RESUMO
BACKGROUND/OBJECTIVES: Effective use of longitudinal study data is challenging because of divergences in the construct definitions and measurement approaches over time, between studies and across disciplines. One approach to overcome these challenges is data harmonization. Data harmonization is a practice used to improve variable comparability and reduce heterogeneity across studies. This study describes the process used to evaluate the harmonization potential of oral health-related variables across each survey wave. METHODS: National child cohort surveys with similar themes/objectives conducted in the last two decades were selected. The Maelstrom Research Guidelines were followed for harmonization potential evaluation. RESULTS: Seven nationally representative child cohort surveys were included and questionnaires examined from 50 survey waves. Questionnaires were classified into three domains and fifteen constructs and summarized by age groups. A DataSchema (a list of core variables representing the suitable version of the oral health outcomes and risk factors) was compiled comprising 42 variables. For each study wave, the potential (or not) to generate each DataSchema variable was evaluated. Of the 2100 harmonization status assessments, 543 (26%) were complete. Approximately 50% of the DataSchema variables can be generated across at least four cohort surveys while only 10% (n = 4) variables can be generated across all surveys. For each survey, the DataSchema variables that can be generated ranged between 26% and 76%. CONCLUSION: Data harmonization can improve the comparability of variables both within and across surveys. For future cohort surveys, the authors advocate more consistency and standardization in survey questionnaires within and between surveys.
RESUMO
BACKGROUND: Cognitive impairment after stroke is common and is present in up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of 2 stroke severity ratings and a caregiver-report of poststroke functioning with longitudinal cognitive outcomes. METHODS AND RESULTS: One hundred fifty-seven caregivers and stroke survivor dyads participated in the CARES (Caring for Adults Recovering From the Effects of Stroke) project, an ancillary study of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) national cohort study. The Glasgow Outcome Scale and modified Rankin Scale scores collected at hospitalization discharge were included as 2 primary predictors of cognitive impairment. The number of caregiver-reported problems and impairments at 9 months following stroke were included as a third predictor. Cognition was measured using a biennial telephone battery and included the domains of learning, memory, and executive functioning. Multiple cognitive assessments were analyzed up to 5 years poststroke, controlling for prestroke cognition and demographic variables of the stroke survivor. Separate mixed models showed significant main effects of the Glasgow Outcome Scale (b=0.3380 [95% CI, 0.14-0.5]; P=0.0009), modified Rankin Scale (b=-0.2119 [95% CI, -0.32 to -0.10]; P=0.0002), and caregiver-reported problems (b=-0.0671 [95% CI, -0.09 to -0.04]; P<0.0001) on longitudinal cognitive scores. In a combined model including all 3 predictors, only caregiver-reported problems significantly predicted cognition (b=-0.0480 [95% CI, -0.08 to -0.03]; P<0.0001). CONCLUSIONS: These findings emphasize the importance of caregiver feedback in predicting cognitive consequences of stroke.
Assuntos
Cuidadores , Cognição , Índice de Gravidade de Doença , Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Cuidadores/psicologia , Idoso , Acidente Vascular Cerebral/psicologia , Pessoa de Meia-Idade , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/diagnóstico , Escala de Resultado de Glasgow , Estados Unidos/epidemiologia , Fatores de Tempo , Fatores de Risco , Função Executiva , Testes NeuropsicológicosRESUMO
BACKGROUND: The Hispanic and Latinx community is disproportionately affected by Alzheimer disease and related dementias (ADRDs). In the United States, approximately 8.5 million caregivers of individuals with ADRDs identify as Hispanic and Latinx people, and caregiving-related stress and burden place caregivers at elevated risk for poor mental health outcomes, as well as loneliness and social isolation. To date, there is limited knowledge about the daily stress experiences of Hispanic and Latinx caregivers. Given this knowledge gap, it is critical to examine how personal, cultural, and contextual factors influence daily stress, mental health, and resilience over time among Hispanic and Latinx ADRD caregivers. OBJECTIVE: The goal of this protocol report is to present the rationale, methodology, planned analytical strategy, progress completed to date, and implications of future findings for "Nuestros Días" (Spanish for "our days"), a fully remote daily diary (DD), observational cohort study examining the day-to-day experiences of Hispanic and Latinx ADRD caregivers. METHODS: The study will recruit a cohort of up to 500 Hispanic and Latinx caregivers of individuals living with ADRD. Participants will complete measures assessing contextual, individual-level, and cultural factors at 3 intervals (enrollment, 6 months, and 12 months). Each of the timepoints will be followed by 21 days of DD surveys to report on daily stress, stress moderators, and mental health variables. RESULTS: Data collection began in March 2023 and is projected to end in December 2026. As of March 2024, we have enrolled 60 caregivers in the Nuestros Días study, 78.9% (n=15) of whom are Spanish speakers. The current completion rate for DD surveys is 79.4%, averaging approximately 18 surveys out of 21 completed. We expect to enroll 10 to 15 participants per month moving forward to achieve our enrollment goal. CONCLUSIONS: Results from this study will identify which Hispanic and Latinx ADRD caregivers, and under what circumstances, appear to be at the greatest risk of experiencing poor mental health outcomes over time. This study represents a critical step forward in providing key guidance to develop effective, culturally sensitive interventions to support the health and well-being of Hispanic and Latinx ADRD caregivers, a historically underrepresented and underserved population in aging and caregiving research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55216.
Assuntos
Cuidadores , Demência , Hispânico ou Latino , Humanos , Hispânico ou Latino/psicologia , Cuidadores/psicologia , Estudos de Coortes , Demência/psicologia , Demência/etnologia , Feminino , Masculino , Estresse Psicológico/psicologia , Pessoa de Meia-Idade , Idoso , Estados Unidos/epidemiologia , Adulto , Diários como AssuntoAssuntos
Acidente Vascular Cerebral , Humanos , Idoso , Masculino , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Feminino , Cognição/fisiologia , Estados Unidos/epidemiologia , Limitação da Mobilidade , Negro ou Afro-Americano/estatística & dados numéricos , Negro ou Afro-Americano/psicologia , População Branca/estatística & dados numéricos , População Branca/psicologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND OBJECTIVES: Ultra-processed foods (UPFs) are linked to cardiometabolic diseases and neurologic outcomes, such as cognitive decline and stroke. However, it is unclear whether food processing confers neurologic risk independent of dietary pattern information. We aimed to (1) investigate associations between UPFs and incident cognitive impairment and stroke and (2) compare these associations with other commonly recommended dietary patterns in the REasons for Geographic and Racial Differences in Stroke study. This prospective, observational cohort study enrolled Black and White adults in the United States from 2003 to 2007. METHODS: The NOVA system was used to categorize items from a baseline food frequency questionnaire according to the level of processing. Participants with incomplete or implausible self-reported dietary data were excluded. Consumption for each category (grams) was normalized to total grams consumed. Scores quantifying adherence to a Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet were also calculated. Incident cognitive impairment was defined using performance relative to a normative sample on memory and fluency assessments. Incident stroke was identified through adjudicated review of medical records. RESULTS: The cognitive impairment cohort (n = 14,175) included participants without evidence of impairment at baseline who underwent follow-up testing. The stroke cohort (n = 20,243) included participants without a history of stroke. In multivariable Cox proportional hazards models, a 10% increase in relative intake of UPFs was associated with higher risk of cognitive impairment (hazard ratio [HR] = 1.16, 95% CI 1.09-1.24, p = 1.01 × 10-5) and intake of unprocessed or minimally processed foods with lower risk of cognitive impairment (HR = 0.88, 95% CI 0.83-0.94, p = 1.83 × 10-4). Greater intake of UPFs (HR = 1.08, 95% CI 1.02-1.14, p = 1.12 × 10-2) and unprocessed or minimally processed foods (HR = 0.91, 95% CI 0.86-0.95, p = 2.13 × 10-4) were also associated with risk of stroke in multivariable Cox models. The effect of UPFs on stroke risk was greater among Black than White participants (UPF-by-race interaction HR = 1.15, 95% CI 1.03-1.29, p = 1.50 × 10-2). Associations between UPFs and both cognitive impairment and stroke were independent of adherence to the Mediterranean, DASH, and MIND diets. DISCUSSION: Food processing may be important to brain health in older adults independent of known risk factors and adherence to recommended dietary patterns.
Assuntos
Fast Foods , Acidente Vascular Cerebral , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Fast Foods/efeitos adversos , População Branca , Estados Unidos/epidemiologia , Dieta Mediterrânea , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Estudos de Coortes , Abordagens Dietéticas para Conter a Hipertensão , Incidência , Fatores de Risco , Adulto , Manipulação de Alimentos , Alimento ProcessadoRESUMO
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 scoresâ ≥â 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]â =â 1.20, pâ <â .001; HRS: ORâ =â 1.14, pâ =â .044) and fewer instrumental activities of daily living limitations (PREHCO: ORâ =â 0.79, pâ =â .019; HRS: ORâ =â 0.58, pâ =â .077; cognitive resilience), fewer activities of daily living limitations (PREHCO: ORâ =â 0.72, pâ =â .031; HRS: ORâ =â 0.67, pâ =â .068; physical resilience), and fewer depressive symptoms (PREHCO: ORâ =â 0.84, pâ =â .015; HRS: ORâ =â 0.69, pâ =â .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.
Assuntos
Hispânico ou Latino , Resiliência Psicológica , Humanos , Masculino , Feminino , Hispânico ou Latino/estatística & dados numéricos , Hispânico ou Latino/psicologia , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Idoso , Memória Episódica , Envelhecimento/psicologia , Envelhecimento/etnologia , Atividades Cotidianas/psicologia , Escolaridade , Nível de Saúde , Estados Unidos/epidemiologiaRESUMO
We examined transdiagnostic and posttraumatic stress disorder (PTSD)-specific associations with multiple forms of trauma exposure within a nationwide U.S. sample (N = 1,649, 50.0% female) of military veterans overselected for PTSD. A higher-order Distress factor was estimated using PTSD, major depressive disorder (MDD), and generalized anxiety disorder (GAD) symptoms as indicators. A structural equation model spanning three assessment points over an average of 3.85 years was constructed to examine the unique roles of higher-order Distress and PTSD-specific variance in accounting for the associations between trauma exposure, measured using the Life Events Checklist (LEC) and Deployment Risk and Resiliency Inventory Combat subscale (DRRI-C), and psychosocial impairment. The results suggest the association between trauma exposure and PTSD symptoms was primarily mediated by higher-order distress (70.7% of LEC effect, 63.2% of DRRI-C effect), but PTSD severity retained a significant association with trauma exposure independent of distress, LEC: ß = .10, 95% CI [.06, .13]; DRRI-C: ß = .11, 95% CI [.07, .14]. Both higher-order distress, ß = .31, and PTSD-specific variance, ß = .36, were necessary to account for the association between trauma exposure and future impairment. Findings suggest that trauma exposure may contribute to comorbidity across a range of internalizing symptoms as well as to PTSD-specific presentations.
Assuntos
Transtornos de Ansiedade , Transtorno Depressivo Maior , Transtornos de Estresse Pós-Traumáticos , Veteranos , Humanos , Feminino , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Masculino , Adulto , Veteranos/psicologia , Veteranos/estatística & dados numéricos , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/diagnóstico , Estados Unidos/epidemiologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Pessoa de Meia-Idade , Acontecimentos que Mudam a Vida , Angústia PsicológicaRESUMO
BACKGROUND: Life-space mobility, which measures the distance, frequency, and independence achieved as individuals move through their community, is one of the most important contributors to healthy aging. The University of Alabama at Birmingham Life-Space Assessment (LSA) is the most commonly used measure of life-space mobility in older adults, yet U.S. national norms for LSA have not previously been reported. This study reports such norms based on age and sex among community-dwelling older adults. METHODS: A cross-sectional analysis using data from the national REasons for Geographic and Racial Disparities in Stroke cohort study. LSA data were available for 10 118 Black and White participants over age 50, which were grouped by age (in 5-year increments) and sex, weighted for the U.S. national population. Correlations were calculated between LSA and measures of functional and cognitive impairment and physical performance. RESULTS: The weighted mean LSA ranged from 102.9 for 50-54-year-old males to 69.5 for males aged 85 and older, and from 102.1 for 50-54-year-old females to 60.1 for females aged 85 and older. LSA was strongly correlated with measures of timed walking, activities of daily living, cognition, depressive symptoms, and quality of life (all p < .001). CONCLUSIONS: We report U.S. national norms for LSA among community-dwelling Black and White older adults. These norms can serve as a reference tool for determining if clinical and research samples have greater or lesser life-space mobility than typical older adults in the United States for their age and sex.
Assuntos
Atividades Cotidianas , Vida Independente , Qualidade de Vida , Idoso , Feminino , Humanos , Masculino , População Negra/estatística & dados numéricos , Estudos de Coortes , Estudos Transversais , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Vida Independente/estatística & dados numéricos , População Branca/estatística & dados numéricos , Idoso de 80 Anos ou maisRESUMO
Objective: Cognitive impairment after stroke is common, present up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of two stroke severity ratings and a caregiver-report of post-stroke functioning with longitudinal cognitive outcomes. Methods: The analysis was conducted on 157 caregivers and stroke survivor dyads who participated in the Caring for Adults Recovering from the Effects of Stroke (CARES) project, an ancillary study of the REasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort study. Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) collected at hospitalization discharge were included as two primary predictors of cognitive impairment. The number of caregiver-reported problems and impairments at nine months following stroke were included as a third predictor. Cognition was assessed using a biennial telephone battery, incorporating multiple cognitive assessments to assess learning, memory, and executive functioning. Longitudinal cognitive scores were analyzed up to five years post-stroke, controlling for baseline (pre-stroke) cognitive scores and demographic variables of each stroke survivor collected at CARES baseline. Results: Separate mixed models showed significant main effects of GOS (b=0.3280, p=0.0009), mRS (b=-0.2119, p=0.0002), and caregiver-reported impairments (b=-0.0671, p<0.0001) on longitudinal cognitive scores. In a combined model including all three predictors, only caregiver-reported problems significantly predicted cognitive outcomes (b=-0.0480, p<0.0001). Impact: These findings underscore the importance of incorporating caregivers feedback in understanding cognitive consequences of stroke.
RESUMO
BACKGROUND: Dental caries is the most common childhood disease worldwide. In the mid-1960s, mandatory Community Water Fluoridation (CWF) was introduced in the Republic of Ireland (RoI) aimed at reducing the prevalence and severity of dental caries in the population. In 2017, approximately, 71% of the Irish population was supplied with fluoridated drinking water. OBJECTIVES: To review all children's dental health surveys at National, Regional and County-levels conducted in the Republic of Ireland from 1950 to 2021 and describe trends in dental caries prevalence. The secondary objective was to compare dental caries experience in children living in areas with and without CWF. METHODS: Seven databases (Embase, Medline Ovid, PubMed, Cochrane, Web of Science, Scopus and Lenus Ireland) were systematically searched followed by lateral searches from reference lists. Studies reporting the caries experience of Irish children were eligible for inclusion. Two authors independently evaluated the quality of included studies using the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS: Thirty-one studies were included. Over the last 70 years, at National, Regional and County levels, mean dmft/DMFT (decayed, missing and filled teeth) scores have decreased and the percentage of caries-free children has increased in 5, 8, 12, and 15-year-olds. The decline in dental caries indices observed throughout the country was greater in children living in areas with CWF. Between the 1960s and 2002, the mean dmft scores for 5-year-olds living in the RoI were reduced by approximately 82% and 69% for the fluoridated and non-fluoridated groups respectively. Reduction in the mean DMFT scores for the 12-year-olds were 75% and 71%, respectively, for the fluoridated and non-fluoridated groups. Between 1961 and 2014, reductions in the mean dmft/DMFT scores among 5 and 12-years-olds living in County Dublin were approximately 88% and 90% respectively. These results should be interpreted in the context of widespread use of fluoridated toothpaste in the RoI. CONCLUSIONS: Large reductions in the prevalence of dental caries in Irish children have been observed over the last seven decades. Greater dental caries reductions have been reported among children living in areas with CWF compared to those without CWF.
Assuntos
Cárie Dentária , Fluoretação , Criança , Pré-Escolar , Humanos , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Irlanda/epidemiologia , PrevalênciaRESUMO
Objectives: To investigate the longitudinal association of life space and neighborhood and built environment (NBE) with subjective memory among individuals 65 and older, and the mediating role of depressive symptoms, a major correlate of life space mobility, NBE, and subjective memory. Methods: We examined community-dwelling participants in the Advanced Cognitive Training for Independent and Vital Elderly study (N = 2,622, Mean age = 73.7 years, 24.9% Black) across annual assessments of up to 3 years. Results: Baseline life space and NBE were positively associated with subjective memory, and these associations were partly mediated by depressive symptoms. Over time, higher baseline life space predicted a better subjective memory as one aged. Life space was concurrently associated with subjective memory across time, mediated by concurrent depressive symptoms. Discussion: Potentially modifiable environmental factors such as life space and NBE appear to influence level and change in subjective memory as we age. Interventions supporting movement in our environments may help offset subjective memory problems, a potential early sign of dementia.
Assuntos
Vida Independente , Características de Residência , Idoso , Humanos , Transtornos da Memória/diagnósticoRESUMO
We used item response theory (IRT) analysis to examine Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) item performance using data from three large samples of veterans (total N = 808) using both binary and ordinal rating methods. Relative to binary ratings, ordinal ratings provided good coverage from well below to well above average within each symptom cluster. However, coverage varied by cluster, and item difficulties were unevenly distributed within each cluster, with numerous instances of redundancy. For both binary and ordinal scores, flashbacks, dissociative amnesia, and self-destructive behavior items showed a pattern of high difficulty but relatively poor discrimination. Results indicate that CAPS-5 ordinal ratings provide good severity coverage and that most items accurately differentiated between participants by severity. Observed uneven distribution and redundancy in item difficulty suggest there is opportunity to create an abbreviated version of the CAPS-5 for determining PTSD symptom severity, but not DSM-5 PTSD diagnosis, without sacrificing precision.
RESUMO
Objectives: Processing speed is essential to functional independence in later life, such as driving a vehicle. Few studies have examined processing speed and driving mobility in the context of racial differences and social determinants of health (SDoH). This study characterized the longitudinal association between processing speed and driving mobility, and how it varied by race and SDoH. Methods: Using data from the control arm of the Advanced Cognitive Training in Vital Elderly study (n = 581, 24.5% Black), multilevel models examined longitudinal associations between processing speed and driving mobility outcomes (driving space, exposure, and difficulty). Race and SDoH moderations were explored. Results: Decline in processing speed measures was associated with increased self-reported driving difficulty, but only for older adults with below-average to average scores for neighborhood and built environments and social community context SDoH domains. Discussion: Findings emphasize the influence of physical and social environmental characteristics on processing speed and driving mobility.
Assuntos
Condução de Veículo , Velocidade de Processamento , Características de Residência , Idoso , Humanos , Autorrelato , Inquéritos e Questionários , Determinantes Sociais da SaúdeRESUMO
Objective: We examined whether social determinants of health (SDoH) are associated with Alzheimer's disease and related dementias (ADRD) risk and the effects of cognitive training over a 20-year follow-up period. Methods: Data were obtained from 1605 participants in ACTIVE. SDoH measures were created using baseline data at the individual and neighborhood level. Incident ADRD was defined using administrative claims data (1999-2019). Cause-specific hazard models estimated associations between SDoH and claims-based diagnosed ADRD. Results: Higher scores on neighborhood and built environment were associated with lower ADRD risk. Trained participants obtained a greater degree of protection from ADRD when they had higher scores for SDoH domains associated with health care and education access. However, there were fewer significant SDoH moderation effects on cognitive training than expected. Discussion: Future work should continue to explore culturally tailored cognitive training interventions to reduce ADRD risk associated with SDoH that disproportionately affects racially diverse aging populations.
Assuntos
Doença de Alzheimer , Treino Cognitivo , Humanos , Envelhecimento , Ambiente Construído , Determinantes Sociais da SaúdeRESUMO
OBJECTIVES: We assessed the relationships between pre- and post-morbid consumer credit history (credit scores, debts unpaid, or in collections) and classification of mild (or greater) cognitive impairment (MCI). METHODS: Generalized Estimating Equation models assessed pre-and post-morbid credit history and MCI risk among 1740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, linked to TransUnion consumer credit data. RESULTS: Each 50-point increase in credit score was associated with up to 8% lower odds of MCI in the next 3 years. In contrast, new unpaid collections over doubled the odds of having MCI in the next 3 years. MCI was associated with subsequent credit score declines and a 47%-71% greater risk of having a new unpaid collection in the next 4 years. DISCUSSION: Credit declines may signal risk for future MCI. MCI may lead to financial challenges that warrant credit monitoring interventions for older adults.
Assuntos
Disfunção Cognitiva , Treino Cognitivo , Crédito e Cobrança de Pacientes , Idoso , Humanos , Disfunção Cognitiva/psicologiaRESUMO
OBJECTIVE: We sought to factor analyze a broad array of aggression measures to identify a comprehensive, coherent factor structure for this construct. BACKGROUND: Measures and models of trait aggression have multiplied to the point of incoherence. METHOD: In Study 1, a diverse sample of 922 undergraduates completed a battery of items acquired from 42 self-report aggression questionnaires. In Study 2, we administered a curated item pool to another diverse sample of 1447 undergraduates, alongside criterion measures. RESULTS: We curated an initial item pool of 734 items down to 289 items that exhibited sufficient variability, were not redundant with other items, and possessed strong loadings onto a central 'trait aggression' factor. These remaining items were best characterized by a six-factor structure, which captured relational, angry, violent, retaliatory, intimate partner, and alcohol forms of aggression. We estimated their hierarchical structure, correlations with their original aggression scales, Five Factor Model trait dimensions, impulsivity facets, and found them to be robust to gender composition and the inclusion of alcohol-naive and intimate-partner-naive participants. CONCLUSIONS: This factor structure mostly supported widely-accepted models of aggressive personality that focus on its overt and relational forms and reactive functions, though proactive aggression only loosely emerged as a distinct entity. We retained the final items as the Comprehensive Aggression Scale (CAS).
RESUMO
Background Non-Hispanic Black adults have a higher proportion of vascular cognitive impairment and Alzheimer's disease and related dementias compared with non-Hispanic White adults that may be due to differences in the burden of cerebral small vessel disease and risk alleles for Alzheimer's disease and related dementias. We describe here the methods of an ancillary study to the REGARDS (Reason for Geographic and and Racial Difference in Stroke) study, which will examine the role of magnetic resonance imaging markers of cerebral small vessel disease and vascular as well as genetic risk factors for Alzheimer's disease and related dementias in racial disparity in the prevalence and trajectory of vascular cognitive impairment and dementia in non-Hispanic White and non-Hispanic Black participants. Methods In participants with no prior history of stroke who had an incident stroke or transient ischemic attack after enrollment in the study, magnetic resonance imaging scans will be evaluated using the Standards for Reporting Vascular Changes on Neuroimaging international consensus criteria and automated analysis pipelines for quantification of cerebral small vessel disease. Participants will be genotyped for APOE ε4 and TREM2 risk alleles for Alzheimer's disease and related dementias. The 6-item screener will define global cognitive function and be the primary cognitive outcome. Conclusions With at least 426 non-Hispanic Black and 463 non-Hispanic White participants who have at least 2 prior and 2 poststroke or transient ischemic attack cognitive assessments, we will have at least 80% power to detect a minimum effect size of 0.09 SD change in Z score, with correction for as many as 20 tests (ie, at P<0.0025, after adjusting for up to 20 covariates) for cognitive decline.
Assuntos
Doença de Alzheimer , Doenças de Pequenos Vasos Cerebrais , Disfunção Cognitiva , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Adulto , Humanos , Alelos , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/genética , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/genéticaRESUMO
BACKGROUND: Retirement represents a crucial transitional period for many adults with possible consequences for cognitive aging. We examined trajectories of cognitive change before and after retirement in Black and White adults. METHODS: Longitudinal examination of up to 10 years (mean = 7.1 ± 2.2 years) using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study-a national, longitudinal study of Black and White adults ≥45 years of age. Data were from 2226 members of the REGARDS study who retired around the time when an occupational ancillary survey was administered. Cognitive function was an average of z-scores for tests of verbal fluency, memory, and global function. RESULTS: Cognitive functioning was stable before retirement (Estimate = 0.05, p = 0.322), followed by a significant decline after retirement (Estimate = -0.15, p < 0.001). The decline was particularly pronounced in White (Estimate = -0.19, p < 0.001) compared with Black (Estimate = -0.07, p = 0.077) participants, twice as large in men (Estimate = -0.20, p < 0.001) compared with women (Estimate = -0.11, p < 0.001), highest among White men (Estimate = -0.22, p < 0.001) and lowest in Black women (Estimate = -0.04, p = 0.457). Greater post-retirement cognitive decline was also observed among participants who attended college (Estimate = -0.14, p = 0.016). While greater work complexity (Estimate = 0.92, p < 0.05) and higher income (Estimate = 1.03, p < 0.05) were related to better cognitive function at retirement, neither was significantly related to cognitive change after retirement. CONCLUSION: Cognitive functioning may decline at an accelerated rate immediately post-retirement, more so in White adults and men than Black adults and women. Lifelong structural inequalities including occupational segregation and other social determinants of cognitive health may obscure the role of retirement in cognitive aging.
Assuntos
Envelhecimento Cognitivo , Disfunção Cognitiva , Masculino , Humanos , Feminino , Idoso , Aposentadoria , Estudos Longitudinais , Cognição , Disfunção Cognitiva/psicologia , Envelhecimento/psicologiaRESUMO
Chronic stress is associated with negative health outcomes, including poorer cognition. Some studies found stress from caregiving associated with worse cognitive functioning; however, findings are mixed. The present study examined the relationship between caregiving, caregiving strain, and cognitive functioning. We identified participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were family caregivers at baseline assessment and used propensity matching on 14 sociodemographic and health variables to identify matched noncaregivers for comparison. Data included up to 14 years of repeated assessments of global cognitive functioning, learning and memory, and executive functioning. Our results showed that when compared to noncaregivers, caregivers had better baseline scores on global cognitive functioning and word list learning (WLL). Among caregivers, a lot of strain was associated with better WLL and delayed word recall in the unadjusted model only. Caregivers with a lot of strain had higher depressive symptoms but not significantly higher high-sensitivity c-reactive protein (hsCRP) at baseline compared to caregivers with no or some strain after covariate adjustment. Although caregiving can be highly stressful, we found caregiving status and caregiving strain were not associated with cognitive decline. More methodologically rigorous studies are needed, and conclusions that caregiving has negative effects on cognition should be viewed with caution. (PsycInfo Database Record (c) 2023 APA, all rights reserved).