Cognitive Aging in the Context of the Housing Crisis: Trends and Evidence From the Health and Retirement Study

We conducted analysis to test if health disparities in cognitive aging were parallel to or different from health disparities in patterns of aging in other systems in the body, and if race/ethnicity-related disparities could be accounted for by differences in socioeconomic circumstances across the life-course. We analyzed data from more than 10,000 adults participating in the US NHANES and US Health and Retirement Study. We measured cognitive aging using neuropsychological tests of processing speed and memory. We measured aging in other systems using composite indices of biological aging based on organ-system function tests and blood chemistries. We conducted analysis to (i) quantify and compare health disparities in cognitive aging and biological aging; (ii) test if individuals exhibiting accelerated cognitive aging were also exhibiting accelerated biological aging; and (iii) test if race/ethnic disparities in cognitive and biological aging could be explained by measured socioeconomic resource differences in childhood and later life.

Inter-connected trends in cognitive aging and depression: Evidence from the health and retirement study

BackgroundModifiable sociocontextual factors powerfully shape ADRD risk, and demonstrably contribute to well‐established racial disparities in cognitive aging. Stressful experiences occurring across the lifespan associate with brain aging and poor cognitive outcomes. However, the importance of timing and even type of stressor remains understudied. We examined relationships between childhood and adulthood traumatic events and cognition among non‐Hispanic Black and White older adults in the Health and Retirement Study (HRS).MethodThe sample included non‐demented adults (N=5,725) aged 65+ with lifetime stress data and complete cognitive testing at the 2006/08, 2010/12, and/or 2014/16 waves. Trauma measures included childhood (0‐11), and adulthood (0‐7) traumatic event counts. Outcomes included global cognition, immediate recall, and delayed recall (Telephone Interview for Cognitive Status). Each exposure‐outcome pair was investigated in separate linear mixed effect models including baseline trauma count, a quadratic trauma term to test for non‐linear relationships, and subject‐specific random intercept. Omnibus Likelihood Ratio Tests (LRT) were conducted to determine if number of traumatic events associated overall with each cognitive outcome. The sample was stratified by race before analysis.ResultBlack participants (N=651) were younger and reported less formal education than White participants (N=5,074). Number of traumatic events in adulthood did not vary by race, but Black participants reported slightly fewer childhood traumas (Table 1) than Whites. Among Whites, childhood traumas associated with poorer global cognition scores but traumas in adulthood showed very modest positive associations across cognitive domains. Among Black participants, no association between childhood trauma and later‐life cognition was observed. A significant non‐linear term for traumatic events indicated cross‐domain cognitive detriment associated with high exposure to adulthood trauma (Table 2; Figure 1).ConclusionAverage exposure to traumas (eg., physical abuse, life‐threatening illness) was low, and in both Black and White older adults, some limited exposure to traumatic events during adulthood predicted modest cognitive benefit. Black HRS participants reporting many traumatic events during adulthood, but not childhood, showed dysfunction in global cognition and recall. Findings highlight importance of adverse events across the full life course, potential threshold effects and co‐occuring chronic stress conditions, and a need to identify resources that buffer impacts of trauma on biology and personal environment.

Introduction: The ongoing marginalization of lesbian, gay, and bisexual people has been hypothesized to produce poorer late-in-life cognitive outcomes, according to mechanisms posited by minority stress and allostatic load theories. Yet the existence of those outcomes remains understudied, and results of existing studies have been contradictory. Using a population-based longitudinal aging study, this paper will compare age at diagnosis of Alzheimer’s disease (AD) or a related dementia and rates of cognitive decline between participants in same-sex relationships (SSRs) and different-sex relationships (DSRs). Methods: The study used longitudinal cognitive-health data from the Health and Retirement Study (HRS; 1998–2018; N = 26,344) to analyze the onset of cognitive impairment and AD/dementia and the rates of cognitive change between participants in SSRs and those in DSRs. We hypothesized that SSR participants would have worse overall cognitive functioning in old age and would experience earlier onset of cognitive impairment. Using multiple regression, we compared the ages at which participants in SSRs and DSRs first reported AD or dementia diagnoses and the ages at which they first scored below cutoffs for cognitive impairment, not dementia (CIND) and possible dementia as determined using the cognitive assessment. The study then compared rates of cognitive decline over time across the SSR and DSR groups, including stratified analyses by education, race/ethnicity, wealth, and sex/gender. Results: Participants in SSRs reported dementia diagnoses (β = −12.346; p = 0.001), crossed the threshold into CIND (β = −8.815; p < 0.001) and possible dementia (β = −13.388; p < 0.001) at a younger age than participants in DSRs. When adjusted for covariates, participants in SSRs also had lower cognition at baseline (β = 0.745; p = 0.003), though having slower rates of cognitive decline when SSR was interacted with time (β = 0.066; p = 0.003). In separate analyses, cognitive differences for SSR participants were only found in participants without undergraduate degrees, with below-median household incomes, and women. Conclusion: Our findings support theories suggesting that marginalization and stigma cause premature cognitive impairment. Findings also suggest that higher education might mitigate the adverse effects of sexuality-minority status on cognitive aging. Results do not support these theories’ claims of more rapid cognitive decline; the lower slopes of cognitive decline with time are compatible with the possibility of slower rates of decline for aging individuals in SSRs.

Mental retirement and health selection: Analyses from the U.S. Health and Retirement Study

ABSTRACTAging is a major risk factor for both normal and pathological cognitive decline. However, individuals vary in their rate of age-related decline. We developed an easily interpretable composite measure of cognitive age, and related both the level of cognitive age and cognitive slope to sociodemographic, genetic, and disease indicators and examined its prediction of dementia transition. Using a sample of 19,594 participants from the Health and Retirement Study, cognitive age was derived from a set of performance tests administered at each wave. Our findings reveal different conclusions as they relate to levels versus slopes of cognitive age, with more pronounced differences by sex and race/ethnicity for absolute levels of cognitive decline rather than for rates of declines. We also find that both level and slope of cognitive age are inversely related to education, as well as increased for persons with APOE Ɛ4 and/or diabetes. Finally, results show that the slope in cognitive age predicts subsequent dementia among non-demented older adults. Overall, our study suggests that this measure is applicable to cross-sectional and longitudinal studies on cognitive aging, decline, and dementia with the goal of better understanding individual differences in cognitive decline.

Social determinants of health, including socioeconomic status (SES), neighborhood conditions and discrimination, are now recognized as critical modifiable risk factors for poor cognitive and brain aging. However, there remain a number of uncertainties regarding their role, including specific pathways and important aspects of exposure. Here, we explore some of these questions by interrogating exposure definitions, employing a lifecourse perspective, exploring study design effects on findings, and testing specific mediation pathways. We incorporate data from 5 cohorts, spanning local neighborhood studies to nationally-representative samples, to explore these questions. First, Meredith Phillips assesses how subjective and objective measures of SES relate to neuroimaging markers of brain health in a middle-aged cohort to address which aspects of SES are most critical to brain health. Second, Andrea Rosso examines neighborhood deprivation measures across the lifecourse in relation to general cognitive aging in a cohort based in 2 historically Black neighborhoods to address critical periods of exposure. Third, Erica Fan assesses the relation of everyday discrimination in relation to cognitive tests across 3 cohorts, exploring how study design and race may affect results. Finally, Greta Cheng tests a mediation pathway from neighborhood SES to general cognitive function through hemoglobin A1C in the Health and Retirement Study. Together, these results advance our understanding of the role of social determinants in cognitive and brain aging with implications for study design and methods. A discussion led by Lisa Barnes will address the advances presented in these studies and consider next steps.

We used longitudinal data from the Health and Retirement Study (1998-2016) to estimate sex-specific age-graded changes in global cognition and memory among White, Black, and U.S.- and foreign-born Latino adults 51 years and older. Among males, racial/ethnic and nativity differences in cognitive function were mainly evident at younger ages, particularly for Blacks compared to Whites. We found no evidence to support male racial/ethnic or nativity differentials in trajectories of cognitive aging. For women, older Blacks and U.S.-Born Latinas, and to a lesser degree foreign-born Latinas, had lower cognitive function at younger ages. However, White women showed more pronounced cognitive aging in comparison to U.S.- and foreign-born Latinas. Results applied to both global and memory outcomes. Our findings support calls for nuanced considerations of racial/ethnic and nativity effects on cognitive aging and ADRDs. Continued monitoring of differential cognitive aging trends is warranted as the vascular and neurologic sequelae of COVID-19 manifests.

Greater neighborhood cohesion is associated with better cognitive function in adulthood and may serve as a protective factor against cognitive impairment and decline. We build on prior work by examining the effects of perceived neighborhood cohesion across the life course on level and change in cognitive function in adulthood. Utilizing longitudinal data from the Health and Retirement Study (1998-2016) and its Life History Mail Survey, we leveraged data from 3,599 study participants (baseline age: 51-89) who participated in up to 10 waves. Respondents provided retrospective ratings of neighborhood cohesion at childhood (age 10), young adulthood (age at the first full-time job), early midlife (age 40), and concurrently at baseline (i.e., late midlife/adulthood); they completed the modified version of the Telephone Interview for Cognitive Status. We fit a univariate latent growth curve model of change in cognitive function across waves and tested whether neighborhood cohesion during each recollected life stage predicted level and change in cognitive function. Greater neighborhood cohesion during childhood and late midlife/adulthood each predicted higher cognitive function at baseline but not the rate of cognitive decline. The final model showed that greater neighborhood cohesion in childhood and in late midlife/adulthood remained significantly associated with higher baseline cognitive function, even after accounting for one another. Findings provide insight into life-course neighborhood contextual influences on cognitive aging. Our results emphasize the need for more research to understand the life-course dynamics between neighborhood environments and cognitive aging.

The present study examines the associations between mental, social, and physical demands of work and cognitive functioning among older adults in the United States. Data from 3,176 respondents in the Health and Retirement Study were analyzed using growth curve modeling (2004-2014). The study investigated differences by gender, race, ethnicity, and education. Higher mental and social demands of work were associated with higher levels of initial cognitive functioning, but were not significantly associated with slower cognitive decline over time. Physical demands of work were negatively associated with initial cognitive functioning and were also marginally associated with a slower rate of decline in cognitive functioning going into older adulthood. In stratified analyses, results varied by sociodemographic characteristics. The results partially support the environmental complexity hypothesis and the productive aging framework in that higher mental and social demands and lower physical demands relate to better cognitive functioning at baseline, with the differences appearing stable throughout older adulthood. The stratified results shed light on addressing disparities in cognitive aging and work environments.

Migration and gender are important factors that differentiate the Latino immigrant experience in the United States. We investigate the association between nativity status, age of migration, and cognitive life expectancies among a nationally representative sample of Latino adults aged 50 and older to explore whether age of migration and gender influence cognitive aging across the life course. This study used data from the Health and Retirement Study (1998-2016) to estimate Sullivan-based life tables of cognitive life expectancies by nativity, age of migration, and gender for older Latino adults. Cognitive status was based on the Langa-Weir algorithm. We test for both within-group (i.e., nativity and age of migration) and gender differences to explore the overall burden of disease among this rapidly growing population. Foreign-born Latinos, regardless of age of migration or gender, spend a greater number of years after age 50 with cognitive impairment/no dementia than U.S.-born Latinos. However, the number of years spent with dementia varied by subgroup with midlife immigrant men and late-life immigrant men and women exhibiting a significant disadvantage relative to the U.S.-born. Furthermore, we document a gender disadvantage for all Latino women, regardless of immigrant status. The robust relationship between nativity, age of migration, and cognitive aging suggests that older foreign-born Latinos experiencing cognitive decline may place serious burdens on families. Future research should target the needs of different subgroups of older Latinos who are entering their last decades of life to develop culturally appropriate long-term care programs.

BackgroundPrevious research suggests that chronic health conditions and financial hardship robustly shape cognitive health outcomes, including ADRD risk in older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship modifies the impact of self‐reported chronic health conditions on episodic memory among a representative sample of older Blacks enrolled in the 2006 Health and Retirement Study (HRS).MethodThe study included 934 older Blacks (50+ years) who completed the psychosocial leave‐behind questionnaire in the 2006 wave of the HRS. Episodic memory included a composite standardized score of immediate and delayed recall. Six chronic health conditions (e.g., hypertension, diabetes, stroke) were summed and dichotomized (0‐1 vs. as ≥2 conditions). Financial hardship was assessed as self‐reported difficulty paying monthly bills (range: not at all=0 to very/completely=3). Weighted OLS regression models tested independent associations between chronic health conditions and episodic memory, controlling for sociodemographic characteristics. An interaction term tested moderation by financial hardship.ResultThe majority of the sample was female (39.34% male) and had less than a high school education (35.89%; Table 1). Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender, education and income (F 2, 49 = 4.97, p= 0.011; see Table 2 and Figure 1).ConclusionThe present study adds to our understanding of cognitive aging among older Black Americans. Results support previous research, pointing to the independent negative effects of both chronic diseases and subjective financial burden, but also extend the literature by suggesting an interactive effect. Specifically, multimorbidity was more strongly associated with worse episodic memory functioning among older Blacks with less financial hardship, which appeared to be driven by the relatively low cognitive functioning among those with the greatest financial hardship. This pattern of results suggest that financial hardship may be just as consequential for cognitive aging as chronic diseases for older Blacks.

Lifecourse Traumatic Events and Cognitive Aging in the Health and Retirement Study

ImportanceFood insecurity is a leading public health issue in the US. Research on food insecurity and cognitive aging is scarce, and is mostly cross-sectional. Food insecurity status and cognition both can change over the life course, but their longitudinal relationship remains unexplored.ObjectiveTo examine the longitudinal association between food insecurity and changes in memory function during a period of 18 years among middle to older–aged adults in the US.Design, Setting, and ParticipantsThe Health and Retirement Study is an ongoing population-based cohort study of individuals aged 50 years or older. Participants with nonmissing information on their food insecurity in 1998 who contributed information on memory function at least once over the study period (1998-2016) were included. To account for time-varying confounding and censoring, marginal structural models were created, using inverse probability weighting. Data analyses were conducted between May 9 and November 30, 2022.Main outcomes and MeasuresIn each biennial interview, food insecurity status (yes/no) was assessed by asking respondents whether they had enough money to buy food or ate less than they felt they should. Memory function was a composite score based on self-completed immediate and delayed word recall task of a 10-word list and proxy-assessed validated instruments.ResultsThe analytic sample included 12 609 respondents (mean [SD] age, 67.7 [11.0] years, 8146 [64.60%] women, 10 277 [81.51%] non-Hispanic White), including 11 951 food-secure and 658 food-insecure individuals in 1998. Over time, the memory function of the food-secure respondents decreased by 0.045 SD units annually (β for time, −0.045; 95% CI, −0.046 to −0.045 SD units). The memory decline rate was faster among food-insecure respondents than food-secure respondents, although the magnitude of the coefficient was small (β for food insecurity × time, −0.0030; 95% CI, −0.0062 to −0.00018 SD units), which translates to an estimated 0.67 additional (ie, excess) years of memory aging over a 10-year period for food-insecure respondents compared with food-secure respondents.Conclusions and RelevanceIn this cohort study of middle to older–aged individuals, food insecurity was associated with slightly faster memory decline, suggesting possible long-term negative cognitive function outcomes associated with exposure to food insecurity in older age.

BackgroundSexual‐minority (e.g., lesbian, gay, bisexual [SM]) people may be at an increased risk of Alzheimer’s disease or a related dementia (ADRD) from stress related to experiences of minoritization. Strong levels of social contact and social support decreases dementia risk; these effects may differ by sex/gender and sexuality. The purpose of this presentation is to elucidate the relationship between cognitive function, social support, and social networks with a focus on sexuality and sex/gender.MethodData analyzed were from waves 8‐14 (2006‐2018) of the Health and Retirement Study, a longitudinal survey of U.S. residents aged ≥51 years (N = 18,183). Participants who reported their sexual orientation as lesbian, gay, or bisexual, or those in same‐sex relationships for at least one wave were classified as SMs. A gender/sexuality variable was created with four levels: SM‐women (n = 101), heterosexual women (n = 9,942), SM‐men (n = 106), and heterosexual men (n = 8,034). Social contact and support were reported for network size, frequency of contact, and quality of interactions across four relationships: spouses, children, family, and friends. Cognitive function was measured on a 27‐point scale. The primary analysis consisted of a series of multiple linear regression models, treating cognition as the outcome, and adjusting for age, wealth, education, and race.ResultDescriptive analysis showed that SM‐men and SM‐women tended to be younger and join the study later than heterosexual men and women, and at baseline, heterosexual men had lower cognitive scores compared to the other three groups (F = 82.44, p&lt;0.001). Moderation analysis showed the relationship between positive spousal support and cognition was inconsistent across gender/sexuality groups (χ2 = 11.58, p = 0.009); SM‐women did not benefit from positive spousal support as much as other gender/sexuality groups. Greater frequency of social contact was associated with higher cognitive function, except among SM‐women where greater social contact was associated with lower cognitive function (χ2 = 9.65, p = 0.023). Support from other social groups did not have differential effects across gender/sexuality groups.ConclusionFindings highlighted variable and gendered effects of social support and social contact on cognitive functioning in aging SM people. Examining differential effects for SM/gender groups is essential to inclusive ADRD research.