Late-life Cognition Research Articles

Music experience predicts episodic memory performance in older adult instrumental musicians

ObjectivePrevious research suggests that there is a relationship between music lessons early in life and cognitive functioning in late life. The current study examined 1) how lifestyle factors, including music lessons, physical and social activity, and health predict late life cognition and 2) how unique music training variables (e.g., hours practiced, years in lessons, age of acquisition) predicted cognitive scores for older adults. MethodsParticipants completed a neuropsychological battery examining major cognitive domains, and completed questionnaires on music experience, physical and social activity, and physician diagnosed health factors. ResultsResults suggested that belonging to the musician group predicted scores on executive functioning, language, and visual spatial ability. Among instrumental musicians, number of years in formal training and current number of hours playing per week predicted scores on verbal memory. Age of acquisition was not a significant predictor of cognitive functioning. ConclusionsMusic training significantly predicted scores on tests of executive function, visual spatial ability, and language, above and beyond other variables, including current age and health and lifestyle factors. The number of years of formal training predicted scores on verbal learning and memory, with significant implications for aging. The results are discussed in the context of cognitive aging and music education.

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.

Explaining the association between social and lifestyle factors and cognitive functions: a pathway analysis in the Memento cohort

BackgroundThis work aimed to investigate the potential pathways involved in the association between social and lifestyle factors, biomarkers of Alzheimer’s disease and related dementia (ADRD), and cognition.MethodsThe authors studied 2323 participants from the Memento study, a French nationwide clinical cohort. Social and lifestyle factors were education level, current household incomes, physical activity, leisure activities, and social network from which two continuous latent variables were computed: an early to midlife (EML) and a latelife (LL) indicator. Brain magnetic resonance imaging (MRI), lumbar puncture, and amyloid-positron emission tomography (PET) were used to define three latent variables: neurodegeneration, small vessel disease (SVD), and AD pathology. Cognitive function was defined as the underlying factor of a latent variable with four cognitive tests. Structural equation models were used to evaluate cross-sectional pathways between social and lifestyle factors and cognition.ResultsParticipants’ mean age was 70.9 years old, 62% were women, 28% were apolipoprotein-ε4 carriers, and 59% had a Clinical Dementia Rating (CDR) score of 0.5. Higher early to midlife social indicator was only directly associated with better cognitive function (direct β = 0.364 (0.322; 0.405), with no indirect pathway through ADRD biomarkers (total β = 0.392 (0.351; 0.429)). In addition to a direct effect on cognition (direct β = 0.076 (0.033; 0.118)), the association between latelife lifestyle indicator and cognition was also mostly mediated by an indirect effect through lower neurodegeneration (indirect β = 0.066 (0.042; 0.090) and direct β = − 0.116 (− 0.153; − 0.079)), but not through AD pathology nor SVD.ConclusionsEarly to midlife social factors are directly associated with higher cognitive functions. Latelife lifestyle factors may help preserve cognitive functions through lower neurodegeneration.

The Association of Vasomotor Symptoms During the Menopausal Transition and Cognition in Later Life (P1-1.Virtual)

The Association of Vasomotor Symptoms During the Menopausal Transition and Cognition in Later Life (P1-1.Virtual)

APOE ε4 and late-life cognition: mediation by structural brain imaging markers.

The apolipoprotein E allele 4 (APOE-ε4) is established as a major genetic risk factor for cognitive decline and late-onset Alzheimer's disease. Accumulating evidence has linked ε4 carriership to abnormal structural brain changes across the adult lifespan. To better understand the underlying causal mechanisms, we investigated the extent to which the effect of the ε4 allele on cognition is mediated by structural brain imaging markers in the population-based Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-Reykjavik). This study included 4527 participants (aged 76.3 ± 5.4 at baseline) who underwent the brain magnetic resonance imaging assessment (of brain tissue volumes, white matter lesion volume, subcortical and cortical infarcts, and cerebral microbleeds) and a battery of neuropsychological tests at baseline. Causal mediation analysis was used to quantify the mediation of the ε4 effect on cognition by these MRI markers, both individually and jointly. We observed that about 9% of the total effect of ε4 carriership on cognition was mediated by white matter lesion volume. This proportion increased to 25% when total brain tissue volume was jointly considered with white matter lesion volume. In analyses separating ε4 homozygotes from ε4 heterozygotes, the effect on global cognition of specifically ε4 homozygosity appeared to be partially mediated by cerebral microbleeds, particularly lobar microbleeds. There was no evidence of mediation of the ε4 effect by cortical or subcortical infarcts. This study shows that the ε4 effect on cognition is partly mediated by white matter lesion volume and total brain tissue volume. These findings suggest the joint role of cerebral small vessel disease and neurodegeneration in the ε4-cognition relationship.

The Mediating Role of Cardiometabolic Dysregulation on the Relation Between Adverse Childhood Experiences and Adult Cognition.

Adverse childhood experiences (ACEs) are uncontrollable stressful events during early life that predispose adults to adverse health outcomes, such as impaired cognitive functioning. However, little is known about the factors indirectly impacting this relation. Biological dysregulation may be one pathway that can help explain the relations between ACEs and later cognition. The current study examined the mediating role of cardiometabolic dysregulation on the relation between ACEs and cognition. Our study gathered data from 1053 participants using three waves of the Midlife in the United States longitudinal study. Linear regression analyses and bootstrapped mediation analyses were performed to analyze the direct and indirect associations of cardiometabolic dysregulation on ACEs and cognition. Our results showed a significant linear relationship between ACEs and cardiometabolic dysregulation ( b = 0.152, standard error [SE] = 0.056, p = .007), and a significant indirect association, such that cardiometabolic dysregulation mediated the relation between ACEs and cognitive status at wave II ( b = -0.007, SE = 0.004, p = .044) and cognitive status at wave III ( b = -0.006, SE = 0.003, p .042). There was no significant direct or indirect relation when cognitive change was the outcome variable. The present study identifies a combined biological pathway that connects ACEs to cognition in late life. These findings supports the need to empirically determine biological mechanism that can be used to develop targeted clinical interventions to prevent the progression of chronic cognitive impairment.

Exploring the Relationship Between Engagement in Enriching Early-Life Activities During Adolescence and Cognition in Later-Life: Results From the Health and Retirement Study.

The cognitive benefits associated with mid- to late-life engagement have been demonstrated in several studies. However, the link between engagement in enriching early-life activities (EELAs) during adolescence and later-life cognition has been relatively unexplored in major epidemiological studies. We examined the EELA-cognition relationship in a nationally representative sample of adults aged 50+. A subset of Health and Retirement Study respondents (n=3482) completed cognitive tests and returned a retrospective early-life activity inventory. Linear regression models analyzed the EELA-cognition relationship, and multiple imputation addressed missingness. Each additional EELA was associated with a 0.36 point higher cognitive score (95% CI: 0.24, 0.47). This relationship remained significant after adjusting for potential confounders (B=0.16; 95% CI: [0.06, 0.26]). EELA engagement was associated with better later-life cognitive performance. This study is understood to be the first to examine the EELA-cognition relationship using a large, nationally representative dataset. The findings highlight the importance of early-life engagement during an important developmental period (e.g., adolescence).

Intergenerational Socioeconomic Mobility and Cognitive Impairment Among Chinese Older Adults: Gender Differences.

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.

How much of the female disadvantage in late-life cognition in India can be explained by education and gender inequality

In social environments characterized by high levels of gender inequality, women fare worse than men in human capital accumulation and health. We examine the association of gender inequality with female disadvantage in late-life cognitive function, using newly available data from Wave 1 (2017–2019) of the Longitudinal Aging Study in India (LASI), representative of the Indian population over the age of 45. We find a substantial female gap in cognition among mid-aged and older adults in India; early life socioeconomic conditions and education explain up to 74 percent of the female disadvantage in cognition, and model predictions suggest that it takes nine years of education on average to overcome this deficit. However, further contextualizing the environment, we find that the level of education at which differences in late-life cognition between women and men become negligible increases with the degree of gender inequality.

Race, Childhood Socioeconomic Status, and Region of Childhood Residence as Intersectional Life-Course Predictors of Cognitive Aging in the United States.

Background and ObjectivesRace, childhood socioeconomic status (cSES), and region of childhood residence are each associated with later-life cognition, but no studies have examined how the confluence of these factors influences later-life cognitive performance. Guided by intersectionality theory, we examined individuals’ social positionality across these dimensions as a predictor of cognitive performance in later life among non-Hispanic White (NHW) and non-Hispanic Black (NHB) older adults.Research Design and MethodsWe used data from the 2010–2016 waves of the Health and Retirement Study with participants aged 65 and older in 2010. We employed growth curve modeling to estimate associations among race, cSES, and region of childhood residence, as well as their interactions, and cognitive performance at baseline and over time.ResultsIdentifying as NHB, residing in the South, and having lower cSES each were associated with poorer later-life cognition at baseline. Childhood residence in the South was an especially strong risk factor for poorer cognition among NHBs. Among NHWs, higher cSES was associated with better baseline cognitive performance, especially among those from the South. NHBs from the South demonstrated a small advantage of higher cSES, but regardless of cSES, NHBs from the South had lower levels of baseline cognitive scores compared to all other subgroups. We observed steeper declines in cognitive performance over the 6-year study period among participants who lived in the South as children.Discussion and ImplicationsOur findings suggest that intersectional social positions across race, cSES, and region of childhood residence primarily influence baseline cognition in later life. Results implicate the importance of attention to multiple life-course social positions in the context of racism within social policies and other initiatives to promote equity in later-life brain health.

The Association Between Adverse Childhood Experiences and Late-Life Cognition: A Systematic Review of Cross-Sectional and Case-Control Studies.

Adverse childhood experiences (ACEs) are a recognized risk factor for unfavorable health outcomes. No prior systematic review has explored the association between ACEs and cognition in late life, a critical period for cognitive fluctuation. The objective of this review is to address the following research question: What is the association between ACEs and late-life cognition? Articles were obtained from PubMed, PsycINFO, and Scopus. The last search was performed in May 2021. Eligible articles examined the association between exposure to at least 1 ACE and the outcome of late-life cognition, measured either by cognitive testing or the presence/absence of a neurocognitive disorder. Data were synthesized narratively using the synthesis without meta-analysis guidelines, and the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Adapted NOS. Twenty articles representing 18 unique studies were included in the narrative synthesis. Associations with lower late-life cognition were reported for: childhood maternal death, parental divorce, physical neglect, emotional neglect, physical abuse, and combinations of ACEs. However, most results were statistically nonsignificant, and many were unlikely to be clinically important. We found an association between ACEs and late-life cognition. However, the direction and magnitude of association varied between and within types of ACEs and measures of cognitive function. Most included articles had a moderate risk of bias. This review is the first attempt to synthesize the literature on this topic and it outlines the next steps to improve the evidence base in the area.

APOE Effects on Late Life Cognitive Trajectories in Diverse Racial/Ethnic Groups.

This study evaluated: (1) apolipoprotein E (APOE) ϵ4 prevalence among Black, Latino, and White older adults, (2) associations of APOE ϵ4 status with baseline level and change over time of cognitive outcomes across groups, and (3) combined impact of APOE ϵ4 prevalence and magnitude of effect on cognitive decline within each racial/ethnic group. Participants included 297 White, 138 Latino, and 149 Black individuals from the longitudinal UC Davis Diversity Cohort who had APOE genotyping and ≥2 cognitive assessments. Magnitude of associations of ϵ4 with cognitive baseline and change across racial/ethnic groups was tested with multilevel parallel process longitudinal analyses and multiple group models. ϵ4 prevalence in Black (46%) and White participants (46%) was almost double that of Latino participants (24%). ϵ4 was associated with poorer baseline episodic memory only in White participants (p=.001), but had a moderately strong association with episodic memory change across all racial/ethnic groups (Blacks=-.061 SD/year, Latinos =-.055,Whites=-.055). ϵ4 association with semantic memory change was strongest in White participants (-.071), intermediate in Latino participants (-.041), and weakest in Black participants (-.022). Calculated cognitive trajectories across racial/ethnic groups were influenced in an additive manner by ϵ4 prevalence and strength of association with cognitive decline within the group. Group differences in ϵ4 prevalences and associations of ϵ4 with cognition may suggest different pathways from APOE to cognitive decline, and, AD possibly having less salient impact on cognitive decline in non-White participants. Differential effects of APOE on episodic memory and non-memory cognition have important implications for understanding how APOE influences late life cognitive decline.

Neighborhood built environments and cognition in later life

Objectives: Maintaining good cognition is crucial in later life. However, most existing research has focused on individual factors impacting cognition, and few studies have investigated the association between neighborhood built environment and older adults’ cognition. This study examined the association between neighborhood built environment and cognition among community-dwelling older adults and identified variations in this association between different age groups in the older population. Methods: Data were derived from a cross-sectional survey of 1873 people aged 65 years and above in Hong Kong. We merged individual data from the survey with neighborhood built environment data based on community auditing and geographical information system. After controlling for individual covariates, we used multivariable linear regression to examine the association between neighborhood built environment and cognition. Results: Residents aged 80 and younger in neighborhoods with a higher land-use mix and more public transport terminals exhibited better cognition. Only the number of community centers in a neighborhood was positively associated with cognition for people older than 80. Conclusion: The built environment creates diverse impacts on different age groups among older adults. Our findings provide useful information for urban planners and policymakers for planning community facilities and built environments that consider the needs of different age groups within the older population.

Education as a moderator of middle-age cardiovascular risk factor-old-age cognition relationships: testing cognitive reserve hypothesis in epidemiological study.

Backgroundhigher educational attainment and less midlife cardiovascular risk factors are related to better old-age cognition. Whether education moderates the association between cardiovascular risk factors and late-life cognition is not known. We studied if higher education provides resilience against the deteriorative effects of higher middle-age body mass index (BMI) and a combination of midlife cardiovascular risk factors on old-age cognition.Methodsthe study population is the older Finnish Twin Cohort (n = 4,051, mean age [standard deviation, SD] = 45.5 years [6.5]). Cardiovascular risk factors and education were studied at baseline with questionnaires in 1975, 1981 and/or 1990 (participation rates of 89, 84 and 77%, respectively). Cognition was evaluated with telephone interviews (participation rate 67%, mean age [SD] =73.4 [2.9] years, mean follow-up [SD] = 27.8 [6.0] years) in 1999–2017. We studied the main and interactive effects of education and BMI/dementia risk score on late-life cognition with linear regression analysis. The study design was formulated before the pre-defined analyses.Resultsyears of education moderated the association between BMI with old-age cognition (among less educated persons, BMI-cognition association was stronger [B = −0.24 points per BMI unit, 95% CI −0.31, −0.18] than among more educated persons [B = −0.06 points per BMI unit, 95% CI −0.16, 0.03], Pinteraction < 0.01). There was a similar moderating effect of education on dementia risk score consisting of cardiovascular risk factors (P < 0.001).Conclusionsour results support the cognitive reserve hypothesis. Those with higher education may tolerate the deteriorative effects of midlife cardiovascular risk factors on old-age cognition better than those with lower education.

Pulmonary Function in Midlife as a Predictor of Later-Life Cognition: The Coronary Artery Risk Development in Adults (CARDIA) Study.

Studies found associations between pulmonary function (PF) and cognition, but these are limited by mostly cross-sectional design and a single measure of PF (typically forced expiratory volume in 1 second [FEV1]). Our objective was to prospectively analyze the association of repeatedly measured PF with cognition. We studied 3 499 participants in the Coronary Artery Risk Development in Young Adults cohort with cognition measured at year 25 (Y25) and Y30, and PF (FEV1 and forced vital capacity [FVC], reflecting better PF) measured up to 6 times from Y0 to Y20. Cognition was measured via Stroop test, Rey-Auditory Verbal Learning Test [RAVLT], and digit symbol substitution test [DSST], which capture executive function, verbal learning and memory, and attention and psychomotor speed, respectively; lower Stroop, and higher RAVLT and DSST scores indicate better cognition. We modeled linear, cross-sectional associations between cognition and PF at Y30 (mean age 55), and mixed models to examine associations between cognition at Y25-Y30 and longitudinal PF (both annual rate of change, and cumulative PF from Y0 to Y20). At Y30, FEV1 and FVC were cross-sectionally associated with all 3 measures of cognition (β = 0.08-0.12, p < .01-.02). Annual change from peak FEV1/FVC ratio was associated with Stroop and DSST (β = 18.06, 95% CI = 7.71-28.40; β = 10.30, 95% CI = 0.26-20.34, respectively), but not RAVLT. Cumulative FEV1 and FVC were associated with Stroop and DSST (β = 0.07-0.12, p < .01-.02), but only cumulative FEV1 was associated with RAVLT (β = 0.07, 95% CI = 0.00-0.14). We identified prospective associations between measures of PF and cognition even at middle ages, adding evidence of a prospective association between reduced PF and cognitive decline.

Effect of childhood proximity to lead mining on late life cognition

IntroductionLead exposure negatively affects cognitive functioning among children. However, there is limited evidence about whether exposure to lead in early life impairs later life cognitive functioning. MethodsParticipants in the prospective Wisconsin Longitudinal Study cohort (N = 8583) were linked to the 1940 Census, which was taken when they were young children. We estimated the effect of living near a lead mine in childhood on late life memory/attention and language/executive function in 2004 (mean age 64) and 2011 (mean age 71). ResultsLead-exposed children had significantly steeper memory/attention decline between 2004 and 2011 and worse language/executive function at baseline in late life. These long-term effects of lead were not mediated through adolescent IQ or late life SES and health factors. DiscussionProximity to lead mining in childhood had long-term effects on late life memory/attention decline and language/executive function, reflecting a possible latent influence of lead exposure. More research is needed to understand behavioral and biological pathways underlying this relationship.

Association of Social Integration with Cognitive Status in a Multi-Ethnic Cohort: Results From the Kaiser Healthy Aging and Diverse Life Experiences Study.

We evaluated overall and race-specific relationships between social integration and cognition in older adults. Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) cohort participants included 1343 Asian, Black, Latino, or non-Latino White Kaiser Permanente Northern California members. We estimated the effect of social integration on verbal episodic memory, semantic memory, and executive function derived from the Spanish and English Neuropsychological Assessment (SENAS) Scales. Social integration scores included marital status; volunteer activity; and contact with children, relatives, friends, and confidants. We estimated covariate-adjusted linear mixed-effects models for baseline and 17-month follow-up cognition. Social integration was associated with higher baseline cognitive scores (average = 0.066 (95% confidence interval: 0.040, 0.092)) overall and in each racial/ethnic group. The association did not vary by race/ethnicity. Social integration was not associated with the estimated rate of cognitive change. In this cohort, more social integration was similarly associated with better late-life cognition across racial/ethnic groups.

Sex-specific effects of prenatal undernutrition on resting-state functional connectivity in the human brain at age 68

Prenatal nutrition may significantly impact brain aging. Results from the Dutch Famine Birth Cohort indicated that prenatal undernutrition is negatively associated with cognition, brain volumes, perfusion and structural brain aging in late life, predominantly in men. This study investigates the association between prenatal undernutrition and late-life functional brain network connectivity. In an exploratory resting-state functional magnetic resonance imaging study of 112 participants from the Dutch Famine Birth Cohort, we investigated whether the within- and between-network functional connectivity of the default mode network, salience network and central executive network differ at age 68 in men (N = 49) and women (N = 63) either exposed or unexposed to undernutrition in early gestation. Additionally, we explored sex-specific effects. Compared to unexposed participants, exposed participants revealed multiple clusters of different functional connectivity within and between the three networks studied. Sex-specific analyses suggested a pattern of network desegregation fitting with brain aging in men and a more diffuse pattern of group differences in women. This study demonstrates that associations between prenatal undernutrition and brain network functional connectivity extend late into life.

Relationship of Blood Pressure and White Matter Hyperintensity Burden With Level of and Change in Cognition in Older Black Adults.

Elevations in blood pressure (BP) and associated white matter hyperintensities (WMHs) are chronic comorbid conditions among older Black adults. We investigated whether WMHs modify the association between late-life BP and cognition within older Black adults. A total of 167 Black adults (age, ~75 years; without dementia at baseline) participating in neuroimaging studies at the Rush Alzheimer's Disease Center were evaluated for BP markers of cardiovascular health, including systolic BP, diastolic BP, pulse pressure, mean arterial pressure (MAP), and hypertension, and were assessed for global and domain-specific cognition at baseline and annually for up to 8 years. WMHs adjusted for intracranial volume were quantified at baseline. Models adjusted for relevant confounders and the interaction of these variables with time revealed differential associations between BP markers and baseline cognition; however, only elevated diastolic BP predicted faster cognitive, that is, episodic memory, decline (estimate = -0.002, standard error = 0.0009, p = .002). Although WMH burden did not modify the association between diastolic BP and episodic memory decline, it did interact with diastolic BP to lower episodic memory at baseline (estimate = -0.051, standard error = 0.012, p = .0001); that is, greater WMHs combined with higher diastolic BP resulted in the lowest baseline episodic memory scores. A similar profile was noted for WMHs, MAP, and baseline episodic memory. Hypertension was neither associated with cognition nor modified by WMH burden after multiple comparisons correction. Late-life diastolic BP was associated with faster rates of episodic memory decline in older Black adults; together with higher WMH burden, it (and MAP) lowered the point at which individuals begin their course of decline toward pathological aging.

Rural/urban dwelling across the life-course and late-life cognitive ability in Mexico

BackgroundUrban advantages in older adults’ cognitive function have been observed. Less is known about early-life urban dwelling and late-life cognition. We evaluate how rural/urban dwelling throughout life and rural to urban shifts in life relate with cognition in Mexico, a country experiencing aging and urbanization. MethodsData came from the 2003 and 2012 Mexican Health and Aging Study (n = 12,238 adults age 50+). Early-life urban dwelling was self-reported. Late-life urban dwelling was based on population size of respondents’ community of residence (community 2500+ people) at the time of survey. Cognitive function was measured across several cognitive tasks. We assess differences in baseline cognitive function and nine-year decline across groups using a latent change score model. ResultsCross-sectionally, compared to always rural dwellers, rural-urban transitions were associated with cognitive benefits, though individuals residing in urban areas continuously through life exhibited the highest levels of cognitive function (β = 0.89, 95% CI: 0.83, 0.96) even after adjusting for SES, health, and health behaviors (β = 0.28, 95% CI: 0.22, 0.35). Longitudinally, always urban dwellers exhibited slower decline than always rural dwellers when adjusting for baseline cognition (β = 0.11, 95% CI: 0.03, 0.18), though faster decline when baseline cognition was not adjusted (β = −0.11, 95% CI: -0.18, −0.04). No differences were observed for cognitive change across comparison groups after adjusting for potential mechanisms. ConclusionsEarly- and late-life urban dwelling may result in cognitive advantages for older Mexican adults. Clinicians should consider where individuals resided throughout life to better understand a patient's likelihood of experiencing poor cognitive outcomes.