Self-rated health and incident dementia over two decades: Replication across two cohorts

Pathways to Racial/Ethnic Inequalities in Dementia

Individuals from minoritized racial/ethnic groups face a disproportionate burden of Alzheimer's disease and related dementias. This health inequality reflects structural racism, which creates and sustains racial differences in social determinants of health, including education access and quality, economic stability, social and community context, neighborhood and built environment, and health care access and quality. Thus, understanding pathways that lead to dementia inequalities requires addressing individual- and system-level factors. This article summarizes evidence linking each social determinant of health to racial/ethnic inequalities in dementia, emphasizing upstream factors and mechanisms as potential levels of intervention. The importance of resilience in marginalized groups as well as critical research considerations for dementia inequalities are also discussed. Future directions highlight the need to understand the common and unique mechanisms driving inequalities across minoritized groups, where research is lacking.

Daily relationship satisfaction and markers of health: Findings from a smartphone-based assessment

Relationship satisfaction is associated consistently with better physical and mental health. Less is known about these associations in daily life, particularly the association between relationship satisfaction and cognitive health. This study examined the daily, within-person association between relationship satisfaction and subjective health markers, including cognitive health. Participants from the United States (N = 303; Mage = 51.71, SD = 7.32) in the Couples Healthy Aging Project (CHAP) completed assessments of relationship satisfaction and health markers every night for eight days. Multilevel modeling was performed by accounting for personal (sex, age, race, education), relational (relationship duration), and contextual (day in the study, weekend day) factors. Within-person, on days when participants were more satisfied with their relationship, they felt healthier, younger, more satisfied with their life, and more purposeful. They also reported a sharper mind, better memory, and clearer thinking; relationship satisfaction was unrelated to whether participants were bothered and disrupted by forgetting. Results indicated that a satisfying romantic relationship is closely associated with better physical, psychological, and cognitive health markers in daily life.

Development of a nomogram model for predicting dementia risk in the older adult population of Weifang, Shandong Province, China: based on the biopsychosocial model

Background

Dementia has emerged as a predominant health challenge. However, there is a notable research gap in the collective screening of dementia risks. Hence, there is a pressing need to formulate a dementia prediction tool tailored to the older adult demographic, enabling the identification of high-risk individuals for dementia.

Methods

From May to October 2023, a multi-stage sampling method was utilized to survey older adult individuals aged 60 and above in Weifang. This study employed the Brief Community Screening Instrument for Dementia (BCSI-D) for the identification of individuals with dementia. We integrated the biopsychosocial model to construct a comprehensive pool of factors influencing dementia. Employing the least absolute shrinkage and selection operator and multivariate logistic regression analyses, independent influencing factors were identified to construct a nomogram prediction model.

Results

Six hundred and sixty valid questionnaires were included in the final analysis, with a validity rate of 95.23%. We identified 178 cases of dementia using the BCSI-D. Napping, lack of concentration, self-assessed health status, education level, residence, social interaction and medical insurance were independent influencing factors for dementia. The efficiency analysis of the prediction model, constructed using these factors, demonstrated area under the receiver operating characteristic of 0.751 for the training set and 0.794 for the test set. The decision curve analysis threshold probabilities for the training and test sets were 5-60% and 1-60%, respectively. The calibration curves of both datasets exhibited a high degree of fitting with the predicted curve.

Conclusion

We developed a dementia risk identification model with noteworthy predictive performance. The proposed model offers theoretical and data support for collective dementia screening.

Life Events and Incident Dementia: A Prospective Study of 493,787 Individuals Over 16 Years

OBJECTIVES

Life events can be stressful and have a detrimental impact on health, but evidence is inconclusive regarding life events and dementia risk. The present study tests whether life events are associated with incident dementia, whether experiencing multiple events has cumulative effects, and whether the associations vary across age, sex, race/ethnicity, socioeconomic status, and genetic vulnerability.

METHODS

UK Biobank participants (N = 493,787) reported on 6 life events that occurred within the past 2 years: serious illness, injury, assault to yourself or close relative, death of a spouse/partner or close relative, marital separation/divorce, and financial problems. Incident all-cause dementia was ascertained through health records from the UK National Health Service over a 16-year follow-up.

RESULTS

Serious illness, injury, or assault to yourself, marital separation/divorce, and financial difficulties were associated with a higher risk of dementia; serious illness, injury, or assault of a close relative was associated with a lower risk of dementia. When combined, experiencing 3-4 events was associated with a more than 2-fold increase in dementia risk. The association for marital separation/divorce was stronger within the first 5 years of follow-up (consistent with reverse causality). Death of a spouse/partner or close relative was mostly unrelated to dementia risk. With few exceptions, the associations were similar across age, sex, race/ethnicity, socioeconomic status, and apolipoprotein E e4 status groups.

DISCUSSION

Severe illness, injury, or personal assault, marital separation or divorce, and financial hardships may raise risk of dementia, particularly when these events occur together.

Pneumococcal vaccination, but not influenza vaccination, is negatively associated with incident dementia among Japanese older adults: The JAGES 2013-2022 prospective cohort study

BACKGROUND

It is unclear whether inactivated influenza vaccination (IIV) or pneumococcal vaccination are associated with the risk of dementia; however, both types of vaccination are recommended for older adults. Studies have shown that the IIV is negatively associated with incident dementia; however, the uptake of pneumococcal vaccinations has not been considered. We investigated the independent associations of IIV and 23-valent pneumococcal polysaccharide vaccine (PPSV23) with incident dementia in older adults.

METHODS

Health-related information on older Japanese adults was obtained through a baseline survey conducted in 2013 (baseline survey). The uptake of IIV and PPSV23 was determined in a second survey conducted in 2016 (second wave). Both surveys were conducted among independent Japanese older adults aged ≥ 65 years at the two surveys and who had not been certified as needing long-term care (LTC). In the second wave, 9,865 participants were followed up for 3.5 years (short-term follow-up), and 6,995 participants were followed up for six years and five months (long-term follow-up) until they required LTC due to dementia onset (incident dementia). A competing risk model with stabilized inverse probability weighting (SIPW) was constructed to calculate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of incident dementia.

RESULTS

PPSV23 uptake was negatively associated with incident dementia among participants in both the short- and long-term follow-up periods after SIPW (short-term follow-up: HR: 0.77, 95 % CI: 0.63 - 0.95; long-term follow-up: HR: 0.83, 95 % CI: 0.70 - 0.97). Conversely, IIV uptake was not associated with incident dementia among participants in either follow-up group (short-term follow-up: HR: 0.86, 95 % CI: 0.63-1.16; long-term follow-up: HR: 0.99, 95 % CI: 0.76-1.29). The PPSV23 uptake was negatively associated with incident dementia in participants without the IIV uptake (short-term follow-up: HR: 0.44, 95 % CI: 0.24 - 0.81; long-term follow-up: HR: 0.47, 95 % CI: 0.29 - 0.76). Conversely, the IIV uptake was not associated with incident dementia regardless of the PPSV23 status (short-term follow-up: HR: 0.87, 95 % CI: 0.62 - 1.23; long-term follow-up: HR: 1.00, 95 % CI: 0.74 - 1.35).

CONCLUSION

Our results suggest that the PPSV23 uptake was independently associated with the incidence of dementia. However, the IIV uptake was not associated with the incidence of dementia.

Self-rated health and HIV outcomes among adults with diagnosed HIV - Medical Monitoring Project, United States

OBJECTIVES

To evaluate associations between self-rated health (SRH) and care outcomes among United States adults with diagnosed HIV infection.

DESIGN

We analyzed interview and medical record data collected during June 2020-May 2021 from the Medical Monitoring Project, a complex, nationally representative sample of 3692 people with HIV (PWH). Respondents reported SRH on a 5-point Likert type scale (poor to excellent), which we dichotomized into "good or better" and "poor or fair". We computed weighted percentages with 95% confidence intervals (CIs) and age-adjusted prevalence ratios (aPRs) to investigate associations between SRH and HIV outcomes and demographic, psychosocial, and behavioral characteristics.

RESULTS

Nationally, 72% of PWH reported "good or better" SRH. PWH with the following characteristics had a lower prevalence of "good or better" SRH, compared with those without: any missed HIV care appointment in the last 12 months (aPR 0.86, 95% CI: 0.81-0.91), symptoms of moderate or severe depression (aPR 0.51, 95% CI: 0.43-0.59) and anxiety (aPR 0.60, 95% CI: 0.54-0.68), unstable housing or homelessness (aPR 0.77, 95% CI: 0.71-0.82), and hunger or food insecurity (aPR 0.74, 95% CI: 0.69-0.80), as well as having a mean CD4 count <200 cells/mm 3 vs. CD4 + >500 cells/mm 3 (aPR 0.70, 95% CI: 0.57-0.86).

CONCLUSIONS

Though SRH is a holistic measure reflective of HIV outcomes, integrated approaches addressing needs beyond physical health are necessary to improve SRH among PWH in the United States. Modifiable factors like mental health, unstable housing or homelessness, and food insecurity warrant further study as potential high-yield targets for clinical and policy interventions to improve SRH among PWH.

Prospective Effects of Self-Rated Health on Dementia Risk in Two Twin Studies of Aging

Subjective health ratings are associated with dementia risk such that those who rate their health more poorly have increased risk for dementia. The genetic and environmental mechanisms underlying this association are unclear, as prior research cannot rule out whether the association is due to genetic confounds. The current study addresses this gap in two samples of twins, one from Sweden (N = 548) and one from Denmark (N = 4,373). Using genetically-informed, bivariate regression models, we assessed whether additive genetic effects explained the association between subjective health and dementia risk as indexed by a latent variable proxy measure. Age at intake, sex, education, depressive symptomatology, and follow-up time between subjective health and dementia risk assessments were included as covariates. Results indicate that genetic variance and other sources of confounding accounted for the majority of the effect of subjective health ratings on dementia risk. After adjusting for genetic confounding and other covariates, a small correlation was observed between subjective health and latent dementia risk in the Danish sample (rE = - .09, p < .05). The results provide further support for the genetic association between subjective health and dementia risk, and also suggest that subjective ratings of health measures may be useful for predicting dementia risk.

Poor self-rated health is associated with faster cognitive decline and greater small vessel disease in older adults with type 2 diabetes

OBJECTIVE

Self-rated health (SRH) is a predictor for poor health outcomes and cognition. Older adults with type 2 diabetes mellitus (T2D) have multi-morbidity and greater cognitive impairment. In the present study we investigated the association of SRH with cognitive decline and brain pathology in older adults with T2D.

METHODS

Participants (n = 1122) were from the Israel Diabetes and Cognitive Decline study, and SRH was categorised as low (n = 202), moderate (n = 400) or high (n = 520). Cognition was measured by four cognitive domains: episodic memory, executive functions, language, and attention/working memory. Global cognition was the average of the cognitive domains. Statistical models adjusted for sociodemographic, cardiovascular, and clinical variables. In a randomly selected subsample (n = 230) that had magnetic resonance imaging, we examined relationships between baseline SRH and brain characteristics (white matter hyperintensities [WMHs], hippocampal, and total grey matter [GM] volumes).

RESULTS

Low SRH was associated with a decline in executive functions, which accelerated over time when compared to high SRH (est = -0.0036; p = <0.001). Compared to high SRH, low SRH was associated with a faster decline in global cognition (est = -0.0024; p = 0.009). Low SRH at baseline was associated with higher volumes of WMHs (est = 9.8420; p < 0.0008). SRH was not associated with other cognitive domains, or with hippocampal and total GM.

CONCLUSIONS

Low SRH is associated with cognitive decline in T2D older adults and may serve as a risk assessment. WMHs may represent an underlying mechanism.

The association between self-rated health, health-related quality of life, and risk of venous thromboembolism

Poor self-rated health (SRH) is associated with various adverse health outcomes, including cardiovascular disease. Little is known about SRH and health-related quality of life (HRQoL) as predictors of first-time venous thromboembolism (VTE). Our aim was to investigate the association between SRH, HRQoL, and risk of VTE in a whole cohort, as well as in women and men separately. A total of 108,025 middle-aged inhabitants (51 % women) of Västerbotten, Sweden, participated in a health examination between 1985 and 2014. Data on SRH, HRQoL, and potential confounders were collected by questionnaire. Participants were followed as a cohort and validated first-time VTE events were registered. The mean follow-up time was 13.9 years, during which 2054 participants experienced a first-time VTE. Overall, 27 % of participants reported their health as very good, 46 % as good, 20 % as average, 5 % as somewhat bad, and 1 % as bad. In a multivariable analysis, compared with participants who self-rated as having very good SRH, hazard ratios (95 % confidence intervals) for VTE were 1.17 (1.02-1.33) with good SRH, 1.27 (1.09-1.47) with average SRH, and 1.48 (1.00-2.18) with bad SRH. The risk of VTE increased with lower SRH for both men (p for trend 0.02) and women (p for trend 0.04). In a fully adjusted model, we also found significant associations between four aspects of HRQoL (general health, bodily pain, vitality, emotional well-being) and VTE risk. In conclusion, lower perceived health is associated with an increased risk of VTE in both men and women.

Development of a self-report measure of cognitive change: assessment of interpretability in two samples, people with HIV and people without HIV

AIM

The overall aim of this study was to develop a method of measuring change in cognitive ability from the person's perspective.

METHODS

Cognitive change items came from an item pool that was used to develop the Communicating Cognitive Concerns Questionnaire (C3Q). The change items were administered to a test sample of 211 people with HIV + and a sample of 484 people drawn from the general population (HIV- sample). Rasch analysis was used to identify items that formed a linear continuum and correlations with measures of related constructs were used to support the interpretability of the new measure.

RESULTS

Eleven of the original 12 change items fit the unidimensional Rasch model in both samples with a near similar ordering of the items. The average value for cognitive change of the HIV + sample was greater than that of the HIV- sample. Values on C3Q-Change correlated most highly (> 0.7) with current self-reported cognitive status and measures of depression and anxiety (> 0.6). The lowest correlation was with performance-based cognitive ability (r = 0.2).

CONCLUSION

The items of C3Q-Change fit a strong measurement model and related to converging constructs in an expected way. Further work needs to be done to assess the meaning of self-reported cognitive change in relationship to measured change and to examine sources of differential item functioning.

The role of social deprivation and depression in dementia risk: findings from the longitudinal survey of health, ageing and retirement in Europe

AIMS

Knowledge on the link of individual social deprivation with dementia is incomplete. We thus aimed to see whether an association with dementia risk can be observed using a recently developed Social Deprivation Index (SoDep Index). Further, as deprivation is related to depression, we investigated the role of depression in the association.

METHODS

We analysed data of 11 623 Survey of Health, Ageing and Retirement in Europe (SHARE) respondents. Social deprivation status was determined by SoDep Index score. Dementia was determined by self-reported diagnosis. Dementia risk by social deprivation status was estimated using Cox proportional hazard models, including relevant covariates (gender, marriage status, chronic conditions). Depressive symptom status was added in a second step. Further, we completed subgroup analyses by social deprivation status and analysed the relevance of depressive symptoms in dementia risk in each deprivation group. In an additional sensitivity analyses we corrected for mortality and used impaired cognitive testing performance as an alternative outcome.

RESULTS

High (v. low) social deprivation status was associated with an increased dementia risk (hazard ratio (HR) = 1.79 [95% CI 1.31-2.45]) in the Cox analysis adjusted for covariates only. Further adjustment for depressive symptom status indicated a largely direct association between social deprivation status and dementia risk. Moreover, compared to not having experienced depressive symptoms in the past or at baseline, those with past (HR = 1.67 [95% CI 1.23-2.25]), baseline (HR = 1.48 [95% CI 1.04-2.10]) or stable depressive symptoms (HR = 2.96 [95% CI 2.12-4.14]) had an increased dementia risk. The association between stable depressive symptom status and dementia risk was in the high social deprivation subgroup particularly pronounced. Sensitivity analyses replicated results.

CONCLUSIONS

Results add to a growing body of evidence indicating that a public health approach to dementia prevention must address socioeconomic inequity. Results suggest a largely direct association between social deprivation and dementia risk. Adults who experience high social deprivation appear particularly affected by detrimental effects of depressive symptomatology on dementia risk and need intervention.

Multidimensional Assessment of Subjective Well-Being and Risk of Dementia: Findings from the UK Biobank Study

This study aimed to examine the associations between subjective well-being (SWB) and risk of all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD). We adopted a multidimensional approach to SWB that included the level and breadth of SWB, the latter indicating the extent to which SWB spreads across life domains. Participants (N=171,197; mean age=56.78; SD=8.16 years) were part of the UK Biobank and were followed up to 8.78 years. Domain-general and domain-specific SWB were measured by single items, and the breadth of SWB was indexed with a cumulative score of satisfaction across domains. Dementia incidence was ascertained through hospital and death records. Cox regression was used to examine the association between SWB indicators and risk of all-cause dementia, AD, and VD. General happiness, health and family satisfaction, and satisfaction breadth (satisfaction in multiple domains) were associated with lower risk of all-cause dementia. The associations held after accounting for socio-demographics, health, behavioral, and economic covariates, and depressive symptoms. Health satisfaction and the breadth of satisfaction were also associated with lower risk of AD and VD, with a pattern of slightly stronger associations for VD compared to AD. Some life domains (e.g., health) may be more fruitfully targeted to promote well-being and help protect against dementia, but it is also important to enhance well-being across multiple domains to maximize the protective effects.

Satisfaction With Life and Risk of Dementia: Findings From the Korean Longitudinal Study of Aging

OBJECTIVES

Life satisfaction is increasingly viewed as an asset associated with better general health, but its association with cognitive health and risk of dementia is less examined. We tested the hypothesis that higher life satisfaction would be associated with lower risk of dementia.

METHODS

Participants were a nationally representative sample of adults (n = 8,021; age range: 45-93 years) from the Korean Longitudinal Study of Aging assessed every 2 years for up to 12 years. Multilevel modeling analysis examined whether life satisfaction is associated with cognitive functioning and decline. The primary analysis used Cox regression to examine the association between baseline life satisfaction and risk of incident dementia.

RESULTS

Between-person differences and within-person changes in life satisfaction were associated with cognitive functioning, but life satisfaction was unrelated to the rate of cognitive decline. Higher life satisfaction was also associated with lower risk of dementia, even after accounting for demographic factors, depressive symptoms, cardiovascular and functional risk factors, health behaviors, and social contact.

DISCUSSION

Satisfaction with life may function as a positive psychological resource for maintaining cognitive functioning and protecting against the risk of dementia.

Prediction of physical functioning and general health status trajectories on mortality among persons with cognitive impairment

BACKGROUND

The concern posed by the confluence of aging and cognitive impairment is growing in importance as the U.S. population rapidly ages. As such, we sought to examine the predictive power of physical functioning (PF) and general health status (GHS) trajectories on mortality outcomes among persons with cognitive impairment (PCIs).

METHODS

We used group-based trajectory models to identify latent group memberships for PF trajectories in 1,641 PCIs and GHS trajectories in 2,021 PCIs from the National Health and Aging Trends Survey (2011-2018) and applied logistic regressions to predict mortality using these memberships controlling for individual characteristics.

RESULTS

We identified six trajectory groups for PF and four groups for GHS. Trajectory group memberships for both outcomes significantly predicted mortality. For PF, group memberships largely captured the average levels over time, and worse trajectories (i.e., lower baselines and faster declines) were associated with higher odds of death. The highest mortality risk was associated with the group experiencing a sharp decline early in its PF trajectory, although its average level across time was not the lowest. For GHS, we observed two groups with comparable average levels across time, but the one with a convex-shape trajectory had much higher mortality risks compared to the one with a concave-shape trajectory.

CONCLUSIONS

Our findings highlighted that health trajectories predicted mortality among PCIs, not only because of general levels but also because of the shapes of declines. Close monitoring health deterioration of PCIs is crucial to understand the health burden of this population and to make subsequent actions.