Key Points Question Does the risk of cognitive decline among US adults vary by sex? Findings In this cohort study using pooled data from 26 088 participants, women, compared with men, had higher baseline performance in global cognition, executive function, and memory. Women, compared with men, had significantly faster declines in global cognition and executive function, but not memory. Meaning These findings suggest that women may have greater cognitive reserve but faster cognitive decline than men.

IMPORTANCE Black individuals are more likely than white individuals to develop dementia. Whether higher blood pressure (BP) levels in black individuals explain differences between black and white individuals in dementia risk is uncertain.OBJECTIVE To determine whether cumulative BP levels explain racial differences in cognitive decline. DESIGN, SETTING, AND PARTICIPANTS Individual participant data from 5 cohorts (January 1971 to December 2017) were pooled from the Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. Outcomes were standardized as t scores (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. The median (interquartile range) follow-up was 12.4 (5.9-21.0) years. Analysis began September 2018. MAIN OUTCOMES AND MEASURESThe primary outcome was change in global cognition, and secondary outcomes were change in memory and executive function. EXPOSURES Race (black vs white).RESULTS Among 34 349 participants, 19 378 individuals who were free of stroke and dementia and had longitudinal BP, cognitive, and covariate data were included in the analysis. The mean (SD) age at first cognitive assessment was 59.8 (10.4) years and ranged from 5 to 95 years. Of 19 378 individuals, 10 724 (55.3%) were female and 15 526 (80.1%) were white. Compared with white individuals, black individuals had significantly faster declines in global cognition (−0.03 points per year faster [95% CI, −0.05 to −0.01]; P = .004) and memory (−0.08 points per year faster [95% CI, −0.11 to −0.06]; P < .001) but significantly slower declines in executive function (0.09 points per year slower [95% CI, 0.08-0.10]; P < .001). Time-dependent cumulative mean systolic BP level was associated with significantly faster declines in global cognition (−0.018 points per year faster per each 10-mm Hg increase [95% CI, −0.023 to −0.014]; P < .001), memory (−0.028 points per year faster per each 10-mm Hg increase [95% CI, −0.035 to −0.021]; P < .001), and executive function (−0.01 points per year faster per each 10-mm Hg increase [95% CI, −0.014 to −0.007]; P < .001). After adjusting for cumulative mean systolic BP, differences between black and white individuals in cognitive slopes were attenuated for global cognition (−0.01 points per year [95% CI, −0.03 to 0.01]; P = .56) and memory (−0.06 points per year [95% CI, −0.08 to −0.03]; P < .001) but not executive function (0.10 points per year [95% CI, 0.09-0.11]; P < .001). CONCLUSIONS AND RELEVANCEThese results suggest that black individuals' higher cumulative BP levels may contribute to racial differences in later-life cognitive decline.

BACKGROUND Using billing data generated through healthcare delivery to identify individuals with dementia has become important in research. To inform tradeoffs between approaches, we tested the validity of different Medicare claims-based algorithms. METHODS We included 5,784 Medicare-enrolled, Health and Retirement Study participants aged &gt;65 years in 2012 clinically assessed for cognitive status over multiple waves and determined performance characteristics of different claims-based algorithms. RESULTS Positive predictive value (PPV) of claims ranged from 53.8-70.3% and was highest using a revised algorithm and 1-year of observation. The trade-off of greater PPV was lower sensitivity; sensitivity could be maximized using 3-years of observation. All algorithms had low sensitivity (31.3-56.8%) and high specificity (92.3-98.0%). Algorithm test performance varied by participant characteristics, including age and race. CONCLUSIONS Revised algorithms for dementia diagnosis using Medicare administrative data have reasonable accuracy for research purposes, but investigators should be cognizant of the trade-offs in accuracy among the approaches they consider.

This article describes the development, design, and implementation of an integrated randomized double-masked placebo-controlled trial (Project Grow Smart) that examines how home/preschool fortification with multiple micronutrient powder (MNP) combined with an early child-development intervention affects child development, growth, and micronutrient status among infants and preschoolers in rural India. The 1-year trial has an infant phase (enrollment age: 6-12 months) and a preschool phase (enrollment age: 36-48 months). Infants are individually randomized into one of four groups: placebo, placebo plus early learning, MNP alone, and MNP plus early learning (integrated intervention), conducted through home visits. The preschool phase is a cluster-randomized trial conducted in Anganwadi centers (AWCs), government-run preschools sponsored by the Integrated Child Development System of India. AWCs are randomized into MNP or placebo, with the MNP or placebo mixed into the children's food. The evaluation examines whether the effects of the MNP intervention vary by the quality of the early learning opportunities and communication within the AWCs. Study outcomes include child development, growth, and micronutrient status. Lessons learned during the development, design, and implementation of the integrated trial can be used to guide large-scale policy and programs designed to promote the developmental, educational, and economic potential of children in developing countries.

Objective: In India, national databases indicate anaemia prevalence of 80 % among 6-35-month-old children and 58 % among 36-59-month-old children. The present study aimed to characterise anaemia and the associated factors among infants and pre-schoolers living in rural India. Design: Multivariate logistic regression analysis of data collected prior to an intervention trial. Fe-deficiency with anaemia (IDA), Fe deficiency with no anaemia (IDNA) and anaemia without Fe deficiency were defined. Serum ferritin, soluble transferrin receptor (sTfR) and sTfR/log ferritin index were used to indicate Fe status. Setting: Twenty-six villages of Nalgonda district, Telangana, India. Data were collected in community sites. Participants: Four hundred and seventy-six infants (aged 6-12 months), 316 pre-schoolers (aged 29-56 months) and their mothers. Results: Prevalence of anaemia among infants and pre-schoolers was 66·4 and 47·8 %, prevalence of IDA was 52·2 and 42·1 %, prevalence of IDNA was 22·2 and 29·8 %, prevalence of anaemia without Fe deficiency was 14·2 and 5·7 %. Among infants, anaemia was positively associated with maternal anaemia (OR = 3·31; 95 % CI 2·10, 5·23; P < 0·001), and sTfR/log ferritin index (OR = 2·21; 95 % CI 1·39, 3·54; P = 0·001). Among pre-schoolers, anaemia was positively associated with maternal anaemia (OR = 3·77; 95 % CI 1·94, 7·30; P < 0·001), sTfR/log ferritin index (OR = 5·29; 95 % CI 2·67, 10·50; P < 0·001), high C-reactive protein (OR = 4·39; 95 % CI 1·91, 10·06, P < 0·001) and young age (29-35 months: OR = 1·92; 05 % CI 1·18, 3·13, P = 0·009). Conclusions: Anaemia prevalence continues to be high among infants and pre-schoolers in rural India. Based on sTfR/ferritin index, Fe deficiency is a major factor associated with anaemia. Anaemia is also associated with inflammation among pre-schoolers and with maternal anaemia among infants and preschoolers, illustrating the importance of understanding the aetiology of anaemia in designing effective control strategies. KeywordsAnaemia Infants Pre-schoolers India Risk factors sTfR/log ferritin index Global estimates indicate that 43 % of children under the age of 5 years suffer from anaemia (1) and that about half of anaemia is caused by Fe deficiency. However, the prevalence and aetiology of anaemia are likely to be context-specific (2) . Due to the high nutrient (e.g. dietary Fe) demands needed to support early physical growth, rapid brain development and early learning capacity, the infancy and pre-school periods are especially vulnerable to anaemia (3,4) . Anaemia and Fe deficiency are associated with perinatal mortality (5) , delayed child mental and physical development, negative behavioural consequences and reduced auditory and visual function (6,7) . Some of the consequences of early anaemia and Fe deficiency may be irreversible (8,9) . In low-and middle-income countries, epidemiological evaluation is important in designing anaemia control programmes (10,11) . In India, national databases indicate an alarming anaemia prevalence of 80 % a...