Gender, Marital Histories, and Cognitive Impairment in Later Life: Does Remarriage Disadvantage Women?

Objectives: Marriage represents a long-term intimate relationship involving high levels of interaction and shared resources. Education, as an inter-individual resource, may influence the health status of an individual and his/her spouse. The aim of this study was to assess the impact of educational mobility through marriage on the risk of cognitive impairment in older adults. Methods: Data were derived from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey. The final sample included 1,396 married men and 671 married women aged 65 years and older. Cognitive impairment was assessed using the Mini-Mental State Exam (MMSE). The gender-specific effect of educational mobility on the risk of cognitive impairment was tested by logistic regression analyses. Results: Older men who experienced downward educational mobility through marriage had a higher risk of cognitive impairment, when compared to their upwardly mobile counterparts. This association was not observed in women. Having more years of schooling protected both men and women from being cognitive impaired in late life. Discussion: These findings provide further evidence that downward socioeconomic mobility through marriage is associated with adverse health outcomes. Yet, the impact of spousal education on health must be understood through the lens of gender. Potential mechanisms that may link spousal education to cognition over the life course were discussed, including health literacy, health behaviors, and household resources.

With population aging and the growing population at-risk of cognitive impairment, Alzheimer’s disease, and related dementias, there is a need for a better understanding of how social factors may affect cognitive impairment. Drawing from stress process theory and social integration theory, we examine the impact of positive and negative dimensions of relationship quality with friends and family on cognitive impairment in later life. We analyze Cox proportional hazards models using nationally representative panel data from the Health and Retirement Study (2006-2016, N=10,626) to examine how the quality of family and friend relationships in adulthood may influence risk of cognitive impairment. Strain with family members and with friends was significantly related to higher risk of cognitive impairment (Hazard Ratio: 1.15 [95% CI: 1.08, 1.21] and 1.20 [95% CI: 1.13, 1.28], respectively). Support from family members was beneficial, related to lower risk of cognitive impairment (HR: 0.93, CI: .89, .99); however, support from friends was related to higher risk of cognitive impairment (HR: 1.10, CI: 1.05, 1.14). Findings reveal the implications of social support and strain in different types of relationships for cognitive health.

There are controversies surrounding the effects of lung function decline on cognitive impairment and dementia. We conducted a meta-analysis and systematic review to explore the associations of lung function decline with the risks of cognitive impairment and dementia. The PubMed, EMBASE, and the Cochrane Library were searched to identify prospective studies published from database inception through January 10, 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using random-effects models. The Egger test, funnel plots, meta-regression, sensitivity, and subgroup analyses were conducted to detect publication bias and investigate the source of heterogeneity. Thirty-three articles with a total of 8,816,992 participants were subjected to meta-analysis. Poorer pulmonary function was associated with an increased risk of dementia (FEV: RR = 1.25 [95% CI, 1.17-1.33]; FVC: RR = 1.40 [95% CI, 1.16-1.69]; PEF: RR = 1.84 [95% CI, 1.37-2.46]). The results of the subgroup analyses were similar to the primary results. Individuals with lung diseases had a higher combined risk of dementia and cognitive impairment (RR = 1.39 [95% CI, 1.20-1.61]). Lung disease conferred an elevated risk of cognitive impairment (RR = 1.37 [95% CI, 1.14-1.65]). The relationship between lung disease and an increased risk of dementia was only shown in total study participants (RR = 1.32 [95% CI, 1.11-1.57]), but not in the participants with Alzheimer's disease (RR = 1.39 [95% CI, 1.00-1.93]) or vascular dementia (RR = 2.11 [95% CI, 0.57-7.83]). Lung function decline was significantly associated with higher risks of cognitive impairment and dementia. These findings might provide implications for the prevention of cognitive disorders and the promotion of brain health.

This study examined the impact of intergenerational socioeconomic mobility on the risk of cognitive impairment in a cohort of Chinese older adults aged 60years and older. Data were derived from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey. Logistic regression models were performed to assess the impact of three dimensions of socioeconomic mobility (occupational mobility, educational mobility, and residential mobility) on the risk of cognitive impairment. We found that men who were stable with non-professional jobs across generations had a higher risk of cognitive impairment than their counterparts who experienced upward occupational mobility compared to their father. This pattern was not observed in women. There was little evidence that educational mobility or residential mobility affected cognitive impairment in later life. The findings have implications for advancing supportive policies and practices related to maximizing the benefits of education and career advancements for cognition in later life.

e16506 Background: Use of androgen deprivation therapy (ADT) may confer a higher risk of cognitive impairment. Published results are variable and lack consensus. Our objective was to perform meta-analysis of the risk of overall cognitive impairment in men receiving ADT for prostate cancer. Methods: Relevant studies were identified through the search of English language articles indexed in PubMed Medline, PsycINFO, Cochrane Library and Web of Knowledge/Science until December 21st2016. Articles were included if they were published in English, reported on original research with adult male subjects undergoing treatment for prostate cancer, incorporated longitudinal comparisons, and included a control group. Controlled intervention studies were required to assess an established cognitive-related endpoint that was measured by a validated instrument, and measure cognitive impairment based on the International Cognition and Cancer Task Force (ICCTF) criteria. The effect of ADT on cognitive impairment was pooled using a random-effects model for controlled intervention and case-control studies separately. Results: Of 221 abstracts, 25 were selected for full-text review, and 8 studies, with 2 controlled studies and 6 case-control studies were identified. Overall cognitive impairment was not significantly different when the results of the 2 prospective studies were pooled (OR: 1.57, 95% CI: 0.50–4.92, P= 0.44), with significant heterogeneity between estimates ( I2: 83%). In retrospective data, the odds of developing any cognitive impairment were significantly higher in men treated with ADT (HR: 1.37, 95% CI: 1.06–1.77, P= 0.02), with considerable heterogeneity ( I2: 84%). Conclusions: The relationship between overall cognitive impairment and use of ADT defined according to the ICCTF criteria in a pooled-analysis of two prospective studies was inconclusive. Although retrospective studies suggest a higher risk of overall cognitive impairment after ADT, we caution readers not to over-interpret this finding given the limitations of retrospective data. Better well-designed prospective studies are needed to assess the effect of ADT on cognitive impairment with long-term follow-up.

Observing later-life health outcomes using a life-course model uncovers critical periods of influence. We investigated the relationship between five multi-component measures of childhood disadvantage (determined by Morton et al., 2022) and risk of cognitive impairment (determined by the Langa-Weir Classification) in later life. Data from the Health and Retirement Study (n= 9,509) were used. We conducted a multivariable parametric survival analysis to examine the relationships between the early life predictors of low socioeconomic status (SES), childhood impairments, risky adolescent behaviors, risky parental behaviors, and childhood chronic illness and the risk of developing later-life cognitive impairment between 2006 and 2016. We found that each additional indicator of low SES, risky adolescent behavior, and impairment in childhood increased the risk of developing cognitive impairment over the 10 years studied (HR=1.14, p < .05; HR=1.15, p < .05; HR=1.19, p < .05). Additional indicators of risky parental behaviors, however, were related to a smaller risk of developing cognitive impairment over time (HR=0.96, p < .05). Childhood chronic illness was not significantly associated with the risk of developing cognitive impairment. These results show that early-life factors might have long-term implications for the development of cognitive impairment in later life and display differential relationships with risk when parsed into competing categories. Measures of disadvantage indicating smaller risk may point to the resilience and plasticity of the brain in early life and highlight the need for the study of multiple life stages in order to track predictors of cognitive impairment throughout the life course.

BACKGROUND: Cumulative blood pressure (BP), which takes into account both the magnitude and duration of BP exposure, is linked to cognitive impairment. However, this association remains unclear in Chinese older adults. The critical level of cumulative BP associated with significantly increased cognitive impairment risk remains elusive. Thus, this study aims to investigate the association between cumulative BP levels and the risk of cognitive impairment in Chinese older adults. METHODS: The Chinese Longitudinal Healthy Longevity Survey (CLHLS) over 16 years was divided into two consecutive sub-cohorts, namely the 2002 sub-cohort from 2002 to 2011 and the 2008 sub-cohort from 2008 to 2018. Cumulative BP exposures were calculated as the area under the curve derived from two consequence BP measurements and their corresponding time intervals. Cognitive impairment was defined according to the years of schooling and total cognitive scores of older adults during the follow-up periods. Hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of cognitive impairment across quartiles of cumulative BP were estimated using multivariable Cox proportional hazard models. Finally, potential dose-response relationships were examined using restricted cubic splines. RESULTS: A total of 2,142 and 1,920 cognitively healthy older adults participants from the two sub-cohorts were included in the analysis, respectively. Over a median follow-up of 6.2 years (IQR 6.1–6.3) and 7.0 years (IQR 6.8–7.2), 542 and 347 older adults experienced cognitive impairment in the two sub-cohorts, respectively. Higher cumulative systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) were significantly associated with a higher risk of cognitive impairment (all Ptrend <0.01). Compared to the lowest quartile in the two sub-cohorts, the HRs (95%CIs) for cognitive impairment risk in the highest quartile were 1.85 (1.33–2.59) and 2.64 (1.76–3.97) for cumulative SBP, 2.00 (1.45–2.75) and 2.20 (1.46–3.33) for cumulative DBP, and 1.59 (1.16–2.18) and 2.10 (1.42–3.10) for cumulative PP, respectively. Linear dose-response patterns were observed for the association between the risks of cognitive impairment with all three cumulative BP levels in both two sub-cohorts. Moreover, cumulative SBP increased from 387.8mm Hg × year to 416.4mm Hg × year over 6 years, whilst cumulative PP increased from 138.7mm Hg × year to 170.8mm Hg × year—equivalent to a mean SBP increase from 131.0mm Hg to 134.8mm Hg and mean PP increase from 46.9mm Hg to 55.3mm Hg—which collectively increased the risk of cognitive impairment. In contrast, cumulative DBP was maintained at 245mm Hg × year over 6 years, whereas the mean DBP progressively decreased from 82.9mm Hg to 79.3mm Hg, showed a significant association with cognitive impairment. CONCLUSIONS: Elevated cumulative SBP, DBP, and PP independently increased subsequent cognitive impairment risk in Chinese older adults.

BackgroundHousework is a crucial aspect of instrumental activities of daily living (IADL), essential for maintaining the independence of older adults. This study aims to explore the association between housework frequency and cognitive impairment by incorporating a multidimensional assessment of cognitive impairment risk factors.MethodsThis study utilized data from the Chinese Longitudinal Health and Longevity Survey (CLHLS, 2014–2018), including 2797 older adults, after excluding individuals aged < 65 years, with cognitive impairment or self-reported dementia, or missing education data at baseline, along with those missing Chinese Mini-Mental State Examination (CMMSE) scores at either baseline or follow-up. Cognitive function was assessed using the education-adjusted CMMSE scores, while housework frequency was classified into three levels. Logistic regression models were employed to examine the association of housework frequency with the risk of cognitive impairment, after adjusting for demographics, living habits, and health-related factors. Further adjustments were made sequentially for baseline CMMSE scores and exercise.ResultsThe risk of cognitive impairment was higher among females, those aged 85 and above and non-exercisers. Compared with those who did housework almost everyday, the risk of cognitive impairment was significantly increased among those who did housework sometimes (OR = 1.50; 95% CI, 1.03–2.17), and even higher among those who never did housework (OR = 1.98; 95% CI, 1.49–2.65) after adjusting for demographics, living habits, and health-related factors. Similar associations were obtained after further adjustments sequentially for baseline CMMSE scores and exercise. In addition, hearing loss, social isolation, and non-smoking were identified as risk factors influencing cognitive impairment. No significant interaction effects were found between age and gender with housework frequency.ConclusionsOur study revealed that Chinese older adults who engaged in less housework had a higher risk of cognitive impairment. Doing housework could serve as a cost-effective strategy to reduce this risk in the context of a healthy aging population in China.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24331-6.

The baby boom generation is approaching the age of greatest risk for cognitive impairment and dementia. There is growing interest in strategies to modify the environment in midlife to increase the probability of maintaining cognitive health in late life. Several potentially modifiable risk factors have been studied in relation to cognitive impairment and dementia in late life, but methodological limitations of observational research have resulted in some inconsistencies across studies. The most promising strategies are maintaining cardiovascular health, engagement in mental, physical, and social activities, using alcohol in moderation, abstaining from tobacco use, and following a heart-healthy diet. Other factors that may influence cognitive health are occupational attainment, depression, personality, exposure to general anesthesia, head injury, postmenopausal hormone therapy, non-steroidal anti-inflammatory medications, and nutritional supplements such as antioxidants. Some long-term observational studies initiated in midlife or earlier, and some randomized controlled trials, have examined the effects of specific cognitive health promotion behaviors in midlife on the risk of cognitive impairment in late life. Overall, these studies provide limited support for risk reduction at this time. Recommendations and challenges for developing effective strategies to reduce the burden of cognitive impairment and dementia in the future are discussed.

To our knowledge, no study has investigated the effect of exposure to formaldehyde on cognition in the general population. Our objective was to examine the association between occupational exposure to formaldehyde and cognitive impairment in middle-aged and young-old adults (≥45 years). In the French CONSTANCES cohort, cognitive function was assessed with a standardized battery of 7 cognitive tests to evaluate global cognitive function, episodic verbal memory, language abilities, and executive functions (e.g., Digit Symbol Substitution Test [DSST]). A global cognitive score was created using principal component analysis. Cognitive impairment was assessed in reference to norms of neuropsychological battery according to age, sex, and education. Lifetime exposure to formaldehyde was assessed using a French Job Exposure Matrix created in the framework of the Matgéné project. After performing multiple imputation, separate modified Poisson regression models were used to evaluate the association between cognitive impairment (<25th percentile) and formaldehyde exposure (exposed/never exposed), exposure duration, cumulative exposure index (CEI), and combination of CEI and time of last exposure. Among 75,322 participants (median age 57.5 years, 53% women), 8% were exposed to formaldehyde during their professional life. These participants were at higher risk of global cognitive impairment (for global cognitive score: adjusted relative risk [aRR] 1.17; 95% confidence interval [CI] 1.11-1.23), after adjusting for confounders (age, sex, education, income, solvent exposure, Effort-Reward Imbalance, night shift, repetitive work, and noisy work). They were at higher risk of cognitive impairment for all cognitive domains explored. Longer exposure duration and high CEI were associated with cognitive impairment, with a dose-effect relationship for exposure duration. Recent exposure was associated with impairment in all cognitive domains. Time did not fully attenuate formaldehyde-associated cognitive deficits especially in highly exposed individuals (for DSST: high past exposure aRR 1.23; 95% CI 1.11-1.36; high recent exposure: aRR 1.24; 95% CI 1.13-1.35). Our findings highlight the long-term detrimental effect of formaldehyde exposure on cognitive health in a relatively young population.

Cardiovascular risk factors increase the risk of dementia in later life. The aims of the current study were to assess the effect of multiple midlife cardiovascular risk factors on the risk of cognitive impairment in later life, and to assess the validity of the previously suggested CAIDE Study risk score predicting dementia risk 20years later. A total of 2,165 Finnish twins were followed and at the end of the follow-up their cognitive status was assessed with a validated telephone interview. The assessment of the risk factors at baseline was based on a self-report questionnaire. Relative risk ratios (RR) were calculated and receiver operating characteristic analyses performed. Midlife obesity (RR 2.42, 95% CI 1.47-3.98), hypertension (RR 1.38, 95% CI 1.01-1.88) and low leisure time physical activity (RR 2.52, 95% CI 1.10-5.76) increased the risk of cognitive impairment after a mean follow-up of 22.6±2.3years. Hypercholesterolemia did not significantly increase the risk (RR 1.52, 95% CI 0.92-2.51). Overweight individuals who gained more than 10% weight between 1981 and 1990 had an increased risk of cognitive impairment (RR 4.27, 95% CI 1.62-11.2). The CAIDE Study risk score combining various individual risk factors had an area-under-curve of 0.74 (95% CI 0.69-0.79, n=591), and there was a strong association between an increasing risk score and the risk of cognitive impairment. The results indicate that multiple midlife cardiovascular risk factors increase the risk of cognitive impairment in later life. Also, a risk score including easily measurable midlife factors predicts an individual's cognitive impairment risk well.

Although associations among insomnia, cognitive impairment, and stroke have been demonstrated, whether insomnia increases the risk of cognitive impairment after stroke remains unclear. The aim ofthis studywasto examine whether insomnia complaints moderated the association between stroke and cognitive impairment in older adults. This study was a secondary data analysis that used data from the National Health Interview Survey 2009. A total of 447 older adults with a mean age of 74.63years (50.1% men) were included. Self-reported insomnia and stroke occurrence were determined using a questionnaire. Cognitive impairment was assessed using the Mini-Mental State Examination. We used multivariate logistic regression to analyze the association between insomnia complaints and cognitive impairment. Participants were categorized into four groups: those with stroke and insomnia (58), those with stroke without insomnia (91), those without stroke with insomnia (116), and those without stroke or insomnia (182). The prevalence of insomnia complaints was 38.9%, and the frequency of poststroke cognitive impairment was 50.3%. After controlling for potential confounders, participants with stroke (with or without insomnia) had a significantly higher risk of cognitive impairment than those without stroke or insomnia (adjusted odds ratios: 4.16 and 2.91, 95% confidence intervals: 1.91-9.07 and 1.56-5.43, respectively). Stroke with or without insomnia complaints was associated with a higher risk of cognitive impairment relative to older adults without stroke or insomnia. The risk of cognitive impairment was the highest among participants with both stroke and insomnia.

Purpose: This study aimed to identify the association between hearing difficulty, masticatory difficulty, and cognitive impairment using data from the Korean Longitudinal Study of Aging. Methods: This secondary data analysis included 6939 Korean adults aged 45 or older with no cognitive impairment at baseline. Self-reported questionnaires measured hearing and masticatory difficulty, and cognitive impairment were assessed using the Korea Mini-Mental State Examination (K-MMSE). Cox models were used to estimate the risk of cognitive impairment associated with the coexistence of hearing and masticatory difficulty.Results: People who coexisted with hearing and masticatory difficulty were 2.4%. The incidence rate of cognitive impairment was 37.7% for the study sample and higher in females than males. Compared to people without hearing and masticatory difficulty, the total study sample with the coexistence of hearing and masticatory difficulty had a higher risk of cognitive impairment (HR: 1.26, 95% CI: 1.03–1.56), females with the coexistence of hearing and masticatory difficulty had a greater risk of cognitive impairment (HR :1.52 95% CI: 1.11–2.09). Conclusion: Coexistence of hearing and masticatory difficulty increased females' cognitive impairment risk. It is recommended to check hearing and masticatory function in a timely, which may be effective in detecting individuals at high risk of cognitive impairment.

Traumatic brain injury (TBI), seizures, and dementia increase with age. There is a gap in understanding the associations of TBI, seizures, and medications such as antiseizure and antipsychotics with the progression of cognitive impairment across racial and ethnic groups. To investigate the association of TBI and seizures with the risk of cognitive impairment among cognitively normal older adults and the role of medications in moderating the association. This multicenter cohort study was a secondary analysis of the Uniform Data Set collected between June 1, 2005, and June 30, 2020, from the National Alzheimer's Coordination Center. Statistical analysis was performed from February 1 to April 3, 2024. Data were collected from participants from 36 Alzheimer's Disease Research Centers in the US who were 65 years or older at baseline, cognitively normal at baseline (Clinical Dementia Rating of 0 and no impairment based on a presumptive etiologic diagnosis of AD), and had complete information on race and ethnicity, age, sex, educational level, and apolipoprotein E genotype. Health history of TBI, seizures, or both conditions. Progression to cognitive impairment measured by a Clinical Dementia Rating greater than 0. Among the cohort of 7180 older adults (median age, 74 years [range, 65-102 years]; 4729 women [65.9%]), 1036 were African American or Black (14.4%), 21 were American Indian or Alaska Native (0.3%), 143 were Asian (2.0%), 332 were Hispanic (4.6%), and 5648 were non-Hispanic White (78.7%); the median educational level was 16.0 years (range, 1.0-29.0 years). After adjustment for selection basis using propensity score weighting, seizure was associated with a 40% higher risk of cognitive impairment (hazard ratio [HR], 1.40; 95% CI, 1.19-1.65), TBI with a 25% higher risk of cognitive impairment (HR, 1.25; 95% CI, 1.17-1.34), and both seizure and TBI were associated with a 57% higher risk (HR, 1.57; 95% CI, 1.23-2.01). The interaction models indicated that Hispanic participants with TBI and seizures had a higher risk of cognitive impairment compared with other racial and ethnic groups. The use of antiseizure medications (HR, 1.23; 95% CI, 0.99-1.53), antidepressants (HR, 1.32; 95% CI, 1.17-1.50), and antipsychotics (HR, 2.15; 95% CI, 1.18-3.89) was associated with a higher risk of cognitive impairment, while anxiolytic, sedative, or hypnotic use (HR, 0.88; 95% CI, 0.83-0.94) was associated with a lower risk. This study highlights the importance of addressing TBI and seizures as risk factors for cognitive impairment among older adults. Addressing the broader social determinants of health and bridging the health divide across various racial and ethnic groups are essential for the comprehensive management and prevention of dementia.

Dietary pattern in midlife and cognitive impairment in late life: a prospective study in Chinese adults