Midlife Cohort Research Articles

Prevalence and incidence of pelvic organ prolapse, bowel and urinary dysfunction in the Integrated Woman's Health Program

ObjectiveDespite its high prevalence, little information is available on the natural history of pelvic floor dysfunction. We aimed to determine the prevalence, incidence and persistence of pelvic organ prolapse (POP), bowel and urinary symptoms over 6–7 years and its associated factors. Study designWomen from a midlife cohort in Asia completed baseline and 6–7-year follow-up assessments. Sociodemographic characteristics and health conditions were obtained at baseline using validated questionnaires. Body mass index (BMI) and physical performance were objectively measured. Main outcome measuresPOP, bowel, and urinary dysfunction were measured using the Pelvic Floor Distress Inventory Short Form 20 at both timepoints. Binary logistic regression was used to analyze independent associations between baseline risk factors and prevalent, new, and persistent symptoms. ResultsOf the 1201 women enrolled at baseline, 62.3 % had symptoms in at least one domain of pelvic floor dysfunction. Poor sleep, poorer perceived health, and disability were associated with prevalent pelvic floor symptoms, while poor sleep doubled the adjusted risk of incident POP (adjusted odds ratio, aOR: 2.3, 95 % Confidence Interval: 1.4–3.9), bowel (aOR: 2.3, 1.4–3.7) and urinary (aOR: 1.7, 1.1–2.9) symptoms at the 6.6-year follow-up visit. Postmenopausal women had reduced risks of prevalent POP (aOR: 0.5, 0.3–0.7) and urinary symptoms (aOR: 0.4, 0.3–0.6), as well as a reduced risk of developing incident urinary symptoms (aOR: 0.4, 0.2–0.8). Good physical performance scores at baseline reduced the risk of incident bowel symptoms (aOR: 0.5, 0.2–0.9), whereas obesity increased the risks of persistent symptoms. ConclusionPoor sleep quality independently predicted incident pelvic floor dysfunction, while poor physical performance was associated with incident bowel symptoms.

White Matter Hyperintensities and Microstructural Alterations in Contact Sport Athletes from Adolescence to Early Midlife.

Studies have demonstrated associations between cumulative concussion and repetitive head impact exposure (RHI) via contact sports with white matter (WM) alterations later in life. The course of WM changes associated with exposure earlier in the lifespan are unclear. This study investigated alterations in white matter (WM hyperintensity [WMH] volume and microstructural changes) associated with concussion and RHI exposure from adolescence to early midlife, as well as the interaction between exposure and age-cohort (i.e., adolescent/young adult compared to early midlife athlete cohorts) on WM outcomes. Participating football players included an adolescent/young adulthood cohort (n=82; Mage=18.41.7) and an early midlife cohort (37 former collegiate players approximately 15-years removed from sport; Mage=37.71.4). Years of football participation and number of prior concussions were exposures of interest. White matter outcomes included log-transformed manually segmented total WMH volume and neurite orientation dispersion and density imaging metrics of microstructure/organization (isotropic volume fraction[Viso], intra-cellular volume fraction[Vic], and orientation dispersion[OD]). Regression models were fit to test effects of concussion history, years of football participation, and age-cohort by years of football participation with WM outcomes. Spearman's correlations assessed associations between significant WM metrics and measures of cognitive and psychological function. A significant age-cohort by years of participation effect was observed for whole brain white matter OD, B=-0.002, SE=0.001, p=0.001. The interaction was driven by a negative association between years of participation and OD within the younger cohort, B=-0.001, SE=0.0004, p=0.008, whereas a positive association between participation and OD in the early midlife cohort, B=0.001, SE=0.0003, p=0.039, was observed. Follow-up ROI analyses showed significant interaction effects for OD in the body of the corpus callosum, genu of the corpus callosum, cingulum, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, posterior thalamic radiation (ps<0.05). Greater concussion history was significantly associated with greater Viso in the early midlife cohort, B=0.001, SE= 0.0002, p=0.010. Years of participation and concussion history were not associated with WMH volume, ps>0.05. Performance on a measure of executive function was significantly associated with years of participation, =.34, p=.04, and a trend was observed for OD, =.28, p=.09 in the early midlife cohort only. The global characterization of white matter changes associated with years of football participation were broadly similar and stable from adolescence through early midlife (i.e., microstructural alterations, but not macroscopic lesions). An inverse association between years of participation and orientation dispersion across age-cohorts may represent a process of initial recovery/reorganization proximal to sport, followed by later reduction of white matter coherence.

The PREVENT dementia programme: baseline demographic, lifestyle, imaging and cognitive data from a midlife cohort study investigating risk factors for dementia.

PREVENT is a multi-centre prospective cohort study in the UK and Ireland that aims to examine midlife risk factors for dementia and identify and describe the earliest indices of disease development. The PREVENT dementia programme is one of the original epidemiological initiatives targeting midlife as a critical window for intervention in neurodegenerative conditions. This paper provides an overview of the study protocol and presents the first summary results from the initial baseline data to describe the cohort. Participants in the PREVENT cohort provide demographic data, biological samples (blood, saliva, urine and optional cerebrospinal fluid), lifestyle and psychological questionnaires, undergo a comprehensive cognitive test battery and are imaged using multi-modal 3-T MRI scanning, with both structural and functional sequences. The PREVENT cohort governance structure is described, which includes a steering committee, a scientific advisory board and core patient and public involvement groups. A number of sub-studies that supplement the main PREVENT cohort are also described. The PREVENT cohort baseline data include 700 participants recruited between 2014 and 2020 across five sites in the UK and Ireland (Cambridge, Dublin, Edinburgh, London and Oxford). At baseline, participants had a mean age of 51.2 years (range 40-59, SD ± 5.47), with the majority female (n = 433, 61.9%). There was a near equal distribution of participants with and without a parental history of dementia (51.4% versus 48.6%) and a relatively high prevalence of APOEɛ4 carriers (n = 264, 38.0%). Participants were highly educated (16.7 ± 3.44 years of education), were mainly of European Ancestry (n = 672, 95.9%) and were cognitively healthy as measured by the Addenbrookes Cognitive Examination-III (total score 95.6 ± 4.06). Mean white matter hyperintensity volume at recruitment was 2.26 ± 2.77 ml (median = 1.39 ml), with hippocampal volume being 8.15 ± 0.79 ml. There was good representation of known dementia risk factors in the cohort. The PREVENT cohort offers a novel data set to explore midlife risk factors and early signs of neurodegenerative disease. Data are available open access at no cost via the Alzheimer's Disease Data Initiative platform and Dementia Platforms UK platform pending approval of the data access request from the PREVENT steering group committee.

Physical Activity and Cognitive Decline Among Older Adults

Physical activity is associated with the risk for cognitive decline, but much of the evidence in this domain comes from studies with short follow-ups, which is prone to reverse causation bias. To examine how length of follow-up, baseline age, physical activity amount, and study quality modify the longitudinal associations of physical activity with cognition. Observational studies of adults with a prospective follow-up of at least 1 year, a valid baseline cognitive measure or midlife cohort, and an estimate of the association of baseline physical activity and follow-up cognition were sought from PsycInfo, Scopus, CINAHL, Web of Science, SPORTDiscus, and PubMed, with the final search conducted on November 2, 2022. Two independent researchers screened titles with abstracts and full-text reports. Two reviewers independently assessed study quality and extracted data. Pooled estimates of association were calculated with random-effects meta-analyses. An extensive set of moderators, funnel plots, and scatter plots of physical activity amount were examined. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Pooled estimates of the associations between physical activity and global cognition, as well as specific cognitive domains, were examined. A total of 104 studies with 341 471 participants were assessed. Analysis of binary outcomes included 45 studies with 102 452 individuals, analysis of follow-up global cognition included 14 studies with 41 045 individuals, and analysis of change in global cognition included 25 studies with 67 463 individuals. Physical activity was associated with a decreased incidence of cognitive impairment or decline after correction for funnel plot asymmetry (pooled risk ratio, 0.97; 95% CI, 0.97-0.99), but there was no significant association in follow-ups longer than 10 years. Physical activity was associated with follow-up global cognition (standardized regression coefficient, 0.03; 95% CI, 0.02-0.03) and change in global cognition (standardized regression coefficient, 0.01; 95% CI, 0.01 to 0.02) from trim-and-fill analyses, with no clear dose-response or moderation by follow-up length, baseline age, study quality or adjustment for baseline cognition. The specific cognitive domains associated with physical activity were episodic memory (standardized regression coefficient, 0.03; 95% CI, 0.02-0.04) and verbal fluency (standardized regression coefficient, 0.05; 95% CI, 0.03-0.08). In this meta-analysis of the association of physical activity with cognitive decline, physical activity was associated with better late-life cognition, but the association was weak. However, even a weak association is important from a population health perspective.

Investigating the brain's neurochemical profile at midlife in relation to dementia risk factors.

Changes in the brain's physiology in Alzheimer's disease are thought to occur early in the disease's trajectory. In this study our aim was to investigate the brain's neurochemical profile in a midlife cohort in relation to risk factors for future dementia using single voxel proton magnetic resonance spectroscopy. Participants in the multi-site PREVENT-Dementia study (age range 40-59 year old) underwent 3T magnetic resonance spectroscopy with the spectroscopy voxel placed in the posterior cingulate/precuneus region. Using LCModel, we quantified the absolute concentrations of myo-inositol, total N-acetylaspartate, total creatine, choline, glutathione and glutamate-glutamine for 406 participants (mean age 51.1; 65.3% female). Underlying partial volume effects were accounted for by applying a correction for the presence of cerebrospinal fluid in the magnetic resonance spectroscopy voxel. We investigated how metabolite concentrations related to apolipoprotein ɛ4 genotype, dementia family history, a risk score (Cardiovascular Risk Factors, Aging and Incidence of Dementia -CAIDE) for future dementia including non-modifiable and potentially-modifiable factors and dietary patterns (adherence to Mediterranean diet). Dementia family history was associated with decreased total N-acetylaspartate and no differences were found between apolipoprotein ɛ4 carriers and non-carriers. A higher Cardiovascular Risk Factors, Aging, and Incidence of Dementia score related to higher myo-inositol, choline, total creatine and glutamate-glutamine, an effect which was mainly driven by older age and a higher body mass index. Greater adherence to the Mediterranean diet was associated with lower choline, myo-inositol and total creatine; these effects did not survive correction for multiple comparisons. The observed associations suggest that at midlife the brain demonstrates subtle neurochemical changes in relation to both inherited and potentially modifiable risk factors for future dementia.

Fractal complexity of daily physical activity and cognitive function in a midlife cohort

High stability of fluctuation in physiological patterns across fixed time periods suggest healthy fractal complexity, while greater randomness in fluctuation patterns may indicate underlying disease processes. The importance of fractal stability in mid-life remains unexplored. We quantified fractal regulation patterns in 24-h accelerometer data and examined associations with cognitive function in midlife. Data from 5097 individuals (aged 46) from the 1970 British Cohort Study were analyzed. Participants wore thigh-mounted accelerometers for seven days and completed cognitive tests (verbal fluency, memory, processing speed; derived composite z-score). Detrended fluctuation analysis (DFA) was used to examine temporal correlations of acceleration magnitude across 25 time scales (range: 1 min–10 h). Linear regression examined associations between DFA scaling exponents (DFAe) and each standardised cognitive outcome. DFAe was normally distributed (mean ± SD: 0.90 ± 0.06; range: 0.72–1.25). In males, a 0.10 increase in DFAe was associated with a 0.30 (95% Confidence Interval: 0.14, 0.47) increase in composite cognitive z-score in unadjusted models; associations were strongest for verbal fluency (0.10 [0.04, 0.16]). Associations remained in fully-adjusted models for verbal fluency only (0.06 [0.00, 0.12]). There was no association between DFA and cognition in females. Greater fractal stability in men was associated with better cognitive function. This could indicate mechanisms through which fractal complexity may scale up to and contribute to cognitive clinical endpoints.

Cardiovascular Disease Risk Assessment Using Traditional Risk Factors and Polygenic Risk Scores in the Million Veteran Program

Primary prevention of atherosclerotic cardiovascular disease (ASCVD) relies on risk stratification. Genome-wide polygenic risk scores (PRSs) are proposed to improve ASCVD risk estimation. To determine whether genome-wide PRSs for coronary artery disease (CAD) and acute ischemic stroke improve ASCVD risk estimation with traditional clinical risk factors in an ancestrally diverse midlife population. This was a prognostic analysis of incident events in a retrospectively defined longitudinal cohort conducted from January 1, 2011, to December 31, 2018. Included in the study were adults free of ASCVD and statin naive at baseline from the Million Veteran Program (MVP), a mega biobank with genetic, survey, and electronic health record data from a large US health care system. Data were analyzed from March 15, 2021, to January 5, 2023. PRSs for CAD and ischemic stroke derived from cohorts of largely European descent and risk factors, including age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, smoking, and diabetes status. Incident nonfatal myocardial infarction (MI), ischemic stroke, ASCVD death, and composite ASCVD events. A total of 79 151 participants (mean [SD] age, 57.8 [13.7] years; 68 503 male [86.5%]) were included in the study. The cohort included participants from the following harmonized genetic ancestry and race and ethnicity categories: 18 505 non-Hispanic Black (23.4%), 6785 Hispanic (8.6%), and 53 861 non-Hispanic White (68.0%) with a median (5th-95th percentile) follow-up of 4.3 (0.7-6.9) years. From 2011 to 2018, 3186 MIs (4.0%), 1933 ischemic strokes (2.4%), 867 ASCVD deaths (1.1%), and 5485 composite ASCVD events (6.9%) were observed. CAD PRS was associated with incident MI in non-Hispanic Black (hazard ratio [HR], 1.10; 95% CI, 1.02-1.19), Hispanic (HR, 1.26; 95% CI, 1.09-1.46), and non-Hispanic White (HR, 1.23; 95% CI, 1.18-1.29) participants. Stroke PRS was associated with incident stroke in non-Hispanic White participants (HR, 1.15; 95% CI, 1.08-1.21). A combined CAD plus stroke PRS was associated with ASCVD deaths among non-Hispanic Black (HR, 1.19; 95% CI, 1.03-1.17) and non-Hispanic (HR, 1.11; 95% CI, 1.03-1.21) participants. The combined PRS was also associated with composite ASCVD across all ancestry groups but greater among non-Hispanic White (HR, 1.20; 95% CI, 1.16-1.24) than non-Hispanic Black (HR, 1.11; 95% CI, 1.05-1.17) and Hispanic (HR, 1.12; 95% CI, 1.00-1.25) participants. Net reclassification improvement from adding PRS to a traditional risk model was modest for the intermediate risk group for composite CVD among men (5-year risk >3.75%, 0.38%; 95% CI, 0.07%-0.68%), among women, (6.79%; 95% CI, 3.01%-10.58%), for age older than 55 years (0.25%; 95% CI, 0.03%-0.47%), and for ages 40 to 55 years (1.61%; 95% CI, -0.07% to 3.30%). Study results suggest that PRSs derived predominantly in European samples were statistically significantly associated with ASCVD in the multiancestry midlife and older-age MVP cohort. Overall, modest improvement in discrimination metrics were observed with addition of PRSs to traditional risk factors with greater magnitude in women and younger age groups.

Heart failure decouples the precuneus in interaction with social cognition and executive functions

Aging increases the risk to develop Alzheimer’s disease. Cardiovascular diseases might accelerate this process. Our study aimed at investigating the impact of heart failure on brain connectivity using functional magnetic resonance imaging at resting state. Here we show brain connectivity alterations related to heart failure and cognitive performance. Heart failure decreases brain connectivity in the precuneus. Precuneus dysconnectivity was associated with biomarkers of heart failure—left ventricular ejection fraction and N-terminal prohormone of brain natriuretic peptide—and cognitive performance, predominantly executive function. Meta-analytical data-mining approaches—conducted in the BrainMap and Neurosynth databases—revealed that social and executive cognitive functions are mainly associated with those neural networks. Remarkably, the precuneus, as identified in our study in a mid-life cohort, represents one central functional hub affected by Alzheimer’s disease. A long-term follow-up investigation in our cohort after approximately nine years revealed more severe cognitive impairment in the group with heart failure than controls, where social cognition was the cognitive domain mainly affected, and not memory such as in Alzheimer’s disease. In sum, our results indicate consistently an association between heart failure and decoupling of the precuneus from other brain regions being associated with social and executive functions. Further longitudinal studies are warranted elucidating etiopathological mechanisms.

Neurogranin in Alzheimer's disease and ageing: A human post-mortem study

Neurogranin (Ng), a post-synaptic protein involved in memory formation, has been investigated as a biomarker in the cerebrospinal fluid (CSF) in Alzheimer's disease (AD) and ageing. CSF Ng levels are elevated in AD relative to healthy controls and correlate with cognition; however, few studies have focused on Ng abundance in the brain. Synapse loss in the brain correlates closely with cognitive decline in AD making synaptic biomarkers potentially important for tracking disease progression, but the links between synaptic protein changes in CSF and brain remain incompletely understood. In the current study, Ng abundance was examined in post-mortem human brain tissue across AD, healthy ageing (HA), and mid-life (ML) cohorts. Ng levels were quantified in three brain regions associated with cognitive change found during ageing and neurodegenerative diseases, namely the middle temporal gyrus, primary visual cortex and the posterior hippocampus using immunohistochemistry. To support immunohistochemical analysis, total homogenate and biochemically enriched synaptic fractions from available temporal gyrus tissues were examined by immunoblot. Finally, we examined whether Ng is associated with lifetime cognitive ageing. Ng levels were significantly reduced in AD relative to HA and ML cases across all regions. Additionally Ng was significantly reduced in HA in comparison to ML in the primary visual cortex. Immunoblotting confirms reduced Ng levels in AD cases supporting immunohistochemical results. Interestingly, there was also a significant reduction of synapse-associated Ng in our group who had lifetime cognitive decline in comparison to the group with lifetime cognitive resilience indicating loss of neurogranin in remaining synapses during ageing is associated with cognitive decline. Our findings indicate that increases in CSF Ng reflect loss of brain neurogranin and support the use of CSF Ng as a biomarker of AD and potentially of cognitive decline in healthy ageing.

Associations of Mid- and Late-Life Severe Hypoglycemic Episodes With Incident Dementia Among Patients With Type 2 Diabetes: A Population-Based Cohort Study.

Severe hypoglycemia is associated with an increased risk of dementia. We examined if the association is consistently present in mid- and late-life hypoglycemia. Using health care data from Population Data BC, we created a base cohort of patients age ≥40 years with incident type 2 diabetes. Exposure was the first occurrence of severe hypoglycemia (hospitalization or physician visit). We assessed exposure versus no exposure in mid- (age 45-64 years) and late-life (age 65-84 years) cohorts. Index date was the later of the 45th birthday (midlife cohort), 65th birthday (late-life cohort), or diabetes diagnosis. Those with hypoglycemia or dementia before the index date were excluded. Patients were followed from index date until dementia diagnosis, death, emigration, or 31 December 2018. Exposure was modeled as time dependent. We adjusted for confounding using propensity score weighting. Dementia risk was estimated using cause-specific hazards models with death as a competing risk. Of 221,683 patients in the midlife cohort, 1,793 experienced their first severe hypoglycemic event. Over a median of 9.14 years, 3,117 dementia outcomes occurred (32 among exposed). Of 223,940 patients in the late-life cohort, 2,466 experienced their first severe hypoglycemic event. Over a median of 6.7 years, 15,997 dementia outcomes occurred (158 among exposed). The rate of dementia was higher for those with (vs. without) hypoglycemia in both the mid- (hazard ratio 2.85; 95% CI 1.72-4.72) and late-life (2.38; 1.83-3.11) cohorts. Both mid- and late-life hypoglycemia were associated with approximately double the risk of dementia, indicating the need for prevention throughout the life course of those with diabetes.

Comparison of midlife offspring cohorts based on family history of Alzheimer’s Disease: multi‐domain risk factors and cognitive function

AbstractBackgroundMaintaining healthy clinical indicators and behavior is positively related to cognitive protection from midlife. However, limited population‐based studies have explored the role of family history on these factors in midlife. Therefore, we examined cognitive‐related risk factors in two midlife cohorts from the same source population in the Age, Gene/Environment Susceptibility‐Reykjavik Study.MethodWe included 446 offspring (aged 61, 49% women) from the random sample (RS) without Alzheimer’s Disease (AD) and 499 offspring (aged 63, 49% women) to AD cases at baseline and during follow up from the main study. Accordingly, we labeled the offspring with and without AD family history as offspring AD and offspring RS, respectively. Clinical factors included BMI, systolic (SBP) and diastolic blood pressure (DBP), cholesterol, fasting glucose, inflammatory factors, and medication. Socio‐behavioral factors included education, smoking, problems of doing usual activities. Cognitive function was evaluated by MMSE and STROOP. To address the potential correlation between siblings within one family, we compared these characteristics with the random effects intercept mixed model by family ID. We also did a sensitivity analysis by comparing people under age 65 to assess reverse causation for specific traits. All models were adjusted for age and sex. Fasting glucose, triglycerides, and inflammatory factors were log‐transformed due to skewness. We consider p&lt;0.05 as statistically significant.ResultAs shown in the table, socio‐behavioral factors, cognitive function, or most clinical characteristics did not differ in the two groups. The Offspring AD had 2.71‐unit lower SBP and 0.03‐unit higher log(glucose) (3% increased glucose) than the RS (p&lt;0.05). The sensitivity analysis among people under age 65 showed a similar pattern, except for the insignificant difference in fasting glucose between offspring AD and RS.ConclusionIn general, there was no difference in AD‐related health profile among midlife offspring with and without AD family history. This analysis of standard cardiovascular and cognitive impairment‐related risk factors suggests that these variables alone will not help identify at‐risk individuals for later‐life cognitive impairment.

Diabetes is related to cognition but not plasma amyloid‐β 42/40 in an African American cohort

AbstractBackgroundThe prevalence of clinical Alzheimer’s disease (AD) and type 2 diabetes is higher in African Americans (AA) relative to non‐Hispanic White Americans. Although diabetes is a risk factor for Alzheimer’s clinical syndrome, it is unclear whether diabetes associates with amyloid‐β, a pathological hallmark of AD. We investigated whether diabetic status was associated with age‐related decline in plasma amyloid‐β (Aβ) 42/40 ratio and cognition in a predominantly dementia‐free AA cohort.MethodParticipants (N=314) were middle‐aged and older adults (Table 1) enrolled in the African Americans Fighting Alzheimer’s in Midlife cohort. EDTA plasma was collected at 1‐8 visits for Aβ 42/40 quantification using immunoprecipitation mass spectrometry (C2N Diagnostics, St. Louis, MO). 52% had &gt;1 plasma Aβ 42/40 measurements over an average interval of 4.9 years (SD=3). Recall (immediate and delayed) and executive functioning were assessed using Rey’s Auditory Verbal Learning Test and Trails B, respectively. Diabetic status was determined from clinician‐report, self‐report, self‐report of antidiabetic medication use or fasting glucose ≥126 mg/dL. Cognitive data from the first of 1‐6 visits and diabetic status were obtained at the same visit as baseline plasma Aβ 42/40 for 96% of participants. Linear mixed‐effects models tested diabetic status as a moderator of age‐related decline in plasma Aβ 42/40 ratio and cognition. If age x diabetic status was not significant, diabetic status was tested without the interaction. Covariates included APOE4 carrier status and sex, and education was included when cognition was the outcome.ResultsDiabetic status did not significantly moderate age‐related decline in plasma Aβ 42/40 (β=0.0001, p=.21) or predict average plasma Aβ 42/40 ratio (β=‐0.001, p=.22). Diabetes was also not significantly related to aging‐associated decline in cognition but was a significant predictor of worse average Trails B scores (Table 2). Results from a cognitively unimpaired subsample (n=261) revealed a similar pattern.ConclusionIn a predominantly dementia‐free AA cohort, diabetes was unrelated to plasma Aβ 42/40 but was related to worse Trails B performance. Poor Trails B performance has been linked in previous studies to cerebrovascular dysfunction. Determining mechanisms, vascular and AD pathological pathways, that link diabetes to increased dementia risk in AAs warrants further investigation.

Poor psychosocial job conditions increase sickness absence: evidence from the PATH Through Life Mid-Aged Cohort

ObjectivesEvidence is mounting that poor psychosocial job conditions increase sickness absence, but there is a need for further rigorous prospective research to isolate the influence of psychosocial job quality from...

Daily Stress Processes in a Pandemic: The Effects of Affect, Worry, and Age

On March 13th, 2020, the World Health Organization declared a novel coronavirus, COVID-19, a pandemic. Given the day-to-day behavioral changes necessitated by this global threat, the current study examined daily stress reactivity and its potential moderators during the COVID-19 pandemic. Two-level, multilevel modeling was used to examine the daily relationship between perceived stress and negative affect, as well as the moderating effects of daily positive affect, average pandemic worry, and age, on this process. Participants included 349 individuals from the young adult, midlife, and later-life cohorts of the Notre Dame Study of Health & Well-being who completed a 28-day, daily diary study amidst the COVID-19 pandemic (NDHWB; Age Range = 26-89). Individuals were affectively reactive to perceived stress during the COVID-19 pandemic, experiencing higher negative affect on days of higher perceived stress. Regarding moderators, older individuals were less stress reactive than younger individuals, and the extent of individuals’ pandemic worry exacerbated their stress reactivity. Furthermore, daily positive affect buffered daily stress reactivity, regardless of pandemic worry and age. In sum, individuals who were younger or more worried about the pandemic tended to be more stress reactive than older or less worried individuals. Furthermore, daily positive affect buffered stress reactivity, and this buffering effect did not depend on age or the extent to which individuals were worried about the pandemic. Thus, mobilizing positive affect during the COVID-19 pandemic may be a promising avenue for intervention in daily stress processes.

Vision Impairment Among Late Mid-Life Women: Michigan Study of Women’s Health Across the Nation

There are few data on mid-life sensory health and its contribution to health and disability outcomes. The Study of Women’s Health Across the Nation—Michigan site (N=252 women, mean age=66.0 years) collected comprehensive data regarding ocular health to estimate the burden and correlates of vision impairment (VI) and unmet need for vision correction in this population. The prevalence of VI based on presenting and best-corrected visual acuity was 11.1% (95% CI 7.5,15.7) and 2.8% (95% CI 1.1,5.6), respectively. Thus, 75.0% of presenting VI was correctable, yet only 29.0% of women wore an appropriate eyeglass prescription. Black women and those with greater financial strain or less education were more likely to have presenting VI, but there were no differences in best-corrected VI. This presentation will include a discussion of the contributions of SWAN to the study of sensory aging, as well as methodological considerations for research from a mid-life aging cohort. Part of a symposium sponsored by Sensory Health Interest Group.

The Role of Midlife Occupational Factors for Trajectories of Cognitive Change

Cognitively enriching environments are usually related to higher levels of cognitive performance, while associations with longitudinal change are less clear. In the present study, we used 20-year longitudinal data from the German Interdisciplinary Longitudinal Study of Adult Development and Aging (ILSE) to examine the role of occupational factors for longitudinal trajectories of cognitive function in midlife. To do so, we used data from 374 participants in the ILSE midlife cohort (born in 1950-52; mean age at baseline = 44 years; 44 % women). Our findings showed that cognitively enriching work environments were associated with higher levels of cognitive function at baseline; however, these associations were not independent of control variables including education. There was no evidence that enriching work environments were related to the maintenance of cognitive abilities. In sum, our findings are in line with notions of “preserved differentiation”. We discuss potential mechanisms underlying these findings.

The role of perceived work environment and work activities in midlife cognitive change.

Previous research documented positive associations between cognitively stimulating work and levels of cognitive performance, while longitudinal associations are less clear. We used 20-year longitudinal data from the Interdisciplinary Longitudinal Study of Adult Development and Aging (ILSE) to examine the role of perceived work environment (autonomy, innovation, social integration, and stress) and work activities derived from an occupational database (related to information, to people, and manual activities) for trajectories of cognitive abilities (processing speed, fluid and crystallized intelligence). We used data from 374 participants in the ILSE midlife cohort (born 1950-52) who were working at baseline and had valid observations on work characteristics and control variables including education, gender, region (former East vs. West Germany), and personal income (mean age at baseline = 44 years, SD = 1, 44% women). Cognitively stimulating perceived work environments (higher levels of autonomy and innovation), higher levels of work activities related to information and people, and lower levels of manual activity at baseline were related to higher initial levels of cognitive ability. Higher work stress was related to higher baseline fluid ability. These associations were largely not independent of control variables. Higher social integration at work was related to less steep increase in crystallized intelligence and higher work stress was related to less decline in processing speed. In sum, our findings were more in line with selection rather than with enrichment effects, with the caveat that our findings rely on work variables taken at baseline. We discuss potential mechanisms underlying these findings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Midlife susceptibility to the effects of poor diet on diabetes risk.

Type 2 diabetes mellitus (T2D) prevalence continues to increase, and age of incidence continues to decrease. More information is needed to target interventions to the ages where they can be most effective. The objective of this study was to explore the degree to which the association between diet and T2D incidence changes through adulthood. Participants were a large number (N = 2818) of community living adults in Canberra and Queanbeyan, Australia across three cohorts; young (20-24 followed to 32-36), mid-life (40-44 followed to 52-56) and late-life (60-64 followed to 72-76). Self-report dietary pattern scores at baseline and diabetes incidence across 12 years follow-up were measured, alongside confounders of caloric intake, sex, smoking status, years of education, hypertension, BMI and physical activity. Cox proportional hazards indicated that neither Western nor Prudent dietary pattern scores were significantly associated with T2D incidence when confounders were included in the model. Unadjusted estimates suggested a positive association between Western dietary pattern scores and subsequent diabetes incidence (HR = 1.40, 95% CI [1.18, 1.64]). Compared with the mid-life cohort, a higher Western dietary pattern score posed a lower risk for incident T2D in the young cohort (unadjusted HR = 0.46, 95% CI [0.22, 0.96]), who also had significantly lower BMI and higher physical activity. No such significant effects were found for the late-life cohort. Our findings indicate that mid-life may be a period of heightened vulnerability to the effects of an unhealthy diet on diabetes risk, but this effect is attenuated when risk factors related to diet, such as adiposity, are taken into account.

A Self-Compassion Group Intervention for Patients Living With Chronic Medical Illness: Treatment Development and Feasibility Study.

Self-compassion is a psychological skill associated with good mental health and adjustment to illness in the second half of life, but to date, few self-compassion-based interventions have been developed specifically for use in midlife and older adult cohorts. The purpose of this study was to develop and test the feasibility of a 4-week group self-compassion-based intervention designed to improve self-report and biological markers of well-being in midlife and older adult patients living with chronic illness. Treatment development drew on existing literature, expert input, and qualitative interview data. Eight patients in outpatient treatment for a chronic illness were recruited from a rehabilitation hospital (during September and October 2017 and again during February and March 2018) to test feasibility. Participants attended a 1-hour group self-compassion-based intervention once per week for 4 weeks. Feasibility was assessed on 6 domains. Measures of well-being and heart rate variability (HRV), an index of nervous system functioning, were also collected. Recruitment was feasible and occurred within the expected time frame. Attendance at sessions was high (84.4%), with no dropouts. Participants found that the intervention was acceptable, rating sessions as enjoyable (6.8/7) and relevant to daily life (6.6/7). There were no adverse events. Secondary analysis revealed pre-post improvements for some well-being outcomes, such as a significant reduction in depressive symptoms (Hedges' g = -1.18, 95% CI, -0.18 to -2.16). A 4-session group self-compassion-based intervention was found to be feasible and acceptable to midlife and older adult patients in treatment for a chronic illness. A larger, randomized pilot trial is needed to explore the efficacy of this intervention. Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12619000709145​.

Disability trends in Canada: 2001-2014 population estimates and correlates.

Disability is a major concern for the health of midlife and older Canadians. Understanding disability trends is critical for detecting socio-economic and health precursors that could be amenable to policy interventions. The purpose of this study is to assess trends in rates of disability among Canadian adults age 40-64 and 65+. We also examine the impact of changing socio-demographic and health factors over time on the trends. Data from the 2001-2014 Canadian Community Health Survey (CCHS), a repeated cross-sectional nationally representative study, are used to estimate age- and gender-stratified logistic regression models of disability as a function of the year of interview to assess trends. Disability is defined as experiencing difficulties with a variety of individual functions, such as seeing, walking, climbing stairs, and bending. Among men and women 65 and older, disability has declined since 2001 in most subgroups and regardless of changing socio-economic and health characteristics. Adults 40-64years of age, in contrast, have experienced stagnating disability over the observation period. If it were not for changes in the distribution of education and household income, the disability rate would be increasing significantly. Older Canadian adults are experiencing mild but systemic improvements in disability. More worrisome is the stagnating trend among midlife cohorts, which could portend greater disability burden in the future as Canada's population ages. Preventive efforts need to be targeted at vulnerable groups at earlier ages in order to prevent future increases in disability-related financial, caregiving, and medical burden.