Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study
Objective To investigate the accumulation of adversities (duration of exposure to any, economic, psychosocial) across the lifecourse (birth to 63 years) on cognitive function in older age, and the mediating role of mental health.Design National birth cohort study.Setting Great Britain.Participants 5...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/11/e074105.full |
| _version_ | 1797429523000590336 |
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| author | Jonathan M Schott Marcus Richards Praveetha Patalay Yiwen Liu Jean Stafford |
| author_facet | Jonathan M Schott Marcus Richards Praveetha Patalay Yiwen Liu Jean Stafford |
| author_sort | Jonathan M Schott |
| collection | DOAJ |
| description | Objective To investigate the accumulation of adversities (duration of exposure to any, economic, psychosocial) across the lifecourse (birth to 63 years) on cognitive function in older age, and the mediating role of mental health.Design National birth cohort study.Setting Great Britain.Participants 5362 singleton births within marriage in England, Wales and Scotland born within 1 week of March 1946, of which 2131 completed at least 1 cognitive assessment.Main outcome measures Cognitive assessments included the Addenbrooke’s Cognitive Examination-III, as a measure of cognitive state, processing speed (timed-letter search task), and verbal memory (word learning task) at 69 years. Scores were standardised to the analytical sample. Mental health at 60–64 years was assessed using the 28-item General Health Questionnaire, with scores standardised to the analytical sample.Results After adjusting for sex, increased duration of exposure to any adversity was associated with decreased performance on cognitive state (β=−0.39; 95% CI −0.59 to –0.20) and verbal memory (β=−0.45; 95% CI −0.63 to –0.27) at 69 years, although these effects were attenuated after adjusting for further covariates (childhood cognition and emotional problems, educational attainment). Analyses by type of adversity revealed stronger associations from economic adversity to verbal memory (β=−0.54; 95% CI −0.70 to –0.39), with a small effect remaining even after adjusting for all covariates (β=−0.18; 95% CI −0.32 to –0.03), and weaker associations from psychosocial adversity. Causal mediation analyses found that mental health mediated all associations between duration of exposure to adversity (any, economic, psychosocial) and cognitive function, with around 15% of the total effect of economic adversity on verbal memory attributable to mental health.Conclusions Improving mental health among older adults has the potential to reduce cognitive impairments, as well as mitigate against some of the effect of lifecourse accumulation of adversity on cognitive performance in older age. |
| first_indexed | 2024-03-09T09:15:19Z |
| format | Article |
| id | doaj.art-eea7475e7b1a4b6998f894b107c9aa41 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-09T09:15:19Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-eea7475e7b1a4b6998f894b107c9aa412023-12-02T07:30:07ZengBMJ Publishing GroupBMJ Open2044-60552023-11-01131110.1136/bmjopen-2023-074105Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort studyJonathan M Schott0Marcus Richards1Praveetha Patalay2Yiwen Liu3Jean Stafford4Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UKMRC Unit for Lifelong Health and Ageing, University College London, London, UKMRC Unit for Lifelong Health and Ageing, University College London, London, UKMRC Unit for Lifelong Health and Ageing, University College London, London, UKMRC Unit for Lifelong Health and Ageing, University College London, London, UKObjective To investigate the accumulation of adversities (duration of exposure to any, economic, psychosocial) across the lifecourse (birth to 63 years) on cognitive function in older age, and the mediating role of mental health.Design National birth cohort study.Setting Great Britain.Participants 5362 singleton births within marriage in England, Wales and Scotland born within 1 week of March 1946, of which 2131 completed at least 1 cognitive assessment.Main outcome measures Cognitive assessments included the Addenbrooke’s Cognitive Examination-III, as a measure of cognitive state, processing speed (timed-letter search task), and verbal memory (word learning task) at 69 years. Scores were standardised to the analytical sample. Mental health at 60–64 years was assessed using the 28-item General Health Questionnaire, with scores standardised to the analytical sample.Results After adjusting for sex, increased duration of exposure to any adversity was associated with decreased performance on cognitive state (β=−0.39; 95% CI −0.59 to –0.20) and verbal memory (β=−0.45; 95% CI −0.63 to –0.27) at 69 years, although these effects were attenuated after adjusting for further covariates (childhood cognition and emotional problems, educational attainment). Analyses by type of adversity revealed stronger associations from economic adversity to verbal memory (β=−0.54; 95% CI −0.70 to –0.39), with a small effect remaining even after adjusting for all covariates (β=−0.18; 95% CI −0.32 to –0.03), and weaker associations from psychosocial adversity. Causal mediation analyses found that mental health mediated all associations between duration of exposure to adversity (any, economic, psychosocial) and cognitive function, with around 15% of the total effect of economic adversity on verbal memory attributable to mental health.Conclusions Improving mental health among older adults has the potential to reduce cognitive impairments, as well as mitigate against some of the effect of lifecourse accumulation of adversity on cognitive performance in older age.https://bmjopen.bmj.com/content/13/11/e074105.full |
| spellingShingle | Jonathan M Schott Marcus Richards Praveetha Patalay Yiwen Liu Jean Stafford Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study BMJ Open |
| title | Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study |
| title_full | Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study |
| title_fullStr | Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study |
| title_full_unstemmed | Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study |
| title_short | Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study |
| title_sort | lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health longitudinal birth cohort study |
| url | https://bmjopen.bmj.com/content/13/11/e074105.full |
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