EARLY-LIFE AND LATE-LIFE COGNITIVE LIFESTYLE AS A WAY TO PROMOTE COGNITIVE RESERVE IN OLDER ADULTS

Abstract Background exposures in childhood and adolescence may impact the development of diseases and symptoms in late life. However, evidence from low- and middle-income countries is scarce. In this cross-sectional study, we examined the association of early life risk factors with frailty amongst older adults using a large, nationally representative cohort of community-dwelling Chinese sample. Methods we included 6,806 participants aged $\ge$60 years from the China Health and Retirement Longitudinal Study. We measured 13 risk factors in childhood or adolescence through self-reports, encompassing six dimensions (education, family economic status, nutritional status, domestic violence, neighbourhood and health). We used multinomial regression models to examine the association between risk factors and frailty. We further calculated the absolute risk difference for the statistically significant factors. Results persons with higher personal and paternal education attainment, better childhood neighbourhood quality and better childhood health status had lower risk of being frail in old age. Severe starvation in childhood was associated with higher risk of prefrailty. The risk differences of being frail were 5.6% lower for persons with a high school or above education, 1.5% lower for those whose fathers were literate, 4.8% lower for the highest neighbourhood quality and 2.9% higher for worse childhood health status compared to their counterparts. Conclusions unfavorable socioeconomic status and worse health condition in childhood and adolescence may increase the risk of late-life frailty amongst Chinese older adults.

Download Full-text

Exposure to urban life and mortality risk among older adults in China

International Journal of Population Studies ◽

10.18063/ijps.2017.01.007. ◽

2017 ◽

Vol 3 (1) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Danan Gu ◽

Qiushi Feng ◽

Jessica M. Sautter ◽

Li Qiu

Keyword(s):

Older Adults ◽

Mortality Risk ◽

Early Life ◽

Late Life ◽

Urban Environments ◽

Urban Life ◽

Residential Status ◽

Family Social Support ◽

Full Life ◽

First Interview

We examined whether exposure to urban environments was linked with mortality in a longitudinal survey dataset of nearly 28,000 Chinese adults who were 65 years of age or older in the years 2002–2014. Urban life exposure was measured by residential status at birth, current residential status, and urban-related primary lifetime occupation, which generated eight different categories of urban life exposure: no exposure, mid-life-only exposure, late-life-only exposure, mid-late-life exposure, early-life-only exposure, early-mid-life exposure, early- & late-life exposure, and full life exposure. We also included a measure of migration, whether the respondent lived in the same county/city at birth and at first interview, to further classify these eight categories. Overall, we found that when demographics were controlled for, compared to those with no urban life exposure and no migration, mortality risk was lower for older adults with mid-late life exposure with or without migration and for older adults with full-life exposure with migration; mortality risk was higher for older adults with early-life-only exposure. Once socioeconomic status, family/social support, health behaviors, and baseline health were simultaneously controlled for, only the higher mortality risk for older adults with early-life-only exposure was still significant. Our findings provided valuable information about how urban life exposure at different life stages was associated with elderly mortality in China.

Download Full-text

The Risk of Dementia in Relation to Cognitive and Brain Reserve

Journal of Alzheimer s Disease ◽

10.3233/jad-200264 ◽

2020 ◽

Vol 77 (2) ◽

pp. 607-618

Author(s):

Sander Lamballais ◽

Jendé L. Zijlmans ◽

Meike W. Vernooij ◽

M. Kamran Ikram ◽

Annemarie I. Luik ◽

...

Keyword(s):

Early Life ◽

Cognitive Reserve ◽

Brain Volume ◽

Late Life ◽

Variance Decomposition ◽

Hazard Ratio ◽

Intracranial Volume ◽

Rotterdam Study ◽

Brain Reserve ◽

Incident Dementia

Background: Individual differences in the risk to develop dementia remain poorly understood. These differences may partly be explained through reserve, which is the ability to buffer cognitive decline due to neuropathology and age. Objective: To determine how much early and late–life cognitive reserve (CR) and brain reserve (BR) contribute to the risk of dementia. Methods: 4,112 dementia-free participants (mean age = 66.3 years) from the Rotterdam Study were followed up for on average 6.0 years. Early-life CR and BR were defined as attained education and intracranial volume, respectively. Late-life CR was derived through variance decomposition based on cognition. Late-life BR was set as the total non-lesioned brain volume divided by intracranial volume. Results: Higher early-life CR (hazard ratio = 0.48, 95% CI = [0.21; 1.06]) but not early-life BR associated with a lower risk of incident dementia. Higher late-life CR (hazard ratio = 0.57, 95% CI = [0.48; 0.68]) and late-life BR (hazard ratio = 0.54, 95% CI = [0.43; 0.68]) also showed lower levels of dementia. Combining all proxies into one model attenuated the association between early-life CR and dementia (hazard ratio = 0.56, 95% CI = [0.25; 1.25]) whereas the other associations were unaffected. These findings were stable upon stratification for sex, age, and APOE ɛ4. Finally, high levels of late-life CR and BR provided additive protection against dementia. Conclusion: The findings illustrate the importance of late-life over early-life reserve in understanding the risk of dementia, and show the need to study CR and BR conjointly.

Download Full-text

Lifelong Engagement: The Role of Cognitive Reserve and Physical Health in Very Late Life

Innovation in Aging ◽

10.1093/geroni/igaa057.2820 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 779-780

Author(s):

Peter Martin ◽

Bradley Willcox ◽

D Craig Willcox

Keyword(s):

Older Adults ◽

Physical Health ◽

Cognitive Functioning ◽

Cognitive Abilities ◽

Structural Equation ◽

Cognitive Reserve ◽

Late Life ◽

Equation Model ◽

Multiple Group ◽

Occupational Complexity

Abstract At the end of a very long life, older adults often experience a significant decline in cognitive function. However, there are older adults who have maintained high levels of cognition and physical health. The purpose of this symposium is to illuminate interdisciplinary findings of cognitive engagement with late-life benefits of cognitive functioning and physical health. Components of cognitive reserve include sociodemographic variables (e.g., education, occupational complexity and responsibility), psychosocial variables (e.g., engaged life style and activity) and physical and genetic reserve (e.g., strength, APOE4). Based on three major research studies (the Japanese SONIC study; the Honolulu Asia Aging Study, HAAS; and the Georgia Centenarian Study, GCS), we highlight important aspects of building cognitive reserve and the implications for cognitive and physical health. The first presentation evaluates the importance of work complexity as a predictor of cognitive and physical health among participants of the SONIC study. Multiple group analyses yielded strong associations of occupational complexity with cognitive functioning for men. The second presentation reports logistic regression findings from the HAAS including education, strength and genetic markers, as well as mental health and their relatedness to cognitive abilities and physical health. The final presentation evaluates a structural equation model from the GCS, highlighting the interrelationship of cognitive reserve components (i.e., education, occupational responsibility, engaged lifestyle, social support, and activity) with cognitive and physical health in very late life. We will summarize and integrate the findings for their theoretical and practical implications and provide future directions.

Download Full-text

Association between early life physical activity and late-life cognition: Evidence for cognitive reserve

Cognitive Reserve ◽

10.4324/9780203783047-17 ◽

2013 ◽

pp. 158-172

Keyword(s):

Physical Activity ◽

Early Life ◽

Cognitive Reserve ◽

Late Life

Download Full-text

Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽

10.1024/1662-9647/a000127 ◽

2015 ◽

Vol 28 (2) ◽

pp. 67-76

Author(s):

Grace C. Niu ◽

Patricia A. Arean

Keyword(s):

Older Adults ◽

Mental Illness ◽

Brain Plasticity ◽

Late Life ◽

Aging Population ◽

The United States ◽

Future Research ◽

Evidence Based ◽

Late Life Depression ◽

Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

Download Full-text

Sex in Late Life: Assessing Adults’ Expectations and the Role of Healthcare Professionals

Innovation in Aging ◽

10.1093/geroni/igaa057.1003 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 313-313

Author(s):

Jill Naar ◽

Raven Weaver ◽

Shelbie Turner

Keyword(s):

Older Adults ◽

Sexual Health ◽

Health Behaviors ◽

Healthcare Professionals ◽

Late Life ◽

Sexual History ◽

Growth Curve Models ◽

The Us ◽

Sexual Health Behaviors ◽

The Life Course

Abstract Sexual activity contributes to quality of life throughout the lifespan. However, stigma about sex in late life influences older adults’ perceptions and healthcare professionals’ perceptions of older adults’ sexual health/behaviors. Using a multi-methods approach, we examined attitudes and knowledge about sexual health/behaviors in late life. Using longitudinal data from the Midlife in the US Study (Wave 1-3; N=7049), we ran age-based growth curve models to analyze changes in levels of optimism about sex in their future. We also piloted a survey with healthcare professionals assessing attitudes, knowledge, and awareness of policy about sexual health/behaviors among older adults. Adults’ expectations became less optimistic with increased age (β = -0.1, SE = 0.003, p < .0001). Men were more optimistic than women at age 20 (p = 0.016), but men’s optimism decreased over the life course at a faster rate than did women’s (p < .0001), so that from ages 40-93, men were less optimistic than women. Among healthcare professionals (N=21), the majority indicated never or rarely asking their clients about sexual history or health/behaviors; however, they indicated some knowledge about issues relevant to older adults (e.g., safe-sex practices, sexual dysfunction). Few indicated awareness about policies related to sexual behavior among residents (i.e., issues of consent, STIs). Among adults, there is a need to address declining optimism for expectations about sex in late life. Health professionals are well-situated to raise awareness and normalize discussions about sexual health, thus countering negative stigma and contributing to increasing optimism for expectations to remain sexually active.

Download Full-text

Longitudinal Association Between Education and Disability in Older Adults Living in Iceland

Innovation in Aging ◽

10.1093/geroni/igaa057.1274 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 396-396

Author(s):

Milan Chang ◽

Olof Geirsdottir ◽

Lenore Launer ◽

Vilmundur Gudnasson ◽

Palmi Jonsson ◽

...

Keyword(s):

Older Adults ◽

Low Socioeconomic Status ◽

Late Life ◽

Mobility Disability ◽

College And University ◽

Disability Status ◽

Adl Disability ◽

And Gender ◽

Access To Medical Care ◽

Life Education

Abstract BACKGROUND: Disabilities among older adults are associated with cumulative adversities such as low socioeconomic status (SES), poor nutrition, and lack of access to medical care and education. However, there is little evidence on the long-term association between education and disability status among older adults in Iceland. The aim of the study was to examine the association between mid-life education and prevalence of disability in activities of daily living (ADL) and mobility disability in late-life using 25 years of longitudinal data. METHODS: A large community-based population residing in Reykjavik, Iceland participated in a longitudinal study with an average of 25 years of follow-up (N=5764, mean age 77±6 yrs, 57.7% of women) Mid-life education was categorized into 2 groups (primary and secondary versus college and university). Disability status in late life was defined with ADL and mobility disability with a binary outcome (no difficulty versus any difficulty). Logistic regression analysis was used to examine the association. RESULTS: After controlling for age and gender, and midlife health risk factors, those who had high education at mid-life were less likely to have ADL disability (Odds Ratio (OR) = 0.75, 95% Confidence Interval (CI): 0.64 ~ 0.88, P ≤ 0.001) and mobility disability (OR = 0.72, 95% CI: 0.61 ~ 0.86, P < 0.001) compared with those who had low education in mid-life. CONCLUSION: People with high mid-life education were less likely to have ADL and mobility disability after 25 years later.

Download Full-text

Genome-wide analysis suggests the importance of vascular processes and neuroinflammation in late-life antidepressant response

Translational Psychiatry ◽

10.1038/s41398-021-01248-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Victoria S. Marshe ◽

Malgorzata Maciukiewicz ◽

Anne-Christin Hauschild ◽

Farhana Islam ◽

Li Qin ◽

...

Keyword(s):

Older Adults ◽

Cerebrovascular Disease ◽

Protein Degradation ◽

Late Life ◽

Cardioembolic Stroke ◽

Symptom Improvement ◽

Antidepressant Response ◽

Polygenic Risk ◽

Remission Status ◽

Genome Wide

AbstractAntidepressant outcomes in older adults with depression is poor, possibly because of comorbidities such as cerebrovascular disease. Therefore, we leveraged multiple genome-wide approaches to understand the genetic architecture of antidepressant response. Our sample included 307 older adults (≥60 years) with current major depression, treated with venlafaxine extended-release for 12 weeks. A standard genome-wide association study (GWAS) was conducted for post-treatment remission status, followed by in silico biological characterization of associated genes, as well as polygenic risk scoring for depression, neurodegenerative and cerebrovascular disease. The top-associated variants for remission status and percentage symptom improvement were PIEZO1 rs12597726 (OR = 0.33 [0.21, 0.51], p = 1.42 × 10−6) and intergenic rs6916777 (Beta = 14.03 [8.47, 19.59], p = 1.25 × 10−6), respectively. Pathway analysis revealed significant contributions from genes involved in the ubiquitin-proteasome system, which regulates intracellular protein degradation with has implications for inflammation, as well as atherosclerotic cardiovascular disease (n = 25 of 190 genes, p = 8.03 × 10−6, FDR-corrected p = 0.01). Given the polygenicity of complex outcomes such as antidepressant response, we also explored 11 polygenic risk scores associated with risk for Alzheimer’s disease and stroke. Of the 11 scores, risk for cardioembolic stroke was the second-best predictor of non-remission, after being male (Accuracy = 0.70 [0.59, 0.79], Sensitivity = 0.72, Specificity = 0.67; p = 2.45 × 10−4). Although our findings did not reach genome-wide significance, they point to previously-implicated mechanisms and provide support for the roles of vascular and inflammatory pathways in LLD. Overall, significant enrichment of genes involved in protein degradation pathways that may be impaired, as well as the predictive capacity of risk for cardioembolic stroke, support a link between late-life depression remission and risk for vascular dysfunction.

Download Full-text

Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001122 ◽

2021 ◽

Vol 30 ◽

Author(s):

Shiyu Lu ◽

Tianyin Liu ◽

Gloria H. Y. Wong ◽

Dara K. Y. Leung ◽

Lesley C. Y. Sze ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Symptom Severity ◽

Social Care ◽

Late Life ◽

Community Dwelling ◽

Service Utilisation ◽

Late Life Depression ◽

Social Care Service ◽

Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

Download Full-text