Perceived Everyday Discrimination and C- Reactive Protein Influence on Cognition of Older Black Adults

Black adults and women are more likely to experience serious cognitive decline in older age than their white and male counterparts. Evidence suggests perceived discrimination is associated with poor cognition in older adults, though the mechanisms remain unclear. Perceived discrimination has been linked to elevated inflammatory markers, such as C-reactive protein (CRP), which increases risk for worse cognitive functioning. Yet, little research has investigated whether CRP is implicated in the association between discrimination and cognition among Black older adults or if this relationship differs by gender. Using 2006-2016 data from Black adults ≥65 years old(N=1343) in the nationally representative Health and Retirement Study, random effects linear regression models (1) tested the association between discrimination and cognitive functioning; (2) explored whether this relationship differed for women and men; and (3) assessed whether elevated CRP mediated the association between discrimination and cognitive functioning. More frequent discrimination was associated with worse cognitive functioning (b= -0.24, SE=0.11, p<0.05), though gender did not moderate this relationship. Elevated CRP was significantly associated with worse cognitive functioning (b= 0.40, SE=0.18, p<0.05). Discrimination remained statistically significant in this model, indicating no mediation by CRP. Of note, inclusion of depressive symptoms and cardiometabolic conditions accounted for the association between both discrimination and CRP with cognitive functioning. These findings demonstrate the need for more within-group research on older Black adults documenting the complex relationship between discrimination, inflammation, and cognitive health. This approach will provide greater understanding of the biopsychosocial mechanisms underlying disparities in cognitive functioning in Black adults.

Effects of the Co-Occurrence of Diabetes and Tooth Loss on Cognitive Function

Using data from the 2006, 2012, and 2018 waves of the Health and Retirement Study, we estimated effects of co-occurrence of diabetes mellitus (DM) and complete tooth loss (CTL), both self-reported, on cognitive function among 10,816 adults age 50+. Cognitive function was measured using a shortened version of the Telephone Interview for Cognitive Status. Results from the fixed effects linear regression model show that in comparison to those with neither condition, adults having both DM and CTL had the worst cognitive function (b = 1.49, p < 0.001), followed by having CTL alone (b = 0.78, p < 0.001), and having DM alone (b = 0.42, p < 0.001). Our study suggests that CTL is a stronger risk factor for lower cognitive function than DM, and the co-occurrence of DM and CTL poses additive risk. Further research is needed to investigate the pathway from DM and CTL to poor cognition.

Survival Bias and Crosstalk between Chronological and Behavioral Age: Age- and Genotype-Sensitivity Tests Define Behavioral Signatures in Middle-Aged, Old, and Long-Lived Mice with Normal and AD-Associated Aging

New evidence refers to a high degree of heterogeneity in normal but also Alzheimer’s disease (AD) clinical and temporal patterns, increased mortality, and the need to find specific end-of-life prognosticators. This heterogeneity is scarcely explored in very old male AD mice models due to their reduced survival. In the present work, using 915 (432 APP23 and 483 C57BL/6 littermates) mice, we confirmed the better survival curves in male than female APP23 mice and respective wildtypes, providing the chance to characterize behavioral signatures in middle-aged, old, and long-lived male animals. The sensitivity of a battery of seven paradigms for comprehensive screening of motor (activity and gait analysis), neuropsychiatric and cognitive symptoms was analyzed using a cohort of 56 animals, composed of 12-, 18- and 24-month-old male APP23 mice and wildtype littermates. Most variables analyzed detected age-related differences. However, variables related to coping with stress, thigmotaxis, frailty, gait, and poor cognition better discriminated the behavioral phenotype of male APP23 mice through the three old ages compared with controls. Most importantly, non-linear age- and genotype-dependent behavioral signatures were found in long-lived animals, suggesting crosstalk between chronological and biological/behavioral ages useful to study underlying mechanisms and distinct compensations through physiological and AD-associated aging.

Abstract P202: Early To Midlife Smoking Trajectories And Cognitive Function In Middle Aged Us Adults: The Coronary Artery Risk Development In Young Adults Study

Introduction: Smoking starts in early adulthood and persists throughout the lifecourse, but the association between these trajectories and midlife cognition remains unclear. We assessed the hypothesis that individuals with a heavy smoking trajectory from early adulthood to midlife would be more likely to demonstrate poor cognition at midlife. Methods: We studied 3364 participants (mean age: 50.1±3.6, 56% female, 46% black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking trajectories were derived in latent class analysis among 1638 ever smokers based on smoking measures every 2-5 years from baseline (age 18-30, 1985-86) through Year 25 (2010-11). We estimated poor cognition using cognitive domain scores ≥1SD below the mean from tests of processing speed (Digit Symbol Substitution Test), executive function (Stroop) and memory (Rey Auditory Verbal Learning Test) at Year 25. Using adjusted logistic regression models, we examined the odds associated with poor midlife cognition and smoking trajectories (reference never smokers, n=1726) from early adulthood to midlife. Results: Five smoking trajectories emerged over 25-years: quitters (20%, 20/100), and minimal stable (40%, 40/100), moderate stable (20%, 20/100), heavy stable (15%, 15/100) and heavy declining smokers (5%, 5/100). As shown in the Figure, heavy stable smokers demonstrated poor cognition on all 3 domains compared to never smokers. Compared to never smokers, both heavy declining and moderate stable smokers exhibited slower processing speed, and heavy declining smokers additionally demonstrated poor executive function. For minimal stable smokers and quitters, no association was observed. Conclusions: In conclusion, we observed a dose-dependent association between early to midlife smoking and cognitive health risk at midlife. Our results underscore the cognitive health risk of moderate and heavy smoking trajectories in early and midlife periods and highlight the potential benefits of quitting, even in midlife.

Difficulties in reporting purpose and dosage of prescribed medications are associated with poor cognition and depression

Knowledge on prescribed medication is important for medication adherence. We determined the presence of cognitive impairment in neurological patients who report not to know reasons and dosages of their medication. Data from 350 patients were collected: sociodemographic data, German Stendal Adherence to Medication Score (SAMS), Montreal Cognitive Assessment (MoCA), and Beck Depression Inventory-II (BDI-II). Eighty-eight (29.0%) patients did not know the reasons for taking their prescribed medication and 83 (27.4%) did not know the doses. Sixty-three (20.8%) knew neither reasons nor dosage. The latter were characterized by higher nonadherence, higher number of prescribed medication per day, lower MoCA, higher BDI, and had more often a lower education level compared with patients who knew the reasons. The MANOVA revealed a significant multivariate effect for not knowing the reasons and not knowing the dosages of medication on MoCA and BDI. Significant univariate effects for not knowing reasons were found for depressive mood, but not for cognitive performance. Significant univariate effects for not knowing dosages were found for cognitive performance, but not for depressive mood. Inaccurate medication reporting is not solely associated with cognitive problems, but also with depression, which has to be taken into account in daily practice and research.

The Status Quo of Doctors’ Occupational Burnout and Its Correlation with the Cognition of Doctor-patient Relationship Tensity

IntroductionTo understand the status quo of doctors’ occupational burnout, analyze the correlation between the occupational burnout and cognition of tensity of doctor-patient relationship (DPR).Material and methodsTake 265 doctors in a general hospital in China as respondents, conduct a survey of the degree of occupational burnout with Maslach Burnout Inventory, score the cognitive quantification of DPR tensity with Difficult Doctor-Patient Relationship Questionnaire-8, and analyze the correlation between them. The cognitive quantitative scores of DPR tensity were also given to 782 inpatients and compared with the doctors’ cognitive scores.ResultsThe degrees of occupational burnout in doctors, including three dimensions of emotional exhaustion, depersonalization and sense of personal achievement, were high. The proportions of moderate or more burnout were 49.8%, 53.2% and 48.7%, respectively. There was a statistical difference in occupational burnout among doctors of different ages and professional titles (P<0.05). Doctors’ cognition of DPR tensity was significantly worse than patients’ cognition (P<0.01). The degrees of emotional exhaustion and dehumanization were positively correlated with the poor cognition of DPR tensity in doctors (P<0.001). The degree of sense of personal achievement was negatively correlated with the poor cognition in doctors (P<0.001).ConclusionsDoctors’ age and professional title are important factors that affect the high degree of occupational burnout. Doctors do not have positive cognition of DPR tensity, which is different from that of patiens. The degree of occupational burnout is closely related to the poor cognition of DPR tensity in doctors.

How Cognitive Impairment Affects Medication Management in Dental Settings

Mishandling medications is commonly seen in persons with dementia, which can lead to poor treatment outcome and serious complications. Whether individuals with cognitive impairment can appropriately manage dental-related medication remains unknown, raising a liability concern for dentists who fail to recognize the patients at risk for mishandling their medications. To address this concern, we conducted a study with 51 participants with various cognitive impairment to describe their ability to handle dental-related medications. After cognitive assessment, participants were asked to set up an antibiotics pill-box and use a mouthwash as instructed, and their performance were scored. Number and type of prompts given to facilitate task completion were also documented. Mishandling of dental-related medications was common in participants with cognitive impairment. As expected, participants with poor cognition needed more assistance on handling their medications. Dentists should be aware of this concern and take it into consideration when treatment plan for these individuals. Part of a symposium sponsored by the Oral Health Interest Group.

Global Cognition Modified the Longitudinal Relationship Between Anemia and Depression in Old Age: The IMIAS Study

Background: We examined the longitudinal relationships between hemoglobin concentrations or the severity of anemia and depression and whether baseline cognitive function modifies these longitudinal relationships over 4 years of follow-up. Methods: A total of 1608 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). The study outcome was depression, defined by a score of 16 or over in the Center for Epidemiologic Studies Depression Scale (CES-D). Longitudinal associations over four years follow-up were examined using generalized estimating equations. Models reported were either unadjusted and adjusted for research sites, alcohol drinking status, body mass index, chronic conditions, activities of daily life disabilities, and polypharmacy. Results: Longuitinal relationships suggested an evidence of multiplicative interaction by baseline global cognition in which 1g/dL increase in hemoglobin concentrations there was a significant reduction in the risk of depression with a stronger effect among participants with good cognitive function (Odds Ratio (OR)=0.85, 95% CI: 0.78-0.92) compared to those with poor cognition (OR=0.89, 95% CI: 0.80-0.97). Anemia and poor cognition at baseline were associated with an increased risk of depression over 4 years of follow-up (OR=5.80, 95% CI: 1.84-18.23). Global cognition was an effect modifier of the longitudinal association between the severity of anemia and depression. Conclusion: In international samples of older adults, hemoglobin concentrations, as well as the severity of anemia, were independent risk factors for depression and these associations differed by global cognitive function.

331 - Global cognition modified the relationship between Anemia and Depression in old age: longitudinal analysis from The IMIAS Study

Running head:role of global cognition in the association between Anemia and depression.Background:We examined the longitudinal relationships between hemoglobin concentrations or Anemia and depression and whether baseline cognitive function modifies these longitudinal relationships over 4 years of follow-up.Methods:A total of 1608 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). The study outcome was depression, defined by a score of 16 or over in the Center for Epidemiologic Studies Depression Scale (CES-D). Longitudinal associations over four years follow-up were examined using generalized estimating equations. Models reported were either unadjusted and adjusted for research sites, alcohol drinking status, body mass index, chronic conditions, activities of daily life disabilities, and polypharmacy.Results:Longuitinal relationships suggested an evidence of multiplicative interaction by baseline global cognition in which 1g/dL increase in hemoglobin concentrations there was a significant reduction in the risk of depression with a stronger effect among participants with good cognitive function (Odds Ratio (OR)=0.85, 95% CI: 0.78-0.92) compared to those with poor cognition (OR=0.89, 95% CI: 0.80-0.97). Anemia and poor cognition at baseline were associated with an increased risk of depression over four years of follow-up (OR=5.80, 95% CI: 1.84-18.23). Global cognition was also an effect modifier of the longitudinal association between the severity of Anemia and depression.Conclusion:In international samples of older adults, hemoglobin concentrations, as well as the severity of Anemia, were independent risk factors for depression, and these associations differed by global cognitive function.

Review for the management of vitamin B12 deficiency in diabetic patients on metformin

Long-term usage of Metformin is associated with lower serum vitamin B12 levels. The lower than normal levels could worsen neurological complications of diabetes, including diabetic neuropathy and poor cognition. Guidelines advise periodic monitoring of vitamin B12 but do not specify frequency, treatment targets or treatment modality. This commentary aims to review the prevalence and the severity of the presentation and to provide evidence-based answers to those clinical questions not answered by current guidelines.