@article {13454, title = {Negative wealth shocks in later life and subsequent cognitive function in older adults in China, England, Mexico, and the USA, 2012-18: a population-based, cross-nationally harmonised, longitudinal study.}, journal = {Lancet Healthy Longev}, year = {2023}, abstract = {

BACKGROUND: Household wealth is positively related to cognitive health outcomes in later life. However, the association between negative wealth shocks and cognitive function in later life, and whether this association might differ across countries at different levels of economic development, is unclear. We aimed to investigate whether negative wealth shocks in later life are associated with cognitive function in older adults in China, England, Mexico, and the USA, and whether this association is modified by country income level.

METHODS: For this population-based, cross-nationally harmonised, longitudinal study, data were analysed from core interviews of the population-based US Health and Retirement Study (2012 and 2016) and its partner studies in China (the China Health and Retirement Longitudinal Study; 2015 and 2018), England (the English Longitudinal Study of Ageing; 2012 and 2016), and Mexico (Mexican Health and Aging Study; 2012 and 2015-16), and their respective Harmonized Cognitive Assessment Protocols (HCAPs). Negative wealth shocks over the follow-up periods of the respective cohorts were defined in two ways: an extreme loss of 75\% or greater from the baseline amount of wealth, and a decline in within-population wealth quintile rank. The primary outcome was the harmonised general cognitive function (GCF) factor score, which was constructed with factor analysis on the HCAP neuropsychological assessments of memory, orientation, attention, executive function, and verbal fluency performance (mean 0; SD 1). We used sampling-weighted, multivariable-adjusted linear models to examine associations.

FINDINGS: Data from 9465 participants were included in this analysis: 3796 from China, 1184 from England, 1193 from Mexico, and 3292 from the USA. The mean baseline age of participants was 68{\textperiodcentered}5 (SD 5{\textperiodcentered}4) years in China (49{\textperiodcentered}8\% women), 72{\textperiodcentered}0 (7{\textperiodcentered}0) years in England (54{\textperiodcentered}6\% women), 70{\textperiodcentered}6 (6{\textperiodcentered}8) years in Mexico (55{\textperiodcentered}1\% women), and 72{\textperiodcentered}7 (7{\textperiodcentered}5) years in the USA (60{\textperiodcentered}4\% women). A wealth loss of 75\% or greater was negatively associated with subsequent cognitive function in the USA (β -0{\textperiodcentered}16 SD units; 95\% CI -0{\textperiodcentered}29 to -0{\textperiodcentered}04) and China (-0{\textperiodcentered}14; -0{\textperiodcentered}21 to -0{\textperiodcentered}07), but not in England (-0{\textperiodcentered}01; -0{\textperiodcentered}24 to 0{\textperiodcentered}22) or Mexico (-0{\textperiodcentered}11; -0{\textperiodcentered}24 to 0{\textperiodcentered}03). Similarly, within-population wealth quintile rank declines were negatively associated with subsequent cognitive function in the USA (β -0{\textperiodcentered}07 per quintile rank decline; 95\% CI -0{\textperiodcentered}11 to -0{\textperiodcentered}03) and China (β -0{\textperiodcentered}07; -0{\textperiodcentered}09 to -0{\textperiodcentered}04), but not in England (-0{\textperiodcentered}05; -0{\textperiodcentered}11 to 0{\textperiodcentered}01) or Mexico (-0{\textperiodcentered}03; -0{\textperiodcentered}07 to 0{\textperiodcentered}01).

INTERPRETATION: The impact of wealth shocks in later life on subsequent lower level of cognitive function of older adults in China, England, Mexico, and the USA differed across macro-level socioeconomic structures. These findings suggest that government policies and social safety nets in countries with different levels of economic development might have a role in protecting older adults from adverse health effects of wealth losses in later life.

FUNDING: US National Institute on Aging, US National Institutes of Health.

}, issn = {2666-7568}, doi = {10.1016/S2666-7568(23)00113-7}, author = {Cho, Tsai-Chin and Yu, Xuexin and Gross, Alden L and Zhang, Yuan S and Lee, Jinkook and Kenneth M. Langa and Lindsay C Kobayashi} } @article {9083, title = {Neuroprotective diets are associated with better cognitive function: The Health and Retirement Study.}, journal = {Journal of the American Geriatrics Society}, volume = {65}, year = {2017}, pages = {1857-1862}, abstract = {

OBJECTIVES: To evaluate the association between the Mediterranean diet (MedDiet) and the Mediterranean-DASH diet Intervention for Neurodegeneration Delay (MIND diet) and cognition in a nationally representative population of older U.S. adults.

DESIGN: Population-based cross-sectional study.

SETTING: Health and Retirement Study.

PARTICIPANTS: Community-dwelling older adults (N~=~5,907; mean age 67.8~{\textpm}~10.8).

MEASUREMENTS: Adherence to dietary patterns was determined from food frequency questionnaires using criteria determined a priori to generate diet scores for the MedDiet (range 0-55) and MIND diet (range 0-15). Cognitive performance was measured using a composite test score of global cognitive function (range 0-27). Linear regression was used to compare cognitive performance according to tertiles of dietary pattern. Logistic regression was used to examine the association between dietary patterns and clinically significant cognitive impairment. Models were adjusted for age, sex, race, educational attainment, and other health and lifestyle covariates.

RESULTS: Participants with mid (odds ratio (OR)~=~0.85, 95\% confidence interval (CI)~=~0.71-1.02, P~=~.08) and high (OR 0.65, 95\% CI~=~0.52-0.81, P~<~.001) MedDiet scores were less likely to have poor cognitive performance than those with low scores in fully adjusted models. Results for the MIND diet were similar. Higher scores in each dietary pattern were independently associated with significantly better cognitive function (P~<~.001) in a dose-response manner (P trend ~<~.001).

CONCLUSION: In a large nationally representative population of older adults, greater adherence to the MedDiet and MIND diet was independently associated with better cognitive function and lower risk of cognitive impairment. Clinical trials are required to elucidate the role of dietary patterns in cognitive aging.

}, keywords = {Cognitive Ability, Eating habits}, issn = {1532-5415}, doi = {10.1111/jgs.14922}, author = {Claire T McEvoy and Heidi M Guyer and Kenneth M. Langa and Kristine Yaffe} } @article {8514, title = {Neuroimaging overuse is more common in Medicare compared with the VA.}, journal = {Neurology}, volume = {87}, year = {2016}, month = {2016 Aug 23}, pages = {792-8}, abstract = {

OBJECTIVE: To inform initiatives to reduce overuse, we compared neuroimaging appropriateness in a large Medicare cohort with a Department of Veterans Affairs (VA) cohort.

METHODS: Separate retrospective cohorts were established in Medicare and in VA for headache and neuropathy from 2004 to 2011. The Medicare cohorts included all patients enrolled in the Health and Retirement Study (HRS) with linked Medicare claims (HRS-Medicare; n = 1,244 for headache and 998 for neuropathy). The VA cohorts included all patients receiving services in the VA (n = 93,755 for headache and 183,642 for neuropathy). Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or a primary headache. Neuroimaging use was measured with Current Procedural Terminology codes and potential overuse was defined using published criteria for use with administrative data. Increasingly specific appropriateness criteria excluded nontarget conditions for which neuroimaging may be appropriate.

RESULTS: For both peripheral neuropathy and headache, potentially inappropriate imaging was more common in HRS-Medicare compared with the VA. Forty-nine percentage of all headache patients received neuroimaging in HRS-Medicare compared with 22.1\% in the VA (p < 0.001) and differences persist when analyzing more specific definitions of overuse. A total of 23.7\% of all HRS-Medicare incident neuropathy patients received neuroimaging compared with 9.0\% in the VA (p < 0.001), and the difference persisted after excluding nontarget conditions.

CONCLUSIONS: Overuse of neuroimaging is likely less common in the VA than in a Medicare population. Better understanding the reasons for the more selective use of neuroimaging in the VA could help inform future initiatives to reduce overuse of diagnostic testing.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Female, Headache Disorders, Primary, Humans, Male, Medicare, Neuroimaging, Peripheral Nervous System Diseases, United States, United States Department of Veterans Affairs, Unnecessary Procedures}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000002963}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27402889}, author = {James F. Burke and Eve A Kerr and Ryan J McCammon and Holleman, Rob and Kenneth M. Langa and Brian C. Callaghan} } @article {7967, title = {Neuropsychiatric disorders and potentially preventable hospitalizations in a prospective cohort study of older Americans.}, journal = {J Gen Intern Med}, volume = {29}, year = {2014}, note = {Export Date: 6 August 2014 Article in Press}, month = {2014 Oct}, pages = {1362-71}, publisher = {29}, abstract = {

BACKGROUND: The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood.

OBJECTIVE(S): To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI).

DESIGN: Prospective cohort study.

PARTICIPANTS: Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008).

MAIN MEASURES: The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

KEY RESULTS: All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95\% Confidence Interval [95\%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95\%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95\%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95\%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95\%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95\%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95\%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95\%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

CONCLUSIONS: Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Cohort Studies, Dementia, depression, Female, Hospitalization, Humans, Male, Mental Disorders, Prospective Studies, Risk Factors, United States}, issn = {1525-1497}, doi = {10.1007/s11606-014-2916-8}, author = {Dimitry S Davydow and Zivin, Kara and Wayne J Katon and Gregory M Pontone and Lydia Chwastiak and Kenneth M. Langa and Theodore J Iwashyna} } @article {8929, title = {New insights into the dementia epidemic.}, journal = {New England Journal of Medicine}, volume = {369}, year = {2013}, month = {2013 Dec 12}, pages = {2275-7}, keywords = {Aging, Cognitive Ability, Dementia, Health Conditions and Status, Older Adults}, issn = {1533-4406}, doi = {10.1056/NEJMp1311405}, author = {Eric B Larson and Kristine Yaffe and Kenneth M. Langa} } @article {7564, title = {National estimates of the prevalence of Alzheimer{\textquoteright}s disease in the United States.}, journal = {Alzheimers Dement}, volume = {7}, year = {2011}, month = {2011 Jan}, pages = {61-73}, publisher = {7}, abstract = {

Several methods of estimating prevalence of dementia are presented in this article. For both Brookmeyer and the Chicago Health and Aging project (CHAP), the estimates of prevalence are derived statistically, forward calculating from incidence and survival figures. The choice of incidence rates on which to build the estimates may be critical. Brookmeyer used incidence rates from several published studies, whereas the CHAP investigators applied the incidence rates observed in their own cohort. The Aging, Demographics, and Memory Study (ADAMS) and the East Boston Senior Health Project (EBSHP) were sample surveys designed to ascertain the prevalence of Alzheimer{\textquoteright}s disease and dementia. ADAMS obtained direct estimates by relying on probability sampling nationwide. EBSHP relied on projection of localized prevalence estimates to the national population. The sampling techniques of ADAMS and EBSHP were rather similar, whereas their disease definitions were not. By contrast, EBSPH and CHAP have similar disease definitions internally, but use different calculation techniques, and yet arrive at similar prevalence estimates, which are considerably greater than those obtained by either Brookmeyer or ADAMS. Choice of disease definition may play the larger role in explaining differences in observed prevalence between these studies.

}, keywords = {Age Factors, Alzheimer disease, Community Health Planning, Data collection, Humans, Incidence, Models, Statistical, Prevalence, Sampling Studies, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2010.11.007}, author = {Brookmeyer, Ron and Denis A Evans and Liesi Hebert and Kenneth M. Langa and Steven G Heeringa and Brenda L Plassman and Walter Kukull} } @article {7571, title = {Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study.}, journal = {J Am Geriatr Soc}, volume = {59}, year = {2011}, month = {2011 Mar}, pages = {473-81}, publisher = {59}, abstract = {

OBJECTIVES: To examine the association between neuropsychiatric symptoms and risk of institutionalization and death.

DESIGN: Analysis of longitudinal data.

SETTING: The Aging, Demographics, and Memory Study (ADAMS).

PARTICIPANTS: Five hundred thirty-seven adults aged 71 and older with cognitive impairment drawn from the Health and Retirement Study (HRS).

MEASUREMENTS: Neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) and caregiver distress were identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned cognitive category. Date of nursing home placement and information on death, functional limitations, medical comorbidity, and sociodemographic characteristics were obtained from the HRS and ADAMS.

RESULTS: Overall, the presence of one or more neuropsychiatric symptoms was not associated with a significantly higher risk for institutionalization or death during the 5-year study period, although when assessing each symptom individually, depression, delusions, and agitation were each associated with a significantly higher risk of institutionalization (hazard rate (HR)=3.06, 95\% confidence interval (CI)=1.09-8.59 for depression; HR=5.74, 95\% CI=1.94-16.96 for clinically significant delusions; HR=4.70, 95\% CI=1.07-20.70 for clinically significant agitation). Caregiver distress mediated the association between delusions and agitation and institutionalization. Depression and hallucinations were associated with significantly higher mortality (HR=1.56, 95\% CI=1.08-2.26 for depression; HR=2.59, 95\% CI=1.09-6.16 for clinically significant hallucinations).

CONCLUSION: Some, but not all, neuropsychiatric symptoms are associated with a higher risk of institutionalization and death in people with cognitive impairment, and caregiver distress also influences institutionalization. Interventions that better target and treat depression, delusions, agitation, and hallucinations, as well as caregiver distress, may help delay or prevent these negative clinical outcomes.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Behavioral Symptoms, Caregivers, Cognition Disorders, Female, Humans, Institutionalization, Male, Neuropsychological tests, Proportional Hazards Models}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2011.03314.x}, author = {Okura, Toru and Brenda L Plassman and David C Steffens and David J Llewellyn and Guy G Potter and Kenneth M. Langa} } @article {7010, title = {Net worth predicts symptom burden at the end of life.}, journal = {J Palliat Med}, volume = {8}, year = {2005}, month = {2005 Aug}, pages = {827-37}, publisher = {8}, abstract = {

OBJECTIVES: To explore the predictors of symptom burden at the end of life.

DESIGN: Observational, secondary analysis of Health and Retirement Study (HRS) data.

SETTING: USA.

PARTICIPANTS: Two thousand six hundred four deceased, older adults.

METHODS: Multivariate Poisson and logistic regression to explore the relationship between sociodemographic and clinical factors with symptoms.

RESULTS: Fatigue, pain, dyspnea, depression, and anorexia were common and severe; 58\% of participants experienced more than 3 of these during their last year of life. Sociodemographic and clinical factors were associated with the number of symptoms as well as the presence of pain, depression, and dyspnea alone. Decedents in the highest quartile of net worth had fewer symptoms (incident rate ratio [IRR] 0.90, confidence interval [CI] 0.85-0.96) and less pain (odds ratio [OR] 0.66, CI 0.51-0.85) than comparisons did. Patients with cancer experienced more pain (OR 2.02, CI 1.62-2.53) and depression (OR 1.31, CI 1.07-1.61). Patients experienced more depression (OR 2.37, CI 1.85-3.03) and dyspnea (OR 1.40, CI 1.09-1.78).

LIMITATION: Use of proxy reports for primary data.

CONCLUSION: Older Americans experience a large symptom burden in the last year of life, largely with treatable symptoms such as pain, dyspnea, and depression. The adequacy of symptom control relates to clinical factors as well as net worth. This association between symptoms and wealth suggests that access to health care and other social services beyond those covered by Medicare may be important in decreasing symptom burden at the end of life.

}, keywords = {Aged, Aged, 80 and over, Data collection, Female, Humans, Logistic Models, Male, Severity of Illness Index, Social Class, Terminally Ill, United States}, issn = {1096-6218}, doi = {10.1089/jpm.2005.8.827}, author = {Maria J Silveira and Mohammed U Kabeto and Kenneth M. Langa} } @article {6793, title = {A national study of the quantity and cost of informal caregiving for the elderly with stroke.}, journal = {Neurology}, volume = {58}, year = {2002}, month = {2002 Jun 25}, pages = {1754-9}, publisher = {58}, abstract = {

BACKGROUND: As the US population ages, increased stroke incidence will result in higher stroke-associated costs. Although estimates of direct costs exist, little information is available regarding informal caregiving costs for stroke patients.

OBJECTIVE: To determine a nationally representative estimate of the quantity and cost of informal caregiving for stroke.

METHODS: The authors used data from the first wave of the Asset and Health Dynamics (AHEAD) Study, a longitudinal study of people over 70, to determine average weekly hours of informal caregiving. Two-part multivariable regression analyses were used to determine the likelihood of receiving informal care and the quantity of caregiving hours for those with stroke, after adjusting for important covariates. Average annual cost for informal caregiving was calculated.

RESULTS: Of 7,443 respondents, 656 (8.8\%) reported a history of stroke. Of those, 375 (57\%) reported stroke-related health problems (SRHP). After adjusting for cormorbid conditions, potential caregiver networks, and sociodemographics, the proportion of persons receiving informal care increased with stroke severity, and there was an association of weekly caregiving hours with stroke +/- SRHP (p < 0.01). Using the median 1999 home health aide wage (8.20 dollars/hour) as the value for family caregiver time, the expected yearly caregiving cost per stroke ranged from 3,500 dollars to 8,200 dollars. Using conservative prevalence estimates from the AHEAD sample (750,000 US elderly patients with stroke but no SRHP and 1 million with stroke and SRHP), this would result in an annual cost of up to 6.1 billion dollars for stroke-related informal caregiving in the United States.

CONCLUSIONS: Informal caregiving-associated costs are substantial and should be considered when estimating the cost of stroke treatment.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Confidence Intervals, Female, Humans, Longitudinal Studies, Male, Multivariate Analysis, Stroke, United States}, issn = {0028-3878}, doi = {10.1212/wnl.58.12.1754}, author = {Hickenbottom, S.L. and A. Mark Fendrick and Kutcher, J.S. and Mohammed U Kabeto and Steven J. Katz and Kenneth M. Langa} } @article {6738, title = {National estimates of the quantity and cost of informal caregiving for the elderly with dementia.}, journal = {J Gen Intern Med}, volume = {16}, year = {2001}, month = {2001 Nov}, pages = {770-8}, publisher = {16}, abstract = {

OBJECTIVE: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia.

DESIGN: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443).

SETTING: National population-based sample of the community-dwelling elderly.

MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status.

RESULTS: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.

CONCLUSION: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cost of Illness, Dementia, Female, Health Care Costs, Humans, Male, Multivariate Analysis, Regression Analysis, Severity of Illness Index, Time Factors, United States}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2001.10123.x}, author = {Kenneth M. Langa and M.E. Chernew and Mohammed U Kabeto and A. Regula Herzog and Mary Beth Ofstedal and Robert J. Willis and Robert B Wallace and Mucha, L.M. and Walter L. Straus and A. Mark Fendrick} }