%0 Journal Article %J Ageing and Society %D 2023 %T Adult children's education and trajectories of episodic memory among older parents in the United States of America %A Pai, Manacy %A Lu, Wentian %A Xue, Baowen %K Adult children %K Cognition %K Education %K Marital Status %K socioeconomic status %X The purpose of this study is to assess the relationship between adult children's education and older parents’ cognitive health, and the extent to which this relationship is moderated by parents’ own socio-economic and marital statuses. Data using Waves 5 (2000) to 13 (2016) are drawn from the Health and Retirement Study (HRS), a nationally representative panel survey of individuals age 50 and above in the United States of America (USA). Older parents’ cognitive functioning is measured using episodic memory from Waves 5–13. Adult children's education is measured using years of schooling, on average, for all adult children of a respondent. Analyses based on multilevel linear growth curve modelling reveal that parents with well-educated adult children report higher memory score over time compared to their counterparts whose children are not as well-educated. We also find that the positive effect of children's education on parents’ cognitive health is moderated by parents’ own education, though not by their income, occupation or marital status. Our work contributes to the growing body of research on the ‘upward’ flow of resources model that assesses the ways in which personal and social assets of the younger generation shape the health and wellbeing of the older generation. Our findings are particularly relevant to the USA given the enduring linkage between socio-economic status and health, and the limited social and economic protection for those of lower social status. %B Ageing and Society %G eng %R 10.1017/S0144686X21000775 %0 Journal Article %J Arch Gerontol Geriatr %D 2023 %T The association between subjective cognitive decline and trajectories of objective cognitive decline: Do social relationships matter? %A Pai, Manacy %A Lu, Wentian %A Chen, Miaoqi %A Xue, Baowen %K Cognition %K Cognitive Dysfunction %K Humans %K Interpersonal Relations %K Memory, Episodic %K Neuropsychological tests %X

OBJECTIVES: We examine the association between subjective cognitive decline (SCD) and the trajectories of objective cognitive decline (OCD); and the extent to which this association is moderated by social relationships.

METHODS: Data come from waves 10 (2010) through 14 (2018) of the Health and Retirement Study, a nationally representative panel survey of individuals aged 50 and above in the United States. OCD is measured using episodic memory, and overall cognition. SCD is assessed using a baseline measure of self-rated memory. Social relationships are measured by social network size and perceived positive and negative social support. Growth curve models estimate the longitudinal link between SCD and subsequent OCD trajectories and the interactions between SCD and social relationship variables on OCD.

RESULTS: SCD is associated with subsequent OCD. A wider social network and lower perceived negative support are linked to slower decline in memory, and overall cognition. None of the social relationship variables, however, moderate the link between SCD and future OCD.

CONCLUSION: Knowing that SCD is linked to subsequent OCD is useful because at SCD stage, deficits are more manageable relative to those at subsequent stages of OCD. Future work on SCD and OCD should consider additional dimensions of social relationships.

%B Arch Gerontol Geriatr %V 111 %P 104992 %G eng %R 10.1016/j.archger.2023.104992 %0 Journal Article %J J Affect Disord %D 2023 %T Bidirectional association between depressive symptoms and mild cognitive impairment over 20 years: Evidence from the health and retirement study in the United States. %A Guo, Yunyun %A Pai, Manacy %A Xue, Baowen %A Lu, Wentian %X

BACKGROUND: Research examining the association between depressive symptoms and mild cognitive impairment (MCI) has yielded conflicting results. This study aimed to examine the bidirectional association between depressive symptoms and MCI, and the extent to which this bidirectional association is moderated by gender and education.

METHODS: Data come from the US Health and Retirement Study over a 20-year period (older adults aged ≥50 years). Competing-risks regression is employed to examine the association between baseline high-risk depressive symptoms and subsequent MCI (N = 9317), and baseline MCI and subsequent high-risk depressive symptoms (N = 9428). Interactions of baseline exposures with gender and education are tested.

RESULTS: After full adjustment, baseline high-risk depressive symptoms were significantly associated with subsequent MCI (SHR = 1.20, 95%CI 1.08-1.34). Participants with baseline MCI are more likely to develop subsequent high-risk depressive symptoms than those without baseline MCI (SHR = 1.16, 95%CI 1.01-1.33). Although gender and education are risk factors for subsequent depression and MCI, neither moderates the bidirectional association.

LIMITATIONS: Items used to construct the composite cognitive measure are limited; selection bias due to missing data; and residual confounding.

CONCLUSIONS: Our study found a bidirectional association between depressive symptoms and MCI. High-risk depressive symptoms are related to a higher risk of subsequent MCI; and MCI predicts subsequent high-risk depression. Though neither gender nor education moderated the bidirectional association, public health interventions crafted to reduce the risk of depression and MCI should pivot attention to older women and those with less formal education.

%B J Affect Disord %G eng %R 10.1016/j.jad.2023.06.046 %0 Journal Article %J BMC Public Health %D 2022 %T Comparing relationships between health-related behaviour clustering and episodic memory trajectories in the United States of America and England: a longitudinal study. %A Liao, Jing %A Scholes, Shaun %A Mawditt, Claire %A Mejía, Shannon T %A Lu, Wentian %K cognitive functioning %K Cross-country comparison %K ELSA %K Health-related behavior clustering %X

BACKGROUND: Health-related behaviours (HRBs) cluster within individuals. Evidence for the association between HRB clustering and cognitive functioning is limited. We aimed to examine and compare the associations between three HRB clusters: "multi-HRB cluster", "inactive cluster" and "(ex-)smoking cluster" (identified in previous work based on HRBs including smoking, alcohol consumption, physical activity and social activity) and episodic memory trajectories among men and women, separately, in the United States of America (USA) and England.

METHODS: Data were from the waves 10-14 (2010-2018) of the Health and Retirement Study in the USA and the waves 5-9 (2010-2018) of the English Longitudinal Study of Ageing in England. We included 17,750 US and 8,491 English participants aged 50 years and over. The gender-specific HRB clustering was identified at the baseline wave in 2010, including the multi-HRB (multiple positive behaviours), inactive and ex-smoking clusters in both US and English women, the multi-HRB, inactive and smoking clusters in US men, and only the multi-HRB and inactive clusters in English men. Episodic memory was measured by a sum score of immediate and delayed word recall tests across waves. For within country associations, a quadratic growth curve model (age-cohort model, allowing for random intercepts and slopes) was applied to assess the gender-stratified associations between HRB clustering and episodic memory trajectories, considering a range of confounding factors. For between country comparisons, we combined country-specific data into one pooled dataset and generated a country variable (0 = USA and 1 = England), which allowed us to quantify between-country inequalities in the trajectories of episodic memory over age across the HRB clusters. This hypothesis was formally tested by examining a quadratic growth curve model with the inclusion of a three-way interaction term (age × HRB clustering × country).

RESULTS: We found that within countries, US and English participants within the multi-HRB cluster had higher scores of episodic memory than their counterparts within the inactive and (ex-)smoking clusters. Between countries, among both men and women within each HRB cluster, faster declines in episodic memory were observed in England than in the USA (e.g., b  = -0.05, 95%CI: -0.06, -0.03, b  = -0.06, 95%CI: -0.07, -0.04). Additionally, the range of mean memory scores was larger in England than in the USA when comparing means between two cluster groups, including the range of means between inactive and multi-HRB cluster for men (b  = -0.56, 95%CI: -0.85, -0.27), and between ex-smoking and multi-HRB cluster for women (b  = -1.73, 95%CI: -1.97, -1.49).

CONCLUSIONS: HRB clustering was associated with trajectories of episodic memory in both the USA and England. The effect of HRB clustering on episodic memory seemed larger in England than in the USA. Our study highlighted the importance of being aware of the interconnections between health behaviours for a better understanding of how these behaviours affect cognitive health. Governments, particularly in England, could pay more attention to the adverse effects of health behaviours on cognitive health in the ageing population.

%B BMC Public Health %V 22 %P 1367 %G eng %N 1 %R 10.1186/s12889-022-13785-7 %0 Journal Article %J Journal of Affective Disorders %D 2021 %T Do depressive symptoms link chronic diseases to cognition among older adults? Evidence from the Health and Retirement Study in the United States. %A Lu, Wentian %A Pai, Manacy %A Shaun Scholes %A Xue, Baowen %K Chronic condition %K cognitive aging %K depression %K Psychological condition %X

BACKGROUND: Few studies have assessed psychological pathways that connect the association between non-psychotropic chronic disease and cognition. We assessed the extent to which the association between the two was mediated by depressive symptoms in older adults.

METHODS: Data came from waves 10-13 (2010-2016) of the Health and Retirement Study in the United States (7,651 men and 10,248 women). Multilevel path analysis, allowing for random intercepts and slopes, was employed to estimate the extent to which depressive symptoms mediated the total effect of a chronic disease on cognition.

RESULTS: We found that the presence of stroke, high blood pressure, diabetes, heart problems, and comorbidity, in both men and women, and lung disease in women, was associated with lower levels of cognition. The total effects of chronic diseases on cognition were partially mediated through depressive symptoms. Depressive symptoms mediated approximately 19%-39% and 23%-54% of the total effects of chronic diseases on cognition in men and women, respectively.

LIMITATIONS: We relied on self-reported diagnoses of diseases and depressive symptoms. Our use of a multilevel path analysis with random slopes precluded the inclusion of binary/categorical dependent variables, and the estimation of standardized beta values.

CONCLUSIONS: To understand the cognitive challenges that chronically ill older adults face, practitioners and policymakers should consider not just the direct symptoms related to chronic diseases, but also the often overlooked psychological conditions faced by older adults.

%B Journal of Affective Disorders %V 294 %P 357-365 %G eng %R 10.1016/j.jad.2021.07.012