Telephone Interview For Cognitive Status Research Articles

The dynamic and reciprocal relationship between perceived everyday discrimination and cognitive function in later life

Objectives This study, based on socioemotional selectivity theory and cognitive theory, investigates the dynamic and reciprocal relationship between perceived discrimination and cognitive function in later life. Methods Data were drawn from four waves of the Health and Retirement Study (HRS 2006, 2010, 2014, and 2018). A total of 4,125 people who were 51 and older were included. Cognitive function was measured by the telephone interview for cognitive status (TICS-27). Perceived discrimination was measured using scores of the perceived everyday discrimination scale. Random intercept cross-lagged panel model (RI-CLPM) was utilized. The model was adjusted for a range of covariates. Subgroup analysis by ethnoracial groups was conducted. Results Cross-sectionally, while lower cognitive function was associated with higher perceived discrimination, this relationship was unidirectional. Longitudinally, higher perceived discrimination predicted lower cognitive function in later waves only among non-Hispanic White individuals. Conclusion Results suggested that a decline in cognitive function may precede and contribute to the worsening of perceived discrimination, which may result in further decline in cognitive function. Lifetime experience of discrimination was discussed as a possible source of the racial/ethnic variations in the relationship. Further study is needed to examine whether this relationship holds among people with cognitive impairment and dementia.

Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults: a competing risk analysis

BackgroundDepressive symptoms and cognitive impairment often interact, rendering their associations controversial. To date, their joint trajectories and associations with dementia and death remain underexplored.AimsTo explore the interactions between depressive symptoms...

"Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black.

Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies. We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models. Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts. These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.

Abstract P252: Baseline Cognitive and Physical Function and Subsequent Occupational Status in Chinese Adults

Background: Declines in cognitive and physical function in later adulthood can have an impact whether or not individuals remain in the workforce, although the relationship is complex and often bidirectional. Little is also known about how this relationship differs in rural versus urban populations. We capitalized on longitudinal data in an urbanizing population to estimate the differential impact of urbanization level with cognitive and physical function on remaining in the work force. Methods: We used longitudinal data from 5,228 adults in the China Health and Nutrition Survey aged 58+ to assess the association between cognitive and physical function at the 2015 survey with whether older adults remained in the work force, based on self-report of either formal or informal work, in 2018. We defined cognitive function using a global cognitive score based on a subset of the modified Telephone Interview for Cognitive Status (TICS) and physical function using limitations as measured by instrumental activities of daily living (IADLs). Given differences in demographics of working status in urban (urban areas or small towns) versus rural villages, we included an interaction term for cognitive function by urban versus rural village residence. In minimally adjusted models, we controlled for age and gender and in fully adjusted models we additionally adjusted for birth cohort, education, region, marital status, and income. Results: In 2018, 48% of adults lived in rural villages and 41% were currently working. In rural villages, we found individuals with any (versus no) physical limitations in 2015 in were more likely to be working in 2018: Any IADL limitations versus no limitations: (OR=0.47 [95% confidence interval (CI) of 0.34-0.65). However, in urban areas, individuals with any (versus no) physical limitations in 2015 were more likely to be working in 2018: Any IADL limitations versus no limitations: OR=2.44 (1.18,5.03). We found no evidence of differential association between cognitive function and subsequent working status in the total sample or by rural village residence in the minimally or fully adjusted models. Conclusion: Physical (but not cognitive) function at baseline impacts future occupational status differently for those in rural versus urban areas which could reflect differences in the types of work being done as well as differences in the availability of economic resources between rural versus urban areas.

Purpose in life and cognitive health: a 28-year prospective study.

To examine the prospective association between purpose in life measured at three points across middle and older adulthood and cognitive outcomes assessed 8-28 years later. Prospective Study. Wisconsin Longitudinal Study of Aging (WLS). WLS participants who reported on their purpose in life at Round 4 (1992-1994; Mage = 52.58), Round 5 (2003-2007; Mage = 63.74), and/or Round 6 (2010-2012; Mage = 70.25) and were administered a cognitive battery at Round 7 (2020; Mage = 79.94) were included in the analysis (N = 4,632). Participants completed the Ryff measure of purpose in life and were administered the telephone interview for cognitive status and measures of verbal fluency, digit ordering, and numeric reasoning. Purpose in life measured at age 52 was related to better global cognitive function and verbal fluency but unrelated to dementia at age 80. In contrast, purpose in life at ages 63-70 was associated with lower likelihood of dementia, as well as better global cognitive function and verbal fluency at age 80. The effect sizes were modest (median Beta coefficient = .05; median odds ratio = .85). A slightly steeper decline in purpose in life between ages 52 and 70 was found for individuals with dementia at age 80. Purpose in life is associated with healthier cognitive function measured up to 28 years later. Individuals with lower purpose, especially in their 60s or older, and with steeper declines in purpose, are more likely to have dementia at age 80.

Emotional distress, social support, and functional dependence predict readiness for hospital discharge in a prospective sample of cognitively intact cardiac arrest survivors

AimTo inform screening, referral and treatment initiatives, we tested the hypothesis that emotional distress, social support, functional dependence, and cognitive impairment within 72 hours prior to discharge predict readiness for discharge in awake and alert cardiac arrest (CA) survivors. MethodsThis was a secondary analysis of a prospective single-center cohort of CA survivors enrolled between 4/2021 and 9/2022. We quantified emotional distress using the Posttraumatic Stress Disorder Checklist-5 and PROMIS Emotional Distress – Anxiety and Depression Short Forms 4a; perceived social support using the ENRICHD Social Support Inventory; functional dependence using the modified Rankin Scale; and cognitive impairment using the Telephone Interview for Cognitive Status. Our primary outcome was readiness for discharge, measured using the Readiness for Hospital Discharge Scale. We used multivariable linear regression to test the independent association of each survivorship factor and readiness for discharge. ResultsWe included 110 patients (64% male, 88% white, mean age 59 [standard deviation ± 13.1 years]). Emotional distress, functional dependence, and social support were independently associated with readiness for discharge (adjusted β’s [absolute value]: 0.25–0.30, all p < 0.05). ConclusionsHospital systems should consider implementing routine in-hospital screening for emotional distress, social support, and functional dependence for CA survivors who are awake, alert and approaching hospital discharge, and prioritize brief in hospital treatment or post-discharge referrals.

Association between experiencing low healthcare quality and developing dementia.

Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older. Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors. Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk. As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.

Is Early-Life Enrichment Associated With Better Cognitive Function Among Older Adults? Examining Home and School Environments.

Objectives: We examine whether early-life enrichment, involving varied and stimulating activities to enhance cognitive function during childhood and adolescence, is associated with cognitive function in later life and whether the benefits persist over time. Methods: Growth curve models were used to examine up to five waves of data from the Health and Retirement Study-a nationally representative survey of adults 50years and older (N = 10,070). We constructed separate measures of early-life enrichment to distinguish sources of influence (i.e., enriched home environment and enriched school environment). Global cognitive function was assessed with a modified version of the Telephone Interview for Cognitive Status. Results: Greater enrichment in each environment was incrementally associated with better cognitive function at baseline, but enrichment was not associated with change in cognitive function over time. Discussion: Receiving enrichment from multiple environments during sensitive periods of cognitive development may be advantageous for cognitive functioning in later life.

Abstract WP240: Long Term Impact of the Los Angeles Barbershop Blood Pressure Study on Stroke/TIA and Cognitive Impairment

Background: Individuals with poorly controlled blood pressure (BP) have a heightened risk of stroke and vascular cognitive impairment. BP reduction has been associated with reduced risk of future stroke and cognitive impairment. Black Americans are disproportionately affected by hypertension and neurologic-target organ damage. Interventions targeted to reduce these disparities are greatly needed. From 2/2015 - 7/2017, 307 Black men were enrolled into a cluster randomised, pharmacist-led BP reduction intervention at 52 Black-owned barbershops in Los Angeles, CA [the Los Angeles Barbershop BP Study (LABBPS)] which demonstrated significant improvement in BP control sustained over a 12-month period. The current study evaluates the long-term impact of the intervention on incident stroke/TIA and prevalent mild cognitive impairment (MCI). Methods: Living participants from the LABBPS were contacted via telephone for interval health history inquiring about the development of symptoms consistent with stroke/TIA since trial end and via telephone interview for Cognitive Status (TICS-M); whereby a score ≤34 was considered positive for possible amnestic MCI. Rates of stroke/TIA were compared using a Pearson’s Chi-squared test. Results: Out of 288 participants, 115 men (50%) with mean (SD) age 62 (9) years, were successfully contacted a median of 6 years after trial end. The distribution of TICS-M scores was similar between groups with 71% and 70% having an abnormal result in the intervention and control groups respectively. Self-reported stroke/TIA occurred in 4 men in the intervention group and 9 in the control group (p = 0.13). Conclusion: Barbershop-based interventions have proven effective in lowering BP in Black men, a group at disparate risk for neurovascular complications. The preliminary results of our follow-up study do not show a significant difference in possible MCI between treatment arms, though there was a trend towards lower incident stroke/TIA seen in the intervention group. Limitations include a lack of interval BP values, unknown durability of the intervention beyond 12 months, and disproportionate impact of COVID-19 pandemic on the health of African American communities which is not accounted for in this analysis.

Evaluation of FRESH scores in predicting outcome and quality of life after aneurysmal subarachnoid haemorrhage in a European patient cohort

BackgroundDespite aneurysmal subarachnoid haemorrhage (aSAH) patients often experiencing physical and mental disabilities impacting their quality of life (QoL), routine assessment of long-term QoL data and predictive tools are limited. This study evaluates the newly developed “functional recovery expected after subarachnoid haemorrhage” (FRESH) scores with long-term outcomes and QoL in European aSAH patients.MethodsFRESH, FRESH-cog, and FRESH-quol scores were retrospectively obtained from aSAH patients. Patients were contacted, and the modified Rankin Scale (mRS), extended short form-36 (SF-36), and telephone interview for cognitive status (TICS) were collected and performed. The prognostic and empirical outcomes were compared.ResultsOut of 374 patients, 171 patients (54.1%) completed the SF-36, and 154 patients completed the TICS. The SF-36 analysis showed that 32.7% had below-average physical component summary (PCS) scores, and 39.8% had below-average mental component summary (MCS) scores. There was no significant correlation between the FRESH score and PCS (p = 0.09736), MCS (p = 0.1796), TICS (p = 0.7484), or mRS 10–82 months (average 46 months) post bleeding (p = 0.024), respectively. There was also no significant correlation found for “FRESH-cog vs. TICS” (p = 0.0311), “FRESH-quol vs. PCS” (p = 0.0204), “FRESH-quol vs. MCS” (p = 0.1361) and “FRESH-quol vs. TICS” (p = 0.1608).ConclusionsThis study found no correlation between FRESH scores and validated QoL tools in a European population of aSAH patients. The study highlights the complexity of reliable long-term QoL prognostication in aSAH patients and emphasises the need for further prospective research to also focus on QoL as an important outcome parameter.

Separate and combined associations of obesity and handgrip strength with cognitive function in older adults: A national cross-sectional study in China

ABSTRACT This study examined the separate and combined associations of obesity and handgrip strength with cognitive function in older adults. In total 4,839 older adults were included in this cross-sectional study, and their body mass index (BMI) and handgrip strength were measured. Cognitive function was evaluated using the Telephone Interview for Cognitive Status. Three individual categories were created for BMI (normal weight: 18.5≤ BMI < 24.0 kg/m2 overweight: 24.0≤ BMI < 28.0 kg/m2 and obesity: BMI ≥ 28.0 kg/m2 and handgrip strength (low, normal, and high tertiles), and then these categories were pooled together. Logistic regression analyses were used to examine the individual and combined associations of obesity and handgrip strength with cognitive function. Results indicated that overweight adults had a lower rate of lower cognitive function than normal weight adults. There was an inverse association between handgrip strength and cognitive function. Participants with overweight and high handgrip strength had a lower likelihood of lower cognitive function compared to those with normal weight and normal handgrip strength. The findings suggested that overweight or high handgrip strength was associated with lower odds of cognitive decline. Moreover, the concurrence of overweight and high handgrip strength had an additive effect on cognitive function in older adults.

Preventing cognitive decline by reducing BP target (PCOT): A randomized, pragmatic, multi-health systems clinical trial

BackgroundGrowing evidence suggests that intensive lowering of systolic blood pressure (BP) may prevent mild cognitive impairment (MCI) and dementia. However, current guidelines provide inconsistent recommendations regarding optimal BP targets, citing safety concerns of excessive BP lowering in the diverse population of older adults. We are conducting a pragmatic trial to determine if an implementation strategy to reduce systolic BP to <130 and diastolic BP to <80 mmHg will safely slow cognitive decline in older adults with hypertension when compared to patients receiving usual care. MethodsThe Preventing Cognitive Decline by Reducing BP Target Trial (PCOT) is an embedded randomized pragmatic clinical trial in 4000 patients from two diverse health-systems who are age ≥ 70 years with BP >130/80 mmHg. Participants are randomized to the intervention arm or usual care using a permuted block randomization within each health system. The intervention is a combination of team-based care with clinical decision support to lower home BP to <130/80 mmHg. The primary outcome is cognitive decline as determined by the change in the modified Telephone Interview for Cognitive Status (TICS-m) scores from baseline. As a secondary outcome, patients who decline ≥3 points on the TICS-m will complete additional cognitive assessments and this information will be reviewed by an expert panel to determine if they meet criteria for MCI or dementia. ConclusionThe PCOT trial will address the effectiveness and safety of hypertension treatment in two large health systems to lower BP targets to reduce risk of cognitive decline in real-world settings.

Assessing patterns of delirium symptoms reveals a novel subtype among elective surgical patients with postoperative delirium.

Prior studies reported incidence of hypoactive and hyperactive subtypes of postoperative delirium, but did not consider cognitive symptoms of delirium which are highlighted in the DSM-5 criteria for delirium. This study aims to address this gap in the literature by classifying cases of delirium according to their constellation of cognitive and motoric symptoms of delirium using a statistical technique called Latent Class Analysis (LCA). Data were from five independent study cohorts (N=1968) of patients who underwent elective spine, knee/hip, or elective gastrointestinal and thoracic procedures, between 2001 and 2017. Assessments of delirium symptoms were conducted using the long form of the Confusion Assessment Method (CAM) pre- and post-surgery. Latent class analyses of CAM data from the first 2days after surgery were conducted to determine subtypes of delirium based on patterns of cognitive and motoric symptoms of delirium. We also determined perioperative patient characteristics associated with each latent class of delirium and assessed whether the length of delirium for each of the patterns of delirium symptoms identified by the latent class analysis. The latent class model from postoperative day 1 revealed three distinct patterns of delirium symptoms. One pattern of symptoms, denoted as the Hyperalert class, included patients whose predominant symptoms were being hyperalert or overly sensitive to environmental stimuli and having a low level of motor activity. Another pattern of symptoms, denoted as the Hypoalert class, included patients whose predominant symptom was being hypoalert (lethargic or drowsy). A third pattern of symptoms, denoted as the Cognitive Changes class, included patients who experienced new onset of disorganized thinking, memory impairment, and disorientation. Among 352 patients who met CAM criteria for delirium on postoperative day 1, 34% had symptoms that fit within the Hyperalert latent class, 39% had symptoms that fit within the Hypoalert latent class, and 27% had symptoms that fit within the Cognitive Changes latent class. Similar findings were found when latent class analysis was applied to those who met CAM criteria for delirium on postoperative day 2. Multinomial regression analyses revealed that ASA class, surgery type, and preoperative cognitive status as measured by the Telephone Interview for Cognitive Status (TICS) scores were associated with class membership. Length of delirium differed between the latent classes with the Cognitive Changes latent class having a longer duration compared to the other two classes. Older elective surgery patients who did not have acute events or illnesses or a diagnosis of dementia prior to surgery displayed varying symptoms of delirium after surgery. Compared to prior studies that described hypoactive and hyperactive subtypes of delirium, we identified a novel subtype of delirium that reflects cognitive symptoms of delirium. The three subtypes of delirium reveal distinct patterns of delirium symptoms which provide insight into varying risks and care needs of patients with delirium, indicating the necessity of future research on reducing risk for cognitive symptoms of delirium.

White matter integrity in hospitalized COVID-19 patients is not associated with short- and long-term clinical outcomes.

SARS-CoV-2 infection is associated with a decline in functional outcomes; many patients experience persistent symptoms, while the underlying pathophysiology remains unclear. This study investigated white matter (WM) integrity on brain MRI in hospitalized COVID-19 patients and its associations with clinical outcomes, including long COVID. We included hospitalized COVID-19 patients and controls from CORONavirus and Ischemic Stroke (CORONIS), an observational cohort study, who underwent MRI-DWI imaging at baseline shortly after discharge (<3 months after positive PCR) and 3 months after baseline scanning. We assessed WM integrity using diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) and performed comparisons between groups and within patients. Clinical assessment was conducted at 3 and 12 months with functional outcomes such as modified Rankin Scale (mRS), Post-COVID-19 Functional Status scale (PCFS), Visual Analogue Scale (VAS), and long COVID, cognitive assessment was conducted by the Modified Telephone Interview for Cognitive Status (TICS-M), and the Hospital Anxiety and Depression Scale (HADS) was used to assess mood disorder. Associations between WM integrity and clinical outcomes were evaluated using logistic regression and linear regression. A total of 49 patients (mean age 59.5 years) showed higher overall peak width of skeletonized mean diffusivity (PSMD) (p = 0.030) and lower neurite density index (NDI) in several WM regions compared with 25 controls at the baseline (p < 0.05; FWE-corrected) but did not remain statistically significant after adjusting for WM hyperintensities. Orientation dispersion index (ODI) increased after 3-month follow-up in several WM regions within patients (p < 0.05), which remained significant after correction for changes in WMH volume. Patients exhibited worse clinical outcomes compared with controls. Low NDI at baseline was associated with worse performance on the Post-COVID-19 Functional Status scale after 12 months (p = 0.018). After adjusting for WMH, hospitalized COVID-19 patients no longer exhibited lower WM integrity compared with controls. WM integrity was generally not associated with clinical assessments as measured shortly after discharge, suggesting that factors other than underlying WM integrity play a role in worse clinical outcomes or long COVID.

Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

As a financial hardship, negative wealth shock has been implicated in some adverse health outcomes. However, associations between negative wealth shock and cognitive decline and dementia have not been examined. To investigate whether negative wealth shock was associated with cognitive decline and incident dementia among middle-aged and older US adults. The Health and Retirement Study (HRS) is a prospective cohort study conducted biennially among US adults older than 50 years. Data from the HRS from calendar years 1996 to 2020 were analyzed from July 1 to 31, 2023. The final sample included 8082 participants with complete data of interest. Wealth status was quantified with questionnaires. Negative wealth shock was defined as a loss of 75% or more in total wealth over a 2-year period. Asset poverty was defined as zero or less total net wealth. Cognitive function was assessed with the modified Telephone Interview for Cognitive Status (TICS-m). Dementia status was determined with TICS-m scores and proxy assessment. Among 8082 participants included (mean [SD] age, 63.7 [5.7] years; 4179 women [51.7%] and 3903 men [48.3%]; 1111 Black [13.7%], 6689 White [82.7%], and 282 other [3.5%]), 1441 developed incident dementia over a median follow-up time of 14 (IQR, 7-20) years. Compared with participants who had positive wealth without shock, those with negative wealth shock had accelerated cognitive decline (β coefficient, -0.014 [95% CI, -0.027 to -0.001]; P = .03) and increased risks of dementia (hazard ratio [HR], 1.27 [95% CI, 1.11-1.46]; P < .001). Higher dementia risks were also found in participants with asset poverty at baseline (HR, 1.61 [95% CI, 1.30-2.00]; P < .001). Associations were found in White participants (HR, 1.34 [95% CI, 1.14-1.58]; P < .001) and participants younger than 65 years (HR, 1.38 [95% CI, 1.13-1.68]; P = .001) but not in other races and ethnicities or those 65 years or older. In this cohort study, negative wealth shock was associated with accelerated cognitive decline and elevated risks of dementia among middle-aged and older US adults, with modifications by age and ethnicity. These findings should be confirmed by further prospective and interventional studies.

RELIGIOSITY, RELIGIOUS BELIEFS, AND COGNITIVE STATUS AMONG BLACK AND WHITE MEN WITH SIMILAR INCOMES

Abstract Black men experience multiple stressors linked with cognitive impairment and have higher risks for Alzheimer’s Disease and related dementias than their White peers. Yet, few studies have focused on coping resources. Religious beliefs and institutions are thought to have health benefits; however, no study to our knowledge has examined religious practices or beliefs and their association with cognitive impairment disparities among Black and White men. The purpose of this study was to examine the association between religious practices and/or beliefs and cognitive status among Black and White men in the Health and Retirement Study (HRS). Data were drawn from Black and White men who reported incomes at or below $50,000 and completed the Core and Leave Behind Questionnaires in the 2016 HRS. The primary outcome was any cognitive impairment, a dichotomous variable derived from a modified version of the Telephone Interview for Cognitive Status (TICS). Religious service attendance, private prayer frequency, and religious beliefs were the primary independent variables. The proportion of Black men was 24.2% and had a larger proportion of individuals with any cognitive impairment than their White peers (47.2% vs 29.4%). Results from race-stratified Modified Poisson Regression models indicated that occasional religious service attendance was beneficial for White men (PR=0.68, CI:0.52-0.89) while private prayer (PR=0.71, CI:0.52-0.98) and religious beliefs (PR=0.90, CI:0.83-0.97) were inversely related to any cognitive impairment among Black men. Full-scale studies of Black men with robust religiosity measures are needed to further examine the association between religious factors and cognitive functioning among this group.

ESTIMATED ARTERIAL STIFFNESS, COGNITIVE DECLINE, AND DEMENTIA AMONG MIDDLE-AGED AND OLDER ADULTS

Abstract Prior research suggests arterial stiffness may be a useful vascular biomarker that predicts age-related cognitive decline. In this paper, we use the Health and Retirement Study (HRS) to examine the relationship between estimated pulse wave velocity (ePWV), which is an under-analyzed but readily available estimate of arterial stiffness, and cognitive decline. The HRS assesses cognitive function with the Telephone Interview for Cognitive Status (TICS). In this 27-point TICS measure, scores between 7 and 11 indicate cognitively impaired but no dementia (CIND) and scores between 0 and 6 indicate dementia. We modeled the relationship between ePVW and cognitive status change from 2006/2008 through 2018. The findings indicate ePWV increases the odds of having CIND and dementia relative to having no CIND or dementia. In addition, ePWV increases the odds of transitioning into CIND and dementia from a higher cognitive functioning state. The results are robust to controlling for: age, age squared, age cubed, systolic and diastolic blood pressure along with sociodemographic characteristics (gender, race, ethnicity, wealth, income, education), health status (history of cardiovascular disease (CVD,) diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, body mass index), and CVD-related biomarkers (C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein (HDL) cholesterol). These findings suggest that ePWV is a simple screening tool and novel biomarker that can be used to monitor vascular cognitive aging and CIND progression in middle-aged and older adults.

IMPACT OF HUSBAND’S DEMENTIA: INNOVATIVE METHODS TO STUDY HEALTH PROFILES AND CO-TRAJECTORIES BETWEEN COUPLES

Abstract Traditional life course studies often focus on how one predictor influences one health outcome that may not be able to capture the interdependence of two or more health trajectories very well. Objectives: (1) demonstrate an innovative method to create a 3-dimensional health profile cube that presents physical, mental, and cognitive health and the changing trajectories over time; (2) display how a woman’s health profile may change due to the onset of their male partner’s dementia; and (3) visualize how couple’s co-trajectories of health profiles may vary by their age, race/ethnicity, and household wealth. Methods: We focus on married and partnered couples, drawing longitudinal data from the Health and Retirement Study (2000-2016; n=3,578). Physical, mental, and cognitive health were respectively measured by functional limitation, depression symptoms (CESD-II), and modified version of the Telephone Interview for Cognitive Status (TICS). We use vector autoregression (VAR) models to analyze these multivariate paths in the same visual representation as the original data. Results: The approach provides both an analytic framework and a visualization tool that depicts data and model in the same spatial representation to permit assessment of model fit and model comparison. This study advances the traditional life course studies by representing underlying processes as a multidimensional time vector of health outcomes, which better reflect the interdependent co-trajectories of health outcomes and the essence of the life course conceptual framework. Discussion: This paper provides a blueprint for studying complex health profiles or trajectories.

RECEIPT OF CHEMOTHERAPY AND COGNITIVE DECLINE AMONG MEDICARE BENEFICIARIES IN THE US HEALTH AND RETIREMENT STUDY

Abstract Research on cancer and cognitive aging outcomes has been inconsistent, with clinic-based studies showing short-term cognitive declines after chemotherapy, and population-based epidemiological studies observing inverse associations between most cancers and subsequent cognitive aging. We aimed to determine the effect of chemotherapy on cognitive decline and mortality among Medicare beneficiaries in the population-based US Health and Retirement Study (HRS). Using data from HRS-Medicare linked participants ≥65, we identified 858 incident breast, prostate, and kidney cancer diagnoses from 2000 to 2016. Cognitive function was measured using the modified telephone interview for cognitive status (range 0 to 27). Cancer treatment (chemotherapy only, other treatments, and no treatment) was obtained from Medicare claims. We used joint modeling to simultaneously model the association between cancer treatment with cognition decline and mortality. Of 858 participants, 38.7% had breast cancer, 52% had prostate cancer, and 11% had kidney cancer. The mean age at diagnosis was 72.8 years (SD=7.62). 31.7% (n=272) received chemotherapy only, 39.5% (n=339) received other treatment, and 28.8% (n=247) received no treatment. In pooled analyses, receipt of chemotherapy (vs. no treatment) was not significantly associated with cognitive decline (β: 0.08; 95% CI: -0.59, 0.76) but was significantly associated with mortality (HR: 1.39; 95% CI: 1.04, 1.88). In joint modeling, the overall hazard ratio for the receipt of chemotherapy (vs. no treatment) was 1.38 (95% CI: 1.02, 1.88). We found that receipt of chemotherapy was associated with an increased hazard of mortality, but not cognitive decline, compared to those who received no treatment.

NEURODEGENERATION BIOMARKERS HELP EXPLAIN ASSOCIATION BETWEEN INFLAMMATION AND COGNITIVE DYSFUNCTION

Abstract There is past evidence that immune aging (or immunosenescence) and high systemic inflammation are associated with cognitive dysfunction and ADRD. However, it is unknown whether these immune-related aging processes are associated with neurodegeneration, tauopathy, amyloid accumulation, and/or vascular issues in the brain. To address this gap, we utilized a set of recently assayed highly innovative markers of neurodegeneration, biomarkers of inflammation, and proportions of naïve lymphocytes (indicative of less immune aging), and cognitive dysfunction (errors on the Telephone Interview for Cognitive Status) in the Health and Retirement Study, a nationally representative sample of US adults over age 50 (N = 3985). Using structural equation modeling (SEM), we estimated latent factors representing neurodegeneration (neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and phosphotau 181 (pTau181)), inflammation (c-reactive protein, IL10, IL1 receptor agonist, IL6, TNF receptor 1, albumin, and percentage of neutrophils), and immune aging (percentages of naïve CD8+ and CD4+ T cells). Results indicate inflammation is associated with neurodegenerative biomarkers (β = .31, p &amp;lt; .001) and with cognitive dysfunction (β = .08, p &amp;lt; .001) after controlling for age, race, gender, education, BMI, smoking, drinking, and immunosenescence. Neurodegenerative biomarkers mediated about half of the association between inflammation and cognitive dysfunction. It appears that greater systemic inflammation may be associated with brain damage and tauopathy. Interventions focused on reducing systemic inflammation may be successful in reducing neurodegeneration and cognitive dysfunction in older adults.