Monitoring Cognitive Functioning: National Survey of Midlife in the United States (MIDUS)

Transcription

1 Monitoring Cognitive Functioning: National Survey of Midlife in the United States (MIDUS) IOM Committee on Public Health Dimensions of Cognitive Aging Panel 3: Epidemiology and Surveillance April 10, 2014 Margie E. Lachman, Ph.D. Psychology Department Lifespan Development Lab, Brandeis University Acknowledge Support from National Institute on Aging

2 Overview MIDUS Brain Health as Lifelong Process BTACT Objective Cognitive Measures Self-Assessments- Subjective Ratings Costs of Cognitive Aging Research Gaps and Recommendations

3 Midlife in the United States (MIDUS) A National Study of Health and Well-Being Time 1: ; Ages (N = 7,100) Time 2: Ages (N = 4,955) Time 3: In the field cognition on small subsample MIDMAC- MacArthur Foundation Research Network on Successful Midlife Development Longitudinal retention rate, adjusted for mortality = 75% includes cognition National Institute on Aging- University of Wisconsin Survey Research Center includes cognition National Institute on Aging- University of Wisconsin Survey Research Center Data available through UM ICPSR

4 Goals: MIDUS Cognitive Assessment- Brief Test of Adult Cognition by Telephone (BTACT) Brief (15-20 minutes) Representation of key abilities in cognitive aging (not a dementia screener) Telephone administration (can also be in person or internet) Reliable and valid Appropriate for diverse sample (e.g., wide age range, different educational levels) Monitor over time Sensitive to changes with aging

5 NIH Toolbox Attention Episodic Memory Executive Function-Cognitive Flexibility Executive Function-Inhibitory Control Language Cognitive Functions Included in U.S. National Institutes of Health (NIH) Toolbox and Corresponding BTACT Subtest Processing Speed Working Memory BTACT Test Attention Switch (Stop and Go Switch Task) Word List Recall (Immediate and Delayed) Category Fluency Stop and Go Switch Task Category Fluency Backward Counting (30-SACT) Digits Backward Number Series NIH Toolbox for the Assessment of Behavioral and Neurological Function (Gershon et al., 2010)

6 MIDUS Brief Test of Adult Cognition by Telephone (BTACT) (Lachman & Tun, 2008; Lachman et al. 2014) TASK THEORETICAL CONSTRUCT(S) SAMPLE ITEMS Word List Recall (immediate and delayed) Backward Digit Span Category Verbal Fluency Episodic verbal memory 15 words (e.g., flower, truck, school) Working memory Spans from 2 to 8 (e.g., 7, 2, 5, 3 = 3, 5, 2, 7) Executive function, semantic memory List as many animals as possible in 60 seconds Number Series Inductive reasoning 5 series of 5 numbers (e.g., 35, 30, 25, 20, 15 correct answer = 10) Backwards Counting (30-SACT) Attention- Switching, Stop and Go Switch Task Processing speed Reaction time, attention, task switching, inhibitory control Counting backward quickly from 100 in 30 seconds Normal condition: Green = Go; Red = Stop Reverse condition: Green = Stop; Red = Go With mixed and switched trials

7 Better Age Differences on Cognitive Tests Significant differences in mean scores by age decade Worse Mean Z-score Backward Counting Category Fluency Word List Delayed Word List Immediate Attention Switch Number Series Digits Backward 30s 40s 50s 60s 70s Age Group Age Group 80s MIDUS II (Lachman & Tun, 2008)

8 BTACT- Factor Structure MIDUS II (Lachman et al., 2010; 2014) r =.42* Episodic Memory r =.79** Executive Functioning α =.71 Immediate Word List Recall Delayed Word List Recall Category Fluency Digits Backward Number Series Backward Counting Attention Switch Confirmatory Factor Solution χ 2 (13) = , p <.001; RMSEA =.08; CFI =.96; GFI =.98; AGFI =.95 ** p <.001, * p<.05

9 Cognitive Functioning By Age BTACT Cognitive Factors by Age (Lachman et al., 2014) Z-scores Episodic Memory Executive Functioning Fitted Trendline Episodic Memory Fitted Trendline Executive Functioning Age

10 Self-Assessments

11 Self-Reports of Cognition CDC/BRFSS Cognitive Impairment Module Ages over % reported increased confusion or memory loss 35.2% of them experienced functional difficulties Swedish Twins Registry Ages over 60 Worried Well - 39% MIDUS Ages 32-85

12 Memory Self-Assessments in the MIDUS Temporal Comparison How would you rate your memory today compared to five years ago: Social Comparison Compared to other people your age, how would you rate your memory: Improved a lot (1%) Improved a little (5%) Stayed the same (52%) Gotten a little worse (38%) Gotten a lot worse (4%) 42% some decline Excellent (12%) Good (42%) Average (34%) Fair (10%) Poor (2%) 54% better than average

13 Are Objective and Subjective Assessments Related? Subjective Assessments not significantly related to objective performance or to age Subjective Assessments are related to neuroticism, depression, negative affect Can they give us meaningful information about early declines?

14 Accuracy of Self-Rating 53% SUBJECTIVE MEMORY LOW HIGH LOW LOW-ACCURATE OVERESTIMATION OBJECTIVE MEMORY N = 846 (25.24%) N = 930 (27.74%) HIGH UNDERESTIMATION HIGH-ACCURATE N = 632 (18.85%) N = 944 (28.16%)

15 Survey of 26 Everyday Life Problems: Memory Problems Frequent and Stressful AGES AGES AGES Reported Frequency Rank Reported Stress Rank Getting everything done # 1 Children # 2 Memory # 3 Memory # 7 Getting everything done # 1 Memory # 2 Memory # 5 Energy level # 3 Memory # 1 Memory # 5 Energy level # 2 Moving quickly # 3 Lachman (2004)

16 Top Memory Problems Reported Daily Diary Study 1 Whitbourne (2005) Ages Daily Diary Study 2 Hahn et al (2014) Ages Trouble with a name 75% 69% Word on tip of tongue 75% 71% Forget why went into room 58% 43% Forget where put something 58% 64% Forgot what started to say 54% 43%

17 Control Beliefs: Percent Reporting A Lot of Control Varies by Domain MIDUS II National and Boston-Area Samples How much control do you have over? 100% 80% 74% 62% 60% 50% 47% 45% 40% 20% 0% Life in general, at present Appearance Health Thinking as quickly as you need to Memory

18 Cognition and Health Preclinical Biomarkers and Allostatic Load

19 MIDUS Allostatic Load Sympathetic Nervous System (2) Urinary epinephrine & norepinephrine Parasympathetic Nervous System (4) SDRR, RMSSD, LF-HRV, & HF-HRV HPA Axis (2) Urinary cortisol & serum DHEA-S Inflammation (5) C-reactive protein, IL-6, E-Selectin 5, fibrinogen & ICAM Cardiovascular Functioning (3) Resting systolic blood pressure, pulse pressure, & heart rate Glucose Metabolism (3) Fasting glucose, blood levels of glycosylated hemoglobin, & insulin resistance Lipid Metabolism (5) BMI, WHR, triglycerides, LDL cholesterol & HDL cholesterol

20 Cognition and Allostatic Load LOESS smoothed (bandwidth 0.8) plots Panel A: Episodic Memory Panel B: Executive Functioning Adjusted for age, education, race, neurological conditions Karlamangla et al., 2014 Neurobiology of Aging

21 Associations between Biomarkers Variables and BTACT Factors Episodic Memory Executive Functioning Cardiovascular Functioning Inflammation Glucose Metabolism Allostatic Load Karlamangla et al., 2014 Neurobiology of Aging

22 Explore the Costs of Cognitive Aging [Hurd et al. (2013) NEJM- Costs of dementia] What are the costs of cognitive aging? Work: Early retirement; days missed Health Care: Testing; assessment; doctor visits Worry and stress Poor decision making Susceptibility to fraud Use of support services Reduced social interactions Calculate monetary cost $$$$

23 Gaps & Recommendations 1. What happens before age 60? Cognitive problems and concerns start early in adulthood Early detection of declines; Warning signs of impairment Assessments at younger ages; Middle age

24 Gaps & Recommendations 2. What measures best capture cognitive aging? Dementia screeners are limited Include more cognitive abilities-see which abilities are diagnostic at early stages- speed, EF, not only memory Self assessments are not always accurate Establish norms; Give feedback How are everyday problems and cognitive test performance related?

25 Gaps & Recommendations 3. Monitor changes in cognition Need quick and reliable cognitive assessments Annual physical, Monitor over time Stress test for cognition, Lab workup Use of informants and diaries to track cognition Which changes are of concern?

26 Gaps & Recommendations 4. Sensitivity to individual differences in cognitive aging Explore Differences by Sex, Educational Attainment, Culture, Ethnicity 5. Importance of health for cognition Clarify links with physical and mental health Relationship to preclinical biomarkers and disease Role of medication in cognitive performance- Side effects

27 Gaps & Recommendations 6. Clarify what we can do for cognitive aging How to take control (Psychosocial and behavioral factors) Protective lifestyle factors Exercise, Good sleep, Positive Attitude Address misconceptions about brain games Education about damaging effects of smoking, sedentary behavior, diet, social isolation etc.

28 The End

29 Panel Questions Questions for panel discussion: What population-based statistics are available on the prevalence of various stages of cognitive change? What needs to be done to improve population based surveillance? What is known from longitudinal studies about the prevalence of various stages of cognitive change? What needs to be done to improve longitudinal studies?

30 Panel Questions What surveillance systems and tools are being used to provide information on cognitive aging? What surveillance and public health monitoring tools are needed to better understand the public health impact of cognitive aging? What are the clinical consequences of cognitive aging in adults who do not have a disease that is accepted as causing or contributing to cognitive impairment? What other types of surveillance systems and tools are needed for cognitive aging? What lessons can be learned from other fields of public health? What can we learn from the life course approach?