The version presented here may differ from the published version. If citing, you are advised to consult the published version for pagination, volume/issue and date of publication Highlights • Trump voters are more concerned about vaccines than other Americans • This effect emerges via Trump voters' greater willingness to believe conspiracies • Reading Trump's antivaxx tweets increases vaccination concern among Trump voters • Trump's antivaxx tweets did not polarize liberal voters into being more provaxx RUNNING HEAD: Donald Trump and vaccination Donald Trump and vaccination:The effect of political identity, conspiracist ideation and presidential tweets on vaccine hesitancy

Objective To identify the components of the neuroticism trait most responsible for its association with cognitive decline and dementia in old age. Design Longitudinal clinical-pathologic cohort study. Setting Chicago metropolitan area. Participants 785 older persons without dementia who completed standard self report measures of 6 components of neuroticism and then had annual clinical evaluations for a mean of 3.4 years and brain autopsy in the event of death. Measurements Incidence of clinically diagnosed Alzheimer's disease, change in global and specific cognitive functions, and postmortem measures of plaques and tangles, cerebral infarction, and Lewy bodies. Results During follow-up, 94 individuals developed Alzheimer's disease. Higher levels of anxiety and vulnerability to stress were associated with increased risk of Alzheimer's disease and more rapid decline in global cognition with no effects for the other four trait components. In analyses of specific cognitive systems, neuroticism subscales were related to decline in episodic memory, working memory, and perceptual speed but not semantic memory or visuospatial ability. No component of neuroticism was related to the neuropathologic lesions most commonly associated with late life dementia. Conclusions Neuroticism's association with late life dementia mainly reflects vulnerability to stress and anxiety and their correlation with decline in the ability to process and retain new information.

Existing evidence suggests that psychosocial stress is associated with cognitive impairment in older adults. Perceived discrimination is a persistent stressor in African Americans that has been associated with several adverse mental and physical health outcomes. To our knowledge, the association of discrimination with cognition in older African Americans has not been examined. In a cohort of 407 older African Americans without dementia (mean age = 72.9; SD = 6.4), we found that a higher level of perceived discrimination was related to poorer cognitive test performance, particularly episodic memory (estimate = −0.03; SE = .013; p < .05) and perceptual speed tests (estimate = −0.04; SE = .015; p < .05). The associations were unchanged after adjusting for demographics and vascular risk factors, but were attenuated after adjustment for depressive symptoms (Episodic memory estimate = −0.02; SE = 0.01; Perceptual speed estimate = −0.03; SE = 0.02; both p’s = .06). The association between discrimination and several cognitive domains was modified by level of neuroticism. The results suggest that perceived discrimination may be associated with poorer cognitive function, but does not appear to be independent of depressive symptoms.

The study addressed the hypothesis that late life cognitive decline leads to loss of well being. Participants are older persons from the Rush Memory and Aging Project. Beginning in 2001, they underwent annual clinical evaluations that included detailed cognitive performance testing and a 10-item self report measure of purpose in life, an aspect of well being. Initial analyses involved 1,049 individuals who were without dementia at baseline and followed a mean of 5.0 years. The intercepts and slopes of global cognition and purpose were positively correlated and level of cognition at a given evaluation predicted level of purpose at the subsequent evaluation, consistent with the study hypothesis. Purpose also predicted subsequent cognition. These findings persisted in analyses that excluded mild cognitive impairment or controlled for time varying levels of depressive symptoms or disability. To see if cognitive decline’s correlation with purpose differed from its correlation with other aspects of well being, we conducted additional analyses on a subgroup of 560 persons without dementia who completed a multidimensional measure of well being once between 2008 and 2011. More rapid cognitive decline in the period preceding well being assessment (mean = 5.5 years, standard deviation = 2.8) was associated with lower level of nearly all aspects of well being (5 of 6 measures), but the extent of the association varied across well being dimensions and was stronger for purpose than for self acceptance and autonomy. The results support the hypothesis that cognitive aging leads to diminished well being, particularly aspects such as purpose in life that involve behavioral regulation.