IMPORTANCE A history of traumatic brain injury (TBI) has been considered a risk factor for Alzhei... more IMPORTANCE A history of traumatic brain injury (TBI) has been considered a risk factor for Alzheimer dementia. However, the specific association of TBI, even without loss of consciousness (LOC), with pathologic findings that underlie Alzheimer dementia, including Alzheimer disease (AD), non-AD neurodegenerative, and vascular pathologic findings, remains unclear. OBJECTIVE To examine the association between TBI with and without LOC and neuropathologic findings in community-based cohorts. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis used neuropathologic data from 1689 participants from the Religious Orders Study, the Rush Memory and Aging Project, and the Minority Aging Research Study. These studies began enrollment in 1994, 1997, and 2004, respectively. The current study's data set was frozen on April 3, 2021, when the mean (SD) length of follow-up for the participants was 8.7 (5.5) years. EXPOSURE Traumatic brain injury exposure was assessed using a standardized, self-reported questionnaire at baseline and annual follow-up visits. Participants were categorized into those (1) without TBI exposure (n = 1024), (2) with TBI with LOC (n = 161), or (3) with TBI without LOC (n = 504). MAIN OUTCOMES AND MEASURES Neuropathologic measures of amyloid-β, paired helical filament tangles, neocortical Lewy bodies, transactive response DNA-binding protein 43, hippocampal sclerosis, gross infarcts, and microinfarcts were assessed. Multiple linear regression and logistic regression models were used to determine whether TBI with or without LOC (compared with no TBI exposure as the reference group) was associated with neuropathologic outcomes after adjusting for age at death, sex, and educational level. Whether the apolipoprotein E (APOE) ε4 allele and sex differences modified associations was also examined.
Older Black adults in the US have higher prevalence and incidence of dementia and perform lower o... more Older Black adults in the US have higher prevalence and incidence of dementia and perform lower on cognitive tests than whites. Some of these differences have been attributed to facets of structural racism such as access to and quality of education and fewer socioeconomic resources. Here, we consider whether John Henryism (JH), a measure of self-perceived high-effort coping in the face of chronic environmental and psychosocial stressors, is associated with cognitive function and decline. JH has been associated with adverse cardiovascular health outcomes among African-Americans, especially those with fewer socioeconomic resources. Using data from MARS, we assessed whether JH, measured with an 8-item questionnaire (mean=16.9, sd=4.8, range: 4-27), was associated with level of cognitive function and rate of cognitive decline. We found one standard deviation increase in JH was associated with lower average cognitive function (□=-0.05, 95% CI: -0.09, -0.01). Higher JH was not associated ...
Objective To test whether postmortem MRI captures brain tissue characteristics that mediate the a... more Objective To test whether postmortem MRI captures brain tissue characteristics that mediate the association between physical activity and cognition in older adults. Methods Participants (N = 318) were older adults from the Rush Memory and Aging Project who wore a device to quantify physical activity and also underwent detailed cognitive and motor testing. Following death, cerebral hemispheres underwent MRI to quantify the transverse relaxation rate R2, a metric related to tissue microstructure. For analyses, we reduced the dimensionality of the R2 maps from approximately 500,000 voxels to 30 components using spatial independent component analysis (ICA). Via path analysis, we examined whether these R2 components attenuated the association between physical activity and cognition, controlling for motor abilities and indices of common brain pathologies. Results Two of the 30 R2 components were associated with both total daily physical activity and global cognition assessed proximate to ...
ObjectiveTo test the hypothesis that Alzheimer's disease and related neuropathologies contrib... more ObjectiveTo test the hypothesis that Alzheimer's disease and related neuropathologies contribute to the association between hospitalization and cognitive decline in old age.MethodsAs part of a longitudinal clinical–pathologic cohort study, 526 older persons (mean age at death = 90.9 years, 71% female) without dementia at baseline completed annual cognitive testing and were autopsied at death. Hospitalization information was obtained from linked Medicare claims records. Neuropathologic examination assessed β‐amyloid burden, tau tangle density, neocortical Lewy bodies, hippocampal sclerosis, chronic gross and microscopic cerebral infarcts, and transactive response DNA binding protein 43 kDa.ResultsOver a mean of 5.1 years, a total of 1,383 hospitalizations occurred, and the mean annual rate of hospitalization was 0.5 (standard deviation = 0.6, median = 0.4). Higher rate of hospitalization was not directly related to higher burden for any of the neuropathologic markers. Higher rate...
Alzheimer Disease & Associated Disorders, 2019
Purpose: Heightened Alzheimer disease (AD) risk among African Americans represents a racial dispa... more Purpose: Heightened Alzheimer disease (AD) risk among African Americans represents a racial disparity in aging. This study examines perceptions of AD risk factors among nondemented older African Americans. Methods: Participants indicated how important nine factors were in increasing one’s AD risk using a Likert-type scale with endpoints 1=not at all important to 4=extremely important. We examined perceptions of AD risk factors as a function of age, education, gender, and global cognition using separate logistic regression models. Patients: Participants were from The Minority Aging Research Study (N=610) with a mean age of 74.5 years, a mean education of 14.9 years, and 24% were men. Results: Of the AD risk factors, predictors were significantly related to genetics and God’s Will. Younger participants (est.=−0.06, P=0.02) and those with more education (est.=0.14, P=0.02) were more likely to report genetics as extremely important. Participants with more education were less likely to i...
Objective Investigate associations of early-life residence and school segregation with cognitive ... more Objective Investigate associations of early-life residence and school segregation with cognitive change in the Minority Aging Research Study. Methods Four hundred ninety-eight blacks (age ~ 73.5; 75% = women) without dementia at baseline self-reported State of birth, residence at age 12, and school segregation status. Census Bureau definitions of South and Northeast/Midwest were used to categorize early-life residence. We evaluated global cognition and five cognitive domains at baseline and annually for ~7.5 years. Linear mixed effects models examined the associations of region of birth and residence at age 12 with baseline level and longitudinal change in cognition. Additional models examined school segregation experience. Results ~65% of Southern-born participants still lived in the South at age 12. Southern birth was associated with lower baseline global cognition and all cognitive domains (p-values ≤ .02) compared to Northern birth, but not cognitive change. A similar profile wa...
The burden of dementia continues to increase as the population ages, with no disease-modifying tr... more The burden of dementia continues to increase as the population ages, with no disease-modifying treatments available. However, dementia risk appears to be decreasing, and progress has been made in understanding its multifactorial etiology. The 2018 National Institute on Aging–Alzheimer's Association (NIA-AA) research framework for Alzheimer's disease (AD) defines AD as a biological process measured by brain pathology or biomarkers, spanning the cognitive spectrum from normality to dementia. This framework facilitates interventions in the asymptomatic space and accommodates knowledge that many additional pathologies (e.g., cerebrovascular) contribute to the Alzheimer's dementia syndrome. The framework has implications for how we think about risk factors for “AD”: Many commonly accepted risk factors are not related to AD pathology and would no longer be considered risk factors for AD. They may instead be related to other pathologies or resilience to pathology. This review u...
Journal of Epidemiology and Community Health, 2018
BackgroundLiteracy, the ability to access, understand and utilise information and concepts from d... more BackgroundLiteracy, the ability to access, understand and utilise information and concepts from diverse sources in ways that promote good outcomes is key to successful ageing. Domain-specific health and financial literacy are particularly relevant to older adults as they face increasingly complex health and financial demands including those related to chronic conditions like type 2 diabetes. We therefore investigated the associations of literacy, including health and financial literacy, with diabetes indicators (ie, haemoglobin A1c and blood glucose) in a community-based cohort study of ageing.MethodsParticipants were 908 non-demented older adults (age ~81 years;75% women) from the Rush Memory and Aging Project. Literacy was measured using questions designed to assess comprehension of health and financial information and concepts and yielded a total score and domain-specific health and financial literacy scores. Non-fasting haemoglobin A1c and blood glucose samples were collected, p...
INTRODUCTION: Apolipoprotein E (APOE) is a susceptibility gene for late-onset Alzheimer's disease... more INTRODUCTION: Apolipoprotein E (APOE) is a susceptibility gene for late-onset Alzheimer's disease neuropathology; less is known about the relationship between APOE and cerebrovascular disease (CVD) neuropathology. METHODS: We investigated associations of APOE status with arteriolosclerosis, macro-and micro-infarcts, and atherosclerosis in 1,383 adults (65.9-108.2 years at death) with and without dementia. Excluding ε2/ε4 carriers, multivariable regressions for each CVD-related neuropathology compared ε4 and ε2 carriers to ε3/ε3 carriers adjusting for confounders including age and Alzheimer's neuropathology. RESULTS: 342 individuals (24.7%;~87.7 years at death;39.9% non-demented) were ε3/ε4 or ε4/ ε4, 180 (13.0%;~89.9 years at death;66.6% non-demented) were ε2/ε3 or ε2/ε2. ε4 carriers had higher odds of macroinfarcts (OR=1.41,95%CI:1.02-1.94,p=0.03) while ε2 carriers had higher
Brain microinfarcts are common in aging and are associated with cognitive impairment. Anterior an... more Brain microinfarcts are common in aging and are associated with cognitive impairment. Anterior and posterior watershed border zones lie at the territories of the anterior, middle, and posterior cerebral arteries, and are more vulnerable to hypoperfusion than brain regions outside the watershed areas. However, little is known about microinfarcts in these regions and how they relate to cognition in aging. Participants from the Rush Memory and Aging Project, a community-based clinical-pathologic study of aging, underwent detailed annual cognitive evaluations. We examined 356 consecutive autopsy cases (mean age-at-death, 91 years [SD = 6.16]; 28% men) for microinfarcts from 3 watershed brain regions (2 anterior and 1 posterior) and 8 brain regions outside the watershed regions. Linear regression models were used to examine the association of cortical watershed microinfarcts with cognition, including global cognition and 5 cognitive domains. Microinfarcts in any region were present in 13...
Our objectives were to characterize the inter-relation of known dementia-related neuropathologies... more Our objectives were to characterize the inter-relation of known dementia-related neuropathologies in one comprehensive model and quantify the extent to which accumulation of neuropathologies accounts for the association between age and dementia. We used data from 1,362 autopsied participants of three community-based clinicopathological cohorts: the Religious Orders Study, the Rush Memory and Aging Project, and the Minority Aging Research Study. We estimated a series of structural equation models summarizing a priori hypothesized neuropathological pathways between age and dementia risk individually and collectively. At time of death (mean age, 89 years), 44% of our sample had a clinical dementia diagnosis. When considered individually, our vascular, amyloid/tau, neocortical Lewy body, and TAR DNA-binding protein 43 (TDP-43)/hippocampal sclerosis pathology pathways each accounted for a substantial proportion of the association between age and dementia. When considered collectively, th...
The American Journal of Geriatric Psychiatry, 2017
Background-Research indicates that stress is linked to cognitive dysfunction. However, few commun... more Background-Research indicates that stress is linked to cognitive dysfunction. However, few community-based studies have explored the relationship between perceived stress and cognitive decline, and fewer still have employed cognitive domains rather than a global measure of cognition. Objective-We examined the relation between perceived stress and the rate of decline in different cognitive domains. Method-Participants were older African Americans without dementia from the Minority Aging Research Study (MARS; N=467, mean age: 73 SD=6.1). A battery of 19 cognitive tests was administered at baseline and at annual intervals for up to 9 years (mean follow up=4 years), from which composite measures of global cognitive function and five specific cognitive domains were derived. The 4-item Cohen's Perceived Stress Scale (PSS) was also administered at baseline. Results-In linear mixed-effects models adjusted for age, sex, education, and vascular risk factors, higher perceived stress was related to faster declines in global cognition (β=−0.019; SE=0.008; t (1951) =−2.46), episodic memory (β=−0.022; SE=0.011; t (1954) =−1.99), and visuospatial ability (β=−0.021; SE=0.009; t (1939) =−2.38) all p < .05. Findings were similar in subsequent models adjusted for demographics, vascular diseases, and depressive symptoms. Conclusions-Results indicate that older African Americans with higher levels of perceived stress have more rapid declines in global cognition than those with lower levels, most notably for episodic memory and visuospatial ability.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jan 30, 2017
To test the hypothesis that higher level of purpose in life is associated with lower subsequent o... more To test the hypothesis that higher level of purpose in life is associated with lower subsequent odds of hospitalization. Longitudinal cohort study. Participants' residences in the Chicago metropolitan area. A total of 805 older persons who completed uniform annual clinical evaluations. Participants annually completed a standard self-report measure of purpose in life, a component of well-being. Hospitalization data were obtained from Part A Medicare claims records. Based on previous research, ICD-9 codes were used to identify ambulatory care-sensitive conditions (ACSCs) for which hospitalization is potentially preventable. The relation of purpose (baseline and follow-up) to hospitalization was assessed in proportional odds mixed models. During a mean of 4.5 years of observation, there was a total of 2,043 hospitalizations (442 with a primary ACSC diagnosis; 1,322 with a secondary ACSC diagnosis; 279 with no ACSCs). In initial analyses, higher purpose at baseline and follow-up wer...
Objective: To determine the incidence of parkinsonism in community-dwelling older adults without ... more Objective: To determine the incidence of parkinsonism in community-dwelling older adults without Parkinson disease. Methods: Four parkinsonian signs were assessed with a modified motor portion of the Unified Parkinson's Disease Rating Scale in 2,001 older adults without parkinsonism. We used Cox proportional hazards models to determine the associations of age and sex with incident parkinsonism (2 or more signs). We calculated the number of events per 1,000 person-years of observation in 3 age strata. Next, we investigated several potential risk factors for incident parkinsonism. Then, we examined longitudinal progression of parkinsonism using discrete-time multistate Markov models. Results: Average age at baseline was 76.8 years (SD 7.62 years). During an average of 5 years of follow-up, 964/2,001 (48.2%) developed parkinsonism. Age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.08-1.10) but not male sex (HR 1.06, 95% CI 0.91-1.23) was associated with incident parkinsonism. The incidence of parkinsonism per 1,000 person-years of follow-up was 36.0 for adults ,75 years of age, 94.8 for those 75-84, and 160.5 for those 85 years or older. Depressive symptoms, neuroticism, urinary incontinence, sleep complaints, and chronic health conditions were associated with incident parkinsonism. Secondary analyses suggest that risk factors are linked with incident parkinsonism via early motor signs of parkinsonism and cognitive function. Transition modeling suggests that while parkinsonism may fluctuate, it is progressive in most older adults and its risk factors increase the odds of its progression. Conclusions: Parkinsonism is common in older adults and increases with age. Identifying modifiable risk factors may decrease the magnitude of this growing public health problem. Neurology ® 2016;87:1036-1044 GLOSSARY BMI 5 body mass index; CI 5 confidence interval; HR 5 hazard ratio; MAP 5 Memory and Aging Project; PD 5 Parkinson disease; ROS 5 Religious Orders Study; UPDRS 5 Unified Parkinson's Disease Rating Scale. Motor impairments such as parkinsonian signs are common in older adults without Parkinson disease (PD) and are associated with a wide range of adverse health outcomes. Cross-sectional studies suggest that parkinsonian signs may affect up to half of older adults. 1 Since parkinsonism is strongly associated with age, its incidence is likely to increase in our aging population and could constitute a major public health problem. Nonetheless, little data are available regarding age-and sex-specific incidence rates of parkinsonism. In this study, we employed a previously validated categorical measure of parkinsonism to determine the age-and sex-specific incidence of parkinsonism in 2,000 older communitydwelling older adults. 2 Then we examined motor and cognitive measures that might capture early signs of parkinsonism and several possible risk factors to determine which were associated with incident parkinsonism. METHODS Participants. Participants were from the Religious Orders Study (ROS) and Memory and Aging Project (MAP), which employ similar data collection procedures, allowing for combined analyses. 3,4 Participation in the annual follow-up evaluations and
The journals of gerontology. Series B, Psychological sciences and social sciences, Jan 12, 2016
Older adults often exhibit low health and financial literacy, but the reasons why remain unclear.... more Older adults often exhibit low health and financial literacy, but the reasons why remain unclear. One possibility is that those older adults at high risk for developing dementia demonstrate low literacy even in the absence of marked cognitive impairment. We therefore examined associations of health and financial literacy with the APOE ε4 allele, the chief genetic risk factor for Alzheimer's disease, among older adults without dementia. Participants were 487 older adults without dementia enrolled in the Rush Memory and Aging Project (mean age = 83, mean years of education = 15, 77% female, 91% non-Hispanic White). Participants underwent APOE genotyping and assessments of cognition, health literacy, and financial literacy. Health and financial literacy scores were also averaged into a total literacy score. ε4 was associated with lower total and health literacy, with a trend toward an association with lower financial literacy, after adjustment for age, sex, and education. Associati...
Journal of Alzheimer's disease : JAD, Jan 22, 2015
Falling victim to financial scams can have a significant impact upon social and financial wellbei... more Falling victim to financial scams can have a significant impact upon social and financial wellbeing and independence. A large proportion of scam victims are older adults, but whether older victims with mild cognitive impairment (MCI) are at higher risk remains unknown. We tested the hypothesis that older persons with MCI exhibit greater susceptibility to scams compared to those without cognitive impairment. Seven hundred and thirty older adults without dementia were recruited from the Rush Memory and Aging Project, a community-based epidemiologic study of aging. Participants completed a five-item self-report measure of susceptibility to scams, a battery of cognitive measures, and clinical diagnostic evaluations. In models adjusted for age, education, and gender, the presence of MCI was associated with greater susceptibility to scams (B = 0.125, SE = 0.063, p-value = 0.047). Further, in analyses of the role of specific cognitive systems in susceptibility to scams among persons with M...
Susceptibility to scams is a significant issue among older adults, even among those with intact c... more Susceptibility to scams is a significant issue among older adults, even among those with intact cognition. Age-related changes in brain macrostructure may be associated with susceptibility to scams; however, this has yet to be explored. Based on previous work implicating frontal and temporal lobe functioning as important in decision making, we tested the hypothesis that susceptibility to scams is associated with smaller grey matter volume in frontal and temporal lobe regions in a large community-dwelling cohort of non-demented older adults. Participants (N = 327, mean age = 81.55, mean education = 15.30, 78.9 % female) completed a self-report measure used to assess susceptibility to scams and an MRI brain scan. Results indicated an inverse association between overall grey matter and susceptibility to scams in models adjusted for age, education, and sex; and in models further adjusted for cognitive function. No significant associations were observed for white matter, cerebrospinal fl...
Aging clinical and experimental research, Jan 21, 2015
There is increasing clinical and legal interest in discrepancies between decision-making ability ... more There is increasing clinical and legal interest in discrepancies between decision-making ability and cognition in old age, a stage of life when decisions have major ramifications. We investigated the frequency and correlates of such discrepancies in non-demented older adults participating in a large community-based cohort study of aging, the Rush Memory and Aging Project. Participants [n = 689, mean age 81.8 (SD 7.6), mean education 15.2 (SD 3.1), 76.8 % female and 93.3 % white] completed a measure of financial and healthcare decision making (DM) and a battery of 19 neuropsychological tests from which a composite measure of global cognition (COG) was derived. Results indicated that 23.9 % of the sample showed a significant discrepancy between DM and COG abilities. Of these, 12.9 % showed DM < COG, while 11.0 % showed DM > COG. Logistic regression models showed older age, being non-white, greater temporal discounting, and greater risk aversion were associated with higher odds o...
Journal of the American Geriatrics Society, Jan 6, 2015
To test the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial a... more To test the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and healthcare decision-making. Community-based epidemiological cohort study. Communities throughout northeastern Illinois. Older persons without dementia from the Rush Memory and Aging Project (N = 730). All participants underwent a detailed clinical evaluation and decision-making assessment using a measure that closely approximates materials used in real-world financial and healthcare settings. This allowed for measurement of total decision-making and financial and healthcare decision-making. Regression models were used to examine whether MCI was associated with a lower level of decision-making. In subsequent analyses, the relationship between specific cognitive systems (episodic memory, semantic memory, working memory, perceptual speed, visuospatial ability) and decision-making was explored in participants with MCI. MCI was associated with lower total, financial, and healthcare decisio...
IMPORTANCE A history of traumatic brain injury (TBI) has been considered a risk factor for Alzhei... more IMPORTANCE A history of traumatic brain injury (TBI) has been considered a risk factor for Alzheimer dementia. However, the specific association of TBI, even without loss of consciousness (LOC), with pathologic findings that underlie Alzheimer dementia, including Alzheimer disease (AD), non-AD neurodegenerative, and vascular pathologic findings, remains unclear. OBJECTIVE To examine the association between TBI with and without LOC and neuropathologic findings in community-based cohorts. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis used neuropathologic data from 1689 participants from the Religious Orders Study, the Rush Memory and Aging Project, and the Minority Aging Research Study. These studies began enrollment in 1994, 1997, and 2004, respectively. The current study's data set was frozen on April 3, 2021, when the mean (SD) length of follow-up for the participants was 8.7 (5.5) years. EXPOSURE Traumatic brain injury exposure was assessed using a standardized, self-reported questionnaire at baseline and annual follow-up visits. Participants were categorized into those (1) without TBI exposure (n = 1024), (2) with TBI with LOC (n = 161), or (3) with TBI without LOC (n = 504). MAIN OUTCOMES AND MEASURES Neuropathologic measures of amyloid-β, paired helical filament tangles, neocortical Lewy bodies, transactive response DNA-binding protein 43, hippocampal sclerosis, gross infarcts, and microinfarcts were assessed. Multiple linear regression and logistic regression models were used to determine whether TBI with or without LOC (compared with no TBI exposure as the reference group) was associated with neuropathologic outcomes after adjusting for age at death, sex, and educational level. Whether the apolipoprotein E (APOE) ε4 allele and sex differences modified associations was also examined.
Older Black adults in the US have higher prevalence and incidence of dementia and perform lower o... more Older Black adults in the US have higher prevalence and incidence of dementia and perform lower on cognitive tests than whites. Some of these differences have been attributed to facets of structural racism such as access to and quality of education and fewer socioeconomic resources. Here, we consider whether John Henryism (JH), a measure of self-perceived high-effort coping in the face of chronic environmental and psychosocial stressors, is associated with cognitive function and decline. JH has been associated with adverse cardiovascular health outcomes among African-Americans, especially those with fewer socioeconomic resources. Using data from MARS, we assessed whether JH, measured with an 8-item questionnaire (mean=16.9, sd=4.8, range: 4-27), was associated with level of cognitive function and rate of cognitive decline. We found one standard deviation increase in JH was associated with lower average cognitive function (□=-0.05, 95% CI: -0.09, -0.01). Higher JH was not associated ...
Objective To test whether postmortem MRI captures brain tissue characteristics that mediate the a... more Objective To test whether postmortem MRI captures brain tissue characteristics that mediate the association between physical activity and cognition in older adults. Methods Participants (N = 318) were older adults from the Rush Memory and Aging Project who wore a device to quantify physical activity and also underwent detailed cognitive and motor testing. Following death, cerebral hemispheres underwent MRI to quantify the transverse relaxation rate R2, a metric related to tissue microstructure. For analyses, we reduced the dimensionality of the R2 maps from approximately 500,000 voxels to 30 components using spatial independent component analysis (ICA). Via path analysis, we examined whether these R2 components attenuated the association between physical activity and cognition, controlling for motor abilities and indices of common brain pathologies. Results Two of the 30 R2 components were associated with both total daily physical activity and global cognition assessed proximate to ...
ObjectiveTo test the hypothesis that Alzheimer's disease and related neuropathologies contrib... more ObjectiveTo test the hypothesis that Alzheimer's disease and related neuropathologies contribute to the association between hospitalization and cognitive decline in old age.MethodsAs part of a longitudinal clinical–pathologic cohort study, 526 older persons (mean age at death = 90.9 years, 71% female) without dementia at baseline completed annual cognitive testing and were autopsied at death. Hospitalization information was obtained from linked Medicare claims records. Neuropathologic examination assessed β‐amyloid burden, tau tangle density, neocortical Lewy bodies, hippocampal sclerosis, chronic gross and microscopic cerebral infarcts, and transactive response DNA binding protein 43 kDa.ResultsOver a mean of 5.1 years, a total of 1,383 hospitalizations occurred, and the mean annual rate of hospitalization was 0.5 (standard deviation = 0.6, median = 0.4). Higher rate of hospitalization was not directly related to higher burden for any of the neuropathologic markers. Higher rate...
Alzheimer Disease & Associated Disorders, 2019
Purpose: Heightened Alzheimer disease (AD) risk among African Americans represents a racial dispa... more Purpose: Heightened Alzheimer disease (AD) risk among African Americans represents a racial disparity in aging. This study examines perceptions of AD risk factors among nondemented older African Americans. Methods: Participants indicated how important nine factors were in increasing one’s AD risk using a Likert-type scale with endpoints 1=not at all important to 4=extremely important. We examined perceptions of AD risk factors as a function of age, education, gender, and global cognition using separate logistic regression models. Patients: Participants were from The Minority Aging Research Study (N=610) with a mean age of 74.5 years, a mean education of 14.9 years, and 24% were men. Results: Of the AD risk factors, predictors were significantly related to genetics and God’s Will. Younger participants (est.=−0.06, P=0.02) and those with more education (est.=0.14, P=0.02) were more likely to report genetics as extremely important. Participants with more education were less likely to i...
Objective Investigate associations of early-life residence and school segregation with cognitive ... more Objective Investigate associations of early-life residence and school segregation with cognitive change in the Minority Aging Research Study. Methods Four hundred ninety-eight blacks (age ~ 73.5; 75% = women) without dementia at baseline self-reported State of birth, residence at age 12, and school segregation status. Census Bureau definitions of South and Northeast/Midwest were used to categorize early-life residence. We evaluated global cognition and five cognitive domains at baseline and annually for ~7.5 years. Linear mixed effects models examined the associations of region of birth and residence at age 12 with baseline level and longitudinal change in cognition. Additional models examined school segregation experience. Results ~65% of Southern-born participants still lived in the South at age 12. Southern birth was associated with lower baseline global cognition and all cognitive domains (p-values ≤ .02) compared to Northern birth, but not cognitive change. A similar profile wa...
The burden of dementia continues to increase as the population ages, with no disease-modifying tr... more The burden of dementia continues to increase as the population ages, with no disease-modifying treatments available. However, dementia risk appears to be decreasing, and progress has been made in understanding its multifactorial etiology. The 2018 National Institute on Aging–Alzheimer's Association (NIA-AA) research framework for Alzheimer's disease (AD) defines AD as a biological process measured by brain pathology or biomarkers, spanning the cognitive spectrum from normality to dementia. This framework facilitates interventions in the asymptomatic space and accommodates knowledge that many additional pathologies (e.g., cerebrovascular) contribute to the Alzheimer's dementia syndrome. The framework has implications for how we think about risk factors for “AD”: Many commonly accepted risk factors are not related to AD pathology and would no longer be considered risk factors for AD. They may instead be related to other pathologies or resilience to pathology. This review u...
Journal of Epidemiology and Community Health, 2018
BackgroundLiteracy, the ability to access, understand and utilise information and concepts from d... more BackgroundLiteracy, the ability to access, understand and utilise information and concepts from diverse sources in ways that promote good outcomes is key to successful ageing. Domain-specific health and financial literacy are particularly relevant to older adults as they face increasingly complex health and financial demands including those related to chronic conditions like type 2 diabetes. We therefore investigated the associations of literacy, including health and financial literacy, with diabetes indicators (ie, haemoglobin A1c and blood glucose) in a community-based cohort study of ageing.MethodsParticipants were 908 non-demented older adults (age ~81 years;75% women) from the Rush Memory and Aging Project. Literacy was measured using questions designed to assess comprehension of health and financial information and concepts and yielded a total score and domain-specific health and financial literacy scores. Non-fasting haemoglobin A1c and blood glucose samples were collected, p...
INTRODUCTION: Apolipoprotein E (APOE) is a susceptibility gene for late-onset Alzheimer's disease... more INTRODUCTION: Apolipoprotein E (APOE) is a susceptibility gene for late-onset Alzheimer's disease neuropathology; less is known about the relationship between APOE and cerebrovascular disease (CVD) neuropathology. METHODS: We investigated associations of APOE status with arteriolosclerosis, macro-and micro-infarcts, and atherosclerosis in 1,383 adults (65.9-108.2 years at death) with and without dementia. Excluding ε2/ε4 carriers, multivariable regressions for each CVD-related neuropathology compared ε4 and ε2 carriers to ε3/ε3 carriers adjusting for confounders including age and Alzheimer's neuropathology. RESULTS: 342 individuals (24.7%;~87.7 years at death;39.9% non-demented) were ε3/ε4 or ε4/ ε4, 180 (13.0%;~89.9 years at death;66.6% non-demented) were ε2/ε3 or ε2/ε2. ε4 carriers had higher odds of macroinfarcts (OR=1.41,95%CI:1.02-1.94,p=0.03) while ε2 carriers had higher
Brain microinfarcts are common in aging and are associated with cognitive impairment. Anterior an... more Brain microinfarcts are common in aging and are associated with cognitive impairment. Anterior and posterior watershed border zones lie at the territories of the anterior, middle, and posterior cerebral arteries, and are more vulnerable to hypoperfusion than brain regions outside the watershed areas. However, little is known about microinfarcts in these regions and how they relate to cognition in aging. Participants from the Rush Memory and Aging Project, a community-based clinical-pathologic study of aging, underwent detailed annual cognitive evaluations. We examined 356 consecutive autopsy cases (mean age-at-death, 91 years [SD = 6.16]; 28% men) for microinfarcts from 3 watershed brain regions (2 anterior and 1 posterior) and 8 brain regions outside the watershed regions. Linear regression models were used to examine the association of cortical watershed microinfarcts with cognition, including global cognition and 5 cognitive domains. Microinfarcts in any region were present in 13...
Our objectives were to characterize the inter-relation of known dementia-related neuropathologies... more Our objectives were to characterize the inter-relation of known dementia-related neuropathologies in one comprehensive model and quantify the extent to which accumulation of neuropathologies accounts for the association between age and dementia. We used data from 1,362 autopsied participants of three community-based clinicopathological cohorts: the Religious Orders Study, the Rush Memory and Aging Project, and the Minority Aging Research Study. We estimated a series of structural equation models summarizing a priori hypothesized neuropathological pathways between age and dementia risk individually and collectively. At time of death (mean age, 89 years), 44% of our sample had a clinical dementia diagnosis. When considered individually, our vascular, amyloid/tau, neocortical Lewy body, and TAR DNA-binding protein 43 (TDP-43)/hippocampal sclerosis pathology pathways each accounted for a substantial proportion of the association between age and dementia. When considered collectively, th...
The American Journal of Geriatric Psychiatry, 2017
Background-Research indicates that stress is linked to cognitive dysfunction. However, few commun... more Background-Research indicates that stress is linked to cognitive dysfunction. However, few community-based studies have explored the relationship between perceived stress and cognitive decline, and fewer still have employed cognitive domains rather than a global measure of cognition. Objective-We examined the relation between perceived stress and the rate of decline in different cognitive domains. Method-Participants were older African Americans without dementia from the Minority Aging Research Study (MARS; N=467, mean age: 73 SD=6.1). A battery of 19 cognitive tests was administered at baseline and at annual intervals for up to 9 years (mean follow up=4 years), from which composite measures of global cognitive function and five specific cognitive domains were derived. The 4-item Cohen's Perceived Stress Scale (PSS) was also administered at baseline. Results-In linear mixed-effects models adjusted for age, sex, education, and vascular risk factors, higher perceived stress was related to faster declines in global cognition (β=−0.019; SE=0.008; t (1951) =−2.46), episodic memory (β=−0.022; SE=0.011; t (1954) =−1.99), and visuospatial ability (β=−0.021; SE=0.009; t (1939) =−2.38) all p < .05. Findings were similar in subsequent models adjusted for demographics, vascular diseases, and depressive symptoms. Conclusions-Results indicate that older African Americans with higher levels of perceived stress have more rapid declines in global cognition than those with lower levels, most notably for episodic memory and visuospatial ability.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jan 30, 2017
To test the hypothesis that higher level of purpose in life is associated with lower subsequent o... more To test the hypothesis that higher level of purpose in life is associated with lower subsequent odds of hospitalization. Longitudinal cohort study. Participants' residences in the Chicago metropolitan area. A total of 805 older persons who completed uniform annual clinical evaluations. Participants annually completed a standard self-report measure of purpose in life, a component of well-being. Hospitalization data were obtained from Part A Medicare claims records. Based on previous research, ICD-9 codes were used to identify ambulatory care-sensitive conditions (ACSCs) for which hospitalization is potentially preventable. The relation of purpose (baseline and follow-up) to hospitalization was assessed in proportional odds mixed models. During a mean of 4.5 years of observation, there was a total of 2,043 hospitalizations (442 with a primary ACSC diagnosis; 1,322 with a secondary ACSC diagnosis; 279 with no ACSCs). In initial analyses, higher purpose at baseline and follow-up wer...
Objective: To determine the incidence of parkinsonism in community-dwelling older adults without ... more Objective: To determine the incidence of parkinsonism in community-dwelling older adults without Parkinson disease. Methods: Four parkinsonian signs were assessed with a modified motor portion of the Unified Parkinson's Disease Rating Scale in 2,001 older adults without parkinsonism. We used Cox proportional hazards models to determine the associations of age and sex with incident parkinsonism (2 or more signs). We calculated the number of events per 1,000 person-years of observation in 3 age strata. Next, we investigated several potential risk factors for incident parkinsonism. Then, we examined longitudinal progression of parkinsonism using discrete-time multistate Markov models. Results: Average age at baseline was 76.8 years (SD 7.62 years). During an average of 5 years of follow-up, 964/2,001 (48.2%) developed parkinsonism. Age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.08-1.10) but not male sex (HR 1.06, 95% CI 0.91-1.23) was associated with incident parkinsonism. The incidence of parkinsonism per 1,000 person-years of follow-up was 36.0 for adults ,75 years of age, 94.8 for those 75-84, and 160.5 for those 85 years or older. Depressive symptoms, neuroticism, urinary incontinence, sleep complaints, and chronic health conditions were associated with incident parkinsonism. Secondary analyses suggest that risk factors are linked with incident parkinsonism via early motor signs of parkinsonism and cognitive function. Transition modeling suggests that while parkinsonism may fluctuate, it is progressive in most older adults and its risk factors increase the odds of its progression. Conclusions: Parkinsonism is common in older adults and increases with age. Identifying modifiable risk factors may decrease the magnitude of this growing public health problem. Neurology ® 2016;87:1036-1044 GLOSSARY BMI 5 body mass index; CI 5 confidence interval; HR 5 hazard ratio; MAP 5 Memory and Aging Project; PD 5 Parkinson disease; ROS 5 Religious Orders Study; UPDRS 5 Unified Parkinson's Disease Rating Scale. Motor impairments such as parkinsonian signs are common in older adults without Parkinson disease (PD) and are associated with a wide range of adverse health outcomes. Cross-sectional studies suggest that parkinsonian signs may affect up to half of older adults. 1 Since parkinsonism is strongly associated with age, its incidence is likely to increase in our aging population and could constitute a major public health problem. Nonetheless, little data are available regarding age-and sex-specific incidence rates of parkinsonism. In this study, we employed a previously validated categorical measure of parkinsonism to determine the age-and sex-specific incidence of parkinsonism in 2,000 older communitydwelling older adults. 2 Then we examined motor and cognitive measures that might capture early signs of parkinsonism and several possible risk factors to determine which were associated with incident parkinsonism. METHODS Participants. Participants were from the Religious Orders Study (ROS) and Memory and Aging Project (MAP), which employ similar data collection procedures, allowing for combined analyses. 3,4 Participation in the annual follow-up evaluations and
The journals of gerontology. Series B, Psychological sciences and social sciences, Jan 12, 2016
Older adults often exhibit low health and financial literacy, but the reasons why remain unclear.... more Older adults often exhibit low health and financial literacy, but the reasons why remain unclear. One possibility is that those older adults at high risk for developing dementia demonstrate low literacy even in the absence of marked cognitive impairment. We therefore examined associations of health and financial literacy with the APOE ε4 allele, the chief genetic risk factor for Alzheimer's disease, among older adults without dementia. Participants were 487 older adults without dementia enrolled in the Rush Memory and Aging Project (mean age = 83, mean years of education = 15, 77% female, 91% non-Hispanic White). Participants underwent APOE genotyping and assessments of cognition, health literacy, and financial literacy. Health and financial literacy scores were also averaged into a total literacy score. ε4 was associated with lower total and health literacy, with a trend toward an association with lower financial literacy, after adjustment for age, sex, and education. Associati...
Journal of Alzheimer's disease : JAD, Jan 22, 2015
Falling victim to financial scams can have a significant impact upon social and financial wellbei... more Falling victim to financial scams can have a significant impact upon social and financial wellbeing and independence. A large proportion of scam victims are older adults, but whether older victims with mild cognitive impairment (MCI) are at higher risk remains unknown. We tested the hypothesis that older persons with MCI exhibit greater susceptibility to scams compared to those without cognitive impairment. Seven hundred and thirty older adults without dementia were recruited from the Rush Memory and Aging Project, a community-based epidemiologic study of aging. Participants completed a five-item self-report measure of susceptibility to scams, a battery of cognitive measures, and clinical diagnostic evaluations. In models adjusted for age, education, and gender, the presence of MCI was associated with greater susceptibility to scams (B = 0.125, SE = 0.063, p-value = 0.047). Further, in analyses of the role of specific cognitive systems in susceptibility to scams among persons with M...
Susceptibility to scams is a significant issue among older adults, even among those with intact c... more Susceptibility to scams is a significant issue among older adults, even among those with intact cognition. Age-related changes in brain macrostructure may be associated with susceptibility to scams; however, this has yet to be explored. Based on previous work implicating frontal and temporal lobe functioning as important in decision making, we tested the hypothesis that susceptibility to scams is associated with smaller grey matter volume in frontal and temporal lobe regions in a large community-dwelling cohort of non-demented older adults. Participants (N = 327, mean age = 81.55, mean education = 15.30, 78.9 % female) completed a self-report measure used to assess susceptibility to scams and an MRI brain scan. Results indicated an inverse association between overall grey matter and susceptibility to scams in models adjusted for age, education, and sex; and in models further adjusted for cognitive function. No significant associations were observed for white matter, cerebrospinal fl...
Aging clinical and experimental research, Jan 21, 2015
There is increasing clinical and legal interest in discrepancies between decision-making ability ... more There is increasing clinical and legal interest in discrepancies between decision-making ability and cognition in old age, a stage of life when decisions have major ramifications. We investigated the frequency and correlates of such discrepancies in non-demented older adults participating in a large community-based cohort study of aging, the Rush Memory and Aging Project. Participants [n = 689, mean age 81.8 (SD 7.6), mean education 15.2 (SD 3.1), 76.8 % female and 93.3 % white] completed a measure of financial and healthcare decision making (DM) and a battery of 19 neuropsychological tests from which a composite measure of global cognition (COG) was derived. Results indicated that 23.9 % of the sample showed a significant discrepancy between DM and COG abilities. Of these, 12.9 % showed DM < COG, while 11.0 % showed DM > COG. Logistic regression models showed older age, being non-white, greater temporal discounting, and greater risk aversion were associated with higher odds o...
Journal of the American Geriatrics Society, Jan 6, 2015
To test the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial a... more To test the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and healthcare decision-making. Community-based epidemiological cohort study. Communities throughout northeastern Illinois. Older persons without dementia from the Rush Memory and Aging Project (N = 730). All participants underwent a detailed clinical evaluation and decision-making assessment using a measure that closely approximates materials used in real-world financial and healthcare settings. This allowed for measurement of total decision-making and financial and healthcare decision-making. Regression models were used to examine whether MCI was associated with a lower level of decision-making. In subsequent analyses, the relationship between specific cognitive systems (episodic memory, semantic memory, working memory, perceptual speed, visuospatial ability) and decision-making was explored in participants with MCI. MCI was associated with lower total, financial, and healthcare decisio...
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Papers by Bryan James