b'AGING IN THE 21ST CENTURYOther health events put patients at risk forBehavioral Factors Comorbid Conditionscognitive decline, including hip fracture (BentlerRecent research examines the potential impact ofSome studies examine the association of medical et al. 2009) and a new diagnosis of chronic ob- exercise and other modifiable risks on cognitiveconditions and dementia with the goal of provid-structive pulmonary disease (Hung et al. 2009).decline. With longitudinal data from HRS linkeding information to increase clinician awareness Having diabetes is associated with dementia, butto dementia diagnosis in ADAMS, Bowen (2012)in treating older patients with multiple chronic over eight years of follow-up, a new diagnosis ofexamines whether a history of vigorous physicalconditions and risks. For example, Gure et al. diabetes does not predict the onset of dementiaactivity three or more times per week affects(2012) find that approximately 40% of HRS par-(Q. Wu et al. 2015).the risk of subsequent dementia. Age, femaleticipants over age 66 with heart failure have some Cross-national comparisons also providesex, presence of the APOEe 4 allele, a historydegree of cognitive impairment. In this group, the useful insight on factors associated with cognitiveof stroke, and poorer cognitive functioning atprevalence of cognitive impairment consistent functioning. Langa et al. (2009) compare non-His- baseline are all associated with an increased riskwith dementia is 15%.panic whites over age 64 on the same measuresof dementia. Mild drinking (one to three drinksMultiple studies identify other neuropsychi-of memory and orientation available in both theper week) as well as being overweight or obeseatric symptoms as comorbid with dementia. For HRS and ELSA. Compared to their counterpartsconfer significant protection against dementia. Inexample, depressive symptoms are associated in England, US adults score significantly betteraddition, vigorous physical activity for at least 12with lower immediate and delayed word recall in on a cognitive scale. Older adults in the US havemonths over the study period reduces dementiathe HRS (Gonzales et al. 2008). The prevalence more risks for heart disease and other diseasesrisk by 21%. Maintaining optimal body weightof depression in the ADAMS sample is 8.5% for that may lead to poorer cognitive function. Butmay be especially important to reduce risk of cog- those with normal cognitive status increasing US adults tend to be wealthier, better educated,nitive decline. Xiang and An (2015a) show thatto 13.4% for those with CIND, and to 20.0% for and have less depression, which accounts for somebeing underweight, having a body mass indexthose with dementia (Steffens et al. 2009). of the US cognitive advantage. US adults are alsoless than 18.5, is a robust risk factor for onset ofSimilarly, Okura et al. (2010) show that other more likely to be taking medications for hyper- cognitive impairment in later life. neuropsychiatric symptoms, such as anxiety, ag-tension, which may help cognitive function.Loneliness is emerging as a signifi- itation, elation and delusions are prev-Interestingly, although depression is a riskcant health risk. One study followsalent among those with cognitive factor for cognitive decline, Saczynski et al.HRS participants aged 65 andimpairment. The percentage (2015) follow HRS participants for six years andolder from 1998 to 2010 andof those with three or show that the use of antidepressants does notfinds that loneliness andmore symptoms increases make any difference in cognitive changes. depressive symptoms bothsharply going from mild lead to cognitive declineto moderate dementia over that period. Looking(from 15.2% to 44.3%) at the reciprocal directionbut then decreases of effect, they show thatslightly with severe low cognitive function pre- dementia (38.2%). Some dicts increasing lonelinessresearch suggests that (Donovan et al. 2016).neuropsychiatric symptoms may actually precede dementia (Beaudreau et al. 2012). 44'