Childhood adversity and adulthood adversity affect cognition later in life. However, the mechanism through which adversity exerts these effects on cognition remains under-researched. We aimed to ...investigate if the effect of adversity on cognition was mediated by distress or neuroticism. The UK Biobank is a large, population-based, cohort study designed to investigate risk factors of cognitive health. Here, data were analysed using a cross-sectional design. Structural equation models were fitted to the data with childhood adversity or adulthood adversity as independent variables, distress and neuroticism as mediators and executive function and processing speed as latent dependent variables that were derived from the cognitive scores in the UK Biobank. Complete data were available for 64,051 participants in the childhood adversity model and 63,360 participants in the adulthood adversity model. Childhood adversity did not show a direct effect on processing speed. The effect of childhood adversity on executive function was partially mediated by distress and neuroticism. The effects of adulthood adversity on executive function and processing speed were both partially mediated by distress and neuroticism. In conclusion, distress and neuroticism mediated the deleterious effect of childhood and adulthood adversity on cognition and may provide a mechanism underlying the deleterious consequences of adversity.
Intraindividual variability (IIV) refers to the variation in reaction time (RT) performance across a given cognitive task. As greater IIV may reflect compromise of the frontal circuitry implicated in ...falls and gait impairment in older adults, we conducted a systematic review of the literature relating to this issue.
Searches were conducted of electronic databases that identified empirical investigations of IIV, falls, and gait in older adult samples with a mean age of 65 years or older. Data were extracted relating to IIV measures, study population, and outcomes.
Of 433 studies initially identified, 9 met inclusion criteria for IIV and falls (n = 5), and gait (n = 4). Representing a total of 2,810 older participants, all of the studies of IIV and falls showed that elevated variability was associated with increased risk of falling, and half of the studies of gait indicated greater IIV was related to gait impairment.
Across studies, IIV measures were consistently associated with falls in older persons and demonstrated some potential in relation to gait. IIV metrics may, therefore, have considerable potential in clinical contexts and supplement existing test batteries in the assessment of falls risk and gait impairment in older populations.
Background
Our previous research shows that self‐report early adversity (EA) is associated with poorer cognition and mental health. Importantly, poor mental health is also associated with both ...cognitive decline and dementia. However, longitudinal work in understanding long term effects of early and adult adversity (AA) on cognitive change is limited. Disentangling adversity types is complex and the mechanisms underlying long term effect are still to be understood. Our aim in this project was to investigate the relationship between EA and AA, and longitudinal mental health and cognition. In this study we also include assessments during Covid‐19 to explore the effects of a high stress load experience on previous and existing longitudinal adversity and mental health.
Method
Our work was conducted using the English Longitudinal Study of Ageing (ELSA UK) and data from 15,355 individuals with a mean age of 64.56 years at timepoint 1 (wave 3), 66.01 years (wave 6) and 67.49 years (wave 9) at timepoints 2, 3 and 68.66 years (Covid wave), we applied a longitudinal panel structural equation model (SEM) to the data. We assessed the effects and interrelationships of EA (self‐report retrospective) measured at timepoint 1 and AA (partner relationship strain) at timepoints 1‐3 on depression and cognition measured at timepoints 1‐3 and on mental health during the Covid‐19 pandemic.
Result
EA (timepoint 1) was associated with increased incidence of AA at all longitudinal timepoints (p <.01), also with higher depression at timepoints 1 and 2 (p <,.01), poorer cognition (verbal fluency) at timepoint 3 (p <.05) and increased depression (p <.01) and anxiety (p <.05) during the Covid‐19 pandemic. AA was associated with higher depression at all timepoints (p <.001) and poorer cognition (verbal fluency and memory) at timepoint 3 (p <.01; p <.05).
Conclusion
The deleterious effect of life course adversity on longitudinal mental health and cognition are significant and during the Covid‐19 pandemic, the effect on depression was significant even when controlling for previous depression. Our results suggest that accumulative stress response may be implicated.
The role of environmental exposures in chronic obstructive pulmonary disease (COPD) remains inconclusive. We examined the association between environmental exposures (PM2·5, greenness, and ...urbanicity) and COPD prevalence using the UK Biobank cohort data to identify key built environment correlates of COPD.
In this cross-sectional, observational study we used baseline data for UK Biobank participants. Included participants were aged 39 years and older, white, had available spirometry data, and had complete data for phenotypes and exposures. COPD was defined by spirometry with the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria. Environmental exposures were PM2·5 derived from monitoring data and interpolated using land-use regression at the participants' geocoded residential addresses. Built environment metrics of residential greenness were modelled in terms of normalised difference vegetation index from remotely sensed colour infrared data within a 500 m residential catchment, and an urbanicity index derived from spatial analyses and measured with a 1 km buffer around each participant's residential address. Logistic regression models examined the associations between environmental exposures and COPD prevalence adjusting for a range of confounders. Subgroup analyses by urbanicity and effect modification by white blood cell count as an inflammatory marker were also done.
We assessed 96 779 participants recruited between April 4, 2006, and Oct 1, 2010, of which 5391 participants had COPD with a prevalence of 5·6%. Each 10 μg/m3 increment in ambient PM2·5 exposure at a participant's residential location was associated with higher odds of COPD (odds ratio 1·55, 95% CI 1·14–2·10). Among the built environment metrics, urbanicity was associated with higher odds of COPD (1·05, 1·01–1·08 per interquartile increment), whereas residential greenness was protective, being associated with lower odds of COPD (0·89, 0·84–0·93 for each interquartile increment in greenness). The results remained consistent in models of COPD defined as per lower limit of normal criteria. The highest quartile of white blood cell count was associated with lower lung function and higher COPD risk with a significant interaction between PM2·5 and white blood cell count only in the model of lung function (p=0·0003).
In this study of the built environment and COPD, to our knowledge the largest done in the UK, we found that exposure to ambient PM2·5 and urbanicity were associated with a higher risk of COPD. Residing in greener areas, as measured by normalised difference vegetation index, was associated with lower odds of COPD, suggesting the potential value of urban planning and design in minimising or offsetting environmental risks for the prevention and management of COPD.
University of Hong Kong, UK Biobank, and UK Economic & Social Research Council.
Research demonstrates a negative relationship between alcohol use and affect, but the value of deprecation is unknown and thus cannot be included in estimates of the cost of alcohol to society. This ...paper aims to examine this relationship and develop econometric techniques to value the loss in affect attributable to alcohol consumption.
Cross-sectional (n = 129,437) and longitudinal (n = 11,352) analyses of alcohol consumers in UK Biobank data were undertaken, with depression and neuroticism as proxies of negative affect. The cross-sectional relationship between household income, negative affect and alcohol consumption were analysed using regression models, controlling for confounding variables, and using within-between random models that are robust to unobserved heterogeneity. The differential in household income required to offset alcohol's detriment to affect was derived.
A consistent relationship between depression and alcohol consumption (β = 0.001, z = 7.64) and neuroticism and alcohol consumption (β = 0.001, z = 9.24) was observed in cross-sectional analyses, replicated in within-between models (depression β = 0.001, z = 2.32; neuroticism β = 0.001, z = 2.33). Significant associations were found between household income and depression (cross sectional β = -0.157, z = -23.86, within-between β = -0.146, z = -9.51) and household income and neuroticism (cross sectional β = -0.166, z = -32.02, within-between β = -0.158, z = -7.44). The value of reducing alcohol consumption by one gram/day was pooled and estimated to be £209.06 (95% CI £171.84 to £246.27).
There was a robust relationship between alcohol consumption and negative affect. Econometric methods can value the intangible effects of alcohol use and may, therefore, facilitate the fiscal determination of benefit.
Experiences of childhood adversity (CA) are thought to account for a signficant amount of lifetime mental disorders. Learning about modifiable bio-psycho-social risk factors and mediators may provide ...the scientific basis for interventions. To achieve this aim, large multimodal datasets are needed to gain the statistical advantage for a multitude of concurrent individual effects, and such studies are currently limited. The current study investigated the role of allostatic load in the association between childhood adversity and psychopathology in a large cohort. We aimed to develop a measure of allostatic load and validate its mediating role in anxiety and depression.
The analysis was conducted on the baseline data from 112,674 subjects in the UK Biobank. Allostatic load indices were selected following review of the literature and both summation as well as confirmatory factor analysis were used to establish the allostatic load measure. After establishing feasibility of the contributing measurement models, we estimated their contribution to depression and anxiety, using structural equation modelling.
A larger percentage of the variance in depression and anxiety was predicted by CA, compared to allostatic load alone. We also identified a significant indirect effect of CA on depression/anxiety, through the mediating role of the allostatic load measurement model.
We conclude that the allostatic load biomarker data in our sample is a useful tool to disentangle the effects of adversity on mental health. Further, we propose an allostatic load index based on confirmatory factor analysis.
The SCCAI was designed to facilitate assessment of disease activity in ulcerative colitis (UC). We aimed to interrogate the metric properties of individual items of the SCCAI using item response ...theory (IRT) analysis, to simplify and improve its performance.
The original 9-item SCCAI was collected through TrueColours, a real-time software platform which allows remote entry and monitoring of patients with UC. Data were securely uploaded onto Dementias Platform UK Data Portal, where they were analysed in Stata 16.1 SE. A 2-parameter (2-PL) logistic IRT model was estimated to evaluate each item of the SCCAI for its informativeness (discrimination). A revised scale was generated and re-assessed following systematic removal of items.
SCCAI data for 516 UC patients (41 years, SD = 15) treated in Oxford were examined. After initial item deletion (Erythema nodosum, Pyoderma gangrenosum), a 7-item scale was estimated. Discrimination values (information) ranged from 0.41 to 2.52 indicating selected item inefficiency with three items < 1.70 which is a suggested discriminatory value for optimal efficiency. Systematic item deletions found that a 4-item scale (bowel frequency day; bowel frequency nocturnal; urgency to defaecation; rectal bleeding) was more informative and discriminatory of trait severity (discrimination values of 1.50 to 2.78). The 4-item scale possesses higher scalability and unidimensionality, suggesting that the responses to items are either direct endorsement (patient selection by symptom) or non-endorsement of the trait (disease activity).
Reduction of the SCCAI from the original 9-item scale to a 4-item scale provides optimum trait information that will minimise response burden. This new 4-item scale needs validation against other measures of disease activity such as faecal calprotectin, endoscopy and histopathology.
BackgroundAlzheimer’s disease (AD), type 2 diabetes mellitus (characterised by insulin resistance) and depression are significant challenges facing public health. Research has demonstrated common ...comorbidities among these three conditions, typically focusing on two of them at a time.ObjectiveThe goal of this study, however, was to assess the inter-relationships between the three conditions, focusing on mid-life (defined as age 40–59) risk before the emergence of dementia caused by AD.MethodsIn the current study, we used cross-sectional data from 665 participants from the cohort study, PREVENT.FindingsUsing structural equation modelling, we showed that (1) insulin resistance predicts executive dysfunction in older but not younger adults in mid-life, that (2) insulin resistance predicts self-reported depression in both older and younger middle-aged adults and that (3) depression predicts deficits in visuospatial memory in older but not younger adults in mid-life.ConclusionsTogether, we demonstrate the inter-relations between three common non-communicable diseases in middle-aged adults.Clinical implicationsWe emphasise the need for combined interventions and the use of resources to help adults in mid-life to modify risk factors for cognitive impairment, such as depression and diabetes.
•There is great variation in cSVD burden experienced in older age.•Maintaining brain health across the life course requires looking beyond traditional vascular risk factors.•Clinical research and ...practice should consider the cumulative, socioeconomic and environmental exposures starting in childhood on SVD burden.•Effective prevention of declining brain heath should include upstream prevention strategies and life course approaches to tackle risk factors early in life.
Cerebral small vessel disease (cSVD) is highly prevalent in the general population, increases with age and vascular risk factor exposure, and is a common cause of stroke and dementia. There is great variation in cSVD burden experienced in older age, and maintaining brain health across the life course requires looking beyond an individual's current clinical status and traditional vascular risk factors. Of particular importance are social determinants of health which can be more important than healthcare or lifestyle choices in influencing later life health outcomes, including brain health. In this paper we discuss the social determinants of cerebrovascular disease, focusing on the impact of socioeconomic status on markers of cSVD. We outline the potential mechanisms behind these associations, including early life exposures, health behaviours and brain reserve and maintenance, and we highlight the importance of public health interventions to address the key determinants and risk factors for cSVD from early life stages.
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