%0 Journal Article %J Forum for Health Economics and Policy %D 2022 %T Future Directions for the HRS Harmonized Cognitive Assessment Protocol. %A Torres, Jacqueline M %A M. Maria Glymour %K Alzheimer %K Dementia %K HCAP %K Measurement %X

In the absence of effective pharmacological treatment to halt or reverse the course of Alzheimer's disease and related dementias (ADRDs), population-level research on the modifiable determinants of dementia risk and outcomes for those living with ADRD is critical. The Harmonized Cognitive Assessment Protocol (HCAP), fielded in 2016 as part of the U.S. Health and Retirement Study (HRS) and multiple international counterparts, has the potential to play an important role in such efforts. The stated goals of the HCAP are to improve our ability to understand the determinants, prevalence, costs, and consequences of cognitive impairment and dementia in the U.S. and to support cross-national comparisons. The first wave of the HCAP demonstrated the feasibility and value of the more detailed cognitive assessments in the HCAP compared to the brief cognitive assessments in the core HRS interviews. To achieve its full potential, we provide eight recommendations for improving future iterations of the HCAP. Our highest priority recommendation is to increase the representation of historically marginalized racial/ethnic groups disproportionately affected by ADRDs. Additional recommendations relate to the timing of the HCAP assessments; clinical and biomarker validation data, including to improve cross-national comparisons; dropping lower performing items; enhanced documentation; and the addition of measures related to caregiver impact. We believe that the capacity of the HCAP to achieve its stated goals will be greatly enhanced by considering these changes and additions.

%B Forum for Health Economics and Policy %G eng %R 10.1515/fhep-2021-0064 %0 Generic %D 2021 %T Future Directions for the HRS Harmonized Cognitive Assessment Protocol %A Torres, W. Jackeline %A M. Maria Glymour %K Alzheimer %K Dementia %K HCAP %X In the absence of effective pharmacological treatment to halt or reverse the course of Alzheimer’s disease and related dementias (ADRDs), population-level research on the modifiable determinants of dementia risk and outcomes for those living with ADRD is critical. The Harmonized Cognitive Assessment Protocol (HCAP), fielded in 2016 as part of the U.S. Health and Retirement Study (HRS) and multiple international counterparts, has the potential to play an important role in such efforts. The stated goals of the HCAP are to improve both our ability to understand the determinants, prevalence, costs, and consequences of cognitive impairment and dementia in the U.S. and to support cross-national comparisons. The first wave of HCAP demonstrated feasibility and value of the more detailed cognitive assessments. To achieve its full potential, we recommend that the HCAP: 1) increase the representation of racial/ethnic minority participants disproportionately affected by ADRDs, 2) administer the HCAP repeatedly and with greater frequency to facilitate longitudinal analyses, cross-national harmonization, and precise characterization of practice and period effects, 3) field a clinical dementia assessment for at least a subset of HCAP participants, 4) phase-in a baseline assessment for people under age 60 in order to facilitate research on the earlier stages of cognitive impairment and midlife dementia prevention, 5) consider dropping lower performing items from the HCAP to increase feasibility of scaling the assessment to more participants at more frequent intervals, 6) enhance the documentation, multi-lingual options, training activities, and randomized sub-studies of language effects or other tools to promote the use of the HCAP and cross-national comparisons, 7) incorporate blood-based AD biomarkers, and 8) improve the capacity of the HCAP to understand the consequences of dementia, including for caregivers and for policy-relevant outcomes such as use of home and community-based services. We believe that the capacity of the HCAP to achieve its stated goals will be greatly enhanced by considering these changes and additions. %I National Institute on Aging %C Bethesda, MD %0 Journal Article %J The American Journal of Geriatric Psychiatry %D 2016 %T Families and Disability Onset: Are Spousal Resources Less Important for Individuals at High Risk of Dementia? %A Pamela M. Rist %A Sze Y Liu %A M. Maria Glymour %K Demographics %K Disabilities %K Health Conditions and Status %K Healthcare %X Objective To determine whether social contacts and spousal characteristics predict incident instrumental or basic activities of daily living (I/ADL) limitations and whether effects differ for individuals with high risk of dementia. Design Cohort study. Setting Biennial interviews of Health and Retirement Study participants over up to 12 years. Participants 4,125 participants aged 65 years and older without baseline I/ADL limitations. Measurements Participants' family characteristics (living arrangements, proximity to children, contacts with friends, marital status, and spouse's depression, employment, and education) and dementia probability (high versus low risk of dementia based on direct and proxy cognitive assessments) were characterized at baseline. Family characteristics and their interactions with dementia probability were used to predict incident I/ADL limitations in pooled logistic regressions. Results ADL limitation incidence was higher among the unmarried (odds ratio OR versus married: 1.14; 95 CI: 1.01 1.30); those married to a depressed spouse (OR versus nondepressed spouse: 1.56, 95 CI: 1.21 2.00); or whose spouse had less than high school education (OR versus spouse with high school or more: 1.29, 95 CI: 1.06 1.57). Living with someone other than a spouse compared with living with a spouse predicted higher risk of both incident ADL (OR: 1.35; 95 CI: 1.11 1.65), and IADL (OR: 1.30; 95 CI: 1.06 1.61) limitations. Effects were similar for respondents with high and low dementia probability. Conclusions Regardless of dementia risk, older adults may receive important marriage benefits, which help delay disability. The salience of spouse's education and depression status implicate modifiable mechanisms, such as information and instrumental support, which may be amenable to interventions. %B The American Journal of Geriatric Psychiatry %V 24 %P 585-594 %G eng %U http://www.sciencedirect.com/science/article/pii/S1064748116001561 %N 7 %4 disability/disability/cognitive function/epidemiology/social ties %$ 999999 %& 585 %R 10.1016/j.jagp.2016.02.003