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. 2023;92(2):425-443.
doi: 10.3233/JAD-220888.

Allostatic Load and Cognitive Function Among Urban Adults in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study

Hind A Beydoun  1 , May A Beydoun  2 , Ana I Maldonado  3 , Marie T Fanelli-Kuczmarski  2 , Jordan Weiss  4 , Michele K Evans  2 , Alan B Zonderman  2
Affiliations

Allostatic Load and Cognitive Function Among Urban Adults in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study

Hind A Beydoun et al. J Alzheimers Dis. 2023.

Abstract

Background: Cross-sectional studies have linked cognition to allostatic load (AL) which reflects multisystem dysregulation from life course exposure to stressors.

Objective: To examine baseline and changes in AL and their relationships with 11 cognitive function test scores, while exploring health disparities according to sex and race.

Methods: Longitudinal [Visit 1 (2004-2009) and Visit 2 (2009-2013)] data were analyzed from 2,223 Healthy Aging in Neighborhoods of Diversity across the Life Span participants. We calculated AL total score using cardiovascular, metabolic, and inflammatory risk indicators, and applied group-based trajectory modeling to define AL change.

Results: Overall and stratum-specific relationships were evaluated using mixed-effects linear regression models that controlled for socio-demographic, lifestyle, and health characteristics. Baseline AL was significantly associated with higher log-transformed Part A Trail Making Test score [Loge (TRAILS A)] (β= 0.020, p = 0.004) and increasing AL was associated with higher Benton Visual Retention Test score [BVRT] (β= 0.35, p = 0.002) at baseline, in models that controlled for age, sex, race, poverty status, education, literacy, smoking, drug use, the 2010 healthy eating index and body mass index. Baseline AL and AL change were not related to change in cognitive function between visits. There were no statistically significant interaction effects by sex or race in fully-adjusted models.

Conclusion: At baseline, AL was associated with worse attention or executive functioning. Increasing AL was associated with worse non-verbal memory or visuo-constructional abilities at baseline. AL was not related to change in cognitive function over time, and relationships did not vary by sex or race.

Keywords: Adults; allostatic load; cognitive function; health disparities; longitudinal study.

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Conflict of interest statement

Conflict of Interest/Disclosure Statement: The authors have no conflict of interest to report.

Figures

Figure 1.
Figure 1.
Study Flowchart – HANDLS (2004–2013) Notes: HANDLS = Healthy Aging in Neighborhoods of Diversity across the Life Span; Cognitive tests include the Mini-Mental State Examination (MMSE), the California Verbal Learning Test (CVLT) Immediate (List A) and Delayed Free Recall (DFR), the Benton Visual Retention Test (BVRT, # of errors), the Brief Test of Attention (BTA), the Animal Fluency test (AF), the Digit Span Forward and Backwards tests (DS-F and DS-B), the Clock Drawing Test (CDT), the Trail making test Part A and B (TRAILS A and B, in seconds).
Figure 2.
Figure 2.
Group-based trajectories for allostatic load – HANDLS (2004–2013) Notes: HANDLS = Healthy Aging in Neighborhoods of Diversity across the Life Span; A = Graphical display of two groups identified using group-based trajectory modeling, whereby ALLOSTATIC represents allostatic load total score and Age (years) represents the time variable. B= Table display of intercept, linear and quadratic terms for the two trajectories in allostatic load identified using group-based trajectories; Group-based trajectory modeling generates the probability of belonging to each group namely, Group 1 and Group 2, for each study participant. As such, we calculated the z-transformed probability of belonging to Group 2 for each of the study participants, since Group 2 increased significantly with linear age (β = +0.047, P=0.003), whereas Group 1 did not increase significantly with linear age (β =+0.092, P=0.16). Subsequently, we examined the z-transformed probability of belonging to Group 2 in relation to cognitive function tests.
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