@article {12159, title = {Does a Cancer Diagnosis in Mid-to-Later Life Modify Racial Disparities in Memory Aging?}, journal = {Alzheimer Disease \& Associated Disorders}, volume = {36}, year = {2022}, pages = {140-147}, abstract = {

BACKGROUND: It is unknown whether an incident cancer diagnosis differentially impacts acute and long-term memory aging between older White and Black Americans.

METHODS: Incident cancer diagnoses and memory (immediate and delayed recall, combined with proxy-reported memory) were assessed at biennial study interviews in the US Health and Retirement Study (N=14,235, 1998-2016). We used multivariable segmented linear mixed-effects models to evaluate the rate of change in standardized memory score (SD/decade) in the years before, acutely at the time of, and in the years following an incident cancer diagnosis, compared to cancer-free adults, by race.

RESULTS: Black participants experienced faster memory decline than White participants (cancer-free group: -1.211 vs. -1.077; P<0.0001). An incident cancer diagnosis was associated with an acute memory drop in White, but not Black participants (-0.065 vs. 0.024; P<0.0001). However, White cancer survivors experienced slower memory decline than cancer-free White adults before and after diagnosis, but this memory advantage was not observed among Black cancer survivors.

CONCLUSIONS: Racial disparities in memory aging are not modified by an incident cancer diagnosis. The acute cancer-related memory decline and long-term memory advantage experienced by White, but not Black, cancer survivors relative to cancer-free older adults, requires further investigation.

}, keywords = {cancer diagnosis, Memory, Racial Disparities}, issn = {1546-4156}, doi = {10.1097/WAD.0000000000000493}, author = {Eastman, Marisa R and Ospina-Romero, Monica and Westrick, Ashly C and Jasdeep S Kler and M. Maria Glymour and Abdiwahab, Ekland and Lindsay C Kobayashi} } @article {10868, title = {Difficulty and help with activities of daily living among older adults living alone with cognitive impairment}, journal = {Alzheimer{\textquoteright}s \& DementiaAlzheimer{\textquoteright}s \& DementiaAlzheimer{\textquoteright}s Dement.}, year = {2020}, month = {2020/06/26}, abstract = {Abstract Introduction There is limited research on difficulties with activities of daily living (I/ADLs) among older adults living alone with cognitive impairment, including differences by race/ethnicity. Methods For U.S. Health and Retirement Study (2000?2014) participants aged 55+ living alone with cognitive impairment (4,666 individuals; 9,091 observations), we evaluated I/ADL difficulty and help. Results Among 4.3 million adults aged 55+ living alone with cognitive impairment, an estimated 46\% reported an I/ADL difficulty; 72\% reported not receiving help with an I/ADL. Women reported more difficulty than men. Compared to white women, black women were 22\% more likely to report a difficulty without help, and Latina women were 36\% more likely to report a difficulty with help. Among men, racial/ethnic differences in outcomes were not significant. Patterns of difficulty without help by race/ethnicity were similar among Medicaid beneficiaries. Discussion Findings call for targeted efforts to support older adults living alone with cognitive impairment.}, keywords = {Activities of Daily Living, Aging in place, CIND, Dementia, Disability, limitations, Living arrangement, population-based study, service gaps}, isbn = {1552-5260}, doi = {10.1002/alz.12102}, author = {Ryan D. Edwards and Willa D Brenowitz and Portacolone, Elena and Kenneth E Covinsky and Bindman, Andrew and M. Maria Glymour and Jacqueline M Torres} } @article {10141, title = {Differential associations between state-level educational quality and cardiovascular health by race: Early-life exposures and late-life health.}, journal = {SSM Population Health}, volume = {8}, year = {2019}, pages = {100418}, abstract = {Cardiovascular diseases (CVD) are patterned by educational attainment but educational quality is rarely examined. Educational quality differences may help explain racial disparities. Health and Retirement Study respondent data (1992-2014; born 1900-1951) were linked to state- and year-specific educational quality measures when the respondent was 6 years old. State-level educational quality was a composite of state-level school term length, student-to-teacher ratio, and per-pupil expenditure. CVD-related outcomes were self-reported (N = 24,339) obesity, heart disease, stroke, ever-smoking, high blood pressure, diabetes and objectively measured (N = 10,704) uncontrolled blood pressure, uncontrolled blood sugar, total cholesterol, high-density lipoprotein cholesterol (HDL), and C-reactive protein. Race/ethnicity was classified as White, Black, or Latino. Cox models fit for dichotomous time-to-event outcomes and generalized estimating equations for continuous outcomes were adjusted for individual and state-level confounders. Heterogeneities by race were evaluated using state-level educational quality by race interaction terms; race-pooled, race by educational quality interaction, and race-specific estimates were calculated. In race-pooled analyses, higher state-level educational quality was protective for obesity (HR = 0.92; 95\%CI(0.87,0.98)). In race-specific estimates for White Americans, state-level educational quality was protective for high blood pressure (HR = 0.95; 95\%CI(0.91,0.99). Differential relationships among Black compared to White Americans were observed for obesity, heart disease, stroke, smoking, high blood pressure, and HDL cholesterol. In race-specific estimates for Black Americans, higher state-level educational quality was protective for obesity (HR = 0.88; 95\%CI(0.84,0.93)), but predictive of heart disease (HR = 1.07; 95\%CI(1.01,1.12)), stroke (HR = 1.20; 95\%CI(1.08,1.32)), and smoking (HR = 1.05; 95\%CI(1.02,1.08)). Race-specific hazard ratios for Latino and Black Americans were similar for obesity, stroke, and smoking. Better state-level educational quality had differential associations with CVD by race. Among minorities, better state-level educational quality was predominately associated with poorer CVD outcomes. Results evaluate the 1900-1951 birth cohorts; secular changes in the racial integration of schools since the 1950s, means results may not generalize to younger cohorts.}, keywords = {Cardiovascular health, Education, Heart disease, Late-life Health, Racial/ethnic differences}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2019.100418}, author = {Anusha M Vable and Thu T Nguyen and David Rehkopf and M. Maria Glymour and Hamad, Rita} } @article {9970, title = {Discrimination in health care and biomarkers of cardiometabolic risk in U.S. adults}, journal = {SSM - Population Health}, volume = {7}, year = {2019}, pages = {100306}, abstract = {Introduction: Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to older adults who are more likely to have existing risk factors or medical conditions that require on-going care. The purpose of this study is to investigate the associations between patient-reported health care discrimination and biomarkers of cardiometabolic risk. Methods: We used 2008{\textendash}2014 data from the Health and Retirement Study, a nationally representative study of US adults ages 50+ (n=12,695 participants contributing up to 16,179 observations) to examine the association between patient-reported experiences of health care discrimination and biomarkers of cardiometabolic risk: high sensitivity C-reactive protein (CRP), Hemoglobin A1c (HbAlc), high-density lipoprotein (HDL), total cholesterol, cystatin C and blood pressure and whether relationships were modified by race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) or gender. We fit generalized estimating equation (GEE) models specifying a binomial distribution and logit link to account for dependency of repeated measures on individuals. Results: Health care discrimination was associated with higher odds of CRP>3 mg/L (OR: 1.20 (95\% CI: 1.10, 1.30) and HbA1c>6.5\% (OR: 1.23 (95\% CI: 1.10, 1.38) but not associated with other biomarkers of cardiometabolic health in the sample as a whole. However, subgroup differences were detected. While health care discrimination was positively associated with elevated HbA1c for non-Hispanics, it was inversely associated with HbA1c for Hispanics. Conclusions: Health care discrimination was associated with increased cardiometabolic risk based on selected biomarkers.}, keywords = {Biomarkers, Discrimination, Racism, Risk Factors}, issn = {23528273}, doi = {10.1016/j.ssmph.2018.10.006}, author = {Thu T Nguyen and Anusha M Vable and M. Maria Glymour and Allen, Amani M.} } @article {8401, title = {Diabetic Phenotypes and Late-Life Dementia Risk: A Mechanism-specific Mendelian Randomization Study.}, journal = {Alzheimer Dis Assoc Disord}, volume = {30}, year = {2016}, month = {2016 Jan-Mar}, pages = {15-20}, publisher = {30}, abstract = {

BACKGROUND: Mendelian Randomization (MR) studies have reported that type 2 diabetes (T2D) was not associated with Alzheimer disease (AD). We adopted a modified, mechanism-specific MR design to explore this surprising result.

METHODS: Using inverse-variance weighted MR analysis, we evaluated the association between T2D and AD using data from 39 single nucleotide polymorphisms (SNPs) significantly associated with T2D in DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) and the corresponding associations of each SNP with AD risk obtained from the International Genomics of Alzheimer{\textquoteright}s Project (IGAP, n=17,008 AD cases and n=37,154 controls). We evaluated mechanism-specific genetic subscores, including β-cell function, insulin sensitivity, and adiposity, and repeated analyses in 8501 Health and Retirement Study participants for replication and model validation.

RESULTS: In IGAP, the overall T2D polygenic score did not predict AD [odds ratio (OR) for the T2D polygenic score=1.01; 95\% confidence interval (CI), 0.96, 1.06] but the insulin sensitivity polygenic score predicted higher AD risk (OR=1.17; 95\% CI, 1.02, 1.34). In the Health and Retirement Study, polygenic scores were associated with T2D risk; the associations between insulin sensitivity genetic polygenic score and cognitive phenotypes were not statistically significant.

CONCLUSIONS: Evidence from polygenic scores suggests that insulin sensitivity specifically may affect AD risk, more than T2D overall.

}, keywords = {Alzheimer disease, Diabetes Mellitus, Type 2, Genetic Predisposition to Disease, Humans, Insulin, Mendelian Randomization Analysis, Phenotype, Polymorphism, Single Nucleotide, Risk Factors}, issn = {1546-4156}, doi = {10.1097/WAD.0000000000000128}, url = {http://europepmc.org/abstract/MED/26650880}, author = {Stefan Walter and Jessica R Marden and Laura D Kubzansky and Elizabeth R Mayeda and Paul K Crane and Chang, Shun-Chiao and Marilyn C Cornelis and David Rehkopf and Mukherjee, Shubhabrata and M. Maria Glymour} } @article {6483, title = {Do Physical Activity, Smoking, Drinking, or Depression Modify Transitions from Cognitive Impairment to Functional Disability?}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {44}, year = {2015}, pages = {1171-1180}, chapter = {1171}, abstract = {Background: Individual-level modifiers can delay onset of limitations in basic activities of daily living (ADLs) among cognitively impaired individuals. We assessed whether these modifiers also delayed onset of limitations in instrumental ADLs (IADLs) among individuals at elevated dementia risk. Objectives: To determine whether modifiable individual-level factors delay incident IADL limitations among adults stratified by dementia risk. Methods: Health and Retirement Study participants aged 65 without activity limitations in 1998 or 2000 (n = 5,219) were interviewed biennially through 2010. Dementia probability, categorized in quartiles, was used to predict incident IADL limitations with Poisson regression. We estimated relative (risk ratio) and absolute (number of limitations) effects from models including dementia, individual-level modifiers (physical inactivity, smoking, no alcohol consumption, and depression) and interaction terms between dementia and individual-level modifiers. Results: Dementia probability quartile predicted incident IADL limitations (relative risk for highest versus lowest quartile = 0.44; 95 CI: 0.28 0.70). Most modifiers did not significantly increase risk of IADL limitations among the cognitively impaired. Physical inactivity (RR = 1.60; 95 CI: 1.16, 2.19) increased the risk of IADL limitations among the cognitively impaired. The interaction between physical inactivity and low dementia probability was statistically significant (p = 0.009) indicating that physical inactivity had significantly larger effects on incident IADLs among cognitively normal than among those with high dementia probability. Conclusion: Physical activity may protect against IADL limitations while smoking, alcohol consumption, and depression do not afford substantial protection among the cognitively impaired. Results highlight the need for extra support for IADLs among individuals with cognitive losses.}, keywords = {Disabilities, Health Conditions and Status, Healthcare}, doi = {10.3233/JAD-141866}, url = {http://dx.doi.org/10.3233/JAD-141866}, author = {Pamela M. Rist and Jessica R Marden and Benjamin D Capistrant and Bei Wu and M. Maria Glymour} } @article {6475, title = {Dementia and dependence: Do Modifiable Risk Factors Delay Disability?}, journal = {Neurology}, volume = {82}, year = {2014}, month = {04/2014}, pages = {1543-1550}, chapter = {1543}, abstract = {Objective: To identify modifying factors that preserve functional independence among individuals at high dementia risk. Methods: Health and Retirement Study participants aged 65 years or older without baseline activities of daily living (ADL) limitations (n = 4,922) were interviewed biennially for up to 12 years. Dementia probability, estimated from direct and proxy cognitive assessments, was categorized as low (i.e., normal cognitive function), mild, moderate, or high risk (i.e., very impaired) and used to predict incident ADL limitations (censoring after limitation onset). We assessed multiplicative and additive interactions of dementia category with modifiers (previously self-reported physical activity, smoking, alcohol consumption, depression, and income) in predicting incident limitations. Results: Smoking, not drinking, and income predicted incident ADL limitations and had larger absolute effects on ADL onset among individuals with high dementia probability than among cognitively normal individuals. Smoking increased the 2-year risk of ADL limitations onset from 9.9 to 14.9 among the lowest dementia probability category and from 32.6 to 42.7 among the highest dementia probability category. Not drinking increased the 2-year risk of ADL limitations onset by 2.1 percentage points among the lowest dementia probability category and 13.2 percentage points among the highest dementia probability category. Low income increased the 2-year risk of ADL limitations onset by 0.4 among the lowest dementia probability category and 12.9 among the highest dementia probability category. Conclusions: Smoking, not drinking, and low income predict incident dependence even in the context of cognitive impairment. Regardless of cognitive status, reducing these risk factors may improve functional outcomes and delay institutionalization.}, keywords = {Health Conditions and Status, Income}, doi = {10.1212/WNL.0000000000000357}, author = {Pamela M. Rist and Benjamin D Capistrant and Bei Wu and Jessica R Marden and M. Maria Glymour} } @article {8020, title = {Diabetes risk, diagnosis, and control: Do psychosocial factors predict hemoglobin A1C defined outcomes or accuracy of self-reports?}, journal = {Ethnicity and Disease}, volume = {24}, year = {2014}, note = {Times Cited: 0}, pages = {19-27}, publisher = {24}, abstract = {Objective: To evaluate the accuracy of self-reported diabetes among multi-ethnic older adults by psychosocial factors and assess predictors of diabetes risk, diagnosis, and control. Design and Methods: The 2006 Health and Retirement Study (N=5,594) was used to determine agreement between self-reported diabetes and measured diabetes (HbA1c = 6.5 ) by age, sex, race/ethnicity, nativity, education, health insurance coverage, body mass index, depressive symptoms, and prior report of racial discrimination. We also examined associations between these factors and pre-diabetes (HbA1c = 6.0- 6.5 ) among individuals without diabetes, and those with undiagnosed and poorly controlled (HbA1c = 8.0 ) diabetes. Results: Accuracy of self-reported diabetes was good (ie, sensitivity = 80 and specificity = 95 ) among all demographic subgroups and across most social strata. Among those who reported racial discrimination, sensitivity of self-reported diabetes was lower among Blacks who reported racial discrimination in comparison to Blacks who did not report racial discrimination (82.7 vs 89.0 ) an association that was marginally statistically significant (P=.05). Blacks and Hispanics had higher odds of pre-diabetes, undiagnosed diabetes, and poor glycemic control. Conclusions: Self-reported diabetes corresponded well with HbA1c assessed disease for all social strata examined in this sample of multi-ethnic older adults. Blacks with a history of racial discrimination may be less likely to know diabetes status.}, keywords = {Demographics, Health Conditions and Status, Other}, author = {White, Kellee and Mondesir, Favel L. and Lisa M. Bates and M. Maria Glymour} } @article {7995, title = {The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {69}, year = {2014}, month = {2014 Jul}, pages = {860-70}, publisher = {69}, abstract = {

BACKGROUND: Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace.

METHODS: Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace.

RESULTS: Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke.

CONCLUSION: Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Black or African American, Cohort Studies, Disabled Persons, Female, Humans, Male, Prospective Studies, Stroke, United States, White People}, issn = {1758-535X}, doi = {10.1093/gerona/glt191}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/01/19/gerona.glt191.abstract}, author = {Benjamin D Capistrant and Nicte I Mejia and Sze Y Liu and Qianyi Wang and M. Maria Glymour} } @article {7982, title = {Does duration of spousal caregiving affect risk of depression onset? Evidence from the Health and Retirement Study.}, journal = {Am J Geriatr Psychiatry}, volume = {22}, year = {2014}, note = {Times Cited: 0}, month = {2014 Aug}, pages = {766-70}, publisher = {22}, abstract = {

OBJECTIVES: To assess the association of current and long-term spousal caregiving with risk of depression in a nationally (U.S.) representative sample of older adults.

METHODS: We studied married and depression-free Health and Retirement Study respondents aged 50 years and older (n~= 9,420) at baseline from 2000 to 2010. Current (>=14 hours per week of help with instrumental/activities of daily living for a spouse in the most recent biennial survey) and long-term caregiving (care at two consecutive surveys) were used to predict onset of elevated depressive symptoms (>=3 on a modified Centers for Epidemiologic Studies Depression scale) with discrete-time hazards models and time-updated exposure and covariate information.

RESULTS: Current caregiving was associated with significant elevations in risk of depression onset (hazard ratio: 1.64; Wald χ(2), 1 df: 28.34; p~<0.0001). Effect estimates for long-term caregiving were similar (hazard ratio: 1.52, Wald χ(2), 1 df: 3.63; p~= 0.06).

CONCLUSIONS: Current spousal caregiving significantly predicted onset of depression; the association was not exacerbated by longer duration of caregiving.

}, keywords = {Aged, Caregivers, depression, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Risk Factors, Spouses, Time Factors, United States}, issn = {1545-7214}, doi = {10.1016/j.jagp.2013.01.073}, author = {Benjamin D Capistrant and Lisa F Berkman and M. Maria Glymour} } @article {8097, title = {Does the Widowhood Effect Precede Spousal Bereavement? Results from a Nationally Representative Sample of Older Adults}, journal = {American Journal of Geriatric Psychiatry}, year = {2014}, note = {Export Date: 6 August 2014 Article in Press}, abstract = {Objective: Increased mortality risk following spousal bereavement (often called the widowhood effect ) is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. Design: Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. Method: Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: recent widows (N = 396) were bereaved between 2004 and 2006, before outcomes were assessed; near widows (N = 380) were bereaved between 2006 and 2008, after outcomes were assessed; married individuals (N = 7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. Results: Compared to married individuals, recent widows had worse depressive symptoms ( = 0.71, 95 confidence interval (CI): 0.57, 0.85 ). Near widows had worse depressive symptoms ( = 0.21, 95 CI: 0.08, 0.34 ), mobility ( = 0.14, 95 CI: 0.01, 0.26 ), and word recall ( = -0.13, 95 CI: -0.23, -0.02 ) compared to married individuals. Conclusions: Health declines before spousal death suggests some portion of the widowhood effect may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse. 2014 American Association for Geriatric Psychiatry.}, keywords = {Adult children, Health Conditions and Status, Net Worth and Assets}, doi = {10.1016/j.jagp.2014.05.004}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84902947790andpartnerID=40andmd5=a8046d229a07ff2a9286365ad66a8086}, author = {Anusha M Vable and S. V. Subramanian and Pamela M. Rist and M. Maria Glymour} } @article {7796, title = {Does the association between depressive symptoms and cardiovascular mortality risk vary by race? Evidence from the Health and Retirement Study.}, journal = {Ethn Dis}, volume = {23}, year = {2013}, month = {2013 Spring}, pages = {155-60}, publisher = {23}, abstract = {

OBJECTIVE: To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites.

DESIGN, SETTING AND PARTICIPANTS: 2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a nationally representative sample of U.S. adults aged > or = 50). Average follow-up was 9.2 years.

OUTCOME MEASURE: Cause of death (per ICD codes) and month of death were identified from National Death Index linkages.

METHODS: The associations between elevated depressive symptoms and mortality from stroke, ischemic heart disease (IHD), or total CVD were assessed using Cox proportional hazards models to estimate adjusted hazard ratios (HRs). We used interaction terms for race by depressive symptoms to assess effect modification (multiplicative scale).

RESULTS: For both Whites and Blacks, depressive symptoms were associated with a significantly elevated hazard of total CVD mortality (Whites: HR=1.46; 95\% CI: 1.33, 1.61; Blacks: HR=1.42, 95\% CI: 1.10, 1.83). Adjusting for health and socioeconomic covariates, Whites with elevated depressive symptoms had a 13\% excess hazard of CVD mortality (HR=1.13, 95\% CI: 1.03, 1.25) compared to Whites without elevated depressive symptoms. The HR in Blacks was similar, although the confidence interval included the null (HR=1.12, 95\% CI: .86, 1.46). The hazard associated with elevated depressive symptoms did not differ significantly by race (P>.15 for all comparisons). Patterns were similar in analyses restricted to respondents age > or =65.

CONCLUSION: Clinicians should consider the depressive state of either Black or White patients as a potential CVD mortality risk factor.

}, keywords = {Aged, Black or African American, Cardiovascular Diseases, depression, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Risk Assessment, Risk Factors, White People}, issn = {1049-510X}, author = {Benjamin D Capistrant and Paola Gilsanz and J Robin Moon and Anna Kosheleva and Kristen K Patton and M. Maria Glymour} } @article {7541, title = {Depressive symptoms predict incident stroke independently of memory impairments.}, journal = {Neurology}, volume = {75}, year = {2010}, note = {Glymour, M M Maselko, J Gilman, S E Patton, K K Avendano, M 1R01MH087544/MH/NIMH NIH HHS/United States 1R21 AG34385-01A1/AG/NIA NIH HHS/United States 1R21AG037889-01/AG/NIA NIH HHS/United States 1R21HD066312-01/HD/NICHD NIH HHS/United States 1RC4MH092707-01/MH/NIMH NIH HHS/United States 5R03MH083335/MH/NIMH NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Neurology Neurology. 2010 Dec 7;75(23):2063-70.}, month = {2010 Dec 07}, pages = {2063-70}, publisher = {75}, abstract = {

BACKGROUND: We evaluated whether depressive symptoms predict the onset of first stroke independently of memory impairment. We conceptualized memory impairment as a marker of preexisting cerebrovascular disease. We hypothesized that if depressive symptoms are causally related to stroke through mechanisms unrelated to cerebrovascular disease, depressive symptoms should predict stroke independently of memory impairment.

METHODS: Incidence of first stroke was assessed with self or proxy reports from 19,087 participants in the Health and Retirement Study cohort (1,864 events). Elevated depressive symptoms (3+ on an 8-item Centers for the Epidemiologic Study of Depression scale) and memory impairment (score of <=6 on a combined immediate and delayed recall of a 10-word list) were used as predictors of incident stroke in Cox survival models with adjustment for sociodemographic and cardiovascular risk factors.

RESULTS: After adjustment for sociodemographic and cardiovascular risk factors, elevated depressive symptoms (hazard ratio = 1.25; 95\% confidence interval 1.12-1.39) and memory impairment (hazard ratio = 1.26; 95\% confidence interval 1.13-1.41) each predicted stroke incidence in separate models. Hazard ratios were nearly unchanged and remained significant (1.23 for elevated depressive symptoms and 1.25 for memory impairment) when models were simultaneously adjusted for both elevated depressive symptoms and memory impairment. Elevated depressive symptoms also predicted stroke when restricting analyses to individuals with median memory score or better.

CONCLUSIONS: Memory impairments and depressive symptoms independently predict stroke incidence. Memory impairment may reflect undiagnosed cerebrovascular disease. These results suggest that depressive symptoms might be directly related to stroke rather than merely indicating preexisting cerebrovascular disease.

}, keywords = {Aged, Aged, 80 and over, depression, Female, Health Surveys, Humans, Incidence, Kaplan-Meier Estimate, Longitudinal Studies, Male, Memory Disorders, Middle Aged, Neuropsychological tests, Predictive Value of Tests, Risk Factors, Statistics, Nonparametric, Stroke, United States}, issn = {1526-632X}, doi = {10.1212/WNL.0b013e318200d70e}, author = {M. Maria Glymour and J Maselko and Gilman, S E and Kristen K Patton and Mauricio Avendano} } @article {10810, title = {Does childhood schooling affect old age memory or mental status? Using state schooling laws as natural experiments.}, journal = {J Epidemiol Community Health}, volume = {62}, year = {2008}, month = {2008 Jun}, pages = {532-7}, abstract = {

BACKGROUND: The association between schooling and old age cognitive outcomes such as memory disorders is well documented but, because of the threat of reverse causation, controversy persists over whether education affects old age cognition. Changes in state compulsory schooling laws (CSL) are treated as natural experiments (instruments) for estimating the effect of education on memory and mental status among the elderly. Changes in CSL predict changes in average years of schooling completed by children who are affected by the new laws. These educational differences are presumably independent of innate individual characteristics such as IQ.

METHODS: CSL-induced changes in education were used to obtain instrumental variable (IV) estimates of education{\textquoteright}s effect on memory (n = 10,694) and mental status (n = 9751) for white, non-Hispanic US-born Health and Retirement Survey participants born between 1900 and 1947 who did not attend college.

RESULTS: After adjustment for sex, birth year, state of birth and state characteristics, IV estimates of education{\textquoteright}s effect on memory were large and statistically significant. IV estimates for mental status had very wide confidence intervals, so it was not possible to draw meaningful conclusions about the effect of education on this outcome.

CONCLUSIONS: Increases in mandatory schooling lead to improvements in performance on memory tests many decades after school completion. These analyses condition on individual states, so differences in memory outcomes associated with CSL changes cannot be attributed to differences between states. Although unmeasured state characteristics that changed contemporaneously with CSL might account for these results, unobserved genetic variation is unlikely to do so.

}, keywords = {Aged, Aging, Censuses, Child, Cognition, Education, Educational Status, Female, Health Status, Humans, Least-Squares Analysis, Male, Massachusetts, Memory, Schools, Socioeconomic factors}, issn = {1470-2738}, doi = {10.1136/jech.2006.059469}, author = {M. Maria Glymour and Ichiro Kawachi and Jencks, Christopher and Lisa F Berkman} } @article {5587, title = {Does Childhood Schooling Affect Old Age Cognitive Function? Evidence from Natural Experiments}, year = {2004}, institution = {Harvard University}, keywords = {Adult children, Demographics, Health Conditions and Status}, author = {M. Maria Glymour and Lisa F Berkman and Robins, James M. and Ichiro Kawachi} }