Depressive Symptoms, Glial Fibrillary Acid Protein Concentrations, and Cognitive Decline in a Cohort Study

BACKGROUND

Little is known about how depressive symptoms and glial fibrillary acid protein (GFAP) concentrations taken together may influence cognitive functioning. Understanding this relationship may inform strategies for screening and early intervention to decrease the rate of cognitive decline.

METHODS

This study sample includes 1 169 participants from the Chicago Health and Aging Project (CHAP), consisting of 60% Black participants and 40% White participants, and 63% female participants and 37% male participants. CHAP is a population-based cohort study of older adults with a mean age of 77 years. Linear mixed-effects regression models tested the main effects of depressive symptoms and GFAP concentrations and their interactions on baseline cognitive function and cognitive decline over time. Models included adjustments for age, race, sex, education, chronic medical conditions, body mass index, smoking status, alcohol use, and their interactions with time.

RESULTS

The interaction of depressive symptomology and GFAP (β = -0.105 [standard error = 0.038], p = .006) on global cognitive function was statistically significant. Participants with depressive symptoms including and above the cutoff and high log of GFAP concentrations had more cognitive decline over time, followed by participants with depressive symptoms below the cutoff and high log of GFAP concentrations, depressive symptom scores including and above the cutoff and low log of GFAP concentrations, and depressive symptom scores below the cutoff and low log of GFAP concentrations.

CONCLUSIONS

Depressive symptoms have an additive effect on the association between the log of GFAP and baseline global cognitive function.

Comparison of Particulate Air Pollution From Different Emission Sources and Incident Dementia in the US

Importance

Emerging evidence indicates that exposure to fine particulate matter (PM2.5) air pollution may increase dementia risk in older adults. Although this evidence suggests opportunities for intervention, little is known about the relative importance of PM2.5 from different emission sources.

Objective

To examine associations of long-term exposure of total and source-specific PM2.5 with incident dementia in older adults.

Design, Setting, and Participants

The Environmental Predictors of Cognitive Health and Aging study used biennial survey data from January 1, 1998, to December 31, 2016, for participants in the Health and Retirement Study, which is a nationally representative, population-based cohort study in the US. The present cohort study included all participants older than 50 years who were without dementia at baseline and had available exposure, outcome, and demographic data between 1998 and 2016 (N = 27 857). Analyses were performed from January 31 to May 1, 2022.

Exposures

The 10-year mean total PM2.5 and PM2.5 from 9 emission sources at participant residences for each month during follow-up using spatiotemporal and chemical transport models.

Main Outcomes and Measures

The main outcome was incident dementia as classified by a validated algorithm incorporating respondent-based cognitive testing and proxy respondent reports. Adjusted hazard ratios (HRs) were estimated for incident dementia per IQR of residential PM2.5 concentrations using time-varying, weighted Cox proportional hazards regression models with adjustment for the individual- and area-level risk factors.

Results

Among 27 857 participants (mean [SD] age, 61 [10] years; 15 747 [56.5%] female), 4105 (15%) developed dementia during a mean (SD) follow-up of 10.2 [5.6] years. Higher concentrations of total PM2.5 were associated with greater rates of incident dementia (HR, 1.08 per IQR; 95% CI, 1.01-1.17). In single pollutant models, PM2.5 from all sources, except dust, were associated with increased rates of dementia, with the strongest associations for agriculture, traffic, coal combustion, and wildfires. After control for PM2.5 from all other sources and copollutants, only PM2.5 from agriculture (HR, 1.13; 95% CI, 1.01-1.27) and wildfires (HR, 1.05; 95% CI, 1.02-1.08) were robustly associated with greater rates of dementia.

Conclusion and Relevance

In this cohort study, higher residential PM2.5 levels, especially from agriculture and wildfires, were associated with higher rates of incident dementia, providing further evidence supporting PM2.5 reduction as a population-based approach to promote healthy cognitive aging. These findings also indicate that intervening on key emission sources might have value, although more research is needed to confirm these findings.

Hypertension and Stroke as Mediators of Air Pollution Exposure and Incident Dementia

Importance

Fine particulate matter air pollution (PM2.5) has been consistently associated with cardiovascular disease, which, in turn, is associated with an increased risk of dementia. As such, vascular dysfunction might be a mechanism by which PM2.5 mediates dementia risk, yet few prior epidemiological studies have examined this potential mechanism.

Objective

To investigate whether hypertension and stroke serve as mediators and modifiers of the association of PM2.5 with incident dementia.

Design, Setting, and Participants

As part of the Environmental Predictors of Cognitive Health and Aging (EPOCH) Project, this cohort study used biennial survey data collected between 1998 and 2016 from respondents of the Health and Retirement Study (HRS), a nationally representative, population-based, cohort in the US. Eligible participants were those over 50 years of age who were free of dementia at baseline and had complete exposure, mediator, outcome, and demographic data from the HRS. Data analysis was conducted from August to November 2022.

Exposures

Exposure to PM2.5, calculated for the 10 years preceding each person's baseline examination according to residential histories and spatiotemporal models.

Main Outcomes and Measures

Incident dementia was identified using a validated algorithm based on cognitive testing and informant reports. The 4-way decomposition causal mediation analysis method was used to quantify the degree to which hypertension and stroke mediated or modified the association of PM2.5 with incident dementia after adjustment for individual-level and area-level covariates.

Results

Among 27 857 participants (mean [SD] age at baseline, 61 [10] years; 15 747 female participants [56.5%]; 19 249 non-Hispanic White participants [69.1%]), 4105 (14.7%) developed dementia during the follow-up period (mean [SD], 10.2 [5.6] years). Among participants with dementia, 2204 (53.7%) had a history of hypertension at baseline and 386 (9.4%) received a diagnosis of hypertension during the follow up. A total of 378 participants (9.2%) had a history of stroke at baseline and 673 (16.4%) developed stroke over the follow-up period. The IQR of baseline PM2.5 concentrations was 10.9 to 14.9 μg/m3. In fully adjusted models, higher levels of PM2.5 (per IQR) were not associated with increased risk of incident dementia (HR, 1.04; 95% CI, 0.98 to 1.11). Although there were positive associations of prevalent stroke (HR, 1.67; 95% CI, 1.48 to 1.88) and hypertension (HR, 1.15; 95% CI, 1.08 to 1.23) with incident dementia compared with those free of stroke and hypertension during follow-up, there was no statistically significant association of PM2.5 with stroke (odds ratio per IQR increment in PM2.5, 1.08; 95%CI, 0.91 to 1.29) and no evidence of an association of PM2.5 with hypertension (odds ratio per IQR increment in PM2.5, 0.99; 95%CI, 0.92 to 1.07). Concordantly, there was no evidence that hypertension or stroke acted as mediators or modifiers of the association of PM2.5 with incident dementia. Although the nonmediated interaction between PM2.5 and hypertension accounted for 39.2% of the total excess association (95% CI, -138.5% to 216.9%), the findings were not statistically significant.

Conclusions and Relevance

These findings suggest that although hypertension may enhance the susceptibility of individuals to air pollution, hypertension and stroke do not significantly mediate or modify the association of PM2.5 with dementia, indicating the need to investigate other pathways and potential mediators of risk.

Race and Apolipoprotein E-e4 Allele Status Differences in the Association Between Loneliness and Cognitive Decline

OBJECTIVE

This study aimed to examine race and apolipoprotein E-e4 allele (APOE-e4) status differences in the longitudinal associations between loneliness and cognitive decline.

METHODS

The study sample is composed of participants ( N = 7696, 64% Black participants and 36% White participants) from the Chicago Health and Aging Project, a population-based cohort study. Mixed-effects regression models were conducted to examine the longitudinal associations between loneliness on global cognitive function and individual tests of cognitive function. Models were also stratified by race and APOE-e4.

RESULTS

A greater percentage of Black participants (17%) reported loneliness at baseline visit compared with White participants (12%). Black and White participants who were lonely individuals had a similar rate of decline in global cognitive function at 0.075 (95% confidence interval [CI] = -0.082 to -0.068) standard deviation unit (SDU) per year for Black participants and at 0.075 (95% CI = -0.086 to -0.063) SDU per year for White participants. Lonely participants with APOE-e4 had a higher rate of global cognitive decline at -0.102 (95% CI = -0.115 to -0.088) SDU per year than for lonely participants without APOE-e4 at -0.052 (95% CI = -0.059 to -0.045) SDU per year.

CONCLUSIONS

The burden of loneliness and its relation to cognitive decline is higher among participants with APOE-e4 compared with those without APOE-e4. Loneliness is associated with cognitive decline in both Black and White participants.

SOCIAL SUPPORT AND LONELINESS AS DETERMINANTS OF THE ONSET OF DISABILITY AMONG PUERTO RICAN OLDER ADULTS

Background

The effect of loneliness and social support on health is poorly understood among older Puerto Ricans. As family size continues to decrease in Puerto Rico due to out-migration, a higher number of older adults have fewer family members to rely on, which may lead to detrimental health outcomes.Method: Using both waves (2002-03 and 2006-07) of the Puerto Rican Elderly: Health Conditions database, we examined the association between social support, living alone, and incident disability among a sample of older adults over 60 years of age residing in Puerto Rico. Disability was defined as the occurrence of difficulties with Activities of Daily Living (ADLs).

Results

13.4% of older adults in our sample developed some form of disability. Older adults who developed a disability indicated receiving higher levels of social support (2.04 vs. 1.64) and loneliness (30.7% vs. 22.8%). Using multivariate logistic regression, we found that receiving social support increased the odds of developing a disability by 17% (OR: 1.17; CI: 1.02 – 1.35). Older adults who live alone had 58% higher odds of developing a disability (OR: 1.58; CI: 1.01 – 2.46).

Conclusion

The presence of social support and loneliness was correlated with a population prone to developing disabilities. Our findings concur with the well-established literature on psychosocial determinants in late life. However, this study represents the first attempt to understand psychosocial measures and disability in Puerto Rico. Public health organizations and healthcare systems must develop new societal mechanisms of support for older adults at risk of developing disabilities.

TYPES OF SOCIAL NETWORKS AND THEIR ASSOCIATION WITH MOBILITY AND DISABILITY IN LATE LIFE

Social networks are critical in maintaining late-life functional health, but, previous studies have focused on isolated dimensions of social networks. We examined whether network types, representing multiple interrelated network characteristics, are associated with mobility and disability among older adults in America. Data are from the National Social Life, Health, and Aging Project, a nationally representative study of 3,005 adults aged 57-85 years at baseline (2005-2006). In a previous analysis, five social network types were derived at baseline, based on nine observed network characteristics. Functional outcomes were examined during two follow-up waves in 2010-2011 and 2015-2016. Mobility-related function was assessed as the time (in seconds) to complete a 6-meter walk. Disability was defined as experiencing any difficulty in performing one of six activities of daily living (ADLs). We estimated the effect of network types on risk of ADL disability onset using logistic regression, and on mobility using generalized linear mixed models. Social network type was associated with mobility over time, such that older adults in the “restricted” network had significantly slower walking times than those in the “diverse” network. There was no association between network types and risk of disability onset in the primary analysis. However, sensitivity analyses showed a protective effect of the “partner-centered” network on a 5-year, but not a 10-year, risk of disability onset. Network types can elucidate older adults’ varied interpersonal and caregiving networks, and identify adults at risk of being socially isolated. However, the utility of network types in predicting late-life functional health may be limited.

Mental health outcomes among Arab refugees, immigrants, and U.S. born Arab Americans in Southeast Michigan: a cross-sectional study

BACKGROUND

Arab refugees and immigrants living in the United States may be exposed to political, economic, social, and environmental stressors that may affect their mental health. Yet, little is known regarding mental health outcomes among Arab Americans. The purpose of this study was to measure depression and anxiety levels among Arabs in Southeast Michigan and determine whether these levels differ by resident status: refugee, immigrant, or U.S. born.

METHODS

We conducted a cross-sectional study in a convenience sample of 275 adults who self-identify as Arab living in Southeast Michigan. Participants were recruited from a non-profit health and social services organization between August-November 2015. Data were collected via self-administered questionnaires, using standardized instruments to assess depression and anxiety symptoms.

RESULTS

All three resident groups exhibited high mean levels of depression and anxiety. Refugees reported higher levels of depression and anxiety than either immigrants or U.S. born Arab Americans. After adjustment for sociodemographics, differences between U.S. born Arab Americans and refugees were statistically significant for depression (b = 2.84; 95% CI: 0.21, 5.47), but not for anxiety. Refugees had significantly higher depression scores (b = 3.18, 95% CI: 1.52, 4.84) and anxiety scores (b = 1.31, 95% CI: 0.11, 2.50) than immigrants. Those reporting political violence and religious persecution as reasons for immigration had the highest levels of depression and anxiety.

CONCLUSIONS

This convenience sample of Arab Americans reported high levels of depression and anxiety symptoms. Refugees appear to have poorer mental health outcomes than either immigrants or U.S.-born Arab Americans.

Increase in frailty of older workers and retirees predicted by negative psychosocial working conditions on the job

Well-established evidence has shown that negative psychosocial working conditions adversely affect the health and well-being of prime-age workers, yet little is known about the consequences on the health of older workers. Our article examines the associations between declines in health in later life, measured as frailty, and negative psychosocial working conditions, and considers the role of retirement. We use longitudinal cross-national data collected by SHARE I and SHARE IV and focus on the respondents who were working at baseline. We find that low reward, high effort, effort to reward ratio, and effort to control ratio were all predictors of increasing frailty. The association between low reward and change in frailty was modified by retirement status at follow-up, with nonretired respondents in low-reward jobs experiencing the largest increases in frailty at follow-up. These results suggest that the effect of psychosocial working conditions on physical health may extend well past the prime working age, and retirement may have a protective effect on the health of older workers in low reward jobs.

BMI and sociodemographic correlates of body image perception and attitudes in school-aged children

OBJECTIVE

The aim of the present study was to identify correlates of body image perception and dissatisfaction among school-aged children from Colombia, a country undergoing the nutrition transition.

DESIGN

Cross-sectional study. Using child-adapted Stunkard scales, children were asked to indicate the silhouette that most closely represented their current and desired body shapes. Body image dissatisfaction (BID) score was estimated as current minus desired silhouette. Height and weight were measured in all children. Sociodemographic data were collected through questionnaires completed by the children's mothers.

SETTING

Public primary schools in Bogotá, Colombia.

SUBJECTS

Children aged 5-12 years (n 629) and their mothers.

RESULTS

Mean BID score was 0·1 (SD 1·7). The strongest predictor of BID was actual BMI-for-age Z-score (BAZ). Compared with children with BAZ ≥ -1 and < 1, those with BAZ ≥ 2 had a 1·9 units higher BID score (P for trend < 0·0001). BID tended to be higher in girls than boys at any level of BAZ. Other correlates of BID included child's height-for-age Z-score, maternal BMI and dissatisfaction with the child's body, and home ownership.

CONCLUSIONS

Among school-aged children from a country experiencing the nutrition transition, body image perception was associated with the child's weight and height, and with maternal BMI, dissatisfaction with the child's body and socio-economic level.

Neighborhood cohesion is associated with reduced risk of stroke mortality

BACKGROUND AND PURPOSE

Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence.

METHODS

Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence.

RESULTS

Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5).

CONCLUSIONS

Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.

Elder self-neglect and abuse and mortality risk in a community-dwelling population

CONTEXT

Both elder self-neglect and abuse have become increasingly prominent public health issues. The association of either elder self-neglect or abuse with mortality remains unclear.

OBJECTIVE

To examine the relationship of elder self-neglect or abuse reported to social services agencies with all-cause mortality among a community-dwelling elderly population.

DESIGN, SETTING, AND PARTICIPANTS

Prospective, population-based cohort study (conducted from 1993 to 2005) of residents living in a geographically defined community of 3 adjacent neighborhoods in Chicago, Illinois, who were participating in the Chicago Health and Aging Project (CHAP; a longitudinal, population-based, epidemiological study of residents aged > or = 65 years). A subset of these participants had suspected elder self-neglect or abuse reported to social services agencies.

MAIN OUTCOME MEASURES

Mortality ascertained during follow-up and by use of the National Death Index. Cox proportional hazard models were used to assess independent associations of self-neglect or elder abuse reporting with the risk of all-cause mortality using time-varying covariate analyses.

RESULTS

Of 9318 CHAP participants, 1544 participants were reported for elder self-neglect and 113 participants were reported for elder abuse from 1993 to 2005. All CHAP participants were followed up for a median of 6.9 years (interquartile range, 7.4 years), during which 4306 deaths occurred. In multivariable analyses, reported elder self-neglect was associated with a significantly increased risk of 1-year mortality (hazard ratio [HR], 5.82; 95% confidence interval [CI], 5.20-6.51). Mortality risk was lower but still elevated after 1 year (HR, 1.88; 95% CI, 1.67-2.14). Reported elder abuse also was associated with significantly increased risk of overall mortality (HR, 1.39; 95% CI, 1.07-1.84). Confirmed elder self-neglect or abuse also was associated with mortality. Increased mortality risks associated with either elder self-neglect or abuse were not restricted to those with the lowest levels of cognitive or physical function.

CONCLUSION

Both elder self-neglect and abuse reported to social services agencies were associated with increased risk of mortality.

A population-based study of hemoglobin, race, and mortality in elderly persons

BACKGROUND

Anemia is associated with increased mortality risk. The impact of mildly low hemoglobin concentration (Hb) on risk for mortality remains unclear, especially among blacks. We examined the racial differences between Hb and mortality.

METHODS

This was a population-based study conducted from 1993 through 2006, in a geographically defined community of Chicago, Illinois. A stratified, random sample of 1806 participants 65 years old or older and 50% black, who were participating in the Chicago Health Aging Project and underwent clinical evaluation. Mortality was ascertained using the National Death Index. Cox proportional hazard models were used to assess the independent relation of Hb to mortality risk.

RESULTS

The proportion of participants with anemia by World Health Organization (WHO) criteria (Hb < 13.0 g/dL for men and < 12.0 g/dL for women) was 39% among blacks, and 17% among whites. Blacks had lower mean Hb (12.6 +/- 1.5 g/dL) than did whites (13.5 +/- 1.5 g/dL). In multivariable analysis, anemia was associated with increased mortality risk in blacks (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.43-2.53) and in whites (HR, 1.85; 95% CI, 1.32-2.59). Among blacks, Hb 0-0.9 g/dL below the anemia threshold is associated with increased mortality risk compared to Hb 0-0.9 g/dL above the anemia cutoff (HR, 1.84; 95% CI, 1.21-2.79), Hb 1.1-2.0 g/dL above the anemia cutoff (HR, 1.35; 95% CI, 0.88-2.05) and Hb 2.1-3.0 g/dL above the anemia cutoff (HR, 2.24; 95% CI, 1.12-4.47). The terms for interaction between black ethnicity/race and anemia suggested that blacks did not have a statistically significant difference in mortality risk compared to whites. Subgroup analyses of interaction terms suggested that Hb 0.1-1.0 g/dL above anemia cutoff group, blacks may have lower mortality risk compared to whites in the mildly low normal ranges of Hb (p =.02).

CONCLUSION

Both anemia by WHO criteria and mild reductions in Hb were related to increased risk of mortality in older blacks and whites.

The Rush Memory and Aging Project: study design and baseline characteristics of the study cohort

The long-term objective of the Rush Memory and Aging Project is to identify the postmortem indices linking genetic and environmental risk factors to the development of Alzheimer's disease (AD). The overall study design involves a detailed assessment of risk factors for AD in older persons without known dementia who agree to annual clinical evaluation and organ donation at the time of death. In contrast to other clinical-pathologic studies which are conducted on special populations, the Rush Memory and Aging Project enrolled a cohort with much greater diversity in terms of educational attainment, in addition to gender, race, and ethnicity. From September of 1997 through April of 2005, more than 1,000 older persons without known dementia from more than 30 residential facilities across the Chicago metropolitan area agreed to participate. Their mean age was 81 years, about a third had 12 or fewer years of education, a third were men, and about 10% were members of a racial or ethnic minority group. More than 950 already have completed their baseline clinical evaluation.

Effects of treating exhaustion in angioplasty patients on new coronary events: results of the randomized Exhaustion Intervention Trial (EXIT)

BACKGROUND

Extreme fatigue is a common complaint in percutaneous coronary intervention (PCI) patients, and is associated with an increased risk for new cardiac events. The objective of the Exhaustion Intervention Trial (EXIT) was to determine whether a behavioral intervention on exhaustion reduces the risk of a new coronary event after PCI.

METHODS AND RESULTS

Seven hundred ten consecutive patients, ages 35 to 68 years, who felt exhausted after PCI were randomized into an intervention group and a usual-care group. The intervention was based on group therapy focusing on stressors leading to exhaustion, and on support for recovery by promoting rest and making rest more efficient. One month after PCI, 50% of the patients felt exhausted. The intervention reduced the odds of remaining exhausted at 18 months by 56% in those without a previous history of coronary artery disease (CAD) (OR = 0.44; 95% CI 0.29-0.66), but had no effect on exhaustion in those with a history of CAD (OR = 0.93; 95% CI 0.56-1.55; p = .78). The intervention did not reduce the risk of a new coronary event within 2 years (RR = 1.14; 95%CI 0.82-1.57). Post-hoc analyses suggest that the effect of the intervention was limited by a positive history of CAD, the presence of a chronic, painful condition (especially rheumatism), and by opposite effects on early and late cardiac events.

CONCLUSION

A behavioral intervention in PCI patients has a beneficial effect on feelings of exhaustion. It could not be demonstrated that the intervention reduces the risk of a new coronary event within 2 years.

Can physical activity attenuate aging-related weight loss in older people? The Yale Health and Aging Study, 1982-1994

The purpose of this analysis was to determine the longitudinal relation between physical activity and the trajectory of weight change in an older cohort (> or =65 years) living in New Haven, Connecticut, who participated in the Established Populations for the Epidemiologic Study of the Elderly between 1982 and 1994 (n=2,812). The authors hypothesized that body weight would decline over the follow-up and that physical activity would play an important role in minimizing weight loss over time. Physical activity and other covariables were self-reported at baseline, while body weight was self-reported annually over 12 years. Multivariable random effects regression demonstrated a curvilinear trajectory of weight loss per year with an accelerated loss at older ages. Baseline body weight was 155 (standard deviation, 30) pounds (70 (standard deviation, 14) kg) for those who survived the entire follow-up and was 153 (standard deviation, 32) pounds (70 (standard deviation, 15) kg) for those who did not. Each 1-unit increase in baseline total activity score minimized this aging-related weight loss, but this relation was most pronounced among those with chronic disease who did not survive the entire follow-up period (n=973; 0.15 pounds (0.07 kg) per year). These data suggest that, among frail older people, even modest levels of physical activity can attenuate the rate of aging- and disease-related weight loss.