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Correlates of memory and executive function in mid-aged and older adults in the CLSA: A minority stress approach
Abstract
Objectives
Maintaining cognitive function is an important component of healthy aging. There is increasing recognition that extraneous factors expedite the typical cognitive aging process. Risk factors for cognitive decline cluster around inequalities and disproportionally affect minority and vulnerable groups. Taking a minority stress approach, we examined the relationship between proxy measures of minority stress and cognitive health in a large sample of Canadians aged 45-85 years.
Methods
Data were drawn from the baseline of the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort study. Memory (n = 36,849) and executive function (n = 36,266) were assessed using standardized assessment tools. We ran multiple linear regression models with memory and executive function as the outcomes. Explanatory variables included known correlates of cognitive health (i.e., demographic, health, and cognitive reserve) and proxy measures of minority stress (i.e., sexual orientation, race, and perceived social standing).
Results
Results were consistent with existing evidence showing that demographic and health variables were associated with cognitive performance. Modifiable health variables, walking and fruit/ vegetable consumption were associated with better cognitive performance, as were cognitive reserve and social support measures. Within the models, racial minority status was consistently associated with lower cognitive performance. As one’s perceived social standing within their own community increased, so too did cognitive function.
Discussion
These findings identify factors that may put people at risk for cognitive decline. There is a need to support the cognitive health of racialized Canadians and members of other disadvantaged groups, while promoting health equity.
... Although ample research has focused on correlates of overall cognitive decline (Plassman et al., 2010;Baumgart et al., 2015), less research has focused on specific risk and protective factors for executive function. Recently, a population-based cross-sectional study by Stinchcombe and Hammond (2021) identified correlates of executive function, similar to those identified by Livingston et al. (2020). For example, smoking, hypertension, sensory issues, and less social support were associated with lower levels of executive function (Stinchcombe and Hammond, 2021). ...
... Recently, a population-based cross-sectional study by Stinchcombe and Hammond (2021) identified correlates of executive function, similar to those identified by Livingston et al. (2020). For example, smoking, hypertension, sensory issues, and less social support were associated with lower levels of executive function (Stinchcombe and Hammond, 2021). Associations between cognitive, physical, and social engagement and executive function have been found in both cross-sectional, and longitudinal analyses. ...
... This framework aligns with that of Stites et al. (2022), which acknowledges the roles of social positioning (i.e., income and social status) and social identity (i.e., gender, race, and sexual orientation) in cognition. For example, research has found cross-sectional differences in executive functioning among members of racialized communities (Chen et al., 2021;Stinchcombe and Hammond, 2021), that may be explained by the social inequities faced by non-White persons (Rea-Sandin et al., 2021). Furthermore, although Black individuals have been found to have lower baseline executive functioning, longitudinal research has found that decline in executive functioning is slower among Black individuals compared to White individuals (Weuve et al., 2018). ...
Maintaining executive functions, including planning, inhibition, and decision-making skills, is important for autonomy and activities of daily living. There is a growing body of evidence linking social determinants and cognitive aging, but less is known about the potential role of social determinants in changes in executive functioning over time. Using data from the Canadian Longitudinal Study on Aging (CLSA), a large cohort of mid-aged and older adults, we examined changes in executive function over a 3-year period. Specifically, we focused on the role of social determinants (i.e., social positioning, social support, education) in explaining these changes. Executive function was measured at baseline and follow-up 3 years later using the Mental Alteration Test (MAT). We computed a reliable change index (RCI) and used a multiple linear regression model to examine the associations between known correlates and change in executive function over the 3-year period (n = 29,344). Older age, higher household income, and greater educational attainment predicted declines in executive function. Health factors (e.g., depression symptoms, physical activity levels) and many social determinants (sexual orientation, gender identity, race, and perceived social standing) were not associated with change in executive function. These results suggest that social determinants of health may be related to initial differences in cognitive functioning (i.e., cross-sectional differences) rather than more rapid cognitive aging.
... Performance disparities in the Black subsample on the measures of neurocognition likely reflect both well-documented disparities in quality of education (e.g., Manly, Jacobs, Touradji, Small, & Stern, 2002) and the chronic impact of systemic racism and perceived discrimination on neurocognitive functioning (Forrester et al., 2019;Stinchcombe & Hammond, 2022). For example, Barnes and colleagues (2012) found that higher levels of perceived discrimination among a sample of older Black participants was associated with poorer performance on measures of episodic memory and perceptual speed even after statistically controlling for demographic variables and vascular risk factors. ...
... Recent studies have examined the relationship between subjective social status and cognitive performance. Results show that a low subjective social status is associated with a poorer baseline memory performance (Zahodne, Kraal, Zaheed, & Sol, 2018) and a higher subjective social status linearly predicts better executive functioning (Stinchcombe & Hammond, 2022). Assessing perceived discrimination in future research can provide additional insight to variations in cognitive aging based on subjective social status (Brewster et al., 2019). ...
... In addition, we extend previous work by examining other negative emotion correlates of neurocognition, including trait anxiety and negative affect. We examined race as a moderator in the context of the RCM, which is consistent with previous work (e.g., Stinchcombe & Hammond, 2022;Zahodne et al., 2014). However, the current study is limited in its operationalization of race as a moderator rather than racial stress and/or perceived discrimination. ...
Objective
To test whether race moderates the relationship between negative emotions and neurocognition by applying the reserve capacity model within a large sample that spans adulthood.
Method
The study sample (N = 1,020) consisted of community-dwelling adults between 18 and 84 years of age who were drawn from the Virginia Cognitive Aging Project. Demographic variables were used to match a sample of Black participants to a sample of White participants. Race was examined as a moderator of the relationship between negative emotions (i.e., depressive symptoms, trait anxiety, and the negative affect subscale from the Positive and Negative Affect Schedule) and neurocognitive variables (episodic memory, reasoning, spatial visualization, and processing speed) with multiple-group structural equation modeling.
Results
After accounting for sociodemographic variables, depressive symptoms were negatively associated with processing speed in both groups, and with worse reasoning in the White subsample. Negative affect was associated with lower reasoning performance in both groups and with lower spatial visualization in the White subsample. Trait anxiety was not significantly associated with the neurocognitive constructs in either group. Multigroup structural equation models showed that the magnitudes of the associations were not different between the Black and White subsamples. Thus, race did not moderate the relationships between depressive symptoms, trait anxiety, and negative affect with neurocognition.
Conclusions
Negative emotions are associated with lower performance on different neurocognitive tasks, but race does not moderate these relationships. Future research should examine perceived discrimination or other psychosocial variables when examining the relationships among negative emotions and neurocognition.
... Further, minority stress has been acknowledged as a risk factor for cognitive decline for lesbian, gay, bisexual, and transgender individuals such that lesbian, gay, bisexual, and transgender individuals may experience accelerated cognitive decline [32]. Consistent with the framework for minority cognitive aging, Stinchcombe and Hammond [33] found that racial minority status, as well as lower perceived social standing, was associated with lower cognitive performance. In a separate study and using a sample of adults aged 65 and older, it was found that higher subjective social status is positively associated with episodic memory [34]. ...
... In our sample, as individuals' perceptions of their social standing increased, their risk of SCD decreased. This aligns with previous research that has found associations between lower social standing and poorer cognition [33,34]. This association may be explained by the impact of social stress on brain health, outlined in Forrester et al.'s [31] framework for minority stress, as well as an increase in stress-related biological factors which can impact cognition, and may have direct and indirect effects on cognitive health [62]. ...
Introduction:
Subjective cognitive decline (SCD), a self-reported decline in cognition in otherwise cognitively healthy people, has been acknowledged as a risk factor for Alzheimer's disease. Using data from the Canadian Longitudinal Study on Aging (CLSA), a large national study with participants' ages of 45-85 years at baseline, we sought to identify correlates of SCD and SCD-related worry.
Methods:
In our primary analysis using a Poisson regression model, associations between biopsychosocial variables and SCD were identified (analytic sample: n = 21,920). In a second analysis using an ordinal regression model, associations between biopsychosocial variables and SCD-related worry were identified (analytic sample: n = 12,694).
Results:
Multiple risk and protective factors of cognitive decline were not associated with SCD within our sample (i.e., physical activity, hypertension, vision problems), as well as minority stress variables such as sexual orientation and race. Rather, psychosocial variables (i.e., depression, perceived social status, and personality traits) showed a more consistent association with SCD within the sample. Greater SCD-related worry, which is believed to increase the risk of future dementia, was associated with specific personality traits, depression, age, gender, and sexuality.
Conclusion:
The results from this study confirm the association between multiple health variables and SCD but also emphasize the importance of considering psychological and social factors when conceptualizing SCD and its risk factors.
... In addition to physical activity, cognitive aging outcomes have been linked to other health behaviors (e.g., fruit and vegetable intake) and sensory health (e.g., hearing) (Stinchcombe & Hammond, 2021), mental health (e.g., depression), as well as social determinants such as social support (Oremus et al., 2020). The strength and direction of associations for our relationships between social determinants and memory correspond with earlier CLSA cross-sectional work, showing disparities in memory by income, education, and race (Stinchcombe & Hammond, 2021). ...
... In addition to physical activity, cognitive aging outcomes have been linked to other health behaviors (e.g., fruit and vegetable intake) and sensory health (e.g., hearing) (Stinchcombe & Hammond, 2021), mental health (e.g., depression), as well as social determinants such as social support (Oremus et al., 2020). The strength and direction of associations for our relationships between social determinants and memory correspond with earlier CLSA cross-sectional work, showing disparities in memory by income, education, and race (Stinchcombe & Hammond, 2021). In their review of how to address social inequities in physical activity, Ball and colleagues (2015) Note. ...
Objectives
To examine associations between physical activity (PA) and prospectively assessed memory in a cohort of cognitively healthy adults, after accounting for understudied social determinants.
Methods
We used data from the Canadian Longitudinal Study on Aging (CLSA). PA (exposure) and memory (outcome) were assessed using validated measures in 2013–2015 and 2015–2018, respectively. Respondents reported their daily number of hours spent engaging in five different PAs. We conducted multiple imputation and used linear regression ( n = 41,394), adjusting for five categories of covariates: demographics, sensory health characteristics, health behaviors, health status, and social determinants (sex/gender, education, income, social support, perceived social standing, race, and sexual orientation).
Results
In crude models, nearly every intensity and duration of PA was associated with better memory. In fully adjusted models, protective associations were attenuated; however, some associations held: all durations of walking, most durations of light activities, moderate activities for ≥1 hour, and strenuous activities for 1 to <2 hours.
Discussion
Some forms of PA may be associated with better memory. The benefits of higher intensity PA may only be realized after social determinants are addressed.
... Further, minority stress has been acknowledged as a risk factor for cognitive decline for lesbian, gay, bisexual, and transgender individuals such that lesbian, gay, bisexual, and transgender individuals may experience accelerated cognitive decline [32]. Consistent with the framework for minority cognitive aging, Stinchcombe and Hammond [33] found that racial minority status, as well as lower perceived social standing, was associated with lower cognitive performance. In a separate study and using a sample of adults aged 65 and older, it was found that higher subjective social status is positively associated with episodic memory [34]. ...
... In our sample, as individuals' perceptions of their social standing increased, their risk of SCD decreased. This aligns with previous research that has found associations between lower social standing and poorer cognition [33,34]. This association may be explained by the impact of social stress on brain health, outlined in Forrester et al.'s [31] framework for minority stress, as well as an increase in stress-related biological factors which can impact cognition, and may have direct and indirect effects on cognitive health [62]. ...
Subjective cognitive decline (SCD), a self‐perceived decline in memory among otherwise cognitively healthy older adults, has been linked to increased risk of Alzheimer’s disease (AD). It is believed that SCD may be a first symptomatic expression of preclinical AD. Identification of SCD precursors may allow for early identification and implementation of intervention to prevent cognitive decline. Using data from the Canadian Longitudinal Study on Aging (CLSA), a national study of over 50,000 participants ages 45‐85 at baseline, we sought to identify potential risk and protective factors for SCD. Participants with diagnosed AD at baseline were excluded. Exposures were measured at baseline and SCD was measured three years later, at first follow‐up, with the question: “Do you feel like your memory is becoming worse?”. A multivariable logistic regression model was used to estimate odds of SCD (analytic sample: n=36,885). Results indicated that 56.1% participants reported SCD. Participants with a post‐secondary education had increased odds of SCD compared to those with less than a secondary school graduation (OR=1.20, 95% CI: 1.09, 1.33). Hearing problems (OR=1.46, 95% CI: 1.36, 1.56) and vision problems (OR=1.14, 95% CI: 1.05, 1.24) were associated with increased odds of SCD. Alcohol consumption also increased the odds of SCD, with infrequent drinkers (OR=1.08, 95% CI: 1.00, 1.16), regular drinkers (OR=1.13, 95% CI: 1.05, 1.22) and frequent drinkers (OR=1.16, 95% CI: 1.07, 1.25) more likely to self‐report SCD than never drinkers. Participants who consumed five or more servings of fruits/ vegetables had reduced odds of SCD (OR=0.95, 95% CI: 0.91, 0.99), when compared to those who consumed <5 servings. Compared to participants who never smoked, former smokers had increased odds of SCD (OR=1.13, 95% CI: 1.08, 1.12), whereas current smokers had reduced odds of SCD (OR=0.91, 95% CI: 0.84, 0.98). Lastly, individuals with diagnosed mood and anxiety disorders had higher odds of SCD compared to those without (OR=1.42, 95% CI: 1.34, 1.50). This study sheds light on prospective correlates of SCD in a large population‐based sample of older Canadians. Many of the factors associated with SCD may be modifiable therefore amenable to early intervention.
... It must be noted that other recent studies support this interpretation. In a population-wide study of aging in Canada (baseline ages ranged from 45 to 85 years), non-heterosexual participants outperformed heterosexual participants on a test of episodic memory (Stinchcombe and Hammond, 2021). Baseline cognitive functioning and trajectories of cognitive decline were not different in another study that compared SSR and MSR participants using the NACC (Correro et al., 2021). ...
Background
Sexual minority (SM) older adults experience mental health disparities. Psychiatric disorders and neuropsychiatric symptoms (NPS) are risk factors for cognitive decline. Although older people in same-sex (SSR) compared to mixed-sex relationships (MSR) perform more poorly on cognitive screening tests, prior studies found no differences in rates of dementia diagnosis or neuropsychological profiles. We sought to explore the role of NPS on neurocognitive outcomes for SM populations. We compared cognitive performance and structural brain parameters of older adults in SSR and MSR.Methods
Data were originally collected at Alzheimer's Disease Research Centers (ADRCs). Inclusion criteria were: age of 55+ years, a study partner identified as a spouse/partner, and availability of T1-MRI brain volumes/thickness. Participants were labeled as either SSR or MSR based on their/their co-participant's reported sex. We identified 1,073 participants (1,037 MSR−555 cognitively unimpaired [CU]; 36 SSR−23 CU) with structural MRI data, Mini-Mental State Exam (MMSE), and Neuropsychiatric Inventory Questionnaire (NPI-Q) scores. A subset of the overall sample completed comprehensive neuropsychological assessment (n = 939; 908 MSR−494 CU; 31 SSR−22 CU). Covariates included in statistical models were age, sex, education, total intracranial volume, and apolipoprotein E genotype.ResultsMultivariate general linear models showed significant diagnosis-by-relationship interaction effects on the left parahippocampal gyrus volume. After stratification by relationship group, only cognitively impaired (CI) MSR had significantly smaller left parahippocampal volumes than MSR-CU. The SSR group showed better episodic memory performance. Severity of neuropsychiatric symptoms was negatively associated with volume/thickness of bilateral fronto-temporal areas and with MMSE scores, predominantly in the MSR group.Conclusion
In our study, MSR participants presented with a more compromised cognitive profile than SSR participants. MSR-CI participants showed significantly smaller left medio-temporal volumes, a neural signature of AD. Neuropsychiatric symptoms predicted smaller fronto-temporal volumes in the MSR more consistently than in the SSR group. These findings may be due to unexplored protective factors against cognitive decline in SM elders. Indeed, social support has been proposed as a protective factor warranting future investigation.
Background:
Lesbian and gay older adults have health disparities that are risk factors for Alzheimer's disease, yet little is known about the neurocognitive aging of sexual minority groups.
Objective:
To explore cross-sectional and longitudinal dementia outcomes for adults in same-sex relationships (SSR) and those in mixed-sex relationships (MSR).
Methods:
This prospective observational study utilized data from the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS) collected from contributing Alzheimer's Disease Research Centers. Participants were adults aged 55+ years at baseline with at least two visits in NACC UDS (from September 2005 to March 2021) who had a spouse, partner, or companion as a co-participant. Outcome measures included CDR ® Dementia Staging Instrument, NACC UDS neuropsychological testing, and the Functional Activities Questionnaire. Multivariable linear mixed-effects models accounted for center clustering and repeated measures by individual.
Results:
Both MSR and SSR groups experienced cognitive decline regardless of baseline diagnosis. In general, MSR and SSR groups did not differ statistically on cross-sectional or longitudinal estimates of functioning, dementia severity, or neuropsychological testing, with two primary exceptions. People in SSR with mild cognitive impairment showed less functional impairment at baseline (FAQ M = 2.61, SD = 3.18 vs. M = 3.97, SD = 4.53, respectively; p < 0.01). The SSR group with dementia had less steep decline in attention/working memory (β estimates = -0.10 versus -0.18; p < 0.01).
Conclusion:
Participants in SSR did not show cognitive health disparities consistent with a minority stress model. Additional research into protective factors is warranted.
The current study examined moderators of the relationship between depressive symptoms and global neurocognition in a large non-clinical community-dwelling sample spanning adulthood. Participants comprised 5,430 individuals between the ages of 18-99 years drawn from the Virginia Cognitive Aging Project. Depressive symptoms were measured via the Center for Epidemiologic Studies-Depression scale and neurocognition was operationalized as a composite variable comprising episodic memory, spatial visualization, processing speed, and reasoning tasks. Moderator variables included physical activity, cognitive activity, education, emotional stability, and openness. Hierarchical regressions were used to examine the influence of depressive symptoms and the moderators on neurocognition. Depressive symptoms significantly predicted neurocognition. Cognitive activity, years of education, and emotional stability moderated the depression-neurocognition relationship by buffering the impact of depressive symptoms on neurocognition. Cognitive activity engagement and level of education may function as a protective influence on those with higher levels of depressive symptoms, while emotional stability may be protective for individuals with lower levels of depressive symptoms. No differences in moderation were found across three age groups representing younger, middle, and older adults. Post-hoc analyses showed years of education and openness as moderators in a subsample excluding individuals with potentially clinically meaningful levels of depressive symptoms.
Satisfaction with Life (SWL) is an important component of healthy aging. We sought to examine the determinants of SWL in a large sample (n = 24,221) of mid- aged and older Canadians, with a specific emphasis on the roles of personality and minority stress variables. After accounting for demographic variables, we cross-sec- tionally examined the contribution of health-related variables, personality traits, and minority stress variables on a continuous measure of SWL. Health-related variables (i.e., self-rated general health, depressive symptoms, activities of daily living, social support availability, caregiving status) accounted for the most variance (24.6%) in SWL. Though accounting for only a small amount of additional variance, personal- ity traits (1.4%) and minority stress variables (0.6%) were statistically associated with SWL. Openness to experience was negatively associated with SWL, whereas neuroticism, agreeableness, emotional stability, and conscientiousness were posi- tively associated. In the full model, minority stress indicators were significantly associated with SWL. For example, self-perceived social standing was positively associated with SWL in the sample. Further, non-White participants reported signif- icantly lower SWL than White participants. Additionally, individuals who reported a higher social standing within their community had higher SWL. Participants who identified as gay, lesbian, or bisexual reported higher SWL when compared to het- erosexual participants. These findings highlight the importance of considering the social determinants of SWL to promote health equity for an aging population.
Objectives
We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States.
Method
We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status (TICS). Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment.
Results
The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (OR = 1.53, p < .001).
Discussion
The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.
Individuals do not possess an entirely accurate assessment of the level of income differences in their society and so changes in quantitative measures of income inequality may not always align with changes in the perceptions of income inequality. This disconnect is partly driven by how people form their opinions about the level of inequality. In this study we explore whether there is an association between perceptions of inequality and health, and if so, how it differs depending on the specific channel through which people formed their opinions about changes in income inequality. Drawing on data from 31 European and Eurasian countries, we find that both men and women are more likely to report bad health when their perceptions of increasing inequality are formed through experiences of inequality in their communities than through media and other channels.
Background: The number of individuals living with dementia is increasing, negatively affecting families, communities, and healthcare systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 and highlight the most important messages for clinicians and neurologists. Methods: GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modeled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analyzed by standardized methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-sweetened beverages). Findings: In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8-51·0), increased from 20.2 million (17·4-23·5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0-2·4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3-31·4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1-2·8) deaths. Overall, 28·8 million (95% UI 24·5-34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4-10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages. Interpretation: The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population aging and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to healthcare systems worldwide. Funding: Bill & Melinda Gates Foundation.
In 2016, the UC Davis Latino Aging Research Resource Center and UC Davis Alzheimer's Disease Center brought together experts from across the country to consolidate current knowledge and identify future directions in aging and diversity research. This report disseminates the research priorities that emerged from this conference, building on an earlier Gerontological Society of America preconference. We review key racial/ethnic differences in cognitive aging and dementia and identify current knowledge gaps in the field. We advocate for a systems-level framework for future research whereby environmental, sociocultural, behavioral, neuropathological, genetic, and psychometric levels of analysis are examined together to identify pathways and mechanisms that influence disparities. We then discuss steps to increase the recruitment and retention of racial/ethnic minorities in aging studies, as none of the recommendations will be possible without strong collaboration between racial/ethnic minority communities and researchers. This approach is consistent with the National Institute on Aging Health Disparities framework.
Although cohort and country differences in average cognitive levels are well established, identifying the degree and determinants of inequalities in old age cognitive functioning could guide public health and policy making efforts. We use all publicly available and representative old age surveys with comparable information to assess inequalities of cognitive functioning for six distinctive age groups in 29 countries. We document that cognitive inequalities in old age are largely determined by earlier educational inequalities as well as gender differential survival rates. For example, a one percentage point increase in the Gini index of past education is associated with an increase of 0.45 percentage points in the Gini index of delayed recall and 0.23 percentage points in the Gini of immediate recall. Results are robust to a variety of alternative explanations and persist even after controlling for gender-related biases in survival rates. Furthermore, we find evidence that unequal opportunities for education −captured by differences in parental background and gender- also have significant effects on inequality of old age cognition.
Background
Social relationships, which are contingent on access to social networks, promote engagement in social activities and provide access to social support. These social factors have been shown to positively impact health outcomes. In the current systematic review, we offer a comprehensive overview of the impact of social activities, social networks and social support on the cognitive functioning of healthy older adults (50+) and examine the differential effects of aspects of social relationships on various cognitive domains. Methods
We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and collated data from randomised controlled trials (RCTs), genetic and observational studies. Independent variables of interest included subjective measures of social activities, social networks, and social support, and composite measures of social relationships (CMSR). The primary outcome of interest was cognitive function divided into domains of episodic memory, semantic memory, overall memory ability, working memory, verbal fluency, reasoning, attention, processing speed, visuospatial abilities, overall executive functioning and global cognition. ResultsThirty-nine studies were included in the review; three RCTs, 34 observational studies, and two genetic studies. Evidence suggests a relationship between (1) social activity and global cognition and overall executive functioning, working memory, visuospatial abilities and processing speed but not episodic memory, verbal fluency, reasoning or attention; (2) social networks and global cognition but not episodic memory, attention or processing speed; (3) social support and global cognition and episodic memory but not attention or processing speed; and (4) CMSR and episodic memory and verbal fluency but not global cognition. Conclusions
The results support prior conclusions that there is an association between social relationships and cognitive function but the exact nature of this association remains unclear. Implications of the findings are discussed and suggestions for future research provided. Systematic review registrationPROSPERO 2012: CRD42012003248.
To investigate the associations between midlife work-related stress and late-life cognition in individuals without dementia from the general population. The Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study population (n = 2000) was randomly selected from independent Finnish population-based surveys (baseline mean age 50 years). Participants underwent two re-examinations in late life (mean age 71 and 78 years, respectively). 1511 subjects participated in at least one re-examination (mean total follow-up 25 years). Work-related stress was measured using two questions on work demands administered in midlife. Multiple cognitive domains were assessed. Analyses were adjusted for several potential confounders. Higher levels of midlife work-related stress were associated with poorer performance on global cognition [β-coefficient, -0.02; 95% confidence interval (CI), -0.05 to -0.00], and processing speed [β -0.03, CI -0.05 to -0.01]. Results remained significant after adjusting for potential confounders. Work-related stress was not significantly associated with episodic memory, executive functioning, verbal fluency or manual dexterity. This study shows that global cognition and processing speed may be particularly susceptible to the effects of midlife work-related stress.
Background
Knowledge on factors affecting the rate of cognitive decline and how to maintain cognitive functioning in old age becomes increasingly relevant. The purpose of the current study was to systematically review the evidence for the impact of retirement on cognitive functioning and on age related cognitive decline.
Method
We conducted a systematic literature review, following the principles of the PRISMA statement, of longitudinal studies on the association between retirement and cognition.
Results
Only seven studies fulfilled the inclusion criteria. We found weak evidence that retirement accelerates the rate of cognitive decline in crystallised abilities, but only for individuals retiring from jobs high in complexity with people. The evidence of the impact of retirement on the rate of decline in fluid cognitive abilities is conflicting.
Conclusion
The review revealed a major knowledge gap in regards to the impact of retirement on cognitive decline. More knowledge on the association between retirement and age related cognitive decline as well as knowledge on the mechanisms behind these associations is needed.
Electronic supplementary material
The online version of this article (doi:10.1186/s12877-017-0556-7) contains supplementary material, which is available to authorized users.
Background and objectives:
Although the role of place on health is not new, less is known about how place matters for cognition. By investigating both neighborhood and home as the sociospatial realms of older adults, we explore associations between health and place across multiple contexts. We also distinguish objective and subjective measures of place and disentangle their differential associations with cognition.
Research design and methods:
We analyzed place effects on cognition from the National Social Life, Health, and Aging Project (N = 2,260) linked to neighborhood characteristics and crime data. We measured place in four ways: (a) objective indicators of neighborhood such as police-reported crime rates and interviewer-reported on presence of disordered conditions on the streets; (b) perceptions of neighborhood by respondents (perceived danger and social cohesion); (c) objective conditions of home (interviewer's report on presence of clutters, odor, and messiness); (4) perceived social support, strain, and threat by household members. The MoCA-SA was used to assess cognitive functioning.
Results:
Subjective interpretations appeared to have more direct effects on cognition than did objective indicators of neighborhood or home. When examining these living environments together, we found the association between neighborhood and cognition is partially explained by characteristics of home environment, especially perceived social support. We found a buffering effect of social support on cognition for women, not for men.
Discussion and implications:
Late life living environments are important contexts for aging. Aging-in-Place interventions should address subjective interpretations of place to reduce future risks of cognitive decline.
Background:
We examined prospectively whether social capital mitigates the adverse effects of natural disaster on cognitive decline.
Methods:
The baseline for our study was established seven months before the 2011 Great East Japan Earthquake and Tsunami in a survey of older community-dwelling adults who lived 80 kilometers west of the epicenter (59.0% response rate). Approximately two and a half years after the disaster, the follow-up survey gathered information about personal experiences of disaster as well as incidence of cognitive disability (82.1% follow-up rate). Our primary outcome was cognitive disability (measured on an 8-level scale) assessed by in-home assessment.
Findings:
The experience of housing damage was associated with risk of cognitive impairment (coefficient = 0.04, 95% confidence interval: 0.02 to 0.06). Factor analysis of our analytic sample (n = 3,566) established two sub-scales of social capital: a cognitive dimension (perceptions of community social cohesion) and a structural dimension (informal socializing and social participation). Fixed effects regression showed that informal socializing and social participation buffered the risk of cognitive decline resulting from housing damage.
Interpretation:
Informal socializing and social participation may prevent cognitive impairment following natural disaster.
Funding:
National Institutes of Health (R01AG042463-04), the Japan Society for the Promotion of Science, the Japanese Ministry of Health, Labour and Welfare and the Japanese Ministry of Education, Culture, Sports, Science and Technology.
Background
Limited research is available on the relationship between social support, social strain, and cognitive function among community-dwelling U.S. Chinese older adults. This study aims to examine the associations between social support/strain and cognitive outcomes.
Methods
Data were drawn from the Population-Based Study of Chinese Elderly (N = 3,159). Cognitive function was measured by a battery of tests including the East Boston Memory Test, the Digit Span Backwards assessment, and the Symbol Digit Modalities Test. Social support and strain were measured by the scales drawn from the Health and Retirement study. Multiple regression analyses were conducted.
Results
Social support was significantly associated with global cognitive function (β = .11, SE = .02, p < .001), episodic memory (β = .11, SE = .03, p < .001), working memory (β = .18, SE = .08, p < .05), and executive function (β = 1.44, SE = .37, p < .001). Social strain was significantly associated with global cognitive function (β = .23, SE = .05, p < .001), episodic memory (β = .27, SE = .07, p < .001), working memory (β = .34, SE = .17, p < .05), and executive function (β = 2.75, SE = .85, p < .01). In terms of sources of social support/strain, higher support from friends was significantly associated with higher global cognitive function (β = .04, SE = .02, p < .05), higher episodic memory (β = .05, SE = .02, p < .05), and higher executive function (β = .71, SE = .29, p < .05). Higher strain from spouse was significantly associated with higher global cognitive function (β = .10, SE = .03, p < .01), higher episodic memory (β = .11, SE = .04, p < .01), and higher executive function (β = 1.28, SE = .49, p < .01). Higher strain from friends was significantly associated with higher executive function (β = 3.59, SE = 1.17, p < .01).
Conclusions
Social support and strain were associated with cognitive outcomes. Future longitudinal studies should be conducted.
Background:
Potentially modifiable lifestyle factors may influence cognitive health in later life and offer potential to reduce the risk of cognitive decline and dementia. The concept of cognitive reserve has been proposed as a mechanism to explain individual differences in rates of cognitive decline, but its potential role as a mediating pathway has seldom been explored using data from large epidemiological studies. We explored the mediating effect of cognitive reserve on the cross-sectional association between lifestyle factors and cognitive function in later life using data from a population-based cohort of healthy older people.
Methods and findings:
We analysed data from 2,315 cognitively healthy participants aged 65 y and over in the Cognitive Function and Ageing Study Wales (CFAS-Wales) cohort collected in 2011-2013. Linear regression modelling was used to investigate the overall associations between five lifestyle factors-cognitive and social activity, physical activity, diet, alcohol consumption, and smoking-and cognition, adjusting for demographic factors and chronic conditions. Mediation analysis tested for indirect effects of the lifestyle factors on cognition via cognitive reserve. After controlling for age, gender, and the presence of chronic conditions, cognitive and social activity, physical activity, healthy diet, and light-to-moderate alcohol consumption were positively associated with cognitive function, together accounting for 20% (95% CI 17%-23%) of variance in cognitive test scores. Cognitive reserve was an important mediator of this association, with indirect effects via cognitive reserve contributing 21% (95% CI 15%-27%) of the overall effect on cognition. The main limitations of the study derive from the cross-sectional nature of the data and the challenges of accurately measuring the latent construct of cognitive reserve.
Conclusions:
Cross-sectional associations support the view that enhancing cognitive reserve may benefit cognition, and maintenance of cognitive health may be supported by a healthy and active lifestyle, in later life.
Objective:
We describe the implementation of cognitive measures within the Canadian Longitudinal Study on Aging (CLSA), a nationwide, epidemiological study of aging, and relate CLSA Tracking cohort data (n over 20,000) to previous studies using these measures.
Method:
CLSA participants (aged 45-85, n over 50,000) provided demographic, social, physical/clinical, psychological, economic, and health service utilization information relevant to health and aging through telephone interviews (Tracking cohort, n over 20,000) or in-person (i.e. Comprehensive cohort, n over 30,000) in both official languages (i.e. English, French). Cognitive measures included: the Rey Auditory Verbal Learning Test (RAVLT) - Trial 1 and five-minute delayed recall; Animal Fluency (AF), the Mental Alternation Test (MAT) (both cohorts); Controlled Oral Word Association Test, Stroop Test, Prospective Memory Test, and Choice reaction times (Comprehensive Cohort).
Results:
Performance on the RAVLT Trial 1 and AF were very similar to comparable groups studied previously; CLSA sample sizes were far larger. Within the CLSA Tracking cohort, main effects of age and language were observed for all cognitive measures except RAVLT delayed recall. Interaction effects (language × age) were observed for AF.
Conclusion:
This preliminary examination of the CLSA Tracking cognitive measures lends support to their use in large studies of aging. The CLSA has the potential to provide the 'best' comparison data for adult Canadians generated to date and may also be applicable more broadly. Future studies examining relations among the psychological, biological, health, lifestyle, and social measures within the CLSA will make unique contributions to understanding aging.
Background:
Evidence suggests that moderate alcohol consumption may protect against cognitive decline and dementia. However, uncertainty remains over the patterns of drinking that are most beneficial.
Objective:
To examine associations between amount and frequency of alcohol consumption with multiple domains of cognitive function in a well-characterized cohort of older community-dwelling adults in southern California.
Design:
Observational, cross-sectional cohort study.
Setting:
A research visit between 1988-1992 in Rancho Bernardo, California.
Participants:
1624 participants of the Rancho Bernardo Study (mean age ± SD = 73.2 ± 9.3 years). Measurements: Participants completed a neuropsychological test battery, self-administered questionnaires on alcohol consumption and lifestyle, and a clinical health evaluation. We classified participants according to average amount of alcohol intake into never, former, moderate, heavy and excessive drinkers, and according to frequency of alcohol intake, into non-drinkers, rare, infrequent, frequent and daily drinkers. We examined the association between alcohol intake and cognitive function, controlling for age, sex, education, exercise, smoking, waist-hip ratio, hypertension and self-assessed health.
Results:
Amount and frequency of alcohol intake were significantly associated with cognitive function, even after controlling for potentially related health and lifestyle variables. Global and executive function showed positive linear associations with amount and frequency of alcohol intake, whereas visual memory showed an inverted U-shaped association with alcohol intake, with better performance for moderate and infrequent drinkers than for non-drinkers, excessive drinkers or daily drinkers.
Conclusions:
In several cognitive domains, moderate, regular alcohol intake was associated with better cognitive function relative to not drinking or drinking less frequently. This suggests that beneficial cognitive effects of alcohol intake may be achieved with low levels of drinking that are unlikely to be associated with adverse effects in an aging population.
Loss of memory is among the first symptoms reported by patients suffering from Alzheimer's disease (AD) and by their caretakers. Working memory and long-term declarative memory are affected early during the course of the disease. The individual pattern of impaired memory functions correlates with parameters of structural or functional brain integrity. AD pathology interferes with the formation of memories from the molecular level to the framework of neural networks. The investigation of AD memory loss helps to identify the involved neural structures, such as the default mode network, the influence of epigenetic and genetic factors, such as ApoE4 status, and evolutionary aspects of human cognition. Clinically, the analysis of memory assists the definition of AD subtypes, disease grading, and prognostic predictions. Despite new AD criteria that allow the earlier diagnosis of the disease by inclusion of biomarkers derived from cerebrospinal fluid or hippocampal volume analysis, neuropsychological testing remains at the core of AD diagnosis.
Even those who do not experience dementia or mild cognitive impairment may experience subtle cognitive changes associated with aging. Normal cognitive changes can affect an older adult's everyday function and quality of life, and a better understanding of this process may help clinicians distinguish normal from disease states. This article describes the neurocognitive changes observed in normal aging, followed by a description of the structural and functional alterations seen in aging brains. Practical implications of normal cognitive aging are then discussed, followed by a discussion of what is known about factors that may mitigate age-associated cognitive decline.
Purpose:
Based on resilience theory, this paper investigates the influence of key health indicators and risk and protective factors on health outcomes (including general health, disability, and depression) among lesbian, gay male, and bisexual (LGB) older adults.
Design and methods:
A cross-sectional survey was conducted with LGB older adults, aged 50 and older (N = 2,439). Logistic regressions were conducted to examine the contributions of key health indicators (access to health care and health behaviors), risk factors (lifetime victimization, internalized stigma, and sexual identity concealment), and protective factors (social support and social network size) to health outcomes, when controlling for background characteristics.
Results:
The findings revealed that lifetime victimization, financial barriers to health care, obesity, and limited physical activity independently and significantly accounted for poor general health, disability, and depression among LGB older adults. Internalized stigma was also a significant predictor of disability and depression. Social support and social network size served as protective factors, decreasing the odds of poor general health, disability, and depression. Some distinct differences by gender and sexual orientation were also observed.
Implications:
High levels of poor general health, disability, and depression among LGB older adults are of major concern. These findings highlight the important role of key risk and protective factors, which significantly influences health outcomes among LGB older adults. Tailored interventions must be developed to address the distinct health issues facing this historically disadvantaged population.
Several studies have demonstrated age-related declines in general executive function and memory. In this study, we examined cross-sectional and longitudinal age effects in more specific cognitive processes that constitute executive function and memory. We postulated that, whereas some components of executive and memory functions would show age differences and longitudinal declines, other specific abilities would be maintained or even improve with repeated testing. In a sample of individuals ≥55 years old from the Baltimore Longitudinal Study of Aging, we found longitudinal declines in inhibition, manipulation, semantic retrieval, phonological retrieval, switching, and long-term memory over a maximum of 14 years follow-up. In contrast, abstraction, capacity, chunking, discrimination, and short-term memory were maintained or even improved longitudinally, probably due in part to repeated testing. Moreover, whereas several different abilities were correlated across participants' cross-sectional performance, longitudinal changes in performance showed more heterogeneous trajectories. Finally, compared with cross-sectional performance, longitudinal trajectories showed better distinction between participants with and those without later cognitive impairment. These results show that longitudinal cognitive aging of executive and memory functions is not a uniform process but a heterogeneous one and suggest that certain executive and memory functions remain stable despite age-related declines in other component processes. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Background
Subjective social status (SSS) predicts health outcomes independently of traditional, objective indicators of socioeconomic status (SES). However, the potential confounding and mediating effects of negative affect and similar psychosocial risk and resilience factors have not been adequately addressed through formal studies of convergent and discriminant validity of SSS measures.
Purpose
The current study provides such a test of construct validity and subsequently examines whether psychosocial factors mediate the relationship between SSS and self-rated health.
Methods
We examined the convergent and discriminant validity of the MacArthur scales of SSS relative to measures of psychosocial risk and resilience (i.e., neuroticism, depressive symptoms, optimism, and marital quality) as well as SES (i.e., income) in 300 middle-aged and older married US couples. We also tested a factor of psychosocial vulnerability as a mediator of the relationship between SSS and self-rated health.
Results
Findings indicated clear convergent and discriminant validity of the MacArthur scales. Further, controlling age and income, both the US and community measures of SSS predicted psychosocial factors for men, however, only the community measure was independently predictive for women. Psychosocial vulnerability significantly mediated the pathway between SSS and self-rated health for men and women after controlling age and income.
Conclusions
These results provide strong support for the construct validity of the MacArthur scales and provide additional evidence of the role of psychosocial risk and resilience factors as mediators of the effects of SSS on health.
Stress is a strong modulator of memory function. However, memory is not a unitary process and stress seems to exert different effects depending on the memory type under study. Here, we explored the impact of social stress on different aspects of human memory, including tests for explicit memory and working memory (for neutral materials), as well as implicit memory (perceptual priming, contextual priming and classical conditioning for emotional stimuli). A total of 35 young adult male students were randomly assigned to either the stress or the control group, with stress being induced by the Trier Social Stress Test (TSST). Salivary cortisol levels were assessed repeatedly throughout the experiment to validate stress effects. The results support previous evidence indicating complex effects of stress on different types of memory: A pronounced working memory deficit was associated with exposure to stress. No performance differences between groups of stressed and unstressed subjects were observed in verbal explicit memory (but note that learning and recall took place within 1 h and immediately following stress) or in implicit memory for neutral stimuli. Stress enhanced classical conditioning for negative but not positive stimuli. In addition, stress improved spatial explicit memory. These results reinforce the view that acute stress can be highly disruptive for working memory processing. They provide new evidence for the facilitating effects of stress on implicit memory for negative emotional materials. Our findings are discussed with respect to their potential relevance for psychiatric disorders, such as post traumatic stress disorder.
Background and Objectives
This study addresses a gap in the knowledge base regarding whether there are differences in mental, cognitive, and functional health between sexual minority women aged 65 and older and their heterosexual counterparts, as well as whether disparities are moderated by age, socioeconomic status, and race/ethnicity.
Research Design and Methods
This study analyzes 2015 Behavioral Risk Factor Surveillance System data from 21 states. Multivariate logistic regression is used to test the hypotheses.
Results
Compared to heterosexual women, lesbian/gay women aged 65 and older report worse functional health and bisexual women report worse cognitive health and more difficulties with instrumental activities of daily living. Disparities are particularly present for women in their late 60s and those in their 70s. While the likelihood of a depression diagnosis tends to be lower for heterosexual women with higher income, the inverse is true of sexual minority women. Additionally, sexual minority women with less education have lower odds of frequent mental distress and activity limitations than those with some college education. Sexual minority women of color have significantly lower odds of frequent mental distress, activity limitations, and use of special equipment compared to white sexual minority women.
Discussion and Implications
Findings indicate a need for gerontological services that provide support to older sexual minority women, particularly in relation to cognitive and functional health. Future research is needed to understand risk and protective factors contributing to these disparities, including forms of resilience that occur among older sexual minority women of color.
Background and objectives:
Little research has examined cognitive health disparities between sexual minority and heterosexual populations. Further, most extant studies rely on subjective measures of cognitive functioning and non-probability samples. This study uses a performance-based cognitive screening tool and a nationally representative sample of older Americans to examine the disparity in cognitive impairment by sexual orientation and the potential mechanisms producing this disparity.
Research design and methods:
Using data from the 2015-16 National Social Life, Health, and Aging Project (N=3,567), we analyzed respondents' scores on the survey-adapted Montreal Cognitive Assessment (MoCA-SA). We estimated ordinal logit regressions to examine the relationship between sexual orientation and cognitive impairment and used the Karlson-Holm-Breen method to assess how mental and physical conditions, health behaviors, and social connections mediate this relationship.
Results:
The prevalence of cognitive impairment is significantly higher among sexual minority older adults than among heterosexual older adults when sociodemographic factors are adjusted for. Depressive symptoms explain some of this prevalence gap. Although anxiety symptoms, physical comorbidity, health behaviors, and social connections may contribute to cognitive impairment, they do not explain the cognitive disparity by sexual orientation.
Discussion and implications:
The findings indicate that depressive symptoms are an important link between minority sexual orientation and cognitive impairment and highlight the importance of studying other potential mechanisms that we could not explore in this study. Future research should further investigate how minority stress processes may unfold to accelerate cognitive decline among sexual minorities over the life course.
Objectives:
Although educational attainment is related to cognitive function in later life, little is known about the mechanisms involved. This study assessed the independent mediating effects of two behavioral variables, physical and cognitive activity, on the association between educational attainment and cognitive function and change.
Methods:
Data were derived from the three waves of the Midlife in the United States (MIDUS) study. Predictors (educational attainment) were from the 1995 baseline, mediators (physical and cognitive activities) were from the 2004 wave, and outcomes (cognitive function) were from the 2004 and 2013 waves. Conditional process modeling was applied using PROCESS in SPSS.
Results:
There were both direct and indirect effects of educational attainment on level and change of executive function (EF) and episodic memory (EM). Physical activity and cognitive activity were both significant mediators for cognitive level. For mediators of change, however, cognitive activity was significant for EF and physical activity was significant for EM.
Discussion:
Physical and cognitive activity are discussed as possible factors for protecting against cognitive decline in later life. The findings have implications for advancing supportive policies and practices related to maximizing the benefits of education and physical and cognitive activities for cognition in middle age and later life.
This study examined differences in symptoms of mental illness, specifically depression, by sexual orientation and examined the protective role of social support among lesbian, gay, and bisexual (LGB) older Canadians. Data were drawn from the Canadian Longitudinal Study on Aging, a national study of adults aged 45-85 years at baseline (n = 46,157). We examined whether the effect of sexual orientation on depression symptoms was moderated by four types of social support: emotional/informational support, affectionate support, tangible support, and positive social interaction. LGB identification was associated with increased depression symptoms relative to heterosexual participants. After adjustment for covariates, bisexual identity remained a significant predictor of depression symptoms. Low emotional/informational social support was associated with increased depression symptoms, an effect that was most pronounced for lesbian and gay participants. The findings contribute to the growing body of research on the mental health of older LGB people.
Background:
Cognitive function is important for healthy aging. Social support availability (SSA) may modify cognitive function. We descriptively examined the association between SSA and cognitive function in a population-level sample of middle- and older-aged adults.
Methods:
We analyzed the tracking dataset of the Canadian Longitudinal Study on Aging. Participants aged between 45 and 85 years answered questions about SSA and performed three cognitive tests (Rey Auditory Verbal Learning Test, Animal Fluency Test and Mental Alternation Test) via telephone. We divided global SSA and global cognitive function scores into tertiles and generated contingency tables for comparisons across strata defined by sex, age group, region of residence, urban vs. rural residence and education.
Results:
The proportion of participants with low global cognitive function was often greater among persons who reported low global SSA. The proportion of persons with high cognitive function was greater in participants with high SSA. The findings were most pronounced for females, 45- to 54-year olds, all regions (especially Québec) except Atlantic Canada, urban dwellers and persons with less than high school education.
Conclusions:
Our results can help public health officials focus on providing social supports to subgroups of the population who would benefit the most from policy interventions.
Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a unique and growing subset of the aging population. The historical context in which they came of age was imbued with victimization and discrimination. These experiences are subjectively stressful and collectively known as minority stress. Older LGBT adults continue to face stressors related to their gender and sexual identities in their daily lives. Importantly, chronic minority stress (CMS), like other forms of chronic stress, is harmful to health and well-being. CMS contributes to LGBT health disparities, including cardiovascular disease and depression, conditions that in turn increase risk for premature cognitive decline. Furthermore, long-term exposure to stress hormones is associated with accelerated brain aging. Yet, the cognitive functioning of LGBT elders and the influence of CMS on their cognition are all but unexplored. In this review, we examine the influences of CMS in LGBT elders and connect those influences to existing research on stress and cognitive aging. We propose a testable model describing how CMS in LGBT elders heightens risk for premature cognitive aging and how ameliorating factors may help protect from CMS risk. Research is desperately needed to calibrate this model toward improving LGBT quality of life and mental health practices.
RÉSUMÉ
Les démences liées à l’âge constituent un problème de santé important au Canada, en particulier chez les communautés autochtones, où les taux de démences surpassent d’environ 34 % ceux retrouvés dans la population canadienne. Cette étude présente une synthèse des données qualitatives tirées des articles traitant de la compréhension culturelle des démences chez les peuples autochtones du Canada. Les résultats principaux suggèrent que peu de recherches ont été effectuées dans ce domaine, en particulier chez les Inuits et les Métis, malgré une progression de l’exploration de ce sujet au Canada. La synthèse de la littérature a révélé que la démence est perçue comme une partie naturelle du cycle de vie par de nombreux Autochtones. Bien que les modèles communautaires et informels de soins soulèvent d’importants défis pour les aidants naturels, ils sont régulièrement appliqués. Cette synthèse sera utile pour les organismes et les prestataires de soins de santé qui recherchent des approches appropriées pour répondre aux besoins des patients et des familles autochtones aux prises avec la démence.
Large-scale studies present the opportunity to create normative comparison standards relevant to populations. Sampling weights applied to the sample data facilitate extrapolation to the population of origin, but normative scores are often developed without the use of these sampling weights because the values derived from large samples are presumed to be precise estimates of the population parameter. The present article examines whether applying sample weights in the context of deriving normative comparison standards for measures of cognition would affect the distributions of regression-based normative data when using data from a large population-based study. To address these questions, we examined 3 cognitive measures from the Canadian Longitudinal Study on Aging tracking cohort (N = 14,110, Age 45-84 years at recruitment): Rey Auditory Verbal Learning Test - Immediate Recall, Animal Fluency, and the Mental Alternation Test. The use of sampling weights resulted in similar model parameter estimates to unweighted regression analyses and similar cumulative frequency distributions to the unweighted analyses. We randomly sampled progressively smaller subsets from the full database to test the hypothesis that sampling weights would help maintain the estimates from the full sample, but discovered that the weighted and unweighted estimates were similar and were less precise with smaller samples. These findings suggest that although use of sampling weights can help mitigate biases in data from sampling procedures, the application of weights to adjust for sampling biases do not appreciably impact the normative data, which lends support to the current practice in creation of normative data. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
We determined whether the course of depression was associated with accelerated decline or deficits in verbal episodic memory and verbal fluency in depressed older adults compared with controls, and whether this was modified by age of onset. There were 1,027 Spanish community-dwelling adults aged 60+ who participated at baseline and at 3-year follow-up. Word-list recall and animal naming tasks were performed at the two time points. Participants were classified according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revised (DSM-IV-TR) criteria for 12-month depression at baseline and follow-up: controls, lifetime, remittent, incident, and persistent depression. Adjusted mixed regression models were fitted and interactions time*depression groups explored. Compared with controls, remittent, incident, and persistent depression were significantly related to worse verbal fluency, and remittent and incident depression to worse verbal episodic memory. In the subsample of subjects with depression, interactions were not significant, and age of onset was not related to either accelerated decline or cognitive deficits. Findings suggest that a history of depression per se might not be associated with cognitive deficits. Older people with late life depression are at higher risk for persistent cognitive deficits, even after the affective episode has remitted, and cognitive deficits might be detectable long before the episode appears. Overall, these findings would support the idea that depression during lifetime would not be a risk factor for cognitive impairment whereas late life depression could represent a prodrome for future dementia. Monitoring the neuropsychological functioning of older people with remittent, incident, and persistent depression is indicated, regardless of the age of onset. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Objective: We present descriptive information on the cognitive measures used in the Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort, relate this to information on these measures in the extant literature, and identify key considerations for their use in research and clinical practice.
Method: The CLSA Comprehensive Cohort is composed of 30,097 participants aged 45–85 years at baseline who provided a broad range of sociodemographic, physical, social, and psychological health information via questionnaire and took part in detailed physical and cognitive assessments. Cognitive measures included: the Rey Auditory Verbal Learning Test – immediate and 5-min delayed recall, Animal Fluency, Mental Alternation Test (MAT), Controlled Oral Word Association Test (COWAT), Stroop Test – Victoria Version, Miami Prospective Memory Test (MPMT), and a Choice Reaction Time (CRT) task.
Results: CLSA Comprehensive Cohort sample sizes were far larger than previous studies, and performances on the cognitive measures were similar to comparable groups. Within the CLSA Comprehensive Cohort, main effects of age were observed for all cognitive measures, and main effects of language were observed for all measures except the CRT. Interaction effects (language × age) were observed for the MAT, MPMT Event-based score, all time scores on the Stroop Test, and most COWAT scores. Main effects of education were observed for all measures except for the MPMT Time score in the French sample, and interaction effects (age × education) were observed for the RAVLT (immediate and delayed) for the English sample and the Stroop Dot time for the French sample.
Conclusion: This examination of the cognitive measures used in the CLSA Comprehensive Cohort lends support to their use in large studies of health and aging. We propose further exploration of the cognitive measures within the CLSA to make this information relevant to and available for clinical practice.
This article provides an overview of research on race-related stressors that can affect the mental health of socially disadvantaged racial and ethnic populations. It begins by reviewing the research on self-reported discrimination and mental health. Although discrimination is the most studied aspect of racism, racism can also affect mental health through structural/institutional mechanisms and racism that is deeply embedded in the larger culture. Key priorities for research include more systematic attention to stress proliferation processes due to institutional racism, the assessment of stressful experiences linked to natural or manmade environmental crises, documenting and understanding the health effects of hostility against immigrants and people of color, cataloguing and quantifying protective resources, and enhancing our understanding of the complex association between physical and mental health.
Stress pervades everyday life and more importantly, affects prefrontal cortices that support executive control functions, processes that are critical to learning and memory as well as a range of life outcomes. The positive or negative effect of stress on cognition depends on an interaction of factors related to the situation and the individual. Research has shown that psychological characteristics related to self-relevance and the availability of resources may lead individuals to perceive a stressor as a threat or challenge, driving performance outcomes. Given that perception is arguably the key to stress reactivity, positive affect and self-belief constructs are discussed in the context of how they may lead to preserved performance in the face of stress. Understanding the underlying mechanisms of stress perception could inform the development of interventions, a socially important endeavor given the impact of stress on health and cognitive functions.
Although sensitive detection of pathological cognitive aging requires accurate information about the trajectory of normal cognitive aging, prior research has revealed inconsistent patterns of age-cognition relations with cross-sectional and longitudinal comparisons. Age trends in four cognitive domains were compared in over 5,000 adults with cross-sectional data, and in almost 1,600 adults with three-occasion longitudinal data. Quasi-longitudinal comparisons, which are similar to cross-sectional comparisons in that there is no prior test experience and are similar to longitudinal comparisons in that the participants are from the same birth cohorts, were also reported. The age trends in quasi-longitudinal comparisons more closely resembled those in cross-sectional comparisons than those in longitudinal comparisons, which suggests that, at least up until about age 65, age-cognition relations in longitudinal comparisons are distorted by prior test experience. Results from cross-sectional and quasi-longitudinal comparisons, which can be assumed to have minimal test experience effects, imply that normal cognitive aging is characterized by nearly linear declines from early adulthood in speed, and accelerating declines in memory and reasoning. However, vocabulary knowledge increased until the decade of the 60’s in all three types of comparisons.
Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially.
Objective:
International estimates suggest the presence of health inequalities among older sexual minorities (i.e., individuals who identify as lesbian, gay, or bisexual and are 65 years old or above). In this study, we investigated the presence of health inequalities among aging lesbian and bisexual females, as well as aging gay and bisexual males in Canada.
Methods:
We used baseline data from the Canadian Longitudinal Study on Aging (CLSA) Tracking and Comprehensive cohorts to cross-sectionally compare self-reported physical and mental health indicators by sex and sexual orientation. Within our analysis sample of 51,208 Canadians 45 years old and over, 2% (n = 1057) of respondents identified as lesbian, gay, or bisexual.
Results:
Compared to heterosexual female peers, lesbian and bisexual females had greater odds of heavy drinking (AOR = 1.8, 95% CI = 1.3-2.4) and being a former smoker (AOR = 1.5, 95% CI = 1.2-1.9). Gay and bisexual males had greater odds of reporting a diagnosis of cancer (AOR = 1.5, 95% CI = 1.0-1.9) and currently smoking (AOR = 1.5, 95% CI = 1.1-2.0), compared to heterosexual males. Female and male sexual minorities had greater odds of reporting mood disorders (including depression) and anxiety disorders relative to heterosexual peers of the same sex.
Conclusion:
These findings highlight the importance of considering both sex and sexual orientation when developing approaches to support the physical and mental health of a diverse aging population in Canada.
Background:
Little is known about subjective cognitive decline (SCD) in lesbian, gay, bisexual, and transgender (LGBT) older adults.
Objectives:
To examine SCD and its association with dementia risk factors, other physical and psychosocial health factors in LGBT older adults.
Methods:
A cross-sectional study of SCD was conducted with LGBT older adults, aged 50 and older (n = 210). SCD was categorized based on endorsement of memory problems and one other cognitive domain. Hierarchical logistic regression examined the associations between demographic factors, dementia risk factors, other health and psychosocial factors, and SCD.
Results:
Nearly 25% of LGBT older adults were classified as having SCD. LGBT older adults who were people of color (OR = 2.5; 95% CI = 1.1- 7.8), depressed (OR = 2.9; 95% CI = 1.3- 6.9), or reported having functional impairment (OR = 2.6; 95% CI = 1.1- 6.5) were significantly more likely to be classified as having SCD (Nagelkerke pseudo R2 = 0.27).
Conclusion:
Depression and functional impairment should be considered when screening LGBT older adults for cognitive impairment and dementia. Future research on the cognitive impairment and dementia risk in LGBT older adults is needed.
Background:
Subjective social status (SSS) is associated with mental and physical health, independent of objective socioeconomic status (SES), but its association with late-life cognitive decline is unknown.
Objective:
This study characterizes the association between SSS and late-life memory trajectories in a large, nationally representative sample of older adults in the United States.
Methods:
Using data from 8,530 participants aged 65 years and older in the Health and Retirement Study, structural equation models tested associations between SSS, objective SES (i.e., educational attainment, occupation, income, and wealth), physical and mental health, and 6-year memory trajectories, controlling for sociodemographic characteristics.
Results:
Independent of objective SES, lower SSS was associated with worse initial memory but not subsequent memory decline. The association between SSS and initial memory was separately mediated by chronic diseases, stroke, and depressive symptoms.
Conclusion:
Results provide preliminary behavioral evidence for the deleterious effects of social stress on cognitive aging. These results may help inform the development of policies and interventions to reduce cognitive morbidity among older adults who perceive a low position on the social hierarchy.
Background:
US-based studies have reported that older blacks perform worse than older whites on cognitive tests and have higher risk of Alzheimer disease dementia (AD). It is unclear whether these findings reflect differences in cognitive decline.
Methods:
The Chicago Health and Aging Project followed individuals, 65+ years old (64% black, 36% white), for up to 18 years. Participants underwent triennial cognitive assessments; stratified randomized samples underwent assessments for AD. We compared black and white participants' cognitive performance, cognitive decline rate (N=7735), and AD incidence (N=2144), adjusting for age and sex.
Results:
Black participants performed worse than white participants on the cognitive tests; 441 participants developed AD. Black participants' incident AD risk was twice that of whites (RR=1.9; 95% CI, 1.4-2.7), with 58 excess cases/1000 occurring among blacks (95% CI, 28 to 88). Among non-carriers of APOE ε4, blacks had 2.3 times the AD risk (95% CI,1.5-3.6), but among carriers, race was not associated with risk (RR=1.1; 95% CI, 0.6-2.0; Pinteraction=0.05). However, cognitive decline was not faster among blacks: the black-white difference in 5-year change in global cognitive score was 0.007 standard unit (95% CI, -0.034 to 0.047). Years of education accounted for a sizable portion of racial disparities in cognitive level and AD risk, in analyses using a counterfactual approach.
Conclusions:
The higher risk of AD among blacks may stem from lower level of cognitive test performance persisting throughout the observation period rather than faster rate of late-life cognitive decline. Disparities in educational attainment may contribute to these performance disparities.
Purpose of the study:
Earlier studies have identified a pattern of cumulative advantage leading to increased within-cohort economic inequality over the life course, but there is a need to better understand how levels of inequality by age have changed in the evolving economic environment of recent decades. We utilized Survey of Income and Program Participation (SIPP) data to compare economic inequality across age groups for 2010 versus 1983-1984.
Design and methods:
We examined changing age profiles of inequality using a summary measure of economic resources taking into account income, annuitized value of wealth, and household size. We adjusted for survey underreporting of some income and asset types, based on National Income Accounts and other independent estimates of national aggregates. We examined inequality by age with Gini coefficients.
Results:
Late-life (65+) inequality increased between the 2 periods, with Gini coefficients remaining higher than during the working years, but with a less steep age difference in inequality in 2010 than in 1983-1984. Inequality increased sharply within each cohort, particularly steeply in Depression-era, war-baby, and leading-edge baby boom cohorts. The top quintile of elderly received increasing shares of most income sources.
Implications:
Increasing inequality among older people, and especially in cohorts approaching late life, presages upcoming financial challenges for elderly persons in the lower part of the income distribution. Implications of this increasingly high-inequality late-life environment need to be carefully evaluated as changes are considered in Social Security and other safety-net institutions, which moderate impacts of economic forces that drive increasingly disparate late-life economic outcomes.
Little is known about Black-White health inequalities in Canada or the applicability of competing explanations for them. To address this gap, we used nine cycles of the Canadian Community Health Survey to analyze multiple health outcomes in a sample of 3,127 Black women, 309,720 White women, 2,529 Black men and 250,511 White men. Adjusting for age, marital status, urban/rural residence and immigrant status, Black women and men were more likely than their White counterparts to report diabetes and hypertension, Black women were less likely than White women to report cancer and fair/poor mental health and Black men were less likely than White men to report heart disease. These health inequalities persisted after controlling for education, household income, smoking, physical activity and body-mass index. We conclude that high rates of diabetes and hypertension among Black Canadians may stem from experiences of racism in everyday life, low rates of heart disease and cancer among Black Canadians may reflect survival bias and low rates of fair/poor mental health among Black Canadian women represent a mental health paradox similar to the one that exists for African Americans in the United States.
Symptoms of memory loss are caused by a range of cognitive abilities or a general cognitive decline, and not just memory. Clinicians can diagnose the syndromes of dementia (major neurocognitive disorder) and mild cognitive impairment (mild neurocognitive disorder) based on history, examination, and appropriate objective assessments, using standard criteria such as Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. They can then diagnose the causal subtypes of these syndromes using standard criteria for each of them. Brain imaging and biomarkers are making progress in the differential diagnoses among the different disorders. Treatments are still mostly symptomatic.
Reports an error in "Neuropsychological assessment of memory in the elderly" by Donald E. Read (Canadian Journal of Psychology Revue Canadienne de Psychologie, 1987[Jun], Vol 41[2], 158-174). On p. 171: The last sentence of the first paragraph should read "This finding has now been replicated in a follow-up study with the same subjects (Read, 1986)." (The following abstract of the original article appeared in record 1988-30166-001.) Administered 3 tests designed for the neuropsychological assessment of older people. The tests focus on evaluating the storage abilities of the brain for both explicit and implicit aspects of memory. Ss were volunteers in 3 age groups: 89 males and 153 females (aged 50–59 yrs); 122 males and 181 females (aged 60–69 yrs); and 77 males and 112 females (aged 70–79 yrs). The tests were (1) the Supermarket Test, designed to measure both immediate and delayed episodic memory for test items, plus episodic recall of the spatial location of the same items; (2) the Visual Closure Test, designed to measure implicit and explicit memory; and (3) the Sequential Geometric Design Test, designed to measure visuoperceptual ability and nonverbal memory. Findings show the tests to work well with patients suffering from mild to severe memory loss and with those in the early stages of dementia. (French abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown.
Methods We studied 1984 older adults (mean age, 77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, ≥80) who underwent audiometric testing in year 5. Participants were followed up for 6 years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and 11 and consisted of the 3MS (measuring global function) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was defined as a 3MS score of less than 80 or a decline in 3MS score of more than 5 points from baseline. Mixed-effects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors.
Results In total, 1162 individuals with baseline hearing loss (pure-tone average >25 dB) had annual rates of decline in 3MS and Digit Symbol Substitution test scores that were 41% and 32% greater, respectively, than those among individuals with normal hearing. On the 3MS, the annual score changes were −0.65 (95% CI, −0.73 to −0.56) vs −0.46 (95% CI, −0.55 to −0.36) points per year (P = .004). On the Digit Symbol Substitution test, the annual score changes were −0.83 (95% CI, −0.94 to −0.73) vs −0.63 (95% CI, −0.75 to −0.51) points per year (P = .02). Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual's baseline hearing loss.
Conclusions Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. Further studies are needed to investigate what the mechanistic basis of this association is and whether hearing rehabilitative interventions could affect cognitive decline.
AD is a public health epidemic, which seriously impacts cognition, mood and daily activities; however, one type of activity, exercise, has been shown to alter these states. Accordingly, we sought to investigate the relationship between exercise and mood, in early-stage AD patients (N=104) from California, over a 1-year period. Patients completed the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Blessed-Roth Dementia Rating Scale (BRDRS), while their caregivers completed the Yale Physical Activity Survey (YALE), Profile of Mood States (POMS), the Neuropsychiatric Inventory (NPI) and Functional Abilities Questionnaire (FAQ). Approximately half of the participants were female, from a variety of ethnic groups (Caucasian=69.8%; Latino/Hispanic Americans=20.1%). Our results demonstrated that the patients spent little time engaged in physical activity in general, their overall activity levels decreased over time, and this was paired with a change in global cognition (e.g., MMSE total score) and affect/mood (e.g., POMS score). Patients were parsed into Active and Sedentary groups based on their Yale profiles, with Active participants engaged in walking activities, weekly, over 1 year. Here, Sedentary patients had a significant decline in MMSE scores, while the Active patients had an attenuation in global cognitive decline. Importantly, among the Active AD patients, those individuals who engaged in walking for more than 2h/week had a significant improvement in MMSE scores. Structured clinical trials which seek to increase the amount of time AD patients were engaged in walking activities and evaluate the nature and scope of beneficial effects in the brain are warranted.
Determining the genetic influences on cognitive ability in old age and in cognitive ageing are important areas of research in an increasingly ageing society. Heritability studies indicate that genetic variants strongly influence cognitive ability differences throughout the lifespan, including in old age. To date, however, only the genes encoding apolipoprotein E (APOE) and possibly catechol-O-methyl transferase (COMT), brain-derived neurotrophic factor (BDNF) and dystrobrevin binding protein 1 (DTNBP1) have repeatedly been associated in candidate gene studies with cognitive decline or with cognitive ability in older individuals. Genome-wide association studies have identified further potential loci, but results are tentative. Advances in exome and/or whole-genome sequencing, transcriptomics, proteomics and methylomics hold significant promise for uncovering the genetic underpinnings of cognitive ability and decline in old age.
RÉSUMÉ
Les Canadiens vivent plus longtemps et les personnes plus âgées composent une part croissante de la population (14% en 2006, projeté d’atteindre 20% d’ici 2021). L’Étude longitudinale canadienne sur le vieillissement (ÉLCV) est une étude longitudinale nationale portant sur le développement adulte et le vieillissement qui recrutera 50 000 Canadien(ne)s âgé(e)s de 45 à 85 ans et qui les suivra pendant au moins 20 ans. Tous les participants fourniront un ensemble d’informations communes sur plusieurs aspects de la santé et du vieillissement, et 30 000 passeront un examen approfondi couplé au don de spécimens biologiques (sang et urine). L’ÉLCV deviendra une source de données riches pour l’étude d’inter-relations complexes entre les facteurs biologiques, physiques, psychosociaux et sociaux qui affectent le vieillissement en santé.