Longitudinal relationships between cognitive functioning and depressive symptoms among Hispanic older adults

This study examines the relationship between cognitive functioning and depressive symptoms across 3 years in a prospective study of 273 community-dwelling, Hispanic older adults in Miami. The analyses extend the literature by testing for a bidirectional or reciprocal relationship between depressive symptoms and cognitive functioning over time and by examining the relationship between these variables among Hispanics, an understudied population at risk of developing depressive symptoms and cognitive impairments. Structural equation modeling with a cross-lagged panel design showed that depressive symptoms were unrelated to subsequent cognitive functioning. However, cognitive functioning was related to subsequent depressive symptoms at every time point, such that poorer cognitive functioning was related to higher depressive symptoms. Findings suggest that cognitive declines may predict depressive symptoms in community-dwelling Hispanic older adults.     

Visual impairment is associated with cognitive impairment among adults aged 50 years and older in China: data from the China Health and Retirement Longitudinal Study

Background

Cognitive impairment is highly prevalent among older people (aged 60 years and older), and vision impairment (VI) may be a risk factor. Our study aimed to examine the relationship between VI and cognitive function among older people in China.

Longitudinal associations of depressive symptoms,subjective memory decline,and cognitive functioning among Chinese older adults: Between-person and within-person perspective

ObjectivesWe examined between- and within-person associations between depressive symptoms and cognitive functioning among Chinese older adults (aged 60+) over time. Furthermore, we also investigated whether subjective memory decline (SMD) is uniquely associated with cognitive functioning above and beyond depressive symptoms for both between-person and within-person associations.MethodsAbout 7385 older adults from the China Health and Retirement Longitudinal Study reported their demographic and health status, and completed self-report measures of depressive symptoms and SMD, as well as a battery of cognitive tests, every two years at three times between 2011 and 2015.ResultsThere were significant between-person and within-person associations between depressive symptoms and cognitive functioning. Furthermore, SMD was uniquely associated with cognitive functioning for both within-person and between-person associations after controlling for depressive symptoms.ConclusionsThe results highlight the importance of careful screening and monitoring of depressive symptoms and SMD for the benefits of cognitive functioning among Chinese older adults. More importantly, SMD has practical implications for the care of Chinese older adults given significant cultural stigma attached to mental illness within Chinese culture.     

The course of functional decline in older people with persistently elevated depressive symptoms: longitudinal findings from the Cardiovascular Health Study

OBJECTIVES: To examine the relationship between persistently high depressive symptoms and long-term changes in functional disability in elderly persons. DESIGN: A community-based, prospective, observational study. SETTING: Participant data from the Cardiovascular Health Study. PARTICIPANTS: From the overall sample of 5,888 subjects, three types of participants were identified for this study: (1) persistently depressed individuals, who experienced an onset of depressive symptoms that persisted over 4 years (n=119); (2) temporarily depressed individuals, who experienced an onset of depressive symptoms that resolved over time (n=259); and (3) nondepressed individuals, with persistently low depressive symptoms throughout the follow-up period who were matched on baseline activity of daily living (ADL) scores, sex, and age to the previous two groups combined (n=378). MEASUREMENTS: Four consecutive years of data were assessed: validated measures of depression (10-item CES-D), functional disability (10-item ADL/instrumental ADL measure), physical performance, medical illness, and cognition. RESULTS: The persistently depressed group showed a greater linear increase in functional disability ratings than the temporarily depressed and nondepressed groups. This association between persistent depression and functional disability was robust even when controlling for baseline demographic and clinical/performance measures, including cognition. The persistently depressed group had an adjusted odds ratio (OR) of 5.27 (95% confidence interval (CI) 3.03-9.16) for increased functional disability compared with the nondepressed group over 3 years of follow-up, whereas the temporarily depressed group had an adjusted OR of 2.39 (95% CI=1.55-3.69) compared with the nondepressed group. CONCLUSION: Persistently elevated depressive symptoms in elderly persons are associated with a steep trajectory of worsening functional disability, generating the hypothesis that treatments for late-life depression need to be assessed on their efficacy in maintaining long-term functional status as well as remission of depressive symptoms. These results also demonstrate the need for studies to differentiate between persistent and temporary depressive symptoms when examining their relationship to disability.     

Social relationships and depressive symptoms among older adults in southern Brazil

OBJECTIVES: This research tests hypotheses from equity theory and social integration theory regarding the effect of social relationships on depressive symptoms. METHODS: The data are based on a representative sample of people aged 60 and older from southern Brazil. The baseline sample consists of 871 subjects interviewed in 1995. Among those baseline subjects, 551 responded in 1999. Cross-sectional and longitudinal multivariate regression models estimate the effect of two dimensions of social relationships (i.e., social exchanges and social integration) on depressive symptoms, controlling for demographic, socioeconomic, and health characteristics. RESULTS: The results indicate that unbalanced exchange increases depressive symptoms, and social integration decreases depressive symptoms. Specifically, older Brazilians who overbenefit or underbenefit from exchanges with relatives have more depressive symptoms than those with balanced exchanges. In addition, depressive symptoms are lower when an older adult who is receiving support is able to reciprocate. More intensive exchanges with relatives, being married, and satisfaction with family relationships decrease depressive symptoms, whereas living alone increases depressive symptoms. DISCUSSION: The results highlight the relevance of social relationships to depressive symptoms among older Brazilians. In addition, the results indicate there is a nonlinear relationship between exchange balance and depressive symptoms in this population. The implications for policy are discussed.     

Bidirectional association between depressive symptoms and type 2 diabetes mellitus: The China Health and Retirement Longitudinal Study

ObjectiveTo prospectively examine the bidirectional relationship between depressive symptoms and type 2 diabetes mellitus (T2DM) among middle-aged and elderly Chinese.MethodsParticipants were enrolled in 2011–2012 (Wave 1) and followed up in 2013–2014 (Wave 2) and 2015–2016 (Wave 3) in the China Health and Retirement Longitudinal Study. Depressive symptoms were evaluated by the Chinese language version of 10-item Center for Epidemiological Studies Depression Scale (CESD-10) at three waves. T2DM was assessed by biochemical biomarkers at Wave 1 and reported physician-diagnosis at Wave 2 and 3. Cox proportional hazards regression was applied to calculate hazard ratio (HR) and 95% confidence intervals (CIs) for the bidirectional association.ResultsParticipants with baseline depressive symptoms were 1.33 times as likely to develop T2DM (HR, 1.33; 95% CI: 1.06, 1.66), compared to their counterparts after adjusting for demographic characteristics and T2DM risk factors. The risk of T2DM increased linearly with higher severity of depression as determined by a higher CESD-10 score (P for trend ? 0.001). In addition, baseline T2DM was associated with increased risk of incident depressive symptoms (1.15; 1.00, 1.31) and persistent depressive symptoms (1.35; 1.03, 1.77).ConclusionThere is a positive bidirectional association between depressive symptoms and T2DM in middle-aged and elderly Chinese.     

Computer use and cognitive decline among Japanese older adults: A prospective cohort study

IntroductionThis study aimed to examine the prospective association between computer use and cognitive decline among community-dwelling Japanese older adults, considering the characteristics of computer users.MethodsThis four-year prospective cohort study was conducted in Obu, Japan. Participants who were cognitive intact at Wave 1 (2011-2012) were followed through the study period. Cognitive decline was defined as scoring below the standard threshold in at least one of four neuropsychological tests at Wave 2 (2015-2016). The association between computer use at Wave 1 and cognitive decline was examined using logistic regression for complete samples (n = 2010, 52.5% female, mean 71.0 ± 4.7 years) and imputed samples (n = 3435, 51.8% female, mean 71.5 ± 5.3 years).ResultsThe computer use group had a reduced adjusted odds ratio (aOR) of cognitive decline, after adjustment for covariates, in both the complete and imputed samples (complete samples: aOR 0.71, 95% confidence interval [CI] 0.52-0.97, p = 0.030; imputed samples: aOR 0.67, 95% CI 0.51-0.88, p < 0.003). Stratified analysis of both samples showed that computer users with ≥ 10 years’ education, a GDS score of < 6, or a walking speed of ≥ 1.0m/s, showed reduced aOR for cognitive decline (aOR 0.61 to 0.69, p < 0.05). Those with < 10 years of education years, GDS scores ≥ 6 of GDS, or walking speed < 1.0m/s did not show significant association.ConclusionComputer use is longitudinally associated with protected cognitive function, based on computer user characteristics.     

Urban neighborhoods and depressive symptoms among older adults

OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older. METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models. RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population. DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.     

Biological age and 12-year cognitive change in older adults: findings from the Victoria Longitudinal Study

BACKGROUND: Although recent cross-sectional findings indicate that markers of biological age (BA) mediate chronological age (CA) differences in cognitive performance, little is known about their influence on actual cognitive changes. OBJECTIVE: The purpose of this investigation is to examine CA and BA as predictors of 12-year cognitive change in a longitudinal sample of older adults. METHODS: Data from the Victoria Longitudinal Study (VLS) were examined for 125 adults between 67 and 95 years of age. Biomarkers, including visual and auditory acuity, grip strength, peak expiratory flow, blood pressure, and body mass index, were submitted to a factor analysis and a composite BA variable was computed based on factor loadings. Intraindividual change across 5 waves of measurement (3-year intervals) was examined as a function of CA and BA for 5 cognitive domains: verbal processing speed, working memory, reasoning, episodic memory, and semantic memory. RESULTS: The latent structure of biomarkers was consistent with previous investigations of functional age and a common factor view of biological aging. Results of hierarchical linear modeling showed that BA predicted actual cognitive change (decline) independent of CA. CONCLUSIONS: As a predictor of cognitive performance in late life, CA is a proxy for biological and environmental influences. We have shown that biological influences are independent predictors of actual cognitive change in older adults. This supports the view that cognitive decline is not due to aging per se, but rather is likely due to causal factors that operate along the age continuum.     

The effect of spousal mental and physical health on husbands' and wives' depressive symptoms, among older adults: longitudinal evidence from the Health and Retirement Survey

OBJECTIVE: To estimate the effect of spousal depressive symptoms and physical health on respondents' depressive symptoms in a national sample of older married couples. METHOD: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents' depressive symptoms. RESULTS: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p < .001). Controlling for spousal depressive symptoms, a decline in the spouses' physical health was associated with a significant reduction in respondent depressive symptoms (p < .05). DISCUSSION: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.     

Poor lung function accelerates cognitive decline in middle-aged and older adults: Evidence from the English Longitudinal Study of Ageing

Background/objectivePrevious studies have linked lung function to cognitive performance. However, it is not clear whether baseline lung function has an effect on the trajectory of cognitive decline during normal aging. This study aimed to examine the association of baseline lung function with long-term changes in cognition among the middle-aged and older adults.MethodsLung function as indicated by forced expiratory volume 1 s (FEV1) and forced vital capacity (FVC), was measured at the baseline examination. Cognition, including memory, time orientation, executive function and processing speed, were tested four times over six years. Generalized estimating equation (GEE) models were used to test the associations between baseline lung function and four visits of cognition in 6080 participants aged 50 years or over from the English Longitudinal Study of Ageing (ELSA).ResultsCompared to participants with higher lung function, those who had lower lung function at baseline experienced a faster rate of decline in memory (joint test: χ²_interaction = 12.07, df = 3, P = 0.007 for FVC), time orientation (joint test: χ²_interaction = 9.49, df = 3, P = 0.023 for FVC) and executive function (joint test: χ²_interaction = 9.13, df = 3, P = 0.028 for FEV1 and joint test: χ²_interaction = 12.76, df = 3, P = 0.005 for FVC). No association was found between baseline lung function and the rate of decline in processing speed (joint test: χ²_interaction = 1.29, df = 3, P=0.733 for FEV1 and joint test: χ²_interaction = 2.35, df = 3, P = 0.503 for FVC).ConclusionsPoor lung function at baseline predicted a faster rate of cognitive decline in memory, time orientation and executive function. The mechanism for this association deserves further investigation.     

Stress and sex differences in depressive symptoms among older adults

The purpose of this study was to determine whether elderly women experience more symptoms associated with depression than elderly men and, if such sex differences exist, to examine several factors that might account for the greater preponderance of psychological distress among women. Unlike previous studies of elderly adults, this study attempted to explain sex differences in depression in terms of differential-exposure and differential-vulnerability to the effects of life stress. The results from a random community survey of 351 older adults indicate that women are more depressed than men. Moreover, a series of demographic-mean decomposition analyses suggest that greater vulnerability among women to the effects of chronic life strains explains a substantial portion of the observed sex differences in distress. Stressful life events were found to be a less important factor in this process.     

Social stressors associated with age-related T lymphocyte percentages in older US adults: Evidence from the US Health and Retirement Study

Exposure to stress is a risk factor for poor health and accelerated aging. Immune aging, including declines in naïve and increases in terminally differentiated T cells, plays a role in immune health and tissue specific aging, and may contribute to elevated risk for poor health among those who experience high psychosocial stress. Past data have been limited in estimating the contribution of life stress to the development of accelerated immune aging and investigating mediators such as lifestyle and cytomegalovirus (CMV) infection. This study utilizes a national sample of 5,744 US adults over age 50 to assess the relationship of social stress (viz., everyday discrimination, stressful life events, lifetime discrimination, life trauma, and chronic stress) with flow cytometric estimates of immune aging, including naïve and terminally differentiated T cell percentages and the ratio of CD4⁺ to CD8⁺ cells. Experiencing life trauma and chronic stress was related to a lower percentage of CD4⁺ naïve cells. Discrimination and chronic stress were each associated with a greater percentage of terminally differentiated CD4⁺ cells. Stressful life events, high lifetime discrimination, and life trauma were related to a lower percentage of CD8⁺ naïve cells. Stressful life events, high lifetime discrimination, and chronic stress were associated with a higher percentage of terminally differentiated CD8⁺ cells. High lifetime discrimination and chronic stress were related to a lower CD4⁺:CD8⁺ ratio. Lifestyle factors and CMV seropositivity partially reduced these effects. Results identify psychosocial stress as a contributor to accelerating immune aging by decreasing naïve and increasing terminally differentiated T cells.

Lifetime exposure to stressful conditions is a known risk factor for poorer health, increasing the risk for early onset of age-related disease and premature death (1–3). Models examining the mechanisms driving these effects have centered on the sequelae of repeated activation and prolonged activation of the sympathoadrenal and hypothalamic pituitary adrenal systems, leading to wear and tear at the biological level (4). Many have postulated that this wear and tear manifests at the cellular level, causing accumulation of DNA damage, increasing inflammation, shortening telomere length, and driving cellular aging (5, 6). Critically short telomere length within immune cells and cellular stress (e.g., DNA damage) can drive cells into a nonreplicating state termed cellular senescence (7, 8). In addition to localized tissue-specific aging (9), age-related changes in immune function contribute to systemic aging, organ failure, and premature mortality, making immunosenescence a critical player in aging and disease (10).Age is a robust determinant of immune cell population composition (11, 12), with aging immune systems characterized by a reduced pool of naïve B and T cells, increased pool of terminally differentiated T cells, increased supply of CD8⁺ cells relative to CD4⁺ T cells, and increased systemic inflammation (13). However, there is substantial variance in the rate of these changes and consequent alterations in immune cell composition among older adults (14). Understanding the contributors to this variance is critical given that immune aging is associated with chronic diseases [e.g., cancer (15) and cardiovascular disease (16)], weakened response to acute infections, increased risk of pneumonia, reduced efficacy of vaccines (17), and organ system aging (10).In the current study we focus on social stressors, that is, difficult or challenging circumstances (18) that arise from social position and experience that are expected to be stressful, that occur in adulthood. Past research has categorized stressors in various ways, often depending on discipline; however, stressors are typically distinguished by timescale (e.g., acute, daily hassles, life events, chronic stressors) (19). We distinguish discrimination-related stressors from other stressors because past research suggests these stressors have distinct, independent effects on health (20–22). We also distinguish traumatic life events from other stressors, as is common in past research (19, 23, 24). Thus, we assess five stress variables that have been well established past research and are available in a large number of studies of health and aging (viz., stressful life events, chronic stress, everyday discrimination, lifetime discrimination, and life trauma). More information about these stressors is available in the SI Appendix.Social stress can modify the immune system in several ways, including increased inflammatory signaling and reduced antiviral responses (18, 25–27), suggesting that social stress may accelerate immune aging (28–38). However, past research has utilized small clinical and specialized samples, potentially limiting power to detect effects, power to assess mediators, and generalizability of results. In the present study, we utilized a nationwide sample of 5,641 US adults over the age of 50 to assess associations between five categories of social stress that have well established effects on heath and enumerative measures of immunological aging, including naïve CD4⁺ T cell percentages (CD4⁺/CD3⁺/CD19⁻/CD45RA⁺/CCR7⁺/CD28⁺) naïve CD8⁺ T cell percentages (CD8⁺/CD3⁺/CD19⁻/CD45RA⁺/CCR7⁺/CD28⁺), terminally differentiated effector memory CD4⁺ T cell percentages (TemRA; CD4⁺/CD3⁺/CD19⁻/CD45RA⁺/CCR7⁻/CD28⁻), terminally differentiated effector memory CD8⁺ T cell percentages (CD8⁺/CD3⁺/CD19⁻/CD45RA⁺/CCR7⁻/CD28⁻), and the ratio of CD4⁺ to CD8⁺ T cells. Analyses also assessed potential mediation of these associations by socioeconomic and lifestyle factors and cytomegalovirus (CMV) seropositivity.     

The association between long-term platelet count and disability-free survival among middle-aged and older Chinese: Evidence from the China Health and Retirement Longitudinal Study

Background and aimsWe aimed to assess the associations of baseline and long-term platelet count (PLT) with disability-free survival (DFS) among middle-aged and older Chinese.Methods and resultsA total of 7296 participants were recruited in the analysis. Updated mean PLT was defined as the mean of the two PLT measurements (4 years between wave 1–3). The long-term status of PLT was defined as persistent low, attenuated, increased and persistent high PLT according to the optimal cut points from the receiver operating characteristic curves of the two PLT measurements, respectively. The primary outcome was DFS, evaluated by the first occurrence of either disability or mortality. During 6-year visit, 1579 participants experienced disability or all-cause mortality. The rates of primary outcome were significantly higher among participants with elevated baseline PLT and updated mean PLT. Multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of primary outcome were 1.253 (1.049–1.496) for highest baseline PLT tertile and 1.532 (1.124–2.088) for highest updated mean PLT tertile, comparing to the lowest tertiles. Multivariable-adjusted spline regression models showed a linear association of baseline PLT (p_linearity < 0.001) and updated mean PLT (p_linearity = 0.005) with primary outcome. Moreover, participants with persistent high PLT and increased PLT had increased risk of primary outcome (ORs [95% CIs]: 1.825 [1.282–2.597] and 1.767 [1.046–2.985], respectively), compared with the reference of those with persistent low PLT.ConclusionThis study proved elevated baseline PLT, especially long-term persist high or increased PLT was associated with less likelihood of DFS among middle-aged and older Chinese.     

Social interactions and depressive symptoms among community dwelling older adults in Nepal: A synergic effect model

In Asian families, where patriarchal family systems are common, living arrangements of older adults are characterized by residing with a married son. This study examines the synergic effects of intergenerational solidarity (emotional and instrumental support exchange and anticipated support) on depression of older adults from a developing country, Nepal. Gender differences are also explored in the study. This was a cross-sectional face-to-face interview study of 489 community dwelling older adults living in an urban area of Nepal. The data were analyzed using multiple regression models with each dimension of intergenerational solidarity and conflict variables entered one-by-one with the confounding variables. The results illustrate that older women receiving lower emotional and instrumental support were significantly more likely to be depressed compared to older men receiving less support from their son. Also, women reporting lower anticipated support and higher conflict with their son were more likely to be depressed than men. Regarding synergic effects, emotional support exchange buffered against the deleterious effects of conflict with depression in older adults. The results highlight a need for further research on late life intergenerational relationships (IR) and mental health of older adults in developing countries so that it can be useful for health care practitioners.     

Nighttime sleep duration,daytime napping,and metabolic syndrome: findings from the China Health and Retirement Longitudinal Study

Sleep and Breathing - This study aimed to assess the association between nighttime sleep, daytime napping, and metabolic syndrome (MetS) in an elderly Chinese population. A cross-sectional study...     

Social and gender inequalities in depressive symptoms among urban older adults of latin america and the Caribbean

OBJECTIVE: This study examined gender differences in depression by examining differential exposure and vulnerability to socioeconomic factors during the life course. METHODS: The data used for the analyses originated from a cross-national survey of older adults living in seven large Latin American cities. We examined associations between depressive symptomatology and socioeconomic conditions and health indicators in childhood, adulthood, and old age. We used the Geriatric Depression Scale to classify respondents with high levels of depressive symptoms. RESULT: The prevalence of depression in the urban population of Latin America was relatively low, ranging across cities from 0.4 to 5.2% in men and from 0.3 to 9.5% in women. Women were more exposed to social and material disadvantages during their life course than men but were not more vulnerable to them than men. Current socioeconomic conditions and health status as well as functional disabilities mainly accounted for gender differences in the prevalence of depression. Additionally, poor health and hunger during childhood, as well as illiteracy or lack of education, were associated with depression in both men and women. DISCUSSION: Cumulative life course exposure to social and material disadvantage and current material, social, and health conditions explain the higher frequency of depression in women.