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The structure and organization of cognitive abilities has been examined across the life span. The current analysis had three specific aims: (1) test the factor structure of a broad cognitive ability battery across three age groups; (2) examine differences in the pattern of factor covariation across age groups; and (3) examine the pattern of factor mean differences across age groups. A sample of 512 older African Americans (mean age = 66.6 years, 25.4% male) from the Baltimore Study of Black Aging was administered a battery of cognitive tests assessing the domains of perceptual speed, verbal memory, inductive reasoning, vocabulary, and working memory. Factor models were estimated separately in middle-age adults (50-59 years, n = 107), young-old adults (60-69 years, n = 198), and old-old adults (70-79 years, n = 207). There was loading invariance across the three age groups that suggests that the selected tests measured cognition similarly across age. There was no evidence of dedifferentiation across increasingly older age groups. Factor mean differences were observed with the middle-age group having significantly higher factor means than the young-old and old-old groups; however, there was only one factor mean difference between the young-old and the old-old groups. The results suggest that a pattern of dedifferentiation of cognitive abilities does not exist within this sample of older African Americans and that the 60-69 year age range may be a critical period for cognitive decline in this population. [ABSTRACT FROM AUTHOR]

This study examined the relationship between elders' cognitive performance and self-reported trouble falling asleep. Analyses were conducted on 174 older independently living, community dwelling African Americans (M age = 72.74; range = 65 to 90). Cognitive performance was measured using the Mini-Mental State Examination, Forward Digit Span task, Backward Digit Span task, Alpha Span task, and California Verbal Learning Test. Results suggested that individuals who reported trouble falling asleep tended to perform significantly worse than individuals who did not report trouble falling asleep on measures tapping short-term memory and working memory after controlling for age, education, gender, depression, and current health. These results demonstrate that a self-report of sleep difficulty may be a unique predictor of cognitive performance. [ABSTRACT FROM AUTHOR]

Background: Research with nondepressed adults suggests that social networks and social support are stable over the life course until very late age. This may not hold true for older adults with depression. We examined baseline status and trajectories of social networks and social support at the group and individual levels over five years.Methods: The sample consisted of 339 initially depressed adults aged 59 or older (M = 69 years) enrolled in a naturalistic study of depression. Measures of social ties, including social network size, frequency of interaction, instrumental support, and subjective support, were administered at baseline and yearly for five years.Results: Latent growth curve models were estimated for each aspect of social ties. On average, social network size and frequency of interaction were low at baseline and remained stable over time, whereas subjective and instrumental support were high at baseline yet increased over time. There was significant variation in the direction and rate of change over time, which was not predicted by demographic or clinical factors.Conclusions: Because increasing social networks may be ineffective and may not be possible for a portion of people who already receive maximal support, interventions to increase social support may only work for a portion of older depressed adults. [ABSTRACT FROM AUTHOR]

In this study, we examined the relationship between within-person blood pressure and cognitive functioning. We conducted an analysis on 36 community-dwelling elderly individuals (age range = 60-87 years). Participants measured their blood pressure and completed cognitive tasks (i.e., the Rey Auditory Verbal Learning Task, the Letter Series test, and the Number Comparison test) twice a day over 60 consecutive days. We observed a significant interaction between within-person change in blood pressure and average blood pressure for the Letter Series test. Individuals with high blood pressure tended to perform poorly, particularly on occasions when their blood pressure level was above their personal average. These results demonstrate that the relationship between blood pressure and cognition at the between-person level and the relationship within each individual should be further explored simultaneously. [ABSTRACT FROM AUTHOR]

The knowledge gained from studying diverse populations should help to address inequities and prepare us to deal with the needs of the increasing number of older minorities in this country. At the same time, research that is not properly conducted threatens to lead us astray and misconstrue relationships and outcomes related to behavioral aspects of aging. In this article, we propose that simple comparisons between groups are neither necessary nor sufficient to advance our understanding of ethnic minorities. We discuss common pitfalls conducted in group-differences research, including a specific treatment on the issue of statistical power issues. Our goal is to encourage the use of multiple methodological designs in the study of issues related to racial and ethnic minorities by demonstrating some of the advantages of lesser employed approaches. [ABSTRACT FROM AUTHOR]

This study used latent variable growth curve modeling to identify predictors and correlates of verbal learning over trials on a list-learning task in patients with dementia. Data from 116 patients evaluated at the Detroit satellite of the Michigan Alzheimer's Disease Research Center were incorporated in the present analyses. Patients were administered the Fuld Object Memory Evaluation, examined independently by a geriatrician, and, if appropriate, given a diagnosis of probable Alzheimer's disease according to criteria from the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association. The presence of dementia significantly predicted both the intercept (i.e., level of performance) and the slope (i.e., learning over trials), with dementia patients demonstrating lower overall levels of performance and less verbal learning over trials. Rate of verbal learning over trials was a significant predictor of everyday functioning (instrumental activities of daily living) above and beyond general cognitive impairment and demographics. [ABSTRACT FROM AUTHOR]

Despite the association of neighborhood quality with poorer adult health, limited research has explored the association between neighborhood disadvantage, e.g. Area Deprivation Index (ADI), and older Black adults' health, prospectively. This observational study examined the association between ADI and changes in longitudinal physical health within older Black adults. The analytic sample ( n  = 317) included data from waves 1 & 2 of the Baltimore Study of Black Aging: Patterns of Cognitive Aging (BSBA-PCA). Study variables included the Area Deprivation Index (ADI), objective (e.g. average heart rate) and subjective (e.g. activities of daily living) measures of physical health. Multiple linear regression models were conducted controlling for sociodemographic and social support characteristics. Participants living in more disadvantaged neighborhoods, based on national and state ADIs, were more likely to have a decreasing heart rate even after adjusting for covariates. Likewise, participants reporting increasing levels of ADL difficulty were living in a neighborhood with greater disadvantage based on national and state ADI rankings. Significant social support received and ADI (national and state) interactions were observed for average heart rate. The findings suggest that research on the effect of neighborhood quality and social support can enhance our understanding of its impact on older Black adults' health prospectively.

Background: Insurance benefit design influences whether individuals with diabetes who require a continuous glucose monitor (CGM) to provide real-time feedback on their blood glucose levels can obtain the CGM device from either a pharmacy or a durable medical equipment supplier. The impact of the acquisition channel on device adherence and health care costs has not been systematically evaluated., Objective: This study aims to compare the adherence rates for patients new to CGM therapy and the costs of care for individuals who obtained CGM devices from a pharmacy versus acquisition through a durable medical equipment supplier using retrospective claims analysis., Methods: Using the Mariner commercial claims database, individuals aged >18 years with documented diabetes and an initial CGM claim during the first quarter of 2021 (2021 Q1, index date) were identified. Patients had to maintain uninterrupted enrollment for a duration of 15 months but file no CGM claim during the 6 months preceding the index date. We used direct matching to establish comparable pharmacy and durable medical equipment cohorts. Outcomes included quarterly adherence, reinitiation, and costs for the period from 2021 Q1 to the third quarter of 2022 (2022 Q3). Between-cohort differences in adherence rates and reinitiation rates were analyzed using z tests, and cost differences were analyzed using 2-tailed t tests., Results: Direct matching was used to establish comparable pharmacy and durable medical equipment cohorts. A total of 2356 patients were identified, with 1178 in the pharmacy cohort and 1178 in the durable medical equipment cohorts. Although adherence declined over time in both cohorts, the durable medical equipment cohort exhibited significantly superior adherence compared to the pharmacy cohort at 6 months (pharmacy n=615, 52% and durable medical equipment n=761, 65%; P<.001), 9 months (pharmacy n=579, 49% and durable medical equipment cohorts n=714, 61%; P<.001), and 12 months (pharmacy 48% and durable medical equipment n=714, 59%; P<.001). Mean annual total medical costs for adherent patients in the pharmacy cohort were 53% higher than the durable medical equipment cohort (pharmacy US $10,635 and durable medical equipment US $6967; P<.001). In nonadherent patients, the durable medical equipment cohort exhibited a significantly higher rate of therapy reinitiation during the period compared to the pharmacy cohort (pharmacy 61/613, 10% and durable medical equipment 108/485, 22%; P<.001)., Conclusions: The results from this real-world claims analysis demonstrate that, in a matched set, individuals who received their CGM through a durable medical equipment supplier were more adherent to their device. For individuals who experienced a lapse in therapy, those whose supplies were provided through the durable medical equipment channel were more likely to resume use after an interruption than those who received their supplies from a pharmacy. In the matched cohort analysis, those who received their CGM equipment through a durable medical equipment supplier demonstrated a lower total cost of care., (©Jason C Allaire, Consuela Dennis, Arti Masturzo, Steven Wittlin. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 22.07.2024.)

Objectives: This study explored the association between place-based characteristics (e.g., neighborhood socioeconomic deprivation) and physical health within older Black adults, a critical gap in the literature as identified by the National Institute on Minority Health and Health Disparities., Methods: The sample was from Wave 1 data of Baltimore Study of Black Aging: Patterns of Cognitive Aging (N = 450; Mage = 68.34). Variables included the area deprivation index (ADI), objective (e.g., average blood pressure) and subjective (e.g., self-rated health) measures of physical health. Multiple linear regression models were conducted controlling for key sociodemographic characteristics., Results: Participants reporting better self-rated health and less likely to need help with activities of daily living were significantly more likely to be living in more disadvantaged neighborhoods based on national and state ADI, respectively, even after adjusting for covariates. A significant age and ADI interaction revealed better self-rated health was associated with a more disadvantaged neighborhood particularly for individuals ≤66 years. There was no significant association between ADI and objective physical health measures., Discussion: The findings suggest that national- and state-level place-based characteristics should be considered along with individual-level factors, which can enrich the scientific understanding of how neighborhood characteristics relate to varying health indicators among older Black adults., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: This study examined engagement levels across various domains of leisure activities in community-dwelling Black adults (age range = 50-80 years) and variability in daily leisure activity engagement and positive affect (PA; positive emotions or mood) and negative affect (NA; negative emotions or mood). Additionally, we explored whether PA and NA were associated with leisure activity engagement and whether these associations varied by sociodemographics., Methods: Fifty adults (78% women; mean education = 11.62 years, standard deviation = 2.4) reported affect and leisure activity engagement over 8 occasions (2-3 weeks)., Results: Participants averaged 3 leisure activities/day with more engagement in watching television (news), walking, reading, and visiting others. Multilevel models identified significant within-person variation across domains of leisure activity engagement. A significant main effect was observed between daily NA and reduced social activity engagement. A significant interaction between NA and education was further illustrated on those occasions when NA was higher than usual, social and total leisure activity engagement tended to be lower, particularly for adults with ≤10 years of education. A significant interaction between NA and education was observed for entertainment activities. However, results indicated adults with ≥14 years of education, and a mean NA above the sample average, tended to engage in more entertainment activities. Finally, a significant interaction between PA and age was observed indicating adults aged ≥73 had a greater social engagement, particularly when daily PA was heightened., Discussion: Results demonstrate within-person changes in the types of leisure engagement among Black adults. Potential factors related to these changes may result from interconnections between affect and demographic factors (age and education)., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: This systematic literature review examines the current immune checkpoint inhibitors treatment paradigms, treatment gaps and unmet needs for treating SCLC with respect to efficacy, safety, health related quality of life (HRQoL) and cost-effectiveness., Methods: A search strategy was developed and executed using the National Library of Medicine bibliographic database (PubMed), Cochrane Library, Embase and Google Scholar. Data regarding efficacy, safety, cost-effectiveness and HRQoL were extracted and entered in a data extraction sheet created a priori., Results: A total of 4961 patients were comprised in all the 12 studies combined. All the studies focus on extensive stage SCLC (ES-SCLC) and not limited stage SCLC (LS-SCLC). All studies used an ICI as the intervention arm and chemotherapy as the control arm. A statistically significant increase in overall survival (OS) and progression free survival (PFS) was observed when ICIs were added to chemotherapy, especially atezolizumab and durvalumab. ICIs in SCLC resulted in immune-related toxicities that have been well-documented in prior immunotherapy trials; their addition to cytotoxic chemotherapy did not worsen chemotherapy-related toxicities. Out of 12 studies, only 3 (25%) included measures to assess the impact of immunotherapy on SCLC patients' HRQoL. Although domain level scores were limited, the addition of ICIs did not seem to worsen symptoms. Two studies conducted a cost-effectiveness analysis of the combination of atezolizumab plus chemotherapy vs. chemotherapy. The addition of atezolizumab to chemotherapy was not found to be cost-effective in either study., Conclusion: Combining ICIs with chemotherapy enhanced OS and PFS as well as not worsening HRQoL. Among all ICIs, PD-L1 inhibitors showed better effectiveness. Future studies should focus on real-world settings and more clinical trials using ICIs for not only ES-SCLC but also LS-SCLC.

Objectives: The theory of selective survival suggests that possibly around 70-75 years of age, Blacks may display substantive changes in their pattern of cognitive decline. This study examined the age-graded pattern of cognitive decline within older Blacks by describing a trend that characterizes differences in the change of cognitive decline from ages 51.5 to 95.5, and hypothesized that this age-graded pattern is nonlinear., Method: Utilizing 2 waves of longitudinal data from the Baltimore Study of Black Aging, this study used multilevel modeling to test whether the interaction between age and the 3-year study period (time between waves) had a positive effect on changes in inductive reasoning, declarative memory, working memory, and perceptual speed., Results: A significant positive interaction between age and wave was found for inductive reasoning, demonstrating an age-grade pattern of change/decline in cognitive pattern for Blacks aged 51.5-95.4. Simple slope probing via the Johnson-Neyman Technique suggested that Black adults ~64 years and younger experienced significant decline in inductive reasoning across study time, whereas for those older than 63.71, the decline was nonsignificant. No significant age-wave interactions were found for declarative memory, working memory, or perceptual speed., Discussion: Findings suggest a selective survival effect for inductive reasoning ability among Blacks. With decline evident so early, common cognitive intervention programs targeting adults 65+ may come too late for Blacks, signifying the importance and urgency for early health interventions and public policy designed to promote cognitive reserve., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Esophageal cancer (EC) makes up 3.2% of all cancers but ranks sixth among cancer-related deaths worldwide. This real-world analysis determined the use of PD-1/PD-L1 (PD[L]1) inhibitors in EC patients after receiving first-line therapy., Methods: Newly diagnosed EC patients initiating first-line treatment were identified in the IBM MarketScan administrative claims databases during the study period (1 May 2015 to 31 October 2020) using ICD-9/ICD-10 codes. Patients were assigned to either the chemotherapy only, radiation only, chemotherapy plus radiation (chemoradiation), or esophageal transhiatal/transthoracic surgery cohorts., Results: 7276 EC patients started first-line therapy (chemotherapy only = 2502, radiation only = 3355, chemoradiation = 1180, surgery = 239). The average age at diagnosis was 62 years and 23% were female. The median time from start of first-line therapy to utilization of a PD(L)1 inhibitor was 259 days. Pembrolizumab (72%) was the most frequently used PD(L)1 inhibitor across the three cohorts, followed by nivolumab (25%). Furthermore, the number of patients receiving a PD(L)1 inhibitor increased each year with the majority (73%) of use occurring between 2018 and 2020., Discussion: Findings from this real-world study suggest that PD(L)1 inhibitors are increasingly used after first-line therapies in EC, especially among patients initially receiving chemotherapy only. New immunological therapies such as PD(L)1 inhibitors hold great promise for patients with solid tumors. A clearer understanding of their real-world utilization is critical.

Objectives: Identify mechanisms associated with video-game-related gains in cognitive functioning., Method: Seventy-nine older adults (Mean age = 72.72, SD = 7.16) participated in a pretest-posttest intervention study. A video game that required four cognitive abilities was developed. The game had two modes: (1) variable priority training (VPT) and (2) single priority training (SPT). After a pretest session, participants completed a battery of cognitive tasks and 'were randomly assigned to either the VPT ( n = 42) or the SPT mode ( n = 37) for an average of 15.94 ( SD = 2.15) one-hour game play sessions. Post-testing was administrated within one week after completion of training., Results: Time (pretest/posttest) by game mode (VPT/SPT) interactions were examined using Multivariate Repeated Measure ANOVAs. No significant multivariate training effects were observed., Discussion: Results suggest that VPT may not be the underlying mechanism responsible for video-game-related gains in cognition. Our results also cast doubts on whether playing video games could lead to cognitive enhancements in older adults., Competing Interests: Conflict of Interest On behalf of all authors, the corresponding author states that there is no conflict of interest.

Objectives: The present study examined potential sources of intra- and inter-individual differences in older adults' control beliefs using a micro-longitudinal design., Method: Older adults (n = 205) ranging in age from 60 to 94 (M = 72.70, SD = 6.72) completed 8 in-person testing sessions within 3 weeks which included assessments of control beliefs (Locus of Control and Perceived Competence), physical health (physical symptoms and sleep self-efficacy), stressors, emotional well-being (Positive Affect and Negative Affect), and cognition (basic cognition tests, everyday cognition, and memory failures)., Results: Multilevel models indicated that on days when older adults had higher sleep self-efficacy, more positive affect, and less negative affect, they also had more internal locus of control and higher perceived competence. Having stressors on the previous occasion was associated with lower internal locus of control on the subsequent occasion. Physical symptoms, everyday cognition, and memory failures could be predictive of locus of control for some older adults., Discussion: Our findings showed the differentiated antecedents of locus of control and perceived competence, the unique role of sleep self-efficacy, positive affect, and negative affect in understanding antecedents of both, as well as the need to study well-being and cognition antecedents of control beliefs in future studies., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The purpose of the current study is to examine the association between subjective memory complaints and sleep (quantity and quality) in African American older adults., Method: Participants from the Baltimore Study of Black Aging (BSBA; n = 351; mean age = 71.99) completed a self-report sleep scale, subjective memory complaint scale, global cognitive status measure, and demographic questionnaire., Results: Worse overall sleep quality was significantly associated with subjective reports of difficulty recalling the placement of objects, recalling specific facts from reading materials, and worse memory currently compared to the past. Specific sleep parameters (e.g., longer sleep latency and shorter sleep duration) were associated with negative appraisals of participants' ability to do specific tasks involving memory (e.g., difficulty recalling placement of objects). Participants classified as poor sleepers (Pittsburgh Sleep Quality Index [PSQI] total score > 5) were more likely to report worse memory now compared to the past than participants classified as good sleepers (PSQI total score ≤ 5)., Conclusions: Evaluation of sleep may be warranted when older adults, particularly African Americans, communicate concerns regarding their memory. Insufficient sleep may be a useful marker of acute daytime dysfunction and, perhaps, cognitive decline. Given memory problems are the hallmark of dementia, our findings support further evaluation of whether poor sleep can aid in the diagnosis of cognitive impairment.

Objectives: The purpose of this study was to determine whether stability and change in cognitive status are associated with sociodemographic characteristics and health function., Design: Secondary analysis of data., Setting: Baltimore Study of Black Aging-Patterns of Cognitive Aging., Participants: Community-dwelling black adults (N = 407; mean age 68.6 ± 9.1)., Measurements: Baseline (n = 602) and 33-month follow-up (n = 450) assessments of cognition, health, and psychosocial function., Results: For the present analyses, participants were grouped as being cognitively normal (n = 249), having stable mild cognitive impairment (MCI) (n = 32), or being MCI converters (n = 72; normal at baseline, MCI at follow-up) or reverters (n = 54; MCI at baseline, normal at follow-up). Multivariate analysis of variance showed that the groups differed significantly in education and lung function (P < .010). Post hoc analyses indicated that converters had fewer years of education than the other groups, whereas those who were cognitively normal had better lung function than converters and reverters (P < .050)., Conclusion: These results suggest that education and lung health are associated with patterns of cognitive status change and stability. Future research should account for sociodemographic and health factors when examining stability of cognitive status classifications., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Introduction: Compared with other racial/ethnic groups, African Americans have higher rates of chronic conditions and suffer a disproportionate burden of disability. We aimed to examine the effects of social support on physical functioning among older African Americans., Methods: We analyzed a sample of 448 urban, community-dwelling, older African Americans (aged 48-98 years) from the Baltimore Study of Black Aging. Baseline physical functioning was collected between 2006 and 2008 (wave 1), and change in physical functioning was collected between 2009 and 2011 (wave 2), physical functioning was assessed by self-reported limitations in 7 activities of daily living-eating, dressing, grooming, walking, bathing, using the toilet, and transferring in and out of bed-using a binary variable to indicate whether the individual had difficulty performing each specific activity. Social support was measured by how frequently participants provided/received goods and services, financial assistance, transportation, companionship, advice, or encouragement (never [0], rarely [1], sometimes [2], frequently [3]). Negative binomial regression models were used to test the effects of social support given, received, and a ratio (support received/support given) on physical functioning for those who improved and those who declined in physical functioning., Results: Participants reported physical functioning at wave 1 (1.24, standard deviation [SD] = 1.98) and at wave 2 (0.34, SD = 0.83). Average social support given was 7.49 (SD = 3.26), and average social support received was 7.81 (SD = 3.17). Those who improved in physical function gave less social support and had lower social support ratios; social support received had no effect. Those who remained stable or declined in physical function gave more social support; neither social support received nor social ratio had an effect., Conclusion: Social support given and social support received as well as the ratio should be considered when seeking to understand how physical functioning changes over time among older African Americans., (Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Older African Americans consistently report diminished capacities to perform activities of daily living (ADL) compared with other racial groups. The extent to which bodily pain is related to declining abilities to perform ADL/ADL disability in African Americans remains unclear, as does whether this relationship exists to the same degree in African American men and women. For nurses to provide optimal care for older African Americans, a better understanding of the relationship between bodily pain and ADL disability and how it may differ by sex is needed. The aim of this study was to examine whether pain, age, education, income, marital status and/or comorbid conditions were associated with ADL disabilities in older African American women and men. This was a cross-sectional descriptive study. The sample included 598 participants (446 women, 152 men) from the first wave of the Baltimore Study on Black Aging. African American women (odds ratio [OR] = 4.06; 95% confidence interval [CI] 2.63-6.26) and African American men (OR = 6.44; 95% CI = 2.84-14.57) who reported bodily pain had greater ADL disability than those who did not report bodily pain. Having two or more comorbid conditions also was significantly associated with ADL disability in African American women (OR = 3.95; 95% CI: 2.09-7.47). Further work is needed to understand pain differences between older African American women and men to develop interventions that can be tailored to meet the individual pain needs of both groups., (Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Objective: This study examined whether there are daily fluctuations in everyday cognition that are consistent with daily fluctuations often observed in traditional measures of basic cognitive abilities., Method: Two hundred six independently living older adults (age range = 60-91 years) were asked to complete a computerized cognitive battery over eight occasions within a 2- to 3-week period., Results: Using multilevel model, significant within-person variability was observed across the Daily Everyday Cognition Assessment (DECA; 46%), with 54% between-person variability. At each occasion, better performance on the DECA was significantly associated with better performance on simple reaction time ( p < .01) and memory (Auditory Verbal Learning Task, p < .01) even after accounting for time, age, education, and performance on other cognitive measures., Conclusion: These findings demonstrate that within-person performance fluctuations can be observed for everyday cognition tasks, and these fluctuations are consistent with daily changes in basic cognitive abilities., (© The Author(s) 2015.)

Objectives: The present study examined the relationship between desegregated schooling and cognitive change in a sample of 420 community-dwelling African American elders (mean age = 68.6; SD = 9.1)., Method: Participants were recruited for the Baltimore Study of Black Aging - Patterns of Cognitive Aging. Cognitive measures from six domains of function were administered at baseline and follow-up 33 months later. Repeated measures multivariate analysis of covariance was conducted; the between subjects factors were schooling type and age cohort, and the within subjects factor was time. Analyses controlled for age, years of education, and sex, and follow-up univariate analyses were used to determine which individual cognitive scores drove the multivariate effects., Results: There were significant multivariate within-group, between-group, and interaction effects (p < .05). Univariate analyses indicated that the desegregated schooling group scored significantly better on Language and Perceptual Speed (p < .01), and the youngest age cohort (50- to 59-year-olds) performed better on measures of Perceptual Speed. There were no significant univariate interactions between schooling group or age cohort and cognitive change over time., Discussion: Overall, these findings suggest a slight advantage of desegregated schooling for cognitive performance, but no advantage of desegregated schooling on the rate of cognitive change over time in this sample., (© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Despite high rates of poor health outcomes, little attention has been focused on associations between prominent health factors and cognitive function in African American men, exclusively. The objective was to examine relationships between cardiovascular and pulmonary health, and cognitive function in African American men., Method: Data from 257 men were pooled from two studies of African American aging. The mean age of participants was 58.15 and mean educational attainment was 11.78 years. Participants provided self-reported health and demographic information, completed cognitive measures, and had their blood pressure and peak expiratory flow assessed., Results: After adjustment, significant relationships were found between average peak expiratory flow rate (APEFR) and cognitive performance measures., Discussion: Results suggest that lung function is important to consider when examining cognitive function in African American men. Understanding the role of health in cognition and implications for quality of life in this population will be critical as life expectancies increase., (© The Author(s) 2014.)

Objective: To examine the relationship between measures of sleep quality and the presence of commonly encountered comorbid and sociodemographic conditions in elderly Black subjects., Method: Analyses included participants from the Baltimore Study of Black Aging (BSBA; n = 450; mean age 71.43 years; SD 9.21). Pittsburgh Sleep Quality Index (PSQI) measured overall sleep pattern and quality. Self-reported and objective measures of physical and mental health data and demographic information were collected for all participants., Results: Sociodemographic and comorbid health factors were significantly associated with sleep quality. Results from regression analyses revealed that older age, current financial strain, interpersonal problems, and stress were unique predictors of worse sleep quality. Sleep duration was significantly correlated with age, depressive affect, interpersonal problems, and stress; only age was a unique significant predictor. While participants 62 years or younger had worse sleep quality with increasing levels of stress, there was no significant relationship between sleep quality and stress for participants 81 years and older., Conclusions: Several potential mechanisms may explain poor sleep in urban, community dwelling Blacks. Perceived stressors, including current financial hardship or hardship experienced for an extended time period throughout the lifespan, may influence sleep later in life.

Objective: Vascular burden has been linked to future depression and cognitive change in predominately European American samples. This study investigated these relationships in older African Americans., Methods: To examine the connection between vascular risk factors, depression, and cognitive change, this study utilized data from 435 older African Americans. Specifically, the study examined the link between vascular risk at baseline with depression and cognitive functioning at a 2.5-year follow-up visit., Results: High baseline vascular risk was associated with increased odds of future depression while controlling for age and current depression. A series of path analyses demonstrated links between baseline vascular risk, increases in depression, and decreases in processing speed., Conclusions: These findings suggest that African Americans with greater vascular burden are at greater risk for depression and cognitive change., (Copyright © 2013 John Wiley & Sons, Ltd.)

Social support and functional ability are related to a number of outcomes in later life among African Americans, including cognitive performance. This study examined how providing and receiving social support was related to fluid and crystallized cognitive abilities among aging African American adults after accounting for functional limitations, age, education, sex, income, and self-reported health. Data from 602 African American adults (M = 69.08, SD = 9.74; 25% male) were analyzed using latent variable modeling. Fluid ability was a second-order factor indicated by measures that assessed verbal memory, working memory, perceptual speed, and inductive reasoning. Crystallized ability was a first-order factor indicated by three measures that assessed vocabulary (Shipley Verbal Meaning Test and parts A and B of the ETS Vocabulary Test). Results indicated that the receipt of social support was negatively related to both fluid and crystallized abilities, while the provision of support was positively related to fluid and crystallized ability. Follow-up tests found that the receipt of support was more strongly related to fluid ability than crystallized ability. There was no significant difference regarding the relationship of provision of support with fluid ability compared to crystallized ability. Results discuss the importance of considering the social context of older adults when examining cognitive ability.

This study examines day-to-day variability in psychometrically defined mild cognitive impairment (MCI) status and potential predictors of changes in MCI status in an independent-living sample of urban dwelling older adults in Baltimore, Maryland. The participant sample consisted of 50 older adults, ranging in age from 50 to 80 years. Participants completed health and cognitive measures (i.e., executive function, language, memory, and global cognition) over 8 occasions within a 2-3-week period. After each testing occasion, a post hoc classification of MCI status was determined using psychometrically defined criteria based on cognitive performance. Participants who classified as MCI after one assessment often did not meet MCI criteria at subsequent occasions. Daily fluctuations in sleep duration were associated with an increased risk for MCI classification. These results demonstrate that changes in sleep may explain changes in MCI status, particularly for African Americans., (2013 APA, all rights reserved)

Previous research suggests that demographic factors are important correlates of cognitive functioning in African Americans; however, less attention has been given to the influence of personality. The present study explored how dimensions and facets of personality predicted individual variability in cognition in a sample of older African Americans from the Baltimore Study of Black Aging. Cognition was assessed by verbal learning and attention/working memory measures. Personality was measured by the NEO Personality Inventory. Linear regressions controlling for demographic factors showed that Neuroticism, Openness, and Agreeableness were significant regression predictors of cognitive performance. Individual facets of all five personality dimensions were also associated with cognitive performance. These findings suggest personality is important in understanding variability in cognition among older African Americans.

We examined short-term intraindividual variability in control beliefs (competence and locus of control) and cognitive performance and the extent to which the constructs travel together over time. Thirty-six older adults (M = 74 years, SD = 5.51) completed questionnaires and cognitive tests twice each day for 60 consecutive days. Results indicated that control beliefs fluctuate within people across time. Multilevel models revealed that control and competence are coupled with concurrent and subsequent performance, but the benefit of occasion-level increases in control depends on individuals' average control. These findings underscore the importance of examining constructs using a within-person approach to identify dynamic processes in cognitive aging.

Objective: The current study examined whether year-to-year variability in cognitive performance differ between individuals cognitively unimpaired and individuals who subsequently develop dementia., Method: Analyses included a case-control sample of Baltimore Longitudinal Study of Aging (BLSA; mean [M] age = 69.90, standard deviation [SD] = 8.92) participants. One hundred and 35 clinically diagnosed demented participants were matched with 135 nondemented participants based on age at initial testing and sex. Cognitive performance was examined using measures of memory, executive function, attention, language, and global mental status performance. Cognitive performance was examined from baseline to 5 years before cognitive impairment (M, assessments = 3.03, SD = 2.80)., Results: As compared with unimpaired individuals, individuals diagnosed with dementia had greater variability on measures of attention, executive function, language, and semantic memory at least 5 years before the estimated onset of cognitive impairment, which may be indicative of maladaptive cognitive functioning. The dementia cases, however, had less variability on visual memory than the unimpaired group, which may suggest that these cases had more difficulty learning., Conclusions: These results demonstrate that performance variability indexed over annual or biennial visits may be useful in identifying early signs of subsequent cognitive impairment.

Unlabelled: BACKGROUND/STUDY CONTEXT: The current study examined the relationship between intellectual control and cognition and related the results to everyday problem solving in a mixed ethnicity sample of 35% African American and 65% Caucasian elders., Methods: Participants completed the Personality in Intellectual Aging Contexts Inventory (PIC; Lachman et al., 1982 , Journal of Research in Personality, 16, 485-501), Everyday Cognition Battery (ECB; Allaire & Marsiske, 1999 , Psychology & Aging, 14, 627-644; 2002 , Psychology & Aging, 17, 101-115), and a battery of basic cognitive ability tests assessing memory, inductive reasoning, and verbal meaning., Results: Results indicated that African Americans had significantly lower intellectual control beliefs relative to Caucasian older adults. Regression models suggested that relationship between control beliefs and cognition was moderated by education and race. Decomposing the interactions with simple slope analysis revealed that across cognitive abilities, better cognitive performance was related to higher control beliefs in African Americans with at least 13 years of education. A similar relationship was also found in Caucasian elders with lower education., Conclusion: African American elders' reaching a higher level of education may provide a basis for which individual differences in intellectual control beliefs are activated and thereby more strongly associated with cognitive performance.

Unlabelled: BACKGROUND/STUDY CONTEXT: Everyday cognition represents the ability to solve problems within domains that are representative of issues faced by adults on a daily basis. The current study examined individual differences in everyday cognitive ability among aging Black/African American adults., Methods: Demographic data on age, gender, education, physical functioning, chronic illnesses, self-reported health, and depression were collected from 248 African American adults (mean age = 67.8 years, standard deviation = 8.47 years). A multiple indicators, multiple causes (MIMIC) modeling approach was used to examine the associations of individual characteristics with latent everyday cognitive ability and composite score indicators., Results: Age, depressive symptoms, and number of chronic illnesses were negatively related to latent everyday cognition. The individual characteristics of age, depressive symptoms, self-rated health, and education were directly associated with composite indicators of latent everyday cognition. This suggests that within this sample of older Black/African American adults that certain composite scores (i.e., telephone use, food preparation, and finances) may be particularly sensitive to these individual characteristics., Conclusion: These results identify specific sources of variability in everyday cognitive ability among aging Blacks/African Americans. These individual differences should be accounted for when studying everyday cognition among Blacks/African Americans and when comparing the everyday cognitive ability of Blacks/African Americans with other groups.

Background: This study identified demographic and health-related characteristics that were related to mobility limitation in a sample of community-dwelling African Americans., Methods: The sample consisted of 602 community-dwelling African-American men and women ages 48-92 years at study inception. Participants who reported being limited "a lot" or "a little" in climbing one flight of stairs or walking several blocks were considered to have mobility limitation. Logistic regression was conducted to estimate the independent effect of each demographic and health-related characteristic on odds of mobility limitation., Results: African Americans who reported two or more medical conditions had higher odds of mobility limitation (women: odds ratio = 3.52; 95% confidence interval: 1.89-6.53 and men: odds ratio = 2.53; 95% confidence interval: 1.10-5.85) than those who reported one or fewer medical conditions. African Americans with major depressive symptoms had higher odds of mobility limitation (women: odds ratio = 2.98; 95% confidence interval: 1.55-5.71 and men: odds ratio = 3.19; 95% confidence interval: 1.33-7.65) than those without major depressive symptoms., Conclusions: These results highlight the importance of creating interventions particularly focused on chronic disease prevention and management for African American men and women during midlife to attempt to delay the onset or impede the progression of mobility problems that will likely become exacerbated in late life and severely affect the quality of life.

The present study examined age differences in the within-person daily associations of basic cognition, everyday cognition, and busyness with forgetting to take medication. The authors extend previous interindividual difference findings by conducting a daily diary study of a baseline assessment and 8 consecutive days of 40 older adults (age = 60-89 years, M = 74.86) and 31 younger adults (age = 18-20 years, M = 18.30) where basic cognition, everyday cognition, busyness, and forgetting medication were assessed each day and entered simultaneously into one model. Results from a logistic multilevel model indicated that performance on Letter Series was beneficial for both age groups, but the role of fluctuations in busyness on forgetting to take medications was opposite for younger and older adults. Younger adults remembered to take their medication the most on days when they had high everyday cognition and were busier. Older adults remembered to take their medication the most on days when they had high everyday cognition but were less busy. These findings highlight the importance of contextual variation in busyness in relation to daily medication adherence for younger and older adults.

The current analysis examined (a) if measures of psychological well-being predict subjective memory, and (b) if subjective memory is consistent with actual memory. Five hundred seventy-nine older African Americans from the Baltimore Study of Black Aging completed measures assessing subjective memory, depressive symptomatology, perceived stress, locus of control, and verbal and working memory. Higher levels of perceived stress and greater externalized locus of control predicted poorer subjective memory, but subjective memory did not predict objective verbal or working memory. Results suggest that subjective memory is influenced by aspects of psychological well-being but is unrelated to objective memory in older African Americans.

This study examined the within-person relationship between sleep and cognitive functioning. Fifty community-dwelling African Americans (age range = 50-80 years) were asked to report their sleep duration and quality the previous evening and to complete cognitive measures over 8 occasions within a 2-3 week period. A within-person daily change in sleep duration was significantly associated with worse global cognitive performance. The greater an individual deviated away from his or her average sleep duration on a particular day, the more likely his or her performance would decline. These results demonstrate that the sleep-cognition relationship can be observed at a within-person level of analysis., ((c) 2010 APA, all rights reserved).)

This study examined the fluid-crystallized distinction of cognitive abilities in African Americans. We analyzed the factorial invariance of a battery of cognitive ability measures in a sample of 197 community-dwelling African American elders. Specifically, factorial invariance was tested in groups of African American elders differing in age (50-61 years, 62-79 years) and education (low, high). Using a partial invariance approach, if non-invariance was found between two groups, we explored the specific model parameters that contributed to the overall lack of invariance. The results indicated that the factor structure was confirmed in the sample as a whole. Evidence of strict invariance was found between age groups. However, a lack of invariance of specific factor loadings, intercepts, and uniqueness terms was found between education groups. The importance of highlighting idiosyncrasies in cognitive performance among African Americans is shown using a within group variation approach.

Objectives: To examine the frequency of Mild Cognitive Impairment (MCI) in African American older adults. The study also plans to explore the specific cognitive domains of impairment as well as whether there are differences in demographics, health, and cognitive performance between MCI and normal participants., Design: Cross-sectional., Setting: Independent-living sample of urban dwelling elders in Baltimore, Maryland., Participants: The sample consisted of 554 subjects ranging in age from 50 to 95 (Mean = 68.79 +/- 9.60)., Measurements: Socio-demographics and health were assessed. Several cognitive measures were administered to assess inductive reasoning, declarative memory, perceptual speed, working memory, executive functioning, language and global cognitive functioning., Results: Approximately 22% of participants were considered MCI (i.e. 18% non-amnestic vs. 4% amnestic). A majority of the non-amnestic MCI participants had impairment in one cognitive domain, particularly language and executive function. Individuals classified as non-amnestic MCI were significantly older and had more years of education than normal individuals. The MCI groups were not significantly different than cognitively normal individuals on health factors. Individuals classified as MCI performed significantly worse on global cognitive measures as well as across specific cognitive domains than cognitively normal individuals., Conclusion: This study demonstrates that impairment in a non-memory domain may be an early indicator of cognitive impairment, particularly among African Americans., ((c) 2010 John Wiley & Sons, Ltd.)

This study examined the within-person relationship between reading vision and cognitive functioning. Analysis was conducted on 36 community-dwelling elderly (age range = 60-87) who completed a reading vision task and three cognitive tests (i.e., Rey Auditory Verbal Learning Task (AVLT), Letter Series, and Number Comparison) twice a day over 60 consecutive days. Significant within-person variability was found for the reading vision measure. Additionally, a main effect was found for reading vision and performance on the AVLT and Number Comparison task; such that on occasions when reading vision was poor, cognitive performance suffered.

Outliers are typically regarded as data anomalies that should be discarded. However, dynamic or "innovative" outliers can be appropriately utilized to capture unusual but substantively meaningful shifts in a system's dynamics. We extend De Jong and Penzer's 1998 approach for representing outliers in single-subject state-space models to a group-based framework. The group-based model enables model predictions concerning the group as a whole while individualized change points are incorporated to capture discrete shifts in each individual's trajectory. An illustrative example using cognitive performance data from N = 38 older adults over 60 days is presented. Results indicated that a subset of older adults showed sudden shifts in learning dynamics in several forms, including sudden jumps in level, slope, and linkage between perceived control and actual performance level. The broader implications of incorporating innovative outliers into studies of intraindividual change are discussed.

We examined the mediating role of health literacy in the relationships between participant demographic characteristics and health information recall. Baseline data from two studies that focused on hypertensive adults (N = 1190; M = 62.28 years, SD = 11.98; 35.5% female; 45.9% African-American) were analyzed. The final model, which adjusted for recruitment site, indicated that financial status, race, and education were indirectly related to health information recall through health literacy. Increasing education was also directly related to better health information recall. Increasing age was not related to health literacy, but was related to poorer health information recall. The final model fit the data very well, chi(2)(3) = 0.69, p = .36, RMSEA = .000 (90% CI = .000 to .024), CFI = 1.00. The results suggest that health literacy might be one of the mechanisms underlying the relationships between participant demographic characteristics and poor health outcomes due to inaccurate recall of instructions.

Objectives: To examine the performance subjects with and without mild cognitive impairment (MCI) on an objective measure of everyday or real-world memory and subjective items assessing competency within the same instrumental domains; to determine whether the Everyday Cognition Battery (ECB) can uniquely predict MCI status., Design: Cross-sectional., Setting: Independent-living sample of urban dwelling elders in Baltimore Maryland., Participants: The sample consisted of 555 subjects ranging in age from 50 to 95 (mean 68.8 +/- 9.6)., Measurements: Objective performance in three instrumental domains (medication use, financial management, nutrition and food preparation) was assessed using the ECB Memory Test. Subjective performance within the same instrumental domains was also assessed., Results: No difference was found between elderly subjects with and without MCI on the subjective items of instrumental activity of daily living (IADL) competency. A significant multivariate effect for cognitive status group (F(3, 507)=21.88, P<.05, eta(2)=.12) was observed for the objective measure, with participants with MCI performing, on average, significantly worse than those without on all thee instrumental domain subscales. The medicine use (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94-0.99) and financial management (OR=0.93, 95% CI=0.91-0.96) subscales of the ECB Memory Test were unique and significant predictors of MCI., Conclusion: This study adds to the growing body of literature suggesting that cognitively complex IADLs might be compromised in elderly people with MCI. Moreover, the ECB Memory Test might be a clinically useful tool in evaluating real-world competency.

Objective: Although social maladjustment appears to be common among abused children, negative outcomes are not inevitable. This investigation was designed to determine whether ethnicity and features of the parenting context predicted children's social adjustment, and whether the strength and direction of these relations differed for abused and nonabused children., Method: Participants included 78 physically abused and 75 demographically matched nonabused children and one of their parents. Observations of parenting were used to measure parental sensitivity, and parent self-reports of depression were obtained using the SCL-90-R. Children's peer social adjustment was measured by teacher report., Results: Using regression analysis, we tested whether each potential protective or vulnerability factor interacted with abuse status in prediction of social adjustment. Results indicated main effects of ethnicity and sensitivity for prosocial behavior, and a main effect of sensitivity for aggression. In addition, there was a significant interaction of ethnicity and abuse status for aggression such that there was a significant difference between abused and nonabused European American children but not between abused and nonabused African American children., Conclusions: Findings indicate that risk for aggressive behavior among abused children might be culturally specific rather than universal. In addition, results point to beneficial effects of parental sensitivity for maltreated children.

In this article, the authors examine the relationship between everyday cognition and mortality. Data were initially collected in 1996-1997 from 171 community-dwelling older people ranging in age from 60 to 92 years old (M = 74 years, SD = 7.38). Participants completed the Everyday Cognition Battery (ECB; J. C. Allaire & M. Marsiske, 1999, 2002) as well as basic cognitive ability tests. Results indicated that participants who died since testing (n = 56) had performed significantly worse than did still-living participants on all measures. Additionally, performance on the ECB Knowledge Test was a significant predictor of death even after controlling for basic cognitive abilities, demographics, and self-rated health., ((c) 2008 APA, all rights reserved.)

Unlabelled: The current study examined the extent to which pulmonary functioning, as measured by average peak expiratory flow, was related to performance on seven cognitive measures. Analyses were conducted on a sample of 396 African American adults ranging in age from 22 to 89 years., Results: Lung functioning was not uniquely associated with cognitive performance in the younger adults, though it emerged as a significant predictor of individual differences in performance on the Telephone Interview of Cognitive Status even after controlling for age, education, and smoking history. Biobehavioral assessments such as the one presented here appear to provide important new insights into the sources of individual differences in cognition observed in this understudied population.