Dorina Cadar

The Role of Lifestyle Behaviors on 20-Year Cognitive Decline

This study examined the association between smoking, physical activity and dietary choice at 36 and 43 years, and change in these lifestyle behaviors between these ages, and decline in verbal memory and visual search speed between 43 and 60–64 years in 1018 participants from MRC National Survey of Health and Development (NSHD, the British 1946 birth cohort). ANCOVA models were adjusted for sex, social class of origin, childhood cognition, educational attainment, adult social class, and depression; then the lifestyle behaviors were additionally mutually adjusted. Results showed that healthy dietary choice and physical activity were associated, respectively, with slower memory and visual search speed decline over 20 years, with evidence that increasing physical activity was important. Adopting positive health behaviors from early midlife may be beneficial in reducing the rate of cognitive decline and ultimately reducing the risk of dementia.

Hearing Impairment and Incident Dementia: Findings from the English Longitudinal Study of Ageing

To determine whether hearing loss is associated with incident physician‐diagnosed dementia in a representative sample.

Educational Inequalities in Health Behaviors at Midlife Is There a Role for Early-life Cognition?

Education is a fundamental cause of social inequalities in health because it influences the distribution of resources, including money, knowledge, power, prestige, and beneficial social connections, that can be used in situ to influence health. Recent studies have highlighted early-life cognition as commonly indicating the propensity for educational attainment and determining health and age of mortality. Health behaviors provide a plausible mechanism linking both education and cognition to later-life health and mortality. We examine the role of education and cognition in predicting smoking, heavy drinking, and physical inactivity at midlife using data from the Wisconsin Longitudinal Study (N = 10,317), National Survey of Health and Development (N = 5,362), and National Childhood Development Study (N = 16,782). Adolescent cognition was associated with education but was inconsistently associated with health behaviors. Education, however, was robustly associated with improved health behaviors after adjusting for cognition. Analyses highlight structural inequalities over individual capabilities when studying health behaviors.

The Association Between Informal Caregiving and Exit From Employment Among Older Workers: Prospective Findings From the UK Household Longitudinal Study.

Abstract Objective This study investigated associations between informal caregiving and exit from paid employment among older workers in the United Kingdom. Method Information on caregiving and work status for 8,473 older workers (aged 50–75 years) was drawn from five waves of Understanding Society (2009–2014). We used discrete-time survival models to estimate the associations of caring intensity and type on the probability of exiting paid work (from >0 to 0 hours/week) in the following year. Models were stratified by sex and working hours, and adjusted for age, self-rated health, long-standing illness, occupation, and partner’s employment status. Results No association was found between caregiving intensity and exit from paid work. Full-time employees who provided care within the household (women and men) or cared for a partner/spouse (women only) more likely to stop working, compared to those not providing care. Women who entered a caregiving role (more than 10 hours/week) were between 2.64 (95% confidence interval [CI]: 1.46, 4.79) and 4.46 (95% CI: 2.53, 7.88) times more likely to exit work (for part-time and full-time workers, respectively), compared to women providing no care. Discussion This study highlights the onset of caregiving as a key period for older workers. Ensuring that caregiving responsibilities are adequately recognized and supported may help extend working life.

The role of cognitive reserve on terminal decline: a cross-cohort analysis from two European studies: OCTO-Twin, Sweden, and Newcastle 85+, UK

Cognitive performance shows a marked deterioration in close proximity to death, as postulated by the terminal decline hypothesis. The effect of education on the rate of terminal decline in the oldest people (i.e. persons 85+ years) has been controversial and not entirely understood. In the current study, we investigated the rate of decline prior to death with a special focus on the role of education and socioeconomic position, in two European longitudinal studies of ageing: the Origins of Variance in the Old‐Old: Octogenarian Twins (OCTO‐Twin) and the Newcastle 85+ study.

Physical and cognitive capability in mid-adulthood as determinants of retirement and extended working life in a British cohort study

Objective Policy in many industrialized countries increasingly emphasizes extended working life. We examined associations between physical and cognitive capability in mid-adulthood and work in late adulthood. Methods Using self-reported physical limitations and performance-based physical and cognitive capability at age 53, assessed by trained nurses from the Medical Research Council (MRC) National Survey of Health and Development, we examined prospective associations with extended working (captured by age at and reason for retirement from main occupation, bridge employment in paid work after retirement from the main occupation, and voluntary work participation) up to age 68 among >2000 men and women. Results Number of reported physical limitations at age 53 was associated with higher likelihood of retiring for negative reasons and lower likelihood of participating in bridge employment, adjusted for occupational class, education, partners employment, work disability at age 53, and gender. Better performance on physical and cognitive tests was associated with greater likelihood of participating in bridge or voluntary work. Cognitive capability in the top 10% compared with the middle 80% of the distribution was associated with an odds ratio of bridge employment of 1.71 [95% confidence interval (95% CI) 1.21-2.42]. Conclusions The possibility for an extending working life is less likely to be realized by those with poorer midlife physical or cognitive capability, independently of education, and social class. Interventions to promote capability, starting in mid-adulthood or earlier, could have long-term consequences for extending working.

Frailty is an independent predictor of incident dementia: Evidence from the English Longitudinal Study of Ageing

The aim of this study was to determine whether frailty in older adults is associated with the risk of subsequent dementia. A total of 8,722 older adults from the English Longitudinal Study of Ageing were followed-up every two years until they reported a diagnosis of dementia, died, or were right censored. Frailty was defined using a frailty index comprised of 47 health deficits. To test if cognitive function influences the relationship between frailty and incident dementia, the analyses were repeated according to lower or upper three quartiles of baseline cognitive function. Competing risks regression and Cox proportional hazard models were used to evaluate whether the degree of baseline frailty was associated with incident dementia. Compared with non-frail participants, pre-frail (HR: 1.51 95%CI [1.12–2.02]) and frail participants (HR: 1.73 95%CI [1.22–2.43]) had a higher risk of developing dementia, after adjustment for covariates. The association between frailty and incident dementia was significant for adults in the upper three quartiles of global cognitive function (HR: 3.48 95%CI [1.98–6.12]), but not for adults who were in the lowest quartile of cognitive function (HR: 1.13 95%CI [0.74–1.71]). Frailty should be monitored alongside cognitive functioning when assessing risk factors for dementia in older adults.

Academic careers: what do early career researchers think?

ARE YOUNG RESEARCHERS GETTING A FAIR DEAL? Early career researchers (ECRs) are often anecdotally described as facing major challenges. These challenges reportedly include lack of job security, too few opportunities to carve out their own interests, fighting to survive in competitive institutions and being perceived as resources rather than as people. These issues have attracted increasing attention in scientific circles and now also in the media. In response to these concerns, the SSM ECR Subcommittee conducted an ECR members’ survey in early 2015 to obtain views on a range of issues. We had 65 responses (response rate 50.7%) of whom approximately three-quarters were female, and a third were based in London. Responses clustered around three main themes: job instability, limited opportunities to develop an academic career and lack of mentoring.

Is education a demographic dividend? The role of cognitive reserve in dementia-related cognitive decline: a comparison of six longitudinal studies of ageing

Abstract Background Education, a marker for cognitive reserve, is thought to be associated with low risks of dementia, but less is known about its association with cognitive decline in preclinical stages of dementia. This study aimed to see whether higher education level could have a protective effect against faster cognitive decline in preclinical stages of dementia and whether this protection is consistent across six different studies around the world. Methods We assessed the association between education and change in mini-mental state examination (MMSE) in people who developed dementia during the study period before the time of dementia diagnosis in six international studies of ageing: Newcastle 85+, UK; Three-City (3C), France; Leiden 85+ and Longitudinal Aging Study Amsterdam (LASA), the Netherlands; Octogenarian Twins (OCTO-Twin), Sweden; and Memory and Ageing Study (MAS), Australia. Using a coordinated analysis approach, we used multilevel models to investigate the role of education in the change in MMSE independently within each cohort, while controlling for common covariates such as age at baseline, sex, and time to dementia diagnosis from study entry within each cohort. Each individuals cognitive scores were aligned according to distance (years) to dementia diagnosis. Findings High levels of education (>12 years) were associated with steeper linear rates of decline in MMSE scores from study entry to time of dementia diagnosis in most cohorts—3C, Leiden 85+, LASA, OCTO-Twin, and MAS. However, in one cohort (Newcastle 85+), higher education was associated with a slow rate of decline in the preclinical stages of dementia (β=0·93, 95% CI 0·09–1·77) compared with lower education, suggesting perhaps a difference in the educational system between the UK and the rest of Europe or Australia during the early 1990s. A random-effects meta-analysis across data from all six studies showed a non-significant steeper cognitive decline with time for those with higher education (β=–0·08, 95% CI –0·17 to 0·003; see appendix for forest plot). Interpretation This coordinated approach analysis revealed no consistent protection for people with higher education in terms of lowering the rate of cognitive decline in the preclinical stages of dementia, which is a major public health burden. This work only partly supports the cognitive reserve hypothesis—ie, the clinical manifestation of dementia is delayed in people with higher education but that a steeper decline occurs once a certain threshold has been reached. Funding The funding sources of this work were the Alzheimers Society (grant number 144) and the Medical Research Council (unit programme number MC_UU_12019/1).

Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England: Evidence From a 12-Year Follow-up in the English Longitudinal Study of Ageing

Importance Lower educational attainment is associated with a higher risk of dementia. However, less clear is the extent to which other socioeconomic markers contribute to dementia risk. Objective To examine the relationship of education, wealth, and area-based deprivation with the incidence of dementia over the last decade in England and investigate differences between people born in different periods. Design, Setting, and Participants Data from the English Longitudinal Study of Ageing, a prospective cohort study that is representative of the English population, were used to investigate the associations between markers of socioeconomic status (wealth quintiles and the index of multiple deprivation) and dementia incidence. To investigate outcomes associated with age cohorts, 2 independent groups were derived using a median split (born between 1902-1925 and 1926-1943). Main Outcomes and Measures Dementia as determined by physician diagnosis and the Informant Questionnaire on Cognitive Decline in the Elderly. Results A total of 6220 individuals aged 65 years and older enrolled in the study (median [interquartile range] age at baseline, 73.2 [68.1-78.3] years; 3410 [54.8%] female). Of these, 463 individuals (7.4%) had new cases of dementia ascertained in the 12 years between 2002-2003 and 2014-2015. In the cohort born between 1926 and 1943, the hazard of developing dementia was 1.68 times higher (hazard ratio [HR] = 1.68 [95% CI, 1.05-2.86]) for those in the lowest wealth quintile compared with those in the highest quintile, independent of education, index of multiple deprivation, and health indicators. Higher hazards were also observed for those in the second-highest quintile of index of multiple deprivation (HR = 1.62 [95% CI, 1.06-2.46]) compared with those in the lowest (least deprived) quintile. Conclusions and Relevance In an English nationally representative sample, the incidence of dementia appeared to be socioeconomically patterned primarily by the level of wealth. This association was somewhat stronger for participants born in later years.