Search

Background. Life-space, a measure of movement through one's environment, may be viewed as one aspect of environmental complexity for older adults. We examined the relationship between life-space and subsequent change in cognitive function. Methods. Participants were 624 community-dwelling Medicare beneficiaries (49% African American) who completed in-home assessments at baseline and follow-up 4 years later. The Life-Space Assessment was used at baseline to measure extent, frequency, and independence of participants' movement within and outside the home. Cognitive decline was measured with the Mini-Mental State Examination (MMSE). Results. In a regression model adjusted for baseline MMSE, age, gender, race, residence (rural/urban), and education, greater life-space at baseline predicted reduced cognitive decline ([beta] = -.177, p < .001). This association remained statistically significant in subsequent models that examined what proportion of the observed association was explained by baseline physical activity, physical function, vascular risk factors, comorbidity, and psychosocial factors. Physical function accounted for the largest proportion (37.3%) of the association between life-space and cognitive decline. There was no significant interaction between life-space and race, gender, or age in predicting cognitive decline. In a logistic regression analysis, participants in the highest quartile of life-space had 53% reduced odds of substantial cognitive decline ([greater than or equal to] 4 points on MMSE) compared to those in the lowest quartile. Conclusions. These preliminary findings suggest that life-space may be a useful identifier of older adults at risk for cognitive decline. Future research should investigate the potential reciprocal relationship between life-space and cognitive function as well as the interrelationship between these factors and physical function. Key Words: Life-space--Cognition--Older adults--Cognitive decline.

We examined associations between multiple aspects of social resources and 5-year change in performance on different domains of cognitive function. Results indicated that lower satisfaction with support was associated with decline in episodic memory performance over 5 years. We also found significant interactions between age and social networks of family and friends and satisfaction with support for the separate cognitive domains. The results suggest that social resources may be differentially important for cognitive change but that different cognitive domains respond in a similar pattern to social resources. Key Words: Cognition--Social support.

Background. A myocardial infarction (MI) results typically in abrupt functional deterioration immediately postevent, followed by recovery. The post-MI health disparities experienced by black older adults may be attributable to the social and health correlates of race. We explored patterns of change in functional status in a community-based sample of 243 older white and black persons hospitalized for an incident MI. Methods. The study sample was drawn from the Established Populations for Epidemiologic Studies of the Elderly (EPESE). All older adults hospitalized for an incident MI between the first two waves of data collection were followed up yearly for two additional years. Nonlinear quadratic trajectories of functional status, as measured by disability in activities of daily living (ADL) and functional limitation (FL). were fit using mixed-effects models. Results. Although there were no nonlinear differences in ADL trajectories, there was a faster nonlinear rate of change in FL in older blacks compared to whites, independent of other social and health factors. The baseline white--black gap in FL widened after the MI by the first follow-up, continued to widen at a less accelerated pace until the second follow-up. and narrowed, by the third follow-up. Conclusions. Disparities in relevant social and health factors did not account for the more abrupt deterioration in FL postevent or for the more substantial recovery in older blacks compared to older whites. Disparities in therapeutic strategies and the 'survival of the fittest' may underlie the pattern of this white--black gap in FL after an incident ML. Key Words: White--black--Disability gap--Heart attack.

Background. With the number of people with dementia increasing, identifying potential protective factors has become more important. We explored the association between physical exercise at midlife and subsequent risk of dementia among members of the HARMONY study. Methods. Measures of exercise were obtained by the Swedish Twin Registry an average of 31 years prior to dementia assessment. Dementia was diagnosed using a two-stage procedure--screening for cognitive impairment followed by full clinical evaluation. We used two study designs: case--control analyses included 264 cases with dementia (176 had Alzheimer's disease) and 2870 controls; co-twin control analyses included 90 twin pairs discordant for dementia. Results. In case--control analyses, controlling for age, sex, education, diet (eating fruits and vegetables), smoking, drinking alcohol, body mass index, and angina, light exercise such as gardening or walking and regular exercise involving sports were associated with reduced odds of dementia compared to hardly any exercise (odds ratio [OR] = 0.63, 95% confidence interval [CI], 0.43-0.9l for light exercise; OR = 0.34, 95% CI, 0.16-0.72 for regular exercise). Findings were similar for Alzheimer's disease alone. In co-twin control analyses, controlling for education, the association between higher levels of exercise and lower odds of dementia approached significance (OR = 0.50, 95% CI, 0.23-1.06; p = .072). Conclusions. Exercise at midlife may reduce the odds of dementia in older adulthood, suggesting that exercise interventions should be explored as a potential strategy for delaying disease onset. Key Words: Exercise--Dementia--Twins--Sweden.

We examined the association between risk of dementia or Alzheimer's disease (AD) and occupation by using measures of complexity of work with data, people, and things. The study included 10,079 members of the population-based Swedish Twin Registry who were participants in the HARMONY study. We diagnosed dementia by means of a two-stage procedure--cognitive impairment screening followed by full clinical evaluation. We analyzed data with case-control and cotwin control designs. The cotwin control design provides control over genetic and familial factors. In the case-control study, controlling for age, gender, and level of education, we found that more complex work with people was associated with reduced risk of AD. Greater complexity of work with people and data was protective in twin pairs discordant for AD. Findings suggest that greater complexity of work, and particularly complex work with people, may reduce the risk of AD.