Evidence map›Paper›PMID 39001609›Full record

ArticleAlzheimer's & dementia : the journal of the Alzheimer's Association2024

Inequalities in accelerated cognitive decline: Resolving observational window bias using nested non-linear regression.

Sean A P Clouston, Douglas W Hanes, Dylan M Smith, Lauren L Richmond, Marcus Richards, Bruce Link

Abstract read
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In one paragraph

Article in Alzheimer's & dementia : the journal of the Alzheimer's Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Observational
  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Sean A P CloustonProgram in Public Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA.ORCID 0000-0002-6124-0329
Douglas W HanesProgram in Public Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA.ORCID 0000-0003-2186-5540
Dylan M SmithProgram in Public Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA.
Lauren L RichmondDepartment of Psychology, Stony Brook University, Stony Brook, New York, USA.
Marcus RichardsMRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK.
Bruce LinkDepartment of Sociology, University of California at Riverside, Riverside, California, USA.

Funding

HRS Yrs29-34: Y33 SSA CoFundingU01AG009740 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Jessica Faul, KENNETH M LANGA · 1990 to 2026
$555.8M
Social inequalities and the onset of Alzheimer's pathology: The role of Race/Ethnicity, cognitive reserve, and occupational complexityRF1AG058595 · NIA · STATE UNIVERSITY NEW YORK STONY BROOK · PI CLOUSTON, SEAN · 2019 to 2019
$3.3M
NIA NIH HHS RF1 AG058595NIA NIH HHS U01 AG009740NIA NIH HHS U01AG009740
6 · The paper itself

Abstract

introductionLimited observational windows lead to conflicting results in studies examining educational differences in Alzheimer's disease and related dementias (ADRD) risk, due to observational window bias relative to onset of accelerated cognitive decline. This study tested a novel model to address observational window bias and tested for the presence and sources of disparities in accelerated cognitive declines due to ADRD.

methodsThe sample examined 167,314 cognitive assessments from 32,441 Health and Retirement Study participants. We implemented a parametric non-linear nested longitudinal regression and reported multivariable-adjusted nodal incidence ratios (aNIR).

resultsUniversity degrees were associated with lower incidence (aNIR = 0.253, 95% confidence interval [CI] = [0.221 to 0.289], p < 0.001), while black participants had a higher incidence (aNIR = 1.995, [1.858 to 2.141], p < 0.001) of accelerated cognitive decline, adjusting for demographic, sociobehavioral, and medical risk factors. Sex-stratified analyses identified diminished educational returns for women and increased incidence among minoritized women. DISCUSSION: Addressing observational window bias reveals large social inequalities in the onset of accelerated cognitive declines indicative of ADRD. HIGHLIGHTS: This study identifies observational window bias as a source of conflicting results among previous studies of educational achievement in Alzheimer's disease and related dementias (ADRD) disparities. The study locates preclinical accelerated cognitive decline, which is indicative of ADRD while occurring 10+ years prior to symptom onset, as a site to study ADRD disparities that mitigates observational window bias. A novel method, nested non-linear regression, is developed to test for differences in the onset of accelerated cognitive decline. Educational and racial/ethnic disparities are demonstrated in the onset of accelerated cognitive decline, as are their intersecting differences with sex/gender.

Indexed as

Cognitive DysfunctionAgedAged, 80 and overAlzheimer DiseaseBiasEducational StatusFemaleHumansIncidenceLongitudinal StudiesMaleMiddle AgedNonlinear DynamicsRisk FactorsSocioeconomic FactorsAlzheimer's and related diseasescognitive pathologylongitudinal cognitive declineparametric segmented modeling

Identifiers

PMID39001609
PMCPMC11350020

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.