Suzanne Satterfield

The University of Tennessee Health Science Center, Memphis, Tennessee, United States

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Publications (170)992.05 Total impact

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    ABSTRACT: To assess the relationship between sensorimotor nerve function and incident mobility disability over 10 years. Prospective cohort study with longitudinal analysis. Two U.S. clinical sites. Population-based sample of community-dwelling older adults with no mobility disability at 2000/01 examination (N = 1,680; mean age ± SD 76.5 ± 2.9, body mass index 27.1 ± 4.6; 50.2% female, 36.6% black, 10.7% with diabetes mellitus). Motor nerve conduction amplitude (poor <1 mV) and velocity (poor <40 m/s) were measured on the deep peroneal nerve. Sensory nerve function was measured using 10- and 1.4-g monofilaments and vibration detection threshold at the toe. Lower extremity symptoms included numbness or tingling and aching or burning pain. Incident mobility disability assessed semiannually over 8.5 years (interquartile range 4.5-9.6 years) was defined as two consecutive self-reports of a lot of difficulty or inability to walk one-quarter of a mile or climb 10 steps. Nerve impairments were detected in 55% of participants, and 30% developed mobility disability. Worse motor amplitude (HR = 1.29 per SD, 95% CI = 1.16-1.44), vibration detection threshold (HR = 1.13 per SD, 95% CI = 1.04-1.23), symptoms (HR = 1.65, 95% CI = 1.26-2.17), two motor impairments (HR = 2.10, 95% CI = 1.43-3.09), two sensory impairments (HR = 1.91, 95% CI = 1.37-2.68), and three or more nerve impairments (HR = 2.33, 95% CI = 1.54-3.53) predicted incident mobility disability after adjustment. Quadriceps strength mediated relationships between certain nerve impairments and mobility disability, although most remained significant. Poor sensorimotor nerve function independently predicted mobility disability. Future work should investigate modifiable risk factors and interventions such as strength training for preventing disability and improving function in older adults with poor nerve function. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
    Journal of the American Geriatrics Society 12/2014; · 4.22 Impact Factor
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    ABSTRACT: Identifying factors associated with functional declines in older adults is important given the aging of the population. We investigated if hearing impairment is independently associated with objectively measured declines in physical functioning in a community-based sample of older adults. Prospective observational study of 2,190 individuals from the Health, Aging, and Body Composition study. Participants were followed annually for up to 11 visits. Hearing was measured with pure-tone audiometry. Physical functioning and gait speed were measured with the Short Physical Performance Battery (SPPB). Incident disability and requirement for nursing care were assessed semiannually through self-report. In a mixed-effects model, greater hearing impairment was associated with poorer physical functioning. At both Visit 1 and Visit 11, SPPB scores were lower in individuals with mild (10.14 [95% CI 10.04-10.25], p < .01; 7.35 [95% CI 7.12-7.58], p < .05) and moderate or greater hearing impairment (10.04 [95% CI 9.90-10.19], p < .01; 7.00 [95% CI 6.69-7.32], p < .01) than scores in normal hearing individuals (10.36 [95% CI 10.26-10.46]; 7.71 [95% CI 7.49-7.92]). We observed that women with moderate or greater hearing impairment had a 31% increased risk of incident disability (Hazard ratio [HR] =1.31 [95% CI 1.08-1.60], p < .01) and a 31% increased risk of incident nursing care requirement (HR = 1.31 [95% CI 1.05-1.62], p = .02) compared to women with normal hearing. Hearing impairment is independently associated with poorer objective physical functioning in older adults, and a 31% increased risk for incident disability and need for nursing care in women. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 12/2014; · 4.31 Impact Factor
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    ABSTRACT: Protracted, systemic inflammation has been associated with adverse effects on cognition and brain structure, and may accelerate neurodegenerative disease processes; however, it is less clear whether changes in inflammation are associated with brain structure.Methods We studied 276 black and white older adults (mean age=83 years at time of imaging) enrolled in a prospective study of aging. Inflammation (measured with CRP) was assessed repeatedly over 6 years (i.e. Year 2, 4, 6, & 8). Brain MRIs were obtained at years 10-11 with DTI; regions of interest included late-myelinating areas vulnerable to aging, including frontal-parietal [superior longitudinal fasciculus (SLF)-dorsal] and temporal (SLF-temporal; uncinate) white matter tracts.ResultsMean CRP values significantly declined (t=-5.54, p<.0001) over 6 years, and subject-specific slopes (BLUPs) all showed a decline (mean=-.57, SD=.53) for our participant sample. More than 50% of study participants were still in the moderate to high cardiovascular risk range based on CRP values at Year 8. After controlling for demographics, vascular risk factors and MRI white matter hyperintensities, larger decreases in CRP values over time were significantly associated with higher fractional anisotropy in the SLF-dorsal [Beta=-0.0052, standard error (SE)=0.003; 95% confidence interval (CI)= -0.0103 to -0.0025, p=.04], SLF-temporal (Beta=-0.0109, SE=0.004; 95%CI=-0.0189 to -0.0029, p=.008), and uncinate (Beta=-0.0067, SE=0.003; 95%CI=-0.0132 to -0.0001, p=.05) fasciculi.Conclusions Results suggest that in a prospective cohort of older individuals, faster declines in inflammation over time are related to indicators of white matter health, even after accounting for vascular risk factors.
    Neurobiology of Aging. 11/2014;
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    ABSTRACT: Cross-sectional studies have found that low serum bicarbonate is associated with slower gait speed. Whether bicarbonate levels independently predict the development of functional limitation has not been previously studied. Whether bicarbonate was associated with incident persistent lower extremity functional limitation and whether the relationship differed in individuals with and without CKD were assessed in participants in the Health, Aging, and Body Composition study, a prospective study of well functioning older individuals DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Functional limitation was defined as difficulty in walking 0.25 miles or up 10 stairs on two consecutive reports 6 months apart in the same activity (stairs or walking). Kidney function was measured using eGFR by the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and CKD was defined as an eGFR<60 ml/min per 1.73 m(2). Serum bicarbonate was measured using arterialized venous blood gas. Cox proportional hazards analysis was used to assess the association of bicarbonate (<23, 23-25.9, and ≥26 mEq/L) with functional limitation. Mixed model linear regression was performed to assess the association of serum bicarbonate on change in gait speed over time.
    Clinical journal of the American Society of Nephrology : CJASN. 11/2014;
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    ABSTRACT: Objective: To quantify racial differences in brain structural characteristics in white and black octogenarians, and to examine whether these characteristics contribute to cognition. Methods: Cross-sectional study of 283 adults 79-89 years old(59.4% white;42.0% women) with data on gray matter integrity via diffusion tensor imaging(mean diffusivity), gray matter atrophy (GMA), whitematter hyperintensities (WMH), literacy, smoking, drinking, income, hypertension and diabetes. Participants were recruited from an ongoing epidemiological study of older adults living in the community with a range of chronic conditions, physical and cognitive function. Standardized betas (sβ) of neuroimaging markers predicting digit symbol substitution test (DSST) and modified mini-mental test(3MS)were computed in multivariable regression models stratified by race. Results: Compared to whites, blacks had lower DSST (p=0.001) and lower 3MS (p=0.006), but also lower mean diffusivity (e.g. higher gray matter micro-structural integrity, p=0.032), independent of sex, income, literacy, body mass index, diabetes and drinking habits. Racial differences were not significant for WMH (p=0.062) or GMA(p=0.4).Among blacks, mean diffusivity and WMH were associated with DSST (sβ=-.209, p=0.037and -.211, p=.038)independent of each other and of covariates; among whites, mean diffusivity, but not WMH, was significantly associated with DSST and 3MS(sβ =-.277, p=.002and -.250, p=0.029). Conclusions: In this cohort of octogenarians living in the community, blacks appeared to have higher microstructural integrity of gray matter as compared to whites. This neuroimaging marker was related to higher cognition even in the presence of WMH and other cardiovascular conditions. If confirmed, these findings suggest microstructural gray matter integrity may be a target to improve cognition, especially among blacks who survive to very old age with a range of chronic cardiovascular conditions.
    Current Alzheimer research. 11/2014;
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    ABSTRACT: Inflammation may represent a common physiological pathway linking both short and long sleep duration to mortality. We evaluated inflammatory markers as mediators of the relationship between sleep duration and mortality in community-dwelling older adults.
    Sleep 10/2014; · 5.10 Impact Factor
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    ABSTRACT: Poor peripheral nerve function is common in older adults and may be a risk factor for strength decline, although this has not been assessed longitudinally.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 10/2014; · 4.31 Impact Factor
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    ABSTRACT: We sought to determine which systolic blood pressure (SBP) characteristics are associated with reduced brain integrity and whether these associations are stronger for white or gray matter. We hypothesized that exposure to higher and variable SBP will be associated with lower structural integrity of both gray and white matter.
    American journal of hypertension. 08/2014;
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    ABSTRACT: Hearing impairment (HI) is highly prevalent in older adults and is associated with social isolation, depression, and risk of dementia. Whether HI is associated with broader downstream outcomes is unclear. We undertook this study to determine whether audiometric HI is associated with mortality in older adults.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 07/2014; · 4.31 Impact Factor
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    ABSTRACT: Results from numerous studies suggest protective effects of the Mediterranean diet for cardiovascular disease, cancer, and mortality. Evidence for an association with a decreased risk of cognitive decline is less consistent and studies are limited by a lack of diversity in their populations.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 07/2014; · 4.31 Impact Factor
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    ABSTRACT: We aimed to examine trajectories of inflammatory markers and cognitive decline over 10 years. Cox proportional hazards models were used to examine the association between interleukin-6 and C-reactive protein (CRP) trajectory components (slope, variability, and baseline level) and cognitive decline among 1323 adults, aged 70-79 years in the Health, Aging, and Body Composition Study. We tested for interactions by sex and apolipoprotein E (APOE) genotype. In models adjusted for multiple covariates and comorbidities, extreme CRP variability was significantly associated with cognitive decline (hazard ratio [HR] 1.6, 95% confidence interval [CI]: 1.1-2.3). This association was modified by sex and APOE e4 (p < 0.001 for both), such that the association remained among women (HR = 1.8; 95% CI: 1.1, 3.0) and among those with no APOE e4 allele (HR = 1.6; 95% CI: 1.1, 2.5). There were no significant associations between slope or baseline level of CRP and cognitive decline nor between interleukin-6 and cognitive decline. We believe CRP variability likely reflects poor control of or greater changes in vascular or metabolic disease over time, which in turn is associated with cognitive decline.
    Neurobiology of aging. 06/2014;
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    ABSTRACT: Whether apolipoprotein E (APOE) E4 allele status which is associated with an increased risk of cognitive decline is also associated with hearing impairment is unknown.
    American journal of Alzheimer's disease and other dementias. 06/2014;
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    ABSTRACT: Background The ability to walk for short and prolonged periods of time is often measured with separate walking tests. It is unclear whether decline in the two-minute walk coincides with decline in a shorter 20-meter walk among older adults.Objective To describe patterns of change in the 20-meter walk and two-minute walk over 8 years among a large cohort of older adults. Should change be similar between tests of walking ability, separate re-testing of prolonged walking may need to be reconsidered.DesignLongitudinal Observational CohortMethods Data were from 1,893 well-functioning older adults (≥ 70 years). The 20-meter walk and two-minute walk were repeatedly measured over 8 years to measure change in short- and prolonged-walking, respectively. Change was examined using a dual group-based trajectory model (dual model) and agreement between walking trajectories was quantified with a Weighted Kappa statistic.ResultsThree trajectory groups for the 20-meter walk and two-minute walk were identified. Over 86% of subjects were in similar trajectory groups for both tests from the dual model. There was high chance corrected agreement (Kappa = 0.84, 95%CI [0.81, 0.86]) between 20-meter walk and two-minute walk trajectory groups.LimitationsOne-third of the original Health ABC cohort was excluded from analysis due to missing clinic visits followed by being excluded for health reasons for performing the two-minute walk, limiting generalizability to healthy older adults.Conclusions Patterns of change in the two-minute walk are similar to the 20-meter walk. Thus, separate re-testing of the two-minute walk may need to be reconsidered to gauge change in prolonged walking.
    Physical Therapy 05/2014; · 2.78 Impact Factor
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    ABSTRACT: Obesity is a risk factor for disability, but risk of specific adipose depots is not completely understood. We investigated associations between mobility limitation, performance, and the following adipose measures: body mass index (BMI) and areas and densities of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) in older adults. This was a prospective population-based study of men (n = 1459) and women (n = 1552) initially aged 70-79 y and free from mobility limitation. BMI was determined from measured height and weight. Adipose tissue area and density in Hounsfield units were measured in the thigh and abdomen by using computed tomography. Mobility limitation was defined as 2 consecutive reports of difficulty walking one-quarter mile or climbing 10 steps during semiannual assessments over 13 y. Poor performance was defined as a gait speed <1 m/s after 9 y of follow-up (n = 1542). In models adjusted for disability risk factors, BMI, and areas of VAT, abdominal SAT, and IMAT were positively associated with mobility limitation in men and women. In women, thigh SAT area was positively associated with mobility limitation risk, whereas VAT density was inversely associated. Associations were similar for poor performance. BMI and thigh IMAT area (independent of BMI) were particularly strong indicators of incident mobility limitation and poor performance. For example, in women, the HR (95% CI) and OR (95% CI) associated with an SD increment in BMI for mobility limitation and poor performance were 1.31 (1.21, 1.42) and 1.41 (1.13, 1.76), respectively. In men, the HR (95% CI) and OR (95% CI) associated with an SD increment in thigh IMAT for mobility limitation and poor performance were 1.37 (1.27, 1.47) and 1.54 (1.18, 2.02), respectively. Even into old age, higher BMI is associated with mobility limitation and poor performance. The amount of adipose tissue in abdominal and thigh depots may also convey risk beyond BMI.
    American Journal of Clinical Nutrition 02/2014; · 6.50 Impact Factor
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    ABSTRACT: Kidney damage is a common sequela of several chronic pathologic conditions. Whether biomarkers of kidney damage are prognostic for more severe outcomes is unknown. We measured three urinary biomarkers (kidney injury molecule-1 [KIM-1], IL-18, and albumin) in 3010 individuals enrolled in the Health, Aging and Body Composition (Health ABC) study and used Cox proportional hazards models to investigate the associations of urinary KIM-1/creatinine (cr), IL-18/cr, and albumin/cr (ACR) with all-cause mortality and cardiovascular disease (CVD). Multivariable models adjusted for demographics, traditional CVD risk factors, and eGFR. Mean age of participants was 74 years, 49% of participants were men, and 41% of participants were black. During the median 12.4 years of follow-up, 1450 deaths and 797 CVD outcomes occurred. Compared with the lowest quartile, successive quartiles had the following adjusted hazard ratios (HRs; 95% confidence intervals [95% CIs]) for mortality: KIM-1/cr: (1.21; 1.03 to 1.41), (1.13; 0.96 to 1.34), and (1.28; 1.08 to 1.52); IL-18/cr: (1.02; 0.88 to 1.19), (1.16; 0.99 to 1.35), and (1.06; 0.90 to 1.25); ACR: (1.08; 0.91 to 1.27), (1.24; 1.06 to 1.46), and (1.63; 1.39 to 1.91). In similar analyses, only ACR quartiles associated with CVD: (1.19; 0.95 to 1.48), (1.35; 1.08 to 1.67), and (1.54; 1.24 to 1.91). Urinary KIM-1 had a modest association with all-cause mortality but did not associate with CVD, and urinary IL-18 did not associate with either outcome. In contrast, albuminuria strongly associated with all-cause mortality and CVD. Future studies should evaluate reasons for these differences in the prognostic importance of individual kidney injury markers.
    Journal of the American Society of Nephrology 02/2014; · 8.99 Impact Factor
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    ABSTRACT: the xanthophylls lutein (L) and zeaxanthin (Z) exist in relatively high concentration in multiple central nervous tissues (e.g. cortex and neural retina). L + Z in macula (i.e. macular pigment, MP) are thought to serve multiple functions, including protection and improvement of visual performance. Also, L + Z in the macula are related to L + Z in the cortex. to determine whether macular pigment optical density (MPOD, L + Z in the macula) is related to cognitive function in older adults. participants were older adults (n = 108, 77.6 ± 2.7 years) sampled from the age-related maculopathy ancillary study of the Health Aging and Body Composition Study (Memphis, TN, USA). Serum carotenoids were measured using high performance liquid chromatography. MPOD was assessed using heterochromatic flicker chromatography. Eight cognitive tests designed to evaluate several cognitive domains including memory and processing speed were administered. Partial correlation coefficients were computed to determine whether cognitive measures were related to serum L + Z and MPOD. MPOD levels were significantly associated with better global cognition, verbal learning and fluency, recall, processing speed and perceptual speed, whereas serum L + Z was significantly related to only verbal fluency. MPOD is related to cognitive function in older people. Its role as a potential biomarker of cognitive function deserves further study.
    Age and Ageing 01/2014; · 3.82 Impact Factor
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    ABSTRACT: Background Unless effective preventive strategies are implemented, aging of the population will result in a significant worsening of the heart failure (HF) epidemic. Few data exist on whether baseline ECG abnormalities can refine risk prediction for HF. Methods We examined a prospective cohort of 2915 participants aged 70-79 years without preexisting HF, enrolled between April 1997-June 1998 in the Health Aging and Body Composition (Health ABC) study. Minnesota Code was used to define major and minor ECG abnormalities at baseline and at year 4 follow-up. Using Cox models, we assessed (1) the association between ECG abnormalities and incident HF and (2) the incremental value of adding ECG to the Health ABC HF Risk Score using the net reclassification index (NRI). Results At baseline, 380 participants (13.0%) had minor and 620 (21.3%) had major ECG abnormalities. During a median follow-up of 11.4 years, 485 (16.6%) participants developed incident HF. After adjusting for the Health ABC HF Risk Score variables, the hazard ratio (HR) was 1.27 (95% confidence interval [CI] 0.96-1.68) for minor and 1.99 (95% CI 1.61-2.44) for major ECG abnormalities. At year 4, 263 participants developed new and 549 had persistent abnormalities; both were associated with increased subsequent HF risk (HR = 1.94, 95% CI 1.38-2.72 for new and HR = 2.35, 95% CI 1.82-3.02 for persistent ECG abnormalities). Baseline ECG correctly reclassified 10.5% of patients with HF events, 0.8% of those without HF events and 1.4% of the overall population. The NRI across the Health ABC HF risk categories was 0.11 (95% CI 0.03-0.19). Conclusions Among older adults, baseline and new ECG abnormalities are independently associated with increased risk for HF. The contribution of ECG screening for targeted prevention of HF should be evaluated in clinical trials.
    American Heart Journal. 01/2014;
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    ABSTRACT: Step length variability (SLV) increases with age in those without overt neurologic disease, is higher in neurologic patients, is associated with falls, and predicts dementia. Whether higher SLV in older adults without neurologic disease indicates presence of neurologic abnormalities is unknown. Our objective was to identify whether SLV in older adults without overt disease is associated with findings from multimodal neuroimaging. A well-characterized cohort of 265 adults (79-90 years) was concurrently assessed by gait mat, magnetic resonance imaging with diffusion tensor, and neurological exam. Linear regression models adjusted for gait speed, demographic, health, and functional covariates assessed associations of MRI measures (grey matter volume, white matter hyperintensity volume, mean diffusivity, fractional anisotropy) with SLV. Regional distribution of associations was assessed by sparse partial least squares analyses. Higher SLV (mean: 8.4, SD: 3.3) was significantly associated with older age, slower gait speed, and poorer executive function and also with lower grey matter integrity measured by mean diffusivity (standardized beta = 0.16; p = 0.02). Associations between SLV and grey matter integrity were strongest for the hippocampus and anterior cingulate gyrus (both β = 0.18) as compared to other regions. Associations of SLV with other neuroimaging markers were not significant. Lower integrity of normal-appearing grey matter may underlie higher SLV in older adults. Our results highlighted the hippocampus and anterior cingulate gyrus, regions involved in memory and executive function. These findings support previous research indicating a role for cognitive function in motor control. Higher SLV may indicate focal neuropathology in those without diagnosed neurologic disease.
    Gait & posture 01/2014; · 2.58 Impact Factor
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    ABSTRACT: Brain-derived neurotrophic factor (BDNF) plays a role in the maintenance and function of neurons. Although persons with Alzheimer's disease have lower cortical levels of BDNF, evidence regarding the association between circulating BDNF and cognitive function is conflicting. We sought to determine the correlates of BDNF level and whether BDNF level was prospectively associated with cognitive decline in healthy older adults. We measured serum BDNF near baseline in 912 individuals. Cognitive status was assessed repeatedly with the modified Mini-Mental Status Examination and the Digit Symbol Substitution test over the next 10 years. We evaluated the association between BDNF and cognitive decline with longitudinal models. We also assessed the association between BDNF level and demographics, comorbidities and health behaviors. We found an association between serum BDNF and several characteristics that are also associated with dementia (race and depression), suggesting that future studies should control for these potential confounders. We did not find evidence of a longitudinal association between serum BDNF and subsequent cognitive test trajectories in older adults, although we did identify a potential trend toward a cross-sectional association. Our results suggest that serum BDNF may have limited utility as a biomarker of prospective cognitive decline.
    PLoS ONE 01/2014; 9(3):e91339. · 3.53 Impact Factor
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    ABSTRACT: To examine whether observed differences in dementia rates between black and white older people living in the community could be explained by measures of socioeconomic status (income, financial adequacy, education, and literacy) and health related factors. Prospective cohort study. General community from two clinic sites in the United States (Pittsburgh, Pennsylvania and Memphis, Tennessee). 2457 older people (mean age 73.6 years; 1019 (41.5%) black; 1233 (50.2%) women), dementia-free at baseline, in the Health, Aging, and Body Composition study. Dementia was determined over 12 years (ending January 2011) by prescribed dementia drugs, hospital records, and decline in global cognitive scores. The influence of socioeconomic status and health related factors on dementia rates was examined in a series of Cox proportional hazard models in which these variables were added sequentially in covariate blocks. Over follow-up, 449 (18.3%) participants developed dementia. Black participants were more likely than white participants to develop dementia (211 (20.7%) v 238 (16.6%), P<0.001; unadjusted hazard ratio 1.44, 95% confidence interval 1.20 to 1.74). The hazard ratio lessened somewhat after adjustment for demographics, apolipoprotein E e4, comorbidities, and lifestyle factors (1.37, 1.12 to 1.67) but was greatly reduced and no longer statistically significant when socioeconomic status was added (1.09, 0.87 to 1.37). These findings suggest that differences in the burden of risk factors, especially socioeconomic status, may contribute to the higher rates of dementia seen among black compared with white older people. Strategies aimed at reducing these disparities may favorably affect the incidence of dementia.
    BMJ (online) 12/2013; 347:f7051. · 17.22 Impact Factor

Publication Stats

5k Citations
992.05 Total Impact Points

Institutions

  • 2007–2014
    • The University of Tennessee Health Science Center
      • • Department of Preventive Medicine
      • • Department of Medicine
      Memphis, Tennessee, United States
    • University of Utah
      • Division of Pulmonary Medicine
      Salt Lake City, UT, United States
  • 1999–2014
    • University of Tennessee
      • Department of Preventive Medicine
      Knoxville, Tennessee, United States
  • 2013
    • King's College London
      • Institute of Psychiatry
      London, ENG, United Kingdom
    • Oregon State University
      • School of Biological and Population Health Sciences
      Corvallis, OR, United States
    • University of Connecticut
      • UConn Center on Aging
      Storrs, Connecticut, United States
  • 2012–2013
    • San Francisco VA Medical Center
      San Francisco, California, United States
    • University of Missouri - St. Louis
      Saint Louis, Michigan, United States
    • Inselspital, Universitätsspital Bern
      • Department of General Internal Medicine
      Bern, BE, Switzerland
  • 2010–2013
    • National Institute on Aging
      • Laboratory of Epidemiology, Demography and Biometry (LEDB)
      Baltimore, Maryland, United States
    • University of Lausanne
      • Faculté de biologie et de médecine (FBM)
      Lausanne, VD, Switzerland
  • 2009–2013
    • The University of Tennessee Medical Center at Knoxville
      Knoxville, Tennessee, United States
    • University of South Carolina
      Columbia, South Carolina, United States
  • 2003–2013
    • University of California, San Francisco
      • • Division of Hospital Medicine
      • • Department of Psychiatry
      • • Department of Epidemiology and Biostatistics
      • • Division of Geriatrics
      San Francisco, CA, United States
  • 2005–2012
    • University of Pittsburgh
      • • Department of Epidemiology
      • • UPMC - Comprehensive Lung Center
      • • Physical Therapy
      Pittsburgh, PA, United States
    • Maastricht University
      Maestricht, Limburg, Netherlands
  • 2011
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Health Policy and Management
      Baltimore, MD, United States
    • Cleveland Clinic
      • Department of Pathobiology
      Cleveland, OH, United States
    • State University of New York Downstate Medical Center
      • Department of Epidemiology and Biostatistics (EPID, BIOS)
      Brooklyn, NY, United States
  • 2009–2011
    • California Pacific Medical Center Research Institute
      • Research Institute
      San Francisco, CA, United States
  • 2007–2011
    • The University of Memphis
      Memphis, Tennessee, United States
  • 2009–2010
    • Duke University
      Durham, North Carolina, United States
  • 2008–2009
    • Emory University
      • • Division of Endocrinology
      • • Division of Cardiology
      Atlanta, GA, United States
    • Boston University
      • Department of Epidemiology
      Boston, MA, United States
    • University of Louisville
      • Department of Psychological and Brain Sciences
      Louisville, KY, United States
  • 2007–2009
    • VU University Medical Center
      • Department of Psychiatry
      Amsterdam, North Holland, Netherlands
  • 2005–2009
    • Wake Forest School of Medicine
      • • Sticht Center on Aging
      • • Department of Internal Medicine
      Winston-Salem, NC, United States
    • University of Florida
      • Department of Aging and Geriatric Research
      Gainesville, FL, United States
  • 2006–2008
    • Vanderbilt University
      • • Department of Neurology
      • • Division of Cardiovascular Medicine
      Nashville, MI, United States
    • University of San Francisco
      San Francisco, California, United States
    • Johns Hopkins Medicine
      • Department of Medicine
      Baltimore, MD, United States
  • 1991–1999
    • Brigham and Women's Hospital
      • • Division of Preventive Medicine
      • • Center for Brain Mind Medicine
      • • Department of Medicine
      Boston, MA, United States
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 1993
    • University of Washington Seattle
      Seattle, Washington, United States