Mental work demands, retirement, and longitudinal trajectories of cognitive functioning

Cognitive reserve in ALS: the role of occupational skills and requirements

OBJECTIVE

Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous neurodegenerative condition featuring variable degrees of motor and cognitive impairment. We assessed the impact of specific, empirically derived occupational skills and requirements on cognitive and motor functioning in ALS.

METHODS

Individuals with ALS (n = 150) were recruited from the University of Pennsylvania's Comprehensive ALS Clinic. The Edinburgh Cognitive and Behavioral ALS Screen (ECAS) measured cognition, and the Penn Upper Motor Neuron (PUMNS) and ALS Functional Rating Scales (ALSFRS-R) measured motor symptoms. We derived 17 factors representing distinct occupational skills and requirements from the Occupational Information Network (O*NET), which were related to cognitive and motor scores using multiple linear regression.

RESULTS

Occupational roles involving greater reasoning ability (β = 2.12, p < .05), social ability (β = 1.73, p < .05), analytic skills, (β = 3.12, p < .01) and humanities knowledge (β = 1.83, p<.01) were associated with better performance on the ECAS, while jobs involving more exposure to environmental hazards (β=-2.57, p < .01) and technical skills (β=-2.16, p<.01) were associated with lower ECAS scores. Jobs requiring more precision skills (β = 1.91, p < .05) were associated with greater motor dysfunction on the PUMNS.

CONCLUSIONS

Occupational histories involving more cognitively complex skills and activities were related to preserved cognitive functioning in ALS consistent with the cognitive reserve hypothesis, while jobs with greater exposure to environmental hazards and technical demands were linked to poorer cognitive functioning. Jobs involving more repetitive movements were associated with worse motor functioning, possibly due to overuse. Occupational history provides insight into protective and risk factors for variable degrees of cognitive and motor dysfunction in ALS.

Correlates of SuperAging in Two Population-Based Samples of Hispanic Older Adults

OBJECTIVES

"SuperAgers" are generally defined as people 80+ years old with episodic memory performance comparable to those 20 years younger. Limited knowledge exists to describe characteristics of SuperAgers, with even less known about Hispanic SuperAgers.

METHODS

We examined indicators of cognitive, physical, and psychological resilience in relation to the likelihood of being a SuperAger using data from 2 population-based studies of Hispanic older adults (Puerto Rican Elderly: Health Conditions [PREHCO] Study; Health and Retirement Study [HRS]). SuperAgers were defined as (1) ≥80 years old, (2) recall scores ≥ the median for Hispanic respondents aged 55-64, and (3) no cognitive impairment during the observation period. Overall, 640 PREHCO participants and 180 HRS participants were eligible, of whom 45 (7%) and 31 (17%) met SuperAging criteria.

RESULTS

Logistic regressions controlling for age and sex demonstrated that higher education (PREHCO: odds ratio [OR] = 1.20, p < .001; HRS: OR = 1.14, p = .044) and fewer instrumental activities of daily living limitations (PREHCO: OR = 0.79, p = .019; HRS: OR = 0.58, p = .077; cognitive resilience), fewer activities of daily living limitations (PREHCO: OR = 0.72, p = .031; HRS: OR = 0.67, p = .068; physical resilience), and fewer depressive symptoms (PREHCO: OR = 0.84, p = .015; HRS: OR = 0.69, p = .007; psychological resilience) were associated with SuperAging, although not all results reached threshold for statistical significance, presumably due to low statistical power. Additionally, known indicators of physical health (e.g., chronic conditions and self-rated health) did not relate to SuperAging.

DISCUSSION

Increasing access to education and recognizing/treating depressive symptoms represent potential pathways to preserve episodic memory among older Hispanic adults.

The Beneficial, Formative Role of Lifetime Exposures across Cognitive Domains in Barbados Using Data from the SABE Study

This study tested the hypothesis that within older Barbadian adults, sex, education, and occupation type lessen age-related cognitive decline. The analyses used a cross-sectional data set from 1325 people collected in the 2006 SABE Study (Health, Well-being, and Aging). Cognition was assessed as scores in each subdomain of the Mini-Mental State Exam. The loss of a single point in each subdomain was predicted by sex, years of education, job type, and their interactions with age. Results demonstrated that age and protective factors affect each cognitive domain differently. High education combined with mentally complex employment helped maintain cognitive performance in later life. Beneficial lifetime exposures are additive, providing combined benefits. Findings provide insight into public policy aiming to minimize the number of adults with cognitive decline and dementia in Barbados and the Caribbean.

Well-designed manufacturing work improves some cognitive abilities in individuals with cognitive impairments

Introduction

Employment is recognized as a fundamental human right, which correlates with better physical and mental health. Importantly, well-designed work, which considers the physical, social, and psychological impacts of work, can serve to enhance the cognitive abilities of workers. Although often overlooked, work for individuals with disabilities, including cognitive impairments, is equally important for their physical and mental well-being. What has not been established, however, is whether well-designed work can also enhance the cognitive abilities of individuals with cognitive impairments.

Methods

Using a longitudinal study design, we investigated the impact of well-designed work on the cognitive abilities of 60 participants (operators) at the AMIPI Foundation factories, which employ individuals with cognitive impairments to produce electrical cables and harnesses for the automobile industry. The same operators were assessed at three different time points: upon hiring (n = 60), and after working in the factory for 1 year (n = 41, since 19 left the factory) and 2 years (n = 28, since 13 more left the factory). We used five cognitive tests evaluating: (1) finger and manual dexterity, bimanual dexterity, and procedural memory using the Purdue Pegboard; (2) sustained and selective attention using the Symbol Cancellation Task; (3) short- and long-term declarative verbal memory and long-term verbal recognition memory using Rey's Audio-Verbal Learning Test; (4) short- and long-term visual recognition memory using the Continuous Visual Memory Test; and (5) abstract reasoning using Raven's Standard Progressive Matrices.

Results

We observed improvements in procedural memory, sustained and selective attention, and short- and long-term visual recognition memory after working in the factory for 1 or 2 years. We did not observe improvements in finger or manual dexterity or bimanual dexterity, nor short- or long-term declarative verbal memory or verbal recognition memory, nor abstract reasoning.

Discussion

We conclude that, in addition to improving physical and mental well-being, well-designed manufacturing work can serve as a training intervention improving some types of cognitive functioning in individuals with cognitive impairments.

2024 Alzheimer's disease facts and figures

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.

Work and self-rated memory among native Hawaiian and other Pacific Islander older adults

OBJECTIVES

Engagement in work has an important association with cognitive health in later life, yet little is known about this association among Native Hawaiian and other Pacific Islander (NHPI) older adults. This study assesses the associations between various work characteristics and memory problems among this population.

DESIGN

Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS), the research question was explored among those who were aged 50+.

RESULTS

Engagement in work, certain occupation types (e.g., clerical or professional occupations compared to blue-collar jobs), and the current/most recent job that is also the longest job held were associated with lower odds of having memory problems.

CONCLUSION

The study's results suggest that work characteristics and opportunities to engage in work are important considerations in preventing memory problems in later life. As the NHPI population experiences cognitive health disparities earlier than other groups, timely interventions that focus on work engagement and a culturally relevant environment require further investigation.

Exploring workability in an older working population: associations with cognitive functioning, sleep quality, and technostress

Objective

This observational study investigates workability and its associations with cognitive functioning, sleep quality and technostress among an older working population, also shedding light on potential differences between two occupational categories with different work schedules.

Methods

Workers aged over 50, employed in different working sectors (banking/finance, chemical and metal-mechanic industry) were administered a self- report questionnaire including Work Ability Index (WAI), cognitive tests (Stroop Color Task, Corsi Blocks, Digit Span), sleep quality questionnaires (Pittsburgh Sleep Quality Index-PSQI; Insomnia Severity Index-ISI; Ford Insomnia Response to Stress Test-FIRST) and technostress scale. Linear regression models evaluated associations among variables, interaction effects investigated potential moderators.

Results

A total of 468 aged workers categorized as white (WCWs; N = 289, 62%) or blue collars (BCWs; N = 179, 38%) were enrolled; most BCWs (N = 104; 58%) were night shift workers. WCWs reported higher workability, cognitive functioning, sleep quality and lower technostress (except for invasion and privacy subscales) than BCWs. Associations between cognitive functioning and workability were statistically significant only for BCWs [slopes equal to 0.2 (0.33), 0.8 (0.34), -0.02 (0.001) for Memory Span Corsi, Block Span Digit and Interference Speed respectively]; additionally, sleep quality significantly moderated this association (p = 0.007). Higher levels of technostress were associated with lower workability, and this relationship was stronger for BCWs.

Conclusion

The aging of the workforce has important implications for occupational health and safety. Our findings suggest potential interventions and protective measures to promote older workers' wellbeing; blue-collar workers particularly should benefit from tailored intervention to sustain workability and prevent technostress, considering the role of healthy sleep habits promotion.

The Mediating Effects of Education and Occupational Complexity Between Race and Longitudinal Change in Late Life Cognition in ACTIVE

This study examined educational and occupational inequality as two aspects of social determinants of health that might mediate the longitudinal relationship between racialization and late life cognitive level and change. Participants were 2371 individuals racialized as Black and White from the ACTIVE study who provided occupational data. Data were analyzed from baseline and five assessments over 10-years using structural equation modeling. Black/White race served as the predictor, occupational complexity (OC) and years of education as mediators, and cognitive (memory, reasoning, and speed of processing) intercept, linear slope, and quadratic slope as the dependent variables. Black/White race showed significant indirect associations through education and OC on level of performance in cognition, linear change in reasoning and memory, and quadratic change in reasoning. Education and OC accounted for 11-16% of the association between race and cognitive level and represent modifiable social determinants of health that are associated with disparities in cognitive aging.

General cognitive ability in high school, attained education, occupational complexity, and dementia risk

INTRODUCTION

We address the extent to which adolescent cognition predicts dementia risk in later life, mediated by educational attainment and occupational complexity.

METHODS

Using data from Project Talent Aging Study (PTAS), we fitted two structural equation models to test whether adolescent cognition predicts cognitive impairment (CI) and Ascertain Dementia 8 (AD8) status simultaneously (NCognitive Assessment = 2477) and AD8 alone (NQuestionnaire = 6491) 60 years later, mediated by education and occupational complexity. Co-twin control analysis examined 82 discordant pairs for CI/AD8.

RESULTS

Education partially mediated the effect of adolescent cognition on CI in the cognitive assessment aample and AD8 in the questionnaire sample (Ps < 0.001). Within twin pairs, differences in adolescent cognition were small, but intrapair differences in education predicted CI status.

DISCUSSION

Adolescent cognition predicted dementia risk 60 years later, partially mediated through education. Educational attainment, but not occupational complexity, contributes to CI risk beyond its role as a mediator of adolescent cognition, further supported by the co-twin analyses.

HIGHLIGHTS

Project Talent Aging Study follows enrollees from high school for nearly 60 years. General cognitive ability in high school predicts later-life cognitive impairment. Low education is a risk partially due to its association with cognitive ability.

Sex differences in cognitive decline among middle-aged and older adults: a cohort study in Europe

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.

Changes in memory and attention during and after occupational rehabilitation: A longitudinal study

BACKGROUND

There is need for more knowledge about the relationship between work and cognitive functioning in sick-listed individuals.

OBJECTIVE

This study investigated whether the degree of work participation is relevant for recovery of cognitive functioning in sick-listed individuals.

METHODS

177 occupational rehabilitation participants and 70 controls participated in a non-randomised, longitudinal study. Participants completed computerised cognitive tests targeting sustained attention and working memory at start and end of rehabilitation and 3 and 12 months after rehabilitation. The change score performance in attention and memory between start and end, start and 3 months and 12 months was compared in individuals on sick leave 100-75%, 74-40% and 39-0% (three sick leave groups) of the time in the year after rehabilitation, and a control group not being on sick leave. Fixed effect analysis of covariance adjusting for education and work ability was used.

RESULTS

The sick leave group 100-75% had significantly lower score on work ability compared to the other groups at baseline. The main findings indicated that the sick leave group 39-0% improved significantly more in sustained attention compared to the sick leave group 100-75% between start and end of rehabilitation and from start of rehabilitation to 3 and 12 months after.

CONCLUSION

The degree of work participation seems relevant to recovery of the cognitive function sustained attention in sick-listed individuals. These findings encourage work rehabilitation clinicians, work consultants and employers to develop RTW plans which take into account that graded employment influence cognitive functioning.

The relationship between working status in old age and cause-specific disability in Japanese community-dwelling older adults with or without frailty: A 3.6-year prospective study

AIM

To examine the effects of employment engagement, classified by frailty and working status, on the incidence of disability in urban community-dwelling older adults.

METHODS

We used data from 6386 initially nondisabled residents aged 65-84 years from Ota City, Tokyo, Japan, in 2016. The observation duration was 3.6 years. Self-administered questionnaires applied the Cox proportional hazard model by assessing the existence of frailty through Check-List 15 (with a score ≥4 indicating the state of frailty), controlling for age, sex, living situation, education level, equivalent income, chronic conditions, body mass index, instrumental activities of daily living, self-rated health, drinking and smoking status, and social activities. We evaluated the predictive value of working status (full-time, part-time, temporary, or nonworker) at baseline for cause-specific disability (dementia-type vs. non-dementia-type) incidence, identified using the long-term care insurance system's nationally unified database.

RESULTS

Of the 6386 participants, 806 (63/1134 full-time workers; 58/1001 part-time workers; 61/547 temporary workers; 624/3704 nonworkers) presented with disabilities during the 3.6-year-long duration. Adjustments for conventional covariates showed that nonfrail full-time and part-time workers, as well as frail full-time workers, had significantly lower risks of all-cause disability incidence. Furthermore, nonfrail and frail full-time workers had significantly lower risks of dementia-type and nondementia-type disabilities, respectively.

CONCLUSIONS

The incidence of disability in older adults was influenced by working and frailty status. Engaging in full-time work thus prevents disabilities in older adults, regardless of their frailty status. Meanwhile, nonfrail older adults are able to avoid disabilities even when engaging in part-time work. Geriatr Gerontol Int 2023; 23: 855-863.

Assigning lifetime occupation domains for older Mexicans: MHAS-O*NET linkage protocol

OBJECTIVE

We developed a MHAS (Mexican Health and Aging Study) and O*NET (Occupational Information Network) linkage to allow global researchers using MHAS data to assign lifetime occupation domains for older Mexicans.

MATERIALS AND METHODS

Three bilingual raters independently matched 440 records with 132 unique occupation codes from the 2012 MHAS. We used a modified Delphi technique to reach agreements. To assess reliability, we compared the distribution of observations between the MHAS file and the MHAS-O*NET linked file across five job categories (upper white collar, lower white collar, upper blue collar, low blue collar, and agriculture/fishing/forestry). The Institutional Review Board at the University of Texas Medical Branch reviewed and approved the research (IRB # 21-0268).

RESULTS

Using the developed 1:1 MHAS-ONET linkage, consistency between MHAS and ONET was 97.4% across the five job categories.

CONCLUSION

This MHAS-O*NET linkage will allow researchers to analyze the association between lifetime occupation and multiple dimensions of health, functionality, and retirement determinants for a low-middle income country with a large proportion of workers in the informal sector.

Pragmatic approaches to handling practice effects in longitudinal cognitive aging research

INTRODUCTION

The challenge of accounting for practice effects (PEs) when modeling cognitive change was amplified by the COVID-19 pandemic, which introduced period and mode effects that may bias the estimation of cognitive trajectory.

METHODS

In three Kaiser Permanente Northern California prospective cohorts, we compared predicted cognitive trajectories and the association of grip strength with cognitive decline using three approaches: (1) no acknowledgment of PE, (2) inclusion of a wave indicator, and (3) constraining PE based on a preliminary model (APM) fit using a subset of the data.

RESULTS

APM-based correction for PEs based on balanced, pre-pandemic data, and with current age as the timescale produced the smallest discrepancy between within-person and between-person estimated age effects. Estimated associations between grip strength and cognitive decline were not sensitive to the approach used.

DISCUSSION

Constraining PEs based on a preliminary model is a flexible, pragmatic approach allowing for meaningful interpretation of cognitive change.

HIGHLIGHTS

The magnitude of practice effects (PEs) varied widely by study. When PEs were present, the three PE approaches resulted in divergent estimated age-related cognitive trajectories. Estimated age-related cognitive trajectories were sometimes implausible in models that did not account for PEs. The associations between grip strength and cognitive decline did not differ by the PE approach used. Constraining PEs based on estimates from a preliminary model allows for a meaningful interpretation of cognitive change.

Retirement and cognitive aging in a racially diverse sample of older Americans

BACKGROUND

Retirement represents a crucial transitional period for many adults with possible consequences for cognitive aging. We examined trajectories of cognitive change before and after retirement in Black and White adults.

METHODS

Longitudinal examination of up to 10 years (mean = 7.1 ± 2.2 years) using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study-a national, longitudinal study of Black and White adults ≥45 years of age. Data were from 2226 members of the REGARDS study who retired around the time when an occupational ancillary survey was administered. Cognitive function was an average of z-scores for tests of verbal fluency, memory, and global function.

RESULTS

Cognitive functioning was stable before retirement (Estimate = 0.05, p = 0.322), followed by a significant decline after retirement (Estimate = -0.15, p < 0.001). The decline was particularly pronounced in White (Estimate = -0.19, p < 0.001) compared with Black (Estimate = -0.07, p = 0.077) participants, twice as large in men (Estimate = -0.20, p < 0.001) compared with women (Estimate = -0.11, p < 0.001), highest among White men (Estimate = -0.22, p < 0.001) and lowest in Black women (Estimate = -0.04, p = 0.457). Greater post-retirement cognitive decline was also observed among participants who attended college (Estimate = -0.14, p = 0.016). While greater work complexity (Estimate = 0.92, p < 0.05) and higher income (Estimate = 1.03, p < 0.05) were related to better cognitive function at retirement, neither was significantly related to cognitive change after retirement.

CONCLUSION

Cognitive functioning may decline at an accelerated rate immediately post-retirement, more so in White adults and men than Black adults and women. Lifelong structural inequalities including occupational segregation and other social determinants of cognitive health may obscure the role of retirement in cognitive aging.

Successful ageing at work: The role of job characteristics in growth trajectories of work ability and motivation to work amongst older workers

In order to age successfully at work, people need to maintain or improve their work ability and motivation to work. This implies a process that develops over time and can differ substantially between individuals. This study investigated whether different trajectories of perceived work ability and motivation to work can be distinguished between older employees over time and to what extent job demands and job resources are predictive of these different trajectories. We applied growth mixture modelling amongst 5799 employees of 45 years and older at four time points. We found five distinct groups of older workers that differed in their trajectories of perceived work ability and four types of groups of older workers that differed in their trajectories of their motivation to work. Higher levels of physical demands, mental demands, autonomy, supervisor support, and colleague support were less common in unfavourable trajectories. This study gives Human Resource Management practitioners insight into how jobs should be designed to stimulate successful ageing at work.

Music Engagement and Episodic Memory Among Middle-Aged and Older Adults: A National Longitudinal Analysis

OBJECTIVES

The objective of this study was to examine associations between music engagement and episodic memory for more than 12 years in a nationally representative sample of middle- and older-aged adults in the United States.

METHODS

This study is based on a secondary analysis of data from a sample (N = 5,021) of cognitively normal adults from the Health and Retirement Study (2006-2018). Episodic memory was measured by immediate and delayed recall tasks. Music engagement was classified as none, passive (i.e., listening to music), active (i.e., singing and/or playing an instrument), or both (i.e., listening to music and singing or playing an instrument).

RESULTS

Compared with those with no music engagement, respondents who reported both passive and active engagement performed 0.258 points better at baseline on episodic memory tasks. This group also performed better across time with scores that declined by 0.043 points fewer per study visit. Additionally, compared to those with no music engagement, participants with passive music engagement had scores that declined by 0.023 points fewer per visit. There were no significant differences in performance at baseline for those with passive or active music engagement, or across time for those with active engagement.

DISCUSSION

The results of this study suggest that engaging in both passive and active music engagement may be superior to engaging with music only passively or actively and that engaging in music both ways may be able to protect against age-related declines in episodic memory. Future research should examine whether community-based music engagement interventions can affect this trajectory of decline.

Cognitive reserve and individual differences in brain tumour patients

The aim of the paper is to determine the effects of the cognitive reserve on brain tumour patients' cognitive functions and, specifically, if cognitive reserve helps patients cope with the negative effects of brain tumours on their cognitive functions. We retrospectively studied a large sample of around 700 patients, diagnosed with a brain tumour. Each received an MRI brain examination and performed a battery of tests measuring their cognitive abilities before they underwent neurosurgery. To account for the complexity of cognitive reserve, we construct our cognitive reserve proxy by combining three predictors of patients' cognitive performance, namely, patients' education, occupation, and the environment where they live. Our statistical analysis controls for the type, side, site, and size of the lesion, for fluid intelligence quotient, and for age and gender, in order to tease out the effect of cognitive reserve on each of these tests. Clinical neurological variables have the expected effects on cognitive functions. We find a robust positive effect of cognitive reserve on patients' cognitive performance. Moreover, we find that cognitive reserve modulates the effects of the volume of the lesion: the additional negative impact of an increase in the tumour size on patients' performance is less severe for patients with higher cognitive reserve. We also find substantial differences in these effects depending on the cerebral hemisphere where the lesion occurred and on the cognitive function considered. For several of these functions, the positive effect of cognitive reserve is stronger for patients with lesions in the left hemisphere than for patients whose lesions are in the right hemisphere. The development of prevention strategies and personalized rehabilitation interventions will benefit from our contribution to understanding the role of cognitive reserve, in addition to that of neurological variables, as one of the factors determining the patients' individual differences in cognitive performance caused by brain tumours.

Cognitive activity at work and the risk of dementia

Dementia prevalence is projected to rise steeply in coming decades, producing tremendous burdens on families, and health and social services. Motivated by the need for further robust evidence on modifiable risk factors, we investigate the relationship between cognitive activity at work and later-life dementia. Using data from the US Health and Retirement Study matched to the O*NET occupational database, we find that a one standard deviation increase in the cognitive activity associated with one's longest held occupation is associated with a 0.9 percentage point reduction in (predicted) dementia, or a 24% reduction relative to the mean. This relationship is consistently found across model specifications and robustness tests. When controlling for individual fixed-effects we find that the association between dementia and work cognitive activity increases with age. Overall, our results provide some evidence in support of the inclusion of cognitive activity at work as a recognized modifiable risk factor for dementia.

Cognitive reserve in ALS: The role of occupational skills and requirements

Background

Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous neurodegenerative condition featuring variable degrees of motor decline and cognitive impairment. We test the hypothesis that cognitive reserve (CR), defined by occupational histories involving more complex cognitive demands, may protect against cognitive decline, while motor reserve (MR), defined by working jobs requiring complex motor skills, may protect against motor dysfunction.

Methods

Individuals with ALS (n=150) were recruited from the University of Pennsylvania's Comprehensive ALS Clinic. Cognitive performance was evaluated using the Edinburgh Cognitive and Behavioral ALS Screen (ECAS), and motor functioning was measured using Penn Upper Motor Neuron (PUMNS) scale and ALS Functional Rating Scales (ALSFRS-R). The Occupational Information Network (O*NET) Database was used to derive 17 factors representing distinct worker characteristics, occupational requirements, and worker requirements, which were related to ECAS, PUMNS, and ALSFRS-R scores using multiple linear regression.

Results

A history of working jobs involving greater reasoning ability (β=2.12, p<.05), social ability (β=1.73, p<.05), analytic skills, (β=3.12, p<.01) and humanities knowledge (β=1.83, p<.01) was associated with better performance on the ECAS, while jobs involving more exposure to environmental hazards (β=-2.57, p<.01) and technical skills (β=-2.16, p<.01) were associated with lower ECAS Total Scores. Jobs involving greater precision skills (β=1.91, p<.05) were associated with greater disease severity on the PUMNS. Findings for the ALSFRS-R did not survive correction for multiple comparisons.

Discussion

Jobs requiring greater reasoning abilities, social skills, and humanities knowledge were related to preserved cognitive functioning consistent with CR, while jobs with greater exposure to environmental hazards and technical demands were linked to poorer cognitive functioning. We did not find evidence of MR as no protective effects of occupational skills and requirements were found for motor symptoms, and jobs involving greater precision skills and reasoning abilities were associated with worse motor functioning. Occupational history provides insight into protective and risk factors for variable degrees of cognitive and motor dysfunction in ALS.

Life course engagement in enriching activities: When and how does it matter for cognitive aging?

Growing evidence suggests that participation in enriching activities (physical, social, and mental) across the life course is beneficial for cognitive functioning in older age. However, few studies have examined the effects of enrichment across the entire life course within the same participants. Using 2,931 participants in the Health and Retirement Study, we linked self-report data from later life and retrospective self-report data from early life and midlife to cognitive performance after Age 65. We categorized participants as having either high (top ∼25%) or average to low (bottom ∼75%) level of enrichment during each life period. Thus, eight groups were identified that reflected unique patterns of enrichment during early, mid, and later life (e.g., high-high-high). Using growth curve modeling, we found that life course enrichment patterns predicted both cognitive functioning and the rate of cognitive decline across five time points spanning 8 years (Aim 1). Groups with high enrichment during at least one life period had higher performance and slower decline in older age, compared to those who had average to low levels of enrichment throughout all three life periods. We also found that high enrichment during each life period independently predicted better cognitive performance and that high enrichment during early and later life also predicted slower cognitive decline (Aim 2). These findings support the idea that high enrichment is beneficial for cognition in later life and that the effects are long-lasting, even when individuals are inconsistent in enrichment engagement throughout the entire life course. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

2023 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 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, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. 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. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. 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 $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. 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 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.

You Can Leave the Younger Workers Out of It! Toward a Centered Paradigm for Studying Older Workers’ Employment Relationships and Late-Career Dynamics

Are late careers worth studying in their own right? The way we think and reason about older workers and late careers—in scholarship and in practice—has been disproportionately informed by a research paradigm that focuses on age differences among employees, which captures how older workers on average differ from younger workers on average. While this contrastive paradigm has been generative, it can also inaccurately portray older workers as a static, homogenous group. In contrast, older workers show considerable heterogeneity (older workers vary), meaningful dynamics (older workers change), and dynamic heterogeneity (older workers vary in how they change). In this paper, we propose that the contrastive paradigm be complemented with a centered paradigm that centers on how older workers vary and change. We develop a theoretical model of how older worker dynamics and older worker heterogeneity shape the quality of their employment relationship—in terms of psychological contracts—which in turn shape their career trajectories and work role enactment. By centering this line of research on older workers, we gain a higher-resolution view of these late careers as unfolding over time and varying among older workers.

Functioning Changes in Varying Ways After Retirement: A Scoping Review

The association between retirement and functioning remains still poorly known. This scoping review examines physical, social, cognitive, and mental functioning after retirement, describes the changes in them, determines the different aspects that affect functioning, and documents the main characteristics of the phenomenon. We systematically scoped the relevant studies on functioning after retirement using CINAHL, MEDLINE, Medic, and PubMed databases. This scoping review included both qualitative and quantitative studies. The studies were analysed with inductive content analysis. After retirement, functioning was found to decline but also improve, and additionally, inequalities in functioning emerged. Functioning after retirement changed in ways which were: declining functioning, improving functioning, and inequalities in functioning. Only a few qualitative studies were found. This scoping review shows that functioning after retirement changes in varying ways. The results show that more qualitative research is needed to help us gain a more profound understanding on, for example, individuals' motives to improve leisure, physical, and social activities after retirement, which are likely to contribute to changes in functioning. Additionally, further longitudinal studies would offer knowledge about the long-term effects of retirement on the different dimensions of functioning.

The Role of Incarceration as a Risk Factor for Cognitive Impairment

OBJECTIVES

The objective of this study was to understand disparities in cognitive impairment between middle-aged formerly incarcerated (FI) and nonincarcerated individuals.

METHODS

The 1979 National Longitudinal Survey of Youth is a nationally representative longitudinal data set containing information on incarceration, cognitive functioning, and other health conditions. Using a modified version of the Telephone Interview for Cognitive Status (TICS-m), adapted from the Health and Retirement Study, we analyzed the association between incarceration and cognitive impairment, cognitive impairment-not dementia and dementia. Multivariable regression models were estimated, including prior incarceration status and covariates associated with incarceration and cognitive functioning.

RESULTS

FI individuals had lower unadjusted scores on TICS-m (-2.5, p < .001) and had significantly greater unadjusted odds ratios (OR) for scoring in the cognitive impairment (OR = 2.4, p < .001) and dementia (OR = 2.7, p < .001) range. Differences were largely explained by a combination of risk factors associated with incarceration and cognition. Education and premorbid cognition (measured by Armed Forces Qualification Test) separately and completely explained differences in the odds of dementia. Regardless of incarceration status, Blacks and Hispanics had significantly greater odds of cognitive impairment and dementia relative to Whites, holding other factors constant.

DISCUSSION

The association between prior incarceration and cognitive impairment in middle age was largely explained by differences in educational attainment and premorbid cognitive functioning, supporting the cognitive reserve hypothesis. Greater prevalence of cognitive impairment and dementia among the FI could create challenges and should be considered in reentry planning. Structural and institutional factors should be considered when addressing health disparities in Alzheimer's Disease and Related Dementias.

Working in old age in Mexico: Implications for Cognitive Functioning

Previous studies indicate that occupation might affect cognitive functioning in late life. As people in low and middle income countries often have to work until late life, we sought to investigate if there are cognitive benefits to working later into life and whether cognitive function deteriorates after exiting the labor force. We analyzed longitudinal data from the Mexican Health and Aging Study (MHAS), a nationally representative sample of Mexican adults age 50+ (n=7,375), that assessed cognitive functioning by verbal learning, delayed recall, and visual scanning. Analyses were carried out using mixed-effects modeling corrected for the influence of gender, IADLs, diabetes, stroke, hypertension, depression, income, and marital status. Results suggest that working actively, compared to exiting the workforce, was associated with cognitive performance only in context with occupation. Domestic workers had a faster decline in verbal learning (b=-0.02, p=0.020) and delayed recall (b=-0.02, p=0.036) if they continued working actively and people working in administration (b=0.03, p=0.007), sales (b=0.02, p=0.044), and educators (b=0.03, p=0.049) had a slower decline in visual scanning if they continued working in old age. Our findings indicate that continued participation in the labor force in old age does not necessarily come with cognitive benefits. Whether or not working actively in later life protects or even harms cognitive functioning is likely to depend on the type of job.

Job demands may determine cognitive and physical aging after retirement

During adulthood, we spend most of our time and efforts at work. However, the impact of employment in aging is poorly explored. Our study addressed how job demands can affect aging after retirement. We have developed a descriptive observational study carried out in 367 older adults with a mean age of 73.9 years (66.5% women and 33.5% men), measuring cognition and functional status. Our results demonstrate that older adults who had high mental demands in their jobs, show better scores in cognition. However, they show poor functional development of basic and instrumental activities of daily life (p< .05). In contrast, former workers who had high physical demands, display lower scores in cognition and lower functional performance in instrumental activities (p< .05). Work life activities contribute to cognitive and physical decline after retirement. Therefore, healthy aging should include interventions that consider the job influence on the age impairment.

The intersectionality of life course socioeconomic status, race, and cognitive decline: An 18-year follow-up

OBJECTIVES

Studies have documented the impact of childhood socioeconomic status (SES) on cognition. However, research that simultaneously considers SES in varied life stages, the multidimensional mechanisms, and racial differences is relatively understudied. This study examines the intersectionality across age, SES, and race and its impact on cognitive trajectories.

METHODS

Using 8376 respondents aged 65+ from the 1998-2016 Health and Retirement Study, we used latent growth curve modeling to examine the effects of four life course models (latency, pathway, accumulation, and mobility) on 18-year trajectories of mental status and episodic memory. We further tested for differences in the links between SES and cognitive trajectories between black and white respondents.

RESULTS

Cognitive function declines with age and is interrelated with SES and race. Adulthood has a stronger effect on cognitive performance than childhood. However, linked positive childhood and adulthood SES contributes to positive cognition. Accumulated SES disadvantages were associated with lower cognition. Older adults with downward mobility and low SES throughout their lifespans had the lowest cognition scores. Life course models operated differently on trajectories of cognitive decline, yet the effects were particularly evident among older black respondents. Overall, those with socioeconomic advantages tended to have a slower decline in cognition, while a faster decline occurred for those with accrued disadvantages.

CONCLUSIONS

Cognitive performance is a complex, longitudinal process intertwined with socioeconomic conditions and population heterogeneity shaped by life course contexts. Policies that facilitate healthy cognitive performance and address SES inequality could equalize health opportunities and address racial cognitive disparities later in life.

Assessing socioeconomic inequalities in cognitive impairment among older adults: a study based on a cross-sectional survey in India

Background

The rapidly aging population is a major concern for countries, especially where cognitive health in older age is poor. The study examined the socioeconomic and health-related factors associated with cognitive impairment among older adults and the contribution of those factors to the concentration of low cognitive functioning among older adults from economically poor households.

Methods

Data this study were derived from the “Building Knowledge Base on Population Ageing in India” (BKPAI) survey, which was carried out in seven major states of India. The effective sample size for the analysis was 9176 older adults aged 60 years and above. Results from descriptive and bivariate analysis were reported in the initial stage. Multivariable logistic regression analysis was conducted to explore the associations. Additionally, the concentration index and concentration curve were used to measure socioeconomic inequality in cognitive impairment among older adults. Wagstaff decomposition was employed to explore the key contributors in the concentration index.

Results

Nearly 60% of older adults suffered from cognitive impairment in the study. The likelihood of cognitive impairment were higher among older adults with a low level of self-perceived income sufficiency [coefficient: 0.29; confidence interval (CI): 0.07- 0.52] compared to older adults with higher levels of perceived income status. Older adults with more than 10 years of schooling were less likely to be cognitively impaired [coefficient: -1.27; CI: − 1.50- -1.04] in comparison to those with no education. Cognitive impairment was concentrated among older adults from households with the lowest wealth quintile (concentration index (CCI): − 0.10: p < 0.05). Educational status explained 44.6% of socioeconomic inequality, followed by 31.8% by wealth status and 11.5% by psychological health. Apart from these factors, difficulty in instrumental activities of daily living (3.7%), caste (3.7%), and perceived income sufficiency to fulfil basic needs (3.0%) explained socioeconomic inequality in cognitive impairment among older adults.

Conclusions

Findings suggest that older adults with lower perceived income, lower levels of education, poor physical and mental health, and poor physical and social resources were more likely to be cognitively impaired. Education, wealth and psychological health are major contributors in socioeconomic inequality in late-life cognitive impairment, which may be target areas in future policy formulation to reduce the inequality in cognitive impairment in older Indian adults.

2022 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 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, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. 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 $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. 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 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.

Psychometric Properties of the Revised Dysexecutive Questionnaire in a Non-clinical Population

Aims

The aim of this study was to assess the psychometric properties of the revised self-rated version of the Dysexecutive Questionnaire (DEX-R) within a non-clinical sample.

Methods

The study was hosted online, with 140 participants completing the DEX-R, GAD-2 and PHQ-2. Sixty participants also completed the FrSBe, with 99 additionally completing the DEX-R again 3 weeks later. Correlations with demographic factors and symptoms of anxiety and depression were conducted. Rasch and factor analysis were also used to explore underlying subconstructs.

Results

The DEX-R correlated highly with the FrSBe, indicating sound concurrent validity. Internal consistency, split-half reliability and test-retest reliability were excellent. Age and symptoms of depression and anxiety correlated with DEX-R scores, with older age associated with less dysexecutive problems. The Rasch analysis confirmed the multidimensionality of the rating scale, and a three-factor structure was found relating to activation-self-regulatory, cognitive and social-emotional processes. Frequencies of responses on DEX-R items varied, many were not fully endorsed indicating specific relevance of most but not all items to patients.

Conclusion

Interpretations of DEX-R ratings of dysexecutive problems should consider mood and individual variation. Systematic comparison of DEX-R responses between healthy and clinical groups could help identify a suitable cut off for dysexecutive symptoms.

Relationship between immunometabolic status and cognitive performance among major depression disorder patients

BACKGROUND

Alterations in cognitive performance have been described in patients with major depressive disorder (MDD). However, the specific risk factors of these changes are not yet known. This study aimed to explore whether inmunometabolic parameters are related to cognitive performance in MDD in comparison to healthy controls (HC) METHODS: Sample consisted of 84 MDD patients and 78 HC. Both groups were compared on the results of cognitive performance measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB), the presence of metabolic syndrome (MetS) and an inflammatory/oxidative index calculated by a principal component analysis of peripheral biomarkers (tumor necrosis factor, C-reactive protein and 4-hydroxynonenal). A multiple linear regression was carried out, to study the relationship between inmunometabolic variables and the global cognitive performance, being the latter the dependent variable.

RESULTS

Significant differences were obtained in the inflammatory/oxidative index between both groups (F₍₁₁₅₇₎= 12.93; p < .001), also in cognitive performance (F₍₁₁₅₇₎= 56.75; p < .001). The inmunometabolic covariate regression model (i.e., condition (HC/MDD), sex, age and medication loading, MetS, inflammatory/oxidative index and the interaction between MetS and inflammatory/oxidative index) was statistically significant (F₍₇₁₅₇₎= 11.24; p < .01) and explained 31% of variance. The condition, being either MDD or HD, (B=-0.97; p < .001), age (B=-0.28; p < .001) and the interaction between inflammatory/oxidative index and MetS (B=-0.38; p = .02) were factors associated to cognitive performance.

LIMITATIONS

Sample size was relatively small. The cross-sectional design of the study limits the possibilities of analysis.

CONCLUSIONS

Our results provide evidence on the conjoint influence of metabolic and inflammatory dysregulation on cognitive dysfunction in MDD patients. In this way, our study opens a line of research in immunometabolic agents to deal with cognitive decline associated with MDD.

Cognitive reserve over life course and 7-year trajectories of cognitive decline: results from China health and retirement longitudinal study

Background

Cognitive reserve (CR) could partly explain the individual heterogeneity in cognitive decline. No study measured CR from a life course perspective and investigated the association between CR and trajectories of cognitive decline in older Chinese adults.

Methods

Data of 6795 Chinese adults aged 60+ from China Health and Retirement Longitudinal Study were used. Global cognition score (0–32) was assessed in all four waves. A life-course CR score was constructed using markers of childhood circumstance, education, highest occupational class, and leisure activities in later life. Latent growth curve modelling (LGCM) was applied to assess the association between CR and trajectories of cognitive decline.

Results

For the life-course CR, factor loadings of markers in adulthood and later life were larger than that of markers in childhood. The life-course CR score (ranged between − 2.727 and 6.537, SD: 1.74) was higher in urban Chinese adults (0.75, SD: 1.90) than in rural Chinese adults (− 0.50, SD: 1.43). The unconditional LGCM results showed that urban older Chinese adults had better global cognition at baseline (intercept: 15.010, 95% CI: 14.783, 15.237) and a slower rate of cognitive decline per year (linear slope: -0.394, 95% CI: − 0.508, − 0.281) than their rural counterparts (intercept: 12.144, 95% CI: 11.960, 12.329; linear slope: -0.498, 95% CI: − 0.588, − 0.408). After controlling for all covariates, one-unit higher CR score was associated with 1.615 (95% CI: 1.521, 1.709) and 1.768 (95% CI: 1.659, 1.876) unit higher global cognition at baseline for urban and rural older Chinese adults, respectively. The slower rate of cognitive decline associated with higher CR was more evident in rural residents (slope: 0.083, 95% CI: 0.057, 0.108) than in their urban counterparts (0.054, 95% CI: 0.031, 0.077).

Conclusions

CR was associated with better baseline cognition and slower cognitive decline in Chinese older adults. Although rural residents were disadvantaged in both CR and cognition, the protective effect of CR against cognitive decline was stronger for them than in those who live in urban area.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12671-6.

Revisiting the Effect of Retirement on Cognition: Heterogeneity and Endowment

Since the seminal paper of Rohwedder and Willis (2010), the effect of retirement on cognition has drawn significant research interest from economists. Especially with ongoing policy discussions about public pension reforms and the increasing burden of dementia, it is indisputably an important research question with significant policy implications. Building on this growing literature, our paper makes two important contributions. First, we explicitly consider cognitive demands of jobs in studying hetereogeneity of the retirement effect. As the primary explanation for the potential adverse effect of retirement is that cognition is better maintained through mental exercise (Salthouse, 2006), by investigating the cognitive demands of the job one retires from we can directly test the hypothesized relationship. Second, we avoid biases associated with omitted variables, particularly by controlling for endowed cognitive ability. While endowed, genetic differences in cognitive ability is an important omitted variable that can explain individual differences in cognitive performance as well as selection into a particular type of job, this inherited characteristic has not been controlled for in the prior literature. Taking advantage of the polygenic risk score of cognition (Davies et al., 2015), we control for individual differences in genetic endowments in estimating the effect of retirement on cognition. We find supporting evidence for differential effects of retirement by cognitive demands of jobs after controlling for innate differences in cognition and educational attainment.

How Welfare Regimes Moderate the Associations Between Cognitive Aging, Education, and Occupation

OBJECTIVES

Previous studies have shown the importance of individual markers of cognitive reserve, such as education and occupation, for cognitive health in old age. However, there has been only little investigation so far on how this relationship varies across contexts.

METHODS

We analyzed data from the Survey of Health, Ageing, and Retirement in Europe, using second-order latent growth models, to assess the moderating role of welfare regimes on the relationship between education and occupation skill level in explaining overall cognitive functioning and decline in old age. Our sample includes 13 European countries using data from 5 regular waves of the survey (2004-2007 and 2011-2015) and 2 retrospective ones (2008-2009 and 2017). Cognitive functioning was modeled as a latent variable measured by immediate and delayed recall, verbal fluency, and numeracy.

RESULTS

74,193 participants were included from the survey. Our analysis showed that the association of education with cognition was weaker overall in Scandinavian countries, but stronger in Southern European countries, relative to Bismarckian ones. However, educational differences in the decline of cognition were more pronounced only in Scandinavian compared to Bismarckian countries. Additionally, higher-skilled occupations in Scandinavian countries had better overall functioning compared to the same occupations in Bismarckian countries, but there was no difference in the decline in cognitive functioning.

DISCUSSION

Our findings indicate that the associations of cognitive functioning and its decline with individuals' cognitive reserve markers (education and occupational skill level) vary according to welfare regimes, showing the importance of contextual factors in cognitive aging processes.

Association of mental demands in the workplace with cognitive function in older adults at increased risk for dementia

Objectives

Growing evidence suggests a protective effect of high mental demands at work on cognitive function in later life. However, evidence on corresponding associations in older adults at increased risk for dementia is currently lacking. This study investigates the association between mental demands at work and cognitive functioning in the population of the AgeWell.de-trial.

Methods

Cross-sectional investigation of the association between global cognitive functioning (Montreal Cognitive Assessment) and mental demands at work in older individuals at increased risk for dementia (Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE)score ≥ 9; n = 941, age: 60–77 years). Occupational information was matched to Occupational Information Network (O*NET)-descriptors. Associations between cognitive function and O*NET-indices executive, verbal and novelty were investigated using generalized linear models.

Results

Higher values of index verbal (b = .69, p = .002) were associated with better cognitive function when adjusting for covariates. No association was observed for indices executive (b = .37, p = .062) and novelty (b = .45, p = .119). Higher education, younger age, and employment were linked to better cognitive function, while preexisting medical conditions did not change the associations. Higher levels of depressive symptomatology were associated with worse cognitive function.

Conclusions

Higher levels of verbal demands at work were associated with better cognitive function for older adults with increased dementia risk. This suggests an advantage for older persons in jobs with high mental demands even after retirement and despite prevalent risk factors. Longitudinal studies are warranted to confirm these results and evaluate the potential of workplaces to prevent cognitive decline through increased mental demands.

Birth Cohorts and Cognitive Reserve Influence Cognitive Performances in Older Adults

BACKGROUND

Evidence suggests birth cohort differences in cognitive performance of older adults. Proxies of cognitive reserve (CR), such as educational attainment and occupational complexity, could also partly account for these differences as they are influenced by the sociocultural environment of the birth cohorts.

OBJECTIVE

To predict cognitive performance using birth cohorts and CR and examine the moderating influence of CR on cognitive performance and structural brain health association.

METHODS

Using ADNI data (n = 1628), four birth cohorts were defined (1915-1928; 1929-1938; 1939-1945; 1946-1964). CR proxies were education, occupational complexity, and verbal IQ. We predicted baseline cognitive performances (verbal episodic memory; language and semantic memory; attention capacities; executive functions) using multiple linear regressions with CR, birth cohorts, age, structural brain health (total brain volume; total white matter hyperintensities volume) and vascular risk factors burden as predictors. Sex and CR interactions were also explored.

RESULTS

Recent birth cohorts, higher CR, and healthier brain structures predicted better performance in verbal episodic memory, language and semantic memory, and attention capacities, with large effect sizes. Better performance in executive functions was predicted by a higher CR and a larger total brain volume, with a small effect size. With equal score of CR, women outperformed men in verbal episodic memory and language and semantic memory in all cohorts. Higher level of CR predicted better performance in verbal episodic memory, only when total brain volume was lower.

CONCLUSION

Cohort differences in cognitive performance favor more recent birth cohorts and suggests that this association may be partly explained by proxies of CR.

Retirement type and cognitive functioning in Japan

OBJECTIVES

A growing literature examines the effect of retirement on cognitive function, but pays little attention to how this relationship may depend upon the nature of retirement. Of particular importance is the growing prevalence of gradual retirement characterized by continued employment - either with a new employer or with the same employer - after retiring from a career job.

METHODS

We use data from men and women aged 50 or older in the Japanese Study of Aging and Retirement to examine the effects of full retirement, partial retirement with the same employer, and partial retirement with a new employer on cognitive function. Our analyses consider the moderating role of career job complexity and exploit distinctive features of the Japanese public pension and mandatory retirement systems to estimate the causal effect of retirement type on cognition.

RESULTS

Results indicate that partial retirement with the same employer has a significant and adverse effect on cognitive function (relative to those not yet retired). In contrast, those who experienced either full retirement or partial retirement with a new employer were, on average, no different from those still in their career job. Partial retirement with a new employer has a beneficial effect on cognition among those who had a high complexity career job.

DISCUSSION

Results are consistent with the idea that novel work exposures and experiences have a beneficial effect on cognition. They also suggest that ongoing policy efforts to promote partial retirement with the same employer may have unexpected adverse implications for cognitive health.

Organizational Justice and Cognitive Failures in Japanese Employees: A Cross-Sectional Study

OBJECTIVE

We examined the association of organizational justice (ie, procedural justice and interactional justice) with cognitive failures, and the mediation effect of psychological distress on this association in Japanese employees.

METHODS

A total of 189 men and 35 women from two sites of a manufacturing company in Japan were surveyed using a self-administered web-based questionnaire. A multiple mediation analysis was conducted.

RESULTS

A significant negative total effect of procedural justice on cognitive failures was observed (c = -0.180 [95% confidence interval: -0.315 to -0.044]). Furthermore, the mediation effect of psychological distress was significant (c-c' = -0.213 [95% confidence interval: -0.323 to -0.115]). Similar patterns were observed for interactional justice.

CONCLUSIONS

Employees may be more likely to experience cognitive failures in daily activities in work settings where organizational justice is lower, which seems to be explained by psychological distress.

On the Biopsychosocial Costs of Alienated Labor

Data from the national, longitudinal Mid-Life in the US (MIDUS) study were used to examine work alienation and its relationship to biological health as well as psychological and social functioning. The alienation measure focuses on the autonomy and creativity the work provides. We hypothesized that alienated work would have negative associations with each of the three domains: in biology, higher 'allostatic load' (biological dysregulation); in psychology, poorer cognitive performance; and socially, negative impacts on family life. The outcomes are generally as predicted, though there are notable differences for men and women.

Mentally Challenging Occupations Are Associated With More Rapid Cognitive Decline at Later Stages of Cognitive Aging

OBJECTIVES

Engaging in mentally challenging activities is associated with reduced risk for cognitive impairment and dementia; however, its association with rates of cognitive decline has been inconsistent. The aim of this study is to test whether working in mentally challenging occupations is related to rates of cognitive change at later older adulthood.

METHOD

The sample consisted of 1,520 individuals (baseline mean age = 78.6 ± 5.1, range = 64-100) from the Einstein Aging Study. Occupation information of each participant was collected retrospectively and linked with the substantive complexity of work score from the Dictionary of Occupational Titles. Cognitive changes in memory, speed, and executive function (EF) domains were represented using two time metrics (i.e., time from retirement, time from study enrollment).

RESULTS

Results from mixed models showed that occupational complexity was associated with significantly faster rates of cognitive decline in speed and EF in the "time from retirement" model but not in the "time from baseline" model. Despite faster cognitive loss, the protective effect of occupational complexity persisted for decades after retirement due to higher initial levels of cognition.

DISCUSSION

The result suggests that protective factors for cognitive health may be associated with delayed onset but more rapid cognitive decline afterwards at later stages of cognitive aging.

Impact of occupational complexity on cognitive decline in the oldest-old

OBJECTIVES

The theory of "Cognitive Reserve" assumes that premorbid factors such as high educational and occupational attainment may enable a better way of coping with brain damage. It has been suggested that more stimulating lifestyles, including more complex work environments, may provide a buffer against cognitive decline in later life. This study aimed to investigate the association between occupational history and cognitive decline in a large cohort of Italian oldest-old.

METHODS

392 individuals (266 women/126 men, mean age 93 ± 3 years) enrolled in the "Mugello study" provided information about their work history. Jobs were classified in nine categories, according to the level of expertise required to perform them, as suggested by the Italian National Institute for Statistics (ISTAT). In addition, socio-demographic characteristics, comorbidities, level of independence, depression, and cognitive status were assessed. The presence of dementia was established based on cognitive status and independence in performing four selected instrumental activities of daily living (ability to manage telephone, transportation, medications, and budget).

RESULTS

Neither work complexity (p = 0.995) nor work duration (p = 0.701) showed a significant effect on the likelihood of presenting a lower cognitive profile or developing dementia (p = 0.385 and p = 0.096, for work complexity and work duration, respectively).

CONCLUSION

In the observed sample of oldest-old individuals, cognitive decline did not seem to be influenced by cognitive reserve as assessed through the evaluation of cognitive status and level of independence. It is conceivable that in this population, the decline of the brain reserve has a preponderant role in the definition of the cognitive profile.

Physical Activity and Health Among Native Hawaiian and other Pacific Islander Older Adults

Objectives: Native Hawaiian and other Pacific Islander (NHPI) older adults often experience social disadvantages and poor health outcomes. Physical activity has been associated with better health in other racial groups, but limited studies have examined these associations in NHPI older adults. Methods: Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n = 1,045), logistic regression models examined associations between physical activity and memory/psychological distress/self-rated health. Results: Sufficient levels of physical activity were associated with lower odds of memory problems, serious psychological distress, and poor/fair self-rated health. Unfortunately, only half of the sample reported sufficient physical activity and approximately 30% reported none. Also, 78% of the sample was estimated to be overweight/obese, and 29% had diabetes. Discussion: Culturally-appropriate interventions are recommended to increase physical activity in this population, which could also help reduce high rates of overweight/obesity and diabetes.

Development of a protective mental work demands questionnaire

OBJECTIVES

Research shows that mental demands at work affect later-life cognitive functioning and dementia risk, but systematic assessment of protective mental work demands (PMWDs) is still missing. The goal of this research was to develop a questionnaire to assess PMWDs.

DESIGN

The instrument was developed in accordance with internationally recognized scientific standards comprising conceptualization, pretesting, and validation via confirmatory factor analysis (CFA), principal component analysis (PCA), and multiple regression analyses.

PARTICIPANTS

We included 346 participants, 72.3% female, with an average age of 56.3 years.

MEASUREMENT

Item pool, sociodemographic questions, and cognitive tests: Trail-Making Test A/B, Word List Recall, Verbal Fluency Test, Benton Visual Retention Test, Reading Minds in the Eyes Test.

RESULTS

CFAs of eight existing PMWD-concepts revealed weaker fit indices than PCA of the item pool that resulted in five concepts. We computed multivariate regression analyses with all 13 PMWD-concepts as predictors of cognitive functioning. After removing PMWD-concepts that predicted less than two cognitive test scores and excluding others due to overlapping items, the final questionnaire contained four PMWD-concepts: Mental Workload (three items, Cronbach's α = .58), Verbal Demands (four, Cronbach's α = .74), Information Load (six, Cronbach's α = .83), and Extended Job Control (six, Cronbach's α = .83).

CONCLUSIONS

The PMWD-Questionnaire intends to assess protective mental demands at the workplace. Information processing demands and job control make up the primary components emphasizing their relevance regarding cognitive health in old age. Long-term follow-up studies will need to validate construct validity with respect to dementia risk.

Does postponing retirement affect cognitive function? A counterfactual experiment to disentangle life course risk factors

Evidence suggests that contemporaneous labor force participation affects cognitive function; however, it is unclear whether it is employment itself or endogenous factors related to individuals’ likelihood of employment that protects against cognitive decline. We exploit innovations in counterfactual causal inference to disentangle the effect of postponing retirement on later-life cognitive function from the effects of other life-course factors. With the U.S. Health and Retirement Study (1996–2014, n = 20,469), we use the parametric g-formula to estimate the effect of postponing retirement to age 67. We also study whether the benefit of postponing retirement is affected by gender, education, and/or occupation, and whether retirement affects cognitive function through depressive symptoms or comorbidities. We find that postponing retirement is protective against cognitive decline, accounting for other life-course factors (population: 0.34, 95% confidence interval (CI): 0.20,0.47; individual: 0.43, 95% CI: 0.26,0.60). The extent of the protective effect depends on subgroup, with the highest educated experiencing the greatest mitigation of cognitive decline (individual: 50%, 95% CI: 32%,71%). By using innovative models that better reflect the empirical reality of interconnected life-course processes, this work makes progress in understanding how retirement affects cognitive function.

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Research is inconclusive as to employments' protection against cognitive decline.

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Causal inference models can better reflect interconnected life-course processes.

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The parametric g-formula shows a substantial protective effect of ongoing employment.

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Protective effect holds for all subgroups, but is greatest for the highest educated.

Multigenerational Households During Childhood and Trajectories of Cognitive Functioning Among U.S. Older Adults

OBJECTIVES

Family structure in childhood influences early brain development and cognitive performance in adulthood. Much less is known about its long-term impact on later-life cognitive functioning. We extend the two-generation family structure approach to investigate the potential contribution of living with grandparents in multigenerational households to differences in cognitive functioning at older ages.

METHODS

Data were drawn from 9 waves of the Health and Retirement Study (1998-2014) merged with newly collected childhood family history data. Five types of family structure were assessed: two-parent households, two-parent households with grandparents, single-parent households, single-parent households with grandparents, and grandparent-headed households. Growth curve models were used to estimate trajectories of cognitive functioning over time.

RESULTS

Childhood family structure was significantly associated with level of cognitive functioning, but not to rate of cognitive decline. Relative to those from two-parent households, individuals who grew up in multigenerational households showed higher levels of cognitive functioning, including those living with a single parent and grandparents. Those who lived with a single parent alone were the most disadvantaged. The effects of these multigenerational households persisted net of childhood and adulthood socioeconomic status and health outcomes.

DISCUSSION

Grandparent coresidence may cultivate a socially enriched home environment, providing resources and protection for early cognitive development that could persist throughout life. Multigenerational living arrangements are likely to increase as the contemporary population ages. More research needs to be done to understand the impact of these living arrangements on future generations' brain health and cognitive aging.