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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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2
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O’Keefe P, Muniz-Terrera G, Voll S, Clouston S, Wanström L, Mann FD, Lee Rodgers J, Hofer SM. Cohort Changes and Sex Differences After Age 50 in Cognitive Variables in the English Longitudinal Study of Ageing. J Gerontol B Psychol Sci Soc Sci 2023; 78:1636-1641. [PMID: 37326391 PMCID: PMC10561880 DOI: 10.1093/geronb/gbad089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES This paper models cognitive aging, across mid and late life, and estimates birth cohort and sex differences in both initial levels and aging trajectories over time in a sample with multiple cohorts and a wide span of ages. METHODS The data used in this study came from the first 9 waves of the English Longitudinal Study of Ageing, spanning 2002-2019. There were n = 76,014 observations (proportion male 45%). Dependent measures were verbal fluency, immediate recall, delayed recall, and orientation. Data were modeled using a Bayesian logistic growth curve model. RESULTS Cognitive aging was substantial in 3 of the 4 variables examined. For verbal fluency and immediate recall, males and females could expect to lose about 30% of their initial ability between the ages of 52 and 89. Delayed recall showed a steeper decline, with males losing 40% and females losing 50% of their delayed recall ability between ages 52 and 89 (although females had a higher initial level of delayed recall). Orientation alone was not particularly affected by aging, with less than a 10% change for either males or females. Furthermore, we found cohort effects for initial ability level, with particularly steep increases for cohorts born between approximately 1930 and 1950. DISCUSSION These cohort effects generally favored later-born cohorts. Implications and future directions are discussed.
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Affiliation(s)
- Patrick O’Keefe
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Stacey Voll
- Institute in Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Sean Clouston
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Linda Wanström
- Department of Computer and Information Science, Linkoping University, Linköping, Sweden
| | - Frank D Mann
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Joseph Lee Rodgers
- Department of Psychology and Human Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Scott M Hofer
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
- Institute in Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
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3
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Guo S, Zheng XY. New evidence of trends in cognitive function among middle-aged and older adults in China, 2011-2018: an age-period-cohort analysis. BMC Geriatr 2023; 23:498. [PMID: 37605117 PMCID: PMC10440902 DOI: 10.1186/s12877-023-04166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Increasing evidence from high-income countries suggests the risk of cognitive impairment has been declining recently. However, related studies in China have rarely been done, and the results are inconsistent. We analyze the trends in cognitive function among middle-aged and older adults in China between 2011 and 2018. METHODS We used data from four waves of the China Health and Retirement Longitudinal Study (CHARLS), including 48918 individuals aged 45 years and older. Cognitive function was assessed using the CHARLS cognitive measures containing episodic memory, orientation, attention, and visuospatial abilities. The hierarchical age-period-cohort (APC) model was used to quantify the separate age, period, and cohort effects on trends in cognitive function. RESULTS The study sample's ages ranged from 45 to 105 years (Mean = 59.2, SD = 9.4). Cognitive function declined with age net of period and cohort effects, an apparent acceleration in the rate of cognitive decline after age 65 was found adjusting for individual characteristics. Although period effects on trends in cognitive function remained stable during the study period, hierarchical APC models demonstrated significant cohort variations. Independent of age and period effects, there was a fluctuating trend across cohorts before 1960 and an overall decline across successive cohorts. CONCLUSIONS Our study indicates that the age effect remains the most crucial factor regarding cognitive decline. Moreover, results demonstrate that cohorts living in social upheaval leading to educational deprivation and/or nutritional deficiency in early life may face a higher risk for cognitive deterioration later in life. Such findings indicate that dementia prevention from a life course perspective and cohort-specific strategies are critical to alleviating the future public-health burdens related to cognitive aging. Ongoing attention should be paid to the role of cross-cohort differences in education on cohort trends in cognition in countries like China that are aging rapidly and have a late start in educational expansion compared to other countries. Other factors, such as environmental stimulation, need to be noticed in younger cohorts.
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Affiliation(s)
- Shuai Guo
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing, 100073, P.R. China
| | - Xiao-Ying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing, 100073, P.R. China.
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4
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Gerstorf D, Ram N, Drewelies J, Duezel S, Eibich P, Steinhagen-Thiessen E, Liebig S, Goebel J, Demuth I, Villringer A, Wagner GG, Lindenberger U, Ghisletta P. Today's Older Adults Are Cognitively Fitter Than Older Adults Were 20 Years Ago, but When and How They Decline Is No Different Than in the Past. Psychol Sci 2023; 34:22-34. [PMID: 36282991 DOI: 10.1177/09567976221118541] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
History-graded increases in older adults' levels of cognitive performance are well documented, but little is known about historical shifts in within-person change: cognitive decline and onset of decline. We combined harmonized perceptual-motor speed data from independent samples recruited in 1990 and 2010 to obtain 2,008 age-matched longitudinal observations (M = 78 years, 50% women) from 228 participants in the Berlin Aging Study (BASE) and 583 participants in the Berlin Aging Study II (BASE-II). We used nonlinear growth models that orthogonalized within- and between-person age effects and controlled for retest effects. At age 78, the later-born BASE-II cohort substantially outperformed the earlier-born BASE cohort (d = 1.20; 25 years of age difference). Age trajectories, however, were parallel, and there was no evidence of cohort differences in the amount or rate of decline and the onset of decline. Cognitive functioning has shifted to higher levels, but cognitive decline in old age appears to proceed similarly as it did two decades ago.
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Affiliation(s)
- Denis Gerstorf
- Department of Psychology, Humboldt University Berlin.,German Socio-Economic Panel Study (SOEP), German Institute for Economic Research (DIW), Berlin, Germany
| | - Nilam Ram
- Departments of Psychology and Communication, Stanford University
| | - Johanna Drewelies
- Department of Psychology, Humboldt University Berlin.,Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Sandra Duezel
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Peter Eibich
- Labor Demography Research Group, Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Stefan Liebig
- German Socio-Economic Panel Study (SOEP), German Institute for Economic Research (DIW), Berlin, Germany
| | - Jan Goebel
- German Socio-Economic Panel Study (SOEP), German Institute for Economic Research (DIW), Berlin, Germany
| | - Ilja Demuth
- Department of Endocrinology and Metabolic Medicine at the Charite-Universitätsmedizin Berlin.,Charité-Universitätsmedizin Berlin, BCRT-Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Gert G Wagner
- German Socio-Economic Panel Study (SOEP), German Institute for Economic Research (DIW), Berlin, Germany.,Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.,Federal Institute for Population Research, Wiesbaden, Germany
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.,Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany
| | - Paolo Ghisletta
- Faculty of Psychology and Educational Sciences, University of Geneva.,UniDistance Suisse.,Swiss National Centre of Competence in Research LIVES, University of Geneva
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5
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Clouston SAP, Muñiz Terrera G, Rodgers JL, O'Keefe P, Mann F, Lewis NA, Wänström L, Kaye J, Hofer SM. Cohort and Period Effects as Explanations for Declining Dementia Trends and Cognitive Aging. POPULATION AND DEVELOPMENT REVIEW 2021; 47:611-637. [PMID: 36937313 PMCID: PMC10021404 DOI: 10.1111/padr.12409] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Studies have reported that the age-adjusted incidence of cognitive impairment and dementia may have decreased over the past two decades. Aging is the predominant risk factor for Alzheimer's disease and related dementias and for neurocognitive decline. However, aging cannot explain changes in overall age-adjusted incidence of dementia. The objective of this position paper was to describe the potential for cohort and period effects in cognitive decline and incidence of dementia. Cohort effects have long been reported in demographic literature, but starting in the early 1980s, researchers began reporting cohort trends in cognitive function. At the same time, period effects have emerged in economic factors and stressors in early and midlife that may result in reduced cognitive dysfunction. Recognizing that aging individuals today were once children and adolescents, and that research has clearly noted that childhood cognitive performance is a primary determinant of old-age cognitive performance, this is the first study that proposes the need to connect known cohort effects in childhood cognition with differences in late-life functioning.
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Affiliation(s)
- Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Graciela Muñiz Terrera
- Biostatistics and Epidemiology, Center for Dementia Prevention, University of Edinburgh, Edinburgh, UK
| | - Joseph Lee Rodgers
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | - Frank Mann
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Nathan A Lewis
- Department of Psychology, University of Victoria, Victoria, BC
| | - Linda Wänström
- Department of Computer and Informational Science, Linköping University, Linköping, Sweden
| | - Jeffrey Kaye
- Oregon Center for Aging and Technology, Oregon Health and Sciences University, and NIA-Layton Aging & Alzheimer's Disease Center, Portland, OR, USA
| | - Scott M Hofer
- Department of Psychology, University of Victoria, Victoria, BC
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Alvarez JA, Medford A, Strozza C, Thinggaard M, Christensen K. Stratification in health and survival after age 100: evidence from Danish centenarians. BMC Geriatr 2021; 21:406. [PMID: 34210289 PMCID: PMC8252309 DOI: 10.1186/s12877-021-02326-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The existence of a super-select group of centenarians that demonstrates increased survivorship has been hypothesized. However, it is unknown if this super-select group possesses similar characteristics apart from extreme longevity. METHODS In this study, we analyse high-quality health and survival data of Danish centenarians born in 1895, 1905 and 1910. We use Latent Class Analysis to identify unobserved health classes and to test whether these super-select lives share similar health characteristics. RESULTS We find that, even after age 100, a clear and distinct gradient in health exists and that this gradient is remarkably similar across different birth cohorts of centenarians. Based on the level of health, we identify three clusters of centenarians - robust, frail and intermediate - and show that these groups have different survival prospects. The most distinctive characteristic of the robust centenarians is the outperformance in different health dimensions (physical, functional and cognitive). Finally, we show that our health class categorizations are good predictors of the survival prospects of centenarians. CONCLUSIONS There is a clear stratification in health and functioning among those over 100 years of age and these differences are associated with survival beyond age 100.
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Affiliation(s)
- Jesús-Adrián Alvarez
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark.
| | - Anthony Medford
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark
| | - Cosmo Strozza
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark
| | - Mikael Thinggaard
- Danish Aging Research Center, Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Kaare Christensen
- Danish Aging Research Center, Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Genetics and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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7
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Munukka M, Koivunen K, von Bonsdorff M, Sipilä S, Portegijs E, Ruoppila I, Rantanen T. Birth cohort differences in cognitive performance in 75- and 80-year-olds: a comparison of two cohorts over 28 years. Aging Clin Exp Res 2021; 33:57-65. [PMID: 32918698 PMCID: PMC7897605 DOI: 10.1007/s40520-020-01702-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/28/2020] [Indexed: 11/12/2022]
Abstract
Objective To evaluate cohort differences in cognitive performance in older men and women born and assessed 28 years apart. Methods Data in this study were drawn from two age-homogeneous cohorts measured in the same laboratory using the same standardized cognitive performance tests. Participants in the first cohort were born in 1910 and 1914 and assessed in 1989–1990 (Evergreen project, n = 500). Participants in the second cohort were born in 1938 or 1939 and 1942 or 1943 and assessed in 2017–2018 (Evergreen II, n = 726). Participants in both cohorts were assessed at age 75 and 80 years and were recruited from the population register. Cognitive performance was measured using the Digit Span test from the Wechsler Memory Scale (WMS), Digit Symbol test from the Wechsler Adult Intelligence Scale (WAIS) and phonemic Verbal Fluency test from the Schaie-Thurstone Adult Mental Abilities Test. Reaction time assessing motor and mental responses was measured with a simple finger movement task, followed by a complex finger movement task. T-tests were used to study cohort differences and linear regression models to study possible factors underlying differences. Results We found statistically significant cohort differences in all the cognitive performance tests, except for the digit span test and simple movement task in men, the later-born cohort performing better in all the measured outcomes. Conclusions The results of this study provide strong evidence that cognitive performance is better in more recent cohorts of older people compared to their counterparts measured 28 years earlier.
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8
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Wetzel M, Vanhoutte B. Putting cumulative (dis)advantages in context: Comparing the role of educational inequality in later-life functional health trajectories in England and Germany. PLoS One 2020; 15:e0244371. [PMID: 33378335 PMCID: PMC7773250 DOI: 10.1371/journal.pone.0244371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The cumulative (dis)advantage (CAD) perspective more and more is examined in a comparative way, to highlight the role of context in generating inequality over the life course. This study adds to this field of research by examining trajectories of activities of daily living (ADL) in later life by educational level in a country comparison of England and Germany, emphasizing differing institutional conditions. METHOD Data used are the English Longitudinal Study of Ageing (ELSA; 11,352 individuals) and the German subsample of the Survey of Health and Retirement in Europe (SHARE; 5,573 individuals). Using population averaged Poisson panel regression models, 12-year trajectories of six birth cohorts are investigated, covering the age range of 50 to 90 years. RESULTS Respondents in England have a higher level of limitations at age 50, and more limited increases over age than in Germany. An educational gradient exists in both countries at age 50. Notably, the educational gradient increases for more recently born cohorts, but declines with increasing age in England, while in Germany educational differences increase for more recently born cohort only. DISCUSSION The current study indicates that CAD processes between educational groups are context sensitive. While England showed convergence of disparities with increasing age, in Germany no differential development was found.
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Affiliation(s)
| | - Bram Vanhoutte
- École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Department of Sociology, University of Manchester, Manchester, United Kingdom
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9
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Graves LV, Drozdick L, Courville T, Farrer TJ, Gilbert PE, Delis DC. Cohort differences on the CVLT-II and CVLT3: Evidence of a negative Flynn effect on the attention/working memory and learning trials. Clin Neuropsychol 2019; 35:615-632. [PMID: 31829090 DOI: 10.1080/13854046.2019.1699605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Although cohort effects on IQ measures have been investigated extensively, studies exploring cohort differences on verbal memory tests, and the extent to which they are influenced by socioenvironmental changes across decades (e.g. educational attainment; ethnic makeup), have been limited. METHOD We examined differences in performance between the normative samples of the CVLT-II from 1999 and the CVLT3 from 2016 to 2017 on the immediate- and delayed-recall trials, and we explored the degree to which verbal learning and memory skills might be influenced by the cohort year in which norms were collected versus demographic factors (e.g. education level). RESULTS Multivariate analysis of variance tests and follow-up univariate tests yielded evidence for a negative cohort effect (also referred to as negative Flynn effect) on performance, controlling for demographic factors (p = .001). In particular, findings revealed evidence of a negative Flynn effect on the attention/working memory and learning trials (Trial 1, Trial 2, Trial 3, Trials 1-5 Total, List B; ps < .007), with no significant cohort differences found on the delayed-recall trials. As expected, education level, age group, and ethnicity were significant predictors of CVLT performance (ps < .01). Importantly, however, there were no interactions between cohort year of norms collection and education level, age group, or ethnicity on performance. CONCLUSIONS The clinical implications of the present findings for using word list learning and memory tests like the CVLT, and the potential role of socioenvironmental factors on the observed negative Flynn effect on the attention/working memory and learning trials, are discussed.
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Affiliation(s)
- Lisa V Graves
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | - Troy Courville
- Professional Education, Georgia Institute of Technology, Atlanta, GA, USA
| | - Thomas J Farrer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Paul E Gilbert
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Dean C Delis
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA, USA
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10
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Spatial navigation deficits - overlooked cognitive marker for preclinical Alzheimer disease? Nat Rev Neurol 2019; 14:496-506. [PMID: 29980763 DOI: 10.1038/s41582-018-0031-x] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Detection of incipient Alzheimer disease (AD) pathophysiology is critical to identify preclinical individuals and target potentially disease-modifying therapies towards them. Current neuroimaging and biomarker research is strongly focused in this direction, with the aim of establishing AD fingerprints to identify individuals at high risk of developing this disease. By contrast, cognitive fingerprints for incipient AD are virtually non-existent as diagnostics and outcomes measures are still focused on episodic memory deficits as the gold standard for AD, despite their low sensitivity and specificity for identifying at-risk individuals. This Review highlights a novel feature of cognitive evaluation for incipient AD by focusing on spatial navigation and orientation deficits, which are increasingly shown to be present in at-risk individuals. Importantly, the navigation system in the brain overlaps substantially with the regions affected by AD in both animal models and humans. Notably, spatial navigation has fewer verbal, cultural and educational biases than current cognitive tests and could enable a more uniform, global approach towards cognitive fingerprints of AD and better cognitive treatment outcome measures in future multicentre trials. The current Review appraises the available evidence for spatial navigation and/or orientation deficits in preclinical, prodromal and confirmed AD and identifies research gaps and future research priorities.
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11
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Bancks M, Alonso A, Allen N, Yaffe K, Carnethon M. Temporal trends in cognitive function of older US adults associated with population changes in demographic and cardiovascular profiles. J Epidemiol Community Health 2019; 73:612-618. [PMID: 30885985 PMCID: PMC7240358 DOI: 10.1136/jech-2018-211985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent estimates suggest that dementia incidence is decreasing in the US possibly due to better management of cardiovascular disease (CVD) risk factors, but these studies lack repeated cross-sectional assessment among a representative US sample. Our objective was to assess temporal trends in cognitive performance in relation to CVD risk factors among older National Health and Nutrition Examination Survey (NHANES) participants. METHODS We used repeated cross-sectional assessment of 5711 participants ≥60 years of age from four NHANES cycles: 1999-2000, 2001-2002, 2011-2012 and 2013-2014. Cognitive function was assessed during each cycle with the Digit Symbol Substitution Test (DSST). We estimated mean DSST score at each cycle and annual trend in DSST before and after adjustment for age, sex, race/ethnicity, education, smoking status, blood pressure, glucose status and body mass index. RESULTS DSST scores was significantly higher for 2011-2012 (difference: 6.7, 95% CI 4.4 to 9.0) and 2013-2014 (difference: 6.2, 95% CI 4.0 to 8.5), but not 2001-2002 (difference: 2.3, 95% CI -0.01 to 4.6) as compared with 1999-2000 before adjustment. We observed a linear trend for higher annual DSST score before adjustment (DSST/year: 0.44, 95% CI 0.31 to 0.57) and after adjustment for age, sex, race/ethnicity, educational attainment and CVD risk factors (DSST/year: 0.17, 95% CI 0.08 to 0.26). Educational attainment was most strongly associated with the attenuation in the trend in cognitive function (77% of trend attenuation and 20% of variance in DSST). CONCLUSION Cognitive function is improving over time for US adults aged ≥60 years. These improvements are strongly associated with greater educational attainment and irrespective of the changing US demographic and cardiovascular health profiles.
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Affiliation(s)
- Michael Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alvaro Alonso
- Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Norrina Allen
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Mercedes Carnethon
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
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12
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Ahrenfeldt LJ, Lindahl-Jacobsen R, Rizzi S, Thinggaard M, Christensen K, Vaupel JW. Comparison of cognitive and physical functioning of Europeans in 2004-05 and 2013. Int J Epidemiol 2019; 47:1518-1528. [PMID: 29868871 PMCID: PMC6208267 DOI: 10.1093/ije/dyy094] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 12/18/2022] Open
Abstract
Background Adult mortality has been postponed over time to increasingly high ages. However, evidence on past and current health trends has been mixed, and little is known about European disability trends. Methods In a cross-sectional setting, we compared cognitive and physical functioning in same-aged Europeans aged 50+ between 2004–05 (wave 1; n = 18 757) and 2013 (wave 5 refresher respondents; n = 16 696), sourced from the Survey of Health, Ageing and Retirement in Europe (SHARE). Results People in 2013 had better cognitive function compared with same-aged persons in 2004–05, with an average difference of approximately one-third standard deviation. The same level of cognitive function in 2004–05 at age 50 was found in 2013 for people who were 8 years older. There was an improvement in cognitive function in all European regions. Mean grip strength showed an improvement in Northern Europe of 1.00 kg [95% confidence interval (CI) 0.65; 1.35] and in Southern Europe of 1.68 kg (95% CI 1.14; 2.22), whereas a decrease was found in Central Europe (-0.80 kg; 95% CI −1.16; −0.44). We found no overall differences in activities of daily living (ADL), but small improvements in instrumental activities of daily living (IADL) in Northern and Southern Europe, with an improvement in both ADL and IADL from age 70 in Northern Europe. Conclusions Our results indicate that later-born Europeans have substantially better cognitive functioning than earlier-born cohorts. For physical functioning, improvements were less clear, but for Northern Europe there was an improvement in ADL and IADL in the oldest age groups.
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Affiliation(s)
- Linda J Ahrenfeldt
- Interdisciplinary Center for Research and Education on Population Change, University of Southern Denmark, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Interdisciplinary Center for Research and Education on Population Change, University of Southern Denmark, Odense, Denmark
| | - Silvia Rizzi
- Interdisciplinary Center for Research and Education on Population Change, University of Southern Denmark, Odense, Denmark
| | - Mikael Thinggaard
- Interdisciplinary Center for Research and Education on Population Change, University of Southern Denmark, Odense, Denmark.,Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - James W Vaupel
- Interdisciplinary Center for Research and Education on Population Change, University of Southern Denmark, Odense, Denmark.,Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
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Grasset L, Jacqmin-Gadda H, Proust-Lima C, Pérès K, Amieva H, Dartigues JF, Helmer C. Temporal Trends in the Level and Decline of Cognition and Disability in an Elderly Population: The PAQUID Study. Am J Epidemiol 2018; 187:2168-2176. [PMID: 29893786 DOI: 10.1093/aje/kwy118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Abstract
In line with declining trends in dementia incidence, we compared the cognitive and functional evolution of 2 "generations" of elderly individuals aged 78-88 years, who were included 10 years apart in the French Personnes Agées Quid cohort (n = 612 in 1991-1992 and n = 628 in 2001-2002) and followed-up for 12 years with assessments of cognition and disability. The impact of specific risk factors on this evolution was evaluated. Differences between the generations in baseline levels and decline over time were estimated using a joint model to account for differential attrition. Compared with the first generation, the second generation had higher performances at baseline on 4 cognitive tests (from P < 0.005). Differences in global cognition, verbal fluency, and processing speed, but not in working memory, were mostly explained by improvement in educational level. The second generation also exhibited less cognitive decline in verbal fluency and working memory. Progression of disability was less over the follow-up period for the second generation than for the first. The cognitive state of this elderly population improved, partially due to improvements in educational level.
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Affiliation(s)
- Leslie Grasset
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Hélène Jacqmin-Gadda
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Cécile Proust-Lima
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Karine Pérès
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Hélène Amieva
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
| | - Jean-François Dartigues
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Bordeaux University Hospital, Memory Consultation, Memory Resource and Research Centre, Bordeaux, France
| | - Catherine Helmer
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
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