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INTRODUCTION: There is limited evidence about factors related to the timeliness of dementia diagnosis in healthcare settings. METHODS: In five prospective cohorts at Rush Alzheimer's Disease Center, we identified participants with incident dementia based on annual assessments and examined the timing of healthcare diagnoses in Medicare claims. We assessed sociodemographic, health, and psychosocial correlates of timely diagnosis. RESULTS: Of 710 participants, 385 (or 54%) received a timely claims diagnosis within 3 years prior to or 1 year following dementia onset. In logistic regressions accounting for demographics, we found Black participants (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.21 to 3.82) and those with better cognition at dementia onset (OR = 1.48, 95% CI: 1.10 to 1.98) were at higher odds of experiencing a diagnostic delay, whereas participants with higher income (OR = 0.89, 95% CI: 0.81 to 0.97) and more comorbidities (OR = 0.94, 95% CI: 0.89 to 0.98) had lower odds. DISCUSSION: We identified characteristics of individuals who may miss the optimal window for dementia treatment and support. Highlights: We compared the timing of healthcare diagnosis relative to the timing of incident dementia based on rigorous annual evaluation.Older Black adults with lower income, higher cognitive function, and fewer comorbidities were less likely to be diagnosed in a timely manner by the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Many studies indicate that smaller life space is related to worse cognitive and motor function. It is plausible that cognitive and motor function also predict life space constriction, thus long‐term, prospective studies are needed of cognitive and motor function as predictors of life space. Methods: A total of 1246 participants of the Rush Memory and Aging Project, who reported initial maximal life space and at least one follow‐up assessment were included in this prospective study, with up to 19 years follow‐up. The outcome of interest was the Modified version of the Life Space Questionnaire; which we categorized into large (beyond community), medium (neighborhood/community), and small (home/yard) life space. Participants also had detailed composite measures of global cognition and motor function as predictors and available at the first life space assessment. Life space transitions over one‐year periods were modeled using multistate Markov modeling, including confounders and both predictors simultaneously. Results: Better cognitive and motor function were broadly associated with lower odds of life space constriction (Cognitive: Large ➔ medium: OR = 0.91, 95% CI 0.83–1.00; Large ➔ small: OR = 0.85, 95% CI 0.74–0.97; Medium ➔ small: OR = 1.01, 95% CI 0.82–1.22. Motor: large ➔ medium: OR = 0.76, 95% CI 0.69–0.83; large ➔ small: OR = 0.58, 95% CI 0.51–0.67; medium ➔ small: OR = 0.71, 95% CI = 0.57–0.87). Conclusions: Combined with previous literature that life space predicts function, these results support the notion of complex inter‐relations of cognitive function, motor function, and life space. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive resilience (CR) can be defined as the continuum of better through worse than expected cognition, given the degree of neuropathology. The relation of healthy diet patterns to CR remains to be elucidated. Methods: Using longitudinal cognitive data and post mortem neuropathology from 578 deceased older adults, we examined associations between the Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) diet at baseline and two standardized CR measures reflecting higher cognitive levels over time (CRLevel¯$_{\overline {{\rm{Level}}}} $), and slower decline (CRSlope), than expected given neuropathology. Results: Compared to individuals in the lowest tertile of MIND score, those in the top tertile had higher CRLevel¯$_{\overline {{\rm{Level}}}} $ (mean difference [MD] = 0.34; 95% confidence interval [CI] = 0.14, 0.55) and CRSlope (MD = 0.27; 95% CI = 0.05, 0.48), after multivariable adjustment. Overall MIND score was more strongly related to CR than the individual food components. Discussion: The MIND diet is associated with both higher cognition and slower rates of cognitive decline, after controlling for neuropathology, indicating the MIND diet may be important to cognitive resilience. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive resilience (CR) has been defined as the continuum of better (or worse) than expected cognition, given the degree of neuropathology. To quantify this concept, existing approaches focus on either cognitive level at a single time point or slopes of cognitive decline. Methods: In a prospective study of 1215 participants, we created a continuous measure of CR defined as the mean of differences between estimated person‐specific and marginal cognitive levels over time, after accounting for neuropathologies. Results: Neuroticism and depressive symptoms were associated with all CR measures (P‐values <.012); as expected, cognitive activity and education were only associated with the cognitive‐level approaches (P‐values <.0002). However, compared with the existing CR measures focusing on a single measure or slopes of cognition, our new measure yielded stronger relations with risk factors. Discussion: Defining CR based on the longitudinal differences between person‐specific and marginal cognitive levels is a novel and complementary way to quantify CR. [ABSTRACT FROM AUTHOR]

Background: Research has suggested optimism is associated with healthy aging and exceptional longevity, but most studies were conducted among non‐Hispanic White populations. We examined associations of optimism to longevity across racial and ethnic groups and assessed healthy lifestyle as a possible mediating pathway. Methods: Participants from the Women's Health Initiative (N = 159,255) completed a validated measure of optimism and provided other demographic and health data at baseline. We evaluated associations of optimism with increments in lifespan using accelerated failure time models, and with likelihood of exceptional longevity (survival to age ≥90) using Poisson regression models. Causal mediation analysis explored whether lifestyle‐related factors mediated optimism‐lifespan associations. Results: After covariate adjustment, the highest versus lowest optimism quartile was associated with 5.4% (95% confidence interval [CI] = 4.5, 6.4%) longer lifespan. Within racial and ethnic subgroups, these estimates were 5.1% (95%CI = 4.0, 6.1%) in non‐Hispanic White, 7.6% (95%CI = 3.6, 11.7%) in Black, 5.4% (95%CI = −0.1, 11.2%) in Hispanic/Latina, and 1.5% (95% CI = −5.0, 8.5) in Asian women. A high proportion (53%) of the women achieved exceptional longevity. Participants in the highest versus lowest optimism quartile had greater likelihood of achieving exceptional longevity (e.g., full sample risk ratio = 1.1, 95%CI = 1.1, 1.1). Lifestyle mediated 24% of the optimism‐lifespan association in the full sample, 25% in non‐Hispanic White, 10% in Black, 24% in Hispanic/Latina, and 43% in Asian women. Conclusions: Higher optimism was associated with longer lifespan and a greater likelihood of achieving exceptional longevity overall and across racial and ethnic groups. The contribution of lifestyle to these associations was modest. Optimism may promote health and longevity in diverse racial and ethnic groups. Future research should investigate these associations in less long‐lived populations. See related Editorial by Cobert et al. and article by Jeffrey M. Levine in this issue. [ABSTRACT FROM AUTHOR]

Introduction:: Few large, randomized trials have evaluated marine n-3 supplements and cognition in healthy older adults. Methods:: Healthy community-dwelling participants aged 60+ years (mean [standard deviation] = 70.9 [5.8] years) in VITAL (randomized trial of n-3 fats [1 g/day, including 840 mg of eicosapentaenoic acid + docosahexaenoic acid] and vitamin D) were included: 3424 whose cognition was assessed by phone (VITAL-Cog; eight neuropsychological tests; 2.8 years) and 794 evaluated in person (CTSC-Cog; nine tests; 2.0 years). The primary outcome was a global score (average of test z-scores) of change over two assessments. We used multivariable-adjusted linearmixed models; substudyspecific results weremeta-analyzed. Results: :We observed no significant effect of n-3 supplementation: the mean difference in annual rate of cognitive change for the n-3 versus placebo group was -0.01 standard units (95% confidence interval [CI]: -0.02, 0.003) in VITAL-Cog and -0.002 (95% CI: -0.04, 0.03) in CTSC-Cog; the pooled difference was -0.01 (95% CI: -0.02, 0.003; P = .15). Discussion:: Marine n-3 supplementation (1 g/day) did not confer cognitive benefits over 2 to 3 years in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Background: Bowel movement frequency and the gut microbiome may be associated with the risk of dementia. Method: We examined the association between bowel movement frequency and cognitive function in 112,753 women and men from Nurses' Health Study (NHS), Nurses' Health Study II (NHSII), and Health Professionals Follow‐Up Study (HPFS) and explored the role of the gut microbiome in explaining these associations in a sub‐cohort of 515 NHSII and HPFS participants. We collected data on bowel movement frequency in 2012/13 and subjective cognitive function from 2014 to 2017 in all participants and objective cognitive function using a neuropsychological battery between 2014 and 2018 in 12,696 NHSII participants. We profiled the gut microbiome using shotgun metagenomics. Result: Bowel movement frequency was associated with overall objective cognitive function and learning and working memory in an inverse J‐shape dose‐response manner (both Pnon‐linearity<0.05). Compared to those with once daily bowel movements, participants with bowel movement frequency of every 3+ days had significantly worse cognition, equivalent to 3.0 (95% confidence interval (CI),1.2, 4.7) years of additional aging. We observed similar J‐shape dose‐response relationships of bowel movement frequency with the odds of subjective cognitive decline and the likelihood of having more subjective cognitive complaints over time. Bowel movement frequencies of every 3+ days and ≥twice /day, compared to once daily bowel movement, were associated with odds ratios of subjective cognitive decline of 1.73 (95% CI, 1.60, 1.86) and 1.37 (95% CI, 1.33, 1.44), respectively. These relationships were generally consistent across three cohorts and subgroups. Bowel movement frequency and subjective cognition were significantly associated with the overall variation of the gut microbiome (both P <0.005) and specific microbial species. Butyrate producers were depleted in those with less frequent bowel movements and worse cognitive function, while a higher abundance of dysbiosis‐related, pro‐inflammatory species was associated with bowel movement frequency of ≥twice/day and worse cognitive function. Conclusion: Less frequent bowel movements were associated with worse cognitive function. The gut microbiome may be a mechanistic link underlying the association between intestinal motility patterns and cognitive function. [ABSTRACT FROM AUTHOR]

Background: Previous research reported associations between more social engagement and better cognitive health. Social engagement is a multidimensional construct encompassing interrelated but distinct domains such as social activity, social network size, perceived social support, and loneliness. These domains are not equally amenable to interventions. We therefore focused on late‐life social activity, as a potentially modifiable facet of social engagement, and examined its relation to risks of dementia and MCI, independent of other aspects of social engagement, lifestyle, and health. Method: In the Rush Memory and Aging Project (MAP), 1923 older adults without dementia at baseline were followed longitudinally, with annual clinical evaluation of dementia and MCI. The frequency of participation in six common social activities was assessed by a validated scale at baseline (mean = 2.6, range: 1‐4.3), as were size of social network, perceived social support, and perceived loneliness. A clinical diagnosis of MCI or dementia was rendered annually based on cognitive tests and diagnostic classification by a clinician. We used Cox proportional hazard models to quantify associations between social activity score and incident dementia or MCI. Primary models controlled for demographics; additional models included covariates for health, other social engagement indicators, and income. In secondary analyses, to consider reverse causality, we excluded participants who developed MCI or dementia within two years after baseline. Result: During a mean follow‐up of 6.7 (std = 4.7) years, 545 (28%) participants developed dementia, and 695 (49% of those without MCI at baseline) developed MCI. Each one‐unit increment in social activity score was associated with a 37% reduction in dementia risk [HR = 0.63, 95% CI: 0.53‐0.74] after adjusting for age, sex, education, race/ethnicity, and marital status (Figure 1A). Social activity was also related to a lower risk of MCI [HR = 0.77, 95% CI: 0.66‐0.89] (Figure 1B). Results were not meaningfully different after adjusting for vascular disease burden, BMI, ADL disability, physical activity, depressive symtoms, social network size, social support, social isolation, and income. Excluding participants who developed MCI or dementia soon after baseline did not change the patterns. Conclusion: Keeping socially active at older age is related to lower dementia risk, possibly informing strategies for developing preventive interventions. [ABSTRACT FROM AUTHOR]

Background: Although numerous studies report an association between loneliness and social resources with cognitive decline and dementia risk, the underlying pathways remain to be explored. Thus, we investigated two possible pathways: an association of loneliness and social resources with (i) neuropathology and (ii) with cognitive resilience to neuropathology. Method: We examined 792 decedents from the Rush Memory and Aging Project, free of dementia at their initial report of the psychosocial risk factors of interest (loneliness, social activity, social support, social network size); all eligible participants completed ≥2 cognitive evaluations and had a postmortem neuropathology evaluation. First, we examined the associations between each psychosocial factor and nine neurodegenerative and vascular neuropathologies, using linear or logistic regression models. Second, we assessed the associations between each psychosocial factor and two cognitive resilience (CR) measures. The measures quantify how late‐life cognitive levels (CR) and cognitive decline (CRSlope) differ from what is expected, given the profile of neuropathology. All models controlled for sex, education, age at death, and medical comorbidities. Result: We found few associations between each psychosocial factor and all nine individual neuropathologies; for example, greater loneliness was not associated with higher global AD pathology (estimated mean difference [MD] for each one‐unit increment in loneliness score = 0.002, 95%CI = ‐0.07,0.07, P =.9), while more social engagement was associated with less global AD pathology (social activity: MD = ‐0.03, 95%CI = ‐0.11,0.05, P =.5; social support: MD = 0.05, 95%CI = ‐0.02,0.11, P =.2). However, we found strong associations between higher degree of loneliness with worse CR (MD = ‐0.25, 95%CI = ‐0.37,‐0.14, P<.0001) and CRSlope (MD = ‐0.23, 95%CI = ‐0.34,‐0.11, P =.0002). In addition, greater participation in social activities was associated with better CR (MD = 0.24, 95%CI = 0.12,0.36, P =.0001) and CRSlope (MD = 0.13, 95%CI = 0.01,0.25, P =.04). There was no relationship between social support or social network and CR. Conclusion: These findings suggest that loneliness and social activity in late life are not directly associated with the accumulation of neuropathologies but may be associated with resilience to neuropathologies. [ABSTRACT FROM AUTHOR]

Introduction: We investigated the relation between self‐reported hearing loss and risk of subjective cognitive function (SCF) decline among women. Methods: We conducted a longitudinal study of 20,193 women in the Nurses' Health Study aged ≥66 years who reported their hearing status and had no subjective cognitive concerns in 2012. SCF scores were assessed by a 7‐item questionnaire in 2012 and 2014. SCF decline was defined as a new report of at least one cognitive concern during follow‐up. Results: Self‐reported hearing loss was associated with higher risk of SCF decline. Compared with women with no hearing loss, the multivariable‐adjusted odds ratios (95% confidence interval) for incident SCF score ≥1 were 1.35 (1.25, 1.47), 1.39 (1.24, 1.56), and 1.40 (1.21, 1.75) among women with mild, moderate, and severe hearing loss, respectively. Recent progression of hearing loss was associated with even higher risk. Discussion: Self‐reported hearing loss was associated with higher risk of incident subjective cognitive function decline in women. [ABSTRACT FROM AUTHOR]

Background: The Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) diet is a hybrid of the Mediterranean and DASH diets, with added foods designed to target brain health. Observational studies demonstrate inverse relations with cognitive decline but clinical trial evidence is lacking. Method: We assigned at random 604 older adults without cognitive impairment, a family history of dementia, BMI>25, and a MIND diet score ≤8 on a 14‐item screener, to the MIND diet or placebo (usual diet) for three years (January 2017 ‐ June 2021); all participants received diet counseling for weight loss, monthly cooking sessions, and other support over 3 years. Cognition was assessed with a 12‐test battery from which a measure of global cognition was derived. The trial was interrupted due to the COVID‐19 global pandemic and analyses were conducted to account for the interruption. Using random effects analyses we assessed rate of cognitive decline from baseline to trial close in each group, both pre‐ and post‐COVID. Result: Overall, 564 participants (93%) completed the trial. In an intent‐to‐treat analysis, those assigned to MIND diet maintained better global cognition compared to placebo control (difference in standard units = 0.015 per year, 95% CI: ‐0.005, 0.034); findings were borderline significant. To help interpret findings, the effect estimate was equivalent to being 4.3 years younger in age for this sample population. Pre‐pandemic, we observed a significant, positive effect of MIND on change in cognition over two years compared to placebo/usual diet (beta = 0.026, 95% CI: 0.001, 0.052). Conclusion: Over three years, the MIND diet was beneficial for cognition compared to usual diet, although results were not formally statistically significant. However, there was evidence of a statistically significant effect of the MIND diet before the start of the COVID‐19 pandemic, which impeded the intervention protocol and outcome ascertainment. [ABSTRACT FROM AUTHOR]

OBJECTIVES: As key team members caring for people with advanced illness, nurses teach patients and families about managing their illnesses and help them to understand their options. Our objective was to determine if nurses' personal healthcare experience with serious illness and end‐of‐life (EOL) care differs from the general population as was shown for physicians. DESIGN: Observational propensity‐matched cohort study. SETTING: Fee‐for‐service Medicare. PARTICIPANTS: Nurses' Health Study (NHS) and a random 20% national sample of Medicare beneficiaries aged 66 years or older with Alzheimer's disease and related dementias (ADRD) or congestive heart failure (CHF) diagnosed in the hospital. MEASUREMENTS: Characteristics of care during the first year after diagnosis and the last 6 months of life (EOL). RESULTS: Among 57 660 NHS participants, 7380 had ADRD and 5375 had CHF; 3227 ADRD patients and 2899 CHF patients subsequently died. Care patterns in the first year were similar for NHS participants and the matched national sample: hospitalization rates, emergency visits, and preventable hospitalizations were no different in either disease. Ambulatory visits were slightly higher for NHS participants than the national sample with ADRD (13.1 vs 12.5 visits; P < .01) and with CHF (13.7 vs 12.5; P < .001). Decedents in the NHS and national sample had similar acute care use (hospitalization and emergency visits) in both diseases, but those with ADRD were less likely to use life‐prolonging treatments such as mechanical ventilation (10.9% vs 13.5%; P = .001), less likely to die in a hospital with a stay in the intensive care unit (10.4% vs 12.1%; P = .03), and more likely to use hospice (58.9% vs 54.8%; P < .001). CHF at the EOL results were similar. CONCLUSIONS: Nurses with newly identified serious illness experience similar care as the general Medicare population. However, at EOL, nurses are more likely to choose less aggressive treatments than the patients for whom they care. J Am Geriatr Soc 67:1582–1589, 2019 See related editorial by Matlock and Fischer. [ABSTRACT FROM AUTHOR]

Introduction: We examined the relation between self‐reported hearing loss, hearing aid use, and risk of subjective cognitive function (SCF) decline. Methods: We conducted an 8‐year (2008–2016) longitudinal study of 10,107 men aged ≥62 years who reported their hearing status in 2006 and had no subjective cognitive concerns in 2008. Change in SCF scores was assessed by a 6‐item questionnaire, and subjective decline was defined as new report of at least one SCF concern during follow‐up. Results: Hearing loss was associated with higher risk of SCF decline. Compared with no hearing loss, the multivariable‐adjusted relative risk (95% CI) of incident SCF decline was 1.30 (1.18, 1.42), 1.42 (1.26, 1.61), and 1.54 (1.22, 1.96) among men with mild, moderate, and severe hearing loss (no hearing aids), respectively (P‐trend <.001). Among men with severe hearing loss who used hearing aids, the multivariable‐adjusted relative risk (95% CI) was 1.37 (1.18, 1.60). Discussion: Hearing loss was associated with substantially higher risk of subsequent subjective cognitive decline in men. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Relatively little is known regarding predictors of advance care planning (ACP) in former nurses. We aimed to evaluate potential predictors of ACP documentation and discussion. DESIGN: Cross‐sectional study, 2012‐2014. SETTING: Nurses' Health Study. PARTICIPANTS: A total of 60,917 community‐dwelling female nurses aged 66 to 93 years living across the United States. MEASUREMENTS: Based on self‐reports, participants were categorized as having (1) only ACP documentation, (2) ACP documentation and a recent ACP discussion with a healthcare provider, or (3) neither. Multivariable log‐binomial models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of the two separate ACP categories vs those with neither. We evaluated various demographic, health, and social factors. RESULTS: The large majority (84%) reported ACP documentation; 35% reported a recent ACP discussion. Demographic factors such as age and race were associated with both ACP categories. In multivariable analyses, race was most strongly associated: compared with whites, African Americans were 27% less likely (PR = 0.73; 95% CI = 0.69‐0.78) to report ACP documentation alone and 41% (PR = 0.59; 95% CI = 0.54‐0.66) less likely to report documentation with discussion. Additionally, health/healthcare‐related characteristics were more strongly associated with ACP documentation plus discussion. Women with functional limitations (PR = 1.15; 95% CI = 1.10‐1.20), women who were recently hospitalized (PR: 1.10; 95% CI = 1.08‐1.12) or women who had seen a physician for health symptoms (PR = 1.43; 95% CI = 1.35‐1.52) or screening (PR = 1.40; 95% CI = 1.32‐1.49) were more likely to report having both ACP documentation and discussion. Social factors showed limited relationships with ACP documentation only; for documentation plus discussion, being widowed and living alone was associated with higher prevalence (PR = 1.21; 95% CI = 1.19‐1.24) and having little emotional support was associated with lower prevalence (PR = 0.84; 95% CI = 0.81‐0.86). CONCLUSIONS: Among older nurses, most of whom reported having documented ACP, 35% reported recent patient‐clinician ACP discussions, indicating a major participatory gap in an element critical to ACP effectiveness. Even in nurses, African Americans reported less ACP documentation or discussion. J Am Geriatr Soc 67:292–301, 2019. [ABSTRACT FROM AUTHOR]

Background: Depression frequently co-occurs with cognitive decline, but the nature of this association is unclear. We examined relations of late-life depressive symptom patterns to subsequent domain-specific cognitive changes.Methods: Depressive symptoms were measured at up to 3 timepoints among 11,675 Nurses' Health Study participants prior to cognitive testing. Depressive symptom patterns were categorized as non-depressed, variable or persistent, based on published severity cutpoints. Outcomes were global, verbal, and executive function-attention composite scores.Results: Participants with persistent depressive symptoms had worse executive function-attention decline compared with non-depressed participants (multivariable-adjusted mean difference = -0.03 units/year, 95% CI: -0.05, -0.01; p = 0.003); this difference was comparable with 8 years of aging. However, being in the persistent versus non-depressed group was not significantly related to verbal (p = 0.71) or global score (p = 0.09) decline. By contrast, compared with the non-depressed group, those with variable depressive symptoms had worse verbal memory decline (multivariable-adjusted mean difference = -0.01 units/year, 95% CI: -0.02, -0.002; p = 0.03); this group showed no differences for global or executive function-attention decline.Conclusions: A variable pattern of depressive symptom severity related to subsequent decline in verbal memory, while a persistent pattern related to decline in executive function-attention. Findings could signal differences in underlying neuropathologic processes among persons with differing depression patterns and late-life cognitive decline. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction We examined the relationship between health care expenditures and cognition, focusing on differences across cognitive systems defined by global cognition, executive function, or episodic memory. Methods We used linear regression models to compare annual health expenditures by cognitive status in 8125 Nurses' Health Study participants who completed a cognitive battery and were enrolled in Medicare parts A and B. Results Adjusting for demographics and comorbidity, executive impairment was associated with higher total annual expenditures of $1488 per person ( P < .01) compared with those without impairment. No association for episodic memory impairment was found. Expenditures exhibited a linear relationship with executive function, but not episodic memory ($584 higher for every 1 standard deviation decrement in executive function; P < .01). Discussion Impairment in executive function is specifically and linearly associated with higher health care expenditures. Focusing on management strategies that address early losses in executive function may be effective in reducing costly services. [ABSTRACT FROM AUTHOR]

Background: Critical illness and intensive care unit (ICU) hospitalization in older patients have been shown to increase risk of long‐term cognitive impairment. However, most data come from patients recruited from the ICU without controls or information on pre‐ICU cognition. We are not aware of a community‐based sample that allows examination of how ICU hospitalization changes risk for dementia. Method: We used data from 5 diverse epidemiologic cohorts at the Rush Alzheimer's Disease Center (RADC) linked to Medicare claims data from 1991 to 2018 to observe ICU hospitalizations (both prior to RADC enrollment and during RADC follow‐up) in older adults enrolled without known dementia. Incident Alzheimer's and all type dementia was assessed using standardized annual cognitive assessment. The association of ICU hospitalization with incident dementia was tested in a time‐varying Cox model allowing hazard rate to change at time of ICU hospitalization during follow‐up. All models were adjusted for age, sex, education, and race. Fully adjusted models also included terms for baseline measures of hypertension, diabetes, BMI, vascular risk factors, vascular disease burden, other chronic medical conditions, functional disabilities, depression, and physical activity. Result: Participants (n = 3,822; mean age = 77.3, SD = 7.5) were followed for an average of 7.8 years (SD = 5.5) from study enrollment. ICU hospitalization was experienced by 1,992 (52.1%) of participants; 1031 (27.0%) before RADC enrollment, and 961 (25.1%) during follow‐up. In models adjusted for demographics, ICU hospitalization was associated with an increased risk of Alzheimer's (HR = 1.63, 95% CI = 1.41, 1.88) and all type dementia (HR = 1.71, 95% CI = 1.48, 1.97). In fully adjusted models, the association was stronger with ICU associated with double the risk of Alzheimer's (HR = 2.10, 95% CI = 1.66, 2.65) and all type dementia (HR = 2.20, 95% CI = 1.75, 2.77). Conclusion: We found that ICU hospitalization was associated with double the risk of dementia in community‐based older adults compared to those who did not experience ICU hospitalization using standardized annual cognitive assessment. These findings could be significant given the high rate of ICU hospitalization in older persons, and rising ICU hospitalizations more recently during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction We examined the association between endogenous sex hormones and both objective and subjective measures of cognitive function. Methods We followed 3044 women up to 23 years in a prospective cohort study. We measured plasma levels of estrone, estrone sulfate, estradiol, androstenedione, testosterone, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S) in 1989–1990, conducted neuropsychologic testing in 1999–2008, and inquired about subjective cognition in 2012. Results Overall, we observed little relation between plasma levels of hormones and either neuropsychologic test performance or subjective cognition. However, after adjustment for age and education, we observed a borderline significant association of higher levels of plasma estrone with higher scores for both overall cognition ( P trend = .10) and verbal memory ( P trend = .08). Discussion There were no clear associations of endogenous hormone levels at midlife and cognition in later life, although a suggested finding of higher levels of plasma estrone associated with better cognitive function merits further research. [ABSTRACT FROM AUTHOR]

Objectives To evaluate and compare the associations between microvascular and macrovascular abnormalities and cognitive and physical function Design Cross-sectional analysis of the Cardiovascular Health Study (1998-1999). Setting Community. Participants Individuals with available data on three or more of five microvascular abnormalities (brain, retina, kidney) and three or more of six macrovascular abnormalities (brain, carotid artery, heart, peripheral artery) (N = 2,452; mean age 79.5). Measurements Standardized composite scores derived from three cognitive tests (Modified Mini-Mental State Examination, Digit-Symbol Substitution Test, Trail-Making Test ( TMT)) and three physical tests (gait speed, grip strength, 5-time sit to stand) Results Participants with high microvascular and macrovascular burden had worse cognitive (mean score difference = −0.30, 95% confidence interval ( CI) = −0.37 to −0.24) and physical (mean score difference = −0.32, 95% CI = −0.38 to −0.26) function than those with low microvascular and macrovascular burden. Individuals with high microvascular burden alone had similarly lower scores than those with high macrovascular burden alone (cognitive function: −0.16, 95% CI = −0.24 to −0.08 vs −0.13, 95% CI = −0.20 to −0.06; physical function: −0.15, 95% CI = −0.22 to −0.08 vs −0.12, 95% CI = −0.18 to −0.06). Psychomotor speed and working memory, assessed using the TMT, were only impaired in the presence of high microvascular burden. Of the 11 vascular abnormalities considered, white matter hyperintensity, cystatin C-based glomerular filtration rate, large brain infarct, and ankle-arm index were independently associated with cognitive and physical function. Conclusion Microvascular and macrovascular abnormalities assessed using noninvasive tests of the brain, kidney, and peripheral artery were independently associated with poor cognitive and physical function in older adults. Future research should evaluate the usefulness of these tests in prognostication. [ABSTRACT FROM AUTHOR]

Background Dementia or other significant cognitive impairment (SCI) are often comorbid with other chronic diseases. To promote collaborative research on the intersection of these conditions, we compiled a systematic inventory of major data resources. Methods Large data sets measuring dementia and/or cognition and chronic conditions in adults were included in the inventory. Key features of the resources were abstracted including region, participant sociodemographic characteristics, study design, sample size, accessibility, and available measures of dementia and/or cognition and comorbidities. Results 117 study data sets were identified; 53% included clinical diagnoses of dementia along with valid and reliable measures of cognition. Most (79%) used longitudinal cohort designs and 41% had sample sizes greater than 5000. Approximately 47% were European-based, 40% were US-based, and 11% were based in other countries. Conclusions Many high-quality data sets exist to support collaborative studies of the effects of dementia or SCI on chronic conditions and to inform the development of evidence-based disease management programs. [ABSTRACT FROM AUTHOR]

Objectives To evaluate associations between sleep duration at midlife and later life and change in sleep duration over time and cognition in older women. Design Participants reported sleep duration in 1986 and 2000, and a subgroup of older participants began cognitive testing in 1995 to 2001; follow-up testing was conducted three times, at 2-year intervals. Setting Prospective Nurses' Health Study cohort. Participants Female nurses aged 70 and older free of stroke and depression at the initial cognitive assessment (N = 15,385). Measurements Validated, telephone-based cognitive battery to measure cognitive function; four repeated assessments over 6 years were averaged to estimate overall cognition at older ages, and trajectories of cognitive change were evaluated over follow up. Results Extreme sleep durations in later life were associated with worse average cognition ( P < .001 for the quadratic term for a global score averaging all six cognitive tests). For example, women sleeping 5 h/d or less had worse global cognition than those sleeping 7 h/d, as did women sleeping 9 h/d or more; differences were equivalent to nearly 2 additional years of age. Associations were similar, although slightly attenuated, for sleep duration in midlife. Women whose sleep duration changed by 2 h/d or more over time had worse cognition than women with no change in sleep duration (e.g., for the global score, P < .001 for the quadratic term). Sleep duration was not associated with trajectories of cognitive function over 6 years, which might be attributable to short follow-up for detecting cognitive decline. Conclusion Extreme sleep durations at midlife and later life and extreme changes in sleep duration over time appear to be associated with poor cognition in older women. [ABSTRACT FROM AUTHOR]

Objective The prediction of successful aging by midlife body mass index (BMI) and waist circumference (WC) was examined. Methods BMI/WC were assessed in 4869 persons (mean age 51.2, range 42-63 in 1991/1993) and survival and successful aging (alive, no chronic disease at age >60 years, not in the worst age- and sex-standardized quintile of cognitive, physical, respiratory,cardiovascular, and mental health) ascertained over a 16-year follow-up, analyzed using logistic regression adjusted for sociodemographic factors and health behaviors. Results 507 participants died, 1008 met the criteria for successful aging. Those with BMI ≥ 30 kg/m2 had lower odds of successful aging (odds ratio or OR) = 0.37; 95% confidence interval or CI: 0.27, 0.50) and survival (OR = 0.55; 95% CI: 0.41, 0.74) compared to BMI between 18.5 and 25 kg/m2. Those with a large WC (≥102/88 cm in men/women) had lower odds of successful aging (OR = 0.41; 95% CI: 0.31, 0.54) and survival (OR = 0.57; 95% CI: 0.44, 0.73) compared with those with a small waist (<94/80 cm in men/women). Analysis with finer categories showed lower odds of successful aging starting at BMI ≥ 23.5 kg/m2 and WC 82/68 cm in men/women. Conclusions Optimal midlife BMI and WC for successful aging might be substantially below the current thresholds used to define obesity. [ABSTRACT FROM AUTHOR]

Abstract: Alzheimer's disease is the public health crisis of the 21st century. There is a clear need for a widely available, inexpensive and reliable method to diagnosis Alzheimer's disease in the earliest stages, track disease progression, and accelerate clinical development of new therapeutics. One avenue of research being explored is blood based biomarkers. In April 2012, the Alzheimer's Association and the Alzheimer's Drug Discovery Foundation convened top scientists from around the world to discuss the state of blood based biomarker development. This manuscript summarizes the meeting and the resultant discussion, including potential next steps to move this area of research forward. [Copyright &y& Elsevier]

Background: Life‐long exposures constitute a primary focus of research on the etiology of many chronic diseases. Yet, identifying the critical windows when risk factors mostly impact the risk of disease remains an open statistical question. Some methods have already been proposed to assess the effect of a time‐varying exposure history. However, research mostly focused on a continuously observed error‐free exposure, a binary or time‐to‐event outcome and a concomitant evaluation of exposure and outcome. Method: We jointly model the trajectory of the exposure over time and its weighted cumulative effect on the subsequent trajectory of the outcome. As we consider separate time‐windows for the exposure and the outcome, inference can be obtained with a two‐stage approach. Subject‐specific predictions of exposure are computed from a flexible mixed model in stage 1, thus handling missing data and error in exposure measurement. In stage 2, weighted time‐dependent effects (modelled by splines) of these predicted exposures are included in the mixed model for the outcome. The method, which was evaluated in simulations, can be easily implemented in standard statistical software (see Figure). Result: We studied the association between body mass index (BMI) history (collected from midlife) and cognition (evaluated after age 70) in the Nurses' Health Study cohort. In a sample of 19,415 women, the method identified two major critical windows of association. Long before the first cognitive evaluation (roughly 24 to 12 years), higher levels of BMI were associated with poorer cognition. In contrast, adjusted for the whole history, higher levels of BMI became associated with better cognition in the last years prior to the first cognitive interview, thus reflecting reverse causation (changes in exposure due to underlying disease). Conclusion: The proposed joint modelling approach provides a flexible tool to evaluate the trajectory of effect of a time‐varying exposure on a subsequent longitudinal outcome. It is particularly useful to explore complex dynamic relationships, as illustrated with BMI and cognition, and address for various clinical questions by identifying critical windows of lifelong exposures. [ABSTRACT FROM AUTHOR]

Background: We evaluated whether higher cumulative Empirical Dietary Inflammatory Pattern (EDIP) scores were associated lower cognitive function, in the Nurses' Health Study. Method: 16,058 post‐menopausal women (mean age 74 (Standard deviation, 2)) completed a validated 116‐item Food Frequency Questionnaire. The EDIP score, previously derived with the use of reduced rank regression to predict circulating inflammatory markers (i.e. C‐reactive protein, tumor necrosis factor α receptor 2 and interleukin‐6), consists of ten anti‐inflammatory and nine pro‐inflammatory components. A cumulative EDIP score was calculated by averaging across five exams (1984‐1998) taking the first exam (1984) or second exam (1986) as baseline exams. The EDIP score was categorized into five quintiles, taking the first (anti‐inflammatory) quintile as the reference category. Cognitive testing was performed through telephone interviews over four follow up exams (1995‐2008). A composite global cognition score, a composite verbal memory score and the Telephone Interview for Cognitive Status (TICS) were calculated and averaged across the four exams. Result: Higher cumulative EDIP scores (i.e. more pro‐inflammatory) were significantly associated with worse performance on global cognitive function (p for trend <0.01) and TICS (p for trend <0.001) after adjustment for age, education and body mass index, physical activity, energy intake, smoking, multivitamin use, depression. The relationship between higher cumulative EDIP scores and TICS remained (p for trend 0.04) following additional adjustments for hypertension, high cholesterol, myocardial infarction, diabetes, menopausal hormone use and nonsteroidal anti‐inflammatory drugs. But the association between the EDIP score and global cognitive function attenuated and became non‐significant. No association was observed between the EDIP score and verbal memory. Conclusion: Higher cumulative EDIP scores strongly associated with worse performance on averaged TICS regardless of the model among older women. But the relationships between the EDIP score and global cognitive function and verbal memory were mainly explained by potential confounders and intermediates leaving findings attenuated and not significant. Our study shows that pro‐inflammatory diets not only are detrimental for risk factors of cognitive decline but also for cognitive function itself. Future studies are encouraged to investigate the relationships in men and over a long follow up period. [ABSTRACT FROM AUTHOR]

Dementia is an important consequence of Parkinson's disease (PD), with few known modifiable risk factors. Cumulative exposure to lead, at levels experienced in the community, may exacerbate PD-related neural dysfunction, resulting in impaired cognition. Among 101 persons with PD ('cases') and, separately, 50 persons without PD ('controls'), we evaluated cumulative lead exposure, gauged by tibia and patella bone lead concentrations, in relation to cognitive function, assessed using a telephone battery developed and validated in a separate sample of PD patients. We also assessed the interaction between lead and case-control status. After multivariable adjustment, higher tibia bone lead concentration among PD cases was associated with worse performance on all of the individual telephone tests. In particular, tibia lead levels corresponded to significantly worse performance on a telephone analog of the Mini-Mental State Examination and tests of working memory and attention. Moreover, higher tibia bone lead concentration was associated with significantly worse global composite score encompassing all the cognitive tests ( P = 0.04). The magnitude of association per standard deviation increment in tibia bone lead level was equivalent to the difference in global scores among controls in our study, who were approximately 7 years apart in age. The tibia lead-cognition association was notably stronger within cases than within controls ( Pdifference = 0.06). Patella bone lead concentration was not consistently associated with performance on the tests. These data provide evidence suggesting that cumulative exposure to lead may result in worsened cognition among persons with PD. © 2012 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Objective: A study was undertaken to relate dietary fat types to cognitive change in healthy community-based elders. Methods: Among 6,183 older participants in the Women's Health Study, we related intake of major fatty acids (saturated [SFA], monounsaturated [MUFA], total polyunsaturated [PUFA], trans-unsaturated) to late-life cognitive trajectory. Serial cognitive testing, conducted over 4 years, began 5 years after dietary assessment. Primary outcomes were global cognition (averaging tests of general cognition, verbal memory, and semantic fluency) and verbal memory (averaging tests of recall). We used analyses of response profiles and logistic regression to estimate multivariate-adjusted differences in cognitive trajectory and risk of worst cognitive change (worst 10%) by fat intake. Results: Higher SFA intake was associated with worse global cognitive ( p for linear trend = 0.008) and verbal memory ( p for linear trend = 0.01) trajectories. There was a higher risk of worst cognitive change, comparing highest versus lowest SFA quintiles; the multivariate-adjusted odds ratio (OR) with 95% confidence interval (CI) was 1.64 (1.04-2.58) for global cognition and 1.65 (1.04-2.61) for verbal memory. By contrast, higher MUFA intake was related to better global cognitive ( p for linear trend < 0.001) and verbal memory ( p for linear trend = 0.009) trajectories, and lower OR (95% CI) of worst cognitive change in global cognition (0.52 [0.31-0.88]) and verbal memory (0.56 [0.34-0.94]). Total fat, PUFA, and trans-fat intakes were not associated with cognitive trajectory. Interpretation: Higher SFA intake was associated with worse global cognitive and verbal memory trajectories, whereas higher MUFA intake was related to better trajectories. Thus, different consumption levels of the major specific fat types, rather than total fat intake itself, appeared to influence cognitive aging. ANN NEUROL 2012; [ABSTRACT FROM AUTHOR]

Objective: Berries are high in flavonoids, especially anthocyanidins, and improve cognition in experimental studies. We prospectively evaluated whether greater long-term intakes of berries and flavonoids are associated with slower rates of cognitive decline in older women. Methods: Beginning in 1980, a semiquantitative food frequency questionnaire was administered every 4 years to Nurses' Health Study participants. In 1995-2001, we began measuring cognitive function in 16,010 participants, aged ≥70 years; follow-up assessments were conducted twice, at 2-year intervals. To ascertain long-term diet, we averaged dietary variables from 1980 through the initial cognitive interview. Using multivariate-adjusted, mixed linear regression, we estimated mean differences in slopes of cognitive decline by long-term berry and flavonoid intakes. Results: Greater intakes of blueberries and strawberries were associated with slower rates of cognitive decline (eg, for a global score averaging all 6 cognitive tests, for blueberries: p-trend = 0.014 and mean difference = 0.04, 95% confidence interval [CI] = 0.01-0.07, comparing extreme categories of intake; for strawberries: p-trend = 0.022 and mean difference = 0.03, 95% CI = 0.00-0.06, comparing extreme categories of intake), after adjusting for multiple potential confounders. These effect estimates were equivalent to those we found for approximately 1.5 to 2.5 years of age in our cohort, indicating that berry intake appears to delay cognitive aging by up to 2.5 years. Additionally, in further supporting evidence, greater intakes of anthocyanidins and total flavonoids were associated with slower rates of cognitive decline ( p-trends = 0.015 and 0.053, respectively, for the global score). Interpretation: Higher intake of flavonoids, particularly from berries, appears to reduce rates of cognitive decline in older adults. ANN NEUROL 2012 [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the association between the type and number of subjective memory complaints (SMCs) and performance on objective cognitive tests. DESIGN: Cross-sectional. SETTING: Nurses' Health Study. PARTICIPANTS: Sixteen thousand nine hundred sixty-four women (mean age 74) who provided information on SMCs. MEASUREMENTS: Telephone cognitive assessments and seven questions regarding SMCs were administered. Cognitive impairment was defined as a score of less than 31 on the Telephone Interview for Cognitive Status (TICS) and below the 10th percentile on other cognitive measures. To assess associations with SMCs, multivariable logistic regression was used to calculate odds ratios for cognitive impairment and multivariable linear regression to calculate mean differences in cognitive test scores, adjusting for age and depressive symptoms. RESULTS: Some SMCs, such as trouble following a group conversation or finding one's way around familiar streets, were more highly associated than others with odds of cognitive impairment. The complaint of forgetting things from one second to the next, generally considered part of normal aging, was not associated with cognitive impairment. In addition, there were strong, linear trends of increasingly worse scores on cognitive tests with increasing numbers of memory complaints. For each additional SMC endorsed, the odds of cognitive impairment increased approximately 20% when each SMC was weighted equally. CONCLUSION: SMCs are associated with objective cognitive status and may be considered by primary care physicians in determining whether follow-up is warranted. [ABSTRACT FROM AUTHOR]

There is evidence from observational studies that increasing physical activity may reduce the risk of cognitive decline in older adults. Exercise intervention trials have found conflicting results. A systematic review of physical activity and exercise intervention trials on cognition in older adults was conducted. Six scientific databases and reference lists of previous reviews were searched. Thirty studies were eligible for inclusion. Articles were grouped into intervention-outcome pairings. Interventions were grouped as cardiorespiratory, strength, and multicomponent exercises. Cognitive outcomes were general cognition, executive function, memory, reaction time, attention, cognitive processing, visuospatial, and language. An eight-member multidisciplinary panel rated the quality and effectiveness of each pairing. Although there were some positive studies, the panel did not find sufficient evidence that physical activity or exercise improved cognition in older adults. Future research should report exercise adherence, use longer study durations, and determine the clinical relevance of measures used. [ABSTRACT FROM AUTHOR]

Abstract: Dementia of the Alzheimer’s type (DAT) is a major public health threat in developed countries where longevity has been extended to the eighth decade of life. Estimates of prevalence and incidence of DAT vary with what is measured, be it change from a baseline cognitive state or a clinical diagnostic endpoint, such as Alzheimer’s disease. Judgment of what is psychometrically “normal” at the age of 80 years implicitly condones a decline from what is normal at the age of 30. However, because cognitive aging is very heterogeneous, it is reasonable to ask “Is ‘normal for age’ good enough to screen for DAT or its earlier precursors of cognitive impairment?” Cost containment and accessibility of ascertainment methods are enhanced by well-validated and reliable methods such as screening for cognitive impairment by telephone interviews. However, focused assessment of episodic memory, the key symptom associated with DAT, might be more effective at distinguishing normal from abnormal cognitive aging trajectories. Alternatively, the futuristic “Smart Home,” outfitted with unobtrusive sensors and data storage devices, permits the moment-to-moment recording of activities so that changes that constitute risk for DAT can be identified before the emergence of symptoms. [ABSTRACT FROM AUTHOR]

Objective Insulin degradation pathways may be related to Alzheimer's disease pathology. In preliminary analyses, we considered the relation of combined lower insulin secretion (c-peptide) and higher insulin––possibly a phenotype for impaired insulin degradation––to cognitive decline. Method Fasting plasma c-peptide and insulin were measured in 1,187 non-diabetic Nurses' Health Study participants (mean age = 64 years). Cognitive testing began 10 years later. Participants completed three repeated assessments (over an average span of 4.4 years) of verbal memory, a strong predictor of Alzheimer disease development. C-peptide and insulin distributions were dichotomized at their medians to create four cross-tabulated categories. Multivariable linear mixed effects models were used to relate c-peptide/insulin categories to cognitive decline. Results Compared to the lower c-peptide/lower insulin group, women with lower c-peptide/higher insulin had a significantly faster rate of verbal memory decline: the mean difference was -0.05 units/year (95% CI -0.09,-0.01). This mean difference was similar to that which we found for women 5 years apart in age, indicating that having a profile of lower c-peptide/higher insulin appeared cognitively equivalent to aging by five years on tests of verbal memory. For women with higher c-peptide/higher insulin, the estimated mean difference in decline compared to those in the lower c-peptide/lower insulin group was statistically significant, but slightly lower, at -0.04 units/year (95% CI: -0.07,-0.02). Conclusion These preliminary analyses of a possible phenotype of impaired insulin degradation provide supportive evidence that deficits in insulin degradation may be related to late-life verbal memory decline. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the epidemiology of urinary incontinence (UI) in older women. DESIGN: Prospective study. SETTING: Nurses' Health Study. PARTICIPANTS: Incidence of UI was determined in 23,792 women aged 54 to 79 without UI at baseline. Progression or remission of UI was determined in 28,813 women with UI at least monthly at baseline. MEASUREMENTS: UI was ascertained according to questionnaires in 2000 and 2002. Rates of incident UI and progression or remission of prevalent UI were calculated. Logistic regression was used to estimate relative risks of UI associated with risk factors. RESULTS: In women with no urine leakage at baseline, 9.2% reported leakage at least monthly after 2 years. For women with leakage at least weekly, the incidence was 3.6%; of these cases, stress UI had the highest incidence, followed by mixed and urge UI. Relationships between UI and age differed for stress UI, which decreased with age (relative risk (RR)=0.63, 95% confidence interval (CI)=0.43–0.92 for aged 70–79 vs 54–59), and urge and mixed UI, which increased with age (RR=2.28, 95% CI=1.09–4.75 and RR=2.11, 95% CI=1.24–3.61, respectively). For prevalent UI in 2000, 32.1% of subjects with leakage once a month progressed to leakage at least once a week over follow-up. Only 8.9% with frequent leakage in 2000 reported improvement to monthly leakage or less, with 2.0% having complete remission. CONCLUSION: The incidence of UI is high in older women, and progression from occasional to frequent leaking is common. Urge UI, for which there are limited effective treatments, increases with age, thus research on UI prevention in older women is particularly important. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To relate diabetes mellitus (DM) status and duration to late-life cognitive impairment and decline in men and women. DESIGN: Prospective cohort. SETTING: Community. PARTICIPANTS: Five thousand nine hundred seven men in the Physicians' Health Study II and 6,326 women in the Women's Health Study (mean age 74.1 and 71.9, respectively, at baseline cognitive assessment); 553 men and 405 women had DM. MEASUREMENTS: Primary outcomes were general cognition (the Telephone Interview for Cognitive Status (TICS) and a global score averaging five tests) and verbal memory. All participants had second assessments approximately 2 years later; women had third assessments an average of 4 years later. RESULTS: In adjusted linear regression models, participants with DM had significantly lower baseline scores for all outcomes, and longer duration of DM was associated with lower scores ( P-trends <.001). Men with DM had significantly greater 2-year cognitive decline than men without DM, and longer duration of DM was associated with worse decline ( P-trends ≤.01). In repeated-measures analyses of response profiles, women with DM had significantly greater 4-year cognitive decline in all outcomes than women without DM. In women, as in men, there was generally greater cognitive decline with longer duration of DM (e.g., the adjusted mean difference in decline on the TICS associated with duration of ≥5 years was −0.74 (95% confidence interval=−1.05 to −0.43) points ( P-trend <.001). There were no significant sex–DM interactions. CONCLUSION: Type 2 DM and longer duration of DM are similarly related to cognitive impairment and decline in men and women. [ABSTRACT FROM AUTHOR]

The article presents a study on the body mass index (BMI), waist circumference and incident urinary incontinence (UI) in older women. It is stated that the Nurses' Health Study was initiated in 1976 where female nurses replied to a questionnaire containing topics such as medical history, lifestyle and UI. The researchers conclude that BMI was independently linked with urge and mixed UI and abdominal adiposity independently linked with stress UI.

The risk of dementia among Parkinson's disease (PD) patients is greatly elevated compared to controls, yet little is known about determinants of cognitive function among PD patients. We assessed the relation between cigarette smoking prior to disease onset and later cognitive function among PD patients (n = 286) and age- and sex-matched controls (n = 1144) participating in the Nurses' Health Study and Health Professionals Follow-up Study. Both groups completed telephone-administered assessments of cognitive function. We used linear regression to calculate mean differences in cognitive test scores across smoking categories, adjusted for age, education, sex, age at onset of PD, and years since diagnosis. PD patients scored significantly worse on all tests than their matched controls. In analyses only among PD cases, but not among controls, current smokers at PD onset scored worse than never smokers on the Telephone Interview for Cognitive Status (difference = −0.82, 95% CI: −1.33, −0.30, P = 0.002) as well as on a global score combining results of all tests (difference = −0.36, 95% CI: −0.72, 0.01, P = 0.06). This difference was equivalent to the difference in global score observed among controls ∼10 years apart in age. Analyses of pack-years of smoking prior to disease onset gave similar results. These findings, nested in prospective cohort studies, suggest that cigarette smoking prior to disease onset is associated with worse cognitive function in PD. © 2007 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between type 2 diabetes mellitus (DM) and development of urinary incontinence in women. Design: Prospective, observational study. Setting: The Nurses' Health Study cohort. Participants: Eighty-one thousand eight hundred forty-five women who reported information on urinary function in 1996. Measurements: Self-reported, physician-diagnosed DM was ascertained using questionnaire from 1976 to 1996 and confirmed using standard criteria. Self-reported urinary incontinence, defined as leakage at least weekly, was ascertained in 1996 and 2000. Logistic regression models were used to calculate multivariate-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relationship between DM (as of 1996) and prevalent and incident incontinence. Results: The risk of prevalent incontinence (multivariate RR=1.28, 95% CI=1.18–1.39) and incident incontinence (multivariate RR=1.21, 95% CI=1.02–1.43) was significantly greater in women with DM than women without. Using a validated severity index, risk of developing severe incontinence was even more substantial in women with DM than in those without (multivariate RR=1.40, 95% CI=1.15–1.71 for leakage enough to wet the underwear; RR=1.97, 95% CI=1.24–3.12 for leakage enough to wet the outer clothing). In addition, risk of incontinence increased with duration of DM ( P-trend=.03 for prevalent incontinence; P=.001 for incident incontinence). Conclusion: DM independently increases risk of urinary incontinence in women. Because risk of incontinence appeared associated with longer duration of DM, even delaying the onset of DM could have important public health implications. [ABSTRACT FROM AUTHOR]

Background Subjective cognitive concerns may represent a simple method to assess likelihood of memory decline among apolipoprotein E ( APOE ) ε4 carriers. Methods We examined the relationship of self-reported subjective cognitive concerns, using seven specific cognitive concerns, with memory and memory decline over 6 years among APOE ε4 carriers and non-carriers from the Nurses' Health Study. Results In both groups, increasing subjective cognitive concern score predicted worse baseline memory and faster rates of subsequent memory decline, after adjustment for age, education and depression. The relation with baseline memory appeared statistically stronger in APOE ε4 carriers ( P -interaction = 0.03). For memory decline, mean differences in slopes of episodic memory (95% CI) for 4 to 7 versus no concern = −0.05 (−0.10, 0.01) standard units in APOE ε4 carriers, and −0.04 (−0.08, −0.01) standard units in non-carriers. Conclusions APOE ε4 carriers with self-assessed cognitive concerns appear to have worse memory, and possibly accelerated memory decline. [ABSTRACT FROM AUTHOR]