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Background: REM-sleep behavior disorder (RBD) and other non-motor symptoms such as hyposmia were proposed by the Movement Disorder Society as research criteria for prodromal Parkinson's disease (P-PD). Global cognitive deficit was later added. Objective: To compare non-motor symptoms, focusing on cognition, between a P-PD group and a matched control group. Methods: In this cross-sectional, case-control study, in a first set of analyses, we performed extensive cognitive testing on people with (n = 76) and a control group without (n = 195) probable RBD and hyposmia. Furthermore, we assessed motor and non-motor symptoms related to Parkinson's Disease (PD). After propensity score matching, we compared 62 P-PD with 62 age- and sex-matched controls. In addition, we performed regression analyses on the total sample (n = 271). In a second set of analyses, we used, a.o., the CUPRO to evaluate retrograde procedural memory and visuo-constructive functions. Results: People with P-PD showed significantly poorer performances in global cognition, visuo-constructive and executive functions, mainly in mental flexibility (p < 0.001; p = 0.004; p = 0.003), despite similar educational levels (p = 0.415). We observed significantly more motor and non-motor symptoms (p < 0.001; p = 0.004), higher scores for depression (p = 0.004) and apathy (p < 0.001) as well as lower quality of life (p < 0.001) in P-PD. CONCLUSIONS: Our findings confirm that global cognitive, executive, and visuo-constructive deficits define the P-PD group. In addition, depression, apathy, and lower quality of life were more prevalent in P-PD. If replicated in other samples, executive and visuo-constructive deficits should be considered in non-motor P-PD. Determining specific patterns will support early recognition of PD, secondary prevention of complications and the development of neuroprotective treatments. [ABSTRACT FROM AUTHOR]

Background: Freezing of gait (FOG), is associated with impairment of different cognitive functions. Previous studies hypothesized that FOG may be due to a loss of automaticity. Research question: To explore whether FOG is associated with impairment in cognitive functions, focusing on retrograde procedural memory, the memory responsible for the automatic, implicit stored procedures that have been acquired in earlier life stages. Methods: In this cross-sectional, case--control study, 288 people with typical Parkinson's disease (PD) from the Luxembourg Parkinson's Study were assigned to Freezers (FOG+) and non-Freezers (FOG-) based on the MDS-UPDRS 2.13 (self- reported FOG episodes) and 3.11 (FOG evaluated by clinicians during gait assessment). Both groups were matched on age, sex and disease duration. Global cognition (MoCA), retrograde procedural memory and visuo-constructive abilities (CUPRO), psychomotor speed and mental flexibility (TMT) were assessed. Furthermore, we repeated our analyses by additionally controlling for depression (BDI-I). Results: Besides lower global cognition (MoCA; p = 0.007) and mental flexibility (TMT-B and Delta-TMT; p < 0.001), FOG+ showed a lower performance in retrograde procedural memory (CUPRO-IS1; p < 0.001) compared to FOG-. After controlling additionally for depression, our main outcome variable CUPRO-IS1 remained significantly lower in FOG+ (p = 0.010). Conclusion: Our findings demonstrated that besides lower global cognition and mental flexibility scores, FOG+ showed lower performance in retrograde procedural memory compared to matched FOG-control patients, even when accounting for factors such as age, sex, disease duration or depression. Significance: In the context of limited treatment options, especially for non-invasive therapeutic approaches, these insights on procedural memory and FOG may lead to new hypotheses on FOG etiology and consequently the development of new treatment options. [ABSTRACT FROM AUTHOR]

PurposeWe sought to examine how different activities performed during employment gaps are associated with later cognitive function and change.MethodsFive cognitive measures were used to indicate cognitive impairment of 18,259 respondents to the Survey of Health, Ageing, and Retirement in Europe (ages 50-73) in 2004/5 or 2006/7. Using complete employment histories, employment gaps of ≥6 months between ages 25 and 65 were identified.ResultsControlling for early life socioeconomic status, school performance, and education, higher risk of cognitive impairment was associated with employment gaps described as unemployment (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.04-1.35) and sickness (OR, 1.78; 95% CI, 1.52-2.09). In contrast, lower risk of cognitive impairment was associated with employment gaps described as training (OR, 0.73; 95% CI, 0.52-1.01) or maternity leave (OR, 0.65; 95% CI, 0.57-0.79). In longitudinal mixed effects models, training and maternity leave were associated with lower 2-year aging-related cognitive decline.DiscussionPeriods away from work described as unemployment or sickness are associated with lower cognitive function, whereas maternity and training leaves are associated with better late-life cognitive function. Both causation and selection mechanisms may explain these findings.

INTRODUCTION: A wide range of modifiable risk factors for dementia have been identified. Considerable debate remains about these risk factors, possible interactions between them or with genetic risk, and causality, and how they can help in clinical trial recruitment and drug development. Artificial intelligence (AI) and machine learning (ML) may refine understanding. METHODS: ML approaches are being developed in dementia prevention. We discuss exemplar uses and evaluate the current applications and limitations in the dementia prevention field. RESULTS: Risk‐profiling tools may help identify high‐risk populations for clinical trials; however, their performance needs improvement. New risk‐profiling and trial‐recruitment tools underpinned by ML models may be effective in reducing costs and improving future trials. ML can inform drug‐repurposing efforts and prioritization of disease‐modifying therapeutics. DISCUSSION: ML is not yet widely used but has considerable potential to enhance precision in dementia prevention. Highlights: Artificial intelligence (AI) is not widely used in the dementia prevention field.Risk‐profiling tools are not used in clinical practice.Causal insights are needed to understand risk factors over the lifespan.AI will help personalize risk‐management tools for dementia prevention.AI could target specific patient groups that will benefit most for clinical trials. [ABSTRACT FROM AUTHOR]

Background: Individuals with depression have an increased dementia risk, which might be due to modifiable risk factors for dementia. This study investigated the extent to which the increased risk for dementia in depression is explained by modifiable dementia risk factors. Methods: We used data from the English Longitudinal Study of Ageing (2008–2009 to 2018–2019), a prospective cohort study. A total of 7460 individuals were included [mean(standard deviation) age, 65.7 ± 9.4 years; 3915(54.7%) were women]. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale-8 (score ≥3) or self-reported doctor's diagnosis. Ten modifiable risk factors for dementia were combined in the 'LIfestyle for BRAin health' (LIBRA) score. Dementia was determined by physician diagnosis, self-reported Alzheimer's disease or the shortened version of the Informant Questionnaire on Cognitive Decline in the Elderly (average score ≥3.38). Structural equation modelling was used to test mediation of LIBRA score. Results: During 61 311 person-years, 306 individuals (4.1%) developed dementia. Participants aged 50–70 years with depressive symptoms had higher LIBRA scores [difference(s.e.) = 1.15(0.10)] and a 3.59 times increased dementia risk [HR(95% CI) = 3.59(2.20–5.84)], adjusted for age, sex, education, wealth and clustering at the household level. In total, 10.4% of the dementia risk was mediated by differences in LIBRA score [indirect effect: HR = 1.14(1.03–1.26)], while 89.6% was attributed to a direct effect of depressive symptoms on dementia risk [direct effect: HR = 3.14(2.20–5.84)]. Conclusions: Modifiable dementia risk factors can be important targets for the prevention of dementia in individuals with depressive symptoms during midlife. Yet, effect sizes are small and other aetiological pathways likely exist. [ABSTRACT FROM AUTHOR]

Background: Research on social determinants of health has identified modifiable risk factors that contribute to an individual's risk of developing dementia [1]. Individuals with mild cognitive impairment (MCI) present a group with highest potential of lifestyle interventions due to the risk of progressing to dementia [2]. The pathways from identified modifiable risk factors for dementia such as education have not been clarified, however understanding the relationships between risk factors and MCI could help identify mechanisms for intervention and reducing risk of progressing to dementia. Previous findings found taxonomic differences in dementia and MCI patients, and further education linked to indicators of gut dysbiosis [3–5]. We sought to test the possibly mediating role of gut dysbiosis and taxonomic differences in the relationship between modifiable risk factors and MCI, independent of genetic risk for developing dementia. Method: Gut microbiome composition was ascertained with 16S rRNA gene amplicon sequencing. MCI classification was based on MoCA performance. Educational attainment in years was grouped. Mediation analysis [6] was conducted decomposing direct and indirect effects of educational attainment on MCI mediated by markers of dysbiosis (Chao1, Inverse Simpson, Shannon) while controlling for polygenic risk of Alzheimer's Disease, Lewy Body Dementia and Parkinson's Disease to account for different etiologic neurodegenerative pathways manifesting as MCI. Taxonomic differences across education groups were further tested (ANCOM‐BC, DESeq2) and PAM clustering based on relative abundance at Genus level was conducted to explore underlying signatures. Result: After exclusion of participants below age 50, or with missing data, n = 256 participants (n = 58 with MCI) of the Luxembourg Parkinson's Study without Parkinson's disease were eligible for analysis (M[SD] Age = 64.7[8.3] years). Higher vs lower educational attainment had a controlled direct effect (CDE) = 0.35 (P<.01) on MCI, Chao1 included as mediator. We did not find significant indirect effects via any indicator of dysbiosis. Clusters with lower abundance of Bacteroides relative to Prevotella and Ruminococcus were at higher risk of MCI. Conclusion: Our findings indicate direct effects of education not mediated by markers of dysbiosis. Taxonomic analysis suggests a signature linked to lower risk of dementia in higher educated individuals. [ABSTRACT FROM AUTHOR]

Socioeconomic factors and genetic predisposition are established risk factors for dementia. It remains unclear whether associations of socioeconomic deprivation with dementia incidence are modified by genetic risk. Participants in the UK Biobank aged ≥60 years and of European ancestry without dementia at baseline (2006–2010) were eligible for the analysis, with the main exposures area-level deprivation based on the Townsend Deprivation Index and individual-level socioeconomic deprivation based on car and home ownership, housing type and income, and polygenic risk of dementia. Dementia was ascertained in hospital and death records. Analysis was conducted in 2021. In this cohort study, 196,368 participants (mean [SD] age=64.1 [2.9] years, 52.7% female) were followed up for 1,545,316 person-years (median [IQR] follow-up=8.0 [7.4–8.6] years). In high genetic risk and high area-level deprivation, 1.71% (95% CI=1.44, 2.01) developed dementia compared with 0.56% (95% CI=0.48, 0.65) in low genetic risk and low-to-moderate area-level deprivation (hazard ratio=2.31; 95% CI=1.84, 2.91). In high genetic risk and high individual-level deprivation, 1.78% (95% CI=1.50, 2.09) developed dementia compared with 0.31% (95% CI=0.20, 0.45) in low genetic risk and low individual-level deprivation (hazard ratio=4.06; 95% CI=2.63, 6.26). There was no significant interaction between genetic risk and area-level (p= 0.77) or individual-level (p= 0.07) deprivation. An imaging substudy including 11,083 participants found a greater burden of white matter hyperintensities associated with higher socioeconomic deprivation. Individual-level and area-level socioeconomic deprivation were associated with increased dementia risk. Dementia prevention interventions may be particularly effective if targeted to households and areas with fewer socioeconomic resources, regardless of genetic vulnerability. [ABSTRACT FROM AUTHOR]

Background: The risk of Alzheimer's disease and other subtypes of dementia is determined by multiple pathways including genetic, environmental and lifestyle factors. With higher risk in socioeconomically deprived individuals, it remains unclear whether associations of genetic risk with dementia incidence may be modified by individual‐ or area‐level socioeconomic deprivation. Method: Participants of the UK Biobank study attended baseline assessments at 22 assessment centers between 2006 and 2010 and were followed‐up until 2016 or 2017. Cox proportional‐hazards regressions with area‐level socioeconomic deprivation based on the Townsend Deprivation Index and individual‐level socioeconomic deprivation based on car and home ownership, housing type, and income were run. A comprehensive polygenic risk score was employed and potential mediation through lifestyle and depressive symptoms was assessed. In an imaging substudy, associations of socioeconomic deprivation with six imaging‐derived phenotypes including white matter hyperintensities were examined. Result: 196,368 participants (mean [standard deviation] age, 64.1 [2.9] years, 52.7% female) aged 60 years and older, of European ancestry, without dementia diagnosis or cognitive impairment at baseline were followed‐up for 1,545,316 person‐years (median [interquartile range] follow‐up, 8.0 [7.4‐8.6] years). In high genetic risk and high area‐level deprivation 1.71% (95% confidence interval, 1.44% to 2.01%) developed dementia compared to 0.56% (95% confidence interval, 0.48% to 0.65%) in low genetic risk and low‐to‐moderate area‐level deprivation (hazard ratio, 2.31; 95% confidence interval, 1.84 to 2.91). In high genetic risk and high individual‐level deprivation 1.78% (95% confidence interval, 1.50% to 2.09%) developed dementia compared to 0.31% (95% confidence interval, 0.20% to 0.45%) in low genetic risk and low individual‐level deprivation (hazard ratio, 4.06; 95% confidence interval, 2.63 to 6.26). There was no significant interaction between genetic risk and area‐level (P =.77) or individual‐level (P =.07) deprivation. An imaging substudy including 11,083 participants found greater burden of white matter hyperintensities associated with higher socioeconomic deprivation. Conclusion: In older adults without dementia area‐level and individual‐level socioeconomic deprivation and genetic risk were significantly and independently associated with a higher risk of dementia. Dementia prevention interventions may be particularly effective if targeted to people living in deprived households and areas, regardless of genetic vulnerability. [ABSTRACT FROM AUTHOR]

The article discusses the mapping of machine learning (ML) approaches for description, prediction, and causal inference in the social and health sciences. It provides a comprehensive, systematic meta-mapping of research questions in the social and health sciences to appropriate ML approaches by incorporating the necessary requirements to statistical analysis in these disciplines.

Objectives: The effects of the COVID-19 outbreak on non-COVID-19-related healthcare need further investigation. Methods: Using the Survey of Health, Ageing and Retirement in Europe's COVID-19 module (2020) (N = 57,025), country-level data from the European Social Survey (2008) and OECD (2020), and logistic regressions, this study examines predictors of older Europeans' forgone, postponed, and denied healthcare during the pandemic. Results: Country-level availability of physicians, healthcare systems' generosity, and beliefs that older persons burden healthcare systems all increased forgone healthcare. Healthcare system generosity increased postponed and denied healthcare. Greater medical resources decreased denied healthcare. Furthermore, missed healthcare varied by individual-level gender (higher rates among women), age, education, and health. Discussion: This study reveals predictors of missed healthcare during the pandemic. To decrease unintended health consequences of a pandemic, both individual-level determinants, such as gender and health, and contextual-level determinants, such as healthcare systems' characteristics, should be considered in research and practice. [ABSTRACT FROM AUTHOR]

Background: Studies have identified modifiable risk factors for both prevalence and incidence of cognitive impairment in lower educated older adults. However, patterns of cognitive change, and risk and protective factors for declining versus stable cognitive trajectories have rarely been described in this population. Our goal was to explore the long‐term trajectories of cognitive function and identify modifiable risk and protective factors for cognitive decline beyond education. Method: We applied group‐based trajectory modelling and multinomial logistic regressions to explore possible trajectories and associated baseline factors on data from a population‐based Health, Welfare and Aging (SABE) survey collected in 2000, 2006, 2010, and 2015 in Sao Paulo, Brazil. Cognitive functioning was assessed using the abbreviated Mini‐Mental State Exam. A total of 354 respondents aged 60 + participating in all follow‐ups were included in the statistical analyses. Result: Group‐based trajectory modelling identified three different cognitive trajectories, specifically groups with stable (37.4%), declining (53.8%), and strongly declining (8.8%) trajectories, with the last one reaching the threshold for cognitive impairment (Figure 1). Socioeconomic status, specifically living in rural areas during childhood and no schooling or primary education, as well as self‐identified race was systematically different between the groups (Table 1). Moreover, respondents in the stable trajectory were more likely to report living in urban areas, more than primary education, to be white, to earn more than four times the minimum wage/month, to practice manual work, craft or artistic activity at least once a week, and less likely to have had stroke or be widowed. On the other hand, those in the strongly declining trajectory were more likely to be black or mixed and smoke at baseline. Conclusion: Our findings suggest substantial potential for modification of risk of cognitive decline even in lower educated older individuals at risk for cognitive impairment. Risk factors related to self‐identified race/ethnicity and socioeconomic status suggest systematic inequalities in brain health potential, with risk for later‐life cognitive impairment. Sample attrition suggests conservative estimates of the magnitude of the risk factors for cognitive decline. Health and social policies should address inequalities to improve later‐life cognitive function of at‐risk individuals. [ABSTRACT FROM AUTHOR]

The population of Latin America and Caribbean (LAC) is ageing rapidly, presenting the highest prevalence rates of dementia in the world. Mild cognitive impairment (MCI) is an intermediate condition between normal ageing, Alzheimer's disease, and related dementias. We conducted a systematic review to evaluate the prevalence of MCI in LAC countries and explore factors associated with MCI (i.e. age, sex/gender, and education). A database search was conducted in September 2020 using PubMed, Web of Science, Scopus, Lilacs, SciELO, EMBASE, and medRxiv for population- or community-based studies, published in English, Spanish, or Portuguese. From 2,155 screened studies, we selected reports including subjects with a precise diagnosis of MCI. A total of 11 studies met the inclusion criteria, adding up to 20,220 participants in nine countries: Brazil, Mexico, Argentina, Colombia, Peru, Cuba, Dominican Republic, Venezuela, and Costa Rica. Estimates for all-type MCI prevalence ranged from 6.8% to 25.5% and amnestic MCI between 3.1% and 10.5%. Estimates differed by age and education, with oldest and lower-educated adults presenting higher MCI prevalence. This first systematic review of the prevalence of MCI discusses the population strata with the highest potential to benefit from dementia risk reduction interventions in LAC countries. [ABSTRACT FROM AUTHOR]

Objectives Childhood socioeconomic disadvantage is consistently associated with lower cognitive function in later life. This study aims to distinguish the contribution of specific aspects of childhood socioeconomic disadvantage for memory performance in mid to late adulthood, with consideration for direct and indirect effects through education and occupation. Methods Data were from adults aged 50 to 80 years who completed the life history module in the 2006/2007 wave of the English Longitudinal Study of Aging (n = 4,553). The outcome, memory score, was based on word recall tests (range: 0–20 points). We used the g-formula to estimate direct and indirect effects of a composite variable for childhood socioeconomic disadvantage and its 4 individual components: lower-skilled occupation of the primary breadwinner, having few books in the home, overcrowding in the home, and lack of water and heating facilities in the home. Results Few books were the most consequential component of childhood socioeconomic disadvantage for later-life memory (total effect: −0.82 points for few books; 95% confidence interval [CI]: −1.04, −0.60), with roughly half being a direct effect. The total effect of a breadwinner in lower-skilled occupations was smaller but not significantly different from a few books (−0.67 points; 95% CI: −0.88, −0.46), while it was significantly smaller with overcrowding (−0.31 points; 95% CI: −0.56, −0.06). The latter 2 total effects were mostly mediated by education and occupation. Discussion A literate environment in the childhood home may have lasting direct effects on memory function in mid to later life, while parental occupation and overcrowding appear to influence memory primarily through educational and occupational pathways. [ABSTRACT FROM AUTHOR]

Background: The analysis of the procedural memory is particularly relevant in neurodegenerative disorders like Parkinson's disease, due to the central role of the basal ganglia in procedural memory. It has been shown that anterograde procedural memory, the ability to learn a new skill, is impaired in Parkinson's disease. However, retrograde procedural memory, the long-term retention and execution of skills learned in earlier life stages, has not yet been systematically investigated in Parkinson's disease. Objective: This study aims to investigate retrograde procedural memory in people with Parkinson's disease. We hypothesized that retrograde procedural memory is impaired in people with Parkinson's disease compared to an age- and gender-matched control group. Methods: First, we developed the CUPRO evaluation system, an extended evaluation system based on the Cube Copying Test, to distinguish the cube copying procedure, representing functioning of retrograde procedural memory, and the final result, representing the visuo-constructive abilities. Development of the evaluation system included tests of discriminant validity. Results: Comparing people with typical Parkinson's disease (n = 201) with age- and gender-matched control subjects (n = 201), we identified cube copying performance to be significantly impaired in people with Parkinson's disease (p = 0.008). No significant correlation was observed between retrograde procedural memory and disease duration. Conclusion: We demonstrated lower cube copying performance in people with Parkinson's disease compared to control subjects, which suggests an impaired functioning of retrograde procedural memory in Parkinson's disease. [ABSTRACT FROM AUTHOR]

Background: Self-stigma in people with Parkinson's disease (PD) can substantially impact quality of life and possibilities for social participation. An integrative analysis of determinants of self-stigma has been lacking. Objective: We sought to explore which complementary insights from qualitative and quantitative studies, as well as from expert consultation, could be gained. Methods: An established mixed methods study design was employed to first conduct a mixed methods scoping review of published qualitative and quantitative literature, and then consult with experts to arrive at an exhaustive list of determinants of self-stigma after a thematic synthesis. Results: A total of 87 unique determinants of self-stigma were identified. Quantitative studies and expert consultations mainly identified personal determinants of people with self-stigma (e.g., age, anxiety, or apathy). In contrast, qualitative studies identified social situations associated with self-stigma (e.g., joint meals of people with typical PD with others). Notably, self-stigma of people with PD was found to be particularly salient in unfamiliar places, at the working place or in contact with people without PD. Across methods, cognitive impairment, tremor, and abnormal walk and unsteady gait, respectively, were associated with self-stigma. Conclusion: The mixed method study design yielded complementary insights, but also factors commonly associated with self-stigma across methods. Future prioritization exercises may gain further insights into self-stigma of people with PD. Facilitating social encounters by both addressing needs of affected people and raising knowledge and public awareness may improve quality of life in people with PD. [ABSTRACT FROM AUTHOR]

Background: Low dementia rates, reflecting underdiagnosis in representative cohort studies, limit statistical power of etiological and preventative research. Although several algorithms for automated classification of presence or absence of dementia have been validated in the Health and Retirement Study (HRS), no such algorithm has yet been applied to the Survey of Health, Ageing and Retirement in Europe (SHARE). Method: The Langa‐Weir classification (LW) was adapted to readily available indicators in SHARE, including immediate and delayed recall. Adapted algorithms additionally included instrumental activities of daily living (IADL) and used cut‐offs defined by either sample‐ or population‐level distributions. Performance was compared to logistic and bayesian‐logistic regression models and a gradient boosting machine (XGBoost) with the same indicators, adjusting for age groups, gender and educational level. The bayesian‐logistic regression used priors for sociodemographic indicators and global dementia incidence. Accuracy, specificity and sensitivity were compared with a train‐test split approach in SHARE wave 7 (2017). Result: In total, N = 72,329 participants (57% female) above age 50 had no missing data on self‐reported dementia diagnosis, immediate or delayed recall and IADLs. LW based on immediate and delayed recall with a score cutoff based on dementia population‐incidence performed best overall (Accuracy =.92, Balanced Accuracy =.75, Sensitivity =.58, Specificity =.92), and showed greatest similarities to participants with self‐reported dementia diagnosis regarding risk factors and comorbidities (i.e., gripstrength, numerical performance, verbal fluency). Results from XGBoost suggested comparable performance however with risk of overfitting. Conclusion: LW adaptations outperformed regression models regarding sensitivity. Comparisons of risk factor and comorbidity distributions suggest meaningful differences in comorbidities and risk factors in participants classified with and without dementia. With a lack of proxy assessments in SHARE, a suspected healthy volunteer bias and the absence of standardized cognitive assessments, probable dementia detection in SHARE necessarily comes with less confidence compared to algorithms tested in HRS. Nonetheless, performance of LW adaptations in SHARE is in line with previous validation studies in HRS. Future research should validate the algorithms through more extensive cognitive assessments once available. [ABSTRACT FROM AUTHOR]

Background: Associations between personality traits and mental health outcomes (depression, anxiety, loneliness, and stress) have rarely been assessed in a population-representative sample of a high-income country during the COVID-19 pandemic. Additionally, as far as we know, the role of health and social behaviors as well as resilience in the personality-mental health relationship has yet to be explored. Methods: A representative sample of 1,828 residents of Luxembourg filled in validated scales to assess personality traits and resilience, depressive symptoms, generalized anxiety, loneliness, and stress, indicating mental health, in mid-April 2020. Results: Approximately 21% of the participants scored above the cut-off for moderate depression and moderate loneliness. Moderate anxiety and moderate stress were present in 6.2 and 0.3% of the participants, respectively. Higher-educated respondents and those living in higher-value housing reported better mental health. Agreeableness and conscientiousness were most consistently associated with better mental health; neuroticism was most consistently associated with worse mental health. Spending more time on social media was also associated with elevated levels of all four mental health outcomes. Social and health behaviors did not change the personality-mental health relationships. Resilience moderated some of the personality-mental health associations, most consistently in neuroticism. Conclusions: Findings suggest educational and socioeconomic inequalities in mental health in a nationally representative sample during the COVID-19 confinement measures. Personality traits, particularly agreeableness, conscientiousness, and low neuroticism were associated with mental health. The moderating role of resilience in the personality-mental health relationship suggests intervention potential to improve mental health during periods of confinement. [ABSTRACT FROM AUTHOR]

Background: Patterns of cognitive change and modifiable factors for declining versus stable cognitive trajectories have rarely been described in a lower‐educated older population. Our goal was to identify heterogeneous long‐term trajectories of cognitive functioning and explore possible factors associated with cognitive decline beyond education, among older Brazilian adults. Method: We used data on n = 1,042 adults aged ≥ 60 from the Health, Welfare and Aging (SABE) without cognitive impairment at baseline over four waves (2000‐2015) in São Paulo, Brazil. We applied group‐based trajectory modelling to identify cognitive trajectories. Cognition was measured using the abbreviated version of the Mini‐Mental State Examination (MMSE). Result: We identified three cognitive groups: stable (n = 754), mild declining (n = 183), and strongly declining (n = 105). The probability of being in the strongly declining group membership was 10.7%. According to the MMSE classification, the mild declining group reached the average threshold for cognitive impairment on the last follow‐up, while the strongly declining group was on the second follow‐up. Furthermore, respondents in the stable trajectory were more likely to report more than primary education, to be white and married, to earn more than four times the minimum wage/month, to live in urban areas during childhood, and to practice vigorous physical activity at least three times a week. On the other hand, those in the strongly declining trajectory were more likely to identify as black or mixed, to self‐report subjective emptiness, and to have lower BMI, diabetes, and stroke. Moreover, both mild and strongly declining participants presented higher average age and lower MMSE scores at baseline compared to the stable trajectory. The multinomial logistic regression analysis revealed that respondents who self‐reported being mixed, had higher age, had primary education, had a stroke, and smoked at baseline were more likely to be in the strongly declining group. Conclusion: Our findings suggest that besides education, interventions to reduce cognitive decline might include health and social policies addressing inequalities and modifiable risk factor burdens to improve later‐life cognitive functioning of at‐risk individuals. Sample attrition suggests estimates of the magnitude of the risk factors for cognitive decline to be conservative. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic inequalities in the risk for cognitive impairment have been reported, which might partly act through structural brain damage or differential numbers of brain connections (structural connectivity). This study investigated the extent to which the association of early‐life socioeconomic status (SES) with later‐life cognitive performance is mediated by later‐life SES, and whether the association of SES with later‐life cognitive performance can be explained by structural brain damage and connectivity. Method: We used cross‐sectional data from the population‐based Maastricht study (n = 4,839; mean age 59.2±8.7 years, 49.8% women). Early‐life SES was assessed retrospectively by self‐reported poverty and parental education. Later‐life SES included education, occupation, and household income. Participants underwent cognitive testing and 3 T magnetic resonance imaging to measure volumes of white matter hyperintensities, gray matter, white matter, cerebrospinal fluid, and structural connectivity. Multiple linear regression analyses tested the associations between SES, brain markers and cognition. Analyses were adjusted for age, sex, and type 2 diabetes (because of oversampling). Structural equation modeling tested mediation. Result: Higher SES was associated with higher grey matter volume, lower white matter volume, and higher structural connectivity. Structural brain damage and lower structural connectivity were associated with lower overall cognitive performance. Both higher early‐life and later‐life SES were associated with overall higher cognitive performance (B [95% CI] medium versus low early‐life SES = 0.17[0.12;0.23]; B high versus low early‐life SES = 0.26[0.20;0.32]; B medium versus low later‐life SES = 0.46[0.41;0.52]; B high versus low later‐life SES = 0.72[0.67;0.78]). The association of early‐life SES with later‐life cognitive performance was partly mediated by later‐life SES (73.8%). The extent to which the association of SES with cognitive performance could be explained by structural brain damage or connectivity was marginal (up to 5.9%). Conclusion: Though there was an association between early‐life SES and later‐life cognitive performance independent of later‐life SES, a large part of this association could be explained by later‐life SES. Structural brain damage and connectivity marginally explained socioeconomic inequalities in cognitive performance. More research is needed to investigate alternative pathways that explain associations of life‐course SES with later‐life cognition. [ABSTRACT FROM AUTHOR]

Objectives Living in a partnership has been shown to benefit later life health in general and decrease the risk of cognitive impairment. Few studies have, however, examined whether different types of partnership transitions also differ with respect to their impact on cognitive trajectories, and whether financial resources, healthy behaviors, cognitive stimulation, and social integration can explain these differences. Methods Data came from six waves of the Survey of Health, Ageing and Retirement in Europe, which is a representative panel for the population aged 50 years or older, and were collected between 2004 and 2017 in 20 European countries. Our sample includes 215,989 valid person-year observations from 78,984 persons. The mean age at baseline is 64 years, and individuals were observed on average 2.7 times. Cognitive functioning was assessed with measures of immediate and delayed recall on a memory test and verbal fluency. Fixed effects regression models were employed to exploit individual-level variation in partnership and simultaneous cognitive changes. Results Partnership status was stable in most respondents (around 90%). Compared to remaining partnered and after controlling for sociodemographic factors, transition to divorce was associated with a steeper decline in immediate and delayed recall. Exploring possible mechanisms, both financial resources and social integration, explained these differences. Additional analyses suggested that effects were mostly driven by individuals with lower education. Discussion Partnership transitions remain infrequent events in later life, but our findings indicate that they can induce less favorable cognitive trajectories compared to partnered individuals, particularly for those with lower cognitive reserve. [ABSTRACT FROM AUTHOR]

Background: Gender differences in late middle-age cognitive performance may be explained by differences in educational or occupational attainment rates, or gender-patterned returns of similar education and occupation to cognitive reserve. We tested these competing hypotheses in the historically highly gender unequal context of South Korea. Methods: Data came from the 2006 wave of the Korean Longitudinal Study of Aging. We included adults aged 45–65 years. Using quantile regression decompositions, we decomposed cognitive performance differences across quantiles into differences due to rates of educational and occupational attainment and differences due to divergent returns to those characteristics. Results: Gender-based cognitive performance differences across deciles were driven by differences in rates of educational and occupational attainment, while the returns to these characteristics were similar for both genders. Conclusions: Findings suggest that educational and occupational characteristics contribute to cognitive performance similarly in men and women, but discordant rates of these characteristics contribute to performance gaps. [ABSTRACT FROM AUTHOR]

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 whether 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  = 6697). Relationships between control and cognition, quantified with standardized 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 ∼0.1 SD 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. [ABSTRACT FROM AUTHOR]

Maintaining cognitive function is a prerequisite of living independently, which is a highly valued component in older individuals' well-being. In this article we assess the role of early-life and later-life nutritional status, education, and literacy on the cognitive functioning of older adults living in poverty in Peru. We exploit the baseline sample of the Peruvian noncontributory pension program Pension 65 and find that current nutritional status and literacy are strongly associated with cognitive functioning for poor older adults. In a context of rising popularity of noncontributory pension programs around the world, our study intends to contribute to the discussion of designing accompanying measures to the pension transfer, such as adult literacy programs and monitoring of adequate nutrition of older adults. [ABSTRACT FROM AUTHOR]

This paper examines the extent to which wellbeing levels change in the transition to retirement depending on transitioning from being employed, unemployed or economically inactive. Whereas transitioning from employment to unemployment has been found to cause a decrease in subjective wellbeing with more time spent in unemployment, it is not clear how transitioning from unemployment to retirement affects wellbeing levels. We use the Survey of Health, Ageing and Retirement in Europe to monitor the life satisfaction of respondents who retire in between two waves. We portray wellbeing scores before and after retirement and then identify the change in life satisfaction during the retirement transition using a First Difference model. Results indicate that being unemployed before retirement is associated with an increase in life satisfaction, but presents mainly a catching-up effect compared to employed persons transitioning to retirement. These results are still significant if we control for selection into unemployment and country differences. Retirement from labour market inactivity does not lead to significant changes in wellbeing. As the wellbeing of unemployed persons recovers after transitioning to retirement, especially the currently unemployed population should be supported to prevent detrimental consequences of economically unfavourable conditions and lower wellbeing. [ABSTRACT FROM AUTHOR]

Objective: Workers approaching retirement may be particularly vulnerable to economic downturns. This study assesses whether exposure to economic downturns around retirement age leads to poorer cognitive function in later life. Method: Longitudinal data for 13,577 individuals in the Health and Retirement Study were linked to unemployment rates in state of residence. Random- and fixed-effect models were used to examine whether downturns at 55-64 years of age were associated with cognitive functioning levels and decline at ≥65 years, measured by the Wechsler Adult Intelligence Scale-Revised. Results: Longer exposure to downturns at 55-64 years of age was associated with lower levels of cognitive function at ≥65 years. Compared to individuals experiencing only up to 1 year in a downturn at 55-64 years of age, individuals experiencing two downturns at these ages had 0.09 point (95% Confidence Interval [CI, -0.17, -0.02]) lower cognitive functioning scores at ≥65 years (3 years: b = -0.17, 95%CI [-0.29, -0.06]; 4 years: b = -0.14, 95%CI [-0.25, -0.02]; ≥5 years: b = -0.22, 95%CI [-0.38, -0.06]). Downturns at 55-64 years of age were not associated with rates of cognitive decline. Discussion: Exposure to downturns around retirement is associated with a long-lasting decline in cognitive function in later life. Policies mitigating the impact of downturns on older workers may help to maintain cognitive function in later life. [ABSTRACT FROM AUTHOR]

Background: High inequalities in Latin America (LA) affect social groups differently, with women being disadvantaged in many domains. Further, dementia prevalence is higher and with earlier onset in LA, especially among women, after accounting for women's longer life expectancy. This narrative review discusses the modifiable risk factors of dementia established by previous studies and postulates further harmful, often hidden, factors experienced by women that might influence gender‐specific time of onset and general prevalence of dementia. Method: We searched databases for qualitative and quantitative articles systematising dementia‐associated factors between genders/sexes in LA. Result: We review hidden modifiable risk factors for late‐life cognitive impairment that should be integrated into future research. In doing this, we point out pervasive gender roles around education, labour market participation, but also the distribution of resources within families and across generations. Gender roles affect family structure living conditions during childhood and extend their influence over the life course. Other stressors strongly correlated with established modifiable risk factors or intrinsically relevant to dementia risk seem to be commonplace in women's lives in LA, such as food insecurity, overweight/obesity, violence, and limited career opportunities. Conclusion: Based on the evidence of gender inequalities in many domains to the disadvantage of women in LA, there is a need to consider unexplored risk factors since they could perpetuate burden of dementia among women disproportionately. Moreover, bringing hidden risk factors to open discussion can encourage and promote public policies to decrease gender inequalities and protect women's health and well‐being. [ABSTRACT FROM AUTHOR]

Birth cohort effects in suicide rates are well established, but to date there is no methodological approach or framework to test the temporal stability of these effects. We use the APC-Detrended (APCD) model to robustly estimate intensity of cohort effects identifying non-linear trends (or ‘detrended’ fluctuations) in suicide rates. The new APC-Hysteresis (APCH) model tests temporal stability of cohort effects. Analysing suicide rates in 25 WHO countries (periods 1970–74 to 2005–09; ages 20–24 to 70–79) with the APCD method, we find that country-specific birth cohort membership plays an important role in suicide rates. Among 25 countries, we detect 12 nations that show deep contrasts among cohort-specific suicide rates including Italy, Australia and the United States. The APCH method shows that cohort fluctuations are not stable across the life course but decline in Spain, France and Australia, whereas they remain stable in Italy, the United Kingdom and the Netherlands. We discuss the Spanish case with elevated suicide mortality of cohorts born 1965–1975 which declines with age, and the opposite case of the United States, where the identified cohort effects of those born around 1960 increase smoothly, but statistically significant across the life course. [ABSTRACT FROM AUTHOR]

Background: Health inequalities reflect multidimensional inequality (income, education, and other indicators of socioeconomic position) and vary across countries and welfare regimes. To which extent there is intergenerational transmission of health via parental socioeconomic status has rarely been investigated in comparative perspective. The study sought to explore if different measures of stratification produce the same health gradient and to which extent health gradients of income and of social origins vary with level of living and income inequality. Methods: A total of 299,770 observations were available from 18 countries assessed in EU-SILC 2005 and 2011 data, which contain information on social origins. Income inequality (Gini) and level of living were calculated from EU- SILC. Logit rank transformation provided normalized inequalities and distributions of income and social origins up to the extremes of the distribution and was used to investigate net comparable health gradients in detail. Multilevel random-slope models were run to post-estimate best linear unbiased predictors (BLUPs) and related standard deviations of residual intercepts (median health) and slopes (income-health gradients) per country and survey year. Results: Health gradients varied across different measures of stratification, with origins and income producing significant slopes after controls. Income inequality was associated with worse average health, but income inequality and steepness of the health gradient were only marginally associated. Conclusions: Linear health gradients suggest gains in health per rank of income and of origins even at the very extremes of the distribution. Intergenerational transmission of status gains in importance in countries with higher income inequality. Countries differ in the association of income inequality and income-related health gradient, and low income inequality may mask health problems of vulnerable individuals with low status. Not only income inequality, but other country characteristics such as familial orientation play a considerable role in explaining steepness of the health gradient. [ABSTRACT FROM AUTHOR]