Cognitive Health In Later Life Research Articles

LONGITUDINAL ASSOCIATIONS BETWEEN SPOUSAL LOSS, RELIGIOUS INVOLVEMENT, AND COGNITIVE HEALTH IN LATER LIFE

Abstract Death of a spouse is one of the major stressors which is more frequently observed in one’s late life. Previous literature showed a link between the death of a spouse and late-life cognitive health and suggested a benefit of having more religious involvements. Applying Stress Process Model, this study examines multiple dimensions of religious involvements and whether they buffer a negative impact of spousal loss on cognitive health in old age. Using data from the Health and Retirement Study (2006 – 2016 waves), we selected older adults who were married at baseline (N = 6658). We conducted a) regression analyses to examine the main effect of spousal loss on cognitive health as well as buffering effect of religious involvement and b) growth curve modeling to analyze the trajectories of cognitive functions. Preliminary analyses showed that spousal loss in late life was associated with poorer cognitive function among older adults at baseline and follow-ups. More frequent attendance at religious services and prayer in private setting were associated with better cognitive function, yet, no buffering effect was found. We observed a gradual decline in cognitive function over time among the widowed respondents. Findings confirm that widowed individuals are more likely to experience cognitive decline over time, compared to married counterparts. While religious involvement might not mitigate the negative impact of spousal loss on cognition, the study supports that each dimension of religious involvement may exert different outcomes in terms of older individual’s cognitive health during widowhood.

BIOPSYCHOSOCIAL RISK AND RESILIENCE PATHWAYS IN DEMENTIA INEQUALITIES

Abstract In the United States, racial/ethnic inequalities in Alzheimer's disease and related dementias persist even after controlling for socioeconomic factors and physical health. Persistent and unexplained disparities suggest: (1) there are unrecognized dementia risk factors that are socially patterned and/or (2) known dementia risk factors exhibit differential impact across social groups. This talk will present data from multiple longitudinal studies of brain and cognitive aging to support each possibility. On average, marginalized racial/ethnic groups are more likely than non-Latinx Whites to experience structural and interpersonal discrimination, social and economic constraints, as well as barriers to accessing high quality education. However, these same groups also show evidence of greater psychosocial resilience that is linked to better late-life cognitive health. This talk will demonstrate how specific psychosocial factors can contribute to or offset dementia disparities, illustrate major challenges to this work, and introduce new data collection efforts to advance the field.

THE PSYCHOSOCIAL IMPACT OF COVID-19 ON COGNITIVE AGING ARAB AMERICAN IMMIGRANTS IN MICHIGAN

Abstract This study examines the psychosocial impact of COVID-19 on cognitive aging Middle Eastern/Arab Americans immigrants and refugees in Michigan. Sociopolitical experiences as an immigrant and/or refugee may have unique effects on late-life cognitive health. Given that social engagement reduces the risk of ADRD, this study sought to examine the consequences of COVID-19 socialization restrictions on familial and communal support systems for aging Middle Eastern/Arab immigrants and refugees. Three focus groups discussions with 8-10 participants each (N=31) conducted at local Arab organizations and religious institutions were conducted followed by inductive analysis. Preliminary results indicate two prominent themes: 1) Social and Familial Hardships; and 2) Isolation. Narratives illustrate the prevalence of psychosocial ADRD risk from COVID-19. Findings are discussed within a stress framework to advance universal and unique elements of Arab immigrant and refugee cognitive aging.

Beyond “Use It or Lose It”: The Impact of Engagement on Cognitive Aging

Biologically based senescence processes and cumulative opportunities for experience collectively give rise to profound changes in cognition in later adulthood, the trajectories of which vary considerably across individuals. This review focuses on how cognitive aging is shaped by engagement—defined as the ongoing investment of personal resources (e.g., time, attention) to activities, social networks, and experiences—through the adult life span. We review evidence for the effects of different forms of engagement on cognitive aging and consider plausible mechanistic pathways for such effects. Working within an ecological framework, we consider “design solutions” for lifestyle engagement to shape adult cognitive development given the necessary trade-offs endemic to goal-directed systems (e.g., current needs versus long-term preparation, flexibility versus robustness, exploration versus exploitation). Given the limited evidence for broad-based effects of skill training on late-life cognitive health, we argue that a promising paradigm for successful cognitive aging will be to probe synergistic effects of engagement on cognitive aging. Recent developments in personal technology offer promise for innovation in intervention and in measurement.

Psychological well-being and cognitive aging in Black, Native American, and White Alzheimer's Disease Research Center participants.

Psychological well-being is associated with cognition in later life but has not been examined across diverse populations—including minoritized communities at disproportionately high risk of dementia. Further, most previous work has not been able to examine links between specific facets of psychological well-being and performance within distinct cognitive domains that can capture subclinical impairment. Using a well-characterized sample followed through enrollment in an NIH-funded Alzheimer’s Disease Center, we sought to test these associations within three racial groups at baseline. Participants were N = 529 cognitively unimpaired Black, American Indian/Alaska Native (AI/AN), and white middle-aged and older adults (mean age = 63.6, SD = 8.1, range = 45–88 years) enrolled in the Wisconsin Alzheimer’s Disease Research Center’s Clinical Core. Predictors included validated NIH Toolbox Emotion Battery scales assessing positive affect, general life satisfaction, and meaning and purpose. Outcomes included performance on widely used tests of executive functioning and episodic memory. We conducted race-stratified regression models to assess within-group relationships. Black and AI/AN participants reported lower life satisfaction than white participants. Racial disparities were not observed for positive affect or meaning and purpose scores. Across groups, life satisfaction predicted better executive functioning. Similar associations were observed for positive affect in Black and AI/AN samples but not among whites. In general, well-being measures were not related to performance on tests of episodic memory. Our results highlight well-being as a potentially important determinant of late-life cognitive health, particularly executive functioning, that is modifiable if older adults are connected with appropriate resources and supports. Further, psychological well-being may represent a potent target for brain health interventions tailored for Black and Native communities.

Strategies to Promote Cognitive Health in Aging: Recent Evidence and Innovations.

We review recent work on applications of non-pharmacologic strategies to promote cognitive health in older adulthood and discuss potential network mechanisms, limitations, and considerations for improving intervention uptake and efficacy. In healthy older adults and patients with mild cognitive impairment, cognitive training produces global and domain-specific cognitive gains, though effect sizes tend to be modest and transfer is variable. Non-invasive brain stimulation has shown moderate success in enhancing cognitive function, though the optimum approach, parameters, and cortical targets require further investigation. Physical activity improves cognitive functions in late life, with emerging trials highlighting key intervention components that may maximize treatment outcomes. Multimodal interventions may be superior to single-component interventions in conferring cognitive gains, although interpretation is limited by modest sample sizes and variability in training components and parameters. Across modalities, individual differences in patient characteristics predict therapeutic response. These interventions may advance cognitive health by modulating functional networks that support core cognitive abilities including the default mode, executive control, and salience networks. Effectiveness of cognitive enhancement strategies may be increased with clinician-led coaching, booster sessions, gamification, integration of multiple intervention modalities, and concrete applications to everyday functioning. Future trials involving rigorous comparisons of training components, parameters, and delivery formats will be essential in establishing the precise approaches needed to maximize cognitive outcomes. Novel studies using patient-level clinical and neuroimaging features to predict individual differences in training gains may inform the development of personalized intervention prescriptions to optimize cognitive health in late life.

The role of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment among older Indian adults

Due to different nature of social engagements of older adults in South Asian countries specially attributed to the traditional family-based care and support, beneficial effects of religiosity and religious involvement on mental health and cognitive function in older age might be different than those in the Western world. Yet, there is a paucity of research in these countries on the role of religion in moderating the relationship between late life depression and cognition. This study explored the association of depressive symptoms with cognitive impairment and the moderating effects of religiosity and religious participation in those associations among older Indian adults. A cross-sectional study was conducted on data that were drawn from the Longitudinal Ageing Study in India wave-1, collected during 2017–2018. The sample size comprised of 31,464 older adults aged 60 years and above. Shortened 10-item Centre for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Items from the Mini-Mental State Examination and the cognitive module of the China Health and Retirement Longitudinal Study and the Mexican Health and Aging Study were adapted for measuring cognitive impairment. Moderated multiple linear regression models were used to test the research hypotheses of the study. The proportion of older adults who reported religion as less important to them was 21.24%, whereas, only 19.31% of the respondents participated in religious activities. The mean score of cognitive impairment (on a scale of 0–43) in the current sample was 19.43 [confidence interval (CI): 19.32–19.53] among men and 23.55 [CI: 23.44–23.66] among women. Older adults with depressive symptoms had significantly higher likelihood of cognitive impairment [aCoef: 0.18, CI: 0.16–0.20] in comparison to older adults with no depressive symptoms. Older individuals who were religious were significantly less likely to have cognitive impairment [aCoef: − 0.43, CI: − 0.61 to − 0.25] than their non-religious counterparts. Compared to older adults who did not participate in religious activities, those who participated in religious activities were less likely [aCoef: − 0.52, CI: − 0.69 to − 0.34] to have cognitive impairment. Further, significant moderating effects of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment were observed. The current study contributes to advancing knowledge about the mental health benefits of religiosity and religious participation by focusing on older adults in India who culturally have limited chances to participate in social activities. The findings suggest that older adults with depressive symptoms may participate in religious activities which may reduce their chances of cognitive impairment. This protective effect of religiosity and religious participation on late life cognitive health has important implications for promoting alternative social support mechanisms for older adults in terms of enhancing their mental wellbeing and contributing to active aging.

Does Childbearing Affect Cognitive Health in Later Life? Evidence From an Instrumental Variable Approach.

Cognitive decline is a widespread concern as populations grow older. However, population aging is partly driven by a decrease in fertility, and family size may influence cognitive functioning in later life. Prior studies have shown that fertility history is associated with late-life cognition, but whether the relationship is causal remains unclear. We use an instrumental variable approach and data from the Survey of Health, Ageing, and Retirement in Europe to examine whether having three or more versus two children affects late-life cognition. Parents often prefer to have at least one son and one daughter. We thus exploit the sex composition of the first two children as a source of exogenous variation in the probability of having three or more children. Results indicate that having three or more versus two children has a negative effect on late-life cognition. This effect is strongest in Northern Europe, perhaps because higher fertility decreases financial resources yet does not improve social resources in this region. Future studies should address the potential effects of childlessness or having one child on late-life cognition and explore the mediating mechanisms.

Childhood Stressors, Relationship Quality, and Cognitive Health in Later Life.

The rising prevalence of cognitive impairment, Alzheimer's disease, and related disorders signals the need for a better understanding of how social factors may affect cognitive health for millions of Americans. Drawing from cumulative inequality theory, we aim to understand the implications of a stressful childhood on social relationships and cognitive health in later life. This study utilizes longitudinal data (2006-2016) from the Health and Retirement Study to examine pathways, both direct and indirect through social relationships in adulthood, from childhood stressors to cognitive health trajectories over time. Respondents reporting a greater number of stressors in childhood had worse cognitive health over time, but those negative effects were not as steep as time progressed. Early-life stressors are also associated with less social support and more social strain in adulthood which, in turn, are associated with initial cognitive health. Finally, pathway analyses confirm that childhood stressors are indirectly associated with initial cognitive health through social strain and social support. Findings reveal that a stressful childhood creates chains of risks that have lifelong implications for cognitive health, both directly and indirectly by creating obstacles for developing healthy and supportive social relationships.

Effects of Health-Promoting Lifestyles in Midlife on Cognitive Functioning in Later Life

Maintaining cognitive function in later life is key to healthy aging because cognitive impairments compromise everyday functional abilities, impeding independent living. Numerous studies have discovered early life experiences and lifestyle behaviors over the lifespan to have substantial influences on cognitive functioning with age. Especially, subtle brain changes related to dementia occur as early as midlife, and lifestyle factors in midlife influence neuropathological development, suggesting that midlife is a critical period for preserving cognitive health in later life. This study investigated the association between lifestyle behaviors in midlife and cognitive performance in later life using 12-year follow-up data from the Korean Longitudinal Study on Aging (KLoSA). Cognitive function was assessed with the Harmonized Cognitive Assessment Protocol (HCAP) for KLoSA. Eight thousand respondents from the KLoSA sample were administered HCAP neuropsychological tests. Hierarchical multiple regression analyses were used to examine whether health-promoting lifestyles at baseline (2006) predicted cognitive function in 2018 after controlling for health-related covariates. We identified a positive influence of health-protective behaviors (non-smoking, moderate drinking, regular exercise, weight management, and health screening) at baseline on language abilities in 2018 (β = .05, p < .05). In addition, health-promoting behaviors covering interpersonal relationships, social engagement, optimistic outlook, and positive attitudes at baseline were predictive of language abilities (β = .08, p < .01), executive function (β = .06, p < .01), and the visuospatial ability (β = .06, p < .05) in 2018. This study highlights the importance of midlife health-promoting lifestyles in maintaining cognitive health in later life.

Emerging Telehealth Advances for Mental and Cognitive Health in Late Life

Over the last year, mental health services offered virtually have increased significantly in response to COVID-19. The rapid adoption of telehealth practices has raised many questions about how to develop and deliver effective interventions for older adults targeting their mental and cognitive health. In this symposium, we present on the feasibility of mental and cognitive health interventions for older adults using telehealth methods with particular focus on how adoption of these telehealth tools have been impacted by the current pandemic. Dr. Touchett and colleagues will present data on the telehealth utilization disparities among older veterans with comorbid disabilities and discuss ethical considerations when providing care for older adults. Dr. Kornblith and colleagues will present pilot data on the feasibility of GOALS, a video telehealth cognitive remediation group intervention for older adults with cognitive and emotional dysfunction related to traumatic brain injuries. Dr. Gould and colleagues will present pilot data on the feasibility and preliminary efficacy of a brief video-delivered self-management intervention BREATHE for older veterans with anxiety disorders. Dr. Weiskittle and colleagues will present their work on the development and dissemination of a brief 8-week telephone group intervention for homebound older adults targeting social isolation. Dr. Jacobs and colleagues will share their findings of a telephone delivered mindfulness intervention for caregivers and persons with dementia. Finally, the discussant, Lauren Moo, MD, an expert in assessing the efficacy of telehealth interventions will tie findings together and provide directions for future research and innovation.

Alcohol consumption and cognitive impairment among Chinese older adults: 8‐year follow‐up of Chinese Longitudinal Healthy Longevity Study

AbstractBackgroundThis is the first study examining the association between alcohol consumption and risk of cognitive impairment (CI) among Chinese older adults (65‐79 years).MethodThe study included 5,894 participants between 65 and 79 years from 2002‐2008 Chinese Longitudinal Healthy Longevity Study (CLHLS). The CI was assessed by Chinese version of Mini‐Mental State Examination (MMSE) . The self‐reported alcohol type and consumption were assessed and converted into pure alcohol consumption in gram. The adjusted cox proportional hazard model was implemented with age as time scale. With abstainers as the reference, hazard ratio (HR) for cognitive impairment was calculated for five levels of alcohol consumption (former drinker, 0.1‐175.0 g for male/0.1‐105.0 g for female per week, 175.1‐350.0 g for male/105.1‐210.0g for female per week, 350.1‐525.0 g for male/210.1‐315.0 g per week, &gt;525.0 g for male/&gt;315.0 g for female per week).Result837 (14.2%) participants developed CI in the follow‐up waves with mean follow‐up of 7.9 (SD 4.6, range 0.17‐17.3) years. There was no evidence that low‐to‐moderate alcohol consumption (0.1‐175.0 g for male/0.1‐105.0 g for female per week) was associated with increased risk of CI (HR: 1.25, 95% CI: 0.91‐1.74); however, heavy alcohol use (&gt;525.0 g for male/&gt;315.0 g for female per week) was associated with increased risk of CI (HR: 1.37, 95% CI: 1.01‐1.84). Compared with abstainers, former drinkers had higher risk of cognitive impairment (HR: 1.50, 95% CI: 1.17‐1.92). In addition, among former drinkers, previous consumption of alcohol above 175.0 g/week for male and 105.0 g/week for female was associated with higher incidence of dementia (HR: 1.61, 95% CI: 1.22‐2.11).ConclusionExcess alcohol consumption in men (&gt;525.0 g/week) and in women (&gt;315.0 g/week) are both significantly associated with increased risk of CI. There is no evidence that low‐to‐moderate alcohol drinking had protective effect against CI. Among former drinkers, heavy drinkers have higher risk of CI compared to non‐drinkers, suggesting heavy consumption of alcohol negatively influences one’s cognitive health in later life even after abstinence. Further investigation is required to determine whether these relationships are mediated by specific environmental or genetic factors.

Exposure to Air Pollution in Relation to Risk of Dementia and Related Outcomes: An Updated Systematic Review of the Epidemiological Literature.

Background:Dementia is a devastating neurologic condition that is common in older adults. We previously reviewed the epidemiological evidence examining the hypothesis that long-term exposure to air pollution affects dementia risk. Since then, the evidence base has expanded rapidly.Objectives:With this update, we collectively review new and previously identified epidemiological studies on air pollution and late-life cognitive health, highlighting new developments and critically discussing the merits of the evidence.Methods:Using a registered protocol (PROSPERO 2020 CRD42020152943), we updated our literature review to capture studies published through 31 December 2020, extracted data, and conducted a bias assessment.Results:We identified 66 papers (49 new) for inclusion in this review. Cognitive level remained the most commonly considered outcome, and particulate matter (PM) remained the most commonly considered air pollutant. Since our prior review, exposure estimation methods in this research have improved, and more papers have looked at cognitive change, neuroimaging, and incident cognitive impairment/dementia, though methodological concerns remain common. Many studies continue to rely on administrative records to ascertain dementia, have high potential for selection bias, and adjust for putative mediating factors in primary models. A subset of 35 studies met strict quality criteria. Although high-quality studies of fine particulate matter with aerodynamic diameter () and cognitive decline generally supported an adverse association, other findings related to and findings related to particulate matter with aerodynamic diameter (, , and ) were inconclusive, and too few papers reported findings with ozone to comment on the likely direction of association. Notably, only a few findings on dementia were included for consideration on the basis of quality criteria.Discussion:Strong conclusions remain elusive, although the weight of the evidence suggests an adverse association between and cognitive decline. However, we note a continued need to confront methodological challenges in this line of research. https://doi.org/10.1289/EHP8716

Long-term Ozone Exposure and Cognitive Impairment among Chinese Older Adults: Analysis of the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND AND AIM: Increasing evidence points to an association between PM₂.₅ exposure and late-life cognitive health, but little is known about whether ambient ozone exposure affects cognitive functioning. This study aimed to examine the association of long-term ozone exposure with risk of cognitive impairment among older adults in China. METHODS: We used longitudinal data from five waves (2005, 2008-2009, 2011-2012, 2014, and 2017-2018) of the Chinese Longitudinal Healthy Longevity Survey. In total, 9,544 participants (aged 81.4 ± 10.8 years at baseline, 48.3% male) with normal cognitive function at the baseline surveys from March 2005 to November 2014 were included in this analysis. The ozone exposure of each participant was estimated by the cumulative annual average ozone concentration for the county of residence. Cognitive function was assessed by the Chinese version of the Mini-Mental State Examination (MMSE). We used a cutoff MMSE score below 18 points with an additional restriction of MMSE decline ≥ 4 points from baseline to define cognitive impairment. A Cox proportional hazard model was utilized to explore the association of ozone exposure with cognitive decline. RESULTS:During an average observation time of 6.5 years (62,133 person-years), 2,601 participants developed cognitive impairment. Preliminary results show that each 10-μg/m³ increase in ozone was associated with a 13.1% increased risk of cognitive impairment [95% confidence interval (CI): 6.8%, 19.8%]. No evidence was found for a threshold down to 70 μg/m³. The association between ozone exposure and risk of cognitive impairment was stronger for men than women (p-value for interaction: 0.03). CONCLUSIONS:Long-term exposure to ozone was associated with an increased risk of cognitive impairment among Chinese older adults. Reducing ambient ozone pollution may delay cognitive decline among older adults in China. KEYWORDS: Ozone, Long-term exposure, Neurodegenerative outcomes

Does Rural Living in Early Life Increase the Risk for Reduced Cognitive Functioning in Later Life?

There is a robust consensus, most recently articulated in the 2020 Lancet Commission, that the roots of dementia can be traced to early life, and that the path to prevention may start there as well. Indeed, a growing body of research demonstrates that early life disadvantage may influence the risk for later life dementia and cognitive decline. A still understudied risk, however, is early life rural residence, a plausible pathway given related economic and educational disadvantages, as well as associations between later life rural living and lower levels of cognitive functioning. We aim to examine whether living in rural environments during early life has long term implications for cognitive health in later life. We employed the Wisconsin Longitudinal Study, which tracked 1 in every 3 high school graduates from the class of 1957, from infancy to ∼age 72. The data include a rich array of prospectively collected early life data, unique among existing studies, as well as later life measures of cognitive functioning. We found a robust relationship between early life rural residence, especially living on a farm, and long-term risk for reduced cognitive performance on recall and fluency tasks. Controls for adolescent cognitive functioning, APOEɛ2 and APOEɛ4, as well as childhood and adult factors, ranging from early life socioeconomic conditions to later life health and rural and farm residency, did not alter the findings. Rural living in early life is an independent risk for lower levels of cognitive functioning in later life.

Psychosocial Protective Factors in Cognitive Aging: A Targeted Review.

The lack of disease-modifying pharmacological agents for dementia highlights the critical importance of prevention, but known modifiable factors (e.g., education, physical health and health behaviors, depression, and social isolation) do not fully represent potential intervention targets. Positive psychosocial factors predict cognitive aging outcomes above and beyond known risk factors and may also correspond to upstream determinants that open up new avenues for prevention and intervention, as well as for reducing racial/ethnic inequalities in dementia. In this brief report, I summarize contemporary evidence for three positive psychosocial factors that appear to be particularly relevant to cognitive aging: perceived control, religious involvement, and social relations. Targeted review and synthesis of published studies. Each of the multidimensional constructs appears to contain "active ingredients" that could help to optimize cognitive aging through disparate mechanisms. Although historically marginalized racial/ethnic groups face disproportionate barriers to accessing certain psychosocial protective factors (e.g., perceived control), these same groups also exhibit naturally occurring sources of psychosocial resilience (e.g., religious involvement) that allow them to achieve better late-life cognitive health than would be otherwise expected. With regard to social relations, converging evidence from disparate studies shows that fostering late-life friendships in particular may have high potential for building cognitive reserve and promoting healthy cognitive aging. Positive psychosocial factors represent culturally relevant resources that, through careful research, could ultimately be harnessed to promote better cognitive aging for a growing and increasingly diverse population of older adults.

A national longitudinal study of marital quality and cognitive decline among older men and women

We provide one of the first national longitudinal studies of the association between trajectories of marital quality and cognitive functioning among older adults, with close attention paid to gender differences. Data were drawn from the Health and Retirement Study (HRS) 2006–2016. Marital quality trajectories were assessed at three waves: 2006/2008, 2010/2012, and 2014/2016. Cognitive trajectories were assessed at five waves: 2008, 2010, 2012, 2014, and 2016. The final analytic sample included 7901 respondents age 50 and older (4334 men and 3567 women) who were either married or cohabiting during the study period. Results from parallel linear growth curve models suggest that among older adults, initial positive marital quality was associated with better initial cognition, and initial negative marital quality was associated with worse initial cognition. Results from multiple group analysis further suggest that marital quality was significantly associated with men's cognitive trajectories but not women's. Among men, an increase in positive marital quality was associated with a slower rate of cognitive decline, whereas an increase in negative marital quality was associated with a faster rate of cognitive decline. These findings suggest that older men who experience a decline in marital quality may be vulnerable to cognitive decline and that reducing marital strain and improving marital quality may protect men's cognitive health in later life.

Cognitive Performance Trajectories Before and After Sleep Treatment Initiation in Middle-Aged and Older Adults: Results From the Health and Retirement Study.

Sleep disturbances are associated with risk of cognitive decline but it is not clear if treating disturbed sleep mitigates decline. We examined differences in cognitive trajectories before and after sleep treatment initiation. Data came from the 2006-2014 Health and Retirement Study (HRS). At each of 5 waves, participants were administered cognitive assessments and scores were summed. Participants also reported if, in prior 2 weeks, they had taken medications or used other treatments to improve sleep. Our sample (N = 3 957) included individuals who at HRS 2006 were 50 years and older, had no cognitive impairment, reported no sleep treatment, and indicated experiencing sleep disturbance. We identified differences between those receiving versus not receiving treatment in subsequent waves and, among those treated (n = 1 247), compared cognitive trajectories before and after treatment. At baseline, those reporting sleep treatment at subsequent waves were more likely to be younger, female, Caucasian, to have more health conditions, to have higher body mass index, and more depressive symptoms (all ps ≤ .015). Decline in cognitive performance was mitigated in periods after sleep treatment versus periods before (B = -0.20, 95% CI = [-0.25, -0.15], p < .001 vs B = -0.26, 95% CI = [-0.32, -0.20], p < .001), and this same trend was seen for self-initiated and doctor-recommended treatments. Trends were driven by those with higher baseline cognitive performance-those with lower performance saw cognitive declines following sleep treatment. In middle-aged and older adults with sleep disturbance, starting sleep treatment may slow cognitive decline. Future research should assess types, combinations, and timing of treatments most effective in improving cognitive health in later life.

Measuring Cognitive Health in Ethnically Diverse Older Adults.

Understanding racial/ethnic disparities in late-life cognitive health is a public health imperative. We used baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study to examine how age, education, gender, and clinical diagnosis, a proxy for brain health, are associated with cross-sectional measures of cognition in diverse racial/ethnic groups. Comprehensive measures of cognition were obtained using the Spanish and English Neuropsychological Assessment Scales and the National Institutes of Health Toolbox Cognitive Health Battery in a sample of 1,695 KHANDLE participants (Asians 24%, Blacks 26%, Latinos 20%, Whites 29%). A 25% random subsample was clinically evaluated and diagnosed with normal cognition, mild cognitive impairment (MCI), or dementia. Cognitive test scores were regressed on core demographic variables and diagnosis in the combined sample and in multiple group analyses stratified by racial/ethnic group. Race/ethnicity and education were variably associated with test scores with strongest associations with tests of vocabulary and semantic memory. Older age was associated with poorer performance on all measures, and gender differences varied across cognitive tests. Clinical diagnosis of MCI or dementia was associated with average decrements in test scores that ranged from -0.41 to -0.84 SD, with largest differences on tests of executive function and episodic memory. With few exceptions, associations of demographic variables and clinical diagnosis did not differ across racial/ethnic groups. The robust associations of cognitive test results with clinical diagnosis independent of core demographic variables and race/ethnicity support the validity of cognitive tests as indicators for brain health in diverse older adults.

Associations Between Loneliness, Reading Ability and Episodic Memory in Non-Hispanic Black and White Older Adults.

Reading ability reflects a variety of beneficial life course exposures and may better index these exposures above and beyond education in racially diverse samples. Growing evidence suggests a negative impact of perceived loneliness on late-life cognitive health when parsing out the effect of other aspects of social relations. Few studies have examined how loneliness interacts with the reading ability or whether it operates differently in Black older adults who have higher dementia risk than Whites. Participants in this cross-sectional study were drawn from the Washington Heights-Inwood Columbia Aging Project (n=425 older adults, Mage=74.23; 58% Black). Linear regressions estimated the main effects and interactions involving reading ability, loneliness, and race (non-Hispanic Black vs. non-Hispanic White) on episodic memory, controlling for age, sex/gender, and years of education. Subsequent models additionally controlled for income, employment status, depressive symptoms, disease burden, marital status, social network size, and number of social groups. Higher reading ability was associated with better memory, but loneliness was not associated with memory. The positive association between reading ability and memory was weaker among individuals with greater loneliness, and this interaction did not differ by race. Loneliness may suppress the protective effect of higher reading ability on cognitive health among both Black and White older adults. Future longitudinal work is needed to clarify causal relationships among loneliness, reading ability, and memory decline.