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Khan N, Malingagio A, Briceño EM, Mehdipanah R, Lewandowski-Romps L, Heeringa SG, Garcia N, Levine DA, Langa KM, Gonzales XF, Morgenstern LB. A Community-Based Study of Cognitive Impairment Caregiving Outcomes Pre- and During the COVID-19 Pandemic. J Appl Gerontol 2024; 43:700-705. [PMID: 37991816 PMCID: PMC11052669 DOI: 10.1177/07334648231215155] [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: 11/23/2023] Open
Abstract
The impact of the COVID-19 pandemic on informal caregiving was examined in a Mexican American (MA) and Non-Hispanic White (NHW) population-based cohort. 395 participants age > 65 years were recruited via door-to-door and phone recruitment as part of the Brain Attack Surveillance in Corpus Christi-Cognitive (BASIC-C) project. Both recipients and caregivers answered questions regarding the recipient's health and the COVID-19 pandemic. 15% of caregivers saw their caregiving recipient less than before the pandemic and 18% saw their recipient more than before. 55% of caregivers reported a slight to severe impact of the pandemic on their caregiving, and 45% reported no impact. For most caregivers, their caregiving role did not change markedly during the pandemic. MA and NHW caregivers had similar survey responses.
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Affiliation(s)
- Noreen Khan
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | | | | | - Steven G Heeringa
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | - Nelda Garcia
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Kenneth M Langa
- University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - Lewis B Morgenstern
- University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Nichols E, Gross AL, Zhang YS, Meijer E, Hayat S, Steptoe A, Langa KM, Lee J. Considerations for the use of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in cross-country comparisons of cognitive aging and dementia. Alzheimers Dement 2024. [PMID: 38805356 DOI: 10.1002/alz.13895] [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] [Received: 12/04/2023] [Revised: 03/28/2024] [Accepted: 04/22/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Informant reports are a critical component of dementia diagnoses, but the comparability of informant reports across countries is not well understood. METHODS We compared the performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) using population-representative surveys in the United States (N = 3183), England (N = 1050), and India (N = 4047). RESULTS Analyses of regression splines and comparisons of model fit showed strong associations between IQCODE and objective cognition at low cognitive functioning in the United States and England; in India, the association was weaker but consistent over the range of cognition. Associations between IQCODE score and informant generation (analysis of variance [ANOVA] p = 0.001), caregiver status (p < 0.001), and years known by the informant (p = 0.015) were different across countries after adjusting for objective cognition. DISCUSSION In India, the IQCODE was less sensitive to impairments at the lowest levels of cognitive functioning. Country-specific adjustments to IQCODE scoring based on informant characteristics may improve cross-national comparisons. HIGHLIGHTS Associations between IQCODE and cognitive testing were similar in the United States and England but differed in India. In India, the IQCODE may be less sensitive to impairments among those with low cognition and no education. Informant characteristics may differentially impact informant reports of decline across countries. Adjustments or culturally sensitive adaptations may improve cross-national comparability.
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Affiliation(s)
- Emma Nichols
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, USA
| | - Yuan S Zhang
- Robert N. Butler Columbia Aging Center, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Erik Meijer
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Shabina Hayat
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Kenneth M Langa
- Department of Internal Medicine and Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Department of Economics, University of Southern California, Los Angeles, California, USA
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Chen S, Nagel CL, Liu R, Botoseneanu A, Allore HG, Newsom JT, Thielke S, Kaye J, Quiñones AR. Mental-somatic multimorbidity in trajectories of cognitive function for middle-aged and older adults. PLoS One 2024; 19:e0303599. [PMID: 38743678 PMCID: PMC11093294 DOI: 10.1371/journal.pone.0303599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Multimorbidity may confer higher risk for cognitive decline than any single constituent disease. This study aims to identify distinct trajectories of cognitive impairment probability among middle-aged and older adults, and to assess the effect of changes in mental-somatic multimorbidity on these distinct trajectories. METHODS Data from the Health and Retirement Study (1998-2016) were employed to estimate group-based trajectory models identifying distinct trajectories of cognitive impairment probability. Four time-varying mental-somatic multimorbidity combinations (somatic, stroke, depressive, stroke and depressive) were examined for their association with observed trajectories of cognitive impairment probability with age. Multinomial logistic regression analysis was conducted to quantify the association of sociodemographic and health-related factors with trajectory group membership. RESULTS Respondents (N = 20,070) had a mean age of 61.0 years (SD = 8.7) at baseline. Three distinct cognitive trajectories were identified using group-based trajectory modelling: (1) Low risk with late-life increase (62.6%), (2) Low initial risk with rapid increase (25.7%), and (3) High risk (11.7%). For adults following along Low risk with late-life increase, the odds of cognitive impairment for stroke and depressive multimorbidity (OR:3.92, 95%CI:2.91,5.28) were nearly two times higher than either stroke multimorbidity (OR:2.06, 95%CI:1.75,2.43) or depressive multimorbidity (OR:2.03, 95%CI:1.71,2.41). The odds of cognitive impairment for stroke and depressive multimorbidity in Low initial risk with rapid increase or High risk (OR:4.31, 95%CI:3.50,5.31; OR:3.43, 95%CI:2.07,5.66, respectively) were moderately higher than stroke multimorbidity (OR:2.71, 95%CI:2.35, 3.13; OR: 3.23, 95%CI:2.16, 4.81, respectively). In the multinomial logistic regression model, non-Hispanic Black and Hispanic respondents had higher odds of being in Low initial risk with rapid increase and High risk relative to non-Hispanic White adults. CONCLUSIONS These findings show that depressive and stroke multimorbidity combinations have the greatest association with rapid cognitive declines and their prevention may postpone these declines, especially in socially disadvantaged and minoritized groups.
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Affiliation(s)
- Siting Chen
- OHSU-PSU School of Public Health, Portland, Oregon, United States of America
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Ruotong Liu
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, Michigan, United States of America
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Heather G. Allore
- Department of Internal Medicine, Yale University, New Haven, Connecticut, United States of America
- Department of Biostatistics, Yale University, New Haven, Connecticut, United States of America
| | - Jason T. Newsom
- Department of Psychology, Portland State University, Portland, Oregon, United States of America
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Ana R. Quiñones
- OHSU-PSU School of Public Health, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
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Zhang YS, O’Shea B, Yu X, Cho TC, Zhang KP, Kler J, Langa KM, Weir DR, Gross AL, Kobayashi LC. Educational Attainment and Later-Life Cognitive Function in High- and Middle-Income Countries: Evidence From the Harmonized Cognitive Assessment Protocol. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae005. [PMID: 38284333 PMCID: PMC10997278 DOI: 10.1093/geronb/gbae005] [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: 08/12/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVES Identifying social policies that can promote cognitive health is crucial for reducing the global burden of dementia. We evaluated the importance of educational attainment for later-life cognitive function in various social and geographic settings. METHODS Using harmonized data for individuals aged ≥65 years from the United States Health and Retirement Study (HRS) and its international partner studies in England, Mexico, China, and India, and each study's respective Harmonized Cognitive Assessment Protocol (HCAP), we conducted a cross-national comparative study to examine the role of educational attainment in later-life cognitive function across countries (n = 14,980, 2016-2019). We used multivariable-adjusted regression to estimate associations between educational attainment and harmonized global cognitive function scores. RESULTS In Mexico, China, and India, the general cognitive function scores on average are approximately one standard deviation of the HRS-HCAP cognitive function score distribution lower compared to the United States and England, paralleling patterns of educational attainment across countries. In all countries, higher educational attainment was associated with progressively higher later-life cognitive function scores. Population-level differences in educational attainment explained about 50%-90% of the observed differences in cognitive function scores across countries. DISCUSSION The relationship between education and later-life cognitive function across social and geographic contexts underscores the crucial role of education to promote cognitive health and reduce dementia risk. Continual improvement of educational attainment in low- and middle-income settings may yield a significant pay-off in later-life cognitive health.
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Affiliation(s)
- Yuan S Zhang
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, New York, USA
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Brendan O’Shea
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Xuexin Yu
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Tsai-Chin Cho
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kelvin Pengyuan Zhang
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jasdeep Kler
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kenneth M Langa
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - David R Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Assari S, Zare H, Sonnega A. Racial Disparities in Occupational Distribution Among Black and White Adults with Similar Educational Levels: Analysis of Middle-Aged and Older Individuals in the Health and Retirement Study. JOURNAL OF REHABILITATION THERAPY 2024; 6:1-11. [PMID: 38774764 PMCID: PMC11108055 DOI: 10.29245/2767-5122/2024/1.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Background Occupational classes play a significant role in influencing both individual and population health, serving as a vital conduit through which higher education can lead to better health outcomes. However, the pathway from education to corresponding occupational classes does not apply uniformly across different racial and ethnic groups, hindered by factors such as social stratification, labor market discrimination, and job segregation. Aims This study seeks to investigate the relationship between educational attainment and occupational classes among Black, Latino, and White middle-aged and older adults, with a focus on their transition into retirement. Methods Using cross-sectional data from the Health and Retirement Study (HRS), this research examines the impact of race/ethnicity, educational attainment, occupational classes, and timing of retirement among middle-aged and older adults. The analysis includes a sample of 7,096 individuals identified as White, Black, or Latino. Through logistic regression, we assess the additive and multiplicative effects of race/ethnicity and education on six defined occupational classes: 1. Managerial and specialty operations, 2. Professional Specialty, 3. Sales, 4. Clerical/administrative support, 5. Services, and 6. Manual labor. Results Participants were Black (n = 1,143) or White (n =5,953). This included Latino (N =459) or non-Latino (n = 6,634). Our analysis reveals a skewed distribution of Black and Latino adults in manual and service occupations, in stark contrast to White adults who were more commonly found in clerical/administrative and managerial positions. Educational attainment did not equate to similar occupational outcomes across racial groups. Key findings include: Firstly, Black individuals with a college degree or higher were less likely to occupy clerical and administrative positions compared to their White counterparts. Secondly, holding a General Educational Development (GED) credential or some college education was generally linked to reduced likelihood of being in managerial roles; however, this inverse relationship was less evident among Black middle-aged and older adults than White ones. Thirdly, having a GED reduced the chances of working in sales roles, while having a college degree increased such chances. An interaction between race and some college education revealed that the impact of some college education on sales roles was more significant for Black adults than for White ones. We did not observe any interaction between ethnicity (Latino) and educational attainment on occupational classes. Given the stability of occupational classes, these findings could also apply to the last occupation held prior to retirement. Conclusion This study highlights significant racial disparities in occupational classes among individuals with comparable levels of education, underscoring the profound implications for health and wellbeing disparities. Future research should explore strategies to alleviate labor market discrimination and job segregation as ways to close these occupational gaps. Additionally, the influence of social stratification, job segregation, and historical legacies, such as the repercussions of the Jim Crow era, on these disparities merits further investigation. Addressing these issues is crucial for enhancing the health and wellbeing of all populations.
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Affiliation(s)
- Shervin Assari
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- Marginalization-Related-Diminished Returns (MDRs) Center, Los Angeles, CA, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD, 20774, USA
| | - Amanda Sonnega
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Khobragade P, Nichols E, Meijer E, Varghese M, Banerjee J, Dey AB, Lee J, Gross A, Ganguli M. Performance of the Informant Questionnaire on Cognitive Decline for the Elderly (IQCODE) in a nationally representative study in India: the LASI-DAD study. Int Psychogeriatr 2024; 36:177-187. [PMID: 35844066 PMCID: PMC9845422 DOI: 10.1017/s1041610222000606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Low and middle-income countries like India anticipate rapid population aging and increases in dementia burden. In India, dementia screening scales originally developed in other contexts need to be assessed for feasibility and validity, given the number of different languages and varying levels of literacy and education. METHOD Using data from the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (N = 4,028), we characterize the performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). We described patterns and correlates of missingness, evaluated the psychometric properties of the scale, and assessed criterion validity against the Hindi Mental State Examination (HMSE) using linear regression. RESULTS Several IQCODE items had high levels of missingness, which was associated with urbanicity, respondent's gender, and informant's generation (same vs. younger generation). Full IQCODE scores showed strong criterion validity against the HMSE; each 1-point increase in IQCODE score was associated with a 3.03-point lower score on the HMSE, controlling for age, gender, and urbanicity. The statistically significant association between IQCODE and HMSE was stronger in urban than rural settings (p-value for interaction = 0.04). Associations between IQCODE and HMSE remained unchanged after removing the three items with the highest levels of differential missingness (remembering addresses and telephone numbers, ability to work with familiar machines, ability to learn to use new gadget or machine). CONCLUSION Findings raise questions about the value of including items with high proportions of missingness, which may signal cultural irrelevance, while removing them did not affect criterion validity.
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Affiliation(s)
| | - Emma Nichols
- Johns Hopkins Bloomberg School of Public Health, Baltimore, US
| | - Erik Meijer
- University of Southern California, Los Angeles, California, US
| | - Mathew Varghese
- Formerly “National Institute of Mental Health and Neuro Sciences”, Currently “St John’s Medical College”, Bangalore, Karnataka, India
| | | | - A B Dey
- Formerly “All India Institute of Medical Sciences”, Delhi, India, Currently “Venu Eye Institute & Research Centre”, New Delhi, India
| | - Jinkook Lee
- University of Southern California, Los Angeles, California, US
| | - Alden Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, US
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Sutin AR, Luchetti M, Stephan Y, Terracciano A. Purpose in life and cognitive performance and informant ratings of cognitive decline, affect, and activities. J Int Neuropsychol Soc 2024; 30:244-252. [PMID: 37609873 PMCID: PMC10884354 DOI: 10.1017/s1355617723000516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE To examine (1) the association between purpose in life and multiple domains of cognitive function and informant-rated cognitive decline, affect, and activities; (2) whether these associations are moderated by sociodemographic factors, cognitive impairment, or depression; (3) whether the associations are independent of other aspects of well-being and depressive symptoms. METHOD As part of the 2016 Harmonized Cognitive Assessment Protocol from the Health and Retirement Study, participants completed a battery of cognitive tests and nominated a knowledgeable informant to rate their cognitive decline, affect, and activities. Participants with information available on their purpose in life from the 2014/2016 Leave Behind Questionnaire were included in the analytic sample (N = 2,812). RESULTS Purpose in life was associated with better performance in every cognitive domain examined (episodic memory, speed-attention, visuospatial skills, language, numeric reasoning; median β =.10, p <.001; median d =.53). Purpose was likewise associated with informant-rated cognitive decline and informant-rated affective and activity profiles beneficial for cognitive health (median β =.18, p < .001; median d =.55). There was little evidence of moderation by sociodemographic or other factors (e.g., depression). Life satisfaction, optimism, positive affect, and mastery were generally associated with cognition. When tested simultaneously with each other and depressive symptoms, most dimensions were reduced to non-significance; purpose remained a significant predictor. CONCLUSIONS Purpose in life is associated with better performance across numerous domains of cognition and with emotional and behavioral patterns beneficial for cognitive health that are observable by knowledgeable others. These associations largely generalize across demographic and clinical groups and are independent of other aspects of well-being.
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Kobayashi LC, O'Shea BQ, Wixom C, Jones RN, Langa KM, Weir D, Lee J, Wong R, Gross AL. Lifetime occupational skill and later-life cognitive function among older adults in the United States, Mexico, India, and South Africa. Alzheimers Dement 2024; 20:1933-1943. [PMID: 38159252 PMCID: PMC10947921 DOI: 10.1002/alz.13665] [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: 05/18/2023] [Revised: 11/20/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION We conducted a cross-national comparison of the association between main lifetime occupational skills and later-life cognitive function across four economically and socially distinct countries. METHODS Data were from population-based studies of aging and their Harmonized Cognitive Assessment Protocols (HCAPs) in the US, South Africa, India, and Mexico (N = 10,037; Age range: 50 to 105 years; 2016 to 2020). Main lifetime occupational skill was classified according to the International Standard Classification of Occupations. Weighted, adjusted regression models estimated pooled and country-specific associations between main lifetime occupational skill and later-life general cognitive function in men and women. RESULTS We observed positive gradients between occupational skill and later-life cognitive function for men and women in the US and Mexico, a positive gradient for women but not men in India, and no association for men or women in South Africa. DISCUSSION Main lifetime occupations may be a source of later-life cognitive reserve, with cross-national heterogeneity in this association. HIGHLIGHTS No studies have examined cross-national differences in the association of occupational skill with cognition. We used data from Harmonized Cognitive Assessment Protocols in the US, Mexico, India, and South Africa. The association of occupational skill with cognitive function varies by country and gender.
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Affiliation(s)
- Lindsay C. Kobayashi
- Center for Social Epidemiology and Population HealthDepartment of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborUSA
- Survey Research CenterInstitute for Social ResearchUniversity of MichiganAnn ArborUSA
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt)University of the WitwatersrandJohannesburgSouth Africa
| | - Brendan Q. O'Shea
- Center for Social Epidemiology and Population HealthDepartment of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborUSA
| | - Caroline Wixom
- Survey Research CenterInstitute for Social ResearchUniversity of MichiganAnn ArborUSA
| | - Richard N. Jones
- Department of Psychiatry and Human BehaviorAlpert Medical SchoolBrown UniversityProvidenceUSA
- Department of NeurologyAlpert Medical SchoolBrown UniversityProvidenceUSA
| | - Kenneth M. Langa
- Survey Research CenterInstitute for Social ResearchUniversity of MichiganAnn ArborUSA
- Department of Internal MedicineSchool of MedicineUniversity of MichiganAnn ArborUSA
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborUSA
- Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMichiganUSA
| | - David Weir
- Survey Research CenterInstitute for Social ResearchUniversity of MichiganAnn ArborUSA
| | - Jinkook Lee
- Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Rebeca Wong
- Sealy Center on AgingUniversity of Texas Medical BranchGalvestonTexasUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
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Kobayashi LC, Jones RN, Briceño EM, Rentería MA, Zhang Y, Meijer E, Langa KM, Lee J, Gross AL. Cross-national comparisons of later-life cognitive function using data from the Harmonized Cognitive Assessment Protocol (HCAP): Considerations and recommended best practices. Alzheimers Dement 2024; 20:2273-2281. [PMID: 38284801 PMCID: PMC10984496 DOI: 10.1002/alz.13694] [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: 07/31/2023] [Revised: 12/01/2023] [Accepted: 12/23/2023] [Indexed: 01/30/2024]
Abstract
The Harmonized Cognitive Assessment Protocol (HCAP) is a major innovation that provides, for the first time, harmonized data for cross-national comparisons of later-life cognitive functions that are sensitive to linguistic, cultural, and educational differences across countries. However, cognitive function does not lend itself to direct comparison across diverse populations without careful consideration of the best practices for such comparisons. This perspective discusses theoretical and methodological considerations and offers a set of recommended best practices for conducting cross-national comparisons of risk factor associations using HCAP data. Because existing and planned HCAP studies provide cognition data representing an estimated 75% of the global population ≥65 years of age, these recommended best practices will support high-quality comparative analyses of cognitive aging around the world. The principles described in this perspective are applicable to any researcher aiming to integrate or compare harmonized data on cognitive outcomes and their risk and protective factors across diverse populations.
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Affiliation(s)
- Lindsay C. Kobayashi
- Department of EpidemiologyCenter for Social Epidemiology and Population HealthUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
- Survey Research CenterUniversity of Michigan Institute for Social ResearchAnn ArborMichiganUSA
| | - Richard N. Jones
- Department of Psychiatry and Human BehaviorWarren Alpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Emily M. Briceño
- Department of Physical Medicine & RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Miguel Arce Rentería
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of NeurologyColumbia University College of Physicians and SurgeonsNew York CityNew YorkUSA
| | - Yuan Zhang
- Department of Sociomedical SciencesColumbia UniversityNew York CityNew YorkUSA
- Robert N. Butler Columbia Aging CenterColumbia UniversityNew York CityNew YorkUSA
| | - Erik Meijer
- Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kenneth M. Langa
- Survey Research CenterUniversity of Michigan Institute for Social ResearchAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Veterans Affairs Center for Clinical Management ResearchAnn ArborMichiganUSA
| | - Jinkook Lee
- Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center on Aging and HealthJohns Hopkins UniversityBaltimoreMarylandUSA
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10
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Gross AL, Nichols E, Angrisani M, Ganguli M, Jin H, Khobragade P, Langa KM, Meijer E, Varghese M, Dey AB, Lee J. Prevalence of DSM-5 mild and major neurocognitive disorder in India: Results from the LASI-DAD. PLoS One 2024; 19:e0297220. [PMID: 38324518 PMCID: PMC10849236 DOI: 10.1371/journal.pone.0297220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION India, with its rapidly aging population, faces an alarming burden of dementia. We implemented DSM-5 criteria in large-scale, nationally representative survey data in India to characterize the prevalence of mild and major Neurocognitive disorder. METHODS The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) (N = 4,096) is a nationally representative cohort study in India using multistage area probability sampling methods. Using neuropsychological testing and informant reports, we defined DSM-5 mild and major neurocognitive disorder, reported its prevalence, and evaluated criterion and construct validity of the algorithm using clinician-adjudicated Clinical Dementia Ratings (CDR)®. RESULTS The prevalence of mild and major neurocognitive disorder, weighted to the population, is 17.6% and 7.2%. Demographic gradients with respect to age and education conform to hypothesized patterns. Among N = 2,390 participants with a clinician-adjudicated CDR, CDR ratings and DSM-5 classification agreed for N = 2,139 (89.5%) participants. DISCUSSION The prevalence of dementia in India is higher than previously recognized. These findings, coupled with a growing number of older adults in the coming decades in India, have important implications for society, public health, and families. We are aware of no previous Indian population-representative estimates of mild cognitive impairment, a group which will be increasingly important in coming years to identify for potential therapeutic treatment.
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Affiliation(s)
- Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emma Nichols
- Center for Economic and Social Research, University of Southern California, Los Angeles, Los Angeles, California, United States of America
| | - Marco Angrisani
- Center for Economic and Social Research, University of Southern California, Los Angeles, Los Angeles, California, United States of America
- Department of Economics, University of Southern California, Los Angeles, Los Angeles, California, United States of America
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Haomiao Jin
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Pranali Khobragade
- Department of Economics, University of Southern California, Los Angeles, Los Angeles, California, United States of America
| | - Kenneth M. Langa
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Institute for Social Research, Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, United States of America
| | - Erik Meijer
- Center for Economic and Social Research, University of Southern California, Los Angeles, Los Angeles, California, United States of America
- Department of Economics, University of Southern California, Los Angeles, Los Angeles, California, United States of America
| | - Mathew Varghese
- Department of Psychiatry, St. John’s Medical College, Bengaluru, Karnataka, India
| | - A. B. Dey
- Venu Geriatric Institute, New Delhi, India
| | - Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, Los Angeles, California, United States of America
- Department of Economics, University of Southern California, Los Angeles, Los Angeles, California, United States of America
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Kraal AZ, Zaheed AB, Krasnova A, Vadari H, Byrd DR, Zahodne LB. Time-lagged associations between two adverse childhood experiences and later-life cognitive function through educational attainment and stroke. J Int Neuropsychol Soc 2024; 30:107-116. [PMID: 37401463 DOI: 10.1017/s135561772300036x] [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] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) have been associated with worse cognitive health in older adulthood. This study aimed to extend findings on the specificity, persistence, and pathways of associations between two ACEs and cognition by using a comprehensive neuropsychological battery and a time-lagged mediation design. METHOD Participants were 3304 older adults in the Health and Retirement Study Harmonized Cognitive Assessment Protocol. Participants retrospectively reported whether they were exposed to parental substance abuse or experienced parental physical abuse before age 18. Factor scores derived from a battery of 13 neuropsychological tests indexed cognitive domains of episodic memory, executive functioning, processing speed, language, and visuospatial function. Structural equation models examined self-reported years of education and stroke as mediators, controlling for sociodemographics and childhood socioeconomic status. RESULTS Parental substance abuse in childhood was associated with worse later-life cognitive function across all domains, in part via pathways involving educational attainment and stroke. Parental physical abuse was associated with worse cognitive outcomes via stroke independent of education. CONCLUSIONS This national longitudinal study in the United States provides evidence for broad and persistent indirect associations between two ACEs and cognitive aging via differential pathways involving educational attainment and stroke. Future research should examine additional ACEs and mechanisms as well as moderators of these associations to better understand points of intervention.
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Affiliation(s)
- A Zarina Kraal
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- G. H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Afsara B Zaheed
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Anna Krasnova
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Harita Vadari
- Department of General Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - DeAnnah R Byrd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Laura B Zahodne
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
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O'Hara L, Neville C, Marr C, McAlinden M, Kee F, Weir D, McGuinness B. Investigating the prevalence of cognitive impairment and dementia in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA): the Harmonised Cognitive Assessment Protocol (HCAP) cross-sectional substudy. BMJ Open 2024; 14:e075672. [PMID: 38296305 PMCID: PMC10831431 DOI: 10.1136/bmjopen-2023-075672] [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: 05/15/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) study is the largest study of ageing in Northern Ireland (NI). The Harmonised Cognitive Assessment Protocol (HCAP) is a substudy of NICOLA designed to assess cognitive impairment and dementia in individuals aged 65 and over. The NICOLA-HCAP substudy is funded by the National Institute on Aging as part of a network for enhancing cross-national research within a worldwide group of population-based, longitudinal studies of ageing, all of which are centred around the US-based Health and Retirement Study. METHODS AND ANALYSIS The NICOLA-HCAP study will draw on the main NICOLA cohort (of 8283 participants) and randomly sample 1000 participants aged 65 and over to take part in the substudy. Participants will complete a series of cognitive tests (n=19) via a computer-assisted personal interview administered in their home (or alternatively within the research centre) and will be asked to nominate a family member or friend to complete an additional interview of validated instruments to provide information on respondent's prior and current cognitive and physical functioning and whether the individual requires help with daily activities. The objectives of the study are: to investigate the prevalence of dementia and cognitive impairment in NICOLA; harmonise scoring of the NICOLA-HCAP data to the HCAP studies conducted in Ireland, the USA and England; to explore the validity of dementia estimates; and investigate the risk factors for dementia and cognitive impairment. ETHICS AND DISSEMINATION The study received ethical approval from the Faculty of Medicine, Health and Life Sciences Research Ethics Committee, Queen's University Belfast. We will provide data from the Northern Irish HCAP to the research community via data repositories such as the Dementias Platform UK and Gateway to Global Aging to complement existing public data resources and support epidemiological research by others. Findings will also be disseminated through peer-reviewed publications and at international conferences.
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Affiliation(s)
- Leeanne O'Hara
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Calum Marr
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - David Weir
- University of Michigan, Ann Arbor, Michigan, USA
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Jones RN, Manly JJ, Langa KM, Ryan LH, Levine DA, McCammon R, Weir D. Factor structure of the Harmonized Cognitive Assessment Protocol neuropsychological battery in the Health and Retirement Study. J Int Neuropsychol Soc 2024; 30:47-55. [PMID: 37448351 PMCID: PMC10787803 DOI: 10.1017/s135561772300019x] [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] [Indexed: 07/15/2023]
Abstract
OBJECTIVE The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS). METHOD The HCAP battery was compiled from existing measures by a cross-disciplinary and international panel of researchers. The HCAP battery was used in the 2016 wave of the HRS. We used factor analysis methods to assess and refine a theoretically driven single and multiple domain factor structure for tests included in the HCAP battery among 3,347 participants with evaluable performance data. RESULTS For the eight domains of cognitive functioning identified (orientation, memory [immediate, delayed, and recognition], set shifting, attention/speed, language/fluency, and visuospatial), all single factor models fit reasonably well, although four of these domains had either 2 or 3 indicators where fit must be perfect and is not informative. Multidimensional models suggested the eight-domain model was overly complex. A five-domain model (orientation, memory delayed and recognition, executive functioning, language/fluency, visuospatial) was identified as a reasonable model for summarizing performance in this sample (standardized root mean square residual = 0.05, root mean square error of approximation = 0.05, confirmatory fit index = 0.94). CONCLUSIONS The HCAP battery conforms adequately to a multidimensional structure of neuropsychological performance. The derived measurement models can be used to operationalize notions of neurocognitive impairment, and as a starting point for prioritizing pre-statistical harmonization and evaluating configural invariance in cross-national research.
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Affiliation(s)
- Richard N. Jones
- - Department of Psychiatry and Human Behavior, Department of Neurology, Brown University Warren Alpert Medical School, Providence
- - Department of Neurology, Brown University Warren Alpert Medical School, Providence
| | - Jennifer J. Manly
- - Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Kenneth M. Langa
- - Institute for Social Research, University of Michigan, Ann Arbor
- - Cognitive Health Sciences Research Program and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- - Veterans Affairs Center for Clinical Management Research, Ann Arbor
| | - Lindsay H. Ryan
- - Institute for Social Research, University of Michigan, Ann Arbor
| | - Deborah A. Levine
- - Cognitive Health Sciences Research Program and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- - Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- - Department of Neurology and Stroke Program, University of Michigan, Ann Arbor
| | - Ryan McCammon
- - Institute for Social Research, University of Michigan, Ann Arbor
| | - David Weir
- - Institute for Social Research, University of Michigan, Ann Arbor
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Westrick AC, Avila‐Rieger J, Gross AL, Hohman T, Vonk JMJ, Zahodne LB, Kobayashi LC. Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India. Alzheimers Dement 2024; 20:16-24. [PMID: 37490296 PMCID: PMC10808282 DOI: 10.1002/alz.13404] [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: 03/03/2023] [Revised: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION We compared gender disparities in later-life memory, overall and by education, in India and the United States (US). METHODS Data (N = 7443) were from harmonized cognitive assessment protocols (HCAPs) in the Longitudinal Aging Study of India-Diagnostic Assessment of Dementia (LASI-DAD; N = 4096; 2017-19) and US Health and Retirement Study HCAP (HRS-HCAP; N = 3347; 2016-17). We derived harmonized memory factors from each study using confirmatory factor analysis. We used multivariable-adjusted linear regression to compare gender disparities in memory function between countries, overall and by education. RESULTS In the United States, older women had better memory than older men (0.28 SD-unit difference; 95% CI: 0.22, 0.35). In India, older women had worse memory than older men (-0.15 SD-unit difference; 95% CI: -0.20, -0.10), which attenuated with increasing education and literacy. CONCLUSION We observed gender disparities in memory in India that were not present in the United States, and which dissipated with education and literacy.
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Affiliation(s)
- Ashly C. Westrick
- Department of EpidemiologyCenter for Social Epidemiology and Population HealthUniversity of Michigan: School of Public HealthAnn ArborMichiganUSA
| | - Justina Avila‐Rieger
- Gertrude H. Sergievsky Center and the Taub Institute for Research in Aging and Alzheimer's DiseaseColumbia UniversityNew YorkNew YorkUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthCenter on Aging and HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Timothy Hohman
- Vanderbilt Memory & Alzheimer's CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt Genetics InstituteVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jet M. J. Vonk
- Department of NeurologyMemory and Aging CenterUniversity of California San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Laura B. Zahodne
- Department of PsychologyUniversity of MichiganAnn ArborMichiganUSA
| | - Lindsay C. Kobayashi
- Department of EpidemiologyCenter for Social Epidemiology and Population HealthUniversity of Michigan: School of Public HealthAnn ArborMichiganUSA
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Morgenstern LB, Briceño EM, Mehdipanah R, Chang W, Lewandowski-Romps L, Gonzales XF, Levine DA, Langa KM, Garcia N, Khan N, Zahuranec DB, Heeringa SG. A Community-Based Study of Dementia in Mexican American and Non-Hispanic White Individuals. J Alzheimers Dis 2024; 97:649-658. [PMID: 38143352 PMCID: PMC10866536 DOI: 10.3233/jad-230729] [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: 12/26/2023]
Abstract
BACKGROUND Little information is available on the prevalence of cognitive impairment in Mexican American persons. OBJECTIVE To determine the prevalence of mild cognitive impairment (MCI) and dementia in those 65 years and older among Mexican American and non-Hispanic white individuals in a community. METHODS This was a population-based cohort study in Nueces County, Texas, USA. Participants were recruited using a random housing sample. The Harmonized Cognitive Assessment (HCAP) participant and informant protocol was performed after Montreal Cognitive Assessment (MoCA) screening. An algorithm was used to sort participants into diagnostic categories: no cognitive impairment, MCI, or dementia. Logistic regression determined the association of ethnicity with MCI and dementia controlling for age, gender, and education. RESULTS 1,901 participants completed the MoCA and 547 the HCAP. Mexican Americans were younger and had less educational attainment than non-Hispanic whites. Overall, dementia prevalence was 11.6% (95% CI 9.2-14.0) and MCI prevalence was 21.2% (95% CI 17.5-24.8). After adjusting for age, gender, and education level, there was no significant ethnic difference in the odds of dementia or MCI. Those with ≤11 compared with ≥16 years of education had much higher dementia [OR = 4.9 (95% CI 2.2-11.1)] and MCI risk [OR = 3.5 (95% CI 1.6-7.5)]. CONCLUSIONS Dementia and MCI prevalence were high in both Mexican American and non-Hispanic white populations. Mexican American persons had double the odds of mild cognitive impairment and this was attenuated when age and educational attainment were considered. Educational attainment was a potent predictor of cognitive impairment.
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Affiliation(s)
- Lewis B. Morgenstern
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI 48109
| | - Emily M. Briceño
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI 48109
| | - Roshanak Mehdipanah
- University of Michigan, School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI 48109
| | - Wen Chang
- University of Michigan Institute for Social Research, Ann Arbor, MI 48109
| | | | - Xavier F. Gonzales
- Texas A&M University-Corpus Christi, Department of Life Sciences, Corpus Christi, TX 78412
| | - Deborah A. Levine
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
- University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, MI 48109
| | - Kenneth M. Langa
- University of Michigan Institute for Social Research, Ann Arbor, MI 48109
- University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, MI 48109
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI 48105
| | - Nelda Garcia
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
| | - Noreen Khan
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
| | - Darin B. Zahuranec
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI 48109
| | - Steven G. Heeringa
- University of Michigan Institute for Social Research, Ann Arbor, MI 48109
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Hu Y, Yu H, Lai Y, Liu J, Tan Y, Lei W, Zhang J, Zhou X, Cao Y, Tang Y, Liu D, Zhang J. Longitudinal trajectory of amplitude of low-frequency fluctuation changes in breast cancer patients during neoadjuvant chemotherapy-A preliminary prospective study. Brain Res Bull 2024; 206:110845. [PMID: 38101650 DOI: 10.1016/j.brainresbull.2023.110845] [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: 09/20/2023] [Revised: 11/15/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023]
Abstract
There is growing evidence that the amplitude of low-frequency fluctuation (ALFF) changes in breast cancer patients after chemotherapy. However, longitudinal changes in ALFF during chemotherapy are unclear. To assess the trajectory of ALFF changes during chemotherapy, 36 breast cancer patients underwent both resting-state functional magnetic resonance imaging and neuropsychological testing at three time points, including before neoadjuvant chemotherapy (NAC) (time point 0, TP0), after one cycle of NAC (before the second cycle of NAC, TP1), and upon completion of NAC (pre-operation, TP2). Healthy controls (HC) received the same assessments at matching time points. We compared the longitudinal changes of ALFF in the NAC and two HC groups. In the NAC group, compared with TP0, ALFF values in the right orbital part of the inferior frontal gyrus, left medial orbital part of the superior frontal gyrus, right insula, left medial part of the superior frontal gyrus, and right middle frontal gyrus declined significantly at TP1 and TP2. Compared with TP1, there were no significant changes in ALFF values at TP2. In the two HC groups, there were no significant changes in ALFF at corresponding intervals. We concluded that for breast cancer patients receiving NAC, ALFF values declined significantly in some brain regions after one cycle of NAC and then remained stable until the completion of NAC, and most of the brain regions with ALFF changes were located in the frontal lobe.
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Affiliation(s)
- Yixin Hu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Hong Yu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yong Lai
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jiang Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yong Tan
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Weiwei Lei
- Department of Intensive Care, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jing Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xiaoyu Zhou
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Ying Cao
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yu Tang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.
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Wang N, Xu H, West JS, Østbye T, Wu B, Xian Y, Dupre ME. Association between perceived risk of Alzheimer's disease and related dementias and cognitive function among U.S. older adults. Arch Gerontol Geriatr 2023; 115:105126. [PMID: 37494832 PMCID: PMC10615679 DOI: 10.1016/j.archger.2023.105126] [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: 04/26/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION The aim of the study was to assess factors associated with the perceived risk of developing Alzheimer's disease and related dementias (ADRD) and how the perceived risk of ADRD was related to cognitive function. METHODS We conducted a retrospective cohort study using 5 waves of data from the Health and Retirement Study (2012-2022) that included adults aged 65 years or older with no previous diagnosis of ADRD at baseline. Cognitive function was measured at baseline and over time using a summary score that included immediate/delayed word recall, serial 7's test, objective naming test, backwards counting, recall of the current date, and naming the president/vice-president (range = 0-35). Perceived risk of developing ADRD was categorized at baseline as "definitely not" (0% probability), "unlikely" (1-49%), "uncertain" (50%), and "more than likely" (>50-100%). Additional baseline measures included participants' sociodemographic background, psychosocial resources, health behaviors, physiological status, and healthcare utilization. RESULTS Of 1457 respondents (median age 74 [IQR = 69-80] and 59.8% women), individuals who perceived that they were "more than likely" to develop ADRD had more depressive symptoms and were more likely to be hospitalized in the past two years than individuals who indicated that it was "unlikely" they would develop ADRD. Alternatively, respondnets who perceived that they would "definitely not" develop ADRD were more likely to be non-Hispanic Black, less educated, and have lower income than individuals who indicated it was "unlikely" they would develop ADRD. Respondents who reported their risks of developing ADRD as "more than likely" (β = -2.10, P < 0.001) and "definitely not" (β = -1.50, P < 0.001) had the lowest levels of cognitive function; and the associations were explained in part by their socioeconomic, psychosocial, and health status. CONCLUSIONS Perceived risk of developing ADRD is associated with cognitive function. The (dis)concordance between individuals' perceived risk of ADRD and their cognitive function has important implications for increasing public awareness and developing interventions to prevent ADRD.
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Affiliation(s)
- Nan Wang
- Department of Public Health Sciences, School of Medicine, UC-Davis, CA, United States of America
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States of America; Duke University School of Nursing, Duke University, Durham, NC, United States of America; Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America.
| | - Jessica S West
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America; Department of Population Health Sciences, Duke University, Durham, NC, United States of America
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States of America; Duke University School of Nursing, Duke University, Durham, NC, United States of America; Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York, NY, United States of America
| | - Ying Xian
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Matthew E Dupre
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America; Department of Population Health Sciences, Duke University, Durham, NC, United States of America; Department of Sociology, Duke University, Durham, NC, United States of America
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Gharbi-Meliani A, Husson F, Vandendriessche H, Bayen E, Yaffe K, Bachoud-Lévi AC, Cleret de Langavant L. Identification of high likelihood of dementia in population-based surveys using unsupervised clustering: a longitudinal analysis. Alzheimers Res Ther 2023; 15:209. [PMID: 38031083 PMCID: PMC10688099 DOI: 10.1186/s13195-023-01357-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Dementia is defined as a cognitive decline that affects functional status. Longitudinal ageing surveys often lack a clinical diagnosis of dementia though measure cognition and daily function over time. We used unsupervised machine learning and longitudinal data to identify transition to probable dementia. METHODS Multiple Factor Analysis was applied to longitudinal function and cognitive data of 15,278 baseline participants (aged 50 years and more) from the Survey of Health, Ageing, and Retirement in Europe (SHARE) (waves 1, 2 and 4-7, between 2004 and 2017). Hierarchical Clustering on Principal Components discriminated three clusters at each wave. We estimated probable or "Likely Dementia" prevalence by sex and age, and assessed whether dementia risk factors increased the risk of being assigned probable dementia status using multistate models. Next, we compared the "Likely Dementia" cluster with self-reported dementia status and replicated our findings in the English Longitudinal Study of Ageing (ELSA) cohort (waves 1-9, between 2002 and 2019, 7840 participants at baseline). RESULTS Our algorithm identified a higher number of probable dementia cases compared with self-reported cases and showed good discriminative power across all waves (AUC ranged from 0.754 [0.722-0.787] to 0.830 [0.800-0.861]). "Likely Dementia" status was more prevalent in older people, displayed a 2:1 female/male ratio, and was associated with nine factors that increased risk of transition to dementia: low education, hearing loss, hypertension, drinking, smoking, depression, social isolation, physical inactivity, diabetes, and obesity. Results were replicated in ELSA cohort with good accuracy. CONCLUSIONS Machine learning clustering can be used to study dementia determinants and outcomes in longitudinal population ageing surveys in which dementia clinical diagnosis is lacking.
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Affiliation(s)
- Amin Gharbi-Meliani
- Neuropsychologie Interventionnelle, U955 E01, Institut Mondor de Recherche Biomédicale & Département d'études Cognitives, INSERM, Ecole Normale Supérieure, Université PSL, Université Paris-Est Créteil, Creteil, 94000, France
| | - François Husson
- Institut Agro, Univ Rennes1, CNRS, IRMAR, Rennes, 35000, France
| | - Henri Vandendriessche
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d'études Cognitives, Ecole Normale Supérieure, Université PSL, INSERM, Paris, 75005, France
| | - Eleonore Bayen
- Département de Rééducation Neurologique, Sorbonne Université, Hôpital Pitié-Salpêtrière-Assistance Publique Hôpitaux de Paris, Paris, 75013, France
- Global Brain Health Institute, University of California, San Francisco, CA, 94143, USA
| | - Kristine Yaffe
- Global Brain Health Institute, University of California, San Francisco, CA, 94143, USA
- Departments of Psychiatry, Neurology and Epidemiology and Biostatistics, University of California, San Francisco, CA, 94143, USA
| | - Anne-Catherine Bachoud-Lévi
- Neuropsychologie Interventionnelle, U955 E01, Institut Mondor de Recherche Biomédicale & Département d'études Cognitives, INSERM, Ecole Normale Supérieure, Université PSL, Université Paris-Est Créteil, Creteil, 94000, France
- Service de Neurologie, Centre de référence maladie de Huntington, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 1 rue Gustave Eiffel, Creteil, 94000, France
| | - Laurent Cleret de Langavant
- Neuropsychologie Interventionnelle, U955 E01, Institut Mondor de Recherche Biomédicale & Département d'études Cognitives, INSERM, Ecole Normale Supérieure, Université PSL, Université Paris-Est Créteil, Creteil, 94000, France.
- Global Brain Health Institute, University of California, San Francisco, CA, 94143, USA.
- Service de Neurologie, Centre de référence maladie de Huntington, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, 1 rue Gustave Eiffel, Creteil, 94000, France.
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Malvitz M, Zahuranec DB, Chang W, Heeringa SG, Briceño EM, Mehdipanah R, Gonzales XF, Levine DA, Langa KM, Garcia N, Morgenstern LB. Driving predictors in a cohort of cognitively impaired Mexican American and non-Hispanic White individuals. J Am Geriatr Soc 2023; 71:3520-3529. [PMID: 37382492 PMCID: PMC10755064 DOI: 10.1111/jgs.18493] [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: 05/01/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Individuals with Alzheimer's disease and Alzheimer's disease-related dementias may lose the ability to drive safely as their disease progresses. Little is known about driving prevalence in older Latinx and non-Hispanic White (NHW) individuals. We investigated the prevalence of driving status among individuals with cognitive impairment in a population-based cohort. METHODS This was a cross-sectional analysis of the cohort BASIC-Cognitive study in a community of Mexican American (MA) and NHW individuals in South Texas. Participants scored ≤25 on the Montreal Cognitive Assessment (MoCA), indicating a likelihood of cognitive impairment. Current driving status was assessed by the Harmonized Cognitive Assessment Protocol informant interview. Logistic regression was used to assess driving versus non-driving adjusted for pre-specified covariates. Chi-square and Mann-Whitney U tests were used to compare NHW and MA differences in driving outcomes from the American Academy of Neurology (AAN) questions for evaluating driving risk in dementia. RESULTS There were 635 participants, 77.0 mean age, 62.4% women, and 17.3 mean MoCA. Of these, 360 (61.4%) were current drivers with 250 of 411 (60.8%) MA participants driving, and 121 of 190 (63.70%) NHW participants driving (p = 0.50). In fully adjusted models age, sex, cognitive impairment, language preference, and Activities of Daily Living scores were significant predictors for the likelihood of driving (p < 0.0001). Severity of cognitive impairment was inversely associated with odds of driving, but this relationship was not found in those preferring Spanish language for interviews. Around one-third of all caregivers had concerns about their care-recipient driving. There were no significant differences in MA and NHW driving habits and outcomes from the AAN questionnaire. CONCLUSIONS The majority of participants with cognitive impairment were currently driving. This is a cause for concern for many caregivers. There were no significant ethnic driving differences. Associations with current driving in cognitively impaired persons require further research.
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Affiliation(s)
- Madelyn Malvitz
- University of Michigan Medical School Department of Neurology
| | | | - Wen Chang
- University of Michigan Institute of Social Research
| | | | - Emily M. Briceño
- University of Michigan Medical School Department of Neurology
- University of Michigan Medical School Department of Physical Medicine and Rehabilitation
| | - Roshanak Mehdipanah
- University of Michigan School of Public Health Department of Health Behavior and Health Education
| | | | - Deborah A. Levine
- University of Michigan Medical School Department of Neurology
- University of Michigan Medical School Department of Internal Medicine
| | - Kenneth M. Langa
- University of Michigan Institute of Social Research
- University of Michigan Medical School Department of Internal Medicine
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor
| | - Nelda Garcia
- University of Michigan Medical School Department of Neurology
| | - Lewis B. Morgenstern
- University of Michigan Medical School Department of Neurology
- University of Michigan School of Public Health Center for Social Epidemiology and Population Health
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De Looze C, Feeney J, Seeher KM, Amuthavalli Thiyagarajan J, Diaz T, Kenny RA. Assessing cognitive function in longitudinal studies of ageing worldwide: some practical considerations. Age Ageing 2023; 52:iv13-iv25. [PMID: 37902512 PMCID: PMC10615066 DOI: 10.1093/ageing/afad122] [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: 03/02/2023] [Indexed: 10/31/2023] Open
Abstract
Over 55 million people live with dementia worldwide. With 40% of modifiable risk factors estimated to contribute to dementia, the potential for prevention is high, and preventive measures, at an early stage of cognitive decline, are likely to positively influence future dementia trends. Countries need reliable health data and adequate measurement tools to quantify, monitor and track early changes in cognitive capacity in the general population. Many cognitive tests exist; however, there is no consensus to date about which instruments should be employed, and important variations in measurement have been observed. In this narrative review, we present a number of cognitive tests that have been used in nationally representative population-based longitudinal studies of ageing. Longitudinal panel studies of ageing represent critical platforms towards capturing the process of cognitive ageing and understanding associated risk and protective factors. We highlight optimal measures for use at a population level and for cross-country comparisons, taking into consideration instrument reliability, validity, duration, ease of administration, costs, literacy and numeracy requirements, adaptability to sensory and fine motor impairments and portability to different cultural and linguistic milieux. Drawing upon the strengths and limitations of each of these tests, and the experience gained and lessons learnt from conducting a nationally representative study of ageing, we indicate a comprehensive battery of tests for the assessment of cognitive capacity, designed to facilitate its standardised operationalisation worldwide.
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Affiliation(s)
- Céline De Looze
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Joanne Feeney
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Katrin M Seeher
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Theresa Diaz
- Epidemiology, Monitoring and Evaluation Unit, Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Mercer’s Institute for Successful Ageing, St. James’s Hospital Dublin, Dublin 8, Ireland
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21
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Lin Z, Chen X. Place of Birth and Cognition among Older Americans: Findings from the Harmonized Cognitive Assessment Protocol. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.12.23296954. [PMID: 37873447 PMCID: PMC10593039 DOI: 10.1101/2023.10.12.23296954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objectives Growing evidence suggests that place of birth (PoB) and related circumstances may have long-lasting and multiplicative contributions to various later-life outcomes. However, the specific contributions to different domains of cognitive function in late life remain less understood. This study aimed to investigate the extent to which PoB contribute to a wide range of later-life cognitive outcomes. Methods A nationally representative sample of Americans aged 65 and older (N=3,216) from the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) was utilized. Cognitive outcomes were assessed in HCAP and linked to HRS state-level PoB data to explore the contribution of birthplace to later-life cognitive disparities. Regression-based Shapley decompositions were employed to quantify this contribution. Results PoB significantly contributed to all assessed cognitive outcomes including memory, executive function, language and fluency, visuospatial function, orientation, global cognitive performance, cognitive impairment and dementia. Geographic disparities in cognitive outcomes were evident, with individuals born in US southern states and foreign-born individuals performing worse than those born in other states. PoB overall accounted for 2.4-13.9% of the total variance in cognition after adjusting for age and sex. This contribution reduced by half when adjusting for a rich set of sociodemographic and health factors over the life course, but PoB still independently explained 2.0-7.1% of the total variance in cognition. Discussion PoB has lasting contributions to later-life cognitive health, with significant geographic disparities observed. Addressing these disparities requires promoting more equalized place-based policies, resources, and early-life environments to improve health equities over the life course.
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Affiliation(s)
- Zhuoer Lin
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Department of Economics, Yale University, New Haven, CT, USA
- Alzheimer’s Disease Research Center, New Haven, CT, USA
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22
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Ren Y, Shahbaba B, Stark CEL. Improving clinical efficiency in screening for cognitive impairment due to Alzheimer's. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12494. [PMID: 37908438 PMCID: PMC10613605 DOI: 10.1002/dad2.12494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION To reduce demands on expert time and improve clinical efficiency, we developed a framework to evaluate whether inexpensive, accessible data could accurately classify Alzheimer's disease (AD) clinical diagnosis and predict the likelihood of progression. METHODS We stratified relevant data into three tiers: obtainable at primary care (low-cost), mostly available at specialty visits (medium-cost), and research-only (high-cost). We trained several machine learning models, including a hierarchical model, an ensemble model, and a clustering model, to distinguish between diagnoses of cognitively unimpaired, mild cognitive impairment, and dementia due to AD. RESULTS All models showed viable classification, but the hierarchical and ensemble models outperformed the conventional model. Classifier "error" was predictive of progression rates, and cluster membership identified subgroups with high and low risk of progression within 1.5 to 3 years. DISCUSSION Accessible, inexpensive clinical data can be used to guide AD diagnosis and are predictive of current and future disease states. HIGHLIGHTS Classification performance using cost-effective features was accurate and robustHierarchical classification outperformed conventional multinomial classificationClassification labels indicated significant changes in conversion risk at follow-upA clustering-classification method identified subgroups at high risk of decline.
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Affiliation(s)
- Yueqi Ren
- Mathematical, Computational and Systems Biology Graduate ProgramCenter for Complex Biological SystemsUniversity of California IrvineIrvineCaliforniaUSA
- Medical Scientist Training Program, School of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Babak Shahbaba
- Mathematical, Computational and Systems Biology Graduate ProgramCenter for Complex Biological SystemsUniversity of California IrvineIrvineCaliforniaUSA
- Department of StatisticsDonald Bren School of Information and Computer SciencesUniversity of California IrvineIrvineCaliforniaUSA
| | - Craig E. L. Stark
- Mathematical, Computational and Systems Biology Graduate ProgramCenter for Complex Biological SystemsUniversity of California IrvineIrvineCaliforniaUSA
- Department of Neurobiology and BehaviorUniversity of California IrvineNeurobiology and BehaviorIrvineCaliforniaUSA
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23
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Nakagawa T. Advances in cross-national comparisons of cognitive ageing. THE LANCET. HEALTHY LONGEVITY 2023; 4:e526-e527. [PMID: 37804840 DOI: 10.1016/s2666-7568(23)00192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Takeshi Nakagawa
- Research Institute, National Center for Geriatrics and Gerontology, Aichi, 474-8511, Japan.
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Gross AL, Li C, Briceño EM, Arce Rentería M, Jones RN, Langa KM, Manly JJ, Nichols E, Weir D, Wong R, Berkman L, Lee J, Kobayashi LC. Harmonisation of later-life cognitive function across national contexts: results from the Harmonized Cognitive Assessment Protocols. THE LANCET. HEALTHY LONGEVITY 2023; 4:e573-e583. [PMID: 37804847 PMCID: PMC10637129 DOI: 10.1016/s2666-7568(23)00170-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonise general and domain-specific cognitive scores from HCAP studies across six countries, and evaluate reliability and criterion validity of the resulting harmonised scores. METHODS We statistically harmonised general and domain-specific cognitive function scores across publicly available HCAP partner studies in China, England, India, Mexico, South Africa, and the USA conducted between October, 2015 and January, 2020. Participants missing all cognitive test items in a given HCAP were excluded. We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies. We generated harmonised factor scores to represent a person's relative functioning on the latent factors of general cognitive function, memory, executive function, orientation, and language using confirmatory factor analysis. We evaluated the marginal reliability, or precision, of the factor scores using test information plots. Criterion validity of factor scores was assessed by regressing the scores on age, gender, and educational attainment in a multivariable analysis adjusted for these characteristics. FINDINGS We included 21 144 participants from the six HCAP studies of interest (11 480 women [54·3%] and 9664 [45·7%] men), with a median age of 69 years (IQR 64-76). Confirmatory factor analysis models of cognitive function in each country fit well: 31 (88·6%) of 35 models had adequate or good fit to the data (comparative fit index ≥0·90, root mean square error of approximation ≤0·08, and standardised root mean residual ≤0·08). Marginal reliability of the harmonised general cognitive function factor was high (>0·9) for 19 044 (90·1%) of 21 144 participant scores across the six countries. Marginal reliability of the harmonised factor was above 0·85 for 19 281 (91·2%) of 21 142 participant factor scores for memory, 7805 (41·0%) of 19 015 scores for executive function, 3446 (16·3%) of 21 103 scores for orientation, and 4329 (20·5%) of 21 113 scores for language. In each country, general cognitive function scores were lower with older age and higher with greater levels of educational attainment. INTERPRETATION We statistically harmonised cognitive function measures across six large population-based studies of cognitive ageing. These harmonised cognitive function scores empirically reflect comparable domains of cognitive function among older adults across the six countries, have high reliability, and are useful for population-based research. This work provides a foundation for international networks of researchers to make improved inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes in pooled analyses. FUNDING US National Institute on Aging.
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Affiliation(s)
- Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Chihua Li
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Survey Research Center, University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | - Emily M Briceño
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Miguel Arce Rentería
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Richard N Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Kenneth M Langa
- Survey Research Center, University of Michigan Institute for Social Research, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Emma Nichols
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA; Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - David Weir
- Survey Research Center, University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | - Rebeca Wong
- School of Public and Population Health, and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Lisa Berkman
- Harvard Center for Population and Development Studies and Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA; Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Survey Research Center, University of Michigan Institute for Social Research, Ann Arbor, MI, USA
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Cho TC, Yu X, Gross AL, Zhang YS, Lee J, Langa KM, Kobayashi LC. Negative wealth shocks in later life and subsequent cognitive function in older adults in China, England, Mexico, and the USA, 2012-18: a population-based, cross-nationally harmonised, longitudinal study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e461-e469. [PMID: 37544315 PMCID: PMC10529910 DOI: 10.1016/s2666-7568(23)00113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Household wealth is positively related to cognitive health outcomes in later life. However, the association between negative wealth shocks and cognitive function in later life, and whether this association might differ across countries at different levels of economic development, is unclear. We aimed to investigate whether negative wealth shocks in later life are associated with cognitive function in older adults in China, England, Mexico, and the USA, and whether this association is modified by country income level. METHODS For this population-based, cross-nationally harmonised, longitudinal study, data were analysed from core interviews of the population-based US Health and Retirement Study (2012 and 2016) and its partner studies in China (the China Health and Retirement Longitudinal Study; 2015 and 2018), England (the English Longitudinal Study of Ageing; 2012 and 2016), and Mexico (Mexican Health and Aging Study; 2012 and 2015-16), and their respective Harmonized Cognitive Assessment Protocols (HCAPs). Negative wealth shocks over the follow-up periods of the respective cohorts were defined in two ways: an extreme loss of 75% or greater from the baseline amount of wealth, and a decline in within-population wealth quintile rank. The primary outcome was the harmonised general cognitive function (GCF) factor score, which was constructed with factor analysis on the HCAP neuropsychological assessments of memory, orientation, attention, executive function, and verbal fluency performance (mean 0; SD 1). We used sampling-weighted, multivariable-adjusted linear models to examine associations. FINDINGS Data from 9465 participants were included in this analysis: 3796 from China, 1184 from England, 1193 from Mexico, and 3292 from the USA. The mean baseline age of participants was 68·5 (SD 5·4) years in China (49·8% women), 72·0 (7·0) years in England (54·6% women), 70·6 (6·8) years in Mexico (55·1% women), and 72·7 (7·5) years in the USA (60·4% women). A wealth loss of 75% or greater was negatively associated with subsequent cognitive function in the USA (β -0·16 SD units; 95% CI -0·29 to -0·04) and China (-0·14; -0·21 to -0·07), but not in England (-0·01; -0·24 to 0·22) or Mexico (-0·11; -0·24 to 0·03). Similarly, within-population wealth quintile rank declines were negatively associated with subsequent cognitive function in the USA (β -0·07 per quintile rank decline; 95% CI -0·11 to -0·03) and China (β -0·07; -0·09 to -0·04), but not in England (-0·05; -0·11 to 0·01) or Mexico (-0·03; -0·07 to 0·01). INTERPRETATION The impact of wealth shocks in later life on subsequent lower level of cognitive function of older adults in China, England, Mexico, and the USA differed across macro-level socioeconomic structures. These findings suggest that government policies and social safety nets in countries with different levels of economic development might have a role in protecting older adults from adverse health effects of wealth losses in later life. FUNDING US National Institute on Aging, US National Institutes of Health.
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Affiliation(s)
- Tsai-Chin Cho
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Xuexin Yu
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Yuan S Zhang
- Robert N. Butler Columbia Aging Center, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jinkook Lee
- Center for Economic and Social Research and Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - Kenneth M Langa
- Department of Internal Medicine, School of Medicine, University of Michigan Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Arce Rentería M, Briceño EM, Chen D, Saenz J, Kobayashi LC, Gonzalez C, Vonk JMJ, Jones RN, Manly JJ, Wong R, Weir D, Langa KM, Gross AL. Memory and language cognitive data harmonization across the United States and Mexico. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12478. [PMID: 37711154 PMCID: PMC10498430 DOI: 10.1002/dad2.12478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/07/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION We used cultural neuropsychology-informed procedures to derive and validate harmonized scores representing memory and language across population-based studies in the United States and Mexico. METHODS Data were from the Health and Retirement Study Harmonized Cognitive Assessment Protocol (HRS-HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex-Cog). We statistically co-calibrated memory and language domains and performed differential item functioning (DIF) analysis using a cultural neuropsychological approach. We examined relationships among harmonized scores, age, and education. RESULTS We included 3170 participants from the HRS-HCAP (Mage = 76.6 [standard deviation (SD): 7.5], 60% female) and 2042 participants from the Mex-Cog (Mage = 68.1 [SD: 9.0], 59% female). Five of seven memory items and one of twelve language items demonstrated DIF by study. Harmonized memory and language scores showed expected associations with age and education. DISCUSSION A cultural neuropsychological approach to harmonization facilitates the generation of harmonized measures of memory and language function in cross-national studies. HIGHLIGHTS We harmonized memory and language scores across studies in the United States and Mexico.A cultural neuropsychological approach to data harmonization was used.Harmonized scores showed minimal measurement differences between cohorts.Future work can use these harmonized scores for cross-national studies of Alzheimer's disease and related dementias.
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Affiliation(s)
- Miguel Arce Rentería
- Department of NeurologyTaub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Emily M. Briceño
- Department of Physical Medicine & RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Diefei Chen
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins University Center on Aging and HealthBaltimoreMarylandUSA
| | - Joseph Saenz
- Edson College of Nursing and Health Innovation at Arizona State UniversityPhoenixArizonaUSA
| | - Lindsay C. Kobayashi
- Department of EpidemiologyCenter for Social Epidemiology and Population HealthUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
- Survey Research CenterUniversity of Michigan Institute for Social ResearchAnn ArborMichiganUSA
| | | | - Jet M. J. Vonk
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Richard N. Jones
- Department of Psychiatry and Human BehaviorWarren Alpert Medical SchoolBrownUniversityProvidence, Rhode IslandUSA
| | - Jennifer J. Manly
- Department of NeurologyTaub Institute for Research on Alzheimer's Disease and the Aging BrainColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Rebeca Wong
- Sealy Center on AgingUniversity of Texas Medical Branch at GalvestonGalvestonTexasUSA
| | - David Weir
- Department of EpidemiologyCenter for Social Epidemiology and Population HealthUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Kenneth M. Langa
- Department of EpidemiologyCenter for Social Epidemiology and Population HealthUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Veterans Affairs Ann Arbor Center for Clinical Management ResearchAnn ArborMichiganUSA
| | - Alden L. Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins University Center on Aging and HealthBaltimoreMarylandUSA
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Gross AL, Li C, Briceno EM, Rentería MA, Jones RN, Langa KM, Manly JJ, Nichols EL, Weir D, Wong R, Berkman L, Lee J, Kobayashi LC. Harmonization of Later-Life Cognitive Function Across National Contexts: Results from the Harmonized Cognitive Assessment Protocols (HCAPs). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.09.23291217. [PMID: 37398152 PMCID: PMC10312860 DOI: 10.1101/2023.06.09.23291217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonize general and domain-specific cognitive scores from HCAPs across six countries, and evaluate precision and criterion validity of the resulting harmonized scores. Methods We statistically harmonized general and domain-specific cognitive function across the six publicly available HCAP partner studies in the United States, England, India, Mexico, China, and South Africa (N=21,141). We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies, as identified by a multidisciplinary expert panel. We generated harmonized factor scores for general and domain- specific cognitive function using serially estimated graded-response item response theory (IRT) models. We evaluated precision of the factor scores using test information plots and criterion validity using age, gender, and educational attainment. Findings IRT models of cognitive function in each country fit well. We compared measurement reliability of the harmonized general cognitive function factor across each cohort using test information plots; marginal reliability was high (r> 0·90) for 93% of respondents across six countries. In each country, general cognitive function scores were lower with older ages and higher with greater levels of educational attainment. Interpretation We statistically harmonized cognitive function measures across six large, population-based studies of cognitive aging in the US, England, India, Mexico, China, and South Africa. Precision of the estimated scores was excellent. This work provides a foundation for international networks of researchers to make stronger inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes. Funding National Institute on Aging (R01 AG070953, R01 AG030153, R01 AG051125, U01 AG058499; U24 AG065182; R01AG051158).
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Hampton OL, Mukherjee S, Properzi MJ, Schultz AP, Crane PK, Gibbons LE, Hohman TJ, Maruff P, Lim YY, Amariglio RE, Papp KV, Johnson KA, Rentz DM, Sperling RA, Buckley RF. Harmonizing the preclinical Alzheimer cognitive composite for multicohort studies. Neuropsychology 2023; 37:436-449. [PMID: 35862098 PMCID: PMC9859944 DOI: 10.1037/neu0000833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Studies are increasingly examining research questions across multiple cohorts using data from the preclinical Alzheimer cognitive composite (PACC). Our objective was to use modern psychometric approaches to develop a harmonized PACC. METHOD We used longitudinal data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), Harvard Aging Brain Study (HABS), and Australian Imaging, Biomarker and Lifestyle Study of Ageing (AIBL) cohorts (n = 2,712). We further demonstrated our method with the Anti-Amyloid Treatment of Asymptomatic Alzheimer's Disease (A4) Study prerandomized data (n = 4,492). For the harmonization method, we used confirmatory factor analysis (CFA) on the final visit of the longitudinal cohorts to determine parameters to generate latent PACC (lPACC) scores. Overlapping tests across studies were set as "anchors" that tied cohorts together, while parameters from unique tests were freely estimated. We performed validation analyses to assess the performance of lPACC versus the common standardized PACC (zPACC). RESULTS Baseline (BL) scores for the zPACC were centered on zero, by definition. The harmonized lPACC did not define a common mean of zero and demonstrated differences in baseline ability levels across the cohorts. Baseline lPACC slightly outperformed zPACC in the prediction of progression to dementia. Longitudinal change in the lPACC was more constrained and less variable relative to the zPACC. In combined-cohort analyses, longitudinal lPACC slightly outperformed longitudinal zPACC in its association with baseline β-amyloid status. CONCLUSIONS This study proposes procedures for harmonizing the PACC that make fewer strong assumptions than the zPACC, facilitating robust multicohort analyses. This implementation of item response theory lends itself to adapting across future cohorts with similar composites. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Olivia L. Hampton
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Shubhabrata Mukherjee
- Department of Medicine, Division of General Internal Medicine, University of Washington
| | - Michael J. Properzi
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Aaron P. Schultz
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Paul K. Crane
- Department of Medicine, Division of General Internal Medicine, University of Washington
| | - Laura E. Gibbons
- Department of Medicine, Division of General Internal Medicine, University of Washington
| | - Timothy J. Hohman
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Paul Maruff
- Cogstate Ltd., Melbourne, Victoria, Australia
| | - Yen Ying Lim
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Rebecca E. Amariglio
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
| | - Kathryn V. Papp
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
| | - Keith A. Johnson
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Dorene M. Rentz
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
| | - Reisa A. Sperling
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
| | - Rachel F. Buckley
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
- Department of Neurology, Brigham and Women’s Hospital, Center for Alzheimer Research and Treatment, Boston, Massachusetts, United States
- Melbourne School of Psychological Science, University of Melbourne
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Nichols E, Ng DK, Hayat S, Langa KM, Lee J, Steptoe A, Deal JA, Gross AL. Measurement differences in the assessment of functional limitations for cognitive impairment classification across geographic locations. Alzheimers Dement 2023; 19:2218-2225. [PMID: 36807779 PMCID: PMC10182237 DOI: 10.1002/alz.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 02/20/2023]
Abstract
INTRODUCTION The measurement of dementia in cross-national contexts relies on the assessment of functional limitations. We aimed to evaluate the performance of survey items on functional limitations across culturally diverse geographic settings. METHODS We used data from the Harmonized Cognitive Assessment Protocol Surveys (HCAP) in five countries (total N = 11,250) to quantify associations between items on functional limitations and cognitive impairment. RESULTS Many items performed better in the United States and England compared to South Africa, India, and Mexico. Items on the Community Screening Instrument for Dementia (CSID) had the least variability across countries (SD = 0.73 vs. 0.92 [Blessed] and 0.98 [Jorm IQCODE]), but also the weakest associations with cognitive impairment (median odds ratio [OR] = 2.23 vs. 3.01 [Blessed] and 2.75 [Jorm IQCODE]). DISCUSSION Differences in cultural norms for reporting functional limitations likely influences performance of items on functional limitations and may affect the interpretation of results from substantive studies. HIGHLIGHTS There was substantial cross-country variation in item performance. Items from the Community Screening Instrument for Dementia (CSID) had less cross-country variability but lower performance. There was more variability in performance of instrumental activities of daily living (IADL) compared to activities of daily living (ADL) items. Variability in cultural expectations of older adults should be taken into account. Results highlight the need for novel approaches to assessing functional limitations.
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Affiliation(s)
- Emma Nichols
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shabina Hayat
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Kenneth M Langa
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Institute for Social Research, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, University of Michigan, Ann Arbor, MI
| | - Jinkook Lee
- Department of Economics, University of Southern California, Los Angeles, CA
- Center for Economic and Social Research, University of California, Los Angeles, CA
| | - Andrew Steptoe
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Rosso AL, Troxel WM, Gary-Webb TL, Weinstein AM, Butters MA, Palimaru A, Ghosh-Dastidar B, Wagner L, Nugroho A, Hunter G, Parker J, Dubowitz T. Design of the think PHRESH longitudinal cohort study: Neighborhood disadvantage, cognitive aging, and alzheimer's disease risk in disinvested, black neighborhoods. BMC Public Health 2023; 23:636. [PMID: 37013498 PMCID: PMC10069058 DOI: 10.1186/s12889-023-15381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Black Americans have disproportionately higher rates and earlier onset of Alzheimer's disease and related dementias (ADRD) relative to White Americans. We currently lack a comprehensive understanding of how the lived experience and broader societal factors, including cumulative exposure to structural racism and the mechanisms underlying the risks, may contribute to elevated ADRD risk in Black Americans. METHODS The Think PHRESH study builds on existing, community-based research infrastructure, from the ongoing Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) studies, to examine the contributions of dynamic neighborhood socioeconomic conditions across the lifecourse to cognitive outcomes in mid- and late-life adults living in two historically disinvested, predominantly Black communities (anticipated n = 1133). This longitudinal, mixed-methods study rests on the premise that neighborhood racial segregation and subsequent disinvestment contributes to poor cognitive outcomes via factors including (a) low access to educational opportunities and (b) high exposure to race- and socioeconomically-relevant stressors, such as discrimination, trauma, and adverse childhood events. In turn, these cumulative exposures foster psychological vigilance in residents, leading to cardiometabolic dysregulation and sleep disruption, which may mediate associations between neighborhood disadvantage and ADRD risk. This premise recognizes the importance of potential protective factors that may promote cognitive health, including neighborhood social cohesion, safety, and satisfaction. The proposed study will leverage our existing longitudinal data on risk/protective factors and biobehavioral mediators and will include: (1) up to three waves of cognitive assessments in participants ages 50 years + and one assessment in participants ages 35-49 years; clinical adjudication of ADRD will be completed in participants who are 50+, (2) extensive surveys of risk and protective factors, (3) two assessments of blood pressure and objectively measured sleep, (4) a comprehensive assessment of life and residential history; and (5) two rounds of in-depth qualitative interviews to reveal lifecourse opportunities and barriers experienced by Black Americans in achieving optimal cognitive health in late life. DISCUSSION Understanding how structural racism has influenced the lived experience of Black Americans, including dynamic changes in neighborhood conditions over time, is critical to inform multi-level intervention and policy efforts to reduce pervasive racial and socioeconomic disparities in ADRD.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, US.
| | - Wendy M Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | - Tiffany L Gary-Webb
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, US
| | | | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, US
| | - Alina Palimaru
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | | | - La'Vette Wagner
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | - Alvin Nugroho
- Survey Research Group, RAND Corporation, Santa Monica, US
| | - Gerald Hunter
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
| | | | - Tamara Dubowitz
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, US
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Bassil DT, Farrell MT, Weerman A, Guo M, Wagner RG, Brickman AM, Glymour MM, Langa KM, Manly JJ, Tipping B, Butler I, Tollman S, Berkman LF. Feasibility of an online consensus approach for the diagnosis of cognitive impairment and dementia in rural South Africa. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12420. [PMID: 37025188 PMCID: PMC10072202 DOI: 10.1002/dad2.12420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION We describe the development and feasibility of using an online consensus approach for diagnosing cognitive impairment and dementia in rural South Africa. METHODS Cognitive assessments, clinical evaluations, and informant interviews from Cognition and Dementia in the Health and Aging in Africa Longitudinal Study (HAALSI Dementia) were reviewed by an expert panel using a web-based platform to assign a diagnosis of cognitively normal, mild cognitive impairment (MCI), or dementia. RESULTS Six hundred thirty-five participants were assigned a final diagnostic category, with 298 requiring adjudication conference calls. Overall agreement between each rater's independent diagnosis and final diagnosis (via the portal or consensus conference) was 78.3%. A moderate level of agreement between raters' individual ratings and the final diagnostic outcomes was observed (average κ coefficient = 0.50). DISCUSSION Findings show initial feasibility in using an online consensus approach for the diagnosis of cognitive impairment and dementia in remote, rural, and low-resource settings.
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Affiliation(s)
- Darina T. Bassil
- Harvard Center for Population and Development StudiesHarvard UniversityCambridgeMassachusettsUSA
| | - Meagan T. Farrell
- Harvard Center for Population and Development StudiesHarvard UniversityCambridgeMassachusettsUSA
| | - Albert Weerman
- Center for Economic and Social ResearchUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Muqi Guo
- Harvard Center for Population and Development StudiesHarvard UniversityCambridgeMassachusettsUSA
| | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Gertrude H. Sergievsky CenterVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - M. Maria Glymour
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kenneth M. Langa
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
- Veterans Affairs Center for Clinical Management ResearchAnn ArborMichiganUSA
| | - Jennifer J. Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Gertrude H. Sergievsky CenterVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Brent Tipping
- Division of Geriatric MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - India Butler
- Division of Geriatric MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)School of Public HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lisa F. Berkman
- Harvard Center for Population and Development StudiesHarvard UniversityCambridgeMassachusettsUSA
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Gavett BE, Ilango SD, Koscik R, Ma Y, Helfand B, Eng CW, Gross A, Trittschuh EH, Jones RN, Mungas D. Harmonization of cognitive screening tools for dementia across diverse samples: A simulation study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12438. [PMID: 37342610 PMCID: PMC10277671 DOI: 10.1002/dad2.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 06/23/2023]
Abstract
Introduction Research focusing on cognitive aging and dementia is a global endeavor. However, cross-national differences in cognition are embedded in other sociocultural differences, precluding direct comparisons of test scores. Such comparisons can be facilitated by co-calibration using item response theory (IRT). The goal of this study was to explore, using simulation, the necessary conditions for accurate harmonization of cognitive data. Method Neuropsychological test scores from the US Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) were subjected to IRT analysis to estimate item parameters and sample means and standard deviations. These estimates were used to generate simulated item response patterns under 10 scenarios that adjusted the quality and quantity of linking items used in harmonization. IRT-derived factor scores were compared to the known population values to assess bias, efficiency, accuracy, and reliability of the harmonized data. Results The current configuration of HRS and MHAS data was not suitable for harmonization, as poor linking item quality led to large bias in both cohorts. Scenarios with more numerous and higher quality linking items led to less biased and more accurate harmonization. Discussion Linking items must possess low measurement error across the range of latent ability for co-calibration to be successful. HIGHLIGHTS We developed a statistical simulation platform to evaluate the degree to which cross-sample harmonization accuracy varies as a function of the quality and quantity of linking items.Two large studies of aging-one in Mexico and one in the United States-use three common items to measure cognition.These three common items have weak correspondence with the ability being measured and are all low in difficulty.Harmonized scores derived from the three common linking items will provide biased and inaccurate estimates of cognitive ability.Harmonization accuracy is greatest when linking items vary in difficulty and are strongly related to the ability being measured.
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Affiliation(s)
- Brandon E. Gavett
- School of Psychological ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Sindana D. Ilango
- Department of EpidemiologyUniversity of Washington School of Public HealthSeattleWashingtonUSA
| | - Rebecca Koscik
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Yue Ma
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Division of Geriatrics and GerontologyDepartment of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Benjamin Helfand
- Department of Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
- Departments of Psychiatry and Human Behavior and NeurologyWarren Alpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
| | - Chloe W. Eng
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Alden Gross
- Department of EpidemiologyJohns Hopkins Bloomberg School Public HealthBaltimoreMarylandUSA
| | - Emily H. Trittschuh
- VA Puget Sound Health Care SystemGeriatric Research Education and Clinical CareSeattleWashingtonUSA
- Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Richard N. Jones
- Departments of Psychiatry and Human Behavior and NeurologyWarren Alpert Medical SchoolBrown UniversityProvidenceRhode IslandUSA
- Department of NeurologyBrown University Warren Alpert Medical SchoolProvidenceRhode IslandUSA
| | - Dan Mungas
- Department of NeurologyUniversity of CaliforniaSacramentoCaliforniaUSA
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Saenz J, Beam CR, Kim AJ. Development of a latent dementia index in the aging, demographics, and memory study: Validation and measurement invariance by sex. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12433. [PMID: 37187808 PMCID: PMC10175944 DOI: 10.1002/dad2.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
Latent variable models can create a latent dementia index (LDI) using cognitive and functional ability to approximate dementia likelihood. The LDI approach has been applied across diverse cohorts. It is unclear whether sex affects its measurement properties. We use Wave A (2001-2003) of the Aging, Demographics, and Memory Study (n = 856). Multiple group confirmatory factor analysis (CFA) was used to test measurement invariance (MI) using informant-reported functional ability and cognitive performance tasks, which we group into verbal, nonverbal, and memory. Partial scalar invariance was found, allowing for testing sex differences in LDI means (MDiff = 0.38). The LDI correlated with consensus panel dementia diagnosis, Mini-Mental State Examination (MMSE), and dementia risk factors (low education, advanced age, and apolipoprotein ε4 [APOE-ε4] status) for men and women. The LDI validly captures dementia likelihood to permit estimation of sex differences. LDI sex differences indicate higher dementia likelihood in women, potentially due to social, environmental, and biological factors.
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Affiliation(s)
- Joseph Saenz
- Edson College of Nursing and Health InnovationArizona State UniversityPhoenixArizonaUSA
| | - Christopher R. Beam
- Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Alice J. Kim
- Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Fillenbaum GG, Mohs R. CERAD (Consortium to Establish a Registry for Alzheimer's Disease) Neuropsychology Assessment Battery: 35 Years and Counting. J Alzheimers Dis 2023; 93:1-27. [PMID: 36938738 PMCID: PMC10175144 DOI: 10.3233/jad-230026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND In 1986, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was mandated to develop a brief neuropsychological assessment battery (CERAD-NAB) for AD, for uniform neuropsychological assessment, and information aggregation. Initially used across the National Institutes of Aging-funded Alzheimer's Disease Research Centers, it has become widely adopted wherever information is desired on cognitive status and change therein, particularly in older populations. OBJECTIVE Our purpose is to provide information on the multiple uses of the CERAD-NAB since its inception, and possible further developments. METHODS Since searching on "CERAD neuropsychological assessment battery" or similar terms missed important information, "CERAD" alone was entered into PubMed and SCOPUS, and CERAD-NAB use identified from the resulting studies. Use was sorted into major categories, e.g., psychometric information, norms, dementia/differential dementia diagnosis, epidemiology, intervention evaluation, genetics, etc., also translations, country of use, and alternative data gathering approaches. RESULTS CERAD-NAB is available in ∼20 languages. In addition to its initial purpose assessing AD severity, CERAD-NAB can identify mild cognitive impairment, facilitate differential dementia diagnosis, determine cognitive effects of naturally occurring and experimental interventions (e.g., air pollution, selenium in soil, exercise), has helped to clarify cognition/brain physiology-neuroanatomy, and assess cognitive status in dementia-risk conditions. Surveys of primary and tertiary care patients, and of population-based samples in multiple countries have provided information on prevalent and incident dementia, and cross-sectional and longitudinal norms for ages 35-100 years. CONCLUSION CERAD-NAB has fulfilled its original mandate, while its uses have expanded, keeping up with advances in the area of dementia.
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Affiliation(s)
- Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Richard Mohs
- Global Alzheimer's Platform Foundation, Washington, DC, USA
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Zaheed AB, Chervin RD, Spira AP, Zahodne LB. Mental and physical health pathways linking insomnia symptoms to cognitive performance 14 years later. Sleep 2023; 46:zsac262. [PMID: 36309871 PMCID: PMC9995792 DOI: 10.1093/sleep/zsac262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/27/2022] [Indexed: 12/04/2022] Open
Abstract
STUDY OBJECTIVES Insomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive functioning across domains; (2) whether insomnia-cognition associations are mediated by mental and physical health; and (3) whether these associations are modified by gender. METHODS Participants included 2595 adults ages 51-88 at baseline (Mage=64.00 ± 6.66, 64.5% women) in the Health and Retirement Study. The frequency of insomnia symptoms (difficulty initiating sleep, night time awakenings, early awakenings, and feeling unrested upon awakening) at baseline (2002) were quantified using a modified Jenkins Sleep Questionnaire. Cognition was assessed in 2016 via the Harmonized Cognitive Assessment Protocol and operationalized with factor scores corresponding to five domains. Depressive symptoms and vascular conditions in 2014 were assessed via self-report. Structural equation models estimated total, indirect, and direct effects of insomnia symptoms on subsequent cognition through depressive symptoms and vascular diseases, controlling for baseline sociodemographic and global cognition. RESULTS Frequent difficulty initiating sleep was associated with poorer episodic memory, executive function, language, visuoconstruction, and processing speed 14 years later (-0.06 ≤ β ≤ -0.04; equivalent to 2.2-3.4 years of aging). Depressive symptoms explained 12.3%-19.5% of these associations and vascular disease explained 6.3%-14.6% of non-memory associations. No other insomnia symptoms were associated with cognition, and no associations were modified by gender. CONCLUSIONS Difficulty initiating sleep in later life may predict future cognitive impairment through multiple pathways. Future research with longitudinal assessments of insomnia, insomnia treatments, and cognition is needed to evaluate insomnia as a potential intervention target to optimize cognitive aging.
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Affiliation(s)
- Afsara B Zaheed
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD 21205, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, USA
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O'Shea DM, Alaimo H, Davis JD, Galvin JE, Tremont G. A comparison of cognitive performances based on differing rates of DNA methylation GrimAge acceleration among older men and women. Neurobiol Aging 2023; 123:83-91. [PMID: 36641830 DOI: 10.1016/j.neurobiolaging.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/02/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
Cognitive heterogeneity increases with age rendering sex differences difficult to identify. Given established sex differences in biological aging, we examined whether comparisons of men and women on neuropsychological test performances differed as a function of age rate. Data were obtained from 1921 adults enrolled in the 2016 wave of the Health and Retirement Study. The residual from regressing the DNA methylation GrimAge clock on chronological age was used as the measure of aging rate. Slow and fast age rates were predefined as 1 standard deviation below or above the sex-specific mean rates, respectively. ANCOVAs were used to test group differences in test performances. Pairwise comparisons revealed that slow aging men outperformed fast aging women (and vice versa) on measures of executive function/speed, visual memory and semantic fluency; however, when groups were matched by aging rates, no significant differences remained. In contrast, women, regardless of their aging rates, education or depressive symptoms maintained their advantage on verbal learning and memory. Implications for research on sex differences in cognitive aging are discussed.
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Affiliation(s)
- Deirdre M O'Shea
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA; Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Boca Raton, FL, USA.
| | | | - Jennifer D Davis
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Boca Raton, FL, USA
| | - Geoffrey Tremont
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
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Briceño EM, Rentería MA, Gross AL, Jones RN, Gonzalez C, Wong R, Weir DR, Langa KM, Manly JJ. A cultural neuropsychological approach to harmonization of cognitive data across culturally and linguistically diverse older adult populations. Neuropsychology 2023; 37:247-257. [PMID: 35482625 PMCID: PMC9639608 DOI: 10.1037/neu0000816] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To describe a cultural neuropsychological approach to prestatistical harmonization of cognitive data across the United States (U.S.) and Mexico with the Harmonized Cognitive Assessment Protocol (HCAP). METHOD We performed a comprehensive review of the administration, scoring, and coding procedures for each cognitive test item administered across the English and Spanish versions of the HCAP in the Health and Retirement Study (HRS) in the U.S. and the Ancillary Study on Cognitive Aging in Mexico (Mex-Cog). For items that were potentially equivalent across studies, we compared each cognitive test item for linguistic and cultural equivalence and classified items as confident or tentative linking items, based on the degree of confidence in their comparability across cohorts and language groups. We evaluated these classifications using differential item functioning techniques. RESULTS We evaluated 132 test items among 21 cognitive instruments in the HCAP across the HRS and Mex-Cog. We identified 72 confident linking items, 46 tentative linking items, and 14 items that were not comparable across cohorts. Measurement invariance analysis revealed that 64% of the confident linking items and 83% of the tentative linking items showed statistical evidence of measurement differences across cohorts. CONCLUSIONS Prestatistical harmonization of cognitive data, performed by a multidisciplinary and multilingual team including cultural neuropsychologists, can identify differences in cognitive construct measurement across languages and cultures that may not be identified by statistical procedures alone. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Emily M. Briceño
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, 48108
| | - Miguel Arce Rentería
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence RI, USA
| | | | - Rebeca Wong
- Sealy Center on Aging, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - David R. Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M. Langa
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Institute for Social Research, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor MI
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI
| | - Jennifer J. Manly
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Columbia University College of Physicians and Surgeons, New York City, NY, USA
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Gharbi-Meliani A, Husson F, Vandendriessche H, Eleonore Bayen F, Yaffe K, Bachoud-Lévi AC, de Langavant LC. Identification of High Likelihood of Dementia in Population-Based Surveys using Unsupervised Clustering: a Longitudinal Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.17.23286078. [PMID: 36865284 PMCID: PMC9980227 DOI: 10.1101/2023.02.17.23286078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background Dementia is defined by cognitive decline that affects functional status. Longitudinal ageing surveys often lack a clinical diagnosis of dementia though measure cognitive and function over time. We used unsupervised machine learning and longitudinal data to identify transition to probable dementia. Methods Multiple Factor Analysis was applied to longitudinal function and cognitive data of 15,278 baseline participants (aged 50 years and more) from the Survey of Health, Ageing, and Retirement in Europe (SHARE) (waves 1, 2 and 4-7, between 2004 and 2017). Hierarchical Clustering on Principal Components discriminated three clusters at each wave. We estimated probable or "Likely Dementia" prevalence by sex and age, and assessed whether dementia risk factors increased the risk of being assigned probable dementia status using multistate models. Next, we compared the "Likely Dementia" cluster with self-reported dementia status and replicated our findings in the English Longitudinal Study of Ageing (ELSA) cohort (waves 1-9, between 2002 and 2019, 7,840 participants at baseline). Findings Our algorithm identified a higher number of probable dementia cases compared with self-reported cases and showed good discriminative power across all waves (AUC ranged from 0.754 [0.722-0.787] to 0.830 [0.800-0.861]). "Likely Dementia" status was more prevalent in older people, displayed a 2:1 female/male ratio and was associated with nine factors that increased risk of transition to dementia: low education, hearing loss, hypertension, drinking, smoking, depression, social isolation, physical inactivity, diabetes, and obesity. Results were replicated in ELSA cohort with good accuracy. Interpretation Machine learning clustering can be used to study dementia determinants and outcomes in longitudinal population ageing surveys in which dementia clinical diagnosis is lacking.
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Affiliation(s)
- Amin Gharbi-Meliani
- Equipe neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Département d'études cognitives, Ecole normale supérieure, Université PSL, Université Paris-Est Créteil, AP-HP Hôpital Henri Mondor-Albert Chenevier, Centre de référence Maladie de Huntington et Service de Neurologie, INSERM, 75005 Paris [ou 94000 Créteil], France
| | - François Husson
- Institut Agro, Univ Rennes1, CNRS, IRMAR, 35000, Rennes, France
| | - Henri Vandendriessche
- Laboratoire de Neurosciences Cognitives et Computationnelles, Département d'études cognitives, Ecole normale supérieure, Université PSL, INSERM, 75005 Paris, France
| | - France Eleonore Bayen
- Global Brain Health Institute, University of California, San Francisco, CA, United States; Sorbonne Université, Hôpital Pitié-Salpêtrière-Assistance Publique Hôpitaux de Paris, Département de Rééducation Neurologique, Paris, France
| | - Kristine Yaffe
- Global Brain Health Institute, University of California, San Francisco, CA, United States; Departments of Psychiatry, Neurology and Epidemiology and Biostatistics, University of California, San Francisco
| | - Anne-Catherine Bachoud-Lévi
- Equipe neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Département d'études cognitives, Ecole normale supérieure, Université PSL, Université Paris-Est Créteil, AP-HP Hôpital Henri Mondor-Albert Chenevier, Centre de référence Maladie de Huntington et Service de Neurologie, INSERM, 75005 Paris [ou 94000 Créteil], France
| | - Laurent Cleret de Langavant
- Equipe neuropsychologie interventionnelle, Institut Mondor de Recherche Biomédicale, Département d'études cognitives, Ecole normale supérieure, Université PSL, Université Paris-Est Créteil, AP-HP Hôpital Henri Mondor-Albert Chenevier, Centre de référence Maladie de Huntington et Service de Neurologie, INSERM, 75005 Paris [ou 94000 Créteil], France; Global Brain Health Institute, University of California, San Francisco, CA, United States
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Yu X, Westrick AC, Kobayashi LC. Cumulative loneliness and subsequent memory function and rate of decline among adults aged ≥50 in the United States, 1996 to 2016. Alzheimers Dement 2023; 19:578-588. [PMID: 35920364 PMCID: PMC9895124 DOI: 10.1002/alz.12734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The study objective was to investigate the association between loneliness duration and memory function over a 20-year period. METHODS Data were from 9032 adults aged ≥50 in the Health and Retirement Study. Loneliness status (yes vs. no) was assessed biennially from 1996 to 2004 and its duration was categorized as never, 1 time point, 2 time points, and ≥3 time points. Episodic memory was assessed from 2004 to 2016 as a composite of immediate and delayed recall trials combined with proxy-reported memory. Mixed-effects linear regression models were fitted. RESULTS A longer duration of loneliness was associated with lower memory scores (P < 0.001) and a faster rate of decline (P < 0.001). The association was stronger among adults aged ≥65 than those aged <65 (three-way interaction P = 0.013) and was stronger among women than men (three-way interaction P = 0.002). DISCUSSION Cumulative loneliness may be a salient risk factor for accelerated memory aging, especially among women aged ≥65. HIGHLIGHT A longer duration of loneliness was associated with accelerated memory aging. The association was stronger among women than men and among older adults than the younger. Reducing loneliness in mid- to late life may help maintain memory function.
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Affiliation(s)
- Xuexin Yu
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Ashly C Westrick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Lipnicki DM, Lam BCP, Mewton L, Crawford JD, Sachdev PS. Harmonizing Ethno-Regionally Diverse Datasets to Advance the Global Epidemiology of Dementia. Clin Geriatr Med 2023; 39:177-190. [PMID: 36404030 PMCID: PMC9767705 DOI: 10.1016/j.cger.2022.07.009] [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: 11/23/2022]
Abstract
Understanding dementia and cognitive impairment is a global effort needing data from multiple sources across diverse ethno-regional groups. Methodological heterogeneity means that these data often require harmonization to make them comparable before analysis. We discuss the benefits and challenges of harmonization, both retrospective and prospective, broadly and with a focus on data types that require particular sorts of approaches, including neuropsychological test scores and neuroimaging data. Throughout our discussion, we illustrate general principles and give examples of specific approaches in the context of contemporary research in dementia and cognitive impairment from around the world.
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Affiliation(s)
- Darren M Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia.
| | - Ben C P Lam
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia
| | - Louise Mewton
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Level 1, AGSM (G27), Gate 11, Botany Street, Sydney, New South Wales 2052, Australia; Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia
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Aksman L, Lynch K, Toga A, Dey AB, Lee J. Investigating the factors that explain white matter hyperintensity load in older Indians. Brain Commun 2023; 5:fcad008. [PMID: 36744010 PMCID: PMC9891346 DOI: 10.1093/braincomms/fcad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 11/08/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
White matter hyperintensities are areas of hyperintense signal on MRI that typically represent cerebrovascular pathology. While focal white matter hyperintensities are common among older individuals, extensive white matter hyperintensities have been found to accelerate the progression of dementia. However, little is currently known about how various socioeconomic, health, lifestyle and environmental factors affect the severity of these lesions, particularly in low- and middle-income countries such as India. We investigated this question using cross-sectional MRI data (n = 126) from a pilot neuroimaging sub-study of an ongoing, nationally representative epidemiological study of late-life cognition in India. As a screening step, we estimated white matter hyperintensity load from fluid-attenuated inversion recovery MRI using a fully automated technique and tested for associations with each factor separately, controlling for age, sex and estimated total intracranial volume in each case. A combined model of white matter hyperintensity load included five factors which were significant after multiple comparisons correction: systolic blood pressure, body mass index, urbanicity status (urban versus rural living), daily chore hours and the frequency of store trips. This model explained an additional 27% of the variance in white matter hyperintensity load (54 versus 27% for the baseline model with only age, sex and estimated total intracranial volume). We accounted for the possibility of reverse causality by additionally controlling for concurrent markers of neurodegeneration and cognitive impairment, with no substantial change in our findings. Overall, our findings suggest that controlling high blood pressure and maintaining both a healthy body mass index and high levels of physical activity may reduce white matter hyperintensity load in older Indian adults, helping to prevent or delay dementia.
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Affiliation(s)
- Leon Aksman
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Kirsten Lynch
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Arthur Toga
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Aparajit Ballav Dey
- Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India
| | - Jinkook Lee
- Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA 90089, USA
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Jin H, Crimmins E, Langa KM, Dey A, Lee J. Estimating the Prevalence of Dementia in India Using a Semi-Supervised Machine Learning Approach. Neuroepidemiology 2023; 57:43-50. [PMID: 36617419 PMCID: PMC10038923 DOI: 10.1159/000528904] [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: 10/17/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Accurate estimation of dementia prevalence is essential for making effective public and social care policy to support individuals and families suffering from the disease. The purpose of this paper is to estimate the prevalence of dementia in India using a semi-supervised machine learning approach based on a large nationally representative sample. METHODS The sample of this study is adults 60 years or older in the wave 1 (2017-2019) of the Longitudinal Aging Study in India (LASI). A subsample in LASI received extensive cognitive assessment and clinical consensus ratings and therefore has diagnoses of dementia. A semi-supervised machine learning model was developed to predict the status of dementia for LASI participants without diagnoses. After obtaining the predictions, sampling weights and age standardization to the World Health Organization (WHO) standard population were applied to generate the estimate for prevalence of dementia in India. RESULTS The prevalence of dementia for those aged 60 years and older in India was 8.44% (95% CI: 7.89%-9.01%). The age-standardized prevalence was estimated to be 8.94% (95% CI: 8.36%-9.55%). The prevalence of dementia was greater for those who were older, were females, received no education, and lived in rural areas. DISCUSSION The prevalence of dementia in India may be higher than prior estimates derived from local studies. These prevalence estimates provide the information necessary for making long-term planning of public and social care policy. The semi-supervised machine learning approach adopted in this paper may also be useful for other large population aging studies that have a similar data structure.
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Affiliation(s)
- Haomiao Jin
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - Eileen Crimmins
- School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Kenneth M. Langa
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - A.B. Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Jinkook Lee
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
- Department of Economics, University of Southern California, Los Angeles, CA, USA
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Kohler IV, Kämpfen F, Bandawe C, Kohler HP. Cognition and Cognitive Changes in a Low-Income Sub-Saharan African Aging Population. J Alzheimers Dis 2023; 95:195-212. [PMID: 37522209 PMCID: PMC10588811 DOI: 10.3233/jad-230271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Cognition and its age-related changes remain vastly understudied in low-income countries (LICs), despite evidence suggesting that cognitive decline among aging low-income populations is a rapidly increasing disease burden often occurring at younger ages as compared to high-income countries (HICs). OBJECTIVE We examine patterns of cognition among men and women, 45 + years old, living in rural Malawi. We analyze how key socioeconomic characteristics predict levels of cognition and its changes as individuals get older. METHODS Utilizing the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) collected during 2012-2017, we estimate standard regression models to analyze predictors of the age- and sex-specific levels and longitudinal changes in cognition. Cognition is assessed with a screening instrument that is adapted to this low-literacy context and measures different domains such as language, attention, or executive functioning. RESULTS Women have lower levels of cognition than men, a pattern in stark contrast to findings in HICs. Schooling and socioeconomic status increase the probability of having consistently high performance during the cognitive assessment. Cognitive decline accelerates with age and is detectable already at mid-adult ages (45-55 years). Despite lower levels of cognitive function observed among women, the pace of decline with age is similar for both genders. CONCLUSION Women are particularly affected by poor cognition in this context. The study emphasizes the importance of prioritizing cognitive health and research on cognition among older individuals in sub-Saharan Africa LICs, to which relatively little health care resources continue to be allocated.
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Affiliation(s)
- Iliana V Kohler
- Population Studies Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Chiwoza Bandawe
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Hans-Peter Kohler
- Population Aging Research Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
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Akushevich I, Kravchenko J, Yashkin A, Doraiswamy PM, Hill CV. Expanding the scope of health disparities research in Alzheimer's disease and related dementias: Recommendations from the "Leveraging Existing Data and Analytic Methods for Health Disparities Research Related to Aging and Alzheimer's Disease and Related Dementias" Workshop Series. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12415. [PMID: 36935764 PMCID: PMC10020680 DOI: 10.1002/dad2.12415] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
Topics discussed at the "Leveraging Existing Data and Analytic Methods for Health Disparities Research Related to Aging and Alzheimer's Disease and Related Dementias" workshop, held by Duke University and the Alzheimer's Association with support from the National Institute on Aging, are summarized. Ways in which existing data resources paired with innovative applications of both novel and well-known methodologies can be used to identify the effects of multi-level societal, community, and individual determinants of race/ethnicity, sex, and geography-related health disparities in Alzheimer's disease and related dementia are proposed. Current literature on the population analyses of these health disparities is summarized with a focus on identifying existing gaps in knowledge, and ways to mitigate these gaps using data/method combinations are discussed at the workshop. Substantive and methodological directions of future research capable of advancing health disparities research related to aging are formulated.
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Affiliation(s)
- Igor Akushevich
- Social Science Research InstituteBiodemography of Aging Research UnitDuke UniversityDurhamNorth CarolinaUSA
| | - Julia Kravchenko
- Duke University School of MedicineDepartment of SurgeryDurhamNorth CarolinaUSA
| | - Arseniy Yashkin
- Social Science Research InstituteBiodemography of Aging Research UnitDuke UniversityDurhamNorth CarolinaUSA
| | - P. Murali Doraiswamy
- Departments of Psychiatry and MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
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Briceño EM, Dhakal U, Sharma U, Adhikari N, Pradhan MS, Shrestha L, Jalan P, Rai J, Langa KM, Lee J, Ghimire D, Mendes de Leon CF. Neuropsychological Assessment of Older Adults in Nepal for Population-Based Dementia Ascertainment: Needs, Challenges, and Opportunities. J Alzheimers Dis 2023; 96:1339-1352. [PMID: 37980674 PMCID: PMC10739926 DOI: 10.3233/jad-230906] [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: 11/21/2023]
Abstract
The population of Nepal is rapidly aging, as in other low and middle-income countries, and the number of individuals living with Alzheimer's Disease and related dementias (ADRD) is expected to increase. However, information about the neuropsychological assessment of ADRD in Nepal is lacking. We first aimed to examine the needs, challenges, and opportunities associated with the neuropsychological assessment of older adults in Nepal for population-based ADRD ascertainment. Second, we introduce the Chitwan Valley Family Study-Study of Cognition and Aging in Nepal (CVFS-SCAN), which is poised to address these needs, and its collaboration with the Harmonized Cognitive Assessment Protocol (HCAP) international network. We reviewed the existing literature on the prevalence, risk factors, available neuropsychological assessment instruments, and sociocultural factors that may influence the neuropsychological assessment of older adults for ADRD ascertainment in Nepal. Our review revealed no existing population-based data on the prevalence of ADRD in Nepal. Very few studies have utilized formal cognitive assessment instruments for ADRD assessment, and there have been no comprehensive neuropsychological assessment instruments that have been validated for the assessment of ADRD in Nepal. We describe how the CVFS-SCAN study will address this need through careful adaptation of the HCAP instrument. We conclude that the development of culturally appropriate neuropsychological assessment instruments is urgently needed for the population-based assessment of ADRD in Nepal. The CVFS-SCAN is designed to address this need and will contribute to the growth of global and equitable neuropsychology and to the science of ADRD in low- and middle-income countries.
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Affiliation(s)
- Emily M. Briceño
- Departments of Physical Medicine & Rehabilitation and Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Usha Dhakal
- Department of Sociology & Gerontology, Miami University, Oxford, Ohio, USA
| | - Uttam Sharma
- Institute for Social and Environmental Research-Nepal (ISER-N), Bharatpur-15, Chitwan, Nepal
| | - Nabin Adhikari
- Institute for Social and Environmental Research-Nepal (ISER-N), Bharatpur-15, Chitwan, Nepal
| | - Meeta S. Pradhan
- Institute for Social and Environmental Research-Nepal (ISER-N), Bharatpur-15, Chitwan, Nepal
| | | | | | - Janak Rai
- Central Department of Anthropology, Tribhuvan University, Nepal
| | - Kenneth M. Langa
- Survey Research Center, University of Michigan Institute for Social Research, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Jinkook Lee
- Department of Economics, University of Southern California, Los Angeles, CA, USA
| | - Dirgha Ghimire
- Institute for Social and Environmental Research-Nepal (ISER-N), Bharatpur-15, Chitwan, Nepal
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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O’Shea DM, Galvin JE. Female APOE ɛ4 Carriers with Slow Rates of Biological Aging Have Better Memory Performances Compared to Female ɛ4 Carriers with Accelerated Aging. J Alzheimers Dis 2023; 92:1269-1282. [PMID: 36872781 PMCID: PMC10535361 DOI: 10.3233/jad-221145] [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: 03/06/2023]
Abstract
BACKGROUND Evidence suggests that APOE ɛ4 carriers have worse memory performances compared to APOE ɛ4 non-carriers and effects may vary by sex and age. Estimates of biological age, using DNA methylation may enhance understanding of the associations between sex and APOE ɛ4 on cognition. OBJECTIVE To investigate whether associations between APOE ɛ4 status and memory vary according to rates of biological aging, using a DNA methylation age biomarker, in older men and women without dementia. METHODS Data were obtained from 1,771 adults enrolled in the 2016 wave of the Health and Retirement Study. A series of ANCOVAs were used to test the interaction effects of APOE ɛ4 status and aging rates (defined as 1 standard deviation below (i.e., slow rate), or above (i.e., fast rate) their sex-specific mean rate of aging on a composite measure of verbal learning and memory. RESULTS APOE ɛ4 female carriers with slow rates of GrimAge had significantly better memory performances compared to fast and average aging APOE ɛ4 female carriers. There was no effect of aging group rate on memory in the female non-carriers and no significant differences in memory according to age rate in either male APOE ɛ4 carriers or non-carriers. CONCLUSION Slower rates of aging in female APOE ɛ4 carriers may buffer against the negative effects of the ɛ4 allele on memory. However, longitudinal studies with larger sample sizes are needed to evaluate risk of dementia/memory impairment based on rates of aging in female APOE ɛ4 carriers.
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Affiliation(s)
- Deirdre M. O’Shea
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, FL, USA
| | - James E. Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, FL, USA
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Ravindranath V. Srinivaspura Aging, Neuro Senescence and COGnition (SANSCOG) study: Study protocol. Alzheimers Dement 2022. [PMID: 36577090 DOI: 10.1002/alz.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/28/2022] [Accepted: 03/29/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Prospective, population-based, aging, and cognition studies are an important approach to understand normal and pathological aging processes. METHODS This is a longitudinal, community-based cohort study (n = 10,000) in rural India, with long-term follow-up for comprehensive evaluation of risk and protective factors associated with cognitive changes during aging. All participants will undergo comprehensive clinical, neurocognitive, and biochemical assessments. Genotyping using genome-wide association studies will be done for all participants. Whole genome sequencing and brain imaging (magnetic resonance imaging) will be done in a subset. RESULTS This study will generate a rich database of clinical, neurocognitive, biochemical, neuroimaging, and genetic data that can help identify risk and protective factors for dementia and other related disorders. DISCUSSION This longitudinal study is first of its kind, involving comprehensive evaluations, spanning phenotype to genotype, in a rural Indian cohort, and has major public health implications.
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Torres JM, Glymour MM. Future Directions for the HRS Harmonized Cognitive Assessment Protocol. Forum Health Econ Policy 2022; 25:7-27. [PMID: 35254747 DOI: 10.1515/fhep-2021-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/07/2022] [Indexed: 01/05/2023]
Abstract
In the absence of effective pharmacological treatment to halt or reverse the course of Alzheimer's disease and related dementias (ADRDs), population-level research on the modifiable determinants of dementia risk and outcomes for those living with ADRD is critical. The Harmonized Cognitive Assessment Protocol (HCAP), fielded in 2016 as part of the U.S. Health and Retirement Study (HRS) and multiple international counterparts, has the potential to play an important role in such efforts. The stated goals of the HCAP are to improve our ability to understand the determinants, prevalence, costs, and consequences of cognitive impairment and dementia in the U.S. and to support cross-national comparisons. The first wave of the HCAP demonstrated the feasibility and value of the more detailed cognitive assessments in the HCAP compared to the brief cognitive assessments in the core HRS interviews. To achieve its full potential, we provide eight recommendations for improving future iterations of the HCAP. Our highest priority recommendation is to increase the representation of historically marginalized racial/ethnic groups disproportionately affected by ADRDs. Additional recommendations relate to the timing of the HCAP assessments; clinical and biomarker validation data, including to improve cross-national comparisons; dropping lower performing items; enhanced documentation; and the addition of measures related to caregiver impact. We believe that the capacity of the HCAP to achieve its stated goals will be greatly enhanced by considering these changes and additions.
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Affiliation(s)
- Jacqueline M Torres
- Department of Epidemiology and Biostatistics, UC San Francisco, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, UC San Francisco, San Francisco, CA, USA
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Manly JJ, Jones RN, Langa KM, Ryan LH, Levine DA, McCammon R, Heeringa SG, Weir D. Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US: The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project. JAMA Neurol 2022; 79:1242-1249. [PMID: 36279130 PMCID: PMC9593315 DOI: 10.1001/jamaneurol.2022.3543] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
Importance Nationally representative data are critical for understanding the causes, costs, and outcomes associated with dementia and mild cognitive impairment (MCI) in the US and can inform policies aimed at reducing the impact of these conditions on patients, families, and public programs. The nationally representative Health and Retirement Study (HRS) is an essential resource for such data, but the HRS substudy providing dementia diagnostic information was fielded more than 20 years ago and more recent data are needed. Objective The Harmonized Cognitive Assessment Protocol (HCAP) was developed to update national estimates of the prevalence of MCI and dementia in the US and examine differences by age, race, ethnicity, and sex. Design, Setting, and Participants HRS is an ongoing longitudinal nationally representative study of people 51 years and older with staggered entry dates from 1992 to 2022 and follow-up ranging from 4 to 30 years. HCAP is a cross-sectional random sample of individuals in HRS who were 65 years or older in 2016. Of 9972 age-eligible HRS participants, 4425 were randomly selected for HCAP, and 3496 completed a comprehensive neuropsychological test battery and informant interview, none of whom were excluded. Dementia and MCI were classified using an algorithm based on standard diagnostic criteria and comparing test performance to a robust normative sample. Exposures Groups were stratified by age, sex, education, race, and ethnicity. Main Outcomes and Measures National prevalence estimates using population weights. Results The mean (SD) age of the study population sample (N = 3496) was 76.4 (7.6) years, and 2095 participants (60%) were female. There were 551 participants who self-identified as Black and not Hispanic (16%), 382 who self-identified as Hispanic regardless of race (16%), 2483 who self-identified as White and not Hispanic (71%), and 80 who self-identified as another race (2%), including American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, or another self-described race. A total of 393 individuals (10%; 95% CI, 9-11) were classified as having dementia and 804 (22%; 95% CI, 20-24) as having MCI. Every 5-year increase in age was associated with higher risk of dementia (weighted odds ratio [OR], 1.95 per 5-year age difference; 95%, CI, 1.77-2.14) and MCI (OR, 1.17 per 5-year age difference, 95% CI, 1.09-1.26). Each additional year of education was associated with a decrease in risk of dementia (OR, 0.93 per year of school, 95% CI, 0.89-0.97) and MCI (OR, 0.94, 95% CI, 0.91-0.97). Dementia was more common among non-Hispanic Black individuals (OR, 1.81; 95% CI, 1.20-2.75) and MCI in Hispanic individuals (OR, 1.42; 95% CI, 1.03-1.96) compared with non-Hispanic White individuals. Other group comparisons by race and ethnicity were not possible owing to small numbers. No differences in prevalence were found between female individuals and male individuals. Conclusions and Relevance Using a comprehensive neuropsychological test battery and large sample, the national prevalence of dementia and MCI in 2016 found in this cross-sectional study was similar to that of other US-based studies, indicating a disproportionate burden of dementia and MCI among older Black and Hispanic adults and those with lower education.
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Affiliation(s)
- Jennifer J. Manly
- Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Kenneth M. Langa
- Institute for Social Research, University of Michigan, Ann Arbor
- Cognitive Health Sciences Research Program and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Lindsay H. Ryan
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Deborah A. Levine
- Cognitive Health Sciences Research Program and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Neurology and Stroke Program, University of Michigan, Ann Arbor
| | - Ryan McCammon
- Institute for Social Research, University of Michigan, Ann Arbor
| | | | - David Weir
- Institute for Social Research, University of Michigan, Ann Arbor
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Yan B, Gao S, Dai M, Gill TM, Chen X. Early-Life Circumstances and Cross-Country Disparities in Cognition Among Older Populations - China, the US, and the EU, 2008-2018. China CDC Wkly 2022; 4:1013-1018. [PMID: 36483009 PMCID: PMC9709302 DOI: 10.46234/ccdcw2022.205] [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] [Received: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
What is already known about this topic? Many health challenges have emerged due to rapid population aging, including declined cognitive ability among older adults. What is added by this report? Childhood circumstances have significant and lasting impacts on cognition in old age. This study compared cognition data from China with both the United States (U.S.) and the European Union (EU) during 2008-2018, finding that childhood circumstances could respectively explain 65.4% [95% confidence interval (CI): 59.4%, 71.4%] (China vs. the U.S.) and 38.2% (95% CI: 35.1%, 41.2%) (China vs. the EU) of the overall differences in cognition among older adults. Family socioeconomic status explained the largest share of differences among all considered childhood circumstances. What are the implications for public health practice? Large disparities in cognition should be addressed by mitigating childhood disadvantages.
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Affiliation(s)
- Binjian Yan
- College of Economics and Management, Nanjing Agricultural University, Nanjing City, Jiangsu Province, China
| | - Shuaifeng Gao
- College of Economics and Management, Nanjing Agricultural University, Nanjing City, Jiangsu Province, China
| | - Minlei Dai
- College of Economics and Management, Nanjing Agricultural University, Nanjing City, Jiangsu Province, China
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, US
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, US
- Department of Economics, Yale University, New Haven, CT, US
- Yale Alzheimer’s Disease Research Center, Yale University, New Haven, CT, US
- Xi Chen,
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