Horvat, P; (2014) Life course socioeconomic position, health behaviours and cognitive function in middle-aged and older persons in four Central and Eastern European populations: findings from the HAPIEE study. Doctoral thesis , UCL (University College London).

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Abstract

Identifying risk factors associated with normal cognitive ageing is a prerequisite for understanding dementia. Potential modifiable risk factors include socioeconomic factors and health behaviours. This thesis investigated the importance of life course socioeconomic position (SEP) and two core health behaviours, alcohol consumption and smoking, for mid-late life cognitive function in four previously unstudied Central and Eastern European populations with historically smaller income inequalities and significant contributions of alcohol and smoking to the high premature mortality in these populations. The thesis used data from over 29,000 men and women aged 45-78 from random population samples in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns participating in the HAPIEE study. Cognitive function was measured using four tests of fluid cognition. SEP measures, alcohol consumption and smoking were self-reported using structured interviews. Structural equation analyses revealed significant associations between SEP measures from across the life course and cognition. Education consistently showed the strongest association with cognition and some accumulation of disadvantage across the life course was observed, similar to studies in Western countries. However, variation in magnitude of these associations across centres may partly reflect the influence of contextual factors. Regression analyses showed modest associations of cognitive function with alcohol and smoking, and neither of these behaviours appeared to significantly mediate the associations between life course SEP and cognition. An inverted U-shaped association indicated slightly worse cognitive performance among male heavy drinkers and lower scores in non-drinkers, compared to light drinkers. Binge drinking and alcohol type were not associated with cognitive performance. Smoking was associated with poorer mental speed in both genders but not with any other cognitive test. The findings suggest a pattern of associations between life course SEP and cognition similar to Western populations and modest associations of alcohol and smoking with mid-late life cognitive performance in these Central and Eastern European populations.

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