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How Selection Over Time Contributes to the Inconsistency of the Association between Sex/Gender and Cognitive Decline across Cognitive Aging Cohorts

Rouanet, A; Avila-Rieger, J; Dugravot, A; Lespinasse, J; Stuckwisch, R; Merrick, R; Anderson, E; ... Proust-Lima, C; + view all (2022) How Selection Over Time Contributes to the Inconsistency of the Association between Sex/Gender and Cognitive Decline across Cognitive Aging Cohorts. American Journal of Epidemiology , 191 (3) pp. 441-452. 10.1093/aje/kwab227. Green open access

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Abstract

The sex/gender and aging-related cognitive decline association remains poorly understood due to inconsistencies in findings. Such heterogeneity could be attributable to the cognitive functions studied and study population characteristics, but also to a differential selection by drop-out and death between men and women. This work aims to evaluate the impact of selection by drop-out and death on the association between sex/gender and cognitive decline. We first compared the most frequently used statistical methods for longitudinal data, targeting either population estimands (marginal models estimated by Generalized Estimating Equations) or subject-specific estimands (mixed/joint models estimated by likelihood maximization) on eight aging studies: six population-based (ACTIVE(1996-2009), Paquid(1988-2014), REGARDS(2003-2016), 3-City(1999-2016), WHICAP(1992-2017), Whitehall II(2007-2016)) and two clinic-based (ADNI(2004-2017), MEMENTO(2011-2016)) studies. We illustrated the differences in the estimands of the sex/gender association with cognitive decline in selected examples and highlighted the critical role of differential selection by drop-out and death. By using the same estimand, we then contrasted the sex/gender association across cohorts and cognitive measures suggesting residual differential sex/gender association depending on the targeted cognitive measure (memory or animal fluency) and the initial cohort selection. We recommend focusing on subject-specific estimands in the alive population for assessing sex/gender differences while handling differential selection over time.

Type: Article
Title: How Selection Over Time Contributes to the Inconsistency of the Association between Sex/Gender and Cognitive Decline across Cognitive Aging Cohorts
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/aje/kwab227
Publisher version: https://doi.org/10.1093/aje/kwab227
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: aging cohorts, cognition, death, drop-out, longitudinal models, selection, sex/gender
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
URI: https://discovery.ucl.ac.uk/id/eprint/10134779
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