@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 {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 {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} }