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INTRODUCTION: Limited observational windows lead to conflicting results in studies examining educational differences in Alzheimer's disease and related dementias (ADRD) risk, due to observational window bias relative to onset of accelerated cognitive decline. This study tested a novel model to address observational window bias and tested for the presence and sources of disparities in accelerated cognitive declines due to ADRD. METHODS: The sample examined 167,314 cognitive assessments from 32,441 Health and Retirement Study participants. We implemented a parametric non-linear nested longitudinal regression and reported multivariable-adjusted nodal incidence ratios (aNIR). RESULTS: University degrees were associated with lower incidence (aNIR = 0.253, 95% confidence interval [CI] = [0.221 to 0.289], p < 0.001), while black participants had a higher incidence (aNIR = 1.995, [1.858 to 2.141], p < 0.001) of accelerated cognitive decline, adjusting for demographic, sociobehavioral, and medical risk factors. Sex-stratified analyses identified diminished educational returns for women and increased incidence among minoritized women. DISCUSSION: Addressing observational window bias reveals large social inequalities in the onset of accelerated cognitive declines indicative of ADRD. HIGHLIGHTS: This study identifies observational window bias as a source of conflicting results among previous studies of educational achievement in Alzheimer's disease and related dementias (ADRD) disparities. The study locates preclinical accelerated cognitive decline, which is indicative of ADRD while occurring 10+ years prior to symptom onset, as a site to study ADRD disparities that mitigates observational window bias. A novel method, nested non-linear regression, is developed to test for differences in the onset of accelerated cognitive decline. Educational and racial/ethnic disparities are demonstrated in the onset of accelerated cognitive decline, as are their intersecting differences with sex/gender.
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Importance: Reports suggest that the individuals who served in rescue operations following the terrorist attacks on the World Trade Center (WTC) have poorer brain health than expected. Objective: To assess the incidence of dementia before age 65 years in a prospective study of WTC responders and to compare incidence among responders with severe exposures to debris vs responders not exposed to building debris or who wore personalized protective equipment (PPE). Design, Setting, and Participants: This prospective cohort study was conducted from November 1, 2014, to January 1, 2023, in an academic medical monitoring program available to verified WTC responders residing on Long Island, New York. Responders 60 years of age or younger without dementia at the time of their first cognitive assessment were followed up every 18 months, on average, for up to 5 years. Exposures: Exposure severity was based on responses to a detailed questionnaire of WTC exposures and exposure-related activities that included exposures to fine particulate dust and potentially neurotoxic debris, duration of work, and the use of PPE. Exposure level was divided into 5 categories ranging from low to severe. Main Outcomes and Measures: Incidence of all-cause dementia before age 65 years was the primary outcome. Dementia was diagnosed following standard guidelines relying on repeated measures of cognition. Results: Of 9891 responders, 5010 were eligible for inclusion in this study of cognitive function (median [IQR] age, 53 [48-57] years; 4573 [91.3%] male). There were 228 cases of dementia identified during 15â¯913.1 person-years of follow-up. Increasing WTC exposure severity was associated with incremental increases in the incidence rate of dementia per 1000 person-years (low, 2.95 [95% CI, 1.07-11.18]; mild, 12.16 [95% CI, 10.09-14.79]; moderate, 16.53 [95% CI, 13.30-20.81]; high, 30.09 [95% CI, 21.35-43.79]; and severe, 42.37 [95% CI, 24.86-78.24]). Adjusting for social, demographic, and relevant medical factors, each unit increase in exposure severity was associated with increased incidence of dementia (adjusted hazard ratio, 1.42 [95% CI, 1.18-1.71]; P < .001; mean risk difference, 9.74 [95% CI, 2.94-32.32] per 1000 person-years; P < .001). Conclusions and Relevance: In this cohort study of WTC responders who survived these unique exposures and participated in a longitudinal follow-up study of cognition from 2014 through 2022, when compared with responders with the lowest exposure levels or responders who used PPE, more severe exposure to dust or debris was significantly associated with a higher risk of dementia before 65 years of age. This study suggests that the reliable use of PPE might help prevent the onset of dementia before age 65 years among individuals exposed to an uncontrolled building collapse. Future research is warranted to determine cerebral biomarkers for individuals with exposure-associated dementia.
Subject(s)
Dementia , Emergency Responders , September 11 Terrorist Attacks , Humans , Dementia/epidemiology , Male , Female , Incidence , Middle Aged , Prospective Studies , Emergency Responders/statistics & numerical data , Occupational Exposure/adverse effects , Occupational Exposure/statistics & numerical data , New York City/epidemiology , Adult , Rescue Work/statistics & numerical data , Personal Protective Equipment/statistics & numerical dataABSTRACT
Spatial memory is important for supporting the successful completion of everyday activities and is a particularly vulnerable domain in late life. Grouping items together in memory, or chunking, can improve spatial memory performance. In memory for desktop scale spaces and well-learned large-scale environments, error patterns suggest that information is chunked in memory. However, the chunking mechanisms involved in learning new large-scale, navigable environments are poorly understood. In five experiments, two of which included young and older adult samples, participants watched movies depicting routes through building-sized environments while attempting to remember the locations of cued objects. We tested memory for the cued objects with virtual pointing, distance estimation, and map drawing tasks after participants viewed each route. Patterns of error failed to show consistent evidence of chunking in spatial memory across all experiments. One possibility is that chunking in spatial memory relies on visual perceptual grouping mechanisms that are not in play during encoding of large-scale spaces encountered through extended route experiences that do not afford concurrent viewing of target locations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Objective The current project aims to identify individuals in urgent need of mental health care, using a machine learning algorithm (random forest). Comparison/contrast with conventional regression analyses is discussed. Participants: A total of 2,409 participants were recruited from an anonymous university, including undergraduate and graduate students, faculty, and staff. Methods: Answers to a COVID-19 impact survey, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were collected. The total scores of PHQ-9 and GAD-7 were regressed on six composites that were created from the questionnaire items, based on their topics. A random forest was trained and validated. Results: Results indicate that the random forest model was able to make accurate, prospective predictions (R2 = .429 on average) and we review variables that were deemed predictively relevant. Conclusions: Overall, the study suggests that predictive models can be clinically useful in identifying individuals with internalizing symptoms based on daily life disruption experiences.
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Objective: The COVID-19 pandemic has simultaneously exacerbated mental health concerns among college students and made it more challenging for many students to access mental health support. However, little is known about the extent of mental health support loss among college students, or which students have lost support. Participants: 415 undergraduate students who reported receiving mental health support prior to the pandemic participated. Methods: Students completed an online questionnaire between March and May of 2020. Researchers examined the extent of support loss and how support loss differed by demographic and mental health variables. Methods pre-registered at https://osf.io/m83hz. Results: 62% of respondents reported loss of mental health support. Loss of support was associated with more severe depressive symptoms (p < .001), more severe anxiety symptoms (p < .001), suicidal ideation (p < .001), and sexual minority identity (p = .017). Conclusions: Loss of support was common, especially among more vulnerable students.
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Objective: The present study examined what specific aspects of the COVID-19 pandemic contributed to psychopathology symptoms among college students during the initial stages of the pandemic. Participants: One thousand and eighty-nine college students (Mage = 20.73, SDage = 2.93) enrolled at a university in New York participated in the study between March and May 2020. Methods: Participants completed self-report measures assessing pandemic-related experiences and psychopathology symptoms. Results: Results indicated that greater COVID-19-related life changes were uniquely associated with greater depression and post-traumatic stress symptoms. Greater concerns about school, home confinement, and basic needs were uniquely associated with greater depression symptoms. Finally, greater COVID-19 infection concerns were uniquely associated with greater generalized anxiety and post-traumatic stress symptoms. Conclusion: The present study indicates that the COVID-19 pandemic had a multifaceted impact on undergraduate students and that specific COVID-19 experiences contributed to higher rates of psychopathology symptoms.
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Older adults exhibit an age-related positivity effect, with more positivity for memories than young adults. Theoretical explanations attribute this phenomenon to greater emphasis on emotion regulation and well-being due to shortened time horizons. Adults, across the lifespan, also exhibit a collective negativity bias (more negativity about their country than their personal past and future) and a future-oriented positivity bias (more positivity for future projections than for memories). Threats to global health (e.g., the COVID-19 pandemic) may shorten future time horizons which may serve to impact emotional valence for memories and future projections. We investigated this possibility in 2020 during the COVID-19 pandemic in young, middle-aged, and older adults (N = 434; age: 18-81 years), for positive and negative events in the past (2019) and future (2021) in the personal and collective domains, as well as for future excitement and worry in these same domains in 1 week, 1 year, and 5-10 years' time. We replicated the collective negativity bias and future-oriented positivity bias, indicating the robustness of these phenomena. However, the pattern of age-related positivity diverged for personal events such that young adults exhibited similar positivity to older adults and more positivity than middle-aged adults. Finally, consistent with theoretical proposals of better emotion regulation with age, older adults reported more muted excitement and worry for the long-term future compared to young adults. We discuss the implications of this work for understanding valence-based biases in memory and future projections across the adult lifespan. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Subject(s)
COVID-19 , Longevity , Humans , Aged , Middle Aged , Aged, 80 and over , Pandemics , Aging , Emotions/physiologyABSTRACT
Introduction: The clock drawing task (CDT) is frequently used to aid in detecting cognitive impairment, but current scoring techniques are time-consuming and miss relevant features, justifying the creation of an automated quantitative scoring approach. Methods: We used computer vision methods to analyze the stored scanned images (N = 7,109), and an intelligent system was created to examine these files in a study of aging World Trade Center responders. Outcomes were CDT, Montreal Cognitive Assessment (MoCA) score, and incidence of mild cognitive impairment (MCI). Results: The system accurately distinguished between previously scored CDTs in three CDT scoring categories: contour (accuracy = 92.2%), digits (accuracy = 89.1%), and clock hands (accuracy = 69.1%). The system reliably predicted MoCA score with CDT scores removed. Predictive analyses of the incidence of MCI at follow-up outperformed human-assigned CDT scores. Discussion: We created an automated scoring method using scanned and stored CDTs that provided additional information that might not be considered in human scoring.
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Past research conducted primarily in young adults has demonstrated the utility of cognitive offloading for benefitting performance of memory-based tasks, particularly at high memory loads. At the same time, older adults show declines in a variety of memory abilities, including subtle changes in short-term memory, suggesting that cognitive offloading could also benefit performance of memory-based tasks in this group. To this end, 94 participants (62 young adults, 32 older adults) were tested on a retrospective audiovisual short-term memory task in two blocked conditions. Offloading was permitted in the offloading choice condition but not in the internal memory condition. Performance was improved for both age groups in the offloading choice condition compared to the internal memory condition. Moreover, the choice to use the offloading strategy was similar across age groups at high memory loads, and use of the offloading strategy benefitted performance for young and older adults similarly. These data suggest that older adults can make effective use of cognitive offloading to rescue performance of memory-based activities, and invites future research on the benefits of cognitive offloading for older adults in other, more complex tasks where age-related memory impairment is expected to be more prominent.
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Cognition , Memory, Short-Term , Young Adult , Humans , Aged , Retrospective StudiesABSTRACT
The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.
Subject(s)
COVID-19 , Pandemics , Male , Humans , Female , Mental Health , Gender Identity , StudentsABSTRACT
Although cognitive offloading, or the use of physical action to reduce internal cognitive demands, is a commonly used strategy in everyday life, relatively little is known about the conditions that encourage offloading and the memorial consequences of different offloading strategies for performance. Much of the extant work in this domain has focused on laboratory-based tasks consisting of word lists, letter strings, or numerical stimuli and thus makes little contact with real-world scenarios under which engaging in cognitive offloading might be likely. Accordingly, the current work examines offloading choice behavior and potential benefits afforded by offloading health-related information. Experiment 1 tests for internal memory performance for different pieces of missing medication interaction information. Experiment 2 tests internal memory and offloading under full offloading and partial offloading instructions for interaction outcomes that are relatively low severity (e.g., sweating). Experiment 3 extends Experiment 2 by testing offloading behavior and benefit in low-severity, medium-severity (e.g., backache), and high-severity interaction outcomes (e.g., heart attack). Here, we aimed to elucidate the potential benefits afforded by partial offloading and to examine whether there appears to be a preference for choosing to offload (i) difficult-to-remember information across outcomes that vary in severity, as well as (ii) information from more severe interaction outcomes. Results suggest that partial offloading benefits performance compared to relying on internal memory alone, but full offloading is more beneficial to performance than partial offloading.
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Cognition , Myocardial Infarction , Humans , Mental Recall , Choice Behavior , ExerciseABSTRACT
Age-related episodic memory deficits imply that older and younger adults differentially retrieve and monitor contextual features that indicate the source of studied information. Such differences have been shown in subjective reports during recognition and cued recall as well as process estimates derived from computational models of free recall organisation. The present study extends the subject report method to free recall to characterise age differences in context retrieval and monitoring, and to test assumptions from a context-based computational model. Older and younger adults studied two lists of semantically related words and then recalled from only the first or second list. After each recall, participants indicated their subjective context retrieval using remember/know judgments. Compared to younger adults, older adults showed lower recall accuracy and subjective reports of context retrieval (i.e., remember judgments) that were less specific to correct recalls. These differences appeared after first-recall attempts. Recall functions conditioned on serial positions were more continual across correct recalls from target lists and intrusions from non-target lists for older than younger adults. Together with other analyses of context retrieval and monitoring reported here, these findings suggest that older adults retrieved context less distinctively across the recall period, leading to greater perceived similarity for temporally contiguous lists.
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Aging , Memory, Episodic , Humans , Aged , Mental Recall , Recognition, Psychology , CuesABSTRACT
Spatial navigation and spatial memory are two important skills for independent living, and are known to be compromised with age. Here, we investigate the neural correlates of successful spatial memory in healthy older adults in order to learn more about the neural underpinnings of maintenance of navigation skill into old age. Healthy older adults watched a video shot by a person navigating a route and were asked to remember objects along the route and then attempted to remember object locations by virtually pointing to the location of hidden objects from several locations along the route. Brain activity during watching and pointing was recorded with functional MRI. Larger activations in temporal and frontal regions during watching, and larger deactivations in superior parietal cortex and intraparietal sulcus during pointing, were associated with smaller location errors. These findings suggest that larger evoked responses during learning of spatial information coupled with larger deactivation of canonical spatial memory regions at retrieval are important for effective spatial memory in late life.
Subject(s)
Healthy Aging , Spatial Navigation , Aged , Brain Mapping , Humans , Magnetic Resonance Imaging , Mental Recall , Spatial Memory , Spatial Navigation/physiologyABSTRACT
Objective The COVID-19 pandemic has worsened college students' mental health while simultaneously creating new barriers to traditional in-person care. Teletherapy and online self-guided mental health supports are two potential avenues for addressing unmet mental health needs when face-to-face services are less accessible, but little is known about factors that shape interest in these supports. Participants: 1,224 U.S. undergraduate students (mean age = 20.7; 73% female; 40% White) participated. Methods: Students completed an online questionnaire assessing interest in teletherapy and self-guided supports. Predictors included age, sex, race/ethnicity, sexual minority status, and anxiety and depression symptomatology. Results: Interest rates were 20% and 25% for at-cost supports (teletherapy and online self-help, respectively) and 70% and 72% for free supports (teletherapy and online self-help, respectively). Patterns emerged by age, anxiety symptom severity, and race/ethnicity. Conclusions: Results may inform universities' efforts to optimize students' engagement with nontraditional, digital mental health supports, including teletherapy and self-guided programs.The SARS-CoV2 (COVID-19) pandemic has taken a severe toll on public health, with effects reaching far beyond unprecedented illness and mortality. Levels of mental health difficulties appear to be rising broadly as the pandemic has progressed, both in the general U.S. population and among college students specifically.1,2 The COVID-19 pandemic and its repercussions may undermine college student mental health in myriad ways.2 Concurrently, students now face the potential for serious illness, loss of loved ones, financial strain, social isolation, loss of on-campus resources, and sudden disruption of routines-creating a "perfect storm" for the emergence or exacerbation of psychological distress.
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The bivariate relationships between brain structure, age, and episodic memory performance are well understood. Advancing age and poorer episodic memory performance are each associated with smaller brain volumes and lower cortical thickness measures, respectively. Advancing age is also known to be associated with poorer episodic memory task scores on average. However, the simultaneous interrelationship between all three factors-brain structure, age, and episodic memory-is not as well understood. We tested the hypothesis that the preservation of episodic memory function would modify the typical trajectory of age-related brain volume loss in regions known to support episodic memory function using linear mixed models in a large adult lifespan sample. We found that the model allowing for age and episodic memory scores to interact predicted the hippocampal volume better than simpler models. Furthermore, we found that a model including a fixed effect for age and episodic memory scores (but without the inclusion of the interaction term) predicted the cortical volumes marginally better than a simpler model in the prefrontal regions and significantly better in the posterior parietal regions. Finally, we observed that a model containing only a fixed effect for age (e.g., without the inclusion of memory scores) predicted the cortical thickness estimates and regional volume in a non-memory control region. Together, our findings provide support for the idea that the preservation of memory function in late life can buffer against typical patterns of age-related brain volume loss in regions known to support episodic memory.
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Memory, Episodic , Adult , Brain/diagnostic imaging , Cognition , Hippocampus , Humans , Magnetic Resonance Imaging , Memory Disorders , Neuropsychological TestsABSTRACT
Individual differences in working memory capacity (WMC) have long been known to relate to performance in domains outside of WM, including attentional control, long-term memory, problem-solving, and fluid intelligence to name a few. Complex span WM tasks, composed of a processing component and a storage component, are often used to index WMC in these types of investigations. Capacity estimates are derived from performance on the storage component only, while processing performance is often largely ignored. Here, we explore the relationship between processing performance and WMC in a large dataset for each of three complex span tasks to better characterize how the components of these tasks might be related. We provide evidence that enforcing an 85% or better accuracy criterion for the processing portion of the task results in the removal of a disproportionate number of individuals exhibiting lower WMC estimates. We also find broad support for differences in processing task performance, characterized according to both accuracy and reaction time metrics, as a function of WMC. We suggest that researchers may want to include processing task performance measures, in addition to capacity estimates, in studies using complex span tasks to index WMC. This approach may better characterize the relationships between complex span task performance and performance in disparate domains of cognition.
Subject(s)
Intelligence , Memory, Short-Term , Attention , Humans , Problem Solving , Reaction TimeABSTRACT
BACKGROUND: Undetected Alzheimer's disease (AD) and stroke neuropathology is believed to account for a large proportion of decline in cognitive performance that is attributed to normal aging. This study examined the amount of variance in age-related cognitive change that is accounted for by AD and stroke using a novel pattern recognition protocol. METHOD: Secondary analyses of data collected for the Health and Retirement Study (N = 17,579) were used to objectively characterize patterns of cognitive decline associated with AD and stroke. The rate of decline in episodic memory and orientation was the outcome of interest, while algorithms indicative of AD and stroke pathology were the predictors of interest. RESULTS: The average age of the sample was 67.54 ± 10.45 years at baseline, and they completed, on average, 14.20 ± 3.56 years of follow-up. After adjusting for demographics, AD and stroke accounted for approximately half of age-associated decline in cognition (51.07-55.6% for orientation and episodic memory, respectively) and explained variance attributed to random slopes in longitudinal multilevel models. DISCUSSION: The results of this study suggested that approximately half of the cognitive decline usually attributed to normal aging are more characteristic of AD and stroke.
Subject(s)
Aging/physiology , Alzheimer Disease/complications , Brain/physiopathology , Cognitive Dysfunction/etiology , Stroke/complications , Aged , Algorithms , Alzheimer Disease/physiopathology , Cognitive Dysfunction/physiopathology , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Memory, Episodic , Middle Aged , Orientation/physiology , Stroke/physiopathology , United StatesABSTRACT
Cognitive offloading refers to the act of reducing the mental processing requirements of a task through physical actions like writing down information or storing information on a cell phone or computer. Offloading can lead to improved performance on ongoing tasks with high cognitive demand, such as tasks where multiple pieces of information must be simultaneously maintained. However, less is known about why some individuals choose to engage in offloading and under what conditions they might choose to do so. In the present study, offloading behavior is investigated in a short-term memory task requiring memory for letters. The present study is a replication and extension of a previous study conducted by Risko and Dunn, and tests the new prediction that individuals with lower working memory capacity will be more likely to offload. Here, we find that offloading information confers a performance advantage over relying on internal memory stores, particularly at higher memory loads. However, we fail to observe that those with poorer memory abilities have a greater propensity for offloading or benefit more from it. Instead, our findings suggest that cognitive offloading may be a valid compensatory strategy to improve performance of memory-based tasks for individuals with a wide range of memory ability.
Subject(s)
Memory, Short-Term/physiology , Mental Recall/physiology , Pattern Recognition, Visual/physiology , Psychomotor Performance/physiology , Adult , Humans , IndividualityABSTRACT
Compared with younger adults, older adults have more difficulty with navigation and spatial memory in both familiar and unfamiliar domains. However, the cognitive mechanisms underlying these effects have been little explored. We examined three potential factors: (a) use of and coordination across spatial reference frames, (b) nonspatial cognitive abilities, and (c) the ability to segment a route into effective chunks. In two experiments, healthy young and older adults watched videos of navigation in a novel environment and had to remember the placement of landmarks along the route. Participants completed three spatial memory tasks-a virtual pointing task, a distance estimation task, and sketch map drawing-for each route. The pointing task depends on updating and accessing the updated egocentric reference frame relative to other frames. Map drawing may rely more on environment-centered processing. The distance estimation task could be solved using either frame of reference. Last, participants segmented each route. In a separate session, working memory, processing speed, and verbal memory were assessed. Older adults performed less well on all spatial tasks compared with younger adults; aging had a stronger negative effect on pointing performance. This may point to impairments in older adults' ability to update and coordinate information across reference frames. Performance on all spatial tasks was predicted by nonspatial task performance. Segmentation did not predict spatial memory. These results underline the importance of situating age differences in navigation in the context of basic transformations of spatial reference frames, and also in the context of nonspatial cognitive abilities. (PsycINFO Database Record