Identifying Midlife Social Exposures That Might Modify Risks of Cognitive Impairment Associated with Early Life Disadvantage

Convened August 29–30, 2024

_______

Bradford Chaney, Rapporteur

Committee on Population

Division of Behavioral and Social Sciences and Education

Proceedings of a Workshop

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by a contract between the National Academy of Sciences and National Institutes of Health (HHSN263201800029I/75N980 23F00014). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-73376-2
International Standard Book Number-10: 0-309-73376-6
Digital Object Identifier: https://doi.org/10.17226/28909

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2025. Identifying Midlife Social Exposures That Might Modify Risks of Cognitive Impairment Associated with Early Life Disadvantage: Proceedings of a Workshop. Washington, DC: National Academies Press. https://doi.org/10.17226/28909.

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WORKSHOP PLANNING COMMITTEE

ROBERT A. HUMMER (Chair), Howard W. Odum Distinguished Professor of Sociology, University of North Carolina at Chapel Hill

JENNIFER AILSHIRE, Professor of Gerontology, Associate Dean of Research, and Associate Dean of International Programs and Global Initiatives, University of Southern California

HECTOR M. GONZÁLEZ, Professor of Neurosciences, University of California, San Diego

JENNIFER J. MANLY, Associate Professor of Neuropsychology, Columbia University

JACQUELINE TORRES, Associate Professor, University of California, San Francisco

ATHEENDAR S. VENKATARAMANI, Associate Professor, University of Pennsylvania School of Medicine

Staff

BRADFORD CHANEY, Project Director

SITARA RAHIAB, Senior Program Assistant (since July 2024)

MADELEINE GOEDICKE, Senior Program Assistant (until July 2024)

MALAY K. MAJMUNDAR, Director, Committee on Population

COMMITTEE ON POPULATION

ANNE R. PEBLEY (Chair), Distinguished Research Professor, University of California Los Angeles

EMILY M. AGREE, Research Professor, Johns Hopkins University

ALLISON E. AIELLO, James S. Jackson Healthy Longevity Professor of Epidemiology, Columbia University

RANDALL Q. K. AKEE, Associate Professor of Public Policy, University of California, Los Angeles

DEBORAH BALK, Professor, Marxe School of Public and International Affairs, Baruch College of the City University of New York

COURTNEY C. COILE, Provost and Lia Gelin Poorvu ‘56 Dean of the College, Wellesley College

SONALDE DESAI, Distinguished University Professor, University of Maryland

KATHARINE M. DONATO, Donald G. Herzberg Professor of International Migration, Georgetown University

TOD G. HAMILTON, Professor of Sociology, Princeton University

SEEMA JAYACHANDRAN, Professor of Economics and Public Policy, Princeton University

KENNETH M. LANGA, Cyrus Sturgis Professor of Medicine, University of Michigan

TREVON LOGAN, Hazel C. Youngberg Trustees Distinguished Professor of Economics, The Ohio State University

JENNA NOBLES, Professor of Demography, University of California, Berkeley

FERNANDO RIOSMENA, Professor of Sociology and Demography and Director of the Institute for Health Disparities Research, University of Texas at San Antonio

DAVID T. TAKEUCHI, Associate Dean for Faculty Excellence, University of Washington

Staff

MALAY K. MAJMUNDAR, Director

Acknowledgments

This document summarizes the discussions and presentations at the Workshop on Identifying Midlife Social Exposures That Might Modify Risk for Cognitive Impairment Associated with Early Life Disadvantage. Held as a hybrid meeting in Washington, DC, on August 29–30, 2024, the workshop was convened by the Committee on Population of the National Academies of Sciences, Engineering, and Medicine, and was sponsored by the National Institute on Aging.

This Proceedings of a Workshop has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. The planning committee’s role was limited to planning and convening the workshop and serving as moderators. The views contained in the proceedings are those of individual workshop participants and do not necessarily represent the views of all workshop participants, the planning committee, or the National Academies.

Bradford Chaney, Project Director

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Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine (National Academies) in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of the proceedings was overseen by DEANNA M. BARCH, Washington University. She was responsible for making certain that an independent examination of the proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.

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Contents

Acronyms and Abbreviations

1 Introduction

ORGANIZATION OF THE PROCEEDINGS

2 Laying the Foundation

EARLY LIFE RESERVES, MIDLIFE PATHWAYS, AND LATER LIFE DEMENTIA RISKS

MIDLIFE MEDIATORS AND MODIFIERS OF EARLY LIFE RISK

DISCUSSION

3 Life Course Models of Cognition and Risk of Dementia

DATA LINKAGES AND NOVEL METHODOLOGIES

SOCIAL AND INSTITUTIONAL PATHWAYS TO DEMENTIA

MIDLIFE PATHWAYS AFFECTING HEALTH

DISCUSSION

4 Educational and Workplace Contexts

EDUCATION AND WORK AS PLACES THAT AFFECT COGNITIVE RESERVE

THE WORKPLACE AS A SOURCE OF STRESS OR MITIGATOR AGAINST STRESS

5 Social and Health Policies

CHALLENGES AND SOURCES OF DATA

METHODS AND DATA FOR EXAMINING SOCIAL POLICIES

COMMENTS ON THE SESSION

6 Social Support and Integration (Neighborhoods)

NEIGHBORHOODS, COGNITIVE HEALTH, AND DEMENTIA RISK: CONCEPTS, CHALLENGES, AND DIRECTIONS

NEIGHBORHOOD CONTEXTS ACROSS THE LIFESPAN AND MIDLIFE COGNITION

QUALITATIVE AND MIXED METHODS APPROACHES TO NEIGHBORHOODS AND COGNITIVE AGING

ADDITIONAL DISCUSSION: DEFINING NEIGHBORHOODS

7 Environmental and Cardiovascular Exposures

THE RELATIONSHIP BETWEEN EARLY AND MIDLIFE CARDIOVASCULAR RELATED EXPOSURES AND LATE LIFE COGNITIVE HEALTH

THE POTENTIAL LEGACY OF ENVIRONMENTAL EXPOSURES, ACROSS THE LIFE COURSE, ON DEMENTIA RISK

COMMENTS ON THE SESSION

8 Key Takeaways and Future Directions

OVERVIEW

DATA AND METHODS

DIRECTIONS, RESOURCES, AND METHODS

References

Appendixes

A Public Meeting Agendas

B Biographies of Planning Committee Members

C Biographies of Workshop Presenters

Box and Figures

BOX

1-1 Statement of Task

FIGURES

1-1 Predicted age trajectories of episodic memory for adulthood, by gender, race, and education

2-1 The social exposome: early life as a critical period

2-2 Alternative models for pathways that can affect dementia or cognitive decline

3-1 Conceptual model of social disparities and AD/ADRD across the life course

3-2 Age ranges covered by four major surveys

4-1 Social stratification of stress exposure

6-1 Simulated tract-to-tract variation in cognitive function among older adults

6-2 Means and standard errors of performance in four cognitive tests as a function of age

6-3 Alternative ways of defining a neighborhood

Acronyms and Abbreviations