Adverse events in older adults and the risk of dementia and cognitive decline

Nilaweera, Dinuli; Gurvich, Caroline; Freak‐Poli, Rosanne; Woods, Robyn L.; Owen, Alice; Murray, Anne M.; Orchard, Suzanne G; Britt, Carlene; Wu, Zimu; McNeil, John J; Ryan, Joanne

doi:10.1016/j.jadr.2023.100592

Cited by 6 publications

(7 citation statements)

References 75 publications

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“…It has been reported that adverse events in late life, including the experience of major financial problems, were associated with increased risks of dementia among 12 789 community-dwelling Australians 70 years and older. 23 The experimental evidence has suggested that psychological stress may increase the activation of the hypothalamicpituitary-adrenal axis, inducing a dysregulation of glucocorticoid levels, which may increase brain vulnerability and pathological cognitive impairment. 24 Data from 2 previous studies using HRS data indicated that wealth loss induced an impairment in mental health, 25 and negative wealth shock was associated with short-term changes in depressive symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, negative wealth shock could be regarded as a stressful life-course event. It has been reported that adverse events in late life, including the experience of major financial problems, were associated with increased risks of dementia among 12 789 community-dwelling Australians 70 years and older . The experimental evidence has suggested that psychological stress may increase the activation of the hypothalamic-pituitary-adrenal axis, inducing a dysregulation of glucocorticoid levels, which may increase brain vulnerability and pathological cognitive impairment …”

Section: Discussionmentioning

confidence: 99%

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Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

Pan,

Gao,

Zhu

et al. 2023

JAMA Netw Open

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ImportanceAs a financial hardship, negative wealth shock has been implicated in some adverse health outcomes. However, associations between negative wealth shock and cognitive decline and dementia have not been examined.ObjectiveTo investigate whether negative wealth shock was associated with cognitive decline and incident dementia among middle-aged and older US adults.Design, Setting, and ParticipantsThe Health and Retirement Study (HRS) is a prospective cohort study conducted biennially among US adults older than 50 years. Data from the HRS from calendar years 1996 to 2020 were analyzed from July 1 to 31, 2023. The final sample included 8082 participants with complete data of interest.ExposuresWealth status was quantified with questionnaires. Negative wealth shock was defined as a loss of 75% or more in total wealth over a 2-year period. Asset poverty was defined as zero or less total net wealth.Main Outcomes and MeasuresCognitive function was assessed with the modified Telephone Interview for Cognitive Status (TICS-m). Dementia status was determined with TICS-m scores and proxy assessment.ResultsAmong 8082 participants included (mean [SD] age, 63.7 [5.7] years; 4179 women [51.7%] and 3903 men [48.3%]; 1111 Black [13.7%], 6689 White [82.7%], and 282 other [3.5%]), 1441 developed incident dementia over a median follow-up time of 14 (IQR, 7-20) years. Compared with participants who had positive wealth without shock, those with negative wealth shock had accelerated cognitive decline (β coefficient, −0.014 [95% CI, −0.027 to −0.001]; P = .03) and increased risks of dementia (hazard ratio [HR], 1.27 [95% CI, 1.11-1.46]; P &lt; .001). Higher dementia risks were also found in participants with asset poverty at baseline (HR, 1.61 [95% CI, 1.30-2.00]; P &lt; .001). Associations were found in White participants (HR, 1.34 [95% CI, 1.14-1.58]; P &lt; .001) and participants younger than 65 years (HR, 1.38 [95% CI, 1.13-1.68]; P = .001) but not in other races and ethnicities or those 65 years or older.Conclusions and RelevanceIn this cohort study, negative wealth shock was associated with accelerated cognitive decline and elevated risks of dementia among middle-aged and older US adults, with modifications by age and ethnicity. These findings should be confirmed by further prospective and interventional studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

Pan,

Gao,

Zhu

et al. 2023

JAMA Netw Open

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“…[9][10][11] Negative Life Events (NLE), such as severe illness, and financial problems, may be associated with increasing cognitive decline in older adults. [12][13][14] Late-life depression is a strong risk factor for normal subjects progressing to MCI 15 and dementia. 14 Several systematic reviews and meta-analyses of environmental risk factors for late-life depression have been published.…”

Section: Introductionmentioning

confidence: 99%

Distress Symptoms of Old Age and Mild Cognitive Impairment are Two Distinct Dimensions in Older Adults Without Major Depression

Tran-Chi,

Maes,

Nantachai

et al. 2024

PRBM

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Background Studies in old adults showed bidirectional interconnections between amnestic mild cognitive impairment (aMCI) and affective symptoms and that adverse childhood experiences (ACE) may affect both factors. Nevertheless, these associations may be confined to older adults with clinical depression. Aim To delineate the relationship between clinical symptoms of aMCI and affective symptoms in older adults without major depression (MDD) or dysfunctions in activities of daily living (ADL). Methods This case-control study recruited 61 participants with aMCI (diagnosed using Petersen’s criteria) and 59 older adults without aMCI and excluded subjects with MDD and ADL dysfunctions. Results We uncovered 2 distinct dimensions, namely distress symptoms of old age (DSOA), comprising affective symptoms, perceived stress and neuroticism, and mild cognitive dysfunctions, comprising episodic memory test scores, the total Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. A large part of the variance (37.9%) in DSOA scores was explained by ACE, negative life events (health and financial problems), a subjective feeling of cognitive decline, and education (all positively). ACE and NLE have a highly significant impact on the DSOA score and are not associated with aMCI or its severity. Cluster analysis showed that the diagnosis of aMCI is overinclusive because some subjects with DSOA symptoms may be incorrectly classified as aMCI. Conclusion The clinical impact is that clinicians should carefully screen older adults for DSOA after excluding MDD. DSOA might be misinterpreted as aMCI.

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“…Previous research has indicated that adverse childhood experiences (ACE), encompassing various forms of abuse (physical, emotional, and sexual), neglect (physical and emotional), and family dysfunctions, are significantly correlated with later cognitive impairments [9][10][11] . Negative Life Events (NLE), such as severe illness, and financial problems, may be associated with increasing cognitive decline in older adults [12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Distress symptoms of old age and mild cognitive impairment are two distinct dimensions in older adults without major depression: effects of adverse childhood experiences and negative life events

Tran-Chi,

Maes,

Nantachai

et al. 2023

Preprint

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BackgroundStudies in old adults showed bidirectional interconnections between amnestic mild cognitive impairment (aMCI) and affective symptoms and that adverse childhood experiences (ACE) may affect both factors. Nevertheless, these associations may be confined to older adults with clinical depression.AimsTo delineate the relationship between clinical symptoms of aMCI and affective symptoms in older adults without major depression (MDD) or dysfunctions in activities of daily living (ADL).MethodsThis case-control study recruited 61 participants with aMCI (diagnosed using Petersen’s criteria) and 59 older adults without aMCI and excluded subjects with MDD and ADL dysfunctions.ResultsWe uncovered 2 distinct dimensions, namely distress symptoms of old age (DSOA) comprising anxiety, depression, perceived stress and neuroticism scores, and mild cognitive dysfunctions (mCoDy) comprising episodic memory test scores, and the total Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. A large part of the variance (37.9%) in DSOA scores was explained by ACE, negative life events (health and financial problems), a subjective feeling of cognitive decline, and education (all positively). While ACE and NLE have a highly significant impact on the DSOA, they are not associated with the mCoDy scores. Cluster analysis showed that the diagnosis of aMCI is overinclusive because some subjects with DSOA symptoms may be incorrectly classified as aMCI.ConclusionsThe clinical impact is that clinicians should carefully screen older adults for DSOA after excluding MDD. DSOA might be misinterpreted as aMCI.

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Adverse events in older adults and the risk of dementia and cognitive decline

Cited by 6 publications

References 75 publications

Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

Distress Symptoms of Old Age and Mild Cognitive Impairment are Two Distinct Dimensions in Older Adults Without Major Depression

Distress symptoms of old age and mild cognitive impairment are two distinct dimensions in older adults without major depression: effects of adverse childhood experiences and negative life events

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