subjective cognitive concerns (SCC) measured in individuals of European (n = 140,921), African (n = 15,788), and Hispanic (n = 8,064) ancestry (EA, AA, and HA, respectively). We then used data from the VA electronic medical record to perform a retrospective survival analysis evaluating PTSD, TBI, APOE ε4, and SCC and their associations with risk of conversion to ADRD in Veterans aged 65 and older. RESULTS PTSD symptoms (B = 0.50-0.52, p < 1E-250) and probable TBI (B = 0.05-0.19, p = 1.51E-07 - 0.002) were positively associated with SCC across all three ancestry groups. APOE ε4 was associated with greater SCC in EA Veterans aged 65 and older (B = 0.037, p = 1.88E-12). Results of Cox models indicated that PTSD symptoms (hazard ratio [HR] = 1.13-1.21), APOE ε4 (HR = 1.73-2.05) and SCC (HR = 1.18-1.37) were positively associated with risk for ADRD across all three ancestry groups. In the EA group, probable TBI also contributed to increased risk of ADRD (HR = 1.18). CONCLUSIONS The findings underscore the value of SCC as an indicator of ADRD risk in Veterans 65 and older when considered in conjunction with other influential genetic, clinical, and demographic risk factors.
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Affiliation(s)
- Zoe E Neale
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Institute for Genomics in Health (IGH), SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jennifer R Fonda
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Educational and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
| | - Erika J Wolf
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
| | - Rui Zhang
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA
| | - Richard Sherva
- Biomedical Genetics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
| | - Kelly M Harrington
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA, USA
| | - Victoria Merritt
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
| | - Matthew S Panizzon
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - Richard L Hauger
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA, USA
| | - J Michael Gaziano
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark W Logue
- National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, 150 South Huntington Ave (116B-2), Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA.
- Biomedical Genetics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02130, USA.
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
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Farmer HR, Thierry AD, Sherman-Wilkins K, Thorpe RJ. An exploration of neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older black adults. ETHNICITY & HEALTH 2024:1-23. [PMID: 38932579 DOI: 10.1080/13557858.2024.2369871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES While existing research has shown that Black adults have worse cognitive functioning than their White counterparts, the psychosocial correlates of cognitive functioning for Black older adults are understudied. The objective of this study was to investigate the relationships among perceived neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older Black adults. METHODS Data were from 3,191 Black adults ages 51+ in the 2008-2016 waves of the Health and Retirement Study to examine associations among neighborhood characteristics, psychosocial resilience (sense of purpose, mastery, and social support), and cognitive functioning among Black adults. Multilevel linear regression models assessed direct effects of neighborhood characteristics and psychosocial resources on cognitive functioning. We then tested whether psychosocial resources moderated the association between neighborhood characteristics and cognitive functioning. RESULTS Mean levels of cognitive functioning, sense of purpose, social support, and mastery were significantly related to neighborhood disorder and discohesion. Regression results showed that levels of neighborhood disorder and high discohesion were significantly associated with cognitive functioning. Sense of purpose was positively associated with cognitive functioning, net of neighborhood characteristics. However, only social support moderated the association between neighborhood discohesion and cognition. CONCLUSIONS These findings demonstrate the importance of examining psychosocial and contextual risk and resilience resources among midlife and older Black adults. This work may inform the development of cognitive behavioral interventions aimed at increasing sense of purpose to promote and enhance cognitive resiliency among Black adults. Altogether, this work may have implications for policy aimed at advancing cognitive health equity.
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Affiliation(s)
- Heather R Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Amy D Thierry
- Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, USA
| | - Kyler Sherman-Wilkins
- Department of Sociology, Anthropology, and Gerontology, Missouri State University, Springfield, MO, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lin Z, Wang Y, Gill TM, Chen X. Association of Childhood Exposure to School Racial Segregation with Late-Life Cognitive Outcomes among Older Americans. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.21.24309186. [PMID: 38947046 PMCID: PMC11213034 DOI: 10.1101/2024.06.21.24309186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
IMPORTANCE Disparities in cognition, including dementia occurrence, persist between White and Black older adults, and are possibly influenced by early educational differences stemming from structural racism. However, the relationship between school racial segregation and later-life cognition remains underexplored. OBJECTIVE To investigate the association between childhood contextual exposure to school racial segregation and cognitive outcomes in later life. DESIGN SETTING AND PARTICIPANTS Data from 16,625 non-Hispanic White (hereafter, White) and 3,335 non-Hispanic Black (hereafter, Black) Americans aged 65 or older were analyzed from the Health and Retirement Study. EXPOSURES State-level White-Black dissimilarity index for public elementary schools in the late 1960s (range: 0-100) was used to measure school segregation. States were categorized into high segregation (383.6) and low segregation (<83.6) based on the top quintile. MAIN OUTCOMES AND MEASURES Cognitive scores, cognitive impairment (with or without dementia), and dementia were assessed using the Telephone Interview for Cognitive Status (TICS) and proxy assessment. Multilevel regression analyses were conducted, adjusting for demographic covariates, socioeconomic status, and health factors. Stratified analyses by race were performed. RESULTS The mean (SD) age of participants was 78.5 (5.7) years, and 11,208 (56.2%) were female. Participants exposed to high segregation exhibited lower cognitive scores (12.6 vs. 13.6; P<0.001) and higher prevalence of cognitive impairment (50.8% vs 41.4%; P<0.001) and dementia (26.0% vs. 19.5%; P<0.001), compared to those with low segregation exposure. Multilevel analyses revealed a significant negative association between school segregation and later-life cognitive even after adjusting sequentially for potential confounders, and these associations were stronger among Black than White participants. Notably, in the fully adjusted model, Black participants exposed to high segregation displayed significantly lower cognitive scores (-0.51; 95% CI: -0.94, -0.09) and higher likelihood of cognitive impairment (adjusted Odds Ratio [aOR]: 1.45, 95% CI: 1.22, 1.72) and dementia (aOR: 1.31, 95% CI: 1.06, 1.63). CONCLUSIONS AND RELEVANCE Our study underscores that childhood exposure to state-level school segregation is associated with late-life cognition, especially for Black Americans. Given the rising trend of school segregation in the US, educational policies aimed at reducing segregation are crucial to address health inequities. Clinicians can leverage patients' early-life educational circumstances to promote screening, prevention, and management of cognitive disorders.
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Affiliation(s)
- Zhuoer Lin
- Department of Health Policy and Management, Yale School of Public Health
| | - Yi Wang
- Department of Internal Medicine, Yale School of Medicine
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health
- Department of Economics, Yale University
- Yale Alzheimer’s Disease Research Center
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9
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Peterson A, Sathe A, Zaras D, Yang Y, Durant A, Deters KD, Shashikumar N, Pechman KR, Kim ME, Gao C, Khairi NM, Li Z, Yao T, Huo Y, Dumitrescu L, Gifford KA, Wilson JE, Cambronero F, Risacher SL, Beason-Held LL, An Y, Arfanakis K, Erus G, Davatzikos C, Tosun D, Toga AW, Thompson PM, Mormino EC, Zhang P, Schilling K, Albert M, Kukull W, Biber SA, Landman BA, Johnson SC, Schneider J, Barnes LL, Bennett DA, Jefferson AL, Resnick SM, Saykin AJ, Hohman TJ, Archer DB. Sex, racial, and APOE-ε4 allele differences in longitudinal white matter microstructure in multiple cohorts of aging and Alzheimer's disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.10.598357. [PMID: 38915636 PMCID: PMC11195046 DOI: 10.1101/2024.06.10.598357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
INTRODUCTION The effects of sex, race, and Apolipoprotein E (APOE) - Alzheimer's disease (AD) risk factors - on white matter integrity are not well characterized. METHODS Diffusion MRI data from nine well-established longitudinal cohorts of aging were free-water (FW)-corrected and harmonized. This dataset included 4,702 participants (age=73.06 ± 9.75) with 9,671 imaging sessions over time. FW and FW-corrected fractional anisotropy (FAFWcorr) were used to assess differences in white matter microstructure by sex, race, and APOE-ε4 carrier status. RESULTS Sex differences in FAFWcorr in association and projection tracts, racial differences in FAFWcorr in projection tracts, and APOE-ε4 differences in FW limbic and occipital transcallosal tracts were most pronounced. DISCUSSION There are prominent differences in white matter microstructure by sex, race, and APOE-ε4 carrier status. This work adds to our understanding of disparities in AD. Additional work to understand the etiology of these differences is warranted.
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Affiliation(s)
- Amalia Peterson
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Aditi Sathe
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Dimitrios Zaras
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Yisu Yang
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Alaina Durant
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Kacie D. Deters
- Department of Integrative Biology and Physiology, University of California, Los Angeles
| | - Niranjana Shashikumar
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Kimberly R. Pechman
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Michael E. Kim
- Department of Computer Science, Vanderbilt University, Nashville, TN
| | - Chenyu Gao
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN
| | - Nazirah Mohd Khairi
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN
| | - Zhiyuan Li
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN
| | - Tianyuan Yao
- Department of Computer Science, Vanderbilt University, Nashville, TN
| | - Yuankai Huo
- Department of Computer Science, Vanderbilt University, Nashville, TN
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN
| | - Logan Dumitrescu
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine A. Gifford
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Jo Ellen Wilson
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
- Veteran‘s Affairs, Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System
| | - Francis Cambronero
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Shannon L. Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Lori L. Beason-Held
- Laboratory for Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Yang An
- Laboratory for Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Konstantinos Arfanakis
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL
| | - Guray Erus
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Duygu Tosun
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Arthur W. Toga
- Laboratory of Neuroimaging, USC Stevens Institute of Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
| | - Elizabeth C. Mormino
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA
| | - Panpan Zhang
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Kurt Schilling
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN2
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | - Marilyn Albert
- Department of Neurology, Johns Hopkins School of Medicine Baltimore, MD
| | - Walter Kukull
- National Alzheimer’s Coordinating Center, University of Washington, Seattle, WA
| | - Sarah A. Biber
- National Alzheimer’s Coordinating Center, University of Washington, Seattle, WA
| | - Bennett A. Landman
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Department of Computer Science, Vanderbilt University, Nashville, TN
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN2
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Julie Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
| | - Angela L. Jefferson
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Department of Computer Science, Vanderbilt University, Nashville, TN
| | - Susan M. Resnick
- Laboratory for Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Andrew J. Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
- Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy J. Hohman
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Derek B. Archer
- Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, TN
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN
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Reynolds A, Greenfield EA, Nepomnyaschy L. Disparate benefits of higher childhood socioeconomic status on cognition in young adulthood by intersectional social positions. ADVANCES IN LIFE COURSE RESEARCH 2024; 60:100608. [PMID: 38552532 PMCID: PMC11129928 DOI: 10.1016/j.alcr.2024.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES Emerging evidence supports the protective effects of higher childhood socioeconomic status (cSES) on cognition over the life course. However, less understood is if higher cSES confers benefits equally across intersecting social positions. Guided by a situational intersectionality perspective and the theory of Minority Diminished Returns (MDR), this study examined the extent to which associations between cSES and cognition in young adulthood are jointly moderated by racialized identity and region of childhood residence. METHODS Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we used multilevel modeling to test associations between cSES and delayed recall and working memory 14 years later when participants were ages 25-34. Further, we examined the influence of racialized identity and region of childhood residence on these associations. RESULTS Higher cSES was associated with higher delayed recall and working memory scores across social positions. However, the strength of the association between higher cSES and working memory differed across racialized subgroups and region of childhood residence. We found a statistically significant three-way interaction between cSES, race and region of childhood residence. Of particular important, a small yet statistically robust association was found in all groups, but was especially strong among White Southerners and especially weak among Black participants from the South. CONCLUSIONS This study contributes to a growing body of research indicating that the protective effects of higher cSES on cognition are not universal across subgroups of intersecting social positions, consistent with the theory of MDR. These findings provide evidence for the importance of considering the role of systemic racism across geographic contexts as part of initiatives to promote equity in life course cognitive aging and brain health.
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Affiliation(s)
- Addam Reynolds
- Andrus Gerontology Center, 3715 McClintock Ave, Los Angeles, CA 90089, USA; Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
| | - Emily A Greenfield
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Lenna Nepomnyaschy
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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11
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Lin Z, Ye J, Allore H, Gill TM, Chen X. Early-Life Circumstances and Racial Disparities in Cognition Among Older Adults in the US. JAMA Intern Med 2024:2818893. [PMID: 38805197 PMCID: PMC11134283 DOI: 10.1001/jamainternmed.2024.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/29/2024] [Indexed: 05/29/2024]
Abstract
Importance Given the critical role of neurocognitive development in early life, understanding the association between early-life circumstances and racial disparities in cognition has important implications. Objective To assess whether racial differences in early-life circumstances are collectively and individually associated with racial disparities in late-life cognition among older adults in the US. Design, Setting, and Participants This cross-sectional study used comprehensive life history data from the Health and Retirement Study, a nationally representative survey of US adults 50 years or older. Data analyses were performed from August 9, 2022, to January 20, 2024. Main Outcomes and Measures Racial differences in early-life circumstances and racial disparities in late-life cognition were investigated using a Blinder-Oaxaca decomposition regression model. Cognitive outcomes, including cognitive score and cognitive impairment, were evaluated using the Telephone Interview for Cognitive Status. Early-life educational experiences were primary explanatory variables; early-life cohort, regional, financial, health, trauma, family relationship factors, and educational attainment were additional explanatory variables; demographic and genetic factors were covariates. Results The study sample comprised 9015 participants; 1634 non-Hispanic Black (hereafter, Black) individuals (18.1%) and 7381 non-Hispanic White (hereafter, White) individuals (81.9%). Among Black participants, the mean (SD) age was 69.2 (9.2) years and 1094 (67.0%) were women. Among White participants, the mean (SD) age was 73.2 (10.1) years and 4410 (59.7%) were women. Cognitive scores (scale, 0-27) were significantly lower among Black participants (13.5 [95% CI, 13.3-13.7] points) than among White participants (15.8 [95% CI, 15.7-15.9] points), while the prevalence of cognitive impairment (cognitive score <12) was significantly higher among Black participants (33.6 [95% CI, 31.3-35.9] percentage points [ppt]) than among White participants (16.4 [95% CI, 15.6-17.2] ppt). Substantial racial differences were observed in early-life circumstances. Overall, differences in early-life circumstances were associated with 61.5% of the racial disparities in cognitive score (1.4 [95% CI, 0.88-2.0] points), and 82.3% of the racial disparities in cognitive impairment (14.2 [95% CI, 8.8-19.5] ppt), respectively. In multivariable analyses, early-life educational experiences were associated with 35.2% of the disparities in cognitive score and 48.6% in cognitive impairment. Notably, school racial segregation (all segregated schooling before college) was associated with 28.8% to 39.7% of the racial disparities in cognition. These findings were consistent in a series of sensitivity analyses. Conclusions and Relevance The findings of this cross-sectional study suggest that less favorable early-life circumstances are associated with clinically meaningful racial disparities in late-life cognition. Policies that improve educational equity have the potential to reduce racial disparities in cognition in older ages. Clinicians may leverage early-life circumstances to promote the screening, prevention, and interventions of cognitive impairment more efficiently, thereby promoting health equity.
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Affiliation(s)
- Zhuoer Lin
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Justin Ye
- Department of Economics, Yale University, New Haven, Connecticut
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
- Yale Alzheimer’s Disease Research Center, New Haven, Connecticut
- Statistical Editor, JAMA Internal Medicine
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Department of Economics, Yale University, New Haven, Connecticut
- Yale Alzheimer’s Disease Research Center, New Haven, Connecticut
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12
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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13
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Sol K, Morris EP, Lee JH, Zaheed AB, Palms JD, Scambray K, Clarke P, Zahodne LB. Histories of neighborhood socioeconomic status contribute to race differences in later-life cognition. Alzheimers Dement 2024; 20:3342-3351. [PMID: 38552138 PMCID: PMC11095476 DOI: 10.1002/alz.13786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Neighborhood characteristics are increasingly implicated in cognitive health disparities, but no research has investigated how the historical context of neighborhoods shapes these disparities. METHODS Four hundred sixty-four Black (55%) and White older adults (Mage = 63.6) were drawn from the Michigan Cognitive Aging Project, a community-based, prospective study of older adults. Participants' addresses at baseline (2017-2020) were geocoded and linked to 2000-2017 measures of neighborhood socioeconomic status (NSES): disadvantage [NDis] and affluence [NAff]. Latent class growth analysis (LCGA) characterized 18 interpolated year trajectories of NSES across 1344 census tracts. Path analysis examined whether NSES trajectory classes mediated the association between race and a global cognition composite. RESULTS LCGA identified three NDis and two NAff trajectory classes, which were associated with participant race. Only one NDis class was associated with cognition, and it mediated the association between the Black race and cognition. DISCUSSION Disinvestment in neighborhoods may be particularly salient in race disparities in cognitive function. HIGHLIGHTS Race is implicated in the likelihood of living in more disadvantaged neighborhoods. Historical trends in neighborhood disadvantage are associated with cognitive function in older adulthood. Identifying patterns of neighborhood change may inform neighborhood-level interventions.
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Affiliation(s)
- Ketlyne Sol
- Social Environment and Health Program, Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
| | - Emily P. Morris
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Ji Hyun Lee
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Afsara B. Zaheed
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Jordan D. Palms
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Kiana Scambray
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Philippa Clarke
- Social Environment and Health Program, Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
| | - Laura B. Zahodne
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
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Cevik SE, Skaar DA, Jima DD, Liu AJ, Østbye T, Whitson HE, Jirtle RL, Hoyo C, Planchart A. DNA methylation of imprint control regions associated with Alzheimer's disease in non-Hispanic Blacks and non-Hispanic Whites. Clin Epigenetics 2024; 16:58. [PMID: 38658973 PMCID: PMC11043040 DOI: 10.1186/s13148-024-01672-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/13/2024] [Indexed: 04/26/2024] Open
Abstract
Alzheimer's disease (AD) prevalence is twice as high in non-Hispanic Blacks (NHBs) as in non-Hispanic Whites (NHWs). The objective of this study was to determine whether aberrant methylation at imprint control regions (ICRs) is associated with AD. Differentially methylated regions (DMRs) were bioinformatically identified from whole-genome bisulfite sequenced DNA derived from brain tissue of 9 AD (5 NHBs and 4 NHWs) and 8 controls (4 NHBs and 4 NHWs). We identified DMRs located within 120 regions defined as candidate ICRs in the human imprintome ( https://genome.ucsc.edu/s/imprintome/hg38.AD.Brain_track ). Eighty-one ICRs were differentially methylated in NHB-AD, and 27 ICRs were differentially methylated in NHW-AD, with two regions common to both populations that are proximal to the inflammasome gene, NLRP1, and a known imprinted gene, MEST/MESTIT1. These findings indicate that early developmental alterations in DNA methylation of regions regulating genomic imprinting may contribute to AD risk and that this epigenetic risk differs between NHBs and NHWs.
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Affiliation(s)
- Sebnem E Cevik
- Toxicology Program, North Carolina State University, Raleigh, NC, USA
| | - David A Skaar
- Toxicology Program, North Carolina State University, Raleigh, NC, USA
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Dereje D Jima
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
| | - Andy J Liu
- Department of Neurology, School of Medicine, Duke University, Durham, NC, USA
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Heather E Whitson
- Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
- Duke Center for the Study of Aging and Human Development, Durham, NC, USA
- Duke/UNC Alzheimer's Disease Research Center (ADRC), Durham, NC, USA
| | - Randy L Jirtle
- Toxicology Program, North Carolina State University, Raleigh, NC, USA.
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA.
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA.
| | - Cathrine Hoyo
- Toxicology Program, North Carolina State University, Raleigh, NC, USA.
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA.
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA.
| | - Antonio Planchart
- Toxicology Program, North Carolina State University, Raleigh, NC, USA
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
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Walker AIB, Trani J, Banks CF, Murphy SA, Zha W, Williams MM, Day GS, Zhu Y, Ances BM, Hill CV, Hudson DL, Babulal GM. Recruiting a prospective community cohort to study Alzheimer's disease and structural and social determinants of health among adults racialized as Black: The ARCHES cohort. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12473. [PMID: 38756718 PMCID: PMC11097001 DOI: 10.1002/trc2.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/23/2024] [Accepted: 03/21/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION This ongoing, prospective study examines the effectiveness of methods used to successfully recruit and retain 238 Black older adults in a longitudinal, observational Alzheimer's disease (AD) study. METHODS Recruitment strategies included traditional media, established research registries, speaking engagements, community events, and snowball sampling. Participants were asked to complete an annual office testing session, blood-based biomarker collection, optional one-time magnetic resonance imaging (MRI) scan, and community workshop. RESULTS Within the first 22 months of active recruitment, 629 individuals expressed interest in participating, and 238 enrolled in the ongoing study. Of the recruitment methods used, snowball sampling, community events, and speaking engagements were the most effective. DISCUSSION The systemic underrepresentation of Black participants in AD research impacts the ability to generalize research findings and determine the effectiveness and safety of disease-modifying treatments. Research to slow, stop, or prevent AD remains a top priority but requires diversity in sample representation. Highlights Provide flexible appointments in the evening or weekends, offering transportation assistance, and allowing participants to complete study visits at alternative locations, such as senior centers or community centers.Continuously monitor and analyze recruitment data to identify trends, challenges, and opportunities for improvement.Implement targeted strategies to recruit participants who are underrepresented based on sex, gender, or education to increase representation.Diversify the research team to include members who reflect the racial and cultural backgrounds of the target population, to enhance trust and rapport with prospective participants.
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Affiliation(s)
- Alexis I. B. Walker
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Jean‐Francois Trani
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- National Conservatory of Arts and CraftsParisFrance
- Centre for Social Development in AfricaFaculty of HumanitiesUniversity of JohannesburgAuckland ParkJohannesburgSouth Africa
| | - Christian F. Banks
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Samantha A. Murphy
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Wenqing Zha
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | | | - Gregory S. Day
- Department of NeurologyMayo Clinic in FloridaJacksonvilleFloridaUSA
| | - Yiqi Zhu
- School of Social WorkAdelphi UniversityGarden CityNew YorkUSA
| | - Beau M. Ances
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | | | - Darrell L. Hudson
- Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
| | - Ganesh M. Babulal
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Institute of Public HealthWashington UniversitySt. LouisMissouriUSA
- Centre for Social Development in AfricaFaculty of HumanitiesUniversity of JohannesburgAuckland ParkJohannesburgSouth Africa
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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16
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Wood I, Song R, Zhang Y, Jacobsen E, Hughes T, Chang CCH, Ganguli M. Ethnoracial Identity and Cognitive Impairment: A Community Study. Alzheimer Dis Assoc Disord 2024; 38:152-159. [PMID: 38748688 DOI: 10.1097/wad.0000000000000617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Identifying potentially modifiable risk factors associated with MCI in different ethnoracial groups could reduce MCI burden and health inequity in the population. METHODS Among 2845 adults aged 65+ years, we investigated potential risk exposures including education, physical and mental health, lifestyle, and sensory function, and their cross-sectional associations with MCI. We compared proportions of exposures between Black and White participants and explored relationships among race, MCI, and exposures. Logistic regression modeled MCI as a function of each exposure in the overall sample adjusting for age, sex, educational level, and race, and investigating race*exposure interactions. RESULTS Compared with White participants, Black participants had greater odds of MCI (OR 1.53; 95% CI, 1.13 to 2.06) and were more likely to report depressive symptoms, diabetes, and stroke, to have high blood pressure and BMI, and to be APOE - 4 carriers. Exposures associated with higher odds of MCI were diabetes, stroke, lifetime smoking, sleep disturbances, social isolation, loneliness, depression and anxiety symptoms, and vision and hearing loss. There were no significant interactions between race and any exposure. CONCLUSIONS Black participants had 53% higher odds of MCI adjusting for age, sex, and education. The same exposures were associated with MCI in Black and White participants.
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Affiliation(s)
- Isabella Wood
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Ruopu Song
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Yingjin Zhang
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Tiffany Hughes
- Master of Public Health Program, Midwestern University College of Graduate Studies, Glendale, AZ
| | - Chung-Chou H Chang
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA
- Department of Medicine
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Department of Neurology, University of Pittsburgh School of Medicine
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA
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Chakraborty R, Kobayashi LC, Jock J, Wing C, Chen X, Phillips M, Berkman L, Kahn K, Kabudula CW, Rosenberg M. Child support grant expansion and cognitive function among women in rural South Africa: Findings from a natural experiment in the HAALSI cohort. PLoS One 2024; 19:e0297673. [PMID: 38446751 PMCID: PMC10917272 DOI: 10.1371/journal.pone.0297673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/11/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Cash transfers are a promising but understudied intervention that may protect cognitive function in adults. Although South Africa has a rapidly ageing population, little is known about the nature of association between cash transfers and cognitive function in this setting. OBJECTIVES We leveraged age-eligibility expansions to South Africa's Child Support Grant (CSG) to investigate the association between duration of CSG eligibility and cognitive function of biological mothers of child beneficiaries in South Africa. METHODS We analysed 2014/2015 baseline data from 944 women, aged 40-59 years with at least one CSG-eligible child, enrolled in the population-representative HAALSI cohort in Agincourt, South Africa. Duration of CSG eligibility for each mother was calculated based on the birth dates of all their children and the CSG age-eligibility expansion years (2003-2012). Cognitive function was measured using a cognitive battery administered at the HAALSI baseline interview. Linear regression was used to estimate the association between duration of CSG eligibility, dichotomized as low (≤10 years) and high (>10 years) eligibility, and cognitive function z-scores of the mothers. RESULTS High vs. low duration of CSG eligibility, was associated with higher cognitive function z-scores in the full sample [β: 0.15 SD units; 95% CI: 0.04, 0.26; p-value = 0.01]. In mothers with one to four lifetime children, but not five or more, high vs. low duration of CSG eligibility, was associated with higher cognitive function z-scores [β: 0.19 SD units; 95% CI: 0.05, 0.34, p-value = 0.02]. CONCLUSION Government cash transfers given to support raising children may confer substantial protective effects on the subsequent cognitive function of mothers. Further studies are needed to understand how parity may influence this relationship. Our findings bring evidence to policymakers for designing income supplementation programmes to promote healthy cognitive ageing in low-income settings.
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Affiliation(s)
- Rishika Chakraborty
- Department of Environmental and Occupational Health, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lindsay C. Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Janet Jock
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Coady Wing
- O’Neill School of Public and Environmental Affairs, Indiana University-Bloomington, Bloomington, Indiana, United States of America
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Meredith Phillips
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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18
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Reynolds A, Greenfield EA, Williams-Butler A. Early life adversity, race, and childhood socioeconomic status: intersecting drivers of later life cognition. Aging Ment Health 2024; 28:511-519. [PMID: 37572032 PMCID: PMC10859546 DOI: 10.1080/13607863.2023.2242296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/06/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Research on associations between early life adversity (ELA) and later life cognition has yielded mixed results and generally have not considered how broader societal systems of stratification potentially influence associations. The current study addresses this gap by exploring if racialized identity and childhood socioeconomic status (cSES) moderate associations between ELA exposure and later life cognition. METHODS Using data from the Health and Retirement Study (Waves 2010-2018), we used growth curve modeling to examine if the confluence of ELA, cSES, and racialized identity is associated with cognition. RESULTS Among White participants, greater exposure to ELA was associated with poorer baseline cognitive functioning, and higher cSES buffered against this association. Among Black participants, exposure to ELA was not associated with baseline cognitive functioning, regardless of cSES. We did not find evidence of any associations between main predictors nor their interactions with change in cognition over time. CONCLUSIONS This study provides evidence that associations between ELA and later life cognition is contingent upon multiple social positions in the United States. These findings support the importance of integrating insights on intersecting social positions within life-course-oriented efforts to reduce racialized cognitive disparities.
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Affiliation(s)
- Addam Reynolds
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA
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19
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Yang YC, Walsh CE, Shartle K, Stebbins RC, Aiello AE, Belsky DW, Harris KM, Chanti-Ketterl M, Plassman BL. An Early and Unequal Decline: Life Course Trajectories of Cognitive Aging in the United States. J Aging Health 2024; 36:230-245. [PMID: 37335551 PMCID: PMC10728348 DOI: 10.1177/08982643231184593] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Objectives: Cognitive aging is a lifelong process with implications for Alzheimer's disease and dementia. This study aims to fill major gaps in research on the natural history of and social disparities in aging-related cognitive decline over the life span. Methods: We conducted integrative data analysis of four large U.S. population-based longitudinal studies of individuals aged 12 to 105 followed over two decades and modeled age trajectories of cognitive function in multiple domains. Results: We found evidence for the onset of cognitive decline in the 4th decade of life, varying gender differences with age, and persistent disadvantage among non-Hispanic Blacks, Hispanics, and those without college education. We further found improvement in cognitive function across 20th century birth cohorts but widening social inequalities in more recent cohorts. Discussion: These findings advance an understanding of early life origins of dementia risk and invite future research on strategies for promoting cognitive health for all Americans.
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Affiliation(s)
- Yang C. Yang
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Department of Sociology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Christine E. Walsh
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Kaitlin Shartle
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Department of Sociology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca C. Stebbins
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Social, Genetic, & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College, London, UK
| | - Allison E. Aiello
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel W. Belsky
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kathleen Mullan Harris
- Carolina Population Center, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- Department of Sociology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Marianne Chanti-Ketterl
- Department of Psychiatry & Behavioral Science, School of Medicine, Duke University, Durham, NC, USA
| | - Brenda L. Plassman
- Department of Psychiatry & Behavioral Science, School of Medicine, Duke University, Durham, NC, USA
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20
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Zuelsdorff M, Sonnega A, Barnes LL, Byrd DR, Rose DK, Cox R, Norton D, Turner RW. Childhood and Adulthood Trauma Associate With Cognitive Aging Among Black and White Older Adults. Am J Geriatr Psychiatry 2024; 32:373-385. [PMID: 38288940 PMCID: PMC10922107 DOI: 10.1016/j.jagp.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 02/23/2024]
Abstract
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.
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Affiliation(s)
- Megan Zuelsdorff
- School of Nursing (MZ), University of Wisconsin-Madison, Madison, WI; Alzheimer's Disease Research Center (MZ), University of Wisconsin-Madison, Madison, WI.
| | - Amanda Sonnega
- Institute for Social Research (AS), University of Michigan, Ann Arbor, MI
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center (LLB), Rush University Medical Center, Chicago, IL
| | - DeAnnah R Byrd
- Edson College of Nursing and Health Innovation (DARB), Arizona State University, Phoenix, AZ; Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation (DARB), Arizona State University, Phoenix, AZ
| | | | - Robynn Cox
- School of Public Policy (RC), University of California, Riverside, CA
| | - Derek Norton
- Department of Biostatistics and Medical Informatics (DN), University of Wisconsin, Madison, WI
| | - Robert W Turner
- School of Medicine & Health Sciences (RWT), The George Washington University, Washington, DC
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21
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Kobayashi LC, Jones RN, Briceño EM, Rentería MA, Zhang Y, Meijer E, Langa KM, Lee J, Gross AL. Cross-national comparisons of later-life cognitive function using data from the Harmonized Cognitive Assessment Protocol (HCAP): Considerations and recommended best practices. Alzheimers Dement 2024; 20:2273-2281. [PMID: 38284801 PMCID: PMC10984496 DOI: 10.1002/alz.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/01/2023] [Accepted: 12/23/2023] [Indexed: 01/30/2024]
Abstract
The Harmonized Cognitive Assessment Protocol (HCAP) is a major innovation that provides, for the first time, harmonized data for cross-national comparisons of later-life cognitive functions that are sensitive to linguistic, cultural, and educational differences across countries. However, cognitive function does not lend itself to direct comparison across diverse populations without careful consideration of the best practices for such comparisons. This perspective discusses theoretical and methodological considerations and offers a set of recommended best practices for conducting cross-national comparisons of risk factor associations using HCAP data. Because existing and planned HCAP studies provide cognition data representing an estimated 75% of the global population ≥65 years of age, these recommended best practices will support high-quality comparative analyses of cognitive aging around the world. The principles described in this perspective are applicable to any researcher aiming to integrate or compare harmonized data on cognitive outcomes and their risk and protective factors across diverse populations.
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Affiliation(s)
- Lindsay C. Kobayashi
- Department of EpidemiologyCenter for Social Epidemiology and Population HealthUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
- Survey Research CenterUniversity of Michigan Institute for Social ResearchAnn ArborMichiganUSA
| | - Richard N. Jones
- Department of Psychiatry and Human BehaviorWarren Alpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Emily M. Briceño
- Department of Physical Medicine & RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Miguel Arce Rentería
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of NeurologyColumbia University College of Physicians and SurgeonsNew York CityNew YorkUSA
| | - Yuan Zhang
- Department of Sociomedical SciencesColumbia UniversityNew York CityNew YorkUSA
- Robert N. Butler Columbia Aging CenterColumbia UniversityNew York CityNew YorkUSA
| | - Erik Meijer
- Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kenneth M. Langa
- Survey Research CenterUniversity of Michigan Institute for Social ResearchAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Veterans Affairs Center for Clinical Management ResearchAnn ArborMichiganUSA
| | - Jinkook Lee
- Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins UniversityBaltimoreMarylandUSA
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22
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Zuelsdorff M, Limaye VS. A Framework for Assessing the Effects of Climate Change on Dementia Risk and Burden. THE GERONTOLOGIST 2024; 64:gnad082. [PMID: 37392416 PMCID: PMC10860581 DOI: 10.1093/geront/gnad082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Indexed: 07/03/2023] Open
Abstract
Alzheimer's disease and related dementias (ADRD) represent a public health crisis poised to worsen in a changing climate. Substantial dementia burden is modifiable, attributable to risk rooted in social and environmental conditions. Climate change threatens older populations in numerous ways, but implications for cognitive aging are poorly understood. We illuminate key mechanisms by which climate change will shape incidence and lived experiences of ADRD, and propose a framework for strengthening research, clinical, and policy actions around cognitive health in the context of climate change. Direct impacts and indirect risk pathways operating through built, social, interpersonal, and biomedical systems are highlighted. Air pollution compromises brain health directly and via systemic cardiovascular and respiratory ailments. Flooding and extreme temperatures constrain health behaviors like physical activity and sleep. Medical care resulting from climate-related health shocks imposes economic and emotional tolls on people living with dementia and caregivers. Throughout, inequitable distributions of climate-exacerbated risks and adaptive resources compound existing disparities in ADRD incidence, comorbidities, and care burden. Translational research, including work prioritizing underserved communities, is crucial. A mechanistic framework can guide research questions and methods and identify clinical- and policy-level intervention loci for prevention and mitigation of climate-related impacts on ADRD risk and burden.
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Affiliation(s)
- Megan Zuelsdorff
- School of Nursing, University of Wisconsin–Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Vijay S Limaye
- Science Office, Natural Resources Defense Council, New York City, New York, USA
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23
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Shore S, Li H, Zhang M, Whitney R, Gross AL, Bhatt AS, Nallamothu BK, Giordani B, Briceño EM, Sussman JB, Gutierrez J, Yaffe K, Griswold M, Johansen MC, Lopez OL, Gottesman RF, Sidney S, Heckbert SR, Rundek T, Hughes TM, Longstreth WT, Levine DA. Trajectory of Cognitive Function After Incident Heart Failure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.09.24302608. [PMID: 38370803 PMCID: PMC10871464 DOI: 10.1101/2024.02.09.24302608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background The size/magnitude of cognitive changes after incident heart failure (HF) are unclear. We assessed whether incident HF is associated with changes in cognitive function after accounting for pre-HF cognitive trajectories and known determinants of cognition. Methods This pooled cohort study included adults without HF, stroke, or dementia from six US population-based cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Linear mixed-effects models estimated changes in cognition at the time of HF (change in the intercept) and the rate of cognitive change over the years after HF (change in the slope), controlling for pre-HF cognitive trajectories and participant factors. Change in global cognition was the primary outcome. Change in executive function and memory were secondary outcomes. Cognitive outcomes were standardized to a t-score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. Results The study included 29,614 adults (mean [SD] age was 61.1 [10.5] years, 55% female, 70.3% White, 22.2% Black 7.5% Hispanic). During a median follow-up of 6.6 (Q1-Q3: 5-19.8) years, 1,407 (4.7%) adults developed incident HF. Incident HF was associated with an acute decrease in global cognition (-1.08 points; 95% CI -1.36, -0.80) and executive function (-0.65 points; 95% CI -0.96, -0.34) but not memory (-0.51 points; 95% CI -1.37, 0.35) at the time of the event. Greater acute decreases in global cognition after HF were seen in those with older age, female sex and White race. Individuals with incident HF, compared to HF-free individuals, demonstrated faster declines in global cognition (-0.15 points per year; 95% CI, -0.21, -0.09) and executive function (-0.16 points per year; 95% CI -0.23, -0.09) but not memory ( -0.11 points per year; 95% CI -0.26, 0.04) compared with pre-HF slopes. Conclusions In this pooled cohort study, incident HF was associated with an acute decrease in global cognition and executive function at the time of the event and faster declines in global cognition and executive function over the following years.
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Affiliation(s)
| | - Hanyu Li
- University of Michigan, Ann Arbor, MI, USA
| | - Min Zhang
- University of Michigan, Ann Arbor, MI, USA
| | | | - Alden L. Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ankeet S. Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | | | | | | | | | | | - Michael Griswold
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Stephen Sidney
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | - Tatjana Rundek
- University of Miami – Miller School of Medicine, Evelyn F. McKnight Brain Institute, FL, USA
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24
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Rahmani A, Najand B, Sonnega A, Akhlaghipour G, Mendez MF, Assari S. Intersectional Effects of Race and Educational Attainment on Memory Function of Middle-Aged and Older Adults With Alzheimer's Disease. J Racial Ethn Health Disparities 2024; 11:81-91. [PMID: 36576695 DOI: 10.1007/s40615-022-01499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND High educational attainment may protect individuals, particularly middle-aged and older adults, against a wide range of health risks, including memory decline with age; however, this protection is less clear in patients with Alzheimer's disease (AD). In addition, this effect may differ across racial groups. According to the Marginalized-Related Diminished Return (MDR) theory, for example, the protective effect of high educational attainment on mental and physical health shows a weaker protective effect for racial minority groups, particularly Black people compared to White individuals. OBJECTIVES This longitudinal study used data of middle-aged and older adults with AD with two aims: first, to test the association between educational attainment and memory, and second, to explore racial differences in this association in the USA. METHODS Data came from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. The total sample was 1673 American middle-aged and older adults. The independent variable was educational attainment measured as years of education. The main outcome was memory operationalized as Rey Auditory Verbal Learning Test (RAVLT) Verbal Forgetting percentage (VF%). Age, gender, and follow-up duration were covariates. Race was the effect modifier. Linear regression model was utilized to analyze the data. RESULTS Of all participants, 68 (4.1%) were Black, and the remaining were White, with a mean age of 75 years old. In the pooled sample, educational attainment did not show a significant association with memory, independent of confounders. Educational attainment showed a significant interaction with race on memory, with higher educational attainment having a different effect on memory in White patients compared to Black patients. CONCLUSION The effect of higher educational attainment on memory differs for Black patients with AD compared to White patients. To prevent cognitive disparities by race, we need to go beyond racial inequality in access to resources (e.g., education) and minimize diminished returns of educational attainment for racial minorities. To tackle health inequalities, social policies should not be limited to equalizing socioeconomic status but also help minority groups leverage their available resources, such as educational attainment, and secure tangible outcomes.
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Affiliation(s)
- Arash Rahmani
- Marginalized-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA, USA
| | - Babak Najand
- Marginalized-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA, USA
| | - Amanda Sonnega
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Golnoush Akhlaghipour
- Marginalized-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA, USA
| | - Mario F Mendez
- Department of Neurology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Shervin Assari
- Marginalized-Related Diminished Returns (MDRs) Research Center, Los Angeles, CA, USA.
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.
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25
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Denning JH, Horner MD. The impact of race and other demographic factors on the false positive rates of five embedded Performance Validity Tests (PVTs) in a Veteran sample. J Clin Exp Neuropsychol 2024; 46:25-35. [PMID: 38353039 DOI: 10.1080/13803395.2024.2314737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/11/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION It is common to use normative adjustments based on race to maintain accuracy when interpreting cognitive test results during neuropsychological assessment. However, embedded performance validity tests (PVTs) do not adjust for these racial differences and may result in elevated rates of false positives in African American/Black (AA) samples compared to European American/White (EA) samples. METHODS Veterans without Major Neurocognitive Disorder completed an outpatient neuropsychological assessment and were deemed to be performing in a valid manner (e.g., passing both the Test of Memory Malingering Trial 1 (TOMM1) and the Medical Symptom Validity Test (MSVT), (n = 531, EA = 473, AA = 58). Five embedded PVTs were administered to all patients: WAIS-III/IV Processing Speed Index (PSI), Brief Visuospatial Memory Test-Revised: Discrimination Index (BVMT-R), TMT-A (secs), California Verbal Learning Test-II (CVLT-II) Forced Choice, and WAIS-III/IV Digit Span Scaled Score. Individual PVT false positive rates, as well as the rate of failing two or more embedded PVTs, were calculated. RESULTS Failure rates of two embedded PVTs (PSI, TMT-A), and the total number of PVTs failed, were higher in the AA sample. The PSI and TMT-A remained significantly impacted by race after accounting for age, education, sex, and presence of Mild Neurocognitive Disorder. There were PVT failure rates greater than 10% (and considered false positives) in both groups (AA: PSI, TMT-A, and BVMT-R, 12-24%; EA: BVMT-R, 17%). Failing 2 or more PVTs (AA = 9%, EA = 4%) was impacted by education and Mild Neurocognitive Disorder but not by race. CONCLUSIONS Individual (timed) PVTs showed higher false positive rates in the AA sample even after accounting for demographic factors and diagnosis of Mild Neurocognitive Disorder. Requiring failure on 2 or more embedded PVTs reduced false positive rates to acceptable levels across both groups (10% or less) and was not significantly influenced by race.
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Affiliation(s)
- John H Denning
- Mental Health Service, Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Michael David Horner
- Mental Health Service, Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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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. 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. Alzheimers Dement 2024; 20:1137-1148. [PMID: 37897802 PMCID: PMC10916974 DOI: 10.1002/alz.13527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/02/2023] [Accepted: 10/06/2023] [Indexed: 10/30/2023]
Abstract
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.
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Affiliation(s)
- Mayra L. Estrella
- Department of EpidemiologyHuman Genetics and Environmental SciencesUniversity of Texas Health Sciences Center at Houston (UTHealth Houston) School of Public HealthBrownsvilleTexasUSA
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Wassim Tarraf
- Institute of Gerontology and Department of Healthcare SciencesWayne State UniversityDetroitMichiganUSA
| | - Sayaka Kuwayama
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Linda C. Gallo
- Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
| | - Benson Wu
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - María J. Marquine
- Departments of Medicine and PsychiatryDuke Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Krista M. Perreira
- Department of Social MedicineUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - Priscilla M. Vasquez
- Department of Urban Public HealthCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Carmen R. Isasi
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Richard B. Lipton
- Department of NeurologyAlbert Einstein College of MedicineNew YorkNew YorkUSA
| | - Josiemer Mattei
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Hector M. González
- Department of Neurosciences and Shiley‐Marcos Alzheimer's Disease Research CenterUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Martha L. Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Melissa Lamar
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral SciencesRush University Medical CenterChicagoIllinoisUSA
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Arias F, Dufour AB, Jones RN, Alegria M, Fong TG, Inouye SK. Social determinants of health and incident postoperative delirium: Exploring key relationships in the SAGES study. J Am Geriatr Soc 2024; 72:369-381. [PMID: 37933703 PMCID: PMC10922227 DOI: 10.1111/jgs.18662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Examining the associations of social determinants of health (SDOH) with postoperative delirium in older adults will broaden our understanding of this potentially devastating condition. We explored the association between SDOH factors and incident postoperative delirium. METHODS A retrospective study of a prospective cohort of patients enrolled from June 18, 2010, to August 8, 2013, across two academic medical centers in Boston, Massachusetts. Overall, 560 older adults age ≥70 years undergoing major elective non-cardiac surgery were included in this analysis. Exposure variables included income, lack of private insurance, and neighborhood disadvantage. Our main outcome was incident postoperative delirium, measured using the Confusion Assessment Method long form. RESULTS Older age (odds ratio, OR: 1.01, 95% confidence interval, CI: 1.00, 1.02), income <20,000 a year (OR: 1.12, 95% CI: 1.00, 1.26), lack of private insurance (OR: 1.19, 95% CI: 1.04, 1.38), higher depressive symptomatology (OR: 1.02, 95% CI: 1.01, 1.04), and the Area Deprivation Index (OR: 1.02, 95% CI: 1.01, 1.04) were significantly associated with increased risk of postoperative delirium in bivariable analyses. In a multivariable model, explaining 27% of the variance in postoperative delirium, significant independent variables were older age (OR 1.01, 95% CI 1.00, 1.02), lack of private insurance (OR 1.18, 95% CI 1.02, 1.36), and depressive symptoms (OR 1.02, 95% CI 1.00, 1.03). Household income was no longer a significant independent predictor of delirium in the multivariable model (OR:1.02, 95% CI: 0.90, 1.15). The type of medical insurance significantly mediated the association between household income and incident delirium. CONCLUSIONS Lack of private insurance, a social determinant of health reflecting socioeconomic status, emerged as a novel and important independent risk factor for delirium. Future efforts should consider targeting SDOH factors to prevent postoperative delirium in older adults.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32608, USA
| | - Alyssa B. Dufour
- Harvard Medical School, Boston, MA 02131, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, RI 02912, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA 02131, USA
- Department of Medicine and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02131, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, MA 02131, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA 02131, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02131, USA
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De Anda‐Duran I, Sunderaraman P, Searls E, Moukaled S, Jin X, Popp Z, Karjadi C, Hwang PH, Ding H, Devine S, Shih LC, Low S, Lin H, Kolachalama VB, Bazzano L, Libon DJ, Au R. Comparing Cognitive Tests and Smartphone-Based Assessment in 2 US Community-Based Cohorts. J Am Heart Assoc 2024; 13:e032733. [PMID: 38226519 PMCID: PMC10926794 DOI: 10.1161/jaha.123.032733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone-based cognitive assessments have emerged as promising tools, bridging gaps in accessibility and reducing bias in Alzheimer disease and related dementia research. However, their congruence with traditional neuropsychological tests and usefulness in diverse cohorts remain underexplored. METHODS AND RESULTS A total of 406 FHS (Framingham Heart Study) and 59 BHS (Bogalusa Heart Study) participants with traditional neuropsychological tests and digital assessments using the Defense Automated Neurocognitive Assessment (DANA) smartphone protocol were included. Regression models investigated associations between DANA task digital measures and a neuropsychological global cognitive Z score (Global Cognitive Score [GCS]), and neuropsychological domain-specific Z scores. FHS participants' mean age was 57 (SD, 9.75) years, and 44% (179) were men. BHS participants' mean age was 49 (4.4) years, and 28% (16) were men. Participants in both cohorts with the lowest neuropsychological performance (lowest quartile, GCS1) demonstrated lower DANA digital scores. In the FHS, GCS1 participants had slower average response times and decreased cognitive efficiency scores in all DANA tasks (P<0.05). In BHS, participants in GCS1 had slower average response times and decreased cognitive efficiency scores for DANA Code Substitution and Go/No-Go tasks, although this was not statistically significant. In both cohorts, GCS was significantly associated with DANA tasks, such that higher GCS correlated with faster average response times (P<0.05) and increased cognitive efficiency (all P<0.05) in the DANA Code Substitution task. CONCLUSIONS Our findings demonstrate that smartphone-based cognitive assessments exhibit concurrent validity with a composite measure of traditional neuropsychological tests. This supports the potential of using smartphone-based assessments in cognitive screening across diverse populations and the scalability of digital assessments to community-dwelling individuals.
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Affiliation(s)
- Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Preeti Sunderaraman
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Edward Searls
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Shirine Moukaled
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Xuanyi Jin
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Zachary Popp
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Cody Karjadi
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Huitong Ding
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Sherral Devine
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Spencer Low
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Honghuang Lin
- University of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Vijaya B. Kolachalama
- Department of MedicineBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Computer ScienceBoston UniversityBostonMAUSA
| | - Lydia Bazzano
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - David J. Libon
- Department of PsychologyRowan UniversityMullica HillNJUSA
- New Jersey Institute of Successful AgingRowan University School of Osteopathic MedicineStratfordNJUSA
| | - Rhoda Au
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
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Rosario MA, Alotaibi R, Espinal-Martinez AO, Ayoub A, Baumann A, Clark U, Cozier Y, Schon K. Personal Mastery Attenuates the Association between Greater Perceived Discrimination and Lower Amygdala and Anterior Hippocampal Volume in a Diverse Sample of Older Adults. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.12.575447. [PMID: 38293042 PMCID: PMC10827091 DOI: 10.1101/2024.01.12.575447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
There is limited research investigating whether perceived discrimination influences brain structures that subserve episodic memory, namely the hippocampus and amygdala. Our rationale for examining these regions build on their known sensitivity to stress and functional differences along the long-axis of the hippocampus, with the anterior hippocampus and amygdala implicated in emotional and stress regulation. We defined perceived discrimination as the unfair treatment of one group by a dominant social group without the agency to respond to the event. A potential moderator of perceived discrimination is personal mastery, which we operationally defined as personal agency. Our primary goals were to determine whether perceived discrimination correlated with amygdala and anterior hippocampal volume, and if personal mastery moderated these relationships. Using FreeSurfer 7.1.0, we processed T1-weighted images to extract bilateral amygdala and hippocampal volumes. Discrimination and personal mastery were assessed via self-report (using the Experiences of Discrimination and Sense of Control questionnaires, respectively). Using multiple regression, greater perceived discrimination correlated with lower bilateral amygdala and anterior hippocampal volume, controlling for current stress, sex, education, age, and intracranial volume. Exploratory subfield analyses showed these associations were localized to the anterior hippocampal CA1 and subiculum. As predicted, using a moderation analysis, personal mastery attenuated the relationship between perceived discrimination and amygdala and anterior hippocampal volume. Here, we extend our knowledge on perceived discrimination as a salient psychosocial stressor with a neurobiological impact on brain systems implicated in stress, memory, and emotional regulation, and provide evidence for personal mastery as a moderating factor of these relationships.
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Affiliation(s)
- Michael A Rosario
- Graduate Program for Neuroscience, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, MA 02118, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
- Center for Systems Neuroscience, Boston University, 610 Commonwealth Avenue, 7 Floor, Boston, MA 02215, USA
| | - Razan Alotaibi
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
- Center for Systems Neuroscience, Boston University, 610 Commonwealth Avenue, 7 Floor, Boston, MA 02215, USA
| | - Alan O Espinal-Martinez
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Amara Ayoub
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
| | - Aletha Baumann
- Department of Psychology, University of the Virgin Islands, RR02 Box 10000, St. Croix, USVI 00823, USA
| | - Uraina Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yvette Cozier
- Slone Epidemiology Center, Boston University, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Karin Schon
- Graduate Program for Neuroscience, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, MA 02118, USA
- Department of Anatomy & Neurobiology, Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
- Center for Systems Neuroscience, Boston University, 610 Commonwealth Avenue, 7 Floor, Boston, MA 02215, USA
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Parrilla MM, Kautiainen RJ, King TZ. Sleep quality and executive function in a diverse sample of healthy young adults. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-9. [PMID: 38170836 DOI: 10.1080/23279095.2023.2297299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Few studies examine the relationship between sleep and executive function in diverse samples of young adults. Our research aims to fill this gap by analyzing how self-reported sleep quality is related to informant-rated executive function as a whole and its working memory component in a diverse sample of 29 healthy college students. Using the self-report measure, the Pittsburgh Sleep Quality Index (PSQI), we divided our sample into two groups based on cutoff criteria (score ≥5: poor sleep): good sleep quality (n = 11) and poor sleep quality (n = 18). Participants were on average 20.86 years old. Informants rated participants' executive functioning and working memory using the Frontal Systems Behavior Scale (FrSBe) and Behavior Rating Inventory of Executive Function (BRIEF). Individuals in the poor sleep quality group were reported as having significantly worse executive function and working memory scores. Young adult college students who report less than 7 hours of sleep per night have lower scores on informant measures of working memory and executive function. This study raises awareness about how self-reported sleep experiences are related to other's observation of cognitive abilities in everyday life in a diverse young adult sample.
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Affiliation(s)
- Maria M Parrilla
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
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Guduguntla BA, Vasbinder A, Anderson E, Azam TU, Blakely P, Webster NJ, Gonzalez R, Atonucci T, Heidebrink JL, Giordani B, Zahodne L, Hampstead BM, Ajrouch KJ, Hayek SS. Biomarkers of chronic inflammation and cognitive decline: A prospective observational study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12568. [PMID: 38532827 PMCID: PMC10964918 DOI: 10.1002/dad2.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
We sought to determine whether the biomarkers of chronic inflammation predict cognitive decline in a prospective observational study. We measured baseline serum soluble urokinase plasminogen activator receptor (suPAR) and high sensitivity C-reactive protein (hs-CRP) levels in 282 participants of the University of Michigan Memory and Aging Project. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and the Clinical Dementia Rating (CDR) scale for up to five time points. SuPAR and hs-CRP levels were not significantly higher in participants with mild cognitive impairment (n = 97) or dementia (n = 59), compared to those with normal cognitive function (n = 126). Overall, 14% of participants experienced significant cognitive decline over the study period. The change in MoCA or CDR scores over time did not differ significantly according to baseline suPAR or hs-CRP levels. Chronic systemic inflammation, as measured by serum suPAR or hs-CRP levels, is unlikely to contribute significantly to cognitive decline.
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Affiliation(s)
| | - Alexi Vasbinder
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Elizabeth Anderson
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Tariq U. Azam
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Pennelope Blakely
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Noah J. Webster
- Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
| | - Richard Gonzalez
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Toni Atonucci
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | | | - Bruno Giordani
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
- Department of NeurologyUniversity of MichiganAnn ArborMichiganUSA
- Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
| | - Laura Zahodne
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Benjamin M. Hampstead
- Department of PsychiatryUniversity of MichiganAnn ArborMichiganUSA
- Mental Health Service Line, Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Kristine J. Ajrouch
- Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
- Eastern Michigan UniversityYpsilantiMichiganUSA
| | - Salim S. Hayek
- Division of CardiologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
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Fazeli PL, Hopkins C, Vance DE, Wadley V, Li P, Turan B, Wang DH, Bowen PG, Clay OJ. Cognitive prescriptions for reducing dementia risk factors among Black/African Americans: feasibility, acceptability, and preliminary efficacy. ETHNICITY & HEALTH 2024; 29:1-24. [PMID: 37463839 PMCID: PMC11232533 DOI: 10.1080/13557858.2023.2231669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Black/African Americans (B/AAs) have double the risk of Alzheimer's disease and related dementia than Whites, which is largely driven by health behaviors. This study examined the feasibility, acceptability, and preliminary efficacy of a pilot randomized clinical trial of an individualized multidomain health behavior intervention among middle-aged and older B/AAs (dubbed Cognitive Prescriptions [CogRx]). DESIGN Thirty-nine community-dwelling B/AA participants aged 45-65 without significant cognitive impairment were randomized to one of three groups: CogRx, Psychoeducation, or no-contact control. The Psychoeducation and CogRx groups received material on dementia prevalence, prognosis, and risk factors, while the CogRx group additionally received information on their risk factor profile across the five CogRx domains (physical, cognitive, and social activity, diet, sleep). This information was used for developing tailored 3-month goals in their suboptimal areas. RESULTS The CogRx program had high retention (all 13 CogRx participants completed the 3-month program and 97% of the full sample completed at least 1 follow-up) and was well-received as exhibited by qualitative and quantitative feedback. Themes identified in the positive feedback provided by participants on the program included: increased knowledge, goal-setting, personalization, and motivation. The COVID-19 pandemic was a consistent theme that emerged regarding barriers of adherence to the program. All three groups improved on dementia knowledge, with the largest effects observed in CogRx and Psychoeducation groups. Increases in cognitive, physical, and overall leisure activities favored the CogRx group, whereas improvements in sleep outcomes favored Psychoeducation and CogRx groups as compared to the control group. CONCLUSION The CogRx program demonstrated feasibility, acceptability, and preliminary efficacy in increasing dementia knowledge and targeted health behaviors. Further refinement and testing of the implementation and effectiveness of similar person-centered dementia prevention approaches are needed on a larger scale in diverse populations. Such findings may have implications for clinical and public health recommendations. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03864536.
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Affiliation(s)
- Pariya L. Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cierra Hopkins
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia Wadley
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Danny H. Wang
- College of Health and Human Development, The Pennsylvania State University, State College, PA, USA
| | - Pamela G. Bowen
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olivio J. Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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Jiang X, Bahorik AL, Graff-Radford NR, Yaffe K. Association of Plasma Amyloid-β and Dementia Among Black and White Older Adults. J Alzheimers Dis 2024; 99:787-797. [PMID: 38701147 DOI: 10.3233/jad-240007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Plasma amyloid-β (Aβ) has emerged as an important tool to detect risks of Alzheimer's disease and related dementias, although research in diverse populations is lacking. Objective We compared plasma Aβ42/40 by race with dementia risk over 15 years among Black and White older adults. Methods In a prospective cohort of 997 dementia-free participants (mean age 74±2.9 years, 55% women, 54% Black), incident dementia was identified based on hospital records, medication, and neurocognitive test over 15 years. Plasma Aβ42/40 was measured at Year 2 and categorized into low, medium, and high tertile. We used linear regression to estimate mean Aβ42/40 by race and race-stratified Cox proportional hazards models to assess the association between Aβ42/40 tertile and dementia risk. Results Black participants had a lower age-adjusted mean Aβ 42/40 compared to White participants, primarily among APOE ɛ4 non-carriers (Black: 0.176, White: 0.185, p = 0.035). Among Black participants, lower Aβ 42/40 was associated with increased dementia risk: 33% in low (hazard ratios [HR] = 1.77, 95% confidence interval 1.09-2.88) and 27% in medium tertile (HR = 1.67, 1.01-2.78) compared with 18% in high Aβ 42/40 tertile; Increased risks were attenuated among White participants: 21% in low (HR = 1.43, 0.81-2.53) and 23% in medium tertile (HR = 1.27, 0.68-2.36) compared with 15% in high Aβ 42/40 tertile. The interaction by race was not statistically significant. Conclusions Among community-dwelling, non-demented older adults, especially APOE ɛ4 non-carriers, Black individuals had lower plasma Aβ 42/40 and demonstrated a higher dementia risk with low Aβ42/40 compared with White individuals.
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Affiliation(s)
- Xiaqing Jiang
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Amber L Bahorik
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, CA, USA
- San Francisco VA Health Care System, San Francisco, CA, USA
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Li C, Stebbins RC, Noppert GA, Carney CX, Liu C, Sapp ARM, Watson EJ, Aiello AE. Peripheral immune function and Alzheimer's disease: a living systematic review and critical appraisal. Mol Psychiatry 2023:10.1038/s41380-023-02355-x. [PMID: 38102484 DOI: 10.1038/s41380-023-02355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND A growing body of literature examines the relationship between peripheral immune function and Alzheimer's Disease (AD) in human populations. Our living systematic review summarizes the characteristics and findings of these studies, appraises their quality, and formulates recommendations for future research. METHODS We searched the electronic databases PubMed, PsycINFO, and Web of Science, and reviewed references of previous reviews and meta-analyses to identify human studies examining the relationship between any peripheral immune biomarkers and AD up to September 7th, 2023. We examined patterns of reported statistical associations (positive, negative, and null) between each biomarker and AD across studies. Evidence for each biomarker was categorized into four groups based on the proportion of studies reporting different associations: corroborating a positive association with AD, a negative association, a null association, and presenting contradictory findings. A modified Newcastle-Ottawa scale (NOS) was employed to assess the quality of the included studies. FINDINGS In total, 286 studies were included in this review. The majority were cross-sectional (n = 245, 85.7%) and hospital-based (n = 248, 86.7%), examining relationships between 187 different peripheral immune biomarkers and AD. Cytokines were the most frequently studied group of peripheral immune biomarkers. Evidence supported a positive association with AD for six biomarkers, including IL-6, IL-1β, IFN-γ, ACT, IL-18, and IL-12, and a negative association for two biomarkers, including lymphocytes and IL-6R. Only a small proportion of included studies (n = 22, 7.7%) were deemed to be of high quality based on quality assessment. INTERPRETATION Existing research on peripheral immune function and AD exhibits substantial methodological variations and limitations, with a notable lack of longitudinal, population-based studies investigating a broad range of biomarkers with prospective AD outcomes. The extent and manner in which peripheral immune function can contribute to AD pathophysiology remain open questions. Given the biomarkers that we identified to be associated with AD, we posit that targeting peripheral immune dysregulation may present a promising intervention point to reduce the burden of AD.
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Affiliation(s)
- Chihua Li
- Social Environment and Health Program, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Rebecca C Stebbins
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Grace A Noppert
- Social Environment and Health Program, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Constanza X Carney
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Chunyu Liu
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ashley R M Sapp
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elijah J Watson
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Allison E Aiello
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York City, NY, USA
- Department of Epidemiology, Mailman School of Public, Columbia University, New York City, NY, USA
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Troxel WM, Madrigano J, Haas AC, Dubowitz T, Rosso AL, Prather AA, Ghosh-Dastidar M, Weinstein AM, Butters MA, Presto A, Gary-Webb TL. Examining the Cross-sectional Association Between Neighborhood Conditions, Discrimination, and Telomere Length in a Predominantly African American Sample. J Racial Ethn Health Disparities 2023; 10:3159-3167. [PMID: 36607563 PMCID: PMC10323042 DOI: 10.1007/s40615-022-01490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/19/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
Disproportionate exposure to adverse neighborhood conditions and greater discrimination may contribute to health disparities among African Americans (AAs). We examined whether adverse neighborhood conditions, alone or in conjunction with discrimination, associate with shorter leukocyte telomere length among a predominantly AA cohort. The sample included 200 residents from two low-income neighborhoods (96% AA; mean age = 67 years). Perceived neighborhood conditions and discrimination were surveyed in 2018, and objective neighborhood conditions (total crime rate, neighborhood walkability, ambient air pollution (PM2.5, black carbon)) were collected in 2017/2018. Relative telomere length (T/S; ratio of telomeric DNA to a single-gene copy) was assessed from blood samples. Linear regression models estimated the main effects of each neighborhood condition and discrimination and their interactions on the T/S ratio. Less walkable neighborhoods were associated with shorter telomeres. Higher air pollution (PM2.5) was associated with shorter telomeres among those experiencing greater discrimination. Findings highlight the importance of understanding the intersecting influences of historic and contemporary sources of systemic racism and how they contribute to accelerated aging among adults.
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Affiliation(s)
- Wendy M Troxel
- Social and Economic Well-Being Division, RAND Corporation, Pittsburgh, PA, 15213, USA.
| | - Jaime Madrigano
- Social and Economic Well-Being Division, RAND Corporation, Arlington, VA, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ann C Haas
- Social and Economic Well-Being Division, RAND Corporation, Pittsburgh, PA, 15213, USA
| | - Tamara Dubowitz
- Social and Economic Well-Being Division, RAND Corporation, Pittsburgh, PA, 15213, USA
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aric A Prather
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Andrea M Weinstein
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Meryl A Butters
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albert Presto
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tiffany L Gary-Webb
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Yahirun J, Vasireddy S, Hayward M. Black-White Differences in Offspring Educational Attainment and Older Parents' Dementia. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:503-519. [PMID: 37265201 PMCID: PMC10692310 DOI: 10.1177/00221465231168910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Jenjira Yahirun
- Dept. of Sociology and Center for Family and Demographic Research, Bowling Green State University, USA
| | | | - Mark Hayward
- Dept. of Sociology and Population Research Center, University of Texas-Austin, USA
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Filigrana P, Moon JY, Gallo LC, Fernández-Rhodes L, Perreira KM, Daviglus ML, Thyagarajan B, Garcia-Bedoya OL, Cai J, Lipton RB, Kaplan RC, Gonzalez HM, Isasi CR. Childhood and Life-Course Socioeconomic Position and Cognitive Function in the Adult Population of the Hispanic Community Health Study/Study of Latinos. Am J Epidemiol 2023; 192:2006-2017. [PMID: 37420108 PMCID: PMC10988221 DOI: 10.1093/aje/kwad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023] Open
Abstract
The Hispanic/Latino population experiences socioeconomic adversities across the lifespan and is at greater risk of cognitive impairment, yet little is known about the role of life-course socioeconomic position (SEP) in cognitive function in this population. Using baseline data (2008-2011) from adults (aged 45-74 years) of the Hispanic Community Health Study/Study of Latinos, we assessed the association between childhood SEP and socioeconomic mobility with cognitive function, and whether this association was mediated by midlife SEP. Childhood SEP was assessed using parental education. An index combining participants' education and household income represented midlife SEP. Socioeconomic mobility was categorized as stable low, downward or upward mobility, and stable high-SEP. Cognitive function measures were modeled using survey linear regression with inverse-probability weighting, accounting for covariates. We used mediation analysis to estimate the indirect effect of childhood SEP on cognition through midlife SEP. High childhood SEP was associated with global cognition in adulthood (coefficient for parental education beyond high school vs. less than high school = 0.26, 95% confidence interval: 0.15, 0.37). This association was partially mediated through midlife SEP (indirect effect coefficient = 0.16, 95% confidence interval: 0.15, 0.18). Low SEP through the life course was associated with the lowest cognitive function. This study provides evidence that life-course SEP influences cognitive performance in adulthood.
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Affiliation(s)
- Paola Filigrana
- Correspondence to Dr. Paola Filigrana, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building-Room 1308, Bronx, NY 10461 (e-mail: )
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Lor Y, George KM, Gilsanz P, Meunier CC, Peterson RL, Hayes-Larson E, Barnes LL, Mungas D, Whitmer RA. What is the association between adverse childhood experiences and late-life cognitive decline? Study of Healthy Aging in African Americans (STAR) cohort study. BMJ Open 2023; 13:e072961. [PMID: 37918928 PMCID: PMC10626853 DOI: 10.1136/bmjopen-2023-072961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are associated with higher risk of chronic disease, but little is known about the association with late life cognitive decline. We examined the longitudinal association between ACEs and late-life cognitive decline in the Study of Healthy Aging in African Americans (STAR). DESIGN Linear mixed models with random intercepts and slope examined the association of individual and composite ACEs with cognitive change adjusting for years from baseline (timescale), baseline age, sex, parental education, childhood socioeconomic status and childhood social support. Participants reported whether they had experienced nine types of ACEs. Executive function and verbal episodic memory were measured up to three times over a 3-year period using the Spanish and English Neuropsychological Assessment Scales. SETTINGS Kaiser Permanente Northern California members living in the Bay Area. PARTICIPANTS STAR is a cohort study of cognitive ageing launched in 2018 that has enrolled 764 black Americans ages ≥50 years (mean age=67.5; SD=8.5). RESULTS Twenty-one per cent of participants reported no ACEs, 24% one ACE, 20% two ACEs, 17% three ACEs and 17% four or more ACEs. Compared with no ACEs, two ACEs (β=0.117; 95% CI 0.052 to 0.182), three ACEs (β=0.075; 95% CI 0.007 to 0.143) and four or more ACEs (β=0.089; 95% CI 0.002 to 0.158) were associated with less decline in executive function. There were no significant associations between number of ACEs and baseline or longitudinal verbal episodic memory or between individual ACEs and executive function or verbal episodic memory. CONCLUSION In this cohort of older black Americans, there was no association between ACEs and baseline cognition or cognitive change in verbal episodic memory; however, experiencing ≥ 2 ACEs was associated with less decline in executive function. These results may indicate that participants who survived to age 50+ and experienced ACEs may have cognitive resilience that warrants further investigation.
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Affiliation(s)
- Yi Lor
- Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Kristen M George
- Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Claire C Meunier
- Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Rachel L Peterson
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Eleanor Hayes-Larson
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, California, USA
| | - Lisa L Barnes
- Department of Neurological Sciences, Rush University, Chicago, Illinois, USA
| | - Dan Mungas
- Department of Neurology, University of California Davis, Sacramento, California, USA
| | - Rachel A Whitmer
- Department of Public Health Sciences, University of California Davis, Davis, California, USA
- Department of Neurology, University of California Davis, Sacramento, California, USA
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Hicken MT, Dou J, Kershaw KN, Liu Y, Hajat A, Bakulski KM. Racial and Ethnic Residential Segregation and Monocyte DNA Methylation Age Acceleration. JAMA Netw Open 2023; 6:e2344722. [PMID: 38019517 PMCID: PMC10687663 DOI: 10.1001/jamanetworkopen.2023.44722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/12/2023] [Indexed: 11/30/2023] Open
Abstract
Importance Neighborhood segregation and poverty may be important drivers of health inequities. Epigenomic factors, including DNA methylation clocks that may mark underlying biological aging, have been implicated in the link between social factors and health. Objective To examine the associations of neighborhood segregation and poverty with 4 DNA methylation clocks trained to capture either chronological age or physiological dysregulation. Design, Setting, and Participants This cohort study uses data from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study that started in 2000 to 2002, with follow-up in 2002 to 2004, 2004 to 2005, 2005 to 2007, and 2010 to 2012. In 2000 to 2002, adults who identified as White or Black race or Hispanic or Chinese ethnicity in 6 US sites (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St. Paul, Minnesota) were sampled for recruitment. A random subsample of 4 sites (Maryland, North Carolina, New York, and Minnesota) were selected for inclusion in the MESA epigenomics ancillary study at examination 5 (2010-2012). Participants who identified as White or Black race or Hispanic ethnicity, were aged 45 to 84 years, and did not have clinical cardiovascular disease were included in this analysis. Data were analyzed from May 2021 to October 2023. Exposure Information on 2000 census tract poverty and Getis-Ord G statistic segregation of Hispanic residents, non-Hispanic Black residents, or non-Hispanic White residents were linked to participant addresses at examination 1 (2000-2002). Main Outcomes and Measures At examination 5, DNA methylation was measured in purified monocytes. DNA methylation age acceleration was calculated using 4 clocks trained on either chronological age or physiological dysregulation. Linear regressions were used to test associations. Results A total of 1102 participants (mean [SD] age, 69.7 [9.4] years; 562 [51%] women) were included, with 348 Hispanic participants, 222 non-Hispanic Black participants, and 533 non-Hispanic White participants. For non-Hispanic Black participants, living in tracts with greater segregation of Black residents was associated with GrimAge DNA methylation age acceleration, a clock designed to capture physiological dysregulation. A 1-SD increase in segregation was associated with 0.42 (95% CI, 0.20-0.64) years age acceleration (P < .001); this association was not observed with other clocks. This association was particularly pronounced for participants living in high poverty tracts (interaction term, 0.24; 95% CI, 0.07-0.42; P = .006). In the overall sample, census tract poverty level was associated with GrimAge DNA methylation age acceleration (β = 0.45; 95% CI, 0.20-0.71; adjusted P = .005). Conclusions and Relevance These findings suggest that epigenomic mechanisms may play a role in the associations of segregated and poor neighborhoods with chronic conditions.
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Affiliation(s)
| | - John Dou
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Yongmei Liu
- Department of Medicine, Duke University, Durham, North Carolina
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle
| | - Kelly M. Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
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Belsky DW, Baccarelli AA. To promote healthy aging, focus on the environment. NATURE AGING 2023; 3:1334-1344. [PMID: 37946045 DOI: 10.1038/s43587-023-00518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
To build health equity for an aging world marked by dramatic disparities in healthy lifespan between countries, regions and population groups, research at the intersections of biology, toxicology and the social and behavioral sciences points the way: to promote healthy aging, focus on the environment. In this Perspective, we suggest that ideas and tools from the emerging field of geroscience offer opportunities to advance the environmental science of aging. Specifically, the capacity to measure the pace and progress of biological processes of aging within individuals from relatively young ages makes it possible to study how changing environments can change aging trajectories from early in life, in time to prevent or delay aging-related disease and disability and build aging health equity.
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Affiliation(s)
- Daniel W Belsky
- Robert N. Butler Columbia Aging Center and Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
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Jones JD, Uribe-Kirby R, Rivas R, Cuellar-Rocha P, Valenzuela Y, Luna K, Dashtipour K, Santos M. Mental health disparities and the role of perceived discrimination among Latinx individuals living with Parkinson's disease. Parkinsonism Relat Disord 2023; 116:105867. [PMID: 37802014 PMCID: PMC10789178 DOI: 10.1016/j.parkreldis.2023.105867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/01/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative disorder with motor and non-motor symptoms including depression and cognitive impairment. There is underrepresentation of Latinxs in PD research as most of the research consists of non-Latinx white participants. The current study investigates longitudinal differences in health disparities among Latinx and White non-Latinx individuals living with PD. As a second aim, we examined the associations between perceived discrimination in healthcare and outcomes from aim 1. METHODS The present study consisted of 25,298 individuals with PD who enrolled in the Fox Insight (FI) online study. Participants were followed annually for up to 3 years. Participants completed measures of depressive symptoms, health-related quality of life (HRQOL), cognitive complaints, subjective motor symptom severity, self-reported income, and perceived discrimination in healthcare. Multilevel models examined the longitudinal differences in non-motor and motor outcomes among Latinx (n = 1161) and White non-Latinx individuals (n = 24,137). RESULTS Latinx participants reported significantly more depressive symptoms and worse HRQOL than non-Latinx individuals. No significant differences were found in cognitive complaints, or motor severity between Latinx and non-Latinx participants. The main effect of perceived discrimination was associated with both depressive symptoms and HRQOL. CONCLUSIONS The current study provides initial evidence of mental health discrepancies among Latinx individuals living with PD and White non-Latinx counterparts. The combination of underrepresentation in research and possible health disparities among Latinx communities may affect the quality of clinical trials/studies and patient care.
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Affiliation(s)
- Jacob D Jones
- Department of Psychology, California State University San Bernardino, San Bernardino, CA, USA; Center on Aging, California State University San Bernardino, San Bernardino, CA, USA.
| | - Ruth Uribe-Kirby
- Department of Psychology, California State University San Bernardino, San Bernardino, CA, USA
| | - Rhiannon Rivas
- Department of Psychology, California State University San Bernardino, San Bernardino, CA, USA
| | - Priscilla Cuellar-Rocha
- Department of Psychology, California State University San Bernardino, San Bernardino, CA, USA
| | - Yenny Valenzuela
- Department of Psychology, California State University San Bernardino, San Bernardino, CA, USA
| | - Kenya Luna
- Department of Psychology, California State University San Bernardino, San Bernardino, CA, USA
| | - Khashayar Dashtipour
- Department of Neurology, Division of Movement Disorders, Loma Linda University Health System, Loma Linda, CA, USA
| | - Maria Santos
- Department of Psychology, California State University San Bernardino, San Bernardino, CA, USA
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Choi EY, Lee H, Chang VW. Cumulative exposure to extreme heat and trajectories of cognitive decline among older adults in the USA. J Epidemiol Community Health 2023; 77:728-735. [PMID: 37541774 DOI: 10.1136/jech-2023-220675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The projected increase in extreme heat days is a growing public health concern. While exposure to extreme heat has been shown to negatively affect mortality and physical health, very little is known about its long-term consequences for late-life cognitive function. We examined whether extreme heat exposure is associated with cognitive decline among older adults and whether this association differs by race/ethnicity and neighbourhood socioeconomic status. METHODS Data were drawn from seven waves of the Health and Retirement Study (2006-2018) merged with historical temperature data. We used growth curve models to assess the role of extreme heat exposure on trajectories of cognitive function among US adults aged 52 years and older. RESULTS We found that high exposure to extreme heat was associated with faster cognitive decline for blacks and residents of poor neighbourhoods, but not for whites, Hispanics or residents of wealthier neighbourhoods. CONCLUSION Extreme heat exposure can disproportionately undermine cognitive health in later life for socially vulnerable populations. Our findings underscore the need for policy actions to identify and support high-risk communities for increasingly warming temperatures.
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Affiliation(s)
- Eun Young Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Haena Lee
- Department of Sociology, Sungkyunkwan University, Seoul, Korea (the Republic of)
| | - Virginia W Chang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
- Department of Population Health, Grossman School of Medicine, New York University, New York, New York, USA
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Lin Z, Chen X. Place of Birth and Cognition among Older Americans: Findings from the Harmonized Cognitive Assessment Protocol. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.12.23296954. [PMID: 37873447 PMCID: PMC10593039 DOI: 10.1101/2023.10.12.23296954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objectives Growing evidence suggests that place of birth (PoB) and related circumstances may have long-lasting and multiplicative contributions to various later-life outcomes. However, the specific contributions to different domains of cognitive function in late life remain less understood. This study aimed to investigate the extent to which PoB contribute to a wide range of later-life cognitive outcomes. Methods A nationally representative sample of Americans aged 65 and older (N=3,216) from the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) was utilized. Cognitive outcomes were assessed in HCAP and linked to HRS state-level PoB data to explore the contribution of birthplace to later-life cognitive disparities. Regression-based Shapley decompositions were employed to quantify this contribution. Results PoB significantly contributed to all assessed cognitive outcomes including memory, executive function, language and fluency, visuospatial function, orientation, global cognitive performance, cognitive impairment and dementia. Geographic disparities in cognitive outcomes were evident, with individuals born in US southern states and foreign-born individuals performing worse than those born in other states. PoB overall accounted for 2.4-13.9% of the total variance in cognition after adjusting for age and sex. This contribution reduced by half when adjusting for a rich set of sociodemographic and health factors over the life course, but PoB still independently explained 2.0-7.1% of the total variance in cognition. Discussion PoB has lasting contributions to later-life cognitive health, with significant geographic disparities observed. Addressing these disparities requires promoting more equalized place-based policies, resources, and early-life environments to improve health equities over the life course.
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Affiliation(s)
- Zhuoer Lin
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Department of Economics, Yale University, New Haven, CT, USA
- Alzheimer’s Disease Research Center, New Haven, CT, USA
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Yannatos I, Stites SD, Boen C, Xie SX, Brown RT, McMillan CT. Epigenetic age and socioeconomic status contribute to racial disparities in cognitive and functional aging between Black and White older Americans. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.29.23296351. [PMID: 37873230 PMCID: PMC10592997 DOI: 10.1101/2023.09.29.23296351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Epigenetic age, a biological aging marker measured by DNA methylation, is a potential mechanism by which social factors drive disparities in age-related health. Epigenetic age gap is the residual between epigenetic age measures and chronological age. Previous studies showed associations between epigenetic age gap and age-related outcomes including cognitive capacity and performance on some functional measures, but whether epigenetic age gap contributes to disparities in these outcomes is unknown. We use data from the Health and Retirement Study to examine the role of epigenetic age gap in racial disparities in cognitive and functional outcomes and consider the role of socioeconomic status (SES). Epigenetic age measures are GrimAge or Dunedin Pace of Aging methylation (DPoAm). Cognitive outcomes are cross-sectional score and two-year change in Telephone Interview for Cognitive Status (TICS). Functional outcomes are prevalence and incidence of limitations performing Instrumental Activities of Daily Living (IADLs). We find, relative to White participants, Black participants have lower scores and greater decline in TICS, higher prevalence and incidence rates of IADL limitations, and higher epigenetic age gap. Age- and gender-adjusted analyses reveal that higher GrimAge and DPoAm gap are both associated with worse cognitive and functional outcomes and mediate 6-11% of racial disparities in cognitive outcomes and 19-39% of disparities in functional outcomes. Adjusting for SES attenuates most DPoAm associations and most mediation effects. These results support that epigenetic age gap contributes to racial disparities in cognition and functioning and may be an important mechanism linking social factors to disparities in health outcomes.
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Affiliation(s)
- Isabel Yannatos
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - Shana D. Stites
- Department of Psychiatry, Perelman School of Medicine, Philadelphia, USA
| | - Courtney Boen
- Department of Sociology, University of Pennsylvania, Philadelphia, USA
| | - Sharon X. Xie
- Deptartment of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA
| | - Rebecca T. Brown
- Division of Geriatric Medicine, Perelman School of Medicine, Philadelphia, USA
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Corey T. McMillan
- Department of Neurology, University of Pennsylvania, Philadelphia, USA
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Sharma S, Hale JM, Myrskylä M, Kulu H. Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016. Demography 2023; 60:1441-1468. [PMID: 37638648 DOI: 10.1215/00703370-10941414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.
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Affiliation(s)
- Shubhankar Sharma
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of St Andrews, St Andrews, Scotland
- University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland, and Rostock, Germany
| | - Jo Mhairi Hale
- University of St Andrews, St Andrews, Scotland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland, and Rostock, Germany
| | - Hill Kulu
- University of St Andrews, St Andrews, Scotland
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Weiss J, Beydoun MA, Beydoun HA, Fanelli-Kuczmarski MT, Banerjee S, Hamrah A, Evans MK, Zonderman AB. Pathways explaining racial/ethnic disparities in incident all-cause dementia among middle-aged US adults. Alzheimers Dement 2023; 19:4299-4310. [PMID: 36868873 PMCID: PMC10475144 DOI: 10.1002/alz.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/16/2022] [Accepted: 01/13/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Racial disparities in dementia incidence exist, but less is known about their presence and drivers among middle-aged adults. METHODS We used time-to-event analysis among a sample of 4378 respondents (age 40-59 years at baseline) drawn from the third National Health and Nutrition Examination Surveys (NHANES III) with administrative linkage-spanning the years 1988-2014-to evaluate potential mediating pathways through socioeconomic status (SES), lifestyle, and health-related characteristics. RESULTS Compared with Non-Hispanic White (NHW) adults, Non-White adults had a higher incidence of AD-specific (hazard ratio [HR] = 2.05, 95% confidence interval [CI]: 1.21, 3.49) and all-cause dementia (HR = 2.01, 95% CI: 1.36, 2.98). Diet, smoking, and physical activity were among characteristics on the pathway between race/ethnicity, SES, and dementia, with health-mediating effects of smoking and physical activity on dementia risk. DISCUSSION We identified several pathways that may generate racial disparities in incident all-cause dementia among middle-aged adults. No direct effect of race was observed. More studies are needed to corroborate our findings in comparable populations.
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Affiliation(s)
- Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, USA
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Hind A. Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Marie T. Fanelli-Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Sri Banerjee
- Public Health Doctoral Programs, Walden University, Minneapolis, MN, USA
| | | | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
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Adkins-Jackson PB, Kraal AZ, Hill-Jarrett TG, George KM, Deters KD, Besser LM, Avila-Rieger JF, Turney I, Manly JJ. Riding the merry-go-round of racial disparities in ADRD research. Alzheimers Dement 2023; 19:4735-4742. [PMID: 37394968 DOI: 10.1002/alz.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION With the rapid expansion of the aging population, the burden of Alzheimer's disease related dementias (ADRD) is anticipated to increase in racialized and minoritized groups who are at disproportionately higher risk. To date, research emphasis has been on further characterizing the existence of racial disparities in ADRD through comparisons to groups racialized as White that are assumed to be normative. Much of the literature on this comparison insinuates that racialized and minoritized groups experience poorer outcomes due to genetics, culture, and/or health behaviors. METHODS This perspective shines a light on a category of ADRD research that employs ahistorical methodological approaches to describe racial disparities in ADRD that puts us on a merry-go-round of research with no benefits to society. METHODS This commentary provides historical context for the use of race in ADRD research and justification for the study of structural racism. The commentary concludes with recommendations to guide future research.
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Affiliation(s)
- Paris B Adkins-Jackson
- Departments of Epidemiology & Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - A Zarina Kraal
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Tanisha G Hill-Jarrett
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Kristen M George
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, California, USA
| | - Kacie D Deters
- Department of Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, California, USA
| | - Lilah M Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Justina F Avila-Rieger
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Indira Turney
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Thomas Tobin CS, Huynh J, Farmer HR, Israel Cross R, Barve A, Robinson M, Leslie EP, Thorpe RJ. Perceived Neighborhood Racial Composition and Depressive Symptoms Among Black Americans Across Adulthood: Evaluating the Role of Psychosocial Risks and Resources. J Aging Health 2023; 35:660-676. [PMID: 35657773 PMCID: PMC10478356 DOI: 10.1177/08982643221100789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To evaluate the relationships between perceived neighborhood racial composition (PNRC), psychosocial risks and resources, and depressive symptoms among young (ages 22-35), middle-aged (ages 36-49), and older (ages 50+) Black Americans. Methods: Full sample and age-stratified linear regression models estimated the PNRC-depressive symptoms association and the extent to which it persisted after accounting for psychosocial risks (i.e., neighborhood disorder, other social stressors) and resources (i.e., mastery, social support, racial identity) among 627 Black Americans in the Nashville Stress and Health Study. Results: Living in racially integrated and predominately White neighborhoods was associated with elevated depressive symptoms. While psychosocial risks and resources explained a substantial portion of these associations, patterns varied across age groups. Discussion: PNRC impacts depressive symptoms among Black Americans by shaping psychosocial risks and resources. Findings underscore interconnections between contextual and psychosocial factors, as well as the distinct mental health significance of these processes across stages of adulthood.
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Affiliation(s)
| | - James Huynh
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
| | - Heather R. Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Rebekah Israel Cross
- Department of Health Behavior/ Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Apurva Barve
- Department of Community Health Sciences, University of California, Los Angeles, CA, USA
| | - Millicent Robinson
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Roland J. Thorpe
- Program for Research on Men’s Health, Hopkins Center for Health Disparities Solutions, Baltimore, MD, USA
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49
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Thorpe RJ, Huang A, Smail E, Clay OJ, Dean L, Aiken-Morgan A, Gellert A, Rebok GW. The Relationship Between Cognition and Mortality Among Older Black and White Men in Advanced Cognitive Training for Independent and Vital Elderly. J Aging Health 2023; 35:119S-125S. [PMID: 36148805 DOI: 10.1177/08982643221128906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the association between baseline cognition and all-cause mortality among Black men and White men. Methods: Data were from 614 Black and White men aged ≥65 years at baseline in the Advanced Cognitive Training for Independent and Vital Elderly trial and their linked mortality information. Cox proportional hazards models were used to determine the association between baseline cognition (memory, reasoning, speed of processing, Mini Mental State Exam) and mortality risk over 20 years, adjusting for covariates. Results: Among White men, higher performance on the memory composite measure was associated with a decreased risk of all-cause mortality (HR: 0.93; 95% CI: 0.89-0.98), whereas the other cognitive measures were not associated with all-cause mortality risk. Among Black men, none of the cognitive measures was associated with all-cause mortality risk. Discussion: There is a need for future work to recruit and retain a larger sample of older Black men to better understand the cognition-mortality relationship.
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Affiliation(s)
- Roland J Thorpe
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alison Huang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, , Baltimore, MD, USA
| | - Emily Smail
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, , Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama, Birmingham, AL, USA
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Adrienne Aiken-Morgan
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - George W Rebok
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, , Baltimore, MD, USA
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50
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Palms JD, Zaheed AB, Morris EP, Martino A, Meister L, Sol K, Zahodne LB. Links between early-life contextual factors and later-life cognition and the role of educational attainment. J Int Neuropsychol Soc 2023; 29:734-741. [PMID: 36537155 PMCID: PMC10279802 DOI: 10.1017/s135561772200090x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Educational attainment is a well-documented predictor of later-life cognition, but less is known about upstream contextual factors. This study aimed to identify which early-life contextual factors uniquely predict later-life global cognition and whether educational attainment mediates these relationships. METHOD Participants were drawn from the Michigan Cognitive Aging Project (N = 485; Mage = 63.51; SDage = 3.13; 50% non-Hispanic Black). Early-life exposures included U.S. region of elementary school (Midwest, South, Northeast), average parental education, household composition (number of adults (1, 2, 3+), number of children), school racial demographics (predominantly White, predominantly Black, diverse), self-reported educational quality, and school type (public/private). Later-life global cognition was operationalized with a factor score derived from a comprehensive neuropsychological battery. Sequential mediation models controlling for sociodemographics estimated total, direct, and indirect effects of early-life contextual factors on cognition through educational attainment (years). RESULTS Higher educational quality, higher parental education, and attending a private school were each associated with better cognition; attending a predominantly Black or diverse school and reporting three or more adults in the household were associated with lower cognition. After accounting for educational attainment, associations remained for educational quality, school type, and reporting three or more adults in the household. Indirect effects through educational attainment were observed for school region, educational quality, school racial demographics, and parental education. CONCLUSIONS School factors appear to consistently predict later-life cognition more than household factors, highlighting the potential long-term benefits of school-level interventions for cognitive aging. Future research should consider additional mediators beyond educational attainment such as neighborhood resources and childhood adversity.
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Affiliation(s)
- Jordan D Palms
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Emily P Morris
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Alexa Martino
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Lindsey Meister
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Ketlyne Sol
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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