Negative wealth shocks in later life and subsequent cognitive function in older adults in China, England, Mexico, and the USA, 2012–18: a population-based, cross-nationally harmonised, longitudinal study

Cho, Tsai-Chin; Yu, Xuexin; Gross, Alden L.; Zhang, Yuan S; Lee, Jinkook; Langa, Kenneth M.; Kobayashi, Lindsay C.

doi:10.1016/s2666-7568(23)00113-7

Cited by 7 publications

(4 citation statements)

References 26 publications

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“…In line with our findings, higher income volatility and more income drops of at least 25% over a 20-year period were associated with poorer cognitive function, smaller total brain volume, and worse microstructural integrity in the brain among 3287 adults with a mean age of 30 years . A 4-year follow-up study reported that associations between negative wealth shock and subsequent cognitive scores of older adults were significantly inverse in the US and China, but not in England or Mexico, suggesting the effects of macrolevel socioeconomic structures . Additionally, negative wealth shock could be regarded as a stressful life-course event.…”

Section: Discussionsupporting

confidence: 87%

“… 22 A 4-year follow-up study reported that associations between negative wealth shock and subsequent cognitive scores of older adults were significantly inverse in the US and China, but not in England or Mexico, suggesting the effects of macrolevel socioeconomic structures. 13 Additionally, negative wealth shock could be regarded as a stressful life-course event. It has been reported that adverse events in late life, including the experience of major financial problems, were associated with increased risks of dementia among 12 789 community-dwelling Australians 70 years and older.…”

Section: Discussionmentioning

confidence: 99%

“…The aforementioned adverse outcomes (eg, inflammation, depression, and cardiovascular diseases) are also risk factors for incident dementia . A recent study has reported associations between negative wealth shock and cognitive function that was measured at only 1 time point . However, whether negative wealth shock is a risk factor for cognitive decline and dementia has not been evaluated previously.…”

Section: Introductionmentioning

confidence: 99%

“… 12 A recent study has reported associations between negative wealth shock and cognitive function that was measured at only 1 time point. 13 However, whether negative wealth shock is a risk factor for cognitive decline and dementia has not been evaluated previously. Based on the longitudinal data of the Health and Retirement Study (HRS), 14 the aim of this study was to examine associations of negative wealth shock with cognitive decline and incident dementia in middle-aged and older adults in the US.…”

Section: Introductionmentioning

confidence: 99%

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Negative Wealth Shock and Cognitive Decline and Dementia in Middle-Aged and Older US Adults

Pan,

Gao,

Zhu

et al. 2023

JAMA Netw Open

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ImportanceAs a financial hardship, negative wealth shock has been implicated in some adverse health outcomes. However, associations between negative wealth shock and cognitive decline and dementia have not been examined.ObjectiveTo investigate whether negative wealth shock was associated with cognitive decline and incident dementia among middle-aged and older US adults.Design, Setting, and ParticipantsThe Health and Retirement Study (HRS) is a prospective cohort study conducted biennially among US adults older than 50 years. Data from the HRS from calendar years 1996 to 2020 were analyzed from July 1 to 31, 2023. The final sample included 8082 participants with complete data of interest.ExposuresWealth status was quantified with questionnaires. Negative wealth shock was defined as a loss of 75% or more in total wealth over a 2-year period. Asset poverty was defined as zero or less total net wealth.Main Outcomes and MeasuresCognitive function was assessed with the modified Telephone Interview for Cognitive Status (TICS-m). Dementia status was determined with TICS-m scores and proxy assessment.ResultsAmong 8082 participants included (mean [SD] age, 63.7 [5.7] years; 4179 women [51.7%] and 3903 men [48.3%]; 1111 Black [13.7%], 6689 White [82.7%], and 282 other [3.5%]), 1441 developed incident dementia over a median follow-up time of 14 (IQR, 7-20) years. Compared with participants who had positive wealth without shock, those with negative wealth shock had accelerated cognitive decline (β coefficient, −0.014 [95% CI, −0.027 to −0.001]; P = .03) and increased risks of dementia (hazard ratio [HR], 1.27 [95% CI, 1.11-1.46]; P &lt; .001). Higher dementia risks were also found in participants with asset poverty at baseline (HR, 1.61 [95% CI, 1.30-2.00]; P &lt; .001). Associations were found in White participants (HR, 1.34 [95% CI, 1.14-1.58]; P &lt; .001) and participants younger than 65 years (HR, 1.38 [95% CI, 1.13-1.68]; P = .001) but not in other races and ethnicities or those 65 years or older.Conclusions and RelevanceIn this cohort study, negative wealth shock was associated with accelerated cognitive decline and elevated risks of dementia among middle-aged and older US adults, with modifications by age and ethnicity. These findings should be confirmed by further prospective and interventional studies.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%