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Meyer JM. Sleep Duration Differences by Education from Middle to Older Adulthood: Does Employment Stratification Contribute to Gendered Leveling? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:182-199. [PMID: 37830412 PMCID: PMC11014895 DOI: 10.1177/00221465231199281] [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: 10/14/2023]
Abstract
Sleep duration changes across the life course and differs by education in the United States. However, little research has examined whether educational differences in sleep duration change over age-or whether sleep duration trajectories over age differ by education. This study uses a life course approach to analyze American Time Use Survey data (N = 60,908), examining how educational differences in weekday sleep duration change from middle to older adulthood (ages 40-79). For men only, differences in total sleep time between individuals with less than a high school degree and those with more education converge in older adulthood. Results suggest that this leveling is explained by decreasing educational stratification in work hours as men enter older adulthood. Findings highlight the importance of employment for shaping gendered socioeconomic differences in sleep and demonstrate differences by education in how sleep duration changes over age, with possible implications for health disparities.
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Affiliation(s)
- Jess M Meyer
- University of Kansas Medical Center, Kansas City, KS, USA
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Wolfova K, Frycova B, Seblova D, Tom S, Skirbekk VF, Brennan Kearns P. Sex differences in cognitive decline among middle-aged and older adults: a cohort study in Europe. Age Ageing 2024; 53:afae078. [PMID: 38640127 PMCID: PMC11028402 DOI: 10.1093/ageing/afae078] [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: 11/22/2023] [Indexed: 04/21/2024] Open
Abstract
OBJECTIVES Previous studies on sex differences in cognitive decline provide inconsistent findings, with many European countries being underrepresented. We determined the association between sex and cognitive decline in a sample of Europeans and explored differences across birth cohorts and regions. METHODS Participants 50+ years old enrolled in the Survey of Health, Ageing and Retirement in Europe had their cognition measured by tests of immediate recall, delayed recall and verbal fluency biennially up to 17 years of follow-up (median 6, interquartile range 3-9 years). We used linear mixed-effects models to assess the relationship between sex and the rate of cognitive decline, adjusting for sociodemographic and health-related characteristics. RESULTS Of 66,670 participants (mean baseline age 63.5 ± standard deviation 9.4), 55% were female. Males and females had similar rates of decline in the whole sample in immediate recall (beta for interaction sex × time B = 0.002, 95% CI -0.001 to 0.006), delayed recall (B = 0.000, 95% CI -0.004 to 0.004), and verbal fluency (B = 0.008, 95% CI -0.005 to 0.020). Females born before World War II had a faster rate of decline in immediate recall and delayed recall compared to males, while females born during or after World War II had a slower rate of decline in immediate recall. Females in Central and Eastern Europe had a slower rate of cognitive decline in delayed recall compared to males. DISCUSSION Our study does not provide strong evidence of sex differences in cognitive decline among older Europeans. However, we identified heterogeneity across birth cohorts and regions.
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Affiliation(s)
- Katrin Wolfova
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague 150 06, Czech Republic
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague 100 00, Czech Republic
| | - Barbora Frycova
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague 150 06, Czech Republic
| | - Dominika Seblova
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague 150 06, Czech Republic
| | - Sarah Tom
- Department of Neurology, Columbia University, New York 10032, NY, USA
- Department of Epidemiology, Columbia University, 10032 New York, NY, USA
| | - Vegard Fykse Skirbekk
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo 0473, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg 60512, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
- Columbia Aging Center, Columbia University, New York 10032, NY, USA
| | - Pavla Brennan Kearns
- Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague 150 06, Czech Republic
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Westrick AC, Avila‐Rieger J, Gross AL, Hohman T, Vonk JMJ, Zahodne LB, Kobayashi LC. Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India. Alzheimers Dement 2024; 20:16-24. [PMID: 37490296 PMCID: PMC10808282 DOI: 10.1002/alz.13404] [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: 03/03/2023] [Revised: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION We compared gender disparities in later-life memory, overall and by education, in India and the United States (US). METHODS Data (N = 7443) were from harmonized cognitive assessment protocols (HCAPs) in the Longitudinal Aging Study of India-Diagnostic Assessment of Dementia (LASI-DAD; N = 4096; 2017-19) and US Health and Retirement Study HCAP (HRS-HCAP; N = 3347; 2016-17). We derived harmonized memory factors from each study using confirmatory factor analysis. We used multivariable-adjusted linear regression to compare gender disparities in memory function between countries, overall and by education. RESULTS In the United States, older women had better memory than older men (0.28 SD-unit difference; 95% CI: 0.22, 0.35). In India, older women had worse memory than older men (-0.15 SD-unit difference; 95% CI: -0.20, -0.10), which attenuated with increasing education and literacy. CONCLUSION We observed gender disparities in memory in India that were not present in the United States, and which dissipated with education and literacy.
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Affiliation(s)
- Ashly C. Westrick
- Department of EpidemiologyCenter for Social Epidemiology and Population HealthUniversity of Michigan: School of Public HealthAnn ArborMichiganUSA
| | - Justina Avila‐Rieger
- Gertrude H. Sergievsky Center and the Taub Institute for Research in Aging and Alzheimer's DiseaseColumbia UniversityNew YorkNew YorkUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthCenter on Aging and HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Timothy Hohman
- Vanderbilt Memory & Alzheimer's CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Genetics InstituteVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jet M. J. Vonk
- Department of NeurologyMemory and Aging CenterUniversity of California San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Laura B. Zahodne
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Lindsay C. Kobayashi
- Department of EpidemiologyCenter for Social Epidemiology and Population HealthUniversity of Michigan: School of Public HealthAnn ArborMichiganUSA
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Cao N, Zeng X, Wang P. Decomposing the change in the cognitive function gap between older men and women over time in China: The Chinese Longitudinal Healthy Longevity Survey. J Glob Health 2023; 13:04143. [PMID: 37988354 PMCID: PMC10662781 DOI: 10.7189/jogh.13.04143] [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: 11/23/2023] Open
Abstract
Background This study explored how modifiable social determinants of cognitive function can influence these gender gaps. Methods We utilized six waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 56,127 individuals aged 65+. The Kitagawa-Oaxaca-Blinder decomposition approach was used for the analysis. Results Older women consistently had lower average levels of cognitive function than men in each period, but the gap is narrowing. From 2002 to 2018, the gender gap in cognitive function decreased by 1.45 (95% confidence interval (CI) = -1.843, -1.097) points. The coefficients for the endowment effects decreased from 0.387 (95% CI = -0.563, -0.211) to 1.789 (95% CI = -2.471, -1.107) from 2005 to 2018. Lifestyle changes, social participation, and physical health factors significantly contributed to explaining the changes in gender gaps in cognitive function. Conclusions Among these contributing factors, lifestyle, social participation, and physical health have emerged as pivotal elements in reducing the gender gap in cognitive function. Targeted interventions for these variables are essential among older women to narrow the cognitive gender gaps effectively.
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Mansoor M, Katz B. Differential Effects of ADHD Polygenic Risk on Cognitive Performance in Later Life. J Atten Disord 2023; 27:1272-1283. [PMID: 37190750 DOI: 10.1177/10870547231172768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Understanding the association between polygenic risk for ADHD and cognition throughout aging has not been widely studied. This study aimed to determine whether ADHD risk influences cognitive performance among individuals at both young-old and middle-old age. METHOD Participants from the Health and Retirement Study, a biennial survey of 20,000 Americans, were compared on executive function and delayed recall measures using regression analyses. RESULTS There was no significant effect of ADHD risk on memory at both age waves for African-ancestry (AA; n = 403) and European-ancestry (EA; n = 2,286). There was, however, a significant association between ADHD risk and performance on executive function for EA at middle-old age (p = .028), but not young-old age; no such association was observed for AA adults. CONCLUSION This finding suggests that ADHD risk may differentially influence cognition among older adults throughout the aging process, with important implications for future research.
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Santamaria-Garcia H, Moguilner S, Rodriguez-Villagra OA, Botero-Rodriguez F, Pina-Escudero SD, O'Donovan G, Albala C, Matallana D, Schulte M, Slachevsky A, Yokoyama JS, Possin K, Ndhlovu LC, Al-Rousan T, Corley MJ, Kosik KS, Muniz-Terrera G, Miranda JJ, Ibanez A. The impacts of social determinants of health and cardiometabolic factors on cognitive and functional aging in Colombian underserved populations. GeroScience 2023; 45:2405-2423. [PMID: 36849677 PMCID: PMC10651610 DOI: 10.1007/s11357-023-00755-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
Global initiatives call for further understanding of the impact of inequity on aging across underserved populations. Previous research in low- and middle-income countries (LMICs) presents limitations in assessing combined sources of inequity and outcomes (i.e., cognition and functionality). In this study, we assessed how social determinants of health (SDH), cardiometabolic factors (CMFs), and other medical/social factors predict cognition and functionality in an aging Colombian population. We ran a cross-sectional study that combined theory- (structural equation models) and data-driven (machine learning) approaches in a population-based study (N = 23,694; M = 69.8 years) to assess the best predictors of cognition and functionality. We found that a combination of SDH and CMF accurately predicted cognition and functionality, although SDH was the stronger predictor. Cognition was predicted with the highest accuracy by SDH, followed by demographics, CMF, and other factors. A combination of SDH, age, CMF, and additional physical/psychological factors were the best predictors of functional status. Results highlight the role of inequity in predicting brain health and advancing solutions to reduce the cognitive and functional decline in LMICs.
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Affiliation(s)
- Hernando Santamaria-Garcia
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA.
- Pontificia Universidad Javeriana (Ph.D. Program in Neuroscience, Department of Psychiatry), Bogotá, Colombia.
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Sebastian Moguilner
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, and CONICET, Buenos Aires, Argentina
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Felipe Botero-Rodriguez
- Pontificia Universidad Javeriana (Ph.D. Program in Neuroscience, Department of Psychiatry), Bogotá, Colombia
| | - Stefanie Danielle Pina-Escudero
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Gary O'Donovan
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Cecilia Albala
- Instituto de Nutrición Y Tecnología de los Alimentos, Universidad de Chile, Avenida El Líbano 5524, Macul, Santiago, Chile
| | - Diana Matallana
- Pontificia Universidad Javeriana (Ph.D. Program in Neuroscience, Department of Psychiatry), Bogotá, Colombia
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
- Mental Health Department, Hospital Universitario Fundación Santa Fe de Bogotá, Memory Clinic, Bogotá, Colombia
| | - Michael Schulte
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Institute of Biomedical Sciences (ICBM), Neurocience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
- Geroscience Center for Brain Health and Metabolism, (GERO), Santiago de Chile, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago de Chile, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago de Chile, Chile
| | - Jennifer S Yokoyama
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Katherine Possin
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lishomwa C Ndhlovu
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Michael J Corley
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Kenneth S Kosik
- Neuroscience Research Institute. Department of Molecular Cellular and Developmental Biology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
- Department of Primary Care, Ohio University, Athens, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Agustin Ibanez
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA.
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile.
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, and CONICET, Buenos Aires, Argentina.
- Trinity College Dublin (TCD), Dublin, Ireland.
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Monge-Martín D, Caballero-Martínez F, João Forjaz M, J. Castillo M, Rodríguez-Blázquez C. Health state perception of people close to retirement age: Relationship with lifestyle habits and subjects' characteristics. Heliyon 2023; 9:e17995. [PMID: 37519727 PMCID: PMC10375557 DOI: 10.1016/j.heliyon.2023.e17995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Aim Societal ageing increases the need for correct and healthy ageing to ensure the well-being of older adults. Practical strategies are needed to acquire healthy habits for the ageing process. This study aims to analyse the lifestyle habits of subjects who are retired or close to retirement and identify factors that could influence their perceived health and that could be related to these habits. Methods A Spanish observational, descriptive, cross-sectional study of subjects close to retirement-age. Socio-demographic, family, work, leisure, social, and clinical-psychological indicators were evaluated. Results 1,700 participants (581 employed; 714 retirees; 405 other-status) were included, average age 63 years, 52% women. Most reported a satisfactory social life (90%), were in live-in relationships (74%), non-smoking (80%), followed a Mediterranean diet (73%), and took medicines daily (70%). Perceived health (EQ-VAS) was 75.9/100, with low disability (12-WHODAS) (7.4/100) and moderate/severe depression. Women reported higher disability (p < 0.001) and depression (p < 0.001), a better social life, and healthier lifestyle, but lower physical/work activity. Retirees reported less depression, better social life, healthier lifestyle, higher physical/work activity, and better sleeping habits. The multivariate model showed a significant association of health-status with disability level, number of chronic diseases, sleep habits, exercise, diet, and alcohol consumption. When depression level was introduced, age and being a woman were also related. Conclusions Retirement does not mean worse health but rather an opportunity to reinforce favourable health activities and improve lifestyle factors. Incorporating the differences related to gender and employment status in health-perception will facilitate the design of healthy ageing strategies.
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Affiliation(s)
- Diana Monge-Martín
- Faculty of Medicine, Francisco de Vitoria University Foundation, Madrid, Spain
| | | | - Maria João Forjaz
- Instituto de Salud Carlos III, National Center of Epidemiology, Madrid, Spain
- REDISSEC, Spain
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Gross AL, Li C, Briceno EM, Rentería MA, Jones RN, Langa KM, Manly JJ, Nichols EL, Weir D, Wong R, Berkman L, Lee J, Kobayashi LC. Harmonization of Later-Life Cognitive Function Across National Contexts: Results from the Harmonized Cognitive Assessment Protocols (HCAPs). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.09.23291217. [PMID: 37398152 PMCID: PMC10312860 DOI: 10.1101/2023.06.09.23291217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonize general and domain-specific cognitive scores from HCAPs across six countries, and evaluate precision and criterion validity of the resulting harmonized scores. Methods We statistically harmonized general and domain-specific cognitive function across the six publicly available HCAP partner studies in the United States, England, India, Mexico, China, and South Africa (N=21,141). We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies, as identified by a multidisciplinary expert panel. We generated harmonized factor scores for general and domain- specific cognitive function using serially estimated graded-response item response theory (IRT) models. We evaluated precision of the factor scores using test information plots and criterion validity using age, gender, and educational attainment. Findings IRT models of cognitive function in each country fit well. We compared measurement reliability of the harmonized general cognitive function factor across each cohort using test information plots; marginal reliability was high (r> 0·90) for 93% of respondents across six countries. In each country, general cognitive function scores were lower with older ages and higher with greater levels of educational attainment. Interpretation We statistically harmonized cognitive function measures across six large, population-based studies of cognitive aging in the US, England, India, Mexico, China, and South Africa. Precision of the estimated scores was excellent. This work provides a foundation for international networks of researchers to make stronger inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes. Funding National Institute on Aging (R01 AG070953, R01 AG030153, R01 AG051125, U01 AG058499; U24 AG065182; R01AG051158).
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Saenz J, Beam CR, Kim AJ. Development of a latent dementia index in the aging, demographics, and memory study: Validation and measurement invariance by sex. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12433. [PMID: 37187808 PMCID: PMC10175944 DOI: 10.1002/dad2.12433] [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: 11/02/2022] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
Latent variable models can create a latent dementia index (LDI) using cognitive and functional ability to approximate dementia likelihood. The LDI approach has been applied across diverse cohorts. It is unclear whether sex affects its measurement properties. We use Wave A (2001-2003) of the Aging, Demographics, and Memory Study (n = 856). Multiple group confirmatory factor analysis (CFA) was used to test measurement invariance (MI) using informant-reported functional ability and cognitive performance tasks, which we group into verbal, nonverbal, and memory. Partial scalar invariance was found, allowing for testing sex differences in LDI means (MDiff = 0.38). The LDI correlated with consensus panel dementia diagnosis, Mini-Mental State Examination (MMSE), and dementia risk factors (low education, advanced age, and apolipoprotein ε4 [APOE-ε4] status) for men and women. The LDI validly captures dementia likelihood to permit estimation of sex differences. LDI sex differences indicate higher dementia likelihood in women, potentially due to social, environmental, and biological factors.
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Affiliation(s)
- Joseph Saenz
- Edson College of Nursing and Health InnovationArizona State UniversityPhoenixArizonaUSA
| | - Christopher R. Beam
- Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Alice J. Kim
- Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Bloomberg M, Dugravot A, Sommerlad A, Kivimäki M, Singh-Manoux A, Sabia S. Comparison of sex differences in cognitive function in older adults between high- and middle-income countries and the role of education: a population-based multicohort study. Age Ageing 2023; 52:afad019. [PMID: 36821646 PMCID: PMC9949595 DOI: 10.1093/ageing/afad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The extent to which education explains variations in sex differences in cognitive function between countries at different levels of economic development is unknown. We examined the role of education in sex differences in four cognitive domains in high- and middle-income countries. METHODS Analyses were based on 70,846 participants, aged 60 years and older, in cohort studies from a high-income (United States) and four middle-income countries (Mexico, Brazil, China, and India). We used weighted linear models to allow nationally-representative comparisons of sex differences in orientation, memory, attention, and fluency using the United States as the reference, before and after adjustment for education, and after stratification by education. RESULTS Females had lower levels of education than males in all countries, particularly in India. Before adjustment for education, sex differences in orientation and attention in all middle-income countries, memory in Brazil, China, and India, and fluency in India were less favourable to females than in the United States (P < 0.010). For example, females outperformed males in memory in the United States (mean difference [male-female scores] = -0.26 standard deviations [95% CI -0.30, -0.22]) but not in China (0.15 [0.09, 0.21]) or India (0.16 [0.13, 0.19]). Adjustment for education attenuated these sex differences. In analyses stratified by education, there were minimal sex differences in the high education group in all countries. CONCLUSION Education contributes to larger female disadvantages in cognitive function at older ages in middle-income countries compared with the United States. Gender equity in education is an important target to reduce sex disparities in cognitive function globally.
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Affiliation(s)
- Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, UK
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
| | | | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, UK
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, UK
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
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O’Shea DM, Maynard T, Tremont G. DNA Methylation "GrimAge" Acceleration Mediates Sex/Gender Differences in Verbal Memory and Processing Speed: Findings From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2022; 77:2402-2412. [PMID: 35715888 PMCID: PMC9799212 DOI: 10.1093/gerona/glac133] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Indexed: 01/20/2023] Open
Abstract
Whether sex/gender differences in rates of biological aging mediate sex/gender differences in cognition in older adults has not been fully examined. The aim of the current study was to investigate this association. Data from up to 1 928 participants (mean age = 75, standard deviation = 7.04, female = 57%) who took part in the 2016 Harmonized Cognitive Assessment Protocol and Venous Blood Study; substudies of the Health and Retirement Study were included in the current study. The residuals from 4 age-adjusted epigenetic clocks (Horvath, Hannum, PhenoAge, and GrimAge) were used to measure biological age acceleration. Sex/gender differences in cognition were tested using a series of analyses of covariance. Mediation analyses tested whether the measures of age acceleration accounted for these sex/gender differences, controlling for age, education, smoking status, and white blood cell count. Women outperformed men on measures of verbal learning, verbal memory, visual scanning, and processing speed. No other significant sex/gender differences were identified. Results from mediation analyses revealed that women's slower rates of GrimAge fully accounted for their faster processing speeds and partially accounted for their better performances on verbal learning, verbal memory, and visual scanning measures. None of the other measures of age acceleration were significant mediators. Accounting for sex/gender differences in biological aging may differentiate between cognitive sex/gender differences that are driven by universal (ie, age-related) versus sex-specific mechanisms. More broadly, these findings support the growing evidence that the GrimAge clock outperforms other clocks in predicting cognitive outcomes.
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Affiliation(s)
- Deirdre M O’Shea
- Address correspondence to: Deirdre M. O’Shea, PhD, Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, 593 Eddy Street Building, 7th Floor, Providence, RI 02903, USA. E-mail:
| | | | - Geoffrey Tremont
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island,USA,Rhode Island Hospital, Providence, Rhode Island, USA
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Jain U, Angrisani M, Langa KM, Sekher TV, Lee J. How much of the female disadvantage in late-life cognition in India can be explained by education and gender inequality. Sci Rep 2022; 12:5684. [PMID: 35383249 PMCID: PMC8983756 DOI: 10.1038/s41598-022-09641-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/25/2022] [Indexed: 11/09/2022] Open
Abstract
In social environments characterized by high levels of gender inequality, women fare worse than men in human capital accumulation and health. We examine the association of gender inequality with female disadvantage in late-life cognitive function, using newly available data from Wave 1 (2017-2019) of the Longitudinal Aging Study in India (LASI), representative of the Indian population over the age of 45. We find a substantial female gap in cognition among mid-aged and older adults in India; early life socioeconomic conditions and education explain up to 74 percent of the female disadvantage in cognition, and model predictions suggest that it takes nine years of education on average to overcome this deficit. However, further contextualizing the environment, we find that the level of education at which differences in late-life cognition between women and men become negligible increases with the degree of gender inequality.
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Affiliation(s)
- Urvashi Jain
- Department of Economics, Finance and Real Estate, University of South Alabama, Mobile, USA
| | - Marco Angrisani
- Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-333, USA
- Department of Economics, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-333, USA
| | - Kenneth M Langa
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA
- Institute for Social Research, University of Michigan, Ann Arbor, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - T V Sekher
- International Institute for Population Sciences, Mumbai, India
| | - Jinkook Lee
- Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-333, USA.
- Department of Economics, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-333, USA.
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13
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McGrattan AM, Pakpahan E, Siervo M, Mohan D, Reidpath DD, Prina M, Allotey P, Zhu Y, Shulin C, Yates J, Paddick S, Robinson L, Stephan BCM. Risk of conversion from mild cognitive impairment to dementia in low- and middle-income countries: A systematic review and meta-analysis. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12267. [PMID: 35310524 PMCID: PMC8918697 DOI: 10.1002/trc2.12267] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/11/2022] [Indexed: 01/29/2023]
Abstract
Introduction With no treatment for dementia, there is a need to identify high risk cases to focus preventive strategies, particularly in low- and middle-income countries (LMICs) where the burden of dementia is greatest. We evaluated the risk of conversion from mild cognitive ompairment (MCI) to dementia in LMICs. Methods Medline, Embase, PsycINFO, and Scopus were searched from inception until June 30, 2020. The search was restricted to observational studies, conducted in population-based samples, with at least 1 year follow-up. There was no restriction on the definition of MCI used as long as it was clearly defined. PROSPERO registration: CRD42019130958. Results Ten thousand six hundred forty-seven articles were screened; n = 11 retained. Of the 11 studies, most were conducted in China (n = 7 studies), with only two studies from countries classified as low income. A qualitative analysis of n = 11 studies showed that similar to high-income countries the conversion rate to dementia from MCI was variable (range 6 . 0%-44 . 8%; average follow-up 3 . 7 years [standard deviation = 1 . 2]). A meta-analysis of studies using Petersen criteria (n = 6 studies), found a pooled conversion rate to Alzheimer's disease (AD) of 23 . 8% (95% confidence interval = 15 . 4%-33.4%); approximately one in four people with MCI were at risk of AD in LMICs (over 3 . 0-5 . 8 years follow-up). Risk factors for conversion from MCI to dementia included demographic (e.g., age) and health (e.g., cardio-metabolic disease) variables. Conclusions MCI is associated with high, but variable, conversion to dementia in LMICs and may be influenced by demographic and health factors. There is a notable absence of data from low-income settings and countries outside of China. This highlights the urgent need for research investment into aging and dementia in LMIC settings. Being able to identify those individuals with cognitive impairment who are at highest risk of dementia in LMICs is necessary for the development of risk reduction strategies that are contextualized to these unique settings.
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Affiliation(s)
- Andrea M. McGrattan
- School of Biomedical, Nutritional and Sports Sciences, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Eduwin Pakpahan
- Department Mathematics, Physics and Electrical EngineeringNorthumbria UniversityNewcastle upon TyneUK
| | - Mario Siervo
- School of Life SciencesThe University of Nottingham Medical SchoolNottinghamUK
| | - Devi Mohan
- Global Public Health Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSubang JayaMalaysia
| | - Daniel D. Reidpath
- Global Public Health Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSubang JayaMalaysia
- International Centre for Diarrhoeal Disease Research, ICDDR,BDhakaBangladesh
| | - Matthew Prina
- Department of Health Service and Population ResearchKing's College LondonLondonUK
| | - Pascale Allotey
- Global Public Health Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaSubang JayaMalaysia
| | - Yueping Zhu
- Department of Psychology and Behavioural SciencesZhejiang UniversityHangzhouChina
| | - Chen Shulin
- Department of Psychology and Behavioural SciencesZhejiang UniversityHangzhouChina
| | - Jennifer Yates
- Institute of Mental HealthNottingham UniversityNottinghamUK
| | - Stella‐Maria Paddick
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
- Gateshead NHS Community Health Foundation TrustGatesheadUK
| | - Louise Robinson
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - the DePEC team
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
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14
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Hu X, Gu S, Zhen X, Sun X, Gu Y, Dong H. Trends in Cognitive Function Among Chinese Elderly From 1998 to 2018: An Age-Period-Cohort Analysis. Front Public Health 2021; 9:753671. [PMID: 34900900 PMCID: PMC8660074 DOI: 10.3389/fpubh.2021.753671] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the effects of age, period, and cohort (APC) on trends in cognitive function among the Chinese elderly, and to explore how gender gaps in cognitive function change with age, period, and cohort. Methods: This study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, and included 90,432 participants aged above 65 years old. The measurement of cognitive function was the score of the Mini-Mental State Examination (MMSE). Cross-classified random-effect models were used to investigate age, period, and cohort trends in cognitive function. Results: Mini-Mental State Examination scores decreased with age at an increasing rate. While the cohort effect was nearly stable, the period effect demonstrated a downward trend from 1998 to 2002 followed by a nearly flat line. Females were associated with lower MMSE scores than males. When age increased, the gender gaps in MMSE scores further increased. The period-based gender gaps in MMSE scores diverged throughout the 20 years, while the cohort-based gender disparities in MMSE scores converged with successive cohorts. Conclusions: Age, period, and cohort had different and independent effects on cognitive function among the Chinese elderly. The effect of age was stronger than that of period and cohort. Gender disparities in cognitive function increased with age and period, and decreased with successive cohorts.
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Affiliation(s)
- Xiaoqian Hu
- School of Politics and Public Administration, Qingdao University, Qingdao, China.,Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuyan Gu
- Center for Health Policy and Management Studies, School of Government, Nanjing University, Nanjing, China
| | - Xuemei Zhen
- Center for Health Management and Policy, School of Public Health, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xueshan Sun
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxuan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.,The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
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15
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Effect of Demographic and Health Dynamics on Cognitive Status in Mexico between 2001 and 2015: Evidence from the Mexican Health and Aging Study. Geriatrics (Basel) 2021; 6:geriatrics6030063. [PMID: 34202004 PMCID: PMC8293108 DOI: 10.3390/geriatrics6030063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022] Open
Abstract
Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.
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16
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Downer B, Avila J, Chen NW, Wong R. Imputation Procedures for Cognitive Variables in the Mexican Health and Aging Study: Evaluating the Bias from Excluding Participants with Missing Data. REALIDAD, DATOS Y ESPACIO : REVISTA INTERNACIONAL DE ESTADISTICA Y GEOGRAFIA 2021; 12:90-105. [PMID: 34721821 PMCID: PMC8553231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Non-response of cognitive data in cohort studies is a barrier to cognitive aging research. We describe the procedures for the imputation of non-responses for cognitive data in the Mexican Health and Aging Study (MHAS). Data came from the 2001-2015 MHAS waves. We also describe the association of cognition with education, age, and other variables in 2015 with and without the imputed values. Between 12.3% and 37.9% of participants were missing data for at least one cognition variable. When we conducted the analysis with and without the imputed values, the relationships between education, age, and cognition were similar in direction and significance, but different in magnitude. Non-response of cognitive data is common and non-random in the MHAS. Investigators should use the data sets that include the imputed values, which are publicly available.
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Affiliation(s)
- Brian Downer
- University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation Sciences, Galveston Texas, United States
| | - Jaqueline Avila
- Brown University, School of Public Health, Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Providence Rhode Island, United States
| | - Nai-Wei Chen
- Beaumont Research Institute, Beaumont Health, Royal Oak Michigan, United States
| | - Rebeca Wong
- University of Texas Medical Branch, Sealy Center on Aging, Galveston Texas, United States
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17
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Borrescio-Higa F, Valenzuela P. Does Education Mitigate the Effect of Population Aging on Health Expenditure? A Panel Data Study of Latin American Countries. J Aging Health 2021; 33:585-595. [PMID: 33913783 DOI: 10.1177/08982643211002338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: To examine whether the effect of population aging on healthcare expenditures as a share of Gross Domestic Product (GDP) is attenuated in more educated countries. Method: The analysis is based on a dataset of 22 Latin American countries between 1995 and 2013. We estimate panel data models with country and time fixed effects, and control for potential nonlinear effects of population aging on health expenditure. Results: We find population aging increases health expenditure as a share of GDP in economies characterized by low levels of education, but this effect is mitigated in economies with higher levels of education. Results are driven by private health expenditures. Discussion: Results suggest population aging and education have a stronger influence on healthcare expenditures in less developed countries. This finding is important in a context in which the rapid growth of the aging population is likely to lead to significant costs in terms of health expenditures, but less so in more educated societies.
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Bloomberg M, Dugravot A, Dumurgier J, Kivimaki M, Fayosse A, Steptoe A, Britton A, Singh-Manoux A, Sabia S. Sex differences and the role of education in cognitive ageing: analysis of two UK-based prospective cohort studies. Lancet Public Health 2021; 6:e106-e115. [PMID: 33516287 PMCID: PMC8141610 DOI: 10.1016/s2468-2667(20)30258-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have shown an excess risk of Alzheimer's disease and related dementias among women. Education is thought to have a causal association with dementia onset. We aimed to investigate the role of education in influencing sex differences in cognitive ageing. METHODS We analysed data from two prospective cohort studies in the UK; the English Longitudinal Study of Ageing (ELSA) and the Whitehall II study, to assess sex differences in cognitive performance and cognitive decline by birth cohort (birth year 1930-38, 1939-45, or 1946-55), before and after adjustment for education, and by high and low education level. Memory was assessed using immediate recall, for which data were available from all waves of the ELSA (2002-14) and Whitehall II (1997-2015) studies. Fluency was assessed using a semantic fluency test based on an animal naming task, with data available from all waves of the Whitehall II study and waves one to five (2002-10) and wave seven (2014) of the ELSA study. Cognitive scores were standardised separately in each study based on the mean and SD of the corresponding test among participants aged 50-59 years with secondary education. FINDINGS 15 924 participants were included from the two studies. In pooled analyses, women had better memory scores than men in all birth cohorts, irrespective of adjustment for education (eg, at age 60 years, birth cohort 1930-38, mean difference between sexes [male scores minus female scores] -0·25 SDs [95% CI -0·32 to -0·19] after adjustment for education), and in both education level groups. Memory decline was faster in men than in women (at age 60 years, birth cohort 1946-55, mean difference in 13-year change -0·15 SDs [-0·20 to -0·09]; after adjustment for education -0·14 SDs [-0·20 to -0·08]). Men had better fluency scores than women in earlier birth cohorts and in the low education group (at age 60 years, birth cohort 1930-38, mean difference 0·20 SDs [95% CI 0·05 to 0·36]); but women had better fluency scores than men in later birth cohorts and in the high education group (at age 60 years, birth cohort 1946-55, mean difference -0·17 SDs [-0·24 to -0·10]). No sex differences were observed for fluency decline. INTERPRETATION Our findings suggest that decreasing disparities between sexes in education, due to secular increases in educational opportunities, could attenuate sex differences in dementia risk and cognitive decline in the future. FUNDING National Institute on Aging, National Institutes of Health; UK Medical Research Council; British Heart Foundation; and National Institute for Health Research.
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Affiliation(s)
- Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Aline Dugravot
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Julien Dumurgier
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France; Cognitive Neurology Centre, Saint-Louis Lariboisière Fernand-Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aurore Fayosse
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Annie Britton
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK; Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, London, UK; Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
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