P1252428408NsHUM - PowerPoint PPT Presentation

Title: P1252428408NsHUM


1
LONGVIEW COGNITIVE CAPITAL OVER THE LAST 50
YEARS SEMINAR 5 ADULT LIFE CHANCES HEALTH
Based on work led by David Batty, Catherine Gale,
Stephani Hatch, Barbara Jefferis, Diana Kuh, and
Marcus Richards
2
PATHWAYS FROM COGNITIVE CAPITAL TO HEALTH

• Mediation
• Cognition may mediate early circumstances that
• influence health
• material home conditions (wealth)
• family interaction (psychosocial)
• developing health itself

3
PATHWAYS FROM COGNITIVE CAPITAL TO HEALTH

• Social causation
• Cognition can determine the acquisition of
  factors that
• influence health
• material resources (wealth)
• psychosocial capital (status, control,
  wellbeing)
• self-care/health literacy (lifestyle, health
  service use)

4
PATHWAYS FROM COGNITIVE CAPITAL TO HEALTH

• Cognition as a biomarker
• Cognition may mark underlying physiological
  processes
• that regulate health
• central nervous system
• autonomic nervous system
• endocrine axes (growth, thyroid, HPA, HPG)
• oxidative biochemistry
• immune function
• genetic pleiotropy

5
British 1946 birth cohort cumulative male death
rate 9 to 54 years for the highest and lowest
quarters of the cognitive score at age 8 years.
Highest quartile
Lowest quartile
9 12 15 18 21 24 27 30
33 36 39 42 45 48 51
54
Kuh, Richards, Hardy, Butterworth Wadsworth Int
J Epidemiol 2004 33 408-413
6
Cognitive ability tests

• __________________________________________________
  __
• 1946 cohort 1970 cohort
• __________________________________________________
  __
• Non-Verbal intelligence Non-verbal (BAS)
• Verbal intelligence - Recall of digits
• Vocabulary - Matrices
• Pronunciation Verbal (BAS)
• Arithmetic - Word definitions
• - Word similarities
• __________________________________________________
  _________

7
LIFESTYLE HEALTH-RELATED BEHAVIOURS
8
Ever smoked cigarettes

• __________________________________________________
  _________
• 1946 cohort (36 y) 1970 cohort (30
  y)
• (63.8) (55.4)
• __________________________________________________
  _________
• Unadjusted 0.83 (0.76, 0.92) p lt 0.001
  -----
• Gender 0.84 (0.76, 0.92) p lt 0.001
  0.92 (0.88, 0.96)
• Parental SC 0.86 (0.77, 0.95) p 0.003
  0.93 (0.89, 0.97)
• Own education 1.07 (0.95, 1.22) p 0.26
  1.08 (1.03, 1.14)
• Adult SC 0.90 (0.80, 1.00) p 0.05
  1.01 (0.96, 1.06)
• Adult earnings 0.80 (0.72, 0.88) p lt 0.001
  0.93 (0.88, 0.98)
• All 1.09 (0.96, 1.24) p 0.19
  1.08 (1.02, 1.15)
• __________________________________________________
  __________

Batty D, Deary I, Schoon I, Gale C. In press
Journal of Epidemiology and Community Health
9
Quit smoking cigarettes

• __________________________________________________
  _________
• 1946 cohort (36 y) 1970 cohort (30
  y)
• (33.4) (34.2)
• __________________________________________________
  _________
• Unadjusted 1.31 (1.16, 1.48) p lt 0.001
  -----
• Gender 1.31 (1.16, 1.48) p lt 0.001
  1.25 (1.18, 1.34)
• Parental SC 1.29 (1.13, 1.47) p lt 0.001
  1.18 (1.10, 1.26)
• Own education 1.13 (0.97, 1.32) p 0.11
  1.10 (1.02, 1.18)
• Adult SC 1.22 (1.06, 1.40) p 0.005
  1.15 (1.07, 1.23)
• Adult earnings 1.30 (1.15, 1.48) p lt 0.001
  1.16 (1.07, 1.25)
• All 1.11 (0.95, 1.31) p 0.19
  1.02 (0.93, 1.11)
• __________________________________________________
  __________

Batty D, Deary I, Schoon I, Gale C. In press
Journal of Epidemiology and Community Health
10
1946 cohort odds of being CAGE positive at 53
yearsper point increase in childhood cognition
at 8 years

• Odds 1.04 (1.01 1.07) p 0.02
• Adjusting for
• Gender
• SES origin and early adversity (fathers social
  class, mothers education, parental divorce,
  suboptimal maternal management
• and poor material home conditions)
• Highest educational qualifications by 26 years)
• Adult SES (social class and household income)
• Adult stressors (unemployment and economic
  hardship)
• Adult health behaviours (exercise and smoking)

Hatch, Jones, Kuh, Hardy, Wadsworth Richards
Soc Sci Med 2007 64 2285-2296
11
Ever CAGE positive (men)

• __________________________________________________
  _________
• 1946 cohort (43 y) 1970 cohort (30
  y)
• (13.7) (20.4)
• __________________________________________________
  _________
• Unadjusted 0.99 (0.84, 1.18) p 0.93
  -----
• Parental SC 1.00 (0.83, 1.21) p 0.98
  1.13 (1.04, 1.24)
• Own education 1.03 (0.82, 1.29) p 0.79
  1.13 (1.04, 1.24)
• Adult SC 1.00 (0.82, 1.22) p 0.99
  1.18 (1.07, 1.30)
• Adult earnings 0.99 (0.82, 1.19) p 0.90
  1.15 (1.03, 1.26)
• Has children 0.99 (0.83, 1.18) p 0.92
  1.11 (1.02, 1.22)
• All 1.03 (0.81, 1.30) p 0.82
  1.16 (1.04, 1.28)
• __________________________________________________
  __________

Batty D, Deary I, Schoon I, Gale C. In press
American Journal of Public Health
12
Ever CAGE positive (women)

• __________________________________________________
  _________
• 1946 cohort (43 y) 1970 cohort (30
  y)
• (9.3) (8.1)
• __________________________________________________
  _________
• Unadjusted 1.43 (1.06, 1.94) p 0.02
  1.44 (1.24, 1.67)
• Parental SC 1.37 (0.99, 1.91) p 0.06
  1.42 (1.22, 1.65)
• Own education 1.09 (0.74, 1.62) p 0.67
  1.46 (1.24, 1.71)
• Adult SC 1.24 (0.89, 1.74) p 0.20
  1.35 (1.16, 1.59)
• Adult earnings 1.16 (0.84, 1.59) p 0.37
  1.44 (1.24, 1.67)
• Has children 1.41 (1.04, 1.91) p 0.03
  1.36 (1.18, 1.58)
• All 1.02 (0.68, 1.53) p 0.92
  1.38 (1.17, 1.64)
• __________________________________________________
  __________

Batty D, Deary I, Schoon I, Gale C. In press
American Journal of Public Health
13
Any physical exercise

• __________________________________________________
  _________
• 1946 cohort (36 y) 1970 cohort (30
  y)
• (65.4)
• __________________________________________________
  _________
• Unadjusted 1.40 (1.28, 1.54) p lt 0.001
  1.21 (1.14, 1.27)
• Gender 1.42 (1.29, 1.56) p lt 0.001
  1.20 (1.14, 1.27)
• Parental SC 1.35 (1.22, 1.49) p lt 0.001
  1.16 (1.10, 1.23)
• Own education 1.23 (1.09, 1.39) p 0.001
  1.06 (1.00, 1.12)
• Adult SC 1.26 (1.13, 1.40) p lt 0.001
  1.15 (1.09, 1.22)
• Adult earnings 1.30 (1.18, 1.43) p lt 0.001
  1.16 (1.09, 1.24)
• All 1.19 (1.05, 1.35) p 0.006
  1.02 (0.94, 1.09)
• __________________________________________________
  __________

Batty D, Deary I, Schoon I, Gale C. Pediatrics
2007 (www.pediatrics.org)
14
Intense physical exercise

• __________________________________________________
  _________
• 1946 cohort (53 y) 1970 cohort (30
  y)
• (37)
• __________________________________________________
  _________
• Unadjusted 1.80 (1.60, 2.02) p lt 0.001
  1.35 (1.29, 1.41)
• Gender 1.81 (1.61, 2.04) p lt 0.001
  1.30 (1.24, 1.36)
• Parental SC 1.71 (1.51, 1.94) p lt 0.001
  1.31 (1.25, 1.37)
• Own education 1.43 (1.23, 1.65) p lt 0.001
  1.25 (1.19, 1.31)
• Adult SC 1.60 (1.40, 1.82) p lt 0.001
  1.22 (1.16, 1.28)
• Adult earnings 1.69 (1.50, 1.90) p lt 0.001
  1.20 (1.14, 1.27)
• All 1.39 (1.19, 1.62) p lt 0.001
  1.15 (1.08, 1.22)
• __________________________________________________
  __________

Batty D, Deary I, Schoon I, Gale C. Pediatrics
2007 (www.pediatrics.org)
15
Healthy food choice at 53 years (1946 cohort)
Healthy food choice representing 1. frequency of
breakfast, 2. type of milk, 3. type of bread, 4.
proportion of energy derived from fat, and 5.
number of daily portions of fruit and vegetables
(odds of gt median total score)

• _________________________________________________
• Unadjusted 1.53 (1.35, 1.73) p lt 0.001
• Gender 1.52 (1.35, 1.72) p lt 0.001
• Parental SC 1.46 (1.28, 1.66) p lt 0.001
• Own education 1.14 (0.98, 1.34) p 0.09
  
• Adult SC 1.44 (1.25, 1.65) p lt 0.001
• Adult earnings 1.57 (1.38, 1.78) p lt 0.001
  
• All 1.14 (0.97, 1.34) p 0.11
• _________________________________________________

Based on forthcoming work in collaboration with
the MRC Human Nutrition Research Centre, Elsie
Widdowson Laboratories, Cambridge
16
Odds of being a vegetarian at 30 years (1970
cohort)

• _______________________
• Unadjusted 1.38 (1.24, 1.53)
• Gender 1.42 (1.28, 1.59)
• Parental SC 1.35 (1.21, 1.51)
• Own education 1.16 (1.03, 1.30)
• Adult SC 1.29 (1.15, 1.45)
• All 1.20 (1.06, 1.36)
• _______________________

Gale C, Deary I, Schoon I, Batty D. British
Medical Journal 2007334245.
17

• Health behaviours summary
• Childhood IQ is mainly protective of harmful
  health-
• related behaviours, although it appears to be
  associated
• with increased risk of potential alcohol
  abuse
• These effects were often explained by
  educational
• attainment or adult SES, although there were
• independent effects of IQ on on risk of
  alcohol abuse
• and being a vegetarian in the 1970 and on
  likelihood of
• undertaking physical exercise in both
  cohorts
• There were few obvious cohort effects, although
• positive associations between IQ and
  potential alcohol
• abuse appeared to be stronger in the 1958
  cohort

18
CHRONIC PHYSICAL DISEASE
19
Hypertension (self reported)

• __________________________________________________
  _________
• 1946 cohort (36 y) 1970 cohort (30
  y)
• (3.1) (7.7)
• __________________________________________________
  _________
• Unadjusted 0.75 (0.59, 0.95) p 0.02
  -----
• Gender 0.74 (0.58, 0.95) p 0.02
  0.90 (0.83, 0.98)
• Parental SC 0.75 (0.57, 0.97) p 0.03
  0.92 (0.84, 0.99)
• Own education 0.69 (0.51, 0.95) p 0.02
  0.93 (0.85, 1.01)
• Adult SC 0.77 (0.58, 1.02) p 0.07
  0.91 (0.83, 0.99)
• Adult earnings 0.78 (0.61, 1.01) p 0.06
  0.89 (0.80, 0.98)
• All 0.70 (0.51, 0.98) p 0.04
  0.94 (0.84, 1.06)
• __________________________________________________
  __________

Batty D, Deary I, Schoon I, Gale C. In press
Journal of Epidemiology and Community Health
20
Obesity (BMI gt 30 kg/m2 WHO)

• __________________________________________________
  _________
• 1946 cohort (36 y) 1970 cohort (30
  y)
• (5.6) (11.3)
• __________________________________________________
  _________
• Unadjusted 0.73 (0.61, 0.88) p 0.001
  -----
• Gender 0.73 (0.61, 0.88) p 0.001
  0.84 (0.79, 0.91)
• Parental SC 0.78 (0.94, 0.95) p 0.02
  0.89 (0.83, 0.96)
• Own education 0.79 (0.62, 1.00) p 0.05
  0.93 (0.86, 1.00)
• Adult SC 0.78 (0.63, 0.97) p 0.02
  0.88 (0.81, 0.95)
• Adult earnings 0.76 (0.63, 0.92) p 0.005
  0.86 (0.79, 0.94)
• All 0.82 (0.64, 1.05) p 0.12
  0.97 (0.88, 1.07)
• __________________________________________________
  __________

Batty D, Deary I, Schoon I, Gale C. In press
Journal of Epidemiology and Community Health
21
Metabolic syndrome at 53 years (1946 cohort)
National Cholesterol Education Program Adult
Treatment Panel III (ATPIII) definition (21.9)

• _________________________________________________
• Unadjusted 0.82 (0.72, 0.94) p 0.004
• Gender 0.82 (0.72, 0.94) p 0.004
• Parental SC 0.86 (0.74, 0.99) p 0.04
• Own education 0.96 (0.80, 1.14) p 0.64
  
• Adult SC 0.85 (0.73, 1.00) p 0.04
• Adult earnings 0.79 (0.69, 0.91) p 0.001
  
• All 0.98 (0.82, 1.18) p 0.84
• _________________________________________________

Metabolic syndrome identified in the 1946 cohort
by Claudia Langenberg (American Journal of Public
Health 2006 96 2216-2221)
22
TIMING OF THE NATURAL MENOPAUSE

• Mediation Cognition may mediate early
  circumstances that influence reproductive ageing
• Social causation Education and cognition
  determine health behaviours (e.g. smoking) that
  trigger early menopause
• Cognition as a biomarker oestrogen facilitates
  neural growth, prevents neuronal damage and
  death, and increases cerebral blood flow

23
Survivor functions for age at menopause by
cognitive ability score at age 8 years
1.00
0.75
Proportion pre/peri menopausal
0.50
0.25
0.00
34
36
38
40
42
44
46
48
50
52
54
56
58
Age (years)
Lowest third
Highest third
Richards et al. Neurology 1999 Kuh et al.
Menopause 2005
24
Effect of one standard deviation change in
cognitive ability at 8 years on age at menopause
Hazard Ratio (95CI)
Unadjusted 0.89 (0.82,0.96)
Adjusted for been breastfed 0.88 (0.81,0.96)
Adjusted for fathers social class 0.91 (0.83,0.99)
Adjusted for parental divorce (by 15) 0.89 (0.82,0.96)
Adjusted for parity 0.88 (0.80,0.95)
Adjusted for smoking 0.91 (0.83,0.99)
Fully adjusted 0.90 (0.82,0.98)
Kuh et al. Menopause 2005 12 475-82
25
COX PROPORTIONAL HAZARDS FORCOGNITION AND AGE AT
MENOPAUSE

• __________________________________________________
  _________
• Age of test Hazard ratio (95 CI) p value
• __________________________________________________
  _________
• 8 years 0.73 (0.62 - 0.86) lt0.001
• 11 years 0.78 (0.67 - 0.91) 0.002
• 15 years 0.80 (0.67 - 0.94) 0.007
• 26 years 0.85 (0.72 - 1.00) 0.048
• __________________________________________________
  ________________

26

• Chronic physical disease summary
• Childhood IQ is associated with reduced risk of
  chronic
• physical disease
• As with health behaviours, this was mostly
  explained by
• educational attainment or adult SES, although
  there is
• an independent inverse association between IQ
  and risk
• of early natural menopause, possibly
  reflecting early
• programming of the reproductive hormonal axis
• There were few obvious cohort effects, although
  
• associations between IQ and self-reported
  hypertension
• appeared to be stronger in the 1946 cohort

27
MENTAL HEALTH
28
1946 cohort total GHQ-28 score at 53 yearsper
point increase in childhood cognition at 8 years

• Regression coefficient (men) -0.04 (-0.22,
  -0.15) p 0.70
• Regression coefficient (women) -0.29 (-0.52,
  -0.06) p 0.01
• Adjusting for
• SES origin and early adversity (fathers social
  class, mothers education, parental divorce,
  suboptimal maternal management
• and poor material home conditions)
• Highest educational qualifications by 26 years)
• Adult SES (social class and household income)
• Adult stressors (unemployment and economic
  hardship)
• Adult health behaviours (exercise and smoking)

Hatch, Jones, Kuh, Hardy, Wadsworth Richards
Soc Sci Med 2007 64 2285-2296
29
LITERACY, COGNITIVE RESERVE, AND COGNITIVE DECLINE
30
1946 cohort
1958 cohort
Fathers occupation
Fathers occupation
0.05
0.08
0.31
0.33
0.21
0.18
Cognitive ability at 8 years
Cognitive ability at 7 years
0.14
0.11
0.54
0.60
Education by 26 years
Education by 23 years
0.47
0.43
Own occupation at 43 years
Own occupation at 33 years
0.50
0.41
0.21
0.24
0.07
0.01
literacy at 53 years
literacy at 43 years
Richards, Power Sacker (In press J Epidemiol
Community Health)
31
Cognitive decline (1946 cohort)
Prior ability
Age
Richards M, Shipley B, Fuhrer F Wadsworth
M British Medical Journal 2005 328 552-554
32
Age specific prevalence of Alzheimers disease
33
BRAIN LESIONS
Clinical expression of disease
INFLUENCING FACTORS Genes Early social and
material environment Educational and
occupational attainment Physical health Health
behaviours and lifestyle
Other influences on disease expression Personalit
y Health service delivery and uptake Cultural
norms
PREMORBID BRAIN SIZE COGNITIVE AND
FUNCTION ABILITY (RESERVE)
Richards M Deary I. A life course approach to
cognitive reserve a model for cognitive aging
and development? Annals of Neurology 2005 58
617-620
34

• But what about wisdom?
• The development of expertise
• The development of contextualisation
• Relativism of values and priorities
• Recognition and management of uncertainty