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Article: Statistical harmonization of everyday functioning and dementia-related behavioral measures across nine surveys and trials.

Chen, Diefei / Jutkowitz, Eric / Gross, Alden L

Alzheimer's & dementia (Amsterdam, Netherlands)

2023 Volume 15, Issue 1, Page(s) e12412

Abstract: Introduction: Efforts to harmonize measures of everyday function and dementia-related behaviors are needed to synthesize across studies in dementia research. There have been some psychometric attempts to harmonize everyday function for secondary ... ...

Abstract	Introduction: Efforts to harmonize measures of everyday function and dementia-related behaviors are needed to synthesize across studies in dementia research. There have been some psychometric attempts to harmonize everyday function for secondary analysis, but far less for dementia-related behaviors. Methods: Statistical co-calibration was performed to generate factor scores representing everyday function and dementia-related behaviors for participants with dementia. We evaluated convergent criterion validity of factor scores and mapped the scores onto established clinical instruments. Results: Factor analyses of included items fit well to available data. Harmonized factors showed expected associations with the Global Clinical Dementia Rating (CDR) score, with greater impairment (higher Global CDR score) corresponding to higher (more severe) levels on factor scores. Discussion: We used large, well-characterized samples to derive harmonized factors representing everyday functions and dementia-related behaviors. These harmonized factors can be used to tackle questions about dementia phenotypes which require either large samples or unique subpopulations.
Language	English
Publishing date	2023-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2832898-X
ISSN	2352-8729
ISSN	2352-8729
DOI	10.1002/dad2.12412
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Article ; Online: Body Mass Index and Cognition: Associations Across  Mid- to Late Life and Gender Differences.

Crane, Breanna M / Nichols, Emma / Carlson, Michelle C / Deal, Jennifer A / Gross, Alden L

The journals of gerontology. Series A, Biological sciences and medical sciences

2023 Volume 78, Issue 6, Page(s) 988–996

Abstract: Background: Higher mid-life body mass index (BMI) is associated with lower late-life cognition. Associations between later-life BMI and cognition are less consistent; evidence suggests reverse causation may play a role. We aimed to characterize ... ...

Abstract	Background: Higher mid-life body mass index (BMI) is associated with lower late-life cognition. Associations between later-life BMI and cognition are less consistent; evidence suggests reverse causation may play a role. We aimed to characterize associations between BMI and cognition across a wide age range during mid- to late life (55-85 years) and examine whether associations vary by gender. Methods: We used data from the Health and Retirement Study (HRS) (N = 39,153) to examine the association between BMI and 3 cognitive outcomes: cognitive level, cognitive decline, and cognitive impairment. We used a series of linear regression, mixed effects regression, and logistic regression models, adjusting for potential confounders. Results: Higher BMI before age 65 (midlife) was associated with lower cognitive performance, faster rates of cognitive decline, and higher odds of cognitive impairment in late life. Averaging across analyses assessing associations between BMI measured before age 60 and late-life cognition, a 5-unit higher level of BMI was associated with a 0.26 point lower cognitive score. Beyond age 65, associations flipped, and higher BMI was associated with better late-life cognitive outcomes. Associations in both directions were stronger in women. Excluding those with BMI loss attenuated findings among women in older ages, supporting the reverse causation hypothesis. Conclusions: In this sample, age 65 represented a critical turning point between mid- and late life for the association between BMI and cognition, which has important implications for recruitment strategies for studies focused on risk factors for late-life cognitive outcomes. Evidence of gender differences raises the need to further investigate plausible mechanisms.
MeSH term(s)	Humans ; Female ; Aged ; Aged, 80 and over ; Body Mass Index ; Sex Factors ; Cognitive Dysfunction/etiology ; Cognitive Dysfunction/complications ; Cognition ; Cognition Disorders/etiology ; Risk Factors
Language	English
Publishing date	2023-01-13
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1223643-3
ISSN	1758-535X ; 1079-5006
ISSN (online)	1758-535X
ISSN	1079-5006
DOI	10.1093/gerona/glad015
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Article ; Online: The NEI VFQ-25C: Calibrating Items in the National Eye Institute Visual Function Questionnaire-25 to Enable Comparison of Outcome Measures.

Goldstein, Judith E / Bradley, Chris / Gross, Alden L / Jackson, Marylou / Bressler, Neil / Massof, Robert W

Translational vision science & technology

2022 Volume 11, Issue 5, Page(s) 10

Abstract: Purpose: To improve the usefulness of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) by enabling estimation of measures on an invariant scale and comparisons between patients and across studies.: Methods: Datasets of ... ...

Abstract	Purpose: To improve the usefulness of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) by enabling estimation of measures on an invariant scale and comparisons between patients and across studies. Methods: Datasets of baseline NEI VFQ-25 responses from nine studies (seven retina randomized trials, n = 2770; two low vision studies, n = 572) were combined. The method of successive dichotomizations was applied to patient ratings of the main NEI VFQ-25 and six supplemental items to estimate Rasch model parameters using the R package 'msd.' Calibrated item measures and rating category thresholds were estimated for the NEI VFQ-25, as well as for two domain-specific versions: the NEI VFQ-VF that includes only visual function items and the NEI VFQ-SE that includes only socioemotional items. Results: Calibrated item measures were estimated from study participants (n = 3342) ranging in age from 19 to 103 years, with mean (SD) age of 69.3 (11) years and a mean logMAR visual acuity of 0.30 (Snellen 20/40). Item measure estimates had high precision (standard error range, 0.026-0.085 logit), but person measure estimates had lower precision (standard error range, 0.108-0.499 logit). Items were well targeted to most persons, but not to those with higher levels of function. Conclusions: Calibrated item measures and rating category thresholds enable researchers and clinicians to estimate visual, socioemotional, and combined measures on an invariant scale using the NEI VFQ-25. Translational relevance: Applying NEI VFQ 25C calibrated item measures (software provided) to the NEI VFQ-25, users can estimate overall, visual, and socioemotional function measures for individual patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Humans ; Middle Aged ; National Eye Institute (U.S.) ; Outcome Assessment, Health Care ; Psychometrics ; Quality of Life ; Surveys and Questionnaires ; United States ; Young Adult
Language	English
Publishing date	2022-04-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2674602-5
ISSN	2164-2591 ; 2164-2591
ISSN (online)	2164-2591
ISSN	2164-2591
DOI	10.1167/tvst.11.5.10
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Article ; Online: Measurement of Prevalent Versus Incident Dementia Cases in Epidemiologic Studies.

Nichols, Emma / Ng, Derek K / James, Bryan D / Deal, Jennifer A / Gross, Alden L

American journal of epidemiology

2022 Volume 192, Issue 4, Page(s) 520–534

Abstract: Because dementia is progressive, incident cases are on average milder than prevalent cases, affecting the performance of cognitive tests and questions on functional limitations (i.e., cognition/functional limitation items) used for dementia assessment. ... ...

Abstract	Because dementia is progressive, incident cases are on average milder than prevalent cases, affecting the performance of cognitive tests and questions on functional limitations (i.e., cognition/functional limitation items) used for dementia assessment. Longitudinal studies assess incident cases, while cross-sectional studies assess prevalent cases, but differences are not typically considered when researchers select items to include in studies. We used longitudinal data from the Religious Orders Study and Memory and Aging Project (ROSMAP) (n = 3,446) collected between 1994 and 2021 to characterize differences in associations between items (cognition: 35 items; functional limitations: 14 items) and incident or prevalent dementia using multinomial regression models with generalized estimating equations, controlling for ROSMAP cohort (Religious Orders Study or Memory and Aging Project), age, sex, race, and education. The association between a given item and incident dementia was significantly weaker than the association between the same item and prevalent dementia for 46 of 49 items. However, there was variability, with larger differences for some items, including naming a pencil (prevalence odds ratio = 0.02 (95% confidence interval: 0.02, 0.03); incidence odds ratio = 0.10 (95% confidence interval: 0.06, 0.17); P for difference < 0.001). Important differences exist in the performance of cognition/functional limitation items for measurement of incident versus prevalent dementia. Differences can inform the choice of items for cross-sectional studies of prevalent cases or longitudinal studies of incident cases, leading to reduced misclassification and increased statistical power.
MeSH term(s)	Humans ; Dementia/epidemiology ; Cross-Sectional Studies ; Aging/psychology ; Longitudinal Studies ; Cognition
Language	English
Publishing date	2022-11-05
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwac197
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Article ; Online: The application of cross-sectionally derived dementia algorithms to longitudinal data in risk factor analyses.

Nichols, Emma / Ng, Derek K / James, Bryan D / Deal, Jennifer A / Gross, Alden L

Annals of epidemiology

2022 Volume 77, Page(s) 78–84

Abstract: Purpose: Dementia algorithms are often developed in cross-sectional samples but implemented in longitudinal studies to ascertain incident dementia. However, algorithm performance may be higher in cross-sectional settings, and this may impact estimates ... ...

Abstract	Purpose: Dementia algorithms are often developed in cross-sectional samples but implemented in longitudinal studies to ascertain incident dementia. However, algorithm performance may be higher in cross-sectional settings, and this may impact estimates of risk factor associations. Methods: We used data from the Religious Orders Study and the Memory and Aging Project (N = 3460) to assess the performance of example algorithms in classifying prevalent dementia in cross-sectional samples versus incident dementia in longitudinal samples. We used an applied example and simulation study to characterize the impact of varying sensitivity, specificity, and unequal sensitivity or specificity between exposure groups (differential performance) on estimated hazard ratios from Cox models. Results: Using all items, algorithm sensitivity was higher for prevalent (0.796) versus incident dementia (0.719); hazard ratios had slight bias. Sensitivity differences were larger using a subset of items (0.732 vs. 0.600) and hazard ratios were 13%-19% higher across adjustment sets compared to estimates using gold-standard dementia status. Simulations indicated specificity and differential algorithmic performance between exposure groups may have large effects on hazard ratios. Conclusions: Algorithms developed using cross-sectional data may be adequate for longitudinal settings when performance is high and non-differential. Poor specificity or differential performance between exposure groups may lead to biases.
MeSH term(s)	Humans ; Dementia/diagnosis ; Dementia/epidemiology ; Cross-Sectional Studies ; Aging ; Longitudinal Studies ; Algorithms
Language	English
Publishing date	2022-12-05
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1074355-8
ISSN	1873-2585 ; 1047-2797
ISSN (online)	1873-2585
ISSN	1047-2797
DOI	10.1016/j.annepidem.2022.11.006
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Article ; Online: Negative wealth shocks in later life and subsequent cognitive function in older adults in China, England, Mexico, and the USA, 2012-18: a population-based, cross-nationally harmonised, longitudinal study.

Cho, Tsai-Chin / Yu, Xuexin / Gross, Alden L / Zhang, Yuan S / Lee, Jinkook / Langa, Kenneth M / Kobayashi, Lindsay C

The lancet. Healthy longevity

2023 Volume 4, Issue 9, Page(s) e461–e469

Abstract: Background: Household wealth is positively related to cognitive health outcomes in later life. However, the association between negative wealth shocks and cognitive function in later life, and whether this association might differ across countries at ... ...

Abstract	Background: Household wealth is positively related to cognitive health outcomes in later life. However, the association between negative wealth shocks and cognitive function in later life, and whether this association might differ across countries at different levels of economic development, is unclear. We aimed to investigate whether negative wealth shocks in later life are associated with cognitive function in older adults in China, England, Mexico, and the USA, and whether this association is modified by country income level. Methods: For this population-based, cross-nationally harmonised, longitudinal study, data were analysed from core interviews of the population-based US Health and Retirement Study (2012 and 2016) and its partner studies in China (the China Health and Retirement Longitudinal Study; 2015 and 2018), England (the English Longitudinal Study of Ageing; 2012 and 2016), and Mexico (Mexican Health and Aging Study; 2012 and 2015-16), and their respective Harmonized Cognitive Assessment Protocols (HCAPs). Negative wealth shocks over the follow-up periods of the respective cohorts were defined in two ways: an extreme loss of 75% or greater from the baseline amount of wealth, and a decline in within-population wealth quintile rank. The primary outcome was the harmonised general cognitive function (GCF) factor score, which was constructed with factor analysis on the HCAP neuropsychological assessments of memory, orientation, attention, executive function, and verbal fluency performance (mean 0; SD 1). We used sampling-weighted, multivariable-adjusted linear models to examine associations. Findings: Data from 9465 participants were included in this analysis: 3796 from China, 1184 from England, 1193 from Mexico, and 3292 from the USA. The mean baseline age of participants was 68·5 (SD 5·4) years in China (49·8% women), 72·0 (7·0) years in England (54·6% women), 70·6 (6·8) years in Mexico (55·1% women), and 72·7 (7·5) years in the USA (60·4% women). A wealth loss of 75% or greater was negatively associated with subsequent cognitive function in the USA (β -0·16 SD units; 95% CI -0·29 to -0·04) and China (-0·14; -0·21 to -0·07), but not in England (-0·01; -0·24 to 0·22) or Mexico (-0·11; -0·24 to 0·03). Similarly, within-population wealth quintile rank declines were negatively associated with subsequent cognitive function in the USA (β -0·07 per quintile rank decline; 95% CI -0·11 to -0·03) and China (β -0·07; -0·09 to -0·04), but not in England (-0·05; -0·11 to 0·01) or Mexico (-0·03; -0·07 to 0·01). Interpretation: The impact of wealth shocks in later life on subsequent lower level of cognitive function of older adults in China, England, Mexico, and the USA differed across macro-level socioeconomic structures. These findings suggest that government policies and social safety nets in countries with different levels of economic development might have a role in protecting older adults from adverse health effects of wealth losses in later life. Funding: US National Institute on Aging, US National Institutes of Health.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Longitudinal Studies ; Mexico/epidemiology ; Socioeconomic Factors ; Aging/psychology ; Cognition
Language	English
Publishing date	2023-08-03
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	2666-7568
ISSN (online)	2666-7568
DOI	10.1016/S2666-7568(23)00113-7
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Article ; Online: Measurement differences in the assessment of functional limitations for cognitive impairment classification across geographic locations.

Nichols, Emma / Ng, Derek K / Hayat, Shabina / Langa, Kenneth M / Lee, Jinkook / Steptoe, Andrew / Deal, Jennifer A / Gross, Alden L

Alzheimer's & dementia : the journal of the Alzheimer's Association

2023 Volume 19, Issue 5, Page(s) 2218–2225

Abstract: Introduction: The measurement of dementia in cross-national contexts relies on the assessment of functional limitations. We aimed to evaluate the performance of survey items on functional limitations across culturally diverse geographic settings.: ... ...

Abstract	Introduction: The measurement of dementia in cross-national contexts relies on the assessment of functional limitations. We aimed to evaluate the performance of survey items on functional limitations across culturally diverse geographic settings. Methods: We used data from the Harmonized Cognitive Assessment Protocol Surveys (HCAP) in five countries (total N = 11,250) to quantify associations between items on functional limitations and cognitive impairment. Results: Many items performed better in the United States and England compared to South Africa, India, and Mexico. Items on the Community Screening Instrument for Dementia (CSID) had the least variability across countries (SD = 0.73 vs. 0.92 [Blessed] and 0.98 [Jorm IQCODE]), but also the weakest associations with cognitive impairment (median odds ratio [OR] = 2.23 vs. 3.01 [Blessed] and 2.75 [Jorm IQCODE]). Discussion: Differences in cultural norms for reporting functional limitations likely influences performance of items on functional limitations and may affect the interpretation of results from substantive studies. Highlights: There was substantial cross-country variation in item performance. Items from the Community Screening Instrument for Dementia (CSID) had less cross-country variability but lower performance. There was more variability in performance of instrumental activities of daily living (IADL) compared to activities of daily living (ADL) items. Variability in cultural expectations of older adults should be taken into account. Results highlight the need for novel approaches to assessing functional limitations.
MeSH term(s)	Humans ; United States ; Aged ; Dementia/psychology ; Activities of Daily Living/psychology ; Cognitive Dysfunction ; Surveys and Questionnaires ; England
Language	English
Publishing date	2023-02-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2211627-8
ISSN	1552-5279 ; 1552-5260
ISSN (online)	1552-5279
ISSN	1552-5260
DOI	10.1002/alz.12994
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Article ; Online: Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India.

Westrick, Ashly C / Avila-Rieger, Justina / Gross, Alden L / Hohman, Timothy / Vonk, Jet M J / Zahodne, Laura B / Kobayashi, Lindsay C

Alzheimer's & dementia : the journal of the Alzheimer's Association

2023 Volume 20, Issue 1, Page(s) 16–24

Abstract: Introduction: We compared gender disparities in later-life memory, overall and by education, in India and the United States (US).: Methods: Data (N = 7443) were from harmonized cognitive assessment protocols (HCAPs) in the Longitudinal Aging Study of ...

Abstract	Introduction: We compared gender disparities in later-life memory, overall and by education, in India and the United States (US). Methods: Data (N = 7443) were from harmonized cognitive assessment protocols (HCAPs) in the Longitudinal Aging Study of India-Diagnostic Assessment of Dementia (LASI-DAD; N = 4096; 2017-19) and US Health and Retirement Study HCAP (HRS-HCAP; N = 3347; 2016-17). We derived harmonized memory factors from each study using confirmatory factor analysis. We used multivariable-adjusted linear regression to compare gender disparities in memory function between countries, overall and by education. Results: In the United States, older women had better memory than older men (0.28 SD-unit difference; 95% CI: 0.22, 0.35). In India, older women had worse memory than older men (-0.15 SD-unit difference; 95% CI: -0.20, -0.10), which attenuated with increasing education and literacy. Conclusion: We observed gender disparities in memory in India that were not present in the United States, and which dissipated with education and literacy.
MeSH term(s)	Male ; Humans ; Female ; United States ; Aged ; Aging/psychology ; Educational Status ; Longitudinal Studies ; Data Collection ; Cognition
Language	English
Publishing date	2023-07-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2211627-8
ISSN	1552-5279 ; 1552-5260
ISSN (online)	1552-5279
ISSN	1552-5260
DOI	10.1002/alz.13404
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Article: Resilient Adaptation Strategies: Unveiling Older Adults' Coping Dynamics Amidst the COVID-19 Pandemic.

Hladek, Melissa deCardi / Wilson, Deborah H / Shofner, Sabrina / Gross, Alden L / Buta, Brian / Bandeen-Roche, Karen / Schoenborn, Nancy

Journal of gerontological nursing

2023 Volume 49, Issue 12, Page(s) 32–39

Abstract: Older adults, who are particularly vulnerable to coronavirus disease 2019 (COVID-19), exhibit less stress and greater well-being than their younger peers. However, there have been no in-depth explorations of adaptive coping strategies among this ... ...

Abstract	Older adults, who are particularly vulnerable to coronavirus disease 2019 (COVID-19), exhibit less stress and greater well-being than their younger peers. However, there have been no in-depth explorations of adaptive coping strategies among this population, nor has the role of frailty status been addressed. The current study examined stress and coping in 30 U.S. older adults (mean age = 81 years, range = 68 to 95 years) amidst the COVID-19 pandemic, uncovering themes of: (1)
MeSH term(s)	Humans ; Aged ; Aged, 80 and over ; COVID-19 ; Pandemics ; Adaptation, Psychological ; Ageism ; Geriatric Nursing
Language	English
Publishing date	2023-12-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	603140-7
ISSN	0098-9134
ISSN	0098-9134
DOI	10.3928/00989134-20231108-04
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Article: Linear linking for related traits (LLRT): A novel method for the harmonization of cognitive domains with no or few common items

Nichols, Emma L. / Cadar, Dorina / Lee, Jinkook / Jones, Richard N. / Gross, Alden L.

Methods. 2021 Nov. 20,

2021

Abstract: Harmonization means to make data comparable. Recent efforts to generate comparable data on cognitive performance of older adults from many different countries around the world have presented challenges for direct comparison. Neuropsychological ... ...

Abstract	Harmonization means to make data comparable. Recent efforts to generate comparable data on cognitive performance of older adults from many different countries around the world have presented challenges for direct comparison. Neuropsychological instruments vary in many respects, including language, administration techniques and cultural differences, which all present important obstacles to assumptions regarding the presence of linking items. Item response theory (IRT) methods have been previously used to harmonize cross-national data on cognition, but these methods rely on linking items to establish the shared metric. We introduce an alternative approach for linking cognitive performance across two (or more) groups when the fielded assessments contain no items that can be reasonably considered linking items: Linear Linking for Related Traits (LLRT). We demonstrate this methodological approach in a sample from a single United States study split by educational attainment, and in two sets of cross-national comparisons (United States to England, and United States to India). All data were collected as part of the Harmonized Cognitive Assessment Protocol (HCAP) and are publicly available. Our method relies upon strong assumptions, and we offer suggestions for how the method can be extended to relax those assumptions in future work.
Keywords	cognition ; England ; India
Language	English
Dates of publication	2021-1120
Publishing place	Elsevier Inc.
Document type	Article
Note	Pre-press version
ZDB-ID	1066584-5
ISSN	1095-9130 ; 1046-2023
ISSN (online)	1095-9130
ISSN	1046-2023
DOI	10.1016/j.ymeth.2021.11.011
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