Multifaceted Demands of Work and Their Associations with Cognitive Functioning: Findings From the Health and Retirement Study

Family Size Across the Life Course and Cognitive Decline in Older Mexican Adults

OBJECTIVES

A growing body of research has identified associations between family size and cognition in older adults. These studies largely focus on older adults' own fertility history instead of sibship size, defined as one's number of siblings. Sibship size may affect cognitive development during early childhood, creating differences that may persist into late life. Using a gendered life course framework, this study evaluates how family size across the life course (both sibship size and number of children) relates to cognitive aging among older Mexican adults.

METHODS

Data come from the 2012, 2015, 2018, and 2021 waves of the Mexican Health and Aging Study (n = 14,872 adults age 50+). We use latent growth curve models to evaluate how family size (sibship size and fertility history) relates with levels of latent general cognitive ability and 9-year cognitive decline and variation across gender.

RESULTS

Small sibship size related to higher levels of cognitive ability among men, but not women. This benefit was somewhat reduced when educational attainment was accounted for. Regarding fertility history, we observed an inverse U-shaped relationship with the level of cognitive ability, regardless of gender, that remained significant even after accounting for sibship size and other confounders. Neither family size measure predicted the rate of cognitive decline.

DISCUSSION

This research broadens our understanding of family size and cognition associations in the context of Mexico's changing demographics that challenge the reliance on family support in late life and highlights potential gender differences.

The dual impact of education and occupation on cognitive functioning in older Mexican adults: A cross-sectional exploratory study

This research investigated the relationship between cognitive performance and an individual's educational attainment as well as occupational mental demands among Mexican adults aged 50 or older. We hypothesized that cognitively demanding work boosts cognitive performance for older adults regardless of their education level. To test our hypothesis, we analyzed data on 12,939 individuals in the 2012 Mexican Health and Aging Study using a Generalized Linear Model with a Gaussian family and identity link function. We assessed cognitive demands of occupations with the National Information Network's descriptors, focusing on worker-oriented and job-oriented mental demands. We found that greater worker-oriented (β = 0.5; CI = 0.45, 0.55) and job-oriented (β = 0.49; CI = 0.45, 0.53) mental demands predicted better cognitive performance. Educational attainment correlated even more strongly with better cognitive performance (β = 0.9; CI = 0.87, 0.92). Both our models showed a statistically significant negative interaction between medium occupational mental demands and medium education level (job-oriented: β = -0.09; CI = -0.14, -0.05; worker-oriented: β = -0.07; CI = -0.12, -0.02). Other interaction terms were not significant. This study highlighted a significant effect of educational attainment on cognitive function, which is more pronounced than that of occupational mental demands. The association of higher occupational mental demands with higher cognitive function appeared to be largely independent of educational background. The similarity in cognitive scores using worker-oriented or job-oriented metrics suggests that both are useful for assessing occupational mental demands. Education and cognitive engagement at work are crucial for promoting cognitive health in aging populations.

Cognitive Health Disparities by Race and Ethnicity: The Role of Occupational Complexity and Occupational Status

Disparities in older age cognitive health by race/ethnicity persist even after controlling for individual-level indicators of childhood and adult socioeconomic status. High levels of labor market segregation mean that Black and Latino workers, on average, may not have the same exposure to jobs involving complex work with data and people as their White counterparts, aspects of work that appear to be protective of older adult cognition. However, the role of variation in exposure to occupational complexity by race/ethnicity remains understudied as an explanation for cognitive disparities at older ages. This paper uses detailed work histories constructed from the Health and Retirement Study (HRS) Occupation and Industry life history data to understand the role of occupational complexity in the development of dementia at older ages. It also addresses a conjecture that complexity reflects occupational status. Findings highlight that: (a) occupations involving complex work with data during working ages may be protective against dementia at older ages, potentially contributing to the differentials in dementia prevalence for Black, Latino, and White workers, and (b) occupational complexity reflects occupational status. This research increases understanding of the implications of labor market segregation for cognitive health disparities by race/ethnicity.

Internet-Based Social Activities and Cognitive Functioning 2 Years Later Among Middle-Aged and Older Adults: Prospective Cohort Study

Background

A number of studies document the benefits of face-to-face social interactions for cognitive functioning among middle-aged and older adults. Social activities in virtual worlds may confer similar if not enhanced cognitive benefits as face-to-face social activities, given that virtual interactions require the additional cognitive tasks of learning and navigating communicative tools and technology platforms. Yet, few studies have examined whether social activities in internet-based settings may have synergistic effects on cognitive functioning beyond those of face-to-face interactions.

Objective

This study examined whether internet-based social activity participation is associated with concurrent and later cognitive functioning, after adjusting for face-to-face social activity participation and sociodemographic covariates.

Methods

For cross-sectional analyses, we included 3650 adults aged 50 years and older who completed questions in the 2020 Health and Retirement Study about social activity participation, including specific internet-based social activities such as emailing or accessing social networks. Cognitive functioning was measured using the standardized cognitive tasks assessing working memory, episodic memory, and attention and processing speed. The longitudinal analyses included the 2034 participants who also completed follow-up cognitive assessments in 2022.

Results

Our results revealed that those with higher levels of internet-based social activity participation had higher levels of concurrent cognitive functioning than those with low levels of internet-based social activity participation, after adjusting for demographic and health-related factors and face-to-face social activity participation (b=0.44, SE 0.07; P<.001). More internet-based social activity participation also predicted better cognitive functioning 2 years later, even when adjusting for baseline cognitive functioning and other covariates (b=0.35, SE 0.09; P<.001).

Conclusions

Our findings suggest that greater engagement in internet-based social activities is associated with higher levels of concurrent cognitive functioning and slower cognitive decline in middle-aged and older adults.

The association between activities and cognitive health: Stratified analysis by APOE ε4 status

Background

Despite the growing evidence on the modifiable and genetic factors associated with cognitive health, little is known about the role of the apolipoprotein E (APOE) gene ε4 allele in the associations between productive or leisure activities and cognitive health.

Objective

This study fills a gap of knowledge by examining the associations among employment, civic engagement, and leisure activities and cognitive health by the presence of APOE ε4 allele, an established risk factor of Alzheimer's disease (AD).

Methods

Using pooled data from the Health and Retirement Study (HRS) Psychosocial and Lifestyle Questionnaires (2010-2016) and the HRS data on APOE ε4 alleles, linear regression models with a lagged dependent variable were performed to examine associations between productive or leisure activities and cognitive functioning at the follow-up time point, as well as the role of APOE ε4 in these associations.

Results

Among all participants, employment, low or high-intensity volunteering, and cognitive/social leisure activities were associated with higher levels of cognitive functioning. The presence of at least one ε4 allele was related to poorer cognitive functioning at the follow-up time point. Among people without the APOE ε4 allele, employment, high-intensity volunteering, and cognitive/social leisure activities were significantly associated with cognitive functioning. Among people with at least one APOE ε4 allele, low-intensity volunteering and cognitive/physical leisure activities were significantly associated with better cognitive functioning.

Conclusions

We found that employment, civic engagement, and leisure activities all contribute to cognitive health, although the benefits may be restricted to low-intensity volunteering and cognitive/physical leisure activities among individuals with at least one APOE ε4 allele, who are known to be inherently at a greater risk of AD, highlighting an avenue to a relatively easily implementable strategy to promote cognitive health in this subpopulation.

Effects of self-rated mental and physical work demands on cognition are dependent in a cross-sectional sample of the Health and Retirement Study

Objective

This study assessed whether self-rated physical and mental work demands were associated with cognition among older working adults and whether their effects were dependent.

Methods

Our cross-sectional sample consisted of 6,377 working older adults uisng the Health and Retirement Study in 2004. Self-rated work demands were summarized from four questions about frequency of mental or physical demands in the respondent's current job. Cognition was assessed using a subset of the Telephone Interview for Cognitive Status. We used multivariable linear regression to test for associations and additive interaction between physical and mental work demands and cognition, adjusted for age, sex, race, education, and practice effect.

Results

Independently, higher physical work demands were associated (P<0.001) with poorer cognition and higher mental work demands were associated (P<0.001) with better cognition. The effect of one work demand measure became more negative as level of the other increased (B for interaction = -0.23, 95% CI: -0.43, -0.03). A one-point increase in mental work demands was associated with 0.79 (95% CI: 0.51, 1.08) points higher cognition score when physical work demands were lowest, but was not associated with cognition when physical work demands were highest (0.11, 95% CI: -0.26, 0.48). The highest predicted cognition score was for the highest mental and lowest physical work demands. Results were robust to additional adjustment for health and behavior covariates.

Conclusions

The associations of self-rated mental and physical work demands on cognition are dependent. Future studies should strongly consider examining interactions to capture the range of work demand effects.

Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review

Cognitive impairment (CI) shares common cardiovascular risk factors with acute myocardial infarction (AMI), and is increasingly prevalent in our ageing population. Whilst AMI is associated with increased rates of CI, CI remains underreported and infrequently identified in patients with AMI. In this review, we discuss the evidence surrounding AMI and its links to dementia and CI, including pathophysiology, risk factors, management and interventions. Vascular dysregulation plays a major role in CI, with atherosclerosis, platelet activation, microinfarcts and perivascular inflammation resulting in neurovascular unit dysfunction, disordered homeostasis and a dysfunctional neurohormonal response. This subsequently affects perfusion pressure, resulting in enlarged periventricular spaces and hippocampal sclerosis. The increased platelet activation seen in coronary artery disease (CAD) can also result in inflammation and amyloid-β protein deposition which is associated with Alzheimer's Dementia. Post-AMI, reduced blood pressure and reduced left ventricular ejection fraction can cause chronic cerebral hypoperfusion, cerebral infarction and failure of normal circulatory autoregulatory mechanisms. Patients who undergo coronary revascularization (percutaneous coronary intervention or bypass surgery) are at increased risk for post-procedure cognitive impairment, though whether this is related to the intervention itself or underlying cardiovascular risk factors is debated. Mortality rates are higher in dementia patients with AMI, and post-AMI CI is more prevalent in the elderly and in patients with post-AMI heart failure. Medical management (antiplatelet, statin, renin-angiotensin system inhibitors, cardiac rehabilitation) can reduce the risk of post-AMI CI; however, beta-blockers may be associated with functional decline in patients with existing CI. The early identification of those with dementia or CI who present with AMI is important, as subsequent tailoring of management strategies can potentially improve outcomes as well as guide prognosis.

Work Demands and Cognitive Health Inequities by Race and Ethnicity: A Scoping Review

BACKGROUND AND OBJECTIVES

This scoping review aimed to chart the scientific literature on the association between workplace demands with cognitive health, and whether race and ethnicity have a direct or indirect relationship between occupational complexity and cognitive health.

RESEARCH DESIGN AND METHODS

PRISMA scoping review guided this study. Peer-reviewed articles were drawn from 5 databases. Inclusion criteria were populations aged 18 and older, U.S.-based studies, a comprehensive conceptualization of workplace demands, and cognitive health outcomes. All articles were screened by title and abstract; qualifying articles proceeded to full-text review.

RESULTS

The majority of studies drew from theories that did not interrogate heterogeneity and minority aging experiences. Consequently, the majority of studies did not include race and ethnicity in their analyses. A small and growing body of research drew from critical perspectives and interrogated cognitive health inequities by race and ethnicity within the context of workplace demands. The association between workplace demands and cognitive health is not linear when race and ethnicity are examined. Emerging evidence suggests interventions to improve substantive complexity among racial and ethnic minorities, and individuals with low education are a promising avenue for intervention research.

DISCUSSION AND IMPLICATIONS

We discuss integrating emerging theories, such as minority stress and revised social determinants of health frameworks, to sharpen the focus and broaden our understanding on racial and ethnic cognitive health inequities in an emerging area of prevention research. This research can advance our basic understanding of preventable health inequities as well as provide important information for interventions.

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

Objectives

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

Methods

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

Results

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

Conclusions

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