Correlates of SuperAging in Two Population-Based Samples of Hispanic Older Adults.

OBJECTIVES: "SuperAgers" are generally defined as people 80+ years old with episodic memory performance comparable to those 20 years younger. Limited knowledge exists to describe characteristics of SuperAgers, with even less known about Hispanic SuperAgers. METHODS: We examined indicators of cognitive, physical, and psychological resilience in relation to the likelihood of being a SuperAger using data from 2 population-based studies of Hispanic older adults (Puerto Rican Elderly: Health Conditions [PREHCO] Study; Health and Retirement Study [HRS]). SuperAgers were defined as (1) ≥80 years old, (2) recall scores ≥ the median for Hispanic respondents aged 55-64, and (3) no cognitive impairment during the observation period. Overall, 640 PREHCO participants and 180 HRS participants were eligible, of whom 45 (7%) and 31 (17%) met SuperAging criteria. RESULTS: Logistic regressions controlling for age and sex demonstrated that higher education (PREHCO: odds ratio [OR] = 1.20, p < .001; HRS: OR = 1.14, p = .044) and fewer instrumental activities of daily living limitations (PREHCO: OR = 0.79, p = .019; HRS: OR = 0.58, p = .077; cognitive resilience), fewer activities of daily living limitations (PREHCO: OR = 0.72, p = .031; HRS: OR = 0.67, p = .068; physical resilience), and fewer depressive symptoms (PREHCO: OR = 0.84, p = .015; HRS: OR = 0.69, p = .007; psychological resilience) were associated with SuperAging, although not all results reached threshold for statistical significance, presumably due to low statistical power. Additionally, known indicators of physical health (e.g., chronic conditions and self-rated health) did not relate to SuperAging. DISCUSSION: Increasing access to education and recognizing/treating depressive symptoms represent potential pathways to preserve episodic memory among older Hispanic adults.

Late-life food insecurity and cognition: exploring timing, duration, and mechanisms among older Mexican adults.

BACKGROUND: Food insecurity (FI) remains a global public health problem. FI is more prevalent in low-and middle-income countries than high-income countries. FI is related with worse cognitive outcomes including cognitive function, cognitive decline, and cognitive impairment. Few studies have sought to identify how patterns of FI relate with cognitive function in old age and the potential mechanisms underlying this association. METHODS: Data from the 2015 and 2018 waves of the Mexican Health and Aging Study (n = 9,654, age 50+) were used in this study. Reports of FI in 2015 and 2018 were combined to create four patterns of FI groups: "persistently food secure", "became food secure", "became food insecure", and "persistently food insecure". Linear regression was used to estimate associations between patterns of FI and cognitive task performance. The mediating roles of depressive symptoms, body mass index, and chronic conditions were tested using Karlson, Holm, and Breen methodology. RESULTS: Approximately half of the sample were persistently food secure, 17% became food secure, 14% became FI, and 15% experienced persistent FI. When adjusting for demographic/socioeconomic confounders, persistent FI related with worse Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency performance compared to the persistently food secure. Becoming FI related with worse Verbal Learning, Visual Scanning, and Verbal Fluency. Mediation analyses provided support for depressive symptoms mediating associations between FI and poorer cognition, where 48% of the association between persistent FI and worse Verbal Recall performance was attributed to higher depressive symptoms. Becoming food secure was not associated with cognitive performance compared to the persistently food secure. CONCLUSIONS: FI may represent an important modifiable risk factor for poorer cognitive outcomes among older adults. Public health efforts should focus on providing stable food access to older adults, especially those living in poverty.

Memory and language cognitive data harmonization across the United States and Mexico.

INTRODUCTION: We used cultural neuropsychology-informed procedures to derive and validate harmonized scores representing memory and language across population-based studies in the United States and Mexico. METHODS: Data were from the Health and Retirement Study Harmonized Cognitive Assessment Protocol (HRS-HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex-Cog). We statistically co-calibrated memory and language domains and performed differential item functioning (DIF) analysis using a cultural neuropsychological approach. We examined relationships among harmonized scores, age, and education. RESULTS: We included 3170 participants from the HRS-HCAP (Mage = 76.6 [standard deviation (SD): 7.5], 60% female) and 2042 participants from the Mex-Cog (Mage = 68.1 [SD: 9.0], 59% female). Five of seven memory items and one of twelve language items demonstrated DIF by study. Harmonized memory and language scores showed expected associations with age and education. DISCUSSION: A cultural neuropsychological approach to harmonization facilitates the generation of harmonized measures of memory and language function in cross-national studies. HIGHLIGHTS: We harmonized memory and language scores across studies in the United States and Mexico.A cultural neuropsychological approach to data harmonization was used.Harmonized scores showed minimal measurement differences between cohorts.Future work can use these harmonized scores for cross-national studies of Alzheimer's disease and related dementias.

Does adding MRI and CSF-based biomarkers improve cognitive status classification based on cognitive performance questionnaires?

BACKGROUND: Cognitive status classification (e.g. dementia, cognitive impairment without dementia, and normal) based on cognitive performance questionnaires has been widely used in population-based studies, providing insight into the population dynamics of dementia. However, researchers have raised concerns about the accuracy of cognitive assessments. MRI and CSF biomarkers may provide improved classification, but the potential improvement in classification in population-based studies is relatively unknown. METHODS: Data come from the Alzheimer's Disease Neuroimaging Initiative (ADNI). We examined whether the addition of MRI and CSF biomarkers improved cognitive status classification based on cognitive status questionnaires (MMSE). We estimated several multinomial logistic regression models with different combinations of MMSE and CSF/MRI biomarkers. Based on these models, we also predicted prevalence of each cognitive status category using a model with MMSE only and a model with MMSE + MRI + CSF measures and compared them to diagnosed prevalence. RESULTS: Our analysis showed a slight improvement in variance explained (pseudo-R2) between the model with MMSE only and the model including MMSE and MRI/CSF biomarkers; the pseudo-R2 increased from .401 to .445. Additionally, in evaluating differences in predicted prevalence for each cognitive status, we found a small improvement in the predicted prevalence of cognitively normal individuals between the MMSE only model and the model with MMSE and CSF/MRI biomarkers (3.1% improvement). We found no improvement in the correct prediction of dementia prevalence. CONCLUSION: MRI and CSF biomarkers, while important for understanding dementia pathology in clinical research, were not found to substantially improve cognitive status classification based on cognitive status performance, which may limit adoption in population-based surveys due to costs, training, and invasiveness associated with their collection.

Development of a latent dementia index in the aging, demographics, and memory study: Validation and measurement invariance by sex.

Latent variable models can create a latent dementia index (LDI) using cognitive and functional ability to approximate dementia likelihood. The LDI approach has been applied across diverse cohorts. It is unclear whether sex affects its measurement properties. We use Wave A (2001-2003) of the Aging, Demographics, and Memory Study (n = 856). Multiple group confirmatory factor analysis (CFA) was used to test measurement invariance (MI) using informant-reported functional ability and cognitive performance tasks, which we group into verbal, nonverbal, and memory. Partial scalar invariance was found, allowing for testing sex differences in LDI means (MDiff = 0.38). The LDI correlated with consensus panel dementia diagnosis, Mini-Mental State Examination (MMSE), and dementia risk factors (low education, advanced age, and apolipoprotein ε4 [APOE-ε4] status) for men and women. The LDI validly captures dementia likelihood to permit estimation of sex differences. LDI sex differences indicate higher dementia likelihood in women, potentially due to social, environmental, and biological factors.

Gender, Personality, and Cognitive Resilience Against Early-Life Disadvantage.

OBJECTIVES: Early-life disadvantage (ELD) relates to lower late-life cognition. However, personality factors, including having an internal locus of control (LOC) or a conscientious personality, relate to resilience and effective stress coping. We explore whether personality factors convey resilience against the negative effects of ELD on cognition, by gender, in Mexico. METHODS: Using the 2015 Mexican Health and Aging Study, we estimated expected cognition using multiple ELD markers to identify a subsample in the lowest quartile of expected cognition given ELD (n = 2,086). In this subsample, we estimated cross-sectional associations between personality and having above-median observed cognitive ability (n = 522) using logistic regression. RESULTS: Among those in the lowest quartile of expected cognition, a more internal LOC (ß = 0.32 [men] and ß = 0.44 [women]) and conscientious personality (ß = 0.39 [men] and ß = 0.17 [women]) were significantly associated with having above-median cognitive ability in models adjusted for demographic confounders. Larger benefits of conscientiousness were observed for men than women. Associations between personality and having above-median cognitive ability remained statistically significant after further adjustment for health, stress, and cognitive stimulation variables, regardless of gender. DISCUSSION: Personality factors may convey resilience among individuals who experienced ELD, potentially breaking the link between ELD and worse late-life cognition. Structural factors and gender roles may affect how much women benefit from personality factors.

The Relationship Between Multimorbidity and Types of Chronic Diseases and Self-Rated Memory.

This study explores the impact of multimorbidity and types of chronic diseases on self-rated memory in older adults in the United States. Data were drawn from the 2011 wave of the National Health and Aging Trends Study (NHATS, N = 6,481). Logistic regressions were used to examine the associations between multimorbidity and types of chronic diseases and fair/poor self-rated memory. Compared to respondents with no or one chronic disease, respondents with multimorbidity showed 35% higher odds of reporting fair/poor self-rated memory. Also, stroke, osteoporosis, and arthritis were identified as increasing the odds of reporting fair/poor self-rated memory by 41%, 20%, and 30%, respectively. Demonstrating the importance of both multimorbidity and types of chronic diseases in self-reporting of memory, our findings suggest the need to educate older adults with multimorbidity and certain types of diseases regarding negative self-rated memory and its consequences.

Working in old age in Mexico: Implications for Cognitive Functioning.

Previous studies indicate that occupation might affect cognitive functioning in late life. As people in low and middle income countries often have to work until late life, we sought to investigate if there are cognitive benefits to working later into life and whether cognitive function deteriorates after exiting the labor force. We analyzed longitudinal data from the Mexican Health and Aging Study (MHAS), a nationally representative sample of Mexican adults age 50+ (n=7,375), that assessed cognitive functioning by verbal learning, delayed recall, and visual scanning. Analyses were carried out using mixed-effects modeling corrected for the influence of gender, IADLs, diabetes, stroke, hypertension, depression, income, and marital status. Results suggest that working actively, compared to exiting the workforce, was associated with cognitive performance only in context with occupation. Domestic workers had a faster decline in verbal learning (b=-0.02, p=0.020) and delayed recall (b=-0.02, p=0.036) if they continued working actively and people working in administration (b=0.03, p=0.007), sales (b=0.02, p=0.044), and educators (b=0.03, p=0.049) had a slower decline in visual scanning if they continued working in old age. Our findings indicate that continued participation in the labor force in old age does not necessarily come with cognitive benefits. Whether or not working actively in later life protects or even harms cognitive functioning is likely to depend on the type of job.

Food Insecurity across the Life-Course and Cognitive Function among Older Mexican Adults.

BACKGROUND: Food insecurity remains a global public health problem. Experiencing food insecurity is related to poorer cognitive function among older adults. However, few studies have examined how food insecurity, experienced over the life-course, relates to cognitive function among older adults in Mexico. METHODS: Data came from the 2015 Mexican Health and Aging Study (n = 11,507 adults aged 50 and over). Early- and late-life food insecurity were ascertained by self-report. We evaluated how both measures of food insecurity related to the performance of multiple cognitive tasks (Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency), while controlling for key health and sociodemographic confounders using linear regression. RESULTS: In descriptive analyses, respondents who experienced food insecurity in either early or late life performed significantly worse on all cognitive tasks when compared to the food secure. In models adjusted for health and sociodemographic confounders, early-life food insecurity predicted worse Verbal Learning performance and late-life food insecurity was associated with poorer Visual Scanning performance. CONCLUSIONS: Food insecurity was related to poorer cognitive function in a nationally representative sample of older adults in Mexico. However, results suggested that the significance of effects depended on cognitive task and when in the life-course food insecurity was experienced.

Rural/urban dwelling across the life-course and late-life cognitive ability in Mexico.

BACKGROUND: Urban advantages in older adults' cognitive function have been observed. Less is known about early-life urban dwelling and late-life cognition. We evaluate how rural/urban dwelling throughout life and rural to urban shifts in life relate with cognition in Mexico, a country experiencing aging and urbanization. METHODS: Data came from the 2003 and 2012 Mexican Health and Aging Study (n = 12,238 adults age 50+). Early-life urban dwelling was self-reported. Late-life urban dwelling was based on population size of respondents' community of residence (community 2500+ people) at the time of survey. Cognitive function was measured across several cognitive tasks. We assess differences in baseline cognitive function and nine-year decline across groups using a latent change score model. RESULTS: Cross-sectionally, compared to always rural dwellers, rural-urban transitions were associated with cognitive benefits, though individuals residing in urban areas continuously through life exhibited the highest levels of cognitive function (ß = 0.89, 95% CI: 0.83, 0.96) even after adjusting for SES, health, and health behaviors (ß = 0.28, 95% CI: 0.22, 0.35). Longitudinally, always urban dwellers exhibited slower decline than always rural dwellers when adjusting for baseline cognition (ß = 0.11, 95% CI: 0.03, 0.18), though faster decline when baseline cognition was not adjusted (ß = -0.11, 95% CI: -0.18, -0.04). No differences were observed for cognitive change across comparison groups after adjusting for potential mechanisms. CONCLUSIONS: Early- and late-life urban dwelling may result in cognitive advantages for older Mexican adults. Clinicians should consider where individuals resided throughout life to better understand a patient's likelihood of experiencing poor cognitive outcomes.

Effect of Demographic and Health Dynamics on Cognitive Status in Mexico between 2001 and 2015: Evidence from the Mexican Health and Aging Study.

Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

Household use of polluting cooking fuels and late-life cognitive function: A harmonized analysis of India, Mexico, and China.

INTRODUCTION: Exposure to high levels of air pollution is associated with poor health, including worse cognitive function. Whereas many studies of cognition have assessed outdoor air pollution, we evaluate how exposure to air pollution from combustion of polluting household fuels relates with cognitive function using harmonized data from India, Mexico, and China. MATERIALS & METHODS: We analyze adults age 50+ in three nationally representative studies of aging with common data collection methods: the 2017-2019 Longitudinal Aging Study in India (n = 50,532), 2015 Mexican Health and Aging Study (n = 12,883), and 2013 China Health and Retirement Longitudinal Study (n = 12,913). Use of polluting fuels was assessed by self-report of wood, coal, kerosene, crop residue, or dung for cooking. Cognitive function was measured by performance across several cognitive domains and summarized into a total cognition score. We used linear regression, by country, to test how polluting cooking fuel use relates with cognition adjusting for key demographic and socioeconomic factors. RESULTS: Approximately 47%, 12%, and 48% of respondents in India, Mexico, and China, respectively, relied primarily on polluting cooking fuel, which was more common in rural areas. Using polluting cooking fuels was consistently associated with poorer cognitive function in all countries, independent of demographic and socioeconomic characteristics. Adjusted differences in cognitive function between individuals using polluting and clean cooking fuel were equivalent to differences observed between individuals who were 3 years of age apart in Mexico and China and 6 years of age apart in India. Across countries, associations between polluting cooking fuel use and poorer cognition were larger for women. CONCLUSIONS: Results suggest that household air pollution from the use of polluting cooking fuel may play an important role in shaping cognitive outcomes of older adults in countries where reliance on polluting fuels for domestic energy needs still prevails. As these countries continue to age, public health efforts should seek to reduce reliance on these fuels.

Adult child socio-economic status disadvantage and cognitive decline among older parents in Mexico.

There is growing interest in the contribution of offspring educational attainment to parents' health outcomes. However, less is known about the impacts of offspring socio-economic status (SES) on parents' cognitive decline or about the role of offspring SES disadvantage. We used data from the Mexican Health and Aging Study (n = 10,426) to evaluate the impact of adult child SES disadvantage on parents' verbal memory trajectories over fourteen years (2001-2015). We estimated linear mixed models and used measures of adult child SES (educational, financial, and employment) disadvantage. Our most robust finding was that having an adult child with less than secondary education was associated with faster decline in verbal memory z-scores for older women (ß: -0.009 [95% CI: -0.01, -0.001]) and men (ß: -0.01 [95% CI: -0.02, -0.01]). Although poor adult child financial well-being was associated with a faster decline in parents' verbal memory z-scores, this finding was less consistent across model specifications. Additional analyses also suggested some evidence of heterogeneity by parents' own educational attainment and gender. These findings highlight the potential importance of children's socio-economic status for the cognitive aging of their older parents.

Solid cooking fuel use and cognitive decline among older Mexican adults.

Studies of air pollution and cognition often rely on measures from outdoor environments. Many individuals in low- and middle-income countries are exposed to indoor air pollution from combustion of solid cooking fuels. Little is known about how solid cooking fuel use affects cognitive decline over time. This study uses data from the 2012, 2015, and 2018 Mexican Health and Aging Study (n = 14 245, age 50+) to assess how use of wood or coal for cooking fuel affects cognition of older adults relative to use of gas. It uses latent change score modeling to determine how using solid cooking fuel affected performance in Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency. Solid cooking fuel was used by 17% of the full sample but was more common in rural areas. Solid fuel users also had lower socioeconomic status. Compared to those using gas, solid fuel users had lower baseline scores and faster decline in Verbal Learning (ß = -0.18, p < 0.05), Visual Scanning (ß = -1.00, p < 0.001), and Verbal Fluency (ß = -0.33, p < 0.001). Indoor air pollution from solid cooking fuels may represent a modifiable risk factor for cognitive decline. Policy should focus on facilitating access to clean cooking fuels.

Offspring Educational Attainment and Older Parents' Cognition in Mexico.

Population-level disparities in later-life cognitive health point to the importance of family resources. Although the bulk of prior work establishes the directional flow of resources from parents to offspring, the "linked lives" perspective raises the question of how offspring resources could affect parental health as well. This paper examines whether adult children's education influences older parents' (aged 50+) cognitive health in Mexico, where schooling reforms have contributed to significant gains in the educational achievements of recent birth cohorts. Harnessing a change in compulsory school laws and applying an instrumental variables approach, we found that each year of offspring schooling was associated with higher overall cognition among parents, but was less predictive across different cognitive functioning domains. More offspring schooling improved parents' cognitive abilities in verbal learning, verbal fluency, and orientation, but not in visual scanning, visuo-spatial ability, or visual memory. The beneficial effects of offspring schooling on those cognitive domains are more salient for mothers compared to fathers, suggesting potential gendered effects in the influence of offspring schooling. The results remained robust to controls for parent-child contact and geographic proximity, suggesting other avenues through which offspring education could affect parental health and a pathway for future research. Our findings contribute to growing research which stresses the causal influence of familial educational attainment on population health.

Educational Benefits and Cognitive Health Life Expectancies: Racial/Ethnic, Nativity, and Gender Disparities.

BACKGROUND AND OBJECTIVES: To examine racial/ethnic, nativity, and gender differences in the benefits of educational attainment on cognitive health life expectancies among older adults in the United States. RESEARCH DESIGN AND METHODS: We used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively healthy, cognitively impaired/no dementia, and dementia life expectancies by gender for older White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults with less than high school, high school, and some college or more. RESULTS: White respondents lived a greater percentage of their remaining lives cognitively healthy than their minority Black or Hispanic counterparts, regardless of level of education. Among respondents with some college or more, versus less than high school, Black and U.S.-born Hispanic women exhibited the greatest increase (both 37 percentage points higher) in the proportion of total life expectancy spent cognitively healthy; whereas White women had the smallest increase (17 percentage points higher). For men, the difference between respondents with some college or more, versus less than high school, was greatest for Black men (35 percentage points higher) and was lowest for U.S.-born Hispanic men (21 percentage points higher). DISCUSSION AND IMPLICATIONS: Our results provide evidence that the benefits of education on cognitive health life expectancies are largest for Black men and women and U.S.-born Hispanic women. The combination of extended longevity and rising prevalence of Alzheimer's disease points to the need for understanding why certain individuals spend an extended period of their lives with poor cognitive health.

Fertility History and Cognitive Function in Late Life: The Case of Mexico.

OBJECTIVES: Mexico is aging rapidly, which makes identification of life-course factors influencing cognition a public health priority. We evaluate how the number of children one has relates to cognition in Mexico, a rapidly aging country that experienced fertility declines across recent cohorts of older people. METHOD: We analyze older adults (age 50+, n = 11,380) from the 2015 Mexican Health and Aging Study. Respondents were categorized by number of children ever born (0-1, 2-3, 4-5, 6+). Using ordinary least squares regression, we estimate independent associations between fertility history and cognition accounting for demographic, socioeconomic, health, and psychosocial factors. RESULTS: We observed an inverse U-shaped relationship between number of children (peaking at 2-3 children) and cognitive function, regardless of gender. In regression analyses adjusted for confounding variables, having 0-1 (vs 2-3 children) was associated with poorer cognitive function only for females. Regardless of gender, having 6+ (vs 2-3 children) was associated with poorer cognitive function. These associations remained significant even after accounting for socioeconomic, health, employment, and psychosocial factors. DISCUSSION: Our results suggest fertility history may play a role in late-life cognitive health and provide evidence that both low and high fertility may relate to poorer cognitive function. We discuss differences by gender.

Spousal Support, Spousal Strain, and Loneliness in Older Mexican Couples.

OBJECTIVES: A growing body of research has identified factors related to loneliness among older adults. Fewer have investigated predictors of loneliness within married couples. This analysis investigates how spousal support and strain relate with loneliness within older couples (age 50+), and whether these associations are modified by functional limitation. The study focuses on Mexico, a country experiencing rapid aging occurring alongside historically limited institutional support for older adults, and where traditional gender roles extend to marriage. METHODS: The analytic sample consisted of 3,584 husband-wife dyads from the 2012 and 2015 Mexican Health and Aging Study. Loneliness was measured using the Three-Item Loneliness Scale. Associations between spousal support, strain, and loneliness were estimated within husband-wife dyads using the Actor-Partner Interdependence Model. RESULTS: Experiencing more spousal support was associated with less loneliness, whereas experiencing spousal strain was associated with more loneliness 3 years later among married adults. The associations between spousal support/strain and loneliness were stronger among husbands with limitations in activities of daily living (ADL) when compared to their counterparts without ADL limitations. DISCUSSION: Among married adults, spousal support and strain may be important factors to understand loneliness within marriage. Effects should be interpreted within the context of functional limitation.

Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population.

BACKGROUND/OBJECTIVES: Several longitudinal studies in high-income countries suggest that depression increases stroke risk. However, few prior studies have evaluated this association in low- and middle-income countries (LMICs), where rapidly aging populations may have markedly different vascular risk profiles. DESIGN: Prospective cohort study. SETTING: The Mexican Health and Aging Study is a national population-based study of older adults in Mexico. PARTICIPANTS: A total of 10,693 Mexican adults aged 50 and older enrolled in 2001 with no history of prior stroke. MEASUREMENTS: Depressive symptoms were assessed with a modified 9-item Centers for Epidemiologic Studies Depression Scale (elevated depressive symptom cutoff ≥5) in 2001 and 2003. We evaluated associations between baseline and short-term (2-year) changes in elevated depressive symptoms (categorized as stable low, recently remitted, recent-onset, or stable high symptoms) with incident self-reported or next-of-kin reported doctor-diagnosed stroke through 2015 using Cox proportional hazards models and sensitivity analyses applying inverse probability weights. RESULTS: Over an average follow-up of 11.4 years (standard deviation = 4.2), 10,693 respondents reported 546 incident strokes. Individuals with elevated baseline depressive symptoms experienced a moderately higher hazard of incident stroke (hazard ratio [HR] = 1.13; 95% confidence interval [CI] = .95-1.36) compared with those without elevated baseline depressive symptoms. In analyses of short-term changes in elevated depressive symptoms (n = 8,808; 414 incident stokes), participants with recent-onset (HR = 1.38; 95% CI = 1.06-1.81) or stable high (HR = 1.42; 95% CI = 1.10-1.84) elevated depressive symptoms had a greater hazard of incident stroke compared to those with stable low/no depressive symptoms, whereas recently remitted (HR = 1.01; 95% CI = .74-1.37) symptoms was not associated with stroke hazard. CONCLUSION: Strategies to reduce depressive symptoms merit evaluation as approaches to prevent stroke in middle-income countries. Findings are similar to those in high-income countries but should be replicated in other LMICs.