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Background Low socioeconomic status (SES) in early and late life has been associated with lower late-life cognition. Less is known about how changes in SES from childhood to late life are associated with late-life cognition, especially among diverse populations of older adults. Methods In a multi-ethnic sample ( n  = 1353) of older adults, we used linear regression to test associations of change in comprehensive measures of SES (financial, cultural, and social domains) from childhood to late life with semantic memory, episodic memory, and executive function. We tested whether the association between SES trajectory and late-life cognition differed by populations who resided in the U.S. during childhood or immigrated to the U.S. as adults. Results Participants with low childhood/high late-life financial capital had better semantic memory (β = 0.18; 95% CI: 0.04, 0.32) versus those with low financial capital in both childhood and late life, regardless of childhood residence. We observed a significant interaction in the association of verbal episodic memory and cultural capital by childhood residence ( p  = 0.08). Participants with a foreign childhood residence had higher verbal episodic memory if they had low childhood/high late-life cultural capital (β = 0.32; 95% CI: 0.01, 0.63), but lower verbal episodic memory if they had high childhood/low late-life cultural capital (β = − 0.40; 95% CI: − 0.94, 0.13). Having high lifecourse social capital was associated with better verbal episodic memory scores among those with a U.S. childhood (β = 0.34; 95% CI: 0.14, 0.55), but lower verbal episodic memory among those with a foreign childhood (β = − 0.10; 95% CI: − 0.51, 0.31). Conclusions High financial and cultural capital in late life is associated with better cognition, regardless of early childhood SES or childhood residence.

ObjectivesAdverse childhood experiences (ACEs) are associated with higher risk of chronic disease, but little is known about the association with late life cognitive decline. We examined the longitudinal association between ACEs and late-life cognitive decline in the Study of Healthy Aging in African Americans (STAR).DesignLinear mixed models with random intercepts and slope examined the association of individual and composite ACEs with cognitive change adjusting for years from baseline (timescale), baseline age, sex, parental education, childhood socioeconomic status and childhood social support. Participants reported whether they had experienced nine types of ACEs. Executive function and verbal episodic memory were measured up to three times over a 3-year period using the Spanish and English Neuropsychological Assessment Scales.SettingsKaiser Permanente Northern California members living in the Bay Area.ParticipantsSTAR is a cohort study of cognitive ageing launched in 2018 that has enrolled 764 black Americans ages ≥50 years (mean age=67.5; SD=8.5).ResultsTwenty-one per cent of participants reported no ACEs, 24% one ACE, 20% two ACEs, 17% three ACEs and 17% four or more ACEs. Compared with no ACEs, two ACEs (β=0.117; 95% CI 0.052 to 0.182), three ACEs (β=0.075; 95% CI 0.007 to 0.143) and four or more ACEs (β=0.089; 95% CI 0.002 to 0.158) were associated with less decline in executive function. There were no significant associations between number of ACEs and baseline or longitudinal verbal episodic memory or between individual ACEs and executive function or verbal episodic memory.ConclusionIn this cohort of older black Americans, there was no association between ACEs and baseline cognition or cognitive change in verbal episodic memory; however, experiencing ≥ 2 ACEs was associated with less decline in executive function. These results may indicate that participants who survived to age 50+ and experienced ACEs may have cognitive resilience that warrants further investigation.

Introduction Few longitudinal studies have examined the joint impact of neighborhood segregation and neighborhood socioeconomic status (NSES) in cognitive decline over time. Methods This study included non‐Hispanic White (NHW, n = 209) and Black participants (n = 118) whose cognition was evaluated as part of an ongoing longitudinal study. Four distinct categories of segregation and NSES were evaluated for their association with cognitive outcomes (episodic memory, semantic memory, executive function, and spatial ability) using race‐specific mixed‐effects models. Results Compared to Black participants living in higher segregation‐lower NSES areas, Black participants living in lower segregation‐lower NSES areas or higher segregation‐higher NSES areas experienced slower decline in episodic memory over time. Compared to NHW participants living in higher segregation‐lower NSES areas, NHWs living in lower segregation‐higher NSES areas experienced faster decline in spatial ability. Discussion Segregation and NSES are differentially associated with cognition depending on participant race. Further research is needed to replicate study results.

INTRODUCTION The prevalence of poor sleep quality and sleep apnea differs by race and ethnicity and may contribute to racial disparities in cognitive aging. We investigated whether sleep quality and sleep apnea risk were associated with cognitive function and decline and whether the associations differed by race/ethnicity. METHODS Participants from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE; N = 1690; mean age: 75.7 years) study, a cohort of Asian, Black, Latino, and White participants, completed a modified Pittsburgh Sleep Quality Index assessing subjective sleep quality, latency, duration, disturbances, sleep medication use, and daytime dysfunction. Sleep apnea risk was measured by questions about snoring, tiredness, and whether apnea was observed. Executive function and verbal episodic memory were assessed at three time points over an average of 2.7 years with the Spanish and English Neuropsychological Assessment Scale. We fit linear mixed‐effect models and stratified analyses by race/ethnicity. RESULTS Higher sleep apnea risk was associated with faster declines in verbal episodic memory (β̂ $\\hat \\beta $ sleep apnea = −0.02, 95% confidence interval [CI], −0.04, −0.001) but not in executive function. Poorer sleep quality was associated with lower levels of and faster decline in executive function but not in verbal episodic memory. Race/ethnicity modified these associations: compared to estimated effects among White participants, poorer global sleep quality (β̂ $\\hat \\beta $ sleep*time = −0.02, 95% CI, −0.02, −0.01) was associated with larger effects on decline in executive function among Black participants. Estimated effects of some individual sleep quality components were also modified by race/ethnicity; for example, sleep medication use was associated with faster declines in executive function (β̂ $\\hat \\beta $ sleep*time = −0.05, 95% CI, −0.07, −0.03) and verbal episodic memory β̂ $\\hat \\beta $ sleep*time = −0.04, 95% CI, −0.07, −0.02) among Black participants compared to White participants. DISCUSSION Observational evidence indicates sleep quality is a promising target for addressing racial/ethnic disparities in cognitive aging, especially among Black older adults. Highlights Sleep apnea risk was associated with faster declines in verbal episodic memory but not executive function among all participants. Global sleep quality was associated with lower levels of and faster decline in executive function but not verbal episodic memory among all participants. Black older adults were particularly susceptible to the estimated adverse cognitive impacts of global sleep quality, particularly the use of sleep medication.

Background Modifiable risks for dementia are more prevalent in rural populations, yet there is a dearth of research examining life course rural residence on late‐life cognitive decline. Methods The association of rural residence and socioeconomic status (SES) in childhood and adulthood with late‐life cognitive domains (verbal episodic memory, executive function, and semantic memory) and cognitive decline in the Kaiser Healthy Aging and Diverse Life Experiences cohort was estimated using marginal structural models with stabilized inverse probability weights. Results After adjusting for time‐varying SES, the estimated marginal effect of rural residence in childhood was harmful for both executive function (β = −0.19, 95% confidence interval [CI] = −0.32, −0.06) and verbal episodic memory (β = −0.22, 95% CI = −0.35, −0.08). Effects of adult rural residence were imprecisely estimated with beneficial point estimates for both executive function (β = 0.19; 95% CI = −0.07, 0.44) and verbal episodic memory (β = 0.24, 95% CI = −0.07, 0.55). Conclusions Childhood rurality is associated with poorer late‐life cognition independent of SES.

Introduction Leisure time activity is associated with better cognitive function but has not been well studied in racially/ethnically diverse cohorts, who may have different access to activities. Methods Frequency of participation in 10 leisure time activities (eg, reading, attending cultural events) and cognition (executive function, semantic memory, and verbal episodic memory) were assessed at Wave 1 in the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, a prospective cohort initiated in 2017. Linear regression models adjusted for sociodemographics and depression estimated cross‐sectional associations between leisure time activity variety and frequency and cognitive domains overall and by race/ethnicity. Logistic regression models estimated odds of cognitive impairment among those in the lowest quartiles of activity variety and frequency. All models controlled for age, sex, education, income, retirement status, and depression. Results Higher leisure time activity variety was significantly associated with better cognition for all, except for verbal episodic memory among Asians (β = 0.05, 95% confidence interval [CI]: −0.004, 0.11) and semantic memory among Latinos (β = 0.04, 95% CI: −0.01, 0.08). Low activity variety was associated with nearly three‐fold increased odds of cognitive impairment (adjusted odds ratio [OR] = 2.87, 95% CI: 1.77, 4.64). Activity frequency was associated with higher executive function only among whites (β = 0.10, 95% CI: 0.02, 0.18). Patterns by race/ethnicity were not explained by education. Discussion Engaging in a wider variety of leisure time activities may be more important than frequently participating in fewer activities for cognitive aging in racially/ethnically diverse cohorts.

Background Lipids play a vital role in brain function. Black Americans experience a disproportionate burden of midlife metabolic disorders and late‐life dementia despite, on average, favorable lipid profiles through midlife. In an all‐Black cohort, we aimed to assess the relationship between early adulthood hyperlipidemia and late‐life cognition, exploring midlife metabolic disorders as mediators. Method This study included Black participants residing in northern California, USA, from the Study of Healthy Aging in African Americans and Kaiser Healthy Aging and Diverse Life Experiences Study. Early adulthood (mean age: 31.2±4.0) hyperlipidemia (total cholesterol ≥ 200 mg dL) was measured as part of routine care at Kaiser Permanente during Multiphasic Health Check‐ups (MHC) between ages 25‐40. Diagnoses of dyslipidemia, diabetes, and hypertension were ascertained from electronic health records in midlife (ages 40‐65 (mean diagnosis age range: 54‐57)). Cognition was assessed at baseline (ages 50+) using the Spanish and English Neuropsychological Assessment Scales measuring z‐standardized executive function (EF), verbal episodic memory (VEM), and semantic memory (SEM). Linear regression models associated early adulthood hyperlipidemia with late‐life cognition adjusting for gender, age at MHC, age at cognitive assessment, and education. Causal mediation analyses decomposed the total effect of early adulthood hyperlipidemia on cognition into natural direct effects and natural indirect effects via midlife metabolic disorders. Result Participants (n = 773) had a mean total cholesterol of 198.6±39.4 mg dL and 44.5% prevalence of hyperlipidemia in early adulthood. Prevalence of midlife dyslipidemia was 46.2%, diabetes 23.9%, and hypertension 58.6%. Mean age at cognitive assessment was 74.3±6.6 years. Early adulthood hyperlipidemia was associated with significantly worse VEM (β[95%CI]:‐0.13[‐0.26,‐0.01]), and non‐significantly worse EF (β:‐0.07[‐0.19,0.04]) and SM (β:‐0.07[‐0.19, 0.04]). The association between early adulthood hyperlipidemia and EF was partially mediated by midlife dyslipidemia (23.4%), diabetes (24.4%), and hypertension (4.0%). The association with VEM was partially mediated by midlife diabetes (10.1%), but not dyslipidemia or hypertension. The association with SEM was mediated by dyslipidemia (38.8%) and diabetes (11.6%), but not hypertension. Conclusion The associations of early adulthood hyperlipidemia on late‐life EF and SM may occur via vascular pathways partially mediated by midlife dyslipidemia and diabetes. Non‐vascular mechanisms should be examined between early adulthood hyperlipidemia and worse late‐life VEM.

Background Age is associated with changes in brain integrity and cognition, but it is not agreed on whether age should be controlled for in statistical models. If age substantially contributes to brain integrity, then we may expect that brain integrity mediates the association of age and cognition. Therefore, we tested whether markers of brain integrity mediate the association of age and cognition. Method Adults ages 50+ from two harmonized cohorts (Kaiser Healthy Aging and Diverse Life Experience, and Study of Healthy Aging in African Americans) who received a 3T brain MRI were included. Executive function (EF) and verbal episodic memory (VEM) were measured using a neuropsychological battery and z‐scored. Linear regression model was used to assess the association of baseline age and follow‐up cognition, adjusting for sex and education. Using mediation analyses, we decomposed the total effect of age into the natural direct and indirect effects via neuroimaging biomarkers of z‐standardized total cerebrum volumes, hippocampal volumes, and log‐white matter hyperintensities (WMH). Result Among 577 participants (mean age=71.3; SD=7.1), 60% were females and 49% had ≥college education. The total effect of age on EF was (β=‐0.04; 95% CI ‐0.05, ‐0.03) and VEM was (β=‐0.02; 95% CI ‐0.04, ‐0.02). The direct effects of age on EF when not mediated is β(95% CI)=‐0.025(‐0.038, ‐0.011) via total cerebrum, β(95% CI)=‐0.036(‐0.046, ‐0.025) via hippocampus, and β(95% CI)=‐0.030(‐0.041, ‐0.019) via WMH. Similarly, the direct effect of age on VEM when not mediated is β(95% CI)=‐0.022(‐0.037, ‐0.007) via total cerebrum, β(95% CI)=‐0.023(‐0.034, ‐0.011) via hippocampus and β(95% CI)=‐0.019(‐0.031, ‐0.007) via WMH. In separate mediation analyses, the association of age on EF was 45.7% (95% CI=24.3, 67.0) mediated through total cerebrum, 11.9% (95% CI=4.3, 19.5) through the hippocampus, and 30.8% (95% CI=16.4, 45.3) through WMH. The association of age on VEM was mediated 33.5% (95% CI=3.5, 63.5) through total cerebrum, 20.4% (95% CI=7.2, 33.6) through hippocampus, and 38.3% (95% CI=15.6, 61.1) through WMH. Conclusion Neuroimaging biomarkers partly mediate the effect of age on cognition. Brain integrity is associated with cognition; therefore, the effects of neuroimaging markers should be carefully considered when assessing the association of age on cognition.

Though depression impacts over 10% of the oldest-old, the contribution of brain health on changes in depression is unknown. This study included 225 participants from LifeAfter90 with magnetic resonance imaging, amyloid positron emission tomography (PET), and repeated Geriatric Depression Scale (GDS) data. We fit linear mixed-effects models for associations of neuroimaging markers with depressive symptom change adjusted for age, gender, race and ethnicity, and education. At baseline, average GDS scores were 2.6 (SD = 2.3) out of 15 possible points, average age was 93.3 (SD = 2.3) years, 56% female, and 22% Black, 25% Asian, 18% Hispanic/Latino, 28% Non-Hispanic White, and 7% as Multiracial/other. Greater baseline occipital volume was associated with slower GDS increase (β = − 0.29; 95% CI − 0.54, − 0.05). Greater baseline free water was associated with faster GDS increase (β = 0.31; 95% CI 0.05, 0.57). Estimates for other neuroimaging biomarkers leaned towards slower, but non-significant, increases in GDS. Estimates were not in the expected direction for amyloid PET and null for frontal cortex volume. Our findings suggest that lower cortical volume and greater white matter injury is associated with increases in depressive symptoms among the oldest old, even for those with low levels of baseline depressive symptoms.

INTRODUCTION The timing of educational attainment may modify its effects on late‐life cognition, yet most studies evaluate education only at a single time point. METHODS Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study cohort participants (N = 554) reported educational attainment (dichotomized at any college education) at two time points, and we classified them as having low, high, or later‐life high educational attainment. Linear mixed‐effects models estimated associations between educational attainment change groups and domain‐specific cognitive outcomes (z‐standardized). RESULTS Compared to low educational attainment, high (β= 0.59 SD units; 95% confidence interval [CI]: 0.39, 0.79) and later‐life high educational attainment (β = 0.22; 95% CI: 0.00, 0.44) were associated with higher executive function. Only high educational attainment was associated with higher verbal episodic memory (β = 0.27; 95% CI: 0.06, 0.48). DISCUSSION Level and timing of educational attainment are both associated with domain‐specific cognition. A single assessment for educational attainment may inadequately characterize protective associations with late‐life cognition. Highlights Few studies have examined both level and timing of educational attainment on cognition. Marginalized populations are more likely to attain higher education in adulthood. Higher educational attainment in late life is also associated with higher cognition.