Background: Visual impairment could worsen sleep/wake disorders and cognitive decline. Objective: To examine interrelations among self-reported visual impairment, sleep, and cognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Miami-site. Method: HCHS/SOL Miami-site participants ages 45–74 years (n = 665) at Visit-1, who returned for cognitive test 7-years later (SOL-INCA). Participants completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), validated sleep questionnaires and test for obstructive sleep apnea (OSA) at Visit-1. We obtained verbal episodic learning and memory, verbal fluency, processing speed, and executive functioning at Visit-1 and at SOL-INCA. Processing speed/executive functioning were added to SOL-INCA. We examined global cognition and change using a regression-based reliable change index, adjusting for the time lapse between Visit-1 and SOL-INCA. We used regression models to test whether 1) persons with OSA, self-reported sleep duration, insomnia, and sleepiness have an increased risk for visual impairment, 2a) visual impairment is associated with worse cognitive function and/or decline, and 2b) sleep disorders attenuate these associations. Result: Sleepiness (β= 0.04; p < 0.01) and insomnia (β= 0.04; p < 0.001) were cross-sectionally associated with visual impairment, adjusting for sociodemographic characteristics, behavioral factors, acculturation, and health conditions. Visual impairment was associated with lower global cognitive function at Visit-1 (β= –0.16; p < 0.001) and on average 7-years later (β= –0.18; p < 0.001). Visual impairment was also associated with a change in verbal fluency (β= –0.17; p < 0.01). OSA, self-reported sleep duration, insomnia, and sleepiness did not attenuate any of the associations. Conclusion: Self-reported visual impairment was independently associated with worse cognitive function and decline.
The incidence of dementia is rapidly increasing. Identifying risk factors for dementia may help improve risk assessment, increase awareness for risk reduction, and identify potential targets for interventions. We use a life-course multi-disciplinary modeling framework to examine leading predictors of incident dementia (ID). We use the Health and Retirement Study (HRS) to measure 57 exposures across 7 different domains: (1) demographic, (2) adverse childhood socioeconomic and psychosocial, (3) adverse adulthood experiences, (4) adult socioeconomic status, (5) health behaviors, (6) social connections, and (7) adult psychological conditions. Our outcome is ID (over 8-years) operationalized using Langa-Weir classification for adults aged 65+ years who meet criteria for cognitively normal at the baseline when all exposures are measured (Nf 1,622 in testing set and Nf1,460 in validation set). We compare standard methods (Logistic regression) with machine learning (ML) approaches (Lasso, Random Forest) in identifying highly predictive exposures across the risk domains of interest. Standard methods identified lower education, childhood financial duress, and pessimism as among the leading factors associated with ID. Psychological factors explained the highest variance for ID, followed by adult socioeconomic and adverse childhood factors. However, ML techniques differed in their identification of (1) predictors and (2) factors predictive importance. The findings emphasize the importance of upstream risk factors and the long-reach of childhood experiences on cognitive health. The ML approaches highlight the importance of life-course multi-disciplinary frameworks for improving dementia risk assessment. Further investigations are needed to identify how complex interactions of life-course risk factors can be addressed through interventions.
BackgroundMany aging Hispanic/Latino persons are worried about memory loss. Prior research suggests that subjective cognitive decline (SCD) and depression, might have common pathways, and could be precursors to cognitive impairment. We examined associations between depression and domains of SCD in a large sample of diverse Hispanics/Latinos.MethodsData included n = 6,189 (unweighted) middle‐aged and older Hispanics/Latinos (Age M = 63.4‐years, SD = 8.2; 55% female; 40.5% with more than High School education) from 6‐heritage groups participating in the Study of Latinos‐Investigation of Neurocognitive Aging (SOL‐INCA), an ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We used survey generalized linear regression to model the associations between depressive symptoms, captured at baseline (2008‐2011) with the Center for Epidemiological Studies‐Depression 10‐Item Scale (CES‐D‐10), and SCD was measured, on average 7‐years later, via the Everyday Cognition Short‐Form (ECog‐12).ResultsHigher depressive symptoms at baseline were linked to worse global (B = .37, SE = .02) and domain specific SCD [Memory (B = .34, SE = .02), Visual Spatial Planning (B = .28, SE = .02), Executive (B = .33, SE = .02)] (ps<0.001) after adjusting for cardiovascular risk and demographic covariates. These associations were more pronounced in individuals who were concerned about their attention, concentration or memory. Hispanic/Latino background (i.e., Dominican, Central American, Cuban, Mexican, Puerto‐Rican, South American, Other) did not modify the associations between depression symptoms and measures of SCD (ps>0.05).ConclusionElevated depressive symptoms were consistently linked to global and domain specific subjective cognitive decline across Hispanics/Latinos of diverse heritages, particularly in the presence of attention, concentration or memory concerns. Our findings underscore the importance of assessing depression when evaluating Hispanics/Latinos with cognitive complaints.
BackgroundHearing impairment among Hispanics/Latinos has been associated with poorer cognition, potentially increasing mild cognitive impairment (MCI) and dementia risk. We aimed to examine associations between baseline hearing impairment with 1) cognition at visit 2 (7‐years later, on average), 2) 7‐year average change in cognition, and 3) mild cognitive impairment (MCI) at visit 2 among diverse Hispanics/Latinos.MethodHispanics/Latinos (n = 6031, average baseline age 56.4‐years) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were enrolled in the SOL ‐ Investigation of Neurocognitive Aging (SOL‐INCA) ancillary study. Hearing impairment was defined as a pure tone average (500, 1,000, 2,000, 4,000 Hz) >25 dBHL in the better ear. Cognitive testing was performed at Visit 1 and again an average of 7‐years later. Tests included measures of learning and memory, verbal fluency, and executive functioning and processing speed, and global cognition (a z‐score composite from averaging each test). MCI was calculated based on NIA‐AA criteria. Survey linear regressions were used to separately model the associations between hearing impairment with outcomes of interest, controlling for age, gender, education, Hispanic/Latino background, field center, marital status, depressive symptoms, income, and Framingham cardiovascular disease risk.ResultPerformance at visit 2: In fully adjusted models, hearing impairment at baseline was associated with lower scores in global cognition (B = ‐0.12; SE = 0.03; p<0.0001) evident in learning, memory and verbal fluency, but not executive function or processing speed at visit 2 (7 years later). 7‐year (average) cognitive change: Hearing impairment was associated with significant change (declines) in processing speed (B = ‐0.12; SE = 0.06; p<0.05) but not with change in global cognition or other cognitive domains. MCI: Hearing impairment was not associated with prevalent MCI.ConclusionWe found that hearing impairment was related to lower cognitive function and increased cognitive decline compared to Hispanics/Latinos with normal hearing. Hearing impairment was not associated with MCI among Hispanics/Latinos, and further longitudinal data are needed to determine if this holds as the cohort continues to age. Future studies should also examine comorbid sensory impairments and type of hearing impairments (noise induced hearing loss, conductive, sensorineural) with cognitive trajectories and MCI risk.
Abstract/ProposalBackgroundVisually impaired individuals may experience increased frequency of sleep/wake disorders, fragmented sleep, insomnia, and short sleep duration. Visual impairment and sleep disorders can have downstream effects on cognitive functioning.MethodSample included n = 590 (unweighted) HCHS/SOL Miami Field Center participants ages 45‐74 at baseline who returned for cognitive examination on average 7‐years later (SOL‐INCA). Participants completed validated ocular (National Eye Institute Visual Functioning Questionnaire; NEI‐VFQ), validated sleep questionnaires for sleepiness, insomnia, sleep duration and objective measures of sleep apnea visit‐1 (2008‐2011). They also completed a battery of neurocognitive tests for verbal episodic learning and memory (Brief Spanish English Verbal Learning Test), verbal fluency (Controlled Oral Word Association), processing speed and executive function (Digit Symbol Substitution) at visit‐1 and at SOL‐INCA. Two additional measures of processing speed/executive functioning were added at SOL‐INCA(Trails‐A, ‐B). We examined global cognitive performance and change using a regression‐based reliable change index, adjusting for the time lapse between visit 1 and SOL‐INCA (all measured in z‐score units). We used regression models to test whether (1) participants with sleep disorders have an increased risk for visual impairment, (2a) ocular health is associated with worse baseline and average 7‐years cognitive function and/or cognitive decline, and (2b) sleep attenuates any of these associations.ResultSleepiness (β = 0.04; p<0.01) and insomnia (β = 0.03; p<0.001) were linked to worse ocular health, and the associations were robust to adjustment for sociodemographic characteristics, acculturation, behavioral risk measures, and health conditions. Worse ocular health was linked to lower global cognitive function at baseline (β = ‐0.14; p<0.001) and on average 7‐years later (β = ‐0.16; p<0.01). The associations were consistent across all considered cognitive domains and robust to demographic adjustments. Ocular health was also associated with a change in verbal fluency (β = ‐0.17; p<0.05), but no change was observed in other cognitive domains. Sleep disorders did not attenuate any of the reported associations.ConclusionSelf‐reported ocular health was independently associated with worse language, memory, and executive function and predicted 7‐year cognitive decline in the language domain.
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