Aging, Demographics, And Memory Study Research Articles

Clusterization of Behavioral and Psychological Symptoms of Dementia as Assessed by Neuropsychiatric Inventory: A Case Against the Use of Principal Component Analysis.

The term Behavioral and Psychological Symptoms of Dementia (BPSD) covers a group of phenomenologically and medically distinct symptoms that rarely occur in isolation. Their therapy represents a major unmet medical need across dementias of different types, including Alzheimer's disease. Understanding of the symptom occurrence and their clusterization can inform clinical drug development and use of existing and future BPSD treatments. The primary aim of the present study was to investigate the ability of a commonly used principal component analysis to identify BPSD patterns as assessed by Neuropsychiatric Inventory (NPI). NPI scores from the Aging, Demographics, and Memory Study (ADAMS) were used to characterize reported occurrence of individual symptoms and their combinations. Based on this information, we have designed and conducted a simulation experiment to compare Principal Component analysis (PCA) and zero-inflated PCA (ZI PCA) by their ability to reveal true symptom associations. Exploratory analysis of the ADAMS database revealed overlapping multivariate distributions of NPI symptom scores. Simulation experiments have indicated that PCA and ZI PCA cannot handle data with multiple overlapping patterns. Although the principal component analysis approach is commonly applied to NPI scores, it is at risk to reveal BPSD clusters that are a statistical phenomenon rather than symptom associations occurring in clinical practice. We recommend the thorough characterization of multivariate distributions before subjecting any dataset to Principal Component Analysis.

MECHANISMS OF CHANGE IN COGNITIVE FUNCTION DOMAINS IN OLDER ADULTS

Abstract It is crucial to gain a better understanding of these relationships in order to have a more comprehensive understanding of cognitive abilities over time and how interventions can target multiple domains to improve overall cognitive function. This study aimed to investigate the mechanism of changes in cognitive function domains in phenotypic networks. This study used data from the Aging, Demographics, and Memory Study (ADAMS) in Wave A and Wave B. We assessed 12 cognitive function domains. Latent profile transition analysis (LPTA) and cross-lagged panel network model were employed to the dynamic interactions of the 12 cognitive function domains over time in both the deterioration and improvement groups. A total of 252 participants were included in the final analysis. LPTA identified five subgroups and categorized all samples into three main categories: improvement group (n=61), deterioration group (n=54), and no change group (n=137). “D9: psychomotor processing” showed the largest value of out-strength in the deterioration group (r=0.941) and improvement group (r=0.969). The strongest direct positive effect in the deterioration group was “C9: psychomotor processing” -> “C8: attention” (β=0.39). In the improvement group, the strongest direct positive effect was “C9=psychomotor processing” -> “C7=visual memory” (β=0.69). Psychomotor processing can affect other cognitive domains, and it plays a crucial role in changes of cognitive function. The paths of psychomotor processing to attention and visual memory were found to be major factors in cognitive deterioration and improvement. Targeting psychomotor processing may lead to the development of more effective and precise interventions.

Mechanisms of Change in Cognitive Function Domains Among Older Adults in Cognitive Deterioration and Improvement Groups: Evidence From Phenotypic Network Structure

ObjectiveTo investigate how cognitive function domains change in phenotypic networks in cognitive deterioration and improvement groups. DesignSecondary data analysis. Setting and ParticipantsRespondents in the Aging, Demographics, and Memory Study (ADAMS) who were 70 years or older at the time of the data collection in 2000 or 2002. MethodsThis study used data from the ADAMS in Wave A and Wave B. We assessed 12 cognitive function domains. Latent profile transition analysis (LPTA) and the cross-lagged panel network model were used to the dynamic interactions of the 12 cognitive function domains over time in both the deterioration and improvement groups. ResultsA total of 252 participants were included in the final analysis. LPTA identified 5 subgroups and categorized all samples into 3 main categories: improvement group (n = 61), deterioration group (n = 54), and no change group (n = 137). “D9: psychomotor processing” showed the largest value of out-strength in the deterioration group (r = 0.941) and improvement group (r = 0.969). The strongest direct positive effect in the deterioration group was “C9: psychomotor processing” -> “C8: attention” [β = 0.39 (0.00, 1.13)]. In the improvement group, the strongest direct positive effect was “C9 = psychomotor processing” -> “C7 = visual memory” [β = 0.69 (0.07, 1.30)]. Conclusion and ImplicationsPsychomotor processing affected other cognitive domains, and it played a crucial role in changes of cognitive function. The paths of psychomotor processing to attention and visual memory were found to be major factors in cognitive deterioration and improvement. Targeting psychomotor processing may lead to the development of more effective and precise interventions.

Sensory impairment and cognitive decline among older adults: An analysis of mediation and moderation effects of loneliness.

Multiple studies have reported that hearing and vision impairment are linked to cognitive decline. Yet little is known about factors that may influence the association between sensory impairment and cognitive decline. This study examined if loneliness mediates or moderates the impact of sensory impairment on cognitive decline as individuals age. This was a longitudinal study using data from the Health and Retirement Study (HRS) and The Aging, Demographics, and Memory Study (ADAMS) (N = 243). We used one timepoint of hearing and vision (ADAMS 2006-2008), one timepoint of loneliness (HRS 2006-2008), and five waves of cognition (HRS 2006-2014). Hearing impairment was defined by an inability to hear pure-tone stimuli of 25 dB at frequencies between 0.5 and 4.0 kHz in either ear. Visual impairment was defined as having corrected binocular vision worse than 20/40. Longitudinal parallel-process (LPP) analysis was conducted at a significance level of α = 0.05 (one-tailed). Loneliness moderated but did not mediate the association between visual impairment and the rate of cognitive decline (standardized β =-0.108, p < 0.05). No moderation or mediation effect of loneliness was found for the association between hearing impairment and cognitive decline. Both vision and hearing impairment were significantly associated with increased severity of loneliness. Visual impairment combined with an elevated level of loneliness may produce a more synergistic, deleterious impact on older adults' cognitive function than visual impairment alone. This study highlights the importance of promoting a healthy social and psychological status for older adults with sensory impairment.

Patterns of sleep disturbances across stages of cognitive decline.

The purpose of this study was to investigate insomnia symptoms and excessive sleep/sluggishness across stages of cognitive decline (cognitively normal [CN], Cognitively Impairment, Not Demented [CIND], dementia) in a large, racially/ethnically diverse sample of older adults (70+) in the US. We also examined whether sleep disturbances at baseline predicted conversion to CIND or dementia at follow-up. In this secondary analysis of the Aging, Demographics, and Memory Study (ADAMS) supplement of the Health Retirement Study, we analyzed patterns of informant-reported insomnia and excessive sleep symptoms among three groups of older adults (n=846): CN, CIND, and dementia. CIND adults were significantly more likely to have informant-reported insomnia symptoms than those in the CN group (p=0.013). This was driven by a significant race/ethnicity-by-insomnia interaction with diagnostic status (p=0.029), such that CIND Black and Hispanic older adults had increased insomnia symptom rates compared to CN, whereas White adults had similar insomnia symptoms across diagnostic status. Across all racial/ethnic groups, the prevalence of excessive sleep symptoms increased stepwise from CN to CIND to dementia (p<0.001). Overall, insomnia symptoms at baseline predicted conversion from CN to CIND (p<0.001, OR=0.288; 95% CI: 0.143-0.580) at 4-year (approximate) follow-up; there was no relationship between baseline insomnia or excessive sleep/sluggishness symptoms and conversion from CIND to dementia. This study provides evidence for the increased risk of insomnia symptoms among Hispanic and Black older adults with CIND, and indicates that insomnia symptoms may be associated with increased risk for development of cognitive impairment.

Predictors of who Serves as an Alzheimer's Disease Research Participant's Study Partner and the Impact of their Relationship on Study Partners' Reports on Participants.

Background: Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) research typically requires participants to enroll with a "study partner" (SP). Little is known about what predicts who steps into the SP role or whether the SP's relationship to the participant affects their reports of disease severity.Methods: Health and Retirement Study data (HRS), collected prior to the Aging, Demographics and Memory Study (ADAMS), was used to identify sociocultural factors that predict who serves as a SP in ADAMS. SP-reported outcomes were compared between three types of participant-SP relationships: spousal, adult child, and other.Results: Spouses (35%) and adult children (39%) were similarly likely to serve as SPs. Factors predicting who served differed. In multivariable analyses, adult children rated participants less impaired than spouses on measures of memory, judgment, and organizational abilities (p < .05). Conclusions: The participant-SP relationship has independent effects on the SP's reports of the severity of cognitive impairments.

Vision, Cognitive Impairment, and Dementia in the Aging, Demographics, and Memory Study

Vision impairment (VI) is common in late-life and may be a modifiable risk factor for cognitive decline and dementia. In this study, using data from the population-based Aging, Demographics and Memory Study (ADAMS), we analyzed the association of VI with cognitive impairment no dementia (CIND) and dementia. We found that VI (binocular presenting acuity <20/40) was significantly associated with incident CIND (OR=3.5, 95% CI=1.4-8.9, p=0.008) and dementia (OR=1.8, 95% CI=1.0-3.1, p=0.040) after adjusting for age. However, among those with CIND, VI was not associated with dementia (OR=0.9, 95% CI=0.4-1.8, p=0.733). The association between VI and CIND remained significant in models fully adjusted for demographic and health factors (OR=2.7, 95% CI=1.0-7.5, p=0.049). We conclude that VI is associated with development of CIND but not with subsequent onset of dementia. These findings suggest that the association between VI and dementia is driven by the elevated risk of dementia among those with CIND.

Patterns Among Same-Sex Spousal Couples: Diverse Sociocultural Representation in Alzheimer’s Research

Emerging evidence shows that understanding characteristic patterns between study partners (SP) and subjects can inform initiatives to diversify representation of sociocultural groups in ADRD research. This study examined same-sex spousal dyads with the goal of identifying bellwethers of opportunities to build diversity in ADRD research. Descriptive analysis of The Aging, Demographics and Memory Study (ADAMS), which enrolled a subset of subjects from the Health and Retirement Study and a SP for each subject. Eight same-sex spousal couples were among 718 SP-subject dyads (1.1%). Gay men were 3 times as likely to be spousal SPs (n=6) than lesbians (n=2), even though women far outnumber men overall. Patterns in caregiving and other characteristics also differed. Same-sex couples are underrepresented in ADRD research. Patterns among those enrolled suggest masculine and feminine norms may drive research engagement. This is discussed in the context of increasing sociocultural diversity in ADRD research across key social groups.

The longitudinal association of vision impairment with transitions to cognitive impairment and dementia

AbstractBackgroundVision impairment (VI) has been identified as a potentially modifiable risk factor for dementia. However, it is not known at what stage of cognitive decline VI exerts an effect. The purpose of this study was to determine whether VI increases the risk of transitions from normal to cognitive impairment no dementia (CIND) and/or from CIND to dementia. These findings may inform understanding of mechanistic processes, as well as the development and implementation of future dementia prevention interventions.MethodWe used longitudinal data including visual acuity and cognitive status from the population‐based Aging, Demographics and Memory Study (ADAMS), a sample drawn from the U.S. Health and Retirement Study. The covariate‐adjusted associations between VI (binocular distance visual acuity &lt;20/40) and odds of cognitive transitions (normal to CIND, CIND to dementia) were evaluated using a series of multivariable logistic regression models.ResultA total of 351 ADAMS participants without dementia at baseline were included (49.6% female, mean age 79.3 years, 21.7% with VI). Of these, 92 participants transitioned from normal to CIND and 76 transitioned from CIND to dementia during the course of the study. The odds of a transition from normal to CIND were 2.7 (95% CI 1.0‐7.5) times greater among those with VI, whereas the odds of a transition from CIND to dementia were not significantly associated with VI (OR= 0.8, 95% 0.4‐1.8).ConclusionThis study indicates that poor vision is associated with transitions from normal to CIND but not from CIND to dementia, suggesting that the impact of VI is greatest early in the process of cognitive decline.

APOE ε4 allele status similarly predicts a latent dementia index as clinical diagnosis of dementia

AbstractBackgroundLatent dementia index (LDI) variables are increasingly popular, mainly because they make it possible to quantify a continuous measure of dementia risk using cognitive and functional ability variables when no clinical gold standard is available. Validation studies of LDI variables tend to include clinical gold standard outcomes and demographic variables (e.g., age and gender). No studies to date, however, have validated LDI variables using APOE ε4 allele status. To the extent that effects are similar, we can claim greater convergent validity of the LDI. The purpose of this study is evaluate whether effects of APOE ε4 allele status on LDI is similar to effects of e4 status on clinical gold standard.MethodThe study included 856 participants from the 2001‐2003 Aging, Demographics, and Memory Study (ADAMS), a subsample from the United States Health and Retirement Study. Respondents completed a comprehensive neuropsychological battery, including tests evaluating cognitive ability across multiple cognitive domains (such as memory, executive function, orientation, attention, spatial ability, and language). Informants provided data on functional ability. The LDI was modeled as a latent variable indicated by task specific cognitive scores and functional ability tasks. Lower LDI scores indicate greater risk of dementia. APOE status was an ordinal variable to indicate the absence (0 alleles) or presence (1 or 2 alleles) of ε4 allele status. Clinical gold standard was determined by neuropsychological assessment, which included medical, functioning, cognitive, and physical exams. Regression analyses were performed to test the correlation between APOE ε4 allele status and both measures of dementia.ResultAPOE ε4 allele status significantly predicted clinical gold standard (OR: 1.44 [.95CI: 1.23, 1.69]). APOE ε4 allele status also significantly predicted LDI (β = ‐0.15, SE =0.04, p &lt; .001). APOE ε4 allele status accounted for approximately half the amount of the variance in LDI (2%) as in clinical gold standard (3.6%).ConclusionBased on the similarity of the effects of APOE ε4 allele status on LDI and clinical gold standard, the LDI appears to be a valid continuous proxy measure of dementia.

The Longitudinal Association of Vision Impairment With Transitions to Cognitive Impairment and Dementia: Findings From the Aging, Demographics and Memory Study.

Vision impairment (VI) is associated with incident cognitive decline and dementia. However, it is not known whether VI is associated only with the transition to cognitive impairment, or whether it is also associated with later transitions to dementia. We used data from the population-based Aging, Demographics and Memory Study (ADAMS) to investigate the association of visual acuity impairment (VI; defined as binocular presenting visual acuity <20/40) with transitions from cognitively normal to cognitive impairment no dementia (CIND) and from CIND to dementia. Multivariable Cox proportional hazards models and logistic regression were used to model the association of VI with cognitive transitions, adjusted for covariates. There were 351 participants included in this study (weighted percentages: 45% male, 64% age 70-79 years) with a mean follow-up time of 4.1 years. In a multivariable model, the hazard of dementia was elevated among those with VI (hazard ratio = 1.63, 95% confidence interval = 1.04-2.58). Participants with VI had a greater hazard of transitioning from cognitively normal to CIND (hazard ratio = 1.86, 95% confidence interval = 1.09-3.18). However, among those with CIND and VI a similar percentage transitioned to dementia (48%) and remained CIND (52%); there was no significant association between VI and transitioning from CIND to dementia (hazard ratio = 0.94, 95% confidence interval = 0.56-1.55). Using logistic regression models, the same associations between VI and cognitive transitions were identified. Poor vision is associated with the development of CIND. The association of VI and dementia appears to be due to the higher risk of dementia among individuals with CIND. Findings may inform the design of future interventional studies.

Sensory Loss and Cognitive Decline among Older Adults: An Analysis of Mediation and Moderation Effects of Loneliness

Multiple studies have reported that hearing and vision loss are linked to cognitive decline. Yet little is known about factors that may influence the association between sensory loss and cognitive decline. This study examined if loneliness mediates or moderates the impact of sensory loss on cognitive decline as individuals age. This was a longitudinal study using data (N = 243) from the Health and Retirement Study (HRS) (2006 – 2014) and its supplement: The Aging, Demographics, and Memory Study (ADAMS) (Wave C). Hearing loss was defined by an inability to hear pure-tone stimuli of 25 dB at frequencies between 0.5 – 4.0 kHz in either ear. Vision loss was defined as having corrected binocular vision worse than 20/40. Loneliness was measured by the 3-item UCLA Loneliness Scale. Longitudinal parallel-process (LPP) analysis was conducted at a significance level of α = .05 (one-tailed). Loneliness moderated but did not mediate the associations between vision loss and the rate of cognitive decline (standardized β = -.108, p < .05). No moderation or mediation effect of loneliness was found for the association between hearing loss and cognitive decline. Both hearing and vision loss were significantly associated with increased severity of loneliness. Vision loss combined with an elevated level of loneliness may produce a more synergistic, deleterious impact on older adults’ cognitive function than vision loss alone. This study highlights the importance of promoting a healthy social and psychological status for older adults with vision loss.

Validation of a latent dementia index in the Aging, Demographics, and Memory Study

AbstractBackgroundLongitudinal studies of aging often lack clinical gold standard measures of dementia and instead rely on nondiagnostic approaches to categorizing study participants as demented or cognitively normal. Recently, latent variable models have been used to estimate latent dementia indexes (LDI) using cognitive ability, memory, and functional ability measures to distinguish dementia risk from general cognitive functioning. The LDI exhibits clinical utility and puts dementia risk on a continuous scale, to approximate the process of becoming demented. The purpose of the current study is to validate an LDI in the Aging, Demographics, and Memory Study (ADAMS) using participants’ neuropsychological assessment and functional ability scores.MethodWe evaluated the 2001‐2003 ADAMS including 856 adults age 65+ who had participated in the United States Health and Retirement Study (HRS). ADAMS respondents were given an extensive neuropsychological battery of tests spanning various cognitive domains and provided information on functional abilities. We analyzed cognitive tasks (trails A&amp;B, digits forward/backward, Shipley VocabularyTest, delayed 10‐word recall, recognition memory, and logical memory) and functional tasks (difficulty with household tasks, using familiar appliances, shopping independently, ability with complicated tasks, and handling small sums of money). Using confirmatory factor analysis, we modeled the LDI by performance on cognitive, memory, and functional ability reports. Validation involved comparing the LDI to the diagnosis of dementia made by a consensus panel including neuropsychologists, neurologists, geropsychiatrists, and internists.ResultsA single factor LDI model fit the data well (Comparative Fit Index = .96; Root Mean Square Error of Approximation = .05, .90CI: [.03, .06]). The LDI significantly predicted clinical gold standard diagnosis (OR = .55, .95CI = [.50, .60]), with LDI scores +1 SD above the LDI mean predicting .36 times lower odds of dementia and LDI scores ‐1 SD below the mean predicting 2.78 times greater odds of dementia.ConclusionAn LDI that does not rely on clinical gold standard dementia diagnoses has good clinical utility in the ADAMS 2001‐2003 sample. Future research includes validating LDI scores longitudinally in ADAMS and extending the LDI approach to the HRS core sample.

What predicts who becomes a study partner in an AD cohort study?

AbstractBackgroundStudies of persons with Alzheimer’s disease (AD) and related dementias typically include “study partners” (SPs) who report on participants’ wellbeing and function. But little is known about what factors predict the type of person who steps into the role. Knowing this will inform barriers to recruitment into AD research. It may also offer a model to anticipate who will be a caregiver in early diagnosis and treatment of AD.MethodsWe analyzed data from the Health and Retirement Study’s (HRS) Aging, Demographics and Memory Study (ADAMS). ADAMS enrolled a subset of individuals in HRS and, for each of these subjects, a SP. HRS data were collected one year prior to the first ADAMS interview and provided a detailed family record of all living, legal and biologic, relatives and a spouse’s rating of their own health. ADAMS data provided who served as a SP reporting on subject instrumental and basic activities of daily living (IADL/BADL). Three distinct regression models examined how psychosocial factors predicted each of the three SP types: spouse, adult child, and other.ResultsAmong subjects with spouses, multivariable analyses showed subject’s age and having a sister predicted that a spouse was less likely to serve as SP (both p&lt;0.05). Among subjects with children, being a women, being older, having more children, more impairments in IADLS, and not having a spouse predicted that an adult child was more likely to serve as SP (all p&lt;0.05). Having a spouse, more children, and having more years of education predicted that a non‐spousal and non‐child person was more likely to serve as SP while being a woman and having a daughter were associated with a lower probability that a non‐spouse and non‐child served as SP (all P&lt;0.05).ConclusionsDifferent factors predict the type of person who may serve as a SP. Our findings show patterns in interpersonal relatedness, educational attainment, and gender norms that may underlie differences in decisions about who serves as SP. This information may help inform recruitment and retention in AD research.

How does what study partners report differ based on their relationship to the primary subject?

AbstractBackgroundStudies of persons with Alzheimer’s disease (AD) and related dementias typically require “study partners” (SPs) to report on the subject’s wellbeing and function. But little is known about how who a SP is might impact on these reports. Knowing this may help inform the interpretation of AD research.MethodsWe analyzed data from 730 older adults and their SPs enrolled in the Aging, Demographics and Memory Study (ADAMS). SPs provided data on their assessment of subjects’ functioning through the following: (1) the Blessed Dementia Rating Scale (BDRS), a multi‐domain informant measure of functional capacity; (2) three single‐item ratings of the subject’s “memory at the present time,” ability “in making judgments and decisions,” and ability to “organize his/her daily activities”; (3) instrumental/basic activities of daily living (IADL/BADL) scales. Subject cognition was assessed in an independent neuropsychological assessment using the mini‐mental status exam (MMSE), Trails A/B, Serial 7s, Boston Naming, and Animal Fluency. Bivariate and multivariable regression analyses were used to examine differences in SP reports based on their relationship to the subject. Demographics of SPs and subjects were also analyzed.ResultsOf SPs, 34.9% (n=255) were spouses, 38.4% (n=281) were adult children, and 26.6% (n=194) had a different relationship to the subject. In bivariate models, adult children were more likely to be college educated and provide care to the subject than spouses. In bivariate analyses, adult children rated subjects as more impaired on the BDRS and single‐item measures of memory, judgment and organizational abilities than did spouses(p&lt;0.05). In multivariable analyses that controlled for differences in cognitive and functional performances, adult children, on average, rated subjects as less impaired on measures of memory, judgment, and organizational abilities than spouses(p&lt;0.05). But, reporting varied in subgroups; in cognitively unimpaired subjects (MMSE&gt;28), only 63.0% of child SPs reported a BDRS that indicated lack of impairment while 90.8% of spousal SPs did so (p&lt;0.05).ConclusionsSpouses and adult children are similarly likely to serve as SPs, but there are differences in how they report on subject functioning. Our findings have important implications for interpreting informant reports, particularly, of persons with no or mild cognitive impairment.

Does an advanced statistical technique perform better than a simple technique for dementia prediction?

AbstractBackgroundCox regression models (CM) employ two strong assumptions: the proportional hazards (PH) and the log‐linearity (LL) of covariates. These assumptions might not hold for all predictor variables, which in turn can lead to biased results. (Abrahamowicz et al., 1997; Ritchie et al., 2016). Generalised Cox regression models (GCM) enable to independently test and relax the assumptions of CM (Abrahamowicz &amp; MacKenzie, 2007).MethodData is used from the Survey of Health, Ageing and Retirement in Europe (SHARE), which includes around 140,000 individuals aged 50 or older followed over seven waves. Data from The Aging, Demographics, and Memory Study (ADAMS) is used for external validation. CM and GCM are used to estimate dementia risk.ResultNone of the predictor included in the analyses fulfils the assumptions of Cox regression. The pseudo R2 is 0.06 (95% CI: 0.047, 0.062; CM) and 0.493 (95% CI: 0.460, 0.506; GCM). The likelihood ratio test results in a p‐value of &lt;0.001. Both models predict dementia moderately well (10‐year risk: 0.737; 95% CI: 0.695, 0.783; CM and 0.746; 95% CI: 0.711, 0.790; GCM).ConclusionThe GCM performs significantly better than the CM in modelling dementia risk. However, this approach has also disadvantages: larger sample needed, only visual examination of effects, long computational time possible. Yet, the generalised Cox regression is an interesting extension of the Cox regression. The option to relax and independently test the assumptions is especially appealing when including continuous variables.

Longitudinal Association Between Hearing Loss, Vision Loss, Dual Sensory Loss, and Cognitive Decline.

To better understand the role of sensory loss as a potentially modifiable risk factor for cognitive decline, this study examined cognitive decline in relation to single modality hearing or vision loss and dual sensory loss. Longitudinal secondary data analysis. The Health and Retirement Study (HRS) and its supplement: The Aging, Demographics, and Memory Study (ADAMS). Individuals aged 73 and older (N = 295). Hearing loss was defined by an inability to hear sounds of 25 dB at frequencies between 0.5 and 4.0 kHz in either ear. Vision loss was defined as having corrected binocular vision worse than 20/40. Dual sensory loss was defined as having both hearing and vision loss. We used one time point of hearing and vision data objectively measured in ADAMS Wave C (June 2006-May 2008) and five waves of cognitive function data measured by the HRS version of the Telephone Interview for Cognitive Status in HRS (2006-2014). Multilevel mixed models were used. Among the participants, 271 completed a hearing assessment and 120 had hearing loss; 292 completed a vision assessment and 115 had vision loss; 52 had dual sensory loss. Older adults with hearing loss had a significantly faster rate of cognitive decline as they aged compared to those with normal hearing (β = -0.16, P < .05). No significant association was found between vision loss and the rate of cognitive decline (β = -0.06, P = .41). Older adults who had dual sensory loss likewise had a significantly faster rate of cognitive decline as they age (β = -0.23, P < .05) compared to those with no sensory loss. Older adults with hearing loss and dual sensory loss have faster rates of cognitive decline than those with normal sensory function.

Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia

Introduction: Formal dementia ascertainment with research criteria is resource-intensive, prompting the growing use of alternative approaches. Our objective was to illustrate the potential bias and implications for study conclusions introduced through the use of alternate dementia ascertainment approaches. Methods: We compared dementia prevalence and risk factor associations obtained using criterion-standard dementia diagnoses to those obtained using algorithmic or Medicare-based dementia ascertainment in participants of the baseline visit of the Aging, Demographics, and Memory Study (ADAMS), a Health and Retirement Study (HRS) sub-study. Results: Estimates of dementia prevalence derived using algorithmic or Medicare-based ascertainment differ substantially from those obtained using criterion-standard ascertainment. Use of algorithmic or Medicare-based dementia ascertainment can, but does not always, lead to risk factor associations that substantially differ from those obtained using criterion-standard ascertainment. Discussion/Conclusions: Absolute estimates of dementia prevalence should rely on samples with formal dementia ascertainment. The use of multiple algorithms is recommended for risk factor studies when formal dementia ascertainment is not available.

Multiple chronic conditions and risk of cognitive impairment and dementia among older Americans: findings from the Aging, Demographics, and Memory Study (ADAMS)

ABSTRACT This study examined the relationship between multiple chronic conditions (MCC) and risk of cognitive impairment with no dementia (CIND) and dementia among older Americans. A sample of 637 individuals aged 70 or older was drawn from the Aging, Demographics, and Memory Study, a supplementary dataset of the larger national Health and Retirement Study. Multinomial logistic regression analysis was conducted to investigate the association between MCC and cognition categorized as (a) no cognitive impairment, (b) CIND, or (c) dementia. Having MCC, particularly three or more chronic conditions, was significantly related to being diagnosed with CIND in our study, but not dementia. Our findings suggest that the presence of MCC may be a risk factor for cognitive impairment in later life. However, further investigation using a longitudinal design is needed to better understand the mechanism of how MCC may be related to CIND and dementia among older adults in the United States.

MULTIPLE CHRONIC CONDITIONS AND RISK OF DEMENTIA AND COGNITIVE IMPAIRMENT

This study explores the relationship between the presence of multiple chronic condition and risk of dementia and cognitive impairment with no dementia (CIND) among older Americans. The study sample included 617 participants aged 70 years and older from the Aging, Demographics, and Memory Study (ADAMS). An expert consensus panel of the ADAMS data provided each participant a cognitive diagnosis into 1) no cognitive impairment, 2) CIND, or 3) dementia. The presence of multiple chronic condition was defined as having three or more chronic conditions in this study (e.g., heart attack, stroke, respiratory problems, cancer, hypertension, diabetes). Functional limitation, depression, cognitive activity engagement, apolipoprotein E (ApoE), and sociodemographic characteristics were included as covariates. A multinomial logistic regression analysis showed that individuals who have multiple chronic conditions have increased odds of being diagnosed with CIND versus no cognitive impairment controlling for other covariates. However, multiple chronic condition was not associated with increased risk of being diagnosed with dementia versus no cognitive impairment. Conclusion: The finding suggests that the presence of multiple chronic conditions may be a risk factor for cognitive impairment in later life. However, further investigation using a longitudinal design is needed to better understand the relationship between cognition and multiple chronic conditions.