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40 Associations Between Cardiovascular Risk, White Matter, and Medication Predictors on Longitudinal Cognitive Change in the National Alzheimer’s Coordinating Center (NACC) Cohort
- Lindsay J Rotblatt, Jared J Tanner, Ronald A Cohen, Ann L Horgas, Michael Marsiske
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 349-350
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- Article
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Objective:
Drawing on the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS), this study aimed to investigate the direct and indirect associations between vascular risk factors/cardiovascular disease (CVD), pharmacological treatment (of CVD), and white matter hyperintensity (WMH) burden on overall cognition and decline trajectories in a cognitively diverse sample of older adults.
Participants and Methods:Participants were 1,049 cognitively diverse older adults drawn from a larger NACC data repository of 22,684 participants whose data was frozen as of December 2019. The subsample included only participants who were aged 60-97 (56.7% women) who completed at least one post-baseline neuropsychological evaluation, had medication data, and both T1 and FLAIR neuroimaging scans. Cognitive composites (Memory, Attention, Executive Function, Language) were derived factor analytically using harmonized data. Baseline WMH volumes were quantified using UBO Detector. Baseline health screening and medication data was used to determine overall CVD burden and total medication. Longitudinal latent growth curve models were estimated adjusting for demographics.
Results:More CVD medication was associated with greater CVD burden; however, no direct effects of medication were found on any of the cognitive composites or WMH volume. While no direct effects of CVD burden on cognition (overall or rate of decline) were observed, instead we found that greater CVD burden had small, but significant, negative indirect effects on Memory, Attention, Executive Functioning and Language (all p’s < .01) after controlling for CVD medication use. Whole brain WMH volume served as the mediator of this relationship, as it did for an indirect effect of baseline CVD on 6-year rate of decline in Memory and Executive function.
Conclusions:Findings from this study were generally consistent with previous literature and extend extant knowledge regarding the direct and indirect associations between CVD burden, pharmacological treatment, and neuropathology of presumed vascular origin on cognitive decline trajectories in an older adult sample. Results reveal the subtle importance of CVD risk factors on late life cognition even after accounting for treatment and WHM volume and highlight the need for additional research to determine sensitive windows of opportunity for intervention.
9 - Men and Women in the Berlin Aging Study
- Edited by Paul B. Baltes, Max-Planck-Institut für Bildungsforschung, Berlin, Karl Ulrich Mayer, Max-Planck-Institut für Bildungsforschung, Berlin
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- Book:
- The Berlin Aging Study
- Published online:
- 06 December 2010
- Print publication:
- 28 November 1998, pp 259-281
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Summary
The feminization of old age justifies a separate chapter on gender differences despite the fact that they are mentioned in almost every chapter, particularly in the last chapter of this book. The aim of the present chapter is to describe in which biopsychosocial variables – physical, functional, and mental health, personality, and social integration – men and women differ. As a summary statement of the empirical data base in this chapter, we can conclude the following: Gender differences found in the domains examined are small and there are few age differences (from ages 70 to over 100) within the noted gender differences. Of the 27 biopsychosocial variables, when considered separately, 14 show significant gender differences and 4 a significant age-by-gender interaction effect. Most of these differences are in the health domain. When adding the five sociodemographic variables and regarding all variables conjointly, we can correctly classify 78% of the men and 83% of the women. In this context the most significant variables are marital and educational status, physical health, and hearing – that is, not being married and having less education, as well as suffering from a musculoskeletal disease, and having good hearing significantly increase the likelihood of being an old woman. We close the chapter with the question of whether the fact of feminization of old age is rendering a discussion about gender differences in old age obsolete.
16 - The Utilization of Medical and Nursing Care in Old Age
- Edited by Paul B. Baltes, Max-Planck-Institut für Bildungsforschung, Berlin, Karl Ulrich Mayer, Max-Planck-Institut für Bildungsforschung, Berlin
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- Book:
- The Berlin Aging Study
- Published online:
- 06 December 2010
- Print publication:
- 28 November 1998, pp 430-449
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Summary
The increasing number of older people in Western societies has made dealing with their needs for help and care a pressing matter. In the interdisciplinary context of the Berlin Aging Study (BASE), involving geriatricians, psychiatrists, psychologists, and sociologists, it was possible to examine how older adults utilize health care and which predicting factors are important.
Major areas of health care utilization are: (1) physician contacts, (2) medication use, (3) different levels of caregiving, including informal, formal, and institutional care, and (4) inpatient treatment for acute illness episodes in hospitals. Results from the BASE assessments show that 85% of persons aged 70 and above had regular physician contact and that 96% used at least one medication. Thirty-one percent received some kind of informal or formal caregiving assistance. Multiple regression analyses revealed differential predictive relationships for each of the three dependent health care utilization variables. Higher use of medications was most strongly predicted by increased numbers of somatic diagnoses, better intellectual functioning, and particular health attitudes. Physician contact was weakly predicted by somatic health variables, hypochondriasis, and living alone. In contrast, living alone was the strongest predictor of the utilization of caregiving services, whereas children living in Berlin served as a protective factor against the need for more formal care. Thus, utilization of health care is a multidimensional phenomenon that continues to depend on the interaction between physical and mental health, attitudinal, and social factors in old age.
15 - On the Significance of Morbidity and Disability in Old Age
- Edited by Paul B. Baltes, Max-Planck-Institut für Bildungsforschung, Berlin, Karl Ulrich Mayer, Max-Planck-Institut für Bildungsforschung, Berlin
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- Book:
- The Berlin Aging Study
- Published online:
- 06 December 2010
- Print publication:
- 28 November 1998, pp 403-429
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Summary
Evidence from gerontological research suggests that physical morbidity and disability in old age are among the most important causes for decline in other functional domains such as social and psychological functioning. However, comprehensive cross-disciplinary analyses on the significance of morbidity and disability in old age and during transition into very old age are scarce.
This chapter examines the strength of associations between (a) somatic and mental health, (b) health and psychosocial status, and (c) objective and subjective health by utilizing multidimensional indicators of physical, mental, psychological, and social functioning from the Berlin Aging Study (BASE) sample (N = 516; age range: 70–103 years). The analyses focus on two central questions, namely: (1) To what extent is health an explanatory variable for age differences in other functional domains? (2) Do the associations between health and other domains themselves vary with age?
The results reveal clear age-independent correlations between somatic and psychiatric morbidity as well as between psychosocial factors and health. Moreover, health indicators fully explain the negative effects of age on psychosocial resources and on mental health. However, the significance of objective health for subjective evaluations decreases significantly with age. In this domain, the findings are consistent with recent hypotheses that emphasize manifold intraindividual mechanisms working to maintain positive self-appraisal despite objective decline.
Introduction
Systemic Aspects of Morbidity and Disability in Old Age
Even if old age is not necessarily associated with illness, physical and mental morbidity and disability are prevalent ailments in late life.