Changes in Neighborhood-Level Socioeconomic Disadvantage and Older Americans’ Cognitive Functioning

in Health and Place (2021)

Background: While associations of neighborhood conditions with cognitive functioning at older ages have been established, few studies have investigated with a dynamic perspective if changing neighborhood ... [more ▼]

Background: While associations of neighborhood conditions with cognitive functioning at older ages have been established, few studies have investigated with a dynamic perspective if changing neighborhood socioeconomic conditions affect older residents’ cognitive declines, and which putative factors mediate this relationship. Method: Using data from waves 2 (2010–2011) and 3 (2015–2016) of the National Social Life, Health, and Aging Project (NSHAP) survey (n = 1837), ordinary least squares regressions and mediation analyses were conducted, adjusting for multiple confounders and testing eight putative mediators. Results: Worsening neighborhood socioeconomic circumstances were associated with cognitive declines. Changes in depressive symptoms, sizes of close social networks, and physical activity substantially mediated this relationship. Discussion: While 18.10% of the total effect occurred through these mechanisms, further pathways may work through contextual- and individual-level variables not assessed in the NSHAP. [less ▲]

The patients’ perspective on access to and use of Personal Health Records

Scientific Conference (2020, October 29)

We present the patients' perspective regarding the use of Personal Health Records, and give insights on patients' characteristics, such as socioeconomic and behavioural factors, that are associated with ... [more ▼]

We present the patients' perspective regarding the use of Personal Health Records, and give insights on patients' characteristics, such as socioeconomic and behavioural factors, that are associated with the access to and use of Personal Health Records. The findings come from the INTERREG APPS project that investigated preferences for and intention to use Personal Health Records in four cross-border regions, in Lorraine/France, Luxembourg, Rhineland-Palatinate and Saarland/Germany, and Wallonia/Belgium. [less ▲]

Programme Démence Prévention (pdp ): A Nation-Wide Programme for Dementia Prevention in Luxembourg

Poster (2020, April)

Objectives: To implement a multi-year nation-wide programme, by the means of a personalised lifestyle intervention, to prevent or to delay cognitive decline that can contribute to development of dementia ... [more ▼]

Objectives: To implement a multi-year nation-wide programme, by the means of a personalised lifestyle intervention, to prevent or to delay cognitive decline that can contribute to development of dementia in Luxembourg. Methods: Participants with mild cognitive impairment, referred to the programme by their treating physician, undergo an extensive cognitive evaluation by a neuropsychologist on relevant neuropsychological domains as well as a structured dementia risk factor assessment. Based on these assessments, individualised lifestyle interventions are offered by diverse national partners involved in the programme, thus filling a gap of not yet reimbursed services in the Luxemburgish healthcare system. After the personalised lifestyle interventions, each participant will undergo a neuropsychological follow-up in order to re-evaluate his/her health status in terms of cognition. Results: We established a participant-centred national network by presenting the programme on many outreach events and efficient stakeholder communication. The network raises the awareness of dementia prevention in the Luxembourgish population, fosters interdisciplinary communication between individual medical and non-medical healthcare professionals and allows for a successful recruitment of the target population. Moreover, we collect information about adherence to the suggested lifestyle changes, as well as the effectiveness of our interventions in reducing risk factors contributing to the onset of dementia. Conclusions: We provide evidence for the feasibility of the implementation of a nation-wide dementia prevention programme including diverse partners offering personalised lifestyle interventions, which are easily transferrable to other countries. Future results from this programme may also help to integrate prevention interventions into the regular healthcare system. [less ▲]

How to actively protect against dementia. Epidemiological evidence from Luxembourg

Presentation (2020, February)

Mental health impact of the confinement measures during the COVID-19 pandemic

in Innovation in Aging (2020), 4(S1), 952

Using cohort data to emulate lifestyle interventions: Long-term beneficial effects of initiating physical activity on cognitive decline and dementia

in Alzheimer's and Dementia: the Journal of the Alzheimer's Association (2020), 16

Background: Intervention studies have shown beneficial short-term effects of physical activity on cognitive decline and reduced risk of dementia. However, randomized controlled trial data of lifestyle ... [more ▼]

Background: Intervention studies have shown beneficial short-term effects of physical activity on cognitive decline and reduced risk of dementia. However, randomized controlled trial data of lifestyle interventions over long time spans are not available due to lack of resources, feasibility or ethical reasons. Drawing from the principles of emulating a ‘target trial’, which apply design principles of randomized trials to the analysis of observational data, cohort data of a large European survey were analyzed to understand the long-term effects of physical activity changes. Method: Biennial assessments of the economic, social, and health situation of respondents aged 50 and older came from the Survey of Health, Ageing and Retirement in Europe (2004-2017). Cognitive functioning (immediate recall, delayed recall, and verbal fluency) and self-reported diagnosis of dementia were assessed at each follow-up. The target trial included sedentary respondents at t1 who, at follow-up (t2), stayed sedentary (“control group”) or newly reported vigorous physical activity more often than once a week (initiators, “treatment group”). Inclusion and exclusion criteria were implemented as close as possible to those of the FINGER trial. Inverse-probability weighting accounted for the probability of initiating physical activity with a large set of predictor variables. Selecting respondents aged 50-85 years old who met the target trial inclusion and exclusion criteria, assessments of cognitive functioning and self-reported diagnosis of dementia were available for 8,781 respondents at t3 (on average 3.02 years later), 3,858 respondents at t4 (5.84 years), and 2,304 respondents at t5 (7.72 years). A total of 304 respondents reported a diagnosis of dementia. Result: Initiators of vigorous physical activity had higher cognitive functioning at two follow-ups compared to non-initiators (t3: “average treatment effect on the treated”, ATET=0.059, CI: 0.028, 0.090), which remained significant after implementing inclusion and exclusion criteria. Initiators had lower risk of dementia compared to non-initiators at all three follow-ups (t3: ATET=-0.009, CI: -0.015, -0.005, relative risk decrease -46.7%), remaining significant after implementing inclusion and exclusion criteria. Conclusion: Emulating a target trial showed long-term benefits of initiating physical activity for cognitive functioning and dementia risk. Multidomain interventions related to nutrition, social, cognitive activities etc. can be similarly emulated. [less ▲]

Examining gender differentials in the association of low control work with cognitive performance in older workers

in European Journal of Public Health (2020)

Background: Limited workplace control, an important dimension of job strain, can reduce occupational opportunities for problem solving and learning. Women may have fewer professional resources to mitigate ... [more ▼]

Background: Limited workplace control, an important dimension of job strain, can reduce occupational opportunities for problem solving and learning. Women may have fewer professional resources to mitigate effects of low control, while conversely, gender-role norms may moderate the influence of occupational psychosocial risk factors. We therefore examined if the links between control and cognitive function were similarly gendered. Methods: This observational, longitudinal study included respondents of the Survey of Health, Ageing and Retirement in Europe who were aged 50-64 years at entry, employed, and provided at least two measurements of control and cognition (n=6,697). Relationships between control and cognition, quantified with standardised scores from verbal fluency, immediate and delayed word recall tests, were explored using linear fixed-effect and random-effect models with gender interactions. Results: Consistent trends of improved verbal fluency performance with high control were evident across analyses, equal to producing around three-quarters of a word more under high control conditions, with an effect size roughly equal to 0.1 standard deviation units (fully adjusted models, range 0.077-0.104 SD), although associations with recall tests were inconsistent. We did not find evidence of clear gender differences in control–cognition relationships for any of the cognitive domains. Conclusions: The cognitive health of older European workers may benefit from improved workplace control irrespective of gender. Possible sources of bias that could explain the lack of gender differences are discussed, particularly gender differences in labour force participation, response behaviour in job control ratings, and implications of gender-role norms on the importance of occupational risk factors. [less ▲]

Gender inequalities across the life course: A societal perspective on gender differences in dementia

Scientific Conference (2019, October)

Introduction. Women are at increased risk of developing dementia, which can only partly be explained with differences in longevity, sex biology, or differences in detection/diagnosis. A promising approach ... [more ▼]

Introduction. Women are at increased risk of developing dementia, which can only partly be explained with differences in longevity, sex biology, or differences in detection/diagnosis. A promising approach at the population level is the systematic investigation of life course conditions for men and women across countries and cohorts in order to detect if schooling or work opportunities differ by gender. In the cognitive reserve framework, education and work reflect opportunities for cognitively stimulating activities, which increase cognitive reserve across the life course, and which could delay cognitive decline and the diagnosis of dementia. Method. We develop a framework for systematizing gender inequalities across different life stages and life domains, with a focus on systematic disadvantages for women that could be relevant barriers to cognitive reserve development. For the empirical analysis, we gather individual information and performance on cognitive tests from several harmonized cross-national aging surveys, i.e. the U.S. Health and Retirement Study and sister studies (SHARE, ELSA, SAGE), separated by cohort. Historical figures on gender inequalities for countries and cohorts, and their relevant timings in the life course of the older respondents, e.g. during schooling, were gathered from different sources, and merged with the individual-level data. Results. The new framework leads to testable hypotheses in both the Western and global context regarding life-course socialization and schooling and work opportunities that have been different for men and women. We will present preliminary evidence of how female (dis)advantages on different cognitive tests – memory, executive functioning – are mirroring societal gender inequalities. Discussion. We need to better understand how different life-course opportunities for men and women can create gender differences in dementia at old ages in order to identify individuals at risk today and improve conditions for future generations. [less ▲]

WYLD Special Symposium: Technological Innovations in Dementia Diagnosis and Care

Scientific Conference (2019, October)

Researchers and entrepreneurs present technological innovations in dementia diagnosis and care, particularly through the use of wearables, apps, and novel data analysis techniques. These innovations ... [more ▼]

Researchers and entrepreneurs present technological innovations in dementia diagnosis and care, particularly through the use of wearables, apps, and novel data analysis techniques. These innovations address complex challenges of differential dementia diagnosis and ensuring high-quality and safe home and formal care. [less ▲]

Epidemiology of and inequalities in ageing

Presentation (2019, June 05)