Biomedical subjects

Denis A Evans

Publications and source records attributed to Denis A Evans.

At least 55 records · Page 3Linked to original sources

PubMed2004

Racial differences in perceived discrimination in a community population of older blacks and whites.

OBJECTIVES: To examine the prevalence of perceived discrimination in an older biracial population and to examine its correlation with depressive symptoms. METHODS: The sample consisted of 2,652 Blacks and 1,630 Whites, 68 years old and older, from the Chicago Health and Aging Project (CHAP). Perceived discrimination was measured with a nine-item scale developed by Williams, Yu, Jackson, and Anderson (1997). RESULTS: A factor analysis of the discrimination scale revealed two subscales, unfair treatment and personal rejection. Blacks scored higher on both subscales as compared with Whites. In linear regression models, race was significantly associated with higher levels of unfair treatment and personal rejection, controlling for demographic variables and socioeconomic status (SES). Each subscale was also positively related to depressive symptoms, and these effects did not vary by race. DISCUSSION: These findings suggest that older Blacks perceive more discrimination than do older Whites. This may have important implications for health differences between older Blacks and Whites.

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PubMed2004

Predictors of beginning and ending caregiving during a 3-year period in a biracial community population of older adults.

OBJECTIVES: We sought to identify predictors of beginning and ending caregiving. METHODS: At baseline and 3-year follow-up, we interviewed 4245 community residents (61.4% Black, 38.4% White, 0.20% other) aged 65 years or older. We used logistic regression to test predictors of beginning caregiving among baseline noncaregivers and of continuing caregiving among baseline caregivers. RESULTS: After control for demographic variables, physically healthier individuals were significantly more likely to become caregivers and to continue caregiving. Mental health had little influence on beginning caregiving, but declining mental heath was associated with continuing caregiving. CONCLUSIONS: Maintenance of physical health and function is essential to the ability of older adults to begin and to continue caregiving. Studies that compare the health of current caregivers with that of noncaregivers may substantially underestimate the impact of caregiving on health.

Black or African American↗

PubMed2003

Validity and reproducibility of a food frequency questionnaire by cognition in an older biracial sample.

It is not currently known how dietary assessment in older persons is affected by cognition. In a 1997-2000 study, the authors assessed the validity and reproducibility of a modified Harvard self-administered food frequency questionnaire (SFFQ) among 118 Black and 114 White randomly selected participants, aged 68-99 years, of the Chicago Health and Aging Project. Participants completed multiple 24-hour dietary recall interviews (mean=3.6) over 12 months and two SFFQs in the first and 12th months. The average energy-adjusted intraclass correlation coefficient for 15 nutrients was 0.59 for 1-year reproducibility in nutrient intake levels assessed by the SFFQ. The average energy-adjusted Pearson correlation coefficient was 0.46 for comparative validity between nutrient intake levels on the SFFQ and the dietary recalls. SFFQ reproducibility was higher among men, and comparative validity with the dietary recalls was higher among women. There were no remarkable differences in the correlations by age, race, educational level, presence of chronic conditions, or cognitive ability. The modified Harvard SFFQ is a reasonable method of dietary assessment even in a population of older persons, some of whom are at advanced age, have chronic health conditions, and have cognitive impairment.

Age Factors↗

PubMed2003

Early life conditions and cognitive functioning in later life.

Early life conditions are related to cognitive development and abilities in childhood and cognitive function in adulthood. However, the association between early life conditions and cognitive change in old age is unknown. The authors examined the relation between socioeconomic position (SEP) and cognitive milieu in childhood and change in cognitive function in a population-based sample of 4,398 community-dwelling adults (62.1% female; 61.7% Black) aged 65 years or older from Chicago, Illinois. Baseline data were collected in 1993-1997. Change in cognitive function was assessed by means of a global cognitive index derived from measures of memory, perceptual speed, and overall cognitive function administered at three in-home assessments between 1993 and 2003, with an average of 5.3 years of follow-up. After results were controlled for age, sex, race, and education, interactions of time with childhood SEP (beta = -0.003, t = -1.0, p = 0.32) and childhood cognitive milieu (beta = -0.0008, t = -0.5, p = 0.62) were nonsignificant, indicating that early life conditions were not related to cognitive change. SEP (beta = 0.034, t = 2.4, p = 0.01) and cognitive milieu (beta = 0.017, t = 2.2, p = 0.03) were associated with absolute level of cognitive function, with better performance being related to higher SEP and a better cognitive milieu. A better SEP and a more stimulating cognitive milieu in childhood have small but significant effects on absolute level of cognitive function; however, they do not seem to protect against cognitive decline in old age.

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PubMed2003

Negative affect and mortality in older persons.

The authors examined the relation of negative affect to mortality in the Religious Orders Study, a longitudinal cohort study of older persons, between 1994 and 2002. Participants were 851 Catholic clergy members without dementia at baseline (mean age, 75.4 (standard deviation, 6.9) years; 68% women). They completed standard measures of depressive symptoms, proneness to anxiety and anger, and patterns of anger expression at baseline and then underwent annual clinical evaluations for a mean of 4.7 (standard deviation, 2.7) years. The association of each scale with mortality was examined in proportional hazards models adjusted for age, sex, education, measures of cognitive function, lower limb function, chronic illness, smoking, alcohol, and obesity. During follow-up, 164 persons died. Measures of internally experienced negative affect, such as depressive symptoms and suppressed anger, were related to mortality, but measures of externally directed negative affect, such as the tendencies to be angry with others and to express anger overtly, were not. Persons with a high score (90th percentile) on a summary measure of internally experienced negative affect were nearly twice as likely to die as persons with a low score (10th percentile). The results suggest that negative affect in older persons, especially internally experienced distress, is associated with an increased mortality risk.

Affect↗

PubMed2003

Incidence of Alzheimer disease in a biracial urban community: relation to apolipoprotein E allele status.

CONTEXT: Few studies compare Alzheimer disease (AD) incidence among black and white subjects. OBJECTIVE: To estimate incidence and the effect of the apolipoprotein E (APOE) epsilon4 allele in these races. DESIGN: Population-based study of disease incidence using a random, stratified sample. SETTING: A geographically defined community of 3 adjacent neighborhoods in Chicago, Ill. PARTICIPANTS: A total of 6158 persons (78.7% overall; 80.5% of the black subjects and 74.6% of the white subjects) participated; 4.1 years later, persons initially free of AD were sampled for clinical evaluation for disease incidence (overall 842 persons [74.8%] participated; 67.6% of the black subjects and 81.9% of the white subjects). INTERVENTIONS: None. MAIN OUTCOME MEASURE: Incident, clinically diagnosed AD. RESULTS: The effect of the APOE epsilon4 allele on the risk of AD differed strongly for black and white subjects. Among white subjects, the presence of the APOE epsilon4 allele was associated with a 2.73-fold (95% confidence interval [CI], 1.40-5.32) increase in risk while among black subjects there was no increase in risk (odds ratio, 1.02; 95% confidence interval, 0.39-2.68). Black race was associated with a nonsignificantly increased risk of AD with an odds ratio of 1.84 (95% CI, 0.73-4.66) if APOE and its interaction with race are considered, and an odds ratio of 1.28 (95% CI, 0.54-2.98) if they are not. The incidence of AD was 1.45% (95% CI, 0.89%-2.01%) per year among persons 65 to 74 years old, 4.73% (95% CI, 3.83%-5.64%) among those 75 to 84 years old, and 9.11% (95% CI, 7.36%-10.9%) among those 85 years and older. CONCLUSION: Apolipoprotein E epsilon4 led to increased risk of AD among white subjects but not black subjects.

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PubMed2003

Dietary fats and the risk of incident Alzheimer disease.

BACKGROUND: Few studies have investigated the effects of dietary fats on the development of Alzheimer disease. We examined the associations between intake of specific types of fat and incident Alzheimer disease in a biracial community study. METHODS: We performed clinical evaluations on a stratified random sample of 815 community residents aged 65 years and older who were unaffected by Alzheimer disease at baseline and who completed a food-frequency questionnaire a mean of 2.3 years before clinical evaluation. RESULTS: After a mean follow-up of 3.9 years, 131 persons developed Alzheimer disease. Intakes of saturated fat and trans-unsaturated fat were positively associated with risk of Alzheimer disease, whereas intakes of omega-6 polyunsaturated fat and monounsaturated fat were inversely associated. Persons in the upper fifth of saturated-fat intake had 2.2 times the risk of incident Alzheimer disease compared with persons in the lowest fifth in a multivariable model adjusted for age, sex, race, education, and apolipoprotein E epsilon4 allele status (95% confidence interval, 1.1-4.7). Risk also increased with consumption of trans-unsaturated fats, beginning with the second fifth of intake (relative risk, 2.4 compared with the lowest fifth; 95% confidence interval, 1.1-5.3). We observed linear inverse associations between Alzheimer disease and vegetable fat (P =.002), and, after further adjustment for other types of fat, marginally significant associations with intake of omega-6 polyunsaturated fat (P =.10 for trend) and monounsaturated fat (P =.10 for trend). Intakes of total fat, animal fat, and dietary cholesterol were not associated with Alzheimer disease. CONCLUSION: High intake of unsaturated, unhydrogenated fats may be protective against Alzheimer disease, whereas intake of saturated or trans-unsaturated (hydrogenated) fats may increase risk.

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PubMed2003

Parkinsonianlike signs and risk of incident Alzheimer disease in older persons.

BACKGROUND: Parkinsonianlike signs are common in older persons, but little is known about how their severity or rate of progression is related to the development of Alzheimer disease (AD) or decline in cognition. OBJECTIVE: To examine the association of progression of parkinsonianlike signs with incident AD and cognitive decline. DESIGN: Longitudinal cohort study. PARTICIPANTS AND SETTING: For up to 8 years, 824 older Catholic clergy members without clinical evidence of AD or Parkinson disease at baseline underwent annual clinical evaluations that included a modified version of the Unified Parkinson's Disease Rating Scale (UPDRS), detailed cognitive function testing, and clinical classification of AD. MAIN OUTCOME MEASURES: Clinically diagnosed AD and change in global and specific measures of cognitive function. RESULTS: During an average of 4.6 years of observation, 114 persons developed AD. The global UPDRS score increased in 79% of participants, who were divided into tertiles with the least, moderate, or most rapid progression. We examined the relationship of progression to disease risk in a proportional hazards model that controlled for baseline global UPDRS and demographic variables. Compared with the 21% without progression, risk of AD more than doubled in the subgroup with the least progression (P =.08), more than tripled in the moderate subgroup (P =.02), and increased more than 8-fold in the subgroup with the most rapid progression (P<.001). This effect was mainly due to worsening gait and rigidity. Rate of change on the global UPDRS measure was inversely correlated with rate of change on a global measure of cognitive function (r = -0.64). CONCLUSION: Progression of parkinsonianlike signs in old age is associated with decline in cognitive function and the development of AD.

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PubMed2003

Consumption of fish and n-3 fatty acids and risk of incident Alzheimer disease.

BACKGROUND: Dietary n-3 polyunsaturated fatty acids improve brain functioning in animal studies, but there is limited study of whether this type of fat protects against Alzheimer disease. OBJECTIVE: To examine whether fish consumption and intake of different types of n-3 fatty acids protect against Alzheimer disease. DESIGN: Prospective study conducted from 1993 through 2000, of a stratified random sample from a geographically defined community. Participants were followed up for an average of 3.9 years for the development of Alzheimer disease. PATIENTS: A total of 815 residents, aged 65 to 94 years, who were initially unaffected by Alzheimer disease and completed a dietary questionnaire on average 2.3 years before clinical evaluation of incident disease. MAIN OUTCOME MEASURES: Incident Alzheimer disease diagnosed in a structured neurologic examination by means of standardized criteria. RESULTS: A total of 131 sample participants developed Alzheimer disease. Participants who consumed fish once per week or more had 60% less risk of Alzheimer disease compared with those who rarely or never ate fish (relative risk, 0.4; 95% confidence interval, 0.2-0.9) in a model adjusted for age and other risk factors. Total intake of n-3 polyunsaturated fatty acids was associated with reduced risk of Alzheimer disease, as was intake of docosahexaenoic acid (22:6n-3). Eicosapentaenoic acid (20:5n-3) was not associated with Alzheimer disease. The associations remained unchanged with additional adjustment for intakes of other dietary fats and of vitamin E and for cardiovascular conditions. CONCLUSION: Dietary intake of n-3 fatty acids and weekly consumption of fish may reduce the risk of incident Alzheimer disease.

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PubMed2003

Alzheimer disease in the US population: prevalence estimates using the 2000 census.

CONTEXT: Current and future estimates of Alzheimer disease (AD) are essential for public health planning. OBJECTIVE: To provide prevalence estimates of AD for the US population from 2000 through 2050. DESIGN: Alzheimer disease incidence estimates from a population-based, biracial, urban study, using a stratified random sampling design, were converted to prevalence estimates and applied to US Census Bureau estimates of US population growth. SETTING: A geographically defined community of 3 adjacent neighborhoods in Chicago, Ill, applied to the US population. PARTICIPANTS: Alzheimer disease incidence was measured in 3838 persons free of AD at baseline; 835 persons were evaluated for disease incidence. Main Outcome Measure Current and future estimates of prevalence of clinically diagnosed AD in the US population. RESULTS: In 2000, there were 4.5 million persons with AD in the US population. By 2050, this number will increase by almost 3-fold, to 13.2 million. Owing to the rapid growth of the oldest age groups of the US population, the number who are 85 years and older will more than quadruple to 8.0 million. The number who are 75 to 84 years old will double to 4.8 million, while the number who are 65 to 74 years old will remain fairly constant at 0.3 to 0.5 million. CONCLUSION: The number of persons with AD in the US population will continue to increase unless new discoveries facilitate prevention of the disease.

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PubMed2003

Design of the Chicago Health and Aging Project (CHAP).

The design of the Chicago Health and Aging Project (CHAP) is described. CHAP is a longitudinal population study of common chronic health problems of older persons, especially of risk factors for incident Alzheimer's disease, in a biracial neighborhood of the south side of Chicago. Special attention is given to three unusual design features of the study. One feature is that clinical evaluation for Alzheimer's disease is confined to a stratified random sample of all participants. This feature results in substantial cost savings and substantially less bias than screening approaches but has the disadvantages of adding analytic complexity and requiring the use of indirect means to identify a disease-free cohort for the development of incident Alzheimer's disease. The second unusual feature is efficiently combining in analyses the successive independent multiple samples that are drawn, one from each data collection cycle. The third unusual feature is entering successive age cohorts of community residents into the study as they attain 65 years of age. This has the advantages of enhancing direct investigation of the effect of age on the action of risk factors for Alzheimer's disease and direct examination of cohort effects. The interaction of these features is described, especially as they pertain to a study in which data are collected in successive waves. The results from these waves must be combined for effective analysis of the relation among risk factors and incident disease.

Age Factors↗

PubMed2002

Dietary intake of antioxidant nutrients and the risk of incident Alzheimer disease in a biracial community study.

CONTEXT: Oxidative processes have been suggested as elements in the development of Alzheimer disease (AD), but whether dietary intake of vitamin E and other antioxidant nutrients prevents its development is unknown. OBJECTIVE: To examine whether intake of antioxidant nutrients, vitamin E, vitamin C, and beta carotene is associated with incident AD. DESIGN, SETTING, AND PARTICIPANTS: Prospective study, conducted from 1993 to 2000, of individuals selected in a stratified random sample of community-dwelling residents. The 815 residents 65 years and older were free of AD at baseline and were followed up for a mean of 3.9 years. They completed food frequency questionnaires an average of 1.7 years after baseline. MAIN OUTCOME MEASURE: Incident AD diagnosed in clinical evaluations with standardized criteria. RESULTS: Increasing vitamin E intake from foods was associated with decreased risk of developing AD after adjustment for age, education, sex, race, APOE epsilon 4, and length of follow-up. Relative risks (95% confidence intervals [CIs]) from lowest to highest quintiles of intake were 1.00, 0.71 (0.24-2.07), 0.62 (0.26-1.45), 0.71 (0.27-1.88), and 0.30 (0.10-0.92) (P for trend =.05). The protective association of vitamin E was observed only among persons who were APOE epsilon 4 negative. Adjustment for other dietary factors reduced the protective association. After adjustment for baseline memory score, the risk was 0.36 (95% CI, 0.11-1.17). Intake of vitamin C, beta carotene, and vitamin E from supplements was not significantly associated with risk of AD. CONCLUSION: This study suggests that vitamin E from food, but not other antioxidants, may be associated with a reduced risk of AD. Unexpectedly, this association was observed only among individuals without the APOE epsilon 4 allele.

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PubMed2002

Participation in cognitively stimulating activities and risk of incident Alzheimer disease.

CONTEXT: Frequent participation in cognitively stimulating activities has been hypothesized to reduce risk of Alzheimer disease (AD), but prospective data regarding an association are lacking. OBJECTIVE: To test the hypothesis that frequent participation in cognitive activities is associated with a reduced risk of AD. DESIGN: Longitudinal cohort study with baseline evaluations performed between January 1994 and July 2001 and mean follow-up of 4.5 years. PARTICIPANTS AND SETTING: A total of 801 older Catholic nuns, priests, and brothers without dementia at enrollment, recruited from 40 groups across the United States. At baseline, they rated frequency of participation in common cognitive activities (eg, reading a newspaper), from which a previously validated composite measure of cognitive activity frequency was derived. MAIN OUTCOME MEASURES: Clinical diagnosis of AD by a board-certified neurologist using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria and change in global and specific measures of cognitive function, compared by cognitive activity score at baseline. RESULTS: Baseline scores on the composite measure of cognitive activity ranged from 1.57 to 4.71 (mean, 3.57; SD, 0.55), with higher scores indicating more frequent activity. During an average of 4.5 years of follow-up, 111 persons developed AD. In a proportional hazards model that controlled for age, sex, and education, a 1-point increase in cognitive activity score was associated with a 33% reduction in risk of AD (hazard ratio, 0.67; 95% confidence interval, 0.49-0.92). Results were comparable when persons with memory impairment at baseline were excluded and when terms for the apolipoprotein E epsilon4 allele and other medical conditions were added. In random-effects models that controlled for age, sex, education, and baseline level of cognitive function, a 1-point increase in cognitive activity was associated with reduced decline in global cognition (by 47%), working memory (by 60%), and perceptual speed (by 30%). CONCLUSION: These results suggest that frequent participation in cognitively stimulating activities is associated with reduced risk of AD.

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PubMed2002

Vitamin E and cognitive decline in older persons.

BACKGROUND: Previous studies raise the possibility that antioxidants protect against neurodegenerative diseases. OBJECTIVE: To examine whether intake of antioxidant nutrients, including vitamin E, vitamin C, and carotene, is associated with reduced cognitive decline with age. DESIGN: Longitudinal population-based study conducted from September 17, 1993, to November 20, 2000, with an average follow-up of 3.2 years. PATIENTS: The patients were 2889 community residents, aged 65 to 102 years, who completed a food frequency questionnaire, on average 18 months after baseline. MAIN OUTCOME MEASURE: Cognitive change as measured by 4 tests (the East Boston Memory Test, which tests immediate and delayed recall; the Mini-Mental State Examination; and the Symbol Digit Modalities Test) at baseline and 3 years for all participants, and at 6 months for 288 randomly selected participants. RESULTS: We used random-effects models to estimate nutrient effects on individual change in the average score of the 4 cognitive tests. The cognitive score declined on average by 5.0 x 10(-2) standardized units per year. There was a 36% reduction in the rate of decline among persons in the highest quintile of total vitamin E intake (-4.3 x 10(-2) standardized units per year) compared with those in the lowest quintile (-6.7 x 10(-2) standardized units per year) (P =.05), in a model adjusted for age, race, sex, educational level, current smoking, alcohol consumption, total calorie (energy) intake, and total intakes of vitamin C, carotene, and vitamin A. We also observed a reduced decline with higher vitamin E intake from foods (P =.03 for trend). There was little evidence of association with vitamin C or carotene intake. CONCLUSION: Vitamin E intake, from foods or supplements, is associated with less cognitive decline with age.

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PubMed2002

The apolipoprotein E epsilon 4 allele and decline in different cognitive systems during a 6-year period.

CONTEXT: Impairment of episodic memory is an early and defining feature of Alzheimer disease (AD). The apolipoprotein E (APOE) epsilon 4 allele is known to influence risk of AD but it has been difficult to establish whether it affects episodic memory differently from other cognitive functions. OBJECTIVE: To examine the association of epsilon 4 with decline in different cognitive systems. DESIGN: Longitudinal cohort study. SETTING: More than 40 groups of Catholic clergy from across the United States. PARTICIPANTS: Older Catholic clergy members without clinical evidence of dementia at baseline underwent annual clinical evaluations for up to 6 years. Of 624 persons eligible for follow-up, 611 (98%) participated, of whom 161 (26%) had at least 1 epsilon 4 allele. They completed an average of 5.5 evaluations (range, 2-7). MAIN OUTCOME MEASURES: Incident AD and annual rates of change in episodic memory, semantic memory, working memory, perceptual speed, and visuospatial ability. RESULTS: The presence of epsilon 4 was associated with risk of developing AD on follow-up (relative risk, 1.92; 95% confidence interval, 1.27-2.89). In a series of random effects models, epsilon 4 was associated with impaired baseline function in episodic memory and visuospatial ability and with more rapid decline in all domains. The effect of epsilon 4 on annual decline in episodic memory (>3-fold increase) was significantly stronger than its effect on decline in other cognitive systems (P<.01), and at baseline, its effect on episodic memory was marginally stronger than its effect on other cognitive domains (P =.06). CONCLUSION: The results suggest that the APOE epsilon 4 allele influences risk of AD by a relatively selective effect on episodic memory.

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PubMed2002

Individual differences in rates of change in cognitive abilities of older persons.

The authors examined change in cognitive abilities in older Catholic clergy members. For up to 6 years, participants underwent annual clinical evaluations, which included a battery of tests from which summary measures of 7 abilities were derived. On average, decline occurred in each ability and was more rapid in older persons than in younger persons. However, wide individual differences were evident at all ages. Rate of change in a given domain was not strongly related to baseline level of function in that domain but was moderately associated with rates of change in other cognitive domains. The results suggest that change in cognitive function in old age primarily reflects person-specific factors rather than an inevitable developmental process.

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PubMedDate not supplied

Do depressive symptoms predict declines in physical performance in an elderly, biracial population?

OBJECTIVE: We investigated whether depressive symptoms, assessed by the 10-item Center for Epidemiological Studies Depression Scale (CES-D), predicted change in physical function in elderly adults. METHODS: Participants were from a biracial, population-based sample of adults aged 65 and older (N: 4069; 61% black; 61% female). Physical function was assessed as a summary performance measure of tandem stand, measured walk, and repeated chair stand (mean [standard deviation], 10.3 [3.5]; range, 0-15), commonly used measures of overall physical health in older adults. Generalized estimating equation models estimated physical function across 3 assessments over 5.4 years of follow up as a function of CES-D scores at baseline. RESULTS: Adjusting for age, sex, race, and education, each 1-point higher CES-D score was associated with a 0.34-point lower absolute level of physical performance (p < .0001), but there was no evidence of a CES-D by time interaction (p = .84), indicating that depressive symptoms at baseline were not associated with greater physical performance decline over time. In secondary analyses, with CES-D scores modeled in 4 categories, overall physical performance showed a graded, inverse association across CES-D categories (p's < .0001). However, we observed no threshold effect for depressive symptoms in relation to change in physical performance. Compared with the referent group (CES-D = 0), the 2 middle CES-D categories (CES-D = 1 or 2-3) evidenced some decline in physical performance over time, but the highest CES-D group (CES-D > or =4) showed no significant physical decline over time (p = .89). CONCLUSION: We observed a strong cross-sectional association between depressive symptoms and overall physical performance. Physical function declined over time, yet depressive symptoms did not consistently contribute to greater decline over an average of 5.4 years of follow up among older adults. Findings highlight the importance of longitudinal models in understanding the relation between depressive symptomatology and physical health.

Age Factors↗

PubMedDate not supplied

Neuroticism, extraversion, and mortality in a defined population of older persons.

OBJECTIVE: The objective of this study was to test the association of the personality traits of neuroticism and extraversion with risk of death in old age. METHODS: A census was taken of a geographically defined urban community in Chicago, and those aged 65 years or older were invited to participate in an in-home interview; 6158 (79% of those eligible) did so. The interview included brief measures of neuroticism and extraversion, medical history, and questions about current participation in cognitive, social, and physical activities. Vital status was subsequently monitored. The association of each trait with risk of death was examined in a series of accelerated failure-time models that controlled for age, sex, race, and education. RESULTS: During a mean of more than 6 years of observation, 2430 persons (39.5%) died. A high level of neuroticism (score = 27; 90th percentile) was associated with a 33% increase in risk of death compared with a low level of neuroticism (score = 9; 10th percentile). A high level of extraversion (score = 33; 90th percentile) was associated with a 21% decrease in risk of death compared with a low level (score = 18; 10th percentile). Adjustment for medical conditions and health-related variables did not substantially affect results, but adjusting for baseline levels of cognitive, social, and physical activity reduced the association of both traits with mortality. CONCLUSIONS: The results suggest that higher extraversion and lower neuroticism are associated with reduced risk of mortality in old age and that these associations are mediated in part by personality-related patterns of cognitive, social, and physical activity.

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