TY - JOUR T1 - Effects of the Co-occurrence of Diabetes Mellitus and Tooth Loss on Cognitive Function. JF - Current Alzheimer Research Y1 - 2021 A1 - Luo, Huabin A1 - Tan, Chenxin A1 - Adhikari, Samrachana A1 - Brenda L Plassman A1 - Kamer, Angela R A1 - Frank A Sloan A1 - Schwartz, Mark D A1 - Qi, Xiang A1 - Bei Wu KW - cognitive function KW - Dementia KW - Diabetes KW - effects of co-occurrence KW - Population KW - Tooth Loss AB -

OBJECTIVE: Both diabetes mellitus (DM) and poor oral health are common chronic conditions and risk factors of Alzheimer's disease and related dementia among older adults. This study assessed the effects of DM and complete tooth loss (TL) on cognitive function, accounting for their interactions.

METHODS: Longitudinal data were obtained from the 2006, 2012, and 2018 waves of the Health and Retirement Study. This cohort study included 7,805 respondents aged 65 years or older with 18,331 person-year observations. DM and complete TL were self-reported. Cognitive function was measured by the Telephone Interview for Cognitive Status. Random-effect regressions were used to test the associations, overall and stratified by sex.

RESULTS: Compared with older adults without neither DM nor complete TL, those with both conditions (b = -1.35, 95% confidence interval [CI]: -1.68, -1.02), with complete TL alone (b = -0.67, 95% CI: -0.88, -0.45), or with DM alone (b = -0.40, 95% CI: -0.59, -0.22), had lower cognitive scores. The impact of having both conditions was significantly greater than that of having DM alone (p < .001) or complete TL alone (p = 0.001). Sex-stratified analyses showed the effects were similar in males and females, except having DM alone was not significant in males.

CONCLUSION: The co-occurrence of DM and complete TL poses an additive risk for cognition. Healthcare and family-care providers should pay attention to the cognitive health of patients with both DM and complete TL. Continued efforts are needed to improve older adults' access to dental care, especially for individuals with DM.

VL - 18 IS - 13 ER - TY - JOUR T1 - Longitudinal Association Between Hearing Loss, Vision Loss, Dual Sensory Loss, and Cognitive Decline. JF - Journal of the American Geriatrics Society Y1 - 2021 A1 - Ge, Shaoqing A1 - McConnell, Eleanor S A1 - Bei Wu A1 - Pan, Wei A1 - Dong, XinQi A1 - Brenda L Plassman KW - ADAMS KW - Cognitive decline KW - Dementia KW - Hearing loss KW - longitudinal KW - vision loss AB -

BACKGROUND/OBJECTIVES: To better understand the role of sensory loss as a potentially modifiable risk factor for cognitive decline, this study examined cognitive decline in relation to single modality hearing or vision loss and dual sensory loss.

DESIGN: Longitudinal secondary data analysis.

SETTING: The Health and Retirement Study (HRS) and its supplement: The Aging, Demographics, and Memory Study (ADAMS).

PARTICIPANTS: Individuals aged 73 and older (N = 295).

MEASUREMENTS: Hearing loss was defined by an inability to hear sounds of 25 dB at frequencies between 0.5 and 4.0 kHz in either ear. Vision loss was defined as having corrected binocular vision worse than 20/40. Dual sensory loss was defined as having both hearing and vision loss. We used one time point of hearing and vision data objectively measured in ADAMS Wave C (June 2006-May 2008) and five waves of cognitive function data measured by the HRS version of the Telephone Interview for Cognitive Status in HRS (2006-2014). Multilevel mixed models were used.

RESULTS: Among the participants, 271 completed a hearing assessment and 120 had hearing loss; 292 completed a vision assessment and 115 had vision loss; 52 had dual sensory loss. Older adults with hearing loss had a significantly faster rate of cognitive decline as they aged compared to those with normal hearing (β = -0.16, P < .05). No significant association was found between vision loss and the rate of cognitive decline (β = -0.06, P = .41). Older adults who had dual sensory loss likewise had a significantly faster rate of cognitive decline as they age (β = -0.23, P < .05) compared to those with no sensory loss.

CONCLUSION: Older adults with hearing loss and dual sensory loss have faster rates of cognitive decline than those with normal sensory function.

VL - 69 IS - 3 ER - TY - JOUR T1 - Oral Health, Cognitive Function, and Mortality: Findings From National Surveys JF - Innovation in Aging Y1 - 2021 A1 - Bei Wu A1 - Keepper, Susie A1 - Saunders, Michele KW - cognitive function KW - Mortality KW - Oral Health AB - Poor oral health, diabetes mellitus (DM), and cognitive impairment are common problems in older adults. Using national surveys, this symposium aims to present new findings regarding the impact of the co-occurrence of DM and poor oral health on cognitive function, cognitive decline, and mortality. This symposium will also cover the topic of dental care use among adult populations in the U.S. Using data from the Health and Retirement Study (HRS) (2006- 2018), the first study shows that adults with both DM and edentulism had the worst cognitive function, followed by those with edentulism alone, and those with DM alone. Using the same HRS data, the second study found that co-occurrence of DM and edentulism had a higher risk of more rapid cognitive decline with advancing age than the presence of each condition alone. The third study used data from the 2006-2016 HRS linked with mortality files, and revealed that the risk of diabetes and edentulism on mortality may vary across racial/ethnic groups. Using the Behavioral Risk Factor Surveillance System survey (2002-2018), the fourth study examined disparities of dental service utilization among racial/ethnic groups (Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives, and Native Hawaiian or other Pacific Islanders). Age differences in dental services were also compared between older adults and other younger and middle-aged populations. This symposium highlights the role of oral health in improving cognitive health. Policies and programs are needed to increase dental care access, a critical way to help maintain good oral health. VL - 5 IS - Suppl _1 ER - TY - JOUR T1 - Edentulism and trajectories of cognitive functioning among older adults: The role of dental care service utilization. JF - Journal of Aging and Health Y1 - 2020 A1 - Sae Hwang Han A1 - Bei Wu A1 - Jeffrey A Burr KW - Cognitive Ability KW - Dental Care KW - Health Services Utilization AB -

OBJECTIVE: This study examined the associations between edentulism, dental care service utilization, and cognitive functioning trajectories among older adults.

METHOD: Longitudinal data from the Health and Retirement Study (2006-2014) were employed to examine individuals aged 51 and older who were identified as having normal cognition at baseline ( N = 12,405). Cognitive functioning was measured with a modified version of the Telephone Interview for Cognition Status. Edentulism was self-reported as total tooth loss at baseline. Dental care service utilization was measured by self-report of having visited a dentist at least once during the previous 2 years.

RESULTS: The results indicated that edentulism and dental care service utilization were independently associated with cognitive decline during the observation period. Findings also showed that dental care service utilization moderated the association between edentulism and cognitive decline.

DISCUSSION: The findings suggested that providing access to dental services may promote cognitive health and potentially reduce health care expenditures.

VL - 32 IS - 7-8 ER - TY - JOUR T1 - Comparison of methods for algorithmic classification of dementia status in the Health and Retirement Study. JF - Epidemiology Y1 - 2019 A1 - Kan Z Gianattasio A1 - Bei Wu A1 - M. Maria Glymour A1 - Melinda C Power KW - Cognition & Reasoning KW - Dementia KW - Meta-analyses KW - Survey Methodology AB -

BACKGROUND: Dementia ascertainment is time-consuming and costly. Several algorithms use existing data from the U.S.-representative Health and Retirement Study (HRS) to algorithmically identify dementia. However, relative performance of these algorithms remains unknown.

METHODS: We compared performance across five algorithms (Herzog-Wallace, Langa-Kabeto-Weir, Crimmins, Hurd, Wu) overall and within sociodemographic subgroups in participants in HRS and Wave A of the Aging, Demographics, and Memory Study (ADAMS, 2000-2002), an HRS sub-study including in-person dementia ascertainment. We then compared algorithmic performance in an internal (time-split) validation dataset including participants of HRS and ADAMS Waves B, C, and/or D (2002-2009).

RESULTS: In the unweighted training data, sensitivity ranged from 53% to 90%, specificity ranged from 79% to 97%, and overall accuracy ranged from 81% to 87%. Though sensitivity was lower in the unweighted validation data (range: 18% to 62%), overall accuracy was similar (range: 79% to 88%) due to higher specificities (range: 82% to 98%). In analyses weighted to represent the age-eligible US population, accuracy ranged from 91% to 94% in the training data and 87% to 94% in the validation data. Using a 0.5 probability cutoff, Crimmins maximized sensitivity, Herzog-Wallace maximized specificity, and Wu and Hurd maximized accuracy. Accuracy was higher among younger, highly-educated, and non-Hispanic white participants versus their complements in both weighted and unweighted analyses.

CONCLUSIONS: Algorithmic diagnoses provide a cost-effective way to conduct dementia research. However, naïve use of existing algorithms in disparities or risk-factor research may induce non-conservative bias. Algorithms with more comparable performance across relevant subgroups are needed.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

VL - 30 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30461528?dopt=Abstract ER - TY - JOUR T1 - Perceived Stress, Social Support, and Dry Mouth Among US Older Chinese Adults JF - Journal of the American Geriatrics Society Y1 - 2019 A1 - Mao, Weiyu A1 - Chen, Yiwei A1 - Bei Wu A1 - Ge, Shaoqing A1 - Yang, Wei A1 - Iris Chi A1 - Dong, XinQi KW - Dry Mouth KW - Stress KW - US Chinese Adults AB - OBJECTIVESDry mouth is a common condition among older adults that negatively influences oral health, general health, and quality of life. The role of psychosocial factors in oral health conditions and diseases remains largely unknown. We conducted a study to examine the relationship between perceived stress and dry mouth among US older Chinese adults and further investigated the potential moderating role of social support and social strain from different sources in the relationship.DESIGNCross‐sectional analysis.SETTINGBaseline of the Population Study of Chinese Elderly in Chicago, a community‐engaged, population‐based longitudinal study of health and well‐being among community‐dwelling US older Chinese adults.PARTICIPANTSIndividuals 60 years or older (N = 3157).MEASUREMENTSPerceived stress was measured by the 10‐item Chinese Perceived Stress Scale to evaluate the degree to which life situations were perceived as stressful during the preceding month on a 5‐point scale, ranging from 0 (“never”) to 4 (“very often”). Dry mouth was a binary self‐reported outcome variable (1 = “dry mouth”). Social support was measured by the Health and Retirement Study's social support and strain scale from sources including spouse, other family members, and friends with a 3‐point response set, ranging from 0 (“hardly ever”) to 2 (“often”). Sociodemographics and disease processes were assessed as covariates. We conducted stepwise logistic regressions with interaction terms.RESULTSHaving higher levels of perceived stress was significantly associated with a higher likelihood of reporting dry mouth (odds ratio = 1.03; 95% confidence interval = 1.02‐1.04). The effect of perceived stress on dry mouth may vary by levels of family and friend support.CONCLUSIONPerceived stress may influence dry mouth either directly or indirectly. To prevent or reduce dry mouth, in addition to disease processes, interventions need to consider psychosocial factors in dry mouth, especially perceived stress and social support, in this growing population. J Am Geriatr Soc 67:S551–S556, 2019.OBJECTIVESDry mouth is a common condition among older adults that negatively influences oral health, general health, and quality of life. The role of psychosocial factors in oral health conditions and diseases remains largely unknown. We conducted a study to examine the relationship between perceived stress and dry mouth among US older Chinese adults and further investigated the potential moderating role of social support and social strain from different sources in the relationship.DESIGNCross‐sectional analysis.SETTINGBaseline of the Population Study of Chinese Elderly in Chicago, a community‐engaged, population‐based longitudinal study of health and well‐being among community‐dwelling US older Chinese adults.PARTICIPANTSIndividuals 60 years or older (N = 3157).MEASUREMENTSPerceived stress was measured by the 10‐item Chinese Perceived Stress Scale to evaluate the degree to which life situations were perceived as stressful during the preceding month on a 5‐point scale, ranging from 0 (“never”) to 4 (“very often”). Dry mouth was a binary self‐reported outcome variable (1 = “dry mouth”). Social support was measured by the Health and Retirement Study's social support and strain scale from sources including spouse, other family members, and friends with a 3‐point response set, ranging from 0 (“hardly ever”) to 2 (“often”). Sociodemographics and disease processes were assessed as covariates. We conducted stepwise logistic regressions with interaction terms.RESULTSHaving higher levels of perceived stress was significantly associated with a higher likelihood of reporting dry mouth (odds ratio = 1.03; 95% confidence interval = 1.02‐1.04). The effect of perceived stress on dry mouth may vary by levels of family and friend support.CONCLUSIONPerceived stress may influence dry mouth either directly or indirectly. To prevent or reduce dry mouth, in addition to disease processes, interventions need to consider psychosocial factors in dry mouth, especially perceived stress and social support, in this growing population. J Am Geriatr Soc 67:S551–S556, 2019. VL - 67 SN - 0002-8614 UR - https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15890 JO - Journal of the American Geriatrics Society ER - TY - JOUR T1 - Racial/ethnic disparities in dental service utilization for foreign-born and U.S.-born middle-aged and older adults. JF - Research on Aging Y1 - 2019 A1 - Wei Zhang A1 - Wu, Yan Yan A1 - Bei Wu KW - Dental Care KW - Health Services Utilization KW - Racial/ethnic differences AB - This study examines racial/ethnic disparities of dental service utilization for foreign-born and U.S.-born dentate residents aged 50 years and older. Generalized linear mixed-effects models (GLMM) were used to perform longitudinal analyses of five-wave data of dental service utilization from the Health and Retirement Study (HRS). We used stratified analyses for the foreign-born and U.S.-born and assessed the nonlinear trend in rates of dental service utilization for different racial/ethnic groups. Findings indicate that Whites had higher rates of service utilization than Blacks and Hispanics regardless of birthplace. For all groups, the rates of service utilization decreased around age 80, and the rates of decline for Whites were slower than others. The U.S.-born showed the trend of higher rates of service utilization than the foreign-born for all racial/ethnic groups. These findings suggest the importance of developing culturally competent programs to meet the dental needs of the increasingly diverse populations in the United States. U1 - http://www.ncbi.nlm.nih.gov/pubmed/31272288?dopt=Abstract ER - TY - JOUR T1 - Does oral health predict functional status in late life? Findings from a national sample. JF - Journal of Aging and Health Y1 - 2018 A1 - Wei Zhang A1 - Wu, Yan Yan A1 - Bei Wu KW - Dental Care KW - Functional limitations AB -

OBJECTIVE: This study aims to examine the association between oral health and the decline in functional status among middle-aged and older adults in the United States.

METHOD: Generalized estimation equation (GEE) Poisson regression models with robust standard errors were used to analyze the longitudinal panel data (2008-2014) from the Health and Retirement Study ( N = 1,243). Oral health was evaluated using self-rated oral health, poor mouth condition, and tooth loss. Decline in functional status was assessed by disabilities in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: Respondents with poor oral health were more likely to experience decline in ADLs/IADLs. Adjusting for sociodemographics and comorbidities attenuated the effects of oral health.

DISCUSSION: Findings suggest that oral health might be one of the important predictors of functioning decline in late life, after adjusting sociodemographics and comorbidities.

VL - 30 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28553812?dopt=Abstract ER - TY - JOUR T1 - Loneliness, depression and cognitive function in older U.S. adults. JF - Int J Geriatr Psychiatry Y1 - 2017 A1 - Nancy J. Donovan A1 - Bei Wu A1 - Dorene M. Rentz A1 - Reisa A. Sperling A1 - Gad A. Marshall A1 - M. Maria Glymour KW - Aged KW - Aged, 80 and over KW - Cognitive Dysfunction KW - Demography KW - Depressive Disorder KW - Female KW - Humans KW - Loneliness KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Risk Factors AB -

OBJECTIVE: To examine reciprocal relations of loneliness and cognitive function in older adults.

METHODS: Data were analyzed from 8382 men and women, age 65 and older, participating in the US Health and Retirement Study from 1998 to 2010. Participants underwent biennial assessments of loneliness and depression (classified as no, low or high depression) determined by the Center for Epidemiologic Studies Depression scale (8-item version), cognition (a derived memory score based on a word list memory task and proxy-rated memory and global cognitive function), health status and social and demographic characteristics from 1998 to 2010. We used repeated measures analysis to examine the reciprocal relations of loneliness and cognitive function in separate models controlling sequentially and cumulatively for socio-demographic factors, social network, health conditions and depression.

RESULTS: Loneliness at baseline predicted accelerated cognitive decline over 12 years independent of baseline socio-demographic factors, social network, health conditions and depression (β = -0.2, p = 0.002). After adjustment for depression interacting with time, both low and high depression categories were related to faster cognitive decline and the estimated effect of loneliness became marginally significant. Reciprocally, poorer cognition at baseline was associated with greater odds of loneliness over time in adjusted analyses (OR 1.3, 95% CI (1.1-1.5) p = 0.005), but not when controlling for baseline depression. Furthermore, cognition did not predict change in loneliness over time.

CONCLUSION: Examining longitudinal data across a broad range of cognitive abilities, loneliness and depressive symptoms appear to be related risk factors for worsening cognition but low cognitive function does not lead to worsening loneliness over time. Copyright © 2016 John Wiley & Sons, Ltd.

VL - 32 UR - http://dx.doi.org/10.1002/gps.4495 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27162047?dopt=Abstract U4 - loneliness/depression/memory/cognitive function/aging/longitudinal ER - TY - JOUR T1 - Social support, social strain, and cognitive function among community-dwelling U.S. Chinese older adults. JF - Journals of Gerontology Series A: Biological Sciences and Medical Sciences Y1 - 2017 A1 - Ge, Shaoqing A1 - Bei Wu A1 - Donald E. Bailey Jr. A1 - Dong, XinQi KW - Adult children KW - Cognitive Ability KW - Community-dwelling AB -

Background: Limited research is available on the relationship between social support, social strain, and cognitive function among community-dwelling U.S. Chinese older adults. This study aims to examine the associations between social support/strain and cognitive outcomes.

Methods: Data were drawn from the Population-Based Study of Chinese Elderly (N = 3,159). Cognitive function was measured by a battery of tests including the East Boston Memory Test, the Digit Span Backwards assessment, and the Symbol Digit Modalities Test. Social support and strain were measured by the scales drawn from the Health and Retirement study. Multiple regression analyses were conducted.

Results: Social support was significantly associated with global cognitive function (β = .11, SE = .02, p < .001), episodic memory (β = .11, SE = .03, p < .001), working memory (β = .18, SE = .08, p < .05), and executive function (β = 1.44, SE = .37, p < .001). Social strain was significantly associated with global cognitive function (β = .23, SE = .05, p < .001), episodic memory (β = .27, SE = .07, p < .001), working memory (β = .34, SE = .17, p < .05), and executive function (β = 2.75, SE = .85, p < .01). In terms of sources of social support/strain, higher support from friends was significantly associated with higher global cognitive function (β = .04, SE = .02, p < .05), higher episodic memory (β = .05, SE = .02, p < .05), and higher executive function (β = .71, SE = .29, p < .05). Higher strain from spouse was significantly associated with higher global cognitive function (β = .10, SE = .03, p < .01), higher episodic memory (β = .11, SE = .04, p < .01), and higher executive function (β = 1.28, SE = .49, p < .01). Higher strain from friends was significantly associated with higher executive function (β = 3.59, SE = 1.17, p < .01).

Conclusions: Social support and strain were associated with cognitive outcomes. Future longitudinal studies should be conducted.

VL - 72 IS - suppl_1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28575260?dopt=Abstract ER - TY - JOUR T1 - Subjective cognitive impairment of older adults: a comparison between the US and China JF - International Journal of Methods in Psychiatric Research Y1 - 2016 A1 - Bei Wu KW - Cross-National KW - Health Conditions and Status KW - Methodology AB - Subjective assessment may be incomparable across countries due to differences in reporting styles. Based on two nationally representative surveys from the US and China, this study used data from three anchoring vignettes to estimate to what extent the US and Chinese older adults aged 50 and above differed in their reporting styles of subjective cognitive impairment. Cross country differences of subjective cognitive impairment were then estimated, both before and after adjusting for reporting heterogeneity. Directly assessed word recall test scores were analyzed to evaluate whether findings based on subjective cognitive impairment was consistent with objective performance. The results revealed a discrepancy between self-reported subjective cognitive impairment and directly assessed memory function among older adults: while Chinese respondents reported lower severity levels of subjective cognitive impairment, the US respondents demonstrated better performance in immediate word recall tests. By accounting for differences in reporting styles using anchoring vignettes data, Chinese older adults showed higher levels of subjective cognitive impairment than the US older adults, which was consistent with results from direct assessment of memory function. Non-negligible differences are present in reporting styles of subjective cognitive impairment. Cross country comparison needs to take into account such reporting heterogeneity. PB - 25 VL - 25 IS - 1 N1 - Times Cited: 0 0 U4 - cross-national comparison/cross Cultural Comparison/CHARLS/Chinese older adults/Cognition/cognitive Impairment/memory functioning ER - TY - JOUR T1 - Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults. JF - Int J Geriatr Psychiatry Y1 - 2016 A1 - Celia F. Hybel A1 - Joan M. Bennett A1 - Lawrence R Landerman A1 - Jersey Liang A1 - Brenda L Plassman A1 - Bei Wu KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Depressive Disorder KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Oral Health KW - Regression Analysis AB -

OBJECTIVE: Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes.

METHODS: The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008.

RESULTS: Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43%), (ii) low but generally stable level of depressive symptoms (41%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism.

CONCLUSIONS: Chronic moderate depressive symptoms are associated with poorer oral health in older adults.

PB - 31 VL - 31 IS - 1 N1 - Export Date: 9 September 2015 Article in Press U1 - http://www.ncbi.nlm.nih.gov/pubmed/25962827?dopt=Abstract U2 - PMC4641817 U4 - Depressive symptoms/Edentulism/Latent class trajectory analysis/Oral health ER - TY - JOUR T1 - Do Physical Activity, Smoking, Drinking, or Depression Modify Transitions from Cognitive Impairment to Functional Disability? JF - Journal of Alzheimer's Disease Y1 - 2015 A1 - Pamela M. Rist A1 - Jessica R Marden A1 - Benjamin D Capistrant A1 - Bei Wu A1 - M. Maria Glymour KW - Disabilities KW - Health Conditions and Status KW - Healthcare AB - 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. VL - 44 UR - http://dx.doi.org/10.3233/JAD-141866 IS - 4 U4 - Cognition/disability/disability/epidemiology/dementia/IADLs/Smoking/alcohol use/physical Activity ER - TY - JOUR T1 - Estimating the Cognitive Effects of Prevalent Diabetes, Recent Onset Diabetes, and the Duration of Diabetes among Older Adults JF - Dementia and Geriatric Cognitive Disorders Y1 - 2015 A1 - Bei Wu A1 - Eric J. Tchetgen Tchetgen A1 - Theresa L Osypuk A1 - Weuve, Jennifer A1 - White, Kellee A1 - Mujahid, Mahasin A1 - M. Maria Glymour KW - Health Conditions and Status AB - Background: Little evidence is available on the effects of incident diabetes or diabetes duration on cognitive aging. Methods: We evaluated the effects of prevalent and incident diabetes on deteriorations in cognitive function, based on participants (n = 8,671) aged 65 in the Health and Retirement Study in 2000. Inverse probability weighting was used to account for selective attrition and time-varying confounding of incident diabetes. Results: Prevalent diabetes predicted higher odds of dementia odds ratio 1.27; 95 confidence interval (CI) 1.03-1.58 and worse memory (-0.06 in z-score units; 95 CI -0.10 to -0.02), but incident diabetes or diabetes duration up to 8 years of follow-up was not predictive. Conclusion: Prevalent diabetes predicted lower cognition but not recent onset diabetes. (C) 2015 S. Karger AG, Basel PB - 39 VL - 39 IS - 3-4 N1 - Times Cited: 0 0 U4 - Diabetes/Cognitive Function/Dementia ER - TY - Generic T1 - Reciprocal relations of loneliness and cognitive function in older U.S. adults Y1 - 2015 A1 - Nancy J. Donovan A1 - Bei Wu A1 - Dorene M. Rentz A1 - Reisa A. Sperling A1 - Gad A. Marshall A1 - M. Maria Glymour KW - Cognitive Ability KW - Lone KW - Relationships AB - In older adults, loneliness has been associated with functional decline and increased progression to dementia. The objective of this study was to examine the reciprocal relations of loneliness and cognitive function in older adults, adjusting for sociodemographic and health-related factors, social network and depression. UR - http://www.alzheimersanddementia.com/article/S1552-5260(15)02344-4/fulltext ER - TY - JOUR T1 - Dementia and dependence: Do Modifiable Risk Factors Delay Disability? JF - Neurology Y1 - 2014 A1 - Pamela M. Rist A1 - Benjamin D Capistrant A1 - Bei Wu A1 - Jessica R Marden A1 - M. Maria Glymour KW - Health Conditions and Status KW - Income AB - 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. VL - 82 IS - 17 U4 - dementia probability/smoking/alcohol/income/depression ER - TY - JOUR T1 - Racial and Ethnic Differences in Obesity and Overweight as Predictors of the Onset of Functional Impairment JF - Journal of the American Geriatrics Society Y1 - 2014 A1 - Wei, Liang A1 - Bei Wu KW - Demographics KW - Health Conditions and Status AB - Objectives To examine racial and ethnic differences in the effects of body mass index (BMI) on the onset of functional impairment over 10 years of follow-up. Design Longitudinal analyses of a cohort from a nationally representative survey of community-dwelling American adults. Setting Six waves (1996 2006) of the Health and Retirement Study (HRS). Participants Two groups of HRS participants aged 50 and older without functional impairment at baseline (1996): 5,884 with no mobility difficulty and 8,484 with no activity of daily living (ADL) difficulty. Measurements Mobility difficulty was a composite measure of difficulty walking several blocks, walking one block, climbing several flights of stairs, and climbing one flight of stairs. ADL difficulty was measured as difficulty in dressing, bathing or showering, eating, and getting in and out of bed without help. The association between baseline BMI and risk of developing functional impairment was estimated using generalized estimating equation models. Results Overweight and obesity were significant predictors of functional impairment. Overweight and obese Hispanics were 41 and 91 more likely, respectively, to develop ADL disability than whites in the same BMI categories. Overweight and severely obese blacks were also more likely than their white counterparts to develop ADL disability. Risk of developing ADL difficulty was higher for Hispanics than for blacks in the obese category. No significant differences in onset of mobility difficulty were found between racial or ethnic groups within any BMI category. Conclusion Blacks and Hispanics were at higher risk than whites of ADL but not mobility impairment. In addition to weight control, prevention efforts should promote exercise to reduce functional impairment, especially for blacks and Hispanics, who are at higher risk. PB - 62 VL - 62 UR - http://dx.doi.org/10.1111/jgs.12605 IS - 1 U4 - obesity/overweight/mobility difficulty/ADL difficulty/racial and ethnic difference ER - TY - JOUR T1 - Combining direct and proxy assessments to reduce attrition bias in a longitudinal study. JF - Alzheimer Dis Assoc Disord Y1 - 2013 A1 - Bei Wu A1 - Tchetgen Tchetgen, Eric J A1 - Theresa L Osypuk A1 - White, Kellee A1 - Mujahid, Mahasin A1 - M. Maria Glymour KW - Aged KW - Bias KW - Caregivers KW - Dementia KW - Female KW - Humans KW - Longitudinal Studies KW - Male KW - Neuropsychological tests KW - Prevalence KW - Proxy AB -

Retaining severely impaired individuals poses a major challenge in longitudinal studies of determinants of dementia or memory decline. In the Health and Retirement Study (HRS), participants complete direct memory assessments biennially until they are too impaired to complete the interview. Thereafter, proxy informants, typically spouses, assess the subject's memory and cognitive function using standardized instruments. Because there is no common scale for direct memory assessments and proxy assessments, proxy reports are often excluded from longitudinal analyses. The Aging, Demographics, and Memory Study (ADAMS) implemented full neuropsychological examinations on a subsample (n=856) of HRS participants, including respondents with direct or proxy cognitive assessments in the prior HRS core interview. Using data from the ADAMS, we developed an approach to estimating a dementia probability and a composite memory score on the basis of either proxy or direct assessments in HRS core interviews. The prediction model achieved a c-statistic of 94.3% for DSM diagnosed dementia in the ADAMS sample. We applied these scoring rules to HRS core sample respondents born 1923 or earlier (n=5483) for biennial assessments from 1995 to 2008. Compared with estimates excluding proxy respondents in the full cohort, incorporating information from proxy respondents increased estimated prevalence of dementia by 12 percentage points in 2008 (average age=89) and suggested accelerated rates of memory decline over time.

PB - 27 VL - 27 IS - 3 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22992720?dopt=Abstract U2 - PMC3731387 U4 - Dementia/Memory decline/dementia probability/composite memory score/Cognitive assessments/Proxy informants ER - TY - JOUR T1 - Cognitive function and acute care utilization. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2003 A1 - Walsh, Edith G. A1 - Bei Wu A1 - Mitchell, Janet B. A1 - Lisa F Berkman KW - Aged KW - Cognition Disorders KW - Female KW - Geriatric Assessment KW - Health Behavior KW - Health Status KW - Hospitalization KW - Hospitals KW - Humans KW - Length of Stay KW - Male KW - Neuropsychological tests KW - Outpatient Clinics, Hospital KW - Severity of Illness Index KW - United States AB -

OBJECTIVES: Little is known about variation in cognitive function across the aged population, or how use and costs of health care vary with cognitive impairment. This study was designed to create a typology of cognitive function in a nationally representative sample, and evaluate acute care use in relation to cognitive function, holding constant confounding factors. By including proxy assessments of cognitive function, this is the first study to include individuals unable to respond themselves.

METHODS: We analyzed the baseline year of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, sponsored by the National Institute on Aging, to create three levels of cognitive function, using direct measures for self-respondents (n = 6,651) and proxy evaluations for the others (n = 792). We used a two-part model to predict the likelihood of using various health services and to evaluate intensity of care among users.

RESULTS: Sixteen percent, 64%, and 20% of the sample fell into the low, moderate, and high cognitive function groups, respectively, that differed significantly on almost all demographic and health status measures, and some utilization measures. Controlling for other health and functional status measures, lower cognitive function had a significant and negative effect on outpatient services, but did not affect hospital use directly.

DISCUSSION: Lower cognitive function may be a barrier to outpatient care, but these analyses should be repeated using administrative use and cost data.

PB - 58B VL - 58 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12496307?dopt=Abstract U4 - Cognitive Function/Health Care Utilization ER - TY - JOUR T1 - Job characteristics and leisure physical activity. JF - J Aging Health Y1 - 2000 A1 - Bei Wu A1 - Frank Porell KW - Demography KW - Exercise KW - Female KW - Humans KW - Job Description KW - Job Satisfaction KW - Leisure activities KW - Male KW - Middle Aged KW - Stress, Psychological KW - United States AB -

OBJECTIVES: This study employs a sample population of older workers to estimate an empirical model of leisure exercise activity. Alternative theories relating work and leisure attitudes relevant for understanding the exercise behavior of older workers are tested empirically.

METHODS: Responses of 6,433 full-time older workers (51 to 61 years old) from the 1992 Health and Retirement Study (HRS) are grouped into two white-collar and blue-collar worker categories and are analyzed to test whether self-reported levels of regular physical activity are associated with the physical demands and stress associated with one's job.

RESULTS: Although the white-collar workers, whose jobs involve more physical efforts, are more likely to do light physical activity, the blue-collar workers, whose jobs are more physically demanding, tend to engage in more vigorous exercise.

DISCUSSION: The empirical results are most supportive of the generalization theory, and they also illustrate the complexity of relationships between work and leisure physical activity.

PB - 12 VL - 12 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/11503731?dopt=Abstract U4 - Job Characteristics/Physical Fitness/Occupational Stress/Workers/Health Behavior/Work to Leisure Relationship/Work Attitudes ER -