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AbstractObjectivesMethodResultsConclusionPerceived discrimination is associated with racial cognitive health disparities. Links between discrimination and cognitive performance, like working memory, in everyday settings (i.e. ambulatory performance) require investigation. Depressive symptoms may be a mechanism through which discrimination relates to ambulatory working memory.Discrimination, retrospective and momentary depressive symptoms/mood, and aggregated and momentary working memory performance among older Black and White adults were examined within the Einstein Aging Study.Racially stratified analyses revealed that discrimination did not relate to Black or White adults’ ambulatory working memory. Among Black adults, however, more frequent discrimination was associated with greater retrospectively reported depressive symptoms, which related to more working memory errors across two weeks (indirect effect p < 0.05). This path was not significant among White adults. Links between discrimination and momentary working memory were not explained by momentary reports of depressed mood for Black or White adults.Depressive symptoms may play an important role in the link between discrimination and ambulatory working memory among Black adults across extended measurements, but not at the momentary level. Future research should address ambulatory cognition and momentary reports of discrimination and depression to better understand how to minimize cognitive health disparities associated with discrimination. [ABSTRACT FROM AUTHOR]

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; M age = 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. [ABSTRACT FROM AUTHOR]

An introduction to articles published within the issue is presented, including one the intersectionality between race and other social factors such as gender and skin tone, another on the risk and protective factors of aging and health, and another on the significance of risk and protective factors among diverse race groups.

• Higher neuroticism was associated with more cognitive errors. • Higher conscientiousness and openness were associated with fewer cognitive errors. • The associations were generally similar across age, sex, race, education, and poverty status. This study examines the association between personality and cognitive errors in the Healthy Aging in Neighborhoods of Diversity across the Life Span study, a sample diverse across race (Black, White) and SES (above, below 125% of the federal poverty line). Participants (N = 1062) completed a comprehensive personality questionnaire and were administered a brief mental status screener of cognitive errors. Higher neuroticism was associated with more cognitive errors, whereas higher openness and conscientiousness were associated with fewer errors. These associations were independent of age, sex, race, poverty status, and education and were generally not moderated by these factors. These findings support the associations between personality and cognition across race and SES. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal pain alters physiological function, which may be evidenced as early as middle age. Previous research has concluded that middle-aged adults are a high-risk group for musculoskeletal pain and report functional limitations similar to older adults. However, few studies have examined the relationships between musculoskeletal pain and physical function, using objective performance measures in a sample of racially and socioeconomically diverse adults. Thus, this study examined musculoskeletal pain in relation to physical function in middle-aged (30-64 years) White and Black adults and investigated whether the relationship varied by sociodemographic characteristics.Methods: This cross-sectional examination incorporated data from the Healthy Aging in Neighborhoods of Diversity across the Life-Span Study. Participants (n = 875) completed measures of musculoskeletal pain and objective measures of physical performance (ie, lower and upper body strength, balance, and gait abnormalities). Physical performance measures were standardized to derive a global measure of physical function as the dependent variable.Results: Approximately, 59% of participants identified at least 1 pain sites (n = 518). Multivariable regression analyses identified significant relationships between greater musculoskeletal pain and poorer physical function (β = -0.07, p = .031), in mid midlife (β = -0.04, p = .041; age 40-54) and late midlife (β = -0.05, p = .027; age 55-64).Conclusions: This study observed that musculoskeletal pain was associated with poorer physical function within a diverse group of middle-aged adults. Future research should longitudinally explore whether chronic musculoskeletal pain identified at younger ages is associated with greater risk for functional limitation and dependence in later life. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to examine satisfaction, test anxiety, and performance using computer-based cognitive batteries versus a paper-and-pencil neuropsychological battery among older Blacks. Method Self-identified Black adults (n = 87, age range: 55–86; mean education = 14) completed two computer-based tests (CogState and Joggle) and a paper-and-pencil neuropsychological battery. After each battery, participants reported their testing anxiety and satisfaction using the batteries. Descriptive, correlational, and regression analyses compared satisfaction, anxiety, and performance across the batteries. Results Majority of the participants reported more satisfaction with the computer-based (Joggle: 66%; CogState: 77%) than the neuropsychological (52%) battery. Participants also reported less testing anxiety after completing the computer-based batteries than the neuropsychological battery, F (2, 172) = 22.96, p <.001. Older adults' familiarity and comfort level with the computer were not associated with their performance on the computer-based tests (p >.05). Although testing anxiety was not associated with performance across the batteries, age and education quality were uniquely associated with performance on the CogState and neuropsychological batteries. Conclusions Computer-based cognitive batteries appear to be less intimidating than the commonly used paper-and-pencil neuropsychological tests for Black adults. Thus, these cognitive batteries may be useful tools for monitoring older Blacks' cognitive status. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that five-factor model personality traits are associated with self-reported sleep. We test whether these associations extend to objective sleep measures in older adulthood and whether measures of objective sleep mediate the relation between personality and subjective sleep. Methods: A random subsample of participants in the National Social Life and Aging Project (NSHAP) wore an accelerometer for up to three nights and had information on FFM personality traits (N = 620). Participants also reported on their feelings of being rested. Results: Higher neuroticism and lower extraversion and conscientiousness were associated with more frequent wake after sleep onset, greater fragmentation, and feeling less rested. Concurrent body mass index, disease burden, perceived stress, and depressive symptoms accounted for these associations. Personality was unrelated to total time spent asleep but conscientiousness was associated with earlier and more consistent bedtimes. None of the objective sleep metrics mediated the relation between personality and subjective sleep. Conclusions: The present research indicates that the associations typically found for personality and subjective sleep extend to objective sleep fragmentation. These objective measures, however, do not account for the relation between personality and feeling rested. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

It is not well understood how neighborhood disadvantage is associated with specific domains of cognitive function and underlying brain health within older adults. Thus, the objective was to examine associations between neighborhood disadvantage, brain health, and cognitive performance, and examine whether associations were more pronounced among women. The study included 136 older adults who underwent cognitive testing and MRI. Neighborhood disadvantage was characterized using the Area Deprivation Index (ADI). Descriptive statistics, bivariate correlations, and multiple regressions were run. Multiple regressions, adjusted for age, sex, education, and depression, showed that higher ADI state rankings (greater disadvantage) were associated with poorer working memory performance (p < .01) and lower hippocampal volumes (p < .01), but not total, frontal, and white matter lesion volumes, nor visual and verbal memory performance. There were no significant sex interactions. Findings suggest that greater neighborhood disadvantage may play a role in working memory and underlying brain structure. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) with disability and physical performance. Method: Wave 1 data were from Costa Rican Longevity and Healthy Aging Study (n = 2,827). Lipoprotein profiles were measured using blood samples. Disability and physical functioning were measured with activities of daily living/instrumental activities of daily living (ADLs/IADLs) and objective assessment of physical performance. Results: Lower HDL-C was associated with greater ADL disability, and lower TC with longer time to pick-a-pencil and Time-Up-Go (TUG) test. Age interacted between (a) TG and lung function, chair stands, and picka- pencil, and (b) HDL-C and TUG. Stratification showed lower TG and longer time picking up a pencil only for those above 84 years. Based on significant interactions with sex, lower TC was associated with slower chair stand time in women and higher HDL-C with slower chair stand time in men. Discussion: Lower levels of lipoproteins may suggest worse physical function, but the association may differ by sex. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We assessed trends, predictors and outcomes of resource utilization in hospital inpatient discharges with a principal diagnosis of Alzheimer's disease (AD) with at least one procedure. Using Nationwide Inpatient Sample data (NIS, 2002-2012), discharges primarily diagnosed with AD, aged ≥60 y and with ≥1 procedure, were selected (Weighted N = 92,300). Hospital resource utilization were assessed using ICD-9-CM codes, while hospitalization outcomes included total charges (TC, 2012$), length of stay (LOS, days), and mortality risk (MR, %). Brain and respiratory/gastrointestinal procedure utilization both dropped annually by 3-7%, while cardiovascular procedures/evaluations, blood evaluations, blood transfusion, and resuscitation ("CVD/Blood") as well as neurophysiological and psychological evaluation and treatment ("Neuro") procedures increased by 5-8%. Total charges, length of stay, and mortality risk were all markedly higher with use of respiratory/gastrointestinal procedures as opposed to being reduced with use of "Brain" procedures. Procedure count was positively associated with all three hospitalization outcomes. In sum, patterns of hospital resources that were used among AD inpatients changed over-time, and were associated with hospitalization outcomes such as total charges, length of stay, and mortality risk. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

/Background: The allostatic framework is a theoretical perspective that identifies allostatic load (AL) as a meaningful measure of dysregulation and desynchrony across biological processes due to cumulative stress exposure, thereby increasing disease risk. Research exploring the relationships of AL with sleep quality have yielded inconsistent findings. We examined AL at three visits (2004–2009 [Visit 1], 2009–2013 [Visit 2] and 2013–2017 [Visit 3]) in relation to sleep quality [Visit 3] among urban adults by sex, race and age group. We analyzed data on 1489 Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) participants [59.6% female, baseline age: 48.2 years, 58.5% African Americans] with available data on cardiovascular, metabolic and inflammatory AL markers and Pittsburgh Sleep Quality Index (PSQI) scores. Least squares regression models were constructed to evaluate AL score at Visit 1 (AL v1) and z-transformed probability of higher trajectory in AL score between Visit 1 and Visit 3 (AL traj) as predictors of PSQI score at Visit 3, controlling for demographic, lifestyle and health characteristics at Visit 1. AL traj was generated using group-based trajectory modeling. In fully adjusted models, AL v1 and PSQI score were positively related among men only (β = 0.43, P = 0.001), whereas higher AL traj was associated with PSQI score among women (β = 0.51, P = 0.001), White (β = 0.45, P = 0.011) and African American (β = 0.33, P = 0.014) populations. There were no statistically significant interactions according to age group (<50 vs. ≥ 50). Disparities exist whereby AL trajectory predicted sleep quality among women irrespective of race and baseline AL predicted sleep quality among men. Future studies should examine bi-directional AL-sleep relationships. • 1489 Healthy Aging in Neighborhoods of Diversity across the Life Span participants. • Allostatic load and Pittsburgh Sleep Quality Index scores. • Baseline allostatic load predicted sleep quality among men. • Allostatic load trajectory predicted sleep quality among women irrespective of race. [ABSTRACT FROM AUTHOR]

Existing disparities regarding Black Americans' psychological health warrant further investigation of socioecological factors that may be associated with negative and positive dimensions of psychological health in this population. Romantic relationship functioning and neighborhood context are two domains relevant to Black Americans' mental health. However, less is known about how they may serve as independent and interactive prospective predictors of Black Americans' psychological health and potentially in distinctive ways for Black men and women. Using data from 333 partnered Black Americans who participated in the Midlife in the United States study, we investigated relationship adjustment and neighborhood quality as independent and interactive predictors of negative and positive affect 10 years later and examined gender differences in these linkages. Higher neighborhood quality predicted lower levels of negative affect and higher levels of positive affect for both men and women a decade later. Additionally, for Black men, the longitudinal association between relationship adjustment and negative affect differed by neighborhood quality such that better relationship adjustment predicted higher subsequent negative affect only for men in lower quality neighborhoods. Findings demonstrate the connections among romantic relationship functioning, ecological resources, and gender in this population and highlight the importance of incorporating socioecological and intersectional perspectives for predicting Black Americans' long-term psychological health. General Scientific Summary: This study suggests that living in higher quality neighborhoods is related to greater positive aspects and lower negative aspects of psychological health over time for Black Americans. Moreover, for Black men specifically, better romantic relationship functioning is connected to poorer psychological health when they reside in lower quality neighborhoods. [ABSTRACT FROM AUTHOR]

Background: The associations between nutritional biomarkers and measures of sleep quantity and quality remain unclear. Methods: Cross-sectional data from the National Health and Nutrition Examination Surveys (NHANES) 2005–2006 were used. We selected 2,459 adults aged 20–85, with complete data on key variables. Five sleep measures were constructed as primary outcomes: (A) Sleep duration; (B) Sleep disorder; (C) Three factors obtained from factor analysis of 15 items and labeled as “Poor sleep-related daytime dysfunction” (Factor 1), “Sleepiness” (Factor 2) and “Sleep disturbance” (Factor 3). Main exposures were serum concentrations of key nutrients, namely retinol, retinyl esters, carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein+zeaxanthin, lycopene), folate, vitamin B-12, total homocysteine (tHcy), vitamin C, 25-hydroxyvitamin D (25(OH)D) and vitamin E. Main analyses consisted of multiple linear, logistic and multinomial logit models. Results: Among key findings, independent inverse associations were found between serum vitamin B-12 and sleep duration, 25(OH)D and sleepiness (as well as insomnia), and between folate and sleep disturbance. Serum total carotenoids concentration was linked to higher odds of short sleep duration (i.e. 5–6 h per night) compared to normal sleep duration (7–8 h per night). Conclusions: A few of the selected serum nutritional biomarkers were associated with sleep quantity and quality. Longitudinal studies are needed to ascertain temporality and assess putative causal relationships. [ABSTRACT FROM AUTHOR]

Among modifiable lifestyle factors, diet may affect cognitive health. Cross-sectional and longitudinal associations may exist between dietary exposures [e.g., caffeine (mg/d), alcohol (g/d), and nutrient adequacy] and cognitive performance and change over time. This was a prospective cohort study, the Baltimore Longitudinal Study of Aging (n = 628-1305 persons depending on the cognitive outcome; ~2 visits/person). Outcomes included 10 cognitive scores, spanning various domains of cognition. Caffeine and alcohol intakes and a nutrient adequacy score (NAS) were estimated from 7-d food diaries. Among key findings, caffeine intake was associated with better baseline global cognition among participants with a baseline age (Agebase) of ≥70 y. A higher NAS was associated with better baseline global cognition performance (overall, women, Agebase <70 y), better baseline verbal memory (immediate and delayed recall, Agebase ≥70 y), and slower rate of decline or faster improvement in the attention domain (women). For an Agebase of <70 y, alcohol consumption was associated with slower improvement on letter fluency and global cognition over time. Conversely, for an Agebase of ≥70 y and among women, alcohol intake was related to better baseline attention and working memory. In sum, patterns of diet and cognition associations indicate stratum-specific associations by sex and baseline age. The general observed trend was that of putative beneficial effects of caffeine intake and nutrient adequacy on domains of global cognition, verbal memory, and attention, and mixed effects of alcohol on domains of letter fluency, attention, and working memory. Further longitudinal studies conducted on larger samples of adults are needed to determine whether dietary factors individually or in combination are modifiers of cognitive trajectories among adults. [ABSTRACT FROM AUTHOR]

To examine the relationship between measures of sleep quality and cognitive performance in HIV-positive individuals stable on combination antiretroviral therapy.Multimethod assessments of sleep quality, patterns, and cognitive performance were assessed in a predominantly black HIV-positive cohort.Sleep quality and patterns were characterized in 36 subjects by polysomnogram, 2-week actigraphy monitoring, and validated sleep questionnaires. Cognitive performance was assessed with a battery of neuropsychological tests.The majority of participants were cognitively impaired [based on Frascati (75%) criteria]. Self-reported mean scores on the Pittsburgh sleep quality index and the insomnia severity scale suggested poor sleep quality. Better cognitive performance, particularly on tasks of attention, frontal/executive function, and psychomotor/motor speed, was associated with polysomnogram sleep indices (ie, reduced wake after sleep onset, greater sleep efficiency, greater sleep latency, and greater total sleep time). Thirty-seven percent of participants had sleep patterns suggestive of chronic partial sleep deprivation, which was associated with significantly worse performance on the digit symbol test (P = 0.006), nondominant pegboard (P = 0.043), and verbal fluency tests (P = 0.044).Our results suggest that compromised sleep quality and duration may have a significant impact on cognitive performance in HIV-positive individuals. Future studies are warranted to determine the utility of sleep quality and quantity indices as potential predictive biomarkers for development and progression of future HIV-associated neurocognitive disorder. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Over 40-million Americans are undiagnosed, misdiagnosed, or untreated for sleep disorders. Despite the growing need to integrate sleep medicine knowledge into the medical education curriculum, educational leaders have struggled to incorporate contemporary medical topics such as sleep medicine into the already packed curricula. We set out to examine the efficacy of an online, self-paced, sleep medicine learning module as an educational tool for medical students. Methods: We studied 87 Johns Hopkins medical students. Participants were randomly assigned to the sham module (SM, n =40) or learning module (LM, n =47). The efficacy of the tool was assessed based on changes in performance (pre- and post-module completion) on a validated sleep knowledge questionnaire (the Dartmouth Sleep Knowledge and Attitude Survey). Results: Improvement in overall sleep knowledge, as measured by the Dartmouth Sleep Knowledge and Attitude Survey, was significantly higher in the LM group compared to the SM group (F(1,84)=9.71, p <.01, η 2 =0.10). Although the SM group’s improvement was significantly lower than the LM group, within-subject comparisons did show improvement from their pre- to post-assessment scores as well. Conclusion: A self-paced learning module is an effective educational tool for delivering sleep medicine knowledge to medical students. [Copyright &y& Elsevier]

Objectives To examine the relationship between erythrocyte mean corpuscular volume ( MCV) and cognitive performance over time. Design Longitudinal. Setting Sample from the Baltimore Longitudinal Study of Aging ( BLSA). Participants Eight hundred twenty-seven participants from the BLSA (mean age 67, range 50-96). Measurements Mean corpuscular volume and several other blood indices were measured, including hemoglobin, iron, ferritin, vitamin B12, folate, white blood cell count, albumin, and erythrocyte sedimentation rate. Cognitive performance was examined using neuropsychological measures of visual memory, verbal memory, language, attention, executive function, and global mental status. Results High MCV levels were significantly associated with lower global mental status even after adjusting for potential confounders. High MCV levels were also significantly associated with high rates of decline on tasks of global mental status, long delay memory, and attention, even after adjusting for potential confounders. Conclusion The findings confirm a previous observation that larger erythrocytes in older adults are associated with poorer cognitive function. Anemia and inflammation do not appear to explain the relationship between MCV and cognition. Further research is needed to clarify the mechanisms behind this association. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 (F3, 507=21.88, P<.05, η2=.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. [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]

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]

Background: The beneficial effect of acute physical exercise on cognitive performance has been studied in laboratory settings and in long-term longitudinal studies. Less is known about these associations in everyday environment and on a momentary timeframe. This study investigated momentary and daily associations between physical activity and cognitive functioning in the context of everyday life. Methods: Middle-aged adults (n = 291, aged 40–70) were asked to wear accelerometers and complete ecological momentary assessments for eight consecutive days. Processing speed and visual memory were assessed three times per day and self-rated evaluations of daily cognition (memory, thinking, and sharpness of mind) were collected each night. The number of minutes spent above the active threshold (active time) and the maximum vector magnitude counts (the highest intensity obtained) before each cognitive test and at a daily level were used as predictors of momentary cognitive performance and nightly subjective cognition. Analyses were done with multilevel linear models. The models were adjusted for temporal and contextual factors, age, sex, education, and race/ethnicity. Results: When participants had a more active time or higher intensity than their average level within the 20 or 60 minutes prior to the cognitive test, they performed better on the processing speed task. On days when participants had more active time than their average day, they rated their memory in the evening better. Physical activity was not associated with visual memory or self-rated thinking and sharpness of mind. Conclusions: This study provides novel evidence that outside of laboratory settings, even small increases in physical activity boost daily processing speed abilities and self-rated memory. The finding of temporary beneficial effects is consistent with long-term longitudinal research on the cognitive benefits of physical activity. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with age-related changes in mean corpuscular volume in adult Whites and African Americans.

Objectives Heterogeneity among Black adults' experiences of discrimination and education quality independently influence cognitive function and sleep, and may also influence the extent to which sleep is related to cognitive function. We investigated the effect of discrimination on the relationship between objective sleep characteristics and cognitive function in older Black adults with varying education quality. Method Cross-sectional analyses include Black participants in the Einstein Aging Study (N  = 104, mean age = 77.2 years, 21% males). Sleep measures were calculated from wrist actigraphy (15.4 ± 1.3 days). Mean ambulatory cognitive function (i.e. spatial working memory, processing speed/visual attention, and short-term memory binding) was assessed with validated smartphone-based cognitive tests (6 daily). A modified Williams Everyday Discrimination Scale measured discriminatory experiences. Linear regression, stratified by reading literacy (an indicator of education quality), was conducted to investigate whether discrimination moderated associations between sleep and ambulatory cognitive function for individuals with varying reading literacy levels. Models controlled for age, income, sleep-disordered breathing, and sex assigned at birth. Results Higher reading literacy was associated with better cognitive performance. For participants with both lower reading literacy and more discriminatory experiences, longer mean sleep time was associated with slower processing speed, and lower sleep quality was associated with worse working memory. Later sleep midpoint and longer nighttime sleep were associated with worse spatial working memory for participants with low reading literacy, independent of their discriminatory experiences. Discussion Sociocultural factors (i.e. discrimination and education quality) can further explain the association between sleep and cognitive functioning and cognitive impairment risk among older Black adults. [ABSTRACT FROM AUTHOR]

In the inpatient setting, prevalence, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of Alzheimer's disease (AD) are largely unknown. We used data on older adults (60+ y) from the Nationwide Inpatient Sample (NIS) 2002-2012. AD prevalence was ∼3.12% in 2012 (total weighted discharges with AD ± standard error: 474, 410 ± 6,276). Co-morbidities prevailing more in AD inpatient admissions included depression (OR = 1.67, 95% CI: 1.63-1.71, p <  0.001), fluid/electrolyte disorders (OR = 1.25, 95% CI: 1.22-1.27, p <  0.001), weight loss (OR = 1.26, 95% CI: 1.22-1.30, p <  0.001), and psychosis (OR = 2.59, 95% CI: 2.47-2.71, p <  0.001), with mean total co-morbidities increasing over time. AD was linked to higher MR and longer LOS, but lower TC. TC rose in AD, while MR and LOS dropped markedly over time. In AD, co-morbidities predicting simultaneously higher MR, TC, and LOS (2012) included congestive heart failure, chronic pulmonary disease, coagulopathy, fluid/electrolyte disorders, metastatic cancer, paralysis, pulmonary circulatory disorders, and weight loss. In sum, co-morbidities and TC increased over time in AD, while MR and LOS dropped. Few co-morbidities predicted occurrence of AD or adverse outcomes in AD. [ABSTRACT FROM AUTHOR]

Background Cognitive impairment, including dementia, is a major health concern with the increasing aging population. Preventive measures to delay cognitive decline are of utmost importance. Alzheimer's disease (AD) is the most frequent cause of dementia, increasing in prevalence from <1% below the age of 60 years to >40% above 85 years of age. Methods We systematically reviewed selected modifiable factors such as education, smoking, alcohol, physical activity, caffeine, antioxidants, homocysteine (Hcy), n-3 fatty acids that were studied in relation to various cognitive health outcomes, including incident AD. We searched MEDLINE for published literature (January 1990 through October 2012), including crosssectional and cohort studies (sample sizes > 300). Analyses compared study finding consistency across factors, study designs and study-level characteristics. Selecting studies of incident AD, our meta-analysis estimated pooled risk ratios (RR), population attributable risk percent(PAR%) and assessed publication bias. Results In total, 247 studies were retrieved for systematic review. Consistency analysis for each risk factor suggested positive findings ranging from ~38.9% for caffeine to ~89% for physical activity. Education also had a significantly higher propensity for "a positive finding" compared to caffeine, smoking and antioxidant-related studies. Meta-analysis of 31 studies with incident AD yielded pooled RR for low education (RR = 1.99; 95%CI: 1.30-3.04), high Hcy (RR = 1.93; 95%CI: 1.50-2.49), and current/ever smoking status (RR = 1.37; 95%CI: 1.23-1.52) while indicating protective effects of higher physical activity and n-3 fatty acids. Estimated PAR% were particularly high for physical activity (PAR% = 31.9; 95%CI: 22.7- 41.2) and smoking (PAR%-31.0%; 95%CI: 17.9-44.3). Overall, no significant publication bias was found. Conclusions Higher Hcy levels, lower educational attainment, and decreased physical activity were particularly strong predictors of incident AD. Further studies are needed to support other potential modifiable protective factors, such as caffeine. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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]

Traditional neuropsychological batteries may account for disparities in education and may produce testing anxiety, particularly for older Black adults. Computerized batteries may be more amenable to use. The current study used mixed-methods content analysis to explore the perceptions of middle-aged and older Black adults (N = 92) about the CogState Brief Battery (CSBB) and Joggle® computerized battery and a traditional paper-and-pencil neuropsychological battery. The data was analyzed using Atlas.ti. Themes were developed and qualitative responses were converted to quantitative counts to make comparisons to thematic differences based on demographics. Results: The majority of participants liked all three batteries. There were no differences based on demographics. Two prevalent themes across all three measures for what participants liked were 1) mental stimulation and memory, and 2) challenging. A disliked theme specific to the computerized batteries was personal competence. In summary, an array of accessible cognitive batteries is necessary to address individual preferences. [ABSTRACT FROM AUTHOR]

• We demonstrate the use of multilevel modeling to examine variability in driving behaviors. • Distracted driving varied within and between drivers in a naturalistic driving study. • Cell phone use and reaching behaviors varied more across trips than across people. • Simulated daily sleep demonstrates how predictors of driving can vary within a person. Current methods of analyzing data from naturalistic driving studies provide important insights into real-world safety-related driving behaviors, but are limited in the depth of information they currently offer. Driving measures are frequently collapsed to summary levels across the study period, excluding more fine-grained differences such as changes that occur from trip to trip. By retaining trip-specific data, it is possible to quantify how much a driver differs from trip to trip (within-person variability) in addition to how he or she differs from other drivers (between-person variability). To the authors' knowledge, the current study is the first to use multilevel modeling to quantify variability in distracted driving behavior in a naturalistic dataset of older drivers. The current study demonstrates the utility of examining within-person variability in a naturalistic driving dataset of 68 older drivers across two weeks. First, multilevel models were conducted for three distracted driving behaviors to distinguish within-person variability from between-person variability in these behaviors. A high percentage of variation in distracted driving behaviors was attributable to within-person differences, indicating that drivers' behaviors varied more across their own driving trips than from other drivers (ICCs =.93). Then, to demonstrate the utility of personal characteristics in predicting daily driving behavior, a hypothetical model is presented using simulated daily sleep duration from the previous night to predict distracted driving behavior the following day. The current study demonstrates substantial variability in driving behaviors within an older adult sample and the promise of individual characteristics to provide better prediction of driving behaviors relevant to safety, which can be applied in investigations of current naturalistic driving datasets and in designing future studies. [ABSTRACT FROM AUTHOR]

This study examined racial, ethnic, and other factors associated with whether older adults discussed their end-of-life (EOL) care wishes with family. A sample of 223 White, 95 African American, and 46 Hispanic adults aged 50 and older from a five-county area of Florida answered questions about sociodemographics, health, and preferences for involving family/friends in health-care decision-making. Analyses describe associations between whether discussions occurred and race/ethnicity and other factors, including preferences for family/friend involvement in health care. In descriptive analyses, one third (n = 113) had not discussed EOL care. No differences were evident between African Americans and non-Hispanic Whites. In multivariate analyses, EOL care discussions were less likely for Hispanics. Further analysis showed this lower likelihood existed among Hispanics with lesser family/friend involvement. Ethnicity influences EOL care discussion, moderated by family/friend involvement, though results are considered preliminary. Knowing the involvement of patients' family/friends could help providers initiate EOL care discussions. [ABSTRACT FROM AUTHOR]

Aging populations are at increased risk of sleep deficiencies (e.g., insomnia) that are associated with a variety of chronic health risks, including Alzheimer's disease and related dementias (ADRD). Insomnia medications carry additional risk, including increased drowsiness and falls, as well as polypharmacy risks. The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBTi), but access is limited. Telehealth is one way to increase access, particularly for older adults, but to date telehealth has been typically limited to simple videoconferencing portals. While these portals have been shown to be non-inferior to in-person treatment, it is plausible that telehealth could be significantly improved. This work describes a protocol designed to evaluate whether a clinician-patient dashboard inclusive of several user-friendly features (e.g., patterns of sleep data from ambulatory devices, guided relaxation resources, and reminders to complete in-home CBTi practice) could improve CBTi outcomes for middle- to older-aged adults (N = 100). Participants were randomly assigned to one of three telehealth interventions delivered through 6-weekly sessions: (1) CBTi augmented with a clinician-patient dashboard, smartphone application, and integrated smart devices; (2) standard CBTi (i.e., active comparator); or (3) sleep hygiene education (i.e., active control). All participants were assessed at screening, pre-study evaluation, baseline, throughout treatment, and at 1-week post-treatment. The primary outcome is the Insomnia Severity Index. Secondary and exploratory outcomes span sleep diary, actiwatch and Apple watch assessed sleep parameters (e.g., efficiency, duration, timing, variability), psychosocial correlates (e.g., fatigue, depression, stress), cognitive performance, treatment adherence, and neurodegenerative and systemic inflammatory biomarkers. • Insomnia disorder is common in middle-aged and older adults. • Cognitive behavioral therapy for insomnia is underutilized in healthcare. • Teletherapy may improve treatment implementation, dissemination, and adherence. • Mobile app linked Smart devices and clinician dashboard may facilitate treatment. • Randomized clinical trial investigating mobile app on insomnia treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of these secondary analyses was to examine cognitive speed of processing training (SPT) gains in cognitive and everyday functioning among older adults with psychometrically defined mild cognitive impairment (MCI). Method: A subgroup of participants from the Staying Keen in Later Life (SKILL) study with psychometrically defined MCI (N = 49) were randomized to either the SPT intervention or an active control group of cognitive stimulation. Outcome measures included the Useful Field of View (UFOV), Road Sign Test, and Timed Instrumental Activities of Daily Living (IADL) Test. A 2 × 2 repeated-measures MANOVA revealed an overall effect of training, indicated by a significant group (SPT vs. control) by time (baseline vs. posttest) interaction. Results: Effect sizes were large for improved UFOV, small for the Road Sign test, and medium for Timed IADL. Discussion: Results indicate that further investigation of cognitive intervention strategies to improve everyday functioning in patients with MCI is warranted. [ABSTRACT FROM AUTHOR]

Background: Research suggests that greater engagement in family discussions concerning end-of-life (EOL) care preferences could improve advance care planning and EOL outcomes. However, a substantial number of people have not had such discussions. Objective: The study's objective was to understand attitudes and experiences influencing engagement in discussions of EOL care preferences with family members, including the role of healthcare providers in such discussions. Methods: We conducted focus group interviews with 36 non-Hispanic White, African American, and Hispanic community-dwelling participants. Participants were divided among groups to explore differences between those who had or had not engaged in EOL care discussions. Atlas.ti version 7 was used to analyze data employing an open-coding method. Results: Participants' mean age was 70 (range: 58–87); three-fourths were female (n = 27). Twenty were white, non-Hispanic; 10 were African American; and 6 were Hispanic. Four themes emerged from the data, (1) being proactive or passive/reactive; (2) perceiving discussion of death as normal or abnormal; (3) response to family resistance/disconnection; and (4) knowledge acquired. A fifth theme, the role of healthcare providers in family EOL care discussions, resulted from facilitators' questions. Theme examination led to identification of a central category, decision-making. Conclusions: It is important to understand the differing experiences and attitudes of those who do or do not engage in EOL discussions. Research is needed on healthcare practitioners' use of decision-making tools to help patients discuss their EOL care preferences with family and others, the goal of which is to provide care consistent with patients' goals. [ABSTRACT FROM AUTHOR]

Rationale Neighborhood characteristics may influence health and well-being outcomes through stressors in daily life. Objectives This study tested whether a varied set of perceived characteristics of neighborhood (i.e., social cohesion, safety, aesthetic quality, violence) predicted stressor frequency and severity as well as negative emotional responses to stressors. We predicted greater reported cohesion and safety and less violence would be associated with less frequent stressor exposure and severity and less intense negative affect following stressors; we conducted subsequent tests of neighborhood aesthetic quality as a predictor. Methods Participants ( n = 233, age 25–65 years) were residents in a socio-economically, racially, and ethnically diverse zip code in Bronx, New York, most who participated in the Effects of Stress on Cognitive Aging, Physiology and Emotion study between 2012 and 2013. They provided demographic information and neighborhood ratings, then participated in the EMA protocol in which they completed brief smartphone surveys of current negative affect and stressor exposure, severity, and recency, five times daily for 14 days. Results No coded neighborhood characteristic was related to the frequency of stressors. Individuals who reported greater neighborhood violence, however, rated their stressors as more severe. Individuals rating their neighborhood lower in safety or aesthetic quality, or higher in violence, had greater negative affect following stressors. Conclusion Even among people living within the same zip code, individual differences in perceptions of neighborhood predict how stressful they appraised stressors in daily life to be and how much negative affect they reported following stressors. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to examine sex- and age-specific relationships of sleep behaviors with all-cause mortality rates.Methods: A retrospective cohort study was conducted among 5288 adults (≥50 years) from the 2005-2008 National Health and Nutrition Examination Surveys who were followed-up for 54.9 ± 1.2 months. Sleep duration was categorized as < 7 h, 7-8 h and >8 h. Two sleep quality indices were generated through factor analyses. 'Help-seeking behavior for sleep problems' and 'diagnosis with sleep disorders' were defined as yes/no questions. Sociodemographic covariates-adjusted Cox regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).Results: A positive relationship was observed between long sleep and all-cause mortality rate in the overall sample (HR = 1.90, 95% CI: 1.38, 2.60), among males (HR = 1.48, 95% CI: 1.05, 2.09), females (HR = 2.32, 95% CI: 1.48, 3.61) and elderly (≥65 years) people (HR = 1.80, 95% CI: 1.30, 2.50). 'Sleepiness/sleep disturbance' (Factor I) and all-cause mortality rate were positively associated among males (HR = 1.22, 95% CI: 1.03, 1.45), whereas 'poor sleep-related daytime dysfunction' (Factor II) and all-cause mortality (HR = 0.75, 95% CI: 0.62, 0.91) were negatively associated among elderly people.Conclusions: Sex- and age-specific relationships were observed between all-cause mortality rate and specific sleep behaviors among older adults. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment, including dementia, is a major health concern with the increasing aging population. Preventive measures to delay cognitive decline are of utmost importance. Alzheimer's disease (AD) is the most frequent cause of dementia, increasing in prevalence from <1% below the age of 60 years to >40% above 85 years of age.Methods: We systematically reviewed selected modifiable factors such as education, smoking, alcohol, physical activity, caffeine, antioxidants, homocysteine (Hcy), n-3 fatty acids that were studied in relation to various cognitive health outcomes, including incident AD. We searched MEDLINE for published literature (January 1990 through October 2012), including cross-sectional and cohort studies (sample sizes > 300). Analyses compared study finding consistency across factors, study designs and study-level characteristics. Selecting studies of incident AD, our meta-analysis estimated pooled risk ratios (RR), population attributable risk percent (PAR%) and assessed publication bias.Results: In total, 247 studies were retrieved for systematic review. Consistency analysis for each risk factor suggested positive findings ranging from ~38.9% for caffeine to ~89% for physical activity. Education also had a significantly higher propensity for "a positive finding" compared to caffeine, smoking and antioxidant-related studies. Meta-analysis of 31 studies with incident AD yielded pooled RR for low education (RR = 1.99; 95% CI: 1.30-3.04), high Hcy (RR = 1.93; 95% CI: 1.50-2.49), and current/ever smoking status (RR = 1.37; 95% CI: 1.23-1.52) while indicating protective effects of higher physical activity and n-3 fatty acids. Estimated PAR% were particularly high for physical activity (PAR% = 31.9; 95% CI: 22.7-41.2) and smoking (PAR% = 31.09%; 95% CI: 17.9-44.3). Overall, no significant publication bias was found.Conclusions: Higher Hcy levels, lower educational attainment, and decreased physical activity were particularly strong predictors of incident AD. Further studies are needed to support other potential modifiable protective factors, such as caffeine. [ABSTRACT FROM AUTHOR]