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Li P, Alkhuzam K, Brown J, Zhang Y, Jiao T, Guo J, Umpierrez GE, Narayan KMV, Kulshreshtha A, Pasquel FJ, Ali MK, Shao H. Association between low cognitive performance and diabetes-related health indicators across racial and ethnic groups in adults with diabetes. Diabetes Obes Metab 2024; 26:3723-3731. [PMID: 38899435 DOI: 10.1111/dom.15715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/11/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024]
Abstract
AIM To examine the associations between low cognitive performance (LCP) and diabetes-related health indicators (including body mass index [BMI], HbA1c, systolic blood pressure [SBP], low-density lipoprotein [LDL] and self-reported poor physical health) and whether these associations vary across racial/ethnic subgroups. METHODS We identified adults aged 60 years or older with self-reported diabetes from the 2011-2014 National Health and Nutrition Examination Survey. Individuals with cognitive test scores in the lowest quartile were defined as having LCP. We used regression models to measure the associations of LCP with diabetes-related biometrics (BMI, HbA1c, SBP and LDL); and self-reported poor physical health. Moreover, we explored potential variations in these associations across racial/ethnic subgroups. RESULTS Of 873 (261 with LCP) adults with diabetes, LCP was associated with higher HbA1c, SBP and LDL (adjusted difference: 0.41%, 5.01 mmHg and 5.08 mg/dL, respectively; P < .05), and greater odds of reporting poor physical health (adjusted odds ratio: 1.59, P < .05). The association between LCP and HbA1c was consistent across racial/ethnic groups, and notably pronounced in Hispanic and Other. BMI worsened with LCP, except for non-Hispanic Black. Excluding the Other group, elevated SBP was observed in people with LCP, with Hispanic showing the most significant association. LDL levels were elevated with LCP for Hispanic and Other. Physical health worsened with LCP for both non-Hispanic Black and Hispanic. CONCLUSIONS We quantified the association between LCP and diabetes-related health indicators. These associations were more pronounced in Hispanic and Other racial/ethnic groups.
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Affiliation(s)
- Piaopiao Li
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Khalid Alkhuzam
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Joshua Brown
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Centre for Drug Evaluation and Safety, Department of Pharmaceutical Evaluation and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Yichen Zhang
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Tianze Jiao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Centre for Drug Evaluation and Safety, Department of Pharmaceutical Evaluation and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Centre for Drug Evaluation and Safety, Department of Pharmaceutical Evaluation and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Guillermo E Umpierrez
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Division of Endocrinology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - K M Venkat Narayan
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ambar Kulshreshtha
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Francisco J Pasquel
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Endocrinology, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Mohammed K Ali
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Hui Shao
- Emory Global Diabetes Research Centre of Woodruff Health Sciences Centre, Emory University, Atlanta, Georgia, USA
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, Georgia, USA
- Centre for Drug Evaluation and Safety, Department of Pharmaceutical Evaluation and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Min SH, Schnall R, Lee C, Topaz M. Relationship between hemoglobin and specific cognitive domain among older adults using network analysis. Aging Ment Health 2024:1-8. [PMID: 38919074 DOI: 10.1080/13607863.2024.2370442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES Hemoglobin (Hgb) is associated with cognitive function, with low and high levels of Hgb leading to impaired cerebral oxygenation and perfusion. Yet, current studies focused on understanding the association between Hgb and cognitive function without consideration for each cognitive domain. Thus, this study aims to identify and visualize potentially interactive associations between Hgb and specific cognitive domains among older adults. METHOD This is a secondary data analysis using Wave II data from the National Social Life, Health, and Aging Project (NSHAP) and included 1022 older adults aged between 65 and 85 years. The network structure of three different models was estimated to understand the association between specific cognitive domains and Hgb in a mixed graphical model using the R-package 'mgm'. Model 1 did not adjust for any covariates, Model 2 adjusted for age and gender, and Model 3 adjusted for all covariates. RESULTS Among all cognitive domains, the visuospatial (edge weight = 0.06-0.10) and memory domains (0.04-0.07) were associated with Hgb in all three models Though not present in Model 3, the attention domain was associated with Hgb in Model 1 and Model 2 (0.08-0.11). In addition, the predictability of Hgb was the highest (8.1%) in Model 3. CONCLUSION Findings from this study suggest that cognition should be considered as a multidimensional construct, and its specific cognitive domain should be carefully assessed and managed in relation to Hgb among older adults.
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Affiliation(s)
- Se Hee Min
- Columbia University School of Nursing, New York, NY, USA
| | - Rebecca Schnall
- Mary Dickey Lindsay Professor of Disease Prevention and Health Promotion in Nursing, Columbia University School of Nursing, New York, NY, USA
| | - Chiyoung Lee
- The University of Arizona College of Nursing, Tucson, AZ, USA
| | - Maxim Topaz
- Elizabeth Standish Gill Associate Professor of Nursing, Columbia University School of Nursing, New York, NY, USA
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Chyr LC, Wolff JL, Zissimopoulos JM, Drabo EF. Analysis of agreement between measures of subjective cognitive impairment and probable dementia in the National Health and Aging Trends Study. Alzheimers Dement 2024; 20:2817-2829. [PMID: 38426381 PMCID: PMC11032562 DOI: 10.1002/alz.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Subjective cognitive impairment (SCI) measures in population-based surveys offer potential for dementia surveillance, yet their validation against established dementia measures is lacking. METHODS We assessed agreement between SCI and a validated probable dementia algorithm in a random one-third sample (n = 1936) of participants in the 2012 National Health and Aging Trends Study (NHATS). RESULTS SCI was more prevalent than probable dementia (12.2% vs 8.4%). Agreement between measures was 90.0% and of substantial strength. Misclassification rates were higher among older and less-educated subgroups due to higher prevalence of false-positive misclassification but did not vary by sex or race and ethnicity. DISCUSSION SCI sensitivity (63.4%) and specificity (92.5%) against dementia were comparable with similar metrics for the NHATS probable dementia measure against the "gold-standard" Aging, Demographics, and Memory Study-based dementia criteria, implying that population-based surveys may afford cost-effective opportunities for dementia surveillance to assess risk and inform policy. HIGHLIGHTS The prevalence of subjective cognitive impairment (SCI) is generally higher than that of a validated measure of probable dementia, particularly within the youngest age group, females, Whites, and persons with a college or higher degree. Percent agreement between SCI and a validated measure of probable dementia was 90.0% and of substantial strength (prevalence- and bias-adjusted kappa, 0.80). Agreement rates were higher in older and less-educated subgroups, driven by the higher prevalence of false-positive disagreement, but did not vary significantly by sex or race and ethnicity. SCI's overall sensitivity and specificity were 63.4% and 92.5%, respectively, against a validated measure of probable dementia, suggesting utility as a low-cost option for dementia surveillance. Heterogeneity in agreement quality across subpopulations warrants caution in its use for subgroup analyses.
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Affiliation(s)
- Linda C. Chyr
- Enterprise Analytics Core, Elevance Health, Inc.WilmingtonDelawareUSA
| | - Jennifer L. Wolff
- Department of Health Policy and ManagementJohn Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Julie M. Zissimopoulos
- Sol Price School of Public PolicyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health PolicyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Emmanuel F. Drabo
- Department of Health Policy and ManagementJohn Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Kindratt TB, Moncriffe B, Ajrouch KJ, Zahodne LB, Dallo FJ. Diabetes Among Racial and Ethnically Diverse Older Adults in the United States with Cognitive Limitations. J Racial Ethn Health Disparities 2024; 11:238-247. [PMID: 36648623 PMCID: PMC10350474 DOI: 10.1007/s40615-023-01514-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
Diabetes is one of the most common coexisting conditions among adults with cognitive limitations. Complexities of diabetes care present challenges for older adults and their caregivers. Few studies have evaluated disparities in the prevalence of coexisting diabetes among older adults with cognitive limitations by race/ethnicity and nativity. Our objectives were to (1) estimate the odds of coexisting diabetes among US- and foreign-born racial/ethnic groups compared to US-born non-Hispanic White older adults and (2) compare US- and foreign-born older adults within each racial/ethnic group. We linked and analyzed 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data among older adults with cognitive limitations (ages ≥ 65 years, n = 4688). The overall prevalence of coexisting diabetes among older adults with cognitive limitations was 30.3%. Among older adults with cognitive limitations and after adjusted for age, sex, education, and risk factors for diabetes and cognitive limitations, non-Hispanic Black (US-born OR = 1.56, 95%CI = 1.23-1.98; foreign-born OR = 2.69, 95%CI = 1.20-6.05) and Hispanic (US-born OR = 2.13, 95%CI = 1.34-3.40; foreign-born OR = 2.02, 95%CI = 1.49-2.72) older adults had higher odds of coexisting diabetes compared to US-born non-Hispanic Whites. There were no differences in the odds of coexisting diabetes among foreign-born non-Hispanic Black and Hispanic adults compared to US-born counterparts. Findings suggest a large potential burden of coexisting diabetes among this growing populations of US- and foreign-born racially/ethnically diverse older adults with cognitive limitations. Future studies are needed to examine how diabetes self-efficacy, treatment, and monitoring are impacted by cognitive limitations and determine ways to improve care in collaboration with caregivers and healthcare providers.
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Affiliation(s)
- Tiffany B Kindratt
- Department of Kinesiology, College of Nursing and Health Innovation, Public Health Program, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 75019-0259, USA.
| | - Berford Moncriffe
- Department of Kinesiology, College of Nursing and Health Innovation, Public Health Program, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 75019-0259, USA
| | - Kristine J Ajrouch
- Department of Sociology, Anthropology and Criminology, Eastern Michigan University, 712 Pray-Harrold, Ypsilanti, MI, 48197, USA
- Institute for Social Research, University of Michigan, 426 Thompson Street, MI, 48104, Ann Arbor, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Florence J Dallo
- School of Health Sciences, Oakland University, Rochester, MI, 48309-4452, USA
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Alkhawaldeh A, Alsaraireh M, ALBashtawy M, Rayan A, Khatatbeh M, Alshloul M, Aljezawi M, ALBashtawy S, Musa A, Abdalrahim A, Khraisat O, AL-Bashaireh A, ALBashtawy Z, Alhroub N. Assessment of Cognitive Impairment and Related Factors Among Elderly People in Jordan. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2024; 29:120-124. [PMID: 38333338 PMCID: PMC10849287 DOI: 10.4103/ijnmr.ijnmr_169_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/08/2023] [Accepted: 10/06/2023] [Indexed: 02/10/2024]
Abstract
Background With an increase in elderly people, it is essential to address the issue of cognitive impairment and support healthy aging. This study aimed to assess cognitive impairment and factors associated with it among older adults. Materials and Methods A cross-sectional study was carried out in different catchment areas within the Jerash governorate in the north of Jordan. The Elderly Cognitive Assessment Questionnaire (ECAQ) and a household face-to-face interview were used to collect data from 220 older adult participants aged 60 years and more. Descriptive statistics were conducted to describe the study variables. Correlation tests were applied to find associations between them. Logistic regression analysis was applied, with a minimum significance level (p < 0.05). Results About 9.10% of the older adults had cognitive impairment. Cognitive impairment was correlated with age, self-perceived health, hypertension, stroke, and mental illness. The primary predictors of cognitive impairment were age [odds ratio (OR) =1.07 (1.01-1.14), p = 0.001] and stroke [OR = 10.92 (1.44-82.85), p = 0.001]. Conclusions While many factors were correlated with cognitive impairment, the strongest predictors of cognitive impairment were age and stroke.
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Affiliation(s)
- Abdullah Alkhawaldeh
- Department of Community and Mental Health Nursing, Princess Salma Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Mahmoud Alsaraireh
- Department of Nursing, Princess Aisha Bint Al Hussein College of Nursing and Health Sciences, Al-Hussain Bin Talal University, Ma’an, Jordan
| | - Mohammed ALBashtawy
- Department of Community and Mental Health Nursing, Princess Salma Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Ahmad Rayan
- Department of Nursing, Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | - Moawiah Khatatbeh
- Al-Balqa Applied University, Prince Al Hussein Bin Abdullah II Academy for Civil Protection, Amman, Jordan
| | | | - Ma’en Aljezawi
- Department of Community and Mental Health Nursing, Princess Salma Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Sa’d ALBashtawy
- Department of Nursing, Princess Salma Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Ahmad Musa
- Faculty of Nursing, Al-Ahliyya Amman University, Amman, Jordan
| | - Asem Abdalrahim
- Department of Community and Mental Health Nursing, Princess Salma Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
| | - Omar Khraisat
- Faculty of Health Sciences, Higher College of Technology, Abu Dhabi, United Arab Emirates
| | - Ahmad AL-Bashaireh
- Department of Public Health, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Zaid ALBashtawy
- Al-Balqa Applied University, Prince Al Hussein Bin Abdullah II Academy for Civil Protection, Amman, Jordan
| | - Nisser Alhroub
- Department of Nursing, Faculty of Nursing, Jerash University, Jerash, Jordan
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Min SH, Topaz M, Lee C, Schnall R. Racial Differences in Older Adult's Mental Health and Cognitive Symptomatology: Identifying Subgroups Using Multiple-Group Latent Class Analysis. J Aging Health 2023:8982643231212547. [PMID: 37907211 PMCID: PMC11139013 DOI: 10.1177/08982643231212547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Little is known on the potential racial differences in latent subgroup membership based on mental health and cognitive symptomatology among older adults. METHODS This is a secondary data analysis of Wave 2 data from the National Social Life, Health, and Aging Project (N = 1819). Symptoms were depression, anxiety, loneliness, happiness, and cognition. Multiple-group latent class analysis was conducted to identify latent subgroups based on mental health and cognitive symptoms and to compare these differences between race. RESULTS Class 1: "Severe Cognition & Mild-Moderate Mood Impaired," Class 2: "Moderate Cognition & Mood Impaired," and Class 3: "Mild Cognition Impaired & Healthy Mood" were identified. Black older adults were more likely to be in Class 1 while White older adults were more likely to be in Class 2 and Class 3. DISCUSSION Clinicians need to provide culturally-sensitive care when assessing and treating symptoms across different racial groups.
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Affiliation(s)
- Se Hee Min
- School of Nursing, Columbia University, New York, NY, USA
| | - Maxim Topaz
- School of Nursing, Columbia University, New York, NY, USA
| | - Chiyoung Lee
- Bothell School of Nursing & Health Studies, University of Washington, Bothell, WA, USA
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Fredriksen-Goldsen K, Petros R, Jung HH, Kim HJ. Sexual Minority Disparities in Subjective Cognitive Impairment: Do They Persist After Accounting for Psychological Distress? J Aging Health 2023; 35:727-735. [PMID: 36843284 PMCID: PMC10680409 DOI: 10.1177/08982643231156286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Objectives: Sexual minority older adults are a health disparate group with disproportionate rates of subjective cognitive impairment (SCI) and psychological distress. This study estimated risks of SCI by sexual orientation and gender, accounting for variations in psychological distress. Methods: We aggregated National Health Interview Survey data (2013-2018) of adults aged 45 and older and implemented logistic regressions of SCI indicators on sexual orientation and psychological distress, adjusting for covariates. Results: Sexual minority adults showed higher likelihoods of SCI in terms of status, severity, frequency, extent, and activity limitations than heterosexuals, even after controlling for psychological distress. SCI risk was significantly higher among sexual minority vs. heterosexual women, with no significant difference among men. Conclusions: Public health initiatives should address this health disparity in SCI and support informal care networks for sexual minorities. Future research is needed that further investigates SCI at-risk groups, with attention to sexual minority women.
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Affiliation(s)
| | - Ryan Petros
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Hailey H Jung
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA, USA
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Dinesh D, Shao Q, Palnati M, McDannold S, Zhang Q, Monfared AAT, Jasuja GK, Davila H, Xia W, Moo LR, Miller DR, Palacios N. The epidemiology of mild cognitive impairment, Alzheimer's disease and related dementia in U.S. veterans. Alzheimers Dement 2023; 19:3977-3984. [PMID: 37114952 DOI: 10.1002/alz.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 04/29/2023]
Abstract
INTRODUCTION US veterans have a unique dementia risk profile that may be evolving over time. METHODS Age-standardized incidence and prevalence of Alzheimer's disease (AD), AD and related dementias (ADRD), and mild cognitive impairment (MCI) was estimated from electronic health records (EHR) data for all veterans aged 50 years and older receiving Veterans Health Administration (VHA) care from 2000 to 2019. RESULTS The annual prevalence and incidence of AD declined, as did ADRD incidence. ADRD prevalence increased from 1.07% in 2000 to 1.50% in 2019, primarily due to an increase in the prevalence of dementia not otherwise specified. The prevalence and incidence of MCI increased sharply, especially after 2010. The prevalence and incidence of AD, ADRD, and MCI were highest in the oldest veterans, in female veterans, and in African American and Hispanic veterans. DISCUSSION We observed 20-year trends of declining prevalence and incidence of AD, increasing prevalence of ADRD, and sharply increasing prevalence and incidence of MCI.
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Affiliation(s)
- Deepika Dinesh
- Department of Public Health, University of Massachusetts at Lowell, Zuckerberg College of Health Sciences, Lowell, Massachusetts, USA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Qing Shao
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Madhuri Palnati
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Sarah McDannold
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Quanwu Zhang
- Easai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
| | - Amir Abbas Tahami Monfared
- Easai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
- McGill University, Epidemiology, Biostatistics, and Occupational Health, Montreal, Quebec, Canada
| | - Guneet K Jasuja
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather Davila
- Center for Access & Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa, USA
- General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Weiming Xia
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren R Moo
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Donald R Miller
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Natalia Palacios
- Department of Public Health, University of Massachusetts at Lowell, Zuckerberg College of Health Sciences, Lowell, Massachusetts, USA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
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Soh Y, Eng CW, Mayeda ER, Whitmer RA, Lee C, Peterson RL, Mungas DM, Glymour MM, Gilsanz P. Association of primary lifetime occupational cognitive complexity and cognitive decline in a diverse cohort: Results from the KHANDLE study. Alzheimers Dement 2023; 19:3926-3935. [PMID: 37057753 PMCID: PMC10517075 DOI: 10.1002/alz.13038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Higher occupational complexity has been linked to favorable cognitive outcomes, but rarely examined in racially and ethnically diverse populations. METHODS In a diverse cohort (n = 1536), linear mixed-effects models estimated associations between main lifetime occupational complexity and domain-specific cognitive decline (z-standardized). Occupational complexity with data, people, and things were classified using the Dictionary of Occupational Titles. RESULTS For occupational complexity with data, highest tertile (vs. lowest) was associated with higher baseline executive function (β = 0.11; 95% confidence interval [CI] 0.00-0.22) and slower annual rate of decline (β = 0.03; 95% CI 0.01-0.06), and higher baseline semantic memory (β = 0.14; 95% CI 0.04-0.25). Highest tertile of occupational complexity with people was associated with higher baseline executive function (β = 0.29; 95% CI 0.18-0.40), verbal episodic memory (β = 0.12; 95% CI 0.00-0.24), and semantic memory (β = 0.23; 95% CI 0.12-0.34). DISCUSSION In a diverse cohort, higher occupational complexity is associated with better cognition. Findings should be verified in larger cohorts. HIGHLIGHT Few studies have examined associations of occupational complexity with cognition in diverse populations. Racial and ethnic minorities are disproportionately exposed to lower occupational complexity. Occupational complexity with data and people are associated with better cognition.
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Affiliation(s)
- Yenee Soh
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Chloe W Eng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Elizabeth Rose Mayeda
- Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Rachel A Whitmer
- Department of Neurology, School of Medicine, University of California, Davis, Davis, California, USA
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Catherine Lee
- Kaiser Permanente Division of Research, Oakland, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Rachel L Peterson
- University of Montana, School of Public and Community Health Sciences, Missoula, MT, USA
| | - Dan M Mungas
- Department of Neurology, School of Medicine, University of California, Davis, Davis, California, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Paola Gilsanz
- Kaiser Permanente Division of Research, Oakland, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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Cai J, Bidulescu A. The association between food insecurity and cognitive impairment among the US adults: The mediation role of anxiety or depression. J Affect Disord 2023; 325:73-82. [PMID: 36603601 DOI: 10.1016/j.jad.2022.12.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Using a nationally representative sample, this study aimed to examine (1) socio-demographic and health-related disparities in cognitive impairment, (2) the association between food insecurity and cognitive impairment, and (3) the mediation role of anxiety or depression in the pathway between food insecurity and cognitive impairment. METHODS Cross-sectional data of 28,508 adults from the 2020 National Health Interview Survey were analyzed. Multivariable logistic regression models were used to estimate associations with cognitive impairment. Mediation analyses were conducted using the four-way decomposition method under a counterfactual framework. RESULTS Disparities in cognitive impairment were observed across socio-demographic and health-related characteristics (all p < 0.0001). Food insecurity was significantly associated with cognitive impairment in the overall population and the magnitude of the association was greater for the young or middle-aged, females and non-Hispanic Blacks than the general population (AOR ranged from 1.19 to 2.54, all p < 0.01). With anxiety as a mediator, 28.66 % of the total effect of food insecurity on cognitive impairment was attributable to mediation only, and 22.39 % was attributable to interaction (between food insecurity and anxiety) and mediation. With depression as a mediator, 22.33 % of the total effect was attributable to mediation only, and 16.00 % was attributable to interaction (between food insecurity and depression) and mediation. LIMITATIONS The cross-sectional design prevents inference of causality. CONCLUSIONS Ensuring available and adequate food resources is important to prevent adverse cognitive outcomes. Clinical interventions or treatments for anxiety or depression may help improve cognitive function.
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Affiliation(s)
- Jiahui Cai
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America.
| | - Aurelian Bidulescu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, United States of America
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Kindratt TB, Dallo FJ, Zahodne LB, Ajrouch KJ. Cognitive Limitations Among Middle Eastern and North African Immigrants. J Aging Health 2022; 34:1244-1253. [PMID: 35606926 PMCID: PMC9633450 DOI: 10.1177/08982643221103712] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate and compare the prevalence of cognitive limitations among Middle Eastern and North African (MENA) immigrants compared to US- and foreign-born non-Hispanic Whites from Europe (including Russia/former USSR) and examine differences after controlling for risk factors. METHODS Cross-sectional data using linked 2000-2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey data (ages >=65 years, n = 24,827) were analyzed. RESULTS The prevalence of cognitive limitations was 17.3% among MENA immigrants compared to 9.6% and 13.6% among US- and foreign-born non-Hispanic Whites from Europe. MENA immigrants had higher odds (OR = 1.88; 95% CI = 1.06-3.34) of reporting a cognitive limitation than US-born non-Hispanic Whites after controlling for age, sex, education, hearing loss, hypertension, depression, social isolation, and diabetes. DISCUSSION To further examine cognitive health among the MENA aging population, policy changes are needed to identify this group that is often absent from research because of their federal classification as non-Hispanic Whites.
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Affiliation(s)
- Tiffany B. Kindratt
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Florence J. Dallo
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Laura B. Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kristine J. Ajrouch
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Department of Sociology, Anthropology and Criminology, Eastern Michigan University, Ypsilanti, MI, USA
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12
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Adjoian Mezzaca T, Dodds LV, Rundek T, Zeki Al Hazzouri A, Caunca MR, Gomes-Osman J, Loewenstein DA, Schneiderman N, Elfassy T. Associations Between Cognitive Functioning and Mortality in a Population-Based Sample of Older United States Adults: Differences by Sex and Education. J Aging Health 2022; 34:905-915. [PMID: 35440227 DOI: 10.1177/08982643221076690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To determine whether cognition is associated with mortality among older US adults. Methods: We studied 5,989 National Health and Nutrition Examination Survey participants age 60+ in years 1999-2014 with mortality follow-up through 2015. Cognitive function was measured in one standard deviation decrements using the Digit Symbol Substitution Test (DSST), Animal Fluency (AnFl), and two Consortium to Establish a Registry for Alzheimer's Disease (CERAD) tests. Results: Each decrement in cognitive function was associated with increased risk of mortality overall (DSST HR: 1.36, 95% CI: 1.25, 1.48), among women only (AnFl: 1.51, 95% CI: 1.02, 2.24), and among those with less than a high school education only (AnFl HR: 1.46, 95% CI: 1.09, 1.97; CERAD-WL HR: 1.34, 95% CI: 1.07, 1.67; and CERAD-DR HR: 1.38, 95% CI: 1.05, 1.82). Discussion: Among US adults, lower cognitive functioning was associated with mortality; associations were stronger among women and those with less education.
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Affiliation(s)
| | - Leah V Dodds
- Department of Public Health Sciences, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, Evelyn F. McKnight Brain Institute, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, 5798Columbia University, New York City, NY, USA
| | - Michelle R Caunca
- Department of Public Health Sciences, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joyce Gomes-Osman
- Department of Neurology, Evelyn F. McKnight Brain Institute, 12235University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Physical Therapy, Miami Miller School of Medicine, Miami, FL, USA
| | - David A Loewenstein
- Department of Psychiatry and Behavioral Sciences, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neil Schneiderman
- Department of Psychology, 5452University of Miami, Coral Gables, FL, USA
| | - Tali Elfassy
- Department of Medicine, 12235University of Miami Miller School of Medicine, Miami, FL, USA
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13
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Fredriksen-Goldsen KI, Jung H, Kim HJ, Petros R, Emlet C. Disparities in Subjective Cognitive Impairment by Sexual Orientation and Gender in a National Population Based Study of U.S. Adults, 2013-2018. J Aging Health 2022; 34:519-528. [PMID: 34645296 PMCID: PMC10484229 DOI: 10.1177/08982643211046466] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: This is the first national population-based study to examine cognitive impairment disparities among sexual minority mid-life and older adults. Methods: Using the National Health Interview Survey (2013-2018), we compared weighted prevalence of subjective cognitive impairment by sexual orientation and gender, among those aged 45 plus, applying logistic regressions adjusting for age, income, education, race/ethnicity, and survey years. Results: Sexual minorities (24.5%) were more likely to have subjective cognitive impairment than heterosexuals (19.1%). Sexual minority women had higher odds of greater severity, frequency, and extent of subjective cognitive impairment. Sexual minorities were also more likely to report activity limitations resulting from cognitive impairment and were no more likely to attribute limitations to dementia or senility. Discussion: Cognitive health disparities are of particular concern in this historically and socially marginalized population. The investigation of explanatory factors is needed, and targeted interventions and policies are warranted to address cognitive challenges faced by sexual minorities.
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Affiliation(s)
| | - Hailey Jung
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Ryan Petros
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Charles Emlet
- School of Social Work, University of Washington, Seattle, WA, USA
- University of Washington, Tacoma, WA, USA
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14
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Lu K, Xiong X, Horras A, Jiang B, Li M. Impact of financial barriers on health status, healthcare utilisation and economic burden among individuals with cognitive impairment: a national cross-sectional survey. BMJ Open 2022; 12:e056466. [PMID: 35508339 PMCID: PMC9073389 DOI: 10.1136/bmjopen-2021-056466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To study the impact of financial barriers to healthcare on health status, healthcare utilisation and costs among patients with cognitive impairment. DESIGN Cross-sectional. SETTING National Health Interview Survey (NHIS), 2011-2017. PARTICIPANTS Patients with cognitive impairment aged 18 years or older. INTERVENTIONS Financial barriers to healthcare were identified using a series of NHIS prompts asking about the affordability of healthcare services. PRIMARY OUTCOME MEASURES Health status was based on a survey prompt about respondents' general health. Healthcare utilisation included office visits, home healthcare visits, hospital stays and emergency department (ED) visits. Economic burden was based on the family spending on medical care. Logistic regression models were used to examine the impact of financial barriers to healthcare access on health status, home healthcare visits, office visits, hospital stays and ED visits, respectively. RESULTS Compared with cognitively impaired respondents without financial barriers to healthcare access, those with financial barriers were more likely to be unhealthy (OR 0.64, 95% CI 0.57 to 0.72). Cognitively impaired respondents with financial barriers were less likely to have home healthcare (OR 0.69, 95% CI 0.48 to 0.99) and more likely to have hospital stays (OR 1.33, 95% CI 1.19 to 1.48) and ED visits (OR 1.50, 95% CI 1.35 to 1.67). In addition, compared with cognitively impaired respondents without financial barriers to healthcare access, those with the barriers were more likely to have an increased economic burden (OR=1.85, 95% CI 1.65 to 2.07). CONCLUSION Financial barriers to healthcare worsened health status and increased use of ED, hospitalisation and economic burden. Policy decision-makers, providers and individuals with cognitive impairment should be aware of the impact of financial barriers and take corresponding actions to reduce the impact.
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Affiliation(s)
- Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaomo Xiong
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Ashley Horras
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, South Carolina, USA
| | - Bin Jiang
- Department of Administrative and Clinical Pharmacy, Peking University, Beijing, China
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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15
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Lawn RB, Jha SC, Liu J, Sampson L, Murchland AR, Sumner JA, Roberts AL, Disner SG, Grodstein F, Kang JH, Kubzansky LD, Chibnik LB, Koenen KC. The association of posttraumatic stress disorder, depression, and head injury with mid-life cognitive function in civilian women. Depress Anxiety 2022; 39:220-232. [PMID: 34970809 PMCID: PMC8901526 DOI: 10.1002/da.23233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Despite evidence linking posttraumatic stress disorder (PTSD), depression, and head injury, separately, with worse cognitive performance, investigations of their combined effects on cognition are limited in civilian women. METHODS The Cogstate Brief Battery assessment was administered in 10,681 women from the Nurses' Health Study II cohort, mean age 64.9 years (SD = 4.6). Psychological trauma, PTSD, depression, and head injury were assessed using online questionnaires. In this cross-sectional analysis, we used linear regression models to estimate mean differences in cognition by PTSD/depression status and stratified by history of head injury. RESULTS History of head injury was prevalent (36%), and significantly more prevalent among women with PTSD and depression (57% of women with PTSD and depression, 21% of women with no psychological trauma or depression). Compared to having no psychological trauma or depression, having combined PTSD and depression was associated with worse performance on psychomotor speed/attention ( β = -.15, p = .001) and learning/working memory ( β = -.15, p < .001). The joint association of PTSD and depression on worse cognitive function was strongest among women with past head injury, particularly among those with multiple head injuries. CONCLUSIONS Head injury, like PTSD and depression, was highly prevalent in this sample of civilian women. In combination, these factors were associated with poorer performance on cognitive tasks, a possible marker of future cognitive health. Head injury should be further explored in future studies of PTSD, depression and cognition in women.
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Affiliation(s)
- Rebecca B Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shaili C. Jha
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jiaxuan Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Audrey R. Murchland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, CA, Los Angeles, CA, USA
| | - Andrea L. Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Seth G. Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Francine Grodstein
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Jae H. Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lori B. Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Carty CL, Noonan C, Muller C, Suchy-Dicey A, Fretts AM, Verney SP, Howard BV, Buchwald D. Mid-Life Physical Activity and Late-Life Cognitive Performance among American Indians. Neuroepidemiology 2022; 56:119-126. [PMID: 35114678 PMCID: PMC9121743 DOI: 10.1159/000521791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/24/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Research on factors associated with late-life cognitive performance in diverse racial/ethnic groups is increasingly important due to the growing size and racial diversity of the elder population. METHODS Using data on American Indians (AIs) from the Strong Heart Study, we measured associations between mid-life physical activity (PA), assessed by a questionnaire or pedometer, and performance on tests of general cognitive function, phonemic fluency, verbal learning and memory, and processing speed. Cognitive tests were administered 7-21 years after PA measurements. To estimate associations, we used regression models with and without inverse-probability weights to account for potential attrition bias in the cohort. RESULTS Questionnaire and pedometer measures of PA were positively associated with cognitive function. Participants in the top quartile of questionnaire-based PA had Modified Mini-Mental State examination scores 3.2 (95% CI: 1.5-4.9) points higher than participants in the lowest quartile. Phonemic fluency scores also trended higher for participants in the top compared to the bottom categories for both PA measures: top questionnaire quartile = 2.7 (95% CI: 0.6-4.8) points higher and top pedometry tertile = 6.7 (95% CI: 2.7-10.7) points higher. We observed no associations between PA and tests assessing verbal learning and memory, or processing speed. Weighted model results were similar, but less precise. CONCLUSIONS In this cohort of AIs with relatively low levels of PA, positive associations between mid-life PA and late-life cognitive performance were dose-dependent and of modest clinical significance.
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Affiliation(s)
- Cara L. Carty
- Department of Medical Education and Clinical Sciences, Institute for Research and Education to Advance Community Health (IREACH), Elson F. Floyd College of Medicine, Washington State University, Seattle, Washington
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health (IREACH), Elson F. Floyd College of Medicine, Washington State University, Seattle, Washington
| | - Clemma Muller
- Department of Medical Education and Clinical Sciences, Institute for Research and Education to Advance Community Health (IREACH), Elson F. Floyd College of Medicine, Washington State University, Seattle, Washington
| | - Astrid Suchy-Dicey
- Department of Medical Education and Clinical Sciences, Institute for Research and Education to Advance Community Health (IREACH), Elson F. Floyd College of Medicine, Washington State University, Seattle, Washington
| | - Amanda M. Fretts
- Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington School of Public Health, Seattle, Washington
| | - Steven P. Verney
- Psychology Clinical Neuroscience Center, University of New Mexico, Albuquerque, New Mexico
| | - Barbara V. Howard
- MedStar Health Research Institute, Hyattsville, Maryland and The Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, District of Columbia
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health (IREACH), Elson F. Floyd College of Medicine, Washington State University, Seattle, Washington
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Wittenberg GF, McKay MA, O’Connor M. Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211030468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.
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Alnijadi AA, Li M, Wu J, Xiong X, Lu ZK. Trend and effects of high-deductible health insurance plans in the health care system: financial access problems in management of cognitive impairment. J Manag Care Spec Pharm 2021; 28:7-15. [PMID: 34949113 PMCID: PMC10372991 DOI: 10.18553/jmcp.2022.28.1.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: High-deductible health plans (HDHPs) are characterized by higher deductibles and lower monthly premiums compared with a typical health plan. HDHPs may reduce, or delay, needed care, which will ultimately lead to poorer access to care for chronically affected participants. OBJECTIVES: To (1) investigate the HDHP enrollment trend and (2) determine the effects of HDHPs on financial access problems for individuals with self-reported cognitive impairment. METHODS: Data between 2010 and 2018 were obtained from the National Health Interview Survey (NHIS). Individuals with cognitive impairment were identified if they were limited by memory difficulties. Problems regarding financial access to health care were assessed based on 6 survey questions from the Centers for Disease Control and Prevention. Multivariable logistic regressions were implemented to evaluate the effects of HDHPs. RESULTS: This study identified 1,148 individuals with cognitive impairment, representing 3.9 million individuals in the United States from 2010 to 2018. A nearly 2-fold increase in HDHP enrollment with cognitive impairment was observed from 2010 (20.9%) to 2018 (41.9%). This increase is similar to that reported for noncognitively impaired individuals. After controlling for possible confounding variables, cognitively impaired individuals with HDPHs were more likely to have overall financial access difficulties compared with those without HDHPs (OR = 1.17, 95% CI = 0.88-1.56, P = 0.271), but this likelihood was not statistically significant. CONCLUSIONS: HDHPs are intended to support effective care options and reduce health care costs. However, our research found that among individuals with cognitive impairment, those with HDHPs experienced some financial access problems, such as affording medical care, follow-up care, and specialists, than those without HDHPs, indicating that HDHPs might have unintended consequences for health care usage. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest or financial interests to disclose.
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Affiliation(s)
- Abdulrahman A Alnijadi
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, and Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis
| | - Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College, Clinton, SC
| | - Xiaomo Xiong
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia
| | - Z Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia
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Garcia MA, Warner DF, García C, Downer B, Raji M. Age Patterns in Self-Reported Cognitive Impairment Among Older Latino Subgroups and Non-Latino Whites in the United States, 1997-2018: Implications for Public Health Policy. Innov Aging 2021; 5:igab039. [PMID: 34917774 PMCID: PMC8670720 DOI: 10.1093/geroni/igab039] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Indexed: 01/02/2023] Open
Abstract
Background and Objectives U.S. Latinos are a heterogeneous population with unique characteristics related to individual-level socioeconomic and contextual factors based on nativity status and country of origin. Population aging and greater public awareness of dementia may contribute to an increasing prevalence of self-reported cognitive impairment. However, population-level trends in self-reported cognitive impairment among Latinos are unclear and it is unknown whether there are differences among Latino subgroups. Thus, this study aims to examine heterogeneity in self-reported cognitive impairment among older U.S. Latino subgroups. Research Design and Methods We used data from the 1997-2018 National Health Interview Survey to document age-specific patterns in self-reported cognitive impairment among U.S.-born Mexican, foreign-born Mexican, island-born Puerto Rican, foreign-born Cuban, and U.S.-born non-Latino Whites aged 60 and older. We estimated hierarchical age-period-cohort cross-classified random effects models (HAPC-CCREM) to isolate age patterns in self-reported cognitive impairment across disaggregated Latino subgroups and U.S.-born non-Latino Whites. Results The overall prevalence of self-reported cognitive impairment increased from 6.0% in 1997 to 7.1% in 2018. This increase was evident among U.S.-born non-Latino Whites and U.S.-born and foreign-born Mexicans but not other Latino subgroups. Fully adjusted HAPC-CCREM estimates indicated that Latinos were more likely to self-report cognitive impairment than U.S-born non-Latino Whites (b = 0.371, p < .001). When disaggregated by Latino subgroup, the difference in the likelihood for self-reported cognitive impairment compared to U.S.-born non-Latino Whites was greatest for island-born Puerto Ricans (b = 0.598, p < .001) and smallest for foreign-born Cubans (b = 0.131, p > .05). Discussion and Implications We found evidence of considerable heterogeneity in the age patterns of self-reported cognitive impairment among U.S. Latino subgroups. We also detected large differences in the likelihood for self-reported cognitive impairment between U.S. Latino subgroups compared to U.S.-born non-Latino Whites. These results underscore the importance of differentiating between unique Latino subpopulations when studying population-level trends in cognitive function.
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Affiliation(s)
- Marc A Garcia
- Department of Sociology, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion, Maxwell School of Citizenship & Public Affairs, Syracuse, New York, USA
| | - David F Warner
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Center of Family and Demographic Research, Bowling Green State University, Bowling Green, Ohio, USA
| | - Catherine García
- Department of Human Development & Family Science, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion, Syracuse University, Syracuse, New York, USA
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mukaila Raji
- Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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21
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Lee M, Nam JH, Yi E, Bhimla A, Nelson J, Ma GX. Differences in Subjective Memory Impairment, Depressive Symptoms, Sleep, and Physical Activity in African American and Asian American Elderly. Brain Sci 2021; 11:1155. [PMID: 34573176 PMCID: PMC8472213 DOI: 10.3390/brainsci11091155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Subjective memory impairment (SMI) is associated with negative health outcomes including mild cognitive impairment and Alzheimer's disease. However, ethnic differences in SMI and disparities in risk factors associated with SMI among minority populations are understudied. The study examined the ethnic differences in SMI, whether SMI was associated with depressive symptoms, sleep, and physical activity (PA), and whether the associations vary across racial/ethnic groups. Methods: Participants included 243 African and Asian Americans (including Chinese, Vietnamese, and Korean Americans) aged 50 or older. Demographic information, SMI, depressive symptoms, daily sleeping hours, and PA levels were assessed. Results: Vietnamese Americans reported the highest SMI score. Depressive symptoms, sleeping hours, and PA levels were significantly associated with SMI. Depressive symptoms were the only significant factor across all ethnic groups. Significant interaction effects were found between ethnicity and health behaviors in predicting SMI. In particular, Vietnamese American participants with greater depressive symptoms and physical inactivity were significantly more likely to experience SMI compared to other ethnic groups Conclusions: Our findings demonstrate ethnic differences in SMI and its association with depressive symptoms, sleep, and PA, which highlight the importance of considering the unique cultural and historical backgrounds across different racial/ethnic groups when examining cognitive functioning in elderly.
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Affiliation(s)
- Minsun Lee
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
| | - Jin-Hyeok Nam
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
| | - Elizabeth Yi
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
| | - Aisha Bhimla
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
| | - Julie Nelson
- Philadelphia Senior Center, Philadelphia, PA 19147, USA;
| | - Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA; (M.L.); (J.-H.N.); (E.Y.); (A.B.)
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
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Salazar-Félix NA, Martin-Del-Campo F, Cueto-Manzano AM, Romo-Flores ML, Velázquez-Vidaurri AL, Sánchez-Soriano A, Ruvalcaba-Contreras N, Calderón-Fabian A, Rojas-Campos E, Cortés-Sanabria L. Prevalence of mild cognitive impairment in automated peritoneal dialysis patients. Nephrol Dial Transplant 2021; 36:2106-2111. [PMID: 34375410 DOI: 10.1093/ndt/gfab238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cognitive deterioration decreases quality of life, self-care and adherence to treatment, increasing mortality risk. There is scarce information of cognitive impairment in peritoneal dialysis, and data are controversial. OBJECTIVE To determine the frequency and associated factors of cognitive impairment in patients on automated peritoneal dialysis (APD). METHODS Cross-sectional study; 71 patients on APD underwent clinical, biochemical and cognitive function evaluation by means of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Cognitive function was also evaluated in healthy controls. RESULTS Mean age was 42 ± 16 years, 79% were men and dialysis vintage was 17 (7-32) months. In APD patients, cognitive impairment was present in 7% (mild deterioration) and 68% according to the MMSE and MoCA, respectively, and in 4% and 37% in the healthy controls. Patients with cognitive impairment (according to MoCA) were older, with lower educational degree, had more frequently diabetes, and higher serum glucose, as well as lower serum creatinine, phosphorus and sodium concentrations than patients with normal cognitive function. In multiple linear regression analysis, predictors for the MoCA score (R2 0.63, p = 0.002) were schooling [B = 0.54 (0.20 to 0.89), p = 0.003], age [B=-0.11 (-0.21 to -0.01), p = 0.04], serum sodium [B = 0.58 (0.05 to 1.11), p = 0.03] and creatinine concentrations [B = 3.9 (0.03 to 0.83), p = 0.03]. CONCLUSION In this sample of APD patients with mean age in the early 40 s, the prevalence of cognitive impairment by MoCA test was 65%, and it was associated to older age, lower educational level and lower serum concentrations of sodium and creatinine.
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Affiliation(s)
- Noé A Salazar-Félix
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Fabiola Martin-Del-Campo
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alfonso M Cueto-Manzano
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - María L Romo-Flores
- Unidad de Diálisis Peritoneal, Hospital General Regional No. 46, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alma L Velázquez-Vidaurri
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Artemio Sánchez-Soriano
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Neri Ruvalcaba-Contreras
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Alejandro Calderón-Fabian
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Enrique Rojas-Campos
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
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23
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Spoer BR, Juul F, Hsieh PY, Thorpe LE, Gourevitch MN, Yi S. Neighborhood-level Asian American Populations, Social Determinants of Health, and Health Outcomes in 500 US Cities. Ethn Dis 2021; 31:433-444. [PMID: 34295131 DOI: 10.18865/ed.31.3.433] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction The US Asian American (AA) population is projected to double by 2050, reaching ~43 million, and currently resides primarily in urban areas. Despite this, the geographic distribution of AA subgroup populations in US cities is not well-characterized, and social determinants of health (SDH) and health measures in places with significant AA/AA subgroup populations have not been described. Our research aimed to: 1) map the geographic distribution of AAs and AA subgroups at the city- and neighborhood- (census tract) level in 500 large US cities (population ≥66,000); 2) characterize SDH and health outcomes in places with significant AA or AA subgroup populations; and 3) compare SDH and health outcomes in places with significant AA or AA subgroup populations to SDH and health outcomes in places with significant non-Hispanic White (NHW) populations. Methods Maps were generated using 2019 Census 5-year estimates. SDH and health outcome data were obtained from the City Health Dashboard, a free online data platform providing more than 35 measures of health and health drivers at the city and neighborhood level. T-tests compared SDH (unemployment, high-school completion, childhood poverty, income inequality, racial/ethnic segregation, racial/ethnic diversity, percent uninsured) and health outcomes (obesity, frequent mental distress, cardiovascular disease mortality, life expectancy) in cities/neighborhoods with significant AA/AA subgroup populations to SDH and health outcomes in cities/neighborhoods with significant NHW populations (significant was defined as top population proportion quintile). We analyzed AA subgroups including Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other AA. Results The count and proportion of AA/AA subgroup populations varied substantially across and within cities. When comparing cities with significant AA/AA subgroup populations vs NHW populations, there were few meaningful differences in SDH and health outcomes. However, when comparing neighborhoods within cities, areas with significant AA/AA subgroup vs NHW populations had less favorable SDH and health outcomes. Conclusion When comparing places with significant AA vs NHW populations, city-level data obscured substantial variation in neighborhood-level SDH and health outcome measures. Our findings emphasize the dual importance of granular spatial and AA subgroup data in assessing the influence of SDH in AA populations.
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Affiliation(s)
- Ben R Spoer
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Filippa Juul
- Department of Epidemiology, NYU College of Global Public Health, New York, NY
| | - Pei Yang Hsieh
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Lorna E Thorpe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Marc N Gourevitch
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Stella Yi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
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24
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Tran P, Tran L. Stroke and Heart Attack Symptom Recognition in Older US Adults by Cognitive Impairment Status. Neuroepidemiology 2021; 55:245-252. [PMID: 34010836 DOI: 10.1159/000516343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cognitive impairment may make stroke and heart attack symptom recognition difficult, potentially resulting in treatment delays for those with these cardiovascular diseases (CVDs). Despite cognitive impairment affecting large numbers of older US adults who are also at increased risk of stroke and heart attack, little is known about stroke and heart attack symptom recognition in this population. As a result, this study sought to determine the impact of cognitive impairment on stroke and heart attack symptom recognition among older US adults. METHODS Using the 2014 and 2017 National Health Interview Surveys, we compared stroke and heart attack symptom recognition levels in US adults aged ≥65 years with cognitive impairment and those without cognitive impairment. Estimates of stroke and heart attack symptom recognition adjusted for CVD-related factors were assessed by cognitive impairment status. We also conducted analyses stratified by living arrangement and stroke and heart attack history for individuals with and without cognitive impairment. RESULTS US adults aged ≥65 years with cognitive impairment were observed to be 3.0-6.7% and 1.6-4.9%, respectively, less likely to recognize an individual stroke and heart attack symptom than similarly aged individuals without cognitive impairment. Recognition of all 5 stroke/heart attack symptoms was also lower among those with cognitive impairment, with this group being 9.7% less likely to recognize all stroke symptoms and 6.7% less likely to recognize all 5 heart attack symptoms compared to people without cognitive impairment. Following adjustment, individuals with cognitive impairment continued to have slightly lower recognition of certain individual stroke and heart attack symptoms as well as of all 5 symptoms of these conditions (stroke OR: 0.70 [95% CI: 0.58-0.85]; heart attack OR: 0.88 [95% CI: 0.75, 1.03]) than those without cognitive impairment. For individuals with cognitive impairment, living with others was linked with slightly better recognition of all individual stroke symptoms and heart attack history with better recognition of all individual heart attack symptoms. CONCLUSIONS Additional work is needed to address the challenge of improving recognition levels for specific stroke and heart attack symptoms in older US adults with cognitive impairment and especially for members of this group who live alone.
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Affiliation(s)
- Phoebe Tran
- Chronic Disease Epidemiology, Yale University, New Haven, Connecticut, USA
| | - Lam Tran
- Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
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25
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Zheng DD, Loewenstein DA, Christ SL, Feaster DJ, Lam BL, McCollister KE, Curiel-Cid RE, Lee DJ. Multimorbidity patterns and their relationship to mortality in the US older adult population. PLoS One 2021; 16:e0245053. [PMID: 33471812 PMCID: PMC7816983 DOI: 10.1371/journal.pone.0245053] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/21/2020] [Indexed: 01/12/2023] Open
Abstract
Background Understanding patterns of multimorbidity in the US older adult population and their relationship with mortality is important for reducing healthcare utilization and improving health. Previous investigations measured multimorbidity as counts of conditions rather than specific combination of conditions. Methods This cross-sectional study with longitudinal mortality follow-up employed latent class analysis (LCA) to develop clinically meaningful subgroups of participants aged 50 and older with different combinations of 13 chronic conditions from the National Health Interview Survey 2002–2014. Mortality linkage with National Death Index was performed through December 2015 for 166,126 participants. Survival analyses were conducted to assess the relationships between LCA classes and all-cause mortality and cause specific mortalities. Results LCA identified five multimorbidity groups with primary characteristics: “healthy” (51.5%), “age-associated chronic conditions” (33.6%), “respiratory conditions” (7.3%), “cognitively impaired” (4.3%) and “complex cardiometabolic” (3.2%). Covariate-adjusted survival analysis indicated “complex cardiometabolic” class had the highest mortality with a Hazard Ratio (HR) of 5.30, 99.5% CI [4.52, 6.22]; followed by “cognitively impaired” class (3.34 [2.93, 3.81]); “respiratory condition” class (2.14 [1.87, 2.46]); and “age-associated chronic conditions” class (1.81 [1.66, 1.98]). Patterns of multimorbidity classes were strongly associated with the primary underlying cause of death. The “cognitively impaired” class reported similar number of conditions compared to the “respiratory condition” class but had significantly higher mortality (3.8 vs 3.7 conditions, HR = 1.56 [1.32, 1.85]). Conclusion We demonstrated that LCA method is effective in classifying clinically meaningful multimorbidity subgroup. Specific combinations of conditions including cognitive impairment and depressive symptoms have a substantial detrimental impact on the mortality of older adults. The numbers of chronic conditions experienced by older adults is not always proportional to mortality risk. Our findings provide valuable information for identifying high risk older adults with multimorbidity to facilitate early intervention to treat chronic conditions and reduce mortality.
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Affiliation(s)
- D. Diane Zheng
- Department of Psychiatry and Behavioral Science, Center for Cognitive Neurosciences & Aging, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
| | - David A. Loewenstein
- Department of Psychiatry and Behavioral Science, Center for Cognitive Neurosciences & Aging, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Sharon L. Christ
- Department of Human Development and Family Studies and Statistics, Purdue University, West Lafayette, Indiana, United States of America
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Kathryn E. McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Rosie E. Curiel-Cid
- Department of Psychiatry and Behavioral Science, Center for Cognitive Neurosciences & Aging, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - David J. Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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Dallo FJ, Kindratt TB, Zahodne L. Prevalence of Self-reported Cognitive Impairment Among Arab American Immigrants in the United States. Innov Aging 2021; 5:igaa058. [PMID: 33442566 PMCID: PMC7788314 DOI: 10.1093/geroni/igaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives Studies evaluating self-reported cognitive impairment among Arab American immigrants have not been conducted. Our objective was 2-fold: (a) to estimate and compare the age- and sex-adjusted prevalence of self-reported cognitive impairment between Arab American immigrants and U.S.- and immigrant non-Hispanic Whites, non-Hispanic Blacks, Hispanics and non-Hispanic Asians and (b) to examine associations between race, ethnicity, nativity status, and cognitive impairment among Arab American immigrants and non-Hispanic Whites (U.S.- and foreign-born) after controlling for explanatory factors. Research Design and Methods We used 18 years (2000–2017) of National Health Interview Survey data (n = 228 985; ages ≥ 45 years). Weighted percentages, prevalence estimates, and multivariable logistic regression models were calculated. Results The age- and sex-adjusted prevalence of self-reported cognitive impairment was significantly higher among Arab American immigrants (9.7%) compared to U.S.-born and non-Hispanic White immigrants (~7.4%). Discussion and Implications This is the first study to indicate that ethnic disparities in self-reported cognitive impairment may extend to Arab American immigrants. Additional studies need to be conducted to better understand the prevalence of cognitive impairment.
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Affiliation(s)
- Florence J Dallo
- Department of Public & Environmental Wellness, Oakland University, Rochester, Michigan, US
| | - Tiffany B Kindratt
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, US
| | - Laura Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, US
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Racine L, Johnson L, Fowler-Kerry S. An integrative review of empirical literature on indigenous cognitive impairment and dementia. J Adv Nurs 2020; 77:1155-1171. [PMID: 33270270 DOI: 10.1111/jan.14665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/26/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Abstract
AIMS To synthesize research findings about Indigenous perspectives on cognitive impairment and dementia. DESIGN Whittemore and Knafl's updated approach to integrative review and PRISMA guidelines for narrative analysis was followed. DATA SOURCES A systematic search of the published literature from 2010-June 2020 was undertaken in four databases and complemented by supplementary searches. REVIEW METHODS Thirty-four studies met the research question and inclusion criteria. RESULTS Four themes describe the findings. Most of the studies were conducted by non-Indigenous researchers and may reflect Western perspectives on dementia rather than Indigenous views. A majority of the studies report epidemiological data or the testing of clinical tools. CONCLUSION The review indicates a dearth of knowledge about Indigenous perspectives on ageing and understanding of cognitive impairment and dementia. Researchers need to draw on Indigenous traditional knowledge, culture, and traditions through a meaningful engagement with Indigenous communities and Elders to indigenize and decolonize dementia care. IMPACT This integrative review highlights the need for community-led discussions and community engagement around Indigenous perspectives, needs, and understandings of ageing, cognitive impairment, and dementia care.
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Affiliation(s)
- Louise Racine
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Letitia Johnson
- Department of History, College of Arts and Science, University of Saskatchewan, Saskatoon, SK, Canada
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28
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Park S, Chen J. Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive deficits or Alzheimer's disease and related dementias. BMC Geriatr 2020; 20:482. [PMID: 33208121 PMCID: PMC7672830 DOI: 10.1186/s12877-020-01888-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/10/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Numerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer's disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive deficits without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of service. METHODS We examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Using the 1996-2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics. RESULTS Black, Asians, and Latinos without cognitive deficits had lower total health care expenditures than whites without cognitive deficits ($10,236, $9497, $9597, and $11,541, respectively). There were no racial and ethnic differences in total health care expenditures among those with cognitive deficits without ADRD and those with ADRD. Across all three groups, however, Blacks, Asians, and Latinos consistently had lower out-of-pocket expenditures than whites (except for Asians with cognitive deficits without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups. CONCLUSIONS Our study did not find significant racial and ethnic differences in total health care expenditures among Medicare beneficiaries with cognitive deficits and/or ADRD. However, we documented significant differences in out-of-pocket expenditures and service-specific expenditures. We speculated that the differences may be attributable to racial and ethnic differences in access to care and/or preferences based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.
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Affiliation(s)
- Sungchul Park
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, USA.
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD, USA
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Kim G, Wang SY, Park S, Yun SW. Mental Health of Asian American Older Adults: Contemporary Issues and Future Directions. Innov Aging 2020; 4:igaa037. [PMID: 33274302 PMCID: PMC7691797 DOI: 10.1093/geroni/igaa037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022] Open
Abstract
Given the increased attention to older Asian Americans due to their increasing numbers in the United States, this article aims to provide a collective appraisal of older Asian American mental health issues by reviewing trends in older Asian American mental health research over the past 2 decades. This review article provides an overview of the current state of mental health and care research on older Asian Americans and vital factors associated with older Asian American mental health and care. We also identify gaps in current research on Asian American mental health issues and propose 5 potential areas for future research into which gerontologists need to put more effort during the next decade. Ways to reduce disparities in mental health and improve the quality of mental health of older Asian Americans are also discussed.
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Affiliation(s)
- Giyeon Kim
- Department of Psychology, Chung-Ang
University, Seoul, South
Korea
| | - Sylvia Y Wang
- Department of Psychology, Misericordia
University, Dallas, Pennsylvania
| | - Soohyun Park
- Department of Psychology, The University of
Alabama, Tuscaloosa
| | - Stacy W Yun
- Department of Psychology, University of
Colorado, Colorado Springs
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30
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Comorbid Pain and Cognitive Impairment in a Nationally Representative Adult Population. Clin J Pain 2020; 36:725-739. [DOI: 10.1097/ajp.0000000000000863] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Zhang PD, Lv YB, Li ZH, Yin ZX, Li FR, Wang JN, Zhang XR, Zhou JH, Wu XB, Duan J, Mao C, Shi XM. Age, Period, and Cohort Effects on Activities of Daily Living, Physical Performance, and Cognitive Functioning Impairment Among the Oldest-Old in China. J Gerontol A Biol Sci Med Sci 2020; 75:1214-1221. [PMID: 31435643 PMCID: PMC7984417 DOI: 10.1093/gerona/glz196] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the trends in impairment regarding activities of daily living (ADL), physical performance, and cognitive function among the oldest-old (those aged 80 and older) in China between 1998 and 2014. METHODS We used data on 34,297 oldest-old individuals from the seven waves of the Chinese Longitudinal Healthy Longevity Study. We estimated age, period, and cohort effects on the prevalence of self-reported ADL impairment, tested physical performance and cognitive function impairment using the age-period-cohort model. RESULTS Regarding age, the prevalence of ADL, physical performance, and cognitive function impairment were highest in the centenarians, but they did not increase with age in this population. Among the literate subgroup, the prevalence of cognitive impairment increased more rapidly with age than that in the illiterate subgroup. Regarding period, the prevalence of self-reported and tested physical impairment slowly increased between 1998 and 2014, but cognitive impairment remained stable. Regarding cohort, ADL impairment continuously decreased. However, physical and cognitive impairment remained stable after a brief decline in the early birth cohorts. CONCLUSIONS The results suggest that the age effect is still the most obvious effect regarding several types of functional impairment. The likelihood of a younger person experiencing functional impairment may not change significantly, but ADL is likely to be amenable to improvement resulting from improved medical and social care. Therefore, increased care for the oldest-old may considerably improve their quality of life, particularly regarding their basic ADL.
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Affiliation(s)
- Pei-Dong Zhang
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Yue-Bin Lv
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhi-Hao Li
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhao-Xue Yin
- Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fu-Rong Li
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiao-Nan Wang
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xi-Ru Zhang
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jin-Hui Zhou
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xian-Bo Wu
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jun Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Chen Mao
- Division of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiao-Ming Shi
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Koch M, Fitzpatrick AL, Rapp SR, Nahin RL, Williamson JD, Lopez OL, DeKosky ST, Kuller LH, Mackey RH, Mukamal KJ, Jensen MK, Sink KM. Alcohol Consumption and Risk of Dementia and Cognitive Decline Among Older Adults With or Without Mild Cognitive Impairment. JAMA Netw Open 2019; 2:e1910319. [PMID: 31560382 PMCID: PMC6777245 DOI: 10.1001/jamanetworkopen.2019.10319] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Substantial heterogeneity and uncertainty exist in the observed associations between alcohol consumption and dementia. OBJECTIVE To assess the association between alcohol consumption and dementia and the roles of mild cognitive impairment (MCI) and apolipoprotein E ε4 (APOE E4) genotype in modifying this association. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Ginkgo Evaluation of Memory Study, conducted from 2000 to 2008 among US community-dwelling participants. This study analyzed 3021 participants aged 72 years and older who were free of dementia. Data analysis was performed from 2017 to 2018. EXPOSURES Self-reported alcohol consumption, drinking frequency, and quantity. MAIN OUTCOMES AND MEASURES Using multivariable proportional hazards regression and linear mixed models, the risk of dementia and the rate of change over time in the Modified Mini-Mental State Examination were estimated. RESULTS Among 3021 participants, the median (interquartile range) age was 78 (76-80) years; 1395 (46.2%) were female. During a median (interquartile range) follow-up of 6.0 (4.9-6.5) years, 512 cases of dementia occurred. For 7.1 to 14.0 drinks per week compared with less than 1.0 drink per week, the hazard ratios for dementia were 0.63 (95% CI, 0.38-1.06) among 2548 participants without MCI and 0.93 (95% CI, 0.47-1.84) among 473 participants with MCI. Among participants with MCI, the hazard ratio for dementia was 1.72 (95% CI, 0.87-3.40) for more than 14.0 drinks per week compared with less than 1.0 drink per week. The association of alcohol intake with dementia differed for participants with and without baseline MCI (P for interaction = .03). Among participants without MCI, daily low-quantity drinking was associated with lower dementia risk than infrequent higher-quantity drinking (hazard ratio, 0.45; 95% CI, 0.23-0.89; P = .02). Findings were consistent when stratified by sex, age, and APOE E4 genotype. Compared with drinking less than 1.0 drink per week, complete abstention (in participants without MCI) and the consumption of more than 14.0 drinks per week (in participants with MCI) were associated with lower Modified Mini-Mental State Examination scores (mean difference at follow-up compared with baseline, -0.46 point [95% CI, -0.87 to -0.04 point] and -3.51 points [95% CI, -5.75 to -1.27 points], respectively). CONCLUSIONS AND RELEVANCE In this study, complete abstention and consuming more than 14.0 drinks per week (compared with drinking <1.0 drink per week) were associated with lower cognitive scores among participants aged 72 years and older. Particular caution is needed among individuals with MCI who continue to drink alcohol.
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Affiliation(s)
- Manja Koch
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Annette L Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Richard L Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland
| | - Jeff D Williamson
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Oscar L Lopez
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rachel H Mackey
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kenneth J Mukamal
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Majken K Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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33
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Iwagami M, Kobayashi Y, Tsukazaki E, Watanabe T, Sugiyama T, Wada T, Hara A, Tamiya N. Associations between self-reported hearing loss and outdoor activity limitations, psychological distress and self-reported memory loss among older people: Analysis of the 2016 Comprehensive Survey of Living Conditions in Japan. Geriatr Gerontol Int 2019; 19:747-754. [PMID: 31237108 DOI: 10.1111/ggi.13708] [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] [Received: 10/22/2018] [Revised: 04/13/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
Abstract
AIM To investigate the associations between self-reported hearing loss and outdoor activity limitations, psychological distress and self-reported memory loss among older people. METHODS We carried out a cross-sectional study using the data from the 2016 Comprehensive Survey of Living Conditions in Japan. The study population included people aged ≥65 years living at home, without a clinical diagnosis of dementia. The exposure of interest was self-reported hearing loss, whereas outcomes included outdoor activity limitations (Yes/No), psychological distress (Kessler Psychological Distress Scale score of ≥5) and self-reported memory loss (Yes/No). We carried out logistic regression analyses, adjusted for age, sex, smoking, alcohol, educational status, number of household members, household expenditure and number of clinical diagnoses requiring outpatient visits. RESULTS Among 137 723 older people (mean age 74.5 years [standard deviation 7.4 years], 45.1% men), 12 389 (9.0%) reported hearing loss. People with hearing loss showed a higher prevalence of outdoor activity limitations (28.9% vs 9.5%, P < 0.001), psychological distress (39.7% vs 19.3%, P < 0.001) and memory loss (37.7% vs 5.2%, P < 0.001) than those without. The adjusted odds ratios comparing people with and without hearing loss were 2.0 (95% confidence interval 1.9-2.1), 2.1 (95% confidence interval 2.0-2.1) and 7.1 (95% confidence interval 6.8-7.4) for outdoor activity limitations, psychological distress and self-reported memory loss. CONCLUSIONS This nationwide study suggested that older people with hearing loss were more likely to experience outdoor activity limitations, psychological distress and memory loss than those without. Early identification of and intervention in hearing loss might potentially reduce the risk of these poor health outcomes. Geriatr Gerontol Int 2019; 19: 747-754.
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Affiliation(s)
- Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan
| | - Yoko Kobayashi
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan.,Research and Support Center on Higher Education for the Hearing and Visually Impaired, Tsukuba University of Technology, Ibaraki, Japan
| | - Eriko Tsukazaki
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan
| | - Taeko Watanabe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan
| | - Takehiro Sugiyama
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan.,Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Public Health/Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuro Wada
- Department of Otolaryngology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akira Hara
- Department of Otolaryngology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Health Services Research & Development Center, University of Tsukuba, Ibaraki, Japan
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34
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Zhu Z, Hu Y, Xing W, Guo M, Wu B. Perceived discrimination and cognitive function in middle-aged and older adults living with HIV in China. AIDS Care 2019; 31:1061-1068. [PMID: 30943753 DOI: 10.1080/09540121.2019.1601674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Middle-aged and older adults with HIV experience double discrimination and cognitive impairment due to both their HIV status and their age. However, the relationship between perceived discrimination and self-reported cognitive ability in middle-aged and older people living with HIV (PLWH) is less clear. We measured self-reported perceived discrimination and cognitive ability using the Expanded Everyday Discrimination Scale and the subscale of the AIDS Health Assessment Questionnaire (AIDS-HAQ). The study sample included 324 middle-aged and older PLWH (over 45 years old) from five designated HIV hospitals in three regions (east coast, middle, and southwest regions) of China. The descriptive analysis showed that 45.37% of the participants reported perceiving discrimination at least once in the past twelve months, and 47.22% reported having at least one type of cognitive impairment. Multiple linear regression results showed that higher levels of perceived discrimination (β = -0.121, P = 0.036) were significantly associated with lower levels of self-reported cognitive ability after controlling for several covariates, including sociodemographic variables, mental health status, health behaviors, and social support. A longer duration of HIV was also related to a lower level of self-reported cognitive ability. Our findings indicate that perceived discrimination is related to self-reported cognitive ability and suggest that counseling services and support systems should be developed to reduce age- and disease-associated discrimination. A reduction in perceived discrimination would improve not only overall wellbeing but also cognitive ability in later life.
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Affiliation(s)
- Zheng Zhu
- a Fudan University School of Nursing , Shanghai , People's Republic of China.,b A Joanna Briggs Institute Centre of Excellence , Fudan University Centre for Evidence-based Nursing , Shanghai , People's Republic of China
| | - Yan Hu
- a Fudan University School of Nursing , Shanghai , People's Republic of China.,b A Joanna Briggs Institute Centre of Excellence , Fudan University Centre for Evidence-based Nursing , Shanghai , People's Republic of China
| | - Weijie Xing
- a Fudan University School of Nursing , Shanghai , People's Republic of China.,b A Joanna Briggs Institute Centre of Excellence , Fudan University Centre for Evidence-based Nursing , Shanghai , People's Republic of China
| | - Mengdi Guo
- c School of public affairs, Zhejiang University , Hangzhou , People's Republic of China
| | - Bei Wu
- d NYU Rory Meyers College of Nursing , New York , USA
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35
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Soria JA, Huisa BN, Edland SD, Litvan I, Peavy GM, Salmon DP, Hansen LA, Galasko DR, Brewer JB, González HM, Rissman RA. Clinical-Neuropathological Correlations of Alzheimer's Disease and Related Dementias in Latino Volunteers. J Alzheimers Dis 2018; 66:1539-1548. [PMID: 30412501 DOI: 10.3233/jad-180789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Clinical, neuropsychological, and neurological procedures used to diagnose Alzheimer's disease (AD) and related dementias were largely developed and validated in well-educated, non-Latino, English-speaking populations. Sociocultural and genetic differences in Latinos might influence the accuracy of clinical diagnosis of AD and other dementias. We aim to compare the accuracy of the clinical diagnosis of AD and related dementias in Latinos with the corresponding neuropathological diagnosis. From the UCSD Alzheimer's Disease Research Center longitudinal cohort, we selected all Latino participants who had autopsy neuropathological studies from 1991 to 2017. Participants underwent annual neurological clinical evaluations, standard neuropsychological tests, neuroimaging, and genotyping of Apolipoprotein E. We calculated the sensitivity and specificity of the clinical diagnosis of AD against the primary pathological diagnosis. Of the 34 participants with a primary neuropathological diagnosis of AD, 33 (97.1%) were correctly clinically diagnosed as having AD at the last clinical evaluation, and 1 was incorrectly diagnosed with dementia with Lewy bodies. Of the 19 participants without a primary neuropathological diagnosis of AD, 8 were incorrectly clinically diagnosed with probable AD at the last clinic evaluation. The clinical diagnosis of AD at the last clinical evaluation had 97.1% sensitivity and 57.9% specificity for autopsy-verified AD. In this Latino cohort, clinicians predicted AD pathological findings with high sensitivity but moderate specificity. Tangle-only dementia was the most common misdiagnosis. Our study suggests that current procedures and instruments to clinically determine AD in Latinos have high sensitivity compared with neuropathology, but specificity needs to be improved.
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Affiliation(s)
- Jose A Soria
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Branko N Huisa
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Steven D Edland
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Irene Litvan
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Guerry M Peavy
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - David P Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Lawrence A Hansen
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Department of Pathology, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Douglas R Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - James B Brewer
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Department of Radiology, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Hector M González
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA
| | - Robert A Rissman
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA.,Shiley-Marcos Alzheimer's Disease Research Center, University of California, San Diego, La Jolla, CA, USA.,VA San Diego Health Care System, La Jolla, CA, USA
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